上海市梅毒感染孕产妇分娩子女健康情况及儿童保健服务利用调查

Health status and healthcare service utilization among children born to women with maternal syphilis in Shanghai

目的:本研究旨在了解梅毒感染孕产妇分娩子女先天梅毒感染情况,分析不同人口学和社会经济特征母亲所分娩子女的健康状况和儿童保健服务利用情况,为进一步优化预防梅毒母婴传播实施方案提供科学依据。方法:本研究采用自行设计的调查问卷,对上海市2014年1月至2015年12月期间被诊断为妊娠梅毒并完成分娩的全部孕产妇进行电话随访。问卷内容包括:分娩子女基本情况、先天梅毒感染情况、近期健康状况和儿童保健服务利用情况等。采用χ^2检验等非参数检验方法比较不同人口学和社会经济特征母亲分娩子女健康状况和卫生服务利用的分布差异。结果:在研究期间确诊妊娠梅毒并完成分娩的1000名对象中,共随访到495例分娩子女的健康结局,其中61名儿童被诊断为先天梅毒,包括57例出生时诊断和4例随访中诊断。母亲孕期未接受治疗的子女发生先天梅毒的比例高于母亲孕期接受治疗者,差异有统计学意义(χ^2=7.214,P=0.027)。对儿童近期健康状况的随访发现:37.8%的研究对象自报在近3个月内其子女有患病经历,以上呼吸道感染(32.3%)和腹泻(3.6%)为主。与未被诊断为先天梅毒的儿童相比,先天梅毒患儿近3个月内疾病患病率更高(47.5%vs.36.6%)。81.6%的梅毒感染孕产妇分娩子女定期接受了儿童保健服务;母亲为非本市户籍、文化程度低、家务/待业、未婚和经产妇的子女,其定期接受儿童保健服务比例较低。在接受过保健服务的儿童中,仅39.7%的家长会告知医务人员子女存在先天梅毒感染风险,其中本市户籍、文化程度高和在职的母亲告知比例较低。结论:梅毒感染孕产妇分娩子女在随访管理过程中失访严重,且家长主动告知医务人员其子女存在梅毒感染风险的比例低。因此有必要在现有儿童保健服务基础上整合先天梅毒检测/咨询相关服务,在更大程度上实现先天梅毒诊断与治疗的及时性。

Objective To assess the health status and health service utilization of children born to syphilis infected mothers during pregnancy,in order to prevent mother-to-child transmission of syphilis to the newborns.Methods Women with maternal syphilis were studied by trained researchers via phone calls,in Shanghai during 2014-2015.Data related to demographics,status of infection and health care,utilization by both mothers and their children were collected through specifically designed questionnaires.Non-parametric tests including chi-square were used to assess the health status and health service utilization of children born to mothers with different demographic and socioeconomic characteristics.Results A total of 495 children born to mothers with maternal syphilis were recruited from 1000 syphilis infected parturient women.A total of 61 out of the 495 children were diagnosed as having congenital syphilis(57 children were diagnosed at birth and another 4 were diagnosed during the follow-up period).Children born to women who received syphilis treatment during pregnancy were at lower risk on congenital syphilis(χ^2=7.214,P=0.027).37.8%of the children were reported to have had different illnesses in the past three months,mainly involving upper respiratory infections(32.3%)or diarrhea(3.6%).Children diagnosed with congenital syphilis showed a higher prevalence of different kinds of diseases,compared to those without congenital syphilis(47.5%vs.36.6%).81.6%of the children had received regular child health care services.Subjects with the following factors as:being immigrant,with lower education,unemployed,unmarried and multipara,were related to the less use of regular child healthcare services.Only 39.7%of the parents would inform the care-takers about the risk of congenital syphilis infection of their own children at the child health care centers.Mothers with residency of Shanghai,having higher education level and employed,were less willing to inform doctors about the risk of congenital syphilis infection of their children.Conclusions Loss to follow-up among children born to syphilis infected pregnant women remained a serious problem.Few parents would be willing to inform the healthcare takers that their children are at risk of syphilis,when receiving child health care services at the centers.It was necessary to integrate the congenital syphilis follow-up programs into the routine child care services so as to timely diagnose and treat the patients with congenital syphilis.