MEDICAL AND SOCIAL FACTORS OF TUBERCULOSIS DEVELOPMENT IN THE ENVIRONMENT OF INTERNAL LABOR MIGRATION

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Relevance.
In connection with the growth of financial instability, general globalization, the scale of internal labor migration is increasing. It is known that migration has a great impact on the spread and deterioration of the epidemiological situation of tuberculosis, especially in countries with low TB prevalence [4]. At the moment, Russia is among the countries experiencing a significant impact of labor migration of the population [1].
Being a socially determined disease associated with unsatisfactory sanitary and hygienic and socio-economic conditions, the society faces the most acute questions about the impact on the health of both migrants themselves and their families [2].
The analysis of the literature devoted to studies of the problems of tuberculosis incidence in Russia among internal labor migrants allows us to identify groups of determinants: socio-structural and contextual determinants (economic, educational, and socio-psychological) as the most likely causes of the increased risk of tuberculosis in this population group [3].
Objective: to identify medical and social risk factors for the development of tuberculosis of interregional labor migrants.
Materials and methods.
A questionnaire containing 20 questions was developed for the study. The questions focused on the assessment of such aspects as: gender, age, level of education, level of awareness about the prevention of tuberculosis, assessment of the presence of risk factors for tuberculosis in domestic labor migrants. The study also used data from the Central Research Institute of Healthcare Organization and Informatization and EMISS State Statistics. For the mathematical analysis of the obtained results, the Microsoft Excel program was used. The study was conducted in the period from January 15 to February 15, 2021.
Results and discussion.
The survey involved 27 people in the age group from 22 to 47 years. At the first stage, the groups were differentiated by gender. So among the studied 74.1 % were men, 25.9% were women. Further, the respondents were separated by marital status, these groups were: 51.9% - married (registered and not registered), 48.1% - unmarried. The survey also took into account the presence of children, so 55.56% of reviewers have children, more than half are children under the age of 14. According to the results of the survey, 86.6% have one child, and 13.3% have two or more children. Among the respondents, 55.56% have chronic diseases: 37.04% have chronic gastritis, 3.7% have diabetes mellitus, and 14.82% have chronic bronchopulmonary diseases. The respondents were residents of the city of Voronezh and Ostrogozhsk, Belgorod, Gubkin, Sochi and Moscow.
The first block was devoted to assessing the presence of social risks of tuberculosis, all respondents in this period of time work on a shift basis or have had such experience for more than one year of life. To the question: "Did you have to move more than once within six months?" - 88.89% agreed, 11.1% noted that they did not work in shifts all the time, migration was associated with the seasonality of work. To the question: "Have you ever lived in a dorm or a room with a large number of people?" - 85.19% answered positively, 14.81% noted that they lived in the company of no more than 2 people. To the question: "How long did you leave to work?» for the option "up to 1 month" gave voice 22,22% of votes "for a period of up to 2 months" - 55,6%, "for a period of more than 2 months" - 22,22%. To the question: "Did you have time during the day for leisure activities (reading books, watching TV programs, etc.)?" - 33.34% noted that they had the opportunity to relax, but not in the usual volume, 66.7% said that they did not have free time, but tried to find an additional source of income or preferred sleep. To the question: "Did you have the opportunity to eat quality food for the period of this time?" - 92.6% ate fast food or ready-made food for takeaway, 7.4% said that they tried to maintain the usual rhythm and quality of food. The prevailing number of individuals is at particular risk. This is due to frequent travel, high stress load, long separation from family, violation of the usual schedule and diet [2]. These determinants cause a high risk of developing tuberculosis in this category of persons. To the question: "Did you have any difficulties when applying for medical help in polyclinics at your place of work?" - 25.928% said that they experienced difficulties (among the reasons noted – refusal of assistance due to living in another region, lack of a complete list of necessary documents), 40.744% did not seek medical help, the rest did not have difficulties in obtaining the necessary medical care.
The second set of questions was aimed at identifying the need for clinical and medical care for symptoms typical of tuberculosis. To the question: "Do you notice a cough (with sputum) for more than 3 weeks, chest pain, fever, sweating, weight loss, when you seek medical help?". Thus, 44.45% of the respondents noted that they would apply within a week, 33.33% would take symptomatic therapy (antipyretics, painkillers) and only in the absence of positive dynamics, they would seek medical help. About 23% of respondents noted that more serious reasons than the above symptoms would be required to seek medical help. This category of citizens creates a high risk, both for themselves and for others, due to the underestimation of the importance of the above-described symptoms. To the question: "How often do you undergo a fluorographic examination?" among the proposed options – "1 time per year" – 74.08% answered positively, "1 time in 2 years" – 14.81%, "1 time in 5 years" – 11.11%. In connection with the above-mentioned determinants of the risk of tuberculosis, the coverage of the fluorographic examination of this category of citizens, as an important resource of the working population, should be 100%. After all, tuberculosis detected at an early stage, from the point of view of therapy, is prognostically more favorable.
The next set of questions aimed to identify the awareness of citizens about tuberculosis in terms of prevention measures. To the question: "Choose from the proposed list of measures that would reduce the risks for you and your loved ones to get tuberculosis?" from the proposed options: 1) "maintaining a healthy lifestyle" - selected by 100% of respondents; 2) "wet cleaning of premises, ventilation" - scored 85.19%, the remaining respondents were convinced that the source of tuberculosis is only public places, but their own housing is protected; 3) "vaccination" - selected by 92.6% of respondents; 4) "X-ray diagnostics" - noted 96.3% of respondents. According to the results obtained on the basis of the questionnaire, the selected positive responses amounted to 90.84%, which reflects a fairly high percentage of knowledge among citizens of this category about tuberculosis prevention measures.
Conclusions.
Based on the results of the study, a number of key conclusions can be drawn:
1. There are a number of organizational problems maintaining the health of migratory populations in the absence of well-established system of prevention and control for the passage of x-ray studies among migrant workers, so of 25.92% of respondents less than 1 time per year undergo x-ray examination.
2. The acute medical and social problems of migrant workers, which are risk factors for the development of tuberculosis. According to the analysis of the data obtained, the following risk groups can be identified: socio-economic (financial instability, group living, increased stress due to moving and new social environment, eating disorders, work and rest), medical-social (difficulties in obtaining medical care), family-educational (breaking family ties for a long period of time, the inability to spend enough time with the family) - all this contributes to a decrease in the quality of life of the population and is a potential condition for the risk of tuberculosis.
3.According to the survey, the awareness of labor migrants about the prevention of tuberculosis infection is at a fairly high level, but they do not always have the opportunity to follow these recommendations.

About the authors

Elena Kharkovskaya

Воронежский государственный медицинский университет им. Н.Н. Бурденко

Author for correspondence.
Email: lenhar.elf@yandex.ru
ORCID iD: 0000-0001-9799-2912
SPIN-code: 3067-1102

студентка

Russian Federation, 394036, Россия, город Воронеж, ул. Студенческая, 10

References