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The objective of the study : to analyze lethal cases of tuberculosis in children and adolescents in Siberian and Far Eastern Federal Districts, to determine the causes that contributed to lethal outcomes. Subjects and methods . Reports on 9 lethal outcomes of tuberculosis in children ( n = 8) and adolescents ( n = 1) in 2018 were retrospectively analyzed in 8 regions of Siberian and Far Eastern Federal Districts. Results. All the deceased lived in socially disadvantaged families. It was found out that parents failed to fulfill their obligations in providing care for the child. All children, except one, were vaccinated with BCG. No one had been diagnosed with HIV infection. Children under 7 years old prevailed. In 63% of cases, exposure to tuberculosis was detected. Immunodiagnosis of tuberculosis was not carried out or was irregular in the majority of cases (75% of lethal cases). All children died within 1 year of follow-up by a TB unit. Tuberculosis with lesions of the central nervous system was registered in 87.5% of lethal cases. Conclusion. The main causes contributing to the death of children due to tuberculosis were the socially disadvantaged families and the lack of attention from social service specialists, defects in the work of physicians from primary health services on the early detection of tuberculosis among children, and defects in the work of phthisiologists in the nidi of tuberculosis infections.

The article describes changes in the main tuberculosis epidemiological indicators in Siberian and Far Eastern Federal Districts over the last decade. The rate of changes was analyzed for 21 regions within two districts, total number and structure of those followed up by phthisiologists in 2007-2016 were compared. TB situation has not significantly improved since the drug resistance and HIV infection become more and more frequent, providing an indirect impact on the epidemiological indicators. It is very difficult to treat such categories of patients and these difficulties do not allow enhancing treatment efficiency and cause an abrupt growth of the costs per one patient, both financial and organizational ones.

The article describes the attempt to find common consistent patterns in the spread of infection, typical of Russia. Actions of the Russian Tuberculosis Control Service are compared to the ones of similar services in the world. It has been shown that the comparative cost-effectiveness per one tuberculosis patient in Russia is disparate regarding the changes in epidemiological rates. Changes in quality management parameters are slow. Increase of funding for TB services without optimization of the cost structure and revision of certain positions within the service is not sufficient for successful operation.

Basing on the data about achievement of targeted rates for efficiency evaluation of the actions aimed at tuberculosis mortality reduction in 2015 and statistic rates for 2014-2015 in 12 regions within Siberian Federal District, the impact of organizational medical activities performed by primary medical services and tuberculosis control services was analyzed in the respect of tuberculosis mortality rate. The article presents results of ranging of regions within Siberian Federal District as per tuberculosis mortality rate and indicators providing impact on the number of those died of tuberculosis.