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Risk areas for tuberculosis among children and their inequalities in a city from Southeast Brazil

ABSTRACT: Background The objective of the study was to identify areas of risk for the appearance of tuberculosis in children and their association with social inequalities in a municipality in southeastern Brazil. Methods Ecological study conducted in Ribeirão Preto, Brazil. To identify areas of spatial risk for tuberculosis in children, we used spatial scanning statistics. To analyze the association of cases of childhood tuberculosis with social vulnerability, we used the Social Vulnerability Index of São Paulo, and four explanatory statistical models were listed. Results There were 96 cases of childhood tuberculosis, of which 90 were geocoded through a process of converting addresses to geographic coordinates. A risk area was identified in the municipality, where children under 15?years old have 3.14 times greater risk of contracting tuberculosis than those living outside this area. The variables identified as risk factors were: number of private and collective households, proportion of children aged 0 to 5?years in the population, proportion of households without per capita income, and the proportion of private households with monthly nominal incomes of up to one quarter of wage minimums. The variables identified as protection factors were the proportion of women under the age of 30?years responsible for the household under and women responsible for the household with an average income over BRL 2344. Conclusion The study showed areas of risk for the occurrence of tuberculosis in children. The study is in line with the End TB Strategy and the 2030 Agenda, which aim to support strategic actions and, therefore, save the lives of children through the systematic, intensified, and comprehensive identification of children with tuberculosis respiratory symptoms in the community.

SUBMITTER: Alves Y

PROVIDER: S-EPMC7541251 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Project description:IntroductionTuberculosis is one of the ten leading causes of death and the leading infectious cause worldwide. The disease represents a challenge to health systems around the world. In 2018, it is estimated that 10 million people were affected by tuberculosis, and approximately 1.5 million people died due to the disease worldwide, including 251,000 patients coinfected with HIV. In Brazil, the disease caused 4,490 deaths, with rate of 2.2 deaths per 100,000 inhabitants. The objective of this study was to analyze the time behavior, spatial, spatial-temporal distribution, and the effects of social vulnerability on the incidence of TB in Brazil during the period from 2001 to 2017.Materials and methodsA spatial-temporal ecological study was conducted, including all new cases of tuberculosis registered in Brazil during the period from 2001 to 2017. The following variables were analyzed: incidence rate of tuberculosis, the Social Vulnerability Index, its subindices, its 16 indicators, and an additional 14 variables available on the Atlas of Social Vulnerability. The statistical treatment of the data consisted of the following three stages: a) time trend analysis with a joinpoint regression model; b) spatial analysis and identification of risk areas based on smoothing of the incidence rate by local empirical Bayesian model, application of global and local Moran statistics, and, finally, spatial-temporal scan statistics; and c) analysis of association between the incidence rate and the indicators of social vulnerability.ResultsBrazil reduced the incidence of tuberculosis from 42.8 per 100,000 to 35.2 per 100,000 between 2001 and 2017. Only the state of Minas Gerais showed an increasing trend, whereas nine other states showed a stationary trend. A total of 326 Brazilian municipalities were classified as high priority, and 22 high-risk spatial-temporal clusters were identified. The overall Social Vulnerability Index and the subindices of Human Capital and Income and Work were associated with the incidence of tuberculosis. It was also observed that the incidence rates were greater in municipalities with greater social vulnerability.ConclusionsThis study identified clusters with high risk of TB in Brazil. A significant association was observed between the incidence rate of TB and the indices of social vulnerability.

Project description:BackgroundBovine tuberculosis (bTB), caused by Mycobacterium bovis, is an infectious disease of cattle that also affects other domestic animals, free-ranging and farmed wildlife, and also humans. In Mozambique, scattered surveys have reported a wide variation of bTB prevalence rates in cattle from different regions. Due to direct economic repercussions on livestock and indirect consequences for human health and wildlife, knowing the prevalence rates of the disease is essential to define an effective control strategy.Methodology/principal findingsA cross-sectional study was conducted in Govuro district to determine bTB prevalence in cattle and identify associated risk factors. A representative sample of the cattle population was defined, stratified by livestock areas (n = 14). A total of 1136 cattle from 289 farmers were tested using the single comparative intradermal tuberculin test. The overall apparent prevalence was estimated at 39.6% (95% CI 36.8-42.5) using a diagnostic threshold cut-off according to the World Organization for Animal Health. bTB reactors were found in 13 livestock areas, with prevalence rates ranging from 8.1 to 65.8%. Age was the main risk factor; animals older than 4 years were more likely to be positive reactors (OR = 3.2, 95% CI: 2.2-4.7). Landim local breed showed a lower prevalence than crossbred animals (Landim × Brahman) (OR = 0.6, 95% CI: 0.4-0.8).Conclusions/significanceThe findings reveal an urgent need for intervention with effective, area-based, control measures in order to reduce bTB prevalence and prevent its spread to the human population. In addition to the high prevalence, population habits in Govuro, particularly the consumption of raw milk, clearly may potentiate the transmission to humans. Thus, further studies on human tuberculosis and the molecular characterization of the predominant strain lineages that cause bTB in cattle and humans are urgently required to evaluate the impact on human health in the region.

Project description:The aim of this study was to investigate the potential risk factors for clinical and subclinical mastitis in smallholder dairy farms in Brazil. A prospective, repeated cross-sectional study was carried out between May 2018 and June 2019 on 10 smallholder dairy farms. Potential risk factors for subclinical and clinical mastitis at the herd and cow level were recorded through interviewing the owner and by observation. A combination of clinical udder examination and the Tamis (screened mug with a dark base) test (Tadabras Indústria e Comércio de Produtos Agrovetereinário LTDA, Bragrança Paulista, SP, Brazil) were applied to observe clinical mastitis, and the California Mastitis Test (Tadabras Indústria e Comércio de Produtos Agrovetereinário LTDA, Bragrança Paulista, SP, Brazil) was used to determine subclinical mastitis. A total of 4567 quarters were tested, 107 (2.3%) had clinical mastitis, while 1519 (33.2%) had subclinical mastitis. At the cow level, clinical mastitis risk was highest in mid-lactation (50-150 days in milk) with OR 2.62 with 95% confidence interval (CI) of 1.03-6.67, while subclinical mastitis was highest in late lactation (> 150 days in milk) with OR 2.74 (95% CI 2.05-3.63) and lower in primiparous (OR 0.54, 95% CI 0.41-0.71) than multiparous cows. At the herd level, using dry-cow treatment (OR 4.23, 95% CI 1.42-12.62) was associated with an increased risk of clinical mastitis. Milking clinical (OR 0.37, 95% CI 0.24-0.56) and subclinical cases last (OR 0.21, 95% CI 0.09-0.47) and cleaning the milking parlor regularly (OR 0.27, 95% CI 0.15-0.46) had decreased odds for subclinical mastitis, while herds with optimized feed had greater odds (OR 9.11, 95% CI 2.59-31.9). Prevalence of clinical mastitis was at its lowest at the first visit in June/July and highest at the last visit in April/June (OR 3.81, 95% CI 1.93-7.52). Subclinical mastitis also presented increased odds in the last visit (OR 2.62, 95% CI 2.0-3.36). This study has identified some risk factors for mastitis on smallholder farms but further research on more farms across more areas of Brazil is required to develop a targeted mastitis control program for smallholder farms.

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Risk areas for tuberculosis among children and their inequalities in a city from Southeast Brazil

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