2013年至2017年嘉兴市≤5岁儿童死亡监测分析
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摘要
目的分析嘉兴市2013年至2017年≤5岁儿童死亡情况,为降低≤5岁儿童死亡率和保障儿童健康提出科学有效的干预措施。方法根据覆盖嘉兴市的妇幼卫生信息监测网络系统导出的≤5岁儿童死亡监测资料及相关妇幼卫生统计报表,分析2013年至2017年≤5岁儿童死亡率及变化趋势、主要死亡原因及顺位和变化趋势,死前保健服务。结果 2013年至2017年嘉兴市≤5岁儿童死亡2 788例,新生儿、婴儿及1～5岁儿童平均死亡率分别为2. 33‰、3. 52‰、4. 83‰,均呈逐年下降趋势(X_(新生儿(NMR))~2=19.641,X_(婴儿(IMR))~2=31.705,X_(1～5岁儿童(U5MR))~2=48.294,均P<0.001);各年份1～5岁本地与流动户籍儿童死亡率比较差异均有统计学意义(X_(2013)~2=26.16,X_(2014)~2=18.45,X_(2015)~2=27. 72,X_(2016)~2=14. 49,X_(2017)~2=24.19;均P <0. 001)。1～5岁儿童的前二位死因为早产低体重和溺水;婴儿、新生儿的前二位死因均为早产低体重、其他先天异常。近五年1～5岁的儿童死亡在医院、在途中和在家中的比例分别为49.60%、15. 64%和34. 76%;虽然本地和流动儿童死前保健服务水平存在一定的差距,但这种差距逐年减小。结论加强孕期保健及高危妊娠的管理;重视三级预防,做好产前筛查等出生缺陷监测工作;加强≤5岁儿童家长的安全教育和儿童监管;加强妇幼保健专业队伍建设及新生儿窒息复苏技术等新生儿抢救技术等业务培训工作;加强流动户籍儿童的保健和管理;提高儿童家长医疗服务利用能力;采取以上措施以进一步降低嘉兴市≤5岁儿童死亡率。
Objective To analyze the death status of children ≤5 years old in Jiaxing City from2013 to 2017, and to provide scientific and effective measures of decreasing the children mortality and ensuring the health of children. Methods Death surveillance data of children ≤5 years old was obtained from monitoring network covering the whole city of maternal and child health information systems and the relevant maternal and child health statistics. The mortality rate, the sequence and changing trend of main death causes, prenatal health services of children ≤5 years old in Jiaxing City from 2013 to 2017 were analyzed. Results From 2013 to 2017, there were 2 788 cases death of children ≤5 years old in Jiaxing City. The neonatal mortality rate(NMR), infant mortality rate(IMR), ≤5 years old children mortality rate(U5 MR) in Jiaxing City were 2.33‰, 3. 52‰ and 4. 83‰, respectively. The mortality rates of all ages showed a declining trend year by year(X_(NMR)~2= 19. 641, P <0. 001; X_(IMR)~2 =31. 705, P <0. 001; X_(U5 MR)~2= 48. 294, P <0. 001). There were significant differences in the mortality between the lower local and the migrant children(X_(2013)~2 = 26. 16, X2014 = 18.45, X_(2015)~2= 27.72, X_(2016)~2=14.49, X2017 = 24.19; P < 0. 001). The top two causes of death in children ≤5 years old were drowning, premature birth and low birth weight. The top two causes of death in infants and newborns were premature birth, low birth weight and other congenital anomalies. In the recent five years, 49. 60% of children ≤5 years old died in the hospital. At the same time, the proportion of deaths on the way and at home was 15. 64% and 34.76% respectively. Although there was a gap in the level of prenatal health services between local and mobile children, the gap has been declining year by year. Conclusions The key measures to decrease the mortality rate of children under 5 years old in Jiaxing City include strengthening the management of pregnancy care and high-risk pregnancy; paying attention to tertiary prevention and doing a good job in monitoring birth defects such as prenatal screening; enhancing safety education and child supervision for parents of children in 1-4 years old; reinforcing the construction of maternal and child health professional team and the technical training of newborn resuscitation techniques such as neonatal asphyxia recovery technology; intensifying the health-care and management of migrant children and improving the ability of parents to utilize child medical service.
Objective To analyze the death status of children ≤5 years old in Jiaxing City from2013 to 2017, and to provide scientific and effective measures of decreasing the children mortality and ensuring the health of children. Methods Death surveillance data of children ≤5 years old was obtained from monitoring network covering the whole city of maternal and child health information systems and the relevant maternal and child health statistics. The mortality rate, the sequence and changing trend of main death causes, prenatal health services of children ≤5 years old in Jiaxing City from 2013 to 2017 were analyzed. Results From 2013 to 2017, there were 2 788 cases death of children ≤5 years old in Jiaxing City. The neonatal mortality rate(NMR), infant mortality rate(IMR), ≤5 years old children mortality rate(U5 MR) in Jiaxing City were 2.33‰, 3. 52‰ and 4. 83‰, respectively. The mortality rates of all ages showed a declining trend year by year(X_(NMR)~2= 19. 641, P <0. 001; X_(IMR)~2 =31. 705, P <0. 001; X_(U5 MR)~2= 48. 294, P <0. 001). There were significant differences in the mortality between the lower local and the migrant children(X_(2013)~2 = 26. 16, X2014 = 18.45, X_(2015)~2= 27.72, X_(2016)~2=14.49, X2017 = 24.19; P < 0. 001). The top two causes of death in children ≤5 years old were drowning, premature birth and low birth weight. The top two causes of death in infants and newborns were premature birth, low birth weight and other congenital anomalies. In the recent five years, 49. 60% of children ≤5 years old died in the hospital. At the same time, the proportion of deaths on the way and at home was 15. 64% and 34.76% respectively. Although there was a gap in the level of prenatal health services between local and mobile children, the gap has been declining year by year. Conclusions The key measures to decrease the mortality rate of children under 5 years old in Jiaxing City include strengthening the management of pregnancy care and high-risk pregnancy; paying attention to tertiary prevention and doing a good job in monitoring birth defects such as prenatal screening; enhancing safety education and child supervision for parents of children in 1-4 years old; reinforcing the construction of maternal and child health professional team and the technical training of newborn resuscitation techniques such as neonatal asphyxia recovery technology; intensifying the health-care and management of migrant children and improving the ability of parents to utilize child medical service.
引文
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[10]邓丽丽,樊兰娟,周卫珍,等.丽水市2010-2014年5岁以下儿童死亡情况分析[J].上海预防医学,2016,28(6):403-405.DOI:10. 19428/j. cnki. sjpm.2016.06.017.
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[4]国家卫生计划生育委员会.2016年我国卫生和计划生育事业发展统计公报[EB/OL].[2017-08-18]. http://www. nhfpc. gov.cn/guihuaxxs/s10748/201708/d82fa7141696407abb4ef764f3edf095.shtml.
[5]詹建英,郑双双,赵正言.浙江省5岁以下儿童意外死亡10年流行趋势分析[J].浙江预防医学,2016,28(5):461-464.DOI:10.19485/j. cnki. issn1007-0931.2016.05.008.
[6]刘芳,张文砚,柴艳婷.孕期保健与5岁以下儿童死亡的关系[J].浙江预防医学,2015,27(8):844-845.
[7]李辉,乔素贞.2010-2014年湖州市5岁以下儿童死亡监测结果分析[J].中国妇幼保健,2016,31(23):5082-5084. DOI:10.7620/zgfybj. j. issn. 1001-4411.2016.23.68.
[8]任霞,庞俊香.2003-2013年北京市石景山区5岁以下儿童死亡状况分析[J].中国妇幼保健,2016,31(7):1442-1444. DOI:10.7620/zgfybj. j. issn. 1001-4411.2016.07.37.
[9]胡洋,李江英,徐海港,等.2008-2013年江西省5岁以下儿童死亡监测结果分析[J].中国妇幼保健,2015,30(35):6264-6266. DOI:10.7620/zgfybj. j. issn. 1001-4411.2015.35.40.
[10]邓丽丽,樊兰娟,周卫珍,等.丽水市2010-2014年5岁以下儿童死亡情况分析[J].上海预防医学,2016,28(6):403-405.DOI:10. 19428/j. cnki. sjpm.2016.06.017.