Fernanda Darliane Tavares de Luna

Individual and social vulnerabilities upon acquiring tuberculosis: a literature systematic review

Tuberculosis is a contagious infectious disease mainly caused by the bacteria Mycobacterium tuberculosis that still meets the priority criteria - high magnitude, transcendence and vulnerability - due to the threat it poses to public health. When taking into consideration the vulnerability conditions that favor the onset of the disease, this article aimed to investigate the implications originated from individual and social vulnerability conditions in which tuberculosis patients are inserted. Databases like MEDLINE, LILACS and SciELO were searched in Portuguese, Spanish and English using the descriptors tuberculosis and vulnerability, and 183 articles were found. After the selection criterion was applied, there were 22 publications left to be discussed. Some of the aspects that characterize the vulnerability to tuberculosis are: low-income and low-education families, age, poor living conditions, chemical dependency, pre-existing conditions/aggravations like diabetes mellitus and malnutrition, indigenous communities, variables related to health professionals, intense border crossings and migration, difficulty in accessing information and health services and lack of knowledge on tuberculosis. Much as such aspects are present and favor the onset of the disease, several reports show high incidence rates of tuberculosis in low vulnerability places, suggesting that some factors related to the disease are still unclear. In conclusion, health promotion is important in order to disfavor such conditions or factors of vulnerability to tuberculosis, making them a primary target in the public health planning process and disease control.Tuberculosis is a contagious infectious disease mainly caused by the bacteria Mycobacterium tuberculosis that still meets the priority criteria - high magnitude, transcendence and vulnerability - due to the threat it poses to public health. When taking into consideration the vulnerability conditions that favor the onset of the disease, this article aimed to investigate the implications originated from individual and social vulnerability conditions in which tuberculosis patients are inserted. Databases like MEDLINE, LILACS and SciELO were searched in Portuguese, Spanish and English using the descriptors tuberculosis and vulnerability, and 183 articles were found. After the selection criterion was applied, there were 22 publications left to be discussed. Some of the aspects that characterize the vulnerability to tuberculosis are: low-income and low-education families, age, poor living conditions, chemical dependency, pre-existing conditions/aggravations like diabetes mellitus and malnutrition, indigenous communities, variables related to health professionals, intense border crossings and migration, difficulty in accessing information and health services and lack of knowledge on tuberculosis. Much as such aspects are present and favor the onset of the disease, several reports show high incidence rates of tuberculosis in low vulnerability places, suggesting that some factors related to the disease are still unclear. In conclusion, health promotion is important in order to disfavor such conditions or factors of vulnerability to tuberculosis, making them a primary target in the public health planning process and disease control.

Patients’ perception regarding the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment: a qualitative study

BackgroundTuberculosis remains an important disease which mainly affects the majority of vulnerable individuals in society, who are subjected to poor living conditions and difficulties to access the services of public health. Under these circumstances, the present study aims to understand patients’ perception in relation to the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment.MethodsA qualitative descriptive cross sectional study was conducted in one large municipality at the state of Paraíba, Northeast of Brazil. The study subjects, who were residents of the study site, covered all tuberculosis cases diagnosed between March and June 2015. The sample was defined by the criteria of response saturation. All interviews were audio recorded, and data analysis was developed through the hermeneutic dialectic method and the theory of Generative Route Sense. The project was approved by the Research Ethics Committee of the University of São Paulo (USP).ResultsA total of 13 individuals were interviewed and the responses were identified into two analytical categories: the difficulties they had and the enabling factors they could mention during their tuberculosis treatment. Patients brought up social exclusion as an obstacle to treatment adherence, which, along with stigmatization, weakened their link with family members and health professionals. Moreover, economic precariousness was a major hindrance to the maintenance of a proper diet and transportation access to health centers. However, social support and directly observed treatment helped to break down barriers of prejudice and to promote individual and family empowerment. Finally, patients also reported that their will to live and faith gave them the strength to continue with the treatment.ConclusionsAccording to patients in this study, social support and the strengthening of links with family members and health professionals may reduce social exclusion and other difficulties they face, thus encouraging them to the adhere to tuberculosis treatment.

Temporal Analysis of a Case Series of Leprosy Patients From a Low Endemic Area in Brazil and the Magnitude of Disability

Leprosy is an infectious disease caused by Mycobacterium leprae infection. The incubation period after the primary infection can be as long as decades. This bacterium has a tropism for macrophages and Schwann cells and as result neuropathies are frequent. The state of Rio Grande do Norte in northeastern Brazil has areas of low and high endemicity for leprosy. The aim of this study was to analyze a leprosy time series from Rio Grande do Norte, from 2005 to 2014, based on data provided by the Notifiable Diseases Information System from the State Secretariat of Health. This was a quantitative, descriptive and analytical study. We considered variables such as sex, age, clinical form, operational classification and disability grade at diagnosis. There were 3,426 cases of leprosy reported of which 1,781 were females (52%). Of those patients, 29% presented disability at diagnosis. The high level of disability in patients along with the lack of information regarding disability levels indicates the need for more effective measures, with early diagnosis to decrease morbidity as leprosy still remains as a serious public health problem.

Recommendations and effectiveness of chemoprophylaxis of latent infection by mycobacterium tuberculosis

Objective: identifying the recommendation and the effectiveness of the treatment of Latent Infection by Mycobacterium tuberculosis (LTBI) according to national and international studies. Method: a descriptive, exploratory study of a quantitative approach with predetermined stages, with searches in LILACS, MEDLINE and IBECS. Results: chemoprophylaxis is recommended in Brazil and other countries; however, in some countries, its achievement is not limited to the restricted use of isoniazid, as in Brazil, but isolated rifampin, or associating them with and in shorter treatment duration, usually three months. Conclusion: given so many favorable results to the use of anti-tuberculosis chemoprophylaxis does not justify the non-implementation of this therapy from the part of professionals tuberculosis service workers in Brazil, considering that there has been little reporting or record about this therapy in Brazilian Health Units. Descriptors: Primary Health Care; Chemoprophylaxis; Latent Tuberculosis. RESUMO Objetivo: identificar a recomendação e a efetividade do tratamento da Infecção Latente pelo Mycobacterium tuberculosis (ILTB) conforme estudos nacionais e internacionais. Método: estudo descritivo, exploratório com abordagem quantitativa, com etapas pré-determinadas, com buscas na LILACS, MEDLINE e IBECS. Resultados: a quimioprofilaxia é recomendada no Brasil e em outros países, contudo, em alguns países, sua realização não se limita ao uso restrito da isoniazida, como no Brasil, mas sim da rifampicina isolada, ou associando-as, e em menor tempo de duração de tratamento, geralmente três meses. Conclusão: diante de tantos resultados favoráveis ao uso da quimioprofilaxia antituberculose, não se justifica a não implementação desta terapêutica por parte dos profissionais trabalhadores de serviços de tuberculose no Brasil, tendo em vista que pouco se tem de relato ou de registro acerca desta terapêutica nas Unidades de Saúde brasileiras. Descritores: Atenção Primária à Saúde; Quimioprofilaxia; Tuberculose Latente. RESUMEN Objetivo: identificar la recomendación y la eficacia del tratamiento de la Infección Latente por el Mycobacterium tuberculosis (ITL) como estudios nacionales e internacionales. Método: este es un estudio descriptivo, exploratorio con enfoque cuantitativo con medidas predeterminadas, con búsquedas en LILACS, MEDLINE y IBECS. Resultados: la quimioprofilaxis se recomienda en Brasil y otros países, sin embargo, en algunos países, su logro no se limita al uso restringido de la isoniazida, como en Brasil, pero aislada rifampicina, o asociarse con, y más corto la duración del tratamiento, por lo general tres meses. Conclusión: en frente de tantos resultados favorables al uso de la quimioprofilaxis contra la tuberculosis no se justifica la no aplicación de esta terapia de la parte de los profesionales trabajadores de los servicios de la tuberculosis en Brasil, teniendo en cuenta que ha habido pocos informes o registro acerca de esta terapia en las Unidades de Salud de Brasil. Descriptores: Atención Primaria de Salud; Quimioprofilaxis; Tuberculosis Latente. Nurse, Master’s Student, Postgraduate Public Health Program/ PPGSP, State University of Paraíba/UEPB. Campina Grande (PB), Brazil. Email: rayrlacz@hotmail.com; Nurse, Master’s Student, Postgraduate Public Health Program/PPGSP, State University of Paraíba/UEPB. Campina Grande (PB), Brazil. Email: fernandarliane@hotmail.com; Degree in Sciences, Doctoral Student, Postgraduate Health Sciences Program/PPGCS, Medical School of the ACB/FMABC. São Paulo (SP), Brazil. Email: sheyllabatista@bol.com.br; Nurse, Master Teacher, Nursing Program, College Santa Maria/ FSM, Doctoral Student, Postgraduate Health Sciences Program/PPGCS, Medical School ACB/FMABC. São Paulo (SP), Brazil. Email: ankilmar@hotmail.com; Nurse, Master Teacher, Nursing Program, College Santa Maria/FSM, Doctoral Student, Postgraduate Health Promotion Program/PPGPS, University of Franca/UNIFRAN. Franca (SP), Brazil. Email: minualsa@hotmail.com; Nurse, Professor Post-Doc, State University of Paraíba/UEPB. Campina Grande (PB), Email: taniaribeiro_2@hotmail.com ORIGINAL ARTICLE Temoteo RCA de, Luna FDT de, Lacerda SNB et al. Recommendations and effectiveness of chemoprophylaxis...

Vulnerability Aspects That Hinder Tuberculosis Healing According to the Perspective of Patients and Healthcare Managers.

Introduction : Tuberculosis is a major public health condition worldwide. The partnership between Healthcare Services and the patient is the gold standard for a successful healing outcome and a reduction in the harm the disease causes to patients and society in general. Objective : To analyze the vulnerability aspects that make tuberculosis healing difficult according to the perspective of patients and public healthcare managers. Method : This is a descriptive study conducted in the year 2013 in Cajazeiras, a town located in the state of Paraiba in the northeastern region of Brazil. The study population was composed of 4 healthcare managers and 29 patients with confirmed tuberculosis diagnosis. In order to gather the sample of tuberculosis patients, a search on the Information System on Diseases of Compulsory Declaration (SINAN, in the Portuguese abbreviation) was run. Results : All patients had fixed addresses. Among these individuals, a total of 12 were of the male sex, 13.6% were smokers, 77.3% were alcohol-free and 13.6% were frequent alcohol consumers. In addition to that, 72.7% of the patients received no public financial support of any sort. As to coping with the disease, 54.5% declared no difficulty at all, 22.7% found it very difficult, 18.2% reported it was somewhat difficult and 4.5% stated it was extremely difficult. Concerning family income, 68.0% lived on up to two minimum wages. Final considerations : The findings in the current study revealed the vulnerability condition upon which tuberculosis patients live, highlighting the social exclusion of this population with their low educational level, their low-income status, their poverty condition and their difficulty in understanding their basic needs, such as the necessity of a well-balanced diet to prevent the adverse effects caused by the drugs during the treatment. Managers identified social stigma, prejudice, denial of the disease with a resultant resistance to treatment, street-dwelling individuals and drinking and smoking habits as major difficulties for tuberculosis control in the city. It is quite clear that the managers approach the universe of vulnerability within its three inseparable dimensions: individual, social and programmatic. A better understanding of the real needs of tuberculosis patients as well as the prioritization of the disease are of utmost importance in the municipal public health agenda, which is based on a higher involvement of managers in the participation, discussion and definition of the application of resources for the disease control and a public health policy that encompasses tuberculosis social issues.