2013-2017年余姚市5岁以下儿童死亡分析

  目的  分析2013-2017年余姚市5岁以下儿童死亡现状及主要死因，为制定相关干预措施提供科学依据。  方法  收集2013-2017年余姚市5岁以下儿童死亡监测资料，应用SPSS 18.0软件对5岁以下儿童的死亡趋势、死因顺位、地区差异和死前医疗保健服务利用情况等进行回顾性分析。  结果  2013-2017年余姚市新生儿、婴儿、1~4岁儿童、5岁以下儿童死亡率（under 5 mortality rate，U5MR）均有下降趋势（P=0.016，0.002，0.038，＜0.001）。监测死亡病例263例，5岁以下儿童死亡以婴儿为主，占68.82%（181/263），先天畸形和意外伤害是5岁以下儿童主要死因。5岁以下儿童死亡地点以医疗机构为主，且93.54%的儿童接受过死前治疗，男童死亡率10.50‰，是女童死亡率的1.54倍（χ2=11.693，P<0.001）。经趋势χ2检验发现，5年来本地人口U5MR无明显下降趋势（χ_趋势2=0.195，P=0.658），而流动人口U5MR波浪式下降趋势明显（χ_趋势2=17.706，P<0.001）。  结论  降低余姚市U5MR的关键是降低婴儿死亡率，而死亡干预的重点内容是预防先天畸形及意外伤害。继续做好妇幼保健工作和大力开展流动儿童安全教育是降低U5MR的两项有效举措。

Mortality analysis on children under 5 years old in Yuyao County from 2013 to 2017

  Objective  To understand the status and main causes of death among children under five years old in Yuyao County from 2013 to 2017, and to provide scientific basis to formulate relevant intervention measures.  Methods  Data monitoring deaths among children under five years old from 2013 to 2017 in Yuyao were collected. Trend of death, death rank, regional difference and utilization of pre-death health care services for children under 5 years old were retrospectively analysed using SPSS 18.0.  Results  From 2013 to 2017, the mortality rate in newborns, infants, 1-4 years old children and children under 5 years old (U5MR) decreased in Yuyao county(P=0.016, 0.002, 0.038, <0.001). Based on monitored 263 cases of deaths, the majority of deaths of children under 5 years old occurred in infants, accounting for 68.82% (181/263). Congenital malformation and unintentional injury were the main causes of death for children under 5 years old. The deaths of children under 5 years old mainly occurred in medical institutions, and 93.54% of the children were treated before death. The mortality rate of boys under 5 years old was 10.50‰, which was 1.54 times of the mortality of girls (χ2=11.693, P<0.001). The trend Chi-square test showed that the U5MR in local residents had no obvious downward trend in the past 5 years (χ_trend2=0.195, P=0.658), while the U5MR in floating population significantly decreased with fluctuation (χ_trend2=17.706, P<0.001).  Conclusion  The key to reduce U5MR in Yuyao is to reduce infant mortality, and the key content of death intervention is to prevent congenital malformations and unintentional injuries. Improving maternal and child health care and developing safety education for migrant children are two effective measures to reduce U5MR.