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Abstract
Background: Despite broad availability of a national tuberculosis (TB) control program that has proved effective in Brazil, TB remains a major cause of morbidity and mortality among indigenous peoples.
Aim: We report the results of an interdisciplinary investigation of TB epidemiology, healthcare services, and ethnomedicine among the Xavante Indians of Central Brazil.
Subjects and methods: Fieldwork components included clinical assessment of TB (479 subjects, 89.3% of the population = 1 year of age), analysis of medical health records, and ethnographic research.
Results: We found TB to constitute a major health risk, with moderately high annual risk of infection (0.94%), moderate prevalence of infection, high percentage of X-ray images suggestive of TB (14.2% in subjects ≥ 10 years of age), and a relatively low percentage of individuals with reactive TB skin tests (16.6% of reactions ≥ 10 mm) despite high BCG vaccine coverage. We also found a high rate of TB patients showing no evidence of prior infection. Ethnographic interviews show that Xavante and biomedical health perspectives are simultaneously divergent in their etiologies but pragmatically compatible.
Conclusion: Ineffective diagnosis procedures compromise the efficacy of existing TB prevention efforts and threaten to undermine otherwise favorable institutional and cultural conditions.
Acknowledgements
The authors thank the Xavante for participating in the research. We thank Francisco Sitomowê, Jamiro Suwepté, Goiano Serema'á, and Vinícius Supretaprã for field assistance and translation, the staff of the Água Boa Regional Office of FUNASA for logistical support during field work, X-ray technician P. R. Machado Neto for conducting radiographs in the field, biologist J. B. Pereira da Silva for conducting the bacteriological tests, nurse G. Fregona for carrying out skin tests, Dr R. Dietze for providing technical support, and Dr A. R. Souza for his contribution to radiograph interpretation.
Declaration of interests: This research was made possible by funds provided by the Brazilian Research Council (CNPq), grant number MCT-CNPq/MS-SCTIE-DECIT/CT 40.0944/2005-7, the Fulbright Commission, Fulbright-Hays Doctoral Dissertation Research Abroad Fellowship, Award No. P022A040016, and the Ford Foundation. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.