新型结核医疗服务可显著降低死亡率（在线收听）

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 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 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 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 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 – 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 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 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 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。