Health-service performance of TB treatment for indigenous and non-indigenous populations in Brazil: a cross-sectional study

Abstract

BackgroundHealth-service evaluation studies are fundamental for proposing interventions and ensuring improvements in healthcare quality. The present study assesses the performance of health services for indigenous and non-indigenous populations with regard to tuberculosis (TB) control.MethodsInterviews with TB patients who underwent treatment between 2009 and 2011 were conducted using the Primary Care Assessment Tool adapted for TB care in Brazil.ResultsPrimary healthcare (PHC) was the first treatment for most patients at symptom onset, and the diagnoses were typically performed by specialized services. Many patients experienced delayed TB diagnoses that required more than three medical appointments (51% and 47% for indigenous and non-indigenous populations, respectively). Indigenous people received social support, such as basic-needs grocery packages (2.19 ± 1.63 vs. 1.13 ± 0.49 for non-indigenous people, p < 0.01) and home visits from health professionals, with an emphasis on the performance of directly observed treatment strategies (DOT; 4.57 ± 0.89 vs. 1.68 ± 1.04 for non-indigenous people, p < 0.01).ConclusionsRegardless of the differences between indigenous and non-indigenous populations, the time needed to receive a TB diagnosis was unsatisfactory for both groups. Furthermore, DOT must be performed with better coverage among non-indigenous patients.

Association between Directly Observed Therapy and Treatment Outcomes in Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis

“…It is always challenging for anyone to provide daily DOT to patients for over 20 months. Poor implementation of DOT has been reported in many studies, though healthcare providers may be the named DOT providers [ 57 , 58 ]. Studies found that family members, with more time to spend with the patients with caring minds, were more cost-effective in terms of time and resources compared to healthcare providers [ 59 ], and may improve MDR-TB treatment outcomes [ 60 ].…”

Acesso aos serviços de saúde para o diagnóstico e tratamento da tuberculose entre povos indígenas do estado de Rondônia, Amazônia Brasileira, entre 2009 e 2011: um estudo transversal*

“…A quarter of the respondents mentioned having needed to return to the Casais five times, and waiting for more than 30 days to get conclusive diagnosis, similarly to reports from rural areas in India and from interior regions of Brazil. [24][25][26][27] Traditional indigenous medicine appeared among the treatment options, but without excluding biomedicine. Both use of medicinal plants and prayer and/or shamanism, either on their own or in association with use of Western medicine, were considered in treatment.…”

Radiological findings of pulmonary tuberculosis in indigenous patients in Dourados, MS, Brazil

“…It is known that the high incidence of tuberculosis in the Brazilian indigenous population may be related to certain characteristics of those individuals, namely, difficult access to health services, inappropriate housing conditions with poor ventilation and high concentration of people in a single residence, illiteracy, high malnutrition rates, intestinal parasitic diseases, alcoholism, as well as immunological particularities ( 38 ) . Additionally, in the group of indigenous patients there are linguistic and cultural barriers which make the treatment more difficult ( 39 ) . These people live in villages, with poor conviviality with non-indigenous people.…”