Acesso à detecção de casos da tuberculose pulmonar no Rio Grande do Sul

Abstract

Objective: To evaluate the access to the detection of pulmonary tuberculosis cases in the health services of municipalities in the state of Rio Grande do Sul. Method: a descriptive study, composed of data extracted from multicentric research. Data were collected in the municipalities of Canoas, Pelotas, Santa Cruz do Sul and Sapucaia do Sul, located in the state of Rio Grande do Sul. People with pulmonary tuberculosis were interviewed between 2013 and 2014. A questionnaire related to geographical access, the use of health services and the provision of tests essential for the diagnosis of tuberculosis. For the analysis of geographical access, the distances between the domicile of the person with tuberculosis and the nearby health services used for first care and diagnosis were measured. It was considered as facilitated access those services located in up to 800 meters and difficult access those located more than 800 meters. The Chi-square test was applied to verify the association between health services located up to 800 meters and those located at a distance of more than 800 meters. Regarding the analysis of the data regarding the use and the offer of exams, the relative and absolute frequencies were described. Results: in the municipalities of Canoas and Pelotas, a statistically significant association was found between the distances of the health services and the first service sought by the people (p = 0.001) and (p = 0.001) respectively. The units of prompt service located more than 800 meters are the most sought after for the first service, 40.5% (32) in Canoas and 35.9% (24) in Pelotas. There was a statistical association between the distances of the health services and the service diagnosed in Canoas (p = 0.004) and Pelotas (p = 0.001), pointing out that specialized services located more than 800 meters away are the most sought, corresponding to 87 , 4% (69) in Canoas and 59.7% (40) in Pelotas. Regarding the use of services in the four municipalities (n = 290), it was verified that 37.5% (109) of the people were diagnosed in the first health service sought and 62.4% (181) had to seek other health services until the diagnosis of tuberculosis. The specialized services were the most used for the first service, with 39.7% (115) of the people and also those who performed better, offering sputum smear microscopy to 64.1% (186), chest X-ray to 57, 2% (166) and anti-HIV examination to 62.7% (182). Conclusion: access to tuberculosis detection presents obstacles in the municipalities under study regarding the offer of actions and the use of health services, but the services are distributed geographically close to those with symptoms of tuberculosis. APS units in this process have the lowest results when compared with other health services, indicating the low participation in the detection of tuberculosis.