Environmental aspects related to tuberculosis and intestinal parasites in a low-income community of the Brazilian Amazon

Abstract

We carried out a cross-sectional study from January to December 2015 on 1,425 inhabitants from a floating population in the Brazilian Amazon (Murinin district, Pará State) to describe the population-based prevalence of tuberculosis (TB) from 2011 to 2014, recent TB contacts (rCts) latently infected with Mycobacterium tuberculosis (LTBI) , the coverage of the local health network, socio-environmental factors, and frequency of intestinal parasitic infection (IPI). We found that the sanitary structure was inadequate, with latrines being shared with other rooms within the same accommodation; well water was the main source of water, and 48% of families had low incomes. The average rate of TB was 105/100, 000 inhabitants per year; one third of TB patients had been household contacts of infected individuals in the past, and 23% of rCts were LTBI. More than half (65%) of 44% of the stools examined (representing 76% of the housing) had IPIs; the highest prevalence was of fecal-oral transmitted protozoa (40%, Giardia intestinalis ), followed by soil-transmitted helminths (23%). TB transmission may be related to insufficient disease control of rCts, frequent relocation, and underreporting. Education, adopting hygienic habits, improving sanitation, provision of a treated water supply and efficient sewage system, further comprehensive epidemiological surveillance of those who enter and leave the community and resources for basic treatment of IPIs are crucial in combating the transmission of these neglected diseases.

Figure 1. - Distribution of the participants (n=402), infected (black bars) and not infected (white bars) with intestinal parasites, stratified by age. They lived in the Murinin District, Benevides, Pará , Brazil, in 2015. *Chi-square test, p≤0.05

Figure 2. Distribution of intestinal infections caused by soil-transmitted helminths (gray bar) and fecal-oral transmitted protozoa (black bar) in stools collected in 2015 from the 402 participants’ houses in the Murinin District, Benevides, Pará , Brazil

Figure 3. Location of the Murinin district, Benevides, Pará State, Brazil and schematic representation of the Family Health Strategy (FHS) coverage areas and location of tuberculosis (TB) patients’ houses (red circles), District Murinin, Benevides, Pará , Brazil. Dark green: FHS Murinin 1. Light Green: FHS Murinin 2. Orange: FHS Paraíso 1. Blue: FHS Paraíso 2. Red lines: Area inhabited but not covered by any FHS. Black circles: TB cases that were not officially notified