The Epidemic Status And Control Strategies Of Tuberculosis In The Domestic Migrant Population In Minhang District, Shanghai

Objective:To describe the epidemic status of tuberculosis(namely,pulmonary tuberculosis in this thesis) in the domestic migrant population in Minhang District from the year 1997 to 2006,to identify problems of tuberculosis control in the domestic migrant population in Minhang District and to analyze their underlying causes,to evaluate the effectiveness of multiple tuberculosis control strategies for the domestic migrant population in Minhang District,and to provide suggestions for the following tuberculosis control measures in the domestic migrant population in Minhang District and other similar districts in China.Methods:1.Data collection methods:routine notification data collection,questionnaire survey,in-depth interview,focus group discussion,literature review,etc.2.Data analysis methods:quantitative data was described and analyzed with SPSS13.0;qualitative data was catergorized and coded with MAXqda2,using stepwise summarizing and disussion to extract critical information.Results:1.The epidemic status of tuberculosis in the domestic migrant population in Minhang District from the year 1997 to 2006:(1) From 1997 to 2006,the tuberculosis notification rates in the domestic migrant population were higher than those in the indigenous population,and the percentage of notificated domestic migrant cases in all notificated cases of Minhang District rose from 32.9%to 70.5%;(2) Before the year 2004,the sputum-positive tuberculosis notification rates in the domestic migrant population were lower than those in the indigenous population, and from 1997 to 2006,the percentage of notificated domestic migrant sputum-positive cases in all notificated sputum-positive cases of Minhang District rose from 31.0%to 65.3%;(3) The average age of the tuberculosis patients in the domestic migrant population was about 20 years younger than that in the indigenous population; (4) The gender ratio of the tuberculosis patients in the domestic migrant population was about 1.7:1,lower than the indigenous population's 2.6:1;(5) From 2003 to 2006,the percentages of newly diagnosed tuberculosis cases in the domestic migrant patients were beyone 90%,all higher than those in the indigenous patients;(6) From 2003 to 2006,the cure rates of the domestic migrant tuberculosis patients rose from 32.5%to 84.1%,all lower than those of the indigenous tuberculosis patients;(7) From 2003 to 2006,the percentages of the treatment seeking delay in the domestic migrant tuberculosis patients rose from 32.2%to 41.4%,and the percentages of the diagnosis delay dropped from 34.1%to 26.2%。2.Under the background of Chinsese economic transition,the causes of problems in tuberculosis control of the domestic migrant population in Minghai District:(1) Lack of awareness and lag of response to the emerging new tuberculosis control problems;(2) Bad management and medical treatment for domestic migrant tuberculosis patients;(3) High medical care expense in the designated tuberculosis hospital,and the consequent bad hospital credits;(4) Low income and lack of medical care insurance in the domestic migrant tuberculosis patients;(5) Lack of social supports and community involvements in the domestic migrant tuberculosis patients;(6) Stigma and privacy concern of the domestic migrant tuberculosis patients, and their unwillingness to be managed and interviewed;(7) No factor was found statistically significant to the treatment seeking delay by Logistic Regression.(8) The eduation level of tuberculosis patients and the type of first treatment hospital were both statistically significant to the diagnosis delay.3.The evaluation of the effectiveness of the multiple tuberculosis control strategies for the domestic migrant population in Minhang District:(1) The economic burden of the domestic migrant tuberculosis patients was reduced; (2) The treatment expense of the domestic migrant tuberculosis cases was cut down;(3) The percentage of the domestic migrant tuberculosis patients treated in the designated tuberculosis hospitals rose;(4) The tuberculosis notification rate rose in the domestic migrant population;(5) The percentage of monitored and managed tuberculosis cases rose in the domestic migrant tuberculosis patients;(6) The cure rate of the domestic migrant tuberculosis patients rose and their rate of losing follow-up dropped;4.Current problems of tuberculosis control and their causes in the domestic migrant population in Minhang District:(1) The tuberculosis incidence remained high in the domestic migrant population;(2) Problems of the treatment seeking delay and the diagnosis delay remained sever in domestic migrant tuberculosis patients;(3) A considerable percentage of domestic migrant tuberculosis patients still lost follow-up;(4) Stigma and privacy concern still existed in the domestic migrant tuberculosis patients;(5) Nearly half of the domestic migrant tuberculosis patients continued working in spite of illness;(6) The domestic migrant tuberculosis patients were still lack of medical care insurance.Discussion and Conclusions:(1) Many aspects of tuberculosis control in the domestic migrant population in Minhang District have been improved;(2) The tuberculosis control in the domestic migrant population under the background of Chinese economic transition is a complicated social problem;(3) Administrative notion changes and policy supports of the government are vital to the success of tuberculosis control in the domestic migrant population;(4) The DOTS strategy was demonstrated effective in the domestic migrant population;(5) A lot of efforts are still needed for the following tuberculosis control in the domestic migrant population in Minhang District. Suggestions:(1) The tuberculosis control in the domestic migrant population should be administrated by the government,using multiple social measures;(2) A effective system of medical care insurance for the domestic migrant population should be established;(3) A variety of measures are needed to improve the tuberculosis prevention in the domestic migrant population;(4) The cooperation between different areas of China in the tuberculosis control of the domestic migrant population should be strengthened.