Epidemiologia da Hanseníase e sua distribuição espacial por determinantes sociais em Juiz de Fora, 1995-2015

Abstract

Leprosy still represents a serious public health problem in Brazil and in the world. Despite the significant reduction in global disease prevalence from 5.4 million in the 1980s to less than 200,000 cases today, the rate of detection of new cases remains almost the same in different regions over the years. Juiz de Fora, a city with more than five hundred thousand people, is a referral point for leprosy treatment for several nearby cities in Minas Gerais. This study analyzed the epidemiological situation of leprosy in Juiz de Fora, comparing two periods marked by demographic changes and adjustments in prevention strategies. A total of 379 new cases were evaluated, of which 238 were diagnosed in period I (1995 to 2004) and 141 in period II (2005 to 2015). The study analyzed the database of leprosy reports (SINAN, Ministry of Health), assessed trends and georeferenced the cases for spatialised ecological analysis. The georeferencing of the cases used the ArcGis program (version 10.2.2) and the occurrence of the cases was evaluated in relation to the Health Vulnerability Index (HVI), an indicator that categorizes socioeconomic and sanitation factors. The results show decrease in the prevalence of the disease and reduction in the rate of detection of new cases. The number of new leprosy cases with grade II disabilities, that signal for late diagnosis, showed significant reduction in period II, but with peaks in the years 1997, 2007 and 2015. A relative decrease in the percentage of multibacillary cases (from 80.2 to 61.5%) and increase for the tuberculoid clinical form was observed. Logistic regression analysis showed association of detection rates with elevated HVI. In conclusion, the epidemiological indicators point to the elimination of leprosy in the municipality of Juiz de Fora, the factors involved and the evidences of hidden cases of the disease in the region are presented in this study.