ABSTRACT
Objective: To identify factors correlated with the incidence and mortality from COVID-19 and investigate syndemic situations at the global level. Method: An ecologic study of confirmed COVID-19 cases and deaths was performed using information collected from the European Center for Disease Prevention and Control in 2019 and 2020. World Bank indicators and information obtained from Worldometer Coronavirus were used to characterize the countries. Descriptive analyses and correlations between independent variables were performed, followed by multiple linear regression analysis to identify factors correlated with COVID-19 incidence and mortality. Results: Data were obtained for 185 countries. Mean case incidence was 16 482/1,000 population, whereas mean COVID-19 mortality was 291/1,000 population, with the highest and lowest rates recorded in North America and East Asia and Pacific respectively. A positive correlation was identified between incidence rate and percent population aged 15 to 64 years, urban population, inequality measured by the Gini coefficient, and six out of the seven regions analyzed (except East Asia and Pacific). Mortality rate was negatively correlated with population aged 0 to 14 years and positively correlated with urban population, inequality measured by the Gini coefficient, and all regions analyzed except East Asia and Pacific. Conclusions: COVID-19 morbidity and mortality were correlated with the burden of chronic diseases, aging population, and low capacity of healthcare services for testing and providing hospital beds, a scenario complicated by social inequality in countries and regions, indicating a syndemic effect.
Objetivo: Identificar los factores correlacionados con la incidencia de COVID-19 y la mortalidad por esa causa y verificar las situaciones de sindemia a escala mundial. Métodos: Se realizó un estudio ecológico de casos de COVID-19 y de defunciones confirmadas por esa causa a partir de la información obtenida del Centro Europeo para la Prevención y el Control de las Enfermedades en el 2019 y el 2020. Para caracterizar a los países, se utilizaron indicadores del Banco Mundial y del sitio web de referencia Worldometer Coronavirus. Se hicieron análisis descriptivos y de correlación entre las variables independientes para crear posteriormente un modelo de regresión lineal múltiple con el fin de identificar los factores correlacionados con la incidencia de COVID-19 y la mortalidad por esa causa. Resultados: Se obtuvieron datos de 185 países. La tasa media de incidencia de casos de COVID-19 fue de 16 482 por mil habitantes y la tasa media de mortalidad por esa causa fue de 291 por mil habitantes. Las regiones de América del Norte y de Asia oriental y el Pacífico presentaron los mayores y menores índices, respectivamente. Se observó una correlación positiva de la tasa de incidencia con la proporción del grupo de 15 a 64 años de edad, la población urbana, la desigualdad medida por el coeficiente de Gini y seis de las siete regiones analizadas (excepto Asia oriental y el Pacífico). La tasa de mortalidad presentó una correlación negativa con el grupo de 0 a 14 años de edad y positiva con la población urbana, la desigualdad medida por el coeficiente de Gini y todas las regiones analizadas, excepto Asia oriental y el Pacífico. Conclusiones: La morbimortalidad por COVID-19 guardó una correlación con la carga de problemas crónicos de salud, el envejecimiento de la población y la poca capacidad de realizar pruebas en los servicios de salud y de ofrecer camas de hospital, cuadro agravado en los países o regiones con una elevada tasa de desigualdad social y característico de una situación de sindemia.
ABSTRACT
BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perceptions of health professionals about MDR-TB, their strategies to ensure adherence to treatment and their challenges in the context of the COVID-19 pandemic in a priority municipality for disease control. METHODS: We conducted a qualitative study and recruited 14 health providers (four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker) working in a city in the state of São Paulo, Brazil. Remote semi-structured interviews were conducted with the participants. For data analysis, the thematic content analysis technique was applied according to the study's theoretical framework. RESULTS: The study revealed the causes of MDR-TB are associated with poverty, vulnerability, and social risk. A pre-judgement from the providers was observed, namely, all patients do not adhere due their resistance and association with drug abuse or alcoholism. The study also observed difficulty among health providers in helping patients reconstruct and reframe their life projects under a care perspective, which would strengthen adherence. Other issues that weakened adherence were the cuts in social protection and the benefits really necessary to the patients and a challenge for the providers manage that. The participants revealed that their actions were impacted by the pandemic and insecurity and fear manifested by patients after acquiring COVID-19. For alleviating this, medical appointments by telephone, delivery of medicine in the homes of patients and visits by health professionals once per week were provided. CONCLUSION: The study advances knowledge by highlighting the challenges faced by the health system with the adherence of patients with MDR-TB in a context aggravated by the pandemic. An improvement in DOT is really necessary to help the patients reframe their lives without prejudices, face their fears and insecurity, recover their self-esteem and motivate in concluding their treatment.