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在马拉维布兰泰尔结核病检测历史的社区层面的变化
E S Nightingale1, H R A Feasey2, M Khundi3
1London School of Hygiene & Tropical Medicine, London, UK.
概括
在马拉维的布兰泰尔,公平的结核病 (TB) 检测准入仍然是一个挑战,观察到很大的局部差异. 研究了贫困等社会经济因素,但并没有完全解释结核病诊断服务利用率的这些差异.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 公平获得结核病 (TB) 诊断服务对于全球卫生目标至关重要.
- 较贫穷的社区往往面临严重的障碍,无法获得基本的诊断服务.
- 马拉维布兰泰尔 (Blantyre) 的"可持续社区广泛的肺部健康 (SCALE) 调查"评估了结核病的流行率和以前的服务参与.
研究的目的:
- 检查在布兰泰尔市内曾经进行过结核病检测的流行率的地理差异.
- 确定影响当地结核病检测率的潜在社会经济决定因素.
- 了解贫困指标对结核病检测的影响.
主要方法:
- 混合效应模型应用于72个社区集群自报的结核病检测数据.
- 经过对个人层面的因素进行调整的分析,包括性别,年龄和艾滋病毒状况.
- 集群级随机拦截被用来解释地理集群,贫困指标被评估为解释变量.
主要成果:
- 在不同社区集群中发现了以前的结核病检测流行率的显著差异,邻近地区之间的相关性很小.
- 来自较不富裕家庭的个人表现出较低的前期结核病测试几率.
- 观察到的结核病检测访问的集群级差异并不能完全由分析中使用的贫困指标解释.
结论:
- 尽管正在积极寻找结核病例的努力,但在布兰泰尔人口中,获得结核病检测仍然不一致.
- 这些发现强调了结核病检测获取的潜在健康不平等,反映了其他全球环境中出现的问题.
- 进一步收集和分析数据至关重要,以确定结核病诊断访问中这些差异的潜在驱动因素.
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