Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
National TB Programme, Department of Public Health, Nay Pi Taw, Myanmar.
BMC Public Health. 2020 Jun 18;20(1):957. doi: 10.1186/s12889-020-09090-w.
The comorbid presence of tuberculosis and diabetes mellitus has become an increasingly important public health threat to the prevention and control of both diseases. Thus, household contact investigation may serve a dual purpose of screening for both tuberculosis and diabetes mellitus among household contacts. We therefore aimed to evaluate the coverage of screening for tuberculosis and diabetes mellitus among household contacts of tuberculosis index cases and to determine predictors of tuberculosis screening.
A household-based survey was conducted in February 2019 in Muang district of Phatthalung Province, Thailand where 95 index tuberculosis patients were newly diagnosed with pulmonary or pleural tuberculosis between October 2017 and September 2018. Household contacts of the index patients were interviewed using a structured questionnaire to ascertain their past-year history of tuberculosis screening and, if appropriate, diabetes mellitus screening. For children, the household head or an adult household member was interviewed as a proxy. Coverage of tuberculosis screening at the household level was regarded as households having all contacts screened for tuberculosis. Logistic regression and mixed-effects logistic regression models were used to determine predictors of tuberculosis screening at the household and individual levels, respectively, with the strengths of association presented as adjusted odds ratios (AOR) and 95% confidence intervals (CI).
Of 61 responding households (64%), complete coverage of tuberculosis screening at the household level was 34.4% and among the 174 household contacts was 46.6%. About 20% of contacts did not receive any recommendation for tuberculosis screening. Households were more likely to have all members screened for tuberculosis if they were advised to be screened by a healthcare professional rather than someone else. At the individual level, contacts aged ≥35 years (AOR: 30.6, 95% CI: 2.0-466.0), being an employee (AOR: 0.1, 95% CI: 0.0-0.8) and those who had lived more than 5 years in the same household (AOR: 0.1, 95% CI: 0.0-0.8) were independent predictors for tuberculosis screening. Coverage of diabetes mellitus screening was 80.6% with lack of awareness being the main reason for not being screened.
Compared to diabetes screening, the coverage of tuberculosis screening was low. A better strategy to improve coverage of tuberculosis contact screening is needed.
结核病和糖尿病合并存在已成为预防和控制这两种疾病的一个日益严重的公共卫生威胁。因此，家庭接触者调查可能具有双重目的，即在家庭接触者中筛查结核病和糖尿病。因此，我们旨在评估在结核病指数病例的家庭接触者中筛查结核病和糖尿病的覆盖面，并确定结核病筛查的预测因素。
2019 年 2 月，在泰国攀牙府 Mueang 区进行了一项基于家庭的调查，该地区在 2017 年 10 月至 2018 年 9 月期间新诊断出 95 例肺或胸膜结核的指数肺结核患者。使用结构化问卷对家庭接触者进行访谈，以确定他们过去一年的结核病筛查情况，如果需要，还进行糖尿病筛查。对于儿童，由家庭负责人或成年家庭成员作为代理进行访谈。家庭层面的结核病筛查覆盖率被视为所有接触者均接受结核病筛查的家庭。使用逻辑回归和混合效应逻辑回归模型分别确定家庭和个体层面结核病筛查的预测因素，关联强度表示为调整后的优势比（AOR）和 95%置信区间（CI）。
在 61 个回应家庭（64%）中，家庭层面结核病筛查的完全覆盖率为 34.4%，174 名家庭接触者的覆盖率为 46.6%。约 20%的接触者未收到任何结核病筛查建议。如果家庭接触者是由医疗保健专业人员而不是其他人建议进行筛查，则更有可能对所有成员进行结核病筛查。在个体层面上，年龄≥35 岁的接触者（AOR：30.6，95%CI：2.0-466.0）、雇员（AOR：0.1，95%CI：0.0-0.8）和在同一家庭居住超过 5 年的接触者（AOR：0.1，95%CI：0.0-0.8）是结核病筛查的独立预测因素。糖尿病筛查的覆盖率为 80.6%，未意识到是未进行筛查的主要原因。
与糖尿病筛查相比，结核病筛查的覆盖率较低。需要采取更好的策略来提高结核病接触者筛查的覆盖率。
