Leprosy after release from treatment in the Brazilian Unified Health System: aspects for access in the Northeast region

Universal access to health services represents a complex process of inter-relationships between users and health services. In a broader sense it includes economic, technical, political and symbolic aspects. For neglected diseases such as leprosy, this is a major challenge. This cross-sectional study aims to characterize access to health care services for people affected by leprosy after release from treatment in the cities of Sobral and Fortaleza. The study included a representative sample 10% of those concluding treatment from 2003 to 2005 (304 cases). Participants were characterized regarding socio demographic and clinical variables and access to health services after release from treatment. The study population was mostly male (58%), physical disabilities (34%) and with leprosy reactions (37%). The biomedical approach of leprosy reactions contemplated in large part to search for and supply of care in this period. The access to care after discharge was particularly weak in rehabilitative interventions such as surgery and psychological attention. We identified important gaps in the operationalization of attention to people affected after release from treatment in both cities. The date also shows the negligence of leprosy as a chronic condition and the resulting difficulties regarding on integrated distance to the comprehensive approach to people with leprosy after release from treatment in the Unified Health System (SUS).

全民可及卫生服务，是卫生服务使用者与服务体系之间复杂互动的动态过程。从广义层面而言，其涵盖经济、技术、政治与符号层面等多个维度。对于麻风病（leprosy）这类被忽视的疾病（neglected diseases）而言，实现全民卫生服务可及是一项重大挑战。本项横断面研究（cross-sectional study）旨在刻画巴西索布拉尔与福塔莱萨两市中，麻风病患者完成治疗后卫生服务可及性的现状特征。本次研究纳入2003年至2005年间完成治疗的患者中10%的代表性样本，共计304例病例。研究人员针对受试者的社会人口学特征、临床变量以及完成治疗后的卫生服务可及情况开展了系统性分析。研究队列中男性占比最高（58%），存在肢体残疾者占34%，出现麻风反应者占37%。此阶段针对麻风反应的生物医学照护路径，核心内容多围绕麻风反应的筛查与医疗服务供给展开。结束治疗后，受试者在手术、心理照护等康复干预类服务的可及性尤为薄弱。研究团队发现，两市在针对完成治疗的麻风病患者的后续照护服务落地实施方面，存在显著短板。本次研究数据同时显示，麻风病作为慢性疾病仍未得到足够重视，且在统一卫生系统（Unified Health System, SUS）框架下，完成治疗的麻风病患者获取综合照护服务的整合式路径仍存在诸多困难。