JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Voi - N'^S /2014 Danh gia hieu qua mot s6 bien phap can thiep lam giam ty so gi6*i tinh sinh 6" huyen cua tinh BSc Giang Effectiveness of Intervention Decreasing Sex Ratio at Birth in Districts of Bac Giang Province Han Thj H6ng Tliiiy*; Le Van Bao**; Hoang Hai** *Sd Yte Bdc Giang **Hgc vien Qudn Y Muc tieu: Danh gia hieu qua mpt sd bien phap can thiep lam giam ty sd gidi tfnh sinh d huy§n cua tinh Bac Giang Ddi tugng vd phuang phdp: nghien cdu can thiep mpt nhom cd so sanh trUdc - sau tren 400 cap vp chong sinh t d thang den het thang 8/2013, tai huyen cCia tinh Bac Giang: Luc Nam, Lang Giang va Viet Yen Kit gud: K\er\ thdc: t ^ l e doi tUpng biet hau qua se gay thieu nd, nam kho lay vp tang 8,1%; cho r i n g khong anh hudng gi den xa hpi giam 8,3%; Thdi do: Jy le mong trai giam 14,6%; khdng quan trpng la trai hay gai tang 5,8%; ThUc hanh: Ty le lUa chpn gidi tinh thai nhi lan sinh gan nhat g i l m 9,2% Ty sd gidi tinh sinh (TSGTKS) toan tinh g i l m 2,3 diem phan tram; t>' sd giudi tinh sinh d cac huyen nghien cdu, theo t h d tU sinh deu giam 'Tty/chda; Kien thdc, thai dp, thuc hanh, lUachgn gidi tinh thai nhi, t y s d gidi ti'nh sinh, Bac Giang Summary: Oob/ecr/Ves; To evaluate the effectiveness of a program aiming to decrease the sex ratio at birth in districts of Bac Giang province Subjects and methods: Group-based intervention with pre- and postcomparison on 400 couples who gave birth from May to the end of August 2013, in districts Luc Nam, Lang Giang, and Viet Yen distncts of Bac Giang province Resuits: The knowledge about the consequence of having more boys than girls (making men difflcult to find their partners) increased by 8.1 %; the prevalence of subjerts thinking that sex-ratio imbalance did not influence the society reduced by8.3% Attitude: Prevalence of respondents who wanted to have a son decreased by 14.6% and that of those who had no concerns about gender of the baby increased by 5.8% Practice: the prevalence of respondents utilizing the fetal sex selections in the nearest birth decreased by 9.2% Sex ratio at birth in Bac Giang province decreased 2.3 percentage points; Sex ratio at birth in all three districts decreased in all birth-orders Keywords: knowledge, attitude, practice, fetal sex selection, Bac Giang province Phan bien khoa hpc; TS DO HOA BINH 126 T$p - 3/2014 TAP CHi Y DUOC LAM S A N G 108 Trong do: D a t van de + n: cd mau nghien cdu (cap vp chdng); Mat can bang gidi tinh sinh (MCBGTKS) da gay I n h hudng nghiem trpng den tinh hinh kinh te, an ninh, chinh tri, xa hdi cua nhieu qudc gia chau A Be khac phuc tinh trang nay, cac nUdc cd ty sd gidi tinh sinh (TSGTKS) cao da phai trien khai rat nhieu bien phap g i l i quyet Tuy nhien, mdi chi nhat cd Han Qudc dua dupe TSGTKS trd ve mdc sinh hpc, sau gan 20 nam thdc hien cac g i l i phap het sdc quyet liet va ddng bd d Viet Nam ndi chung va d Bic Giang ndi rieng, MCBGTKS dien nhanh, cang lan rdng va da den mdc nghiem trpng [1], [3], [5] Neu de tinh trang tiep tuc keo dai, khdng cd su can thiep manh me, se gay he luy nhieu mat den sU phat trien kinh te - xa hpi cua tinh Bac Giang ndi rieng va e l nUde ndi chung Chdng tdi tien hanh nghien cdu "Danh gia hieu q u i m p t sd bien phap -1- p,: la ty le ddi tUpng biet hanh vi chan doan gidi tfnh thai nhi (GTTN) bl phap luat cam trudc can thiep la 63,3% (td ket qua dieu tra thdc trang); -I- P2: la ty le ddi t d p n g biet hanh vi chan doan GTTN bj phap luat cam sau can thiep, vdi mong mudn tang them ddpc 15%, len k h o i n g 78%; + a: Mdc y nghia t h d n g ke, chpn gia tri a = 0,05; ^Zi.^^=1,96 -I- p: Xac suat pham sal lam loai 2, chpn p = 0,05 (luc mau = 95%) ^ Z,.p= 1,645 Thay sd, tinh ddpc n = 243 Tfnh den thdi diem dieu tra sau can thiep, cd 413 ddi tUpng sinh nen da tien hanh dieu tra toan bd 413 ddi t u p n g Tuy nhien, qua trinh dieu tra cd 13 ddi t d p n g khdng tham gia, cdn lai 400 ddl tUpng da t u nguyen can thiep lam gicim ty le sd gidi tinh sinh d tham gia nghien cdu, nen chung tdi da chpn n = 400 Huyen cua tinh B^c Giang n h ^ m muc tieu cCia (Luc Nam: 134; Lang Giang: 133; Viet Yen: 133) nghien cdu: Ddnh gid hieu qud mot so bien phdp can - Phuong phap t h u thap sd lieu: Phdng van true thiip Idm giam TSGTKS d huyen cua tinh Bdc Giang tiep cac ddi t d p n g nghien cdu bSng bd cau hoi thiet ke san; phan tfch sd lieu t h d cap Ddi tucing va phuong phap nghien cdu - B i e n s d nghien cdu: + Hieu q u i can thiep lam thay ddl kien thdc (ty 2.7 Dia diem, doi tuang, thai gian nghien cdu - Dia diem nghien cdu: huyen Luc Nam, Lang Giang, Viet Yen cua tfnh B^c Giang le ddi tuong biet hau qua cilia LCGTTN gay thieu nd, nam khd lay vp; biet chan doan GTTN bj phap luat cam); thai dp (mong mudn ve gidi tfnh tiep - Ddi t d p n g nghien cdu la cac cap v p chdng: theo); thdc hanh (ty- le LCGTTN lan sinh gan + Nghien cdu thuc trang tien hanh tren 1.164 nhat) cua ddi tdpng ve LCGTTN cap vp chdng sinh t r o n g nam (td 1/2007 den het 12/2011) -1- Hieu q u i doi vdi TSGTKS: toan tinh, huyen nghien cdu, theo t h d tU sinh + Danh gia hieu q u i can thiep: 400 cap vp chong sinh t d thang den het thang 8/2013 - Sd lieu dugc phan tfch b^ng phan mem Epi info 6.04 - Thdi gian trien khai cac bien phap can thiep: t d 6/2012 den 8/2013 2.2 Phuang phap nghien eCtu - T h i e t ke nghien cdu: nghien cdu can thiep m d t nhdm c d s o sanh t r u d c - s a u - Cd mau danh gia hieu q u i can thiep tinh theo cdng t h d c [6]: _ 2.3 Mot sd bien phip can thiep da trien khai - Can thiep tren quy md todn tinh: ThUc hien cac bien phap q u I n ly nha nddc: (thanh, kiem tra cac co sd cung cap dich vu, x d ly vi pham); tham mUu ban hanh Chi thi, hudng dan cua Chu tjch UBND tinh ve thuc hien nghiem tuc Luat Hdn nhan va gia dinh cung n h u nhdng van b i n phap quy cOa Nha nudc hien {Z,.a/z^Z|.B)^x(piqi + pjq;) hanh; cd cam ket cda cap uy, chinh quyen cac cap, cac nganh; thdc hien truyen thdng da phdong tien 127 JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Ty le sinh eon lan t r d len, TSGTKS theo t h d t u Giang tang 2,9 diem phan tram (1,45 diem phan sinh va TSGTKS chung cho tat ca cac lan sinh cda ddi tram/nam); vdi tdc d p nhU vay, neu khdng ddpc t u p n g sau can thiep deu giam hon so vdi trudc can khdng che, ty sd cd the tang den 122,6 vao nam thiep; dac biet lan sinh t h d t r d di, TSGTKS g i l m rd 2013 Tuy nhien, sau t h d i gian can thiep, TSGTKS ret (55,2%), CSHQ dat 24,9% nam 2013 c d n l 17,4, g i l m dupe 2,3 diem phan tram; neu 50 vdi da tang cda tinh, X^ sd da g i l m ddpc Ban luan k h o i n g 5,2 diem phan tram T Hieu qua thay doi kien thdc, thii do, thuc hinh lUa chgn gidi tinh thai nhi Ket q u i nghien cdu cdn cho thay, TSGTKS cOa huyen nghien cdu, TSGTKS c h u n g cua tat c l cac lan + Kien thdc cua ddi tugng ve LCGTTN: Sau can sinh va cda t d n g lan sinh theo t h d t d sinh cua cac thiep, t^ le ddi tupng biet hau q u i cua LCGTTN tang ddi t u p n g deu giam Dieu cho thay viec trien len, chi 8,3% ddi tUpng cho rang viec LCGTTN khai cac g i l i phap can thiep d d n g b d cd sU cam ket khdng cd I n h hudng gi ddi vdi xa hdi, g i l m 4,3% so va vao cupc cda ca he t h d n g chfnh tn da cd hieu q u i vdi trudc can thiep; t j le biet hau qua cda LCGTTN t r o n g viec lam g i l m TSGTKS Day cung la bai hpc rut gay thieu phu nd, nam gidi se khd lay vp 66,3%, tang t d m p t sd nddc (Trung Qudc, An Dp ), rat nhieu 8,1%; t y l e ddi tupng biet hanh vi chan doan GTTN bj cac g i l i phap can t h i e p lam giam TSGTKS da ddpc phap luat cam 78,3%, tang 15,0% so vdi trudc can thiep Nhdng thay doi ve kien thdc se cd sU tac ddng den thUe hanh LCGTTN cua ddi tUpng Dieu cho thay hieu q u i cua cdng tac truyen t h o n g , bien quy djnh cua phap luat lien quan den LCGTTN trien khai, nhdng hieu qua bi gidi han viec thdc hien khdng quyet liet, d d n g b d va thieu su cam k^t e h f n h t r i [ ] , [4], [7] Ket luan + Thdi cua ddi tUOng: Sau thdi gian can thiep, sd ddi tupng chUa cd eon trai mong mudn gidi tfnh Nghien cdu sau can thiep tren 400 cap vp chdng cda tiep theo la trai g i l m t d 45,4% xudng sinh t r o n g thdi gian t d t h i n g den het t h i n g cdn 36,4%; sd ddi tUpng cho la khdng quan trpng 8/2013, tai huyen nghien cdu eho thay: (1) Kien viec gidi tinh eon tiep theo la gai hay trai cung tang thdc: t)/ le ddi t d p n g biet hau q u i cua LCGTTN se t d , % len 27,7% NhUvay, mong mudn sinh gay thieu nd, nam khd lay v p tang , % ; khong I n h trai d cac ddi t u p n g tren dja ban nghien cdu sau can hudng gl den xa hpi g i l m dupe 4,3%; biet hanh vi thiep cd g i l m hon, quan niem cua cac cap vp chdng ve gidi tfnh cua eon khdng quan trpng tang va co hieu qua rd ret Dieu cho thay thai dp cua ddi tupng ve viec nhat dinh p h l i cd eon trai da cd sU chuyen bien + Thuc hanh LCGTTN cua doi tugng: Ket q u i nghien cdu cho thay ty le LCGTTN lan sinh gan nhat eon 8,8%, giam 9,2% so vdi trudc can thiep (18,0%) NhUvay, sau thdi gian can thiep, kien thdc, thai dp cac ddi tupng ve LCGTTN cd sU thay ddi da tac dpng tfch cue den thUe hanh LCGTTN, yeu td chan doan GTTN bi phap luat cam tang dupe 15,0%; T h I i dp: t^ le m o n g m u d n trai t r o n g lan sinh tiep theo g i l m 14,6%; k h d n g quan t r p n g la trai hay gai tang 5,8%; Thdc hanh: ty le LCGTTN lan sinh gan nhat g i l m 9,2% (2) TSGTKS: Toan tinh: nam 2013 la 117,4, giam 2,3 diem phan tram; huyen nghien cdu: Luc Nam giam 13,4; Lang Giang g i l m 1,2; Viet Yen g i l m 6,4 diem phan tram; TSGTKS theo t h d t u sinh, TSGTKS chung tat c l cac lan sinh deu g i l m han so vdi trudc can thiep quan trpng gdp phan lam giam TSGTKS 4.2 Hieu qua doi vdi TSGTKS cua ei tinh vi huyen nghien cdu Nam 2009, TSGTKS cua B k Giang la 116,8; nam 2011 la 119,7 nghia la nam TSGTKS cua Bic 130 Tai lieu t h a m khSo Christophe Z Guilmoto (2008), 'Thay ddi t^ sd gidi tfnh sinh d Viet Nam thdi gian g i n d S / ' , Tong quan cdc bang chdng Ha Npi Tgp - S o 3/2014 TAP CHl Y DL/CC LAM SANG 108 Nguyen Xuan Hdng (2008), "Mot so cich g i l i quyet cija cac nudc khu vuc Chau A n h i m l i y lai su can bSng gidi tfnh sinh", K^yeu Hdi thao xay dUng De dn can thiip cdc yeu tddnh hudng dinh cua Trung Qudc va Han Qudc", Top chi Ddn sd & Phdt trien, s6 000) UNFPA (2010), "J^ sd gidi tfnh sinh Chau A va Viet Nam", Tong quan tdi lieu nham hUdng ddn gidi tinh sinh, Ha Noi, 12/2008 nghien cdu ve chfnh sdch, Ha Npi Duong Qudc Trpng (2011), T y sd gidi tinh sinh Jones d Viet Nam; cac dac diem ca b i n va g i l i phap" Tap introduction chi Dan sd& Phdt trien, sd (124) estimation", EmergMedJ, 20:453-458 SJ, Carley to S, Harrison power and M (2003) "An sample size Duong Qudc Trpng (2009), "Mpt sd nhan xet ve Li, Shuzhuo (2007), Imbalanced Sex Ratio at Birth kinh nghiem cdng tac dan sd - Ke hoach hda gia and Comprehensive Intervention in China, Report for UNFPA 131 ... nguyen can thiep lam gicim ty le sd gidi tinh sinh d tham gia nghien cdu, nen chung tdi da chpn n = 400 Huyen cua tinh B^c Giang n h ^ m muc tieu cCia (Luc Nam: 134 ; Lang Giang: 133 ; Viet Yen: 133 )... sd, tinh ddpc n = 2 43 Tfnh den thdi diem dieu tra sau can thiep, cd 4 13 ddi tUpng sinh nen da tien hanh dieu tra toan bd 4 13 ddi t u p n g Tuy nhien, qua trinh dieu tra cd 13 ddi t d p n g khdng... d tU sinh + Danh gia hieu q u i can thiep: 400 cap vp chong sinh t d thang den het thang 8/20 13 - Sd lieu dugc phan tfch b^ng phan mem Epi info 6.04 - Thdi gian trien khai cac bien phap can thiep: