农村转移孕产妇基本公共卫生服务健康管理项目认知、利用及满意度的调查与分析

Survey and analysis of health management of public health service cognition, utilization and satisfaction among rural immigrating pregnant women

目的了解农村转移孕产妇对基本公共卫生服务孕产妇健康管理服务项目的认知、利用和满意度现状，发现农村转移孕产妇基本公共卫生服务健康管理服务实施过程中存在的问题，为促进农村基本公共卫生服务的发展提供建议。方法2016年5—7月期间选取微山湖湖区330名农村留守孕产妇、300名农村转移孕产妇作为调查对象进行问卷调查，农村转移孕产妇平均年龄为（28.6±3.7）岁，留守孕产妇平均年龄为（28.3±3.4）岁，农村转移孕产妇文化程度以高中及中专最多，占44.9%，留守孕产妇文化程度以初中最多，占65.5%，农村转移人口孕产妇职业以工人为主，占31.4%，农村留守孕产妇职业以务农为主，占36.7%。结果农村转移孕产妇和留守孕产妇对健康管理项目中的＂孕期一般体检、妇科检查＂知晓率最高，分别为77.7%和78.3%。而对孕晚期的2次产前随访知晓率最低，分别为22.6%和23.0%，差异无统计学意义。农村转移孕产妇、农村留守孕产妇对孕产妇健康管理服务的了解率分别为24.7%、17.9%，差异具有统计学意义（Z=-1.993，P=0.046）；孕晚期分娩、母乳喂养的相关知晓率分别为36.2%、47.6%，差异具有统计学意义（χ^2=7.933，P=0.005）。农村转移孕产妇、留守孕产妇《孕产妇保健手册》建册率分别为40.4%、54%，（χ^2=11.065，P=0.001），其中在乡镇卫生院的建册率分别为46.6%、73.3%，（χ^2=21.104，P=0.000 0）；3次及以上产检及随访服务的利用率分别为8.4%、23.0%，（χ^2=23.878，P=0.000）；孕妇健康及胎儿生长发育评估利用率分别为9.8%、23.6%，（χ^2=20.460，P=0.000）；产前指导（分娩准备、母乳喂养）的利用率分别为8.0%、13.7%，（χ^2=5.011，P=0.027）；异常或危急孕产妇转诊利用率分别为22.0%、34.8%，差异均有统计学意义（χ^2=12.133，P=0.001）。结论农村留守孕产妇基本公共卫生服务利用现状好于农村转移孕产妇，存在不均衡性。因此建议相关卫生行政部门应加强宣传，更好地普及此项服务，促进孕产妇基本公共卫生服务均等化的发展。

Objective To analyze the cognition, utilization and satisfaction on pregnancy health management of basic public health services, and to find out potential problems and provide suggestions for promoting equality in rural basic public health. The Weishan Lake area was selected as the sample point and the left behind pregnant women in the countryside as control. Methods In the period from May 2016 to July, questionnaires were designed for the pregnancy health management of basic public health services, 330 left-behind pregnant women and 300 rural immigrating pregnant women were selected as our target interviewees. The average age of rural immigrating pregnant women and the left-behind pregnant women was （28.6±3.7） years, and （28.3±3.4） years old, respectively; the degree of education of rural immigrating pregnant women and the left-behind pregnant women was secondary specialized school or high school and junior middle school, respectively. The occupation of rural immigrating pregnant women was mainly workers; accounting for 31.4%, while the occupation of the left-behind pregnant women was farming, accounting for 36.7%. Results The awareness rate of ＂general pregnancy examination and gynecological examination＂ in health management items of rural immigrating pregnant women and left-behind pregnant women was the highest, which were 77.7% and 78.3%, respectively, and the lowest awareness rate of the 2 prenatal follow-up was the lowest in the third trimester, which was 22.6% and 23.0%, respectively. The difference was not statistically significant. The maternal health management service understanding rate of rural immigrating pregnant women and left-behind pregnant women were 24.7% and 17.9% respectively , the difference was statistically significant （Z=-1.993, P=0.046）; the awareness rate of delivery and breastfeeding in late pregnancy were 36.2% and 47.6% respectively, and the difference was statistically significant （χ^2= 7.933, P=0.005）. The rate of the registering of the maternal health care handbook of rural immigrating pregnant women and left-behind pregnant women were 40.4% and 54% respectively, and the difference was statistically significant （χ^2=11.065, P=0.001）, Among them, the rate of registering in township hospitals was 46.6% and 73.3% respectively, and the difference was statistically significant （χ^2=21.104, P=0.0000）; the utilization rate of 3 or more antepartum examination and follow-up services was 8.4% and 23% respectively, and the difference was statistically significant （χ^2=23.878, P=0.000）. The growth and development of the health of pregnant women and fetal assessment and utilization rates were 9.8% and 23.6%, the difference was statistically significant （χ^2=20.460, P=0.000）; prenatal guidance （childbirth preparation, breastfeeding） utilization rate were 8%, 13.7%, the difference was statistically significant （χ^2=5.011, P=0.027）; abnormal or critical maternal referral utilization rate were 22% and 34.8%, the difference was statistically significant （χ^2= 12.133, P=0.001）. Conclusion Imbalance exists in acquiring basic public health services of the two pregnant women cohort, the left-behind pregnant women are better than the rural immigrating pregnant women. Therefore, the government should propagate this service by muhi-channel to improve their cognition and utilization of this policy implemented, and to promote the development of the services.