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Rev Latino-am Enfermagem 2007 setembro-outubro; 15(número especial):774-9 www.eerp.usp.br/rlae

774

SOCIOECONOMIC AND DEMOGRAPHIC PROFILE OF LEPROSY CARRIERS ATTENDED IN NURSING CONSULTATIONS Marli Teresinha Cassamassimo Duarte

1

Jairo Aparecido Ayres2 Janete Pessuto Simonetti2 Duarte MTC, Ayres JA, Simonetti JP. Socioeconomic and demographic profile of leprosy carriers attended in nursing consultations. Rev Latino-am Enfermagem 2007 setembro-outubro; 15(número especial):774-9. Leprosy is a contagious infectious disease that manifests due to unfavorable socioeconomic factors, endemic levels and individual conditions. This study aimed to recognize the socioeconomic and demographic profile and degree of incapacity installed in leprosy carriers attended at the School Health Center in Botucatu. Data were obtained through nursing consultation performed in 37 patients. The results showed a predominance of individuals with stable union (78%), whites (92%), age between 30 and 49 years old (51%), low level of schooling (68% with incomplete primary education) and those with per capita familial income less than one minimum salary (59 %). More than one third of the patients investigated (35%) presented some degree of physical incapacity. The association of low socioeconomic profile with the presence of physical incapacities assigns greater vulnerability to this population and can negatively influence their quality of life. DESCRIPTORS: leprosy; socioeconomic factors; residence characteristics; disabled persons

PERFIL SOCIOECONÓMICO Y DEMOGRÁFICO DE PORTADORES DE LEPRA ATENDIDOS EN CONSULTA DE ENFERMERÍA La lepra es una enfermedad infecto-contagiosa que se manifiesta debido a factores socioeconómicos desfavorables, niveles de endemia y condiciones individuales. El objetivo de este estudio fue reconocer el perfil socioeconómico y demográfico 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 enfermería realizada en 37 pacientes. Los resultados mostraron una predominancia 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 primaria incompleta) y con renta familiar per capita menor que un salario mínimo (59 %). Más de un tercio de los pacientes investigados (35%) presentaban algún grado de incapacidad física. La asociación del bajo perfil socioeconómico con la presencia de incapacidades físicas imprime mayor vulnerabilidad a esa población, lo que puede influenciar negativamente su calidad de vida. DESCRIPTORES: lepra; factores socioeconómicos; distribuición espacial de la población; personas con discapacidad

PERFIL SOCIOECONÔMICO E DEMOGRÁFICO DE PORTADORES DE HANSENÍASE ATENDIDOS 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 socioeconômico e demográfico 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 meio do instrumento de consulta de enfermagem. Os resultados mostraram predominância de indivíduos com união estável (78%), brancos (92%), com idade entre 30 e 49 anos (51%), com baixo nível de escolaridade e com renda familiar per capita menor que um salário mínimo. Mais de um terço dos pacientes investigados (35%) apresentavam algum grau de incapacidade física. A associação do baixo perfil socioeconômico com a presença de incapacidades físicas imprime maior vulnerabilidade a essa população, podendo impactar negativamente a sua qualidade de vida. DESCRITORES: hanseníase; fatores socioeconômicos; distribuição especial da população; pessoas portadoras de deficiência

1 Assistent Professor, e-mail: [email protected]; 2 PhD Assistent Professor, e-mail: [email protected], [email protected]. Medical School of Botucatu, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil

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INTRODUCTION

Socioeconomic and demographic profile... Duarte MTC, Ayres JA, Simonetti JP.

775

Congo. Despite there was a 1.47 per 10,000 population decrease in prevalence in Brazil in 2005,

Over

history, the measures taken to face

the coefficient of detection of new cases did not have

the problem of leprosy based on isolating the patient,

analogous decrease, with 40 to 50 thousand new cases

which could not control its endemic, but contributed

diagnosed every year(3).

greatly to increase the fear and the stigma associated

The goal for elimination in 2004 was

with it. Mandatory isolation, as a recommendation to

achieved by the State of São Paulo, with a prevalence

control leprosy continued until the beginning of the

coefficient of 0.44 diseased patients per 10,000

60’s, and was officially abolished in 1962

(1)

.

inhabitants. In spite of that, in 2005, 2438 new cases

Known as “Hansen’s disease”, leprosy is one

were detected (0.66/10,000 inhabitants), and 76

of the oldest diseases of mankind and it has been

cases were younger than 15 years old. Among these,

described since 600 B.C., India, and Africa are

9 % already presented mild to severe physical

considered its cradle. Mentioned in biblical texts,

disabilities in the time of detection, pointing out to

leprosy was related to impurity and divine punishment

late diagnoses(1).

which contributed to the increase of prejudice and psychosocial problems

(2)

.

In addition to individual conditions, other factors

are

related

to

the

endemic

levels:

The first cases of leprosy in Brazil were

unfavorable socioeconomic conditions, poor health,

notified in 1600 in the city of Rio de Janeiro, then in

as well as overcrowded houses influence the risk for

the States of Bahia and Pará, it was introduced by

getting the disease(4). In the literature, several studies

settlers and African slaves (2). In the 40’s the high

from the 20th century have associated the

endemicity in the North led the authorities to justify

socioeconomic factor as a predisposing cause of

this location because of the tropical climate. However,

leprosy(5).

it is known that in countries with cold weather,

A study published in 1996, aiming at knowing

endemics have also occurred, and a direct correlation

the ways of social reproduction (ways of working and

must be established not with the weather, but with

living) that form leprosy families, observed that most

the socioeconomic situation of the population

(2)

.

of them were in outcast groups located in regions

Up to recently, leprosy had no specific

were social exclusion is higher(5).

treatment. In the 40’s, Sulfones were discovered,

Highlighting this aspect, the Millennium

contributing to outpatient treatment that started in

declaration, approved by the General Assembly of

the 60’s. After this period, with the advent of

the United Nations in 2000, with the plans of all State-

Clofazimine in the 70’s, and Rifampicin with its

Members of the United Nations (UN) to improve the

bacterial properties, there was the concept of cure

lives of all inhabitants of the planet in the 21st century,

for the disease. Howev e r, only as of 1989,

established as one of its goals to reduce poverty and

polychemotherapy was introduced in Brazil, and it

famine, presenting several concrete commitments

became an essential instrument to eradicate

that, if met in the scheduled time, will improve the

leprosy

(1)

destiny of mankind in this century(6).

.

Although

Brazil

has

experienced

an

Poverty can be defined as being deprived of

expressive process of change in its profile of morbidity

conditions that allow individuals to have a life they

and mortality in the last decades, as chronic-

can value. Being deprived of such may mean

degenerative diseases instead of infectious and

insufficient economic conditions to meet your wishes,

parasitic diseases have taken the first positions among

lack of physical ability to develop some activities,

main causes of death, leprosy is still a relevant public

have no access to education and health, and have

health problem.

political and civil rights disrespected(7).

According to the World Health Organization

Availability or absence of resources for low

(WHO), up to the beginning of 2006, only six countries

income population contributes positively or negatively

had not reached the goal of eradicating leprosy: less

to living conditions and influences the choice,

than 1 case in 10,000 inhabitants. Brazil is 4th place,

evaluation,

with 27,313 cases, which corresponds to a prevalence

treatment

and

adherence

to

recommended

(8)

.

of 1.5 cases/10,000 inhabitants, behind only of

Considering the disabling potential of leprosy,

Mozambique, Nepal and Democratic Republic of

with consequent deformities that may lead to

Socioeconomic and demographic profile... Duarte MTC, Ayres JA, Simonetti JP.

776


problems to those affected by it such as decrease in

In order to check the presence of differences

working capacity, limitation of social life and

in frequencies of the sociodemographic characteristics

psychological problems, just detecting that cases are

according to clinical form of the disease, cross-

high in Brazil is not enough. It is important to consider,

tabulations were performed and the differences

also, the context in which the individual is inserted,

underwent

subsidizing interventions, to enable a better care of

assessments were processed using SPSS 12.0

this population and their family.

software.

Pearson’s

chi-square

test.

These

The objective of this study was to know the socioeconomic and demographic profile, and the grade of disability of leprosy affected people seen in Centro

OUTCOMES

de Saúde Escola de Botucatu (Botucatu School Health Of the 37 patients studied, 14 (38%) had

Center).

Lepromatous leprosy (L), 11 (30%) Tuberculoid (T), 6 (16%) Borderline (B), 3 (8%) Indeterminate (I), and 3 (8%) Pure Neural Leprosy (PN).

METHODS

Data

Descriptive study developed in the School Health Center (CSE), of the Medical School of Botucatu, UNESP. The Program of Leprosy Support has been developed since 1989 and is a reference to the micro-region of Botucatu, Health Regional

referring

and

Table 1 - Distribution of patients seen in nursing consultations, according to sociodemographic variables, Botucatu, 2007

Directory, DIR XI as of decree 51433 of 12/28/2006 Variable

Frequency Nº

%

Statistic Test value

P value

z=0.97

p=0.33

z=6.99

p