中国5岁以下儿童生存策略研究

Study on survival strategy of children under 5 years old in China

目的分析近年来我国5岁以下儿童健康现状，发现存在的主要问题和薄弱环节，将国际倡导的在降低儿童死亡率方面起到良好效果且成本低廉的策略和措施与中国实际情况相结合，提出未来一段时期适宜中国国情的降低5岁以下儿童死亡和减少儿童疾病发生的干预策略和措施。方法利用生物统计学方法对我国5岁以下儿童的死亡率、死因构成、患病情况、伤害等数据进行分析，通过文献分析法归纳提炼适宜的干预措施，通过专家咨询和专家研讨对干预措施进行筛选和论证。结果2000—2012年，5岁以下儿童死亡率年均下降幅度为9．6％。2012年新生儿死亡占5岁以下儿童死亡的51．3％，死亡的主要原因为早产／低出生体重、窒息／产伤和先天畸形，全国围产儿出生缺陷总发生率为145．64／万。近年来我国5岁以下儿童的超重率显著增加，2010年0-岁儿童伤害死亡率为84．2／10万，1—4岁儿童伤害死亡率为32．8／10万。结论近年来国际组织提出过很多具有低成本高收益的干预措施，对于降低新生儿死亡率的效果明显，但在我国各地区开展的不平衡，贫困落后地区尚缺乏对这些干预措施的充分利用，应将这些低成本、高收益的基本妇幼干预措施进行普及与推广。

Objective To analyze the health status of children under 5 years old in China in recent years, find out the main existing problems and weak links, incorporate the globally-promoted inexpensive strategies and measurements which have telling effects in lowering children mortality in Chinese actual situation, put forward the Chinese-oriented strategies and effective interventions in reducing the mortality of children under 5 years old and children diseases. Methods The mortality rate, causes of death, prevelance, injury and other data of children under 5 years old were analyzed statistically. Document analysis was used to summarize and refine the appropriate intervention meas- ures. Through expert consultation and expert discussion, the intervention measures were screened and demonstrated. Results The average annual mortality rate of children under 5 years old decreased by 9.6% from 2000 to 2012. In 2012, neonatal deaths accounted for 51.3% a- mong the children under 5 years old and the main causes of death were premature birth/low birth weight, asphyxia/birth trauma, and congen- ital malformations. The total incidence rate of birth defects in the whole country was 145.64/ten thousand. In recent years, the overweight rate of children under 5 years old in China increased significantly. In 2000, children injury mortality rates in 0-year-old group and 1-4- year-old group were 84. 2/ten thousand and 32. 8/ten thousand, respectively. Conclusion There were a lot of intervention measures with low cost and high return put forward by international organization in recent years. These interventions have telling effects on reducing neonatal mortality, yet they are far from overwhelmingly full implementation in different regions, especially the impoverished and disadvantage areas. Therefore, in next phase, Chinese government is supposed to pay more attention to popularization and promotion of these basic maternal and children interventions with low input and high yield.