RESUMO
SETTING: Mozambique, one of the world's high tuberculosis (TB) burden countries, has conducted only one national-level drug resistance survey, in 2007-2008. OBJECTIVE: To determine the drug resistance patterns of laboratory-confirmed TB cases. DESIGN: This was a population-level survey conducted over a 1-year period in the district of Manhiça. All laboratory-confirmed cases were evaluated for first-line anti-tuberculosis drug susceptibility testing using liquid culture. RESULTS: Resistance to at least one first-line drug was observed in 44 of 276 isolates (15.9%). Prevalence of drug resistance to each of the five anti-tuberculosis drugs tested was 4.0% for streptomycin, 10.1% for isoniazid (INH), 6.2% for rifampicin, 3.6% for ethambutol and 1.1% for pyrazinamide. The overall prevalence of multidrug-resistant TB (MDR-TB) was 5.1%: 3.8% (95%CI 2.0-7.0) in new and 13.2% (95%CI 5.8-27.3) in retreatment cases. Respectively 4.6% and 2.6% of new and retreatment cases were INH-monoresistant. Previous history of anti-tuberculosis treatment was associated with having MDR-TB (OR 4.3, 95%CI 1.3-14.1). CONCLUSION: The prevalence of drug resistance in the district of Manhiça is slightly higher than, but still compatible with, previous national estimates. INH monoresistance was high, posing the risk of hidden monotherapy in the continuation phase.
Assuntos
Antituberculosos/farmacologia , Isoniazida/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto , Farmacorresistência Bacteriana , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Moçambique/epidemiologia , Mycobacterium tuberculosis/isolamento & purificação , Prevalência , Estudos Prospectivos , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologiaRESUMO
From the first day in prison, convicts are exposed to several types of diseases, many of which can be prevented by vaccination. During captivity, the risk of acquiring these types of diseases is known to be higher than outside prison. This increased risk can be explained by structural and logistical factors in prison, as well as by acquired behaviour before and during captivity. Furthermore, for many prisoners captivity is an opportunity to access the health care system and therefore a chance to update their adult vaccination status. The traditional concept suggesting that prisons are primarily designed to ensure public safety should be complemented by this aspect of health, which is a broader approach to public safety.