Diagnóstico situacional e operacional das ações de controle da hanseníase em município hiperendêmico do maranhão

Abstract

INTRODUCTION: Limitations for the proper implementation of leprosy control actions (LCA) in states and municipalities can strongly contribute to the perpetuation of Mycobacterium leprae transmission in their communities. Thus, constant monitoring of local leprosy control programs seems to be essential for identifying weaknesses, performance and implementing solutions. OBJECTIVE: To conduct a situational and operational diagnosis of leprosy control actions in a hyperendemic municipality in Maranhão. METHOD: Exploratory, analytical, ecological study, with qualitative and quantitative research approach. Developed in the municipality of Imperatriz, covering the teams of the family health strategy (FHS), professionals linked to the leprosy control program, individuals notified with leprosy in the period from 2001 to 2020. Data from the Notifiable Diseases Information System (SINAN) were collected and analyzed. The cases were georeferenced and analyzed to identify spatial clusters. The home addresses of notified cases were georeferenced and analyzed to identify spatial clusters. The FHS territories were also georeferenced to produce digital maps of the coverage areas. These results guided an active search among contacts of index cases and students from two municipal public schools. RESULTS: After evaluating the ACH in the city through the LEM, it was identified that the Basic Health Units (BHU) do not act as recommended for the evaluation of people affected by the disease, causing difficulties in making a diagnosis and initiating treatment. From 2001 to 2020, 6,726 cases were reported in the municipality of Imperatriz, 5,842 were georeferenced (90.8%). The spatial distribution pattern of the cases was heterogeneous with the formation of statistically significant clusters. The distribution of cases by BHU identified that 13.99% of all cases in the period were identified by a BHU. Until 2020, the municipality of Imperatriz had 41 FHS teams in the urban area of the municipality, which represented 60% of FHS coverage. The coverage area of 39 teams (95%) was georeferenced. The analysis indicated that individuals residing in a discovered area by the FHS are 14% more likely to be diagnosed with multibacillary (OR: 1.14; 95%:1.05-1.32; p=0.04) and 40% more chance of having chronic grade 2 disabilities at diagnosis (OR: 1.40; 95% :1.07-1.84; p=0.01). It was observed that over the years the chance of occurrence of multibacillary cases increased (year 2002: OR: 1.67; 95%:1.14-2.44; p<0.001; year 2019: OR: 8.06; 95%:4.86-13.36; p<0.001). The active search action resulted in three (17.6%) diagnoses of relapses among the index cases, 17 (25.3%) new cases among their household contacts and nine (12.3%) new cases among the students. CONCLUSION: Despite the high number of diagnoses carried out by the municipality, the present study identified weaknesses that result in relevant hidden endemic disease. The desired control of leprosy as a public health problem will not be achieved before the effective diagnosis and treatment of current cases that have not yet been identified. Case detection would increase significantly if the fight against leprosy was adequately carried out by the health system.