高级检索

克拉玛依市妇幼保健服务现状分析与对策研究

Status quo analysis and countermeasures of maternal and child health services in Karamay City

  • 摘要: 目的 了解克拉玛依妇幼保健服务现状,分析服务模式利与弊,探索解决问题的对策。方法 采用定量研究和定性研究相结合的方法。通过产科质量评估,与相关妇幼保健专家访谈,开展基线调查等进行定性分析,收集近五年妇幼卫生年报运用EXCEL2007和SPSS17.0对妇幼保健服务指标、健康指标进行定量分析。结果 ①市妇幼保健所为市疾病预防控制中心的一个科室,履行市级妇幼保健机构职能。助产服务依托4家综合医院产科,妇幼保健服务由社区卫生服务中心(乡卫生院)承担。②全市社区卫生服务中心妇幼保健专业技术人员45人,占从事妇幼保健服务人员总数28.48%。高级职称仅1人,占0.63%,大学以上学历17人,占10.76%,年龄40岁以上29人,占64.4%。③全市产妇数、产检率、产检≥5次、产后访视率及住院分娩率近五年呈上升趋势并保持较高水平。各年度比较差异有统计学意义(P <0.01)。孕产早检率、系统管理率均低于同期全国的平均水平。全市5年平均剖宫产率59.77%,高于全区和全国平均水平。高危孕产妇占比呈现明显上升趋势,5年高危孕产妇占孕产妇总数的33.36%。巨大儿发生率逐年上升,平均发生率为13.78%。各年度比较差异有统计学意义(P <0.01)。近5年全市孕产妇平均死亡率为26.89/10万,高出全国同期(20.1/10万)6.79个百分点。2013-2014年孕产妇死亡有抬头趋势,总体死亡率变化趋势差异有统计学意义(P <0.05)。结论 ①克拉玛依市妇幼保健服务体系不完善,机构不健全。②全市妇幼保健管理模式呈分段、分级管理。基层妇幼保健专业技术人员短缺,尤其高级人才缺乏,服务能力明显不足。③高危孕产妇数量逐年递增,巨大儿发生率呈上升趋势,剖宫产率常年以地州为单位居全自治区前列。建议①建立健全地市、县区、乡(社区卫生服务中心)三级妇幼保健机构。②综合医院与基层社区卫生服务中心形成对口帮扶关系,加大培训力度,不断提升基层服务能力和水平。③利用“互联网+、妇幼卫生信息平台”将社区妇幼保健与临床一线的产儿科服务紧密连接在一起,弥合克拉玛依市妇幼保健分段管理的弊端,建立克拉玛依地区的孕产期保健互联网+无缝隙健康管理模式,将产科分险管理关口前移。

     

    Abstract: Objective To understand the current situation of maternal and child health care services in karamay, analyze the advantages and disadvantages of service modes, and explore the countermeasures to solve the problems.Methods A combination of quantitative research and qualitative research was used. Through obstetric quality assessment, interviews with relevant maternal and child health experts, based on a baseline survey, qualitative analysis was conducted. The annual report on maternal and child health in the past five years was used to quantitatively analyzed. The indicators of maternal and child health services and health indicators were analyzed by EXCEL 2007 and SPSS 17. 0.Results ① The Karamay Maternal and Child Health Care Center is a department of the Municipal Center for Disease Control and Prevention that performs the functions of a municipal-level maternity and child care agency.Midwifery services rely on the obstetric departments of 4 general hospitals, and maternal and child health services are undertaken by the community health service centers (township health centers). ② There are 45 maternal and child health professional and technical personnel in all community health service centers in the city, accounting for 28. 48% of the total number of maternity and child care services personnel. Only one person has a senior professional title, accounting for 0. 63%. There are 17 professional workers with bachelor degree or above, accounting for 10. 76%. There are 29 professional workers aged over 40 years old, accounting for 64. 4%. ③ The number of pregnant women in the city, the antenatal examination rate, the times of antenatal examination ≥ 5 times, the rate of postpartum visit and the rate of hospital delivery have shown an upward trend in recent five years and maintained a relatively high level in the past five years. There were statistically significant differences among different years (P < 0. 01). The rate of early antenatal examination and the rate of systematic management were lower than the national average. The average cesarean section rate during the five years was 59. 77%, which was higher than the average level of the whole autonomous region and the whole country. The incidence of high-risk maternal ratios and macrosomia increased year by year. Five-year high-risk maternal women accounted for 33. 36% of the total number of pregnant women. The incidence of macrosomia has increased year by year. The average incidence of macrosomia in the five years was 13. 78%. There was a statistically significant difference between each year (P < 0. 01). In the past five years, the average maternal mortality rate was 26. 89 per 100 000, which was 6. 79 percentage points higher than the national average (20. 1/10 million). There was a upward trend in maternal mortality from 2013 to 2014, and there was a statistically significant difference in the overall mortality trend (P < 0. 05).Conclusion ① Karamay city's maternal and child health service system is not perfect and its institutions are imperfect. ② The city's maternity and child care management model is segmented and disassembled. There is a shortage of grass-roots personnel, especially is lack of senior personnel, and the service capacity is obviously insufficient. ③ The number of high-risk pregnant women has been increasing year by year, the incidence of macrosomia has been on an upward trend, and the rate of cesarean section has been ranked as the forefront of the whole autonomous in terms of prefectures. Recommend ① To establish and improve the construction of three levels of maternal and child health institutions in prefectures, counties, districts and townships (community health service centers). ② To form counterpart-assistance relationships between comprehensive hospitals and grass-roots community health service centers, and increase training efforts, and continuously improve grass-roots service capabilities and levels. ③ To utilize "Internet +, MCH Information Platform" to link community maternal and child health care with clinical firstline paediatric services to bridge the shortcomings of segmented management of maternity and child care in the city and establish a health care internet and seamless health in the Karamay region. To shift the barriers for the management of obstetrics risks.

     

/

返回文章
返回