Leprosy diagnosis in municipalities other than the patients' place of residence: spatial analysis, 2001-2009

The study analyzed the flow of persons with leprosy from their municipality (county) of residence to that of their diagnosis in a highly endemic area in Brazil. The study was based on data from the National Information System for Notifiable Diseases from 2001 to 2009 in the States of Maranhao, Para, Tocantins, and Piaui. Of the 373 municipalities, 349 (93.6%) had at least one resident with leprosy that had been diagnosed in a different municipality (4,325 cases, or 5.2% of the total). The municipalities with the most cases reported elsewhere were Timon (248) and Sao Jose de Ribamar (201), Maranhao State. The municipalities that received the most exogenous cases for diagnosis were Sao Luis (719.), capital of Maranhao, and Teresina (516), capital of Piaui. Goiania (146), capital of Goias, and the Federal District (42) also reported numerous cases, even though they are located more than 1,000km from the endemic area. The flow indicates gaps in the decentralization of comprehensive care for persons with leprosy and calls attention to the difficulties associated with patient monitoring during and after multidrug therapy