Y HQC VIET NAM THANG 5 - SO 2^2015
THirC TRANG CONG T A C THONG KE THONG TIN TU" VONG I TAI TRAM Y TE XA CUA HUYEN BAO LAM TINH LAM DONG
Nguyin Phuo'ng Hoa*, Nguyin Dang Vu-ng*, Nguyen Thi Tuyet Nhung*
statistical work at communal health centers lacked cf knowledge and skills and different levels between communes iii the district. The supervision activities for mortality statistics were not conducted regularly.
There are not coordination between departments / units (medical, population network and justice) in the collection of statistical mortality information.
Keywords: health statistics, mortality, VA method
TOIVI TAT
Thong ke thong tin tir vong c6 y nghTa rat quan trong trong viec cung cap cac bang chirng giup cho cong tac hoach dmh chinh sach y te, xay diTng^cac chiTOng trinh can thiep, nham giam ty le mac benh, giam ty xuat tir vong. Nghien cifu mo ta cat ngang di/dc tien hanh nham danh gia thUc trang cong tac thong ke thong tin tir vong tai tram y te xa ciia huyen Bao Lam, tinh Lam Dong n3m 2012. Ket qua nghien Cliu cho thay so lu'Ong THTV dUdc ghi nhan bj bo sot trong giai doan tir 2008-2012 la 5%, rieng nam 2012 ty I? nay la 7%. Ty le khong phii hdp NNTV giiJa so A6 va phu'dng phap dieu tra VA chung ciia toan huyen la 31,2% (xa cao nhat la 61,2% va xa thap nhat la 10%). Nhan lUc tham gia cong tac thong ke tai TYT xa con thieu kien thirc va ky nang va trinh dp I<h6ng dong deu giUa cac xa trong huyen. Cong tac kiem tra giam sat dam bao chat lu'Ong ciia cac thong tin tir vong thu thap tai cpng dong tnen khai khong thudng xuyen. Chu'a co si; phoi hop giO'a cac nganh/ddn vj (y te, dan so va tu' phap xa) trong viec thu thap va thong ke thong tin tir vong
TW khoa: cong tac thong ke y te, tir vong, phu'Ong phap VA
SUIVIMARY
STATUS OF MORTALITY STATISTICS AT COMMUNAL HEATH CENTERS I N BAO LAM
DISTRICT, LAM DONG PROVINCE Mortality statistics is very important in providing evidence to support the developing of health policy, building interventions to reduce rates of morbidity and mortality, The cross-sectional study was conducted to assess the status of mortality statistics at communal health centers in Bao Lam district, Lam Dong Province in 2012. The results indicated that the recorded dead number was missed 5% in the period 2008-2012, special in 2012 this rate was 7%. The rate of cause of death un-matched between A6 books and VA methods of the whole district was 31.2% (61.2% is the highest and lowest as 10%). Health staff who take part in
* Trudng Dai hpc Y Ha Npi
Chju trach nhiem chinh: Nguyen Phu'dng Hoa Email: [email protected] Dt: 0912819186 Ngay nhan bai: BllllOiS
Ngay phan bien khoa hoc: 3/3/2015 Ngay duyet bai: 1/4/2015
I. OAT V A N DE
Thong tin ve mo hinh nguyen nhan tiT vong rat quan trpng, la mpt yeu to can thiet cho qua trinh xay du'ng ke hoach va hoach dinh chinh sach y te. Tir vong la mpt chi so de do lu'dng htJn so vdi nhu'ng chi so y te khac nhu' tinh hinh mac benh. Cac so lieu ve tir vong la mpt trong nhOlig ciii sd y te quan trpng nhat, nham danh gia tinh trang sire khoe va y te cua cac quoc gia, ciing vdi cac chi so thdng ke ve sinh de va tinh trang di cu' [ 1 ] . Ngoai ra, thong tin ve nguyen nhanti^
vong se giiip cho viec danh gia tong the ganh nang benh tat d nhu'ng dia ban khac nhau. Viec tim hieu mo hinh tir vong, du'dc coi la mpt dieu kien quan trpng trong dinh hu'dng cac hoat dong y te va ho t r d viec xay du'ng chinh sach du^ tren bang chu'ng. So lieu thong ke tir vong thu'dng du'dc sir dung nham [ 2 ] : (1) Xac dinh cac linh vy'c cham soc sire khoe can du'dc du tien duS tren hien trang mo hinh benh tat va nguyen nhan tir vong; (2) Lu'a chpn cac can thiep hieu qua ddi vdi nhUng nguyen nhan tir vong co the phdng tranh hoac lam giam nhe du'dc; (3) Danh gia xu hu'dng ciia cac nguyen nhan tir vong qua tirng thdi ky; (4) So sanh mo hinh nguyen nhan tir vong theo cac nhdm (theo vung, theo cac quoc gia hoac giii'a cac ca the theo gidi va nhom tuoi); (5) Lu'dng gia tac dpng ciia cac chu'dng trinh can thiep doi vdi cac nguyen nhan gay til vong. I^ac dii vay, hien nay nhieu quoc gia van chu'a cd du'dc he thong thu thap va dang ky so lieu tot va dang tin cay.
Tai Viet Nam, trong he thong bieu mau bao cao da ban hanh ciia nganh y te, Bp y te da quy dinh cho tram y te thu thap tat c^ cac tru'dng
Y HOC VIET NAM THANG 5 - SO 2/2015
hdp tir vong thupe dja ban xa/phu'dng quan ly dii chet d bat ky ndi nao vao so A6/YTCS [4]. Tuy nhien, do chu'a cd cac quy djnh cu the ve each ghi nhan thong tin, kiem tra chat lu'dng thong tin va bao cao so lieu tir vong dinh ky nen chat lu'dng thong tin ve tit vong edn chu^ bao dam.
Can cd cac nghien cu'u danh gia chat lu'dng so lieu trong so' A6 eiia TYT xa de lap ke hoach can thiep nang cao chat lu'dng sd lieu thong ke va ke hoach sir dung so lieu trong cong tac hoach dinh cac chu'dng trinh cham sdc sire khde can du'dc du tien. Nghien ciTu nay du'dc tien hanh vdi mue tieu: Md ta thWc trang cdng tic thdng ke thdng tin tW vong tai tram y te xa cua huyen Bio Lim, ttnh Lim Ddng nam 2012.
IL OOI TirONG VA PHUONG PHAP NGHIEN CUU 2.1. Oja diem nghien cu'u: Nghien cu'u du'dc tien hanh tai huyen Bao Lam tinh Lam Oong. Bao Lam la mot huyen phi'a nam tinh Lam Oong. He thdng y te cd ban kien toan tir huyen xuong xa va thon ban, cac tram y te (TYT) xa deu cd bac sT, thdc hien kham chu'a benh bao hiem y te ngay tai tram. Ooi ngu y te thon ban da qua dao tao ti^ 3 - 6 thang bo trf du cho 126 thon trong toan huyen.
2.2. Doi tu'dng nghien cu'u: Cac tru'dng hdp tir vong (THTV) tir ngay 01/01/2008 den ngay 31/12/2012 du'dc ghi nhan tir cac nguon:
so A6/YTCS ciia 14 tram y te xa thupc huyen Bao Lam, danh sach tii vong chu sinh va sd sinh ciia dpi cham sdc sire khde sinh san thupc Trung tam
y te Bao Lam, danh sach THTV eiia can bp dan so xa, danh sach THTV du'dc ghi nhan tai td phap xa.
Cac tru'dng hdp tir vong trong nam 2012 du'dc ben hanh phdng van bang bp cau hdi de xac dinh nguyen nhan tir vong (phu'dng phap VA)
2.3. Cac noi dung nghien cu'u:
- Sd lu'dng eac THTV ghi nhan du'dc tir cae nguon sd lieu
- Xac dinh nguyen nhan tir vong (NNTV) bang phu'dng phap VA [5] va so sanh vdi NNTV du'dc ghi nhan trong so A6 ciia TYT xa.
-Tinh hinh nhan lu'c lam eong tac ghi nhan thong ke bao cao thong tin ve tir vong, tai thon ban, xa va huyen. Cong tac kiem tra giam sat chat lu'dng sd lieu tir vong tai cac tram y te xa.
2.4. Phan tich so lieu: Phan tich so lieu du'dc thu'c hien bang phan mem thdng ke Stata phien ban 12.0. Thuat toan Khi binh phu'dng (x^) du'dc sir dung nham so sanh sd khac biet glu'a cac nhdm. Nghien ciru sir dung mire y nghTa a = 0,05 va khoang tin cay 95%.
2.5. So IUdng cac tru'dng hdp tir vong du'dc ghi nhan
Cd 1434 tru'dng hdp tir vong du'dc ghi nhan tir so A6 tir 2008 den 2012 (trong dd cd 341 TTHTV trong nam 2012). Doi chieu vdi so lieu THTV tong hdp tir nguon cpng tae vien dan sd va tu' phap xa cho thay tong sd THTV trong khoang thdi gian dd la 1504 (thieu 70 THTV). Ty le bd sot THTV trong giai doan nay la 5%.
III. KET QUA NGHIEN CU'U
Hinh 1. Ty le bd sdt tru'dng hdp tiT vong d so A6 nam 2012
25
(7%)331 (93%)
Phat hien moi
• Da CO bao cao
Nhin xet: Tinh rieng trong nam 2012, so tru'dng hdp tir vong bj sdt du'dc phat hien them khi kiem tra giam sat, doi chieu cac nguon so lieu la 25 tru'dng hdp, ehiem 7%.
Y HOC VIET NAM THANG 5 - SO 2/2015
Bang 1. Ty le bo sdt trifdnq hdp tir vona theo nhdm tuo'i tai huyen Bao Lam nam 2012.
Nhom tuoi 0 - 9 tuoi 10 - 19 tuoi 20 - 29 tuoi 30 - 39 tuoi 40 - 49 tuoi 50 - 59 tuoi 60 - 69 tuoi 70 79 tuoi
> 80 tuoi Tong cong
Phat hien them Phat hien them
2 1 4 2 5 0 4 0 7 25
Trong so A6 19 17 26 27 37 41 35 54 75 331
Tong cong 21 18 30 29 42 41 39 54 82 356
Ty le (O/o) 9,5 5,6 13,3 6,9 12,0
10,3
8,5 100,0
Nhin xit: Theo ket qua nghien culi thi so THTV bi bo sot gap d hau het cac nhom tuoi, cao nhat la nhom 20-29 tuoi (chlem 13,3%).
Hinh 2, Mile 6q phu hdp nguyen nhan ttr vong d so A6 va cJieu tra VA nam 2012 Khong trung
hop; 31,2%
Triing hgrp:
68.8%
Nhin xit: Ket qua dieu tra cho thay van con 31,2% NNTV duac ghi nhan trong so A6 la chuS dung.
Cac THTV nay du'dc ghi nhan NNTV triTc tiep hoac chung chung nen ichong xac djnh dydc nguyen nhan chfnh gay tii vong.
Bang 2. So sanh mtfc do phii hdp nguyen nhan ttr vonq d so A6 va dieu tra VA theo xa Xa/phirdng
Loc Bac Loc Bao BLa Loc Lam Loc Phu Loc Thang
Loc Ngai
Chan doan Trung hdp n 7 9.
4 8 7 34 44
%
38,8 75 80 61,5 87,5 65,4 86,3
Khong trung hop n
11 3 1 5 1 18
7
%
61,2 25 20 38,5 12,5 34,6 13,7
Tong cong
18 12 5 13
8 52 51
Y HOC VIET NAM THANG 5 - SO 2/2015
Loc DiTc Tan Lac Loc An Loc Nam Loc Thanh Loc Quang Loc Tan
Tong f/ Mire do phii hdp
14 9 26 25 40 9 9 245
77,8 69,2 54,2 75,7 71,4 90 47,4 68,8
4 4 22
8 16 1 10 111 NNTV cd su" khac biet giiTa cac
22,2 30,8 45,8 24,3 28,6 10 52,6 31,2 xa trong h
18 13 48 33 56 10 19 356 jyen. Xa Loc Ba khong phii hdp cao nhat, chlem 61,2%; tiep theo la xa L Tan v ~*',5%. Xa cd ty le khong phii hdp thap nhat la xa L Quang vdi 10%.
Thirc tr^ng nguion nhan lu'c tham gia cong tac thong ke tuT vong
Nhan li/c ciia he thong lam cong tac thdng ke, bao cao tir vong dii ve so lu'dng va cd cau theo quy djnh. Tuy vay, hoat dpng nay chu'a du'dc chu trgng, can bp ehu^ du'dc dao tao, can bp chuyen trach dan sd xa chiem khoang 90% la
khong cd chuyen mdn y te, can bp y te tram hau het la kiem nhiem tir 3 den 4 chu'dng trinh dtran y te qudc gia. Cong tac giam sat kiem tra khdng thu'dng xuyen, viec phoi hdp glu'a ba he thdng d cd sd khong dong bp. Bieu mau thu thap khong thdng nhat nen so lieu chu'a day dii va cap nhat.
Bang 3. Chat lu'dng thdng ke thong tin tir vong va thdi Thdi gian dao tao cho
yte thon ban Chu'a dao tao Dao tao 3 thang Dao tao 6 thang Dao tao 9 thang Dao tao tren 9 thang
Tong cong
gian dao tao chuyen mon Cong tac thong Ice thong tin tu* vong Dung va du
n 8 7 6 24
1 46
%
28,6 41,2 42,8 41,4 33,3
Dung, chu'a day dii n
8 5 5 25 2 45
%
28,6 29,4 35,8 43,1 66,7
Khdng dung n 12 5 3 9 0 29
%
42,8 29,4 21,4 15,5
Nhin xet: Nhdm nhan vien y te thon ban du'dc dao tao cd chat lu'dng thdng ke thong tin tii vong tdt hdn nhdm chu^ du'dc dao tao, sir khac biet cd y nghia thdng ke (p<0,05).
Bang 4. Hieu qua cua conq tac giam sat thong
Cong tac giam sat
Thu'dng xuyen Khong thu'dng xuyen
Khong giam sat
ke thonq tin tit vonq Cong tac thong i<e thdng tin tu' vong Dung, du
n 4 40
2
%
66,7 40,4 13,3
Dung, chu'a day dii n
2 39
4
%
33,3 39,4 26,7
Khong dung n 0 20
9
%
0,0 20,2 60,0
P
0,01
Nhinxit-Ty le thong ke khong dung d nhom khong dUdc giam sat la 60% (p<0,05), sir khac biet CO y nghTa thong ke (p<0,01). Khi cong tac kiem tra giam sat du'dc thirc hien thu'dng xuyen thi chat lu'dng thong ke tir vong du'dc nang len, ty le so lieu thong ke day dii va chinh xac la 66,7%.
Y HOC VIET NAM THANG 5 - S O 2/2015
IV. BAN LUAN
4.1. So lu'dng cac tru'dng hdp tuT vong Trong nam 2012, khi giam sat so lieu thong ke da ghi nhan them 25 THTV bi bo sot chiem ty le 7%. Ket qua dieu tra cho thay ty le bd sdt trai deu d cac nhom, khac vdi mdt so nhan djnh tru'dc dd nhdm bi bd sdt nhieu nhat la nhdm tre em dac biet d nhdm tre du'di 1 tuo'i, dieu nay cd the do chu'dng trinh cham sdc su'e khde sinh san va he thong cpng tac vien dan so d hoat dpng tu'dng doi tot [5],[7].
Ket qua nghien ciru ciia chiing tdi cho thay can trien khai cdng tac tap huan ve thu thap thong tin tir vong cho can bp y te cd sd, ben canh do can trien khai thu'dng xuyen cdng tac kiem tra giam sat quy trinh va chat lu'dng so lieu du'dc thu thap.
4.2. Xac djnh nguyen nhan tuT vong So sanh NNTV du'dc ghi nhan trong so A5 va NNTV du'dc xac dinh bang phu'dng phap phdng van (VA) cho thay cd 68,8% la triing hdp, khdng triing hdp la 31,2%. Xa cd ty le xac djnh NNTV khdng triing hdp cao nhat la Lpe Bac (61,2%) va thap nhat la xa Lpe Quang (chi cd 10%). Trong thdc te neu benh nhan tru'dc khi tuf vong khdng du'dc dieu tri tai cd sd y te viec xac djnh NNTV se gap nhieu khd khan, vi vay can xay du'ng va thi diem quy trinh thu thap thong tin de xac dinh NNTV cho tirng THTV tai cpng dong ma CBYT khdng cd thdng tin ve benh tat/ dm dau [8].
4.3. Cong tac thong ke tii' vong Qua ket qua khao sat chung tdi nhan thay tai cac xa cd cau CBVT nhu" nhau, sd THTV trong nam van d 2 con so, khac nhau d can bp y te lam cdng tac thong ke. Ve dieu kien kinh te xa hdi 2 xa Ldc Bac, Lpe Bao la 2 xa dac biet khd khan, la viing cd 90% la dong bao dan tpc thieu so. Viec thu thong tin ve tir vong cd the bj anh hu'dng mot la ve trinh dp ciia can bp y te lam thong ke, trong dd cd sd thieu phoi hdp ciia cac can bp y te khac tai tram. So vdi thdng tin du'dc ghi nhan trong so A6, khi ap dung phu'dng phap phdng van de dieu tra NNTV se han che du'dc sd tru'dng hdp khdng xac djnh du'dc NNTV (tir 13,9% giam xuong cdn 7%), va neu ap dung chd y te xa cap nhat thdng tin theo tirng thang thi hieu qua se cao hdn vi han che du'dc sai sd nhd lai. Khao sat ve he thong lam cdng tac lam
cdng tac quan ly tir vong tai dia ban (trong dd co ca kiem nhiem), chiing toi nhan thay so lu'dng nhan li/c da dap irng du'dc nhu cau cong viec.
100% can bp lam cdng tae nay ehu^ du'dc tap huan bai ban ma chi lam theo kinh nghiem hoac ngu'di tru'dc chi ngu'di sau theo hinh thiTc bat chu'dc. Cdng tae kiem tra giam sat ve ghi nhan thdng tin va bao cao tir vong khdng chat che cf cac cap lanh dao he thdng, tham chi cd luc co ndi cdn dieu ehinh so lieu tir vong vi thanh tich dja phu'dng.
Nghien cu'u nay eho thay so lieu tir vong cua he thong thong ke thu'dng quy djnh ky du'dc thu thap bdi nhan vien y te thon ban, cdng tac vien dan sd, tru'dng thdn, y te xa, chuyen trach dan sd xa va tu' phap xa da thu du'dc so lieu tir vong, Tuy nhien, chat lu'dng sd lieu tir vong cdn han che do cac ly do: han che ve trinh dp, chda du'dc dao tao ve each ghi nhan thdng ke bao cao thdng tin tir vong dac biet la viec xae nhan nguyen nhan gay tir vong. Do kiem nhiem nhieu chu'dng trinh, cac chi so thu thap ciia tirng he thdng chu'a dong bd, thieu kinh phf hoat dpng, thieu kiem tra giam sat, trong bao cao ddi liic thieu trung thu'c do ehay theo thanh tich vi du nhd dieu chinh sd lieu cho dat vdi chi tieu ciia nghj quyet ve ty le tang dan sd ttr nhien. Mot nguyen nhan khac la do dja ban rdng, bien dpng dan so Idn do di dan ty" do vao lap nghiep nen van de quan ly nhan hp khau khd khan.
V. KET LUAN
So lu'dng THTV tai cdng dong bi bd sdt trong giai doan tir 2008-2012 la 5%, rieng nam 2012 ty le nay la 7%. Chu'a cd su" phdi hdp glu'a cac nganh/ddn vj (y te, dan so va tu' phap xa) trong viec thu thap va thong ke thdng tin tir vong
Ty le khdng phii hdp NNTV giiJa sd' A6 va phu'dng phap dieu tra VA chung ciia toan huyen la 31,2% (xa cao nhat la 61,2% va xa thap nhat la 10%).
Nhan lu'c tham gia cdng tac thdng ke tai TYT xa cdn thieu kien thirc va ky nang va trinh do khdng dong deu glu'a cac xa trong huyen. Cong tac kiem tra giam sat dam bao chat lu'dng ciia cac thdng tin tir vong thu thap tai cpng dong chu^ du'dc trien khai djnh k'/
Y HOC VIET NAM THANG 5 - SO 2/2015
C3n tap huan va hu'dng dan eho can bp tram y te (dac biet la y/bac sy) ve quy trinh thu thap thdng tin ve sd lu'dng eac THTV (phdi hdp vdi nhan vien y t e thdn ban, mang lu'di can bp dan so, tu" phap xa,...); nguyen tac xac djnh NNTV.
TAI LIEU T H A M KHAO
1. WHO (2006). Counting the dead is essential for health the Bulletin interview, http / / www hoint/
bulletin/ volume/84/3.
2. Omran AR (1971). The epidemiological transibson: a theory of the epidemiology and population chang. Milbank 49: 509-538.
3. Setel PW., Sankoh O., Rao C , Veikoff VA., et al (2005). Sample registration of vital events with
verbal autopsy: a renewed commitment to measunng and monitonng vital statistics, Bull World Health Organ 2005, 83: 611-617.
Quyet dinh so 2553/2002-BYT va Quyet djnh so 379/2002-BYT. Ve quy dmh bieu mau va thu thap so lieu tir vong.
World Health' Organization (2005). WHO technical consultation on verbal autopsy tools.
Geneva.
Nien giam thong k*^ huyen Bao lam (2012).
In tai chi cue thong i.^ tinh t i m Dong trang 9 - 20.
Tran Quang Huy (2000). Tfnh chinh xac cua so lieu bao cao tir vong cua he thong theo doi thu'dng --, -^ huyen Ba Vi - Ha Tay. Tap chi nghien cdu , hue. 61(2); 20-25.
DIEU KIEN LAO DONG CUA NGV DAN DANH BAT HAI SAN XA BQ 6" HUYEN V A N D O N , TINH Q U A N G NINH
T 6 M TAT
Dieu kien lao dpng ciia ngu' dan danh bat hai san xa bd d huyen Van Don, tinh Quang Ninh co nhieu yeu to bat ldi den sire khde: Tieng on cao vu'pt TCVSCP, (100% so tau khao sat), vi khi hau ndng (50% mau), dp am thap (25% mau), it gid (100% mau); d ham tau toi (100% mau); co 50% mau do do mng duTig tai thdi diem t3ng toe khong dat TCVSCP. Thdi gian lao dpng dai ngay tren bien (15,9 ± 5,3 ngay/chuyen), vdi 80% lao dpng ban dem. BHLD chu:a bao dam day dii, it sii" dung quan ao BHLD, dac biet kinh (0,3%), khau trang (7%). Thieu phu'dng tien giai tri, nu'de sinh hoat va thu'c pham tu'di song. NgU dan co nhieu thdi quen anh hu'dng khong tot den su'e khoe.
TWkhda: Dieu kien lao dpng, Ngu' dan danh bat hai san xa bd.
SUMIVIARY
U B O U R C O N D I T I O N S OF OFFSHORE
' Tru&ng Cao ding Yte Quang Ninh
** Hpc vien Quan y Chju tracli nhiem chinh: Hoang Hai
Email: [email protected] Ot; 0983358810 Ngay nhan bai: 28/2/2015
Ngay phan bien khoa hpc; 28/3/2015 Ngay duyet biii: 3/4/2015
Tang Xuan Chau*, Dao Xuin Vinh**, Hoang Hai**, Nguyen Hong Hanh*
FISHERMEN I N VAN DON D I S T R I S T QUANG N I N H PROVINCE This paper descnbes the working conditions •^.
fishermen fishing offshore in Van Don district, Quang Ninh province. Research results show that there are many disadvantages to health: high noise exceeding the permissible standards (100% of the survey vessels), microclimate hot (50% samples), low humidity (25% samples), less wind (100% samples);
less light intensity in hatches (100 samples); 50%
sample vibration accelerabon not met hygiene standards allow. Long working bme at sea (15.9 ± 5.3 days/tnp), with 80% of workers at night. Labor protection is not fully secured, less use of labor protecbon clothing, special glass (0.3%), mask (7%).
Lack of recreational facilities, water and fresh food.
Rshermen have many habits affect health.
Keywords: Working condition. Offshore fishermen
I. OAT VAN OE
Danh bat hai san xa bd la nganh nghe truyen thong, lau ddi ciia cu' dan ven bien, hai dad. Moi tru'dng, dieu kien lao dpng ciia ngu" dan danh bat hai san xa bd ludn doi mat vdi nhieu yeu to nguy cd anh hu'dng den sire khde, tinh mang nhu* dieu kien thdi tiet khac nghiet bao gid, rung lac, trdn tru'dt.., dieu kien dinh duQng,
