RESUMO
Major gaps still exist in the knowledge about leprosy, particularly with regard to how it spreads. Leprosy epidemiology remains complicated due to the specific characteristics of Mycobacterium leprae. To describe epidemiologic trends for the 21st century, the first part of this paper gives an overview of the epidemiology of leprosy, followed by past trends and the present situation of new-case detection as a proxy of the incidence. The third part, regarding predicted epidemiologic trends for the 21st century, elaborates on the main topic of this paper. With limited diagnostic tools to detect infection with M leprae, other methods are necessary to estimate trends in incidence and transmission. A computer program has been developed for modeling the transmission and control of leprosy (SIMLEP). The effect of failure to sustain early case detection beyond 2005 on leprosy incidence and case detection is shown. Important unanswered questions are whether the incubation period is contagious and how rapid close contacts of leprosy patients are infected. As long as such key questions remain unanswered, it will be difficult to estimate the impact of control strategies on the transmission of M leprae on resulting disease incidence. In the meantime we can expect that the global new-case detection trends will stay more or less stable or only decrease slightly for many years to come. There is a need of new preventive interventions to change this situation and reduce the incidence of leprosy in the 21st century.
Assuntos
Humanos , Hanseníase/epidemiologia , Fatores de Tempo , PrevisõesRESUMO
BACKGROUND: Since the introduction of the national notifiable diseases information system (SINAN) in Pernambuco State, Brazil, in 1994, many problems have been encountered. The aim of this study was to evaluate the SINAN software, quality of data input, the transfer of the computerised data from the municipality to state levels, human resources and other factors associated with the health information system infrastructure (HIS). METHODS: A cross-sectional study was carried out in Pernambuco state, North-eastern Brazil, in 2005. A sample of health regions and municipalities was chosen. SINAN forms from those municipalities were analysed and the flow of notifications followed from municipal level to the regional and finally to the state. Professionals from health units, district, municipal and regional Hansen's Disease Control Programme (HDCP) and Epidemiological Surveillance System (ESS) coordinators, health secretaries and managers of the municipalities and health regions selected were interviewed. RESULTS: SINAN software is functioning up to expectation. However, at all levels of the health system, serious weaknesses not related to the SINAN software were found, varying from lack of human resources (limited number of staff and staff development), lack of infrastructure (office space, computers, supplies, etc.) to an absence of effective coordination, management and supervision of the HIS. CONCLUSIONS: Lack of reliable, complete and timely information, and especially the lack of widespread analysis and use of available information in planning and management of health services were the main weaknesses found. Many areas need urgent attention: the quality of patient examination, recording and reporting, the timely processing of quality data, the coordination and management of disease control programmes, and the use of HIS reports by the health services and health managers. Regular feedback, supportive supervision visits and annual reviews are essential to monitor the system and make sure that essential information is decentralised and used by the primary health services and HDCP coordination. Assessing the quality of services from a client perspective would give additional information for the identification of strengths and weaknesses of the Hansen's disease (leprosy) services.
Assuntos
Sistemas de Informação Administrativa/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , Serviços Preventivos de Saúde/organização & administração , Brasil/epidemiologia , Estudos Transversais , Estudos de Avaliação como Assunto , Humanos , Sistemas de Informação , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , SoftwareRESUMO
No Brasil, a hanseníase permanece como um importante problema de saúde pública. Embora um grande progresso tenha sido obtido nos Programas de Controle da Hanseníase (PCH), em todos os níveis do governo nos últimos 20 anos, algumas ações não foram potencializadas. O motivo: lacunas de informação relacionadas a áreas específicas da doença, exacerbadas pela ausência de instrumentos apropriados para avaliação e análise sistemática. As Investigações em Sistemas de Serviços de Saúde (ISSS) visam obter dados necessários para a disponibilização de informações relevantes a gestores e coordenadores de programas com vistas à tomada de decisões mais sólidas. No Brasil, quatro cursos de ISSS para o PCH foram organizados por duas organizações não-governamentais (ONGs) Netherlands Leprosy Relief (NLR) e a British Leprosy Relief Association (LRA), entre 2001 e 2005. Equipes chave que atuavam no PCH de vários estados foram convidadas para participar dos cursos. As propostas de pesquisas eram desenvolvidas durante um seminário de ISSS e desenvolvidas no campo. Os temas de pesquisa dos projetos incluíram: integração dos PCH na rede de serviços de atenção primária; porcentagem elevada de casos novos diagnosticados e tratados em centros de referência do estado; impacto psicológico e social de reabilitação cirúrgica; eficácia da neurolise; qualidade do sistema nacional de informações em saúde e efetividade da detecção de novos casos e de campanhas de educação em saúde. Após a conclusão do trabalho de campo, os dados foram analisados com a elaboração de relatórios de pesquisa. Os resultados e a recomendações foram apresentados posteriormente a financiadores e gestores dos estados. Os resultados práticos das oficinas de ISSS incluem a definição de novas diretrizes nos PHC; a melhoria de bancos de dados do sistema nacional de informação em saúde e a revisão dos dados epidemiológicos. Estes resultados foram apresentados em congressos nacionais e internacionais e publicados em revistas...
Assuntos
Humanos , Serviços de Saúde , Hanseníase/prevenção & controle , Sistemas de Informação , Pesquisa Operacional , BrasilRESUMO
O objetivo deste artigo é avaliar o papel das ações educativas em saúde específicas para hanseníase em relação aos fatores que influenciam o usuário a buscar o serviço, bem como a forma com que ele adquiriu o conhecimento sobre hanseníase. A população deste estudo foi constituída por casos novos de hanseníase do município de Ariquemes, Rondônia, do primeiro semestre de 2004. Caracteriza se por ser descritivo exploratório. Responderam ao questionário 55 indivíduos. Verificou-se que a televisão e cartazes têm papel considerável para informar, mas não para motivar. A rede social família com parentes em tratamento ou em alta foi fundamental na motivação pela procura do atendimento e na aquisição do conhecimento sobre a doença. O conteúdo assimilado através de ações educativas não evoca o preconceito ou medo, mas não foi suficiente para acabar com o estigma já existente. As ações educativas em saúde só atingirão sua função quando considerarem que os indivíduos acometidos com esta doença não são cidadãos isolados, que seu contexto familiar é o núcleo central motivador e que merecem uma atenção ininterrupta das esferas governamentais, no tocante à educação, ao acesso ao serviço, à manutenção de sua dignidade. Conclui-se que é necessário planejar e compor campanhas educativas cujos contextos sejam os familiares e específicos da região.
Assuntos
Humanos , Educação em Saúde , Hanseníase/prevenção & controle , Meios de Comunicação de MassaRESUMO
Para descrever a satisfação de indivíduos atingidos pela hanseníase com neurite grave, submetidos à neurolise de troncos periféricos, 70 indivíduos foram entrevistados no Estado de Rondônia. Foram utilizados questionários estruturados com perguntas fechadas para avaliar os aspectos sócio-demográficos e clínicos. Além disso, foi avaliada a opinião e a satisfação em relação à neurolise, utilizando se perguntas abertas. Quarenta e cinco (64,3 por cento) eram do sexo masculino (idade média: 43 anos; variação: 18 - 81 anos). A maioria dos indivíduos (77 por cento) apresentava a forma dimorfa da doença. Sessenta (85 por cento) estavam satisfeitos com o resultado da cirurgia. Não houve nenhuma diferença considerável relativa à satisfação, quando estratificada segundo tronco nervoso operado. Os dados oriundos das perguntas abertas foram categorizados segundo temas: dor, perda sensitiva, déficit motor, dificuldades para realizar atividades diárias, trabalho e lazer. A opinião mais importante foi alívio da dor e possibilidade de realização de atividades diárias novamente. A aparência estética da cicatriz foi mencionada como um aspecto negativo por um indivíduo. Os dados evidenciam que a descompressão cirúrgica foi vista de modo positivo pelos indivíduos atingidos pela hanseníase, mas que há aspectos psico sociais que precisam de atenção. A satisfação dos pacientes deve ser levada em consideração, como também a avaliação objetiva da dor e o déficit sensitivo e motor após neurólise.
Assuntos
Humanos , Hanseníase , Neurite (Inflamação) , Neuritos/cirurgia , Satisfação do PacienteRESUMO
No Brasil, a hanseníase permanece como um importante problema de saúde pública. Embora um grande progresso tenha sido obtido nos Programas de Controle da Hanseníase (PCH), em todos os níveis do governo nos últimos 20 anos, algumas ações não foram potencializadas. O motivo: lacumas de informação relacionadas a áreas específicas da doença, exacerbadas pela ausência de instrumentos apropriados para avaliação e análise sistemática. As Investigações em Sistemas de Serviços de Saúde (ISSS) visam obter dados necessários para disponibilização de informações relevantes a gestores e coordenadores de programas com vistas à tomada de decisões mais sólidas. No Brasil, quatro cursos de ISSS para o PCH foram organizados por duas organizações não-governamentais (ONGs), Netherlands Leprosy Relief (NLR) e a British Leprosy Relief Association (LRA), entre 2001 e 2005. Equipes-chave que atuavam no PCH de vários estados foram convidadas para participar dos cursos. As propostas de pesquisas eram desenvolvidas durante um seminário de ISSS e desenvolvidas no campo. Os temas de pesquisa dos projetos incluíram: integração dos PCH na rede de serviços de atenção primária; porcentagem elevada de casos novos diagnosticados e tratados em centros de referência do estado; impacto psicológico e social de reabilitação cirúrgica; eficácia da neurolise; qualidade do sistema nacional de informações em saúde e efetividade da detecção de novos casos e de campanhas de educação em saúde. Após a conclusão do trabalho de campo, os dados foram analisados com a elaboração de relatórios de pesquisa. Os resultados e as recomendações foram apresentados posteriormente a financiadores e gestores dos estados. Os resultados práticos das oficinas de ISSS incluem a definição de novas diretrizes nos PCH; a melhoria de bancos de dados do sistema nacional de informação em saúde e a revisão dos dados epidemiológicos. Estes resultados foram apresentados em congressos nacionais e internacionais e publicados em revistas científicas. As ISSS tiveram um resultado positivo nas rotinas de trabalho dos treinandos por meio do processo de ensino da metodologia de pesquisa, da coleta de dados relevantes e da implementação das recomendações que se originam dos trabalhos. Conclui-se que as ISSS são veículos importantes para o desenvolvimento de profissionais de saúde e como ferramenta prática para melhorar a efetividade dos PCH, principalmente nos níveis estaduais e municipais. As ISSS também são um exemplo de uma cooperação bem sucedida entre /ongs e organizações governamentais que trabalham com PCH.
Assuntos
Hanseníase/diagnóstico , Hanseníase/epidemiologia , Hanseníase/fisiopatologia , Hanseníase/prevenção & controleRESUMO
O objetivo deste artigo é avaliar o papel das ações educativas em saúde específicas para hanseníase em relação aos fatores que influenciam o usuário a buscar o serviço, bem como a forma com que ele adquiriu o conhecimento sobre hanseníase. A população deste estudo foi constituida por casos novos de hanseníase do município de Ariquemes, Rondônia, do primeiro semestre de 2004. Caracteriza-se por ser descritivo exploratório. Responderam ao questionário 55 indivíduos. Verificou-se que a televisão e cartazes têm papel considerável para informar, mas não para motivar. A rede social - família com parentes em tratamento ou em alta - foi fundamental na motivação pela procura do atendimento e na aquisição do conhecimento sobre a doença. O conteúdo assimilado através de ações educativas não evoca o preconceito ou medo, mas não foi suficiente para acabar com o estigma já existente. As ações educativas em saúde só atingirão sua função quando considerarem que os indivíduos acometidos com esta doença não são cidadãos isolados, que seu contexto familiar é o núcleo central motivador e que merecem uma atenção ininterrupta das esferas governamentais, no tocante à educação, ao acesso ao serviço, à manutenção de sua dignidade. Conclui-se que é necessa´rio planejar e compor campanhas educativas cujos contextos sejam os familiares e específicos da região.
Assuntos
Humanos , Hanseníase/epidemiologia , Hanseníase/fisiopatologia , Hanseníase/prevenção & controleRESUMO
Para descrever a satisfação de indivíduos atingidos pela hanseníase com neurite grave, submetidos à neurolise de troncos periféricos, 70 indivíduos foram entrevistados no Estado de Rondônia. Foram utilizados questionários estruturados com perguntas fechadas para avaliar os aspectos sócio-demográficos e clínicos. Além disso, foi avaliada a opinião e a satisfação em relação à neurolise, utilizando-se perguntas abertas. Quarenta e cinco (64,3%) eram do sexo masculino (idade média: 43 anos; variação: 18-81 anos). A maioria dos indivíduos (77%) apresentava a forma dimorfa da doença. Sessenta (85%) estavam satisfeitos com o resultado da cirurgia. Não houve nenhuma diferença considerável relativa à satisfação, quando estratificada segundo tronco nervoso operado. Os dados oriundos das perguntas abertas foram categorizados segundo temas: dor, perda sensitiva, déficit motor, dificuldades para realizar atividades diárias, trabalho e lazer. A opinião mais importante foi alívio da dor e possibilidade de realização de atividades diárias novamente. A aparência estética da cicatriz foi mencionada como um aspecto negativo por um indivíduo. Os dados evidenciam que a descompressão cirúrgica foi vista de modo positivo pelos indivíduos atingidos pela hanseníase, mas que há aspectos psico-sociais que precisam de atenção. A satisfação dos pacientes deve ser levada em consideração, como também a avaliação objetiva da dor e o déficit sensitivo e motor após neurolise.
Assuntos
Humanos , Hanseníase/cirurgia , Hanseníase/epidemiologia , Hanseníase/fisiopatologia , Hanseníase/reabilitaçãoRESUMO
Would it not have been better to have left out the word 'elimination' altogether in the question and do what WHO has done in its new strategic plan for 2006-2010, 'Global Strategy for further reducing the Leprosy Burden and Sustaining Leprosy Control Activities'? Why not use a title such as 'The Role of Dermatologists in reducing the Leprosy Burden and Sustainig Leprosy Control Activities'? Some elements of the 'foundation' of the elimination policy have been (and are still) very controversial, its definition and the unsubstantiated (up till now) claim that when reaching a prevalence rate of less than 1 per 10,000, the transmission of the infection would be interrupted and the incidence would therefore decline.
Assuntos
Controle de Doenças Transmissíveis/métodos , Dermatologia , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Brasil/epidemiologia , Controle de Doenças Transmissíveis/tendências , Doenças Endêmicas , Política de Saúde , Humanos , Hanseníase/terapia , Organização Mundial da SaúdeRESUMO
In Brazil, Hansen's disease (HD) is still a public health problem. Although much progress has been made in Hansen's disease control (HDC) at all levels of government over the past 20 years, efforts have been hampered by information gaps related to specific areas of the disease, exacerbated by an absence of appropriate evaluation instruments and routine systematic analysis. Health Systems Research (HSR) aims to collect the necessary data to provide the most relevant information to policy makers and health managers to take more informed decisions. In Brazil, four HSR courses on HDC were organized by two non-governmental organizations (NGOs), Netherlands Leprosy Relief (NLR) and the British Leprosy Relief Association (LEPRA) between 2001 and 2005. Key personnel working in HDC from various states were invited to participate in the courses. The research proposals were developed during an HSR workshop and carried out in the field. The research topics of the projects included the following: the integration of HDC programmes into the primary health care system; the high percentage of the new patients diagnosed and treated at state referral centres; the psychological and social impact of surgical rehabilitation; the efficacy of neurolysis; the quality of the national health information system and the effectiveness of new case detection and health education campaigns. Following the completion of the field work, the data were analysed and a research report written. The results and recommendations were later presented to key stakeholders and policy makers in the states. Practical outcomes of the HSR courses include the drafting of new HDC guidelines; improvement of health information system databases and the revision of epidemiological data. These results have been presented at national and international congresses and published in peer-reviewed jornals. HSR has had a positive impact on the working routines of trainees through the process of learning the research methodology, collecting relevant data and implementing the recommendatons that originate from the findings. We conclude that HSR is an important vehicle for human resource development and a practical tool to improve the effectiveness of HDC programmes, primarily at the state and municipal levels. HSR also is an example of a successful cooperation between NGOs and governmental organizations working in HDC.
Assuntos
Controle de Doenças Transmissíveis/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Serviços Preventivos de Saúde/organização & administração , Brasil/epidemiologia , Currículo , Humanos , Formulação de Políticas , Pesquisadores/educaçãoRESUMO
This retrospective study of impairments in a decentralized and integrated, routine Hansen's disease (HD) programme was done on a cohort of all new patients detected in Rondônia state from 1996 to 1999. It shows that the dynamics of impairments during treatment in Rondônia are similar to what has been published in other recent studies from Africa and Asia. Data about impairments at detection and at release from treatment (cure), the prescription of steroids, and epidemiological information are provided. Of the original 5350 new patients, 4230 patients (80%) completed multidrug therapy (MDT) and had complete data about their impairment status. At the start of treatment, 9% of the paucibacillary (PB) and 26% of the multibacillary (MB) patients had WHO grade 1 impairment. Three percent of the PB and 11% of the MB patients had visible deformities (WHO grade 2 impairment). Of the patients without impairments (grade 0) at the start of treatment, 5% of the PB and 20% of the MB patients developed impairments during treatment. Of the PB patients with a WHO impairment grade 1 at start of treatment, 34% improved and 6% got worse. Of the MB patients 34% improved and 12% became worse. In a separate study of patients from the 1997 intake, 17% of the PB and 58% of the MB patients were treated at least once with a course of steroids or thalidomide during MDT treatment. It is noted in the literature that the percentage of persons with recent nerve function impairment (NFI), nerve pain or tenderness and/or reaction reactions differs between projects. This may reflect real differences or may be caused by differences in routine monitoring and/or criteria and methods of treatment. The use of the WHO maximum score, particularly for the patients with grade 2, is not as sensitive to change as utilizing the summary of Eye, Hand and Foot (EHF) scores. If overall impairment figures are given, the proportions of MB patients may define the differences between projects, therefore it is important to analysis and present the results of PB and MB patients separately. The most simple (outcome) indicator to estimate the effectiveness of patient management would be the proportions of patients with impairment grade 0 at start of treatment who develop either grade 1 or 2 impairments during treatment. An additional (outcome) indicator could be the proportion of patients with impairment grade 1 at start of treatment who develop grade 2 impairments during treatment. Currently, no operational targets or acceptable level of performance for patient management have been set. This would be important to enable programme managers to determine if adequate patient education, treatment and follow up have been provided after the disease detection to prevent and/or minimize problems associated with the disease. The available evidence strongly suggests that reactions and impairments related to HD will continue to occur in large numbers, requiring the development of adequate infrastructures and sustainable services to detect and to manage problems associated with HD during and after MDT treatment.
Assuntos
Controle de Doenças Transmissíveis , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/prevenção & controle , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Coortes , Avaliação da Deficiência , Quimioterapia Combinada , Doenças Endêmicas , Feminino , Humanos , Incidência , Hansenostáticos/administração & dosagem , Hanseníase/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Estudos Retrospectivos , Medição de Risco , População Rural , Índice de Gravidade de Doença , Organização Mundial da SaúdeRESUMO
AIM: This paper is the first in a series of three reports on the occurrence of reactions and impairments in leprosy in Thailand. This first paper gives a general overview about the methodology of the study, some epidemiological observations, delay in detection, multidrug therapy (MDT) completion rates and relapses. The other two papers report on: II. Reactions and III. Neural and Other Impairments. This study was carried out from 1987 until 1995 in three neighboring provinces in northeastern Thailand. STUDY DESIGN: A population-based, prospective cohort study. STUDY POPULATION: All 640 newly diagnosed leprosy patients in the three provinces, registered between October 1987 and September 1990, were included [420 paucibacillary (PB) and 220 multibacillary (MB)]. This group was followed up (actively and passively) until the end of 1995. METHODS: Patients were found by active and passive case finding. All new, untreated leprosy patients from the area were enrolled and started on the World Health Organization (WHO) MDT (WHO/MDT) regimen. A vertical control service was run by specialized leprosy workers. During treatment the patients received their monthly doses at home. During surveillance the patients were followed up once a year by a special team. Patients were questioned about delay in detection. Treatment completion rates were calculated. The occurrence of reactions and neural and other impairments at the beginning of, during and after treatment was ascertained. After treatment, the occurrence of late reactions and relapses was recorded. RESULTS: A higher frequency of leprosy was found among the male patients, especially in the MB group. However, in the PB group a higher female/male ratio was found in the age group 55 years and older. There was an increase in the detection rate from the youngest age group to the age group 55 years and older, which showed the highest detection rate. Treatment completion rates were high, 95% in both in the PB and MB treatment groups. About 50% of the new cases reported a delay between onset and registration of 1 year or more. By 1995, 93% of the original patient group was still available for follow up. By the end of 1995, 8 PB and 2 MB relapses were recorded.
Assuntos
Masculino , Feminino , Humanos , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Hanseníase/tratamento farmacológicoRESUMO
AIM: This is the second paper in a series of three papers on the occurrence of reactions and impairments in leprosy in Thailand, and focuses on the prevalence and incidence of reactions, including silent neuropathy. STUDY DESIGN: A population-based, prospective cohort study. STUDY POPULATION: All 640 newly diagnosed and registered leprosy patients in three neighboring provinces in northeastern Thailand registered between October 1987 and September 1990 were included [420 paucibacillary (PB) and 220 multibacillary (MB)]. This group was followed up (actively and passively) until the end of 1995. METHODS: Clinical data and data on the sensibility and motor function of the eyes, hands and feet were obtained when appropriate. The occurrence of reactions, including silent neuropathy, at the beginning of, during and after treatment was ascertained. During surveillance mild late reactions were also recorded. RESULTS: Severe reversal reactions (RR) at the start of and during treatment were seen in 2.6% [confidence interval (CI) 1.1-4.1] of the PB and 29% (CI 23-35) of the MB patients. In the PB group the majority (82%) of severe RR were found at the start of treatment. In the MB group 35% of the severe RR were found at the start of treatment and another 59% during the first year of treatment. It is shown that there is a statistically highly significant increasing proportion of patients with severe RR starting from tuberculoid and going toward borderline lepromatous. The incidence rate of severe RR during treatment was 1.4 (CI 0.46-4.5) per 100 person-years at risk (PYAR) for PB patients and 12 (CI 9.0-16) per 100 PYAR for MB patients. Late (mild and severe) RR were seen in 2.7% of the PB and 9% of the MB patients (35% of these reactions being considered severe). Late reactions were mainly seen in borderline tuberculoid (PB group) and in borderline lepromatous patients. Recent silent neuropathies were seen at first examination and during treatment in 1.4% of the pB and 4.1% of the MB patients. During surveillance only a few silent neuropathies were seen. If all severe RR, severe erythema nodosum leprosum and silent neuropathies at the start of, during and after treatment were added together, then 53% of the borderline lepromatous and 42% of the lepromatous patients had or developed one or another serious complication in need of steroid treatment.
Assuntos
Masculino , Feminino , Humanos , Doenças do Sistema Nervoso Periférico/etiologia , Hanseníase/complicações , Hanseníase/epidemiologia , Hanseníase/prevenção & controleRESUMO
AIM: This the third paper in a series of three papers on the occurrence of reactions and impairments in leprosy in Thailand, and focuses on the prevalence and incidence of neural and other impairments in leprosy. STUDY DESIGN: A population-based, prospective cohort study. STUDY SUBJECT: All 640 newly diagnosed and registered leprosy patients in three provinces of northeastern Thailand between October 1987 and September 1990 were included [420 paucibacillary (PB) and 220 multibacillary (MB)]. This group of patients was followed up until the end of 1995. METHODS: Clinical data; data on the sensibility and motor function of eyes, hands and feet, and data on wounds and bone loss were obtained where appropriate. The occurrence of neural and other impairments at first examination, during treatment and during surveillance was ascertained. RESULTS: The relationship between impairment prevalence (grade 2 of the combined PB and MB groups and grades 1 and 2 together of the combined PB and MB groups) and duration of disease (before diagnosis) was found to be statistically significant. Increased delay in detection led to increased problems of impairments. Too many patients still develop new/additional impairments while on treatment and thereafter. The incidence of nerve function impairment (NFI) among patients without impairments at first examination while on treatment was 1.7 [ 95% confidence interval (CI) 0.45-4.4] per 100 person-years at risk (PYAR) for the PB group and 12 (CI 8.4-17) per 100 PYAR for the MB group. Additionally, 2% of the PB and 11% of the MB patients who already had impairments at first examination developed new NFI while on treatment. The outcome, comparing the first examination with the last examination during/after surveillance [changes in the voluntary muscle test (VMT), the sensory test (ST), wound count and bone loss], indicated that of the PB patients 3.7% improved, 3.7% got worse and 3.9% kept the same impairment; of the MB patients 19% improved, 18% got worse and 2.9% kept the same impairment. During treatment most of the new/additional impairments were due to new/increase in NFI; during surveillance slightly more than 50% were due to new/increase in NFI. Eighty-three percent of the MB patients without impairments at first examination who developed NFI during treatment improved (completely or partially) after receiving prednisolone. Only 62% of the MB patients with a grade 1 impairment at first examination and who developed a severe reaction or recent silent neuropathy improved after receiving prednisolone. There is a need for an indicator to measure new/additional impairments while on treatment and thereafter. It is proposed to measure changes in impairment by measuring changes in VMT, ST, wound count and bone loss.
Assuntos
Masculino , Feminino , Humanos , Doenças do Sistema Nervoso Periférico/etiologia , Hanseníase/complicações , Hanseníase/epidemiologia , Hanseníase/prevenção & controleRESUMO
The aim of this prospective study was to determine the effectiveness and safety of the multidrug therapy as recommended by the World Health Organization (WHO/MDT) in 1982. One-hundred-eighty-eight newly diagnosed leprosy patients [130 paucibacillary (PB) and 58 multibacillary (MB) patients] from three provinces in northeastern Thailand were recruited into a study from April 1984 to March 1985. The study lasted until May 1996. The results showed that 182 patients finished their course of WHO/MDT, representing a treatment completion rate of 95%; 167 (122 PB and 45 MB) were released from surveillance (RFS); 82 PB patients were still available for follow up by the end of 1994 and 31 MB patients by May 1996. Two PB patients were diagnosed with a relapse, showing a relapse rate of 0.2 per 100 person-years at risk. After an average of 8 years of follow up, no MB relapses have been diagnosed. The proportion of patients with a WHO grade 2 disability among PB and MB patients increased from 4% and 8% at the start of treatment to 7% and 13% at last examination, respectively. It is concluded that the fixed-duration, 6-month WHO/MDT regimen for PB leprosy and the 24-month regimen for MB leprosy are effective, acceptable and safe, and that clinical activity, histopathological activity and/or a positive skin smear at release from treatment (RFT) have no bearing on the efficacy of the WHO/MDT regimens. The relapse rates are low and in accordance with most published data available to date. The importance of skin-smear services for a reliable classification (WHO PB/MB classification for control programs) is stressed.
Assuntos
Masculino , Feminino , Humanos , Adulto , Hanseníase/classificação , Hanseníase/tratamento farmacológico , Organização Mundial da Saúde/organização & administraçãoRESUMO
The rapid village survey (RVS) method has been developed as a simpler, less-expensive alternative to random sample surveys for determining the prevalence of leprosy and was compared with a total population survey (TVS). In the RVS, the cluster population receives clear information about the disease, and those with symptoms are invited to be examined by the survey team. A list of household contacts and suspects was made and those on the list were actively traced. The registered population was 20,815; 10 new patients were found among the 2034 people self-reporting in the RVS, 0 among the household contacts and suspects, and an additional 2 new patients in the TVS. There were 12 registered patients among the sample population. The prevalence rate found by the RVS was 1.06 per 1000(95% CI = 0.49-1.63) and in the TVS 1.16 per 1000 (95% CI = 0.5-1.77). The man-days and costs of an RVS are considerably less than those for a TVS. It was concluded that the RVS is a valid replacement for the TVS as conducted in Khon Kaen Province, Thailand. The RVS can be applied under low-endemic conditions and could be carried out by the general health staff.