Risk factors associated with drug-resistant tuberculosis in prisons in Sao Paulo State, Brazil (2006-2016).

INTRODUCTION: Prisons are high-risk settings for drug-resistant tuberculosis because the prevalence of the tuberculosis (TB) is much higher than in the general population. This study to investigated the factors associated with drug-resistant tuberculosis in prisons in the state of São Paulo, Brazil. METHODOLOGY: Retrospective cohort of drug-resistant TB cases for incarcerated people in São Paulo state, reported in the Tuberculosis Patient Control System between 2006 and 2016. To analyze the factors associated with drug-resistant TB, the backward method (likelihood ratio) was used, determining the adjusted odds ratio and respective 95%CI coefficients. Multiple models were proposed to adjust for potential confusion and interaction. The best fit model was selected based on the lowest Akaike information criterion coefficient. RESULTS: In total, 473 drug-resistant tuberculosis cases were reported in the prison population of Sao Paulo state, the majority were male. The cases that presented negative results for sputum smear and sputum culture had, respectively, an aOR=0.6 and aOR=0.16 for drug-resistant tuberculosis in relation to the cases with positive results. The cases where the patient had AIDS and reported alcoholism, respectively, an aOR=1.47 and aOR=1.60 for drug-resistant TB. Individuals with a background treatment history for TB presented a stronger association with drug-resistant tuberculosis, aOR=35.08. CONCLUSIONS: Sputum spear, sputum culture, chest X-ray, AIDS, alcoholism and background treatment history for TB were factors associated with resistance to antituberculosis drugs among prisoners. This is useful for the implementation of disease control measures related to the detection and monitoring of cases in the prison system.

Effect of social development in reducing tuberculosis mortality In northeastern Brazil areas.

INTRODUCTION: Tuberculosis (TB) is the primary cause of death among infectious diseases affecting groups in extreme poverty. Social improvements could reverse this situation in Brazil. This study aims to demonstrate the spatial relationship between social development (SD) and TB mortality in Natal, a city in northeastern Brazil. METHODOLOGY: Ecological study. The study population comprised TB deaths recorded in the Mortality Information System between 2008 and 2014. The units of analysis were 59 human development units (HDUs). Raw and smoothed mortality rates were calculated using the global empirical Bayes method. Primary components analysis was used to develop the SD indicators. An association between TB mortality and SD was verified using multiple linear regression analysis. Spatial autocorrelation was verified using models with global spatial effects. Analyses were performed using Statistica version 12.0, ArcGIS version 10.2, Statistical Package for the Social Sciences version 20.0, and OpenGeoDa 1.0.1. The significance level was established at 5% (p < 0.05). RESULTS: The TB mortality rate with non-random spatial distribution ranged between 0.52 and 8.90 per 100,000 inhabitants. The spatial lag model was chosen because it presented the highest log-likelihood value, lowest AIC, and highest R2. A negative association was found between TB mortality and SD (R2 = 0.207; p = 0.03). CONCLUSIONS: The results show a negative association between TB mortality and the high SD indicator. This study can support decision-making in terms of collective projects within public health in order to link the health field to other sectors, aiming for social well-being and human development.