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Trajman A. The social drivers of tuberculosis, reconfirmed. THE LANCET. INFECTIOUS DISEASES 2024; 24:5-6. [PMID: 37591302 DOI: 10.1016/s1473-3099(23)00390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Anete Trajman
- Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; McGill University, Montreal, QC, Canada.
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Ferreira MRL, Bonfim RO, Bossonario PA, Maurin VP, Valença ABM, Abreu PDD, Andrade RLDP, Fronteira I, Monroe AA. Social protection as a right of people affected by tuberculosis: a scoping review and conceptual framework. Infect Dis Poverty 2023; 12:103. [PMID: 37993962 PMCID: PMC10664497 DOI: 10.1186/s40249-023-01157-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Tuberculosis is an infectious disease strongly influenced by social determinants closely associated with cycles of poverty and social exclusion. Within this context, providing social protection for people affected by the disease constitutes a powerful instrument for reducing inequalities and enhancing inclusion and social justice. This study aimed to identify and synthesize strategies and measures aimed at ensuring social protection as a right of people affected by tuberculosis. METHODS This is a scoping review, with searches conducted in six databases in February 2023. We included publications from 2015 onwards that elucidate strategies and measures of social protection aimed at safeguarding the rights to health, nutrition, employment, income, housing, social assistance, and social security for people affected by tuberculosis. These strategies could be implemented through policies, programs, and/or governmental agreements in any given context. The data extracted from the articles underwent descriptive analysis and a narrative synthesis of findings based on the dimensions of social protection. Additionally, we developed a conceptual framework illustrating the organizational and operational aspects of measures and strategies related to each dimension of social protection identified in this review. RESULTS A total of 9317 publications were retrieved from the databases, of which sixty-three publications were included. The study's results highlighted measures and strategies concerning the social protection of people affected by tuberculosis. These measures and strategies revolved around the rights to proper nutrition and nourishment, income, housing, and health insurance, as well as expanded rights encompassing social assistance and social welfare. It was reported that ensuring these rights contributes to improving nutritional status and the quality of life for individuals with tuberculosis, along with reducing catastrophic costs, expanding access to healthcare interventions and services, and fostering TB treatment adherence, thereby leading to higher rates of TB cure. CONCLUSIONS Our findings identify social protection measures as a right for people affected by tuberculosis and have the potential to guide the development of evidence-based social and health policies through collaboration between tuberculosis control programs and governmental entities.
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Affiliation(s)
| | - Rafaele Oliveira Bonfim
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | | | | | | | - Paula Daniella de Abreu
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Inês Fronteira
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University Lisbon, Lisbon, Portugal
- National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Aline Aparecida Monroe
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
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Dave JD, Rupani MP. Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? - A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India. Int J Health Policy Manag 2022; 11:2552-2562. [PMID: 35174676 PMCID: PMC9818107 DOI: 10.34172/ijhpm.2022.5784] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/08/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A direct benefit transfer (DBT) program was launched to address the dual epidemic of under-nutrition and tuberculosis (TB) in India. We conducted this study to determine whether non-receipt of DBT was associated with unfavorable treatment outcomes among patients with TB and to explore the perspectives of patients and program functionaries regarding the program. METHODS We conducted a retrospective cohort study among 426 patients with drug-sensitive pulmonary TB on treatment during January-September 2019 to determine the association between non-receipt of DBT and unfavorable treatment outcomes, which was followed by in-depth interviews of 9 patients and 8 program functionaries to explore their perspectives on challenges and suggestions regarding the DBT program. Multivariate logistic regression was applied to determine whether non-receipt of DBT was independently associated with unfavorable treatment outcomes, while the in-depth interviews were transcribed to describe them as codes and categories. RESULTS Among the 426 patients, 9% of the patients did not receive DBT and 91% completed their treatment. Non-receipt of DBT was associated with a 5 (95% CI: 2-12) times higher odds of unfavorable treatment outcomes on multivariable analysis. Patients not owning a bank account was the primary challenge perceived by the program staff. The patients perceived the assistance under DBT to be insufficient to buy nutritious food throughout the course of treatment. The program functionaries as well as the patients suggested increasing the existing assistance under DBT along with the provision of a monthly nutritious food-kit. CONCLUSION DBT improved the treatment completion rates among patients with TB in our setting. Provision of a monthly nutritious food-kit with an increase in the existing assistance under DBT might further improve the treatment outcomes. Future research should determine the long-term financial sustainability for 'DBT plus food-kit' vs. universal cash transfers in India.
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Affiliation(s)
- Jigna D. Dave
- Department of Respiratory Medicine, Government Medical College Bhavnagar, Maharaja Krishnakumarsinhji Bhavnagar University, Bhavnagar, India
| | - Mihir P. Rupani
- Department of Community Medicine, Government Medical College Bhavnagar, Maharaja Krishnakumarsinhji Bhavnagar University, Bhavnagar, India
- Division of Clinical Epidemiology, ICMR-National Institute of Occupational Health (NIOH), Ahmedabad, India
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4
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D’Apice C, Ghirotto L, Bassi MC, Artioli G, Sarli L. A realist synthesis of staff-based primary health care interventions addressing universal health coverage. J Glob Health 2022; 12:04035. [PMID: 35569053 PMCID: PMC9107778 DOI: 10.7189/jogh.12.04035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Clelia D’Apice
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL – IRCCS, Reggio Emilia, Italy
| | - Maria C Bassi
- Medical Library, Azienda USL – IRCCS, Reggio Emilia, Italy
| | - Giovanna Artioli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Leopoldo Sarli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
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Nidoi J, Muttamba W, Walusimbi S, Imoko JF, Lochoro P, Ictho J, Mugenyi L, Sekibira R, Turyahabwe S, Byaruhanga R, Putoto G, Villa S, Raviglione MC, Kirenga B. Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study. BMC Public Health 2021; 21:2167. [PMID: 34836521 PMCID: PMC8620143 DOI: 10.1186/s12889-021-12056-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja. METHODS We conducted a convergent parallel mixed methods study in 10 TB Diagnostic and Treatment Units. The study enrolled former TB patients diagnosed with drug-susceptible TB between April 2018 and March 2019. Unit TB and laboratory registers were reviewed to identify pre-treatment losses to follow-up. Four focus group discussions with former TB patients and 18 key informant interviews with healthcare workers were conducted. Principle component analysis was used to generate wealth quintiles that were compared to treatment outcomes using the proportion test. The association between sociodemographic characteristics and TB treatment outcomes was evaluated using the chi-square test and multiple logistic regression. RESULTS A total of 313 participants were randomly selected from 1184 former TB patients recorded in the unit TB registers. Of these, 264 were contacted in the community and consented to join the study: 57% were male and 156 (59.1%) participants had unsuccessful treatment outcomes. The wealthiest quintile had a 58% reduction in the risk of having an unsuccessful treatment outcome (adj OR = 0.42, 95% CI 0.18-0.99, p = 0.047). People who were employed in the informal sector (adj OR = 4.71, 95% CI 1.18-18.89, p = 0.029) and children under the age of 15 years who were not in school or employed (adj OR = 2.71, 95% CI 1.11-6.62, p = 0.029) had significantly higher odds of unsuccessful treatment outcome. Analysis of the pre-treatment loss to follow-up showed that 17.2% of patients with pulmonary bacteriologically confirmed TB did not initiate treatment with a higher proportion among females (21.7%) than males (13.5%). Inadequate food, belonging to migratory communities, stigma, lack of social protection, drug stock-outs and transport challenges affected TB treatment outcomes. CONCLUSIONS This study confirmed that low socio-economic status is associated with poor TB treatment outcomes emphasizing the need for multi- and cross-sectoral approaches and socio-economic enablers to optimise TB care.
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Affiliation(s)
- Jasper Nidoi
- Makerere University Lung Institute (MLI), Kampala, Uganda.
| | | | | | - Joseph F Imoko
- Makerere University Lung Institute (MLI), Kampala, Uganda
| | | | | | | | | | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Control Program (NTLP), Kampala, Uganda
| | - Raymond Byaruhanga
- National Tuberculosis and Leprosy Control Program (NTLP), Kampala, Uganda
| | | | - Simone Villa
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Mario C Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Bruce Kirenga
- Makerere University Lung Institute (MLI), Kampala, Uganda
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Sant'Anna CC, de Oliveira MCB. The long-running issues of tuberculosis. LANCET GLOBAL HEALTH 2021; 9:e1339-e1340. [PMID: 34534470 DOI: 10.1016/s2214-109x(21)00401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Clemax Couto Sant'Anna
- Pediatrics Department, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Cola JP, Prado TND, Sales CMM, Maciel ELN. Family Health Strategy and determinants of directly observed treatment for tuberculosis in Brazil: a cross-sectional study with surveillance system data, 2014-2016. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2020; 29:e2020284. [PMID: 33295589 DOI: 10.1590/s1679-49742020000500010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/31/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the association between tuberculosis determinants and performance of directly observed treatment (DOT) under different levels of Family Health Strategy (FHS) coverage in Brazil. METHODS This was a cross-sectional study using data on tuberculosis cases notified between 2014 and 2016 on the Notifiable Health Conditions Information System, as well as data on FHS coverage in the municipality of residence. Logistic regression was used. RESULTS 177,626 individuals were included; being an alcohol user (odds ratio (OR) 1.09 - 95% confidence interval % [95%CI] 1.03;1.16), being deprived of liberty (OR=1.21 - 95%CI 1.12;1.32) and positive sputum smear microscopy (OR=1.15 - 95%CI 1.10;1.21) increased the chances of DOT being performed . When stratified by FHS coverage, these associations became weak in the highest stratum of coverage. CONCLUSION DOT being performed was associated with determinants of tuberculosis. However, association was not confirmed among residents in municipalities with higher FHS coverage.
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Affiliation(s)
- João Paulo Cola
- Universidade Federal do Espírito Santo, Laboratório de Epidemiologia, Vitória, ES, Brasil
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de Paula Martins L, Trevisol DJ, Schuelter-Trevisol F. Effect of the Bolsa Familia Programme on tuberculosis treatment outcomes. LANCET GLOBAL HEALTH 2020; 7:e565. [PMID: 31000126 DOI: 10.1016/s2214-109x(19)30152-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Leonardo de Paula Martins
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina, Tubarão 88704-900, Brazil
| | - Daisson José Trevisol
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina, Tubarão 88704-900, Brazil
| | - Fabiana Schuelter-Trevisol
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina, Tubarão 88704-900, Brazil.
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Gomes CBES, Gutiérrez AC, Soranz D. Política Nacional de Atenção Básica de 2017: análise da composição das equipes e cobertura nacional da Saúde da Família. CIENCIA & SAUDE COLETIVA 2020; 25:1327-1338. [DOI: 10.1590/1413-81232020254.31512019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/14/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo A Estratégia Saúde da Família é a principal forma de organização do sistema de saúde brasileiro. Contudo, a terceira edição da Política Nacional de Atenção Básica (PNAB) passou a reconhecer financeiramente outros tipos de equipes. Para analisar os efeitos da PNAB de 2017 na composição das equipes, foi realizado um estudo de série temporal de 2007 a 2019 utilizando dados do Cadastro Nacional de Estabelecimentos de Saúde (CNES) de postos de trabalho e de equipes e a cobertura nacional da Saúde da Família. Observou-se a concentração de médicos nas regiões Sudeste e Nordeste e oscilação dessa categoria profissional ante os acontecimentos do Programa Mais Médicos. Houve acréscimo de 5% de enfermeiros e redução de 0,3% dos ACS no país. A despeito da autorização e financiamento para implantação de equipes de “Atenção Básica” (eAB), elas correspondem a menos de 1% do total de equipes. Vale ressaltar que a modalidade preferencial dos gestores municipais se mantem pela Equipes de Saúde da Família, correspondendo a 75% do total de equipes e em crescimento. Apesar dos questionamentos e expectativas gerados pela PNAB de 2017 no contexto da Atenção Primária à Saúde, conclui-se que, em relação às equipes e suas composições, não houve mudança significativa após dois anos de sua vigência.
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Benzaken AS, Pereira GFM, Cunha ARCD, Souza FMAD, Saraceni V. Adequacy of prenatal care, diagnosis and treatment of syphilis in pregnancy: a study with open data from Brazilian state capitals. CAD SAUDE PUBLICA 2019; 36:e00057219. [PMID: 31939547 DOI: 10.1590/0102-311x00057219] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022] Open
Abstract
To assess the adequacy of prenatal care offered in the Brazilian capital cities and the diagnosis of gestational syphilis through public data from health information systems. The modified Kotelchuck index for adequacy of prenatal care was built using Brazilian Information System on Live Births (SINASC) data. Data on gestational syphilis, congenital syphilis, estimated population coverage by the Family Health Strategy (FHS), the Municipal Human Development Index (MHDI) and data from National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) were accessed in public sites. The profile of pregnant women associated with inadequate care was assessed by logistic regression. In total, 685,286 births were analyzed. Only 2.3% of women did not attend prenatal appointments. The mean adequacy was 79.7%. No correlation was found between adequacy of prenatal care and FHS coverage (p = 0.172), but a positive correlation was found with the MHDI (p < 0.001). Inadequacy of prenatal care was associated with age below 20 years old, schooling less than 4 years, non-white skin color and not having a partner. Among the congenital syphilis cases, 17.2% of mothers did not attend prenatal care. Gestational syphilis more often affected vulnerable women, including a higher proportion of adolescents, women with low schooling, and women of non-white color. The PMAQ-AB showed a median availability of 27.3% for syphilis rapid tests, 67.7% for benzathine penicillin, and 86.7% for benzathine penicillin administration by health teams. The use of public data showed a low adequacy of prenatal care in Brazilian capitals, denoting insufficient quality for the diagnosis and treatment of gestational syphilis, despite the availability of supplies. Continuous monitoring can be carried out using public data, indicating to local strategies to eliminate congenital syphilis.
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Affiliation(s)
| | - Gerson Fernando Mendes Pereira
- Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis do HIV/Aids e das Hepatites Virais, Ministério da Saúde, Brasília, Brasil
| | - Alessandro Ricardo Caruso da Cunha
- Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis do HIV/Aids e das Hepatites Virais, Ministério da Saúde, Brasília, Brasil
| | - Flavia Moreno Alves de Souza
- Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis do HIV/Aids e das Hepatites Virais, Ministério da Saúde, Brasília, Brasil
| | - Valéria Saraceni
- Coordenação de Doenças Transmissíveis, Secretaria Municipal de Saúde, Rio de Janeiro, Brasil
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Barreto ML, Ichihara MY, Almeida BA, Barreto ME, Cabral L, Fiaccone RL, Carreiro RP, Teles CAS, Pitta R, Penna GO, Barral-Netto M, Ali MS, Barbosa G, Denaxas S, Rodrigues LC, Smeeth L. The Centre for Data and Knowledge Integration for Health (CIDACS): Linking Health and Social Data in Brazil. Int J Popul Data Sci 2019; 4:1140. [PMID: 34095542 PMCID: PMC8142622 DOI: 10.23889/ijpds.v4i2.1140] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The Centre for Data and Knowledge Integration for Health (CIDACS) was created in 2016 in Salvador, Bahia-Brazil with the objective of integrating data and knowledge aiming to answer scientific questions related to the health of the Brazilian population. This article details our experiences in the establishment and operations of CIDACS, as well as efforts made to obtain high-quality linked data while adhering to security, ethical use and privacy issues. Every effort has been made to conduct operations while implementing appropriate structures, procedures, processes and controls over the original and integrated databases in order to provide adequate datasets to answer relevant research questions. Looking forward, CIDACS is expected to be an important resource for researchers and policymakers interested in enhancing the evidence base pertaining to different aspects of health, in particular when investigating, from a nation-wide perspective, the role of social determinants of health and the effects of social and environmental policies on different health outcomes.
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Affiliation(s)
- ML Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - MY Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - BA Almeida
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - ME Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Computer Science Department, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - L Cabral
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - RL Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Statistics Department, Federal University of Bahia (UFBA), Brazil.
| | - RP Carreiro
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - CAS Teles
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - R Pitta
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - GO Penna
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Tropical Medicine Centre, University of Brasília (UnB), Brazil.
- Escola Fiocruz de Governo, FIOCRUZ Brasília, Brazil.
| | - M Barral-Netto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - MS Ali
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
| | - G Barbosa
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - S Denaxas
- Institute of Health Informatics, University College London, United Kingdom.
| | - LC Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
| | - L Smeeth
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
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Trajman A, Wakoff-Pereira MF, Ramos-Silva J, Cordeiro-Santos M, Militão de Albuquerque MDF, Hill PC, Menzies D. Knowledge, attitudes and practices on tuberculosis transmission and prevention among auxiliary healthcare professionals in three Brazilian high-burden cities: a cross-sectional survey. BMC Health Serv Res 2019; 19:532. [PMID: 31362728 PMCID: PMC6668184 DOI: 10.1186/s12913-019-4231-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/07/2019] [Indexed: 01/27/2023] Open
Abstract
Background Tuberculosis elimination requires treatment of latently infected high-risk persons, such as contacts of index cases. Identification and referral of tuberculosis contacts for investigation are major barriers in the contact cascade-of-care. These tasks rely heavily on auxiliary primary healthcare workers in many low- and middle-income countries. We aimed to understand their knowledge, attitudes and practices (KAP) regarding contact investigation in Brazil. Methods We conducted a cross-sectional KAP survey on tuberculosis transmission and prevention among 135 auxiliary healthcare workers in three tuberculosis high-burden Brazilian cities. Trained interviewers applied a translated version of a previously applied questionnaire. Open answers were classified in pre-defined objective categories and analysed quantitatively. Answers were further classified as satisfactory or not according to criteria set by a panel of three specialists. Results Although 66% had received tuberculosis training in the past 10 years, only 19% were trained for tuberculosis prevention. 64% could not clearly distinguish latent tuberculosis infection (LTBI) from active tuberculosis; 63% did not know how to diagnose LTBI and 52% did not know how to prevent progression to active tuberculosis. Most believed that it is important to investigate adult (99%) and child (96%) contacts for LTBI. However, not all invite contacts - children (81%) or adults (71%) - to the clinic, despite only 24% perceiving difficulties for investigation. Conclusions Gaps in KAP among auxiliary health workers have been reported in other areas, such as obstetrics and other infectious diseases. To the best of our knowledge, this is the first KAP survey on tuberculosis transmission and prevention among auxiliary health care workers, and relevant gaps were also found. Knowledge gaps were notably related to LTBI management, including how to recognize it and prevent progression to active tuberculosis through treatment, despite most recognizing the importance of investigating contacts. Auxiliary healthcare workers in three Brazilian high-burden cities have important knowledge gaps despite their perception of the importance of tuberculosis prevention among contacts. They need to incorporate contact referral as one of their tasks to enable progress toward the target of tuberculosis elimination. Electronic supplementary material The online version of this article (10.1186/s12913-019-4231-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anete Trajman
- Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Universidade, Rio de Janeiro, Rua Macedo Sobrinho 74/203, Humaitá, Rio de Janeiro, 22271-080, Brazil. .,Respiratory Epidemiology & Clinical Research Unit (RECRU), McGill University, Montreal, Canada.
| | - Maria F Wakoff-Pereira
- Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Universidade, Rio de Janeiro, Rua Macedo Sobrinho 74/203, Humaitá, Rio de Janeiro, 22271-080, Brazil
| | - Jonas Ramos-Silva
- Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Universidade, Rio de Janeiro, Rua Macedo Sobrinho 74/203, Humaitá, Rio de Janeiro, 22271-080, Brazil
| | - Marcelo Cordeiro-Santos
- Fundação de Medicina Tropical Dr. Heitor Dourado Vieira, Universidade Estadual do Amazonas, Manaus, AM, Brazil
| | | | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Dick Menzies
- Respiratory Epidemiology & Clinical Research Unit (RECRU), McGill University, Montreal, Canada
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Corrêa DSRC, Moura AGDOM, Quito MV, Souza HMD, Versiani LM, Leuzzi S, Gottems LBD, Macinko J. Reform movements in the Federal District Health Care System:conversion of the Primary Health Care assistance model. CIENCIA & SAUDE COLETIVA 2019; 24:2031-2041. [PMID: 31269162 DOI: 10.1590/1413-81232018246.08802019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/29/2019] [Indexed: 11/21/2022] Open
Abstract
CONCLUSION The Unified Health System has undergone constant evolution and expansion since the publication of Brazil's 1988 Federal Constitution. The Federal District has provided contributions to the field of Primary Health Care Policy, especially between 2016 and 2018, by defining the Family Health Strategy as the definitive way of organizing Primary Health Care (PHC) services and by establishing a set of actions aimed at conversion of existing PHC services to this model. This article describes and analyzes the key processes of this change. The method used was analysis of ordinances, resolutions, reports and other documents, as well as assessment of data from official databases. We emphasize the development of a normative structure that includes the teams' implementation, the professionals' work processes, changes in medical specialties and reorganization of the health professionals who already worked in PHC. with an effect of increasing the population's Family Health Strategy coverage (in a population of approximately 3 million inhabitants) from 28% to 69% during a two-year period, the experience demonstrates the feasibility of incremental changes in health policies such as defining priorities, better management of the workforce, training and decentralized planning to increase access to health services.
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Affiliation(s)
| | | | - Marcus Vinícius Quito
- Secretaria de Estado de Saúde do Distrito Federal. STN, Asa Norte. 70086-900 Brasília DF Brasil.
| | - Heloiza Machado de Souza
- Secretaria de Estado de Saúde do Distrito Federal. STN, Asa Norte. 70086-900 Brasília DF Brasil.
| | - Luciana Martins Versiani
- Secretaria de Estado de Saúde do Distrito Federal. STN, Asa Norte. 70086-900 Brasília DF Brasil.
| | - Sérgio Leuzzi
- Secretaria de Estado de Saúde do Distrito Federal. STN, Asa Norte. 70086-900 Brasília DF Brasil.
| | | | - James Macinko
- UCLA Fielding School of Public Health, University of California Los Angeles. Los Angeles CA EUA
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Effect of the Bolsa Familia Programme on tuberculosis treatment outcomes – Authors' reply. THE LANCET GLOBAL HEALTH 2019; 7:e566. [DOI: 10.1016/s2214-109x(19)30153-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/25/2019] [Indexed: 11/22/2022] Open
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15
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J Carter D, Daniel R, Torrens AW, N Sanchez M, Maciel ELN, Bartholomay P, Barreira DC, Rasella D, Barreto ML, Rodrigues LC, Boccia D. The impact of a cash transfer programme on tuberculosis treatment success rate: a quasi-experimental study in Brazil. BMJ Glob Health 2019; 4:e001029. [PMID: 30740248 PMCID: PMC6347926 DOI: 10.1136/bmjgh-2018-001029] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/04/2018] [Accepted: 11/06/2018] [Indexed: 02/04/2023] Open
Abstract
Background Evidence suggests that social protection policies such as Brazil’s Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in tuberculosis (TB) elimination. However, study limitations hamper conclusions. This paper uses a quasi-experimental approach to more rigorously evaluate the effect of BFP on TB treatment success rate. Methods Propensity scores were estimated from a complete-case logistic regression using covariates from a linked data set, including the Brazil’s TB notification system (SINAN), linked to the national registry of those in poverty (CadUnico) and the BFP payroll. Results The average effect of treatment on the treated was estimated as the difference in TB treatment success rate between matched groups (ie, the control and exposed patients, n=2167). Patients with TB receiving BFP showed a treatment success rate of 10.58 percentage points higher (95% CI 4.39 to 16.77) than patients with TB not receiving BFP. This association was robust to sensitivity analyses. Conclusions This study further confirms a positive relationship between the provision of conditional cash transfers and TB treatment success rate. Further research is needed to understand how to enhance access to social protection so to optimise public health impact.
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Affiliation(s)
- Daniel J Carter
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Rhian Daniel
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana W Torrens
- Tropical Medicine Department, University of Brasília, Brasília, Brazil
| | | | | | | | - Draurio C Barreira
- National Tuberculosis Programme/Ministry of Health of Brazil, Brasília, Brazil
| | - Davide Rasella
- Centro de Pesquisas Gonçalo Muniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Mauricio L Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.,Centro de Integração de Dados de Conhecimentos para Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Centro de Integração de Dados de Conhecimentos para Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Delia Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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16
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Albuquerque ACD, Cesse EÂP, Felisberto E, Samico IC, Frias PGD. Avaliação de desempenho da regionalização da vigilância em saúde em seis Regiões de Saúde brasileiras. CAD SAUDE PUBLICA 2019; 35Suppl 2:e00065218. [DOI: 10.1590/0102-311x00065218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/01/2018] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo foi avaliar o desempenho da regionalização da vigilância em saúde em seis Regiões de Saúde com diferentes níveis de desenvolvimento no Brasil. Adotou-se uma abordagem quantitativa transversal e os dados foram coletados utilizando-se um questionário estruturado, elaborado com base nas três dimensões da pesquisa (Política, Estrutura e Organização), aplicado a 31 atores-chave da vigilância em saúde das Regiões de Saúde e dos municípios selecionados. Utilizou-se, como tendência central, o escore médio, e para cada dimensão e atributo foram construídos índices sintéticos. Atribuíram-se três pontos de corte para avaliação do desempenho: valores iguais ou abaixo de 4,99 foram considerados insatisfatórios; entre 5,00 e 6,99, intermediários; e iguais ou acima de 7,00, satisfatórios. O estudo evidenciou que o desempenho da regionalização da vigilância em saúde foi considerado satisfatório apenas em uma região, intermediário em quatro e insatisfatório também em uma. Entre as três dimensões, os melhores desempenhos foram da Política e da Organização, e o mais frágil, da Estrutura. Conclui-se que, em geral, quanto maior o nível de desenvolvimento socioeconômico e da oferta de serviços, melhor o desempenho da regionalização da vigilância em saúde. A avaliação apresentada retrata a complexidade de contextos de diferentes regiões brasileiras, o que contribui para o entendimento da dinâmica da regionalização da vigilância em saúde no país.
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