Sisodia R S, Jain D K, Agarwal S S, Gupta Avdhesh
IMA, New Delhi 110029.
J Indian Med Assoc. 2011 Oct;109(10):742, 747-50.
Tuberculosis has been with mankind since time immemorial. No other disease has so much sociological, economic and health significance as tuberculosis. In the poorly functioning tuberculosis control programme, the ratio of incidence to prevalence may be as high as 1: 3.5. Experience and observations from both developed and developing countries have demonstrated that if case detection and cure rates in smear positive cases are consistently achieved to 70 % and 85 % respectively, the incidence would decline to 5% annually while prevalence decline very rapidly, being reduced to less than half of its previous level within three years. Since RNTCP India is based on scientific principles of DOTS strategy, its effective clinical and public health management, committed and co-ordinated efforts of public and private partners (IMA) would certainly lead to decline the prevalence (already declined from 586/1,00,000 in 1990 to 185/1,00,000 population in 2008 - 68 % reduction), mortality rate from 42/ 1,00,000 in 1990 to 21/1,00,000 in 2015 (already reduced to 24/1,00,000 in 2008 - 43 % reduction) as target set under indicator 23 of TB-related Millennium Development Goal. This kind of impact would result in halting and reversing TB Incidence to pave way for future effective control of TB, which may not remain a public health problem by 2050. Thus, TB control is a winnable battle.
结核病自古以来就一直伴随着人类。没有其他疾病像结核病这样具有如此重大的社会学、经济和健康意义。在运作不佳的结核病控制项目中，发病率与患病率之比可能高达1:3.5。发达国家和发展中国家的经验及观察结果表明，如果涂片阳性病例的病例发现率和治愈率分别持续达到70%和85%，发病率将以每年5%的速度下降，而患病率下降非常迅速，在三年内降至此前水平的一半以下。由于印度的国家结核病控制规划基于直接观察短程治疗（DOTS）策略的科学原则，其有效的临床和公共卫生管理，以及公共和私人合作伙伴（印度医学协会）的坚定且协调一致的努力，肯定会使患病率下降（已从1990年的586/10万降至2008年的185/10万人口——降低了68%），死亡率从1990年的42/10万降至2015年的21/10万（2008年已降至24/10万——降低了43%），这是结核病相关千年发展目标指标23设定的目标。这种影响将导致结核病发病率停止上升并实现逆转，为未来有效控制结核病铺平道路，到2050年结核病可能不再是一个公共卫生问题。因此，结核病控制是一场可以打赢的战斗。
