Chirico C, Kuriger A, Fernández H, Morcillo N
Programa de Control de la Tuberculosis, Hospital Dr. Antonio Cetrángolo, Vicente López, Argentina.
Medicina (B Aires). 1999;59(4):332-8.
Tuberculosis (TB) continues to be a serious health problem in most of the districts in the 5th Sanitary Region of Buenos Aires Province (RSV) which is located in North Buenos Aires City suburbs. The aim of this study was to analyse and compare the evolution of the TB epidemiological situation in ten districts, in a thirteen year period (1984-96) and to analyse possible reasons for differences. The average annual variation (VAP) of morbidity rate was calculated in order to estimate the trends of TB in these communities along time. Reporting to the National and Provincial TB Control Programmes of TB cases is mandatory for physicians and these data were used as a source of information for the number of cases and rates. A statistical analysis was performed. Our results showed that the VAP value for the whole RSV was lower than -5.0%. On this basis several districts were identified as having a TB critical situation. The proportion of smear positive cases among TB patients reported decreased during this period, suggesting that smear microscopy was being poorly used as a diagnostic tool for TB. Furthermore, the cure rates of the patients attained--in average--only 60.0% and several warning indicators (IA)--like TB meningitis cases and mortality due to TB in people younger than thirty years old, as well as TB--HIV/AIDS association--have been observed to grow in several districts. Previous world global experience and those obtained in other provinces in our own country, suggest that the unique possible strategy for modifying this situation, is to set up the directly observed treatment (DOTS), according to World Health Organization/International Union Against Tuberculosis and Lung Diseases (WHO IVATLD) recommendations, in order to achieve the control of TB.
结核病在位于布宜诺斯艾利斯市北部郊区的布宜诺斯艾利斯省第五卫生区（RSV）的大多数地区仍然是一个严重的健康问题。本研究的目的是分析和比较十个地区在13年期间（1984 - 1996年）结核病流行病学情况的演变，并分析差异的可能原因。计算发病率的年均变化率（VAP）以估计这些社区结核病随时间的趋势。医生向国家和省级结核病控制项目报告结核病病例是强制性的，这些数据被用作病例数和发病率的信息来源。进行了统计分析。我们的结果表明，整个RSV的VAP值低于 -5.0%。在此基础上，确定了几个结核病形势严峻的地区。在此期间，报告的结核病患者中涂片阳性病例的比例下降，这表明涂片显微镜检查作为结核病诊断工具的使用情况不佳。此外，患者的治愈率平均仅达到60.0%，并且在几个地区观察到了一些警示指标（IA）——如结核性脑膜炎病例、30岁以下人群因结核病导致的死亡率以及结核病与艾滋病毒/艾滋病的关联——呈上升趋势。以往的全球经验以及我国其他省份的经验表明，改变这种状况的唯一可能策略是根据世界卫生组织/国际抗结核和肺病联盟（WHO - IUATLD）的建议，建立直接观察治疗（DOTS），以实现结核病的控制。
