Population aging and migrant workers: bottlenecks in tuberculosis control in rural China.
BACKGROUND
Tuberculosis is a serious global health problem. Its paradigms are shifting through time, especially in rapidly developing countries such as China. Health providers in China are at the forefront of the battle against tuberculosis; however, there are few empirical studies on health providers' perspectives on the challenges they face in tuberculosis control at the county level in China. This study was conducted among health providers to explore their experiences with tuberculosis control in order to identify bottlenecks and emerging challenges in controlling tuberculosis in rural China.


METHODS
A qualitative approach was used. Semi-structured, in-depth interviews were conducted with 17 health providers working in various positions within the health system of one rural county (ZJG) of China. Data were analyzed based on thematic content analysis using MAXQDA 10 qualitative data analysis software.


RESULTS
Health providers reported several problems in tuberculosis control in ZJG county. Migrant workers and the elderly were repeatedly documented as the main obstacles in effective tuberculosis control in the county. At a personal level, doctors showed their frustration with the lack of new drugs for treating tuberculosis patients, and their opinions varied regarding incentives for referring patients.


CONCLUSIONS
The results suggest that several problems still remain for controlling tuberculosis in rural China. Tuberculosis control efforts need to make reaching the most vulnerable populations a priority and encourage local health providers to adopt innovative practices in the local context based on national guidelines to achieve the best results. Considerable changes in China's National Tuberculosis Control Program are needed to tackle these emerging challenges faced by health workers at the county level.
Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P. R. China ; Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, P. R. China.
Sumedh
S
Bele
Department of Tuberculosis, Center for Disease Control and Prevention of Zhangjiagang, Suzhou, P. R. China.
Wei
W
Jiang
Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P. R. China.
Hui
H
Lu
Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P. R. China.
Hua
H
You
Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P. R. China.
Hong
H
Fan
Department of Tuberculosis, Center for Disease Control and Prevention of Zhangjiagang, Suzhou, P. R. China.
Lifang
L
Huang
Department of Tuberculosis, Center for Disease Control and Prevention of Zhangjiagang, Suzhou, P. R. China.
Qungang
Q
Wang
Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, P. R. China.
Hongbing
H
Shen
Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P. R. China ; Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, P. R. China.
Jianming
J
Wang
D000368:Aged; D000375:Aging / Q000502:physiology*; D000995:Antitubercular Agents / Q000191:economics; D002681:China / Q000453:epidemiology; D003140:Communicable Disease Control / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D010820:Physicians / Q000523:psychology*; D011379:Prognosis; D036301:Qualitative Research; D012424:Rural Population; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000523:psychology*; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology
D000995:Antitubercular Agents