title: The study of tuberculosis-attributed deaths as a tool for disease control planning in Rio de Janeiro, Brazil.
abstract: METHODS
  Two tuberculosis (TB) reference hospitals and three general hospitals in Rio de Janeiro (RJ).
  
  
  OBJECTIVE
  To analyze TB-attributed deaths as a tool for evaluating the TB control program in RJ.
  
  
  METHODS
  Retrospective study based on 302 medical records selected from the 1998 death database.
  
  
  RESULTS
  Of 1146 registered adult (>14 years) TB-attributed deaths in RJ, 328 occurred in five hospitals, and 302 records were analyzed. Median age was 47.5 (17-89) years; 237 (78.5%) were male. Median time elapsed from onset of symptoms until diagnosis was 60 (7-730) days; median hospitalization was 60 (0-517) days. Acid-fast bacilli sputum smears were performed in 200 (69%) of 290 cases of pulmonary disease. Among 32 (36%) smear-negative patients, culture was done in only one. The recommended regimen (RHZ) was used in 175 (58%). Among 125 re-treatment patients, 55 (44%) were on RHZ instead of RHZE. Notification to health authorities was recorded in 131 (43.4%) cases.
  
  
  CONCLUSIONS
  In RJ, young people die from TB. Major issues identified in the public health system were poor detection and notification and a high default rate, perpetuating the spread of TB. Treating professionals do not follow guidelines, and political commitment is needed to ensure TB control in the state and in the country.
authors.affiliation: Department of Medicine, Gama Filho University, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Selig
authors.forename: M T C T
authors.initials: MT
authors.lastname: Belo
authors.forename: E G
authors.initials: EG
authors.lastname: Teixeira
authors.forename: A J L A
authors.initials: AJ
authors.lastname: Cunha
authors.forename: R
authors.initials: R
authors.lastname: Brito
authors.forename: K
authors.initials: K
authors.lastname: Sanches
authors.forename: A L
authors.initials: AL
authors.lastname: Luna
authors.forename: M
authors.initials: M
authors.lastname: Muller
authors.forename: C
authors.initials: C
authors.lastname: Gamba
authors.forename: C
authors.initials: C
authors.lastname: Belo
authors.forename: F
authors.initials: F
authors.lastname: Vento
authors.forename: A
authors.initials: A
authors.lastname: Trajman
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001938:Brazil; D003140:Communicable Disease Control; D016208:Databases, Factual; D005260:Female; D006291:Health Policy; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D011050:Policy Making; D011057:Politics; D011203:Poverty; D011634:Public Health; D012189:Retrospective Studies; D014397:Tuberculosis, Pulmonary / Q000401:mortality* / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents