1 Assist ent Professor, e- m ail: m t duarte@fm b.unesp.br; 2 PhD Assist ent Professor, e- m ail: ayres@fm b.unesp.br, j pessut o@fm b.unesp.br. Medical School of Bot ucat u, Universidade Est adual Paulist a “ Júlio de Mesquit a Filho”, Brazil
Disponible en castellano/ Disponível em língua portuguesa SciELO Brasil w w w .scielo.br/ rlae
SOCI OECONOMI C AND DEMOGRAPHI C PROFI LE OF LEPROSY CARRI ERS ATTENDED I N
NURSI NG CONSULTATI ONS
Mar li Ter esin h a Cassam assim o Du ar t e1 Jair o Apar ecido Ay r es2 Janet e Pessut o Sim onet t i2
Duart e MTC, Ayres JA, Sim onet t i JP. Socioeconom ic and dem ographic profile of leprosy carriers at t ended in nursing consult at ions. Rev Lat ino- am Enferm agem 2007 set em bro- out ubro; 15( núm ero especial) : 774- 9.
Lepr osy is a cont agious infect ious disease t hat m anifest s due t o unfav or able socioeconom ic fact or s, endem ic lev els and indiv idual condit ions. This st udy aim ed t o r ecognize t he socioeconom ic and dem ogr aphic pr ofile and degr ee of incapacit y inst alled in lepr osy car r ier s at t ended at t he School Healt h Cent er in Bot ucat u. Dat a were obt ained t hrough nursing consult at ion perform ed in 37 pat ient s. The result s showed a predom inance of indiv iduals w it h st able union ( 78% ) , w hit es ( 92% ) , age bet w een 30 and 49 y ear s old ( 51% ) , low lev el of schooling ( 68% w it h incom plet e pr im ar y educat ion) and t hose w it h per capit a fam ilial incom e less t han one m inim um salar y ( 5 9 % ) . Mor e t han one t hir d of t he pat ient s inv est igat ed ( 3 5 % ) pr esent ed som e degr ee of ph y sical in capacit y . Th e associat ion of low socioecon om ic pr of ile w it h t h e pr esen ce of ph y sical in capacit ies assigns gr eat er v ulner abilit y t o t his populat ion and can negat iv ely influence t heir qualit y of life.
DESCRI PTORS: lepr osy ; socioecon om ic fact or s; r esiden ce ch ar act er ist ics; disabled per son s
PERFI L SOCI OECONÓMI CO Y DEMOGRÁFI CO DE PORTADORES DE LEPRA ATENDI DOS EN
CONSULTA DE ENFERMERÍ A
La lepr a es una enfer m edad infect o- cont agiosa que se m anifiest a debido a fact or es socioeconóm icos desfavorables, niveles de endem ia y condiciones individuales. El obj et ivo de est e est udio fue reconocer el perfil socioeconóm ico y dem ográfico y el grado de incapacidad instalado de los portadores de lepra atendidos en el Centro de Salud Escuela de Botucatu. Los datos fueron obtenidos a través de consulta de enferm ería realizada en 37 pacientes. Los resultados m ostraron una predom inancia de individuos con unión estable (97,8% ), blancos (92% ), con edad entre 30 y 49 años (51% ), con bajo nivel de escolaridad (68 % con enseñanza prim aria incom pleta) y con renta fam iliar per capita m enor que un salario m ínim o (59 % ). Más de un tercio de los pacientes investigados (35% ) presentaban algún grado de incapacidad física. La asociación del baj o perfil socioeconóm ico con la presencia de incapacidades físicas im prim e m ayor vulnerabilidad a esa población, lo que puede influenciar negativam ente su calidad de vida.
DESCRI PTORES: lepra; fact ores socioeconóm icos; dist ribuición espacial de la población; personas con discapacidad
PERFI L SOCI OECONÔMI CO E DEMOGRÁFI CO DE PORTADORES DE HANSENÍ ASE
ATENDI DOS EM CONSULTA DE ENFERMAGEM
A hanseníase é doença infecto-contagiosa para a qual, além das condições individuais, outros fatores relacionados aos níveis de endemia e às condições socioeconômicas desfavoráveis influem no risco de adoecer. Objetivou-se reconhecer o perfil socioeconôm ico e dem ográfico e o grau de incapacidade instalado dos portadores de hanseníase, atendidos no Centro de Saúde Escola de Botucatu, São Paulo, Brasil. Fizeram parte do estudo 37 pacientes. Os dados foram obtidos por m eio do instrum ento de consulta de enferm agem . Os resultados m ostraram predom inância de indivíduos com união estável (78% ), brancos (92% ), com idade entre 30 e 49 anos (51% ), com baixo nível de escolaridade e com renda fam iliar per capita m enor que um salário m ínim o. Mais de um terço dos pacientes investigados (35% ) apresentavam algum grau de incapacidade física. A associação do baixo perfil socioeconôm ico com a presença de incapacidades físicas im prim e m aior vulnerabilidade a essa população, podendo im pactar negativam ente a sua qualidade de vida.
I NTRODUCTI ON
O
v er hist or y, t he m easur es t ak en t o face the problem of leprosy based on isolating the patient, which could not cont rol it s endem ic, but cont ribut ed greatly to increase the fear and the stigm a associated wit h it . Mandat ory isolat ion, as a recom m endat ion t o cont rol leprosy cont inued unt il t he beginning of t he 60’s, and was officially abolished in 1962( 1).Known as “ Hansen’s disease”, leprosy is one of t he oldest diseases of m ank ind and it has been d escr i b ed si n ce 6 0 0 B. C., I n d i a , a n d Af r i ca a r e con sider ed it s cr adle. Men t ion ed in biblical t ex t s, leprosy was related to im purity and divine punishm ent w hich cont r ibut ed t o t he incr ease of pr ej udice and psy chosocial pr oblem s( 2).
Th e f i r st cases of l ep r osy i n Br azi l w er e notified in 1600 in the city of Rio de Janeiro, then in t he St at es of Bahia and Par á, it w as int r oduced by set t ler s and Afr ican slav es( 2). I n t he 40’s t he high
endem icit y in t he Nort h led t he aut horit ies t o j ust ify this location because of the tropical clim ate. However, i t i s k n o w n t h at i n co u n t r i es w i t h co l d w eat h er, endem ics have also occurred, and a direct correlation m ust be est ablished not wit h t he weat her, but wit h t he socioeconom ic sit uat ion of t he populat ion( 2).
Up t o r e ce n t l y, l e p r o sy h a d n o sp e ci f i c t r eat m en t . I n t h e 4 0 ’s, Su lfon es w er e discov er ed, cont r ibut ing t o out pat ient t r eat m ent t hat st ar t ed in t h e 6 0 ’ s. Af t e r t h i s p e r i o d , w i t h t h e a d v e n t o f Cl o f azi m i n e i n t h e 7 0 ’s, an d Ri f am p i ci n w i t h i t s bact er ial pr oper t ies, t her e w as t he concept of cur e f o r t h e d i s e a s e . H o w e v e r, o n l y a s o f 1 9 8 9 , poly chem ot her apy w as int r oduced in Br azil, and it b e c a m e a n e s s e n t i a l i n s t r u m e n t t o e r a d i c a t e lepr osy( 1).
Al t h o u g h Br a zi l h a s e x p e r i e n ce d a n expressive process of change in its profile of m orbidity a n d m o r t a l i t y i n t h e l a st d e ca d e s, a s ch r o n i c-d eg en er a t i v e c-d i sea ses i n st ea c-d o f i n f ect i o u s a n c-d parasitic diseases have taken the first positions am ong m ain causes of death, leprosy is still a relevant public healt h problem .
According t o t he World Healt h Organizat ion ( WHO) , up to the beginning of 2006, only six countries had not reached t he goal of eradicat ing leprosy: less than 1 case in 10,000 inhabitants. Brazil is 4th place, with 27,313 cases, which corresponds to a prevalence o f 1 . 5 cases/ 1 0 , 0 0 0 i n h ab i t an t s, b eh i n d o n l y o f Mo za m b i q u e, Nep a l a n d D em o cr a t i c Rep u b l i c o f
Co n g o . D e sp i t e t h e r e w a s a 1 . 4 7 p e r 1 0 , 0 0 0 populat ion decrease in prevalence in Brazil in 2005, the coefficient of detection of new cases did not have analogous decrease, with 40 to 50 thousand new cases diagnosed every year( 3).
Th e g o a l f o r e l i m i n a t i o n i n 2 0 0 4 w a s achieved by t he St at e of São Paulo, wit h a prevalence coef f icien t of 0 . 4 4 d iseased p at ien t s p er 1 0 , 0 0 0 inhabit ant s. I n spit e of t hat , in 2005, 2438 new cases w er e d et ect ed ( 0 . 6 6 / 1 0 , 0 0 0 in h ab it an t s) , an d 7 6 cases were younger t han 15 years old. Am ong t hese, 9 % a l r e a d y p r e se n t e d m i l d t o se v e r e p h y si ca l disabilit ies in t he t im e of det ect ion, point ing out t o lat e diagnoses( 1).
I n addit ion t o in div idu al con dit ion s, ot h er f a c t o r s a r e r e l a t e d t o t h e e n d e m i c l e v e l s : unfav or able socioeconom ic condit ions, poor healt h, as well as overcrowded houses influence t he risk for get t ing t he disease( 4). I n t he lit erat ure, several st udies
f r o m t h e 2 0 t h c e n t u r y h a v e a s s o c i a t e d t h e socioecon om ic f act or as a p r ed isp osin g cau se of lepr osy( 5).
A study published in 1996, aim ing at knowing the ways of social reproduction ( ways of working and living) that form leprosy fam ilies, observed that m ost of t hem w er e in out cast gr oups locat ed in r egions were social exclusion is higher( 5).
Hi g h l i g h t i n g t h i s a sp e ct , t h e Mi l l e n n i u m declar at ion, appr ov ed by t he Gener al Assem bly of the United Nations in 2000, with the plans of all State-Mem bers of t he Unit ed Nat ions ( UN) t o im prove t he lives of all inhabitants of the planet in the 21st century, established as one of its goals to reduce poverty and f am in e, pr esen t in g sev er al con cr et e com m it m en t s t hat , if m et in t he scheduled t im e, will im prove t he dest iny of m ankind in t his cent ury( 6).
Povert y can be defined as being deprived of condit ions t hat allow individuals t o have a life t hey ca n v a l u e . Be i n g d e p r i v e d o f su ch m a y m e a n insufficient econom ic condit ions t o m eet your wishes, lack of phy sical abilit y t o dev elop som e act iv it ies, hav e no access t o educat ion and healt h, and hav e polit ical and civil right s disrespect ed( 7).
Availabilit y or absence of r esour ces for low incom e population contributes positively or negatively t o l i v i n g co n d i t i o n s a n d i n f l u e n ce s t h e ch o i ce , e v a l u a t i o n , a n d a d h e r e n ce t o r e co m m e n d e d t reat m ent( 8).
problem s t o t hose affect ed by it such as decrease in w o r k i n g ca p a ci t y, l i m i t a t i o n o f so ci a l l i f e a n d psychological problem s, j ust det ect ing t hat cases are high in Brazil is not enough. I t is im portant to consider, also, t he cont ext in which t he individual is insert ed, subsidizing int ervent ions, t o enable a bet t er care of t his populat ion and t heir fam ily.
The obj ect ive of t his st udy was t o know t he socioeconom ic and dem ographic profile, and the grade of disability of leprosy affected people seen in Centro de Saúde Escola de Botucatu ( Botucatu School Health Cen t er ) .
METHODS
Descr ipt iv e st u dy dev eloped in t h e Sch ool He a l t h Ce n t e r ( CSE) , o f t h e Me d i ca l Sch o o l o f Bot ucat u, UNESP. The Pr ogram of Lepr osy Suppor t has been developed since 1989 and is a reference to t h e m i cr o - r e g i o n o f Bo t u ca t u , He a l t h Re g i o n a l Direct ory, DI R XI as of decree 51433 of 12/ 28/ 2006 becam e part of t he Regional Depart m ent of Healt h -DRS VI - Bauru.
Th e Pr o g r a m i s d e v e l o p e d b y a m ultiprofessional team acting on detection, treatm ent and follow- up of cases, prevent ion and t reat m ent of disabilit ies and surveillance of t hose in cont act wit h pat ient s. From January 2004 t o Decem ber 2006, 36 pat ient s w er e under going poly chem ot her apy ( PCT) , and 35 were in clinical follow- up, aft er PCT. Am ong t h ese, 3 7 w er e p ar t of t h e st u d y. Tw en t y - sev en patients undergoing PCT and 10 patients with finished treatm ent accepted to take part in the study and gave t heir writ t en consent . Dat a were obt ained t rough an in st r u m en t f or n u r sin g con su lt at ion , collect ed b y nurses working in t he program aft er approval of t he Et hical Research Com m it t ee of FMB, UNESP.
Sociod em og r ap h ic v ar iab les an d g r ad e of d i sa b i l i t y w e r e a sse sse d u si n g Tu k e y ’s m u l t i p l e com parison t est . I n t he com parison of groups, sm all let t er s w er e used, consider ing t hat t he pr opor t ions f o l l o w e d b y, a t l e a st , o n e l e t t e r d i d n o t d i f f e r. Significance level adopted for the tests em ployed was 5 % .
Quant it at iv e st udy of t he v ar iables: fam ily incom e, clinical for m , and t r eat m ent sit uat ion w er e perform ed by frequency distribution, whose outcom es ar e pr esent ed by absolut e and r elat iv e per cent age fr equencies.
I n order to check the presence of differences in frequencies of the sociodem ographic characteristics accor d in g t o clin ical f or m of t h e d isease, cr oss-t ab u l aoss-t i o n s w er e p er f o r m ed an d oss-t h e d i f f er en ces u n d e r w e n t Pe a r so n ’ s ch i - sq u a r e t e st . Th e se a sse ssm e n t s w e r e p r o ce sse d u si n g SPSS 1 2 . 0 soft w ar e.
OUTCOMES
Of t he 3 7 pat ient s st udied, 1 4 ( 3 8 % ) had Leprom at ous leprosy ( L) , 11 ( 30% ) Tuberculoid ( T) , 6 ( 16% ) Bor der line ( B) , 3 ( 8% ) I ndet er m inat e ( I ) , and 3 ( 8% ) Pure Neural Leprosy ( PN) .
D a t a r e f e r r i n g t o so ci o e co n o m i c a n d dem ographic profile are dem onst rat ed on Table 1.
Table 1 - Dist r ibu t ion of pat ien t s seen in n u r sin g co n su l t a t i o n s, a cco r d i n g t o so ci o d e m o g r a p h i c variables, Bot ucat u, 2007
e l b a i r a
V Frequency Statistic
º
N % Testvalue Pvalue * r e d n e G e l a
M 21/37 57
7 9 . 0 =
z p=0.33 e
l a m e
F 16/37 43
* * s u t a t s l a t i r a M p i h s n o it a l e r e l b a t
S 28/37a 78
e l g n i
S 4/37b 11
d e c r o v i
D 3/37b 8
r e / w o d i
W 1/37b 3
* e c a R n a i s a c u a
C 34/37 92
9 9 . 6 =
z p<0.001 e l p o e p n w o r
B 3/37 8
* * p u o r g e g A 5 1
< 1/37b 3
9 2 o t 5
1 6/37b 16
9 4 o t 0
3 19/37a 51
9 5 o t 0
5 6/37b 16
= 06 5/37b 14
* * n o i t a c u d E e t a r e ti ll
I 3/37b 8
y r a t n e m e l E e t e l p m o c n
I 25/37a 68
y r a t n e m e l E e t e l p m o
C 3/37b 8
l o o h c S h g i H e t e l p m o c n
I 1/37b 3
l o o h c S h g i H e t e l p m o
C 5/37b 14
* * y t i C u t a c u t o
B 27/37a 73
u t a c u t o B -I X R I
D 9/37b 24
u t a c u t o B -I X R I D e d i s t u
O 1/37c 3 * z test;
* * Tukey’s t est
Of t he 37 r efer r ed, 21 ( 57% ) w er e m ales, and 16 ( 43% ) were fem ales, t here was no st at ist ical significant difference in t his variable.
28 ( 78% ) , Caucasians, 43 ( 92% ) wit h ages ranging from 30 t o 49, 19 ( 51% ) . Mean age of t he pat ient s studied was 42 (SD± 3.3) .
Median of y ear s st u died w as 4 y ear s w it h st at ist ically significant predom inance of pat ient s wit h schooling cor r esponding t o I ncom plet e Elem ent ar y Educat ion, ( 25 - 68% ) , t hat is, less t han 8 years of st udy.
Regarding occupation, several industries were involved; m ost of them ( 24 - 65% ) worked providing ser v ices. Am ong t hese people, 9 ( 24% ) w or k ed in dom estic services ( housewife, cleaner, m aid) , 6 ( 16% ) in civil construction; 3 ( 8% ) in agriculture, 2 ( 5% ) in shops, and 2 ( 5% ) in t ext ile indust ry. I n addit ion t o these activities, 2 ( 5% ) were underage, and 4 ( 11% ) w er e r et ir ed.
Most patients 27 ( 73% ) were from Botucatu, 9 ( 24% ) lived in t owns from DI R XI - Bot ucat u, and one ( 3% ) was from São Paulo.
Sociodem ographic variables st udied here do not dem onst r at e associat ions w it h clinical for m s of t he disease.
Me a n f a m i l y i n c o m e w a s 1 . 1 w a g e s (SD± 1.3) .
I n Table 2 dat a r efer r ing t o fam ily incom e m ay be obser v ed.
Table 2 - Dist r ibu t ion of pat ien t s seen in n u r sin g consult at ions according t o fam ily incom e, Bot ucat u, 2007
Table 3 - Dist r ibu t ion of pat ien t s seen in n u r sin g co n su l t a t i o n a cco r d i n g t o g r a d e o f d i sa b i l i t i e s, Bot ucat u, 2007
e m o c n i y li m a
F Nº %
y r a l a s 5 . 0
< 8/37 21 5
.
0 |–1salary 14/37 38 1 –| 2salary 12/37 32 >2salary 2/37 5
d e r a l c e d t o
N 1/37 3
When assessing grade of disability presented, it was observed that m ost studied patients ( 24 - 65% ) did not present disabilities, however, m ore than a third ( 13 - 35% ) present ed t hem , 7 ( 19,0% ) wit h grade I of disabilit y, an d 6 ( 1 6 , 0 % ) w it h gr ade I I . Of t h e patients with disabilities, five ( 13.5% ) presented them in m ore than one follow- up. I nferior lim bs were m ore frequent ly involved ( p< 0.05) .
D a t a r e g a r d i n g g r a d e o f d i sa b i l i t y a r e present ed on Table 3.
* Grade 0: corresponds to no problem s wit h eyes, hands and feet due to leprosy; Grade I : entails decrease or loss of sensibility in eyes, hands and feet and Grade I I : in eyes is relat ed t o the presence of lagophthalm os and/ or ect ropion and/ or t richiasis and/ or central corneal opacit y and/ or visual acuit y lower t han 0.1 or not being able t o count fingers at 6 m ; in hands and feet , t o t he presence of t rophic lesions and/ or t raum at ic, claw hands, re- absorpt ion, hands, feet drop, and ankle contracture ( BRASI L, 2002) .
RE and LE: right eye and left eye; SRL and SLL: superior right lim b and superior left lim b; I RL and I LL: inferior right lim b and inferior left lim b; HDL: higher disabilit y grade*.
Am ong pat ient s present ing disabilit y grade I or I I , 7 ( 18% ) were undergoing PCT and 4 had finished it ( 16% ) .
DI SCUSSI ON
Regarding t he form s of t he disease, only 3 pat ien t s ( 8 % ) w er e I n det er m in at e, con sider ed as clinical m anifest at ion of t he disease( 9) w her eas t he
m aj or it y, 3 4 pat ien t s ( 9 2 % ) pr esen t ed bor der lin e, point ing out for a lat er diagnoses.
I n anot her st udy, Leprom at ous leprosy was also the m ost frequent and the I ndeterm inate the less frequent( 10).
This im plies fut ur e com plicat ions once t he disease has a high disabling capacity, therefore, early d i a g n o se s a n d su i t a b l e t r e a t m e n t p r e v e n t t h e d e v e l o p m e n t o f p h y si ca l d i sa b i l i t i e s t h a t a r e considered as one of t he elem ent s t hat hinder work and social activities leading to poor living conditions( 3).
Th er ef or e, a gr eat er in v est m en t in h ealt h services is necessary t o divulge and give guidelines o f t h i s d i se a se , so t h a t i n d i v i d u a l s h a v e t h e opport unit y t o have early det ect ion, decreasing t he possibilit ies of developing disabilit ies.
Reg ar d i n g g en d er, o t h er w o r k s o b ser v ed pr edom inance of m ales am ong affect ed populat ion, differing of t he dat a found in t his st udy, since t here w as n o st at i st i cal l y si g n i f i can t d i f f er en ce i n t h i s variable( 10- 11).
b m i
L Grade0 GradeI Grade II
º
N % Nº % Nº %
E
R 34/37a 92 2/37b 5 1/37b 3
E
L 34/37a 92 1/37b 5 2/37b 3
L R
S 33/37a 89 1/37b 3 3/37b 8
L L
S 32/37a 86 1/37b 3 4/37b 11
L R
I 28/37a 76 7/37b 19 2/37b 5
L L
I 28/37a 76 7/37b 19 2/37b 5
D G
Of t he 31 pat ient s st udied, ( 84% ) w er e in econom ically productive phase ( 15 - 59) , which is an im por t ant fact because t his is a disease w it h high disabling pot ent ial w hich int er fer ed dr am at ically in work and social life of the patient, leading to econom ic loses and psychological t raum a( 11).
Tim e dedicat ed t o school of t he indiv iduals st udied ( m ean 4 ± 3.3) was lower com pared t o t he populat ion of Bot ucat u, t hat according t o t he SEADE foundation ( 2007) , in the age group between 15 - 64, in t he year 2000, t he m ean st udy years was 8.1, as well as t o t he populat ion of t he St at e of São Paulo, that presented m ean 7.64 years of study in the sam e per iod.
Re g a r d i n g f a m i l y i n co m e , i t ca l l e d o u r attention; the fact that the m aj ority of the population studied ( 22 - 59% ) had fam ily incom e lower than one m inim um salary, being below the poverty line( 12). Only
t w o p a t i e n t s ( 5 % ) h a d f a m i l y i n co m e o v e r t w o m inim um salaries. Thus, it was observed t hat m ost patients studied ( 34 - 92% ) had fam ily incom e below the average incom e of the city of Botucatu and of the St at e of São Paulo, which was respect ively 2.81 and 2.92 m inim um salaries in t he year of 2000.
A st u d y co n d u ct ed i n 1 9 9 6 w i t h l ep r o sy patients in the city of São Paulo, detected that 41.9% of those surveyed had fam ily incom e higher than 1.8 m inim um salary, a percent age t hat was higher t han t hat observed here, once 32% of pat ient s present ed t his fam ily incom e( 5).
I ncom e is one of the socioeconom ic indicators used to create the Hum an Developm ent I ndex ( HDI ) . According t o t he Hum an Developm ent Report ( HDR) of 2005, Brazil is in 64t h posit ion in t he world rank regarding incom e, highlight ing inequalit y: 46.9% of t he incom e is wit hin t he richest 10% and only 0.7% w it h in t h e poor est 1 0 % . I t also st at es t h at social inequality hinders econom ic developm ent and benefits of the poorest( 13).
Econom ic aspect s m ay influence t he ways t o face healt h problem s, and t hey could be different in a n i n d i v i d u a l a cco r d i n g t o t h e st a g es o f h ea l t h m aint enance t oget her w it h social and psy chological aspect s( 8).
Pr edom in an ce of pr of ession s w or k in g w it h ser v ices w as obser v ed, in clu din g n ot on ly gen er al ser v ices, but also household ser v ices, w hose t ask s r eq u ir e n o q u alif icat ion an d t en d t o lead t o p oor working relations. This was in agreem ent with the poor educat ion observed in m ost surveyed people.
The study of social reproduction of leprosy in t he cit y of São Paulo ident ified t hat m ost affect ed people w er e in in t er m ediat e an d in f er ior br ack et , w or k ing in infor m al, under paid and unsk illed j obs, corroborat ing t he dat a observed here( 5).
W h e n a sse ssi n g t h e g r a d e o f p h y si ca l disabilities, although such classification are done using specific t echniques st andardized by t he World Healt h Or ganizat ion and count er signed by t he Minist r y of Healt h( 3) it was difficult y t o com pare t hese dat a wit h
t h o se f r o m t h e l i t e r a t u r e , b e ca u se o f t h e t i m e assessm ent w as per for m ed and t he w ay dat a w er e obt ained.
I n t h is st u d y, t h e g r ad e of d isab ilit y w as assessed when nursing consult at ion was carried out , and, t her efor e, w it h m ost pat ient s under going PCT ( 2 7 - 7 3 % ) and w it h t he r em aining pat ient s aft er d i sch ar g e ( 1 0 - 1 6 % ) . I n t h e st u d i es r ead , t h i s assessm ent was perform ed in the stages of diagnoses and discharge, and secondary dat a were used( 1,14).
I n t he St at e of São Paulo, in 2005, around 14% of cases started treatm ent with physical disability, 9% severe and m oderate, a percentage that was lower than that found in this study( 1).
I n a study perform ed in the city of São José do Rio Pret o, int erior of São Paulo, wit h inform at ion obt ained from chart s, it was observed t hat from 39 patients cared for in 2003, 69.2% were grade 0; 25.6% w er e gr ade I ; 2 . 6 % gr ade I I , and 2 . 6 % w er e not assessed at diagnoses. Percentage of patients without disabilit ies was close t o t hat observed in t his st udy whereas in grade I I we had a great er percent age( 15).
Physical disabilit ies m ay lead t o decrease in working capacity, together with lim iting social life, this could be worsening, as observed here, when associated w i t h w or k i n g w i t h ser v i ces t h at ov er al l , ar e n ot connected with social securit y, and are badly paid .
CONCLUSI ON
I t was concluded t hat t he populat ion st udied w as con cen t r at ed on less pr iv ileged lev els of t h e so ci e t y, w h i ch i s i n a g r e e m e n t w i t h t h e p r o f i l e described in t he lit erat ure, and it is associat ed wit h t he risk of being affect ed by leprosy.
AKNOW LEDGMENTS
We would like to thank professors Dr. Márcia Gu i m a r ã e s d a Si l v a a n d D r Ma r i a An t o n i e t a
Car v alhaes, for t heir suppor t in st at ist ical analy sis and Noem ia Macedo, Ludm ila Braga and Neíse Milanesi t hat for m t he t eam for car e of people affect ed by Leprosy at CSE.
REFERENCES
1. Secret aria de Est ado da Saúde de São Paulo ( SP) . PCH -Pr ogr am a de Cont r ole da Hanseníase. Cam panha Est adual de Com bat e à Hanseníase. São Paulo ( SP) : CVE - Cent ro de Vigilân cia Epidem iológica; 2 0 0 6 .
2. Minist ério da Saúde ( BR) . Secret aria Nacional de Program as Esp eci a i s d e Sa ú d e. D i v i sã o Na ci o n a l d e D er m a t o l o g i a Sanit ária. Cont role da hanseníase: um a propost a de int egração ensino- ser v iço. Rio de Janeir o ( RJ) : DNDS/ NUTES; 1989. 3 . Or gan ização Pan - Am er ican a de Saú de. Sit u ación de la lepra en la región de las Am éricas: clim inación de la lepra co m o p r o b l em a d e sal u d p ú b l i ca. [ m o n o g r ap h y o n t h e I nt ernet ] . Washingt on: PAHO; 2005 [ acesso 14 m aio 2007] . Disponível em : ht t p: / / www.paho.org/ spanish/ ad/ dpc/ cd/ lep-am er icas. ht m .
4. Minist ério da Saúde ( BR) . Secret aria de Polít icas de Saúde. Depar t am ent o de At enção Básica. Guia par a o cont r ole da hanseníase. Brasília ( DF) : Minist ério da Saúde; 2002. 5 . H e l e n e LMF, Sa l u m MJL. A r e p r o d u çã o so ci a l d a hanseníase: um est udo do perfil de doent es com hanseníase n o m u n i cíp i o d e Sã o Pa u l o . Ca d Sa ú d e Pú b l i ca 2 0 0 2 ; 1 8 ( 1 ) : 1 0 1 - 1 3 .
6 . Pr ogr am a das Nações Un idas par a o Desen v olv im en t o ( PNUD) . O que é a Declaração do Milênio? [ hom epage on t he I nt er net ] . New Yor k : PNUD; 2001 [ acesso 14 m aio 2007] . Disponível em : ht t p: / / www.unicrio.org.br/ Text os/ decm n.ht m l. 7. Souza AP. Por um a política de m etas de redução da pobreza. São Paulo em Per spect iva 2004; 18( 4) : 20- 7.
8 . Ger h ar dt TE. I t in er ár ios t er apêu t icos em sit u ações de pobreza: diversidade e pluralidade. Cad Saúde Pública 2006; 2 2 ( 1 1 ) : 2 4 4 9 - 6 3 .
9. Araúj o MG. Hanseníase no Brasil. Rev Soc Bras Med Trop. 2 0 0 3 ; 3 6 ( 3 ) : 3 7 3 - 8 2 .
10. Moreno RD, Woods W, Moreno N, Trindade R, Tavares J Net o. Alt er ações ocu lar es n a h an sen íase ob ser v ad as em pacient es am bulat or iais do ser viço de r efer ência da cidade de Rio Branco, Acre - Brasil. Arq Bras Oft alm ol. 2003; 66: 7 5 5 - 6 4 .
11. Aquino DMC, Caldas AJM, Silv a AAM, Cost a ML. Per fil dos pacient es com hanseníase em ár ea hiper endêm ica da Am azônia do Maranhão, Brasil. Rev Soc Bras Med Trop. 2003; 3 6 ( 1 ) : 5 7 - 6 4 .
12. Fundação SEADE. Per fil m unicipal. [ hom epage on t he I nt er net ] . São Paulo: SEADE; 2007 [ acesso 30 j an 2007] . Disp on ív el em : h t t p : / / w w w. sead . g ov. b r / p r od u t os/ p er f il/ perfil.php.
13. Pr ogr am a das Nações Unidas par a o Desenv olv im ent o ( PNUD) . Obj et ivos de desenvolvim ent o do m ilênio [ hom epage on t h e I n t er n et ] . Br asília: PNUD; 2 0 0 7 [ acesso 1 4 m aio 2007] . Disponível em : http: / / www.pnud.org.br/ odm / index.php. 14. Pr ogr am a das Nações Unidas par a o Desenv olv im ent o ( PNUD) . Í ndice de desenvolvim ent o hum ano. [ hom epage on t h e I n t e r n e t ] . Br a síl i a : PNUD ; 2 0 0 7 [ a ce sso 1 4 m a i o 2 0 0 7 ] . D i sp o n ív e l e m : h t t p : / / p t . w i k i p e d i a . o r g / w i k i / % C3 % 8 Dn d ice_ d e_ Desen v olv im en t o_ Hu m an o.
15. Nardi SMT, Marciano LHSC, Virm ound MCL, Baccarelli R. Sist em as de inform ação e deficiências físicas na Hanseníase. Bol Ep id em iol Pau l [ ser ial on - lin e] . 2 0 0 6 [ acesso 9 f ev 2 0 0 7 ] ; ( 2 7 ) . [ a b o u t 3 p ] . D i sp o n ív e l e m : h t t p : / / cve.saude.sp.gov.br.
