Article type
Year
Abstract
Background: in Cuba, tuberculosis (TB) was one of the diseases with the highest incidence and mortality in the 1950s. It was among the 10 leading causes of death, with rates between 19.2 and 16.4 per 10,000 inhabitants. In 1959, with the triumph of the Revolution, economic policies emerged that raised the level of income and contributed to a better quality of life.
The diagnosis of TB in patients with HIV reached values between 0.5% and 5.1% in the period 1995 to 2005. During the first 12 years of the 21st century, in Havana, the incidence and prevalence of the disease showed particularities, which make it the second hightest province to contribute morbidity cases and with a tendency to increase that may compromise efforts to eliminate TB as a health problem in Cuba.
Objectives: to describe morbidity and mortality behaviour due to TB in Havana province according to social, economic and living conditions. To characterize the perceptions that patients with TB and health managers have about access to health services for treatment according to living conditions.
Methods: we used information from official sources: Obligatory Declaration Disease cards, Death Certificates and epidemiological surveys; from survey instruments and semi-structured interviews, constructed and validated by a group of experts. We described morbidity and mortality in the population of Havana municipalities according to socioeconomic characteristics and living conditions, by means of stratification made with municipal living conditions, rates, years of life potentially lost (YLLP), standardized morbidity, mortality and lethality rates using tests of statistical significance.
We identified the perception of users and managers of the TB Program on access to health services for patient care in Havana municipalities.
Results: there was over-morbidity due to TB in the unfavourable stratum, in adults, male, with primary schooling, black skin colour, separated, retired or unemployed with low household income and overcrowding.
There were difficulties in the extreme strata with specialized attention, community education, distance from services, sexual and cultural stigmas, with food and transportation.
We identified social, economic and access inequalities that influenced disease behaviour.
Conclusions: morbidity due to TB in Havana responds to changes in living conditions of social and economic variables; in the unfavourable and regular strata they stopped living for a greater number of years, and in the rest of the strata social and economic conditions exist to increase the disease.
The greatest effects on health access dimensions were evidenced in the conglomerates with the most social and economic disadvantage.
Patient or healthcare consumer involvement: this work has a large patient involvement because of the type of study.
The diagnosis of TB in patients with HIV reached values between 0.5% and 5.1% in the period 1995 to 2005. During the first 12 years of the 21st century, in Havana, the incidence and prevalence of the disease showed particularities, which make it the second hightest province to contribute morbidity cases and with a tendency to increase that may compromise efforts to eliminate TB as a health problem in Cuba.
Objectives: to describe morbidity and mortality behaviour due to TB in Havana province according to social, economic and living conditions. To characterize the perceptions that patients with TB and health managers have about access to health services for treatment according to living conditions.
Methods: we used information from official sources: Obligatory Declaration Disease cards, Death Certificates and epidemiological surveys; from survey instruments and semi-structured interviews, constructed and validated by a group of experts. We described morbidity and mortality in the population of Havana municipalities according to socioeconomic characteristics and living conditions, by means of stratification made with municipal living conditions, rates, years of life potentially lost (YLLP), standardized morbidity, mortality and lethality rates using tests of statistical significance.
We identified the perception of users and managers of the TB Program on access to health services for patient care in Havana municipalities.
Results: there was over-morbidity due to TB in the unfavourable stratum, in adults, male, with primary schooling, black skin colour, separated, retired or unemployed with low household income and overcrowding.
There were difficulties in the extreme strata with specialized attention, community education, distance from services, sexual and cultural stigmas, with food and transportation.
We identified social, economic and access inequalities that influenced disease behaviour.
Conclusions: morbidity due to TB in Havana responds to changes in living conditions of social and economic variables; in the unfavourable and regular strata they stopped living for a greater number of years, and in the rest of the strata social and economic conditions exist to increase the disease.
The greatest effects on health access dimensions were evidenced in the conglomerates with the most social and economic disadvantage.
Patient or healthcare consumer involvement: this work has a large patient involvement because of the type of study.
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