The effect evaluation of a new tuberculosis management model in rural areas of Guangxi / 中华预防医学杂志

ABSTRACT

<p><b>OBJECTIVE</b>To explore the effect of new model for tuberculosis (TB) control and management, and provide a scientific basis and justification for making TB control strategies in rural communities.</p><p><b>METHODS</b>Among those townships with low TB service accessibility by the county TB control institute in Guangxi Xingye county (population of 679 thousands), four townships with total population of 152 518 and inconvenient transportation, were selected as the experimental group to conduct a new model research project.Based on the accessibility for community services, setting diagnosis and treatment management centers in township hospitals, employing family treatment supporters to supervise the treatment process. The TB cases of the base-line and the project expiration of the experimental group were 44 and 117. Meanwhile, three townships including Dapingshan, Longan and Gaofeng in the county with the similar condition and total population of 133 303 were selected as the control group. The control group conducted the provisions of national TB control program in the county TB clinic management. The TB cases of the base-line and the project expiration of the control group were 56 and 110. By double-direction comparison method, the effect of the new model was evaluated through TB patients detection, treatment outcomes and TB control management data. SPSS 13.0 statistical software was adopted and Chi-square test was used for analyzing technical data.</p><p><b>RESULTS</b>After two-year project research implementation, in the experimental group the detection rate of new smear-positive TB patients increased from 16.39/100 000 (25/152 518) to 51.14/100 000 (78/152 518) (χ(2) = 27.281, P < 0.01), the cure rate of new smear-positive cases increased from 71.4% (15/21)to 91.1% (51/56) (χ(2) = 4.812, P < 0.05), and the completing treatment rate in newly diagnosed smear-negative cases improved from 23.5% (4/17)to 71.4% (15/21) (χ(2) = 8.622, P < 0.01); the loss rate of newly diagnosed smear-positive cases dropped from 23.8% (5/21) to 0.0% (0/56) (χ(2) = 10.608, P < 0.01), and the loss rate of newly diagnosed smear-negative cases decreased from 64.7% (11/17) to 4.8% (1/21) (χ(2) = 15.624, P < 0.01). Meanwhile, the cure rate of new smear-positive cases in the experimental group, 91.1% (51/56), was higher than the control group, 72.0% (36/50) (χ(2) = 6.531, P < 0.05). The loss rate of newly diagnosed smear-positive cases in the experimental group (0.0% (0/56)) was lower than the control group (16.0% (8/50)) (χ(2) = 7.534, P < 0.01). During the project implementation, in the experimental group the on time rate of taking medicine, 91.5% (107/117) and receiving medicine, 100.0% (117/117), the reexamining sputum ratio, 83.6% (98/117) were higher than that in the control group 81.8% (90/110), 92.7% (102/110) and 64.5% (71/110). The differences were statistically significant (χ(2) = 4.589, 8.820 and 11.005, P < 0.05).</p><p><b>CONCLUSION</b>The new management model had been proved effective. It can improve TB case detection and cure rates, reduce the loss rate of patients, and improve patient treatment and management conditions as well.</p>