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Factors associated to relapse of leprosy in Mato Grosso, Central-Western Brazil

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To analyze factors associated with relapse of leprosy. Retrospective case-control study including 159 patients older than 15 diagnosed with leprosy attending reference centers for leprosy in five municipalities in the state of Mato Grosso, central-western Brazil. Cases (n=53) were patients with relapsed leprosy diagnosed from 2005 to 2007 who were compared with controls (n=106) matching for gender and operational classification who were considered cured after treatment in 2005. Data was obtained from the local Notifiable Diseases Database, medical records and interviews. For the analyses conditional logistic regression and hierarchical approaches were used. After adjustment, the following factors were associated with relapse of leprosy: living in rental housing (OR = 4.1; 95%CI: 1.43;12.04); living in houses constructed of wood and mud (OR = 3.2; 95%CI: 1.16;8.76); living with dwellings with more than five people (OR = 2.1; 95%CI: 1.03;4.36); alcohol use disorder (OR = 2.8; 95%CI: 1.17;6.79); irregular treatment (OR =3.8; 95%CI: 1.44;10.02); lack of knowledge about the disease/treatment (OR = 2.6; 95%CI: 1.09;6.13); use of public transportation to get to the clinic (OR = 5.5; 95%CI: 2.36;12.63); clinical form of the disease (OR = 7.1; 95%CI: 2.48;20.52), and treatment regimen (OR = 3.7; 95%CI: 1.49;9.11). The predictive factors of relapse are associated with housing conditions, living habits, organization of health services, clinical forms of leprosy and treatment regimen. Health services should educate patients on the disease as well as ensure consistent treatment.
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... Quanto à recidiva, um estudo de caso controle encontrou chance maior entre aqueles que residam em casas alugadas, com mais de cinco pessoas, domicílio de madeira ou taipa, com transtornos relacionados ao álcool, apresentando irregularidade no tratamento, nenhum esclarecimento sobre a doença, e usando transporte coletivo para acesso à unidade de saúde (8) . ...
... As condições de moradia também influenciaram o risco de infecção, adoecimento e recidiva da doença. Péssimas condições de moradia e um número maior de residentes no domicílio intensificam a exposição ao bacilo entre os contatos domiciliares de pacientes de hanseníase (27) e pode contribuir, inclusive, para a reinfecção exógena e recidiva (8) . ...
... A ocorrência de recidiva foi mais frequente entre os pacientes que utilizavam o transporte coletivo para se deslocar até o serviço de saúde, por isso fatores associados à dificuldade no transporte reforçam a necessidade de descentralização das ações de controle da hanseníase. O atendimento descentralizado facilita o acesso aos serviços de saúde e contribuem para o diagnóstico oportuno, adesão ao tratamento e maior equidade na assistência aos casos de hanseníase (8,44) . ...
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... Studies on exogenous reinfection and endogenous reactivation of chronic diseases, such as tuberculosis and leprosy, show that susceptible individuals are infected by the bacillus through contact with patients with multibacillary leprosy. [3][4][5]10,11 Surveillance of leprosy contacts is a priority action for disease control. Contacts of leprosy cases mean those who cohabit or have cohabited with leprosy patients and can be classified as household, neighbourhood or social contacts (n the workplace, school, etc.) or community. ...
... A current case of leprosy in the family is associated with a 2.9-fold increased risk of a healthy family member becoming infected; this risk increases with a family history of the disease. 5,10,11,19,20 Bakker et al. 11 reported that household contacts of patients with multibacillary leprosy had a four-fold greater risk of becoming infected than non-contacts. Ximenes et al. ...
... In addition, the authors are unable to explore other potential risk factors of worsening disability. Previous studies have indicated that multibacillary disease, treatment delay, educational status and irregular treatment were predictors of worsening disability; 7,19,21,27,28 these factors should be considered in further studies. Although the data used were from major leprosy referral hospitals in Southern Nigeria, it is not generalizable to the whole country. ...
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... Os indivíduos de nível social e econômico baixo, apresentando condições precárias de saúde, déficit de higiene, ausência de saneamento básico, alimentação inadequada e moradia ruim possuem o risco aumentado de contrair doenças transmissíveis se comparado com pessoas que apresentam qualidade de vida mais elevada 23 . Ainda se destaca que o risco de se ter hanseníase aumenta 2, 1 vezes em indivíduos, que residem com cinco ou mais pessoas no domicilio 24 . ...
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