甘肃省5县市先天缺陷干预工程效果评价

发布时间：2018-05-09 10:05

本文选题：先天缺陷 + 发生率　；参考：《兰州大学》2012年硕士论文

【摘要】：目的通过定量和定性研究,了解甘肃省5县(市)先天缺陷干预工程开展情况,探讨甘肃省先天缺陷重点干预对策,为进一步指导优生优育和有效预防先天缺陷发生提供科学依据。方法对甘肃省敦煌市、泾川县、徽县、渭源县和永靖县,2008年10月1日～2010年9月30日所有孕28周以上出生的新生儿(包括活产、死胎、死产)进行普查；比较分析敦煌市、泾川县、徽县、渭源县及永靖县基线及终末调查的孕28周以上出生的新生儿(包括活产、死胎、死产)先天缺陷发生率及构成的变化；采用1：1配对病例对照研究,分析176例先天缺陷儿母亲孕期暴露因素,对先天缺陷可能的危险因素采用单因素与多因素logistic回归分析；对县乡村妇幼专干和计生专干、基层医务人员和孕28周以上分娩的妇女进行问卷调查；同时对县级和乡级计生局及计生站的计生工作管理人员、县级和乡级医院妇保和妇产科专业技术人员及部分孕妇进行三个层面的定性访谈。结果 (1)2009年5县(市)先天缺陷总发生率为7.49%o,居于前三位的先天缺陷病种分别为先天性心脏病、色素痣和神经管畸形；2010年5县(市)先天缺陷总发生率为8.35‰,居于前三位的先天缺陷病种分别为先天性心脏病、神经管畸形和色素痣、脑积水。2年间被调查各市/县先天缺陷发生率不尽相同,其中敦煌市先天缺陷发生率最高,为14.65‰,徽县先天缺陷发生率最低,为3.28%o。 (2)母亲患遗传病(OR=4.407,95%CI=0.925～21.008)、孕期患流感(OR=1.986,95%CI=0.992～3.976)、孕期服用保胎药(OR=2.466,95%CI=0.981～6.148)是围产儿先天缺陷发生的主要危险因素。 (3)被调查5县(市)围产儿先天缺陷发生率终末调查时为8.35%o,较基线调查时的14.02‰,下降了40.44%。基线与终末调查先天缺陷发生顺位及构成不同。 (4)5县(市)妇女叶酸知晓率和服用率分别为93.85%、84.92%,叶酸规范服用率为22.19%；育龄妇女主要通过计生系统宣传教育来了解叶酸相关知识。 (5)基层妇幼保健人员对相关知识如神经管畸形发生的时间、神经管畸形的诊断、生育神经管畸形儿的高危人群、增补叶酸人群正确应答率较低,均不到50.00%；其中35-44岁的工作人员接受培训(36.21%)、知道健康妇女需要补充叶酸(36.21%)、认为有必要向育龄妇女介绍叶酸的重要性(37.45%)、对妇女进行宣传教育(37.24%)、免费发放叶酸(37.24%)、指导并监督服用叶酸率(34.98%)较低。 (6)基层医务人员相关知识知晓率较低,知道我国神经管畸形发生存在性别差异的县级医务人员有123人,占51.04%,乡级医务人员有41人,占24.26%；知道生育神经管畸形儿高危人群的县、乡级医务人员分别有47人(19.50%)、42人(24.85%)。知道孕期叶酸缺乏会对孕妇、胎儿造成影响的县、乡级医务人员分别有89人(36.93%)、85人(50.30%)；会给每位育龄妇女讲解增补叶酸重要性的县、乡级医务人员分别有236人(97.93%)、169人(100.00%)；有129名(53.00%)县级医务人员和152名(89.94%)乡级医务人员接受相关知识的培训；通过专家讲座、培训获取相关知识的县级医务人员有169人(70.12%),乡级医务人员有92人(54.44%)。结论甘肃省5县(市)出生缺陷干预工程实施效果明显,育龄妇女自我保健认知得到进一步提高,但仍需进一步加强干预工程的宣传和实施力度,提高基层妇幼保健人员的综合业务素质。
[Abstract]:objective
Through quantitative and qualitative research, the development of congenital defect intervention projects in 5 counties (cities) of Gansu province was understood, and the key intervention measures of congenital defects in Gansu were discussed, which provided scientific basis for further guidance of eugenics and effective prevention of congenital defects.
Method
In Dunhuang, Jingchuan County, Hui County, Weiyuan county and Yongjing County, all newborn babies born in 28 weeks from October 1, 2008 to September 30, 2010 (including live birth, stillbirth and stillbirth) were surveyed, and the newborn babies born in Dunhuang City, Jingchuan County, Hui County, Weiyuan County, Yongjing county and Yongjing County were compared and analyzed for more than 28 weeks of birth (package). The incidence of congenital defects and the change of the constitution of the congenital defects were included. The 1:1 matched case control study was used to analyze the factors of pregnancy exposure in 176 cases of congenital defect mothers. The possible risk factors of congenital defects were analyzed by single factor and multiple factor Logistic regression analysis. At the same time, a questionnaire survey was conducted among women who gave birth for more than 28 weeks of pregnancy; at the same time, a qualitative interview was conducted on three levels of the county-level and rural family planning bureaus and the management staff of the family planning stations, the women's Insurance and obstetrics and gynecological professionals at the county and township level hospitals and some pregnant women.
Result
(1) in 2009, the total incidence of congenital defects in 5 counties (cities) was 7.49%o. The first three congenital defects were congenital heart disease, pigmented nevus and neural tube malformation, and the total incidence of congenital defects in 5 counties (cities) was 8.35 per thousand in 2010. The first three congenital defect diseases were divided into congenital heart disease, neural tube malformation, pigmented nevus and hydrocephalus. In.2, the incidence of congenital defects in every city / county was different. The incidence of congenital defects in Dunhuang was the highest, 14.65 per thousand. The incidence of congenital defects in Hui County was the lowest, which was 3.28%o.
(2) mothers suffering from genetic diseases (OR=4.407,95%CI=0.925 to 21.008), influenza in pregnancy (OR=1.986,95%CI=0.992 to 3.976) and pregnancy protective drugs (OR=2.466,95%CI=0.981 to 6.148) during pregnancy (OR=2.466,95%CI=0.981 to 6.148) are the main risk factors for congenital defects in perinatal infants.
(3) the survey of the incidence of congenital defects in perinatal infants in 5 counties was 8.35%o, which was 14.02 per thousand compared with the baseline survey, which decreased the incidence and composition of congenital defects in the 40.44%. baseline and terminal survey.
(4) the awareness rate and taking rate of folic acid in women in 5 counties (cities) were 93.85%, 84.92%, and 22.19% of the folic acid standard, and women of childbearing age were mainly educated to understand folic acid related knowledge.
(5) the workers and children at the grass-roots level, such as the time of the occurrence of neural tube malformation, the diagnosis of neural tube malformation, the high risk population of the birth nerve tube malformation, the correct response rate of the supplemented folic acid group were lower than 50%, and the staff of 35-44 years of age received training (36.21%), and the health women needed to supplement folic acid (36.21%). It is necessary to introduce the importance of folic acid to women of childbearing age (37.45%), publicity and education for women (37.24%), free folic acid (37.24%), and guidance and supervision of the low rate of folic acid (34.98%).
(6) the awareness rate of basic medical staff related knowledge was low. There were 123 county-level medical personnel who knew that there were gender differences in neural tube malformation in China, accounting for 51.04%, and 41 in township level medical personnel, accounting for 24.26%. There were 47 (19.50%) and 42 people (24.85%) in rural areas with high risk of birth neural tube malformation, and 42 people (24.85%). There were 89 (36.93%) and 85 (50.30%) medical staff in the county where the acid deficiency could affect the pregnant women and the fetus, and the importance of supplementing folic acid was explained to every woman of childbearing age. There were 236 (97.93%) and 169 (100%) from the township level medical staff, and 129 (53%) county-level medical staff and 152 (89.94%) township medical staff accepted. The training of related knowledge; through the expert lectures, the training of the county level medical staff was 169 (70.12%), and the township medical staff had 92 people (54.44%).
conclusion
The implementation effect of the birth defect intervention project in 5 counties (cities) of Gansu province is obvious, and the self-care cognition of women of childbearing age has been further improved, but it still needs to further strengthen the propaganda and implementation of the intervention project to improve the comprehensive service quality of the women and children health care workers at the grass-roots level.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R174

【参考文献】