Factors associated with tuberculosis in persons deprived of liberty in Espírito Santo

Macedo, Laylla Ribeiro; Maciel, Ethel Leonor Noia; Struchiner, Claudio Jose

doi:10.11606/s1518-8787.2020054001818

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Sumário

Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054001818 copy

Factors associated with tuberculosis in persons deprived of liberty in Espírito Santo

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVES

To calculate the rate of tuberculosis cases per prison unit in Espírito Santo; present the individual, clinical, and institutional characteristics of the cases in persons deprived of liberty (PPL); and analyze the association between these characteristics and treatment outcome in this population.

METHODS

The study included cases of tuberculosis in the PPL of Espírito Santo from 2014 to 2016. Rate calculation, descriptive analysis and hierarchical logistic regression were performed considering the individual, clinical and institutional levels.

RESULTS

The rate of diagnosed cases per prison unit in the state ranged from 0 to 17.3 cases per 1,000 inmates. Of all reported cases, 218 (72.6%) healed, 21 (7.0%) dropped out, 1 (0.3%) died of tuberculosis, 2 (0.7%) died from other causes, 56 (18.7%) transferred the treatment site and 2 (0.7%) developed drug-resistant tuberculosis. The adjusted analysis showed that supervised treatment ensures success (CR = 0.29; 95%CI 0.01–0.76).

CONCLUSIONS

The study highlighted the importance of knowing the TB treatment outcome in the PPL to implement measures to reduce failure, and the contribution of supervised treatment in this process.

Prisoners. Tuberculosis; epidemiology. Tuberculosis; Multidrug-Resistant; epidemiology

Characteristics	Success n (%)	Failure n (%)	Total cases n (%)
Individual conditions
Gender
Male	216 (73.7)	77 (26.3)	293 (97.7)
Female	2 (28.6)	5 (71.4)	7 (2.3)
Age group
18 to 29 years	144 (75.0)	48 (25.0)	192 (64.0)
30 to 39 years old	53 (66.2)	27 (33.8)	80 (26.7)
40 years or older	21 (75.0)	7 (25.0)	28 (9.3)
Ethnicity
White	46 (65.7)	24 (34.3)	70 (23.3)
Black	33 (70.2)	14 (29.8)	47 (15.7)
Asian	1 (100.0)	0 (0.0)	1 (0.3)
Mixed race	127 (76.5)	39 (23.5)	166 (55.4)
Indigenous	0 (0.0)	0 (0.0)	0 (0.0)
Not reported	11 (68.8)	5 (31.2)	16 (5.3)
Schooling level
Illiterate	6 (85.7)	1 (14.3)	7 (2.3)
1 to 4 years	35 (56.7)	27 (43.5)	62 (20.7)
5 to 8 years	109 (83.8)	21 (16.2)	130 (43.3)
> 8 years	41 (78.8)	11 (21.2)	52 (17.3)
Not applicable	1 (50.0)	1 (50.0)	2 (0.7)
Not reported	26 (55.3)	21 (44.7)	47 (15.7)
Clinical conditions
Aids
No	193 (78.1)	54 (21.9)	247 (82.3)
Yes	11 (61.1)	7 (38.9)	18 (6.0)
Not reported	14 (40.0)	21 (60.0)	35 (11.7)
Diabetes mellitus
No	207 (74.2)	72 (25.8)	279 (93.0)
Yes	5 (83.3)	1 (16.7)	6 (2.0)
Not reported	6 (40.0)	9 (60.0)	15 (5.0)
Mental illness
No	213 (74.2)	74 (25.8)	287 (95.7)
Yes	2 (50.0)	2 (50.0)	4 (1.3)
Not reported	3 (33.3)	6 (66.7)	9 (3.0)
Alcoholism
No	164 (74.2)	57 (25.8)	221 (73.7)
Yes	52 (72.2)	20 (27.8)	72 (24.0)
Not reported	2 (28.6)	5 (71.4)	7 (2.3)
Admission
New case	159 (74.0)	56 (26.0)	215 (71.7)
Relapse	15 (65.2)	8 (34.8)	23 (7.7)
Re-entry after dropping out	25 (75.8)	8 (24.2)	33 (11.0)
Does not know	1 (100.0)	0 (0.0)	1 (0.3)
Transfer	18 (64.3)	10 (35.7)	28 (9.3)
Postmortem	0 (0.0)	0 (0.0)	0 (0.0)
Type
Pulmonary	197 (74.3)	68 (25.7)	265 (88.3)
Extrapulmonary	16 (59.3)	11 (40.7)	27 (9.0)
Pulmonary + extrapulmonary	5 (62.5)	3 (37.5)	8 (2.7)
Radiography
Normal	6 (66.7)	3 (33.3)	9 (3.0)
Suspect	183 (75.0)	61 (25.0)	244 (81.3)
Other pathology	2 (40.0)	3 (60.0)	5 (1.7)
Not performed	20 (60.6)	13 (39.4)	33 (11.0)
Not reported	7 (77.8)	2 (22.2)	9 (3.0)
Sputum smear
Negative	56 (77.8)	16 (22.2)	72 (24.0)
Positive	150 (72.5)	57 (27.5)	207 (69.0)
Not performed	10 (62.5)	6 (37.5)	16 (5.3)
Not applicable	2 (40.0)	3 (60.0)	5 (1.7)
Sputum culture
Negative	37 (71.2)	15 (28.8)	52 (17.3)
Positive	74 (81.3)	17 (18.7)	91 (30.3)
Pending	57 (64.0)	32 (36.0)	89 (29.7)
Not performed	50 (73.5)	18 (23.5)	68 (22.7)
Supervised treatment
No	21 (58.3)	15 (41.7)	36 (12.0)
Yes	191 (84.9)	34 (15.1)	225 (75.0)
Not reported	6 (15.4)	33 (84.6)	39 (13.0)

Characteristics	Success n (%)	Failure n (%)	Total of cases n (%)
Institutional Conditions
Establishment type
Provisional	98 (71.0)	40 (29.0)	138 (46.0)
Closed	94 (82.5)	20 (17.5)	114 (38.0)
Semi-open	17 (50.0)	17 (50.0)	34 (11.3)
Mixed	9 (64.3)	5 (35.7)	14 (4.7)
Safety measure	0 (0.0)	0 (0.0)	0 (0.0)
Occupation rate
Below 99.99%	10 (58.8)	7 (41.2)	17 (5.7)
100.00–199.99%	180 (72.6)	68 (27.4)	248 (82.6)
200.00% or more	28 (80.0)	7 (20.0)	35 (11.7)
Management
Public	207 (71.9)	81 (28.1)	288 (96.0)
Co-management	11 (91.7)	1 (8.3)	12 (4.0)
Type of building
Designed	197 (72.2)	76 (27.8)	273 (91.0)
Adapted	21 (77.8)	6 (22.2)	27 (9.0)
Visit unit
No	27 (71.1)	11 (28.9)	38 (12.7)
Minimum	84 (67.7)	40 (32.3)	124 (41.3)
Expanded	107 (77.5)	31 (22.5)	138 (46.0)
Health unit
Support	6 (66.7)	3 (33.3)	9 (3.0)
Minimum	33 (67.3)	16 (32.7)	49 (16.3)
Differentiated minimum	13 (72.2)	5 (27.8)	18 (6.0)
Expanded	166 (74.1)	58 (25.9)	224 (74.7)
Education unit
No	49 (73.1)	18 (26.9)	67 (22.3)
Minimum	18 (78.3)	5 (21.7)	23 (7.7)
Expanded	151 (71.9)	59 (28.1)	210 (70.0)
Health team
Technical only	10 (52.6)	9 (47.4)	19 (6.3)
Minimum	20 (76.9)	6 (23.1)	26 (8.7)
Differentiated minimum	35 (70.0)	15 (30.0)	50 (16.7)
Expanded	8 (50.0)	8 (50.0)	16 (5.3)
Differentiated expanded	145 (76.7)	44 (23.3)	189 (63.0)
Work rate
No	30 (78.9)	8 (21.1)	38 (12.7)
0.10–14.99%	142 (72.1)	55 (27.9)	197 (65.6)
15.00–29.99%	35 (89.7)	4 (10.3)	39 (13.0)
30.00–44.99%	3 (27.3)	8 (72.7)	11 (3.7)
45.00–59.99%	3 (60.0)	2 (40.0)	5 (1.7)
60.00% or more	5 (50.0)	5 (50.0)	10 (3.3)
Education rate
No	51 (70.8)	21 (29.2)	72 (24.0)
0.10–14.99%	61 (65.6)	32 (34.4)	93 (31.0)
15.00–29.99%	77 (79.4)	20 (20.6)	97 (32.3)
30.00–44.99%	9 (81.8)	2 (18.2)	11 (3.7)
45.00–59.99%	11 (64.7)	6 (35.3)	17 (5.7)
60.00% or more	9 (90.0)	1 (10.0)	10 (3.3)

Characteristics	Gross OR (95%CI)	p-value	Adjusted OR (95%CI)	p-value

Aids		0.105		0.159
No	1.00		1.00
Yes	2.27 (0.80–6.06)		2.26 (0.59–8.62)
Type		0.112		0.044
Pulmonary	1.00		1.00
Extrapulmonary	1.99 (0.86–4.46)		1.81 (0.38–8.52)
Pulmonary + extrapulmonary	1.73 (0.34–7.27)		4.98 (0.51–48.11)
Sputum smear		0.058		0.094
Negative	1.00		1.00
Positive	1.33 (0.71–2.56)		1.31 (0.42–4.40)
Not performed	2.10 (0.63–6.59)		2.19 (0.54–16.19)
Not applicable	5.25 (0.80–42.54)		43.85 (1.47–1303.20)
Radiography		0.084		0.220
Normal	1.00		1.00
Suspect	0.66 (0.17–3.23)		0.38 (0.04–3.08)
Other pathology	3.00 (0.32–34.76)		1.29 (0.07–22.38)
Not performed	1.30 (0.28–7.02)		0.92 (0.09–8.93)
Supervised treatment		< 0.001		0.002
No	1.00		1.00
Yes	0.24 (0.11–0.53)		0.29 (0.10–0.76)
Management		0.165		0.123
Public	1.00		1.00
Co-management	0.23 (0.01–1.22)		0.21 (0.26–1.70)
Occupancy rate		0.124		0.037
below 99.99%	1.00		1.00
100.00–199.99%	0.53 (0.19–1.53)		0.51 (0.18–1.43)
200.00% or more	0.35 (0.09–1.27)		0.23 (0.06–0.88)
Visit unit		0.170		0.040
No	1.00		1.00
Minimum	1.16 (0.53–2.67)		1.03 (0.45–2.33)
Expanded	0.71 (0.32–164)		0.52 (0.22–1.23)

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[1] Correspondence: Laylla Ribeiro Macedo Centro de Ciências da Saúde Av. Marechal Campos, 1468 29047-105 Vitória, ES, Brasil E-mail: layllarm@hotmail.com