Medical ecology of schistosomiasis haematobia in the developing countries : Changes which took place in a long-term control program

有几种工具可以控制血吸虫病。当这些工具有效地结合在一起时，血吸虫病的控制就会成功。本研究旨在探讨群众性化疗、安全供水和健康教育三大血吸虫病防治工具的优缺点。研究是在肯尼亚血吸虫病流行区进行的。集体化疗对社区发病率的影响在连续10年每两年重复一次集体化疗的村子里，超声评估的血尿和尿路发病率都很低。膀胱癌发病以10~19岁青年为主。输尿管和肾脏的发病率仅在30岁以上的人群中观察到。结论：1.膀胱病理常自发消失。安全供水(5个社区立管和1个淋浴器)对村民行为的影响人类接触水的总频率显著下降。然而，接触频率的减少取决于水接触的活跃度和从家到立管的距离。健康教育对村民疾病认知和行为的影响健康教育材料采用世界卫生组织教材和自制录像带。由社区健康教育人员对村民进行健康教育。通过健康教育前后的KAP调查对健康教育效果进行评价。KAP研究表明，健康教育很容易向村民提供血吸虫病知识和预防感染的知识。然而，村民的行为改变似乎需要时间来预防血吸虫病的感染。本研究报告了三种主要血吸虫病控制工具的优缺点。这项研究的结果将有助于发展中国家的血吸虫病控制。

There exist several tools to control schistosomiasis. When these tools will be combined effectively, the control of schistosomiasis will be successful. The present study aims to search the advantage and weakness of three major tools for control of schistosomiasis, mass-chemotherapy, safe water supply and health education. The studies were done in the endemic area of schistosomiasis haematobia in Kenya.1. Effect of mass-chemotherapy on the morbidity in the communityIn the village where mass-chemotherapy was repeated every two years for 10 years, haematuria and urinary tract morbidity assessed by ultrasound were very low. The major bladder morbidity was observed on the young people aged from 10 to 19 years. Morbidity of ureter and kidney were observed only for people aged over 30 years. Bladder pathology frequently disappeared spontaneously.2. Effect of safe water supply (5 community stand pipes and one shower unit) on the behavior of villagersThe total frequency of human water contact decreased significantly. However, the reduction in the frequency of contact depend on water contact activity and the distance from the home to the standpipe.3. Effect of health education on the perception of disease and behavior of the villagersHealth education materials used were WHO textbook and home made video tapes. Health education was provided the villagers by community health educators. Effect of health education was evaluated by the KAP studies done before and after the education. KAP studies clearly showed that health education easily provide the villager the knowledge on schistosomiasis and prevention of infection. However, it seems to take time for the villagers to make behavioral changes so as to prevent the infection of schistosomiasis.The present study reports the advantages and weakness of three major tools of control of schistosomiasis. The results of the study will contribute the control of schistosomiasis in the developing countries.