Incapacidades físicas em hanseníase e seus determinantes: Palmas-TO, 2016-2017

Abstract

Leprosy is a chronic, infectious and contagious disease, caused by Mycobacterium leprae, being considered an important public health problem due to its magnitude and transcendence. Physical disabilities in leprosy can lead to permanent sequelae in the individual, resulting in impairment of the quality of life of the person with the disease and consequent biopsychosocial damage, and the best way to prevent disabilities is to diagnose and treat them early. The objective of this study is to identify the factors that are associated with physical disabilities at the time of diagnosis of patients with leprosy in Palmas -TO, from 2016 to 2017. This is a descriptive-quantitative study. The study population were new cases of leprosy, diagnosed in the municipality of Palmas-TO, in the period from 2016 to 2017. The SINAN (National System of Notifiable Diseases) notification forms and the Simplified Neurological Assessment forms were used, for analysis of sociodemographic and clinical variables, and identification of nerve impairment and degree of physical disability. After tabulating the data, the descriptive statistics of the variables of interest for the study were calculated and the results showed 1,537 cases of leprosy reported in Palmas-TO, during the study period. Based on the established criteria, 900 simplified neurological assessments were analyzed. Most patients were female (52%), with a mean age of 41.8 years, multibacillary (96%), dimorphic clinical form (84%) and 48% had disability grade 1 at diagnosis. There was a statistically significant association between disabilities and the variables age, education, clinical form and presence of thickened and/or painful nerves at the time of diagnosis. As for the neurological condition, it was characterized by thickening predominantly of the radial, ulnar, fibular and tibial nerves, pain on palpation of the radial nerve, muscle weakness in thumb abduction and sensory loss, predominantly in the lower limbs. Shock was the main complaint reported in the median nerve evaluation. The segment that presented the greatest impairment (pain and/or shock and/or thickening) was the ulnar nerve (64.48%). When relating the degree of disability to nerve impairment, it was found that 63.7% of patients with degree of disability 1 or 2 at diagnosis had pain and/or thickening in at least one of the evaluated nerve segments. The high prevalence of physical disabilities at the time of diagnosis configures late detection of cases. The health team must be proactive in the search for cases and act to prevent the onset or worsening of physical disabilities, considering the groups with greater vulnerability and impairment in the initial assessment.