广西腹泻病患者诊治行为及费用调查

目的 调查广西壮族自治区腹泻病患者就诊和治疗情况,了解其诊治行为特征和治疗费用负担.方法 从腹泻病发病率较高的柳州市和罗城县城乡居民中搜集腹泻患者,调查腹泻病患者诊治行为和治疗费用使用情况,应用SPSS 13.0软件进行统计分析.结果 腹泻病患者就诊率为28.28%(125/442);50.91%(225/442)的患者购药在家治疗,20.81%(92/442)的患者未采取任何治疗措施;腹泻患者以就诊村/个体诊所和乡镇/社区医院为主,就诊率冬季高于夏季(P<0.001);<5岁儿童就诊率较高;腹泻病例就诊治疗费平均41元,其中,门诊40元,住院533.5元,村/个体诊所20元,乡镇/社区医院99.5元,县级以上医院100元;在家自治费平均3元;就诊治疗费高于在家自费治疗(P<0.001),住院治疗费高于门诊治疗费(P<0.001);在乡镇/社区与县级以上医院的就诊治疗费高于村/个体诊所(P<0.001).结论 腹泻病以就诊基层医疗机构为主,病后就诊率偏低,而治疗费并不低;应采取措施降低医疗费用,提高居民的就诊意识,并加大基层卫生服务和腹泻病预防控制方面的投入,以有效降低腹泻病的疾病负担.     

广西感染性腹泻发病及疾病负担分析

目的 了解广西壮族自治区感染性腹泻实际发病情况及疾病负担.方法 采用整群随机抽样的方法进行抽样,对抽中的社区或村屯的所有居民共2万余人分别于2007年8月和12月进行2次入户调查,数据录入并进行发病率、伤残调整损失寿命年(DALYs)和经济负担等指标的计算.结果 两周发病率和病死率分别为1.04%和0.00%,夏季两周发病率(1.21%)高于冬季(0.89%)(χ2=10.0578,P=0.0015).推算的全人群年发病率为0.2887次/人年,以<5岁年龄组为高,其中O岁～组为1.4428次/人年;男、女性分别为0.3091次/人年和0.2673次/人年.腹泻病人就诊率28.05%、住院率2.04%,自己买药、使用家庭药箱治疗和不作任何治疗者分别占37.10%,13.80%和21.04%.总DALYs为0.1935/千人年,以中青年为高,其中20～49岁为0.2971/千人年.所导致的直接经济损失和间接经济损失人均分别为43.02和18.35元,总经济损失人均61.37元,推算出广西因腹泻导致的年经济损失为87896.61万元.结论 广西腹泻病以<5岁儿童为高危人群,患病后不就诊现象相当普遍,依然导致一定的疾病负担.     

农村居民腹泻病例就诊模式

目的 了解农村居民腹泻病例的就诊率和就诊机构,为制定相应的卫生政策提供参考依据.方法 按照多阶段分层随机整群抽样方法,选择浙江省象山县石浦镇、西周镇、新桥镇的6个行政村,采用WHO对腹泻病例的定义,分别在2006年12月和2007年3月、6月、9月对调查点的农村居民进行腹泻病发病和就诊情况的调查.结果石浦、西周、新桥3个镇的农村人群,平均两周腹泻病发病率为0.65%,60岁以上年龄组的两周腹泻病发病率1.11%,高于其他年龄组.两周腹泻病就诊率为47.83%,10岁以下儿奄就诊率最高(100.00%),不同季节、不同年龄组就诊率有所不同.我县农村居民腹泻病患者到村卫生室或社区卫生服务站的就诊率为69.70%.Logistic回归方法进行腹泻就诊影响因素分析,结果显示季节、文化程度和是否发热对选择就诊有影响.结论 农村居民腹泻病例多数就近选择村卫生室或社区卫生服务站就诊,应加强对乡村医生医疗服务质量的培训.     

杭州市城乡社区人群腹泻病发病及就诊情况调查

目的了解杭州市城乡社区人群腹泻病发病水平、就诊情况及医疗费用等。方法采取整群抽样的方法抽取上城区2个社区和萧山区3个乡镇居民作为调查对象,共4次入户调查了解其2周内腹泻病发生情况、就诊情况以及因腹泻病产生的各类医疗费用等。结果杭州市共调查了41496人,腹泻病年发病率为0.32次/人年,其中农村年发病率0.41次/人年,高于城市的0.23次/人年。7月和10月是腹泻病高发季节,5岁以下年龄组及55岁以上年龄组两周发病率较高。杭州市腹泻病的就诊率为31.01%,城乡差异无统计学意义,医疗治疗总费用人均为76.08元,报销费用占医疗就诊总费用的15.05%。结论杭州市腹泻病发病率较高,5岁以下儿童及老年人是高发人群,应进一步提高城乡居民患病后的就诊率。     

郑州地区腹泻病例就诊流向调查

目的研究当前腹泻病例的就诊率及就诊机构,为制定相关卫生政策提供参考依据。方法采用多阶段分层整群抽样方法,共抽取10个社区/村,分别于4个季节进行腹泻发病及就诊情况的入户调查。结果本次调查中共调查22 540人次,2周腹泻发病率为1.069%;城市、农村的2周腹泻发病率分别是0.679%、1.407%;城市和农村腹泻病人就诊率分别是42.13%和82.25%,就诊率在城市和农村之间差异有统计学意义(χ2=94.209,P<0.05);城区以在二级综合/儿童医院就诊比例最高(61.33%),农村以到个体诊所就诊的比例最高(93.90%),第4季度和第2季度就诊率较高(77.22%和75.00%)。结论该地区人群腹泻病发病率仍属较高水平,目前城乡腹泻病例就诊模式不同,城市腹泻病例就诊率低于农村。建议政府应该继续加强改进预防控制腹泻病的政策措施,降低发病率;同时应合理配置医疗卫生资源,更好满足群众健康需求。     

郑州地区腹泻病例就诊流向调查

目的研究当前腹泻病例的就诊率及就诊机构,为制定相关卫生政策提供参考依据。方法采用多阶段分层整群抽样方法,共抽取10个社区/村,分别于4个季节进行腹泻发病及就诊情况的入户调查。结果本次调查中共调查22 540人次,2周腹泻发病率为1.069%;城市、农村的2周腹泻发病率分别是0.679%、1.407%;城市和农村腹泻病人就诊率分别是42.13%和82.25%,就诊率在城市和农村之间差异有统计学意义(χ2=94.209,P<0.05);城区以在二级综合/儿童医院就诊比例最高(61.33%),农村以到个体诊所就诊的比例最高(93.90%),第4季度和第2季度就诊率较高(77.22%和75.00%)。结论该地区人群腹泻病发病率仍属较高水平,目前城乡腹泻病例就诊模式不同,城市腹泻病例就诊率低于农村。建议政府应该继续加强改进预防控制腹泻病的政策措施,降低发病率;同时应合理配置医疗卫生资源,更好满足群众健康需求。     

嘉兴市社区人群腹泻病疾病负担调查

目的了解嘉兴市社区人群腹泻病流行特征、临床表现和经济负担,为合理配置卫生资源及决策提供依据。方法采用分层多阶段随机整群抽样方法抽取调查对象,一年四次入户调查两周、一个月及三个月腹泻病发病情况和经济负担等。结果调查21 277人次,二周发病率0.58%,腹泻病年发病率0.151次/人年,1岁组和50-59岁组人群发病率较高;78.57%病例腹泻1-3天,81.25%病例腹泻最多每天5次,儿童发热率、就诊率均明显高于成人;病例次均经济负担539.18元,其中直接医疗费用为94.96元,儿童病例直接医疗费用占调查人群的75.32%;估算全市总经济负担4.30亿元,约占年生产总值3.08‰。结论腹泻病临床表现较轻,就诊率低,疾病负担重,建议加强儿童与50-59岁年龄人群腹泻病防控。     

广西不同职业人群感染性腹泻发病及求医行为抽样调查

[目的]了解目前广西各职业人群中感染性腹泻的发病、求医行为特征,为腹泻病干预提供依据。[方法]采用整群随机抽样,对抽中的社区和村屯所有常住居民约2万余人应用统一的调查表进行入户调查。[结果]发现腹泻病例248人,腹泻病两周发病率为1.21%。散居儿童人群中腹泻病发病率最高。腹泻病例中,27.42%的病例不做任何治疗,53.23%选择自行服药治疗,19.35%到各级医疗机构求医。[结论]低年龄、广泛人际交流性质职业的人群特征是腹泻病的危险因素。腹泻病例就诊率较低,其中散居儿童的求医强度较高,农民的求医强度较低。     

1989～1996年淄川区腹泻病监测结果分析

为了解腹泻病发病情况,探讨流行规律.分析了淄川区连续7年的腹泻病监测资料.全人群推算发病率为0.3376次/人年,5岁以下儿童为0.8085次/人年,无病死.发病高峰在6～8月.病人中肠炎占90%以上,55%左右在村卫生室治疗,就诊病人静脉输液率27.27%.治疗者中抗生素使用率91.05%,2.02%使用口服补液.影响儿童腹泻病发病的因素主要是饭前便后不洗手、常喝生水、家庭经济条件较差、看护人文化程度较低.认为应开展健康教育,建立良好的卫生行为.加强对医务人员的技术培训,以降低腹泻病发病率,减少危害.     

郑州市腹泻病流行病学特征和就诊流向调查

[目的]研究人群腹泻病的发病率和流行特征,了解当前腹泻病例的就诊率及就诊机构,为制定相关卫生政策提供参考依据。[方法]采用多阶段随机整群抽样方法,共抽取10个社区/村,分别于4个季节进行腹泻发病及就诊情况的入户调查。[结果]共调查22540人次,2周腹泻发病率为1.069%;城市、农村的2周腹泻发病率,分别是0.679%、1.407%,农村腹泻病发病率高于城市(95%CI:0.935～1.203);年龄﹤10岁组者的2周、1个月、3个月的腹泻发病率均最高,分别是1.53%,2.60%,4.70%,其次是40～岁年龄组;职业以学龄前儿童最高,2周、1个月、3个月发病率分别为2.01%、3.61%和6.57%,与其他职业相比差异有统计学意义;城市和农村腹泻病人就诊率分别是42.13%和82.25%,就诊率在城市和农村之间差异有统计学意义(χ2=94.209,P﹤0.05);城乡人群中腹泻就病例就医模式不同:城区以在二级综合/儿童医院就诊比例最高(61.33%),农村以到个体诊所就诊的比例最高(93.90%)。[结论]该地区人群腹泻病发病率仍属较高水平,防治工作重点应为年龄在0～10岁和40～50岁之间;就诊模式城市农村不同。建议政府应该继续加强改进预防控制腹泻病的政策措施,降低发病率;同时应合理医疗卫生资源配置,更好适应群众健康需求。     

不同形式结核病防治宣传活动成本效益分析

目的评价河北省16个结核防治项目县开展的不同形式结核病防治宣传活动的效果,分析不同结核病防治宣传活动的成本效益。方法利用河北FIDELIS结核病控制项目月报、季报和实施报告获得就诊患者数、不同结核病防治宣传活动开展的频度和成本。利用调查表,随机调查初诊患者的就诊信息来源。结果就诊患者就诊信息的3个主要来源是墙体广告(占26.4%)、电视(占17.4%)和政府布告(占15.1%)。在不同宣传活动中,获得一个就诊患者的平均成本从低到高依次为政府布告、电视、广播、墙体广告和宣传单/画。结论在开展结核病防治宣传活动时,应该结合当地实际情况,针对不同目标人群开展不同形式的宣传活动。充分利用政府布告、墙体广告和电视等覆盖面广,可信度高,成本效益好的宣传活动手段。     

基于TOPSIS法和RSR法的2020年广西孕产妇保健服务质量综合评价

目的 对广西各地市妇幼保健服务质量进行评价,了解广西不同地区妇幼保健服务水平,为“十四五”广西相关部门进一步精准施策、改善孕产妇保健服务质量提供循证依据。方法 以2020 年广西及各地市的孕产妇保健服务相关指标（系统管理率、建卡率、孕产妇死亡率、住院分娩率、产后访视率和产前检查率）为基础,运用TOPSIS法和RSR法对广西各地区的孕产妇保健服务状况进行综合评价。结果 2020年,广西孕产妇死亡率为8.37/10万,孕产妇的系统管理率、建卡率、产后访视率、产前检查率和住院分娩率等指标均超过90%,其中,住院分娩率超过99%,部分地市达到100%。依据TOPSIS法计算所得的Ci值对广西各地市妇幼保健服务质量进行排序,前三位是梧州市、钦州市和北海市;末三位是是南宁市、防城港市和贺州市。TOPSIS法和RSR法相结合进行分档,梧州市、北海市、钦州市被评定为“好”;南宁市、防城港市被评定为“差”;其他地市被评定“中”。结论 广西不同地区之间孕产妇保健服务质量存在明显差异;进一步降低孕产妇死亡率,将是广西今后妇幼卫生保健工作的难点与重点。     

苏州市5岁以下社区儿童腹泻发病及就诊情况调查

  目的  了解苏州市5岁以下社区儿童腹泻病的发生及就诊情况,为相关卫生政策的制定提供参考。  方法  采用重复横断面调查的设计和分层随机抽样的方法,了解儿童过去1月内的腹泻病发生及就诊情况。  结果  苏州市5岁以下儿童过去1月内腹泻病发生率为3.39%,平均每人每年腹泻0.41次;腹泻后的就诊率为72.50%。其中6月龄~1岁组儿童腹泻发生率最高为5.97%(χ2 =126.52, P < 0.001)。不同季节儿童腹泻的就诊率差异无统计学意义,就诊行为模式相对固定,未就诊首要原因是家长认为病情不重,未就诊腹泻儿童首选自行服药治疗。  结论  苏州市5岁以下社区儿童腹泻疾病负担值得重视,特别是低年龄婴幼儿;应加强对儿童家长相关宣教,进一步完善医疗卫生建设,加强儿童腹泻病监测。     

成都市居民腹泻病流行特征及就医现状调查

目的了解成都市腹泻病流行现状及就诊趋势,为腹泻病管理和防控措施的制定提供基础数据。方法按照多阶段随机抽样的方法选择成都市成华区和大邑县29 355名居民为调查对象,采用问卷调查的方式对其腹泻发病和就医现状进行调查。结果腹泻的2周发病率为3.8%。10岁组的腹泻发病率在各年龄段中最高,为7.4%,学生的腹泻发病率在各职业中最高,为5.9%,各年龄段间和职业间腹泻发病率差异均有统计学意义。被调查的腹泻患者中仅有28.4%选择到医院就诊或住院治疗,34.7%的被调查者腹泻后不做任何治疗,36.9%的被调查者腹泻后自行买药治疗。结论成都市居民腹泻发病率较高,尤其是低年龄段学生的腹泻发病最多,需要进一步加强居民,尤其是重点人群的健康教育和行为干预等工作。     

广西感染性腹泻病例求医行为特征及影响因素研究

目的了解广西居民腹泻病例的求医行为特征及其影响因素,为进一步行为干预提供依据。方法采用社区整群随机抽样,开展入户调查。从中筛选出腹泻病例,收集相关信息进行分析。结果夏、冬季节2次调查总共访问家庭11 865户,共42 330人。调查中收集腹泻病例442例,其中21.04%的病例未做任何治疗,50.90%的病例选择自行服药治疗,26.02%的病例到各级医疗机构门诊求医,2.04%的病例到医疗机构住院治疗。腹泻病例的单日最高腹泻次数、腹泻天数、病例年龄是求医行为强度的影响因素。冬季腹泻病例的求医行为强度高于夏季腹泻病例,城市腹泻病例和农村腹泻病例之间、男性腹泻病例和女性腹泻病例之间的求医行为强度差异无统计学意义。结论本次调查样本量大,收集腹泻病例多,抽样较为合理。广西居民对腹泻病这一类发病普遍、有自限性的疾病关注程度不高,其求医的意愿并不强烈,腹泻病就诊率较低。大部分病例选择自行服药治疗。居民对低年龄和高年龄的＂老幼＂人群的健康关注程度较高,其求医行为强度也相应较高。     

Factors associated with seeking medical care and submitting a stool sample in estimating the burden of foodborne illness

Laboratory-based surveillance is a foundation for public health and is essential for determining the incidence of most foodborne diseases caused by bacterial pathogens; however, reported cases represent a subset of infections in the community. To identify the factors associated with seeking medical care and submitting a stool specimen among persons with acute diarrheal illness, we used multivariate logistic regression to analyze data from two 12- month population-based telephone surveys conducted in the Foodborne Diseases Active Surveillance Network (FoodNet) from 2000 to 2003. Of 31,082 persons interviewed, 5% reported an acute diarrheal illness in the four weeks prior to the interview; of these, 20% sought medical care. On multivariate analysis, among persons with an acute diarrheal illness, factors associated with seeking medical care included: male sex; age <5 or >or=65 years; household income <25,000 dollars; having health insurance; diarrhea duration >or=3 days; having bloody diarrhea, fever, vomiting, sore throat, or cough. Of those seeking medical care, 19% provided a stool sample. Bloody diarrhea (odds ratio [OR] 3.35; 95% confidence interval [CI] 1.18-9.51) and diarrhea duration >or=3 days (OR 3.81; 95% CI: 1.50-9.69) were the most important factors associated with submission of a stool specimen. Cases of acute diarrheal illness ascertained through laboratory-based public health surveillance are likely to differ systematically from unreported cases and likely over-represent those with bloody diarrhea and longer diarrhea duration.     

Determinants of Care Seeking for Children With Pneumonia and Diarrhea in Guatemala: Implications for Intervention Strategies

Objectives. We identified barriers to care seeking for pneumonia and diarrhea among rural Guatemalan children.Methods. A population-based survey was conducted twice from 2008 to 2009 among 1605 households with children younger than 5 years. A 14-day calendar recorded episodes of carer-reported pneumonia (n = 364) and diarrhea (n = 481), and formal (health services, public, private) and informal (neighbors, traditional, local shops, pharmacies) care seeking.Results. Formal care was sought for nearly half of severe pneumonias but only for 27% within 2 days of onset, with 31% and 18%, respectively, for severe diarrhea. In multivariable analysis, factors independently associated with formal care seeking were knowing the Community Emergency Plan, mother’s perception of illness severity, recognition of World Health Organization danger signs, distance from the health center, and having someone to care for family in an emergency.Conclusions. Proximal factors associated with recognizing need for care were important in determining formal care, and were strongly linked to social determinants. In addition to specific action by the health system with an enhanced community health worker role, a systems approach can help ensure barriers are addressed among poorer and more remote homes.Globally, some 7.6 million children younger than 5 years die annually, the majority from low-income countries.1 Two of the most important causes are acute lower respiratory infections, mainly pneumonia and diarrhea (18% and 14% of all deaths in children younger than 5 years, respectively). Adequate access to health care for young children with pneumonia and diarrhea is extremely important in improving survival as there are cheap and effective interventions available. In 2003, the Bellagio Child Survival Study group reviewed child survival interventions feasible for delivery in low-income settings, and concluded that if effective interventions had global coverage, 63% of childhood deaths could be prevented.2 The power of existing interventions is not matched by the capacity of health systems to deliver them to those in greatest need in a comprehensive way and on an adequate scale.3 This situation persists, and a recent study of global research priorities for the prevention of deaths from pneumonia among children by 2015 identified barriers to care seeking and access as one of the highest priorities.4In Guatemala, the 2006 infant mortality rate was 31 per 1000 live births, and under-5 mortality was 41 per 1000 child-years.5 In rural areas where the majority of the population resides, the infant mortality rate and under-5 mortality rates are likely considerably higher. On the basis of their investigation, Heuveline and Goldman suggested that improved access to health care could have considerable impact on under-5 mortality in Guatemala.6 Studies conducted in the 1990s found that health care uptake was very poor, with between 60% and 80% of families not seeking any formal, qualified health care for acute lower respiratory infections and diarrhea.6,7 In relation to poor uptake, poverty was seen as an important predictor, and education and ethnicity were found to be less important.8In addition to informal health care in Guatemala (traditional healers, midwives, neighbors, local stores, pharmacies), formal services are provided by the Ministry of Public Health and Social Assistance (MSPAS). The main health facilities include health posts (usually staffed by an auxiliary nurse), health centers (staffed by at least 1 doctor and qualified nurse), and “national” (general) and specialized hospitals. Recently there has been substantial growth in private services (individual doctors and hospitals), stimulated by rising income in urban areas and dissatisfaction with public services. Other health services are provided by the Social Security Institute and nongovernmental organizations. From 1997, MSPAS has also funded the Programme to Extend Coverage of Basic Health Services (Extension de Cobertura [EdC]). This program, part of the wider Comprehensive Health Care System (Sistema Integrado Atencion de Salud), involves the contracting of nongovernmental organizations to extend basic services to impoverished rural populations.9Following a randomized controlled trial investigating the impact of reducing household air pollution on pneumonia among children,10 and motivated by efforts to develop integration of protection, prevention, and treatment,11 we carried out a study in the same communities of Comitancillo and San Lorenzo into barriers to health care access. We used mixed methods (population-based surveys and qualitative interviews and focus groups) to understand the key demand and supply-side issues that could inform future interventions to improve access to high-quality care. We report here results from the survey component, and focus on the determinants of formal care seeking for maternal report of an episode in children of pneumonia, diarrhea, or both in the past 14 days, with “formal” care defined as contact with 1 or more MSPAS, private, or EdC services.     

2013 - 2014年广西诺如病毒腹泻暴发疫情特征分析

目的 分析广西壮族自治区诺如病毒腹泻暴发疫情的流行特征及影响因素,为疾病防控提供科学依据。方法 采用现场流行病学调查方法收集2013年1月至2014年12月广西地区诺如病毒腹泻疫情报告及个案资料,并进行整理分析。结果 2013年1月至2014年12月,广西共报告6起诺如病毒腹泻疫情,累计病例257例,99.61%为临床诊断病例,无死亡病例。疫情暴发地点主要集中在学校;病例时间分布有明显季节性,主要集中在春秋季的3、10和11月;病例年龄主要为1～10岁(29.13%)和11～20岁(54.72%);可能的传播途径包括经水、食物、人传人接触传播等多途径。共采集87份病例、48份食堂从业人员肛拭子,检出诺如病毒RNA阳性数分别为44份和4份,检出率分别为50.57% 和8.33%。结论 广西地区诺如病毒暴发疫情主要发生在人口密集的学校,应重点针对中小学校, 开展健康宣教,加强个人卫生习惯,同时加强饮用水卫生、食品卫生等监测工作, 减少诺如病毒腹泻暴发疫情的发生。