埃塞俄比亚西北部东戈贾姆地区的结核感染源及相关因素。
Tuberculosis infectious pool and associated factors in East Gojjam Zone, Northwest Ethiopia.
机构信息
School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Microbiology, Unit for Genome Dynamics, Faculty of Medicine, University of Oslo, Oslo, Norway.
出版信息
BMC Pulm Med. 2019 Nov 29;19(1):229. doi: 10.1186/s12890-019-0995-3.
BACKGROUND
Globally, tuberculosis (TB) lasts a major public health concern. Using feasible strategies to estimate TB infectious periods is crucial. The aim of this study was to determine the magnitude of TB infectious period and associated factors in East Gojjam zone.
METHODS
An institution-based prospective study was conducted among 348 pulmonary TB (PTB) cases between December 2017 and December 2018. TB cases were recruited from all health facilities located in Hulet Eju Enesie, Enebse Sarmider, Debay Tilatgen, Dejen, Debre-Markos town administration, and Machakel districts. Data were collected through an exit interview using a structured questionnaire and analyzed by IBM SPSS version25. The TB infectious period of each patient category was determined using the TB management time and sputum smear conversion time. The sum of the infectious period of each patient category gave the infectious pool of the study area. A multivariable logistic regression analysis was used to identify factors associated with the magnitude of TB infectious period.
RESULTS
Of the total participated PTB cases, 209(60%) were male, 226(65%) aged < 30 years, 205(59%) were from the rural settings, and 77 (22%) had comorbidities. The magnitude of the TB infectious pool in the study area was 78,031 infectious person-days. The undiagnosed TB cases (44,895 days), smear-positive (14,625 days) and smear-negative (12,995 days) were major contributors to the infectious pool. The overall average median TB management time was 142.4 days (IQR, 98-238 days). Similarly, the average sputum smear conversion time of PTB cases (new and repeat) was 46 days. Residence, knowledge, form of TB, smoking, alcohol history, distance from the facility, comorbidity history and stigma were statistically significant factors TB infectious period (p-value< 0.05).
CONCLUSIONS
The magnitude of the TB infectious pool is high even if it is lower than the findings of previous studies. This might be an indicator of poor access to TB services, service delays, low community awareness, impaired facility readiness, and poor transportation. Improving personal awareness and behavior, timely management of commodities, and using the TB management time in TB control are crucial to improving TB control activities.
背景
在全球范围内，结核病（TB）仍是一个重大的公共卫生关注点。采用可行的策略来估计结核病的传染期至关重要。本研究旨在确定东戈贾姆地区结核病传染期的规模及其相关因素。
方法
这是一项于 2017 年 12 月至 2018 年 12 月期间在 348 例肺结核（PTB）病例中开展的基于机构的前瞻性研究。从位于 Hulet Eju Enesie、Enebse Sarmider、Debay Tilatgen、Dejen、Debre-Markos 镇行政和 Machakel 区的所有卫生机构招募结核病病例。通过使用结构化问卷进行的出院面谈收集数据，并使用 IBM SPSS 版本 25 进行分析。使用结核病管理时间和痰涂片转换时间确定每个患者类别的结核病传染期。每个患者类别的传染期总和构成了研究区域的传染池。采用多变量逻辑回归分析确定与结核病传染期规模相关的因素。
结果
在参与的肺结核病例中，209 例（60%）为男性，226 例（65%）年龄<30 岁，205 例（59%）来自农村地区，77 例（22%）有合并症。研究区域的结核病传染池规模为 78031 人日。未确诊的结核病病例（44895 人日）、涂片阳性（14625 人日）和涂片阴性（12995 人日）是传染池的主要贡献者。总体平均中位数结核病管理时间为 142.4 天（IQR，98-238 天）。同样，新和复治肺结核病例的平均痰涂片转换时间为 46 天。居住地、知识、结核病形式、吸烟、饮酒史、与机构的距离、合并症史和耻辱感是结核病传染期的统计学显著因素（p 值<0.05）。
结论
即使低于之前研究的发现，结核病传染池的规模仍然很高。这可能表明结核病服务的获取不足、服务延迟、社区意识低下、机构准备不足和交通条件差。提高个人意识和行为、及时管理商品以及在结核病控制中使用结核病管理时间对于改善结核病控制活动至关重要。
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