Keywords
Endemicity
Health Indicators
How to Cite
Copyright © | All rights reserved.
The journal holds the exclusive copyright for the publication of this article under the terms of Brazilian law 9610/98.
Partial reproduction
The use of parts of the texts, figures and questionnaire of the article is free, being mandatory the citation of the authors and journal.
Total reproduction
It is expressly prohibited and must be authorized by the journal.
Abstract
Objective: To establish tuberculosis endemicity levels in the Brazilian Amazon and identify municipalities relevant to sustaining disease transmission. Methods: This was an ecological and analytical study using data on newly reported tuberculosis cases from 2009 to 2024 in municipalities within the Brazilian Amazon. Tuberculosis notification and demographic data were obtained from the Notifiable Diseases Information System and the Brazilian Institute of Geography and Statistics. Incidence rates were calculated, outliers were identified and excluded (incidence >69.11 per 100,000 population), and the unsupervised k-means learning algorithm was applied for clustering. Cluster validity was assessed using the Silhouette Index (SI) and Davies–Bouldin Index (DBI). Results: Five endemicity levels were identified: low (<13.60), moderate (13.60–22.91), high (22.91–33.70), very high (33.70–48.79), and hyperendemic (>48.79 per 100,000 population). Validation indicated well-defined clusters (DBI = 0.59 and SI values predominantly above 0.50). Seven of the nine state capitals were among the hyperendemic municipalities, and an additional 232 municipalities were classified as having very high or hyperendemic levels. Conclusion: The proposed classification provides a robust tool for epidemiological surveillance and public health planning, enabling the identification of the municipalities most vulnerable to tuberculosis.
References
AMARAL CCA, et al. Comparação do perfil epidemiológico da tuberculose antes e após a COVID-19 no estado do Pará. Revista Eletrônica Acervo Saúde, 2021; 15 (1): 1-9.
BOCCIA D, et al. Cash transfer and microfinance interventions for tuberculosis control: review of the impact evidence and policy implications. International Journal of Tuberculosis and Lung Disease, 2011; 15(Suppl 2): S37-S49.
BHARGAVA A, BHARGAVA M. Tuberculosis deaths are predictable and preventable: comprehensive assessment and clinical care is the key. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 2020; 19: 100155.
BRASIL. Ministério da Saúde. Manual de recomendações para o controle da tuberculose no Brasil. 2. ed. atual. Brasília, DF: Ministério da Saúde, 2019. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/tuberculose/manual-de-recomendacoes-e-controle-da-tuberculose-no-brasil-2a-ed.pdf. Acessado em: 20 nov. 2025.
BRASIL. Ministério da Saúde. Brasil Livre da Tuberculose. Plano Nacional pelo Fim da Tuberculose como Problema de Saúde Pública. Secretaria de Vigilância em Saúde. Ministério da Saúde. Brasília-DF, 2021. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/tuberculose/brasil-livre-da-tuberculose. Acessado em: 25 de nov. 2025.
BRAISIL. Ministério da Saúde. Boletim epidemiológico 16: Proteção social e tuberculose no Brasil, 2025; vol. 16. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/edicoes/2025/boletim-epidemiologico-volume-56-no-16.pdf/@@download/file. Acesso em: 28 jul. 2026.
CHAKAYA J, et al. Global Tuberculosis Report 2020 – Reflections on the Global TB burden, treatment and prevention efforts. International Journal of Infectious Diseases, 2021; 113 (Suppl 1): S7-S12.
DAMM Y, et al. Health benefits of reduced deforestation in the Brazilian Amazon. Commun Earth Environ. 2024;5(1): 693.
DE SÁ, ACMGN. et al. Blood count reference intervals for the Brazilian adult population: National Health Survey. Revista Brasileira de Epidemiologia. 2023;26. doi: 10.1590/1980-549720230004.supl.1.1.
DE SOUZA NKM, et al. Temporal and spatial persistence of tuberculosis cases in Brazilian municipalities between 2001 and 2022. Ciencia e Saude Coletiva. 2025;30(7).
HARLING G, CASTRO MC. A spatial analysis of social and economic determinants of tuberculosis in Brazil. Health & Place, 2014; 15: 56-67.
IBGE. Instituto Brasileiro de Geografia e Estatística. Portal eletrônico, Disponível em: https://www.ibge.gov.br/. Aceso em 02 fev. 2026.
LIMA NR de O, et al. Health in the Legal Amazon: an analysis of morbidity and mortality indicators between 2010 e 2021. Ciencia e Saude Coletiva. 2025; 30(1).
MACIEL EL, REIS-SANTOS, B. Determinants of tuberculosis in Brazil: from conceptual framework to practical application. Rev Panam Salud Publica. 2015; 38(1).
MOMAHHED SS, et al. K-means clustering of outpatient prescription claims for health insureds in Iran. BMC Public Health. 2023; 23(1).
MOREL, MC. Inovação em Saúde e Doenças Negligenciadas. Caderno de Saúde Publica. Rio de Janeiro. Fundação Osvaldo Cruz, 2006; 22 (8): 1522-1523.
NGUYEN T-A, et al. Population-wide active case finding as a strategy to end TB. The Lancet Regional Health - Western Pacific. 2024; 46: 101047.
OU X, et al. High proportion of tuberculosis recent transmission in rural areas of Northeastern China: a 3-year prospective population-based genotypic and spatial analysis in Hinggan League, China. Amarican Society for Microbiology. Microbiology Spectrum. 2025; 13 (8).
PELISSARI DM, et al. Spatial distribution of tuberculosis in Brazil: a nationwide study. BMC Infectious Diseases, London. 2018; 18 (154).
SAN PEDRO A, OLIVEIRA, RM. Tuberculosis and socioeconomic indicators: systematic review of the literature. Revista Panamericana de Salud Pública, Washington, DC. , 2013; 33 (4): 294-301.
SENA IVO, et al. Estudio clínico-epidemiológico de la coinfección TB-VIH en municipio prioridad: análisis de 10 años. Enferm. glob, Murcia. 2020; 19 (60): 85-119.
WHO. WORLD HEALTH ORGANIZATION. Global tuberculosis report 2023. Geneva: World Health Organization, 2023. Disponível em: https://iris.who.int/server/api/core/bitstreams/ cc23b85f-72c0-4177-8137-cb1161da1025/contente. Acessado em: 15 de jul. 2026.
WHO. WORLD HEALTH ORGANIZATION. Global Tuberculosis Report. World Health Organization, 2024. Disponível em: https://www.who.int/publications/i/item/9789240102149. Acesso em: 23 ago. 2026.