【作者】 任忠和；

【导师】 徐凌忠； 王英；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2009， 硕士

【摘要】 研究背景:结核病是一种严重危害人类健康的慢性传染病。在20世纪60年代曾被宣称“作为一个公共卫生问题将于2000年被消灭。2000年,全国结核病流行病学抽样调查结果显示,我国活动性肺结核患病率仍高达367/10万,其中涂阳肺结核患病率高达122/10万。1993年,世界卫生组织(WHO)提出了“全球结核病处于紧急状态宣言”。据WHO估算,全球有20亿人已经受结核菌感染,每年约有200万人死于结核病,2020年死亡总数估计将达到3500万。1998年,WHO再次指出“遏制结核病行动刻不容缓”。2002年卫生部疾病控制司印发的《中国结核病防治规划实施工作指南》中明确宣布了我国是全球22个结核病高负担国家之一。国务院办公厅2001年发布的《全国结核病防治规划(2001-2010年)》,提出“全国结核病防治知识知晓率到2005年达到60%,到2010年应达到80%”的目标。目前,中国大约80%的结核病人在农村,结核病疫情在经济不发达的中西部地区尤为严重。结核病是中国农村因病致贫,因病返贫的主要疾病之一。有效遏制结核病疫情,不仅需要政府的投入和医务人员的努力,更需要多个部门的配合和公众对结核病的了解。这也是我们本次把调查选在农村的主要原因。通过调查分析,进一步了解和掌握村民对结核病防治知识知晓水平情况,为相关卫生部门提供参考,以便有目标地开展结核病防治健康教育与健康促进工作。研究目的:了解和探讨包头市农村村民有关结核病防治知识的知晓率,以及获得信息的渠道,分析其可能影响因素,为当地今后更有效地开展结核病防治健康教育与健康促进工作提供参考。研究方法:采用完全随机抽样方法,应用《全国公众结核病防治知识信念行为调查报告》(2006年)推荐的全国公众结核病防治知识、信念、行为调查问卷对包头市土右旗1156例15岁及以上的村民的结核病防治知识知晓情况及获得信息渠道进行询问式问卷调查。主要调查结果:共调查1156例,其中男性493例(42.7%),女性663例(57.3%)。调查对象中年龄最小为15岁,最大为73岁,平均年龄为50.2岁。村民结核病防治核心信息总知晓率为40.5%;3条主要核心信息全部知晓率为7.8%;2条主要核心信息全部知晓率为12.6%;8条核心信息全部知晓率为7.4%。有72.2%的调查对象认为肺结核能传染,有37.0%的调查对象正确回答国家关于免费检查和免费治疗肺结核的问题。随年龄增高知晓率降低(p＜0.05),男性知晓率高于女性(p＜0.05),不同文化程度调查对象结核病防治知晓率有差别(p＜0.05)。单项知识知晓率差距较大,绝大多数村民知道肺结核是一种严重威胁健康的传染病,其主要症状为咳嗽,对劳动能力有很大影响,但可以治愈。而对肺结核的早期就诊、就诊的专业机构名称、免费检查和治疗政策等方面知识和信息的知晓率偏低。对结核病人的歧视情况较为普遍,46.4%的村民选择与肺结核病人接触保持距离,甚至不交往。村民主要通过人际渠道获取结核病信息,覆盖率达到75.9%。媒体传播中以电视覆盖率最高,为43.6%,报纸、杂志、书刊覆盖率最低,为11.6%。结论与建议:村民对结核病知识有一定了解,但8条核心信息总知晓率(40.5%)低于全国平均水平(48.9%)。8条核心信息全部知晓率较低(7.4%),男性知晓率高于女性,各年龄组间知晓率有差异,随着年龄的增大,结核病防治知识知晓率降低。村民结核病知识知晓率现状距《全国结核病防治规划(2001-2010)》目标存在较大的差距,应以此为努力方向,进一步加大结核病防治工作力度,持续推进结核病控制健康促进工作。在整体加强宣传教育、普及结核病防治知识的同时,应注意侧重于女性和老年人。村民对结核病传染性、预防方面、专门诊治机构和国家有关免费政策的知识理解不够全面,知晓率偏低。建议应有针对性地加强这几方面的知识宣传,提高村民结核病知识的总知晓率,让村民真正了解并享受到国家关于结核病控制项目的政策。另外,对结核病病人歧视的情况应引起重视,有46.4%的人选择不与肺结核病人交往或保持距离,结核病防控机构要做好这方面的工作,注意正确引导。村民获得结核病防治知识的主要途径为人际渠道,其次为电视和宣传画册,通过广播、书刊获取信息的人较少。建议加强广播、电视、报纸等社会媒体的宣传,建立长效机制,根据村民的需求开展多形式的健康教育。调查中发现,村民认为健康教育宣传品是一种较好的获得卫生知识的途径,它的针对性比较强,因此在今后的结核病防治工作中,应充分发挥宣传品的作用,使之与广播、电视等大众传播媒体形成有益的补充。结核病健康促进教育在农村中的开展任重道远。所有的调查结果均表明,结核病知识知晓率农村低于城市,而我国疫情特点是农村高于城市,这极不利于结核病的预防和早期患者的发现。农村社区是今后开展结核病健康教育的重点区域,应在农村广泛开展结核病健康教育工作,提高农村社区居民结核病防治知识水平。更多还原

【Abstract】 BackgroundTuberculosis (TB)is a chronic disease that has done much harm to human beings’ health, and it was declared in 60s last century that TB would be wiped out in 2000 as a problem in public health. The result of nationwide epidemiolo-gical sampling survey of TB in 2000, however, revealed that the incidence of active TB came up to 367/100000 and the incidence of smear positive TB was up to 122/100000. In 1993 WHO proclaimed a worldwide emergency state of TB. According to WHO’s estimates, 2 billion people worldwide have been infected by TB and about two million people die of TB each year. The total number of deaths of TB is expected to reach 35 million in 2020. In 1998, WHO again pointed out that immediate actions must be taken to hold back TB. It was stated in Implementation Guide to China’s Project of TB Prevention and Control published in 2002 by the Disease Control Division of the Ministry of Public Health that China is one of the 22 TB heavy-burden countries in the world. An object was set in National TB Project of Prevention and Control(2001-2010)issued in 2001 by the General Office of State Council that nationwide awareness rate of TB prevention and control was to reach 60% in 2005 and 80% in 2010. At present, around 80% of tuberculosis patients in China live in the countryside. Tuberculosis epidemic in economically underdeveloped central and western regions is particularly serious. Tuberculosis is also one of the serious diseases that is responsible for the poverty and the return of some peasants to the poverty in the country of China. Effectively preventing and controlling TB epidemic requires not only the fund-input of the government and the efforts of the medical community but also multi-sectoral co-operation and public awareness of TB, which accounts for the conduct of the present investigation in the country. The investigation was performed to further evaluate the villagers’ knowledge of TB prevention and control, and thus to provide referential basis for the health sectors, so that prevention and control education of TB, health education and promotion work of health care could be carried out with a definite target.ObjectiveTo study and investigate the rural villagers’ awareness level of TB prevention and control in the city of Baotou and their access to information as well, and to analyze its possible predisposing factors so as to provide the reference for further education of more effective tuberculosis prevention and control, health education and health promotion work in the future.MethodsWith sampling at complete random, the questionnaire of public knowledge, beliefs, behaviors in national tuberculosis prevention and control recommended by "Report" was used to make an investigation on the awareness level of TB prevention and control and the access to the information concerning TB among 1156 villagers(15 years old and the above) from Tuyouqi in the city of Baotou.ResultsOf 1156 villagers questioned for the investigation, there were 493 males(42.7%) and 663 females(52.7%),with the youngest 15 years old and the eldest 73 years old,50.2 years old on the average. The villagers’ total awareness rate of core information for TB prevention and control was 40.5%;the total awareness rate of 3 leading items of core information was 7.8%;the total awareness rate of another two key items of core information was 12.6% and the total awareness rate of all the eight items of information was 7.4%.72.2% of the responders were aware that tuberculosis was an infectious disease;37.0% of the responders could correctly answer the questions about the state’s policy of free medical exam and treatment of TB. It was found that the villagers’ awareness level fell with advance in age(P<0.05) and that the male’s awareness level was higher than the female’s(P< 0.05).There was a remarkable difference in single-item awareness rate among the individuals. The vast majority of the villagers learnt that tuberculosis is a serious infectious disease that can bring on a threat against the health, with a remarkable symptom of persistent cough, and significantly affect the ability to work, but can be cured. The villagers’ awareness rate of early treatment of tuberculosis, specialized medical organizations for tuberculosis, free exam and treatment policies was comparatively low. There commonly existed discrimination against TB patients and 46.4% of the villagers chose to keep TB patients at distance or even to avoid contacting with them.The Villagers acquired TB information mainly through interpersonal communication, with a coverage of 76 percent. Television led the media in providing TB information, with a coverage of 43.8%. Newspapers, magazines and books took the lowest coverage of 11.6%.Conclusion and SuggestionsVillagers in the countryside have a certain understanding of TB, but the total awareness rate of eight items of core information(40.5%) is lower than the nationwide average(48.9%). The complete awareness rate of eight items of core information is comparatively low(7.4%), with the male’s awareness rate higher than the female’s. There are differences in awareness rate among various age groups, and the awareness rate of TB prevention and control drops with age. There is a huge gap between the villagers’ awareness rate of TB and the target rate of awareness established in National TB Project of Prevention and Control(2001-2010). Every effort should be made to enhance TB prevention and control and to strengthen health education. Much attention should be paid to the popularization and publicity of knowledge concerning TB prevention and control, with an emphasis on the females and the old.Villagers fail to acquire a comprehensive understanding of TB infection and prevention. Moreover, they are not well -informed about specialized organizations for diagnosis and treatment of TB, and state’s policies of free treatment of TB. It is suggested that special efforts should be made to strengthen the publicity of the knowledge on the above aspects and to raise the villagers’ awareness rate of TB, making the villagers fully understand and enjoy the state’s policies of TB prevention and control. Additionally, much attention should be paid to the discrimination against TB patients, as 46.4% of the villagers choose to keep them at a distance or not to make contact with them. TB prevention and control organizations are supposed to offer correct guidance and manage to change such conditions.The main way for villagers to get TB information is interpersonal communication, followed by television and propaganda pictures. Fewer villagers gain information from broadcasting, books and magazines. It is advised to promote the media propaganda through broadcasting, television and newspapers, etc. Various forms of health education should be carried out to meet the needs of the villagers, thus establish the long-term mechanism. As the survey suggests, health education and publicity materials is a better way for the villagers to obtain health knowledge, which is well directed and should be made the best use of in the future TB prevention and control, serving as a useful complement to such mass media as broadcasting and television.It is a long way to go to carry out health education in the rural areas. The result of the investigation shows that the people’s awareness rate of TB in the country is lower than that in urban areas. The epidemic characteristics in China, however, is that the incidence of TB in the country is higher than that in the urban areas, which is not conducive to the prevention of TB and identification of TB patients in the early stage. Village communities are the crucial areas for the future TB health education. Extensive TB education ought to be launched so as to raise the residents’ awareness level of TB prevention and control in the village communities.更多还原