Evolution of tuberculosis incidence rates in the V Sanitary Zone of Buenos Aires Province during the period 1984-1996.

Tuberculosis (TB) continues to be a serious health problem in most of the districts in the 5(th) Sanitary Region of Buenos Aires Province (RSV) which is located in North Buenos Aires City suburbs. The aim of this study was to analyse and compare the evolution of the TB epidemiological situation in ten districts, in a thirteen year period (1984-96) and to analyse possible reasons for differences. The average annual variation (VAP) of morbidity rate was calculated in order to estimate the trends of TB in these communities along time. Reporting to the National and Provincial TB Control Programmes of TB cases is mandatory for physicians and these data were used as a source of information for the number of cases and rates. A statistical analysis was performed. Our results showed that the VAP value for the whole RSV was lower than -5.0%. On this basis several districts were identified as having a TB critical situation. The proportion of smear positive cases among TB patients reported decreased during this period, suggesting that smear microscopy was being poorly used as a diagnostic tool for TB. Furthermore, the cure rates of the patients attained -in average- only 60.0% and several warning indicators (IA) -like TB meningitis cases and mortality due to TB in people younger than thirty years old, as well as TB -HIV/AIDS association- have been observed to grow in several districts. Previous world global experience and those obtained in other provinces in our own country, suggest that the unique possible strategy for modifying this situation, is to set up the directly observed treatment (DOTS), according to World Health Organization/International Union Against Tuberculosis and Lung Diseases (WHO IVATLD) recommendations, in order to achieve the control of TB.