T/D^P CHf NGHIEN CO'U Y HQC
Summary
THE OVERLOAD AT PEDIATRIC CONSULTING ROOM AND TREATMENT DEPARTMENTS OF SAINT PAUL HOSPITAL HANOI:
EVIDENCES FROM STAFFING AND HOSPITAL STATISTIC
This study aims to describe and analyze the overall situation of the overload of Pediatric consulting room and Pediatric treatment department of Saint Paul Hospital and related factors.
Overall, the overload was reported in both the consulting room as well as treatment departments.
Children patients who had insurance coverage registered at St. Paul accounted for only 63.5% of those came to consulting room, versus 28% are those who by-passed lower level clinics in average, a doctor spent 6.8 minutes per patient. Data showed a clear burden of clinical staffs, even with the support of additional contract-based staffs. Some recommendations were proposed to St. Paul hospital as well as health managers.
Key word: Overload at hospital. Pediatrics, Saint Paul hospital Hanoi
DICH Tt HOC VU DICH S 6 T PHAT BAN 2009 TAI LAO CAI
> • • • •
Ddo Thj Minh An\ Nguyin Tri Cuvng^
Widn ddo tpo Y hpc dw phdng vd Y ti cdng cdng - Dpi hpc YHa Npi
^Tmng tdm y ti dw phdng tinh Ldo Cai Nghidn cwu dwac thwc hipn nhdm md ta ddc dim djch ti hpc (DTH) djch sdt phdt ban (SPB) ndm 2009 tinh Lao Cai. Kit qua nghidn cuv eho thiy: SPB xay ra d tit cd cdc nhdm tudi: cao d nhdm 10-15 (178/100.000), 5-9 (144,3/100.000). < 1 tudi (79.5/100.000). nhdm > 15 mic thip nhit Khdng cd swkhdc bipt tl lp mic giwa nam vd nd; Djch phdn bd khdng ddng diu giwa cdc dja bdn, ndng thdn mic cao han thdnh thj (76,9/100,000 so vdi 19,4/100,000). Djch xdy ra tw thdng 2 din thdng 5 gdm cdc tnrdng hpp mk mbella (41.6%). sdi (7,8%) vd SPB khdng phdi mbella vd sdi (50,6%). Dlnh djch vdo ngdy thd 12 sau khdi phdt Mdt sd tmdng hap dd tidm vie xin sdi vin mie SPB (sdi, mbella, sdt phdt ban ehwa rd nguydn nhdn).
Tmng tdng sd cdc tmdng hap SPB, 76,8% cd tiin sw tiip xuc DTH.
Td khod: Sdt phdt ban, rubella, sdi, vg djch, Ldo Cai, Vift Nam
I. DAT
VANDt
sdt phdt ban Id bilu hifn cua bfnh nhilm triing do nhilu tdc nhdn gdy ndn nhung phd biln nhit phai k l d i n id sdt phdt ban do virus sdi vd rubella [8]. Theo thdng kd eiia Td eh&e Y t l T h l gidi (WHO), tinh ridng ndm 2009 d§
ed 121.344 trudng hgp m i e rubella duge bdo cdo t& 167 nudc thdnh vidn [9]. Tgi Vift Nam, trong 3 ndm trd lgi ddy, nh&ng trudng hgp sdt, phdt ban nghi sdi hay nghi rubela dugc goi ehung Id ca sdt phdt ban duge bdo cdo d
56/64 tinh thdnh phd vdi han 20.000 ea mdc sdt phdt ban trong dd 4/64 tinh ed sd mic trdn 1.000 ea gdy sg quan tdm ehO y ciia cfng ddng [11].
Ldo Cai Id tinh vimg eao bidn gidi, ndm ehlnh gi&a viing Ddng Ble vd vung Tdy Bdc eiia Vift Nam, cdch Hd Nfi 296km theo dudng s i t vd 345km theo dudng bf. Trong nh&ng ndm g i n ddy sdt phdt ban d tmh Ldo Cai c6 chilu hudng gia tdng. Ndm 2006 ed 50 ca;
2007 ed 55 ea; 2008 ed 60 ea; d f c bift ndm 100
2009 t& thang 2 - 5, thdng kd sa bf dd cd 288 ea [1]. Cdu hdi ddt ra Id vdi chilu hudng djch sdt phdt ban ngdy edng gia tdng nhu vfy thl ddc dilm djch te hoe sdt phdt ban ed gi thay ddi so vdi sdt phdt ban kinh diln khdng? Vi vdy nghidn cuu ndy nhim cdc muc tieu:
M6 ta phdn bd cdc trudng hgp mie sdt phdt ban trong ndm 2009 tai dja bdn tinh Ldo Cai.
Mo ta cde y l u td anh hudng tdi djch sdt phdt ban ndm 2009 tai dja bdn tinh Ldo Cai.
II. 06l TU'QNG VA PHU'QNG
P H A P I.DditygngDan vj mau: philu dieu tra trudng hgp sdt phdt ban tgi 4 huyfn ed djch sdt phdt ban xay ra (Sa Pa, Ldo Cai, Bdt Xdt, Bao Ydn) trong khoang thdi gian 12/ 02/2009 d i n 06/ 5/2009.
Dan vj nghien c&u: nh&ng trudng hgp sdt phat ban.
III. K^T QUA
— — TAP CHi NGHIEN CO'U Y HQC
2. Phuang phdp
2.1. Thiet ke: Md ta cdc trudng hgp bfnh su dyng ky thuft hdi c&u trdn:
Philu dilu tra trge filp cdc bfnh nhdn >
16 tudi hofc bd, me bfnh nhdn nlu bfnh nhdn < 16.
Philu xdt nghifm huylt thanh hpc ca sdt, phdt ban nghi sdi/ rubella.
2.2. C& mau vi phircng phip chgn mau Todn bf 288 trudng hgp sdt, phdt ban dd cd philu dilu tra, xdt nghifm trdn 4 huyfn, TP (Sa Pa, TP Ldo Cai, Bdt Xdt, Bao Ydn).
2.3. XCr ly vi phan tich so lieu
Nhfp vd kilm tra chat lugng sd lieu dinh lugng.
Nhdp Hfu bing chuang trinh EPI-DATA.
Cdc thdng kd md ta, test x^ phdn tich dan, da biln duge su dung.
1. Dac dilm djch t l benh sdt phdt ban tai Ldo Cai nam 2009
Bang 1. Phan bd sd mdc sdt phdt ban theo nhdm tudi Huyen,
TP
Ndng thdn Thdnh phd
Bdo Yen Bdt Xdt Sa Pa Ldo Cai Tong sd Nhdm
tudi % n % n %
Tyle (*)
< 1 1-4 5 - 9 10-15
>15 Nam/
n&
Cfng 6
1 1 4 11 12/
11 23
26,1 4,35 4,35 17,4 47,8
100 1 6 57 108
3 92/
83 175
0,6 3,4 32,6 61,7 1,7
100 2 5 14
2 9 17/
15 32
6,25 15,6 43,8 6,25 28,1
100 2 2 11
9 34 30/
28
"58
3,45 3,45 19 15,5 58,6
100 11 14 83 123
57 151 288
3,84 4,86 28,8 42,7 19,8 137 100
<0,01
<0,01
<0,01
<0,01
<0,01
>0,05
79,5 33,7 144,3 178,0 13,6
48,1 (*) TL/100.000 dan trong nhdm tudi.
TCNr.YH 7R (H) 2011 101
TiD^P CHl NGHlfeN CO'U Y HQC
Bang 1 eho thiy, trong tdng sd ede trudng hgp sdt phdt ban dugc ghi nhfn, ede ca bfnh tfp trung phin ldn d nhdm trdn 5 tudi: 10 15 (42,7%), 5 9 (28,8%) vd > 15 (19,8%). Tuy nhidn ty If mie d cdc nhdm tudi thay ddi trdn 4 dja bdn. Tgi Bio Ydn mie eao d nhdm > 15 tudi vd nhdm < 1 tudi, tgi Sa Pa mic cao d nhdm 5 9 tudi vd > 15 tudi, tgi Bdt Xdt mic eao d nhdm 10 15 vd nhdm 5 - 9, tgi TP Ldo Cai mic eao d nhdm > 15 vd nhdml0 -15 tudi.
Khi tinh ty If mdc trdn 100.000 ddn trong tung
50 1
nhdm tudi cho thiy nhdm 10 15 tudi mic cao nhit (178/100.000) filp din Id nhdm 5 9 tu6i (144,3/100.000) vd nhdm mic cao th& ba Id nhdm dudi mft tudi (79,5/100.000). Nhdm mdc thlp nhit Id nhdm > 15 tudi. Bdt Xdt cd ty 1$
mic trdn 100.000 ddn eao nhit (249,6) trong khi dd Bio Ydn ty If mie trdn 100.000 ddn Id thlp nhit. (30,1). Trong vu djch ty 1$
mlc/100.000 ddn d vimg ndng thdn cao han d thdnh thj (76,9/100,000 so vdi 19,4/100,000). Sy khde bift ndy ed y nghTa thdng kd (p < 0,01).
xO' .^ s^
dp<^^ ^^^ ^c^^^ ^^' >y 4 ' ^*^' <V^' ^V^' <^' B i l u dd 1. Sd ca mdc theo thd'i gian
Tgi Ldo Cai, djch sdt phdt ban xiy ra trong thdi gian tu thdng 2 din thdng 6 ndm 2009. Dinh eao nhit eua djch vdo cudi thdng 2 vd diu thdng ba sau dd sd trudng hgp mie giam din vd sau dd Igi tdng lgi vdo tuin thu hai eiia thdng 3 vdi 2 dinh djch thu phdt. Tuy nhidn, sd mie tgi 2 dinh djch ndy thlp han so vdi dlnh djch tidn phdt vd sau dd djch gilm din eho din hit vdo thdng 6.
Bdng 2. Bdng kit qud huylt thanh hgc
Huyfn, thdnh Bao Ydn
Bdt Xdt SaPa TP Ldo Ca
Tdng
phd n
16 62 15 49 142
n 2 37
7 13 59
Rubella
% 12,5 59,7 46,7 26,5 41.6
n 5 1 1 4 11
Sai
% 31,3
1,6 6.7 8,2 7.8
Trong vu djch sdt phdt ban trong tdng sd 288 bfnh nhdn sdt phdt ban chiing tdi lly dugc 142 mdu huylt thanh mang x'dt nghifm Kit qua xdt nghifm eho thiy: Rubella (+) chilm 41,6%, sdi (+) chilm 7,8%. Nhu vfy, djch sdt phdt ban gdm nh&ng trudng hgp mie rubella, sdi vd khdng thufc hai nhdm ndy.
102
TAP CHI NGHIEN CO'U Y HQC Bang 3. Tiln su* tiem v i e xin sdi
Rubella Sdi
Rubella vd sdi (-) Tdng
n 59 11 72 142
v i e xin sdi 1 mui
7 1 14 22
%
11,8 9,0 19,4
v i e xin sdi 2 mQi
45 2 50 97
%
76,3 18,1 69,4
Tdng sd (%) tiem 1 + 2 mui
88,1 27,1 28,8
Cd
ylutd
DTH 41
8 60 109
%
69,5 72,7 83,3 76,8 Bing 3 cho thiy, trong cdc trudng hgp sdt phdt ban dugc xdt nghifm, cd nh&ng trudng hgp dd tidm vie xin sdi nhung v l n mie sdi. Nhung trudng hgp fidm sdi dan gid vln cd t h l mic Rubella vd sdt phdt ban khdng phai sdi vd rubella. Ty If cdc trudng hgp sdt phdt ban cd filp xuc vdi ylu td djch te hpc eao (76,8%).
IV. BAN LUAN
Cdc nghidn c&u trdn t h l gidi dd chi ra, tgi cdc nude chua triln khai tidm v i e xin vd cde nudc phdt triln giai doan trudc triln khai tidm vie xin, ty If m i e d tre em cao han ngudi Idn [7]. Theo tac gia Rafilal A, (2003), tgi Rumani trong vu djch ldn nam 2002 2003, nhdm cd ty If mle/100.000 ngudi cao nhit trong dp tudi di hoc (2.564/100.000 tre 5 9 tudi va 2.446/100.000 tre tu 10 15 tudi) [5]. Trong nghidn c&u ciia ehiing tdi, ty If ndy cung Id cao nhit (356/100.000 tre 10 - 15 vd 288,7/
100.000tre5-9tudi).
Nghien c&u eiia eae tdc gia nudc ngodi Julia Brotherton (2001) tgi Australia [6], eiia James L Gale va cfng sg (1972) tai Odi Loan vd mft sd nghien c&u tgi ede qudc gia khde cung nhu k i t qua nghidn c&u v l djch t l hpc s6t phdt ban, rubella ciia cdc tac gia trong nudc Huynh Thj Phuang Lien (2004) [2], Vidn Quang Mai (2005) [4], Hd Minh Nguyft (2006), Dang Thanh Huyin (2007) cho thiy djch sdt phdt ban thudng cd ty If m i c cao d ndng then han thdnh thj, khdng ed sg khde bift v l ty If mie gi&a nam va n&, thdi gian vu djch thudng tu thang 2 d i n thang 5 va hilm cd trudng hgp xay ra vdo mOa ning ndng. Ket qua nghien c&u ciia ehiing tdi cung phii hgp
vdi cdc nghidn cuu ndy. 06 Id, ty If mlc/100.000 ddn cao nhat d vung nong thdn (115/100.000 ddn) trong khi dd khu vgc thdnh thj (58/100.000 ddn). Djch xay ra tu 12/2 d i n 06/5.
v l k i t qua xdt nghifm huylt thanh, nghien cuu cua Huynh Thj Phuang Lien tai mien Bdc trong cdc nam 2000 2003 cho thiy ty If rubella (+) tren tdng sd cdc trudng hgp sdt phdt ban theo cde dja ban dao dong tu 1,37 48% [3]. Nghidn c&u eiia chiing toi ty If chung rubella duang tinh la 41,6%.
Trong vu djch sdt phdt ban tai Ldo Cai ghi nhdn ddng thdi sg ed mdt cua 3 tdc nhdn Id rubella, sdi vd nhdm khdng sdi khdng rubella.
Vifc xdt nghifm IgM khdng rubella cdc mdu ed kit q u i dm tinh vdi IgM khdng sdi Id ein thilt d l xdc djnh nguydn nhdn. Trong sd mie sdi (+) ed 27,1% dd duge tidm vie xin sdi (1- 2 mui). Nhu vdy ddp &ng miln djch sdi d nh&ng trudng hgp ndy Id khdng c6 vd can cd nh&ng nghidn c&u phdn tich v l nh&ng ylu td anh hudng tdi hifu qua eua vie xin sdi trong edng ddng.
v l filp xiic vdi y l u td djch t l h p c , 76,8%
cdc trudng hgp mdc sdt phdt ban d i u cd tilp xiic ylu td dieh t l hpc. Ty If filp xuc vdi y l u td djch t l hoe trong nghien c&u nay eao han •
TAP CHl NGHIEN CO'U Y HQC
nghidn c&u cua Puthavathana P, 1985 tgi Thdi Lan (5,14%) [10].
V. K^T LUAN
Djch sdt phdt ban tgi Ldo Cai ndm 2009 gdp d t i t e l ede nhdm tudi, tfp trung eao nhit d nhdm 10 15 tudi (178/100.000), nhdm 5 9 tudi (144,3/100.000) vd nhdm dudi 1 tudi (79,5/100.000). Nhdm m i c thlp nhit Id nhdm
> 15 tudi. Ty If mic d nam vd n& Id nhu nhau.
Djch phdn bd khdng ddng d i u gi&a cdc huyfn.
Mic cao nhit d Bdt Xdt. 249/100.000 ddn, thlp nhit d Bio Ydn 30/100.000 ddn (p < 0,01).
Ndng thdn mic cao han thdnh thj (115/100.000 so vdi 58/100.000 vdi p < 0,01). Djch xiy ra tu thdng 2 d i n thdng 5. Dfnh djch vdo ngdy thu 12 tinh tu thdi dilm khdi phdt. Djch bao gdm cdc tm-dng hgp mic Rubella (41,6%), sdi (7,8%) vd sdt phdt ban khdng phai Rubella vd sdi (50,6%). Tiem vie xin sdi khdng ed y nghTa phdng bfnh ddi vdi bfnh nhdn sdt phdt ban, Ty If tilp xue DTH trong nhdm nh&ng bfnh nhdn mie sdt phdt ban eao (76,8%).
TAI LIEU THAM KHAQ
1. Nguyin Dinh Cv (2009). Xult hifn djch bfnh sdt phdt ban d Bdt Xdt vd tidu chay c l p d tre em vimg eao Ble Hd. Trung tdm y t l dg phdng tinh Ldo Cai, Bdo cdo thdng kd.
2. Huynh Thj Phu'ang Lidn. (2004). Tlm hilu sg luu hdnh vl riit rubella d trd em t& 1 - 15 tudi vd phy n& mang thai 3 thdng d i u tgi Hd Nfi, Hii Phdng vd Thanh Hda. Bdo cdo tdng k i t d l tdi nghidn c&u khoa hoe c l p Bf, Vifn v f sinh djch t l trung uang, Hd Nfi.
3. Huynh Thj Phu'ang Lidn, vd cfng s^>
(1998). Budc d i u fim hilu sg ed mft cOa khdng t h l khdng vi rOt rubella d phu n& trong nhdm tudi sinh d l . Ky y l u edng trinh, Vifn v0 sinh djch t l hoc Hd Nfi (1990) 87-90.
4. Vidn Quang Mai (2005). Ode dilm djch t l hpc bfnh sdi d mft sd tinh miln trung sau 7 ndm tidm v i e xin sdi 1995 2002. Lufn dn tiln s9 Y hoc, Vifn v f sinh djch t l Trung uang.
5. A Rafila et al (2004). A large rubella outbreak, Romania. Eurosurveillance, 9, (4).
6. Julia Brotherton (2001). Measles in NSW, 1991 2000. New South Wales Public Health Bullefin 12 (7) 200 - 204.
7. J. Thomas Grayston et al. The Epidemiology of Rubella on Taiwan 1, Introducfion and Description of the 1957-1958 Epidemiology. Oxford Journals Medicine, International Journal of Epidemiology. 245-252.
8. Harry D et al. Evaluating the Febrile Patient with a Rash. The American Family Physician Web.
9. P Strebel, A.D., M Gacic-Dobo (2009).
Progress Toward Control of Rubella and Pre- vention of Congenital Rubella Syndrome Woridwide. National Center for Immunization and Respiratory Diseases, CDC. October 15, 2010/59(40); 1307-1310.
10. Puthavathana P, W . C , Kositanont U, Lamkom R (1985). Rubella outbreak in Thailand. Southeast Asian J Trop Med Public Health; 16 (3): 414-20. 4.
11. WHO. Reported measles cases and incidence rates by WHO Member States 2010, 2011, as of 14 September 2011.
Summary
EPIDEMIOLOGY OF A RASH FEBRILE OUTBREAK IN LAO CAI PROVINCE IN 2009
Th2 study was carried out to describe fi-ie epidemiology of the seariet fever occurring in Lao Cai in 2009. The results show that: the cases distributed through all age groups but dominated by groups 10 -15 (178/100.000), 5 - 9 (144,3/100.000), < 1 (79.5/100.000) while prevalence of group
> 15 years old was the least. Regarding risk of infection, there was no difference between men 104