华支睾吸虫病健康教育对小学生知识、行为和信念的影响

Effect of health education on the awareness and control of clonorchiasis in primary school students

目的在流行区开展小学生华支睾吸虫病健康教育并分析其效果。方法 2017-2018年,在广西宾阳县选择2所小学作为对照组和干预组。基线调查通过问卷调查获取小学生华支睾吸虫病相关知识、生食淡水鱼行为及信念情况(将来能否做到不生食淡水鱼)。在干预组开展综合的健康教育,包括竖立华支睾吸虫病健康教育展板、播放防治动画片、发放宣传单以及开展手抄报和作文比赛。对照组不开展上述措施。干预后6个月,开展健康教育效果评估调查,调查内容与基线调查类似。结果干预组和对照组同时参与基线调查和评估调查的小学生分别为251人和153人。干预组小学生基线调查和评估调查时对华支睾吸虫病的传播途径、早期症状、并发症、致癌性的知晓率分别为15.1%(38/251)、 92.4%(232/251)(P <0.01), 6.8%(17/251)、 43.4%(109/251)(P <0.01), 4.8%(12/251)、 94.8%(238/251)(P <0.01),和4.8%(12/251)、 57.8%(145/251)(P <0.01);对照组分别为9.2%(14/153)、 56.9%(87/153)(P <0.01), 0.7%(1/153)、 33.3%(51/153)(P <0.01),2.6%(4/153)、 42.5%(65/153)(P <0.01)和2.6%(4/153)、 20.9%(32/153)(P <0.01)。干预组基线调查时,过去1年有16人曾生食淡水鱼,评估调查时他们在过去6个月均未再生食淡水鱼;对照组基线调查时,过去1年有35人曾生食淡水鱼,评估调查时其中20人过去6个月未继续生食淡水鱼;干预组和对照组差异有统计学意义(P <0.01)。干预组基线调查时235人过去1年未生食淡水鱼,评估调查时有1人在过去6个月生食淡水鱼,比例为0.4%;对照组的比例为5.1%(6/118);干预组和对照组差异有统计学意义(P <0.01)。干预组基线调查时关于将来能否做到不生食淡水鱼,表示"能"、"不能"和"不确定"的构成比分别为71.3%(179/251)、17.1%(43/251)和11.6%(29/251),评估调查时分别为97.2%(244/251)、 2.0%(5/251)和0.8%(2/251),差异有统计学意义(P <0.01)。对照组基线调查时表示"能"、"不能"和"不确定"的构成比分别为79.7%(122/153)、 4.6%(7/153)和15.7%(24/153);评估调查时分别为83.0%(127/153)、 2.6%(4/153)和14.4%(22/153),差异无统计学意义(P> 0.05)。结论在小学开展华支睾吸虫病综合的健康教育能够有效提高小学生的相关防治知识,促进生食淡水鱼行为的转变,加强不生食淡水鱼的信念。

Objective To evaluate the effect of health education on the awareness and control of clonorchiasis in primary school students in the endemic areas.Methods This study was implemented in Binyang County,Guangxi from 2017 to 2018.One primary school was selected as intervention group while another as non-intervention control group.A baseline questionnaire survey was firstly implemented in all students to understand their knowledge,practice and awareness related to clonorchiasis and the danger to eat raw fishes.Then,the comprehensive health education was carried out in the intervention group including the demonstration of an education cartoon and bulletin board on the transmission,prevention and control of clonorchiasis,distribution of educational brochure and conducting an drawing and essay competition related to the knowledge of the diseases.These educational activities did not perform in the control school.Six months later,a similar questionnaire survey were conducted to evaluate the effect of the education.Results Total 251 students in intervention group and 153 in control group participated in both baseline and evaluation surveys.In the intervention group,the awareness for the transmission route,early symptoms,complications,and carcinogenicity of clonorchiasis from 15.1%(38/251),6.8%(17/251),4.8%(12/251) and 4.8%(12/251) in the baseline survey significantly increased to 92.4%(232/251),43.4%(109/251),94.8%(238/251) and 57.8%(145/251),respectively,in the evaluation survey 6 months later,with statistical significance (P < 0.01).In contrast,in the non-intervention control group,the awareness for transmission route,early symptoms,complications,and carcinogenicity of clonorchiasis from 9.2%(14/153),0.7%(1/153),2.6%(4/153) and 2.6%(4/153) in the baseline survey increased to 56.9%(87/153),33.3%(51/153),42.5%(65/153) and 20.9%(32/153),respectively,in the evaluation survey,however,the increase was not as much as the intervention group.In intervention group,16 students (16/251) who had history to eat raw freshwater fish during the past year in the baseline survey decreased to none to eat raw fish during the past 6 months.For those with no history to eat raw fish (235) in baseline survey,there was only one (1/235) who ate raw fish during the past 6 months.In the non-intervention control group,35 students (35/153) who had history to eat raw freshwater fish during the past year in the baseline survey decreased to 15 to eat during the past 6 months.Out of 118 students who had not eaten raw fish,6 had eaten raw fish during the past 6 months.The proportion of those who had history to eat raw fish but changed not to eat after baseline survey and those who had no history to eat raw fish but did after the baseline survey was significantly different between the two groups (P < 0.01).As to the awareness not to eat raw freshwater fish in future in intervention group,the rates for answering yes,no or not sure were 71.3%(179/251),17.1%(43/251) and 11.6%(29/251),respectively,in baseline survey changed to 97.2%(244/251),2.0%(5/251) and 0.8%(2/251) in evaluation survey (P < 0.01).In non-intervention control group,the rates of answering yes,no or not sure in the baseline survey [79.7%(122/153),4.6%(7/153) and 15.7%(24/153)] had no significant change compared to the answers in evaluation survey [83.0%(127/153),2.6%(4/153) and 14.4%(22/153)](P > 0.05).Conclusion The comprehensive health education intervention in primary school students could effectively increase their knowledge and awareness to the transmission and prevention of clonorchiasis,as well as change their risk behavior to eat raw fish.