Migration and Hansen’s
disease in Mato Grosso
Migração e hanseníase
em Mato Grosso
Maria da Conceição Cavalcanti MagalhãesI
Emerson Soares dos SantosII
Maria De Lourdes de QueirozIII
Messias Lucas de LimaIII
Rita Christina Martins BorgesIII
Maria Silva SouzaIII
Alberto Novaes RamosIV
I
Abstract
Studies on medical geography about leprosy discuss the role of the detailed report of
the occupation of the territories as a basis of
the permanence of leprosy focus. In Brazil,
the states that present the highest rates of
detection historically are in the Amazon
region, which shows an uneven regional
evolution of the disease. his paper analyzes the evolution of leprosy contextualizing
the migratory processes that occurred in the
State of Mato Grosso since the second half
of the 20th century. he economic dynamism
that occurred in the State in the 1970s, 1980s
and 1990s caused population growth rates
higher than the national average. he data
analyzed permitted an association between
the evolution of leprosy and the process of
occupation of the mato-grossense territory.
However, the permanence of leprosy in the
municipalities of the Baixada Cuiabana,
as well as in other municipalities that lost
population, seem to point to the existence
of geographic contexts of diferent vulnerability to the social production of the disease
in the tate. he migration would explain
the appearance and evolution of leprosy.
However, we consider that the maintenance
of the endemic can be associated to contextual factors related to environment.
Keywords: leprosy; migration; detection rats; special analysis; environment;
geographic information systems.
Secretaria Executiva do Ministério da Saúde – Brasília (DF), Brasil
II
Departamento de Geografia da Universidade de São Paulo – São Paulo (SP), Brasil
III
Secretaria de Estado de Saúde de Mato Grosso – Cuiabá (MS), Brasil
IV
Departamento de Saúde Comunitária da Faculdade de Medicina da
Universidade Federal do Ceará – Fortaleza (CE), Brasil
Trabalho realizado na Oficina de Pesquisa Operacional em Serviços de Saúde, promovida pelo
Ministério da Saúde, Universidade Federal do Ceará e Netherland Leprosy Relief (NLR).
Fonte de financiamento: nenhuma.
Correspondência: Maria da Conceição Cavalcanti Magalhães – SQS 205, Bloco I, Apto. 606, Asa
Sul – CEP: 70295-050 – Brasília (DF), Brasil – E-mail: mariac.magalhaes@uol.com.br
Conflito de interesse: nada a declarar.
1
Rev Bras Epidemiol
2011; xx(x): xxx-xxx
Resumo
Introduction
Trabalhos de geograia médica sobre hanseníase discutem o papel da ocupação dos
territórios como fundamento da permanência de focos leprógenos. No Brasil, os
Estados que apresentam as mais altas taxas
de detecção, historicamente, se localizam
na região amazônica, o que evidencia uma
desigual evolução regional da doença. Este
trabalho analisa a evolução da hanseníase
contextualizando os processos migratórios
que ocorreram no Estado de Mato Grosso
a partir da segunda metade do século XX.
O crescimento econômico ocorrido no
Estado nas décadas de 1970, 1980 e 1990
provocou taxas de crescimento populacional maiores que a média nacional. Os dados
analisados permitem uma associação entre
o crescimento e dispersão dos coeicientes
de detecção da hanseníase com o processo
de ocupação do território mato-grossense.
Entretanto, a permanência da hanseníase
em municípios da Baixada Cuiabana, assim
como em outros municípios que sofreram perda de população, parece apontar
a existência de contextos geográicos de
diferentes vulnerabilidades à produção
social da doença. A migração explicaria a
instalação e evolução da hanseníase, entretanto consideramos que a manutenção
da endemia pode estar associada a fatores
contextuais relacionados com o ambiente.
Leprosy, also known as Hansen’s
disease, is a serious problem of public
health in Brazil: the country diagnoses 90%
of the cases of the Americas; worldwide, it
is the second in absolute number of cases,
surpassed only by India1. Historically, the
main endemic areas in the world are in
regions of tropical climate, characterized
for presenting high temperature and heavy
rain. Besides the natural assumptions,
to the territorial distribution of leprosy,
unfavorable conditions of life, nutritional
deiciencies and migratory movements
are added among other factors. he study
of leprosy presents a vast literature that, in
several ways, direct or indirectly, indicates
that the distribution of leprosy is restricted
to certain areas, called foci, belts or bands.
Some works of medical geography about
the disease discuss the role of history of
territory occupation as a basis of the permanence of leprosy cases2,3.
he geographic presentation in leprosy
focus, without a deinitive explanation, as
well as a prolonged subclinical evolution
of the disease, associated to the intense
migratory movements of the last decades
and to the concentration of the population
in cities, makes the leprosy geography one
of the most diicult chapters of the world,
regional and local nosogeography4.
In Brazil, the states that historically
present the highest detections and the most
unfavorable evolution of the endemics are
located in the northern and Center-western
regions, which show an uneven regional
evolution and suggest the existence of
geographic contexts of diferent vulnerabilities to the social production of leprosy.
Data from 2007, of the Ministry of Health5,
show the commitment of the Legal Amazon
in relation to leprosy, since this area, with
12.7% of the Brazilian population , concentrates 38.9% of the new cases detected in
the country.
he concept of Legal Amazon, essentially political, replaces that of the
Brazilian Amazon. his one that comprised
Palavras chave: hanseníase; migração; taxa
de detecção; análise espacial; ambiente;
sistemas de informação geográica.
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2011; xx(x): xxx-xxx
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Migration and Hansen’s disease in Mato Grosso
Magalhães, M.C.C. et al.
an area of 3.7 millions of km2 occupied
by the ‘Tropical Dense and non-dense
Rainforest’, when it became Legal Amazon
also increased its area in 1.3 million of km2.
Today, it includes a long stretch of transitional vegetation with about 700 thousand
of km2, bordering the center-western
savanna and the northern ields in the
states of Roraima, Pará and Amapá.
he Center-western region registered an
abrupt inversion in the proportion of people
living in the urban and rural areas, of the
second half from the XX th century on. In
1940, when it had the smallest level of urbanization among the Brazilian regions, 80% of
its population lived in rural areas. In 1996,
84% of the population lived in urban areas6.
In the 1960s, 1970s and 1980s, Mato Grosso
was the target of the Brazilian government
programs that aimed at occupying the
territory, setting up colonization programs
based on settlements. here was also the
opening of important highways, such as
BR-163 (Cuiabá-Santarém), that led the
migratory lows to the newly opened areas,
directly impacting on the demographic
dynamics of the state and in the process of
spatial redistribution of its population. he
rapid colonization led to the proliferation
of new municipalities in the frontier areas
that until today sufer with the absence of
infrastructure and services7. Mato Grosso
has an essentially agricultural economy,
linked to a growing urbanization, but still
has extended areas of forests and non-occupied forests. he existence of these areas
is a strong attraction to the increase in the
migratory movement, which generated a
fast economic growth in the last years.
he migratory process alters the epidemiological structure of the evasion areas,
as well as the migrant reception, with
immediate relexes over the individual
and collective risks of diseases8. As
the relationship between man and the
environment are the action of nature on
man and the human action modeling
nature9, the economic development and
the migration and urbanization processes
that arise from it, produces changes in the
occurrence and distribution of infectious
and parasite diseases .
his study aims at describing the leprosy
behavior in the state of Mato Grosso, and its
relationship with the migratory movements
that occurred there since the second half of
the 20th century.
Methodology
It is a Nosogeography study – or Health
Geography – focusing on the relationship
between the territorial diferentiation of
leprosy and the evolution of the population
in Mato Grosso, in diferent scales of
analyses: mesorregional, micro regional
and municipal. It aims at identifying both
the changes occurred in the spatial organization during the period studied as well as
the epidemiological situation of the disease.
In this way, given the meaning that has the
migratory movements of the population in
the dynamics of leprosy transmission, the
population growth and the evolution of
leprosy cases are analyzed.
he place of study is the state of Mato
Grosso, located to the west of the centerwestern region of Brazil, with most of its
territory occupied by the Legal Amazon
(Figure 1). It has an area of 906,806.9 km2
and it has Cuiabá as the capital. It is divided
into 141 municipalities, distributed in
ive mesorregions and 23 micro regions.
he population is of 2,803,274 inhabitants
(IBGE-2006).
Organization and Data analyses
Historical series of detection coeicient of leprosy cases for the state were
built. From 1960 to 1998, reports from the
Technical Area of Sanitation Dermatology
(ATDS) of the Ministry of Health (MS) were
used, and, from 1999 on, the source of data
was the Sistema de Informações de Agravos
de Notiicação - SINAN (National Disease
Notiication System), that is decentralized
to all the municipalities. An evaluation of
the NDNS database quality was carried
out, taking into account completeness,
Migration and Hansen’s disease in Mato Grosso
Magalhães, M.C.C. et al.
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Rev Bras Epidemiol
2011; xx(x): xxx-xxx
Mesorregion
I - Center-south
II - Northeast
III - North
IV - Southeast
V - Southwest
Mesorregioes Boundary
Microrregioes Boundary
Figure 1. Study area: Mato Grosso State divided by meso and micro-regions
Figura 1. Área em estudo: Estado de Mato Grosso por meso e microrregiões
consistence and duplication in the register,
with those considered inconsistent being
removed. For the population data, the source
used was the Brazilian Institute of geography
and Statistics (IBGE). For the description of
the migratory movements in Mato Grosso
secondary data, provided by IBGE (2000)
and by the Planning Department of Mato
Grosso through the Zoneamento SócioEconômico Ecológico10 (Ecological Socioeconomic Zoning) were used.
Spatial Analysis
he historical series are presented
through graphics and maps. he maps
show the space-time evolution, with the
distribution of cases in the state aggregated by municipalities, whose data are
medium coeicients in a three-year period.
It is worth highlighting that the research
presented here was submitted to the
analysis of the Research Ethics Committee
of the State Health Department of Mato
Grosso, and approved under the protocol
number 331/07.
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Migration and Hansen’s disease in Mato Grosso
Magalhães, M.C.C. et al.
Results
he historical series of the detection
coeicient of leprosy of Mato Grosso since
1960 shows an exponential growth from 1970
to 1995, with an apparent stabilization since
then, thereafter, keeping itself at a high level.
he state coeicient, in 2006, is three times
higher than the parameter that the Ministry
of Health (MH) deines as hyperendemicity
(more than 4 cases per 10,000 inhabitants),
with almost all its mesorregions also above
12 cases per 10,000 inhabitants.
he economical growth that occurred
between the 1970s and the 1990s brought
a considerable increase in the state
population. Its rates of population growth
are higher than the national and the Centerwestern average (Table 1). In Figure 2 it is
possible to notice the evolution of the matogrossense population, which coincides with
the increase in leprosy detection rates.
Analyzing the data per micro regions
(Figure 2), we observe that the highest
leprosy detection coeicients were
presented by the Northern, Northeastern
Table 1. Population growth of Mato Grosso, Midwest and Brazil, in the 1960 and 1990’s years
Tabela 1. Crescimento populacional em Mato Grosso, no Centro-Oeste e no Brasil, nas décadas de
1960 e de 1990
Period
1960–1970
1970–1980
1980–1990
Mato Grosso
6.3%
6.6%
5.4%
Midwest
6.2%
4.3%
2.7%
Brazil
2.9%
2.6%
1.7%
Source: ZSEE-Seplan-MT, 2002.
Fonte: ZSEE-Seplan-MT, 2002.
3,000,000
18.00
16.00
14.00
População
Population
2,000,000
12.00
10.00
1,500,000
8.00
1,000,000
6.00
4.00
Coef. de Detecção
(1/10.000
hab)
Detection
Rate (1/10,000
inhab.)
2,500,000
500,000
2.00
0
0.00
População
MT
MT
Center-South
Centro- Sul
Coeficiente
de Detecção
Detection
Rate
Northeast
North
Southeast
Nordeste
Norte
Sudeste
Southwest
Sudoeste
Source: Reports of ATDS, Sinan, IBGE
Fonte: Relatórios da ATDS, Sinan, IBGE
Figure 2. Population growth and rates of detection of leprosy - Mato Grosso and meso-regions,
1960–2006
Figura 2. Crescimento populacional e coeficiente de detecção de hanseníase - Mato Grosso e mesorregiões, 1960–2006
and Southwestern mesorregions of the
state, with all their micro regions presenting
an increase in the detection coeicient.
he southeastern region of the state also
shows an increase in the coeicient in all
its micro regions, while the Center-south
shows a stable behavior of its micro regions,
except for the Alto Pantanal, that reveals a
reduction of its coeicient provoked by the
municipality of Cáceres (Table 2).
Between 1996 and 1999, the incidence
of the disease is higher in the municipalities with more than 50,000 inhabitants,
that is, in the most populous cities of the
state, as shown in Figure 3. In later periods
there was a homogenization of the rates
occurred, and it is possible to notice that
they increase in the smaller municipalities,
which represents an inter-municipal low
of the disease, possibly due to migratory
movements related to the economic growth
that occurred in these areas.
he northern mesoregion, until the late
1990s, had received a great deal of population,
and except for Colíder, all the other micro
regions have a positive population growth
(Figure 4). he population decrease of the
micro region of Colíder was caused mainly
by the exit of the population of Peixoto de
Azevedo, a city with a high rate of Leprosy
detection that migrated mainly to Sinop
and Sorriso, municipalities that belong to
Migration and Hansen’s disease in Mato Grosso
Magalhães, M.C.C. et al.
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Rev Bras Epidemiol
2011; xx(x): xxx-xxx
Table 2. Rate of detection of leprosy by micro-regions - Mato Grosso, 1996/1999, 2000/2003 and
2004/2006
Tabela 2. Coeficientes de detecção por microrregião em três períodos: 1996-1999, 2000-2003, 2004-2006.
(1/10.000 hab)
Mesoregion
Micro-region
Center-south
Northeast
North
Southeast
Southwest
1996–1999
2000–2003
2004–2006
Alto Pantanal
9.74
9.27
7.48
Alto Paraguai
22.37
19.77
19.39
Cuiabá
7.84
10.17
10.80
Rosário Oeste
10.07
8.10
8.41
Canarana
10.76
12.90
16.26
Médio Araguaia
20.74
19.91
17.88
Norte Araguaia
10.10
13.76
12.28
Alta Floresta
5.11
10.20
9.83
Alto Teles Pires
7.10
12.12
13.50
Arinos
3.96
9.60
13.65
Aripuanã
4.96
8.26
12.19
Colíder
5.79
11.33
12.15
Paranatinga
14.50
19.52
12.70
Parecis
8.49
15.13
19.98
Sinop
6.07
13.31
13.67
Alto Araguaia
3.23
6.52
7.75
Primavera do Leste
8.36
8.60
9.02
Rondonópolis
11.23
11.71
10.82
Tesouro
8.33
9.85
14.53
Alto Guaporé
4.15
10.55
8.52
Jauru
11.31
13.79
14.97
Tangara da Serra
14.83
22.14
13.09
1996-1999
2000-2003
2004-2006
40
20
Range
Municipalmunicipal
population
( x 1,000)
Faixa
de of
população
(x 1.000)
Source: Sinan/IBGE
Fonte: Sinan/IBGE
Figure 3. Rate of detection of leprosy by municipies and population range - Mato Grosso,
1996/1999, 2000/2003 and 2004/2006
Figura 3. Taxa de detecção de hanseníase por municípios e faixas de população - Mato Grosso,
1996/1999, 2000/2003 e 2004/2006
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Migration and Hansen’s disease in Mato Grosso
Magalhães, M.C.C. et al.
>5
0
<5
0
20
<2
0
10
<1
0
>5
0
<5
0
20
<2
0
10
<1
0
>5
0
<5
0
20
10
<2
0
0
<1
0
Detection
Rate01/10.000
(1/10,000hab.)
hab.)
Coef.
Detecção
Source: Sinan/IBGE.
Fonte: Sinan/IBGE.
Detection Rate (1/10,000 inhab)
2004-2006
70.0
00.0
Population Growth - % (1991-2000)
-4 < -0.5
-0.5 < -0.5
0.5 < 2
2<5
5<8
8 < 11
11 < 14
Mesoregions Boundary
Micro-regions Boundary
Source: ZSEE-Seplan-MT 2002
Fonte: ZSEE-Seplan-MT 2002
Figure 4. Rate of population growth of the micro-regions of Mato Grosso in the 1990’s years
Figura 4. Taxas de crescimento populacional das microrregiões mato-grossenses na década de 1990
Attraction and Migratory effective
in Mato Grosso state
between 1970 and 2000
Low Attraction
Mean Attraction
High Attraction
Detection Rate (1/10.000 inhab)
70.0
00.0
Mesoregions Boundary
Hansen’s disease Foci
Old Focus
Recent Focus
Source: ZSEE-Seplan-MT 2002
Fonte: ZSEE-Seplan-MT 2002
Figure 5. Attraction degree and effective migratory participation in Mato Grosso
Figura 5. Grau de atração e participação do efetivo migratório em Mato Grosso
Migration and Hansen’s disease in Mato Grosso
Magalhães, M.C.C. et al.
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Rev Bras Epidemiol
2011; xx(x): xxx-xxx
the micro regions of Sinop and Alto Teles
Pires, respectively.
Continuing with the analysis of Figure 4,
a decrease of the population in the
micro region of Alto Paraguay is noticed.
Considerable population groups migrate
from the municipalities of this micro region
to the municipalities of the Alto Teles Pires
and Parecis micro regions.
he emergent economic growth made
possible a considerable increase of the
state population, superior to the national
average, although this increase has
occurred in an uneven way, inluenced
by the regional environmental speciicities. he Zoneamento Sócio-Econômico
Ecológico de Mato Grosso10 classiies the
municipalities of Mato Grosso according to
their degree of attractiveness and efective
participation of the migrants in the state
(Figure 5).
In the 1990s data, the municipalities of
the northern mesoregion were classiied
by presenting “strong” and “medium level
of attractiveness”. hese municipalities are
also those that increased the detection rates
the most since the beginning of 2000. Also
analyzing the evolution of the deforestation
in Mato Grosso by meso and micro region,
a coincidence between the increase of the
leprosy detection coeicients and the growth
of deforested areas is observed. he deforestation can be associated to the entrance of
people in preserved natural environments
and shortage of health political structures.
Discussion
he territory that today is the state of
Mato Grosso, was initially exploited by
Portuguese settlers, attracted by the hunt
for the Indigenous people and by the gold
mining. he irst settlement of Cuiabá was
founded in 1719, and in the next decade it
became one of the most populous nucleation of the region and, as a consequence of
the great expansion of the mining activity,
the surrounding areas were populated11.
In 1723, the city of Diamantino and the
nucleus of Rosário Oeste as points of
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Migration and Hansen’s disease in Mato Grosso
Magalhães, M.C.C. et al.
support between Cuiabá and the gold and
diamond mines in the interior of the region
appeared. Other settlements were created,
such as Alto Paraguai, Nossa Senhora do
Livramento, Santo Antonio do Leverger and
Barão de Melgaço. In the second half of the
XVIIIth century, the settlement axis moves
towards the western region, and Vila Bela da
Santíssima Trindade was founded in 1752.
he development of Cáceres estimulates the
creation of Barra does Bugres settlement12.
In the late 19th century and in the
irst decades of the 20th century, the
population increase that occurred in Mato
Grosso gave rise to urban centers such as
Poxoréo, Guiratinga, Barra do Garças, Alto
Araguaia and Tesouro, known irst as “small
camping grounds of diamond miners at the
entrance of the diamond ields”, since they
had their origins in the process of exploration of diamonds. In the late 1960s of
the 20th century, with the depletion of the
diamond mines several of these nuclei went
into decline and their inhabitants began
migrating to other urban centers and rural
areas. In some settlements almost all the
inhabitants left.
A report of the director of Lázaros
hospital, of 1927, informs that the situation of
leprosy in the state is alarmingly spreading,
having as the main foci: Rondonópolis,
Cáceres, Ladário and Poconé. Added to this
legion of patients already existent, there are
others from other states, initially São Paulo,
Minas Gerais and neighboring countries
such as Paraguay. It is estimated that the
number of patients is more than 700.
Numerous foci of leprosy were identiied in
dwellers on the banks of the Guaporé River13.
hese foci, identiied in the beginning of last
century, still remain, nowadays, as leprosy
hyperendemic areas in the state.
Due to the short duration, the mining
cycle had little inluence in the territorial
planning of Mato Grosso, and the urbanization occurred due to the advance of
the agricultural activity, which attracted
workforce of other regions of the country.
In the irst moment, in the 1950s and 1960s,
the migratory low came mainly from Bahia,
Minas Gerais and Goiás. From the next
decade on, the origin of the migratory low
was mainly from the south of the country.
Besides the occupation of the agricultural frontier, which started in the 1940s,
the construction of Brasília provided the
intensive growth of the urban nuclei of
varied sizes. During the 1970s the process of
rural exodus in the region is initiated, more
evident in the1980s14.
he opening of federal highways, such
as BR 070, 158, 163, 364, among many other
state highways, facilitated the occupation
of the territory. Agriculture spread quickly,
giving rise to a network of cities and roads12.
he state of Mato Grosso experiences a
phase of economic expansion, based on
a combined agriculture and stock raising
activity that attracted a great migratory low
in the 1970s, 1980s and early 1990s. Driven
by the actions of the federal programs, the
economic development that expanded the
combined agriculture and stock raising
frontier triggered territorial, political,
economic and social changes. When facing
this kind of population occupation, the
soybean culture appears, an agricultural
activity highly capitalized and mechanized,
seen as a viable option in the savannas or
as a way of recovering areas with pastures14.
However, the use of lands for this crop and
for pastures, linked to the search for timber,
were and still are the biggest responsible
causes for the destruction of the forests6.
he stock raising activity that is being
introduced more and more in the areas
previously occupied by forests made the
cattle of Mato Grosso the second largest of
the country6. Other aspects that should be
considered when one intends to understand
the occupation process of Mato Grosso are
the disrespect to the Indigenous lands and
the predatory efect of the gold mining.
hese elements, together, end up causing
great foci of social tension in the state6.
In 1996, the municipalities with the
highest detection coeicients concentrated mainly in the Center-northern part
of the state, where the micro regions of Alto
Pantanal, Tangará da Serra, Rosário Oeste,
Alto Paraguai and Parecis are located. he
municipalities that belong to the microregion of Alto Paraguai, along with the
municipality of Diamantino, in the microregion of Parecis, are areas of ancient
occupation that began in the 19th century,
when the intense gold mining activity
attracted a great number of migrants and
supported the economy of the region.
Between 1996 and 1999, the eastern part of
the state, mainly the municipalities close
to Rondonópolis and Barra do Garças,
stand out with high detection coeicients,
however in lower intensity. he formation
and growth of Rondonópolis had a direct
inluence of the development programs of
the Federal Government. Being elevated to
the category of municipality in 1953, just
over ten years its population had doubled.
he rapid process of urbanization,
observed since the 1980s, a consequence
of the rural exodus and of the migratory
movement of several regions of the country,
generated severe social problems in the
municipality that attracted to itself the
attendance to the surrounding regions in
relation to the inancial, commercial and
welfare activities, overloading the existing
structure. Barra do Garças, a municipality
founded in the 1920s by migrants from
Bahia that discovered the diamond mines in
the Araguaia River, became, in 1940, a local
and later regional development pole, due
to colonization projects and development
plans of the Federal Government.
To the north of Barra do Garças, the
municipalities cut by the BR-158 highway
belong to an area whose occupation was
intensiied during the 1970s and 1980s,
with the implantation of a great number
of combined agriculture and stock raising
projects with the support of oicial subsides,
keeping a narrow relationship with the
southeast of Pará. hese municipalities, in
this time and still today, present a high level
of social exclusion.
In 1998, the municipalities near
Rondonópolis showed an increase in case
detection. Also in this year, Barra do Garças,
Médio Araguaia, Arenápolis and the micro
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Rev Bras Epidemiol
2011; xx(x): xxx-xxx
region Alto Paraguai, presented the highest
rates of the state. his area corresponds to
former foci, existent since the beginning of
the XXth century. Some of these municipalities were places for the spread of leprosy in
Mato Grosso13.
Since the 1990s, the endemic gradually
moved towards the North, in the Centernorth- northwestern direction, with
the municipality of Peixoto de Azevedo
presenting the highest detection coeicient.
Peixoto de Azevedo had its formation linked
to the discovery of gold mines in the region
and to the arrival of thousands of gold
miners that came from Itaituba and other
regions of Pará and Maranhão that dwelt in
precarious houses along the BR-1637.
In the Center-south of the state, the
population from the city Primavera do Leste
presented a fast growth since the early 2000s,
with the arrival of people from the south
of the country and the neighboring cities,
mainly of the municipalities that belong to
the micro region of Tesouro, that also transferred population to the city of Rondonópolis.
It is important to recognize that the municipalities near Rondonópolis are characterized
as historical foci of leprosy since the time of
the onset of the disease in the state.
Nowadays, we can consider that a
great part of the state territory is strongly
modiied by the activities of the last
three decades. With the advent of new
combined agriculture and stock raising
technologies, the development axis moved
from the pantanal to the lands of plateaus
and depressions. he progressive advent
towards the northwest of the state was
facilitated by the opening of roads, which
coincides with the movement of the disease
expansion in Mato Grosso. Similar associations between leprosy and migration were
done in the Amazon, as stated by Penini15,
when he describes that the Amazon spaces
of high historical prevalence of leprosy
coincide with those of great concentration
of rubber extractors, whose majority came
from the northeast of the country. For the
reality of Acre, Silveira et al. and Klein16,17
defends the direct link between leprosy
Rev Bras Epidemiol
2011; xx(x): xxx-xxx
10
Migration and Hansen’s disease in Mato Grosso
Magalhães, M.C.C. et al.
that installed itself in the state in the early
20th century with the migratory lows of the
rubber cycle. In Rondônia, when studying
the relationships between migration and
leprosy, Oliveira et al.18 observes the limited
conditions of life of the migrant population,
associated to the precarious physical conditions of these geographic spaces in the
process of infection of the disease.
It stands out that studies on spatiality
of leprosy conirm their close relationship
with the socio-economic conditions19,20.
Other studies carried out21-25 also relate the
occurrence of leprosy with environmental
factors, such as regions with vegetation,
climatic types, average annual rainfall, or to
one real diferentiation of territorial vulnerability by the presence or not of human or
environmental infection sources.
hus, an association between the
migratory processes and the expansion of
leprosy in Mato Grosso is observed. he
municipalities with the highest detection
presented high population growth, mainly
in the 1970s and 1980s. he Northern
mesoregion, that has grown more recently,
also presented a considerable increase in its
detection rates after 2000, having received
a large number of people during the 1990s.
Although many micro regions are losing
population, being classiied as of low level of
migratory attraction, one does not notice that
the detection rates have decreased. Instead,
the coeicients maintain themselves in some
municipalities and progressively increase in
others, while the populations occupy and
transform new spaces.
hese results would indicate that the
migrations in the last decades seem not to
participate of the increase in the detection
rates in some municipalities, what does not
mean to eliminate the inluence of the high
increases of the previous decades, mainly
in the outskirts of these cities, where the
economic and social situations deteriorate
during this period. Other epidemiological
factors, associated to a higher environmental or even individual vulnerability of
migrants or natives of these regions, must
also be taken into account.
Another issue is how the performance
of the health service may be inluencing the
Leprosy behavior in diferent places. Studies
as those of Queiróz and Scatena26 relate the
increase of the detection of leprosy cases to
operational issues of health care services,
such as the number of technicians trained,
coverage of control measures, among
others. From 1996 to 2007, there was, in
Mato Grosso, an increase of 115.5% in the
coverage of the control measures carried
out by the health units.
he analysis of the quality of the health
services in the state suggests that the decentralization of the leprosy control measures
not always have inluenced the performance
of the services. he detection increase seems
to be related to the rise in the suspicion of
cases by the family health teams (ESF), but
the quality of care to the patient, as contact
exams and evaluation of the level of physical
incapacity, does not seem to be inluenced
by it. Besides, operational issues could not
explain the maintenance of an epidemic for
more than half a century.
Conclusions
he data analyzed allow an association
between the evolution of leprosy and the
process of occupation of the mato-grossense territory. he municipalities with
the highest rates of detection present high
population growth, mainly in the 1970s
and 1980s. he northern mesorregião that
had a more recent growth, received a large
number of people in the 1990s, it presented
a considerable increase in the detection
coeicient of the disease after 2000.
he historical permanence of leprosy in
the municipalities of Baixada Cuiabana, as
well as in others that sufered the process of
population loss, such as Peixoto de Azevedo,
Alto Paraguai and Poxoréo, seems to point
to the existence of geographic contexts
of diferent vulnerability to the social
production of the disease in the state.
he migration would explain the installation and the evolution of leprosy, however
the maintenance of the endemic could be
associated with other factors, such as the
environmental. he northern and northeastern mesorregions, predominantly
covered by the Amazon Forest, present a
tendency of increase of the detection rate.
It is also observed that there is an association between the elevation of the detection
coeicients and the increase of the deforested areas, by meso and micro regions.
hey are areas of combined agriculture and
stock raising expansion and the people have
a higher contact with the natural and still
preserved spaces.
he observations about the largest
increases and the highest detection coeicients would be coincident with some
municipalities of higher social exclusion.
However, in others that also have high
coeicients, this relationship is not
observed. Even if one cannot disregard the
existence of other factors that would act in
the disease transmission, we also consider
that, even in municipalities with the lowest
indexes of social exclusion, there are several
peripheral areas of extreme poverty.
Acknowledgment
Ministério da Saúde – MS.
Deutsche Lepra-und Tuberkulosehilfe
–DAHW.
Netherland Leprosy Relief - NLR.
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Submitted on: 05/01/2011
Final version presented on: 17/02/2011
Accepted on: 19/02/2011