A Clinical-Epidemiological and Geospatial Study of Tuberculosis in a Neglected Area in the Amazonian Region Highlights the Urgent Need for Control Measures

Abstract

Tuberculosis (TB) is an infectious communicable disease, which despite global efforts, still needs special attention in regions with difficult access. This study aims to describe the spatial and epidemiological trends of TB incidences from 2013 to 2018 in Marajó Island, the Amazonian region, Pará, Brazil. We have obtained secondary data from the Brazilian TB databases and performed geospatial and statistical analyses on the data for new TB cases, relapses, and re-admissions. From 2013 to 2018, 749 new cases were reported, in which the diagnostics (culture) was not performed for 652 (87.2%) patient samples, the drug resistance test (DST) was performed for nine (1.2%) samples, and one (0.13%) was multidrug-resistant TB (MDR-TB). The rapid molecular testing (RMT) was performed on 40 (5.3%) patient samples, with results indicating that eight (20%) were susceptible to rifampicin and two (5%) were rifampicin resistant. Overall, the cure rate was 449 (66.7%), while relapses and re-admissions were 41 and 44, respectively. On the geospatial distribution, the municipality of Soure stands out with a high number of incidences, relapses, and re-admissions. Spatially, the eight MDR cases were randomly distributed. Our data highlight the urgent need for TB control measures in this region, by introducing the Xpert-Ultra® MTB/RIF (Cepheid, Sunnyvale, CA, USA) and Ogawa-Kudoh.

Geospatialization of tuberculosis and income transfer programs among Indigenous peoples in an endemic territory

“…In Marajó, the high incidence rates may be influenced by the small local Indigenous population. A study conducted in this mesoregion, from 2013 to 2018, considering the general population, identified TB incidence ranging from 55.07/100 thousand inhabitants and 32/100 thousand inhabitants, thus, below the rate in Indigenous ( 24 ) . This data confirms the difference in the behavior of the disease between Indigenous and non-Indigenous peoples and strengthens the need to conduct studies with this group ( 4 ) .…”

“…The Marajó mesoregion, also known as the Marajó archipelago, comprises 16 municipalities and hosts the worst Municipal Human Development Indices (MHDI) in Brazil, ranging from 0.418 to 0.543, which reflects the situation of vulnerability and social exclusion of the population in general, both Indigenous and non-Indigenous. Studies point to health as a worrying factor in this mesoregion, as there is an insufficient number of beds, medical care, and health care, aggravated by the difficulty of access throughout the archipelago ( 7 , 24 ) . The behavior of TB in the mesoregion is still little addressed, being a territory neglected by the State ( 24 ) .…”

“…Studies point to health as a worrying factor in this mesoregion, as there is an insufficient number of beds, medical care, and health care, aggravated by the difficulty of access throughout the archipelago ( 7 , 24 ) . The behavior of TB in the mesoregion is still little addressed, being a territory neglected by the State ( 24 ) .…”

“…In addition to the challenges presented, initiatives external to Amerindian interests, such as the implementation of large power generation projects, agricultural expansion, and logging enterprises, have produced intense social, economic, and environmental transformations since the 1970s. Such initiatives have mainly reached the southeast and Southwest mesoregions municipalities, which have the largest Indigenous population contingent in the State of Pará ( 24 ) . Even in the face of economic investments, much progress must be made to achieve improvement in the quality of life of Indigenous peoples.…”

Evolutionary ethnobiology and knowledge about medicinal resources used to treat COVID-19 symptoms in Salvaterra, Marajó, Pará, Brazil

“…Marajó is composed of 16 municipalities and is considered one of the poorest regions of Pará and Brazil. Some of these municipalities have the lowest Municipal Human Development Indices (MHDIs) in the state, and one of them, Melgaço, has the lowest MHDI in the country [25,26]. In the municipality of Salvaterra, the lack of public policies, especially in health and education, coexists with a great body of traditional knowledge about medicinal resources [27,28,26].…”