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Cabral BVB, Sousa GJB, Cordeiro LI, Maranhão TA, Pereira MLD. Temporal Pattern and Spatial Distribution of Tuberculosis Prevalence Associated with Multimorbidity in Brazil. Rev Soc Bras Med Trop 2024; 57:e00408. [PMID: 39082518 PMCID: PMC11290848 DOI: 10.1590/0037-8682-0625-2023] [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: 12/26/2023] [Accepted: 05/24/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Four main chronic conditions may be involved in the tuberculosis pathogenic process and/or clinical evolution: HIV/AIDS, diabetes mellitus, mental illness, and Chronic Obstructive Pulmonary Disease. This study aimed to determine the spatiotemporal pattern of tuberculosis (TB) associated with multimorbidity in Brazil. METHODS Ecological study use data from the Notifiable Diseases Information System (SINAN), collected from the electronic portal of the Department of Informatics of the SUS (DATASUS). These data included TB cases that were reported between 2007 and 2021 and were associated with two or more chronic clinical health conditions (multimorbidity). RESULTS A total of 7,795 cases of TB associated with multimorbidity were recorded, with an average growth trend of 4.6% per year (95% Confidence Interval (CI): 3.3-5.9; p<0.001) and higher growth in the first temporal segment (2007 to 2011) (8.9%; 95%CI: 4.2-13.9; p=0.002). The spatial analysis, after Bayesian smoothing, highlighted the main municipalities states of the study, namely: São Paulo (19.8%; n = 297), Porto Alegre (23.6%; n = 354), and Rio de Janeiro (44.8%; n = 672). The proportion of extremely poor (β=-0.002), the bolsa família program (β=0.002), the average per-person income (β=0.001), and the percentage of the population living in households with a density of more than 2 people per bedroom (β=0.001) were related to chronic health conditions. CONCLUSIONS These findings will stimulate public action to manage this situation. However, as this is still a recent topic in the literature, we encourage the development of studies on the synergistic characteristics of TB and other clinical conditions.
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Affiliation(s)
| | - George Jó Bezerra Sousa
- Universidade Estadual do Ceará, Departamento de Enfermagem, Fortaleza, CE, Brasil
- Secretaria de Saúde do Ceará, Fortaleza, CE, Brasil
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Tavares RBV, Berra TZ, Alves YM, Popolin MAP, Ramos ACV, Tártaro AF, de Souza CF, Arcêncio RA. Unsuccessful tuberculosis treatment outcomes across Brazil's geographical landscape before and during the COVID-19 pandemic: are we truly advancing toward the sustainable development/end TB goal? Infect Dis Poverty 2024; 13:17. [PMID: 38369536 PMCID: PMC10874548 DOI: 10.1186/s40249-024-01184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Tuberculosis is one of the most significant infectious diseases for global public health. The reallocation of healthcare resources and the restrictions imposed by the COVID-19 pandemic have hindered access to TB diagnosis and treatment. Increases in unfavorable outcomes of the disease have been observed in Brazil. The objective of this study was to analyze the spatial distribution of unfavorable TB treatment outcomes in Brazil before and during the pandemic. METHODS An ecological study with spatial analysis was conducted with all 5569 municipalities in Brazil. All reported cases of tuberculosis between January 2010 and December 2021, as well as reported cases of COVID-19 from February 2020 to December 2021, were included. The outcomes studied encompass loss to follow-up, drug-resistant tuberculosis, and death. The Getis Ord GI* technique was employed to assess spatial association, and the Kernel density estimator was used to identify areas with concentrated increases or decreases in outcomes. Bivariate Local Moran's I was used to examine the spatial association between outcomes and COVID-19 incidence. The study was approved by the Research Ethics Committee of Ribeirão Preto Nursing School, University of São Paulo. RESULTS There were 134,394 cases of loss to follow-up, 10,270 cases of drug resistance, and 37,863 deaths. Clusters of high and low values were identified for all three outcomes, indicating significant changes in the spatial distribution patterns. Increases in concentrations were observed for lost to follow-up cases in the Southeast, while reductions occurred in the Northeast, South, and Midwest. Drug-resistant tuberculosis experienced an increase in the Southern and Southeastern regions and a decrease in the Northeast and South. TB-related deaths showed notable concentrations in the Midwest, Northeast, South, and Southeast. There was an increase in high occurrence clusters for deaths after 2020 and 2021 in the Northeast. CONCLUSIONS The pandemic has brought additional challenges, emphasizing the importance of enhancing efforts and disease control strategies, prioritizing early identification, treatment adherence, and follow-up. This commitment is vital for achieving the goal of tuberculosis elimination.
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Affiliation(s)
- Reginaldo Bazon Vaz Tavares
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil.
| | - Thaís Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Marcela Antunes Paschoal Popolin
- Federal University of Tocantins, Palmas Campus (FUT), Quadra 109 Norte, Avenida NS 15, Plano Diretor Norte, Palmas, Tocantins, Brazil
| | - Antônio Carlos Vieira Ramos
- State University of Minas Gerais, Passos Campus (SUMG), Avenida Juca Stockler, 1130, Bairro Belo Horizonte, Passos, Minas Gerais, Brazil
| | - Ariela Fehr Tártaro
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Clara Ferreira de Souza
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
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Lourenço LV, Coelho KSC, Merhy EE. Continuing education practices in primary health care for addressing users with tuberculosis. Salud Colect 2023; 19:e4542. [PMID: 38006654 DOI: 10.18294/sc.2023.4542] [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: 06/25/2023] [Accepted: 10/11/2023] [Indexed: 11/27/2023] Open
Abstract
Interruption of tuberculosis treatment constitutes one of the obstacles to disease control. The standards established in health policies, at times, prove to be inflexible, tending to obscure the difficulties experienced by individuals in treatment. The aim of this article is to analyze the practices of continuous health education developed by family health teams at healthcare units in Maré, Rio de Janeiro, Brazil, in cases of tuberculosis treatment interruption. An exploratory qualitative study was conducted with twelve healthcare professionals from the team between August and November 2021. The findings from this research regard continuous health education as a strategy to enhance care processes, fostered through the lived experiences of the healthcare workers, enabling the creation of knowledge and exchanges that expand the effective treatment of tuberculosis with creativity and flexibility in the dynamics of interactions with users. This care takes place in the live work in action, whether in the hallways of healthcare units or within the community, as it occurs in real-time practice.
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Affiliation(s)
- Letícia Vieira Lourenço
- Magíster en Atención Primaria de la Salud. Coordinadora pedagógica, Programa de Residencia en Enfermería Familiar y Comunidad, Secretaría Municipal de Salud, Rio de Janeiro, Brasil
| | - Karla Santa Cruz Coelho
- Doctora en Salud Colectiva. Profesora asociada, Universidade Federal do Rio de Janeiro, Campus Macaé, Río de Janeiro, Brasil
| | - Emerson Elias Merhy
- Doctor en Salud Colectiva. Profesor Titular, Universidade Federal do Rio de Janeiro, Campus Macaé, Río de Janeiro, Brasil
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Batista JFC, Santos VSDO, de Jesus CVF, Lima SO. Time series of cases and treatment outcomes from tuberculosis in Sergipe, 2012-2021. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230041. [PMID: 37729348 PMCID: PMC10511026 DOI: 10.1590/1980-549720230041] [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: 03/01/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE The objectives of this study were: (1) to analyze the temporal trend of tuberculosis treatment outcomes in the state of Sergipe; (2) to identify the existence of seasonality of tuberculosis; (3) to verify the influence of the rapid molecular test (MTB-RIF) in the time series of tuberculosis and its treatment outcomes in the state of Sergipe; and (4) to verify treatment outcomes. METHODS Ecological study on tuberculosis and three treatment outcomes (cure, interruption of treatment, and death) extracted from Datasus. Incidence and mortality rates were calculated for the crude occurrences of cases and deaths and the proportions of cure and interruption of treatment (%). The time series was analyzed using Prais-Winsten regression from Jan to Dec/2021. RESULTS The total incidence rate was 36.35 cases per 100,000 inhabitants, with an increase of 0.44% per month (95%CI 0.35; 0.54). The cure rate was 64.0% with a steady trend (p>0.05). The percentage of treatment interruption was 13.3%, with a reduction of -0.73%/month (95%CI -1.11; -0.34). The total mortality rate was 1.92 deaths/100,000 inhabitants with a stationary trend. After the implementation of the MTB-RIF, there was an increase in the incidence rate of 0.65% per month. Seasonality was not identified in any of the analyses performed (p>0.05). CONCLUSION There was an increase in incidence rates, reduction in treatment interruption and mortality in the state of Sergipe. Seasonality was not identified. The rapid molecular test showed a growth effect on the incidence rate.
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Costa GF, Garcez JCD, Marcos W, Ferreira ALDS, Andrade JAA, Rodrigues YC, Lima LNGC, Conceição EC, Lima KVB. Factors Associated with Tuberculosis Outcome in a Hyperendemic City in the North of Brazil. Healthcare (Basel) 2023; 11:healthcare11040508. [PMID: 36833042 PMCID: PMC9957009 DOI: 10.3390/healthcare11040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023] Open
Abstract
Ananindeua city, State of Pará, North of Brazil, is a hyperendemic area for tuberculosis (TB), with a cure rate below the recommendation by the Brazilian Ministry of Health. We aimed to describe: (I) the TB incidence coefficient of Ananindeua municipality comparatively against Brazilian data; (II) TB treatment outcomes; (III) to compare the socioeconomic and epidemiological characteristics of abandonment versus cure outcome; and (IV) to evaluate the risk factors associated with TB treatment abandonment in Ananindeua city, from 2017 to 2021. This is a retrospective, descriptive, and cross-sectional epidemiological study which used secondary TB entries. Data were analyzed by linear regression, descriptive statistics, and associations were made using the Chi-square test and G-test, followed by univariate and multivariate logistic regression analyses. Cure rates ranged from 28.7% to 70.1%, abandonment between 7.3% and 11.8%, deaths from the disease ranged from 0% to 1.6%, and drug-resistant tuberculosis (TB-DR) rates had frequencies from 0% to 0.9%. Patient transfer rates to other municipalities were between 4.9% and 12.5%. The multivariate analysis showed that alcohol is almost 2 times more likely to lead an individual to abandon treatment and use of illicit drugs was almost 3 times more likely. Individuals between 20 and 59 years of age were also more likely to abandon treatment almost twice as often. Finally, data obtained in the present report is of great relevance to strengthen epidemiological surveillance and minimize possible discrepancies between the information systems and the reality of public health in high endemicity areas.
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Affiliation(s)
- Gabriel Fazzi Costa
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
- Correspondence: (G.F.C.); (K.V.B.L.); Tel.: +55-91-3214-2116 (K.V.B.L.)
| | - Juliana Conceição Dias Garcez
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
| | - Weber Marcos
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
| | - Ana Lúcia da Silva Ferreira
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
| | | | - Yan Corrêa Rodrigues
- Program in Epidemiology and Health Surveillance (PPGEVS), Evandro Chagas Institute (IEC), Ananindeua 67030-000, PA, Brazil
| | - Luana Nepomuceno Gondim Costa Lima
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health of Brazil, Ananindeua 67030-000, PA, Brazil
| | - Emilyn Costa Conceição
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch 7602, South Africa
| | - Karla Valéria Batista Lima
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health of Brazil, Ananindeua 67030-000, PA, Brazil
- Correspondence: (G.F.C.); (K.V.B.L.); Tel.: +55-91-3214-2116 (K.V.B.L.)
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Aplicativo SARA para tratamento de pessoas com tuberculose: estudo metodológico. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ao03391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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