JOURNAL OF COMMUNITY MEDICINE
Y
HOC_
^ ^ ^^
CONG DONG 2018
HliC TRANG, MOT SO YEU TO LIEN QUAN DEN KIEN HUfC VE KHAM SANG LOG VA TU VAN TRUdC TIEM
: H U N G CUA N H A N VIEN TRAM Y TE X A , HUYEN TUf KY,
INH HAI DUONG
TOM TAT
Muc tieu ciia nghien ciiu la md ta thuc trang va mgt sd eu td lien quan den kien thuc ve kham sang Igc va tu vSn
•udc tiem chiing ciia nhan vien tram y tl xa (TYTX) tai uyen Tu Ky, tinh Hai Duong. Nghien ciiu dupe thiet ke at ngang md ta, phdng van 53 nhan vien y te (NVYT) lam 6ng tac kham sang Igc va tu van trudc tiem chiing tai 27 YTX ve thdng tin nhan khau hgc, kien thiic ve cong tac em chung va kham sang Igc, tu van trudc tiem chiing. Ket ua cho thay: (1) NVYT da cd kien thiic ve tiem chiing, ve ham sang Igc va tu van trudc tiem chiing, my nhien chua ay dil va toan dien khi ty le tra Idi diing va day dii cac ngi ung rat thap (1,9 - 9,3%)). (2) Co mdi lien quan cd y nghia long ke giiia trinh dp chuyen mdn va tham nien cdng tac ua NVYT vdi kiSn thiic ve kham sang Igc va tu van trudc lem chung. Khuyen nghi bao gdm tang cudng dao tao, tap uan cho NVYT, xay dung bd tai lieu tham khao ndi bg va net lap kenh thdng tm hd trg cho TYTX.
Tij khoa: Tiem chiing, kham sang Ipc, tu van trudc iem chung, nhan vien y te.
SUMMARY
THE CURRENT SITUATION AND SOME ACTORS RELATED TO KNOWLEDGE ON ICREENING EXAMINATION AND PRE- 'ACTIONATION COUNSELLING OF COMMUNE lEALTH STATION STAFFS IN TU KY DISTRICT, lAI DUONG PROVINCE
The objective of the smdy was to describe the urrent simation and some factors related to knowledge n screening examination and pre-vaccination counselling f commune health station staffs in Tu Ky district, Hai
n i a m Thj Phi/dng Dung', Mai Xuan ThuS Tran HQU Bich^
Duong province. A cross-sectional descriptive smdy was conducted to interview 53 health workers in 27 commune health stations for demographic and theu knowledge on immunizations, screening examination and pre-vaccination counselling. The results show that:
(1) Health workers had knowledge on immimizations, screening examination and pre-vaccination counselling, but not ftiUy and comprehensively, when the rate of correct and ftiU answer is very low (1,9 - 9.3%). (2) There are a statistically significant relationship between the level of professionalism, seniority of health worker and their knowledge on screening examination and pre-vaccination counselling. Recommendations include: To strengthen trainning for health workers; To develop a set of internal references; To establish a supportive information channel for commune health stations.
Keywords: Immunization, screening examination, pre-vaccination counselling, healthcare worker.
I. DAT VAN DE
Tiem chiing md rgng (TCMR) la mgt trong nhirng chuong trinh muc tieu siic khoe quan trgng hang dau d Viet Nam, gop phan giam thieu tac hai va ganh nang do cdc benh truyen nhiem phd bien va nguy hiem cho tre em. Trong quy trinh thuc hien an toan tiem chiing, kham sang Ipc va tu van trudc tiem chiing la mgt trong nhiing budc quan trpng, lien quan mat thiet den giam sat, theo ddi nhirng phan ling bat Igi sau tiem vac xin cua tre. Tuy nhien, tren thuc te va ket qua nhieu nghien ciiu gan day cho thay ty le thuc hien day dii cac budc kham sang Ipc vit tu van trudc tiem chiing tai cac dia phuong, dac biet la myen y te co sd con thap, co lien quan den kien thiic
. Trung tam Y te huyfin Tu Ky, tinh Hai Dirong . Vien Chiln liroc vi Chinh sach Y te . Trudng Dai hgc Y tl Cong cong
.% Ngay nhan bai: 02/07/2018 |
~ SO 5 (46) - Thang 09-10/2018
Ngay phan bien: 07/07/2018 | » Ngay duyet dang' 23/08/2018
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WebsHe yhoccongdong.viciia nhan vien xa thuc hien cong tac nay. Do do, muc tieu cua nghien cim nay la mo ta thuc trang va mot sd yeu to lien quan din kiln thuc vl kham sang Igc va m van hTidc tiem chiing ciia nhan vien TYTX tai huyen Tii Ky, tinh Hai Duong.
n . DO! TUONG VA PHU'ONG PHAP N G H I £ N ClfU
D6i tuong nghien cihi: NVYT thuc hien cong tac kham sang Igc va tu vin trudc tiem chiing tai cac TYTX, thi trIn ciia huyen Tir Ky, tinh Hai Duong.
ThM gian va dja diem nghien cihi:
Thdi gian: Thang 2/2018 din thang 6/2018.
Dia diim: Tit ca cac TYTX, thi trln thuoc huy?n Tii Ky, tinh Hai Duong.
Thiit ke nghiSn cihi: Thiit kl nghien cuu ck ngang mo ti, kit hop giiia nghien cim dinh lupng va dinh tinh
Co mau va chon mau: Chgn mlu toan bp NVYT thi^c hi?n kham sang Ipc, tu vin trudc tiem chiing tai 27
TYTX, thi trIn huyen Tu Ky. Mdi TYT cd 2 NVYtd cdng tac nay, nhung do tai thdi diim nghien ciiu c6p NVYT vSng mat, khdng thi tham gia nghien ciiu nen tAif sd NVYT tham gia nghien ciiu nay la 53 ngudi.
Phu-ffng pbap thu thap thdng tin: Sii dung philuhii phdng vin ban cau tnic.
Phuong phdp phSn tich so lieu: Sii dung phln Epidata 3.1 dl nhap lieu va phln mim Stata dl ph&i' Sl lieu dupe kilm tra tinh logic v^ nhit quan, thing kSmi ta va sii dung kilm dinh •/} dl so sanh cac ty I?, sir d^^
OR va khoang tin cay de do ludng dp manh ciia su ket h^p B?o due cua nghien cuu: Nghien cuu da dugc H(
ding khoa hgc va Hdi ddng dao diic trudng Dai hgcYt Cdng cgng thdng qua va cho phep tiln hanh nghiSn NghiSn ciiu dugc tiln hanh tr6n sv tu nguypn tham gia.
dii tugng.
III. KET QUA NGHlfeN CUtl VA BAN L U ^ 1. Thdng tin chung ciia doi tu^^g nghien cuu Bdng 1. Thong tin chung cua ddi tuong nghien curu (n=53)
Dac diem
Tudi
Giai tinh
Trinh do va ciiiic danh chuyen mon
So nam lam chuyen mon
S6 nam lam tai TYT xa
Chijc danh quan ly
Tham gia tap huan ve cong tac tiem chiing trong nam 2017
Duoi 30 tu6i 3 1 - 4 0 tuoi 41 - 50 tuoi Tren 50 tuoi Nam Nil Bac sT da khoa/chuyen khoa Y Sl da khoa Y Sl san nhi Y sT y hoc co truyen Duoi 10 nam 11-20 nam 20 - 30 nam Tren 30 nam Dual 10 nam 11-20 nam 20 - 30 nam Tren 30 nam Tram tnrong/ Tram pho Khong lam quan ly Co Khong
Tans^
7 11 10 25 32 21 20 28 3 2 14 6 22 11 14 7 24 8 28 25 49 4
Tyl?(%) 13,2 1 20,7 18,9 47,2 60,4 39,6 37,7 52,8 5,7 3,8 26,4 11,3 41,5 20,8 26,4 13,2 45,3 15,1 52,8 47,2 92,5 7,5
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JOURNAL OF COMMUNITY MEDICINE
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Nghien ciiu tiln hanh phdng vln 53 NVYT lam cdng
•ac kham sang Igc va tu vln trudc tiem chiing tai 27 TYTX, t i tran ciia huyen Tu Ky, tinh Hai Duong. Vl do hili, sl
"IVYT lam cdng tac kham sang Igc va tu van trudc tiem '•hiing tai cac TYTX, thi trIn phin Idn co dp mdi tii 50 - 60 u6i, chilm 47,2%. Vl gidi, sd NVYT la nam chilm ty le ap lao vdi 60,4%, trong khi ty le NVYT nu chi chilm 39,6%.
i'/l trmh dp va chiic danh chuyen mon, ty le NVYT la bac 'y chiem 37,7%, trong khi y sy da khoa chilm 52,8%, y sy
san nhi chiem 5,7% va y sy y hpc cd tmyen chiem 3.8%i.
v l kinh nghiem chuyen mon va kinh nghiem lam viec tai TYTX, sl NVYT co 20 - 30 nam lam chuyen mon dIu chilm ty le cao nhat, Ian lugt la 41,5% va 45,3%. Ve cdng tac quan ly, 52,8% NVYT dang thuc hien cdng tac tram trudng hoac tram phd tai TYTX. Ve tham gia tap huan cdng tac tiem chimg, mdi cd 92,5%o NVYT dupe tham gia tdi thieu 1 Idp tap huan trong nam 2017.
2. Kiln thiic cua NVYT ve cdng tac tiem chung Bdng 2. Kien thuc cua NVYT vi cong tac tiim chung (n—53)
'i Ndi dung
~Kien thtec ve vac xin
Vac xm VGB miii dau tien can tiem cho tre t6i da trong vong 24 gia diu sau sinh Co the tiem vdc xin Soi cho tre khoe manh tir 9 thang tu6i
i: Vac xin BCG - Lao thuong de lai seo sau khi tiem
Khoang each thai gian giira cac lifiu DPT - VGB - Hib (Quinvaxem) t6i thi^u la 01thang
_ Tre CO the tiem 2 loai vac xin trong ciing mot buoi tiem ehiing _ Kien thuc ve nhmtg ddu hieu tre can phai hodn tiem vac xin - Tre mac cac benh cap tinh, dac biet la cac benh nhiem triing
Tre sot > 37,5°C hoac ha than nhiet < 35,5 °C {do nhift do tai nach)
; Tre mcri dung cac san pham globulin mien dich trong vong 3 thang trir truong hop
• tre dang sii dung globulin mien dich dieu tri viem gan B
. Tre dang hoac moi ket thiic dot dieu tri corticoid (uong, tiem) trong vong 14 ngay
• Tre CO can nang duoi 2000g ,
Cac truong hap tam hoan tiem chung khac theo huong dan cua nha san xuat d6i
• voi timg loai vac xin
Kien thuc ve nhimg ddu hieu nguy hiim sau tiem chung md gia dinh phdi dua Ire den cif sd y te
Tre mac cac benh cap tinh, dac biet la cac benh nhiem triing Tre s6t > 37,5°C hoac ha than nhiet < 35,5 °C (do nhiet do tai nach) Tre quay khoe nhieu
Tre CO thay doi mau sac da, niem mac Tre bi run chan tay
Tre CO biSu hien CO giat Tre CO biiu hien bat thuimg khac
TiinsS 36 49 43 52 50 51 2 48 49 13 36 8 7 1 1 53 25 12 1 28 5
Tyl|(%) 67,9 92,5 81,1 98,1 94,3 96,2 3,8 90,6 92,5 24,5 67,9 15,1 13,2 1,9
1,9 100 47,2 22,6 1,9 52,8 9,4
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S 6 5 (46) - Thang 09-10/2018 Website yhoccongdong.vnKiln thiic ciia NVYT vl tiem chiing dugc danh gia dua tren kiln thiic vl vie xin, vl nhiing dIu hieu tre phai hoan tiem vie xin va vl nhirng diu hieu nguy hiem sau tiem chiing ma gia dinh phai dua tre den co sd y te.
D6i vdi kiln thiic vl v5c xin, ty le NVYT tra Idi dung cac cau hdi kiln thiic rieng le dIu d miic cao tren 80%, tuy nhien chi cd 67,9% NVYT tra Idi diing va dly du kiln thiic ve vac xin.
DII vdi kiln thiic lien quan din nhiing dlu hieu tre cin phai hoan tiem vSc xin, chi co 3,8% NVYT cd the tra loi diing dly dii cac dlu hieu tre can phai hoan tiem vac xin. Phin Idn NVYT dlu Ua Idi dugc cac dlu hieu co ban la khi tre mic cac b?nh d p tinh, dac biet la cac benh nhiem tning (90,6%), tre sdt > 37,5°C hoac ha than nhiet < 35,5
°C khi do nhiet dg tai nach (92,5%), tre dang hoac mdi kit thiic dgt dilu tri corticoid (uong, tiem) trong vong 14 ngay
(67,9%). Trong khi cac dau hi?u khac ciing quan trgng nJn, tre mdi dung cac san pham globulin miln dich trong v6ii|, 3 thang tni trudng hgp tre dang su dung globuhn n^]
dich dilu tri viem gan B, tre cd can nang dudi 2000giii cac trudng hgp tam hoan tiem chung khdc theo huong dli cua nha san xult ddi vdi timg loai vSc xm cd ty IS NVYJ tra Idi dimg lin lugt chi la 24,5%; 15,1% va 13,2%.
Dli vdi nhiing dau hieu nguy hilm sau tiem chiing iffl gia dinh phai dua tre den co sd y tl, chi cd 1,9% NVYTlii Idi diing va dly dii. Cac NVYT mdi chi tra loi dugc cic dap an ca ban, nhimg lai khdng tra Idi dugc cac dap an lilo quan din tre cd thay ddi mau sac da, niem mac (22,6%), ue CO biiu hien bit thudng khac (9,4%) va tre bi run cl^
tay (1,9%).
3. Kiln thirc cua NVYT vl kham sang loc va hrva truo'c tiem chiing
Bdng 3. Kiin thuc ciia NVYT vi khdm sdng Igc vd tu vSn tru&c tiem chung (n=53) Noi dung
Khai thdc thong tin vi tiin sir vd thong tin lien quan den tre Irte&c khi khdm sdng Ipc vd tu van tru&c tiem chung
Xac dinh tfin, tuoi, dia chi ciia tre Khai thac tinh hinh sire khoe hien tai ciia tre Khai thac tien sit benh tat, tien sii di ling eiia tre Kiem tra phieu/so tiem chiing va tien sir tiem chung ciia tre Ngi dung khdm sdng Ipc cho tre tru&c tiem chung Quan sat tinh than tinh tao, nhanh nhen Quan sat the frang, mau da, niem mac Kiem tra than nhiet
Nghe tim, phoi
Kham thuc the theo timg truong hap cu the Npi dung tu van cho tre vd gia dinh tru&c tiem chung Thong bao vac xin tre duoc tiem chung
Giai thich nhirng phan img co the xay ra sau tiem chung Huong diin theo doi, cham soc sau tiem chiing Hen Hch dem chung tiep theo
Tan so 7 11 43 31 40 13 . 31
37 47 49 26 5 50 39 29 9
TylS(%) 13,2 20,8 81,1 58,5 75,5 24,5 58,5 69,8 88,7 92,5 49,1 9,43 94,3 73,6 54,7 17,0
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JOURNAL OF COMMUNITY MEDICINE
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Khi hoi ve khai thac thdng tin lien quan din tiln su va ien quan den tre trudc khi kham sang Ipc va tu vln trudc iSm chiing, chi 13,2% NVYT tra Idi dly du dugc cac ndi iung thdng tin. Cac NVYT con chua tra Idi dugc cac ndi iung lien quan din khai thac tiln su benh tat, tiln su di ing ciia tre, khi chi co 58,5% NVYT tra Idi cho dap an lay. Ty le NVYT tra Idi vl ndi dung xac djnh ten, mdi, dia :hi ciia tre d miic rat thIp, chi 20,8%.
Doi vdi cac npi dung kham sang Ipc cho tre trudc iem chung, mac dii ket qua d timg npi dung kham dlu cao, ihung chi cd 24,5%o sd NVYT tra Idi dugc dly dii cac ndi iung kham sang Ipc trudc tiem chiing cho tre em, trong to cac NVYT chua quan tam din viec kham thuc thi theo .ung trudng hgp cu thi, khi chi cd 49,1% NVYT tra Idi
dugc ndi dung nay.
Ddi vdi cac npi dung ma NVYT tu van cho tre va gia dinh trudc tiem chung, chi 9,43% NVYT tu van day dil cac ndi dung cho tre va gia dinh. Hau bet cac NVYT dlu cung cap thong tin cho gia dinh tre ve io^i vac xin tre dugc tiem chung (ten loai vac xin, du phdng benh gi), chilm 94,3%. Ty le NVYT tra Idi ndi dung giai thich nhiing phan ting cd the xay ra sau tiem chiing chiem 73,6%. Noi dung ve hudng dan theo doi, cham sdc sau tiem chiing dugc 54,7% NVYT de cap den. Trong khi dd, chi 11,0% NVYT tra loi ve viec hen lich tiem chung tiep theo.
4. Moi lien quan giira cac yeu to ca nhSn va kien thiic vS kham sang loc v^ tu van trudc tiem chung
Bdng 4. Moi lien quan giira cdc yeu to cd nhan vd kiin thirc vi khdm sdng loc vd tu vdn tru&c tiim chiing Y£u to lien quan
Trinh do chuySn mdn:
Ysy Bac sy Tham nien cong tac
Dudi 20 nam - Tir 20 nam trd len
Ty sl chinh (OR)
1 3,29
1 2,63
95% khoang tin cay ciia OR
1,73 - 9,84
0,95-6,91
Gia tri p
0,015
0,02 Cd mlu phan tich (n = 53) (*) Nhdm so sanh (—) Khong ap dung
Bien phu thudc: Kien thiic ve kham sang Igc va tu van trudc tiem chiing Qua phan tich sd lieu, cd mdi lien quan cd y nghia
thdng ke (p<0,05) giira trinh do chuyen mdn va tham nien cong tac vdi kien thiic ve kham sang Igc va tu van trudc tiem chiing cho tre em Nhiing NVYT co trinh do chuyen mdn bac sy cd kien thiic ve kham sang Igc va tu van trudc tiem chung cho tre cao ban 3,29 Ian nhiing NVYT cd trinh dg chuyen mdn la y sy (p = 0,015). Nhiing NVYT cd tham nien cdng tac tu 20 nam trd len cd kien thuc ve kham sang Ipc va tu van trudc tiem chiing cao hon 2,63 ian so vdi nhiing NVYT cd tham nien cdng tac dudi 20 nam (p=0,02).
IV. KET L U ^
v l CO ban, cac NVYT lam cdng tac kham sang loc va M vln trudc tiem chung tai 27 TYTX, thi tran ciia huyen
Tii Ky, tinh Hai Duong da cd kien thiic ve tiem chiing, ve kham sang Igc va tu van trudc tiem chiing, tuy nhien chua day dil va toan dien khi ty le tra Idi diing va day dii cac npi dung rat thap.
Nghien ciiu de xuat mot sd kien nghi sau;
- Tang cudng td chiic cac lap tap huan hoac dao tao tai chd ve ti6m chiing cho NVYT cac TYT xa, theo timg npi dimg chuyen de, dao tao theo hudng cam tay chi viec.
- Xay dung bg tai lieu tham khao ndi bd cho cac tram, trong do CO cac hudng dan chi tiet ve cdng tac kham sang Ipc va tu van trudc tiem chiing, hd trg NVYT trong qua trinh lam viec,
- Thiet lap cac kenh thdng tin ho trg cho myen xa va tang cudng tuong tac trao doi giua myen huyen va tuyen xa, giiia cac xa vdi nhau.
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S 6 5 (46) - Thang 09-10/2018 Website' yhoccongdong vnTAI LIEU THAM KHAO
S 1. Bo Y tl (2015), Quyit dmh so 230I/QD-BYTngdy 12/06/2015 cua Bd tnrong Bd Y ti vi viec "Ban hdnh hu^
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Hau Giang nam 2014. Tap chi Y hgc Du Phdng, Sl i 2( 172), Tr. 116-122.
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SO5(46)-Thang09-10/20l8 I . _
