Tuberculosis among the Xavante Indians of the Brazilian Amazon: an epidemiological and ethnographic assessment.
BACKGROUND
Despite broad availability of a national tuberculosis (TB) control program that has proved effective in Brazil, TB remains a major cause of morbidity and mortality among indigenous peoples.


OBJECTIVE
We report the results of an interdisciplinary investigation of TB epidemiology, healthcare services, and ethnomedicine among the Xavante Indians of Central Brazil.


METHODS
Fieldwork components included clinical assessment of TB (479 subjects, 89.3% of the population = 1 year of age), analysis of medical health records, and ethnographic research.


RESULTS
We found TB to constitute a major health risk, with moderately high annual risk of infection (0.94%), moderate prevalence of infection, high percentage of X-ray images suggestive of TB (14.2% in subjects > or = 10 years of age), and a relatively low percentage of individuals with reactive TB skin tests (16.6% of reactions > or = 10 mm) despite high BCG vaccine coverage. We also found a high rate of TB patients showing no evidence of prior infection. Ethnographic interviews show that Xavante and biomedical health perspectives are simultaneously divergent in their etiologies but pragmatically compatible.


CONCLUSIONS
Ineffective diagnosis procedures compromise the efficacy of existing TB prevention efforts and threaten to undermine otherwise favorable institutional and cultural conditions.
Basta
Paulo Cesar
PC
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro (RJ), Brazil.
Coimbra
Carlos E A
CE
Welch
James R
JR
Corrêa Alves
Luiz Carlos
LC
Santos
Ricardo Ventura
RV
Bastos Camacho
Luiz Antonio
LA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000884:Anthropology, Cultural; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D015994:Incidence; D007199:Indians, South American; D007223:Infant; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000208:ethnology*; D055815:Young Adult