摘要目的评估健康教育和改良炉灶防治燃煤污染型地方性氟中毒(简称燃煤型氟中毒)的效果.方法2014年,将2006年落实综合防治的11个县按防治前病区8～12岁儿童氟斑牙检出率分为:低检出率(检出率＜60％)、中检出率(检出率为60％～ 90％)、高检出率(检出率＞90％)三类病区.每类病区抽取1个县,分别为钟山、六枝、习水,每个县抽取2个乡,对全体在校8～ 12岁儿童按《氟斑牙诊断》进行检查.在抽中的乡中,每个乡抽取2个村,每个村抽取20户家庭户和4～6年级的1个班学生调查氟中毒防治知识知晓情况和家庭户炉灶使用、粮食干燥及淘洗等相关生活行为情况.结果钟山、六枝、习水3个县8～12岁儿童氟斑牙检出率分别为5.49％(198/3 607)、8.33％(72/864)、12.46％(179/1 437),均明显低于防治前[41.88％(931/2223)、61.91％(4 863/7855)、91.25％(2 439/2 673)],差异均有统计学意义(x2=1 166.43、909.56、2 508.96,P均＜0.01).学生知晓率分别为78.03％ (792/1 015)、84.93％(1 465/1 725)、80.18％(910/1 135),均明显高于防治前[23.19％(640/2 760)、47.41％(2 368/4 995)、40.25％(3 405/8 460)],差异均有统计学意义(x2=947.96、736.61、644.69,P均＜0.01).户主知晓率分别为86.75％(347/400)、95.25％(381/400)、86.25％(345/400),均明显高于防治前[17.78％(80/450)、37.20％(279/750)、25.27％(139/550)],差异均有统计学意义(x2=402.97、359.49、344.55,P均＜0.01).炉灶合格且能正确使用的家庭户占调查户数的百分比分别为96.25％(77/80)、96.25％(77/80)、93.75％(75/80),均明显高于防治前[4.92％(348/7 078)、21.51％(7 461/34 693)、6.73％(475/7 062)],差异均有统计学意义(x2=1 181.55、262.63、842.82,P均＜0.01).非取暖季节使用清洁能源的家庭户占调查户数的百分比分别从防治前的0 (0/7 078)、0(0/34 693)、0(0/7062)提高到防治后的98.75％(79/80)、98.75％(79/80)、96.25％(77/80).辣椒正确干燥率分别为96.25％(77/80)、95.00％(76/80)、97.50％(78/80),均明显高于防治前[5.55％(5/90)、26.00％(39/150)、52.73％(58/110)],差异均有统计学意义(x2=139.52、99.36、45.64,P均＜0.01).辣椒食前淘洗率分别为93.75％(75/80)、95.00％(76/80)、93.75％(75/80),均明显高于防治前[74.44％(67/90)、87.33％(131/150)、34.55％(38/110)],差异均有统计学意义(x2=11.47、3.91、67.36,P均＜0.05).结论贵州省实施健康教育和改良炉灶综合防治燃煤型氟中毒的效果显著.

abstractsObjective To evaluate the effects of health education and improved stoves on control of coalburning-borne endemic fluorosis in Guizhou Province.Methods In 2014,according to the detectable rate of dental fluorosis of children aged 8-12 before implementing control measures,11 counties were divided into three layers:low detection rate (detection rate was less than 60％),medium detection rate (detection rate from 60％ to 90％) and high detection rate (detection rate was greater than 90％).One county was selected from each layer and two towns were selected in each county.According to the "Diagnosis of Dental Fluorosis" (WS/T 208-2011),dental fluorosis of all children aged 8-12 was examined in all towns;At the same time,in the 2 villages in each town,20households and students of one class in grade 4 to 6 were selected to survey knowledge about prevention and control of coal-burning-borne endemic fluorosis;and to survey the situation of improved stoves,drying and elutriation of corn and chillies,and related life behavior.Results The detectable rate of dental fluorosis of children aged 8-12was 5.49％ (198/3 607),8.33％ (72/864),12.46％ (179/1 437),and it was significantly lower than before implementing control measures [41.88％ (931/2 223),61.91％ (4 863/7 855),91.25％(2 439/2 673),x2 =1 166.43,909.56,2 508.96,all P ＜ 0.01].Correct answer rates of students about knowledge on endemic fluorosis were 78.03％ (792/1 015),84.93％ (1 465/1 725) and 80.18％ (910/1 135),the correct answer rates of knowledge were significantly higher than those before implementing control measures [23.19％ (640/2 760),47.41％ (2 368/4 995) and 40.25％ (3 405/8 460),x2 =947.96,736.61,644.69,all P ＜ 0.01].Correct answer rates of family householders about knowledge on endemic fluorosis were 86.75％ 047/400),95.25％ (381/400) and 86.25％ (345/400),the correct answer rates of knowledge were higher than those before implementing control measures [17.78％ (80/450),37.20％ (279/750) and 25.27％ (139/550);x2 =402.97,359.49,344.55,all P ＜ 0.01].The percentages of households whose stoves were qualified and can be used correctly to the total households were 96.25％ (77/80),96.25％ (77/80) and 93.75％ (75/80),and before implementing control measures [4.92％ (348/7 078),21.51％ (7 461/34 693) and 6.73％ (475/7 062)],and the differences were statistically significant (x2 =1 181.55,262.63,842.82,all P ＜ 0.01).The percentages of households using clean energy in heating season to the total households increased from 0 (0/7 078),0 (0/34 693),0(0/7 062) to 98.75％ (79/80),98.75％ (79/80),96.25％ (77/80).The rates of the three counties whose inhabitants could bake the chillies correctly were 96.25％ (77/80),95.00％ (76/80) and 97.50％ (78/80),which were significantly higher than before implementing control measures [5.55％(5/90),26.00％ (39/150),52.73％ (58/110),x2=139.52,99.36,45.64,all P ＜ 0.01].Who cooked chillies after washing were 93.75％ (75/80),95.00％ (76/80),93.75％ (75/80),which were significantly higher than before implementing control measures [74.44％ (67/90),87.33％ (131/150),34.55％ (38/110),x2 =11.47,3.91,67.36,all P ＜ 0.05].Conclusion The effects of health education and improving stoves on coal-burning-borne endemic fluorosis in the three counties of Guizhou Province are remarkable.