Tuberculosis among the Xavante Indians of the Brazilian Amazon: An epidemiological and ethnographic assessment

BACKGROUND: Despite broad availability of a national tuberculosis (TB) control program that has proved effective in Brazil, TB remains a major cause of morbidity and mortality among indigenous peoples. AIM: We report the results of an interdisciplinary investigation of TB epidemiology, healthcare services, and ethnomedicine among the Xavante Indians of Central Brazil. SUBJECTS AND METHODS: Fieldwork components included clinical assessment of TB (479 subjects, 89.3% of the population = 1 year of age), analysis of medical health records, and ethnographic research. RESULTS: We found TB to constitute a major health risk, with moderately high annual risk of infection (0.94%), moderate prevalence of infection, high percentage of X-ray images suggestive of TB (14.2% in subjects > or = 10 years of age), and a relatively low percentage of individuals with reactive TB skin tests (16.6% of reactions > or = 10 mm) despite high BCG vaccine coverage. We also found a high rate of TB patients showing no evidence of prior infection. Ethnographic interviews show that Xavante and biomedical health perspectives are simultaneously divergent in their etiologies but pragmatically compatible. CONCLUSION: Ineffective diagnosis procedures compromise the efficacy of existing TB prevention efforts and threaten to undermine otherwise favorable institutional and cultural conditions.