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. 2021 Feb 24;47(2):e20200119.
doi: 10.36416/1806-3756/e20200119. eCollection 2021.

Tuberculosis in Brazil: one country, multiple realities

[Article in English, Portuguese]
Andreza Oliveira Cortez  1 , Angelita Cristine de Melo  1   2 , Leonardo de Oliveira Neves  3 , Karina Aparecida Resende  2 , Paulo Camargos  1
Affiliations

Tuberculosis in Brazil: one country, multiple realities

[Article in English, Portuguese]
Andreza Oliveira Cortez et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: To identify the determinants of tuberculosis-related variables in the various regions of Brazil and evaluate trends in those variables over the ten-year period preceding the end of the timeframe defined for the United Nations Millennium Development Goals (MDGs).

Methods: This was an ecological analytical study in which we utilized eight national public databases to investigate the 716,971 new tuberculosis cases reported between 2006 and 2015.

Results: Over the study period, there were slight reductions in the prevalence, incidence, and mortality associated with tuberculosis. Brazil did not reach the MDG for tuberculosis-related mortality. Among the performance indicators of tuberculosis control, there were improvements only in those related to treatment and treatment abandonment. In terms of the magnitude of tuberculosis, substantial regional differences were observed. The tuberculosis incidence rate was highest in the northern region, as were the annual mean temperature and relative air humidity. That region also had the second lowest human development index, primary health care (PHC) coverage, and number of hospitalizations for tuberculosis. The northeastern region had the highest PHC coverage, number of hospitalizations for primary care-sensitive conditions, and tuberculosis-related mortality rate. The southern region showed the smallest reductions in epidemiological indicators, together with the greatest increases in the frequency of treatment abandonment and retreatment. The central-west region showed the lowest overall magnitude of tuberculosis and better monitoring indicators.

Conclusions: The situation related to tuberculosis differs among the five regions of Brazil. Those differences can make it difficult to control the disease in the country and could explain the fact that Brazil failed to reach the MDG for tuberculosis-related mortality. Tuberculosis control measures should be adapted to account for regional differences.

Objetivo:: Identificar os determinantes das variáveis da tuberculose nas diversas regiões do Brasil e avaliar as tendências dessas variáveis ao longo dos dez anos anteriores ao término do prazo definido para os Objetivos de Desenvolvimento do Milênio (ODM) das Nações Unidas.

Métodos:: Estudo analítico ecológico no qual utilizamos oito bancos de dados públicos nacionais para investigar os 716.971 casos novos de tuberculose notificados entre 2006 e 2015.

Resultados:: Durante o período estudado, houve ligeiras reduções na prevalência, incidência e mortalidade associadas à tuberculose. O Brasil não atingiu o ODM de mortalidade por tuberculose. Entre os indicadores de desempenho no controle da tuberculose, houve melhora apenas naqueles relacionados a tratamento e abandono de tratamento. Em termos da magnitude da tuberculose, foram observadas diferenças regionais substanciais. A taxa de incidência de tuberculose foi maior na região Norte, assim como a temperatura média anual e a umidade relativa do ar. Essa região também apresentou a segunda menor média do índice de desenvolvimento humano, a menor cobertura de atenção primária à saúde (APS) e o menor número de hospitalizações por tuberculose. A região Nordeste apresentou a maior cobertura de APS, o maior número de hospitalizações por condições sensíveis à atenção primária e a maior taxa de mortalidade por tuberculose. A região Sul apresentou as menores reduções nos indicadores epidemiológicos, juntamente com os maiores aumentos na frequência de abandono de tratamento e de retratamento. A região Centro-Oeste apresentou a menor magnitude geral de tuberculose e melhores indicadores de monitoramento.

Conclusões:: A situação da tuberculose difere entre as cinco regiões do Brasil. Essas diferenças podem dificultar o controle da doença no país e podem explicar o fato de o Brasil não ter atingido o ODM de mortalidade por tuberculose. As medidas de controle da tuberculose devem ser adaptadas para dar conta das diferenças regionais.

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Figures

Figure 1
Figure 1. Magnitude of tuberculosis in Brazil as a whole and by region, 2006-2015. TB: tuberculosis; PTB: pulmonary tuberculosis; N: northern; NE: northeastern; SE: southeastern; S: southern; and CW: central-west.
Figure 2
Figure 2. Performance indicators of tuberculosis control in Brazil as a whole and by region, 2006-2015. TB: tuberculosis; SSM: sputum-smear microscopy; DOT: directly observed therapy; PTB: pulmonary tuberculosis; N: northern; NE: northeastern; SE: southeastern; S: southern; and CW: central-west. aAmong cases of PTB. bAmong cases in which the 1st SSM was positive. cAmong all cases of TB.
Figure 3
Figure 3. Accessibility, organization, and performance indicators of health care services in Brazil as a whole and by region, 2006-2015. PHC: primary health care; PCSCs: primary care-sensitive conditions; N: northern; NE: northeastern; SE: southeastern; S: southern; and CW: central-west.
Figure 4
Figure 4. Socioeconomic impact of tuberculosis in Brazil as a whole and by region, 2006-2015. TB: tuberculosis; PHC: primary health care; PCSCs: primary care-sensitive conditions; N: northern; NE: northeastern; SE: southeastern; S: southern; and CW: central-west.
See this image and copyright information in PMC

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