Fatores associados ao grau 2 de incapacidade em hanseníase nas macrorregiões de saúde do Tocantins

Abstract

Introduction: Leprosy is highly infectious and can cause severe disabilities, with Brazil being one of the countries with the highest number of cases. The global strategy from 2021 to 2030 aims to eliminate the disease, however, Tocantins faces significant challenges due to its hyperendemicity. Disabilities, especially Grade 2 (GIF2), have a relevant economic and social impact. Even with adequate treatment, many patients develop disabilities, highlighting the importance of prevention and early diagnosis. Objective: To investigate the factors associated with grade 2 disability in leprosy in the health macro-regions of the State of Tocantins. Methodology: This is a cross-sectional epidemiological study of leprosy cases with GIF2 in the health macro-regions of Tocantins reported between 2013 and July 2023 registered in SINAN/DATASUS. Descriptive analysis was performed with absolute and relative frequency counting and the Chi-square test to verify the association of the variables of interest, considering p<0.05. Results: Between 2013 and 2023, 1,441 cases of GIF 2 were registered in the North and South-Central macro-regions of Tocantins. Of these, 338 (23.45%) occurred in the North and 1,103 (77.54%) in the South-Central. Men were the majority, with 248 (73.37%) in the North and 739 (67.00%) in the South-Central. The brown race prevailed, representing 233 (68.93%) of the cases in the North and 695 (63.01%) in the South-Central. The most affected age group was 30 to 59 years, with 163 (48.22%) cases in the North and 582 (52.77%) in the Center-South. Most patients had low levels of education, limited to elementary school, totaling 172 (50.89%) in the North and 511 (46.33%) in the Center-South. Most diagnoses were new cases, with 225 (66.57%) in the North and 729 (66.10%) in the Center-South. The most common clinical form was dimorphic, recorded in 194 (57.40%) in the North and 759 (68.81%) in the Center-South. More than five skin lesions were present in 141 (41.71%) cases in the North and 452 (40.98%) in the Center-South. The absence of reactive episodes was predominant, with 196 (57.98%) of patients in the North and 710 (64.37%) in the Center-South. The variables that presented statistical association (p <0.05) were sex, age group, education, mode of entry, clinical form, skin lesions and reactive episode. Final consideration: Through the study, it was possible to identify the clinical and sociodemographic profile of cases diagnosed with GIF2 in leprosy, highlighting factors associated with late diagnosis. These findings reinforce the importance of early diagnosis and improvements in access to primary care, which are essential to reduce disabilities and strengthen disease control.