Deficiências após a alta medicamentosa da hanseníase: prevalência e distribuição espacial

Abstract

OBJECTIVE:To estimate the frequency of people with leprosy-related physical disabilities after release from multidrug treatment and to analyze their spatial distribution. METHODS:Descriptive cross-sectional study with 232 leprosy patients treated between 1998 and 2006. Physical disabilities were assessed using the World Health Organization disability grading and the eye-hand-foot (EHF) sum score. The residential address of patients and rehabilitation centers were geocoded. It was estimated the overall frequency of physical disability and frequency by disability grade (grade 0, grade 1, and grade 2) according to the WHO disability grading taking into consideration clinical and sociodemographic variables in the descriptive analysis. Student's t-test, chi-square test (χ2), and Fisher's test were used as appropriate at a 5% signifi cance level. RESULTS:Of the patients studied, 51.6% were female, mean age 54 years old (SD 15.7), 30.5% had less than 2 years of formal education, 43.5% were employed, and 26.9% were retired. Borderline leprosy was the most prevalent form of leprosy (39.9%). A total of 32% of these patients had disabilities according to the WHO disability grading and the EHF score. Disabilities increased with age (p = 0.029), they were more common in patients with multibacillary leprosy (p = 0.005) and poor self-rated physical health (p < 0.001). Those who required prevention/rehabilitation care traveled on average 5.5 km to the rehabilitation center. People with physical disabilities lived scattered across the city but they were mostly concentrated in the most densely populated and socioeconomically deprived area. CONCLUSIONS:There is a high frequency of people with leprosy-related disabilities after release from multidrug therapy. Prevention and rehabilitation actions should target uneducated and older patients, those who had multibacillary forms of leprosy and poor self-rated physical health. The travel distance to rehabilitation centers calls for reorganization of local care networks.

Compreendendo a “alta em hanseníase”: uma análise de conceito

“…Analyzing the selected articles, a predominance of publications in English (6,(11)(12)(13)(14)(15)(16)(17) was observed, totaling 61.53% (8 items), and the others (18)(19)(20)(21)(22) were in English, highlighting the periodic with the highest number of publications being from the Revista da Sociedade Brasileira de Medicina Tropical (Journal of the Brazilian Society of Tropical Medicine), with a total of 15.38% (2 articles) (6,12) . Based on the visibility achieved by the review, the steps proposed are performed according to the Concept Analysis Model (9) : concept selection; determination of the objectives of the conceptual analysis; identification of possible uses of the concept; determining attributes; identifying concept antecedents and consequents; presentation of a model case and an opposing case.…”

“…In the review conducted for this specific case, four possibilities of use were found related to the term patient discharge in leprosy: patient discharge by cure (12,14,21) , drug discharge (6,15,19) , bacteriological discharge (21)(22) and post-discharge (11,(15)(16)(17) . The four terms (patient discharge by cure, drug discharge, bacteriological discharge and post-discharge) refer to the mental construct of patient discharge in leprosy and refer to the period that starts after completion of MDT, whose pattern layout is composed of two groups of drugs, depending on the operational classification of leprosy cases: dapsone and rifampin or dapsone, rifampicin and clofazimine (31) .…”

“…It is emphasized that the completion of MDT is intrinsically related to the user's exclusion from the active record, failing to be systematically monitored and accompanied by health services (11) . Once excluded from the ministerial record, there is the continuity of health care (11,(14)(15)(16)18,(20)(21)(22) , considered another consequent of the concept patient discharge in leprosy. The need for follow-up takes place due to the possibility of worsening the degree of disability (6,11,(13)(14)(15)(16)(21)(22) , development of leprosy reactions (12,14,17,(21)(22) and any recurrence episodes (12,17,19) .…”

“…Due to the magnitude of the existing problems after completion of MDT, coupled with the fragile health system provided to those individuals who carry with them the scars left by leprosy (5) , it is necessary to take more effective actions at the time of diagnosis and after the end of treatment (2) . When considering the presence of neurological impairment and the consequent disabilities in individuals who have completed MDT for leprosy, which is a serious problem to be faced (7) , the need for patient follow up that structures defined actions (8) . Faced with the achievements and challenges that characterize leprosy in its historical, social, and stigmatizing route, confined to neglected diseases.…”

O Papel Transformador do Estudante de Medicina no Cenário da Endemia de Hanseníase no Brasil: Relato de Experiência

“…O tratamento foi iniciado para hanseníase paucibacilar (PB). 8,9 . Diversos estudos apontam que a descentralização melhorou a detecção de casos da doença, com aumento no registro dos mesmos 10 .…”