Contacts of individuals with tuberculosis: analysis from the perspective of vulnerability

Introdução: A tuberculose (TB) ainda se configura como epidemia global. A investigação de TB, ativa ou latente, entre os contatos de pessoas diagnosticadas com a doença e dos indivíduos que possuem maior susceptibilidade em desenvolvê-la, assim como a oferta de tratamento preventivo são componentes da nova estratégia para a eliminação da tuberculose até 2050. Objetivo: Analisar as vulnerabilidades de contatos de indivíduos que foram notificados com a tuberculose no município de Campina Grande/PB e suas implicações no controle da enfermidade. Método: Estudo descritivo-exploratório, com recorte transversal, de abordagem quanti-qualitativa. O conceito de Vulnerabilidade constituiu o referencial teórico. Os participantes no estudo foram 23 responsáveis por 46 contatos, com até 18 anos, das pessoas que foram notificadas com formas transmissíveis da TB no ano de 2016, além de 48 profissionais de saúde dos serviços de saúde que assistiram a pessoa com TB durante seu tratamento. A coleta de dados foi realizada por meio de análise documental de dados em prontuários, entrevista semiestruturada e registros de observação em campo. Foi utilizado um roteiro específico para cada grupo de participantes. A análise dos dados quantitativos compreendeu resultados descritivos. Para a análise dos depoimentos dos participantes foi realizada análise do discurso. Resultados: A maioria dos contatos possuía idade entre 6 e 14 anos (47,8%: 22), porém, também se verificou crianças com idade até 5 anos (37,0%: 17); 65,2% (30) eram filhos do caso índice. O domicílio foi o suposto local onde ocorreu a exposição dos contatos. Foram convocados para consulta, 29 (63%) contatos, dos quais 75,9% (22) foram levados pelos responsáveis. Dos contatos que fizeram algum exame, quatro foram diagnosticados com infecção latente e foram indicados para a quimioprofilaxia, mas apenas dois completaram o esquema preventivo. Dos depoimentos dos responsáveis pelos contatos emergiram duas categorias analíticas: Processo Saúde-Doença-Cuidado e Assistência; dos depoimentos dos profissionais emergiu a categoria Assistência. Da análise dos depoimentos foram encontrados elementos de vulnerabilidade individual, social e programática, dentre os quais, ressaltam-se: escasso conhecimento sobre a doença, ausência de informações repassadas pelos profissionais da saúde, e/ou orientações incorretas e inadequadas, o que compromete o entendimento sobre a importância da investigação dos contatos, e implica em atitudes inadequadas na prevenção da transmissão da doença aos contatos. A precariedade das condições sociais, concretizadas, dentre outros, pelo baixo poder aquisitivo, implicou, em alguns casos, na ausência às consultas, e na não realização de exames para o diagnóstico, também justificadas pela ausência de sintomatologia nos contatos, medo em relação a certos procedimentos (teste tuberculínico), falta de tempo para ir ao serviço, dificuldade de acesso aos serviços, escassez de teste tuberculínico e demora no agendamento de exames. A participação da equipe de saúde é fundamental para o controle dos contatos, com especial relevância para o Agente Comunitário de Saúde. Conclusão: Elementos de vulnerabilidade nas dimensões individual, social e programática representam limitações para o controle da tuberculose no Município e devem ser alvo de intervenções no âmbito das políticas públicas de saúde do Município, e requerem interação com a intersetorialidade.Introduction: Tuberculosis (TB) remains as a global epidemic. Searching TB patients contacts that could present active or latent TB and those most likely to develop it, as well as providing preventive treatment, are components of the new TB Elimination Strategy by 2050. Objective: To analyze vulnerabilities of TB patients contacts in the city of Campina Grande / PB and its implications for disease control. Method: Descriptive exploratory cross-sectional study with a quantitative and qualitative approach. The concept of Vulnerability constituted the theoretical framework. Study participants were 23 responsible for 46 contacts, aged up to 18 years, of people who were notified of transmissible forms of TB in 2016, and 48 health care professionals who assisted the person with TB during their treatment. Data collection was performed through documentary analysis of medical records, semi-structured interviews and field observation records. A specific questionnaire was used for each group of participants. The analysis of quantitative data included descriptive results. For the analysis of the participants\' statements, speech analysis was performed. Results: Most contacts were aged between six and 14 years (47.8%: 22), but there were also children aged up to five years (37.0%: 17); 65.2% (30) were children of the index case. The domicile was the supposed place where contact exposure occurred. 29 (63%) contacts were called for consultation, of which 75.9% (22) were taken by their guardians. Of the contacts who underwent some screening, four were diagnosed with latent infection and were referred for chemoprophylaxis, but only two completed the preventive regimen. From the statements of those responsible for contacts emerged two analytical categories: Health-Disease-Care and Care Process; from the testimonies of professionals emerged the category Assistance. From the analysis of the testimonies, elements of individual, social and programmatic vulnerability were found, among which the following stand out: poor knowledge about the disease, lack of information provided by health professionals, and / or incorrect and inadequate guidelines, which compromises the understanding about the importance of contact investigation, and implies in inappropriate attitudes in preventing the transmission of the disease to contacts. The precariousness of social conditions, materialized, among others, by the low purchasing power, implied, in some cases, in the absence to medical appointments, and the lack of tests for diagnosis, also justified by the absence of symptomatology in contacts, fear regarding certain procedures (tuberculin skin test), lack of time to go to the service, difficulty in accessing services, shortage of tuberculin skin test, and delay in scheduling exams. The participation of the health team is fundamental for contact control, with special relevance for the Community Health Agent. Conclusion: Elements of vulnerability in the individual, social and programmatic dimensions represent limitations for the control of tuberculosis in the municipality and should be the target of interventions within the public health policies of the municipality, and require interaction with inter-sectoriality

Tuberculosis desde la perspectiva del hombre y de la mujer*

Objective: To analyze aspects related to the experience of tuberculosis from the perspective of men and women with tuberculosis. Method: Qualiquantitative cross-sectional study. Patients with tuberculosis in the city of Campina Grande-PB were interviewed through a semi-structured questionnaire between September/2017 and January/2018. Discourse Analysis and Chi-Square test were performed. Results: Sixty-three subjects were interviewed, of which 34 (54.0%) were men. There was an association of the category gender with level of education (p = 0.004), work activity (p = 0.023), time spent on activities outside the home (p = 0.013), and time spent on activities at home (p = 0.001). The analysis of the statements specially revealed that men perceive their role as the family’s main provider and the women with a social role of caregiver, often postponing the search for a health care due to fear of not being able to perform this role in the family and/or in society. Conclusion: The weakness caused by the disease and the long duration of treatment changed the interviewees’ routine, causing suffering and frustration, with consequences in the performance of social roles within the family and in society, constituting a barrier to adherence to tuberculosis treatment.Objetivo: Analisar aspectos relacionados à vivência da tuberculose na perspectiva de homens e mulheres portadores de tuberculose. Método: Estudo transversal qualiquantitativo. Entrevistou-se, por meio de questionário semiestruturado, pacientes com tuberculose no município de Campina Grande-PB, entre setembro/2017 e janeiro/2018. Realizou-se Análise de Discurso e teste Qui-Quadrado. Resultados: Entrevistaram-se 63 sujeitos, sendo 34 (54,0%) do sexo masculino. Evidenciou-se associação da categoria gênero com escolaridade (p = 0,004), atividade de trabalho (p = 0,023), tempo despendido em atividades fora do domicílio (p = 0,013) e tempo despendido em atividades no domicílio (p = 0,001). A análise dos depoimentos revelou, principalmente, que o homem percebe seu papel como provedor principal da família e, a mulher, no papel social de cuidadora, adiando muitas vezes a busca por um serviço de saúde com receio de não conseguir exercer esse papel na família e/ou na sociedade. Conclusão A debilidade causada pela doença e a longa duração do tratamento mudaram a rotina dos entrevistados, causando sofrimento e frustração, com decorrências no desempenho dos papéis sociais no interior da família e na sociedade, constituindo-se em barreira na adesão ao tratamento da tuberculose.Objectivo: Analizar aspectos relacionados con la experiencia de la tuberculosis desde la perspectiva de hombres y mujeres con tuberculosis. Método: Estudio transversal cualicuantitativo. Fueron entrevistados pacientes con tuberculosis del municipio de Campina Grande-PB, por medio de cuestionario semiestructurado, entre septiembre/2017 y enero/2018. Se realizaron Análisis del Discurso y Chi-Cuadrado. Resultados: Sesenta y três sujetos fueron entrevistados, de los cuales 34 (el 54,0%) eran del sexo masculino. Hubo asociación de la categoria género con escolaridad (p = 0,004), actividad laboral (p = 0,023), tiempo dedicado a actividades fuera del domicilio (p = 0.013) y tiempo dedicado a las actividades em el domicilio (p = 0,001). El análisis de las declaraciones reveló, principalmente, que el hombre percibe su rol como principal proveedor de la familia y, la mujer, em el rol social de cuidadora, postergando muchas veces la búsqueda de un servicio de salud por temor a no poder realizar ese rol en la familia y/o en la sociedad. Conclusión: La debilidad provocada por la enfermedad y la larga duración del tratamiento modificaron la rutina de los entrevistados, provocando sufrimiento y frustración, con consecuencias en el desempeño de los roles sociales en la familia y en la sociedad, constituyendo una barrera para la adherencia al tratamiento de la tuberculosis

Occurrence of tuberculosis cases in Crato, Ceará, from 2002 to 2011: a spatial analisys of specific standards

OBJECTIVE: to analyze the spatial distribution of tuberculosis in Crato, Ceará, Brazil, from 2002 to 2011, aiming to check for a point pattern. METHODS: This is an ecological, temporal trend and hybrid design study, with a quantitative approach. A total of 261 cases of tuberculosis were geo-referenced and 20 (7.1%) were considered as losses due to the lack of address. The profile of patients in 10 years of study was in accordance with the following pattern: men aged between 20 and 59 years, with low schooling, affected by the pulmonary form of tuberculosis and who were cured from the disease. RESULTS: The analysis of the spatial distribution of tuberculosis points out that in the period of study, new cases of the disease were not distributed on a regular basis, indicating a clustered spatial pattern, confirmed by the L-function. The map with the density of new cases estimated by the Kernel method showed that the "hot" areas are more concentrated in the vicinity of the central urban area. CONCLUSION: The study allowed pointing out areas of higher and lower concentration of tuberculosis, identifying the spatial pattern, but it also recognized that the disease has not reached all of the population groups with the same intensity. Those who were most vulnerable were the ones who lived in regions with higher population densities, precarious living conditions, and with intense flow of people

Analysis of the Tuberculosis Occurrence Through the Use of Geoprocessing

Background: For the control of tuberculosis (TB), it must be adopted specific measures in areas of high transmission. Thus, it was aimed to identify the spatial pattern of new tuberculosis cases in Juazeiro do Norte-CE/ Brazil, from 2001 to 2012. Methods and Findings: It is a hybrid design, ecological study and temporal trend. The new cases reported with TB were included as subjects of research. It was outlined the socio demographic profile; the spatial analysis of cases was made through the Kernel technique and the nearest neighbor method with simulation. Among 914 new TB cases, there was a predominance of males (56,0%),  aged between 20 to 39 years (42,0%), with incomplete elementary school (43,2%), pulmonary clinical form (89,1%). 79,1% of patients achieved a cure and 5,3% abandoned the treatment. In the studied period, it was identified homogeneous spatial distribution and non-random pattern, with the highest concentration of cases in the southern region of the city. Conclusion: The identification of spatial pattern becomes relevant, in order that it can contribute to the strengthening of the TB control by providing information that optimizes activities such as: active search, health education, notification of new cases and supervising the treatment performed by health professionals