| Background: Report on National Random Survey for the Epidemiology of Tuberculosis in 2000 showed the serious epidemic situation in China,while the TB case detection was only around 30%.The new tuberculosis registration rate of smear position case chimbed up to 43% in 2003,but far below the National TB Control Programme (NTP) goal of 70%.Around 80% of the tuberculosis come from rural areas.Rural docors as the base of the three-level medical networks,how big a factor were they in the TB case detection? What are the problems with their work? Discuss this problem in depth, and provid basis for making stategies of control and prevention.Aim: Study on status,troubles and its influencing factors of rural doctors in TB case detection, raise a improving preparatory measures of TB control in rural areas.Come up with some practical suggestions for improve the case detection and ensure the efficient implement of the China tuberculosis control project (CTCP).Methods: The study was carried out in Jiulongpo district and Dazu county,Chongqing.Both quantitative and qualitative methods were applied.Various stakeholders including health services users,providers and supervisors were investigated.Quantitative study: 208 rural doctors, 189 arrived at TB research institute patients come from rural areas were interviewed with structured questionnaire.These questionnaire data were doubled entered into database of EPI data3.02 software.In data analysis,SAS 8.2 software was applied.Qualitative interview: Focus groups discussion included 2 groups of medical workers in township and 4 groups of rural doctors. In-depth interviews were carried for 4 patients,35 suspects,10 villagers and 12 organize related person.Using MAXqda,thematic framework method was applied to analyze qualitative data from both FGD and in-deth interviews.Results:1. The study showed villagers and patients were low in recognition of TB,giving rise to neglect the prevention of TB,a lack of vigilance,patients delay. 47.09% patients did not to the hospital after symptoms. 58.20% TB patients had health seeking delay,the median of health seeking delay was 22 days.Attitude to sickness was the primary factor influencing health seeking.Only 11.64% patients acquired education from doctors including 4.23% from rural doctors.2. 52.38% TB patients first choose village clinic for their symptoms.Convenience was the main reasons for choice.Low capability and behaviour of rural doctors influence the case detection of TB.They had no enough knowledge on TB and lower capability to make diagnosis.The average score of knowledge about TB was 9.44±2.28. Only 8.08% TB patients who first choose village clinic for their symptoms were considered suspects. 66.14% TB patients had confirmed diagnosis delay,the median of confirmed diagnosis delay was 23 days. In addition, the conditions of basic medical and health institutions are poor, influence TB patients confirmed diagnoses in time.3. Financing and supervision mechanism of health care influence the quality of health care.The difficulty faced by providing matching funds,distribution and economic interests influence the medical action of rural doctors.The lack of encouragement funds brought about the lack of enthusiasm.Conclusions: Strengthening the training of rural doctors, appling reasonable contents and patterns for different group of people.Improving recognition for local government, arranging enough matching fund, providing incentive strategy.The government should ensure more funds will be devoted to TB prevention, establish and improve compensation mechanism and security system.Formulating the supervision and management policies,developing a long term work-plan for health education and promotion , and monitoring the progress regularly to improve public knowledge and attitude. Raising case detection rate actively.
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