Vulnerability aspects that hinder tuberculosis healing according to the perspective of patients and healthcare managers

Abstract

Introduction : Tuberculosis is a major public health condition worldwide. The partnership between Healthcare Services and the patient is the gold standard for a successful healing outcome and a reduction in the harm the disease causes to patients and society in general. Objective : To analyze the vulnerability aspects that make tuberculosis healing difficult according to the perspective of patients and public healthcare managers. Method : This is a descriptive study conducted in the year 2013 in Cajazeiras, a town located in the state of Paraiba in the northeastern region of Brazil. The study population was composed of 4 healthcare managers and 29 patients with confirmed tuberculosis diagnosis. In order to gather the sample of tuberculosis patients, a search on the Information System on Diseases of Compulsory Declaration (SINAN, in the Portuguese abbreviation) was run. Results : All patients had fixed addresses. Among these individuals, a total of 12 were of the male sex, 13.6% were smokers, 77.3% were alcohol-free and 13.6% were frequent alcohol consumers. In addition to that, 72.7% of the patients received no public financial support of any sort. As to coping with the disease, 54.5% declared no difficulty at all, 22.7% found it very difficult, 18.2% reported it was somewhat difficult and 4.5% stated it was extremely difficult. Concerning family income, 68.0% lived on up to two minimum wages. Final considerations : The findings in the current study revealed the vulnerability condition upon which tuberculosis patients live, highlighting the social exclusion of this population with their low educational level, their low-income status, their poverty condition and their difficulty in understanding their basic needs, such as the necessity of a well-balanced diet to prevent the adverse effects caused by the drugs during the treatment. Managers identified social stigma, prejudice, denial of the disease with a resultant resistance to treatment, street-dwelling individuals and drinking and smoking habits as major difficulties for tuberculosis control in the city. It is quite clear that the managers approach the universe of vulnerability within its three inseparable dimensions: individual, social and programmatic. A better understanding of the real needs of tuberculosis patients as well as the prioritization of the disease are of utmost importance in the municipal public health agenda, which is based on a higher involvement of managers in the participation, discussion and definition of the application of resources for the disease control and a public health policy that encompasses tuberculosis social issues.