本文關(guān)鍵詞：中國瘧疾風(fēng)險管理策略研究　出處：《華中科技大學(xué)》2016年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 瘧疾 風(fēng)險 風(fēng)險要素 風(fēng)險評估 風(fēng)險管理 策略

【摘要】：根據(jù)瘧疾的流行歷史可分為瘧疾流行、控制、消除前、消除(2010-2020)和消除后的成果鞏固階段(2020-)。中國現(xiàn)在處于瘧疾消除階段,部分地區(qū)通過消除瘧疾考核后,資源投入,政策投入和瘧疾工作模式需要調(diào)整。然而,隨著本地病例的逐漸消除,輸入性瘧疾病例逐年增多,瘧疾傳染源依然存在；同時傳播媒介按蚊不可能被消滅,外來瘧原蟲感染本地媒介而導(dǎo)致產(chǎn)生二代病例等風(fēng)險仍然可能發(fā)生。針對瘧疾病例、病媒和瘧疾流行季節(jié)瘧疾疫區(qū)流入人口等瘧疾風(fēng)險表征的監(jiān)測管理涉及到的管理部門較多,相應(yīng)瘧疾工作主體從瘧疾消除前的衛(wèi)生系統(tǒng)逐漸擴大到了多部門協(xié)作,廣義的瘧防系統(tǒng)脆弱性由此產(chǎn)生。目前針對中國瘧疾消除后的瘧疾風(fēng)險管理仍處于探索階段,相應(yīng)的研究較少,因此開展系統(tǒng)的瘧疾風(fēng)險管理策略研究有重要意義。[目的]旨在界定瘧疾風(fēng)險內(nèi)涵,構(gòu)建瘧疾風(fēng)險管理的概念框架,梳理中國瘧疾消后的風(fēng)險管理主體,識別和分析瘧疾風(fēng)險要素,構(gòu)建瘧疾風(fēng)險評估指標(biāo)模型并進行瘧疾風(fēng)險評估,分析風(fēng)險的來源,提出相應(yīng)的瘧疾風(fēng)險管理策略體系,為中國瘧疾風(fēng)險管理體系的建立提供理論和方法的支持。[方法](1)文獻研究法。利用Pubmed、Web of Science等英文數(shù)據(jù)庫和CNKI、萬方等中國期刊網(wǎng)等數(shù)據(jù)庫搜集國內(nèi)外關(guān)于瘧疾和風(fēng)險管理的文獻,用于界定瘧疾風(fēng)險和瘧疾風(fēng)險管理的內(nèi)涵,構(gòu)建瘧疾風(fēng)險管理概念框架和分析瘧疾風(fēng)險要素。(2)現(xiàn)場調(diào)查法。在廣西、安徽和湖北省共抽取有瘧疾流行史的八個縣的所有疾病預(yù)防控制中心和10縣級及以上的瘧疾治療醫(yī)院以及24個鄉(xiāng)鎮(zhèn)衛(wèi)生院的瘧防人員、鏡檢人員和醫(yī)生共計166人,村醫(yī)53人,居民1219名,進行相應(yīng)的問卷調(diào)查；現(xiàn)場考核鏡檢人員閱片能力；調(diào)查八個縣疾控疾控機構(gòu)數(shù)據(jù),為風(fēng)險評估和風(fēng)險來源分析提供素材。(3)個人深入訪談法�；谠O(shè)計的訪談提綱,對疾控機構(gòu)和醫(yī)院瘧疾治療科室的相關(guān)負責(zé)人進行深入訪談,并借助扎根理論的原則,運用Nvivo軟件進行分析,以尋找當(dāng)前瘧疾工作現(xiàn)狀,取得的經(jīng)驗,存在的問題和策略的邏輯關(guān)系(4)數(shù)理統(tǒng)計方法。在進行處理專家咨詢結(jié)果時使用Kruskal-Wallis秩和檢驗專家協(xié)調(diào)系數(shù)；運用了熵值法優(yōu)化瘧疾風(fēng)險評估指標(biāo)權(quán)重；同時在評估瘧疾風(fēng)險發(fā)生的可能性和系統(tǒng)脆弱性時分別使用了綜合指數(shù)法和加權(quán)TOPSIS法；在瘧疾風(fēng)險來源分析時運用了相關(guān)性分析和二元Logistic回歸法分別分析相關(guān)性及影響因素。(5)專家咨詢法。專家咨詢法主要來研究瘧疾風(fēng)險管理主體的影響力和對瘧疾工作的支持力度,以及篩選關(guān)鍵的瘧疾風(fēng)險要素和確定瘧疾風(fēng)險評估指標(biāo)體系。[主要結(jié)果](1)瘧疾風(fēng)險管理概念框架是由瘧疾風(fēng)險管理的主體、客體、過程路徑及其三者之間的相互關(guān)系構(gòu)成。管理主體是由政府、行政部門和業(yè)務(wù)部門及其相互間的關(guān)系組成,客體主要是指導(dǎo)致風(fēng)險發(fā)生可能性和瘧防系統(tǒng)脆弱性的瘧疾風(fēng)險要素集。過程路徑主要指日常的瘧疾風(fēng)險防范路徑和監(jiān)測到瘧疾風(fēng)險表征后的瘧疾風(fēng)險管理過程路徑。(2)瘧疾風(fēng)險評估指標(biāo)體系主要由瘧疾風(fēng)險發(fā)生的可能性和瘧防系統(tǒng)脆弱性兩個維度構(gòu)成。瘧疾風(fēng)險可能性指標(biāo)體系由傳染源、傳播媒介風(fēng)險和人群暴露風(fēng)險3個二級指標(biāo)和7個三級指標(biāo)組成。瘧防系統(tǒng)脆弱性指標(biāo)體系主要經(jīng)濟脆弱性、社會脆弱性、衛(wèi)生系統(tǒng)脆弱性和風(fēng)險敏感性5個二級指標(biāo)和16個三級指標(biāo)組成。(3)瘧疾消除后潛在的風(fēng)險主要來自于無法監(jiān)測外來瘧原蟲感染了的本地媒介(病媒)；缺少生化檢驗的血液傳播風(fēng)險；由高風(fēng)險人群的瘧防知識行為和疫區(qū)流入人口數(shù)量信息缺乏導(dǎo)致的社會脆弱性;由基層篩查能力弱、瘧防經(jīng)費縮減和對靶人群主動篩查困難導(dǎo)致衛(wèi)生系統(tǒng)脆弱性；由相關(guān)風(fēng)險管理主體間協(xié)作困難導(dǎo)致的政治脆弱性；以及政府重視程度。[結(jié)論](1)瘧疾風(fēng)險管理是一個多部門聯(lián)合行動的過程。一般情況下是通過監(jiān)測、培訓(xùn)、宣教和溝通協(xié)作等進行風(fēng)險防范,瘧疾風(fēng)險表征一旦被監(jiān)測到,則進入瘧疾風(fēng)險評估、風(fēng)險源分析和風(fēng)險處置過程(2)基于世界衛(wèi)生組織的瘧疾風(fēng)險評估框架,從瘧疾風(fēng)險發(fā)生的可能性和瘧防系統(tǒng)脆弱性兩個維度進行瘧疾風(fēng)險綜合評估,當(dāng)前中國的瘧疾流行和暴發(fā)的可能性較小,但是歷史上非高發(fā)的流行縣域需要適當(dāng)降低瘧防系統(tǒng)脆弱性,同時密切關(guān)注瘧疾風(fēng)險發(fā)生的可能性。[創(chuàng)新與不足]本研究的主要創(chuàng)新點：(1)基于理論分析,構(gòu)建了瘧疾消除后的瘧疾風(fēng)險管理概念框架,并應(yīng)用到了瘧疾風(fēng)險要素識別與分析、風(fēng)險評估、風(fēng)險來源分析和風(fēng)險處置過程。(2)基于定量與定性相結(jié)合的分析方法從瘧疾風(fēng)險發(fā)生的可能性和系統(tǒng)脆弱性兩個維度構(gòu)建了消除后的瘧疾風(fēng)險綜合評估指標(biāo)體系。據(jù)此,從定量的角度對樣本地區(qū)進行了風(fēng)險評估,最終又在世界衛(wèi)生組織的評估框架的指導(dǎo)下,從定性的角度進行綜合評估。(3)基于風(fēng)險評估與風(fēng)險分析結(jié)果,對樣本地區(qū)消除后的瘧疾風(fēng)險管理提出了符合瘧疾消除階段瘧疾風(fēng)險管理的策略建議。本研究的不足之處：(1)瘧疾風(fēng)險發(fā)生的可能性和瘧防系統(tǒng)脆弱性的評估是借助綜合評價法進行的,評估結(jié)果是相對的。(2)在進行專家咨詢過程中,專家并沒有針對咨詢指標(biāo)的算法提出太多的異議,尤其是對定性指標(biāo)轉(zhuǎn)化成定量指標(biāo)過程中,相關(guān)指標(biāo)的賦分可進一步推敲。(3)選擇的風(fēng)險評估指標(biāo)缺乏公認的標(biāo)準(zhǔn),絕對的評估結(jié)果難以轉(zhuǎn)換。
[Abstract]:According to the epidemic history of malaria can be divided into the malaria epidemic, control, elimination, elimination (2010-2020) and after the elimination of consolidating the results (2020-). Chinese is now in the malaria elimination stage, investment of resources in some areas by eliminating malaria, assessment, policy input and malaria work mode needs to be adjusted. However, with the gradual elimination of local cases of imported malaria cases increased year by year, malaria epidemic still exists; at the same time the spread of Anopheles can not be eliminated, foreign media caused by local malaria infection two generation case risk is still possible. In cases of malaria, more monitoring and management of disease vectors and malaria epidemic season in malaria endemic areas such as malaria risk population the characterization of the related to the management, the corresponding work from the main malaria malaria elimination before the health system has gradually expanded to the cooperation of many departments, in the broad sense of malaria prevention system brittle Weak resulting. The malaria risk management Chinese malaria elimination is still in the exploratory stage, the corresponding research is less, so the research on malaria risk management strategy system has important significance. The purpose is to define the connotation of malaria risk], construct the framework of risk management of malaria, malaria elimination after combing China risk management subject identification and analysis of risk factors of malaria, malaria construction risk assessment index model and malaria risk assessment, risk source analysis, put forward the corresponding system of malaria risk management strategy, support method. To provide theory and method for the establishment of risk management system Chinese malaria] (1) the literature research method. By using Pubmed, Web of Science English and CNKI database, Wanfang China journal net database is a collection of domestic and foreign literature about malaria and risk management, to define the risk of malaria and malaria The connotation of risk management, construct the malaria risk management framework and the analysis of malaria risk factors. (2) the scene investigation. In Guangxi, Anhui and Hubei province were selected in all eight counties in malaria endemic disease prevention and control center and the history of the 10 above the county level and the treatment of malaria hospitals and 24 township health centers in malaria anti personnel, examiners and doctors a total of 166 people, 53 village doctors, 1219 residents, conducted a questionnaire survey of the corresponding site assessment examiners; reading ability; investigation of eight County CDC CDC data, provide material for risk assessment and source analysis. (3) personal interview the design of the interview method. Based on the CDC and hospital treatment of malaria department responsible person to conduct in-depth interviews, and using the principles of grounded theory analysis using Nvivo software to find the current malaria working status, the experience gained, The logical relationship problems and Strategies of the (4) statistical methods. Using the Kruskal-Wallis rank sum test expert coordination coefficient in processing the results of expert consultation; the optimization of evaluation index weight of malaria risk at the same time using the entropy method; comprehensive index method and weighted TOPSIS method in vulnerability assessment system and possible risk of malaria the analysis of malaria risk sources; in use respectively analysis of correlation and influencing factors of correlation analysis and Logistic regression method. Two yuan (5) expert consultation. The expert consultation method mainly to study the influence of the main malaria blast risk management and work on malaria support, and screening the key elements and determine the risk of malaria malaria the main results of the risk assessment index system.] (1) the concept of malaria risk management framework is composed of a body, the malaria risk management object, process route and third A relationship between them. The subject is composed by the government management, administrative departments and business units and the relationship between the object, mainly refers to the risk possibility and risk factors of malaria prevention system vulnerability. The process mainly refers to the daily path of malaria risk prevention and monitoring of malaria risk management path to path of malaria after the risk characterization. (2) and the possibility of malaria risk assessment index system is mainly composed of malaria risk prevention system vulnerability in two dimensions. The possibility of malaria risk index system from the source of infection, media and risk exposure risk of 3 level two indexes and 7 level three indexes of malaria prevention system. The main vulnerability index system of economic vulnerability, social vulnerability, health system vulnerability and risk sensitivity of 5 level two indexes and 16 level three indexes. (3) after the elimination of potential malaria The risk is mainly from the outside can not monitor the Plasmodium infection local media (vector); lack of blood biochemical test the risk of spreading from high risk population; knowledge of malaria prevention and epidemic population inflow behavior information due to the lack of social vulnerability; by primary screening can weak the malaria prevention funding reduced to the target population active screening difficulties led to the vulnerability of the health system; political vulnerability caused by the difficulties of risk management related to the subject of cooperation between; and the attention of the government. Conclusion: (1) malaria risk management is a process of multi sectoral joint action. Under normal circumstances is through monitoring, training, education and communication of risk prevention once, malaria risk characterization in malaria monitoring, risk assessment, risk source analysis and risk disposal process (2) malaria risk assessment framework based on WHO, from malaria blast And the possibility of malaria crisis prevention system vulnerability of the two dimensions of comprehensive assessment of malaria risk, the malaria epidemic and outbreak China less likely, but the history of the high incidence of non epidemic malaria prevention system of county need appropriate to reduce the vulnerability, while paying close attention to the possibility of "innovation and shortage of blast crisis in malaria] major innovations this study: (1) based on the theoretical analysis, constructs a concept framework of risk management of malaria malaria elimination, and applied to the identification and analysis of risk factors of malaria, risk assessment, risk source analysis and risk disposal process. (2) system and the possibility of quantitative and qualitative analysis method based on the combination of the occurrence of malaria from the risk of the vulnerability of the two aspects after the elimination of malaria risk comprehensive evaluation index system. Therefore, the risk assessment of the sample area from the quantitative angle, and finally in the world The evaluation framework of Health Organization under the guidance of the comprehensive evaluation from the qualitative point of view. (3) the results of risk assessment and risk analysis based on the risk management of malaria elimination of the sample area is put forward based on the strategy of eliminating malaria malaria risk management proposal stage. The deficiency of this study: (1) evaluation and the possibility of malaria malaria risk prevention system vulnerability is the use of comprehensive evaluation method, the evaluation results are relative. (2) in the process of expert consultation, expert consultation and not for index algorithm is proposed too many objections, especially on the qualitative indexes into quantitative indexes, related index score further scrutiny. (3) the risk assessment index selection lack of accepted standards, the absolute evaluation results are difficult to convert.

【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R531.3
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本文編號：1432107