Vulnerabilidade em redes de convívio domiciliar com sobreposição de casos de hanseníase em municípios dos estados do Piauí e Rondônia

Abstract

Leprosy persists as a neglected chronic condition with a high morbidity and mortality burden in Brazil. The operationalization of control actions to interrupt the transmission dynamics is complex and demands new tools. The overlapping of leprosy cases in household social networks (HSN) translates into potential increased risk, and can be useful as a sentinel indicator for prioritization of the actions for contact surveillance. The objective of this study was to analyze sociodemographic, economic, clinical, and operational aspects related to new cases (NC) of leprosy that compose HSN with overlap of the disease in municipalities of the State of Piauí and Rondônia between 2001 to 2014 . This was a cross-sectional study, with descriptive and analytical approaches, performed from HSN in the municipalities of Rolim de Moura (Rondônia) and Picos (Piauí). The study was defined in two stages. In Stage 1, the population was composed of all NC of leprosy evaluated (reference cases, RC) in the IntegraHans North-Northeast and IntegraHans Piauí research projects in the municipalities of Picos and Rolim de Moura. In Stage 2, we included NC in the HSN with overlapping (more than one NC of leprosy in the same HSN) of the municipality of Picos were involved, with the Coprevalent Cases (CPC - contacts that were later diagnosed as NC), and their contacts. For the bivariate analyzes, three outcomes were considered: overlapping of cases in HSN, generations affected in HSN, density of cases in HSN, and number of generations affected by HSN. The calculation of the prevalence ratios with 95% confidence intervals was adopted. Of the total of 287 NC evaluated in the municipalities, 129 NC (44.9%) in Picos and 98 NC (65.3%) in Rolim de Moura reported the occurrence of overlap. The highest risk for occurrence of overlap was found to be in the municipality of Picos (PR=1.45, 95% CI 1.22–1.73, p-value=0.0001) and to reside with more than 4 people (PR=1.27, 95% CI 1.05–1.53, p-value=0.0191). In the second stage of the study, 94 cases of leprosy residing in the municipality of Picos, linked to 46 HSN, were addressed. There was a higher frequency of female cases (61.7%, n=58), race/color brown/Brazilian pardo (73.4%, n=69), age group of 41-60 years (37.2%, n=35), with a basic education (46.8%, n=44), family income of 1 to 2 minimum wages (47.9%, n=45), and living with 4 or more people in the same household (56.4%, n=53) prior to diagnosis. There was a higher proportion of multibacillary cases (54.3%, n=51), while the time of greatest occurrence between CR and CPC from the same HSN was 0–3 years (72.7%, n=64), with a significant association with NC number in HSN (PR=1.69, 95% CI 1.12–2.55, p-value=0.0009). The time between diagnoses of cases when lower than 3 years was significantly protective for overlap (PR=0.67, 95% CI0.45–0.98, p-value=0.0100). The overlapping of leprosy cases in HSN is a prevalent event in the hyperendemic contexts analyzed. Its use as an indicator of increased risk is operable in the contexts of basic health care, enhancing contact surveillance actions. There is a clear need to intensify and qualify actions to control leprosy based on the RC approach. The recognition and follow-up of HSN with overlapping of cases as sentinel events amplifies the possibility of control when considering aspects of greater vulnerability present in these scenarios.