Chronic sequelae and disabilities are one of the main problems in leprosy. The current study aimed to estimate the prevalence of disabilities in leprosy patients after successfully completing multidrug therapy in Araguaína, Tocantins State, Brazil. This was a cross-sectional study including 282 cases diagnosed from 2004 to 2009. The degrees of disability at diagnosis and at discharge from treatment were collected from medical records and the National Information System for Notifiable Diseases (SINAN). A simplified neurological workup was performed after discharge from treatment. The prevalence of disabilities at diagnosis was 29.4%, and 8.9% of then was grade II. Between diagnosis and discharge, the degree of physical disability worsened in 25% of cases. At diagnosis, the proportion of deformities was significantly higher in men (RR = 1.7; 95%CI: 1.23-2.37). There was a significant association between disability and multibacillary disease (p < 0.001) and occurrence of reactions (p < 0.001). The data show that after discharge from multidrug therapy, in order to prevent chronic sequelae and functional limitations, continuous monitoring is still needed for individuals that have been recorded as cured and thus deleted from the records.

OBJECTIVE To analyze, stratifield by gender, trends of the new case leprosy detection rates in the general population and in children; of grade 2 disability, and of proportion of multibacillary cases, in the state of Bahia, Brazil from 2001 to 2014.METHODS A time series study based on leprosy data from the National Information System for Notifiable Diseases. The time trend analysis included Poisson regression models by infection points (Joinpoint) stratified by gender.RESULTS There was a total of 40,054 new leprosy cases with a downward trend of the overall detection rate (Average Annual Percent Change [AAPC = -0.4, 95%CI -2.8–1.9] and a non-significant increase in children under 15 years (AAPC = 0.2, 95%CI -3.9–4.5). The proportion of grade 2 disability among new cases increased significantly (AAPC = 4.0, 95%CI 1.3–6.8), as well as the proportion of multibacillary cases (AAPC = 2.2, 95%CI 0.1–4.3). Stratification by gender showed a downward trend of detection rates in females and no significant change in males; in females, there was a more pronounced upward trend of the proportion of multibacillary and grade 2 disability cases.CONCLUSIONS Leprosy is still highly endemic in the state of Bahia, with active transmission, late diagnosis, and a probable hidden endemic. There are different gender patterns, indicating the importance of early diagnosis and prompt treatment, specifically in males without neglecting the situation among females.

RESUMO RESUMO RESUMO RESUMO RESUMO Caracterizar a limitação funcional, de atividade, consciência de risco, e restrição à participação social em pessoas atingidas pela hanseníase no pós-alta. Estudo seccional-descritivo com 69 residentes em Sobral, Ceará, com alta entre 2003 a 2005. Foram realizados exame físico dermato-neurológico, avaliação demográfica, de limitação funcional-atividade-consciência de risco e de restrição à participação social. Vinte (28,9%) apresentaram escores SALSA 19 e 20 e escore EHF zero. O maior escore EHF foi alcançado por dois participantes, com 25 e 28 na escala SALSA. Na escala de participação 37 (53,6%) não apresentaram restrição e tinham escore EHF zero. Dois (2,9%) com escore EHF zero tinham leve restrição e 1 (1,5%), grande restrição. Reafirma-se a potencialidade destas ferramentas para a atenção integral aos portadores. Descritores: Descritores: Descritores: Descritores: Descritores: Hanseníase/reabilitação; Risco; Atividades cotidianas; Participação social. ABSTRACT ABSTRACT ABSTRACT ABSTRACT ABSTRACT To characterize the functional limitation, activity limitation, risk conscience, and the social participation in people reached by hansen's disease in the post-MDT period. Cross-sectional, descriptive study, accomplished in 2006. Sixty-nine residents in Sobral that had discharge from MDT between 2003-2005 participated. The subjects were interviewed: demographic evaluation, dermato-neurological exams, evaluation of functional limitation-activity-risk conscience and the restriction in social participation. Twenty (28.9%) presented SALSA scores 19 and 20 and EHF score zero. The largest EHF score was reached by two participants, with scores 25 and 28 in the SALSA scale. In the participation scale 37 (53.6%) didn't present restriction and had EHF scores zero. Two (2.9%) with EHF score zero had mild restriction, and 1 (1.5%) severe restriction. This study reaffirms the potentiality of these tools for integral care of people reached. Descriptors: Descriptors: Descriptors: Descriptors: Descriptors: Leprosy/rehabilitation; Risk; Activities of daily living; Consumer Participation. RESUMEN RESUMEN RESUMEN RESUMEN RESUMEN Caracterizar la limitación funcional de actividad, conciencia de riesgo y restricción a la participación social en personas atingidas por la lepra en el post-alta. Estudio seccional y descriptivo con 69 sitiados en Sobral, Ceará, con alta entre 2003 y 2005. Fueron hechos examen físico dermatológico y además neurológico, evaluación demográfica, de limitación funcional, actividad y conciencia de riesgo y de restricción a la participación social. Veinte (28,9%) presentaron escores SALSA 19 y 20 escore EHF cero. La mayor EHF fue alcanzada por dos participantes, con 25 y 28 años en la escala SALSA. En la categoría participación, 37 (53,6%) no presentaron restricción y tenían escore EHF cero. Dos (2,9%) con EHF cero tenían poca restricción y 1 (1,5%), gran restricción. Delante de eso, se afirma una vez más la potencialidad de éstas herramientas para la atención integral a los porta...

Introduction: Neural damages are among the main factors that contribute to physical disability in leprosy. Systematic monitoring using a broad physical, psychological and social approach is necessary. Objective: The objective of this study was to characterize the limitation of activity and social participation and its correlation with disabilities and/or impairment in individuals after being discharged from a multidrug leprosy therapy. Method: A cross-sectional study conducted in Araguaína, state of Tocantins, which is a leprosy hyperendemic municipality. We included cases of patients who were discharged from treatment considered as cured from January 2004 to December 2009. We performed dermatological examination and applied the Screening Activity Limitation and Safety Awareness (SALSA) and social participation scales. Results: We included 282 individuals (mean age: 45.8 years old). The paucibacillary operational classification was more common (170; 60.3%). The eye-hand-foot score ranged from 0 to 12 (mean: 0.7). A total of 84 (29.8%) individuals presented limited activity. A slight restriction in social participation occurred in 18 (6.3%) cases. There was a statistically significant correlation between activity limitation, age (r = 0.40; p < 0.0001) and degree of functional limitation (r = 0.54; p < 0.0001), as well as of restricted social participation, activity limitation (r = 0.56, p < 0.0001) and functional limitations (r = 0.54, p < 0.0001). Conclusion: Functional limitation due to leprosy had an impact on the conduct of activities and social participation after the discharge from a leprosy treatment. The association between Screening of Activity Limitation and Safety Awareness and participation scales will assist in designing evidence-based assistance measures.

Cad. Saúde Colet., 2014, Rio de Janeiro, 22 (4): 351-8Resumo O acesso universal aos serviços de saúde representa um processo complexo de inter-relações. Em um sentido mais amplo, incorpora dimensões que passam por aspectos econômicos, técnicos, políticos e simbólicos. Para doenças negligenciadas, como a hanseníase, por exemplo, reverte-se em maiores desafios. Este estudo objetivou caracterizar o acesso aos serviços de saúde por pessoas atingidas pela hanseníase em pós-alta de poliquimioterapia (PQT) nos municípios de Fortaleza e Sobral. Estudo transversal descritivo que incluiu 10% da população que recebeu alta entre 2003 e 2005 (304 pessoas), com caracterização sociodemográfica e clínica, bem como exploração de modalidades e contextos relativos ao acesso no pós-alta. A população era em sua maioria masculina (58%), com alta proporção de incapacidades físicas (34%) e estados reacionais (37%). A abordagem biomédica dos estados reacionais contemplou, em grande parte, a busca e a oferta de atenção nesse período. O acesso à atenção pós-alta foi frágil principalmente em intervenções como cirurgias reabilitadoras e atenção psicológica. Foram identificadas importantes lacunas em termos da operacionalização da atenção às pessoas atingidas no momento do pós-alta em ambos os municípios, o que traduz a relativa negligência em relação à hanseníase como condição crônica e o consequente distanciamento para a abordagem integral a essas pessoas no Sistema Único de Saúde (SUS).Palavras-chave: hanseníase; acesso aos serviços de saúde; atenção à saúde. AbstractUniversal access to health services represents a complex process of inter-relationships between users and health services. In a broader sense it includes economic, technical, political and symbolic aspects. For neglected diseases such as leprosy, this is a major challenge. This cross-sectional study aims to characterize access to health care services for people affected by leprosy after release from treatment in the cities of Sobral and Fortaleza. The study included a representative sample 10% of those concluding treatment from 2003 to 2005 (304 cases). Participants were characterized regarding socio demographic and clinical variables and access to health services after release from treatment. The study population was mostly male (58%), physical disabilities (34%) and with leprosy reactions (37%). The biomedical approach of leprosy reactions contemplated in large part to search for and supply of care in this period. The access to care after discharge was particularly weak in rehabilitative interventions such as surgery and psychological attention. We identified important gaps in the operationalization of attention to people affected after release from treatment in both cities. The date also shows the negligence of leprosy as a chronic condition and the resulting difficulties regarding on integrated distance to the comprehensive approach to people with leprosy after release from treatment in the Unified Health System (SUS).