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[IMPORTANCE OF HEALTH CARE FOR THE ERADICATION OF TUBERCULOSIS--Efforts Implemented in Nishinari Ward, Osaka City].

1) Changes in the incidence rate of tuberculosis in Osaka City and Nishinari Ward. The incidence rate of tuberculosis among people living in Osaka City (per 100,000 people) was 41.5 (number of patients: 1,109) in 2011--an approximately 50% decrease from 82.6 in 2001. However, the figure is 2.3 times higher than the national incidence rate of tuberculosis (17.7), and the highest of all ordinance-designated cities and prefectures. Osaka City consists of 24 wards, and the incidence rate of tuberculosis varies from ward to ward. Although the incidence rate of tuberculosis in Nishinari Ward in 2011 was 199.6 (number of patients: 242) and the highest by far in the city, the figure is approximately 50% of the incidence rate in 2001 (405.9). There were two other wards with the incidence rate of 50.0 or higher, and the lowest incidence rate was 22.4. The incidence rate of tuberculosis in the Airin area of Nishinari Ward is particularly high. Although the number of newly registered patients decreased from 336 to 128 over the past ten years, and the incidence rate significantly decreased from 1,120.0 to 426.7 (when the population of the area was estimated to be 30,000), it is still 24.1 times higher than the national incidence rate. 2) Basic guidelines for tuberculosis strategy developed by Osaka City. Osaka City has developed basic guidelines for tuberculosis strategy to address patients with tuberculosis and eradicate the disease. The first and second periods of the basic guidelines for tuberculosis strategy were ten years from 2001 and 2011, respectively. The overall objective of these basic guidelines was to significantly reduce the incidence rate of tuberculosis, and numerical targets related to basic policies and specific activities were set to accomplish the goal. The basic guidelines allow Osaka City, including its public health centers, to implement measures against tuberculosis as a municipal project. 3) Assessment of the City's efforts. The measures were assessed on a regular basis at the committee on the assessment of measures for tuberculosis and analysis assessment review meetings, and, as the results, problems were identified and activities were further promoted and reviewed based on scientific evidence. 4) Important measures for patients with tuberculosis living in Nishinari Ward, Osaka City. In addition to the measures implemented by Osaka City, Nishinari Ward plans to improve the measures for the prevention of tuberculosis. 1. Although tuberculosis screening tests conducted in the Airin area have been effective for its early detection to some extent, the rate of identification of patients from 2007 to 2011 was still high (163/18,378). It is necessary to further promote tuberculosis screening. 2. Although the outcomes in general were improved by emphasizing drug administration guidance, there are still many homeless people with tuberculosis and patients who may stop taking drugs. The outcomes of these patients are poor, and, therefore, it is necessary to provide them with improved support.