Reviewing the therapeutic management of leprosy in primary care: demand case series referred to a university hospital in the midwest region of Brazil

Abstract

Background: Leprosy still represents a negleted public health problem in Brazil. Early and ade quate treatment of leprosy, carried out in a primary health network is essential to reduce morbidity and sequelae. Objective: To analyze the therapeutic management of leprosy patients referred from primary healthy services to a secondary specialized service. Methods: An analytical retrospective study using medical records and the Notifiable Diseases Information System. Patients diagnosed with leprosy, referred to a secondary specialized out patient clinic, between 2016 and 2017, in Goiás state, were included. The treatment carried out in the primary health services was compared to the Ministry of Health guidelines. Results: Two-hundred twenty-five leprosy patients were included, of whom 33.3% were referred by leprosy reactions, 27.1% by sequelae, and 10.2% by suspected recurrence or reinfection. Reviewing the therapeutic management, 123 (54.7%) were considered inadequate, 92 (40.9%) adequate, and 10 (4.4%) inconclusive. Of the 200 multibacillary patients, 39.5% had adequate management. In contrast, 12 (85.1%) out of 14 paucibacillary patients had adequate manage ment ( 2 = 11.43 and p < 0.001). Regarding the leprosy reactions and sequelae management, 59.3% and 19.5% were considered inadequate, respectively. There was no difference between the percentage of adequate or inadequate management when considering the Goiás health macroregions ( 2 = 7.23; 4 degrees of freedom; p = 0.12). Study limitations: Use of recorded data, with incomplete medical records and lack of patient follow-up.