【作者】 王震；

【导师】 汪洋；

【作者基本信息】 重庆医科大学 ， 流行病与卫生统计学， 2012， 硕士

【摘要】 目的：了解重庆市三峡库区血吸虫病综合防治措施的实施以及对库区居民的影响情况，并对其进行评估，为建立血吸虫病潜在流行区的防治模式提供科学依据。方法：采用定量研究（调查问卷）和定性研究（访谈）相结合的研究方法。（1）定量研究。在重庆市三峡库区采用多阶段分层整群随机抽样的方法，从库区的万州区、开县、云阳三区/县的示范点与内、外对照点随机抽取1434名居民，采用问卷调查的方式获取调查对象对血吸虫病的认识情况。在示范点随机抽取72名卫生专业人员，采用问卷调查的方式获取调查对象参与实施综合防治措施的情况。（2）定性研究。采用个人深入访谈和关键人物访谈两种定性研究方法，针对不同的访谈对象采取相应的访谈提纲进行访谈，获取相关资料。（3）分析方法。定量资料，采用EpiData3.0软件双人录入数据并建立数据库，数据运用SPSS18.0统计软件分析数据。定性资料，采用MAXQDA10.0软件录入访谈内容，运用主题框架法分析数据。结果：（1）重点监测方面，示范点内23.61%的卫生专业人员同步参与流行病学调查和疫情监测，27.78%同步参与钉螺调查、实施药物灭螺，25%同步进行人和家畜的血吸虫病筛查，9.72%同步实施家畜管理。各类环境及动、植物引进监测未发现血吸虫病传染源钉螺，人群血清学检测未发现阳性结果。（2）“改水改厕”方面，示范点内20.83%的卫生专业人员同步参与实施“改水改厕”项目。居民自来水的使用率由76.33%上升为96.38%，差异具有统计学意义（P<0.05）；卫生厕所的使用率由53.68%上升到78.85%，差异具有统计学意义（P<0.05）。（3）健康教育方面，示范点内50%的卫生专业人员同步参与实施健康教育，59.58%的居民参加了血吸虫病健康教育，健康教育形式主要为知识宣讲（81.94%），发放宣传单（88.89%），墙体广告或者宣传栏（54.17%），广播、电视等传媒宣传（29.17%）。健康教育的内容主要为血吸虫病的流行情况（96.40%）、传播途径(95.83%)、主要症状（93.06%）、预防（93.06%）、危害（90.27%）。专业人员的各项血吸虫病防治知识的平均正确率为89.59%。居民血吸虫病防治知识得分及格率由6.44%（52/807）上升到78.15%（669/856），明显高于内（49.86%）、外对照点（32.16%），差异均有统计学意义（P<0.05）。96.14%的居民血吸虫病防治态度及信念得分为“好”，高于内（77.26%）、外对照点（69.35%），差异具有统计学意义（P<0.05）。59.58%的居民已不接触江湖水，高于外对照点（30.65%），差异具有统计学意义（P<0.05）。（4）影响因素方面，重点监测的影响因素主要是资金不足、专业人员缺乏、地方政府及相关部门重视程度不够。“改水改厕”的影响因素主要是资金不足。健康教育效果的影响因素是居民的学历与是否参加健康教育。结论：重庆市三峡库区血吸虫病综合防治措施开展顺利，基本完成预期目标。居民的血吸虫病防治知识、血吸虫病防治态度及信念得到了大幅度的提高，血吸虫病防治意识增强，血吸虫病易感行为得到有效控制，基本建立了与三峡库区实际情况相适应的血吸虫病防治模式。为今后卫生部门在血吸虫病潜在流行区开展血吸虫病防治工作提供了科学依据。更多还原

【Abstract】 Objective: The research has learnt the implementation of preventionand control strategy for schistosomiasis and evaluates. It will providescientific basis of establishing the model of the comprehensive preventionand control in potential endemic area of Schistosomiasis.Methods: The research has used both quantitative and qualitativestudy methods.(1)Quantitative research: Cluster random sampling was used tosurvey1434residents in villages of Wan Zhou, Kai Xian, Yuen Yang and72health professionals, and questionnaire was used to investigate theknowledge of schistosomiasis and launching of comprehensive preventionand control measures.(2)Qualitative research: Different interviewers have used differentguidelines. Both in-depth interviews and key figures interviews were usedto collect qualitative data.(3)Data analysis: The data of quantitative study were double enteredusing EpiData3.0and analyzed by SPSS18.0. The qualitative data were analyzed by thematic Framework method.Result:(1)The key monitoring, the proportion of health professionals wascarrying out the epidemiological investigation and the disease surveillance(23.61%), the survey of snail and killing snail by drug (27.78%), thescreening of schistosomiasis for human and livestock the management oflivestock(25%), the management of livestock(9.72%) in the demonstration.There have not found snails and source of infection of schistosomiasis inthe various types of environment and the introduction of flora and fauna,and not found positive result in serological surveillance for floatingpopulation.(2) Improving drinking water and lavatories,20.83%of healthprofessionals have carried out improving drinking water and lavatories. Therate of using tap water from Water Supply Company and water tower madeby local residents went up from76.33%to96.38%and using lavatories withthe feces harmless management went up from53.68%to78.85%. Accordingto Statistics test, P＜0.05,the difference have statistical sense.(3)The health educations, in the demonstration50%of healthprofessionals have carried out health education.59.58%of residents havejoined it. The forms of it were lectures (81.94%), leaflets (88.89%),billboards (54.17%); media (29.17%).The content of it were prevalence(96.40%), transmission (95.83%), and symptom (93.06%), and prevention (93.06%), harm of schistosomiasis (90.27%). The average rate ofcorrecting of the knowledge about schistosomiasis prevention among healthprofessionals were89.59%. The passing rates were78.15%,and it washigher than inside(49.86%)and outside the control point(32.16%).Thedifference have statistical sense(P＜0.05). The rate of that scores of theattitude and belief of schistosomiasis prevention among residents were“good” in demonstration were96.14%,and it was higher thaninside(77.26%)and outside the control point(69.35%),the difference havestatistical sense(P＜0.05).59.58%of residents had not touched the Yangtze,and it was higher than outside the control point(30.65%), the difference havestatistical sense(P＜0.05).(4)The influencing factors, the factors of influencing the keymonitoring were funds, professionals, attention. The factors of influencingimproving drinking water and lavatories were funds. The factors ofaffecting the effect of health education were education and whether toaccept.Conclusion：The effect of the comprehensive prevention and controlstrategy for schistosomiasis were well. There have improved the knowledgeabout schistosomiasis prevention and the attitude and belief amongresidents, and have improved the awareness of schistosomiasis preventionamong residents. There have established the mode of prevention and controlstrategy for schistosomiasis that adapt to actual situation of the Three Gorges Reservoir area, and have provided the scientific basis ofestablishing the mode of prevention and control strategy for schistosomiasisin potential endemic area for health sector.更多还原