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从印度阿格拉市一个城市贫民窟环境中开展的活动性肺结核病例发现工作中吸取的经验教训。

Lessons learnt from active tuberculosis case finding in an urban slum setting of Agra city, India.

作者信息

Prasad Banuru Muralidhara, Satyanarayana Srinath, Chadha Sarabjit Singh

机构信息

The International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.

The International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.

出版信息

Indian J Tuberc. 2016 Jul;63(3):199-202. doi: 10.1016/j.ijtb.2016.08.006. Epub 2016 Sep 9.

DOI:10.1016/j.ijtb.2016.08.006
PMID:27865243
Abstract

Active case finding (ACF) is recognized as one of the key strategies to reach the missing 3 million cases in high tuberculosis (TB) burden countries. In India, we conducted ACF as a pilot project to assess its operational feasibility in four slums of Agra city in 2012 and covered 3940 households (in 14 wards) with a population of 21,870. Trained community volunteers visited households with an intention to provide information on TB and refer those with cough ≥2 weeks for sputum smear examination. Volunteers identified 8 persons with cough of ≥2 weeks by asking the first or the main respondent of the household. However, by directly asking (or probing) all available members of the household, they identified 374 persons with cough of ≥2 weeks. All 382 persons with cough of ≥2 weeks were referred for sputum smear examination. While 40% of those referred reached health facilities for sputum examination on their own, 60% had to be accompanied by the community volunteers to the health facility for sputum smear examination by Ziehl-Neelsen staining method. Eventually, seven persons were found to be sputum smear positive. This study highlighted important aspects for implementing ACF: First, all household members have to be asked for TB symptoms and Second, mere referral for sputum examination is not enough and there is a need to support people to reach the health facility for sputum smear examination.

摘要

主动病例发现(ACF)被认为是在结核病高负担国家发现遗漏的300万病例的关键策略之一。在印度,我们于2012年在阿格拉市的四个贫民窟开展了ACF试点项目,以评估其操作可行性,覆盖了3940户家庭(分布在14个选区),人口为21870人。经过培训的社区志愿者走访家庭,目的是提供结核病相关信息,并将咳嗽≥2周的人转介进行痰涂片检查。志愿者通过询问家庭的第一或主要受访者,识别出8名咳嗽≥2周的人。然而,通过直接询问(或探查)家庭中的所有可用成员,他们识别出374名咳嗽≥2周的人。所有382名咳嗽≥2周的人都被转介进行痰涂片检查。虽然40%被转介的人自行前往医疗机构进行痰检,但60%的人必须由社区志愿者陪同前往医疗机构,采用萋-尼氏染色法进行痰涂片检查。最终,发现7人痰涂片呈阳性。这项研究突出了实施ACF的重要方面:第一,必须询问所有家庭成员的结核病症状;第二,仅仅转介进行痰检是不够的,需要支持人们前往医疗机构进行痰涂片检查。

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