黔东南州实施提高新生儿乙肝疫苗首针及时接种率项目效果分析

Evaluation of MOH /GAVI project for improving timely birth dose coverage of hepatitis B vaccina-tion in Qiandongnan,Guizhou

目的对黔东南州实施提高新生儿乙肝疫苗首针及时接种率项目效果进行分析,探索提高边远少数民族地区新生儿乙肝疫苗首针及时接种率的有效策略和措施。方法项目实施前后分别进行了基线调查和评估调查。基线调查对全州县级疾控中心、负责接生医疗卫生机构和好、中、差各1个乡镇卫生院的疫苗接种和管理情况进行调查;在抽取的3个乡镇中每乡镇按好、中、差各抽取1个村,每村随机抽取5名2009年出生的儿童家长和5名孕妇进行乙肝疫苗预防接种的知识、态度、行为(KAP)问卷调查。评估调查为随机抽取1个县级负责接生的医疗卫生机构和1个乡镇卫生院调查了解其2011年住院分娩儿童乙肝疫苗首针及时接种率,再对抽取的乡镇随机抽取1个中等水平的村,入村调查2011年在家和在医院出生的儿童各5名,了解其乙肝疫苗首针及时接种情况,同时对其母亲或监护人进行KAP问卷调查。以上资料结合乙肝疫苗接种常规报表等资料进行统计分析,对项目关键指标实现情况及其影响因素进行分析。结果通过1年的项目实施,黔东南州各县报告乙肝疫苗首针及时接种率平均从2009年的54.93%上升到2011年的92.05%,并且实现以县为单位新生儿乙肝疫苗首针及时接种率达到75%以上目标。农村孕产妇对乙肝疫苗接种知晓率、孕妇住院分娩率分别从项目前的30.4%(437/1 439)和79.8%(41 231/51 668)提高到项目后的69.9%(202/289)和89.9%(44 494/49 488),差异均有统计学意义(均P<0.01)。评估调查结果显示全州在家和住院分娩儿童抽样乙肝疫苗及时接种率分别为84.8%(39/46)和99.2%(247/249),差异有统计学意义(P<0.01)。结论该项目对提高该地区新生儿乙肝疫苗首针及时接种率效果明显,提高住院分娩率及在家分娩儿童乙肝疫苗首针及时接种率仍是今后工作重点。

Objective To evaluate the effective measures of MOH/GAVI project to improve the timely birth dose coverage of hepatitis B vaccination in Qiandongnan Miao and Dang Autonomous Prefec- ture, Guizhou Province. Methods Baseline and assessment surveys were conducted before and after im- plementation of MOH/GAVI project respectively. Vaccination and management was investigated in county CDCs, medical and health institutions for delivery, and one of township hospitals from different three level towns. One village was chosen in each level town of all counties. Five children horn in 2009 and five preg- nant women were randomly chosen from the village to conduct the hepatitis B vaccination KAP question- naire. The timely birth dose coverage of hepatitis B vaccination in 2011 were conducted in the assessment survey by randomly sampling in one medical and health institution for delivery and one township hospital. Five children born at home and hospital respectively were investigated for the status of timely birth dose of hepatitis B vaccination and their mothers or guardians were surveyed by KAP questionnaires. The informa- tion above and conventional hepatitis B vaccination reports and other information were used to analyze the implementation and its influencing factors. Results The reported timely birth dose coverage of hepatitis B vaccination has been significantly improved from 54. 93% in 2009 to 92.05% in 2011 after implementation of MOH/GAVI project for one year. The birth dose coverage of hepatitis B vaccination reached the goal of more than 75% in counties. Awareness rate of hepatitis B vaccination for pregnant women and hospitalized delivery rate of pregnant women in rural area have increased from 30. 4% （437/1 439 ） to 69.9% （202/289） and from 79. 8 % （ 41 231/51 668 ） to 89. 9 % （ 44 494/49 488 ） （ all P 〈 0. 01 ）. The rate of pregnant women production in hospital was 99. 2% （247/249）, higher than that in self-house （84. 8%, 39/46） （P 〈 0. 01 ）. Conclusion Large progress has been made after the implementation of project for improving timely birth dose coverage of hepatitis B vaccination in Qiandongnan, Guizhou. It is still the fo- cus of future work to improve the rate of hospital birth and timely birth dose coverage of hepatitis B vaccina- tion for children delivered at home.