淮安市2010—2016年医疗机构对输入性疟疾防控作用

Role of medical institutions in imported malaria prevention and control since initiation of malaria elimination program in Huai'an,2010-2016

目的通过回顾性分析2010—2016年淮安市报告的输入性疟疾病例诊断和救治情况,评估医疗机构在输入性疟疾防控中的作用。方法对2010—2016年淮安市网络直报系统和疟疾防治系统的疟疾病例流行病学个案调查表中疟疾疫情、病例诊断和治疗等个案数据信息,采用描述流行病学方法分析医疗机构在疟疾病例的报告、确诊和治疗中的作用。结果 2010—2016年淮安市共报告输入性疟疾病例286例,其中死亡2例,均为恶性疟,输入来源地为非洲,病死率为0.70%。医疗机构和疾控机构分别报告病例207例(占72.38%)和79例(占27.62%)。在201例输入性疟疾病例中,171例首诊为疟疾,诊断正确率为85.07%(171/201)。医疗机构的首诊正确率(78.87%,112/142)明显低于疾控机构(100.00%,59/59)(P<0.05)。乡镇级及以下、县级、地市级和省级医疗机构的首诊正确率分别为4.12%(15/34)、95.24%(40/42)、87.69%(57/65)和0(0/1),各级医疗机构间的差异有统计学意义(P<0.05)。医疗机构和疾控机构确诊的病例比例分别为65.67%(132/201)和34.43%(69/201),两者间差异有统计学意义(P<0.05)。乡镇级及以下、县级和地市级医疗机构的确诊比例分别为4.98%(10/201)、21.39%(43/201)和39.30%(79/201),各级医疗机构间的差异有统计学意义(P<0.05),各级疾控机构间的差异亦具有统计学意义(P<0.05)。结论各级医疗机构间的首诊准确率和确诊率差异较明显,基层医疗单位的疟疾诊疗知识溃泛和镜检疟原虫的能力较差,其诊断准确率明显低于同级疾控机构。

Objective To retrospectively overview the diagnosis and treatment of imported malaria in Huai＇an City from 2010 to 2016, and evaluate the role of medical institutions in imported malaria prevention and control. Methods The information on malaria epidemic situation as well as its diagnosis and treatment in Huai＇an City from 2010 to 2016 was collected from the infectious disease surveillance system and information management system for the prevention and treatment of parasitic disease. The descriptive analysis was performed to determine the role of medical institutions in the reporting,diagnosis and treatment of malaria cases. Results A total of 286 imported malaria cases were reported in Huai＇an City from 2010 to 2016, of which 2 patients died. The fatality rate was 0.70%. The 2 patients were all due to falciparum malaria and the imported infectious sources were from Africa. The number of cases reported by medical institutions and disease control agencies were 207（72.38%） and 79（27.62%） respectively. Among the 201 imported malaria cases with diagnosis records from 2012 to 2016, 171 cases were first diagnosed to be malaria, with a diagnostic accuracy of 85.07%（171/201）. The accuracy of first diagnosis by medical institutions（112/142, 78.87%） was significantly lower than that by disease control agencies（59/59,100.00%）（P〈0.05）. The accuracies of first diagnosis by medical institutions at the town-ship level or below, the county level,the city/prefecture level and the provincial level were 4.12%（15/34）, 95.24%（40/42）, 87.69%（57/65） and 0（0/1）, respectively（P〈0.05）. The cases diagnosed by medical institutions and disease control agencies constituted 65.67%（132/201） and 34.43%（69/201） respectively, with a significant difference between them（P〈0.05）. In addition, the cases diagnosed by medical institutions at the town-ship level or below, the county level and the city/prefecture level constituted 4.98%（10/201）, 21.39%（43/201） and 39.30%（79/201）, respectively（P〈0.05）. The similar results were also obtained for disease control agencies of the above levels（P〈0.05）. Conclusions There are considerable differences among the medical institutions of different levels in the first diagnosis accuracy and diagnosis rate of malaria. The medical institutions of lower levels have lower diagnosis rate compared to the disease control agencies at the same levels because of the lack of malaria diagnosis knowledge and the skill of microscopic examinations.