【作者】 张海涛；

【导师】 甄清；

【作者基本信息】 吉林大学 ， 公共卫生硕士（专业学位）， 2017， 硕士

【摘要】 目的:了解吉林省地方性氟中毒病区降氟改水情况,掌握地方性氟中毒病区控制现状,及时发现防治措施实施过程中存在的问题,为调整防治策略提供科学依据。方法:2015年,采用分层整群抽样,共抽取6个病区县(洮南市、乾安县、农安县、安图县、辉南县),共计997个自然村作为调查点,开展地方性氟中毒病区控制现状调查,包括病区降氟改水情况、8~12岁儿童氟斑牙检出情况。水氟测定采用离子选择电极法(GB/T 5750.5-2006);8~12岁儿童氟斑牙诊断采用《氟斑牙诊断》(WS/T208-2011),氟斑牙流行强度采用氟斑牙指数进行判断;病区是否达到控制依据地方性氟中毒病区控制标准(GB 17017-2010)进行判断;数据汇总、整理采用Microsoft EXCEL 2007软件,数据统计分析采用SPSS17.0软件,率的比较用χ~2检验。结果:1.调查点基本情况6个病区县(市)共有997个自然村,527550人;有153个自然村无8~12岁年龄段儿童,其余844个共调查8~12岁儿童13225人。2.调查点降氟改水措施实施情况997个自然村中,有933个已实施改水,改水率为93.58%;有64个未实施改水,占6.42%。在已实施改水的933个自然村中,改水工程正常使用的有693个,正常使用率为74.28%;改水工程不能正常使用的有240个,占25.72%。在改水工程正常使用的693个自然村中,有584个水氟含量合格(≤1.2mg/L),占84.27%,有109个水氟含量超标(>1.2mg/L),占15.73%。3.开展8~12岁儿童氟斑牙检查的病区自然村降氟改水措施实施情况844个自然村中,有780个已实施改水,改水率为92.42%;有64个未实施改水,占7.58%。在已实施改水的780个自然村中,改水工程正常使用的有568个,正常使用率为72.82%;改水工程不能正常使用的有212个,占27.18%。在改水工程正常使用的568个自然村中,有485个水氟含量合格,占85.39%;有83个水氟含量超标,占14.61%。4.8~12岁儿童氟斑牙检查结果共检查13225人,检出氟斑牙患者3193人,检出率为24.14%,氟斑牙指数为0.42。改水村氟斑牙检出率为23.55%,氟斑牙指数为0.41;未改水村氟斑牙检出率为32.13%,氟斑牙指数为0.46;检出率差异有显著性(χ~2=32.244,P<0.001)。改水工程正常使用村氟斑牙检出率为17.40%,氟斑牙指数为0.28;改水工程不能正常使用村氟斑牙检出率为42.83%,氟斑牙指数为0.84;检出率差异有显著性(χ~2=8.106,P<0.001)。改水工程正常使用且水氟含量合格村氟斑牙检出率为15.67%,氟斑牙指数为0.22;水氟含量超标村氟斑牙检出率为34.54%,氟斑牙指数为0.80;检出率差异有显著性(χ~2=1.922,P<0.001)。比较8~12岁儿童各年龄组间氟斑牙检出率,未改水自然村差异无显著性(χ~2=3.981,P>0.05);改水工程不能正常使用自然村差异有显著性(χ~2=28.336,P<0.001);改水工程正常使用自然村差异有显著性(χ~2=29.121,P<0.001)。5.开展8~12岁儿童氟斑牙检查的地方性氟中毒病区控制现状844个自然村中,有388个饮用水氟含量合格,氟斑牙检出率≤30%,达到了控制标准的占45.97%。有456个未达到控制标准,占54.03%,其中,有359个饮用水氟含量不合格,未达到控制标准;有97个氟斑牙检出率>30%,未达到控制标准。结论:调查点尚未全部实施改水;已改水病区改水工程正常使用率较低;改水工程正常使用病区存在水氟含量超标现象。调查点8~12岁儿童氟斑牙检出率已降至非病区水平(≤30%),氟斑牙流行强度为边缘流行。除改水工程正常使用且水氟含量合格病区氟斑牙检出率已降至非病区水平,无氟斑牙流行外,未改水病区、改水工程不能正常使用病区和水氟含量超标病区氟斑牙检出率均在30%以上,氟斑牙边缘流行或极轻度流行。吉林省地方性氟中毒病区达到病区控制标准的不足50%。更多还原

【Abstract】 Objective:To understandthe situation of water-improving and defluorination project in Jilin endemic fluorosis areas and grasp the present control situation as well as timely problem detection existing in implementation process;to provide a scientific basis for prevention and control strategies.Methods:The identified endemic fluorosis areas in Jilin province were stratified by using stratified cluster sampling in 2015,one county(district)were randomly selected from each city(state)in the areas(Taonan,Qianan,Lishu,Nongan,Antu,Huinan),a total of 977 villages were selected as survey spots where endemic fluorosis control status investigationwas conducted includingwater-improving and defluorination project,children dental fluorosis detection aging from 8 to 12.Water fluoride determination by ion selective electrode method(GB/T 5750.5 2006);children dental fluorosis detection aging from 8 to 12 using Dental Fluorosis Diagnosis(WS/T208-2011),Fluorosis index was used to determine the prevalence of fluorosis;fluorosis area control determination on the basis of endemic fluorosis area control standard(GB 17017-2010);data collection and sorting by Microsoft EXCEL 2007;data analysis using SPSS17.0 software and ratio comparison by Chi-squared test.Results:1.Basic situation of survey spotsA total of 997 natural villages in the 6 counties(cities)with the population of 527550.There were 153 natural villages without children aged 8 to 12 years old,13225 children from 8 to 12 years old were surveyed inthe rest 844 villages.2.Water-improving and defluorination project implementation in survey spotsA total of 933 villages out of 997 had been implemented the project with water-improving rate of 93.58%;64 villages did not implement the project,accounting for 6.42%.693projects under normal service conditions with normal utilization rate of 74.28%;240projects could not normallybe used,accounting for 25.72%.584 villages out of 693 had qualified water fluorine content(≤1.2mg/L),accounting for 84.27%,there were 109 villages exceeded standard(>1.2mg/L),accounting for 15.73%.3.Water-improving and defluorination project implementation in the villages where children dental fluorosis detection aging from 8 to 12 was conductedA total of 780 villages out of 844 had been implemented the project with water-improving rate of 92.42%;there are 64 did not implement the project,accounting for 7.58%.568 project under normal service conditions with normal utilization rate of 72.82%;212 projectscould not normally be used,accounting for 27.18%.485 villages out of 568 had qualified water fluorine content,accounting for 85.39%,there were 83 villages exceeded standard,accounting for 14.61%.4.Children dental fluorosis detection aging from 8 to 12A total of 3193 cases out of 13225 had been detected with detection rate of 24.14%,dental fluorosis index was 0.42.In the water-improving villages with detection rate of 23.55%,dental fluorosis index was 0.41;in the no water-improving villages with detection rate of 32.13%,dental fluorosis index was 0.46;the comparison of children dental fluorosis detection between water-improving villages and non-water-improving villages had significant difference(χ2=32.244,P<0.001).In the villages where project under normal service conditionswith detection rate of 17.40%,dental fluorosis index was 0.28;in the villages where project could not under normal service conditions with detection rate of 42.83%,dental fluorosis index was 0.84;The comparison of children dental fluorosis detection between villages under normal use seditions and the abnormal(χ2= 8.106,P<0.001).In the villages where project under normal service conditions and water fluorine contents were qualified with detection rate of 15.67%,dental fluorosis index was 0.22;in the villages wherewater fluorine contentsexceeded standard with detection rate of 34.54%,dental fluorosis index was 0.80;The comparison of children dental fluorosis detection between villages with qualifiedwater fluorine contents and standard exceeding villages(χ2=1.922,P<0.001).Children dental fluorosis detection rate of each age groupwas compared,there was no significant difference among non-water-improving villages(χ2=3.981,P>0.05);there was significant difference among villages where project could not be normally used(χ2= 28.336,P<0.001);there was significant difference among villages where project could be normally used(χ2= 29.121,P<0.001).5.Control status of endemic fluorosis area where children dental fluorosis detection aging from 8 to 12 was conductedA total of 388 villages out of 844 had qualified drinking water fluorine contentswith dental fluorosis detection rate of 30% or less,the 45.97% could meet the control standard;there were 456 villages did not reach thecontrol standard,the 54.03% could meet the control standard.there were 359 villages where drinking water fluorine content was unqualified and not meet control standard;there were 97 villages where dental fluorosis detection ratewas more than 30%,did not reach thecontrol standard.Conclusion:Survey spots has not yet been fully implemented water improvement;has been implementedwater improvement,but some project cannot be normal used;in the area where project can be normally used,there is a phenomenon that water fluorine content exceeded the standard.Children dental fluorosis detection rate aging from 8 to 12 in survey spots has reduced to non-endemic area(≤30%),dental fluorosis was on the verge of epidemic process,dental fluorosis detection rate is over 30% in Taonan,the epidemic process is in mild level,other counties has reduced to non-endemic area.Children dental fluorosis detection rate in non-water-improving areas is over 30%,dental fluorosis was on the verge of epidemic process.Children dental fluorosis detection rate inthe areas where the project could not be normally used and water fluorine contents exceeded the standard was over 30%,the epidemic process is in very light level.Children dental fluorosis detection rate in the areas where the project could be normally used and water fluorine contents meet the standardhas reduced to non-endemic area,No dental fluorosis is found,the condition has been effectively controlled.Less than 50% of endemic fluorosis areas can meet the control standard in Jilin province.更多还原