valencia 2002

1
Leprosy in Brazil Epidemiology and Social
Aspects
Vera Andrade PAHO/WHO, Brazil
2
Brazil

• Area 8,514,215.3 Km²
• Population 174,632,960 inhabitants
• Population density (inhabitants per Km²) 19.94
• Mean geometric rate of annual increase 1991/1996
  1.64
• Urbanization rate 81.25

3
Health Indicators

• Fertility rate 2.16
• Infant mortality rate (per 1,000 live births)
  31.80
• Life expectancy rate 69.04
• Main cause of death Cardiovascular diseases
  (27.59)
• Annual public investment Forty billion reais

4
The Brazilian Nation

• Type of Government Federative Democracy
• Number of States 27
• Number of Municipalities 5,561
• Official Language Portuguese
• Ethnic Composition Native Brazilian indigenous
  peoples, Portuguese, Africans, Spaniards,
  Italians, Germans, Poles, Arabs, Jews, Japanese

5
Unify the Health System (SUS)

• Principles
• Universalization of Care The entire public,
  private or state-controlled network would now
  care for the population in a universal manner,
  without restrictions or clauses governing
  coverage.
• Equality of Care As well as universal care,
  everyone would have access to the same forms of
  coverage throughout the entire national
  territory.
• Integrality of Health Care Everyone would have
  access to health as a whole concept, or one
  composed of actions towards the individual, the
  collectivity, and the environment.

6
Geopolitical Division of Brazil

• 27 States
• 1 Federal District
• 5,561 Municipalities

State-level prevalence rates range from 0.31
to 15 per 10,000 inhabitants.
Municipal-level prevalence rates range from 0 to
130 per 10,000 inhabitants.
Rio de Janeiro
7
Leprosy New Cases (Brazil, 1962-2001)
Source Ministry of Health, Brazil.
8
Leprosy Registered Cases (Brazil, 1962-2001)
Source Ministry of Health, Brazil.
9
Highly Endemic Area Prevalence Rates
Leprosy Prevalence Rates (Brazil, 2000)
Sources Ministry of Health, Brazil
10
Highly Endemic Area Prevalence Rates
0.98
Leprosy Prevalence Rates (Brazil, 2000)
0.99
0.58
Sources Ministry of Health, Brazil
0.31
11
Highly Endemic Area Prevalence Rates
4.64
3.75
0.98
2.37
1.07
2.99
Leprosy Prevalence Rates (Brazil, 2000)
1.85
2.52
0.99
4.57
4.61
1.31
5.00
3.47
2.51
0.58
Sources Ministry of Health, Brazil
0.31
12
Highly Endemic Area Prevalence Rates
4.64
11.55
3.75
12.75
6.40
9.85
0.98
2.37
6.46
1.07
7.79
2.99
9.18
10.98
Leprosy Prevalence Rates (Brazil, 2000)
1.85
14.68
14.52
2.52
0.99
4.57
4.61
1.31
5.00
3.47
2.51
9.99
0.58
Sources Ministry of Health, Brazil
0.31
13
Large Geographical Area and Literacy Rates
Educational Level less than 1 year of school (
Brazil, 1996)
Upper limit
10.0
Source Data from IBGE/DATASUS/SE/MS  
14
Large Geographical Area and Literacy Rates
Educational Level less than 1 year of school (
Brazil, 1996)
Upper limit
10.0
22.0
Source Data from IBGE/DATASUS/SE/MS  
15
Large Geographical Area and Literacy Rates
Educational Level less than 1 year of school (
Brazil, 1996)
Upper limit
10.0
22.0
30.0
Source Data from IBGE/DATASUS/SE/MS  
16
Large Geographical Area and Literacy Rates
Educational Level less than 1 year of school (
Brazil, 1996)
Upper limit
10.0
22.0
30.0
50.0
Source Data from IBGE/DATASUS/SE/MS  
17
Large Geographical Area and Literacy Rates
Educational Level less than 1 year of school (
Brazil, 1996)
Upper limit
10.0
22.0
30.0
50.0
77.4
Source Data from IBGE/DATASUS/SE/MS  
18
Highly Endemic Area and Literacy Rates
10.0
22.0
0.99
Leprosy Prevalence Rates (Brazil, 2000)
Educational Level less than 1 year of school (
Brazil, 1996)
30.0
5.00
50.0
9.99
77.4
Upper limit
Upper limit
Sources Ministry of Health, Brazil
Source Data from IBGE/DATASUS/SE/MS  
19
Structural Obstacles to Leprosy Integration
(pre-1997)

• Overly specialized.
• Services not well integrated.
• Limited coverage.
• Continued negative image of leprosy in community
  campaigns.

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• Key Activities for Leprosy Elimination
• (Brazil, continuing to 2005)
• Ensure that all health facilities are in a
  position to diagnose and treat leprosy.
• Guarantee the availability of MDT in all health
  units.
• Encourage people to actively look for treatment,
  by increasing awareness of the early signs and
  easing their fear of leprosy.
• Help ensure patient compliance and high rates of
  cure.
• Monitor progress of the accelerated elimination
  strategy.

21
P O O R A C C E S S
TO TREATMENT
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FEAR OF LEPROSY
AND UNDERSTANDING OF LEPROSY LIMITED
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7 D E F O R M I T Y R A T E S AMONG NEW CASES
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Continued Negative Image of Hanseniasis in
Communities
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National Decisions (19972002)

• Decentralization and integration are the most
  important aspects to identifying (hidden) cases.
• Increase accessibility of services and coverage
  to the population all health care units.
• Decrease stigma and negative image involve
  communities.

26
Decentralization and Integration Identification
of (Hidden) Cases
October 2002 The Minister of Health signed new
guidelines and strategies to stimulate and
consolidate actions for the elimination of
leprosy, including the creation of a bonus
incentive for the detection and confirmation of
leprosy diagnoses, to be offered to 607
municipalities and districts considered as
priority areas for the elimination of the
disease.
27
Increase Service Accessibility and Population
Coverage (All health-care units)
The city governments of 607 municipalities will
receive US 20 (R 60) for each notification of a
new case and the state, US 3 (R 10).
The Ministry of Health hopes to increase by 30
the detection of new leprosy cases in the
country.
28
Positive image Would you say I have leprosy?
Decrease Stigma and Negative Image Involve
Communities
Developing communications concepts and materials
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Decrease of Stigma, Negative Image Community
Involvement
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Community Awareness as an Integral Element of
Decentralization Package Involving
Celebrities

• Ney Mato Grosso
• from MORHAN

Ney Latorraca from MORHAN
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