本文選題：農(nóng)村兒童 + 常規(guī)免疫　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的本研究通過調(diào)查廣西農(nóng)村地區(qū)兒童常規(guī)免疫乙肝疫苗、卡介苗、脊灰疫苗、百白破疫苗、麻疹疫苗的接種時(shí)間,了解疫苗接種率和接種狀態(tài)(包括未接種、提前接種、延遲接種、及時(shí)接種、及時(shí)全程接種)和延遲接種中位延遲時(shí)間,分析農(nóng)村地區(qū)疫苗接種服務(wù)模式對兒童疫苗接種質(zhì)量的影響情況,為制定針對廣西農(nóng)村地區(qū)兒童免疫接種服務(wù)政策提供參考依據(jù)。方法本研究為橫斷面調(diào)查研究。采用分層多階段整群抽樣方法于2015年6月-2015年8月抽樣調(diào)查廣西120個(gè)村,采取入戶調(diào)查方式,共調(diào)查18~48月齡兒童1062名。調(diào)查內(nèi)容包括兒童姓名、性別、出生日期、常規(guī)免疫基礎(chǔ)免疫接種日期,包括乙肝疫苗第1劑次、第2劑次和第3劑次,卡介苗第1劑次,脊灰疫苗第1劑次、第2劑次和第3劑次,百白破疫苗第1劑次、第2劑次、第3劑次和第4劑次,麻疹疫苗第1劑次和第2劑次的接種日期。數(shù)據(jù)整理采用Epidata3.1建立數(shù)據(jù)庫,進(jìn)行雙錄入和校對核查。采用R3.3.3軟件survey包加權(quán)統(tǒng)計(jì)分析乙肝疫苗、卡介苗、脊灰疫苗、百白破疫苗、麻疹疫苗的未接種率、提前接種率、延遲接種率、及時(shí)接種率、及時(shí)全程接種率和95%置信區(qū)間估計(jì),用加權(quán)Kaplan-Meier估計(jì)延遲接種的中位延遲時(shí)間,乙肝疫苗、脊灰疫苗、百白破疫苗、麻疹疫苗及時(shí)全程接種率和同種疫苗不同劑次及時(shí)接種率比較采用卡方檢驗(yàn),以p=0.05為檢驗(yàn)水準(zhǔn)。結(jié)果1.兒童基本情況:男性580(54.61%)名,女性482(45.39%)名;18-24月齡88(8.29%)名,25-36月齡542(51.04%)名,37-48月齡432(40.68%)名。2.乙肝疫苗第一劑次接種率100%(95%CI,100-100),及時(shí)接種率71.8%(95%CI,66.8-76),延遲接種率28.2%(95%CI,23.7-33)中位延遲時(shí)間1天(95%CI,1-31);第二劑次接種率100%(95%CI,100-100),及時(shí)接種率87.5%(95%CI,86-89),提前接種率3.83%(95%CI,2.17-7),延遲接種率8.63%(95%CI,6.89-11),中位延遲時(shí)間20天(95%CI,7-53);第三劑次接種率100%(95%CI,100-100),及時(shí)接種率66.1%(95%CI,58.9-73),提前接種率5.46%(95%CI,3.07-10),延遲接種率28.5%(95%CI,22.3-36),中位延遲時(shí)間25天(95%CI,11-58);三劑次全程接種率100%(95%CI,100-100),及時(shí)全程接種率46.61%(95%CI,40.5-53),提前、延遲或未接種率53.4%(95%CI,47.2-59)。3.卡介苗:卡介苗接種率100%(95%CI,100-100),及時(shí)接種率69.3%(95%CI,64.1-74),延遲接種率30.7%(95%CI,26-36),中位延遲時(shí)間1天(95%CI,1-31)。4.脊灰疫苗第一劑次接種率100%(95%CI,100-100),及時(shí)接種率80.7%(95%CI,75.7-85),提前接種率3.84%(95%CI,2.43-6),延遲接種率15.5%(95%CI,12.4-19),中位延遲時(shí)間28天(95%CI,9-63);第二劑次接種率99.9%(95%CI,99.7-100),及時(shí)接種率74.2%(95%CI,67.4-80),提前接種率1.98%(95%CI,1.04-4),未接種率0.06%(95%CI,0.01-0),延遲接種率23.7%(95%CI,18.5-30),中位延遲時(shí)間天23(95%CI,8-53);第三劑次接種率99.8%(95%CI,99.3-100),及時(shí)接種率66.4%(95%CI,58.7-73),提前接種率2.29%(95%CI,1.31-4),未接種率0.16%(95%CI,0.03-1),延遲接種率31.1%(95%CI,24.4-39),中位延遲時(shí)間30天(95%CI,12-64);三劑次全程接種率99.8%(95%CI,99.3-100),及時(shí)全程接種率63%(95%CI,54.6-71),提前、延遲或未接種率37%(95%CI,29.4-45)。5.百白破疫苗第一劑次接種率99.9%(95%CI,99.7-100),及時(shí)接種率81.3%(95%CI,73.7-87),提前接種率1.87%(95%CI,0.92-4),延遲接種率16.8%(95%CI,11.6-24),中位延遲時(shí)間19天(95%CI,5-48);第二劑次接種率99.7%(95%CI,95.8-100),及時(shí)接種率72.7%(95%CI,64.1-80),提前接種率1.89%(95%CI,1.12-3),延遲接種率25.4%(95%CI,18.7-33),中位延遲時(shí)間29天(95%CI,12-74);第三劑次接種率99.8%(95%CI,99.0-100),及時(shí)接種率59.9%(95%CI,49.9-69),提前接種率2.4%(95%CI,1.17-5),未接種率0.16%(95%CI,0.02-1),延遲接種率37.6%(95%CI,28.7-47),中位延遲時(shí)間36天(95%CI,13-83);第四劑次接種率93.1%(95%CI,89.2-96),及時(shí)接種率76.1%(95%CI,69.9-81),提前接種率5%(95%CI,3.9-6),未接種率6.89%(95%CI,4.3-11),延遲接種率12.1%(95%CI,8.2-17),中位延遲時(shí)間104天(95%CI,42-262);四劑次全程接種率93.1%(95%CI,89.2-96),及時(shí)全程接種率46.8%(95%CI,39.2-55),提前、延遲或未接種率53.2%(95%CI,45.4-61)。6.麻疹疫苗第一劑次接種率97.8%(95%CI,95.4-99),及時(shí)接種率61.8%(95%CI,55.1-68),提前接種率2.52%(95%CI,0.93-7),未接種率2.24%(95%CI,1.09-5),延遲接種率33.4%(95%CI,28.3-39),中位延遲時(shí)間29天(95%CI,9-68);第二劑次接種率94.1%(95%CI,91.2-96),及時(shí)接種率78.6%(95%CI,69.8-85),提前接種率5.02%(95%CI,2.86-9),未接種率5.87%(95%CI,3.86-9),延遲接種率10.52%(95%CI,5.91-18),中位延遲時(shí)間130天(95%CI,55-315);二劑次全程接種率92.9%(95%CI,88.7-96),及時(shí)全程接種率46.6%(95%CI,40.5-53),提前、延遲或未接種率53.4%(95%CI,47.2-59)。7.乙肝疫苗、脊灰疫苗、百白破疫苗、麻疹疫苗及時(shí)全程率卡方檢驗(yàn)差異有統(tǒng)計(jì)學(xué)意義(x~2=86.830,P0.05),卡方兩兩比較分析中除了Hep B疫苗和DTP疫苗差異無統(tǒng)計(jì)學(xué)之外,其他疫苗兩兩比較差異均有統(tǒng)計(jì)學(xué)意義。8.同種疫苗不同次劑及時(shí)接種率分布卡方檢驗(yàn)結(jié)果乙肝疫苗及時(shí)接種率卡方檢驗(yàn)結(jié)果x~2=151.320,P0.05,差異有統(tǒng)計(jì)學(xué)意義,三劑次分別兩兩卡方檢驗(yàn)差異均有統(tǒng)計(jì)學(xué)意義。脊灰疫苗及時(shí)接種率卡方檢驗(yàn)結(jié)果x~2=54.202,P0.05,差異有統(tǒng)計(jì)學(xué)意義,三劑次分別兩兩卡方檢驗(yàn)差異均有統(tǒng)計(jì)學(xué)意義。百白破疫苗及時(shí)接種率總體卡方檢驗(yàn)結(jié)果x~2=150.520,P0.05,差異有統(tǒng)計(jì)學(xué)意義,三劑次分別兩兩卡方檢驗(yàn)結(jié)果除了第一劑次和第四劑次(x~2=1.573,P=0.210)差異無統(tǒng)計(jì)學(xué)意義外,其他兩兩比較差異均有統(tǒng)計(jì)學(xué)意義。麻疹疫苗及時(shí)接種率總體卡方檢驗(yàn)x~2=80.284,P0.05,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論廣西農(nóng)村兒童常規(guī)免疫接種覆蓋率維持在較高水平,但是單劑次疫苗及時(shí)接種率不高,多劑量疫苗及時(shí)全程接種率較低,存在延遲接種現(xiàn)象,中位延遲時(shí)間較長。此外通過比較疫苗及時(shí)接種率與接種劑量、接種時(shí)間關(guān)系,發(fā)現(xiàn)疫苗及時(shí)接種率隨著疫苗接種劑量增多而降低,免疫接種時(shí)間表推薦疫苗接種時(shí)間越遲,疫苗及時(shí)接種率越低,延遲接種中位延遲時(shí)間越長。農(nóng)村現(xiàn)行鄉(xiāng)鎮(zhèn)衛(wèi)生院集中接種服務(wù)模式中,鄉(xiāng)鎮(zhèn)衛(wèi)生院、鄉(xiāng)村醫(yī)生、家庭等三方以及廣西農(nóng)村地理環(huán)境現(xiàn)況影響兒童疫苗接種及時(shí)性。建議相關(guān)部門將疫苗接種及時(shí)率應(yīng)納入疫苗接種考核指標(biāo);采取財(cái)政激勵(lì)措施,提高預(yù)防保健人員和鄉(xiāng)村醫(yī)生工作積極性;積極提供和有效推廣聯(lián)合疫苗,簡化免疫接種方案,完善免疫接種時(shí)間表,增加延遲接種補(bǔ)種最佳時(shí)間安排,充分發(fā)揮村醫(yī)在疫苗接種服務(wù)中的“通訊員”作用;免疫知識宣傳關(guān)口前移,消除兒童監(jiān)護(hù)人接種疫苗的猶豫;針對偏遠(yuǎn)山區(qū)兒童開展靈活便民的上門接種服務(wù)等多種措施提高農(nóng)村地區(qū)兒童疫苗及時(shí)全程接種率。
[Abstract]:The purpose of this study through the investigation of Guangxi rural area children routine immunization hepatitis B vaccine, BCG, polio vaccine, DPT vaccine, measles vaccine inoculation time, understand the vaccination rate and vaccination status (including vaccination, early vaccination, delayed immunization, timely vaccination and timely vaccination) a time delay and delay analysis of the impact of vaccination. The service mode of vaccination in rural areas of children's vaccination quality, provide scientific evidence for the development of service policy for the vaccination of children in rural area of Guangxi. Methods this study was a cross-sectional study. Using stratified cluster sampling method in June 2015 August -2015 survey of 120 villages in Guangxi, by household survey, survey 1062 children aged 18~48 months. The survey includes the child's name, gender, date of birth, routine immunization based immunization date, including hepatitis B First doses of vaccine, second doses and third doses of BCG, first doses of polio vaccine, first doses, second doses and third doses, first doses of DPT vaccine, second doses, third doses and fourth doses of measles vaccine, first doses and second dose vaccination date. Data using Epidata3.1 to establish database, double entry and check with the R3.3.3 software package survey weighted statistical analysis of hepatitis B vaccine, BCG, polio vaccine, DPT vaccine, measles vaccine inoculated rate, early vaccination rate, delayed vaccination rate, timely vaccination rate and timely vaccination rate confidence interval estimation and 95% bit. The delay time, using weighted Kaplan-Meier estimation delay in inoculation of hepatitis B vaccine, polio vaccine, DPT vaccine, measles vaccine timely vaccination rate and different doses of vaccine with timely vaccination rate compared by chi square test, with p=0.05 as the standard test. Results 1 .鍎跨鍩烘湰鎯呭喌:鐢鋒，

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