Souza W V, Ximenes R, Albuquerque M F, Lapa T M, Portugal J L, Lima M L, Martelli C M
Fundação Oswaldo Cruz, Centro de Pesquisas Aggeu Magalhäes, Recife, Pernambuco, Brasil.
Rev Panam Salud Publica. 2000 Dec;8(6):403-10. doi: 10.1590/s1020-49892000001100005.
In Brazil the challenge of meeting the needs of those living in deprived areas has generated discussions on replacing the existing approach to epidemiological surveillance with an integrated public health surveillance system. This new approach would supplant the traditional focus on high-risk individuals with a method for identifying high-risk populations and the areas where these persons live. Given the magnitude of the problem that tuberculosis (TB) poses for Brazil, we chose that disease as an example of how such a new, integrated public health surveillance system could be constructed. We integrated data from several sources with geographic information to create an indicator of tuberculosis risk for Olinda, a city in the Brazilian state of Pernambuco. In order to stratify the urban space in Olinda and to check for an association between the resulting TB risk gradient and the mean incidence of the disease between 1991 and 1996, we applied two different methods: 1) a "social deprivation index" and 2) principal component analysis followed by cluster analysis. Our results showed an association between social deprivation and the occurrence of TB. The results also highlighted priority groups and areas requiring intervention. We recommend follow-up that would include treating acid-fast bacilli smear-positive pulmonary TB cases, tracing of these persons' contacts, and monitoring of multidrug-resistant cases, all in coordination with local health services.
在巴西，满足贫困地区居民需求的挑战引发了关于用综合公共卫生监测系统取代现有流行病学监测方法的讨论。这种新方法将以一种识别高危人群及其居住地区的方法取代传统的对高危个体的关注。鉴于结核病给巴西带来的问题规模，我们选择该疾病作为一个例子，来说明如何构建这样一个新的综合公共卫生监测系统。我们将来自多个来源的数据与地理信息相结合，为巴西伯南布哥州奥林达市创建了一个结核病风险指标。为了对奥林达市的城市空间进行分层，并检验由此产生的结核病风险梯度与1991年至1996年期间该病平均发病率之间的关联，我们应用了两种不同的方法：1）“社会剥夺指数”；2）主成分分析随后进行聚类分析。我们的结果显示了社会剥夺与结核病发生之间的关联。结果还突出了需要干预的优先群体和地区。我们建议进行后续行动，包括治疗耐酸杆菌涂片阳性的肺结核病例、追踪这些人的接触者以及监测耐多药病例，所有这些都要与当地卫生服务部门协调进行。
