Distribuição espacial e fatores determinantes da ocorrência de hanseniase em municípios da região de saúde do Bico do Papagaio, estado do Tocantins no período de 2008 - 2018

Abstract

Leprosy is an infectious disease caused by Mycobacterium leprae, a mandatory intracellular bacterium that infects macrophages, dendritic cells, keratinocytes and Schwann cells and can cause deformities and physical disabilities, in addition to psychological damage due to the stigmatization of patients. Brazil is among the countries that most report leprosy cases in the world and the state of Tocantins has a high detection rate, being classified as hyper-endemic. The objective of the study was to identify social and individual factors associated with the occurrence of leprosy in municipalities in the health region of Bico do Papagaio, northern Tocantins, from 2008 to 2018. A sectional, descriptive study was conducted with data secondary cases of leprosy cases notified in municipalities in the health region of Bico do Papagaio - TO in the period from 2008 to 2018, registered in the Notifiable Diseases Information System - SINAN. Additionally, an unpaired case-control study was carried out to assess possible determinants of the disease in the region, by conducting interviews with patients notified for leprosy in the years 2016 to 2018. The epidemiological study revealed a record of 1257 new cases, of which 173 (13.76%) occurred in children under 15 years old. There was a predominance of the disease in males (54.49%), aged between 15 and 59 years (65%), in brown individuals (69.93%), illiterate or who attended elementary school (60.76% ) and residents of the urban area (74.14%). The multibacillary form was more frequent (58.63%) as well as dimorphic (38.66%) and with up to 5 injuries (56.56%). Degree of physical disability 2 (GIF) was registered for 3.98% of those notified and nerve involvement in 25.38%. Sputum smear microscopy was positive in 41.46% (209/504) of the individuals submitted to the exam and was ignored or not performed in 59.9% of the notifications. Leprosy reactions were recorded in 12.25% of those notified. The average general detection coefficient in the general population was 59.89 / 100 thousand inhabitants and in children under 15 years of age, 8.88 cases / 100 thousand. The degree of physical disability 2 had a detection rate of 23.24 cases / 1 million inhabitants. The spatial distribution of the disease showed a predominance of hyper-endemic or very high endemic areas over the study period. In the case-control study, a greater chance of the occurrence of leprosy was observed in black (OR = 2.56; p = 0.001) and brown (OR = 1.36, p = 0.015) individuals, with low education (OR = 3.23 , p = 0.006) and with occupations that do not require school training (OR = 4.24, p <0.001). Homes with up to 4 rooms (OR = 4.02; p <0.001), which had a water supply (OR = 19.56, p <0.001) and who were visited by a health agent, also appeared as associated with the occurrence of leprosy. health (OR = 2.87, p = 0.016). Individuals who did not receive BCG immunization (OR = 2.2; 0.014) and who reported a previous case of leprosy in the family (OR = 4.35; p <0.001) were also more likely to become infected. The data show that in the health region of Bico do Papagaio the diagnosis of leprosy still occurs late, with a high occurrence of multibacillary cases, especially among children under 15 years of age. The intimate contact between individuals in larger families and small households, without any immunological protection and with the presence of cases of the disease, are risk factors for leprosy infection and in families assisted by the public health system, the chance of diagnosis of the disease is bigger.