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系統識別號 U0026-2507201123172000
論文名稱(中文) 空間分析於災後傳染病之應用-莫拉克風災之萬丹鄉鉤端螺旋體病群聚危險因子分析
論文名稱(英文) Applying Spatial Analysis to Post-disaster Infectious Diseases - An Analysis of Risk Factors for Cluster of Leptospirosis at Wandan Township after Typhoon Morakot
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 99
學期 2
出版年 100
研究生(中文) 張雅婷
研究生(英文) Ya-Ting Chang
學號 T86984051
學位類別 碩士
語文別 中文
論文頁數 83頁
口試委員 指導教授-王亮懿
口試委員-陳國東
口試委員-林漢良
口試委員-潘銘正
口試委員-洪敏南
中文關鍵字 災後傳染病  空間分析  莫拉克風災  鉤端螺旋體  危險因子 
英文關鍵字 Post-disaster infectious diseases  Spatial analysis  Typhoon Morakot  Leptospirosis  Risk factors 
學科別分類
中文摘要 目的:2009年8月初莫拉克颱風過境臺灣,屏東縣萬丹鄉淹水地區出現了台灣近年來最大宗的鉤端螺旋體群聚感染,但未能查明確切感染源頭,這是因為災後傳染病的調查往往因為時間匆促以及受災害地點的空間與環境的限制,使得環境採樣與風險確認的困難。因此本研究欲利用GIS地理資訊系統與空間分析方法來分析2009年莫拉克風災過後萬丹鄉嚴重淹水地區的鉤端螺旋體病例分佈的群聚情形與探究可能的危險因素與相關環境風險因素。
方法:本研究使用屏東縣政府衛生局的2009年8月的鉤端螺旋體確診病例資料、萬丹鄉災後生活重建中心所調查的家戶資料以及相關環境風險位置(如畜牧場、萬丹大排位置),判別罹病的危險因素,並使用核密度分析找出疾病發生的熱區範圍,以及空間掃描統計分析瞭解疾病的空間分布的聚集位置,最後考慮距離與洪水流經方向的關係,使用邏輯斯迴歸分析找出顯著的環境風險因素。
結果:本研究發現男性、年齡在20~59歲以及家戶人口數較多者有顯著高的風險。病例的空間分布,在灣內村與後村村有熱區的現象,並在灣內村發現顯著的疾病聚集位置。最後發現疑似感染源可能位在某三個環境風險周遭範圍,其亦位於疾病熱區與病例聚集的位置附近。
結論:本研究利用空間分析將疑似感染源的範圍鎖定在某三個環境風險周遭範圍。本篇研究結果與方法供災後疫病爆發的調查與防疫之參考。
英文摘要 BACKGROUND: When Typhoon Morakot hit Taiwan in August 2009, it brought flood in Wandan township of Pingtung county, which caused the biggest cluster of leptospirosis in recent years. However, it is failed to examine the source of the cluster of leptospirosis because of several limits such as the haste time and the flood environment. Under these restrictions, it is difficult to take samples for examination. A generic geographic information system (GIS) as well as spatial analysis was used to develop a method for source detection and to find possible risk factors and related environment risk factors.
METHODS: Data of Leptospirosis confirmed case in August 2009, household data, and related environment risk locations were used to estimate disease risk factors. We performed a case-control study to analyze risk factor between case and control. Geographic information systems (GIS) , spatial scan statistic (SaTScan),and kernel density estimation(KDE) were used to detect leptospirosis hotspots and a most likely significant purely spatial cluster. Finally, using logistic regression to find evident environment risk factors.
RESULTS: In the study, we found that male gender, age between 20 to 59 years old, and person who live in the household which have more residents are significantly higher incidence risk. The hotspot maps produced by kernel density estimation showed spatial trend patterns of leptospirosis. There are two regions revealed higher incidences at Wan-Nei village and Hou-Cun village. Also, a most likely significant purely spatial cluster was found at Wan-Nei village. At last, it is found that possible source of leptospirosis outbreak is probably located at certain three environment risk areas; that is, near the hotspot and spatial cluster.
CONCLUSION: This study uses spatial analysis to minimize possible disease origin into certain three environment risk areas. The research result and method can be used as a reference of disease investigation and prevention after disasters.
論文目次 目錄
第一章 緒論 1
第一節 研究動機 1
第二節 研究地區與背景 3
第三節 研究目的 9
第二章 文獻回顧 10
第一節 鉤端螺旋體病的概要 10
一、 病原體特性 10
二、 人類的臨床症狀 12
三、 傳染途徑 14
第二節 鉤端螺旋體病的流行情形 16
一、 世界的流行情形 16
二、 臺灣的流行情形 19
第三節 鉤端螺旋體病的危險因子 25
第四節 地理資訊系統與傳染病研究 27
一、 GIS定義與空間分析的種類 27
二、 GIS空間分析在傳染病的研究 30
三、 應用地理資訊系統於鉤端螺旋體病的研究 31
第三章 研究問題與假說 33
第一節 研究問題 33
第二節 研究假說 33
第四章 材料與方法 34
第一節 資料來源 34
第二節 資料處理 36
第三節 資料分析方法 40
一、 研究變項的描述性統計與地圖呈現 40
二、 控制地理環境因素之危險因素分析 40
三、 空間熱點與聚集分析 41
四、 疑似感染源之推論性統計 45
第五章 研究結果 48
一、 研究變項的描述性統計與地圖呈現 48
二、 控制地理環境因素之危險因素分析 49
三、 空間熱點與聚集分析 50
四、 疑似感染源之推論性分析 51
第六章 討論 53
第七章 結論與建議 56
一、 結論 56
二、 建議 56
第八章 參考文獻 57


表目錄
表5-1:戶政資料與調查家戶與人數對照表 65
表5-2:研究地區的家戶人口特徵與家戶特徵 66
表5-3:研究地區的鉤端螺旋體病例人口學特徵與家戶特徵 67
表5-4:研究地區的畜牧場類別與數量 68
表5-5:病例與配對對照個案的危險因素分析 68
表5-6:病例與隨機對照個案到各環境距離變項的檢定 69
表5-7:病例與隨機對照個案到畜牧場距離與畜牧場後端家戶之邏輯式迴歸 71
表5-8 不同聚落空間的病例發病日中位數與發病率 77




圖目錄
圖5-1:研究地區的家戶空間分布 78
圖5-2:研究地區的病例空間分布 78
圖5-3:研究地區的鉤端螺旋體病發病日別之空間位置 79
圖5-4:研究地區的畜牧場空間分布(房舍範圍) 80
圖5-5:研究地區的畜牧場空間分布(畜牧場中心點) 80
圖5-6:研究地區的家戶、病例與環境變項之空間分布 81
圖5-7:研究地區的病例與依環境配對的對照個案之空間分佈 81
圖5-8:研究地區的鉤端螺旋體病例分布之核密度估計分析 82
圖5-9:灣內村、後村村的病例與隨機對照個案之空間分布 82
圖5-10:灣內村、後村村的病例與隨機對照個案之空間聚集分析 83
圖5-11:灣內村、後村村的病例與隨機對照個案之疑似感染源分析 83

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