Health-service performance of TB treatment for indigenous and non-indigenous populations in Brazil: a cross-sectional study

BMC Health Services Research

Julio Croda¹  Natália Daiane Garoni Martins¹  Marcella Paranhos Rodrigues¹  Giovana de Castro Oliveira¹  Aline Mara da Silva Alves¹  Everton Ferreira Lemos¹ 

[1] Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Rodovia Dourados – Itaúm. Km 12, Dourados, Mato Grosso do Sul 79804-970, Brazil

关键词: Health services;    Control;    Prevention;    Indigenous;    Tuberculosis;   

Others  :  1130880
DOI  :  10.1186/1472-6963-14-237

 received in 2013-01-25, accepted in 2014-05-07,  发布年份 2014

【 摘 要 】

Background

Health-service evaluation studies are fundamental for proposing interventions and ensuring improvements in healthcare quality. The present study assesses the performance of health services for indigenous and non-indigenous populations with regard to tuberculosis (TB) control.

Methods

Interviews with TB patients who underwent treatment between 2009 and 2011 were conducted using the Primary Care Assessment Tool adapted for TB care in Brazil.

Results

Primary healthcare (PHC) was the first treatment for most patients at symptom onset, and the diagnoses were typically performed by specialized services. Many patients experienced delayed TB diagnoses that required more than three medical appointments (51% and 47% for indigenous and non-indigenous populations, respectively). Indigenous people received social support, such as basic-needs grocery packages (2.19 ± 1.63 vs. 1.13 ± 0.49 for non-indigenous people, p < 0.01) and home visits from health professionals, with an emphasis on the performance of directly observed treatment strategies (DOT; 4.57 ± 0.89 vs. 1.68 ± 1.04 for non-indigenous people, p < 0.01).

Conclusions

Regardless of the differences between indigenous and non-indigenous populations, the time needed to receive a TB diagnosis was unsatisfactory for both groups. Furthermore, DOT must be performed with better coverage among non-indigenous patients.

【 授权许可】

   
2014 Lemos et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]WHO: World Health Organization: Global tuberculosis control. WHO report 2011. In Book World Health Organization. Global tuberculosis control. WHO report. Geneva: Library Cataloguing-in-Publication;
• [2]Hernandez Sarmiento JM, Davila Osorio VL, Martinez Sanchez LM, Restrepo Serna L, Grajales Ospina DC, Toro Montoya AE, Arango Urrea V, Vargas Grisales N, Estrada Gomez M, Lopera Valle JS, García Gil JJ, Restrepo L, Mejía G, Zapata E, Gómez V, Lopera D, Domicó Domicó JL, Robledo J: Tuberculosis in indigenous communities of Antioquia, Colombia: epidemiology and beliefs. J Immigr Minor Health 2013, 15(1):10-16.
• [3]Melo TEMP, Resendes APC, Souza-Santos R, Basta PC: Distribuição espacial e temporal da tuberculose em indígenas e não indígenas de Rondônia, Amazônia Ocidental, Brasil. [Spatial and temporal distribution of tuberculosis in indigenous and non-indigenous of Rondônia State, Western Amazon, Brazil]. Cad Saude Publica 2012, 28:267-280.
• [4]Culqui DR, Trujillo OV, Cueva N, Aylas R, Salaverry O, Bonilla C: Tuberculose na população indígena do Peru 2008. Rev Peru Med Exp Salud Publica 2010, 27:8-15.
• [5]Romero-Sandoval NC, Flores-Carrera DE, Sánchez-Pérez HJ, Pérez-Sánchez I, Mateo MM: Tuberculose pulmonar em uma comunidade indígena nas montanhas do Equador. Int J Tuberc Lung Dis 2007, 11:550-555.
• [6]Sanchez-Perez HJ, Diaz-Vazquez A, Najera-Ortiz JC, Balandrano S, Martin-Mateo M: Multidrug-resistant pulmonary tuberculosis in Los Altos, Selva and Norte regions, Chiapas, Mexico. Int J Tuberc Lung Dis 2010, 14:34-39.
• [7]Maes M, Kremer K, van Soolingen D, Takiff H, de Waard JH: 24-locus MIRU-VNTR genotyping is a useful tool to study the molecular epidemiology of tuberculosis among Warao Amerindians in Venezuela. Tuberculosis (Edinb) 2008, 88:490-494.
• [8]Ruffino-Netto A: Programa de Controle da Tuberculose no Brasil: situação atual e novas perspectivas. Informe Epidemiológico do Sus 2001, 10:129-138.
• [9]Brasil. Ministério da Saúde. Secretaria Executiva. Departamento de Apoio à descentralização. Coordenação Geral de Apoio à gestão: Descentralização: Diretrizes operacionais dos países pela vida, em defesa do SUS e de gestão. Brasília, DF: Série A. Normas e Manuais Técnicos; 2006.
• [10]Brasil Ministério da Saúde Secretaria de Vigilância em Saúde Departamento de Vigilância Epidemiológica: Manual de recomendações para o controle da tuberculose no Brasil/Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância Epidemiológica. Brasília: Ministério da Saúde; 2011.
• [11]Heufemann NEC, Maria Jacirema Ferreira Gonçalves JFC, Garnelo ML: Avaliação do programa de controle da tuberculose em cenário Amazônico: desafios em Coari [Evaluation of a tuberculosis control program in an Amazonian scenario: challenges in Coari]. Acta Amaz 2013, 43(1):33-42.
• [12]Brunello ME, de Paula Andrade RL, Monroe AA, Arakawa T, Magnabosco GT, Orfão NH, Scatena LM, Villa TC: Tuberculosis diagnostic pathway in a municipality in south-eastern Brazil. Int J Tuberc Lung Dis 2013, 17(10 Suppl 1):41-47.
• [13]Oliveira MF, Arcêncio RA, Ruffino-Netto A, Scatena LM, Palha PF, Villa TCS: A porta de entrada para o diagnóstico da tuberculose no sistema de saúde de Ribeirão Preto/SP. [The front door of the Ribeirão Preto Health System for diagnosing tuberculosis]. Rev Esc Enferm USP 2011, 45:898-904.
• [14]Villa TC, Ponce MA, Wysocki AD, Andrade RL, Arakawa T, Scatolin BE, Brunello ME, Beraldo AA, Scatena LM, Monroe AA, Sobrinho RA, de Sá LD, Nogueira JDE A, Assis MM, Cardozo-Gonzales RI, Palha PF: O diagnóstico precoce da tuberculose nos serviços de saúde em diferentes regiões do Brasil [Early diagnosis of tuberculosis in the health services in different regions of Brazil]. Rev Lat Am Enfermagem 2013, 21:190-198.
• [15]Augusto CJ, Carvalho Wda S, Gonçalves AD, Ceccato M, de Miranda SS: Características da tuberculose no estado de Minas Gerais, Brasil: 2002–2009. [Characteristics of tuberculosis in the state of Minas Gerais, Brazil: 2002–2009]. J Bras Pneumol 2013, 39(3):357-364.
• [16]Donaldson AE: Is operational research true science? What should it be used for? Public Health Action 2013, 3(3):189.
• [17]Soares CE, Pacheco AG, Mello FC, Durovni B, Chaisson RE, Cavalcante SC: Improvements in treatment success rates with directly observed therapy in Rio de Janeiro City. Int J Tuberc Lung Dis 2006, 10(6):690-695.
• [18]Ponce MA, Wysocki AD, Scatolin BE, Andrade RL, Arakawa T, Ruffino Netto A, Monroe AA, Scatena LM, Vendramini SH, Villa TC: O diagnóstico de tuberculose e avaliação do primeiro serviço de saúde utilizado por pacientes em São José do desempenho do Rio Preto, Estado de São Paulo, Brasil. [Tuberculosis diagnosis and performance assessment of the first health service used by patients in São José do Rio Preto, São Paulo State, Brazil]. Cad Saude Publica 2013, 29(5):945-954.
• [19]Beraldo AA, Arakawa T, Pinto ES, Andrade RL, Wysocki AD, da Silva Sobrinho RA, Scatolin BE, Orfão NH, Ponce MA, Monroe AA, Scatena LM, Villa TC: Atraso na busca por serviços de saúde para o diagnóstico da tuberculose em Ribeirão Preto, São Paulo. Cien Saude Colet 2012, 17(11):3079-3086.
• [20]Croda MG, Trajber Z, Lima Rda C, Croda J: Tuberculosis control in a highly endemic indigenous community in Brazil. Trans R Soc Trop Med Hyg 2012, 106:223-229.
• [21]Marques AMCC, Rivaldo V: 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. [Assisted treatment and tuberculosis cure and treatment dropout rates in the Guaraní-Kaiwá Indian nation in the municipality of Dourados, Mato Grosso do Sul, Brazil]. Cad Saude Publica 2003, 19:1405-1411.
• [22]Costa DC: Política indiginista e assistência à saúde: Noel Nutels e o serviço de Unidades Sanitárias Aéreas. Cad Saude Publica 1987, 4:388-401.
• [23]Conde MB, Melo FAF, Marques AMC, Cardoso NC, Pinheiro VGF, Dalcin PTR, Machado Junior A, Lemos ACM, Netto AR, Durovni B, Sant’Anna CC, Lima D, Capone D, Barreira D, Matos ED, Mello FCQ, David FC, Marsico G, Afiune JB, Silva JRL, Jamal LF, Telles MAS, Hirata MH, Dalcomo MP, Rabahi MF, Cailleaux-Cesar M, Palaci M, Morrone N, Guerra RL, Dietze R, et al.: III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia. J Bras Pneumol 2009, 35:1018-1048.
• [24]Macinko JAC: Validation of a Methodology for Rapid Assessment of Organizational Characteristics and Performance of Primary Care Services of the Unified Health System (SUS) at a Local Level. Brasília: Organização Pan-Americana da Saúde; 2006.
• [25]Villa TCS, Ruffino-Netto A: Questionário para avaliação de desempenho de serviços de atenção básica no controle da TB no Brasil. [Questionnaire for evaluating the performance of primary care services for TB control in Brazil]. J Bras Pneumol 2009, 35:610-612.
• [26]Starfield B: Atenção primária - equilíbrio entre necessidades de saúde, serviços e tecnologia. Brasília: UNESCO, Ministério da Saúde; 2002.
• [27]Bland JM, Altman DG: Statistics notes: Cronbach’s alpha. BMJ 1997, 314:572.
• [28]Palha PF, da Silva LM, Wysocki AD, Andrade RL, Protti ST, Scatena LM, Villa TC: [Access to healthcare services for tuberculosis: analysis of patient satisfaction]. Rev Esc Enferm USP 2012, 46:342-348.
• [29]Silva-Sobrinho RA, Andrade RLP, Ponce MAZ, Wysocki AD, Brunello ME, Scatena LM, Ruffino-Netto A, Villa TCS: Retardo no diagnóstico da tuberculose em município da tríplice fronteira Brasil, Paraguai e Argentina. [Delays in the diagnosis of tuberculosis in a town at the triple border of Brazil, Paraguay, and Argentina]. Rev Panam Salud Publica 2012, 31:461-468.
• [30]Basnet R, Hinderaker SG, Enarson D, Malla P, Morkve O: Delay in the diagnosis of tuberculosis in Nepal. BMC Public Health 2009, 9:236.
• [31]Diez M, Bleda MJ, Alcaide J, Castells C, Cardenal JI, Dominguez A, Gayoso P, Guitierrez G, Huerta C, Lopez MJ, Moreno T, Muñoz F, García-Fulgueiras A, Picó M, Pozo F, Quirós JR, Robles F, Sánchez JM, Vanaclocha H, Vega T, Multicentre Project for Tuberculosis Research (MPTR) Study Group: Determinants of health system delay among confirmed tuberculosis cases in Spain. Eur J Public Health 2005, 15:343-349.
• [32]Demissie M, Lindtjorn B, Berhane Y: Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health 2002, 2:23.
• [33]Menezes AMB, Costa JD, Gonçalves H, Morris S, Menezes M, Lemos S, Oliveira RK, Palma E: Incidência e fatores de risco para tuberculose em Pelotas, uma cidade do Sul do Brasil. [Incidence and risk factors for tuberculosis in Pelotas, a city in the south of Brazil]. Rev Bras Epidemiol 1998, 1:50-60.
• [34]Welch JR, Coimbra CE Jr: Perspectivas culturais sobre transmissão e tratamento da tuberculose entre os Xavánte de Mato Grosso, Brasil.[Culturais perspectivas de tuberculose de transmissão e de tratamento entre os Xavante de Mato Grosso State, Brasil]. Rev Esc Enferm USP 2011, 27(1):190-194.
• [35]Amaral AS, Tamaki EM, Sales CM, Renovato RD: Avaliação da descentralização do programa de controle da tuberculose do nível secundário para o nível primário do sistema de saúde de Dourados-MS. [Evaluation of the Decentralization of the Tuberculosis Control Program from Secondary to Primary Level in the Health System of Dourados-MS]. Saúde e Sociedade 2010, 19:794-802.
• [36]WHO: World Health Organization: Tuberculosis control: surveillance, planning, financing: WHO Report 1999. Geneva;
• [37]Buchér JB, Thomas KM, Guzman D, Riley E, Dela Cruz N, Bangsberg DR: Community-based rapid HIV testing in homeless and marginally housed adults in San Francisco. HIV Med 2007, 8(1):28-31.
• [38]Pronyk PM, Kim JC, Makhubele MB, Hargreaves JR, Mohlala R, Hausler HP: Introduction of voluntary counseling and rapid testing for HIV in rural South Africa: from theory to practice. AIDS Care 2002, 14(6):859-865.
• [39]Bowles KE, Clark HA, Tai E, Sullivan PS, Song B, Tsang J, Dietz CA, Mir J, Mares-DelGrasso A, Calhoun C, Aguirre D, Emerson C, Heffelfinger JD: Implementing rapid HIV testing in outreach and community settings: results from an advancing HIV prevention demonstration project conducted in seven U.S. cities. Public Health Rep 2008, 123(Suppl 3):78-85.
• [40]Buchillet D: Algumas reflexões sobre tuberculose, cultura e antropologia. Anuário de Antropologia, Rio de Janeiro: IRD/ISA; 2000.
• [41]Athias R, Machado M: A Saúde indígena no processo dos Distritos Sanitários: temas críticos e propostas para um diálogo interdisciplinar. Cad Saude Publica 2001, 17(2):425-431.
• [42]Buchillet D, Gazin P: A situação da tuberculose na população indígena do alto rio negro (Estado do Amazonas, Brasil). Cad Saude Publica 1998, 14(2):181-185.