Article(id=1241067200262492578, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409445, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1727107200000, receivedDateStr=2024-09-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773823078455, onlineDateStr=2026-03-18, pubDate=1741536000000, pubDateStr=2025-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773823078455, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773823078455, creator=13701087609, updateTime=1773823078455, updator=13701087609, issue=Issue{id=1241067197318091153, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773823077754, creator=13701087609, updateTime=1773823268053, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241067995544482681, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241067995544482682, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=869, endPage=874, ext={EN=ArticleExt(id=1241067203877982713, articleId=1241067200262492578, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Health education on schistosomiasis in Tanzanian schools and its implications for China’s foreign public health assistance, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=

Globally, schistosomiasis remains a serious public health problem, especially in sub-Saharan Africa. Although mass drug administration (MDA) has achieved certain results in the past few decades, its coverage and long-term effectiveness is still limited. As one of the economical and effective strategies, the standardized and systematic implementation of health education plays an important role in the global prevention and control of schistosomiasis. Taking the prevention and control of schistosomiasis in Tanzania as an example, this paper focuses on school health education and analyzes its positive role in improving students’ knowledge, attitude and behavior change towards schistosomiasis. This paper reviews the practical experience of schistosomiasis health education in Tanzania, analyzes the difficulties and challenges of carrying out school health education in Africa, and provides references for China’s overseas schistosomiasis prevention and control and public health assistance under the Belt and Road Initiative.

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在全球范围内,血吸虫病仍然是一项严重的公共卫生问题,特别是在撒哈拉以南非洲地区。尽管过去几十年,大规模人群服药(mass drug administration,MDA)取得一定成效,但其覆盖率和长期有效性仍然存在限制。健康教育作为经济且有效策略之一,规范系统开展此项工作,对全球血吸虫病防控具有重要作用。本文以坦桑尼亚血吸虫病防控为例,聚焦学校健康教育,分析其在提高学生对血吸虫病知识水平、态度和行为改变等方面发挥的积极作用。文章综述了坦桑尼亚血吸虫病健康教育的实践经验,分析非洲开展学校健康教育的困难与挑战,为“一带一路”倡议下我国对外血吸虫病防控及公共卫生援助提供参考。

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黄玉政,E-mail:
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李晓静(1999—),女,硕士在读,研究方向:公共卫生

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坦桑尼亚学校血吸虫病健康教育及对中国援外公共卫生的启示
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李晓静 1, 2, 3 , 黄玉政 1, 2, 3
现代预防医学 | 健康与社会行为 2025,52(5): 869-874
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现代预防医学 | 健康与社会行为 2025, 52(5): 869-874
坦桑尼亚学校血吸虫病健康教育及对中国援外公共卫生的启示
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李晓静1, 2, 3, 黄玉政1, 2, 3
作者信息
  • 1.南京医科大学公共卫生学院,江苏 南京 211166
  • 2.江苏省血吸虫病防治研究所,国家卫生健康委员会寄生虫病预防与控制技术重点实验室,江苏 无锡 214064
  • 3.南京医科大学热带病研究中心,江苏 无锡 214064
  • 李晓静(1999—),女,硕士在读,研究方向:公共卫生

通讯作者:

黄玉政,E-mail:
Health education on schistosomiasis in Tanzanian schools and its implications for China’s foreign public health assistance
Xiao-jing LI1, 2, 3, Yu-zheng HUANG1, 2, 3
Affiliations
  • School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
出版时间: 2025-03-10 doi: 10.20043/j.cnki.MPM.202409445
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在全球范围内,血吸虫病仍然是一项严重的公共卫生问题,特别是在撒哈拉以南非洲地区。尽管过去几十年,大规模人群服药(mass drug administration,MDA)取得一定成效,但其覆盖率和长期有效性仍然存在限制。健康教育作为经济且有效策略之一,规范系统开展此项工作,对全球血吸虫病防控具有重要作用。本文以坦桑尼亚血吸虫病防控为例,聚焦学校健康教育,分析其在提高学生对血吸虫病知识水平、态度和行为改变等方面发挥的积极作用。文章综述了坦桑尼亚血吸虫病健康教育的实践经验,分析非洲开展学校健康教育的困难与挑战,为“一带一路”倡议下我国对外血吸虫病防控及公共卫生援助提供参考。

学生  /  健康教育  /  血吸虫病  /  “一带一路”  /  卫生援助

Globally, schistosomiasis remains a serious public health problem, especially in sub-Saharan Africa. Although mass drug administration (MDA) has achieved certain results in the past few decades, its coverage and long-term effectiveness is still limited. As one of the economical and effective strategies, the standardized and systematic implementation of health education plays an important role in the global prevention and control of schistosomiasis. Taking the prevention and control of schistosomiasis in Tanzania as an example, this paper focuses on school health education and analyzes its positive role in improving students’ knowledge, attitude and behavior change towards schistosomiasis. This paper reviews the practical experience of schistosomiasis health education in Tanzania, analyzes the difficulties and challenges of carrying out school health education in Africa, and provides references for China’s overseas schistosomiasis prevention and control and public health assistance under the Belt and Road Initiative.

Students  /  Health education  /  Schistosomiasis  /  Belt and Road Initiative  /  Health assistance
李晓静, 黄玉政. 坦桑尼亚学校血吸虫病健康教育及对中国援外公共卫生的启示. 现代预防医学, 2025 , 52 (5) : 869 -874 . DOI: 10.20043/j.cnki.MPM.202409445
Xiao-jing LI, Yu-zheng HUANG. Health education on schistosomiasis in Tanzanian schools and its implications for China’s foreign public health assistance[J]. Modern Preventive Medicine, 2025 , 52 (5) : 869 -874 . DOI: 10.20043/j.cnki.MPM.202409445
血吸虫病是一种严重危害人体健康、影响社会经济发展的人兽共患寄生虫病,主要流行于热带和亚热带地区的78个国家和地区,全球约2.4亿人感染,7.79亿人面临感染风险[1],据估计93%居住在撒哈拉以南非洲地区[2]。面临这一严峻挑战,预防性化疗(preventive chemotherapy,PC)成为当前控制血吸虫病的主要策略[3-4]。但受限于药品供应、地理及环境条件等因素,其效果与覆盖范围受到制约[5-7]。特别是自2020年新冠疫情以来,非洲许多国家的传染病药物分发计划被迫中断,进一步加剧了血吸虫病等疾病的感染风险[8]。一些学者也质疑现有策略是否会达到和维持预期的治疗覆盖率水平[9-10]。在此背景下,世界卫生组织(World Health Organization,WHO)在2021年强调需要将PC与其他补充策略结合,特别是健康教育的重要性[11-12]。同时有研究表明,健康教育可能是血吸虫病防控中效果较好的补充策略之一[13-15],可以通过增加对血吸虫病预防和传播知识的了解,提高对PC方案的依从性,减少对寄生虫的接触[12]
坦桑尼亚作为血吸虫病高负担国家之一,在血吸虫病防控方面取得了一定成效。自20世纪80年代以来,坦桑尼亚逐步建立和完善了一系列相关政策和措施。1988年,启动了全国性的血吸虫病防控项目,重点开展了大规模人群服药(MDA)和健康教育活动。2000年,加入了全球防治血吸虫病联盟,进一步加强了国际合作和技术交流。2010年,坦桑尼亚卫生部发布了《国家血吸虫病防控战略规划》,明确了未来十年的防控目标和具体措施[16-17]。其中,利用学校作为健康教育的主阵地,通过系统化的课程和活动,将血吸虫病的预防知识传授给青少年儿童,是经济有效且具有长远价值的[7,18-19]
近年,中国自“一带一路”倡议提出以来,对非援助已从单纯的临床医疗逐渐扩展到公共卫生领域[20]。援坦桑尼亚桑给巴尔血吸虫病防控项目是公共卫生援外的典型代表,通过现场防控、技术培训和健康教育等多种形式,与受援国展开了密切合作,取得了较好成效。但也应清醒认识到,中国公共卫生援助仍面临挑战,如资金投入不足、技术转化效率较低等[21]。因此,总结坦桑尼亚血吸虫病防控经验,探讨针对学校血吸虫病健康教育发展过程,明确其面临的挑战,为非洲国家实现2030血吸虫病消除目标及中国公共卫生援外项目实施策略提供参考。
自上世纪以来,非洲地区的血吸虫病高度流行,通过近百年来WHO、政府和社区的共同努力,其在血吸虫病防控方面取得了巨大成就。在这一漫长的防控历程中,健康教育作为重要的防控手段之一,逐渐得到了广泛的重视和推广。在健康教育发展初期,坦桑尼亚的血吸虫病患病率约为52%[6,22-23],这一数据远高于同期非洲其他国家的平均患病率(约为40%)[2]。然而,通过一系列包括健康教育在内的有效防控措施的实施,该地区的血吸虫病患病率得到了显著控制。据2004年的数据显示,坦桑尼亚桑给巴尔群岛的血吸虫病患病率已经成功降至20%以下[24]。其中,通过传统宣传手段如连环画小册子、宣传海报及简单讲座等形式,向学生普及血吸虫病的基本知识、传播途径以及预防措施[2,25],是学校健康教育的重要环节。
近年来,随着国际援助项目的深入实施,坦桑尼亚学校健康教育在血吸虫病防控领域迎来了快速发展。多国援助不仅带来了先进的防治技术和实践经验,还推动了教学方式的多样化创新。通过积极教学法、现场实践活动、家庭卫生调查等多元化手段,师生对血吸虫病的预防意识得到了显著提升[26-27]。同时,学校开始将血吸虫病防治知识纳入课程体系,设立专门健康教育课程,进一步强化了教育的系统性和连续性[27]。在此过程中,跨国合作也至关重要,特别是中国等血吸虫病防治先进国家的经验与技术输入,为学校健康教育带来了多媒体展示、动画教学、互动问答等新颖教学手段,极大提升了学生的学习兴趣与参与度。另外,借助当地穆斯林宗教教师的力量,进一步拓宽了健康教育的覆盖面和影响力[28]。各国之间的合作与交流,促进了知识、技术和经验的共享,不仅推动了坦桑尼亚学校健康教育体系的完善与提升,也为当地公共卫生事业注入了新的活力。
1998年,坦桑尼亚一项研究显示,培训教师掌握积极教学法、寄生虫学基础及预防策略,并在课堂上传授血吸虫病相关知识,辅以歌曲、故事、图片等创新教学材料[26],具有较好效果。同时,桑给巴尔的非传统健康教育项目也采用“Juma na Kichocho”连环画小册子作为教学工具,向小学五年级学生普及寄生虫知识[2]。此外,Unguja和Pemba岛的伊斯兰学校开展了大规模健康教育活动,结合互动行为改变练习,教师专业培训后运用参与式和互动式教学方法[28],使教学过程生动有趣,学生更加投入,有效传递了血吸虫病的相关知识,彰显了课堂教育在健康教育干预中的核心作用。
在坦桑尼亚北部两所小学实施的参与性健康教育计划显示,学生对血吸虫病及肠道蠕虫病的认知水平显著提升。该计划融合了多样化教育形式,如鼓励学生记录个人日记、自编自演血吸虫情景剧,并引导学生参与家庭卫生调查[27],这些举措激发了学生的学习热情和参与感。通过艺术形式深化理解,使健康教育更生动、易于接受,促进了血吸虫病防治知识传播,增强了社区健康意识。值得一提的是,有研究借助了Kichocho Day这一特色活动日的设立,进一步丰富了健康教育的实践内容。在Kichocho Day,学生们通过拔河、跳绳和篮球等体育活动,在玩耍中学习关于血吸虫病知识[28]。此外,学校还积极拓宽教育活动的边界,组织学生实地考察水源,讨论水体污染问题[26]。增强了学生的环保意识和社会责任感,也为他们提供了参与社区健康改善的实际途径。
宣传活动是健康教育不可或缺的一环。卫生部门精心策划了健康宣传日活动,通过宣传海报和深入学校、社区的互动活动,广泛传播血吸虫病预防与治疗信息[29]。这些措施强调个人防护,如避免在水源附近排尿、减少接触不安全水源,并推广药物治疗方案,旨在提升公众健康意识。同时,学校利用座右铭板或每日留言板融入血吸虫病防治知识[26],使学生在日常学习中潜移默化地增强健康意识。
坦桑尼亚的研究显示,健康教育在提高血吸虫病知信行方面起到了关键作用。1988年项目追踪调查表明,持续的健康教育不仅成功转变了学生的健康态度,还促使他们采取积极行为,如增加如厕后洗手、减少赤脚,从而有效降低了感染风险[26]。“Juma na Kichocho”连环画小册子的使用增强了学生对血吸虫病防治的认识,知识掌握与积极态度均显著提升,得分增长达5%[2]。吡喹酮MDA宣传运动也成功传授了相关知识,改变了不良行为,降低了感染率[30]。这些措施在一定程度上改善了学生对疾病的认知和态度,促进了行为改变。
健康教育在动员学生、教师和社区参与方面发挥了积极作用。在参与式实践活动中,学生通过亲身实践激发了主动参与的动力[2,26-27]。教师原本可能因为管理班级多、工资偏低而不愿额外普及血吸虫相关知识,但通过健康教育活动也增强了教师的兴趣,使他们积极参与血吸虫病教育课程中[26-27]。进一步地研究表明,教师和学龄儿童的积极参与是带动社区参与防治活动的关键[31]。例如,有妇女受孩子影响,不仅学到新知识,还采取了实际行动如建卫生厕所、饮用开水[26]。揭示了健康教育项目具备强大的社区动员潜力,特别是能够激发当地学生、教师及整个社区的积极参与性。这一理念在坦桑尼亚与肯尼亚的研究中也得到了验证[32]-33]。
健康教育可显著提升经济和社会效益,使血吸虫病发病率降低,医疗费用减少约30%[6],就诊患者数量减少40%[24],劳动生产率提高15%[34],医疗服务满意度提升20%[35]。健康教育项目不仅减轻了医疗负担,还增强了居民自我健康意识,提升了医疗服务质量和效率。
血吸虫病健康教育受多种因素影响,包括客观因素和主观因素。客观因素包括经济社会发展水平、文化习俗、基础设施条件等;主观因素包括受教育者的接受度、施教者的专业能力、教育内容与方式的适宜性等,这些因素综合影响了健康教育的效果和实际实施情况。
综合过往研究成果,坦桑尼亚地区男孩在同等健康教育条件下血吸虫病患病率普遍高于女孩,女性感染率约低30%[36]。这主要受社会文化习俗和性别角色分工的影响。在坦桑尼亚的特定文化背景下,男性多从事捕鱼、水上作业等高风险活动,频繁接触疫水[3037-38]。而女孩受穆斯林文化习俗的约束,其参与水中活动的机会少,感染几率降低[39]。此外,物质资源匮乏也是重要因素,基础防护设备如手套、橡胶靴等物资稀缺[40-42],不仅削弱了健康教育效果,也限制了居民在从事高风险活动时采取防护措施的能力,间接促进了血吸虫病的传播。数据显示,缺乏防护设备的社区血吸虫病感染率比有防护设备的社区高出约30%[35]。同时,水与环境卫生基础设施的不足,特别是缺乏靠近农田的公共厕所等补充性设施[43-47],进一步恶化了居民的生活环境,增加了接触疫水的机会,使居民感染率比有卫生设施的社区高出约25%[48],影响了健康教育成效。
首先,个人的健康信念、态度和行为倾向直接影响健康教育接受度。一项调查发现,对血吸虫病了解较少的居民,其感染率比了解较多的居民高出约20%[36]。信息不对称可能导致部分群体因健康知识匮乏或对该病危害性的低估,而未能有效将健康宣教内容转化为预防行动[49]。此外,部分男性因捕鱼、游泳等生活习惯,不愿或难以改变而导致其感染率比其他人群高出约40%[50-51]。其次,施教者的专业素养与教学策略。在坦桑尼亚,拥有较强专业能力的施教者所负责的项目,其成功率较于普通施教者高出大约30%[628]。所以,若施教者缺乏针对血吸虫病的专业知识、或无法采用生动有趣的教学方式吸引受众,又或是无法根据目标群体的文化背景和社会习惯调整教学策略,那么健康教育的实际效果将会受到影响。最后,健康教育内容与形式的适应性也同样重要。数据表明,内容和形式更具适应性的健康教育项目,其成效往往比内容和形式单一的高出约25%[6]。因此,为了确保健康教育的有效性,教育内容需贴合实际需求并考虑文化背景,形式应多样有趣,以更好地激发受众的学习兴趣和参与热情。
上述文献中开展的各种活动表明,近年来,以学校为基础的血吸虫病健康教育在坦桑尼亚取得了较好成效。学校作为复杂的社会系统,将学生群体作为健康教育的直接受众,不仅扩大了预防工作的覆盖范围,还可以培养其成为未来健康社区的关键参与者[38]。通过健康教育,学生增强了血吸虫病危害认识,掌握了预防知识,改变了不良行为。
尽管取得了一定成效,但健康教育仍面临挑战。首先,学生对健康知识的理解不够全面和准确,存在认知误区,教育内容需更具针对性和深度。其次,教育方式传统,缺乏创新和互动性,难以持续激发学生兴趣。最后,自然环境、物质环境以及社会文化习俗等也制约健康教育效果。特别是对于学龄期儿童这一高风险群体,如何将健康教育内容与他们的日常生活和劳动活动紧密结合,成为亟待解决的问题。
中国援助坦桑尼亚桑给巴尔岛血吸虫病防治项目已被编入2021年《新时代的中国国际发展合作》白皮书,为非洲血吸虫病健康教育提供了新举措。为进一步优化坦桑尼亚血吸虫病健康教育的成效,我们提出以下提升策略:一是更新教育内容,根据学生实际需求,不断更新和完善教材内容,确保血吸虫病知识的全面性和准确性。增加实用性和针对性强的教育内容,如如何正确使用个人防护用品、如何识别疫水等,帮助学生更好地理解和应用健康知识。二是创新教育方式,采用户外实践活动、互动式教学、多媒体教学等多样化教学手段,激发学生的学习兴趣和参与度;定期对教师进行专业培训,提高其教学能力和创新意识,鼓励教师根据学生的实际情况调整教学策略。三是改善基础设施,为涉水活动提供如手套、胶鞋等个人防护用品,减少学生接触疫水的风险;加强水与环境卫生基础设施建设,如建设公共厕所、改善水源水质等,减少疫水的传播途径。四是推动社区多方参与,动员社区领导者、宗教人士、社区卫生志愿者等各方力量参与学校健康教育活动,形成合力。如培训社区卫生志愿者定期开展健康教育活动,多频次扩大覆盖范围,提高学生和居民的自我保健能力[52-54]。五是加强合作与资源整合,加强政府间的合作,共同制定和实施血吸虫病防控计划[55];鼓励企业和社会组织参与血吸虫病防控项目,提供资金、技术和人力资源支持;积极争取国际组织的援助和支持,引进先进的防控技术和经验,提升防控效果。
综上所述,坦桑尼亚血吸虫病健康教育虽取得进展,但仍面临挑战。未来,在中国“一带一路”公共卫生援助项目倡议下,并结合现有经验继续为坦桑尼亚血吸虫病健康教育注入了新活力。深化合作、加大资源投入,持续优化教育内容与方式,结合社区参与和基础设施改善,以全面提升健康教育效果,促进居民健康与社会经济的可持续发展。这一地区的成功经验也将为非洲乃至全球的健康教育和公共卫生事业提供有益的借鉴和启示。
  • 国家重点研发计划(2024YFC2310902)
  • 国家自然科学基金项目(81673673)
  • 江苏省国际科技合作项目(BZ2024044)
  • 江苏省医学科研重点项目(ZDB2020037)
  • 江苏省“科教强卫工程”专项经费资助(ZDXKA2015016)
  • 江苏省省属公益类科研院所自主科研经费项目资助(BM2018020)
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doi: 10.20043/j.cnki.MPM.202409445
  • 接收时间:2024-09-24
  • 首发时间:2026-03-18
  • 出版时间:2025-03-10
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  • 收稿日期:2024-09-24
基金
国家重点研发计划(2024YFC2310902)
国家自然科学基金项目(81673673)
江苏省国际科技合作项目(BZ2024044)
江苏省医学科研重点项目(ZDB2020037)
江苏省“科教强卫工程”专项经费资助(ZDXKA2015016)
江苏省省属公益类科研院所自主科研经费项目资助(BM2018020)
作者信息
    1.南京医科大学公共卫生学院,江苏 南京 211166
    2.江苏省血吸虫病防治研究所,国家卫生健康委员会寄生虫病预防与控制技术重点实验室,江苏 无锡 214064
    3.南京医科大学热带病研究中心,江苏 无锡 214064

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黄玉政,E-mail:
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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