Ipuge Y A, Rieder H L, Becx-Bleumink M, Kimerling M E
National Tuberculosis/Leprosy Programme, Ministry of Health, Dar es Salaam, Tanzania.
East Afr Med J. 1997 Dec;74(12):816-8.
Through systematic evaluation of information contained in tuberculosis patients treatment cards, we present an example of a rapid operations evaluation method for identifying issues important to a national tuberculosis programme (NTP). Analysis of all 279 treatment cards of patients scheduled to attend one specific clinic day was made ((Kinondoni district in Dar es Salaam, Tanzania). Two hundred and twenty five patients (81%) were diagnosed as having pulmonary tuberculosis. Males accounted for 61% of cases. Ninety two per cent were cases without prior history of treatment. Of all patients, those under 15 years and those aged 25 to 54 years were more likely to be sputum smear-negative compared with other age groups. A chest radiograph was obtained as recommended to support the diagnosis in only 61 (38%) of 160 cases diagnosed as sputum smear-negative pulmonary tuberculosis. Initial drug dosing based on weight (mg/kg) revealed frequent dosing errors of isoniazid (97%) and pyrazinamide (65%), almost exclusively overdosing, in sputum smear-positive patients. Systematic examination of patient treatment cards provided usefull information and raises issues important to NTP planning and operations. Weaknesses in the execution of the national programme in Dar es Salaam were identified: the under-utilisation of chest radiography to diagnose sputum smear-negative tuberculosis and overdosing of certain drugs.
通过对结核病患者治疗卡所含信息进行系统评估，我们给出了一个快速业务评估方法的实例，用于确定对国家结核病规划（NTP）至关重要的问题。对计划在特定门诊日就诊的所有279名患者的治疗卡进行了分析（坦桑尼亚达累斯萨拉姆的基农多尼区）。225名患者（81%）被诊断为患有肺结核。男性占病例的61%。92%为无既往治疗史的病例。在所有患者中，15岁以下和25至54岁的患者与其他年龄组相比，痰涂片阴性的可能性更大。在160例被诊断为痰涂片阴性肺结核的病例中，仅61例（38%）按建议进行了胸部X光检查以辅助诊断。对痰涂片阳性患者基于体重（mg/kg）的初始药物剂量计算显示，异烟肼（97%）和吡嗪酰胺（65%）经常出现剂量错误，几乎全是过量用药。对患者治疗卡的系统检查提供了有用信息，并提出了对NTP规划和业务至关重要的问题。确定了达累斯萨拉姆国家规划执行中的薄弱环节：胸部X光检查在诊断痰涂片阴性结核病方面利用不足以及某些药物过量使用。
