Leprosy is an infectious disease caused by Mycobacterium leprae, a mandatory intracellular
bacterium that infects macrophages, dendritic cells, keratinocytes and Schwann cells and can
cause deformities and physical disabilities, in addition to psychological damage due to the
stigmatization of patients. Brazil is among the countries that most report leprosy cases in the
world and the state of Tocantins has a high detection rate, being classified as hyper-endemic.
The objective of the study was to identify social and individual factors associated with the
occurrence of leprosy in municipalities in the health region of Bico do Papagaio, northern
Tocantins, from 2008 to 2018. A sectional, descriptive study was conducted with data
secondary cases of leprosy cases notified in municipalities in the health region of Bico do
Papagaio - TO in the period from 2008 to 2018, registered in the Notifiable Diseases
Information System - SINAN. Additionally, an unpaired case-control study was carried out to
assess possible determinants of the disease in the region, by conducting interviews with patients
notified for leprosy in the years 2016 to 2018. The epidemiological study revealed a record of
1257 new cases, of which 173 (13.76%) occurred in children under 15 years old. There was a
predominance of the disease in males (54.49%), aged between 15 and 59 years (65%), in brown
individuals (69.93%), illiterate or who attended elementary school (60.76% ) and residents of
the urban area (74.14%). The multibacillary form was more frequent (58.63%) as well as
dimorphic (38.66%) and with up to 5 injuries (56.56%). Degree of physical disability 2 (GIF)
was registered for 3.98% of those notified and nerve involvement in 25.38%. Sputum smear
microscopy was positive in 41.46% (209/504) of the individuals submitted to the exam and was
ignored or not performed in 59.9% of the notifications. Leprosy reactions were recorded in
12.25% of those notified. The average general detection coefficient in the general population
was 59.89 / 100 thousand inhabitants and in children under 15 years of age, 8.88 cases / 100
thousand. The degree of physical disability 2 had a detection rate of 23.24 cases / 1 million
inhabitants. The spatial distribution of the disease showed a predominance of hyper-endemic or
very high endemic areas over the study period. In the case-control study, a greater chance of
the occurrence of leprosy was observed in black (OR = 2.56; p = 0.001) and brown (OR = 1.36,
p = 0.015) individuals, with low education (OR = 3.23 , p = 0.006) and with occupations that
do not require school training (OR = 4.24, p <0.001). Homes with up to 4 rooms (OR = 4.02; p
<0.001), which had a water supply (OR = 19.56, p <0.001) and who were visited by a health
agent, also appeared as associated with the occurrence of leprosy. health (OR = 2.87, p = 0.016).
Individuals who did not receive BCG immunization (OR = 2.2; 0.014) and who reported a
previous case of leprosy in the family (OR = 4.35; p <0.001) were also more likely to become
infected. The data show that in the health region of Bico do Papagaio the diagnosis of leprosy
still occurs late, with a high occurrence of multibacillary cases, especially among children under
15 years of age. The intimate contact between individuals in larger families and small
households, without any immunological protection and with the presence of cases of the
disease, are risk factors for leprosy infection and in families assisted by the public health system,
the chance of diagnosis of the disease is bigger.
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