Evidências da determinação social da tuberculose por meio da especialização: uma contribuição para a vigilância em saúde

Abstract

The objective was to analyze the spatio-temporal distribution of tuberculosis cases and its relationship with the social determinants of health in the urban area of Crato/CE/ Brazil, from 2002 to 2011. Ecological, temporal trend and hybrid design study, with a quantitative approach. 261 new cases of tuberculosis were georeferenced. The construction of Geographical Information System, preparation of maps and spatial analysis were made using the ArcGis software - version 9, by Esri. In order to characterize the study subjects, it was used the software R where the data were submitted to absolute and relative frequency calculations. The profile of patients in 10 years of study obeyed the following pattern: males (64,0%), aged between 20 to 59 years old (73,6%), with low schooling (59,0%), affected by pulmonary form of tuberculosis (80,1%) and that have achieved the cure of the disease (77,0%). The distribution of tuberculosis in points form showed that the new disease cases were not distributed on a regular basis, indicating a clustered spatial pattern. The map with the cases density through the estimated Kernel, revealed that there are cases of the disease spread widely across the city, however, the "hot" areas demonstrate that these are more concentrated in the vicinity of the map central region. The graph of the function L pointed out positive values, being the same above the envelopes, which characterizes and confirms the grouping of cases. It was built a Tuberculosis Determination Indicator using data from the Census 2010. A thematic map was generated and it indicated high, intermediate and low social determination for the disease, which was compared to the map of cases concentration by means of Kernel estimation. The areas with the highest number of illness cases coincided with the concentration areas of poverty and of social intermediate determination. The study revealed that the disease has not reached all population groups with the same intensity, those who were most vulnerable, in fact, were the ones who dwelt in regions with fewer infrastructures and where the flow of people is intense. The techniques presented in this work proved they are useful as a tool to be used by Health Surveillance Services, as it provides valuable information on identifying vulnerable areas of tuberculosis occurrence. Thus, greater efforts should be provided in the planning of preventive actions in the identified areas to plan strategic interventions and selective monitoring in these localities, in a more active and effective, thereby fostering greater impact on changes in the epidemiological picture of the disease.