1
|
Nóvoa-Lôbo NMD, Campos MR, Pires DC. [Tuberculosis in the Brazilian prison system: scenarios via Joinpoint, from 2007 to 2019]. CAD SAUDE PUBLICA 2023; 39:e00166722. [PMID: 37792817 PMCID: PMC10552813 DOI: 10.1590/0102-311xpt166722] [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: 09/13/2022] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 10/06/2023] Open
Abstract
This study describes and compares tuberculosis (TB) data among persons deprived of liberty and the general Brazilian population, from 2007 to 2019, using the Joinpoint tool to observe changes in trends. This study focuses on women and older adults, for HIV testing, and on the number of detainees according to prison capacity. This is a retrospective, quantitative, and analytical study, which uses methods of regression of time series data from secondary data of unrestricted access collected from the Brazilian Information System for Notifiable Diseases (SINAN), Brazilian Institute of Geography and Statistics (IBGE), and from analytical reports made available by the Brazilian National Penitentiary Department (DEPEN). The results show a considerably higher increase in the prevalence of TB in persons deprived of liberty in all perspectives analyzed; increased HIV testing; and a debatable trend of stability in the number of detainees according to prison capacity. When analyzing trends in prevalence, services, and determinants, it is curious to see the temporal non-coincidence in most cases. Clearly, national policies against TB do not have the same effect within prisons and even the National Policy for Comprehensive Health Care for People Deprived of Liberty in the Prison System (PNAISP) showed restricted effects in view of the health situation herein analyzed. Despite working with secondary data of variable reliability, comparisons were reached that can impact health decisions and actions. Although lacking complete and definitive answers, it was possible to launch a new point-of-view on the evolution of questions for which reflection is essential.
Collapse
Affiliation(s)
| | - Mônica Rodrigues Campos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de janeiro, Brasil
| | - Débora Castanheira Pires
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| |
Collapse
|
2
|
Ribeiro CC, Santos ADS, Tshua DH, Oliveira RDD, Lemos EF, Bourdillon P, Laranjeira A, Gonçalves CCM, Andrews J, Ko A, Croda J. Delay in the diagnosis and treatment of tuberculosis in prisons in Mato Grosso do Sul, Brazil. Rev Soc Bras Med Trop 2023; 56:e00152023. [PMID: 37493729 PMCID: PMC10367220 DOI: 10.1590/0037-8682-0015-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/26/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The number of tuberculosis (TB) cases in prisons is higher than that in the general population and has been reported as the most common cause of death in prisons. This study evaluated the delay in the diagnosis and treatment of TB in Brazilian prisons. METHODS A retrospective cohort study was conducted between 2007 and 2015 using data from the five largest male prisons in Mato Grosso do Sul, Brazil. TB case data was collected from the National Database of Notifiable Diseases (SINAN), GAL-LACEN, and prison medical records. The following variables were recorded: prison, year of diagnosis, age, race, education, HIV status, smoking status, comorbidities, number of symptoms, percentage of cures, delay in diagnosis, patient delay, provider delay, laboratory delay, and delay in treatment. Descriptive statistics were used for the variables of interest. RESULTS A total of 362 pulmonary TB cases were identified. The average time between the first symptom and reporting of data was 94 days. The mean time between symptom onset and laboratory diagnosis was 91 days. The average time from symptom onset to first consultation was 80 days. The time between diagnosis and treatment initiation was 5 days. CONCLUSIONS Delays were significant between reporting of the first symptoms and diagnosis and significantly smaller from the time between notification and start of treatment. Control strategies should be implemented to diagnose cases through active screening, to avoid delays in diagnosis and treatment, and to reduce TB transmission.
Collapse
Affiliation(s)
- Carla Celina Ribeiro
- Universidade Federal da Grande Dourados, Faculdade de Ciências da Saúde, Dourados, MS, Brasil
| | - Andrea da Silva Santos
- Universidade Federal da Grande Dourados, Faculdade de Ciências da Saúde, Dourados, MS, Brasil
| | | | - Roberto Dias de Oliveira
- Universidade Federal da Grande Dourados, Faculdade de Ciências da Saúde, Dourados, MS, Brasil
- Universidade Estadual de Mato Grosso do Sul, Curso de Enfermagem, Dourados, MS, Brasil
| | - Everton Ferreira Lemos
- Universidade Estadual de Mato Grosso do Sul, Faculdade de Medicina, Campo Grande, MS, Brasil
| | - Paul Bourdillon
- Yale University School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, United States of America
| | - Alexandre Laranjeira
- Faculdade de Medicina de São José do Rio Preto, Hospital de Base, São José do Rio Preto, SP, Brasil
| | - Crhistinne Cavalheiro Maymone Gonçalves
- Secretaria Estadual de Saúde de Mato Grosso do Sul, Campo Grande, MS, Brasil
- Universidade Estadual de Mato Grosso do Sul, Curso de Medicina, Campo Grande, MS, Brasil
| | - Jason Andrews
- Stanford University School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, CA, United States of America
| | - Albert Ko
- Yale University School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, United States of America
| | - Julio Croda
- Universidade Estadual de Mato Grosso do Sul, Curso de Medicina, Campo Grande, MS, Brasil
- Fundação Oswaldo Cruz, Mato Grosso do Sul, Campo Grande, MS, Brasil
| |
Collapse
|
3
|
Placeres AF, de Almeida Soares D, Delpino FM, Moura HSD, Scholze AR, dos Santos MS, Arcêncio RA, Fronteira I. Epidemiology of TB in prisoners: a metanalysis of the prevalence of active and latent TB. BMC Infect Dis 2023; 23:20. [PMID: 36631770 PMCID: PMC9835258 DOI: 10.1186/s12879-022-07961-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) in prisons usually occurs at higher rates than in the general population, especially in developing countries. TB has been reported as the most common cause of death among prisoners. Studies have shown limitations for early detection of TB in prisons that seem to result from mistaken concepts about TB, delayed diagnosis mainly due to the naturalization of lack of healthcare for this population METHODS: A scoping review was performed using the methodology of the Joanna Briggs Institute to assess "What are the scientific evidences on the epidemiology of TB in the prison system?". Then, a meta-analysis was performed to assess the prevalence of TB (active and latent) TB in prisoners. The results are presented as prevalence, in percentage, through random effects models, with a confidence interval of 95%. RESULTS Regarding active TB, the results of the metanalysis showed that countries with a high burden of TB had a prevalence of 3.54% [2.71; 4.63], countries not considered to be high burden TB countries had a prevalence of 1.43% [0.86; 2.37]. Latent TB had a prevalence of 51.61% [39.46; 63.58] in high TB burden countries and a prevalence of 40.24% [23.51; 59.61] in countries with low TB burden. In terms of development, in low- and lower-middle-income countries, the prevalence of active TB was 3.13% [1.84; 5.29] and in high- and upper-middle income countries the prevalence was 2.25% [1.70; 2.99]. The prevalence of latent TB in high- and middle-income countries was 43.77% [28.61; 60.18] and of 49.42% [45.91; 52.94] in low and lower middle-income countries. CONCLUSION Our analysis suggests that TB, and probably other infectious diseases, find fertile ground in prisons where previous acquire social disadvantages seem to thrive-therefore, TB in prisons is a global public health problem and effective strategies are needed to control the disease are needed targeting the prison environment, including rapid health assessments to understand each context and to implement tailored and precision interventions.
Collapse
Affiliation(s)
- Aline Ferreira Placeres
- grid.10772.330000000121511713Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Débora de Almeida Soares
- grid.10772.330000000121511713Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Felipe Mendes Delpino
- grid.411221.50000 0001 2134 6519Programa de Pós Graduação em Enfermagem, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Heriederson Sávio Dias Moura
- grid.11899.380000 0004 1937 0722Escola de Enfermagem de Ribeirão Preto (EERP/USP), Universidade de São Paulo, São Paulo, Brazil
| | - Alessandro Rolim Scholze
- grid.441795.aUniversidade Estadual do Norte do Paraná, Campus Luiz Meneguel de Bandeirantes, Bandeirantes, Brazil
| | - Márcio Souza dos Santos
- grid.11899.380000 0004 1937 0722Escola de Enfermagem de Ribeirão Preto (EERP/USP), Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- grid.11899.380000 0004 1937 0722Escola de Enfermagem de Ribeirão Preto (EERP/USP), Universidade de São Paulo, São Paulo, Brazil
| | - Inês Fronteira
- grid.10772.330000000121511713Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| |
Collapse
|
4
|
Guirelli AO, Bispo TR, Colpas DR, de Campos IB, Chimara E, Cergole-Novella MC, Rodart IF, dos Santos Candido V, Segura-Ramírez PJ, dos Santos Menezes Gaiotto Daros V, dos Santos Carmo AM. Tuberculosis/COVID-19 co-infection detected in a single sputum sample using a rapid molecular test. Braz J Microbiol 2022; 53:633-639. [PMID: 35107805 PMCID: PMC8809221 DOI: 10.1007/s42770-021-00677-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
Tuberculosis (TB) and COVID-19 affect the lungs and are transmitted mainly by aerosols or particles of saliva from infected persons. Clinical similarities between diseases can affect correct diagnosis. Individuals belonging to the population deprived of liberty (PDL) are at increased risk of contagion due to precarious sanitary conditions and overcrowded environments. A variety of specimens may be suitable for the diagnosis of COVID-19, using molecular diagnostic techniques; however, there is little data on the analysis of sputum samples with the Xpert Xpress SARS-CoV-2® for the diagnosis of COVID-19, especially in this population group. The present study reports a case of TB and COVID-19 co-infection detected in sputum from an individual belonging to the PDL. For the detection, it used the GeneXpert platform (Cepheid, USA). Mycobacterium tuberculosis complex (MTC) was detected using the Xpert MTB/RIF Ultra® cartridge and SARS-CoV-2 was detected using the Xpert Xpress SARS-CoV-2® cartridge. The genes IS6110 and IS1081 were detected within 80 min indicating the presence of MTC, with no mutations related to resistance to rifampicin. The SARS-CoV-2 E and N2 genes were detected within 45 min. The result was confirmed by RT-qPCR with detection of E, N, and RdRP/S genes in the sputum and nasopharyngeal (NP) specimens. Rapid diagnoses that allow the identification and differentiation of such diseases are important for adequate epidemiological surveillance, isolation of infected individuals, and interruption of the transmission chain. Using the GeneXpert platform, specimens can be tested as soon as they are received, without the need for prior preparation. The US Food and Drug Administration has issued emergency authorization for the use of the Cepheid Xpert Xpress SARS-CoV-2 for the rapid detection of SARS-CoV-2 using specimens from a NP or nasal wash/aspirate. The case presented here gains an innovation with the use of the sputum to COVID-19 diagnosis.
Collapse
Affiliation(s)
- Akemi Oshiro Guirelli
- Santo André Regional Center, Adolfo Lutz Institute, Av Ramiro Colleoni, 240 – Vila Dora, Santo André, SP Zip Code 09040-160 Brazil
| | - Thayná Rosa Bispo
- Santo André Regional Center, Adolfo Lutz Institute, Av Ramiro Colleoni, 240 – Vila Dora, Santo André, SP Zip Code 09040-160 Brazil
| | - Daniela Rodrigues Colpas
- Santo André Regional Center, Adolfo Lutz Institute, Av Ramiro Colleoni, 240 – Vila Dora, Santo André, SP Zip Code 09040-160 Brazil
| | - Ivana Barros de Campos
- Santo André Regional Center, Adolfo Lutz Institute, Av Ramiro Colleoni, 240 – Vila Dora, Santo André, SP Zip Code 09040-160 Brazil
| | - Erica Chimara
- Adolfo Lutz Institute, Av Dr Arnaldo, 355 – Pacaembu, São Paulo, SP Zip Code 01246-902 Brazil
| | - Maria Cecília Cergole-Novella
- Santo André Regional Center, Adolfo Lutz Institute, Av Ramiro Colleoni, 240 – Vila Dora, Santo André, SP Zip Code 09040-160 Brazil
| | - Itatiana Ferreira Rodart
- Santo André Regional Center, Adolfo Lutz Institute, Av Ramiro Colleoni, 240 – Vila Dora, Santo André, SP Zip Code 09040-160 Brazil
| | - Valéria dos Santos Candido
- Santo André Regional Center, Adolfo Lutz Institute, Av Ramiro Colleoni, 240 – Vila Dora, Santo André, SP Zip Code 09040-160 Brazil
| | - Paula Jimena Segura-Ramírez
- Santo André Regional Center, Adolfo Lutz Institute, Av Ramiro Colleoni, 240 – Vila Dora, Santo André, SP Zip Code 09040-160 Brazil
| | | | - Andreia Moreira dos Santos Carmo
- Santo André Regional Center, Adolfo Lutz Institute, Av Ramiro Colleoni, 240 – Vila Dora, Santo André, SP Zip Code 09040-160 Brazil
| |
Collapse
|
5
|
Martins LHI, Ferreira DC, Silva MT, Motta RHL, Franquez RT, Bergamaschi CDC. Frequency of osteonecrosis in bisphosphonate users submitted to dental procedures: A systematic review. Oral Dis 2021; 29:75-99. [PMID: 34402147 DOI: 10.1111/odi.14003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the frequency of osteonecrosis of the jaw in bisphosphonate users submitted to dental procedures. METHODS This systematic review searched the sources: MEDLINE, EMBASE, Web of Science, Scopus, and Virtual Health Library, with no restriction on language or publication date. Reviewers, in pairs and independently, selected the studies, extracted their data, and assessed the risk of bias. Meta-analyses were pooled using the DerSimonian and Laird random effects model. RESULTS A total of 27 studies (5391 participants) were included. The most reported bisphosphonates were zoledronate (n = 17 studies) and alendronate (n = 19) for treating cancers (n = 11) and osteoporosis (n = 16), respectively. Twelve studies were of low methodological quality. The frequency of osteonecrosis was 2.7% (95% CI: 0.9-5.2%) and proved higher for intravenous [6.9% (0.7-17.3%)] than oral [0.2% (0.9-5.2%)] bisphosphonate use. No association between longer treatment duration and greater frequency of osteonecrosis was observed. CONCLUSIONS Higher frequency of osteonecrosis was observed in intravenous bisphosphonate users submitted to dental extraction. Further studies collecting more detailed information on the bisphosphonates used and of greater methodological rigor are warranted to confirm these findings and better inform prescribers, dental surgeons, and other professionals on risks of bisphosphonate use in this patient group.
Collapse
Affiliation(s)
| | | | | | - Rogério Heládio Lopes Motta
- Division of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
| | | | | |
Collapse
|
6
|
Lima SVMA, de Araújo KCGM, Nunes MAP, Nunes C. Early identification of individuals at risk for loss to follow-up of tuberculosis treatment: A generalised hierarchical analysis. Heliyon 2021; 7:e06788. [PMID: 33981876 PMCID: PMC8085707 DOI: 10.1016/j.heliyon.2021.e06788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/03/2021] [Accepted: 04/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We characterise the loss to follow-up (locally termed abandoned) of tuberculosis treatment with individual and ecological health determinants and to identify the predictive capacity of these risk factors. METHODS A cohort study with individual and ecological characterisation of patients diagnosed with tuberculosis in Sergipe/Brazil from 2015 to 2018 with either loss to follow-up or completion of treatment as a therapeutic outcome was performed. The examined variables were based on the social determinants of health with descriptive analysis, binary logistic regression, a generalised hierarchical model and graphical presentation using a nomogram. RESULTS The loss to follow-up accounted for 18.21% of the 2,449 studied cases. The characteristics revealed that the highest abandonment percentages were people who: were male (20.0%), had black skin colour (20.3%), were aged 20-39 years (21.8%), had 4-7 years of schooling (23.6%), re-entered treatment after abandonment (36.5%), used alcohol (31.0%), used drugs (39.3%), were smokers (26.5%) and were homeless (55.4%). The ecological characteristics showed that individuals living in municipalities with a high human development index (HDI; odds ratio [OR]: 1.91) and high-income inequality (OR: 1.81) had a greater chance of not finishing the treatment. Most of these variables were identified as predictors in the generalised hierarchical model; the receiver operating characteristic curve (ROC) curve had 0.771 precision and 84.0% accuracy. CONCLUSION The group of identified characteristics influenced the loss to follow-up of tuberculosis treatment. This data provides evidence for the early identification of individuals who are at greater risk of abandoning tuberculosis treatment.
Collapse
Affiliation(s)
- Shirley Verônica Melo Almeida Lima
- Post-Graduate Program in Health Sciences, Federal University of Sergipe, Brazil
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Portugal
| | | | | | - Carla Nunes
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Portugal
- Public Health Research Centre, Universidade NOVA de Lisboa, Portugal
| |
Collapse
|
7
|
MONTECUCCO ALFREDO, DINI GUGLIELMO, RAHMANI ALBORZ, STICCHI LAURA, DURANDO PAOLO. The seedbeds of Tuberculosis: is it time to target congregate settings and workplaces? JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E324-E330. [PMID: 33150222 PMCID: PMC7595065 DOI: 10.15167/2421-4248/jpmh2020.61.3.1759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022]
Abstract
Countries where the incidence of Tuberculosis (TB) is low display a low transmission rate in the general population, and this rate has progressively declined in recent decades; however, TB epidemiology has shown a shift of the disease burden from the general population to specific populations at higher risk, such as vulnerable individuals and hard-to-reach groups. In low-incidence countries, preventive and therapeutic strategies must therefore be geared towards targeted interventions in these populations, with the priority being to promptly identify and treat latent tuberculosis infection (LTBI) rather than manage infectious cases. One of the most complex challenges in this area is to identify population subgroups with increased incidence/prevalence of LTBI/TB. The aim of this study was to provide a concise overview of the main studies and available evidence concerning the epidemiology of TB and LTBI in non-healthcare congregate settings, with specific emphasis on studies conducted in occupational settings and workplaces. Recognizing settings at increased risk might contribute to eliminating TB in low-incidence countries, a challenge which requires tailored responses. Occupational and preventive medicine has a major role to play in directing ad hoc policies and programs of LTBI surveillance. If TB is to be eradicated, it is essential to contain the seedbeds of infection: indeed, as long as a large reservoir of infected subjects exists, new active TB cases may arise at any time.
Collapse
Affiliation(s)
- ALFREDO MONTECUCCO
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- IRCCS Polyclinic San Martino Hospital, Genoa, Italy
| | - GUGLIELMO DINI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- IRCCS Polyclinic San Martino Hospital, Genoa, Italy
| | - ALBORZ RAHMANI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- IRCCS Polyclinic San Martino Hospital, Genoa, Italy
| | - LAURA STICCHI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- IRCCS Polyclinic San Martino Hospital, Genoa, Italy
| | - PAOLO DURANDO
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- IRCCS Polyclinic San Martino Hospital, Genoa, Italy
| |
Collapse
|
8
|
Lima SVMA, Cruz LZ, Araújo DDC, Santos ADD, Queiroz AAFLN, Araújo KCGMD, Mendes IAC. Quality of tuberculosis information systems after record linkage. Rev Bras Enferm 2020; 73:e20200536. [DOI: 10.1590/0034-7167-2020-0536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/03/2020] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to analyze the quality of a tuberculosis notification information system after record linkage and spatial and temporal distribution of tuberculosis in a Brazilian state. Method: an ecological study carried between 2006 and 2016 in Sergipe, Brazil. A deterministic linkage was performed with Notifiable Diseases Information System and Mortality Information System, recording 7,873 cases and 483 deaths. The temporal trend of tuberculosis incidence was calculated. Results: there was an increase among men (2.75%), > 60 years (6.29%), higher education (4.34%) and indigenous (4.76%). A total of 190 new cases (2.9%) was found. There was an increasing trend in tuberculosis incidence with a concentration of deaths in the metropolitan region. Conclusion: the quality of the information system showed fragility in identifying cases and deaths in Sergipe. Temporal distribution showed an increasing trend in tuberculosis incidence, and spatial distribution identified higher incidences in southeastern Brazil.
Collapse
|
9
|
Verônica Melo Almeida Lima S, Victor Muniz Rocha J, de Araújo KCGM, Antonio Prado Nunes M, Nunes C. Determinants associated with areas with higher tuberculosis mortality rates: an ecological study. Trop Med Int Health 2019; 25:338-345. [PMID: 31755621 DOI: 10.1111/tmi.13349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To characterise tuberculosis deaths in a region of northeast Brazil during the period from 2006 to 2017 and to identify determinants associated with areas with higher tuberculosis mortality rates. METHODS Ecological descriptive study of deaths from tuberculosis with multivariate mapping and logistic regression, carried out from 2006 to 2017 in the 75 municipalities of Sergipe, Brazil. The focus of the analysis was the mean mortality rate from tuberculosis, dichotomised according to the median. The independent variables were selected based on the conceptual model of the social determinants of health. RESULTS Mortality due to tuberculosis in Sergipe, Brazil, was most prevalent among males, mixed-race people, and people over 40 years old and with a low level of education. Multivariate logistic regression identified the mean incidence rate for tuberculosis (aOR: 1.06), the proportion of HIV testing (aOR: 7.10), people without primary education and with informal occupation (aOR: 1.26) and people living in urban households without waste collection service (aOR: 0.10) as determinants associated to municipalities with higher tuberculosis mortality rates, with area under the ROC curve of 84% (P-value 0.000). Mapping revealed evident spatial variability. CONCLUSIONS The tuberculosis epidemic in Brazil is determined by access to health services, especially the provision of HIV testing among those diagnosed with tuberculosis, accelerated urbanisation with large pockets of poverty and unsanitary housing conditions, corroborating global trends.
Collapse
Affiliation(s)
- Shirley Verônica Melo Almeida Lima
- Post-Graduate Program in Health Sciences, Federal University of Sergipe, São Cristóvão, Brazil.,NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | | | | | | | - Carla Nunes
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal.,Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| |
Collapse
|