The Effect Of DOTS Strategy Implementation And The Treatment Delay And Its Influencing Factors Of Tuberculosis In High Endemic Area Of Yunnan Province

ObjectiveEfforts are made to evaluate the implementation effects of DOTS (directly observed treatment strategy) in a certain high endemic area of tuberculosis in Yunnan Province, explore delay in seeking medical care by tuberculosis patients in this area and the influencing factors, and propose related suggestions to solve the problem of delay in seeking medical care by local tuberculosis patients, which can provide important decision basis to improve the tuberculosis control policy for the public.Methods:The DOTS evaluation adopts the quantitative research method. The data of the implementation of county tuberculosis control program is collected from the tuberculosis information management system, and statistic analysis is conducted to the data. For research on delay in seeking medical care, the research method that combines quantitative and qualitative analysis is adopted. Through quantitative research, we use the tuberculosis information management system to investigate the data of epidemic situation under delay in seeking medical care in a fixed period for the county, and conduct statistical analysis; various sociological investigation tools are used to conduct qualitative research to interview different groups and explore the causes and influencing factors for the delay in seeking medical care by patients, such as the onsite semi-structured interview and observational method.Results:1. Investigate the implementation situation of DOTS in the county:the DOTS was smoothly initiated in 2002.(1) On the government aspect:the local government treats tuberculosis as one of the key diseases of prevention and treatment, and attaches high importance to the tuberculosis control work; financial funds on various levels are basically in place, but the local municipal and county-level financial input is significantly inadequately, and the county-level input per capita is significantly lower than the provincial level; the equipped quantity of institutions and equipment satisfies related requirement, but the minimum personnel allocation requirement is not satisfied;(2) The investigated county can actively provide free medicine, supervision, training and health promotion work;(3) On the aspects of patient discovery and sputum test, the reported morbidity of investigated county is higher than the provincial and municipal level for many years, which also presents a continuously increased trend, and the epidemic is severe, which is at a high prevalence situation; the outpatient rate for patients in the preliminary diagnosis is slightly lower than the provincial level; the detection level is higher than the provincial level, and 100%of patients in the preliminary diagnosis accepted the x-ray chest film examination, which satisfies the requirement of overall objective; the overall transfer treatment and tracking level of investigated county is lower than the provincial level, which does not reach the planning requirement either; the screening rate for those who had close contact with patients with smear positive pulmonary tuberculosis satisfies the planning index;(4) On the aspect of treatment management, through comparison between initial treatment and retreatment TB, the proportion of retreated patients with smear positive pulmonary tuberculosis increases every years, which has problem on treatment management; the negative conversion rate of patients after initial treatment of 2-3 months satisfies the standard; the cure rate and treatment completion rate can basically reach the planning index; the system management rate satisfies the regulated requirement.2. Delay in seeking medical care by tuberculosis patients:in the investigated county, the median and range interquartile of delay in seeking medical care increase with time, which indicates the delay in seeking medical care becomes more severe every day. Among all the registered tuberculosis patients’medical records from October,2014 to March,2015 exported from the tuberculosis management information system,8.3% of the patients delayed for less than 2 weeks in seeking medical care, while 13.0%of the patients delayed for more than 90 days in seeking medical care; the median of delay in seeking medical care is 60 days, the range interquartile is (35 days,75 days), and the longest delay was 1138 days. Occupation and therapeutic classification have influence on the delay time of smear positive TB patients; for patients with the occupation of farmer and the therapeutic classification of retreatment, the risk of delay in seeking medical care is higher; the factors of gender, age, nationality and patient source do not have significant impact on the delay in seeking medical care by patient. Among the 20 interviewed tuberculosis patients, the he range interquartile of delay in seeking medical care is 36.75,62 and 69.75 days; the causes for delay include the geographical environment, natural condition, finance, input of human resources, comprehensive quality of medical staff, implementation and effects of medical training, untimely diagnosis of disease by the medical institution, the patient’s awareness of tuberculosis knowledge, economic problem and medical service radius.Conclusions:In the investigated county, the implementation effects of DOTS are obvious, and the implementation of DOTS should be continuously promoted. The delay in seeking medical care is serious. The local government should attach more importance to the prevention and treatment work of tuberculosis, and actively support the tuberculosis prevention and treatment. Efforts should be made to increase funds input for tuberculosis prevention and treatment, and strengthen the construction of a professional team and the interaction between medical treatment and prevention. For the deficiencies of DOTS, related discussion should be conducted for improvement. In the high prevalence area, permitted by the condition, a series of screening works can be conducted to actively find the patients.