Salami A K, Oluboyo P O
Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
West Afr J Med. 2003 Jun;22(2):114-9. doi: 10.4314/wajm.v22i2.27928.
This study evaluates the management outcome of patients with pulmonary tuberculosis (PTB) over a nine year period. Essentially the cure rate, rate of default and fatality rate were all estimated. Factors predisposing to poor drug compliance were also reviewed.
This was conducted by analysing the medical records of all newly diagnosed cases of PTB. Patients' demographic data, their social and past medical histories were obtained from their records. The extents of the lung lesions were determined from their chest X-rays. Criteria were set to define those that were (a) cured, (b) defaulted (c) transferred (d) had treatment failure and (e) died. The chi-square test of significance was used to estimate the difference between those that were cured and those that defaulted therapy. Multiple regression models were used to determine the level of interplay among the various factors contributing to patients' poor therapy compliance; the best of these was recorded.
Out of the 1,741 cases of PTB treated over the studied period, 43.7% were cured, 0.3% had treatment failure, 44.2% defaulted therapy, 0.2% were transferred to other treatment centers while a fatality rate of 11.6% was recorded. Male gender, old age (> or =) 65 years), unmarried status, and previous default from therapy were found associated with poor therapy compliance. Others were unemployment, cigarette smoking and the use of alcohol.
The cure rate of PTB in this study was very low, while the rate of default from therapy was quite high. These are in contrast to WHO target for TB control. To improve on these, directly observed therapy short course (DOTS) strategy for treating TB has to be adopted and implemented at all our treatment points for PTB. There should be emphasis on the Primary health Care (PHC) centers, because majority of PTB patients are grass root people and PHC set-ups are closer to them.
本研究评估了九年期间肺结核（PTB）患者的治疗结果。主要对治愈率、违约率和死亡率进行了估算。还回顾了导致药物依从性差的因素。
通过分析所有新诊断的PTB病例的病历进行研究。从病历中获取患者的人口统计学数据、社会和既往病史。根据胸部X光片确定肺部病变的程度。设定标准来定义那些（a）治愈、（b）违约、（c）转诊、（d）治疗失败和（e）死亡的患者。使用卡方显著性检验来估计治愈患者和违约治疗患者之间的差异。使用多元回归模型来确定导致患者治疗依从性差的各种因素之间的相互作用水平；记录其中最佳模型。
在研究期间治疗的1741例PTB病例中，43.7%治愈，0.3%治疗失败，44.2%违约治疗，0.2%转诊至其他治疗中心，记录的死亡率为11.6%。发现男性、老年（≥65岁）、未婚状态以及既往违约治疗与治疗依从性差有关。其他因素包括失业、吸烟和饮酒。
本研究中PTB的治愈率非常低，而违约治疗率相当高。这些与世界卫生组织的结核病控制目标形成对比。为了改善这些情况，必须在我们所有的PTB治疗点采用并实施直接观察短程治疗（DOTS）策略。应强调初级卫生保健（PHC）中心，因为大多数PTB患者是基层民众，而PHC机构离他们更近。
