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目的通过回顾性分析2010—2016年淮安市报告的输入性疟疾病例诊断和救治情况,评估医疗机构在输入性疟疾防控中的作用。方法对2010—2016年淮安市网络直报系统和疟疾防治系统的疟疾病例流行病学个案调查表中疟疾疫情、病例诊断和治疗等个案数据信息,采用描述流行病学方法分析医疗机构在疟疾病例的报告、确诊和治疗中的作用。结果 2010—2016年淮安市共报告输入性疟疾病例286例,其中死亡2例,均为恶性疟,输入来源地为非洲,病死率为0.70%。医疗机构和疾控机构分别报告病例207例(占72.38%)和79例(占27.62%)。在201例输入性疟疾病例中,171例首诊为疟疾,诊断正确率为85.07%(171/201)。医疗机构的首诊正确率(78.87%,112/142)明显低于疾控机构(100.00%,59/59)(P<0.05)。乡镇级及以下、县级、地市级和省级医疗机构的首诊正确率分别为4.12%(15/34)、95.24%(40/42)、87.69%(57/65)和0(0/1),各级医疗机构间的差异有统计学意义(P<0.05)。医疗机构和疾控机构确诊的病例比例分别为65.67%(132/201)和34.43%(69/201),两者间差异有统计学意义(P<0.05)。乡镇级及以下、县级和地市级医疗机构的确诊比例分别为4.98%(10/201)、21.39%(43/201)和39.30%(79/201),各级医疗机构间的差异有统计学意义(P<0.05),各级疾控机构间的差异亦具有统计学意义(P<0.05)。结论各级医疗机构间的首诊准确率和确诊率差异较明显,基层医疗单位的疟疾诊疗知识溃泛和镜检疟原虫的能力较差,其诊断准确率明显低于同级疾控机构。
Objective To evaluate the role of medical institutions in the prevention and control of imported malaria by retrospectively analyzing the diagnosis and treatment of imported malaria reported in Huaian from 2010 to 2016. Methods The epidemiological data of malaria cases, diagnosis and treatment of malaria cases in the 2010-2016 online direct reporting system and malaria prevention and control system of Huai’an City were used to describe the epidemiological analysis of malaria cases in medical institutions The report, the role of diagnosis and treatment. Results A total of 286 cases of imported malaria were reported from 2010 to 2016 in Huai’an City. Among them, 2 died of falciparum malaria and the origin of the disease was from Africa. The case fatality rate was 0.70%. Medical institutions and CDC reported 207 cases (72.38%) and 79 cases (27.62%) respectively. Of the 201 cases of imported malaria, 171 were first diagnosed as malaria, with a diagnostic accuracy rate of 85.07% (171/201). The first diagnosis accuracy of medical institutions (78.87%, 112/142) was significantly lower than that of CDC (100.00%, 59/59) (P <0.05). The accuracy of first diagnosis at township level and below, county level, prefecture level and provincial level medical institutions was 4.12% (15/34), 95.24% (40/42), 87.69% (57/65) and 0 (0 / 1). The differences among the medical institutions at all levels were statistically significant (P <0.05). The proportion of cases diagnosed by medical institutions and CDC was 65.67% (132/201) and 34.43% (69/201), respectively, with statistical significance (P <0.05). The rates of diagnosis at the township level and below, county-level and municipal-level medical institutions were 4.98% (10/201), 21.39% (43/201) and 39.30% (79/201), respectively Statistical significance (P <0.05), the differences between CDC institutions at all levels also had statistical significance (P <0.05). Conclusions The accuracy and the diagnosis rate of first visit among medical institutions at all levels are quite different. The knowledge of malaria diagnosis and treatment in grassroots units is poor and the ability of microscopic examination of Plasmodium is poor. The accuracy of diagnosis is obviously lower than that of CDC.