Jaramillo E
School of Public Health, Universidad of Valle, Cali, Colombia.
Soc Sci Med. 1999 Aug;49(3):393-404. doi: 10.1016/s0277-9536(99)00114-8.
Tuberculosis is an important cause of death, mainly in the less developed countries. Thus far the strategy for its control had relied on the diagnosis of sick individuals and provision of chemotherapy. However, this strategy is problematic for several reasons: poor education about the disease and the low income of people with tuberculosis are important barriers for them to have access to early diagnosis and to keep adherence to treatment; provision of 'preventive therapy' to the enormous pool of people infected with tuberculosis is not feasible in less developed countries; and finally, long-term political commitment with the strategy is unlikely. Several facts indicate that tuberculosis patterns in different populations are shaped by biological, behavioral and socio-economic factors. This paper argues that a lasting control of tuberculosis requires a strategy based on a broader model of causality, which takes account of all these three causal factors.
结核病是一个重要的死因，主要发生在欠发达国家。到目前为止，结核病控制策略一直依赖于对患病个体的诊断和化疗的提供。然而，这一策略存在几个问题：对该疾病的教育不足以及结核病患者的低收入是他们获得早期诊断和坚持治疗的重要障碍；在欠发达国家，为大量感染结核病的人群提供“预防性治疗”是不可行的；最后，不太可能对该策略做出长期的政治承诺。一些事实表明，不同人群中的结核病模式受到生物学、行为和社会经济因素的影响。本文认为，要持久控制结核病需要一种基于更广泛因果关系模型的策略，该模型要考虑到所有这三个因果因素。
