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Schistosomiasis control and the health system in P.R. China.

ABSTRACT: Over the last sixty years advances have been made in the control of schistosomiasis in P.R. China. There are, however, difficult challenges still to be met. This paper looks at the extent to which the health system offers a positive environment for the control of the disease. It starts by tracing three phases in schistosomiasis control: disease elimination strategy through snail control (1950s-early 1980s); morbidity control strategy based on chemotherapy (mid 1980s to 2003); integrated control strategy (2004+). Each one of these phases took place in distinct policy-making environments. The paper partly draws on these phases to set out five issues of disease control and discusses them in the context of the health system and its recent trends. These cover the policy-making process, intersectoral action for health, equity and access to health services, funding for public goods and externalities, and strengthening resource management and planning. These issues form the basis of an agenda for integrating research and capacity strengthening in the Chinese health system with a view to creating a more positive enabling environment for schistosomiasis control. In so doing it is important to emphasize the role and integrity of the public sector against its commercialization, the underlying value of equity, a systems wide perspective, and the role of advocacy.

SUBMITTER: Collins C

PROVIDER: S-EPMC3710143 | biostudies-other | 2012

REPOSITORIES: biostudies-other

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Schistosomiasis control and the health system in P.R. China.

Collins Charles C Xu Jing J Tang Shenglan S

Infectious diseases of poverty 20121101 1

Over the last sixty years advances have been made in the control of schistosomiasis in P.R. China. There are, however, difficult challenges still to be met. This paper looks at the extent to which the health system offers a positive environment for the control of the disease. It starts by tracing three phases in schistosomiasis control: disease elimination strategy through snail control (1950s-early 1980s); morbidity control strategy based on chemotherapy (mid 1980s to 2003); integrated control ...[more]

PMID: 23849320

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Project description:BACKGROUND:Snail control is an important component in the national schistosomiasis control programme in China, by application of chemical molluscicides, forestry projects, agriculture projects and water conservancy projects in recent decades. However, there are still wide areas of snail inhabited in China which remains a great challenge to achieve the goal of schistosomiasis elimination by 2025. Therefore, a SWOT (strengths, weaknesses, opportunities and threats) analysis on snail control measures is required for precision schistosomiasis control. METHODS:The SWOT approach, which is a well-known structured analysis tool, was used to identify and evaluate the specific characteristics of four types of snail control measures in China, including chemical mollusciciding, forestry, agriculture, and water conservancy projects. The analysis were carried out based on the information collection from literature review, of research papers, books, annual report database of national schistosomiasis control programme in China, reports from the academic forums, and so on. RESULTS:For chemical mollusciciding, application strategy needs to focus on specific local settings, such as stage of schistosomiasis control, environmental factors, and limitations from external policies and internal deficiencies. Regarding forestry projects, the optimal strategies are to cooperate with other national forestry programmes to share the investment costs and pay attention on wetland protection. In agriculture projects, it is necessary to develop related cash crop industries and combine with national farmland consolidation projects simultaneously to increase the total economic benefits. Concerning water conservancy projects, the main purpose is to control snail migration from snail area to snail-free areas nationwide. CONCLUSIONS:Integrated strategies for various measures application and a top-level designed cooperation mechanism will be the necessary to eliminate snail and schistosomiasis in China.

Project description:BackgroundSince the founding of the China, the Chinese government, depending on the changing epidemiological situations over time, adopted different strategies to continue the progress towards elimination of schistosomiasis in the country. Although the changing pattern of schistosomiasis distribution in both time and space is well known and has been confirmed by numerous studies, the problem of how these patterns evolve under different control strategies is far from being understood. The purpose of this study is, therefore, to investigate the spatio-temporal change of the distribution of schistosomiasis with special reference to how these patterns evolve under different control strategies.Methodology / principal findingsParasitological data at the village level were obtained through access to repeated cross-sectional surveys carried out during 1991-2014 in Guichi, a rural district along the Yangtze River in Anhui Province, China. A hierarchical dynamic spatio-temporal model was used to evaluate the evolving pattern of schistosomiasis prevalence, which accounted for mechanism of dynamics of the disease. Descriptive analysis indicates that schistosomiasis prevalence displayed fluctuating high-risk foci during implementation of the chemotherapy-based strategy (1991-2005), while it took on a homogenous pattern of decreasing magnitude in the following period when the integrated strategy was implemented (2006-2014). The dynamic model analysis showed that regularly global propagation of the disease was not present after the effect of proximity to river was taken into account but local pattern transition existed. Maps of predicted prevalence shows that relatively high prevalence (>4%) occasionally occurred before 2006 and prevalence presents a homogenous and decreasing trend over the study area afterwards.ConclusionsProximity to river is still an important determinant for schistosomiasis infection regardless of different types of implemented prevention and control strategies. Between the transition from the chemotherapy-based strategy to the integrated one, we noticed a decreased prevalence. However, schistosomiasis would remain an endemic challenge in these study areas. Further prevention and control countermeasures are warranted.

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Schistosomiasis control and the health system in P.R. China.

Publications

Schistosomiasis control and the health system in P.R. China.

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