2018―2019年上海市浦东新区儿童急性呼吸道感染患病及就诊行为

Prevalence and healthcare-seeking practices of children with acute respiratory infections in Pudong, Shanghai during 2018―2019

目的了解上海市浦东新区社区儿童急性呼吸道感染(acute respiratory infections,ARI)和流感样症状(influenza like illness,ILI)发生情况及其相关就诊行为特征,并探索其影响因素。方法使用横断面研究设计、多阶段随机抽样方法,对上海市浦东新区0~14岁儿童的监护人进行面对面问卷访谈,调查2018―2019年冬春季发生ARI相关情况、就诊行为,并使用多因素Logistic回归分析模型分析其影响因素。结果共回收2375份有效调查问卷,2018―2019年冬春季上海市浦东新区儿童ARI和ILI患病率分别为36.1%(858/2375)和14.0%(332/2375);2~4岁儿童ARI患病率(42.4%)高于其他年龄组(OR=2.072,95%CI:1.482~2.896);具有呼吸系统基础疾病(OR=2.740,95%CI:1.865~4.025)是儿童ARI患病的危险因素;相较于幼托儿童,散居(OR=0.579,95%CI:0.426~0.785)和在校(OR=0.547,95%CI:0.434~0.688)儿童ARI患病风险较低。儿童ARI相关就诊率和住院率分别为58.5%(502/858)和1.7%(15/858)。2~4岁(OR=0.297,95%CI:0.170~0.521)和5~14岁(OR=0.286,95%CI:0.149~0.549)儿童就诊率均低于1岁以内儿童。影响就诊行为的主要因素为发病症状(发热、咳嗽、咽痛、咳痰和乏力)(均有P<0.05);81.1%(407/502)的儿童前往二级以上医疗机构就诊。结论上海地区儿童冬春季急性呼吸道感染带来的疾病负担很重,不可忽视。应持续开展基于社区和医疗机构的综合监测以获得更加准确的疾病负担资料,并推行流感、肺炎等呼吸道传染病疫苗接种等防控措施的实施。

Objective To acquire the incidence of acute respiratory infections(ARI)and influenza like illness(ILI)among children in Pudong New Area,Shanghai,and to explore the characteristics of their healthcare-seeking practices and the influencing factors.Methods Cross-sectional study design and multi-stage random sampling method were used to conduct face-to-face questionnaire interviews with guardians of children aged 0-14 years old in Pudong New Area,Shanghai.ARI related conditions and healthcare-seeking practices during the winter and spring of 2018-2019 were investigated through those interviews.The influencing factors were analyzed by multivariate Logistic regression model.Results A total of 2375 valid questionnaires were collected.The prevalences of ARI and ILI among children in Pudong New Area,Shanghai during the winter and spring of 2018-2019 were 36.1%(858/2375)and 14.0%(332/2375).The prevalence of ARI in children aged 2-4 years old(42.4%)was significantly higher than other age groups(OR=2.072,95%CI:1.482-2.896).Suffering from basic respiratory diseases(OR=2.740,95%CI:1.865-4.025)was the risk factor for ARI in children.Compared with children in kindergarten,the risk of ARI in diaspora children(OR=0.579,95%CI:0.426-0.785)and in school students(OR=0.547,95%CI:0.434-0.688)were lower.The rates of ARI related healthcare-seeking and hospitalization were 58.5%(502/858)and 1.7%(15/858),respectively.Healthcare-seeking rate of 2-4 years old children(OR=0.297,95%CI:0.170-0.521)and 5-14 years old children(OR=0.286,95%CI:0.149-0.549)were significantly lower than children under 1 year old.The main factors affecting the behavior of consultations were symptoms(fever,cough,sore throat,sputum,and fatigue)(all P<0.05).81.1%(407/502)of children had gone to the secondary medical institutions for healthcare.Conclusions The burden of disease caused by ARI among children in Shanghai cannot be ignored.Comprehensive monitoring based on communities and medical institutions should be continued to obtain a more accurate disease burden data,and vaccination against respiratory infectious diseases such as influenza and pneumonia and other preventive measures should be promoted.