Publicação: 29 de agosto de 2022
Tuberculosis (TB) remains a serious public health problem, with approximately 10 million new cases reported annually. Knowledge about the quantitative evolution of theses and dissertations (T&Ds) examining human TB in Brazil can contribute to generating strategic planning for training professionals in this field and disease control. Therefore, this study highlights the role of T&Ds on TB in national scientific disclosures.
An integrative review related to TB was performed, including T&Ds produced in Brazil and completed between 2013 and 2019.
A total of 559,457 T&Ds were produced, of which 1,342 were associated with TB, accounting for 0.24% of the total number of T&Ds in Brazil. This was evidenced by a predominance of themes such as attention/health care, epidemiology, and TB treatment, and 80.2% of the T&Ds on TB were related to the large areas of health and biological sciences. Only 19.7% of T&Ds were associated with groups of patients considered at risk for TB, and 50.9% were produced in southeastern Brazil. The 1,342 T&Ds on TB were developed in 416 postgraduate programs linked to 121 higher education institutions (HEIs). We highlight that 72.7% of T&Ds on TB were produced in federal HEIs, 27.4% in state HEIs, and 8.5% in private HEIs.
Strategic themes, such as TB control, require public policies that aim to increase the number of doctors and masters with expertise in TB, with geographic uniformity, and in line with the priorities for disease control.
Tuberculosis (TB) remains a serious public health problem and is responsible for approximately 10 million new cases and 1.5 million deaths annually. Moreover, it is one of the main causes of death caused by a single infectious agent. Brazil is a priority country for this public health problem1, with approximately 90,000 new cases per year and a TB/human immunodeficiency virus (HIV) coinfection proportion of 11%2.
At the World Health Assembly in 2014, the World Health Organization approved the End Tuberculosis Strategy. Their main objectives were to reduce 90% of TB cases and 95% of TB deaths by 2035. In addition, the strategy aims to eliminate or minimize the economic impact on families affected by TB3. In the following year, the United Nations launched the Sustainable Development Goals, which included a 90% reduction in deaths caused by TB by 20304,5.
Brazil’s National Tuberculosis Control Program has used several strategies to control the disease, most of which are consistent with scientific evidence and guidelines recommended by the World Health Organization. This effort has resulted in improvements in epidemiological indicators, such as a reduction in the incidence and mortality of TB6,7. However, there are still many challenges, such as TB in prisons, TB/HIV coinfection, drug-resistant TB, other comorbidities (e.g., diabetes mellitus, mental health disorder, alcohol, illicit drugs, and tobacco use), a high proportion of treatment abandonment, low adherence to directly observed treatment, low contact evaluation, latent TB diagnosis and treatment, low coverage of rapid molecular diagnosis, and a low proportion of patients and family members who receive social protection6,8.
The success of actions that support global and national TB control and elimination strategies depends on qualified professionals generating, evaluating, and correctly using scientific knowledge. In Brazil, doctors and masters (D&M) are formed within the National Postgraduate System, whose Postgraduate Programs (PGPs) are accredited and periodically evaluated using the Coordination of Higher-level Personnel Improvement (CAPES) evaluation system9.
Knowledge about the quantitative evolution of theses and dissertations (T&Ds) produced in the area of human TB, as well as information about the spatiotemporal, thematic, and institutional distribution and its relationship with the TB burden in different populations and regions of Brazil, can contribute to generating strategic planning for the training of professionals in this theme. In addition, this study highlights the essential role of T&Ds in national scientific disclosures.
An integrative review was performed, including T&Ds related to TB, completed between January 1, 2013 and December 31, 2019, and made available in the CAPES database. This study was carried out based on the principles of scientometrics, which consist of “Quantitative assessment and analysis of intercomparisons of activity, productivity, and scientific progress10.”
T&Ds identification and classification were performed independently by two researchers using the T&Ds catalog made available using the CAPES (Ministry of Education, Federal Government, Brazil) in Portuguese at https://dadosabertos.capes.gov.br/dataset.
The search for T&Ds was performed using the following Portuguese terms: Mycobacterium tuberculosis, Mycobacteria, antituberculostatics, isoniazid, and rifampicin. In addition, authorized descriptors in Portuguese, synonyms/alternative terms, related terms, and generic terms were used (DeCS/MeSH Health Sciences Descriptors – https://decs.bvsalud.org/) (Supplementary Material Table 1S). T&Ds that had any of these terms in the title, abstract, or keywords I were selected.
After the initial screening, the selected T&Ds were individually analyzed by two researchers, and those that mentioned any of the terms used in the search (Supplementary Material Table 1S) but whose work content was not associated with TB were excluded. The data were analyzed considering each thesis and dissertation equivalent to a doctorate and master’s degree (professional and academic), respectively. In addition, the following variables were evaluated: T&Ds theme, the total number of T&Ds on TB produced in Brazil, period of time for D&M academic formation, CAPES assessment area, CAPES large knowledge areas, CAPES knowledge areas, subareas, risk groups for TB included in T&Ds, and T&Ds geographic and institutional distribution.
According to the CAPES, the assessment areas are grouped into a large knowledge area, which in turn are grouped into knowledge areas and subareas (first level: large knowledge area: gathering of different knowledge areas, due to the affinity of their objects, cognitive methods, instrumental resources, and reflecting specific sociopolitical contexts; second level: knowledge area: set of interrelated knowledge, collectively constructed, gathered according to the nature of the investigation object, and for the purposes of teaching, research, and practical applications; and third level: subarea: segmentation of the knowledge area established according to the object of study and recognized and widely used methodological procedures)11.
T&Ds were classified into the following themes: attention/health care, biochemistry, diagnosis, drugs, epidemiology, genetics, immunology, resistance, and treatment. The classification was performed by searching for keywordII in Portuguese associated with different themes (Supplementary Material List 1S). For T&Ds related to more than one theme, the main theme and its associated themes were independently defined by two researchers.
Data were tabulated in Microsoft Excel and analyzed using International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) software version 20.0 (International Business Machines Corporation – IBM – Armonk – New York – USA). The absolute and relative frequencies were determined.
Between 2013 and 2019, considering all PGPs and knowledge areas, 559,457 T&Ds were produced in Brazil, of which 2,665 were initially selected as being associated with TB using the terms described in the Supplementary Material Table 1S. After an individual analysis, 1,342 T&Ds were selected for their association with TB, accounting for 0.24% of the total number of T&Ds produced in Brazil, of which 31.8% (427/1,342) were theses and 68.2% (915/1,342) were dissertations.
The total number of completed T&Ds in Brazil increased by 38.7% between 2013 and 2019, while the number of T&Ds on TB was proportionally reduced annually, beginning in 2014. When comparing 2013 and 2019, there was a 24.5% reduction in academic dissertations associated with TB, whereas the number of theses increased by 26%. Despite this, the number of theses concluded showed a 9% reduction between 2018 (the year with the greatest production) and 2019 (Table 1).