| Tuberculosis (TB) is a chronic infectious respiratory disease, and its popularity has seriously hindered the development of social and economic. The World Health Organization 2014 global tuberculosis report showed:There were about 9 million new TB patients around the world in 2013, and 1.5 million people died of TB, and the number of Chinese TB patients accounted for 11% of the global total. Due to the lack of sustained and effective vaccine, the most effective measures for TB control is early detection and treatment of TB patients. However, data show that about 3 million people are estimated to remain undiagnosed or not notified and untreated in 2012, and China is one of the major countries which TB case detection was insufficient. Therefore, we need to further improve the strategies of TB case finding.The TB case finding strategies include active case finding strategy and passive case finding strategy, and passive case finding strategy more depends on patient’s awareness about TB symptom and self-perception.However, the fifth epidemiological survey data in 2010 showed that the awareness rate of TB prevention and control information was only 57% in China, and there was a high proportion in patients without suspicious symptoms, which had weakened the effect of passive case finding strategy. Therefore, it had important practical significance to implement active case finding strategy. Scholars at home and abroad had carried out some related research into active case finding strategy, but the studies basically focused on specific populations, such as HIV/AIDS. drug addicts, tuberculosis suspicious symptom and so on, however, there was not yet a systematic and wide research on acuve case finding strategy. The study would comprehensive carry out active TB case finding strategy in the sites and investigate the awareness of TB core information in the field of "twelfth five-year" national science and technology major projects "tuberculosis incidence and intervention model research"Objective:To learn the actual effect of active case finding strategy for TB implemented in Pingguo county, and evaluate the advantage and disadvantage of it, and then explore the application in rural areas.Method:A cross-sectional survey was practiced among permanent residents over 15 years old in two towns of Pingguo County, we collected their basic information, the awareness of suspicious symptoms and core information of tuberculosis by face-to-face questionnaire interviews, and then carried out health education. Meanwhile chest X-ray and sputum examination were implemented to screen for TB among some people, including tuberculosis suspicious symptoms, more than 65 years old, diabetes, close contact with TB patient, previous TB patient and HIV/AIDS. So we obtained the information of TB patients by active screening. All of the work was carried out once a year in 2013 and 2014. At the same time, we used a retrospective study method, via TB management information system, case records form TB prevention and control institutions, and medical records of TB patients, to collect information about TB patients detected form 2013 to 2014 as passive case finding data. Finally, we compared active case finding data to that of passive case finding.Results:1. The awareness of TB core informationIn the two survevs, the awareness rates of TB core information were 41.18% and 44.88% respectively, there was a statistical difference between them (χ2=296.686 P=0.000). After carrying out health education, the number of people with suspicious symptoms active visiting a doctor increased each year, accounting for 75.83% and 81.78% respectively, mainly concentrated in the 40 to 45 age group.2. The screening for pulmonary tuberculosis symptomatic suspectsThere were 344 pulmonary TB symptomatic suspects being screened out in the two surveys, including 181 males and 163 females, at a rate of 0.81%. And the screening rate in the key population was higher than in the general population (χ2=13.396 P=0.000).All of those people mainly concentrated in the 55 to 65 age group, low education.3. The implementation effect of active case findingA total of 99 active TB patients were found in the two surveys by active case finding, including 61 male and 38 female. The total detection rate was 0.23%, which was higher than passive case finding (0.16%), with a statistically significant difference (χ2=5.836 P=0.016). There were 87 active TB patients being found among the key populations in the two surveys, and almost of them were over 65 years old. While there were only 12 active TB patients being found among the general populations.Among all of the patients,80 were over 65 year old (80.81%),and 48 were illiterate or semiliterate (48.49%).After implementing active case finding strategy in the sites, the registration rates of active TB were 139.81/100000 and 161.89/100000 respectively, much higher than before (x 2=32.589 P=0.000)-A comparison of basic characteristics and clinical features of TB patients between active case finding and passive case finding in the corresponding period We found that more than 80.80% of patients detected by active case finding were 65 years old or older, but only 22.78% of patients detected by passive case finding were over 65 years old. And 7(7.07%) patients detected by active case finding appeared TB symptoms, while 72 (91.14%) patients detected by passive case finding showed TB symptoms, the latter was much more than the former, and there was a statistical difference between them(x2= 125.802 P=0.000). In addition, there were more sputum smear-positive and pulmonary cavity lesions in patients detected by passive case finding than in those detected by active case finding, and the differences were statistically significant (x-=10.295 P=0.001; χ2=6.288 P=0.012)In the study, we totally spent 984637 yuan on active case finding and 51000 yuan on passive case finding, and according to the numbers of pulmonary TB patients, we found that the direct cost of detecting a pulmonary TB patient by active case finding strategy was 9946 yuan, and 646 yuan by passive case finding strategy. We hypothesized that all pulmonary TB patients got anti-tuberculosis treatment in time, there would be 25 people avoid dying of TB and 216 people being infected, and we could reduce 22 new patients. We reduced a direct medical costs of 14988 yuan by decreasing new patients, and saved DALY value of 864.5, and achieved a social value of 13774424.3 yuan. In other words, if we want to save one DALY we have to spend 1139 yuan, but if we spend lyuan we will get 14 yuan social benefits return.Conclusions:1. The awareness rate of TB core information in the sites was very low, especially among elderly people. Health education can promote people to change incorrect cognition and behavior, which will lead them to see a doctor in time.2. Active case finding strategy increased the detection of TB patients, particularly the elderly ones. Patients, particularly the ones without symptom, were found in the early stages of disease and were given anti-tuberculosis treatment in time, which would reduce the transmission of TB and achieve the secondary prevention effect.3. Active case finding strategy requires a high implementation cost, but has great social benefits, so we should choose the priority objects before widely carrying out active case finding strategy in areas where economy is underdeveloped.4. According to the awareness of TB knowledge among people and the characteristics of active case finding strategy, we known that active case finding strategy and passive case finding strategy should be used together, mutually promoted, so as to increase the detection of TB patients. |
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