中国疟疾风险管理策略研究

发布时间：2018-01-16 07:22

  本文关键词：中国疟疾风险管理策略研究　出处：《华中科技大学》2016年博士论文　论文类型：学位论文

  更多相关文章： 疟疾 风险 风险要素 风险评估 风险管理 策略

【摘要】：根据疟疾的流行历史可分为疟疾流行、控制、消除前、消除(2010-2020)和消除后的成果巩固阶段(2020-)。中国现在处于疟疾消除阶段,部分地区通过消除疟疾考核后,资源投入,政策投入和疟疾工作模式需要调整。然而,随着本地病例的逐渐消除,输入性疟疾病例逐年增多,疟疾传染源依然存在；同时传播媒介按蚊不可能被消灭,外来疟原虫感染本地媒介而导致产生二代病例等风险仍然可能发生。针对疟疾病例、病媒和疟疾流行季节疟疾疫区流入人口等疟疾风险表征的监测管理涉及到的管理部门较多,相应疟疾工作主体从疟疾消除前的卫生系统逐渐扩大到了多部门协作,广义的疟防系统脆弱性由此产生。目前针对中国疟疾消除后的疟疾风险管理仍处于探索阶段,相应的研究较少,因此开展系统的疟疾风险管理策略研究有重要意义。[目的]旨在界定疟疾风险内涵,构建疟疾风险管理的概念框架,梳理中国疟疾消后的风险管理主体,识别和分析疟疾风险要素,构建疟疾风险评估指标模型并进行疟疾风险评估,分析风险的来源,提出相应的疟疾风险管理策略体系,为中国疟疾风险管理体系的建立提供理论和方法的支持。[方法](1)文献研究法。利用Pubmed、Web of Science等英文数据库和CNKI、万方等中国期刊网等数据库搜集国内外关于疟疾和风险管理的文献,用于界定疟疾风险和疟疾风险管理的内涵,构建疟疾风险管理概念框架和分析疟疾风险要素。(2)现场调查法。在广西、安徽和湖北省共抽取有疟疾流行史的八个县的所有疾病预防控制中心和10县级及以上的疟疾治疗医院以及24个乡镇卫生院的疟防人员、镜检人员和医生共计166人,村医53人,居民1219名,进行相应的问卷调查；现场考核镜检人员阅片能力；调查八个县疾控疾控机构数据,为风险评估和风险来源分析提供素材。(3)个人深入访谈法。基于设计的访谈提纲,对疾控机构和医院疟疾治疗科室的相关负责人进行深入访谈,并借助扎根理论的原则,运用Nvivo软件进行分析,以寻找当前疟疾工作现状,取得的经验,存在的问题和策略的逻辑关系(4)数理统计方法。在进行处理专家咨询结果时使用Kruskal-Wallis秩和检验专家协调系数；运用了熵值法优化疟疾风险评估指标权重；同时在评估疟疾风险发生的可能性和系统脆弱性时分别使用了综合指数法和加权TOPSIS法；在疟疾风险来源分析时运用了相关性分析和二元Logistic回归法分别分析相关性及影响因素。(5)专家咨询法。专家咨询法主要来研究疟疾风险管理主体的影响力和对疟疾工作的支持力度,以及筛选关键的疟疾风险要素和确定疟疾风险评估指标体系。[主要结果](1)疟疾风险管理概念框架是由疟疾风险管理的主体、客体、过程路径及其三者之间的相互关系构成。管理主体是由政府、行政部门和业务部门及其相互间的关系组成,客体主要是指导致风险发生可能性和疟防系统脆弱性的疟疾风险要素集。过程路径主要指日常的疟疾风险防范路径和监测到疟疾风险表征后的疟疾风险管理过程路径。(2)疟疾风险评估指标体系主要由疟疾风险发生的可能性和疟防系统脆弱性两个维度构成。疟疾风险可能性指标体系由传染源、传播媒介风险和人群暴露风险3个二级指标和7个三级指标组成。疟防系统脆弱性指标体系主要经济脆弱性、社会脆弱性、卫生系统脆弱性和风险敏感性5个二级指标和16个三级指标组成。(3)疟疾消除后潜在的风险主要来自于无法监测外来疟原虫感染了的本地媒介(病媒)；缺少生化检验的血液传播风险；由高风险人群的疟防知识行为和疫区流入人口数量信息缺乏导致的社会脆弱性;由基层筛查能力弱、疟防经费缩减和对靶人群主动筛查困难导致卫生系统脆弱性；由相关风险管理主体间协作困难导致的政治脆弱性；以及政府重视程度。[结论](1)疟疾风险管理是一个多部门联合行动的过程。一般情况下是通过监测、培训、宣教和沟通协作等进行风险防范,疟疾风险表征一旦被监测到,则进入疟疾风险评估、风险源分析和风险处置过程(2)基于世界卫生组织的疟疾风险评估框架,从疟疾风险发生的可能性和疟防系统脆弱性两个维度进行疟疾风险综合评估,当前中国的疟疾流行和暴发的可能性较小,但是历史上非高发的流行县域需要适当降低疟防系统脆弱性,同时密切关注疟疾风险发生的可能性。[创新与不足]本研究的主要创新点：(1)基于理论分析,构建了疟疾消除后的疟疾风险管理概念框架,并应用到了疟疾风险要素识别与分析、风险评估、风险来源分析和风险处置过程。(2)基于定量与定性相结合的分析方法从疟疾风险发生的可能性和系统脆弱性两个维度构建了消除后的疟疾风险综合评估指标体系。据此,从定量的角度对样本地区进行了风险评估,最终又在世界卫生组织的评估框架的指导下,从定性的角度进行综合评估。(3)基于风险评估与风险分析结果,对样本地区消除后的疟疾风险管理提出了符合疟疾消除阶段疟疾风险管理的策略建议。本研究的不足之处：(1)疟疾风险发生的可能性和疟防系统脆弱性的评估是借助综合评价法进行的,评估结果是相对的。(2)在进行专家咨询过程中,专家并没有针对咨询指标的算法提出太多的异议,尤其是对定性指标转化成定量指标过程中,相关指标的赋分可进一步推敲。(3)选择的风险评估指标缺乏公认的标准,绝对的评估结果难以转换。
[Abstract]:According to the epidemic history of malaria can be divided into the malaria epidemic, control, elimination, elimination (2010-2020) and after the elimination of consolidating the results (2020-). Chinese is now in the malaria elimination stage, investment of resources in some areas by eliminating malaria, assessment, policy input and malaria work mode needs to be adjusted. However, with the gradual elimination of local cases of imported malaria cases increased year by year, malaria epidemic still exists; at the same time the spread of Anopheles can not be eliminated, foreign media caused by local malaria infection two generation case risk is still possible. In cases of malaria, more monitoring and management of disease vectors and malaria epidemic season in malaria endemic areas such as malaria risk population the characterization of the related to the management, the corresponding work from the main malaria malaria elimination before the health system has gradually expanded to the cooperation of many departments, in the broad sense of malaria prevention system brittle Weak resulting. The malaria risk management Chinese malaria elimination is still in the exploratory stage, the corresponding research is less, so the research on malaria risk management strategy system has important significance. The purpose is to define the connotation of malaria risk], construct the framework of risk management of malaria, malaria elimination after combing China risk management subject identification and analysis of risk factors of malaria, malaria construction risk assessment index model and malaria risk assessment, risk source analysis, put forward the corresponding system of malaria risk management strategy, support method. To provide theory and method for the establishment of risk management system Chinese malaria] (1) the literature research method. By using Pubmed, Web of Science English and CNKI database, Wanfang China journal net database is a collection of domestic and foreign literature about malaria and risk management, to define the risk of malaria and malaria The connotation of risk management, construct the malaria risk management framework and the analysis of malaria risk factors. (2) the scene investigation. In Guangxi, Anhui and Hubei province were selected in all eight counties in malaria endemic disease prevention and control center and the history of the 10 above the county level and the treatment of malaria hospitals and 24 township health centers in malaria anti personnel, examiners and doctors a total of 166 people, 53 village doctors, 1219 residents, conducted a questionnaire survey of the corresponding site assessment examiners; reading ability; investigation of eight County CDC CDC data, provide material for risk assessment and source analysis. (3) personal interview the design of the interview method. Based on the CDC and hospital treatment of malaria department responsible person to conduct in-depth interviews, and using the principles of grounded theory analysis using Nvivo software to find the current malaria working status, the experience gained, The logical relationship problems and Strategies of the (4) statistical methods. Using the Kruskal-Wallis rank sum test expert coordination coefficient in processing the results of expert consultation; the optimization of evaluation index weight of malaria risk at the same time using the entropy method; comprehensive index method and weighted TOPSIS method in vulnerability assessment system and possible risk of malaria the analysis of malaria risk sources; in use respectively analysis of correlation and influencing factors of correlation analysis and Logistic regression method. Two yuan (5) expert consultation. The expert consultation method mainly to study the influence of the main malaria blast risk management and work on malaria support, and screening the key elements and determine the risk of malaria malaria the main results of the risk assessment index system.] (1) the concept of malaria risk management framework is composed of a body, the malaria risk management object, process route and third A relationship between them. The subject is composed by the government management, administrative departments and business units and the relationship between the object, mainly refers to the risk possibility and risk factors of malaria prevention system vulnerability. The process mainly refers to the daily path of malaria risk prevention and monitoring of malaria risk management path to path of malaria after the risk characterization. (2) and the possibility of malaria risk assessment index system is mainly composed of malaria risk prevention system vulnerability in two dimensions. The possibility of malaria risk index system from the source of infection, media and risk exposure risk of 3 level two indexes and 7 level three indexes of malaria prevention system. The main vulnerability index system of economic vulnerability, social vulnerability, health system vulnerability and risk sensitivity of 5 level two indexes and 16 level three indexes. (3) after the elimination of potential malaria The risk is mainly from the outside can not monitor the Plasmodium infection local media (vector); lack of blood biochemical test the risk of spreading from high risk population; knowledge of malaria prevention and epidemic population inflow behavior information due to the lack of social vulnerability; by primary screening can weak the malaria prevention funding reduced to the target population active screening difficulties led to the vulnerability of the health system; political vulnerability caused by the difficulties of risk management related to the subject of cooperation between; and the attention of the government. Conclusion: (1) malaria risk management is a process of multi sectoral joint action. Under normal circumstances is through monitoring, training, education and communication of risk prevention once, malaria risk characterization in malaria monitoring, risk assessment, risk source analysis and risk disposal process (2) malaria risk assessment framework based on WHO, from malaria blast And the possibility of malaria crisis prevention system vulnerability of the two dimensions of comprehensive assessment of malaria risk, the malaria epidemic and outbreak China less likely, but the history of the high incidence of non epidemic malaria prevention system of county need appropriate to reduce the vulnerability, while paying close attention to the possibility of "innovation and shortage of blast crisis in malaria] major innovations this study: (1) based on the theoretical analysis, constructs a concept framework of risk management of malaria malaria elimination, and applied to the identification and analysis of risk factors of malaria, risk assessment, risk source analysis and risk disposal process. (2) system and the possibility of quantitative and qualitative analysis method based on the combination of the occurrence of malaria from the risk of the vulnerability of the two aspects after the elimination of malaria risk comprehensive evaluation index system. Therefore, the risk assessment of the sample area from the quantitative angle, and finally in the world The evaluation framework of Health Organization under the guidance of the comprehensive evaluation from the qualitative point of view. (3) the results of risk assessment and risk analysis based on the risk management of malaria elimination of the sample area is put forward based on the strategy of eliminating malaria malaria risk management proposal stage. The deficiency of this study: (1) evaluation and the possibility of malaria malaria risk prevention system vulnerability is the use of comprehensive evaluation method, the evaluation results are relative. (2) in the process of expert consultation, expert consultation and not for index algorithm is proposed too many objections, especially on the qualitative indexes into quantitative indexes, related index score further scrutiny. (3) the risk assessment index selection lack of accepted standards, the absolute evaluation results are difficult to convert.

【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R531.3
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本文编号：1432107