Auregan G, Rabarijaona L, Rabemananjara O, Ramaroson F, Razafindrazaka N, Boisier P
Service de Lutte contra la Tuberculose et la Lèpre, Institut d'Hygiène Sociale, BP, Antananarivo Madagascar.
Arch Inst Pasteur Madagascar. 1995;62(1):26-30.
The experience of a 51 months continuous action of tuberculosis control in a pneumophysiology department of an important general hospital which works according to the principle of cost recovery, is reported. This centre, with an average of 345 annual cases, is the third in Madagascar. During the studied period (from September 1989 to December 1993), 1418 tubercular patients have been diagnosed, distributed into 57.7% of pulmonary tuberculosis and 42.3% of extrapulmonary tuberculosis. The number of extrapulmonary tuberculosis is obviously higher than in the rest of the country structure (16%); among them, pleurisies are distinctly prevailing (present in 29.6% of tubercular patients), other serositis take an important place, immediately after peripheric adenopathies (101 cases that is to say 7.1%); the high proportion of laryngitis shows the importance and oldness of bacilli infected pulmonary lesions. 13.7% of the patients have two or more tubercular localizations. Bacteriological proof has been done for 97.3% of the pulmonary tuberculosis and 7% of the extrapulmonary tuberculosis. A certitude proof has globally been acquired for 82.5% of the patients. 97.9% of the sick started a treatment. 7% of death were noted (95 cases), two thirds of them during the first month after diagnosis and two thirds due to pulmonary tuberculosis with positive microscopy. The average recovery rate within the studied period was 68.2% for all patients without distinction; 67.6% (456/674) for pulmonary tuberculosis with positive microscopy and 76% (265/349) for pulmonary tuberculosis with positive microscopy among civil servants and equivalent. It has been noted that private persons who pay their medical expenses showed a significantly less good compliance (60.9% of recovery rate) than civil servants whose medical expenses are entirely refunded.
报告了一家重要综合医院的肺生理科按照成本回收原则持续开展51个月结核病防治工作的经验。该中心平均每年有345例病例，在马达加斯加排名第三。在研究期间（1989年9月至1993年12月），共诊断出1418例结核病患者，其中肺结核占57.7%，肺外结核占42.3%。肺外结核的数量明显高于该国其他地区结构（16%）；其中胸膜炎明显占主导（占结核病患者的29.6%），其他浆膜炎也占重要地位，仅次于外周淋巴结病（101例，即7.1%）；喉炎的高比例表明受杆菌感染的肺部病变的严重性和长期性。13.7%的患者有两个或更多结核病灶。97.3%的肺结核和7%的肺外结核进行了细菌学检测。总体上82.5%的患者得到了确诊。97.9%的患者开始接受治疗。记录到7%的死亡率（95例），其中三分之二在诊断后的第一个月内死亡，三分之二死于痰涂片阳性的肺结核。在研究期间，所有患者的平均治愈率为68.2%；痰涂片阳性的肺结核患者中，总体治愈率为67.6%（456/674），公务员及同等人员中痰涂片阳性的肺结核患者治愈率为76%（265/349）。值得注意的是，自费的私人患者的依从性明显低于医疗费用全免的公务员（治愈率为60.9%）。
