THyC HANH THEO DOI TRE DifOi 1 TU6l SAU TIEM CHUNG CClA BA ME TAI THANH P H 6 HA LONG, QUANG NINH, 2011
Trjin Nhu DuoTig, Nguyen Thi Dung*
Vien Ve sinh Dich te Trung nang, Ha Noi
*Triing tdm Yte Dir phong Quang Ninh
T O M T A T
Cac vie xin dIu c6 fl9 an todn rdt cao, tuy nhiSn, ciJng gi6ng nhu' thu6c, vdc xm cung gSy ra nhlj'ng phdn ling sau tifim chung b cdc mi>c 3$ khac nhau. Nh&ng phSn ling sau tiSm chOng c6 th6 du'p'c phing ngCra va giam nh^ n^u c6 sy ket hpp ch$t che giu'a cSn bO y t^ vS cha m? trS c6 con du'p'c ti&m chCing Vdi thlM k l nghi&n ciju mfi td, chung tfii ti^n hdnh nghifen cifu thyc hdnh theo dSi tr6 sau tidm chung cua ba mp tai thanh ph6 Hp Long Qudng Ninh nSm 2011 Thftng tin dirge thu Ih^p bdng quan sSt Igi ch5 va phfing vdn bd m? tpi tram y te ngay sau khi tifim vd tgi hO gia dinh sau tiSm chung 3 ngSy theo phl^u di^u tra dugc thiet ke tru-dc, K^t qud cho thdy 11,4 % s6 ba mpdS khong cung cdp thflng tin v l tinh trgng sdc khfie cua tr^ cho cdn bO y t l tru&c khi tiSm chung. 13,5% so bS m? I<h6ng thyc hi§n theo doi trS sau ti&m tgi tram y te. 8,6% so bd m? khfing thyc hi|n theo doi tr§ tgi nhS dO th&i gian qui djnh. C^c ly do khien bi m? khong thyc hi^n tot cac qui djnh ve theo ddi tre gim: 43,8% khSng bilt; 40,2% ba me bill nhung khong Ihyc hi#n vlquab^n, 18,8% cho IS khdng cIn thilt, C6ng tac tu-vln v^ hu&ngdSn bS m§ cua cSn b $ y t l trudc tiSm chung ia mpt vific lam quan trpng giCip cSc bd m§ hilu, tg gidc thyc hign theo doi tri se giOp cham sdc tr§
tot ho'n va tang sy an toan trong sir dyng vdc xm ph6ng bpnh.
Tip kh6a: phdn gng sau tifim chung, vac xm, Vi^t Nam.
I. DAT VAN DE 2000. Benh udn vdn so sinh dugc loai hir vao nam 2005. Ty I? mac benh khac trong chuang Chuane trinh Tiem chiing md rdng . ^ - i . ^ - . i . . - i i i i ! . i
^ 6 - & trmh tiem chung mo rpng nhu bach hau, ho (TCMR) d Viet Nam la mgt trong nhiing
chuong trinh myc tieu Quoc gia duoc danh gia
sdi, viem nao Nhat Ban cung da giam hang tram lan so vdi thdi ky trudc tiem chimg.
14 Meuqua nhat ttong cac chuong trinh muc ^ a c dii c4c vjc xin sii dung trong tieu y te. TCMR bSt dSu du(7c triSn khai tir nam (.jj^^g trinh TCMR dSu c6 do an toan cao, tuy 1981 voi 6 loai vie xin C0 ban, den nay TCMR ^ign_ ^dng gij^g ^ „ (a„^^^ ,j.(,„g q^j tji^jj ^^
da bao phu 100% xa phuong tren ca nuoc vol i^^g khong thS tranh khoi co nhiing phan ling 10 loai vJc xin. Thanh tmi va y nghTa cua tiem khang mong mu6n. Khi ty le tiem chimg cang chimg da duoc khang dinh sau hon 25 nam hoat cao, s6 ISn tiem vac xin cang nhi^u thi xac xuat dpng. Ty le tre em mac cac benh truyen nhigm gap cac phan ling cang gia tang. Phan ung sau nguy hiem c6 vac xin phong benh da giam di tiem chimg va miic dp anh huong cua no khong ro ret. Benh bai liet da dupe thanh toan tir nam nliirng chi phu thupc vao chat lupng vac xin ma Tac gia- Trin Nhu Duong Phan bien 1: PGS. TS. NguySn Thi Thu Yto Dia chi: Vipn Vp sinh Dich tg trung tTong Vipn vp sinh dich te Trung uong.
Bien thoai: 0988761312 Phan bifn 2: TS. Duong Thi H6ng Email: [email protected] Vipn vp sinh dich tl Trung uong.
Ngay nhan bii: 26/5/2012 Ngay dang bai: 31/10/2012
Tap chi Y hoc du phong, Tap XXII, s6 5 (132) 51
cdn ph\,\ lhu(K ri\t nhi^u viio y6u t6 khAc nhu:
ky thupt bAo qudn vflc xin, kf iiSng thgc hAnh ticm chiing, ky nSng chflm sdc vi (hen ddi tri sau tiem chung ciia cAc bA mv*. Do v&y phAn ling sau tiem chiing cd the dugc phdng ngCra vA giAm nhi; neu cd sg k^t hgp chpt ch5 gifra c;ui bg y te \ :'i cha mi; tri cd con dugc ticni chung.
Nghien ciiu nAy ciia chung tdi nh5m dAnli giA thgc hAnh then ddi tri sau tifim viic xin ciia cac bA iiii; tpi trpm y ic vA Ipi nhA d thAnh pho Ha Long, tinh QuAng Ninh, nam 2011, 11. P H U O N G P H A P NGHlfcN ( 6 I I 2.1. Di'u lugng nghien ii'iu
Cdc bA m? cd con dudi 1 tuoi dugc tiem chiing trong chuang trinh TCMR, cd khA nAng nghe, tra Idi phdng van vA dong ^ tham gia vAo nghien ciiu.
2.2. Thiet ke nghien cii'u
Sii dung phuang phap djch te hgc md tA.
2.3. Thdi gian nghien ciru
Nghien ciiu dugc trien khai trong nSm 2011. S6 li$u dugc thu th^p cho phAn tich trong (hdi gian tu ngAy 25/1/2011 d6n 29/8/2011.
2.1. Dia (liem nghien ciVii
ThAnh ph6 Hp Long, tinh QuAng Ninh.
2.'>. ( (i ni;iii vii each chgn mau Chgn ni3u tiiy ti§n 200 bA m? cd con dirdi 1 tuoi dugc ti6m chung trong TCMR.
2.6. K v Ihii0< thu (hap t h o n g tin Thdng tin ve thgc hAnh chSm sdc tri sau tiflm chiing ciia bA m? dugc thu thpp thdng qua quan sAt tpi cho, phdng van bd m? tpi trpm y te ngay sau khi tiem va tai hO gia dinh sau tiem chiing 3 ngdy dc hoAn thdnh phieu dicu tra thiet kc s3n.
2.7. IMiiin tich so lieu:
So li?u dugc nhpp vA phan tich bang phan mem SPSS vdi cdc thupl todn thdng ke vA ket quA dugc trinh bAy dudi dpng bdng va bieu do.
i n . K E T QUA
Bdng 1. Ty 1$ bd m? cung cap thdng tin v4 si>c khde cua trd khi den tiem chung
Cung d p thong tin Tlns6
Khdng C6 nhung thilu Day ail
21 28 136
T y l § % 11.4 15,1 73,5
T6ng c$ng 100
Bdng 1 cho thay 73,5% so bd m? da thgc djnh cua BYT Tuy nhien van cdn 11,4 % so ba hi?n tot vi?c cung dp dii cdc thdng tin can thiet m? khdng cung cap bat cii thdng tin ndo cho cho CBYT trudc khi tiem chiing theo dung qui CBYT khi cho eon tiem chiing.
52 Tap chi Y hgc d\r phdng, T^p XXII, s6 5 (132)
Bdng 2. Ty l# bd m? thg<c h!$n theo ddi tr6 30 phiiit tpi trpm y tS sau khi tiSm chdng
Ngi dung Tlnsd T:^ 1$ %
KhOngthgchi^n Theo doi khong dO thdi gian Theo doi dii thdi gian
13,5 47,0 39,5 Tong
BAng 2 cho thay chi cd 39,5% so bA m? cd cho con d Ipi theo doi nhung khdng dii thdi thgc hi?n theo doi dii 30 phiit sau khi tiem theo gian; co tdi 13,5% so ba m? cho con ve ngay diing hudng dan ciia cAn bO y te; 47% ba m? sau khi vira tiem chiing ma khdng theo doi gi.
Bdng 3. Th^'c hdnh theo ddi trd sau tiem tpi nhd trong 24 gid* ddu sau tiSm Ndi dung
Khong thgc hi$n Theo doi khong dii thdi gian Theo doi dii thdi gian Tong
Bang 3 cho ket qua 100% cac ba me chung, trong do chi cd 8,6% so ba me khdng deu thuc hien theo doi tre tai nha sau khi tiem thuc hi?n theo doi du thdi gian qui dinh.
Bang 4. Ly do bd m? khdng thgc hif n theo ddi ho^c theo doi tre khong dii 30 phut sau ti§m d-trpmy t l
L'j do Tan so (n=112) Ty I^ %
Khong biet Cho la khdng can thiet Qud b^n viec khac Khong co cho ngoi theo doi Khdc
43,8 18,8 40,2 17,0
Tap chi Y hgc du phdng. Tap XXII, so 5 (132)
BAng 4 cho ket qud cd 43,8% s6 bA m? vl qud b§n (40,2%), vl cho Id khdng can thiii khdng biet c;in theo doi tri t6i Ihieu 30 phut (18,8%) ho$c do TYT khdng cddu cho cho cdc ngay Ipi diem tiem cluing Nhi6u bA m? khdc bd m? ng6i Ipi theo ddi (11,0%).
mjic dd cd bi^t nhung vSn khdng Oigc hi^n
Bdng 5. Ly do bd m? khdng thi^c hl^n theo dOi trd dCi thd*! gian 6- n h i trong 24 gid* dku sau tifim
Khftng bill
Ly do Tins6
Ty i$ %
Cho id khfing c i n thi6l
BAng 5 cho thay 1^ do chu yeu khi^n ba m? khdng thgc hign theo doi du thdi gian tpi nha la do cdc ba mi; cho Id khdng can thiet (87,5%) vi khdng thay tri cd dau hi?u gi khdc thudng.
IV. B A N LUAN
An toAn tiem chimg Id mgt trong sd muc tieu quan trgng cua chuong trinh TCMR.
Trong khi trach nhiem ciia nganh Y te la dam bao chat lugng vAc xin, thgc hi?n dimg ky thupt tiem chung, thi vai trd cua bd m? ciing rat quan hgng trong vi?c chu dgng phoi hgp vdi CBYT khi cho tre tiem chimg, man thii hudng dan ciia CBYT ve theo doi tri sau tiem chimg vA biet xti tri dung cAch khi h-e cd cdc biSu hi?n phAn ling sau dim.
11,4% sd bd m? khdng cung cap thdng tin gi ve siic khde ciia ft-i trudc khi tiem chiing;
15,1% sd ba m? cung cap khdng day dii cdc thdng dn ve siic khde hi?n tpi, tien su b?nh tat, tien sii di img va phan ling ciia lan tiem chiing trudc. Dieu dd chiing td da cd 26,5% so tri khdng dugc bA m? ndm rd ve tinh trpng siic khde ciia con trudc khi tiem chiing. Tpi nhiing khu vuc thdnh thi-noi dan cu tap trung ddng, s\r qua tdi trong ngAy tiem chiing IA kha ph6 bien
vA rat dl dan den vi^c mOt s6 CBYT bd sdt cdc ngi dung trong qui trinh tiem chiing. Tpi quan I lai Bd Trung, I Id Ngi theo Tran Thj Phuong Anh cd tdi 25% trpm trudng khdng thgc hi?n khdm phan topi trudc khi chi dinh tiem chiing.
Vi^c bd qua ho$c kham phin lopi khdng day dii cd the dan tdi vi?c chi dmh tiem chiing khdng phii hgp, tiem an nguy ca gia tang phan ling sau tiem nang. Do do vice cdc bd me chii dgng phoi hgp vdi CBYT la thict thuc gdp phan phdng trdnh cdc phan ling npng.
Cd 13,5% bd m? khdng Uieo ddi va 47%
bd m? theo ddi con khdng dii 30 phtit tai tram y tc sau khi tiem chiing. Nhu vay cd 60,5%
tri khdng dugc theo doi day dii 30 phut sau khi tiem chiing tpi trpm y ic Cac ly do 43,8%
IA khdng biet phAi theo doi, 40,2% ba m? biet nhung khdng thuc hien vi qua ban, 18,8% cho IA khdng can thiet... Cac bd m? khdng thgc hien vi chua thgc sg hicu ly do can theo ddi chat che siic khde sau khi tiem de phdng tranh phan ling n$ng IA soc phan v? do vac xin - mgt phan ung npng cd ty 1? tii vong rat cao nhung Ipi dieu tri dugc neu xir tri sdm vd diing. Mgt sd ba me co tam l^ chii quan vi xac suat xdy ra soc phan v?
Id rat hiem. De bA me tuan thii tdt, CBYT cdn gidi thich ro hon cho bd m? va nen thgc hi?n tuy8n truyin sdm trudc khi bA me cho con tiem
54 Tap chi Y hpc d\r phong, T^p XXII, so 5 (132)
chung. Nin to chiic tuy€n truyen ho^c phdt td rod tu khi bA m? di khdm thai ho^c tiim phdng udn vdn sg tdng dugc hi?u qud truyen thdng cho cdc bA m?.
V. K E T L U ^
Thuc hdnh theo doi tri dudi I tuoi sau tiem vac xin trong TCMR da dugc cAc bA m?
d thdnh pho Hp Long, Qudng Ninh thgc hi?n tucmg ddi tot. Tuy idiien, van cdn m^t ty 1?
dang ke cdc bd m? khdng theo doi tri ho$c theo ddi khdng dii thdi gian dugc yiu cSu tpi Tram Y te cung nhu tpi nhd. Ly do chinh ciia vigc theo ddi chua t6t Id do qud bpn, khdng biet hope chua nhpn thiic ro dugc y nghTa vd tam quan trgng ciia viec theo doi nAy.
Ldi cdm an: Cdc tdc gid xin chdn thdnh cdm an Trung tdm Y te Dif phong tinh Qudng Ninh, Thing tdm Y te thdnh pho Hg Long vd cdc Trgm y te phudng thuoc thdnh pho Hg Long dd phoi hgp va ho tra rat nhieu de thuc hien nghien cuu ndy
TAI LIEU THAM KHAO
1. Tran Thj Phuang Anh (2008), Kien thirc, thgc hdnh ve an todn tiem chiing ciia cdn bg y te phudng quan Hai BA Trung HA Ngi nAm 2008, Luan van chuyen khoa I, Trudng Dpi hgc Y te cdng cgng Hd Ngi, HA Ngi.
2. Dg dn Tiem chung md rgng (2004), Giam sAt phdn ling sau tiem chiing, Hd Ngi.
3. Dg dn Tiem chiing md rgng (2011), BAocdo tong ket tiem chiing md rgng nam 2010.
4. BarafF LJ, Cody CL, Cherry JD, DTP- associated reactions: an analysis by injection site, manufacturer, prior reactions and dose. Pediatrics 1984;73:31-6.
5. Cody CL, Baraff LJ, Cherry JD, Marcy SM, Manclark CR, The nature and rate of adverse reactions associated with DTP and DT immunization in infants and children.
Pediatrics 1981; 68:650-60.
6. Immunization safety surveillance:
guidelines for managers of immunization programmes on reporting and investigating adverse events following immunization
Tap chi Y hgc du phong, Tap XXII, so 5 (132)
PRACTICES OF MOTHERS ON MONITORING IMMUNIZATION IN HA LONG, QUANG NINH, 2011
CHILDREN AFTER
Tran Nhu Duong, Nguyen Thi Dung*
National Institute of Hygiene and Epidemiology, Hanoi
*Qiiang Ninh Provincial Ccntci for Preventive Medicine
Most vaccine are very safe, however, similar to drug, vaccine can cause adverse even after immimization at difference levels. Those adverse even can prevent or minimize with the close cooperation between health workers and mothers. We conduct this descriptive smdy focus on the practice of mother on momtoring children after immunization in Ha Long. Quang Ninh in 2011 Information collected by observing and interview mother in health center right after their children have immunization and at their house after three days by investigation form. The results have shown that 11.4 % of mothers did not provide their children health situation to health worker
before immunization. 13,5%oofmothersdidnol monitor their child after immunization in health center, 8,6%i of mother not meet the minimum time of monitoring their child at home. The reason that mother not follow the guideline of child monitoring include: 43,8% don't know, 40,2% known but too busy, 18,8% think that is not necessary. Health-worker's consultation and guiding to mother before immunization is important to help mothers understand and self- awareness on monitoring their children, which help better care for children and increase the immunization safety.
Keywords: immunization adverse even, vaccine, Vietnam.