中国血吸虫病疫情纵向研究及晚期血吸虫病患者生存质量调查
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摘要
血吸虫病是一种严重影响人们健康、阻碍社会经济发展的寄生虫病,在我国流行已有2100多年的历史。解放初期,我国南方的广东、上海、广西、福建、浙江、湖南、湖北、江西、安徽、江苏、四川、云南等12个省、自治区、直辖市的370县(市)有血吸虫病流行,估计当时全国有病人1160万,病牛120万头,钉螺面积143亿m~2。建国后,在党和政府的领导下,经过近半个世纪的努力,我国血吸虫病防治工作取得了巨大的成绩。
但是,上世纪80年代以来,中国的血吸虫病防治工作面临着严峻的形势和挑战。一是血吸虫病疫情回升严重;长江流域特大洪水频发、全球气候变暖、流行区域人流物流急剧增加,市场经济体制转型对人们思想观念及行为带来巨大冲击,增加了血吸虫病防治工作的难度。二是防治经费投入严重不足;上世纪八十年代以来,防治工作所需的药物和医疗费用明显上升,严重影响了防治工作的正常开展。三是重点流行区的湖区和大山区钉螺孳生环境复杂,受环境因素影响很大,灭螺十分困难;人畜防治不同步,加上耕牛敞放,传染源难以控制,综合治理难度大。四是血吸虫病防治机构和专业人员不能适应防治工作的需要。因此,控制血吸虫病流行和遏制疫情回升已是当时中国主要的公共卫生问题。为此,中国政府决定从1992年起实施了为期10年的世界银行中国控制血吸虫病项目,以有效控制控制血吸虫病。
鉴于当时的血吸虫病流行情况及世行血防项目的需求,为了动态跟踪血吸虫病流行态势,科学地评估世行血防项目期间及实施后的效果,自1990年起,我们在全国血吸虫病主要流行区建立了35个血吸虫病研究队列,以行政村常住居民及家畜为主要研究对象,采用流行病学纵向监测技术、结合血吸虫病病例个案调查、社会学、寄生虫病学等方法,从流行类型、流行层次等多个层面,系统分析了队列内研究对象各年血吸虫感染率与感染度、急性血吸虫病与晚期血吸虫病发病、家畜感染率、钉螺密度、钉螺感染率等监测指标,旨在掌握不同疫区血吸虫病疫情变化的趋势,同时,在分析上述指标纵向变化的基础上,结合各队列所采取的干预措施,评价不同干预措施实施的效果,探讨影响疫情变化的自然因素和社会因素。
通过长达15年,25余万人次的纵向研究,可以得出下列初步结论:
①研究试区中属重度流行区(感染率＞15%)的数量显著降低,证明世行项目控制血吸虫病的效果显著。但是部分试区研究期间的疫情反复,提示血吸虫卜乐喂ぷ鞯某て谛院透丛有浴?
②在世行项目所主导的以化疗为主降低人群血吸虫感染率的措施下,重中度疫区人群的感染率得到了显著的下降,但降低到感染率5%水平时,很难继续降低。因此为巩固控制效果,并进一步降低人群血吸虫感染率,其他辅助的措施如健康宣教、家畜同步化疗、环境改造灭螺及化学灭螺等措施均应同步实施。
③再感染难以控制,加大了疾病控制的难度。研究血吸虫再感染的流行特征及其影响的环境及遗传因素将是今后控制策略中面临的新问题。
④各试区耕牛感染率普遍较高。而在“以机代牛”的试区中,2003年的感染率已降为0,进一步论证了耕牛在血吸虫传播中的作用,亦提示了加强对耕牛的管理是控制和消灭血吸虫病的有效途径之一。
⑤各试区的螺情较为严重,且试区间和年间差异显著。灭螺要与当地农业、产业改革相结合,才能取得满意的效果。
⑥血吸虫病已消灭地区的研究结果显示,当地居民的病情及螺情已得到有效的控制,但由于试区内流动人员的增加,输入性的病例可能成为血吸虫传播得到控制与阻断地区的一个日益突出的问题。因此,在此类地区应强对流动人口、疫区返回人员的监测,防止输入病例,避免血吸虫病在当地死恢复燃。
第二部分晚期血吸虫病患者生存质量调查
上海市青浦区曾经是全国10个血吸虫病重度流行县之一。该地区历史上确认6014例晚期血吸虫病病人,占全市总病人数的29.28%。1983年该区达到消灭血吸虫病标准后,至今无新增晚期血吸虫病病人。
在血吸虫病传播阻断多年后,我们旨在通过本次横断面调查,了解上海市青浦区晚期血吸虫病患者的生存现状、生存质量及其影响因素,探索改善和提高其生存质量的有效途径,为有关部门采取进一步的关怀和管理措施提供必要的依据。为此,我们运用WHOQOL-BREF量表,采用整群抽样的方法,对上海市浦浦区的赵巷、重固和西岑三个镇的历史晚期血吸虫病病人及部分对照进行了调查,以分析比较晚血血吸虫病患者的生存现状及质量。研究的主要结果为:
①现存晚期血吸虫病患者以女性、老年患者为主,男、女患者性别比为100:247,平均年龄为70.79±7.95岁。临床分型以巨脾型为主,占73.30%;脾切除率达91.54%。在职业、住房、饮用水来源、厕所、收入、医疗费用自付比例、支付方式、赡养、护理需求和不适时的措施等基本情况和社会支持方面与一般人群无显著性差异,显示目前存活的晚期血吸虫病患者的生活条件并未因血吸虫病而受到太大的影响。
②在健康状况方面,晚期血吸虫病患者既往患有1种及以上疾病的比例达56.55%,36.95%的晚血患者患2种及以上的疾病,甚至同时患有6种疾病;在所患疾病种中,前3位依次是循环系统疾病、消化系统疾病和呼吸系统疾病;与此相对应的是过去1年住院次数和医疗费用方面,晚期血吸虫病患者均较一般人群严重。显示现存晚期血吸虫病患者除了血吸虫病的危害外,还负担着高于一般人群的疾病负担和经济负担。
③在日常生活能力方面,完全正常者占73.30%,显示大多数日常生活能力情况良好,但仍有多达16.92%的人功能明显下降,与一般人群比较,晚期血吸虫病患者主要在乘坐公共车辆、做饭菜、做家务、吃饭、洗衣、洗澡、购物7个方面的日常生活能力为差。在每周体力活动方面,晚期血吸虫病患者在每周活动次数少于1次者达12.27%,高于一般人群的7.47%。
④晚血患者中有86.57%的人生存质量综合评分在中等(49分)及以上,在生存质量的生理、心理、社会关系和环境领域中分别有83.25%、92.54%、96.51%和95.35%的人评分在中等(14分)以上。与一般人群比较,在综合水平、生理和心理领域方面的差异仍有统计学显著性。因此,血吸虫病对现存晚血患者生存质量的影响仍然比较明显,并主要影响到晚血患者生存质量的生理和心理两个领域,而对反映社会适应的社会关系和环境领域的影响不显著。
⑤生存质量影响因素的多元逐步Logistic回归分析结果表明,在生存质量各领域的影响因素中,食欲、每周体力活动次数、家庭月人均收入和性别为主要的正向影响因素,食欲好、每周体力活动次数越多、家庭月人均收入越高的男性生存质量各领域评价为较好的可能性越大,生存质量越好;而家庭摩擦影响、日常生活能力、2周内患急性病、赡养情况和缺齿情况为主要的负向影响因素,家庭摩擦影响越大、日常生活能力越低、2周内患有急性疾病、由子女或他人赡养和缺齿10颗以上的人其生存质量各领域评价为较好的可能性越低。
PartⅠThe Longitudinal Study on Endemic Situation of Schistosomiasis in China
Schistosomiasis remains a major parasitic diseases causing serious damage to people's health and hindering the development of social economy.Schistosomiasis has long been endemic in China since at lease 21 years ago.According to the records in 1950s,11.6 million people suffered from schistosomiasis,1.2 million cattle infected, the total area of Oncomelania snail habitats was 14.3 billion m~2,and more than 100 million people were at risk of the infection,which distributed in 370 counties covering 10 provinces of Hunan,Hubei,Jiangxi,Anhui,Jiangsu,Zhejiang,Fujian, Guangdong,Yunnan,Sichuan,the municipality of Shanghai and the autonomous region of Guangxi,in the south China over the past 50 years.Led by the Party and the government,great progress has been made in schistosomiasis control in China.
Since the 1980s,schistosomiasis control has been a hard task confronting China. Firstly,the prevalence increased considerably.Along with the natural disaster such as serious floods,global warming of weather,sharply increasing of migrant population and the transition of the commune system to a household responsibility system in the early 1980s,schistosomiasis control became more difficulty.Secondly,lack of funding for prevention and treatment was serious.Since 1980s,funds for schistosomiasis control reduced year by year,while the price of medicines and cost for medical treatment rose considerably,and control work was affected seriously. Thirdly,control of source of the infection was difficult and combined approaches for the control were very difficult to practice because of complicated environment of Oncomelania snail habitats in the lake regions and mountainous areas,and chemotherapy for man and domestic animals was no synchronous.Fourthly, institutions for schistosomiasis control and professionals could not meet the demands of control work.All in all,to control the endemicity of schistosomiasis and to roll back its rise in prevalence were a major public health problem in China by that time. So that,the government began to launch the 10 years' World Bank Loan Programme for Schistosomiais Control(WBLPSC) since 1992 to control Schistosomiasis in China.
In term of endemic situation of schistosomiasis and the demands of WBLPSC,in order to follow up the endemicity and evaluate the effectiveness of WBLPSC,35 cohorts of schistosomiasis were set up in 1990,which represented the different eco-epidemiological settings and endemic levels were selected using multiple-stage cluster sampling method.
The abundant results obtained from the annual cross-sectional surveys including data of annual human infection prevalence and infection intensity,the incidence of acute schistosomiasis and advanced cases,prevalence rate of animal reservoirs,snail density and snail infection rate.The database based on the above results helped the government to understand longitudinally how the schistosome-endemic situation changed over time.It was also helpful to evaluated whether control strategies were effective,to explore the related natural and social factors,to provide scientific proof to formulate and adopt anti-schistosomiasis policies.
Along with the 15 years,250,000 person-years longitudinal study,following results were made:
First,the number of highly endemic areas has been reduced significantly,which indicated that the control strategies of WBLPSC were effective.However,the fluctuations of the endemic situation in some pilots,support the notion that schistosomiasis is a long-term tasks.
Second,while the infection rates among humans decreased significantly after implementation of control measures built around chemotherapy suggested by WBLPSC,it is hard to further decrease the rates,once the infection rate is below 5%. Thus,to consolidate control efforts and to further decrease prevalence rates among humans,other control measures are imperative,i.e.health education,chemotherapy of livestock and snail control by means of environmental management or mollusciciding.
Third,the re-infection of schistosomiasis is a main problem for schistosomiasis control.It will be the new approaches to study the epidemiologic characteristics of re-infection and its risk factors such as environmental factors and genetic factors.
Fourth,the infection rate of cattle was often at a high level.In the pilots schistosomiasis infection rates were well controlled after the cattle disappeared, underscoring their important role in transmission.
Five,the snail situation varied considerably over time;in most cases,the densities of living snails and infected snails were high.Thus,there is need to emphasis snail control to monitor progress of interventions through suitable surveillance tools,especially in areas where transmission is under control.
Six,the longitudinal study in transmission interrupted the areas indicated that the morbidity and snail were well controlled.However,with the increasing of mobile population,the imported cases may be the main problems in there areas.Thus,it is need to emphasis the surveillance on the persons who are from endemic areas of schistosomiasis.
PartⅡCross-sectional Survey on the Quality of Life of Advanced Cases of Schistosomiasis
Qingpu district(county) of Shanghai was one of the ten most serious endemic counties of schistosomiasis in China.The number of cumulative advanced cases was 6014,which occupied thirty percent of total cases in Shanghai.Since the criteria of interruption of schistosomiasis reached in 1983,no new advanced case was found.
To understand the survival status,the quality of life(QOL) of advanced cases of schistosomiasis,to analyze the it's possible factors on QOL and to explore the best ways to improve the QOL of these cases,three towns(Zhaoxiang,Chonggu and Xicen) was selected randomly as the study sites with the cluster sampling in Qingpu district.All the survival patients of advanced cases and some controls were interviews in these study sites with the constructed questionnaires to study the QOL and influencing factors.The main results were as follows:
First,among the study population,more than 50%subjects were female and old residents.The ration of female to male was 247:100 and average age was 70.79±7.95. 73.30%of advanced cases were classified as splenomegaly,and 91.54%had operation history for splenectory among them.There were no significant differences between two groups(cases and controls) in the some basic living conditions,such as career, housing,type to drinking water,toilet and average income per month.We also did find any differences in the payment mode of medical expenditure,ratio of charges at user's own expenses,and health service needs.It was indicated that previous disease history of schistosomiasis has no more impact on the living status.
Second,concerning the health status,56.55%of the survival patients with advanced schistosmiasis were afflicted with at least one type of disease.36.95%of cases suffered from more than two types of diseases.The first three kinds of diseases bases on prevalence were circulatory diseases,digestive diseases and respiratory disease.The survival patients with advanced schistosomiasis were in more serious condition that that of the controls on the anamnesis,inpatient times and medical expenses in the last year.
Third,73.30%of patients reported that they can be involved in the normal activities,which was similar to the controls.However,16.92%of patients reported the capabilities of normal activities reduced.The differences with controls consisted of public vehicles,cooking,doing housework,eating,washing clothes,bathing,and shopping.87.83%of cases had at least on time of weekly physical activity,which was lee that of controls.
Four,86.57%of advanced cases had a more than medium level(≥49) score of QOL.Evaluation by patient self was higher than that of controls according to WHOQOL-BREF.In the four components of WHOQOL-BREF,the score of physical, psychological,social relationship and environment above medium level(≥14) were 83.25%、92.54%、96.51%and 95.35%respectively.Compared with the controls,the score of QOL were lower in general,and the components of physical and psychological domain.
Five,the multi-variables by Logistic regression indicated that appetite,physical activities,average income of family members per person,and gender were the positive factors on QOL.The negative factors were family contradiction,disease history in the past two weeks,economic supply and teeth lost.The most important factors were family contradiction,appetite and activity of daily living scale.
但是,上世纪80年代以来,中国的血吸虫病防治工作面临着严峻的形势和挑战。一是血吸虫病疫情回升严重;长江流域特大洪水频发、全球气候变暖、流行区域人流物流急剧增加,市场经济体制转型对人们思想观念及行为带来巨大冲击,增加了血吸虫病防治工作的难度。二是防治经费投入严重不足;上世纪八十年代以来,防治工作所需的药物和医疗费用明显上升,严重影响了防治工作的正常开展。三是重点流行区的湖区和大山区钉螺孳生环境复杂,受环境因素影响很大,灭螺十分困难;人畜防治不同步,加上耕牛敞放,传染源难以控制,综合治理难度大。四是血吸虫病防治机构和专业人员不能适应防治工作的需要。因此,控制血吸虫病流行和遏制疫情回升已是当时中国主要的公共卫生问题。为此,中国政府决定从1992年起实施了为期10年的世界银行中国控制血吸虫病项目,以有效控制控制血吸虫病。
鉴于当时的血吸虫病流行情况及世行血防项目的需求,为了动态跟踪血吸虫病流行态势,科学地评估世行血防项目期间及实施后的效果,自1990年起,我们在全国血吸虫病主要流行区建立了35个血吸虫病研究队列,以行政村常住居民及家畜为主要研究对象,采用流行病学纵向监测技术、结合血吸虫病病例个案调查、社会学、寄生虫病学等方法,从流行类型、流行层次等多个层面,系统分析了队列内研究对象各年血吸虫感染率与感染度、急性血吸虫病与晚期血吸虫病发病、家畜感染率、钉螺密度、钉螺感染率等监测指标,旨在掌握不同疫区血吸虫病疫情变化的趋势,同时,在分析上述指标纵向变化的基础上,结合各队列所采取的干预措施,评价不同干预措施实施的效果,探讨影响疫情变化的自然因素和社会因素。
通过长达15年,25余万人次的纵向研究,可以得出下列初步结论:
①研究试区中属重度流行区(感染率＞15%)的数量显著降低,证明世行项目控制血吸虫病的效果显著。但是部分试区研究期间的疫情反复,提示血吸虫卜乐喂ぷ鞯某て谛院透丛有浴?
②在世行项目所主导的以化疗为主降低人群血吸虫感染率的措施下,重中度疫区人群的感染率得到了显著的下降,但降低到感染率5%水平时,很难继续降低。因此为巩固控制效果,并进一步降低人群血吸虫感染率,其他辅助的措施如健康宣教、家畜同步化疗、环境改造灭螺及化学灭螺等措施均应同步实施。
③再感染难以控制,加大了疾病控制的难度。研究血吸虫再感染的流行特征及其影响的环境及遗传因素将是今后控制策略中面临的新问题。
④各试区耕牛感染率普遍较高。而在“以机代牛”的试区中,2003年的感染率已降为0,进一步论证了耕牛在血吸虫传播中的作用,亦提示了加强对耕牛的管理是控制和消灭血吸虫病的有效途径之一。
⑤各试区的螺情较为严重,且试区间和年间差异显著。灭螺要与当地农业、产业改革相结合,才能取得满意的效果。
⑥血吸虫病已消灭地区的研究结果显示,当地居民的病情及螺情已得到有效的控制,但由于试区内流动人员的增加,输入性的病例可能成为血吸虫传播得到控制与阻断地区的一个日益突出的问题。因此,在此类地区应强对流动人口、疫区返回人员的监测,防止输入病例,避免血吸虫病在当地死恢复燃。
第二部分晚期血吸虫病患者生存质量调查
上海市青浦区曾经是全国10个血吸虫病重度流行县之一。该地区历史上确认6014例晚期血吸虫病病人,占全市总病人数的29.28%。1983年该区达到消灭血吸虫病标准后,至今无新增晚期血吸虫病病人。
在血吸虫病传播阻断多年后,我们旨在通过本次横断面调查,了解上海市青浦区晚期血吸虫病患者的生存现状、生存质量及其影响因素,探索改善和提高其生存质量的有效途径,为有关部门采取进一步的关怀和管理措施提供必要的依据。为此,我们运用WHOQOL-BREF量表,采用整群抽样的方法,对上海市浦浦区的赵巷、重固和西岑三个镇的历史晚期血吸虫病病人及部分对照进行了调查,以分析比较晚血血吸虫病患者的生存现状及质量。研究的主要结果为:
①现存晚期血吸虫病患者以女性、老年患者为主,男、女患者性别比为100:247,平均年龄为70.79±7.95岁。临床分型以巨脾型为主,占73.30%;脾切除率达91.54%。在职业、住房、饮用水来源、厕所、收入、医疗费用自付比例、支付方式、赡养、护理需求和不适时的措施等基本情况和社会支持方面与一般人群无显著性差异,显示目前存活的晚期血吸虫病患者的生活条件并未因血吸虫病而受到太大的影响。
②在健康状况方面,晚期血吸虫病患者既往患有1种及以上疾病的比例达56.55%,36.95%的晚血患者患2种及以上的疾病,甚至同时患有6种疾病;在所患疾病种中,前3位依次是循环系统疾病、消化系统疾病和呼吸系统疾病;与此相对应的是过去1年住院次数和医疗费用方面,晚期血吸虫病患者均较一般人群严重。显示现存晚期血吸虫病患者除了血吸虫病的危害外,还负担着高于一般人群的疾病负担和经济负担。
③在日常生活能力方面,完全正常者占73.30%,显示大多数日常生活能力情况良好,但仍有多达16.92%的人功能明显下降,与一般人群比较,晚期血吸虫病患者主要在乘坐公共车辆、做饭菜、做家务、吃饭、洗衣、洗澡、购物7个方面的日常生活能力为差。在每周体力活动方面,晚期血吸虫病患者在每周活动次数少于1次者达12.27%,高于一般人群的7.47%。
④晚血患者中有86.57%的人生存质量综合评分在中等(49分)及以上,在生存质量的生理、心理、社会关系和环境领域中分别有83.25%、92.54%、96.51%和95.35%的人评分在中等(14分)以上。与一般人群比较,在综合水平、生理和心理领域方面的差异仍有统计学显著性。因此,血吸虫病对现存晚血患者生存质量的影响仍然比较明显,并主要影响到晚血患者生存质量的生理和心理两个领域,而对反映社会适应的社会关系和环境领域的影响不显著。
⑤生存质量影响因素的多元逐步Logistic回归分析结果表明,在生存质量各领域的影响因素中,食欲、每周体力活动次数、家庭月人均收入和性别为主要的正向影响因素,食欲好、每周体力活动次数越多、家庭月人均收入越高的男性生存质量各领域评价为较好的可能性越大,生存质量越好;而家庭摩擦影响、日常生活能力、2周内患急性病、赡养情况和缺齿情况为主要的负向影响因素,家庭摩擦影响越大、日常生活能力越低、2周内患有急性疾病、由子女或他人赡养和缺齿10颗以上的人其生存质量各领域评价为较好的可能性越低。
PartⅠThe Longitudinal Study on Endemic Situation of Schistosomiasis in China
Schistosomiasis remains a major parasitic diseases causing serious damage to people's health and hindering the development of social economy.Schistosomiasis has long been endemic in China since at lease 21 years ago.According to the records in 1950s,11.6 million people suffered from schistosomiasis,1.2 million cattle infected, the total area of Oncomelania snail habitats was 14.3 billion m~2,and more than 100 million people were at risk of the infection,which distributed in 370 counties covering 10 provinces of Hunan,Hubei,Jiangxi,Anhui,Jiangsu,Zhejiang,Fujian, Guangdong,Yunnan,Sichuan,the municipality of Shanghai and the autonomous region of Guangxi,in the south China over the past 50 years.Led by the Party and the government,great progress has been made in schistosomiasis control in China.
Since the 1980s,schistosomiasis control has been a hard task confronting China. Firstly,the prevalence increased considerably.Along with the natural disaster such as serious floods,global warming of weather,sharply increasing of migrant population and the transition of the commune system to a household responsibility system in the early 1980s,schistosomiasis control became more difficulty.Secondly,lack of funding for prevention and treatment was serious.Since 1980s,funds for schistosomiasis control reduced year by year,while the price of medicines and cost for medical treatment rose considerably,and control work was affected seriously. Thirdly,control of source of the infection was difficult and combined approaches for the control were very difficult to practice because of complicated environment of Oncomelania snail habitats in the lake regions and mountainous areas,and chemotherapy for man and domestic animals was no synchronous.Fourthly, institutions for schistosomiasis control and professionals could not meet the demands of control work.All in all,to control the endemicity of schistosomiasis and to roll back its rise in prevalence were a major public health problem in China by that time. So that,the government began to launch the 10 years' World Bank Loan Programme for Schistosomiais Control(WBLPSC) since 1992 to control Schistosomiasis in China.
In term of endemic situation of schistosomiasis and the demands of WBLPSC,in order to follow up the endemicity and evaluate the effectiveness of WBLPSC,35 cohorts of schistosomiasis were set up in 1990,which represented the different eco-epidemiological settings and endemic levels were selected using multiple-stage cluster sampling method.
The abundant results obtained from the annual cross-sectional surveys including data of annual human infection prevalence and infection intensity,the incidence of acute schistosomiasis and advanced cases,prevalence rate of animal reservoirs,snail density and snail infection rate.The database based on the above results helped the government to understand longitudinally how the schistosome-endemic situation changed over time.It was also helpful to evaluated whether control strategies were effective,to explore the related natural and social factors,to provide scientific proof to formulate and adopt anti-schistosomiasis policies.
Along with the 15 years,250,000 person-years longitudinal study,following results were made:
First,the number of highly endemic areas has been reduced significantly,which indicated that the control strategies of WBLPSC were effective.However,the fluctuations of the endemic situation in some pilots,support the notion that schistosomiasis is a long-term tasks.
Second,while the infection rates among humans decreased significantly after implementation of control measures built around chemotherapy suggested by WBLPSC,it is hard to further decrease the rates,once the infection rate is below 5%. Thus,to consolidate control efforts and to further decrease prevalence rates among humans,other control measures are imperative,i.e.health education,chemotherapy of livestock and snail control by means of environmental management or mollusciciding.
Third,the re-infection of schistosomiasis is a main problem for schistosomiasis control.It will be the new approaches to study the epidemiologic characteristics of re-infection and its risk factors such as environmental factors and genetic factors.
Fourth,the infection rate of cattle was often at a high level.In the pilots schistosomiasis infection rates were well controlled after the cattle disappeared, underscoring their important role in transmission.
Five,the snail situation varied considerably over time;in most cases,the densities of living snails and infected snails were high.Thus,there is need to emphasis snail control to monitor progress of interventions through suitable surveillance tools,especially in areas where transmission is under control.
Six,the longitudinal study in transmission interrupted the areas indicated that the morbidity and snail were well controlled.However,with the increasing of mobile population,the imported cases may be the main problems in there areas.Thus,it is need to emphasis the surveillance on the persons who are from endemic areas of schistosomiasis.
PartⅡCross-sectional Survey on the Quality of Life of Advanced Cases of Schistosomiasis
Qingpu district(county) of Shanghai was one of the ten most serious endemic counties of schistosomiasis in China.The number of cumulative advanced cases was 6014,which occupied thirty percent of total cases in Shanghai.Since the criteria of interruption of schistosomiasis reached in 1983,no new advanced case was found.
To understand the survival status,the quality of life(QOL) of advanced cases of schistosomiasis,to analyze the it's possible factors on QOL and to explore the best ways to improve the QOL of these cases,three towns(Zhaoxiang,Chonggu and Xicen) was selected randomly as the study sites with the cluster sampling in Qingpu district.All the survival patients of advanced cases and some controls were interviews in these study sites with the constructed questionnaires to study the QOL and influencing factors.The main results were as follows:
First,among the study population,more than 50%subjects were female and old residents.The ration of female to male was 247:100 and average age was 70.79±7.95. 73.30%of advanced cases were classified as splenomegaly,and 91.54%had operation history for splenectory among them.There were no significant differences between two groups(cases and controls) in the some basic living conditions,such as career, housing,type to drinking water,toilet and average income per month.We also did find any differences in the payment mode of medical expenditure,ratio of charges at user's own expenses,and health service needs.It was indicated that previous disease history of schistosomiasis has no more impact on the living status.
Second,concerning the health status,56.55%of the survival patients with advanced schistosmiasis were afflicted with at least one type of disease.36.95%of cases suffered from more than two types of diseases.The first three kinds of diseases bases on prevalence were circulatory diseases,digestive diseases and respiratory disease.The survival patients with advanced schistosomiasis were in more serious condition that that of the controls on the anamnesis,inpatient times and medical expenses in the last year.
Third,73.30%of patients reported that they can be involved in the normal activities,which was similar to the controls.However,16.92%of patients reported the capabilities of normal activities reduced.The differences with controls consisted of public vehicles,cooking,doing housework,eating,washing clothes,bathing,and shopping.87.83%of cases had at least on time of weekly physical activity,which was lee that of controls.
Four,86.57%of advanced cases had a more than medium level(≥49) score of QOL.Evaluation by patient self was higher than that of controls according to WHOQOL-BREF.In the four components of WHOQOL-BREF,the score of physical, psychological,social relationship and environment above medium level(≥14) were 83.25%、92.54%、96.51%and 95.35%respectively.Compared with the controls,the score of QOL were lower in general,and the components of physical and psychological domain.
Five,the multi-variables by Logistic regression indicated that appetite,physical activities,average income of family members per person,and gender were the positive factors on QOL.The negative factors were family contradiction,disease history in the past two weeks,economic supply and teeth lost.The most important factors were family contradiction,appetite and activity of daily living scale.
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