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Caracterização epidemiológica dos casos com suspeita de Tuberculose Pulmonar recebidos pelo Laboratório de Micobactérias do HMP/IS em Luanda, entre 2012 e 2013
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Introdução
Apesar de, recentemente, terem sido alcançados progressos no controlo da Tuberculose (TB) a nível global, ainda se observa um aumento de casos nos países em desenvolvimento ou de baixa renda, como é o caso de Angola, onde a taxa de deteção foi de 64%, em 2015. Apesar da atenção dada à TB nos últimos anos, com iniciativas e linhas de financiamento para o controlo e prevenção da doença, continuam a ser friáveis os dados disponíveis sobre quem procura e como é procurado o diagnóstico de TB ou feita a sua confirmação, quais os exames de diagnóstico realizados e os protocolos subjacentes e qual o desfecho do tratamento, entre outros. Quando estes aspetos são afunilados para contextos específicos, como é o caso do sistema de serviços de saúde militar, o desconhecimento tende a se agravar visto que não existem estudos de base sobre os mesmos.
Objectivo
Este estudo teve como objectivo caracterizar os casos de suspeita de TB enviados para o laboratório de micobacteriologia do departamento de patologia clínica do Hospital Militar Principal/Instituto Superior (HMP/IS), em Luanda, Angola, em 2012 e 2013.
Material e métodos
Para dar resposta ao objectivo, foi realizado um estudo quantitativo, observacional, transversal, descritivo, envolvendo 3993 doentes suspeitos de TB com idade igual ou superior a 18 anos, internados ou não, independentemente do sexo, ser civil ou militar e que enviaram pelo menos dois produtos biológicos para análise laboratorial para o laboratório de micobacteriologia do HMP/IS em 2012 e 2013.
Os dados foram recolhidos dos cadernos de registo de rotina do laboratório de micobactérias e inputados numa base de dados Excel, importada para o software SPSS v.22 com recurso ao qual se realizou a análise estatística.
Resultados
A maior parte dos suspeitos de TB atendidos neste serviço, eram homens, militares, e em idade produtiva. A maioria tinha suspeita de TB pulmonar e a expectoração era a amostra mais utilizada para confirmação diagnóstica. A baciloscopia foi o exame mais solicitado e a TB pulmonar foi a forma mais prevalente entre os casos positivos. A prevalência de TB foi de 22% sendo considerada elevada. Apenas 19,0% dos casos foram confirmados com os três métodos disponíveis. Detectaram-se 7 casos de TB-MR e mais de metade dos casos tinha uma ou mais resistência aos fármacos utilizados. Os meios de diagnóstico disponíveis provaram ser de grande utilidade, porém poderiam ser acrescidas novas metodologias e equipamentos de forma a detectar mais precocemente casos de TB e TB-MR.
Discussão e recomendações
Os achados do estudo, nomeadamente, a alta prevalência de TB, o predomínio de TB na forma pulmonar, a idade média dos casos, o sexo masculino, a sua proveniência e militares de patentes mais baixas como os mais afectados, estão de acordo com a literatura
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consultada. Detectaram-se falhas no preenchimento dos pedidos de exames, o que enviesou em muitos aspectos os resultados do estudo. Apesar das limitações que o contexto angolano apresenta no diagnóstico, tratamento de TB e compreensividade dos sistemas de informação em saúde, consideramos relevante a replicação deste estudo, o que nos permitirá conhecer e comparar a realidade de outros laboratórios, identificando boas práticas e dificuldades e padronizando técnicas de trabalho quer no sistema de saúde militar quer no civil. O nosso estudo mostra que há a necessidade de se desenvolver mais esforços
Introduction Despite the recent progress on Tuberculosis (TB) control at a global level, there has still been an increase in the number of cases in developing or low-income countries, such as Angola. In 2015 the detection rate in this country was 64%. Although a lot of attention has been given to tuberculosis in recent years, with initiatives and funding for disease control and prevention, available data on who and how the diagnosis of tuberculosis is obtained or confirmed; which of the diagnostic tests are being used; what are the underlying protocols and the outcomes, among others are still scarce and frail. When these aspects are contextualized to specific environments, such as the Angolan military health care system, the lack of information is even greater, since there are no baseline studies on the quality of TB diagnosis. Objective The main objective is this study was to characterize the suspected cases of TB that were sent to the mycobacteriology laboratory of the department of clinical pathology of the Hospital Militar Principal / Instituto Superior (HMP/IS), in 2012 and 2013. Methodology In order to achieve the objectives of this research, a quantitative, cross-sectional, descriptive study was carried out, with a sample of 3993 patients suspected of having TB that had at least two samples sent for analysis in the HMP/IS mycobacteriology laboratory in 2012 and 2013. The participants where aged 18 years or older, hospitalized or not, no matter the gender, civil or military status. Data were collected from the routine diaries of the mycobacteria laboratory and inserted into an Excel database, which was then imported into SPSS software v.22 to perform descriptive statistical analysis was done. Results The majority of the suspected cases of TB treated were military men in the productive age group. Most were suspected of having pulmonary TB, and sputum was the most commonly used sample. Bacilloscopy was the most requested test and pulmonary TB was the most prevalent form among the positive cases. There was a 22% prevalence of TB. Only 19 % of the cases were confirmed by the three available methods. The available means of diagnosis proved to be very useful, but new methodologies and equipment should be added in order to increase earlier detections of TB and MR-TB. Discussion and recommendations The findings of the study (high prevalence of TB, predominance of TB in its the pulmonary form, productive age of the cases, male gender, origin and being military of the lowest rank), are in accordance with the available literature. Fill-in errors in the viii examination requests were identified, which might have biased the results of the study in several aspects. Despite the limitations presented by the Angolan context for TB diagnosis and treatment, and taking into consideration the comprehensiveness of available Health Information System, we consider the replication of this study to be relevant. We believe that it will allow us to better understand and compare the reality of other laboratories, to identify good practices and difficulties and to standardize techniques in both the military and civilian health systems. Our study shows that there is a need of greater efforts in the fight against tuberculosis, since the exposure of the military and civilian’s population to this disease is real.
Introduction Despite the recent progress on Tuberculosis (TB) control at a global level, there has still been an increase in the number of cases in developing or low-income countries, such as Angola. In 2015 the detection rate in this country was 64%. Although a lot of attention has been given to tuberculosis in recent years, with initiatives and funding for disease control and prevention, available data on who and how the diagnosis of tuberculosis is obtained or confirmed; which of the diagnostic tests are being used; what are the underlying protocols and the outcomes, among others are still scarce and frail. When these aspects are contextualized to specific environments, such as the Angolan military health care system, the lack of information is even greater, since there are no baseline studies on the quality of TB diagnosis. Objective The main objective is this study was to characterize the suspected cases of TB that were sent to the mycobacteriology laboratory of the department of clinical pathology of the Hospital Militar Principal / Instituto Superior (HMP/IS), in 2012 and 2013. Methodology In order to achieve the objectives of this research, a quantitative, cross-sectional, descriptive study was carried out, with a sample of 3993 patients suspected of having TB that had at least two samples sent for analysis in the HMP/IS mycobacteriology laboratory in 2012 and 2013. The participants where aged 18 years or older, hospitalized or not, no matter the gender, civil or military status. Data were collected from the routine diaries of the mycobacteria laboratory and inserted into an Excel database, which was then imported into SPSS software v.22 to perform descriptive statistical analysis was done. Results The majority of the suspected cases of TB treated were military men in the productive age group. Most were suspected of having pulmonary TB, and sputum was the most commonly used sample. Bacilloscopy was the most requested test and pulmonary TB was the most prevalent form among the positive cases. There was a 22% prevalence of TB. Only 19 % of the cases were confirmed by the three available methods. The available means of diagnosis proved to be very useful, but new methodologies and equipment should be added in order to increase earlier detections of TB and MR-TB. Discussion and recommendations The findings of the study (high prevalence of TB, predominance of TB in its the pulmonary form, productive age of the cases, male gender, origin and being military of the lowest rank), are in accordance with the available literature. Fill-in errors in the viii examination requests were identified, which might have biased the results of the study in several aspects. Despite the limitations presented by the Angolan context for TB diagnosis and treatment, and taking into consideration the comprehensiveness of available Health Information System, we consider the replication of this study to be relevant. We believe that it will allow us to better understand and compare the reality of other laboratories, to identify good practices and difficulties and to standardize techniques in both the military and civilian health systems. Our study shows that there is a need of greater efforts in the fight against tuberculosis, since the exposure of the military and civilian’s population to this disease is real.
Descrição
Palavras-chave
Programa de controlo da tuberculose nas forças armadas angolanas Tuberculose Casos suspeitos de tuberculose Tuberculose pulmonar Diagnóstico laboratorial da tuberculose.
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical