Padrões de comprometimento neural, limitação de atividade, participação social e fatores associados nas pessoas em pós alta de hanseníase nos anos de 2004 – 2009, Araguaína - TO

Abstract

The neural damage is one of the main factors contributing to disability in leprosy. Systematic monitoring is needed, using an integrated approach including physical, psychological and social aspects. The aim of this study is to characterize the patterns of neural impairment, activity limitation, social participation and associated factors in individuals after release from leprosy treatment in Araguaína (Tocantins state), a hyperendemic municipality for the disease. In a cross-sectional study we evaluated individuals who were released as cured from treatment between 2004 and 2009. Dermatological examination was performed, and, characterization of functional impairment, activity limitation and restriction of social participation were described. A total of 282 participants (mean age: 45.8 years) were included. The most frequent clinical form was paucibacillary leprosy (170; 60.3%). Physical disabilities occurred more frequently after discharge, in 83 (20.6%) cases. At diagnosis, visible impairments were 1.7 more common in males (p = 0.166). There was a significant association between physical disabilities and both multibacillary disease (p <0.001) and occurrence of leprosy reactions (p <0.001). From diagnosis to release from treatment, physical disabilities worsened in 6.7%, whereas in the period after release from treatment, physicial disabilities worsened in 25.1% participants. The eye, hand and foot score ranged from 0 to 12 (mean: 0.7; median: 0). A total of 84 (29.8%) participants showed any degree of activity limitation. A light restriction in social participation occurred in 18 (6.3%) cases. There was a significant correlation of activity limitation with older age (r = 0.40, p <0.0001) and with the degree of functional limitation (r = 0.54, p <0.0001), and of social participation restriction with activity limitation (r = 0.56, p <0.0001) and functional limitation (r = 0.54, p <0.0001). There was a high prevalence of neural and sensory loss, significantly associated with sociodemographic and clinical variables (p <0.0001). After release from MDT, there is a need for systematic monitoring of leprosy-affected individuals who are no longer considered as diseased by medical records, in order to prevent disease-specific sequels, reduce functional limitation, and increase social participation.