Muniyandi M, Ramachandran R, Balasubramanian R, Narayanan P R
Tuberculosis Research Center (ICMR), Mayor V R Ramanathan Road, Chetput, Chennai, India 600 031.
J Commun Dis. 2006 Mar;38(3):204-15.
Tuberculosis (TB) affects the most productive age group and the resultant economic cost for society is high. Even though diagnostic and treatment services under TB control are offered free of cost, TB patients do incur out of pocket expenditure. Tuberculosis Research Centre under took a series of studies on economic aspects of TB. We interviewed TB patients enrolled under TB control programme in south India, and assessed the following: socio-economic status of patients (SLI - standard of living index) and economic impact on patients, families both before and after Revised TB Control Programme (RNTCP) and the impact of parental TB on children. In addition patient's perceptions of physical, mental, social well being during and after completion of treatment were also elicited. A TB patient incurs out of pocket expenditure of Rs 5986 amounting to about 13,000 crores a year for the country; 11% of children dropped out of school on account of parental illness and 20% of the children had to take up employment in order to supplement income especially if the father had TB. About 64% of TB patients registered under RNTCP were poor (low SLI). The provider cost to treat a TB patient under RNTCP was Rs 1587/- for Category I, Rs 1924/- for Category II and Rs 1417/- Category III. At the end of treatment even though 47% of patients continued to have respiratory symptoms, 54% of patients perceived 'happy mental status'. Majority of the patients registered under RNTCP were poor. Patients' and provider costs and the impact on patients including families on account of TB were enormous. About half of TB patients, despite completing treatment successfully had persistent respiratory ill health resulting in frequenting health facilities. This information is vital for programme planners indicating that the existing control programs have been ineffective. To achieve success in control programs, the existing ones should be amended as there is evolution of resistance in the parasite as well as the vector. Public health education, to make the people aware about preventive aspects of the disease is important. The possibility of the existence of animal reservoirs should also be considered and checked out for better control measures.
结核病（TB）影响的是最具生产力的年龄组，给社会带来的经济成本很高。尽管结核病控制项目下的诊断和治疗服务是免费提供的，但结核病患者仍需自掏腰包支出费用。结核病研究中心对结核病的经济方面进行了一系列研究。我们采访了印度南部结核病控制项目登记在册的结核病患者，并评估了以下内容：患者的社会经济状况（生活水平指数——SLI）以及结核病对患者及其家庭在修订后的结核病控制项目（RNTCP）实施前后的经济影响，还有父母患结核病对子女的影响。此外，还了解了患者在治疗期间及治疗结束后对身体、心理和社会幸福感的认知。一名结核病患者每年自掏腰包支出5986卢比，全国每年总计约1.3万亿卢比；11%的儿童因父母患病而辍学，20%的儿童不得不就业以补贴家庭收入，尤其是父亲患结核病的家庭。在RNTCP登记的结核病患者中，约64%为贫困人口（低SLI）。在RNTCP下治疗一名结核病患者，第一类患者的医疗服务提供者成本为1587卢比，第二类为1924卢比，第三类为1417卢比。治疗结束时，尽管47%的患者仍有呼吸道症状，但54%的患者认为自己“心理状态良好”。在RNTCP登记的患者大多数是贫困人口。结核病给患者及其家庭带来的患者成本和医疗服务提供者成本以及影响是巨大的。约一半的结核病患者尽管成功完成了治疗，但仍持续存在呼吸道健康问题，导致频繁前往医疗机构。这些信息对项目规划者至关重要，表明现有的控制项目效果不佳。为了在控制项目中取得成功，由于寄生虫和传播媒介产生了抗药性，应修订现有项目。开展公共卫生教育，让人们了解该疾病的预防知识很重要。还应考虑动物宿主存在的可能性并进行排查，以采取更好的控制措施。
