TCNCYHphu trWdng 71 (6) - 2010
KIEN THLfC VA THAI DO CUA NGliOll C H A M SOC TRE VE SU" DUNG KHANG SINH CHO TRE EM D l / 6 l 5 TUOI
6 VUNG NONG THON VIET NAM
Nguyen Van Yen', Nguyen Quynh Hoa^
' s d Y te Ha Ndi, ~Benh vien Hdu nghi Viet Nam Cuba
Muc tieu: ngddi cham sdc tre (NCST), dac biet cac ba me, ddng vai trd rat quan trong trong viec xd tri cac benh d tre em. Nghien cdu nay md ta kien thdc, thai dd cua NCST ve sd dung thudc khang sinh cho tre bi NKHHCT trong cong dong. Doi tugng, phuang phap nghien cdu: 828 hd gia dinh tai huyen Ba vl ddac phdng van bing bo ciu hdi ve hieu biet ve khang khang sinh va kien thdc ve sd dung khang sinh trong dieu tri NKHHCT. Sau cuoc thao luan nhdm duac to chdc de thu thip cac thdng tin ve quan diem, thai do ciia NCST trong sd dung thudc. Ket qua: 85% NCST cd kien thdc dung trong trddng hap ho khdng cd sdt, nhung chi cd 55%o sd ngudi dung khi tre bi ho kem theo sdt. Ve tong the, chi cd 13%o NCST cd kien thdc dung trong tat ca cac tinh hudng NKHHCT. Ket luan: da sd ngUdi cham sdc tre thieu kien thdc ve cac nguyen tSc sd dung khang sinh cho tre bi NKHHCT va cd nhdng quan niem sai lam ve thudc khang sinh.
Tii khoa: sd dung khang sinh, tre em, NKHHCT
I. D A T V A N D E
0 Viet Nam, nhiem khuan hd ha'p cap tfnh (NKHHCT) cd ty le mac cao n h i t va la nguyen nhan gay td vong hang dau do d c benh nhiem khuan d tre em dodi 5 tudi [1]. Theo thdng ke, NKHHCT d tre em la nguyen nhan phd bien nha't de hp gia dinh tim kiem djch vu y te. NgOdi cham sdc tre (NCST), dac biet cac ba me, ddng vai trd rat quan trpng trong viec xd trf d c benh d tre em.
Hp la ngifdi nhan bie't d c dau hieu bat thudng dau tien d tre, d i n h gia mde dp nguy hiem cua benh, quye't dinh dUa tre di k h I m benh d dau va cd cho tre udng thudc hay khdng. ChOa cd n h i l u nghien cdu danh g i l kien thdc cua hd gia dinh ve sd dung khang sinh trong d i l u trj NKHHCT d tre em. Xuat phat td nhdng ly do dd, chung tdi tien hanh nghien cdu vdi muc tieu: Mo ta kien thdc, thai do cua ngUdi cham soc tre ve sd dung thudc khang sinh cho tre bi NKHHCT trong cong dong.
II. DOI TUONG VA PHUONG PHAP NGHIEN CLfu
Ap dung phifpng phap nghien cdu md t l cat
ngang, ket hpp giOa nghien cdu dinh lUpng (quantitative study) va nghien cdu dinh tfnh (qualitative study), tien hanh tai 847 hd gia dinh cd tre em dUdi 5 tudi tai 13 cum dan cU thudc Co sd thUc dia dich te' hoc Ba Vi (Filabavi) td thang 3 den thang 6/2007. ' ••
Nghien cdu dinh lupng: ngUdi cham sdc chinh cho tre trong hp gia dinh dUpc phdng van trUc tiep bang bp cau hdi ca'u true de thu thap thdng tin ve hieu bie't ve k h I n g khang sinh va kien thdc ve sif dung k h I n g sinh trorig dieu trj NKHHCT. Nghien cdu dinh tinh: s l u cuoc t h I o luan nhdm dUpc td chdc vdi cac ba, bd', me la nhOng ngOdi cham sdc tre de thu thap d c thdng tin v l quan diem, thai dp xung quanh viec sd dpng khang sinh va cham sdc dieu tri khi tre dm.
Sd lieu djnh lUpng dOdc nhap bang Epi Info 6.04, phan tich tren Stata 13.0. Sd lieu dinh tinh dupc phan tfch theo phUong phap phan tich npi dung (content analysis).
in.KETQUA
1. Dac diem cua ddi tUdng nghien cdu
TCNCYH phu trWdng 71 (6) - 2010
Trong sd 828 hd gia dinh ddng y tham gia nghien cOu, NCST chd yeu la d c ba me (83%), tiep theo la ba (8%), b d (6%), va nhdng ngOdi khIc, nho chj hoac cd, di (3%). Cac dac diem cua tre va NCST dope mo ta theo tOng vung dja ly d Bing 1. Da sd NCST tham gia nghien cOu la ndng dan va cd trinh dp van h o i cap 2.
2. Hieu biet va nhan thufc cua ngu'di cham soc tre v4 nhOng van de lien quan den khang khang sinh va hau qua cua sU khang khang sinh
Cd 6 0 % NCST dope phdng va'n da tOng nghe den thuat ngO " k h I n g k h I n g s i n h " hoac "khang thudc", "nhdn thud'c". Tuy nhien, chi cd 15% hieu dung v l hau q u i cua va'n d l nay nhU: Khang khang sinh se d i n den that bai trong dieu tri, I n h hudng d i n hieu q u i dieu trj khdng nhOng cua b i n than benh nhan ma cdn anh hOdng den nhdng ngUdi khac trong cpng ddng khi mac benh nhiem trung do lay lan vi khuan k h I n g thudc... 5 0 % NCST khdng biet gi ve hau q u i cua k h I n g k h I n g sinh hay nguyen nhan cua KKS (bang 2).
3. Kien thuTc cua ngOdi cham soc tre v l suf dung khang sinh trong dleu trj nhiem khuan ho hap cap d tre em
Theo da sd NCST, bieu hien sdt d tre em dUdc coi la dau hieu quan trpng trong viec quyet djnh sd dung khang sinh cho tre bj NKHHCT. Bang 3 cho thay, khi trd bi ho khdng cd sdt thi 85% NCST tra Idi dung rang khdng d n sd dung k h I n g sinh, nhUng ch? cd 5 5 % sd ngUdi dUdc hdi da t r i ldi ddng rang khdng p h i i dung k h | n g sinh khi t r i bi ho va kem theo sdt. Vdi d c trieu chdng bieu hien cua viem phdi d trd em (ho n h i l u , sdt cao, khd thd) chi cd 4 7 % NCST biet rang sd dung k h I n g sinh de d i l u tri la can thiet. Danh gia kien thdc tdng the ve sd dung k h I n g sinh cho tr^ em thi chi cd 1 3% NCST cd kien thdc dung trong tat c l d c tinh hudng NKHHCT.
Ket qua phan tfch don bien (x^test) va da bien cho thI'y NCST sd'ng d vung m i l n ndi cd kien thdc v l sd dung k h I n g sinh tdt hdn ngOdi sdng d vung ddng bang hay trung du.
Bang 3. Quan diem cua NCST ve can thiet sd dung khang sinh cho tre em co trieu chdng NKHHCT phan theo vung dia ly
Trieu chiJng NKHHCT
Trd bi ho, khdng cd sdt Tre bi ho, kem theo sdt
Tre bi ho n h i l u , sdt cao, dau ngUc, khd thd
Cho tat c l d c trieu chdng NKHHCT Kien thdc dung ve SD khang sinh cho NKHHCT
Dong b i n g ni = 273 (%)
4 8 ( 1 8 ) * 145 (53)*
154(56)*
87 (32) 29 (11)*
Trung du n j = 277 (%)
75 (27)*
153 (55)*
149 (54)*
111 (40) 18 (7)*
M i e n nui n , = 278 (%)
3 ( 1 ) * 72 (26)*
82(30)*
108 (39) 63 (23)*
Tong sd^
N = 828 (%) 702(15) 458 (55)
385 (47)
306 (37)
110(13)
' Cd sd khac dieted y nghia thdng ke, / test (p < 0,05).
il>!
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TCNCYHphu trWdng 71 (6) - 2010
4. Quan diem va t h a i dp cua ngUdl cham soc tre em ve su' dung thudc khang sinh cho tre em
Qua d c cude t h I o luan nhdm, nhdng ngOdi tham gia cd chung y kien rang khang sinh la mpt loai thudc dac biet, khdng nen tuy tien sd dung ma can phai dung theo chi dinh cua nhan vien y te. N h i l u ngUdi cho rang bat budc p h i i dung khang sinh cho d c benh viem nhiem, vdi v i du nhu viem hpng, hoac ho kem theo sdt. Mpt sd nhdm bay td sU to ngai v l viec cac b i c sy lam dung k h I n g sinh, ke ddn khi khdng thUc sO can thie't nen hp chi tuan thd tuyet dd'i khi tre bi benh nang. Viec tO d i l u tri bang k h I n g sinh, vdi d c ten thudc nhU Bisepton (co - trimoxazole), amoxicillin, ampicillin, cung dUpc thao luan d h i u het cac nhdm. Me cua tre la ngUdi thudng chju trach nhiem chinh ve van d l n l y . Khdng ai de cap den nguy cd cua viec gay ra nguy cd khang thudc k h I n g sinh dp sd dung khdng dung.
I V . B A N L U A N
Ket q u i nghien cdu cho tha'y ngUdi cham sdc tre cd nhOng quan niem sai lam v l thud'c khang sinh va da so hp thieu kidn thdc v l sd dpng khang sinh cho tre bj NKHHCT. Theo da so' NCST, thud'c k h I n g sinh c i n sd dung trong n h i l u tfnh hud'ng n h u t r e chi bj ho, hay d m lanh thdng thudng. Day la vl'n d l sO dung- khang sinh bat hdp ly da dUdc d l cSp trong nhOng nghien cdu trUdc d Viet Nam va the gidi [ 2 - 5 ] . Theo hUdng dan cua Bd y te va Td chdc y te the gidi, khang sinh J<hdng can thie't dung trong nhdng trUdng hpp NKHHCT the nhe,^ dp can nguyen virus chiem tdi 70 - 8 0 % d c trUdng hpp nay [6]. C I c nghien cdu trUdc d i y da che t h i y khdng cd bang chdng v l hieu qua cua k h I n g sinh trong d i l u trj NKHHCT khi khdng cd cac dl'u hieu cua benh viem phdi nhU khd thd, thd nhanh [7]. Khang sinh cung khdng cd hieu q u i trong viec dU phdng cac bdi n h i l m vi khuan cda N K H H C T the
nhe [8]. 6 cdng ddng huyen Ba V i , da sd NCST nhan thdc sai lam rang sd dung k h I n g sinh la bat budc d tre khi cd sdt kem theo, mac du thOc te sdt khdng hoan toan la dau hieu cua n h i l m khuan. Day cd the chinh la mpt trpng d c ly do d i n de'n sU ddi hdi k h I n g sinh ba't hpp ly khi tim kiem djch vu y te cua NCST va gay ra tinh trang sd dung k h I n g sinh bat hdp ly phd bie'n d cpng ddng huyen Ba vi [9]. Chfnh vi vay m l rat can thie't cd chUdng trinh g i l o due tai cpng ddng ve hieu q u i cua k h I n g sinh, hau qua cua khang k h I n g sinh v l d i l n bie'n binh thUdng cua cIc benh N K H H C T the nhe nham d i thien tinh trang sd dung k h I n g sinh bat hpp ly v l khang k h I n g sinh tram trpng nhU hien nay.
V . K E T L U A N
Da.so' ngUdi cham sdc tre thieu kien thdc ve d c nguyen tac sd dung k h I n g sinh cho tr^ bj NKHHCT va cd nhOng quan niem sai lam ve thud'c k h I n g sinh. Can tuyen t r u y i n trong cpng ddng de nang cao hieu bie't cho ngUdi dan ve sd dung khang sinh hpp ly va hau q u i cua khang khang sinh.
T A I L I E U T H A M K H A O
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(2001). Management of childhood acute respira- tory infections at private pharmacies in Vietnam.
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(2000). Antibiotic medication and bacterial resistance to antibiotics: a survey of children in a Vietnamese community. Trop M e d Int Health, 5 (10), 7 1 1 - 2 1 .
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Drug use among children under 5 w i t h respiratory illness and/or diarrhoea in a rural district of
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TCNCYH phu trWdng 71 (6) - 2010
Vietnam. Pharmacoepidemiol Drug Saf, 18 (6), 4 4 8 - 5 3 .
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Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries.
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(Review). The Cochrane Library 2007.
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335: 982.
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Summary
K N O W L E D G E A N D P E R C E P T I O N OF A N T I B I O T I C S FOR C H I L D R E N U N D E R F I V E A M O N G C A R E G I V E R S I N T H E RURAL A R E A OF V I E T N A M
Objective: Household members, particularly mothers, play a crucial role in managing childhood illness. This paper aims to assess knowledge, attitude and perceptions of child - caregivers about antibiotic treatment for ARls. Methods: Caregivers in 828 households in Bavi were interviewed using a structured questionnaire regarding the case management of childhpod ARI. Six focus group discussions with mothers, fathers and grandmothers were conducted. Results: For management of non - febrile common colds, 8 5 % of caregivers stated correctly that antibiotics are not required. For febrile colds and pneumonia, 4 5 % and 47% respectively stated that they would require antibiotics. Only 13% demonstrated correct, in accordance with standard guidelines, overall knowledge for all three situations. Caregivers perceived antibiotic use as mandatory for illness with fever. Conclusion: Most of the caregivers lacked knowledge and misperceived about antibiotic treatment for common colds.
Keywords: antibiotic use, children under five, ARI
