復興鄉結核病的治療

The prevalence and mortality of tuberculosis (TB) in Taiwan aboriginal villages remain high. In order to investigate possible reasons for this, we enrolled from July 1, 1991, through June 30,1994, TB patients from Fu-Shing Shiang that were centrally registered into this study. We reviewed data from the National TB Date Base, medical records of the Taiwan Provincial Chronic Disease Control Bureau and the treatment and management cards of TB patients from the health station. TB patients registering during the same period at Guan-Yin Shiang were chosen as a control group. There were 73 patients from Fu-Shing Shiang and 53 patients from Guan-Yin Shiang included in the study. Among the Fu-Shing shiang patients, 48 (65.8%)were male and 25 (34.2%) were female. The mean age was 41.9 years. There were 33.3% with a family historyof TB, 23.8% with a past history of TB and 27.5% with risk factors for TB, including 18.8% who were alcoholics. The patient registry showed that 60.6% of patients were found at clinics of the official TB control sysytem, 16.7% by Mass-Miniature Radiography and only 18.2% from other medical resources. On chest X-rays, 50.7% had far-advanced pulmonary TB at diagnosis. Treatment was completed in 49.3% of patients. Of the 50.7% who did not finish their treatment, 14.9 % died of TB and 35.8% defaulted due to moncooperation. Age, alcohol use, the source of can finding, SEverity on chest X-rays and treatment cot come of Fu-Shing Shiang were all statistically difference (P valure < 0.05) form comparable data at Guarn-Yin Shiang. Those from Fu-Shing Shiage with a past history of TB and risk factors for TB, particularly alcohol abuse, had a significantly lower treatment completion rate (P valve < 0.05). From our analysis, major TB control problems of aboriginal villages are delay in detection and poor compliance with treatment. In order to reduce TB prevalence and mortality in this setting, police promoting early detection of TB and health education to reinforce patient compliance cannot to overemphasized. Directly observed therapy, the best strategy for increasing compliance, is recommended to increase treatment completion rate. However, attention to more fundamental issues, such as improving the quality of life, changing unhealthy life styles, enhancing health education and access to medical resources, are also required to solve the problem of TB in aboriginal villages.