[Tuberculosis in 0-14 year-olds in Cuba (1994-2003)]. / Tuberculosis en niños de 0-14 años: Cuba, 1994-2003.

INTRODUCTION: Tuberculosis in infants and children is a sign of continuous transmission. The present article describes the distribution and the trend in incidence rates of new tuberculosis cases in 0-15-year-olds in Cuba. METHODS: Incidence rates and their trend were estimated by provinces and age groups for the 1994-2003 period. Distribution and overall variation percentages, annual average rates, and rates and percentages according to classification were determined. RESULTS: The incidence rate decreased from 0.76 x 10(5) in 1994 to 0.31 in 2003 (59.2% of the overall reduction and 6.6% of the annual average reduction). The highest rate (1.06 x 10(5)) was found in 1995 (26 cases). In almost all provinces, the incidence trend decreased, except in the City of Havana, Sancti Spíritus, Santiago de Cuba, and the Isle of Youth. Childhood tuberculosis was mainly pulmonary (69.6%). Among the affected population, the highest percentages were found in the groups aged 10-14 years (35.6%) and 1-4 years (35.2%). CONCLUSIONS: Tuberculosis is infrequent and is extremely uncommon in infants. Notification is low throughout the country and the overall trend shows a steady decrease.

Tuberculosis en niños de 0-14 años: Cuba, 1994-2003 / Tuberculosis in children 0-14 years: Cuba, 1994-2003

Introducción: La ocurrencia de tuberculosis en niños es un signo detransmisión continua de la infección. En este estudio describimosla distribución y tendencia de las tasas de incidencia de casos nuevos de tuberculosis de niños menoresde 15 años de edad en Cuba.Métodos Se estimaron las tasas de incidencia y su tendencia, porprovincias y grupos de edades del período 1994-2003. Sedeterminó la distribución porcentual, porcentaje de variaciónglobal y promedio anual de las tasas, así como las tasas y porcentajes de tuberculosis según su localización.Resultados La tasa de incidencia disminuyó de 0,76 105 en 1994 a0,31 en 2003 (59,2 por ciento reducción global y 6,6 por ciento reducción anual como promedio). En 1995 se notificó la tasa más alta1,06 105 (26 casos). En casi todas las provincias la tendencia de la incidencia fue descendente, excepto en CiudadHabana, Sancti Spíritus, Santiago de Cuba e Isla de la Juventud. El 69,6 por ciento de la tuberculosis infantil fue de localización pulmonar. Los grupos de edades de 10-14 años (35,6 por ciento) y 1-4 (35,2 por ciento) presentaron los porcentajes más altos dentro de la población infantil afectada.Conclusiones La tuberculosis es muy poco frecuente y más bien raraen menores de un año y en general presenta notificaciónmuy baja en todo el país con una tendencia global descendentemantenida(AU)

Introduction: Tuberculosis in infants and children is a sign of continuoustransmission. The present article describes the distribution and the trend in incidence rates of new tuberculosiscases in 0-15-year-olds in Cuba. Methods Incidence rates and their trend were estimated by provinces and age groups for the 1994-2003 period. Distribution and overall variation percentages, annual averagerates, and rates and percentages according to classification were determined. Results The incidence rate decreased from 0.76 105 in 1994 to0.31 in 2003 (59.2 percent of the overall reduction and 6.6 percent ofthe annual average reduction). The highest rate (1.06 105) was found in 1995 (26 cases). In almost all provinces, the incidence trend decreased, except in the City of Havana,Sancti Spíritus, Santiago de Cuba, and the Isle of Youth. Childhood tuberculosis was mainly pulmonary (69.6 percent).Among the affected population, the highest percentages were found in the groups aged 10-14 years (35.6%) and1-4 years (35.2percent). ConclusionsTuberculosis is infrequent and is extremely uncommon in infants. Notification is low throughout the country and the overall trend shows a steady decrease(AU)

Tuberculosis en niños de 0-14 años: Cuba, 1994-2003 / Tuberculosis in 0-14 year-olds in Cuba (1994-2003)

Introducción La ocurrencia de tuberculosis en niños es un signo de transmisión continua de la infección. En este estudio describimos la distribución y tendencia de las tasas de incidencia de casos nuevos de tuberculosis de niños menores de 15 años de edad en Cuba. Métodos Se estimaron las tasas de incidencia y su tendencia, por provincias y grupos de edades del período 1994-2003. Se determinó la distribución porcentual, porcentaje de variación global y promedio anual de las tasas, así como las tasas y porcentajes de tuberculosis según su localización. Resultados La tasa de incidencia disminuyó de 0,76 × 105 en 1994 a 0,31 en 2003 (59,2 % reducción global y 6,6 % reducción anual como promedio). En 1995 se notificó la tasa más alta 1,06 × 105 (26 casos). En casi todas las provincias la tendencia de la incidencia fue descendente, excepto en Ciudad Habana, Sancti Spíritus, Santiago de Cuba e Isla de la Juventud. El 69,6 % de la tuberculosis infantil fue de localización pulmonar. Los grupos de edades de 10-14 años (35,6 %) y 1-4 (35,2 %) presentaron los porcentajes más altos dentro de la población infantil afectada. Conclusiones La tuberculosis es muy poco frecuente y más bien rara en menores de un año y en general presenta notificación muy baja en todo el país con una tendencia global descendente mantenida

Introduction Tuberculosis in infants and children is a sign of continuous transmission. The present article describes the distribution and the trend in incidence rates of new tuberculosis cases in 0-15-year-olds in Cuba. Methods Incidence rates and their trend were estimated by provinces and age groups for the 1994-2003 period. Distribution and overall variation percentages, annual average rates, and rates and percentages according to classification were determined. Results The incidence rate decreased from 0.76 × 105 in 1994 to 0.31 in 2003 (59.2 % of the overall reduction and 6.6 % of the annual average reduction). The highest rate (1.06 × 105) was found in 1995 (26 cases). In almost all provinces, the incidence trend decreased, except in the City of Havana, Sancti Spíritus, Santiago de Cuba, and the Isle of Youth. Childhood tuberculosis was mainly pulmonary (69.6 %). Among the affected population, the highest percentages were found in the groups aged 10-14 years (35.6 %) and 1-4 years (35.2 %). Conclusions Tuberculosis is infrequent and is extremely uncommon in infants. Notification is low throughout the country and the overall trend shows a steady decrease

[Evaluation of health surveillance at several primary care units in Cuba]. / Evaluación de la vigilancia en salud en algunas unidades de atención primaria en Cuba.

BACKGROUND: The organization and operation of the epidemiological monitoring carried out at several Primary Care facilities in Cuba was assessed by means of a study conducted for the purpose of ascertaining the effectiveness of the monitoring in question and of contributing to further improve the mechanisms thereof and thus improve the health conditions of the population. This assessment was implemented at eight Polyclinics in the city of Havana throughout the 1998-1999 period. METHOD: By means of the implementation of an integral methodology, an assessment was made of the three factors involved in the monitoring system at the facilities in question, that is, the organization, the process and the results thereof. For this purpose, a survey which quantified some aspects of the system (sensitivity, opportunity, representativeness, usefulness) and a semi-structured survey of epidemiologists and other physicians involved in the monitoring in question in addition to the users of the system was used. RESULTS: The assessment of the organization revealed the monitoring organization to be adequate. In the assessment of the process, sensitivity was found to be low at some polyclinics, problems existing at many of them with regard to the opportunity and flexibility of the system. The assessment of the results of the monitoring revealed them to be satisfactory as regards their effectiveness for detecting acute events, as well as in the perception of the users with regard to the usefulness of these results for solving the problems pinpointed. CONCLUSIONS: The monitoring done at the polyclinics assessed is indicative of there being an adequate organization of the monitoring, although some shortcomings were found to exist with regard to the fulfillment of some aspects of the monitoring. This however has no bearing on the results for the system as a whole, which is capable of detecting any epidemiological situation of importance and of suggesting appropriate measures for controlling the situation.

[Evaluation of surveillance in primary health care: a methodological proposal]. / Evaluación de la vigilancia en la atención primaria de salud: una propuesta metodológica.

Given the development of public health, hygiene and epidemiology in Cuba and their linking with primary care, and particularly, the novel approach to health surveillance in its different implementation alternatives, it is necessary to develop new forms and methods for surveillance evaluation at this level. The paper is aimed at presenting methodological proposal for assessing surveillance in primary health care. We made a literature review of known documents, guides or manuals which have been published in Cuba and in other countries and we interviewed a group of experts in this field. An initial instrument was worked out and tested in three health areas of the capital and afterwards, it was modified accordingly. The process of assessment was divided into 4 aspects: structure, process or functioning, results or usefulness and economic evaluation. To assess functioning of surveillance, we took the analysis of its attributes into account, i.e., simplicity, flexibility, acceptability, sensitivity positive predictive value, representativity, opportunity and also integrality and responsiveness capacity. We described steps to be implemented and elements to be considered. Generally, the evaluation should be carried out in a week. The cost of implementing each evaluating process is estimated at 40 Official Announcement. V Workshop of university libraries of Latin and the Caribbean. Upon finishing the evaluation, a report should be submitted with the comprehensive assessment and recommendations for the evaluated level.

[The knowledge, attitudes and practice of population groups with respect to tuberculosis. 1994-1996]. / Conocimientos, percepciones y prácticas de grupos de población respecto a la tuberculosis. 1994-1996.

The development of successful tuberculosis control programs requires the people's involvement, hence a study was performed to identify knowledge, perceptions and practices of the population regarding occurrence, transmission, treatment and control of this disease. The focal group technique was used in 6 sets of persons aged 15 years and over from 6 municipalities of the City of Havana. These groups thought that tuberculosis had declined in the last ten years but had increased again in the last 2-3 years, that it was a contagious disease presenting symptoms such as cough, hemoptysis, loss of weight, fever. They considered it as a terrible, undesirable sickness associated with poverty and caught due to malnourishment, poor hygiene of the sick person and his/her relatives and smoking. Some thought that this disease was curable and other that it was not. Several other people believed that patients should be isolated in hospital whereas others stated that they could have a normal life at home, most preferred to be informed about the disease by TV and radio. It was concluded that a quantitative study should be performed based on these results.

[Distribution and trends of tuberculosis by age groups and municipalities in La Habana City, Cuba (1986-1998)]. / Distribución y tendencia de la tuberculosis por grupos de edades y por municipios en ciudad de La Habana, Cuba. (1986-1998).

BACKGROUND: The province of Havana City, the capital and most densely populated city in Cuba, totals around 27% of the new cases of tuberculosis. This article is for the purpose of describing the distribution and trend of the tuberculosis cases rates from 1986 to 1998, by municipalities and age groups in this province. METHOD: A calculation was made of the rates and of the total percentage of deviation of these rates, in addition to the annual average deviation both throughout two time periods and between the two (1986-1993 and 1994-1998). The trends were calculated by simple linear regression. RESULTS: Throughout the 1986-1993 period, the case rate for this province underwent a 6% increase. Throughout the 1994-1998 period, it dropped by 7.3%. The three most densely-populated cities showed a higher rate increase. Of the 15 municipalities, only La Lisa showed a drop in the rates throughout the entire period in question. The rates by ages were similar throughout all of the municipalities, being higher for individuals > 65 years of age. Six tenths (0.6%) of the cases reported involved people under 15 years of age. The infantile tuberculosis rates were very low for the time period under analysis. CONCLUSIONS: The differences among the municipalities in question make it necessary for different measures to be taken to achieve a greater impact and repercussion in Cuba. The drop in the rates detected over the last three years is indicative of the epidemic being brought under control and the national tuberculosis control program being reinstated.

[The management of tuberculosis in the Republic of Cuba]. / Manejo de la tuberculosis en la República de Cuba.

The essential aspects for the management of tuberculosis surveillance and control are described to propitiate their divulgation among to health professionals. Since 1970 there is an integrated program under way within the health services based on the localization of cases by the bacilloscopic examination and the sputum culture in symptomatic respiratory patients, the ambulatory controlled treatment, the investigation of the contacts of the notified cases, including the chemoprophylaxis with isoniacide, and the BCG vaccination to newborns. In 1995, the percentage of symptomatic patients detected at the general medicine offices was of 0.7%, whereas the percentage of the first bacilloscopy performed among the symptomatic individuals was of 78.6%, 99.5% of the detected contacts were investigated. 37.9% of the new cases were diagnosed at the primary health care level. After a decreasing trend maintained from 1979 to 1991, mortality has increased from 50 deaths (0.5 x 10(5)) in 1991 to 157 (1.4 x 10(5)) in 1995, and the incidence rose from 503 (4.7 x 10(5)) in 1991 to 1,574 (14.3 x 10(5)) in 1994, and to 1,553 (14.0 x 10(5)) in 1995, which suggests that the increase observed during the last 6 years begins to stop. The primary resistance to tuberculostatics was of 3.5% in 1992-1995, and of 11.5% in 1996. A priority integrated program of surveillance and control adjusted to the present socioeconomic conditions of the country is still going on.

Asthma mortality in Cuba during 1972-1993.

UNLABELLED: Morbi-mortality due to asthma has increased in recent years both throughout the world in Cuba. A study of mortality caused by this disease has conducted in order to describe its current trend in the country. METHOD: A time series study was conducted which included all deaths attributed to asthma in Cuba recorded in the vital statistics records of the Ministry of Public Health from 1972 to 1993. Rates, secular trends of general mortality and according to gender were estimated. The proportional mortality for the 1972-1993 period was calculated and the potential years of life lost during the 90-92 trienium were quantified. RESULTS AND DISCUSSION: A drop in these global rates occurred between 1972 and 1975, with values of 3.6; 4.1; 3.0; 2.2; respectively; possibly due to the introduction of disodic chromoglycate among other drugs and the beginning of the Asthmatic Patient Program. An later increase in mortality was observed until 1993 (5.9 x 100,000 inhabitants) which may attributed to a drop of the intensity and regularity of said program and to other internationally knowledge factors which are present in our country. The trend of general mortality rose during this period and was greater in females than in males; which means that the risk to die of this cause has increased. Proportional Mortality since 1980 (0.50%) also increased until 1993 (0.80%). Potential years of life lost due to premature death ranged from 5,646 in 1990 to 7,386 in 1992. The increase in proportional mortality and the potential years of life lost suggest that this disease should been given priority by the National Health Program as a preventable cause of death, especially in women. CONCLUSIONS: There is a rising trend of mortality among asthmatic patients during the period under consideration. Asthma is a cause of premature death in Cuba.

Prescription of antibiotics for mild acute respiratory infections in children.

Acute respiratory infections (ARI), the leading class of ailments causing people to seek health care, rarely require antibiotics. Nevertheless, many physicians prescribe them needlessly. Hence, reducing the unnecessary use of antibiotics is one aim of any ARI control program. To help determine whether this aim might be achieved through a combination of refresher training for family physicians and public education campaigns, two 1991 interventions were carried out in four health areas (designated A, B, C, and D) in the city of Havana, Cuba. In each area, 10 clinics staffed by family physicians were selected through simple random sampling. In two areas (A and B), a refresher training program on ARI for health personnel was instituted at each clinic, while in areas A and C a community education program was set up. No intervention was carried out in area D. Simultaneously, from January through December 1991 trained individuals visited and administered a standard questionnaire every 15 days to 1,600 families (40 per clinic) systematically selected by random sampling. The aim of this procedure was to record the number of ARI episodes occurring among children under 5 years old, the treatment chosen in these cases, and whether antibiotics were employed. The results showed that when the two interventions were initiated, antibiotics were prescribed for 26%, 20%, 11%, and 19% of the mild ARI cases occurring in areas A, B, C, and D respectively (P > 0.05). In the period immediately following the interventions, antibiotic prescription rates declined by 26% and 63% in areas A and B, while increasing by 2% and 48% in areas C and D. Overall, prescription of antibiotics in the intervention areas A and B combined decreased by 54% (95% CI: 31-69%). These data suggest that a refresher training program for health personnel can rapidly reduce the unnecessary prescribing of antibiotics for ARI cases, but that public education alone does not appear effective.

[The trends by province of tuberculosis in Cuba: 1979-1993]. / Tendencias por provincias de la tuberculosis en Cuba: 1979-1993.

This study was carried out in order to describe tuberculosis trends in Cuba and its provinces between 1979 and 1993. For this purpose, reports of new cases of all forms of tuberculosis were obtained from the National Statistics Bureau of the Ministry of Public Health. In addition, tuberculosis incidence rates and their trends between 1979 and 1992 were determined. The data were analyzed by means of simple linear and exponential regression models. Finally, the percentage reductions in incidence between 1979 and 1992 were calculated and the observed changes were described in reference to the expected values derived from the regression models. The number of new tuberculosis cases reported in Cuba decreased from 1133 (11.6 per 100,000 population) in 1979 to 633 (5.8 per 100,000) in 1992 (a 44% reduction). In 1993, 788 cases were reported (7.2 per 100,000). In almost all the provinces the incidence tended to decrease between 1979 and 1992, and the average annual number of new case notifications fell between 4.0 and 5.4%, although in some, less than 3%. In 1992, the number of new case notifications in the country was 25% higher than in 1991, and the incidence rates in all the provinces were higher than expected. The incidence in La Habana, the City of Havana, Villa Clara, Cienfuegos, Ciego de Avila, Santiago de Cuba, and Guantánamo exceeded the overall national incidence. In 1993, incidence in the country was 55.6% higher than it had been in 1991 and 24.5% higher than in 1992. Incidence rose in all provinces, and especially in the City of Havana, Matanzas, and Guantánamo. Although incidence remained below 8 cases per 100,000 population between 1992 and 1993, it rose during those years, as it did in other countries. The increase appears to be attributable to the economic crisis that affects the country and to have very little connection to human immunodeficiency virus infection.

[The estimation of morbidity from acute respiratory infections in adults]. / Estimación de la morbilidad por infecciones respiratorias agudas en adultos.

In order to estimate morbidity by acute respiratory infections in an adult population, a study was carried out in four health areas of City of Havana, to know the real morbidity and the one assisted for this population group. A sample was selected from 10 physicians' offices at each health area, and in each one of them a random sample of 40 families was taken, that at least should include 400 elderly people of 65 years old or more. A semi-monthly visit was done to each selected family for over a year, by an interviewer trained with that purpose. Incidence rate found in adults from 15 to 64 years was of 509.5 for 1,000 years/persons, almost three times the rate reported by the inactive surveillance, and in elders of 65 years and more it was of 943.8 for 1,000 years/persons, 8.8 times the rate reported by inactive surveillance.

[Progress in surveillance of acute respiratory infections in the Republic of Cuba]. / Progresos en la vigilancia de las infecciones respiratorias agudas en la república de Cuba.

BACKGROUND: A process of techniques perfection of the epidemiologic surveillance of morbidity by Acute Respiratory Infections, with the purpose of obtaining a better and more appropriate description of the problem, was carried out. METHODS: A mathematical model of Fourier harmonic analysis and an Arima model was applied to the time series of weekly consulting rates for those diseases by age groups and provinces. This allowed to identify the epidemical moments, based on the prediction of expected values and an specific cut-off. RESULTS: The application of this technique made it possible and early and appropriate identification of an epidemical rise in children of less than 1 year, between July and August of 1988, with the identification of the Respiratory Syncytial Virus, as the aetiological agent. In the age-group of 5-14 years, a rise was observed in September, at the beginning of the school-year, and a smaller one between May-June of 1989. In the group age of 65 years and more, an epidemical increase took place from July to October. CONCLUSIONS: The use of these techniques provided new possibilities to make more precise and appropriate recommendations to improve epidemiological surveillance of these diseases at a national level.

[Training of epidemiology personnel in Cuba]. / Formación de personal en epidemiología en Cuba.

We describe the academic characteristics of the Master of Epidemiology Program taught at the Instituto de Medicina Tropical "Pedro Kourí", in La Habana, Cuba. We provide a description of the structure of the course along with its didactical principles, the main objectives of the different academic modules and the number and background of graduates from seven Classes. We also discuss potential work areas for graduates and short-term perspectives for their continuing education.

[Stages of the historic evolution of the antituberculosis campaign in Cuba]. / Recuento de las etapas de evolución histórica de la lucha antituberculosa en Cuba.

A brief account is provided on the main characteristics of the stages in the historical evolution of struggle against tuberculosis in Cuba. The foundations and the steps taken in tuberculosis control are noted. A synthesis of therapeutic schemes used in the last 20 years is provided and the tendency of notification of new cases in 1979-1988 is discussed. During that ten-year period there was a 38.8% reduction.

[Influenza and other acute respiratory infections. Republic of Cuba, 1989]. / Influenza y otras infecciones respiratorias agudas. República de Cuba, 1989.

Information is provided on the epidemiological situation of influenza and other acute respiratory tract diseases in Cuba during 1989. General mortality rate was 25.4 per 105 inhabitants. Global morbidity rate was 373.9 per 1,000 inhabitants. The highest morbidity rate reported corresponded to children 5-14 years old and under 1 year of age. Serologically, the viral agent proportionally most identified was influenza virus type A (H3N2).

[Sampling procedure for a survey of an interventional study on acute respiratory infections]. / Procedimiento muestral para una encuesta de un estudio de intervención sobre infecciones respiratorias agudas.

A description is made of the methodology used for obtaining a sample made up of 500 children under 5 years and 500 adults 65 year old and more, in order to carry out an intervention study on acute respiratory tract infections in an urban zone in Havana City and in a rural zone in Matanzas province, where different intervention stops will be taken with regards sanitary education about management of acute respiratory tract infections for the population and training for primary care medical personnel. We show the way the selected sample fits was planned with a very homogeneous distribution in the 8 areas under study, which allows for great reliability in the results.

[Primary-care morbidity and true morbidity due to acute respiratory infections]. / Morbilidad asistida y morbilidad real por infecciones respiratorias agudas.

The present work presents the study of morbidity due to acute respiratory infections (ARI) in areas of the town of Lisa in Ciudad Habana, and Isla Juventud (Cuba), to characterize different aspects of morbidity measured by health care attendance and to measure true morbidity. About 90% of consultations for ARI were first-time consultations, while their ratio to further consultations was 5.3. True morbidity rates (TMR), obtained trough active research, ranged from 110.4 to 163.4 cases per 1000 inhabitants, considerably higher than morbidity rates measured by primary care consultations (MRPCC) in the same time period. The true morbidity index (TMI), as measured by the ratio of the two previous rates, ranged from 5 to 15. A high proportion (47.6%) of cases reported no medical care attendance. These results provide approximate estimates of true morbidity in the study area, and allow the establishment of a new control program, also improving epidemiologic surveillance within primary care activities.

[Methodology for the epidemiologic study on acute respiratory infections]. / Metodología para un estudio epidemiológico sobre infecciones respiratorias agudas.

The foundations and methodology for an epidemiological study on acute respiratory diseases are described. The study took place in 4 urban health areas in Havana City and 4 rural doctor's offices in Matanzas. A discussion is carried out regarding the intervention design for the staff of the health primary assistance team headed by the family doctor.

[Automated sentinel system of infectious diseases in Cuba]. / Sistema automatizado de vigilancia de las enfermedades infecciosas en Cuba.

We state that the creation of the Automated System of Epidemiological Surveillance should become an integral part of the Service of Hygiene and Epidemiology of the Republic of Cuba, which allows for the operative evaluation of the epidemiological situation in the country in order to take timely anti-epidemiological and prophylactic steps.