02549nas a2200277   4500000000100000008004100001653001500042653001200057653001700069653001700086653001100103100001400114700001400128700002200142700001200164700001400176700002000190700001900210700001400229700001700243245011600260856005100376300001400427490000700441520182300448       2017                            d10aPrevention10aleprosy10aEpidemiology10aDisabilities10aBrazil1 aHaefner K1 aWalther F1 aAndré Chichava O1 aAriza L1 aAlencar C1 aDe Alencar MDJF1 aNovaes Ramos A1 aRichter J1 aHeukelbach J00aHigh occurrence of disabilities caused by leprosy: census from a hyperendemic area in Brazil's Savannah region.  uhttps://leprosyreview.org/article/88/4/52-0532  a520–5320 v883 a<p>Objectives: To describe leprosy-related disabilities, we performed a census including people affected by leprosy in 78 municipalities of Tocantins state in northern Brazil. The study consisted of a review of patient charts, structured questionnaires, and clinical examinations for disabilities of eyes, hands, and feet (August–December 2009), according to WHO standards. Results: A total of 910 individuals diagnosed from 2006 to 2008 were included (clinical examination and application of questionnaires), but information from patient charts was not available in all cases, resulting in different denominators. The majority (783/858; 91·3%) had completed multidrug therapy. The most common clinical findings included: enlarged/painful peripheral nerves (412/910, 45·3%), namely of ulnar (207; 22·7%), posterior tibial (196; 21·6%), peroneal (186; 20·5%), and radial cutaneous nerves (166; 18·2%); reduction/loss of sensibility 201/907 (22·2%) and reduced motor function (185/906, 20·4%). At diagnosis, 142/629 (22·6%) had Grade 1 disability (G1D), and 28/629 (4·5%) had Grade 2 disability (G2D). At the time of the study, 178/910 (19·6%) presented with G1D, and 84/910 (9·2%) with G2D. Disability grading was significantly higher in males (P , 0·01). Subjects with G2D showed claw hands (26; 2·9%), followed by plantar ulcers (23; 2·5%), abrasion/excoriation on the foot (12; 1·3%), claw foot (7; 0·7%), and drop foot (7; 0·7%). Conclusions: Leprosy-related disabilities were common in a highly endemic area. Prevention and rehabilitation measures, especially after release from treatment, should be intensified by the primary health care system. Policy makers need to be aware of an ongoing demand for leprosy control programmes, even in a world of constantly reducing leprosy detection.</p>