The Research On Influencing Factors Of Human Echinococcosis In High Endemic Areas In Tibetan Plateau

BackgroundEchinococcosis,a serious zoonotic disease,is caused by larvae of echinococcus parasitizing in humans and various herbivorous and other animals.It is endemic around the world,especially prevalent in the agricultural and pastoral areas in western and northern of China.With about 60 million people at risk,echinococcosis has become a major public health problem in China.As Tibetan Plateau is the most severe region of echinococcosis.Control efforts in this region will play an important role in reducing the prevalence of the disease.ObjectiveTo investigate the influencing factors of human echinococcosis through questionnaires,in order to inform policy makers in disease control.MethodsA total of 8 villages with high prevalence were selected in Naqu County in Tibet autonomous region,and Shiqu County in Sichuan Province in August,September 2017,where the environment and altitude were similar.A door-to-door questionnaire survey was carried out by using 1:1 case-control methods to investigate the influencing factors.ResultsA total of 378 samples were collected,with 189 pairs of patients and healthy individuals.In the case group,there were 92 males and 97 females with the youngest of 8 years old and the oldest of 86 years old.The average was 42.29 years of age.140 herders accounted for the largest distribution of occupations,the others were 27 lama and 22 students.In education distribution,illiterate took the biggest amount of educational level with 129 in total.A total of 57 were at elementary education level,2 were junior high school educational level and one was senior high school level.For living style,148 were settled-down,39 were semi-nomadic populations who settled down in winter while migrated in summer,and 2 were nomadic.The median year of keeping dogs was 5.00 years with 1.00 dogs in median.The median number of keeping dogs was 8.00 dog year.In the control group,gender distribution was similar with the case group.With minimum age of 8 years old and the maximum age of 84 years old.The average was 42.36 years old.Occupation distribution was similar to that in the case group.For educational level,illiterate accounted for the main part with 126 individuals,while 62 were at primary school level and 1 from junior high school.The majority was settlement population with 158 in number.A total of 30 populations settled down in winter and shifted to be nomadic in summer.The year of keeping dogs was 4.00 years and the number of keeping dogs was 1.00 in median,respectively.The median year and number of keeping dogs was only 6.00.In the area of knowledge and cognition,the average score was 3.89,and the total passing rate was 84.39%.There was a statistically significant difference in the mean score of different groups(U=13652.000,P=0.000<0.05).In addition,significant difference was found in the mean score among different regions(U=9710.500,P=0.037<0.05).Based on univariate analysis,significant differences were identified in the variations of the years of keeping dogs(U=15205.000,P =0.012<0.05),the number of dogs(U=15888.500,P=0.046<0.05),the year number of dogs(U=15213.500,P=0.012<0.05),the way of raising(?2=3.932,P=0.047<0.05),feeding behavior of raw offals(?2=10.998,P=0.001<0.05),the presence of stray dogs(?2=5.214,P=0.022<0.05),hand-washing behavior(U=15876.500,P=0.043<0.05),source of drinking water(P=0.001<0,05)between the study group and the control group.According to multivariate conditional logistic regression analysis,keeping dogs,way of dog feces treatment,feeding dogs with raw offals,the presence of and source of drinking water were independent risk factors of echinococcosis transmission.As a result,the risk of echinococcosis increased 2.128 times in keeping dogs and was 0.429 times higher in burying dog feces deeply than that untreated..The risk of echinococcosis increased 2.628 times in feeding dogs with raw offals and was 2.066 times higher in the presence of stray dogs.The risk of echinococcosis was 3.111 times higher in drinking water from rivers than that in wells.ConclusionIt showed that the risk factors of human echinococcosis in Tibetan Plateau lied in behavior of keeping dogs,untreated dog feces,feeding dogs with raw offals,the presence of stray dogs and drinking water in rivers.It was indicated that the management of dogs and regular de-worming should be enhanced,especially in stray dogs.Health education of healthy behavior of drinking water was recommended to strengthen among herdsmen.