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de Oliveira Serra MAA, da Silva RAA, Monari FF, Silva JOE, de Sá Junior JX, Silva RDAE, Fontoura IG, Neto MS, de Araújo MFM. Individual, socioeconomic and healthcare access factors influencing the delays in leprosy presentation, diagnosis and treatment: a qualitative study. Trans R Soc Trop Med Hyg 2023; 117:852-858. [PMID: 37615659 DOI: 10.1093/trstmh/trad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND This study investigated the factors influencing the presentation, diagnosis and treatment of leprosy in primary healthcare. METHODS Qualitative research was conducted on patients undergoing treatment in a priority hyperendemic region for leprosy control in northeastern Brazil. Interviews were conducted between September and December 2020 at primary healthcare centers. Data were analysed based on the basic interpretive qualitative structure according to Andersen and Newman's model of healthcare utilisation. RESULTS Knowledge of leprosy symptoms influenced patients' search for a diagnosis. Unfavorable socioeconomic conditions experienced by patients made diagnosis and treatment difficult. Incorrect evaluations by health professionals caused difficulties and delays in obtaining a diagnosis of leprosy. Perceptions about the disease, such as non-acceptance of the disease and the adverse effects of the medications, affected treatment seeking and treatment continuity. CONCLUSIONS Patients with leprosy faced delays and healthcare access barriers related to knowledge of the disease, socioeconomic conditions and the structure of healthcare services, which must be considered when creating care plans, surveillance and control actions against leprosy. Appropriate interventions are necessary to reduce delays and better control the disease.
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Affiliation(s)
| | | | - Flavia Ferreira Monari
- Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, Maranhão 65.915.060, Brazil
- Faculdade de Imperatriz (FACIMP-Wyden), Imperatriz, Maranhão 65.910.140, Brazil
| | | | | | | | | | - Marcelino Santos Neto
- Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, Maranhão 65.915.060, Brazil
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Graepp Fontoura I, Lima VC, Fontoura VM, Santos FS, de Jesus Costa ACP, de Oliveira FJF, de Oliveira Feitosa M, de Almeida Tavares HS, Lima LNF, Falcão ADS, Silva RDAE, Dias ICCM, Dos Santos LH, Bezerra JM, Fonseca SCT, Santos Neto M. Spatial analysis of congenital syphilis in a federative unit in northeastern Brazil. Trans R Soc Trop Med Hyg 2021; 115:1207-1217. [PMID: 33578429 DOI: 10.1093/trstmh/traa191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/17/2020] [Accepted: 12/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Congenital syphilis is an infectious disease that affects 1 million children a year worldwide. METHODS The objective of this study was to describe a spatial analysis of the epidemiological characteristics of congenital syphilis in the state of Maranhão, Brazil from 2007 to 2018. This was an ecological study using data obtained in May 2020 from three Brazilian information systems. The spatial correlation was analyzed according to local and global Moran indexes. RESULTS During the 12-y period, 1 426 177 children were born. Of these children, 3684 acquired congenital syphilis (0.26%; mean annual rate of 2.62/1000 live births) and 70 died (1.90%; mean annual rate 0.05). The clusters were statistically significant according to the global Moran index of 0.40 (p=0.01). Spearman's correlation coefficient between the rate of detection of syphilis in pregnant women and family health strategy teams was strong, positive and significant (ρ=0.73; p<0.00). Most of the variables studied showed a trend of annual increase (p<0.05). CONCLUSIONS The use of spatial analysis tools have made it possible to detect areas with both a greater and a lesser need for intervention, and to more effectively improve and monitor those areas to change the epidemiological profile of the disease.
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Affiliation(s)
- Iolanda Graepp Fontoura
- Departm ent of Nursing, Universidade Federal do Maranhão, 65.915-240, Imperatriz, Maranhão, Brazil
| | - Valckinara Carreiro Lima
- Departm ent of Nursing, Universidade Federal do Maranhão, 65.915-240, Imperatriz, Maranhão, Brazil
| | - Volmar Morais Fontoura
- Department of Nursing, Universidade Estadual do Tocantins, 77.960-000, Augustinópolis, Tocantins, Brazil
| | - Floriacy Stabnow Santos
- Departm ent of Nursing, Universidade Federal do Maranhão, 65.915-240, Imperatriz, Maranhão, Brazil.,Department of Master Course in Health and Technology, Universidade Federal do Maranhão, Avenue da Universidade, without number, 65.915-240, Imperatriz, Maranhão, Brazil
| | - Ana Cristina Pereira de Jesus Costa
- Departm ent of Nursing, Universidade Federal do Maranhão, 65.915-240, Imperatriz, Maranhão, Brazil.,Department of Master Course in Health and Technology, Universidade Federal do Maranhão, Avenue da Universidade, without number, 65.915-240, Imperatriz, Maranhão, Brazil
| | - Francisca Jacinta Feitoza de Oliveira
- Departm ent of Nursing, Universidade Federal do Maranhão, 65.915-240, Imperatriz, Maranhão, Brazil.,Department of Health Sciences, Faculdade de Medicina do ABC, 09.060-870, Santo André, São Paulo, Brazil
| | | | - Hanari Santos de Almeida Tavares
- Department of Nursing, Universidade Estadual do Tocantins, 77.960-000, Augustinópolis, Tocantins, Brazil.,Department of Environmental Sciences Teaching, Universidade Federal do Pará, 66.075-110, Belém, Pará, Brasil
| | - Lilian Natália Ferreira Lima
- Department of Nursing, Universidade Estadual do Tocantins, 77.960-000, Augustinópolis, Tocantins, Brazil.,Department of Infectious and Parasitius Agents Biology, Universidade Federal do Pará, 66.075-110, Belém, Pará, Brazil
| | - Arissane de Sousa Falcão
- Department of Nursing, Faculdade Facimp Wyden, 65.900-000, Imperatriz, Maranhão, Brasil.,Management Department, Universidade de Taubaté, 12.081-010, Taubaté, São Paulo, Brasil
| | | | - Ismália Cassandra Costa Maia Dias
- Departm ent of Nursing, Universidade Federal do Maranhão, 65.915-240, Imperatriz, Maranhão, Brazil.,Department of Master Course in Health and Technology, Universidade Federal do Maranhão, Avenue da Universidade, without number, 65.915-240, Imperatriz, Maranhão, Brazil
| | - Leonardo Hunaldo Dos Santos
- Departm ent of Nursing, Universidade Federal do Maranhão, 65.915-240, Imperatriz, Maranhão, Brazil.,Department of Master Course in Health and Technology, Universidade Federal do Maranhão, Avenue da Universidade, without number, 65.915-240, Imperatriz, Maranhão, Brazil
| | - Janaina Miranda Bezerra
- Departm ent of Nursing, Universidade Federal do Maranhão, 65.915-240, Imperatriz, Maranhão, Brazil
| | | | - Marcelino Santos Neto
- Departm ent of Nursing, Universidade Federal do Maranhão, 65.915-240, Imperatriz, Maranhão, Brazil.,Department of Master Course in Health and Technology, Universidade Federal do Maranhão, Avenue da Universidade, without number, 65.915-240, Imperatriz, Maranhão, Brazil
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