Ana Maria Campos Marques

A medicação assistida e os índices de cura de tuberculose e de abandono de tratamento na população indígena Guaraní-Kaiwá no Município de Dourados, Mato Grosso do Sul, Brasil

In January 1998, home treatment regimens were launched in the municipality of Dourados, State of Mato Grosso do Sul, Brazil, and accompanied by indigenous health agents as a means of replacing the previous regimen, in which Guaraní-Kaiwá tuberculosis patients were systematically hospitalized for up to six months in the Porta da Esperan a Hospital. In order to verify whether this change in strategy had any effect on the cure and treatment dropout rates, a retrospective study was conducted on 594 patient records from January 1996 to December 1999. Patients were divided into two groups: Group I, treated by hospitalization (291 cases) and Group II, treated as outpatients (303 cases). Group II patients showed a significant increase in the cure rate and a significant reduction in the treatment dropout rate. The study also showed a high tuberculosis prevalence rate in children (40%), subsequently reported to the competent health authorities and thus launching specific projects to deal with this epidemiological reality. Based on these results, it is recommended that the assisted treatment strategy be adopted for other Indian populations.

Tuberculosis among Brazilian indigenous individuals aged less than 15 years-old in State of Mato Grosso do Sul, Brazil

INTRODUCTION This study describes the epidemiological aspects of TB among Brazilian Native Indians aged less than 15 years-old in Mato Grosso do Sul, Brazil, between 2000 and 2006. METHODS A retrospective observational study based on secondary data collected from the health system of Brazilian indigenous peoples, Special Indigenous Sanitary District (DSEI), and National System of Notifiable Diseases (SINAN) databases. The variables analyzed were: frequency of TB according to sex, age, clinical presentation and outcome. The Fisher test and the incidence tendency curve were calculated (p<0.01). RESULTS TB prevalence was 20.4% (224/1,096). The incidence rate decreased 14% per year during the study period. TB was more prevalent among Brazilian indigenous individuals aged less than 5 years-old and among those aged less than one year-old. More than half of TB cases were male and the most common clinical presentation was pulmonary TB (92.9%). Cure was the most common outcome (91.1%), followed by abandoned treatment (3.6%) and death (2.2%). CONCLUSIONS The high cure rate, reduced mortality and the progressive decrease in TB incidence rate during the study period indicate the effectiveness of supervised treatment of the new TB control model implemented among Brazilian indigenous peoples on 2000.

Diagnóstico da tuberculose em indígenas menores de quinze anos por meio de um sistema de pontuação em Mato Grosso do Sul

OBJECTIVE: To evaluate the process of diagnosing pulmonary tuberculosis in smear-negative indigenous children and adolescents under 15 years of age with the modified Brazilian National Ministry of Health Scoring System (mBNMH-SS). METHODS: This was a retrospective descriptive study involving 49 indigenous patients under 15 years of age with tuberculosis, treated between 2007 and 2010 in the state of Mato Grosso do Sul, Brazil. RESULTS: Of the 49 patients, 27 (56%) were under 5 years of age, 33 (67%) had symptoms suggestive of tuberculosis, 24 (49%) were underweight, and 36 (73.5%) had been BCG vaccinated. The tuberculin skin test was positive in 28 patients (57%), 18 (64%) of whom had an induration ≥ 10 mm. Chest X-rays were performed in 37 (76%) of the patients, 31 (84%) of whom had only one chest X-ray taken. Among those 37 patients, the radiological findings were suggestive of tuberculosis in 16 (43%), infiltration/condensation in 10 (27%), and normal in 4 (11%). The Indigenous Health Care Teams made the diagnosis in 31 (63%) of the cases, using the original BNMH-SS in only 14 (45%). We calculated the mBNMH-SS scores for 30 (61%) of the 49 patients. Among the 30 cases scored, a diagnosis of tuberculosis was found to be highly likely, possible, and unlikely in 16 (53%), 11 (37%), and 3 (10%), respectively. CONCLUSIONS: The proportion of highly likely and possible diagnoses was consistent with the standard proportion of cases diagnosed by the teams (90%), demonstrating the epidemiological applicability of the mBNMH-SS for the diagnosis of pulmonary tuberculosis in the indigenous population, within the scenario of the health care provided.

Magnitude da tuberculose pulmonar na população fronteiriça de Mato Grosso do Sul (Brasil), Paraguai e Bolívia

Este estudo analisou a magnitude da tuberculose pulmonar no periodo de 2007 a 2010 em municipios sul-mato-grossenses fronteiricos ao Paraguai e a Bolivia. Na regiao de fronteira, as taxas de incidencia (49,1/100 mil habitantes), de mortalidade (4,0/100 mil) e de abandono do tratamento (11,3%) foram 1,6, 1,8 e 1,5 vez maiores do que na regiao nao fronteirica. Entre indigenas da fronteira, as taxas de incidencia (253,4/100 mil habitantes), mortalidade (11,6/100 mil) e coinfeccao por HIV (1,9/100 mil) foram, respectivamente, 6,4, 3,2 vezes e 1,9 vez maiores do que entre os nao indigenas nesta regiao. Estar na regiao de fronteira revelou-se fator de protecao contra coinfeccao por HIV. Constatou-se associacao entre ser indigena e nao abandonar o tratamento. Conclui-se que a populacao residente nesses municipios de fronteira vivencia elevado risco de adoecimento, de morte e de abandono do tratamento de tuberculose pulmonar, o que requer acoes diferenciadas de vigilância em saude.

Pulmonary tuberculosis among residents of municipalities in Mato Grosso do Sul State, Brazil, bordering on Paraguay and Bolivia

Este estudo analisou a magnitude da tuberculose pulmonar no periodo de 2007 a 2010 em municipios sul-mato-grossenses fronteiricos ao Paraguai e a Bolivia. Na regiao de fronteira, as taxas de incidencia (49,1/100 mil habitantes), de mortalidade (4,0/100 mil) e de abandono do tratamento (11,3%) foram 1,6, 1,8 e 1,5 vez maiores do que na regiao nao fronteirica. Entre indigenas da fronteira, as taxas de incidencia (253,4/100 mil habitantes), mortalidade (11,6/100 mil) e coinfeccao por HIV (1,9/100 mil) foram, respectivamente, 6,4, 3,2 vezes e 1,9 vez maiores do que entre os nao indigenas nesta regiao. Estar na regiao de fronteira revelou-se fator de protecao contra coinfeccao por HIV. Constatou-se associacao entre ser indigena e nao abandonar o tratamento. Conclui-se que a populacao residente nesses municipios de fronteira vivencia elevado risco de adoecimento, de morte e de abandono do tratamento de tuberculose pulmonar, o que requer acoes diferenciadas de vigilância em saude.

Magnitud de la tuberculosis pulmonar en la población fronteriza de Mato Grosso do Sul (Brasil), Paraguay y Bolivia

Este estudo analisou a magnitude da tuberculose pulmonar no periodo de 2007 a 2010 em municipios sul-mato-grossenses fronteiricos ao Paraguai e a Bolivia. Na regiao de fronteira, as taxas de incidencia (49,1/100 mil habitantes), de mortalidade (4,0/100 mil) e de abandono do tratamento (11,3%) foram 1,6, 1,8 e 1,5 vez maiores do que na regiao nao fronteirica. Entre indigenas da fronteira, as taxas de incidencia (253,4/100 mil habitantes), mortalidade (11,6/100 mil) e coinfeccao por HIV (1,9/100 mil) foram, respectivamente, 6,4, 3,2 vezes e 1,9 vez maiores do que entre os nao indigenas nesta regiao. Estar na regiao de fronteira revelou-se fator de protecao contra coinfeccao por HIV. Constatou-se associacao entre ser indigena e nao abandonar o tratamento. Conclui-se que a populacao residente nesses municipios de fronteira vivencia elevado risco de adoecimento, de morte e de abandono do tratamento de tuberculose pulmonar, o que requer acoes diferenciadas de vigilância em saude.