我国预防接种服务现状研究

发布时间：2018-01-02 12:42

本文关键词：我国预防接种服务现状研究　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景预防接种服务是国家基本公共卫生服务中的一项重要内容,是疾病预防控制工作的主要组成部分,其工作质量的高低直接关系到免疫规划相关传染病的预防和控制效果。近年来,我国预防接种服务工作取得了很大的进步,重大传染病防治工作取得了明显进展,但也存在一些问题,如部分儿童接种不及时甚至漏种、部分家长不重视、不信任预防接种等。因此,了解预防接种服务中存在的实际问题,对改进预防接种工作具有十分重要的意义。2015年,国家卫生计生委疾控局委托国家卫生计生委卫生发展研究中心对国家基本公共卫生服务项目中的疾控项目进行调查,本文从调查中筛选出有关预防接种服务的内容,对全国6个地区的预防接种服务情况进行研究。疫苗接种率及相关疾病防控情况是评价预防接种服务的重要指标,预防接种机构相关设施设备配备情况和基层医务人员的素质是影响预防接种工作质量的重要指标,儿童预防接种服务情况及家长满意度对发现预防接种服务工作存在的问题具有重要意义,本文将主要从上述几个方面对我国预防接种服务工作进行研究。研究目的了解我国预防接种工作的现状,包括当前疫苗接种情况及疾病防控情况、基层预防接种机构面临的困难及挑战、儿童接种情况及儿童家长满意度等,发现当前我国预防接种服务工作存在的问题和小足,进而为提高预防接种服务水平提供政策建议。研究方法按照立意抽样方法,根据行政区划、地理分布与经济发展水平,从全国选择北京、广东、湖北、吉林、云南、新疆6地作为调研省份,每个省份按GDP水平高、中、低各选择一个县。通过问卷、座谈等方式对相关机构(卫生计生行政部门、技术指导机构、社区卫生服务中心/站、乡镇卫生院、村卫生室)和相关医务人员进行调查。通过批质量保证抽样法对预防接种服务情况及儿童家长满意度开展入户问卷调查,共调查1550人。利用EpiData3.02建立数据库,利用Excel2013和SPSS20.0对数据进行整理和统计分析,计数资料的统计描述用率或构成比表示,不同组间的率或构成比的比较用χ2检验,不同组间均值的比较用t检验或方差分析,采用Logistic回归对儿童漏种或未接种的影响因素及儿童家长预防接种整体满意度的影响因素进行分析。研究结果1.新生儿首剂乙肝疫苗及时接种率有波动,新疆2014年较2013年降低了5.35个百分点,广东省和湖北省在2014年也出现略有下降的情况;6省的儿童乙肝疫苗全程接种率自2012年开始均达到99%以上;6省的含麻疹成分疫苗第二剂次接种率2013年以来均达到99%以上。除云南外,各地乙肝发病率均有了大幅下降,但广东省、湖北省和新疆地区乙肝发病率仍然高达146.81/10万、104.91/10万、166.62/10万;近年来麻疹发病率呈现出抬头的趋势,网络报告病例数大幅增加,特别是2014年北京市和吉林省麻疹发病率快速攀升均超过了11/10万;2014年各省的疑似预防接种异常反应调查诊断分类率均较2009年取得了很大进步,特别是云南省由2009年的88.60%提高到了 99.58%。2.本次调查的34个机构,82.35%是规范门诊;平均每个机构的接种房屋面积为87.22 m2,其中吉林平均每个机构接种面积最大,为120 m2,最低的是云南,为60.5m2。平均每个机构拥有4.06个冰箱,1.18个冰柜,9.35个冷藏包。3.各地从事预防接种工作的医务人员以女性为主,占82.25%;年龄26-45岁占71.02%;岗位方面,医生占33.33%,护士占41.67%,公共卫生占14.49%,其他占10.51%;65.94%的人是初级职称或无职称;学历以专科学历为主,占43.84%;54.35%的人月平均收入3000元及以下;6地只从事预防接种服务的医务人员占20.65%,从事6种及以上公共卫生服务的占37.68%;有18.48%的医务人员明确表示上级专业技术指导机构对基层医疗机构人员的指导不足;15.22%的工作人员对承担服务的积极性评价比较低甚至有一定的抵触情绪。4.接受调查的适龄接种儿童建证率为98.97%,建卡率为98.52%,卡证相符合的达到97.81%。6个调研地点建证率、建卡率、卡证符合率均在95%以上,其中湖北省的建证率、建卡率、卡证符合率均最低。5.6地有184名适龄接种儿童有漏种或未接种的情况,占总人数的11.87%,其中新疆地区适龄接种儿童漏种或未接种比例最高,漏种或未接种比例为19.02%;卡方检验结果显示,被调查家长的年龄、学历、职业、调查地类型、是否有预防接种证、是否有预防接种卡是影响2-6岁适龄接种儿童漏种或未接种的因素;多因素分析结果显示,被调查家长的年龄、职业、是否有预防接种证、是否有预防接种卡是影响2-6岁适龄接种儿童漏种或未接种的因素。6.从6个调研地来看,新疆地区家长对接种的满意度相对较高,湖北相对较低;从各个条目来看,满意度最高的是整体满意度,得分为(4.26±0.52),得分最低的是家到接种门诊的距离(4.13±0.61)和疫苗接种情况介绍满意度(4.13±0.63)。从城乡来看,乡镇地区家长的整体满意度高于城镇地区。单因素分析结果显示,被调查家长与儿童的关系、户籍、通知预防接种的方式、等候时间、步行到预防接种门诊的时间、医务人员是否告知注意事项6个因素是影响家长预防接种整体满意度的因素。多因素分析结果显示,等待时间、医务人员是否告知注意事项是影响家长预防接种服务整体满意度的因素。政策建议:1.多项措施并举减少疫苗漏种现象,进一步提高疫苗接种率。2.进一步发挥专业机构的指导作用。3.进一步提升基层服务能力。4.加强免疫规划疫苗及冷链设备的使用管理工作,保证疫苗质量。5.加快预防接种信息化建设和管理。6.加大预防接种服务的宣传力度。
[Abstract]:The research background of immunization services is an important content of basic public health services in the country, is the main part of the work of disease prevention and control, prevention and control effect is directly related to immunization related infectious diseases of the quality of its work. In recent years, China's pre vaccination service work has made great progress, work the prevention and control of major infectious diseases has made significant progress, but there are also some problems, such as part of vaccination of children is not timely or even missing, some parents do not pay attention, do not trust the vaccination. Therefore, to understand the actual problems of vaccination services, is very important for the improvement of the vaccination work has significance for.2015 years, the national health plan the Commission for Disease Control Commission of health development research center on the livelihood of national basic public health service project commissioned by the National Health Bureau disease control project survey, this paper from the survey screen Select the relevant vaccination service content of vaccination services in 6 areas of the country. The prevention and control of related diseases and vaccination rate is an important index to evaluate the quality of vaccination service, preventive vaccination institutions equipped with related facilities and equipment and grassroots medical staff is an important index affecting the quality of immunization of children. Vaccination service and satisfaction of parents is very important for prevention of existing immunization services work, this article mainly from the aspects of China's prevention research vaccination service work. Objectives: to understand the status quo of China's vaccination work, including the current situation of prevention and control of vaccination and disease, primary prevention difficulties and challenge inoculation facing the organization, vaccination of children and parents satisfaction, found that China's current vaccination service work The existing problems and the small foot, so as to improve the vaccination service level to provide policy recommendations. Research methods in accordance with the purposive sampling method, according to the administrative division, geographical distribution and the level of economic development, from the choice of Beijing, Guangdong, Hubei, Jilin, Yunnan, Xinjiang 6 provinces as the research, according to the high level of GDP in each. Low provinces, each choose a county. Through the questionnaire, discussion on relevant institutions (health administrative departments, technical guidance institutions, community health service center / station, township hospitals, village health room) were investigated and related medical staff. Through a lot quality assurance sampling method to carry out questionnaire survey on prevention vaccination service and satisfaction of parents of children, a total of 1550 people were investigated. Using EpiData3.02 database, the data were analyzed by Excel2013 and SPSS20.0, enumeration data described by rate or composition More than that, among different groups or percentages of the 2 test was used to compare between different groups, compared with the mean t test or analysis of variance, influence by Logistic regression on children missing or unvaccinated factors and parents of children vaccination overall satisfaction analysis. The results of 1. newborn first dose of hepatitis B vaccine timely vaccination rate fluctuations, Xinjiang in 2014 5.35 percentage points lower than in 2013, Guangdong province and Hubei province have declined slightly in 2014; the whole course vaccination rate of hepatitis B vaccine in children 6, since the beginning of 2012 reached 99% to 6; the province contains second doses of measles containing vaccine since vaccination rate in 2013 of more than 99%. In addition to Yunnan, around the incidence of hepatitis B were dropped, but the Guangdong Province, Hubei province and the incidence of hepatitis B in Xinjiang area rate is still as high as 146.81/10 million, 104.91/10 million, 166.62/10 million in recent years; The incidence rate of measles showed a rising trend of network, the number of reported cases increased significantly, especially in 2014, Beijing city in Jilin province and the incidence of measles in the rapid rise of more than 11/10 million; in 2014 the suspected abnormal reaction to vaccination survey diagnostic classification rate than in 2009 has made great progress, especially in Yunnan province increased from 88.60% in 2009 the 34 99.58%.2. in this survey, 82.35% standard outpatient; average institutions vaccination housing area is 87.22 m2, of which Jilin average institutions inoculated with the largest area, 120 m2, Yunnan is the lowest, 60.5m2. average institutions have 4.06 refrigerators, 1.18 freezers, 9.35 refrigerator.3. all engaged in the vaccination work of medical personnel in female dominated, accounting for 82.25%; aged 26-45 years old accounted for 71.02% jobs, accounting for 33.33%; the doctor, public health nurses accounted for 41.67%, accounting for 14.49%, other Accounted for 10.51%; the primary title or title 65.94% people; education to college education, accounting for 43.84%; 54.35% of the average monthly income of 3000 yuan and below 6; only engaged in immunization service medical personnel accounted for 20.65%, 6 or more engaged in public health services accounted for 37.68%; 18.48% of the medical staff clear said the guidance of higher professional and technical guidance to staff basic medical institutions; 15.22% staff on the positive evaluation of bear services is relatively low and even some resentment.4. survey of school-age children vaccinated building card rate is 98.97%, the record rate is 98.52%, the cards reached 97.81%.6 research sites building card rate, rate card consistent with the certificate card, the coincidence rate is above 95%, the Hubei province building card rate cards, card rate, coincidence rate was the lowest.5.6 of 184 school-age children vaccinated or unvaccinated leakage situation, the total people The number of 11.87%, the Xinjiang area of school-age children vaccinated or unvaccinated the highest proportion of leakage or leakage, no vaccination rate was 19.02%; chi square test results show that the surveyed parents age, education, occupation, investigation type, whether vaccination certificate, whether there is a card is the influence factors of prevention at the age of 2-6 school-age children vaccinated or unvaccinated leakage; multi factor analysis showed that the surveyed parents age, occupation, whether vaccination certificate, whether vaccination card is 2-6 year old age children vaccinated or unvaccinated.6. leakage factors from 6 research, Xinjiang area parents' satisfaction to inoculation Hubei is relatively high, relatively low; from the entry point of view, is the highest satisfaction overall satisfaction score was (4.26 + 0.52), the lowest score is the home to the vaccination clinic distance (4.13 + 0.61) and vaccination satisfaction (4.13 introduction 0.63). From the view of urban and rural areas of the township, the overall satisfaction of parents is higher than that in urban areas. The single factor analysis showed that the relationship between parents and children in the household registration, investigation, notice of vaccination, waiting time, walk to vaccination clinics, medical staff advise whether note 6 factors are the influence factors of parents the overall satisfaction of vaccination. The results of multivariate analysis showed that the waiting time, inform the medical staff whether precautions are the influence factors of parents satisfaction. Preventive vaccination service policy recommendations: 1. measures simultaneously to reduce the leakage phenomenon of the vaccine, to further improve the vaccination rate of.2. to further play the guiding role of.3. professional organizations to further enhance the ability of grassroots service.4. strengthen the EPI vaccine and the use of cold chain equipment management, ensure the quality of the vaccine inoculation of.5. to accelerate the construction of information and Prevention Manage.6. to increase the publicity of vaccination services.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R186

【相似文献】