Tuberculosis among the Xavante Indians of the Brazilian Amazon: An epidemiological and ethnographic assessment

• Published in: Annals of human biology 2010-10, Vol.37 (5), p.643-657
• Main Authors: Basta, Paulo Cesar, Coimbra Jr, Carlos E. A., Welch, James R., Corrêa Alves, Luiz Carlos, Santos, Ricardo Ventura, Bastos Camacho, Luiz Antonio
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anthropology, Cultural; Brazil - epidemiology; Child; Child, Preschool; epidemiology; Female; Health Knowledge, Attitudes, Practice; Health Services; Healthcare Disparities - ethnology; Humans; Incidence; Indians, South American; Infant; Male; medical anthropology; Middle Aged; Prevalence; South American Indians; tuberculin skin test; Tuberculosis; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - ethnology; Young Adult
• ISSN: 0301-4460; 1464-5033
• DOI: 10.3109/03014460903524451

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.