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082-PA12 Tuberculosis control in China
Abstracts
National TB Control Program is failing to achieve its goals. Aimed to improve TB Control Program in Cali, needs assessment and adjustments were made in 1993 by the local Public Health Office and the Colombian League Against Tuberculosis and Lung Disease-Chapter of Valle. Assessment conclusions pointed to insufficient integration in the PHC network, miscarriage of resources, and lack of education to patients and community, as principal flaws. Adjustments consisted of: 1) Designation of a leader health worker as program manager at district level and at each health unit. 2) Training of all nurse assistants in TB control strategies and case finding techniques. 3) Monthly qualitative appraisal and quarterly quantitative evaluation of each health centre. 4) A statement of rules aimed to abolish mismanagement practices. Comparing 1993 with the previous year, it was found an increase of 110% in number of direct smears, and an increase of 44% in smear positive pulmonary patients. Number of cases found with less than 1 month with cough increased by 75%. Despite lacking a cohort design to assess cure and compliance rate, cases egressing the program in 1993 by healing increased from 78% to 85%, and egressing by uncompliance decreased from 17% to 10%. Integration of the TB Control Program in the PHC is an achievable goal. Political willingness, improvement in management skills and leadership in health workers are key factors to attain a successful integration. Integration could make feasible a high diagnostic coverage and cure rate, fundamental targets in TB control.
075-PA12 Hungary
Reshaped National TB Program in
Kozma, D., Pataki, G., Vaddsz, I. Kordnyi National Institute of TB, Budapest
Background: After steady decline of TB epidemic till the late 80s incidence started to increase since 1991 (1994:40.8 per 100,000). Disease is common among middle aged men. A considerable proportion of new detected patients are alcoholics, homeless and/or jobless people. In the TB epidemic there are important geographical differences. Main elements of National Tuberculosis Program: Increasing activity and strengthening collaboration of institutes responsible for anti TB fight (Ministry of Welfare and Public Health Office). Publishing recommendations and guidelines from National TB Institute for dispensaries and general practitioners. Up-to-date computerised notification and follow-up system. Active case finding in certain areas and in certain risk groups. Continuing BCG vaccination of newborns and revaccination. More effective contact tracing. Chemoprevention according to newly adapted indications. Fully supervised short course chemotherapy. Social care and management of patients.
111
Conclusion: Introducing the revised National Program, decline in TB epidemic can be expected within a few years.
082-PA12
Tuberculosis control in China
Li Zheng Min, Duan Mu Hong Jin, Zhao Feng Zeng. National Tuberculosis Control Center, Beijing, P.R. China
In 1990, the prevalence of active pulmonary tuberculosis was 523/100,000 and the prevalence of smear-positive was 134/100,000. In comparison with the results in 1979, the prevalence of active pulmonary tuberculosis showed a 27% decrease and the annual reduction rate was 2.8%; the prevalence of smear-positive pulmonary tuberculosis had reduced to 28.3% and the annual reduction rate has 3.0%. The Tuberculosis Control Project, China, was initiated in 1992 with the loan provided by the World Bank and technical cooperation provided by the WHO. The project covered 12 provinces (560 million). The sputum conversion rate was 90.2% at the end of third month. The "Strengthening and Promoting Tuberculosis Control Project" was initiated in 1993 with support by government and covered another 9 provinces. The sputum conversion rate was 90.6% at the end of second month.
083-PA12 Preliminary treatment results of SM(+) pulmonary TB cases treated by intermittent short course chemotherapy (SCC) of Hubei province in 1992-1994 Guanghua Tang, Aiqing Xiao, Qiang Lu. Institute of TB Control Hubei Prov. Academy of Medical Sciences, Wuhan, P.R. of China
Objectives: To assess the treatment result of intermittent SCC regimens recommended by TB Component of Chinese Infectious and Endemic Disease Project Loaned by the World Bank. Methods: Data on the sputum conversion and the cure rate at the end of 2nd, 3rd months and treatment were obtained from the quarterly reports stipulated by TB Control Project Office of Public Health Ministry and WHO, TB register and other sources. Results: Since April 1992, SCC with fully intermittent regimen 2H~R3Z3S3(E3)/4H3R3, has been treated for new SM(+) pulm. TB cases and 2H3R3Z3S3E3/6H3R3E3 for relapsed and failed SM(+) cases. The sputum conversion rate at the end of 2nd, 3rd months of chemotherapy were 89.9% (3238/3603) and 94.7% (3414/3603) for new cases; 83.9% (3528/4207) and 89.3% (3758/4207) for relapsed and other retreated. The treatment results of SM(+) pulm. TB cases will be evaluated separately by cohort analysis as follows: of 3603 new cases, 3381 (93.8%) cured, 41 (1.1%) treatment completed 60 (1.7%) failed, 57 (1.6%) died, 5 (0.9%) moved out, 35 (1.0%) defaulted and 24 (0.6%) excluded. While, of 4207 relapsed and other retreated cases, 3611 (85,8%) cured,
National TB Control Program is failing to achieve its goals. Aimed to improve TB Control Program in Cali, needs assessment and adjustments were made in 1993 by the local Public Health Office and the Colombian League Against Tuberculosis and Lung Disease-Chapter of Valle. Assessment conclusions pointed to insufficient integration in the PHC network, miscarriage of resources, and lack of education to patients and community, as principal flaws. Adjustments consisted of: 1) Designation of a leader health worker as program manager at district level and at each health unit. 2) Training of all nurse assistants in TB control strategies and case finding techniques. 3) Monthly qualitative appraisal and quarterly quantitative evaluation of each health centre. 4) A statement of rules aimed to abolish mismanagement practices. Comparing 1993 with the previous year, it was found an increase of 110% in number of direct smears, and an increase of 44% in smear positive pulmonary patients. Number of cases found with less than 1 month with cough increased by 75%. Despite lacking a cohort design to assess cure and compliance rate, cases egressing the program in 1993 by healing increased from 78% to 85%, and egressing by uncompliance decreased from 17% to 10%. Integration of the TB Control Program in the PHC is an achievable goal. Political willingness, improvement in management skills and leadership in health workers are key factors to attain a successful integration. Integration could make feasible a high diagnostic coverage and cure rate, fundamental targets in TB control.
075-PA12 Hungary
Reshaped National TB Program in
Kozma, D., Pataki, G., Vaddsz, I. Kordnyi National Institute of TB, Budapest
Background: After steady decline of TB epidemic till the late 80s incidence started to increase since 1991 (1994:40.8 per 100,000). Disease is common among middle aged men. A considerable proportion of new detected patients are alcoholics, homeless and/or jobless people. In the TB epidemic there are important geographical differences. Main elements of National Tuberculosis Program: Increasing activity and strengthening collaboration of institutes responsible for anti TB fight (Ministry of Welfare and Public Health Office). Publishing recommendations and guidelines from National TB Institute for dispensaries and general practitioners. Up-to-date computerised notification and follow-up system. Active case finding in certain areas and in certain risk groups. Continuing BCG vaccination of newborns and revaccination. More effective contact tracing. Chemoprevention according to newly adapted indications. Fully supervised short course chemotherapy. Social care and management of patients.
111
Conclusion: Introducing the revised National Program, decline in TB epidemic can be expected within a few years.
082-PA12
Tuberculosis control in China
Li Zheng Min, Duan Mu Hong Jin, Zhao Feng Zeng. National Tuberculosis Control Center, Beijing, P.R. China
In 1990, the prevalence of active pulmonary tuberculosis was 523/100,000 and the prevalence of smear-positive was 134/100,000. In comparison with the results in 1979, the prevalence of active pulmonary tuberculosis showed a 27% decrease and the annual reduction rate was 2.8%; the prevalence of smear-positive pulmonary tuberculosis had reduced to 28.3% and the annual reduction rate has 3.0%. The Tuberculosis Control Project, China, was initiated in 1992 with the loan provided by the World Bank and technical cooperation provided by the WHO. The project covered 12 provinces (560 million). The sputum conversion rate was 90.2% at the end of third month. The "Strengthening and Promoting Tuberculosis Control Project" was initiated in 1993 with support by government and covered another 9 provinces. The sputum conversion rate was 90.6% at the end of second month.
083-PA12 Preliminary treatment results of SM(+) pulmonary TB cases treated by intermittent short course chemotherapy (SCC) of Hubei province in 1992-1994 Guanghua Tang, Aiqing Xiao, Qiang Lu. Institute of TB Control Hubei Prov. Academy of Medical Sciences, Wuhan, P.R. of China
Objectives: To assess the treatment result of intermittent SCC regimens recommended by TB Component of Chinese Infectious and Endemic Disease Project Loaned by the World Bank. Methods: Data on the sputum conversion and the cure rate at the end of 2nd, 3rd months and treatment were obtained from the quarterly reports stipulated by TB Control Project Office of Public Health Ministry and WHO, TB register and other sources. Results: Since April 1992, SCC with fully intermittent regimen 2H~R3Z3S3(E3)/4H3R3, has been treated for new SM(+) pulm. TB cases and 2H3R3Z3S3E3/6H3R3E3 for relapsed and failed SM(+) cases. The sputum conversion rate at the end of 2nd, 3rd months of chemotherapy were 89.9% (3238/3603) and 94.7% (3414/3603) for new cases; 83.9% (3528/4207) and 89.3% (3758/4207) for relapsed and other retreated. The treatment results of SM(+) pulm. TB cases will be evaluated separately by cohort analysis as follows: of 3603 new cases, 3381 (93.8%) cured, 41 (1.1%) treatment completed 60 (1.7%) failed, 57 (1.6%) died, 5 (0.9%) moved out, 35 (1.0%) defaulted and 24 (0.6%) excluded. While, of 4207 relapsed and other retreated cases, 3611 (85,8%) cured,