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Open Access Research article

Evaluation of the tuberculosis programme in Ningxia Hui Autonomous region, the People’s Republic of China: a retrospective case study

Yu Rong Yang126, Donald P McManus2, Darren J Gray23, Xiao Ling Wang4, Shu Kun Yang5, Allen G Ross6, Gail M Williams3 and Magda K Ellis278*

Author affiliations

1 Ningxia Medical University, Ningxia Hui Autonomous Region, Ningxia, the People’s Republic of China

2 Molecular Parasitology Laboratory, Queensland Institute of Medical Research, Brisbane, Australia

3 School of Population Health, University of Queensland, Brisbane, Australia

4 Ningxia Infectious Disease Hospital, Yinchuan, Ningxia Hui Autonomous Region, Yinchuan, People’s Republic of China

5 The first Yinchuan City Hospital, Yinchuan, Ningxia Hui Autonomous Region, Ningxia, People’s Republic of China

6 Griffith Health Institute, Griffith University, Brisbane, Australia

7 Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, UK

8 Centenary Institute, Sydney, Australia

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Citation and License

BMC Public Health 2012, 12:1110  doi:10.1186/1471-2458-12-1110

Published: 23 December 2012

Abstract

Background

Tuberculosis is a devastating disease due to its rapid transmission and high rate of mortality. Ningxia Hui Autonomous Region (NHAR), located in the North-west, is one of the poorest provinces in China and national surveys have shown TB has been hyper endemic in NHAR for several decades. As no active surveys had been undertaken since the initiation of the DOTS control program across all of NHAR.

Methods

A retrospective study was undertaken of all clinical records of TB patients registered from January 2005 to September 2009. Poisson regression was performed to investigate the change in incidence over time and accounted for age, sex and county. Length of time on treatment, disease severity and patient delay were assessed by county.

Results

More than 30% of patients had been on treatment for over 12 months and 10% for over 3 years, reflecting drug-resistance or failure of DOTS. More than 93% of patients had grade III disease at time of diagnosis and >15% of patients had severe disease grade IV-V in some NHAR counties. Further, 8.8% of patients were not diagnosed for over 6 months from the onset of symptoms; this was as high as 20% in some counties. The reported incidence of TB is most likely grossly underestimated and the data indicate TB is a major public health concern in NHAR.

Conclusions

It is clear that active surveillance is necessary to determine the full extent of the burden of TB in NHAR. New control and treatment strategies for TB are required that increase awareness in the health-care system and at the individual and community level.

Keywords:
Prevention and control; Communicable disease control; Directly observed treatment short course strategy; DOTS