Y HOC VIET NAM T H A N G 9 - SO 1/2011 children: A prospective descriptive epidemiological
study", Pediatr Crit Care Med ^ (1), pp. 1-7
4. Dent CL, Ma Q, Dastrala et al (2006), "Plasma neutrophil gentinase-associated lopocalin predicts acute kidney injury, morbidity and mortality after pediatric surgery: a prospective uncontrolled cohort study". Critical care 11, pp. 1-8
5. Duzova All, Bakkaloglu A, Mukaddes K et al (2010), "Biology and outcome of acute kidney injury in children" Pediatr Nephrol 25, pp.1453-1461 6. Hoste EAJ, Clement G et al (2006), "RIFLE
criteria for rcute kidney injury are associated v^ith 9.
hospital mort:ality in citically ill patients: a cohort:
analysis. Critical Care, pp. 1-10
Loza R, Luis E et al (2006), "Factorrs associated with mortality in acute renal failure in children", Pediatr Nephrol 1\, pp. 106-109
Otukesh Hasan, Hoseini R, Hooman N et al.
Prognosis of acute renal failure in children. Pediatr Nephrol 2006, 21:1873-1887
Plotz FB, Angelique SB et al (2008), "Pediatric acute kidney injury in the ICU: an independent evaluation of pRIFLE criteria", Intensive care Med, pp. 134-138
KIEN THUnC PHONG CHONG HIV/AIDS CUA NGUAl LAO DONG
LAM VIEC THUOC LINH VUC CAP NU6c SINH HOAT NONG THON TAI MOT SO TINH
Tran Dac Phu*
T 6 M TAT
Trong qua trinh trien khai thuc hien ChUdng trinh muc tieu Qudc gia nUdc sach va ve sinh moi tnidng nong thon giai doan II (NTP2) nham dat chi tieu 85% sd ho dupc siT dung nude sach va 70% sd ho gia dinh co nha tieu hop ve sinh vao nSm 2010, he thdng td chirc va doi ngu nhOmg ngUdi lao dong lam viec trong ITnh vUc cap nUdc va ve sinh moi trudng nong thon khong ngCmg phat trien ve sd lUdng tren pham vi ca nUdc [7]. Oe cd cd sd xay dung ke hoach long ghep cac hoat dong cung cap nudc sach va ve sinh mdi trudng vdi viec phong chdng HIV/AIDS cho ngud: lao dong lam viec trong moi tn/dng dac thii [2], mot nghien cufu ve kien thuc phong chdng HIV/AIDS cua ngUdi lao dpng thuoc rrnh vuc nay dUdc tien hanh. Ket qua dieu tra cho thay: 1) Ty le hieu biet ve cac nhdm ddi tUdjig c6 nguy cd cao lay nhiem HIV/AIDS cdn han che. VSn con mot sd dang ke ddi tUdng ngUdi'lao dong khong biet rang xet nghiem la each duy nhat de nhari biet mot ngUdi nhilm HIV. 2) Mifc do hieu biet v^ cac bien phap phong lay nhilm HIV cCia ngUdi lao dpng con chua day du. 3) Chi cd ba benh LTQOTD dUdc nhieu ddi tUdng biet den nhieu nhat la HIV/AIDS, giang mai va benh lau. Hdn mot nifa ddi tUdng nghien ciifu khong biet bat ky mot trieu chirng nao cOa benh LTQDTD. Mdi cd gan 70% can bo cong nhan biet dung ve nhurng ddi tUdng can phai dieu tri khi da c6 QHTD vdi ngUdi bj benh LTQDTD.
* Cue Quan /y- mdi trudng yte-BpYte
SUMMARY:
Workers in rural water supply sector with knowledge on HIV/AIDS control and prevention
In the implementation of the National Target Program on Rural Water Supply and Sanitation in the phase II (NTP2) with the aim at attaining 85% of households using clean water and 70% of those having hygienic latrines in 2010, the organizational system and wori<force in Rural Water Supply and Sanitation sector have incessantly developed in the quantity nationwide [7,8]. In order to have basis for development of plan for integration of njral water supply and sanitation with HIV/AIDS control and prevention for the workers who are working in particular environment [2], a study on the knowledge of the workers in this field on HIV/AIDS prevention and control was conducted. The results showed that:
1) The proportion of respondents who was aware of high risk target groups was low. There was still a remarkable number of workers did not know that blood test is the only way to identify a person infected HIV. 2) The knowledge wori<ers in rural water supply sector on the prevention methods of HIV transmission was not sufficient. The prevention methods of HIV transmission from HIV infected persons were not known widely. 3) Only three sexual transmitted diseases known by the most respondents were HIV/AIDS, syphilis and gonorrhoea. More than a half of interviewees were not able to tell any syptoms of STDs. Nearly 70% of respondents knew
Y HQC VI$T NAM THANG 9-S6 1/2011 correctly about the persons who need a treatment
when having sex with people infected with STDs.
I.
OAT VANoi
d Vidt Nam, tir khi ph^t hi§n trirdng hdp nhiem HIV diu tidn nam 1990 tai th^nh phd Ho Chi IVIinh, tinh ddn ng^y 30/9/2010, c^ niTdc c6 tdi 180.312 ngi/di nhiem HIV/AIDS dang cdn sdng, trong dd c6 42.339 b§nh nhSn AIDS v^
tdng sd 48.368 trirdng hdp tCf vong lidn quan 6dn AIDS [1,3]. Cho dd'n nay, HIV/AIDS da xuat hidn d tat c^ cac tinh, th^nh trdn cS nirdc [6]. Oe gdp phan thirc hien tdt Chi/dng trinh muc tieu qudc gia nirdc sach v§ sinh mdi trirdng ndng thdn giai doan II, vdi nhijfng hoat dong cOa Chirdng trinh 1^ xSy dimg kd hoach long ghep c^c bidn phap gi^m thieu HIV/AIDS phii hdp vdi cac hoat ddng dac thii trong ng^nh c^p nirdc va vd sinh nhSm bao vd sire khde cho ngirdi lao ddng, chiing tdi tien hanh cudc dieu tra "KiSh thtic phdng chdng HIV/AIDS
cua ngwdi lao d^ng lim W#c thudc Unh vub cdp nu6c sinh hoat ndng thdn tai mdt sd tinh" nhSm thu thap thdng tin cIn thiet.
II. o d i lapNG VA PHUONG PHAP NGHIEN COU Thdi gian ti^n hanh nghien ciru tir dau thang 11 d^n het thang 12 nam 2010 (2 thang).
Sir dung thi^t k^ nghidn ciru cIt ngang md ta qua dieu tra djnh li/dng tdng sd 420 can bd, cong nhan vien nganh cap nirdc (bao gom cdng nhan khao sat tham dd, cong nhan xay dimg lap dat cac cdng trinh Ccip nirdc) tai 6 tinh da diTdc sir hd trd tir cac ngudn vien trd qudc te la Lao Cai, Oi§n Bidn, Ninh Thuan, Oak Lik, Tra Vinh va An Giang. Nhir vay, tai mdi tinh se dieu tra 70 ngirdi bIng each lap danh sach toan bd can bd, cdng nhan thirdng di xay lip tai cac cdng trinh va chon theo phi/dng phap ngau nhien he thdng tir danh sach nay ra sd ddi ti/dng dirdc phong v^n.
III. KET QuA NGHIEN CCfU
3.1. Kien thut: vdnhin biet ddi tupng cd nguy cacao bj nhiem HIV vi ngudf nhiem HIV Bang 1: T9 le ddi tUdng biet cac dd'i tUdng cd nguy cd cao bj nhiem HIV
Thong tin NgUdi h^nh nghe mai dam
Khach lang chdi
NgUdi nghien chich ma tuy Nhdm dan di bien dong
S H T D dong gidi
NgUdi mac cac BLTQDTD Khong biet
Khac
n=420 35 123 366 18 10 25 9 12
% 77,4 29,3 87,1 4,3 2,4 6.0 2,1 2,9
cac nhdm cd nguy cd cao bj lay nhiem HIV duoc cac ddi tuong nghien cilU dua ra la nhdm ngUdi nghien chich ma tuy (87,1%) va nhdm ngUdi hanh nghe mai dam (77.4%). ThUd te, con cac nhdm ddi tUOng khac bao gdm nhdm khach lang chdi, nhdm dan di bien dong, nhdm sinh hoat tinh due ddng gidi va nhdm mic cae benh LTCIDTD cQng la nhdhg nhdm quan the ed nguy ed cao bj nhiem HIV [5], tuy nhien c6 r^t it can bo, cong nhan nganh nube biet den. Ben canh dd, van odn 2,1% ddi tuong khdng biet dUdc b^t ky mot nhdm ddi tiWng nao c6 nguy cd cao bi lay nhiem HIV.
80 -]
60 - 40 - 20 - 0 -
15
1
73,8
3,1
Di/a vao hinh Du'a vao ket qua Di/a vao loi song dang ben ngoai XN
Y HOC VigT NAM THANG 9 - s 6 1/2011
Xet nghiem mau la each duy nhat dung de ed the nhan biet chinh xac mdt ngUdi nao dd da bi nhiem HIV hay khdng [4]. Khi dUde hdi ve each nhan biet mot ngUdi nhiem HIV, cd 73,8% ddi tUdng phdng van tra Idi dung. Nhung cung edn mot t^ le khdng nhd cac ddi tUdng phong van cho rang cd the nhan biet mot ngudi nhiem HIV thdng qua hinh dang be ngoai hoac Idi sdng cOa ho (16,0% va 3,1%).
Bang 2:1^ le ddi tuong bidt cae quyen va nqhTa vu ciia nqUdi nhiem Thong tin
Song, hoa nhap vdi cong dong va xa hoi DUdc dieu tri va CSSK
Hpc van hda, hpc nghe lam viec
DUdc giOr bi mat rieng tu lien quan den HIV/AIDS
Ti^ Choi kham, chOra benh khi dang dieu tri benh AIDS trong giai doan cudi
Thuc hien phong lay nhiem HIV cho ngudi khac
Thong bao ket qua XN HIV cCia minh cho vd/chong/ngudi chuan bj ket hon vdi minh
Thuc hien cac quy dinh v l dieu tri bang thudc khang HIV Khong biet
Ket qua nghien cCru cho thay, hieu biet ve quyen va
n=420 267
164 93
15 5 176
60 38 86 nghTa vu cQa n
HIV
% 63,6 39,0 22,1 3,6
1,2 41,9
14,3 9,0 20,5
gudi nhiem HIV cOa dd tUdng phdng van eon han che. Quyen cOa ngudi nhiem HIV duoc ddi tUdng nghien ciru biet den nhieu nhat la quyen sdng, hda nhap vdi cong ddng va xa hdi (63,6%), tiep den la quyen dUdc dieu tri va cham sdc sUe khoe (39,6%). Tuy nhien, cd rat it ddi tuong biet den quyen dUdc giOr bi mat rieng tu lien quan den HIV/AIDS va quyen tU chdi kham, chura benh khi dang dieu tri benh AIDS trong giai doan cudi cOa ngUdi nhiem HIV.
Ve nghTa vu eOa ngirdi nhiem HIV, chUa den 50% ddi tUdng bidt ngudi nhiem HIV phai cd nghTa vu thUc hien phdng lay nhilm HIV cho ngUdi khac.
3.2. Kiih thtic ve phdng liy nhiem HIV
Bang 3: T9 le ddi tUOng biet cae bien phap phdng lay nhiem HIV
Thong tin n=420
Khong SHTD vdi nhilu ngudi, chung thiiy 1 vd 1 chong 260 61,9
SufdungBCS khi SHTD 316 75,2
Khong tiem chich ma tuy 171 40,7
Khong dung chung BiCT 260 61,9
Truyen mau an toan 34 8,1
Chl diing cac dung cu vd triing 16 3,8
Khong tiep xuc tare tiep vdi mau va cac djch cd the cCia ngudi nhiem HIV 45 10,7
Me bi HIV thi khdng cho con bu 14 3,3
Khong biet 1.9
Khac 15 3,6
Ket qua bang tren cho thay mUe do hieu biet ve cae bien phap phdng tranh lay nhiem HIV cOa cdng nhan, can bo nganh nUdc ehUa day 6Ci. Bien phap dUdc nhieu ddi tuong dUa ra nhat la
"Sir dung BCS khi QHTD" cung chi chiem 75,2% chung eho 6 tinh. Mot sd each thuoc ve chuyen mdn [4] nhU truyen mau an toan (mau da qua xet nghiem), chi dimg cac dung cu y te da dUdc khCT triing, khdng tiep xue true tiep vdi mau, tinh dich va djch am dao eOa ngudi bj nhiem HIV tuy duoc neu ra nhung vdi t^ le riit thap (chi dudi 11 % sd ddi tuong).
Y HQC VIST NAM THANG 9 - S6 1/2011
Bang 4: T9 le ddi tuong biet eac bidn phap phdng tranh lay nhiem HIV ddi vdi ngUdi nhiem HIV Thong tin
Sif dung BCS khi QHTD
Tranh stf dung chung ban ch^i d^nh rSng, dao cao rSu Tranh sif d'ing chung BKT
Tranh cho ngudi kh^c tilp xuc vdi mau va ciic dich cd thi ciia minh KhuySn ban tinh di xet nghiem
Nlu 1^ phu nCr ma sinh con thi khong d l cho con bu Kh.ic
Khdng biet
n=4?0 269 131 193 155 32 10 40 20
% 64,0 31,2 46,0 36,9 7.6 2,4 9,5 4,8
Cd 64,0% ddi tuOng nghidn eUu bidt ngUdi nhiem HIV e^n sCf dung BCS khi QHTD. Bien phap tranh silr dung chung BKT duoc 46,0% ddi tuOng dUa ra, 36,9% cho ring ngUdi nhiem HIV can tranh eho ngudi khac tidp xiie vdi mau va eac eh^t dich co thi ciia minh. 31,2% eho rang can phai sijf dung rieng mdt sd dung cu nhu ban chai danh rang, cao ludi, dao cao, dao lam, dd cit mdng tay. Tuy nhidn, van edn 4,8% ddi tuong nghidn eifu khdng bidt dUOc ba't ky mdt bien phap phdng tranh nao.
3.3. Kidn thuic vdcic b$nh liy truydn qua dudng tinh dye
Bidu dd2: T^ le ddi tuong biet eac bdnh lay truyen qua dudng tinh due
Viem gan B
Nam
HIV/AIDS
Benh lau 10,7
Z]10
14,8 2,1
. Li-Ui, ,l!«^. iiill.»f.'li JlLiL'JlLl'J!!^,* .' -Li-,1 , T^essnassam SH78,1
J 'U D - - i
1 1 1 1 1 1 1 1 1
0 10 20 30 40 50 60 70 80 90
Chl ed ba benh LTQOTD dUOe nhieu ddi tuong biet den nhieu nhat, d6 la HIV/AIDS (78.1%), giang mai (70.0%), benh lau (63.1%).
Cdn mot t/ le dang ke ddi tUOng nghien eiifU khdng biet cac benh vien gan B, nam, ha cam.
trung roi cung la nhOfng benh LTQOTD. Oae biet, van edn 7.6% ddi tUOng khdng biet bat ky mdt benh LTQOTD nao.
Bang 5: T9 Id ddi tuong biet cae tridu ehimq ciia benh lay truyen q Thong tin
Dau viing bung
Chay mii/djch nieu dao/huyet trang/kh( hu Di tilu dau, budt
Dau rat bd phSn sinh due Loet sui bp phan sinh due NgiTa bp phSn sinh due Khac
Khdng biet/KTL
ua dudng tinh due n=420
21 70 66 63 68 79 26 233
% 5.0 16,7 15,7 15,0 16,2 18.8 6.2 55.5 C6 tdi hdn mot nCta (55,5%) ddi tUOng nghien cufu khong biet bat cCf mot trieu chirng nao cOa benh LTQOTD. Cac trieu chirng thudng gap nhat cOa benh LTQOTD cung dUOc rat it ddi tUOng nghien ciru biet den (tir 5,0-18,8%).
Y HQC VigT NAM T H A N G 9 • s 6 1/2011
Bang 6: T9 le ddi tuong biet eae ddi tuonq can phai dieu tri khi QHTD vdi ngudi bi benh LTC20TD Thong tin
Chl can dilu tri eho ngudi benh Dilu trj eho ca 2 vd chong
Dilu tri cho ngudi benh va eho tat ea nhirng ngudi da eo QHTD vdi ngUdi benh
Khong biet/KTL
n=420 60 48 289
23
% 14,3 11,4 68.8 5,5 T9 le can bo, cong nhan nganh nude hilu
dung ve eac ddi tUOng can dieu tri khi phat hien mdt ngudi mie benh LTQOTD kha cao nhuiig cung edn mot t^ ie dang ke ngudi tra Idi hieu chUa dung ve van de nay, bao gdm, 14,3% ddi tUdng cho rang chi can dieu tri eho ngUdi bi bdnh LTQOTD. 11,4% eho rang chi can dieu trj cho ca 2 vd chdng. T^ le ddi tuong phong va'n khdng biet can phai dieu trj eho nhufng ai khi mdt ngudi eo QHTD vdi ngudi bi benh LTQOTD la 5,5%.
V. KET LUAN
Kien thCrc cOa can bo, edng nhan nganh c^p nudc VSIVITNT ve phong chdng HIV edn han che:
1. T9 le biet ve cac nhdm ddi tuong ed nguy cd cao lay nhiem HIV chUa nhieu. Van edn mot sd dang ke (26%) ddi tuong can bd cdng nhan nganh cap nude khong biet rang ehi cd xet nghiem mau la each duy nhat de nhan biet mot ngudi nhilm HIV.
2. Mire do hieu biet ve eac bien phap phdng lay nhiem HIV cOa can bo. edng nhan nganh cap nude chira day dO. Cae bien phap de mdt ngudi da nhiem HIV phdng lay nhiem cho ngudi khac cung ehua duoc biet rdng rai, t9 le lan lUdt la: 64% biet can si^ dung BCS khi QHTD, 46% biet can tranh s(s dung chung BKT, 36,9% biet tranh cho ngUdi khac tiep xue vdi mau va cac djch co the cOa ngudi benh, va chi 2,4% biet neu la phu nOf ma sinh eon thi khong de cho con bu.
3. Chl ed ba benh LTQOTD dUOe nhieu ddi tuong biet den nhieu nhat la HIV/AIDS, giang mai va benh lau. Hdn mot nCta ddi tuong nghien eifU khdng biet ba't ky mdt trieu chirng nao eOa bdnh LTQOTD. Chua den 70% can bo edng nhan biet dung ve nhOhg ddi tUdng can phai dieu tri khi da cd QHTD vdi ngUdi bi benh LT(30TD.
TAI LlfU THAM K H A O
1. Bo Y te. BC sd 887/BC-BYT vS Cdng tac phdng chdng HIV/AIDS 9 thdng dSu nSm 2010.
2. Bo Y te, QD s6 34/2007/QO-BYT ve vi§c phe duyet ChUdng trinh h^nh dong Quoc gia Can thiep giam tac hai trong du phong lay nhilm HIV giai doan 2007-2010.
3. Bo Y te, Cue Phong chong HIV/AIDS (2009).
Lfdc tfnh va DU bao HIV/AIDS tai Viet Nam giai doan 2007- 2012.
4. Bo Y te J2006), Nhiem khuln lay qua dudng tinh due/ Nhiem khuan dudng sinh san. HUdng dan thuc hanh cd ban.
5. Nguyin Dure Chung, Tran Thj Bieh Tra (2010), TJ' le nhiem HIV d cac nhom doi tUdng nguy cd cao tai Ha Noi trong 10 nSm (1996-2005), Cac cdng trinh nghidn cCfu khoa hoc vS HIV/AIDS giai doan 2006-2010, So 742+743, Y hoc thUc hanh, BYT x_b.
6. Nguyin Thanh Long, Nguyen Thj Minh Tam, Nguyin Thj Huynh, Nguyin Dure Hong, Trjnh H6a Binh, trjnh Duy Luan (2010), Oanh gia ket qua du an phong lay nhiem HIV tai Viet Nam, Cac cdng trinh nghidn cCtu khoa hoc v l HIV/AIDS giai doan 2006-2010, So 742+743, Y hoc thUC h^nh, BYTXB.
7. Thii tirdng ehlnh phu, QD sd 36/2004/QD-TTg v l vi§c ph§ duy§t Chien lUdc quoc gia phdng, chong HIV/AIDS "d Viet Nam den nSm 2010 v^
tam nhin 2020.