湖南省2014-2017年7岁以下儿童保健服务情况及健康状况分析

目的 分析湖南省2014-2017年7岁以下儿童保健服务情况和健康状况,为制定儿童保健管理措施提供理论依据。 方法 选用湖南省2014-2017年妇幼卫生年报数据,计算新生儿访视率、儿童系统管理率、生长迟缓率、超重率和儿童死亡率等儿童保健服务情况指标及儿童健康状况评价指标,并比较指标在不同年份、不同户籍性质间的差异。 结果 2014-2017年,湖南省活产数319.20万例,城市112.55万例(35.26%),农村206.65万例(64.74%),与2014年相比,2017年活产数增长6.97%,城市增长速度大于农村。新生儿访视率、6个月内婴儿纯母乳喂养率、5岁以下儿童血红蛋白检查率和3岁以下儿童系统管理率分别为95.24%、70.39%、74.60%和89.10%,2017年较2014年分别上升2.40%、2.65%、13.16%和5.40%;6个月内婴儿母乳喂养率、身高体重检查率和7岁以下儿童健康管理率分别为89.32%、89.38%和92.60%,四年间均达85%以上。5岁以下儿童生长迟缓、低体重、超重、肥胖检出率分别为0.87%、1.30%、1.01%、0.49%,生长迟缓、低体重检出率农村高于城市,而超重、肥胖检出率城市高于农村。贫血、中重度贫血患病率分别为3.92%、0.46%,均农村高于城市。与2014年相比,2017年生长迟缓率、低体重率和中重度贫血患病率分别下降了13.68%、19.72%和10.42%,而超重率、肥胖率和贫血患病率分别上升21.74%、8.51%和25.74%。5岁以下儿童死亡率、婴儿死亡率和新生儿死亡率分别为5.91‰、3.77‰和2.18‰,2017年较2014年分别下降31.13%、31.72%、32.33%。非户籍活产数33 869例,5岁以下儿童死亡率、婴儿死亡率、新生儿死亡率分别为8.03‰、5.55‰、3.48‰,比本地户籍的分别高出26.40%、32.07%、37.36%。 结论 湖南省儿童保健服务情况逐渐完善,儿童健康状况有所改善,但超重和肥胖儿童比率上升,户籍和非户籍儿童死亡率差异较大,要进一步提升儿童保健服务和健康水平,需提高儿童保健管理质量,提倡均衡营养喂养,减少超重或肥胖儿童数量,加强非户籍儿童管理。

Health services and health status of children under 7 years old in Hunan Province, 2014-2017

Objective To analyze the health services and health status of children under 7 years old in Hunan Province from 2014 to 2017, and to provide a theoretical basis for formulating child care management measures. Methods We selected the data from Annual Report on Maternal and Child Health in Hunan Province from 2014 to 2017, and calculated the evaluation indicators regarding children’s health services and health status, such as neonatal visiting rate, child system management rate, growth retardation rate, overweight rate and child mortality rate. The differences in indicators of different years and different household registrations were compared. Results There were 3.192 million live births in Hunan Province during 2014-2017, including 1.125 million (35.26%) cases in cities and 2.067 million (64.74%) cases in rural areas. The number of live births in 2017 increased by 6.97 % as compared with that in 2014, and the number of live births in cities was growing faster than that in rural areas. The neonatal visiting rate, exclusive breastfeeding rate of infants within 6 months, hemoglobin test rate of children under 5 years old and system management rate of children under 3 years old were 95.24%, 70.39%, 74.60% and 89.10% respectively. These rates in 2017 respectively increased by 2.40%, 2.65%, 13.16% and 5.40% as compared with those in 2014. Breastfeeding rate of infants within 6 months, height and weight check-up rate and health management rate of children under 7 years old were 89.32%, 89.38% and 92.60% respectively, and these rates in 2014-2017 were all above 85%. The detection rates of growth retardation, low body weight, overweight and obesity in children under 5 years old were 0.87%, 1.30%, 1.01% and 0.49% respectively. The detection rates of growth retardation and low body weight were higher in rural areas than in urban areas, but the detection rates of overweight and obesity were higher in cities than in rural areas. The prevalence rates of anemia and moderate-to-severe anemia were 3.92% and 0.46% respectively, and the above-mentioned rates were higher in rural areas than in cities. The detection rates of growth retardation, low body weight and moderate-to-severe anemia in 2017 declined by 13.68%, 19.72% and 10.42% respectively as compared with those in 2014, while the prevalence rates of overweight, obesity and anemia increased by 21.74%, 8.51% and 25.74% respectively. The mortality rate of children under 5 years old, infant mortality rate and neonatal mortality rate were 5.91‰, 3.77‰ and 2.18‰ respectively, and the above-mentioned rates in 2017 decreased by 31.13%, 31.72% and 32.33% respectively as compared with those in 2014. The number of non-household registration live births was 33,869. The mortality rate of children under 5 years old, infant mortality rate and neonatal mortality rate in non-household registration children were 8.03‰, 5.55‰ and 3.48‰ respectively, which were 26.40%, 32.07% and 37.36% higher than those in the local household registration children. Conclusions The situation of child health care services in Hunan Province has gradually improved, and the health status of children has ameliorated. However, the proportions of overweight and obese children increase, and the difference in the mortality rates of household registration and non-household registration children is significant. It is necessary to improve the quality of child care management, promote balanced nutritional feeding, reduce the number of overweight or obese children and strengthen the management of non-household children so as to further improve child care services and health status.