| Tuberculosis (TB) is a chronic contagious disease which seriously damages population health. China is one of the 22 countries which have the heavy burden caused by tuberculosis and the number of patients with tuberculosis is the second highest. Globally, there were an estimated 9.27 million incident cases of TB in 2007. Most of the estimated number of cases in 2007 were in Asia (55%) and Africa (31%). Moreover, China had the second most new patients with tuberculosis directly following India. Obviously, tuberculosis does not get effectively controlled in China, which means that it is not only a public health problem but also a complicated social and economic problem. The epidemic of tuberculosis inhibits the social and economic development, especially in the rural areas, which results in the rural people becoming poor or falling back to poverty. The mass floating populations bring difficulties to the control of tuberculosis. In addition, the adverse factors, such as the bad situations, heavy conditions and fast mobility, threat the control of tuberculosis.DOTS strategy, widely considered as the most effective, play an important role in the control of tuberculosis. Furthermore, of all the Stop TB Strategy that WHO's recommended approach, WHO firstly mentioned pursuing high-quality DOTS expansion and enhancement. The implementation of the DOTS strategies and the accordance of patients relate directly to the cure of patients. In the future work to control tuberculosis, improving the quality of DOTS and control of the floating patients with tuberculosis are main challenges. In 2003, WHO proposed an explanation for DOTS in the report of "Adherence to Long-term Therapies: Evidence for Action" and it was that patients had to take medicines during the whole treatment process according to prescribed requirements. From the angle of the practical work of tuberculosis control, the definition merely pointed the most significant part of the DOTS strategy which was the adherence. Hence, it must be valuable academically and practically to study the adherence of DOTS.The stratified cluster random sampling was used in the study. Specifically, the resident patients with tuberculosis were selected in 36 townships of the 6 counties/cities/districts in 3 area cities of Shandong province from January 1st,2006 to September 30th,2007 and it amounted to 819 patients. The floating patients were chosen in the 12 counties/cities/districts of Jinan, Dongying, Yantai, Binzhou, Qingdao, Linyi, Weifang since the January 1st,2007 and it amounted to 314 patients.The study provided the descriptive analysis of the base situation of the floating patients with tuberculosis; counted the current supervision and management, adherence to physical test; conducted the univariate analysis of the possible influencing factors of the adherence of taking dugs; and finally the unconditionally Logistic regression was used to explore the influencing factors.Main results as follows:â… . The supervision and management of patients with tuberculosis, especially the resident patients, is poor in Shandong province and the motivation of primary doctors is low.â…¡. Most resident and floating patients with tuberculosis can abide by the doctor's advice and go to take test and bring medicine in centers for the prevention and treatment of tuberculosis. The reasons that never taking drugs regularly are different for the two kinds of patients, the side effects of drugs for resident patients and lack of money and inconvenient traffic for floating patients. As for the reason never taking test regularly, the resident patients think that they do not need tests and the floating ones consider that the traffic is not convenient and they do not have enough time.â…¢.91.1 percent of resident patients can take medicines regularly during the whole treatment process, while only 84.1 percent floating patients can. The two main reasons of missing drugs are forgetting and side effects of drugs and the main reason of stopping treatment is side effect of drugs. In addition,31.3 percent floating patients broke off their treatment just because they do not have drugs which do not happen to the resident patients.â…£. The influencing factors of the resident patients'adherence of taking medicines include the time needed from dwellings to the nearest hospital center, the time needed from the dwellings to the center for prevention and treatment in counties, and the evaluation of the preferential policy to tuberculosis. The influencing factors for floating patients are the occupations of patients and whether accept a propaganda and education about tuberculosis related information.Suggestions:â… . DOTS strategy is the most important way to improve the adherence of treatment, prevent and cure tuberculosis.â…¡. Pay much attention to the propaganda and education about prevention and treatment of tuberculosis.â…¢. Fully utilize the doctors'role of supervision and visitation and improve the management of patients.â…£. Enhance the construction of the primary system of prevention and treatment of tuberculosis, and improve the access of health service based on the principle of patients centeredâ…¤. Insist on the free policy and increase the fund in order to provide more preferential motivating measures for patients.â…¥. Emphasize the prevention and treatment of floating patients with tuberculosis and facilitate the management of floating patients by the comprehensive measures.
|
PDF Full Text Request