Abstract: Objective To evaluate the cost?effectiveness of the comprehensive control measures carrying out in schistosomia? sis endemic inner embankment of marshland and lake regions from 2006 to 2010，so as to provide the reference for further rational allocation of limited health resources and ultimately speeding up the procedure of schistosomiasis elimination. Methods With ref? erence to the requirements of the national schistosomiasis transmission control and phase goals for schistosomiasis control in Hubei Province，Jiangling County，one schistosomiasis control pilot of Hubei Province combined with the National Health and Family Planning Commission and Ministry of Agriculture，was selected for the study. A definition of the infection rates of human and do? mestic animals was used for endemic villages stratified by different layers（i.e.，the village with the infection rates of human and domestic animals ≥3% belonged to the first layer，≥ 1% belonged to the second layer；<1% belonged to the third layer） . By us? ing the stratification method and cost?effectiveness analysis，the endemic villages stratified with the different layers were investi? gated and all the data of schistosomiasis endemic situation，cost and effectiveness of schistosomiasis control were collected and comprehensively analyzed from 2006 to 2010. Results In the effectiveness of schistosomiasis control，by the end of 2010， there were no first layer villages，there were 114 second layer villages，and there were 18 third layer villages in Jiangling Coun? ty. In the former first layer villages，the schistosomiasis patients decreased year by year ultimately to 0；but in the second and third layer villages，the schistosomiasis patients increased. In the fecal treatment and management，the coverage rates of harm? less sanitary latrines were 27.45% in 2009 and 48.74% in 2010 respectively in the second layer villages，whereas there were no harmless sanitary latrines in the first and third layer villages. In the 5 years，the input of comprehensive control measures was 10 266 3900 Yuan，much higher than the human and buffalo examinations and treatments，Oncomelania hupensis snail investi? gation and elimination（4 183 000 Yuan）and other labor inputs（2 239 500Yuan） . In the ratio of cost?effectiveness，the annual ratio of unit cost（1% reduction of human and buffalo infection and 1 hm2 reduction of snail areas）increased yearly. In addition， the semi?logarithmic stability trend analysis of health inputs and cost showed that there was a stable balance between inputs and cost in the different layers（logarithmic values of any two layers of pair?wise comparison were <1，and in the third layer villages， the annual average logarithmic values of 5 years were <1） . Whereas，in the first and second layer villages，the annual average cost was fluctuated（the costs was higher than the inputs） . Conclusion The schistosomiasis situation is reduced year by year in Jiangling County from 2006 to 2010. Whereas，the main infection source（buffaloes）still exists and the present control mea? sures including fecal management should be further strengthened. In the resource allocation，in the field of health，the annual distribution of key inputs and unit?cost control also has a further space of adjustment.

Key words: Schistosomiasis；Comprehensive treatment；Cost ?effectiveness；Epidemic situation；Marshland and lake re? gion；Inner embankment type； Cost

摘要： 目的 目的 对湖沼垸内型血吸虫病流行区2006-2010年期间血吸虫病防治工作投入与效果进行综合分析与评价， 为 此类亚型地区加快消除血吸虫病进程， 进一步合理配置有限卫生资源提供参考。方法 方法 选择湖北省与国家卫生和计划生 育委员会 （原卫生部， 简称国家卫生计生委）、 农业部联合防治血吸虫病试点之一的湖北省江陵县， 参考全国血吸虫病防治 传播控制达标考核、 湖北省阶段防治工作目标要求， 2006-2010年以人畜感染率分层 （即人和畜感染率都≥ 3%为一层村， 3% >人和畜感染率≥ 1%为二层村； 人和畜感染率均< 1%为三层村） 为依据， 采用分层分析方法， 选择当地当年各分层覆盖 流行村为研究对象， 回顾性调查、 收集防治工作效果与费用数据， 所有数据经汇总后进行费用?效果综合分析。结果 结果 疫情 防治效果显示， 截止2010年， 江陵县无一层村， 二层村共计114个， 三层村共计18个。 血吸虫病病人数， 一层村绝对数逐 年减少直至0， 二、 三层村绝对人数增加。粪便管理方面， 无害化厕所覆盖率仅二层村2009、 2010年分别为27.45%、 48.74%， 而一、 三层村均为0。防治费用经贴现后， 当地5年总防治费用中， 综合治理投入 （10 266.39万元） 远高于查治投入 （418.30万元） 与人工投入 （223.95万元）。综合治理费用中， 国土、 农业、 水利部门费用占据前3位。卫生经费投入显示， 分 层村均呈国家级>省级>县级， 且年均都呈增长态势； 费用?效果比显示， 人群、 耕牛感染率与病人数下降1%、 感染性钉螺面 积下降1 hm2的单位成本比值均逐年趋高。卫生投入的半对数差值稳定性分析显示， 各分层村两两比较均< 1， 三层村 （5 年年均差值均< 1） 投入与费用较稳定， 一、 二层村均呈年均费用大于投入的波动状态。结论 结论 2006-2010年江陵县血吸虫 病疫情逐年降低， 但主要传染源尚存， 需加强控制与清除； 扩大粪便管理覆盖面是下一步工作的重点之一。资源配置上， 卫生领域内重点投入与单位成本控制、 费用的年均分配有进一步调整的空间。

关键词: 血吸虫病； 综合治理； 投入?效果； 疫情； 湖沼； 垸内型； 费用