Tuberculosis and cash transfer programs in the indigenous social context of the Amazon in Pará
DOI:
https://doi.org/10.12957/reuerj.2026.94587Keywords:
Indigenous Culture, Tuberculosis, Social Determinants of Health, Government Programs, Social VulnerabilityAbstract
Objective: to analyze the association between tuberculosis among indigenous individuals who are beneficiaries of cash transfer programs and the social determinants of health. Methods: a cross-sectional, analytical study with a quantitative approach, conducted with 548 tuberculosis cases among indigenous individuals in the state of Pará from 2014 to 2023. Socio-environmental data were collected and subjected to descriptive and inferential analysis. The research protocol was approved by the Research Ethics Committee. Results: among the 548 cases, 161 were beneficiaries of cash transfer programs. There was an association between being a beneficiary and conditions such as being literate, having access to the public sewer system, having a septic tank, and having a bathroom in the household. Conclusions: the association between unfavorable social determinants of health and tuberculosis cases among beneficiaries of cash transfer programs reinforces the context of indigenous vulnerability and the need for integrated health, education, and social assistance policies to reduce inequalities.
References
1. Grigorio GL, Glória SKM, Simões OM, Rodrigues KC, Pereira PF. Directly observed treatment for tuberculosis in primary health care: discourses and practices. Rev. Enf. UFJF. 2025 [cited 2025 Abr 25]; 11(1):1-14. Available from: https://periodicos.ufjf.br/index.php/enfermagem/article/view/42990.
2. Ministério da Saúde (Br). Secretaria de Vigilância em saúde e ambiente. Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis. Boletim epidemiológico: tuberculose 2025. Brasília (DF): Ministério da Saúde; 2025 [cited 2025 May 10]. Available from: https://www.gov.br/aids/pt-br/central-de-conteudo/boletins-epidemiologicos/2025/boletim-epidemiologico-tuberculose-2025/view.
3. Carmo IA, Maia JC, Novaes JVC, Almeida LS, Pereira NAC, Costa GVR, et al. The challenges for tuberculosis control in Brazil. Braz J Hea Rev. 2022 [cited 2025 May 10]; 5(6):23969–78. DOI: http://dx.doi.org/10.34119/bjhrv5n6-168.
4. Ministério da saúde (Br). DATASUS. TabNet. Tuberculose: Casos confirmados notificados no Sistema de Informação de Agravos de Notificação: segundo ano de diagnóstico, raça indígena, região e estado [recurso eletrônico]. Brasília (DF): Ministério da Saúde; 2025 [cited 2025 May 10]. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinannet/cnv/tubercbr.def.
5. Ministério da Saúde (Br). Secretaria de Vigilância em Saúde. Brasil Livre da Tuberculose: Plano Nacional pelo Fim da Tuberculose como Problema de Saúde Pública: estratégias para 2021-2025. Brasília (DF): Ministério da Saúde; 2021 [cited 2025 May 10]. Available from: Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/tuberculose/brasil-livre-da-tuberculose/view.
6. Ghazy RM, Sallam M, Ashmawy R, Elzorkany AM, Reyad OA, Hamdy NA, et al. Catastrophic costs among tuberculosis-affected households in Egypt: Magnitude, cost drivers, and coping strategies. Int J Environ Res Public Health. 2023 [cited 2025 May 10]; 20(3):2640. DOI: http://dx.doi.org/10.3390/ijerph20032640.
7. Souza WL, Costa FA. Bolsa família program: beneficiaries narratives presented in scientific productions. Estud Pesqui Em Psicol. 2021 [cited 2025 May 10]; 21(3):950–70. DOI: http://dx.doi.org/10.12957/epp.2021.62692.
8. Jesus GS, Gestal PFPS, Silva AF, Cavalcanti DM, Lua I, Ichihara MY, et al. Effects of conditional cash transfers on tuberculosis incidence and mortality according to race, ethnicity and socioeconomic factors in the 100 Million Brazilian Cohort. Nat Med. 2025 [cited 2025 May 10]; 31(2):653–62. DOI: http://dx.doi.org/10.1038/s41591-024-03381-0.
9. Lima IB, Nogueira LMV, Trindade LNM, Rodrigues ILA, André SR, Sousa AI. Geospatialization of tuberculosis and income transfer programs among Indigenous peoples in an endemic territory. Rev Bras Enferm. 2022 [cited 2025 May 10]; 76(2):e20220216. DOI: http://dx.doi.org/10.1590/0034-7167-2022-0216.
10. Zeitoune RCG, Dias JR, Nascimento FPB, Motta MCS, Sousa MHN, Cardoso MD, et al. Access to government social programs and the tuberculosis control program: a multicenter study. Rev Bras Enferm. 2022 [cited 2025 May 11]; 75(Suppl.2):e20210454. DOI: https://doi.org/10.1590/0034-7167-2021-0454.
11. Lima SVMA, Rocha JVM, Araújo KCGM, Nunes MAP, Nunes C. Determinants associated with areas with higher tuberculosis mortality rates: an ecological study. Trop Med Int Health. 2020 [cited 2025 May 11]; 25.3):338–45. DOI: https://doi.org/10.1111%2Ftmi.13349.
12. Moreira ASR, Kritski AL, Carvalho ACC. Social determinants of health and catastrophic costs associated with the diagnosis and treatment of tuberculosis. J Bras Pneumol. 2020 [cited 2025 May 11]; 46(5):e20200015. DOI: https://doi.org/10.36416/1806-3756/e20200015.
13. León-Giraldo H, Rivera-Lozada O, Castro-Alzate ES, Aylas-Salcedo R, Pacheco-López R, Bonilla-Asalde CA. Factors associated with mortality with tuberculosis diagnosis in indigenous populations in Peru 2015-2019. Int J Environ Res Public Health. 2022 [cited 2025 May 11]; 19(22):15019. DOI: https://doi.org/10.3390/ijerph192215019.
14. Correia D, Mendes Áquilas, Carnut L. Social determination of the health-disease process in the Latin American context: the importance of critical thinking in health. Crit. Revolucionária. 2022 [cited 2026 Jan 27]; 2:e002. DOI: https://doi.org/10.14295/2764-4979-RC_CR.v2-e002.
15. Ministério da Saúde (Br) Fundação Nacional de Saúde. Política Nacional de Atenção à Saúde dos Povos Indígenas aprovada pela Portaria n.º 254, de 31 de janeiro de 2002. Brasilia (DF): Ministério da Saúde; 2002 [cited 2025 May 10]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/politica_saude_indigena.pdf.
16. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 [cited 2025 May 11]; 61(4):344–9. DOI: https://doi.org/10.1016/j.jclinepi.2007.11.008.
17. Orfão NH, Souza IJ, Santos BA, Feitosa VG, Souza DS, Alves CLM. Tuberculosis case reporting: a comparative profile between indigenous and non-indigenous people. Rev Baiana Saúde Pública. 2022 [cited 2025 May 11]; 46(3):39–52. DOI: https://doi.org/10.22278/2318-2660.2022.v46.n3.a3749.
18. Vaz IF, Paiva NS, Viana PVS. Spatial-temporal evolution of tuberculosis incidence rates in indigenous and non-indigenous people of Brazil, from 2011 to 2022. Rev Bras Epidemiol. 2023 [cited 2025 May 11]; 26:e230055. DOI: http://dx.doi.org/10.1590/1980-549720230055.2.
19. Santos BA, Feitosa VG, Orfão NH. Perfil epidemiológico da tuberculose nos povos indígenas: revisão de literatura. RISE. 2021 [cited 2025 May 11]; 2(2):93-118. DOI: https://doi.org/10.56344/2675-4827.v2n2a20216.
20. Instituto Brasileiro de Geografia e Estatística (Br). Censo demográfico 2010: características da população e dos domicílios: resultados do universo [Site de Internet]. Rio de Janeiro (RJ): IBGE; 2011 [cited 2025 May 13]. Available from: https://www.ibge.gov.br/estatisticas/sociais/saude/9662-censo-demografico-2010.html.
21. Instituto Brasileiro de Geografia e Estatística (Br). Censo Demográfico 2022: indígenas: características das pessoas e dos domicílios, por situação urbana ou rural do domicílio – resultados do universo [Site de Internet]. Rio de Janeiro (RJ): IBGE; 2023 [cited 2025 May 13]. Available from: https://sidra.ibge.gov.br/pesquisa/censo-demografico/demografico-2022/universo-indigenas-caracteristicas-pessoas-e-domicilios-situacao-urbana-ou-rural.
22. Delpino FM, Arcêncio RA, Nunes BP. Social determinants and mortality from tuberculosis in Brazil: a literature review. Rev Baiana Saúde. 2021 [cited 2025 May 13]; 45(1):228–41. DOI: http://dx.doi.org/10.22278/2318-2660.2021.v45.n1.a3479.
23. Yoshimura FK, Borstel GCCV, Zaura C, Marcelino VMR, Garcia ICM, Nunes PLP, Ceranto DCFB. Tuberculosis: a review of the literature. Braz. J. Hea. Rev. 2021 [cited 2025 Apr 25]; 4(3):14223-31. DOI: https://doi.org/10.34119/bjhrv4n3-354.
24. Silva ALG, Sá AMM, Santos DN, Lima IB, Corrêa LRS, Nogueira LMV. Latent tuberculosis among people living with HIV and contacts in a hyperendemic state. Acta Paul Enferm. 2024 [cited 2025 May 02]; 37:eAPE02115. DOI: http://dx.doi.org/10.37689/acta-ape/2024AO000021155.
25. Silva TC, Pinto ML, Orlandi GM, Figueiredo TMRM, França FOS, Bertolozzi MR. Tuberculosis from the perspective of men and women. Rev esc enferm USP. 2022 [cited 2025 May 15]; 56:e20220137. DOI: https://doi.org/10.1590/1980-220X-REEUSP-2022-0137.
26. Caldas RJC, Santos NCC, Rodrigues ILA, Paiva BL, Trindade LDNM, Nogueira LMV. Spatial pattern of malaria in indigenous and nonindigenous populations in the state of Pará. Cogitare Enferm. 2021 [cited 2025 May 15]; 26:e76244. DOI: https://doi.org/10.5380/ce.v26i0.76244.
27. Braga CAM, Silva RP. O Programa Bolsa Família entre os povos indígenas: o impacto entre os Akwe Xerente. Serv Soc Em Rev. 2021 [cited 2025 May 15]; 24(1):105. DOI: https://doi.org/10.5433/1679-4842.2021v24n1p105.
28. Instituto Brasileiro de Geografia e Estatística (Br). Índice de Desenvolvimento Humano: Pará: panorama dos municípios [Site de Internet]. Rio de Janeiro (RJ): IBGE; 2023 [cited 2025 May 05]. Available from: https://cidades.ibge.gov.br/brasil/pa/panorama.
29. Kruger RB. Colonização da transamazônica durante o governo militar: manifestações do dispositivo colonial. Rev Geoamazônia. 2022 [cited 2025 May 05]; 10(19):100. DOI: http://dx.doi.org/10.18542/geo.v10i19.13405.
30. Ferreira MR, Junior ON. Aprimoramento de indicadores sociais: Índice de Desenvolvimento Humano simplificado e ajustado para comunidades indígenas. Rev Tempo Mundo. 2024 [cited 2025 May 08]; 34:389–417. DOI: http://dx.doi.org/10.38116/rtm34art15.
31. Athila AR. The indigenous “Bolsa Família” (Family Allowance): monetarization, income redistribution, and the social life of the Rikbaktsa, Brazilian Amazon. Cien Saude Colet. 2024 [cited 2025 May 10]; 29:(12):e08532024. DOI: https://doi.org/10.1590/1413-812320242912.08532024.
32. Ministério da Justiça e Segurança Pública (Br). Secretaria Nacional de Políticas Penais. Relatório de Informações Penais – 2º semestre de 2024 [Site de Internet]. Brasília (DF): SENAPPEN. 2025 [cited 2025 May 25]. Available from: https://www.gov.br/senappen/pt-br/servicos/sisdepen/relatorios/relipen/relipen-2o-semestre-de-2024.pdf.
33. Filard MF, Oliveira MMV, Oliveira TRRC, Fernandes RC, Oliveira FLLC. Direitos dos povos originários no cárcere: uma análise da aplicação da Resolução CNJ Nº 287/2019 na Vara de Execução Penal do Amazonas. Rev Delos. 2025 [cited 2025 May 25]; 18(65):e4487. DOI: http://dx.doi.org/10.55905/rdelosv18.n65-113.
34. Ministério da Previdência e Assistência Social (Br). Decreto nº 3.048, de 6 de maio de 1999. Aprova o Regulamento da Previdência Social, e dá outras providências. Braíslia (DF): Casa Civil; 1999 [cited 2025 May 25]; Seção 1:1. Available from: https://www.planalto.gov.br/ccivil_03/decreto/d3048.htm.
35. Arcêncio RA, Belchior AS, Arroyo LH, Bruce ATI, Santos FL, Yamamura M, et al. Spatial distribution and dependence of mortality due to tuberculosis in a city in the Amazon region. Cad Saude Colet. 2022 [cited 2025 May 25]; 30(1):1–12. DOI: http://dx.doi.org/10.1590/1414-462x202230010308.
36. United Nations Organization. Sustainable development goals [Site de Internet]. Genebra (GE): UNO; 2015 [cited 2025 May 25]. Available from: https://brasil.un.org/pt-br/sdgs.
37. Raupp L, Cunha GM, Fávaro TR, Santos RV. Sanitation conditions of indigenous and nonindigenous households in Brazil according the 2000 and 2010 national censuses. Cien Saude Colet. 2020 [cited 2025 May 26]; 25(10):3753–63. DOI: http://dx.doi.org/10.1590/1413-812320202510.04602019.
38. Oliveira MVG, Marinho GL, Abreu AMM. The Xavante indigenous population in Mato Grosso: health-related sociodemographic characteristics. Esc Anna Nery. 2022 [cited 2025 May 26]; 26:e20210084. DOI: http://dx.doi.org/10.1590/2177-9465-ean-2021-0084pt.
39. Abascal A, Rothwell N, Shonowo A, Thomson DR, Elias P, Elsey H, et al. “Domains of deprivation framework” for mapping slums, informal settlements, and other deprived areas in LMICs to improve urban planning and policy: a scoping review. Comput Environ Urban Syst. 2022 [cited 2025 May 26]; 93:101770. DOI: http://dx.doi.org/10.1016/j.compenvurbsys.2022.101770.
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Copyright (c) 2026 Jaqueline Ferreira de Oliveira, Tais Oliveira da Silva, Ingrid Bentes Lima, Ivaneide Leal Ataíde Rodrigues, Camilla Cristina Lisboa do Nascimento, Raquel Gomes da Silva, Lucinéia Ferreira Ferreira, Laura Maria Vidal Nogueira
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