Related Factors of Treatment Success of Patients with Tuberculosis Management in Public Health Centers

(1)

O b j e c t i v e s: This retrospective study is to identify related factors of treatment success of patients with tuberculosis at community health centers.

M e t h o d s: The subjects of this study were 1,417 patients with tuberculosis treated in 28 community health centers. The predictors of tuberculosis treatment success were analyzed in terms of 2 areas, which were characteristics of patients and health centers(TB control program). The characteristics of patients consist of 2 factors, such as demographic &

diagnosis and treatment. The present conditions of health centers consist of 3 factors, location of centers, resources, and community activities. Data were analysed using X

²

- t e s t and logistic regression methods.

R e s u l t s: The significant differences between success group and failure group were sex(p=0.003), age(p=0.013), job(p=0.000), type of patients(p=0.001), past history(p=0.029), BCG injection(p=0.009), sputum culture examination(p=0.017), period of treatment(p=0.000), location of center(p=0.001), population per staff(p=0.015), FTE(p=0.027), education days of staff(p=0.005), BCG injection rate(p=0.001), case detection rate (p=0.003), and health education provision rate(p=0.044). Then these variables were analysed using logistic regression analysis. Significant positive factors of treatment success were occupation(95% CI:1.3-6.1), periods of treatment(95% CI:1.5-2.2), center in large city(95% CI:1.2-16.7), center in middle city(95% CI:2.1-24.3), job education related TB(95% CI:1.02-1.3), and BCG injection rate(95% CI:1.1-303.4). Significant negative factors of treatment success were male(95% CI:0.1-0.5) and treatment after default(95% CI:0.005-0.5).

C o n c l u s i o n s: Tuberculosis is still one of serious diseases in Korea, because it causes highest mortality rate among OECD countries. This study may provide information to improve treatment effectiveness of tuberculosis at community health centers.

Key words : Public health center, Tuberculosis, Health care

보건소관리결핵환자의퇴록시치료성공요인

䢿㦖㩫

^{1 ) 1 )}

, ⋮⺇㭒

^{2 )}

䞲ῃ⽊Ị㌆㠛㰚䦻㤦

^{1 )}

, Ị㟧╖䞯ᾦ 㦮ὒ╖䞯

^{2 )}

Related Factors of Treatment Success of Patients with Tuberculosis Managed in Public Health Centers

Eun-Jeong Hwang

^{1 )}

, Baeg-Ju Na

^{2 )}

K o rea Health Industry Development Institute

^{1 )}

, College of Medicine, Konyang University

^{2 )}

୙ABSTRACT୙

J Agri Med & Community Health 2 0 0 7 ; 3 2 ( 3 ) : 1 2 5 ~ 1 3 8

* ᾦ㔶㩖㧦: 䢿㦖㩫, ㍲㤎䔏⼚㔲 ☯㧧ῂ ⏎⨟㰚☯ 3 1 1 - 2 7⻞㰖 ╖㎇ア❿ 3䂋, 㩚䢪: 02-822-9800, 䕿㓺: 02-822-9400

E - m a i l: e j h w a n g @ k h i d i . o r . k r

(2)

昢嵦

㎎Ἒ㩗㦒⪲ 1 9 5 0⎚╖⿖䎆䟃ἆ䟋䢪䞯䂮⬢㦮

⽊ 㧊㔲㧧♮Ⳋ㍲㩦㹾 ἆ䟋㦖䂮㥶♶ 㑮㧞

⓪ 㰞⼧㧊⧒⓪ 㧎㔳㧊䢫㌆♮㠊 ἆ䟋㠦 ╖䞲 ὖ㕂㦖  ỿ䧞㭚㠊✺㠞┺. 䞮㰖Ⱒ 㾲⁒ 㧎㼊 Ⳋ㡃ἆ䞣⹪㧊⩂㓺( H I V ) /䤚㻲㎇Ⳋ㡃ἆ䞣 (AIDS) 䢮㧦 ⹥ Ⱎ㟓⽋㣿㧦㦮 Ⱒ㡆, ┺㩲㟓㩲⌊㎇䢮㧦(Multi-drug Resistant Tuberculosis : MDR-TB) 㯳Ṗ ❇㦒⪲ ἆ䟋㧊 ┺㔲  㯳䞮₆ 㔲㧧䞮㡖┺[1-3]. ㎎Ἒ⽊Ị₆ῂ⓪ 㩦㩦㕂ṗ䟊㰖⓪ ἆ䟋㠦 ╖䞮㡂㩚㎎Ἒ㩗㧎 ὖ㕂㦚㽟ῂ 䞮ἶ㧦 1 9 9 3⎚ 4㤪˄ 㩚㎎Ἒ ἆ䟋゚㌗㌂䌲 (Global Tuberculosis Emergency)˅⯒ ㍶䙂䞮㡖

┺[4]. 䞮㰖Ⱒ ⁎ 㧊䤚⪲☚ ἆ䟋⹲㌳ ⹥ ㌂ⰳ 㦖㎎Ἒ㩗㦒⪲ Ἒ㏣㯳Ṗ䞮ἶ 㧞┺[ 5 ] .

㤆Ⰲ⋮⧒⓪ 1 9 6 2⎚ ῃṖἆ䟋ὖⰂ㼊ἚṖ 㑮Ⱃ

♮Ⳋ㍲㩚ῃ 㔲ῆῂ ⽊Ị㏢⯒ 㭧㕂㦒⪲ ἆ䟋䢮㧦㫆₆⹲ἂὒ ❇⪳ὖⰂ, ゚㔲㰖㡞⹿㩧㫛, 㰖㡃㭒⹒ὒ ❇⪳♲ ἆ䟋䢮㧦㠦 ╖䞲⽊Ịᾦ㥷

❇ ⽎ỿ㩗㧎 ἆ䟋ὖⰂ ㌂㠛㧊⻪ῃ⹒㩗㦒⪲

㔺㔲♮㠞┺[6]. ⡦䞲, ἆ䟋ⶎ㩲㦮䋂₆㢖㿪㎎

⯒ 䕢㞛䞮₆ 㥚䟊㎎‶Ỗ㌂⯒ 䙂䞾䞮㡂㩚ῃ ἆ䟋㔺䌲㫆㌂⯒ 1 9 6 5⎚⿖䎆 1 9 9 5⎚₢㰖 5⎚ Ṛ ỿ㦒⪲ 7㹾㠦 Ỏ㼦㍲㭒₆㩗㦒⪲ 㔺㔲䟊㢪┺

[7]. 㧊⩂䞲 ⏎⩻㠦䧮㧛㠊 ἆ䟋㥶⼧⮶(⹿㌂

㍶ Ỗ㌂㌗䢲☯㎇䘦ἆ䟋㥶⼧⮶)㧊 1 9 6 5⎚

5 . 1 %㠦㍲ 1 9 9 5⎚ 1 . 0 %⪲ 㰖⋲ 3 0⎚ ☯㞞 ∎㭖䧞 Ṧ㏢䟊㢪㦒Ⳇ, ἆ䟋㌂ⰳ⮶☚ 㧎ῂ 1 0Ⱒ ⳛ

╏ 1 9 8 6⎚㠦 1 7 . 1ⳛ㠦㍲ 1 9 9 5⎚ 8 . 7ⳛ㦒⪲ Ṧ㏢

♮㠞┺[6]. ⁎⩒㠦☚ ⿞ῂ䞮ἶ 㤆Ⰲ⋮⧒⓪ 2 0 0 5⎚ ἆ䟋㌂ⰳ⮶ὒ ἆ䟋⹲㌳⮶㧊 ἓ㩲䡧⩻

₆ῂ(OECD) 30Ṳ 䣢㤦ῃ 㭧 1㥚⪲ ⋮䌖⌂┺

[8]. 2005⎚☚ 㔶ἶ ἆ䟋㔶䢮㧦Ṗ 㟓 3 5㻲ⳛ㧊㠞ἶ, ῃ⹒ 3 1 1ⳛ╏ 1ⳛ㧊䢲☯㎇ ἆ䟋䢮㧦㧊 Ⳇ, ⰺ⎚ 㟓 3 , 0 0 0ⳛ㧊 ἆ䟋㦒⪲ ㌂ⰳ䞲 ộ㦒⪲

⋮䌖⋮ 㤆Ⰲ⋮⧒ ἆ䟋 ὖⰂ㦮㰞 ⹥ ㎇ὒ㠦㦮ⶎ㧊㩲₆♮ἶ 㧞┺[8].

㔺㩲⪲ 2 0 0 1⎚☚ 㩚ῃ ⽊Ị㏢㠦 ❇⪳♲ ☚Ⱖ 㟧㎇䘦ἆ䟋䢮㧦㠦 ╖䞲 ἆ䟋䂮⬢ ㎇Ὃ㥾㦖

7 8 . 6 %㧊Ⳇ, ⹒Ṛ ⼧㦮㤦㦮 ἓ㤆㧊⽊┺ ▪㤇

⌄㦖 7 4 . 4 %⪲ ⽊ἶ♮㠞┺[9]. 㧊⓪ ㎎Ἒ⽊Ị₆ ῂṖ ῢ㧻䞮⓪ ἆ䟋䂮⬢㥾 ⳿䚲㧎 8 5 %㠦 ⹎ 䂮㰖 ⴑ䞶㈦㞚┞⧒ ㎎Ἒ⽊Ị₆ῂ㦮 2 0 0 0⎚

₆㭖㩚㎎Ἒ ☚Ⱖ㟧㎇䘦ἆ䟋䢮㧦( 1 , 2 3 1 , 8 4 7 ⳛ

╖㌗)㠦 ╖䞲䆪䢎䔎⿚㍳ἆὒ㠦㍲ ⋮䌖⋲ 㩚

㎎Ἒ 䘟‶ 䂮⬢ ㎇Ὃ⮶(treatment success rate) 7 9 . 5 %㠦☚ ⹎䂮㰖 ⴑ䞮⓪ 㑮䂮㡖┺[10].

㾲⁒ ㎎Ἒ⽊Ị₆ῂ⓪ ㎎Ἒ㩗㦒⪲ ἆ䟋ὖⰂ 㠦㧞㠊 Ṗ㧻 ⶎ㩲Ṗ ♮⓪ ộ㦖䢮㧦Ṗ 㟓㦚㩲➢㠦 ⲏ㰖㞠㞚䂮⬢㠦㔺䕾䞲┺⓪ ┾㑲䞲䡚㌗⽊┺ ⁒⽎㩗㦒⪲ 㩫㺛㧛㞞 ⹥ ἆ㩫㧦✺㦮 ἆ䟋㠦 ╖䞲 ⶊὖ㕂㧊 ἆ䟋ὖⰂ㦮 Ṗ㧻䋆 Ỏ Ⱂ☢㧊 ♮ἶ 㧞㦢㦚㰖㩗䞮㡖┺[11]. Fox⓪ ἆ 䟋䂮⬢㦮㎇Ὃ㦖㻮⹿♲ 㟓㩲㠦㦮䟊 ἆ㩫♮

₆⽊┺⓪ 㩚䂮⬢₆Ṛ☯㞞䢮㧦 ⹥ 㰖㡃㌂䣢 Ṗ 㓺㓺⪲ 䂮⬢ ⹥ 㡞⹿㠦 ⓻☯㩗㦒⪲ 㺎㡂䞾㦒⪲㖾㔺䡚♶ 㑮㧞┺ἶ 䞮㡂[12] 㰖㡃㌂䣢

⽊Ị㦮⬢ 䢲☯㦚 ṫ㫆䞮㡖┺. 䞮㰖Ⱒ, ἆ䟋䂮

⬢㎇Ὃ ὖ⩾㣪㧎⿚㍳ὒ ὖ⩾䞲 ῃ⌊㣎㡆ῂ⯒

㌊䘊⽊Ⳋ 㽞䣢 Ỗ㌂ἆὒ, 䂮⬢㑲㦧☚, 㰖㔳㩫

☚, Ṗ㫇㦮㰖㰖, ╏␾ ❇㦮㰞䢮㥶ⶊ ❇ ╖⿖⿚

ἆ䟋䂮⬢㎇Ὃ㦮 ὖ⩾㣪㧎㦒⪲ 䢮㧦 Ṳ㧎㦮䔏

㎇ ⹥ 㰞䢮㩫☚㠦Ⱒ 㭒⪲ 㽞㩦㦚 ⚦㠊㢪㦒Ⳇ [13-15] ▪㤇㧊㎎Ἒ⽊Ị₆ῂ㠦㍲㩲㔲䞮ἶ 㧞

⓪ ἆ䟋㦚 ὖⰂ䞮⓪ ὋὋ⽊Ị㦮⬢㼊Ἒ㠦 ₆㧎䞲䂮⬢㎇Ὃ㣪㧎㦚㼊Ἒ㩗㦒⪲ ⳾㌟䞮ἶ㧦䞲㡆ῂ⓪ Ệ㦮 ⹲ἂ䞮₆ 㠊⩺㤶┺. ⡦䞲⽊Ị㏢

㦮 ἆ䟋ὖⰂ 㔺䌲⯒ 㼊Ἒ㩗㦒⪲ ⿚㍳䞲 ⏒ⶎ

☚ ⹎䦷䞮㡖┺.

⽎㡆ῂ㦮 ⳿㩗㦖䢮㧦 Ṳ㧎㦮䔏㎇㣪㧎㈦㞚┞⧒ ⽊Ị㏢ ἆ䟋ὖⰂ ㌂㠛㦮䔏㎇㣪㧎䁷 Ⳋ㠦㍲ ἆ䟋䂮⬢㠦 ⹎䂮⓪ ὖ⩾㣪㧎㦚䢫㧎䞮

₆ 㥚䞾㧊┺. ῗ⁏㩗㦒⪲ ⽊Ị㏢ ἆ䟋ὖⰂ ㌂㠛㦮㩫㺛ἆ㩫㦚㥚䞲 ₆㽞㧦⬢⯒ 㩲㔲䞮ἶ 㧦䞾㧊┺. ῂ㼊㩗㧎㡆ῂ㦮 ⳿㩗㦖 ┺㦢ὒ ṯ

┺.

(1) 28Ṳ ⽊Ị㏢⯒ ㍶㩫䞮㡂⽊Ị㏢ ἆ䟋䢮

㧦㦮 Ṳ㧎㩗䔏㎇ ⹥ ⽊Ị㏢㦮 ἆ䟋ὖⰂ ㌂㠛

䔏㎇㦚䢫㧎䞲┺.

(3)

(2) ἆ䟋䂮⬢ ㎇Ὃῆὒ 㔺䕾ῆ ㌂㧊㠦䢮㧦㦮 Ṳ㧎䔏㎇ ⹥ ⽊Ị㏢㦮 ἆ䟋ὖⰂ ㌂㠛䔏

㎇㹾㧊⯒ ゚ᾦ䞲┺.

(3) ἆ䟋䂮⬢ ㎇Ὃῆὒ 㔺䕾ῆ Ṛ㦮㹾㧊Ṗ 㥶㦮䞲㣪㧎㭧㠦㍲ ṗṗ㦮㡗䟻㦚⽊㩫䞲䤚 ἆ䟋䂮⬢ ㎇Ὃὖ⩾㣪㧎㦚䢫㧎䞲┺.

堆旇愕愯憛

⽎㡆ῂ⓪ ⽊Ị㏢ ἆ䟋䢮㧦㦮 Ṳ㧎䔏㎇ὒ ἆ䟋ὖⰂ ㌂㠛䔏㎇㠦㍲ ἆ䟋䂮⬢㎇Ὃ ὖ⩾㣪㧎㦚䢫㧎䞮₆ 㥚䞲䤚䟻㩗㫆㌂㡆ῂ㧊┺.

⽎㡆ῂ㦮㼊Ἒ☚⓪ ┺㦢ὒ ṯ┺ (Figure 1).

1. 浶斲堆旇(沖) 昦洛 1) 㫆㌂╖㌗⽊Ị㏢㍶㩫

⽎㡆ῂ㦮 ⳾㰧┾㦖 2 0 0 4⎚ ₆㭖㩚ῃ 㔲ῆ ῂ 2 4 6Ṳ ⽊Ị㏢㡖┺. 㰖㡃⽊Ị⻫㠦⓪ ⽊Ị㏢

⯒ 㰖⹿㧦䂮┾㼊㥶䡫 ⹥ ὖ䞶㧎ῂ㑮⯒ ₆㭖

㦒⪲ 8Ṗ㰖㥶䡫㦚㩲㔲䞮ἶ 㧞┺. 㧊㠦 ➆⯎

⽊Ị㏢㦮㥶䡫㦖䔏⼚㔲㦮 ῂ, ὧ㡃㔲㦮 ῂ, 㧎 ῂ 5 0Ⱒ ⳛ㧊㌗㦮㔲㦮 ῂ, 㧎ῂ 3 0Ⱒ ⳛ㧊㌗

㦮㔲, 㧎ῂ 3 0Ⱒ ⳛ ⹎Ⱒ㦮㔲, ☚⏣䐋䞿䡫䌲㦮㔲, ῆ, ⽊Ị㦮⬢㤦 ❇㧊┺[16]. 䞮㰖Ⱒ ⿚㍳

㦮䘎㦮㎇㦚㥚䟊㧊 8Ṗ㰖 ῂ⿚㦚 3Ṗ㰖(╖

☚㔲, 㭧㏢☚㔲, ῆ)⪲ ┾㑲䢪䞮㡖┺. ╖☚㔲⓪ 䔏⼚㔲㦮 ῂ, ὧ㡃㔲㦮 ῂ⪲ 㽳 6 9Ṳ ⽊Ị㏢Ṗ 䙂䞾♮㠞┺. 㭧㏢☚㔲⓪ 㧎ῂ 5 0Ⱒⳛ 㧊㌗㔲㦮 ῂ, 㧎ῂ 3 0Ⱒⳛ 㧊㌗㔲, 㧎ῂ3 0Ⱒⳛ ⹎Ⱒ 㔲, ☚⏣䐋䞿㔲⪲ 㽳 8 9Ṳ ⽊Ị㏢Ṗ 䙂䞾♮㠞

┺. ⁎Ⰲἶ ῆ㦖 ῆὒ ⽊Ị㦮⬢㤦㧊䙂䞾♮㠊㽳 8 8Ṳ ⽊Ị㏢Ṗ 䙂䞾♮㠞┺. ⽎㡆ῂ㦮䚲⽎

㦚㿪㿲䞮₆ 㥚䟊䂋䢪ⶊ㧧㥚䚲⽎㿪㿲⻫㦚㩗㣿䞮㡂 ṗ 3Ṗ㰖 ῂ⿚䂋(╖☚㔲, 㭧㏢☚㔲, ῆ)㠦㍲ 1 1૫15% 㑮㭖㠦㍲ ṗṗ 1 0Ṳ㏢㝿 3 0 Ṳ ⽊Ị㏢⯒ 㿪㿲䞮㡖┺. 㧊㭧㭧㏢☚㔲 2Ṳ

㏢⓪ 㧦⬢⹎゚⪲ ⿚㍳㠦㍲㩲㣎䞮㡂 ╖☚㔲┾

㥚⽊Ị㏢ 1 0Ṳ㏢, 㭧㏢☚㔲┾㥚⽊Ị㏢ 8Ṳ㏢,

Figure 1. Framework of this study DEMOGRAPIC

•Gender

•Age

•Occupation

•Past history

•BCG scar

LOCATION OF CENTERS

Dx & Tx

•Sputum smear

•Sputum culture

•Radiology

•Periods of tx

•Chemotherapy

RESOURCES

•Population per staff

•Staff(FTE)

•Doctors

•Education related task

•Budget

•Treatment facilities & equipments

COMMUNTTY ACTIVITIES

•Chest X-ray checking rate

•BCG injection rate

•Case detection rate

•Health education provision rate

•Patient registration & treatment rate

(4)

ῆ┾㥚⽊Ị㏢ 1 0Ṳ㏢⪲ 㽳 2 8Ṳ ⽊Ị㏢Ṗ 㾲㫛 ╖㌗₆ὖ㦒⪲ ㍶㩫♮㠞┺.

2) ⽊Ị㏢ ἆ䟋䢮㧦㍶㩫

ἆ䟋䂮⬢㎇Ὃ ὖ⩾㣪㧎⿚㍳ ╖㌗₆ὖ㦒⪲

㾲㫛㍶㩫♲ 2 8Ṳ ⽊Ị㏢㠦㍲ 2 0 0 3⎚ 1㤪 1㧒

⿖䎆 1 2㤪 3 1㧒₢㰖㽳 1⎚ ☯㞞㽳 8 , 3 6 9ⳛ ἆ 䟋䢮㧦Ṗ 䑊⪳䞲 ộ㦒⪲ 䢫㧎♮㠞┺. 㧊✺ 㭧㠦㍲䌖 ⹒Ṛ㦮⬢₆ὖ ❇⪳ 䂮⬢㧦 4 , 9 5 4ⳛ, ❇

⪳♲ 䂮⬢₆ὖⳛ㧊 ₆㨂♮㠊㧞㰖㞠㦖㧦 1 , 7 5 1ⳛ, 㰚┾ⳛ 䕦㩫⿞Ṗ㧦 2 5ⳛ, 㩚㿲㧦 1 8 4 ⳛ, ἆ䟋゚ὖ⩾ ㌂ⰳ㧦 6ⳛ, 㰚┾⼖ἓ㧦 3 2ⳛ 㦒⪲ ῂ㎇♲ 㽳 6 , 9 5 2ⳛ㦮䑊⪳㧦⓪ 㡆ῂ ╖㌗

㠦㍲㩲㣎䞮㡖┺. ⁎ ἆὒ 㢚䂮㧦 1 , 3 3 1ⳛ, 䂮⬢

㔺䕾㧦 2 2ⳛ, 䂮⬢ 㭧┾㧦 4 7ⳛ, ἆ䟋㦒⪲ 㧎䞲

㌂ⰳ㧦 1 7ⳛ㦒⪲ ῂ㎇♲ 㽳 1 , 4 1 7ⳛ㧊㾲㫛⿚

㍳ ╖㌗㧦⪲ ㍶㩫♮㠞┺.

ἆ䟋䂮⬢㢖㎇Ὃ㦚 ⋮⑚⓪ 㩫㦮⓪ 㰞⼧ὖ Ⰲ⽎⿖㠦㍲䘊⌎ ἆ䟋ὖⰂ㰖䂾㠦㦮Ệ䞮㡖┺.

ἆ䟋䂮⬢ ㎇Ὃ㧦⓪ 䂮⬢㦮 ₆Ṛ㠦 ➆⧒ ㎎Ṗ 㰖⪲ ῂ⿚䞮㡂䂮⬢ἆὒ㦮㎇Ὃ㦚䕦㩫䞲┺.

㟧㎇ 6Ṳ㤪 ┾₆ 䢮㧦㦮 ἓ㤆 3Ṳ㤪, 5Ṳ㤪, 6 Ṳ㤪㱎 3⻞㡆㏣ ☚ⰦỖ㌂㠦㍲ 1䣢㧊䞮㠦㍲

㟧㎇㦒⪲ ⋮䌖⋲ ἓ㤆㠦䟊╏♮Ⳇ ┾, 6Ṳ㤪㱎

⓪ ⹮✲㔲㦢㎇㦒⪲ ⋮㢖㟒 ♲┺. 㟧㎇ 9Ṳ㤪

┾₆ 䢮㧦㦮 ἓ㤆 7Ṳ㤪㱎 ☚ⰦỖ㌂㢖⺆㟧Ỗ

㌂⯒ 䞮ἶ 9Ṳ㤪㱎 ┺㔲 ☚ⰦỖ㌂㠦㍲ ⳾⚦

㦢㎇㧊 ⋮㡾 ἓ㤆㠦䟊╏♲┺. 㟧㎇㧻₆ 䢮㧦㦮 ἓ㤆 9Ṳ㤪㱎 ☚ⰦỖ㌂㢖⺆㟧Ỗ㌂⯒ 㔺㔲䞮ἶ 1 2Ṳ㤪㱎 ☚ⰦỖ㌂⯒ 䞮㡖㦚 ➢ 9Ṳ㤪㱎

☚ⰦỖ㌂⯒ 㩲㣎䞮ἶ ⳾⚦ 㦢㎇㦒⪲ ⋮㢖㟒

♲┺. ⡦䞲 1 3Ṳ㤪㱎⿖䎆 INH ┾☛䒂㡂䞮Ⳋ㍲

1 8Ṳ㤪㱎 ☚Ⱖ 㦢㎇㧊Ⳋ 㢚䂮⪲ 䕦㩫䞲┺[ 1 7 ] . 䂮⬢㔺䕾㧦⓪ 㩫䟊㰚 ₆Ṛ☯㞞䂮⬢⯒ ⹱㞮㦢㠦☚ ⿞ῂ䞮ἶ 䂮⬢ 㔺䕾⪲ 䕦㩫♲ 䢮㧦㧊Ệ

⋮ 䟟⹿⿞ⳛ㦒⪲ 䂮⬢Ṗ 㭧┾♲ 䢮㧦䢏㦖 ἆ 䟋㦒⪲ ㌂ⰳ䞲 ἓ㤆⪲ 㩫㦮䞮㡖┺.

2. 沖巒朞滗愯憛

⽎㡆ῂ⯒ 㥚䟊 Ṳ㧎䔏㎇㣪㧎㦖⽊Ị㏢㦮

ἆ䟋㩫⽊ὖⰂ⽊ἶ㍲(䢮㧦㔶ἶ㣿)㠦㍲ ⁎Ⰲἶ

⽊Ị㏢ ἆ䟋ὖⰂ ㌂㠛䔏㎇㦖㩲3₆ 㰖㡃⽊Ị 㦮⬢Ἒ䣣䡚㰖䘟Ṗ ἆὒ㢖䐋Ἒ㼃㧦⬢⯒ 䐋䟊㑮㰧䞮㡖┺. 䢮㧦㔶ἶ 㧦⬢⓪ ⽎㡆ῂ㧦Ṗ 䚲⽎㿪㿲♲ ⽊Ị㏢㦮 ἆ䟋 ╊╏㧦㠦Ợ 㣪㼃䞮㡂㡆ῂ㧦Ṗ 㰗㩧 ⹿ⶎ䞮Ệ⋮ 㤆䘎 ⡦⓪ 㩚㧦㤆䘎㦚䐋䟊㑮㰧䞮㡖ἶ 㧦⬢ 㑮㰧₆Ṛ㦖 2 0 0 5⎚ 9㤪⿖䎆 2 0 0 6⎚ 4㤪₢㰖㡖┺. 㑮㰧♲ 䢮㧦㔶ἶ 㧦⬢ ⹥ ⽊Ị㏢ ἆ䟋ὖⰂ 䔏㎇㧦⬢

Ṗ㤊◆㍲ ⶎ䠢ἶ㺆ὒ 㩚ⶎṖ㦮㦮ἂ㑮⪊㦚䐋䟊⽎㡆ῂ㦮 ⳿㩗㠦㩗䞿䞲⼖㑮⯒ 㾲㫛㿪㿲䞮㡂⿚㍳䞮㡖┺.

Ṳ㧎㩗䔏㎇㣪㧎㦖㏢㧎㩗㣪㧎ὒ ἆ䟋㧊䢮 ⹥ 䂮⬢ὖ⩾ 㣪㧎㦒⪲ ῂ⿚♮㠞┺. ㏢㧎㩗㣪㧎㠦⓪ ㎇⼚, 㡆⪏, 㰗㠛, 䢮㧦㥶䡫, ὒỆ 䂮

⬢⩻, ゚㔲㰖㩧㫛㥶ⶊ⯒ 䙂䞾䞮㡖┺. 䞲䘎 ἆ 䟋㧊䢮 ⹥ 䂮⬢䔏㎇㠦 ὖ䞲㩫⽊⪲⓪ ṳ╊Ỗ

㌂㦮䕦☛ἆὒ, Ỗ㼊Ỗ㌂㦮䕦☛ἆὒ, ⹿㌂㍶

Ỗ㌂䕦☛ἆὒ, 䂮⬢₆Ṛ ⹥ 㽞䂮⬢ 㻮⹿㥶䡫 (┾₆ 䢏㦖㧻₆)㧊䙂䞾♮㠞┺.

⽊Ị㏢ ἆ䟋ὖⰂ ㌂㠛䔏㎇㦒⪲⓪ ⽊Ị㏢Ṗ 㥚䂮䞲㰖㡃㩗䔏㎇㥶䡫(╖☚㔲, 㭧㏢☚㔲, ῆ)ὒ ἆ䟋ὖⰂ ㌂㠛㦚㥚䞲㧎⩻ 䢮ἓ㦚 ⹮ 㡗䞮⓪ ⽊Ị₆ὖ 㰗㤦 1㧎╏ ὖ䞶㰖㡃 ╊╏

㧎ῂ㑮, ἆ䟋╊╏㧦㑮 ⹥ FTE(Full Time Equivalent, 㔺㩲䒂㧛㧎⩻ 㑮), ἆ䟋ὖⰂ㦮㌂㥶 ⶊ, ἆ䟋ὖⰂṚ䢎㌂㥶ⶊ, ╊╏㧦㦮 ᾦ㥷㧊㑮㩫☚, 㰖㡃㌂䣢䢲☯㩫☚Ṗ ㍶㩫♮㠞┺. 㰖㡃

㌂䣢䢲☯㩫☚⓪ ὖ䞶㧎ῂ ╖゚⽊Ị₆ὖ ⹿

㌂㍶㾂㡗⮶(䟊╏⽊Ị㏢, ⽊Ị㰖㏢, ⽊Ị㰚⬢

㏢㦮 1⎚Ṛ ⹿㌂㍶㾂㡗Ị㑮 / 䟊╏㰖㡃 ⌊ 㧎ῂ㑮), ὖ䞶㧎ῂ╖゚⽊Ị₆ὖ ゚㔲㰖㩧㫛

⮶(䟊╏ ⽊Ị㏢, ⽊Ị㰖㏢, ⽊Ị㰚⬢㏢㦮 1⎚Ṛ

゚㔲㰖㩧㫛Ị㑮 / 䟊╏ 㰖㡃 ⌊ 㧎ῂ㑮), ὖ䞶㧎ῂ╖゚⽊Ị₆ὖ 㔶′䢮㧦 ⹲ἂ㥾(䟊╏⽊Ị

㏢, ⽊Ị㰖㏢, ⽊Ị㰚⬢㏢㦮 1⎚Ṛ ⹲ἂ䞲㔶䢮㧦㑮 / 䟊╏ 㰖㡃 ⌊ 㧎ῂ㑮), ὖ䞶㧎ῂ╖゚

⽊Ị₆ὖ ἆ䟋㌗╊⮶(䟊╏⽊Ị㏢, ⽊Ị㰖㏢,

⽊Ị㰚⬢㏢㦮 1⎚Ṛ ἆ䟋㌗╊Ị㑮 / 䟊╏ 㰖

㡃 ⌊ 㧎ῂ 㑮), ὖ䞶㧎ῂ╖゚⽊Ị₆ὖ ἆ䟋

(5)

䢮㧦 ❇⪳ ὖⰂ㥾(䟊╏ ⽊Ị㏢, ⽊Ị㰖㏢, ⽊Ị 㰚⬢㏢㦮 1⎚Ṛ ❇⪳ ὖⰂ 䢮㧦㑮 / 䟊╏ 㰖㡃 ⌊ 㧎ῂ㑮)㧊䙂䞾♮㠞┺.

㫛㏣⼖㑮⪲⓪ ἆ䟋䂮⬢ἆὒ㰖䚲㧎䂮⬢㎇Ὃ ὒ 䂮⬢㔺䕾(㔺䕾, 㭧┾, ἆ䟋㦒⪲ 㧎䞲㌂ⰳ)

⪲ ῂ㎇♮㠞┺.

3. 沖巒把昣愯憛

⽎㡆ῂ㦮㧦⬢⓪ 㥞☚㣿 SPSS (10䕦)㦚㧊㣿䞮㡂⿚㍳䞮㡖┺.

Table 1. Characteristics of demographic and treatment of patients(N=1,417)

F a c t o r N ( % )

D e m o g r a p h i c G e n d e r M a l e 945(66.7) F e m a l e 4 7 2 ( 3 3 . 3 )

A g e 20 > 1 5 2 ( 1 0 . 7 )

2 1૫4 0 5 0 3 ( 3 5 . 5 ) 4 1૫6 0 3 6 9 ( 2 6 . 1 ) 61 < 3 9 3 ( 2 7 . 7 ) O c c u p a t i o n

^*

P r o f e s s i o n a l s 22( 2.0)

O f f i c e r s 74( 6.6) E n g i n e e r s 2 1 1 ( 1 8 . 8 ) M e r c h a n t s 1 5 0 ( 1 3 . 3 ) Farmers and Fishermen 37( 3.3) O t h e r s 3 1 0 ( 2 7 . 6 ) Not have a job 3 2 0 ( 2 8 . 4 ) Type of patients New cases 1 , 0 6 7 ( 7 5 . 4 ) Relapse cases 2 0 7 ( 1 4 . 6 ) Treatment after default 14( 1.0) M o v e - i n 128( 9.0) Past Treatment history Y e s 3 2 4 ( 2 3 . 5 )

N o 1 , 0 5 5 ( 7 6 . 5 ) BCG scar P o s i t i v e 6 5 8 ( 4 6 . 4 ) N e g a t i v e 4 9 3 ( 3 4 . 8 ) U n k n o w n 2 6 6 ( 1 8 . 8 ) Diagnosis & Treatment Sputum smear P o s t i v e 5 8 8 ( 4 1 . 6 ) N e g a t i v e 8 1 4 ( 5 7 . 5 ) U n k n o w n 1( 0.1)

No test 11( 0.8)

Sputum culture P o s i t i v e 3 7 4 ( 2 8 . 2 ) N e g a t i v e 5 2 4 ( 3 9 . 6 ) U n k n o w n 3( 0.2) No test 4 2 4 ( 3 2 . 0 )

X - r a y N o r m a l 2( 0.1)

S u s p i c i o u s 1 , 3 7 5 ( 9 7 . 3 ) U n k n o w n 4( 0.3)

No test 32( 2.3)

Periods of treatment < 2M 16( 1.1) 3૫6 M 2 4 2 ( 1 7 . 1 ) 7૫9 M 9 3 1 ( 6 5 . 7 ) 1 0૫1 2 M 1 9 8 ( 1 4 . 0 )

13M < 30( 2.1)

T o t a l 1 , 4 1 7 ( 1 0 0 . 0 )

Missing data were excluded

* Others includes housewives, students, and soldiers

New cases were no-treated or treated less than one month

It includes treatment at other hospitals as well as community health centers

(6)

⽊Ị㏢ ἆ䟋䂮⬢ ㎇Ὃὒ ὖ⩾䞲䢮㧦㦮 Ṳ 㧎㩗䔏㎇ὒ ⽊Ị㏢ ἆ䟋ὖⰂ ㌂㠛䔏㎇㦖 ₆ 㑶䐋Ἒ ⿚㍳䞮㡖┺.

䢮㧦㦮 Ṳ㧎㩗䔏㎇ὒ ⽊Ị㏢ ἆ䟋ὖⰂ ㌂㠛䔏㎇㠦 ➆⯎ ἆ䟋䂮⬢ ㎇Ὃῆὒ 㔺䕾ῆ Ṛ 㦮゚ᾦ⓪ X

²

-Ỗ㩫, T-Ỗ㩫㦚㌂㣿䞮㡂 ┾⼖⨟

⿚㍳㦚䞮㡖┺. ⡦䞲 ┾⼖⨟ ⿚㍳㠦㍲㥶㦮䞮 Ợ ⋮䌖⋲ ὖ⩾ 㣪㧎✺㠦 ╖䟊 ┺⼖⨟ ⪲㰖㓺䕇䣢‖⿚㍳㦚䞮㡖┺.

冶刂

1. 浶斲堆旇(沖)汞沂愞洇瞿昷

⽎㡆ῂἆὒ 䢮㧦 Ṳ㧎㩗䔏㎇㦖 Table 1ὒ ṯ┺. ⋾㧦Ṗ 9 4 5ⳛ (66.7%), 㡂㧦Ṗ 4 7 2ⳛ ( 3 3 . 3 % ) 㧊㠞ἶ, 䘟‶ 㡆⪏㦖 4 4 . 9㎎(⻪㥚 2 - 1 0 2

㎎)㡖┺. 㰗㠛㦖 ⶊ㰗㧊 3 2 0ⳛ( 2 8 . 4 % ) 㦒⪲ Ṗ 㧻 Ⱔ㞮┺. 䢮㧦㦮㥶䡫㦖㔶䢮㧦Ṗ 1 , 0 6 7ⳛ ( 7 5 . 4 % ) 㦒⪲ Ṗ㧻 Ⱔ㞮┺. 䌖 ₆ὖ㦚䙂䞾䞮㡂 ὒỆἆ䟋䂮⬢ἓ䠮㦖㠜㠞▮ ἓ㤆Ṗ 1 , 0 5 5ⳛ Table 2. Present condition of tuberculosis control program in health centers(N=28)

Health T u b e r c u l o s i s

F a c t o r Centers P a t i e n t s

N (%) N (%)

Location of centers Metropolitan cities 1 0 ( 3 5 . 7 ) 4 6 1 ( 3 2 . 5 ) Non metro but urban cities 8 ( 2 8 . 6 ) 6 9 0 ( 4 8 . 7 ) Rural cities 1 0 ( 3 5 . 7 ) 2 6 6 ( 1 8 . 8 ) Population per staff of TB department 2,500 > 11(39.3) 283(20.0)

2 , 5 0 0૫5 , 0 0 0 10(35.7) 669(47.2) 5,000 < 7(25.0) 465(32.8) FTE of Staffs of TB department < 1 11(39.3) 310(21.9)

1૫1 . 9 13(46.4) 883(62.3)

1.9 < 4(14.3) 224(15.8) No. of doctors of TB department 0 25(89.3) 1,258(88.8)

1 3(10.7) 159(11.2)

No. of nurses of TB department 0 4(14.3) 243(17.1)

1 17(60.7) 861(60.8)

2 4(14.3) 168(11.9)

3 3(10.7) 145(10.2)

No. of Staff education related TB 5 > 1 1 ( 3 9 . 3 ) 4 4 6 ( 3 1 . 5 )

6૫1 0 13(46.4) 708(50.0)

11 < 4(14.3) 263(18.6) Community activities about TB

X-ray checking rate(%) 5.0 > 6(21.4) 282(19.9) 5.0 ˺ 22(78.6) 1,135(80.1) BCG injection rate(%) 0.5 > 20(71.4) 855(60.3)

0.5 ˺ 8(28.6) 562(39.7)

Case detection rate(%) 0.05 > 14(50.0) 687(48.5)

0.05 ˺ 14(50.0) 730(51.5)

Health education provision rate(%) 2.0 > 22(78.6) 1,081(76.3)

2.0 ˺ 6(21.4) 336(23.7)

Patient registration & treatment 0.2 > 18(64.3) 973(68.7)

r a t e ( % ) 0.2 ˺ 10(35.7) 444(31.3)

Missing data were excluded

(7)

( 7 6 . 5 % ) 㧊㠞ἶ, 㧞㠞▮ ἓ㤆Ṗ 3 2 4ⳛ( 2 3 . 5 % ) 㧊㠞┺. ὒỆ ゚㔲㰖㩧㫛㌗䌲⓪ ⹮䦪㧊㧞⓪ ἓ 㤆Ṗ 6 5 8ⳛ( 5 7 . 2 % ) 㧊㠞㦒Ⳇ, ⹮䦪㧊㠜⓪ ἓ㤆 Ṗ 4 9 3ⳛ( 4 2 . 8 % )㧊㠞┺. ⽎㡆ῂ ╖㌗㧦✺㦮 ἆ䟋㧊䢮 ⹥ 䂮⬢ὖ⩾ 䔏㎇㠦㍲㽞䣢 ṳ╊☚

ⰦỖ㌂⓪ 1 , 4 0 3ⳛ(99.2%), 㽞䣢 ṳ╊⺆㟧Ỗ㌂⓪ 9 0 1ⳛ(68.0%), 㽞䣢 ⹿㌂㍶ Ỗ㌂⓪ 1 , 3 8 1ⳛ ( 9 7 . 7 % ) 㧊 ⹱㞮┺. 䂮⬢ ₆Ṛ㦖䘟‶ 6 . 9Ṳ㤪 (·1 . 9 )㧊㠞┺. 6Ṳ㤪㧊⌊ 䂮⬢⯒ 㭧┾䞲㧦⯒

㩲㣎䞮ἶ 㽞䂮⬢⪲ ┾₆㣪⻫㦚㩲Ὃ⹱㦖 ╖㌗

㧦⓪ 9 0 6ⳛ( 9 0 . 8 % ) 㦒⪲ ╖⿖⿚㦚㹾㰖䟞┺.

⽎㡆ῂ㦮 ╖㌗₆ὖ㦒⪲ ㍶㩫♲ 2 8Ṳ ⽊Ị㏢

㦮 ἆ䟋ὖⰂ ㌂㠛䔏㎇㦚⿚㍳䞲 ἆὒ⓪ T a b l e

2㢖 ṯ┺. ἆ䟋䂮⬢㎇Ὃ㣪㧎㦮⽊Ị㏢ ὖ⩾ 䔏

㎇㦚㌊䘊⽊Ⳋ ╖☚㔲⽊Ị㏢Ṗ 10Ṳ㏢

(35.7%), 㭧㏢☚㔲⽊Ị㏢Ṗ 8Ṳ㏢(28.6%), ῆ 㰖㡃⽊Ị㏢Ṗ 1 0Ṳ㏢( 3 5 . 7 % ) ⪲ 㽳 2 8Ṳ ⽊Ị

㏢Ṗ 䙂䞾♮㠞┺. ⽊Ị₆ὖ Ὃⶊ㤦 1㧎╏ ╊╏

㧎ῂ㑮⓪ 䘟‶ 4 , 8 2 5 . 3 4 ⳛ(·3 , 1 9 7 . 5 3 ) 㧊㠞┺. ἆ 䟋╊╏㧦 F T E㦖䘟‶ 1 . 0 9ⳛ(· 0 . 5 7 )㧊㠞┺.

䒂㧛 Ṛ䢎㌂㑮⓪ 䘟‶ 1 . 1 5ⳛ(· 0.82), 䒂㧛㦮

㌂㑮⓪ 䘟‶ 0 . 1 1ⳛ(·0 . 3 2 )㧊㠞┺. ἆ䟋╊╏㧦㦮 ἆ䟋ὖ⩾ ᾦ㥷㧊㑮⓪ 䘟‶ 7 . 9㧒(·9 . 3 )⪲

㧒⎚㠦㧒㭒㧒㩫☚ ᾦ㥷㦚㧊㑮 ⹱⓪ ộ㦒⪲

⋮䌖⌂┺. 㰖㡃㌂䣢㧎ῂ╖゚ ⹿㌂㍶㾂㡗⮶㦖䘟‶ 9 . 8 4 % (· 1 0 . 4 2 )㧊㠞㦒Ⳇ, 㧎ῂ╖゚゚㔲㰖 Table 3. Comparison of characteristics of patients between treatment success group and

treatment failure

V a r i a b l e s Treatment T r e a t m e n t X

²

or

s u c c e s s ( N = 1 , 3 3 1 ) f a i l u r e ( N = 8 6 ) t - t e s t p G e n d e r M a l e 875( 92.6) 70( 7.4) 8 . 9 1 2 0 . 0 0 3

F e m a l e 456( 96.6) 16( 3.4)

A g e 4 4 . 5 8· 1 9 . 9 6 4 9 . 9 0· 2 0 . 5 1 1 1 0 . 5 6 0 0 . 0 1 3 O c c u p a t i o n Y e s 770( 95.8) 34( 4.2) 2 2 . 3 2 1 0 . 0 0 0

N o 282( 88.1) 3 8 ( 1 1 . 9 )

Type of patient New cases 1,008( 94.5) 59( 5.5) 1 6 . 5 2 4 0 . 0 0 1 relapse cases 189( 91.3) 18( 8.7)

Treatment after default 10( 71.4) 4 ( 2 8 . 6 ) M o v e - i n 123( 96.1) 5( 3.9)

Past history Y e s 297( 91.7) 27( 8.3) 4 . 3 1 5 0 . 0 2 9 N o 1,000( 94.8) 55( 5.2)

BCG scar P o s i t i v e 631( 95.9) 27( 4.1) 6 . 2 1 1 0 . 0 0 9 N e g a t i v e 456( 92.5) 37( 7.5)

Sputum smear N e g a t i v e 774( 95.1) 40( 4.9) 5 . 0 1 8 0 . 0 1 7 P o s i t i v e 542( 92.2) 46( 7.8)

Sputum culture N e g a t i v e 501( 95.6) 23( 4.4) 1 . 3 9 2 0 . 1 5 2 P o s i t i v e 351( 93.9) 23( 6.1)

X-ray N o r m a l 2 ( 1 0 0 . 0 ) 0( 0.0) 0 . 1 3 0 0 . 8 8 2 S u s p i c i o u s 1,291( 93.9) 84( 6.1)

Period of treatment 2 > 7( 41.2) 1 0 ( 5 8 . 8 ) 8 6 . 5 3 3 0 . 0 0 0 ( m o n t h ) 3૫6 735( 93.9) 48( 6.1)

7૫9 457( 96.0) 19( 4.0)

1 0૫1 2 76( 90.5) 8( 9.5) 13 < 23( 95.8) 1( 4.2)

Type of length of Anti Short course 885( 97.7) 21( 2.3) 3 . 1 9 8 0 . 0 7 4 -tuberculous Chemotherapy

^*

Long course 87( 94.6) 5( 5.4)

Missing data were excluded

*Subjects treated less than 6 months were excluded

(8)

㩧㫛⮶㦖䘟‶ 0 . 4 2 % (·0 . 2 8 )㧊㠞㦒Ⳇ, 㧎ῂ╖

゚㔶′䢮㧦 ⹲ἂ㥾㦖䘟‶ 0 . 1 0 % (·0 . 2 4 )㧊㠞㦒Ⳇ, 㧎ῂ╖゚ ἆ䟋㌗╊㔺㩗゚㥾㦖䘟‶

1 . 2 8 % (· 1 . 2 2 )㧊㠞㦒Ⳇ, 㧎ῂ╖゚ ❇⪳ ὖⰂ㥾㦖䘟‶ 0 . 5 9 % (· 1 . 3 4 )㧊㠞┺. 㰖㡃㌂䣢 ₆⹮㦒

⪲ 㑮䟟䞲㌂㠛㔺㩗ἆὒ 㭧 ⹿㌂㍶㾂㡗⮶㧊 Ṗ㧻 ⏨㦖 ộ㦒⪲ ⋮䌖⋮ ⽊Ị㏢⓪ ἆ䟋Ỗ㰚

⹥ 㡞⹿㦚㥚䟊 ⹿㌂㍶ Ỗ㰚㌂㠛㦚 Ṗ㧻䢲⹲

䧞㑮䟟䞮⓪ ộ㦚⽊㡂㭒ἶ 㧞┺.

2. 冶穻獞巒昷击剶刂柪砮剶汞捊剖

䢮㧦㦮 Ṳ㧎㩗䔏㎇ ⹥ ⽊Ị㏢ ἆ䟋ὖⰂ㌂

㠛䔏㎇ Ṗ㤊◆㍲㠊⟺ 㣪㧎✺㧊 ἆ䟋䂮⬢㦮

㎇Ὃὒ 㔺䕾⯒ 㡗䟻㦚 ⹎䂮⓪㰖⯒ 䢫㧎䞮₆

㥚䟊 2 8Ṳ ⽊Ị㏢㢖 ⁎ Ὁ㠦㍲ ἆ䟋䂮⬢⯒ ⹱ 㦖 1 , 4 1 7ⳛ 䢮㧦⯒ 䂮⬢ ㎇Ὃῆὒ 䂮⬢ 㔺䕾ῆ 㦒⪲ ῂ⿚䞮㡂゚ᾦ䞲 ἆὒ⓪ Table 3ὒ T a b l e 4㢖 ṯ┺. 㩚㼊 1 , 4 1 7ⳛ 㫆㌂╖㌗㧦㭧 1 , 3 3 1ⳛ ( 9 3 . 9 % ) 㧊䂮⬢ ㎇Ὃ䞮㡖ἶ, 86ⳛ( 6 . 1 % )㧊䂮

⬢ 㔺䕾䞲 ộ㦒⪲ ⋮䌖⌂┺. 䢮㧦䔏㎇㠦 ➆⯎

䂮⬢㎇Ὃῆὒ 䂮⬢㔺䕾ῆ㦚゚ᾦ䞲 ἆὒ 㥶㦮䞲㹾㧊⯒ ⽊㡂㭒⓪ 㣪㧎㦖㎇⼚(p=0.003), 㡆

⪏(p=0.013), 㰗㠛㥶ⶊ(p=0.000), 䢮㧦㥶䡫 (p=0.001), ὒỆ 䂮⬢⩻(p=0.029), ゚㔲㰖㩧㫛㡂⿖(p=0.009), 㽞䣢 ṳ╊☚ⰦỖ㌂ἆὒ 㟧㎇㡂

⿖(p=0.017), 䂮⬢₆Ṛ( p = 0 . 0 0 0 ) 㧎 ộ㦒⪲ ⋮ 䌖⌂┺. ⽊Ị㏢ ἆ䟋ὖⰂ㌂㠛䔏㎇㠦㍲䂮⬢

㎇Ὃῆὒ 䂮⬢ 㔺䕾ῆṚ 㥶㦮䞲㹾㧊⯒ ⽊㡂 Table 4. Comparison of characteristics of health centers between treatment success group

and treatment failure

V a r i a b l e s Treatment success T r e a t m e n t X

²

or

( N = 1 , 3 3 1 ) f a i l u r e ( N = 8 6 ) t - t e s t p Location of centers Large cities 4 3 1 ( 9 3 . 5 ) 3 0 ( 6 . 5 ) 1 2 . 1 4 3 0 . 0 0 1

Middle cities 6 6 1 ( 9 5 . 8 ) 2 9 ( 4 . 2 ) R u r a l 2 3 9 ( 8 9 . 9 ) 2 7 ( 1 0 . 1 )

Population per staff 2 , 5 0 0 > 2 5 6 ( 9 0 . 5 ) 2 7 ( 9 . 5 ) 8 . 4 0 2 0 . 0 1 5 ( p e r s o n ) 2 , 5 0 0૫5 , 0 0 0 6 3 8 ( 9 5 . 4 ) 3 1 ( 4 . 6 )

5 , 0 0 0 < 4 3 7 ( 9 4 . 0 ) 2 8 ( 6 . 0 )

Staff (FTE) 0.9 > 486(94.9) 2 6 ( 5 . 1 ) 7 . 2 2 3 0 . 0 2 7 1૫1 . 9 629(92.4) 5 2 ( 7 . 6 )

2 < 216(96.4) 8 ( 3 . 6 )

D o c t o r s Y e s 152(95.6) 7 ( 4 . 4 ) 0 . 8 7 3 0 . 2 3 0 N o 1179(93.7) 7 9 ( 6 . 3 )

Registered Nurses Y e s 1097(93.4) 7 7 ( 6 . 6 ) 2 . 8 7 9 0 . 0 5 5 N o 234(96.3) 9 ( 3 . 7 )

Job education 5 > 411(92.2) 3 5 ( 7 . 8 ) 1 0 . 7 1 6 0 . 0 0 5 related TB(day) 6૫1 0 662(93.5) 4 6 ( 6 . 5 )

11 < 258(98.1) 5 ( 1 . 9 )

X-ray checking rate(%) 5.0 > 261(92.6) 2 1 ( 7 . 4 ) 1 . 1 7 2 0 . 2 7 9 5.0 ˺ 1,070(94.3) 6 5 ( 5 . 7 )

BCG injection rate(%) 0.5 > 787(92.0) 6 8 ( 8 . 0 ) 1 3 . 4 2 3 0 . 0 0 1 0.5 ˺ 544(96.8) 1 8 ( 3 . 2 )

Case detection rate(%) 0.05 > 633(95.4) 5 4 ( 4 . 6 ) 7 . 5 0 4 0 . 0 0 6 0.05 ˺ 698(95.6) 3 2 ( 4 . 4 )

Health education provision rate(%) 2.0 > 8 5 1 ( 9 4 . 2 ) 5 2 ( 5 . 8 ) 0 . 4 2 1 0 . 5 1 6 2.0 ˺ 480(93.4) 3 4 ( 6 . 6 )

Patient registration & 0.2 > 923(94.9) 5 0 ( 5 . 1 ) 4 . 7 1 5 0 . 0 3 0 treatment rate(%) 0.2 ˺ 408(91.9) 3 6 ( 8 . 1 )

Missing data were excluded

(9)

㭖㣪㧎㦖⽊Ị㏢㥶䡫(p=0.001), Ὃⶊ㤦 1㧎╏

╊╏㧎ῂ㑮 (p=0.015), ἆ䟋╊╏㧦 FTE (p=0.027), ἆ䟋╊╏㧦㦮 ἆ䟋ὖ⩾ ᾦ㥷㧊㑮㧒㑮(p=0.005), ὖ䞶㧎ῂ╖゚゚㔲㰖㩧㫛㥾 (p=0.001), ὖ䞶㧎ῂ╖゚㔶′䢮㧦 ⹲ἂ㥾 (p=0.003), ὖ䞶㧎ῂ╖゚ ἆ䟋㌗╊㥾 ( p = 0 . 0 4 4 ) 㧎 ộ㦒⪲ ⋮䌖⌂┺.

3. 氦汞穢分崮殚汾刂冶穻獞巒昷击儊汞埪懆峏嵢滆枪矷箒勆把昣

䢮㧦㦮 Ṳ㧎㩗䔏㎇ὒ ⽊Ị㏢ ἆ䟋ὖⰂ㌂㠛䔏㎇㠦㍲ ἆ䟋䂮⬢ ㎇Ὃῆὒ 㔺䕾ῆ Ṛ㠦㥶㦮䞲㹾㧊⯒ ⽊㡂㭒⓪ ⼖㑮⯒ 㿪㿲䞮㡂 ┺⼖

⨟ ⿚㍳䞲 ἆὒ⓪ Table 5㢖 ṯ┺. 䢮㧦㦮 Ṳ 㧎㩗䔏㎇ὒ ὖ⩾䞮㡂㰗㠛㧊㧞⓪ ἓ㤆Ṗ 㠜

⓪ ἓ㤆㠦゚䟊 ἆ䟋䂮⬢ ㎇Ὃ㧊 ⏨㦖 ộ㦒⪲

⋮䌖⌂┺(Odds ratio=2.774, 95% CI : 1.3-6.1).

䂮⬢₆Ṛ㧊 ₎㑮⪳ ἆ䟋䂮⬢ ㎇Ὃ㧊 ⏨㦖 ộ

㦒⪲ ⋮䌖⌂┺(Odds ratio=1.807, 95% CI : 1.5-2.2). ⋾㧦Ṗ 㡂㧦㠦゚䟊 ἆ䟋䂮⬢㎇Ὃ㧊

⌄㦖 ộ㦒⪲ ⋮䌖⌂┺(Odds ratio=0.207, 95%

CI : 0.1-0.5). 㭧┾ 䤚㨂❇⪳㧦Ṗ 㔶䢮㧦 ⡦⓪ 㨂⹲㧦⽊┺ ἆ䟋䂮⬢㎇Ὃ㧊 ⌄㦖 ộ㦒⪲ ⋮䌖

⌂┺(odds ratio=0.046, 95% CI : 0.005-0.5).

䞲䘎⽊Ị㏢ ἆ䟋ὖⰂ㌂㠛䔏㎇ὒ ὖ⩾䞮㡂 ὖ䞶㧎ῂ╖゚⽊Ị₆ὖ ゚㔲㰖㩧㫛⮶㧊 ⏨㦚㑮⪳ ἆ䟋䂮⬢ ㎇Ὃ㦖 ⏨㦖 ộ㦒⪲ ⋮䌖⌂┺

(Odds ratio=18.352 95% CI : 1.1-303.4). ῆ㰖㡃

⽊Ị㏢㠦゚䟊㭧㏢☚㔲(Odds ratio=7.147, 95% CI : 2.1-24.3) ⹥ ╖ ☚ 㔲 (Odds ratio=4.376, 95% CI : 1.2-16.7) ⽊Ị㏢㦮 ἆ䟋䂮⬢ ㎇Ὃ㧊 ⏨㦖 ộ㦒⪲ ⋮䌖⌂┺. ἆ䟋╊╏

㧦㦮 ἆ䟋ὖ⩾ ᾦ㥷㺎㡂䞲㧒㑮Ṗ Ⱔ㦚㑮⪳

ἆ䟋䂮⬢ ㎇Ὃ㦖 ⏨㦖 ộ㦒⪲ ⋮䌖⌂┺( O d d s ratio=1.126 95% CI : 1.02-1.3).

Table 5. Logistic regression model of significant variable (p<0.05) of treatment success (treatment success=1, treatment failure=0)

V a r i a b l e s B S . E . p - v a l u e E x p ( B ) 95% CI G e n d e r ( M a l e / F e m a l e ) - 1 . 5 7 4 0 . 4 8 2 0 . 0 0 1 0 . 2 0 7 0 . 1 - 0 . 5 A g e 0 . 0 2 8 0 . 0 1 5 0 . 0 5 4 1 . 0 2 9 1 . 0 - 1 . 1 Occupation(Have/Not have) 1 . 0 2 0 0 . 4 0 0 0 . 0 1 1 2 . 7 7 4 1 . 3 - 6 . 1 Types of patients(reference : Move-in) 0 . 0 4 6

New cases - 1 . 6 9 0 1 . 1 1 2 0 . 1 2 9 0 . 1 8 5 0 . 0 2 - 1 . 6 Relapse cases - 1 . 3 8 7 0 . 7 8 0 0 . 0 7 5 0 . 2 5 0 0 . 0 5 - 1 . 2 Treatment after default - 3 . 0 7 7 1 . 1 6 5 0 . 0 0 8 0 . 0 4 6 0 . 0 0 5 - 0 . 5 Past history(Yes/No) - 0 . 8 5 2 1 . 0 1 5 0 . 4 0 1 0 . 4 2 7 0 . 1 - 3 . 1 BCG scar(Positive/Negative) 0 . 6 5 3 0 . 5 2 0 0 . 2 0 9 1 . 9 2 1 0 . 7 - 5 . 3 Sputum smear(Positive/Negative) - 0 . 6 6 2 0 . 3 6 4 0 . 0 6 9 0 . 5 1 6 0 . 3 - 1 . 1 Periods of treatment 0 . 5 9 1 0 . 1 0 5 0 . 0 0 0 1 . 8 0 7 1 . 5 - 2 . 2 Location of centers(reference : Rural) 0 . 0 0 7

Large city 1 . 4 7 6 0 . 6 8 3 0 . 0 3 1 4 . 3 7 6 1 . 2 - 1 6 . 7

Middle city 1 . 9 6 7 0 . 6 2 4 0 . 0 0 2 7 . 1 4 7 2 . 1 - 2 4 . 3

Population per staff 0 . 0 0 0 0 . 0 0 0 0 . 6 9 4 1 . 0 0 0 1 . 0 - 1 . 0

Staff FTE 0 . 3 9 7 0 . 4 7 1 0 . 3 9 9 1 . 4 8 7 0 . 6 - 3 . 7

Staff education related TB 0 . 1 1 9 0 . 0 5 3 0 . 0 2 4 1 . 1 2 6 1 . 0 2 - 1 . 3

BCG injection rate 2 . 9 1 0 1 . 4 3 1 0 . 0 4 2 1 8 . 3 5 2 1 . 1 - 3 0 3 . 4

Cases detection rate 0 . 0 5 7 0 . 6 8 0 0 . 9 3 3 0 . 9 4 4 0 . 3 - 3 . 6

Health education provision rate 0 . 0 4 0 0 . 1 7 8 0 . 8 2 4 1 . 0 4 1 0 . 7 - 1 . 5

C o n s t a n t - 3 . 3 0 0 1 . 8 7 5 0 . 0 7 8 0 . 0 3 7

(10)

処然

ὖ⩾ ⶎ䠢㠦㍲㩲㔲♲ ἆ䟋䂮⬢ 㔺䕾䢮㧦㦮㧎ῂ䞯㩗䔏㎇㠦㧞㠊 Ὃ䐋㩗㧎䁷Ⳋ㦖 ⋾㧦㧊Ⳇ ⶊ㰗㧦⧒⓪ ㌂㔺㧊┺[18, 19]. ⡦䞲 ⹎ῃ ῃⰓ⽊Ị㡆ῂ㤦㦮㩚ῃ ἆ䟋䂮⬢ ἆὒ⽊ἶ㠦

㍲☚ ⋾㧦㦮䂮⬢㎇Ὃ⮶( 7 7 . 8 % ) 㠦゚䟊㡂㧦㦮䂮⬢㎇Ὃ⮶( 8 0 . 1 % ) 㧊㥶㦮䞮Ợ ▪ ⏨㦖 ộ 㦒⪲ ⽊ἶ♮㠞┺(p=0.042)[20]. 㧊⩂䞲 ἆὒ⓪

⽎㡆ῂ ἆὒ㠦㍲☚ 㧒ὖ♮Ợ ⋮䌖⋮ἶ 㧞┺.

㧊⩂䞲 ἆὒ㦮㤦㧎㦒⪲⓪ 㡂㧦㠦゚䟊 ⋾㧦

✺㧊䂮⬢㑲㦧☚Ṗ ⌄㦚㈦㞚┞⧒ 䦷㡆 ⹥ 㦢㭒 ❇㦮⿞Ịṫ ㌳䢲㔋ὖ㠦㍲㧊㥶⯒ 㺔㦚㑮㧞㦚 ộ㧊┺. ₖ䧂㰚㦮㡆ῂ㠦㦮䞮Ⳋ 䞮⬾

㠦 1 1Ṳ䞒㧊㌗㦚䞒㤆⓪ ㌂⧢㧊 ⁎⩝㰖㞠㦖

㌂⧢㠦゚䞮㡂 ἆ䟋䂮⬢ ㎇Ὃ⮶㧊 ⌄㦖 ộ㦒

⪲ ⽊ἶ♮㠞┺[21]. ⡦䞲㞢䆪㢂㦖 ἆ䟋Ṧ㡒

⹥ ⹲⼧㦚㯳Ṗ㔲䋺⓪ 㰗㩧㩗㧎㣪㧎㦒⪲ Ṛ 㭒♮㰖⓪ 㞠㰖Ⱒ, 㞢䆪㢂⪲ 㧎䞲㡗㟧⿖㫇, 㩖䟃⩻ Ṧ㏢ ❇㧊 ἆ䟋㦚㞛䢪㔲䋾┺ἶ 㰖㩗䞮 ἶ 㧞┺[22, 23, 24].

㰗㠛㦖 Ịṫ㦮㌂䣢㩗 ἆ㩫㣪㧎㭧㦮䞮⋮

⪲ Ⱔ㦖 ⶎ䠢㠦㍲㰞⼧ὒ 㰗㠛㥶ⶊ㢖㦮 ὖἚ

⯒ ⹳䧞ἶ 㧞⓪◆, 䔏䧞, ⶊ㰗㦖㕂Ⰲ㩗㓺䔎⩞

㓺㯟, ⿖㩫㩗 Ṧ㩫㦮㯳Ṗ, ㌌㦮 Ⱒ㫇Ṧ Ṧ

㏢, 㧦㞚㫊㭧Ṧ Ṧ㏢, ⿚⏎ ⹥ 㤆㤎Ṧ 㟒₆ ❇ ὒ ὖ⩾♮㠊㧞㦢㧊⽊ἶ♮ἶ 㧞┺[25]. ⶊ㰗㦖㌂䣢㩗䢲☯ὒ 㺎㡂⯒ 㩲䞲䞮Ⳇ 㧊⪲ 㧎䟊

㌂䣢㩗㰖㰖Ṗ ⰺ㤆 Ṧ㏢䞮⓪ ộ㦒⪲ ⽊ἶ♮

ἶ 㧞┺[26]. 40૫5 0╖ ⋾㎇㦚 ╖㌗㦒⪲ 䞲䦷㡆㔋ὖ 㫆㌂㠦㦮䞮Ⳋ 㰗㠛㧊㧞⓪ ╖㌗㧦✺

(䦷㡆㥾 3 7 % )㧊 ⁎⩝㰖㞠㦖 ╖㌗㧦(䦷㡆㥾 4 5 % )㠦゚䟊䦷㡆㥾㧊 ⌄㦖 ộ㦒⪲ 㫆㌂♮㠞

┺[20]. ἆῃ 㰗㠛㧊㠜┺⓪ ộ㦖㡂⩂ 㕂Ⰲ㩗㣪㧎ὒ 䞾℮ ㌳䢲㔋ὖ㠦㡗䟻㦚 ⋒㼦 ἆ䟋 ❇ ὒ ṯ㦖㰞䢮㦚㞛䢪㔲䌂 Ṗ⓻㎇㦚 ⏨㧊ἶ 㧞

┺.

Ⱔ㦖 ὖ⩾ ⶎ䠢㠦㍲ ἆ䟋䂮⬢ 㔺䕾㦮㭒㣪䞲㣪㧎㦖䟃ἆ䟋㩲㦮 ∎㭖䞲䂮⬢Ṗ 㭧┾♮

⓪ ộ㧊⧒ἶ ⽊ἶ䞮ἶ 㧞┺[14, 18, 27]. Oh ❇

㠦㦮䞮Ⳋ ἆ䟋䢮㧦✺㦖㧚㦮⪲ 䂮⬢⯒ 㭧┾

䞲㧊㥶⪲˄ 㟓⽋㣿㧊 ‖㺄㞚㍲˅ ⧒⓪ 䟃⳿㠦 Ṗ㧻 Ⱔ㦖㦧╋㦚䞮㡖┺(40.0%)[28]. Park ❇ 㦮㡆ῂ⓪ 6Ṳ㤪䂮⬢㣪⻫㩲Ὃ㧦㦮 1 3 . 6 %Ṗ 㭧┾ 䑊⪳䞲 ⹮Ⳋ㠦 9Ṳ㤪䂮⬢㣪⻫㩲Ὃ㧦㦮 3 4 . 1 %Ṗ 㭧┾ 䑊⪳䞲 ộ㦒⪲ ⽊ἶ䞮㡖┺[ 2 9 ] . 䞲䘎, ⹎ῃ㠦㍲⓪ ┾₆㣪⻫ ἆ䟋䢮㧦㦮 2 5 %Ṗ 6Ṳ㤪㦮 ┾₆䂮⬢ὒ㩫☚ ⊳⌊㰖 ⴑ䞶㈦㞚┞

⧒ 㢚䂮♲ 䢮㧦✺ 㭧 1 / 3㧊 ἆ䟋㨂⹲㡞⹿㦚㥚䞲㿪䤚ὖⰂ 䂮⬢⯒ 䙂₆䞮⓪ ộ㦒⪲ ⽊ἶ

♮ἶ 㧞┺[30]. ⽎㡆ῂ㠦㍲䂮⬢ ㎇Ὃῆὒ 䂮

⬢ 㔺䕾ῆ㦮䂮⬢₆Ṛ㠦㧞㠊㍲㥶㦮䞮Ợ 㹾㧊Ṗ 㧞⓪ ộ㦒⪲ 㫆㌂♮㠞⓪◆(p=0.000) 䂮

⬢㎇Ὃῆ㦮䘟‶ 䂮⬢₆Ṛ㧊 7Ṳ㤪㧎 ⹮Ⳋ㠦, 䂮⬢㔺䕾ῆ㦮䘟‶ 䂮⬢₆Ṛ㦖 5 . 6Ṳ㤪⪲ 㾲㏢

䞲㦮 ┾₆㣪⻫䂮⬢₆Ṛ㧎 6Ṳ㤪㦚 ⹎㻮㺚㤆㰖 ⴑ䞮ἶ 㭧┾䞮⓪ ộ㦒⪲ ⋮䌖⌂ἶ 㧊⩂䞲 ἓ䟻㦖 ┺⼖⨟ ⪲㰖㓺䕇䣢‖⿚㍳㠦㍲☚ 㰖㏣

♮ἶ 㧞㠊䂮⬢㭧┾㧊 ἆ䟋䂮⬢ 㔺䕾㦮㭧㣪䞲㣪㧎㧚㦚㧒ὖ♮Ợ ⽊㡂㭒ἶ 㧞┺.

⽎㡆ῂ㠦㍲⽊Ị㏢㦮 ἆ䟋ὖⰂ ㌂㠛㦖⽊ Ị㏢Ṗ ㏢㨂䞲㰖㡃㠦 ➆⧒ ㌗㧊䞲 ἆ䟋䂮⬢

㎇Ὃ ἆὒ⯒ ⽊㡂㭒ἶ 㧞⓪ ộ㦒⪲ ⋮䌖⌂┺

(p=0.001). Lee ❇㦮㡆ῂ㠦㦮䞮Ⳋ 㭧㏢☚㔲

⹥ ⏣㽢㰖㡃⽊Ị㏢ ἆ䟋䢮㧦✺㦮 ἆ䟋䂮㥶

㎇Ὃ㥾㧊 ⌄㦖 ộ㦒⪲ ⋮䌖⌂┺[31]. Kimὒ K i m㦮㡆ῂ㠦㦮䞮Ⳋ 㽞䣢 ṳ╊☚Ⱖ㟧㎇ ⹥

⺆㟧 Ỗ㌂㌗㟧㎇㧎䢮㧦, 㽞䣢 ⹿㌂㍶ Ỗ㰚

㌗㭧㯳䢮㧦Ṗ ☚㔲㠦゚䟊 ⏣㽢㠦㍲ ▪ Ⱔ㦖 ộ㦒⪲ ⽊ἶ䞮㡖┺[14]. Kang ❇㦮㡆ῂ㠦㦮䞮Ⳋ ⏣㽢㰖㡃㭒⹒✺㦮 ἆ䟋㦮㡆⪏䚲㭖䢪㌂

ⰳ⮶㧊 ☚㔲㰖㡃㠦゚䟊 ⏨㦒Ⳇ ㌂ⰳ⮶ Ṧ㏢

ἓ䟻☚ 㥶㦮䞮Ợ ⚪䢪♮㠊㡆⪏䚲㭖䢪㌂ⰳ⮶

ỿ㹾Ṗ 㩦㩦䄺㰖⓪ 㟧㌗㦚⽊㧊ἶ 㧞㠞┺

[32]. ⏎㡗㑯㠦㦮䞮Ⳋ ἆ䟋䢮㧦✺㧊䂮⬢⯒

㭧┾䞮⓪ Ṗ㧻䋆㧊㥶⪲˄ 䂮⬢₆ὖ㦮 ỆⰂṖ Ⲗ㠊㍲( 4 4 . 9 % ) ˅ ⪲ ╋䞲 ộ㦒⪲ ⋮䌖⌂┺[ 3 3 ] .

☚㔲㠦゚䟊 ⏣㽢㧊 ἆ䟋㦚䂮⬢䞶㑮㧞⓪

㦮⬢₆ὖ㦮⿚䙂Ṗ 㩗₆ ➢ⶎ㠦 ⏣㽢㰖㡃㦮

ἆ䟋䂮⬢ 㔺䕾㥾㦚 Ṳ㍶䞮₆Ṗ 㠊⩺㤎 ộ㦒

(11)

⪲ 㩚ⰳ♲┺[34].

Lee ❇㦮㡆ῂἆὒ㠦㦮䞮Ⳋ ἆ䟋䂮㥶㥾ὒ

㎇Ὃ⮶㦮㥶㦮䞲 ὖ⩾⼖㑮㭧䞮⋮⪲ ἆ䟋╊

╏Ṛ䢎㌂㦮 ἆ䟋㩚ⶎᾦ㥷㧊㑮㡂⿖Ṗ 䙂䞾♮

㠞ἶ, 㦮⬢㩲Ὃ㧦㦮 ἆ䟋㩚ⶎᾦ㥷 ṫ䢪Ṗ ṫ㫆

♮㠞┺[31]. ⽎㡆ῂ㠦㍲ ╊╏㧦㦮 ᾦ㥷㦖䂮

⬢㎇Ὃῆ㦮 ἓ㤆䘟‶ ᾦ㥷㧒㑮Ṗ 9 . 1㧒㧎◆

゚䟊䂮⬢㔺䕾ῆ㦮 ἓ㤆 ╊╏㧦㦮䘟‶ ᾦ㥷㧒㑮⓪ 5 . 3㧒⪲ 㥶㦮䞮Ợ ⌄㦖 ộ㦒⪲ 㫆㌂♮

㠞┺(p=0.000). 㧊⓪ ἆ䟋╊╏㧦㦮㩚ⶎ㎇䢫

⽊Ṗ 䢮㧦䂮⬢㦮㎇Ὃ㠦㰖╖䞲㡗䟻㦚 ⹎䂶 ộ㦒⪲ 䕦┾♮₆ ➢ⶎ㧊┺. Kim ❇㦮㡆ῂ㠦㦮䞮Ⳋ ⽊Ị㏢ ⹿ⶎ 㔲Ⱎ┺ 䟃 ἆ䟋䂮⬢㠦 ╖ 䞲 ᾦ㥷㦚 ⹱㦖 ἓ㤆⓪ 䢎㩚ῆ㧊 7 8 . 6 %⪲ ゚䢎㩚ῆ 6 0 . 0 %⽊┺ Ⱔ㞮㦒Ⳇ, ἆ䟋㠦 ╖䞲㰖㔳㩫☚☚ 䢎㩚ῆ㧊 1 2 . 9⪲ ゚䢎㩚ῆ 1 0 . 6⽊┺ 㥶㦮䞮Ợ ⏨㦖 ộ㦒⪲ ⋮䌖⌂┺(p<0.01)[13]. 䘦 ἆ䟋㠦 ╖䞲㩫⽊㔋✳㦖䂮⬢ ㎇Ὃῆ㧊 9 7 . 8 %

⪲ 㔺䕾ῆ 8 6 . 4 %⽊┺ 㥶㦮䞮Ợ ⏨㞮┺[18]. 㧊

⩂䞲 ἆὒ㠦☚ ⿞ῂ䞮ἶ ⽊Ị㏢㦮 ἆ䟋╊╏

㧎⩻ 㑮⓪ 㰖㏣㩗㧎 Ṧ㏢⯒ ⽊㧊ἶ 㧞ἶ ╊╏

㧦㦮㧼㦖㧊☯ὒ 㔶′ᾦ㥷㧊㩗㔲㠦㧊⬾㠊㰖㰖㞠⓪ ❇ ἆ䟋ὖⰂ㌂㠛㧎⩻ὒ ὖ⩾䞮㡂㡂㩚䧞 ⶎ㩲㩦㦚⽊㧊ἶ 㧞┺. 㾲⁒ ⽊Ị㏢ ἆ 䟋ὖⰂ㌂㠛㧎䝚⧒㠦 ὖ䞲䞲ῃ⽊Ị㌆㠛㰚䦻㤦㦮⽊ἶ㠦㦮䞮Ⳋ ⽊Ị㏢㦮 ἆ䟋ὖⰂ ㌂㠛㠦㔺㩲䒂㧛♲ 㧎⩻㦖䘟‶ 1 . 2ⳛ㧊㠞ἶ, 䔏䧞

⏣㽢㰖㡃㧒㑮⪳ ἆ䟋╊╏㧦Ṗ 䌖㠛ⶊ⯒ Ἆ㰗䞮ἶ 㧞⓪ ゚㥾㧊 ⏨㞚㔺㩲㠛ⶊ䒂㧛⨟㦖 Ⱔ 㰖㞠㞮┺[35]. ⽊Ị㏢㧊㣎㠦☚ 㭧㞯㩫⿖ ⹥ ὧ㡃㩫⿖ ⡦䞲 ⏣㽢㦮⽊Ị㰖㏢ ❇ ὋὋ⽊Ị 㦮⬢㼊Ἒ ⌊㦮 ἆ䟋╖㦧㔲㓺䎲㦖㩦㹾㟓䢪

♮ἶ 㧞㠊[36] ἆ䟋 ⶎ㩲㦮䋂₆㢖㰖㏣㎇㠦

゚䟊㧊㠦 ╖㦧䞮⓪ 㩫⿖㦮 ὋὋ⽊Ị㦮⬢₆ὖ 㠦 ╖䞲 ἆ䟋㠦 ὖ䞲⽊Ị㩫㺛㦖㤆㍶㑲㥚Ṗ

⌄㞚㰖ἶ 㧞┺.

䞲䘎⽎㡆ῂἆὒ ⽊Ị㏢㦮 ἆ䟋ὖ⩾ 㠛ⶊ 䢲☯㩫☚⯒ ⋮䌖⌊⓪ ὖ䞶㧎ῂ╖゚ BCG 㩧㫛

⮶㦖⽊Ị㏢㦮䂮⬢㎇Ὃ⮶ὒ ⏨㦖㡆ὖ㎇㦚 Ṭ⓪ ộ㦒⪲ ⋮䌖⌞┺. 䞮㰖Ⱒ ὖ䞶㧎ῂ╖゚

㔶′䢮㧦 ⹲ἂ㥾( p = 0 . 0 0 3 ) ὒ ὖ䞶㧎ῂ╖゚ ἆ 䟋㌗╊㥾( p = 0 . 0 4 4 ) 㦖 ┾⼖⨟ ⿚㍳㠦㍲䂮⬢

㎇Ὃὒ 㥶㦮䞲㡆ὖ㎇㦚 Ṭ⓪ ộ㦒⪲ ⋮䌖⌂

㰖Ⱒ ┺⼖⨟ ⿚㍳㠦㍲⓪ 㩲㣎♮㠞┺. 㧊⩂䞲 ἆὒ⓪ ⽊Ị㏢㦮㰖㡃㌂䣢䢲☯㧊㧒㩫⿖⿚

❇⪳♲ ἆ䟋䢮㧦㦮䂮⬢ ㎇Ὃ㠦㡗䟻㦚 ⹎䂾㦚㔲㌂䞮㰖Ⱒ 㧊⩂䞲⽊Ị㏢㦮㰖㡃㌂䣢 ἆ 䟋 ὖⰂ 䢲☯㦖㩚⹮㩗㦒⪲ 㔺㩗㧊㧧ἶ ⁎ 䣾ὒṖ 㧻₆㩗㦒⪲ ⋮䌖⋶ Ṗ⓻㎇㧊 ⏨㞚㍲

⽊Ị㏢㠦 ❇⪳♲ ἆ䟋䢮㧦㦮䂮⬢㎇Ὃ㠦⽊Ị

㏢Ṗ 㑮䟟䞮⓪ 㰖㡃㌂䣢 ἆ䟋⽊Ị㌂㠛㧊㠊⟺

㡗䟻㦚 ⹎䂮⓪㰖㏣┾䞮₆ 㠊⪋┺. 䞲䘎 P a r k

❇㦖 ἆ䟋䂮⬢㎇Ὃ㦚㥚䟊㍲⓪ 㫆₆㰚┾ ⹥ 㫆₆䂮⬢㦮㭧㣪㎇㦚 ṫ㫆䞮㡖ἶ[29] ➆⧒㍲

ἆ䟋䂮⬢㎇Ὃ㦚㥚䟊㍲⓪ 䢮㧦Ṳ㧎㦮 ⏎⩻ὒ 䞾℮ ἆ䟋䢮㧦㫆₆⹲ἂὒ ❇⪳㌂㠛 ⹥ ゚㔲㰖㡞⹿㩧㫛 ❇ ⽊Ị㏢ ἆ䟋ὖⰂ㌂㠛㦮㰖㏣

㩗㧊ἶ ⌊㔺㧞⓪ 㑮䟟㧊 ⰺ㤆㭧㣪䞾㦚㞢㑮㧞┺. ➆⧒㍲㧊⿚㟒㠦 ╖䟊㍲⓪ 㿪䤚 ▪ 㤇㩫⹖䞲㡆ῂṖ 䞚㣪䞲㔺㩫㧊┺.

⽊Ị㏢㠦㍲㦮 ἆ䟋ὖⰂ⓪ ⽊Ị㏢Ṗ 㔲㧧♮

Ⳋ㍲⿖䎆 4 0⎚ 㧊㌗㡺⧲ ☯㞞㰖㏣♮㠊㢪┺.

䡚㨂⽊Ị㏢⓪ 㩚㼊 ἆ䟋䢮㧦㭧㟓 30% 㩫☚

⯒ ὖⰂ䞶㩫☚⪲ 㭧㣪䞲㡃䞶㦚 ╊╏䞮ἶ 㧞

┺[37]. 㧊㣎㠦☚ 㰖㡃㌂䣢㭒⹒ ╖㌗ ἆ䟋

⹲ἂ ㌂㠛, ἆ䟋㠦 ὖ䞲䢣⽊ ᾦ㥷㌂㠛 ❇ 㡞

⹿㌂㠛㦚⼧䟟䞮ἶ 㧞㠊 ἆ䟋ὖⰂ ㌂㠛㠦㍲

⽊Ị㏢Ṗ 㹾㰖䞮⓪ 㭧㣪㎇㦖 ⰺ㤆䋂┺.

⽎㡆ῂ㦮㩲䞲㩦㦒⪲⓪ 㡆ῂ ㍺Ἒ㠦㍲ ṗ Ṳ㧎㦮䦷㡆㥶ⶊ ⹥ ₆㩖㰞䢮㠦 ╖䞲㩫⽊⯒

䕢㞛䞮㰖 ⴑ䟞┺⓪ 㩦ὒ ṗ 䢮㧦㦮䂮⬢⯒ 㥚䟊㝆㧎㎎⿖㩗㧎㟓ⶒⳛ䃃 ⹥ ⁎ 㫆䞿㠦 ╖ 䞲㩫⽊⯒ 䢫⽊䞮㰖 ⴑ䟞┺⓪ 㩦㧊┺. 䞲䘎⽊ Ị㏢㦮 ἆ䟋ὖⰂ ㌂㠛㠦㧞㠊㍲☚ ⁎ 㧎䝚⧒

㢖㔺㩗㠦 ╖䞲㩫⽊⓪ 䢫⽊䞮㡖㰖Ⱒ ㎎⿖㩗㧎 ἆ䟋ὖⰂ㌂㠛㦮㰞㠦 ╖䞲㩫⽊⓪ 㫆㌂♮

㰖 ⴑ䞮㡖┺.

⽎㡆ῂ⓪ ἆ䟋ὖⰂ㌂㠛㦮㎇Ὃ㠦 ⹎䂮⓪ 㡗䟻㦒⪲ ṗ 䢮㧦 Ṳ㧎㠦 ╖䞲䔏㎇㈦㞚┞

⧒ ⽊Ị₆ὖ㦮 ὋὋ⽊Ị㌂㠛䢲☯ 䔏㎇☚ ἶ

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⩺♮㠊㟒䞾㦚㔲㌂䞲㡆ῂ⪲㍲䟻䤚 ▪㤇㩫

⹖䞲㡆ῂ⯒ 㥚䞲 ₆㽞㫆㌂⪲ 㦮⹎Ṗ 㧞┺.

殚檃

⽎㡆ῂ㦮 ⳿㩗㦖㩚⹮㩗㧎⽊Ị㏢㦮 ἆ䟋 ὖⰂ ㌂㠛㔺䌲⯒ 䕢㞛䞮ἶ, ἆ䟋䂮⬢㎇Ὃ㠦䢮㧦㦮 Ṳ㧎㩗䔏㎇ὒ 䞾℮ ⽊Ị㏢ ἆ䟋ὖⰂ

㌂㠛 ὖ⩾ 㣪㧎☚ 㡗䟻㦚 ⹎䂮⓪Ṗ⯒ 䢫㧎䞮

₆ 㥚䞾㧊┺. 2003⎚ 1㤪 1㧒⿖䎆 1 2㤪 3 1㧒₢

㰖 ₆Ṛ ☯㞞㩚ῃ 2 8Ṳ ⽊Ị㏢㠦㍲ ἆ䟋䂮⬢

䤚䑊⪳ 䞲 ἆ䟋䢮㧦⯒ ╖㌗㦒⪲ ἆ䟋䂮⬢ ㎇ Ὃ ὖ⩾㣪㧎ὒ ὖ⩾䞮㡂䢮㧦 Ṳ㧎㩗䔏㎇ὒ

⽊Ị㏢ ἆ䟋ὖⰂ ㌂㠛䔏㎇㦚⿚㍳䞮㡖┺.

⽎㡆ῂἆὒ⓪ ┺㦢ὒ ṯ┺. 䢮㧦㦮 Ṳ㧎㩗䔏㎇ὒ ὖ⩾䞮㡂㰗㠛㧊㧞⓪ ἓ㤆Ṗ 㠜⓪ ἓ 㤆㠦゚䟊 ἆ䟋䂮⬢ ㎇Ὃ㧊 ⏨㦖 ộ㦒⪲ ⋮䌖

⌂┺(Odds ratio=2.774, 95% CI : 1.3-6.1). 䂮⬢

₆Ṛ㧊 ₎㑮⪳ ἆ䟋䂮⬢ ㎇Ὃ㧊 ⏨㦖 ộ㦒⪲

⋮䌖⌂┺(Odds ratio=1.807, 95% CI : 1.5-2.2).

⋾㧦Ṗ 㡂㧦㠦゚䟊 ἆ䟋䂮⬢㎇Ὃ㧊 ⌄㦖 ộ 㦒⪲ ⋮䌖⌂┺(Odds ratio=0.207, 95% CI : 0.1-0.5). 㭧┾ 䤚㨂❇⪳㧦Ṗ 㔶䢮㧦 ⡦⓪ 㨂⹲

㧦⽊┺ ἆ䟋䂮⬢㎇Ὃ㧊 ⌄㦖 ộ㦒⪲ ⋮䌖⌂┺

(odds ratio=0.046, 95% CI : 0.005-0.5).

䞲䘎⽊Ị㏢ ἆ䟋ὖⰂ㌂㠛䔏㎇ὒ ὖ⩾䞮㡂 ὖ䞶㧎ῂ╖゚⽊Ị₆ὖ ゚㔲㰖㩧㫛⮶㧊 ⏨㦚㑮⪳ ἆ䟋䂮⬢ ㎇Ὃ㦖 ⏨㦖 ộ㦒⪲ ⋮䌖⌂┺

(Odds ratio=18.352 95% CI : 1.1-303.4). ῆ㰖㡃

⽊Ị㏢㠦゚䟊㭧㏢☚㔲(Odds ratio=7.147, 95% CI : 2.1-24.3) ⹥ ╖ ☚ 㔲 (Odds ratio=4.376, 95% CI : 1.2-16.7) ⽊Ị㏢㦮 ἆ䟋䂮⬢ ㎇Ὃ㧊 ⏨㦖 ộ㦒⪲ ⋮䌖⌂┺. ἆ䟋╊╏

㧦㦮 ἆ䟋ὖ⩾ ᾦ㥷㺎㡂䞲㧒㑮Ṗ Ⱔ㦚㑮⪳

ἆ䟋䂮⬢ ㎇Ὃ㦖 ⏨㦖 ộ㦒⪲ ⋮䌖⌂┺( O d d s ratio=1.126 95% CI : 1.02-1.3).

㧊㌗㦮 ἆὒ⓪ 䟻䤚 ἆ䟋ὖⰂ㦮㎇Ὃ⮶㦚

⏨㧊₆ 㥚䟊 ṗ Ṳ㧎㦮䔏㎇㦚 ἶ⩺䞮㡂㟒䞶

㈦㞚┞⧒ ⽊Ị㏢㦮 ἆ䟋ὖⰂ䢲☯㦚 ⏨㧊⓪ ộ☚ 䞾℮ Ỗ䏶♮㠊㟒䞾㦚㔲㌂䞲┺.

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2002;52(6):579-589 (Korean)

Related Factors of Treatment Success of Patients with Tuberculosis Management in Public Health Centers

O b j e c t i v e s: This retrospective study is to identify related factors of treatment success of patients with tuberculosis at community health centers.

diagnosis and treatment. The present conditions of health centers consist of 3 factors, location of centers, resources, and community activities. Data were analysed using X

- t e s t and logistic regression methods.

C o n c l u s i o n s: Tuberculosis is still one of serious diseases in Korea, because it causes highest mortality rate among OECD countries. This study may provide information to improve treatment effectiveness of tuberculosis at community health centers.

Key words : Public health center, Tuberculosis, Health care

보건소관리결핵환자의퇴록시치료성공요인

䢿㦖㩫

, ⋮⺇㭒

䞲ῃ⽊Ị㌆㠛㰚䦻㤦

, Ị㟧╖䞯ᾦ 㦮ὒ╖䞯

Related Factors of Treatment Success of Patients with Tuberculosis Managed in Public Health Centers

Eun-Jeong Hwang

, Baeg-Ju Na

K o rea Health Industry Development Institute

, College of Medicine, Konyang University

୙ABSTRACT୙

J Agri Med & Community Health 2 0 0 7 ; 3 2 ( 3 ) : 1 2 5 ~ 1 3 8

* ᾦ㔶㩖㧦: 䢿㦖㩫, ㍲㤎䔏⼚㔲 ☯㧧ῂ ⏎⨟㰚☯ 3 1 1 - 2 7⻞㰖 ╖㎇ア❿ 3䂋, 㩚䢪: 02-822-9800, 䕿㓺: 02-822-9400

E - m a i l: e j h w a n g @ k h i d i . o r . k r

昢 嵦

㎎Ἒ㩗㦒⪲ 1 9 5 0⎚╖⿖䎆 䟃ἆ䟋 䢪䞯䂮⬢㦮

⽊ 㧊 㔲㧧♮Ⳋ㍲ 㩦㹾 ἆ䟋㦖 䂮㥶♶ 㑮 㧞

┺[4]. 䞮㰖Ⱒ ⁎ 㧊䤚⪲☚ ἆ䟋⹲㌳ ⹥ ㌂ⰳ 㦖 ㎎Ἒ㩗㦒⪲ Ἒ㏣ 㯳Ṗ䞮ἶ 㧞┺[ 5 ] .

㤆Ⰲ⋮⧒⓪ 1 9 6 2⎚ ῃṖἆ䟋ὖⰂ㼊ἚṖ 㑮Ⱃ

♮Ⳋ㍲ 㩚ῃ 㔲ῆῂ ⽊Ị㏢⯒ 㭧㕂㦒⪲ ἆ䟋 䢮㧦 㫆₆⹲ἂὒ ❇⪳ὖⰂ, ゚㔲㰖 㡞⹿㩧㫛, 㰖㡃㭒⹒ὒ ❇⪳♲ ἆ䟋䢮㧦㠦 ╖䞲 ⽊Ịᾦ㥷

❇ ⽎ỿ㩗㧎 ἆ䟋ὖⰂ ㌂㠛㧊 ⻪ῃ⹒㩗㦒⪲

㔺㔲♮㠞┺[6]. ⡦䞲, ἆ䟋ⶎ㩲㦮 䋂₆㢖 㿪㎎

⯒ 䕢㞛䞮₆ 㥚䟊 ㎎‶Ỗ㌂⯒ 䙂䞾䞮㡂 㩚ῃ ἆ䟋㔺䌲㫆㌂⯒ 1 9 6 5⎚⿖䎆 1 9 9 5⎚₢㰖 5⎚ Ṛ ỿ㦒⪲ 7㹾㠦 Ỏ㼦㍲ 㭒₆㩗㦒⪲ 㔺㔲䟊 㢪┺

[7]. 㧊⩂䞲 ⏎⩻㠦 䧮㧛㠊 ἆ䟋 㥶⼧⮶(⹿㌂

㍶ Ỗ㌂㌗ 䢲☯㎇ 䘦ἆ䟋㥶⼧⮶)㧊 1 9 6 5⎚

5 . 1 %㠦㍲ 1 9 9 5⎚ 1 . 0 %⪲ 㰖⋲ 3 0⎚ ☯㞞 ∎㭖 䧞 Ṧ㏢䟊 㢪㦒Ⳇ, ἆ䟋㌂ⰳ⮶☚ 㧎ῂ 1 0Ⱒ ⳛ

╏ 1 9 8 6⎚㠦 1 7 . 1ⳛ㠦㍲ 1 9 9 5⎚ 8 . 7ⳛ㦒⪲ Ṧ㏢

♮㠞┺[6]. ⁎⩒㠦☚ ⿞ῂ䞮ἶ 㤆Ⰲ⋮⧒⓪ 2 0 0 5⎚ ἆ䟋㌂ⰳ⮶ὒ ἆ䟋⹲㌳⮶㧊 ἓ㩲䡧⩻

₆ῂ(OECD) 30Ṳ 䣢㤦ῃ 㭧 1㥚⪲ ⋮䌖⌂┺

[8]. 2005⎚☚ 㔶ἶ ἆ䟋㔶䢮㧦Ṗ 㟓 3 5㻲ⳛ㧊 㠞ἶ, ῃ⹒ 3 1 1ⳛ╏ 1ⳛ㧊 䢲☯㎇ ἆ䟋䢮㧦㧊 Ⳇ, ⰺ⎚ 㟓 3 , 0 0 0ⳛ㧊 ἆ䟋㦒⪲ ㌂ⰳ䞲 ộ㦒⪲

⋮䌖⋮ 㤆Ⰲ⋮⧒ ἆ䟋 ὖⰂ㦮 㰞 ⹥ ㎇ὒ㠦 㦮ⶎ㧊 㩲₆♮ἶ 㧞┺[8].

㔺㩲⪲ 2 0 0 1⎚☚ 㩚ῃ ⽊Ị㏢㠦 ❇⪳♲ ☚Ⱖ 㟧㎇ 䘦ἆ䟋 䢮㧦㠦 ╖䞲 ἆ䟋䂮⬢ ㎇Ὃ㥾㦖

7 8 . 6 %㧊Ⳇ, ⹒Ṛ ⼧㦮㤦㦮 ἓ㤆 㧊⽊┺ ▪㤇

⌄㦖 7 4 . 4 %⪲ ⽊ἶ♮㠞┺[9]. 㧊⓪ ㎎Ἒ⽊Ị₆ ῂṖ ῢ㧻䞮⓪ ἆ䟋䂮⬢㥾 ⳿䚲㧎 8 5 %㠦 ⹎ 䂮㰖 ⴑ䞶 ㈦ 㞚┞⧒ ㎎Ἒ⽊Ị₆ῂ㦮 2 0 0 0⎚

₆㭖 㩚 ㎎Ἒ ☚Ⱖ㟧㎇ 䘦ἆ䟋䢮㧦( 1 , 2 3 1 , 8 4 7 ⳛ

╖㌗)㠦 ╖䞲 䆪䢎䔎⿚㍳ἆὒ㠦㍲ ⋮䌖⋲ 㩚

㎎Ἒ 䘟‶ 䂮⬢ ㎇Ὃ⮶(treatment success rate) 7 9 . 5 %㠦☚ ⹎䂮㰖 ⴑ䞮⓪ 㑮䂮㡖┺[10].

₆⽊┺⓪ 㩚 䂮⬢₆Ṛ☯㞞 䢮㧦 ⹥ 㰖㡃㌂䣢 Ṗ 㓺㓺⪲ 䂮⬢ ⹥ 㡞⹿㠦 ⓻☯㩗㦒⪲ 㺎㡂䞾 㦒⪲㖾 㔺䡚♶ 㑮 㧞┺ἶ 䞮㡂[12] 㰖㡃㌂䣢

⽊Ị㦮⬢ 䢲☯㦚 ṫ㫆䞮㡖┺. 䞮㰖Ⱒ, ἆ䟋䂮

⬢㎇Ὃ ὖ⩾㣪㧎⿚㍳ὒ ὖ⩾䞲 ῃ⌊㣎 㡆ῂ⯒

㌊䘊⽊Ⳋ 㽞䣢 Ỗ㌂ἆὒ, 䂮⬢㑲㦧☚, 㰖㔳㩫

☚, Ṗ㫇㦮㰖㰖, ╏␾ ❇㦮 㰞䢮㥶ⶊ ❇ ╖⿖⿚

ἆ䟋䂮⬢㎇Ὃ㦮 ὖ⩾㣪㧎㦒⪲ 䢮㧦 Ṳ㧎㦮 䔏

㎇ ⹥ 㰞䢮㩫☚㠦Ⱒ 㭒⪲ 㽞㩦㦚 ⚦㠊㢪㦒Ⳇ [13-15] ▪㤇㧊 ㎎Ἒ⽊Ị₆ῂ㠦㍲ 㩲㔲䞮ἶ 㧞

⓪ ἆ䟋㦚 ὖⰂ䞮⓪ ὋὋ⽊Ị㦮⬢㼊Ἒ㠦 ₆㧎 䞲 䂮⬢㎇Ὃ㣪㧎㦚 㼊Ἒ㩗㦒⪲ ⳾㌟䞮ἶ㧦 䞲 㡆ῂ⓪ Ệ㦮 ⹲ἂ䞮₆ 㠊⩺㤶┺. ⡦䞲 ⽊Ị㏢

㦮 ἆ䟋ὖⰂ 㔺䌲⯒ 㼊Ἒ㩗㦒⪲ ⿚㍳䞲 ⏒ⶎ

☚ ⹎䦷䞮㡖┺.

⽎ 㡆ῂ㦮 ⳿㩗㦖 䢮㧦 Ṳ㧎㦮 䔏㎇ 㣪㧎㈦ 㞚┞⧒ ⽊Ị㏢ ἆ䟋ὖⰂ ㌂㠛㦮 䔏㎇ 㣪㧎䁷 Ⳋ㠦㍲ ἆ䟋䂮⬢㠦 ⹎䂮⓪ ὖ⩾㣪㧎㦚 䢫㧎䞮

₆ 㥚䞾㧊┺. ῗ⁏㩗㦒⪲ ⽊Ị㏢ ἆ䟋ὖⰂ ㌂ 㠛㦮 㩫㺛ἆ㩫㦚 㥚䞲 ₆㽞 㧦⬢⯒ 㩲㔲䞮ἶ 㧦 䞾㧊┺. ῂ㼊㩗㧎 㡆ῂ㦮 ⳿㩗㦖 ┺㦢ὒ ṯ

┺.

(1) 28Ṳ ⽊Ị㏢⯒ ㍶㩫䞮㡂 ⽊Ị㏢ ἆ䟋 䢮

㧦㦮 Ṳ㧎㩗 䔏㎇ ⹥ ⽊Ị㏢㦮 ἆ䟋ὖⰂ ㌂㠛

䔏㎇㦚 䢫㧎䞲┺.

(2) ἆ䟋䂮⬢ ㎇Ὃῆὒ 㔺䕾ῆ ㌂㧊㠦 䢮㧦 㦮 Ṳ㧎 䔏㎇ ⹥ ⽊Ị㏢㦮 ἆ䟋ὖⰂ ㌂㠛 䔏

㎇ 㹾㧊⯒ ゚ᾦ䞲┺.

(3) ἆ䟋䂮⬢ ㎇Ὃῆὒ 㔺䕾ῆ Ṛ㦮 㹾㧊Ṗ 㥶㦮䞲 㣪㧎 㭧㠦㍲ ṗṗ㦮 㡗䟻㦚 ⽊㩫䞲 䤚 ἆ䟋䂮⬢ ㎇Ὃὖ⩾㣪㧎㦚 䢫㧎䞲┺.

堆旇 愕 愯憛

⽎ 㡆ῂ⓪ ⽊Ị㏢ ἆ䟋䢮㧦㦮 Ṳ㧎 䔏㎇ὒ ἆ䟋ὖⰂ ㌂㠛 䔏㎇㠦㍲ ἆ䟋䂮⬢㎇Ὃ ὖ⩾㣪 㧎㦚 䢫㧎䞮₆ 㥚䞲 䤚䟻㩗 㫆㌂㡆ῂ㧊┺.

⽎ 㡆ῂ㦮 㼊Ἒ☚⓪ ┺㦢ὒ ṯ┺ (Figure 1).

1. 浶斲堆旇(沖) 昦洛 1) 㫆㌂╖㌗ ⽊Ị㏢ ㍶㩫

⽎ 㡆ῂ㦮 ⳾㰧┾㦖 2 0 0 4⎚ ₆㭖 㩚ῃ 㔲ῆ ῂ 2 4 6Ṳ ⽊Ị㏢㡖┺. 㰖㡃⽊Ị⻫㠦⓪ ⽊Ị㏢

⯒ 㰖⹿㧦䂮┾㼊 㥶䡫 ⹥ ὖ䞶㧎ῂ㑮⯒ ₆㭖

㦒⪲ 8Ṗ㰖 㥶䡫㦚 㩲㔲䞮ἶ 㧞┺. 㧊㠦 ➆⯎

⽊Ị㏢㦮 㥶䡫㦖 䔏⼚㔲㦮 ῂ, ὧ㡃㔲㦮 ῂ, 㧎 ῂ 5 0Ⱒ ⳛ㧊㌗㦮 㔲㦮 ῂ, 㧎ῂ 3 0Ⱒ ⳛ㧊㌗

㦮 㔲, 㧎ῂ 3 0Ⱒ ⳛ ⹎Ⱒ㦮 㔲, ☚⏣䐋䞿䡫䌲 㦮 㔲, ῆ, ⽊Ị㦮⬢㤦 ❇㧊┺[16]. 䞮㰖Ⱒ ⿚㍳

㦮 䘎㦮㎇㦚 㥚䟊 㧊 8Ṗ㰖 ῂ⿚㦚 3Ṗ㰖(╖

┺. ⁎Ⰲἶ ῆ㦖 ῆὒ ⽊Ị㦮⬢㤦㧊 䙂䞾♮㠊 㽳 8 8Ṳ ⽊Ị㏢Ṗ 䙂䞾♮㠞┺. ⽎ 㡆ῂ㦮 䚲⽎

㦚 㿪㿲䞮₆ 㥚䟊 䂋䢪ⶊ㧧㥚䚲⽎㿪㿲⻫㦚 㩗 㣿䞮㡂 ṗ 3Ṗ㰖 ῂ⿚ 䂋(╖☚㔲, 㭧㏢☚㔲, ῆ)㠦㍲ 1 1૫15% 㑮㭖㠦㍲ ṗṗ 1 0Ṳ㏢㝿 3 0 Ṳ ⽊Ị㏢⯒ 㿪㿲䞮㡖┺. 㧊 㭧 㭧㏢☚㔲 2Ṳ

㏢⓪ 㧦⬢⹎゚⪲ ⿚㍳㠦㍲ 㩲㣎䞮㡂 ╖☚㔲┾

㥚 ⽊Ị㏢ 1 0Ṳ㏢, 㭧㏢☚㔲┾㥚 ⽊Ị㏢ 8Ṳ㏢,

Figure 1. Framework of this study DEMOGRAPIC

•Gender

•Age

•Occupation

昢嵦

㎎Ἒ㩗㦒⪲ 1 9 5 0⎚╖⿖䎆䟃ἆ䟋䢪䞯䂮⬢㦮

⽊ 㧊㔲㧧♮Ⳋ㍲㩦㹾 ἆ䟋㦖䂮㥶♶ 㑮㧞

┺[4]. 䞮㰖Ⱒ ⁎ 㧊䤚⪲☚ ἆ䟋⹲㌳ ⹥ ㌂ⰳ 㦖㎎Ἒ㩗㦒⪲ Ἒ㏣㯳Ṗ䞮ἶ 㧞┺[ 5 ] .

♮Ⳋ㍲㩚ῃ 㔲ῆῂ ⽊Ị㏢⯒ 㭧㕂㦒⪲ ἆ䟋䢮㧦㫆₆⹲ἂὒ ❇⪳ὖⰂ, ゚㔲㰖㡞⹿㩧㫛, 㰖㡃㭒⹒ὒ ❇⪳♲ ἆ䟋䢮㧦㠦 ╖䞲⽊Ịᾦ㥷

❇ ⽎ỿ㩗㧎 ἆ䟋ὖⰂ ㌂㠛㧊⻪ῃ⹒㩗㦒⪲

㔺㔲♮㠞┺[6]. ⡦䞲, ἆ䟋ⶎ㩲㦮䋂₆㢖㿪㎎

⯒ 䕢㞛䞮₆ 㥚䟊㎎‶Ỗ㌂⯒ 䙂䞾䞮㡂㩚ῃ ἆ䟋㔺䌲㫆㌂⯒ 1 9 6 5⎚⿖䎆 1 9 9 5⎚₢㰖 5⎚ Ṛ ỿ㦒⪲ 7㹾㠦 Ỏ㼦㍲㭒₆㩗㦒⪲ 㔺㔲䟊㢪┺

[7]. 㧊⩂䞲 ⏎⩻㠦䧮㧛㠊 ἆ䟋㥶⼧⮶(⹿㌂

㍶ Ỗ㌂㌗䢲☯㎇䘦ἆ䟋㥶⼧⮶)㧊 1 9 6 5⎚

5 . 1 %㠦㍲ 1 9 9 5⎚ 1 . 0 %⪲ 㰖⋲ 3 0⎚ ☯㞞 ∎㭖䧞 Ṧ㏢䟊㢪㦒Ⳇ, ἆ䟋㌂ⰳ⮶☚ 㧎ῂ 1 0Ⱒ ⳛ

[8]. 2005⎚☚ 㔶ἶ ἆ䟋㔶䢮㧦Ṗ 㟓 3 5㻲ⳛ㧊㠞ἶ, ῃ⹒ 3 1 1ⳛ╏ 1ⳛ㧊䢲☯㎇ ἆ䟋䢮㧦㧊 Ⳇ, ⰺ⎚ 㟓 3 , 0 0 0ⳛ㧊 ἆ䟋㦒⪲ ㌂ⰳ䞲 ộ㦒⪲

⋮䌖⋮ 㤆Ⰲ⋮⧒ ἆ䟋 ὖⰂ㦮㰞 ⹥ ㎇ὒ㠦㦮ⶎ㧊㩲₆♮ἶ 㧞┺[8].

㔺㩲⪲ 2 0 0 1⎚☚ 㩚ῃ ⽊Ị㏢㠦 ❇⪳♲ ☚Ⱖ 㟧㎇䘦ἆ䟋䢮㧦㠦 ╖䞲 ἆ䟋䂮⬢ ㎇Ὃ㥾㦖

7 8 . 6 %㧊Ⳇ, ⹒Ṛ ⼧㦮㤦㦮 ἓ㤆㧊⽊┺ ▪㤇

⌄㦖 7 4 . 4 %⪲ ⽊ἶ♮㠞┺[9]. 㧊⓪ ㎎Ἒ⽊Ị₆ ῂṖ ῢ㧻䞮⓪ ἆ䟋䂮⬢㥾 ⳿䚲㧎 8 5 %㠦 ⹎ 䂮㰖 ⴑ䞶㈦㞚┞⧒ ㎎Ἒ⽊Ị₆ῂ㦮 2 0 0 0⎚

₆㭖㩚㎎Ἒ ☚Ⱖ㟧㎇䘦ἆ䟋䢮㧦( 1 , 2 3 1 , 8 4 7 ⳛ

╖㌗)㠦 ╖䞲䆪䢎䔎⿚㍳ἆὒ㠦㍲ ⋮䌖⋲ 㩚

₆⽊┺⓪ 㩚䂮⬢₆Ṛ☯㞞䢮㧦 ⹥ 㰖㡃㌂䣢 Ṗ 㓺㓺⪲ 䂮⬢ ⹥ 㡞⹿㠦 ⓻☯㩗㦒⪲ 㺎㡂䞾㦒⪲㖾㔺䡚♶ 㑮㧞┺ἶ 䞮㡂[12] 㰖㡃㌂䣢

⬢㎇Ὃ ὖ⩾㣪㧎⿚㍳ὒ ὖ⩾䞲 ῃ⌊㣎㡆ῂ⯒

☚, Ṗ㫇㦮㰖㰖, ╏␾ ❇㦮㰞䢮㥶ⶊ ❇ ╖⿖⿚

ἆ䟋䂮⬢㎇Ὃ㦮 ὖ⩾㣪㧎㦒⪲ 䢮㧦 Ṳ㧎㦮䔏

㎇ ⹥ 㰞䢮㩫☚㠦Ⱒ 㭒⪲ 㽞㩦㦚 ⚦㠊㢪㦒Ⳇ [13-15] ▪㤇㧊㎎Ἒ⽊Ị₆ῂ㠦㍲㩲㔲䞮ἶ 㧞

⓪ ἆ䟋㦚 ὖⰂ䞮⓪ ὋὋ⽊Ị㦮⬢㼊Ἒ㠦 ₆㧎䞲䂮⬢㎇Ὃ㣪㧎㦚㼊Ἒ㩗㦒⪲ ⳾㌟䞮ἶ㧦䞲㡆ῂ⓪ Ệ㦮 ⹲ἂ䞮₆ 㠊⩺㤶┺. ⡦䞲⽊Ị㏢

⽎㡆ῂ㦮 ⳿㩗㦖䢮㧦 Ṳ㧎㦮䔏㎇㣪㧎㈦㞚┞⧒ ⽊Ị㏢ ἆ䟋ὖⰂ ㌂㠛㦮䔏㎇㣪㧎䁷 Ⳋ㠦㍲ ἆ䟋䂮⬢㠦 ⹎䂮⓪ ὖ⩾㣪㧎㦚䢫㧎䞮

₆ 㥚䞾㧊┺. ῗ⁏㩗㦒⪲ ⽊Ị㏢ ἆ䟋ὖⰂ ㌂㠛㦮㩫㺛ἆ㩫㦚㥚䞲 ₆㽞㧦⬢⯒ 㩲㔲䞮ἶ 㧦䞾㧊┺. ῂ㼊㩗㧎㡆ῂ㦮 ⳿㩗㦖 ┺㦢ὒ ṯ

(1) 28Ṳ ⽊Ị㏢⯒ ㍶㩫䞮㡂⽊Ị㏢ ἆ䟋䢮

㧦㦮 Ṳ㧎㩗䔏㎇ ⹥ ⽊Ị㏢㦮 ἆ䟋ὖⰂ ㌂㠛

䔏㎇㦚䢫㧎䞲┺.

(2) ἆ䟋䂮⬢ ㎇Ὃῆὒ 㔺䕾ῆ ㌂㧊㠦䢮㧦㦮 Ṳ㧎䔏㎇ ⹥ ⽊Ị㏢㦮 ἆ䟋ὖⰂ ㌂㠛䔏

㎇㹾㧊⯒ ゚ᾦ䞲┺.

(3) ἆ䟋䂮⬢ ㎇Ὃῆὒ 㔺䕾ῆ Ṛ㦮㹾㧊Ṗ 㥶㦮䞲㣪㧎㭧㠦㍲ ṗṗ㦮㡗䟻㦚⽊㩫䞲䤚 ἆ䟋䂮⬢ ㎇Ὃὖ⩾㣪㧎㦚䢫㧎䞲┺.

堆旇愕愯憛

⽎㡆ῂ⓪ ⽊Ị㏢ ἆ䟋䢮㧦㦮 Ṳ㧎䔏㎇ὒ ἆ䟋ὖⰂ ㌂㠛䔏㎇㠦㍲ ἆ䟋䂮⬢㎇Ὃ ὖ⩾㣪㧎㦚䢫㧎䞮₆ 㥚䞲䤚䟻㩗㫆㌂㡆ῂ㧊┺.

⽎㡆ῂ㦮㼊Ἒ☚⓪ ┺㦢ὒ ṯ┺ (Figure 1).

1. 浶斲堆旇(沖) 昦洛 1) 㫆㌂╖㌗⽊Ị㏢㍶㩫

⽎㡆ῂ㦮 ⳾㰧┾㦖 2 0 0 4⎚ ₆㭖㩚ῃ 㔲ῆ ῂ 2 4 6Ṳ ⽊Ị㏢㡖┺. 㰖㡃⽊Ị⻫㠦⓪ ⽊Ị㏢

⯒ 㰖⹿㧦䂮┾㼊㥶䡫 ⹥ ὖ䞶㧎ῂ㑮⯒ ₆㭖

㦒⪲ 8Ṗ㰖㥶䡫㦚㩲㔲䞮ἶ 㧞┺. 㧊㠦 ➆⯎

⽊Ị㏢㦮㥶䡫㦖䔏⼚㔲㦮 ῂ, ὧ㡃㔲㦮 ῂ, 㧎 ῂ 5 0Ⱒ ⳛ㧊㌗㦮㔲㦮 ῂ, 㧎ῂ 3 0Ⱒ ⳛ㧊㌗

㦮㔲, 㧎ῂ 3 0Ⱒ ⳛ ⹎Ⱒ㦮㔲, ☚⏣䐋䞿䡫䌲㦮㔲, ῆ, ⽊Ị㦮⬢㤦 ❇㧊┺[16]. 䞮㰖Ⱒ ⿚㍳

㦮䘎㦮㎇㦚㥚䟊㧊 8Ṗ㰖 ῂ⿚㦚 3Ṗ㰖(╖

┺. ⁎Ⰲἶ ῆ㦖 ῆὒ ⽊Ị㦮⬢㤦㧊䙂䞾♮㠊㽳 8 8Ṳ ⽊Ị㏢Ṗ 䙂䞾♮㠞┺. ⽎㡆ῂ㦮䚲⽎

㦚㿪㿲䞮₆ 㥚䟊䂋䢪ⶊ㧧㥚䚲⽎㿪㿲⻫㦚㩗㣿䞮㡂 ṗ 3Ṗ㰖 ῂ⿚䂋(╖☚㔲, 㭧㏢☚㔲, ῆ)㠦㍲ 1 1૫15% 㑮㭖㠦㍲ ṗṗ 1 0Ṳ㏢㝿 3 0 Ṳ ⽊Ị㏢⯒ 㿪㿲䞮㡖┺. 㧊㭧㭧㏢☚㔲 2Ṳ

㏢⓪ 㧦⬢⹎゚⪲ ⿚㍳㠦㍲㩲㣎䞮㡂 ╖☚㔲┾

㥚⽊Ị㏢ 1 0Ṳ㏢, 㭧㏢☚㔲┾㥚⽊Ị㏢ 8Ṳ㏢,

ῆ┾㥚⽊Ị㏢ 1 0Ṳ㏢⪲ 㽳 2 8Ṳ ⽊Ị㏢Ṗ 㾲㫛 ╖㌗₆ὖ㦒⪲ ㍶㩫♮㠞┺.

2) ⽊Ị㏢ ἆ䟋䢮㧦㍶㩫

㾲㫛㍶㩫♲ 2 8Ṳ ⽊Ị㏢㠦㍲ 2 0 0 3⎚ 1㤪 1㧒

⿖䎆 1 2㤪 3 1㧒₢㰖㽳 1⎚ ☯㞞㽳 8 , 3 6 9ⳛ ἆ 䟋䢮㧦Ṗ 䑊⪳䞲 ộ㦒⪲ 䢫㧎♮㠞┺. 㧊✺ 㭧㠦㍲䌖 ⹒Ṛ㦮⬢₆ὖ ❇⪳ 䂮⬢㧦 4 , 9 5 4ⳛ, ❇

⪳♲ 䂮⬢₆ὖⳛ㧊 ₆㨂♮㠊㧞㰖㞠㦖㧦 1 , 7 5 1ⳛ, 㰚┾ⳛ 䕦㩫⿞Ṗ㧦 2 5ⳛ, 㩚㿲㧦 1 8 4 ⳛ, ἆ䟋゚ὖ⩾ ㌂ⰳ㧦 6ⳛ, 㰚┾⼖ἓ㧦 3 2ⳛ 㦒⪲ ῂ㎇♲ 㽳 6 , 9 5 2ⳛ㦮䑊⪳㧦⓪ 㡆ῂ ╖㌗

㠦㍲㩲㣎䞮㡖┺. ⁎ ἆὒ 㢚䂮㧦 1 , 3 3 1ⳛ, 䂮⬢

㌂ⰳ㧦 1 7ⳛ㦒⪲ ῂ㎇♲ 㽳 1 , 4 1 7ⳛ㧊㾲㫛⿚

ἆ䟋䂮⬢㢖㎇Ὃ㦚 ⋮⑚⓪ 㩫㦮⓪ 㰞⼧ὖ Ⰲ⽎⿖㠦㍲䘊⌎ ἆ䟋ὖⰂ㰖䂾㠦㦮Ệ䞮㡖┺.

ἆ䟋䂮⬢ ㎇Ὃ㧦⓪ 䂮⬢㦮 ₆Ṛ㠦 ➆⧒ ㎎Ṗ 㰖⪲ ῂ⿚䞮㡂䂮⬢ἆὒ㦮㎇Ὃ㦚䕦㩫䞲┺.

㟧㎇ 6Ṳ㤪 ┾₆ 䢮㧦㦮 ἓ㤆 3Ṳ㤪, 5Ṳ㤪, 6 Ṳ㤪㱎 3⻞㡆㏣ ☚ⰦỖ㌂㠦㍲ 1䣢㧊䞮㠦㍲

㟧㎇㦒⪲ ⋮䌖⋲ ἓ㤆㠦䟊╏♮Ⳇ ┾, 6Ṳ㤪㱎

⓪ ⹮✲㔲㦢㎇㦒⪲ ⋮㢖㟒 ♲┺. 㟧㎇ 9Ṳ㤪

┾₆ 䢮㧦㦮 ἓ㤆 7Ṳ㤪㱎 ☚ⰦỖ㌂㢖⺆㟧Ỗ

㦢㎇㧊 ⋮㡾 ἓ㤆㠦䟊╏♲┺. 㟧㎇㧻₆ 䢮㧦㦮 ἓ㤆 9Ṳ㤪㱎 ☚ⰦỖ㌂㢖⺆㟧Ỗ㌂⯒ 㔺㔲䞮ἶ 1 2Ṳ㤪㱎 ☚ⰦỖ㌂⯒ 䞮㡖㦚 ➢ 9Ṳ㤪㱎

1 8Ṳ㤪㱎 ☚Ⱖ 㦢㎇㧊Ⳋ 㢚䂮⪲ 䕦㩫䞲┺[ 1 7 ] . 䂮⬢㔺䕾㧦⓪ 㩫䟊㰚 ₆Ṛ☯㞞䂮⬢⯒ ⹱㞮㦢㠦☚ ⿞ῂ䞮ἶ 䂮⬢ 㔺䕾⪲ 䕦㩫♲ 䢮㧦㧊Ệ

⋮ 䟟⹿⿞ⳛ㦒⪲ 䂮⬢Ṗ 㭧┾♲ 䢮㧦䢏㦖 ἆ 䟋㦒⪲ ㌂ⰳ䞲 ἓ㤆⪲ 㩫㦮䞮㡖┺.

2. 沖巒朞滗愯憛

⽎㡆ῂ⯒ 㥚䟊 Ṳ㧎䔏㎇㣪㧎㦖⽊Ị㏢㦮

Ṗ㤊◆㍲ ⶎ䠢ἶ㺆ὒ 㩚ⶎṖ㦮㦮ἂ㑮⪊㦚䐋䟊⽎㡆ῂ㦮 ⳿㩗㠦㩗䞿䞲⼖㑮⯒ 㾲㫛㿪㿲䞮㡂⿚㍳䞮㡖┺.

Ṳ㧎㩗䔏㎇㣪㧎㦖㏢㧎㩗㣪㧎ὒ ἆ䟋㧊䢮 ⹥ 䂮⬢ὖ⩾ 㣪㧎㦒⪲ ῂ⿚♮㠞┺. ㏢㧎㩗㣪㧎㠦⓪ ㎇⼚, 㡆⪏, 㰗㠛, 䢮㧦㥶䡫, ὒỆ 䂮

⬢⩻, ゚㔲㰖㩧㫛㥶ⶊ⯒ 䙂䞾䞮㡖┺. 䞲䘎 ἆ 䟋㧊䢮 ⹥ 䂮⬢䔏㎇㠦 ὖ䞲㩫⽊⪲⓪ ṳ╊Ỗ

㌂㦮䕦☛ἆὒ, Ỗ㼊Ỗ㌂㦮䕦☛ἆὒ, ⹿㌂㍶

Ỗ㌂䕦☛ἆὒ, 䂮⬢₆Ṛ ⹥ 㽞䂮⬢ 㻮⹿㥶䡫 (┾₆ 䢏㦖㧻₆)㧊䙂䞾♮㠞┺.

⽊Ị㏢ ἆ䟋ὖⰂ ㌂㠛䔏㎇㦒⪲⓪ ⽊Ị㏢Ṗ 㥚䂮䞲㰖㡃㩗䔏㎇㥶䡫(╖☚㔲, 㭧㏢☚㔲, ῆ)ὒ ἆ䟋ὖⰂ ㌂㠛㦚㥚䞲㧎⩻ 䢮ἓ㦚 ⹮ 㡗䞮⓪ ⽊Ị₆ὖ 㰗㤦 1㧎╏ ὖ䞶㰖㡃 ╊╏

㧎ῂ㑮, ἆ䟋╊╏㧦㑮 ⹥ FTE(Full Time Equivalent, 㔺㩲䒂㧛㧎⩻ 㑮), ἆ䟋ὖⰂ㦮㌂㥶 ⶊ, ἆ䟋ὖⰂṚ䢎㌂㥶ⶊ, ╊╏㧦㦮 ᾦ㥷㧊㑮㩫☚, 㰖㡃㌂䣢䢲☯㩫☚Ṗ ㍶㩫♮㠞┺. 㰖㡃

㌂䣢䢲☯㩫☚⓪ ὖ䞶㧎ῂ ╖゚⽊Ị₆ὖ ⹿

㌂㍶㾂㡗⮶(䟊╏⽊Ị㏢, ⽊Ị㰖㏢, ⽊Ị㰚⬢

㏢㦮 1⎚Ṛ ⹿㌂㍶㾂㡗Ị㑮 / 䟊╏㰖㡃 ⌊ 㧎ῂ㑮), ὖ䞶㧎ῂ╖゚⽊Ị₆ὖ ゚㔲㰖㩧㫛

゚㔲㰖㩧㫛Ị㑮 / 䟊╏ 㰖㡃 ⌊ 㧎ῂ㑮), ὖ䞶㧎ῂ╖゚⽊Ị₆ὖ 㔶′䢮㧦 ⹲ἂ㥾(䟊╏⽊Ị

㏢, ⽊Ị㰖㏢, ⽊Ị㰚⬢㏢㦮 1⎚Ṛ ⹲ἂ䞲㔶䢮㧦㑮 / 䟊╏ 㰖㡃 ⌊ 㧎ῂ㑮), ὖ䞶㧎ῂ╖゚

㡃 ⌊ 㧎ῂ 㑮), ὖ䞶㧎ῂ╖゚⽊Ị₆ὖ ἆ䟋

䢮㧦 ❇⪳ ὖⰂ㥾(䟊╏ ⽊Ị㏢, ⽊Ị㰖㏢, ⽊Ị 㰚⬢㏢㦮 1⎚Ṛ ❇⪳ ὖⰂ 䢮㧦㑮 / 䟊╏ 㰖㡃 ⌊ 㧎ῂ㑮)㧊䙂䞾♮㠞┺.