Study Of The Management And Treatment Of Floating Population Tuberculosis In Shenzhen

Research purposesSince 1993 World Health Organization (WHO) declared that tuberculosis (TB) was a global health emergency, and reaffirmed the urgent need for accelerated action against tuberculosis in 1998, tuberculosis epidemic was focused by the international attention again. The prevalence of tuberculosis remains a global public health problem and serious social problem. Population floating is a part of globalized economy,and it is promoting the development of the country and regional economy, at the same time has brought about a lot of social hygiene problems. Population floating is one of main factors that caused a lot of area tuberculosis cases to spread and outbreak. How to control tuberculosis is the same problem to many countries.As many kinds of factors, the tuberculosis morbidity rate of floating population is obviously higher than registering population in Shenzhen. In this study through we analysed the current situation and characteristic of tuberculosis prevent and control in Shenzhen, defined the mode of management and treatment of floating population tuberculosis, we investigated the essential feature of floating population tuberculosis, psychological health status of patient, influence factors ,the disease burden of tuberculosis,etc.We appraised the cost-benefit of treating floating population tuberculosis with population stayed temporarily, household registering population, explore the comprehensive appraisal method and index systems . It may demonstrate the mode of controlling floating population tuberculosis for other citys in the whole country,and the results may be precent a foundation for the prevention and control policy of floating population tuberculosis in our country too.Research methodsThis research used document retrieval, field investigation, descriptive analysis, subjective scale to explore the characteristic of the positive pulmonary tuberculosis of floating population and population stayed temporarily, household registering population in Shenzhen, x~2 test,T-test, the variance analysis, Kruskal-Wallis Test are used in the process of document analysis and data administration. Association clustering analysis is used too.ContentsThe contents are as follows: (1) the basic characteristic of floating population tuberculosis, including the social demography characteristic,the disease distribution, a medical examination characteristic, the service project demand, the self-test weary condition, the self-test anxious condition and the social support condition and so on. (2)the factors affecting the management and treatment of floating population tuberculosis: medical examination the number of times, the examination detention, the diagnosis delays, loses visits, the medicine leaks, the direction takes medicine and so on. (3) Performance evaluation of the model of floating population tuberculosis control,including the life quality appraisal, the degree of satisfaction and the reactivity appraisal, disease economy burden appraised and the disease control effect appraisal.ResultsThe results indicated that the remarkable achievement were obtained to manage and treat the floating population tuberculosis with 1 year experiment and 1 year promotion in Shenzhen.1 . The tuberculosis control system have been formed perfectly. There are 6 administrative regions, 47directly observed treatment secondary spot, 523 directly observed treatment third spot.2 The men and women sexual ratio is 1.59,the patients in 15 - 34 year group account for 79.0 percent, there are 44.9 percent discoverture, 39.5 percent unfixed work, 58.1 percen residence time low 1 year, 57.1 percent in Baoan district, 94.1 percent transfer, 87.3 percent clinical consultation, 44.9% percent first examination in the town hospital.3 There are obviously sexual difference in factor 2 (t=2.653, P=0.009) with the appraising of the subjective fatigue scale(SFS), the female is higher than the male (female 27.62±8.73, male 24.30±8.71), the healthy inspection group is lower than other groups (P<0.05).The subjective anxious scores does not have the significant difference (P>0.05); There were significant difference in the score in total, subjective support and objective support between the different marital status or in the different work mobility (P<0.05),and not significance difference in the degree of support utilizing (P>0.05 ).4 The rate of more then 3 times to receive medical examination is 27.8 percent in the individual clinic and the highest than the other two groups. The main cause of a medical examination detention is ignoring(54.5%),next is light symptom (16.7%). The main cause of diagnosis delays is misdiagnose (20.8%), next is the work or studies busily (19.4%), ignoring (18.1%).In the lost patients,there are 52.6% housings time within half year, 47.4% not unfixed work. There are 53.7% drug leak because of work.5 The score of general health, vitality and mental health in the floating population were lower than in the population of the household register, the people stayed temporarily(P<0.05). It was still lower than the other two groups after 2 (3 ) months and 6 (7 ) months(P<0.05). But the score of social functioning in floating population was higher than the other two groups.The change rate of general health and social functioning scores were significant difference in the three groups ( x ~2=12.088, P=0.002 and x~2=11.611, P=0.003). The change rate of the general health score in floating population was higher than the household register population and people stayed temporarily. 6 52.55% floating populations tuberculosis are satisfactory to directly observed treatment in Shenzhen, 6.63% very satisfactory. The satifaction degree of floating population is highest than population stayed temporarily, household registering population.There are still space to promote the degree of satisfaction and the reactivity in the health service.7 The organization cost is 141.44 Yuan to cure a floating population patient, the family cost 1654.25 Yuan, and the social cost 810.48 Yuan. There are lower than the patient in population stayed temporarily 302.56 Yuan, 1956.65 Yuan, 1208.81 Yuan or household registering population 303.09 Yuan, 2193.50 Yuan, 1108.48 Yuan. The direct economics burden is 1129.48 Yuan,and the indirect economics burden 309.33 Yuan in floating population, but population stayed temporarily, household registering population 1332.91 Yuan ,1644.97 Yuan, 487.79 Yuan and 391.85 Yuan.8 The directly observed chemotherapy management rate is 79.93%, 90.77% and 98.91% in floating population, population stayed temporarily and household registering population. There are the significant difference ( x~2=25.709, P=0.000).The regular treatment rate is 100%. The complete treatment rate is 82.44%, 90.07%, 96.70%,and there are the significant difference. The sputum bacterial negative rate is 92.09%, 93.80%, 93.96% in floating population, population stayed temporarily and household registering population. And has not the significant difference. The cavity close rate is 78.13%, 65.59% and 89.09%,and has the significant difference ( x~2=10. 658, P=0.005). At the same time,the cavity close rate of floating population is higher than population stayed temporarily,but has not the significant difference (x~2=2.875, P=0.064). The cure rate is 86.98%, 93.05% and 92.86%,and has the significant difference. ICT score is 16.85%, 19.00% and 25.58%.Policy suggestionsConsidering the performance evaluation results of floating population case management and treatment in Shenzhen, this paper supply six suggestions as follows.(l) continue to develop the physical examination system in the unit when it employs labors, and strengthen to give publicity to the knowledge to prevent and control tuberculosis.(2) further complete the suspicious tuberculosis patient's transfer, and strengthen the individual clinic doctor's training.(3) enhance the treatment and management effect of the floating population tuberculosis, and realize the entire treatment course free project as soon as possible. (4) continue to strengthen the directly observed treatment third spot, and improve the quality of health service. (5) cannot neglect the service for the tuberculosis outpatient,establish the perfect mechanism among the different region. (6) further reduce the medical cost for tuberculosis prevent and control, strive for the various supports.