新疆维吾尔自治区荒漠型黑热病流行区影响因素调查

Influencing factors for desert-type Kala-azar in epidemic area in Xinjiang

目的调查新疆维吾尔自治区(新疆)荒漠型黑热病流行区可能的流行因素,为制定和控制荒漠型黑热病的策略提供科学依据。方法在伽师县卧里托格拉克镇,按东、西、南、北、中,各方向选取2~3个2016年9月至2017年7月有病例报告的村作为调查范围,村报告病例作为病例组,按1∶3比例在同村同组或相邻组选择性别相同、年龄相差不超过1岁、无黑热病史及黑热病临床症状或体征的健康婴幼儿作为对照,以研究对象家庭为单位,入户面对面询问调查对象父母、观察或测量调查区等方式收集野生动物或家畜、生活行为和环境为内容的调查问卷,结果采用单因素和多因素条件logistic回归分析。结果共调查140名儿童,其中病例组35例,对照组105人。单因素分析结果显示:调查户30 m周围畜圈羊(山羊)数量增加、调查户不使用驱蚊香/杀虫剂、不悬挂密闭帘子、30 m区域是荒漠环境、目标儿童在门庭露宿、不使用蚊帐是罹患黑热病的危险因素,调查户门庭与畜圈距离增加是保护因素。多因素分析结果显示:调查户30m周围畜圈羊(山羊)数量增加,目标儿童在门庭露宿是儿童罹患黑热病的危险因素,门庭与畜圈距离增加是保护性因素。结论荒漠型黑热病流行区居住地周围30 m范围内畜圈羊(山羊)数量,目标儿童夏天在门庭露宿行为,畜圈与门庭距离是目标儿童患黑热病的影响因素。

Objective To investigate possible factors of desert-type Kala-azar in epidemic area in in Xinjiang, and provide scientific basis to formulate and control strategies for desert-type Kala-azar in Xinjiang. Methods In Gholtoghraq township of Jiashi county, we selected 2–3 villages in the east, west, south, north, and central parts, between September 2016 and July2017, respectively, where Kala-azar cases had been to the epidemic information system in recent years, the reported cases were used as case groups, the gender and age matched control group composed of healthy young children in the same village(same or adjacent group) who had no history of Kala-azar and clinical symptoms or signs of Kala-azar for a 1∶3 case control study.The parents of the children were interviewed in household surveys using questionnaires collecting the information about wild animals or domestic animals, living behavior and environment. The results were analyzed by univataite and multivariate conditional logistic regression analyses. Results A total of 140 children were investigated, of which 35 were in case group and 105 were in control group. Univariate analysis results showed that the differences in increased number of sheep(goats) in the livestock pen within 30 meters of surveyed household, and using no mosquito repellent or insecticide, using no curtain,desert environment within 50 meters, sleeping in the open near door and using no mosquito nets were risk factors for deserttype Kala-azar, increased distance between door and livestock pen was protective factor. The results of multivariate analysis showed that the differences in increased number of sheep(goats) in livestock pen within 30 meters of the survey households and sleeping near door were risk factors for desert-type Kala-azar, increased distance between door and livestock pen was protective factor. Conclusion The number of sheep(goats) in livestock pen within 30 meters of household, sleeping in the open near door in summer and distance between livestock pen and door were the associated factors of desert-type Kala-azar in children in epidemic area in Xinjiang.