TAP CHfY Dl/QC HOC CAN THa - SO 13-14/2018 TAI LIEU THAM KHAO
1. Bp Giao dvic va Dao tao, (2007), Quyit dinh sd 73/2007/QD-BGDDT: Quyit djnh ban hdnh qui dfnh vi hogt ddng y ti trong cdc trucmg tieu hgc, truang trung hgc ca sd. trudng g'ung hgc phd thdng vd tru&ng phd thdng cd nhiiu cdp hgc. Truy cgp 12/8, 2017, from bttps://thuvienphapluat.vn/van-ban/Giao-duc/Quyet-dinh-73-2007-QD-BGDDT-Quy- dinh-hoat-dong-y-te-tmong-tieu-hoc-trung-hoc-co-so-pho-thong-60656.aspx
2. Thii Tudng Chinh Phu, (2006), Chi thf 23/2006/CT-TTg- Chi thi vi vijc tdng cudng cdng tdc y te trong cdc tnr&ng hgc. Truy cap 12/8, 2017, from https://thuvienphapluat.vn/van- ban/Giao-duc/Chi-thi-23-2006-CT-TTg-tang-cuong-cong-tac-y-te-truong-hoc-13022.aspx 3. Thii Tudng Chinh Phii, (2009), Quyit dinh sd 401/QD-TTg: Quyit dinh vi vijc phi duyjt
chuang trinh phdng. chdng bjnh, tgt ti-ong cdc ca sd gido dgc thudc hj thdng gido duucj qudc ddn. Truy cdp 12/8, 2017, from https://thuvienphapluat.vn/van-ban/Giao-duc/Quyet- dinh-401-QD-TTg-phe-duyet-chuong-ttinh-pbong-chong-benh-tat-trong-cac-co-so-giao- duc-thuoc-he-ti!ong-giao-duc-quoc-dan-86772.aspx
4. Nguyen, D. T., Dedding, C , Pham, T. T. & Bunders, J., (2013), "Perspectives of pupils, parents, and teachers on mental health problems among Vietnamese secondary school pupih",BMC Public Health. 13, 1046.
5. Nguyen, D. T., Dedding, C , Pham, T. T., Wright, P. & Bunders, J., (2013), "Depression, anxiety, and suicidal ideation among Vietnamese secondary school students and proposed solutions: a cross-sectional study", 5A/C Pufi/ic/feaftA, 13, 1195.
6. Niemi, M., Thanh, H. T., Tuan, T. & Falkenberg, T., (2010), "Mental health priorities in Vietnam: a mixed-methods analysis", BMC Health Serv Res, 10, 257.
7. Tran, B. P., (2007), Improving Knowledge of factors that influence the mental health of school children in Viemam, Unpublished Thesis ftir the Master of Public Health, Queensland University of Technology, Brisbane.
8. Tran, Q. A., Dunne, M. P., Vo, T. V. & Luu, N. H., (2015), "Adverse Childhood Experiences and the Health of University Students in Eight Provinces of Vietnam", Asia Pac J Public Health, 27(8 Suppl), 26S-32S.
9. Vuong, D. A., Van Ginneken, E., Morris, L, Ha, S. T. & Basse, R., (2011), "Mental health in Vietaam: Burden of disease and availability of services", Asian J Psychiatr, 4(\), 65-70.
(Ngdy nhgn bdi: 14/11/2017-Ngdy duyjt ddng 05/01/2018)
TINH H I N H T I E M NGlTA V I E M G A N SIEU VI B LIEU S O SINH VA M O T SO YEU T O LIEN Q U A N T A I V U N G D O N G B A N G S 6 N G CUtJ LONG
N A M 2 0 I 5
Trdn Nguyin Du, LeMinh Hiru, Nguyin Tan Dgt, Phgm Thi Tam"
Tru&ng Dgi hgc YDugc Cdn Tha
* Email:pttam@ctump. edu. vn TOM T A T
B^t van de: Ddng bdng sdng Ciru Long (DBSCL) Id vitng dfch te cao cua viem gan siiu vl (VGSV) B (13% HBsAg duang tinh). Muc tiiu Nghien c&u- 1) xdc dfnh ty li tiem chung viem gan B & tre sa sinh tiong vdng 24 gid sau sinh vd ly do tre sa sinh khdng dugc chiing ngira; 2) xdc djnh mgt sd yiu td nhdn khdu—xa hgi hgc lien quan din vijc tiem ngira viim gan B dtie sa sinh a ddng bdng sdng Ciru Long. Boi tugng va phuang phdp nghiin cu:u: Nghien cuu cdt ngang tien
TAP CHl Y Dl/QC HQC CAN THQ - S 6 13-14/2018
526tretirlO- 11 thdng tudi vd cdc bd me tgi vimg Ddng bdng Sdng Cuu Long. Thu thdp du lieu tiem n&ra dua tren the/sd tiem ngita. Ly do khdng dugc tiim ngira dugc thu thgp qua phong vSn true tiep bd m? tgi hd gia dinh dua trin bg cdu hdi sogn sdn. Tiem ngira vaccine VGSVB so smh dang th&i gian dugc dinh nghia la tre dugc tiem tiong vdng 24 gid tinh tu luc dugc sinh ra Ket qud: Ty li tiem ngua vaccine VGSVB trong vdng 24 gid sau sinh Id 46.6%. L^ do chinh tre khong dugc tiem vaccine Id khdng dugc cung cdp bdi nhdn vien y li (53%), vd tre khdng du sue khoe di tiem ngira (27%). Cdc yiu td lien quan din dugc tiem vaccine VGSV B sa sinh la & vimg nong thdn, hgc vdn cao cua cha. Kit lugn: Ty li tiem ngira vaccine VGSVB trong vdng 24 gid sau sinh tgi viing DBSCL thdp hon mgc tieu qudc gia. Vijc tiem vaccine ngua VGSV B dung thai gian vdn Id mgt thdch thiic ddi v&i sue khoe cdng ddng vd cdc bijn phdp de tdi uu hda qudn ly kip thai la rdt cdn thiet.
Tir khda: Tiem chiing, viem gem siiu vi B, vaccine, tie sa sinh, Dong Bdng Sdng Cuu Long A B S T R A C T
T H E C O V E R A G E R A T E O F H E P A T I T I S B B I R T H D O S E VACINATION AND I T S R E L A T E D F A C T O R S I N M E K O N G D E L T A , 2015
Tran Nguyen Du, Le Minh Huu, Nguyen Tan Dat, Pham Thi Tatn Can Tho University of Medicine andPharmacy Background: Mekong River Delta is highly endemic for hepatitis B virus infection (13%
HBsAg positivity). Objectives: 1) determine immunization coverage rates of the neonatal hepatitis B vaccination within 24 hours after birth, and 2) to identify some socio-demographic factors influencing neonatal hepatitis B immunization, and assess reasons why neonates are not being immunized in Mekong River. Materials and methods: A cross-sectional survey was conducted among 526 children aged 10 to 11 months and their mothers in the Mekong Delta. Data were obtained from immunization cards. Information for reasons for failure to immunize children was recorded on the questionnaires. Timely birth dose vaccination hepatitis B was defined as infant receiving within 24 hours of birth. Results: The rate of hepatitis B vaccine within 24 hours after birth is 46.6%. The main reasons for not vaccinating children are not provided by health worhrs (53%), and children are not healthy enough to get vaccinated (27%). Factors related to vaccinated hepatitis B vaccination are in rural areas, with higher levels of education. Conclusion:
The coverage of hepatitis B vaccination within 24h after birth was lower than the national target.
The finding that 36.9% of infants were unvaccinated within seven days represents a significant concern. That implies that timely hepatitis B vaccination coverage is still a challenge to public health and measures to optimize timely administiation are urgently needed to be taken.
Key words: Vaccination, hepatitis B, vaccine, newborn, Mekong River Delta, Vietnam I. DAT VAN DE
Viet Nam cd ty Id nhidm viem gan sidu vi B (VGSV B) cao vdi tten 8% ngucri tiudng tiianh (11% ddn 19% d ddng bdng sdng Cftu Long (DBSCL)) udc tinh bj nhiem virus mgn tinh [4]. Ty Id hien nhidm VGSV B man tmh d tte em da gidm dang kd d Viet Nam sau khi tidm vaccine VGSV B cho tte ndm 2002 va dua vaccme vdo vao chuor^
dhtii chung ngfta tte em qudc gia nam 2003 [11], nhung ty Id van edn thip d cdc khu virc khd tidp can, nai du trft vaccine la thdch thftc va nai cd ty Id ldn phu nii sinh con tai nha.
Mftc do bao phu cao la cin thidt de ngdn chdn sy lay truydn VGSV B cho tte sa sinh, va quan trgng han Id nen tidm ttong vdng 12 gid hodc 24 gid sau sinh. Viec nhilm VGSV B sdm gdy ra gdnh nang cho bdnh nhdn viem gan B, vi dy: bdnh gan man tinh, xo gan v^
ung thu gan [7]. Ngoai ra, ndu ldy truydn benh VGSV B chu sinh (cdch lay ttuydn chinh
TAP CHf Y Dl/QC HOC CXN THO-Sd 13-14/2018
VGSV B d Ddng Nam A) khdng dugc kidm soat thi tuang lai sd lgi tao ra cdc the he phy nft mang thai nhidm VGSV B va eo nguy ca truyen cho eon hg.
O mien Nam Viet Nam, nai md 10,5% phu nft mang thai la ngudi mang virus VGSV B [6], sd lieu vd lidu tidm ngua vd thdi gian tidm ngua la rdt hgn chd. Ddnh gia muc do bao phu lieu so sinh, bao gdm phan tich tinh kip thdi, nghien euu ly do tti hoan tidm chftng va cdc bien phdp c6 thd de tang ty le bao phu, la can thiet de xac dinh eae mue tieu cho cac hdnh dgng ldm giam ty le hien nhidm VGSV B mgn tinh xudng dudi 2%
ttong sd tte em dudi nam tudi vdo nam 2012 so vdi mue tidu tam thdi, hudng tdi muc tieu cudi ciing dudi 1%, ddy la myc tidu kidm soat VGSV B d cdp qudc gia vd khu vuc Tay Thai Binh Duong cua WHO [13]. Nghien cftu nhlm muc tidu: 1) xdc dinh ty Id tidm chftng viem gan B d tte sa sinh ttong vdng 24 gid sau sinh vd ly do tte sa sinh khdng dugc tidm ngfta; 2) xdc dinh mdt so yeu td lidn quan ddn vide tidm ngfta vidm gan B d trd sa sinh d ddng bang sdng Cuu Long.
n. » 6 l TU'ONG vA PHUONG PHAP NGHIEN ClTU 2.1. Doi tirgng nghidn cim
Trd em tft 10 - 11 thang tudi va m? eua tte c6 tdn ttong danh sach tte em dudi 1 tudi do ttam y td qudn ly, cd hd khau thudng tru tgi xa/phudng nghien cftu tgi tinh Vinh Long, Ca Mau va thanh phd Cdn Tha. Thdi gian tiiu thdp sd li^u: 12/2014- 1/2015.
2.2. Phirong phap nghien cuu
Thiit ki nghien ctru: Nghidn cftu cdt ngang md ta ed phan tich.
Ca mdu vd phuang phdp chpn mdu: Chgn 526 tte em tft 6 thang - 11 thdng tudi vd cac bd me tgi khu vuc DBSCL qua ba giai dogn duge didu chinh hi phuang phdp chpn mau 30 cum cua WHO [8], [12], [14]. Thft nhdt, 3 tmh la tiidnh i^bd Cdn Tha, tmh Vmh Long, va tmh Ca Mau dd dugc lya chgn mdt each ed chft y ttong sd 13 tinh eua ddng bdng sdng Cuu Long, dai dien cho vung do thi, ndng thdn vd vung sau vung xa. Sau dd, 3 huyen ttong mdi tinh duge lua chgn dugc chgn tiieo vi tti dia ly bao gdm mdt huy?n d trung tdm, mgt d ndng thdn, va mgt d vung sau yiing xa cfta tinh. Cudi cung, moi huyen dugc lya chgn ngau nhien 3 xa, trft thanh phd Cdn Tha (TPCT) vdi 4 xa, tdng cgng cd 30 xd tiiam gia khao sat. Tiep tiieo, tit cd tre dudi 12 tiidng tudi dugc lidt ke. Tft danh sach ndy, 17 tte sa sinh tuoi tii 6 ddn 11 thdng dugc chgn ngau nhidn dd tham gia cugc khdo sat. Ndu mdt dua tte dugc chgn khdng tiie duge dua vao (thay ddi dia chi hodc khong thd tidp xuc sau ba lln ddn nha) thi dfta tte tidp theo ttong danh sdch se duge thay thd. Tre em md ngudi me tft chdi tham gia se khdng duge thay the.
Npi dung nghien ctru: Thu thap dft lieu vd tiem ehung dya tten the tiem chung hogc so tidm chung cfta tte. Ly do khdng dugc tiem ngfta cua trd dugc thu tiiap dy ttdn bg cau hdi xay dyng sdn. Tidm ngua vaccine vidm gan sieu vi B dung lidu duge dinh nghia la tte dugc tidm vaccme VGSV B trong vdng 24 gid tinh tft luc dugc smh ra.
Cdng cu vd phuang phdp thu thdp sd liju: Bdng edu hdi da duge didu chinh tft eac mdu didu tta theo tidu ehuin cua WHO [8], [12], [14], phft hgp vdi tinh hinh eua DBSCL.
Dft lidu thu dugc tft cdc tiie/sd tiem ngfta, danh sach tte dugc luu tai cdc ttam y te ya ndu khdng cd thi thdng tin tidm ngfta cua tte duge ghi lgi khi phdng van ngudi me. The/sd tidm ngfta cd nhdn duge coi Id ngudn thdng tin chinh, tidp theo la tiidng tin cua ttgm y td va sy nhd lgi cua ngudi me. Trong trudng hgp tre khdng dugc tidm ngfta, eac ly do khdng tidm ngfta se dugc thu thap.
T*P CHf Y D i r o c HQC CAN THO - SO 13-14/2018
Phuang phap xit ly s6 li$u: DO lieu dupe nhap va xvi 1^ bang phan mem SPSS 18.0.
Uac tinh ty le tiem ngita vaccine VGSV B vod muc y nghia 95%. Dung test th6ng ke j ^ 2 phia va miic y nghia p < 0,05 tk xac djnh m6i lien he giiia dp bao phu ti6m ngiia va cSc ySu t6 nhan k h k - xa hpi hpc. Dimg mo hmh hdi quy logistic da bien v4 hoi quy Cox dS uac lupng ty s6 Odds va ty s6 nguy cp (Hazard Ratio).
III. KET QUA NGHIEN ClTU
3.1. Ty If tiSm ngira vaccine viSm gan B lieu sff sinh Bang 1. Dac d i t o t i t o ngira vaccine VGSV B lidu sp sinh
1
Tiem vaccipe vi£m gan B trong 24 gio" sau sinh Ty le %
Tiem dung thai gian (trona vong 24 ma sau sinh) 46,6
Tiem tre (ngay 2 - ngay 7 sau sinli) Khong tiem (tiem sau ngay 7 iioac khong tiem)
T8ng 100,0
' " » g , 1 :=^= ' ^^^^
Ty le t i t o ngiia vaccine VGSV B lieu so sinh diing gicr (trong vong 24 gicr smh) la 46,6% (can cii tren the/so t i t o chung ca nhan).
BiSu da 1. Ty IS t i t o ngira VGSV B so sinh trong 24 gift: tdng thS va theo tinh C6 su khac biet dang kS vS ty le bao phu cua 3 tinh: 31,2% 6 TPCT (do thi), 45,4% 6 Vihh Long (n6ng thon) va 62,6% 6 Ca Mau (vung sSu, vimg xa).
Bang 2. Ly do tre khong dupe t i t o ngiia vaccine VGSV B so sinh trong 24 gici Ly do tre khong duoc tiem vaccine viem gao B trong 24 gi&
Khong dupe cung cap bai nhan vien y te Tre khong dii sue khoe tai thai diem tiem ngira Khong CO san vaccine tai nai sinh tre
Co tiem ngira (theo lai ke me) nhimg khong co ghi trong so Cha me khong y thuc duac tSm quan trong ciia tiem chiing Ly do khac
T6ngC)
T4ns6 129 66 23 13 5 7 243
Tyl8%
53,1 27,2 9,5 53 2,0 2,9 100,0 (*)Trong so 281 tri khong dugc tiem vaccine VGSV B trong vong 24 gid sau sinh CO 38 tre khong tim dugc ly do.
KhoJng 53% phu huynh cung cip thong tin ring tre khong duoc t i t o vaccine VGSV B li6u so smh hoac c6 t i t o nhimg t i t o tre hon 24 gift sau sinh boi khong duoc nhan vien y te t i t o ngiia, nguyen nhdn ph6 biSn tiep theo la tre khong du s i c khoe de tiSiB ngiia (27,2%).
3.2. Cac yeu to lien quan den tiSm ngii^ vaccine viem gan B lieu sa sinh
TAP CHI Y Dl/OC Hpc CAN THg - SO 13-14/2018
Bdng 3. Cdc yeu td lidn quan ddn tidm ngfta vaccme VGSV B ttong vdng 24 gid sau sinh (phdn tich hdi quy logistic)
1
Yeu to dir bao1
Phan tich don bien OR (95%CI) 1 p
Phan tich da bien OR (95%CI) 1 p 1 Tinh/thanh
l e a n Tho
"
VTnh Long CaMau
1
1,82(1,17-2,82)
-
0,008 3,69(2,36-5,75) <0,001
1 1,87(1,18-2,95) 3,36 (2,08-6,42)
0,007
-
<0,001 Phutmg tien di chuyen chinh den noi tiem vaccine
Xe dap/di bo Xe gan may Xuong may
1 2,66(1,04-6,83) 4,09(1,22-13,7)
0,041
-
0,022
1 1,99(0,71-5,54) 1,91(0,52-7,05)
0,187
-
0,329 Hoc van ciia cha
Mil chir/Tieu hoc Trung hoc ca sa THPT Dai hoc/Sau dai hoc
1 2,03(1,25-3,31) 2,45(1,49-4,03) 3,71 (1,80-7,65)
0,004
-
<0,001
<0,001
1 1,86(1,11-3,14) 2,29(1,35-3,90) 2,76(1,27-5,96)
0,018
-
0.002 0,010 So con diroi 5 tuoi trong gia dinh
1 con 2 con Tir 3 con tro ISn
1 1,23 (0,83-1,83) 2,31 (1,07-4,97)
0,289
-
0,031
1 1,43 (0,93-2,19) 2,21 (0,98-4,98)
0,096
-
0,055 D3n t$c ciia tre
Kinh Khac
1
0,48 (0,24-0,98)
-
0,043
1
0,61(0,29-1,29) 1 0,198 Ty IS tiSm ngira vaccme VGSV B lieu so sinh cao a 2 tinh Vmh Long va C^ Mau nSu so vol TPCT, voi OR hieu chinh (KTC95%) hiong ling la 1,87 (1,18-2,95) va 3,36 (2,08-6,42). Su khac biet CO y n ^ a th6ng kS voi p>0,05.
Phan tich da biSn cho thay trinh dp hpc vin cao ciia cha la yeu to tien doan dang ke cho viec bi VGSV B trong vong 24 gia.
Bang 4. Ty s6 nguy ca (Hazard Ratio - HR) tiSm Vaccine VGB liSu so sinh theo c4c ySu t6 lien quan (m6 hinh hoi qui Cox)
Yeu to du bao Phan tich dffn bien HR(95%CI)
Phan tich da bien HR hifu chinh
(95%Cr) CanTho
VTnh Long 2,06(1,50-2,81) 2,01(1.47-2,75)
CaMau 3,13(2,32-4,23)
Phinmg tien di chuyen chinh den noi tiem vaccine
3,04(2,22^,15) Xe dap/di bo
Xe gan may 1,52(0,83-2.77) 1,15(0,62-2.14)
Xuong may 1,95(0,93-4,08) 1,02(0,48-2,19) 0,944
Hoc van cua cha Mil chit/rieu hgc
Tmng hpc eg sd 1,56(1,13-2,15) 1,40(1,01-1,94) 0.042
1,58(1,14-2,19) 1.44(1,03-2,01)
Sai hoc/San dai hoc 2.04(1,33-3,12) 1.47(0,95-2,29) 0,081
TAP CHi Y D i r g e HQC CAN T H O - 5 6 1 3 - 1 4 / 2 0 1 8
Vaccme VGB liSu so sinh duoc tiem som hon tai Vinh Long va Ca Mau so voi Cto Tho voi HR hieu chinh (KTC95%) lin lupt la 2,01 (1,47-2,75) v4 3,04(2,22-4,15). Sii khac bi?t co y nghia thdng ke vpi p<0,05.
Vaccine VGB liSu so sinh dupe tiem som o nhihig gia dinh co hpc van ciia c h trung hpc co sp hoac trung hoc ph6 th6ng so voi hpc vin tiiu hpc hojc mii chu voi HR hieu chinh (KTC95%) lin lupt la 1,4 (1,01-1,94) va 1,44(1,03-2,01). Su khac biet coy nghia th6ng ke voi p<0,05.
IV. BAN LUAN
4.1. Ty If tiem ngiia vaccine v i t o gan B trong v5ng 24 gifr sau sinh vi ly do tre sa sinh khong dir^-c chiing ngiia
Theo T6 chiic Y t i thS gioi, vaccme VGSV B Ueu so smh phai dupe t i t o cho lie ctog som ctog t i t (ttpng vong 24 giot sau sinh), djc biet tai nhiSng quic gia la viing djch tl nguy CO cao - nhihig noi phin dong d t o s i lay nhiSm viem gan B theo ducmg me ttuySn sang con ttong thoi kj" chu sinh, trong d6 co Viet Nam [15]. Ntai 2012, Bp Y tS da ban btah quyit dinh 2620/QD-BYT vS viec huong dan tiSm ngiia vaccne VGSV B, trong do ySu ciu ty IS tiem ngira vaccine viSm gan B cho h e ttong vong 24 gio sau sinh phai dat tir 65% ttd ISn [1]. Trong nghien cilu cua chung t6i, ty IS t i t o ngita vaccme VGSV B cho tie ttong vong 24 gid sau sinh chi dat 46,6%, thip ban tiSu chuto cua Bp Y te. Ty le tiem ngira vaccine VGSV B td ngay thii 2 den ngay thii 7 la 16,5% ("lieu VGSV B 24 gid tiem til"). Ty IS tiem ngira vaccine VGSV B ttong vdng 24 gid sau sinh ttong nghiSn cira ciia chiing toi (46,6%) ciing thip hon nghien ciru cua tac gia Duong Thi H6ng (52,2%) [3] va Bill Huy Nhanh (80,1%) [5]. Tuy nhien theo chiing toi, kit qua niy lai phto anh diing thuc ttang tiSm ngiia vaccine viem gan B ttong vdng 24 gid tai vimg DBSCL hien nay khi co nhieu ly do dan den viec tte sing ra khong dupe tiem ngay vaccine VGSV B ttong vdng 24 gid diu tiSn. Ching han 53% ba me ndi ring con cua hp khdng dupe tiem vi nhan vieny t i tai noi hp sinh khong cung cap vaccine VGSV B. Ly do p h i biin k i tiip d i ai khong dupe tiSm vaccine viSm gan B liiu so sinh la tte khdng dii siic khde d i tiSm ngiia, voi 27,2%. Xac djnh tte c6 du siic khde di tiSm ngita hay khdng do \k nhan viSn y te (bdc si, y si, nft hd sinh, diiu duang...) thuc hien, viec qua than ttpng voi nhiing chi dinh tiem chimg vaccine VGSV B ben canh mat tich cue la cd thi h ^ chS nhihig phto ung sau tiSm cho tte nhung dong thdi cung bo qua ca hdi bao ve tte khdi lay nhilm benh. Do do vi?c tap huto vS khtoi stog lpc tre trudc khi tiem ngira cho ddi ngii nhan vien y te la rat can thiet. Viec tte khdng du siic khde khong nhit thiet de Ik ly do khong tiem chung, nSn viec giao due cho cha me tte vS nhfing trudng hpp dupe t i t o va chong chi dinh tiSm chiing cung rit quan ttpng.
Vdi mpt tri cd me nhiem VGSV B (HBsAg duong tmh), nguy co lay nhiem VGSV B ctog gia tang nSu tiSm sau ngay thii 7 niu so vdi tiem ttong vdng 3 ngay dau sau sinh [10]. NghiSn ciiu ciia chiing tdi chp thiy cd din 36,9% tte khdng dupe tiem ngiia vaccine VGSV B liSu sp sinh ttong vdng 7 ngay sau sinh, day la mdt vin di dang lo ngai.
Tai viing DBSCL, niu sanh thudng, cac b^ me thudng chi phai d lai bpnh vien toi da 3 ngay, sau dd hp dupe bac si cho v i n h i Do do, viec triin idiai tiem ngira vaccine VGSV B liSu sp sinh cho tte ttong vdng 7 ngay diu sau sinh tai nhimg noi gin nha cac sto phu, nhu tt^ y te xa/phudng, cung la mpt ttong nhiing bien phap quan ttpng nen dupe xem xet den ttong chiSn luoc Itai gia ttog ty le tiem ngira vaccine VGSV B lieu so sinh ttong vdng ^ ngay dto sau sinh.
158
TAP CHfY Dl/OC HOC C X N THO - s6 13-14/2018
4.2. Mdt so yeu to lien quan 6kn tiem ngua vaccine vi€m gan B trong vong 24 gid sau sinh va lieu sa sinh
Viec nhdn biet duac eac yeu td nguy ca ddn den vi8c tiem ngira tre hoac khdng dugc tiem ngiia vaccine SGSV B hSu so sinh cd th8 giup tap trung can thiep vdo nhom d6i tugng nguy ca cao khdng dugc tiem ngiia hoac cd tiem nhung tiem tre. Nghien cdu cua chung tdi cho thay tiem ngiia vaccine VGSV B lieu sa sinh dung thdi gian quy dinh cd lien quan dSn khu vuc dia ly vd hgc vdn ngudi cha cua dda tre. Ket qua nay tuang tu nhu nghien cuu khdc nhu t^i Gambia, tre so sinh tai vdng ndng thdn cd ty le ti6m ngira VGSV B cao han khu v\rc thdnh thi hoac ven thanh thi va nhung tre cd me cd hgc vdn cao cd ty le tiem ngira cao ban nhutig tre cd me cd hgc vdn thdp hon [9].
BSn canh do, nghiSn cdu cua tdc gia Duong Thi H6ng cung cho thdy trmh do hgc van cua ngudi m? cang cao anh hudng tich cue dSn ty le tiem ngira vaccine VGSV B trong vdng 24 gid [3], Nhiing no luc trong tuang lai cdn dac bi8t chu y den viec gidi quyet cdc yeu td nguy ca nay d§ tdng cudng sir bdo ve nhdm chdng ldy nhilm VGSV B giai doan chu sinh tai Viet Nam.
Nghien ciiu cua chung tdi ciing chi ra su khac biet v8 ty 1$ tiem ngira vaccine VGSV B so sinh giiia cac tinh thdnh. Ket qua cho thdy ty le tiem chung vaccine VGSV B sa sinh tai Vihh Long va Cd Mau lai cao ban Idii so vdi TPCT. Sir bi^n thign v^ ty le ti6m ngira vaccine VGSV B ndy cho thdy su khdc nhau trong cdc chinh sdch ldm tdng muc do bao phu ti6m ngira vaccine VGSV B, nhu ludn ddm bao cd sdn vaccine VGSV B trong phdng smh de ti6m ngay sau sinh hoac cd cac quy ^ n h tiem vaccine cd nhiing ngdy cudi tudn hodc le, ddy nhfing thdi dikm md nguy co tre khdng dugc tiem vaccine hoac co tiem nhung tiem tre la rdt cao. Ngodi ra, su qua tai trong cdng viec cua cdc nhdn vien y te cimg la mgt trong nhung ly do ddn den viec tti hodn tiem ngira vaccine. Nen cd chinh sdch dac bi^t ve tiem ngua vaccme lieu sa sinh tai cdc ca sd y te, \i dudng nhu viec khdng tiem ngiia vaccine VGSV B khong anh hudng gi dki cdc ca sd y t^ (cd nhd nude ldn tu nhan). Do do, can thuc hien cdc bien phdp lam gia tang nhdn tfaiic tdm quan trgng cua vi£c tiem ngira vaccine VGSV B lieu sa sinh dung thdi gian quy dBnb cho cdc nha cung cdp dich vu y te.
V. K ^ T L U A N
Ty le tiem chung vaccine VGSV B trong vdng 24 gid sau smh (46,6%) tiidp ban muc tiSu qudc gia. Phat hien cd 36,9% tre sa sinh khdng dugc tiem phdng hodc khdng tiem trong vdng 7 ngdy Id mdt mdi lo ngai dang k l . Ly do chmh ddn den vice tre khdng dugc tiem vaccine VGSV B so smh dung thdi gian quy dinh Id do bdi khdng dugc cung cdp bdi nhdn vien y t6 (53%) hodc tre khdng du sue khde dk tiem ngira (27%). Dia phuong sin song vd cha cd trinh do hgc vdn cao la cdc y8u t6 lien quan dugc tiSm vaccine VGSV B 24 vd dugc tiem lidu so sinh so vdi tre s6ng tai thdnh phd vd cha hgc vdn thdp. ViSc tiem vaccine ngira benh VGSV B dung thdi gian van la mOt thach thiic ddi vdi sue khoe cgng ddng vd cac bien phdp dS tdi uu hda qudn ly kip thdi la rat cdn thiet.
T A I L I E U T H A M K H A O
1. BO Y ta (2012), Quyit dinh 2620/QD-BYT v/v Ban hdnh "Hudng ddn tiiin khai tiim vaccine viem gan B lieu sa sinh ", Ha Ngi.
2. D\r an Tiem chung md rgng (2013), Kit qud tiim chung ma rgng quy IV/2013, Ha Ngi.
TAP CHI Y D i r g e HQC CXN THO - SO 13-14/2018
3. Duong Thi Hong va cgng sir (2015), "Thirc t r ^ g tiem vaccine viem gan B sa sinh t^i huy?n Yen dung, tinh Bdc Giang nam 2015 va mgt s6 yeu t6 lien quan", Tgp chi yhgc duphdng, tap XXVI, s6 1 (174) 2016, trang 3 5 ^ 2 .
4. Ph^m van Linh, Huynh Thi Kim Yen, Lam Thi Thu Phuang (2016). "Nghien ciiu tinh hinh nhilm virus viem gan B v a C tai cdc huy^n thanh ph6 Can Tha nam 2016", Tgp chi YDugc hgc Can Tha. t|p 3-4 (2016), trang 13-20.
5. Biii Huy Nhanh (2012), "Mo hinh triM khai vaccine viem ganB cho tre trong vong 24 gi& dk sau sinh t^ tinh Hai Duong", Bdo cdo hdi nghi chuyen de Tiem chimg ma rgng, irang 25 - 30.
6. Dao Thi My Phugng, V6 Minh Tudn (2015), "Nghien ciiu !>• I? nhilm viem gan B cr phu nCr mang thai va mgt so ygu t6 liSn quan tai tinh Binh Duong nam 2014", Tgp chi Yhgc Thdnhphd Hd ChiMinh>tap 19, so 1 nam 2015.
7. Pham Song (2009), Viem gan virus B, D, C, A, E: ca bdn, hijn dgi vd cap nhgt, Nha xuSt ban Yhoc, HaNpi.
8. Henderson, R,H. and T. Sundaresan (1982), Cluster sampling to assess immunization coverage: a review of experience with a simplified sampling methods, Vol.60(2), pp. 253- 260, Bulletin of the World Health Organiation.
9. Jasseh Momodou, Reiko Miyahara, Pierre Gomez (2016), "Barriers to timely administration of birth dose vaccines in The Gambia, West Africa", Vaccine, Vol.34, pp.3335-3341.
10. Joun W. Ward (2010), "Epidemiology and Global Health Burdem of Viral Hepatitis", Viral Hepatitis: Five Decades of Progress and Promises for the Future, pp. S - 15.
11. Nguyen Tran Hien, Minh Huong Vu, Van Cuong Nguyen et al (2014), "A reduction in chronic hepatitis B virus infection prevalence among children in Vietnam demonstrates the importance of vaccination". Vaccine. 3; Vol.32(2), pp. 217-222.
12. World Health Organization (2005), Immunization coverage cluster suvey - Reference manual 2005, Geneva.
13. WHO Regional Office for the Western Pacific (2007), Report of third expert working group meeting on Hepatitis B, Manila, Phillippines.
14. World Health Organization (2008), Module 7: The EPI coverage survey, in Trainningfor mid-level of managers (MLM), Geneva.
15. World Health Organization (2013), Practices to improve coverage of the hepatitis B birth dose vaccine, Geneva.
(Ngdy nhdn bdi: 14/11/2017 - Ngdy duyjt dang: 05/01/2018)
NGHIEN C i r u TINH HINH STRESS V A © A N H GIA K E T QUA CAN THIEP 6 SINH VlfeN N G A N H Y H O C DU* P H 6 N G TAI TRlT^NG © ^
HOC Y DU'QfC CAN T H O N A M 2016-2017
Phgm Thi Tam', Phgm Trung Tin TruangBai hoc YDugc Cdn Tha
* Email:ptiam@ctump. edu. vn TOM TAT
Dgt van de: Tinh tigng stiess tiong mdi truang gido due dd dirge ghi nhgn la nghiem tigng ban trong nhieu ITnh vuc. ddt biet la d ddi tugng sinh vien. hgc vien tgi cdc tiudng dgi hgc vd cao dangy khoa tien thi gidi. Nhu vgy. nghiin cim ndy dugc tiin hdnh v&i muc dich tgo ca sii cho nhiing nghiin cim tiip theo vi stress a ddi tugng sinh vien cdc ti-udng y khoa. Mgc tiiu nghiin ciru: l)Xdc djnh ti U stress, muc dg stress vd cdc yiu td lien quan a sinh vien ngdnh Yhgc 160
