title: [Tuberculosis in Amazonian municipalities of the Brazil-Colombia-Peru-Venezuela border: epidemiological situation and risk factors associated with treatment default].
abstract: OBJECTIVE
  To describe the epidemiological situation and the incidence of tuberculosis and to investigate the factors associated with treatment default in the Amazonian municipalities located in the northern Brazilian international border.
  
  
  METHODS
  This retrospective study employed sociodemographic, clinical, and epidemiological tuberculosis data recorded in the Brazilian Notifiable Diseases Information System (SINAN) between 2001 and 2010. Logistic regression was used to identify factors associated with treatment default.
  
  
  RESULTS
  Tuberculosis affected mostly indigenous peoples (51.9%), males (57.9%), and people aged 25-44 years (31.4%). The predominant clinical presentation was pulmonary (89.7%), yet in 24.5% of the cases the patients did not undergo sputum smear microscopy, and only half received supervised treatment. In 70.0% of the cases notified, patients were discharged as cured. Treatment default was recorded in 10.0% of the patients. Of all deaths, 4.1% were by tuberculosis and other causes, and 1.7% by multidrug-resistant tuberculosis. The average incidence by race/color was greater among indigenous peoples, ranging from 202.3/100 000 in 2001 to 65.6/100 000 in 2010. Treatment default was associated with failure to perform the follow-up smear at the second, fourth, and sixth months (OR = 11.9, 95%CI: 7.4-19.0); with resuming treatment after default (OR = 3.0, 95%CI: 1.5-5.9); and with living in specific subregions, particularly the Alto Solimões region (OR = 6.7, 95%CI: 4.6-9.8).
  
  
  CONCLUSIONS
  The present results show a high incidence of tuberculosis in the Amazon portion of the northern Brazilian international border, especially among indigenous peoples. Considering the socio-cultural specificities of these populations and the poor tuberculosis control in this area, the authors of the study conclude that the integration of different national health systems is both necessary and urgent.
authors.affiliation: Centro de Atenção Integral à Saúde, Universidade Federal do Amazonas, Manaus, AM, Brasil, elsia@amazonia.fiocruz.br.
authors.forename: Elsia Nascimento
authors.initials: EN
authors.lastname: Belo
authors.affiliation: Departamento de Sociodiversidade em Saúde, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brasil.
authors.forename: Jesem Douglas Yamall
authors.initials: JD
authors.lastname: Orellana
authors.affiliation: Departamento de Sociodiversidade em Saúde, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brasil.
authors.forename: Antônio
authors.initials: A
authors.lastname: Levino
authors.affiliation: Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
authors.forename: Paulo Cesar
authors.initials: PC
authors.lastname: Basta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003105:Colombia / Q000453:epidemiology; D015897:Comorbidity; D004641:Emigration and Immigration; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D007199:Indians, South American / Q000706:statistics & numerical data; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010568:Peru / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D013383:Suburban Population / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology; D014505:Urban Population / Q000706:statistics & numerical data; D014687:Venezuela / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
vernacular_title: Tuberculose nos municípios amazonenses da fronteira Brasil-Colômbia-Peru-Venezuela: situação epidemiológica e fatores associados ao abandono.