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目的了解陕西省延安市育龄妇女掌握出生缺陷和优生知识的水平、对此的态度和行为(KAP)以及对预防出生缺陷服务的相关需求及获取方式,从而为本市进一步提高出生缺陷服务质量、制定优生优育服务策略及出生缺陷干预措施的整体方案提供科学依据。方法采用分阶段随机抽样法,于2015年11月至2017年1月在延安市13个区县中随机抽取4个区县共471名18~45岁准备妊娠及妊娠期妇女进行访谈及问卷式调查。结果延安市育龄妇女出生缺陷知识总体掌握程度欠缺,平均得分仅(8.00±2.22)分(13分制),其中40.3%不及格,26.3%良好,对“预防出生缺陷的叶酸增补方案”、“围孕妇女的个体化营养素补充”知晓度最低,回答正确频度分别仅为26.9%、5.0%。经比较分析发现高年龄、城市、受教育程度的增加、高收入、有妊娠史的妇女对相关知识点得分普遍高于低年龄、郊区和农村、低文化程度、低收入、初次妊娠妇女。态度方面,76.6%的育龄妇女经计划生育部门开展的宣传途径来获取优生相关知识,大部分育龄妇女对“优生优育”方面的知识表现出相对积极的态度。行为方面,接受过或有意愿接受婚前医学检查、孕前优生检查及孕期常规产检者分别占63.1%、75.8%和90.0%。对其中339名受孕妇女进行妊娠期不良因素调查发现,孕早期经常长时间用电脑及看电视者(每天累计超过4小时)占47.5%,怀孕前3个月丈夫未戒烟、戒酒者达到近50.0%左右。0.4mg叶酸服用率达到87.9%,从开始服用叶酸到现在坚持每天服用者占67.6%,而从怀孕前三个月开始并坚持每天服用者仅占25.4%;受教育程度越高,叶酸服用率也越高(P=0.021,OR=0.646),而有妊娠史的妇女对叶酸进行正确的增补频率较无妊娠史妇女反而变低(P=0.001,OR=2.760)。结论延安市育龄妇女出生缺陷相关知识掌握不够,但态度积极,有较大提高空间;影响出生缺陷的不良因素发生频率较高,叶酸服用不规范,应根据相关影响因素认真开展多种渠道的健康教育宣传,以提高育龄妇女预防出生缺陷知识的知晓率,有效降低出生缺陷发生的风险。
Objective To understand the level of birth defects and eugenics knowledge of women of childbearing age in Yanan City, Shaanxi Province, their attitudes and behavior (KAP) and their related needs and access to services for the prevention of birth defects, so as to further enhance the service quality of birth defects in this Municipality, Provide prenatal and postnatal care strategies and birth defects interventions overall program to provide a scientific basis. Methods A total of 471 pregnant women and pregnant women aged 18 to 45 aged from 18 to 45 were interviewed and questionnaires were randomly selected from 13 districts and counties in Yan’an City from November 2015 to January 2017 in staged random sampling method survey. Results The knowledge of birth defects in women of childbearing age in Yan’an City was generally lacking in knowledge. The average score was only (8.00 ± 2.22) points (13 points), of which 40.3% failed and 26.3% were good. The “folic acid supplementation plan to prevent birth defects” , “Pregnancy women’s individualized nutrient supplement ” the lowest awareness, the correct frequency of responses were only 26.9%, 5.0%. After comparative analysis, women with higher age, city, education level, higher income and pregnancy history score higher than those with lower age, suburban and rural areas, lower education level, lower income and first pregnancy. In terms of attitude, 76.6% of women of childbearing age gained the knowledge of eugenics through the propaganda channels carried out by the family planning departments, and most of the women of childbearing age showed a relatively positive attitude towards the knowledge of “prenatal and postnatal care.” In terms of behavior, 63.1%, 75.8% and 90.0% of those who received or were willing to undergo premarital medical examinations, prenatal checkups and prenatal checkups, respectively, accounted for 63.1%, 75.8% and 90.0% respectively. A survey of 339 pregnant women with adverse pregnancy outcomes found that 47.5% of them used computers and watchers for a long time in their first trimester (more than 4 hours per day in the first trimester), and they did not quit smoking in the first 3 months of pregnancy, 50.0% or so. 0.4mg folic acid intake rate reached 87.9%, from the beginning to take folic acid to now insist on taking 67.6% of daily users, but from the first trimester of pregnancy and insist on taking only 25.4% of daily users; higher education, folic acid intake (P = 0.021, OR = 0.646). However, women with a history of pregnancy had a lower frequency of correct folic acid supplementation than women without a history of pregnancy (P = 0.001, OR = 2.760). Conclusions There is not enough knowledge about birth defects in women of childbearing age in Yan’an City, but they have a positive attitude and room for improvement. The frequency of adverse factors affecting birth defects is high and the use of folic acid is not standardized. Careful implementation of multiple channels of health should be carried out according to relevant factors Education and publicity to raise awareness of women of childbearing age to prevent birth defects, effectively reduce the risk of birth defects.