新疆医疗机构黑热病诊断现状及医生黑热病诊断标准知晓调查

Investigation on current situation of kala-azar diagnosis in medical institutions and awareness of diagnostic criteria in doctors in Xinjiang

目的掌握新疆南北疆医疗机构黑热病诊断与卫生行业标准的符合率以及医生对黑热病诊断标准内容的知晓率,查找黑热病诊断中存在的问题,提出解决建议并为全疆制定黑热病防治规划提供参考依据。方法采用典型抽样方法,在南疆喀什地区和北疆乌鲁木齐市各抽取1所报告病例数最多的医疗机构开展现况调查,调查内容包括诊断符合率、实验室检测开展情况及入院-诊断时间;根据黑热病诊断标准设计调查问卷,选择2所医疗机构的儿科和感染科全部医生调查黑热病相关知识知晓率。结果共核查黑热病病例34例,与标准中分型诊断总的符合率为14.7%,其中乌鲁木齐市某医院为30.8%、喀什地区某医院为4.8%,两所医院差异无统计学意义(Fisher确切概率法,P=0.059);喀什地区某医院12例病例未开展任何实验室检测,两所医院间入院-诊断时间差异无统计学意义(z=-0.684,P=0.494);黑热病知晓率喀什地区某医院(75.3%)高于乌鲁木齐某医院(55.0%),差异有统计学意义(χ^2=14.039,P<0.01)。31名医生中,近一年接受过相关培训的仅6人。结论南北疆两所医疗机构诊断符合率均较低,南疆喀什地区医生黑热病相关知识知晓率高于北疆乌鲁木齐市;应加强临床医生对黑热病诊断标准的培训,规范黑热病诊断和病例报告。

Objective To understand the coincidence rate between diagnosis of kala-azar and diagnostic criteria in medical institutions,and the awareness of kala-azar diagnosis in doctors in Xinjiang,find out the problems in the diagnosis of kalaazar,so as to provide reference for formulating the prevention and control schedule of kala-azar in Xinjiang.Methods A prevalence survey was conducted in one medical institution with the most reported patients in Urumqi of northern Xinjiang and in Kashi prefecture of southern Xinjiang by way of typical sampling.The diagnostic coincidence rate,laboratory testing and time from hospitalized admission to diagnosis were included in this survey.According to the diagnostic criteria of kalaazar,questionnaire was designed for investigating awareness of kala-azar knowledge in doctors from the department of pediatric and infections in the two medical institutions.All the doctors in pediatrics and infectious department of 2 medical institutions were selected to investigate the awareness rate of kala-azar knowledge.Results All 34 kala-azar cases were examined with overall diagnostic coincidence rate of 14.7%,that is 30.8%in the hospital in Urumqi and 4.8%in the hospital in Kashi prefecture.There was no statistical difference in the diagnostic coincidence rate(Fisher exact probability test,P=0.059)and in the time from hospital admission to diagnosis(z=-0.684,P=0.494)between the two hospitals.The 12 cases from the hospital in Kashi prefecture weren’t taken any laboratory testing.The awareness rate of kala-azar knowledge was higher in the hospital in Kashi(75.3%)than in Urumqi(55.0%),with statistical difference(χ^2=14.039,P<0.01).Out of the 31 doctors,only 6 received relevant training in the recent year.Conclusions The diagnostic coincidence rates are low in both hospitals in the northern and southern Xinjiang.The doctors,awareness rate of kala-azar knowledge is higher in Kashi than in Urumqi.The training of kala-azar diagnosis should be strengthened in clinical doctors,the case report on kala-azar diagnosis should be normalized.