Apresentao do PowerPoint

1
CURRENT SITUATION OF HANSENS DISEASE IN BRAZIL  

• 1. National HD Control Program - PNCH, Health
  Surveillance Secretariat (SVS), Ministry of
  Health, Brasilia, Brazil
• National Information System on Notifiable
  Diseases Sinan/SVS/MoH
• 3. Department of Epidemiological Surveillance,
  Health Surveillance Secretariat (SVS), Ministry
  of Health, Brasilia, Brazil

• HD determinants in Brazil
• Migration from the countryside to the urban
  peripheries, the major migratory flows to broad
  regions of the Amazon and Center-West and the
  persistence of inequity in essential services
  (health, education and housing) have been
  historical and socioeconomic determinants of the
  large stock of individuals infected by M.leprae
  in Brazil. It should be pointed out that such
  determinants persist even today in certain
  municipalities.
• In addition to structural deficiencies in public
  services in areas of recent settlement in a
  country of continental dimensions, there is
  technical and political omission which persists
  in some health services and is a constant
  challenge to the management of the Unified Health
  System (SUS). The present level of autonomy of
  regional and local governments in Brazil
  restricts the governability of public policy at
  the central level thus social control and
  citizenship development become a decisive factor
  in the advocacy of regional and local commitment
  for HD control programs, in order to guarantee
  the supply of quality health services with good
  levels of resolution, whether public or private.
• 2006 Highlights
• Brazil ranked second in number of new cases
  detected in the world.
• 44,176 cases were in MDT treatment (31/12/06)
• An average of 47,612 new cases have been detected
  yearly, in the last 5 years(2.5/10.000
• 55 ?,Age 39 (20-29) 18 illiterates 55 7
  years/ school)
• Children under 15 represented 8 of the new
  cases.
• 6 the new cases was detected with Grade 2 of
  disability.
• A total of 53 of new cases detected was MB.
• At the end of 2007 about 15.000 health units were
  in position to diagnose and treat HD cases but it
  is only 34 of all health facilities existing.
  Control measures were being integrated into the
  basic health care services and showed a great
  diversity among the 27 states in the quality of
  their decentralization process.
• HD was one of the priority diseases on the
  Ministry of Healths political agenda (3 levels
  comission of SUS/ management/Pacts of SUS)
• Historical series analyses
• The Brazilian Ministry of Health provided the
  leprosy detection and prevalence data and
• the population estimates for the period. The
  Brazilian detection rates from 1980 to 2006 were
  adjusted as a parabolic function of time. The
  prevalence ratio data from 1990 to 2006 was
  adjusted to a logarithm model.

Even considering important reduction in this
indicator in the latest years, it is still high
and is one of the major challenges that the PNCH
is now facing (fig 5)
North Northeast Southeast South Midwest
Of those new cases detected in the last 5 years,
8.4 of them occur among children under 15 years
of age (map 1). This map presenting 385
municipalities, with 70 of all new cases under
15 years of age.
HD detection rate 0-14 Pop 0-14 years of
age gt10.000 inhabitants, with detection rate
0-14 years of age 0,46/10.000inh
Brazil has been reducing the prevalence of HD
gradually as seen in Fig 6, and have shown a
strong drop to 1.4/10000 in 2004 and 2005.
However it was explained by the methodology used
wich excluded from prevalence calculation all
Paucibacillary (PB) and multibacillary (MB) cases
in treatment for more than 6 to 12 months from
the date of diagnosis and others. Even
considering the period prevalence critetia, the
adjustment of this indicator results in its
increase to 2.37/10.000inhabitants, however
showing a decrease from 2005 to 2006.
Historical series on HD detection analyses
indicates that the detection rate has remained
high, but it seems that may have been a
considerable reduction in new case generation.
However, it also shown that active transmission
of the disease is still taking place, especially
in conjunction with those determinants factors
presenting in Northern, Northeast and Midwestern
regions of Brazil and on the outskirts of the
large mega-cities (Fig 1,2 and 3).
North Northeast Southeast South Midwest
PennaPenna showed that sudden decrease as
observed in the previous official Brazilian data
(2004-05), was only explained by operational
changes Fig4. If we consider the indicator per
100.000 and not per 10,000 in order to have a
better comparison with other diseases, we can
affirm that I some states of those 3 regions
mentioned above the HD incidence is higher than
AIDS and tuberculosis disease for instance.
The cure rate is the indicator considered on the
3 levels of SUS comission (Health Pact) The 85
achieved in 2006 is the highest rate from the
last years
E-mail hanseniase_at_saude.gov.br
Note 2006 data consultation database
12/2007-SINAN/SVS/MS UBS Health Centers
Health Units/ Data from 2007 under consolidation