Tuberculosis in Amazonian municipalities of the Brazil-Colombia-Peru-Venezuela border: epidemiological situation and risk factors associated with treatment default/Tuberculose nos municipios amazonenses da fronteira Brasil-Colombia-Peru-Venezuela: situacao epidemiologica e fatores associados ao abandono

• Published in: Revista panamericana de salud pública Vol. 34; no. 5; p. 321
• Main Authors: Basta, Paulo Cesar, Levino, Antonio, Belo, Elsia Nascimento, Orellana, Jesem Douglas Yamall
• Format: Journal Article
• Language: Spanish
• Published: Pan American Health Organization 01.11.2013
• Subjects: Venezuela; Colombia; Brasil; Perú
• ISSN: 1020-4989

Objective. To describe the epidemiological situation and the incidence of tuberculosis and to investigate the factors associated with treatment default in the Amazonian municipalities located in the northern Brazilian international border. Methods. This retrospective study employed sociodemographic, clinical, and epidemiological tuberculosis data recorded in the Brazilian Notifiable Diseases Information System (SINAN) between 2001 and 2010. Logistic regression was used to identify factors associated with treatment default. Results. Tuberculosis affected mostly indigenous peoples (51.9%), males (57.9%), and people aged 25-44 years (31.4%). The predominant clinical presentation was pulmonary (89.7%), yet in 24.5% of the cases the patients did not undergo sputum smear microscopy, and only half received supervised treatment. In 70.0% of the cases notified, patients were discharged as cured. Treatment default was recorded in 10.0% of the patients. Of all deaths, 4.1% were by tuberculosis and other causes, and 1.7% by multidrug-resistant tuberculosis. The average incidence by race/color was greater among indigenous peoples, ranging from 202.3/100 000 in 2001 to 65.6/100 000 in 2010. Treatment default was associated with failure to perform the follow-up smear at the second, fourth, and sixth months (OR = 11.9, 95%CI: 7.4-19.0); with resuming treatment after default (OR = 3.0, 95%CI: 1.5-5.9); and with living in specific subregions, particularly the Alto Solimoes region (OR = 6.7, 95%CI: 4.6-9.8). Conclusions. The present results show a high incidence of tuberculosis in the Amazon portion of the northern Brazilian international border, especially among indigenous peoples. Considering the socio-cultural specificities of these populations and the poor tuberculosis control in this area, the authors of the study conclude that the integration of different national health systems is both necessary and urgent. Key words Tuberculosis; epidemiology; border areas; indigenous population; patient dropouts; Brazil. Descrever a situacao epidemiologica da tuberculose, mapear a sua incidencia e investigar fatores associados ao abandono do tratamento nos municipios do Amazonas que integram o Arco Norte da faixa de fronteira internacional do Brasil. Metodos. Este estudo retrospectivo analisou caracteristicas sociodemograficas e clinicoepidemiologicas dos casos de tuberculose notificados no Sistema de Informacao de Agravos de Notificacao (SINAN) entre 2001 e 2010. Utilizou-se regressao logistica para identificacao de fatores associados ao abandono do tratamento. Resultados. Houve predominio de casos em indigenas (51,9%), em homens (57,9%) e em individuos na faixa de 25 a 44 anos (31,4%) de idade. A forma clinica predominante foi a pulmonar (89,7%). Mesmo assim, 24,5% dos casos nao realizaram baciloscopia de escarro, e somente metade realizou tratamento supervisionado. A alta por cura representou 70,0% das notificacoes, e o abandono, 10,0%. Obitos por tuberculose e por outras causas somaram 4,1%, e a tuberculose multirresistente somou 1,7%. A incidencia media segundo raca/cor revelou-se maior entre os indigenas, variando de 202,3/100 000 em 2001 a 65,6/100 000 em 2010. O abandono do tratamento esteve associado a nao realizacao das baciloscopias de acompanhamento no segundo, quarto e sexto mes (OR = 11,9; IC95%: 7,4 a 19,0); ao reingresso pos-abandono (OR = 3,0; IC95%: 1,5 a 5,9); e a residencia em algumas sub-regioes, sobretudo no Alto Solimoes (OR = 6,7; IC95%: 4,6 a 9,8). Conclusoes. Na porcao amazonense do Arco Norte da fronteira internacional do Brasil, predominam elevadas taxas de incidencia por tuberculose, sobretudo em indigenas. As especificidades socioculturais dessas populacoes e o precario controle da tuberculose na regiao determinam a necessidade urgente de integrar os diferentes sistemas nacionais de saude. Palavras-chave Tuberculose; epidemiologia; areas de fronteira; populacao indigena; pacientes desistentes do tratamento; Brasil.