TAP CHi Y DLfOC L A M SANG 108 Tap 9 - S6 1 /2014
Mot so khac biet ve dac diem sinh hoc, Icinh tg-xa hoi va tigp can dich vu y te giu*a cac dang tat tM chSt, tinh than va da khuyet tat
Some Differences in Biological Characteristics, Socioeconomic Characteristics and Access to Health Services Among People with Physical, Mental and Multiple Disabilities
Nguyen Thi Minh Thuy, Le Thu Ha Dgi hoc Yle Cdng cdng
Dat vdn di: NgUdi khuyet tat thudng la doi tugng gap nhieu khd khan trong viec tiep can cac dich vu y te, giao due va viec lam. MUc dp cua khd khan ma ngudi khuyet tat gap phai khac nhau giQa cac dang khuyet tat. Muc tieu: Tim hieu mdt sd khac biet ve dac diem sinh hgc, kinh te - xa hdi va tiep can djch vu y te gida cac dang tat the chat, tinh than va da khuyet tat tai huyen Chi Linh, tinh Hai DUOng.
Phuang phdp: Nghien ciiu cat ngang, phdng van 18.473 ngUdi khuyet tat dUOc phat hien trong dieu tra khuyet tat tai 7 xa va thj tran thudc huyen Chi Linh, tinh Hai Duong. Ket qua va ket luon cua nghien cdu:
NgUdi khuyet tat tinh than cd trung binh tuoi thap hOn so vOi ngUdi khuyet tat the chat va da khuyet tat.
Ty le mil chd va ty le thudc ho gia dinh ngheo d ngUdi khuyet tat the chat (9,1% va 10,3%) thap nhat trong ba dang tat. NgUdi khuyet tat the chat cd nguyen nhan chu y^u do tuoi cao (65,5%) va cd xu hudng it tiep can dich vu y t4 han. Khuyet tat do nguyen nhan bam sinh, chat dpc da cam hay benh tat pho bien d ngudi da khuyet tat va khuyet tat tinh than. Khuyen nghi: Can cd nhdng nghien cUu sau hon de cai thien tudi thg cua ngudi khuyet tat tinh than, tang cudng tiep can dich vu y te cho ngUdi khuyet tat the chat
7"u'/c/ido:Oac diem smh hoc, kmh t § - x a hpi, ti§p can dich vu y t § , dang khuy§t tat Summary:
Introductions: People with disabilities (PWDs) have been coping with barriers that make them difficult in education, employment and access to health care services. In addition, the level of difficulties among PWDs differs by types of disability. Objectives: To find some differences in biological characteristics, socioeconomic charactenstics and access to health services among people with physical, mental and multiple disabilities in Chi Linh District, Hai Duong Province. Method- A cross-sectional study was conducted on 18,473 PWDs in seven communities in Chi Linh District, Hai Duong Province. Result and conc/us/on: The average age of people with mental disabilities is lower than those with physical and multiple disabilities. The people with physical disabilities have the lowest rate of illiteracy (9.1%) and poor households (10.3%) among three categories of disability. The main cause contnbuting to physical disabilities is due to high age (65 5%). Disabilities due to congenital causes. Agent Orange or illnesses are
Plian bi^n khoa 1190: TS. DO HOA BINH
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 9 - N"1 /2014
more common in the people with mental and multiple disabilities. Those with physical disabilities have less access to health care services Recommendation: Further research should be done to improve the longevity for the people with mental disabilities and increase access to health services among people with physical disabilities.
Keywords: biological eharacterisics, socioeconomic characteristics, access t o health services, type of disability
1 . D a t van d e
Td chUc Y t§ The gidi (TCYTTG, 2010) Ude t i n h hien cd hdn 1 ti ngUdi, tUdng d u a n g khoang 15%
dan sd the gidi bi a'nh hudng bdi khuyet t a t [1]. Tai My (nam 2010), t r o n g so 51,5 trieu ngUdi khuyet tat (NKT) t r u d n g t h a n h , cd 16,8 t n e u NKT t i n h than; 15,7 trieu NKT v4 giao hep; 41,5 trieu NKT t h e chat va 4 trieu NKT d ea 3 dang nay. Ben canh d o , cung ed sU chenh lech ve ty le t i m kiem dUdc viec lam gida cae dang tat. Trong khi ty le cd viec lam d NKT the chat va khuyet tat tinh than tai My lan luot la 40,8% va 51,9%, thi ehi cd 24% ngUdi mae ea khuyet tat v§
giao tiep, the chat va t i n h t h a n la cd viec lam [2].
Ngoai ra, so lieu dieu tra khuyet tat tai m d t sd qudc gia tren t h e gidi nhU Ireland (2011), Kenya (2008) cdn cho thay su chenh lech ve tuoi, gidi, trinh dp hgc vin gida cac dang khuyet tat [3], [4]. Tai Viet Nam, theo so lieu cua Tong dieu tra Dan so va Nha d (nam 2009), ty ie dan sd t d 5 t u d i t r d len cd khd khan t r o n g viec thuc hien it nhat m d t t r o n g bdn chUc nang nhin, nghe, van d d n g , va tap t r u n g hoac ghi n h d chiem 7,8%. Trong d d , ed 4 9 % sd ngUdi da khuyet tat (cd khd khan t r o n g viee t h u c hien it nhat tU 2 chdc nang t r d len). NgUdi da khuyet tat t r o n g dp t u o i trudng thanh cd hoc va'n t h a p hdn so vdi ngudi chi cd m p t dang khuyet tat t r o n g cung dp t u o i [5].
Chi Linh la m d t huyen D o n g bang Bac Bd t h u d c tinh Hai DUdng, va nam t r o n g v u n g ed tdc dp do thj hda nhanh. Tai day, t y le hien mae khuyet tat t r o n g dan sd chiem 28,2% [6]. Chung tdi tien hanh nghien ciiu nay nham muc tieu t i m hieu m p t sd khae biet v&
dac diem smh hpc, kinh ti - xa hdi va tiep can dieh vu y t§ giUa cae dang tat t h e chat, t i n h than va da khuyet tat tai mdt vai diem dan cU eua huyen Chi Linh, tinh Hai DUdng.
2 . D o i t U t f n g va phUtfng p h a p
Nghien cUu dUde tien hanh tren t d n g sd 18.473 NKT duac phat hien t r o n g dieu tra khuyet tat tai 7 xa va thj tran cua huyen Chi Linh, t i n h Hai Duong, narti t r o n g he t h d n g Giam sat dan sd-djeh te hoc (CHILILAB) ciJa t r u d n g Dai hoc Y te Cdng edng Ha Ndi. Thiet ke nghien cdu dUdc sii d u n g la dieu tra cat ngang, t i e n hanh t U t h a n g 5/2007 den thang 1/2008.
Dieu tra vien eua CHILILAB da den gap va phdngvan true t i e p NKT hoac ngudi cham sdc chinh NKT (neu NKT khdng ed kha nang t u tra Idi) de thu thap cac t h d n g tin ve NKT. Nghien cdu sU d u n g phan loai khuyet tat cua TCYTTG t r o n g c h u a n g trinh phuc hoi ehde nang dua vao edng d d n g , bao gdm 7 nhom khuyet tat: khd khan van d d n g , khd khan nghe noi, khd khan ve nhin, khd khan ve hoe, d d n g kinh, hanh vi xa la va m a t cam giac. DUa tren 7 nhdm nay, chdng tdi phan loai NKT t h a n h 3 n h d m Idn: nhom ehi mac khuyet tat t h e chat (gdm nhdng ngudimacH nhdt Id mot trong cdc khuyet tdt vi van dgng, nghe noi, nhin, vd mdt cdm gidc); n h d m chi mac khuyet tat t i n h than (gdm nhdng ngudi mdc it nhdt Id mot trong sd cdc khuyet tdt vi hoc, dgng kinh, hdnh vi xa Ig) va n h d m da khuyet tat (gdm nhdng ngudi mdc ca khuyet tdt the chdt vd khuyet tdt tinh thdn). Tieu chuan phan loai hd n g h e o / k h d n g ngheo sU d u n g trong nghien cUu can cU vao danh sach hd ngheo cua xa,dU0cxac d j n h theo tieu chuan hd n g h e o do Bd Lao dpng, ThUdng b i n h v a X a hdi xac d i n h nam 2006. NKTdiiflc xac d i n h la cd phuang tien truyen thdng rieng n§u gia d i n h ho d a n g sdng cd sd hUu it nhat 1 trong cacviit d u n g g d m radio, tivi, dau video, may vi tinh; c6 phuang tien lien Igc rieng n§u gia d i n h ho dang s6ng cd sd h i i u it nhat 1 t r o n g cae vat d u n g gdm difn
TAP CHi Y DU'OC LAM S A N G 108 Tap 9 - S6 1 /2014
thoai ban, dien thoai di d d n g ; cd phuong tien di chuyen hien dgi rieng n4u gia d'lnh ho dang sdng ed sa hCfu it nhat 1 t r o n g cac p h u a n g tien g d m xe may, d td. MUc dp ban che hoat d d n g / s u t h a m gia eua NKT duac chia lam 5 cap d p , bao g d m khdng bj han che, han che mdc dp nhe, t r u n g binh, nang va rat nang (Khdng bi han che: NKT cd the thuc hien dugc moi hoat dgng khdng cdn trg giup; Han che miic do nhe: Can trg giup trong mgt vdi hoat dong, Han che muc dd trunq binh: cdn trg giup trong da so cdc hogt ddng, Han che mUc do ndng: Cdn trg giup trong phdn
Idn cdc hogt ddng vd Han che muc dd rdt ndnq: Phu thudc)
Cae sd lieu nghien eUu duoc nhap, lam sach bang phan m e m Epidata 3.0 va phan tich bang phan mim SPSS 16.0. Ca'c p h u a n g pha'p don b i e n d u a c a p d u n g de thUe hien cac phan tich t h d n g ke md ta.
Kiem dinh Khi binh phUdng (^^) duge sii d u n g de tim hieu su khac biet ve ty le phan bd cac dang khuyet tat theo cac y l u t d sinh hpc, kinh ti - xa hdi (tudi, gidi, dan tdc, van hda, nghe nghiep,...).
3. Ket qua nghien cuTu
Bang 3 . 1 . Phan bo cac dang tat theo dac diem sinh hoc va kinh t§ - xa hpi
Oac diem
Dp tuoi trung binh***
Nhom tuoi***
Gidi tinh***
Dan toe
Ton giao
Trinh do hoc van***
Nghe nghiep***
0-5 6-17 18-59
>60 Nam NU Kmh Khac Khong Co Con nho MO chU(ke ca chi biet doc
va biet Viet) Trinh do pho thong (cdp i, il, ill)
Trung cap trd len Cdn nho/Hoc sinh, sinh vien
Lam rudng Thu cdng/Buon bdn Vien chUc/Cong nhdn Huu/ngudi cao tuoi/noi trd
That nghiep Khdc
Dang l<huyet tat n (%) Khuy&t tat
the chat (n=l 7.9001
50,9 80 (0,5) 1011 (5,6) 11792 (65,9) 5017(28,01 8169(45,61 9731 (54,41 17846(99,71 54(0,3) 17866(99,8)
34(0,2) 123(0,7) 1632(9,1) 12340(68,9)
3805(21,3) 1861 (10,4) 5399(30,1) 2412(13,5) 2190(12,2) 5381 (30,1) 53 (0,31 604 (3,41
KhuySt tat tinh than (n=243)
32,8 3(1,2) 41 (16,9) 184(75,71 15(6,2) 134(55,11 109(44,91 242 (99,61 1 (0,41 243(1001 0(01 8 (3,31 61 (25,11 160(65,8) 14(5,8) 35(14,4) 109(449) 19(7,8) 4(1,6) 24 (9,9)
8 (3,31 44(18,1)
Oa l<huy&t tat (n=330)
42.8 11 (3,3) 33(10,0) 201 (60,9)
85 (25,8) 180(545) 150(45,5) 329 (99,7) 1 (0,3) 330(100) 0(0) 14(4,21 149(45,2) 151 (45,81 16 (4,81 31 (9,41 82 (24,9) 15(4,5)
7(2,1) 90 (27,3)
8 (2,4) 97 (29.4)
JOURNAL OF 108 - CLINICAL IVlEDICiNE AND PHARMACY Vol 9 - N"1 /20M
Bang 3 . 1 . (tiep theo)
Dac diem
Tmh trang hon nhan***
Dac diem kmh t e * * *
Ket hdn, song vdi va/chong Chua ket hdn Lythdn, iydi.goa Khong thudc hd ngheo
Thuoc ho ngheo Co phuong tien t r u y i n thong rieng***
Co phuong tien iien iac rieng***
Co phi/ong tien di chuy§n hien dai rieng***
Dang l<huyet tat n (%) Khuyet tat
the chat (n=17.9001 13081 (73,11 2530(14,1) 2289(12,81 16052(89,71 1848(10,3) 17225 (96,21 10631 (59,41 12777(71,4)
KhuyMtat tinh than (n=243) 97 (39,9) 126(51,9) 20 (8,21 177(72,8) 66 (27,21 210(86,41 69 (28,4) 113(46,5)
Da khuy§ttat (n=330) 116(35,1) 162(49,1)
52(15,8) ' 240 (72,7)
90 (27,3) 293 (88,8) 112(33,9) 148(44,8)
**^p<0,001;**p<0,01;^p<0,05
Xet vi dac diem sinh hpc, NKT the chat cd dp tuoi t r u n g binh la 50,9 t u o i , cao han so vdi t r u n g binh tudi cua NKT t i n h than (32,8 tudi) va da khuyet tat (42,8 tuoi) (p<0,001). Nhdm t u d i eung cd sU khac biet rd ret giUa cac dang tat (x^ = 163,4; p<0,001).Ty le khuyet tat the chat va da khuyet tat deu cao nhat d dp tuoi 18-59, sau do la n h d m t u d i 60 t r d len. Tuy nhien, a n h d m khuyet tat t i n h than, dp t u d i 18-59 chiem ty le eao nhat, sau dd den n h d m 6-17 t u d i . Trong n h d m khuyet tat t h e chat, nU chiem 54,4%, cao han so vdi ty le nam chiem 45,6%. Ngupc lai, trong nhdm khuyet tat t i n h than va da khuyet tat, nU chiem ty le thap hon nam. Su khae biet nay la ed y nghia t h d n g ke (/^ = 18,8; p<0,001).
Ve dac diem kinh ti ~ xa hdi eua NKT tai Chi Linh, ngudi da khuyet tat cd ty le mu c h d (bao g d m
ca chi biet dpc va b i e t v i e t ) cao nhat t r o n g 3 dang tat (45,2%), eao gap 5 l l n ty le nay d n h d m khuyet ^t the chat (9,1%) (x^ - 531,5; p<0,001). NKT lam nghe n d n g d n h d m khuyet tat t i n h t h a n cd ty le cao hen so vdi 2 n h d m khuyet tat edn lai (p<O,OOl).Tren70%
sd NKT t h e chat hien dang sdng cung vdi vd/chong m i n h , t y le n g u d i ehUa kdt hdn chiem 14,1%. Trong khi d d , d n h d m khuyet tat t i n h t h a n va da khuyet tjit v i n cd tdi V2 sd ngddi chua ket hdn (p<0,001). T;^l^
hd ngheo t r o n g n h d m khuyet tat t h e chat thap hdn so vdi 2 n h d m khuyet t a t cdn lai (p<0,001). NKT the chat eung ed t y le cd p h u a n g tien truyen thong rieng, ed p h u a n g tien lien lac rieng, cd phuang tien di chuyen hien dai rieng eao nhat t r o n g 3 dang tat (p<0,001).
Bang 3.2. Phan b d cac dang t a t t h e o dac d i e m khuyet tat
Dac diem
Thai gian mac </ n d m * T5 nam***
>5 n d m * * *
Dang l<huyet tat n (%) Khuyet tat
the chat (n= 17.900)
1314(7,31 10727(59,9) 6491 (36,3)
K h u y t t t a t tinh than (n=243)
6(2,5) 47(19,3) 189(77,8)
Da khuyet
•tat (n=330) 26 (7,9) 114(34,5) 268 (81,2)
TAP CHl Y DUQC lAUi S A N G 108 Tap 9 - So 1 /2014
Nguyen nhan gay khuyet tat
Mac do han c h i hoat dong/SU
tham gia***
Bang 3.2. (tiep theo)
Dac diem
Bam sinh***
Tainan**
Thien tai Chien tranh Chdt doc da cam***
Benh tdt***
Tudi cao***
Khdng ro Khdng bi han chi
Hon che mUc do nhe vd trung binh Hon che mire do ndng vd rdt ndng
Dang khuyet tat n (%) Khuyet tat
the chat (n=l 7.900)
517(2,91 957 (5,31 6 (0,031 202(1,11 20(0,1) 4392 (24,5) 11716(65,5) 2475(13,8) 7940 (44,4) 9090 (50,8) 870 (4,8)
Khuyet tat tinh than (n=243) 80 (32,9) 17(7,0)
0(01 0(01 4(1,61 107(44,01
3(1,21 35 (14,41 42 (17,3) 180(74,1) 21 (8,6)
Da khuyet tat (n=330) 143 (43,3)
32 (9,7) 0(0) 6(1,8) 12(3,6) 170(51.5) 95 (28,81 40(12,1) 18(5,4) 149(45,21 163(49,41
***p<0,001;**p<0,01;*p<0,05
Being 3.2 eho thay, ty le ngudi cd t h d i gian mae khuyet tat tren 5 nam d nhdm khuyet tat tinh than (77,8%) va da khuyet tat (81,2%) cao gap hon 2 lan so vdi n h d m khuyet tat the chat (36,3%) (x^=448,3;
p<0,001). Khuyet tat do nguyen nhan bam sinh, chat doe da earn hay benh tat d n h d m da khuyet tat va khuyet tat tmh than chiem x^ le cao hon so vdi n h d m khuyet tat the chat (p<0,001). NgUdc lai, khuyet tat do nguyen nhan tuoi eao lai cd xu hUdng pho bien hdn d NKT the chat (chiem 65,5%) (x^ = 609,1; p<0,001).
Trong 3 nhdm khuyet tat, n h d m khuyet tat the chat cd ty le khdng bi ban ehe hoat ddng/su tham gia cao nhat (44,4%). Han che d mUc dp nhe va t r u n g binh chiem ty le cao d nhdm khuyet tat tinh than (47,3% va 26,8%). Nhdm da khuyet tat ed ty 1^ han che d mdc dp nang va rat nang eao hon 2 nhdm khuyet tat cdn lai.
SU khae biet nay ia cd y nghla t h d n g ke (x^=1852,4; p<0,001).
Bang 3.3. Tiep can d j c h v u y te cua cac d a n g t a t
Dac diem
Da tCrng di kham ve khuyet tat***
Dia diem kham
Bienphdp dieu tri duoc chi dinh
Xd*
Huy^n***
Tinh***
Trung uong Tunhdn***
Khdm, cho idi khuyen**
Tap luyen***
Chdm ciru'**
Dieu tri thuoc***
Dang khuyet tat n (%1 K h u y l t t a t the
chat (n=17.9001 7704 (43,0) 1110(14,4) 2914(37,8) 1566(20,3) 2365 (30,7) 1733(22,5) 3991 (51,8) 429 (5,6) 2053 (26,6) 2477 (32,2)
Khuyet tat tinh than (n=2431 135(55,61
22(16,3) 65(48,1) 79 (58,5) 44 (32,6) 3 (2,2) 59 (43,7)
1 (0,71 1 (0,71 114(84,41
Da k h u y l t t j t (n=330) 223 (67,6)
48(21,5) 126(56,5) 123(55,2) 69 (30,9) 33(10,31 138(61,9) 41 (18,4) 32(14,3) 143(64,1) '*p<0,001; • " p < 0 , 0 1 ; *p<0,05
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Voi 9 - N"1 /2014
Theo Bang 3.3, ngUdi da khuyet tat cd t y Ig da t u n g di kham ve khuyet tat cao nhat (67,6%), va chiem ty le thap nhat la a NKT t h e chat (43,0%) ( x ' = 93,5; p<0,001). Trong sd n h d n g ngudi da di kham vi khuyet tat eua m i n h , ngudi da khuyet tat ed ty le di kham d tuyen xa va huyen cao han so vol NKT the chat va t i n h t h a n (p<0,05). Ty le di kham d tuyen t i n h cao nhat d NKT t i n h t h a n ( x ' = 454,3; p<0,001). NKT the chat ed xu hudng di kham d ea sd t u nhan nhieu hon so vdi ngUdi d dang khuyet tat khac (x^ = 22,4;
p<0,001). Ben canh d d , ngudi da khuyet tat cd t y le duoc kham, eho Idi khuyen hoac dUoc ehi djnh dieu tri theo hinh thUc tap luyen eao hon so vdi ngUdi d dang tat khac (p<0,01). Dieu t h cham ciiu dUde ap d u n g nhieu nhat d NKT the chat (x^ = 30,4; p<0,001).
Dieu trj bang thude ehu yiu gap d NKT t i n h than (84,4%), va it gap nhat la d NKT the chat (32,2%) ( X ' = 423,8; p<0,001).
Dae diim sinh hpc
Tudi: Dieu tra khuyet tat tai Ireland (nam 2006) cho thay, khuyet tat vi tri tue va nhan thUe t h u d n g p h d bien d nhdm tudi tre hon (38% d dp t u d i 0-17, tren 25% d dp tudi 18-34). Khuyet tat ve cam xuc, tam ly va sue khde tam than eung ed xu h u d n g t u a n g t d , vdi tren 2/3 sd ngudi mic d dp t u d i 18-64.
Trai lai, 1/3 sd NKT ve nhin (36%), nghe (38%), van d d n g (33%) tap t r u n g d dp tuoi 75 t r d len [7]. Dieu nay cung cd phan t u a n g d d n g vdi kdt qua nghien CUu cua chung tdi, vdi ty le khuyet tat the chat va da khuyet tat eao nhat d n h d m t u d i tU 18 t r d len, t r o n g khi khuyet tat t i n h than lai chiem ty le cao d n h d m 0- 59 tudi. Tudi t r u n g binh cua NKT t i n h t h a n t h a p hon cd the do mac benh khi edn rat n h d (ty le do nguyen nhan bam sinh eao, bang 3.2) va anh h u d n g eua khuyet tat nang ne (ty le ban che hoat d d n g / s u t h a m gia cao, bang 3.3) nen NKT thudc n h d m nay cd tudi t h o thap hon.
Gidi: Nghien eUu eua chung tdi cho thay, t r o n g n h d m khuyet tat t h e chat, nU chiem 54,4%, cao hon so vdi ty le nam (chiem 45,6%). Nguac lai, t r o n g n h d m khuyet tat t i n h t h a n va da khuyet tat, n i i
ehiem h? le t h a p ban n a m . Kdt qu5 nay eung tUong t u vdi nghien c d u tai Kenya (nam 2008), vdi ty 1^
khuyet t a t t i n h t h a n d nam la 5 4 % va d n d la 46%, t r o n g khi khuyet tat t h e chat d n d lai chiem ty Ig cao han so vdi nam (50,3% so vdi 49,7%) [4].
Oac d i e m kinh te - xa hdi eCia cac dang tat Hgc vdn: NgUdi da khuyet tat t h u d n g la doi tUdng gap nhieu khd khan hdn ca trong vigc tiep can cae djch vu giao due. Theo sd lieu cua Tong dieu tra dan sd va Nha d tai Viet Nam (nam 2009), ngifdi da khuyet t a t t r o n g dp t u d i t r u d n g thanh cd hoc van t h a p hdn so vdi ngudi chi ed m d t dang khuyet l^t t r o n g eung dp t u d i [5]. Nghien cUu cua chdng toi cung eho thay, ngUdi da khuyet t a t cd ty le mu chii cao nhat t r o n g sd 3 dang tat (chiem 45,2%), trong khi t y !e nay d NKT t i n h t h a n la 2 5 , 1 % va d NKT the chat c h i i a 9 , 1 % .
Viec Idm - thu nhap: s d lieu ve khuyet tat 6 ngudi t r u d n g t h a n h tai My (nam 2010) cho thay, ty Ig ed viec lam d NKT t h e chat la 40,8% va NKT tinh than la 51,9%. SU p h d i h d p cCia ea 2 dang tat nay khien t j le cd viec lam giam x u d n g ehi cdn 25,4% [2]. Trong nghien cUu eua chung t d i , t y le ngudi khuyet tat hien d a n g lam vien chUc/cdng nhan (hudng lUdng thang) cao nhat la d NKT t h e chat (6,4%). Ty le nay 6 ngudi da khuyet tat t u y cd t h a p hon (chi§m 1,6%), n h u n g t h a p nhat la d NKT t i n h t h a n (chiem 0,5%).
Tinh trgng hdn nhdn: Ket qua nghien cdu cho thay, tj le ngudi chua kdt hdn t r o n g nhdm khuyet tat t h e chat (chiem 14,1%) t h a p han nhieu so vdi n h d m khuyet tat t i n h than va da khuyet tat (khocing 50% so ngudi chua kdt hdn). Dieu tra khuyet tat tai Ireland nam 2007 cung cho ket qua t u a n g tu, vdi ty le chua kit hdn d ngUdi 25-44 t u o i bi khuyet tat ve tri t u e / n h a n thUc la 83%, NKT ve t a m ly/eam xuc la 63%, va deu cao han so vdi d NKT the chat (chiem 51%) [3].
Kinh te': Trong sd 3 dang tat duoc de cap trong nghien cuu cua chung t d i , n h d m da khuyet tat cd tj le thudc ho ngheo eao nhat (27,3%), tiep den la n h d m khuyet tat t i n h than (27,2%), va thap nhat IS n h d m khuyet tat t h e chat (10,3%) (p<0,001; Bdr\g 3.1). SU khac biet nay ed t h e do ty le NKT cd viec lam dem lai muc" t h u nhap dn d j n h hang thang (nhi/
TAP CHi Y DU'Q'C L A M S A N G 108 Tap 9 - So 1 /2014
cdng nhan/vien chiie) d n h d m khuyet tat t i n h than va da khuyet tat t r o n g nghien ciiu deu thap hon so vdi nhdm khuyet tat t h e ehat.
Dac diem ve khuyet tat
Thdi gian mac: Theo ket qua nghien eUu cua chung tdi, NKT t h e chat cd t h d i gian mac khuyet tat ngan ban so vdi NKT t i n h than va da khuyet tat (p<0,001; Bdng 3.2). Ty le ngddi ed t h d i gian mac khuyet tat tren 5 nam d n h d m khuyet tat t m h than (77,8%) va da khuyet tat (81,2%) cao gap hdn 2 ISn nhdm khuyet tat the chat (36,3%). Dieu nay ed t h e duoc li giai bdi NKT t i n h t h a n va da khuyet tat t r o n g nghien cUu cd dp t u o i t r u n g binh thap hon so vdi NKTthechat.
Nguyen nhdn khuyet tdt: Nghien cUu cCia chung tdi cho thay, khuyet tat do nguyen nhan bam sinh, chat ddc da cam hay benh tat phd bien hon d ngUdi da khuyet tat va khuyet tat t i n h than. Trong khi d d , khuyet tat do nguyen nhan t u d i cao lai chiem da sd d NKT the chat (chiem 65,5%) (p<0,001; Bdng 3.2). Sd lieu dieu tra khuyet tat tai Ireland (nam 2008) mac du khdng de cap den nguyen nhan khuyet tat do tudi cao, nhUng eung eho thay m d t sd k e t q u a t U d n g ddng vdi nghien cUu cua chung tdi. Theo dd, khuyet tat do tai nan, chan t h u a n g hay nga phd bien nhat d NKT van ddng (16,0%). Khuyet tat do nguyen nhan bam sinh chu yeu gap d NKT ve t r i tue/nhan thUe (24,6%). Khuyet tat do nguyen nhan stress t h u d n g cao d NKT ve cam xue/tam li/sdc khde tam than (17,3%). Khuyet tat do benh khdng ed sU chenh lech nhieu giUa eae dang tat [3].
Tii'p can djch vu y tecua cie dang tat Trong nghien cUu cua chung t d i , ngddi da khuyet tat cd ty le da tUng di kham ve khuyet tat cao nhat (67,6%), sau d d den NKT t i n h than (55,6%) va chiem ty le thap nhat la d NKT t h e chat (43,0%) (-^^ = 93,5; p<0,001; Bdng 3.3). Ket qua nay cung ed phan tUdng t u vdi nghien cdu tai Ireland (nam 2006). Theo d d , ty te NKT tai Ireland sd d u n g dich vu y te cao nhat la n h d m khuyet tat ve ndi (27,6%), khuyet tat ve tri tue (21,5%), khuyet tat ve ghi n h d va tap trung (17,5%). Nhdm khuyet tat ve van d d n g .
nghe, nhin cd t y l e s U d u n g djch vu thap hdn (14,5%;
15,2%va6,8%)[7].
5. Ket tuan
Tai Chi Linh, NKT tinh than cd t r u n g binh t u d i thap hdn so vdi NKT the ehat va da khuyet tat. Ty le m u ehU va ty le thudc hd gia dinh ngheo d ngUdi khuyet tat t h e ehat (9,1% va 10,3%) thap nhat t r o n g ba dang tat. NKT the chat cd nguyen nhan chu yiu do t u d i cao (65,5%) va cd xu hUdng it tiep can djch vu y td hon. Khuyet tat do nguyen nhan bSm sinh, ehat dpc da cam hay benh tat pho bien d ngUdi da khuyet tat va khuyet tat tinh than.
Khuyen nghi
Can ed nhUng nghien cUu sau hon de cai thien tudi tho cua ngudi khuyet tat t m h than, tang eUdng tiep can djch vu y te cho ngudi khuyet tat the ehat.
Tai lieu t h a m khao
1. WHO (2011). World report on disability 2011.
From:
http;//whqlibdoc.who.int/pubiications/20n/9789 240685215_eng.pdf
2. Brault M. W. (2012). Americans with disabilities:
2010. US Department of Commerce, Economics and Statistics- Administration, US Census Bureau.
From'
http://www.census.gov/prod/2012pubs/p70- 131.pdf
J. Watson D., Nolan B. (2011). A Social Portrait of People with Disabilities in Ireland. Department of Social Protection, The Economic and Social Research Institute, Dublin 2, Ireland. From:
http://www.socialinclusion.ie/documents/2011- 09-21_SocPortraitPWDReportforWebsite.pdf 4. NCAPD (2008) Kenya National Survey for Persons
with Disabilities: Preliminary Report. National Coordinating Agency for Population and Development, Nairobi, Kenya. From:
httpV/w ww.afri-can.org/CBR%20lnformation/
KNSPWD%20Preiim%20Report%20-
%20Revised.pdf
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 9 - N " 1 /2014
5 UNFPA (2011). Ngudi khuyet tat d Viet Nam: Mdt sd ket qua chu yiu tU Tdng dieu tra Dan sd va Nha d Viet Nam 2009. Ha Ndi, Viet Nam.
https://vietnam.unfpa.Org/webdav/site/vietnam/s hared/Publications%202011/Disability_Viet.pdf 6. N g u y i n Thi Minh Thuy, Dang Sy Duy, Hoang Van
Quynh (2008). Ty le hien mae khuyet tat tai Chi Linh nam 2007. Tap chi Nghien cUu Y hgc. 58(5), 99-104.
7. Central Statistics Office [CSO] (2010). National Disability Survey 2006: Volume 2. Stationery Office, Dublin, Ireland. From:
http://www.cso.ie/en/media/csoie/
releasespublieations/doeuments/otherreleases/na tionaldisabilityvol2/NDS2006Publicatlon.pdf
