Science Center of the San Francisco Bay Are. - interagency meeting. Geneve. WHO/RHR/01.19.
Intemet (Infertility Resources - Developed and ^ ^^^ (2010) Infecundity, infertility and maintained by Internet Health Resources). childlessness in developing countries, http://
5. W H O (2001). Reproductive health indica- www.who.int/reproductivehealth/topics/infertility/
tors for global monitoring: report of the second DHS - CR9.
Summary
INFERTILITY AND CHEMICAL EXPOSURE IN VIET NAM
Infertility related to the physical, chemical and life style factors. Objectives: Analyse the environmental and occupational risk factors of women and their husband relating to the overal infertility.
Method: 14.396 reproductive age (1 5 - 49 years df age) ceuples being volunteery took part in the study in 8 echdiogical regions representative for 8 provinces. The descriptive study used the 60 random cluster sampling technique for each province. Structure questionnaires were used to collect information. Results:
The environmental and occupational factors such as exposure to chemicals, radiation, smoking, illigal drug use and alcohol drink were frequently increased risk of infertility but no significant. Multivariate analysis of all factors of women and men together shown that there were three factors as alcohol use of women, man's exposure to chemicals and man's smoking significantly related to infertility. Conclusion and recommendation: Alcohol use of women, man's exposure to chemicals and man's smoking significantly related to infertility. Factors influencing the infertility should be studied to provide evidence for policy making and planning.
Keywords: Infertility, chemical factors
NUdc SACH, CONG TRINH VE SINH VA ML/C SONG LIEN QUAN T 6 | MAC BENH TIEU CHAY QUA SO LIEU DIEU TRA Y TE QUOC GIA
Tran Du'c Thuang Bjorn Lasen^
Wu Khoa hge va Dao tao, Bd Y te ;^Ngan hang The gidi
Nude sach va cdng trinh v$ sinh ddng vai trd quan trgng trong ganh nang benh tat do tieu chay. Muc tieu: nghien cdu phan tieh sd lieu td Diiu tra Y te Qudc gia nam 2001/2 nham tim hieu vi thUe trang cung cap nUdc sach va cdng trinh vd sinh, mde do mac tieu chay va cac yeu td lien quan den tieu ehay trong cac nhdm ddi tugng. Do'i tdgng va phdong phap nghien cdu: mot ca sd dU lieu gom 36.000 hd gia dinh vdi tren 150.000 ddi tugng cd thdng tin dugc sd dung de phan tich. Ket qua: nhdng tien bd trong cung cap nUdc sach va cdng tnnh ve sinh song van cd sU khac biet trong tiep can vdi ngudn nUdc sach trong cac nhdm thu nhap; ty ie va thdi gian mic tieu chay khac nhau Hen quan den nha ve sinh, ngudn nude gin nai d nhiim mifc sd'ng dan cU, yeu td dan tdc... Nghien cdu dUa ra mot sd khuyen nghi Uu tien ddi vdi mot sd ddi tUang cd nguy ca cao va giai phap giam mic tieu chay trong cdng ddng.
Tijf khoa: nUdc sach, cong trinh ve sinh, tieu chay
I. DAT VAN DE
NUdc sach va cdng trinh ve sinh ddng vai trd quan trpng do'i vdi ganh nang benh tat do tieu ehay. Viee nghien cdu thUc trang ca'p nUdc va ve sinh Men quan de'n doi ngheo rat c i n thiet do cac bp ngheo cd xu hddng cd ty le mac benh cao hon; ft tiep can djch vu y te; ft ngudn lUc tai chinh de tra cho djch vu y te chat lUpng; ft cac ngudn lUc de thay ddi hanh v i ; va giam thu nhap do mac benh. Mpt nghien cdu trUdng hpp dUOc thUe hien bdi Bp Y te va Ngan hang The^ gidi de tim hieu md'i lien quan giOa cap nUdc, ve sinh, tieu chay va ddi ngheo. Muc tieu cua nghien cdu la tim hieu:
/. Thac trang cung cap nadc sach va cong trinh ve sinh.
2. Mde do mac tiSif chay tren cac nhom ddi taang.
3. Cac yeu td liSn quan den nguy ca mac tieu chay trong eae nhom ddi tagng.
II. DOI TUONG VA PHUONG P H A P
NGHIEN CU'U
1. Do'i tupng nghien cifu
Nghien cUu nay sd dung dU lieu td d i i u tra hp gia dinh trong Dieu tra Y te qud'c gia (DTYTQG) dupe thUc hien nam 2001 - 2002. Cupc dieu tra dupe trien khai tren mpt m l u gdm 36.000 hp gia dinh d ta't ca cac tinh cua Viet Nam, trong dd bao gdm mpt tap hpp Idn cac thong tin v i ngudn cung ca'p nude sinh hoat, cdng trinh ve sinh va hanh vi cua hp gia dinh trong viee xd ly nude udng gdm:
dun sdi va xd ly nUdc ud'ng bang boa chat; xae dinh cac ngudn d n h i i m gan gieng khoi; ty le hien nhiem va cac chi sd cda mde dp nghiem trpng cua benh tieu chay cap tfnh d tat ca cac nhdm tudi, va tinh trang kinh te xa hpi nhU. mde sdng, trinh dp va dac diem nha d.
2. Phuong phap nghien cu'u
DU lieu dupc cung ca'p bao gdm cac tap hdp cac Cd sd dd lieu rieng biet dUpc ket xuat td tap dd lieu d i i u tra y te qudc gia 2001 - 2002. Tap hpp cac tap tin cd sd dff lieu dUdc lien ket va ket xuat cac thdng tin theo tinh thanh va ca nhan Men quan tdi hp gia dinh. Dd lieu sau dd ddpc phan tfch bang phan m i m SPSS, gem viee tfnh toan cac ty le va phan tfch hdi quy. Thdng tin md ta ty le theo dia phUdng dUpc the hien tren ban dd de tien quan sat.
III. KET QUA VA B A N LUAN
1. Thij'c trang cung cap nUdc sach va cong trinh
ve sinh "
1.1. Nguon cung cap nddc sach: ngudn cung cap nUdc sach dUdc cai thien dang ke treng thap ky qua. Theo bao cao Dieu tra Y te qudc gia Viet Nam 2001 - 2002, khoang 8 0 % dan sd cd sd dung ngudn nddc sach de an ud'ng. Ty le dan so' sd dung nUde gieng khoan tang tU 5% trong 1992 - 1993 den hon 2 0 % trong 2001 - 2002 (hinh 1).
Viee sd dung nUdc be mat giahi tU 2 0 % den con 10%. Theo Bp Y te nUdc gieng dao each ngudn d nhiem dUdi 7 met khdng dupe coi la hpp ve sinh, da giam td tren 5 0 % den dddi 3 5 % .
1.2. Cac loai cong trinh ve sinh: viee sd dpng nha ve sinh cung dddc cai thien trong thap ky qua (hinh 3). Ty le dan sd khdng cd nha ve sinh da giam td hon 2 5 % trong 1 992 - 1 993 den 1 2 - 1 3%
trong 2001 - 2002. Ty le dan so' sd dung nha ve sinh tu hoai tang td dUdi 10% den hdn 2 0 % . "Cac nha ve sinh khac", bao gdm nha ve sinh khdng dddc xd ly an toan, giam xudng cdn dUdi 10%. Ty le dan so' suf dung nha ve sinh ddn gian van cdn phd bien vdi 3 0 % dan sd, va gan 1 5% dan so' sd dung nha ve sinh chung. "Nha ve sinh khac", gdm nha ve sinh ddn gian, va nha ve sinh chung cd the dupc coi la khdng hpp ve sinh. -'• ' '•''
H1992 - 1993 B 1 9 9 7 - 1998 0 2 0 0 1 -2002
% 60 50 40 30 I 20
10 0
Nude may Gieng NUdc mUa Gieng khdi Song ho Nu6c khac khoan sudi ao
Nguon nifdc udng
Bieu do 1. Cac ngudn cung cap nadc tai Viet Nam 1992 - 2002
Nguon: Dieu tra Y te Qudc gia 2001 - 2002. Bao eao eiia Bd Y te, Viet Nam (2004). Dd lieu dUgc lay td Diiu tra mifc sdng dan cu 1992/1993 va 1997/1998, va Dieu tra Y te Qudc gia 2001 - 2002.
%
B8 1992- 1993
^ 1 9 9 7 - 1 9 9 8 n 2001 - 2002
Loai hoxi
Bieu do 2. Ty le dan sd sd dung cac loai nha ve sinh tai Viet Nam 1992 - 2002
Ngudn: DTYTQG 2001 - 02. Bao cao eua Bd Y te (2004). Dd lieu td Dieu tra mde sdng dan eU 1992/93 va 1997/98, va DTYTQG 2001 - 2002.
Mac du cd nhdng tien bp dang ke trong cung cap nUdc sach va sd dung nha ve sinh trong thap kf qua, van cdn cd sU khac biet dang ke gida cac tinh (bieu dd 3). Tren 5 0 % dan so' sd dung nUde b i mat (ngudn nUde md, khdng ddpc b i o ve nhu ao, hd, sdng) la ngudn nUdc sinh boat chu yeu d 6 tinh nam d vdng Tay Bac, M i i n Trung va Ddng bang Sdng Cdu Long, va hon 2 5 % dan sd sd dung ngudn nddc g i n ngudn d nhiem tai 6 tinh khac. Sau tinh d phfa bac va m i i n trung cd ty le dan so' khdng cd nha ve sinh vifdt qua 50%.
1.3. Bao phu nddc sach va cong trinh ve sinh trong nhom dan cU ngheo: DTYTQG cung cap thdng tin ve mde chi tieu cua hp gia dinh va da difpc nhdm cac hp gia dinh thanh cac nhdm theo mde sdng tieu chuan. D i i u nay cho phep phan tfch tinh hinh sd dung nUdc sach cdng trinh ve sinh cua cac hp gia
dinh ngheo va khdng ngheo. Tren 17% cua 2 0 % nhdm dan sd ngheo nha't sd dung nddc b i mat lam nddc udng, trong khi chi cd 3% cua 2 0 % cac ho giau nha't sd dung nUdc b i mat. Ddi vdi dan cU sd dung gieng dao, 2 7 % cua nhdng ngUdi ngheo nha't cd mpt ngudn d n h i i m g i n gieng, trong khi chi cd 1 3% cda ngUdi giau nhat cd mpt ngudn d n h i i m g i n gieng.
Ty le dan sd sd dung nUdc be mat Ty le dan sd sd dung nUdc Ty ie dan sd khdng cd nha ve sinh gin nguon d nhiim.
7 ^
0C1 £ 5 10 j 10 25
HA .
Bieu do 3. Ty IS dan sd khdng cd nadc sach va nha ve sinh . Nguon: tinh toan td dO lieu DTYTQG 2001 - 2002
Ngheo Can ngheo Trung binh Kha Giau
—*™N6ngth6n —•—Thanh thj
Bieu do 4. Ty IS dan sd khong sd dung nadc sach Nguon: tinh toan tU dd Hdu DTYTQG 2001 - 2002
Ty le dan sd ma khdng cd nddc sach tdc la sd dung nUdc b i mat hoae gieng dao gan ngudn d n h i i m , difpc trinh bay treng hinh 4 thee cac nhdm mde sdng dan cU tieu ehuan. Cd khoang 8% dan sd dd thj va 22% dan sd ndng thdn khdng cd nddc udng an toan. SU chenh lech gida nhdm dan cU ngheo nha't va nhdm giau nha't dang ke d ca ndng thdn va dd thj.
Bieu dd 5 trinh bay ty le dan sd khdng cd nha ve sinh theo nhdm mde sd'ng cda thanh thj va ndng thdn. Thanh thj cd ty le khdng cd nha ve sinh tha'p hdn ndng thon cung nhU ddi vdi sd dung nUde sach.
Su chenh lech nhdm ngheo va khong ngheo Idn hdn dang ke so vdi sd dung ngudn nude khdng hpp ve
Ngheo Can ngheo Trung binh Kha
— # — N o n g thon — • — T h a n h thj
Hinh 5. Ty IS dan sd khong co nha ve sinh theo cac nhdm mde sdng Nguon: tinh toan td dd lieu DTYTQG 2001 - 2002
Giau
2 . MUc dp m i c tieu chay t r e n cac n h o m ddi tUpng Theo ket qua Dieu tra Y te Qudc gia Viet Nam 2001 - 2002, Vy le mac tieu chay khac nhau dang ke gida cac tinhV Mpt chi sdganh nang benh tieu c h l y da dupe tao ra tU cac sd lieu d i i u tra phan anh c l ty le lay n h i i m va thdi gian mac benh [bieu do 6).
Ganh nang benh tieu c h l y cao nha't d Tay Bac va Mien Trung cung nhU trong mpt sd ft c i c tinh d vung Ddng Bic va Ddng bang sdng Ci!fu Long.
0 cap dp toan qudc, ty le lay n h i i m tieu chay d tre em dUdi 5 tudi trong nhdm "ngheo" cao gap ddi so vdi nhdm "giau" (bieu do 7). Do'i vdi nhdm tre dudi 5 tudi, ty le mac nay g i n nhU gidng nhau tren ta't ca cac nhdm mUc sdng. Thdi han mac tieu chay trung binh la 3,1 ngay d tre em dddi 5 tudi va 2,5 ngay trong dan sd hdn 5 tudi (bieu do 9). Do'i vdi tre em dddi 5 tudi, thdi gian mac tieu c h l y trung binh la 3,3 ngay trong cac hp gia dinh ngheo nha't va 2,8 ngay trong cac hp gia dinh giau nha't. Ddi vdi sd dan tren 5 tudi, con sd tddng dng la 3 trong ngay ddi vdi nhffng ngUdi ngheo nha't va 2 ngay ddi vdi ngUdi giau.
Chi sd ganh nang
benh tat Ty Is hd ngheo
'u-**")
Index i < 5
5-8 r " 8-11
^ " ^ \ i ' v " >
t n c i d P i c c of Poverty,1999
Bieu dd 6. Canh nang do tieu chay va ty IS bg ngheo d Viet Nam
Lifu y: ehl sd ganh nang benh do tieu ehay d day duge dnh la tieh sd cua ty le lay nhiim va thdi gian cua benh tieu chay, bang each sd dung dd lieu ehung eho tat ca cac nhdm tudi. Ket qua duge tinh td DTYTQG 2001 - 2002. Ty le ddi
DTYTQG hdi vi mac tieu ehay trong vdng 4 tuan trUde dieu tra
ngheo duge tinh td ket qua Tdng diiu tra dan sd va nha d nam 1999 va Diiu tra mde sdng dan cu nam 1997.
Ty le mac tieu chay cao hon nhieu d tre em trong hp ngheo la mot md'i quan tam. NhOng bp ngheo thudng cd ft kha nang tiep can cac djch vu cham sdc y te. Hp cung cd ft ngudn Idc tai chfnh de tra cho c I c djch vu cd cha't lUpng. Do dd, tre em trong hp ngheo cd nguy cP cao hon, khdng chi mac benh tat, ma cdn cd nguy cd td vdng cad hdn do tieu chay.
3. Cac yeu td lien quan den nguy cP mac tieu
chay trong cac nhom do'i tUpng
N h i i u nghien cdu td khap ndi tren the gidi da chdng minh sd anh bUdng cua ngudn cung cap nUdc, cdng trinh ve sinh va banh vi ve sinh tdi benh tieu ehay (Curtis va Cairncross 2003; Few- trell va Colford 2004; Esrey va cpng sU 1991). Dd lieu DTYTQG 2001 - 2002 la mpt cP hpi hiem cd de danh gia vai trd cua cac yeu to khac nhau v i nguy CO mac tieu chay tai Viet Nam. Mpt phan tfch hdi quy da bien logic da ddpc thdc hien bang each sd dung thdng tin cbi tiet cua bdn 150.000 ca nhan dff lieu D T Y T Q G .
10%
8%
6%
4%
2%
0%
8.2%
7n%
• Du'O'i 5 tuoi TO 5 tudi tro" len
6.6%
5 ^ %
4 . 2 %
2.2% 2.3% 2 . 1 % 2.2% 1.9%
3.50 3.00 2.50 2.00 1.50 1.00 0.50 0.00
Ngheo Can ngheo Trung binh Kha Giau Bieu do 7. Ty IS hien mac tieu chay theo tudi va nhdm mde sdng
Nguon: tinh toan td dd lieu DTYTQG 2001 - 2002
-— - -
3.10
2.50
""
DUdi 5 tuoi TiT 5 tudi trd len
Bieu dd 8. Thdi gian mac tiSu chay trung binh (ngay) Nguon: tinh toan td dd lieu DTYTQG 2001 - 2002
Sd dung ngudn nUdc md khong an toan (vi du, nude be mat) de an udng hang ngay lam tang nguy ed benh tieu chay len hdn 51 % d tre em dddi 5 tudi va 3 3 % d ngddi tren 5 tudi, so vdi Xy le trung binh cho ti't ca ngudn nddc udng k b i c . Tre em trong cac bp gia dinh khdng cd nha ve sinh cd nguy cd mac tieu chay cao hon tre em trong cac hp gia dinh cd nha ve sinh la 34%. Nguy co cua nhdm dan sd tren 5 tudi cao bon 23%. Trinh dp hpc van cung la yeu td anh hudng den tieu chay. Tre em cd me hpc chda het tii'u hoe cd nguy cd mac tieu chay cao hdn 27% so vdi tre em ed me hpc tren tieu hpc.
Tifpng tu nhu vay, trong nhdm dan sd tren 5 tudi, nhffng ngUdi chda hoc xong tieu hpc cd nguy cP mac tieu chay cao hdn nhdm hpc xong tieu hpc trd len 24%. Nhdm ngddi dan tpc thieu sd cd nguy co mac tieu chay eao hpn 44%".
Hinh 7 cho thay tre em tron cac hp gia dinh
"ngheo" cd ty le mac tieu ehay gan nhu la cao gap ddi cho tre em trong cac hp "giau". Mpt sd ly do cho sU chenh lech nay cd the do cac hp gia dinh "ngheo" cd n h i i u k h i nang sd dung nddc b i mat hdn bp "giau", khdng cd cdng trinh hpp ve sinh, va trinh dp hoc va'n tha'p bon. Tuy nhien, ngheo ddi phai la yeu td I n h bUdng den benh tieu ehay d tre em ben ngoai nhffng yeu t d nay. Mpt each giai thfch cho nhdm dan tpc cua eha me phan anh trong nhdm mde sdng cua tre em, nhd dan tdc thieu sd cd xu hudng ngheo hdn da sd dan sd d Viet Nam.
Cac loai ngudn nUdc udng nhd nddc may, gieng dao, gieng khoan, nUdc mUa cung dUdc phan tfch de danh gia nguy cd cda benh tieu c h l y . Khdng cd sU khac biet v i nguy co tieu chay ddi vdi cac loai nUdc udng. TdOng tU nhU vay, khdng ed sU khac biet v i nguy ed trong viee sd
dung cac loai nha ve sinh nhU nha ve sinh tham don gian, dpi nUdc, va nha ve sinh td heal hien dai. Tuy nhien, khi gieng khdi ddpc phan tfch mpt each rieng biet thi cd sU khac biet trong nguy cd bj benh tieu chay giffa gieng khdi cd va khdng ed ngudn d n h i i m g i n dd. Nguy cd bj benh tieu ehay d mpi nhdm tudi tang len 1 5 % trong nhdm sif dung gieng khdi g i n ngudn d n h i i m so vdi khong khdng gan ngudn 6 n h i i m (bieu do 9)^ Ddi vdi cung mpt nhdm c l the, vf du, nhffng ngddi sd dung gieng khpi, nguy cP mac benh tieu chay cua ngddi khdng cd nha ve sinh cao hon nhdm cd nha ve sinh la 3 6 % . Ude tfnh nay cd phan cao hdn Ude tinh tU m l u toan bp cac ca nhan trong dff lieu DTYTQG. ' • - • ' - ' ••
Gan 3 5 % dan sd sd dung gieng khoi. Theo DTYTQG, khoang 2 0 % sd gieng khoi d g i n mpt ngudn d n h i i m . Ty le sd dung gieng khdi lam ngudn nUdc udng theo nhdm mde sdng dUOc trinh bay trong bieu dd 10. Khoang 2 7 % hp gia dinh ngheo sd dung gieng dao gan ngudn d n h i i m , so vdi 1 3% ddi vdi hp giau.
Bieu dd 11 trinh bay ty le % dan sd sd dung gieng khdi lay nddc sinh boat theo tinh. Mpt sd tinh cd ty le hp sd dung gieng khdi tren 75%, va dudi 5% d Ddng bang Sdng Cdu Long. Mdt sdtinh cd tren 4 0 % sd gieng khoi d gan ngudn d n h i i m .
Phan tfch cac yeu t d anh hddng den thdi gian mac benh tieu chay cho tha'y: khdng cd nha ve sinh lam tang thdi gian len 1/3 ngay ddi vdi nhdm tren 5 tudi. Loai ngudn nddc khdng cd anh hddng den thdi gian mac benh. NgUdi dan tpc thieu so cd sd ngay mac tieu chay trung binh cao hdn 1/3 ngay bat ke loai cdng trinh ve sinh sd dung va cac yeu to' Men quan khac. Nhdm ngheo cung cd thdi gian bj benh tieu chay cao hon ngoai sd Men quan
-Dd lieu DTYTQG khdng cd thdng tin ve dan toe eua tre dUdi 5 tudi.
^Mau ddi tugng sd dung gieng khai ed va khdng ed gin nai d nhiem khdng du idn de phan tich rieng nhdm tre em va ngudi Idn ' ::Ws-'i •''" '"'V^.r^,'/!
den viee khdng cd cdng trinh ve sinh va nhdm dan tpc thieu so'. Ddi vdi ho gia dinh sd dung gieng khdi lam ngudn nUdc ud'ng, gieng g i n ngudn d nhiem lam tang them 1/4 ngay mac benh tieu chay trung binh. Khdng cd yeu td nao dddc xae dinh lam tang thdi gian cua benh tieu chay d tre em dUdi 5 tudi.
' Viee sd dung nUdc mUa lam ngudn nUdc chfnh chd sinh hoat tang qua cac sd lieu d i i u tra tif 1992 - 1993 va 1997 - 1998 den 2001 - 2002. Tren 5 0 % hp gia dinh sd dung nddc mUa t^i mpt so' tinh d Ddng bang song Hong va
khoang 10 - 3 0 % d Ddng bang song Cdu Long.
Khdng cd nguy cd nao dUpc tim tha'y trong nghien cdu nay tU ngudn nddc mUa so vdi cac ngudn nude sach dUpc bao ve khac. Do dd nddc mUa la mpt lUa chpn k h i thi tai cac dja phUdng cd gieng khdi khdng an tdan hdac nhffng ngudn nddc khdng dUdc bao ve (nUdc be mat) va chi phf sd dung nddc ngam hoae nUdc m I y cdn cao.
Trong thUc te', ndi chung cac hp gia dinh kha hon hay sd dung nUdc mUa. Chi cd 6 % so' hp ngheo nha^t sd dung nddc mUa so vdi 14 - 1 6 % cua nhdm thu nhap "trung b i n h " .
40%
35%
30%
25%
20%
15%
10%
5%
0%
'Phan
^
15%
367o
Co ngudn 6 nhiim gSn gilng kho'i* Khong co nha VS Bieu do 9. Nguy ca taang ddi cua tiSu chay
tieh nay ehl tinh cho ddi tUang sd dung nguon nUdc gieng khai eho sinh boat.
Ngheo Can ngheo Trung binh Kha Giau Bie'u do 10. Ty IS dan cUsd dung nguon nadc td gieng khai gan ngudn d nhiim
Nguon: tinh toan td dd lieu DTYTQG 2001 - 2002
Ty le dan sd sd dung gieng khai
Ty IS dan sd dung gieng khai gan ngudn d nhiSm
•i
Percent 0 0 1 5 5 ID 10 25 25 40
#
T \
Bieu dd 11. Ty IS dan sd sd dung gieng khai Nguon: tinh toan tU dd lieu DTYTQG 2001 - 2002.
IV. KET LUAN v A KIEN NGHI.
Ket luan:
Viet Nam da dat nhffng thanh tUu an tUpng trong ITnh vUc cap nUdc va ty le bao phd cdng trinh ve sinh;
Hien van cdn sU khac biet trong viee tiep can vdi c I c ngudn cung cap nUde sach va cdng trinh ve sinh phu hpp trong dd ngddi ngheo cd ty le bao phu tha'p hon;
Ngheo ddi cd tac dpng dang ke den mac benh tieu c h l y d tre em nhUng khdng t i e dpng tdi ngUdi Idn;
Nude b i mat, nUde gieng khdi d n h i i m va thieu nha ve sinh gay ra ty le mac benh benh tieu c h l y cao bdn dang ke so vdi cac ngudn nUdc khac va cd cdng trinh ve sinh;
Thieu nha ve sinh, gieng khdi g i n vdi cac ngudn d nhiem, va ddi ngheo lam tang thdi gian trung binh mac benh tieu c h l y ;
Nghien cdu khdng tim thay bat ky sd khac biet v i nguy co bj benh tieu chay td nddc may sach.
gieng khdi sach, gieng khean, nddc mUa, hoae nUdc mang l l n ;
Nghien cdu khong tim tha'y bat ky sU khac b i i t v i nguy cd mac b | n h tieu chay giffa sd dung nha ve sinh ddn gian so vdi cac loai nha ve sinh khIc;
Giao due lam giam rui ro mac benh tieu chly, cho thay tam quan trpng cda viee tang cddng ve sinh trong viee giam nguy cP mac tieu c h l y ;
Thieu nude sach dac biet phd bien d mot sd tinh phfa Bac, m i i n Trung va Ddng bang song Cdu Long va thieu nha ve sinh la phd bien d cae tinh m i i n ndi phfa Bac va m i i n Trung;
Kien nghj:
Can Uu tien cung ca'p cung cap nUde sach va ve sinh cd ban cho cac ho gia dinh va dac biet la cho cac hp ngheo vi ty le mac tieu chay cao hdn trong khi ft kha nang ehi tra cac djch vu y te.
Thd hai phai ddpc Uu tien de giai quyet 6 nhiem gieng khoi. D i i u nay ddi hdi hdn nffa sU hieu biet ve cac giai phap cd chi phf vdi hieu qua cao.
Tang cUdng ve sinh can dUdc Idng ghep mot p b l n trong cung cap nUdc va ve sinh mdi trUdng.
Rda tay la mpt each de lam giam mac benh tieu chay den 4 5 % (Curtis va Cairncross 2003).
Trong dieu kien can thiep theo khu vUc, cae binh 3, 6 va 11 gpi y cho viee xae djnh cac dia pbUdng Ud tien che cap nUde, ve sinh mdi trUdng va tang cddng g i l d due ve sinh.
T A I LIEU THAM KHAO
1. Bp Y te - Tong cue Thdng ke (2003). D i i u tra y te qudc gia 2001 - 02. Nha xuat ban Y hpe.
2. Curtis, V. and Cairncross, S. (2003). Effect of Washing Hands with Soap on Diarrhoea Risk in the Community: A Systematic Review. Lancet In- fectious Diseases. Vol 3.
3. Esrey, S.A., Potash, J.B., Roberts, L., and Shift, C. (1991). Effects of Improved Water Supply
and Sanitation on Ascariasis, Diarrhoea, 4. Fewtrell, L. and J. Colford Jr. (2004). Water, D r a c u n c u l i a s i s , H o o k w o r m i n f e c t i o n . Sanitation and Hygiene: Interventions and Schistosomiasis, and Trachoma. W H O Bulletin, Diarrhoea - A systematic review and meta - Vol. 69, No. 5. analysis. HNP Discussion Paper. World Bank.
Summary ' ' ' '-.
THE RELATION BETWEEN WATER SUPPLY, SANITATION LIVING STANDARD AND DIARRHEA
Water supply and sanitation play an important role in disease burden due to diarrhea. The study analyzed data from national health survey in 2001 - 2002 to explore the state of water supply and sanitation; the level of diarrhea and other factors related to diarrhea in the interest population. A database of 36,000 households w i t h over 150,000 individuals has been used for analysis. Results showed improvements in water supply and sanitation, but still there are differences in access to clean water sources in the income groups, the rates and duration of diarrhea related to the use of sanitation facility, pollution source close to the dug well, poverty, ethnic minority... The study provides some recommendations for a number of priorities to address the high - risk subjects and measures to reduce diarrhea prevalence in the community. • ' J ' • . • • ' " - ' ••
Keywords: clean water, sanitation, diarrhea
HIEU QUA CAN THIEP MO DUC THE THUY TINH VA
TINH HINH MU LOA 6 TINH BINH DjNH GIAI DOAN 2001-2007
Nguyen Chi Dung ij.ii ^ky 's.'X-^ ;v, Benh vien Mat Trung Uang
Danh gia hieu qua md due the thuy tinh (DTTT) va ty Id mu Ida d cdng dong qua tdng giai doan de lap ke hoach phdng chdng mu Ida. Muc tiSu: (1) Xae dinh ty le mu va nguyen nhan gay mu giai doan 2001- 2007. (2) Danh gia hieu qua trUde sau md DTTT tai cdng dong. Doi tagng va phaang phap nghiSn cdu:
nghien cdu cit ngang md ta tien hanh trudc-sau tren 1.773 ngudi td 50 tudi trd len. Ket qua: ty le mu 2 mat va 1 mat nam 2001 la 7,33%o va 13,37%o, nam 2007 la 5,76%o va 10,21%o. Nguyen nhan chinh gay mu (2001) la DTTT (74,6%o), gidcdm (8,5 %o), bdnh ban phin sau (6,9%o), sea giae mac (3,1 %o), nam 2007 la DTTT (70,0%), gidcdm (10,8%o), benh ban phin sau (6,9%o), bie'n chdng phiu thuSt (4,6%o). Ty le DTTT mu 2 mit:
4,34%o, mu 1 miti 9,59%o (2001); tuang Ung 3,04%o va 9,19%o (2007). Ty IS bao phu phiu thuat la 54,1 %o (2001) va 59,5%o (2007). Ty IS ket qua phiu thuat kem giam td 31,63%o (2001) xudng 28,0%o (2007). Ket luan: ty IS mu d Binh Dinh sau 6 nam giam nhiiu. Nguyen nhan chinh gay mu vin la DTTT. Ty ie bao phu va ty le thanh cdng phiu thuat diu tang. Chien luge trong 10 nam tdi vin la day manh md DTTT, nang cao chat lugng phiu thuat de dat muc tieu "Thi giae 2020" . , ^ ^., .,, ,,
TU khoa: mu loa va can thl^p DTTT Binh Djnh :! ,