Factors associated with TB in an indigenous population in Brazil: the effect of a cash transfer program

Malacarne, Jocieli; Kolte, Ida Viktoria; Freitas, Lais Picinini; Orellana, Jesem Douglas Yamall; Souza, Maximiliano Loiola Ponte de; Souza-Santos, Reinaldo; Basta, Paulo Cesar

doi:10.1590/S1678-9946201860063

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Original Article • Rev. Inst. Med. trop. S. Paulo 60 • 2018 • https://doi.org/10.1590/S1678-9946201860063 copy

Factors associated with TB in an indigenous population in Brazil: the effect of a cash transfer program

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The Mato Grosso do Sul State (MS) has the second-largest indigenous population and the highest incidence rates of TB among indigenous people in Brazil. However, little is known about the risk factors associated with active TB in indigenous people in the region, especially regarding socioeconomic factors. The aim of this study is to assess the effect of the Family Allowance Program (BFP) and of other predictors of active TB in a high-risk indigenous population in Brazil. We conducted a case-control study with incident TB cases matched by age and by village of residence (1:2 proportion) between March 2011 and December 2012. We used a conditional logistic regression for data analysis. A total of 153 cases and 306 controls were enrolled. The final model included the following risk factors: alcohol consumption (low-risk use OR=2.2; 95% CI 1.1-4.3; risky use OR=2.4; 95% CI 1.0-6.0; dependent/ damaging use OR=9.1; 95% CI 2.9-29.1); recent contact with a TB patient (OR=2.0; 95% CI 1.2-3.5); and male sex (OR=1.9; 95% CI 1.1-3.2). BFP participation (OR=0.5; 95% CI 0.3-0.6) and BCG vaccination (OR=0.5; 95% CI 0.3-0.9) were found to be protective factors against TB. Although the BFP was not designed to target TB-affected households specifically, our findings reveal the importance of the BFP in preventing one of the most important infectious diseases among adults in indigenous villages in Brazil. This result is in line with the End-TB strategy, which identifies social protection, poverty alleviation and targeting other determinants of TB as key actions.

KEYWORDS:
Risk factors; Case-control study; Tuberculosis; Indigenous population; Cash transfer programs

Variables		Cases		Controls		Crude		Adjusted		p-value
Variables		n	%	n	%	OR	95% CI	OR	95% CI	p-value
Sex
	Female	52	34.0	187	61.1	1^* * Reference value		1^* * Reference value
	Male	101	66.0	119	38.9	3.0	2.0-4.5	1.9	1.1-3.2	0.010
Educational level
	9 or more years	8	5.2	30	9.8	1^* * Reference value
	5 to 8 years	23	15.0	67	22.0	1.6	0.6-3.9	--	--
	1 to 4 years	61	39.9	114	37.4	3.0	1.2-7.5	--	--
	No schooling	61	39.9	94	30.8	4.0	1.5-10.6	--	--
Crowding
	>1 room	60	39.2	173	56.5	1^* * Reference value
	≤ 1 room per household	93	60.8	133	45.5	2.3	1.5-3.5	--	--
BFP
	No	97	63.4	131	43.0	1^* * Reference value		1^* * Reference value
	Yes	56	36.6	174	57.0	0.4	0.3-0.6	0.5	0.3-0.6	< 0.001
Indoor air pollution
	No	68	44.4	166	54.2	1^* * Reference value
	Yes	85	55.6	140	45.8	2	1.2-3.2	--	--
Smoking
	No smoking	88	58.3	224	73.9	1^* * Reference value
	Up to 10 cigarettes per day	34	22.5	64	21.1	1.5	0.9-2.4	--	--
	>10 cigarettes per day	29	19.2	15	5.0	5.6	2.7-11.6	--	--
AUDIT
	No use	82	53.6	245	80.0	1^* * Reference value		1^* * Reference value
	Low-risk use	34	22.2	37	12.1	3.0	1.6-5.2	2.2	1.1-4.3
	Risky use	18	11.8	17	5.6	4.1	1.9-8.9	2.4	1.0-6.0
	Dependent/damage use	19	12.4	7	2.3	9.0	3.4-23.4	9.1	2.9-29.1	< 0.001
Contact with a patient with active TB
	No	90	62.9	210	70.2	1^* * Reference value		1^* * Reference value
	Yes	53	37.1	89	29.8	1.5	1.0-2.3	2.0	1.2-3.5	0.008
BCG vaccination
	No	51	33.8	73	24.3	1^* * Reference value		1^* * Reference value
	Yes	100	62.2	228	75.7	0.6	0.3-0.9	0.5	0.3-0.9	0.030

Variables		BFP-Cases				p-value	BFP-Controls				p-value
		Yes		No			Yes		No
		n	%	n	%		n	%	n	%
Sex						0.300					0.200
	Female	22	39.3	30	30.9		112	64.4	75	57.3
	Male	34	60.7	67	69.1		62	35.6	56	42.7
Educational level
	9 or more years	5	8.9	3	3.1	0.800	15	8.7	15	11.5	0.040
	5 to 8 years	9	16.1	14	14.4		48	27.7	19	14.5
	1 to 4 years	25	44.6	36	37.1		62	35.8	51	38.9
	No schooling	17	30.4	44	45.4		48	27.7	46	35.1
Crowding
	>1 room per household	29	51.8	31	32.0	0.010	105	60.3	67	51.1	0.100
	≤ 1room per household	27	48.2	66	68.0	0.010	69	39.7	64	48.9	0.100
Indoor air pollution
	No	30	53.6	38	39.2	0.080	104	59.8	61	46.6	0.020
	Yes	26	46.4	59	60.8	0.080	70	40.2	70	53.4	0.020
Regular Employment
	No	50	89.3	96	99.0	0.006	153	87.9	114	87.0	0.810
	Yes	6	10.7	1	1.0	0.006	21	12.1	17	13.0	0.810
Pension
	No	51	91.1	58	59.8	0.000	154	88.5	98	74.8	0.002
	Yes	5	8.9	39	40.2	0.000	20	11.5	33	25.2	0.002
Number of persons per room
	Under 2 persons	15	26.8	42	43.3	0.040	43	24.7	61	46.6	0.000
	More than 2 persons	41	73.2	55	56.7	0.040	131	75.3	70	53.4	0.000
Smoking
	No smoking	33	58.9	55	56.7	0.900	125	71.8	99	77.3	0.500
	Up to 10 cigarettes per day	12	21.4	22	22.7		40	23.0	24	18.8
	>10 cigarettes per day	11	19.6	18	18.6		9	5.2	5	3.9
AUDIT
	No use	35	62.5	47	48.5	0.300	141	81.0	104	79.4	0.500
	Low-risk use	9	16.1	25	25.8		18	10.3	19	14.5
	Risky use	6	10.7	12	12.4		11	6.3	5	3.8
	Dependent/damage use	6	10.7	13	13.4		4	2.3	3	2.3
Contact with a patient with active TB
	No	30	54.5	60	68.2	0.100	114	67.1	95	74.2	0.100
	Yes	25	45.5	28	31.8	0.100	56	32.9	33	25.8	0.100
BCG vaccination
	No	16	29.6	35	36.1	0.400	37	21.5	36	28.1	0.100
	Yes	38	70.4	62	63.9	0.400	135	78.5	92	71.9	0.100

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[1] Correspondence to: Paulo Cesar Basta Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rua Leopoldo Bulhões 1480, Manguinhos, CEP 21041-210, Rio de Janeiro, RJ, Brazil Tel: +55 21 2598-2683E-mail:paulobasta@gmail.com