蚊孳生水体周围居民疟疾休止期预防性服药的效果评价

Evaluating the effect of preventive medicine for residents living around mosquito breeding water during rest period of malaria

目的评价蚊孳生水体周围居民疟疾休止期划范同服药措施埘疟疾的控制效果。方法采用分层整群随机抽样法，于2007年3月选取淮河沿岸及其以北地区疟疾高发的6个县，每县根据2006年病例数将A然村分为5层，每层抽取1个A然村，即每县抽取5个自然村，共抽取30个自然村。每个自然村调查300～500名对象，合计12860名。将每个县的5个自然村按区组随机化法分配到3个处理组中，其中，干预1组有9个自然村，4362名捌查对象；十预2组有12个自然村，4471名调查对象；非干预组有9个自然村，4027名调查对象。，应朋问卷渊查研究对象基本情况。调查疟疾病例与蚊孳生水体分布的关系，并以此作为划范围服药的依据。对干预1组采取划范围服药措施，对干预2组采取常规服药策略，非干预组不实施干预策略。计算2006、2007年各组研究对象疟疾发病率、标化发病率、发病率净变化值（干预前后标化发病率差值）、年龄别发病率，以及划范围服药措施的保护率、效果指数和病例捕获率。结果干预1组共服药1219名（占27．9％），干预2组共服药219名（占4．9％）。2006年干预前，干预1组、干预2组和非干预组分别以50～59岁、60～69岁和70岁以上年龄组发病率较高，其发病率分别是36．22％e（18／497）、40．11‰（15／374）和34．88％（9／258）。干预后，干预1组和十预2组均以70岁以上年龄组发病率较高，分别为9．17‰（3／327）和22．01‰（7／318）；非干预组以30～39岁年龄组发病率较高，为24．88‰（10／402）。干预1组、干预2组和非干预组2006年疟疾发病率分别为18．78‰（83／4420）、20．27‰（93／4587）和14．61‰（53／3627），标化发病率分别为18．85‰、20．72‰和14．89‰；2007年干预后的发病率分别为2．75‰（12／4362）、11．63‰（52／4471）和12．17‰（49／4027），标化发病率分别为2．81‰、12．75‰和12．35‰。各组发病率净变化值分别为16．04％、7．97％和2．54％，干预1组和非干预组间的发病率净变化值差异有统计学意义（X2=7．74，P〈0．05）。与非十预组相比，干预1组划范围服药的保护率和效果指数分别为84．2％和6．31。划范围服药的病例捕获率约为69．2％（9／13）。结论蚊孳生水体周围居民疟疾休止期划范围服药措施对清除潜在疟疾传染源、降低疟疾发病率效果明显。

[ Abstract] Objective To evaluate the effect of preventive medicine tbr residents living around mosquito breeding water during rest period of malaria by delimiting a certain range. Method The study adopted the stratified cluster random sampling method to select subjects from 6 counties in the high epidemic area along and north of the Huai River since March 2007. Then the villages of 6 counties were stratified into five levels according to the case reported in year 2006, and one village was randomly selected from each level,thereby 30 villages were selected in total. 300 - 500 subjects were interviewed in each village, and in total 12 860 subjects were recruited in the study. The five selected villages in each county were allocated to three intervention groups according to the block randomization method. The first intervention group included 9 villages ,4362 people; the second intervention group was consisted of 12 villages, 4471 people; the non-intervention group had 9 villages,4027 people. The basic information of the subjects were collected by questionnaire to analyze the relation between malaria cases and the distribution of the mosquito breeding water, then accordingly delimited the range for preventive medicine. Group 1 received the delimiting preventive medicine treatment, group 2 received routine medicine treatment, while non-treatment group received no treatment. The morbidity, standardized morbidity, net change of morbidity （ the D-value of the standardized morbidity before and after the intervention ） , age-specified incidence, and the protective rate （PR）, effectiveness index （IE） and the capture rate of the delimited method group were then calculated. Results Group 1 had 1219 （27.9%） people taking medicine and Group 2 had 219 （4. 9% ） people. In 2006, before the prevention conducting, the high incidence aging group in the first, second and nonintervention group was separately people aging 50 -59,60 -69 and ≥70 years old; whose incidence was 36. 22%o（18/497） ,40. 11‰ （15/374） and 34. 88%o （ 9/258 ） respectively. After the intervention, the high incidence aging groups in the first and second intervention group changed to the population over 70 years old, with incidence at 9. 17%o （ 3/327 ） and 22. 01%o （ 7/318 ） respectively ; while the high incidence aging groups in the nonintervention group changed to people aging between 30 - 39 years old, with the rate at 24. 88%0 （10/402）. In 2006, the morbidity of malaria in the first, second intervention group and nonintervention group was separately l 8.78%o （ 83/4420 ） , 20. 27%0 （ 93/4587 ） and 14. 61%0 （ 53/3627 ） ; while the standardized incidence was separately 18.85‰, 20. 72%0 and 14. 89‰. In 2007, after the prevention conducting, the morbidity in the three groups was 2. 75‰ （ 12/4362 ）, 11. 63‰（ 52/4471 ） and 12. 17‰（ 49/4027 ）, respectively; while the standardized incidences was 2. 81%o, 12. 75‰ and 12. 35%o, respectively. The net value of changes of morbidity in the three groups was separately 16. 04%, 7.97% and 2. 54%. The difference in net values of changes of morbidity between intervention group 1 and 2 had statistical significance （X2 = 7.74, P 〈0. 05 ）. Comparing with the nonintervention group, the PR and IE in intervention group 1 was separately 84. 2% and 6. 31; while the capture rate was 69.2% （9/13）. Conclusion The delimiting preventive medicine treatment during rest period of malaria was very effective for eliminating the potential infection source of malaria and reducing the morbidity of malaria.