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

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Epidemiologia e Serviços de Saúde

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

Organization of health services for tuberculosis case diagnosis and treatment in Manaus, Amazonas, Brazil, 2014^* * Article derived from the Master’s Degree thesis “Follow-up of new tuberculosis cases: clinical/epidemiological profile and organization of the health service”, defended by Daniel Souza Sacramento at the Postgraduate Program in Public Health, Society and Endemic Diseases, Federal University of Amazonas, and Leônidas and Maria Deane Institute/Oswaldo Cruz Foundation, in 2015.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

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

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, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Daniel Souza Sacramento - Av. Barcelos, No. 2228, Praça 14 de Janeiro, Manaus, AM, Brazil. Postcode: 69020-200 E-mail: dsacramento@ig.com.br