Bernatas J J, Ali I M, Ismaël H A, Matan A B, Aboubakar I H
National Tuberculosis Programme, Ministry of Health, Djibouti, Djibouti.
Int J Tuberc Lung Dis. 2003 Aug;7(8):724-9.
Decentralisation of directly observed treatment (DOT) for tuberculosis patients in three public centres in Djibouti city from April 2000.
To evaluate decentralisation based on the success rate by site of treatment and according to certain critical variables.
Comparative evaluation of the success rate of smear-positive patients followed in all treatment centres from 1 May 2000 to 31 March 2001.
The success rate was 58% for the main centre, Centre Paul Faure, and 81% for all the peripheral centres together (P < 10.6). It was 80% for the three new centres and 85% for the established centres (P > 0.05). Age under 20 years, female sex and treatment centre were factors linked to success. After stratification, sex was shown to be the confounding variable. Multivariate analysis shows that non-Djibouti nationality is related to treatment success (P = 0.02). In the groups of established and new centres, there is an inverse linear relationship between success rate and workload, with greater capacity in the established centres.
Urban decentralisation of DOT increases the chances of treatment success among smear-positive patients. Another centre for supervised treatment needs to be created in one of the public health centres in Djibouti city.
2000年4月起，吉布提市三个公共中心对结核病患者的直接观察治疗（DOT）实行去中心化管理。
根据治疗地点及某些关键变量评估去中心化管理的效果。
对2000年5月1日至2001年3月31日期间所有治疗中心的涂片阳性患者的成功率进行比较评估。
主要中心保罗·富尔中心的成功率为58%，所有周边中心的成功率总计为81%（P < 10.6）。三个新中心的成功率为80%，已设立中心的成功率为85%（P > 0.05）。20岁以下、女性及治疗中心是与成功相关的因素。分层后，性别被证明是混杂变量。多变量分析表明，非吉布提国籍与治疗成功相关（P = 0.02）。在已设立中心和新中心组中，成功率与工作量呈负线性关系，已设立中心的能力更强。
城市DOT去中心化管理增加了涂片阳性患者治疗成功的机会。需要在吉布提市的一个公共卫生中心设立另一个督导治疗中心。
