Leprosy Control Actions Research Articles

Evaluation by Community Health Agents of the attributes of Primary Health Care for fighting leprosy

Objective: To evaluate whether the attributes of Primary Healthcare are present in leprosy control actions in Londrina from Community Health Workers (CHW) perspectives. Methods: Observational and evaluative study. Data collection took place between January and March 2020 in Londrina, Paraná, using the questionnaire "Primary Care Assessment Tool (PCATool) - Hansen's disease - CHW version" and a population-based census of 246 CHWs from 52 Primary Healthcare Units. The analyses used a cutoff point (≥ 6.6), central tendency, and dispersion measures. One-way ANOVA and Tukey's post hoc tests were used to analyze differences. Results: The general performance towards the primary healthcare attributes were evaluated as strong (mean = 6.95 / SD = 1.08) and the essential score (mean = 7.39 / SD = 1.0). On the other hand, the derived score was evaluated as poor (mean = 6.07 / sd = 1.06). Concerning the Access attribute, the rural zone had a lower score than the urban (mean = 4.47 / SD = 1.63). As for the Comprehensiveness attribute of services provided to leprosy patients, the central region had a lower mean (mean = 4.87 / SD = 3.44) than the south region (mean = 6.76 / SD = 2, 24). Concerning the Integrality, the rural region presented a higher score (mean = 8.15 / SD = 1.22) than the western (mean = 6.16 / SD = 2.91) and central regions (mean = 6.13 / SD = 3.27). As for Community Orientation, the western region had a lower mean than the others (mean = 5.04 / SD = 2.44). The vocational guidance attribute had a higher average in the rural region (mean = 4.14 / SD = 2.62). Final Considerations: The study highlights issues that can be improved, such as first contact access, catalog of services offered to leprosy patients, information provided to the community, professional training, and differences in PHC performance between urban and rural regions.

Leprosy and tuberculosis control scenario of the national program for the improvement of access and quality of primary care in Brazil

BackgroundIn Brazil, despite advances in public health policies aimed at eliminating and controlling infectious and parasitic diseases, the incidence of neglected diseases is still high. The epidemiological scenario in Brazil of diseases such as tuberculosis and leprosy evidences a public policy agenda that has not been resolute in terms of control, nor in terms of elimination.ObjectiveTo analyze the actions of diagnosis and treatment of leprosy and tuberculosis in the context of primary health care.MethodsIn this ecological study, data from the third cycle of the Program for the Improvement of Access and Quality of Primary Care were extracted from electronic address of the Primary Health Care Secretariat of Brazil in the area of Actions, Programs and Strategies. A total of 37,350 primary health care teams were that answered the questionnaire were eligible, with variables extracted from leprosy and tuberculosis control actions. The municipalities were grouped according to the characteristic of the Brazilian municipality. The partition chi-square and the Residuals Test were used to assess whether there was a difference in the proportion of tuberculosis and leprosy actions between types of municipalities. Statistics were carried out using Minitab 20 and Bioestat 5.3.ResultsRegarding the leprosy treatment location, there is a higher proportion of people referred to be treated at the reference in adjacent rural (p = 0.0097) and urban (p < 0.0001) municipalities; monitoring of people with leprosy referred to the service network (p. = 0.0057) in remote rural areas. Lower proportion of teams requesting bacilloscopy in remote rural areas (p = 0.0019). Rural areas have a higher proportion of teams that diagnose new cases (p = 0.0004). Regarding the actions of diagnosis and treatment of tuberculosis. There is a higher proportion of teams that carry out consultations at the unit itself in rural areas when compared to adjacent intermediaries (p = 0.0099) and urban (p < 0.0001); who requested sputum smear microscopy in adjacent intermediaries (p = 0.0021); X-ray in adjacent intermediaries (p < 0.0001) and urban (p < 0.0001); collection of the first sputum sample in urban (p < 0.0001) and adjacent rural areas (p < 0.0001); directly observed treatment (p < 0.0001) in adjacent rural municipalities.ConclusionThere are inequalities in the diagnosis and treatment of leprosy and tuberculosis among the types of municipalities.

Spatial patterns of new leprosy cases in a northeastern state of Brazil, 2011-2021.

To analyze the spatial patterns of leprosy in Pernambuco from 2011 to 2021. This is an ecological epidemiological study, carried out with data from the Notifiable Diseases Information System, based on new cases of leprosy among inhabitants of Pernambuco, between 2011-2021. An empirical Bayesian analysis of local and spatial dependence was performed with the global and local Moran indices. 25,008 new cases of leprosy were registered with an annual case detection rate in the general population of 16.51 cases/100,000 inhabitants - which is considered high. Among those younger than 15 years of age, there were 5.16 cases/100,000 inhabitants (high) and 0.89/100,000 inhabitants with degree II of physical disability (low); there were also many high-risk cases with an overall Moran index of 0.33 (p<0.001), active transmission (0.26; p<0.001), and subsequent diagnosis of the disease (0.12; p<0.006), as well as distribution in macro-region 1 and macro-region 4. There was a heterogeneous spatial distribution in the state, showing two overviews, the first being the presence of municipalities with high risk of disease transmission and the second with clusters of silent municipalities, reinforcing the character of leprosy neglect as a major public health problem. This study brings reflections for leprosy control actions, due to the identification of priority areas to combat this disease in Pernambuco.

Hansenapp: Development of a mobile application to assist primary healthcare providers to control leprosy.

To describe the development and validation of a mobile application to assist health professionals in the management of patients with leprosy and surveillance of contacts in primary healthcare. A methodological and developmental study was conducted in three phases: integrative literature review, mobile application development and application validation by health professionals. The construction of the application was supported by the literature review, Nielsen's heuristics and expert validation. Five experts individually analysed the prototype draft and performed two rounds of iterations to refine their recommendations. The validation step was performed by consulting health professionals working in primary healthcare, who evaluated the application for relevance, clarity and usability using a questionnaire based on task-technology fit theory. The mobile app's content, navigation methods and interaction were refined based on the discussions with experts. Their recommendations were applied, and the mobile app was revised until the final version was approved. Content validity indexes of 0.94 (p= 0.007), 0.99 (p> 0.0001) and 0.93 (p= 0.01) were obtained. The developed application is a technological tool that could assist primary healthcare providers in dealing with leprosy patients and their contacts in terms of management, planning, monitoring, evaluation, treatment and follow-up, in addition to leprosy control actions.

The development of a Portuguese mobile application for clinical support in detecting leprosy suspects

Objectives: To describe the planning and development of a mobile application for assessing leprosy suspects. Methods: The technological production was carried out using four of the five phases of the ADDIE model: Analysis, Design, Development, and Implementation from August 2017 to August 2018. Results: The “Hansen’s disease” application integrates images, videos, and text with essential information for the evaluation of dermatoneurological suspects. It is available for free on Play Store and Apple Store, with the possibility of offline handling, and comprises a size of 42.25 MB. Conclusions: The application is expected to support health care professionals in leprosy control actions among the susceptible population and confirmed case communicators to eliminate transmission and achieve Sustainable Development Goal 3—health and well-being for all by 2030.

Atuação dos enfermeiros nas ações de controle da hanseníase na atenção primária à saúde

The nurse working in Primary Health Care has an extremely relevant role in the care provided to the person affected with leprosy. Thus, the study aims to analyze the role of nurses in leprosy control actions in primary health care portrayed in the light of the literature. It is an integrative literature review in which searches were carried out in the databases: Latin American and Caribbean Literature in Health Sciences, Nursing Database, PubMed Central, Scientific Electronic Library Online, ColecionaSUS and Portal de Periodicos CAPES, using as search strategies the crossing of the descriptors: '' Primary Health Care '', '' Hansen's disease '' and '' Nursing ''. Twelve articles were selected for the study, when analyzing the importance of integrating leprosy actions in Primary Health Care, it was found that, despite some weaknesses, the service is able to carry out leprosy control actions. Adequate assistance to clients with leprosy is important to obtain a cure and nurses have a fundamental role in providing services to these clients, seeking to minimize the impact of this disease and its complications.

Therapeutic itinerary of people with leprosy: paths, struggles, and challenges in the search for care.

to understand how the therapeutic itineraries of people affected by leprosy are processed. this is a descriptive, qualitative study, conducted in April 2018 in Barão de Grajaú in Maranhão, with interviews in the form of narratives of seven patients who had a late leprosy diagnosis. the search for diagnosis is a major difficulty in accessing health services, resulting in a late diagnosis and, consequently, with the presence of visible deformities. It was noticed that the health units do not have a flow, nor protocols for comprehensive treatment, and these people are referred to a referral unit in another state to perform sputum smear microscopy. leprosy control actions need reformulations that seek the relationship between operational activities, epidemiological indicators and risk factors, in accordance with the real needs of each region, thus highlighting the gaps evidenced in the therapeutic itineraries.

Exploratory analysis based on leprosy epidemiological and operational indicators in the city of Governador Valadares/MG/Brazil

Governador Valadares (GV) is a municipality of recognized leprosy hyperendemicity. From 2001 to 2010, the municipal health management invested in a heterogeneous way in the decentralization of control actions to expand access to diagnosis, highlighting the years 2002 and 2004, when training-campaigns took place in the Family’s Health Program. It is an epidemiological study, of a descriptive nature, of a longitudinal type, developed in the city of GV/Minas Gerais/Brazil. The variables collected were: Age group, categorized as &lt;15 years and&gt; 15 years; Gender; Year of notification; Operational classification categorized as paucibacillary and multibacillary; Number of registered household and outside contacts, classified by whole numbers starting with zero (no communications), and mode of entry, as new or not. The estimates obtained from the analysis of municipal indicators reveal that the coefficients of general detection and children under 15 years old remained at hyperendemic levels during the ten years of study with an apparent decrease in general detection to the period studied. Furthermore, according to national parameters, it was observed maintenance of a consistent number of diagnoses in children under 15 and insufficient contact examination coverage. Our study points to the importance of continuing leprosy control actions over time. Observing the findings related to some epidemiological and operational leprosy indicators in GV from 2001 to 2010 makes us aware of a high disease burden. Keywords: Epidemiological parameters, leprosy, operational indicators

Alterações bucais em pacientes com hanseníase: conhecimentos e práticas dos profissionais de nível superior da equipe Saúde da Família de um município do Nordeste Brasileiro

A hanseníase é uma doença infectocontagiosa que se manifesta principalmente através de sinais e sintomas dermatoneurológicos. Este estudo analisou o conhecimento e as práticas de profissionais de nível superior da equipe Saúde da Família (eSF) sobre a inter-relação entre a hanseníase e suas alterações bucais. Trata-se de um estudo transversal, observacional e analítico, com abordagem quantitativa. A amostra de conveniência compreendeu 24 médicos, 45 enfermeiros e 24 cirurgiões-dentistas (CDs) da eSF de um município do Nordeste do Brasil. O instrumento de coleta de dados foi um questionário estruturado com escalas do tipo Likert de 5 pontos. Baseado nos escores da pesquisa, interpretou-se que os profissionais possuem um conhecimento "insuficiente” sobre as alterações bucais na hanseníase e uma prática "adequada”. As evidências sinalizaram a necessidade do aprimoramento do conhecimento sobre a alterações bucais na hanseníase e organização das práticas profissionais de todos os envolvidos na eSF, pois para garantir o atendimento integral é fundamental despertar para a importância das práticas odontológicas no desenvolvimento das ações de controle a hanseníase na eSF.

Primary care quality and its effects on leprosy monitoring indicators.

to evaluate the quality of primary care in leprosy control actions, to correlate effects on monitoring indicators. a cross-sectional study, conducted in Belo Horizonte, from July to September 2014. Interviews with 408 professionals were conducted through the application of a tool that assesses attributes of primary care in leprosy control actions, and monitoring indicators were calculated. Spearman correlation was used, significance level p < 0.05. the overall score correlated with the percentage of cases treated in primary care and of family health staff coverage. The derived score correlated with the percentage of cases treated in primary care, and the essential score correlated with the proportion and rate of cases diagnosed, with grade 2 physical disability. the quality of leprosy control actions performed by primary care professionals produces impacts on health indicators, and developing strategies consistent with the reality of the territory is necessary.

Primary health care in leprosy, assessed by users and professionals

Objective: Evaluate the performance of primary health care in control of leprosy in Teresina, Brazil from the perspective of users and professionals.&#x0D; Methods: This cross-sectional, descriptive study involved 25 healthcare users with leprosy and 34 professionals (physicians and nurses) working in 13 municipal health units within the urban area of Teresina. The data were collected from January to June, 2017, using the Instrument for Assessing the Performance of Primary Care in Leprosy Control Actions, a document based on the Primary Care Assessment Tool/PCATool Brasil which measures the presence and extension of essential and derived attributes from primary health care.&#x0D; Results: The mean scores obtained for the essential, derived and global attributes, through the perception of the users, were lower than 6.6, indicating that the primary health services in Teresina are not sufficiently oriented to carry out leprosy control actions, mainly in terms of access, integrality of services provided, family orientation and community orientation. The professionals showed a contrasting view, with averages exceeding 6.6 for all attributes and scores. The difference in perception between the groups was significant for all attributes except for coordination (Mann-Whitney U test, p = 0.479).The overall evaluation of quality was not influenced by the user’s clinical or socioeconomic variables, but rather by the organization/provision of services.&#x0D; Conclusions: The municipal health units within the urban area of Teresina must be strongly guided by primary health care attributes in order to reach higher levels of user satisfaction.&#x0D;

Control Actions on Leprosy in Primary Health Care in a Brazilian Capital: Profile of Professionals and Users

Objective: analyze profile of users of primary health care services affected by leprosy, as well as the medical professionals and nurses responsible for the follow - up of these patients. &#x0D; Methods: This is a field study that surveyed the socioeconomic and clinical profile of 26 patients affected by leprosy, attended at the municipal health units of the urban area of ​​Teresina-PI, as well as the professional profile and clinical practices of 15 physicians and 19 nurses responsible for the follow-up of these patients.&#x0D; Results: It was observed a profile of people affected by leprosy, characterized by: individuals aged 50 years or more; predominantly male; with low schooling and income. The clinical characteristics reveal a high prevalence of multibacillary cases of leprosy and with a significant diagnosis of some degree of physical disability. Regarding the profile of the professionals and their clinical behaviors, it was verified that the majority had post-graduation and a long time of experience in primary health care and leprosy control actions, however, it has been shown that they do not always put into practice all actions necessary for the diagnosis and treatment of the disease.&#x0D; Conclusions: The profile of patients with leprosy treated at the municipal health units in the urban area of Teresina was similar to that found in other Brazilian territories, thus evidencing the need to implement public social support policies and more effective diagnostic and therapeutic follow-up practices by reduce the high rates of endemicity of the disease.

Avaliação do programa de controle da hanseníase: estudo por triangulação de métodos

Aim: To evaluate the municipal program of hanseniasis control in Canaã dos Carajás, PA. Method: This is a quantitative study, for the evaluation of health services, whose evaluative proposal is the triangulation of methods, through the study of the structure, processes and results. Results: several weaknesses were found in the program structure. Although some attributes have not been positively evaluated in a general aspect, the scores found allowed a good rating of the municipality's performance in terms of leprosy control actions. The appraised indicators showed fluctuations over the time series. Conclusion: the city has poor structure, high guidance for the development of leprosy actions in primary care and regular quality indicators according to the established parameters.

INCAPACIDADES FÍSICAS EM HANSENÍASE: CARACTERIZAÇÃO, FATORES RELACIONADOS E EVOLUÇÃO

Este estudo objetivou caracterizar os casos novos de hanseníase; analisar os aspectos socioeconômicos, demográficos, clínico-epidemiológicos e de acesso ao diagnóstico e tratamento relacionados à ocorrência de hanseníase com incapacidades físicas; e a evolução das incapacidades durante o tratamento. Foi realizada uma pesquisa de coorte retrospectiva na região de saúde de Diamantina-MG. Foram analisadas 107 notificações de hanseníase entre 2005 a 2010 e 71 entrevistas. A maioria dos diagnósticos foram multibacilares (73,2%) e com incapacidade física (79,1%). Houve relação estatística entre o desenvolvimento de deformidades físicas e os acometidos pela hanseníase com menor nível de escolaridade, com maior comprometimento neural e commaior dificuldade de deslocamento até a unidade de saúde, além de manutenção do grau de incapacidade física. Existe uma reduzida capacidade operacional da Estratégia de Saúde da Família quanto às Ações de Controle daHanseníase e necessidade de implementação da política de acordo com o Sistema Único de Saúde.

Decentralization of leprosy control actions in the micro-region of Almenara, State of Minas Gerais

This study analyzes the decentralization process of Leprosy control actions for Family Health Strategy units in the cities of the Almenara micro-region, in the state of Minas Gerais, Brazil. This qualitative research, based on the concept "Technological Organization of Work", was carried out in nine municipalities. Semi-structured interviews and document research were used for data collection. Forty-five interviews with care providers and health managers were conducted. The data collection took place between November 2007 and February 2008. Content Analysis was utilized to study the data and results indicate that the cities present different levels of decentralization and that the process was determined based on local specifications and on the engagement of care providers and health managers. Several cities kept a reference team to provide support to primary health care. The conclusion is that the decentralization process is a strategy that proves to be useful in facing Leprosy in the micro-region.

Role of dermatologists in leprosy elimination and post-elimination era: the Brazilian contribution

Dermatologists in Brazil have always been involved in care of leprosy patients, and have been alternating with public health physicians in the management of control policies. It is worth mentioning that Fernando Terra, founder of the Brazilian Society of Dermatology (BSD) in 1912, established the position of intern dermatologist at the Hospital dos Lizaros, in Rio de Janeiro, in 1913 (Souza-Araújo, 1952; Oliveira, 1991). In 1920, the dermatologist Eduardo Rabello formulated the first national public policy on the control of leprosy in the country, which was called 'Inspection of Prophylaxis of Leprosy and Venereal Diseases'. His son was an enthusiast of dermatological research and his main legacy was the polarity concept of leprosy (Rabelo, 1937). However, from 1930 to 1985, the public health physicians were in charge of the political guidelines that represented the period of establishing the vertical programmatic structure, with compulsory isolation of patients (1933-1962). Moreover, the federal states coordinated the control actions, based on the leprosy prophylaxis campaign. The dermatologists resumed the conduction of the control process in 1986, when multi-drug therapy (MDT) was implemented in the country, and in 1991, when decentralization of public healthcare services to the municipal level took place. In 2003 again, the dermatologists were no longer in control of the national policy. However, active dermatologists have acted in Brazilian references on diagnosis and treatment of Hansen's disease, at municipal, state and national levels. It is true that dermatologists have been getting away from leprosy control actions. And one could ask: who will replace this specialist? In the 'post-elimination' era, when the public primary healthcare technicians no longer consider leprosy of much significance, the knowledge of the expert in this disease and its differential diagnoses will be crucial.