[Factors associated with diagnostic delay for patients with smear-positive pulmonary tuberculosis in rural Hunan, China].

OBJECTIVE: To explore the influences of socio-economic, health services, cultural beliefs, and symptoms on health seeking behavior of tuberculosis patients attending county tuberculosis dispensaries in rural Hunan province of China. METHODS: A cross-sectional descriptive survey was conducted in 4 counties randomly stratified by economic status from 122 counties, Hunan, China. After informed consent, a consecutive sample of patients, aged 15 years and older, with smear-positive pulmonary tuberculosis were interviewed and completed a pre-tested questionnaire. RESULTS: A total of 318 patients with smear-positive pulmonary tuberculosis were interviewed. The median of patient delay, health system delay and total delay were 30, 24 and 65 days, respectively. Logistic regression shows that factors significantly contributed to patient delay were haemoptysis, far distance to health institute, seeking folk therapy, and lower per capita income. Factors significantly associated with health system delay were female, lower level of education, prior health education on tuberculosis, seeking folk therapy and stigma associated with tuberculosis. CONCLUSION: In order to reduce diagnostic delay, integrated measures including extensive training of medical staff in non-tuberculosis health facilities, decentralization of services and more specific and effective health education on tuberculosis should be taken.

[Knowledge and practice regarding tuberculosis among final-year medical students in Hunan, China].

OBJECTIVE: To ascertain the level of knowledge, skills and ability about tuberculosis among final-year medical students in Hunan province of China. METHODS: The final-year medical students from 3 medical schools were asked to complete a pre-tested questionnaire by random sampling. The questionnaire consisted of 12 and 6 multiple-choice questions assessing knowledge and practices about tuberculosis, respectively. RESULTS: Four hundred and thirty-nine questionnaires were returned with a response rate of 97.6%. The majority of the students knew well on signs/symptoms associated with tuberculosis, but only a few students knew the prevalence of smear-positive pulmonary tuberculosis in China in 2000, while 25.5% of them knew of the BCG vaccination. 33.5% of the participants understood the policy of convergence case-management of tuberculosis. Analysis showed that six of twelve items were slightly statistically different among the respondents. The study also demonstrated that 334 respondents had prescribed 80 different treatment regimens but only 16.8% were correct. 33.4% of the participants ordered sputum examination during tuberculosis treatment course. Only 4.5% had transferred the patients with tuberculosis to local tuberculosis dispensary after their discharge from hospital. CONCLUSIONS: Knowledge and practice competency regarding tuberculosis among the final-year medical students were generally inadequate. Many misunderstandings were found in the field of BCG vaccination, the status of tuberculosis and the performance of National Tuberculosis Project (NTP). These findings suggest that there is a lack of emphasis on proper health education about tuberculosis. Students in medical schools need more training and more practice.

[A nested case-control study on the influencing factors of tuberculosis among people living with HIV/AIDS in Hunan province].

OBJECTIVE: To determine the risk factors related to tuberculosis infection among people living with HIV/AIDS and to develop strategies for preventing the co-infection. METHODS: A 1:2 matched nested case-control study was carried out to analyze the influencing factors of tuberculosis among people living with HIV/AIDS. RESULTS: 1018 people living with HIV/AIDS were followed up for one year with a total number of 736.75 person-years, among them 62 tuberculosis cases were diagnosed. The incidence density of tuberculosis among people living with HIV/AIDS was 8.42 persons per 100 person-years. Factors as education level(OR = 0.483), vaccination history of Bacille Calmette Guerin (OR = 0.561), CD(4)(+) count T-lymphocyte (OR = 0.356), unemployment (OR = 1.976), living alone (OR = 2.646), and smoking (OR = 2.215) were significantly related to the prevalence of tuberculosis among people living with HIV/AIDS. CONCLUSION: High education level, with vaccination history of Bacille Calmette Guerin and high level of CD(4)(+) T-lymphocyte count were protective factors while being unemployed, living alone, and smoking habit were risk factors related to the prevalence of tuberculosis among people living with HIV/AIDS.