| BackgroundTuberculosis(Tuberculosis,TB)is one of key social diseases.Its incidence and control are affected by many social factors(social,political,legal,cultural and economic).Tuberculosis is one of the top ten fatality diseases in the world,and ranks first in the fatality rates of single infectious diseases.China is one of the 22 countries with a high burden of tuberculosis in the world.Although the Chinese government has adopted many TB control strategies and has achieved certain results,according to the 2019 Global TB Report,there are still 886,000 TB patients in China in 2018,the epidemic trend of tuberculosis in China is still very serious.The long treatment cycle of tuberculosis patients,large side effects of drugs,easy development of drug resistance,easy arising of serious complications,and heavy financial burden of tuberculosis patients are the reasons for the long-term epidemic of tuberculosis.At the same time,patients themselves don’t have sufficient recognition of tuberculosis,leading to poor compliance in the treatment and management of tuberculosis,which may lead to poor treatment effects.Health education is one of the key measures to improve patients’ compliance with tuberculosis treatment.However,there are few reports on the literatures about health education based on the characteristics of tuberculosis patients.PurposesTo command the epidemiological characteristics of TB patients in Chongqing with retrospective study,and to formulate health education strategies based on the characteristics of TB patients,and conduct effect evaluation on health education strategies through follow-up;also to improve non-drug intervention strategies for TB patients to provide a certain evidence-based basis for tuberculosis prevention and treatment.Method1.Retrospective study: Collected registration data in the medical system of Chongqing Public Health Medical Center(CPHMC)from January 1 to December 31,2018 to conduct a retrospective study.Analyzed the epidemiological characteristics of TB patients and the risk factors of drug-resistant TB and HIV infection.SPSS18.0 was used to process and analyze data,chi-square test was used to analyze the related factors of DR-TB and HIV-infected patients,and binomial logistic regression model was used to further screen risk factors.P<0.05 was statistically significant.2.Follow-up study: Based on the results of the retrospective study,non-drug intervention strategies for TB patients were formulated.Newly diagnosed TB patients in CPHMC were selected for health education,and questionnaire survey methods were used to collect the changes on awareness rate of core tuberculosis knowledge,health promotion behaviors and lifestyle of patients pre-and post-health education,to further investigate patients’ compliance during treatment and analyze the effectiveness of non-drug intervention strategies.Epidata3.1 was used to establish a database and enter data,SPSS18.0 was used to sort and analyze the data,while paired chi-square test was used to analyze the intervention effect.P<0.05 was statistically significant.Results1.Analysis of characteristics of pulmonary tuberculosis(PTB)patients in Chongqing1)A total of 1827 patients were enrolled in this study,most of whom were male(65.5%,n=1197)and Han nationality(91.4%,n=1670).72.9%(n=1331)of the patients were between21-60 years old,and most of the patients were from the districts and counties of Chongqing(66.1%,n=1207).455(24.90%)patients had DR-TB,of which 87.03% were MDR-TB.110(6%)TB patients were infected with HIV concurrently.2)Binomial logistic regression result showed that farmers,retreated patients,and patients with drug-related liver injury were more likely to develop DR-TB.3)Binomial logistic regression results showed that men,unemployed,living in the main city,aged between 21-60,and non-retreatment patients were more likely to be infected with HIV.2.Evaluation of the effect of health education for PTB patients1)A total of 151 newly diagnosed TB patients were enrolled in the group,and a total of118(78.15%)TB patients were investigated during the follow-up(post-intervention)in June.Among the 151 TB patients,males accounted for a relatively high proportion of 70.2%,and the majority were 25-54 young adults,accounting for 60%;most of the patients had unstable financial sources,such as farming/migrant working/no fixed income(60.8%,n=87).There were 18 people who developed resistance,and the incidence of resistance was 11.92%.2)After the intervention,the patient’s awareness rate of core tuberculosis knowledge was significantly higher than that before the intervention,but the awareness rate of the consequences of non-standard treatment was lower than that before the intervention,and the difference was statistically significant.Although the awareness rate of symptoms of tuberculosis increased after intervention,the difference was not statistically significant.3)After the intervention,the behaviors of wearing masks when going out,reducing the frequency of appearance in public places,correctly handling sputum,and frequently opening windows for ventilation all improved,and the difference was statistically significant.However,other preventive behaviors changes were not statistically significant.4)The lifestyle of tuberculosis patients changed significantly after six months of treatment intervention.43.9% of patients would quit smoking and reduce smoking after the illness,22.8% of patients would quit and reduce alcohol consumption after the illness,80.8%of patients expressed that they would pay attention to dietary nutrition after the illness.5)A follow-up survey was conducted on patients’ compliance behavior during treatment.The proportion of patients who missed medication and interrupted treatment showed a monthly downward trend.After six months,the proportion of missed medication and interrupted treatment decreased from 12.80% and 4.50% to zero,respectively.The proportion of non-regular sputum examinations increased from 28.1% to 64%.Conclusions1.Young men,socially disadvantaged groups and students are at a higher risk of tuberculosis.The co-infection of DR-TB and TB/HIV is still a challenge for the prevention and treatment of tuberculosis in Chongqing.Therefore,medical care services for tuberculosis and HIV must be integrated to promote early identification and treatment of TB/HIV-positive co-infected patients among the unemployed,young people,and tuberculosis patients in major urban areas.2.Health education strategies based on the characteristics of TB patients can significantly improve the awareness rate of newly-treated patients on the core knowledge of tuberculosis,and improve patients’ preventive behaviors and lifestyle behaviors.Health education can improve patients’ compliance with medication and treatment,thereby improving the effectiveness of tuberculosis treatment. |
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