【作者】 乔晓东；

【导师】 吴擢春； 罗剑锋；

【作者基本信息】 复旦大学 ， 社会医学与卫生事业管理， 2008， 硕士

【摘要】 研究目标总体目标为评价卫生Ⅷ项目对于项目地区婴儿死亡的影响,具体目标为评估和确定项目县常规统计报告中的婴儿死亡率(IMR)数据的准确性;系统分析各类项目县婴儿死亡率的变化情况,包括分析比较不同贷款来源、不同干预措施的项目县的婴儿死亡特征(死亡年龄,死亡原因,性别、死亡地点等)的差异及整个项目期间的时间变化趋势;分析项目干预措施以及当地社会、经济等因素对项目地区婴儿死亡率的影响。资料和方法1.资料来源:本次研究所用资料主要有项目县逐年上报监督评价资料,现场调查漏报调查资料和本次评价期间收集的项目县婴儿死亡报告卡和人口学资料。2.分析方法:一般性统计描述方法为主分析项目县婴儿死亡率变化及婴儿死亡特征变化,利用多水平重复测量模型分析婴儿死亡率的影响因素。研究结果1.项目地区的平均漏报率由前半阶段的27.8%降至项目后半段的25.4%,仅有轻微的下降趋势。2.全部项目县的漏报校正后的婴儿死亡率在项目期间大幅下降,与全国农村地区婴儿死亡率的平均水平的差距逐渐缩小,至项目末期项目地区仅比全国农村地区高2.4‰。3.新生儿死亡在全部婴儿死亡中比例提高,DFID试点县和MCH干预县提高的幅度要大于一般项目县。4.在项目期间,项目地区死亡婴儿中男性的比例一直大于女性。男、女婴儿死亡率在整个项目期间基本相同,且在项目期间均有快速下降,由项目前期男、女婴儿的死亡率均在39‰左右降至项目末期的21‰以下。5.死于医院的婴儿的比例不断上升。分性别来看,男性婴儿和女性婴儿死于医院的比例均在上升,且男性死亡婴儿中死于医院中的比例相对女性增加得更快。6.项目地区婴儿死亡前曾经就诊于门诊和医院的比例在项目期间不断上升。按干预类型看,DFID试点县和MCH干预县未就医的比例在下降,而一般项目县未就医的比例小幅上升。7.项目地区在项目早期有五分之一的婴儿死亡前未进行诊断,而在项目末期,有73%的婴儿在死亡前曾到过乡级或乡级以上的医院进行诊治。一般项目县中死前未进行诊断的比例下降幅度慢于其它两个类型的项目县。8.项目地区通过临床诊断确诊婴儿死亡原因的比例不断增加。DFID试点县和MCH干预县通过临床诊断确定死因的比例的增幅要高于一般项目县。9.项目地区感染性疾病的死因顺位和死亡率均为下降趋势:先天异常类死因的比例和死亡率呈上升趋势;新生儿窒息在项目末期成为项目地区婴儿死亡的第一位死因;诊断不明类的疾病在项目期间均排在第4位。10.项目地区婴儿死亡率的影响因素为年份,孕产妇系统管理率,年内四苗接种率和项目地区粗出生率,而干预类型、农民人均纯收入等变量与婴儿死亡率没有统计学上的意义。结论1.项目地区的平均婴儿死亡率和全国农村的婴儿死亡率的平均水平的差距是在逐渐缩小的,说明卫生Ⅷ项目的实施可以提高项目地区的婴儿健康水平,项目的实施对于婴儿死亡率的下降是有明显效果的。2.项目地区新生儿死亡的比例上升,婴儿死前的卫生服务利用水平提高,感染性疾病对于项目地区婴儿的死亡威胁在降低,项目地区婴儿死亡的特征向发达国家转变,MCH干预县和DFID试点县的死亡模式转变的速度和程度要优于一般项目县。3.婴儿死亡率的影响因素分析表明,项目地区的婴儿死亡率的下降主要是因为提高了项目地区的孕产期的妇幼保健服务利用水平,同时在项目地区人均收入水平对于婴儿死亡率的影响并不显著。更多还原

【Abstract】 ObjectiveThe overall objective is to evaluate the impact of healthⅧproject on infant death. The specific objective are to analyze the trend of infant mortality rate in overall project counties,to compare the difference of infant death and times trend among the three type project counties,and explore the influencing factors of infant mortality rate.Materials and Methods1.Source of materials:In this study,we mainly use the three sources of data,which are monitoring data of project counties,underreporting data by household survey and collected infant death certificates and demographic data of project counties.2.Methods:Descriptive statistical methods were used to analyze the trend of infant mortality rate and characteristics of infant death in project counties.Besides,in this study,we applied the multi-level model to explore the influencing factors of infant mortality rate of project counties.Results1.Underreporting rate of infant death dropped a little during the period of project, from 27.8%in the early stage to 25.4%at the end of the project.2.Infant mortality rate in project counties dropped remarkably,and showed a more rapid decreasing than that of national countryside’s average level.At the end of the project,the infant mortality rate in project counties was only 2.4%0 higher than national countryside’s average level3.Among all reported deaths,proportion of neonatal deaths was increasing,and the DFID trial counties and MCH intervention counties had the higher increase amplitude.4.In project counties,proportion of male infant deaths was always larger than female infant deaths.The male infant mortality death was approximately the same with the female,both of which dropped from 39‰of early stage of project to 21‰of the end of project.5.Proportion of infant death occurred at home was decreasing.From the view of gender,both the proportions of male and female infant death occurred at hospital was increasing,but the male part showed the higher increase amplitude.6.During the project,more and more infant would seek treatment before death either in clinics or hospitals.Proportion of infant death that had not treatment seeking before death of DFID trial counties and MCH intervention counties was decreasing,but increasing in common project counties.7.At the early stage of project,one fifth of infants did not do any diagnosis before death.In comparison,73%of infant got the diagnosis before death at the county level or above medical facilities.Proportion of infants that did not do any diagnosis before death in common project counties show a decreasing trend,but the lower amplitude than that of the other two types of counties.8.Proportion of diagnosing cause of infant death by clinical methods was increasing steadily,and DFID trial counties and MCH intervention counties showed the higher increase amplitude.9.Proportion and mortality rate of infectious diseases was decreasing gradually. Proportion and mortality rate of congenital abnormal diseases was increasing. Neonatal asphyxia became the first cause of infant deaths.Acatalepsy diseases occupied the 4^th place during the period of the project.10.The results of multi-level analysis demonstrated that the influencing factors of infant mortality rate in project were year,systemic management of pregnant women,immunization coverage rate of four vaccines,crude birth rate.Besides, type of intervention and net income per capita of the farmers did not show the statistical correlation with the infant mortality rate.Conclusions1.The gap of infant mortality rate between project counties and national countryside’s average level was reduced,which demonstrated that implementation of healthⅧproject efficiently promote the health of infant and accelerates the decreasing of infant mortality rate.2.In the project areas,the utilization of maternal and child care was rising,with the higher proportion of neonatal deaths and lower threats of infectious diseases. Infant death profile of project areas is changing towards that of developed areas, and among the three types of interventions,DFID trial counties and MCH intervention counties displayed the more rapid transition. 3.In project areas,the decreasing of infant mortality rate is mainly because the implementation of project greatly improves the utilization of maternal and child care,and income has little impact on the infant mortality rate.更多还原