The changing face of tuberculosis control in a rural district of New Zealand.
METHODS
Waikato Health District (WHD), New Zealand.


OBJECTIVE
To describe the changing epidemiology of TB in the WHD and the factors responsible for this.


METHODS
Descriptive epidemiological study of all notified TB cases from the WHD from 1 January 1992 to 31 December 2001. Major outcome measures were delay of diagnosis and treatment outcome.


RESULTS
There were 244 cases included. Over the 10-year period, TB incidence has remained stable in the WHD. There has been a significant reduction of TB in the Maori population (from 30.3 to 12.5/100,000, P = 0.03). This has been matched by a rise in the overseas-born population (from 4.6 to 21.2/100,000, P = 0.04). Tuberculosis became a predominantly urban disease during the study period. Delay in diagnosis (>4 weeks) occurred in 85% of cases, with significantly more delays in older age groups. Use of directly observed therapy (OR 3.65, 95%CI 1.24-10.76), and being a migrant (OR 3.52, 95%CI 1.74-7.09), were significantly associated with improved treatment outcome.


CONCLUSIONS
A significant change in the epidemiology of TB has occurred over the last decade. Tuberculosis control strategies need to be developed to effectively diagnose and treat patients from diverse cultural backgrounds.
van der Oest
A C
AC
Menzies School of Health Research, Darwin, Northern Territory, Australia. clif.vanderoest@nt.gov.au
Kelly
P
P
Hood
D
D
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D012307:Risk Factors; D012424:Rural Population; D016896:Treatment Outcome; D014376:Tuberculosis / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control*
D000995:Antitubercular Agents