Fatores de risco para incapacidade física anotados no momento do diagnóstico de 19.283 casos novos de hanseníase, no período de 2000 a 2005, em Minas Gerais, Brasil.

Abstract

The association between physical deformity and leprosy has often been described in the literature, although very few reports have analysed the magnitude and significance of such association with respect to the presence of physical incapacity. The present study is a retrospective, descriptive and exploratory analysis of a population of 19.283 patients whose medical condition was notified to the Sistema Nacional de Informações de Agravo de Notificação (SINAN, Minas Gerais, Brazil) during the period 2000-2005. The indicators associated with physical incapacity, and the weigh of each indicator on the resultant prognosishave been examined. Additionally, the proportion of new cases presenting physical deformities and the number of cases that were not diagnosed during the period of the study (hidden prevalence) were also estimated. The demographic, epidemiological, clinical andtherapeutic data related to each patient were analysed using the EPI-INFO software. The results were evaluated statistically and presented in graphical and tabular form using SPSS software. The demographic and clinical variables investigated were significantly associatedwith the existence of physical incapacity at the time of diagnosis. The risk of level II incapacity was 16.5 fold higher in patients with lepromatous leprosy, and 12.8 fold higher in patients presenting the borderline form. The occurrence of more than one injured nerve increased the chances of a patient developing level II incapacity 8.4 times, while an age of =15 years increased the probability 7 fold. Individuals presenting the multibacillary form were 5.7 times more vulnerable to deformities than patients presenting the paucibacillary form. The risk of deformities was 5.6 times higher amongst patients lacking formal education. The riskof developing level II incapacity increased 4.5 times when a tuberculoid leprosy was detected during diagnosis; and in cases in which detection of the disease was achieved by the examination of collectives groups the risk of level II incapacity increased 1.98 times. Males were 1.83 times more vulnerable than females. When bacilloscopy was positive at the time of diagnosis, the risk of acquiring level II incapacity was increased 1.7 times. The occurrence of more than five cutaneous lesions increased the chance of deformity by 1.6 times. The proportion of diagnosed cases with level II incapacity was high (10.1%). Moreover, an estimation of the hidden prevalence of the disease indicated that the diagnosis of leprosy was overlooked in 6.407 patients (24.9 %) during the period of study. The most important risk factors contributing to the prognosis of physical incapacity were, in decreasing order of frequency: presence of lepromatous leprosy, presence of borderline leprosy, more than oneinjured nerve, age equal or higher than 15 years, multibacillary classification, lack of formal education, presence of tuberculoid leprosy. These factors must be considered as strong indicators of the prognosis of physical incapacity. The results obtained indicate that very littleprogress has been made with regard to the application of physical incapacity indicators in the healthl services of the State of Minas Gerais, during the period 2000 2005. Since the risk of physical incapacity amongst patients remains very high, further intensive strategies must beemployed in order to address this problem.