Determinantes sociais de saúde relacionados à epidemiologia da tuberculose: subsídios para reorientar os serviços de saúde

• Autor(a) principal: Baldan, Sueli Santiago
• Data de Publicação: 2017
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório do Centro Universitário Braz Cubas
• Texto Completo: https://repositorio.cruzeirodosul.edu.br/handle/123456789/398
• topic: Tuberculose; Coinfecção; Desenvolvimento humano; Determinantes sociais de saúde; Epidemiologia; CNPQ::CIENCIAS DA SAUDE

The fight against tuberculosis (TB) requires an approach with multisectoral actions in order to obtain effective results, including actions that involve social, economic and environmental aspects, in order to overcome the purely biomedical approach. Thus, understanding the occurrence of tuberculosis, in an extended way, considering the individual and its social space, allows a greater control over the disease. This study aimed to describe the Social Determinants of Health (SDH) and factors related to TB epidemiology in the state of Mato Grosso do Sul (Brazil). It is an exploratory study of the ecological type, with multivariate analysis and geoprocessing of secondary data obtained in the data platform of the Ministry of Health, IBGE and State Department of Health of Mato Grosso do Sul. The study included 78 municipalities. The results suggest that municipalities with lower rates of social and economic development, and with greater social inequality, present less effective health services for TB, due to the low supply of HIV testing, the higher percentage of treatment abandonment and deaths and to the low supply of directly observed treatment (DOT). The cases of TB in Mato Grosso do Sul show a random spatial distribution, due to the absence of clustering. The coverage of the Family Health Strategy (FHS) and DOT in some municipalities contribute to adherence to treatment and to the control of the number of TB cases. For other municipalities, these strategies have been ineffective in reducing the TB Incidence Coefficient (IC-TB) and the percentages of treatment abandonment. Municipalities that have indigenous reserves have higher IC-TB than others, a factor related to ethnic and racial vulnerability. The socio-demographic profile of TB / HIV coinfection, compared with the Human Development Index (HDI) of municipalities, indicates a predominance of cases in males with low schooling and a high percentage of deaths. The highest number of cases of HIV-TB coinfection occurs in municipalities with a high HDI. In the study period, 9.7% of the individuals with TB had coinfection with the HIV virus, but in 29.3% of the reported cases, serological status investigation was not performed. The cure rate of TB cases in the study period was lower than the one recommended by the Ministry of Health, the rate of treatment abandonment identified was higher than expected and the percentage of deaths due to TB was elevated. The association between cases of TB/HIV and HDI coinfection in areas with higher population density indicates the need to adopt specific strategies according to the characteristics of the localities. These results point to the need to reorient the care model adopted for TB control, seeking to implement effective intersectoral actions to change the social determinants associated with TB.