| Objective To understand the status of case detection and treatment management on tuberculosis(TB) patients in Guangdong province, and investigating their influencing factors. In order to provide advice to further improve TB control work.Methdos A multistage sample design was used to obtain where and population of research. Both qualitative and quantitative methods were used. The interview meetings were carried with the decision makers, managers and medical staffs, in order to understand the measures, implementation and suggest of TB control work. We collected the data about TB patient form 2010 to 2013, such as case registration and treatment condition. Qusetionnaire survey was used to understand the status of patients, masses, TB medical staffs and students. The influence factors of case detection, treatment management and TB knowledge awareness were analyzed by using c2 tests and Logistic regression analysis.Results The registration rate of active TB patients decreased year by year, which had fallen 19.7% than 2010. The constituent ratio of new smear-positive, retreated smear-positive and smear-negative was 47.8%, 5.0% and 47.2%, respectively. The discovery rate of new smear positive patients kept the trend of decrease, which had fallen 10.7%. The arrival rate of TB patients was 91.2% in 2013, and it had rose 12.4% than the rate in 2010. About 94% to 99% close contacts had been screened each year, and their incidence was 320 per 10 million to 410 per 10 million. The result of questionnaire showed that the awareness rate among patient was 58.7%. Most TB patients were found by clinical consultation(84.1%), and we found the old aged was more likely to be detected by this method(31-49 years old: OR=3.31,95%CI 1.37-7.96. ≥50 years old: OR=5.80,95%CI 1.79-18.80). Among 227 persons who were found by clinical consultation, the rate of patient delay was 42.3%(mean was 4.1 weeks, minimum was 0 week, maximum was 90 weeks), and the risk factor was lack of awareness with TB. Most patients(48.5) had chosen the polyclinic at their first treatment, and only 15.9% had chosen the TB institution. We found that more patients who had a pate TB history would choose the TB institution than other. There were 57.0 percent of patients could be diagnosed with TB at their first treatment, and the old aged was more likely to be misdiagnosed than younger(OR=0.46,95%CI 0.23-0.93). Most patients were misdiagnosed as cold(17.4%), pneumonia(4.4%) and trachitis(4.1%). The rate of diagnosis delay was 32.6%, and the risk factor was age and diagnosing in non- TB institution. There were 8.1 percent of patients had been screened, and the old group had fewer opportunities to screen than younger.From 2010 to 2013, the cure rate of smear positive patients was 92.3%(new smear positive was 93.2%; retreated smear positive was 84.7%). Most patients(70.4%) would get the medicine from TB institutions each month or each week. Over fifty percent patients(54.4%) did not accept supervision in their treatment. And we found most patients who lived in the west Guangdong did not accept supervision than other places(c2=19.20, P<0.001). There were 44 patients(16.7%) had discontinued their treatment, and the rate was higher among the people who had TB history. Busy(18.2%), untoward effect(15.9%) and feeling better(15.9%) were the main reasons of therapy discontinued. And the patients continued their treatment because of feeling uncomfortable(38.6%), work did not busy(18.2%) and untoward effect had reduced(13.6%).Conclusions 1. The case detection had met the requirement in Guangdong province, but there was still existed some problems, suah as the high rate of delay, lack of know and confidence among residents, and lack of active screening among TB institutions.2. The treatment management of TB patients was well structured. But the rate of treatment interrupted still maintained higher level, and the work of supervision should be further improved.3. The awareness of TB among each group was not enough, and the TB health education work should be improved. |
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