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一种结核病合并糖尿病的综合管理方法：孟加拉国卫生机构的提供情况和准备情况。

An approach to integrated management of diabetes in tuberculosis patients: Availability and readiness of the health facilities of Bangladesh.

机构信息

Pi Research Consultancy Center, Dhaka, Bangladesh.

M Abdur Rahim Medical College, Dianjpur, Bangladesh.

出版信息

PLoS One. 2024 Aug 26;19(8):e0309372. doi: 10.1371/journal.pone.0309372. eCollection 2024.

DOI:10.1371/journal.pone.0309372

PMID:39186706

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11346952/

Abstract

BACKGROUND

Comorbidity of diabetes mellitus and tuberculosis (TB) is a major public health concern in low- and middle-income countries including Bangladesh. An integrated approach is required for adequate management of diabetes mellitus and TB. The objective of the present study was to investigate the availability and readiness of the TB care centers of Bangladesh toward diabetic patients' management.

METHODS

The present study was conducted based on existing data obtained from the Bangladesh Health Facility Survey (BHFS) 2017. Data collected from a total of 303 facilities providing TB services were retrieved. The outcome variables of the present study were availability and readiness of the TB health facilities for providing diabetes mellitus service. Readiness was measured for four domains: staff and guidelines, equipment, diagnostic facility and basic medicine. The independent variables were: facility level, management authority and location of the facility. Binary and multiple logistic regression models were constructed for both the outcome variables (availability and readiness) to find out their predictors.

RESULTS

Services for diabetes mellitus were available in 68% of the TB facilities while high readiness was present in 36% of the facilities. For domain-specific readiness index, readiness for the domains of staff and guidelines, equipment, diagnostic facility and basic medicine was reported in 46%, 96%, 38% and 25% facilities respectively. In the logistic regression model, availability of diabetes mellitus services was better in primary level (aOR 2.62, 95% CI 1.78-4.77) and secondary level (aOR 3.26, 95% CI 1.82-9.05) facilities than community facilities. Similarly, readiness of diabetes mellitus care was also better in these facilities (aOR 2.55, 95% CI 1.05-4.71 for primary and aOR 2.75, 95% CI 1.80-4.32 for secondary facilities). Besides, private TB facilities had better availability (aOR 2.84, 95% CI 1.75-5.89) and readiness (aOR 2.52, 95% CI 1.32-4.29) for diabetes mellitus care.

CONCLUSION

Availability and readiness for providing diabetes mellitus services in TB care providing facilities in Bangladesh is inadequate.

摘要

背景

糖尿病和结核病（TB）合并症是包括孟加拉国在内的低收入和中等收入国家的主要公共卫生问题。需要采取综合方法来充分管理糖尿病和结核病。本研究的目的是调查孟加拉国的结核病护理中心在管理糖尿病患者方面的可用性和准备情况。

方法

本研究基于 2017 年孟加拉国卫生设施调查（BHFS）获得的现有数据进行。共从 303 家提供结核病服务的设施中检索到数据。本研究的结果变量是结核病卫生设施提供糖尿病服务的可用性和准备情况。准备情况通过四个领域进行衡量：人员和指南、设备、诊断设施和基本药物。独立变量是：设施级别、管理权限和设施位置。对两个结果变量（可用性和准备情况）构建二项和多项逻辑回归模型，以找出其预测因素。

结果

68%的结核病设施提供糖尿病服务，而 36%的设施具有较高的准备水平。就特定领域的准备指数而言，人员和指南、设备、诊断设施和基本药物的准备情况分别在 46%、96%、38%和 25%的设施中报告。在逻辑回归模型中，初级（aOR 2.62，95%CI 1.78-4.77）和二级（aOR 3.26，95%CI 1.82-9.05）设施提供糖尿病服务的可用性均优于社区设施。同样，这些设施的糖尿病护理准备情况也更好（初级设施的 aOR 2.55，95%CI 1.05-4.71；二级设施的 aOR 2.75，95%CI 1.80-4.32）。此外，私立结核病设施提供糖尿病护理的可用性（aOR 2.84，95%CI 1.75-5.89）和准备情况（aOR 2.52，95%CI 1.32-4.29）更好。