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Free Content The impact of directly-observed treatment on the epidemiology of tuberculosis in Beijing

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SETTING: Fully supervised chemotherapy, or directly observed treatment (DOT), for newly detected smear-positive cases in Beijing, has been successfully implemented for two decades.

OBJECTIVE: To evaluate the progress made in tuberculosis control, and in particular to evaluate the impact of DOT on tuberculosis epidemiology in Beijing.

DESIGN: Epidemiological parameters on tuberculosis, consisting of mortality, prevalence, notification rate, tuberculous meningitis in children and initial drug resistance rate, were collected and analysed. Their trends were evaluated and compared with DOT implemented for new smear-positive cases in Beijing from 1978 to 1996.

RESULTS: The coverage of DOT for new smear-positive pulmonary tuberculosis cases has increased from 10% in 1978 to more than 90% since 1990. Since DOT was introduced in 1978, mortality from tuberculosis has declined by an average of more than 7% per year. The prevalence of smear-positive cases decreased from 127/100000 in 1979 to 16/100000 in 1990, with a mean reduction rate of 17.2%, and the rates of chronic cases and tuberculous meningitis in children decreased dramatically. The rate of newly registered smear-positive cases decreased from 18.9/100000 in 1986 to 7.3/100000 in 1996, giving an average annual reduction rate of 9.1 during this period. Initial resistance to isoniazid and streptomycin decreased from respectively 13.9% and 12.3% in 1978–1979 to 4.2% and 5.8% by 1996. The level of multidrug resistance was low and stable, at 0.8% in 1996.

CONCLUSION: The experience of the Beijing tuberculosis control programme convincingly demonstrates that it is possible to improve the epidemiological situation rapidly in a low-income country, at very low cost and in a manner that is self-sufficient and sustainable.
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Keywords: Beijing; DOT; epidemiology; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Beijing Research Institute for Tuberculosis Control, Beijing, People's Republic of China; and The Collaborating Centre of The International Union Against Tuberculosis and Lung Disease, Beijing, People's Republic of China 2: International Union Against Tuberculosis and Lung Disease, Paris, France

Publication date: October 1, 2000

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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