PHYSICAL DISABILITIES IN LEPROSY: CHARACTERIZATION, FACTORS RELATED AND EVOLUTION* Gabriela de Cássia Ribeiro1, Francisco Carlos Félix Lana2 1Nurse. Ph.D. in Nursing. Nursing professor at the Federal University of Vale do Jequitinhonha e Mucuri. Diamantina, Minas Gerais, Brazil. 2Nurse. Ph.D. in Nursing. Professor at the Nursing School of the Federal University of Minas Gerais. Belo Horizonte, Minas Gerais, Brazil. ABSTRACT: The aim of this study was tocharacterize the new cases of leprosy; analyze socioeconomic, demographic, clinical-epidemiological, and access to diagnosis and treatment aspects related to the occurrence of leprosy with physical disabilities; and analyze the development of disabilities during treatment.A retrospective cohort survey was conducted in the health region of Diamantina, Minas Gerais, Brazil. One hundred seven reports of leprosy and 71 interviews were analyzed between 2005 and 2010. The most frequent diagnoses were multibacillary (73.2%) and physical disability (79.1%). There was a statistical relationship between the development of physical deformities and those affected by leprosy with lower levels of schooling, higher neural involvement, and greater difficulties in accessing the health unit, in addition to the maintenance of the degree of disability. There is a reduced operational capacity of the Family Health Strategy (FHS) regarding leprosy control actions and the need to implement the policy according to the Unified Health System (SUS, from its acronym in Portuguese). DESCRIPTORS: Leprosy; Epidemiology; Disabled persons; Health services accessibility. INCAPACIDADES FÍSICAS EM HANSENÍASE: INCAPACIDADES FÍSICAS EN ENFERMEDAD DE HANSEN: CARACTERIZAÇÃO, FATORES RELACIONADOS E CARACTERIZACIÓN, FACTORES ASOCIADOS Y EVOLUÇÃO EVOLUCIÓN RESUMO: Este estudo objetivou caracterizar os casos novos RESUMEN: Este estudio tuvo el objetivo de caracterizar de hanseníase; analisar os aspectos socioeconômicos, los casos nuevos de enfermedad de Hansen; analizar demográficos, clínico-epidemiológicos e de acesso ao los aspectos socioeconómicos, demográficos, clínico- diagnóstico e tratamento relacionados à ocorrência de epidemiológicos y de acceso al diagnóstico y tratamiento hanseníase com incapacidades físicas; e a evolução das relacionados a la ocurrencia de enfermedad de Hansen con incapacidades durante o tratamento. Foi realizada uma incapacidades físicas; y la evolución de las incapacidades pesquisa de coorte retrospectiva na região de saúde de durante el tratamiento. Fue realizada una investigación Diamantina-MG. Foram analisadas 107 notificações de retrospectiva en la región de salud de Diamantina-MG. hanseníase entre 2005 a 2010 e 71 entrevistas. A maioria Fueron analizadas 107 notificaciones de enfermedad de dos diagnósticos foram multibacilares (73,2%) e com Hansen entre 2005 y 2010, así como 71 entrevistas. La mayoría incapacidade física (79,1%). Houve relação estatística entre de los diagnósticos fue de multibacilares (73,2%) y con o desenvolvimento de deformidades físicas e os acometidos incapacidad física (79,1%). Hubo relación estadística entre pela hanseníase com menor nível de escolaridade, com el desarrollo de deformidades físicas y los acometidos por maior comprometimento neural e com maior dificuldade de la enfermedad de Hansen con menor nivel de escolaridad, deslocamento até a unidade de saúde, além de manutenção con mayor comprometimiento neural y con mayor dificultad do grau de incapacidade física. Existe uma reduzida de desplazamiento hasta la unidad de salud, además de capacidade operacional da Estratégia de Saúde da Família manutención del grado de incapacidad física. Hay una quanto às Ações de Controle da Hanseníase e necessidade reducida capacidad operacional de la Estrategia de Salud de de implementação da política de acordo com o Sistema la Familia cuanto a las Acciones de Control de Enfermedad Único de Saúde. de Hansen y necesidad de implementación de la política de DESCRITORES: Hanseníase; Epidemiologia; Pessoas com acuerdo con el Sistema Único de Salud. incapacidade física; Acesso aos serviços de saúde. DESCRIPTORES: Enfermedad de Hansen; Epidemiología; Personas con incapacidad física; Acceso a los servicios de salud. *Article extracted from the master’s thesis entitled “Factors related to the prevalence of physical disabilities in leprosy in the microregion of Diamantina, Minas Gerais.”Nursing School of the Federal University of Minas Gerais, 2012. Corresponding author: Received: 08/05/2015 Gabriela de Cássia Ribeiro Finalized: 10/08/2015 Universidade Federal dos Vales do Jequitinhonha e Mucuri Rodovia MGT 367, Km 583, nº 5000 - 39100-000 - Diamantina, MG, Brasil E-mail: [email protected] Cogitare Enferm. 2015 Jul/set; 20(3): 495-502 495 INTRODUCTION With the large number of late diagnoses and grade 2 disability in the health region of Leprosy has great importance for public health Diamantina, the objectives of this study were to because it is an infectious and chronic disease that characterize the new leprosy cases in the region primarily affects people in poor socioeconomic in the period between 2005 to 2010 andanalyze conditions. It has a long incubation period and the socioeconomic, demographic, clinical- there is a predilection for a bacillus known as epidemiological, and access to diagnosis and mycobacterium leprae by neural and epithelial treatment aspects related to the occurrence of cells, which makes it a highly disabling disease(1). leprosy with physical disabilities, in addition to identifying the development of disabilities in the However, leprosy is curable with supervised diagnosis and in the discharge medication. treatment using multidrug therapy (MDT), which may be of 6 or 12 months’ duration, depending on METHOD the operational classification(2). An epidemiological with retrospective cohort Leprosy patients are classified according to the study was conductedagainst the backdrop of the number of skin lesions, bacterial load, and level health region of Diamantina, located in Vale do of involvement of the peripheral nerves.When Jequitinhonha, Minas Gerais, Brazil. The region there is no neural involvement, patients are has 15 municipalities and approximately 167,000 classified as grade 0 in terms of disability. Grade inhabitants. 1 disability occurs when there is a decrease or loss of sensitivity in the eyes, hands, and feet, and The period defined for the study included the grade 2 disability when there are more serious years from 2005 to 2010. The choice of this time injuries inthe eyes, hands, and feet(2). periodwas made due to a specific feature of the physical disabilities related to leprosy, which are These complications may be responsible for highly sensitive to fluctuations in the operational permanent damage, as they may reach the nerve capacity of health services, especially regarding receptors responsible for pain, vision and tactile staff turnover. sensitivity, making the individuals affected by it more susceptible to accidents, burns, wounds, In five of the municipalities, there was no and even amputations, resulting in social and diagnosis of leprosy in this period. The research psychological damage that affects their quality of was conducted in 10 cities that had made life(3). notifications, which were: Alvorada de Minas; Carbonita; Coluna; Couto de Magalhães de For this reason, in 2010 the World Health Minas; Datas; Diamantina; Gouveia; Itamarandiba; Organization published The Enhanced Global Presidente Kubitschek; and Serro. Strategy for Further Reducing the Disease Burden due to Leprosy (2011-2015), and outlined the The database of the Information System for overall objective for the year 2015: a reduction of Notifiable Diseases (SINAN, from its acronym in 35% in leprosy diagnosis withgrade 2 disability Portuguese) “Leprosy for analysis of notifications” per 100,000 inhabitants, compared to the data was made available by the Coordination of the presented in 2010(1,4). Sanitary Dermatology Programfrom the State Department of Health and Health Regional For the success and scope of the proposed Superintendence of Diamantina. goal, the early diagnosis of leprosy is necessary, followed by proper treatment, surveillance of To collect data, a structured questionnaire, contacts, and access to public health services(5). divided into blocks, was used. The first block included the analysis of the SINAN notifications In 2013, Brazil recorded 31,044 new cases, of new cases of leprosy, and the other blocks presenting a detection rate of 15.44/100,000 were related to socioeconomic, demographic, inhabitants; 64.4% of these new cases were clinical-epidemiological, and access to diagnosis diagnosed as multibacillary, and 7.3% of patients and treatment aspects. had grade 2disability(6). One hundred seven SINAN reporting forms In 201, the health region of Diamantina, Minas were evaluated, and the sample consisted of 71 Gerais, Brazil, presented 16 new cases of leprosy, respondents. Thirty-six did not participate in the a detection rate of 9.6/100,000 inhabitants. study due to moving to cities outside the study However, 56.3% of the reports corresponded to area (10), impossibility of locating the individual the diagnosis of grade 2 disability(7). 496 Cogitare Enferm. 2015 Jul/sep; 20(3): 495-502 (15), and death (11). cases of leprosy were analyzed, and the city of Diamantina had the highest proportion of cases, Data collection took place between February with 47.7% (n=51), followed by the municipalities and March 2011. The subjects were contacted by