江西省村级卫生机构传染病症状监测能力评价及对策研究

发布时间：2018-05-20 02:33

本文选题：传染病 + 症状监测　；参考：《复旦大学》2013年硕士论文

【摘要】：自SARS危机暴发后,我国于2004年建立了法定传染病实时报告系统,该系统以病例诊断为基础,自实施后有效地改善了传染病报告的及时性。但是在农村地区,疫情的迟报和漏报现象依然非常严重,尤其在村级卫生机构,因为人员、设备等资源匮乏,往往无法及时发现传染病。症状监测作为一种新兴的公共卫生监测手段引起了普遍的关注。相对于传统的疾病监测,症状监测是收集病人在疾病确诊前的健康相关事件或行为。以医疗机构为例,症状监测不依赖特定诊断,而对人群中非特异性的临床症状(如发热、腹泻等)的发生频率进行监测,通过发现聚集性病例或可疑事件,对传染病进行早期预警。对于缺乏实验室诊断条件的农村地区,症状监测不失为一种有效的补充监测手段。症状监测系统的设计与建立过程复杂,需要综合考虑实际需求、现实条件以及可利用的资源等诸多因素。只有当卫生机构的资源配置和能力水平与症状监测的设计相适应时,监测系统才能正常运行。本研究依托于欧盟项目“中国农村地区传染病症状整合监测系统”(Integrated Surveillance System in rural China, ISSC),以江西省的2个县作为研究现场,探讨了在农村地区建立传染病症状监测的可行性及存在的问题,并对2个县的村级卫生机构和村级卫生人员开展传染病症状监测的能力进行了综合评价。第一部分江西省村级卫生机构建立传染病症状监测的可行性研究目的研究在村级卫生机构建立传染病症状监测是否可行及存在的问题。方法对江西省2个县37个乡镇的355名村医进行问卷调查,了解村医对症状监测的认知和接受度：在两县各开展1组小组访谈,定性研究症状监测数据采集与报告的可行性及存在的问题。结果79.6%的村医会在门诊日志上详细记录每位病人的信息,仅2.0%从来不做门诊记录；74.8%的村医门诊日志记录包含症状监测所需的基本信息；“一村一所”管理模式下村医门诊日志的记录情况(Χ2=22.036,P0.0001)和监测信息的登记情况(Χ2=7.794,P0.0001)明显好于“一村多所”分布模式下的村医；网络直报是村医首选的监测报告方式(56.4%)；60.6%的村医认为自己能够每天记录和上报监测信息,但45.7%的村医认为工作量较大；村医的传染病症状知识得分平均为40.60±19.32分。结论在村级卫生机构建立传染病症状监测具有一定的可行性,但需对门诊日志记录进行规范化管理,实现症状监测数据源的电子化,简化数据采集与报告流程,提高村医对症状监测的认知水平。第二部分江西省村级卫生机构建立传染病症状监测的能力现状研究目的研究江西省村级卫生机构建立传染病症状监测的能力现状及资源条件。方法采用多阶段整群抽样的方法,调查并分析了江西省2个县15个乡镇155家村卫生室的基本设置、硬件配备、信息化程度以及经营管理状况。结果村卫生室的平均服务人口为1657人,最远的居民步行到村卫生室的平均时间为37.6分钟；91.0%的村卫生室一周7天都开诊,“一村一所”管理模式下村卫生室开诊的稳定性优于“一村多所”模式(P0.05)；在听诊器、体温计、血压计、出诊箱、紫外灯等诊疗设备的配置上,“一村一所”模式下的村卫生室明显多于“一村多所”模式(P0.01)；村卫生室的电脑配备率为95.5%,网络覆盖率为86.5%,但35.5%网速较慢,17.4%经常断网,26.5%有时会停电。结论村卫生室基本具备症状监测信息化建设的资源和条件,监测频率可以日为单位进行；“一村一所”管理模式下村卫生室的硬件配置和经营状况优于“一村多所”模式,更适合症状监测的开展。第三部分江西省村级卫生人员传染病症状监测能力评价及对策研究目的研究江西省村级卫生人员开展传染病症状监测的综合能力及意愿并提出对策和建议。方法采用多阶段整群抽样的方法,通过问卷调查分析江西省2个县15个乡镇253名村医的基本卫生服务能力及电脑操作能力、传染病防控能力和提供公共卫生服务的意愿及经济驱动因素等。结果村医平均年龄44.56±11.92岁；160名监测报告员中约有12.5%不会使用电脑；村医最常接诊的疾病主要有上呼吸道感染、急性和慢性胃肠道感染、高血压和糖尿病；“一村一所”管理模式下村医接诊的病人数明显多于“一村多所”模式(Z=-8.105,P0.0001)；村医接触最多的五种传染病是流感、其他感染性腹泻、流行性腮腺炎、水痘和痢疾；75.9%的村医发现传染病人后会立即报告乡镇卫生院；”一村多所”模式下村医提供公共卫生服务的意愿(Χ2=4.827,P=0.028)和获得的公共卫生服务补贴(Z=83.863,P0.0001)要高于“一村一所”管理模式下的村医。结论村医的卫生服务能力和传染病防控能力基本满足开展症状监测的要求；发热、咽痛、咳嗽、腹泻、皮疹应作为优先关注的目标监测症状；“一村一所”管理模式下的村医开展症状监测的能力更强,但其依从性会受经济因素的影响。
[Abstract]:Since the outbreak of the SARS crisis, a real time reporting system for notifiable infectious diseases was established in 2004. The system is based on case diagnosis and has effectively improved the timeliness of infectious disease reports. However, in rural areas, the delay and failure of the epidemic are still very serious, especially in village level health institutions, because of personnel, equipment and other funds. Symptoms monitoring, as a new means of public health monitoring, has aroused general concern. Compared with traditional disease monitoring, symptom monitoring is the collection of health related events or behaviors before the diagnosis of the disease. The frequency of non specific clinical symptoms (such as fever, diarrhoea, etc.) in the group is monitored, and early warning of infectious diseases is carried out by discovering clustered cases or suspicious events. For rural areas lacking laboratory diagnostic conditions, symptom monitoring is an effective supplementary monitoring method.
The design and establishment of the symptom monitoring system is complex and requires a comprehensive consideration of practical needs, realistic conditions and available resources. Only when the resources allocation and ability level of the health institutions adapt to the design of symptoms monitoring, the monitoring system can be carried out normally. This research is based on the EU project "China rural areas." Integrated Surveillance System in rural China (ISSC) and 2 counties of Jiangxi province were used as the research sites. The feasibility and problems of establishing the symptoms monitoring of infectious diseases in rural areas were discussed, and the surveillance of infectious diseases in village level health institutions and village health workers in 2 counties was carried out. The first part of the village level health institutions in Jiangxi province to establish the feasibility of monitoring the symptoms of infectious diseases in the village level health institutions to establish infectious disease symptoms monitoring is feasible and existing problems. Methods of 37 villages and towns in 2 counties in Jiangxi Province, 355 village doctors to investigate the symptoms of village doctors to understand the symptoms of the symptoms Cognition and acceptance of monitoring: 1 groups of group interviews were conducted in two counties to determine the feasibility and problems of symptom monitoring data collection and report. Results 79.6% of the village doctors recorded each patient's information in the outpatient log, only 2% never made outpatient records, and 74.8% of the village medical clinic logs included symptom surveillance. The basic information needed is to be measured; the records of the village medical clinic log (2=22.036, P0.0001) and the registration of monitoring information (2=7.794, P0.0001) are obviously better than the village doctors under the "one village and many" distribution pattern under the "one village and one village" management model; the network direct report is the monitoring report of the village medical first selection (56.4%); and 60.6% of the village doctors believe that We can record and report monitoring information every day, but 45.7% of the village doctors think the workload is large; the average knowledge score of the infectious disease symptoms of village doctors is 40.60 + 19.32 points. Conclusion it is feasible to establish the symptoms monitoring of infectious diseases in the village health institutions, but it is necessary to standardize the records of the log records in the outpatient department to realize the symptom monitoring number. According to the electronization of source, simplify the process of data collection and reporting, and improve the cognition level of village doctors for symptom monitoring.
The second part is about the current situation of the monitoring of infectious disease symptoms in village health organizations in Jiangxi.
Objective to study the status and resource conditions of establishing infectious disease symptoms monitoring in Jiangxi village health institutions. Methods using multi stage cluster sampling method, the basic settings, hardware, information level and management status of 155 village health rooms in 15 villages and towns in 2 counties of Jiangxi province were investigated and analyzed. The service population was 1657 people, the average time for the farthest residents to walk to the village health room was 37.6 minutes, and 91% of the village health rooms were open for 7 days a week. The stability of the village clinics was better than the "one village multiple" model (P0.05) under the management mode of "one village one house"; and the diagnosis and treatment of the stethoscope, thermometer, blood pressure meter, the outpatient box, and the ultraviolet lamp were set up. In the configuration, the village health room was obviously more than the "one village and many" model (P0.01). The village health room's computer allocation rate is 95.5%, the network coverage rate is 86.5%, but the 35.5% network speed is slower, 17.4% often breaks the net, and the 26.5% is sometimes blackout. Conclusion village Wei Sheng room basically has the resources and article of symptom monitoring information construction. The monitoring frequency can be carried out in a day, and the hardware configuration and management of the village health room is better than the "one village" model under the management mode of "one village one house".
The third part is the evaluation and countermeasure research of infectious disease symptom monitoring ability of village level health personnel in Jiangxi province.
Objective to study the comprehensive ability and willingness of village health workers to monitor the symptoms of infectious diseases in Jiangxi, and to put forward countermeasures and suggestions. Methods using multi stage cluster sampling method, the basic health service ability and computer operation ability of 253 village doctors in 15 villages and towns in 2 counties of Jiangxi province were investigated and analyzed. The average age of village doctors was 44.56 + 11.92 years old. The average age of village doctors was 44.56 + 11.92 years old; about 12.5% of the 160 monitoring Rapporteur would not use the computer; the most common diseases of the village doctors were upper respiratory tract infection, acute and chronic gastrointestinal infection, hypertension and diabetes; "one village one" management model village. The number of patients receiving medical treatment is obviously more than "one village and many" models (Z=-8.105, P0.0001); five kinds of infectious diseases that the village doctor contact most are influenza, other infectious diarrhea, mumps, chickenpox and dysentery; 75.9% of the village doctors will report the township health care hospital immediately after the infection of the patients; and the village doctor provides the public sanitation under the "one village" model. 2=4.827 (P=0.028) and public health service subsidies (Z=83.863, P0.0001) are higher than the "one village one village" management model. Conclusion the health service ability and infectious disease prevention and control ability of village doctors basically meet the requirements of symptom monitoring; fever, sore throat, cough, diarrhea, rash should be the priority attention. Objective monitoring symptoms; village doctors have stronger ability to carry out symptom monitoring, but their compliance will be affected by economic factors.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R181.8

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