TUBERCULOSIS CONTROL PROGRAMME IN CHINA
by
Dr Duanmu Hong Jiu
and
Dr Qian Yuan Fu
National Tuberculosis Control Center
Ministry of Health
Beijing, China
1 EPIDEMIOLOGY
1.1 PREVALENCE
The prevalence of pulmonary tuberculosis in some big cities in China at the end of fourth decades this century was about 5000/100,000 and the mortality was about 200/100,000. They decreased to 2000/100,000 and 40/100,000 respectively at early sixth decades. Three nationwide random sampling epidemiological surveys on tuberculosis had been carried out in 1979, 1984/85 and 1990 respectively. The results of first survey in 1979 showed that the prevalence of radiological active pulmonary tuberculosis was 717/100,000 and the prevalence of smear positive pulmonary tuberculosis was 187/100,000. In this case, the estimated number of active pulmonary tuberculosis cases and smear positive cases were about seven millions and one million eight hundred thousands respectively in that time.
The prevalence of active pulmonary tuberculosis and smear positive cases declined to 523/100,000 and 134/100,000 respectively in the third nationwide survey conducted in 1990. The estimated number of above-mentioned tuberculosis cases dropped to six millions and one million fifty hundred thousands respectively. The annual reduction rate of active tuberculosis and smear positive cases from 1979 to 1990 were 2.8% and 3.0% respectively. The smear positive prevalence in countryside areas (141/100,000) was 2.8 times higher than that of cities (50/100,000).
1.2 PREVALENCE BY GENDER AND AGE
The prevalence of both active tuberculosis and smear positive tuberculosis among female and male increased with the increase of age. However, the increase of smear positive prevalence before 20 years of age was much faster and became slower after this age. The highest peak was on the age group of 70 and than decreased slowly. The patients of 20-59 age groups accounted for 63.5% of total patients and it was 55.4% for the age group above 45 years of age.
The smear positive prevalence of female was 89.1/100,000 and it was much lower than that of male (160.3/100,000). The proportion was about 1:1.8. So far as age as concerned, the prevalence of female before 15 years of age was higher than male. The intersection was on 20 years and than the prevalence of male was higher than female and the sexual difference became more significantly thereafter. On the age group of 60, the proportion of female and male was about 1:3.3.
1.3 TUBERCULOSIS MORTALITY
The mortality of pulmonary tuberculosis in 1984/85 was 31/100,000 and it dropped to 19.3/100,000 in 1990. The annual reduction rate was 8.3%.
The children under 14 years had the lowest mortality. It climbed up gradually during adolescence and youth and then significantly rose after 40 years of age. The highest peak was on aged group ABOVE 60. The female mortality of 20-29 age group was slightly higher than that of male, and the male mortality was higher after 40 years of age. The male mortality of aged population above 70 was 160.9/100,000 and was much higher than that of female (95.9/100,000).
1.4 TUBFERCULOSIS INFECTION RATE
PPD test was carried out among 122,000 children who have no BCG scar and history of BCG vaccination. The average infection rate of 0-14 age group was 7.5%. The infection rates among seven and fourteen years old children were 6.6% and 13.4% respectively. Based on the formula given by the Tuberculosis Surveillance Research Unit (TSRU), the annual risk of infection in 1990 survey was 0.8% and the annual reduction rate of 0-14 age group was 2%.
2. THE NATIONAL TUBERCULOSIS CONTROL PROGRAMME
2.1 POLICY AND TARGET
In accordance with the results of three nationwide epidemiological surveys and epidemiological trends as well as the experiences on tuberculosis control in the Country, the "National Tuberculosis Control Programme, 1991-2000" was developed in 1991. The principal technical policies of tuberculosis control will be as follows:
◆The priority of tuberculosis control should be given to the reduction and elimination of infectious sources;
◆The tuberculosis control in countryside areas should be very much highlighted;
◆Directly Observed Treatment with Short-course chemotherapy regimens (DOTS) should be effectively carried out in the Country; and
◆Tuberculosis control activities at grass-roots level should be integrated to the primary health care system:
The target of tuberculosis control programme for the year of 2000 in the country will be as follows:
