江苏省基层医疗卫生机构疟疾快速诊断试纸应用现状

Current status of malaria rapid diagnostic testing strips application in primary-level healthcare providers in Jiangsu Province

目的 了解江苏省基层医疗卫生机构疟疾快速诊断（RDT）试纸的应用现状及疟疾检测人员对试纸的评价。方法 于2016年11-12月，在江苏省采用分层随机抽样的方法，在设区市、县（市、区）、乡镇分别选取878家医疗和118家疾控机构作为调查地点，再采用自制问卷收集每个机构2015年疟疾检测工作情况、RDT试纸使用情况和对RDT试纸的评价情况；以及收集每个机构选派的1名疟疾检测人员的个人信息及其对RDT试纸的评价。分别比较医疗机构和疾控机构间、不同层级医疗机构间、不同层级疾控机构间评分情况。结果 2015年，江苏省疟疾病例数为405例；疟疾血液检查开展数检测量为36.22万人次；共向医疗卫生机构免费提供疟疾RDT试纸10万人份。所选取的996家医疗卫生机构中，628家在2015年应用了RDT试纸，使用量的P50（P25，P75）为10（2，25）人份，其中，疾控机构[15（5，52）人份]高于医疗机构[10（2，25）人份]（Z=-3.42，P=0.001）；而疾控机构对RDT试纸关于单次检测时间方面的评分[10（8.5，10）]高于医疗机构[9（8，10）]（Z=-2.20，P=0.028）。614名完成调查且其所在单位2015年使用了RDT试纸的疟疾检测人员中，来自疾控机构者对于RDT试纸在单次检测时间、检测操作难度和结果判定难度方面评价的P50（P25，P75）分别为[10（9，10）、10（9，10）、10（9，10）]，均高于来自医疗机构的疟疾检测人员[9（8，10）、9（8，10）、9（8，10）]（Z值分别为-2.55、-2.97和-2.96，P值均〈0.05）。结论 RDT试纸已在江苏省基层医疗卫生机构广泛应用，疾控机构的RDT试纸使用量高于医疗机构；疾控机构及其疟疾检测人员对于RDT试纸的单次检测时间、检测操作及结果判定难度方面的评价高于医疗机构及其疟疾检测人员。

Objective To investigate the current status of malaria rapid diagnostic test （RDT） strips application and malaria laboratory technicians＇ evaluation about them at primary healthcare provider level in Jiangsu Province.Methods From November to December 2016, 878 medical institutions and 118 CDCs of city, county and township/community level in Jiangsu Province were selected as study samples using stratified random sampling method. Self-designed questionnaire was distributed to investigate the institution＇s malaria work task, RDT strips application and evaluation status in 2015. We also investigated the socio-demographic information and collected the RDT strips evaluation score from the malaria laboratory technicians selected from the institutions investigated （one technician from each institution）. Rank sum test was performed to compare the RDT strips evaluation scores between medical institutions and CDCs, and among different medical institutions and CDCs.Results In 2015, 405 cases of malaria were reported, 362 200 person-time of malaria blood testing task was conducted, and 100 000 RDT strips were procured and provided for healthcare providers in Jiangsu province for free. Of the 996 healthcare institutions investigated, 628 used RDT strips in the year 2015 and the median （P25, P75） of RDT strips volume used in these institutions was 10 （2, 25）. The volume of RDT strips used in CDCs （15 （5, 52）） was significantly higher than that in medical institutions （10 （2, 25）, （Z=3.42, P=0.001））. The investigated CDCs gave higher score on RDT strips＇ testing time per operation （10 （8.5, 10）） than medical institutions （9（8, 10）, （Z=-2.20, P=0.028））. The employers of 614 investigated malaria laboratory technicians used RDT strips in 2015. The median of the scores given by CDC malaria laboratory technicians for RDT strips in terms of testing time per operation, testing operation and results judgement difficulties were 10 （9, 10）, 10 （9, 10） and 10 （9, 10）, respectively, which were significantly higher than those from technicians of medical institutions （9 （8, 10）, 9 （8, 10）, 9 （8, 10）, （Z values were -2.55, -2.97 and -2.96, respectively; P values were all less than 0.05））.Conclusion RDT strips had been widely performed in health institutions in Jiangsu Province. The amount of RDT strips used in CDCs was significantly higher than that in medical institutions. Primary-level institutions and malaria laboratory technicians generally recognized RDT strips＇ advantage for application in terms of testing time and operational procedure. CDCs and malaria laboratory technicians from them gave higher regards on RDT strips in terms of testing time per operation, testing operation and results judgement difficulties compared with that of medical institutions.