Avaliação das ações de controle da hanseníase em município hiperendêmico do estado de Mato Grosso.

Abstract

Introduction: Despite the introduction of effective therapy, with the fall in the number of cases each year, and permanent vigilance, perseveres leprosy as a public health problem in many countries and in Brazil. The characteristics of infectivity and chronicity of the disease and the peculiarity of peripheral nerve predilection of Mycobacterium leprae, the allies still present insufficient information about the disease by population and health workers, allow that Brazil continues as the second country in the number of cases and register many with disabilities and deformities installed. To contain the spread of the disease and seeking its elimination as a public health problem, Brazil imposed in recent decades strategies among which stands out the program of decentralization of leprosy and its integration with primary care network throughout the country, considered as a solution to achieve this goal. Objectives: This study aimed to evaluate the actions of leprosy control, its decentralization and the influence of organizational context in its implementation in the city of Cáceres - MT between 2004 and 2009 as well as conducting epidemiological characterization of disease in the period. Methodology: We performed an evaluative analysis of the implementation of the type of structure and process to estimate the degree of implementation of actions for the control of leprosy in Cáceres and decentralization in basic health units in the urban area. We used closed and semi-structured instrument based on standards for leprosy program activities and the structure of health facilities. We visited ten health units serving leprosy cases in the county where the items were verified physical installation, material resources and human resources trained in leprosy, with scores assigned by weight, with 15 points, 15 points and 10 points respectively. Were also analyzed 419 records of patients diagnosed with leprosy between 2004 and 2009 and interviewed the coordinators of the health units, the coordinator of the PCH and municipal health manager for process analysis, assessing the routine of the health unit, concentration parameters in leprosy and composition of the chart, assigning score by weight, with 20 points, 25 points and 15 points respectively. Retrieved weighted average score achieved by the plant, the degree of implementation was calculated by simple rule of three and classified into one of the categories: implemented, acceptable, poor, critical. Was also conducted epidemiological characterization of disease during the study period by comparing the epidemiological data obtained from medical records with the data available in SINAN. Results: The epidemiological characterization shows majority of new cases (89.5%) in men (60.9%), economically active age group (73.8%), mixed race (45.3%) from the urban area (82.6), clinical tuberculoid (31.5%), zero degree of disability (58.4%), and classified as paucibacillary (64.9%). The data found in the records differ from data available on SINAN, and found 34 cases more, increasing the detection rate and 17 cases that have not reported in epidemiological investigation forms the input mode and not included in SINAN. The implementation of actions to leprosy control in the municipality was classified as acceptable, gaining 38.45 points (ratio of 73.9%). Conclusion: There is no agreement entres data in records and data recorded in SINAN, and the first rise the detection of the disease in the period: The implementation of actions in leprosy was considered acceptable, being hindered by physical installation of health facilities, lack of resources trained human leprosy; performance of doctors and community workers, lack of trained professionals; not completeness of records; mainly as a laboratory and degree of disability. The organizational context influences the implementation of the CMS by not ix acting in strategy formulation and execution control of health policy for leprosy; high turnover of local health managers; turnover of health professionals, especially doctors; funds not target and financial dependence on other sources. Considering the parameters of this review, leprosy control activities are decentralized in Cáceres.