Avaliação epidemiológica da hanseníase e dos serviços responsáveis por sua assistência no município de Coari - Amazonas

Made available in DSpace on 2015-04-22T22:06:37Z (GMT). No. of bitstreams: 1 Dissertacao-Felicien Goncalves Vasquez.pdf: 1963728 bytes, checksum: 7508d3abd130cd99a8d73d3e469f684a (MD5) Previous issue date: 2008-03-15CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorLeprosy is an infectious-contagious disease that still represents a serious Public Health Problem in Brazil, being in second place worldwide in number of new cases. In the end of the year 2006 having 44.436 cases of leprosy, according to World Health Organization (WHO). This study aims to describe demographic , clinical and epidemiological aspects of leprosy and to evaluate implementation of control activities and accessibility to Multidrug Therapy (MDT) in the Municipality of Coari, Amazonas State. In order to do that, secondary data extracted from the National Notification of Aggravations System (SINAN) from 1997 to 2005, and primary data, filled by the researcher himself were used to evaluate during three field trips, the implementation of leprosy control actions and the organizational context in the municipality. The Leprosy Elimination Method (LEM) was used to analyze active patients files, which is a proposed tool by WHO to monitor leprosy. In order to verify implementation degree, a second score system was used considering for the structure: physical structure (1,5), supplies (1,5), human resources (1,0) and for the process 19 parameters (6,0). The data was stored and analyzed using software Epi-Info versus 3.4.1. and presented in tables and graphs. Statistical analysis was performed using parametric Student T and ANOVA tests and the nonparametric Pearson chi-square, Fisher Extract and Mann-Whitney. During the study period, it was observed a decline of 63,1% in the prevalence coefficient, 47,6% in the general detection and 91,9% in younger than 15 years old detection rate. The mean average was 30,8± 16,2 years, 70,8% male, 63,7% with multibacillary forms, and 36,9% with I and II degree of discapacity, noticing a statistical association at a 5% level in relation to gender and operational classification (p < 0.001), age and degree of discapacity (p = 0.002). Control leprosy implementation degree at municipality was classified as unsatisfactory (64,2%). Nevertheless, the dimension presenting even worse characteristics was the structure due to its human resource classified as critical. In the accessibility analysis, it was observed that patients of rural zones travel and average of 51 Km, taking them 6 hours and spend close to R$ 22,50 with transportation to have access to the drugs. In addition, the disease distribution in the municipality is not homogeneous, since 42,9% of the patients from rural zones were coming from communities along the Copeá River. The data shows that in Coari municipality, there is a great number of cases with late diagnosis and a probable occult prevalence of the disease, becoming necessary the adoption of actions that involve among other things, decentralization of actions, health professionals training and implementation of tools that could contribute for the identification of priority areas aiming to reach leprosy elimination goal.A hanseníase é uma doença infecto-contagiosa que ainda representa um sério problema de saúde pública no Brasil, país que ocupa o segundo lugar no mundo em número de casos novos, encerrando o ano de 2006 com 44.436 casos, de acordo com os dados da Organização Mundial de Saúde (OMS). Neste estudo, buscou-se descrever os aspectos demográficos, as características clínicas e epidemiológicas da hanseníase, além de avaliar a implantação das ações de controle e a acessibilidade aos serviços de Poliquimioterapia (PQT) no município de Coari, no Estado do Amazonas. Para tanto, utilizou-se dados secundários extraídos do Sistema Nacional de Agravos de Notificação (SINAN) no período de 1997 a 2006 e dados primários, preenchidos pelo próprio pesquisador para avaliar a implantação das ações de controle da hanseníase e o contexto organizacional no município, durante três visitas de campo. Na pesquisa com pacientes em registro ativo, utilizou-se o método Leprosy Elimination Monitoring (LEM), que é um instrumento proposto pela OMS para monitoramento da hanseníase. Para verificar o grau de implantação, utilizou-se um sistema de escores no qual para a estrutura foram considerados: instalação física (1,5), recursos materiais (1,5) e recursos humanos (1,0); e para processo 19 parâmetros (6,0). Os dados foram armazenados e analisados no software Epi-Info vs 3.4.1 e apresentados em tabelas e gráficos. Na análise estatística foram utilizados os testes paramétricos t de Student e ANOVA e os não paramétricos qui-quadrado de Pearson, Exato de Fisher e Mann-Whitney. No período do estudo observou-se um declínio de 63,1% no coeficiente de prevalência, 47,6% no de detecção geral e 91,9% em menores de 15 anos. A média geral de idade foi de 30,8 ± 16,2 anos, 70,8% masculino, 63,7% da forma multibacilar e 36,9% com grau I e II de incapacidade, constatando-se ainda associação estatística ao nível de 5% do sexo em relação à classificação operacional (p