Disparities in Echinococcosis Control in Xizang, China: An Assessment Based on the Health Resource Density Index.

BACKGROUND

Echinococcosis remains a major public health concern in Xizang, China, characterized by high endemicity in remote and underserved areas. Despite long-term implementation of the national control program, the effectiveness of interventions may be constrained by insufficient and unevenly distributed health human resources (HHR).

OBJECTIVES

To evaluate the distribution of HHR in Xizang and its association with echinococcosis prevalence at the township level using the health resource density index (HRDI).

METHODS

Township-level data on echinococcosis prevalence were collected from the Xizang Center for Disease Control and Prevention. HHR data were collected from the China Health Statistics Yearbook 2022. HRDI was constructed to quantify HHR allocation by integrating population size and geographic area. Differences in HRDI across regions and production types were analyzed using the Kruskal-Wallis test with Bonferroni correction for multiple comparisons. Spatial autocorrelation analysis using Moran's I and Getis-Ord Gi∗ statistics was performed to identify clustering patterns of HRDI. Spearman's rank correlation was used to evaluate the relationship between HRDI and echinococcosis prevalence.

RESULTS

The density of health technicians in Xizang (7.0 per 1000 population) was lower than the national average, with pronounced urban-rural disparities. Significant differences in HRDI were observed across cities (p < 0.05), with the lowest levels identified in Ali and Nagqu. In addition, HRDI varied significantly across production types (p < 0.05), with lower levels observed in semiagricultural and semipastoral areas and pastoral areas. Spatial analysis revealed significant clustering of HRDI, with low-value clusters predominantly distributed in pastoral areas such as Ali and Nagqu. HRDI was negatively correlated with echinococcosis prevalence (rs = -0.326, p < 0.05).

CONCLUSIONS

Insufficient and uneven distribution of HHR is associated with increased echinococcosis prevalence in Xizang. Strengthening HHR allocation in high-endemic areas, alongside community-based interventions and improved health service accessibility, is essential for enhancing the effectiveness of echinococcosis control programs.