RESUMO
Background: Poor living conditions promote the spread of communicable diseases. It happened with Tuberculosis (TB) and is happening with COVID-19. Due to its dynamic nature, this group of diseases must be studied in the context of the social determinants of health. Aim: To describe the epidemiological behavior of COVID-19 in response to the control strategies implemented by the Chilean Ministry of Health and its similarities with the socio-economic distribution of TB in the Metropolitan Region (MR) of Chile. Material and Methods: The 2018 Tuberculosis rates and average income of districts belonging to the MR were described, as well as the incidence rates of COVID-19. A Pearson correlation analysis was applied between the rates of both diseases, to assess similarities in the epidemiological distribution patterns. Results: The RM accounts for over 50% of the total national cases of COVID-19. After the implementation of selective quarantines, only four districts in the RM managed to control the outbreak (those with the highest incomes). In the rest, a clear increase in cases was observed. The districts with the highest increase in cases were the most disadvantaged, and those with the highest TB rates during 2018, with a correlation coefficient of 0.6. Conclusions: Control policies cannot deepen health inequalities. If vulnerable groups, as well as the factors that determine their health, are not properly identified, the consequences of the current pandemic could be even more devastating.
Assuntos
Humanos , Tuberculose/epidemiologia , Infecções por Coronavirus/epidemiologia , Fatores Socioeconômicos , Chile/epidemiologia , Disparidades nos Níveis de SaúdeRESUMO
Resumen Introducción: El Programa chileno de Control y Eliminación de Tuberculosis (PROCET) ha permitido reducir la mortalidad por esta enfermedad en 78%, entre los años 2004 y 2013. No obstante, luego de décadas de resultados exitosos, a partir del 2000 ocurrió un enlentecimiento en la reducción de incidencia y desde el 2014, un aumento de ésta. Objetivos: Describir la evolución socio-epidemiológica de los casos de tuberculosis (TBC), desde 2005 al 2018, estratificando según país de origen, en Servicios de Salud de la Región Metropolitana (RM). Métodos: Estudio transversal con componente ecológico. Se consideraron las variables: edad, sexo, localización de la TBC, confirmación bacteriológica, co-infección con VIH, privación de libertad, país de procedencia y efectividad de la terapia anti-tuberculosis. Resultados: Se notificaron 7.507 casos, de los cuales 75,1% fue de localización pulmonar y 65,4% bacteriológicamente demostrado. Un 19,0% de los casos pertenecieron a personas no nacidas en Chile, con un aumento de esta proporción en los últimos seis años. Las tasas de incidencia, descendientes en la primera mitad del período, exhibieron un alza a partir del 2012, alejándolas del umbral de eliminación. Se observó en 74,3% éxito en la terapia y 13,4% de muerte en los casos evaluados. Conclusiones: En los últimos años, la incidencia de TBC en la RM aumentó. Los nuevos grupos vulnerables, especialmente los migrantes, requieren con urgencia, que se implementen y refuercen estrategias como la educación, pesquisa activa y acciones de control de TBC.
Abstract Background: The Chilean Program for the Control and Elimination of Tuberculosis (PROCET) has reduced mortality from this disease by 78% between 2004 and 2013. However, after decades of successful results, starting in 2000 there was a slowdown in the reduction of incidence and since 2014, an increase in it. Aim: To describe the socio-epidemiological evolution of tuberculosis (TB) cases treated at health clinics in the Metropolitan Region (MR) of Chile from 2005 to 2018, stratifying by country of origin. Methods: Cross-sectional study with ecological components, including analyses of age, sex, TB localization, bacteriological confirmation of diagnosis, co-infection with HIV, incarceration, country of origin, and effectiveness of tuberculosis treatment. Results: A total of 7,507 TB cases were recorded during the study period; 75.1% of cases were pulmonary tuberculosis, and 65.4% were bacteriologically confirmed. Overall, 19.0% of cases involved persons born outside of Chile, with the proportion of cases in foreign-born persons increasing over the past 6 years. Incidence decreased during the first half of the study period but then began to increase after 2012, moving the country away from the threshold of elimination. A total of 74.3% of cases were treated successfully, and 13.4% expired. Conclusion: In recent years, TB incidence has increased in the MR of Chile, possibly attributable to growing populations of vulnerable groups such as immigrants. This finding suggests an urgent need to implement and reinforce strategies such as education, an active screening model and more efficient contact tracing to prevent the spread of TB.
Assuntos
Humanos , Tuberculose/epidemiologia , Chile/epidemiologia , Incidência , Estudos Transversais , Emigrantes e ImigrantesRESUMO
Background: Tuberculosis (TB)/HIV coinfection has a high mortality rate. Aim: To describe socio-epidemiological characteristics of tuberculosis (TB)-HIV coinfection, and aspects associated with its prevalence, from 2005 to 2018. Material and Methods: Analysis of the registry of the tuberculosis control and elimination program of three public health services of metropolitan Santiago. The variables considered were: TB/HIV coinfection, age, sex, location of tuberculosis, bacteriological confirmation, incarceration, commune of residence, country of origin and effectiveness of the tuberculosis therapy. Results: We analyzed 7507 TB cases, of whom 12% corresponded to cases of coinfection. The number of coinfections doubled in the last 6 years. In 2018, 45% of coinfection cases occurred in migrants. Of the total cases evaluated, 53% were successfully treated and 28% died. Conclusions: The remarkable increase in TB/HIV coinfection, urgently demands new prevention and control strategies, aimed at the most vulnerable groups.
Assuntos
Humanos , Masculino , Feminino , Tuberculose/epidemiologia , Infecções por HIV/epidemiologia , Coinfecção/epidemiologia , Fatores Socioeconômicos , Chile/epidemiologia , Prevalência , Cidades/epidemiologiaRESUMO
Resumen Introducción: La adecuada adherencia a la TARV tiene un alto impacto en la sobrevida en el SIDA. Existe poco consenso sobre las causas de la baja adherencia al tratamiento en mujeres, estando éstas en una situación de desigualdad en términos de prevención y cuidados relacionados. Objetivos: Explorar y describir los aspectos socioculturales vinculados a la adherencia de mujeres al tratamiento anti-retroviral para el VIH/SIDA. Material y Métodos: Estudio cualitativo, exploratorio-descriptivo. La población de estudio fueron mujeres chilenas de 18 de edad o más con infección por VIH/SIDA. El tamaño de la muestra se definió por saturación de información. Se realizaron entrevistas en profundidad a 16 mujeres contactadas en siete centros públicos de atención a personas con infección por VIH en cuatro regiones del país, atendiendo al criterio de saturación de la información. Resultados: Existen diversos factores socio-culturales que determinan el grado de adherencia que las mujeres adoptan en relación al TARV. Los más relevantes son la satisfacción vital, el imaginario sobre el VIH, la disposición de sus redes frente al diagnóstico y la disponibilidad de información. Discusión: Se hace necesario incursionar en intervenciones específicas considerando los aspectos socio-culturales y satisfaciendo las necesidades psicosociales de las mujeres. Se hace imprescindible que las políticas públicas y los equipos de salud consideren dichos aspectos para mejorar la adherencia a la TARV.
Background: Adequate adherence to HAART has a high impact on survival of AIDA patients. There is little consensus on the causes of low adherence to treatment in women, who are in a situation of inequality in terms of prevention and related care. Objectives: To explore and describe the socio-cultural aspects related to the adherence of women to antiretroviral treatment for HIV / AIDS. Material and Methods: Qualitative, exploratory-descriptive study. The study population was focused on Chilean women, who are 18 years of age or older, living with HIV/AIDS. The sample size was defined by information saturation. In-depth interviews were conducted with 16 women contacted in seven public care centers for people living with HIV (PLHIV) in 4 regions of the country, and it was take into account the saturation of the information. Results: There are several sociocultural factors that determine the level of adherence that women adopt in relation to HAART. The most relevant ones are the vital satisfaction, the imaginary about HIV, the availability of their networks in front of diagnosis and the availability of information are fundamental. Discussion: It is necessary to enter into specific interventions considering the sociocultural aspects and satisfying the psychosocial needs of women. It is imperative that public policies and health teams consider these aspects to improve adherence to HAART.
Assuntos
Humanos , Feminino , Adulto , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Características Culturais , Adesão à Medicação/estatística & dados numéricos , Fatores Socioeconômicos , Chile , Fatores Sexuais , Pesquisa Qualitativa , Adesão à Medicação/psicologiaAssuntos
Humanos , Masculino , Feminino , Infecções por HIV/prevenção & controle , Doenças Transmissíveis Emergentes/prevenção & controle , Prevenção Primária , Infecções por HIV/epidemiologia , Chile/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Doenças Transmissíveis Emergentes/epidemiologia , Prevenção SecundáriaRESUMO
Introduction: Meningococcal disease (MD) is a public health problem worldwide, due to its high morbidity and mortality. Most cases occur in sub-Saharan Africa, where there is a marked seasonal pattern with predominance during the dry season. Objectives: To describe the morbidity of MD in the Metropolitan Region (MR) of Chile and explore whether there is a correlation between the number of cases with the levels of atmospheric particulate matter PM 10 and PM 2.5, relative humidity (RH), temperature and total environmental pollen. Materials and Methods: Ecological time series study, statistical analysis with R 3.0.1, graphics with Excel 2013. Results: Between 2010 and 2013, 234 MD cases were reported in the MR with an increasing trend. There is a seasonal pattern with an increase of cases from August to October, and a decrease from March to April. There is no correlation with the levels of PM10 and PM2.5. There is a slight positive correlation with RH and a slight negative correlation with temperature. There is a moderate positive correlation with the levels of total environmental pollens. Discussion: Overcrowding and the winter viral infections could explain the increased incidence of MD and the slight correlation with RH and temperature. The moderate correlation with the pollens could be explained by an effect of irritation of the upper airway. Conclusions: More epidemiological studies whose designs allow a greater causal inference are required.
Introducción: La enfermedad meningocóccica (EM) constituye un problema de salud pública mundial debido a su alta morbi-mortalidad. La mayor cantidad de casos ocurre en África subsahariana, donde existe un marcado patrón estacional en la estación seca. Objetivos: Describir la morbilidad de la EM en la Región Metropolitana (RM) de Chile y explorar si existe correlación entre el número de casos con PM 10, PM 2,5 humedad relativa (HR), temperatura y pólenes ambientales totales. Materiales y Métodos: Estudio ecológico tipo series de tiempo, análisis estadístico con R 3.0.1, gráficos con Excel 2013. Resultados: En el período 2010-2013 se notificaron 234 casos de EM en la RM, con una tendencia al alza. Se observa un patrón estacional con aumento de casos entre agosto y octubre y una disminución entre marzo y abril. No existe correlación con los niveles de PM 10 ni de PM 2,5. Se describe una correlación positiva leve con la HR y negativa leve con la temperatura. Existe correlación moderada positiva con los niveles de pólenes totales ambientales. Discusión: El hacinamiento y las infecciones virales de invierno podrían explicar el aumento de casos de EM y la correlación leve con la HR y la temperatura. La correlación moderada con los pólenes podría explicarse por un efecto de irritación de la vía aérea superior. Conclusiones: Se requieren más estudios epidemiológicos cuyos diseños permitan una mayor inferencia causal.