Table of Content

10 September 2012, Volume 34 Issue 9

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Development and expectation of tuberculosis service system in China

JIANG Shi-wen，ZHANG Hui，WANG Li-xia

Chinese Journal of Antituberculosis. 2012, 34(9):  557-559. 

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The effect analysis of building the Shandong standardized county for tuberculosis prevention and control

GUO Xiao-yan, LI Fang, WANG Yu, JIN Jin, SONG Chun-yan

Chinese Journal of Antituberculosis. 2012, 34(9):  560-566. 

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Objective  To describe the effect of normative county establishment activity of the tuberculosis prevention and control in Shandong.   Methods  The standard for normative county was developed according to “the tuberculosis prevention and control normative”. The county health administration of 38 demonstration counties volunteered to make application, health administration at prefecture level reviewed primarily and the provincial health bureau approved, 19 counties were determined as establishment units finally. Financial support and technical guide were provided by the provincial TB control center. The county TB dispensaries standardized the TB control work according to the standard, those passed examination of the provincial health bureau became “normative county”.   Results  In the 19 establishment units, 17 units are approved to be “normative county”. The TB control funding of these counties has come up to more than 0.3 yuan per capita. The number of professional staffs also meets the standard of the normative. The proportion of the patients for first visit in the whole population has almost reached 300/100 000. The rates of taking X-ray and sputum test have reached 100%. The cure rate of new smear positive patients remains at 85% and above. The total arrival rate of non TB institutes has reached 90% and above.   Conclusion  The professional proficiency of the basic organizations of TB control has been generally improved and the foundation of better TB control work has been laid through the establishment activity.

Frequency and geographical distribution of people with suspected pulmonary tuberculosis symptoms in China

LI Jun，LIU Xiao-qiu, LI Xue，JIANG Shi-wen，ZHANG Hui，WANG Li-xia

Chinese Journal of Antituberculosis. 2012, 34(9):  567-571. 

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Objective  To understand the frequency and geographical distribution of people with suspected pulmonary tuberculosis (PTB) symptoms in China.   Methods  According to the fifth National Tuberculosis Epidemiological Sampling Survey, questionnaire survey was adopted to screen the people with suspected PTB symptoms (cough, expectoration ≥2 weeks and/or hemoptysis) aged 15 and above nationwide (excluding Hong Kong, Macao and Taiwan regions), the rates of people with suspected PTB symptoms in different population and areas were analyzed.   Results  The rate of people with suspected PTB symptoms in population aged 15 and above was 2.1% (5399/252 940). The rate in male was 2.8% (3324/116 939), higher than 1.5% (2075/136 001) of female (χ²=521.9, P<0.001). There was a significant statistic difference among the rate of different age groups (χ²=2356.6,P<0.001). People aged 65 and above was 2.976-3.335 times (OR=3.150，95%CI=2.976-3.335) more likely to develop suspected PTB symptoms than people aged 15 to 65. The rate in residence was 2.2% (5026/229 923), higher than 1.6% (373/23 017) of migrants (χ²=30.8, P<0.001). The rate in rural area was 2.5% (3488/138 057), higher than 1.7% (1911/114 883) of urban area (χ²=214.4, P<0.001). The rate in western, central and eastern regions were 3.6% (2522/69 896), 2.0% (1603/80 926) and 1.2% (1274/102 118) respectively, with significant statistic differences (χ²=1066.9, P<0.001). Significant statistic differences were also found among the rates in plain, hill, mountain and other areas (χ²=350.8, P<0.001).   Conclusion  Various measures should be taken to increase the case detection efficiency of people with suspected PTB symptoms in China.

Analysis of the socio-economic status of 1301 tuberculosis cases

RUAN Yun-zhou, HE Guang-xue, ZHANG Hui, JIANG Shi-wen, WANG Xue-jing, WANG Li-xia

Chinese Journal of Antituberculosis. 2012, 34(9):  572-575. 

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Objective  To describe and analyze the socio-economic status of active tuberculosis patients detected in the fifth National Tuberculosis Epidemiological Sampling Survey.   Methods  1301 cases out of 1310 active TB patients detected in the fifth National Tuberculosis Epidemiological Sampling Survey were interviewed face-to-face by the trained professionals with structured questionnaire including the socio-economic status and medical expenses.   Results  Among 1301 cases, 32.3% (420/1301) cases were illiterates or semiliterates, 59.2% (770/1301) were farmers, 15.4% (201/1301) had no occupation, 48.8% (635/1301) were 60 years old or above and more than 70% were distributed in the middle-western region (965/1301) or in rural areas (928/1301). 82.8% (1070/1293) cases had the annual family income per capita which were below the local average. 50.8% (555/1092) had the personal income which were accounted for half of the total household income or above. For medical expenses during the diagnosis period, it was 360 yuan (median) for new cases, among whom 74.2% (161/217) paid the total medical expenses by themselves, and 16.9% (36/213) were in catastrophic expenditures. During the same period, it was 790 yuan (median) for known cases, among whom 62.5% (80/128) paid the total medical expenses by themselves, and 19.5% (26/133) were in catastrophic expenditures. Due to illness during the diagnosis period, 21.1% (130/617) were in the loss of working time and the loss of income was 16.6-18.2 yuan per day.   Conclusion  Pulmonary tuberculosis cases have low socio-economic status and are special populations with fragile economy. Suffering from tuberculosis poses adouble whammy for the family with both the sources of income reduction and high medical expenses. It is recommended that the government should improve TB patients’ care and subsidies, and  expand free items for diagnosis appropriately.

Analysis on the national reimbursement situation of outpatient medical expenses of pulmonary tuberculosis in different medical insurance systems in 2009

ZHANG Can-you, WANG Li-xia, CHENG Jun, ZHANG Hui

Chinese Journal of Antituberculosis. 2012, 34(9):  576-579. 

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Objective  To identify the reimbursement situation of outpatient medical expenses of pulmonary tuberculosis in different medical insurance systems.  Methods  The data of the reimbursement situation of outpatient medical expenses of pulmonary tuberculosis of 2613 counties/districts in 2009, which came from the final assessment of National Tuberculosis Control  Programme (2001—2010)was utilized to analyse the following questions: whether to reimburse the outpatient medical expenses, whether there was a reimbursement norm, and the ratio/limit of the reimbursement in the New Rural Cooperative Medical System, the Basic Medical Insurance System for Urban Residents and the Basic Medical Insurance System for Urban Employees.  Results  The ratios of the counties/districts, which could reimburse the outpatient medical expenses, of different medical insurance system were 51.1% (1324/2592), 21.8% (561/2575) and 27.5% (705/2568); the ratios of the counties/districts, which had reimbursement norms, were 835% (1106/1324), 70.4% (395/561) and 73.9% (521/705); the medians of the reimbursement ratios were 40% (P₂₅：30%，P₇₅：50%), 50% (P₂₅：40%，P₇₅：60%) and 75% (P₂₅：65%，P₇₅：85%); the medians of the reimbursement limits were 490 Yuan (P₂₅：215 Yuan，P₇₅：600 Yuan), 500 Yuan (P₂₅：100 Yuan，P₇₅：800 Yuan) and 825 Yuan (P₂₅：450 Yuan，P₇₅：2000 Yuan).  Conclusion  With the exception of current free medical policies for pulmonary tuberculosis patients in China, the coverage of reimbursement of outpatient medical expenses of pulmonary tuberculosis remains limited, the ratio/limit of the reimbursement is not enough, and reimbursement norms in the national essential medical insurance system have not been developed yet in some of the counties/districts. The economic burden is still heavy for pulmonary tuberculosis cases.

Human resources survey and staffing assessment of Beijing district level tuberculosis institutions

CHEN Xi, WANG Yan-li, HE Xiao-xin, ZHANG Hong-wei, ZHANG Tian-hao, GUO Hai-jun, ZHAO Xin, GAO Zhi-dong, Li Bo, HONG Feng

Chinese Journal of Antituberculosis. 2012, 34(9):  580-584. 

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Objective  To investigate the situation of human resources of TB prevention and control system at district level in Beijing, and evaluate the fairness of demographic and geographic distribution of health resources.  Methods  All 326 professionals at 18 district level TB institutions were investigated by questionnaires from August to September in 2011, including their age, educational background, and professional title information. The data related to population and geographical acreage was also collected to estimate the fairness by Lorenz Curve and Gini Coefficient.  Results  Among the 326 TB professionals at the district level in Beijing, the mean age was (42.04±5.37) years. Most professionals were graduated from college or below, accounting for 74.85 % (244/326), undergraduate degrees accounted for 21.78% (71/326), master degrees accounted for 3.07% (10/326), no doctoral degrees. 52.15% (170/326）staff had junior titles, 40.18% (131/326) had medium level titles, and only 4.60% (15/326) had senior titles. The average service population per professional was 53 800, and service radius of 4.05 km. According to the demographic and geographic distribution, the Gini Coefficient is 0.49 and 0.62 respectively.  Conclusion  In Beijing district level TB institutions, the education of TB professionals was inadequate, number of staff with medium or senior title was low, and the staffing did not meet the fairness requirement in geographical and population distribution. Therefore, Beijing district level human resources need to be further strengthened.

Systematic review and implemention progress of DOTS strategy

CHENG Shi-ming, LIU Er-yong, WANG Fang, MA Yan, ZHOU Lin, WANG Li-xia, WAN Li-ya

Chinese Journal of Antituberculosis. 2012, 34(9):  585-591. 

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Objective  To describe and review the implementation progress of DOTS strategy.  Methods  Through discussion with the invited experts, we determined the key words of retrival literature, and searched 12 database, 4 health agencies websites and Google Scholar. A total of 2182 papers between 1990—2010 were searched out including papers describing or evaluating DOTS strategy, cost-effectiveness analysis, experience on prevention and control.  Results  Of the 26 studies included in the analysis, 11 studies were WHO annual reports, 10 studies aimed to describe and evaluate DOTS strategy, 5 studies aimed to evaluate the effectiveness of DOTS strategy; the implementation of the DOTS strategy raised the cure rates by 13.1%-92.1%,the treatment success rate increased to 92.4%-95.0%, the registration rate increased by 163.0%-217.8%; prevalence rate and the loss rate decreased by 30.0%-50.0% and 73.0%-52.6% respectively. In addition, implementation of the DOTS strategy improved the cost-effectiveness as well. Conclusion  The strong government commitment is prerequisite for sustainable implementation of the strategy, effective implementation of the DOTS strategy put the TB under control, meanwhile has a good cost-effectiveness.

Analysis of detection and treatment outcomes of pulmonary tuberculosis in China from 2001 to 2010

LI Xue, LIU Xiao-qiu, ZHANG Hui, CHEN Rong, JIANG Shi-wen, XIE Hai-bo

Chinese Journal of Antituberculosis. 2012, 34(9):  592-595. 

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Objective  To analyze case finding and treatment outcomes of pulmonary tuberculosis in China from 2001 to 2010 and provide scientific evidence for TB control and prevention.  Methods  The data of TB information management system of National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, TB Control Quarterly Report from 2004 to 2010 and TB Control Annual Report from 2001 to 2010 in China were used, combined with special investigation to collect TB data. Description statistic was applied to analyse the referral and tracing situation of 5 799 344 TB patients reported by general hospitals via internet-based infectious disease reporting system from 2004 to 2010, as well as the situation of 15 864 493 TB suspects for the first visit in TB dispensary  from 2006 to 2010 and 8 285 978 active TB patients registered in TB dispensary at all levels from 2001 to 2010.  Results  The average referral arrival rate and tracing arrival rate were 45.1% （2 614 216/5 799 344） and 64.6% （1 740 840/2 695 781） respectively by general hospitals via internet-based infectious disease reporting system during 2004 to 2010. The overall arrival rate has increased from 56.9% （263 324/463 085） in 2004 to 86.5% （846 268/978 477） in 2010. From 2006 to 2010, about 15 864 493 TB suspects were treated by TB dispensary at all levels, almost 3.173 million per year. From 2001 to 2010, 8 285 978 active TB patients were found by TB dispensary at all levels, among whom 4 501 587 (54.3%) were smear positive, 3 563 369 (43.0%) were smear negative and 221 022 (2.7%) were no smear examination. The proportion of re-treatment dropped from 15.8% （89 112/562 801） in 2005 to 11.2% （54 216/484 115 ） in 2010 and the proportion of no smear examination dropped from 7.9% （39 396/495 635） in 2001 to 0.3% （2461/906 856） in 2010.  Conclusion  With the implementing of  National Tuberculosis Control Programme, the TB case detection has been continuously improved and remarkable achievement has been made in China.

Systematic review on the management model for multi-drug resistant tuberculosis

WANG Ni，WANG Li-xia，ZHU Kun，LIU Er-yong，ZHOU Lin，CHENG Shi-ming，WAN Li-ya

Chinese Journal of Antituberculosis. 2012, 34(9):  596-600. 

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Objective  Systematic review on different international management model for multi-drug resistant tuberculosis and explore the strategies tailored to China.  Methods  Related publications, conference information and other materials were searched in PubMed, ProQuest, CHKD and WANFANG DATA (2000—2010)，1151 studies were retrieved, except view articles, letters, news, editorials, reviews, bibliography and conference summary, 14 full-text studies and 3 published documents were included and analyzed.  Results  The results showed that there are mainly 4 kinds of management model：inpatient-based model，mainly implemented in the United States, France and other developed countries, patients are asked for receiving inpatient treatment (3 studies), outpatient-based model，patients are required to take examination and receive drug regularly in outpatient (1 studies), inpatient-outpatient based model，patients need to receive inpatient treatment throughout the intensive phase or until sputum bacteriological conversion, and then continued outpatient treatment (4 studies), and community-based model, mainly adopted in low and middle income countries, upgrades from the outpatient-based model and with emphasis on the NTP coverage (6 studies).  Conclusion  The model selection should base on the TB epidemic, economy, the coverage of NTP and the health care system. The inpatient-community-based management model should be developed for the management of drug resistant TB in China.

The recommendation for programmatic management of multi-drug resistant tuberculosis training needs analysis

XU Cai-hong, LI Ren-zhong, WANG Li-xia, CHEN Ming-ting

Chinese Journal of Antituberculosis. 2012, 34(9):  601-603. 

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To provide policy advice for training needs analysis and budget of Programmatic Management of Multidrug Resistant Tuberculosis (PMDT) through analyzing the training category, frequency and human resource requirement of China Global Fund TB Program and China MOH-Gates Foundation TB Control Project. Results show for smooth operation of PMDT,  clinical long-term training, training on laboratory, PMDT guideline and intensive training were necessary. The numbers of staff needed training were 10, 48, and 6 at provincial, prefecture and county level respectively. The average training fee for each PMDT sites was 1.25 million yuan. This paper provides reference for training needs analysis and budget of PMDT conducted nationwide in future.

Discussion and application of the social benefit assessment methods for tuberculosis control and prevention

RUAN Yun-zhou, HE Guang-xue, CHENG Shi-ming, JIANG Shi-wen, WANG Li-xia

Chinese Journal of Antituberculosis. 2012, 34(9):  604-610. 

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Three most common methods in Health Economics such as cost-effectiveness, cost-utility, cost-benefit were employed to assess the social effect, social utility and social cost during the implementation of the National Tuberculosis Control Programme (2001—2010) (referred to as the “NTP”). Data come from “NTP” final assessment report and China Statistical Yearbook-2011. The results showed that the total of about 8.36 billion yuan of a variety of resources were invested during the implementation of the“NTP”, successfully treated with 4.31 million cases of infectious TB patients, prevented 32.31 (19.39-48.47) million healthy people from infection, about 3.23 (1.94-4.85) million healthy people were avoided becoming pulmonary tuberculosis cases, and 2.26 (1.36-3.39) billion yuan of medical cost was saved. On the other hand, about 389.44 billion yuan of the social and economic losses altogether were saved because of patients’ recovery and social productivity loss reduction with successful treatment. On the basis of the current staff and facilities, additional input of the government with one yuan can produce the economic benefits of 46.8 yuan. Only 259 yuan needed to avoid a healthy person infected and only 272 yuan needed to save the loss of a DALY. The implementation of the “NTP” has achieved good social and economic effects, and it is recommended that the government at each level continues to increase the investment of TB control.

Tuberculosis epidemic situation and control strategy

CHEN Wei，XIA Yin-yin，CHENG Shi-ming

Chinese Journal of Antituberculosis. 2012, 34(9):  611-613. 

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The application of γ interferon release test in detecting the latent infection of Mycobacterium tuberculosis

XIONG Yong-chao, HOU Yue-yun, ZHAO Jian-zhong, GUO Hui, HE Guang-xue

Chinese Journal of Antituberculosis. 2012, 34(9):  613-616. 

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