Rubel A J, Garro L C
Department of Family Medicine, University of California, Irvine, Orange 92613-1491.
Public Health Rep. 1992 Nov-Dec;107(6):626-36.
The burden of tuberculosis on the public health is staggering. Worldwide, annual incidence of new cases is estimated to be about 8 million. Almost 3 million deaths occur yearly. Early case identification and adherence to treatment regimens are the remaining barriers to successful control. In many nations, however, fewer than half those with active disease receive a diagnosis, and fewer than half those beginning treatment complete it. The twin problems of delay in seeking treatment and abandonment of a prescribed regimen derive from complex factors. People's confusion as to the implications of the tuberculosis symptoms, costs of transportation to clinic services, the social stigma that attaches to tuberculosis, the high cost of medication, organizational problems in providing adequate followup services, and patients' perception of clinic facilities as inhospitable all contribute to the complexity. Sociocultural factors are emphasized in this report because hitherto they have not been adequately explored. Salient among those sociocultural factors is the health culture of the patients. That is, the understanding and information people have from family, friends, and neighbors as to the nature of a health problem, its cause, and its implications. A knowledge of the health culture of their patients has become a critical tool if tuberculosis control programs are to be successful. Several anthropological procedures are recommended to help uncover the health culture of people served by tuberculosis clinics.
结核病对公共卫生造成的负担惊人。在全球范围内，估计每年新增病例约800万。每年有近300万人死亡。早期病例识别和坚持治疗方案仍是成功控制结核病的障碍。然而，在许多国家，患有活动性疾病的人中不到一半得到诊断，开始治疗的人中不到一半完成治疗。寻求治疗延迟和放弃规定治疗方案这两个问题源于复杂的因素。人们对结核病症状的影响感到困惑、前往诊所就医的交通费用、结核病所带来的社会耻辱感、药物的高昂成本、提供充分后续服务方面的组织问题，以及患者认为诊所设施不友好，所有这些都导致了情况的复杂性。本报告强调社会文化因素，因为迄今为止它们尚未得到充分探讨。这些社会文化因素中突出的是患者的健康文化。也就是说，人们从家人、朋友和邻居那里获得的关于健康问题的性质、原因及其影响的理解和信息。如果结核病控制项目要取得成功，了解患者的健康文化已成为一项关键工具。建议采用几种人类学方法来帮助揭示结核病诊所服务对象的健康文化。
