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目的:降低5岁以下儿童死亡率是儿童保健的主要内容之一,分析恩施州5岁以下死亡儿童生前卫生服务利用和未就医的原因,为降低儿童死亡率提供依据。方法:收集2000-2011年恩施州5岁以下儿童死亡报告卡共5775份,采用描述性分析方法和卡方检验对资料进行分析。结果:5岁以下儿童在医院死亡的比例由2000年的30.8%增至2011年的53.7%。死前利用住院和门诊服务的比例分别从2000年的43.6%和5.1%增至2011年的63.8%和17.7%,未治疗或未就诊的比例由2000年的51.3%降至2011年的18.5%。来不及送医是2000-2011年死亡儿童未就医的最主要原因,由2000年的65.0%增至2011年的84.0%。死前未治疗或未就诊的儿童首位死因2000-2004年为出生窒息,2005年及以后主要为意外窒息。结论:儿童死亡前卫生服务利用率明显提高;儿童在医院死亡的比例上升;死于意外伤害未及时得到治疗的儿童增加;加强意外伤害的防范是降低恩施州儿童死亡率的重要措施。
OBJECTIVE: To reduce the mortality rate of children under 5 years of age is one of the main contents of child health care. To analyze the causes of health services utilization and non-medical care of the under-five children in Enshi Autonomous Prefecture and to provide basis for reducing the child mortality rate. Methods: A total of 5775 report cards of children under 5 years of age in Enshi Prefecture from 2000 to 2011 were collected. The descriptive analysis and chi-square test were used to analyze the data. Results: The proportion of children under 5 years old who died in the hospital increased from 30.8% in 2000 to 53.7% in 2011. The proportion of inpatient and outpatient services before death increased from 63.6% and 5.1% respectively in 2000 to 63.8% and 17.7% in 2011. The proportion of untreated or untreated patients dropped from 51.3% in 2000 to 18.5% in 2011, . Too late to send doctors was the leading cause of the non-attendance of children who died in 2000-2011, from 65.0% in 2000 to 84.0% in 2011. First cause of death of untreated or untreated child Prior to death was birth asphyxiation during 2000-2004, with major asphyxiation in 2005 and beyond. Conclusions: The utilization rate of children’s health services before death increased significantly; the proportion of children died in hospitals increased; the number of children who died of accidental injuries not being treated in time increased; and the prevention of accidental injuries was an important measure to reduce child mortality rate in Enshi prefecture.