Análise da demanda de casos de hanseníase aos serviços de saúde através do uso de técnicas de análise espacial

Abstract

Hansen disease or leprosy is a major endemic disease in Brazil. Well-designed strategies, including decentralization of basic care, are needed to reduce its prevalence. The article begins by describing the structure and supply of services for treating leprosy cases in the country, after which it analyzes the trends in epidemiological and operational indicators, comparing the periods before and after decentralization of services to the municipal (local) level. Finally, spatial analysis allowed identifying the territorial distribution of this endemic and analyzing the pattern of geographic areas according to care provided by health facilities and its evolution. Based on the location of the geographic centers in the census tracts by place of residence, and using spatial smoothing technique based on Kernel estimation, the study constructed domain areas of care for each health facility or unit. Following municipalization of care, there was an increase in the detection and treatment by the municipalities themselves, reducing patient evasion to neighboring counties and causing changes in demand trends, with an increase in use of services by the clientele and important alterations in the epidemiological and operational indicators.

Spatial distribution of leprosy in Brazil: a literature review

“…Table 1, Table 2 and Table 3 show the articles' summaries according to the scale used: two evaluated regions/ mesoregions 14,15 ; 13 used the scale of municipalities 10,[16][17][18][19][20][21][22][23][24][25][26][27] ; 4 evaluated districts [28][29][30][31] ; 6 studied neighborhoods [32][33][34][35][36][37] ; 7 analyzed the census tracts [38][39][40][41][42][43][44] ; and 3 investigated households [45][46][47] . Within each scale, the articles were organized by location: Brazil, Northern, Northeast, Midwest, and Southeast regions.…”

“…Within each scale, the articles were organized by location: Brazil, Northern, Northeast, Midwest, and Southeast regions. In all, 4 approached Brazil 10,16-18 , 7 studied the Northern region or the states of the Amazon region 14,19,20,[38][39][40]45 , 11 focused on the Northeast region [21][22][23]28,[32][33][34][35][36]40,41 , 4 the Midwest region 15,29,37,46 , and 12 the Southeast region [24][25][26][27]30,31,36,37,[42][43][44]47 .…”

“…On the other hand, some studies reaffirm trend evaluations, showing that the increase of NCDR related to coverage of health services does not reflect a true increase in the incidence 40 , but an increase in the detection of new cases that would otherwise remain undiagnosed -the hidden prevalence. However, the trend, for the next few years, would be a decrease in disease incidence 55 .…”

“…Another point to be considered is the difficulty experienced by various authors in making geographical references of leprosy cases, because of the incompleteness of the addresses in the SINAN, or insufficient information. Such instances were more frequent on the outskirts of the cities, where the NCDR was higher and it would be more relevant to obtain this information 37,40 . .…”

Controle da hanseníase no Estado de São Paulo: análise histórica

“…10,11,13,20 The overall scope of the fi ght against leprosy and the complexity of the issues it raises is impressive, showing intricate convergences of national history, and of medical, governmental, and international policies. 24 The history of the fi ght against leprosy in São Paulo was unique, b as is the whole sanitary movement it was part of, uncommon in global health history, both in the way it developed and the pace in which it was implemented.…”