【作者】 裴凌云；

【导师】 李芝兰；

【作者基本信息】 兰州大学 ， 儿少卫生与妇幼保健学， 2012， 硕士

【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。更多还原

【Abstract】 ObjectiveIn this study, we used both quantitative survey and qualitative interview to find out the monitoring work on congenital defects in five counties/cities of Gansu province, and then to discuss the key intervention countermeasure of congenital defects in Gansu province, in order to provide a scientific basis for guiding prepotency and effective intervention of congenital defects.MethodsA general investigating was conducted on all the neonatus who were born in Dunhuang city, Jingchuan county, Hui county, Weiyuan county and Yongjing county in Gansu province from October1,2008to September30,2010. Compare with the birth defects incidence and constituent ratio of infant between baseline survey and terminal survey in Dunhuang, Jingchuan, Huixian, Weiyuan and Yongjing. A1:1matched case-control study was carried out to investigate176cases of birth defect children and their parents, to analyze the possible risk factors by simple and multiple factors Logistic regression. A questionnaire survey was conducted on these people who were family planning professionals and women and children health care professionals in five counties/cities. A qualitative investigation was conducted on managers, pregnant women and health technicians.Results(1) In2009, the incidence of congenital defects was7.49%o in five counties/cities, and the top three diseases were congenital heart disease, pigmented nevus and neural tube defects. The incidence of congenital defects in2010was8.35%o, and the top three diseases were congenital heart disease, neural tube defects and pigmented nevus, hydrocephalus. While each county (city) had different incidence of congenital defects, the highest congenital defects ratio was in Dun huang city, which was14.65%o, while the lowest ratio was in Hui county, which was3.28%o.(2) The risk factors of perinatal birth defects were:genetic disease in mother (OR=4.407,95%CI=0.925-21.008); influenza suffering during pregnancy (OR=1.986,95%CI=0.992-3.976); tocolytic agent usage during pregnancy (OR=2.466,95%CI=0.981-6.148) (3) In the five counties/cities, the congenital defects incidence of perinatal infants was8.35%o in the terminal survey, while baseline survey was14.02%o, the change was decreased by40.44%. The occurences and composition ratio sequences of congenital defects were different from terminal to baseline survey.(4) The rate of folic acid awareness and intake rate were93.85%and84.89%, the rate of normative intake was21.89%. Women of reproductive age were mainly educated by birth control department to know the knowledge of folic acid.(5) There was a low rate of correctly answer the questions of occurrence time of neural tube defects, diagnostic methods of neural tube defects, high-risk groups of children who had neural tube defects children, groups of folic acid supplement. The correct response rate was less than50%. Among the people who aged from35to44,36.21%had received professional training, aware of healthy women need to supplement folic acid, account for36.21%, People who thought it is necessary for reproductive women to supplement folic acid, account for37.45%, the rates of providing publicity and education for women and giving folic acid freely were both37.24%, the rate of guiding and supervising women taking folicacid was34.98%.(6) There were123(51.04%) medical personnels at the county level know that birth defects existd gender difference, while there were41(24.26%) medical personnels in township level. There were47(19.50%) medical staff in county level,42(24.85%) medical staff in township level know the high-risk groups who could give birth to children of neural tube defects.89(36.93%) medical workers in county level, and85(50.30%) medical workers in township level know that folate deficiency during pregnancy could affect pregnant woman and fetus. There were236(97.93%) medical staff in county level, and169(100.00%) people in township level who would illustrate the importance of folic acid supplement for every woman of childbearing age. There were129(53.53%) medical workers in county level, and152(89.94%) in township level who had received training about folic acid. There were169(70.12%) medical staff in county level, and92(54.44%) in township level who obtained knowledge about folic acid by lectures and trainings.ConclusionThe effect of birth defects intervention project is apparently, the cognition of self-care awareness has been further improved. Howerver, implementation efforts and propaganda work should be strengthened, the quality of comprehensive service of ordinary staff of should be improved.更多还原