Elsia Nascimento Belo1, Jesem Douglas Yamall Orellana2, Antônio Levino2, Paulo Cesar Basta3. 1. Centro de Atenção Integral à Saúde, Universidade Federal do Amazonas, Manaus, AM, Brasil, elsia@amazonia.fiocruz.br. 2. Departamento de Sociodiversidade em Saúde, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brasil. 3. Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Abstract
OBJECTIVE: To describe the epidemiological situation and the incidence of tuberculosis and to investigate the factors associated with treatment default in the Amazonian municipalities located in the northern Brazilian international border. METHODS: This retrospective study employed sociodemographic, clinical, and epidemiological tuberculosis data recorded in the Brazilian Notifiable Diseases Information System (SINAN) between 2001 and 2010. Logistic regression was used to identify factors associated with treatment default. RESULTS: Tuberculosis affected mostly indigenous peoples (51.9%), males (57.9%), and people aged 25-44 years (31.4%). The predominant clinical presentation was pulmonary (89.7%), yet in 24.5% of the cases the patients did not undergo sputum smear microscopy, and only half received supervised treatment. In 70.0% of the cases notified, patients were discharged as cured. Treatment default was recorded in 10.0% of the patients. Of all deaths, 4.1% were by tuberculosis and other causes, and 1.7% by multidrug-resistant tuberculosis. The average incidence by race/color was greater among indigenous peoples, ranging from 202.3/100 000 in 2001 to 65.6/100 000 in 2010. Treatment default was associated with failure to perform the follow-up smear at the second, fourth, and sixth months (OR = 11.9, 95%CI: 7.4-19.0); with resuming treatment after default (OR = 3.0, 95%CI: 1.5-5.9); and with living in specific subregions, particularly the Alto Solimões region (OR = 6.7, 95%CI: 4.6-9.8). CONCLUSIONS: The present results show a high incidence of tuberculosis in the Amazon portion of the northern Brazilian international border, especially among indigenous peoples. Considering the socio-cultural specificities of these populations and the poor tuberculosis control in this area, the authors of the study conclude that the integration of different national health systems is both necessary and urgent.
OBJECTIVE: To describe the epidemiological situation and the incidence of tuberculosis and to investigate the factors associated with treatment default in the Amazonian municipalities located in the northern Brazilian international border. METHODS: This retrospective study employed sociodemographic, clinical, and epidemiological tuberculosis data recorded in the Brazilian Notifiable Diseases Information System (SINAN) between 2001 and 2010. Logistic regression was used to identify factors associated with treatment default. RESULTS:Tuberculosis affected mostly indigenous peoples (51.9%), males (57.9%), and people aged 25-44 years (31.4%). The predominant clinical presentation was pulmonary (89.7%), yet in 24.5% of the cases the patients did not undergo sputum smear microscopy, and only half received supervised treatment. In 70.0% of the cases notified, patients were discharged as cured. Treatment default was recorded in 10.0% of the patients. Of all deaths, 4.1% were by tuberculosis and other causes, and 1.7% by multidrug-resistant tuberculosis. The average incidence by race/color was greater among indigenous peoples, ranging from 202.3/100 000 in 2001 to 65.6/100 000 in 2010. Treatment default was associated with failure to perform the follow-up smear at the second, fourth, and sixth months (OR = 11.9, 95%CI: 7.4-19.0); with resuming treatment after default (OR = 3.0, 95%CI: 1.5-5.9); and with living in specific subregions, particularly the Alto Solimões region (OR = 6.7, 95%CI: 4.6-9.8). CONCLUSIONS: The present results show a high incidence of tuberculosis in the Amazon portion of the northern Brazilian international border, especially among indigenous peoples. Considering the socio-cultural specificities of these populations and the poor tuberculosis control in this area, the authors of the study conclude that the integration of different national health systems is both necessary and urgent.
Authors: Marli Marques; Eunice Atsuko Totumi Cunha; Maria do Socorro Nantua Evangelista; Paulo Cesar Basta; Ana Maria Campos Marques; Julio Croda; Sonia Maria Oliveira de Andrade Journal: Rev Panam Salud Publica Date: 2017-04-20
Authors: Jocieli Malacarne; Ida Viktoria Kolte; Lais Picinini Freitas; Jesem Douglas Yamall Orellana; Maximiliano Loiola Ponte de Souza; Reinaldo Souza-Santos; Paulo Cesar Basta Journal: Rev Inst Med Trop Sao Paulo Date: 2018-10-25 Impact factor: 1.846