Evaluation of staff performance and material resources for integrated schistosomiasis control in northern Senegal

BACKGROUND: A project to improve integrated control of schistosomiasis in the primary health care system of northern Senegal was implemented from February 1995 until September 1999, shortly after a Schistosoma mansoni outbreak. The activities included additional training of doctors and nurses in symptom-based treatment and making praziquantel (PZQ) available for an affordable price. OBJECTIVE: To investigate staff performance and the availability and costs of diagnostic materials and PZQ at the end of this intervention project. METHODS: We performed structured interviews with staff from 55 health care facilities in five districts. RESULTS: Respondents from 23 health care facilities reported both S. haematobium and S. mansoni in the coverage area, 32 reported only S. haematobium and three only S. mansoni. The average cost to patients for consultation, diagnosis, treatment and transportation to a referral health care facility was approximately 1.60 Euro. Fifty-seven per cent of the health care facilities with reported S. haematobium in the coverage area treated patients presenting with haematuria on symptoms; 56% of the health care facilities with reported S. mansoni in the coverage area treated patients presenting with blood in stool on symptoms. Thirteen per cent performed a diagnostic test for patients presenting with haematuria and 12% for patients presenting with blood in stool. The remainder, approximately one-third of the health care facilities, referred their patients to another facility for a diagnostic test. Implementation of symptom-based treatment in all health care facilities will reduce the total costs by 0.43 Euro (29%) for patients infected with S. haematobium and 0.78 Euro (46%) for patients infected with S. mansoni. Of the 53 health care facilities with schistosomiasis in their area, 37 had PZQ in stock of which 33 (88%) sold PZQ for the recommended retail price of 0.15 Euro per tablet (or 0.60 Euro per course of four tablets) or lower. CONCLUSION: Four years after the start of the intervention project, patients presenting with schistosomiasis related symptoms can generally expect proper diagnosis and treatment at all levels of the health care system in Northern Senegal, either at the initial visited health care facility or after referral. However, a further reduction of the total costs of treatment is still possible by a better implementation of symptom-based treatment and further reduction of the costs of PZQ.     

鄱阳湖血吸虫病重疫区学生16年健康教育效果纵向观察

目的研制有效控制重疫区学生感染的血吸虫病健康教育干预模式,并观察其远期干预效果。方法应用实验研究方法,1992年基线调查后,1993-1999年和2000-2007年分别应用"信息传播+防护技能培训+奖惩激励"和"信息传播+行为参与+行为激励"干预实验组目标人群。结果干预前(1992)实验组和对照组血防知识知晓率、血防态度正确率、疫水接触率和血吸虫感染率均无显著差异。干预后1年(1993)实验组血防知识知晓率和血防态度正确率分别由干预前8.99、55.06提高到94.38、98.88;疫水接触率和血吸虫感染率分别由干预前14.55、13.94下降到1.87、2.25;对照组干预前后上述各项指标均无明显变化。干预后2-7年(1994-1999)实验组疫水接触率和血吸虫感染率均较干预前显著下降,但均未降至0。干预后8-15年(2000-2007)实验组均无疫水接触者和血吸虫感染者。结论应用"信息传播+行为参与+行为激励"模式干预可使重度疫区学生明显减轻甚至可完全避免血吸虫感染。     

安徽省血吸虫病防治健康教育材料使用现状调查

目的 了解流行区血吸虫病防治健康教育材料的使用情况,为制作针对性健康教育材料提供依据。 方法 通过问卷调查,比较各类人群对不同类型健康教育材料的可及性差异。 结果 当地成人电视、电影的可及率高于流动人口（P<0.01）,高年级学生在学校观看录像多于低年级（P <0.05）;当地成人报纸、宣传折页和展板的可及率高于流动人口（P <0.01）,高年级宣传折页可及性高于低年级（P <0.05）;实物宣传品可及率,人群间差异无统计学意义。 结论 不同人群对血吸虫病防治健康教育材料的使用情况存在差异;健康教育材料制作,应针对不同人群,采用适宜的健康教育材料才能最大限度发挥宣传效益。     

Prevalence,awareness, treatment and control of hypertension among adults 50 years and older in Dakar,Senegal

Background

Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease. Despite these facts, no study on the prevalence, awareness, treatment and control on arterial hypertension in Senegal has been conducted, specifically among elderly people.

Methods

Five hundred people aged 50 years and older, living in the city of Dakar were interviewed. This sample was constructed using the combined quota method in order to strive for representativeness of the target population.

Results

Prevalence of hypertension was 65.4% in our sample. Half of those suffering from high blood pressure were aware of their problem and among the latter, 70% said they were on treatment. However, of these, only 17% had controlled arterial blood pressure. The only factor associated with awareness, treatment and control of hypertension was the frequency of doctor visits.

Conclusion

Improving follow-up health checks of older adults are necessary to limit the consequences of hypertension in Dakar.     

Schistosomiasis screening and health education for children: action research in Nile delta villages

In Egypt an important component of the national schistosomiasis control policy is the regular screening of school children through the rural health units. In the Nile delta, a major challenge for the programme is the increasing predominance of Schistosoma mansoni , as compared to Schistosoma haematobium over the past 20 years, and the need to adjust strategies to this new reality. The action research project, growing out of an in-depth study of schistosomiasis in two Nile delta villages, is intended to provide recommendations for schistosomiasis control to the Egyptian Ministry of Health and Population. This paper explores the practice of school-based screening. We then describe the designing and testing of a revised screening procedure, which focuses on the collection of stool specimens to diagnose S. mansoni and which is comprehensive and gender-sensitive. Opportunities for health education are discussed briefly, as this is necessary for an effective screening procedure and to prevent reinfection. In conclusion, we mention the need to incorporate screening and health education into an integrated control strategy.     

健康教育在血吸虫病防治中的作用

血吸虫病防治是一项复杂的社会系统工程,需要广大干部群众参与,采取科学防治技术,进行群防和群控,才能最终达到消灭的目的。本文主要阐述了健康教育在血防工作中的地位和作用。     

仪征市学生血防健康教育效果调查

仪征市在试点学校连续3年开展血防健康教育，学生的血防知识知晓率和行为正确率分别从项目实施前的56．65％和51．07％提高到91．17％和93．77％，健康教育效果显著。     

长丘山区血吸虫病传播控制地区人群血防知识现况

目的了解长丘山区血吸虫病传播控制地区人群血吸虫病防治（血防）知识知晓情况。方法在四川省长丘山区采用随机整群抽样方法对居民及学生进行抽样,应用问卷调查方法进行调查。结果共调查150名居民和209名学生。各项血防知识知晓率〉90％的居民占60．00％（其中女性“血吸虫病治愈后再接触疫水是否还会感染”和“主要的血吸虫病治疗药物”知晓率均为75．40％）,血防态度正确率为99．30％～100．00％,血防行为正确率均〉80％。学生问卷中,除“钉螺的外形大小”和“一年之中最容易感染血吸虫的月份”外,其余血防知识知晓率均〉90％,态度和行为正确率也均〉80％。结论当地居民和学生血防知识知晓情况已达到国家2008年的防治目标。     

血吸虫病健康教育作品评选方法的建立与应用

目的促进省级血防健康教育（血防健教）作品的设计与制作,提高全国血防健教工作水平。方法将血防健教作品分为声像、实物和印刷3种类型;通过展评,由群众和专家投票确定入围作品,再通过专家集中评分的方法,按健教作品的所得分数确定评选等级。结果全国10个省选送了103件血防健教作品参加评比,其中实物类作品46件,印刷类作品31件,声像类作品26件。共评选出获奖作品32件,其中一等奖3件,二等奖6件,三等奖9件,优秀作品14件。获一等奖的作品为《血防水杯》、《小学生血防健教画报》和《血防健教方言小品》。结论群众和专家相结合的血防健教作品综合评选方法公正、科学,为血防健教作品评选建立了新方法。     

湖沼地区家庭主妇血防健康教育现况调查

目的了解湖沼地区家庭主妇血防健康教育现状。方法采用现场随机问卷方式调查荆州市20～65岁家庭主妇,统计正确应答数,计算血防知识知晓率和正确行为形成率。结果家庭主妇血防知识知晓率和正确行为形成率分别为96.80%和98.40%,不同年龄之间差异无统计学意义（P均〉0.05）。文盲血防知识知晓率为87.50%,低于小学至高中文化程度者,差异有统计学意义（P〈0.05）。家庭主妇获取血防知识途径主要来自宣传年画。结论家庭主妇血防知识知晓率和正确行为形成率均达到现行目标要求,血防知识知晓率与受教育程度有关。     

Global health education consortium: 20 years of leadership in global health and global health education

The Global Health Education Consortium (GHEC) is a group of universities and institutions committed to improving the health and human rights of underserved populations worldwide through improved education and training of the global health workforce. In the early 1990s, GHEC brought together many of the global health programs in North America to improve competencies and curricula in global health as well as to involve member institutions in health policy, development issues, and delivery of care in the inner cities, marginalized areas, and abroad.     

健康教育控制渔船民血吸虫病效果

目的通过对渔船民血防健康教育干预,提高其血防知识知晓率、血防行为正确率,以减少血吸虫感染和传播的机会。方法成立血防健康教育志愿者队伍,参与和开展血防健康教育干预活动;加强渔船民粪便管理,采用问卷方式调查渔船民健康教育干预前后血防知识知晓率和血防行为正确率的变化;2005～2007年,每年定期对渔船民血吸虫病进行查治,分析健康教育干预后其血吸虫感染情况变化。结果渔船民血防知识知晓率和血防行为正确率从23.85%和6.59%分别提高到95.70%和53.42%（P〈0.01）。无害化厕所和粪便收集器使用率分别为80.21%和54.52%;2005～2007年血检阳性率为19.24%、12.27%和8.15%,与2004年（27.95%）比较,差异均有统计学意义（P均〈0.05）。结论通过血防健康教育干预,不仅提高了渔船民的血防意识,而且还不同程度地改变了其不良行为,从而减少了渔船民血吸虫感染和传播的机会。     

A school-based approach to the control of urinary schistosomiasis and intestinal helminth infections in children in Matuga, Kenya: impact of a two-year chemotherapy programme on prevalence and intensity of infections

A school- and chemotherapy-based urinary schistosomiasis and intestinal helminth infection control programme was conducted in Matuga Division, Kwale District, Coast Province with teachers taking care of diagnosis, treatment and health education. More than 12 000 children in 36 primary schools were included in the 2-year programme. Results for 20 evaluation schools are presented. Children with haematuria were treated with praziquantel (40 mg/kg) once a year. Within 2 years, the prevalence of haematuria in the schools was reduced from 28% (range 8–68%) to 11.4% (range 3–23%). More than 80% of the schoolchildren were infected with one or more intestinal helminths at baseline. After one year with levamisole mass chemotherapy, single dose (2.5 mg/kg) three times a year (once per school term), the prevalence of Ascaris infection was reduced by 83% from 18% to 3%, but there was no change in pretreatment prevalences of hookworm (57%) and Trichuris (56%) infections. In the second year of the programme, albendazole 600 mg once every six months was administered to the children in 10 randomly selected schools. This resulted in 52% and 23% reductions in prevalences of hookworm and Trichuris infections, respectively, in these schools and a reduction in mean intensity of infection of 52.8% and 50.3%, respectively.     

Integrated community-directed treatment for the control of onchocerciasis, schistosomiasis and intestinal helminths infections in Uganda: advantages and disadvantages

Onchocerciasis is co-endemic with schistosomiasis and intestinal helminths infections, which are all diseases of the rural and the poorest communities in Africa. Community-directed treatment (ComDT) for the control of onchocerciasis is the only functional health approach in most of these communities and the strategy has proven to be effective for onchocerciasis control. This study was conducted to assess the feasibility of integrating ComDT with ivermectin for the control of onchocerciasis, and with praziquantel (PZQ) and mebendazole (MBD) for the control of schistosomiasis and intestinal helminths infections in children aged 5-14 years, and to assess advantages and disadvantages of the integrated ComDT over the routine ComDT and the school-based treatment approach. Integrated ComDT achieved higher treatment coverage (85%) for PZQ and MBD than the school-based treatment approach (79%) among children aged 5-14 years (P = 0.03). There were more reported adverse reactions after treatment with a combination of PZQ and MBD in the school-based treatment approach (33%) than for the combination of ivermectin and MBD on day 1 and PZQ on day 2 in the integrated ComDT (18%). However, all adverse reactions were mild (headache, nausea/vomiting and abdominal pain). The integrated ComDT also achieved higher ivermectin treatment coverage for all ages (81.3%) than routine ComDT (77.2%) (P = 0.0003). To achieve even better coverage for PZQ and MBD among the targeted high risk groups, integrated ComDT should treat all age groups in areas where the prevalence of schistosomiasis and intestinal helminths infections is >50%. This would minimize the shortage of the drugs targeted to treat the high risk groups, as the non-targeted groups, will inevitably demand and receive the treatment from the distributors. The results of this study show that PZQ and MBD treatment for the control of schistosomiasis and intestinal helminths, respectively, can be integrated with ivermectin treatment for the control of onchocerciasis without negatively affecting ivermectin treatment coverage.     

湖北省血防健康教育工作现况及成效评价

目的掌握湖北省各地血防健康教育工作现状及需求,以便有针对性地开展血防健教工作。方法通过问卷调查及实地调研的方式,收集各地从事防治血吸虫病健康教育工作的现状和需求信息,包括机构设置、人员基本信息、设备和经费及工作形式等,并进行分析和评价。结果对24个县(市)血防机构调查的结果显示,设独立健教科室的有12个,占50%;从事血防健康教育工作人员的年龄最小34岁,最大58岁,平均年龄46.5岁;学历高中及以下有5人(20.80%),大专有16人(66.67%),本科及以上有3人(12.50%);有专项经费的为10个(占41.70%),无经费的为3个(占12.50%)。结论湖北省血防健教工作成效显著,但在专职人员和经费方面尚有不足。     

山丘型流行区血防健康教育和健康促进的发展与模式探索

随着血吸虫病防治工作的推进,山丘型流行区逐步达到血吸虫病传播控制和传播阻断标准,开始向消除阶段迈进。新的防治形势下,作为血吸虫病重要防治措施之一的健康教育亦面临新的挑战,传统血防健康教育已不能适应流行区社会、经济、文化发展及群众生产、生活方式日趋变化的需求。因此,需要建立精准的血防健教模式,高效推进防治措施的落实。本文总结了健康教育在山丘型流行区血吸虫病防治中的重要作用,并针对此类地区血吸虫病流行态势变化和防治目标要求,探讨了以优化政策环境和营造社区氛围为基点的新模式,以推动健康教育和健康促进在血吸虫病防治工作中的精准和持续实施。     

山丘型流行区血防健康教育和健康促进的发展与模式探索

随着血吸虫病防治工作的推进，山丘型流行区逐步达到血吸虫病传播控制和传播阻断标准，开始向消除阶段迈进。新的防治形势下，作为血吸虫病重要防治措施之一的健康教育亦面临新的挑战，传统血防健康教育已不能适应流行区社会、经济、文化发展及群众生产、生活方式日趋变化的需求。因此，需要建立精准的血防健教模式，高效推进防治措施的落实。本文总结了健康教育在山丘型流行区血吸虫病防治中的重要作用，并针对此类地区血吸虫病流行态势变化和防治目标要求，探讨了以优化政策环境和营造社区氛围为基点的新模式，以推动健康教育和健康促进在血吸虫病防治工作中的精准和持续实施。     

北京市燕山地区中小学生结核病防治健康教育效果观察

目的 评价燕山地区中小学生结核病防治健康教育效果,为更有效地开展结核病防治健康工作提供依据。 方法 将燕山地区14所学校学生,分成高、中、小学生3组,对14条信息进行问卷调查,收回合格问卷1-531份,合格率99.4%。经过6个月的健康教育工作后,同样对象、同样内容再次作答,收回合格问卷1-511份,合格率99.6%。 结果结核病知识内容知晓率为：43.4%,其中10条全部正确者占5.8%,咳嗽、咳痰多长时间应该考虑可能是得了肺结核病？如果怀疑得了肺结核病最好去哪里看病？检查、治疗肺结核病有免费政策吗？正确回答上述3条者占26.7%。经过6个月形式多样的健康教育工作后,结核病知识内容知晓率有了很大提高至71.1%;其中全部正确者占25.2%;前述3条全部正确者占54.8%;经差异性分析,健康教育前后,除小学组的结核病知识内容全部正确者差异无统计学意义外,其余差异有统计学意义。 结论 在学校开展健康教育宣传工作,对提高燕山地区中小学生结核病防治知识水平有显著效果,为今后工作重点提供了科学依据。