Análise da eliminação da hanseníase como problema de saúde pública no Brasil.

Abstract

Leprosy, an infectious-chronic and stigmatizing disease, is still a public health problem in Brazil and is considered a neglected disease. In this millennium, after the spread of polychemotherapy to treat the disease and several international efforts to encourage its elimination, there was a decrease in the burden of leprosy in the world, however, some countries persist with a high prevalence. Brazil comprises one of the most endemic countries, deserving attention of the public managers to elaborate and continuity of programs directed to the elimination of the disease. In 2016, for this purpose, the guidelines for surveillance and elimination of leprosy were created by the Ministry of Health, which guided the use of disease monitoring indicators as a public health problem; and the quality of the services offered. Thus, the objective was to analyze the progress of the elimination of leprosy as a public health problem through the indicators of disease monitoring. This is a cross-sectional, retrospective, descriptive study with a quantitative and documentary approach based on leprosy cases confirmed and reported in the Information System for Notifiable Diseases from 2001 to 2016 in Brazil. For the description of the investigation, we used the Strengthening the Reporting of Observational Studies in Epidemiology, and after data collection we performed an analysis of the indicators of disease monitoring with discussion based on current literature. Among the results found, endemic parameters showed a tendency to decrease in all regions, except for the proportion of grade 2 of physical disability among new cases - which is increasing and is higher in the South and Southeast; decrease in the proportion according to gender, revealing a higher prevalence in males; and increase in the proportion according to operational classification, indicating an increase in the percentage of multibacillary cases among the new cases. In addition, no region reached hyperendemic value, however, only the South registered low endemia for two of the parameters used. Thus, the reduction of the endemic disease was not uniform either by the indicator used or by region, and even if there is a tendency to reduce the endemic disease, it is not possible to predict when it will be considered eliminated. Questions about the specificity of the indicators have also been raised, and there is no consensus in the literature on which parameter best defines the endemic, but is often evaluated by the concepts of prevalence and rate of detection. It is concluded that efforts should be continued to combat the disease and further studies should be encouraged to evaluate the efficacy and specificity of each indicator in the elimination of leprosy.