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目的:系统描述1990～2009年中国5岁以下儿童健康状况和卫生保健服务利用的变化趋势与城乡差异。方法:利用1993年、1998年、2003年、2008年4次国家卫生服务调查和《2010年中国卫生统计年鉴》有关数据,分地区和年份分析儿童健康与医疗保健状况。结果:1993～2008年婴儿低出生体重比例从3.4%下降到2.7%,5岁以下儿童两周患病率从20.0%下降到17.4%;儿童计划免疫建卡比例从61.5%上升到97.9%,5岁以下儿童两周患病就诊率从31.0%上升到97.0%。新生儿死亡率、婴儿死亡率和5岁以下儿童死亡率分别从1991年的33.1‰、50.2‰和61.0‰下降到2009年的9.0‰、13.8‰和17.2‰,但这三大指标农村仍分别为城市的2.4、2.7和2.8倍;3岁以下儿童系统管理率从1990年的46.3%上升到2009年的77.2%。结论:在过去近20年里,中国儿童健康状况显著改善,城乡差距不断缩小,但受制于地区间社会经济发展不平衡,儿童健康状况和卫生保健服务利用的不公平性仍然存在。应将农村地区和城市流动妇女和儿童作为重点干预对象,实施有效的妇幼保健服务项目,以进一步提高我国儿童健康水平。
OBJECTIVE: To systematically describe the trends of changes in the health status of children under 5 years of age and the utilization of health care services in China from 1990 to 2009 and the differences between urban and rural areas. Methods: Based on the data of four national health service surveys in 1993, 1998, 2003 and 2008 and the “China Health Statistical Yearbook 2010”, the status of children’s health and medical care was analyzed by region and year. Results: The proportion of infants with low birth weight dropped from 3.4% to 2.7% from 1993 to 2008, the two-week prevalence of children under 5 years decreased from 20.0% to 17.4%, and that of children with planned immunity increased from 61.5% to 97.9% The two-week prevalence rate of children under 5 years old rose from 31.0% to 97.0%. Neonatal mortality, infant mortality and under-five mortality dropped from 33.1 ‰, 50.2 ‰ and 61.0 ‰ in 1991 to 9.0 ‰, 13.8 ‰ and 17.2 ‰ in 2009 respectively, but the rural areas of the three major indicators still differ 2.4, 2.7 and 2.8 times that of cities; the system management rate for children under 3 years of age rose from 46.3% in 1990 to 77.2% in 2009. Conclusion: In the past two decades, the health status of children in China has been significantly improved and the gap between urban and rural areas has been steadily narrowing. However, due to the imbalanced social and economic development among the regions, the unfairness in the use of children’s health and health care services still exists. Migrant women and children in rural areas and cities should be the focus of interventions, and effective MCH services should be implemented to further improve the health of children in our country.