Ethnic and Racial Inequalities in Notified Cases of Tuberculosis in Brazil

Abstract

ObjectiveThis study analysed clinical and sociodemographic aspects and follow-up for notified cases of tuberculosis (TB) and explored inequalities in incidence rates and outcome by colour or race and the geographic macro-regions of Brazil.MethodsThis paper reports the results of a population-based descriptive epidemiological study of all notified cases of TB in Brazil during the period from 01/01/2008 to 31/12/2011. We analysed sociodemographic and clinical variables according to colour or race (white, black, Asian, mixed, and indigenous) and geographic macro-regions of the country (North, Northeast, Central-West, South, and Southeast).ResultsDuring the study period, the average incidence of TB in Brazil was 36.7 cases per 100,000 inhabitants, with the highest rates occurring in the North and Southeast regions. The analysis of TB notifications by colour or race revealed that the indigenous population presented the highest incidence rates in all macro-regions except the South, where higher rates were reported in black patients. ‘Cured’ was the most frequently reported treatment outcome for all skin colour categories. The highest cure rate occurred among the indigenous population (76.8%), while the lowest cure rate occurred among the black population (70.7%). Rates of treatment default were highest among blacks (10.5%) and lowest among the indigenous population (6.9%). However, the fatality rate was similar across race categories, varying between 2.8% and 3.8% for whites and the indigenous population, respectively. The lowest cure rates were observed when follow-up was inadequate (58.3%), and the highest was observed when the follow-up was classified as excellent (96.8%).ConclusionsThis study revealed that—apart from the heterogeneous distribution of TB among the Brazilian macro-regions—ethnic-racial inequalities exist in terms of clinical-epidemiological characteristics and incidence rates as well as follow-up for cases undergoing treatment. The highest rates of TB occurred among the indigenous people.

Tuberculose entre crianças e adolescentes indígenas no Brasil: fatores associados ao óbito e ao abandono do tratamento

“…Embora empírico e não validado, o indicador de acompanhamento adotado neste estudo está fortemente ligado ao manejo dos casos de TB, no âmbito da atenção básica, uma vez que considera a realização de baciloscopias de controle no 2 o , 4 o e 6 o meses de tratamento; o exame de contatos; e o tratamento diretamente observado. Em nossa interpretação, quando essas ações são realizadas de maneira regular e/ou insuficiente, o risco de abandono e óbito na vigência do tratamento é exacerbado, conforme apontado aqui e em outros estudos 10,24,25,26 .…”

“…Empregou-se um sistema de classificação empírico utilizado por outros autores 10,24,25,26 para análise do acompanhamento dos casos. Este sistema combina cinco recomendações da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) 27 , a saber: (1) se o caso notificado realizou baciloscopia de controle no 2 o mês de tratamento; (2) baciloscopia de controle no 4 o mês de tratamento; (3) baciloscopia de controle no 6 o mês de tratamento; (4) se houve registro de exames de contatos; e (5) se o tratamento foi diretamente observado.…”

Assessment of Tuberculosis incidence and treatment success rates of the indigenous Maká community in Paraguay

“…Pediatric TB cases are generally considered less infectious and are most often caused by household contacts. (22-26) The Maká families live in single room houses (11, 27) with an increased risk of transmission, as sleeping with adults, crowded houses, and bad ventilation are known risk factors for pediatric infections. (22, 28-30) Additionally, the large number of unknown treatment outcomes implies that follow-up of TB patients is insufficient, which could lead to recurrence of disease and ongoing transmission.…”

Cultura dos povos originários da floresta amazônica na gestação e no puerpério: uma revisão de escopo sob o ponto de vista da segurança alimentar e nutricional

“…A maior parte das internações registradas ocorreu por diarreia e doenças respiratórias, confirmadas por outros estudos recuperados na revisão 14, 15 . A maior proporção de casos de tuberculose em menores de 15 anos indica transmissão ativa e infecção recente nas aldeias, sugerindo que o controle dos contatos não está sendo realizado de forma satisfatória pela rede de cuidados, em estudo desenvolvido em Rondônia.…”