Low performance of operational indicators for leprosy control in the state of bahia: Spatiotemporal patterns, 2001–2014

Objective To characterize spatiotemporal patterns of operational indicators for leprosy control in the state of Bahia from 2001 to 2014. Methods This is a population-based ecological study, with spatial distribution and autocorrelation of operational indicators for leprosy control. Results From 2001 to 2007, 42.7% (n=178) of the municipalities presented a cure rate lower than 75%, increasing to 61.4% (n =291) from 2009 to 2014. Between 2001 and 2007, 32.5% (n=54) of the municipalities reported more than 10% of the total number of relapses in the state, increasing to 36.9% (n=75) between 2008 and 2014. From 2001 to 2014, 38% (n=159) of the municipalities presented an assessment index of disability grading at the time of diagnosis within the regular performance parameter. Between 2009 and 2014, the number of municipalities with a high incidence of grade 2 disability (G2D) at the time of diagnosis increased, reaching 55.3% (n=230) of the municipalities. Most municipalities in the state of Bahia showed poor performance in the implementation of planned actions for leprosy control, with little change or relative worsening in the patterns of operational indicators throughout the historical series. Conclusion The operational context in Bahia indicates significant institutional vulnerability, leading to the need for expansion and qualification of the surveillance and health care network in the different regions and conditions analyzed in the public health system (Sistema Único de Saúde – SUS)

Leprosy diagnosis in municipalities other than the patients' place of residence: spatial analysis, 2001-2009

The study analyzed the flow of persons with leprosy from their municipality (county) of residence to that of their diagnosis in a highly endemic area in Brazil. The study was based on data from the National Information System for Notifiable Diseases from 2001 to 2009 in the States of Maranhao, Para, Tocantins, and Piaui. Of the 373 municipalities, 349 (93.6%) had at least one resident with leprosy that had been diagnosed in a different municipality (4,325 cases, or 5.2% of the total). The municipalities with the most cases reported elsewhere were Timon (248) and Sao Jose de Ribamar (201), Maranhao State. The municipalities that received the most exogenous cases for diagnosis were Sao Luis (719.), capital of Maranhao, and Teresina (516), capital of Piaui. Goiania (146), capital of Goias, and the Federal District (42) also reported numerous cases, even though they are located more than 1,000km from the endemic area. The flow indicates gaps in the decentralization of comprehensive care for persons with leprosy and calls attention to the difficulties associated with patient monitoring during and after multidrug therapy