A comparison of three types of targeted, community-based methods aimed at promoting early detection of new leprosy cases in rural parts of three endemic states in India.

BACKGROUND: India achieved elimination of leprosy nationally in 2005, but since then the number of patients with grade 2 disability at diagnosis increased steadily indicating delay in diagnosis. Therefore, there was a need for public health interventions which can increase case finding in their earlier stage. The objective of this study is to compare the effectiveness of three such community-based interventions; 1) Enhancement of community awareness on leprosy; 2) Education and motivation of "Index" leprosy cases; and 3) Involvement of Non-Formal Health Practitioners (NFHPs) to promote early detection of new cases of leprosy. METHODOLOGY/PRINCIPAL FINDINGS: Three community-based interventions were implemented between April 2016 and March 2018, embedded within the National Leprosy Eradication Program (NLEP) of India. Interventions were 1) increasing awareness through involvement of Gram Panchayat (local government) in the community regarding early signs of leprosy (Awareness), 2) providing health education and motivating newly diagnosed leprosy patients to bring suspects from their contacts (Index) and 3) training local non-formal health practitioners (NFHP). Each intervention was implemented in a group of ten blocks (sub-division of district) with an additional ten blocks as control (with no intervention). The main outcomes were number of new cases detected and number of grade 2 disability among them. They were obtained from the routine NLEP information system and compared between these interventions. On an average, there was an addition of 1.98 new cases in Awareness blocks, 1.13 in NFHP blocks and 1.16 cases in Index intervention blocks per month per block after adjusting for changes in control blocks during the same period. In terms of ratio, there was a 61%, 40% and 41% increase in case notification in awareness, Index and NFHP intervention, respectively. Overall, the percentage of grade 2 disability across intervention blocks declined. CONCLUSION: The Awareness intervention appears to be more effective in detection of new cases, compared to Index case motivation and sensitization of NFHPs. However, it is important to stress that while selecting strategies to increase early diagnosis it is important to determine, which is the most appropriate for each context or area and must be decided depending on the local context.

Leprosy educational practices with adolescents: an integrative literature review / Prácticas educativas sobre la enfermedad de Hansen (Lepra) con adolescentes: revisión integrativa de la literatura / Práticas educativas sobre hanseníase com adolescentes: revisão integrativa da literatura

ABSTRACT Objectives: to identify scientific evidence in the literature regarding educational actions on leprosy developed with adolescents. Method: an integrative review of the literature, with the following research question: what are the leprosy educational practices currently being developed with adolescents? The search was performed in the following databases: MEDLINE, Scopus, LILACS, CINAHL, BVS Hanseníase and other sources, using "adolescent"; "leprosy"; "health education"; "public health", and "public health practice" as keywords. Results: the sample was comprised of nine studies. Leprosy educational practices with adolescents verifiably promote change in knowledge when they are based on constructivist methodologies. The nurse is recognized as a professional with potential for developing these educational practices. Final considerations: actions for leprosy education with adolescents do lead to changes in knowledge, but new research is needed to evaluate their effectiveness in further improving this knowledge as well as changing behaviors and practices.

RESUMEN Objetivo: Identificar las evidencias científicas de la literatura con relación a las prácticas educativas sobre la enfermedad de Hansen desarrolladas con adolescentes. Método: Se trata de una revisión integrativa de la literatura, con el cuestionamiento a continuación: ¿cuáles prácticas educativas sobre la enfermedad de Hansen están siendo desarrolladas con adolescentes? La búsqueda fue realizada en las bases de datos Medline, Scopus, Lilacs, CINAHL, Enfermedad de Hansen y en otras fuentes por medio de los descriptores: adolescente; enfermedad de Hansen; educación en salud; salud pública; y práctica de salud pública. Resultados: Nueve estudios compusieron la muestra. Se certificó que las prácticas educativas sobre enfermedad de Hansen con adolescentes promueven el cambio de conocimiento cuando se basan en la metodología constructivista y que el enfermero es reconocido como profesional con potencial para su desarrollo. Consideraciones finales: Las prácticas educativas sobre la enfermedad de Hansen con adolescentes resultan en cambios en el conocimiento, sin embargo, son necesarias nuevas investigaciones que evalúen su efectividad en la mejora del conocimiento y en los cambios de actitud y de prácticas.

RESUMO Objetivo: identificar as evidências científicas da literatura a respeito das práticas educativas sobre hanseníase desenvolvidas com adolescentes. Método: trata-se de uma revisão integrativa da literatura, com o seguinte questionamento: quais práticas educativas sobre hanseníase estão sendo desenvolvidas com adolescentes? A busca foi realizada nas bases de dados Medline, Scopus, Lilacs, CINAHL, Hanseníase e em outras fontes por meio dos Descritores: adolescente; hanseníase; educação em saúde; saúde pública; e prática de saúde pública. Resultados: nove estudos compuseram a amostra. Verificou-se que as práticas educativas sobre hanseníase com adolescentes promovem mudança de conhecimento quando se baseiam na metodologia construtivista e que o enfermeiro é reconhecido como profissional com potencial para o seu desenvolvimento. Considerações finais: as práticas educativas sobre hanseníase com adolescentes resultam em mudanças no conhecimento, porém são necessárias novas pesquisas que avaliem a sua efetividade na melhora do conhecimento e nas mudanças de atitude e de práticas.

Leprosy educational practices with adolescents: an integrative literature review.

OBJECTIVES: to identify scientific evidence in the literature regarding educational actions on leprosy developed with adolescents. METHOD: an integrative review of the literature, with the following research question: what are the leprosy educational practices currently being developed with adolescents? The search was performed in the following databases: MEDLINE, Scopus, LILACS, CINAHL, BVS Hanseníase and other sources, using "adolescent"; "leprosy"; "health education"; "public health", and "public health practice" as keywords. Results: the sample was comprised of nine studies. Leprosy educational practices with adolescents verifiably promote change in knowledge when they are based on constructivist methodologies. The nurse is recognized as a professional with potential for developing these educational practices. Final considerations: actions for leprosy education with adolescents do lead to changes in knowledge, but new research is needed to evaluate their effectiveness in further improving this knowledge as well as changing behaviors and practices.

Health education and promotion actions among teams of the National Primary Care Access and Quality Improvement Program, Rio Grande do Sul state, Brazil. / Ações educativas e de promoção da saúde em equipes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, Rio Grande do Sul, Brasil.

OBJETIVO: to investigate the provision of health education and promotion actions in primary care, and their association with demographic characteristics and Family Health Strategy (FHS) coverage in Rio Grande do Sul state, Brazil. METHODS: this is a cross-sectional study conducted with 816 teams that adhered to the 2012 Primary Care Access and Quality Improvement Program. RESULTS: the most frequent actions were directed towards people with diabetes (91.2%), hypertension (90.8%) as well as antenatal and postnatal care (84.6%). The least frequent were directed to wards crack, alcohol and other drug users (32.4%), anxiolytic/benzodiazepine users (20.3%), people with tuberculosis (31.4%) and leprosy (21.0%). The greatest provision of health promotion and education actions occurred in smaller municipalities and with greater Family Health coverage. CONCLUSION: actions aimed at the reproductive period and chronic morbidities were the focus of primary care. FHS implementation strengthens health promotion.

Assessment of the implementation of the Leprosy Control Program in Camaragibe, Pernambuco State, Brazil. / Avaliação da implantação do Programa de Controle da Hanseníase em Camaragibe, Pernambuco.

OBJECTIVE: to assess the implementation of the actions of the Leprosy Control Program in Camaragibe, Pernambuco State, Brazil. METHODS: evaluative research with 'implementation analysis', based on criteria, indicators and parameters guided from the construction of the Logic Model; four components were assessed - management, health care, epidemiological surveillance, health education and communication -; direct observation/questionnaire was used, as well as data from the Information System for Notifiable Diseases. RESULTS: the implementation of the program was incipient (58.3%); the estimate for the components varied from 'not implemented' (health education and communication, 48.0%), 'incipient' (management, 53.3%; health care, 57.2%) to 'partially implemented' (epidemiological surveillance, 73.0%); in 2012, it was observed low proportion of examined contacts (28.4%), treatment dropout (34.1%), limited standardization of patient care flow, and poor resolution of problems by managers. CONCLUSION: the level of implementation found was related to the organization of services, with negative repercussions regarding the result indicators.

Perfil epidemiológico da hanseníase no período de 2009 a 2013 no município de Montes Claros (MG) / Epidemiological profile of leprosy in the period 2009 to 2013 in thecity Montes Claros (MG), Brazil

OBJETIVO: Avaliar o perfil epidemiológico da hanseníase nomunicípio de Montes Claros (MG), no período de 2009 a 2013.MÉTODOS: Trata-se de um estudo observacional, retrospectivocom variáveis quantitativas em que os dados foram extraídosda ficha de notificação/investigação de hanseníase do Sistema deInformação de Agravos de Notificação (SINAN). RESULTADOS:oram notificados 230 casos durante o período estudado.Observou-se a predominância de casos no sexo masculino e dacor parda, sendo que o grau zero de incapacidade foi detectadoem 79,56% dos pacientes. A maioria era multibacilar, pertencenteprincipalmente às formas clínicas dimorfa e virchowiana.CONCLUSÃO: Nos últimos anos, houve uma redução expressivano número de casos da hanseníase na população estudada,sendo atingida a meta proposta pela Organização Mundial daSaúde nos anos de 2012 e 2013. Para que esse índice seja sustentadonos próximos anos, é necessário que as campanhas deconscientização, a busca ativa de casos, e o tratamento precoce eeficaz sejam trabalhados e mantidos.(AU)

OBJECTIVE: To evaluate the epidemiological profile ofhanseniasis in Montes Claros (MG), Brazil, from 2009 up to2013. METHODS: n observational, retrospective study withquantitative variables showing data which were obtained from the record files dealing with notification and investigationabout hanseniasis from the Sistema de Informação de Agravosde Notificação (SINAN). RESULTS: A total of 230 caseswere reported during the studied period. We observed thepredominance of cases in males and mulatto, whereas the zerodegree of disability was detected in 79.56% of the patients,the majority of them being multibacillar, belonging mainly todimorphal and the virchowiana clinical forms. CONCLUSION:In the last years an significant reduction in the number ofhanseniasis cases in the studied population was evident. Thedesirable goal proposed by World Health Organization wasattained in the years 2012 and 2013. For this reason, in order tomaintain this index in the coming years, it is necessary to keepthe awareness campaigns, the active search for positive cases, aswell as the early and effective treatment.(AU)

Selective Special Drive (SSD): an effective tool to promote new case detection through community participation--an experience during 2005-2010 in Mumbai slums.

As per the Guidelines of National Leprosy Eradication Programme (NLEP), Government of India, new case detection (NCD) in leprosy is to be promoted by voluntary reporting through Information, Education and Communication (IEC). Accordingly, in addition to the routine IEC activities, Maharashtra Lokahita Seva Mandal (MLSM) carried out Selective Special Drive (SSD) in slum pockets in Mumbai since 2005-06. The SSD methodology prescribed under Leprosy Elimination Action Program (LEAP) of ALERT-INDIA was adopted which included selection of slum pockets, identification and training of Community Volunteers (CVs), door-to-door focused IEC through CVs using standard IEC material and referral of voluntarily reported suspected cases to nearby Health Posts under General Health Services or to Leprosy Referral Centre (LRC) established through MLSM for diagnosis and treatment. During the years, 2005-06 to 2009-10, MLSM conducted five annual SSDs in 53 slum pockets having 187,391 house-holds with the total enumerated population of 882,114 of which 563,040 (63.8%) could be covered through house-to-house IEC by 772 trained CVs/CHVs. As a result, 108 new cases (PB - 79 and MB - 29) were detected with the NCD rate ranged between 13/100,000 and 34/100,000 which is much higher than the reported NCDR in Mumbai (i.e. 6/100,000). Of the new MB cases 6 were lepromatous leprosy cases. Voluntary reporting of new cases was also found to be enhanced during the subsequent period following SSD. SSD activity encourages intensified IEC with community participation and integrates General Health Services resulting into better voluntary reporting of new cases. It is, therefore recommended that the SSD with the methodology prescribed under LEAP may be considered for incorporation in NLEP.

Atenção Primária e Hanseníase: desafios educacionais e assistenciais

A hanseníase mantém-se um desafio dentro das políticas públicas brasileiras. O Brasil registra um número de casos ainda elevado, que faz do país o segundo em números absolutos e o primeiro em valores relativos no mundo. Ainda que consiga cumprir a meta assumida junto a Organização Mundial de Saúde, de menos de um caso para cada dez mil habitantes, o desafio de controlar a doença ainda persistirá. O número de casos novos em menores de quinze anos demonstra que o desafio é maior do que se supõe, já que há transmissão ativa, e, portanto pacientes ainda não diagnosticados. A Atenção Primária a Saúde (APS), embora responsável por grandes avanços, não foi capaz de resolver este problema específico de saúde, mesmo sendo o nível mais adequado de atenção e o que mais propriamente trabalha com ferramentas de educação na saúde. O objetivo deste trabalho foi avaliar a hanseníase como foco de ação da APS e da Educação em Saúde, sendo avaliadas tanto a atenção primária como estratégia de atenção quanto algumas estratégias educativas como meio de promoção e comunicação em saúde. Encontrou-se que a APS, ainda que seja o nível mais adequado para o cuidado, apresenta barreiras de acesso e de qualidade da atenção que fazem com que oportunidades de cuidado sejam desperdiçadas.

Questões tais como ambiência, qualificação profissional, sobrecarga de trabalho e população excessiva de cobertura interferem diretamente no cuidado.Especificamente quanto a educação para hanseníase, os profissionais da APS não foram adequadamente qualificados durante a graduação, e os mecanismos de educação permanente não são capazes de modificar a prática clínica. Além disto, aforma como a Educação em Saúde é feita dentro das políticas públicas mostrou-se ineficaz, contaminada ainda pelo estigma e pelas crenças concernentes a “lepra” e a dissociação da gravidade da doença com a nomenclatura “hanseníase”. Conclui-seque a abordagem da hanseníase passa necessariamente pela qualificação da atenção primária, pela redução do número de usuários por equipe, pela modificação das estratégias educativas e pela necessidade de adequar os currículos de graduação à casuística real das unidades de saúde, tanto em termos do contato direto com a doença hanseníase, quanto em relação ao uso adequado das ferramentas educacionais.

Atenção Primária e Hanseníase: desafios educacionais e assistenciais / Primary attention and Leprosy: educational and welfare challenges

A hanseníase mantém-se um desafio dentro das políticas públicas brasileiras. O Brasil registra um número de casos ainda elevado, que faz do país o segundo em números absolutos e o primeiro em valores relativos no mundo. Ainda que consiga cumprir a meta assumida junto a Organização Mundial de Saúde, de menos de um caso para cada dez mil habitantes, o desafio de controlar a doença ainda persistirá. O número de casos novos em menores de quinze anos demonstra que o desafio é maior do que se supõe, já que há transmissão ativa, e, portanto pacientes ainda não diagnosticados. A Atenção Primária a Saúde (APS), embora responsável por grandes avanços, não foi capaz de resolver este problema específico de saúde, mesmo sendo o nível mais adequado de atenção e o que mais propriamente trabalha com ferramentas de educação na saúde. O objetivo deste trabalho foi avaliar a hanseníase como foco de ação da APS e da Educação em Saúde, sendo avaliadas tanto a atenção primária como estratégia de atenção quanto algumas estratégias educativas como meio de promoção e comunicação em saúde. Encontrou-se que a APS, ainda que seja o nível mais adequado para o cuidado, apresenta barreiras de acesso e de qualidade da atenção que fazem com que oportunidades de cuidado sejam desperdiçadas...

Questões tais como ambiência, qualificação profissional, sobrecarga de trabalho e população excessiva de cobertura interferem diretamente no cuidado.Especificamente quanto a educação para hanseníase, os profissionais da APS não foram adequadamente qualificados durante a graduação, e os mecanismos de educação permanente não são capazes de modificar a prática clínica. Além disto, aforma como a Educação em Saúde é feita dentro das políticas públicas mostrou-se ineficaz, contaminada ainda pelo estigma e pelas crenças concernentes a “lepra” e a dissociação da gravidade da doença com a nomenclatura “hanseníase”. Conclui-seque a abordagem da hanseníase passa necessariamente pela qualificação da atenção primária, pela redução do número de usuários por equipe, pela modificação das estratégias educativas e pela necessidade de adequar os currículos de graduação à casuística real das unidades de saúde, tanto em termos do contato direto com a doença hanseníase, quanto em relação ao uso adequado das ferramentas educacionais...

Using a clinic based creativity initiative to reduce HIV related stigma at the Infectious Diseases Institute, Mulago National Referral Hospital, Uganda.

BACKGROUND: Stigma has been associated with chronic health conditions such as HIV/AIDS, leprosy, tuberculosis, Mental illness and Epilepsy. Different forms of stigma have been identified: enacted stigma, perceived stigma, and self stigma. Stigma is increasingly regarded as a key driver of the HIV/AIDS epidemic and has a major impact on public health interventions. OBJECTIVES: The initiative was to provide activities in the clinic while patients waited to be seen by healthcare professionals. It was envisaged this would contribute to reduction of clinic based stigma felt by clients. METHODS: This was a repeated cross-sectional survey (October-November 2005 and March-April 2007) that was conducted at the Infectious Diseases Institute clinic (IDC) at Mulago, the national referral hospital in Uganda. We utilized quantitative (survey) and qualitative (key informants, focus group discussions) methods to collect the data. Data were collected on stigma before the creativity initiative intervention was implemented, and a second phase survey was conducted to assess effectiveness of the interventions. RESULTS: Clients who attended the IDC before the creativity intervention were about twice as likely to fear catching an infection as those who came after the intervention. The proportion that had fears to be seen by a friend or relative at the clinic decreased. Thus during the implementation of the Creativity intervention, HIV related stigma was reduced in this clinic setting. CONCLUSIONS: The creativity intervention helped to build self esteem and improved communication among those attending the clinic; there was observed ambiance at the clinic and clients became empowered, with creative, communication and networking skills. Improved knowledge and communication are key in addressing self stigma among HIV positive individuals.

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.

[Meanings and use of educational materials on Hansen disease according to public health officials in the Municipality of Rio de Janeiro, Brazil]. / Significados e usos de materiais educativos sobre hanseníase segundo profissionais de saúde pública do Município do Rio de Janeiro, Brasil.

This article reflects on the communications processes in the Hansen Disease Control Programs under the Unified National Health System (SUS) in Brazil, analyzing how professionals at two public health services in Rio de Janeiro perceive the educational materials on the disease. The article discusses how analysis of printed materials favors negotiation of prevailing meanings and practices on Hansen disease in the programs. Thirty-eight different educational materials were analyzed (produced from 1993 to 2005 by governmental and nongovernmental institutions) through two focus groups with program staff. Six materials were examined during the focus groups. The findings showed the communications processes are vertical and fragmented, with an emphasis on campaigns, centralized production of materials, homogenization of target publics, and a focus on biomedical knowledge. Horizontal and participatory activities were uncommon. A gap was identified between the institutionalization of the discourse on Hansen disease as an alternative to leprosy terminology and its circulation and uptake among different social actors.

Significados e usos de materiais educativos sobre hanseníase segundo profissionais de saúde pública do Município do Rio de Janeiro, Brasil / Meanings and use of educational materials on Hansen disease according to public health officials in the Municipality of Rio de Janeiro, Brazil

O artigo objetiva refletir sobre os processos comunicativos de Programas de Controle de Hanseníase (PCH) do Sistema Único de Saúde (SUS), por meio da análise da recepção de materiais educativos por profissionais de dois serviços de saúde pública no Rio de Janeiro, Brasil. O trabalho discute em que medida a análise de impressos favorece a negociação dos sentidos e das práticas sobre hanseníase vigentes nos PCH. Foram analisados 38 materiais produzidos entre 1993 a 2005, por instituições governamentais e não-governamentais e realizados dois grupos focais com profissionais atuantes no PCH. Durante os grupos focais 6 materiais foram examinados. Os resultados revelaram a verticalidade e fragmentação nos processos comunicativos, expressas pela: ênfase em campanhas, produção centralizada, homogeneização dos públicos e conteúdos e privilégio dado ao saber biomédico. As atividades horizontais e participativas não eram comuns. Foi identificada uma lacuna entre a institucionalização do discurso da hanseníase, como alternativa à terminologia da lepra, e a sua circulação e consumo entre os diferentes atores sociais.

This article reflects on the communications processes in the Hansen Disease Control Programs under the Unified National Health System (SUS) in Brazil, analyzing how professionals at two public health services in Rio de Janeiro perceive the educational materials on the disease. The article discusses how analysis of printed materials favors negotiation of prevailing meanings and practices on Hansen disease in the programs. Thirty-eight different educational materials were analyzed (produced from 1993 to 2005 by governmental and nongovernmental institutions) through two focus groups with program staff. Six materials were examined during the focus groups. The findings showed the communications processes are vertical and fragmented, with an emphasis on campaigns, centralized production of materials, homogenization of target publics, and a focus on biomedical knowledge. Horizontal and participatory activities were uncommon. A gap was identified between the institutionalization of the discourse on Hansen disease as an alternative to leprosy terminology and its circulation and uptake among different social actors.

Observations from a 'special selective drive' conducted under National Leprosy Elimination Programme in Karjat taluka and Gadchiroli district of Maharashtra.

The special selective drive (SSD) was conducted on a request from the Joint Director of Health Services (Leprosy and TB) Government of Maharashtra. The study team comprised the Foundation for Medical Research (FMR), assisted by a member of the Acworth Leprosy Hospital Society for Research, Rehabilitation and Education in Leprosy and two from Kushtrog Nivaran Samiti (KNS). The drive was conducted in select villages covered by 6 primary health centers (PHCs) in Karjat taluka of Raigad district and 45 PHCs in Gadchiroli district from March to May 2009 and had the cooperation of the district and PHC level staff. The aim was to train and deploy community level workers (CWs) for early leprosy case detection and through them, to create leprosy awareness in the community. A total of 1053 CWs (126 in Karjat taluka, 927 in Gadchiroli district) were given intensive training by the team. The CWs then carried out a one-day house-to-house leprosy awareness drive in their areas and listed persons such 'suspects' in both Karjat taluka (no. = 514) and Gadchiroli district (no. = 1325). Around 40% of 'suspects' presented themselves at the PHCs for examination by the medical team; of these 38 (29%) and 281 (45%) respectively turned out to be previously undetected definite cases of leprosy. The PHC-wise NCDR ranged from 5 - 27/10,000 in Karjat (14/10,000) and 2 - 35/10,000 in Gadchiroli (average 13/10,000), both rates being much higher than the reported State average of 1.1/10,000. There was a high proportion of child cases (14 and 24% respectively) and grade 2 disability (18% and 12% respectively) which indicate continued transmission of leprosy and delayed diagnosis of cases. The study also notes poor diagnostic skills among the PHC staff. Significant shortage and irregular disbursement of MDT from district store PHCs, combined with transport problem which probably contributed to delay in treatment in over 50% of the cases confirmed by the team.

Proposta pedagógica para aprimorar os conceitos básicos em hanseníase: álbum seriado como um recurso no processo de orientação / Pedagogic proposal to improve basic concepts on leprosy: the picture album series as a teaching resource

Este estudo objetivou avaliar o nível de conhecimento dos funcionários de uma instituição de saúde que atende pacientes atingidos pela hanseníase sobre a doença e uniformizar seus conceitos utilizando um Álbum Seriado (AS) como instrumento de ensino-aprendizagem. O nível de conhecimento sobre hanseníase foi avaliado em 224 funcionários, antes (pré-teste) e depois (pós-teste) do uso do AS como um recurso didático-pedagógico para oferecer informações sobre hanseníase. Entre os participantes 37,9% trabalhavam na administração, 55 % na assistência e 7,1% não informaram; 36,4% possuíam o ensino médio e 32,5% o superior completo e, em média, atuavam na área há 13,6 (± 9,6) anos. Confrontando os resultados do pré e pós-teste no tema Aspectos Gerais, houve aumento no percentual de acerto de 63% para 81%; em Diagnóstico, aumentou de 78% para 87%; Transmissão, de 57 % para 79,5% e em Tratamento, de 48% para 76 %. No intervalo entre a apresentação do AS e o pós-teste, 41% dos funcionários buscaram informações adicionais. O percentual geral de acertos no pré-teste foi acima de 48%, mas no pós-teste foi superior a 76%, isto é, o nível de conhecimento sobre a hanseníase era mediano, mas aumentou após os esclarecimentos com o uso do AS. A intervenção educativa empregada facilitou a aquisição e a uniformização de conhecimentos sobre a doença.

The aim of this study was to access and standardize the knowledge on leprosy of professionals at a health institution specialized in leprosy assistance. The picture album series (PAS) was used as an educational resource. The level of knowledge was evaluated in 224 workers, before (pre-test) and after (post- test) the picture album series was utilized as the source of information about leprosy. Among the participants 37.9% worked in the administrative area, 55 % in assistance and 7.1% did not inform; 36.4% of the workers presented middle school level and 32.5% were graduated. The mean time of experience with leprosy was 13.6 (± 9.6) years. The statements in the test were related to themes about leprosy: General Aspects, Transmission, Diagnosis and Treatment. When results of the pre and post-tests were confronted, there was an increased percentage of right questions in General Aspects theme (from 63% to 81%); for Diagnosis, the right questions increased from 78% to 87%, for Transmission, from 57 % to 79,5% and for Treatment, from 48% to 76%. During the interval between presentation of the PAS and application of the post-test, 41% of the workers looked for additional information about leprosy. The percentage of right answers was above 48% in the pre-test and above 76% in the post-test, which shows intermediate initial level of knowledge. However, the level of knowledge on leprosy improved after the PAS was used. It suggests that the educative intervention facilitated acquisition of information about the disease, as well as standardized the knowledge.

Detección precoz de lepra infantile a tra´ves del entrenamiento de profesores de esucelas primarias: experiencia en un barrio periférico de Cuiabá-Mato Grosso (Brasil) / No disponible

La lepra continúa siendo hoy un problema de Salud Pública muy importante en algunos países, como el Brasil. A pesar de los importantes avances en materia de tratamientos en los últimos 10 años, la inexistencia de un medio diagnóstico que detecte la microbacteria en los estadios iniciales de la enfermedad y la también inexistencia de vacuna eficaz para prevención primaria hacen del tratamiento precoz la única arma de que disponemos para evitar en los posible la aparición de las incapacidades. Por otra parte, la alta 0prevalencia de la lepra en muchos países coexiste con una situación de desamparo social y sanitario, permaneciendo los pacientes en estadios iniciales – en su mayoría niños- lejos de los circuitos habituales de los servicios médicos. Es por ello que los profesores de las escuelas primarias ocupan un lugar destacado en el plan de detección precoz, pues son elementos en constante contacto con los niños, cumpliendo una doble misión: por un lado, siendo agentes multiplicadores de educación sanitaria, enseñando a los alumnos los signos y síntomas precoces de la lepra y modificando actitudes de repulsa hacia los enfermos; por otra parte, profesores entrenados para detectar estos signos precoces serán centinelas “de punta”, detectando con prontitud la aparición de la primera mancha en el niño. El trabajo muestra los resultados de detección de nuevos casos entre los niños de una escuela primaria de un barrio periférico de Cuiaba-Mato Grosso (Brasil) realizada por los propios profesores tras un breve entrenamiento por parte del equipo de atención primaria del barrio (AU)

Leprosy is still a public health problem in several countries in the World including Brazil. Although during the last 10 years there have been important advances in the field of treatment there is still no diagnostic test for early detection or an effective vaccine for primary prevention, so we have to depend entirely on early treatment to prevent possible patient incapacities. On the other hand, the high prevalence of leprosy exists together with social and health needs, so that the patient remains at the early stage of disease (mainly children) able to access the public health services. This is why the teachers at the primary school level have such an important role in early detection since they are in constant contact with the school children carrying on an important double mission: on one hand multiplying health, teaching the children the signs and symptoms of the disease and changing the negative social attitudes towards the affected individuals. So, thee teachers are “first level” guards detecting the first signs of disease. This study presents the results on early case detection in children form the primary school in the neighborhood of Cuiabá-Mato Grosso (Brazil) carried put by the teachers after attending a short training course by the local primary health care team (AU)

Educação conscientizadora na pratica do enfermeiro em hanseniase / Consciousness education in leprosy nursing practice 2005

No presente estudo de natureza qualitativa, objetivamos levantar as necessidades de aprendizagem, com o desenvolvimento de um programa educativo relacionado á hanseniase com o seu portador, mediado pela metodologia da pesquisa-ação e baseado no referencial teorico da educação concientizadora de Paulo Freire. Trabalhamos com dezenove sujeitos no primeiro momento e com seis de ambos os sexos, nos momentos subsequentes. A investigação ocorreu em uma Faculdade de Medicina do interior paulista. A coleta de dados foi efetivada por meio de entrevistas, observação participante, circulo de discussões e visita domiciliar. A analise dos dados foi desenvolvida à luz do referencial da educação conscientizadora. Os resultados apontaram cinco temas geradores: a desinformação da doença, sinais e sintomas da hanseniase, transmissão da doença, estigma e a falta de prevenção para as incapacidades fisicas. Elaboramos um plano de ensino para cada tema gerador, desenvolvemos o programa educativo com situações problematizadoras da realidade do portador, motivando o sujeito ao dialogo. O levantamento das necessidades de aprendizagem de monstrou a relevancia da inserçao do portador em um processo educativo, no qual este foi o sujeito da açao, principalmente ao utilizarmos as tematicas com estrategias facilitadoras para o seu aprendizado. O programa educativo desenvolvido desencadeou a tomada de consciencia, o desenvolvimento de capacidades e habilidades para o autocuidado. A avaliaçao do processo de conscientização permitiu comprovarmos a mudança de um sujeito passivo em ativo e reflexivo, multiplicador de informações e transformador de sua realidade, respeitando seu contexto cultural.