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通过对云南省40个卫Ⅵ项目县1992年到1998年5岁以下儿童死亡状况及相关妇幼保健服务进行分析,发现5岁以下儿童死亡率、婴儿死亡率和新生儿死亡率均有明显下降,其下降幅度都大于同期全省和全国农村平均水平,至1998年均已低于项目目标。肺炎、新生儿窒息、早产低出生体重和腹泻仍然是1998年婴儿的主要死亡原因。与1992年相比,婴儿死于家中的比例明显下降,死于医院(县、乡医院)、送医院途中及死前24小时就诊于乡卫生院的比例显著增加。婴儿死亡率与部分妇幼保健服务水平呈负相关。由此提出了强化危重症儿童转诊与抢救、提高乡卫生院对儿童疾病的救治能力、落实5岁以下儿童急性呼吸道感染、腹泻标准病例管理和临床病例管理、推广新生儿窒息新法复苏技术、加强社区动员与参与、加强妇幼健康教育等重点措施,推行孕产妇、儿童系统管理、新法接生和住院分娩、新生儿访视等基本措施,以降低5岁以下儿童死亡率、婴儿死亡率和新生儿死亡率。同时,针对儿童死亡漏报现象,提出应规范儿童出生、死亡的监测工作,加强对原始信息资料的管理。
Through the analysis of the deaths of children under 5 years of age from 1992 to 1998 in 40 Wei Ⅵ project counties in Yunnan Province and related maternal and child health care services, it was found that the mortality rate of children under 5 years of age, infant mortality rate and neonatal mortality rate were significantly decreased, The declines were greater than the average level of the province and the country’s rural areas in the same period and were below the project target by 1998. Pneumonia, neonatal asphyxia, preterm low birth weight and diarrhea continue to be the leading cause of death in infants in 1998. Compared with 1992, the proportion of infants who died at home dropped significantly. The proportion of infants who died in hospitals (county and township hospitals), sent to hospitals and visited township hospitals 24 hours before death increased significantly. Infant mortality was negatively correlated with some maternal and child health services. Therefore, it is proposed to strengthen the referral and rescue of critically ill children, improve the ability of township hospitals to treat and treat children’s diseases, implement the standard case management and clinical case management of acute respiratory infections and diarrhea in children under 5 years old, popularize the new resuscitation technology of neonatal asphyxia, Strengthen community mobilization and participation, strengthen the key measures such as health education for women and children, and promote basic measures such as maternal and child system management, delivery of new laws and hospital delivery, visit of newborns, and so on to reduce the under-five mortality rate, infant mortality rate and newborn rate Mortality. At the same time, according to the phenomenon of omission of child death, it is proposed that the monitoring of children’s birth and death should be standardized and the management of the original information material should be strengthened.