鄱阳湖血吸虫病重疫区成年男性居民18年健康教育效果观察

Longitudinal observation on effect of health education for adult male residents for 18 years in heavy epidemic areas of schistosomiasis around Poyang Lake region

目的研制提高重疫区成年男性居民血吸虫病化疗依从性、有效控制疾病的健康教育干预模式,并观察其远期干预效果。方法应用实验研究方法 ,对1993-2009年应用"血吸虫病化疗依从性干预+防护技能培训"健康教育模式干预实验组目标人群的效果进行纵向观察。结果干预前(1992年)实验组和对照组居民血防知识知晓率、化疗态度正确率、疫水接触率和血吸虫感染率均无显著差异,实验组发现3例晚期血吸虫病人。干预1年后(1993年)实验组居民血防知识知晓率由干预前的67.35%提高到91.92%(χ2=18.553,P<0.01),化疗态度正确率由干预前的56.44%提高到97.98%(χ2=48.722,P<0.01);化疗行为依从率由干预前的46.46%提高到92.08%(χ2=49.074,P<0.01);干预4年后,多数成年男性居民肝、脾肿大及肝纤维化趋向好转和稳定,未见新发晚期血吸虫病人;干预17年后,目标人群血吸虫病化疗依从率均达90%以上;干预前后目标人群接触疫水主要方式均为捕鱼,接触疫水率和血吸虫感染率均未见下降。结论应用"血吸虫病化疗依从性干预+防护技能培训"健康教育模式干预可显著提高重疫区成年男性居民血吸虫病化疗依从性,有效控制患病。

Objective To develop an intervention model of health education for improving treatment adherence to schistosomiasis in adult male residents in heavy endemic areas so as to control the disease efficiently,and to observe the long term effect of the intervention.Methods The experiment study method was adopted.The baseline survey was carried out in 1992.The health education model of ＂treatment adherence intervention to schistosomiasis ＋ protection skill training＂ was employed to intervene to the target population of the experiment group from 1993-2009.Results Before the intervention（1992）,there were no significant differences in the awareness rate of schistosomiasis control knowledge,the correct rate of treatment attitude,the contact rate of infested water and the infection rate of Schistosome japonicum between the experimental group and the control group.There were 3 cases of advanced schistosomiasis in the experimental group.One year after the intervention（1993）in the experimental group,the awareness rates of schistosomiasis control knowledge increased from 67.35% to 91.92%（χ2=18.553,P0.01）;the correct rate of treatment attitude increased from 56.44% to 97.88%（χ2=48.722,P0.01）;the adherence rates of treatment rose from 46.46% to 92.08%（χ2=49.074,P0.01）.Four years after the intervention,hepatomegaly,splenomegaly and hepatic fibrosis showed a tendency to improve and stabilize in most adult male residents with no new advanced schistosomiasis case found.Seventeen years after the intervention,the adherence rate of treatment in the target population was more than 90%.Because the primary way of contacting infested water was fishing before and after the intervention,both the rate of contacting infested water and the infection rate of schistosome were not found to decline.Conclusion The application of the intervention model of ＂treatment adherence intervention to schistosomiasis ＋protection skill training＂can significantly improve the treatment adherence for schisto-somiasis in adult male residents in heavy endemic areas,and can efficiently control this disease.