A cohort of cases initiating tuberculosis treatment from May 2001 to July 2003 was followed in Recife, Pernambuco State, Brazil, to investigate biological, clinical, social, lifestyle, and healthcare access factors associated with three negative tuberculosis treatment outcomes (treatment failure, dropout, and death) separately and as a group. Treatment failure was associated with treatment delay, illiteracy, and alcohol consumption. Factors associated with dropout were age, prior TB treatment, and illiteracy. Death was associated with age, treatment delay, HIV co-infection, and head of family's income. Main factors associated with negative treatment outcomes as a whole were age, HIV co-infection, illiteracy, alcoholism, and prior TB treatment. We suggest the following strategies to increase cure rates: further training of the Family Health Program personnel in TB control, awareness-raising on the need to tailor their activities to special care for cases (e.g., literacy training); targeting use of directly observed therapy for higher risk groups; establishment of a flexible referral scheme to handle technical and psychosocial problems, including alcoholism; and increased collaboration with the HIV/AIDS program.

O objetivo do presente estudo foi identificar fatores associados ao acesso geográfico aos serviços de saúde por portadores de tuberculose em três capitais do Nordeste do Brasil. A amostra foi composta por casos novos de tuberculose, notificados em 2007. Foram utilizados dados provenientes do Sistema de Informação sobre Agravos de Notificação, e do Cadastro Nacional de Estabelecimento de Saúde. Os endereços dos domicílios e das unidades de saúde foram georreferenciados e, utilizando a distância entre o domicílio e a unidade de atendimento de cada caso, foi considerado acesso dificultado quando esta distância foi maior do que 800 metros. Foram estimadas as razões de prevalência bruta e ajustada por meio de regressão de Poisson. Verificou-se que após ajuste com as variáveis estudadas, apenas a variável unidade básica, em Salvador, Bahia (RP = 0,75; IC95%: 0,720-0,794) e em Recife, Pernambuco (RP = 0,402; IC95%: 0,318-0,508), manteve associação com o acesso dificultado. O estudo concluiu que a descentralização do atendimento em unidade básica pode contribuir com a melhoria do acesso aos serviços de saúde.

OBJECTIVE:The BCG vaccine has been in use since 1921, but still arouses controversy and uncertainties. The objective was to analyze the protective effect of the BCG vaccine in its fi rst and second doses and the accompanying vaccination policies. METHODS:A systematic review of the literature in both English and Spanish was carried out, covering the period 1948 to 2006, using the PubMed database. The main search terms used included BCG vaccine, BCG effi cacy, BCG and tuberculosis. The studies were grouped by design, with the main results from the clinic tests, case-control studies and meta-analyses presented separately. RESULTS:The protective effect of the fi rst dose of the BCG vaccine against tuberculosis in its miliary and meningeal forms is high. However, the results vary in relation to the pulmonary form of the disease, with some indicating zero effect and others levels of nearly 80%. Research is being carried out to develop new vaccines that could substitute the BCG or be used as a booster. CONCLUSIONS:There are evidences that the protective effect of the BCG vaccine does not increase with a second dose. In spite of its limitations and the expectation that a new tuberculosis vaccine will be developed in the future, the BCG vaccine remains an important tool in controlling the harmful effects of tuberculosis, particularly in countries with medium or high incidence levels of the disease.

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