Turning liabilities into resources: informal village doctors and tuberculosis control in Bangladesh
Turning liabilities into resources: informal village doctors and tuberculosis control in Bangladesh
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DOI：
10.2471/blt.05.023929
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发表时间：
2006-06-01
期刊：
影响因子：
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通讯作者：
Lönnroth, Knut
中科院分区：
文献类型：
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作者：
Hamid Salim, MA;Uplekar, Mukund;Lönnroth, Knut
1998年，孟加拉国达米安基金会邀请半合格的私人“乡村医生”（孟加拉语为“乡村医生”）参加孟加拉国农村2 600万人口的结核病方案。该组织培训了12 525名乡村医生，不仅将疑似结核病病例转诊进行免费诊断，而且免费提供直接观察治疗。转诊来源和DOT地点被记录为标准化结核病记录和报告系统的一部分，这使我们能够量化乡村医生对病例发现率的贡献，也使我们能够对治疗结果进行分类队列分析。2002 - 2003年，研究区痰涂片阳性肺结核病例中有11%是由村医转诊的，村医转诊病人的痰涂片阳性率为14.4%。1998-2003年期间，18 792名患者接受了村医的DOT治疗，占接受治疗患者的20%至45%。整个治疗期间的成功率约为90%。在随机检查治疗依从性时采集的尿液样本中，98%的乡村医生治疗的患者异烟肼呈阳性。在公私混合DOTS框架内，由半合格的私营卫生保健提供者提供的服务是改善农村贫困人口获得负担得起的高质量结核病治疗的可行和有效的方法。在资源贫乏的国家，存在着大量的非正规卫生工作者，可用于实现公共卫生目标。乡村医生参与结核病控制现已成为孟加拉国的国家政策。
In 1998, the Damien Foundation Bangladesh invited semi-qualified, private "gram dakter" (Bangla for "village doctors") to participate in tuberculosis (TB) programmes in a population of 26 million people in rural Bangladesh. The organization trained 12 525 village doctors to not only refer suspected TB cases for free diagnosis but also to provide directly observed treatment (DOT) free of charge. Source of referral and place of DOT was recorded as part of the standardized TB recording and reporting system, which enabled us to quantify the contribution of village doctors to case detection rates and also allowed disaggregated cohort analysis of treatment outcome. During 2002 and 2003, 11% of all TB cases with positive sputum smears in the study area had been referred by village doctors; the rate of positive tests in patients referred by village doctors was 14.4%. 18 792 patients received DOT from village doctors, accounting for between 20% and 45% of patients on treatment during the 1998-2003 period. The treatment success rate was about 90% throughout the period. Urine samples taken during random checks of treatment compliance were positive for isoniazid in 98% of patients treated by village doctors. Within the framework of Public-Private Mix DOTS, services provided by semi-qualified private health care providers are a feasible and effective way to improve access to affordable high quality TB treatment in poor rural populations. The large informal health workforce that exists in resource poor countries can be used to achieve public health goals. Involvement of village doctors in TB control has now become national policy in Bangladesh.