| BackgroundsChina is one of the 22 TB high-burden and the 27 serious MDR-TB countries in the world. At present, about 1,300,000 tuberculosis is taken in our country every year, take up 14.3% of outbreak and the potential occupies 2nd in the world. The fifth national tuberculosis epidemiological random sampling survey in 2010 displayed that the incidence of activity tuberculosis is 459/100,000 in our country. The tuberculosis controls mainly from infection source,spread path and easy feeling crowd three aspect to establish the strategy. At present time the BCG is the only vaccine that aims at tuberculosis, but the domestic and international research expresses the BCG only have effecting on child's tuberculosis and tubercle meningtis prevention, to other TB have no obvious prevention action. So, the key of TB control work is to detect in time and thoroughly cure TB patients completely, low the transmition of the infection source. The TB health seeking delay that could accelarate the portion of dead and transmitting among health people, has become an important influence factors which increase the spread of the disease and exacerbate the suffering of patients, and further, taken more difficult to TB control. Otherwise, as the development of ecnomic the man fluidity to continuously increased which bring more important challenge to TB control. From these reasons, this study aims at the proportion of TB patients in fluid and register population,the health seeking delay and the influncing factors in Shandong province of TB project of global found 5th. In order to establishment to correspond to control TB measure lower the health seeking delay and contaminate, to advance the TB control work in Shandong province.ObjectiveTo understand the present situation of registered and floating tuberculosis health seeking delay in counties of Global fund project in Shandong Province, try to explore and compare the constitution of tuberculosis patients between registered and floating and,also the influence factors of patients delay, then puts forward the relative countermeasures to prevent the tuberculosis Transmission among health people.MethodsAdopt the whole flock of sample method, Selected four in 23 countries of Global fund programme in Shandong Province, the cases of tuberculosis registered in TB dispensaries in four counties including registered and floating population TB cases as the research object, observe it to seek health seeking delay and the influencing factors EpiData 3.0 was used to establish the database and SPSS was used to analyze the data. Using descriptive research methods,To analyze onset features of registered population and floating population on incidence reported. Use the method of Single and multiple variable to analyze and compare the related factors for registered and floating health seeking delay.Results1.There are 595 registered tuberculosis patients in the 928 cases in the studied term,And the floating population patients are 333 cases, which accounted for 35.88%. Floating population patients give priority to young and middle-aged, the proportion of the under 30 years is 56.46% and 60 years old and above is 10.81%; The registered tuberculosis patients give priority to middle and the older the proportion of the under 30 years is 28.07% and 60 years old or above accounted for 32.77%. The differences of age and occupational structure of registered tuberculosis patients and floating patients both have a statistically significant. (P<0.001).2. The proportion of all tuberculosis patients delayed accounted for 62.72%, The rate of health seeking delay for registered population and floating population are 66.39% and 56.16%,the results after standardization are 63.37% and 56.16%; the health seeking delay between registered population and floating population has no difference(P=0.152);the average of health seeking delays 56.31% days and the median is 17days,the median of registered and floating population are 21 and 15 days, the discrepancy has statistics meaning(P<0.001); The rate of health seeking delay for newly and recurrent patients are 61.66% and 74.67%,has significant differences(P=0.026).The median of newly and recurrent health seeking delay were 17 and 30 days, there were significant differences(P=0.020).3.Multivariate analysis showed that cough and expectoration and no hemoptysis, old, farmers, sputum smear-positive are risk factors of health seeking delay. The risk of health seeking delay Patients with symptom of cough and expectoration(OR=2.800, 95%CI:1.942-4.036) higher than the others; compared to the under 29 years old,the risk of patients delay both the group the 30-59 years and over 60 years high, the value of OR were 2.714(95%CI:1.535-3.079) and 2.469(95%CI:1.655-3.683). The risk of farmers patients higher than workers (OR=1.615,95%CI:1.127-2.314).The risk of the sputum smear-positive is 1.845(95%CI:1.346-2.528)times of the smear negative.4.Study on the relationship between health seeking delay and sputum smear-positive showed,the proportion of smear-positive were 59.79% and 34.10% in the delays and the nones, there were significant differences(P<0.001).the proportion of smear-positive were 50.25% and 50.15% in residents and the floating population,there were no significant differences(P=0.976). the proportion of sputum smear-positive in residents and the floating population of the delays were 58.73% and 62.03%,there were no significant differences(P=0.449).Conclusions1. There still exists serious delay in seeking health care among the TB patients, the proportion of health seeking delay is 62.72%, there were no significance difference in residents and the floating population. The median of health seeking delays 17days, the residents are longer than the floating people. With the increasing of age, the health risk due to delayed diagnosis and treatment markedly elevate. The implementation of Global Fund Tuberculosis Project (floating population) will significantly avoid the delay of seeking health care and the diagnosis of TB in the floating population. This project is warranted to be promoted in the area with clustering of floating population.2. Cough, expectoration, ages, farmers, sputum smear-positive are risk factors of health seeking delay. It is quite beneficial to Propaganda the knowledge of TB prevention and control to more people. In this way, we would improve their awareness of the risk of tuberculosis and role of physical examination in screening TB. When suspicious symptoms appear, they can prevent diagnosis and treatment delay by taking physical examination right away in professional medical institutions.3. The rate of sputum smear-positive in the delays were increased notably. Do well the work related to patients see a doctor in time, lower the rate of patients delay have high fatal public health sense of controlling the infection source4. Both the rate and the time of health seeking delay of the recurrent patients higher than the newly ones, it hints although the recurrent patients suffer from TB in the past, TB suspicious symptom cannot arouse their adequate appreciate, After appearing symptom could not see a doctor in time. it hints the recurrent patients have not enough knowledge on tuberculosis control and prevention in the course of therapy of the past. |
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