| Objective: Xinjiang where the disease incidence rate of pulmonary tuberculosis occupies first place of China is the particularly prevention and control district.This study discussed time,people,places,spatial distribution characteristic and prevention and control characteristic of pulmonary tuberculosis based on the descriptive statistics method and exploratory spatial data analysis model.The prevention and control effects were evaluated and sorted by every single county of 94 counties in Xinjiang.BP neural network simulative interference was conducted to present suggestions for resolving the issues,provideing scientific evidence to support further development of tuberculosis prevention and control.Methods: The Author collected the data about population structure,social economy,environmental and meteorological,hygiene level from Network for System of Infectious Diseases and Tuberculosis Report System in 14 districts and 94 counties of Xinjiang 2011-2015.The Author also used ArcGIS10.2,a GIS software,and analyzed the overall situation and spatial autocorrelation tend based on all the data about tuberculosis in the districts and counties and then got the spatial distribution character and assemble mode.For the analysis of tuberculosis influence factor,Spearman Rank Correlation was used to analyze the correlation of tuberculosis reporting morbidity and ecological factors,OLS regression model was used to filter the variants and discuss the ecological factors of tuberculosis disease.The author divided Xinjiang to three types of regions based on the the pulmonary tuberculosis disease incidence rate in order to analyze situation of tuberculosis prevention and control.Delphi method was used to ascertain the 12 index of the tuberculosis prevention and contr ol effects evaluation system.APH method was used to determine the weight function of the index of the system.TOPSIS weighting method was used to rank the tuberculosis prevention and control effects in the 94 counties.BP neural network modeling was used to simulate the interference experience to present suggestions for resolving the problem.Results: 1.Xinjiang where the disease incidence rate of pulmonary tuberculosis occupies first place of China which is two or three times as much as the whole country.The disease incidence rate distribution of pulmonary tuberculosis presented significant seasonal changes.The highest disease incidence rate focus on December and January and the lowest focus on June-October.52.56% pulmonary tuberculosis suffers were male and 47.44% were female.The sex ratio(M F)was1.11:1.The incidence rate raises with the raise of age and always much bigger than the national figure in all age groups but the senior incidence was the highest.The incidence rate of elderly people over the age of 60 years was 46.77%.Most of pulmonary tuberculosis suffers were farmers and herdsmen,accounting for 72.11%.The thematic maps of pulmonary tuberculosis incidence rate indicated that epidemic situation in Southern Xinjiang was much higher than in Northern and Eastern Xinjiang.The The spatial distribution trend charts indicated that the incidence rate tend was declined obviously from west to east and increased obviously from north to south.The result of spatial autocorrelation analysis of pulmonary tuberculosis incidence indicated that there is moderate degree of spatial clusters both in districts and counties.At the districts level,the hot spots were mainly located in the south of Xinjiang,such as Hotan,Kashgar,Kirgiz Autonomous Prefecture of Kizilsu and Aksu where the cold spot was never detected.At the counties level,the hot spots were almost always located in the southwest and south of Xinjiang,including most counties of Hotan,Kashgar,Kirgiz Autonomous Prefecture of Kizilsu,and partial counties of Aksu in every year from 2011 to 2015.The cold spots were almost always located in the middle-north of Northern Xinjiang and east of East Xinjiang dispersedly,including all the counties of Karamay,Urumqi,Changji Hui Autonomous Prefecture and some counties of northern Bayingolin Mongol Autonomous Prefecture,Kumul,Turpan and Altay in every year from 2011 to 2015.2.Compared the data of all the districts that the researchers found a positive correlation between pulmonary tuberculosis incidence and the 4 variables which are minority percentage,rural population,annual mean temperature and water resources per capita.The researchers also found a negative correlation between pulmonary tuberculosis incidence and the 6 variables which are per capita GDP,urban per capita disposable income,annual average rainfall and days of air quality standards in more than grade two and average number of hospital beds and doctors per 10,000.Compared all the data of all the counties,the researchers found a positive correlation between pulmonary tuberculosis incidence and the 6 variables which are minority percentage,rural population proportion,annual mean temperature,annual average sunshine,annual dust days,annual sand days and annual sandstorm days.The researchers also found a negative correlation between pulmonary tuberculosis incidence and the 2 variables which are annual average rainfall and annual average relative humidity.Based on the result of OLS regression analysis,minority percentage and rural population are positive correlated with tuberculosis incidence at the districts level.Rural residents' disposable income is negative correlated with tuberculosis incidence at the districts level.Rural population is positive correlated with tuberculosis incidence at the counties level.Annual average relative humidity is negative correlated with tuberculosis incidence at the counties level.3.The author divided Xinjiang to three types of regions based on the pulmonary tuberculosis disease incidence rate at the districts and counties level in order to analyze situation of tuberculosis prevention and control.Type I regions included the most counties of Urumchi,Hui Autonomous Prefecture of Changji and Karamay.Type II regions included the part counties of Altay and Urumchi,Bayingolin Mongol Autonomous Prefecture,Kazak Autonomous Prefecture of Ili,Bortala Mongol Autonomous Prefecture,Tacheng,Turpan,Hami and Aksu.Type III regions included the most counties of Kizilsu Kirghiz Autonomous Prefecture,Kashgar,Khotan and Aksu.4.A new three forming an organic whole was established for tuberculosis disease prevention and control in Xinjiang.The organizations,including organizations for disease prevention and control,designated medical institution and primary-level medical and health care institutions,are mainly invested by government and supported hierarchically.Compared with the case of TB patients without chemotherapy,35477 of deaths and 39013 new tuberculosis cases were prevented from 2011 to 2015.1159199 DALYS were saved which the direct economic benefit was ?26.57 million and the indirect economic benefit was up to ?27.27 billion.5.There are a lot of problem need to be resolved in spite of the achievement in TB prevention and control.The investment was not sufficient both in the districts and counties level.The investment is only 5.27% from districts level and 12.69% from counties level of all budget on TB prevention and control.Especially in the type III regions,the TB controlling relied on the central government,autonomous government and other outside support.The human resource was also insufficient.Only 81.31% stuffing was allocated for TB prevention and control.Human resource structure was not reasonable.Most professionals in type III regions were only graduated from junior college and technical secondary school.6.Basically,the planning objective of TB prevention and control has been achieved.The 7 main indexes,including close contacts screening rate of smear-positive pulmonary tuberculosis patients,new smear-positive tuberculosis patients,new smear-negative tuberculosis patients completed treatment,HIV infection rate of tuberculosis screening,TB patients HIV screening rate,successful treatment of the floating population of tuberculosis patients,TB fixed dose compound(FDC)using coverage,had achieved the requirements of the twelfth Five-year Plan.But there were still 3 indexes,including sputum examination rate for first time patients,report rate of tuberculosis patients and suspected patients,Tuberculosis prevention and control of core information awareness,that have not achieved the goal.There were 4 districts where the TB prevention and control situation was grim.The Tuberculosis incidence sufferer in these regions were 70.74% of overall Xinjiang.The foundation construction and laboratory facilities were poor and the prevention and control of personnel were insufficient and changed frequently so that the prevention and control quality could not be guaranteed.7.12 indexes were determined for tuberculosis control effect comprehensive evaluation system based on Delphi method.The tuberculosis control effect were screened using TOPSIS method that indicated the results in Northern and Eastern Xinjiang were much better than in Southern Xinjiang.The analysis and experiment of dynamic model of BP neural network were used to interfere the situation stimulatingly for all types regions.The experiment indicated that the tuberculosis incidence will decrease if the rate of management and treatment were enhanced for type I regions.The tuberculosis incidence will decrease if the new smear-positive tuberculosis patients and successful treatment of the floating population of tuberculosis patients were increased for type II regions.The experiment indicated that the tuberculosis incidence will increase in 2018 in the type III area if the prevention and control could not making progress.Conclusion: Xinjiang occupies the first place of the disease incidence rate of pulmonary tuberculosis in China.The type III regions which tuberculosis incidence clustering occurred,such as Khotan,Kashgar,Kizilsu Kirghiz Autonomous Prefecture and Aksu,where the investment and the human resource for disease prevention and control is insufficient.So,the tuberculosis prevention and control effect is worse than other regions.The type I regions,such as Karamay,Urumqi and Changji,where tuberculosis incidence rate was controlled better because of the sufficient investment and the human resource for disease prevention and control.The analysis and experiment of dynamic model of BP neural network were used to interfere the situation stimulatingly for all types regions.The experiment indicated that the tuberculosis incidence will increase in 2018 in the type III area if the prevention and control could not making progress.So,the further actions should be taken in the Southern Xinjiang.Increasing the investment on fundamental construction,human resource,improving the medical conditions,detecting the patient effectively and reducing the route of transmission will decrease the incidence rate of pulmonary tuberculosis finally. |
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