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背景:南印度 Tiruvallur 地区。目的:了解 14 岁以上成年人在结核感染和患病、就医途径、就医行为、诊断延误、接受 DOT的方便程度、疾病歧视以及治疗依从性等方面的性别差异。方法:相关数据主要来自:1)社区调查,2)在公立初级保健卫生机构(PHIS)主动就医的病人,3)转诊到 PHIS 进行痰涂片检查的可疑结核病人;4)DOTS 策略下的登记报告结核病人。并将社区调查结果与 PHIS 登记病人进行比较。结果:社区人群中 66%的男性和 57%的女性感染了结核菌;男性和女性的涂阳肺结核患病率分别为568/10 万和87/10 万。在 PHIS 就医的男性少于女性,男女之比为 68:100。女性占社区调查发现涂阳病人的 13%;占 PHIS 发现病人的 20%(P<0.05)。随着年龄的增长,男性和女性的登记率显著降低。女性感觉难于与家人讨论自己病情的比例要高于男性(21%∶14%),也更需要有人陪伴去接受 DOT(11%∶6%)。男性的治疗中断率比女性高 1 倍(19%∶8%;P<0.01)。结论:尽管女性发病后更容易遭受歧视和不便,但女性更易于利用医疗服务、接受 DOTS 策略登记以及依从治疗。而男性以及高龄病人在诊断和 DOT服务方面更需要帮助。
Background: Tiruvallur region, South India. OBJECTIVES: To understand the gender differences in TB infection and illness, access to medical care, medical practices, delays in diagnosis, accessibility to DOT, disease discrimination and treatment adherence among adults over 14 years of age. Methods: The data are mainly from 1) community surveys, 2) patients who voluntarily seek medical treatment at PHIS, 3) suspicious TB patients referred to PHIS for sputum smear examination, 4) patients under DOTS strategy Register report tuberculosis patients. The results of the community survey were compared with those of PHIS registered patients. Results: 66% of the men and 57% of the women in the community were infected with Mycobacterium tuberculosis. The prevalence rates of smear positive tuberculosis in both men and women were 568/10 and 87/10, respectively. The number of men seeking medical treatment at PHIS was less than that of women, and the ratio of men to women was 68: 100. Women accounted for 13% of smear-positive patients in community surveys and 20% of patients found PHIS (P <0.05). With age, registration rates for both men and women have dropped significantly. Females feel more difficult to discuss their illness with their family than males (21%: 14%) and also need someone to accompany DOT (11%: 6%). Treatment discontinuation rates in men were twice as high as those in women (19%: 8%; P <0.01). Conclusion: Although women are more vulnerable to discrimination and inconvenience after their onset, women are more likely to use medical services, receive DOTS policy enrollment, and adhere to treatment. Men and older patients need help in diagnostics and DOT services.