Conocimientos, percepciones y prácticas de personal de salud en la detección de sintomáticos respiratorios en una región de muy alto riesgo de trasmisión de tuberculosis en el Perú / Knowledge, perceptions and practices of health care workers about detection ofrespiratory symptomatics in a very high risk region of tuberculosis transmission in Peru

Introducción. Tacna es una región de muy alto riesgo de transmisión de tuberculosis. Sin embargo, se ha encontrado que el rendimientodiagnóstico de la baciloscopia en sus establecimientos de salud es del 1,5%. Objetivo. Describir los conocimientos, percepcionesy prácticas sobre detección de sintomáticos respiratorios (SR). Diseño. Estudio transversal. Lugar. Establecimientos de salud de laDirección Regional de Salud de Tacna. Participantes. Profesionales de salud (médicos y enfermeras). Intervenciones. Cuestionarioestructurado auto-administrado y anónimo, elaborado por los autores del estudio en base a la vigente “Norma Técnica de Salud parala Atención Integral de las Personas Afectadas por Tuberculosis”. Principales medidas de resultado. Frecuencia absoluta y relativa deconocimientos adecuados, percepciones y prácticas sobre detección de sintomáticos respiratorios. Resultados. De 178 profesionalesde salud (médicos y enfermeras), 89,9% conocían la definición de SR; 93,3% sabía que debe solicitarse dos muestras de esputo a losSR; 22,5% conocía el indicador que evalúa la calidad de detección de SR, y 28,1%, el indicador que evalúa la capacidad del personalpara realizar la baciloscopia entre los sintomáticos respiratorios identificados; 49,4% sabía que la meta del indicador de intensidadde búsqueda es 5 por 100 atenciones en mayores de 15 años y 60,8% señaló haber leído la norma técnica vigente. Conclusiones. Enel estudio, existió una brecha en el conocimiento de médicos y enfermeras en la detección de sintomáticos respiratorios. Esta brechafue mayor en el conocimiento sobre los indicadores operacionales de detección.

Introduction. Tacna is a region with very high risk of tuberculosis transmission; however, the diagnostic performance of directsmears in their healthcare centers is 1.5%. Objectives. To describe the knowledge, perceptions and practices about detectionof respiratory symptomatic subjects. Design. Cross sectional study. Setting. Health care centers of Tacna Regional HealthDirectorate. Participants. Health professionals including physicians and nurses. Interventions. A structured self-administered,anonymous questionnaire, developed by the authors, based on the current "Technical Standard for Comprehensive Management ofPeople Affected by Tuberculosis", was applied to 178 health professionals (physicians and nurses). Main outcome measures. Absoluteand relative frequency of adequate knowledge, perceptions and practices on detection of respiratory symptomatic subjects. Results. Inthe study, 89.9% knew the definition of respiratory symptomatic, 93.3% was aware that two sputum specimens should be requested tothe respiratory symptomatic persons, 22.5% recognized the indicator that assesses the quality of detection of respiratory symptomatic,and 28.1% knew the indicator that assesses the ability of staff to perform the smear in identified respiratory symptomatic. 49.4%distinguished that the goal of the search intensity indicator is 5 per 100 attentions in people older than 15 years, and 60.8% reportedhaving read the current technical standard. Conclusions. A gap in the knowledge of physicians and nurses in the detection of respiratorysymptomatic subjects was found. This gap was greater in knowledge about operational indicators of detection.

Prevalence of patients with respiratory symptoms through active case finding and diagnosis of pulmonary tuberculosis among prisoners and related predictors in a jail in the city of Carapicuíba, Brazil / Prevalência de sintomáticos respiratórios através da busca ativa, diagnóstico de tuberculose pulmonar entre pessoas privadas de liberdade e fatores associados em uma cadeia pública no município de Carapicuíba, Brasil

BACKGROUND: Prisons offer a fertile setting for the transmission of tuberculosis due to the presence of many classic risk factors for both infection and disease: overcrowding, poor ventilation, and little sunlight. Prisoners are often malnourished and have poor hygiene and are more likely to have a background of alcohol and drug abuse. OBJECTIVES: To determine the prevalence of prisoners with respiratory symptoms and pulmonary tuberculosis (PTB) through active case finding in a prisoner population of the county jail of Carapicuíba, and to study possible related variables. METHODS: This was a cross-sectional study, and respiratory symptomatic individuals (RSI) were detected through active case finding. Socio-demographic data were collected from inmates' judicial history using a specific questionnaire. The RSI provided sputum specimens for detection of acid fast bacilli and culture for mycobacterium identification. RESULTS: Among the 397 prisoners studied, 154 reported respiratory symptoms for more than three weeks, and were considered RSI; the variables associated with RSI were: having already been tried and incarcerated for more than six months and seven were diagnosed as PTB (1,763 cases/ 100,000 inhabitants). CONCLUSIONS: The prevalence of RSI and PTB cases were respectively 39 and 35 times greater than the general population.

INTRODUÇÃO: Estabelecimentos prisionais são um campo favorável para a transmissão de tuberculose (TB), devido a presença de vários fatores de risco clássicos, tanto para a infecção como para a doença: aglomeração, falta de ventilação e de iluminação, como também o fato de os detentos receberem uma nutrição deficitária e os locais possuí-rem condições de higiene precárias; uma grande proporção dos detentos apresentam história pregressa de alcoolismo e uso de drogas ilícitas nas dependências desses estabelecimentos. OBJETIVOS: Determinar a prevalência de sintomáticos respiratórios (RSI) e casos de tuberculose pulmonar (TBP) através da busca ativa em população privada de liberdade na cadeia pública do município de Carapicuíba e estudar os prováveis fatores associados. MÉTODO: O desenho de estudo foi do tipo corte transversal, realizou-se a busca ativa de RSI e os dados sociodemográficos foram coletados em questionários específicos a partir dos processos judiciais dos participantes. Os RSI foram submetidos ao exame de baciloscopia e cultura para micobactérias do escarro. RESULTADOS: Dos 397 detentos estudados, 154 relataram tosse por mais de três semanas, considerados RSI. Os fatores associados à presença de sintomas respiratórios foram estar preso há mais de seis meses e ter sido julgado. Foram diagnosticados 7 casos de tuberculose pulmonar, 1.763 casos por 100.000 detentos. CONCLUSÕES: A prevalência de RSI e casos de TBP foram 39 e 35 vezes superior ao encontrado na população em geral respectivamente.

Perspectivas del paciente en relación con la calidad de los esputos para baciloscopias en tuberculosis / The outlook of patients with respect to the quality of sputum smears for bacilloscopy in tuberculosis

INTRODUCCIÓN: la tuberculosis (TB) es aún un grave problema de salud para muchos países. Un aspecto importante es la efectividad en la pesquisa de las personas sintomáticas respiratorias (SR) sospechosas de la enfermedad. OBJETIVO: evaluar la factibilidad de la aplicación de encuestas epidemiológicas rápidas para algunos aspectos de la recolección y calidad de los esputos en sintomáticos respiratorios. MÉTODOS: se aplicó un cuestionario previamente validado por expertos a personas sintomáticas respiratorias de 10 municipios de Ciudad de La Habana en enero-febrero de 2006. Para la selección de los sintomáticos respiratorios, se ejecutó un muestreo por conglomerados trietápico. RESULTADOS: la encuesta tuvo buena aceptación de la población investigada, que aportó los datos solicitados. El tiempo promedio de duración de la tos fue 15,3 d; 87,1 por ciento de las muestras de esputos se obtuvo en las primeras horas de la mañana y 80 por ciento de los investigados las consideraron de buena calidad. CONCLUSIONES: estos hallazgos son aceptables e importantes para la vigilancia y control de la tuberculosis en esta provincia y muestran la utilidad de las encuestas.

INTRODUCTION: tuberculosis is still one of the most serious health problems in many countries and one important aspect is the effective screening of respiratory symptomatic TB suspects. OBJECTIVES: to evaluate the feasibility in the administration of rapid epidemiological surveys for some aspects of sputum smears collection and quality in respiratory symptomatic TB suspects. METHODS: a previously expert-validated questionnaire was administered to people with respiratory symptoms from January to February 2006 in ten municipalities of Ciudad de la Habana province. For the selection of the respiratory symptomatic suspects, a three-phase cluster sampling was performed. RESULTS: the survey was well accepted by the study population which provided the requested data. Cough persisted for 15,3 days; 87,1 percent of sputum smears were taken early in the morning and 80 percent of the studied people considered it as good. CONCLUSIONS: these findings are acceptable and important for TB surveillance and control in this province and show the usefulness of these surveys.

Situación de la tuberculosis en Colombia, 2002

En Colombia, la tuberculosis continúa siendo un problema de salud pública. El objetivo de este estudio fue describir y analizar el comportamiento epidemiológico de la tuberculosis en Colombia durante el 2002 para identificar prioridades de intervención en su control. Se analizaron los datos consolidados del Informe trimestral de casos y actividades del 2002 recolectados por el Programa Nacional de Tuberculosis. En los últimos 10 años, el comportamiento de la tuberculosis es claramente fluctuante, específicamente hasta 1997 cuando se inicia una tendencia sostenida al incremento. Dos terceras partes de las entidades territoriales tuvieron incidencias superiores al promedio nacional (26 por 100.000 habitantes). Seis departamentos se clasificaron de muy alto riesgo (>50 por 100.000 habitantes). De 11.376 casos, 7.787 fueron casos nuevos pulmonares bacilíferos. El mayor número de casos nuevos de tuberculosis pulmonar bacilífera se observó en el sexo masculino y en el grupo de 25 a 34 años, mientras que la mayor incidencia se notificó para el grupo de 65 años y más. La proporción de pacientes sintomáticos respiratorios examinados en mayores de 15 años disminuyó. La positividad de la baciloscopia fue de 3,8% y el promedio de baciloscopias fue de 1,6 por paciente. Los indicadores de seguimiento aún no se encuentran dentro de los valores fijados. La aplicación de criterios normados a los pacientes de tuberculosis, por parte de las entidades prestadoras de servicios, así como el desarrollo de actividades de vigilancia, la retroalimentación a los informes, la supervisión en los diferentes niveles y la garantía de voluntad política para la implementación de la estrategia DOTS son elementos necesarios que permitirán el buen funcionamiento del programa de tuberculosis en el país.

Situation of tuberculosis in Colombia, 2002 Tuberculosis (TB) remains an important public health problem in Colombia. Therefore, in 2002, the epidemiological behavior of TB was described in order to identify priority interventions for its control. Data were analyzed from the 2002 "Quarterly Report of Cases and Activities" collected by the National TB Program. TB demonstrated a fluctuating behavior during the past decade, particularly until 1997, when regularly increasing trend began. Two thirds of the 32 departments of Colombia had incidence rates above the national average (>26 per 100,000); six departments were classified as being at very high risk (incidence >50 per 100,000). Of 11,376 cases, 7,787 were new pulmonary smear-positive cases; most of them were males aged 25 to 34 years, with the highest incidence in age group 65 or older. A decrease was observed in respiratory symptomatic patients aged 15 years or older. Smear positivity from all patients was 3.8% and the smear average was 1.6 per patient. Follow up indicators are still under the desirable levels.The application of health care guidelines to TB patients by health care institutions, as well as the development of monitoring activities, the report feedback are essential elements in an effective TB control program. However, successful implementation also requires careful supervision at each level of application and political will at local and department levels to adhere to DOTS.