Características sociodemográficas de la población inmigrante diagnosticada de tuberculosis en la Comunidad de Madrid

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Abstract

Objetivo: Describir las características sociodemográficas de la población inmigrante enferma de tuberculosis en la Comunidad de Madrid. Pacientes y método: Estudio descriptivo. Captación de casos: 15 hospitales de la Comunidad de Madrid y 3 consultas de atención primaria de la Cruz Roja. Se incluyeron a los inmigrantes económicos, mayores de 15 años, no internos en prisión y diagnosticados de tuberculosis durante el año 2003. Resultados: Se identificaron 312 personas, 296 formaron parte del estudio. Las principales nacionalidades fueron Ecuador (27,4%) y Marruecos (19,3%). Un 18,9% de la población no tenía cobertura sanitaria. El tiempo medio transcurrido desde la entrada en España y la enfermedad fue de 29,5 meses. El 66,9% vivía con algún familiar. El 63,2% de la población que estaba laboralmente activa realizaba trabajos informales. El principal factor de riesgo fue ser bebedor de riesgo. Conclusiones: Es necesario conocer la situación sociosanitaria de la población inmigrante enferma de tuberculosis para poder adaptar los programas de control a una nueva situación epidemiológica y social.

Translated abstract

Objetive: To describe the social and demographic characteristics of immigrant patients diagnosed of tuberculosis in the Community of Madrid. Participants and method: Descriptive study. The information was gathered from the patients diagnosed in 15 hospitals of the Community of Madrid, and 3 primary health Red Cross facilities. Criteria for inclusion: to be tuberculosis diagnosed during the year 2003, to be economic immigrant, to be older than 15 year-old, and not to be in prison. Results: 312 persons were identified. 296 were included in the study. Main nationalities: Ecuador (27.4%) and Morocco (19.3%). The 18.9% of the population does not have health insurance. The time between the arrival to Spain and the illness was 29.5 months. The 66.9% of the cases lived with some relatives. The 63.2% of the active population worked in the informal economy. The main risk factors was to be risk drinker. Conclusions: To know the social and sanitary situation of immigrant patients diagnosed of tuberculosis is base to adapt the control programs to a new epidemiologist and social situation.

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Current status of treatment completion and fatality among tuberculosis patients in Spain.

M Caminero, , P Lara … (2004)

To determine treatment completion among patients with tuberculosis (TB), and to analyse factors associated with treatment default and fatality. A prospective cohort study of patients who began treatment between 1 June 1999 and 31 May 2000 in areas where members of the SEPAR Tuberculosis and Respiratory Infections Group work. Factors associated with treatment default and fatality were studied using logistic regression, calculating odds ratios (OR) and their 95% confidence intervals (95%CI). The study involved 142 physicians from 76 different hospitals who provided information on 1515 cases. Eighty-two per cent of the patients completed treatment correctly, 14% defaulted, 5% died, 0.5% failed, and 8.7% interrupted treatment due to transfer or other reasons. The variables associated with default were intravenous drug use (IVDU) (OR 6.00, 95%CI 2.59-13.89) and immigration (OR 8.57, 95%CI 3.78-19.45); sex, age, homelessness, incarceration, directly observed treatment (DOT) or hospitalisation were not associated with default. Variables found to be predictive of fatality were alcoholism (OR 6.38, 95%CI 2.09-19.48), human immunodeficiency virus (HIV) infection (OR 7.08, 95%CI 2.08-29.15) and age >64 years (OR 10, 95%CI 2.9-34.07), whereas sex, IVDU, homelessness, DOT and hospitalisation were not. In industrialised countries, IVDU patients and immigrants should be targeted for DOT, while to reduce fatality rates stricter monitoring is required for patients who are alcoholic, HIV-infected, or aged >64 years.

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An exploration of the social stigma of tuberculosis in five "municipios" of Nicaragua to reflect on local interventions.

Bruno Dujardin, Jean Macq, Guillermo Martinez de Tejada … (2005)

The social stigma of tuberculosis is much less studied than those of other diseases such as AIDS or mental problems. However, it has important implications on the affected person's well being and on the epidemic's control. Our study aims at exploring this social stigma in five local health systems of Nicaragua, prior to implementing interventions to reduce it. Through in-depth interviews and focus groups involving stakeholders in the care of people affected by tuberculosis (PATBs), we analysed interactions between PATBs and family members, first line government health services' personnel, and community members. According to our results, the interaction between stakeholders and PATBs can be described as the intersection between two sets of contradictory feelings and attitudes: (a) feelings of affection and supportive attitudes toward PATBs opposed to the fear of being infected or that PATBs will infect others and, (b) confidence in PATBs considered to be unlucky opposed to mistrust of PATBs considered to be negligent. PATBs react against this mainly by hiding their condition which leads them to a, loss of confidence and depression. This intricate group of feelings and attitudes is influenced by two sets of determinants related to domination and power between stakeholders and issues of knowledge and information. Analysing tuberculosis-related social stigma as a social process enabled us to better understand some key social structural factors of health care system's organisation and identify locally acceptable interventions to reduce such stigma. The fact of analysing, in a more thorough study, some interventions in the currently changing social structural context of health care systems in Nicaragua will give us a better insight into the relevance of our analysis and the interventions' effectiveness in reducing the social stigma of tuberculosis.