我国西部四省县乡级助产机构新生儿早期基本保健技术能力现状调查

Investigation on early essential newborn care in county and township health facilities in four provinces of western China

目的了解我国西部四省县乡助产机构新生儿早期基本保健技术能力现状,为制定有针对性的干预措施提供依据。方法采用信函调查方式,于2017年6月-2018年9月收集贵州、青海、四川、宁夏4省(区)21个县的助产机构数据,采用描述性统计方法分析各省新生儿早期基本保健干预措施的开展情况,采用χ2检验比较不同级别机构的干预措施实施率。结果233所县、乡级助产机构参与调查。1)孕产妇相关干预措施:高危孕妇管理率(98.9%)、梅毒孕妇治疗率(97.9%)、孕妇叶酸服用率(88.8%)等均处于较高水平,早产儿胎膜早破母亲使用抗生素治疗的比例较低(60.1%)。2)新生儿分娩后相关干预措施:出生后进行90 min母婴皮肤接触的比例为41.8%,生后1 h内完成首次母乳喂养的比率为77.7%,开展早产儿袋鼠式护理的机构比例为24.7%。3)新生儿疾病相关干预措施:可开展新生儿败血症和新生儿肺炎疾病诊疗的机构分别为33.5%和47.8%,接受肌肉注射维生素K1的新生儿比例为69.8%。结论我国西部4省县乡级助产机构的新生儿早期基本保健技术实施现状与世界卫生组织的建议存在差距,应针对这些不足和差距开展干预。

Objective To investigate the current situation of early essential newborn care and related health care service in health facilities of four provinces in Western China,so as to provide basis for developing targeted intervention.Methods A mail survey was conducted to collect data in the midwifery health facilities of Guizhou,Qinghai,Sichuan,Ningxia from June 2017 to September 2018.Descriptive statistical analysis was used to compare implementation rates of early essential newborn care interventions.Chi-square test was used to compare rates among different level of facilities.Results Totally 233 health facilities from county and township participated in the study.1)In terms of perinatal care service,the surveillance rate of high-risk pregnancy(98.9%),the treatment rate of pregnancy with syphilis(97.9%),folic acid consumption rate of pregnant women(88.8%)were relatively high.The rate of antibiotics usage among mothers with premature rupture of membranes was relatively low(60.1%).2)In terms of newborn care service after delivery,the rate of skin-to-skin contact in 90 minutes after birth was 41.8%.Early initiation of breastfeeding rate in 1 hour after birth was 77.7%.And 24.7%of health facilities could implement kangaroo mother care for preterm newborns.3)In terms of the treatment for newborn common diseases,the proportion of facilities that could diagnose and treat neonatal sepsis and neonatal pneumonia was 33.5%and 47.8%,respectively.And the rate for newborn receiving intramuscular injection of vitamin K1 was 69.8%.Conclusion s There are gaps between the current early essential newborn care and the WHO recommendations in health facilities of county and township in four provinces of Western China.So targeted interventions are suggested to be developed to address these gaps.