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目的评估中国疟疾防治系统的脆弱性,为疟疾的风险管理提供策略建议。方法采用分层随机抽样和典型抽样相结合的方法于2015年7月—2016年2月在湖北、安徽和广西3个省共抽取8个样本县(区),通过文献检索、小组头脑风暴和专家咨询等方法编制调查问卷对样本县(区)疟疾流行现状和居民的疟疾防治知识进行调查,选出代表性指标,运用TOPSIS法对样本县(区)的疟疾防治系统脆弱性进行评估。结果通过文献检索、小组头脑风暴和专家咨询,最终选取经济脆弱性、社会脆弱性、政治脆弱性、卫生系统脆弱性和敏感性5个维度共19个指标,权重系数为0.009 2~0.103 7,其中,疫区流入人员数量(0.100 6)和政府疟疾风险关注度(0.103 7)权重系数较大;中国8个样本县(区)疟疾防治系统脆弱性从高到低依次为湖北省潜江市(0.652 42)、安徽省淮南田家庵区(0.578 39)、安徽省肥西县(0.509 58)、湖北省广水市(0.459 92)、广西省都安县(0.405 82)、安徽省淮南谢家集区(0.369 89)、广西省天峨县(0.234 74)、广西省南丹县(0.181 66),总体的系统脆弱性不高。结论中国疟疾防治系统总体脆弱性不高,政府疟疾风险关注度和疫区流入人员数量是影响疟疾防治系统脆弱性最为重要的风险因素。
Objective To assess the vulnerability of malaria control systems in China and provide strategic advice on malaria risk management. Methods A total of 8 sample counties (districts) in Hubei, Anhui and Guangxi provinces from July 2015 to February 2016 were selected by a combination of stratified random sampling and typical sampling. Through literature review, group brainstorming and Expert consultation and other methods to prepare questionnaires to investigate the status of malaria in sample counties (districts) and malaria prevention and control knowledge of residents, select representative indicators and evaluate the vulnerability of malaria control systems in sample counties (districts) by TOPSIS. Results A total of 19 indicators including economic vulnerability, social vulnerability, political vulnerability, health system vulnerability and sensitivity were selected through literature search, group brainstorming and expert consultation. The weight coefficients ranged from 0.009 2 to 0.103 7. Among them, the number of inflow of infested persons (0.1006) and attention degree of government malaria (0.103 7) were larger. The vulnerability of malaria control systems in 8 sample counties (districts) in China was from Qianjiang (0.652 42), Tianjia’an District of Huainan in Anhui Province (0.578 39), Feixi County of Anhui Province (0.509 58), Guangshui City of Hubei Province (0.459 92), Du’an County of Guangxi Province (0.405 82) In the catchment area (0.369 89), Tian’e County in Guangxi Province (0.234 74) and Nandan County in Guangxi Province (0.181 66), overall system vulnerability is not high. Conclusion The overall vulnerability of the malaria control system in China is not high. The attention of the government on malaria risk and the inflow of infested population are the most important risk factors affecting the vulnerability of the malaria control system.