Thực hành chăm sóc bà mẹ mang thai và trẻ em dân tộc thiểu số dưới 2 tuổi

36 Xa hgi hgc so (138), 2017 THirC H A N H CHAM SOC BA ME MANG THAI VA TRE EM DAN T O C THIEU SO D I T O I TUOI NGUY£NH6NGTHAI' Tdm tdt: Cdi thi$n qud trinh chdm sdc, nudi duong, bdo ve bd me mang thai vd tre em dudi tudi cd y nghia rdt quan trgng chiin luac phdt triin ngudn nhdn luc ddn tdc thiiu sd, mdt nhiing uu tiin hdng ddu cua Chinh phii chuong trinh quoc gia vi gidm ngheo bin vOng giai doan 2011-2020 Bdi viit phdn tich sd li4u cua du dn nghien cuu 203 bd m? thugc 12 ddn tgc thiiu sd tgi tinh dang nudi 330 tre dudi tuoi nam 2015 Cdc phdn tich cung cdp mgt s6 bdng chung vi dnh hudng cua ddi ngheg, kho khdn tiip can cdc dfch v^ xa hgi ca bdn, phong tiic tap qudn lac hau vd khdc biet gidi din vi^c chdm sdc nudi dudng tre em ddn tdc thieu sd giai doan ddu ddi tir den tudi, vd tit dua mdt sd khuyin nghj, chinh sdch ho tra vd md hinh can thi?p nhdm ndng cao sice khoe thi chdt va tinh thdn cua nhdm tre ddn tdc thieu sd Tit khda: tre em, sinh dd, ddn tde thilu sd, cham sdc sdc khde Gidi thif u Giam ngheo, phat trien ben viing vung dan tdc mien nui, thu hpp khoang cdch gifia cac nhdm dan tOc va dgc bipt la phat trien ngudn nhdn lyc dan tOc thieu sd (DTTS) la mpt nhung uu tien hanh dau eua Chinh phu ede chuong trinh nghi sy quoc gia vS djnh hudng gidm nghdo bin vung giai dogn 2011 -2020 (Chinh phd, 2011) Trong nhung nam qua, Vipt Nam da cd nhieu ehinh sach, chuong trinh hS trg phat trien eho cdc eOng ddng DTTS vd dd thu dugc nhfing thdnh tyu nhdt dinh Ngudn nhdn lye cd vai trd ddc bi?t quan trpng mpi chien luge phdt trien xa hOi Yeu td ngudi la ngudn lyc nOi sinh cd y nghia quyet dinh tien trinh giam ngheo vd phat triln bin vung Chinh phu va Uy ban Ddn tOc nhdn thdc rd chdt lupng cham sdc tre em dudi tudi cd vai trd quan trpng phdt trien ngudn nhan lue DTTS Tuy nhien cho din nay, 54 dan tde thieu sd d Vipt Nam van chu ylu sdng d vimg cfi dilu kien kinh t l xa hOi khd khdn va thudng bi tyt hdu ve nhilu chi tieu phat triln kinh tl xd hOi so vdi mdt bdng chung todn qude Ndm 2014 ed nude cd gdn 6% hp ngheo, dd 46,6% la hO dan toe thilu sd (Bp Lao dOng, Thuang Binh va Xd hOi, 2015) Tre em DTTS thudng gap nhilu khd khdn tid nggi tiong nudi dudng va ehdm sdc sdc khde Cir tre em DTTS sdng d vimg dde biet khd khan cd em dang ehiu thipt thoi ve tiep can voi Vi4n Xd hgi hgc, Vign Hdn ldm Khoa hgc xd hgi Vift Nam eac dich vy xa hOi ca ban nhu cham sdc y t l , dinh dudng, gido dye, nude sgch va vO sinh, chd d va bao trg xd hOi (UBDT, IRC, UNICEF, 2015) Tinh trang suy dinh duong the cdi cge d tre em DTTS cdn kha cao, tren 40% d cae tinh Lao Cai, Kon Tum, va tren 50% d cac nhom ddn tOc thilu sd ngudi Mdng, Ba Na va Gia Rai (UNDP, 2013) Theo kit qud Tdng dilu tra dan sd va nha d ndm 2009 tiii mdc chit trd em d cae dan tOc thieu sd cd gidm, nhung van cdn cao Cy thi, ty sudt td vong tre em dudi tudi cda cac dan tgc Mudng, Tay, Thai, Mdng idn lugt Id 34, 36, 41 va 72 phan nghin, so vdi 19 phdn nghin d dan tOc Kinh (Tdng cue Thdng ke, 2011: 45) Do dd, viee phdn tich tim hilu thyc trgng va nguyen nhan nhdm tilp tuc no luc nang cao sue khde ba me, tre em DTTS la rat can thilt Bai vilt sd dyng dfi lipu td dy an nghien edu Uy ban Dan tgc thue hien vao nam 2015 tgi tinh Ha Giang, Gia Lai, Ninh Thuan, Sdc Trdng' nhdm phan tich mOt sd vdn dl ehinh vipc chdm sdc nudi duong ba mp mang thai va tre cm dudi tuoi d mdt sd cdng ddng ddn tOc thilu sd Ve mdu khao sat, tai moi tinh kl tren lya chpn huyen vd td moi huypn chpn xa cd nhieu nhdm DTTS sinh sdng Trong mdi xa se lya ehpn ngau nhien thdn/ban dl khao sat Nhu vliy tdng cOng cd 16 thdn ban cua xa tiong tinh dugc ehpn vao mau nghien edu Cdc xd dugc chpn vao mau deu cd nhieu tOc ngudi cung sinh sdng va la xa d ^ biOt khd khdn hodc cd cac thdn/bdn ddc bipt khd khdn Td 16 thdn/ban nay, nhdm nghien cihi dd len danh sach va lya chgn ngdu nhien 203 ba mp DTTS dang nudi cdc dudi tuoi dl tham gia trd ldi bdng hdi dinh lugng, dd dd thu thap thdng tin lien quan din cham sdc sdc khde 330 tie (cd 166 tre nam vd 164 tie nu) dudi tudi (trong dd cd thdng tin vl vice cham sdc tre dudi tudi) Mau khao sat ed 12 DTTS, bao gdm dan tOc Mdng, Dao, Tay Nting, La Chi va Cd Lao d tinh Ha Giang; ddn tpc Ba Na vd Gia Rai d tinh Gia Lai; dan tde Chdm va Raglay d tinh Ninh Thi4n; ddn tdc Khmer vd Hoa d tinh Sdc Trang Ben cgnh khao sat dinh lugng, dy an cdn tidn hdnh tai dia ban nghidn euu nhilu phdng van sau va phdng vdn nhdm t|;p trung ve chu dl nghien edu Cham sdc su-c khde b^ m$ dan tpc thiiu so mang thai Hipn nay, tgi vdng DTTS va miin nui vipc chdm sdc thai vd ba mp mang thai van ehiu anh hudng kha nhilu cda vdn hda phong tuc tap quan Tinh trang tao hdn dd giam song van edn tuong ddi phd bien, dde bipt eac dan tOc sdng tgi vung nui cao nhu Mdng, Dao, Ba Na Tdo hdn dnh hudng xdu den sdc khde ba mp, thai nhi mang thai sdm cae bd mp chua phat triln day du v l the ehat, chua cd dugc nhfing kiln thuc, k^ ndng v l chdm soc thai nhi vd trd nhd Cdng tac k l hoach hda gia dinh cdc DTTS da cd nhilu thdnh tich dang k l , nhung de nhilu con, khoang each sinh eon ngdn van edn kha phd biln, dnh hudng xau tdi sdc khde eua thai phy ' Dy in "NhOng ylu to kinh tl, vin hda vi xi hOi inh hudng tdi diyc hinh bio vf vd chim sdc trfi em tu din tuoi ciia dong bio DTTS vi dl xudt nhOng giii phip, chinh sich h5 trg hoic md hhih can thif p phii hpp vdi van hda din tOc t ^ dilu kifn cii thi|n chim sdc tre tho cua cic DTTS" UNICEF tii trgr 38 Thuc hdnh cham soc Da m? mang tnai va ire em Tinh trgng phi^ nu Ba Na, Gia Rai de ddy, de nhiiu Id phd biin, ldm cho tre em thiiu dn, ty 1$ suy dinh dudng cao Nguyin nhdn chinh la chi 28% cap va chdng dp dung cdc bi$n phdp trdnh thai Ddi vdi cdc bd me nhiiu tuoi, so ciia hg phd biin Id 6-7 (PVS, nfi, 32 tudi, ngudi Kmh, hgc vdn eao ddng, ehuyen trdch dan so ^) Cd tdi 70% phy nfi DTTS khdng dn gi them ngoai bfia com chung vdi gia dinh tiong suit thdi gian mang thai Ty le ndy rat eao tgi Gia Lai vdi 87% va Ha Giang voi 83% Ty Ip phu nfi DTTS cd dn them hang thdi gian mang thai chi Id 14% song cd each biet rdt Idn giua eae vimg/cdc ddn tOe Phy nfi Khmer d Sdc Trdng cd t^ le bdi dudng hang ngdy thdi ky mang thai la 34% gdp 30 Idn so vdi phu nfi Ba Na/Gia Rai d Gia Lai chi vdi ty 10 1% (xem them Bang 1) Bing T^ l | bi mf c6 i n them ngoii bO^ ctrm gia dinh mang thai 0071 vj: % m Giang (A/ong Dao, TayNmg, La Chi, CdLao) 82,5 Gia Lai {BaNa, Gia Rai) Ninh Thuan {Cham, Raglay) Sdc Trang {Khmer, Hoa) Chimg 86,7 58,1 51,4 70,3 Thinh thoang (thdng l^n) 5,0 12,2 20,9 4,1 10,9 Thudng xuySn (tuSn lin) 2,5 0,0 7,0 10,8 4,8 H ^ g ng&y S,8 1,1 14,0 33,8 13,6 Khdng nhd 1.2 80 0,0 0,0 0,0 0,3 90 86 74 330 Khdng an th€m gl N Ngudn- Khdo sdi cua du dn tgi linh, 2015 Tap qudn udng rugu, hiit thudc la cua ddng bao DTTS d Gia Lai hay dn kieng qua mue la nhfing phong tye ed hgi din sdc khde ba me mang thai va tre so sinh Quan niem phai lam viec nhilu eho de de, hay thdi quen khdng gidm lam cac vipc lao dong san xuat ndng nhge thdi k^' mang thai cd thi tdc dOng khdng tot tdi sdc khde ba me vd thai nhi Phu nu Mdng chua khdng nghi ddu, nd ldm din de thi thdi Cd dira de ngoai nuang Niu nhu vgy thi chdng khdc dd cho va Ngudi gid cdn bdo ldm cdc vi$c cho de de Chiia vdn lam cdc cdng vi?c binh thudng khdng kieng vi$c ndng ddu (TLN nam, 62 tudi, ngudi Mdng, hgc vdn 1, Gia lang) Kit qud khdo sat cho thdy, 46% phu nfi van di ldm binh thudng mang thai T^ 1§ ndy tai Gia Lai la 82% Ngugc lgi, eo 38% ba me giam lam vipc ndng ho^c nghi ngai mang thai, chu ylu tap tiimg d cdc DTTS d Nam BO nhu Khmer (61%), Chdm va Raglay (52%) Tuy nhien, mang thai phu nfi dd ed y tilde tranh ldm cae edng viee dOc hgi nhu phun thudc trfi sau, thude bao vp thyc v|it Cdng tdc y tl dy phdng tiong tiidi gian mang tiiai dd cd kit qud khd tit Ty Ip phy nfi kham tiiai dinh k^ va tiem ehung day du mang tiiai la 77%, cao nhdt la mlu d Sdc Trang (96%) noi chu ylu la ba mp ngudi Khmer, tilp din Id d Ninh Thudn (88%), Ha Giang (86%) vatiidpnhdt la tai Gia Lai (43%) Thuc hien khdm thai dinh ky vd tidm ehiing ddy dd da gdp phan gidm ty 1? chit sinh cda ca me va eon, gidm cae tai biln san khoa gdp phdn ddm bdo sdc khde cho ca mp va Nhu vdy, ty le bd me kham thai, tiem chiing ddy dd toan mau nghien edu gan dat dupe so vdi Chuong trinh mue tieu y tl qude gia "Din 2015 t^ 18 phu nfi dugc khdm thai it nhdt lan vao thai ky dat 80%" vd cao hon kha nhilu so vdi kit qua ciia dy an "Chdm sdc sdckhodsinhsan va cai thidntinhtiBngdinh dudng trd em 2013" vdi ehi 58% bdmp dugc khdmtiiaidu idntiongthai ky (Uy ban Dan tOe va BO Y tl, 2013) Cac thong tin dinh tinh efing eho thay, chudn myc gia tri ciia trai hay gai it anh hudng tdi quyet dinh mang thai va cham sdc thai Cdng ding khdng ed nghi le gi dae biet de cau sinh dugc trai hay gai, khdng ed cae nghi le hay thu thuat lya chgn gidi tinh thai nhi Do khdng hi qua nhieu sdc ep ve sd eon (ehi bi phat tiln nhung khdng nop efing khd thu), nen neu ed nhu eau trai hay eon gdi cd the hp se de din dugc thi thdi Noi sinh de Lua ehpn noi sinh vd ngudi dd dd da cd sy khac biOt khd Idn gifia cdc vdng miin va gifia eac dan tgc Trong mau khdo sat, ba mp DTTS d vung nui cao tai Ha Giang, Gia Lai thudng lya chgn de tai nhd ngudi nha hay ba mu dd, dd phy nfi DTTS d Sdc Trdng vd d Ninh Thuan thudng lya chgn sinh de tai tram y tl xd hay benh vien huydn, tinh Dieu ham y ve chien luge van dOng tuyen truyen giam sinh de tai nha la mOt thach thdc Idn ddi vdi edc DTTS sdng d mien ndi Do dilu kien dia ly ddc thu cua viing ddn tOc va mien mii, giao thdng khd khan, eOng vdi thdi quen phong tyc tap quan, ty 1? de tgi nhd ngudi nha hay ba my dd kha cao tgi Gia Lai (85%) vd Ha Giang (47%) (Bdng 2) Mdc du ngudi nha/bd my (phdn Idn khdng dugc dao tao) d& de song nhfing tai biln san khoa it xay Dd la vi cac bd my thudng cd tham nien hanh nghi tdi vai ehyc ndm vdi nhieu kinh nghiem Cdc bd dd rdt cd trdch nhi^m, cd true 1-2 ngdy khdng chgp mdt cimg sdn ph dii cdc bd diu nhiiu tudi Vdi kinh nghiem hdng chuc ndm hdnh nghi phdt hi ca de kho hg di nghi gia dinh dua din benh vi?n (TLN phy nfi thdn, 52 tudi, hgc vdn Idp 9) Tuy nhien, de tgi nhd van ham chda nhilu rdi ban tgi cac co sd y tl vd cdn ed nhihig giai phap giam thilu Hon nfia, de tai nha cdn gay tinh trang lam gidy ehdng sinh, giay khai sinh cham, ddn din nguy ca tre gdp nhilu khd khdn viOc tilp can vdi cac djch vy xd hgi co ban sau Giam thilu tinh trgng dd tgi nhd ngudi nha/ba my dd cdn Id nhipm vy cua cdc dia phuong de cd the dgt chi tieu "Ty le phy nfi de can bg dugc ddo tgo dd dat 96%" cua Chuong trinh Myc tidu y tl Qude gia2012-2015 40 Thitc hdnh cham sdc bd m? mang thai vdtreem Bing Noi sinh v i ngvdi Atk d£ Ban vf:% Tgi nhi, ngudi nhi, b i my T^i nhi, y t^ thon bin dd Tgi trgm y t l x3 H i Giang (Mong Dao Toy, Nitng, La Chi, Cd Lao) 46,8 0,0 26,6 Tgi b^nh vi^n huyfn, tinh N Gia Lai (BaNa, Gia Rai) Ninh Thuin (Chdm Raglay) 85,4 33,7 0,0 Sdc Tring (Khmer, Hoa) Chung 1,1 13,5 1,2 5,8 0,0 39,2 0,3 17,1 26,6 59,3 60,8 39,3 79 89 86 74 328 Ngudn: Khdo sal ciia du dn tgi linh, 2015 Ty Ip sinh d tiam y t l xa khd thdp (17%), thgm ehi chi 1% d Gia Lai Trong do, dd de Id mOt chdc ndng quan trpng ciia tiam y tl xd va hoan toan mien phi Dilu dat nhieu vdn de can gidi quyet cd ve tiang thiet bi, trinh dO chuydn mdn ciing nhu co chi ldm vide cda y te tuyen xd Vi dy, theo quy dinh, tram y t l xa chi ed mOt ngudi trye vao budi tdi, nlu ngudi dd khdng du khd ndng dd de (dilu dudng vien, duge ta) thi vipc sinh de ngoai gid hdnh chinh la mOt khd khan eho ba me tid dg vao ban dem md muon smh tai tigm y te xa Ty le ba me lya chpn sinh tgi bpnh vien huypn/tinh kha cao, 39%, nhdt la vdi phu nfi Khmer, Chdm, Raglay (61% d Sdc Trdng) Ngodi 1^ tdng va cac phuong tien giao thdng dugc cdi thipn tgi Ninh Thuan vd Sdc Trdng, lya chpn cho thdy da c6 sy tiiay ddi nhgn thdc va thue hidn hanh vi sinh de nhilu gia finh va bd m? mudn dda ddi tiong dilu kidn tot nhat cd thi Kit qua efing cho thdy, khdng cd khac bipt Idn vl lya chgn noi sinh phdn tiieo gidi tmh cua tie Ty 1$ sinh de d nhd la 42% ti^ng sd ti-e nam va 45% so tre nfi Ty 1? sinh de d benh vien huypn/tinh Id 40% tiong so tie nam va 39% tiong sd tre nfi Nhu V9.y chua cd bdng chdng ve anh hudng cua gidi tinh thai nhi tdi su lya chpn nai smh tsortg eOng dong DTTS Chdm soc sue khoe ba me vd tre em durdi tuoi 4.1 Dinh dirdng cho tre em vd bd m^ nudi Ben cgnh nhfing dnh hudng eiia phong tyc tap quan, ehl dO dinh duong eho ba m? DTTS nudi cdn hi ehi phoi nhilu bdi dilu kipn kinh tl vd nhan thdc eua cpng ddng tiong nudi dudng ti^ em Cd tdi 68% ba mp hdu nhu khdng an gi tiiem ngodi bfia com cung gia dinh tiong suit tiidi gian cho bu Ty Ip rdt cao d Gia Lai vdi 93% Ha Giang la 75% Vdi bfia dn hdng cdn chua du dinh dudng cho ngudi binh tiiudng, ehua noi ddn nhu cau dinh dudng ciia ba m? nudi con, vipc tie bi suy dinh dudng la khd tidnh Nguge lai, t;^ Ip ba mp an them hang ngdy tiong thdi gian cho bu cd khdc bi$t Idn gifia cac tinh: Sdc Trang la 58%, tiong d Ninh Thu^n chi la 8% vd khdng ddng kl d Gia Lai (Bang 3) Nguyin Hong Thdi 41 Bing Ty if bi m^ cd 9n thSm ngoii b&a 3n chung vdi gia dinh tbdi gian cho bu Dan vi:% Chung 68,2 Sdc Trang (Khmer, Hoa) 29,7 6,8 1,4 6,3 0,0 15,9 10,8 6,6 15,0 0,0 8,0 58,1 18,4 80 90 86 74 330 Ha Giang {Mong, Dao, Taj/, Nitng, La Chi, Co Lao) Gia Lai (BaNa, Gia Rai) Ninh Thuln (ChUm, Raglay) Khong an thgm gl 75,0 93,3 Thinh thoang (thing/Ian) 10,0 6,7 Thudng xuyen (tuan/lan) 0,0 Hang N 68,1 Ngudn: Khdo sal cua du dn Igi tinh, 2015 Hau nhu khdng cd sy khde biet ve che dp dinh dudng eho ba me nudi tiai hay eon gdi Ty Ip bd mp khdng an gi them ngodi bfia cam gia dhih hdu nhu khdng khdc biet giua nudi eon tiai va nudi gai Ty le ba mp cd dn thdm hdng ngdy nudi eon tiai la 20%, cao hon mOt chdt so vdi va nudi gai (17%) Nhin chung, vile nudi trai hay nudi gdi khdng cd dnh hudng tdi che dO dinh dudng eiia mp thdi gian cho eon bu Cac ba me DTTS chd ylu nudi eon bdng sfia mp Chi tiong trudng hgp khdng cd sfia hay nhgn nudi hp mdi nudi eon bang ngudn thdc dn ngoai sfia mp Thdi gian eho bu tuong ddi dai, 64% cdc bd me eho bu tu 12 thdng trd Idn Mdt sd noi tgi Gia Lai cd thdi quen cho bu tdi cd em Trong mau khao sdt cd tre tuoi van bu mp Tap quan tu nhien nudi bdng siia me la phu hgp vdi kien thdc nudi eon hipn dgi Tuy nhidn vipc cho bu qua lau va tinh trgng khdu phdn dn cua cac bd mp khdng duge cai thien tiong thdi k^ cho bu dan din chdt lugng sfia mp khdng du dinh dudng Tre em DTTS duge eho dn thdm ngoai bu m? (dn ddm) kha sdm, 47% tre dn ddm dugc tu 3-6 thdng Dilu dang quan tdm la vipc cho trd "dn ddm" da sd theo kieu tinyin thdng, ecrm gia dinh cd gi thi mp nha diit cho Cd 42% ba mp da cd y thdc ndu chao cho nhung ehi la chao gao, khdng bd sung thdm dinh dudng gi Viee cho dn them qua sdm vd dn cam nha khdng hgp ve sinh cd thi gay hau qua khdng tdt din sue khde eua tre Tre a day din 5-6 thdng Id dn com nhd rdi cd dua thdng da cho dn cam nhd M? nd nhd rdi ddt cho nd dn M? khdng dugc dn them gi ddu An com ciing gia dinh binh thudng Di nuang thi mang ngd ndu (men men) di theo dn vdi nude sudi thdi Khdng cd gi dn thim ddu (TLN mp, 34 tiioi, ddn tOc Mdng, hpe vdn 2/12) Cd khoang 1/3 (32%) ba mp mua cdc goi chao, bdt ddng sin vdi gid 2000 3000d/gdi v l pha vdi nude sdi rli eho dn them ngodi bu mp Du ehua dugc kilm dinh chdt lugng, nhimg nhimg san pham ddng goi nhu the khd cd the bd sung dinh dudng ngodi sfia mp cho tre 42 Thuc hdnh chdm soc bd mg mang thai vdtreem Chi dp dinh dudng danh cho tie cdn phy fliuOc nhilu vao nhgn tiidc cda gia dmh, eOng ddng va phong tyc tap qudn D I dam bdo dinh dudng cho tie can phai tuydn tmyen van dOng bd me, gia dmh vd cOng ddng thay ddi cd nhan thdc va thyc hanh Bd me gia dinh y thuc rdt kem vi chdm sdc dinh duang cho tre Cdc budi thuc hdnh ndu chao dinh duang dugc tiin hdnh dinh ky thudng xuyen, nhung ho khdng ldm Hg noi ban di ldm vi met khdng cd thdi gian Khdng kiim dugc thtic dn di ndu chdo dinh duang, mgc dii chung tdi da trinh dien bdng nhiing rau cd qud cua dia phuong Tdm cd cua dc hg cd thi kiim dugc du di ndu chdo dinh dudng cho tre Hg thich mua chdo ddng gdi han vi tiin han Ga vit nhiiu hdi mua khdng bdn nhimg a lgi chai hg sdn sdng thit di tiip khdch Nhung bdo thit cho vg dn cho du dinh dudng thi khdng (TLN gido vien mdm non, nfi, ddn tde Nung, 32 tudi, hpc vdn Dgi hpc) Cdng tac tuyen truyen tgp huan cho cdc bd mp ve thyc hdnh dinh dudng cho tre dudi tudi dd dugc thyc hipn song kit qud han ehe Sd lipu ciia dy an Uy ban Ddn tOc va Vien Dinh duong thue hien cho thdy "cd 59% cac bd mp cd tham gia day diieac budi tiiuc hdnh dinh dudng va 24% tham gia khdng bdn" Tuy nhien, gifia viee co tham gia tgp huan vd cd thyc hanh tiong thue t l vdn eon khoang each kha Idn Vdi nhieu ly vipc thuc hanh nau chao dinh dudng eho tie dien khdng thudng xuyen tiong cOng dong DTTS 4,2 Yte dfjTphdng vd khdm chita b^nh Cdng tdc y tl du phong, tiem chimg theo chuong trinh myc tieu qude gia cho tie DTTS dudi tudi dd dugc thuc hien kha tit, du ggp nhilu khd khdn dia hinh phuc tgp, eae thdn/ban d xa trung tdm va phong tyc tdp qudn cdn Igc hau Tinh chung, 96% tie dudi tuoi dugc tiem chdng day dd Vdi 4% tie khdng dupe tiem ehdng day du vd ddng han (tiem thieu mui nhdc lgi), hai ly dupe dua nhilu nhdt la "khdng bilt !uc ndo va tiem d ddu" (54%) va" bo mp di lam xa khdng dua eon di tidm duge" (31%) Hai 1^ ham y rdng, viec di lam nuong ray xa hay di cu di lam xa (Ninh Thudn, Sdc Trdng) la nhihig ly quan trgng nhdt anh hudng tdi ty 1? tie dugc tiem chung ddy du Do vgy de khdc phyc can ed nhung chinh sach tdng the phat triln kinh t l xa hOi tai dia phuong dl dam bdo sinh ke cho cdc hd gia dinh Kdt qua nghien cdu ghi nhgn khdng cd sy khac bi$t gifia tie nam va nfi t>' le duge tiem chung ddy du Tgi mgt sd vimg nui cao, viing sdu, nhdn thdc cua cdc bd mp cdn thap cung cd dnh hudng tdi vipc tie dugc tiem chiing ddy dd Cd hien tuong Id tiim miii ddu tre thudng biphdn ung nen s6t nh^ M? thdy v^y khdng hiiu, khdng tin vdo thudc nin cdc mui nhdc lgi Idn sau trdn khdng cho di tiim niia dnh hudng tdi hi^u qud cua tiem chung (PVS, nfi, y tl thdn ban, 38 tiidi, dan tOc Ba Na, hpc van 8/12) Cdng tdc khdm chfia bOnh cho ti^ dudi tuoi dd cd ehuyin biln khd tdt chinh sdch cdp BHYT mien phi cho tie dudi tudi Tinh chung, cd 82% trd bj dm dd sii dung the BHYT kham chua benh tgi eac ea sd y tl eua nha nude nhu tram y tl xa, bOnh vien cac tuyen Trgm y tl xa Id noi ed ty 1$tiedin khdm chfia bdnh cao nhdt vdi 64% Ty Id chfia bdnh tai trgm y tl xa d mien nui cao ban so vdi viing thdp, cy the la 77% d Ha Giang, 69% d Gia Lai, vd chi 46% d Ninh Thuan (Bang 4) LTutienlya chgn thd hai dh khdm chfia bpnh cho tre la bpnh vien khu vuc, bpnh vipn huypn (18%) Song cdn su khdc biet kha Idn gifia cdc vung miin ma nguydn nhdn ea bdn la dieu kiOn dia ly va hg tdng giao thdng Ty le d mdu nghidn cdu Ninh Thugn la 35%, gdp Idn d Hd Giang III Bang Noi khim chiis b^nh cho tre dirdi tu5i Idii bj 6m 13,3 1,1 Sdc T i ^ g (Khmer, Hoa) 0,0 Thay ciing, thly mo 2,5 0,0 0,0 0,0 Y te thon bin 0,0 3,3 0,0 0,0 0,9 76,5 69,4 46,0 66,2 63,9 Benh vien khu virc, huyen 5,0 14,0 34,5 17,6 18,1 Phdng kham tu, nha thudc 1,2 0,0 19,5 16,2 9,1 N 79 90 87 73 329 Tv chila Ha Giang (Mong, Dao, Toy, Niing, La Chi, CdLao) 15,0 TrtutlxixSi Gia Lai (BaNa, Gia Rai) Chung 0,6 7,6 Ngudn: Khdo sdt cua du dn lgi linh, 2015 Vdi cac benh thdng thudng, khoang 8% gia dhih vdn sd dyng cdc bdi thulc ddn gian de chiia bpnh eho tie Hipn tugng chfia bpnh bdng ciing bai hau nhu da duge logi bd song ehua hoan toan triet dd Chiia benh bdng ciing Ii thi khdng cdn nhung nhiiu gia dinh vdn kit hgp vua ch tgi cdc trgm y ti viia cung tgi nhd Tre dm thi ldm Ii cung niu khdng d& thi ma din trgm Ngudi bf b$nh ngng binh vi$n chua khdng khdi thi gia dinh vdn mdi th den cung le (TLN cOng dong, nam, 46 tudi, ddn tOc Dao, trudng thdn) Viec lya chgn ca sd khdm chfia bpnh cho tre nam va tie nfi co sy khac biOt nhung khoang cdch rdt nhd nen khdng thi kit luan dd Id cd nhiing ddu hipu vl bdt binh ddng gidi tiong lya chgn noi kham chfia bpnh cho tre dudi tudi 4.3, Bao vf vd chdm soc tre em dit&i tuoi Tai tdt ca cac dia phuong tham gia vao nghidn cdu, vipc thyc hanh bao v? chdm sdc tre em dudi tuli deu gia dinh, cOng ddng dam nhiem Khdng noi nao cd edc hinh thue nhd trd cdng lap Hai xd d Sdc Trdng la nai gdn ed nhdm tre tu thyc song so tre Khmer dudi tudi dugc giri d la khdng dang kl Thdi gian nghi khdng tham gia lao ddng sdn xuat sau sinh dl chdm sdc eon nhd cd su khac biet kha ro rang cua cdc bd mp DTTS d vdng nui cao va d vung thdp hon Tgi Hd Giang vd Gia Lai ed tdi 69% ba mp di lam nuang rdy xa vong 44 Thuc hanh chdm soc bd mg mang thai vd tre em thang sau sinh, ty le tai Ninh T h u ^ , Sdc Trdng chi bdng 1/25 vdi khodng 2,5% Ngugc lgi, cd tdi 68% ba mp Khmer nghi ban thang khdng tham gia vdo hogt dOng san xudt sau sinh Vd t j len ndy rat thdp d Hd Giang vdi 2,6% va Gia Lai vdi 8% (Bang 5) Bang Ty 1$ b i mf b i t Ska tham gia lao d$ng sin xuit theo sd t h i n g sau sinh Nmh Thugn (Chdm, Raglay) Sdc Tring (Khmer, Hod^ Don vj: % Chung H i Giang (Mdng, Dao, Tdy, Niinz La Chi, C& Lao) Gia Lai (BaNa, Gia Rai) Dudi thing 69,2 68,2 2,4 2,7 36,4 Tir 3-6 thing 24,4 12,5 25,9 11,0 18,5 Til 6-9 thing 3,8 11,4 37,6 16,4 17,6 dang nghi chua di lim 2,6 8,0 32,9 68,5 26,8 Khdng nhd/khdng hik 0,0 0,0 1,2 1,4 0,6 N 78 88 85 73 324 TrSn thing, Nguon: Khdo sdt cua du dn lgi tinh, 2015 Cdc bd me vung ndi cao phdi di ldm nuang ray xa mdi smh dupe td 3-6 thang thi khd bao dam viee bdo vp va cham sdc eon Ty Ip phdi mang Idn nuong ray khd cao d Gia Lai (89%) va d Ha Giang eiing nhu Ninh Thudn (45%) Vdi lya chpn nay, cd tdi 88% tie da tung bi muoi, cdn triing dOc dot vd 60% cdm ndng mua Mdt khac, vipc dl d nhd cho anh chi hay dng ba tidng bd mp di lam rdt phd bien d Sdc Trang (93%), va tiep den la Ninh Thuan (53%) Do thilu vdng bd mp trdng nom cac tai ngn thuang tich hay xdy nhdt vdi tie thdi ky la: edn triing, mu5i ddt chd cdn (35%), nga tren cao xudng (12%) vd bdng Ida, nude sdi (8%) Nhu vgy, giai doan trd dudi tudi du dugc bdo vp cham sdc dudi hinh thdc ndo logi hinh ke tren diu kha rdi ro Tham chi d mOt sd dia bdn khao sdt dd cd trudng hgp tre hi chet rdn dOe cdn, da Id, dudi nude Do d dia phuang khdng cd md hinh trdng tre hipn dgi nhu nhd tre nen vipc cai thiOn chdt lugng cham sdc bdo vp tre DTTS giai doan gSip rat nhilu khd khdn Ddy la khoang bi bd ngd bdo v? chdm sdc trd DTTS can nhanh ehdng cd bipn phap, gidi phap khdc phyc Kit qua khao sat djnti tinh eung cho thdy, dilu kipn ddc thd d miin n^i phia Bdc gdn bidn gidi, vipc dk eon nhd d nha thilu vdng bd mp cdn co nguy co bj bdt cdc Ngoai ra, d mdt vai DTTS cdn tdn tai phong tyc t|ip quan anh hudng tieu cyc tdi an toan vd chdm sdc sdc tre em, chdng hgn tap tyc ban, cho lam nudi (ngudi nhan nudi phai tra mOt sd tiln) hay dii eon Anh em hg gdn nlu ed mgt b l cd thi dii eho Nlu ddi td qua be thi nhihig dda tire thudng hay cdi xuong, ho?ic cd thi cd nhimg anh hudng tdi tam l;^ tinh cam Dieu edn dugc su quan tam cda cdc co quan chdc ndng vd ed eae bipn phdp, ehinh sach can thipp Sau day Id trudng hgp cu thi mua eon ve nudi: Em 24 tudi ddn tdc Niing Ldy chdng ndm khdng co Chdng Id trai du nhdt Em nhgn nudi chdu gdi hi$n dang hoc mdm non tgi trudng ndy Ngudi ch Id ddn tgc La Chi hai vg chdng bd Ngudi La Chi hay cho hon cd ddn tgc khdc Em mua chdu tir be, mua mdt 6,2 tri?u Sau dd ldm le sang tin dd Ngudi DTTS da ldm Ii sang tin ddi hg Id khdng liin quan gi v&i nda (vdi b me de) Bd m? bdn hien lgi ldy chdng dang d cung xd Ddn tgc La C sdng nhiiu a xa Bdn Dudi cd tgp qudn niu kinh ti khd Ididn la bdn Hg quan ni$m day chi Id khdng nudi dugc nin giei di (PVS, me nhdn nudi, 24 tudi, hpc vdn 7/12, ndng nghiep) Ketlu^n Trong cdng ddng cdc DTTS, dilu kiOn kinh tl khd khdn, phong tyc tgp qudn Ige hgu, nhgn thuc ve sue khde ba m? va tre em eon thap nen che dO dinh dudng, nghi ngoi cho cdc bd me mang thai va nudi bd chua dugc ddm bdo ldm anh hudng tdi sue khde cua bd mp va ty le tie hi suy dinh dudng cao Cdn phdi cd chuong tiinh ddo tao, tap huan nhdm thay ddi nhan thue, thuc hdnh vd cung cdp cac sdn phdm dinh dudng cho bd mp tiong thdi ky mang thai va cho bu Nhd nude nen cd chinh sdch tang cudng hS trg tien/san pham dinh dudng cho eac ba mp thuOc hO DTTS ngheo thang cud! thai ky va thang sau sinh "Hnhtiangsinh de tgi nha cdn ph6 biln cd thi din din cdc tai biln sdn khoa vd tinh trang phap ly cua tid (ldy chdng sinh, khai sinh, bdo hiem y td) dugc lam rat ehdm vd cdn nhilu sai sdt Trong dd, chdc ndng dd de cuatigmy tl xd chua dugc thue hien tot cd khdch quan va ehd quan Tap quan dn kieng sau sinh, nhd com cho tid dn td rat sdm, thoi quen mua cdc loai chao bOt ddng gdi sdn vdi gia 2-3 ngdn ddng/gdi, cho dn dam thay cho thuc hanh ndu chao dinh dudng cdn dugc nghien edu danh gia them de dam bao chi dinh dudng cho trd Trong cpng ddng cac DTTS, chua cd bdng chdng vl bat binh dang gidi nudi dudng ehdm sdc, bao ve, kham chfia bdnh gifia tie trai va tre gai sudt thdi gian mang thai va tre td 0-24 thang Chinh sdch cdp bao hilm y te cho trd dudi tudi dd dem lgi hiOu qud caotiongviee chdm sdc sdc khde cho trd em Tuy nhien, nhilu nguydn nhdn khac van edn ti 10 dang kl trd DTTS dudi tuli (tiong cd cd tre dudi tudi) chua co bao hilm y te, hode bi sai cac dfi lieu tiong the Dilu gay kho khdn cho tre bi benh ndng phai khdm chfia bpnh tgi tuyen tinh va trung uong Cdng tac y tl du phdng cho ba mp va tre em DTTS da duge thyc hiOn khd tdt Ty 10 cac ba mp thuc hien tidm chdng vd kham thai djnh k5' dd dgt duge myc tidu chuong tiinh qude gia y tl giai doan 2012 - 2015 Tre sa sinh dugc tiem chung kha day du, diing thdi dilm, du so mui theo quy dinh Tuy nhien dilu kien dia hinh vd nhdn thdc ehua ddy du, cdng tac tiem chdng eho tie em DTTS cdn gdp nhieu tid nggi ed the anh hudng tdi chat lugngtidmchung 46 Thuc hdnh chdm soc bd m? mang thai vd tre em Cdng tdc bao vp, giao due ti^ em DTTS td din tudi hdu nhu cdn hi bd ngd Tgi vung DTTS vd mien mii, gdn nhu khdng cd eae md hinh giao dye cdng lap va tu tiiuc eho nhdm tre Toan bO vipc cham sdc bdo vp, gido dye tre nhdm tudi phy thugc vao gia dhih va hg hang Dd dl nha cho ngudi nha tidng hay mang theo len nuong ray diu c6 nguy ea dang k l eho sue khde va an toan tie nhd Day la van de ma Nha nude, ehinh quyIn cac cdp edn nhanh ehdng cd nhung chinh sdch, md hinh can thiOp de dam bao quyIn tie em va tgo dilu kien eho tre dupe phat trien todn dien Ben cgnh dd, can ed tiiem nghien euu tim hilu vd dua eac gidi phap tich hgp de dng phd vdi cac tap tuc Igc hgu cdn tdn tgi d mdt sd DTTS cd thi dnh hudng tieu eye den su an toan va phat trien toan dien eua tie nhd Tai li^u t h a m k h a o Bo Lao ddng Thuong binh v i X i hoi 2015 Quy^t dinh so 1294/QD-LDTBXH phS duy§t k^t qui dilu tra, ri soil hO ngheo, hg cin nghSo nam 2014, ngiy 15/9/2015 Chinh phu 2011 Nghj quySt so 80/NQ-CP ngiy 19/5/2011 ciia Chfnh phii ve djnh hudng giim n ^ o bin vOng thdi kSf tir nim 2011 d6n nim 2020 Chinh phii 2012.Quyet dmh 1208/QD-TTg ngiy 4/9/2012 cua Thu tudng Chinh phii PhS duy§l Chirong trhih m^c ti6u qude gia Y t l giai do^n 2012 - 2015 Plan 2013 Gidi thi?u chuong trinh chim sdc v i phit trien tri tho toin di^n Xem link http://www.wob.be/vietnam/files/p09_plan int_chuong_trinh_giao_duc_plan_vn.pdf Bd Y tk 2013 Bio cio "Du i n Chim sdc siic khde sinh sanh v i cii thifn tinh tr^mg dinh dudng 2013" A\rc hifn tai tinh: Son La, Quing Ngii, Dik LSk, KiSn Giang Vy Tong hop - Oy ban Dan lOc vi Vi^n Dinh dudng Tong cyc Th6ng ke 2011 Miic sinh va miic chil o Vi$l Nam: thuc irgng, xu huong vd nhiing khdc biit Tdng dilu tra Din s6 v i Nhi d Vi^t Nam nim 2009 UBDT, IRC, UNICEF (Uy ban Din t§c, Cdng ty Tu vdn v i Nghien cihi Phit triln, Quy Nhi ddng Lifin h i ^ quoc) 2015 Ngiifeo da ehieu tre em Vi^t Nam vimg dan tdc thilu so - Thyc trang, bi&i dgng vi nhimg thich thOrc Bio cio nghien cihi H i N$i UNDP 2013 Mifc liiu ihien nien ky: Gidm ly 14 id vong cua Ire em  ... kSf tir nim 20 11 d6n nim 20 20 Chinh phii 20 12. Quyet dmh 120 8/QD-TTg ngiy 4/9 /20 12 cua Thu tudng Chinh phii PhS duy§l Chirong trhih m^c ti6u qude gia Y t l giai do^n 20 12 - 20 15 Plan 20 13 Gidi thi?u... thing 69 ,2 68 ,2 2,4 2, 7 36,4 Tir 3-6 thing 24 ,4 12, 5 25 ,9 11,0 18,5 Til 6-9 thing 3,8 11,4 37,6 16,4 17,6 dang nghi chua di lim 2, 6 8,0 32, 9 68,5 26 ,8 Khdng nhd/khdng hik 0,0 0,0 1 ,2 1,4 0,6... hang ngdy thdi ky mang thai la 34% gdp 30 Idn so vdi phu nfi Ba Na/Gia Rai d Gia Lai chi vdi ty 10 1% (xem them Bang 1) Bing T^ l | bi mf c6 i n them ngoii bO^ ctrm gia dinh mang thai 0071 vj: %