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地点:Red Sea、Gadaref以及Khartoum州的转诊医院和初级卫生保健(PHC)机构。目的:评价结核病诊疗服务分散化对结核病临床表现以及治疗结局的影响。设计:在苏丹选定三个地区,根据PHC机构和转诊医院病人的常规信息进行病例发现以及治疗结局的队列分析。结果:就诊于转诊医院的结核病人中有2/3得以确诊,而在PHC机构的就医者则只有1/3明确了结核病诊断。女性病例占PHC机构报告病例的46％,占转诊医院报告病例的37.9％(OR=1.398,95％可信区间:1.343-1.455)。高年龄组人群就医于PHC机 构的可能性大于转诊医院。在转诊医院就医的病人中,38％治愈,29.3％完成疗程但未进行涂片检查,17.3％中断治疗;而在PHC机构的就医者,则有58％治愈,17.8％完成疗程但未进行涂片检查,11.6％中断治疗。结论:PHC机构为较高比例的女性以及年老结核病人提供了医疗服务,这提示女性以及年老结核病人对PHC机构有较高的利用率。PHC机构有较高的治愈率和较低的治疗中断率,这可能反映出其具有良好的直接督导治疗以及随访条件。
Location: Red Sea, Gadaref and Khartoum state referral hospitals and primary health care (PHC) agencies. OBJECTIVE: To evaluate the impact of decentralized treatment services for tuberculosis on clinical manifestations and outcomes of tuberculosis. Design: Three regions were selected in the Sudan and cohort analyzes of case findings and treatment outcomes were conducted on the basis of routine information from PHC institutions and referral hospital patients. Results: Two-thirds of tuberculosis patients attending referral hospitals were diagnosed, while only one-third of physicians in PHC establish a diagnosis of tuberculosis. Female cases accounted for 46% of reported cases in PHC institutions and 37.9% of reported cases in referral hospitals (OR = 1.398, 95% confidence interval: 1.343-1.455). Older groups are more likely to seek PHC institutions than referral hospitals. Of the patients referred to the hospital, 38% were cured, 29.3% completed the treatment but did not undergo smear examination, and 17.3% discontinued treatment while 58% of the PHC institutions were cured and 17.8% completed the treatment but did not proceed Pap smear, 11.6% discontinued treatment. Conclusion: The PHC facility provided medical services to a high percentage of women as well as older TB patients, suggesting that women and older tuberculosis patients have a higher utilization rate of PHC institutions. PHC institutions have a higher cure rate and a lower treatment disruption rate, which may indicate that they have good direct supervision and treatment and follow-up conditions.