High occurrence of disabilities caused by leprosy: census from a hyperendemic area in Brazil's savannah region

Objectives: To describe leprosy-related disabilities, we performed a census including people affected by leprosy in 78 municipalities of Tocantins state in northern Brazil. The study consisted of a review of patient charts, structured questionnaires, and clinical examinations for disabilities of eyes, hands, and feet (August – December 2009), according to WHO standards. Results: A total of 910 individuals diagnosed from 2006 to 2008 were included (clinical examination and application of questionnaires), but information from patient charts was not available in all cases, resulting in different denominators. The majority (783/858; 91·3%) had completed multidrug therapy. The most common clinical findings included: enlarged/painful peripheral nerves (412/910, 45·3%), namely of ulnar (207; 22·7%), posterior tibial (196; 21·6%), peroneal (186; 20·5%), and radial cutaneous nerves (166; 18·2%); reduction/loss of sensibility 201/907 (22·2%) and reduced motor function (185/906, 20·4%). At diagnosis, 142/629 (22·6%) had Grade 1 disability (G1D), and 28/629 (4·5%) had Grade 2 disability (G2D). At the time of the study, 178/910 (19·6%) presented with G1D, and 84/910 (9·2%) with G2D. Disability grading was significantly higher in males ( P , 0·01). Subjects with G2D showed claw hands (26; 2·9%), followed by plantar ulcers (23; 2·5%), abrasion/excoriation on the foot (12; 1·3%), claw foot (7; 0·7%), and drop foot (7; 0·7%). Conclusions: Leprosy- related disabilities were common in a highly endemic area. Prevention and rehabilitation measures, especially after release from treatment, should be intensified by the primary health care system. Policy makers need to be aware of an ongoing demand for leprosy control programmes, even in a world of constantly reducing leprosy detection

Motives and determinants for residence change after leprosy diagnosis, central Brazil

Objective: To determine the extent of population movement after diagnosis with leprosy and to describe the underlying motives and determinants for relocation.\ud \ud Design: A cross-sectional study was conducted among those newly diagnosed with leprosy in 79 endemic municipalities in the state of Tocantins, central Brazil. Individuals were identified through the National Information System for Notifiable Diseases (SINAN) database and interviewed with structured questionnaires.\ud \ud Results: In total, 224(20.9%) out of 1070 individuals relocated after their diagnosis with leprosy. Respondents moved to another neighbourhood in the same municipality (n = 178, 79.5%), followed by another municipality in Tocantins state (n = 26, 11.6%) and in another state (n = 11, 4.9%). The primary motives and/or determinants for relocation were: home ownership (n = 55, 28.4%), familial reasons (n = 43, 19.2%), to seek better living conditions (n = 27, 13.9%), employment (n = 26, 11.6%), and better neighbourhood (n = 22, 9.8%). Other motives were related to better access to leprosy diagnosis/treatment (n = 11, 4.9%), owner-terminated rental (n = 5, 2.2%), personal finances/could not afford housing (n = 4, 1.8%). Perceived stigma due to leprosy was mentioned by one participant (0.5%).\ud \ud Conclusion: In Tocantins state, population movement is lower among individuals recently diagnosed with leprosy, as compared to the overall population. The primary motives for relocation after leprosy diagnosis were related to lifestyle changes. Stigma and treatment-related reasons did not appear to be common motives for population movement. These results may reflect policy changes instituted from the Brazilian Program of Leprosy Control to decentralise leprosy services and intensify health education campaigns within a broader concept of Information, Education and Communication