Collazos Constanza, Carrasquilla Gabriel, Ibáñez Milcíades, López Lilia Edith
Centro de Estudios e Investigación en Salud, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
Biomedica. 2010 Oct-Dec;30(4):519-29.
One of the greatest challenges in tuberculosis control is the early detection of cases. Detection is hindered by low level of active search for respiratory symptoms by health consultants and the small number of tubercular smear tests ordered by health personnel.
The prevalence of individuals with respiratory symptoms was estimated in Bogotá Health Service Institutions, along with the proportion of those receiving diagnostic baciloscopies (smear or culture tests).
A cross sectional survey was carried out in 113 health service institutions located in the city of Bogotá, involved 3,170 users and covered a 10-month period between June 2005 and March 2006. Sampling design was based on a probabilistic, stratified, multistage, cluster-without-replacement strategy. A telephone follow-up and review of laboratory registers was done to identify symptomatic individuals for whom baciloscopy was requested.
The prevalence of symptomatic individuals was 7.5% (95%CI 6.4-8.6%). A higher prevalence occurred in public institutions, 9.5% (95%CI 8.0-10.9%), in institutions of first level, 8.6% (95%CI 7.4-9.8), in persons ≥ 60 years of age 15.8% (95%CI 12.4-19.2%) and in health users with social security, 7.6% (95% CI 6.4-8.7%). In 47% of symptomatic cases, a baciloscopic procedures were not ordered.
The study updated the prevalence ofrespiratory symptomatic individuals in Colombia and due to the large sample size (and small confidence interval), inferences can be generalized to the entire health service system in Bogotá. The current tuberculosis program goals in Bogotá require adjustment based on the current prevalence of 7.5% compared with a 1977 estimate of 10%.. The study recommends an awareness program for physicians to use TB diagnostic tests in suspect cases.
结核病控制面临的最大挑战之一是病例的早期发现。健康咨询人员对呼吸道症状的主动筛查水平较低以及卫生人员所安排的结核涂片检查数量较少，阻碍了病例的发现。
估计波哥大卫生服务机构中出现呼吸道症状的个体的患病率，以及接受诊断性细菌学检查（涂片或培养检查）的个体比例。
在波哥大市的113家卫生服务机构中开展了一项横断面调查，涉及3170名使用者，调查涵盖2005年6月至2006年3月的10个月期间。抽样设计基于概率性、分层、多阶段、无放回整群抽样策略。通过电话随访和查阅实验室登记记录，以确定被要求进行细菌学检查的有症状个体。
有症状个体的患病率为7.5%（95%置信区间6.4 - 8.6%）。在公共机构中患病率较高，为9.5%（95%置信区间8.0 - 10.9%），在一级机构中为8.6%（95%置信区间7.4 - 9.8%）；在60岁及以上人群中为15.8%（95%置信区间12.4 - 19.2%），在有社会保障的卫生服务使用者中为7.6%（95%置信区间6.4 - 8.7%）。在47%的有症状病例中，未安排细菌学检查程序。
该研究更新了哥伦比亚有呼吸道症状个体的患病率，并且由于样本量较大（以及置信区间较小），所得推论可推广至波哥大的整个卫生服务系统。与1977年估计的10%相比，波哥大目前结核病规划目标需根据当前7.5%的患病率进行调整。该研究建议开展一项针对医生的宣传项目，以便在疑似病例中使用结核病诊断检测。
