[Magnitude of social determinants in the risk of death from tuberculosis in Central-west Brazil]

Social protection in areas vulnerable to tuberculosis: a mixed methods study in São Luís, Maranhão

OBJECTIVES

to analyze the risk areas for tuberculosis and the influences of social protection on the development of treatment for the disease in the municipality of São Luís, Maranhão.

METHODS

this is explanatory sequential mixed method research. In the quantitative phase, the data were obtained from the Notifiable Diseases Information System from 2010 to 2019, with georeferencing being carried out to identify areas vulnerable to tuberculosis. In the qualitative phase, semi-structured interviews were carried out with individuals who received social benefits.

RESULTS

7,381 cases were geocoded, and, from the purely spatial scanning analysis, it was possible to identify 13 spatial clusters of risk. As for the interviews, there was a positive relationship between patient improvement and receiving benefits.

CONCLUSIONS

geographic space and social determinants are relevant for reorienting monitoring actions for the conditions that generate the health-disease process.

Factors Associated with Mortality with Tuberculosis Diagnosis in Indigenous Populations in Peru 2015-2019

OBJECTIVE

To identify factors associated with mortality in indigenous populations diagnosed with tuberculosis in Peru, 2015-2019.

METHODS

We conducted a nested case-control study in a retrospective cohort using the registry of indigenous peoples of the National Health Strategy for TB Prevention and Control of the Ministry of Health of Peru. A descriptive analysis was performed, and then bivariate and multivariate logistic regression was used to evaluate associations between the variables and the outcome (alive-deceased). The results are shown as OR with their respective 95% confidence intervals.

RESULTS

The mortality rate of the total indigenous population of Peru was 1.75 deaths per 100,000 indigenous people diagnosed with TB. The community of Kukama Kukamiria-Yagua reported 505 (28.48%) individuals, followed by the Shipibo-Konibo community with 385. The final logistic model showed that indigenous males (OR = 1.93; 95% CI: 1.001-3.7) with a history of HIV prior to TB (OR = 16.7; 95% CI: 4.7-58.7), and indigenous people in old age (OR = 2.95; 95% CI: 1.5-5.7) were factors associated with a greater chance of dying from TB.

CONCLUSIONS

It is important to reorient health services among indigenous populations, especially those related to improving a timely diagnosis and early treatment of TB/HIV co-infection, to ensure comprehensive care for this population considering that they are vulnerable groups.

Mortality inequalities measured by socioeconomic indicators in Brazil: a scoping review

OBJECTIVE

Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil.

METHODS

This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations.

RESULTS

Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation.

CONCLUSIONS

Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.

Identifying Hotspots of People Diagnosed of Tuberculosis with Addiction to Alcohol, Tobacco, and Other Drugs through a Geospatial Intelligence Application in Communities from Southern Brazil

(1) Background: tuberculosis (TB) is considered one of the leading causes of death worldwide by a single infectious agent. This study aimed to identify hotspots of people diagnosed with tuberculosis and abusive use of alcohol, tobacco, and other drugs in communities through a geospatial intelligence application; (2) Methods: an ecological study with a spatio-temporal approach. We considered tuberculosis cases diagnosed and registered in the Notifiable Diseases Information System, which presented information on alcoholism, smoking, and drug abuse. Spatial Variations in Temporal Trends (SVTT) and scan statistics were applied for the identification of Hotspots; (3) Results: between the study period, about 29,499 cases of tuberculosis were reported. When we applied the SVTT for alcoholism, three Hotspots were detected, one of which was protective (RR: 0.08–CI95%: 0.02–0.32) and two at risk (RR: 1.42–CI95%: 1.11–1.73; RR: 1.39–CI95%: 1.28–1.50). Regarding smoking, two risk clusters were identified (RR: 1.15–CI95%: 1.01–1.30; RR: 1.68–CI95%: 1.54–1.83). For other drugs, a risk cluster was found (RR: 1.13–CI95%: 0.99–1.29) and two protections (RR: 0.70–CI95%: 0.63–0.77; RR: 0.76–CI95%: 0.65–0.89); (4) Conclusion: it was evidenced that in the communities being studied, there exists a problem of TB with drug addiction. The disordered use of these substances may harm a person’s brain and behavior and lead to an inability to continue their treatment, putting the community at further risk for TB.

Impact of social protection programs on adults diagnosed with Tuberculosis: systematic review

OBJECTIVES

to analyze the impact of social protection programs on adults diagnosed with Tuberculosis.

METHODS

systematic review conducted by PRISMA, with registration PROSPERO CRD42019130884. The studies were identified in the VHL, PubMed, Scielo, CINAHL and Scopus databases, using the descriptors "Social Protection" and "Tuberculosis", in combination with keywords combined with Boolean operators AND and OR. Observational and interventional studies published until October 23, 2019, in Portuguese, English and Spanish, were included.

RESULTS

social protection programs improve the treatment of tuberculosis, cure rates, adherence to treatment, the provision of services for the control of TB and reduce poverty.

CONCLUSIONS

social protection programs have a positive impact on the treatment and control of people diagnosed with Tuberculosis.

Early identification of individuals at risk for loss to follow-up of tuberculosis treatment: A generalised hierarchical analysis

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.

Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key

The goal of reducing tuberculosis (TB) mortality in the END TB Strategy can be achieved if TB deaths are considered predictable and preventable. This will require programs to examine and address some key gaps in the understanding of the distribution and determinants of TB mortality and the current model of assessment and care in high burden countries.

Most deaths in high-burden countries occur in the first eight weeks of treatment and in those belonging to the age group of 15–49 years, living in poverty, with HIV infection and/or low body mass index (BMI). Deaths result from extensive disease, comorbidities like advanced HIV disease complicated with other infections (bacterial, fungal, bloodstream), and moderate-severe undernutrition. Most early deaths in patients with TB, even with TB-HIV co-infection, are due to TB itself.

Comprehensive assessment and clinical care are a prerequisite of patient-centered care. Simple independent predictors of death like unstable vital signs, BMI, mid-upper arm circumference, or inability to stand or walk unaided can be used by programs for risk assessment. Programs need to define criteria for referral for inpatient care, address the paucity of hospital beds and develop and implement guidelines for the clinical management of seriously ill patients with TB, advanced HIV disease and severe undernutrition as co-morbidities. Programs should also consider notification and audit of all TB deaths, similar to audit of maternal deaths, and address the issues in delays in diagnosis, treatment, and quality of care.

Quality of tuberculosis information systems after record linkage

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.