||Tuberculosis control and social change.
||AME J PUB HEALTH 1994, 84, 1721-1723.
This is an editorial with the view that TB and
its control are manifestations of social and economic development.
During the past eight years, active TB cases increased substantially
in the US and other industrialized countries due to several social,
economic and epidemiological factors. Available data suggest that
two important steps are necessary for TB control: 1) to identify
all persons with active disease and ensure their complete treatment
and, 2) to identify high-risk persons with TB infection (such as
HIV-infected persons) and provide them with complete preventive
treatment. Four articles in the American Journal of Public Health
(Nov. 1994, Vol. 84, No. 11), illustrated the challenges and priorities
of modern TB control. Buskin et al (p. 1750), after reviewing risk
factors for active TB among patients in King County, Washington,
USA, suggested expanded outreach and services. Leonbardt et al (p.
1834) showed that with persistence, sensitivity and a mobile van,
public health workers gained the trust and participation of patients
and their social network which allowed 74% of infected contacts
complete isoniazid preventive therapy. The need to provide services
to underserved populations and, to improve the co-ordination and
communication among health care workers, public health programs,
clinics and other agencies in serving difficult-to-reach places
were emphasised by Ciesie et al (p. 1729). Lastly, Dr. George Comstock
(p. 1729), after a review of the past and prospective strategies
for controlling TB, called for a renewed investigation of the epidemiology
of TB, especially, to find answers to questions such as: Where does
most transmission occur? How can risk of infection best be predicted?
Following the collective recommendations of these studies and improving
the social and economic environment globally would enhance successful
|KEYWORDS: SOCIAL CHANGE; USA.