Fatores associados ao diagnóstico tardio da hanseníase em 74 municípios endêmicos do estado do Tocantins

• Autor(a) principal: Oliveira, Alexcian Rodrigues de
• Data de Publicação: 2011
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
• Texto Completo: http://www.repositorio.ufc.br/handle/riufc/6529
• topic: Hanseníase; Diagnóstico Tardio; Epidemiologia; Prevenção de Doenças

Late diagnosis of leprosy contributes to maintenance of high transmission levels in endemic areas. We conducted a population-based cross-sectional in 74 municipalities of a leprosy-endemic cluster in Tocantins state (North Brazil). Of the 1.635 new cases reported from 2006 to 2008, 936 (57.2%) were included in the study. Collection of data was performed through face-to-face structured questionnaires. In total, 53% were classified as paucibacillary and 42% as multibacillary leprosy; in 5% this information was not available. Two hundred and ninety (31%) had indeterminate clinical form, 156 (16,7%) tuberculoid, 239 (25,5%) borderline, and 91 (9,7%) lepromatous, with 160 (17,1%) cases with unknonwn clinical presentation at diagnosis. Degree of disability was 0 in 470 cases (50,3%), 1 in 146 (15,6%) and 2 in 28 (3%). We used two indicators for late diagnosis of leprosy: degree of disability 2 at the moment of diagnosis (outcome I); and clinical forms considered late stage disease (tuberculoid/borderline/lepromatous) (outcome II). In bivariate analysis, delayed diagnosis was associated with: male gender (OR=2,46; 95% IC: 1,07-5,67), illiteracy (OR=2,52; 95% CI: 1,17-5,45), multibacillary disease (OR=11,38; 95% CI: 3,40-38.09), difficult access to health facility (OR=3,06; 95% CI: 1,41-6,65) [outcome I]; and illiteracy (OR=1,82; 95% CI: 1,26-2,62), 1 or 2 persons per household (OR=1,60; 95% CI: 1,07-2,37), passage through more than one health facility before diagnosis (OR=2,06; 95% CI: 1,32-3,22), use of other treatments before multidrug therapy (OR=2,78; 95% CI: 1,92-4,02) and no believe in cure (OR=2,74; 95% CI: 1,25-6,01) [outcome II]. In multivariable logistic regression analysis, the following variables were included in the final model: male gender (OR=1.52; 95% CI: 0,61-3,78), illiteracy (OR=1,97; 95% CI: 0,81-4,82), difficult access to health facility (OR=1,99; 95% CI: 0,78-5,16) [outcome I]; and illiteracy (OR=1,10; 95% CI: 0,55-2,21), 1 or 2 persons per household (OR=1,11; 95% CI: 0,56-2,20), passage through more than one health facility before diagnosis (OR=1,09; 95% CI: 0,54-2,20), use of other treatments before multidrug therapy (OR=1,56; 95% CI: 0,88-2,77) and no believe in cure (OR=1,12; 95% CI: 0,35-3,56) [outcome II]. Our findings allow the identification of vulnerable groups to further reduce late diagnosis of leprosy.