| Objectives1.To explore effective implementing ways of measures for preventing and controlling typhoid and paratyphoid fever and establish a set of effective,feasible and suitable pattern of preventing and controlling work in schools of countryside by the effect evaluation.2.To provide beneficial experiences to prevent and control the epidemic of typhoid and paratyphoid fever in schools by summing up and accumulate experiences of intervention.MethodsA longitudinal development and check epidemiological experimental study is designed in this applied research.Take schools as the intervention area,according to the epidemic characteristics and dangerous factors of typhoid and paratyphoid fever in schools,we borrow some effective experiences,then put forward and take comprehensive intervention measures(such as water source disinfection and participation health education) to decrease the incidence of typhoid and paratyphoid fever outbreak in schools.According to the intervention research nature,cluster randomized test is designed in this study.Schools are taken as the clusters.All the schools in researching field are divided into intervention group and control group by using cluster delaminated coupled sampling methods.An experimental epidemiological effective evaluation method is used to estimate the intervention effect.The effect is comprehended through comparing the change before and after intervention and the net effect of intervention is analyzed by conferring with control group.The Index of evaluation includes intervention measures implement ratio,effect of intervention,net effect ratio(NER),nature effect ratio(NAR),protection ratio,effect index and cost-benefit ratio.Results1.The cafeteria and restroom reorganizes rate of intervention group is 90%and 85%,which is higher than control group(50.6%and 33.3%)(P＜0.05),but majority of reorganizes is to renovate and increase the facility of three defences,post the hygienic slogan and add the facility of washing hands.While taking hardware reorganizes to causes the layout of cafeteria conforming to the classification and district processing hygienic requirements and enable the restroom to have refiller type sanitation restroom, reorganize rate of both group is lower than 25%and there is no statistical differences.In the final stage investigation,the intervention group surpasses the control group in the cafeteria personnel health management and training,tableware disinfection,restroom disinfection processing,water source disinfection,health information competition and so on(P＜0.05);There's no difference between the two groups in the facility guarding against flies,mouse and dust,the formulation of health system,the installation facility of washing hands and the hygienic knowledge propaganda education,while carrying out rate approaches 100%.The realization rate of both groups below 60%in those aspects including the cafeteria having streamlined production,district and classified processing,the restroom hardware reorganizes,meanwhile there's non-statistical difference.2.A few of the investigated schools(intervention group is 15%,control group is 0) can provide sufficient boiling water,but all can provide the loaded in barrels water.All schools in intervention group have strengthened the management around the water source environment,like adding the well cover and railing as protectant facilities, simultaneously the drinking water is disinfected in scientific standard way.The qualified rate of intervention group drinking water promoted from 10%to 82.61%, which was higher than control group 47.83%(P＜0.01).3.The year febrile registration rate of intervention group and control group is 1.1‰and 1.0‰respectively.Specimen gathering rate of control group is 5.8‰which is obviously higher than 3.8‰of the intervention group(P＜0.01).Case of illness investigate rate and the following up rate of both groups are 100%.The specimen gathering number and the masculine specimen number collected by individual or village clinic and the public health center of small towns has accounted for 58%and 67%,while collected by the county level medical therapy units has only accounted for 8%and 10%4.Results of laboratory monitor.39 paratyphoid A masculine strains are isolated cultured by 399 blood preparation hemoculture.The isolating rate of control group and intervention group is 15.35%and 3.39%that has statistical significance(P＜0.01).The sensitivity,specificity,false positive rate,Youden index,masculine likelihood ratio, negative likelihood ratio and Kappa value of the single sera Widal's reaction is 32.35%, 83.28%,16.72%,15.63%,1.93,0.82 and 0.11 respectively.5.Main appearance of the intermediate stage effects in this intervention research is the alteration of target population's learning attitude and behavior.After the comprehensive intervention,comparing the two groups with themselves,people's cognition of the typhoid and paratyphoid preventing and controlling knowledge had enhanced obviously,and comparing two group of crowd,besides the enhancement known rate of "environment can prevent this sickness" has non-statistical significance, other 7 items all have statistical difference(P＜0.05),and also the net effect percentage exceed 50%.After the intervention,the manner behavior improvement was inferior to the elementary knowledge knows rate.Comparing the two group of crowd,the improvement of "typhus had reported teacher" has statistical significance,other 6 items have no statistical difference(P＞0.05),while the improvement rate of three behaviors that comprise "typhus had reported teacher","don't drink raw water" and "washing hands before eating" attributing to the intervention measure is higher than 50%.6.In 2007,the intervened group have not explode epidemic situation of the typhoid and paratyphoid fever,but the control group has 2 explode epidemic situation, which involved 2 schools,18 diseased students,suffers from rate is 0.75%.The typhoid and paratyphoid incidence density of the intervention group is 23/100000 while the control group is147/100000 and X~2=23.21.It has statistical significance.The effect of general intervention is 314/100,000,which brings the net effect percentage is 48.1%and the natural effect percentage is 51.59%.The comprehensive intervention protection ratio is 84.35%(95%CI:70.63%～98.07%),the effect index is 6.39.7.The comprehensive benefits of intervention include social efficiency,direct and indirect economic efficiency and so on.The direct investment cost is 70138 Yuan,the direct economic efficiency is 73788 Yuan,the indirect economic efficiency is 103303.2 Yuan,the control cost of explode is 319822 Yuan.The intervention measure cost-benefit ratio is 1:7.08.Besides the economic efficiency,this research also has obtained huge social efficiency.ConclusionsThis research has established a set effective work pattern and the mechanism initially to suit the school prevention,discovery,report,diagnosis and control typhoid and paratyphoid fever.The comprehensive intervention pattern has obtained remarkable results of the prevention and control of typhoid and paratyphoid fever in schools and got up good epidemiological effect,meanwhile has acquired considerable economic efficiency and social efficiency.All these show that this pattern in school area implementation is effective,acceptable and easily to be carried out,moreover it is suitable to be popularized in schools that frequently outbreak typhoid and paratyphoid fever.And also we draw following conclusions:1.The monitor system of typhoid and paratyphoid fever that based on the fixed crowd enhanced sensitivity of the epidemic situation report and played the early warning forecast role,simultaneously also enhanced the early processing ratio of epidemic situation,maximum limit prevented the epidemic situation spreading and reduced carrier's formation and the origin of infection accumulation.The establishment of this system should take the basic medical service unit(village two levels) as a key point.2.As the traditional preventing and controlling measures of typhoid and paratyphoid fever lack pertinency and feasibility,the effect is not ideal.At the same time,there exists some problems in the realization stratification plane and is short of effective realization ways.According to the special details of the schools,some feasible, acceptable and practical "emergency" measures are carried out to substituent the doctrinal preventing and controlling measures,such include "adding the well cover or safe guards and the scientific water source disinfection","providing the loaded in barrels water","adding the facility of washing bands","the cafeteria practitioner health management","the three defence facility","the tableware disinfection" and "the health education" and so on.All these methods are used to substitute the measures which are difficult to be carried out in short-terms,such as alteration of water and restroom and cafeteria et al.3.The authenticity of the diagnosis of paratyphi A by the Widal trial of single share blood is worse and the diagnosis value is weak.The basic health unit should understand the practical value of Widal trial correctly and make clear diagnosis after the dynamic observation of the Widal trial according to the union epidemiology history and the clinical manifestation.4.Carrying out the health education have the fine result in the students.The pointed participation health education is more remarkable than the general conventional hygienic knowledge education in the manner behavior improvement aspect.The health education can get effect instantly to the knowledgeable question,while the behavior change relatively lag.This reminds us the change of health custom should be supposed to be the key point of the health education intervention.In the concrete implementation, we may hand from the harm and correction of bad hygienic behavior,spread the healthy knowledge and give behavior instruction,moreover long-term and plan organized education should be performed.5.The method of simple continue water source sterilized have more effect in enhancing the water quality than the method of daily water source sterilized.And it's implementation is convenient,price is inexpensive,may promote to the whole country.6.After the scene practice experience,according to the nature of intervention research,Cluster randomized design will be easily implemented in a geographic area or community.
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