Tuberculosis and social aspects in a Brazilian state of high vulnerability: a systematic review.
Elivelton Sousa Montelo, Amanda Silva de Oliveira, Zulimar Márita Ribeiro Rodrigues and 1 others
PMID 42659503WHAT IT FOUND
TB in Maranhão clustered in vulnerable territories and was more frequent among men of working age, low schooling, alcohol use, diabetes, HIV coinfection and food insecurity.
Better primary care was associated with greater case detection; social benefits were linked to improvement and adherence.
Key findings
01TB cases and deaths were concentrated in socially vulnerable territories in Maranhão, including São Luís, Imperatriz and northern and central regions.
02Sociodemographic factors were associated with unfavourable TB outcomes: men of working age, low schooling, alcohol use, TB/HIV coinfection, diabetes, food insecurity and undernutrition.
03Health service organization and social protection were linked to TB detection and treatment outcomes: better primary care structure was associated with greater detection, hospital-based diagnosis predominated in São Luís, and social benefits were associated with improvement and adherence.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review synthesizes observational studies, not tested interventions, so it cannot show that any nursing or service action caused better TB outcomes. Only one case-control study was included and no prospective cohort studies were available, limiting causal inference. Qualitative evidence was incipient, so patient experiences of TB and treatment were poorly represented. Meta-analysis was not possible because study designs and indicators were heterogeneous. Evidence was concentrated in São Luís, Imperatriz and Caxias, so findings may not apply to all parts of Maranhão. Language restrictions, the 2014 to 2025 time frame and inclusion of only indexed articles may have introduced selection and publication bias. Included study quality varied, with one study scoring 60% on MMAT.
Declared interests
Funding was provided by CAPES and FAPEMA, and the first author is a CAPES scholarship holder. The supplied text does not report competing interests.
The easy way to misread this
Do not read these social and service factors as proven causes of TB outcomes or as evidence that a particular nursing intervention works. The review included observational studies and no meta-analysis, so it cannot establish causation or test treatment effects.