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OBJECTIVE: To evaluate the incidence of Mycobacterium tuberculosis infection, using tuberculin skin test, among community health agents (CHAs) monitoring TB patients in the city of Cachoeiro de Itapemirim, Brazil. METHODS: We included 30 CHAs acting in the Family Health Program and 30 of their family members residing in the same household. The tuberculin skin test results of each CHA were compared with those of the corresponding family member. RESULTS: Of the 30 CHAs, 27 (90.0%) were female, compared with 23 (76.7%) of the 30 family members (p = 0.299). The mean age of the CHA group and of the family member group was, respectively, 36.8 and 39.7 years. No statistically significant difference was found between the groups regarding the level of education. Regarding M. tuberculosis exposure, the same number of participants in the two groups reported having known or had contact with a TB patient (17 individuals; 56.7%). There was a statistically significant difference regarding positive tuberculin skin test results (26.7% in the CHA groupand 3.3% in the family member group; p = 0,011). CONCLUSIONS: M. tuberculosis infection was significantly higher among CHAs than among their family members, fueling the debate on the occupational risk involved in the activities of these professionals.

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OBJETIVO: Avaliar a incidência de infecção por Mycobacterium tuberculosis através da prova tuberculínica em agentes comunitários de saúde (ACS) que acompanham pacientes em tratamento de TB no município de Cachoeiro de Itapemirim (ES). MÉTODOS: Incluímos 30 ACS que atuam no Programa de Saúde da Família e 30 de seus familiares residentes no mesmo domicílio. Comparamos o resultado do teste tuberculínico de cada ACS e do membro familiar correspondente. RESULTADOS: Entre os 30 ACS, 27 (90,0 por cento) eram do sexo feminino, ao passo que entre os 30 familiares, 23 (76,7 por cento) eram do sexo feminino (p = 0,299). A idade média do grupo ACS e do grupo dos familiares foi, respectivamente, 36,8 e 39,7 anos. Não houve diferença estatística no nível de escolaridade entre os grupos estudados. Na investigação da exposição ao M. tuberculosis, o mesmo número de indivíduos nos dois grupos afirmou conhecer ou já ter tido algum contato com paciente com TB (17 indivíduos; 56,7 por cento). Houve diferença estatisticamente significativa quanto ao resultado positivo da prova tuberculínica nos dois grupos (26,7 por cento no grupo ACS e 3,3 por cento no grupo de familiares; p = 0,011). CONCLUSÕES: A infecção por M. tuberculosis entre os ACS foi significativamente maior que entre seus familiares, e isso contribui para o debate em torno do risco ocupacional envolvido nas atividades destes profissionais.

OBJECTIVE: To evaluate the incidence of Mycobacterium tuberculosis infection, using tuberculin skin test, among community health agents (CHAs) monitoring TB patients in the city of Cachoeiro de Itapemirim, Brazil. METHODS: We included 30 CHAs acting in the Family Health Program and 30 of their family members residing in the same household. The tuberculin skin test results of each CHA were compared with those of the corresponding family member. RESULTS: Of the 30 CHAs, 27 (90.0 percent) were female, compared with 23 (76.7 percent) of the 30 family members (p = 0.299). The mean age of the CHA group and of the family member group was, respectively, 36.8 and 39.7 years. No statistically significant difference was found between the groups regarding the level of education. Regarding M. tuberculosis exposure, the same number of participants in the two groups reported having known or had contact with a TB patient (17 individuals; 56.7 percent). There was a statistically significant difference regarding positive tuberculin skin test results (26.7 percent in the CHA groupand 3.3 percent in the family member group; p = 0,011). CONCLUSIONS: M. tuberculosis infection was significantly higher among CHAs than among their family members, fueling the debate on the occupational risk involved in the activities of these professionals.

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A tuberculose acomete 8 milhões de pessoas anualmente em todo o mundo. A população de asilos convive com situações de fragilidade social, favorecendo a transmissão da doença. O objetivo deste trabalho foi traçar o perfil epidemiológico de casos notificados de tuberculose entre de moradores de abrigos em Vitória e Vila Velha no período de2000 a 2006. No período foram notificados 32 casos, 23 residentes de Vitória, 9 em Vila Velha, com idade média de 41 anos, sendo 30 do sexo masculino. A forma pulmonar foi predominante (88%), 91% dos casos apresentaram raios-X suspeito e 97% não realizaram o teste tuberculínico. O tratamento supervisionado ocorreu em50% dos pacientes. 50% dos pacientes obtiveram cura, 18,8% abandonaram o tratamento, 15,6% morreram e 15,6% foram transferidos. Apesar das dificuldades de controlar a tuberculose no interior de abrigos, realizar um rastreamento dessa população seria indicado para evitar a disseminação da doença.

RESUMO

This study analyzes the knowledge of community health workers in tuberculosis control and their self-perceived knowledge and the importance they ascribe to their role in fighting the disease, in Vitória, Espírito Santo State, Brazil. The study adopted a cross-sectional design, with a pre-tested, semi-structured questionnaire completed by 105 randomly selected health workers. The comparison of proportions between the groups formed by stratification according to time-on-the-job used the chi-squared test with 5% significance. Mean age was 34.5 (+/-9.7) years. Sixty-six community health workers (62.9%) had worked on the job for three years or less. Longer time on the job was positively associated with increased understanding of the disease and activities actually performed in TB control. Still, numerous flaws were observed in TB knowledge and control measures among community health workers. Improvements in continuing education for these workers could foster a more effective contribution to detecting new TB cases in the community and improved treatment adherence by patients.

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Este estudo analisa o conhecimento dos agentes comunitários de saúde no controle da tuberculose e a autopercepção do seu nível de conhecimento e de sua importância no enfrentamento da doença, no Município de Vitória, Espírito Santo, Brasil. Tratou-se de um estudo de corte transversal. Um questionário semi-estruturado, auto-aplicável e pré-testado foi preenchido por 105 agentes comunitários de saúde randomicamente selecionados. A comparação das proporções entre os grupos formados pela estratificação por tempo de serviço foi realizada usando-se o teste qui-quadrado com nível de significância de 5 por cento. A idade média foi de 34,5 (± 9,7) anos. Atuavam há três anos ou menos 66 agentes comunitários de saúde (62,9 por cento). Observou-se que um maior tempo de atividade está relacionado com um aumento do nível de compreensão em torno da doença, bem como das atividades efetivamente realizadas no controle da tuberculose. Contudo, de maneira geral, os conhecimentos e as ações do agente comunitário de saúde mostraram-se muito falhos. Entende-se que com melhorias na educação permanente desses profissionais seria possível uma maior contribuição deles para o aumento da detecção de novos casos na comunidade e para maior adesão dos pacientes ao tratamento.

This study analyzes the knowledge of community health workers in tuberculosis control and their self-perceived knowledge and the importance they ascribe to their role in fighting the disease, in Vitória, Espírito Santo State, Brasil. The study adopted a cross-sectional design, with a pre-tested, semi-structured questionnaire completed by 105 randomly selected health workers. The comparison of proportions between the groups formed by stratification according to time-on-the-job used the chi-squared test with 5 percent significance. Mean age was 34.5 (±9.7) years. Sixty-six community health workers (62.9 percent) had worked on the job for three years or less. Longer time on the job was positively associated with increased understanding of the disease and activities actually performed in TB control. Still, numerous flaws were observed in TB knowledge and control measures among community health workers. Improvements in continuing education for these workers could foster a more effective contribution to detecting new TB cases in the community and improved treatment adherence by patients.

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We carried out an ecological study in which the spatial distribution of 979 new tuberculosis cases between 2000 and 2005 were analyzed. The risk was estimated using the local empirical Bayesian method. The local indicators of spatial association were calculated to evaluate autocorrelations of incidence between adjoining districts. We found that the tuberculosis cases were heterogeneously distributed between districts, and it was possible to identify regions in which there was a high risk of becoming ill.

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Realizou-se um estudo ecológico com a análise da distribuição espacial dos 979 novos casos de tuberculose entre 2000 e 2005. Utilizou-se o Método Bayesiano Empírico Local para estimação do risco. O Índice de Moram Local foi calculado para avaliação das autocorrelações entre as incidências de bairros limítrofes. Observou-se que a tuberculose distribui-se heterogeneamente entre os bairros, sendo possível identificar regiões com alto risco de adoecimento.

We carried out an ecological study in which the spatial distribution of 979 new tuberculosis cases between 2000 and 2005 were analyzed. The risk was estimated using the local empirical Bayesian method. The local indicators of spatial association were calculated to evaluate autocorrelations of incidence between adjoining districts. We found that the tuberculosis cases were heterogeneously distributed between districts, and it was possible to identify regions in which there was a high risk of becoming ill.

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Estudo retrospectivo de perfil dos casos de TBMR do Espírito Santo, entre 2000 e 2004. Identificou-se 61 pacientes com TBMR, sendo a amostra composta por 57 casos, que tiveram seus prontuários revisados para obtenção das variáveis estudadas. Estimou-se como prevalência para a TBMR combinada 0,87 por cento (0,66 - 1,13; IC95 por cento). O teste anti-HIV foi feito em 78,9 por cento dos casos, sendo 11,1 por cento positivos. Investigando co-morbidades, destacaram-se etilismo e tabagismo. Encontrou-se 11 casos de resistência primária (RI) e 46 de resistência adquirida (RA), com média de 2,3 ± 1,3 tratamentos anteriores. Em 35,1 por cento dos casos houve relato de contato prévio conhecido com doente de tuberculose, enquanto em 67,9 por cento não houve ou nega-se ter havido. Dez pacientes (17,5 por cento) foram tratados com o esquema de 1ª linha, 18 (31,6 por cento) com o de 2ª linha e 27 (47,4 por cento) com o de 3ª linha. Dezoito (31,6 por cento) tiveram tratamento auto-administrado, e 39 (68,4 por cento) supervisionado. Quanto ao desfecho, houve cura em 33 casos (71,7 por cento), abandono em 7 (15,2 por cento) e óbito em 5 (10,9 por cento), 1 caso de falência e 11 (19,3 por cento) estão em tratamento. Dos 10 casos encerrados de RI, 80 por cento (8/10) foram curados, contra 69,4 por cento (25/36) dos casos de RA. Concluímos que a prevalência de TBMR é baixa no ES. A cura foi alcançada em 70 por cento dos casos. As co-morbidades podem ser importante fator interveniente para um desfecho satisfatório do tratamento. Os resultados enfatizam a necessidade de busca, diagnóstico e realização de TSA para identificação da RI e a supervisão do tratamento de todos os casos de tuberculose.

This is a retrospective profile study of MRTB cases in Espírito Santo, between 2000 and 2004. Sixty-one patients were identified as MRTB, in a sample of 57 cases. All clinical charts of these cases were reviewed for the variables studied. The combined prevalence of MRTB was estimated as 0.87 percent (0.66 - 1.13; 95 percent CI). Anti-HIV tests were performed in 78.9 percent of cases, yielding 5 (11.1 percent) positive results. Regarding co-morbidity, alcoholism and smoking have a special importance. 11 cases (19.3 percent) of primary resistance (IR) were found, while 46 (80.7 percent) were cases of acquired resistance (AR), with an average of 2.3 ± 1.3 previous treatments. 35.1 percent of the cases informed a known previous contact with a person with tuberculosis, while for 67.9 percent, the contact was denied or was not the case. 10 patients (17.5 percent) had been treated with a 1st line regimen, 18 (31.6 percent) with a 2nd line one, and 27 (47.4 percent) with 3rd line. Eighteen (31.6 percent) had had self-administered treatment, while 39 (68.4 percent) had undergone supervised treatment. Outcome for 33 cases (71.7 percent) was cure, abandon for 7 (15.2 percent) and death for 5 (10.9 percent); there was one case of treatment failure and 11 (19.3 percent) were still in treatment. Of the 10 cases of IR with a defined outcome, 80 percent (8/10) were cured, against 69.4 percent (25/36) of AR cases. We concluded that the prevalence of MRTB is low in the state of Espírito Santo. Cure was reached in about 70 percent of all treatments. Associated co-morbidity can be a major drawback for satisfactory treatment outcome. Our results emphasize the need for case finding, search, diagnosis and performance of SAT for the identification of IR and implementation of supervised treatment for all tuberculosis cases.

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