Determinantes sociais de doenças e agravos nas comunidades quilombolas de Feira de Santana-BA

Abstract

Studies relating to the investigation of the standards of life and health of Quilombola populations are still limited, especially regarding the analysis of the factors associated with the prevalence of injuries and diseases. Aims: Analyzing diseases and injuries which are more prevalent and verifying their association with socioeconomic, environmental factors and health patters in Quilombola communities in Feira de Santana, Bahia, in 2016. Materials and methods: this is a population-based prevalence study carried out with 864 adults quilombolas of both sexes, aged above 18 years, residents in two Quilombolas communities of Feira de Santana, Bahia. A probabilistic sample was used. The data were collected through home visits, having been applied three validated instruments, containing questions related to demographic, socio-economic standards, environmental, health patterns as well as diseases and injuries. Descriptive and bivariate analyses were carried out, whereas a IC80% and p ≤ 0,20 were considered to verify the association between the exposure and outcome variables. An exploratory factor analysis, from the use of the tetrachoric correlation, in order to identify which diseases and injuries represent the higher prevalence the most. In order to analyze the factors associated with diseases and injuries, it was used the hierarchical logistic regression analysis. Data were analyzed using the statistical package Stata Corportion College Station, United States (STATA), in version 12.0. As a result of this research findings, two scientific papers were written. The first one is a descriptive study, which aimed to trace the epidemiological profile of the living standards and health of Quilombola communities. To achieve the aims of this article, averages of the quantitative variables and absolute and relative frequencies of qualitative variables of each community were estimated as well as the prevalence of injuries and diseases. The second article is an exploratory study, which analysed the social determinants of disease and injuries in Quilombolas communities of Feira de Santana, Bahia. Through the exploratory factor analysis, latent factors were established. In addition, bivariate and multivariate analyses were carried out to test statistically significant association. Results: in the first article, it was found that Quilombola communities of Feira de Santana, Bahia have very similar demographic andsocioeconomic characteristics and both are vulnerable in theirlife and health standards. From 864 respondents, 63,0% were female, married, with an avarage of 42,6 years of age and an average of 7 years of schooling, as well as 73,4% have informal jobs, especially in the roles of farmer labors and agricultors. In relation to environmental vulnerability, it is pointed out that 99,5 percent have no sanitarian system. Among the data on health patterns, it was noted that 67,1% said that they rarely seek for health services. The most prevalent diseases were: Hypertension (22,3%); diseases of bones (15,8%); diseases of sspine (38,4%) parasitic diseases (25,0%). The most prevalent health aggravations were linked to mental health: anxiety (26,7%); phobias (12,3%) and mental disorders (18,4%). In the second article it was found that the factors which responded more to diseases and most prevalent injuriess were related to mental health diseases (48,8%), chronic diseases (39,2%) and diseases of bones and spine (50,0%). Factor 1: mental health injuries it was found that families who do not receive social benefits have 1,43 times higher chance of having some aggravation in mental health. Factor 2: chronic diseases, it was found that individuals who have little consumption of vegetables and fruits show to have possibility of 1,42 times higher chances to develop a chronic disease. Factor 3: diseases of the bones and spine. It was observed that the individuals who are working have 1,44 times greater chance of having bone and spine diseases. For those who receiving social benefits, that possibility raises to 1,93 times of chance to develop spine and bone diseases. The hierarchical logistic regression analysis was performed for the three factors (1-mental health harms, 2-chronic diseases and bone diseases and 3 column). Multivariate analysis on the associated factors of diseases and injuries in the Quilombola communities, with respect to the factor 1 were: receiving social benefits (HR=1,63 CI80%:1,07; 2,50); material used in the construction of the house (HR=3,22; CI80%:1,17; 8,80); disposal of the garbage (HR=1,51 CI80%:1,07; 2,13); have bathroom (HR=2,82; CI80%:1,17; 6,77); self-assessment of health (HR=2,64 CI80%:1,92; 3,65); type of medication: (HR=0,15; CI80%:0,05; 0,45); problems with cavities/canal (HR=1,47 CI80%:1,07; 2,01); age (HR=1,84; CI80%:1,19; 2,84) and sex (HR=0,48 CI80%:0,34; 0,67). In relation to the factor 2, were: material used in the construction of the house (HR=3,18; CI80%:1,09; 9,28); have bathroom (HR=3,69 CI80%:1,36; 10,01); age (HR=1,87; CI80%:1,18; 2,95) and sex (HR=0,47; IC80%:0,32; 0,68). For factor 3, the variables were: years of study (HR=1,77; CI80%:1,20; 2,62); self-assessment of health (HR=1,64; CI80%:1,15; 2,32); type of medication (HR=6,12; CI80%: 2,59; 14,4) and age (HR=1,61; CI80%:1,03; 2,51). Conclusions: scientific evidence was produced about the living standards and health of Quilombola communities of Feira de Santana, Bahia and of social determinants associated with diseases and injuries that reach these populations the most. Thus, it was found that diseases and injuries in Quilombola populations are determined by demographific, socioeconomic, environmental factors and health patterns. It is expected that the results of this study may support further research with this kind of population and that it may contribute to the implementation of specific health and social policies, as well as to carry out intersectoral interventions with loco-regional applicability.