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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

BRAZIL REPORT: Action Plan Targets Child Cases

Government focuses on reducing the number of transmission sources.

The annual meeting of Brazil's National Hansen's Disease Program (PNCH) was held July 2-4 in Brasilia.


Brazil has yet to move past the interim goal of eliminating Hansen's disease as a public health problem, but is making efforts in this direction by focusing on reducing the number of transmission sources. Recent federal administrations have made the disease a priority, and this can be seen in the latest Ministry of Health action plan for 2008-2011. The goal to 2011 is to reduce the child detection rate by 10%, which calls for strengthened epidemiological surveillance activities.

Of new cases in Brazil, 8% occur among children under the age of 15, representing a major challenge for the country's National Hansen's Disease Program (PNCH). This indicates that adults with Hansen's disease who have not been diagnosed are transmitting the disease to children and adolescents, usually within the same family.

Undiagnosed adults are transmitting the disease to children and adolescents.

This could be related to the fragile performance of household contacts surveillance, given that under 50% of contacts were examined in 2006-2007. One of the priorities of the action plan, therefore, is to improve surveillance in identified clusters.

The action plan also includes several measures for providing financial support to Brazil's most endemic regions, in addition to projects to strengthen organizations of people affected by the disease. The government is also paying a monthly stipend to help people isolated in colony hospitals in the past to recover their citizenship rights.

To ensure the technical, political and social sustainability of PNCH, several partnerships have been formed with different stakeholders.

These stakeholders include members of the International Federation of Anti-Leprosy Associations (ILEP), scientific societies, religious leaders and organizations of people affected by Hansen's disease such as the Movement for the Reintegration of People Affected by Hansen's Disease (MORHAN), GAMAH (a group of women affected by the disease) and the International Association for Integration, Dignity and Economic Advancement (IDEA).

CLOSE COOPERATION

To reinforce the permanent integration of the PNCH within the basic health care system, with a view to expanding patient access and refining epidemiological surveillance, the program is working closely with the health ministry's Basic Care Department (DAB) and Information System (SINAN) and is also liaising closely with state and municipal authorities. In addition, PNCH recently issued five new learning materials on Disability Prevention and Rehabilitation.

Investment in the managerial training of technical personnel at the regional and local level has focused on program improvement. This is in view of the importance of monitoring and evaluation (M&E) as key administrative instruments to improve the effectiveness of the program. A total of 380 technicians from the most endemic municipalities have been trained.

At PNCH's annual meeting held in Brasilia on July 2-4, the 220 stakeholders attending gave their enthusiastic backing to the government's action plan and also welcomed the Hansen's disease awareness campaign that was to launch on July 6 (see facing page).

AUTHOR: Dra. Maria Leide W. de Oliveira.

Dra. Maria Leide is coordinator of Brazil's National Hansen's Disease Program

LEPROSY FACTS

In the past five years, Brazil has identified around 47,000 new cases of leprosy annually.