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BackgroundAlthough the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method.MethodsData were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk—RR) of leprosy. Maps considering these risks and their confidence intervals were constructed.ResultsA total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721–4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133–52.984) and 15.24 (95%CI = 10.114–22.919).ConclusionThese findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.

This study aimed to analyze user satisfaction with access and care in Primary Health Care (PHC) based on non-urgent demand for emergency services. 28 non-urgent users of emergency services were intentionally interviewed across five health districts in the city of Riberão Preto in São Paulo State. These users had been treated in PHC at least once in the previous six months prior to data collection aimed at evaluating the services. Content analysis was used to analyze the interviews. The results showed there to be satisfaction with care received from health professionals in PHC and dissatisfaction with delays in arranging an appointment and with difficulty to receive care based on spontaneous demand. There was found to be no difference in the levels of satisfaction between the users from different health districts. The article concludes that obstacles to access to PHC services represent a barrier for populations wishing to receive care, with repercussions in terms of user satisfaction and high demand for emergency care. To ensure universal, equal, and organized access to actions and services at different levels, healthcare networks were created that constitute organizational arrangements of sets of health services coordinated among themselves through common goals and cooperative and interdependent actions that enable the provision of continuous and comprehensive care to the population, coordinated by primary health care (PHC). 2 However, profound changes must be made in order for this form of care organization to overcome a fragmented healthcare system that does not ensure continuity and is centered on acute conditions, through emergency care units (ECUs). 2 Emergency care units are also defined as points of entry to initial health care by SUS users. 3 However, the guarantees set forth in Brazilian legislation represent one step among many required to construct the SUS. For the right to health to become a reality, changes must occur in the social model, because in practice, access is still selective, focalized, and excludisionary. 4 From this perspective, even though they are considered a point of entry to the system, ECUs treat only the main complaints that led users to the health service. 5 This frequent search for emergency care demonstrates that the health needs of users are not being met by PHC. When users resort to health services, they are looking for something or some action from health professionals that will resolve, or at least minimize, the problem that led them to seek out that service. Thus, it is understood that if a point of entry fails, necessary care is postponed. 6 Health needs are related to social production and reproduction, and accessibility to health actions. Additionally, health care must be planned, considering existing demand, COMUNICAÇÃO SAÚDE EDUCAÇÃO 2018; 22(65):387-98and that health services that must be willing to address these needs, understanding their meanings and the subjects involved in the production and consumption of health. 7 According to this logic, humanization means tak...