Contribution of operational research in China National Center for TB Control and Prevention, China...
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Transcript of Contribution of operational research in China National Center for TB Control and Prevention, China...
Contribution of operational research in China
National Center for TB Control and Prevention, China CDC
Jiang Shiwen2009.12.3 Cancun
Background
• China is one of high TB(MDR) burden countries in the world
TB Situation• Second largest number of TB patients in the world• 44.5% of the population infected TB • Internet-based Communicable Disease Reporting
System in 2008– 1.17 million TB patients reported, Ranks the
second largest diseases• Prevalence: 4.5 million PTB patients / 1.5 million
SS+ TB patients in 2000• 130,000 TB death in 1999• 120,000 MDR-TB cases occurred in 2008
Achievements of NTP main targets
Challenges for MDG
Millennium Development Goals
DOTS quality need to be improved
Insufficient supporting mechanism
Migrant, MDR-TB and TB/HIV
challenges
Weak infection control
Inadequatesocial mobilization
AddressingAddressingChallengesChallenges
What do we need to reach the MDG?
• DOTS quality need to be improved• Migrant, MDR-TB and TB/HIV challenges to
be solved• ……• Operational research is one very important
issues of our need?
Activities taken for operational research
• Established a operational mechanismSubmit the proposalsReview the proposalsSupervision of researchAudit the research reports
• Implemented operational researches
What do we done for operational research in China
• Epidemical survey• Socio – economic study on TB patients• Survey of the status of knowledge, attitude and
practice of TB among common people• M&E indicators• FDC treatment and drug management• MDR-TB• TB/HIV• Incentives• ……
Example of contribution of operational researches for NTP in China
• National random survey for the epidemiology of TB in 2000
• Socio – economic study on TB patients• Collaboration between hospitals and TB
dispensaries• M&E indicators
National random survey for the epidemiology of TB in 2000
• In order to realize the dynamic epidemiological situation of tuberculosis as well as to identify, access and evaluate the effect of the implementation of the national tuberculosis control program
• The first , the second and the third nationwide random sampling survey for the epidemiology of tuberculosis was conducted respectively in 1979,1990 and 2000
National random survey for the epidemiology of TB in 2000
Main results• In this survey, the prevalence of active,
smear positive and bacteriological positive pulmonary tuberculosis were 367/100,000, 122/100,000 and 160/100,000 respectively.
• The estimated numbers of patients for above-mentioned categories of pulmonary tuberculosis were 4.51 millions, 1.5 millions and 1.96 millions respectively.
• The annual reduction rate of the prevalence of SS+ pulmonary tuberculosis between 1979 and 2000 was 3.8% and it was 3.2% between 1990 and 2000. In general, the declining in the Country in the past twenty years was sluggish.
Utilization and contribution• To provide the information
to central government• State council issued the
NATIONAL TUBERCULOSIS CONTROL PROGRAME (2001 – 2010)
• Central government Increasing the funding from 5 million USD in 2001 to 76 million USD in 2009
Government financial input
• Harmonizing all available financial resources for NTP
• 2001-2008– Central government: 2.16 billion RMB Yuan– Local government: 2.0 billion RMB Yuan
National random survey for the epidemiology of TB in 2000
Results The prevalence of tuberculosis was higher in middle and western than the eastern areas. Utilization
Following activities are supporting for the middle and western areas.
Central government project
WB/DFID project GF project (R1,R4
and R8) JACA project DFB project
Socio – economic study on TB patients
Results • Among 1278 patients, the average annual income per
person of the families with tuberculosis patients who were engaged in countryside field occupation was 941 Yuan and 80% of them were lower than the average annual income per person at same locality in 2000
• Among 1278 patients, 91.9% had no any kind of medical insurance and have to pay medical expense by themselves.
• The various causes for escaping from clinical consultation, 55.2% of escaping was due to not mind by patients themselves and financial problem was the next cause (37.3%).
• The causes of irregular and/or interrupted treatment ,the main causes were economic difficulty (44.5%) and patients did not mind themselves (42.6%).
Utilization• Government
provide funding to free the diagnosis(X films and sputum smear examination) and TB drugs
All active PTB 1278 ( 100%)
With symptoms 1096 ( 85.8%)
Visited doctor 469 ( 49.1%)
Diagnosed TB 378 ( 29.6%)
Registered 93( 7.3%)
Onion of case finding in China data from TB survey in 2000
Aim of case finding The thin-skinned onion
70%+
All active PTB 1278 ( 100%)
With symptoms 1096 ( 85.8%)
Visited doctor 469 ( 49.1%)
Diagnosed TB 378 ( 29.6%)
Registered 93( 7.3%)
Based on the results to take the policies and strategies
Incentive basic medical staff to refer the TB symptom suspects
Training the medical staff to identify the TB symptom suspects
Implementing the refer and tracing strategy in medical institutes and TB dispensaries
NTP M&E indicators system in China
Results • Method Firstly ,drafted and listed the indicators
used the Brainstorming and expert experiences
Second, use the delphi method to product the indicators and indicator standard by experts in different level
• Results: the number of key indicators is 35 , : the number of assistant indicators is 38
Utilization• Put the
indicators to NTP indicators handbook