Karki Bindu, Kittel Guenter, Bolokon Ignatius, Duke Trevor
1 Charité-Universitätsmedizin Berlin, Berlin, Germany.
2 Lutheran Health Service, Etep, Morobe, Papua New Guinea.
Asia Pac J Public Health. 2017 Jan;29(1):17-27. doi: 10.1177/1010539516683497. Epub 2016 Dec 29.
Papua New Guinea is one of the 14 highest-burden countries for tuberculosis (TB) infection, but few community-based studies exist. We evaluated a low-cost method of active community case finding in Kabwum and Wasu in Morobe Province, Papua New Guinea. Over 3 months we visited 26 villages and screened adults and children for symptoms and signs of TB. Sputum samples were examined using smear microscopy. A total of 1700 people had chronic symptoms, of which 267 were suspicious for TB on further examination. Sputum from 230 symptomatic adults yielded 97 samples that were positive for acid-fast bacilli. In addition, 15 cases of extrapulmonary TB in adults and 17 cases of TB in children were identified. One hundred and thirty people were identified with active TB disease among the source population of approximately 17 000, giving an estimated prevalence of 765 per 100 000. One hundred and six (82%) cases were not previously diagnosed. The cost per case identified was US$146. It is feasible to conduct active community-based case finding and treatment initiation for TB with limited resources and in remote areas, and in Papua New Guinea the yield was high. Active case finding and follow-up of treatment in villages is needed to address the hidden burden of TB in Papua New Guinea and other high-burden Asia Pacific countries.
巴布亚新几内亚是结核病感染负担最高的14个国家之一，但基于社区的研究很少。我们评估了在巴布亚新几内亚莫罗贝省卡布武姆和瓦苏进行社区主动病例发现的低成本方法。在3个多月的时间里，我们走访了26个村庄，对成人和儿童进行结核病症状和体征筛查。痰标本采用涂片显微镜检查。共有1700人有慢性症状，其中267人经进一步检查怀疑患有结核病。230名有症状成人的痰液中有97份标本抗酸杆菌呈阳性。此外，还发现了15例成人肺外结核病例和17例儿童结核病例。在约17000人的源人群中，有130人被确诊患有活动性结核病，估计患病率为每10万人765例。其中106例（82%）此前未被诊断。发现每例病例的成本为146美元。在资源有限的偏远地区开展基于社区的结核病主动病例发现和治疗启动是可行的，在巴布亚新几内亚，检出率很高。需要在村庄开展主动病例发现和治疗随访，以解决巴布亚新几内亚和其他高负担亚太国家结核病的隐性负担问题。
