Risk areas for the occurrence of leprosy in border countries of South America - Brazil and Argentina.

OBJECTIVE: The aim was to analyze the spatial association and relative risk (RR) of leprosy cases diagnosed in southern Brazil and in the Argentinean province of Misiones during 2010 to 2016. METHODS: This ecological-type epidemiological study analyzed data from the Health Ministries of both countries. The analysis included frequency measures, spatial autocorrelation, RR cluster analysis and map construction. RESULTS: A hyperendemic occurrence was identified in all study regions, in the state of Paraná 71.2% of the municipalities were hyperendemic and in Misiones, Argentina 41.2%. The GI* statistical analysis showed clusters of high incidence rates in the state of Paraná and low-risk clusters in much of the state of Rio Grande do Sul, both in Brazil. The analysis indicated an area with RR equal to 3.87 - (p < .0001) when considering the entire territory and an RR of 2.80 - (p < .0001) excluding the state of Paraná, with the number of departments of Misiones, Argentina included in the risk clusters increasing significantly. CONCLUSIONS: The findings indicate a high probability of similar illness in adjacent areas, according to their relative position in space, as the occurrence of the disease is influenced by neighboring clusters.

Hanseníase em países fronteiriços na américa do sul: um estudo ecológico / Lepra en los territories fronterizos de sudamérica: estudio ecológico / Leprosy in border countries in south america: an ecological study

RESUMO Objetivo: caracterizar o perfil clínico epidemiológico e a distribuição espacial da incidência da hanseníase em territórios fronteiriços da América do Sul. Método: trata-se de um estudo ecológico. O estudo compreendeu a Província de Misiones na Argentina e a Região Sul do Brasil. A população foi composta por 10.319 casos novos de hanseníase, diagnosticados entre 2010 e 2016. Resultados: o estado do Paraná foi o mais endêmico, representando 70,2% (n=7,247) dos casos. Houve predomínio da classificação operacional multibacilar (79,8%, n=8.233) e Grau 0 de incapacidade física (50,6%, n=5.223). Em Misiones 18,9% utilizaram esquema de tratamento substitutivo. No período, notou-se uma situação hiperendêmica em 780 (65,5%) dos municípios/ departamentos estudados. Conclusão: o estudo mostrou que as regiões estudadas apresentam alta endemicidade, transmissão ativa e diagnóstico tardio da hanseníase. Essas tendências entrelaçadas à força de morbidade e de transmissão recente e persistente da doença, ampliam a relevância da hanseníase como problema de saúde pública na região.

RESUMEN Objetivo: caracterizar el perfil clínico epidemiológico y la distribución espacial de la incidencia de la lepra en los territorios fronterizos de Sudamérica. Metodología: se trata de un estudio ecológico. El estudio incluyó la Provincia de Misiones en Argentina y la Región Sur de Brasil. La población estaba compuesta por 10.319 nuevos casos de lepra diagnosticados entre 2010 y 2016. Resultados: el estado de Paraná fue el más endémico, representando el 70,2% (n=7.247) de los casos. Predominaron la clasificación operacional multibacilar (79,8%, n=8.233) y el Grado 0 de discapacidad física (50,6%, n=5.223). En Misiones, el 18,9% utilizó un régimen de tratamiento de sustitución. En el periodo se observó una situación hiperendémica en 780 (65,5%) de las ciudades/departamentos estudiados. Conclusión: El estudio mostró que las regiones estudiadas tienen alta endemicidad, transmisión activa y diagnóstico tardío de la lepra. Estas tendencias entrelazadas en cuanto a la fuerza de la morbilidad y la transmisión reciente y persistente de la enfermedad aumentan la importancia de la lepra como un problema de salud pública en la región.

ABSTRACT Objective: to characterize the epidemiological clinical profile and spatial distribution of the incidence of leprosy in border territories of South America. Method: this is an ecological study. The study included the Province of Misiones in Argentina and the Southern Region of Brazil. The population consisted of 10,319 new leprosy cases diagnosed between 2010 and 2016. Results: the state of Paraná was the most endemic, representing 70.2% (n=7.247) of the cases. There was a predominance of multibacillary operational classification (79.8%, n=8,233) and Grade 0 of physical disability (50.6%, n=5,223). In Misiones, 18.9% used a substitution treatment regimen. In the period, a hyperendemic situation was observed in 780 (65.5%) of the studied cities/departments. Conclusion: the study revealed that the regions studied have high endemicity, active transmission and late diagnosis of leprosy. These intertwined trends in the strength of morbidity and recent and persistent transmission of the disease increase the relevance of leprosy as a public health problem in the region.

Social determinants, their relationship with leprosy risk and temporal trends in a tri-border region in Latin America.

BACKGROUND: Brazil is the only country in Latin America that has adopted a national health system. This causes differences in access to health among Latin American countries and induces noticeable migration to Brazilian regions to seek healthcare. This phenomenon has led to difficulties in the control and elimination of diseases related to poverty, such as leprosy. The aim of this study was to evaluate social determinants and their relationship with the risk of leprosy, as well as to examine the temporal trend of its occurrence in a Brazilian municipality located on the tri-border area between Brazil, Paraguay and Argentina. METHODS: This ecological study investigated newly-diagnosed cases of leprosy between 2003 and 2015. Exploratory analysis of the data was performed through descriptive statistics. For spatial analysis, geocoding of the data was performed using spatial scan statistic techniques to obtain the Relative Risk (RR) for each census tract, with their respective 95% confidence intervals calculated. The Bivariate Moran I test, Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) models were applied to analyze the spatial relationships of social determinants and leprosy risk. The temporal trend of the annual coefficient of new cases was obtained through the Prais-Winsten regression. A standard error of 5% was considered statistically significant (p < 0.05). RESULTS: Of the 840 new cases identified in the study, there was a predominance of females (n = 427, 50.8%), of white race/color (n = 685, 81.6%), age range 15 to 59 years (n = 624, 74.3%), and incomplete elementary education (n = 504, 60.0%). The results obtained from multivariate analysis revealed that the proportion of households with monthly nominal household income per capita greater than 1 minimum wage (ß = 0.025, p = 0.036) and people of brown race (ß = -0.101, p = 0.024) were statistically-significantly associated with risk of illness due to leprosy. These results also confirmed that social determinants and risk of leprosy were significantly spatially non-stationary. Regarding the temporal trend, a decrease of 4% (95% CI [-0.053, -0.033], p = 0.000) per year was observed in the rate of detection of new cases of leprosy. CONCLUSION: The social determinants income and race/color were associated with the risk of leprosy. The study's highlighting of these social determinants can contribute to the development of public policies directed toward the elimination of leprosy in the border region.

Características demográficas, sociais e clínicas de mulheres em idade fértil atingidas pela Hanseníase / Demographic, social and clinical characteristics of women in childbearing age affected by Leprosy / Características demográficas, sociales y clínicas de mujeres en edad fértil que sufren de la enfermedad de Hansen

Objetivo: descrever as características demográficas, sociais e clínicas de mulheres em idade fértil atingidas pela hanseníase em uma capital do nordeste brasileiro. Método: estudo descritivo de corte transversal, com abordagem quantitativa. A população do estudo foi composta por 217 mulheres, e resultou em uma amostra intencional de 60, que atenderam aos critérios de inclusão. Resultados: os dados revelaram que 95,0% do conjunto amostral, encontrava-se na faixa de 20 a 49 anos. O modo de detecção que apresentaram uma maior porcentagem foram: o encaminhamento e a demanda espontânea, constituindo 60,0% dos casos. Identificou-se que 30,0% foram diagnosticadas na forma dimorfa, o que afirma os dados referente à classificação multibacilar. Conclusão: as características demográficas, sociais e clínicas foram: mulheres economicamente ativas, predominantemente analfabetas, que possuem companheiros e desempenham ocupações remuneradas e domésticas.

Aim: to describe demographic, social and clinical characteristics of women in childbearing age affected by leprosy in a capital city in the northeast of Brazil. Method: crosssectional descriptive study, with quantitative approach. The study was composed by 217 women, resulting in an intentional sample of 60, who have attended the criteria of inclusion. Results: the data showed that 95% of the subjects were set between 20 and 49 years of age. The detection modes which presented a higher percentage were both the handling and the spontaneous demands, with 60% of the cases. It was identified that 30% were diagnosed in the dimorphic form, which is confirmed by the data regarding the multibacillary classification. Conclusion: the demographic, social and clinical characteristics were: economically active women, mostly illiterate, who are married and perform both remunerated and domestic occupations

Objetivo: describir las características demográficas, sociales y clínicas de mujeres en edad fértil que sufren de la enfermedad de Hansen en una capital del Nordeste brasileño. Método: estudio descriptivo de cohorte transversal, con análisis cuantitativo. La población del estudio fue compuesta por 217 mujeres, de esas se estableció una muestra intencional de 60, en las cuales se verificó los criterios de inclusión. Resultados: los dados evidenciaron que 95,0% del conjunto de la muestra tenía entre 20 y 49 años. El modo de detección que presentó un mayor porcentaje fue: la orientación y búsqueda de tratamiento espontánea, constituyendo 60% de los casos. También se identificó que 30% de esas mujeres fue diagnosticada de forma dimorfa, lo que ratifica los dados sobre la clasificación multibacilar. Conclusión: las características demográficas, sociales y clínicas de ese grupo fue: mujeres económicamente activas, en la mayoría analfabetas, que tienen compañeros y desempeñan ocupaciones remuneradas y domésticas.

Avaliação dos indicadores epidemiológicos e operacionais para a hanseníase em municípios prioritários no estado do Paraná, 2001 a 2010 / Evaluation of leprosy epidemiological and operational indicators in priority municipalities in the state of Paraná, 2001 to 2010 / Evaluación de indicadores epidemiológicos y operativos para hanseniasis en municipios de prioridad en el estado de Paraná, 2001 a 2010

OBJETIVO: descrever os indicadores epidemiológicos e operacionais da hanseníase nos municípios de Curitiba, Londrina e Foz do Iguaçu, estado do Paraná, Brasil. MÉTODOS: estudo ecológico descritivo de série temporal com dados do Sistema de Informação de Agravos de Notificação, sobre o período de 2001 a 2010; a análise dos indicadores seguiu os parâmetros indicados no Guia de Controle da Hanseníase do Ministério da Saúde, 2002. RESULTADOS: no período estudado, houve redução do coeficiente de prevalência da hanseníase por 10.000 habitantes em Foz do Iguaçu (de 4,3 para 2,6) e Londrina (de 1,7 para 1,2); Curitiba apresentou menos de 1 caso por 10.000 habitantes no período; a proporção de cura e consequente efetividade do tratamento mostrou-se regular nos três municípios. CONCLUSÃO: os indicadores epidemiológicos sinalizaram redução do diagnóstico de hanseníase mas sugerem a existência de casos ocultos; os indicadores operacionais apontaram discreta melhoria na qualidade do atendimento aos portadores da doença.

OBJECTIVE: to assess the epidemiological and operational indicators of leprosy in the cities of Curitiba, Londrina and Foz do Iguaçu, in Paraná state, Brazil. METHODS: this was a descriptive ecological time-series study using Notifiable Diseases Information System data, for the period 2001-2010. Indicator analysis was performed as per the parameters listed in the 2002 version of the Health Ministry's Leprosy Control Guide. RESULTS: prevalence decreased from 4.3 to 2.6 in Foz do Iguaçu and from 1.7 to 1.2 in Londrina, whilst Curitiba had less than 1 case per 10,000 inhabitants in the period. The cure rate and consequent treatment effectiveness was regular in the three municipalities. CONCLUSION: although the cities studied have shown improvement, this is not yet sufficient to control the disease. The work already begun needs to be fully implemented in forthcoming years.

OBJETIVO: describir los indicadores epidemiológicos y operacionales de la hanseniasis en las ciudades de Curitiba, Londrina y Foz de Iguazú, estado de Paraná, Brasil. MÉTODOS: estudio ecológico descriptivo de series temporales, con datos del Sistema de Información de Enfermedades de Declaración Obligatoria, para el período de 2001 - 2010; el análisis de indicadores siguió los parámetros indicados en la Guía de Control de Hanseniasis, del Ministerio de Salud, 2002. RESULTADOS: en el periodo estudiado, hubo una reducción de la prevalencia de hanseniasis por cada 10 000 habitantes, en las ciudades de Foz do Iguaçu (de 4,3 para 2,6) y Londrina (de 1,7 para 1,2); Curitiba mostró una prevalencia de 1 caso por 10.000 habitantes en ese periodo; la proporción de cura y por consiguiente la eficacia del tratamiento fue regular en los tres municipios. CONCLUSIÓN: los indicadores epidemiológicos mostraron reducción en el diagnóstico de hanseniasis, pero sugieren la existencia de casos ocultos; los indicadores operacionales muestran a una discreta mejoría en la calidad de atención a los portadores de esta enfermedad.

[Prospects for the elimination of leprosy as a public health problem in the State of Paraná, Brazil]. / Perspectivas de eliminação da hanseníase como problema de saúde pública no Estado do Paraná, Brasil.

Leprosy, an endemic contagious/infectious disease, is still a public health problem in most States of Brazil, despite an important decrease in the prevalence rate in recent years. The current study aims to analyze the prospects for the elimination of leprosy in the State of Paraná, based on detection and prevalence rates for the years 2000 to 2005, in addition to data on gender, age, clinical form, operational classification, and number of skin lesions. Data were obtained from the Reportable Diseases Information System (SINAN) and the Tabnet software. Leprosy detection and prevalence rates in Paraná remained unaltered during the study period. The leprosy detection rates were high or very high in the majority of the health districts in the State. In terms of prevalence, eight health districts had reached the goal of eliminating the disease. In conclusion, the State of Paraná is close to reaching the goal of eliminating leprosy. Based on the study results, actions are recommended to eliminate the disease as a public health problem.

Perspectivas de eliminação da hanseníase como problema de saúde pública no Estado do Paraná, Brasil / Prospects for the elimination of leprosy as a public health problem in the State of Paraná, Brazil

A hanseníase, moléstia infecto-contagiosa endêmica, constitui ainda problema de saúde pública na maioria dos estados brasileiros, embora, nos últimos anos, venha apresentando queda importante em seu coeficiente de prevalência. Este estudo tem por objetivo analisar a perspectiva de eliminação da hanseníase no Estado do Paraná por meio dos coeficientes de detecção e de prevalência, nos anos de 2000 a 2005, além do sexo, idade, forma clínica, classificação operacional e número de lesões de pele. A fonte de informações foi o banco de dados do Sistema de Informação de Agravos de Notificação (SINAN) e o programa Tabnet. Os coeficientes de detecção e de prevalência da hanseníase no Paraná permaneceram sem alteração no período de estudo. Verificou-se, no Paraná, segundo as Regionais de Saúde, que o coeficiente de detecção da hanseníase foi, em sua maioria, alto ou muito alto. Quanto à prevalência, oito Regionais de Saúde alcançaram a meta de eliminação. Conclui-se que o Estado do Paraná está próximo de alcançar a meta de eliminação da hanseníase. Recomenda-se o fortalecimento das ações para que a eliminação da doença como um problema de saúde pública seja uma realidade.

Leprosy, an endemic contagious/infectious disease, is still a public health problem in most States of Brazil, despite an important decrease in the prevalence rate in recent years. The current study aims to analyze the prospects for the elimination of leprosy in the State of Paraná, based on detection and prevalence rates for the years 2000 to 2005, in addition to data on gender, age, clinical form, operational classification, and number of skin lesions. Data were obtained from the Reportable Diseases Information System (SINAN) and the Tabnet software. Leprosy detection and prevalence rates in Paraná remained unaltered during the study period. The leprosy detection rates were high or very high in the majority of the health districts in the State. In terms of prevalence, eight health districts had reached the goal of eliminating the disease. In conclusion, the State of Paraná is close to reaching the goal of eliminating leprosy. Based on the study results, actions are recommended to eliminate the disease as a public health problem.

Evaluation of incapacity level in leprosy: a strategy to sensitize and train the nursing team / Avaliação do grau de incapacidade em hanseníase: uma estratégia para sensibilização e capacitação da equipe de enfermagem / Evaluación del grado de incapacidad en hanseníasis: una estrategia para la sensibilización y la capacitación del equipo de enfermería

The main problems caused by leprosy are physical incapacities. This study evaluated the level of patients' incapacity in treatment and in discharge in 11 municipal districts of the14th Regional of Health of Paraná, at the same time it promoted discussion and qualified nursing professionals of local teams. It was verified that 79.8 percent of the population evaluated presented some degree of incapacity and that some of the professionals ignored the evaluation technique. The percentage of patients with incapacity levels I and II was high, fact that corroborates the late diagnosis of cases. The need of a permanent self-care process associated to polichemotherapy and continuous evaluation of new and old cases in order to avoid the illness physical incapacities is highlighted.

Os principais problemas decorrentes da hanseníase são as incapacidades físicas. O presente estudo avaliou o grau de incapacidade dos pacientes em tratamento e em alta, em 11 municípios da 14ª Regional de Saúde do Paraná, ao mesmo tempo em que promoveu discussão e capacitou os profissionais de enfermagem das equipes locais. Verificou-se que 79,8 por cento da população avaliada apresentava algum grau de incapacidade e que parte dos profissionais desconhecia a técnica de avaliação. Foi grande a porcentagem de pacientes com grau de incapacidade I e II, fato que corrobora o diagnóstico tardio dos casos. Destaca-se a necessidade de permanente processo de autocuidado, associado à poliquimioterapia e avaliação contínua dos casos novos e antigos para evitar as incapacidades físicas conseqüentes do agravo.

Los principales problemas originados de la lepra son las inhabilidades. El actual estudio evaluó el grado de incapacidad de los pacientes en tratamiento y los que ya habían sido curados en 11 ciudades de la 14ª Regional de la Salud de Paraná, Brasil. Al mismo tiempo, promovió discusión y capacitación de los profesionales de enfermería de los equipos locales. Fue verificado que el 79,8 por ciento de la población evaluada presentó cierto grado de incapacidad y que los profesionales no conocían la técnica de evaluación. Era alto el porcentaje de pacientes con grado de incapacidad I e II, hecho que comprueba la diagnosis retrasada de los casos. Se destaca la necesidad de un proceso permanente de autocuidado, asociado a la poliquimioterapia y la evaluación continua de los casos nuevos y viejos para prevenir las inhabilidades consiguientes de la enfermedad.

Evaluation of incapacity level in leprosy: a strategy to sensitize and train the nursing team.

The main problems caused by leprosy are physical incapacities. This study evaluated the level of patients' incapacity in treatment and in discharge in 11 municipal districts of the 14th Regional of Health of Paraná, at the same time it promoted discussion and qualified nursing professionals of local teams. It was verified that 79.8% of the population evaluated presented some degree of incapacity and that some of the professionals ignored the evaluation technique. The percentage of patients with incapacity levels I and II was high, fact that corroborates the late diagnosis of cases. The need of a permanent self-care process associated to polichemotherapy and continuous evaluation of new and old cases in order to avoid the illness physical incapacities is highlighted.