TY LE V A M O T SO YEU TO LIEN QUAN DEN TL/VONG - 6 TRE D\J6\ 1 TUOI TAI HUYEN BA VI NAM 1999 - 2010 ''''
Tran Kim Thanh, Nguyen PhOdng Hoa TrUdng Dai hoc Y Ha Noi So Hdu td vong, dac biet la ty le td vong d tre dudi 1 tuoi li mot chi sd quan trong cung cap bang chdng cho cdng tac hoach djnh chinh sich y te. Muc tieu: xic-djnh ty Id va md ta mdt sd yeu td lien quan den td vong cua tre dddi 1 tdoi tai huyen Ba VI, Hi Ndi. Doi tugng va phuang phap nghien cdu: dieu tra theo ddi dgc d tre dddi 1 tudi tai ca sd thdc dia djch ti hoc Ba VI. Ket qua: cd 9370 tre - nam theo ddi ddac trong tong so 9639 tre dddi 1 tuoi tai Ba VI td nam 1999 den thing 6/2010. Ty le td vong cua tre dddi 1 tudi la 12,7 tren 1000 tre - nam. Khdng cd sd khac biet ve ty le td vong gida tre trai va tre gai. Ty le td vong trong nhdm tre de non (20,2%o) cao han tre du thing (8,4%o). Tre de nhe cin khi sinh (< 2500g) cd ty le td vong cao han nhdm tre cd can nang binh thddng (97,9%o so vdi 7,9%o; p < 0,01). Ket luan: ty le td vong d tre dddi
1 tuoi ciia Vi&t Nam thip so vdi mot sd nude. Tre de thieu thing va cin ning khi sinh cd sd Hen quan vdi ty le td vong.
TO khda: ty le td vong, tre dOdi 1 tudi
I. DAT VAN DE
Ty le tfl vong tre dfldi 1 tudi dac biet can t h i l t trong viec danh gia q u y l n con ngUdi eung nhU I I dau vao quan trpng trong viec Udc Ifldng tudi thp trung binh. Trong e l c nhdm tfl vong theo nhdm tudi thi ty le tfl vong tre dfldi 1 tudi chju anh hfldng Idn nhat bdi tinh hinh kinh te - xa hdi, d i l u ki|n y t l . Ty le tfl vong t r i dfldi 1 tudi p h i n anh ehinh x l c tinh trang sdc khde cua mdt q u I n the va c h i t Iflpng eua d c dich vu cham see sflc khde cung nhu d c yeu to kinh te - xa hpi.
Mac du sd lieu td vong cd mpt vai trd rat quan trpng, song tren thflc te d nhieu nflde tinh d i y du va chfnh xac cua sd lieu nay edn rat thap. Viet Nam dupe d i n h gia ed ty le td vong d tre dUdi 1 tudi thap hon so vdi d c nflde cd cung d i l u kien kinh te. Tuy nhien, he thdng ghi nhan va danh gia e l c trfldng hdp td vong, dac biet la td vong d tre dfldi 1 tudi cdn ehUa day du va cd nhflng thdng tin k h I e nhau [2, 3].
Cd sd thUe dja djch t l hpe Ba Vi la mpt he thdng theo doi dpc cae sU kien lien quan d i n b i l n dpng dan sd tai Ba V i . Uu diem eua cP sd thflc dia
nay la cd he thdng theo ddi lien tpc trong k h o i n g thdi gian dai nen cd dp tin cay eao hpn d c nghien cflu eat ngang. Chat lifdng sd lieu td vong dfldc thu thap tai FilaBavi da dUdc tac gia T r i n Quang Huy va cdng sfl b i n luan khi sc sinb vdi sd lieu bao eao cua Uy ban nhan dan xa cung nhU Uy ban dan sd. Nhdm t i e g i l thI'y he thdng b i o d o cua Uy ban nhan dan xa t h i l u hut tdi 19% so' trUdng hpp tfl vong, d i l u tra dan so' ( d i l u tra cat ngang) t h i l u 4 % so'trfldng hpp tfl vong, trong khi dd sd lieu cua FilaBavi chi bd sdt 1 trfldng hdp tren cung 1 dia ban vao eung thdi diem [4]. D i l u nay cd the giai thich la do khdng phai mpi trfldng hdp td vong d i u dflpc hp gia dinh khai bao, dac biet la d c trfldng hpp tfl vong d tre dfldi 1 tudi va trd nhd la rat d l bd sdt. Nham mue dich cung cap thdng tin mdt each day du va chinh x l c , giup eac nha hoach djnh chfnh sach xay dflng k l hoach ve y t l ndi chung va cham sdc ba me va tre em ndi rieng, ehdng tdi tien hanh nghien eflu nay vdi muc tieu: , .,.^. .^^ ,.,..; ^,,.,
1. Xac dinh ty le td vong cua tre dddi 1 tudi tai huyen Ba' Vi trong han 11 nam theo doi td nam 1999 dS'n thang 6/2010.
2. Mo ta mgt sd ydu td lien quan de'n td vong d tre dudi 1 tudi tai huyen Ba Vi, Ha Ngi.
II. DOI TUONG VA PHUONG
P H A PNGHIEN CL/U
1 . Dja diem nghien ciifu: tai cd sd thflc dia djeh te hpe FilaBavi thude huyen Ba V i , Ha N p i .
2. Ddi tuong nghien cufu: tre dUdi 1 tudi tai cd s6 thifc dia FilaBavi.
3. Chon mau va c5 mSu
Huyen Ba Vi cd 32 xa. Dan sd toan huyen khoang 235000 ngUdi. Ddn vi chpn m l u la lang, mpt sd l i n g Idn dfldc tach ra de phuc vu cho cdng tac chpn m l u . Toan bp huyen Ba Vi dUde ehia thanh 352 cum vdi trung binh mdi cum ed 146 hp gia dinh va 676 ngUdi. A p dung phUdng p h l p chpn mau nhieu bfldc, ket hdp p h i n tang theo tinh c h i t dia ly (khu vfle m i l n ndi, vung gd ddi va ven sdng); trong tflng t i n g x l c sua't cua nhflng cum dupe chpn vad m l u nghien cflu ty le vdi so' lUdng dan cU cua cum dd (phUdng phap chpn m l u PPS). 69 cum da dupe chpn vdi sd dan la 51024 ngUdi sd'ng trong 11.089 hp gia dinh. Tat d d c hd gia dinh thupe nhflng cum da dUde chpn vao nghien cdu d i u dope d i l u tra phdng van, so' ngUdi thupe m l u d i l u tra dflde theo ddi chiem khoang 2 0 % tdng so'dan eua toan huyen Ba V i .
4. Thu thap sd lieu
Day la mpt nghien cflu t h u i n tap, bao gdm sau eupc d i l u tra cP b i n hp gia dinh (1999, 2 0 0 1 , 2003, 2005 va 2007, 2009) vdi muc dich thu thap thdng tin v l tinh hinh kinh te - xa hpi cda d e hp va thdng tin ca nhan eua tflng thanh vien trong hp. Cd 3 t h i n g mpt lan (hang quy) se ed d i l u tra vien den tflng hp gia dinh de phdng van trflc tiep thu thap ba't ky nhflng thay ddi nao v l nhan khau hpe cua hp gia dinh trong 3 t h i n g vfla qua (nhfl sinh de, thai nghen, td vpng, di dan) va d i l n thdng tin vao mau tflpng Ong ne'u ed sfl kien. Thdi
gian theo doi la 11,5 nam - tO 1/1/1999 d i n 30/06/2010.
Cac dieu tra vien deu dflpc tap huan can than de tie'n hanh phdng van thu thap thdng tin tranh bo sdt sfl kien. Hang thang va cudi moi nam deu cd td chdc hdi thao rut kinh nghiem va t$p huan lai.
De dam b i o tinh chinh x l c va dp tin cay cija sd lieu dieu tra, cd sd thflc dja dich t l hpe FilaBavi da xay dflng quy trinh g i l m sit vdi nhieu cap dp khac nhau. Giam sit vien thflc dia phai dam b i o phong vl'n lai 5% sd hp gia dinh dieu tra dflpc trong tdng ddt. Nghien eflu vien thflc hien viec g i l m sit thu thap thdng tin tai thflc dja, kiem tra thdng tin cCia d c phieu phdng van da hoan thanh, kiem tra sd lieu nhap m i y cua nhan vien van phdng. Ngoai ra, ehfldng trinh ludn nhan dflpe sfl hd trp va hop tie cua chinh quyen dia phfldng va h i u h i t cac hp dan thupe dia ban nghien cflu. Dp vay, cac thdng tin thu thap dflde tai cd sd thflc dia dich t l hoc FilaBavi cd tinh tin cay eac.
5. Phan tfch sd^ lieu
Nghien eflu sfl dung phan men Access 2000 de nhap so lieu, phan tich so' lieu bang phan men Stata phien b i n 10.0. Ty le tfl vong dfldc tinh dUa tren q u I n the theo ddi vdi ddn vj la tre - nam.
Thdi gian theo ddi dUde xae djnh la khoing thdi gian khi tflng e l the bat dau vao m l u nghien edu (tre dUde sinh ra hoae tre < 1 tudi ehuyen den) cho den khi ra khdi quan the theo ddi (chuyen di khdi m l u nghien cdu hoac td vong hoac khi t r i trdn 1 tudi). T h u l t t o l n Khi binh phUdng (x^) dUdc sfl dung nham so s i n h sfl khac biet gifla d c nhdm. Nghien cdu sd dung mde y nghTa a = 0,05 va khoang tin cay 9 5 % .
III. KET QUA
Tdng sd cd 9639 tre dfldi 1 tudi dUdc theo ddi tai cd sd thflc dja djeh t l hpe Ba Vi (tfl nam 1999 den het thang 6/2010) vdi 9370 tre - nam. Sau 11,5 nam thee ddi, cd 119 trfldng hdp td vong cda
tre dudi 1 tudi dupe ghi nhan, trong dd sdtre trai (95% Cl 10,9 - 18,2) va ty le tfl vong d tre gai la la 73 tre va tre gai la 46 tre. Ty le tfl vong chung 10,6 tre tren 1000 tre - nam (95% Cl 7,4 - 13,8).
cho d 2 gidi la 12,7 tren 1000 tre - nam. Ty le td Tuy nhien, sfl khae biet nay khdng cd y nghia vong d tre trai la 14,5 tre tren 1000 tre - nam thd'ng ke (p > 0,05).
1999 -
2003 -
2007 - Nam
- 2 0 0 2
- 2 0 0 6
- 6 / 2 0 1 0
Bang 1. Ty le td
Ty le tfl vong 9 5 % Cl Ty le tfl vong 9 5 % Cl Ty le tfl vong 9 5 % Cl
vong d tre dudi 1 tudi theo
Tre trai 19,0 1 1 , 7 - 2 7 , 5
16,4 8,8 - 2 3 , 2
10,4 5,6 - 14,4
gidi tai Ba Vi
Tre gal 14,3 7,3 - 2 1 , 3
8,3 2,9 - 13,1
9,8 5,0 - 14,6
Tong cong 17,0 11,7 - 2 2 , 3
12,3 7,6 - 16,4
10,1 6,8 - 13,4 Bang 1 cho ta thiy ty le td vong cua tre trai cd xu hifdng cao han tre gai qua cac nam va ty le td vong chung cua 2 gidi giam din theo thdi gian. Tuy nhien, sd khac biet nay chda cd y nghia thdng ke, p > 0,05.
2 5 . 0 0 I
t 2 0 . 0 0
t 15.00
1 10.00
5.00
0.00
D Rat ngheo
• Ngheo D Trung binh oKha
• Giau
1999-2002
2 0 0 3 - 2 0 0 62007-6/2010
T5ng s6 N a m Bieu do 1. Ty le td vong cua tre dudi 1 tudi theo tinh trang kinh teBieu do 1 cho thiy ty le td vong tre dddi 1 tudi thap nhit d nhdm hd gia dinh cd dieu kien kinh giau (9,9%o), tiep theo la cac nhdm cd kinh te trung binh, ngheo, rit ngheo va kha.
Bang 2 cho thay thdi gian mang thai ed lien quan tdi ty le tfl vong d tre dfldi 1 tudi. Nhdm tre bj de non (nhd hdn 37 t u i n ) ed ty le tfl vong cao hdn so vdi nhdjri tre ed thdi gian mang thai du 37 tuan. Sfl khIc biet nay cd y nghTa thdng ke vdi p < 0,01.
Nghien cflu cho thay ty le tfl vong d tre nhe can khi sinh (can nang < 2500g) rat cao 97,9 tren 1000 tre - nam. Trong khi dd nhdm tre ed can nang binh thfldng thi ty le nay chi la 7,9 tren 1000 tre - nam. Sfl
khae biet nay cd y nghTa thdng ke vdi p < 0,01
Ddi vdi trinh dp hpe van cua me, chung tdi nhan thay ehi cd sfl khac biet cd y nghTa thdng ke ve X'^ l | tfl vong cua tre cd me bj mu chO va eae nhdm tre ma me cd trinh dp hpe van cao hdn (p < 0,05).
K i t q u i nghien cflu eung cho thay ty le td vong dfldi 1 tudi la 20,2 tren 1000 tre - nam d nhflng ba me sinh con khi tudi tren 40, ty le nay cd xu hfldng eao hpn cac nhdm tudi khac, sfl khae biet nay chUa cd y nghTa thdng ke (p > 0,05).
Bang 2. Mgt sd yeu td lien quan den ty le td vong d tre dUdi 1 tudi Cac yeu t d lien quan S d t r e tuf vong Tre - nam Ty le 9 5 % Cl
Thdi gian mang thai
Sinh non
(< 37 tuan) 69 3420 20,2 1 5 , 5 - 2 4 , 9 Sinh du thang
(> 37 tuan)
<0,01
50 5950 8,4 6,1 - 10,7
Can nang khi sinh
Nhe can
(< 2500g) 48 483 97,9 7 1 , 4 - 1 2 4 , 4
Binh thfldng (> 2500g)
< 0,001
71 8887 7,9 6 , 1 - 9 , 7
Trinh dp hpe van cua me
Nhdm tuoi eua me
Mu
cho Tieu hpe PTCS PTTH>PTTH
< 2 0 20 - 29 3 0 - 3 9
7 11 74 22 5 - 8
72 17
128 951 5613 2148 530 578 6060 1525
54,7 11,6 13,2 10,2 9,4 13,8 11,9 11,1
19,3-94,1 4,8 - 18,4 10,2-16,2
5,5-14,4 1,2 - 17,6 4,3 -23,3 9,2 - 14,6 5,8 - 16,3
>0,05
>0,05
> 4 0 22 1206 20,2 12,3 - 2 8 , 1
IV. B A N LUAN
Ty le tfl vong d tre dUdi 1 tudi cd xu hUdng g i l m dan qua cac giai doan, tO 17%o (1999 - 2002) xudng edn 10,1 %o (2007 - 6/2010). Day ed the la mpt bang chflng chflng minh hieu q u i cua d e chUPng trinh y te can thiep nhU ehfldng trinh tiem chung md rdng, phdng chdng suy dinh dfldng, phdng chd'ng nhiem khuan hd ha'p cap tfnh (ARI), cham sdc sdc khde sinh san va dac biet la hieu qua cua chfnh sach b i o hiem y te m i l n phf cho tre em (dUdc trien khai tfl nam 2005) [1].
Tfl ket qua nghien cdu tren, chdng tdi nhan
tha'y ty le tfl vong d tre dfldi 1 tudi thupe hd gia dinh ed dieu kien kinh te giau la thap nha't so vdi cac nhdm cd dieu kien kinh te ngheo hdn (9,9%o).
Tuy nhien, nghien edu nay eho tha'y ty le td vong d tre dudi 1 tudi thude hp gia dinh cd d i l u kien kinh t l kha edn cao. D i l u nay ed the la do d nhdm kinh te kha, ngUdi me cd viec lam dn djnh nen cd ft thdi gian cham sdc eon. C i n ed d c nghien eflu sau hdn de tim hieu ngUdi cham sdc tre trflc tiep la ai? Thdi gian bu me d nhdm tre nay la bao lau?
N h i l u nghien cflu tren the gidi cho thay thdi gian mang thai va can nang khi sinh anh hfldng
rat Idn den tinh trang sdc khde va ty le td vong dan qua eae nam. Yeu td thdi gian mang thai, can cua tre [5, 6). Trong nghien cdu cua chung tdi, nang cua tre khi sinh, trinh dp hoc van va dieu nhdm tre bi sinh non (thdi gian mang thai ft hpn 9 kien kinh te cd mdi lien quan den ty le tfl vong thang) cd ty le tfl vong dfldi 1 tudi eao gap 2,4 l l n cua tre.
so vdi nhdm tre sinh du thang. 5 nhdm tre cd can ^ I n t r i l n khai d c chifdng trinh y te can thiep nang khi sinh thap (< 2500g) cd ty le tfl vong cao ^ ^ g , ^ ^^^ 5^.,^ ^hde ba me va tre em, dac biet cho gip 12,5 l l n so vdi nhdm ed can nang khi sinh ^^^ j - j^,^,.,g j|.,^,g^ ^^-^^^ ^g^^^l ^ g ^ ^ ^ ^^ ^^ frj|.,h binh thifdng (> 2500g). Cae y van da chflng minh ^^ ^ ^ ^ ^g-p j|.|g-
thdi gian mang thai va can nang eua tre khi sinh
chiu n h i l u anh hifdng bdi ehe dp dinh difdng, T A l L I E U T H A M K H A O
cham sdc, nghi ngdi cua ba me trong sudt thdi ky 1 . Bp V te (2008),. B i o d o ket qua Chifdng mang thai. Cae y l u td nay chiu anh hfldng eua trinh Cham sdc sflc khde sinh san. Vu Bao ve sdc tinh trang kinh te hp gia dinh, trinh dp hpe van khde Ba me va Tre em, Bp Y te. 1 3 - 1 6
cua ba me, phong tuc tap quan... Tai Viet Nam, i^,^c-,\ D „ ( * i-* • D • '^ ° ' ^ 2. Byass P (2003). Pattern of mortality in Bavi, chuong trinh cham sdc sflc khde cho phu nfl mang . . . . , „ „ „ .^^. ^ J i D ki- ui M T I
" r • G Vietnam, 1999 - 2 0 0 1 . Scand J Public Health; 3 1 : thai va tre em da dflpc t r i l n khai rpng rai tren e l „ . ,
nrfde va da dat difdc n h i l u k i t q u i dang khfch le.
^ . , , . - . , , , , ^, - . , ~ , , 3. Hieu DT, Hanenberg R, Vach T H , Vinh Cac ehi so ve ty le tre de non va tre nhe can khi D Q , Sokal D (1999). Maternal mortality in
Vietnam. Studies in Family Planning; 30: 329 - 338.
4. Huy TQ, Long N H , Hoa DP, Byass, Eriksson B (2003). Validity and completeness of death reporting and registration in a rural district of Vietnam. Scand J Public Health; 3 1 : 12 - 18.
sinh phan I n h hieu qua cua eae ehflpng trinh can thiep nay [1 ].
Nghien eflu cua chung tdi cho thay trinh dp hoc v i n mu chfl la yeu td can trd viec tiep can vdi cac chifdng trinh cham sdc sflc khde. Viee t i l p nhan cac thdng tin ve y te d nhdm mu chfl bi han
che hon so vdi d c nhdm k h I e . D i l u nay la 5- Obed E, Charles Z, Abubakarl S (2010).
nguyen nhan lam eho ty le tfl vong tre difdi 1 tuoi Clustering of childhood mortality in the Kintampo d nhdm nay (54,7%o) cao hdn h l n so vdi d e Health and Demographic surveillance system in nhdm hpe van k h I e . Ghana. Global health action; Sup.1: 8 - 15
„^ „ 6. Syed M, Ahmed H, Muhammad Z, Rumesa R (2010). High concentration of childhood deaths Ty le td vong d tre difdi 1 tudi tai huyen Ba Vi in the low - lying areas of Chakaria HDSS, la 12,7 tren 1000 tre - nam va cd xu hifdng g i l m Bangladesh. Global health action; Sup.l: 70 - 76
Summary
RATE AND RISK FACTORS AFFECT INFANT MORTALITY IN BAVI FROM 1999 TO 2010
Mortality data, specially on infant mortality, are an important health indicator and provide evidence for developing public health action. Objective: to identify infant mortality rate (IMR) as well as describe the association between infant mortality and its risk factors. Method: a cohort study was cpndLieted in the demographic surveillance site in Bavi. Study subjects were children under the age of 1. Results: there are 9639 children under 1 year during the period study. The total children - year we follow - up was 9370.
The infant mortality rate was 12.7 per 1000 children - years. The IMR among premature deliveries (20.2%o) was higher than among full term deliveries (8.4%o). A statistically significant difference between children with low birth weight and normal birth weigh (98.9%o vs. 7.9%o; p < 0.01). Conclusions: The IMR in Vietnam was lower than that in some other countries. Premature delivery and low birth weight were factors related to infant mortality.
Keywords: mortality, infant
GANH NANG BENH TAT DO TL/ VONG S6(M
• • •
6 VIET NAM NAM 2006
Nguyin Thj Trang Nhung^ , Nguyin PhOdng Hoa^, Bui Ngoc Llnh\ Nguyen Thanh HOdng^
'Trifdng Dai hoc Y te Cdng cdng; -Trddng Dai hoc Y Ha Ndi Cinh ning benh tat do td vong sdm duac sd dung de dinh gii md hinh benh tit, giup cic nha hoach dinh chinh sich cd them nhCfng bang chdng cho viec phin bo nguon ldc y te. Muc tieu: ddc Idang ganh ning benh tit do td vong sdm cua Viet Nam nim 2006. Ddi tugng va phuang phap nghien ciiu: chi sd nam sdng bi mi't (Years of Life Loss - YLL) duac dung de dinh gii ginh nang benh tit do td vong. Chi sd nay ddac Udc Idang dda vao sd Idang td vong va ky vong sdng chuan cua tdng nhdm tuoi va nguyen nhin. Nguyen nhan td vong ddac xic dinh bang phdang phdng van (VA) tai 64 tinh/thanh tren ca nddc. Ket qua: nim 2006, tong sd ganh nang benh tit do td vong sdm d Viet Nam ddc Idang vao khoang 9,6 trieu YLLs. Canh ning benh tat do td vong d nd gidi cao hon nam gidi vdi nhdm benh khdng liy nhiim, nhdng vdi nhdm nguyen nhin tai nan thuang tich thi ganh ning d nd thap han. Ket luan: Viet Nam mi't 9,6 tneu YLLs vao nam 2006 do td vong. Cac benh hang dau giy ra ginh ning benh tat do td vong sdm d Viet nam la dot quy, chin thuang va ung thu.
TO khoa: ganh nSng benh tat do td vong sdm (YLL), xac dinh nguyen nhan td vong bang phfldng phap phong van (VA)
L D A T V A N D E
Hien nay, viec danh gia g i n h nang benh tat do tfl vong chu yeu dfla vao eac sd lieu v l sd trifdng hdp tfl vong hoac ty suat tfl vong. Ngoai ra, mpt each khae de do Ifldng g i n h nang benh tat do tfl vong sdm la sd nam sd'ng t i l m tang bi mat (Year of Potential Life Loss - YPLL). Cac chi sd nay tfldng dd'i d l d i l n g i i i va tinh toan nhflng lai han ehe bdi I n h hfldng cua tudi vdi eac van de sflc khde dflde so sanh. Ddi vdi xa hpi, cac trifdng hdp tfl vong d nhdm ngifdi tre, dac biet la tre em thi cd tinh chat nghiem trpng hdn eac trfldng hdp tfl vong d nhdm tudi Idn hdn [5]. Chi sd ganh nang benh tat do tfl vong sdm (YLL) da giai q u y l t dfldc van d l nay bang each xem xet tfl vong dfla vao ky
vpng sd'ng [8]. Chi sd YLL vdi chi sd do lifdng g i n h nang benh tat khdng gay ra td vong (Years Lived with Disability - YLD) ca'u thanh nen ehi sd - Sd nam sdng tan tat hieu ehinh (DALYs - Disability Adjusted Life Years). Cac chi sd va phfldng phap nay do Muray va Aland Lopez dfla ra l l n dau tien vao nam 1993 trong dfl I n do Ifldng ganh nang benh tat toan cau do Td ehfle Y te the gidi va Trfldng Dai hpe Havard thflc hien [8].
D i n h gia g i n h nang benh tat do tfl vong sdm da dfldc tinh toan tai Viet Nam mpt each rieng le tren quy md nhd va sd dung cac so' lieu khac nhau [ 1 , 3). Diem ehung eua cac nghien eflu nay la dung chi sd - So' nam sdng t i l m tang bj mat (PYLL) de do g i n h nang benh tat cho q i i l n the.
