Clinical-epidemiological characteristics and temporal trend of new cases of grade 2 disability leprosy in the state of Maranhão, Brazil, 2011- 2020.

MAIN RESULTS: Out of 2,147 grade 2 disability leprosy cases, the majority were male, of mixed race/skin color, multibacillary and borderline. The São Luís regional health unit showed a falling trend. IMPLICATIONS FOR SERVICES: The results can guide strategies for the leprosy control program in the state, aiming at new approaches towards early diagnosis, treatment and prevention of disabilities. PERSPECTIVES: Further studies are needed, such as spatial distribution of cases and detection rates of leprosy in children under 15 years of age, in order to gain a better understanding of the epidemiological profile of leprosy in Maranhão. OBJECTIVE: to describe the clinical and epidemiological characteristics of new cases of grade 2 disability leprosy and to analyze its trend in the state of Maranhão, from 2011 to 2020. METHODS: this was a descriptive cross-sectional and ecological time-series study, using data from the Notifiable Health Conditions Information System. A descriptive analysis of the event was carried out according to the sociodemographic and clinical-laboratory characteristics of the cases. The temporal trend of event incidence was analyzed using Prais-Winsten regression. RESULTS: of the 2,147 cases, 71.5% were male, 48.9% had up to 8 years of schooling, 66.5% were of mixed race/color, 95.5% had the multibacillary form, 58.8% were borderline, 32.3% had negative bacilloscopy at diagnosis. There was a stationary trend in the state and a falling trend in the São Luís Health Region (annual percentage change = -64.4%; 95% confidence interval: -73.7;-51.9). CONCLUSION: incidence trend was stable in the state of Maranhão and falling in São Luís.

Leprosy prevalence spatial distribution and trend in a health region in Northeast Brazil, 2008-2017: an ecological study.

MAIN RESULTS: A total of 4,029 leprosy cases were notified. Mean prevalence varied between 2.0 and 11.5 cases/10,000 inhab. Spatial distribution of the cases was heterogeneous and there was a falling prevalence trend over the years studied. IMPLICATIONS FOR SERVICES: These findings point to the need to strengthen active tracing strategies and expand health actions and services targeting leprosy, with the aim of increasing detection and early treatment of cases. PERSPECTIVES: It is important to carry out epidemiological investigations on the spatial distribution and prevalence of leprosy in other health regions in the state, in order to identify other areas with greater vulnerability to leprosy. OBJECTIVE: to analyse the spatial distribution and trend of leprosy in municipalities of a health region in a Northeast Brazilian state. METHODS: this was an ecological time-series study based on compulsory notification of leprosy cases by the municipalities covered by the Imperatriz-MA Regional Health Management Unit, between 2008 and 2017; prevalence and mean prevalence for the period were calculated; spatial analysis of the area was carried out and maps were generated using ArcGis 10.5. Prais-Winsten regression was used for trend analysis. RESULT: 4,029 cases of the disease were identified, and average prevalence ranged from 2.0 to 11.5 cases/10,000 inhabitants-year. The overall trend was downward. Governador Edson Lobão had the highest prevalence, 11.5 cases/10,000 inhabitants, and Lajeado Novo had the lowest prevalence, 2.0 cases/10,000 inhabitants. CONCLUSION: spatial distribution of leprosy cases was heterogeneous in the municipalities studied and prevalence had a falling trend.

Distribuição espacial e tendência da prevalência da hanseníase em uma regional de saúde do Nordeste brasileiro, 2008-2017: um estudo ecológico / Leprosy prevalence spatial distribution and trend in a health region in Northeast Brazil, 2008-2017: an ecological study / Distribución espacial y tendencia en la prevalencia de la lepra en una región sanitaria del Nordeste de Brasil, 2008-2017: un estudio ecológico

Objetivo: analisar a distribuição espacial e a tendência da hanseníase em municípios de uma regional de saúde de um estado no Nordeste brasileiro. Métodos: estudo ecológico e de séries temporais, sobre a notificação compulsória dos municípios integrantes da Unidade Gestora Regional de Saúde de Imperatriz, Maranhão, Brasil, entre 2008 e 2017; foram determinadas as prevalências e a média para o período; realizou-se a análise espacial de área e os mapas foram gerados pelo aplicativo ArcGis 10.5; na análise de tendência, utilizou-se a regressão de Prais-Winsten. Resultado: foram identificados 4.029 casos da doença e as médias de prevalência variaram de 2,0 a 11,5 casos/10 mil habitantes/ano, com tendência descendente; Governador Edson Lobão apresentou a maior prevalência, 11,5 casos/10 mil hab., e Lajeado Novo a menor, 2,0 casos/10 mil hab. Conclusão: a distribuição espacial dos casos de hanseníase foi heterogênea nos municípios estudados e a tendência da prevalência, decrescente.

Objective: to analyse the spatial distribution and trend of leprosy in municipalities of a health region in a Northeast Brazilian state. Methods: this was an ecological time-series study based on compulsory notification of leprosy cases by the municipalities covered by the Imperatriz-MA Regional Health Management Unit, between 2008 and 2017; prevalence and mean prevalence for the period were calculated; spatial analysis of the area was carried out and maps were generated using ArcGis 10.5. Prais-Winsten regression was used for trend analysis. Result: 4,029 cases of the disease were identified, and average prevalence ranged from 2.0 to 11.5 cases/10,000 inhabitants-year. The overall trend was downward. Governador Edson Lobão had the highest prevalence, 11.5 cases/10,000 inhabitants, and Lajeado Novo had the lowest prevalence, 2.0 cases/10,000 inhabitants. Conclusion: spatial distribution of leprosy cases was heterogeneous in the municipalities studied and prevalence had a falling trend.

Objetivo: analisar la distribución espacial y la tendencia de la lepra en una región sanitaria de un estado del Nordeste brasileño. Métodos: estudio ecológico y de serie temporal, con notificación obligatoria de los municipios de la Unidad de Gestión Regional de Salud de Imperatriz-MA, entre 2008-2017. Se determinaron la prevalencia y la media del período y se realizó un análisis del espacio de área, los mapas se generaron en ArcGis 10.5. Para el análisis de tendencia se utilizaron regresiones de Prais-Winsten. Resultado: se identificaron 4.029 casos y las prevalencias promedio oscilaron entre 2,0 y 11,5 casos/10.000 habitantes-año, con tendencia al descenso. Governador Edson Lobão presentó la mayor prevalencia 11,5 casos/10.000 habitantes y Lajeado Novo la menor prevalencia 2,0 casos/10.000 habitantes. Conclusión: la distribución espacial de los casos de lepra fue heterogénea en los municipios y la tendencia de prevalencia decreciente.

Características clínico-epidemiológicas e tendência temporal de casos novos de hanseníase com grau 2 de incapacidade física, no estado do Maranhão, 2011-2020 / Clinical-epidemiological characteristics and temporal trend of new cases of grade 2 disability leprosy in the state of Maranhão, Brazil, 2011- 2020 / Características clínico-epidemiológicas y tendencia temporal de los nuevos casos de lepra grado 2 de discapacidad en el estado de Maranhão, Brasil, 2011-2020

Objetivo: descrever as características clínico-epidemiológicas dos casos novos de hanseníase com grau 2 de incapacidade física e analisar sua tendência no estado do Maranhão, Brasil, 2011-2020. Métodos: estudo transversal descritivo e ecológico de série temporal, com dados do Sistema de Informação de Agravos de Notificação; realizou-se análise descritiva do evento segundo características sociodemográficas e clínico-laboratoriais dos casos; a tendência temporal da incidência do evento foi analisada pela regressão de Prais-Winsten. Resultados: dos 2.147 casos notificados, 71,5% foram do sexo masculino, 48,9% possuíam até 8 anos de estudo, 66,5% eram de raça/cor da pele parda, 95,5% da forma multibacilar, 58,8% da forma dimorfa e 32,3% com baciloscopia negativa no diagnóstico; observou-se estacionaridade na tendência no estado, e tendência decrescente na regional de saúde de São Luís (variação anual = -64,4%; intervalo de confiança de 95% -73,7;-51,9). Conclusão: a tendência da incidência foi estável no estado do Maranhão e decrescente em São Luís.

Objective: to describe the clinical and epidemiological characteristics of new cases of grade 2 disability leprosy and to analyze its trend in the state of Maranhão, from 2011 to 2020. Methods: this was a descriptive cross-sectional and ecological time-series study, using data from the Notifiable Health Conditions Information System. A descriptive analysis of the event was carried out according to the sociodemographic and clinical-laboratory characteristics of the cases. The temporal trend of event incidence was analyzed using Prais-Winsten regression. Results: of the 2,147 cases, 71.5% were male, 48.9% had up to 8 years of schooling, 66.5% were of mixed race/color, 95.5% had the multibacillary form, 58.8% were borderline, 32.3% had negative bacilloscopy at diagnosis. There was a stationary trend in the state and a falling trend in the São Luís Health Region (annual percentage change = -64.4%; 95% confidence interval: -73.7;-51.9). Conclusion: incidence trend was stable in the state of Maranhão and falling in São Luís.

Objetivo: describir las características clínicas y epidemiológicas de los nuevos casos de lepra con discapacidad física grado 2 y analizar su tendencia en el estado de Maranhão, de 2011 a 2020. Métodos: estudio transversal descriptivo y ecológico de serie temporal con datos del Sistema de Información de Agravamiento de Notificaciones. Se realizó un análisis descriptivo de características sociodemográficas y clínico-laboratoriales. La tendencia temporal de la incidencia de eventos se analizó mediante la regresión de Prais-Winsten. Resultados: de los 2.147 casos, 71,5% era masculino, 48,9% tenía hasta 8 años de escolaridad, 66,5% era de raza/piel parda, 95,5% de forma multibacilar, 58,8% dimorfa, 32,3% con baciloscopia negativa al diagnóstico. Hubo tendencia estacionaria en el estado y tendencia decreciente en la Región de Salud São Luís (variación anual = -64,4%; intervalo de confianza 95%: -73,7;-51,9). Conclusión: la tendencia de la incidencia se mantuvo estable en el estado de Maranhão y decreciente en São Luís.

Serum Levels of Ficolin-3 and Mannose-Binding Lectin in Patients with Leprosy and Their Family Contacts in a Hyperendemic Region in Northeastern Brazil.

The present study aimed at analyzing the serum levels of mannose-binding lectin (MBL) and ficolin-3 (FCN3) in leprosy patients and their healthy family contacts in a hyperendemic region in northeastern Brazil. A cross-sectional study was carried out with 90 patients who had been diagnosed with leprosy and 79 healthy family contacts. Serum levels of the MBL and FCN3 proteins were measured using the immunofluorometric assay (ELISA). Clinical information was determined from the patients' charts. It was observed that the leprosy patients were more likely to be male (OR = 2.17; p = 0.01) and younger than fifteen years of age (OR = 2.01; p = 0.03) when compared to the family contacts. Those under 15 years of age had higher levels of MBL (4455 ng/mL) than those over 15 years of age (2342 ng/mL; p = 0.018). Higher FCN3 levels were identified in patients with indeterminate leprosy (41.9 µg/mL) compared to those with the lepromatous form (34.3 µg/mL; p = 0.033) and in those with no physical disabilities (38.1 µg/mL) compared to those with some disability (p = 0.031). Higher FCN3 levels were also observed in the group of patients without leprosy reactions (37.4 µg/mL) compared to those with type 1 (33.7 µg/mL) and type 2 (36.1 µg/mL) reactions. The MBL levels were higher in children under 15 years of age than they were in adults. It was evidenced that higher FCN3 serum levels were associated with early and transient clinical forms and lower expression in severe forms of leprosy.

Leprosy in the context of the Family Health Strategy in an endemic scenario in Maranhão: prevalence and associated factors. / Hanseníase no contexto da Estratégia Saúde da Família em cenário endêmico do Maranhão: prevalência e fatores associados.

This study aimed to describe the prevalence of leprosy and verify the factors associated with multibacillary clinical types in a Family Health Strategy priority setting to control and monitor the disease in northeastern Brazil. This cross-sectional study used data from the Notifiable Diseases Information System related to leprosy cases notified in Imperatriz, Maranhão, between 2008 and 2017. The prevalence was determined yearly and for the period. Poisson regression models with a significance level of 5% were employed to associate the variables and the multibacillary clinical types. Most of the 2,476 leprosy cases analyzed referred to multibacillary clinical types. The prevalence ranged from 7.8 and 15.6/10,000 inhabitants, with high and very high endemicity levels. The variables male, age groups between 30 and 59 years and ≥60 years, schooling <8 years, level 2 physical disability, types 1 and 2 reactive episodes, and urban residence area showed significant associations (p≤0.05) with multibacillary clinical types. Such findings can serve as a basis for elaborating and implementing leprosy control and surveillance measures, gearing actions to the most vulnerable groups, and becoming more effective.

Este estudo objetivou descrever a prevalência da hanseníase e verificar os fatores associados às formas clínicas multibacilares em cenário da Estratégia Saúde da Família, prioritário para o controle e a vigilância da doença no nordeste brasileiro. Trata-se de estudo transversal, que utilizou dados do Sistema de Informação de Agravos de Notificação relativos aos casos de hanseníase notificados em Imperatriz, Maranhão, entre 2008 e 2017. Determinaram-se as prevalências a cada ano e para o período. Para associar as variáveis e as formas clínicas multibacilares, utilizaram-se modelos de regressão de Poisson, com nível de significância de 5%. Dos 2.476 casos de hanseníase analisados, a maioria referiu-se às formas clínicas multibacilares. A prevalência variou entre 15,6 e 7,8/10 mil habitantes, encontrando-se níveis alto e muito alto de endemicidade. As variáveis sexo masculino, faixas etárias entre 30 e 59 anos e ≥60 anos, escolaridade <8 anos, grau 2 de incapacidade física, episódio reacional tipos 1 e 2 e zona de residência urbana apresentaram associações significativas (p≤0,05) com as formas clínicas multibacilares. Tais achados podem servir de base para elaboração e implementação de medidas de controle e vigilância da hanseníase, direcionando as ações para os grupos mais vulneráveis e tornando-se mais efetivas.

Hanseníase no contexto da estratégia saúde da família em cenário endêmico do maranhão: prevalência e fatores associados / Leprosy in the context of the family health strategy in an endemic scenario in maranhão: prevalence and associated factors

Resumo Este estudo objetivou descrever a prevalência da hanseníase e verificar os fatores associados às formas clínicas multibacilares em cenário da Estratégia Saúde da Família, prioritário para o controle e a vigilância da doença no nordeste brasileiro. Trata-se de estudo transversal, que utilizou dados do Sistema de Informação de Agravos de Notificação relativos aos casos de hanseníase notificados em Imperatriz, Maranhão, entre 2008 e 2017. Determinaram-se as prevalências a cada ano e para o período. Para associar as variáveis e as formas clínicas multibacilares, utilizaram-se modelos de regressão de Poisson, com nível de significância de 5%. Dos 2.476 casos de hanseníase analisados, a maioria referiu-se às formas clínicas multibacilares. A prevalência variou entre 15,6 e 7,8/10 mil habitantes, encontrando-se níveis alto e muito alto de endemicidade. As variáveis sexo masculino, faixas etárias entre 30 e 59 anos e ≥60 anos, escolaridade <8 anos, grau 2 de incapacidade física, episódio reacional tipos 1 e 2 e zona de residência urbana apresentaram associações significativas (p≤0,05) com as formas clínicas multibacilares. Tais achados podem servir de base para elaboração e implementação de medidas de controle e vigilância da hanseníase, direcionando as ações para os grupos mais vulneráveis e tornando-se mais efetivas.

Abstract This study aimed to describe the prevalence of leprosy and verify the factors associated with multibacillary clinical types in a Family Health Strategy priority setting to control and monitor the disease in northeastern Brazil. This cross-sectional study used data from the Notifiable Diseases Information System related to leprosy cases notified in Imperatriz, Maranhão, between 2008 and 2017. The prevalence was determined yearly and for the period. Poisson regression models with a significance level of 5% were employed to associate the variables and the multibacillary clinical types. Most of the 2,476 leprosy cases analyzed referred to multibacillary clinical types. The prevalence ranged from 7.8 and 15.6/10,000 inhabitants, with high and very high endemicity levels. The variables male, age groups between 30 and 59 years and ≥60 years, schooling <8 years, level 2 physical disability, types 1 and 2 reactive episodes, and urban residence area showed significant associations (p≤0.05) with multibacillary clinical types. Such findings can serve as a basis for elaborating and implementing leprosy control and surveillance measures, gearing actions to the most vulnerable groups, and becoming more effective.

Leprosy in children under 15 years of age in a municipality in northeastern Brazil: evolutionary aspects from 2003 to 2015.

INTRODUCTION: The Integrated Program of Leprosy Control was initiated in 2003 in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy. Here, we present the evolution of the indicators of leprosy within the established period in children aged <15 years. METHODS: This is a descriptive study based on an active search for cases and spontaneous healthcare demand for leprosy, with an evolutionary analysis of the detection coefficient of new cases. We considered individuals aged <15 years diagnosed with leprosy from January 2003 to December 2015. To evaluate the factors associated with clinical and operational forms, Chi-square, Fisher's exact, or Fisher-Freeman-Halton tests were performed. RESULTS: A total of 61 new cases were detected (6.9% of the total leprosy cases diagnosed in the municipality during the study period), and the majority was found in males (62.3%). The most frequent operational classification was paucibacillary (67.2%), and this association increased with age. The tuberculoid clinical form was the most prevalent in both sexes and in the age range of 10 to <15 years. There was a reduction in the detection coefficient from 21.84/100,000 inhabitants in 2003 to 2.79/100,000 in 2015. CONCLUSIONS: Despite the progress in the control of leprosy, this historical series shows that it is necessary to strengthen educational measures and implement control actions, so that the disease ceases to be a public health problem in the population aged <15 years.

Leprosy in children under 15 years of age in a municipality in northeastern Brazil: evolutionary aspects from 2003 to 2015

Abstract INTRODUCTION The Integrated Program of Leprosy Control was initiated in 2003 in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy. Here, we present the evolution of the indicators of leprosy within the established period in children aged <15 years. METHODS: This is a descriptive study based on an active search for cases and spontaneous healthcare demand for leprosy, with an evolutionary analysis of the detection coefficient of new cases. We considered individuals aged <15 years diagnosed with leprosy from January 2003 to December 2015. To evaluate the factors associated with clinical and operational forms, Chi-square, Fisher's exact, or Fisher-Freeman-Halton tests were performed. RESULTS A total of 61 new cases were detected (6.9% of the total leprosy cases diagnosed in the municipality during the study period), and the majority was found in males (62.3%). The most frequent operational classification was paucibacillary (67.2%), and this association increased with age. The tuberculoid clinical form was the most prevalent in both sexes and in the age range of 10 to <15 years. There was a reduction in the detection coefficient from 21.84/100,000 inhabitants in 2003 to 2.79/100,000 in 2015. CONCLUSIONS Despite the progress in the control of leprosy, this historical series shows that it is necessary to strengthen educational measures and implement control actions, so that the disease ceases to be a public health problem in the population aged <15 years.

Perfil epidemiológico dos contatos intradomiciliares de casos de hanseníase em capital hiperendêmica no Brasil / Epidemiological profile of in-house contacts of leprosy cases in a brazilian hypertendemic capital / Perfil pidemiológico de los contactos em casa de casos de leprosa em uma capital hipertendémica brasileña

Objetivo: Avaliar a situação dos contatos intradomiciliares dos casos de hanseníase notificados no ano de 2012 em São Luís/Maranhão. Métodos: Estudo quantitativo-descritivo-transversal, com coleta de dados utilizando-se instrumento estruturado. Resultados: A maioria dos contatos intradomiciliares eram mulheres (51,87%), idade entre 0 e 20 anos (40,29%), parentesco consanguíneo de 1º grau (54,92%), forma dimorfa (59,78%) e multibacilares (75,53%). Do total, 1880 (67,96%) não realizaram o exame dermatoneurológico. Entre os examinados, houve maior frequência no distrito Bequimão (28,48%), no qual 59,82% eram mulheres, idade entre 0 a 20 anos (44,77%). Ao exame, 91,27% apresentou-se normal. Dentre os suspeitos, 36,73% tinham hanseníase, 58,21% possuíam cicatriz da 1ª dose da BCG e 59,98% foram encaminhados a vacinação. A prevalência da doença entre os contatos foi de 1,62%. As ações da vigilância de contatos classificaram-se como precárias em São Luís. Conclusão: A maioria dos contatos registrados não foi examinada, evidenciando necessidade de fortificação das ações da vigilância no município

Objective: To evaluate the situation of in-house contacts of the cases of leprosy reported in 2012 in São Luis, Maranhão. Methods: Quantitative cross-sectional descriptive study, with data collection using a structured instrument. Results: The majority of in-house contacts were women (51.87%), from 0 to 20 years of age (40.29%), first-degree kinship (54.92%), dimorphic shape (59.78) and multibacillary (75.53%). In total, 1880 (67.96%) did not take the dermato-neurological exam. Among those tested, there was a greater frequency in the Bequimão district (2.48%), 59.82% were women, from 0 to 20 years of age (44.77%). On the exam, 91.27% were normal. Among those suspected of carrying the disease, 36.73% had leprosy, 58.21% had scars from the first dose of BCG and 59.98% were sent to receive vaccination. The prevalence of the disease among the contacts was 1.62%. The actions of contact monitoring were classified as precarious in São Luis. Conclusion: The majority of registered contacts were not examined, highlighting the need for strengthening of monitoring efforts in the city

Objetivo: Evaluar la situación de los contactos intradomiciliares de los casos de hanseniasis notificados en el año 2012 en São Luis - MA. Métodos: Estudio cuantitativo-descriptivo-transversal, con recolección de datos utilizando instrumento estructurado. Resultados: La mayoría de los contactos intradomiciliares eran mujeres (51,87%), edad entre 0 y 20 años (40,29%), parentesco consanguíneo de primer grado (54,92%), forma dimorfa (59,78%), multibacilares (75,53%). Del total, 1880 (67,96%) no realizaron el examen dermatoneurológico. Entre los examinados, hubo mayor frecuencia en el distrito de Bequimão (28,48%), el 59,82% eran mujeres, entre 0 a 20 años (44,77%). En el examen, el 91,27% se presentó normal. Entre los sospechosos, el 36,73% tenían hanseniasis, el 58,21% tenía cicatriz de la 1ª dosis de BCG y el 59,98% fueron encaminados a la vacunación. La prevalencia de la enfermedad entre los contactos fue del 1,62%. Las acciones de la vigilancia de contactos se clasificaron como precarias en San Luis. Conclusión: La mayoría de los contactos registrados no fueron examinados, evidenciando necesidad de fortificación de las acciones de la vigilancia en el municipio

Factors associated with leprosy in a municipality of the Pre-Amazon region, state of Maranhão, Brazil.

INTRODUCTION: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. METHODS: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. RESULTS: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. CONCLUSIONS: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

Factors associated with leprosy in a municipality of the Pre-Amazon region, state of Maranhão, Brazil

Abstract INTRODUCTION: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. METHODS: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. RESULTS: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. CONCLUSIONS: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

Programa de controle da hanseníase em capital hiperendêmica: uma avaliação operacional / Programa de control de la lepra en una capital hiperendémica: una evaluación operacional / Leprosy control program in a hyperendemic capital: an operational assessment

Objetivo avaliar o Programa de Controle da Hanseníase em capital hiperendêmica no Brasil. Método pesquisa de avaliação, realizada em todas as instituições de saúde que operacionalizavam o programa de controle da hanseníase no município de São Luís, Maranhão, Brasil, abrangendo todos os casos novos e contatos de casos de hanseníase notificados no ano de 2012. Resultados o programa foi classificado como "Bom" quanto às taxas de abandono (3,4%) e quanto ao grau de incapacidade física no diagnóstico (94,6%). Os indicadores proporção de alta por cura (42,5%) e proporção de contatos examinados (29,1%) foram classificados como "Precários". O indicador proporção de casos curados no ano com grau de incapacidade física avaliado na alta foi classificado como "Regular" (82,5%). Conclusão o Programa de Controle da Hanseníase no município não vem atuando de maneira efetiva e resolutiva, sugerindo uma deficiência na qualidade do acompanhamento dos casos até a completude do tratamento.

Objetivo evaluar el Programa de Control de la Lepra en una capital hiperendémica en Brasil. Método estudio de evaluación, realizada en todas las instituciones de salud que operaban el programa de control de la lepra en el municipio de São Luís, Maranhão, Brasil, abarcando todos los nuevos casos y los contactos de casos de lepra notificados durante el año de 2012. Resultados el programa fue clasificado como "Bueno" con relación a las tasas de abandono (3,4%) y al grado de incapacidad física en el diagnóstico (94,6%). Los indicadores proporción de alta por cura (42,5%) y proporción de contactos examinados (29,1%), fueron clasificados como "Precarios". El indicador proporción de casos curados en ese año con grado de incapacidad física evaluado en el alta, fue clasificado como "Regular" (82,5%). Conclusión el Programa de Control de la Lepra en el municipio, no viene actuando de manera efectiva y resuelta, sugiriendo una deficiencia en la calidad del acompañamiento de los casos hasta la conclusión del tratamiento.

Objective assess the Leprosy Control Program in a hyperendemic capital in Brazil. Method assessment study, developed in all health institutions that operated in the Leprosy control program in the city of São Luís, Maranhão, Brazil, covering all new and contact cases of leprosy notified in 2012. Results the program was classified as "Good" when considering the abandonment rates (3.4%) and the degree of physical disability in the diagnosis (94.6%). The indicators proportion of discharge due to cure (42.5%) and proportion of examined contacts (29.1%) were ranked as "Precarious". The indicator proportion of cured cases per year with assessment of degree of physical disability upon discharge was classified as "Regular" (82.5%). Conclusion The Leprosy Control Program in the city has not been working in an effective and problem-solving manner, suggesting that the quality of the case monitoring until the completion of treatment is deficient.