中西部地区进一步降低孕产妇死亡率的策略研究

发布时间：2018-06-22 23:48

本文选题：中西部 + 孕产妇死亡　；参考：《复旦大学》2013年硕士论文

【摘要】：一、研究背景与目标孕产妇死亡率是反映一个国家或地区经济社会发展水平的重要指标,我国在《联合国千年宣言》中承诺到2015年将孕产妇死亡率降低到22.2/10万。2010年我国孕产妇死亡率为30.0/10万,与国际承诺的目标还存在一定差距。但是不可忽视的是中西部地区整体的孕产妇死亡率高于全国平均水平,要实现千年目标,中西部是重点。政府也一直很重视中西部地区,采取政策干预和项目干预来改善孕产妇死亡率状况,中西部孕产妇死亡率在干预下总体呈现下降趋势,但是近年来下降速度趋缓,2010年10多个省份孕产妇死亡率甚至出现了反弹。这可能是因为措施针对关键因素发挥针对性的效力后,对象因措施的推进调整了自己的行为和发展方向,原来影响孕产妇死亡的关键因素发生变化,因此,若要使孕产妇死亡率保持继续下降的趋势,需重新审视现阶段关键影响因素,制定针对性干预措施。本研究的目的是在了解中西部孕产妇死亡率和住院分娩的基本情况和变化趋势基础上,分析降低孕产妇死亡率和提高住院分娩率的关键影响因素,制定相应的干预策略,进一步降低孕产妇死亡率,为实现千年发展目标提供依据。二、材料与方法根据渐进主义政策模型和孕产妇死亡生存分析框架,构建降低孕产妇死亡率的理论模型。运用系统论,矛盾分析法,渐进主义理论及利益相关者理论对中西部地区影响因素及干预策略进行分析。主要的资料来源包括文献评阅、现场调查、专家咨询和定性访谈等。通过文献归纳分析法对文献的外部特征进行定性及半定量分析,以明确妇幼保健干预策略和模式的研究现状。通过专家咨询及现场调查法了解中西部地区、典型调查地区的孕产妇死亡现存问题、影响因素及需要的支持。调查收集的资料采用QSR NVivo8、Excel2007建立数据库和数据录入,用SPSS18.0及QSR NVivo8进行统计分析。三、主要研究结果 (一)国内研究多以现状描述为主孕产妇死亡是研究热点,目前国内在降低孕产妇死亡率的研究中,多以地区为单位进行描述性分析,以孕产妇死亡卡和医院死亡病例为资料结合孕产妇死亡评审分析孕产妇死亡的流行病学特征,并探讨孕产妇死亡的原因及策略,却少见对这些建议和措施的实施及实施效果的评价。 (二)中西部地区部分省份孕产妇死亡率出现反弹中西部地区近年来孕产妇死亡率下降趋缓,部分省份出现反弹。对典型调查地区甘肃省和新疆生产建设兵团进行分析,甘肃省孕产妇死亡率降低明显,但下属市级甘南州孕产妇死亡率出现反弹,并且其住院分娩率低于全省平均水平。新疆生产建设兵团住院分娩率较高,但孕产妇死亡率出现反弹。 (三)孕产妇死亡率的影响因素分析运用矛盾分析法分析地区差异,运用利益相关者法分析不同对象的诉求,可得出甘肃省和新疆生产建设兵团孕产妇死亡率的关键影响因素。甘肃省妇幼卫生状况的影响因素以社会因素为主,山高路远、经济条件差和信仰活佛的习俗使得住院分娩率一直处于低位。住院分娩率不高,交通不便急救转诊不畅,产科急救水平差等综合因素则造成了孕产妇死亡。兵团的住院分娩率已经达到较高水平,孕产妇死亡率反弹的主要原因在于流动人口和计划外生育者孕产妇的死亡。兵团人口基数较少,孕产妇死亡绝对数的较小变化引起了孕产妇死亡率的较大变化,导致远高于全国平均水平。 (四)降低孕产妇死亡率的实施策略研究利用孕产妇死亡生存分析理论框架,并结合文献及实证中对干预措施的收集,本研究针对孕产妇死亡形成了三大维度九大干预策略。对于每个地区,干预措施和干预策略分为两类,一类是在针对原有影响因素在原有措施或策略上的继续推进,一类是针对新的关键影响因素采取的新的措施或策略。干预模式的制定思路是,基于孕产妇影响因素的研究,利用专家评分法确定孕产妇死亡的关键影响因素,然后评价关键影响因素在孕产妇死亡生存分析框架中所处的模块,根据模块即可对应相应的策略,最后,集合这些策略,就形成了适宜当地的干预模式。甘肃模式主要是采用策略4、策略6、策略7、策略8,进一步提高保健意识及畅通急救绿色通道。兵团模式主要是采用策略3、策略5,提升基层医院及市区综合医院产科综合救治能力,并抓好流动人口和计划外生育者的孕产妇管理。将典型调查地区干预模式研究的思路外推到中西部其他区域,即可形成中西部地区进一步降低孕产妇死亡率的策略。四、研究主要结论 (一)降低孕产妇死亡率需要差异化管理,分类指导；各地区选择策略时需深入分析关键影响因素,探索最适合当地的干预模式。 (二)合理配置人员,并完善人才激励机制。 (三)加强各个利益相关者之间的协调,最大化发挥社会效益；全社会努力,提高孕产妇文化素质,优化保障体系。
[Abstract]:I . Background and Objectives

The maternal mortality rate is an important indicator reflecting the economic and social development level of a country or region . In the United Nations Millennium Declaration , the maternal mortality rate is reduced to 22.2 per 100,000 . In 2010 , the maternal mortality rate in the central and western regions is higher than the national average . In the middle and western regions , the maternal mortality rate is higher than the national average . In the middle and western regions , the key influencing factors of the maternal mortality rate have been improved . The aim of this study is to improve the maternal mortality rate and increase the rate of maternal mortality . The aim of this study is to develop corresponding intervention strategies to further reduce maternal mortality and provide the basis for achieving the Millennium Development Goals .

II . MATERIALS AND METHODS

Based on the progressive policy model and the analysis frame of maternal mortality survival analysis , the paper constructs a theoretical model for reducing maternal mortality . The main sources include literature review , field investigation , expert consultation and qualitative interview . The main sources include literature review , field investigation , expert consultation and qualitative interview . The main sources include literature review , field investigation , expert consultation and qualitative interview .

III . Main research results

( 1 ) The domestic research is mainly described in the current situation

Maternal mortality is a hot spot . At present , in the study of reducing maternal mortality , a descriptive analysis is carried out in many areas . The maternal mortality rate and the hospital death cases are combined with maternal mortality review to analyze the epidemiological characteristics of maternal mortality , and the causes and strategies of maternal mortality are discussed . However , the evaluation of the implementation and implementation of these recommendations and measures is rare .

( II ) Maternal mortality in some provinces of the central and western parts of the country rebounded

In the middle and western regions , the maternal mortality rate has declined in recent years , and some provinces have rebounded . In the typical survey area , Gansu Province and Xinjiang Production and Construction Corps carried out the analysis , the maternal mortality rate in Gansu Province decreased obviously , but the rate of maternal mortality in Gansu Province was lower than the average of the province average . The hospitalization rate of the Xinjiang Production and Construction Corps was higher , but the maternal mortality rate rebounded .

( III ) Analysis on the Influencing Factors of Maternal Mortality

Using the contradiction analysis method to analyze the regional difference , the key influencing factors of maternal mortality in Gansu and Xinjiang Production and Construction Corps were analyzed by means of stakeholder method . The factors affecting maternal and child health in Gansu Province were mainly due to social factors , high mountain road , poor economic conditions and living Buddha ' s customs , which resulted in the death of maternal mortality . The hospitalization delivery rate of the regiment had reached a higher level , and the rate of maternal mortality was mainly due to the death of the floating population and the unplanned fertility . The small change of the absolute number of maternal deaths resulted in a greater change in maternal mortality , which resulted in a much higher level of maternal mortality .

( IV ) Study on the Implementation Strategy of Reducing Maternal Mortality

Based on the theoretical framework of maternal mortality survival analysis and the collection of intervention measures in combination with literature and demonstration , this study has formed a three - dimensional nine - dimensional intervention strategy for maternal deaths .

The development of intervention model is based on the study of maternal influence factors , the key influencing factors of maternal mortality are determined by using expert scoring method , and then the key influencing factors are evaluated in the framework of maternal mortality survival analysis .

IV . Main conclusions of the study

( i ) Reducing maternal mortality requires differentiated management and classification guidance ;
In each region selection strategy , the key influencing factors should be analyzed in depth , and the most suitable intervention mode is explored .

( 2 ) reasonably allocate personnel and improve the talent incentive mechanism .

( 3 ) To strengthen coordination among various stakeholders and maximize social benefits ;
Full - society efforts to improve the cultural quality of pregnant women and optimize the guarantee system .
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R173

【参考文献】