| The struggle between the mankind and infectious disease is an eternal subject. Our country achieved the world interest at the infectious disease control. The incidence and death rate of the infectious disease maintain the relatively stable low level. Under this situation, we have neglected the importance of disease control on the thought. In recent years, the speed that the virus makes a variation and travels is accelerated day by day because of the influence of globalization, abuse of antibiotic, development of communication and travel, environmental factors, etc. the infectious diseases which have been already controlled reoccur and new infectious diseases emerge constantly. All these infectious diseases aggravate the burden of the disease. Immunity and corresponding precautionary measures dropped the incidence of disease and death rate of some common infectious diseases to a low level, but in developing countries with a population of about 85% of the world's total, the infectious diseases remain a serious public health problem.The report of infectious disease is an important content of the infectious disease management. The overall, prompt, accurate report is the source of information in preventing the infectious diseases from spreading. The prevention and control of information to infectious disease play a very important role. On abroad, they mostlyadopt the national electronic monitoring system to raise the report quality. The epidemic information transmission of our country is not unobstructed. Failing to report, reporting belatedly occurs sometimes. These all lead to the inaccurate figures which are from the reporting system. Failing to report is one of the main reasons that cause figures to be inaccurate. All the centers for disease control and prevention investigate the cases of fail to report at least once a year for medical organizations and for rural residents every two years. The rate of fail to report is 11%~50% for medical organizations and 50%~90% for rural residents. Many documents are the work report of CDC. Investigations are more carried for medical organization and urban residents than for rural residents. The situation of infectious disease report and analysis of loss report is not quantitative analysis but qualitative description.Though the network report system that our country adopted improves the transmission speed of information at present, it still can not improve the quality of source data. This study focused on the situation of loss report of rural residents and medical organization in monitored and unmonitored point in Henan, in order to improve the report quality and provide more perfect principles to government's policymakers.Material and methods:1.Object: infectious diseases loss report of village: choose Yiyang county of Luoyang and Queshan county of Henan Province as the scene and local formal registered permanent residence or local rural residents of the above of half a year as the respondent. Investigation of failing to report of the medical organization: Select one grade of medical organizations, military hospital, the individual clinic and village clinic in the district level, county level and city level.2.Methods: adopt multi-stage stratified cluster sampling and simple random sampling method to confirm samples. Confirm the sample size according to national relevant standards; this study researches the situation and causes of infectious diseases fail to report through rural residents and medical organization.3.Content: investigate the situation of infectious diseases occurrence (orsuspected occurrence) and treatment on January 1 - December 31, 2003.Including the respondent's basic situation, incidences of infectious diseases, time of being sick, treatment, medical organization making a definite diagnosis of infectious diseases, the reason of loss report, etc.Loss report investigation for hospital includes mainly kinds of infectious diseases were failed to report, infectious diseases administration of hospital, doctors, quality of infectious diseases report, situation of net report system.4. Analysis of the data: use FoxPro 6.0 and Spss 12.0 to input, audit and analyze the data.4.1 Describing statistics: Describe hospital form, the sorts of infectious diseases, and the form of doctors who are in duty with cake picture; Describe loss report rate of different ages, different seasons and different regions with column picture; Describe the loss report rate of different gender, educational level and the title of a technical post of the doctors with compound column picture.4.2 statistic analysis: x2-test, Rank test, Alternate analysis.Results:Part one: loss report investigation of rural residents1. Kinds of infectious diseases which were failed to report and loss report rate of the two counties: Queshan County finds altogether 143 cases 10 kinds of infectious diseases legally in Class B, Class C and 41 cases were reported, 102 cases were failed to report. The loss report rate of Queshan is 77.33%. Yiyang County finds altogether 319 cases 12 kinds of infectious diseases legally in Class B, Class C and 15 cases were reported, 304 cases were failed to report. The loss report rate of Yiyang is 95.30%.2. Loss report rate comparison of monitored point and unmonitored point: loss report rates of monitored point and unmonitored point are 71.33% and 95.30%. There is significant difference between them and loss report rate of unmonitored point is higher. There is significant difference in respiratory and Intestinal infectious disease of two points. There is no significant difference in composition of theorganization that the infectious disease patients go to. According to village clinic, commune hospital, hospital at county level, loss report rates of unmonitored point are always higher than monitored point.3. Comparison of loss report rates between tuberculosis and other infectious diseases: the loss report rates of tuberculosis and other infectious diseases are respectively 54.55% and 96.75%. There is significant statistical difference between them (p<0.001) and the loss report rate of tuberculosis is less than that of other infectious diseases.4. Distributions of the loss report of legal infectious diseases4.1 gender distributions: the loss report rates of male and female is 94.80% and 95.90%. There is no significant statistical difference between the two groups (p=0.646).4.2 age distributions: the loss report rates of infant group, children's group, teenager's group, middle aged group and old group are respectively 100.00%, 98.06%, 82.22%, 92.11%, and 96.15%. There are significant statistical differences around those groups (P<0.001). The loss report rate of infant group is the most.4.3 season distributions: the loss report rates of spring, summer, autumn and winter are respectively 88.10%, 94.03%, 99.23% and 93.75%. There is significant statistical difference around the four seasons (P<0.001) and the loss report rate of autumn is the most.Part two: Loss report investigation of medical organization1. Kinds of infectious diseases that were failed to report and loss report rate 133 230 cases from clinic daily record and cases in hospital were investigated.12 kinds total 1053 cases were found. 895 cases were reported and 158 cases were failed to report. The loss repot rate is 15.00%. The infectious diseases found were Virus hepatitis, pulmonary tuberculosis, bacillary dysentery, syphilis, gonorrhea, epidemic hemorrhagic fever, measles, AIDS, Japanese Type-B encephalitis, epidemic cerebrospinal meningitis, whooping cough, mumps.2. Distribution of the cases .2.1 distributions of regions: the loss report rates of infectious diseases ofJiaozuo city, Hebi city, Shangqiu city, Xinyang city and Xinxiang city are 5.80%, 12.92%, 12.24%, 10.90% and 34.30% respectively. There are significant statistical differences in loss report rates around those regions (P<0.001) and the loss report rate of Xinxiang city is the most.2.2 loss report rates distribution of different rank of hospital: the loss report rates of hospital in city, district hospital, hospital in county, village clinic, private hospital, military hospital are 8.42%, 4.87%, 7.38%, 25.45%, 44.44% and 52.94%. The loss report rates of different rank of hospitals are different (P<0.001).2.3 Formation of loss report: 70.44% was failed to report by doctors; 10.69% was failed to report by health promoting dept.; 14.47% was failed to report by net report system.3.The information of the person who charge the infectious diseases report3.1 Basic information of the personal responsible for infectious diseases report: The full-time staff is 2 times of the part-time personnel's who responsible for infectious diseases report in CDC and medical organization. 32.65% of personal responsible for infectious diseases report in CDC gain the bachelor degree and that of medical organization is only 6.12%.3.2 Doctor's knowledge of infectious disease: All individual doctors do not know for which kind legal infectious disease is divided and which diseases every kind includes. 3 of 6 private doctors and 52% doctors in hospital do not know the time limit of infectious diseases report.4. Medical organization loss report situation of monitored point and unmonitored points: Xinyang city is the monitored point and the other four cities are unmonitored points in this study. There is significant difference on loss report rate of these two kinds. Loss report rate of medical organizations in unmonitored point is higher. According to the clinical doctors, the loss report rate is higher in unmonitored point. It is the main reason of failing to report that the patient has not returned the laboratory test reports.5. Administrative situation of the infectious disease report: the leading groups have been established in every CDC and adopt the hierarchical management systemstrictly; provide supervision and guidance to the subordinate unit irregularly. Rules and regulations are sound. They have made the preventing and curing scheme to the great infectious disease and made the system of rewards and penalties. The leaders of the medical organization pay attention to the infectious disease report and have made the self- inspection system. Every hospital has daily clinic record but some hospitals fill in incompletely. Private clinics do not have infectious diseases administration system.6. Quality of the card of infectious disease report: 89% of all cards are filled in intact. Registered permanent residence address, address, reporting hospital and person are the main content which are not filled in. 88% of the cards are filled in accurately and the inaccurate content is mainly the first visit date, date of the onset, age and job.Conclusion:1. The Situation of failing to report of the rural legal infectious disease in Henan Province is more serious. The diseases whose failing to report rate are more higher are Virus hepatitis, Measles, Bacillary dysentery. Propose these diseases be report as the special diseases.2. The village clinic is the key link causing the rural resident's infectious disease to fail to report. Propose setting up essential incentive mechanism as soon as possible, perfect the tertiary disease information feedback and medical prevention and health care network.The clinical doctors are the key tache who leads to the loss report of medical organization. Propose strengthening the supervision and rewards and punishments measure of legal infectious diseases reporting to the clinician and the inspectors.3. Result that the infectious disease trains is relatively bad. The doctors do not know which disease should be reported or whom they should report to, etc. Propose strengthening the examination to the result of training of staff member of hygiene at the basic level.4. The rate of failing to report of military hospital is relatively high. ProposeInfectious disease report work of military hospital and general hospital should all belong to local hygiene administrative department on management.5. Policy recommendationsStrengthen the supervision law enforcement dynamics of the infectious disease report, set up and amplify the incentive mechanism of the legal infectious disease report; Accelerate studying and explore the country purchases system of the public health service. Improve the whole quality of epidemic reporting team and equipe the essential facilities of the epidemic reporting organization.
|
PDF Full Text Request