Organization of health services for tuberculosis case diagnosis and treatment in Manaus, Amazonas, Brazil, 2014

Sacramento, Daniel Souza; Lavor, Débora Cristina Brasil da Silva; Oliveira, Laura Raquel Teixeira de; Gomes, Adriana Patrícia Brelaz Lopes; Gonçalves, Maria Jacirema Ferreira

doi:10.5123/S1679-49742019000200007

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 28 (2) • June 2019 • https://doi.org/10.5123/S1679-49742019000200007 linkcopy

Organization of health services for tuberculosis case diagnosis and treatment in Manaus, Amazonas, Brazil, 2014^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to describe the organization of health services for tuberculosis case diagnosis and treatment in the city of Manaus, Amazonas, Brazil.

Methods: this was a descriptive study of 156 new tuberculosis cases diagnosed and residing in Manaus in 2014, characterized according to socioeconomic, demographic, health-disease process aspects, relationship with health services and treatment outcome, by administering individual questionnaires in the 1^st and 6^st months of treatment.

Results: some 70% of cases were diagnosed at the tuberculosis reference center; most of the cases were unaware that there was a community health agent in their neighborhood; regarding treatment follow-up, 55.3% had to join an appointment waiting list; only 67.3% of cases were monitored by the same professional throughout entire treatment.

Conclusion: the findings indicate presence of barriers to case diagnosis and treatment, both in the referral center and also in primary healthcare units.

Keywords:
Tuberculosis; Health Services; Diagnostic Services; Time-to-Treatment

Variables	Place of diagnosis			Place of treatment			%
	Referral center	Emergency care/ hospital	PHCU^a	Referral center	PHCU^a without FHS^b	PHCU^a with FHS^b
	(n=105)	(n=38)	(n=9)	(n=65)	(n=70)	(n=17)
Sex
Male	63	30	3	38	48	10	63.2
Female	42	8	6	27	22	7	36.8
Ethnicity/skin color
Brown	79	26	7	45	54	13	73.7
Not brown	26	12	2	20	16	4	26.3
Marital status
Single	61	17	3	28	42	11	53.3
Not single	44	21	6	37	28	6	46.7
Age group (in years)
18-29	32	14	3	18	26	5	32.2
30-59	62	19	5	39	38	9	56.6
≥60	11	5	1	8	6	3	11.2
Number of people in the household
Up to 2	26	3	1	12	11	7	19.7
3 or more	79	35	8	53	59	10	80.3
Employed
Yes	62	27	5	37	47	10	61.8
No	43	11	4	28	23	7	38.2
Monthly income (in monthly minimum wages)
Up to 1	55	12	4	29	34	8	46.7
1 to 3	43	16	2	23	29	9	40.1
More than 3	7	10	3	13	7	0	13.2
Education level (in years of schooling )
<8	50	10	1	19	30	12	40.1
>8	55	28	8	46	40	5	59.9
Presence of comorbidities
Yes	52	19	5	33	33	10	50.0
No	53	19	4	32	37	7	50.0
Smoking
Yes	27	2	1	10	14	6	19.7
No	78	36	8	55	56	11	80.3
Drinking
Yes	39	7	2	16	25	7	31.6
No	66	31	7	49	45	10	68.4
Regular use of drugs
Yes	10	5	0	5	8	2	9.9
No	95	33	9	60	62	15	90.1
Anti-HIV^c serological testing
Positive	3	1	0	1	2	1	2.6
Negative	63	24	7	41	43	10	61.9
Not tested	39	13	2	23	25	6	35.5

Variables	Diagnosis service			%
Variables	Referral center	Emergency care/hospital	PHCU^a	%
How did the patient reach the health service
On their own initiative, or recommended by friends	32	2	2	23.7
Sent by health professional or health service	73	36	7	76.3
Clinical form
Pulmonary	92	27	6	82.2
Extra-pulmonary	13	11	3	17.8
Felt they were listened to during initial care
Always/most of the time	94	35	8	90.1
Never/hardly ever	11	3	1	9.9
Knows the CHA^b in their neighborhood
Yes	24	6	3	21.7
No, or no CHA^b	81	32	6	78.3

Variables	Place of treatment			%
Variables	Referral center	PHCU^a without FHS^b	^- PHCU ^a with FHS ^b	%
Booking medical appointments
In advance, or referral	22	37	9	44.7
Join an appointment waiting list	43	33	8	55.3
Waiting time for initial care
Up to 1 hour	55	65	15	88.8
More than 1 hour	10	5	2	11.2
Monitoring of treatment by the same health professionals
Always	36	51	14	67.4
Most of the time	28	17	2	31.3
Hardly ever	1	0	1	1.3
If they need to ask about the disease/treatment, who do they ask
Family and friends	9	6	5	13.3
Health professionals	24	45	9	52.0
Didn't need to ask questions	32	17	3	34.7
Who is the professional who answers the questions
Professional with a graduation degree	9	37	8	-
Professional with high school qualifications	15	8	1	-
Booking return visits
Scheduled in advance	22	37	9	44.7
Join an appointment waiting list	43	33	8	55.3
Received home visits
Yes	0	12	8	13.3
No	65	56	9	86.7
If bacilliferous, how many follow-up sputum smears were carried out
Up to 3 smears	-	25	10	42.2
More than 3 smears	-	41	7	57.8
Number of months in which missed appointments
None	35	49	8	57.8	60.5
1 month or more	30	21	9	39.5
Number of months in which they were late for appointments
None	55	62	11	39.5	84.2
1 month or more	10	8	6	15.8
Wanting to continue the treatment at the health service - 1st month
Yes	56	33	8	63.8
No	9	37	9	36.2
Wanting to continue the treatment at the health service - 6th month
Yes	18	15	4	24.7
No	47	53	13	75.3
Treatment outcome
Cured	61	61	11	87.5
Not cured	4	9	6	12.5

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Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 (61) 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[TFN8] a) PHCU: primary health care unit.

[TFN9] b) FHS: Family Health Strategy.

[TFN10] c) HIV: human immunodeficiency virus.

Organization of health services for tuberculosis case diagnosis and treatment in Manaus, Amazonas, Brazil, 2014*

Organization of health services for tuberculosis case diagnosis and treatment in Manaus, Amazonas, Brazil, 2014^*