Análise dos indicadores de monitoramento da eliminação da Hanseníase enquanto problema de saúde pública no Estado do Rio de Janeiro: período 2011-2021

Abstract

Hansen’s disease is endemic in Brazil, and despite national strategies for detection and control, it continues to be a public health problem. It is related to unfavorable conditions involving socioeconomic factors, being classified by the World Health Organization as a Neglected Tropical Disease prevalent in developing countries. Transmission occurs through the upper respiratory tract, through close and prolonged contact with a person affected by the disease without treatment. Among infectious diseases, it is considered one of the leading causes of physical disability due to its potential to cause nerve damage. To analyze the results of the monitoring indicators for Hansen’s disease elimination, describing the situational analysis of the disease in the State of Rio de Janeiro and regions from 2011 to 2021. This is an ecological study of a time series of Hansen’s disease monitoring indicators. Data collection was based on newly reported cases in the State of Rio de Janeiro Sistema de Informação de Agravos de Notificaçãofrom 2011 to 2021. From the database query, we constructed the epidemiological and operational indicators for monitoring the elimination of Hansen’s disease as a public health problem, as officially recommended by the Ministry of Health. The highest frequency of cases was among males, self-identified as black, with incomplete elementary education, and residents of the metropolitan region I, municipality of Rio de Janeiro. There was a reduction in the detection rates, going from high to medium, with a sharp decrease in the years of the COVID-19 pandemic. The detection rate in the population aged 0-14 years decreased from medium to low; the indicator "proportion of contacts" alternated between precarious and regular; the indicator “proportion of cure” showed a declining trend and remained regular throughout the period; the indicator “proportion of abandonment” increased during the pandemic period (7.9% and 8.4%); the indicator “proportion of new cases” evaluated at the time of diagnosis showed a declining trend as well as an increase in the proportion of cases with Stage 2 Disabilities. New Hansen’s disease cases in the State of Rio de Janeiro affect people with greater social vulnerability, a recurrent situation among those with neglected diseases. Regarding the COVID-19 pandemic inference, underreporting of new cases was evident due to the significant decrease in the detection rate, the increase in treatment abandonment, the reduction in the proportion of new Hansen’s disease cases evaluated for the degree of physical disability, and the constancy in Stage 2 Disabilities proportion. These findings may derive from barriers in access, the abeyance of scheduled appointments and home visits, and the suspension of active search actions due to the Public Health Emergency. Due to the magnitude of Hansen’s disease and its impact on public health, we concluded that the Sistema Único de Saúde managers in Rio de Janeiro should increasingly invest in the implementation of public policies to address the disease, which should be integrated into the healthcare network and elaborated from appropriate strategies and goals to the situational analysis at regional and/or municipal level to meet the needs of their respective populations.