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BMJ Case Rep. 2018 Aug 11;2018. pii: bcr-2018-225794. doi: 10.1136/bcr-2018-225794.

Multidrug-resistant tuberculosis in rural China: lack of public awareness, unaffordable costs and poor clinical management.

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Department of Tuberculosis, Shenyang Tenth People's Hospital and Shenyang Chest Hospital, Shenyang, China.
School of Public Health, The University of Hong Kong, Hong Kong, China.


China has the second highest global incidence and prevalence of multidrug-resistant tuberculosis (MDR-TB). We describe here the life experience of a rural Chinese farmer with complicated and aggressive TB. It is unclear if this patient contracted MDR-TB initially or developed MDR-TB during treatment because the initial laboratory results are dubious. The lack of public awareness of TB in rural China fuelled by a belief in toxicity of TB treatment, as mentioned by his brother, caused the patient to stop his TB treatment repeatedly long before completion. The cost of MDR-TB treatment in China is unaffordable for most Chinese, especially those in rural areas. He paid about ¥300 000 (almost US$50 000) for his TB treatment. He was discharged early twice for 'financial difficulties'. This case highlights excessive costs, lack of public awareness, poor patient education, inadequate follow-up, lack of coordination between clinical services and the importance of treatment adherence.


global health; healthcare improvement and patient safety; infectious diseases; tb and other respiratory infections

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