Article Text
Abstract
Objective This study aimed at identifying demographic, socio-economic and tuberculosis (TB) exposure factors associated with non-compliance with the tuberculin skin test, the management and prevention of non-compliance to the test. It was carried out in the context of a survey of latent TB infection among undergraduate students taking healthcare courses in two universities in Salvador, Brazil, a city highly endemic for TB.
Methods This is a cross-sectional study of 1164 volunteers carried out between October 2004 and June 2008. Bivariate analysis followed by logistic regression was used to measure the association between non-compliance and potential risk factors through non-biased estimates of the adjusted OR for confounding variables. A parallel evaluation of occupational risk perception and of knowledge of Biosafety measures was also conducted.
Results The non-compliance rate was above 40% even among individuals potentially at higher risk of disease, which included those who had not been vaccinated (OR 3.33; 95% CI 1.50 to 7.93; p=0.0018), those reporting having had contact with TB patients among close relatives or household contacts (p=0.3673), or those whose tuberculin skin test status was shown within the survey to have recently converted (17.3% of those completing the study). In spite of the observed homogeneity in the degree of Biosafety knowledge, and the awareness campaigns developed within the study focussing on TB prevention, the analysis has shown that different groups have different behaviours in relation to the test. Family income was found to have opposite effects in groups studying different courses as well as attending public versus private universities.
Conclusions Although the data presented may not be directly generalisable to other situations and cultural settings, this study highlights the need to evaluate factors associated with non-compliance with routine testing, as they may affect the efficacy of Biosafety programs.
- Health monitoring
- latent tuberculosis
- occupational risk
- Biosafety
- immunology
- tuberculosis
- epidemiology
- health and safety
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To cite: Rocha SS, Marinho JM, Oliveira ES, et al. Non-compliance with health surveillance is a matter of Biosafety: a survey of latent tuberculosis infection in a highly endemic setting. BMJ Open 2011;1:e000079. doi:10.1136/bmjopen-2011-000079
Funding This work was supported by the Fundação de Amparo à Pesquisa do Estado da Bahia—FAPESB (Convênio 160/03) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (Proc. Nr. 476860/2007-5). AEMJ, JR and ECL have received scholarships from FAPESB, and ESO has received a scholarship from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).
Competing interests None.
Ethics approval The Ethics Committee of the Centro de Pesquisas Gonçalo Moniz (CEP-CPqGM/FIOCRUZ) approved this study.
Contributors All authors actively participated in analysis of the research results. SSR, JMM, CMCM, SA and TB were responsible for study design. SSR, JMM, ESO, JSR, ECL, AEM Jr, SA and TB participated in field work, in the logistics and in managing the administration of the tuberculin skin test and the questionnaires. SSR, JMM, ESO, JSR, ECL, AEM Jr, CMCM, SA and TB also participated in the training of study monitors. ESO, JSR, ECL, AEM Jr, CMCM and TB participated in the creation and management of the database. SSR, CMCM, AA and TB were responsible for the statistical analysis and writing of the manuscript.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Additional data from this survey are being analysed and will be published in the future.