| Tuberculosis (TB) is one of the greatest public health problems in the world. Globally, TB caused 1.8 million deaths in 2007, and TB is among the top ten causes of death worldwide, especially in Asia and Africa. It is very important in tuberculosis (TB) control to detect the disease as early as possible and to ensure that those diagnosed complete their treatment and get cured. The World Health Organization (WHO) has proposed that treatment outcome is an important indicator of tuberculosis control. Improving cure rate of TB cases, especially smear-positive cases, is without doubtly the most effective measure to interrupt the chain of transmission of Mycobacterium tuberculosis.Objective:1,To understand the epidemiological features of registered pulmonary tuberculosis in Qiaokou district of Wuhan city during 2003 to 2007;2,To analyze the demographic and clinical characteristics of registered patients with pulmonary tuberculosis;3,To analyze the treatment outcome of different demographic and clinical characteristics among patients with pulmonary tuberculosis;4,To analyze factors associated with treatment outcome among patients with pulmonary tuberculosis, and to provide some reference advices for improving the cure rate.Method:Data were the yearly report forms of tuberculosis control work from 2003 to 2007 in Qiaokou district of Wuhan city, patients'clinical data searched, and demographic data provided by the Wuhan city health bureau. Data were entered into an Epidata (version 3.1) database and checked for errors by trained workers. Data analysis was done using the SPSS statistical software program version 15.0 (Statistical Product and Service Solutions 15.0).1. Newly registered TB rate, smear newly registration rate, treatment success rate were calculated;2. Cases and frequencies (%) were used to describe demographic and clinical characteristics; Using Chi-square test to analyze demographic and clinical data among five years;3. Using Chi-square test to analyze the treatment outcomes on different demographic and clinical characteristics;4. Binary logistic regression model was used to identify the risk factors to the treatment outcome. Odds ratios (OR) and their 95% confidence intervals (CI), were used as estimate of relative risk. A P value less than 0.05 was considered statistically significant.Results:1. Overall, there were 2502 cases of newly registered tuberculosis patients in Qiaokou district during 2003 to 2007, with 70.94 per 100000 of average incidence of recently newly registered rate, and showed a declining trend as the years. 5-year average incidence of recently smear positive newly registered rate was 28.16 per 100000. The average smear positive ratio was 44.4%; the ratio between male incidence of recently new registration rate and female incidence of recently new registration ratio was 2.13; the ratio between male smear positive incidence of recently new registration rate and female incidence of recently smear positive new registration ratio was 2.53.2. Registered TB patients aged 15 to 39 took the highest proportion, reaching 48.1%;79.1% of patients had no job;the 5-year ratio between new and retreatment cases was 4.47~8.89,which had a significant difference((?)2=14.805,P=0.005), and the 5-year average ratio was 6.4;the 5-year ratio between smear positive and smear negative was 0.58~1.08, which showed a increasing trend as the years((?)2 = 23.389, P<0.001), and the 5-year average ratio was 0.8;31.5% of patients had cavitations;61.9% of patients were from referral;81.5% of patients had good compliance, and the 5-year compliance showed a declining trend;The median of diagnosis delay was 23 days, and the 5-year median of diagnosis delay showed a increasing trend. 3. A total treatment success rate was 90.6%, and showed a downward trend as the years, while the rate of defaulters and others showed upward trend in recent years; the 5-year average treatment success rate of smear positive patients was 88.7%, and showed a downward trend as the years, from 93.5% to 83.4%((?)2 =19.369, P=0.001).The 5-year average treatment success rate of new cases and retreatment cases were 92.3% and 80.2% respectively ((?)2 =50.530, P<0.001). The 5-year average treatment success rate of smear positive TB patients and smear negative TB patients were 88.7% and 92.2% respectively ((?)2 =9.322, P=0.002). The treatment success rates for new smear positive patients and for new smear negative patients were 91.7% and 92.6% respectively((?)2 =0.601, P=0.438). The treatment success rates for retreatment smear positive patients and for retreatment smear negative patients were 78.2% and 86.0% respectively ((?)2 =2.500, P=0.114). The treatment success rate for new smear negative patients is higher than retreatment smear positive patients ((?)2 =50.492, P<0.001).4. In the binary logistic regression analysis, risk factors for successful treatment were sex, diagnostic delay, patient category, sputum smear, and compliance with treatment. In our study, treatment success possibility for females was significantly higher than males (OR=1.859, 95%CI:1.169-2.955);Treatment success possibility for diagnosis delayer was lower than non-diagnosis delayer(OR=0.396, 95%CI:0.264-0.593); Treatment success possibility for new case was significantly higher than retreatment (OR=2.673, 95%CI:1.655-4.319);Treatment success possibility for patients who complied with treatment was significantly higher than patients with poor adherence (OR=26.648, 95% CI:17.661-40.208) ; Treatment success possibility for smear-positive patients was significantly higher than smear-negative patients (OR=0.595, 95% CI: 0.396-0.893).Conclusions:1 Tuberculosis detection rate was in decline in Qiaokou district of Wuhan city, indicating that the detection ability of TB had a certain extent decline after the World Bank loan projects.2 The discovery and management of patients should pay great attention to young adults and unemployed people.3 The 5-year average treatment success rate for smear-positive patients was 88.7%, this number meets the WHO targeted success rate of 85% for all smear positive cases, and also to reached the target level of 85% for smear positive cases in China control program (2001 ~ 2010), but the treatment success rate for smear-positive patients showed a downward trend as the years.4 It is important and difficult for TB control to improve the treatment success rate for retreatment, especially in retreatment smear positive patients.5 Early diagnosis of tuberculosis patients and compliance with treatment could improve the success rate of TB treatment. |
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