Leprosy and tuberculosis control scenario of the national program for the improvement of access and quality of primary care in Brazil.

BACKGROUND: In Brazil, despite advances in public health policies aimed at eliminating and controlling infectious and parasitic diseases, the incidence of neglected diseases is still high. The epidemiological scenario in Brazil of diseases such as tuberculosis and leprosy evidences a public policy agenda that has not been resolute in terms of control, nor in terms of elimination. OBJECTIVE: To analyze the actions of diagnosis and treatment of leprosy and tuberculosis in the context of primary health care. METHODS: In this ecological study, data from the third cycle of the Program for the Improvement of Access and Quality of Primary Care were extracted from electronic address of the Primary Health Care Secretariat of Brazil in the area of Actions, Programs and Strategies. A total of 37,350 primary health care teams were that answered the questionnaire were eligible, with variables extracted from leprosy and tuberculosis control actions. The municipalities were grouped according to the characteristic of the Brazilian municipality. The partition chi-square and the Residuals Test were used to assess whether there was a difference in the proportion of tuberculosis and leprosy actions between types of municipalities. Statistics were carried out using Minitab 20 and Bioestat 5.3. RESULTS: Regarding the leprosy treatment location, there is a higher proportion of people referred to be treated at the reference in adjacent rural (p = 0.0097) and urban (p < 0.0001) municipalities; monitoring of people with leprosy referred to the service network (p. = 0.0057) in remote rural areas. Lower proportion of teams requesting bacilloscopy in remote rural areas (p = 0.0019). Rural areas have a higher proportion of teams that diagnose new cases (p = 0.0004). Regarding the actions of diagnosis and treatment of tuberculosis. There is a higher proportion of teams that carry out consultations at the unit itself in rural areas when compared to adjacent intermediaries (p = 0.0099) and urban (p < 0.0001); who requested sputum smear microscopy in adjacent intermediaries (p = 0.0021); X-ray in adjacent intermediaries (p < 0.0001) and urban (p < 0.0001); collection of the first sputum sample in urban (p < 0.0001) and adjacent rural areas (p < 0.0001); directly observed treatment (p < 0.0001) in adjacent rural municipalities. CONCLUSION: There are inequalities in the diagnosis and treatment of leprosy and tuberculosis among the types of municipalities.

Fall-Related Hospitalizations in Elderly People: Temporal Trend and Spatial Distribution in Brazil.

This study aims to identify the temporal variation and the spatial dependence structure of the hospitalization rate for falls in the elderly residing in Brazil in the period between 2010 and 2021. This ecological study employs secondary data from the Brazilian Ministry of Health about the fall-related hospitalization of people aged 60 years old and over. A time-series analysis was carried out, employing the joinpoint model. For the spatial analysis, the Moran autocorrelation technique was employed. In Brazil, between 2010 and 2021, there were 1,270,341 hospitalizations for falls recorded among the elderly in the Brazilian Hospitalization System. There was a continuous upward trend between 2010 and 2019 for all age groups, female and male, and all Brazilian regions. The trend stabilized between 2019 to 2021. The North and Northeast regions had faster upward trends among all Brazilian regions, and there was also a faster upward trend among women compared to men. A high-high pattern in hospitalization incidence was noticed from 2011 to 2019 in the states of São Paulo, Minhas Gerais, Paraná, and Mato Grosso do Sul. The results of this study provide subsidies for Brazilian health authorities to implement more efficient public policies to improve the quality of life of elderly people.