Ebola, fragile health systems and tuberculosis care: a call for pre-emptive action and operational research
Ebola, fragile health systems and tuberculosis care: a call for pre-emptive action and operational research
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DOI：
10.5588/ijtld.15.0355
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发表时间：
2015-11-01
影响因子：
4
通讯作者：
Harries, A. D.
中科院分区：
文献类型：
--
作者：
Zachariah, R.;Ortuno, N.;Harries, A. D.
2013年末爆发的埃博拉疫情是迄今为止规模最大、持续时间最长的一次。它发生在世界上一个原有卫生系统已经脆弱的地区，在疫情期间，由于以下原因而进一步恶化：卫生工作者大量死亡；卫生设施暂时或永久关闭；卫生工作者得不到报酬；民众对感染埃博拉病毒或受到埃博拉病毒污名的固有恐惧，这对求医行为产生了不利影响；对受埃博拉病毒影响的社区进行强制隔离，限制弱势个人使用卫生设施；以及国际社会反应迟缓。也有报告称，由于凌驾于与埃博拉相关的优先事项之上，采购和供应链存在缺陷，导致药品和消耗品短缺。提供结核病(TB)护理和实现有利的治疗结果需要一个功能齐全的卫生系统、准确的患者跟踪和高度的患者对治疗的坚持。此外，由于埃博拉很容易通过体液传播，在暴发期间需要避免使用对结核病诊断和治疗至关重要的针头。我们强调持续的埃博拉疫情可能危及结核病活动的方式，并建议在等待业务研究证据的同时采取先发制人的预防措施。
The Ebola outbreak that started in late 2013 is by far the largest and most sustained in history. It occurred in a part of the world where pre-existing health systems were already fragile, and these deteriorated further during the epidemic due to a large number of health worker deaths; temporary or permanent closure of health facilities; nonpayment of health workers; intrinsic fear of contracting or being stigmatised by Ebola among the population, which negatively influenced health-seeking behaviour; enforced quarantine of Ebola-affected communities, restricting the access of vulnerable individuals to health facilities; and late response by the international community. There are also reports of drug and consumable stockouts due to deficiencies in the procurement and supply chain as a result of overriding Ebola-related priorities. Providing tuberculosis (TB) care and achieving favourable treatment outcomes require a fully functioning health system, accurate patient tracking and high patient adherence to treatment. Furthermore, as Ebola is easily transmitted through body fluids, the use of needles-essential for TB diagnosis and treatment-needs to be avoided during an outbreak. We highlight ways in which a sustained Ebola outbreak could jeopardise TB activities and suggest pre-emptive preventive measures while awaiting operational research evidence.