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目的评价甘肃省提高新生儿乙肝疫苗首针及时接种率试点项目效果,总结项目策略与经验,为制订有效的乙肝控制策略和措施提供科学依据。方法项目实施前后,采用概率比例规模抽样(PPS)方法在甘肃省天水市7个县(区)中每个县(区)随机抽取30个村级接种单位,每村入户调查7名共1 470名儿童的乙肝疫苗接种情况和儿童家长乙肝知识知晓情况以及210名村医新生儿乙肝疫苗首针及时接种的影响因素;每个县(区)随机抽取2所县级以上医疗机构及3所乡(镇)卫生院,调查住院分娩孕妇HBsAg检测率及医务人员乙肝知识知晓情况。结果通过2年项目工作的实施,天水市儿童乙肝疫苗首针及时率从基线调查时的75.24%(1 106/1 470)提高到终期评估的94.83%(1 394/1 470);住院分娩率从基线调查时的55.85%(818/1 470)提高到终期评估时的81.43%(1 197/1 470);住院分娩孕妇HBsAg受检率由基线调查时的80.00%(14 830/18 537)提高到了终期评估时的99.21%(32 584/32 842);终期调查时医务人员和儿童家长乙肝知识知晓率比基线调查结果有了明显提高;村医认为影响新生儿及时接种首针乙肝疫苗的原因依次为“不知道有新生儿出生”、“距离太远,入户需要很长时间”及“接种点无乙肝疫苗”。结论通过项目的实施,天水市新生儿乙肝疫苗首针及时率、孕产妇住院分娩率以及各级医务人员和儿童家长乙肝知识知晓率均有了明显提高。
Objective To evaluate the effectiveness of pilot projects to improve timely vaccination coverage of newborns with hepatitis B vaccine in Gansu Province and to summarize the project strategies and experiences so as to provide a scientific basis for formulating effective hepatitis B control strategies and measures. Methods Before and after the implementation of the project, 30 village-level inoculation units were randomly selected from each county (district) in 7 counties (districts) in Tianshui City of Gansu Province by using Probabilistic Scale-Sampling (PPS) 470 children’s hepatitis B vaccination and knowledge of children’s hepatitis B knowledge and 210 village doctors newborns hepatitis B vaccine timely vaccination impact factors; each county (district) randomly selected 2 above the county level medical institutions and 3 Township (town) hospitals to investigate the detection rate of HBsAg in pregnant women hospitalized and medical staff knowledge of hepatitis B situation. Results Through the implementation of the two-year project, the first needle-to-hour rate of hepatitis B vaccine for children in Tianshui increased from 75.24% (1 106/1 470) at the baseline survey to 94.83% (1 394/1 470) of the final assessment; and hospital delivery Rates increased from 55.85% (818/1 470) at the baseline survey to 81.43% (1 197/1 470) at the final assessment; the rate of HBsAg in pregnant women at hospital delivery increased from 80.00% at the baseline survey (14 830/18 537) increased to 99.21% (32 584/32 842) at the final assessment; the knowledge of hepatitis B among medical staff and children’s parents at the end of the survey was significantly higher than that of the baseline survey; Hepatitis B vaccine for needle causes were followed by “do not know the newborn was born,” “too far away from home, take a long time” and “vaccination point without hepatitis B vaccine.” Conclusion Through the implementation of the project, the first needle-to-hour rate of neonatal hepatitis B vaccination, the hospital delivery rate of pregnant women and the knowledge rate of hepatitis B among medical staff and children’s parents at all levels have been significantly improved.