title: Assessment of integration of the leprosy program into primary health care in Aracaju, state of Sergipe, Brazil.
abstract: BACKGROUND
  The aim of this study was to assess the epidemiological and operational characteristics of the Leprosy Program before and after its integration into the Primary healthcare Services of the municipality of Aracaju-Sergipe, Brazil.
  
  
  METHODS
  Data were drawn from the national database. The study periods were divided into preintegration (1996-2000) and postintegration (2001-2007). Annual rates of epidemiological detection were calculated. Frequency data on clinico-epidemiological variables of cases detected and treated for the two periods were compared using the Chi-squared (χ²) test adopting a 5% level of significance.
  
  
  RESULTS
  Rates of detection overall, and in subjects younger than 15 years, were greater for the postintegration period and were higher than rates recorded for Brazil as a whole during the same periods. A total of 780 and 1,469 cases were registered during the preintegration and postintegration periods, respectively. Observations for the postintegration period were as follows: I) a higher proportion of cases with disability grade assessed at diagnosis, with increase of 60.9% to 78.8% (p < 0.001), and at end of treatment, from 41.4% to 44.4% (p < 0.023); II) an increase in proportion of cases detected by contact examination, from 2.1% to 4.1% (p < 0.001); and III) a lower level of treatment default with a decrease from 5.64 to 3.35 (p < 0.008). Only 34% of cases registered from 2001 to 2007 were examined.
  
  
  CONCLUSIONS
  The shift observed in rates of detection overall, and in subjects younger than 15 years, during the postintegration period indicate an increased level of health care access. The fall in number of patients abandoning treatment indicates greater adherence to treatment. However, previous shortcomings in key actions, pivotal to attaining the outcomes and impact envisaged for the program, persisted in the postintegration period.
authors.affiliation: Departamento de Saúde, Universidade Estadual do Sudeste da Bahia, Jequié, BA. tulio.raposo@hotmail.com
authors.forename: Marcos
authors.initials: M
authors.lastname: Túlio Raposo
authors.forename: Maria Ines Battistella
authors.initials: MI
authors.lastname: Nemes
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007918:Leprosy / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011320:Primary Health Care; D015397:Program Evaluation; D012720:Severity of Illness Index; D055815:Young Adult