Morrow R H
Soc Sci Med. 1984;19(10):1039-49. doi: 10.1016/0277-9536(84)90306-x.
The vector and soil transmitted parasitic infections produce a highly diverse group of diseases in terms of the importance of their impact upon human populations and in terms of the control methods that might limit that impact. In Ghana a method was developed for quantitatively assessing the relative importance of different disease problems by estimating the amount of healthy life lost through illness, disability and death as a result of each disease. The quantitative assessment is derived from information on incidence rate, case fatality rate and the extent and duration of disability produced by the disease. The method may be used to help decide the priorities for the allocation of resources to alternative procedures or programmes by calculating the amount of healthy days of life which may be saved by different approaches and then relating these savings to the costs of the approaches. Each of the vector and soil transmitted parasitic diseases in Ghana had special characteristics that influenced the estimates of their relative importance. Attribution of death due to malaria posed special problems, but even with the most conservative estimate malaria was the single most important cause of loss of healthy life of all diseases in Ghana. For schistosomiasis there is such great uncertainty concerning how much disability or mortality that results from infection that the relative importance of schistosomiasis could not be usefully estimated; thus research into the extent of disability and death caused by schistosomiasis should have a very high priority if rational allocation of resources for its control is to be achieved. Onchocerciasis, though not generally considered an important cause of mortality, is an important cause of chronic severe disability. The importance of ascariasis and hookworm remain uncertain both because of the lack of information as to the extent of disability and mortality that they produce and the lack of data in Ghana as to their prevalence and intensity of infection. Guinea worm was of little importance from the national point of view, but was highly important in focal areas. Trypanosomiasis would appear to be of minor importance because its incidence was quite low, but for an epidemic disease such as trypanosomiasis the importance must be estimated based on what would occur if there were not effective surveillance and control methods. Diverse though this group of parasitic diseases is a common thesis is that each has been relatively neglected in relation to its importance and for each a considerable reduction in loss of healthy life should be achievable at reasonable cost.
病媒传播和土壤传播的寄生虫感染所引发的疾病种类繁多，这些疾病对人类群体的影响程度以及可能限制这种影响的控制方法各不相同。在加纳，人们开发了一种方法，通过估计每种疾病导致的因疾病、残疾和死亡而损失的健康生命数量，来定量评估不同疾病问题的相对重要性。这种定量评估源自发病率、病死率以及疾病所致残疾的程度和持续时间等信息。该方法可用于通过计算不同方法可能挽救的健康生命天数，然后将这些挽救的天数与方法成本相关联，来帮助确定资源分配给替代程序或项目的优先级。加纳的每种病媒传播和土壤传播的寄生虫病都有其特殊特征，这些特征影响了对其相对重要性的估计。疟疾导致的死亡归因存在特殊问题，但即便采用最保守的估计，疟疾仍是加纳所有疾病中导致健康生命损失的最重要单一原因。对于血吸虫病，感染所致残疾或死亡率的不确定性极大，以至于无法有效估计血吸虫病的相对重要性；因此，如果要合理分配资源来控制血吸虫病，对其所致残疾和死亡程度的研究应具有极高的优先级。盘尾丝虫病虽然通常不被视为重要的死亡原因，但却是慢性严重残疾的重要原因。蛔虫病和钩虫病的重要性仍不确定，这既是因为缺乏关于它们所致残疾和死亡率程度的信息，也是因为加纳缺乏关于其流行率和感染强度的数据。从国家层面来看，麦地那龙线虫病不太重要，但在局部地区却极为重要。锥虫病似乎不太重要，因为其发病率相当低，但对于像锥虫病这样的流行病，其重要性必须基于没有有效监测和控制方法时可能发生的情况来估计。尽管这组寄生虫病各不相同，但一个共同的观点是，相对于其重要性而言，每种疾病都相对受到忽视，而且以合理成本大幅减少健康生命损失应该是可以实现的。
