昆山市结核病控制现状及对策研究
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摘要
目的:通过分析1996-2008年昆山市的结核病防控现状,总结成功的经验,发现存在的问题,为新时期制定结核病防控政策措施提供科学依据。
对象和方法:对昆山市结核病防治网络、人力资源、政策支持、全球基金结核病流动人口防治项目等基本情况,1996年-2008年结核病防治数据等资料,采用定量研究和定性研究相结合的方法进行综合分析,并对综合医院医护人员结核病控制知识知晓情况进行抽样调查和综合评价。
结果:昆山市活动性肺结核病人登记率、涂阳新登记率、涂阳病人百分比、涂阳肺结核病人迁出率分别由1996年的26.24/10万、6.95/10万、26.49%、0上升至2008年的73.18/10万、43.19/10万、59.02%、5.1%,涂阳肺结核病人治愈率由1996年的92.31%下降至2008年的88.24%;不同防控阶段其活动性肺结核病人登记率、涂阳新登记率、涂阳病人百分比有显著性差异,涂阳病人治愈率与迁出率之和无显著性差异;2004-2008年,流动人口平均活动性结核病人登记率、平均涂阳新登记率、平均涂阳肺结核病人治愈率显著低于户籍人口,平均迁出率显著高于户籍人口;同时,尚存在现患情况不明、人力资源不足、管理能力不强、知识知晓率不高、流动人口大量涌入等困难和问题。
结论:1996-2008年,昆山市结核病防治工作总体呈现良好态势;单纯的DOTS措施的实施对结核病防治工作推动成效并不明显,而从2004年起在DOTS措施基础上增加的行政干预措施对结核病登记发现工作起到了很强的推动作用,但对结核病的治疗转归尚无明显成效;昆山市流动人口结核病防治工作虽总体处于平稳态势,但防治形势不容乐观;下阶段,昆山市要制定并出台区域性结核病防治规划;增加结防人员总量,改善人员结构,加强人员培训,保持队伍稳定;通过完善奖惩制度,加强环节和督导管理,加强医防合作等进一步加强行政管理;加强信息建设,探寻结核病防治管理新途径;加大宣传力度,不断提升各层次人群结核病防治知识和防治政策知晓率;研究流动人口防控对策。
Objective: To understand and analyze present status of tuberculosis prevention and control in Kunshan from 1996 to 2008, summarize successful experience, find out problems, and provide scientific basis for establishing measures of tuberculosis prevention and control in the new period.
Subject and Method: By adopting quantitative and qualitative methods, the paper conducts a comprehensive analysis on the tuberculosis prevention network in Kunshan, human resources, policy support, and the Global Fund Program for tuberculosis prevention and treatment among mobile population, as well as the tuberculosis prevention and treatment data from 1996 to 2008. Moreover, sampling survey and overall evaluation are carried out on tuberculosis control knowledge acquired by medical staff from general hospitals.
Results: From 1996 to 2008, the registration rate of active tuberculosis cases, new registration rate of smear-positive cases, percentage of smear-positive cases and emigration rate of smear-positive patients increase from 26.24/100000, 6.95/100000, 26.49% and 0 to 73.18/100000, 43.19/100000, 59.02% and 5.1% respectively, and the cure rate of smear-positive patients declines from 92.31% to 88.24%. In the different stages, there are significant differences among the registration rates of active tuberculosis cases, new registration rates of smear-positive cases and percentages of smear-positive cases, and there is no significant difference in terms of emigration rate and cure rate of smear-positive patients. From 2004 to 2008, the statistical data of the mobile population is lower than that of the registered population in respect of registration rate of active tuberculosis cases, new registration rate of smear-positive cases and smear-positive patient cure rate on average, and is remarkably higher in the average emigration rate. Meanwhile, difficulties and problems caused by unknown condition of patients, lack of human resource, insufficient management capacity, inadequate knowledge about TB and mobile population swarming into the city still exist.
Conclusion: From 1996 to 2008, tuberculosis control and prevention in Kunshan are generally in good condition. DOTS measures alone didn’t have significant effects on promoting tuberculosis control and prevention, but the administrative intervention measures which began to work with the DOTS measures from 2004 have greatly impelled tuberculosis case registration and detection. In spite of that, the results are still not highly significant in the aspect of the therapeutic outcomes of tuberculosis. Generally speaking, the tuberculosis prevention and control of mobile population in Kunshan are in a stable situation, but still unoptimistic. In the next stage, regional tuberculosis prevention and control plans should be worked out; the number of relevant staff for tuberculosis control should be increased; organization structure should be improved; staff training should be strengthened and staff stabilization should be maintained. Besides, the link and supervisory managements should be reinforced by improving system of rewards and penalties, and administrative management, such as treatment-prevention cooperation, should be promoted. Moreover, more efforts should be put into information construction and research of new management way of tuberculosis control and prevention. Finally, awareness of population at all levels on tuberculosis control and prevention and relevant policies should be raised by spreading the knowledge more widely. And countermeasures on tuberculosis control and prevention of mobile population should be further studied.
对象和方法:对昆山市结核病防治网络、人力资源、政策支持、全球基金结核病流动人口防治项目等基本情况,1996年-2008年结核病防治数据等资料,采用定量研究和定性研究相结合的方法进行综合分析,并对综合医院医护人员结核病控制知识知晓情况进行抽样调查和综合评价。
结果:昆山市活动性肺结核病人登记率、涂阳新登记率、涂阳病人百分比、涂阳肺结核病人迁出率分别由1996年的26.24/10万、6.95/10万、26.49%、0上升至2008年的73.18/10万、43.19/10万、59.02%、5.1%,涂阳肺结核病人治愈率由1996年的92.31%下降至2008年的88.24%;不同防控阶段其活动性肺结核病人登记率、涂阳新登记率、涂阳病人百分比有显著性差异,涂阳病人治愈率与迁出率之和无显著性差异;2004-2008年,流动人口平均活动性结核病人登记率、平均涂阳新登记率、平均涂阳肺结核病人治愈率显著低于户籍人口,平均迁出率显著高于户籍人口;同时,尚存在现患情况不明、人力资源不足、管理能力不强、知识知晓率不高、流动人口大量涌入等困难和问题。
结论:1996-2008年,昆山市结核病防治工作总体呈现良好态势;单纯的DOTS措施的实施对结核病防治工作推动成效并不明显,而从2004年起在DOTS措施基础上增加的行政干预措施对结核病登记发现工作起到了很强的推动作用,但对结核病的治疗转归尚无明显成效;昆山市流动人口结核病防治工作虽总体处于平稳态势,但防治形势不容乐观;下阶段,昆山市要制定并出台区域性结核病防治规划;增加结防人员总量,改善人员结构,加强人员培训,保持队伍稳定;通过完善奖惩制度,加强环节和督导管理,加强医防合作等进一步加强行政管理;加强信息建设,探寻结核病防治管理新途径;加大宣传力度,不断提升各层次人群结核病防治知识和防治政策知晓率;研究流动人口防控对策。
Objective: To understand and analyze present status of tuberculosis prevention and control in Kunshan from 1996 to 2008, summarize successful experience, find out problems, and provide scientific basis for establishing measures of tuberculosis prevention and control in the new period.
Subject and Method: By adopting quantitative and qualitative methods, the paper conducts a comprehensive analysis on the tuberculosis prevention network in Kunshan, human resources, policy support, and the Global Fund Program for tuberculosis prevention and treatment among mobile population, as well as the tuberculosis prevention and treatment data from 1996 to 2008. Moreover, sampling survey and overall evaluation are carried out on tuberculosis control knowledge acquired by medical staff from general hospitals.
Results: From 1996 to 2008, the registration rate of active tuberculosis cases, new registration rate of smear-positive cases, percentage of smear-positive cases and emigration rate of smear-positive patients increase from 26.24/100000, 6.95/100000, 26.49% and 0 to 73.18/100000, 43.19/100000, 59.02% and 5.1% respectively, and the cure rate of smear-positive patients declines from 92.31% to 88.24%. In the different stages, there are significant differences among the registration rates of active tuberculosis cases, new registration rates of smear-positive cases and percentages of smear-positive cases, and there is no significant difference in terms of emigration rate and cure rate of smear-positive patients. From 2004 to 2008, the statistical data of the mobile population is lower than that of the registered population in respect of registration rate of active tuberculosis cases, new registration rate of smear-positive cases and smear-positive patient cure rate on average, and is remarkably higher in the average emigration rate. Meanwhile, difficulties and problems caused by unknown condition of patients, lack of human resource, insufficient management capacity, inadequate knowledge about TB and mobile population swarming into the city still exist.
Conclusion: From 1996 to 2008, tuberculosis control and prevention in Kunshan are generally in good condition. DOTS measures alone didn’t have significant effects on promoting tuberculosis control and prevention, but the administrative intervention measures which began to work with the DOTS measures from 2004 have greatly impelled tuberculosis case registration and detection. In spite of that, the results are still not highly significant in the aspect of the therapeutic outcomes of tuberculosis. Generally speaking, the tuberculosis prevention and control of mobile population in Kunshan are in a stable situation, but still unoptimistic. In the next stage, regional tuberculosis prevention and control plans should be worked out; the number of relevant staff for tuberculosis control should be increased; organization structure should be improved; staff training should be strengthened and staff stabilization should be maintained. Besides, the link and supervisory managements should be reinforced by improving system of rewards and penalties, and administrative management, such as treatment-prevention cooperation, should be promoted. Moreover, more efforts should be put into information construction and research of new management way of tuberculosis control and prevention. Finally, awareness of population at all levels on tuberculosis control and prevention and relevant policies should be raised by spreading the knowledge more widely. And countermeasures on tuberculosis control and prevention of mobile population should be further studied.
引文
1.全国结核病流行病学抽样调查技术指导组.第四次全国结核病流行病学抽样调查报告[J].中华结核和呼吸杂志,2002,25(1):3-7.
2. 2002年世界结核病日主题:遏制结核病,消除贫困.中国结核网.http://www.chinatb.org.
3.范本达,许卫国,陈宗兰.2001-2004年江苏省肺结核病发现状况与转归分析[J].中国防痨杂志,2006,28(3):138.
4.陈静,梅建,沈梅,等.上海市6个区基层医务人员结核病防治知识调查[J].现代预防医学,2008(11).
5.林相,马晓,陆蓓蓓.目前我国人群结核病知识知晓率调查研究概况[J].海峡预防医学杂志,2008,14(2):24.
6.黄惠良.昆山市从业人员体检中外来人口肺结核患病情况的调查分析[J].中国初级卫生保健,2000,14(1):28-29.
7.刘琴,汪洋.流动人口结核病流行现况及控制对策研究[J].预防医学情报杂志,2005,21(6):682.
1.林相,马晓,陆蓓蓓.目前我国人群结核病知识知晓率调查研究概况[J].海峡预防医学杂志,2008,14(2):23-24.
2.谢艳光,房宏霞,王红艳,等.黑龙江省全人口结核病知识知晓情况调查报告[J].中国防痨杂志,2006,28(4):206-209.
3.刘北斗,李群,徐旭卿,等.浙江省结核病特定知识知晓率调查结果分析[J].中国健康教育,2005,27(6):385-388.
4.赵敏捷,林相,李宗宝,等.宁波市居民结核病防治知识知晓率调查分析[J].中国健康教育,2006,22(1):39-40.
5.梁珏,谭青云,李蜀,等.肺结核病人家属结核病防护知识的调查分析[J].国际护理学杂志,2006,25(6):437-439.
6.王湘苏,许卫国,黄明豪,等.江苏省结核病防治知识知晓率调查与分析[J].中国健康教育,2004,20(12):1095-1096.
7.林定文.南宁市城区结核病健康教育评价[J].广西预防医学,2004,10(1):39-41.
8.黄飞,么鸿雁,刘剑君.中国2003～2006年新涂阳肺结核病人发现趋势[J].中国公共卫生, 2009, (05) :519-520.
9.中华人民共和国卫生部.2000年全国结核病流行病学抽样调查资料汇编[M].北京:人民卫生出版社,2003:37-48.
10.卫生部:06年我国结核病发现率和治愈率均超目标[EB/OL].http://www.gov.cn.
11.胡达敏.控制结核病最新方法-DOTS方案[J].抗感染药学,1997,01
12.刘剑君,么鸿雁.我国结核病的流行现状和防治对策[J].预防医学论坛,2006, 12(5):640.
13.刘琴,汪洋.流动人口结核病流行现况及控制对策研究[J].预防医学情报杂志,2005,21(6):680-682.
14.成诗明,刘二勇,杜昕.老年结核病患者对中国结核病控制的影响[J].中华流行病学杂志,2004,25(8):655-657.
15.徐瑛,庞学文,哈孝圣.艾滋病与结核病双重感染的研究进展[J].天津医药,2007,35(5):393-395.
16.袁静,余卫业,胡毅文,等.23例艾滋病合并结核病患者的临床特点[J].中华结核和呼吸杂志,2004,27(11):767-770.
17.涂诗意,孟庆跃.我国结核病防治法规政策评述和主要问题分析[J].中国初级卫生保健,2007,21(2):5-7.
18.刘剑君,么鸿雁,刘二勇.我国结核病疫情与社会经济因素的关系[J].中华流行病学杂志,2004,25(12)1032-1034.
19.陶威武.山东省卫V项目涂阳肺结核病人治疗管理情况的研究[J].中国预防医学杂志,2004,5(2):97-99.
20.孙莹.肺结核患者中断治疗的原因分析及对策[J].中国城乡企业卫生,2003,10(5):33.
21.杨玉森,董家梅.98例肺结核患者中断治疗的原因的分析[J].中国乡村医药杂志,2004,6(11):13-14.
22.朱建福,王伟炳,王法弟,等.结核病患者治疗依从性及影响因素分析[J].中国公共卫生,2007,23(6):691.
23.陈品儒,王艳红,李昕洁.耐多药结核病的研究进展[J].临床荟萃,2007,22(4):302.
24.黄起烈,陈伟,张兴树.深圳市外来人口肺结核防治效果及影响研究[J].中国防痨杂志,2001,23(6):360-363.
25.倪政,张金兰.上海市闵行区外来人口结核病发现与治疗[J].上海预防医学杂志,2003,15(9):448-453.
26.刘勋,杨成凤,王凤娥.湖北省2001-2005年老年肺结核疫情分析[J].中国热带医学,2006,6(10):1786-1788.
27.吴方,俞丽娜.海宁市传染病网络直报系统结核病发现情况分析[J].浙江预防医学,2006,18(1)57-58.
28.林淑芳,陈求扬.激励机制对提高肺结核病人发现率的影响[J].海峡预防医学杂志,2004,1094]:72-73.
2. 2002年世界结核病日主题:遏制结核病,消除贫困.中国结核网.http://www.chinatb.org.
3.范本达,许卫国,陈宗兰.2001-2004年江苏省肺结核病发现状况与转归分析[J].中国防痨杂志,2006,28(3):138.
4.陈静,梅建,沈梅,等.上海市6个区基层医务人员结核病防治知识调查[J].现代预防医学,2008(11).
5.林相,马晓,陆蓓蓓.目前我国人群结核病知识知晓率调查研究概况[J].海峡预防医学杂志,2008,14(2):24.
6.黄惠良.昆山市从业人员体检中外来人口肺结核患病情况的调查分析[J].中国初级卫生保健,2000,14(1):28-29.
7.刘琴,汪洋.流动人口结核病流行现况及控制对策研究[J].预防医学情报杂志,2005,21(6):682.
1.林相,马晓,陆蓓蓓.目前我国人群结核病知识知晓率调查研究概况[J].海峡预防医学杂志,2008,14(2):23-24.
2.谢艳光,房宏霞,王红艳,等.黑龙江省全人口结核病知识知晓情况调查报告[J].中国防痨杂志,2006,28(4):206-209.
3.刘北斗,李群,徐旭卿,等.浙江省结核病特定知识知晓率调查结果分析[J].中国健康教育,2005,27(6):385-388.
4.赵敏捷,林相,李宗宝,等.宁波市居民结核病防治知识知晓率调查分析[J].中国健康教育,2006,22(1):39-40.
5.梁珏,谭青云,李蜀,等.肺结核病人家属结核病防护知识的调查分析[J].国际护理学杂志,2006,25(6):437-439.
6.王湘苏,许卫国,黄明豪,等.江苏省结核病防治知识知晓率调查与分析[J].中国健康教育,2004,20(12):1095-1096.
7.林定文.南宁市城区结核病健康教育评价[J].广西预防医学,2004,10(1):39-41.
8.黄飞,么鸿雁,刘剑君.中国2003～2006年新涂阳肺结核病人发现趋势[J].中国公共卫生, 2009, (05) :519-520.
9.中华人民共和国卫生部.2000年全国结核病流行病学抽样调查资料汇编[M].北京:人民卫生出版社,2003:37-48.
10.卫生部:06年我国结核病发现率和治愈率均超目标[EB/OL].http://www.gov.cn.
11.胡达敏.控制结核病最新方法-DOTS方案[J].抗感染药学,1997,01
12.刘剑君,么鸿雁.我国结核病的流行现状和防治对策[J].预防医学论坛,2006, 12(5):640.
13.刘琴,汪洋.流动人口结核病流行现况及控制对策研究[J].预防医学情报杂志,2005,21(6):680-682.
14.成诗明,刘二勇,杜昕.老年结核病患者对中国结核病控制的影响[J].中华流行病学杂志,2004,25(8):655-657.
15.徐瑛,庞学文,哈孝圣.艾滋病与结核病双重感染的研究进展[J].天津医药,2007,35(5):393-395.
16.袁静,余卫业,胡毅文,等.23例艾滋病合并结核病患者的临床特点[J].中华结核和呼吸杂志,2004,27(11):767-770.
17.涂诗意,孟庆跃.我国结核病防治法规政策评述和主要问题分析[J].中国初级卫生保健,2007,21(2):5-7.
18.刘剑君,么鸿雁,刘二勇.我国结核病疫情与社会经济因素的关系[J].中华流行病学杂志,2004,25(12)1032-1034.
19.陶威武.山东省卫V项目涂阳肺结核病人治疗管理情况的研究[J].中国预防医学杂志,2004,5(2):97-99.
20.孙莹.肺结核患者中断治疗的原因分析及对策[J].中国城乡企业卫生,2003,10(5):33.
21.杨玉森,董家梅.98例肺结核患者中断治疗的原因的分析[J].中国乡村医药杂志,2004,6(11):13-14.
22.朱建福,王伟炳,王法弟,等.结核病患者治疗依从性及影响因素分析[J].中国公共卫生,2007,23(6):691.
23.陈品儒,王艳红,李昕洁.耐多药结核病的研究进展[J].临床荟萃,2007,22(4):302.
24.黄起烈,陈伟,张兴树.深圳市外来人口肺结核防治效果及影响研究[J].中国防痨杂志,2001,23(6):360-363.
25.倪政,张金兰.上海市闵行区外来人口结核病发现与治疗[J].上海预防医学杂志,2003,15(9):448-453.
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