Volume
5, Issue 1, p. 15-19, April 2022
Doi: https://doi.org/10.32435/envsmoke.20225115-19
Environmental
Smoke,
e-ISSN: 2595-5527
“Interdisciplinary thinking and
conservation strategies beyond protected areas”
Full
Article:
TUBERCULOSIS IN THE
CITY OF JUAZEIRO DO NORTE-CE, BETWEEN THE YEARS 2010 TO 2020
Wagner
Bernardo Silva1* (https://orcid.org/0000-0003-0544-2193); Beatriz Maria da Conceição Murilo1 (https://orcid.org/0000-0001-6630-4566); Cassiano Augusto Oliveira da Silva2
(https://orcid.org/0000-0002-8461-9104)
1Bachelor Student in Pharmacy, Federal
University of Campina Grande (UFCG), Cuité, Paraíba, Brazil
2PhD
Student in Religious Sciences, Federal University of Paraíba (UFPB), João
Pessoa, Paraíba, Brazil
*Corresponding author: wagner.bernardo@estudante.ufcg.edu.br
Submitted
on: 11 Mar. 2022
Accepted
on: 23 Mar. 2022
Published
on: 30 Apr. 2022
License: https://creativecommons.org/licenses/by/4.0/
Tuberculosis is an infectious disease caused
by the bacterium Mycobacterium tuberculosis Zopf, 1883 and is estimated
to be responsible for about 1.9 million deaths worldwide. In Brazil, every year
70,000 people are infected and 4,500 die. Thus, the objective was to
investigate the epidemiological profile of those affected by tuberculosis in
Juazeiro do Norte-CE, between 2009 and 2019. This was an epidemiological,
retrospective, analytical, documentary, ecological and quantitative study using
secondary data from the “Departamento de Informática do Sistema Único de Saúde” (DATASUS). The variables analyzed were year, sex,
age group, ethnicity, education and area of residence.
1,093 cases of tuberculosis were found, with 2019 being the most prevalent. The
epidemiological profile of those affected was predominantly men (67.9%), aged
20 to 59 years (69.6%), brown (75.5%), with low education (35.4%) and living in
urban area (92.6%). These data can be used for the creation of public policies
aimed at serving the population most susceptible to tuberculosis in the city.
Keywords: Tuberculosis. Epidemiology. Mycobacterium
tuberculosis.
1 Introduction
Tuberculosis (TB) is an infectious and
contagious disease (DE ANDRADE et al., 2020), characterized by granulomatous
lesions (tubers) in various organs, especially the lungs, and if left untreated
it can lead to the individual's death (CAMPOS et al., 2014).
The causative agent of
tuberculosis is the bacterium Mycobacterium tuberculosis Zopf, 1883,
which has an alcohol-acid resistant (BAAR) cell wall and is resistant to
antibiotics, due to the mycolic acids that compose it (SANTOS et al., 2019).
The patient with tuberculosis
presents a different amount of symptoms such as night
sweats, dry cough (or with sputum) for more than three weeks, evening fever,
weight loss and excessive tiredness (PINTO et al., 2011). Thus, the diagnosis
consists of observing these symptoms or using laboratory methods, which are
bacteriological (bacilloscopy, rapid molecular test and mycobacterial culture)
and imaging through chest X-rays, in cases of the pulmonary form (SILVA;
ANDRADE JÚNIOR, 2020).
However, the disease has a
treatment that is based on pharmacotherapy for six months with two phases. The
intensive in the first two months with the use of the drugs isoniazid,
rifampicin and pyrazinamide and the double phase carried out in the last four
months with isoniazid and rifampicin (RABAHI et al., 2017).
Despite being a treatable and
easily diagnosed disease, tuberculosis is still a global and national public
health problem, since in 2019 in Brazil, 73,846 new cases were diagnosed and the incidence rate increased compared to other
years (BRASIL, 2020).
Epidemiological analyses can
contribute information to help control and prevent the resurgence of collective
fear of tuberculosis, as well as providing indications on the effectiveness of
control measures in combating it (COSTA et al., 2020). However, it is seen that
there is an absence of epidemiological studies carried out in several Brazilian
municipalities, such as the city of Juazeiro do Norte in the state of Ceará.
Thus, the objective of this study was to elucidate the
epidemiological profile of individuals affected with tuberculosis in the city
of Juazeiro do Norte-CE.
2 Material and
Methods
2.1 Study Design
This is an epidemiological,
retrospective, analytical, documentary, ecological and quantitative study in
which data were collected from the “Departamento de Informática do Sistema Único de Saúde” (DATASUS) (BRASIL, 2021).
2.2 Study Area
The city of Juazeiro do Norte is located in the metropolitan region of Cariri in
the state of Ceará (Figure 1). Its population for the year 2019 was 276,264,
with an average of 1.8 minimum wages for formal workers. Adding to this, in
health, the year 2009 presented 94 health establishments linked to the “Sistema
Único de Saúde” (SUS)
(IBGE, 2021).
Figure 1. Location map of the city of
Juazeiro do Norte-CE.
Access on:
https://drive.google.com/file/d/15PMYPsu2OkFJMkHbdLw3MxQrAD-aFa9L/preview
Source: Prepared with Qgis (2021).
2.3 Analysed Variables
The variables year, sex, age
group, race, education and area of residence and evolution of the cases were
studied.
2.4 Ethical Procedures
Due to the fact that this research was carried out using
secondary public data available through DATASUS and, therefore, it does not
have variables that allow the identification of the individuals studied, this
study waived the authorization of the Research Ethics Committee as provided for
in the resolution No. 510, of April 7, 2016, of the “Conselho
Nacional de Saúde” (CNS).
3 Results and Discussion
Between 2010 and 2020, there were
1,090 cases of tuberculosis in individuals in the city of Juazeiro do Norte-CE,
as shown in the figure below (Figure 2).
Figure
2. Percentage of Tuberculosis cases in Juazeiro do Norte
– CE, between 2010 and 2020.
Access on: https://drive.google.com/file/d/1uctDYif7gpaT_r9MR2eZ6jYTv9neVaCX/preview
Source:
Survey Data (this study), 2021.
Checking Figure 1, it is noted that the year 2019 was the year in which the highest
percentage of cases was found with 12.1%, followed by the years 2018 (10.5%),
2013 and 2019 (9.7%) and 2017 (9.6%). The years 2010, 2011 and 2012 were those
in which the lowest percentage of cases (7.8%) was observed.
This increase in the number of cases over the years is due to the
implementation of the “Programa Nacional de Combate à Tuberculose” (PNCT),
which has goals such as early diagnosis, treating all those affected and
increasing prevention campaigns to promote control initiatives suitable for the
disease (SILVA; ANDRADE
JÚNIOR, 2020).
In addition, in 2017, health professionals in the city of Juazeiro do
Norte underwent a training course on practices in surveillance and control of
actions aimed at the disease, contributing to greater quality and quantity of
notifications in subsequent years (ESP/CE, 2017).
The association between age group and gender of those affected by TB can
be seen in table 1.
Regarding the sex of those affected, there was a predominance of males,
representing 67.9% of cases. This finding corroborates a study carried out in
the city of Catolé do Rocha-PB, between 2009 and 2019, in which of the 91
affected with tuberculosis, 63.7% were men (SILVA; ANDRADE JÚNIOR, 2020).
The higher prevalence of males may be involved
with cultural traits, in which men consume more alcoholic beverages, tobacco
and less interest in self-care, which contributes to depression of the immune
system and favours infection with M. tuberculosis (PINTO et al., 2019).
Table
1. Association between and sex and age group of those
affected with TB in Juazeiro do Norte – CE, between 2010 and 2020.
|
Age Group |
Male |
Female |
||
|
n |
% |
n |
% |
|
|
<1-4 years old |
16 |
2.2 |
6 |
1.7 |
|
5- 9 years old |
4 |
0.5 |
0 |
0 |
|
10 to 19 years old |
33 |
4.4 |
30 |
8.6 |
|
20 to 59 years old |
543 |
73.1 |
218 |
62.3 |
|
≥ 60 years old |
147 |
19.8 |
96 |
27.4 |
|
Total |
743 |
100 |
350 |
100 |
Source:
Survey Data (this study), 2021.
The age group that prevailed in individuals with tuberculosis was 20 to
59 years old, with 69.6%, followed by those aged 60 years and over (22.2%) and
10 to 19 (5.8%). Similar results were observed in the city of Crato-CE, between
2002 and 2011, of which out of 261 TB cases, about 73.6% were aged between 20
and 59 years (PINTO et al., 2019).
This high prevalence of individuals aged 20 to 59 years is justified by
the fact that this age group is more active in work fields and, consequently,
in large agglomerations, which contributes to greater exposure to the bacillus
(COSTA et al., 2020).
The table 2 shows the ethnicity of those affected by tuberculosis.
Table
2. Race of tuberculosis patients in Juazeiro do
Norte-CE, from 2010 to 2020.
|
Race |
n |
% |
|
White |
120 |
10.9 |
|
Black |
89 |
8.2 |
|
Yellow |
8 |
0.7 |
|
Mulatto |
825 |
75.5 |
|
Indigenous |
4 |
0.4 |
|
Ignored |
47 |
4.3 |
|
Total |
1.093 |
100 |
Source: Survey Data (this study),
2021.
Regarding the affected race,
mulatto individuals were the most affected with 75.5%, followed by white
(10.9%).
The fact that most tuberculosis
patients are of the mulatto race/colour may be due to the fact that around
60.7% of the 249,939 inhabitants of Juazeiro do Norte declare themselves as
brown, as shown in the latest census by the Brazilian Institute of Geography
and Statistics (IBGE, 2021).
The table 3 shows the educational
level of those affected by tuberculosis.
Table 3. Percentage of education of those
affected with Tuberculosis in Juazeiro do Norte – CE, between 2010 and 2020.
|
Education |
n |
% |
|
No
Schooling* |
106 |
9.7 |
|
Low
education level** |
387 |
35.4 |
|
Average
schooling*** |
185 |
16.9 |
|
High education
**** |
41 |
3.8 |
|
Ignored |
351 |
32.1 |
|
Not
applicable |
23 |
2.1 |
|
Total |
1,093 |
100 |
Illiterate*, Complete and
Incomplete Elementary School**; Complete and incomplete secondary education***,
Complete and incomplete higher education ****.
Source: Survey Data (this study),
2021.
Regarding education, it was found
that individuals with low education had the highest percentage (35.4%),
followed by those with average (16.9%), those without education (9.7%) and
those with high education had the lowest percentage with 3.9% of cases. The
data obtained are similar to those found in the study
carried out in Iguatu-CE, in which the majority of
those infected had a low level of education (CAMPOS et al., 2014).
Few years of study are related to
the lack of knowledge about the disease, leading to difficulties in
understanding the methods of prevention and treatment of TB (SANTOS et al.,
2019).
The area of residence of the
affected is also an important factor to understand the behaviour of the disease
in the city, as can be seen in the table below (Table 4).
Table 4. Area of residence of those
affected with tuberculosis in Juazeiro do Norte-CE, between 2010 and 2020.
|
Residence Area |
n |
% |
|
Urban |
1,012 |
92.6 |
|
Rural |
54 |
4.9 |
|
Periurban |
2 |
0.2 |
|
Ignored |
25 |
2.3 |
|
Total |
1,093 |
100 |
Source: Survey Data (this study),
2021.
In the city of Juazeiro do
Norte-CE, with regard to the area of residence of the
infected, there was a higher prevalence in the urban area (92.6%) compared to
rural (4.9%) and peri-urban (0.2%). About 2.3% of cases were ignored. High
prevalence of cases in urban residents was also verified in the city of Rondonópolis-MT, between 2001 and 2015, with a contingent
of 90.4% of the 1,082 affected (SANTOS et al., 2019).
The fact that most cases come
from urban areas is due to the fact that these places
have vast agglomerations and, consequently, promote greater transmission of the
bacillus (SILVA; ANDRADE JÚNIOR, 2020). However, despite the low percentage of
cases, data from rural areas are worrying, as many residents have difficulties
in accessing health services.
The table 5 shows the clinical
situation of those affected by tuberculosis in the city of Juazeiro do
Norte-CE.
Table 5. Clinical situation of cases of
tuberculosis patients in Juazeiro do Norte, between 2010 and 2020.
|
Clinical Situation |
n |
% |
|
Cure |
722 |
66.1 |
|
Abandonment |
44 |
4.2 |
|
Death
from TB |
42 |
3.8 |
|
Death
from other causes |
31 |
2.8 |
|
Transfer |
31 |
2.8 |
|
Others* |
7 |
0.5 |
|
Ignored |
216 |
19,8 |
|
Total |
1,093 |
100 |
*TB-Dr; Schema Change; Primary
dropout.
Source: Survey Data (this study),
2021.
From the analysis of the table, it can be seen that most of those affected evolved to the
state of cure and a small percentage died from the disease. However, this
indicates that improvements should be made in the city's health system for
better control of the disease, since even if some individuals have evolved to a
cure, it is still a small percentage.
It is important to report the
numbers ignored in the survey, as this fact indicates the need for improvements
in filling in the notification forms, as these data are extremely relevant for
the actions of health surveillance in the municipality.
4 Conclusions
A total of 1,093 cases of
tuberculosis were found, and 2019 was the year in which the highest percentage
of those affected was observed in Juazeiro do Norte-CE.
The profile of those affected was
predominantly male individuals, aged 20 to 59 years, of mixed race, with low
education and living in urban areas. Regarding the clinical evolution, most of
those affected evolve to a cure.
The data obtained in this study
can serve to guide the development of public policies aimed at the most
susceptible population and thus contribute to the reduction of cases, in
addition to allowing greater health promotion and protection against
tuberculosis in the city.
CREDIT AUTHORSHIP
CONTRIBUTION STATEMENT
All the authors have carried out all the stages in this manuscript, such
as Conceptualization, Data curation, Formal analysis, Methodology, Project
administration, Writing, Formal analysis and
Validation.
DECLARATION OF INTEREST
The authors disclose that they have no known competing financial
interests or personal relationships that could have appeared to influence the
study reported in this manuscript.
FUNDING SOURCE
The authors declare that no funding is applicable for this research.
REFERENCES
BRASIL. Ministério
da Saúde. Secretaria de Vigilância em Saúde.
Boletim Epidemiológico
Especial. Governo Federal. 2020. Available from:
https://www.saude.gov.br/images/pdf/2020/marco/24/Boletim-tuberculose-2020-marcas--1-.pdf.
BRASIL. Casos de Tuberculose – Desde 2001. Departamento de Informática
do Sistema Único de Saúde
(DATASUS). Governo Federal. 2021. Available from:
https://datasus.saude.gov.br/acesso-a-informacao/casos-de-tuberculose-desde-2001-sinan/.
CAMPOS, R.I.; LUNA NETO, R.T.; LEITE,
S.F.P.; SARAIVA, N.B.; LIMA, F.V.F.; FERREIRA, N.B.; BARROSO, M.L. Análise do perfil epidemiológico da tuberculose no município de Iguatu–Ceará. Cadernos de Cultura e Ciência, v. 13, n. 1, p. 61-68, 2014. Available from:
https://doi.org/10.14295/cad.cult.cienc.v13i1.815.
COSTA, N.M.G.B.; BARBOSA, T.C.S;
SILVA, A.R.C; SILVA K.C.; SILVA, A.L.L. Tuberculosis situation in Ceará: an
epidemiological analysis. Brazilian Journal of Development, São José dos
Pinhais, v. 6, n. 8, p. 63049-63058, 2020. Available
from:
https://doi.org/10.34117/bjdv6n8-658.
DE ANDRADE, S.M.; CUNHA, M.A.;
SANTOS, A.C.S.; ARAÚJO, F.C.; VERDE, R.M.C.L.; SOARES, L.F.; OLIVEIRA, E.H.
Tuberculosis in São Luís-Maranhão, Brazil: analysis of the epidemiological behavior between 2010 and 2018. Research, Society
and Development, v. 9, n. 6, p. e91963514, 2020. Available from:
https://doi.org/10.33448/rsd-v9i6.3514.
ESP/CE. ESCOLA DE SAÚDE PÚBLICA
DO CEARÁ. Juazeiro do Norte recebe curso de tuberculose. Secretaria da Saúde. Governo do Estado do Ceará. 2017. Available
from:
https://www.esp.ce.gov.br/2017/08/29/juazeiro-do-norte-recebe-curso-de-tuberculose/.
IBGE. Instituto Brasileiro de Geográfia e Estatistica. Juazeiro do Norte-CE. 2021. Available
from:
https://cidades.ibge.gov.br/brasil/ce/juazeiro-do-norte/panorama.
PINTO, M.L.; SILVA, T.C.; GOMES,
L.C.F.; BERTOLOZZI, M.R.; VILLAVICENCIO, L.M.M.; AZEVEDO, K.M.F.A.; FIGUEREDO,
T.M.R.M. Occurrence of tuberculosis cases in Crato, Ceará, from 2002 to 2011: a
spatial analisys of specific standards. Revista Brasileira de Epidemiologia, v. 18, n. 2, p. 313-325, 2015. Available
from:
https://doi.org/10.1590/1980-5497201500020003.
QGIS. QGIS Development Team. QGIS
Geographic Information System. Open Source Geospatial
Foundation Project. 2021. Available from: http://qgis.osgeo.org.
RABAHI, M.F.; SILVA JÚNIOR,
J.L.R.; FERREIRA, A.C.G; TANNUS-SILVA, D.G.S.; CONDE, M.B. Tuberculosis
treatment. Jornal
Brasileiro de Pneumologia, Brasília,
v. 43, n. 6, p. 472-486, 2017. Available from:
https://doi.org/10.1590/S1806-37562016000000388.
SANTOS, D.A.S.; MARQUES, A.L.A;
OLINDA, R.A.; GOULART, L.S. Epidemiological profile of tuberculosis in a
municipality of the south of Mato Grosso. Revista
Interdisciplinar, Teresina, v. 12, n. 2, p.
25-33, 2019. Available from:
https://dialnet.unirioja.es/servlet/articulo?codigo=7868632.
SILVA, W.B.; ANDRADE JÚNIOR, F.P.
Epidemiological profile of affected by tuberculosis in Catolé do Rocha-PB,
during the years 2008 to 2018. Journal of Medicine and Health Promotion,
Patos, v. 5, n. 3, p. 90-99, 2020. Available from:
https://jmhp.fiponline.edu.br/publicacoes/v-5-n-3.