Perfil clínico-epidemiológico de pacientes que abandonaram o tratamento de hanseníase / Clinical and epidemiological profile of patients who dropped out leprosy treatment

O controle da hanseníase depende de um tratamento com a dose completa em até 18 meses, o abandono implica na transmissão e em quadros de incapacidade física. OBJETIVO: O objetivo da pesquisa foi identificaro perfil clínico-epidemiológico dos pacientes que abandonaram o tratamento de hanseníase em Teresina-PI.MATERIAL E MÉTODOS: Trata-se de um estudo de natureza descritiva, transversal, com abordagem quantitativa. Os dados referentes a esses indivíduos nas coortes de 2011 a 2014 foram obtidos por meio do Sistema de Informações de Agravos de Notificação.RESULTADOS: Do total de 1770 casos de hanseníase notificados nesse período, 34 casos foram considerados abandono de tratamento. Verificou-se que 54,9%eram homens, 79,5% estavam na faixa etária de 15 a59 anos, 68% eram pardos e 59% tinham até 3 anos de escolaridade . A maioria dos casos de abandono era pacientes multibacilares (61,8%) e 32% apresentava aforma dimorfa. A maior parte dos diagnósticos deu-se por demanda espontânea (55,8%). No momento do diagnóstico, 29,4% dos pacientes possuía algum graude incapacidade física. Pacientes multibacilares tiveram uma média de 3,6 contatos, sendo que cerca da metade foram examinados. Com relação à suspensão da poliquimioterapia, observa-se que paucibacilares tomaram 1,84 doses, enquanto multibacilares, 6,94 doses. CONCLUSÃO: Os multibacilares apresentaram menor adesão ao tratamento, evidenciando maior risco de transmissão. Fazem-se necessárias campanhas de detecção da doença, para evitar sua evolução e as consequentes incapacidades físicas, e ainda reduzir possibilidade de transmissão entre contatos.

Leprosy control depends on a treatment based on full dose within 18 months, the dropping out of the treatment implies in transmission and development of disability. OBJECTIVE: The objective of the study was to identify the clinical and epidemiological profile of patients who dropped out the leprosy treatment in Teresina, PI. MATERIAL AND METHODS: It is a descriptive, transversal study with a quantitative approach. Data relating to individuals in the cohorts from 2011 to 2014 were obtained from the Notifiable Diseases Information System. RESULTS: From the total1770 leprosy cases reported in the period, 34 cases were considered treatment dropouts, 54.9% of them were men, 79.5% aged between 15 and 59 years, 68% were from brown and 59% had up to 3 years of schooling. Most of the abandonment cases were multibacillary patients (61.8%) and 32% had borderlineleprosy. The majority of the diagnosis was made byspontaneous demand (55.8%). At diagnosis, 29.4% ofpatients had some degree of disability. Multibacillary patients had an average of 3.6 contacts, and about half were examined. Regarding the suspension of multidrug therapy, it was observed that paucibacillary took 1.84 doses, while multibacillary, 6.94 doses. CONCLUSION: Multibacillary patients showed lower adherence to treatment, presenting higher risk of transmission. Campaigns for active search of new cases are necessary to prevent disease evolution and the resulting physical disabilities , while reducing the possibility of transmission between contacts.

Abandono do tratamento da tuberculose em pacientes HIV/ADIS atendidos no Instituto de Infectologia Emilio Ribas no ano de 2010 / Abandonment treatment of tuberculosis patients in HIV / ADIS seen at Emilio Ribas Institute of Infectious Diseases in 2010

INTRODUÇAO: Em 1993 a tuberculose foi considerada pela Organização Mundial da Saúde (OMS) como reemergência mundial devido ao aumento significativo do número de casos da doença, associada à epidemia de HIV e ao surgimento de resistência aos tuberculostáticos. OBJETIVO: Investigar a taxa de abandono do tratamento de tuberculose e fatores preditivos desse abandono. MATERIAIS E METODOS: Trata-se de um estudo observacional de corte transversal, de abordagem quantitativa com levantamento de dados secundários dos casos de tuberculose notificados pelo IIER que, tiveram encerramento pelo critério abandono no ano de 2010. Os dados foram coletados a partir do TBWEB e das fichas de notificação do Serviço de Epidemiologia da instituição. RESULTADOS: Dos 56 casos de abandono no tratamento, 10 (17,9%) são do sexo feminino e 46 (82,1%) do sexo masculino. A média de idade foi de 36,9 anos, sendo a idade mínima de 17 anos e a máxima de 64 anos. O segundo mês de tratamento foi o de maior índice de abandonos no grupo, sendo que 24 (42,9%) abandonaram o tratamento neste período, outros 12 (21,4%) no terceiro mês de tratamento. Uma parcela de 9 (16,1%) casos abandonaram o tratamento logo no primeiro mês. Ser um caso de Retratamento após abandono confere um RR de 1,43 (IC = 1,054 - 2,0311) e um p 0,05, o que demonstra significância estatística entre o abandono e o histórico de abandono anterior. Pacientes que faziam uso de álcool e drogas simultaneamente apresentou um RR 1,72 (IC = 1,2407 ­ 2,3873) com p valor de 0,02. As variáveis tipo sexo, diabetes, formas clinicas, Caso novo, retratamento após falência e recidiva não apresentaram significância estatística. CONCLUSAO: As estratégias para controle da doença necessitam considerar os fatores associados ao abandono relacionados com os hábitos, o conhecimento sobre sua doença e a motivação a complementar o tratamento. Logo buscando maior proximidade entre o serviço e o paciente

Iatrogenic stigma in outpatient treatment for Hansen's disease (leprosy) in Brazil.

This paper explores how iatrogenic stigma, or stigma that is produced through a patient's encounter with physicians or with biomedicine in general, might emerge in outpatient treatment for Hansen's disease, or leprosy. Based on in-depth interviews with people affected by Hansen's disease and observations conducted at several public health clinics in Rio de Janeiro, Brazil, this research identified several aspects of the biomedical encounter that generated or contributed to stigma, either felt or enacted. Also noted in the research were positive examples of techniques used by physicians and health care workers for minimizing or circumventing stigma. The paper touches upon several topics, such as culturally mediated responses to medication side effects and communication between health care workers and patients, that might be salient or useful for health educators and others who are attempting to reduce health-related stigma.

Efeitos adversos da poliquimioterapia em pacientes com hanseníase: um levantamento de cinco anos em um Centro de Saúde da Universidade Federal de Uberlândia / Adverse effects of multidrug therapy in leprosy patients: a five-year survey at a Health Center of the Federal University of Uberlandia

The introduction of multidrug therapy (WHO/MDT)-composed by the drugs dapsone, clofazimine and rifampicin has enabled the cure of Hansen's disease, however, the adverse effects of these drugs were not given priority by the health team. Aiming to determine MDT's adverse effects' magnitude and relate them to the non-adhesion of patients to the treatment, a study of 187 charts of patients treated with MDT from January of 1995 to May 2000, was carried out at a Health Center of the Federal University of Uberlandia. Side effects were recorded in 71 patients' charts. Among the 113 side effects found, 80 (70.7 per cent) were related to dapsone, 7 (6.2 per cent) were caused by rifampicin and 26 (20.5 per cent) were attributed to clofazimine. These effects induced 28 (14.9 per cent), patients to change the therapeutic scheme, representing 39.4 per cent from the 71 patients with adverse effects. Throughout this study, the importance is discussed of considering MDT's adverse effects when training the health team to heighten the patient's adhesion to the treatment and thereby collaborating to eliminate Hansen's disease as a public health problem.

Efeitos adversos da poliquimioterapia em pacientes com hanseníase: um levantamento de cinco anos em um Centro de Saúde da Universidade Federal de Uberlândia / Adverse effects of multidrug therapy in leprosy patients: a five-year survey at a Health Center of the Federal University of Uberlândia

A implementaçäo da poliquimioterapia (PQT/OMS) - composta pelas drogas dapsona, clofazimina e rifampicina - possibilitou a cura da hanseníase, porém näo foram priorizados o manejo dos efeitos adversos pelas equipes de saúde. Objetivando determinar a magnitude dos efeitos adversos da poliquimioterapia para hanseníase e relacioná-los como possível causa de näo adesividade do paciente ao tratamento, revisou-se prontuários de 187 pacientes tratados com PQT, de 1995 a 2000, no Centro de Saúde Escola (CSE) -UFU, com registro de efeitos colaterais em 71 pacientes (37,9 por cento). Dentre os 113 efeitos adversos, 80 (70,7 por cento) relacionaram-se à dapsona, 7 (6,2 por cento) à rifampicina, 26 (20,5 por cento) à clofazimina. Esses efeitos levaram à mudança de esquema terapêutico em 28 (14,9 por cento) dos 187 pacientes ou 39,4 por cento dos 71 com efeitos adversos. Discute-se a importância de considerar os efeitos adversos da PQT na capacitaçäo das equipes de saúde para maior adesäo do paciente ao tratamento, colaborando para eliminar a hanseníase como problema de saúde pública

[Adverse effects of multidrug therapy in leprosy patients: a five-year survey at a Health Center of the Federal University of Uberlândia]. / Efeitos adversos da poliquimioterapia em pacientes com hanseníase: um levantamento de cinco anos em um Centro de Saúde da Universidade Federal de Uberlândia.

The introduction of multidrug therapy (WHO/MDT)-composed by the drugs dapsone, clofazimine and rifampicin has enabled the cure of Hansen's disease, however, the adverse effects of these drugs were not given priority by the health team. Aiming to determine MDT's adverse effects' magnitude and relate them to the non-adhesion of patients to the treatment, a study of 187 charts of patients treated with MDT from January of 1995 to May 2000, was carried out at a Health Center of the Federal University of Uberlândia. Side effects were recorded in 71 patients' charts. Among the 113 side effects found, 80 (70.7%) were related to dapsone, 7 (6.2%) were caused by rifampicin and 26 (20.5%) were attributed to clofazimine. These effects induced 28 (14.9%), patients to change the therapeutic scheme, representing 39.4% from the 71 patients with adverse effects. Throughout this study, the importance is discussed of considering MDT's adverse effects when training the health team to heighten the patient's adhesion to the treatment and thereby collaborating to eliminate Hansen's disease as a public health problem.

Status of long absentees among multibacillary leprosy patients admitted to a controlled clinical study.

Of 210 multibacillary leprosy patients who were admitted to a trial of two drug regimens, fifty-seven were excluded from efficacy analysis at 120 months for various reasons. Thirty-three of these patients were identified as long absentees. Efforts were made to contact these patients through letters and home visits to assess their clinical and bacteriological status and to find out the reasons for default. Twenty-one patients were thus retrieved. Only one patient was found to be having active disease requiring treatment; the rest were clinically inactive and bacteriologically negative.

The pattern of 'drop-out' of smear-positive cases at an urban leprosy centre.

One hundred nineteen smear-positive leprosy cases registered at an urban leprosy centre in Bombay in 1991 were followed for three years to study the 'drop-out' pattern in them and judge the utility of some corrective measures for the same. The measures included having maps showing exact location of the patient's residence, paying home visits on registration days and subsequent persuasion and counselling both at the clinic and at the residence of patients. The results were compared with 'drop-out' in smear-positive cases registered at the same centre in 1989, 1990, 1992 and 1993. By introduction of the special measures, the 'drop-out' rate was significantly reduced from 52% (for other years) to 36% (1991). The expenses incurred for the successful recovery of 'drop-out prone' patients and ensuring regularity in drug intake was Rs. 659/- per patient. This study of 'drop-out' patient shows that there are three categories of the so-called drop-outs: (i) the false 'drop-outs' (51%): these patients get transfer as per their convenience to other leprosy centres or medical services (private practitioners or consultants) within the city (ii) drop-outs due to migration: the migration is forced on them due to some genuine reason, and (iii) persistent offenders: this is a group of adamant, non co-operative, or, distressed patients. For the first two category of patients it is advisable to introduce a good referral system. For the recalcitrant defaulters, supervised short-term drug therapy will probably be the best option.

Fatores que interferem no controle da hanseníase na rede básica de assistência à saúde / Factors involved in leprosy control in basic network of medical assistence

Foram avaliados os motivos de irregularidade dos pacientes no controle de Hanseníase no Centro de Saúde do bairro Tibery, onde já estava implantado o programa descentralizado de atendimento ao portador da doença. De um total de 115 pacientes registrados na unidade, foram detectados através das fichas de aprazamento e banco eletrônico, 45 por cento de faltosos no controle em 1987 (52 pacientes). Foram aplicados questionários em visitas domiciliares a 24 destes (46 por cento), sendo que, 28 pacientes (54 por cento) näo foram localizados devido à mudança de endereço ou recusa em responder o questionário. Analisou-se as formas clínicas apresentadas, a faixa etária, a situaçäo trabalhista, os exames dermato-neurológicos e baciloscópicos no último ano, o uso regular da medicaçäo, o conhecimento sobre a doença e as causas relatadas pelos pacientes de falta ao controle. Säo discutidas as falhas do programa de controle da hanseníase relacionando os fatores psicossociais e técnico-operacionais que interferem na integraçäo do programa como atividade de rotina nos Centros de Saúde

Psychosocial dimensions of drug default in leprosy.

The study focuses on the causes and factors related to drug default among leprosy patients. 52 cases were selected using systematic random sampling technique on the basis of clinic records showing drug default. Awareness about the disease, motivation to be cured, age, caste, education, income, knowledge of the significant others in the family regarding the patient's condition were taken as variables. Statistical analysis of association and relation reveal that motivation to be cured is very significantly different for high and low groups of awareness about the disease. In addition, high and low levels of motivation differed significantly when treated individually with other variables as age, education and rural/urban background. These results demonstrate that improved health education, rendered by the medical team can yield far better results in eliminating the problem of drug default.

Dropouts during treatment for leprosy (a study in the ELEP leprosy control project, Dharmapuri district, Tamilnadu during 1975-77).

Certain Social and Related Factors responsible for 231 dropout leprosy patients from treatment are discussed. Dropout rate was lowest among lepromatous patients (1.2% Vs 10.9% among nonlepromatous patients); patients with stigma/deformity were significantly less (P less than .001); among dropouts; proportion of wage-earners was high in them (p less than .001); student dropouts were few (Z-2.78, P less than .05, X2 - 10.32, d.f.-1, P less than .005); there was little association between socioeconomic status and dropout rate (P greater than .5); dropouts amongst patients who self-registered for treatment were much less than in those who were enlisted for treatment during survey (P less than .05); 38% had dropped out within the first six months of registration for treatment; lepromatous patients attended clinics for more than 25 months before becoming dropouts; fear of loss of wages, belief that it was not leprosy, social stigma attached to the disease, disinterest for treatment when lesions were small and few, dissatisfaction with treatment, and belief that patches self-healed were the main causes for discontinuance of treatment; all those who dropped out due to shyness were women of 15-44 age-group.

Are defaulters with paucibacillary leprosy a problem?

This study examined the risk of relapse in 421 paucibacillary patients who had defaulted after varying periods of dapsone monotherapy; short of the recommended course. The 421 patients contributed a total of 2,162 person years of risk; 10 patients relapsed, giving a relapse rate of 4.6 per 1000 persons years of risk, or a crude relapse rate (RR) of 2.4%. This paper discusses the issue of defaulters with paucibacillary leprosy and the findings of the study suggest that defaulters with paucibacillary leprosy are not a serious problem in terms of leprosy control.

[Evaluation of the campaign against leprosy conducted by the Grandes Endémies du Cap-Vert sector in the Dakar urban area from 1975 to 1979]. / Bilan de la lutte contre la lèpre, menée par le secteur des Grandes Endémies du Cap-Vert dans l'agglomération dakaroise de 1975 à 1979.

Study of Hansen disease registered cases during five years is realized under OMSLEP rules. This population of 1428 patients is observed under "entrance" and "outlet" parameters from the patients register. The author notices the high prevalence rate, 35.5% and the disability rate which induces a late-track. Looking for the follow-up, the outratio is too high and it exists a difference between the paucibacillary or multibacillary defaulters. Dakar area is characterized on Hansen's disease by: --a low prevalence rate, under 0.5%; --a high lepromatous ratio, about 35.5%; --a low children rate observed between the domiciliary contacts; --a constant course of the incidence of 5 Dakar patients while Senegal presents a decrease of Hansen's population.

Regularity of dapsone intake by leprosy patients attending urban treatment centre.

Dapsone/Creatinine in urine ratios were determined in statistically randomised samples of 965 leprosy patients attending out-patient department of Acworth Leprosy Hospital and 44 inmates of the Hospital. The percentage of irregularity in DDS treatment was found in 43 and 22.6 respectively in out-patients and inmates of the Hospital. The need to assess the possible response for irregularity in treatment is stressed and the hazard of infectious cases remaining without treatment or with incomplete treatment is pointed out.