Socio Economic Position in TB Prevalence and Access to Services: Results from a Population Prevalence Survey and a Facility-Based Survey in Bangladesh
Socio Economic Position in TB Prevalence and Access to Services: Results from a Population Prevalence Survey and a Facility-Based Survey in Bangladesh
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DOI：
10.1371/journal.pone.0044980
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发表时间：
2012-09-27
期刊：
影响因子：
3.7
通讯作者：
van Leth, Frank
中科院分区：
文献类型：
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作者：
Hossain, Shahed;Quaiyum, Mohammad Abdul;van Leth, Frank
背景：孟加拉国自1993年以来一直免费提供直接督导下的短程化疗，但不同人群获得结核病服务的信息没有很好的记录。本研究的目的是评估和比较孟加拉国社区主动发现病例和国家结核病控制规划常规发现病例的社会经济状况。方法和结果：对2007-2009年全国结核病流行调查中纳入的21,427户家庭的SEP进行了有效资产项目评估。主成分分析生成家庭得分，并按四分位数分类。将33例主动确定病例的分布与240例国家结核控制项目病例在相同SEP四分位数上的分布进行比较，以评估不同人群获得结核病服务的情况。结核病的人群患病率在最低四分位数人群（95.4,95% CI: 48.0-189.7）和最高四分位数人群（19.5,95% CI: 6.9-55.0）中高出5倍。在调查中发现的33例病例中，25例（75.8%）来自下2个四分位数，其余8例（24.3%）来自上2个四分位数。在国家结核控制规划被动发现的结核病病例中，其中一半以上（137例（57.1%））来自最上层的两个四分位数，98例（41%）来自第二四分位数，5例（2%）来自最低人群的四分位数。当对其他因素或它们之间的相互作用进行调整时，该分布不受影响。结论：研究结果表明，尽管短程化疗是免费的，但贫困人口并没有平等地获得短程化疗。然而，这些数字应该谨慎解释，因为需要进行更多的研究，以评估深入的贫困指标及其与孟加拉国提供的结核病服务的获取有关的决定因素。
Background: In Bangladesh DOTS has been provided free of charge since 1993, yet information on access to TB services by different population group is not well documented. The objective of this study was to assess and compare the socio economic position (SEP) of actively detected cases from the community and the cases being routinely detected under National Tuberculosis Control Programme (NTP) in Bangladesh.Methods and Findings: SEP was assessed by validated asset item for each of the 21,427 households included in the national tuberculosis prevalence survey 2007-2009. A principal component analysis generated household scores and categorized in quartiles. The distribution of 33 actively identified cases was compared with the 240 NTP cases over the identical SEP quartiles to evaluate access to TB services by different groups of the population. The population prevalence of tuberculosis was 5 times higher in the lowest quartiles of population (95.4, 95% CI: 48.0-189.7) to highest quartile population (19.5, 95% CI: 6.9-55.0). Among the 33 cases detected during survey, 25 (75.8%) were from lower two quartiles, and the rest 8 (24.3%) were from upper two quartiles. Among TB cases detected passively under NTP, more than half of them 137 (57.1%) were from uppermost two quartiles, 98 (41%) from the second quartile, and 5 (2%) in the lowest quartile of the population. This distribution is not affected when adjusted for other factors or interactions among them.Conclusions: The findings indicate that despite availability free of charge, DOTS is not equally accessed by the poorer sections of the population. However, these figures should be interpreted with caution since there is a need for additional studies that assess in-depth poverty indicators and its determinants in relation to access of the TB services provided in Bangladesh.