血吸虫病流行村综合防治策略实施效果与费用-效果评价

Evaluation on the implementation of comprehensive strategy and cost-effectiveness of schistosomiasis control in Lushan county,Sichuan province

目的了解不同综合疫情流行村的血防综合治理策略和实施效果。方法对四川省芦山县2007-2012年综合疫情重度L村、中度Z村和轻度F村的人口状况、血吸虫病情和螺情、综合防治措施和血防投入经费等资料进行收集和分析。结果 2007-2012年3村从卫生血防、传染源控制、环境综合改造等方面实施综合治理,L村人群血吸虫感染率由0.58%下降到0,下降率100.00%;Z村除2010年人群感染率0.10%外,其他年份均为0;F村各年人群感染率为0。3村均无急性血吸虫患者、病牛检出,耕牛感染率和感染性螺数均为0,但有螺面积、活螺平均密度因2008年受汶川特大地震灾害影响而出现波动。2007-2012年L村、Z村和F村年人均血防经费投入360.79元、332.40元、170.72元。L村自2008-2012年血吸虫每百人感染率下降1.00%的平均费用352.92元,Z村和F村因人群感染率始终均为0而无法计算下降费用。3村2010-2012年来每km2活螺平均密度下降1.00%的费用696.82元、139.45元、2 191.22元。结论芦山县综合疫情重度L村、中度Z村和轻度F村的疫情得到有效控制,3村实施的以控制传染源为主的血防综合治理策略效果凸显。在降低人群感染率和活螺平均密度方面,L村实施的综合防治措施具有较好的费用-效果;在降低活螺平均密度方面,Z村所采取的血防综合措施具有良好的费用-效果;F村则表现出投入和产出失衡,应适时调整部分血防措施。但也应注意,愈是疫情轻度村,其防治难度愈大,愈要保证一定血防经费的投入,以促进血防工作的有效运行,加强疫情监测,防止疫情反弹,故其效果评价指标下降所需费用会有所偏高。

Objective To understand the implementation results of villages with different endemic degrees of schistosomiasis in Lushan County, Sichuan Province. Methods Data of local population, schistosomiasis endemic situation,snail, comprehensive measures and funding of three types of villages, village L （ severe）, Z （moderate） and F （mild） in Lushan County from 2007 to 2012 were collected. Results Comprehensive measures were taken （ performance of public health, control of infectious source, environmental improvement and other measures ）, as the result, the infection rate of schistosomiasis in L village decreased from 0.58% to 0, （reduce rate, 100. 00% ） ; In village Z, the human infection rate for each year was 0 ,except the year 2010 （0.10%） . In village F,the human infection rate for each year was 0.30%, no acute case was found,cattle infection rate and snail infection rate were 0. However,the snail area,the average density of living snails for 2008 showed fluctuation, it might be influenced by the Wenchuan earthquake. From 2007-2012, the averageper capita annual schistosomiasis funding for L, Z and F were 360.79 yuan,332. 40 yuan, 170. 72 yuan, respectively. In village L,from 2008-2012 ,the average expenditure for reducing 1.00% per hundred patients was 352.92 yuan,while Z and F village, because of human infection rate remained 0, the reducing expenditure could not be calculated. The three villages, from 2010 to 2012,the average expenditure for reducing live snail density per square Km was 696. 82 yuan,139. 45 yuan, 2 191.22 yuan,respectively. Conclusions All of the three types of villages, L, Z and F were under effective control. In these three villages, the comprehensive measure, stressing the control of infectious source, showed significant outcome. On reducing human infection rate and average live snail density, L village showed better cost-effectiveness ; On reducing average live snail density, Z village had better cost-effectiveness too. However, F village was unbalanced between inputs .and outputs, timely adjustment of control measure was necessary. But it should be noted that, the milder the endemic, the more difficult the control,the more investment should be ensured, so as to accelerate the effective operation of schistosomiasis control, endemic surveillance, and preventing rebound. Therefore, the expenditure for evaluating the outcome might also be somewhat increased.