Demissie M, Getahun H, Lindtjørn B
Centre for International Health, University of Bergen, Norway.
Soc Sci Med. 2003 May;56(10):2009-18. doi: 10.1016/s0277-9536(02)00182-x.
Non-compliance is a major problem in the treatment of tuberculosis (TB). This paper assesses the effectiveness of "TB clubs" in improving compliance with TB treatment and their impact in improving societal attitudes associated with TB. The study utilised both quantitative (cohort study) and qualitative (focus group discussion and an in-depth interview) methods. The cohort study was conducted in two rural districts of Northern Ethiopia. A total of 128 sputum positive pulmonary patients were enrolled and followed, 64 in the TB club and 64 in the comparison groups, to determine treatment outcome of anti-TB therapy. The impact of the TB clubs in changing societal attitudes and behaviour associated with TB was assessed using qualitative methods. The treatment completion rate was significantly better (X2=5.41, P<0.02) in the TB club group, 44 out of 64 patients (68.7%) completed treatment in TB club while only 30 of the 64 (46.8%) completed treatment in the comparison group. The defaulter rate was also significantly lower (X2=11.57, P<0.001) in the TB club group 8/64 (12.5%) compared to 26/64 (40.6%) in the comparison group. The qualitative part of the study also demonstrated remarkable changes in patients' understanding of TB, patients' initial reaction to a TB diagnosis, misconceptions as to the cause and treatment of TB, the social isolation and compliance and belief in the modern health care in the TB club area. The complementary results obtained from the quantitative and qualitative components of the study indicate that the TB club approach has a significant impact in improving patients' compliance to anti-TB treatment and in building positive attitudes and practice in the community regarding TB. This study, thus, provides convincing evidences that the TB club approach is useful in delivering TB treatment successfully in rural populations. Further large-scale studies are needed to find out whether this approach is applicable on a national scale and to other developing countries.
不遵守治疗规定是结核病治疗中的一个主要问题。本文评估了“结核病俱乐部”在提高结核病治疗依从性方面的有效性及其对改善与结核病相关的社会态度的影响。该研究采用了定量（队列研究）和定性（焦点小组讨论和深入访谈）方法。队列研究在埃塞俄比亚北部的两个农村地区进行。共招募并随访了128例痰涂片阳性的肺结核患者，其中64例在结核病俱乐部，64例在对照组，以确定抗结核治疗的结果。使用定性方法评估了结核病俱乐部在改变与结核病相关的社会态度和行为方面的影响。结核病俱乐部组的治疗完成率明显更高（X2 = 5.41，P < 0.02），64例患者中有44例（68.7%）在结核病俱乐部完成治疗，而对照组64例中只有30例（46.8%）完成治疗。结核病俱乐部组的违约率也明显更低（X2 = 11.57，P < 0.001），为8/64（12.5%），而对照组为26/64（40.6%）。该研究的定性部分还表明，在结核病俱乐部地区，患者对结核病的理解、患者对结核病诊断的初始反应、对结核病病因和治疗的误解、社会隔离以及对现代医疗保健的依从性和信念都有显著变化。从该研究的定量和定性部分获得的补充结果表明，结核病俱乐部方法在提高患者对抗结核治疗的依从性以及在社区中建立对结核病的积极态度和做法方面具有重大影响。因此，本研究提供了令人信服的证据，证明结核病俱乐部方法有助于在农村人口中成功提供结核病治疗。需要进一步进行大规模研究，以确定这种方法是否适用于全国范围以及其他发展中国家。
