Epidemiologia da hanseníase e a descentralização das ações de controle no brasil / La epidemiología de la lepra y la descentralización de las acciones de control en brasil / Leprosy epidemiology and the decentralization of control actions in brazil

Objetivo analisar a situação epidemiológica da hanseníase no Brasil e sua associação com a descentralização das ações de controle. Método estudo ecológico misto com dados secundários do Sistema de Informação de Agravos de Notificação dos municípios brasileiros. Utilizou-se modelo de regressão binomial negativo entre 2001 e 2015. Resultados a análise das variações geográficas e temporais mostrou comportamentos heterogêneos dos três indicadores epidemiológicos de hanseníase. O aumento significativo desses foi associado à proporção de casos diagnosticados na Atenção Primária à Saúde (p<0,001; p=0,003; p=0,015); já a proporção da cobertura populacional estimada por Estratégia Saúde da Família foi associada somente à redução significativa do indicador taxa de detecção entre menores de quinze anos (p=0,017). Conclusão a interpretação simultânea dos principais indicadores epidemiológicos da hanseníase no Brasil reforçou a gravidade da situação e evidenciou que a satisfatória disponibilidade da ESF é insuficiente para o controle da doença.

Objetivo analizar la situación epidemiológica de la lepra en Brasil y su asociación con la descentralización de las acciones de control. Método estudio ecológico misto con datos secundarios del Sistema de Información de Agravamientos de Notificación de los municipios brasileños. Se utilizó un modelo de regresión binomial negativa entre 2001 y 2015. Resultados el análisis de las variaciones geográficas y temporales mostró un comportamiento heterogéneo de los tres indicadores epidemiológicos de la lepra. El aumento significativo se asoció a la proporción de casos diagnosticados en Atención Primaria de Salud (p<0,001, p=0,003, p=0,015), mientras que la proporción de cobertura poblacional estimada por la Estrategia de Salud Familiar (ESF) se asoció únicamente a la reducción significativa de la tasa de detección del indicador entre los menores de quince años (p=0,017). Conclusión la interpretación simultánea de los principales indicadores epidemiológicos de la lepra en Brasil reforzó la gravedad de la situación y evidenció que la satisfactoria disponibilidad del ESF es insuficiente para el control de la enfermedad.

Objective to analyze the epidemiological situation of leprosy in Brazil and its association with the decentralization of control actions. Method mixed ecological study with secondary data from the Sistema de Informação de Agravos de Notificação (Brazilian Information System on Notifiable Diseases) of Brazilian municipalities. A negative binomial regression model was used between 2001 and 2015. Results The analysis of geographic and temporal variations showed heterogeneous behavior of the three epidemiological indicators of leprosy. The significant increase in these was associated with the proportion of cases diagnosed in Primary Health Care (p<0.001; p=0.003; p=0.015); whereas the proportion of population coverage estimated by the Family Health Strategy (FHS) was associated only with the significant reduction in the indicator detection rate among children under fifteen (p=0.017). Conclusion the simultaneous interpretation of the main epidemiological indicators of leprosy in Brazil reinforced the gravity of the situation and evidenced that the satisfactory availability of the FHS is insufficient for the control of the disease.

Prophylaxis and treatment of diseases in western São Paulo state: the Sanitation Service and trachoma in the early twentieth century. / A profilaxia e o tratamento das enfermidades do oeste paulista: o Serviço Sanitário e o tracoma no princípio do século XX.

In 1906, Emílio Ribas reorganized the Sanitation Service and centralized São Paulo state public health services in the state capital. A campaign to combat trachoma, an ophthalmic disease, was implemented as part of this project. This article analyzes this campaign, which provided care for the sick living on rural properties in a process that predated the 1917 Rural Sanitary Code. The empirical data was obtained from government reports, decrees, medical journals and newspapers. We conclude that Ribas, by creating an organization that integrated the efforts of the sanitary districts and the Trachoma Commission medical teams, sought to form a complex apparatus to combat the diseases present in both urban areas and the countryside.

Em 1906, Emílio Ribas reorganizou o Serviço Sanitário e centralizou na capital os serviços de saúde pública do estado de São Paulo. Nesse projeto, a campanha de combate ao tracoma, uma enfermidade oftálmica, foi implantada. Este artigo analisa essa campanha que atendeu os enfermos das propriedades rurais em um processo que antecedeu ao Código Sanitário Rural de 1917. O material empírico foi composto por relatórios governamentais, decretos, periódicos médicos e jornais. Concluímos que Ribas, ao criar uma estrutura que unificou os esforços dos distritos sanitários com as equipes de atendimento das Comissões do Tracoma, buscou formar um complexo aparato para combater as enfermidades presentes tanto nas áreas urbanas quanto na zona rural.

A profilaxia e o tratamento das enfermidades do oeste paulista: o Serviço Sanitário e o tracoma no princípio do século XX / Prophylaxis and treatment of diseases in western São Paulo state: the Sanitation Service and trachoma in the early twentieth century

Resumo Em 1906, Emílio Ribas reorganizou o Serviço Sanitário e centralizou na capital os serviços de saúde pública do estado de São Paulo. Nesse projeto, a campanha de combate ao tracoma, uma enfermidade oftálmica, foi implantada. Este artigo analisa essa campanha que atendeu os enfermos das propriedades rurais em um processo que antecedeu ao Código Sanitário Rural de 1917. O material empírico foi composto por relatórios governamentais, decretos, periódicos médicos e jornais. Concluímos que Ribas, ao criar uma estrutura que unificou os esforços dos distritos sanitários com as equipes de atendimento das Comissões do Tracoma, buscou formar um complexo aparato para combater as enfermidades presentes tanto nas áreas urbanas quanto na zona rural.

Abstract In 1906, Emílio Ribas reorganized the Sanitation Service and centralized São Paulo state public health services in the state capital. A campaign to combat trachoma, an ophthalmic disease, was implemented as part of this project. This article analyzes this campaign, which provided care for the sick living on rural properties in a process that predated the 1917 Rural Sanitary Code. The empirical data was obtained from government reports, decrees, medical journals and newspapers. We conclude that Ribas, by creating an organization that integrated the efforts of the sanitary districts and the Trachoma Commission medical teams, sought to form a complex apparatus to combat the diseases present in both urban areas and the countryside.

Impact of common skin diseases on children in rural Côte d'Ivoire with leprosy and Buruli ulcer co-endemicity: A mixed methods study.

BACKGROUND: Skin-related neglected tropical diseases (skin NTDs) occur against a background of a very high prevalence of common skin diseases in sub-Saharan Africa. In this study, we examined the knowledge, attitude and practices (KAP) and the impact of common skin diseases in children living in a leprosy and Buruli ulcer (BU) co-endemic district in a west African country of Côte d'Ivoire, in order to help inform disease control efforts for skin NTDs. METHODS AND PRINCIPLE FINDINGS: Fourteen focus group discussions (FGDs) with schoolchildren, 5 FGDs with parents of a child affected with skin disease(s), and 27 in-depth semi-structured interviews with key personnel were conducted. The Children's Dermatology Quality of Life Index (CDLQI) questionnaire was applied to 184 schoolchildren with skin diseases. We found that there was ignorance or neglect towards skin diseases in general, due to their high prevalence and also the perceived minimal impact on children's daily lives. While the median score for the CDLQI questionnaire was 5 (IQR 2-9) out of 30, a range of scores was observed. Symptoms such as pruritus and experiencing bullying by classmates contributed to reduction in their quality of life. Poor hygiene was considered as a major cause of skin diseases. CONCLUSIONS/SIGNIFICANCE: Despite their high impact on affected populations, we observed a high level of ignorance and neglect toward common skin diseases. There is a critical need to increase awareness of skin diseases, or skin health promotion, which supports changing of the health-seeking behaviour for skin conditions. This will aid in early detection and treatment of the skin NTDs, in addition to providing benefits for those affected by other skin diseases. Educational opportunities should be utilized to their utmost. One would be associated with water, sanitation, and hygiene (WASH) strategies, but careful messages need to be developed and delivered.

The National Tuberculosis Control Programme of Liberia Laboratory Programme Performance.

Background: Tuberculosis (TB) is a major public health problem in Liberia. Little is known about the TB laboratory performance of Liberia and the challenges after the 14 years of civil war which ended in 2003. The purpose of the study was to evaluate the TB laboratory performance of Liberia. Methods: A cross-sectional study was conducted from 2014 to 2015. The study was conducted using quantitative data of TB case findings, sputum microscopy proficiency testing, and on-site assessment of sputum microscopy laboratories in Liberia. 80 laboratories participated in the proficiency testing. Besides, four years' (2012-2015) TB case finding data obtained from the National Leprosy and Tuberculosis Control Programme (NLTCP) were used to complement the study. The data were analysed using descriptive statistics. Results: From the 80 TB sputum microscopy testing laboratories participating in proficiency testing, only 20 (25%) scored acceptable performance. 46 (58%) TB microscopy laboratories reported quantification errors for the proficiency panel slide 6 which was 3+. The national TB smear-positive cases notified were 4342 in 2012 but decreased to 3820 and 2448 in 2013 and 2014, respectively. The TB smear case detection rate showed an increase from 68% in 2010 to 78% in 2011 and a decrease to 60%, 57%, and 42% in 2012, 2013, and 2014, respectively. Conclusion: Between 2010 and 2013, the NLTCP succeeded in increasing the number of TB sputum microscopy laboratories. At most of the TB microscopy sites, the TB laboratory quality system was not implemented. The NLTCP of Liberia should develop strategies to overcome its challenges in TB laboratory testing.

Inventory of the epidemiological situation of leprosy in Haiti (2013-2017) for the Five-Year Plan: A first stage toward the implementation of the international strategy to combat leprosy, 2016-2020.

Leprosy is endemic in Haiti and remains a disease misunderstood by the population. In 2018, the national program to fight tuberculosis and leprosy (PNLTL) produced its first strategic plan against leprosy to implement the international strategy of the World Health Organization (WHO). The objective of this study was to describe the epidemiological situation of leprosy in Haiti, to assess its prevalence and morbidity, and to guide the strategies of the national plan. A retrospective study of all cases of leprosy diagnosed in the three centers providing care for this disease in Haiti reviewed the new cases at these centers from January 2013 through December 2017. In all, 232 new patients were recorded, or 49 new cases a year. Multibacillary leprosy was predominant: 86%, compared with the international mean of 60 %. Children accounted for 14 % of the new cases (7.5 % internationally), a finding that is evidence of active community transmission. Of the new cases in 2017, 8 %, including one child, had grade 2 impairments. Nearly all the leprosy cases - 94 % (218/232) - came from the two districts with treatment centers (West and Artibonite). Efforts must continue to implement the international strategy to fight leprosy to ensure a reduction by 2020 in the rate of grade 2 impairments among new cases and the number of new cases among children.

Factors associated with the delay of diagnosis of leprosy in north-eastern Colombia: a quantitative analysis.

OBJECTIVES: To determine the average time in months between the beginning of symptoms and the diagnostic confirmation of leprosy by the health system and to investigate factors associated with diagnostic delay. METHODS: A total of 249 patients older than 15 years diagnosed with leprosy between 2011 and 2015, in 20 endemic municipalities of north-eastern Colombia, provided informed consent and were interviewed face-to-face. Clinical histories from health centres or hospitals where study participants were treated for leprosy were also reviewed. RESULTS: The mean delay in diagnosis of leprosy was 33.5 months. About 14.9% of patients showed a visible deformity or damage (disability grade 2, DG2) at the time of diagnosis. In multivariable regression analysis, five or more consultancies required to confirm the diagnosis and not seeking care immediately after noticing first symptoms were associated with longer diagnostic delay. CONCLUSIONS: Our study found a significant delay in diagnosis of leprosy in north-eastern Colombia, which might explain the continuously high rate of DG2 among new cases being notified in the country. Both patient- and health system-related factors were associated with longer diagnostic delay. Interventions to increase awareness of disease among the general population and timely referral to a specialised health professional are urgently needed in our study setting.

Who Neglects Neglected Tropical Diseases? - Korean Perspective.

Neglected tropical diseases (NTDs) are a group of tropical infectious diseases of poorest people. Of 17 NTDs managed by WHO, two, guinea worm disease (by 2015) and yaws (by 2020) are targeted for eradication, and four (blinding trachoma, human African trypanosomiasis, leprosy, and lymphatic filariasis) for elimination by 2020. The goals look promising but 11 others are still highly prevalent. Soil-transmitted helminths (STHs) are one NTD which prevail over the world including temperate zones. They had been highly prevalent in Korea but are mostly disappearing at present through systematic and sustainable control activity. The successful experience of STH control enables Korean experts to develop many programs of NTD control in developing countries. Several programs of both official development aid and non-governmental organizations are now targeting NTDs. Most NTDs are low in health priority compared to their health threats because they are chronic, insidious, and of low mortality. No one, including the victims, raised priority of NTD control with a loud voice in the endemic field of the diseases. After the millennium development goals declared disease control over the world, NTDs are becoming less neglected globally. Even with limited resources, beginning a sustainable national program is the key for the control and elimination of NTDs. No more neglect, especially no more self-neglect, can eliminate diseases and upgrade quality of life of the neglected people.

Leprosy: a glossary.

Leprosy continues to afflict residents from a number of countries in Africa, South America, and southeast Asia, despite the marked reduction in the number of cases of leprosy worldwide, after the introduction of the multidrug regimens as recommended by the World Health Organization (WHO-MDT). With the increasing immigration of individuals from risk areas to Europe and the United States, knowledge of the basic concepts of leprosy would be helpful to clinicians caring for immigrants in nonendemic areas. We present a comprehensive, updated, and critical glossary of the most relevant terms related to leprosy.

Leprosy: a glossary

Leprosy continues to afflict residents from a number of countries in Africa, South America, and southeast Asia, despite the marked reduction in the number of cases of leprosy wordwide, after the introduction of the multidrug regimens as recommended by the World Health Organization (WHO-MDT). With the increasing immigration of individuals from risk areas to Europe and the United States, knowledge of the basic concepts of leprosy would be helpful to clinicians caring for immigrants in nonendemic areas. We present a comprehensive, updated, and critical glossary of the most relevant terms related of leprosy.

Public-private mix in tuberculosis control: an assessment of level of implementation in Jos, Plateau State.

AIMS AND OBJECTIVES: After the initial gains in Tuberculosis case detection and cure rates, progress became stunted by persisting constraints and challenges in the implementation of the Directly Observed Treatment Short course strategy. This prompted the Stop Tuberculosis partners in 2006 to adopt innovative approaches including the Public-Private Mix, to improve access to and quality of care. This paper assesses the level of Public-Private Mix in Tuberculosis control in Jos, Plateau State. MATERIALS AND METHODS: This was a facility-based, cross sectional study where data from all consenting private health care facilities owned by medically trained personnel and private medical practitioners in Jos North and Jos South Local Government Areas was collected using structured questionnaires. RESULTS: Eight (47.1%) of all 17 facilities assessed gave anti Tuberculosis drugs on clinical suspicion of Tuberculosis, 5(29.4%) required Acid Fast Bacillus result and 3(17.6%) referred elsewhere for the Tuberculosis management. Only 6 facilities (35.3%) were microscopy, treatment centres, or both. Ten (58.8%) of the facilities had the Directly Observed Treatment Short course guidelines, but these could be sighted in only 5 (29.4%), while six (35.3%) had Tuberculosis record and referral forms. In 13 (76.5%) of the facilities, no local government Tuberculosis and Leprosy supervisors had ever visited them. Only 30 (57.7%) medical practitioners had access to the Directly Observed Treatment Short course. Thirty two (61.5%) respondents treated Tuberculosis according to the Directly Observed Treatment Short course strategy, but 19 (36.5%) still used the conventional method. Only 22(42.3%) practitioners had ever received any training on the Directly Observed Treatment Short course strategy. CONCLUSION: The level of Public-Private Mix in Tuberculosis control in Jos is low.

[International cooperation with the neglected tropical disease Buruli ulcer in Togo].

The objectives of this paper are to grasp the current status of an endemic disease, known as Buruli ulcer (BU), in the Republic of Togo and the expansion of international assistance in the field. By adopting the explicit support model, this paper also compares the obtained research results with those of the Republic of Ghana and Benin, to clarify the primary functions played among respective governments, WHO, and NGO. Under the auspices of the WHO Global Buruli Ulcer Initiative (GBUI, 1998-), National Buruli Ulcer Control Programme (NBUCP) in the Togo was initiated in 1999. However, due to the shortage of national budget and politico-economic instabilities of the nation, the actual implementation of NBUCP proved to be problematic. It was after 2007 that the programme began to move forward with the interventions of NGOs like DAHW and Handicap International. Currently, major players involved in the implementation of the policies provided by the GBUI are WHO, NGOs and the targeted governments. In other words, the organizations involved in BU treatment work together by fulfilling their functions. Unlike the neighboring countries, the Togolese government encountered much difficulty in materializing its national programme. Largely due to the political instability and the severe shortage of national budget, stronger assistances from NGOs were required at various levels of the national health measures from formulating to implementing the programme. As the programmes in Togo and Ghana/Benin expanded over the years, the respective support model revealed to be unique and different. In Ghana and Benin, intimate cooperation among WHO, government and NGOs has been established. In Togo, strengthening of collaboration among the three players is expected.

The production of social discourse on Hansen' disease and health education materials in Brazil: a skin patch as something harmless or a serious disease?

AIMS: Hansen's disease is endemic in Brazil and government control programmes promote publicity campaigns to increase the detection of new cases through the production and distribution of educative material. OBJECTIVES: This study analyses a set of 276 educational materials produced by governmental and non-governmental organisations that work to control Hansen's disease in Brazil. It describes the content of the materials and the way the issues were approached. DESIGN: It is a qualitative study that adopts the theoretical and methodological framework of the semiology of social discourse. RESULTS: Analysis reveals that the relations between the enunciator and recipient of the materials are asymmetrical as a result of the technical and educational language employed. Biomedical information forms the basis for social representations an practices of Hansen's disease, as opposed to historical collective knowledge of 'leprosy'. The prioritised topics are: signs and symptoms of the disease, treatment stigma, cure and surveillance. CONCLUSIONS: The institutionalisation of public education on Hansen's disease in Brazil was not limited simply to the change of terminology from 'leprosy' to 'Hansen's disease,' but was shaped also by new educational practices. It is recommended that the evaluation and production of new materials be incorporated into the set of activities already carried out in health centres so as to expand the discussion on content, language and the best way to address the disease in the materials.

Clusters of leprosy transmission and of late diagnosis in a highly endemic area in Brazil: focus on different spatial analysis approaches.

OBJECTIVE: The Brazilian National Hansen's Disease Control Program recently identified clusters with high disease transmission. Herein, we present different spatial analytical approaches to define highly vulnerable areas in one of these clusters. METHOD: The study area included 373 municipalities in the four Brazilian states Maranhão, Pará, Tocantins and Piauí. Spatial analysis was based on municipalities as the observation unit, considering the following disease indicators: (i) rate of new cases/100,000 population, (ii) rate of cases <15 years/100,000 population, (iii) new cases with grade-2 disability/100,000 population and (iv) proportion of new cases with grade-2 disabilities. We performed descriptive spatial analysis, local empirical Bayesian analysis and spatial scan statistic. RESULTS: A total of 254 (68.0%) municipalities were classified as hyperendemic (mean annual detection rates >40 cases/100,000 inhabitants). There was a concentration of municipalities with higher detection rates in Pará and in the center of Maranhão. Spatial scan statistic identified 23 likely clusters of new leprosy case detection rates, most of them localized in these two states. These clusters included only 32% of the total population, but 55.4% of new leprosy cases. We also identified 16 significant clusters for the detection rate <15 years and 11 likely clusters of new cases with grade-2. Several clusters of new cases with grade-2/population overlap with those of new cases detection and detection of children <15 years of age. The proportion of new cases with grade-2 did not reveal any significant clusters. CONCLUSIONS: Several municipality clusters for high leprosy transmission and late diagnosis were identified in an endemic area using different statistical approaches. Spatial scan statistic is adequate to validate and confirm high-risk leprosy areas for transmission and late diagnosis, identified using descriptive spatial analysis and using local empirical Bayesian method. National and State leprosy control programs urgently need to intensify control actions in these highly vulnerable municipalities.

Trends in new leprosy case detection over 57 years (1952-2008) in Yuxi, Yunnan Province of Southwest China.

BACKGROUND: Leprosy control and management in China was maintained via a vertical system. Despite substantial achievements in leprosy control in the past decades, leprosy has not been completely eliminated in several endemic areas of Yunnan Province, China. OBJECTIVES: To report the epidemiological trends and management of leprosy in Yuxi, Yunnan Province from 1952 to 2008. DESIGN: Diagnosis, control, and treatment data for 2223 leprosy cases detected from 1952 to 2008 were analysed. RESULTS: Two large-scale house-to-house surveys were launched in 1957-1958 and 1964-1965, and a remarkable number of new cases were identified during these two surveys. The overall prevalence rate of leprosy in the Yuxi region presented a roughly unimodal distribution between 1952 and 2008, with a peak (9.27 per 10000 population) in 1965. This reflects a combination of case detection and duration of treatment. Overall, the age distribution of the patients changed dramatically over the years, and there were only two childhood cases between 1995 and 2008 (both occurring in 1998). Nearly half of the total cases (49.1%) were classified as multibacillary leprosy type. With the introduction and ubiquitous coverage of the WHO multi-drug therapy (MDT) in this area, leprosy elimination was achieved in 1992. In recent years, the majority of cases (> 80%) were detected by passive approaches, and there is an increasing tendency to find multibacillary leprosy patients. CONCLUSIONS: Our results provide an overall profile of our 57-year effort regarding the leprosy control in the Yuxi region. The trend in detection of new cases in recent years suggested that the transmission of leprosy has stopped in the area or, at least, dramatically declined.