24 leprosy spread in urban area: part i: epidemiological...
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LEPROSY SPREAD IN URBAN AREA: PART I: Epidemiologicalcharacteristics of an endemic urban area for leprosy:
the county of São Gonçalo, Rio de Janeiro state, Brazil
Vera L.G. ANDRADE1
Paulo Chagastelles SABROZA2
Antonia J. Werneck de CASTROS3
Célio Paula MOTTA4
24
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ABSTRACT - Among the needs of deepening the epidemiological inquiry studies of leprosydiffusion in urban area, the evaluation of the Local Information System stands out as baseinstrument to carry out an epidemiological and operational analysis. The information systemwas utilized also as base to the populational planning studies. In the present paper, theachievement of the recorded cases mapping in three sanitary units in respective copyholdsectors, as well as the analysis of the specific epidemiological and operational indicators,permited the characterization of the São Gonçalo county as urban endemic area for leprosy,the delimitation of the foci and the inquiry planning. Starting with the specific indicators,according to age, sex, clinical form in the case register date, it was verified a higher detectionrate in women than in men, as well as an increase of the tendency of the tuberculoid forms.In the epidemiological inquiry conducted during 85 days, 926 dwellings were visited withinterview, physical examination, anthropometric measurings and soluble antigen (SA) application.Such inquiry was conducted by a staff of health professionals and specially trainned andstandardized community members. The produced results confirmed that in the copyholdsectors without registered cases, no case, was found and that the domiciliary visits during theSunday do not presented a superior productivity to the allover days of the week. The wholeof the findings lead oneself to conclude that the Local Information System is a valuableinstrument for the description of the endemic characteristics in this county and file aconstruction adequate to the planning of populational studies.
Key words: Leprosy. Urban area. Epidemiology. Inquiry. Contacts. Morbidity.
1) Supervisor of Leprosy Control Program. Collectiveealth Superintendence, Rio de Janeiro stateecretariat SUDS/SESRJ.
2) Associate Professor, Public Health Nationalchool/FIOCRUZ.
3) Public Health Physician, Leprosy Control Program.ollective Health Superintendence, SUDS/SESRJ.
4) Coordinator of the Leprosy Control Program.ollective Health Superintendence, SUDS/RJ.
1 - INTRODUCTION
At present nearly, 80% of the Brazilianpopulation live in endemic area for leprosy,where prevalence rate exceeds 1 case per1.000 inhabitants. In the state of Rio deJaneiro this rate was 2.0 per 1,000 inhabitantsin December 1987.
Indicators forthe continued evaluationof programme activities for Leprosy Control,as well as epidemiological indicators, are
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ANDRADE. V. L. G. - LEPROSY SPREAD IN URBAN AREA: PART I: Epidemiological characteristics of an
endemic urban area for leprosy: the county of São Gonçalo, Rio de Janeiro state, Brazil 25
already defined and standardized so that theanalysis of such indicators can provide someknowledge on the endemic.
The Rio de Janeiro Leprosy ControlProgram is of vertical nature and since itsimplantation in 1970 the aims have been todetect cases by exclusively passive demandand provide treatment to them. In 1986,polychemotherapy was introduced in areaswith the highest prevalences.
Knowing the actual number of bothactive and reported cases is a difficult task toperform since up to now there is no systematicremoval of healed cases, deaths, and individualswho have left the area. Cases who discontinuedtreatment and because of many reasons couldnot be retrieved contribute to make the activereporting even more inflated. During this periodseveral technical - administrative measurementshave been implemented, thus interfering inthe different prevalence rates for the period.
The annual detection of new cases, orreporting rate, allows us to estimate the dy-namics of the endemic. Considering that thisepidemiological indicator is a close estimateof incidence, the pattern for the study areacan be determined. However, the influence ofepidemiological factors on the establishedpattern cannot be distinguished from that ofoperational indicators.
Its is recognized that the number ofcases alone does not differentiate risk factorsin a population. Moreover, the delimitation offoci through space distribution of cases, ratesby sex, age , degree o f d isab i l i t y andimmunological memory, transmission patterns,infection of contacts and the general population,and soc ia l fac tors , they al l const i tu teepidemiological categories required for thestudy of leprosy spread.
The Local Information System providesdata to the central level. Both the analysisusing indicators and the feedback to the locallevel are tools for obtaining epidemiologicalknowledge on the area. In this first stage, thepresent paper investigates the source ofsecondary data as a basic tool for performingan epidemiological and operational analysisof two moments of leprosy diagnosis in anurban area of Rio de Janeiro. The use of thisset of epidemiological indicators for the
assessment of leprosy transmission patterns
will be discussed.
In addition, the information system will be
used as population basis. The present paper
shows produtivity results of the epidemiological
study undertaken in the area with the purpose of
investigating household risk factors and the ability
to discriminate groups originated from positive
response to the skin test.
2 - MATERIAL AND METHODS
AREA DESCRIPTION
Located in the Metropolitan Area ofRio de Janeiro, the county of São Gonçalohas 228Km2 of area, corresponding to 3.5%of its territory. It is the 10
thcounty in geographic
size and in 1988 its population was estimatedin 790,000 inhabitants, with annual growthrate of 2.7%. São Gonçalo ranks 4
thin number
of inhabitants and 5th
in population density,with 3,461 inhabitants/Km
2, according to data
provided by the Instituto Brasileiro de Geo-grafia e Estatística (IBGE).
The county is divided into five districts:
1st
district - São Gonçalo (town seat), with 4,244inhabitants/km
2
2nd
district - Ipiiba, with 1,773 inhabitants/km2
3rd
district - Monjolo, with 2,456 inhabitants/km
2
4th
district - Neves, with 13,833 inhabitants/km
2
5th
district- Sete Pontes, with 3,335 inhabitants/ km2
The town seat is situated at 13m ofaltitude, 22° 49' 30" S and 43° 02' 30" W, and is28km distant from Rio de Janeiro downtown.
The local topography consists ofmountain ridges (25%), lowlands (60%) andspits of land running into the sea (15%).
The county began to be settled in 1579by the Portuguese. In the 1920's it experiencedits economic zenith, leading the country in
HansenInt. 15(1-2):24-045 ,1990
ANDRADE. V. L O. - LEPROSY SPREAD IN URBAN AREA: PART I: Epidemiological characteristics of anendemic urban area for leprosy: the county of São Gonçalo. Rio de Janeiro State. Brazil
the production of oranges, fowls and eggs. Itsindustrial setup collected the country's secondincome at that time. There followed a periodof economic exhaustion and today this is acity with peripheral features whose economyno longer markedly contributes for the economicgrowth of the state, showing a meaninglessprimary production. The secondary sectorrests on the retail trade in the county's 3 ,4
district.
Its proximity to the cities of Rio deJaneiro and Niterói, associated with pooropportunities for better work conditions, haveled more and more people choosing to lookfor a job in other urban centers.
According to IBGE criteria(9), the residentpopulation is exclusively urban. With regardto migratory characteristics, 46% of thepopulation are migrants. Of these, 59% live inthe county for over 10 years.
The county has 148,386 households,11% of which are headed by women. Sixtyper cent of these families have monthly incomebetween 1 and 5 minimum wages (US$ 60,00).
Among individuals over 5 years of age,80,5% are enrolled in schools located in thecounty, of which 78% are private schools.The rate of students per teacher is 23.8.
Health infrastructure consists of 4hospitals, 5 polyclinics, 1 health center and 4health units depending exclusively on publicresources. The ratio of 275 inhabitants perhospital beds includes those of philanthropicand private nature.
In 1980 the county had childhood mortalityrate of 52/1.000 and life expectancy of 63.3years.
The "Carlos Antonio da Silva" HealthCenter Niterói, the "Washington Luiz Lopes"Health Center and the “Hélio Cruz” HealthUnit in São Gonçalo, are linked to the StateSecretariat of Health and provide care formost leprosy patients living in São Gonçalo.
2 . 2 LOCAL INFORMATION SYSTEMLEPROSY
The study of the magnitude of theendemic in this county from 1967 to 1987consisted in the analysis of data obtainedfrom files kept by the three major uni tsassisting leprosy cases in the area. Reportsfollow general lines which have been developedby the Leprosy Control Program, whose planning,technical rules definition, and managementprocedures are attributed to the State Secretariatof Health, through its Sanitary DermatologyCoordinating Committee. All activities aredeveloped according to guidelines set up bythe National Division of Sanitary Dermatology- Ministry of Health.
According to the historical overview,the first patient reported in the county datesfrom 1929 in Niterói, despite routine assistanceat the "Hélio Cruz" Unit only began in 1951. In1972, there were only4 patients under treatmentat the "Washington Luiz" Health Center.
In 1984, through an agreement set betweenthe State Secretariat of Health and non-governmental agencies, the Dermatological Serviceof the "Washington Luiz" Health Center wentthrough a process for new technical andadministrative orientation. This project wasessentially based on the implantation ofpolychemotherapy regimens recommended by who(40), associate with improvenients on theinformation system by testing the model proposedby the Curupaiti State Hospital 3 in primary careUnits. In 1988, this procedure was introduced at the"Hélio Cruz" Health Unit.
Table I shows prevalence data exclusivelyrelated to leprosy-confirmed patients living inSão Gonçalo, excluding individuals with definitivedischarge and those who died during thereporting period.
2.3 THE EPIDEMIOLOGICAL SURVEY
Considering the need for other variableswith higher explanatory value for the leprosydissemination process, a household survey
Hansen. Int 15(1-2): 24 - 045 4920
26
was conducted in three different groups ofexposure in relation to reported cases.
An aerophotometric map (figure 1)containing the description of the census tractwas used to define low, mean and high
prevalence areas. The cases were marked,yielded to the reporting made in December1987 in streets corresponding to addressesprovided by the primary care Unity were markedin this map.
TABLE 1 - DESCRIPTIONS OF LEPROSY CASES REPORTED IN THE COUNTY OF SÃOGONÇALO - DECEMBER 1987
SOURCE : DGE/SESRJ
FIGURE 1 - LIFE - TIME PREVALENCE OF HANSEN'S DISEASE IN SÃO GONÇALOMUNICIPALITY RIO DE JANEIRO - BRASIL - 1988
GENERAL REPORTING 2131DISCHARGE AND DEATH 281NOT LIVING IN THE COUNTY 174UNAVAILABLE DATA 5ACTIVE REPORTING 1676
~//.l~
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ANDRADE. V. L. G. - LEPROSY SPREAD IN URBAN AREA: PART I: Epidemiological characteristics of an
endemic urban area for leprosy: the county of São Gonçalo, Rio de Janeiro state, Brazil 27
ANDRADE. V. L. O. - Leprosy spread in urban area: part I: Epidemiological characteristics of anendemic urban area for leprosy: the county of Sao Gonçalo, Rio de Janeiro slate, Braz!
Participants
Groutheir intradoare all indcase under
Grouin four adjocase, thatcontacts.
Grouconsists ofadded by indwellings.
Thebased on t
Age betw- Cannotleprosy; - Shfor over 1 ye
Cannot be- Should volstudy.
The fieldeleven stafassistants (Health Systeby town disassistants aanthropomecommunity mAll investisome traininleprosy an
Hansen.Int15(1-2):24
questionnaire administration. All reading andmeasuring devices were standardized.
At least two visits were made to eachsampled household. The first visit consistedin the interview for filling the questionnaire,administering the antigen and making thedermatological examination. The second visitwas made 48 hours after the previous visitwith the purpose of making intradermoreactionreadings, anthropometric measurements anddermatological reexamination of suspects forleprosy identified during the first visit. Allsuspects were led to the health center formedical examination.
Of the 406 dwellings included in thestudy, we knew the name and address of all203 index cases randomly selected. A letter
28
Members: the selection of 203index case dwellings was made bythe systematic drawing of one outof each five cases included in thenominal list of the active reportingby date of detection. The peripheralpopulation sample was obtainedselecting 203 core dwellings with noreported case of leprosy. Thenumber of core dwellings selectedat random in each tractcorresponded to the overall numberof dwellings within the tract. For theselection of each dwelling, onestreet was chosen at random andnumbers were assigned to eachdwelling. Then the core dwellings
were picked out.p I consisted of index cases andmiciliary contacts. These contactsividuals living together with thethe same roof.p II included all individuals livingining dwellings in relation to eachis, neighboring extradomiciliary
p Ill, the peripheral population,all individuals living in core dwellingsdividuals living in other four neighbor
definition of the study groups washe following criteria:
een 7 and 60 yearscarry any disease other thanould live in the same householdar;
pregnant at the time of study;untarily choose to take part in the
research was carried out byfs constituted by two nursingPMW) assigned by the Unifiedm and county dwellers appointedtrict associations. The nursing
dministered the antigen and madetric measurements, while theembers applied the questionnaire.gators were provided withg that included basic notions ond techniques for ant igen and
-045,1990
was sent explaning the reasons for the homevisit. Each investigator received a questionnairecontaining the address provided by thehealth units, without previously knowing whetherthey were going to deal with sick or healthypeople (with index cases or the peripheralpopulation). Only supervisors had a previousknowledge on such data.
The Soluble Antigen (SA) used in thestudy was provided by the Biomedical Instituteof Venezuela. It was prepared from M.lepraesuspension obtained from experimental lesionsin armadi lhos and puri f ied according toDRAPPER'S, method (IMMLEP protocol 3/79). Protein contents were determined usingLOWRY'S method adjusted to 2,5 hg/ml. Anintradermal injection containing 0,1 ml antigenwas given at the rigth forearm.
Interviews were made after filling theindividual "close-type question" questionnairein which information was collected on allindividuals who accepted to take part in thesurvey.
The dermatological examination by PMWconsisted the checking of leprosy suggestivelesions through physical examination withoutclothes. Cases taken as suspect by theinterviewing staff were led to the local healthservice for clinical examination by an expert.
The survey was carried out fromAugust to November 1988 and lasted 85days. All Individuals who failed to be found atthe time of the first visit were revisited onSaturdays and Sundays during the monthsof October and November.
ANDRADE. V. L. 0. - Leprosy spread In urban area: part I: Epidemiological characteristics of anendemic urban area for leprosy: the county of São Gonçalo, Rio de Janeiro state, Brazil
Softwares used for data processingwere Epi Info and Least Means Squares cur-ve fitting by Don McDade. The study of 2 x 2tables association was made using Mandel-Haenszel's chi-squared.
3 - RESULTS
Figure 2 shows the indicators for 1967/1987, revealing an increase in prevalencefrom 0.76 to 2.12 per 1.000 inhabitants, aswell as an increase in case detection ratesfrom 5,23 per 1.000 inhabitants in the beginningof the period to 16.26 per 1.000 inhabitants in1987. In São Gonçalo, 44% of new casesalong the period have been reported in thepast 5 years, as in the remaining counties ofthe states of Rio de Janeiro
29.
The prevalence indicator showed annualgeometrical increase of 6%, while case detectionrates had an increase of 5%.
Figure 3 shows differentiated prevalencesin relation to each district. In Ipiiba (2
nddistrict)
this variation is 1.27°/0 0, and in Neves (4th
district), 2.80°/00. The prevalence in the countyas a whole is 2.12°/00.
With regard to different sex-specificprevalence reasons in each district, an overallrate of 0.99 was observed. In the district ofIpiiba, prevalence reasons diverge from theaverage prevalence shown by the remaninigdistricts according to clinical form and by sex.The district of Neves shows a high prevalenceof women with tuberculoid forms and men
with virchowian forms. Prevalence reasonsbeing more than 1 for tuberculoid forms andless than 1 for lepromatous and dimorphousforms indicates that women are more commonlyattacked by tuberculoid forms, while man aremore likely to constitute lepromatous anddimorphous cases (table 2).
The proportion of new tuberculoidcases in relation to the overall number of casesdetected in the period, excluding indeterminatescases, reaches more than 40% pointing to aninvariable attack of resistant individuals (Fi-gure 4).
Case detection rates correspond tothe number of diagnosed cases or thenumber of cases that entered the servicesrecords - "reporting incidence" - rather thanthe number of new cases of disease in thatyear. Average detection rates, specific byage, sex and clinical form, increase with age,independently from sex and clinical form,showing its highest rates in individuals agedover 60 years. Women's average age at thetime of detection was 22 years. in 1967 and52 years in 1987; this change such variationwas not observed in men, whose average ageremained under 40 years. Case detectionrates by tuberculoid form are higher in womenthan in men for all age groups, excluding menaged 60 years or older (Figure 5).
Hansen Int, 15(1.2): 24.045,1090
29
H
30
ANDRADE. V. L. G. - Leprosy spread in urban area: part I: Epidemiological characteristics of anendemic urban area for leprosy: the county of São Gonçalo, Rio de Janeiro state, Brazil
ansen. Int 15(1.2):
l l l l l l l l l l l l l l l l l l l l l 06 7 6 8 6 9 7 0 7 l 7 2 7 3 7 4 7 5 7 6 7 7 7 8 7 9 8 0 8 l 8 2 8 3 8 4 8 5 8 6 8 7
* • est imated prevalence . r 2 = 0 , 9 8
Δ• est imated detect ion . r 2 = 0 , 5 9 a
f i t : y = ae bt
Rio de Janeiro - Brasil 196
24 - 045 ,1990
a = 0,64 b = 0,06
= 4,10 b = 0,04
FIGURE 2 - TIME TREND OF LEPROSY
in São Gonçalo
7/1987
ANDRADE. V.LG. - Leprosy Spread in Urban area: part is Epidemiological characteristics ofan endemic urban area for leprosy: the county of São Gonçalo, Rio de Janeiro, Brazil
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32 ANDRADE V.LG. - Leprosy Spread in Urban area: part I: Epidemiological characteristics ofan endemic urban area for leprosy. the county of Sao Gonçalo, Rio de Janeiro, Brazil
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ANDRADE. V.LG. - Leprosy Spread in Urban area: part I: Epidemiological characteristics ofan endemic urban area for leprosy: the county of Sâo Gonçalo, Rio de Janeiro, Brazil
33
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ANDRADE. V.LG. - Leprosy Spread in Urban area: part I: Epidemiological characteristics of
an endemic urban area for leprosy: the county of São Gonçalo, Rio de Janeiro, Brazil
ANDRADE. V.L.G. - Leprosy spread In urban area: part I: Epidemiological characteristics of an
endemic urban area for leprosy: the county of São Gonçalo, Rio de Janeiro state, Brazil 35
In 79 of the visited households thepresence of sick people was initially denied,afterwards being confirmed by a carefulinvestigation.
Among dwellings proposed in the sampledesign, 66.4% were investigated. In 3.5% theinvestigation was not possible because somepatients gave an inaccurate or non existingaddress to the Health Units. By reasons ofsafety or difficulty of ac ess, 16.4% failled tobe investigated (table 4). Refusals in acceptingthe inquiring staff were 10.5% in the intra-domiciliary group, against 26.2% in all studygroups (table 5).
The dermatological examination identified260 suspects, 44 of which went to the HealthCenter within a period of 3 months. Five new caseshave been confirmed at the health center up tonow: 3 extra-domiciliary contacts (2 tuberculoid and1 indeterminate) and .2 intra-domiciliary contacts (1tuberculoid and 1 dimorphous). Initial case-findingrates for intra and extra-domiciliary contacts are7.41 and 3.62 per 1.000 examined contactsrespectivelly.
Ha
Case detection rates by clinical form,given in Figure 6, show an increase of tuberculoidforms compared to virchowian and dimorphousforms, the former with speed of increasingthree times that of the latter, mainly in 1975and subsequent years. With regard to theoverall period, the increase of tuberculoidforms was 9% at the year, against 3% forlepromatous and dimorphous forms.
Time trend behavior of indeterminateclinical forms also revealed an increase of6% at the year.
The map (figure 1) shows the distributionof census tracts according to the occurrenceof leprosy reported case. Among 532 tracts,12% had no leprosy case reported. Fifty percent of the population live in tracts with prevalenceexceeds 2/1,000 inhabitants. The highest rateof patients by census tract corresponds tothe lowest frequency of resident population(table 3).
Operational results of the study of 3,540visits to 926 dwellings show that the averagenumber of dwellings visited by each team was6 at the day. The productivity of such visits onSundays was inferior to those made duringthe remaining days of the week (figure n9 7).
Of the 203 dwellings randomly selectedas index case households, 73 had this situationconfirmed by including patients identified duringthe household survey.
nsen. Int 15(1-2): 24 - 045,1990
36
Han
ANDRADE. V.LG. - Leprosy Spread in Urban area: part I: Epidemiological characteristics of
an endemic urban area for leprosy: the county of São Gonçalo, Rio de Janeiro, Brazil
FIGURE 6 - TIME TRENDS BY CLINICAL FORM
1967/1987 São Gonçalo
Rio de Janeiro - Brasil
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ANDRADE V.LG. - Leprosy Spread in Urban area: part I: Epidemiological characteristics ofan endemic urban area for leprosy: the county of São Gonçalo, Rio de Janeiro, Brazil 3
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38 ANDRADE. V.LG. - Leprosy Spread in Urban area: part I: Epidemiological characteristics ofan endemic urban area for leprosy: the county of Sao Gonçalo, Rio de Janeiro, Brazil
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ANDRADE. V.LG. Leprosy Spread in Urban area: part I: Epidemiological characteristics ofan endemic urban area for leprosy: the county of São Gonçalo, Rio de Janeiro, Brazil
39
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Aan endemic urban area for leprosy. the county of Sao Gonçalo, Rio de Janeiro, Brazil
40
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NDRADE V.LG. Leprosy Spread In Urban area: part I: Epidemiological characteristics of
ANDRADE- V.L.Q. - Leprosy spread in urban area part I: Epidemiological characteristics of anendemic urban area for leprosy: the county of São Gonçalo, Rio de Janeiro state, Brazil 4
4 - DISCUSSION AND CONCLUSIONS
The Local Information System has shownthat the county of São Gonçalo is an endemicarea for leprosy, with focal distribution ofcases, that is, with sharp differences of endemiclevel among census tracts.
Prevalence rates being steady duringthe studied period suggest that there is alarge number of inactive patients as well aspatients who have long ago discontinuedtreatment but have not been eliminated fromrecords, thereby leading to a false number ofpatients who need treatment and generatingdistorted cost-benefit assessments of bothcontrol activities and space distribution ofexposure sources
older age groups.
men and women.
The increase of indeterminate formdetection rates points to a gradual improvementof control activities in this county.
With regard to operational indicatorsof the household survey, both the providingof incorrect addresses and the refusal ofpatients to identify themselves to interviewers
Hansen Int 15(1-2): 24-045 1990
express their restricted confidence inservices, worsened by the abcense of houinterviewers in the routine assistance.
The new cases diagnosed durinsurvey are paucibacillary cases, and no ccase has been identified in this group.level reports proved to be reliable concthe distribution of cases since no preleprosy patient has been found in necensus tracts.
upctdcebtt2
inin Brazil that gives the age at onset.
cItapopulation studies.
ettarein their own communities.
phrctpwhose results will be the subject of future
1
healthsehold
g thehronicLocal
erningvalentgative
Age average of case at the time ofdetection showed a paradoxical increaseconsidering the pattern of a spreadingendemic (26.26). The observed behavior ofaverage detection rates in age groups forboth males and females can bee attributedto the fact that, even becoming infected atearly adulthood, individuals show longincubation periods, something that wouldexplain they becoming ill at a moreadvanced age
26. Such increase could also be
explained by a change in the transmissibilityrisk in cohort groups
20, which is rather unlikely
because of the actual increase of rates in
Tuberculoid form detection rates beinghigher in women than in man
1,2,6,31during the
studied period may be due to the women'sdemand for health services and their increasedparticipation in the work market during theabove-mentioned period, thereby makingexposure possibilities being alike for both
Indicators recommended for the f ollow-p of control activities
10, that is, reported
revalence at the end of the years, annualase detect ion rates, proport ion of new
uberculoid cases in relation to new lepromatous,imorphous and tuberculoid cases, and asase detection rates by clinical form, they allxpress an endemic pattern with spreadingehavior. The indicator age average at the
ime of detection or case reporting indicatedhat the endemic moved in a reverse direction1 The age of patients at the time of reportingntroduced errors in the analysis28 since up toow there is no longitudinal study on leprosy
Altogether these findings led to theonclusion that the Leprosy Program's Localnformation System is a useful tool for describinghe characteristics of the endemic and buildingdequate databases for the planning of
Refusals to answer the questionnairesxpress an individual choice influenced by
he accumulated knowledge on leprosy, byhe understanding of the research objectives,nd by methodological failures, but rather aight of all individuals to voluntary chooseither to participate or not in surveys proposed
According to the results obtained in theresent study regarding the productivity ofome visits made during the week and theeliability on the local information system, theounty of São Gonçalo is a suitable area forhe study of risk factors of leprosy spread inopulation groups of an endemic urban area,
ANDRADE- V.L.G. - Leprosy spread In urban area: part I: Epidemiological characteristics of anendemic urban area for leprosy: the county of Sao Gonçalo, Rio de Janeiro state, Brazil42
publications.
Acnowledgements:
of this work, Tatiana M. Moreira and Dra. CoraLuíza de Araújo Post for the training, Maria T.Blanco for case mapping, Heloisa, Diniz,Marcela de Paula and Marilena Cardo-soSantos for the design, Ruth dos R. Amaral, Dra-Cláudia P. Valle, Dra. Pauline L. Kale, MariaCristina Cecconi and Dr. José L. O- Côrtes ofState Secretariat of Health, Marcelo Brando fortranslating the manuscript, the interviewing staffand community of São Gonçalo.
The authors would like to acknowledgethe Ministry of Health, Superintendence ofCommunity of the Rio de Janeiro Secretariat ofHealth, for financing the study. The HealthInstitutions of the Unified Health System/RJ.The National School of Public Health of theFIOCRUZ. The Raul Follereau Foundation.Especially Professor Adauto Araújo for hissupervision and support, Saúl Franco forelaborating the method. Manoel Zuniga for hiscriticism and suggestions, Dr- J- Convit forproviding the SA, Dr. Maria Leide W.D.R.Oliveira, Professor Cláudia Travassos and Dr-
Sérgio Aroucafor encouraging the elaborationHansen. Int 15(1-2): 24- 045 ,1990
ANDRADE- V-L-G- - Leprosy spread In urban area: part I: Epidemiological characteristics of an
endemic urban area for leprosy: the county of São Gonçalo. Rio de Janeiro state, Brazil 43
RESUMO - Dentre as necessidades de aprofundamento dos estudos epidemiológicos da difusão daHanseníase em meio urbano, destaca-se a avaliação do Sistema Local de Informação, comoinstrumento de base para se efetuar uma análise epidemiológica e operacional. O sistema deinformação foi utilizado ainda como base para o planejamento do estudo populacional. No presentetrabalho, a realização do mapeamento dos casos registrados em três Unidades Sanitárias nosrespectivos setores censitários, assim como a análise dos indicadores específicosepidemiológicos e operacionais, permitiram a caracterização do município de São Gonçalo comoárea urbana endêmica de Hanseníase, a delimitação dos focos e o planejamento do inquérito. Apartir dos indicadores específicos, segundo idade, sexo e forma clínica na data do registro do casoverificou-se uma taxa de detecção mais elevada nas mulheres do que nos homens, comotambém uma tendência de aumento das formas Tubercu!áides. No inquérito epidemiológicodesenvolvido durante 85 dias, visitaram-se 926 domicílios, onde realizaram-se entrevista, examefísico, medidas antropométricas e aplicação do Antígeno Solúvel (AS)- Tal inquérito foi levado acabo com equipe de profissionais de saúde e de comunitários especialmente treinados epadronizados. Os resultados produzidos confirmaram que nos setores censitários sem casosregistrados não foi encontrado nenhum caso e que as visitas domiciliares durante o domingo nãoapresentaram uma produtividade superior aos demais dias da semana. O conjunto dos achadosnos leva a concluir que o Sistema Local de Informação é um instrumento válido para a descriçãodas características da endemia neste município e a construção de um cadastro adequado aoplanejamento de estudos populacionais.
Palavras-chave: Hanseníase. Área Urbana. Epidemiologia. Inquérito. Contatos. Morbidade.
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