Covid-19 e hanseníase em Sergipe, Brasil, 2020: impacto da pandemia e intervenção de enfrentamento à prevalência oculta da doença por uma equipe de atenção primária à saúde

Abstract

Introduction: The COVID-19 pandemic resulted in substantial changes in the routines of health services, with a likely impact on the fight against other endemic diseases in Brazil, among which leprosy stands out. Brazil is the only country that has not yet reached the goal of eliminating the disease as a public health problem. Sergipe, in 2019, had an overall detection rate of 14.1 cases/100,000 inhabitants (n=325 cases), prevalence of 1.41/10,000/inhabitant and a detection rate of 4.2 /100 thousand (n=22) indicating its presence and the recent transmission strength of the endemic disease in the state. Objective: This study aims to analyze the impact of the COVID-19 pandemic in the fight against leprosy in Sergipe, Brazil in 2020 and report the experience of reducing the hidden prevalence of the disease by a primary health care team in the interior of the state, during the pandemic. Methods: This study was structured in two parts: the first, of an ecological nature, and the second, an experience report. For the ecological component of the time series, the study area was the state of Sergipe and considered the period January 2017 to December 2020. At this stage, the epidemiological indicators of monitoring and evaluation of leprosy and clinical/epidemiological variables were analyzed. The second stage consisted of an experience report carried out in the municipality of Estância, located 67 km from the state capital (Aracaju). In the municipality, the action was carried out at the Leonor Barrreto Franco Family Health Unit, located in the Cidade Nova neighborhood. The experience consisted of offering dermatological and neurological examinations to patients who attended the health unit from September 2020 to January 2021. Results: In 2020, there was a reduction of 22.2% in the number of new cases of leprosy in the general population (325 in 2019; 253 in 2020) and of 44.4% in the overall detection coefficient (14.1/ 100,000 in 2019; 7.9 cases/100,000 in 2020). In children under 15 years of age, there was a 50% drop in records (22 cases in 2019; 11 cases in 2020) and 49.8% in the detection coefficient (4.2/100 thousand in 2019; 2.1/100 thousand in 2020). The number of municipalities without registration of the disease increased both in the general population, from 25 (33.3%) municipalities in 2019 to 29 (38.6%) in 2020, and in those under 15 years old, from 63 (84 .0%) to 68 (90.7%). Regarding the coping action, 235 individuals were evaluated, with 06 clinical diagnoses of leprosy (2.5%), among which, one was under 15 years of age. In the city, throughout the year 2020, there were a total of nine new cases of leprosy. Without the project, the coefficient of detection of new cases of leprosy in the city would be 4.3/100 thousand inhabitants and, with the project, this coefficient was three times higher (12.9/100 thousand inhabitants). Conclusion: The COVID-19 pandemic resulted in a negative impact on coping with leprosy in the state of Sergipe, posing even greater challenges in the process of coping with the disease. The offer of dermatological and neurological examinations during routine medical consultations in vulnerable areas, allowed to reveal the hidden prevalence of leprosy in the Cidade Nova neighborhood, Estância, Sergipe. Recommendations: The urgent elaboration, by the state of Sergipe, of a plan to fight leprosy that aims to mitigate the harmful effects of the COVID-19 pandemic in the process of coping with the disease. The coping plan must consider the important role of Primary Health Care in the context of leprosy, as well as the qualification of epidemiological indicators.