CAJ | 학술논문

目的明确湖北中华按蚊地区疟疾高发病率的社会和行为学因素,为设计以改善该地区疟疾流行状况为日的的应用性研究提供基线数据.方法选取湖北省枣阳市璩湾镇曹冲村为研究点,于2004年6～7月,通过与市疾病预防控制中心及乡镇卫生院疟防人员的专题小组讨论了解该地区的疟疾流行与防治状况、与村领导的专题小组讨论了解该村的疟疾流行与防治状况以及村民的疟防知识、态度和行为,并通过简单随机抽样和问卷共调查了201户居民的家庭情况、疟防知识信念、家庭患疟情况和求医行为、家庭疟疾预防行为、对疟防活动的知晓情况等.结果 70%多的居民认为疟疾与蚊虫叮咬有关,有30.8%的居民给出了错误看法,有13.9%的居民不知道疟疾如何引起和传播.约97%的居民知道反复发冷发热是疟疾的典刑症状,77.1%的居民表示患疟后到村诊所就诊.95%的家庭拥有蚊帐,81%的家庭拥有蚊虫驱避剂,98.0%的居民认为服用抗疟药是预防患疟疾的首要方法.村诊所不具备显微镜或快速诊断试条,村医受经济利益驱动常对症状不典刑患者给与抗生素或退热药治疗,上报疟疾病例的积极性不高.乡镇卫生院工资低,疟防人员流动性大.结论科学的疟防知识尚未完全取代当地居民的传统认识,有必要开展一项有针对性的健康教育活动,进一步改善当地居民的疟疾防治知识、意识和行为;村医在疟疾防治中的作用需要加强,有必要加大对村医正确诊断、规范治疗和及时上报疟疾病例方面的支持、培训和管理;基层疟防人员的稳定性应予以重视.
목적 명학호북중화안문지구학질고발병솔적사회화행위학인소,위설계이개선해지구학질류행상황위일적적응용성연구제공기선수거.방법 선취호북성조양시거만진조충촌위연구점,우2004년6～7월,통과여시질병예방공제중심급향진위생원학방인원적전제소조토론료해해지구적학질류행여방치상황、여촌령도적전제소조토론료해해촌적학질류행여방치상황이급촌민적학방지식、태도화행위,병통과간단수궤추양화문권공조사료201호거민적가정정황、학방지식신념、가정환학정황화구의행위、가정학질예방행위、대학방활동적지효정황등.결과 70%다적거민인위학질여문충정교유관,유30.8%적거민급출료착오간법,유13.9%적거민불지도학질여하인기화전파.약97%적거민지도반복발랭발열시학질적전형증상,77.1%적거민표시환학후도촌진소취진.95%적가정옹유문장,81%적가정옹유문충구피제,98.0%적거민인위복용항학약시예방환학질적수요방법.촌진소불구비현미경혹쾌속진단시조,촌의수경제이익구동상대증상불전형환자급여항생소혹퇴열약치료,상보학질병례적적겁성불고.향진위생원공자저,학방인원류동성대.결론 과학적학방지식상미완전취대당지거민적전통인식,유필요개전일항유침대성적건강교육활동,진일보개선당지거민적학질방치지식、의식화행위;촌의재학질방치중적작용수요가강,유필요가대대촌의정학진단、규범치료화급시상보학질병례방면적지지、배훈화관리;기층학방인원적은정성응여이중시.
Objective To determine the social and behavioral factors that may contribute to high malaria incidence in the Anopheles sinensis areas of Hubei Province and provide the baseline data for designing an appropriate operational research strategy to improve the malaria situation in central part of China. Methods From June 23 to July 28 of 2004, the social and behavioral data associated with the acquisition, transmission, diagnosis and treatment, prevention and control of malaria were collected from Caochong, one of the hyperendemic villages in Hubei province, through one Focus Group Discussion (FGD) with malaria control service personnel from township hospital and county CDC, one FGD with the village leaders, and one household survey with the randomly sampled 201 questionnaire respondents. Results More than 70% of the respondents linked malaria with mosquito bites, while 30.8% of the respondents described the local misconceptions, and 13.9% of the respondents did not know any information on malaria infection and transmission. About 97% of the respondents knew repeated fever and chill were the common symptoms of malaria, 77.1% of the people would seek treatment at the village clinics once they had contracted malaria. The rates of households using bed nets and mosquitocide or mosquito incense was more than 95% and 81% respectively, while 98.0% of the respondents thought of taking the antimalarials as the first way to prevent from malaria infection. The private doctors had no microscopes or Rapid Diagnostic Tests (RDTs) and they always prefer to give antibiotics and febrifuge treatment to the patient without typical malaria symptoms. The private doctors would not like to report the cases they diagnosed because this is time-consuming and not economically rewarding. The salary for the malaria control professionals at grassroots level was low, and the phenomenon of the brain drain was common. Conclusion Villagers' beliefs and practices reflect dualistic system where the scientific and cultural explanations exist side-by-side, and the role of village doctors in malaria control and prevention cannot be undermined. Helath education is necessary for improving the knowledge and perceptions of the local people on malaria infection, transmission, prevention, and the necessity of seeking blood test and drug treatment at township hospital. Moreover, the private sectors (village doctors) can be provided with training and facilities to avoid misdiagnosis, drug misuse, and case under-reporting. It is also important to pay more attention to the brain drain of the malaria control professionals at ground level.