Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil

Abstract

Reorientation of the public health policies in Brazil over the last 20 years in association with a stable rate of new-case detection prompted the establishment of a decentralized leprosy control strategy. The aim was to move from a vertical model associated with general dermatological services to one in which the diagnosis and treatment of the disease would be integrated into the primary care level of the national health care facilities. Once patients demand for leprosy reference centers began to be affected by the process of integrating leprosy diagnosis into the basic health care services, it was necessary to determine the profile of all our referrals in light of the new decentralization policy.ObjectiveWe evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals.MethodsThis is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy.ResultOur data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis.ConclusionThe results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.

Spatial clustering, social vulnerability and risk of leprosy in an endemic area in Northeast Brazil: an ecological study

“…This study identified that these areas have a higher proportion of patients with advanced forms of leprosy, vis a vis MB leprosy and individuals with grade 2 disability, likely reflecting a late diagnosis and barriers to access health services. Brazil, Bangladesh and India have long reported the well‐established relationship between poverty and the occurrence of advanced forms of leprosy and that patients in areas with good primary healthcare services are diagnosed earlier . Socio‐economic differences influence not only access, but also the quality and utilization of health services …”

“…Brazil, 5,17,22,26,27 Bangladesh 16 and India [28][29][30] have long reported the well-established relationship between poverty and the occurrence of advanced forms of leprosy and that patients in areas with good primary healthcare services are diagnosed earlier. 22,31,32 Socioeconomic differences influence not only access, but also the quality and utilization of health services. 6 Our findings also highlight that leprosy has not declined over time in municipalities with high social vulnerability, despite major efforts to eradicate leprosy with active case detection and contact tracing.…”

Hanseníase e carência social: definição de áreas prioritárias em estado endêmico do Nordeste brasileiro

“…According to the authors, socioeconomic and environmental conditions are linked to the permanence of the leprosy transmission chain. Thus, the presence of geographic areas with high social deprivation and which also have high leprosy detection coefficients explains the influence of the fragile socioeconomic conditions of the population on the maintenance of the Mycobacterium leprae transmission chain [38][39][40][41][42] . As a result of all the investigations conducted here, the central element chosen for the definition of priority areas was high/very high social deprivation.…”

Estudo espacial da hanseníase na Bahia, 2001-2012: abordagem a partir do modelo bayesiano empírico local

“…One explanation for these findings may be based on the expansion of the primary health care network all over Brazil in recent years. 9,20,21 A study conducted by Nery et al 20 which analyzed 1,358 Brazilian municipalities, showed that the then Family Health Program (FHP) -now referred to as the Family Health Strategy (FHS) -made progress in increasing the detection of new cases of leprosy. Moreover, the existence of decentralized health centers was also associated with increased detection of the disease.…”