Leprosy in Brazil: How Can Brazil Meet the World Health Organization's Goal of Leprosy Control?
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BACKGROUND: Leprosy causes a high social and economic cost on communities. Brazil has the second most cases of leprosy in the world. Brazil's incidence of leprosy decreased significantly with the start of multi drug therapy in 1981, but over the past ten years, the incidence has remained fairly fixed. OBJECTIVE: Brazil has not met the World Health Organization's leprosy goal for a prevalence of less than one patient per 10,000 inhabitants. The purpose of this literature review is to evaluate the progress of Brazil's leprosy control measures and highlight the areas in which Brazil can concentrate to meet this goal. METHODS: An online literature search was performed through the Ovid and PubMed databases describing leprosy in Brazil and management practices. Publications in Portuguese were translated into English. RESULTS: Several studies were found that identified various factors impeding the progress of Brazil toward its prevalence target. These general categories include: society and culture, stigma and isolation, vaccination and chemoprophylaxis, decentralization of resources and the leprosy control action, molecular tools, and relapses and non-adherence. CONCLUSION: Leprosy continues to be a public health problem in Brazil and the incidence rates are not improving. The various factors impeding Brazil can be grouped into three main areas: prevention, diagnosis, and treatment. Optimizing resources in the ten clusters with the highest incidence rates will allow Brazil to reach its WHO prevalence goal.