Tang Shenglan, Squire Stephen Bertel
International Health Research Group of Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
Health Policy. 2005 Apr;72(1):93-104. doi: 10.1016/j.healthpol.2004.06.009.
China has made a significant achievement in tackling the TB epidemic over the last decade, due largely to the implementation of directly-observed treatment strategy (DOT). The cure rate of TB cases reached more than 90% for registered TB patients. However, the case detection rate has, unfortunately, been very low (some 30%). Using available information, this paper identifies four main problems facing TB control in China, these are, low case finding, a substantial proportion of TB patients failing to complete standardised treatment, increased proportion of MDR TB patients, and lack of effective TB control among "floating populations". The paper also analyses the possible causes of these problems associated with socio-economic barriers in care seeking, ineffectiveness of TB services, particularly in poor areas, lack of co-operation between health facilities, and weakness of political and financial commitments of local governments to TB control. The paper ends with the discussion of opportunities and challenges facing TB control and makes recommendations for further actions and research.
在过去十年中，中国在结核病防治方面取得了显著成就，这在很大程度上归功于直接观察治疗策略（DOT）的实施。登记在册的结核病患者治愈率达到了90%以上。然而，遗憾的是，病例发现率一直很低（约30%）。利用现有信息，本文确定了中国结核病控制面临的四个主要问题，即病例发现率低、相当一部分结核病患者未能完成标准化治疗、耐多药结核病患者比例增加以及“流动人口”中缺乏有效的结核病控制。本文还分析了这些问题的可能原因，这些原因与寻求医疗服务时的社会经济障碍、结核病服务无效（特别是在贫困地区）、卫生机构之间缺乏合作以及地方政府对结核病控制的政治和财政承诺薄弱有关。本文最后讨论了结核病控制面临的机遇和挑战，并为进一步行动和研究提出了建议。
