温州地区高危儿童保健管理效果评价

Evaluation of the effectiveness of health care management for high-risk children in the Wenzhou area

目的探讨妇幼三级保健网络支持下的高危儿童保健管理模式并评价其有效性、可行性。方法选取试点区县开展0~3岁高危儿童保健管理试点,同时选取活产数及妇幼保健机构条件基本一致的非试点区县。通过分类分级保健管理,比较两组儿童的生长、发育情况、随访、筛查、转诊及诊断等情况的异同。结果试点区县的高危儿童在1岁时体质量、身长和头围均好于非试点区县,差异有统计学意义(t=-3.005、-3.026、-2.756,均P<0.05)。试点区县早期早产儿体质量高于非试点区县,差异有统计学意义(t=-2.680,P<0.05),身长和头围差异无统计学意义(t=-1.346、-1.781,均P>0.05)。不同孕周的高危儿童体格生长指标试点区县均高于非试点地区,但增长总体趋于一致。孕周<34周高危儿童中,男童在体质量指标的优势较为显著,女童身长的优势较为显著。试点区县的发育异常检出率均低于非试点区县,差异有统计学意义(χ^(2)=9.887、5.558,均P<0.05)。结论依托妇幼保健三级管理网络的高危儿童保健管理模式能够提高儿童体格和发育水平,在0~1岁即为高危儿童提供更好的照护和养育,对该类儿童的远期发展有着显著作用,值得在全市推广。

Objective To explore the model of health care management for high-risk children supported by a three-tier maternal and child health care network and to evaluate its effectiveness and feasibility.Methods A pilot project on health care management of high-risk children aged O-3 years was conducted in a pilot district and county,and a non-pilot district and county with the same number of live births and conditions of maternal and child health care institutions were selected.Through categorized and graded health care management,we com-pared the growth and development of children in the two groups.The similarities and differences in growth,development,follow-up,screen-ing,referral,and diagnosis between the two groups of children were compared.Results High-risk child in the pilot counties had better weight,length and head circumference at 1 year of age than those in the non-pilot counties.The differences were statistically significant(t=-3.005,-3.026,-2.756,all P<0.05).The weight of early preterm infants was higher in the pilot counties than in the non-pilot coun-ties.The differences were statistically significant(t=-2.680,P<0.05),but the differences in length and head circumference were not sta-tistically significant(t=-1.346,-1.781,both P>0.05).Physical growth indicators of high-risk children at different gestational weeks The physical growth indicators of high-risk children at different gestational weeks were higher in the pilot areas than in the non-pilot areas,but the growth tended to be consistent in general.Among high-risk children at<34 weeks of gestation,boys had a more significant advantage in weight indexes,while girls had a more significant advantage in length indexes.The detection rates of developmental abnormalities in the pi-lot counties were lower than those in the non-pilot counties,and the differences were statistically significant(X^(2)=9.887,5.558,both P<0.05).Conclusion The health care management model for at-risk children based on the three-tier management network of maternal and child health care can improve the physical and developmental level of children,and provide better care for at-risk children from O to 1 year old.It is worthwhile to promote this model in the city because it has a significant effect on the long-term development of these children.