What lessons can be drawn from tuberculosis (TB) control in China in the 1990s? An analysis from a health system perspective.
China has made a significant achievement in tackling the TB epidemic over the last decade, due largely to the implementation of directly-observed treatment strategy (DOT). The cure rate of TB cases reached more than 90% for registered TB patients. However, the case detection rate has, unfortunately, been very low (some 30%). Using available information, this paper identifies four main problems facing TB control in China, these are, low case finding, a substantial proportion of TB patients failing to complete standardised treatment, increased proportion of MDR TB patients, and lack of effective TB control among "floating populations". The paper also analyses the possible causes of these problems associated with socio-economic barriers in care seeking, ineffectiveness of TB services, particularly in poor areas, lack of co-operation between health facilities, and weakness of political and financial commitments of local governments to TB control. The paper ends with the discussion of opportunities and challenges facing TB control and makes recommendations for further actions and research.
Tang
Shenglan
S
International Health Research Group of Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. stang@liv.ac.uk
Squire
Stephen Bertel
SB
D002681:China / Q000453:epidemiology; D003140:Communicable Disease Control / Q000458:organization & administration* / Q000592:standards; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D023801:Directly Observed Therapy; D018166:Health Care Reform / Q000592:standards*; D006297:Health Services Accessibility; D006801:Humans; D007373:Interinstitutional Relations; D009111:Local Government; D010349:Patient Compliance; D011203:Poverty; D011635:Public Health Administration; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D014171:Transients and Migrants; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology