| Objectives:To analyze the epidemiological and clinical characteristics of scrub typhus cases in Guilin.To analyze and report the cognitive status of on-the-job medical staff,students and residents in high-incidence areas of Guilin city level county hospital on scrub typhus,and explore the potential obstacles affecting their cognition.To formulate and implement the intervention strategy of health education,and to investigate the effect of health education on scrub typhus disease awareness,attitude and behavior of college students and residents in high-incidence areas before and after health education.Methods:(1)Retrospective analysis:The surveillance data of scrub typhus in Guilin City between January 2017 and September 2020.The clinical records of30 cases with scrub typhus admitted to the First Affiliated Hospital of Guilin Medical University between November 15,2018 and August 11,2021 were retrospectively collected and analyzed.The epidemiological history,clinical manifestations,imaging examination,laboratory examination,complications,treatment and outcome information of the patients were analyzed SPSS28.0software was used to make statistical analysis of each index.LSD-t test andχ~2 test were used to analyze the difference between the test results of different items.α=0.05 test level was used,and P<0.05 was considered to be statistically significant.(2)Health education intervention:the combination of two modes of health education was adopted.The new media health education model is mainly in the form of sand painting,using fragmented short video communication.The traditional health education model is carried out by distributing paper version of propaganda folding pages and propaganda fans.(3)Questionnaire research:Convenient sampling method was used to select on-the-job medical staff from Guilin urban and county hospitals.The cognitive status of scrub typhus was investigated by stratified cluster random sampling of students in a university and residents in high incidence area with corresponding self-made questionnaire.Health education intervention strategies were implemented for students and residents in high-prevalence areas and follow-up was conducted to analyze and discuss the effects of health education on scrub typhus cognition of this group.Epidata3.1 software was used to establish the database for double input,SPSS28.0 statistical software was used for processing and analysis,χ~2 test and multiple logistic regression model were used to analyze the relevant data.Quantitative data were described by mean±standard deviation,α=0.05 was used as the test level,and P<0.05 was considered statistically significant.Results:(1)Epidemiological status and clinical characteristics of scrub typhus disease in Guilin:From January 2017 to September 2020,a total of 536cases of scrub typhus were reported in Guilin,mainly in females aged 50 to 59years(90 cases)and males aged 60 to 69 years(58 cases).Among the prefectures under the administration of Guilin,Yangshuo County had the highest number of scrub typhus cases,and the incidence showed an increasing trend year by year,with a sharp rise from June and a peak in August.The most common symptoms in 30 patients were fever(93.33%),eschar or ulcer(83.33%),and headache(56.67%).Twelve cases were tested positive by Weil-Felix test.Statistical analysis showed that in patients with multiple organ dysfunction syndrome(MODS),the proportions of severe cases,abnormal albumin level,abnormal serum creatinine level,occult blood in urine,and proteinuria were significantly higher than those in the patients without MODS(P<0.05).Laboratory test results showed statistically significant differences of platelets,red blood cells,aspartate aminotransferase,hemoglobin,and alanine aminotransferase,levels before and after treatment(P<0.05).Among the 26 patients treated with doxycycline,the length of hospitalization in the patients taking doxycycline on the day of visit was statistically shorter than that in those not taking doxycycline on the day of visit(P<0.05).(2)Analysis of the cognitive status and influencing factors of residents in Guilin on scrub typhus:128 medical staff in Guilin knew about scrub typhus,the awareness rate was 63.68%,and the average score was(12.04±0.206).Univariate analysis and multivariate logistic regression model analysis showed that compared with those who had not treated scrub typhus,those who had treated scrub typhus(OR=3.102,95%CI:1.491-6.456)knew the insurance factor of scrub typhus,and the differences were statistically significant(P<0.05).The total knowledge rate of scrub typhus among students in a university in Guilin was18.64%.Univariate analysis and multivariate logistic regression model analysis showed that the ratio of non-only children to only children(OR=0.551,95%CI:0.430-0.707),annual household income≥310,000 versus<60,000(OR=0.257,95%CI:0.078-0.851)were the limiting factors for knowledge of scrub typhus.Compared with Han ,Miao (OR=0.298,95%CI:0.161-0.551)and Yao (OR=0.318,95%CI:0.144-0.701)were the limiting factors for knowing scrub typhus.The average score of scrub typhus knowledge was(11.02±6.46),and the awareness rate was 49.26%.Residents who had no contact with scrub typhus were the limiting factors for their knowledge of scrub typhus(OR=0.291,95%CI:0.160-0.530),and retirees were the limiting factors for their knowledge of scrub typhus(OR=0.493,95%CI:0.273-0.892).Compared with residents with primary school education andbelow,senior high school(OR=1.876,95%CI:1.019-3.454),junior college(OR=2.315,95%CI:1.234-4.341),bachelor degree(OR=2.330,95%CI:1.198-4.531)is whether the contributing factors of scrub typhus are known.(3)Evaluation of the effect of health education on scrub typhus in Guilin residents:The survey results after intervention showed that the total awareness rate of the intervention subjects increased to 46.50%,and the difference was statistically significant(χ~2=184.524,P<0.001).The average score was(11.20±5.34),and the awareness rate of all scrub typhus related knowledge subjects before and after intervention had statistical significance(P<0.05).The survey results showed that the attitudes and behaviors of the survey subjects before and after intervention were statistically significant in"think it is necessary to carry out health education activities on scrub typhus in universities","if a roommate/friend suffers from tsutsugamusia",and"if a neighbor/classmate suffers from scrub typhus",and the latter were better than the former(P<0.05).After intervention,the survey results showed that the total awareness rate of the respondents increased to 71.00%,the difference was statistically significant(χ~2=326.042,P<0.001),and the average score reached(13.71±5.63).At the same time,except for"drug treatment selection"and"the number of known serotypes of rickettsia tsutsugamushi",the awareness rate of other knowledge topics related to scrub typhus before and after intervention had statistical significance(P<0.05).There were significant differences in attitudes and behaviors of the survey subjects to"if someone around suffers from scrub typhus","if a neighbor/colleague suffers from scrub typhus",and"if someone has an unknown fever,they will go to the doctor directly",and the latter were all better than the former(P<0.05).Conclusions:(1)Scrub typhus patients in Guilin are mainly middle-aged and elderly people,mostly occurred in summer and autumn,with various clinical manifestations and may be with multiple organ damage.Therefore,close attention should be paid to the risk factors of MODS in scrub typhus.The diagnosis of scrub typhus should be made as early as possible and symptomatic treatment be provided in time to prevent further deterioration to severe illness or death(2)Medical staff,students and residents of high-incidence areas in Guilin have insufficient cognition of scrub typhus related knowledge,and there is a great demand for acquiring scrub typhus related knowledge.Therefore,attention should be paid to the training of knowledge and professional skills related to scrub typhus for medical staff in high-incidence areas,and targeted special education should be carried out for students and residents in high-incidence areas,so as to improve the cognition status of different groups on scrub typhus,improve the diagnosis and treatment level of scrub typhus and control its spread.(3)It is feasible and effective to carry out health education propaganda of scrub typhus in colleges and towns by combining new media with tradition,and health education intervention is helpful to improve the awareness level of residents and students in areas with high incidence of scrub typhus.The publicity departments at all levels and relevant administrative departments should strengthen the publicity and report of scrub typhus prevention and control,and actively implement health education to the population with different characteristics,so as to ensure the improvement of people’s awareness of related knowledge and self-protection awareness,and effectively control the occurrence and outbreak of scrub typhus. |
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