Auregan G, Rakotomanana F, Ratsitorahina M, Rakotoniaina N, Rabemananjara O, Raharimanana R, Boisier P
Institut d'Hygiène Sociale, Service Tuberculose-Lèpre, Antananarivo, Madagascar.
Arch Inst Pasteur Madagascar. 1995;62(1):18-23.
Within 42 months, from June 1990 to December 1993, 454 cases of tuberculosis have been recorded in the central remand home of Antananarivo. The tubercular prevalence observed was there eight times superior to that of the global population of Madagascar. Among the 360 pulmonary tuberculosis, only one did not have any bacteriological proof; among the 94 extrapulmonary tuberculosis, 37 have been proved by histology or bacteriology. Among the extrapulmonary tuberculosis, pleurisies were obviously preeminent (79/94). Association of tubercular localizations could be observed with 21% of the patients. New cases of smear-positive pulmonary tuberculosis (PMT+) represented 81% of all the PMT+, recurrences were 9% and revivals 10%. Since February 1991, the 8 months short course regimen was the standard applied; before, the lack of stock did not allowed any standardization. The PMT+ new cases recovery rate increased from 42.5% in 1990 to 74% in 1993, whereas lethality decreased from 23% in 1990 to 8% in 1993. Patient dropouts were noted only with released or escaped individuals. Treatment failure rate was 4%. The diminution of cases despite the constancy of prisoners number and the carrying out of activities by the same health team make questionable the explanatory factors of the burst of tuberculosis-diseases in a prison milieu. Because of the importance of prison tubercular foci in terms of public health and the satisfactory results obtained, the Programme proposes to apply the model of partnership developed between the Tonga soa NGO and the prison administration to other prisons in Madagascar.
在1990年6月至1993年12月的42个月内，塔那那利佛中央还押中心记录了454例结核病病例。该中心观察到的结核病患病率是马达加斯加全球人口患病率的八倍。在360例肺结核病例中，只有1例没有任何细菌学证据；在94例肺外结核病例中，37例已通过组织学或细菌学得到证实。在肺外结核中，胸膜炎明显占多数（79/94）。21%的患者可观察到结核病变部位的关联。涂片阳性肺结核新病例（PMT+）占所有PMT+病例的81%，复发率为9%，复燃率为10%。自1991年2月以来，8个月短程化疗方案成为标准治疗方案；在此之前，由于药品短缺无法实现任何标准化。PMT+新病例的治愈率从1990年的42.5%提高到1993年的74%，而死亡率从1990年的23%降至1993年的8%。仅在获释或逃脱的人员中出现患者退出治疗的情况。治疗失败率为4%。尽管囚犯人数保持不变且由同一卫生团队开展活动，但病例数仍有所减少，这使得对监狱环境中结核病爆发的解释因素产生了疑问。鉴于监狱结核病灶对公共卫生的重要性以及所取得的令人满意的结果，该方案提议将汤加索阿非政府组织与监狱管理部门之间建立的伙伴关系模式应用于马达加斯加的其他监狱。
