老年结核病患者对中国结核病控制的影响

目的 分析在现代结核病控制策略(DOTS策略)下老年结核病患者对中国结核病控制的影响。方法 根据2000年全国结核病流行病学抽样调查中老年结核病的患病特征,对照分析在实施DOTS策略地区和非DOTS策略地区老年结核病患者的发现、治疗和管理现状。结果 ≥65岁年龄组肺结核涂阳患病率为440/10万,是各年龄组平均涂阳患病率的3.6倍;≥65岁老年人涂阳病例数占全人口涂阳病例数的28.6％;在已实施DOTS策略的13个省和未实施DOTS策略的15个省中,老年涂阳病例数分别占各年龄组涂阳病例数的28.8％和28.9％;1992～2000年在实施DOTS策略的13省新涂阳病例登记数中,≥65岁老年结核病患者占11.4％。结论 老年结核病患者涂阳患病率高,不论在实施DOTS策略地区或非DOTS策略地区,所有涂阳病例中老年涂阳病例构成比例大,而新涂阳病例登记比例却最低。老年结核病患病率高、发现率低是结核病控制工作中值得关注的问题。     

安徽省濉溪县2003—2010年结核病预防与控制效果评价

目的 分析安徽省濉溪县2003-2010年结核病预防与控制效果.方法按《全国结核病防治规划(2001-2010年)》和《中国结核病防治规划实施工作指南》及有关《项目实施计划》所规定的指标、标准和定义进行调查、核实及统计分析.结果安徽省濉溪县2003-2010年共登记涂阳患者3 922例,年均登记率为43.90/ 10万,其中新涂阳患者年均登记率为36.30/10万,登记率由2003年的14.14/10万上升到2010年的36.21/10万(x2=111.80,P＜0.01);新涂阳任务指标年均完成率为104.85％;涂阳患者年均治愈率为93.73％,治愈率由2003年的86.21％提高到2010年的97.07％ (x2=31.04,P＜ 0.01),其中新涂阳患者年均治愈率为94.76％,复治涂阳年均治愈率为88.81％,两者的治愈率均呈波状上升趋势;涂阴患者年均完成治疗率为95.54％.结论 濉溪县结核病防治工作效果显著,认真执行DOTS策略是结核病人高发现率、高治愈率和防止耐多药产生的有效措施.     

江西省第一轮全球基金结核病项目实施效果分析

目的分析和评价江西省第一轮全球基金结核病项目实施效果。方法收集2003年4月-2008年3月江西省第一轮全球基金项目工作计划、项目工作和财务季度报表、结核病规划季报表,分析第一轮全球基金结核病项目实施效果。结果项目地区现代结核病策略(DOTS)2003年的覆盖率从42.9%上升到2005年的100%。项目实施期间,共接诊可疑症状者138 695例,发现涂阳肺结核患者38 244例,其中新发涂阳肺结核患者32 186例,完成项目计划发现指标的131.5%,新涂阳肺结核患者登记率由2004年的23.90/10万上升到2007年56.64/10万。新涂阳治愈率达到93.0%。结论通过实施第一轮全球基金结核病项目,推动现代结核病策略的实施,有效发现和治愈活动性结核病患者,从而有效降低江西省结核病发病率和死亡率,引进带有经费预算的项目管理和工作模式,并广泛应用于江西省结核病防治和疾病控制工作中。     

长春市结核病防治规划实施4年效果评价

目的了解实施《全国结核病防治规划》中期目标效果,为如期实现《全国结核病防治规划》目标提供依据。方法收集分析2003—2006年项目季报表及相关资料。结果DOTS覆盖率100％,可疑者就诊率10．8／万。全市加强了结核病综合防治措施,传染源的发现率和治愈率逐年提高,新发涂阳病人登记率由30．80／10万到48．64／10万,提高了57．9％,新涂阳病人治愈率92．8％。4年共接诊肺结核可疑症状者30397例。结论建立以DOTS为主的结核病控制模式,是提高肺结核病人发现率和治愈率的根本保证。     

综合医院转诊结核病患者对发现结核病影响的系统评价

目的 评价近10年来综合医院及乡镇卫生院对疑似结核病和结核病患者实施报告转诊制度对提高中国结核病患者发现率的影响。方法 系统评价、Meta分析,通过原始数据计算出每个研究的RR值或RD值(率差),通过合并RR或RD值来评价总的效果;使用Excel、SPSS、RevMan软件进行统计学分析。结果 采取干预措施后随访5年,涂阳患者新登记率和新发涂阳患者登记率5年均为上升的趋势,前3年增长幅度逐年增大,从第4年开始增长幅度出现下降。漏转率合并RR值为0.36,95％CI为0.25～0.53。结论 合并的结果显示,实施综合医院转诊制度后有益于结核病患者发现率的提高。     

安庆市2003～2007年结核病防治效果评价

目的分析安庆市2003～2007年结核病防治工作的效果,为控制结核病流行提供依据。方法收集结核病统计监测报表进行分析。结果5年期间,安庆市有48 459例肺结核可疑症状者就诊,就诊率为1.60‰;痰涂片检查率和阳性检出率分别为72.44%和36.37%;登记活动性肺结核21 528例,其中新涂阳肺结核12 768例,新涂阳登记率为33.40/10万,34.77%涂阳病人来自医院转诊;2005年起新涂阳患者发现率达到70%以上;初治涂阳肺结核治愈率为92.46%,复治为78.89%。结论安庆市结核病防治形成了规范化、科学化归口管理体系,建立起以DOTS为主的结核病控制工作模式,达到高发现率、高治愈率效果。     

2001-2009年常德市结核病控制效果分析

目的分析常德市结核病控制项目实施9年的效果,为结核病防治工作可持续发展提供依据。方法收集2001-2009年湖南省常德市中国疾病预防控制信息系统资料、13个县(市、区)中国结核病防治规划登记资料、相关纸质文书、报表等资料。按照《中国结核病防治规划实施工作指南》和其它相关要求进行统计分析。结果常德市2002年启动现代结核病控制策略,2004年以县为单位DOTS策略覆盖率达到100%。2001-2009年全市共接诊结核病可疑症状者123 538例,可疑者年就诊率从2001年的113.74/10万上升到2009年的324.61/10万;发现涂阳肺结核患者25 758例,其中新涂阳患者21 800例,新涂阳肺结核登记率平均为40.07/10万,新涂阳肺结核发现率平均为65.63%;初治涂阳平均治愈率为88.8%,复治涂阳平均治愈率为82.0%。结论实施DOTS策略,可提高肺结核患者的发现率和治愈率,减少结核病的传播,产生明显的社会防治效益。     

2005--2006年六安市裕安区肺结核病人调查

收集六安市裕安区2005—2006年初诊病人及登记肺结核病人相关数据，并进行统计分析，为实施国家结核病控制DOTS策略提供依据。可疑病人就诊率1．86‰，新涂阳登记率41．98／10万，新涂阳病人发现率71．79％，痰涂片阳性检出率41．72％，涂阳病例初复比3．59：1。病人初诊来源以就诊、转诊和日常推荐为主，分别占登记病例的49．55％、35．36％和8．45％，其中转诊人数2006年明显高~2005年。可见，加强农村地区结核病防治宣传力度，提高医疗机构结核病转诊率，是做好病人发现工作的重点。     

2002-2009年会同县肺结核患者发现状况与转归分析

目的评价会同县2002-2009年肺结核患者发现及治疗效果。方法利用县疾控中心相关记录及月报表、季报表、网络专报督导及检查资料进行分析。结果 2002-2009年共接诊10096例可疑症状者,可疑就诊率36.4/万,查出活动性肺结核病人2631例,查出阳性病人1527例,涂阳登记率55/10万;新涂阳患者1350例,新涂阳登记率48.6/10万。八年间新涂阳肺结核患者中治愈1202例,其治愈率89.0%,且复治涂阳病人逐年减少。结论全面实施DOTS策略后,肺结核病人的发现率和转归成效均有较大的提高。     

武汉市结核病防治规划中期效果评价

目的：分析《武汉市结核病防治规划（2001～2010年）》中期执行的效果。方法：对2001—2005年项目执行情况的资料进行汇总分析。结果：现代结核病控制策略（DOTS）覆盖率以乡（街）为单位达到100％；5年共登记活动性肺结核病人30634例，涂阳肺结核登记率分别由2000年的33．90／10万，提高到2005年的51．30／10万，初治涂阳和复治涂阳治愈率分别达到94.4％和88.4％。结论：武汉市肺结核病人登记率、治愈率较规划前提高，但仍需提高武汉市结核病防治，工作的整体水平。     

Low access to a highly effective therapy: a challenge for international tuberculosis control

OBJECTIVE: To determine the scale of the tuberculosis (TB) problem facing the international Stop TB Partnership by measuring the gap between present rates of case detection and treatment success, and the global targets (70% and 85%, respectively) to be reached by 2005 under the WHO DOTS strategy. METHODS: We analysed case notifications submitted annually to WHO from up to 202 (of 210) countries and territories between 1980 and 2000, and the results of treatment for patients registered between 1994 and 1999. FINDINGS: Many of the 148 national DOTS programmes in existence by the end of 2000 have shown that they can achieve high treatment success rates, close to or exceeding the target of 85%. However, we estimate that only 27% of all the new smear-positive cases that arose in 2000 were notified under DOTS, and only 19% were successfully treated. The increment in case-finding has been steady at about 133 000 additional smear-positive cases in each year since 1994. In the interval 1999- 2000, more than half of the extra cases notified under DOTS were in Ethiopia, India, Myanmar, the Philippines, and South Africa. CONCLUSION: With the current rate of progress in DOTS expansion, the target of 70% case detection will not be reached until 2013. To reach this target by 2005, DOTS programmes must find an additional 333 000 cases each year. The challenge now is to show that DOTS expansion in the major endemic countries can significantly accelerate case finding while maintaining high cure rates.     

Did we reach the 2005 targets for tuberculosis control?

The World Health Assembly set targets to detect by 2005 at least 70% of all new sputum smear-positive cases arising each year and to cure at least 85% of these cases. The national tuberculosis (TB) control programmes of 199 countries reported that in 2005, 2.3 million new smear-positive cases were diagnosed under WHOs DOTS strategy, out of an estimated 3.9 million (95% confidence limit (CL) 3.4 million to 4.4 million) new smear-positive cases arising in that year, a global case detection rate of 60% (95% CL 52% to 69%). Of 2.1 million new smear-positive patients registered for treatment in 2004, 84% had successful outcomes. Of the regions, only the WHO Western Pacific Region reached both targets, with case detection and treatment success rates of 76% and 91%, respectively; South-East Asia reached the treatment success target with a rate of 87%. In relation to countries, WHO estimates that 67 achieved the target detection rates and 57 achieved the target for treatment success, with 26 - including high-burden countries China, the Philippines and Viet Nam - achieving both targets. DOTS programmes diagnosed more than 26 million patients (all forms of TB) in 1995-2005. Building on this success, the Global Plan to Stop TB 2006-2015, describes the actions needed to implement WHOs new Stop TB Strategy over the coming decade to reduce TB incidence, prevalence and deaths in line with the Millennium Development Goals.     

综合性医院归口诊治肺结核病的改革实践

目的:充分发挥综合医院作用,提高肺结核病人发现率。方法:通过全面推行结核病控制策略(DOTS),改革防制模式,实行以一所综合医院为归口诊治、其他医院机构为归口转诊、疾控中心为归口管理模式,建立转诊制度,明确各自职责和分工。结果:全县传染源发现率平均已达96.7%;新发涂阳肺结核病新登记率从1995年~1999年30.1/10万上升到2000年~2005年44.50/10万,增长了47.8%;转诊率从1995年~1999年82.1%上升到2005年的98.5%,增长了20%。结论:改革后的结核病归口诊治管理模式,利用现有医疗资源,有效提高了肺结核病人的转诊率和涂阳病人的发现率,发挥了综合性医院对结核病控制工作的重要作用。     

2001～2006年青海省结核病控制项目实施效果分析

[目的]分析青海省结核病控制项目执行情况,找出执行过程中存在的问题和障碍,提出改进意见,为今后结核病控制可持续发展提供依据.[方法]对2001～2006年以来全省各地的项目资料,项目经费投入和使用情况,及季报、年报等流行病学资料进行总结分析.[结果]截至2005年全省DOTS策略以县为单位覆盖率已达到100%,6年来,发现并治疗传染性肺结核病人10637例,全省新发涂阳肺结核病人发现率达到并维持在73%以上;治愈率达到了90.5%.全省各级结核病经费投入逐年增加.[结论]通过在全省推广现代结核病控制策略,政府承诺得到加强,病人发现和治疗管理效果显著.     

福建省结核病控制工作模式的研究

[目的]总结福建省"三位一体"(结防机构、综合性医院和乡镇卫生院共同参与)结核病控制新模式的成效。[方法]制定工作模式评估方案,以人力资源建设、DOTS覆盖、公众防控知识、病人发现及治疗管理和社会效益等指标,对新模式进行评价。[结果]结防机构及能力建设得到加强;公众结核病防治核心信息知晓率高于全国平均水平;综合性医院转诊比例逐年增高;以县为单位的DOTS覆盖率已达100%;2005年以来新涂阳肺结核病人发现率稳定在70.0%以上,登记满1年的病人治愈率88.2%以上,圆满完成结核病防治规划目标,获得较好的社会和经济效益。[结论]福建省"三位一体"的结核病控制新模式巳逐步完善并取得初步成效,建议进一步制定和实施更有效的对策和行动并推广应用。     

广西南宁市世行贷款中国结核病控制项目中期效果评价

目的评价南宁市世行贷款／英国赠款中国结核病控制项目（2002—2005年）中期执行的效果。方法根据卫生部的中期评估调查表，收集南宁市2002—2005年8个项目单位常规监测等相关资料，汇总分析。结果南宁市2004年DOTS策略覆盖率达到100％，4年来共接诊可疑肺结核症状者42358例，发现活动性肺结核病人16067例，其中涂阳病人6012例，涂阳病人登记率从2002年的11．51／10万上升到2005年的37．03／10万，初治涂阳病人治愈率从2002年的76．7％提高到2005年的92．4％。结论通过实施世行贷款结核病控制项目，实现了南宁市结核病控制中期目标，初步建立了结核病控制可持续发展机制，但仍需进一步加强结核病控制工作。     

The DOTS strategy in China: results and lessons after 10 years

OBJECTIVE: To analyse the five-point tuberculosis (TB) strategy, DOTS, 10 years after its implementation in one-half of China's population, and to suggest lessons for future implementation of the DOTS strategy. METHODS: We analysed trends in case-finding and treatment outcome over time following implementation of the DOTS strategy in each county, using routine reporting data from the Infectious and Endemic Disease Control (IEDC) project (1991 - 2000). We also determined the proportion of counties with different levels of case-finding for the fifth and sixth years of DOTS implementation. FINDINGS: From 1991 to 1995, DOTS expanded rapidly to cover more than 90% of target population and counties. By 2000, 8 million TB suspects had received free diagnostic evaluation: 1.8 million TB cases were diagnosed, free treatment was provided to 1.3 million smear-positive cases, and more than 90% were cured. During DOTS implementation, the percentage of previously treated cases decreased among all smear-positive cases and treatment outcomes improved. Despite these achievements, the detection rate for new smear-positive cases in the project was estimated to be only 54% in 1998, and 41.2% of the counties had a below average or low level of case-finding (with substantial variation between provinces). CONCLUSIONS: The IEDC project demonstrated that it is feasible to rapidly expand DOTS on a large scale. The global target of an 85% cure rate was quickly achieved, and the level of drug-resistance was probably reduced by this project. However, case-detection did not reach the 70% global target, and more research is needed on how to enhance this.     

Tuberculosis in health care workers in Malawi.

Although sub-Saharan Africa has the highest rates of tuberculosis (TB) and human immunodeficiency virus (HIV) infection in the world, the rates of TB amongst its health care workers (HCWs) are poorly documented. We therefore conducted a country-wide investigation. All district/government and mission hospitals in Malawi that diagnose and care for TB patients were visited in order to obtain information on hospital-based HCWs and their incidence of TB in 1996. Hospital TB case loads, country-wide TB notification numbers and national population estimates for 1996 were obtained, which enabled TB case notification rates to be calculated. In 1996, 108 (3.6%) of 3042 HCWs from 40 hospitals were registered and treated for TB: 22 with smear-positive pulmonary TB (PTB), 40 with smear-negative PTB and 46 with extrapulmonary TB. The overall case fatality rate was 24%. Compared with the adult general population aged > or = 15 years, the relative risk [95% confidence interval (CI)] in HCWs of all types of TB was 11.9 [9.8-14.4], of smear-positive PTB 5.9 [3.9-9.0], of smear-negative PTB 13.0 [9.5-17.7] and of extrapulmonary TB 18.4 [13.8-24.6], P < 0.05. The 1996 hospital TB case load ranged from 29 to 915: there were no cases of TB in HCWs in hospitals whose case load was < or = 100 patients, while the TB case rate among HCWs was similar in hospitals with annual case loads of 101-300 or > 300. The annual risk of TB was high among all categories of HCW, especially clinical officers. This study shows a high rate of TB in HCWs in Malawi, and emphasizes the need for practical and affordable control measures for the protection of HCWs from TB in low-income countries.     

From mosques to classrooms: mobilizing the community to enhance case detection of tuberculosis

In response to the global challenge of inadequate case detection of tuberculosis (TB), the Fund for Innovative DOTS Expansion through Local Initiatives to Stop Tuberculosis (FIDELIS) was developed in 2003 to rapidly assess and implement innovative approaches to increase the detection of new smear-positive TB cases. As previously reported, a wide range of target populations and interventions has been incorporated into successful FIDELIS projects.