河南省腹泻与改水改厕关系及成本—效益分析

发布时间：2018-04-13 18:27

本文选题：腹泻 + 改水改厕　；参考：《中国疾病预防控制中心》2008年硕士论文

【摘要】： 近年来，我国农村地区的改水改厕工作进展迅速，各级政府和群众对此投入了大量的人力物力财力。实践证明，安全卫生饮用水和卫生厕所在预防肠道传染病方面具有十分重要的作用。因此，开展改水改厕与腹泻关系研究并探讨其成本效益比具有很好现实意义。目的：了解河南省农村地区腹泻发病现状，分析改善家庭供水和家庭厕所与腹泻发病的关系，探讨改水改厕预防腹泻发病的投入成本及其经济效益，为政府制定防控腹泻政策和合理配置卫生资源提供依据。方法：按照分层多阶段随机整群抽样方法抽取样本，并通过问卷调查的方式收集河南省中牟和睢县两地13个行政村2891名农村居民的腹泻发病、家庭供水和家庭厕所的建设、使用、维护等信息，采用多(两)组设计计量资料的秩和检验和多元线形回归分析方法，研究当地农村地区腹泻与人口学因素、供水和厕所类型、饮水类型、粪便处理方式、个人卫生行为之间的关系，探讨腹泻发病与村庄改水改厕程度之间的联系。采用效益成本比例法研究改水改厕控制腹泻发病的经济效益。结果：1．调查农村人口2891人，全年调查对象共发病474人次，总发病率为16．40％。 2．集中式供水人群发病率为17．72％，分散式供水人群发病率为15．16％，，两组之间无统计学差异(χ~2=1．6740，p0．05)；当地居民主要饮用井水、自来水和桶装水，其发病率分别为16．52％、16．79％和2．78％，3组人群的发病无统计学差异(χ~2=3．13，p0．05)。 3．当地居民使用的厕所类型主要有简单水冲式、沼气池式、渗漏旱厕、不渗漏旱厕和双瓮漏斗式，其人群发病率分别为25．00％、23．56％、21．27％、13．62％和12．32％，各组人群之间发病具有统计学差异(χ~2=32．230，p0．01)；农户采用的粪便处理方式主要有将粪便直接施于农田、粪便不做处理直接施放于环境、高温堆肥和将粪便统一收集后集中处理，各组人群的发病率分别为25．58％、22．22％、15．11％、14．31％，各组发病率之间差异显著(χ~2=8．65，p0．05)。 4．当地居民有喝生水的习惯，经常喝生水的人群发病率为22．64％，从来不喝生水人群发病率为10．78％，各组人群发病率存在统计学差异(χ~2=16．21，p0．001)。每次饭前都洗手人群的发病率为14．96％，有时洗手人群的发病率为22．79％，两组发病率差异显著(χ~2=9．99，p0．01)。但便后洗手的频率与是否发病没有统计学差异(χ~2=2．2057，p0．05)，便后每次都洗、有时洗和从不洗人群的发病率分别为15．47％、17．32％、15．38％。 5．将供水、环境卫生、卫生行为等多因素综合考虑，进行多元回归分析，能够进入回归方程的哑变量有从不喝生水、完整下水道水冲式厕所、不渗漏旱厕、厕所在室内、直接施于农田，偏相关系数分别为-0．08499、-0．37524、-0．04759、0．44944、0．07254。 6．以村为单位进行人群发病率研究，未改水改厕村发病率为18．05％，部分改水改厕村发病率为17．17％，完全改水改厕村发病率为9．51％，3组人群发病率存在统计学差异(χ~2=16．34，p0．001)，且部分改水改厕村与未改水改厕村发病率也存在显著统计学差异(χ~2=14．38，p0．001)。 7．全部被调查人群年人均一次腹泻负担为118．77元，其中人均直接医疗费用为26．08元，直接非医疗费用为7．68元，间接经济负担为85．02元，人均误工误学2．39天。完全改水改厕村人均一次腹泻负担为30．23，其中人均直接医疗费用为11．62元，直接非医疗费用为2．08元，间接经济负担为16．53元，人均误工误学0．68天。 8．被调查人群户均改水改厕建设投资为1264．78元，其中改水建设投资为435．63元，户均厕所建设投资为829．15元。完全改水改厕村户均改水改厕建设投资为1405．15元，其中改水建设投资为578．21元，改厕建设投资为826．94元，年人均改水建设投资为3．82元，年人均改水续生成本53．63元，年人均改厕建设投资为7．31元，实行完全改水改厕每人每年须投入64．76元。 9．完全改水改厕方式预防腹泻的经济效益和投资成本的比值为1．51：1。结论：1．家庭供水类型(集中式供水、分散式供水)和饮水类型(井水、自来水、桶装水)在没有改善水质的条件下对个体发病也没有实质性影响。 2．使用不同类型的厕所和个人卫生行为可以影响个体腹泻发病，但卫生厕所管理不善或使用不当，则难以发挥其卫生厕所的作用。 3．村庄的改水改厕程度对人群的发病存在显著影响。改水改厕率越高，发病越少，反之则越多。 4．在农村地区实行完全改水改厕能够有效预防腹泻的发病，具有一定的经济效益，其经济效益与投资成本之间的比值约为1．51：1。
[Abstract]:In recent years , the reform of water and toilet in rural areas has made rapid progress , and government and people at all levels have invested a lot of manpower and material resources . It has been proved that safe and sanitary drinking water and sanitary toilets have a very important role in the prevention of intestinal infectious diseases . Therefore , it is of practical significance to study the relationship between water diversion and diarrhea and to explore its cost - benefit ratio .

Objective : To understand the present situation of diarrhea in rural areas of Henan Province , analyze the relationship between family water supply and family toilet and diarrhea , discuss the input cost and economic benefit of prevention of diarrhea by changing water and toilet , and provide the basis for government to formulate prevention and control diarrhea policy and rational allocation of health resources .

Methods : The relationship between diarrhea and demographic factors , water supply and toilet types , types of water supply and toilet , type of water supply and toilet , type of water supply and toilet , type of water supply , toilet type , type of drinking water , treatment of excrement and personal hygiene were studied by means of questionnaire investigation . The relationship between diarrhea and demographic factors , water supply and toilet types , drinking type , excrement disposal and personal hygiene were studied .

Results : 1 . The total incidence rate was 16.40 % .

2 . The incidence of centralized water supply was 17.72 % , and the incidence rate was 15.16 % . There was no statistical difference between the two groups ( 蠂 ~ 2 = 1.6740 , p0.05 ) .
The incidence of drinking well water , tap water and barrel water were 16.52 % , 16.79 % and 2.78 % , respectively . There was no statistical difference between the three groups ( 蠂 ~ 2 = 3.13 , p0.05 ) .

3 . The types of toilets used by local residents mainly include simple water flushing type , methane tank type , leaking dry toilet , non - leaking dry toilet and double - urn funnel type , the morbidity of the population is 25.00 % , 23.56 % , 21.27 % , 13.62 % and 12.32 % , respectively , and the incidence among the groups has statistical difference ( 蠂 ~ 2 = 32.230 , p0.01 ) ;
The fecal treatment methods adopted by the farmer mainly applied to the farmland and the excrement was not treated directly in the environment , the high - temperature compost and the centralized treatment after the unified collection of the manure , the morbidity of the groups was 25.58 % , 22.22 % , 15.11 % and 14.31 % , respectively , and the incidence among the groups was significant ( 蠂 ~ 2 = 8.65 , p0.01 ) .

4 . Local residents had the habit of drinking raw water , the incidence rate of people who drank raw water frequently was 22.64 % , and the incidence rate of drinking water was 10.78 % . There was a statistical difference in the incidence of population groups ( 蠂 ~ 2 = 16.21 , p0.001 ) . The incidence of hand washing was 14.96 % , and the incidence of hand washing was 22.79 % , and the incidence of the two groups was significantly different ( 蠂 ~ 2 = 9.99 , p0.01 ) . However , there was no statistical difference ( 蠂 ~ 2 = 2.2057 , p < 0.05 ) . The incidence of washing , washing and never washing were 15.47 % , 17.32 % and 15.38 % , respectively .

5 . Multiple factors such as water supply , sanitation and sanitation are considered comprehensively , and multivariate regression analysis is carried out . The dummy variables that can enter the regression equation have never drank raw water , complete sewer water flushing toilet , do not leak the dry toilet , the toilet is indoors , directly applied to the farmland , and the correlation coefficient is - 0.08499 , - 0.37524 , - 0.04759 , 0.44944 , 0.07254 , respectively .

6 . The incidence of the population incidence in the village was 18.05 % , the incidence rate of partially changed toilet villages was 17.17 % , and the incidence rate was 9.51 % . There was a significant difference in the incidence among the three groups ( 蠂 ~ 2 = 16.34 , p0.001 ) .

7 . The annual per capita annual diarrhea burden of all the surveyed population is 118 . 77 yuan , of which the direct medical cost per capita is 26.08 yuan , the direct non - medical expense is 7.68 yuan , the indirect economic burden is 85.02 yuan , the average person ' s direct medical expense is 11.62 yuan , the direct non - medical expense is 2.08 yuan , the indirect economic burden is 16.53 yuan , and the per person ' s error of error is 0.68 days .

8 . The investment of the water - changing and toilet - changing facilities of the surveyed population is 1264.78 yuan , of which the investment of water - changing construction is 435.63 yuan , and the construction investment of the household - average toilet is RMB 829.15 yuan . The investment of the water - changing and water - changing toilet is RMB 8.21 yuan , the construction investment of the toilet is RMB 826 . 94 yuan , the annual per capita water - change construction investment is RMB 3.82 yuan , the annual per capita water - change construction investment is RMB 7.31 yuan , and the annual per capita water - change toilet construction investment is RMB 64.76 yuan .

9 . The ratio of economic benefits and investment costs for the prevention of diarrhoea by completely changing the water - to - toilet mode is 1 . 51 : 1 .

Conclusion : 1 . Family water supply types ( centralized water supply , decentralized water supply ) and type of drinking water ( well water , tap water , barrel water ) have no substantive impact on individual morbidity without improving water quality .

2 . The use of different types of toilet and personal hygiene can affect the incidence of individual diarrhea , but the management of sanitary toilet is not good or improper , so it is difficult to play the role of sanitary toilet .

3 . The change of water and toilet in the village has a marked effect on the morbidity of the population . The higher the water - changing toilet rate , the less the incidence , the more .

4 . The effective prevention of diarrhea in rural areas can effectively prevent the onset of diarrhea , with a certain economic benefit , and the ratio between economic benefit and investment cost is about 1 . 51 : 1 .

【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R127;R181.3

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