Leprosy-free Palmas in Tocantins State, Brazil
Brazil is the second highest leprosy burden country in the world. In 2016, a total of 25 218 new cases were reported, corresponding to 12.2 per 100 000 population. Among them were 1696 children diagnosed with leprosy. More than half of the cases occur in only five states (out of 27).
Fear and lack of knowledge among health professionals could explain the excessive centralization of diagnosis and the low rate of contact screening. Facing also such challenges, the “Leprosy-free Palmas” project was developed in 2016.
The project includes the following six steps: (i) evaluation of the prior knowledge of the disease by health professionals; (ii) visits to all health units, centres of reference in diagnosis and rehabilitation, and laboratories; (iii) training of all the health professionals of the units through theoretical and theoretical-practical classes, on-the-job training, with evaluation and discussion of leprosy cases, suspected cases and contacts; (iv) on-site solution of clinical difficulties identified during the visit, and feedback for subsequent intervention by managers; (v) monitoring and formative opinion through the Platform for Distance Education and Continuing Education; and (vi) sample evaluation and follow-up of patients and their intra-and extra-municipal contacts residing in the municipality of Palmas or other municipalities, in or outside the State of Tocantins, through cooperation between the Municipal and State Health Secretariats where the contacts reside, with The intention of breaking the chain of transmission and obtaining the cure of the disease.
During the first ten months, on-the-job training was performed in 38 health care points of the care network, 131 visits / meetings were conducted for training, 697 patients were involved during the training. Mapping has allowed prioritization of geographic intervention areas.
The project yielded the following results:
- 100% of Family Health Strategy doctors and nurses were trained for clinical management and diagnosis of leprosy;
- 100% of Support Nucleus Family´s Healthy teams were trained;
- The case detection increased by more than 80%; the case detection rate increased from 56.1 per 100 000 in 2015 to 231 per 100 000 in 2016;
- More than 15% of cases re-entered for treatment due to inadequate earlier therapy and / or due to operational classification error;
- More than 90% of the diagnoses of leprosy were made in peripheral health units;
- Clinical management of leprosy reactions in primary care was significantly improved;
- Disability assessment was systematically undertaken at the time of completing the treatment: disability grading was evaluated in 91% of the cases at the time of diagnosis; there was a reduction in visible deformities from 9.9% in 2015 to 7.6% in 2016.
- Contact screening increased from 5% to 30%. Of all cases detected, 16% was done so through contact examination.
The success of the project can be attributed to a strong local vision and leadership with the Mayor of the municipality taking personal charge. Proper coordination of and collaboration between all important stakeholders is critical. These include the municipality and state health services, the public health institute, the national leprosy programme, patient organizations, the PAHO/WHO collaborating center Institute Lauro de Souza Lima and the PAHO/WHO Country Office for Brazil. The project is fully embedded in local structures, makes use of local infrastructure and is executed through the existing health cadre. This set-up will ensure sustainability.
It has allowed redirecting of funds towards enhancing primary health care, constructing of a referral hospital, physiotherapy unit, etc. These facilities will benefit not only leprosy patients but also other patients requiring surgery, physiotherapy or counseling services.