ITONeaUDNtNGHIEKCItUI
Thifc trang su" dung dich vu kham chila NKDSS cuia phu ni! di crf tud'i 18-49 Iam viec tai KCN
Sai Ddng, Long Bien, Ha N6i nam 2011
Le Thi Kim Anh (*), Fham Thi Lan Lidn (**), Vu Hoang Lan (*), Esther Schelling (***)
Di cu trong nudc cd stf tham gia ddng ddo cda phu nd do nhu cdu lao dgng tgi cdc khu cong nghiip nhe. kinh doanh vd djch vu d cdc thdnh phd ldn. Mac du di cu dem din co hQi viic ldm vd thu nhgp.
nH lao d0ng di cu ggp nhieu khd khan trong cu^c sdng va chdm soc siic khde. Nghien cdu nhdm mS td thuc trgng vd cdc yen tdliin quan din viic sii dung dich vu khdm chUa nhiem khudn dudng sinh sdn (NKDSS) cua phii nQ di cu tudi 18 - 49 lao d^ng tat khu cdng nghifp Sdi Dong, Hd Ngi vdi cd m^u 29! ddi lUgng. Kit qud cho thdy hdu hit nH lao d^ng di cU con tri vd chUa ldp gia dinh, diiu kiin sdng con hgn che (25,8% sti dung nudc gti'ng khoan va 25,4% sd dung chung nhd vf sinh). Trong 55 ddi tugng cd sddung dfch VM khdm chQa tgi cosdy te. ij li khdm dfnh ky cdn thd'p (27,3%). Cdc yiu id nhu trlnh d^ hoc vdn iren trung hpc phd thdng (OR=3.42), dicutii2ldn trd lin (OR=2,68).
Ihu nhdp trung binh trin 3 trifu/thdng (OR=2,33). tti ddnh gid bdn thdn cd mdc NKDSS (OR=6,96).
khong e nggi xdu hdkhi di khdm (OR=2,86), vd viic biit duoc cdc co sd y tied dich v^ khdm chUa NKDSS tgi Hd Ngi (0R= 10,42) Id nhiing yi'u td thudn li?i thuc ddy phtf nSdi cUsHdung dich v^ khdm chaa NKDSS.
TU khda: pht^ nH di cU. nhiim khudn dUdng sinh sdn, khu cong nghiep, cO sd y te,. sH dung dfch vu y ti
Health service utilization for reproductive tract infections of female migrants aged 18-49
working at industrial zones in Long Bien district, Ha Noi, 2011
Le Thi Kim Anli (•), Pliam Thi Lan Lien (**), Vu Hoang Lan (•), Esther Schelling (•*•)
Rural-to-urban migration involves a high proportion of females because job opponunities for female migrants have increased m urban areas in the formal sector such as textile, footwear and garment factories which favor employment of women. Migration is one of few ways available to access
Tap cW Y t§' C6ng cflng, 2.2012, S6 23 (23) 33
|T6'NGeUAN&
employment providing better wages, but migrants have faced many difficulties in life such as poor living condition and health care services. This study aimed to capture the use of health care services for reproductive tract infections (RTIs) of female migrants aged 18-49 working in Sai Dong industrial zone. The sample size consisted of 291 female migrants. The results showed that most female migrants were young and single, and had poor living condition (25.8% using unsafe drinking water and 25.4%
sharing toilet). The proportion of using health care services for RTIs at health center was low, particularly for regular examination (27.3%). This study report also stated some protective factors of RTI health care utilization, such factors includes higher education level (OR=3.42). multiple movements (OR=2.68), high monthly income (OR=2.33), a thought of having RTIs (OR=6,96), less ashamed of seeking for RTI care (OR~2.86), and knowledge of health centers for RTI care in Ha Noi (OR=I0.42).
Keywords: female migrants. RTIs, industrial zones, health center, use of health care services
Tdc giS:
(*) ThS. Lfi Thi Kim Anh - BM. Dicb te - Thdng kS, Tnrdng Dai hpc Y tfi^ Cong Cpng Vifin Nhifit ddi v i Y td Cfing C^ng Thuy SJ, Dal hpc Basel, Thuy SJ (**) l b s . Pham Thi Lan Lifin - Trung tim Y tdQuin Long Bifin
(•) TS. Vii Hoing Lan • BM. Dich tS - Thdng ke, Tnrdng Dai boc Y td Cong Cpng (***) TS. Esther Schelling • Vifin Nhiet ddi vi Y te Cong Cpng Thiiy Sf. Dai hpc Basel. Thuy SJ
1. D ^ t vSTn d l
Tfldng ttf c a e qud'c gia chau A , tde ddng ciia qua trinh dd thi h d a , khdc bidi ve mflc sdng, chdnh lech thu nhdp, cd h d i vide Iam vd tid'p c^n dich vu xa hpi la d a n d e n c^c d d n g di cfl trong nfldc [3]. Hidn nay, do nhu e l u lao dpng tai edc khu cdng nghiep (KCN) n h e , kinh doanh va dich vu d c a c thdnh p h d ldn, qua trinh di ctfcd stf tham gia ddng dao cua phu nff [2].
De'n n a m 2 0 0 9 , s d Itfdng nff gidi da nhidu hdn s d Ifldng n a m gidi trong ta't ca c a c Ioai hinh ddn sd di ctf [5]. H i u he't phu n f l d i c f l d l u cdn tre va chfla lap gia dinh [6].
M a c dfl di ctf d e m d e n ed hpi vide lam vd lang t h e m Ihu n h a p , ngtfdi di cfl thtfdng dtfdc x e m la n h d m d e bi ton thfldng do cdc khd khan trong CUQC sd'ng, thu n h d p , vd "hda nhdp xa hdi" (bat ldi, thidt thdi trong cdc m d i quan he xd hdi). Nhieu nghien ctfu (NC) cho thay rling lao d d n g di ctf khdng cd mgi cd chd' n a o d e cd thd bao v ? sflc k h d e , ly Id ngtfdi lao d p n g lrf chffa bdnh khi d'm Id kha cao d ca n a m va nff d o h p it lie'p can cd sd y te' (CSYT), ty 1? phu
nff di cfl tfl chffa b e n h la 7 6 % , trong khi d o d n a m la 7 0 % [4], Nhffng khd khan nhfl thu n h a p thap, dieu kien sdng k d m vd thie'u thdng tin ve chdm sdc sflc khoe, nhflng rdo can trong viec tie'p c$n dich vu y te la mdt s d yd'u td chinh a n h hfldng ddn stfc k h d e cua nff Iao ddng di cfl [2]. Nhidu N C cung da chi ra rang m a c dfl ngtfdi ddn di efl lfl ndng thdn ra thanh thi cd cd hoi tdt hdn d e thay ddi h a n h vi c h a m sdc stfc khoe (CSSK) va co cd hdi tie'p can cdc D V Y T td't hdn, nhrfng h o It de'n C S Y T so vdi ngrfdi khdng dictf [11,12].
Cdc N C g a n ddy trdn cdc n h d m Iao ddng di ctf da tap Irung vdo van d e bdnh lay truyen qua drfdng linh due ( L T Q D T D ) , nhidm khuan drfdng sinh san (NKDSS) vd/hode HIV/AIDS, thdi q u e n trf dieu t n khi ed c a c vin d e stfc khoe, h o a c chi di k h a m kbi cd trieu chtfng ndng van cdu pho bie'n [ I I ] . Dieu ndy eung lrfdng ttf d cac qudc gia cd thu n b a p thS^p [16,18, 2 0 ] . T a i cac qud'c gia n a y , cdc I^ do khdng di k h d m chu ydu la nhan thflc sai vd n g u y d n n h a n , trieu chtfng va cdch dieu iri cua bdnh, sd bi p h a n
34 Tap chi Y td C d n g cdng, 2.2012, So 23 (23)
ITllNGQUUI&NGHllNCKUl
bidt ddi xtf, e ngai, xa'u hd trong vide kie'm tra bp ph^n sinh due. stf thuan tien cua cdc nha ihudc ttf nhdn hoac cho rang day Id van de ddn gian vd binh thtfdng. Nhffng 1^ do nay khdng chi can trd viee siJf dting DVYT khi cd tridu chflng benh ma cdn ban che viec stf dung DVYT trong tham khdm dinh kj' - mpt ydu cau quan trpng irong vide phdl hidn sdm, chan dodn, dieu tri sdm bdnh de duy tri va cai thidn dieu kien sflc khde. Nghien crfu nay nham md td Ihtfc trang sfl dung dich vu va cdc yeu td lien quan den vide stf dung dich vu khdm chffa NKDSS cua phil nfl di cfl tudi 18-49 Iao dpng trong khu cdng nghiep Sai Ddng. Dia bdn NC la 2 phfldng Sai Dong vd Thach Ban, quda Long Bien, Ha Npi. Day la 2 phfldng ndm tren dia bdn cua KCN Sdi Dong, hau hdt ngfldi lao ddng di cfl ldm vide tai KCN tam trd lai 2 phfldng ndy.
2. Phrftfng phap nghidn cihi
Nghien cflu stf dung phfldng phdp c&t ngang cd phdn tich tren 291 dd'i ifldng Id phu nff lao dpng di cfl dfla theo tfdc tinh ed mau tfdc Itfdng t^ Id ed hidu chinh vdi quan the hifu ban. Phtfdng phdp chpn mau ngau nhien hd thd'ng dtfa trdn khung mdu bao gdm ngfldi di cfl ed va khdng ed dang k^ dfldc dp dung de chpn ede ddi ttfdng phii hdp theo lidu ehi: (i) nfl di ctf ttf cdc dia phrfdng khdc ngoai Hd Npi (Ha Npi cu, khdng kd cac khu vrfe thupc Ha Tay cu trtfdc khi sdt nh$p), (ii) 18-49 ludi, (iii) tam tni lien tuc trdn dia ban NC ttf 6 thdng de'n dfldi 5 nam, (iv) ldm viec tai edc cd sd stf dung Iao dpng trong KCN Sai Ddng.
Viec thu tb^p thdng tin stf dung bd cau hdi phdng vd'n, bao gdm cdc thdng tin lien quan ddn cac dde di^m nhdn khau hoc. qud trinh di efl, dieu kidn sdng, thu nhap va chi tidu, cdc khd khan ihuan Idi trong ddi sd'ng, vd viec stfdung DVYT trong khdm chffa NKDSS ciia phu nfl lao dpng di etf.
Hai khdi niem chinh trong NC la CSYT va "stf dung dich vu kham chtfa henh (KCB) tai CSYT"
dfl^c dinh nghia cu the. Theo Luat khdm chfla benh sd 40/2009/QHI2 ngdy 23/11/2009, CSYT (bao gdm cd sd cdng va ttf) Id cd sd ed dinh hode ltfu ddng da dtfdc cap gid'y phep hoat ddng va cung ca'p dich vu khdm bdnh. chtfa benh [10]. Viec "stfdung dich vu KCB tai CSYT" dtfdc hieu la khi dd'i trfdng cd den CSYT de' stf dung ba't cfl hinh thflc cung cd'p dich vu nhtf ttf va'n. khdm, dieu tri, mua thudc do CSYT cung ca'p.
NC dfldc chap thugn va man thu yeu clu cda
Hdi ddng Dao dflc NC Y sinh hpc Trtfdng Dai hoc Y te" Cdng cdng. Ket qua NC dtfdc nh^p li^u vJ phan tieh bang phan mem EpiData 3.1 vd SPSS 16.0. Hdi quy logistics va kiem dinh tinh phil h^p cda md hmh thd'ng kd (Hosmer & Lemeshow test) dtfdc stf dung de phdn tfch cdc yd'u td lien quan d^
viec stf dung DVYT. Cdc kiem dinh dtfdc thtfc higi d mflc J nghia 5%.
3. K^'t qua nghidn cihi
Hau het cdc ddi Itfdng phu nff Iao ddng di cir trong NC cdn tre vdi trung binh Id 24, nho nh^t ||
18 va ldn nhd't la 47 tudi. Trong dd, nhdm tudi 18 - 24 chid'm nhieu nhat vdi ty Id 64,3% trong khi nhiia ludi ttf 30 trd len ehiem ty le thd'p nhdft (6.2%). Trinh dd hpc v^n ciia da sd ddi tfldng la THPT (63,6%), nhom cd trtnh dd hpc va'n cao - trdn THPT - chiem tf le thd'p hdn (21%). Ty Id cd quan h? tinb due U 32%, trong dd, ly 1$ cd quan hd linh due d nfl lao dpng di efl ehrfa kdt hdn la 10%.
Bdng 1. Mgtsd thong tin chung eua DTNC (n= 291)
D i c d l f m
Nhmn tail
2 5 - 2 9 lulSi 9 3D moi Tiinh iq hpc v^n Diffli THFT THPT TrenTHPT
III
Tin gido Theo lea pia Khons theo ton Clio TiahlrgnghSii
D a k e l h n n Chua k6'i han Qmmhihnlii^c Da c6 QHTD ChUa
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187 86 IS
45 183 61
278
15 276
71 220
93 198
T j l *
64,3 29.S
1.5.5 63.6 21,0
95.';
4 j
5.2 94.8
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iafi aha vi sinh Ding n e n g Diln° chune
T i D s f
107
98 09 84
' 4 9 4 :
62
^16 75
717 74
DKJ
am siM
21^ 74M
1
Bang 1 cung cho thay da sdnff di ctf den lfl nd|
thdn (63,2%), luy nhidn sdnff di ctf dd'n ttf cdc thi' thi khdc quanh Ha Ndi ciing cbie'm ly Ie khd cao (36,8%). Khi dd'n ctf tni tai ndi d mdi, 85,6% dffi ttfdng ed dang k;y tam tni vdi chinh quyen dia phtfdng. Didu kidn sdng vdn edn mdt sdhan che vfii 25,8% dd'i Ifldng stf dung nfldc gieng khoan trong smh boat vd 25,4% s^ dung chung nha ve sinh. Tj le CO BHYT cua cac ddi tfldng NC khd eao, 78,7^.
Tap chi Y te C6ng cdng, 2.2012, Sd 23 (23) 35
I TfiNG QIAN & NGHIEN cilu I
Bang 2. Ly do di khdm phu khoa tgi cdc CSYT cua phu nffdi cU
D^c did'm Khdm phu khoa Igi CSYT
Co Khong Ly do di khdm phu khoa tai CSYT
Co dfu hifu mac bfinh Kham dinh ky Khdm miSn phi KhSc Logi h\nh CSYT
CSYTcfing CSYTM
T i n sif 291
55 236 55 32 15 I 10 55 46 9
Tyl$
18.9 81,1 58.2 27,3 7.7 18,2
83.6 16.4
B a n g 2 md ta v i e c sfl dung C S Y T dd k h d m chffa cdc b d n h phu khoa trong vdng 6 thdng trtfdc N C . Chi cd 55 ddi itfdng da ltfa chpn CSYT, trong dd chu yd'u Id C S Y T c d n g vdi 46/55 ddi lrfdng (chidm 83,6%). Cd dau hipu m a c bdnh N K D S S Id I^ do chinh di k h d m N K D S S cda nff di ctf (58,2%), Iy do k h d m dinh ky cd ty Id tha'p hdn, chiem 2 7 , 3 % . D a u hidu m ^ c b e n h dtfdc thu thdp dtfa iren vide liet k e cdc iridu chtfng t h e o hfldng d i n cdch tidp c§n hpi chfl^g/trieu cfaiJng cua T o chtfc y te t h d gidi dtfdc Bd Y t e " stf dung.
Bdng 3. Cdc yiu tdlien quan den vifc s&dgng dfch vu KCB NKDSS tgi cdc CSYT (phdn tich dtfn bien)
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55 IKI.VI.O) 37(16 01 J i 22128,9) 33115.31 35 51(29J1
4(3,4) 55 27148JI 2Sr 11.91
M , 191 KM 187 291 SJ 238 291 93 198 219 60 231 291 76 215 291 174 117 291 S«
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0,023 0.015
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11.71 (4.1 - 33 45f
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K e i qua p h a n tich ddn bidn trong b a n g 3 eho tha'y cd n h i e u y e u id' lien q u a n d e n v i e c stf d u n g dich vu k h a m chfla NKDSS tai cde C S Y T ciia nff lao d p n g di ctf. Nff lao dpng di ctf ludi Itf 25 trd ldn cd k h a nang Irfa chpn stf d u n g dich vu c a o hdn ga^p 2 lan so vdi n h d m tudi dfldi 2 5 . Tfldng lfl, nff lao d d n g di ctf n h i e u lan, da ed q u a n b e tinh due hode da cd con, thu n h a p cao (ttf 3 trldu/lbang trd Idn), bidt edc C S Y T cd dich vu k h a m chffa N K D S S tai Ha Npi, bode ni7 Iao dong di ctf ttf ddnh gid ban thdn cd the bi bdnh N K D S S cd kha n a n g ltfa chon dich vu c a o hdn.
Ghi chfl: Bang ndy chi lidt kd cdc ydu td'cd Iidn quan ^ nghia d e n viec stf dung dich vu KCB N K D S S qua phan tich ddn b i e n . Cdc yeu to khac nhtf trinh dp hpc v^n, thdi gian di ctf, thdi gian ldm v i d e , khdng ed ^ nghia khi phdn tich ddn bien n e n khdng drfde trinhbdy. Tuy nhidn, cac yd'u td'nay dfldc dfla vao phan tich da bidn d e kidm sodl gay nhieu l i e m tang.
Bdng 4. M6 hinh hoi quy da bien mgt sdyeu tdlien quan den vifc sU dgng dfch vtf khdm chi2a NKDSS cua phu nU di cU
IBttn a^ iij>) Mu^a^ :^2Snm Tr,nh^kpc,iA TTIPT
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Kiem dfoh tinh phi h^p cua nw tiinlt thong lc£
(Hosmer & Lemeshow lest):
X^=I1.901, df=S,p = 0,}56
' 36 T a p chi Y te C d n g cdng, 2.2012, Sd 23 (23)
I TfiNG QUIUI& NGHIlN e^If I
Khi drfa vao md hinh phan tich da bien vdi cdc bien sdkhdc de loai bd eac gay nhidu va trfdng tdc.
mpt sd yeu id khdng cdn ih^ hien mdi lien quan vdi vipc sfl dung dich vu khdm chffa NKDSS tai cae CSYT (Bang 4).
Bang 4 trinh bay ket qua cua mo hlnh hoi quy da bien. Ket qua cho thay nhflng yeu td trinh do hpc vd'n. sd lan di etf, thu nhap binh quan/thang, tfl ddnh gid tinh trang mac NKDSS, sfl e ngai xd'u hd, va vipc biet dfldc cdc CSYT cd dich vu khdm chffa NKDSS tai Ha Npi Id cac yeu tdUdn quan dd'n stf dung dicb vu. Phu nff di ctfcd trinh dd hpe va'n tren THPT ed ty Id di kham NKDSS cao gdfp 3,4 Ian so vdi phu nff ed trinh dp dfldi THPT (OR = 3,42,95%
CI: 1,22 - 9,55); nhflng ngfldi da di ctf ttf 2 lan trd ldn cd ty lp di khdm NKDSS eung eao hdn 2,68 lan so vdi nhflng ngtfdi di ctf Ian dau (OR = 2,68, 95%
Cl: 1.05- 6,82); nhffng ngtfdi cd thu nhdp irung binh tfl 3 trieu ddng/thdng trd len cd ly Id sfl dung dich vy kham cao hdn 2,33 lan so vdi nhi?ng ngtfdi cd thu nhdp dfldi 3 tripu ddng/thdng (OR = 2,33, 95% CI:
1,03 - 5,31), nhffng ngfldi ttf ddnh gid ban thda cd mac bpnh cd ty lp di khdm cao hdn 7 lan so vdi nhflng ngtfdi lfl danh gid khdng mac benh (OR = 6,96, 95% Cl; 2,91 - 16,66), nhflng ngfldi khdng e ngai/xd'u hd khi di khdm cung cd ly Id di khdm cao hdn gin 3 Ian so vdi nhffng ngtfdi ngai/xd'u hd (OR
= 2,86, 95%C1 1,12 -7,28); nbflng ngtfdi da bie't CSYT khdm chffa NKDSS tai Hd Npi cd t^ Id di khdm cao hdn 10 lan so vdi nhffng ngtfdi chfla biet Cd sd nao tai Ha Ndi (OR = 10,42, 95%CI: 3,12- 34,73) sau khi kiem sodl cdc yeu tdcdn lai trong md hinh.
4. Ban luSn
NC nay dtfdc thflc hien tren 291 phu nfl di cfl tudi 18 - 49 lao dpng lai KCN. Dp tudi trung binh cua dd'i tfldng (24 lud'i) vd ty le cd hpc van tflTHPH trd len ttfdng ttf ke't qua dieu tra di ctf nam 2O04 cua Tong Cue thdng ke va cac kd't qua dieu tra ve di ctf khdc tren ddi ttfdng lao ddng tai cac KCN [8, 11].
Cdc NC cung da chi ra rang, ludng di efl ehd ye'u dd'n ede KCN Id ttf ndng thdn, phu nfl di cfl thtfdng ddc Ihdn. NC nay cung khdng dinh eac dac diem dd.
Ngoai ra, cung can luu y de'n ty le 10% nfldi ctf chfla kdt hdn da quan hd linh due, ty le ndy eao hdn trong NC Qudc gia ve vi ihdnh nien. thanh nien 2 - SAVY 2, Trong SAVY 2. dd'i ttfdng NC chd yd'u la thanh thieu nien (14-25 mdi) sdng cung gia dinh ndn van
ehiu stf quan ly cua gia dinh [ 1].
Dieu kipn sd'ng ciia nff Iao dpng di ctf Idm vi^
trong cdc KCN khd han chd'vdi khoang '4 ddi tuang sfl^ dung nrfdc gidng khoan va dung chung nha v^
sinh. Ben c^nh dd, ty Id kha cao nfl lao dpng di cir cd the BHYT do hau he't ddi ttfdng ldm viec laicSc xi nghidp trong KCN vd yen clu ddng BHYT cho ngtfdi lao ddng ia bat bupc theo Lu§t lao dpng. TJ le nay cung cao hdn so vdi nhdm lao ddng tiJ do [ 13]. Ket qua nay cung ttfdng ddng vdi cdc NC khic [ 11,12]. Stf ttfdng ddng eua nhflng dac didm dao so, xa hdi cd bdn cda mdu NC khang dinh tinh dai diea eua mlu so vdi quan the phu nff di ctf lao dpng (ai edc KCN ndi chung.
Trong toan bd ddi ttfdng NC, ehi ed 55/291 dffi tfldng phu nff di ctf da di khdm chffa NKDSS tai CSYT trong vdng 6 thang trflde thdi diem NC. Hau hd't dd'i ttfdng di khdm Id do co da'u hipu mac benh, Ty le di khdm dinh ky Id khd thap. NC cung da cW ra cd nhieu ydu td Iidn quan dd'n viec stf dung dicb vu khdm chffa NKDSS cda nff lao dpng di ctf. Vdi 20 bien sd' dpc ldp dtfdc drfa vao md hinh Wc ban dau, phan tieh hdi qui da bien drfdc thrfc hi£n ii kidm soat cdc gay nhidu vd Itfdng tac tiem tang. Ki'l qua md hinh cho tha'y stf khdc biet vd t^ 1$ stfdung dich vu khdm chfla NKDSS ed y nghia vd mat thdng ke giffa nhdm cd irinh dp hpc vd'n iff THPT trd len, hoac di etf tfl 2 lan trd len, hoac cd Ihu nhdp til" 3 trieu/thdng trd len, trf ddnh gid ban thdn cd m^t bdnh, khdng cam th^y xa'u hd khi di khdm, hoSc nhdm da biet cae CSYT cd dich vu khdm pbu khoa tai Ha Npi so vdi cde nhdm Itfdng flng, Dilu nay cung ttfdng tfl nhfl kei qua mdt sdNC cda P J. Garcia et al. (2006) tai Lima, Peru, cua A, Shihavong etal.
(2011) tai Lao, cda Go. VF et al. (2002) tai mien Bac Viet Nam khi cung da chi ra rang srf ky thi, ngai ngung, x^u hd Id mdt trong nhffng I^ do khidn ngiiSi bi NKDSS khdng di ddn CSYT [15, 18. 20]. Vi^ce ngai hoac xa'u bo khi stf dung dich vu khdm chBa NKDSS tai cdc cd sd y tdcd the din den vide nfllao dpng di cfl ltfa chon vipc trf didu tri bang each VS mua thude tai cdc nhd thude nhfl trong NC cua Ngo et al. (2007). Lan et al. (2008) [17,19]. Hai NC naj da cho thd'y nha thud'c ttf lai Vipt Nam la ndi benh nhan mac NKDSS, nhiem khuan LTQDTD thrfdng xuydn de'n de dieu tri hoac tim ldi khuydn trtfdc khi tim kid'm cham sdc ttf cdc CSYT chfnh thflc vi chi phi tha'p hdn. kha ndng liep can nhieu hdn vd it kJ thi hdn. Tuy nhieo, vide didu tri b^nh
Tap chi Y t§' Cdng cdng, 2.2012, Sd 23 (23) 3^
|TfKG|UM&H6HIEHetfU|
LTQDTD/NKDSS d eae nha thude tfl nhdn lai khdng tudn tbeo chuan Quoc gia htfdog dan dieu tri.
Dieu ndy de ddn den kha ndng chffa khdi bpnh cua cdc ddi ttfdng ihtfdng khdng cao, va cd nguy cd tao ra vipc khdng ihudc.
Ngodi ra, dtia tren mdt sd'NC tai Vipl Nam da cho tha'y ludi cd lidn quan ddn NKDSS (tJ Ie mac NKDSS tap trung nhieu nhd't d nhdm ludi 31- 40 luoi), hode mdi lidn quan giffa sdcon va nguy cdbi NKDSS, yd'u td thrfc hdnh vd sinh khi QHTD lien quan vdi tJ le mac NKDSS [7, 9,14]. Didu ndy cd Ihd gitfp IJf giai nhflng dd'i trfdng phu nff di ctf trong NC nay cd ludi ddi nhieu hdn, da cd QHTD va da cd con cd kha nang cd nguy cd mac NKDSS cao hdn so vdi nhdm so sanh ttfdng tfng, do dd cac nhdm nay cd ly Id stf dung dich vu khdm chfla NKDSS nhieu hdn.
Tdm lai, phu nff di cfl lao dpng tai cdc KCN Ihtfdng tre, trong dd ludi sinh san vd chtfa co gia dinh. Vide stfdung cdc dich vu y te trong khdm chffa NKDSS tai cac CSYT cdn han che do nhieu nguyen nhdn. Nghidn etfu ndy da neu ra ede nguydn nhdn Iidn quan dd'n ban thdn nff Iao ddng di efl nhfl trinh dp hoc va'n, ihu nh^p hang thdng, sd Ian di ctf, sfl ngai ngflng, xa'u hd khi di khdm eua edc dd'i ttfdng.
Mac dfl vide cd hay khdng cd bao hiem y te khdng lien quan den vide stf dung dieh vu tai CSYT, tuy nbien nghien cflli eung cho tbay khd nhidu nfl lao ddng di ctfdi khdm NKDSS tbtfdng ehpn CSYT co dang ky bao hiem. Nhffng kdt qua nay g^i y vide tang ctfdng cung ca'p bao hiem y td' cho cac ddi Itfdng nfl lao ddng di cfl ndi chung vd nff Iao ddng di ctf lam vide trong cdc KCN ndi ridng, ngoai ra, vide cai thien dieu kien sdng, ihu nh§p, nang cao kien thflc va thai dd cua edc ddi itfdng ddi vdi bpnh la vd cung cln thiet.
Ldii cam dn
Nhdm lac gia xin cam dn Trung tam Qudc gia vd ndng itfe nghien ctfu Bac - Nam Thuy Sy (NCCR N- S) thupc Vien nhiet ddi vd Y te Cdng Cdng Thuy Sy da tai ird kinh phi thtfc hipn nghien cflli nay.
Nhdm ldc gia cung xin cam dn Uy ban nban dan qudn Long Bidn, Trung tdm Y id'qudn Long Bien, Uy ban nhdn ddn phtfdng Thach Ban, Tram y le phtfdng Thach Bdn, vd phii nfldi etf tham gia nghien ctfu da giup dd, tao didu kidn tien hanh nghidn ciJu.
Tdc gia cung xin gtfi ldi cam dn deh cac thay cd Trrfdng Dai hpc Y te'cdng cpng da cd nhffng gdp y sdu sac gitfp hodn thipn nghidn cfl^i nay.
38 Tap chi Y te C6ng cdng, 2,2012, Sd 23 (23)
