Medical University of Havana.
MEDICC Rev. 2011 Jul;13(3):29-34. doi: 10.37757/MR2011V13.N3.7.
Following a tripling of tuberculosis incidence in Cuba between 1991 and 1994 (from 4.7 to 14.7 per 100,000), the National TB Control Program was revamped in 1995 and the National Reference Center for Childhood TB and Provincial Childhood TB Commissions were created as a strategy for addressing this emerging health problem.
Assess the impact of Cuba's new strategy for TB control in children aged <15 years during the period 1995-2005.
A descriptive review of health services and systems was conducted in Cuba, examining 157 cases of TB diagnosed in children aged <15 years during the period 1995-2005 and comparing impact and process indicators for selected years (1995, 2000, and 2005). Impact indicators included reduction in: a) incidence; b) serious forms (peritoneal, meningeal, miliary, combined); c) mortality; and d) case outcomes (cure, death, treatment drop-out, treatment failure). Process indicators were proportion of cases with: a) microbiological tests; b) knowledge of infection source; c) diagnoses obtained through adult case contact tracing; d) time to diagnosis <60 days; and e) post-mortem diagnoses.
During the period 1995-2005, TB rates in children aged <15 years fell by 50% (from 1.0 to 0.5 per 100,000), more evident in children <10 years. The Havana rate was three times the national rate. Diagnosis was post-mortem in three serious cases (1.9%); there were four deaths (2.5%), none after 2000. Only seven children (4.5%) had serious forms, none after 2002. Except for cases diagnosed post-mortem, all children received treatment directly supervised by health personnel. Cure rate was 99.4%; there were no treatment drop-outs or chronic cases; one relapse was reported (0.6%). Knowledge of infection source increased to 90% over the selected years. Microbiological tests were conducted in 90% of cases, with isolation in 30.9%. No isolate was drug-resistant, nor were there reports of infectious contacts with resistance. We found no HIV coinfection. At the end of the study, time to diagnosis of ≥60 days persisted in 40% of cases.
Creation of a National Reference Center for Childhood TB and Provincial Childhood TB Commissions has contributed to improved TB diagnosis and control in children aged <15 years, achieving incidence similar to that during the period prior to TB re-emergence and to those of some developed countries. Improvements are needed in the work and systematic training of health personnel, especially at the primary health care level, in order to eliminate TB as a national health problem by 2015.
1991 年至 1994 年期间，古巴的结核病发病率增长了两倍（从每 10 万人 4.7 例增加到 14.7 例），因此，古巴于 1995 年对国家结核病控制规划进行了改革，并成立了国家儿童结核病防治中心和省级儿童结核病委员会，以此作为应对这一新兴健康问题的策略。
评估古巴 1995 年至 2005 年期间为控制儿童结核病而采取的新策略的效果。
对古巴的卫生服务和系统进行了描述性审查，对 1995 年至 2005 年期间确诊的 157 例 15 岁以下儿童结核病病例进行了分析，并比较了选择年份（1995 年、2000 年和 2005 年）的影响和过程指标。影响指标包括：a）发病率下降；b）严重形式（腹膜、脑膜、粟粒性、混合性）下降；c）死亡率下降；d）病例结局（治愈、死亡、治疗中断、治疗失败）改善。过程指标包括：a）微生物学检查的比例；b）感染源知识的比例；c）通过成人病例接触追踪获得诊断的比例；d）诊断时间<60 天的比例；e）尸检诊断的比例。
1995 年至 2005 年期间，15 岁以下儿童结核病发病率下降了 50%（从每 10 万人 1.0 例降至 0.5 例），10 岁以下儿童的降幅更为明显。哈瓦那的发病率是全国平均水平的三倍。3 例严重病例（1.9%）是尸检诊断；有 4 人死亡（2.5%），均发生在 2000 年以后。只有 7 名儿童（4.5%）患有严重形式的结核病，均发生在 2002 年以后。除了尸检诊断的病例外，所有儿童都接受了卫生人员直接监督的治疗。治愈率为 99.4%；没有治疗中断或慢性病例；有 1 例复发（0.6%）。感染源知识在选择的年份中增加到 90%。90%的病例进行了微生物学检查，其中 30.9%有分离培养。没有发现耐药菌株，也没有报告具有耐药性的传染性接触者。我们没有发现 HIV 合并感染。研究结束时，仍有 40%的病例诊断时间≥60 天。
成立国家儿童结核病防治中心和省级儿童结核病委员会有助于改善 15 岁以下儿童的结核病诊断和控制，使发病率达到结核病再次出现前的水平，并与一些发达国家相当。需要改进卫生人员的工作和系统培训，特别是在初级卫生保健层面，以便到 2015 年消除结核病这一国家卫生问题。
