云南省农村产妇死亡对婴幼儿生长发育的影响研究

发布时间：2018-06-24 04:36

本文选题：婴幼儿 + 产妇死亡　；参考：《昆明医科大学》2012年硕士论文

【摘要】：目的了解死亡产妇所生婴儿的生存、生长发育状况,分析产妇死亡给婴幼儿生长发育带来的影响,为制定促进农村死亡产妇所生婴幼儿生长发育干预措施提供依据。方法本研究为队列研究。以云南省农村地区作为研究现场,以2009年6月-2010年9月期间发生产妇于产后42天内死亡所生1-4月龄存活婴儿为研究对象(暴露组),采用1：2配对方法选取存活产妇所生婴儿作为对照组。配对条件为：新生婴儿满1个月龄不超过4个月龄,家庭结构相同、经济状况尽量一致、尽可能来自同一个行政村。基线调查包括问卷调查家庭基本情况、父母亲的社会人口学特征,母亲本次怀孕情况、分娩情况及预防接种和两周患病情况,测量婴儿身长、体重。一年后,进行随访调查,内容包括：主要照顾者的社会人口学特征、家庭经济状况、小儿患病情况、喂养方式、辅食添加的类型、时间和频率、大运动发育状况以及出牙时间和出牙数,采用BayleyⅢ对小儿进行神经心理发育的测评,并测量身长、体重、头围和胸围。结果基线调查期间,全省共报告农村孕28周至产后42天死亡169例,死亡产妇活产婴儿70例,其中,新生儿死亡9例,存活的60例婴儿及家庭和120例健康产妇所生婴儿及家庭纳入研究。均衡性检验：婴儿的家庭结构、经济情况、是否来自同一行政村等均衡分布,婴儿的性别和有无先天畸形暴露组与对照组差异无统计学意义,有较好的可比性。小儿母亲是否产检、产检孕期、产检次数两组差异无统计学意义。暴露组小儿母亲的产检异常检出率为32.1%,明显高于对照组母亲的15.8%,差异有统计学意义。暴露组剖宫产、早产及新生儿窒息的比例均高于对照组,差异有统计学意义。暴露组婴儿营养不良的患病率为30.0%,明显高于对照组19.2%。随访调查共追踪到42例死亡产妇所生小儿和84例健康产妇所生小儿。失访率30.0%。暴露组小儿的主要照顾者是祖父或外祖父母的占78.6%,对照组小儿的主要照顾者是母亲的占60%以上,暴露组小儿的主要照顾者没上过学的比例占50.0%,对照组小儿主要照顾者的受教育程度小学及以上居多,主要照顾者的受教育差异有统计学意义, 家庭人均收入分布在1000-3000元之间,暴露组家庭因产妇死亡列为本地贫困户或低保户的占35.7%,高于对照组(20.2%)；暴露组家庭人均食品消费为(1428.20±804.90)元、人均肉蛋奶消费(368.88±266.75)元,低于对照组家庭人均食品消费(1792.08±1098.61),人均肉蛋奶消费(423.00±391.22)元；暴露组早产、低出生体重和出生窒息的比例分别为23.8%、31.0%和19.0%,均高于对照组的2.4%、7.1%和3.6%,差异有统计学意义。暴露组婴儿营养不良患病率为30%,对照组营养不良患病率为13.3%,两组间营养不良患病率差异有统计学意义(x2=7.252,P0.007)。随访时,暴露组和对照组营养不良患病率分别为38.1%和29.8%,生区迟缓患病率较基线时升高,低体重患病率较基线时呈明显下降趋势,暴露组的营养不良患病率略高于对照组,但差异无显著性意义；暴露组和对照组的Bayleylll各子量表平均得分低于美国常模组标准；两组调查对象的Bayleylll各子量表得分,除了社会情绪量表得分两组间差异无统计学意义以外,暴露组小儿的认知、语言、动作量表平均得分均低于对照组小儿的平均得分,但因素分析显示母亲死亡小儿发生认知、语言和动作得分低于美国常模平均水平的危险分别是对照组小儿的2.02、2.50和2.40倍。营养不良多因素Logistic回归分析显示,非母亲照料、出生后有患病史和在婴儿早期就患有营养不良婴幼儿患营养不良的危险性更大。多元逐步回归分析显示,母亲死亡其小儿的认知和动作发育有明显影响,非母亲照料的小儿认知发育较滞后,早产对小儿语言、动作发育影响显著,抚养者的受教育程度与小儿社会情绪发育成正相关。结论死亡产妇所生婴儿死亡率高；产妇死亡对婴儿早期营养不良发生和对婴幼儿认知、语言、动作发育有显著影响,但是未显示对幼儿早期体格发育、营养状况和社会情绪的影响,早产和非母亲照料是婴幼儿发育迟滞的危险因素。因此,加强农村孕妇的孕期保健,特别是高危管理,减少孕产妇死亡是根本,对死亡产妇所生婴儿的生存问题、生长发育滞后应引起高度重视,加强儿童保健指导与服务,促进死亡产妇所广生婴幼儿健康成长十分迫切。
[Abstract]:Objective To understand the survival and development status of the infant born in maternal mortality , analyze the effects of maternal death on the growth and development of infants and infants , and provide a basis for the development of interventions to promote the growth and development of infants born in rural areas .

Methods This study was conducted in the study of cohort study . In the rural area of Yunnan Province as the research field , 1 - 4 month - old survival infants who died during the 42 - day postpartum period from June 2009 to September 2010 were selected as the control group . The paired conditions were as follows : 1 month - old infants with no more than 4 months of age , the same family structure , and the economic conditions as much as possible from the same administrative village .

Results During the baseline survey , 169 cases were reported from 28 weeks to 42 days postpartum in rural areas , and 70 cases of maternal live births were reported . Among them , 9 cases were neonatal death , 60 infants and families living and 120 healthy pregnant women were included in the study .

There was no significant difference between the infant ' s family structure , the economic situation , whether it came from the same administrative village , etc . There was no statistical significance between the infant sex and the congenital deformity exposure group and the control group . The abnormal rate of the infant ' s mother ' s abnormality was 32 . 1 % , which was significantly higher than that in the control group . The incidence of the infant malnutrition in the exposed group was 30.0 % , which was significantly higher than that of the control group 19.2 % .

The follow - up survey tracked 42 cases of maternal deaths and 84 healthy women . The rate of follow - up was 30.0 % .

The main caregivers of the children exposed to the exposure group were grandfathers or grandparents , 78.6 % , the main caregivers of the control group were more than 60 % of the mothers , the proportion of the primary caregivers in the exposure group was 50.0 % , the education level of the primary caregivers in the control group was primary and higher , and the education difference of the main caregivers was statistically significant ,

The family per capita income distribution is between 1000 and 3000 yuan , and the number of households in the exposed group is 35 . 7 % , which is higher than that of the control group ( 20.2 % ) .
The per capita food consumption in the exposed group was ( 1428.20 卤 804.90 ) yuan , per capita meat egg milk consumption ( 368.88 卤 266.75 ) yuan , lower than that of the control group ( 1792.08 卤 1098.61 ) , and the per capita consumption of meat and egg milk ( 423.00 卤 399.22 ) yuan ;

The prevalence of malnutrition among the exposed group was 30 % , and the prevalence rate of malnutrition in the control group was 13.3 % , and the prevalence of malnutrition among the two groups was statistically significant ( x2 = 7.252 , P0.007 ) .

At the follow - up , the prevalence of malnutrition in the exposed group and the control group were 38 . 1 % and 29 . 8 % , respectively .
The mean scores of Bayleylll sub - scales in the exposed group and the control group were lower than those of the American common module .
The scores of Bayleylll sub - scale of the two groups were significantly lower than those in the control group except for the difference between the scores of the social mood scale score and the social mood scale score , but the factors analysis showed that the risk of cognitive , language and action scores of the mother ' s death in children was lower than that of the normal average of the United States , which were 2 . 02 , 2 . 50 and 2 . 40 times of that of the control group respectively .

Multivariate stepwise regression analysis showed that mother died of child ' s cognition and action development , and the children ' s cognitive development of non - mother tended to be delayed . The effect of preterm birth on children ' s language and action development was significant , and the degree of education of child - raising was positively correlated with the development of children ' s social mood .

Conclusion The infant mortality rate in maternal mortality is high .
Maternal mortality has a significant impact on the infant ' s early malnutrition and the cognition , language and action development of infants . However , it is not shown that the effects of early physical development , nutritional status and social mood of infants , preterm birth and non - maternal care are the risk factors for the development of infants . Therefore , it is essential to strengthen maternal health in rural areas , especially high - risk management , to reduce maternal mortality , and to strengthen the guidance and service of child health care and to promote the healthy growth of infant and infant .
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R179

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