南京市儿童蛲虫病综合防控措施干预效果评价

Evaluation of the intervention effect of comprehensive prevention and control measures on enterobiasis among children in Nanjing City

目的评价南京市儿童蛲虫病综合防控措施干预效果,为儿童蛲虫病防控策略的制定和调整提供实践依据。方法采用整群随机抽样法,2022年9—10月在南京市12个区中各随机抽取1所幼儿园,对全部儿童开展蛲虫感染情况调查,分别在主城区和郊区各选取感染率较高且环境、规模等相近的4所幼儿园,将其全部儿童、与儿童同住的1名监护人和每个班级的班主任纳入研究对象。其中主城区2所和郊区2所幼儿园为实验组,实施儿童蛲虫病综合防控干预措施;其余4所为对照组,实施传统蛲虫病防控措施,两组均开展为期1年的干预(2022年11月—2023年11月)。实验组干预分为症状监测(对疑似儿童蛲虫感染的症状进行监测)、同伴监测(对患儿同住家人和同班级儿童、玩伴采样检测)、环境监测(采用透明胶纸对阳性患儿家庭和所在班级环境粘贴采样),并从“知、信、行”3个维度切入,家庭、学校、社区多部门协同开展健康教育干预。对照组干预仅对检测发现的阳性患儿驱虫治疗,对患儿及其家属进行健康宣教。干预实施完成后采用透明胶纸肛拭法对两组儿童开展蛲虫感染情况调查。干预实施前后,分别对每个班级的班主任和与儿童同住的1名监护人开展蛲虫病防治相关问卷调查。结果干预前,实验组和对照组蛲虫感染率分别为1.5%(13/885)和1.4%(12/886),差异无统计学意义(χ^(2)=0.042,P>0.05)。干预期间,实验组症状监测共发现疑似症状儿童234人,其中有肛门瘙痒症状者占比最多(34.6%,81/234),其次为睡觉磨牙症状者(20.5%,48/234);疑似症状儿童共检出阳性8例,有肛门瘙痒症状者占比最多(5/8),其次为睡觉磨牙症状者(2/8)。同伴监测共在患儿同住家人中检出阳性4例,同班级儿童中检出阳性2例。环境监测中在患儿家庭环境中检出毛绒玩具阳性样品4份,被子、床单、沙发阳性样品各2份,在患儿班级中检出课桌和椅子阳性样品各1份。干预1年后,实验组蛲虫感染率由干预前的1.5%下降至0.1%(1/885)(χ^(2)=10.368,P<0.05),低于干预后的对照组(0.9%,8/886)(χ^(2)=4.014,P<0.05)。干预前两组在儿童卫生行为习惯、家长及教师蛲虫病“知、信、行”各知识点正确率的差异均无统计学意义(P>0.05);干预后,实验组儿童饭前便后是否洗手、是否勤剪指甲、是否有咬手指习惯、是否有咬玩具等习惯行为的正确率(89.9%,796/885;88.9%,787/885;85.8%,759/885;86.8%,768/885)和是否有单独毛巾、每周洗澡频率、每个月被褥晾晒频率卫生习惯的正确率(89.2%,789/885;85.7%,758/885;78.9%,698/885)均高于对照组(61.7%,547/886;71.2%,631/886;56.2%,498/886;59.8%,530/886;78.8%,698/886;78.8%,698/886;68.6%,608/886)(χ^(2)=192.194、86.989、187.741、164.402、35.371、14.285、24.010,均P<0.05);干预后,实验组儿童家长蛲虫病“知、信、行”全部题目的正确率均高于对照组(均P<0.05),干预后实验组教师对蛲虫病认知调查各题的正确率均高于对照组(均P<0.05)。结论儿童蛲虫病综合防控措施的实施有效降低了儿童蛲虫感染率,实现及时阻断、精准防控,同时提升了家长、教师的蛲虫防病健康素养和认知水平,促进其态度和行为的转变,并带动儿童养成良好卫生行为习惯,有效预防和阻断蛲虫病的传播和蔓延。

Objective To evaluate the intervention effect of comprehensive prevention and control measures on enterobiasis among children so as to provide a informative basis for formulating and adjusting the prevention and control strategies.Methods Using random cluster sampling method,one kindergarten was selected from each of the 12 districts in Nanjing to conduct a survey on the infection of Enterobius vermicularis among all children in September to October 2022.Based on the survey results,four kindergartens with higher infection rates and similar environment and scale were selected from both urban and suburban areas,respectively.All children from 8 kindergartens,one guardian living with each child and the class teacher of each class were enrolled in the survey.Among them,two kindergartens in the urban area and two in the suburbs were assigned as the experimental group implemnting compre‑hensive control measures,while the remaining four kindergartens as the control group carring out traditional control measures;both groups conducted one‑year intervention from November 2022 to November 2023.For the experimental group,the intervention measres comprised of symptom surveillance(on children’s suspected symptoms of Enterbobius infection),companion surveillance(sampling test for positive children’s family members living together with,classmates and playmates),and environmental surveillance(using transparent adhesive tape pasting method to collect environmental samples from positive children’s families and classes),as well as health education with three‑dimension of“knowledge,attitude,and practice”as entering point to perform educational intervention jointly with multiple sectors including families,schools,and communities.The intervention measures for the control group were deworming for positive children only and health education delivered to the children and their family members.The After completion of the intervention study,anal swab method with transparent adhesive tape was used to examine the E.vermicularis infection rate in the children of two groups,respectively.Before and after the inervention,questionnaire survey on E.vermicularis control related knowledge was delivered to one class teacher of each class and one guardian living with each child,respec‑tively.Results Before the intervention,the E.vermicularis infection rates in the experimental group and the control group were 1.5%(13/885)and 1.4%(12/886),respectively,showing no significant difference between the two groups(χ^(2)=0.042,P>0.05).A total of 234 children with suspected symptoms were found during symptom monitoring in the experimental group,among them,anal itching proportion was found the highes(34.62%,81/234),followed by sleeping teeth grinding symptom(20.5%,48/234).A total of 8 positive cases were detected,of which symptoms of anal itching accounted for the highest(5/8),followed by symptoms of sleeping teeth grinding(2/8).In companion surveillance,four positives were detected from positive children’s family members and two positives from their classmates,repectively.In environmental surveillance,four positives were found from plush toys samples,and two positive samples of blankets,sheets,and sofas were detected in the positive children’s family environment,respectively,and one positive sample was found from the desk and chair of their classroom,respectively.After one‑year intervention,the infection rate in the ex‑perimental group decreased from 1.5%(13/885)before intervention to 0.1%(1/885)(χ^(2)=10.368,P<0.05),which was significantly lower than that in the control group after intervention(0.9%,8/886)(χ^(2)=4.014,P<0.05).The question‑naire showed that prior to the intervention,there was no significant difference in positive response rate towards children’s hygiene behaviour habits,and parents’and teachers’awareness points regarding to enterobiasis“knowledge,attitude,and practice”between the two the groups(all P>0.05).The correct response rates to the questions“whether washing hands before and after meals,habits of trimming nails,biting fingers and biting toys”(89.9%,796/885;88.9%,787/885;85.8%,759/885;86.8%,768/885)and correct hygiene habits rates of“whether have a separate towel,frequency of weekly showers,and frequency of monthly bedding drying”(89.2%,789/885;85.7%,758/885;78.9%,698/885)in the experimental group were significantly higher than those in the control group(61.7%,547/886;71.2%,631/886;56.2%,498/886;59.8%,530/886;78.8%,698/886;78.8%,698/886;68.6%,608/886)after intervention(χ^(2)=192.194,86.989,187.741,164.402,35.371,14.285,24.010;all P<0.05).After intervention,the positive response rates to all questions towards enterobiasis“knowledge,attitude,and practice”the experimental group were significantly higher those in the control group(all P<0.05).In post‑intervention,the positive response to all questions towards awareness of enteroviasis in teachers were all significantly higher than those in the control group(all P<0.05).Conclusion Implementation of comprehensive prevention and control measures effectively reduced E.vermicularis infection rate in children,achieved timely interruption and precise control,meanwhile,raised parents’and teachers’health awareness and cognitive level on enterobiasis,and promoted changes of their attitudes and behaviours,driving children to develop good hygiene habits,and leading to effectively prevent and interrupt the transmission and spread of enterobiasis.