I Tfi'ilG QUAN & NGHIEN Clfu I
Tac ddng cua bidn doi khi hau tdi stfc khoe t r e em
P h a n T h i i y L i n h (*), Ld T h i T h a n h Htfdng (*)
Biin ddi khi hdu dd, dang vd si con nip tuc dnh hudng tdi stfc khoe con ngudi. Theo Chuang trinh Muc tiiu Qudc gia ve iing pho vdi bii'n ddi khi hdu, tre em nam trong nhom ddi tUOng di bi tdn ihucfng bdi biin ddi khi hgu nhu su gia tdng nhiit dg, nudc biin ddng, lu lut, cdc hien tuang thdi tiet ctfc doan, v.v... Trong ngi dung cua bdi tdng quan, nhom ldc gid si di cdp nhffng tdc dgng cua bii'n ddi khi hgu din nhom ddi tuang de bi tdn thuang Id tre em, vd dUa ra mdt sd de xudt nham gidm thiiu nhtfng dnh hudng cua biin ddi khi hgu tdi nhdm ddi tUOng nay.
Ttf khda: Biin ddi khi hdu, tre em, stfc khoe, di bi ton thuang.
Impacts of climate change on child health
P h a n T h u y L i n h (*), Le T h i T h a n h H u o n g (*)
Human health has been affected by climate change. As slated in the National Target Program of Climate Change Response, children are included in the most vulnerable group due to climate change effects such as rising temperature, rising sea level, flood, extreme weather events, elc. In this article, the authors review impacts of climate change on child health and propose some measures in order to mitigate such impacts on this group.
Key words: Climate change, children, health, vulnerable
Cic t i c gia:
(•): Trtfdng Dai hoc Y16' Cong cOng:
- CN. Phan Thily Linh. Bg m5n Stfc khoe Mdi trtfdng, Trtfdng Dai hpc Y te Cong cdng.
Dia chl: 138 Giang V5. Ba Dinh, Hi N^i. Email: [email protected],vii.
- Ths. Lfi Thi Thanh HtftJng, Phd trtfdng BQ mon Stfc khde Moi trtfdng, Trtfdng Dai hoc Y te Cflng c^i Dja chi: 138 Gi3ng Vo, Ba Dinh, HA Npi. EmaQ: [email protected]
4 T a p chi Y tfi' Cdng cdng, 3.2013, Sd 27 (27)
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1.0at van de
Theo To chiJc Y tfi' The gidi (WHO), tic dong trtfc tiep ctia thifin tai ciing vdi bie'n doi khi hau (BDKH) bao gom cac stf kien thdi tiet ctfc doan nhtf 10 lut. bao, han han, sdng nhiet cd the dan den cac hau qua srfc khde nghiem trgng [31]. Tiep can vdi nudc sach va chat Itfdng ntfdc cung hi de dpa bdi sir thay doi moi trtfdng. BDKH anh htfdng tdi san Itfdng cay trong, an ninh Itfdng thtfc va tinh trang suy dinh dtfdng d tat ca cac dd'i Itfdng, trong dd ire em dtfdc cot la doi ttfdng dfi bi ton thtfdng. Tre em cdn dl mac cac benh lay truyin qua thtfc pha'm/ntfdc uo'ng, nhay cam vdi dieu laen thdi tiel. Cac chS't gay 6 nhilm trong khong khi cdn cd the dan tdi cac bfinh dtfdng hd hap ma tre em dfi bi tdn ihtfdng nhtf benh hen suyen [4, 6]. BDKH con anh htfdng tdi stf phan bo va so Itfdng cac loat vat chti, ttf do anh htfdng tdi s6 ltfdng vector va stf lay truyen benh sdt ret, sd't xu§'t huyfi't [21]. Thien tai, lu lijl va han han khifi'n ngtfdi dan phai thay ddi chd d, gay ra nhtfng khd khSn trong vific tie'p c^n dich vu y te [27]. Do stf phit tridn nhanh chong ca ve the cha't va nhan thtfc nen tre em dl bi tdn thtfdng bdi nhiJng nguy cd sinh hpc, hda hoc va vat ly tir mdi trtfdng do BDKH hdn la ngtfdi trtfdng thinh [4].
Bai vie't nay se irinh bay sd bp tdng quan ve BDKH va cac hau qua cua BDiCH tdi stfc khoe tre em.
2. Phiftfng phap nghien cvln
Tai lieu stf dung cho bai tdng quan dtfpc tim kie'm tren cd sd dff lieu PubMed, trang web cua Uy ban Lien Chinh phu ve Bifi'n ddi khi h$u (IPCC), Bo Y te', Bp Tai Nguyen vS Mdi trtfdng. CSc tai lieu dtfdc phat hanh ttf nam 2000 de'n thang 4 nam 2012, Ttf khda dtfdc diing de tim kifi'm tai Ueu la "chmate change", "child health", "bifi'n ddi khi hau". Cac tai li?u dtfdc tfu tifin chpn la cac bai bao tdng quan. Cac lii lieu cung cS'p thdng tin ve tac dong cua bie'n ddi khi hau dfi'n stfc khoe tre em va mot so' bien phap tfng phd vdi bien doi khi hau. Cac tai lieu diu dtfdc stf diing dtfdi dang ban day dii (full - text), Cac npi dung trong bai bao nay chi stf dung 31 tai heu tbam khao da dtfdc gidi han ndi dung ve bien ddi khi hau (5 tii lieu), tac dpng ciia bifi'n ddi khi hau de'n srfc khde tre em (21 tai li$u) va cac bifin phap rfng phd vdi bifi'n ddi khi hau (5 tai lieu).
3. Kg't qua nghidn cihi 3.1. Tdng quan ve bien ddi khi hqu
Theo IPCC (2007), cac hoat dpng ciia con ngtfdi, chu yeu la vi^c ddt chiy cic nguyen lieu hda thach, pha rirng da lam tang ndng dp khi CO2 trong khi quydn len hdn 30% kd ttf cupc each mang cong nghiep ttf the'ky XIX [19], Thtrc vgy, nong dp khi CO2 trong khi quyen da lang itf 230 ppm tif thdi cich mang cong nghifip len khoang 380 ppm vao nam 2005, va hi#n nay nong dp khi CO2 dtfdc xem 11 cao hdn cic miJc trong suo't giai doan 650.000 nam gan day [18]. Theo Cd quan Bao ve Mdi trtfdng Hoa Ky (EPA, 2009), tinh tren toan cau. ltf(?ng khi thai nha kinh vao khi quydn do hoat ddng cua con ngtfdi tang 26% trong giai doan ttf 1990 - 2005 [15].
Nhifit dp be mat trai dS't da tang xi'p xi 0,6°C, trong dd khoang 2/3 sir ndng len bat diu til nam 1975 [30]. Cac nha khoa hpc dtf doin rang hien ttfdng ndng len cdn xay ra manh hdn niJa, k^o theo dd la stf thay ddi vl Itfdng mtfa va khi hSu cua trai dat trong the ky 21 [19].
Theo IPCC (2007), mtfc ntfdc bien toan clu da tang ngay cang cao trong the' ky 20. So' heu quan irac mtfc ntfdc bidn trong giai doan 1961 - 2003 da cho tha'y mtfc ntfdc bidn tang trung binh ttf 1,8 ± 0,5 mm/nam. So' li?u do dac ttf ve tinh TOPEX/POSEIDON Irong giai doan 1993 - 2003 cho thay tdc dd tang cua mtfc ntfdc bien trung binh toan clu la 3,1 ± 0.7 mm/nam, nhanh hdn dang ke so vdi thdi ky 1961 - 2003. Theo dif doin cua IPCC.
dfi'n giffa nhtfng nam 2090 mtfc ntfdc bien se lang vdi td'c dd khoang 4mm/nam, tijy thudc vio tiftig khu vtfc dia 1^ [18].
Ngtfdi ta da quan sat thay nhffng thay ddi cd bien dp rpng cua cac dilu kien nhifit dp ciTc doan hay nhiet dp khac nghiet (extreme temperatures) trfin pham vi toan thfi' gidi trong vdng 50 nam qua.
Nhffng ngay lanh, dem lanh va nhffng ngay cd bang, tuye't it xuS't hien hdn, trong khi nhffng ngiy ndng, dem ndng vi cac ddt sdng nhiel xua't hien thtfdng xuyen hdn [ 10,14]. Cac dilu kien thdi tifi't ctfc doan do BDKH giy ra thtfdng hen quan den thien tai nhtf bao, 10 lut, han ban va nhffng vti chiy rtfng ldn.
BDKH da gdp phan lim tang tan sua't xua't hifin cua cic thien lai ndi tren [18].
3.2. Tdc dqng cua bien doi khi hqu tdi silc khoe tre em
3.2.1. Nhtfng chdn thuang ve the chdi Dudi nudc
Hifiu rfng nha kinh lam cho nhiet d§ trong khong
Tap chi Y te Cdng cdng, 3.2013, Sd 27 (27) 5
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ichi a'm len, dan tdi dp am trong khdng khi tang va ntfdc bdc hdi nhanh hdn, lam tang tan suat cua cac cdn bao vi nhffng trSn Iu lut, giy ra nhflng anh htfcing dfi'n tre em [4, 24]. Trong mpt tran lu lut d qu$n Sarlahi cua Nepal, ty lfi trf vong hen quan ddn 10 lut ciia tre em cao gi'p 6 lln ty lfi tff vong cua ngtfdi din trong khu vtfc mpt nam trtfdc khi Iran 10 lut dien ra. Ty 1$ trf vong trong nhdm dan sd dtfdc ghi lai la 13,3/1000 ddi vdi ire nff vi 9,4/1000 ddi vdi tre nam. Trong dd, tre em ttf 2 - 9 tuoi cd kha nang bi tti" vong cao gap 2 lan so vdi bd^ hoac me [28], Tre em so'ng d vung ddng bang ngap lu cd nguy cd cao bi dudi nUdc, do tre em khong biel bdi va cdn phij thuoc vio ngtfdi ldn trong trtfdng hdp khan ci'p. Ddt dilu tra y id va tai nan thtfdng tich d Bangladesh nam 2003 vdi hdn 171.000 hp gia dinh iham gia da cho thi'y rang dudi ntfdc la nguyen nhan hing d^u din tdi ttf vong d tre em dp tudi ttf 1 - 18.
Cung theo dilu tra nay thi gan 17.000 tre em d Bangladesh hi dudi ntfdc mdi nam [28].
Nguy ca dnh hudng do cdc dp lUc ve nhiit (song nhiit/sdng lanh)
BDKH lam tang ca ve tin sui't vi ctfdng dp cua cic ddt sdng nhiet, din tdi ty lfi ttf vong vi mac cic bpnh nghiem trpng tang len, dac biet d tre em. Tre em khd cd the kiem soit dtfdc nhipt dp cua ban than, die biet nfi'u mpt ddt sdng nhiet dien ra dot ngpt vi nghiem trpng [27]. Mpt nghien ctfu ciia Knou'lton vi cdng sir da chi ra rang trong ddt sdng nhi^t nam 2006 d Cahfornia, sd' tre em tff 0 - 4 ludi phai tdi phdng khim cap ctfu do mi't can bang difin giai tang Ifin so vdi nhffng giai doan khong cd sdng nliiet [26]. Tic dpng ctia cic dieu kien nhifit do ciTc doan tdi stfc khoe ci5a tre em chtfa dtfdc nghifin ctfu mpt each day dii, dac bifit 6 nhffng qud'c gia dang phit trifi'n [5].
3.2.2. Nudc sack va cdc binh lay truyin qua nudc
Nudc sgch vd chdt luong nudc
BDKH lam giam stf tie'p can cua con ngtfdi vdi ntfdc sach va cic he thd'ng ve sinh, gay ra nhifng hau qua nghiem trpng tdi stfc khde cua tre em [13], Theo nghien crfu cua Bates vi cpng stf, tic ddng ciia BDKH theo khu vtfc se lam cho radt ntfa dan so' toan cau sdng gan lutf vifc song hi khan hie'm ntfdc vao nam 2050 [7]. Thifi'u ntfdc se din tdi han hin k6o dai lam giam ca vl so' Itfdng va chat Itfdng ciia cic ngudn cung ca'p ntfdc. tff dd din tdi trf vong, suy
dinh dtfdng, cac benh tmyln nhilm va benh dtfSng ho hap [13]. Lii liJt cdn cd the din tdi ngudn ntfdc bi d nhifim do cic kim loai ning, hoac cac chat dpc hai khic ttf cic binh chrfa hoac c^c hda cha't da tdn tai trong moi trtfdng nhtf thud'c trff sau. Cic kim loai nang trong dd cd chi cd the' gay anh htfdng Idn tdi stfc khoe tre em. Cac kim loai nang va mpt so^chat dpc khic cd the qua nhau thai va cdn di vao sffa me, 1am anh htfdng tdi stf lang trtfdng va stf phit trien cua tre. Khi tre cai sffa me, tre cd nguy cd phdi nhiem vdi cac chat 6 nhifim cd the cd m|t trong sffa ngoai, ntfdc udng va thifc pham [20].
Cdc binh lay truyin qua thtfc phdm vd nudc udng Tifiu chay li nguyfin nhan gay ttf vong hang dau d tre em, hiu hfi't cac ca trf vong la do nrfdc bi 6 nhiem, dieu kien ve sinh khong dam bao. Moi nam cd gin 2 tri?u em ttf vong do benh tieu chay. BDKH dtfdc dtf doin se lam tang ty 16 mac va mtfc dp trim trpng cua benh tieu chay [8, 12]. Mpt nghien ciJu ve mdi lifin quan giffa ntfdc sach va benh tifiu chay tie'n hinh d rapt sd dao khu viTc Thai Binh Dtfdng da chi ra rang tre sd sinh vi tre nho die biet de bi tdn thtfdng bdi tifiu chay [4]. Rotavirus vln li nguyfin nhin hing dau din tdi lifiu chay 5 tre em, Cic ye'u td nhtf nhiet dd cao, dp ^m tbap va mifc ntfdc song cao da lam tang ty le mdi m^c cua benh tifiu chay do rotavirus d Dhaka, Bangladesh [4]. Ty le ttf vong cua tre era do lieu chay d cic ntfdc cd thu nhap ihap, dac biet d khu vtfc can Sahara luon d mffc cao mgc dil da cd nhiJog cai thifin trong vific cham sdc va stf dung lieu phip bU ntfdc qua dtfdng udng. Tre em d khu vtfc nay cd the sd'ng sdt sau khi trai qua cic can bfinh cap tinh nhtfng sau dd Iai ttf vong do tieu chay keo dii hoic suy dinh dtfdng [9].
Theo Yoko va cpng stf, tre em phai chiu ginh nang ldn nhi't do bfinh ta d mot sd ntfdc nhtf Indonesia, An Dp va Mozambique [4].
3.2.3. Cdc benh dudng ho hdp
BDKH lifin quan tdi 6 nhiem khdng khi d ca hai khia canh nguyen nban (thai cic khi gay hifiu ffng nha kinh) va khia canh anh hrfdng (cac ddt song nhiet d cac khu vtfc do lhi lam tang ndng do cac chi't 6 nhifim trong khong khi) [4]. Mpt chi't gay 6 nhilm khong khi pho bifi'n la hat bui min (PM), cd mdi lien quan vdi sif gia tang cac ca benh di tfng va hen suyen [14]. Tre em dac bifit dfi bi tdn thtfdng bdi cac benh gay ra do 6 nhilm khong khi do phdi cua ire em con dang trong giai doan phat trien va nhip th6
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ciia tre em cao hdn ngtfdi trtfdng thanh. Phoi cua tre chtfa phat trien hoan thien se khd cd thd hdi phuc hoan loan sau tdn thtfdng [4]. Ty le smh non, tre nhe can, va irf vong sd sinh diu ting len d nhffng cdng ddng cd ndng dd chat hat min cao [24]. Nhifit dp khong khi am Ifin thtfdng di kem vdi ndng dO d zon ting cao. 0 nhiem 6 zpn mat dal li mpt chat giy kich thich pbdi, lam anh hrfdng ldi mang nhiy cua he hd ha'p, cac mo phdi va chtfc ning ho ha'p. Phdi nhilm vdi ndng do cao d zon lim tang sd' ca nh|p vien do viem phdi, hen suyfin, viem mui di ffng, va ca trf vong sd sinh. Theo danh gii cua Perry va cpng srf, BDKH vao nhffng nam 2020 cd the lam tang sd ca cap ctfu phai nhip vifin do hen suyfin cua tre tff 0-17 ludi 6 khu vtfc trung tim cua thanh phd New York len khoang 7,3% [12, 25).
3.2.4. Cdc binh lay truyen qua vector Sdt ret
Stf phan bo' va lay truyen theo miia cua bfinh sdt ret bi anh htfdng bdi BDKH vi ca vector va ki sinh triing (KST) diu nhay cam vdi nhiet dp [29].
Nhiet dd anh hrfdng tdi tdc dp phit trie'n cua KST sdt rfit trong vector li mudi va ca tdc dp phit trien cua mudi. Sdca sdt rfit mdi mac tang Ifin d cic vung mien mii cua Kenya cd mo'i lifin quan vdi Itfdng mtfa vi nhiet dd tang cao 3 - 4 thing trtfdc dd [17].
Theo WHO, hang nam cd ttf 350 - 550 trieu ca mac so't rfit, trong dd hdn 1 trifiu ca ttf vong. Do he mien dich chtfa phit trien hoan chinh nfin Ire em cd nguy cd iff vong cao bdn, 75% cic ca iff vong do sd't ret xay ra d tre em dtfdi 5 tudi [4]. B$nh sdt ret giy ra bdi KST Plasmodium, lay truyen ttf ngtfdi niy sang ngrfdi khic qua vfi't dd't ciia mudi Aonopheles mang KST. Day la mpl va'n de srfc khoe die biet nghifim trpng d chau Phi, vdi 20% sd' ca ttf vong cua tre era khu vtfc niy la do sdt ret [20]. Theo tfdc tinh cua WHO, d khu vtfc can Sahara cd khoang 250 trieu ca sd't ret trong dd 90% gay ra bdi Plasmodium falciparum, din tdi 881.000 ca ttf vong vio nam 2008, trong dd 80% cic ca ttf vong niy xay ra d tre em dtfdi 5 tudi [3].
Sdt xudt huyit
Sdt xua't huye't Dengue (SXHD) lam anh htfcing tdi 50 - IOO trieu ngtfdi mdi nam. vi giy ra hang chuc nghin ca ttf vong 6 tre em [23]. Nhffng dinh gia vl thay ddi trong gidi han dia If cua lay truyen SXHD tinh de'n yfi'u tp' BDIGl va dan so' da chi ra rang 50 - 60% din sdtoan cau se bi anh htfdng b5i
sdt xuat huylt vao cudi the' ky 21. SXHD anh htfdng tdi ta't ca cac dd tudi. luy nhien ganh ning bdnh tat va phan ldn cic ca ttf vong do SXHD cao nha't d nhdm tre em. O mdt sdqudc gia chau A. SXHD la nguyen nhin hang dau dan tdi cac ca nhap vi#n va trf vong cl tre em [4,16]. Udc tinh c6 khoang 1/3 dan sd toan clu dang sdng cl nhiJng khu vtfc cd khi hiu phu hdp cho stf lay truyen virus dengue. Ltfdng mtfa cao va nhiet dp cao cd the lim ting srf liy nhifim, tuy nhien cic nghien ciJu cdn chi ra rang ban hdn cOng cd the la mdt nguyen nhan do cic vgt dting chtfa ntfdc trong gia dinh lang Ifin, tao dilu kifin thuan ldi cho moi trtfdng sinh san cua raudi [9].
3.2.5. Suy dinh dudng
BDKH giy ra cac dieu kien thdi tifi't cifc doan lim tram trpng hdn tinh trang suy dinh dtfdng [11].
Cac dilu kifin thdi tiet ctfc doan nhtf han han va 10 lut lam de dpa tdi nang sua't ciy trdng va nang sul^t chan nuoi. Do vay, BDKH tic dpng trtfc tifi'p de'n an ninh Itfdng thtfc va lam tram trong hdn tinh trang suy dinh dtfdng 5 tre em [22]. Suy dmh dtfdng la nguyen nhin cd ban din tdi it nhi't 3,5 irifiu ca trf vong mdi nim, va 1/3 trong so'nay la tre em dtf(3i 5 tudi. Tre em bi suy dinh dtfdng man tinh trong vong 2 - 3 nam diu ddi cd the bi tang trtfdng chira va anh htfdng dfi'n kha ning hpc tap. Tre nhe can con cd h^ mien dich yfi'u nfin tre de mac cic bfinh nhilm trung [II, 20]. Mpt nghifin crfu da dtfpc tien hanh d mpt vOng sa mac cua An D6 de tim hieu lic dpng ciia han hin de'n tinh trang dinh dtfdng cua tre em 0 - 5 tudi.
Tmh trang dinh dtfdng cua tre em trong nghifin cffu dtfpc danh gii bdi sd lieu nhSn trac hpc, che dp in uo'ng va cic da'u hieu lam sing ctia thie'u hut dinh dtfdng. vi kdt qua cho tha'y ca suy dinh dtfdng the gly com va suy dinh dtfdng the cdi cpc, cic di'n hifiu suy dinh dtfdng trong thdi gian ng^n vi ca trong thdi gian dii [4].
3.2.6. Di cuvd tiep can vdi cdc dich vu y te cabdn
Phil nff vi tre em chiera ty le ldn trong so'nhffng ngtfdi mat ndi 5 do thien tai. Stf di din, thay ddi chd 6 thtfdng giy nhffng anh htfdng hit ldi cho tre em nhtf lam tang nguy cd tre bi lam dung va buon bin.
Nhffng gia dinh ngheo mat chd d ihtfdng phai sdng 6 vung ngoai 6 cd cd sd ha tang kfim. gan vdi nhffng khu cong nghiep, tie'p xtic vdi cha't thai ddc hai [4].
Td chtfc Bao ve Tre em cua Anh da tfdc tinh rang hang irieu tre em se bi giet hai, va cd nguy cd hi ddi.
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bfinh tat, hi l a m dung ca v l the cha't v i tinh diJc khi dictf [11]. N g o a i ra c i c can t h i e p v e y t e c h a n g h a n nhtf tifim vac xin ( d i e biel vdi b ? n h s5i) cd t i c d d n g q u a n trpng dfi'n stf sdng sdt cua tre era, nhtfng thtfc le' tbi rat k h d k h a n d e tie'n h a n h nhffng can t h i e p y t e ' n i y irong nhdm dan s d k h o quan Iy. T r e e m hi suy dinh dtfdng v i phu nff m a n g thai la nhffng n h o m ddi ttfdng CO nguy cd cao khi h p di chuyfi'n tdi nhffng khu vtfc b e n h sdi r e t ltfu h i n h . Di dan tao d i l u kifin thuan ldi cho stf lan rpng cua ki sinh triing sdt rfit P.
falciparum k h a n g thudc chloroquine, d a c bifit d nhffng ngtfcfi ti nan d D o n g N a m A va N a m A [4].
3.3. tJngpho vdi bien doi khihqu 3.1. Thich tfng va gidm nhe ldc dong cua bien ddi khi hau
Chung ta chi cd the' giam nhe v i thich ffng vdi BDKH do d a y la mpt q u i trinh khdng the d a o ngtfdc dtfdc. Nhffng ntfdc dang p h i t trien dang p h a i ddi m a t vdi nguy cd ldn hdn ttf B D K H , nd t i e dpng tdi srf phSt trifin kinh te - xa hpi va kha n a n g dfi bi tdn thrfdng cua con ngtfdi [ 1 , 2 ] . H^ tho'ng canh b a o sdm c i c ddt sdng nhiel da drfdc thrfc hifin n h a m canh b i o cho ngrfdi d a n va chinh q u y l n ve dich b e n h cd the bung phat dtfa vao drf b i o v l thdi tiet va mdi trrfdng.
Nhffng drf b i o theo mua cd the dtfdc stf dung d e tang kha n i n g phiic hdi vdi BDICH. bao gdm ca iham hpa lien quan d e h thdi tiel [9]. C i c bien p h a p giam nhe B D K H p h a n ldn lap trung vao nguyfin nhan gay ra BDKH, do l i han chfi'va giam thieu str p h i t thai c i c Ichi n h i kinh. T h e o IPCC, can thie't p h a i cat giam tff 60 - 7 0 % khi thai gay hieu ffng trfin toan cau d e c i n b a n g n d n g dp c i c khi gay hieu tfng nha kinh trong khi quyen va ban che'nhifng thifit hai cho h e sinh t h i i cOng nhrf cac h ? ly sinh k h i c [27].
3.2. Su tham gia cua ire em vao cdc chuang irinh tfng phd vdi bien ddi khi hdu B a n g 1 dtfdi day la mpt sd boat dpng ffng phd vdi BDKH lifin quan de'n tre e m . C i c boat dpng n a y c l n cd stf tham gia ctia tre em trong cac gia dinh, trtfdng hoc va d cpng ddng.
K^'t l u S n va k h u y g ' n n g h i
Hifin nay chrfa cd nhieu n g h i e n ctfu v l t i c dpng
Bdng 1. M0t sdhoat dQng tfng phd vdi BDKH lien quan din tre em
H o a l W o g
G i i o d u c k y nanj i 6 i i g k ^ i b«p vdi pi<oaiic mSi m i ^ j ^ l^nc ^ b f p rnai ctiuODg Inab gido due. bao fflm Uius lioc. [D^Q b?c site U i t e . Danf ao mnb do nhan Ihil^ ve faieii dai khi b5u Giam nil rn UiiCn lai va sir chuan b| i,U saag
n | u y a l
• Chu^nbiilo.taiiE ustAa.
Dao lao n j l i l Lrong ihirang m(i, lam netiep, chim s6c !ifc Lhoe, v v de g l i i quy^[ ian ii 5uv Uioii miii inWiig va t^fi cflui Sn nSc lam cho dianh men
• T i f p cSn v A nbOng ibaoh men kbong di bqc
• Cdi Ihicr Iiep cjn vdi 111I& such
• Cai diicD tx^p ^ n vdi r l u ^ iddn^-
Khuyfn Lhich n i n ^ luong ihaj t h f 3 dc aisint hgc v i ming iSin v \t
• U n i v i h v d i Q u ; K l b i t u a n E T D i n c l u D u i n p f a i i t n f n u i a e
• C i c chi^n dich \im kach dc ccm sbng.
• G l i m sJtvAbSo t i l cdc Tram cung cfp nirdc
• B i o hiftn rti ra
• Ninn cao nhin ihdc i i i c hien phip toeni soSt b ohiim) D i i d i ^ 0 inrang boc va cflng doog
d tnifltij hoc VB i f l n g Jong
miVnehoc
d m / d n g h o c v i i f i m g i ^ y
congdin?
Nguon : UNICEF (2008) [I]}.
cua BDKH ldi srfc khoe con ngrfdi tai Vifit Nara, dac bifit chtfa cd nghifin ctfu 6 ITnh vtfc t i e dpng ciia BDKH tdi stfc khoe ciia tre e m C i c n g h i e n ctfu da chi ra r i n g c l n tfu tifin nhdra dd'i Itfdng tre era trong c i c bifin p h a p giam thieu nguy cd chung cua cdng ddng do bifi'n ddi khi hau. Do vay, n h d m l i c gia cd mpt s6' khuyen nghi nhtf sau:
- Cdc chinh phd vd cdc co quan qudc ti, cdc td chtfc cdn ddy mgnh han ntfa cdc hdnh ddng/chuong trinh nham tiin ldi gidm thieu luang khi nha kinh duoc thdi vdo khi quyen.
- Can cd cdc nghiin ctfu, cdc chucmg trinh ddnh gid tdc dgng cua BDKH ldi stfc khoe cUa con ngudi noi chung, ddc biit Id stfc khoe cua tre em.
- Long ghep cdc vdn di cUa tre em vdo vdn bdn chinh sdch liin quan din BDKH: Cdc ban ngdnh cdn phdi tham gia vao qud trinh hinh thdnh cdc vdn bdn chinh sdch deddm bdo rang cdc nhu cdu cua Ire duac ddp tfng.
- Tdng cudng gido due moi trudng vd ky ndng song cho tre.
- Ddm bdo stf tham gia cda tre em trong nhtfng no Itfc thich tfng vdi BDKH.
8 T a p chi Y tfi' Cdng cdng, 3.2013, Sd 27 (27)
ITd'NGOUAN&NGHIENCirUI
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Ti^ng Anta
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