ABSTRACT
ObjectiveTo investigate the distribution of Kashin-Beck disease(KBD) in Tibet, and assess the disease status. Methods Between 2007 and 2008, a survey was done on KBDepidemiology which was carried out in four prefectures of 26 counties according to the east, south, west, north and center in Nakchu,Lhoca, Nyingtri and Shigatse districts of Tibet, with towns and villages as baseline survey points. According to the KBD e survey scheme, KBD clinical examination for adults was also carried out and at the same time clinical and right hand anteroposterior X-ray examinations were given to children aged 4 - 13. The partition of endemic area was based on the criteria of national standards for Kashin-Beck disease diagnoses《GB 16395-1996》. Slight KBD area:clinical prevalence of Kashin-Beck disease grade Ⅰ and above was less than 10％ or X-ray detection rate ＜ 10％ of children; the moderate prevalent KBD area: clinical prevalence of Kashin-Beck disease grade Ⅰ and above was between 10％ and 20％ or X-ray detection rate was between 10％ and 30％ of children; severe KBD area: clinical prevalence of KBD grade Ⅰ and above was more than 20％ or X-ray detection rate was higher than 30％ of children.ResultsA total of 108 townships of 26 counties were surveyed, 14 686 adults were clinically examined, cases detection of grade Ⅰ and above were 637 people, the prevalence was 4.34％, and no case of grade Ⅲ was detected.Of 5769 children's right anteroposterior X-ray film, 102 were detected positive; the prevalence rate was 1.77％.Metaphysis was affected in most of the child cases, which accounting for 89.2％ (91/102). Amongst all the counties, there were 10 counties, clinical detection rate of adult KBD was 0, and children's X-ray detection rate of KBD was also 0. In 1 county the clinical prevalence rate for adults KBD was 0 and X-ray detection rate for children was 3.66(7/191 ). In 12 counties the clinical prevalence rate for adults KBD was between 1.03％ and 7.54％, X-ray detection rate for children was between 0 and 7.76％, amongst all these counties surveyed there were 5 counties,the detection rate for children was 0. In 3 counties the clinical prevalence rate for adult KBD was between 10.69％and 13.88％, the X-ray detection rate for children was between 5.31％ and 7.76％. Conclusions According to the criteria for diagnoses of KBD, within the 26 counties surveyed, 10 counties are non-endemic areas, 13 counties are slight endemic areas, 3 counties are medium endemic areas. So far, KBD is prevalent in 52 counties of 7 prefectures (cities) in Tibet, the disease is widely distributed, the situation is still severe, and there is a need to continue to strengthen KBD surveillance.
ABSTRACT
Objective To assess the endemic trend of Kaschin-Beck disease in Tibet and to provide scientific basis for prevention and etiology study of the disease. Methods A questionnaire designed by us was administered to 905 participants who were from Lhundrop county, Medro Gongkar county of Lhasa municipality and Sangri county of Lhoka region in July to November, 2007. The Kashin-Beck disease diagnostic criteria(GB 16003-1995) was used for clinical diagnosis, and children 5 to 14 years old were taken right wrist X-ray film for diagnosis.Results One hundred and forty-four genealogies were recruited in this study. The interview and clinical examination were done to 905 persons, 208 persons were detected with Kaschin-Beck disease, and the detectable rate was 22.98%(208/905). The numbers of patients with degrees Ⅰ , Ⅱ and Ⅲ of Kaschin-Beck disease were 148, 43 and 17, respectively, with proportion of 71.15%(148/208), 20.67%(43/208) and 8.17%(17/208) out of all patients, respectively. The detectable rates of Kaschin-Beck disease were 29.73% (102/343) and 18.86%(106/562), respectively in Lhasa and Lhoka district, and the difference between this two districts was statistically significant(x2= 15.257, P＜ 0.01) . A total of 368 males and 537 females were recruited in this study, the detectable rates of male and female with Kaschin-Beck disease were 19.29% (71/368) and 25.51% (137/537), respectively,and the difference between male and female was statistically significant (x2 = 5.372, P ＜ 0.01) . In this study most patient were between 31 to 70 years old, the patients with degrees Ⅱ or Ⅲ of Kaschin-Beck disease were mostly above 40 years old. There were only 5 patients who were less and equal 20 years old in chinical diagnosis. The Xray positive detectable rate of children between 5 to 14 years old was 6.85% (10/146). Conclusions The condition of Kashin-Beck disease area is relatively stable in these two regions in recent years, and shows a downward trend. However, there are still positive child cases diagnosed by X-ray, which should arouse the attention of the relevant departments to further strengthen the implementation of control measures.
