IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v21y1985i9p1023-1042.html
   My bibliography  Save this article

Field testing along a disease gradient: Some geographical dimensions of tuberculosis in Puerto Rico

Author

Listed:
  • Hunter, John M.
  • Arbona, Sonia

Abstract

The spatial pattern of reported tuberculosis incidence in Puerto Rico is characterized by numerous high-low gradients among continguous municipios. Tuberculin testing of some 1500 subjects along one such gradient reveals that there is no difference in sensitivity and suggests that the gradients are artifacts of reporting. Correlative associations with tuberculin conversion were generally weak, except for age-dependency. Collected personal histories demostrated that the web of familial and intergenerational relationships is a major force in perpetuating the disease. Concealment of infection, denial and poor compliance in chemotherapy regimens compound the difficulties of case-discovery and case-control. Interviews in a sample of twelve health centers confirmed that, without the presence of trained and assigned tuberculosis nurses, the health care providers' 'index of suspicion' for tuberculosis is generally low. Absence of a tuberculosis clinic virtually dictates serious under-reporting of incidence in that municipio. Despite the success of Puerto Rico's control program over past decades, a reservoir of tuberculosis persists. The level of endemicity is relatively low but unsatisfactory in the context of public health aspirations.

Suggested Citation

  • Hunter, John M. & Arbona, Sonia, 1985. "Field testing along a disease gradient: Some geographical dimensions of tuberculosis in Puerto Rico," Social Science & Medicine, Elsevier, vol. 21(9), pages 1023-1042, January.
  • Handle: RePEc:eee:socmed:v:21:y:1985:i:9:p:1023-1042
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/0277-9536(85)90423-X
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:21:y:1985:i:9:p:1023-1042. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.