Qualidade de vida e hanseníase em um município hiperendêmico: um estudo dos sujeitos tratados e dos contatos intradomiciliares

Abstract

Leprosy is a chronic disease that can lead to irreversible and stigmatizing physical injuries, interfering with the quality of life (QOL) of the subjects and their household contacts (IC). Objective: To evaluate the health-related quality of life (HRQoL) of people treated for leprosy and their IC, in addition to checking the socio-cultural factors and associated health conditions, in the territories of the Family Health Strategy in the municipality of Imperatriz - Maranhão. Material and Methods: This was a quantitative, descriptive and cross-sectional study, in a population composed of 172 new cases, diagnosed in 2018, in the health districts of ImperatrizMA and monitored by the Leprosy Control Program. Data collection took place during a home visit between January and March 2020, resulting in a sample of 123 treated subjects and 301 IC after applying the inclusion and exclusion criteria. Individual interviews were conducted using: socio-cultural and health questionnaire, World Health Organization Quality of Life (WHOQOL-bref) and Stigma Scale. The study was approved by the Research Ethics Committee of Universidade Ceuma under the number 3,611,230. The SPSS software was used for statistical analysis. Calculations of frequency and measures of central tendency and variability were performed. Normality was verified by the Kolmogorov – Smirnov test. The association between socio-cultural variables and health conditions with HRQoL and Stigma was verified using the Chi-square or Fisher's Exact test. To perform these tests, the quantitative variables HRQoL and Degree of Stigma were categorized. Spearman's correlations between continuous quantitative variables (HRQoL, HRQOL domains and degree of stigma) were also estimated. The level of significance was set at 5% for statistical tests. Results and discussion: The general QOL was unsatisfactory for 50.4% of the treated subjects and the degree of stigma was high in 48% of the cases. There was no significant association between the categories of stigma (high and low) and HRQoL (satisfactory and unsatisfactory) of the treated individuals. The variables associated with the HRQoL categories were: age range, marital status, education, occupation / profession, number of daily contacts, income and reaction episodes. As for the degree of stigma, only marital status showed a significant association. As for IC, HRQoL was unsatisfactory for 89.4% and the degree of stigma was high in 43.2% of cases. A significant association was found between the categories of stigma (high and low) and HRQoL (satisfactory and unsatisfactory). The variables associated with the CI's HRQoL were: age range, marital status, education, occupation / profession and family income (p <0.001). For the degree of stigma, the following were associated: age group, marital status, education and family income. The HRQoL was significantly related to all WHOQOL-bref domains, mainly to the physical and social relations domains, both in the treated subjects and in the IC. In contacts, stigma maintained a significant relationship with all domains of HRQoL, and proportionately inverse for the environmental, psychological and social domains. Conclusion: Considerable portion of the subjects, even after being discharged due to cure, presented unsatisfactory HRQoL and a high degree of stigma. And most of their contacts have unsatisfactory HRQoL and a low degree of stigma. It was found that unfavorable living conditions related to poverty, such as low level of education, income, number of daily contacts, marital status and occupation are related to the HRQoL of these people and their IC, who are also vulnerable to illness. Public policies aimed at early diagnosis, psychosocial rehabilitation and greater reduction in the transmission chain are necessary, since Hansen's disease must be understood as a socio-health problem that directly impacts the subjects' HRQoL and IC