由結核病看花蓮縣秀林鄉原住民健康及社會概況

Tubercnlosis and Public Heerlth Statas of Taiwan Aborigiu in Shiu-Cin Village, Hualien

郭煌宗(Huang-Tsung Kuo) ； 樂俊仁

《慈濟醫學雜誌》 4卷4_S期 (1992/12) Pp. 1-19

https://doi.org/10.6440/TZUCMJ.199212.0001

摘要

自從民國73年以後結核病開始退出台灣省的十大死亡原因之外。75年結核病在台灣的盛行率是0.88%。死亡率也自民國41年後，由每拾萬人91.6人降至10.7人。台灣在結核病的防治上確實有相當顯著的成就。
但是在74年9月及10月的兩個月之間，在花蓮門諾醫醫院診斷了5個罹患結核性腦膜炎和來自同一個家庭的3個肺結核的小孩子。不幸的結果是，各有一個結核性腦膜炎與栗粒性肺結核的小孩相繼死亡，並且有兩個結核性膜腦炎的孩子留下了嚴重的神經性後遺症。其他的孩子則於出院後在家中繼續接受長期的抗結核藥物治療。在這8個個案中，我們意外的發現竟有7個是來自花蓮縣秀林鄉和平村。因此我們開始深深的懷疑，它是個結核病小流行事件。
在多次與防癆局溝通後，我們進行了和平村的結核病篩檢。很意外的發現其盛行率高達4.54%。因此隨即對秀林鄉展開大規模的結核病篩檢。結果，盛行率是2.52%，其中有20.9%的新個案是開放性肺結核個案。由於秀林鄉有超過81%的泰雅族同胞，不禁令人考慮到它們的地緣性、酗酒、社會適應、及特殊的種族性是否也在這個現象中扮演了重要的角色。我們限析了多槓醫療與非醫療的報告，以試圖讓此問題在本報告中有較完整的全貌。

關鍵字

結核病 ； 小流行 ； 原住民

並列摘要

After 1984, tuberculosis (TB) is out of top 10 cause of death in Taiwan. The Prevalence rate in 1986 is 0.88%. The mortality rate per 100000 people decreases from 91.6 persons to 10.7 persons since 1952. The achievement of TB control in Taiwan is really impressive.
However, 5 children with TB meningifis and 3 children of the same family with pulmonary TB was diagnosed within 2 month, in Mennonite Christian Hospifal, Hualien, Taiwan in 1985. One of TB meningitis and pulmonary TB (military type) died due to delay of transfer Two of TB meningitis got severs neurologic sequalae The rest of them got clinical improvement and received further anti-TB treatment Since 7 of theses 8 children came from a small village Ho-Ping. A endemic TB event is highly suspected.
After several times notification, the centrol TB control burea accepted our report, and a complete TB screen start in that small village Unexpectedly, the prevalence rate resulted to be 4.54%, a significant high inci-dence. Hater on, a even larger TB screen action was set forth in 8 small village in the neighbourhood, which be-longed to a large rural village Shiu-Lin. Over 81% of people in Shiu-Lin are Atayal people, which is one of 9tribes of mountain people in Taiwan The prevalence rate is 2.52%, and 20.1% of these new TB patient have positive sputum culture. The reason, why such sin event could occur, is thoroughly reviewed and discussed in this study.

並列關鍵字

Tuberculosis ； TB ； endemic event ； aborigines