消除阶段的疟疾患者分布及就医选择分析

Analysis on the distribution and treatment of malaria patients in the phase of eradication of malaria in China

目的:了解我国疟疾消除阶段的患者分布及就诊机构特征。方法:采用多阶段分层整群抽样的方法,抽取浙江、江苏、安徽、河南、四川、云南六省共102家医院作为样本医院,收集样本医院2014年1月1日—2016年12月31日所有疟疾患者在医院治疗过程中的病历、门诊和住院病例治疗费用原始明细结算清单。采用Excel 2016和SPSS 20.0等软件进行统计分析。结果:本次调查共收集疟疾病例1 633例,发现我国疟疾患者在就诊月份上呈现W型分布。疟疾分型以恶性疟为主,河南和四川的间日疟患者有反弹趋势。77.10%的患者选择了三级医院,52.05%的住院患者在市级医疗机构,23.58%的患者在省级医疗机构。结论:疟疾发病高峰期出现新的时间段,具备疟疾治疗能力的医院防线逐渐收缩,疟疾救治能力相对集中在影响较大的高水平医院。建议构建区域疟疾治疗防线,加强培训重症疟疾治疗知识,提高疟疾救治能力。

Objective: To understand the distribution and treatment of malaria patients, and the characteristics of sampled hospitals in thephase of eradication of malaria, and provide support for medical resources allocation in the later stages of malaria eradication phase.On this basis, this study aims at promoting the realization of the ultimate goal of total eradication of malaria in China by 2020. Methods: A multi-stage stratified cluster sampling method was used. A total number of 102 hospitals in Zhejiang, Jiangsu, Anhui, Henan, Sichuan and Yunnan Provinces were selected to collect original information on in-patient and out-patient of malaria in terms of medical records and treatment costs during the periodfrom January1st 2014 toDecember 31th2016. In order to conduct accurate statistical analysis, Excel 2016, SPSS 20.0 and other Software were used. Results: The survey results collected a total number of 1633 malaria patients, and these patients showed a W-shaped distribution during the months of treatment. Most of malaria patients from Henan and Sichuan Provinceswere diagnosed as having been affected by falciparum and vivax malaria,and their number sharply increased.This is paper also revealed the ratios of malaria patientsin terms of their choice of health services, namely from tertiary hospitals, municipal medical institutions and provincial medical institutions;those were77.10%, 52.05% and 23.58%, respectively. Conclusions:A new period of peak incidence of malariais detected from 2014 to 2016. With hospitals line of malaria defending ability shrinking, it was found that malaria treatment capacitiesare relatively concentrated in the high level hospitals, which plays a greater role when it comes to the prevention and control of malaria. It is recommended that regional malaria treatment lines should be built,and severe malaria treatment knowledge trainingsshould be prepared and attended in mass in orderto improve malaria treatment capacities.