Desigualdades sociais e tuberculose: análise segundo raça/cor, Mato Grosso do Sul

Abstract

OBJECTIVE:To describe the sociodemographic and clinical-epidemiological characteristics of tuberculosis cases and identify associated factors with abandoning treatment and death whilst undergoing treatment. METHODS:Epidemiological study based on cases of tuberculosis recorded in indigenous and non-indigenous individuals according to race/color in Mato Grosso do Sul, Midwestern Brazil, between 2001 and. Descriptive analysis of the cases was carried out according to the variables of sex, age group, residence, type of test used in the diagnosis, clinical form, supervised treatment and final status, according to race/color. Univariate/multivariate logistic regression analyses were used to identify predictors of abandoning treatment and death, using odds ratio as a measure of association. A time series of incidence according to race/color was constructed. RESULTS:In the period, 6,962 new cases of tuberculosis were registered, 15.6% being among indigenous. The illness was predominantly found in men and adults (20-44 years old) in all groups. Most of the indigenous patients lived in rural areas (79.8%) and 13.5% of the records in indigenous occurred in children aged < 10 years. The average incidence in the state was 34.5/100,000 inhabitants, being 209.0, 73.1, 52.7, 23.0 and 22.4 in indigenous, and those with yellow, black, white and brown skin, respectively. Patients aged 20 to 44 years (OR = 13.3, 95%CI 1.9;96.8), male (OR = 1.6, 95%CI 1.1;2.3) and of black race/color (OR = 2.5, 95%CI 1.0;6.3) were associated with abandoning treatment, while patients aged > 45 years (OR = 3.0, 95%CI 1.2;7.8) and with the mixed form (OR = 2.3, 95%CI 1.1;5.0) showed association with death. Although they only account for 3.0% of the population, the indigenous were responsible for 15.6% of cases recorded during the period. CONCLUSIONS:Major inequalities in the tuberculosis illness process were found between the categories studied. Incidence in the indigenous population was consistently higher than recorded in any other group, reaching more than six times the national average. It was among those with black and brown skin that the worst treatment results were observed, as they were twice as likely to abandon treatment as the indigenous. Poor program performance was strongly associated with abandoning treatment and death. It is thought that as long as there is no reduction in poverty inequalities in health indicators will remain.

Profile Of Elderly Diagnosed With Tuberculosis In A Reference Hospital In Brazil

“…Among the existing weaknesses, it is pointed out that the high dropout rates motivated the failure of therapy, which concurs with the findings of this series, which obtained the cure rate lower than that recommended by the World Health Organization (WHO) and dropout rates and higher mortality [39]. The percentage related to the dropout rate was almost three times higher than the percentage rated acceptable by WHO.…”

Magnitude da tuberculose pulmonar na população fronteiriça de Mato Grosso do Sul (Brasil), Paraguai e Bolívia

“…Na população indígena, a despeito da precariedade das condições socioeconômicas e outros agravantes, a cobertura oferecida pela Estratégia Saúde da Família (ESF) e pela ampliação do Tratamento Diretamente Observado (TDO) tem sido mostrado efetiva 35,36 , o que possivelmente explica a associação entre ser indígena e não abandonar o tratamento de tuberculose pulmonar. Esse sucesso pode estar associado à adequada infraestrutura dos serviços ofertados pelo Distrito Sanitário Especial Indí-gena de Mato Grosso do Sul (DSEI-MS), à disponibilidade de recursos humanos (em termos de qualificação, número suficiente e baixa rotatividade) e ao envolvimento da comunidade nas ações de controle da doença 43 .…”

Fatores associados ao desfecho desfavorável do tratamento da tuberculose em um hospital geral do município do Rio de Janeiro, 2007 a 2014

“…O predomínio de pessoas do sexo masculino, raça/ cor não branca, adultos jovens e com baixa escolaridade é relatado na literatura. 3,8,10,13,14 Entretanto, o nosso percentual de mulheres é maior do que o relatado por outros autores, fato esse que pode estar relacionado à presença de uma maternidade de alto risco referência para gestantes soropositivas para o HIV. 10,13,15 O predomínio de indivíduos com faixa etária economicamente ativa e baixo nível de escolaridade corrobora o resultado de outros estudos.…”

“…3,8,10,13,14 Entretanto, o nosso percentual de mulheres é maior do que o relatado por outros autores, fato esse que pode estar relacionado à presença de uma maternidade de alto risco referência para gestantes soropositivas para o HIV. 10,13,15 O predomínio de indivíduos com faixa etária economicamente ativa e baixo nível de escolaridade corrobora o resultado de outros estudos. 3,8,10,13,14 A baixa escolaridade reflete um conjunto de determinantes socioeconômicos desfavoráveis, que pode aumentar a vulnerabilidade à tuberculose e contribuir com aumento da sua incidência.…”