Incidência de tuberculose por município, Brasil 2001-2003: uma abordagem sobre o programa de controle e fatores determinantes da doença

• Autor(a) principal: Gonçalves, Maria Jacirema Ferreira
• Data de Publicação: 2007
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/4629
• topic: Tuberculosis; Epidemiology; Statistical models; AIDS; Program evaluation; Tuberculose; Epidemiologia; Modelos estatísticos; AIDS; Avaliação de programa; CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA::EPIDEMIOLOGIA

This research assessed tuberculosis status in Brazil, from 2001 to 2003, in conformity with performance indicators of the National Tuberculosis Control Program (NTCP), and estimated the effects of determinant factors of the disease s incidence rate. The evaluation used the non-hierarchical cluster analysis, in order to assemble Brazilian municipalities according to tuberculosis (TB) and AIDS morbidity and to the NTCP s performance as well. These clusters were mapped, comparing the distribution among municipalities, in metropolitan areas, priority municipalities, and according to the population size. The Pearson chi-square was employed to test the association among categories. Multilevel longitudinal modeling identified and estimated the effects of the disease determinants. There were three levels, formed by years, municipalities and metropolitan areas. The model was the random intercept and slope. Variables able to reduce variance among levels were retained, thus assuming that they would explain the disease s hierarchical variability. It included income, population density, cure proportion, AIDS incidence rate and the large Brazilian regions. Evaluation showed that epidemiological situation was worrisome in municipalities with Low TB and high AIDS and High TB and AIDS. The Very low TB and AIDS cluster concentrated 50% of municipalities, what may indicate notification problems. There are six program performance clusters. Good and Good with low DOTS predominate in small municipalities, non-priority and outside metropolitan areas. For Moderate performance, there is a larger proportion of priority municipalities. Regular and Weak clusters are concentrated in 10% of municipalities, with high treatment default and very low cure rates. The Very weak cluster was characterized by the lack of performance indicators. Multilevel analysis identified AIDS as impacting factor for tuberculosis, not previously found in other studies; interaction between income and AIDS, and an important contribution of metropolitan areas in tuberculosis distribution, which has heterogeneous expressions among large Brazilian regions. The analysis established distinctions among municipalities and showed that there is no association between more morbidity and better performance of the program, displaying inadequacy of surveillance in the Brazilian epidemiological situation. The program needs to be reinforced, so as to consider AIDS while setting its control strategies. Moreover, population s low income and population density, already studied in other research works, also played a very important role in these results.