避孕药具首诊登记与随访服务的试点实施效果评价

Effects of first-diagnosed registration and follow-up service system for contraceptives in pilot units

目的：评价避孕药具首诊登记制度与随访服务规范的试点实施效果.方法：在江苏、广东、吉林和云南4个省的10个试点县,于2009年1月1日～～3月31日对县、乡计划生育服务机构需要落实避孕措施的育龄妇女按照常规要求进行健康筛查、使用登记,并在落实避孕措施后的第3、6个月随访.结果：6171例妇女选择放置（首次和再次）了涉及26个品种IUD,规范完成首诊登记和健康筛查记录比例为88.62％,但避孕药使用者仅为1.32％.IUD首次使用占43.46％;放置IUD高危人群达30.65％,其中,首次放置者中占48.72％,再次放置者中占16.75％.在随访中,首次放置IUD的高危人群未进行妇科检查的占64.59％;有副反应或健康问题妇女中未接受妇科检查的比例为48.96％,未得到医学处理占36.82％.各类IUD的副反应和使用终止率不同：各省试点首次放置IUD的种类各有不同,IUD疼痛、出血、感染等副反应或健康问题比例高达18.84％,安舒型IUD发生风险最高（OR =1.72,95％CI 1.15～2.58）;FRCu200C IUD使用3个月的终止率（7.41％）高于其他IUD（P＜0.01）.结论：明确了避孕药具首诊登记制度与随访服务规范的必要性和可行性;首次报告IUD使用者高危人群的比例和随访存在的不足,应特别关注避孕药的使用对象,加强高危人群的医学随访,及时治疗副反应和健康问题.要加强政府采购目录外产品的管理,不同地区要因地制宜选择安全有效的避孕方法,为群众提供计划生育和生殖健康优质服务.

Objective：To evaluate the effect of the first-diagnosed registration and follow-up service system for contraceptives in pilot units.Methods：Women of reproductive health who needed taking the contraceptive measures in family planning service institutions of the township or the county experienced health screening and registration of the contraceptives use,and were followed up in the third months and sixth months in 10 pilot counties in 4 provinces of Jiangsu,Guangdong,Jilin and Yunnan from January 1st,2009 to March 31st.Results：Twenty-six different kinds of intrauterine device （IUD） were inserted among 6171 women of childbearing age.The proportion of conducting the first-diagnosed registration and health screening recode of IUD insertion （first and once more） was 88.62％,while that in contraceptive users was only 1.32 ％.The proportion of the first-time IUD user was 43.46 ％,and the high-risk population in IUD users reached 30.65％,in whom 48.72％ was the first-time IUD users,and 16.75％ inserted once more.About 64.59％ of the high-risk population in the first-time IUD users had no gynecological examination in follow-up,and 48.96％ with side effects and other health problems had not experienced gynecological examination.About 36.82％ of side effects had no medical treatment.There were different incidence of side effects and the termination rate among different types of IUD.Different kinds of IUD were used in different pilot units.The prevalence of side effects due to IUD insertion,such as pain,bleeding,infection and other health problems was as high as 18.84％.The risk of side effect of the Anshu Ring was the highest （OR 1.72,95％CI 1.15-2.58）.The termination rate of FRCu200C IUD （7.41％） the third month aher IUD insertion was higher than those of other IUDs （P＜0.01）.Conclusion：This study has been the first prospective one of its kind in China,which analyzes the proportion of the high-risk population in IUD users,the prevalence of side effects and the termination rate in IUD users among different types of IUDs,and the proportion of side effects without medical treatment in follow-up.The result shows that the first-diagnosed registration and follow-up service system for contraceptives could be implemented effectively in pilot units,while there are some problems need to be improved to enhance the science,pertinence and effectiveness of family planning and reproductive services.