Study On The Effectiveness Of School Tuberculosis Prevention And Control Measures In A City

Objective:The purpose of this study is to analyze the incidence of tuberculosis(TB)and related indicators in various years since the implementation of school TB prevention and control measures in a city,evaluate the implementation effect of relevant measures,and analyze the implementation logic of TB prevention and control measures in schools.From the perspective of the influence of the implementation of every measure on the incidence of tuberculosis in the city,the advantages and disadvantages of the measures were analyzed,and the targeted recommendations for further improvement of the measures were put forward,so as to provide scientific basis and empirical support for the construction of tuberculosis prevention and control system in our school.Methods:The expert interview method is used to understand the specific measures of the city's school TB prevention and control.In this study,the information about TB case reports in every rank school,screening data were collected from January 1st,2012to December 31st,2016.Taking physical examination rate,strong positive rate,TB second attack rate and school TB reporting incidence rate as indicators,from the perspective of effect of each measure in school TB prevention and control,the implement effect of school TB prevention and control measures in the city is analyzed.Excel 2007 was used to record related data,and descriptive analysis,correlation analysis,chi-square test and nonparametric rank sum test were used to analyze the related data.All statistical analyses use SPSS 22.0 software packages.Results:1.The city's school TB prevention and control measures mainly includes five contents,namely TB physical examination for enrolled school freshmen,close contact screening,high-risk schools monitoring and screening,preventive treatment for latent TB infection,and TB knowledge education.2.In 2012-2016,a total of 1,119,006 school freshmen were enrolled,and a total of845,716 freshmen accepted TB physical examination,accounting for 75.58%.The differences in screening rates in each year were statistically significant(?~2=67480.148,P<0.05).The total number of strong positive TST was 26,206,and the total positive rate was 30.9%.The differences in each year were statistically significant(?~2=925.154,P<0.05).A total of 291 cases of active pulmonary TB were identified,the total incidence rate was 34.41/10~5,and the incidence of each year was statistically significant(?~2=41.831,P<0.05),showing a downward trend(?~2=16.985,P<0.05).3.A total of 1230 new student TB cases occurred in 2012-2016 in the city,and90,168 close contacts were generated.A total of 84,322 among them were screened,accounting for 93.52%.The difference of screening rate in each year was statistically significant(?~2=1819.574,P<0.05).In 2012-2016,there were 158 second attack cases,the total second attack rate is 175.23/10~5,and the difference of second attack rate in each year was statistically significant(?~2=17.195,P<0.05),showing a decline trend(?~2=14.299,P<0.05).4.The TB incidence of the 5 schools in the first batch of high-risk schools monitoring and screening in 2012-2016 was statistically significant(?~2=68.055,P<0.05).After 5 schools were included in high-risk schools monitoring and screening,TB incidence of the year had declined in all schools.Meanwhile,TB incidence continues to decline in 2 schools,which have been excluded from"high TB outbreak risk schools".5.In 2013-2016,6225 LTBI students were screened through close contact screening,and a total of 1891 LTBI were received for preventive treatment,accounting for 30.38%.The total number of LTBI screened by sporadic cases was 894.There were121 people who completed the treatment,accounting for 13.53%.The total number of LTBI screened by the cluster epidemic cases amounted to 997,a total of 632 people completed the treatment,accounting for 63.39%.The rate of complete treatment of LTBI produced by sporadic cases was statistically significant compared with cluster epidemic cases(?~2=448.892,P<0.05).The total number of effective protective treatment in 2013-2016 was 452,accounting for 7.26%of the total number of LTBI.6.The average visiting time of student TB cases in the city was 18.30±27.07 days in 2012-2016,and the difference in visiting time of each year was not statistically significant(H=7.300,P>0.05).In the past 5 years,there were 476 delayed treatment cases,and the total delay rate was 34.29%.There was no statistical significance for the difference of the delay rate in each year(?~2=5.064,P>0.05).7.The reported school TB incidence in 2012-2016 in the city is 31.61/10~5,31.90/10~5,27.84/10~5,27.15/10~5 and 26.22/10~5,respectively.The differences are statistically significant(?~2=18.453,P<0.05)and there was a downward trend(?~2=8.033,P<0.05).Since the school TB prevention and control strategy was implemented,the annual descending rate of the reported school TB incidence was17.05%.Conclusion:The primary role of TB physical examination to school freshmen is to prevent the transmission of input cases within the school.The implementation of standardized close contact screening process can promote the decline in TB second attack rate in schools.High-risk schools monitoring and screening can effectively reduce the TB incidence in schools for a long time.Students have poor compliance with preventive treatment and the effective of protection are less.Students have a high rate of delay in visiting their TB symptoms.The school TB prevention and control measures do have the effect of reducing the incidence of school TB.We should continue to improve the five measures from four aspects,which including update the screening tools,expand the monitoring scope,evaluate the rationality and economy of preventive treatment,and enrich the content of TB knowledge education.