title: [Leprosy diagnosis in municipalities other than the patients' place of residence: spatial analysis, 2001-2009].
abstract: The study analyzed the flow of persons with leprosy from their municipality (county) of residence to that of their diagnosis in a highly endemic area in Brazil. The study was based on data from the National Information System for Notifiable Diseases from 2001 to 2009 in the States of Maranhão, Pará, Tocantins, and Piauí. Of the 373 municipalities, 349 (93.6%) had at least one resident with leprosy that had been diagnosed in a different municipality (4,325 cases, or 5.2% of the total). The municipalities with the most cases reported elsewhere were Timon (248) and São José de Ribamar (201), Maranhão State. The municipalities that received the most exogenous cases for diagnosis were São Luís (719), capital of Maranhão, and Teresina (516), capital of Piauí. Goiânia (146), capital of Goiás, and the Federal District (42) also reported numerous cases, even though they are located more than 1,000 km from the endemic area. The flow indicates gaps in the decentralization of comprehensive care for persons with leprosy and calls attention to the difficulties associated with patient monitoring during and after multidrug therapy.
authors.affiliation: Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brasil. carllosalencar@ufc.br
authors.forename: Carlos Henrique Morais de
authors.initials: CH
authors.lastname: Alencar
authors.forename: Alberto Novaes
authors.initials: AN
authors.lastname: Ramos
authors.forename: Sebastião Alves de
authors.initials: SA
authors.lastname: Sena Neto
authors.forename: Christine
authors.initials: C
authors.lastname: Murto
authors.forename: Maria de Jesus Freitas de
authors.initials: Mde J
authors.lastname: Alencar
authors.forename: Jaqueline Caracas
authors.initials: JC
authors.lastname: Barbosa
authors.forename: Jorg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D001938:Brazil / Q000453:epidemiology; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D018563:Disease Notification; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D063426:Human Migration / Q000706:statistics & numerical data; D006801:Humans; D007256:Information Systems; D007918:Leprosy / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D011320:Primary Health Care; D062206:Spatial Analysis