影响湖南省晚期血吸虫病防治的社会因素研究
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摘要
目的 通过对湖南省血吸虫病防治历程及有关政策和疫情资料的回顾，对晚期血吸虫病患者的社会人口学、社会经济学、求医行为和医疗费用、生活质量的定量研究和对晚期血吸虫病患者和血吸虫病防治专业人员的定性研究，从社会医学的角度探索加强晚期血吸虫病防治的重要性和影响湖南省晚期血吸虫病防治的相关社会因素，为有关部门制定晚期血吸虫病防治策略提供决策依据。
方法 采用文献研究的方法对湖南省血吸虫病防治工作历程、体制和相关政策变化以及晚期血吸虫病疫情等进行研究；用自制的问卷和生活质量评定量表对94位晚期血吸虫病患者采取面谈法收集资料；采用深度访谈对61位晚期血吸虫病患者、14位血吸虫病防治管理者、46位临床医生和5位专家进行定性研究。抽样方法为偶遇抽样和判断抽样。资料分析采用二次分析法、趋势检验法、t检验、比较分析法和举例说明法。
结果 湖南省现有的晚期血吸虫病的防治效果与预期有差距。共94位晚期血吸虫病患者进入研究，平均年龄为56.55±10.01岁，受教育程度为4.73±3.93年。面谈的对象一共有126位，包括61位晚期血吸虫病人、65位临床医生、血吸虫病防治管理者和专家。患者年龄偏大，受教育程度低，经济收入低，医疗费用花费大，生命质量差，社会支持程度较高，缺乏必要的防治知识和医疗信息，难以正确选择卫生服务；缺乏自身对健康负责的观念；经济条件差，难以承受治疗费用；缺乏高效的接近患者系统。血防系统筹资模式不适应血吸虫病防治工作开展的需要，卫生资源质量不高，缺乏对晚期血吸虫病疫情的有效监测，卫生服务的可及性差，防治技术科技含量低，血吸虫防治机构提供卫生服务的能力有限。疫区卫生资源整合程度不高，反应性和公平性较差，血防系统筹资困难，缺乏各相关部门的协调，
中南大学硕士学位论文 中文摘要
缺乏对疫区居民的医疗卫生保障体系和有效社会救助措施。
结论 晚期血吸虫病的防治非常重要，影响其防治的社会因素与
患者本人、卫生服务的提供者、外部环境等有关。患者缺乏自我表现
保健意识、不能正确的选择卫生服务、缺乏自身对健康负责的观念，
对卫生服务的客观需要和实际需求有差距，血防系统提供卫生服务的
能力难以满足实际需要，缺乏高效的接近患者系统，难以为思者提供
忧质的卫主服务。政府对卫生系统没有进行全行业的管理，卫生资源
难以有效整合，反应性和公平性较差，血防系统的筹资困难，部门间
缺乏协调，血吸虫病疫区居民缺乏必要卫生保障体系和社会救助措
施。晚期血吸虫病的防治需要政府相关部门的积极支持，血防机构和
非血防医疗机构之间的信息互通、资源整合、协调一致和晚期血吸虫
病患者的积极配合。
OBJECTIVES To explore, from the perspective of social medicine, the importance of strengthening late stage schistosomiasis control and related social barriers to prevention and treatment of late stage schistosomiasis in Hunan Province, so as to provide decision-making basis for establishing strategies by related departments for late stage schistosomiasis control, by retrospectively reviewing the process of schistosomiasis control, related policies and data on epidemic situation, quantitatively studying social demography, socioeconomics,health seeking behavior, medical cost and living quality of the patients with late stage schistosomiasis, and qualitatively studying late stage schistosomiasis cases and anti-schistosomiasis professionals.
METHODS Literature and document review was carried out to review the process and system of schistosomiasis control, and the changes in related policies and epidemic situation during the past 20 years. Self-made questionnaire and tables assessing life quality were used to collecting data by interviewing 94 late stage schistosomiasis patients. In-depth interviews were introduced to make qualitative study on 61 late stage schistosomiasis patients, 14 anti-schistosomiasis officials, 46 clinicians and 5 experts. Sampling was accidental and judgmental. Data analysis included secondary- analysis, trend analysis, t test, analytic comparison and illustration.
RESULTS There are difference between existing and anticipative effectiveness on late stage schistosomiasis control in Hunan Province, and health resources couldn't correspond to the changes in epidemic situation. 94 late stage schistosomiasis patients were included in this study, with an average age of 56.55?0.01 and an average educational period of 4.73^3.93. 126 subjects were interviewed, including 61 late stage schistosomiasis patients, 65 clinicians, anti-schistosomiasis managers and experts. The patients with late stage schistosomiasis tend to be old, with lower education and income, much higher burden of medication cost, poor sense of their own health, and lack of an efficient
iii
"close-to-client" system. The financing of anti-schistosomiasis health care services poorly met the needs of anti-schistosomiasis control. Health resources lacked in quality, which made epidemic situation of late stage schistosomiasis under poor surveillance. Health services had poor accessibility and anti-schistosomiasis had lower science and technology. Anti-schistosomiasis institution only had limited ability to provide health services. Health resources integrated poorly in endemic areas, with lower reactivity and equity. Financing of anti-schistosomiasis system was difficult, lacking in coordination between each related departments, and thus lacking in health safeguard system and effective measures of social help.
CONCLUSIONS Jt is very important for the prevention and treatment of late stage schistosomiasis. Social barriers to prevention and treatment of late stage schistosomiasis are related with the patients themselves, providers of health services and outer environment. The patients have poor sense of their own health and can't appropriately select health services. The ability to provide health services can't meet actual needs by anti-schistosomiasis system. Anti-schistosomiasis system lacks an efficient "close-to-client" system, and it's difficult to provide high-quality health services. The government doesn't carry out all-professional management of health system, which makes health resources difficult to integrate and thus have poor reactivity and equity. Difficulty in financing anti-schistosomiasis system and lack in coordination between departments make the residents short of necessary health safeguard system and effective measures of social help in epidemic areas. Late stage schistosomiasis control needs active support from related governmental departments, information exchange, resources integration and harmonization between anti-schistosomiasis institutions and other medical institutions, and active cooperation of late st
方法 采用文献研究的方法对湖南省血吸虫病防治工作历程、体制和相关政策变化以及晚期血吸虫病疫情等进行研究；用自制的问卷和生活质量评定量表对94位晚期血吸虫病患者采取面谈法收集资料；采用深度访谈对61位晚期血吸虫病患者、14位血吸虫病防治管理者、46位临床医生和5位专家进行定性研究。抽样方法为偶遇抽样和判断抽样。资料分析采用二次分析法、趋势检验法、t检验、比较分析法和举例说明法。
结果 湖南省现有的晚期血吸虫病的防治效果与预期有差距。共94位晚期血吸虫病患者进入研究，平均年龄为56.55±10.01岁，受教育程度为4.73±3.93年。面谈的对象一共有126位，包括61位晚期血吸虫病人、65位临床医生、血吸虫病防治管理者和专家。患者年龄偏大，受教育程度低，经济收入低，医疗费用花费大，生命质量差，社会支持程度较高，缺乏必要的防治知识和医疗信息，难以正确选择卫生服务；缺乏自身对健康负责的观念；经济条件差，难以承受治疗费用；缺乏高效的接近患者系统。血防系统筹资模式不适应血吸虫病防治工作开展的需要，卫生资源质量不高，缺乏对晚期血吸虫病疫情的有效监测，卫生服务的可及性差，防治技术科技含量低，血吸虫防治机构提供卫生服务的能力有限。疫区卫生资源整合程度不高，反应性和公平性较差，血防系统筹资困难，缺乏各相关部门的协调，
中南大学硕士学位论文 中文摘要
缺乏对疫区居民的医疗卫生保障体系和有效社会救助措施。
结论 晚期血吸虫病的防治非常重要，影响其防治的社会因素与
患者本人、卫生服务的提供者、外部环境等有关。患者缺乏自我表现
保健意识、不能正确的选择卫生服务、缺乏自身对健康负责的观念，
对卫生服务的客观需要和实际需求有差距，血防系统提供卫生服务的
能力难以满足实际需要，缺乏高效的接近患者系统，难以为思者提供
忧质的卫主服务。政府对卫生系统没有进行全行业的管理，卫生资源
难以有效整合，反应性和公平性较差，血防系统的筹资困难，部门间
缺乏协调，血吸虫病疫区居民缺乏必要卫生保障体系和社会救助措
施。晚期血吸虫病的防治需要政府相关部门的积极支持，血防机构和
非血防医疗机构之间的信息互通、资源整合、协调一致和晚期血吸虫
病患者的积极配合。
OBJECTIVES To explore, from the perspective of social medicine, the importance of strengthening late stage schistosomiasis control and related social barriers to prevention and treatment of late stage schistosomiasis in Hunan Province, so as to provide decision-making basis for establishing strategies by related departments for late stage schistosomiasis control, by retrospectively reviewing the process of schistosomiasis control, related policies and data on epidemic situation, quantitatively studying social demography, socioeconomics,health seeking behavior, medical cost and living quality of the patients with late stage schistosomiasis, and qualitatively studying late stage schistosomiasis cases and anti-schistosomiasis professionals.
METHODS Literature and document review was carried out to review the process and system of schistosomiasis control, and the changes in related policies and epidemic situation during the past 20 years. Self-made questionnaire and tables assessing life quality were used to collecting data by interviewing 94 late stage schistosomiasis patients. In-depth interviews were introduced to make qualitative study on 61 late stage schistosomiasis patients, 14 anti-schistosomiasis officials, 46 clinicians and 5 experts. Sampling was accidental and judgmental. Data analysis included secondary- analysis, trend analysis, t test, analytic comparison and illustration.
RESULTS There are difference between existing and anticipative effectiveness on late stage schistosomiasis control in Hunan Province, and health resources couldn't correspond to the changes in epidemic situation. 94 late stage schistosomiasis patients were included in this study, with an average age of 56.55?0.01 and an average educational period of 4.73^3.93. 126 subjects were interviewed, including 61 late stage schistosomiasis patients, 65 clinicians, anti-schistosomiasis managers and experts. The patients with late stage schistosomiasis tend to be old, with lower education and income, much higher burden of medication cost, poor sense of their own health, and lack of an efficient
iii
"close-to-client" system. The financing of anti-schistosomiasis health care services poorly met the needs of anti-schistosomiasis control. Health resources lacked in quality, which made epidemic situation of late stage schistosomiasis under poor surveillance. Health services had poor accessibility and anti-schistosomiasis had lower science and technology. Anti-schistosomiasis institution only had limited ability to provide health services. Health resources integrated poorly in endemic areas, with lower reactivity and equity. Financing of anti-schistosomiasis system was difficult, lacking in coordination between each related departments, and thus lacking in health safeguard system and effective measures of social help.
CONCLUSIONS Jt is very important for the prevention and treatment of late stage schistosomiasis. Social barriers to prevention and treatment of late stage schistosomiasis are related with the patients themselves, providers of health services and outer environment. The patients have poor sense of their own health and can't appropriately select health services. The ability to provide health services can't meet actual needs by anti-schistosomiasis system. Anti-schistosomiasis system lacks an efficient "close-to-client" system, and it's difficult to provide high-quality health services. The government doesn't carry out all-professional management of health system, which makes health resources difficult to integrate and thus have poor reactivity and equity. Difficulty in financing anti-schistosomiasis system and lack in coordination between departments make the residents short of necessary health safeguard system and effective measures of social help in epidemic areas. Late stage schistosomiasis control needs active support from related governmental departments, information exchange, resources integration and harmonization between anti-schistosomiasis institutions and other medical institutions, and active cooperation of late st
引文
[1] WHO.The control of schistosomiasis:second report of the WHO Expert Com mittee. Geneva:World Health Organization, 1993
[2] 中华人民共和国卫生部疾病控制司编．血吸虫病防治手册．上海：上海科技出版社．2000(第三版)：1
[3] 陈贤义，姜庆五，赵根明，等．2000年全国血吸虫病疫情通报，中国血吸虫病防治杂志．2001．13(3)：129～131
[4] 方金城 吴昭武主编．湖南省防治血吸虫病研究．长沙：湖南人民出版社．2000：8
[5] 湖南省血吸虫病防治领导小组办公室编．湖南省血吸虫病防治工作统计资料(1956～2001) (内部资料)
[6] 刘兆春，肖水源．血吸虫病与社会经济发展，医学与社会．2002．15(4)：13～14
[7] 袁鸿昌，中国血吸虫病防治的成就与经验，中华流行病学杂志．1999．20(1)：3～6
[8] 周宏春，王毅，于秀波，等编．长江中游退田还湖与可持续发展．北京：经济科学出版社，2002：1
[9] Dongbao Yu,Jesus N Sarol Jr, Guy Hutton, et al. Cost-effectiveness analysis of the impacts on infection and morbidity attributable to three chemotherapy schemes against schistosoma japonicum in hyperendemic areas of the Donning Lake Region, China, Southeast Asian J Trop Med Public Health, 2002.33 (3) :442～443
[10] 风笑天著 社会学研究方法．北京：中国人民大学出版社．2001：119～120
[11] http://www.moh.gov. cn/jbkz/xgflfg/200206170017.htm
[12] 风笑天著 社会学研究方法．北京：中国人民大学出版社．2001：217～220
[13] 李春波，何燕玲．健康状况问卷 SF-36的介绍，国外医学精神病学分册。2000．29(2)：116～119
[14] Ren XS,et al.J Clin Epidemiol. 1998;51(11):1129～1138
[15] Ware JE.SF-36 Health Survey. Mannual and Interpretation Guide. Boston. M A:The Health Intitute, 1993
[16] 袁方主编．社会研究方法教程．北京：北京大学出版社．1997：274～275
[17] 风笑天著 社会学研究方法．北京：中国人民大学出版社．2001：227，312
[18] 孙振球主编．医学统计学．北京：人民卫生出版社．2002：395
[19] 郭见多．李启杨，尹小梅，等．晚期血吸虫病生命质量量表测定分析．中国行
为医学，2002，11(4)：382～384
[20] 官亚宜．TDR社会经济学研究的未来趋势，国外医学寄生虫病分册．1992．19(2)：81～82
[21] 世界卫生组织编著．宏观经济与卫生．北京：人民卫生出版社，2002：16，16～17
[22] 湖南省血吸虫病防治领导小组办公室编．湖南省血吸虫病防治工作统计资料(2001)(内部资料)：72，23
[23] 李宁秀，刘朝杰，李俊，等．四川省城乡居民SF-36评价参考值，华西医科大学学报．2001．32(1)43～47
[24] 肖永先，张华艳，岳成云，等．50例晚期血吸虫病患者SCL—90量表调查分析，中国血吸虫病防治杂志．1997．9(3)：186
[25] 戴维·波普诺(美)著，社会学(李强，等译)．北京：中国人民大学出版社(第十版)，1999：444～447
[26] http://www.moh.gov.cn/jbkz/xgflfg/200206170017.htm
[27] 杨德森主编．行为医学．长沙：湖南科技出版社．1998：114
[28] 杨德森主编．行为医学．长沙：湖南科技出版社．1998：470～476
[29] 郑杭生主编 社会学概论新修．北京：中国人民大学出版社，2002：502
[30] 邱鸿钟，黎冬生主编．新编卫生经济学．广州：华南理工大学出版社，2001：43
[31] 戴维·波普诺(美)著，社会学(李强，等译)．北京：中国人民大学出版社(第十版)，1999：343
[32] 黄铿凌，农彩云，黎学铭，等．广西血防人力资源现状调查分析，中国血吸虫病防治杂志．2000．12(3)：187～188
[33] 陈英耀，王立基，王华．卫生服务可及性评价，中国卫生资源．2000．3(6)：279～282
[34] 世界卫生组织编著．宏观经济与卫生．北京：人民卫生出版社，2002：16，5
[35] 陈焱，何永康，刘启立，等．影响当前洞庭湖区血吸虫病疫情的主要因素分析，中国人畜共患病杂志．2000．16(5)：101～103
[2] 中华人民共和国卫生部疾病控制司编．血吸虫病防治手册．上海：上海科技出版社．2000(第三版)：1
[3] 陈贤义，姜庆五，赵根明，等．2000年全国血吸虫病疫情通报，中国血吸虫病防治杂志．2001．13(3)：129～131
[4] 方金城 吴昭武主编．湖南省防治血吸虫病研究．长沙：湖南人民出版社．2000：8
[5] 湖南省血吸虫病防治领导小组办公室编．湖南省血吸虫病防治工作统计资料(1956～2001) (内部资料)
[6] 刘兆春，肖水源．血吸虫病与社会经济发展，医学与社会．2002．15(4)：13～14
[7] 袁鸿昌，中国血吸虫病防治的成就与经验，中华流行病学杂志．1999．20(1)：3～6
[8] 周宏春，王毅，于秀波，等编．长江中游退田还湖与可持续发展．北京：经济科学出版社，2002：1
[9] Dongbao Yu,Jesus N Sarol Jr, Guy Hutton, et al. Cost-effectiveness analysis of the impacts on infection and morbidity attributable to three chemotherapy schemes against schistosoma japonicum in hyperendemic areas of the Donning Lake Region, China, Southeast Asian J Trop Med Public Health, 2002.33 (3) :442～443
[10] 风笑天著 社会学研究方法．北京：中国人民大学出版社．2001：119～120
[11] http://www.moh.gov. cn/jbkz/xgflfg/200206170017.htm
[12] 风笑天著 社会学研究方法．北京：中国人民大学出版社．2001：217～220
[13] 李春波，何燕玲．健康状况问卷 SF-36的介绍，国外医学精神病学分册。2000．29(2)：116～119
[14] Ren XS,et al.J Clin Epidemiol. 1998;51(11):1129～1138
[15] Ware JE.SF-36 Health Survey. Mannual and Interpretation Guide. Boston. M A:The Health Intitute, 1993
[16] 袁方主编．社会研究方法教程．北京：北京大学出版社．1997：274～275
[17] 风笑天著 社会学研究方法．北京：中国人民大学出版社．2001：227，312
[18] 孙振球主编．医学统计学．北京：人民卫生出版社．2002：395
[19] 郭见多．李启杨，尹小梅，等．晚期血吸虫病生命质量量表测定分析．中国行
为医学，2002，11(4)：382～384
[20] 官亚宜．TDR社会经济学研究的未来趋势，国外医学寄生虫病分册．1992．19(2)：81～82
[21] 世界卫生组织编著．宏观经济与卫生．北京：人民卫生出版社，2002：16，16～17
[22] 湖南省血吸虫病防治领导小组办公室编．湖南省血吸虫病防治工作统计资料(2001)(内部资料)：72，23
[23] 李宁秀，刘朝杰，李俊，等．四川省城乡居民SF-36评价参考值，华西医科大学学报．2001．32(1)43～47
[24] 肖永先，张华艳，岳成云，等．50例晚期血吸虫病患者SCL—90量表调查分析，中国血吸虫病防治杂志．1997．9(3)：186
[25] 戴维·波普诺(美)著，社会学(李强，等译)．北京：中国人民大学出版社(第十版)，1999：444～447
[26] http://www.moh.gov.cn/jbkz/xgflfg/200206170017.htm
[27] 杨德森主编．行为医学．长沙：湖南科技出版社．1998：114
[28] 杨德森主编．行为医学．长沙：湖南科技出版社．1998：470～476
[29] 郑杭生主编 社会学概论新修．北京：中国人民大学出版社，2002：502
[30] 邱鸿钟，黎冬生主编．新编卫生经济学．广州：华南理工大学出版社，2001：43
[31] 戴维·波普诺(美)著，社会学(李强，等译)．北京：中国人民大学出版社(第十版)，1999：343
[32] 黄铿凌，农彩云，黎学铭，等．广西血防人力资源现状调查分析，中国血吸虫病防治杂志．2000．12(3)：187～188
[33] 陈英耀，王立基，王华．卫生服务可及性评价，中国卫生资源．2000．3(6)：279～282
[34] 世界卫生组织编著．宏观经济与卫生．北京：人民卫生出版社，2002：16，5
[35] 陈焱，何永康，刘启立，等．影响当前洞庭湖区血吸虫病疫情的主要因素分析，中国人畜共患病杂志．2000．16(5)：101～103