Estudo epidemiológico do grau de incapacidade física da hanseníase numa séria histórica de 2010 a 2022 no sul da Bahia

Abstract

A chronic infectious disease, leprosy has Mycobacterium leprae (M. leprae) as its etiological agent. It is transmitted through the upper airways of people infected with the multibacillary form, without treatment, which release droplets of the bacillus. M. leprae has a tropism for skin cells and peripheral nerves and can cause physical disabilities. Checking the degrees of physical disability (GIF), at the time of diagnosis and upon discharge due to cure, allows evaluating the quality of monitoring offered by health establishments and the disabling potential of the disease. Compulsory notification, its registration is mandatory in the National Information System for Notifiable Diseases (SINAN), although the incompleteness of the data and failures in notification create obstacles in the evaluation of services, in planning actions, and in controlling the disease. Studies show that the state of Bahia has the fifth worst performance in the country's GIF assessment. Due to the high prevalence in the state, it is necessary to individualize the evaluation of GIF in the southern region of Bahia. Objectives – Identify grade 1 and 2 physical disabilities and factors associated with their occurrence, in the population affected by leprosy, in the municipalities that make up the Ilhéus Health Operational Base of the Southern Regional Health Center of the State of Bahia, in the 2010 historical series to 2022. Material and methods – This is an ecological and cross-sectional study, which uses secondary data from SINAN. The sample consisted of 608 new cases of leprosy diagnosed between 2010 and 2022 in the Ilhéus Health Operational Base municipalities. The variables observed were: sex, age, race, education, zone, clinical form, degree of physical disability at diagnosis and discharge due to cure, operational classification, number of affected nerves and reaction. The relative frequency was calculated and the association was performed using Pearson's chi-square test of the variables with GIF 0 and GIF 1 and 2, at the time of diagnosis and discharge due to cure. Results – There was a predominance of men over the age of 15, black-brown, from urban areas and with education above the 4th grade, with a dimorphic, multibacillary clinical form, with up to 1 compromised nerve and no reaction. It was observed that 19.73% of GIFs of new cases were not evaluated at diagnosis, 46.88% were not evaluated at discharge due to cure and only 46.71% were evaluated at both moments. An association was found between GIF 1 and 2 (being disabled) with the variables sex, affected nerves, operational classification and reaction at diagnosis and with the variables affected nerves, education, sex and reaction at discharge due to cure. A percentage of 2.79% worsened, 4.11% progressed and 39.80% remained stable in the analysis of the evolution of the pattern of GIFs at diagnosis and at discharge due to cure. Conclusion – The occurrence of grade 1 and 2 physical disabilities was found in the population affected by leprosy in the municipalities that make up the Ilhéus Health Operational Base, associated with males, with two or more compromised nerves, development of reaction and low education. Notification and monitoring of the evolution of GIFs 1 and 2 is low, signaling the precariousness of leprosy monitoring in Southern Bahia.