El difícil camino del control sanitario de la tuberculosis

Abstract

Tuberculosis continues to be a worldwide prevalent disease. Chile has established a tuberculosis control program since the earliest 70s which contributed to decrease the annual incidence of tuberculosis by 50% every decade, reaching the rate of 20 per 100.000 inhabitants the year 2000 ("early phase of tuberculosis elimination as a public health problem "). Unfortunately since this time the descent rate is becoming slower and between years 2009-2011 has achieved a stationary rate of13 x 100.000. This deterioration in the epidemiological situation of tuberculosis in Chile runs in parallel with the successive reductions in the budget assignedfor its control. A higher incidence of tuberculosis in high risk groups (HIVpopulation, migrants, prisoners and elderly people) were not responsible for this epidemiologic deterioration. Lack of diagnosis in smear positive pulmonary tuberculosis patients is the most important source ofpersistent community infection. Only 25% of the estimated goal of sputum smear screening among medical consultations in primary care was achieved. Between the years 20062010 193.416 less sputum smear examinations were done. This means that nearly 966 smear positive tuberculosis patients were no identified as we know that about 0.5% smears are positive in this setting. A shortage of funds for tuberculosis in our country could increase its incidence as it was shown in Brazil, Cuba and Uruguay and would demand larger resources to strengthen the tuberculosis program. This epidemiological scene is worse in the Metropolitan Region where 40% of the country population concentrated 60% of the incidence of tuberculosis the year 2011. In this area we found counties with the highest rates. There is the need to strengthen the tuberculosis program in these areas and to organize teams in the primary care settings in order to increase case finding through the performance of sputum smears in symptomatic adult patients.