降低人类免疫缺陷病毒感染孕产妇所生婴儿死亡率的综合干预措施分析

Analysis of comprehensive intervention measures on reducing the mortality rate of infants born to human immunodeficiency virus-infected pregnant women

目的评估降低人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染孕产妇所生婴儿死亡率的综合干预措施的实施效果。方法纳入2005年至2019年四川省HIV抗体检测结果为阳性且经确证的HIV感染孕产妇所生的9773名婴儿。分析基线(2005年至2016年)与进行综合干预措施后(2017年至2019年)全省和省内不同地区婴儿死亡率、死亡构成、死亡时间、主要死因的变化情况。统计学分析采用χ^(2)检验和趋势χ^(2)检验。结果干预后,四川省HIV感染孕产妇所生婴儿死亡率为49.6‰(221/4455),较基线[83.5‰(444/5318)]下降40.6%,凉山彝族自治州为53.3‰(186/3491),较基线[103.1‰(379/3676)]下降48.3%,且四川省和凉山彝族自治州婴儿死亡率呈逐年下降趋势(趋势χ^(2)=42.058、60.041,均P<0.01)。干预后,四川省和凉山彝族自治州HIV感染孕产妇所生新生儿死亡占婴儿死亡比例分别由基线的29.3%(130/444)、25.9%(98/379)下降至13.6%(30/221)、9.7%(18/186),差异均有统计学意义(χ^(2)=19.918、20.020,均P<0.01)。四川省和凉山彝族自治州婴儿死亡月龄由基线的以1月龄内为主[31.5%(140/444)、28.5%(108/379)]延后至2~3月龄为主[27.6%(61/221)、28.5%(53/186)],差异均有统计学意义(χ^(2)=24.642、26.009,均P<0.01)。肺炎、腹泻、疑似HIV感染、早产或低出生体质量导致的婴儿死亡率分别由基线的44.4‰(236/5318)、12.0‰(64/5318)、4.9‰(26/5318)、4.3‰(23/5318)下降至26.9‰(120/4455)、7.6‰(34/4455)、1.8‰(8/4455)、0.7‰(3/4455),差异均有统计学意义(χ^(2)=21.010、4.734、6.691、12.182,均P<0.05)。结论通过实施综合干预措施,四川省和艾滋病高流行地区HIV感染孕产妇所生婴儿死亡率下降明显,但其较高死亡风险、中低流行地区的死亡问题仍需引起重视,应进一步加强HIV感染孕产妇所生婴儿的6月龄内保健,针对主要死因,提高随访和保健服务质量。

Objective To evaluate the effect of comprehensive intervention measures on reducing the mortality rate of infants born to human immunodeficiency virus(HIV)-infected pregnant women.Methods A total of 9773 infants born to pregnant women with positive HIV antibody and confirmed HIV infection in Sichuan Province from 2005 to 2019 were included.The changes of infant mortality,death composition,time of death,and main causes of death in the whole province and different regions at baseline(2005 to 2016)and after comprehensive intervention measures(from 2017 to 2019)were analyzed.Statistical analysis was conducted by chi-square test and trend chi-square test.Results After the intervention,the infant mortality rate born to HIV-infected mothers was 49.6‰(221/4455),which dropped 40.6%compared to the baseline(83.5‰(444/5318)),and that in Liangshan Yi Autonomous Prefecture was 53.3‰(186/3491),which dropped 48.3%compared to the baseline(103.1‰(379/3676)).Furthermore,the infant mortality rate in Sichuan Province and Liangshan Yi Autonomous Prefecture decreased with time(trendχ^(2)=42.058 and 60.041,respectively,both P<0.01).The proportions of infant death of HIV-infected mothers among the total infant death in Sichuan Province and Liangshan Yi Autonomous Prefecture decreased from 29.3%(130/444)and 25.9%(98/379)to 13.6%(30/221)and 9.7%(18/186),respectively,and the differences were statistically significant(χ^(2)=19.918 and 20.020,respectively,both P<0.01).The infant death time was mainly delayed from less than one month(31.5%(140/444)and 28.5%(108/379),respectively)to 2-3 months(27.6%(61/221)and 28.5%(53/186),respectively)in Sichuan Province and Liangshan Yi Autonomous Prefecture,and the differences were statistically significant(χ^(2)=24.642 and 26.009,respectively,both P<0.01).The infant mortality rates due to pneumonia,diarrhea,suspected HIV infection,premature delivery or low birth weight decreased from 44.4‰(236/5318),12.0‰(64/5318),4.9‰(26/5318)and 4.3‰(23/5318)at baseline to 26.9‰(120/4455),7.6‰(34/4455),1.8‰(8/4455)and 0.7‰(3/4455),respectively,and the differences were statistically significant(χ^(2)=21.010,4.734,6.691 and 12.182,respectively,all P<0.05).Conclusions Through the implementation of comprehensive intervention measures,the infant mortality rates of HIV-infected mothers in Sichuan Province and the high endemic areas decrease significantly.However,it is necessary to pay more attention to the high death risk and the infant death in the middle or low endemic areas.The infant health care of HIV-infected mothers within six months should be strengthened.The quality of follow-up and health care services targeted to the main cause of death should be improved.