Multi-criteria decision making for determining best teaching method using fuzzy analytical hierarchy process

During the outbreak of COVID-19, information technology played a critical role in promoting education all around the world. Online teaching boosts students' learning processes and has a good impact on their learning during the epidemic. Big data technology transforms traditional teaching approaches and learning processes by providing a rich learning resource for diverse teaching elements and improving teachers' teaching techniques. Due to the COVID-19 epidemic, online education spread quickly, and traditional instruction was abruptly switched to online mode, posing a number of issues for students and management. Choosing a decent teaching technique is not an easy option, and it is even more difficult when it comes to selecting the approach. We used the Fuzzy Analytical Hierarchy Process (Fuzzy AHP) method to evaluate four instructional methods based on seven criteria to solve this challenge. Fuzzy AHP is a powerful, simple, and direct way for determining which approach is the most efficient and effective. To simplify the selection process and address the issue of uncertainty, the Fuzzy AHP technique employs the geometric mean method. The Fuzzy AHP approach was found to be efficient and successful in the decision-making process in this study.

[Epidemic situation and diagnosis of imported malaria before and after malaria elimination in Nanjing City, Jiangsu Province]

OBJECTIVE

To analyze the epidemiological characteristics and diagnosis of imported malaria before and after malaria elimination in Nanjing City of Jiangsu Province, so as to provide the scientific evidence for formulating the malaria control strategy after malaria elimination.

METHODS

Data pertaining to the epidemic situation and individual investigation of malaria in Nanjing City before (from 2012 to 2016) and after malaria elimination (from 2017 to 2020) were captured from the National Notifiable Communicable Disease Reporting System and the Information System for Parasitic Diseases Control and Prevention and were analyzed statistically.

RESULTS

A total of 178 malaria cases were reported in Nanjing City from 2012 to 2020, and all were imported cases. There were 99 malaria cases reported before malaria elimination in Nanjing City, including 78 cases with Plasmodium falciparum malaria (78.79%), 5 cases with P. vivax malaria (5.05%), 10 cases with P. ovale malaria (10.10%), 3 cases with P. malariae malaria (3.03%) and 3 cases with mixed infections (3.03%), and 79 malaria cases reported after elimination, including 63 cases with P. falciparum malaria (79.75%), 5 cases with P. vivax malaria (6.33%), 9 cases with P. ovale malaria (11.39%), 2 cases with P. malariae malaria (2.53%). There was no significant difference in the proportion of each type of malaria cases in Nanjing City before and after malaria elimination (χ² =2.400, P > 0.05). Malaria cases mainly acquired Plasmodium infections in African regions, and no significant difference was seen in the proportion of malaria cases returning to Nanjing City from African countries before and after malaria elimination (χ² = 0.093, P > 0.05). The number of malaria cases peaked in Nanjing City in January and during the period from May to July before elimination, and there was no apparent seasonal variation in the distribution of malaria cases after elimination. The proportion of malaria cases living in Nanjing City was significantly greater after malaria elimination than before elimination (72.15% vs. 55.56%; χ² = 5.187, P = 0.023). The proportions of businessmen and international students were both 5.05% before malaria elimination, and increased to 15.19% and 13.92% after elimination, respectively (χ² = 5.229 and 4.229, both P values < 0.05). The percentage of definitive diagnosis of malaria at initial diagnosis was 18.75% in county-level hospitals before malaria elimination and increased to 61.11% after elimination (χ² = 6.275, P = 0.012), while the proportion of malaria cases with definitive diagnoses in county-level hospitals was 4.04% before malaria elimination and increased to 13.92% after elimination (χ² = 5.562, P = 0.018). During the period from 2012 to 2020, the proportion of malaria cases with definitive diagnoses within 1 to 3 days post-admission increased from 27.27% in Nanjing City before malaria elimination to 45.57% after elimination (χ² = 6.433, P = 0.011).

CONCLUSIONS

The epidemic situation of imported malaria remains serious in Nanjing City during the post-elimination stage, and malaria parasite infections predominantly occur in African regions. In addition, there are changes in regional and occupational distributions of malaria cases and the diagnostic capability of malaria increases in county-level hospitals in Nanjing City after malaria elimination. Further improvements in the malaria surveillance system and the diagnostic and treatment capability of malaria in medical institutions at each level are required to consolidate malaria elimination achievements in Nanjing City.

[Epidemic situation of malaria in Lishui City from 2013 to 2018]

OBJECTIVE

To analyze the epidemic situation and epidemiological characteristics of malaria in Lishui City from 2013 to 2018, so as to provide the evidence for formulating the malaria control strategy.

METHODS

The data pertaining malaria cases in Lishui City from 2013 to 2018 were captured from National Notifiable Communicable Disease Reporting System and the Information System for Parasitic Diseases Control and Prevention, and the epidemiological features of malaria cases were analyzed.

RESULTS

A total of 119 malaria cases were reported in Lishui City from 2013 to 2018, including 101 cases with falciparum malaria (84.87%), 6 cases with vivax malaria (5.04%), 8 cases with ovale malaria (6.72%), and 4 cases with mixed infection (3.36%). Among the 119 cases, there were one local case with blood transfusion-induced malaria and 118 cases with over- seas imported malaria. There were 98.32% of the imported malaria cases acquiring infection in African countries, and most cases were reported in Qingtian County (60.50%) and Liandu District (22.69%). In addition, 86.55% of the malaria cases were detected in individuals at ages of 20 to 50 years, and most cases were found in oversea workers (52.94%) and businessmen (38.65%).

CONCLUSIONS

Most of the malaria cases in Lishui City are imported from Africa, and the monitoring and health education pertaining to malaria control knowledge requires to be intensified among high-risk populations.

[Epidemic situation of malaria in Jiangsu Province in 2019]

OBJECTIVE

To analyze the epidemic situation of malaria in Jiangsu Province in 2019, so as to provide the scientific basis for the development of the strategy for the prevention of re-introduction of imported malaria.

METHODS

The malaria case report information, epidemiological case investigation information, epidemic foci investigation and management report in Jiangsu Province in 2019 were collected, and all epidemiological data were descriptively analyzed.

RESULTS

A total of 244 malaria cases were reported in Jiangsu Province in 2019, and all cases were laboratory-confirmed overseas imported cases, including 4 cases with vivax malaria, 206 cases with falciparum malaria, 12 cases with malariae malaria and 22 cases with ovale malaria. In 2019, there were 12 malaria cases progressing into severe cases in Jiangsu Province, with one death. Nanjing, Nantong, Lianyungang, Taizhou and Changzhou cities contributed the largest number of malaria cases in 2019, with the number of malaria cases accounting for 59.84% of total cases in Jiangsu Province. The infections occurred in Papua New Guinea (2 cases), Pakistan (1 case) and 27 African countries (241 cases), including Angola, the Democratic Republic of the Congo, Nigeria, Equatorial Guinea, Cote d'Ivoire and so on. There were 77 cases (31.55%) with a visit to doctor on the day of onset, and 146 cases (59.84%) within 1 to 3 days after onset. In addition, there were 149 cases (61.06%) with definitive diagnosis at the first visit and 77 cases (31.55%) diagnosed within 1 to 3 days after the visit, and the mean duration from the visit to definitive diagnosis was (0.80 ± 1.59) d, which significantly shortened as compared to that (1.34 d ± 2.59 d) in 2018 (U = 2.53, P < 0.05).

CONCLUSIONS

Intensifying the surveillance and management of imported malaria and improving the diagnostic capability of imported malaria and the treatment of severe malaria cases are required to consolidate the achievements of malaria elimination in Jiangsu Province.

[Epidemic situation of malaria in Jiangsu Province in 2018]

OBJECTIVE

To analyze the epidemic situation of malaria in Jiangsu Province in 2018, so as to provide scientific evidence for formulating post-elimination malaria surveillance schemes and technical measures in Jiangsu Province.

METHODS

The malaria case report cards, epidemiological individual investigation forms of malaria cases and foci data were collected from Jiangsu Province in 2018, and the epidemic situation of malaria was descriptively analyzed.

RESULTS

A total of 243 malaria cases were reported in Jiangsu Province in 2018, which increased by 1.67% in relative to in 2017 (239 cases), and these cases included 171 cases with falciparum malaria, 14 cases with vivax malaria, 15 cases with quartan malaria, 42 cases with ovale malaria and a case with mixed infection of P. vivax and P. ovale. All cases were overseas imported, and no local secondary cases were found. The malaria cases were predominantly workers (76.54%). Nantong City (48 cases), Yangzhou City (33 cases) and Taizhou City (22 cases) were the most 3 cities with the largest number of malaria cases across Jiangsu Province. The malaria infections predominantly occurred in African areas (96.30%), and the other 9 cases had infections in Asia (8 cases) and Central America (1 case). There were 125 cases (51.44%) and 91 cases (37.45%) with definitive diagnosis at the day of admission and within 1 to 3 days post-admission, respectively. The percentages of definitive diagnosis at initial diagnosis were 48.27%, 88.76% and 97.30% at township-, county- and city-level medical institutions, respectively, and the percentage of definitive diagnosis at initial diagnosis was significantly lower in township-level medical institutions than in county- (χ² = 21.47, P < 0.01) and city-level medical institutions (χ² = 32.86, P < 0.01).

CONCLUSIONS

There are no local malaria cases in Jiangsu Province; however, the number of overseas imported malaria cases remains high in China. In the future, improving the post-elimination malaria surveillance system, enhancing the awareness of malaria prevention and control knowledge among high-risk populations, increasing the diagnostic capability of malaria in medical institutions, and improving the management of imported malaria cases should be performed to consolidate the achievements of malaria elimination.

[Epidemic situation of imported malaria and diagnostic capabilities of medical institutions in Wuhan City from 2008 to 2017]

OBJECTIVE

To understand the epidemiological characteristics of imported malaria and the control and diagnostic capacities of the medical institutions in Wuhan City, so as to offer the evidence for formulating the surveillance and control strategies.

METHODS

From 2008 to 2017, the epidemiological data of imported malaria were collected. The information including gender, age, distribution, vocational background, positive rate of fever patients, and time of final diagnosis was analyzed with the descriptive statistic method. The Plasmodium species composition and infection source were analyzed by chi square test. The initial and confirmed diagnosis abilities of medical institutions were analyzed by rank sum test.

RESULTS

Totally, 424 imported malaria cases were reported, including 301 falciparum malaria cases (70.99%). The male population aged 20 to 49 years was the main morbidity group, and the incidence was not related to seasons. For the parasite species, there was a significant difference between African countries and Southeast Asian countries (χ² = 205.83, P < 0.01). Plasmodium ovale and P. malariae were all imported from sub-Saharan Africa. For diagnostic capacities of the medical institutions at different levels, the initial diagnosis (Z = -3.89, P < 0.01) and confirmed diagnosis (χ² = 53.88, P < 0.01) were significantly different, respectively. The ability of malaria diagnosis was improved rapidly in the clinical laboratory after 2008 and achieved to 100% in 2010. The detection rate within 24 hours increased to at least 90% and the detection rate within 6 days decreased to 0 in 2016.

CONCLUSIONS

Although the medical institutions in Wuhan City have strong ability to treat imported malaria, they are still faced with a serious situation for malaria control and elimination. The capacity building should be strengthened constantly.

[Epidemic situation of malaria in Dalian City from 2005 to 2016]

OBJECTIVE

To describe and analyze the epidemiological characteristics of malaria in Dalian City, so as to provide the evidence for adjusting and formulating malaria control strategy and measures, being in accordance with the practical situation in Dalian City.

METHODS

The data of malaria cases in Dalian City from 2005 to 2016 were collected from China Diseases Surveillance Information Reporting Management System (DSIRMS), to describe and analyze the epidemiologic characteristics of malaria in Dalian City.

RESULTS

A total of 143 malaria cases were reported in Dalian from 2005 to 2016, including 115 laboratory diagnosed cases, 27 clinically diagnosed cases, and 1 suspected diagnosed case. Among the 115 laboratory diagnosed patients, 65 patients were infected with Plasmodium falciparum, 19 were infected with P. vivax, and 15 had mixed infection, 4 were infected with P. ovale, 3 were infected with P. malariae, and 9 were unclassified. All the cases were imported, 127 were imported from Africa, accounting for 88.81%, mainly were imported from Equatorial Guinea, Liberia, Ghana and Nigeria. Most of the cases were imported from May to October, accounting for 58.74% (84/143), and the imported cases emerged a small peak in August. The ratio of males to females was 10∶1, and the median age was 42 years. Among the total cases, fishermen, migrant workers, and work-man accounted for 55.24% (79/143). Seventy-five patients lived in rural districts, and 68 patients lived in urban districts. The median interval from backing to China to disease onset was 8 days. The proportion of disease onset within one month after backing to China was 76.27% (90/118). The median interval from disease onset to diagnosis was 4 days, and the longest interval was 71 days. Totally 141 patients were cured and 2 died.

CONCLUSIONS

In order to avoid malaria death, we should strengthen the malaria prevention and control, especially in rural districts, enhance the training for professionals in the county health facilities, and the surveillance and health education for those who are returned from malaria-endemic areas.

[Epidemiological analysis of malaria prevalence in Jiangsu Province in 2017]

OBJECTIVE

To understand the malaria epidemic situation and characteristics in Jiangsu Province in 2017, so as to provide the evidence for formulating the targeted strategy of malaria elimination.

METHODS

The data of malaria cases in Jiangsu Province in 2016 were collected from China's Routine Diseases Surveillance Information System (CRDSIS).

RESULTS

Totally, 239 imported malaria cases were reported in Jiangsu Province in 2017, and the cases decreased by 22.40% compared to 308 cases in 2015. Except 2 malaria case caused by blood transfusion, the rest patients were all imported. Among them, there were 163 falciparum malaria cases, 21 vivax malaria cases, 11 quartan malaria cases, 43 ovale malaria cases, and 1 mixed infection case (Plasmodium falciparum and P. ovale). The numbers of imported cases of Nantong (39 cases, 16.32%), Suzhou (26 cases, 10.88%), Taizhou (25 cases, 10.46%), Huai'an (24 cases, 10.04%), and Lianyungang (22 cases, 9.21%) ranked in the top 5 cities across Jiangsu Province, the malaria cases in the five cities accounted for 56.90% (136/239). The infection source areas of the imported malaria cases included Africa (225 cases), Asia (8 cases), Oceania (2 cases), and South America (2 cases).

CONCLUSIONS

Jiangsu Province has no local malaria cases for 6 consecutive years. Despite the imported cases in 2017 decreased some-what compared to that in 2016, it is still necessary to strengthen the surveillance of imported malaria cases and improve malaria diagnosis and treatment in the whole province.

[Epidemic situation of imported malaria in Beijing City, 2017]

OBJECTIVE

To explore the epidemic situation and epidemiological characteristics of imported malaria in Beijing City in 2017, so as to provide the evidence for developing malaria control interventions.

METHODS

The data of registered malaria cases were collected and analyzed by using descriptive epidemiological methods.

RESULTS

A total of 90 malaria cases were reported in Beijing in 2017, and all the cases were imported. The 90 cases included 74 cases of falciparum malaria (82.22%), 10 cases of vivax malaria (11.11%), 4 cases of ovale malaria (4.45%) and 2 cases of malariae malaria (2.22%), and 97.78% of the malaria patients were at ages of 19 to 61 years. Eighty-one cases (90.00%) came back from Africa and 44 cases (48.89%) suffered two or more courses of malaria. Among the 66 patients with disease onset after returning from abroad, 53 cases (80.30%) of falciparum malaria had an onset within two weeks. The patients went to the malaria-endemic areas were mainly because of working (46.34%) or business (41.46%). Eighty-nine cases used mosquito nets while living in malaria-endemic areas and 59 cases used mosquito repellents in addition.

CONCLUSIONS

The prevention and control for imported malaria is still the major target for the surveillance in Beijing City. The highly efficient surveillance system for malaria should be sustained, and the awareness of the disease among migrant workers should be enhanced.

[Epidemic situation of malaria in Qingdao City from 2012 to 2017]

OBJECTIVE

To investigate the epidemic situation and its epidemic characteristics of malaria in Qingdao City from 2012 to 2017, so as to provide the evidence for the prevention and control of malaria in this city.

METHODS

The data of cases and epidemiological characteristics of malaria in Qingdao City, 2012-2017 were collected from the China's disease prevention and control system infectious disease report information management system and parasitic disease prevention and control information management system, and analyzed.

RESULTS

A total of 103 cases of malaria were reported in Qingdao City from 2012 to 2017, and all of them were imported. Among them, 98 (95.15%) were imported from Africa and 5 (4.85%) from Asia. There were 92 laboratory confirmed cases (89.32%) and 11 (10.68%) clinically diagnosed cases. The highest incidence occurred in 2016 (0.28/105) . According to the classification of cases, there were 87 falciparum malaria cases (84.47%), 13 vivax malaria cases (12.62%), and 3 ovale malaria cases (2.91%) . These patients were mainly young men, and the male to female ratio was 19.6∶1. There were malaria case reports in each month, and the peak onset season was not obvious. Newly diagnosed and confirmed units were mainly municipal medical institutions; the median of onset-definite diagnosis was 4 days. There was one death case, but there were no recurrence, reburning, and imported secondary cases.

CONCLUSIONS

There were no local malaria cases in Qingdao City from 2012 to 2017. The prevention and control of imported malaria is the focus of the future work.

[Epidemiological characteristics of malaria in Leshan City, 1950-2015]

OBJECTIVE

To analyze the epidemiological characteristics of malaria in Leshan City, so as to provide the evidence for formulating the strategy and measures for consolidating the achievements of malaria elimination.

METHODS

The data of epidemiological characteristics of malaria in Leshan City from 1950 to 2015 were collected and analyzed with the descriptive epidemiology method.

RESULTS

There were four larger scale epidemics of malaria in Leshan City from 1950 to 2015. The order of malaria in infectious diseases dropped from the first to the twentieth. The peak season for malaria epidemics ceased. The Plasmodium species, patient age, occupation and sex distribution of malaria were different in the different periods. In November 2016, the whole city achieved the national standard for malaria elimination.

CONCLUSIONS

After years of prevention and control, the epidemiological characteristics of malaria have changed significantly in Leshan City, and the effect of anti-malarial measures is significant. In the future, we should strengthen the monitoring, and prevention and control of imported malaria.

[Epidemiological analysis of malaria surveillance in Jinan City from 2012 to 2016]

OBJECTIVE

To analyze the epidemiological characteristics of malaria reported in the malaria surveillance system in Jinan City from 2012 to 2016, so as to provide the evidence for improving the ability of diagnosis, treatment, prevention and control of malaria.

METHODS

The data of all reported malaria cases in the malaria surveillance system were retrospectively analyzed.

RESULTS

From 2012 to 2016, 91 malaria cases were found in Jinan City, of which one patient died. All the cases were imported and 95.60% (87 cases) of them came from Africa (note：most of the people were Chinese residents who had been in Africa for the export of labor service and came back China). Falciparum malaria accounted for the most (82.42%, 75 cases). All the cases were adult males, and were mainly migrant workers. The median time from onset to being confirmedly diagnosed was 5 days, and the median time from seeing a doctor to being diagnosed was 1 day. The medical institutions where the patients first visited were mainly municipal medical institutions (42 cases, 46.15%). The misdiagnosis rate was 100% in village clinics and township health centers (8/8 and 2/2, respectively). The misdiagnosis rate was lowest in the municipal medical institutions (3/42, 7.14%). There were 41 malaria patients (45.05%) with complications.

CONCLUSIONS

The situation of overseas imported malaria in Jinan City is becoming more and more serious. It is necessary to further strengthen the related professional training for doctors and strengthen the multi-sectoral cooperation for health education, etc. in order to find the cases in time and conduct the active standardized treatment, so as to prevent the second generation cases.

[Malaria epidemiological analysis in Tengchong City from 2010 to 2015]

OBJECTIVE

To analyze the malaria epidemiological characteristics in Tengchong City from 2010 to 2015, so as to provide the evidence for adjusting and formulating measures in the elimination stage.

METHODS

The malaria data were collected and analyzed by using Microsoft Excel 2010 in Tengchong City from 2010 to 2015.

RESULTS

There were 1 408 malaria cases reported in Tengchong City from 2010 to 2015, including 1 091 cases of Plasmodium vivax infection, 256 cases of P. falciparum infection, 5 cases of P. malariae infection, 1 case of Plasmodium ovale infection, 1 case of mixed infections, and 54 unclassified cases. Totally 1 390 imported cases were recorded and 98.06% of them (1 363/1 390) were imported from Myanmar. Most of the patients (n = 908) were aged from 21 to 40 years, and the male to female ratio was 11.03∶1. The highest-risk populations were farmers and migrant workers. The most cases were observed in April and June, and at that time, most of the floating workers returned.

CONCLUSIONS

Imported malaria is severe in Tengchong City, and there is a great challenge to malaria elimination.

[Investigation and analysis of overseas imported malaria prevalence in Henan Province from 2012 to 2014]

OBJECTIVE

To understand the epidemic characteristics of imported malaria in Henan Province from 2012 to 2014, so as to provide the evidence for proposing the reasonable suggestions for imported malaria prevention and control.

METHODS

The data of imported malaria were collected and the epidemic characteristics were analyzed in Henan Province from 2012 to 2014.

RESULTS

A total of 569 imported malaria cases were reported in Henan Province from 2012 to 2014, including 445 cases of falciparum malaria, 48 cases of vivax malaria, 61 cases of ovale malaria, 14 cases of quartan malaria, and 1 case of mixed infection. All the malaria cases were confirmed in laboratory. During the three years, the time of higher incidence was in Spring Festival, and May and June, and the cases mainly distributed in Luoyang, Zhengzhou, Puyang, Xinxiang, Anyang, Xuchang and Nanyang cities, accounting for 68.54%. Totally 82.43% of the patients were male youth and middle-aged. Of the 569 patients, 534 (93.85%) returned from Africa and 35 (6.15%) returned from Southeast Asian countries. The average time was 6.22 d and the median was 4 d from the onset to diagnosis. Among 569 cases, 290 (50.97%) were confirmed by different levels of centers for disease prevention and control, and 279 (49.03%) were diagnosed by different levels of medical institutions.

CONCLUSIONS

The imported malaria cases have been increased obviously in recent 3 years in Henan Province. Therefore, the health education for the knowledge about malaria prevention and control, and the technician training should be strengthened.

[Analysis of epidemic situation of schistosomiasis in Wuhu County from 2012 to 2016]

Objective To analyze the epidemic situation of schistosomiasis in Wuhu County from 2012 to 2016, so as to provide the reference for adjusting the control strategy. Methods The data of schistosomiasis prevention and control in Wuhu County from 2012 to 2016 were collected and longitudinally analyzed. Results Since 2013, the average infection rate of schistosomiasis in the population decreased year by year, and the infection rate decreased to 0 in 2016. Since 2012, the infection rate of livestock was 0. The area with Oncomelania hupensis snails decreased year by year, but it drastically rebounded in 2016. No schistosome-infected snails were found since 2012. Conclusions Schistosomiasis epidemic is effectively controlled in Wuhu County, but there is a possibility of recovery. In the next stage, we should focus on strengthening the control of snails and imported infectious sources in order to consolidate the achievements of prevention and control.

[Analysis of overseas imported malaria and implication for prevention and control strategy in Shijiazhuang City from 2012 to 2015]

Objective To analyze the overseas imported malaria situation of Shijiazhuang City from 2012 to 2015, so as to provide the evidence for exploring the prevention and control strategy. Methods The data of overseas imported malaria were collected and analyzed with the descriptive method including Plasmodium species, population characteristics, epidemic focus distribution, onset time, diagnosis and treatment in Shijiazhuang City from 2012 to 2015, and the time from the onset to first medical visit, time from first medical visit to being diagnosed, and time from onset to being diagnosed of different Plasmodium species were analyzed respectively with the statistical analysis method. Results A total of 92 overseas imported malaria cases were reported in Shijiazhuang City from 2012 to 2015, including 88 cases from African countries (falciparum malaria taking 53.41%), and 4 cases from Southeast Asian and other countries (vivax malaria taking 50%). Eighty-nine cases were distributed in 28 counties (districts) of 6 cities in Hebei Province, except 2 persons with foreign nationalities and 1 with Anhui Province census register. The male and young adults were dominant. The median time from the onset to seeing a doctor was one day and the median time from seeing a doctor to being diagnosed was five days. Most cases were reported by the Fifth Hospital of Shijiazhuang which was the sentinel hospital. Totally 42.39% of the cases were misdiagnosed when the first visit to a doctor. All of the cases were laboratory confirmed and 100% of them received the standard treatment after diagnosis. Conclusions The overseas imported malaria cases are increasing rapidly with years and the malignant malaria cases were more than other malaria cases in Shijiazhuang City. It is necessary to further strengthen the long-term cooperation mechanism between the medical institutions and the entry-exit inspection and quarantine department. The technician training should be strengthened to avoid the severe cases and death cases.

[Analysis of assessment results of malaria elimination in counties (districts) of Huai'an City]

Objective To analyze the results of the assessment of malaria elimination in 8 counties (districts) in Huai'an City, Jiangsu Province, so as to provide evidences for consolidating the achievement of malaria elimination. Methods The data from the network reports of malaria epidemic situation, blood examinations of febrile patients, epidemiological questionnaires of malaria cases, investigation and disposal of epidemic focuses were collected and analyzed in Huai'an City from 2010 to 2016. The results of the assessment on the clinicians'ability of malaria diagnosis and treatment as well as the inspectors'skill of Plasmodium microscopic examinations were analyzed. In the natural village where the last local case of malaria was reported, no less than 200 blood filter papers were made for gene detection of Plasmodium. Results From 2010 to 2016, 308 malaria cases were reported in Huai'an City. Totally 323 002 patients received blood detection of malaria, among which 272 ones were positive and the positive rate was 0.08%. The majority of the malaria cases were imported, except 19 and 3 local infection cases in 2010 and 2011, respectively. Except Qinghe District, a total of 1 420 blood filter papers from the other 7 counties (districts) were detected genetically, and the results were all negative. Six of the eight counties (districts) gained an average score of 20 points on the Plasmodium microscopic examination, and Jinhu County and Huai'an District got a minimum average score of 19.6 points. In capacity assessment of malaria diagnosis and treatment, Hongze District gained the highest average score of 20 points, and Huai'an District got the lowest average score of 18.8 points. The malaria elimination assessment scores of the eight counties (districts) were all above 97 points. All the 8 counties (districts) in Huai'an City passed the malaria elimination assessment at county (district) level until 2016. Conclusions All the 8 counties (districts) in Huai'an City have passed the malaria elimination assessment with high scores. After the malaria elimination, the monitoring still should continue to consolidate the achievement.

[Epidemic situation of imported malaria in Chengdu City from 2012 to 2016]

Objective To understand the malaria epidemic situation in Chengdu City, so as to provide the evidence for effectively carrying out the malaria elimination work. Methods The data of imported malaria in Chengdu City from 2012 to 2016 were collected from the Disease Surveillance Information Reporting System of Chinese Center for Disease Control and Prevention and analyzed respectively. Results A total of 240 imported malaria cases were reported in Chengdu City from 2012 to 2016. In detail, 68.75% of the cases were falciparum malaria cases, 20.41% were vivax malaria cases, 2.50% were quartan malaria cases, 6.25% were ovale malaria cases, and 2.08% were mixed Plasmodium infections. Among them three patients died, with a mortality of 1.25%. All of the cases were infected overseas, among which 224 patients returned from Africa and 16 patients from Southeast Asia. The annual average morbidity was 0.28/100 000, and there was a significantly difference among annual average morbidities (χ² = 23.87, P < 0.001). There were malaria cases reported in every month, and no significantly difference among seasons (χ² = 0.833, P > 0.05). Conclusion The number of overseas imported malaria in Chengdu City increases year by year. The effective measures to control the overseas imported malaria should be strengthened to consolidate the achievements of malaria elimination.

[Retrospective analysis of schistosomiasis elimination history in Jingxi City, Guangxi Zhuang Autonomous Region]

OBJECTIVE

To understand the schistosomiasis epidemic and control history in Jingxi City, so as to provide the evidence for improving the future work.

METHODS

The data of schistosomiasis prevention and control work were collected and analyzed comprehensively in Jingxi City from 1956-2015.

RESULTS

From 1956, the schistosomiasis prevention and control work carried out, and in 1985, Jingxi City reached the standard of schistosomiasis transmission interrupted and no local schistosome infected residents and livestock were found for 36 years. In May 2016, the city reached the national standard of Schistosomiasis Elimination Assessment Review. The cumulative number of schistosomiasis detection of residents was 348 801 person-times, and 10 434 schistosomiasis patients were found. The cumulative number of schistosomiasis detection of cattle was 20 674 head-times, and 590 schistosome infected cattle were found. The cumulative schistosomiasis treatment number of residents was 18739 person-times, and 512 cattle were treated. The cumulative detection area with Oncomelania hupensis was 65 213.25 hm², and 353.80 hm² area with O. hupensis snails was found.

CONCLUSIONS

Jingxi City has reached the standard of schistosomiasis elimination, but there is still recurrence of O. hupensis snails, and the imported infection source exists. Therefore, we should strengthen the monitoring of floating population.

[Analysis of epidemic situation of imported malaria in Donghai County from 2005 to 2015]

OBJECTIVE

To understand the epidemic situation, epidemiological characteristics and clinical features of imported malaria in Donghai County, Lianyungang City from 2005 to 2015.

METHODS

The epidemiological data of imported malaria in Donghai County from 2005 to 2015 were collected and analyzed by the descriptive epidemiological method.

RESULTS

A total of 126 imported malaria cases were reported in Donghai County from 2005 to 2015, including 101 falciparum malaria cases (80.19%), 13 ovale malaria cases (10.32%), 7 vivax malaria cases (5.56%), 4 quartan malaria cases (3.17%), and 1 case with mixed infection (0.79%). These cases were distributed in 14 towns, and mainly in 4 towns namely Niushan, Tuofeng, Shiliu, and Huangchuan, and the cases in the 4 towns accounted for 63.49% of the total cases. The cases occurred in the whole year, but the peak period of the disease was in April, which was related to the returned time of these patients from foreign countries. All the patients were male and aged from 20 to 55 years, and those aged from 20 to 50 years accounted for 90.70%.

CONCLUSIONS

The epidemic situation of imported malaria presents a rising trend in Donghai County in recent 10 years. To control imported malaria, the above-mentioned 4 towns with more migrant construction workers and businessmen should be treated as key areas. Meanwhile, the floating population management, disposal of the malaria epidemic spots, mosquito vector monitoring as well as health education should be strengthened.

Role and evolution trend of multiple enteroviruses in epidemic of hand, foot and mouth disease

There are a variety of enteroviruses (EV) that can cause hand, foot and mouth disease (HFMD), and the major pathogens include enterovirus 71 (EV71) and coxasckievirus A16 (CVA16). EV71 and CVA16 have attracted much attention for their high prevalence and pathogenicity, and disease surveillance and vaccine development are mainly concentrated on them. EV71 can cause serious harm to children with HFMD, especially the damage to the nervous system such as aseptic meningitis, brain stem encephalitis and paralytic disease, or even lead to death. However, in recent years, due to the epidemic of EV71 and CVA16, people have established an immune barrier through natural infection in a certain degree. Although there is no cross protection between types, the immune protection against the relevant type can persist for a long time. Thus, the number of HFMD cases caused by EV71 and CVA16 shows a decreasing trend, while the epidemic of HFMD caused by other EV exhibits an upward trend. Further studies found that non-EV71 and non-CVA16 EV are very complex, and there are also differences in EV prevalence each year, which makes the development, evolution and control of HFMD become complicated. At present, there is no enough attention paid to the sporadic virus in the HFMD epidemic, and a complete research system for non-EV71 and non-CVA16 EV has not formed. Therefore, it is necessary to strengthen the monitoring of multiple non-EV71 and non-CVA16 EV, further investigate their pathogenicity and genetic characteristics, and evaluate the relative frequency and biological hazard of infection. In this review, we summarize a variety of EV changes, molecular evolution, as well as typical epidemics, which may provide clues to the development of antiviral drugs and vaccines, and prevention and control of HFMD.

[Epidemiological analysis of malaria prevalence in Taixing City from 2005 to 2015]

OBJECTIVE

To understand the malaria prevalence and epidemic characteristics in Taixing City from 2005 to 2015, so as to provide the evidences for formulating the prevention and control strategy.

METHODS

The malaria data of Internet reported cases as well as the reports on epidemiological survey of malaria cases in Taixing City from 2005 to 2015 were collected and analyzed with the methods of descriptive statistics and correlation analysis.

RESULTS

A total of 61 malaria cases were reported in Taixing City from 2005 to 2015, including 4 local cases and 57 imported cases. There were 9 cases of vivax malaria, 47 cases of falciparum malaria, 2 cases of malariae malaria, and 3 cases of ovale malaria. There was no seasonality in the occurrence of imported malaria. Though there was no correlation between the times of malaria attack and the duration for going out (r = 0.154, P = 0.253), there was a negative correlation between the former and the timeliness for visiting a doctor (r = -0.312, P = 0.014).

CONCLUSIONS

The malaria cases are mainly imported ones in Taixing City, and the Plasmodium species of infection are diverse. Imported malaria overseas remains the key point for malaria control in Taixing City.

[Effect of prevention and control system for malaria eliminating in Huai'an City]

OBJECTIVE

To investigate the execution and effect of the prevention and control system for malaria eliminating in Huai'an City from 2010 to 2015, so as to provide the evidence for formulating and adjusting the strategy and measures for malaria elimination.

METHODS

The data of network malaria reports, blood tests of feverish patients, epidemiology investigation forms of case study of malaria patients in the report system, and the investigation and disposition forms of epidemic foci were collected and analyzed statistically.

RESULTS

From 2010 to 2015, there were 267 malaria cases in total in Huai'an City. Totally 303 016 feverish patients had blood tests, and 231 of them showed positive and the positive rate was 0.08%. The epidemiological case studies showed that all the patients were foreign imported cases except 22 local infected vivax malaria cases in 2010 and 2011. All the malaria cases were reported after diagnosis within 24 hours through the directly reported network, and the implementation rate was 100%. All the malaria cases had an epidemiological investigation within 3 days with 100% implementation rate, in which 261 (97.95%) cases were investigated within 2 days. All the cases had an epidemical investigation and disposition within 7 days with 100% implementation rate, in which 252 (94.38%) cases were completed within 5 days.

CONCLUSIONS

The implementation rate of malaria elimination work mode has reached 100% in Huai'an City from 2010 to 2015, and there are no local infected cases in recent four years.

[Epidemiological analysis of malaria prevalence in Sichuan Province, 2012-2014]

OBJECTIVE

To understand the characteristics of malaria prevalence in Sichuan Province from 2012 to 2014, so as to provide evidences for improving the work of malaria elimination.

METHODS

The epidemiological data of malaria cases in Sichuan Province were collected from the Disease Surveillance Information Reporting System of Chinese Center for Disease Control and Prevention, and analyzed with the descriptive epidemiological method.

RESULTS

A total of 690 imported malaria cases were reported in Sichuan Province from 2012 to 2014. In detail, 54.49% (376/690) were falciparum malaria cases, 42.03% (290/690) were vivax malaria cases, 0.58% (4/690) were malariae malaria cases, 1.88% (13/690) were ovale malaria cases, and 1.01% (7/690) were mixed infection cases with Plasmodium vivax and P. falciparum. Among them, five cases died. Totally 671 malaria cases were infected overseas, accounting for 97.25% of the total cases. Among which, 517 patients returned from Africa and 138 patients returned from Southeast Asia. There were malaria cases reported in the whole year, and 185 cases were reported in May and June, accounting for 26.81% of the total cases. The cases distributed in 20 prefecture-level cities in the whole province, and there were 137 and 105 ones reported in Guangan and Chengdu, respectively, which accounted for 35.07% of the total cases.

CONCLUSIONS

The number of patients with overseas imported malaria in Sichuan Province increases year by year, and therefore effective measures should be carried out to control the overseas imported malaria.

[Epidemiological analysis of malaria prevalence in Hubei Province from 2010 to 2014]

OBJECTIVE

To understand the malaria epidemic situation in Hubei Province from 2010 to 2014, so as to provide the evidence for formulating the effective malaria elimination strategies and measures in this province.

METHODS

The data from the Disease Reporting Information System of Chinese Center for Disease Control and Prevention were collected and analyzed with the descriptive epidemiological method for the epidemiological characteristics of malaria in Hubei Province from 2010 to 2014.

RESULTS

A total of 997 malaria cases were reported in Hubei Province from 2010 to 2014, there were 618 cases of vivax malaria, 352 cases of falciparum malaria, 18 cases of Plasmodium ovale infection, and 9 cases of Plasmodium malariae infection. Among all the reported cases, 479 were local cases and 518 were imported cases. No local malaria cases were reported from Hubei Province since 2013. The overall imported malaria cases showed a gradual increasing trend from 2010 to 2014, the proportion of falciparum malaria increased quite significantly from 2010 to 2014. The malaria cases were mainly distributed in Xiangyang, Wuhan, Xiaogan, Yichang, Jingmen and Suizhou cities, reaching 81.85% of the cases of the whole province. There were 810 male cases and 187 female cases, with a sex ratio of 4.33:1. The local malaria cases were mainly aged from 40 to 69 years, accounted for 78.29% of the total local cases, and 88.22% (457/518) of the whole local cases were concentrated in 20-49 age groups. The local cases were mainly farmers (67.01%). Among the imported malaria cases, the occupation distribution concentrated mainly on the worker, migrant worker, and farmer (63.90%).

CONCLUSIONS

The local malaria epidemic situation has been effectively controlled in Hubei Province, which reflects the initiative achievements of malaria elimination. However, there are still many imported malaria cases from abroad. Therefore, the imported malaria from abroad still remains the key of malaria control in Hubei Province.

[Analysis of malaria epidemic situation in Pingguo County, Guangxi Zhuang Autonomous Region from 1951 to 2014]

OBJECTIVE

To explore the law and distribution characteristics of malaria prevalence in Pingguo County, Guangxi Zhuang Autonomous Region, so as to provide the evidence for formulating the targeted control strategy and measures after malaria elimination.

METHODS

The data of malaria epidemic situation in Pingguo County from 1951 to 2014 were collected and analyzed with the retrospective epidemiological method.

RESULTS

From 1951 to 2014, there were 71 365 malaria cases reported in the county. The malaria incidence dropped from 429.43/10 000 in 1960 to 0 in 1993. Since 2002, there was no local endogenous infection case reported. In 1993, this county achieved the standard of malaria elimination basically, and in 2014, passed the examination and evaluation of malaria elimination.

CONCLUSIONS

In Pingguo County, the comprehensive malarial control strategy is effective in different stages. In the future, the monitoring of mobile population and dealing with imported malaria cases timely is the key of consolidation of malaria control achievements.

[Analysis of malaria epidemic situation in Changzhou City from 2010 to 2014]

OBJECTIVE

To grasp the malaria epidemic situation in Changzhou City from 2010 to 2014, so as to provide the evidence for formulating and adjusting malaria control strategies and measures.

METHODS

The epidemiological data of malaria cases in the special report system from 2010 to 2014 were collected, and the malaria epidemic situation and the diagnosis and treatment of malaria patients were analyzed.

RESULTS

There were 132 malaria cases reported in Changzhou City from 2010 to 2014, with a decrease of 27.47% compared to 182 cases from 2005 to 2009. Among the 132 cases, 2 cases were local infected cases and the remaining 130 cases were imported cases. Four cases were clinically diagnosed and 128 cases were laboratory confirmed, with 97 cases of malignant malaria, 14 cases of vivax malaria, 13 cases of ovale malaria, and 4 cases of quartan malaria. The 132 cases were distributed in five districts：56 cases in Jintan City, 51 cases in Liyang City, 19 cases in Tianning District, 3 cases in Wujin District, and 3 cases in Xinbei District. The median duration between the onset and treatment of the disease was 2 days, and the median duration between the diagnosis and treatment was 1 day. The diagnosing units were concentrated on the county-level disease control agencies, and medical institutions at county and municipal levels, accounting for 92.42% (122/132). From 2011 to 2014, there were no local malaria cases.

CONCLUSIONS

From 2012 to 2014, there have been no local malaria cases in Changzhou City, and the goal of eliminating malaria has been achieved basically. However, there are still many imported malaria cases, and the infected species are diverse. Therefore, imported malaria is still the key of malaria prevention and control.

[Epidemic situation of malaria and progress of malaria elimination in Nantong City from 2008 to 2014]

OBJECTIVE

To analyze the epidemic status and progress of malaria elimination in Nantong City, so as to provide evidences for adjusting the control measures and guiding the work of malaria elimination.

METHODS

The data about the epidemic situation of malaria and malaria elimination in Nantong City from 2008 to 2014 were collected and analyzed by the method of descriptive epidemiology.

RESULTS

From 2008 to 2014, a total of 305 malaria cases were reported in Nantong City, with an annual average incidence of 0.57/100 000. Among all the cases, 26 (8.52%) were local tertian malaria cases and 279 (91.48%) were imported cases; 276 cases (90.49%) were male and most of them were young adults, and those aged in 20-59 accounted for 91.48% (279/305). There were cases reported in each month, with no obvious seasonality. The imported cases were mainly distributed in Hai'an County (80 cases), Haimen City (71 cases) and Tongzhou District (41 cases), and the total percentage of them was 68.82% among all the imported malaria cases in Nantong City. There were no local malaria cases reported in Nantong City since 2011. Qidong City, Rudong County, Chongchuan District, Development Zone and Gangzha District have reached the criteria of malaria elimination in Jiangsu Province.

CONCLUSIONS

From 2008 to 2014, the malaria cases in Nantong City are mainly imported cases, the number of local cases has decreased significantly, and there has been no local infected cases reported in the continuous 4 years of 2011-2014. Totally 5 counties (cities, districts) among the 9 have reached the criteria of malaria elimination in Jiangsu City. In the future, the control of imported malaria should still be strengthened, and the work of malaria elimination should still be promoted.

[Analysis of epidemic situation of malaria in Longlin Various Nationalities Autonomous County in Guangxi from 1951 to 2014]

OBJECTIVE

To analyze the data of epidemic situation of malaria in Longlin Various Nationalities Autonomous County, Guangxi Zhuang Autonomous Region, China from 1951 to 2014 and discuss the distribution characteristics and epidemic law, so as to provide the evidences for developing the prevention and control strategies of the disease.

METHODS

The data about the epidemic situation of malaria in Longlin Various Nationalities Autonomous County were collected and analyzed statistically with Excel 2007.

RESULTS

Totally 93 460 malaria cases were reported from 1951 to 2014 in the county. There were two morbidity peaks of malaria during this period, namely 1950s and 1970s, and the annual average incidence rates were 3 237.94/100 000 and 1 572.12/100 000, respectively, but it began to flatten after 1980s. Before 2000, the local cases were the main type, however, there were no endogenous cases since 2008. In 1950s, falciparum malaria was the main type of the disease, and the cases with falciparum malaria, tertian malaria and quartan malaria were accounted for 45.01% (2 392/5 314), 33.72% (1 792/5 314) and 19.55% (1 039/5 314), respectively; while in 1960s, the proportion of cases with tertian malaria increased, that of the cases with quartan malaria decreased, and there were no quartan malaria cases reported since 1980s. There were imported malaria cases reported since 1990s, and a total of 51 cases were found in this period, among which, 50 cases (98.04%) were tertian malaria, and the main infection sources were the cases from epidemic areas in other provinces of China. After 2000, the imported malaria cases with falciparum malaria increased, with a proportion of 60.00% (21/35), and the infection sources were mainly from Africa and Southeast Asia.

CONCLUSIONS

The local endemic of malaria in Longlin Various Nationalities Autonomous County has been effectively controlled, but the situation of imported malaria is still severe in this county. Therefore, strengthening the surveillance of floating population, especially the workers backing from overseas, is still the key of malaria prevention and control in the future.