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目的了解云南省孕产妇健康管理服务现状,为下一步工作提供依据。方法对云南省妇幼卫生年报表数据、现场报表数量复核和现场质量抽查孕产妇健康管理服务情况,死亡孕产妇监测及评审,以及基层医疗卫生机构设备、人员配置情况等进行调查与分析。结果 2014年妇幼卫生年报表显示全省孕产妇健康管理率为96.18%,孕早期检查率为94.39%,产后访视率为97.76%,高危产妇管理率达99.97%,孕产妇系统管理率为93.90%。现场抽查的孕产妇健康管理率、孕早期检查率和高危产妇管理率均低于妇幼卫生年报表率,产后访视率(大多电话访视)高于妇幼卫生年报表率(P<0.05);按规范随访时间及次数提供服务的孕产妇健康管理率为54.38%,其中孕早、中、晚期规范随访率分别为84.38%、68.13%和83.75%;孕早、中、晚期随访按规范要求做的各辅助检查项目(有报告单)所占比例分别为50.63%~83.13%、32.50%~41.25%、35.63%~36.88%。2014年126例死亡孕产妇中,110例接受至少1次产检,产检率为87.30%,41例接受5次及以上产检,产检率为32.54%,产检多由村医负责完成。全省有62.54%(182/291)的社区卫生服务中心配全了孕产妇健康管理服务辅助检查5项设备,其中以社区卫生服务中心为第一名称注册的机构中有56.71%,乡镇卫生院外出举办/挂牌的社区卫生服务中心中有70.08%。平均每个社区卫生服务机构配备基本公共卫生服务项目的孕产妇健康管理服务工作人员数量为专职0.4名(中心0.68名,站0.39名),兼职0.7名(中心0.65名,站0.86名)。结论云南省妇幼卫生年报表中的孕产妇健康管理率虚高,云南省孕产妇实际规范健康管理率偏低,尤其是死亡孕产妇的健康管理率低,基层医疗卫生机构健康管理辅助检查设备及人员配备不足。
Objective To understand the status quo of maternal health management services in Yunnan Province and provide basis for further work. Methods The data of maternal and child health year in Yunnan Province, the number of on-site reports and on-site quality checks of maternal health management services, the monitoring and evaluation of maternal deaths, the equipment and staffing of primary health care institutions were investigated and analyzed. Results The maternal and child health annual report 2014 showed that the maternal health management rate was 96.18% in the province, 94.39% in the first trimester, 97.76% in the postpartum period, 99.97% in the high-risk maternity women and 93.90% in the pregnant women %. The maternal health management rate, the rate of first trimester check - up and the high risk maternal management rate were all lower than the MCH reporting rate. The postpartum visit rate (mostly telephone interview) was higher than that of MCH (P <0.05). The maternal health management rate was 54.38%. The standardized follow-up rates in early, middle and late pregnancy were 84.38%, 68.13% and 83.75% respectively. The follow-up of early, middle and late pregnancy was required according to the rules Of the auxiliary inspection items (with reports) accounted for 50.63% ~ 83.13%, 32.50% ~ 41.25%, 35.63% ~ 36.88% respectively. Among 126 pregnant women who died in 2014, 110 received at least one prenatal check-up, the rate of check-up was 87.30%, 41 received 5 or more check-ups, and the check-up rate was 32.54%. There were 62.54% (182/291) CHCs in the province equipped with 5 items of aids for maternal health management services, of which 56.71% were registered as community health service centers under the first name, township hospitals 70.08% of the community health service centers held / listed outside. The average number of maternal health management services provided by each community health service with basic public health services was 0.4 full time (0.68 at the center, 0.39 at the station) and 0.7 part-time (0.65 at the center with 0.86 at the station). Conclusion The maternal health management rate in Yunnan MCH report is high, and the actual normative health management rate of maternal in Yunnan Province is low. Especially, the maternal health management rate of death maternal is low. The health management auxiliary inspection equipment of primary health care institutions and Staffing is inadequate.