Análise espacial da hanseníase no município de Belo Horizonte e sua relação com o índice de vulnerabilidade da saúde

Abstract

Leprosy is, until today, an important issue for Brazilian public health. Recent data point to the country remaining in second position in the absolute number of cases. Within the country, the condition is even more diversified, with a higher concentration of among the poorer layers of the population. Thus, the knowledge of its spatial distribution, and its relations with adverse life conditions, is fundamental for formulating and implementing control strategies. The objective of this study was to analyze the spatial distribution of leprosy cases in the municipality of Belo Horizonte, Minas Gerais, and its relations to the Health Vulnerability Index (HVI). This is an ecological study. To reflect the adverse life conditions, we used the HVI 2012, composite indicator elaborated by the Municipal Secretariat of Health of Belo Horizonte (SMSA-BH). The data regarding this disease were obtained from the Sistema de Informação de Agravos de Notificação (SINAN), and the geographical coordinates, obtained from the Sistema de Vigilância Epidemiológica (SISVE). The cartographic basis, in digital and georeferenced formats, was made available by the SMSA-BH. Initially, we conducted an analysis considering the municipality as an indivisible unit. We compared the epistemological and operational indicators of leprosy to the parameters established by the Ministry of Health and to other results described in other papers concerning this theme. Subsequently, the home addresses of the cases were georeferenced and calculated the rate of detection by census tract. The Global Empirical Bayesian method was used in order to obtain a mellowed leprosy detection rate. These analyses, as well as the confection of the maps, were done using the R software, version 3.2.1. Statistical Package for the Social Sciences (SPSS) for Windows version 19 was used for statistical analysis: descriptive statistics (medians and percentiles) and analytics (Kruskal-Wallis and Mann-Whitney tests). The coefficients of detection found place the municipality as an endemic area. In addition, the detection of leprosy in children under 15 years of age, the percentages of cases diagnosed in the form of clinical multibacillary and/or already presenting any physical disability, indicate that the health services are not capable of detecting all cases, which contributes in maintaining the disease transmission chain. The spatialization of the leprosy cases showed heterogeneous distribution, highlighting areas that must be considered priority for the control program of the disease. The evidences presented in this study also highlight the need for intensifying measures aimed at improving the life conditions of the population, given that, in Belo Horizonte, leprosy faces a pattern constructed under iniquity, such as attested by its relation with HVI. We believe that the results obtained can be used to prepare for the planning and implementation of more specific measures for the context of the area.