中国血吸虫病防治杂志
中國血吸蟲病防治雜誌
중국혈흡충병방치잡지
CHINESE JOURNAL OF SCHISTOSOMIASIS CONTROL
2014年
3期
254-259
,共6页
张华明%余晴%张瑕%曹淳力%李石柱%朱红
張華明%餘晴%張瑕%曹淳力%李石柱%硃紅
장화명%여청%장하%조순력%리석주%주홍
血吸虫病%综合治理%投入-效果%疫情%湖沼%垸内型%费用
血吸蟲病%綜閤治理%投入-效果%疫情%湖沼%垸內型%費用
혈흡충병%종합치리%투입-효과%역정%호소%완내형%비용
Schistosomiasis%Comprehensive treatment%Cost-effectiveness%Epidemic situation%Marshland and lake re-gion%Inner embankment type%Cost
目的对湖沼垸内型血吸虫病流行区2006-2010年期间血吸虫病防治工作投入与效果进行综合分析与评价，为此类亚型地区加快消除血吸虫病进程，进一步合理配置有限卫生资源提供参考。方法选择湖北省与国家卫生和计划生育委员会（原卫生部，简称国家卫生计生委）、农业部联合防治血吸虫病试点之一的湖北省江陵县，参考全国血吸虫病防治传播控制达标考核、湖北省阶段防治工作目标要求，2006-2010年以人畜感染率分层（即人和畜感染率都≥3%为一层村，3%>人和畜感染率≥1%为二层村；人和畜感染率均<1%为三层村）为依据，采用分层分析方法，选择当地当年各分层覆盖流行村为研究对象，回顾性调查、收集防治工作效果与费用数据，所有数据经汇总后进行费用-效果综合分析。结果疫情防治效果显示，截止2010年，江陵县无一层村，二层村共计114个，三层村共计18个。血吸虫病病人数，一层村绝对数逐年减少直至0，二、三层村绝对人数增加。粪便管理方面，无害化厕所覆盖率仅二层村2009、2010年分别为27.45%、48.74%，而一、三层村均为0。防治费用经贴现后，当地5年总防治费用中，综合治理投入（10266.39万元）远高于查治投入（418.30万元）与人工投入（223.95万元）。综合治理费用中，国土、农业、水利部门费用占据前3位。卫生经费投入显示，分层村均呈国家级>省级>县级，且年均都呈增长态势；费用-效果比显示，人群、耕牛感染率与病人数下降1%、感染性钉螺面积下降1 hm2的单位成本比值均逐年趋高。卫生投入的半对数差值稳定性分析显示，各分层村两两比较均<1，三层村（5年年均差值均<1）投入与费用较稳定，一、二层村均呈年均费用大于投入的波动状态。结论2006-2010年江陵县血吸虫病疫情逐年降低，但主要传染源尚存，需加强控制与清除；扩大粪便管理覆盖面是下一步工作的重点之一。资源配置上，卫生领域内重点投入与单位成本控制、费用的年均分配有进一步调整的空间。
目的對湖沼垸內型血吸蟲病流行區2006-2010年期間血吸蟲病防治工作投入與效果進行綜閤分析與評價，為此類亞型地區加快消除血吸蟲病進程，進一步閤理配置有限衛生資源提供參攷。方法選擇湖北省與國傢衛生和計劃生育委員會（原衛生部，簡稱國傢衛生計生委）、農業部聯閤防治血吸蟲病試點之一的湖北省江陵縣，參攷全國血吸蟲病防治傳播控製達標攷覈、湖北省階段防治工作目標要求，2006-2010年以人畜感染率分層（即人和畜感染率都≥3%為一層村，3%>人和畜感染率≥1%為二層村；人和畜感染率均<1%為三層村）為依據，採用分層分析方法，選擇噹地噹年各分層覆蓋流行村為研究對象，迴顧性調查、收集防治工作效果與費用數據，所有數據經彙總後進行費用-效果綜閤分析。結果疫情防治效果顯示，截止2010年，江陵縣無一層村，二層村共計114箇，三層村共計18箇。血吸蟲病病人數，一層村絕對數逐年減少直至0，二、三層村絕對人數增加。糞便管理方麵，無害化廁所覆蓋率僅二層村2009、2010年分彆為27.45%、48.74%，而一、三層村均為0。防治費用經貼現後，噹地5年總防治費用中，綜閤治理投入（10266.39萬元）遠高于查治投入（418.30萬元）與人工投入（223.95萬元）。綜閤治理費用中，國土、農業、水利部門費用佔據前3位。衛生經費投入顯示，分層村均呈國傢級>省級>縣級，且年均都呈增長態勢；費用-效果比顯示，人群、耕牛感染率與病人數下降1%、感染性釘螺麵積下降1 hm2的單位成本比值均逐年趨高。衛生投入的半對數差值穩定性分析顯示，各分層村兩兩比較均<1，三層村（5年年均差值均<1）投入與費用較穩定，一、二層村均呈年均費用大于投入的波動狀態。結論2006-2010年江陵縣血吸蟲病疫情逐年降低，但主要傳染源尚存，需加彊控製與清除；擴大糞便管理覆蓋麵是下一步工作的重點之一。資源配置上，衛生領域內重點投入與單位成本控製、費用的年均分配有進一步調整的空間。
목적대호소완내형혈흡충병류행구2006-2010년기간혈흡충병방치공작투입여효과진행종합분석여평개，위차류아형지구가쾌소제혈흡충병진정，진일보합리배치유한위생자원제공삼고。방법선택호북성여국가위생화계화생육위원회（원위생부，간칭국가위생계생위）、농업부연합방치혈흡충병시점지일적호북성강릉현，삼고전국혈흡충병방치전파공제체표고핵、호북성계단방치공작목표요구，2006-2010년이인축감염솔분층（즉인화축감염솔도≥3%위일층촌，3%>인화축감염솔≥1%위이층촌；인화축감염솔균<1%위삼층촌）위의거，채용분층분석방법，선택당지당년각분층복개류행촌위연구대상，회고성조사、수집방치공작효과여비용수거，소유수거경회총후진행비용-효과종합분석。결과역정방치효과현시，절지2010년，강릉현무일층촌，이층촌공계114개，삼층촌공계18개。혈흡충병병인수，일층촌절대수축년감소직지0，이、삼층촌절대인수증가。분편관리방면，무해화측소복개솔부이층촌2009、2010년분별위27.45%、48.74%，이일、삼층촌균위0。방치비용경첩현후，당지5년총방치비용중，종합치리투입（10266.39만원）원고우사치투입（418.30만원）여인공투입（223.95만원）。종합치리비용중，국토、농업、수리부문비용점거전3위。위생경비투입현시，분층촌균정국가급>성급>현급，차년균도정증장태세；비용-효과비현시，인군、경우감염솔여병인수하강1%、감염성정라면적하강1 hm2적단위성본비치균축년추고。위생투입적반대수차치은정성분석현시，각분층촌량량비교균<1，삼층촌（5년년균차치균<1）투입여비용교은정，일、이층촌균정년균비용대우투입적파동상태。결론2006-2010년강릉현혈흡충병역정축년강저，단주요전염원상존，수가강공제여청제；확대분편관리복개면시하일보공작적중점지일。자원배치상，위생영역내중점투입여단위성본공제、비용적년균분배유진일보조정적공간。
Objective To evaluate the cost-effectiveness of the comprehensive control measures carrying out in schistosomia-sis endemic inner embankment of marshland and lake regions from 2006 to 2010,so as to provide the reference for further rational allocation of limited health resources and ultimately speeding up the procedure of schistosomiasis elimination. Methods With ref-erence to the requirements of the national schistosomiasis transmission control and phase goals for schistosomiasis control in Hubei Province,Jiangling County,one schistosomiasis control pilot of Hubei Province combined with the National Health and Family Planning Commission and Ministry of Agriculture,was selected for the study. A definition of the infection rates of human and do- mestic animals was used for endemic villages stratified by different layers(i.e.,the village with the infection rates of human and domestic animals ≥3% belonged to the first layer,≥ 1% belonged to the second layer;<1% belonged to the third layer). By us- ing the stratification method and cost-effectiveness analysis,the endemic villages stratified with the different layers were investi- gated and all the data of schistosomiasis endemic situation,cost and effectiveness of schistosomiasis control were collected and comprehensively analyzed from 2006 to 2010. Results In the effectiveness of schistosomiasis control,by the end of 2010, there were no first layer villages,there were 114 second layer villages,and there were 18 third layer villages in Jiangling Coun- ty. In the former first layer villages,the schistosomiasis patients decreased year by year ultimately to 0;but in the second and third layer villages,the schistosomiasis patients increased. In the fecal treatment and management,the coverage rates of harm- less sanitary latrines were 27.45% in 2009 and 48.74% in 2010 respectively in the second layer villages,whereas there were no harmless sanitary latrines in the first and third layer villages. In the 5 years,the input of comprehensive control measures was 10 266 3900 Yuan,much higher than the human and buffalo examinations and treatments,Oncomelania hupensis snail investi- gation and elimination(4 183 000 Yuan)and other labor inputs(2 239 500Yuan). In the ratio of cost-effectiveness,the annual ratio of unit cost(1% reduction of human and buffalo infection and 1 hm2 reduction of snail areas)increased yearly. In addition, the semi-logarithmic stability trend analysis of health inputs and cost showed that there was a stable balance between inputs and cost in the different layers(logarithmic values of any two layers of pair-wise comparison were <1,and in the third layer villages, the annual average logarithmic values of 5 years were <1). Whereas,in the first and second layer villages,the annual average cost was fluctuated(the costs was higher than the inputs). Conclusion The schistosomiasis situation is reduced year by year in Jiangling County from 2006 to 2010. Whereas,the main infection source(buffaloes)still exists and the present control mea- sures including fecal management should be further strengthened. In the resource allocation,in the field of health,the annual distribution of key inputs and unit-cost control also has a further space of adjustment.
