X1000306-1961-62_Part01 — Page 24

TABLE 10-Cond.

19,777

1958

1930

1961

Under treatment from previous year

5,887

9,132

13,733 16,062

16,433

Started Treatment during the year

7,964

11.546

11,357 12.617

12.381

Completed treatment

1,213

1,048

2.064

3.724

Failed to allend

2,869

1,048

5,391

4.975

3,776 4.967

Admitted to hospital from Chest

Clinics

1,078

1,5||

1.587

Sull on treatment at end of year

1,392

099 16.433 17,714

J

9,132 13,733 16,062 * Streptomycin course extended by daily Injections.

146. Treatment at the Chest Clinics is by ambulatory chemotherapy which includes daily injections of streptomycin 6 days each week for periods up to nine months or more and concurrently combined PAS/ INAH in tablet form issued weekly to be taken daily. The oral therapy is continued for a period of up to two years from the start of treatment. Some chronic cases with positive sputum are maintained for long periods on INAH in the hope that they will become 'catalase negative*. Hospital admission is arranged for those patients whose treatment can be ex- pedited by surgical or other means or who, for purely medical reasons, require in-patient treatment.

147. An analysis during the year of 1,500 patients who had com- pleted treatment showed that 65% showed satisfactory radiological im- provement and just over 94% of cases with positive sputum had been rendered sputum negative. Of those who fail to complete treatment, just under one third default during the first three months, the next largest group being those who have completed 12 months treatment. Amongst patients who can be traced, the majority give the reason that they are loo busy to attend.

148. There are four full time Government Chest Clinics, each with its own X-ray department, which are open all day on week days and offer one evening diagnostic session each week. Part time clinics are maintained at twelve centres, visited once weekly by the tuberculosis staff, where daily treatment is continued by the permanent staff of the centres visited. A sessional advisory service is also maintained at four other centres maintained by voluntary agencies.

149. In addition there are injection sessions for patients receiving daily streptomycin at seven other centres; these are for the convenience of patients who cannot travel regularly to the main or branch clinics, They are supplemented by injection sessions on five nights each week at the four full time chest clinics for patients who cannot attend during

34

the day. These injection centres, particularly the evening ones, are very popular.

150. Not surprisingly there is a large number of patients who do not attend with complete regularity. It is for this purpose that the very comprehensive regimen of treatment was instituted in 1958. If occasional injection sessions are missed the combined PAS/INAH tablets, provided they are taken regularly, will ensure that the long term result is not affected materially. Irregular drug taking is, however, a world wide phenomenon under such circumstances and it is of interest that surprise urine checks show that irregularity of drug taking varies from only 3% to 16% in the various clinics in the Colony.

151. The general picture is that new cases of tuberculosis coming forward for treatment are doing so at a much earlier stage of the disease. There is, however, still a not inconsiderable number attending the Gov- ernment Clinics for the first time with extensive disease and who have had treatment previously either in Hong Kong or in China. Of these many have organisms resistant to one or more of the standard drugs in use. The size of this resistance problem is unknown and is the subject of urgent study and investigation. However, once a chronic case with Tesistant organisms is detected, contact investigations follow and treat- ment is fully supervised. It is the undetected resistant case moving freely in the community that is the main problem and, until prevalence surveys can be mounted, the total problem posed remains obscure. Contact Tracing

152. Once a case of tuberculosis is diagnosed, Tuberculosis Workers visit the home and arrange for the examination of Eamily or close house- hold contacts. Those under 8 years of age are tuberculin tested and those over that age are X-rayed. During the year a total of 18,411 contacts underwent a full investigation, the findings being:

Under 8 years of age

Tuberculin Tests

TABLE II

CONTACT EXAMINATIONS 1960-61

Clinical Andings of contacts showing Positive Mantoux

Negative Positive

Active T.B.

Inactive T.B.

Suspicious T,B,

Free of T.B.

Percentage of Contacts found to have active

tuberculosis

35

1950

196)

907

831

2,392

3.102

69

92

10t

(25

473

$10

1.749

2.375

2.09%%

2.34%