BackgroundLow adherence to multidrug therapy against leprosy (MDT) is still an important obstacle of disease control, and may lead to remaining sources of infection, incomplete cure, irreversible complications, and multidrug resistance.Methodology/Principal FindingWe performed a population-based study in 78 municipalities in Tocantins State, central Brazil, and applied structured questionnaires on leprosy-affected individuals. We used two outcomes for assessment of risk factors: defaulting (not presenting to health care center for supervised treatment for >12 months); and interruption of MDT. In total, 28/936 (3.0%) patients defaulted, and 147/806 (18.2%) interrupted MDT. Defaulting was significantly associated with: low number of rooms per household (OR = 3.43; 0.98–9.69; p = 0.03); moving to another residence after diagnosis (OR = 2.90; 0.95–5.28; p = 0.04); and low family income (OR = 2.42; 1.02–5.63: p = 0.04). Interruption of treatment was associated with: low number of rooms per household (OR = 1.95; 0.98–3.70; p = 0.04); difficulty in swallowing MDT drugs (OR = 1.66; 1.03–2.63; p = 0.02); temporal non-availability of MDT at the health center (OR = 1.67; 1.11–2.46; p = 0.01); and moving to another residence (OR = 1.58; 95% confidence interval: 1.03–2.40; p = 0.03). Logistic regression identified temporal non-availability of MDT as an independent risk factor for treatment interruption (adjusted OR = 1.56; 1.05–2.33; p = 0.03), and residence size as a protective factor (adjusted OR = 0.89 per additional number of rooms; 0.80–0.99; p = 0.03). Residence size was also independently associated with defaulting (adjusted OR = 0.67; 0.52–0.88; p = 0.003).ConclusionsDefaulting and interruption of MDT are associated with some poverty-related variables such as family income, household size, and migration. Intermittent problems of drug supply need to be resolved, mainly on the municipality level. MDT producers should consider oral drug formulations that may be more easily accepted by patients. Thus, an integrated approach is needed for further improving control, focusing on vulnerable population groups and the local health system.

Migração entre pessoas com hanseníase: estudo de base populacional no Centro-Oeste do Brasil La migración entre personas con lepra: un estudio basado en la población en el centro de Brasil

RESUMOEm decorrência de surtos epidêmicos no Ceará, em especial no Cariri Cearense, faz-se relevante o mapeamento de casos por localidade, sendo este o objetivo principal deste trabalho. Os dados foram acessados pelo "Sinan Net", analisados pelos programas Microsoft Office Execel 2007, epiinfo (versão 3.5.2) e stata (versão 10) e relacionados a outras bibliografias. Os resultados foram que o desmatamento, migração e urbanização são características identificadas nas áreas afetadas, sendo possível identificar 3 municípios como mais acometidos com mais de 70% dos casos de LTA e LV e outros 3 como um possível novo "cluster" de transmissão. Conclui-se que na região a Leishmaniose é autóctone e a análise do quantitativo de casos demonstra que houve uma maior disseminação da patologia em determinadas localidades suscitando necessidade de melhor acompanhamento das áreas mais afetadas.Palavras-chave: leishmania; transmissão; aglomeração; endêmico; negligenciada ABSTRACTBecause of epidemic outbreaks in Ceará, Cariri from Ceará in particular, is relevant the mapping of cases by location to be this is the main objective of this work. Data were accessed by the "Sinan Net", analyzed with Microsoft Office Execel2007, epiinfo (version 3.5.2) and Stata (version 10) and bibliographies related. The results was deforestation, urbanization and migration characteristics are identified in the affected areas, it did possible to identify three towns most affected above 70% of cases of "LTA" and "LV" and other three as a possible new "cluster" of transmission. The conclusion was in region Leishmaniasis is autochthonous and the quantitative analysis of the cases shows that there was a greater spread of the disease in certain localities pointing need for better accompany of most affected areas.

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