影响AFP病例及时采集粪便标本的多因素分析

ANALYSIS OF FACTORS AFFECTING TIMELY COLLECTION OF STOOL SAMPLES FROM AFP CASES

用Ｌｏｇｉｓｔｉｃ回归模型分析了影响急性弛缓性麻痹（ＡＦＰ）病例１４天内及时采集粪便标本的因素。单因素分析发现，地区级和省级医疗机构首诊ＡＦＰ病例、报告ＡＦＰ疫情、采集不及时便的危险度均高干村、乡级（ＯＲ在２。７～４．７，Ｐ在０．００６～０．０６之间），地区级卫生防疫站进行流行病学调查、采集不及时便的危险度高于县级卫生防疫站（ＯＲ＝２．４，Ｐ＜０．００６）。多元分析发现，１４天内采便的完成受到从麻痹发生到采便各个环节经历时间的综合影响。麻痹至就诊是影响四川省１９９５年ＡＦＰ病例及时采便的主要环节（ＯＲ＝５．４３，Ｐ＜０．００１），就诊至报告（ＯＲ＝４．９７，Ｐ＜０．００１）、报告至调查（ＯＲ＝４．２９，Ｐ＝０．０５５）、调查至采便（ＯＲ＝５．００，Ｐ＜０．００１）也是影响及时采便的较重要环节。提示：ＡＦＰ病例就诊的早晚以及医疗卫生单位对ＡＦＰ病例的诊断、报告、调查、采便等一系列相互联系活动的响应速度，同时制约着１４天内采便的完成，要提高采便及时率，应把监测重点放在县级及县级以下，采取以早诊断、早报告、早调查、早采便为目的的综合性干预措施。

he nonconditional Logistic regression model was applied to estimate the magnitude of the fac-tors related to stool collection within 14 days.It was found by using one variable model that therisks of stool collecting after 14 days from the first diagnosis, and AFP reporting made bythe prefecture and provincial levels when higher than that by the village and township levels(OR between 2.7 and 4.7, P value between 0.006 and 0.06 respectively).The multiple modelshowed that stool collection within 14 days was affected by the length of in every processfrom paralysis to stool collection. The interval between onset of paralysis and the first time seekingfor medical care was the most dominant bottlenecks for AFP cases in Sichuan in 1995(OR=5.43,P<0.001)The others lied in the interals from first contact to report,from report to investigation,and from investigation to stool collection.Their ORs were 4.97(P<001),4.29(P=0.055)and 5.00(P<0.001)respectively.It concluded that factors hindering the stool collection within 14 days werehow quickly an AFP patient went to see a doctor and how soon a diagnosis of AFP was made, and reported by doctors as well as investigated and stools collected by Epidemic PreventionStation. These activities related to each other.Comprehensive countermeasures should be takenin or-der to increase the proportion of timely collected stools of AFP cases, which should give first priorityto county and its lower levels in surveillance and aim at early diagnosis,early reporting, earlyinvestigation and early stool collecting.