Indicators of tuberculosis morbimortality in hospitals in the city of São Paulo, Brazil

Abstract

Introduction: The treatment of tuberculosis is currently carried out in outpatient health services and hospitalization is only recommended for the more severe cases or for those facing social problems. In São Paulo, however, a considerable number of tuberculosis patients are still hospitalized. Objective: To study the socio-demographic and clinical-epidemiological characteristics of hospitalized tuberculosis patients in the city of São Paulo in 2001. Specific Objetive: To calculate tuberculosis morbimortality indicators for inpatients. Methods: Indicators of morbimortality of inpatients were calculated taking as sources, data from the São Paulo state tuberculosis information system - (Epitb) registration program, and the follow-up and analysis of reports and population data from Deinfo/ SEMPLA and FIPE. Results: A total of 2,473 tuberculosis patients were hospitalized in the city of São Paulo in 2001. The hospitalization rate for these patients was 23.5 per 100,000 inhabitants, and the mortality rate found was 4.1 per 100,000 inhabitants with 485 deaths, yielding a fatality rate of 17.4%. Discussion: The TB/HIV co-infection rate was of 32.7% among inpatients and 12.5% among those not hospitalized, showing that the Aids epidemic has caused a considerable impact both in the magnitude and in the severity of the situation of hospitalized tuberculosis patients. The higher fatality rate (48.4%) is of disseminated / miliary tuberculosis, of which the majority occurs in HIV-positive patients. If, however, known HIV-positive cases are excluded, the fatality rate still remains high, i.e. 15%, showing that the severity of cases is not only due to co-infection. Conclusions: Taking all points into consideration, the indicators showed an alarming situation. Recommendation: It is recommended that the epidemiological surveillance of municipalities establish flows and follow-up strategies for tuberculosis patients who have been hospitalized, mainly those in large urban centers, in order to guarantee continuity of care and modify the present scenario.