Tuberculosis in Brazil: one country, multiple realities.

OBJECTIVE: To identify the determinants of tuberculosis-related variables in the various regions of Brazil and evaluate trends in those variables over the ten-year period preceding the end of the timeframe defined for the United Nations Millennium Development Goals (MDGs). METHODS: This was an ecological analytical study in which we utilized eight national public databases to investigate the 716,971 new tuberculosis cases reported between 2006 and 2015. RESULTS: Over the study period, there were slight reductions in the prevalence, incidence, and mortality associated with tuberculosis. Brazil did not reach the MDG for tuberculosis-related mortality. Among the performance indicators of tuberculosis control, there were improvements only in those related to treatment and treatment abandonment. In terms of the magnitude of tuberculosis, substantial regional differences were observed. The tuberculosis incidence rate was highest in the northern region, as were the annual mean temperature and relative air humidity. That region also had the second lowest human development index, primary health care (PHC) coverage, and number of hospitalizations for tuberculosis. The northeastern region had the highest PHC coverage, number of hospitalizations for primary care-sensitive conditions, and tuberculosis-related mortality rate. The southern region showed the smallest reductions in epidemiological indicators, together with the greatest increases in the frequency of treatment abandonment and retreatment. The central-west region showed the lowest overall magnitude of tuberculosis and better monitoring indicators. CONCLUSIONS: The situation related to tuberculosis differs among the five regions of Brazil. Those differences can make it difficult to control the disease in the country and could explain the fact that Brazil failed to reach the MDG for tuberculosis-related mortality. Tuberculosis control measures should be adapted to account for regional differences.

Aspectos que influenciam a gravidez na adolescência / Aspectos que influyen en el embarazo adolescente / Aspects that influence the teenage pregnancy

Estudo qualitativo, de abordagem descritiva com a aplicação da técnica de análise de conteúdo na sua vertente de análisetemática sobre a gravidez na adolescência. O objetivo deste estudo foi analisar os aspectos relacionados à gravidez naadolescência na área de abrangência de uma equipe de saúde da família no município de Divinópolis. Como instrumentode coleta de dados foi utilizada entrevista semiestruturada. As adolescentes do estudo possuíam informações dos métodoscontraceptivos, principalmente da camisinha e pílulas, mas não tinham a concepção do benefício e da importância dessesmétodos. Apesar de saberem das dificuldades existentes, as adolescentes, por vezes, almejavam a maternidade. Agravidez envolvendo adolescentes apresenta fatos característicos que devem ser destacados como influentes para a suaocorrência, tais como: falta de informação e diálogo no ambiente familiar; abordagem inadequada dessetema nasescolas; poucos avanços nos serviços de saúde que articulem o planejamento familiar com a comunidade;e precariedadede políticas públicas que conscientizem os adolescentes sobre a importância da prevenção da gestação nessa fase da suavida.

This study is characterized as a descriptive qualitative research approach applying the technique of content analysis onteenage pregnancy. The aim of this study was to analyze aspects related to teenage pregnancy in an area covered by afamily health team in the city of Divinópolis. Thesemistructured interview was used as an instrumentfor data collection.The adolescents in this study had information on contraceptive methods, especially on condoms and pills, but didn’t haveany idea of the importance and benefits of those methods. Despite knowing the difficulties experienced, adolescentssometimes craved for motherhood. Pregnancy involving teens presents peculiar facts that should be highlighted asinfluential for its occurrence, such as lack of information and dialogue in the adolescents’ family environment; no properapproach of this topic in schools; hardly any advancements in health services that combine family planning withcommunity; and precarious public policies that makeadolescents aware of the importance of preventingpregnancy attheir age.

Estudio cualitativo, el enfoque descriptivo, con latécnica de análisis de contenido en su análisis temático arrojar sobre elembarazo adolescente. El objetivo de este estudio fue analizar los aspectos relacionados con el embarazo adolescente enun área cubierta por un equipo de salud de la familia en la ciudad de Divinópolis. Como se utilizó uninstrumento derecolección de datos la entrevista semi-estructurada. Los adolescentes del estudio tenía información sobre los métodosanticonceptivos, especialmente los condones y píldoras, pero no tenían ni idea de la importancia y losbeneficios de estosmétodos. A pesar de conocer las dificultades, los adolescentes a veces anhelaba la maternidad. El embarazo presentahechos que involucran adolescentes característica adestacar como influyente por su ocurrencia, como la falta deinformación y el diálogo en el entorno familiar, laidoneidad de este tema en las escuelas, los avances en los servicios desalud que combinan la planificación familiar con lacomunidad y las políticas públicas consciente de que los adolescentessobre la importancia de la prevención del embarazoen esta etapa.