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目的对湖沼垸内型血吸虫病流行区2006-2010年期间血吸虫病防治工作投入与效果进行综合分析与评价,为此类亚型地区加快消除血吸虫病进程,进一步合理配置有限卫生资源提供参考。方法选择湖北省与国家卫生和计划生育委员会(原卫生部,简称国家卫生计生委)、农业部联合防治血吸虫病试点之一的湖北省江陵县,参考全国血吸虫病防治传播控制达标考核、湖北省阶段防治工作目标要求,2006-2010年以人畜感染率分层(即人和畜感染率都≥3%为一层村,3%>人和畜感染率≥1%为二层村;人和畜感染率均<1%为三层村)为依据,采用分层分析方法,选择当地当年各分层覆盖流行村为研究对象,回顾性调查、收集防治工作效果与费用数据,所有数据经汇总后进行费用-效果综合分析。结果疫情防治效果显示,截止2010年,江陵县无一层村,二层村共计114个,三层村共计18个。血吸虫病病人数,一层村绝对数逐年减少直至0,二、三层村绝对人数增加。粪便管理方面,无害化厕所覆盖率仅二层村2009、2010年分别为27.45%、48.74%,而一、三层村均为0。防治费用经贴现后,当地5年总防治费用中,综合治理投入(10 266.39万元)远高于查治投入(418.30万元)与人工投入(223.95万元)。综合治理费用中,国土、农业、水利部门费用占据前3位。卫生经费投入显示,分层村均呈国家级>省级>县级,且年均都呈增长态势;费用-效果比显示,人群、耕牛感染率与病人数下降1%、感染性钉螺面积下降1 hm2的单位成本比值均逐年趋高。卫生投入的半对数差值稳定性分析显示,各分层村两两比较均<1,三层村(5年年均差值均<1)投入与费用较稳定,一、二层村均呈年均费用大于投入的波动状态。结论 2006-2010年江陵县血吸虫病疫情逐年降低,但主要传染源尚存,需加强控制与清除;扩大粪便管理覆盖面是下一步工作的重点之一。资源配置上,卫生领域内重点投入与单位成本控制、费用的年均分配有进一步调整的空间。
Objective To comprehensively analyze and evaluate the input and effect of schistosomiasis control during the period from 2006 to 2010 in the endemic areas of lakes and embankments of schistosomiasis embankment, so as to provide a reference for further accelerating the process of schistosomiasis elimination in this subtype area and further rational allocation of limited health resources. Methods Hubei Province, one of the pilot projects of joint prevention and treatment of schistosomiasis by Hubei Provincial Health and Family Planning Commission (formerly the Ministry of Health, Ministry of Health, Ministry of Agriculture) and Ministry of Agriculture, was selected in reference to the national standard of transmission control of schistosomiasis prevention and control. Hubei Province Stages of prevention and control work target requirements, 2006-2010 infection rate of human and animal stratification (that is, human and animal infection rate ≥ 3% for the village, 3%> human and livestock infection rate ≥ 1% for the second floor village; and Livestock infection rate were <1% for the village of three layers) as the basis, using stratified analysis method, select the local coverage of the stratified popular village as the research object, retrospective investigation, collection of prevention and control work results and cost data, all the data summary After the cost - a comprehensive analysis of the effect. Results The prevention and treatment of the outbreak showed that as of 2010, no village in Jiangling County, a total of 114 villages in the second floor, a total of 18 villages in the three layers. The number of schistosomiasis patients, the absolute number of layers of villages decreased year by year until 0, the absolute increase in the second and third village. In manure management, the coverage rate of harmless toilets is only two stories in 2009 and 2010, respectively 27.45% and 48.74%, while the first and third villages all have zero coverage. After the prevention and treatment expenses were discounted, among the total 5 years of prevention and control expenses, the investment in comprehensive management (106.639 million yuan) was much higher than the investment made by Zhazhi (4.183 million yuan) and the manpower input (22.3295 million yuan). Among the comprehensive treatment expenses, the costs of the departments of land administration, agriculture and water conservancy occupy the top three places. Investment in health funds shows that the stratified villages are all at the state level, provincial level and county level with an average annual growth rate. The cost-effectiveness ratio shows that the infection rates and numbers of cattle, cattle and cattle population are reduced by 1% The unit cost of 1 hm2 decreased gradually year by year. The analysis of semi-logarithmic difference of health investment shows that the average of each level of village is <1, and the investment of three-level village (average annual difference of 5 years <1) The average annual cost is greater than the input volatility. Conclusion The epidemic situation of schistosomiasis in Jiangling County decreased year by year from 2006 to 2010, but the main source of infection still survived. Control and clearance should be strengthened. Expansion of manure management coverage is one of the focuses of the next step. Resources allocation, the key input in the field of health and unit cost control, the average annual cost allocation of room for further adjustment.