Tubercle最新文献

A retrospective study of factors associated with poor patient compliance with antituberculosis therapy was conducted in Taiping, Perak. 219 patients were studied. Male patients and hospital referrals were significantly more likely to default. Patients with tuberculous lymphadenitis alone had a greater rate of default, but this just failed to reach significance (0.05 < p < 0.10). Six of 7 male hospital referrals with tuberculous lymphadenitis alone defaulted. Patients treated as outpatients from the start were more compliant. Housewives were also highly compliant. It was noticed that patients who defaulted tended to do so during early stages of treatment.

Declining use of the services of local dispensaries has often been suggested as a significant factor in the rising trend of tuberculosis in Turkey after 1970. Data confirming this view were insufficient until this study, which consists of an evaluation of the records of 51 086 subjects seen by the tuberculosis dispensary in Elaziǧ between 1985–1989. We found that, despite an expected yearly population increase, there were no significant differences in the numbers of diagnostic and follow-up procedures as well as preventive and therapeutic interventions recorded in different years, and that cases of active tuberculosis lost to follow-up had gradually increased. The least effective method of case-finding, mass screening, had been employed most frequently.

These results revealed a less than optimum use of the services of the tuberculosis dispensary and prompted us to suggest the following changes: (1) diversion of economic resources currently used for mass screening in order to use them for better purposes; (2) functional integration of tuberculosis dispensaries with local, general or university hospitals, since a separate system for tuberculosis care is accompanied by a segregating and stigmatising effect for all concerned; (3) entering all patients and contacts into a computerised database to alleviate the problems associated with inadequate follow-up.

We conclude that existing control programmes should be reviewed and improved to prevent an increase of tuberculosis, particularly in developing countries like Turkey.

The prevalence and incidence of active tuberculosis among 21 959 recently arrived (1982–1985) immigrants from 7 selected Asian countries into British Columbia (BC), Canada, were reviewed. Among these newly arrived immigrants, 1173 (5.3%) were judged to have inactive tuberculosis at the immigration examination in their country of origin. In this subgroup, 14 of 932 (1.5%) were found to have active tuberculosis at the initial examination after arrival in Canada. Subsequently, 7 further cases arose in this group of inactive cases giving an average annual incidence rate of 0.33% over the 4-year period of study. Only 3 of these 21 cases had previous antituberculosis chemotherapy. The remaining 20 786 recent immigrants with normal X-rays at the immigration examination contributed 30 cases during the next 4 years — an average annual incidence rate of 0.08% or 8 times the comparable rate for BC (0.01%).

The limitations of the immigration screening process are illustrated and the value of early surveillance of immigrants designated as having inactive tuberculosis is underlined. The apparent failure to exclude active disease prior to the arrival of these immigrants is one factor elevating the incidence of active tuberculosis in the first few years after arrival in the host country. Other factors include the relatively high prevalence of inactive tuberculosis among the immigrants from certain countries and their high rate of early relapse after entry, especially in those not previously treated. Such immigrants should be considered for chemoprophylaxis immediately after entry.

Tuberculosis remains a major health problem in South-East Asia and ranks high in the list of causes of morbidity and mortality. There are still many smear-positive cases, about half a million in Indonesia and almost 400 000 in the Philippines, and these are a reservoir of infection. Cooperation between countries in this region is required for the control of tuberculosis.