Shimouchi A
The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan.
Respirology. 2001 Mar;6(1):75-8. doi: 10.1046/j.1440-1843.2001.00301.x.
Tuberculosis (TB) is the top killer of the productive age group in developing countries. More than half of cases in the world occur in Asia-Pacific region. The number of cases will increase in the next decades due to increase in urban poor population and HIV incidence, and poor access to health services and poor TB programme. The mainstay of effective strategy is to promote DOTS. DOTS population coverage is high, 58% in the Western Pacific Region but low; 29% in the southeast Asia region. Even among intermediate TB-burden countries in Asia, reduction of incidence has stagnated in recent years because of aging population, health problems in the urban poor population and influx of populations from high endemic areas. Indicators of successful TB programmes are high cure rate and low drug resistance rate. There is a strong correlation between the overall quality of TB control in the past and the current primary drug-resistant rate. To solve these problems, priority should be given to nationwide implementation of DOTS in high TB-burden countries with emphasis on ensuring availability of free anti-TB drugs and strengthening primary health care. General hospitals and private sector should be involved in control programmes to prevent drug resistant cases.
结核病是发展中国家劳动年龄人群的首要杀手。全球一半以上的病例发生在亚太地区。由于城市贫困人口增加、艾滋病毒感染率上升、获得医疗服务的机会有限以及结核病防治项目不力，未来几十年病例数量将会增加。有效策略的主要支柱是推广直接观察短程化疗（DOTS）。DOTS的人口覆盖率较高，西太平洋区域为58%，但东南亚区域较低，仅为29%。即使在亚洲结核病负担中等的国家，近年来发病率的下降也因人口老龄化、城市贫困人口的健康问题以及高流行地区人口的涌入而停滞不前。成功的结核病防治项目的指标是高治愈率和低耐药率。过去结核病控制的总体质量与当前的原发性耐药率之间存在很强的相关性。为解决这些问题，应优先在结核病高负担国家全国范围内实施DOTS，重点是确保免费抗结核药物的供应并加强初级卫生保健。综合医院和私营部门应参与防治项目以预防耐药病例。
