新型结核医疗服务可显著降低死亡率

新型结核医疗服务可显著降低死亡率

A new study shows that redesigning medical services for tuberculosis 1 can dramatically reduce the death rate. The research was conducted in a local health district in the West African nation of Togo.

一项新的研究表明，对医疗服务体制进行重塑将大大减少肺结核死亡率。这是西非国家多哥在当地医疗地区所进行的研究。

TB is blamed for two million deaths every year. Most of them are in developing countries. It’s also the second leading cause of death among infectious diseases.

每年，死于肺结核的人数为200万人。绝大多数都发生在发展中国家。肺结核也是所有传染性疾病中致死率第二高的疾病。

Over the years, TB and HIV have been closely linked because TB easily infects those with weakened immune systems. Also, new drug resistant 2 strains of TB have arisen, often making treatment difficult and painful and sometimes ineffective.

多年以来，由于肺结核很容易侵扰免疫系统弱的机体，所以肺结核也常常与艾滋病紧密相连。由于肺结核对新药的抗药性加强，致使治疗变得更加困难，有时疗效并不显著。

But a study in Togo reports a 10 percent drop in TB deaths following changes in services in the Lacs Health District. It’s located in the country’s southern Maritime 3 Region.

但是一项来自多哥的研究表明，对拉卡斯医疗地区的医疗服务做出改革之后，肺结核死亡率降低了10%。该地位于多哥南部的滨海地区。

Dr. Kossivi Afanvi works for Togo’s Ministry 4 of Health. He was health director of the Lacs District from 2008 to 2015. He said when he arrived there was much room for improvement in the treatment of TB.

科西维·阿法尼博士在多哥的卫生部门工作。2008年到2015年间，他担任拉卡斯地区的医疗主任。刚刚抵达这里时，他称就治疗肺结核来说，还有许多上升的空间。

“The treatment rate of tuberculosis was very, very low at 80 percent. And the death rate was very, very high at 13 percent.”

肺结核的治愈率很低，当时只有80%。死亡率很高，达到了13%。

Afanvi is the lead author of the Togo study appearing in BMJ Quality Improvement Reports. He had received training from the Boston-based Institute for Healthcare Improvement, a non-profit organization. In 2012, Afanvi implemented 5 – what’s called -- a System Quality Improvement Model in Lacs.

刊登在“BMJ质量改进报告”的这份多哥研究中，阿法尼是此次研究的主要作者。他曾经在波士顿的卫生保健改善机构接受过培训，这是一个非营利组织。2012年，阿法尼实施了一个名叫“体制质量改善”的模式。

“So, we decided 6 to increase the treatment success rate to at least 85 percent and to reduce the mortality rate to five percent,”

我们决定将治愈率提高到至少85%，将死亡率减少到5%。

Two years later, the program exceeded its goals. The mortality rate quickly fell from 13 to three percent. And by the time he took a new job early this year, he said there were no TB deaths in Lacs District.

两年之后，此项目超过了预期目标。死亡率从13%迅速降到3%。今年年初，他换了新的工作，他称拉卡斯地区再无死亡病例。

There’s a hospital and more than 30 health clinics in Lacs. The model called for increasing TB screening in every location where there was a registered nurse. If a test is positive, it’s followed by intensive treatment.

在拉卡斯，有一家医院，30多家医疗诊所。该系统要求增加每个地区对肺结核的筛查，每个地区配备一名护士。如果检测结果呈阳性，那么将对患者进行强化治疗。

What’s more, screening was also done for HIV. Treating those infected with the AIDS virus can strengthen their immune systems and in turn make them better able to defend against TB.

更重要的是，人们也对艾滋病进行筛查。对感染艾滋病的病患进行治疗将加强他们的免疫系统，反过来，病患也能够更好地抵御肺结核。

Dr. Afanvi is now in charge of the neighboring Vo Health District, where he’s also implemented the System Quality Improvement Model.

如今，阿法尼博士负责拉卡斯附近的沃医疗地区，他也同样在那里实施了“体制质量改善”模式。

“In my new district, I decided to use the model to manage other programs. I came here in February and according to the immunization program the rate was at 75 [percent].But actually we are at 91 [percent] for vaccinating 7 or immunizing children,”

在这一地区，我决定用这一模式来处理其他项目。我是二月份来的，依据这里的免疫项目，这里的免疫率为75%。但是实际上，儿童的疫苗接种率和免疫率为91%。

And the TB death rate has also dropped sharply in Vo.

在沃地区，肺结核的死亡率也迅速降低。

Afanvi has recommended to Togo’s Ministry of Health that the model be applied 8 to the entire country.

阿法尼还将这一模式推荐给了多哥的医疗部，希望这一模式能够在全国推行开来。