Clarke M, Dick J, Zwarenstein M, Diwan V
Department of Public Health Sciences, Division of International Health (IHCAR), Karilinska Institutet, Stockholm, Sweden.
Curationis. 2003 Dec;26(4):66-71. doi: 10.4102/curationis.v26i4.885.
This study was conducted in the Boland health district of the Cape Winelands of South Africa where there is a high tuberculosis incidence and prevalence. A survey conducted on 211 farms in the study district during 1998, reported that 65% (n = 9042) of all workers on these farms, were temporarily employed. Temporary farm workers live in communities either within or the outskirts of the boundaries of the Boland health district, from where they are transported to work daily.
To estimate the point prevalence of sputum smear-positive tuberculosis among temporary farm workers in the Boland health district, and to determine whether temporary farm workers diagnosed with tuberculosis, have access to anti-tuberculosis treatment.
The study took the form of a cross-sectional active case finding survey amongst adult temporary farm workers (not living on farms) on the four study farms in the Boland health district.
Data was analysed using the Epi Info Version 6 computer programme. Four (4) existing (self-reported) tuberculosis cases were identified and six (6) previously undiagnosed new sputum smear-positive cases of tuberculosis were detected. The total point prevalence was 10 cases of tuberculosis in the cohort of temporary farm workers, resulting in a point prevalence rate of 2,809 cases per 100,000 temporary farm workers (95% CI 1,090-4,527). If the four (4) self-reported cases of tuberculosis are excluded in the calculation, the point prevalence of new sputum smear-positive tuberculosis cases is six (6) and the prevalence rate 1,685 cases per (95% CI 468-2909). Of the four self-reported tuberculosis cases, one indicated that their supply of medication was depleted, whereas the other three indicated that they had the required treatment at home.
Tuberculosis is a major health problem in this region of South Africa and the incidence is projected to increase in correlation with the increasing prevalence of HIV/AIDS. Recent legislative changes in South Africa have resulted in a trend where farmers decrease their permanent work force and increase their use of a temporary work force. The nature of temporary employment in the agricultural industry creates potential difficulties for farm workers to access tuberculosis health care. The early detection and effective case management of this high-risk group presents a special challenge to the South African health community.
本研究在南非开普葡萄酒乡的博兰卫生区开展，该地区结核病发病率和患病率较高。1998年对研究区内211个农场进行的一项调查显示，这些农场所有工人中有65%（n = 9042）为临时工。临时农场工人居住在博兰卫生区边界内或周边的社区，他们每天从那里被运送至农场工作。
估计博兰卫生区临时农场工人中痰涂片阳性结核病的现患率，并确定被诊断为结核病的临时农场工人是否能获得抗结核治疗。
本研究采用横断面主动病例发现调查的形式，对博兰卫生区四个研究农场的成年临时农场工人（不住在农场）进行调查。
使用Epi Info 6版计算机程序对数据进行分析。共识别出4例（自我报告的）现有结核病病例，并检测到6例之前未被诊断出的新的痰涂片阳性结核病病例。在临时农场工人队列中，结核病的总现患率为10例，现患率为每100,000名临时农场工人中有2,809例（95%可信区间1,090 - 4,527）。如果在计算中排除4例自我报告的结核病病例，新的痰涂片阳性结核病病例的现患率为6例，患病率为每100,000名中有1,685例（95%可信区间468 - 2909）。在4例自我报告的结核病病例中，1例表示其药物供应已耗尽，而其他3例表示他们在家中接受了所需治疗。
结核病是南非该地区主要的健康问题，预计其发病率将随着艾滋病毒/艾滋病患病率的上升而增加。南非最近的立法变化导致了一种趋势，即农场主减少其长期劳动力，增加对临时劳动力的使用。农业行业临时就业的性质给农场工人获得结核病医疗保健带来了潜在困难。对这一高危人群的早期发现和有效的病例管理对南非卫生界提出了特殊挑战。
