Maria de Lourdes Sperli Geraldes Santos

Poverty: socioeconomic characterization at tuberculosis

This study aimed to evaluate the epidemiological status of Tuberculosis regarding to the socioeconomic characteristics of São José do Rio Preto between 1998 and 2004. Indexes estimated for 432 urban census tracts from the demographic census of 2000, sorted systematically according to the values of socioeconomic factors and grouped into quartiles were taken into account. The socioeconomic characterization was outlined based on Schooling, Income, and Number of Residents. The incidence rates were considered for 1998, 1999, 2003, and 2004. The socioeconomic factor accounted for 87% of the total variation. The disease prevalence is higher in the poorest areas. The incidence rate and the risk of being infected by TB in the poorest areas declined in 2003 and 2004. The results confirm that TB is determined by the populations living conditions in the city studied. It strengthens the relevance of understanding the TB conditional social factors to transform the worrisome scenario in which this population is inserted.

Análise espacial da co-infecção tuberculose/HIV: relação com níveis socioeconômicos em município do sudeste do Brasil

INTRODUCTION Spatial analysis of the distribution of tuberculosis/HIV coinfection was performed and associated with socioeconomic indicators in São José do Rio Preto, from 1998 to 2006. METHODS New TB/HIV coinfection cases were georeferenced and incidence coefficients were calculated for spatial units. Morans index was used to evaluate spatial associations of incidences. Multiple regressions selected variables that could best explain the spatial association of incidences. The local indicator of spatial association was used to identify significant spatial groupings. RESULTS Morans index was 0.0635 (p=0.0000) indicating that the incidence association occurred. The variable that best explained the spatial association of incidence was the percentage of heads of families with up to three years of education. The LISA cluster map for TB/HIV coinfection incidence coefficients showed groups with high incidence rates in the North and low incidence in the South and West regions of the municipality. CONCLUSIONS The study elucidated the spatial geographic distribution of TB/HIV coinfection and determined its association with socioeconomic variables, thus providing data for oriented planning, prioritizing socially disadvantaged regions that present a higher incidence of the disease.

Pobreza: caracterização socioeconômica da tuberculose

This study aimed to evaluate the epidemiological status of Tuberculosis regarding to the socioeconomic characteristics of São José do Rio Preto between 1998 and 2004. Indexes estimated for 432 urban census tracts from the demographic census of 2000, sorted systematically according to the values of socioeconomic factors and grouped into quartiles were taken into account. The socioeconomic characterization was outlined based on Schooling, Income, and Number of Residents. The incidence rates were considered for 1998, 1999, 2003, and 2004. The socioeconomic factor accounted for 87% of the total variation. The disease prevalence is higher in the poorest areas. The incidence rate and the risk of being infected by TB in the poorest areas declined in 2003 and 2004. The results confirm that TB is determined by the populations living conditions in the city studied. It strengthens the relevance of understanding the TB conditional social factors to transform the worrisome scenario in which this population is inserted.

A GERÊNCIA DAS AÇÕES DE CONTROLE DA TUBERCULOSE EM MUNICÍPIOS PRIORITÁRIOS DO INTERIOR PAULISTA

The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care.The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care. GESTION DE PROGRAMAS DE CONTROL DE LA TUBERCULOSIS EN MUNICIPIOS DEL INTERIOR DEL ESTADO DE SAO PAULO RESUMEN: La investigacion tuvo como objetivo analizar la gestion de programas de control de la tuberculosis en municipios del interior del Estado de Sao Paulo. La recoleccion de datos se realizo en junio de 2005, a traves de entrevistas semiestructuradas con los coordinadores del Programa de Control de la Tuberculosis de los siete municipios prioritarios. Para el analisis de los datos se empleo el Analisis de Contenido Tematico. Las encuestas senalaron nudos criticos en la captacion y manutencion de presupuestos para recursos humanos y vehiculos; recursos humanos insuficientes y sin preparo; desconocimiento del destino de los presupuestos asignados al combate a la tuberculosis y falta de autonomia en la gestion de dichos recursos; dificultades de comunicacion e integracion con gestores; falta de priorizacion de la enfermedad en la agenda politica; priorizacion de otras enfermedades con repercusion politica mas visible y necesidad de coparticipacion. Se concluye que los coordinadores trabajan bajo presion; ocupan doble posicion de transmision, tanto en el plan jerarquico como en las relaciones con el ambiente y ni siempre disponen de recursos adecuados y suficientes. DESCRIPTORES: Tuberculosis. Gestion de servicios de sanidad. Atencion primaria de salud.

O controle de comunicantes de tuberculose no programa de controle da tuberculose em um município de médio porte da Região Sudeste do Brasil, em 2002

OBJECTIVE This study aimed to describe the investigation of tuberculosis contacts enrolled in the Tuberculosis Control Program of the municipality of São José do Rio Preto, Brazil in 2002. METHODS A descriptive study was conducted using secondary data obtained from the Tuberculosis Notification Database, as well as charts and registries compiled by the São José do Rio Preto Tuberculosis Control Program in 2002. RESULTS A total of 166 household tuberculosis contacts were enrolled in the Program. Of those, 82 were male, and 84 were females. The incidence of tuberculosis was highest (70%) in the 15 to 59 age bracket: 42 (25.3%) of the cases occurred in individuals from 0 to 19 years of age; 73 (44%) in those from 20 to 49; and 44 (25.5%) in those 50 or over. In terms of their relationship with the index patient, 41 (24.7%) were children; 29 (17.5%) were partners; 22 (13.2%) were siblings, and 15 (9.1%) were mothers. The following tests were requested: (in 12%) sputum smear microscopy, culture or both; (in 100%) chest X-ray, revealing 2 suspected cases of pulmonary tuberculosis and 5 cases of other diseases; (in 7.2%) tuberculin skin test, the results of which showed that 4.2% were nonreactors, and that 1.2% presented an induration of 8 mm. Among the contacts examined, the disease was detected in 3 (1.8%). CONCLUSION There is no systematization in the monitoring of individuals who are in contact with tuberculosis patients.

The epidemiological dimension of TB/HIV co-infection

This study aimed to analyze the epidemiological indicators of TB/HIV co-infection in São José do Rio Preto, São Paulo, Brazil from 1998 to 2006. Data of new TB cases that initiated treatment between January 1998 and December 2006 were obtained from the TB Notification System (EPI-TB) and 306 cases were reported. The incidence rate was 5.1/100,000 inhabitants in 2006. Most cases were men (72.5%) with ages ranging between 20 and 59 years (96.4 %). The majority (51%) had incomplete primary education. Pulmonary TB was the most common type (52.9%) and 46.1% of the patients received supervised treatment. In 2006, the cure rate was 33.3%, 14.3% death rate and no patient abandoned the treatment. Diagnosis occurred at the hospital in 60% of the cases. Results show the need of improved coordination between the citys Tuberculosis Control Program and the Sexually Transmitted Diseases and HIV Program.El objetivo fue analizar los indicadores epidemiologicos de la coinfeccion tuberculosis y virus de la inmunodeficiencia humana (TB/VIH) en el municipio de Sao Jose del Rio Preto, Sao Paulo, Brasil, en el periodo de 1.998 a 2.006. Los datos de los casos nuevos de TB, que iniciaron el tratamiento entre enero de 1.998 y diciembre de 2.006, fueron recolectados del Sistema de Notificacion de la TB (EPI-TB). Fueron notificados 306 casos. El coeficiente de incidencia fue de 5,1/100.000 hab, en 2006. Hubo predominio de personas del sexo masculino (72,5%), en el intervalo de edad de 20 a 59 anos (96,4%). La mayoria (51%) no poseia la ensenanza fundamental completa. La forma clinica pulmonar fue relevante (52,9%) y recibieron tratamiento supervisado 46,1% enfermos. En 2.006, la tasa de cura fue de 33,3%, de muertes 14,3%, y no hubo ningun caso de abandono. Entre los casos, 60% fueron diagnosticados en el hospital. Los datos reflejan la necesidad de tener una mayor articulacion entre el Programa Municipal de Control de la Tuberculosis y el Programa Municipal de DST/SIDA.

A dimensão epidemiológica da coinfecção TB/HIV

This study aimed to analyze the epidemiological indicators of TB/HIV co-infection in São José do Rio Preto, São Paulo, Brazil from 1998 to 2006. Data of new TB cases that initiated treatment between January 1998 and December 2006 were obtained from the TB Notification System (EPI-TB) and 306 cases were reported. The incidence rate was 5.1/100,000 inhabitants in 2006. Most cases were men (72.5%) with ages ranging between 20 and 59 years (96.4 %). The majority (51%) had incomplete primary education. Pulmonary TB was the most common type (52.9%) and 46.1% of the patients received supervised treatment. In 2006, the cure rate was 33.3%, 14.3% death rate and no patient abandoned the treatment. Diagnosis occurred at the hospital in 60% of the cases. Results show the need of improved coordination between the citys Tuberculosis Control Program and the Sexually Transmitted Diseases and HIV Program.El objetivo fue analizar los indicadores epidemiologicos de la coinfeccion tuberculosis y virus de la inmunodeficiencia humana (TB/VIH) en el municipio de Sao Jose del Rio Preto, Sao Paulo, Brasil, en el periodo de 1.998 a 2.006. Los datos de los casos nuevos de TB, que iniciaron el tratamiento entre enero de 1.998 y diciembre de 2.006, fueron recolectados del Sistema de Notificacion de la TB (EPI-TB). Fueron notificados 306 casos. El coeficiente de incidencia fue de 5,1/100.000 hab, en 2006. Hubo predominio de personas del sexo masculino (72,5%), en el intervalo de edad de 20 a 59 anos (96,4%). La mayoria (51%) no poseia la ensenanza fundamental completa. La forma clinica pulmonar fue relevante (52,9%) y recibieron tratamiento supervisado 46,1% enfermos. En 2.006, la tasa de cura fue de 33,3%, de muertes 14,3%, y no hubo ningun caso de abandono. Entre los casos, 60% fueron diagnosticados en el hospital. Los datos reflejan la necesidad de tener una mayor articulacion entre el Programa Municipal de Control de la Tuberculosis y el Programa Municipal de DST/SIDA.

Current epidemiological aspects of tuberculosis and the impact of the DOTS strategy in disease control

O artigo tem por objetivo apresentar a situacao atual da tuberculose e o impacto da estrategia DOTS (Directly Observed Treatment Short Course) nos Programas Nacionais de Controle da doenca no mundo, na America Latina e no Brasil. Os dados evidenciam tendencia de declinio lento da doenca no mundo (1%), em 2003. No Brasil, os dados indicam tendencia descendente constante na incidencia, com queda aproximada de 3% ao ano. A estrategia DOTS tem sido recomendada a todos os paises. O Brasil necessita melhorar a vigilância da doenca, principalmente em relacao a confirmacao da conversao da baciloscopia ao termino do tratamento.This article aims to present the current situation of tuberculosis and how the DOTS (Directly Observed Treatment Short Course) strategy has impacted national tuberculosis control programs worldwide, in Latin America and in Brazil. Data reveal a tendency towards a slow decline in disease rates (1%) around the world in 2003. In Brazil, data indicate a constant downward tendency of approximately 3% a year in incidence levels. The DOTS strategy has been recommended to all countries. Brazil needs to improve its tuberculosis surveillance efforts, particularly in terms of confirming negative sputum smear results at the end of treatment.

Aspectos epidemiológicos atuais da tuberculose e o impacto da estratégia DOTS no controle da doença

O artigo tem por objetivo apresentar a situacao atual da tuberculose e o impacto da estrategia DOTS (Directly Observed Treatment Short Course) nos Programas Nacionais de Controle da doenca no mundo, na America Latina e no Brasil. Os dados evidenciam tendencia de declinio lento da doenca no mundo (1%), em 2003. No Brasil, os dados indicam tendencia descendente constante na incidencia, com queda aproximada de 3% ao ano. A estrategia DOTS tem sido recomendada a todos os paises. O Brasil necessita melhorar a vigilância da doenca, principalmente em relacao a confirmacao da conversao da baciloscopia ao termino do tratamento.This article aims to present the current situation of tuberculosis and how the DOTS (Directly Observed Treatment Short Course) strategy has impacted national tuberculosis control programs worldwide, in Latin America and in Brazil. Data reveal a tendency towards a slow decline in disease rates (1%) around the world in 2003. In Brazil, data indicate a constant downward tendency of approximately 3% a year in incidence levels. The DOTS strategy has been recommended to all countries. Brazil needs to improve its tuberculosis surveillance efforts, particularly in terms of confirming negative sputum smear results at the end of treatment.

Tuberculosis contact control in Brazil: a liberature review (1984-2004)

Este estudo tem como proposito identificar as medidas de controle de comunicantes de tuberculose (TB) no Brasil, inseridos nos planos de controle da TB. Trata-se de artigo de revisao da literatura referente ao periodo de 1984 a 2004, que tem como fonte os manuais de controle da TB do Ministerio da Saude e da Secretaria de Estado da Saude de Sao Paulo, e artigos localizados nas bases de dados Medline e Lilacs. RESULTADOS: identificou-se lacuna na normatizacao das medidas de controle durante a decada de 1984 a 1994. Conclui-se que faltou aos profissionais de saude incorporar as acoes de controle e prevencao de TB na perspectiva da vigilância em saude e monitoramento sistematico.This study aims to review plans for tuberculosis control through the analysis of measures for tuberculosis contact tracing in Brazil from 1984 to 2004. This article presents a literature review on tuberculosis control published in manuals of the Ministry of Health and the State Department of Health of Sao Paulo, and in Medline and Lilacs databases. There was a gap in the standardization of control measures in the decade from 1984 to 1994. It was concluded that health professionals need to incorporate TB control and prevention actions from the perspective of health surveillance and systematic monitoring.