Orellana Jesem Douglas Yamall, Gonçalves Maria Jacirema Ferreira, Basta Paulo Cesar
Instituto Leônidas e Maria Deane, FIOCRUZ, Brazil.
Rev Bras Epidemiol. 2012 Dec;15(4):714-24. doi: 10.1590/s1415-790x2012000400004.
With the intention of improve knowledge on the epidemiological situation of tuberculosis (TB) among vulnerable populations in Brazil, our objective was to analyze sociodemographic characteristics and operational indicators related to TB control, comparing indigenous and non-indigenous people, in Rondônia. We conducted a retrospective and descriptive epidemiological study of new TB cases reported between 1997, January 1st and 2006, December 31st. We excluded duplicate records and those for whom the results of treatment was change in diagnosis and transfer. TB cases were classified into two categories: indigenous and non-indigenous people and analysis was performed according to sex, age, origin (urban /rural), State of residence, clinical form, diagnostic tests, monitoring indicators and results of treatment. Altogether 4832 cases were reported, with 322 cases (6.7%) in indigenous people. There was a male predominance (ratios: 1.7 to 1.3 in non-indigenous and indigenous people). The majority of cases for indigenous people (82.6%) was in rural area and there was high concentration of cases (36.0%) in children < 15 years. The analysis of diagnostic tests showed a predominance of smear positive in non-indigenous (56.1%) and smear negative and smear not performed in indigenous people (31.7% and 35.4% respectively, P value=0.0001). There was difference in the monitoring in relation to smear of second month (6.1% positivity, P value = 0.0001) and exam at least one contact (69.6%, P value = 0.017) for non-indigenous. On the other hand, DOTS was more associated with indigenous people cases (23.6%, P value = 0.0001). Stands out the predominance of cure in both groups, with bigger concentration in indigenous people (90.4%, P value = 0.0001) and higher rate of noncompliance in non-indigenous (14.7%, P value = 0.0001). The approach showed useful for elucidate inequalities and has exceeded the usual analysis carried out surveillance on services that aim to delineate the epidemiological situation based only on rates or absolute values.
为了增进对巴西弱势群体结核病（TB）流行病学情况的了解，我们的目标是分析朗多尼亚州与结核病控制相关的社会人口学特征和业务指标，比较原住民和非原住民。我们对1997年1月1日至2006年12月31日期间报告的新结核病病例进行了回顾性描述性流行病学研究。我们排除了重复记录以及那些治疗结果为诊断改变和转诊的记录。结核病病例分为两类：原住民和非原住民，并根据性别、年龄、出身地（城市/农村）、居住州、临床类型、诊断检测、监测指标和治疗结果进行分析。共报告了4832例病例，其中原住民有322例（6.7%）。男性占主导（比例：非原住民为1.7比1.3，原住民为1.7比1.3）。原住民的大多数病例（82.6%）在农村地区，15岁以下儿童中的病例高度集中（36.0%）。诊断检测分析显示，非原住民中涂片阳性占主导（56.1%），而原住民中涂片阴性和未进行涂片检测的分别占31.7%和35.4%（P值=0.0001）。非原住民在第二个月涂片监测方面（阳性率6.1%，P值=0.0001）以及至少对一名接触者进行检查方面（69.6%，P值=0.017）存在差异。另一方面，直接观察短程治疗（DOTS）与原住民病例的关联更大（23.6%，P值=0.0001）。值得注意的是，两组中治愈均占主导，原住民中的集中度更高（90.4%，P值=0.0001），非原住民中的不依从率更高（14.7%，P值=0.0001）。该方法显示有助于阐明不平等情况，并且超越了通常仅基于发病率或绝对值来描绘流行病学情况的服务监测所进行的分析。
