Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019

Abstract

Leprosy contacts represent a priority population for the achievement of leprosy control, based on surveillance and care actions in Primary Health Care (PHC). In order to analyze operational patterns of leprosy case contact surveillance and possible epidemiological and operational factors that may influence the coverage of this action in the state of Ceará, we conducted a cross-sectional analytical study of time series and spatial analysis. We used the database of the Sistema de Informação de Agravos de Notificação (SINAN) for the 2008-2019 cohort for the analysis of coverage indicators and performance of contact examination, as well as the overall detection coefficient of new cases (NC). Binary logistic regression analysis was performed to verify the potential association between sociodemographic and clinical variables of NC with the performance of the evaluation of contacts examined among those registered (100% of contacts examined). The odds ratio (OR) was calculated for each independent variable, with 95% confidence intervals (95% CI). Variables with p-values less than 0.20 were included in the model for multivariate logistic regression analysis, with estimates of crude and adjusted OR and their respective 95% CI. Time trend analysis was based on Joinpoint regression, in addition to the analysis of time and space dimensions, respectively, by means of the Monte Carlo permutation method and spatial distribution over time. The worst proportion of assessed contacts among those registered occurred in the macro-region of Fortaleza (58.7%) and only the macro-region of Sobral recognized a tendency to increase. The proportion of CN among the contacts assessed, for the state varied between 0,6-1,2%, values close to those of the macro- region of Fortaleza (1,3-2,5%), but distant from the macro-region of Cariri (29,7%). There was a significant downward trend in the state in the period 2011-2019 (APC -17.6a 95%CI [-26.4 to -7.8]). A total of 234 potential cases were estimated among unexamined contacts in the state. We found a higher risk for not assessing all contacts registered mainly when the person with leprosy was: resident in rural area (OR - adjusted 2.01; 95%CI 1.81-2.22) and multibacillary case (OR - adjusted 1.19; 95%CI 1.11-1.28). For the analysis by Joinpoint, the general trend was an increase in leprosy cases where all contacts among the registered contacts were examined (APC 2.1*, 95%CI 1.2 to 3.0). There are gaps in the contact surveillance process, especially in the macro-region of Fortaleza and in the state capital. The Cariri macro-region has the highest detection coefficients with the best performance in contact surveillance and also stood out for having had the highest yield for detection of NC among the contacts examined. It is essential to understand to what extent the tendency of decrease of NC throughout the state is not related to failures in surveillance actions. We hope that the evidence generated can encourage the planning of surveillance actions of contacts directed to local realities, focusing on macro-regions with the worst performance, including those with of low PHC coverage.