基于公共卫生服务均等化的血吸虫病防治研究Ⅱ：血吸虫病防治服务探讨

Study of schistosomiasis control based on the equality of public health services II ： evaluation on schistosomiasis control service

目的通过对两类血吸虫病防治（简称血防）服务实施者的工作效果进行探讨，为推动血防工作纳入公共卫生服务均等化提供科学依据。方法在湖北省江陵县选择血吸虫病疫情相仿的虾湖村和万场村，分别按县级血防机构为模式一和乡（镇）卫生院为模式二的血防服务实施主体，采用观察法比较两种血防服务实施主体查灭螺、查治病等服务工时；采取小组访谈方法了解该县所有血吸虫病流行村卫生人员的血防服务内容和意愿；采用优劣势分析法（strengths weakness opportunity threats，SWOT）对上述结果进行分析。结果江陵县虾湖村和万场村的常住人口分别为571人和618人，2011年人群推算感染率分别为1．72％和2．01％．两村的血吸虫病疫情相仿。在模式一情况下，每百名居民所需投入血检服务工时为2．57：每百名居民所需投入治疗服务工时为2．67；每百名居民所需投入粪检服务工时为11．94：每百名居民所需投入健康教育服务工时为2．49。在模式二情况下．每百名居民所需投入血检服务工时为2．82；每百名居民所需投入治疗服务工时为3．13；无技术力量开展粪检和查灭螺工作：每百名居民所需投入健康教育服务工时为17．78。对全县10所乡（镇）卫生院、88个村卫生室的负责人员进行访谈，共有90名乡（镇）卫生院院长及村卫生室负责人参加访谈，其中29人参与血防查病现场采样：41人参与对血检阳性患者的治疗；48人参与血防健康教育；无人参与血防查、灭螺工作。县级血吸虫病防治机构具有整体的综合防治观念，熟知综合防治知识和技能，以及血吸虫病检查等专项技术，但是无法实时了解居民的疫水接触等不卫生行为，而且，在短期内收集全体居民的血样和粪样困难很大。在实施基本公共卫生服务均等化的工作中，乡（镇）卫生院和村卫生室为村民建立了个人健康档案，可为慢性和晚期血吸虫病患者提供临床医疗服务，可及时与每位村民联系采集血样和粪样等查病工作，但是，防治血吸虫病的现场工作强度大，而且补贴低，因此，乡（镇）卫生院和村卫生室没有承担钉螺调查和消灭，以及血清学和病原学检查的工作的技能。结论在血吸虫病流行区．应将各项防治血吸虫病措施纳入基本公共卫生服务均等化体系。分别由县级血防机构、乡（镇）卫生院和村卫生室实施，保障居民获得最基本、最有效的基本公共卫生服务的目标。

Objective To evaluate the effects of schistosomiasis control service by 2 sorts of implementer for the purpose of bringing schistosomiasis control into the content of equality of public health services. Methods Xiahu and Wanehang villages with similar schistosomiasis endemic situation in Jiangling County were selected as study sites. The implementers were county level of schistosomiasis control as model 1, town- ship health center and village clinic as model 2. The working hours of snail survey and control, disease exami- nation, and treatment were compared by observation method between 2 sorts of impiementers. The village clinic staff was interviewed on schistosomiasis control and willingness by focus groups interview. The above data was analysized by strengths weakness opportunity threats （SWOT）. Results The residents Xiahu and Wanchang villages were 571 and 618, the calculated human infection rates were 1.72% and 2.01%, the schis- tosomiasis endemic situation was similar. In model 1, the working hours of schistosomiasis examination was 2.57, the working hours of treatment was 2.67, the working hours of stool examination was 11.94, the working hours of health education was 2.49. In model 2, the working hours of schistosomiasis examination was 2.82, the working hours of treatment was 3.13, the working hours of health education was 17.78, without ability for stool examination, snail survey and control. 90 staff from 10 township health centers and 88 village clinics was interviewed. Among them, 29 staff participated in schistosomiasis examination, 41 staff participated in treat- ment, 48 staff participated in health education. No staff participated in snail survey and control. The profes- sional of county agency of schistosomiasis control had overall concept of comprehensive control, mastered the knowledge of schistosomiasis control and technique of examination, but had the difficulty for human blood and fecal samples collection in short time and controlling the unhealthy behavior of water contact in real time. Up- on the equality of public health services, the individual health records were established by township health center and village clinic, they had rich clinical experience and offered service for chronic and advanced schis- tosomiasis patients. The village clinic professional could help blood and fecal samples collections. But town- ship health center and village clinic were of inability for snail survey and control as well as examination on pathogens and blood samples. Conclusion For the sake of achievement of people acquiring equality of public health services, the measures of schistosomiasis prevention and control should be incorporated into public health services. The prevention and control activities should be implemented by county schistosomiasis control agencies, township health centers and village clinics.