Análise espacial da hanseníase na microrregião de Almenara - Minas Gerais: relações entre a situação epidemiológica e as condições sócio - econômicas

Abstract

Leprosy is an infect-contagious disease that can cause physical disabilities and deformities. It is considered a public health issue in Brazil, for which the goal established by the World Health Organization is elimination of the disease by 2010. The distribution of leprosy is uneven across space, as the disease is more concentrated in poorer areas. Thus, the knowledge of its spatial behavior and its relations with socio-economic conditions is fundamental in the formulation of strategies aiming at its elimination. The objective of this study is to analyze the epidemiological situation of leprosy in the micro-region of Almenara, MG, in the period from 1998 to 2006, according to its spatial distribution, seeking to associate it with the socio-economic conditions of the population. This is an ecological study. The study scene is the Almenara micro-region, in Jequitinhonha River Valley, MG. The data about the disease were taken from Leprosy Notification Reports obtained from the State Department of Health. Socio-economic data were taken from the 2000 IBGE (Brazilian Institute for Geography and Statistics) Census, and from them the so-called Health Vulnerability Index (HEVI), composed by 13 variables encompassing sanitation, dwelling, education, income, health and social aspects was elaborated. Digital cartographic bases were provided by IBGE. In the epidemiological analysis, we compared the obtained indicators with the standards set by the Ministry of Health and with results found in previous studies. Cases of the disease were georeferenced by censitary sector and spatial analysis was performed using the software SatScan. The high detection coefficients we found give the micro-region the status of hyperendemic. Moreover, the high percentage of cases diagnosed in the multibacillary clinical presentations and/or already with some physical disability indicates that health services are not being able to detect all existing cases in the area, which contributes to the maintenance of the disease transmission chain. Kruskal-Wallis test revealed an inverse relation between HEVI and the detection of leprosy, whereby the areas with little vulnerability presented the higher coefficients. Spatial analysis identified two clusters, being one with observed detection coefficients above and the other below the expected value. We believe that the results hereby obtained will serve to guide both the elaboration and implementation of more specific measures for controlling and preventing Hansens disease in the region.