| Objective:To estimate and predict the rabies exposure epidemic trend through investigating the current allocation situation of rabies exposure preventive treatment clinic,distribution characteristics of rabies exposed population and injured animals in Lanzhou.To analyze related factors influencing rabies post-exposure treatment including delayed treatment and wound treatment in order to provide a basis for the rational allocation of health resources to treat rabies exposure and the formulation of comprehensive prevention and control strategies for rabies.Methods:The distribution of outpatient resources for rabies exposure prevention and treatment in Lanzhou City and the outpatient visit data of exposed population were collected.The rabies exposure and treatment clinic,human resource allocation and distribution characteristics of rabies exposure were descriptively analyzed by using SPSS IBM 25.0.The ArcGIS 10.2 spatial statistical analysis tool was used to analyze the accessibility of the outpatient configuration and to visualize the results.Logistic regression was used to analyze the influencing factors of wound treatment and delayed treatment after rabies exposure.Results:The number of rabies exposure and treatment clinics in Lanzhou increased year by year.In 2018,the coverage rate of rabies exposure and treatment clinics was2.88 per 100,000 people.The spatial distribution of exposed treatment clinic and exposed patients showed spatial aggregation(P<0.01),and the ratio was 0.518,Z=-9.352,P<0.01.The average age of medical staff in RPTCs human resource allocation was 35.25±9.94 years old,In terms of academic qualifications,majors,and professional titles,they were mainly junior college(53.12%),nursing(81.99%),primary(75.76%),and part-time(72.06%).The average length of employment was 5.49±4.73years.The proportion of males exposed to rabies was higher than that of females.The sex ratio was 1.21:1,the average age was 32.06±19.12 years old,and the highest proportion was 15.23%in the 15-year age group.The time series analysis showed as a simple seasonal fluctuation(R~2=0.553,P=0.300>0.05),and the seasonal distribution was mainly in summer and autumn(June-October),with the peak value in July.The number of county and district with annual exposure rate higher than 200.00/100,000 gradually increased.The exposure classification was mainly grade II exposure(55.30%)and grade III exposure(40.51%).Essen procedure was mostly used(87.50%),and the inoculation completion rate was 72.51%,the standard vaccination rate was 72.60%,and the passive immunization rate was 8.66%in the III-level exposed population.The timely disposal rate of PEP was 94.74%;the animals which attacked human were mainly dogs(76.18%),the family breeding animals accounted for 50.24%,and the animals with vaccination history accounted for 44.16%.The main causes of injury were teasing(47.47%)and active assault(34.09%).people exposed to rabies who correctly got wound treatment,considered rabies to be preventable(OR=2.347,95%CI:1.263-4.360,P<0.05)and knew the route of rabies transmission(OR=2.851,95%CI:1.573-5.164,P<0.05)tended to conducted inappropriate wound treatment.However,that who often contacted with animals(OR=0.603,95%CI:0.398-0.914,P<0.05)and had related knowledge of rabies infectionsources(OR=0.257,95%CI:0.173-0.383,P<0.001)Tendtocarry on standard wound management.The interrelationship existed between PEP initiation delay and exposure caused by playing with animals(P=0.022<0.05),bite and bite-scratch combined injury(P=0.014<0.05),wound self-treatment and medical treatment(P<0.001)and considering rabies as preventable(P=0.007<0.05).Among them,bite and bite-scratch combined injury(OR=0.569,95%CI:0.363-0.892,P<0.05),wound self-management and medical institution treatment(OR=0.362,95%CI:0.206-0.634,P<0.05)were protective factors for PEP initiation delay,while exposure caused by playing with animals(OR=1.618,95%CI:1.073-2.441,P<0.05)and considering rabies to be preventable(OR=4.229,95%CI:1.487-12.031,P<0.05)were risk factors.Conclusion:1.the distribution of outpatient resources for RPTC is unbalanced and unreasonable in Lanzhou.The number of RPTC increases year by year.In terms of spatial distribution,it is agglomerative,mainly concentrated in the central urban area,while services in the outlying towns and villages and remote rural areas cannot cover the whole region.2.the imbalanced allocation of human resources cannot meet the needs of the current stage.The medical personnel in suburban counties are understaffed,with relatively low academic and professional titles,short working experience and high proportion of part-time jobs.3.The rabies exposure rate shows an increasing trend,from336.64/100,000 in 2016 to 443.38/100,000 in 2018,which is lower than the rabies incidence in China.Exposure after disposal rate(94.74%)is higher,timely vaccination completion rate(72.51%),the entire specification coverage(72.60%)and grade?exposed to passive immunity preparation utilization rate(8.66%)are below the national average monitoring;4.The rabies vaccination rate of the injured animals was 25.61%in Lanzhou,lower than the national average monitoring level;5.The cause of injury,the way of injury,the way of wound disposal,the chance of contact with animals and the knowledge rate of rabies exposure are the influencing factors for the standard disposal after exposure. |
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