2005至2014年恩施州5岁以下儿童死亡原因分析

邓仕清

(恩施州妇幼保健计划生育服务中心保健科，湖北 恩施 445000)



【医学荟萃】

2005至2014年恩施州5岁以下儿童死亡原因分析

邓仕清

(恩施州妇幼保健计划生育服务中心保健科，湖北 恩施 445000)

目的了解恩施州5岁以下儿童主要死亡原因变化情况，为寻找进一步降低5岁以下儿童死亡率的干预措施提供依据。方法对2005～2014年恩施州5岁以下儿童死亡资料进行描述性统计分析。结果2005至2014年，恩施州5岁以下儿童死亡率由20.9‰下降至8.5‰，婴儿死亡率由为17.5‰下降至6.1‰，新生儿死亡率由11.7‰降至3.4‰，自2011年起实现了联合国千年发展目标，两个时段死亡率比较差异有统计学意义(χ2=234.525，P<0.05)。前5位死因依次为肺炎、早产或低出生体重、出生窒息、意外窒息、先天性心脏病；前后两个时段相比，肺炎、早产或低体重、出生窒息、意外窒息构成比分别下降了0.7%、1.1%、3.7%、0.3%；先天性心脏病构成比上升3.5%。死亡儿童就诊情况改善，住院治疗比例上升12.6%，未就医比例下降13.1%；5岁以下儿童死亡未治疗或未就诊原因主要是来不及送医，占72.3%，比例上升了23.9%。结论恩施州5岁以下儿童死亡率显著下降；死亡原因中，前五位5岁以下儿童死因顺位变化不大，但溺水、交通事故等儿童意外死亡增加，因此，需要有针对性地加强健康教育和健康促进工作。

5以下岁儿童；死亡率；死亡原因；变化趋势

[Abstract]Objective To understand the change of major causes of child death in children under 5 and to provide evidence for interventions to further reduce mortality of them. Methods Descriptive analysis was conducted on children death data from 2005 to 2014. Results The mortality of children under 5 in Enshi Prefecture dropped from 20.9‰ to 8.5‰, that of infants dropped from 17.5‰ to 6.1‰, and that of neonates dropped from 11.7‰ to 3.4‰. The dropped mortality had achieved the Millennium Development Goals since 2011.There was significant difference in mortality between two periods (χ2=234.525,P<0.05). Pneumonia, premature birth or low birth weight, neonatal asphyxia, accidental asphyxia and congenital heart disease were the leading five causes of child death. Among these five leading causes, the constituent ratios of pneumonia, premature birth or low birth weight, neonatal asphyxia and accidental asphyxia decreased by 0.7%,1.1%, 3.7% and 0.3%, respectively, while the ratio of congenital heart disease increased by 3.5%. The utility of health service increased, with the proportion of inpatient children increased by 12.6% and the proportion of untreated children decreased by 13.1%. Delay or being late to hospital accounted for 72.3% of children without health care-seeking, which increased by 23.9%.Conclusion Mortality of childrem under 5 declines significantly. Among the death causes, the rank of first five causes change little, but the mortality due to drowning or traffic accident increases. Therefore, health education and promotion work should be strengthened.

[Key words]children under 5 years; mortality; death cause; change trend

5岁以下儿童死亡率是国际公认的衡量一个国家社会经济、文化发展和国民健康水平的重要标志，也是政府部门进行妇幼卫生工作计划、管理和决策的重要依据。恩施州地处湖北西南端，境内居住地全部为山区，是中国最年轻的少数民族自治州。本文对恩施州2005至2014年5岁以下儿童死亡资料进行分析，以期了解恩施州5岁以下儿童主要死亡原因变化情况，为进一步降低5岁以下儿童死亡率和寻找有针对性的干预措施提供依据。

1资料与方法

1.1资料来源

资料来自2005～2014年恩施州8个县(市)利用三级妇幼保健网络上报的儿童死亡报告卡及妇幼卫生年报，由专人进行审核、整理，共收集5岁以下儿童死亡报告卡6 006例，均为本地户口。

1.2方法

按照《中国5岁以下儿童死亡监测方案》要求进行填写和整理死亡报告卡，死因分类按照国际疾病ICD-10进行，并对所有5岁以下儿童死亡卡进行汇总分析。……