π'æπ∏åµ âπ

 ∂“π°“√≥å«—≥‚√§„π‚√ß欓∫“≈™ÿ¡™π Ù ·Ààß

®—ßÀ«—¥π§√√“™ ’¡“ æ.». ÚıÙ¯-Úıı

 ¡∫—µ‘ ∏π“πÿ¿“æ‰æ»“≈

*

*‚√ß欓∫“≈‚ππ Ÿß ®—ßÀ«—¥π§√√“™ ’¡“

ÒÚ¯˜

∫∑§—¥¬àÕ °“√«‘®—¬π’È¥”‡π‘π°“√‡æ◊ËÕ»÷°…“ ∂“π°“√≥å·≈–«‘∑¬“°“√√–∫“¥¢Õß«—≥‚√§ ®“°√–∫∫‡ΩÑ“√–«—ß

«—≥‚√§·∫∫∫Ÿ√≥“°“√¢Õß‚√ß欓∫“≈™ÿ¡™π Ù ·Ààß„π®—ßÀ«—¥π§√√“™ ’¡“ „πªïß∫ª√–¡“≥ ÚıÙ¯- Úıı. ª√–™“°√∑’Ë»÷°…“‰¥â·°àºŸâªÉ«¬«—≥‚√§∑ÿ°§π∑’Ë¢÷Èπ∑–‡∫’¬π√—°…“„π‚√ß欓∫“≈ Ù ·Ààß §◊Õ

‚√ß欓∫“≈‚ππ Ÿß, ‚√ß欓∫“≈ªí°∏ß™—¬, ‚√ß欓∫“≈À⫬·∂≈ß ·≈–‚√ß欓∫“≈ ’§‘È«. °“√‡ΩÑ“

√–«—߇ªìπ√Ÿª·∫∫¢Õß‚√ß欓∫“≈. ‡§√◊ËÕß¡◊Õ∑’Ë„™â„π°“√«‘®—¬„π§√—Èßπ’ȉ¥â·°à∫—µ√ºŸâªÉ«¬πÕ°, ∫—µ√

∫—π∑÷°°“√∫”∫—¥«—≥‚√§ (TB Ò), ∑–‡∫’¬πºŸâªÉ«¬«—≥‚√§ (TB Û) ·≈–∑–‡∫’¬π√“¬™◊ËÕºŸâªÉ«¬µ√«®

‡ ¡À–®“°ÀâÕß™—≥ Ÿµ√ (TB Ù). «‘‡§√“–Àå¢âÕ¡Ÿ≈‚¥¬ ∂‘µ‘‡™‘ß∫√√¬“¬‡ªìπ®”π«π, §à“√âÕ¬≈–, Õ—µ√“,

·≈–Õ—µ√“ à«π.

„π¿“æ√«¡∑—Èß Ù ‚√ß欓∫“≈„π™à«ß Û ªï (æ.». ÚıÙ¯-Úıı) ¡’Õ—µ√“ªÉ«¬«—≥‚√§ ˜Ù.Û, ÒÒÚ.Ò ·≈–¯Ò.Ò µàÕ· πª√–™“°√, Õ—µ√“ºŸâªÉ«¬«—≥‚√§√“¬„À¡à ˆÙ.˘, Ò.˜, ˆ˘. µàÕ· πª√–™“°√, Õ—µ√“°“√‡ ’¬™’«‘µ¢ÕߺŸâªÉ«¬«—≥‚√§‡∑à“°—∫ ¯.Ò, ÒÙ. ·≈– Û.ı √“¬µàÕ· πª√–™“°√µ“¡≈”¥—∫, Õ—µ√“°“√√—°…“‰¥âº≈√âÕ¬≈– ˜Û.ı ·≈–Õ—µ√“°“√√—°…“À“¬¢“¥ ıÛ.ı, ¡’ºŸâªÉ«¬«—≥‚√§√“¬„À¡àµ‘¥

‡™◊ÈÕ‡Õ™‰Õ«’√à«¡¥â«¬√âÕ¬≈– Ù.˜, ı.¯ ·≈– ÒÒ. µ“¡≈”¥—∫. „π·µà≈– ∂“π∫√‘°“√¡’Õ—µ√“°“√√—°…“

 ”‡√Á®·≈–Õ—µ√“°“√µ“¬ ∑’Ë·µ°µà“ß°—π.  à«πÀπ÷Ëß∑’Ë¡’º≈Õ¬à“ß¡“°§◊Õ °“√µ‘¥‡™◊ÈÕ‡Õ™‰Õ«’, ‚¥¬ ∂“π

∫√‘°“√∑’Ë¡’ºŸâªÉ«¬«—≥‚√§∑’˵‘¥‡™◊ÈÕ‡Õ™‰Õ«’¡’Õ—µ√“°“√µ“¬ Ÿß (√âÕ¬≈– ÙÙ.Ú) ·≈–Õ—µ√“°“√√—°…“ ”‡√Á®

µË”.

Õ“™’æ∑’Ë¡’Õ—µ√“°“√√—°…“ ”‡√Á® Ÿß‰¥â·°à ¢â“√“™°“√ π—°‡√’¬π π—°»÷°…“ (√âÕ¬≈– Ò) ·≈– π—°‚∑…

(√âÕ¬≈– ˘Ò.˘) ‡π◊ËÕß®“°‡ªìπ°≈ÿà¡∑’˵‘¥µ“¡ßà“¬. ºŸâªÉ«¬«—≥‚√§´÷Ë߇ªìπ‡∫“À«“π¥â«¬¡’Õ—µ√“°“√√—°…“

 ”‡√Á® Ÿß∂÷ß√âÕ¬≈– Ò.

°“√√—°…“√–¬– —Èπ·∫∫¡’ºŸâ°”°—∫°‘𬓠π—Èπ®–‰¥âº≈¡“°¢÷Èπ∂â“°“√°”°—∫ ∑”‚¥¬‡®â“Àπâ“∑’Ë “∏“√≥ ÿ¢

´÷Ëß¡’º≈∑”„Àâ°“√√—°…“À“¬¢“¥·≈–°“√√—°…“ ”‡√Á® ‡æ‘Ë¡¢÷Èπ¡“°°«à“ °“√°”°—∫‚¥¬≠“µ‘ À√◊Õ‰¡à¡’ºŸâ°”°—∫

·≈–¡’§à“§«“¡‡ ’ˬߠ—¡æ—∑∏å‡∑à“°—∫ Ò.ÛÛ Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘. °“√∑”°“√°”°—∫‚¥¬≠“µ‘π—Èπ„Àâ º≈°“√√—°…“ ”‡√Á®‰¡à·µ°µà“ß‚¥¬π—¬ ”§—≠∑“ß ∂‘µ‘°—∫°“√‰¡à¡’ºŸâ°”°—∫°“√°‘π¬“.

§” ”§—≠: «—≥‚√§, √–∫∫‡ΩÑ“√–«—ß«—≥‚√§·∫∫∫Ÿ√≥“°“√, °“√√—°…“‚¥¬¡’ºŸâ°”°—∫°“√°‘π¬“, ‚√ß æ¬“∫“≈™ÿ¡™π

ÒÚ¯¯

¿Ÿ¡‘À≈—ß·≈–‡Àµÿº≈

«—≥‚√§‡ªìπ‚√§µ‘¥µàÕ∑’ˇªìπªí≠À“ “∏“√≥ ÿ¢∑’Ë ”§—≠„π ª√–‡∑»‰∑¬. ®“°√“¬ß“π°“√§âπÀ“√“¬ªÉ«¬∑’Ë°√¡§«∫§ÿ¡

‚√§‰¥â√—∫√“¬ß“π®“°æ◊Èπ∑’˵à“ß Ê „π æ.». ÚıÙ˘ æ∫ºŸâªÉ«¬

«—≥‚√§∑ÿ°ª√–‡¿∑ ÛÛ,ÙÚÚ √“¬ §‘¥‡ªìπÕ—µ√“ªÉ«¬ ıÛ.Û˜

µàÕª√–™“°√· π§π, ‡ ’¬™’«‘µ ÚÒˆ √“¬ §‘¥‡ªìπÕ—µ√“ªÉ«¬µ“¬

o.ÛÙ µàÕª√–™“°√· π§π ^(Ò). „π æ.». Úııo Õߧ尓√Õπ“¡—¬

‚≈°‰¥â®—¥„Àâª√–‡∑»‰∑¬Õ¬Ÿà„πÕ—π¥—∫ Ò˜ ¢Õß ÚÚ ª√–‡∑»

∑’Ë¡’ ∂“π°“√≥å«—≥‚√§√ÿπ·√ß∑’Ë ÿ¥ ·≈–§“¥«à“„π æ.». ÚıÙ¯

®–¡’ºŸâªÉ«¬ª√–¡“≥ ÒÛÒ,ooo √“¬ (ÚoÙ µàÕª√–™“°√· π§π)

‡ªìπºŸâªÉ«¬„À¡à∑ÿ°ª√–‡¿∑ ˘Ò,ooo √“¬ (ÒÙÚ µàÕª√–™“°√

· π§π), ºŸâªÉ«¬√–¬–·æ√à‡™◊ÈÕ ÙÒ,ooo √“¬ (ˆÛ µàÕ ª√–™“°√· π§π), ºŸâªÉ«¬‡ ’¬™’«‘µ ÒÚ,ooo √“¬ ‡ªìπÕ—µ√“µ“¬

Ò˘ µàÕª√–™“°√· π§π ·≈–¡’ºŸâªÉ«¬«—≥‚√§√“¬„À¡àµ‘¥‡™◊ÈÕ

‡Õ™‰Õ«’√à«¡¥â«¬√âÕ¬≈– ˜.ˆ^(Ú).

®“° ∂“π°“√≥å«—≥‚√§¢Õߪ√–‡∑»‰∑¬∑’Ë·π«‚πâ¡°“√

·æ√à√–∫“¥‡√‘Ë¡ Ÿß¢÷Èπ °√¡§«∫§ÿ¡‚√§®÷ߥ”‡π‘π°“√‚§√ß°“√

æ—≤π“√–∫∫‡ΩÑ“√–«—ß«—≥‚√§·∫∫∫Ÿ√≥“°“√¢÷Èπ ‡π◊ËÕß®“°

√–∫∫‡ΩÑ“√–«—ß·∫∫‡¥‘¡ºà“π√“¬ß“π ıoˆ π—Èπ‡ΩÑ“√–«—߉¥â

‡©æ“–ºŸâªÉ«¬‡ ¡À–æ∫‡™◊ÈÕ·≈–ºŸâªÉ«¬«—≥‚√§πÕ°ªÕ¥‡∑à“π—Èπ, µ≈Õ¥®π‰¡à¡’§«“¡‡™◊ËÕ¡‚¬ß°—∫º≈°“√√—°…“À“¬. ‚√ß欓∫“≈

‚ππ Ÿß®—ßÀ«—¥π§√√“™ ’¡“‰¥â√—∫°“√§—¥‡≈◊Õ°®“° ”π—°√–∫“¥

«‘∑¬“·≈– ”π—°ß“π “∏“√≥ ÿ¢®—ßÀ«—¥π§√√“™ ’¡“ „À⇪ìπ‚√ß æ¬“∫“≈µâπ·∫∫ Ò „π ÒÚ ·Ààß∑—Ë«ª√–‡∑» ∑’ˇ¢â“√à«¡‚§√ß°“√

æ—≤π“√–∫∫‡ΩÑ“√–«—ß«—≥‚√§·∫∫∫Ÿ√≥“°“√¡“µ—Èß·µà æ.».

ÚıÙ¯^(Û). µàÕ¡“„π æ.». ÚıÙ˘ ‰¥â¢¬“¬‡æ‘Ë¡‚√ß欓∫“≈„π

®—ßÀ«—¥π§√√“™ ’¡“Õ’° Û ·Ààß ‰¥â·°à‚√ß欓∫“≈ ’§‘È«, À⫬·∂≈ß ·≈–ªí°∏ß™—¬. „π°“√»÷°…“§√—Èßπ’È®÷ߪ√– ß§å∑’Ë®–

ª√–‡¡‘π ∂“π°“√≥å«—≥‚√§„π Ù ‚√ß欓∫“≈µâπ·∫∫„π

®—ßÀ«—¥π§√√“™ ’¡“ ‡æ◊ËÕæ—≤π“√–∫∫°“√¥Ÿ·≈ºŸâªÉ«¬«—≥‚√§

„Àâ¡’ª√– ‘∑∏‘¿“æ ‚¥¬¡ÿàßÀ«—ß„Àâ∫√√≈ÿ‡ªÑ“À¡“¬°“√§âπæ∫

ºŸâªÉ«¬√“¬„À¡à‰¡àπâÕ¬°«à“√âÕ¬≈– ˜o ·≈–¡’Õ—µ√“°“√√—°…“

Abstract Tuberculosis Situation in Four Community Hospitals in Nakorn Ratchasima Province, 2005-2007

Sombat Thananuparppaisal*

*Nonesoong Hospital, Nakorn Ratchasima Province

The aims of this research were to examine the situation and epidemiology of tuber- culosis in four district hospitals in Nakhon Ratchasima Province in fiscal years 2005-2007.

All tuberculosis patients registered between October 2004 and September 2007 were se- lected for the study.

The research instruments consisted of OPD card, treatment card, tuberculosis record, and sputum examination record. The data were analyzed by using descriptive statistics.

The results showed that prevalence rates were 74.3, 112.1, 81.1 per 100,000 popula- tion respectively in 2005-2007. Incidence rates were 64.9, 100.7, 69.0 per 100,000 and mor- tality rates were 8.1, 14.0,3.5 per 100,000 respectively during that period. The success rate was 73.5 percent and cure rate was 53.5 percent. The percentages of HIV infection in tuberculosis cases were 4.7, 5.8 and 11.0, increasing by year, with a high mortality rate of 44.2 percent.

A high success rate was found in the occupation of civil servants (100%), students (100%) and prisoners (91.9%). Tuberculosis cases with diabetes mellitus were also found to have a high success rate (100%). Directly observed therapy (DOT) by health personnel produced a relative risk of 1.33 significance compared with no direct observation. How- ever, DOT, with observation by cousins, showed no significant difference compared with that produced by no direct observation.

Key words: tuberculosis, integrated tuberculosis surveillance system, district hospital

ÒÚ¯˘

 ”‡√Á®‰¡àπâÕ¬°«à“√âÕ¬≈– ¯ı^(Ú,ı).

√–‡∫’¬∫«‘∏’»÷°…“

°“√«‘®—¬§√—Èßπ’ȇªìπ°“√«‘®—¬‡™‘ßæ√√≥π“ ·≈–°“√«‘®—¬‡™‘ß

«‘‡§√“–Àå. ª√–™“°√∑’Ë»÷°…“‰¥â·°àºŸâªÉ«¬«—≥‚√§∑’Ë¢÷Èπ∑–‡∫’¬π

√—°…“„π‚√ß欓∫“≈∑’Ë∑”°“√‡ΩÑ“√–«—ß«—≥‚√§·∫∫∫Ÿ√≥“°“√ Ù

·ÀàߢÕß®—ßÀ«—¥π§√√“™ ’¡“ „π æ.». ÚıÙ¯-Úıı §◊Õ Õ”‡¿Õ‚ππ Ÿß, ªí°∏ß™—¬, À⫬·∂≈ß ·≈– ’§‘È«.

‡§√◊ËÕß¡◊Õ∑’Ë„™â„π°“√»÷°…“‰¥â·°à Ò. ∫—µ√ºŸâªÉ«¬πÕ°

Ú. ∫—µ√∫—π∑÷°°“√√—°…“«—≥‚√§ (TB oÒ) Û. ∑–‡∫’¬πºŸâªÉ«¬«—≥‚√§ (TB oÛ)

Ù. ∑–‡∫’¬π√“¬™◊ËÕºŸâªÉ«¬µ√«®‡ ¡À–®“°ÀâÕß™—≥ Ÿµ√

(TB oÙ)

°“√‡°Á∫√«∫√«¡¢âÕ¡Ÿ≈®“°°“√‡ΩÑ“√–«—ß·∫∫‚√ß欓∫“≈

·≈–≈ß∑–‡∫’¬πºŸâªÉ«¬∑ÿ°√“¬∑’Ë«‘π‘®©—¬‰¥â«à“‡ªìπºŸâªÉ«¬«—≥‚√§,

„™â𑬓¡‡æ◊ËÕ°“√‡ΩÑ“√–«—ß«—≥‚√§·∫∫∫Ÿ√≥“°“√∑’ˉ¥â∑”°“√

ª√—∫ª√ÿß ´÷ËߺŸâªÉ«¬∑’Ë∑”°“√≈ß∑–‡∫’¬π·≈–√“¬ß“π®–∑”°“√

µ‘¥µ“¡®π ‘Èπ ÿ¥°√–∫«π°“√√—°…“·≈–∑√“∫º≈°“√√—°…“

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√–∫∫§Õ¡æ‘«‡µÕ√å ‚¥¬√«∫√«¡¢âÕ¡Ÿ≈®“°√–∫∫‡«™√–‡∫’¬π

¢Õß‚√ß欓∫“≈®“°∫—µ√ºŸâªÉ«¬πÕ°, ∫—µ√√—°…“ºŸâªÉ«¬«—≥‚√§

(TBoÒ) ·≈–√“¬ß“πº≈™—π Ÿµ√ (TB oÙ). «‘‡§√“–Àå¢âÕ¡Ÿ≈‚¥¬

„™â√–∫∫§Õ¡æ‘«‡µÕ√å∑—Èß®—¥‡°Á∫∑”∞“π¢âÕ¡Ÿ≈, ª√—∫ª√ÿߢâÕ¡Ÿ≈

·≈–®—¥∑”√“¬ß“πº≈°“√‡ΩÑ“√–«—ß. ¢âÕ¡Ÿ≈®“°Àπ૬‡ΩÑ“√–«—ß

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®—¥∑”√“¬ß“π‰¥â√—∫∂÷ß«—π∑’Ë Û °—𬓬π æ.». Úııo ®–

ºà“π°“√µ√«® Õ∫·°â‰¢ª√—∫ª√ÿß„Àâ¡’§ÿ≥¿“æ ·≈â««‘‡§√“–Àå

„π¿“æ√«¡¢Õß®—ßÀ«—¥ ‚¥¬„™â‚ª√·°√¡§Õ¡æ‘«‡µÕ√å∑’Ë®—¥∑”

¢÷Èπ‡æ◊ËÕ®—¥∑”∞“π¢âÕ¡Ÿ≈ à«π°≈“ß∑’Ëæ√âÕ¡√—∫¢âÕ¡Ÿ≈∑’ˇ¢â“¡“

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√“¬ß“π àߢâÕ¡Ÿ≈¬âÕπ°≈—∫‰ª¬—ßÀπ૬ߓπ∑’ˇ°’ˬ«¢âÕß∑ÿ° Û ‡¥◊Õπ

‚¥¬‡©æ“–Àπ૬ߓπ‡ΩÑ“√–«—ß∑’Ë√à«¡°—πæ—≤π“√–∫∫‡ΩÑ“√–«—ß

«—≥‚√§·∫∫∫Ÿ√≥“°“√. Õ’°∑—Èߥ”‡π‘π°“√ àߢâÕ¡Ÿ≈‡æ◊ËÕ‡º¬

·æ√àºà“π√–∫∫ÕÕπ‰≈πå∫π‡«Á∫‰´µå¢Õß ”π—°√–∫“¥«‘∑¬“.

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·≈–§à“æ’.

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ÚıÙ¯ -Úıı æ∫¢âÕ¡Ÿ≈¥—ß· ¥ß„πµ“√“ß∑’Ë Ò.

‡¡◊ËÕ§”π«≥‡ªìπÕ—µ√“ªÉ«¬µàÕ· πª√–™“°√ æ∫«à“ ¡’Õ—µ√“

ªÉ«¬«—≥‚√§ Ÿß„πÕ”‡¿ÕÀ⫬·∂≈ß, Õ”‡¿Õ ’§‘È«, Õ”‡¿Õ‚ππ Ÿß

·≈–Õ”‡¿Õªí°∏ß™—¬ µ“¡≈”¥—∫, ‚¥¬Õ”‡¿Õ ’§‘È«¡’Õ—µ√“ªÉ«¬ Ÿß

„πæ.». ÚıÙ˘ ‡π◊ËÕß®“°¡’±—≥± ∂“π„πÕ”‡¿Õ ’§‘È« ¡’ºŸâªÉ«¬

«—≥‚√§´÷Ë߇ªìππ—°‚∑…„π™à«ß Û ªï ıÒ §π ·≈–≈ß∑–‡∫’¬π

„πæ.». ÚıÙ˘ ∂÷ß ÙÛ §π ¥—ß√Ÿª∑’Ë Ò.

Õ—µ√“°“√√—°…“ ”‡√Á®‡∑à“°—∫Õ—µ√“°“√√—°…“À“¬¢“¥ + Õ—µ√“°“√√—°…“§√∫°”Àπ¥. °“√√—°…“À“¬¢“¥À¡“¬∂÷ߺŸâªÉ«¬

∑’Ë¢÷Èπ∑–‡∫’¬π°“√√—°…“‡ªìπ«—≥‚√§‡ ¡À–∫«° ·≈–¡’º≈°“√

µ√«®‡ ¡À–‡ªìπ≈∫ Ú §√—Èß ‚¥¬µâÕß¡’º≈°“√µ√«®‡ ¡À–

Àπ÷Ëߧ√—È߇ªìπ≈∫‡¡◊ËÕ ‘Èπ ÿ¥°“√√—°…“. °“√√—°…“§√∫À¡“¬∂÷ß ºŸâªÉ«¬∑’Ë¢÷Èπ∑–‡∫’¬π°“√√—°…“‡ªìπ«—≥‚√§‡ ¡À–∫«° ·≈–¡’º≈

°“√µ√«®‡ ¡À–‡¡◊ËÕ ‘Èπ ÿ¥°“√√—°…“√–¬–µâπ‡ªìπ≈∫ ·µà„π

√–¬–°“√√—°…“µàÕ‡π◊ËÕß ‰¡à¡’º≈°“√µ√«®‡ ¡À– À√◊Õ¡’‡æ’¬ß Àπ÷Ëߧ√—Èß∑’ˇªìπ≈∫ ‚¥¬∑’Ë°√¡§«∫§ÿ¡‚√§ °√–∑√«ß “∏“√≥ ÿ¢

‰¥â°”À𥇰≥±åÕ—µ√“°“√√—°…“ ”‡√Á®‰«â∑’Ë √âÕ¬≈– ¯ı. ¥—ßπ—Èπ

‡¡◊ËÕ·¬°ª√–‡¿∑ºŸâªÉ«¬«—≥‚√§‡©æ“–∑’Ë¡’‡ ¡À–∫«° ®÷ß  “¡“√∂§”π«≥Õ—µ√“°“√√—°…“ ”‡√Á®‰¥â¥—ßπ’È

Õ—µ√“°“√√—°…“ ”‡√Á®„π·µà≈–ªï®–·ª√‰ªµ“¡Õ—µ√“°“√

‡ ’¬™’«‘µ¥â«¬ ‚¥¬Õ”‡¿Õ ’§‘È«¡’Õ—µ√“°“√√—°…“ ”‡√Á®„πæ.».

Úıı µË”∂÷ß√âÕ¬≈– ı ·≈–¡’Õ—µ√“°“√‡ ’¬™’«‘µ Ÿß∂÷ß√âÕ¬≈–

Û˜.ı. ‡¡◊ËÕ»÷°…“Õ—µ√“°“√µ‘¥‡™◊ÈÕ‡Õ™‰Õ«’„πºŸâªÉ«¬«—≥‚√§¢Õß Õ”‡¿Õ ’§‘È« æ∫«à“„π æ.». Úıı ¡’Õ—µ√“°“√µ‘¥‡™◊ÈÕ‡Õ™‰Õ«’

ÒÚ˘

√Ÿª∑’Ë Ò · ¥ßÕ—µ√“ªÉ«¬¢Õß«—≥‚√§µàÕ· πª√–™“°√·¬°µ“¡Õ”‡¿Õ

.

µ“√“ß∑’Ë Ò ®”π«πºŸâªÉ«¬«—≥‚√§·¬°µ“¡√“¬Õ”‡¿Õ„πªïß∫ª√–¡“≥ ÚıÙ¯ -Úıı

Õ”‡¿Õ ®”π«πª√–™“°√ ÚıÙ¯ ÚıÙ˘ Úıı √«¡

‚ππ Ÿß ÒÒÚ,o¯˜ ÒÒÛ ¯Ù ˘Û Ú˘

ªí°∏ß™—¬ ˘ı,¯ı˘ ÙÚ Ù˘ ˆÒ ÒıÚ

À⫬·∂≈ß ˆ¯,Û¯˘ ˜¯ ˘¯ ˜Ò ÚÙ˜

 ’§‘È« ˘Ù,˘ÒÙ ÙÛ Ò¯ı ˜ˆ ÛÙ

√«¡ Û˜Ò,ÚÙ˘ Ú˜ˆ ÙÒˆ ÛÒ ˘˘Û

Õ—µ√“ªÉ«¬µàÕ· πª√–™“°√ ˜Ù.Û ÒÒÚ.Ò ¯Ò.Ò

Õ—µ√“ºŸâªÉ«¬„À¡àµàÕ· πª√–™“°√ ˆÙ.˘ Ò.˜ ˆ˘.

Õ—µ√“°“√‡ ’¬™’«‘µ√âÕ¬≈– ¯.Ò ÒÙ. Û.ı

µ“√“ß∑’Ë Ú ®”π«π√“¬·≈–§à“√âÕ¬≈–¢ÕߺŸâªÉ«¬«—≥‚√§ ·¬°µ“¡Õ”‡¿Õ

Õ”‡¿Õ ‡ ¡À–∫«° ‡ ¡À–≈∫ √—°…“≈⡇À≈« «—≥‚√§πÕ°ªÕ¥ Õ◊Ëπ Ê √«¡

‚ππ Ÿß ÒÛ˜ (Ù˜.Ú) ¯¯ (Û.Û) ¯ (Ú.¯) Úı (¯.µ) ÛÚ (ÒÒ.) Ú˘

ªí°∏ß™—¬ ˘Û (ˆÒ.Ú) Ù (Úˆ.Û) Ú (Ò.Û) Ò (ˆ.ˆ) ˜ (Ù.ˆ) ÒıÚ

À⫬·∂≈ß ˘Ù (Û¯.Ò) ˘Ú (Û˜.Ú) Ò (.Ù) Ò˘ (˜.˜) ÙÒ (Òˆ.ˆ) ÚÙ˜

 ’§‘È« Òˆ˘ (ıı.ˆ) ˜Ù (ÚÙ.Û) ˆ (Ú.) Û (˘.˘) Úı (¯.Ú) ÛÙ

√«¡ Ù˘Û (Ù˘.ˆ) Ú˘Ù (Ú˘.ˆ) Ò˜ (Ò.˜) ¯Ù (¯.ı) Òı (Ò.ˆ) ˘˘Û

ÚıÙ¯ ÚıÙ˘ Úıı

‚ππ Ÿß ªí°∏ß™—¬

À⫬·∂≈ß  ’§‘È«

Õ—µ√“µàÕ· π Úı.

Ú.

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ÒÚ˘Ò

√Ÿª∑’Ë Ú · ¥ßÕ—µ√“°“√√—°…“ ”‡√Á®„πºŸâªÉ«¬«—≥‚√§‡ ¡À–∫«° ·¬°µ“¡ ∂“π∫√‘°“√·≈–√“¬ªï (n=Û¯ı)

√Ÿª∑’Ë Û · ¥ßÕ—µ√“°“√‡ ’¬™’«‘µ„πºŸâªÉ«¬«—≥‚√§ ·¬°µ“¡ ∂“π∫√‘°“√·≈–√“¬ªï

√Ÿª∑’Ë Ù · ¥ß§à“√âÕ¬≈–¢Õß°“√µ‘¥‡™◊ÈÕ‡Õ™‰Õ«’ „πºŸâªÉ«¬«—≥‚√§ ‡ª√’¬∫‡∑’¬∫√“¬ ∂“π∫√‘°“√·≈–√“¬ªï

‚ππ Ÿß ªí°∏ß™—¬

À⫬·∂≈ß  ’§‘È«

‚ππ Ÿß ªí°∏ß™—¬

À⫬·∂≈ß  ’§‘È«

ÚıÙ¯ ÚıÙ˘ Úıı

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µ“√“ß∑’Ë Û º≈°“√√—°…“·¬°µ“¡º≈°“√µ√«®·Õπµ‘‡Õ™‰Õ«’ √“¬ (√âÕ¬≈–)

√—°…“À“¬¢“¥ √—°…“§√∫ ≈⡇À≈« µ“¬ ¢“¥¬“‡°‘π Ú ‡¥◊Õπ ‚ÕπÕÕ° ‡ª≈’ˬπ«‘π‘®©—¬ ‰¡à ¡—§√„®

∫«° ˜ (Òˆ.Û) ÒÚ (Ú˜.˘)  () Ò˘ (ÙÙ.Ú) Ú (Ù.ˆ) Û (˜.)  ()  ()

≈∫ ˜Ù (Ùˆ.) Ù˘ (Û.Ù) Û (Ò.˘) ÒÒ (ˆ.¯) ˘ (ı.ˆ) ˘ (ı.ˆ) Ù (Ú.ı) Ú (Ò.Ú)

‰¡à‰¥âµ√«® ÒÙÒ (ÚÙ.Û) Ú˘ı (ı.¯) Ú (.Û) ˆı (ÒÒ.Ú) ÛÒ (ı.Û) ÛÛ (ı.˜) Ò (Ò.˜) Ù (.˜)

µ“√“ß∑’Ë Ù º≈°“√√—°…“ºŸâªÉ«¬«—≥‚√§‡ ¡À–∫«° ·¬°µ“¡ªí®®—¬Õ“™’æ, ‡ªìπ‡∫“À«“π, ·≈–°“√√—°…“·∫∫¡’ºŸâ°”°—∫ √“¬ (√âÕ¬≈–)

À“¬ §√∫ µ“¬ ¢“¥¬“ Õ◊Ëπ Ê °“√√—°…“ ”‡√Á® (%)

Õ“™’æ

‡°…µ√°√ ˜ˆ (ı.˜) Ûı (ÚÛ.Û) Ò¯ (ÒÚ.) ˜ (Ù.˜) ÒÙ (˘.Û) ˜Ù

√—∫√“™°“√ Û (Ò)     Ò

§â“¢“¬ Û (ı.) Ú (ÛÛ.Û)   Ò (Òˆ.˜) ¯Ú.Û

π—°‡√’¬ππ—°»÷°…“ Ú (Ò)     Ò

Õ‘ √– ˜ (˜˜.¯)  Ú (ÚÚ.Ú)   ˜˜.¯

√—∫®â“ß ı¯ (ıˆ.Û) Ò¯ (Ò˜.ı) ÒÒ (Ò.˜) ¯ (˜.¯) ¯ (˜.¯) ˜Û.¯

π—°‚∑… Ú˘ (˜¯.Ù) ı (ÒÛ.ı) Ú (ı.Ù) Ò (Ú.˜)  ˘Ò.˘

·¡à∫â“π Ò (ÙÒ.˜) ˜ (Ú˘.Ú) Û (ÒÚ.ı) Ò (Ù.Ú) Û (ÒÚ.ı) ˜.˘

π—°∫«™ Ò (ÒÚ.ı) Ú (Úı.) Û (Û˜.ı) Ú (Úı.)  Û˜.ı

‰¡à∑√“∫ Òı (Ûˆ.ˆ) ¯ (Ò˘.ı%) ¯ (Ò˘.ı) Û (˜.Û) ˜ (Ò˜.Ò) ıˆ.Ò

‡∫“À«“π

‡ªìπ ˜ (Ò)     Ò

‰¡à‡ªìπ ÛÛ (ˆ.) ı (˘.Ò) ˆ (Ò.˘) Ú (Û.ˆ) ˘ (Òˆ.Ù) ˆ˘.Ò

‰¡à∑√“∫ Òˆˆ (ıÒ.Ù) ˜Ú (ÚÚ.Û) ÙÒ (ÒÚ.˜) Ú (ˆ.Ú) ÚÙ (˜.Ù) ˜Û.˜

DOT*

‡®â“Àπâ“∑’Ë “∏“√≥ ÿ¢ ÚÛ (˜ˆ.˜) Û (Ò.) Û (Ò.) Ò (Û.Û)  ¯ˆ.˜

≠“µ‘ Òı˘ (ıÚ.) ˆˆ (ÚÒ.ˆ) Ûˆ (ÒÒ.¯) Òˆ (ı.Ú) Ú˘ (˘.ı) ˜Û.ˆ

‰¡à¡’ºŸâ°”°—∫ ÚÙ (Ù˘.) ¯ (Òˆ.Û) ¯ (Òˆ.Û) ı (Ò.Ú) Ù (¯.Ú) ˆı.Û

√—°…“ ”‡√Á® √—°…“‰¡à ”‡√Á® §«“¡‡ ’ˬߠ—¡æ—∑∏å §à“æ’

DOT*

‡®â“Àπâ“∑’Ë “∏“√≥ ÿ¢ Úˆ (¯ˆ.˜) Ù (¯ˆ.˜) Ò.ÛÛ .Û˜

≠“µ‘ ÚÚı (˜Û.ı) ¯Ò (Úˆ.ı) Ò.ÒÛ .ÚÛÚ

‰¡à¡’ºŸâ°”°—∫ ÛÚ (ˆı.Û) Ò˜ (ÛÙ.˜) Ò

* DOT = Directly observation treatment

ÒÚ˘Û

„πºŸâªÉ«¬«—≥‚√§ Ÿß∂÷ß√âÕ¬≈– Ò˜  Ÿß°«à“Õ”‡¿ÕÕ◊Ëπ Ê.

‡¡◊ËÕ»÷°…“º≈°“√√—°…“„πºŸâªÉ«¬«—≥‚√§∑’˵‘¥‡™◊ÈÕ‡Õ™‰Õ«’

‚¥¬¡’ºŸâªÉ«¬«—≥‚√§∑’Ë¡’º≈·Õπµ‘‡Õ™‰Õ«’∫«° ÙÛ §π §‘¥‡ªìπ

√âÕ¬≈– ı.Ù¯ ¡’º≈·Õπµ‘‡Õ™‰Õ«’≈∫ ÒˆÒ §π ·≈–‰¡à‰¥âµ√«®

Ú¯Ò §π (√«¡ºŸâ∑’ˉ¡à¬‘π¬Õ¡µ√«®®”π«π ı §π). ∂ⓧ‘¥√âÕ¬

≈–‡©æ“–°≈ÿà¡∑’Ë à߇≈◊Õ¥µ√«®æ∫«à“¡’Õ—µ√“µ‘¥‡™◊ÈÕ‡Õ™‰Õ«’„π

°≈ÿࡺŸâªÉ«¬«—≥‚√§ Ÿß∂÷ß√âÕ¬≈– ÚÒ.Ò ·≈–ºŸâªÉ«¬¡’º≈°“√

√—°…“¥—ßµ“√“ß∑’Ë Û.

«‘®“√≥å

„π¿“æ√«¡ Ù ‚√ß欓∫“≈„π™à«ß Û ªï (æ.». ÚıÙ¯- Úıı) ¡’Õ—µ√“ªÉ«¬¢Õß«—≥‚√§ ˜Ù.Û, ÒÒÚ.Ò ·≈– ¯Ò.Ò µàÕ· πª√–™“°√µ“¡≈”¥—∫ ´÷Ë߬—߉¡à Ÿß°«à“§à“‡©≈’ˬ¢Õߪ√–‡∑»

(ÚoÙ µàÕª√–™“°√· π§π) ·≈–Õ—µ√“ºŸâªÉ«¬«—≥‚√§√“¬„À¡à ˆÙ.˘, Ò.˜, ˆ˘. µàÕ· πª√–™“°√µ“¡≈”¥—∫ ´÷Ë߉¡à Ÿß

°«à“§à“‡©≈’ˬ¢Õߪ√–‡∑» (ÒÙÚ µàÕª√–™“°√· π§π) ‡™àπ°—π.

„π à«π¢Õß°“√√—°…“¢âÕ¡Ÿ≈√«¡∑—Èß Û ªï ¡’Õ—µ√“°“√√—°…“

 ”‡√Á®√âÕ¬≈– ˜Û.ı ·≈–Õ—µ√“°“√√—°…“À“¬¢“¥√âÕ¬≈– ıÛ.ı

´÷Ëߵ˔°«à“‡ªÑ“À¡“¬∑’Ë°”Àπ¥‰«â‚¥¬°√¡§«∫§ÿ¡‚√§∑’˵âÕß°“√

Õ—µ√“°“√√—°…“ ”‡√Á®‰¡àπâÕ¬°«à“√âÕ¬≈– ¯ı^(Ú,ı).

„π à«π¢ÕßÕ—µ√“°“√‡ ’¬™’«‘µ¢ÕߺŸâªÉ«¬«—≥‚√§ ¯.Ò, ÒÙ. ·≈– Û.ı √“¬µàÕ· πª√–™“°√„π æ.». ÚıÙ¯-Úıı

µ“¡≈”¥—∫ ‡∑’¬∫°—∫Õ—µ√“°“√‡ ’¬™’«‘µ¢Õߪ√–‡∑»‰∑¬‡∑à“°—∫ Ò˘

µàÕª√–™“°√· π§π^(Ú)

¡’ºŸâªÉ«¬«—≥‚√§√“¬„À¡àµ‘¥‡™◊ÈÕ‡Õ™‰Õ«’√à«¡¥â«¬√âÕ¬≈–

Ù.˜, ı.¯ ·≈– ÒÒ. µ“¡≈”¥—∫ ´÷Ëß„°≈⇧’¬ß°—∫√–¥—∫

ª√–‡∑»√âÕ¬≈– ˜.ˆ. °“√§”π«≥§à“√âÕ¬≈–π’ȉ¥â√«¡°≈ÿà¡∑’ˉ¡à

‰¥âµ√«®‡¢â“‰ª¥â«¬. °√≥’∑’ˉ¡à√«¡ºŸâ∑’ˉ¡à‰¥âµ√«®®–‡∑à“°—∫

ÛÚ.ı, Ò˜.Û ·≈– ÚÙ.¯ „π·µà≈–ªïµ“¡≈”¥—∫ ·≈–‡¡◊ËÕ¥Ÿ

·π«‚πâ¡·≈â«æ∫«à“°“√µ‘¥‡™◊ÈÕ‡Õ™‰Õ«’„πºŸâªÉ«¬«—≥‚√§ ¡’·π«

‚π⡇æ‘Ë¡¢÷Èπ‡√◊ËÕ¬ Ê „π·µà≈–ªï.

„π·µà≈– ∂“π∫√‘°“√¡’Õ—µ√“°“√√—°…“ ”‡√Á®·≈–Õ—µ√“

°“√µ“¬∑’Ë·µ°µà“ß°—π.  à«πÀπ÷Ëß∑’Ë¡’º≈Õ¬à“ß¡“°§◊Õ °“√µ‘¥

‡™◊ÈÕ‡Õ™‰Õ«’ ‚¥¬ ∂“π∫√‘°“√∑’Ë¡’ºŸâªÉ«¬«—≥‚√§∑’˵‘¥‡™◊ÈÕ‡Õ™‰Õ«’

®–¡’Õ—µ√“°“√µ“¬ Ÿß ·≈–Õ—µ√“°“√√—°…“ ”‡√Á®µË”. ºŸâªÉ«¬

«—≥‚√§∑’˵‘¥‡™◊ÈÕ‡Õ™‰Õ«’¡’Õ—µ√“°“√µ“¬ Ÿß∂÷ß√âÕ¬≈– ÙÙ.Ú.

„°≈⇧’¬ß°—∫°“√»÷°…“¢Õß¿—∑∑‘√“ ∑“ß√—µπ ÿ«√√≥^(ı) ®÷ߧ«√‰¥â

‡πâπ°“√µ√«®À“√–¥—∫ CD4 ·≈–„À⬓‚§‰∑√¡Õ°´“‚´≈ „πºŸâ µ‘¥‡™◊ÈÕ‡Õ™‰Õ«’ ‡æ◊ËÕªÑÕß°—π‚√§µ‘¥‡™◊ÈÕ©«¬‚Õ°“ µà“ß Ê ^(ˆ)

Õ“™’æ∑’Ë¡’Õ—µ√“°“√√—°…“ ”‡√Á® Ÿß‰¥â·°à ¢â“√“™°“√ π—°‡√’¬π π—°»÷°…“ ·≈– π—°‚∑…. „π à«π¢Õßπ—°‚∑…π—Èπ πà“®–‡°‘¥®“°

°“√¥Ÿ·≈„À⬓լà“ß„°≈♑¥ ·≈–‰¡à “¡“√∂‡¥‘π∑“߉ª‰Àπ‰¥â

®÷ß∑”„Àâ¡’Õ—µ√“°“√√—°…“ ”‡√Á® Ÿß∂÷ß√âÕ¬≈– ˘Ò.˘ ´÷Ëߧ≈⓬

°—∫„π°≈ÿà¡¢ÕߺŸâªÉ«¬«—≥‚√§´÷Ë߇ªìπ‡∫“À«“π¥â«¬ ¡’Õ—µ√“°“√

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§«∫§ÿ¡‚√§∑’Ë ı „À⧔·π–π”„π°“√»÷°…“§√—Èßπ’È.

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æ— ¥ÿ¿—≥±å; Úııo.

ÒÚ˘Ù

Ú. World Health Organization. Global tuberculosis control : surveil- lance, planning, financing. WHO report 2007. Geneva, (WHO/

HTM/TB/2007.376). Available from : http://www.who.int/tb/publi- cations/global_report/2007/pdf/full.pdf ‡¢â“∂÷߇¡◊ËÕ Ù °ÿ¡¿“æ—π∏å ÚııÒ Û.  ”π—°√–∫“¥«‘∑¬“ °√¡§«∫§ÿ¡‚√§ °√–∑√«ß “∏“√≥ ÿ¢. ·π«∑“ß

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Ù. °√–∑√«ß “∏“√≥ ÿ¢. ·π«∑“ß°“√¥”‡π‘πß“π§«∫§ÿ¡«—≥‚√§·Ààß™“µ‘.

°√ÿ߇∑æœ : ‚√ßæ‘¡æå ”π—°ß“πæ√–æÿ∑∏»“ π“·Ààß™“µ‘. æ‘¡æå§√—Èß∑’Ë Ò. (©∫—∫ª√—∫ª√ÿß); ÚıÙ¯.

ı. ¿—∑∑‘√“ ∑“ß√—µπ ÿ«√√≥. ª√– ‘∑∏‘º≈°“√√—°…“ºŸâªÉ«¬«—≥‚√§¥â«¬

√–∫∫¬“√–¬– —Èπ¿“¬„µâ°“√ —߇°µ‚¥¬µ√ß (DOTS) „πÕ”‡¿Õ “¬∫ÿ√’

®—ßÀ«—¥ªíµµ“π’ „π·ºπæ—≤π“ “∏“√≥ ÿ¢·Ààß™“µ‘©∫—∫∑’Ë ˘ ªï ÚıÙı- ÚıÙ˘. «“√ “√§«∫§ÿ¡‚√§ Úııo;ÛÛ:Úı˘-ˆ˜.

ˆ.  ”π—°‚√§‡Õ¥ å «—≥‚√§ ·≈–‚√§µ‘¥µàÕ∑“߇滠—¡æ—π∏å. §Ÿà¡◊Õ·π«

ªØ‘∫—µ‘°“√º ¡º “π«—≥‚√§·≈–‚√§‡Õ¥ å. °√ÿ߇∑æœ : ‚√ßæ‘¡æå

°“√»“ π“  ”π—°ß“πæÿ∑∏»“ π“·Ààß™“µ‘; ÚıÙ¯.