Quality of healthcare services to reduce leprosy in Brazil: a trend analysis from 2001 to 2020

Mártires, Gabriel da Silva; Lima, Géssica Liana dos Santos; Gomes, Danilo Esteves; Lessa, Angelina do Carmo; Souza, Celsa da Silva Moura; Ignotti, Eliane; Freitas, Ronilson Ferreira

doi:10.1590/1980-549720240034

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 27 • 2024 • https://doi.org/10.1590/1980-549720240034 copy

Quality of healthcare services to reduce leprosy in Brazil: a trend analysis from 2001 to 2020

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the temporal trend of healthcare services quality indicators to reduce leprosy in Brazil, over a 20-year period.

Methods:

This is an epidemiological study with a temporal trend, whose data were extracted from the Notifiable Diseases Information System. Indicators were constructed from the Ministry of Health Technical-Operational Manual that presents the Guidelines for Surveillance, Care and Elimination of Leprosy as a Public Health Problem. For trend analysis of the selected indicators, the Prais-Winsten model was used and the Average Annual Growth Rate (AAGR) was also calculated.

Results:

In the 20-year time series investigated here, 732,959 cases of leprosy were reported in Brazil. The trend was stationary for: new leprosy cases cure rate (β=-0.000; p=0.196; AAGR=-0.2), new leprosy cases drop out rate (β=-0.001; p=0.147; AAGR=-0.4), new leprosy cases contact tracing rate (β=-0.001; p=0.112; AAGR=1.6), new cases of leprosy with degree physical disability assessment rate among new cases (β=-0.000; p=0.196; AAGR=-0.2) and cases cured in the year with the degree of physical disability assessed (β=0.002; p=0.265; AAGR=0.5); while the indicator of recurrence rate among cases reported in the year (β=0.019; p<0.001; AAGR=0.5) showed an increasing trend.

Conclusion:

Based on the evaluation of indicators to assess the quality of healthcare services to reduce leprosy, it was evident that Brazil has major challenges for its full implementation, with improvements being necessary in the quality of care service offered to the population.

Keywords:
Epidemiology; Temporal distribution; Leprosy; Health status indicators; Public health

Indicator	Construction	Utility	Parameters
Proportion of leprosy cure among newly diagnosed cases in the cohort years.	Numerator: New leprosy cases residing in a specific location, diagnosed in the cohort years, and cured by December 31st of the evaluation year. Denominator: Total new leprosy cases residing in the same location and diagnosed in the cohort years. Multiplication factor: 100.	Evaluate the quality of care and follow-up of new cases diagnosed until treatment completion.	Good: =90%; Regular: =75 to 89.9%; Poor: <75%
Proportion of leprosy cases in treatment abandonment among newly diagnosed cases in the cohort years.	Numerator: New leprosy cases diagnosed in the cohort years who abandoned treatment by December 31^st of the evaluation year. Denominator: Total new leprosy cases diagnosed in the cohort years. Multiplication factor: 100.	Assess the quality of care and monitoring of newly diagnosed cases until treatment completion.	Good: <10%; Regular: 10 to 24.9%; Poor: =25%.
Proportion of contacts examined among newly diagnosed leprosy cases in the cohort years.	Numerator: Number of contacts of new leprosy cases examined by current residence location and diagnosed in the cohort years (PB diagnosed in the year before the evaluation year and MB diagnosed two years before the evaluation year). Denominator: Total contacts of new leprosy cases recorded by current residence location and diagnosed in the cohort years (PB diagnosed in the year before the evaluation year and MB diagnosed two years before the evaluation year). Multiplication factor: 100.	Measures the capacity of services to conduct surveillance of contacts of newly diagnosed leprosy cases, thereby enhancing the timely detection of new cases.	Good: =90,0%; Regular: =75.0 to 89.9%; Poor: <75.0%.
Proportion of relapse cases among the cases reported in the year.	Number of reported cases of leprosy relapse/total reported cases in the year x 100.	Identify notifying municipalities of relapse cases for monitoring of therapeutic failure.	No parameter specified.
Proportion of new leprosy cases with the degree of physical disability assessed at diagnosis.	Numerator: new cases of leprosy with the degree of physical disability assessed at diagnosis, residing in a specific location and detected in the year of assessment. Denominator: new cases of leprosy, residing in the same location and diagnosed in the year of assessment. Multiplication factor: 100.	Measure the quality of care in health services.	Good: =90%; Regular: =75 to 89.9%; Poor: <75%.
Proportion of cases cured within the year with the degree of physical disability assessed among new leprosy cases in the cohort period.	Numerator: cases cured within the year with the degree of physical disability assessed at the time of cure, residing in a specific location. Denominator: total cases cured within the year residing in the same location. Multiplication factor: 100.	Measure the quality of care in healthcare services.	Good: =90%; Regular: =75 a 89,9%; Poor: <75%.

Year	Indicators
	Proportion of cure of leprosy among new cases diagnosed in the cohort years		Proportion of leprosy cases in treatment abandonment among new cases diagnosed in the cohort years		Proportion of contacts examined among new leprosy cases diagnosed in the cohort years.
	Proportion	Classification	Proportion	Classification	Proportion	Classification
2001	86.97	Regular	6.97	Good	62.03	Poor
2002	87.23	Regular	5.79	Good	52.10	Poor
2003	86.05	Regular	5.67	Good	44.67	Poor
2004	86.56	Regular	5.23	Good	47.21	Poor
2005	87.16	Regular	4.83	Good	53.93	Poor
2006	86.26	Regular	5.24	Good	59.77	Poor
2007	87.47	Regular	5.48	Good	70.14	Poor
2008	87.18	Regular	5.03	Good	68.86	Poor
2009	85.36	Regular	4.92	Good	70.74	Poor
2010	83.72	Regular	4.34	Good	73.02	Poor
2011	84.44	Regular	4.25	Good	75.12	Regular
2012	82.77	Regular	4.51	Good	77.08	Regular
2013	85.16	Regular	4.86	Good	78.93	Regular
2014	83.76	Regular	5.33	Good	79.26	Regular
2015	81.68	Regular	6.04	Good	78.80	Regular
2016	80.74	Regular	6.16	Good	81.01	Regular
2017	79.09	Regular	6.12	Good	82.37	Regular
2018	80.70	Regular	6.13	Good	82.35	Regular
2019	74.68	Poor	7.64	Good	78.87	Regular
2020	77.07	Regular	6.43	Good	73.17	Poor

Year	Indicators
	Proportion of relapse cases among cases reported in the year^* * No classifcation parameter specified.		Proportion of new leprosy cases with assessed degree of physical disability at diagnosis		Proportion of cases cured in the year with assessed degree of physical disability among new leprosy cases in the cohort period
	Proportion	Classification	Proportion	Classification	Proportion	Classification
2001	2.7	-	88.29	Regular	62.96	Poor
2002	2.8	-	88.09	Regular	61.33	Poor
2003	2.9	-	88.70	Regular	60.77	Poor
2004	3.1	-	88.66	Regular	60.44	Poor
2005	3.4	-	89.38	Regular	60.67	Poor
2006	3.5	-	90.70	Good	59.22	Poor
2007	3.5	-	89.15	Regular	70.18	Poor
2008	3.8	-	89.33	Regular	73.36	Poor
2009	3.9	-	90.33	Good	73.88	Poor
2010	3.9	-	90.69	Good	73.75	Poor
2011	4.3	-	90.74	Good	72.25	Poor
2012	4.7	-	89.87	Regular	71.62	Poor
2013	4.6	-	89.47	Regular	71.42	Poor
2014	4.8	-	88.77	Regular	70.30	Poor
2015	5.3	-	88.73	Regular	69.59	Poor
2016	5.6	-	88.64	Regular	69.03	Poor
2017	6.0	-	88.58	Regular	68.45	Poor
2018	6.3	-	88.15	Regular	70.39	Poor
2019	5.7	-	87.29	Regular	68.21	Poor
2020	5.8	-	84.60	Regular	67.81	Poor

Indicators	Prais-Winsten					Average Annual Growth Rate (AAGR%)			Trend
	ß	95%CI		p value^* * Significance level p<0.05	R²2. Costa MS, Silva Júnior PCB, Moura JPG, Pantoja PVN, Silva MP. Políticas para hanseníase: a evolução da gestão em saúde. Rev Enf 2015; 1(2): 104-8. https://doi.org/10.5935/2446-5682.20150018 https://doi.org/10.5935/2446-5682.201500...	TIA%	95%CI
	ß	Lower	Upper	p value^* * Significance level p<0.05		TIA%	Lower	Upper
Proportion of leprosy cure among new cases diagnosed in the cohort years	-0.000	-0.002	0.000	0.196	0.999	-0.2	-0.5	0.1	Stationary
Proportion of leprosy cases in treatment abandonment among new cases diagnosed in the cohort years	-0.001	-0.004	0.000	0.147	0.967	-0.4	-1.0	0.2	Stationary
Proportion of contacts examined for new leprosy cases diagnosed in the cohort years	0.006	-0.001	0.015	0.112	0.955	1.6	-0.4	3.6	Stationary
Proportion of leprosy relapse cases among those reported in the year	0.019	0.016	0.021	<0.001	0.916	0.5	-0.4	1.5	Growing
Proportion of new leprosy cases with assessed degree of physical disability at diagnosis	-0.000	-0.002	0.000	0.196	0.999	-0.2	-0.5	0.1	Stationary
Proportion of cases cured in the year with assessed degree of physical disability among new leprosy cases in the cohort period.	0.002	-0.001	0.006	0.265	0.987	0.5	-0.4	1.5	Stationary

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[1] Corresponding author: Ronilson Ferreira Freitas. Rua Afonso Pena, 1.053, Centro, CEP: 69020-160, Manaus (AM), Brasil. E-mail: ronifreitas@ufam.edu.br