RESUMO
OBJECTIVES: To analyse the profile of tuberculosis (TB) among Bolivian immigrants, investigate the impact that this population has on the trends of TB and assess equity in access to TB treatment, in the city of São Paulo, Brazil. METHODS: Descriptive study of the epidemiological profile of TB in four city districts with large Bolivian populations, comparing cases among Brazilians and Bolivians, during the 1998-2008 period was carried out. We used logistic regression to adjust the treatment outcome for potential confounders. RESULTS: We identified 2056 new TB cases: 65.7% in Brazilians, 32.1% in Bolivians and 2.2% among other nationalities. Although TB incidence remained stable (high) over the study period, the annual proportion of cases among Bolivians increased from 15.0% to 53.0%. In comparison with the Brazilians, the Bolivians were younger (median age, 24 vs. 40 years; P < 0.0001) and presented a lower unemployment rate (3.1%vs. 11.6%; P < 0.0001), a lower rate of HIV co-infection (1.5%vs. 28.5%; P< 0.001), a higher proportion of individuals receiving supervised treatment (81.5%vs. 62.0%; P < 0.0001) and a higher proportion of cures (71.6%vs. 63.2%; P< 0.0001). After having been adjusted for potential confounder, cure after treatment was not associated with nationality. CONCLUSIONS: Bolivian immigrants influenced the incidence but not the trends of TB among Brazilians in the study area. We found no significant differences between Bolivians and Brazilians regarding healthcare access or treatment outcome. Guaranteed universal health care access for all, including undocumented individuals, contributes to health equity. Specific intervention strategies are warranted for immigrants with tuberculosis.
Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bolívia/etnologia , Brasil/epidemiologia , Criança , Pré-Escolar , Emprego , Feminino , Acessibilidade aos Serviços de Saúde/economia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Política Pública , Adulto JovemRESUMO
Textos sobre vigilância à saúde com discussäo voltada para os marcos conceituais e as possibilidades nas práticas de saúde, dirigidas para a questäo da qualidade de vida. Mostra a necessidade de serem formuladas políticas para o setor saúde, capazes de oferecer respostas interinstitucionais, onde a integraçäo de iniciativas de assistência, prevençäo e promoçäo à saúde possam garantir a globalizaçäo das açöes de intervençäo. Por fim, apresenta projeto de vigilância do óbito infantil (AMSB)