Vulnerability to loss of follow-up and death due to tuberculosis among homeless individuals in Brazil: a retrospective cohort study. / Vulnerabilidade à perda de seguimento e ao óbito por tuberculose nas pessoas em situação de rua no Brasil: um estudo de coorte retrospectiva.

This retrospective cohort study identified factors associated with loss of follow-up and death due to tuberculosis (TB) in the homeless population (HP) in Brazil, estimating odds ratios (OR) and their 95% confidence intervals (95%CI) by multinomial logistic regression. A total of 3,831 TB cases in this population were analyzed, of which 57.0% had unfavorable outcomes. Loss of follow-up was associated with: history of abandonment (OR=2.38; 95%CI 2.05-2.77), unknown HIV serology (OR=1.79; 95%CI 1.38-2.32), HIV coinfection (OR=1.73; 95%CI 1.46-2.06), drug use (OR=1.54; 95%CI 1.31-1.80), age (OR=0.98; 95%CI 0.97-0.99), mixed clinical form (OR=0.64; 95%CI 0.42-0.97), extrapulmonary form (OR=0.46; 95%CI 0.29-0.73), government beneficiary (OR=0.64; 95%CI 0.50-0.81), and supervised treatment (OR=0.52; 95%CI 0.45-0.60). Regarding death, the following were associated: age (OR=1.03; 95%CI 1.01-1.05), unknown HIV serology (OR=2.39; 95%CI 1.48-3.86), alcohol consumption (OR=1.81; 95%CI 1.27-2.58), and supervised treatment (OR=0.70; 95%CI 0.51-0.96). Overlapping vulnerabilities in the health-disease process of homeless individuals with TB were observed, requiring comprehensive and cross-sectoral care practices.

Esta coorte retrospectiva identificou os fatores associados à perda de seguimento e ao óbito por tuberculose na população em situação de rua no Brasil, estimando-se as odds ratios (OR) e seus intervalos de confiança de 95% (IC95%) por regressão logística multinominal. Analisaram-se 3.831 casos de tuberculose nessa população, dos quais 57,0% tiveram desfechos desfavoráveis. Associaram-se à perda de seguimento: histórico de abandono (OR=2,38; IC95% 2,05-2,77), desconhecimento da sorologia do HIV (OR=1,79; IC95% 1,38-2,32) e coinfecção com HIV (OR=1,73; IC95% 1,46-2,06), uso de drogas (OR=1,54; IC95% 1,31-1,80), idade (OR=0,98; IC95% 0,97-0,99), forma clínica mista (OR=0,64; IC95% 0,42-0,97) e extrapulmonar (OR=0,46; IC95% 0,29-0,73), auxílio de programa governamental (OR=0,64; IC95% 0,50-0,81) e tratamento supervisionado (OR=0,52; IC95% 0,45-0,60). Em relação ao óbito, associaram-se: idade (OR=1,03; IC95% 1,01-1,05), desconhecimento da sorologia do HIV (OR=2,39; IC95% 1,48-3,86), uso de álcool (OR=1,81; IC95% 1,27-2,58) e tratamento supervisionado (OR=0,70; IC95% 0,51-0,96). Percebeu-se a sobreposição de vulnerabilidades no processo saúde-doença das pessoas em situação de rua com tuberculose, demandando práticas cuidativas intersetoriais e integrais.

Therapeutic itineraries of quilombola adults for oral health care in a rural district of Bahia, Brazil. / Itinerários terapêuticos para cuidados em saúde bucal de adultos quilombolas de um distrito rural da Bahia, Brasil.

This study examined the oral health-related therapeutic itineraries of quilombola adults in a rural district of Vitória da Conquista, Bahia. This qualitative study involved ten semi-structured interviews of adult members of the quilombola community, in May 2021, which were then transcribed and analysed using content analysis. The results showed little or poor oral hygiene at some stage of life, especially in childhood and adolescence, the use of popular oral health care practices, and experiences of professional care featuring tooth extraction. Use of health services was mostly reported only in the period prior to the COVID-19 pandemic. Responses as to perceived ease of access to health services in the community varied. One common complaint as to satisfaction with oral health was the need to use or replace dental prostheses. This study concluded that oral health must be promoted jointly with disease prevention, dental rehabilitation and recognition for the knowledge and worldview of the quilombola population.

O estudo analisou os itinerários terapêuticos relacionados à saúde bucal de adultos quilombolas de um distrito rural de Vitória da Conquista, Bahia. Trata-se de uma pesquisa qualitativa, na qual foram realizadas dez entrevistas semiestruturadas com adultos quilombolas em maio de 2021, transcritas e analisadas por meio da análise de conteúdo. Os resultados evidenciaram ausência e/ou precariedade na higiene bucal em alguma fase da vida, especialmente infância e adolescência; utilização de práticas populares para cuidado a saúde bucal e experiências de cuidado profissional marcados pela exodontia. A utilização de serviços de saúde foi relatada, em sua maioria, apenas no período anterior à pandemia de COVID-19, os entrevistados divergiram quanto à percepção de facilidade do acesso aos serviços de saúde em sua comunidade. Os relatos sobre a satisfação da saúde bucal destacaram a necessidade de uso ou substituição de próteses dentárias. À guisa de conclusão, entende-se que é necessária a promoção de saúde bucal de forma articulada com ações que possibilitem a prevenção de agravos, a reabilitação odontológica e a valorização do conhecimento e da visão de mundo da população quilombola.

Association between racial iniquities and oral health status: a systematic review. / Associação entre iniquidades raciais e condição de saúde bucal: revisão sistemática.

The present study aimed to investigate the association between racial iniquities and oral health status. This is a systematic review with a protocol registered on the Prospero Platform (CRD42021228417), with searches carried out in electronic databases and in gray literature. Our study identified 3,028 publications. After applying the eligibility criteria and risk of bias analysis, 18 studies were selected. The results indicate that individuals of black/brown race/skin color have unfavorable oral health conditions, mainly represented by self-rated oral health, tooth loss, caries, and periodontitis. The results showed racial iniquities in oral health in different countries, for all analyzed indicators, with a greater vulnerability of the black population.

O objetivo deste estudo é investigar a associação entre iniquidades raciais e condição de saúde bucal. Trata-se de revisão sistemática com protocolo cadastrado na plataforma prospero (CRD42021228417), com buscas realizadas em bases de dados eletrônicas e na literatura cinzenta. Identificou-se 3.028 publicações e após aplicação dos critérios de elegibilidade e análise do risco de vieses, 18 estudos foram selecionados. Os resultados indicam que indivíduos de raça/cor da pele preta/parda apresentam condições de saúde bucal desfavorável, representada principalmente pela autoavaliação de saúde bucal, perda dentária, cárie e periodontite. Os resultados evidenciaram iniquidades raciais em saúde bucal em diferentes países, para todos os indicadores analisados, com maior vulnerabilidade da população negra.

Itinerários terapêuticos para cuidados em saúde bucal de adultos quilombolas de um distrito rural da Bahia, Brasil / Therapeutic itineraries of quilombola adults for oral health care in a rural district of Bahia, Brazil

Resumo O estudo analisou os itinerários terapêuticos relacionados à saúde bucal de adultos quilombolas de um distrito rural de Vitória da Conquista, Bahia. Trata-se de uma pesquisa qualitativa, na qual foram realizadas dez entrevistas semiestruturadas com adultos quilombolas em maio de 2021, transcritas e analisadas por meio da análise de conteúdo. Os resultados evidenciaram ausência e/ou precariedade na higiene bucal em alguma fase da vida, especialmente infância e adolescência; utilização de práticas populares para cuidado a saúde bucal e experiências de cuidado profissional marcados pela exodontia. A utilização de serviços de saúde foi relatada, em sua maioria, apenas no período anterior à pandemia de COVID-19, os entrevistados divergiram quanto à percepção de facilidade do acesso aos serviços de saúde em sua comunidade. Os relatos sobre a satisfação da saúde bucal destacaram a necessidade de uso ou substituição de próteses dentárias. À guisa de conclusão, entende-se que é necessária a promoção de saúde bucal de forma articulada com ações que possibilitem a prevenção de agravos, a reabilitação odontológica e a valorização do conhecimento e da visão de mundo da população quilombola.

Abstract This study examined the oral health-related therapeutic itineraries of quilombola adults in a rural district of Vitória da Conquista, Bahia. This qualitative study involved ten semi-structured interviews of adult members of the quilombola community, in May 2021, which were then transcribed and analysed using content analysis. The results showed little or poor oral hygiene at some stage of life, especially in childhood and adolescence, the use of popular oral health care practices, and experiences of professional care featuring tooth extraction. Use of health services was mostly reported only in the period prior to the COVID-19 pandemic. Responses as to perceived ease of access to health services in the community varied. One common complaint as to satisfaction with oral health was the need to use or replace dental prostheses. This study concluded that oral health must be promoted jointly with disease prevention, dental rehabilitation and recognition for the knowledge and worldview of the quilombola population.

Associação entre iniquidades raciais e condição de saúde bucal: revisão sistemática / Association between racial iniquities and oral health status: a systematic review

Resumo O objetivo deste estudo é investigar a associação entre iniquidades raciais e condição de saúde bucal. Trata-se de revisão sistemática com protocolo cadastrado na plataforma prospero (CRD42021228417), com buscas realizadas em bases de dados eletrônicas e na literatura cinzenta. Identificou-se 3.028 publicações e após aplicação dos critérios de elegibilidade e análise do risco de vieses, 18 estudos foram selecionados. Os resultados indicam que indivíduos de raça/cor da pele preta/parda apresentam condições de saúde bucal desfavorável, representada principalmente pela autoavaliação de saúde bucal, perda dentária, cárie e periodontite. Os resultados evidenciaram iniquidades raciais em saúde bucal em diferentes países, para todos os indicadores analisados, com maior vulnerabilidade da população negra.

Abstract The present study aimed to investigate the association between racial iniquities and oral health status. This is a systematic review with a protocol registered on the Prospero Platform (CRD42021228417), with searches carried out in electronic databases and in gray literature. Our study identified 3,028 publications. After applying the eligibility criteria and risk of bias analysis, 18 studies were selected. The results indicate that individuals of black/brown race/skin color have unfavorable oral health conditions, mainly represented by self-rated oral health, tooth loss, caries, and periodontitis. The results showed racial iniquities in oral health in different countries, for all analyzed indicators, with a greater vulnerability of the black population.

Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020.

BACKGROUND: Tuberculosis (TB) is a preventable and a curable disease. In Brazil, TB treatment outcomes are particularly worse among homeless populations who are either of black race, malnourished or living with HIV/AIDS and other comorbidities. This study therefore evaluated factors associated with unsuccessful TB treatment among homeless population (HP) compared to those with shelter. METHODOLOGY/PRINCIPAL FINDINGS: The study population was composed of 284,874 people diagnosed with TB in Brazil between 2015 and 2020 and reported in the Information System for Notifiable Diseases (SINAN), among which 7,749 (2.72%) were homeless and 277,125 (97.28%) were sheltered. Cox regression analysis was performed with both populations to identify factors associated with unsuccessful TB treatment, and significant predictors of TB treatment outcomes. Results show that HP are more susceptible to unfavorable outcomes when compared to sheltered people (Hazard Ratio (HR): 2.04, 95% CI 1.82-2.28). Among the HP, illicit drug use (HR: 1.38, 95% CI 1.09-1.74), mental disorders (HR: 2.12, 95% CI 1.08-4.15) and not receiving directed observed treatment (DOT) (HR: 18.37, 95% CI 12.23-27.58) are significant predictors of poor treatment outcomes. The use of illicit drugs (HR: 1.53, 95% CI 1.21-1.93) and lack of DOT (HR: 17.97, 95% CI 11.71-27.59) are associated with loss to follow-up, while lack of DOT (HR: 15.66, 95% CI 4.79-51.15) was associated with mortality among TB patients. CONCLUSION/SIGNIFICANCE: Homeless population living in Brazil are twice at risk of having an unsuccessful treatment, compared to those who are sheltered, with illicit drugs use, mental disorders and lack of DOT as risk factors for unsuccessful TB outcomes. Our findings reinforce the arguments for an intersectoral and integral approach to address these determinants of health among the vulnerable homeless populations.

Performance evaluation of tuberculosis control in Brazilian municipalities.

OBJECTIVE: To evaluate the performance of tuberculosis control in Brazilian municipalities. METHODS: This is an ecological study on Brazilian municipalities that notified at least four new cases of tuberculosis, with a minimum of one new case of pulmonary tuberculosis between 2015 and 2018. The municipalities were stratified according to the population in < 50 thousand, 50-100 thousand, 100-300 thousand, and > 300 thousand inhabitants, and the k-means method was used to group them within each population range according to the performance of six indicators of the disease. RESULTS: A total of 2,845 Brazilian municipalities were included, comprising 98.5% (208,007/211,174) of new tuberculosis cases in the period. For each population range, three groups (A, B, and C) of municipalities were identified according to the performance of the indicators: A, the most satisfactory; B, the intermediates; and C, the least satisfactory. Municipalities in group A with < 100 thousand inhabitants presented results above the targets for laboratory confirmation (≥ 72%), abandonment (≤ 5%), and cure (≥ 90%), and comprised 2% of new cases of the disease. Conversely, municipalities of groups B and C presented at least five indicators with results below the targets - HIV testing (< 100%), contact investigation (< 90%), directly observed therapy (< 90%), abandonment (> 5%), and cure (< 90%) -, and corresponded to 66.7% of new cases of tuberculosis. In group C of municipalities with > 300 thousand inhabitants, which included 19 of the 27 capitals and 43.1% of new cases of tuberculosis, the lowest percentages of contact investigation (mean = 56.4%) and directly observed therapy (mean = 15.4%) were verified, in addition to high abandonment (mean = 13.9%) and low coverage of primary health care (mean = 66.0%). CONCLUSIONS: Most new cases of tuberculosis occurred in municipalities with unsatisfactory performance for disease control. Expanding the coverage of primary health care in these places can reduce abandonment and increase the contact investigation and directly observed therapy.

Hypertension in Quilombola children and adolescents.

ABSTRACT: To determine the prevalence of prehypertension (PH) and hypertension (AH) in quilombola children and adolescents, as well as to analyze sociodemographic, behavioral, and health characteristics.Prevalence study conducted in random samples of quilombola children and adolescents from 06 to 19 years of age, in remaining quilombo communities in Cachoeira-Bahia. Identification, sociodemographic, behavioral, anthropometric, and blood pressure (BP) data were used. Descriptive analyses of the variables of interest were performed based on absolute (N) and included frequencies (percentage, prevalence). Pearson's Chi-square (χ2) and Fisher Exact tests determined possible differences.Of the 668 participants, 54.3% were children, 51.2% were male, and 29.4% presented alterations in BP. PH and AH were found in 12.7% and 14.3% of the children, respectively; for adolescents, these values were 12.5% and 15.4%, respectively. No statistically significant difference was found between the prevalence of AH in the 2 population groups, nor between the PH measurements. Most families reported a low socioeconomic status. Among children, 6.6% were underweight, 14.6% were overweight, 10.7% were obese, 12.7% presented a Waist-to-Height Ratio (WHtR) > 0.5; 70.1% were inactive and 88.4% had a sedentary lifestyle; 5.6% of the adolescents were underweight, 12.8% were overweight, 9.2% were obese, 11.5% presented a WHtR > 0.5; 78% were inactive and 92.1% had a sedentary lifestyle. Normotensive children and adolescents, and those with alterations in BP differed only in terms of the Body Mass Index (P = .007) and WHtR (P < .001). The consumption of unhealthy foods was high.The high prevalence of PH and AH, as well as of exposure to potential risk factors for AH in quilombola children and adolescents, reveals a worrisome situation, and demands further studies to identify risk factors for this disease and the need for interventions beyond the health sector, especially as regards disease prevention and control in the early stages of life, aiming to reduce its prevalence as adults.

Performance evaluation of tuberculosis control in Brazilian municipalities / Avaliação de desempenho do controle da tuberculose em municípios brasileiros

ABSTRACT OBJECTIVE To evaluate the performance of tuberculosis control in Brazilian municipalities. METHODS This is an ecological study on Brazilian municipalities that notified at least four new cases of tuberculosis, with a minimum of one new case of pulmonary tuberculosis between 2015 and 2018. The municipalities were stratified according to the population in < 50 thousand, 50-100 thousand, 100-300 thousand, and > 300 thousand inhabitants, and the k-means method was used to group them within each population range according to the performance of six indicators of the disease. RESULTS A total of 2,845 Brazilian municipalities were included, comprising 98.5% (208,007/211,174) of new tuberculosis cases in the period. For each population range, three groups (A, B, and C) of municipalities were identified according to the performance of the indicators: A, the most satisfactory; B, the intermediates; and C, the least satisfactory. Municipalities in group A with < 100 thousand inhabitants presented results above the targets for laboratory confirmation (≥ 72%), abandonment (≤ 5%), and cure (≥ 90%), and comprised 2% of new cases of the disease. Conversely, municipalities of groups B and C presented at least five indicators with results below the targets - HIV testing (< 100%), contact investigation (< 90%), directly observed therapy (< 90%), abandonment (> 5%), and cure (< 90%) -, and corresponded to 66.7% of new cases of tuberculosis. In group C of municipalities with > 300 thousand inhabitants, which included 19 of the 27 capitals and 43.1% of new cases of tuberculosis, the lowest percentages of contact investigation (mean = 56.4%) and directly observed therapy (mean = 15.4%) were verified, in addition to high abandonment (mean = 13.9%) and low coverage of primary health care (mean = 66.0%). CONCLUSIONS Most new cases of tuberculosis occurred in municipalities with unsatisfactory performance for disease control. Expanding the coverage of primary health care in these places can reduce abandonment and increase the contact investigation and directly observed therapy.

RESUMO OBJETIVO Avaliar o desempenho no controle da tuberculose dos municípios brasileiros. MÉTODOS Estudo ecológico com municípios brasileiros que notificaram pelo menos quatro casos novos de tuberculose, com no mínimo um caso novo de tuberculose pulmonar entre 2015 e 2018. Os municípios foram estratificados de acordo com a população em < 50 mil, 50-100 mil, 100-300 mil e > 300 mil habitantes e foi utilizado o método k-médias para agrupá-los dentro de cada faixa populacional segundo desempenho de seis indicadores da doença. RESULTADOS Foram incluídos 2.845 municípios brasileiros abrangendo 98,5% (208.007/211.174) dos casos novos de tuberculose do período. Para cada faixa populacional identificou-se três grupos (A, B e C) de municípios segundo desempenho dos indicadores: A os mais satisfatórios, B os intermediários e C os menos satisfatórios. Municípios do grupo A com < 100 mil habitantes apresentaram resultados acima das metas para confirmação laboratorial (≥ 72%), abandono (≤ 5%) e cura (≥ 90%), e abrangeram 2% dos casos novos da doença. Por outro lado, os municípios dos grupos B e C apresentaram pelo menos cinco indicadores com resultados abaixo das metas - testagem HIV (< 100%), exame de contatos (< 90%), tratamento diretamente observado (< 90%), abandono (> 5%) e cura (< 90%) -, e corresponderam a 66,7% dos casos novos de tuberculose. Já no grupo C dos municípios com > 300 mil habitantes, que incluiu 19 das 27 capitais e 43,1% dos casos novos de tuberculose, encontrou-se os menores percentuais de exames de contatos (média = 56,4%) e tratamento diretamente observado (média = 15,4%), elevado abandono (média = 13,9%) e baixa cobertura da atenção básica (média = 66,0%). CONCLUSÕES Grande parte dos casos novos de tuberculose ocorreu em municípios com desempenho insatisfatório para o controle da doença, onde expandir a cobertura da atenção básica pode reduzir o abandono e elevar o exame de contatos e tratamento diretamente observado.

Epidemiological characteristics and temporal trends of new leprosy cases in Brazil: 2006 to 2017.

Our study aims to describe trends in new case detection rate (NCDR) of leprosy in Brazil from 2006 to 2017 overall and in subgroups, and to analyze the evolution of clinical and treatment characteristics of patients, with emphasis on cases diagnosed with grade 2 physical disabilities. We conducted a descriptive study to analyze new cases of leprosy registered in the Brazilian Information System for Notificable Diseases (SINAN), from 2006-2017. We calculated the leprosy NCDR per 100,000 inhabitants (overall and for individuals aged < 15 and ≥ 15 years) by sex, age, race/ethnicity, urban/rural areas, and Brazilian regions, and estimated the trends using the Mann-Kendall non-parametric test. We analyzed the distributions of cases according to relevant clinical characteristics over time. In Brazil, there was a sharp decrease in the overall NCDR from 23.4/100,000 in 2006 to 10.3/100,000 in 2017; among children < 15 years, from 6.94 to 3.20/100,000. The decline was consistent in all Brazilian regions and race/ethnicity categories. By 2017, 70.2% of the cases were multibacillary, 30.5% had grade 1 (G1D) or 2 (G2D) physical disabilities at diagnosis and 42.8% were not evaluated at treatment completion/discharge; cases with G2D at diagnosis were mostly detected in urban areas (80%) and 5% of cases died during the treatment (leprosy or other causes). Although the frequency of leprosy NCDR decreased in Brazil from 2006 to 2017 across all evaluated population groups, the large number of cases with multibacillary leprosy, physical disabilities or without adequate evaluation, and among children suggest the need to reinforce timely diagnosis and treatment to control leprosy in Brazil.

The association between a conditional cash transfer programme and malaria incidence: a longitudinal ecological study in the Brazilian Amazon between 2004 and 2015.

BACKGROUND: Malaria causes 400 thousand deaths worldwide annually. In 2018, 25% (187,693) of the total malaria cases in the Americas were in Brazil, with nearly all (99%) Brazilian cases in the Amazon region. The Bolsa Família Programme (BFP) is a conditional cash transfer (CCT) programme launched in 2003 to reduce poverty and has led to improvements in health outcomes. CCT programmes may reduce the burden of malaria by alleviating poverty and by promoting access to healthcare, however this relationship is underexplored. This study investigated the association between BFP coverage and malaria incidence in Brazil. METHODS: A longitudinal panel study was conducted of 807 municipalities in the Brazilian Amazon between 2004 and 2015. Negative binomial regression models adjusted for demographic and socioeconomic covariates and time trends were employed with fixed effects specifications. RESULTS: A one percentage point increase in municipal BFP coverage was associated with a 0.3% decrease in the incidence of malaria (RR = 0.997; 95% CI = 0.994-0.998). The average municipal BFP coverage increased 24 percentage points over the period 2004-2015 corresponding to be a reduction of 7.2% in the malaria incidence. CONCLUSIONS: Higher coverage of the BFP was associated with a reduction in the incidence of malaria. CCT programmes should be encouraged in endemic regions for malaria in order to mitigate the impact of disease and poverty itself in these settings.

Physical disabilities caused by leprosy in 100 million cohort in Brazil.

BACKGROUND: Leprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures and targeted interventions to mitigate its impact on affected individuals. This study investigated such factors among the most vulnerable portion of the Brazilian population. METHODS: A large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, covering the period 2001-2015, including over 114 million individuals. Data were linked to the leprosy notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to a multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervals. RESULTS: Among the original cohort members 21,565 new leprosy cases were identified between 2007 and 2014. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21 and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2.39 and 1.95, respectively), less schooling (with a clear dose response effect) and being a multibacillary patient (ORs 3.5 and 8.22). Protective factors for both grades were being female (ORs 0.81 and 0.61) and living in a high incidence municipality (ORs 0.85 and 0.67). CONCLUSIONS: The findings suggest that the developing of physical disabilities remains a public health problem which increases the burden of leprosy, mainly for those with severe clinical features and worse socioeconomic conditions. Early diagnosis is paramount to decrease the incidence of leprosy-related disability and our study points to the need for strengthening control actions in non-endemic areas in Brazil, where cases may be missed when presented at early stages in disease. Both actions are needed, to benefit patients and to achieve the WHO goal in reducing physical disabilities among new cases of leprosy.

Street people in Brazil: a descriptive study of their sociodemographic profile and tuberculosis morbidity, 2014-2019. / População em situação de rua no Brasil: estudo descritivo sobre o perfil sociodemográfico e da morbidade por tuberculose, 2014-2019.

OBJECTIVE: To characterize the sociodemographic profile of street people (SP) registered on the Single Register for Social Programs (CadÚnico) as at 2019 and tuberculosis morbidity in this population notified on the Notifiable Health Conditions Information System (Sinan) from 2014 to 2018. METHODS: This was a descriptive study carried out with data from Sinan and CadÚnico. RESULTS: 127,536 people registered on CadÚnico and 14,059 with tuberculosis notified on Sinan were included in the study. Higher concentrations of SP were found in the states of the South and Southeast regions. In the two subpopulations analyzed, there was a predominance of male SP (CadÚnico = 86.8%; Sinan = 80.9%), people of Black race/skin color (CadÚnico = 67.5%; Sinan = 64.1%) and with incomplete high school education or less (CadÚnico = 81.9%; Sinan = 60.1%). The high treatment dropout proportion (39.0%) was reflected in the high percentage of reentry and relapse. CONCLUSION: Tuberculosis continues to be a serious Public Health problem that aggravates survival conditions on the streets of Brazil.

Homeless Population in Brazil: a descriptive study on the sociodemographic profile and morbidity from tuberculosis, 2014-2019 / Población sin hogar en Brasil: estudio descriptivo sobre el perfil sociodemográfico y la morbilidad por tuberculosis, 2014-2019 / População em situação de rua no Brasil: estudo descritivo sobre o perfil sociodemográfico e da morbidade por tuberculose, 2014-2019

Objective: To characterize the sociodemographic profile of the homeless population (PSR) registered in the Cadastro Único para Programas Sociais (CadÚnico) until 2019 and the tuberculosis morbidity in this population notified in the Sistema de Informação de Agravos de Notificação (Sinan) from 2014 to 2018. Methods: Descriptive study carried out with data from Sinan and CadÚnico. Results: 127,536 people registered in CadÚnico and 14,059 with tuberculosis notified in Sinan were included. Higher concentrations of PSR were observed in the South and Southeast states. In the two subpopulations analyzed, there was a predominance of male PSR (CadÚnico = 86.8%; Sinan = 80.9%), black race/skin color (CadÚnico = 67.5%; Sinan = 64.1%) and low education (CadÚnico = 81.9%; Sinan = 60.1%). The high dropout proportion (39%) of treatment was evidenced by the high percentage of reentry and relapse. Conclusion: Tuberculosis still remains a serious problem that aggravates the condition of survival on the streets of Brazil.

Objetivo: Caracterizar o perfil sociodemográfico da população em situação de rua (PSR) inscrita no Cadastro Único para Programas Sociais (CadÚnico) até 2019, e da morbidade por tuberculose nessa população notificada no Sistema de Informação de Agravos de Notificação (Sinan) no período 2014-2018. Métodos: Estudo descritivo, sobre dados do Sinan e do CadÚnico. Resultados: Foram incluídas 127.536 pessoas cadastradas no CadÚnico e 14.059 com tuberculose notificadas no Sinan. Foram observadas maiores concentrações da PSR nos estados das regiões Sul e Sudeste. Nas duas subpopulações analisadas, predominou uma PSR do sexo masculino (CadÚnico = 86,8%; Sinan = 80,9%), de raça/cor da pele negra (CadÚnico = 67,5%; Sinan = 64,1%) e escolaridade até o ensino médio incompleto (CadÚnico = 81,9%; Sinan = 60,1%). A alta proporção de abandono (39%) do tratamento refletiu-se nos elevados percentuais de reingresso e recidiva. Conclusão: A tuberculose permanece como grave problema de Saúde Pública, que agrava a condição de sobrevivência nas ruas do Brasil.

População em situação de rua no Brasil: estudo descritivo sobre o perfil sociodemográfico e da morbidade por tuberculose, 2014-2019 / Población sin hogar en Brasil: estudio descriptivo sobre el perfil sociodemográfico y la morbilidad por tuberculosis, 2014-2019 / Street people in Brazil: a descriptive study of their sociodemographic profile and tuberculosis morbidity, 2014-2019

Objetivo: Caracterizar o perfil sociodemográfico da população em situação de rua (PSR) inscrita no Cadastro Único para Programas Sociais (CadÚnico) até 2019, e da morbidade por tuberculose nessa população notificada no Sistema de Informação de Agravos de Notificação (Sinan) no período 2014-2018. Métodos: Estudo descritivo sobre dados do Sinan e do CadÚnico. Resultados: Foram incluídas 127.536 pessoas cadastradas no CadÚnico e 14.059 com tuberculose notificadas no Sinan. Foram observadas maiores concentrações da PSR nos estados das regiões Sul e Sudeste. Nas duas subpopulações analisadas, predominou uma PSR do sexo masculino (CadÚnico = 86,8%; Sinan = 80,9%), de raça/cor da pele negra (CadÚnico = 67,5%; Sinan = 64,1%) e escolaridade até o ensino médio incompleto (CadÚnico = 81,9%; Sinan = 60,1%). A alta proporção de abandono (39,0%) do tratamento refletiu-se nos elevados percentuais de reingresso e recidiva. Conclusão: A tuberculose permanece como grave problema de Saúde Pública, que agrava a condição de sobrevivência nas ruas do Brasil.

Objetivo: Caracterizar el perfil sociodemográfico de la población sin hogar (PSR) inscrita en el Registro Único para Programas Sociaes (CadÚnico) hasta 2019 y la morbilidad tuberculosa en esta población notificada en el Sistema de Información de Agravamientos de Notificación (Sinan) de 2014 a 2018. Métodos: Estudio descriptivo realizado con datos del Sinan y CadÚnico. Resultados: Se incluyeron 127.536 personas registradas en el CadÚnico y 14.059 con tuberculosis notificada en el Sinan. Se observaron concentraciones más altas de PSR en los estados del Sur y Sudeste. En las dos subpoblaciones analizadas, hubo predominio de PSR masculina (CadÚnico = 86,8%; Sinan = 80,9%), raza/color negra (CadÚnico = 67,5%; Sinan = 64,1%) y baja escolaridad, hasta la secundaria incompleta (CadÚnico = 81,9%; Sinan = 60,1%). Se evidenció una alta proporción de abandono (39,0%) del tratamiento por el alto porcentaje de reingreso y recaída. Conclusión: La tuberculosis sigue siendo un problema grave de Salud Pública, que agrava la condición de supervivencia en las calles de Brasil.

Objective: To characterize the sociodemographic profile of street people (SP) registered on the Single Register for Social Programs (CadÚnico) as at 2019 and tuberculosis morbidity in this population notified on the Notifiable Health Conditions Information System (Sinan) from 2014 to 2018. Methods: This was a descriptive study carried out with data from Sinan and CadÚnico. Results: 127,536 people registered on CadÚnico and 14,059 with tuberculosis notified on Sinan were included in the study. Higher concentrations of SP were found in the states of the South and Southeast regions. In the two subpopulations analyzed, there was a predominance of male SP (CadÚnico = 86.8%; Sinan = 80.9%), people of Black race/skin color (CadÚnico = 67.5%; Sinan = 64.1%) and with incomplete high school education or less (CadÚnico = 81.9%; Sinan = 60.1%). The high treatment dropout proportion (39.0%) was reflected in the high percentage of reentry and relapse. Conclusion: Tuberculosis continues to be a serious Public Health problem that aggravates survival conditions on the streets of Brazil.

Coletivo Nós nas Ruas e Programa Corra pro Abraço: ações para o enfrentamento da Covid-19 em Salvador, BA, Brasil / Colectivo Nosotros en las Calles y Programa Corre para el Abrazo: acciones para el enfrentamiento de la Covid-19 en Salvador, BA, Brasil / Nós Nas Ruas Collective and Corra Pro Abraço Program: actions to confront Covid-19, Salvador, BA, Brazil

Relato de experiência que descreve parte das ações para o enfrentamento da Covid-19 da população em situação de rua de Salvador, Bahia. Essa iniciativa ocorreu pela articulação de um coletivo vinculado às universidades com um programa do governo do estado que atua com pessoas em situação de rua. Nas atividades desenvolvidas, destacaram-se a articulação entre as duas equipes para contribuir no processo adaptativo do trabalho nesse novo contexto, o diálogo com a população em situação de rua e o fortalecimento da rede de sensibilização social. As vivências ao longo do processo de trabalho demarcaram questões basilares na estruturação social como pobreza, desamparo, racismo, desassistência e desigualdades. A pandemia expôs a complexidade da desigualdade social e a urgência de uma sociedade engajada na reparação das fragilidades já existentes.

Relato de experiencia que describe parte de las acciones para el enfrentamiento de la Covid-19 con la población que vive en la calle en Salvador, Bahia. Esta iniciativa tuvo lugar gracias a la articulación de un colectivo vinculado a las universidades, con un programa del gobierno del estado que actúa con las personas que viven en la calle. En las actividades desarrolladas se destacaron la articulación entre los dos equipos para contribuir en el proceso adaptativo del trabajo en ese nuevo contexto, el diálogo con la población que vive en la calle y el fortalecimiento de la red de sensibilización social. Las vivencias durante el proceso de trabajo delimitaron cuestiones basilares en la estructuración social, tales como pobreza, desamparo, racismo, desasistencia y desigualdades. La pandemia expuso la complejidad de la desigualdad social y la urgencia de una sociedad comprometida con la reparación de las fragilidades ya existentes.

Experience report describing a part of the activities done with the homeless population of Salvador, Bahia in order to confront Covid-19. This initiative occurred through the articulation of a collective (group) linked to universities with a program of the state government that works with homeless persons. The main activities developed were: the articulation between the two teams to contribute to the adaptive process of working in this new context, the dialogue with the street population and the strengthening of the social awareness network. The experiences throughout the work process highlighted basic issues in social structuring such as poverty, helplessness, racism, desistance and inequalities. The pandemic exposed the complexity of social inequality and the urgency of a society engaged in repairing existing weaknesses.

Epidemiological characteristics and temporal trends of new leprosy cases in Brazil: 2006 to 2017 / Características epidemiológicas e tendências temporais de casos novos de hanseníase no Brasil: 2006 a 2017 / Características epidemiológicas y tendencias temporales de nuevos casos de lepra en Brasil: de 2006 a 2017

Abstract: Our study aims to describe trends in new case detection rate (NCDR) of leprosy in Brazil from 2006 to 2017 overall and in subgroups, and to analyze the evolution of clinical and treatment characteristics of patients, with emphasis on cases diagnosed with grade 2 physical disabilities. We conducted a descriptive study to analyze new cases of leprosy registered in the Brazilian Information System for Notificable Diseases (SINAN), from 2006-2017. We calculated the leprosy NCDR per 100,000 inhabitants (overall and for individuals aged < 15 and ≥ 15 years) by sex, age, race/ethnicity, urban/rural areas, and Brazilian regions, and estimated the trends using the Mann-Kendall non-parametric test. We analyzed the distributions of cases according to relevant clinical characteristics over time. In Brazil, there was a sharp decrease in the overall NCDR from 23.4/100,000 in 2006 to 10.3/100,000 in 2017; among children < 15 years, from 6.94 to 3.20/100,000. The decline was consistent in all Brazilian regions and race/ethnicity categories. By 2017, 70.2% of the cases were multibacillary, 30.5% had grade 1 (G1D) or 2 (G2D) physical disabilities at diagnosis and 42.8% were not evaluated at treatment completion/discharge; cases with G2D at diagnosis were mostly detected in urban areas (80%) and 5% of cases died during the treatment (leprosy or other causes). Although the frequency of leprosy NCDR decreased in Brazil from 2006 to 2017 across all evaluated population groups, the large number of cases with multibacillary leprosy, physical disabilities or without adequate evaluation, and among children suggest the need to reinforce timely diagnosis and treatment to control leprosy in Brazil.

Resumo: O estudo teve com objetivos descrever as tendências na taxa de detecção de casos novos (TDCN) de hanseníase no Brasil em 2006-2017, global e por subgrupos, e analisar a evolução das características clínicas e terapêuticas dos pacientes, com ênfase nos casos diagnosticados com incapacidade física grau 2. Realizamos um estudo descritivo par analisar casos novos de hanseníase registrados no Sistema de Informação de Agravos de Notificação (SINAN), 2006-2017. Calculamos a TDCN de hanseníase por 100.000 habitantes (global e para indivíduos < 15 e ≥ 15 anos de idade) por sexo, idade, raça/etnicidade, área urbana/rural e macrorregião do Brasil e estimamos as tendências com o teste não paramétrico de Mann-Kendall. Analisamos as distribuições de casos de acordo com características clínicas relevantes ao longo do tempo. No Brasil, houve uma queda marcante na TDCN global, de 23,4/100.000 em 2006 para 10,3/100.000 em 2017; entre crianças < 15 anos, de 6,94 para 3,20/100.000. A queda foi consistente em todas a regiões brasileiras e em todas as categorias de raça/etnicidade. Até 2017, 70,2% dos casos eram multibacilares, 30,5% apresentavam incapacidades físicas grau 1 (G1D) ou grau 2 (G2D) ao diagnóstico e 42,8% não foram avaliados ao encerramento do tratamento ou alta; os casos com G2D ao diagnóstico foram detectados majoritariamente nas áreas urbanas (80%), e 5% dos casos faleceram durante o tratamento (devido à hanseníase ou por outras causas). Embora a frequência da TDCN da hanseníase tenha diminuído no Brasil entre 2006 e 2017 em todos os grupos avaliados, o número grande de casos com hanseníase multibacilar, incapacidades físicas ou sem avaliação adequada e entre crianças sugere a necessidade de reforçar o diagnóstico e tratamento oportunos para controlar a hanseníase no Brasil.

Resumen: Se realizó este trabajo con el fin de describir la tendencia general y en subgrupos de la tasa de detección de nuevos casos de lepra (NCDR por sus siglas en inglés) en Brasil, entre 2006-2017, así como para analizar la evolución de las características clínicas y de tratamiento de los pacientes, con énfasis en los casos diagnosticados con un grado 2 de discapacidad física. Realizamos un estudio descriptivo para analizar los nuevos casos de lepra registrados en el Sistema Brasileño de Información de Enfermedades de Notificación (SINAN), 2006-2017. Calculamos la NCDR de lepra por cada 100.000 habitantes (general e individuos con una edad < 15 y ≥ 15 años) por sexo, edad, raza/etnicidad, áreas urbanas/rurales y regiones brasileñas, y estimamos las tendencias usando el test no paramétrico de Mann-Kendall. Analizamos las distribuciones de casos según las características clínicas relevantes a lo largo del tiempo. En Brasil, hubo una drástica disminución en general de NCDR de los 23,4/100.000 en 2006, a los 10,3/100.000 en 2017; entre niños < 15 años, desde los 6,94 a los 3,20/100.000. El decremento fue consistente en todas las regiones brasileñas y categorías de raza/etnicidad. En 2017, un 70,2% de los casos fueron multibacilares, un 30,5% tenían grado 1 (G1D) o 2 (G2D) discapacidad física en el diagnóstico y un 42,8% no fueron evaluados al completar el tratamiento/ser dados de alta; casos con G2D en el diagnóstico fueron en su mayoría detectados en áreas urbanas (80%) y un 5% de los casos murieron durante el tratamiento (lepra u otras causas). A pesar de la frecuencia de lepra los NCDR decrecieron en Brasil de 2006 a 2017, a través de todos los grupos de población evaluados, el elevado número de casos con lepra multibacilar, discapacidad física o sin una adecuada evaluación, y entre niños sugiere la necesidad de reforzar a tiempo el diagnóstico y tratamiento para controlar la lepra en Brasil.

Perfil epidemiológico e distribuição espacial da hanseníase em Paulo Afonso, Bahia / Perfil epidemiológico y distribucion espacial de la lepra en Paulo Afonso, Bahia / Epidemiological profile and spatial distribution of leprosy in Paulo Afonso, Bahia

Objetivos analisar as características epidemiológicas e distribuição dos casos novos de hanseníase na população de Paulo Afonso, Bahia, entre 2000 e 2015. Método estudo descritivo com todos os casos novos de hanseníase notificados no Sistema de Informações de Agravos de Notificação. Foram utilizadas variáveis sociodemográficas e clínicas e calculados os coeficientes de detecção anuais. Estimativas populacionais foram obtidas no Instituto Brasileiro de Geografia e Estatística. Resultados a maioria dos 1.069 casos novos notificados foi do sexo feminino (57,2%), residiam na zona urbana (92%), raça/cor parda (66,92%), ensino fundamental (67,6%), maiores de quinze anos (92,5%), forma clínica tuberculoide (48,26%), paucibacilares (62,3%), grau de incapacidade física no diagnóstico (45,93%) e na cura (29,75%). Conclusão o perfil epidemiológico da hanseníase em Paulo Afonso é similar ao nacional, houve variações nos coeficientes de detecção da hanseníase entre os anos e a análise espacial evidenciou distribuição heterogênea, com maior concentração de casos nos bairros periféricos.

Objetivos analizar las características epidemiológicas y la distribución de nuevos casos de lepra en la población de Paulo Afonso, Bahía, entre 2000 y 2015. Método estudio descriptivo con todos los nuevos casos de lepra reportados en el Sistema de Información de Enfermedades Notificables. Se utilizaron variables sociodemográficas y clínicas y se calcularon los coeficientes anuales de detección. Las estimaciones de población se obtuvieron del Instituto Brasileño de Geografía y Estadística. Resultados la mayoría de los 1.069 nuevos casos notificados fueron mujeres (57,2%), que viven en el área urbana (92%), raza/color parda (66,92%), escuela primaria (67,6%), con más de quince años (92,5%), forma clínica de tuberculoide (48,26%), paucibacilario (62,3%), grado de discapacidad física al diagnóstico (45,93%) y en la cura (29,75%). Conclusión el perfil epidemiológico de la lepra en Paulo Afonso es similar al nacional, hubo variaciones en los coeficientes de detección de lepra entre años y el análisis espacial mostró una distribución heterogénea, con una mayor concentración de casos en barrios periféricos.

Objectives to analyze the epidemiological characteristics and distribution of new leprosy cases in the population of Paulo Afonso, Bahia, Brazil, between 2000 and 2015. Method descriptive study with all new cases of leprosy reported at the Notifiable Diseases Information System. Sociodemographic and clinical variables were used and annual detection coefficients were calculated. Population estimates were obtained from the Brazilian Institute of Geography and Statistics. Results most of the 1,069 new reported cases were female (57.2%), living in the urban area (92%), brown race/color (66.92%), elementary school (67.6%), over fifteen years of age (92.5%), tuberculoid clinical form (48.26%), paucibacillary (62.3%), degree of physical disability at diagnosis (45.93%) and cure (29.75%). Conclusion the epidemiological profile of leprosy in Paulo Afonso is similar to the national one, with variations in leprosy detection coefficients between years and spatial analysis showing heterogeneous distribution, with a higher concentration of cases in peripheral neighborhoods.