Study On Epidemic Characteristics And The Risk Factors Of Anti-tuberculosis Treatment Effect Of Multidrug-resistance Tuberculosis In Yunnan Province

Objective:To analyze the epidemic characteristics and the influencing factors of MDR-TB in Yunnan Province,and to provide corresponding countermeasures for the prevention and control of MDR-TB in Yunnan Province.To analyze the status of treatment of MDR-TB patients by analyzing the treatment of MDR-TB patients and the factors that affect the treatment of patients with MDR-TB.To investigate the main problems and counter measures of the MDR-TB prevention and control through analyze the treatment effect and influencing factors of MDR-TB patients.Methods:1.System data analysis.The data of smear-positive pulmonary tuberculosis patients with MDR-TB screening on "Tuberculosis information management system" were collected retrospectively,to analyze the epidemic characteristics and the influencing factors of MDR-TB in Yunnan Province from 2012 to 2016.To collect the data of MDR-TB patients in Yunnan Province from 2012 to 2016,to analyze the treatment and management of MDR-TB patients and the related factors influencing the patients’treatment.2.Investigation of influencing factors.On the basis of literature review about MDR-TB treatment effect,I designed questionnaire and interview outline to collect data.Access to medical record information of MDR-TB patients who were treated and managed in Yunnan CDC tuberculosis clinical treatment centers(TCC)and the third people’s hospital in Kunming.Investigate the information which is not provided by the medical record,through outpatient follow-up and telephone follow-up.Different treatment stages of MDR-TB patients were interviewed in one-to-one,face-to-face manner.This study using epidata 3.1 entry data,SPSS 17.0 software for statistical analysis.Using proportions,mean,standard deviation for statistical description,and chi square test,binary logistic regression analysis for statistical analysis.Significant difference was P<0.05.Results:1.685 MDR-TB patients were reported in Yunnan Province from 2012 to 2016.There were 499 male patients accounting for 72.85%and 186 female patients accounting for 27.15%.The ages mainly concentrated in the 15一and 30一age group.In MDR-TB patients,there are 382(55.77%)patients also resistant to other anti-tuberculosis drugs.The detection rate of MDR-TB in high risk population was 30.34%higher than that in newly smeared patients 3.51%.The detection rate of Diqing was the highest(18.18%),and the detection rate of Wenshan was the lowest(4.52%).Age,nationality,occupation,census register,type of registration were influencing factors of MDR-TB.2.364 MDR-TB patients were receive treatment,the rate of treatment was 53.14%in Yunnan Province from 2012 to 2016.Among 321 MDR-TB patients who were not receive treatment,191 patients of rejection,17 patients died,14 patients were lost.Age,nationality and type of registration were influencing factors of patients receive MDR treatment.3.The six months at the end of negative rate,twelve months at the end of negative rate and success rate of treatment were 80.09%,83.06%and 65.82%respectively in Yunnan Province from 2012 to 2016.Age,census register,ofloxacin resistance,previous history of anti-tuberculosis treatment,treatment at the end of six months sputum culture results,combined with other diseases and adverse drug reactions were influencing factors of patients treatment effect.4.Qualitative study found that awareness level of TB knowledge of MDR-TB patients was relatively low,and patients are more or less discriminated against.Expensive medical costs and serious adverse drug reactions are the main factors that affect the compliance and treatment of MDR-TB patients.Conclusions:1.MDR-TB suspicious screening effect was significant in Yunnan Province.High risk group screening is still the focus of work.MDR-TB patients also resistance to other anti-TB drug should pay attention,especially for the ofloxacin resistance.2.MDR-TB patients with high rates of treatment.But the patients who not receive treatmen due to refusal,death and loss of follow-up should pay attention.Develop effective interventions,implement patiens management,improve patients compliance has become new priority area of MDR-TB prevention and control in our province.3.The six months at the end of negative rate,twelve months at the end of negative rate and success rate of treatment were higher.Age,census register,previous history of anti-tuberculosis treatment,and adverse drug reactions were influencing factors of patients treatment effect.4.The awareness level of TB knowledge,discrimination and the economic burden of MDR-TB patients will affect the patient’s compliance and treatment effect.