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.

Polymorphisms in the TGFB1 and IL2RA genes are associated with clinical forms of leprosy in Brazilian population

BACKGROUND Leprosy is a chronic infectious disease caused by Mycobacterium leprae, and compromises the skin and peripheral nerves. This disease has been classified as multibacillary (MB) or paucibacillary (PB) depending on the host immune response. Genetic epidemiology studies in leprosy have shown the influence of human genetic components on the disease outcomes. OBJECTIVES We conducted an association study for IL2RA and TGFB1 genes with clinical forms of leprosy based on two case-control samples. These genes encode important molecules for the immunosuppressive activity of Treg cells and present differential expressions according to the clinical forms of leprosy. Furthermore, IL2RA is a positional candidate gene because it is located near the 10p13 chromosome region, presenting a linkage peak for PB leprosy. METHODS A total of 885 leprosy cases were included in the study; 406 cases from Rondonópolis County (start population), a hyperendemic region for leprosy in Brazil, and 479 cases from São Paulo state (replication population), which has lower epidemiological indexes for the disease. We tested 11 polymorphisms in the IL2RA gene and the missense variant rs1800470 in the TGFB1 gene. FINDINGS The AA genotype of rs2386841 in IL2RA was associated with the PB form in the start population. The AA genotype of rs1800470 in TGFB1 was associated with the MB form in the start population, and this association was confirmed for the replication population. MAIN CONCLUSIONS We demonstrated, for the first time, an association data with the PB form for a gene located on chromosome 10. In addition, we reported the association of TGFB1 gene with the MB form. Our results place these genes as candidates for validation and replication studies in leprosy polarisation.

Overcoming prejudice.

PIP: People of African descent comprise a large proportion of Brazil's population. While racism exists in the country, it is commonly denied. Most Afro-Brazilians live in poor areas, with poor health care services, sanitation, schools, and transport. Since HIV is linked to poverty, Afro-Brazilians are more affected by HIV than is the overall population. Although Afro-Brazilians contribute to Brazil's culture, they do not benefit from that contribution. Recognizing this considerable social problem, Project Araye was created in 1996 to address issues of race and HIV. Building upon religious and cultural traditions, the project is staffed by Afro-Brazilians who are knowledgeable in both health issues and Afro-Brazilian culture. Project Araye supports a wide range of diverse community leaders in linking sexual health and HIV with other health concerns which affect Afro-Brazilians such as sickle-cell anemia, diabetes, and leprosy. One important challenge has been overcoming the target population's denial of HIV and encouraging Afro-Brazilians to accept that HIV also affects them. Community leaders include religious leaders, rap musicians, artists, and other people respected by various communities. Activities include visits to samba dance schools, Umbanda and Candomble temples, and street youth groups to provide HIV-related information.^ieng

Gender issues in the elimination of leprosy in India.

PIP: Leprosy control personnel and social science researchers, including members of the Gender and Tropical Diseases Task Force, convened at the Agharkar Research Institute in Pune, India, during November 26-28, 1996, to discuss gender issues in eliminating leprosy in India. Conference participants heard and discussed the results of a study of gender differences upon the impact of leprosy conducted during 1993-96 in 4 districts of Maharashtra State. The study explored whether gender issues affect the timing and mode of detection, treatment-seeking behavior, and compliance; the impact of the disease on social, family, and personal life; and the role of the family in mediating that impact. A sharp decline was observed in the number of registered cases among women aged 11-19 years, a period coinciding with the arrangement of marriage in India, followed by a sharp increase in female cases aged 20-35, compared to the number of cases among men. Significantly fewer female cases than male cases were detected through voluntary reporting. In urban areas, sex differences in registered cases were minimal, while in rural and tribal areas, significantly more males than females were registered. While many women reported that pregnancy and childbearing exacerbated their disease, they were not informed about such risks when going for treatment. Non-leprosy health personnel were poorly trained to recognize early symptoms of the disease, making family support key in determining the course of disease, coping, and treatment. There was also considerable superstition over leprosy in the larger community often associated with sins in a past existence.^ieng

The population of persons with disabilities in Pakistan.

PIP: This article provides a discussion of deficiencies in the data collection on disabilities in Pakistan, identifies data sources, and makes recommendations for improving the quality of the data. Major trends in disabilities are identified. In Pakistan, there is social stigma attached to persons with disabilities. Disabilities are concealed within families so as not to limit the marriage prospects of relatives who might otherwise be suspected of carrying defective genes. Religion perpetuates superstitions about the disabled. Families bear an extra expense in caring for a disabled member, due to loss of additional labor, increased demands on resources for taking care of the disabled member, and increased need to compensate with higher fertility. There is a lack of social institutional support for care of the disabled. The population censuses of 1961 and 1981 were the first to collect information on the disabled. The inadequacy of census data led to the initiation of a national survey in 1984/85 for collecting data on blindness, deafness, mutism, leprosy, retardation, lameness, and handicaps. A special in-depth survey on disabilities was also conducted in Islamabad and Rawalpindi districts in 1986. This survey focused on mental retardation, visual and hearing disabilities, deformity and wasting of the limbs, and physical disabilities, such as paralysis. This survey was the most valid but it was not comparable to prior surveys. Trends indicate a smaller number of disabled at older ages. Specific disabilities by age showed some peculiar age patterns that suggest unreliability. Data from the 1984/85 survey show higher sex ratios for all disabilities for certain provinces compared to the national ratios. If the trend accurately reflects increased disabilities, the education of high risk groups must be improved, accessibility to medical care must be increased, and the population needs to be educated about the disabled. Government social programs need more accurate assessments of the causes of disability and the extent and duration of disablement.^ieng

Tuberculosis control programme in rural area: experiences from the field.

PIP: According to the Indian National Tuberculosis Program (NTP), only 30% of tuberculosis (TB) patients receiving conventional treatment and 52% of those receiving short-course chemotherapy (SCC) complete the treatment. Incompletely cured patients return to the community, and each sputum-positive case can infect 10-14 people in the course of a year. Direct monitoring of chemotherapy is a must for success, especially if rifampicin is used after accurate diagnosis based on bacteriological examination. The National Leprosy Eradication Program, which has involved voluntary organizations, provides an example to be followed by NTP. This example was considered when the Karuna Trust, a voluntary organization, launched a TB control program on January 1, 1992, for Yelandur taluk, covering a population of 69,484 in 40 villages. A staff consisting of a medical officer, a supervisor, a smear technician, and paramedical workers had undergone training at the National TB Institute in Bangalore. Detection of cases was carried out by house-to-house visits, which could detect about 65% of cases. It was also found that TB treatment had been started without a sputum examination, sputum-positive cases had been on rifampicin, and data recording was incomplete. Up to October 1994, a total of 231 cases were registered and compliance was ensured by home visits. Private practitioners were carrying out harmful activities by not enforcing full patient compliance and thereby contributing to the increasing number of drug-resistant cases. In contrast, this program had a default of only 19.1% among sputum-positive cases, but even these can be recovered with an interaction with private practitioners. Treatment failure amounted to 10.1%, all having been on rifampicin. Retreatment requires more expensive second-line drugs. Drug collection will be decentralized for the convenience of patients; and an adequate supply of drugs was secured. Some suggestions were also made concerning adequate resources, integration of the program, monitoring, and involving nongovernmental organizations in implementation and evaluation.^ieng

Leprosy care. The impact of multiple drug therapy.

PIP: There are currently an estimated 10-12 million cases of leprosy in the world. Until relatively recently, dapsone was the mainstay of drug therapy against this disease, but it had to be administered for very long periods of time and began to lose effectiveness in the face of growing disease resistance. New standard, multi-drug regimens were therefore recommended by WHO in 1982 and have since become the standard minimum necessary treatment in leprosy control programs. Multiple drug therapy (MDT), if administered early enough, can cure leprosy before deformity develops. Its cost and complexity, however, impede its widespread dissemination where needed. Much of rural Africa especially suffers from a lack of MDT due to financial constraints, geographic isolation, transport difficulties, and poor healthcare infrastructure. Dr, William Philip of the United Kingdom Aberdeen Royal Infirmary describes the introduction of MDT into and throughout rural northwestern Uganda over the period 1986-90. The introduction of MDT in West Nile has made a positive impact against leprosy. Most patients have been released from treatment or will be released soon after completing their regimes, so that only new cases will be receiving drug therapy. This large drop in case load will allow greater effort to be placed upon early case detection and treatment. MDT over time will reduce the number of patients needing drug therapy and leave only few disabled patients after a few decades. In so doing, MDT seems to be the approach needed to control and eventually eradicate leprosy. It is hoped that this program experience will help guide program implementation in other areas where MDT has yet to be introduced.^ieng

Informe anual del programa de control de tuberculosis 1993

Presenta datos estadísticos producidos por el Programa de Control de Tuberculosis y Lepra durante el año 1993. Destaca los datos de captación de pacientes sintomáticos Respiratorios, el diagnóstico de los BAAR positivos y todas las formas de tuberculosis por SILAIS, y las coberturas con BCG, del tratamiento acortado y los resultados de las cohortes de tratamiento

Leprosy: an urgent need to step up use of MDT in Africa.

PIP: 10-12 million people in the world have leprosy. India claims about 4 million of these cases. Overall at least 20% of the cases are children. In the 1940s, dapsone was the only drug used to treat leprosy. By the early 1970s, dapsone did not perform as expected and Mycobacterium leprae were beginning to exhibit resistance to dapsone. In 1982, WHO published results of its study which recommended fixed and relatively short duration regimens of multiple drug therapy (MDT) for all people with leprosy. It also listed recommendations on diagnosis, classification, and distribution of patients to either pauci or multibacillary groups. MDT depends on what type of leprosy patients have. For example, patients with multibacillary leprosy receive rifampicin, clofazimine, and dapsone whereas those with paucibacillary leprosy receive only rifampicin. In many African countries, however, MDT is not used. Yet cases of leprosy exist in 94% of Africa's countries. Moreover 37% have highly prevalent leprosy and the lowest percentage of patients on MDT (18% vs. world average of 56%). In fact, Nigeria is included in the group of 5 countries with 84% of all cases. Until the various countries in Africa can satisfy the ideal requirements for establishing a MDT program, they should begin MDT at least on a small scale. They do need, however, an adequate supply of the drugs. The other requirements include a good plan of action, laboratory facilities, transport, and referral centers. If the period of time needed to meet these requirements is long, then physicians should conduct pre MDT screenings to diagnose cases and determine who needs chemotherapy. The best way to diagnose cases is from clinical experience and paying particular attention to dermatological and neurological findings. Early identification is needed since leprosy cases are stigmatized. This article includes MDT dosages in adults and children.^ieng

Care and development of children in tribal areas.

PIP: About 53 million people (8% of the population) of India belong to various tribes in about 400 tribal communities. These groups live in different ecological geoclimatic conditions throughout India ranging from the Sub-Himalayas to the islands in the Bay of Bengal and in the Arabian Sea. They also differ in distinct biological traits and cultural and socioeconomic background. Due to cultural patterns which vary from tribe to tribe, they are all at different stages of social, cultural, and economic development. Since the tribes live in isolated and inaccessible areas, it is hard to implement health care and nutrition activities, elementary education, and preventive promotive health care. The government does plan to provide rural day care for 0-3 year old children. The Integrated Child Development Services (ICDS) Scheme reaches 2197 of 5143 tribal development blocks. ICDS activities include immunization of children and mothers, health education, and supplementary nutrition. The government also promotes primary health care in tribal areas. Despite these efforts, child welfare and development in tribal areas have not improved. Recently nongovernmental organizations have joined child welfare and development efforts in tribal areas. The Jigyansu Tribal Research Center has compiled a long list of recommendations to improve child welfare and development efforts in tribal areas including improving preventive activities especially those that target specific local diseases such as cerebral malaria and leprosy, introduction of traditional herbal medicines, and comprehensive data collection.^ieng

Burma.

PIP: Demographic, political, and physical characteristics of Burma are outlined, the largest country on the Southeast Asian mainland. The population of Burma is predominantly rural with the most prevalent ethnic group being the Burmans. Theravada Buddhism is the religion of approximately 85% of the Burmese. Burma was unified in the 11th century by King Anawrahta. In 1988, General U Ne Win, the country's president, stepped down from his position after a series of violent riots protesting severe economic conditions. That same year, military rule was established and 2 new parties came into being: the National Unity Party and the National League for Democracy. Since August 1988, the issuance of tourist visas has been halted due to the unrest. Longterm visas for business purposes can be obtained, however. For those travelling to Burma, yellow fever inoculation certification is required. Cholera, tuberculosis, plague, leprosy and typhoid are all endemic as well, and dengue fever is present. A fairly inaccessible country, all international flights enter and exit through the country's capital, Rangoon. The tourist visiting Burma will see an agricultural nation. Approximately 70% of the country's exporting economy comes from the sale of rice and teak.^ieng

AIDS in Africa--an update.

PIP: At least 1 million people in Central and East Africa are infected with HIV-1, and there are 10,000 new cases of AIDS per year. HIV-1 is spreading into the Ivory Coast, Ghana, Mozambique, Angola and southern Africa. HIV-2 is prevalent in West Africa, particularly Senegal and Guinea-Bissau. Groups at greatest risk for HIV-1 are prostitutes, their customers, and patients with a history of sexually-transmitted diseases, which cause breaches in mucosal epithelium. 24% of pregnant women in Uganda are infected, and the risk of transplacental infection is estimated to be between 17% and 79%. Blood transfusion is the 3rd most frequent mode of infection, largely due to need for blood by anemic women. Repeated pregnancy is a cofactor in the progression of AIDS, and infected infants suffer intrauterine growth retardation, premature birth, low birth weight, and high mortality in the 1st week of life. AIDS in adults is often accompanied by tuberculosis, herpes zoster, hepatitis B, herpes type 2, and leprosy. Clinical diagnosis of AIDS is made by enzyme-linked immunosorbent assay, but African patients have a high frequency of anti-p24 antibody which masks the p24 antigenemia. Some African countries have AIDS education programs, condom distribution and blood screening, but AIDS control programs need to be integrated with primary health care.^ieng

Togo.

PIP: This compendium on Togo contains a summary of current and projected demographic indicators, of government population policies and attitudes, and of the current status of the country's population data collecting system. The information is further summarized in a 1-page fact sheet. In 1981 the total population was 2.7 million. In 1980-85, the annual population growth rate was 2.9%, and the annual natural increase rate was 2.9%, life expectancy at birth was 48.7 years, the infant mortality rate was 113, and the crude birth rate was 45.4. Per capita income was US$406 in 1979, and in 1981, 67% of the labor force was engaged in agriculture. Currently the government has no policies in regard to population growth and is satisfied with the current fertility level. Earlier the government's position was pronatalist; but, in 1976, the government approved the establishment of the Togolese Family Welfare Association (ATBEF), an affiliate of the International Planned Parenthood Federation. In addition, the government is promoting the integration of family planning services in the nation's primary health program. The government is concerned with the problem of teenage pregnancy. Abortion, except to save the life of the mother, is illegal, and there are no legal provisions concerning sterilization. In recent years, the government adopted several measures aimed at improving the status of women. These measures included the passage of a new family code. The major concerns of the government are to improve the health status of the population and to promote rural and regional development. The primary health care program was expanded in 1977, and the country has a fairly successful immunization program. It also operates a leprosy control program and is improving the country's water supply. Currently the level of international migration, both emigration and immigration, is low, and the government has no migration policy. Togo has a low urban rate (17.4%), and between 1970-80, the rate of annual urban growth rate was 5.3%. The government is concerned about the high rate of growth in Lome, the capital city. Togo conducts a census every 10 years, and the last one was conducted in 1981. Birth and death registration is incomplete. There is no institutionalized mechanism for promoting the integration of population and development planning.^ieng

[An overall index as a measure of quality in a census or survey]. / Un indice global como medida de la calidad en un censo o encuesta

PIP: A method for evaluating the quality of census or survey data is outlined. The method is based on a model developed in 1961 by Hansen, Hurvitz, and Bershad. The use of the present model for comparisons of data quality among countries is described and evaluated. Applications to data from Cuba, Spain, Hungary, and the United States are included. (summary in ENG, RUS)^ieng

A saúde no Rio Grande do Sul: 1970/1982 / Health in Rio Grande do Sul: 1970/1982

Trata-se de uma síntese das condiçöes de saúde e do meio ambiente no Estado do Rio Grande do Sul, no período de 1970 a 1982. A expansäo da rede de serviços, o crescimento em termos quantitativos e qualitativos, dos recursos humanos, a incorporaçäo de tecnologia, refletiram-se no melhor desempenho do setor saúde-meio ambiente, constatados nos indicadores utilizados para avaliaçäo destas áreas. Os dados apresentados dizem respeito a: dados gerais sobre o Rio Grande do Sul; indicadores de saúde e indicadores sócio-econômicos; características da populaçäo adulta, 1978; atividades da secretaria da saúde e do meio ambiente; controle de doenças transmissíveis: Cobertura vacinal da populaçäo menor de um ano, poliomielite, sarampo, tétano, difteria, febre tifóide, tuberculose, hanseníase, doenças venéreas, raiva e doença meningocócica; assistência materno-infantil; outros problemas de saúde: doenças cardiovasculares, câncer, doença mental, intoxicaçöes e saúde oral; problemas ambientais no Estado e vigilância sanitária. Finalizando, apresenta-se um quadro sobre as perspectivas para a área de saúde e meio ambiente no Rio Grande do Sul