Đang tải... (xem toàn văn)
HOATDONG KH CN W L l mit tinh phat dpng toan dan si> d^ng mudi idt t^i tripong Tilu hpc Chau C u ^ g , Quy Hgp l\/ld HINH GIAI PHAP CAN THIEP LAM GIAM TY LE BUOU CO HOC SINH 8 10 TUOI 0 NGHE AN • Nguy[.]
HOATDONG KH-CN WL l mit tinh phat dpng toan dan si> d^ng mudi idt t^i tripong Tilu hpc Chau C u ^ g , Quy Hgp l\/ld HINH GIAI PHAP C A N THIEP LAM GIAM TY LE BUOU CO HOC SINH 8-10 TUOI NGHE AN • Nguyen Van Hoan, Nguyen Thanh Binh Benh vien Npi tiet tinh Nghe An I DAT VAN BE Idt la mdt vi chat dinh dudng rat can thiet de tdng hgp hdc mdn tuyen giap vdn ddng vai trd quan trgng cho su Idn len va phat hien cua ngudi Thieu idt se gay nhung hau qua nghiem trgng, anh hudng den sue khde nguoi, dugc ggi chung la cac roi loan thieu idt (CRLDTI), bao gdm: thieu nang tuyen giap, thieu nang tri tue, dSn ddn, thai chet luu, sdy thai, de non va phd bien nhat la benh buou cd dia phucmg Benh buou cd dia phuang khdng phai la hau qua nang ne ciia thieu idt nhung nd la hau qua rat phd bien va thudng dugc dimg nhu la mpt chi sd danh gia tinh trang thieu idt, dac biet la ty le benh buou cd cua tre em Nghe An la mot nhung dia phuong cd dac diem kha dac thu viec san xuat, tuyen truyen, van dgng sii dung mudi idt de phdng chdng buou cd va CRLDTI Cac nghien ciiu, danh gia mgt each quy md, toan dien nham de xuat giai phap phu hgp vdi dac diem dia phuong viec giam ty le budu co Ilia tudi hgc sinh ndi rieng va ca cdng ddng ndi chung chua dugc thuc hien Vi vay, viec trien khai S6 11/2014- de tai 'Nghien cuu de xudt gidi phdp gidm ty le budu CO hoc sinh a tuoi 8-10 tren dia bdn tinh Nghe An " la rat can thiet va y nghia Ket qua nghien ciiu giai doan I (2011-2012) Clia de tai cho thay tmh trang CRLDTI dang quay Ud lai d Nghe An la nguy co rat can ke Cac chi sd chuyen mdn co ban, tien quyet dc danh gia viec toan CRLDTI da va dang khdng tri dugc nua, xu hudng giam d4n qua cac mdc thcri gian nam/lan theo quy dinh kiem tra, danh gia cua WHO, Bd Y te Viet Nam va da cham han chdt, cu the: ty le buou cd vung mien niii tang tir 1,18% (2009) len 1,8% (2012); dd phu mudi idt giam tir 95% (2005) xudng 90,6% (2012); miic trung vi idt nieu giam tit 165 mcg/1 (2005) xudng 101 mcg/I (2012) Dac biet, viing ddng bang ven bien, ty le ho gia dinh dimg mudi idt du tieu chuan phdng benh (>150 mcg/lOg) chi dat 83,8%, idt nieu trung vi chi dat 86 mcg/I Nguyen nhan chinh dugc xac dinh la do: Thieu mang ludi phan phdi, cung ling mudi lot cho nhan dan mua sii dung cd nhu cau; Thi§u KIO3 de tron vao mudi din din xhiiu Tgp chi KH-CN Nghe An ' ' HOATDONG KH-CN + Miic idt nieu trung vi: tir 10-20mcg/dl mudi idt va cac chS phim cd idt cung ung cho ngudi + Ty le phu nQ tir 18^9 tudi nhSn thiic diy dii dan; Cdng tac xa hdi hda theo quy dinh ciia Chinh phu tai Nghi dinh 163/ND-CP 29/12/2005 chua vh cac tac hai cua viec thieu hut idt va tac dung dugc tri thudng xuyen, tham chi mai mgt dan ke ciia viec dimg mudi idt dii tieu chuan phdng benh tir sau hoan muc tieu toan cudi nam >90% * Ve linh vuc du phdng 2005 N6u nhung nguyen nhan neu hen khdng dugc He thdng cac giai phap da trien khai phu hgp khac phuc kip thdi, chic chSn Uong tuong lai rat gSn, tinh trang cac rdi loan thieu idt se quay trd lai voi vdi cdng tac du phdng tren dia ban toan tmh lien ngudi dan Nghe An quan ddn hoat dpng phdng chdng CRLDTI Cu Chinh vi vay, k^t qua thuc hien dS tai "Nghien th6: da kien toan Ban chi dao hoat ddng phdng, cim di xudt gidi phdp gidm ty le budu co hpc sinh achdng CRLDTI va ban hanh quy che hoat ddng tudi 8-10 tren dia bdn tinh Nghe An" giai doan IIClia Ban chi dao, dua vao ke hoach hoat dpng (2013-2014) cd y nghia quan trgng ddi vdi thuc tiin thudng xuyen; diy manh truyen thdng nhieu hinh cdng tac quan ly phdng chdng CRLDTI tai tinh Nghe thiic; tang cudng tdt cdng tac tra, kiem tra, An hien giam sat chit lugng; td chiic tap huan, dao tao nang cao trinh dp, nang luc hoat dpng; nang cip II KET QUA TH^TC HIEN Md hinh giai phap can thiep cac labo kidm nghiem, xet nghiem cua chuang Thuc trang v6 tri ben vimg cac qua trinh tai Benh vien Ndi tiet Nghe An va tai cac xi toan CRLDTI va benh budu cd hien tren nghiep san xuat mudi idt dia ban ca nude va Nghe An dang la van de lo ngai Md hinh cac giai phap can thiep nhan Bien phap chuyen mdn co ban xuyen sudt va lau dai manh vai trd cdng tac xa hdi hda phdng chong Clia chiing ta d6 phong chdng CRLDTI dd la bd sung CRLDTI, cac benh vien, trung tam y te idt cho CO thg thdng qua mudi idt va cac che pham cac tuyen la don vi diu mdi thudng true de hoat cd idt nhu bdt canh idt, nude mam idt Cac giai phap dgng la phu hgp vdi tinh hinh thuc tien cua dia ve cdng tac to chiic, ve trien khai ndi dung da phuong dugc Nha nuac quy dinh, giao trach nhiem * Ve ITnh vuc dieu tri Nghi dinh 163/ND-CP 29/12/2005 vd viec san Md hinh cac giai phap can thiep da chii trpng xuSt, cung img mudi idt cho ngudi an Tuy nhien, cdng tac dieu tri song song vdi lmh vuc du phong theo cac nghien ciiu danh gia giai doan 2006-2012 Cu the: dinh ky dieu tra, danh gia benh budu co thi cac chi sd chuyen mon chinh cua hoat ddng de trien khai dieu tri kip thdi cho cac trudng hgp phdng chdng CRLDTI tai Nghe An da giam den miic phat hien theo diing phac chuyen mdn; trien thap nhat Trude thuc trang tren, md hinh giai phap khai tap huan, dao tao ve chuyen mdn thudng can thiep lam giam ty le buou cd hgc smh d tudi xuyen cho cac can bd chuyen khoa tham gia cdng 8-10 tren dia ban Nghe An da tap trung vao giai quyet khac phuc cac nguyen nhan dugc nit tir thuc tac dieu tri toan tinh; tap tnmg tham muu trang hoat ddng phdng chdng CRLDTI tren dia ban, nang cap cac trang thiet bi, co sd tang de du dd nhan manh ngudn lire xa hdi hda, phdi hgp dieu kien dieu tri cho benh nhan d cac tuyen Cac chi tieu chuyen mon chinh d^t thxgc lien nganh, td chiic chinh tri tren ca hai linh vuc: du \fhi triSn khai mo hinh phdng va dieu tri 2.1 Ty le bu&u c6 hgc sinh 8-10 tuoi Md hinh da tap trung danh gia hieu qua dat Theo ket qua dieu tra danh gia sau can thiep dugc thdng qua nhieu hinh thiic: tap huln chuyen cho thay, ty le budu cd hgc sinh 8-10 tudi toan tinh mdn, giam sat thuc tien, hdi thao, thdng ke dam la 0,73%, thap hon so voi bao cao ciia Ta Van bao cd CO sd khoa hgc de tri bdn vung kdt qua Binh va cs, Benh vien Ndi tiet Trung uong cho toan CRLDTI dat dugc sau k6t thiic khu vuc khu cu (3,2%) va tuong duong vdi ket chuong trinh vao cudi nam 2005 voi cac chi so qua Clia Trung tam Ndi tiet Nghe An dieu tra nam chuyen mdn chinh sau: 2006(1,24%) + Ty le budu cd hpc sinh 8-10 tudi 90% biet cd y nghia (p0,05) Nhu vay, budc diu trien khai md hinh cac giai phap can thiep Iam giam ty le budu cd hpc sinh 8-10 tudi da cd hieu qua, nhien de cd hieu qua rd ret hon niia can ap dung rdng rai, thudng xuyen md hinh thdi gian tdi va cd danh gia thudng xuyen, dinh ky theo timg giai doan 2.1 Tinh hinh thu nhap idt cua cgng ^ng Thu nhap idt ciia cdng ddng ndi chung va cac ddi tuong nghien ciiu ndi rieng dugc danh gia qua ndng dp trung vi idt bai tiet qua nude tieu pham vi toan tinh va timg viing Ket qua dieu tra danh gia cho thay ndng idt nieu trung vi toan tinh la 10,3mcg/dl Danh gia chi sd idt nieu trung vi theo timg viing tinh thi SO 11/2014- vimg ddng bang - ven bien thap nhat (8,9mcg/dl), tiep den la vimg mien niii thap (10,9mcg/dl) va vimg mien niii cao (13,3mcg/dl) Gia tri idt nieu thap nhit la 2,9mcg/dl va cao nhat la 19,9mcg/dl Ket qua cimg phu hgp voi ket qua cua cac tac gia khac nhu Ta Van Binh va cs nghien ciiu d Van Chin - Yen Bai (2004) va d Viet Nam (2005), vdi Vo Xuan Lilu va cs o Ddng Nai (2005) Theo ket qua danh gia, miic idt nieu tnmg vi giai doan II (I0,3mcg/dl) cao hon cd y nghia so vdi ket qua giai doan I (10, Imcg/dl) Tuy nhien de danh gia cu the va ro ret tinh hieu qua cua md hinh can thiep thi can trien khai mdt each thudng xuyen, lau dai hon nira md hinh hen dia ban toan tinh 2.3 Tmh hinh su dung mudi idt vd cdc chi phdm cd idt Theo ket qua dieu tra danh gia sau triin khai md hinh cac giai phap can thiep, toan tmh da cd 92,87% hd gia dmh dimg che phim idt; dd cd 90,73% hd gia dinh dimg ch6 pham idt du tieu chuan phdng benh theo quy dinh tieu chuin cua UNICEF Trong do, vimg ddng bang - ven bien cd ty le bao phu mudi idt va cac che phim cd idt du tieu chuan phdng benh chidm 83,8%; vimg mien niii thap la 92,6%; vung miin niii cao la 95,8% Ket qua cao hon so voi kit qua didu tra Clia Vo Xuan Lilu d Ddng Nai (2005) va kdt qua dieu tra giai doan I ciia de tai, nhien su khac biet chua cd y nghia Tgp chi KH-CN Nehe An 113] HOATDONG KH-CN Nliu vay, theo ket qua danh gia, ty le bao phit mudi idt va cac che pham cd idt dii tieu chuan phdng benh loan tinh, vimg mien niii thap da tang len so voi giai doan I (90,73%; 92,6% so vdi 90,6%; 91,2%) Rieng viing ddng bang - ven bien cd ty le dp bao phu mudi idt va cac che pham cd idt du tieu chuan phdng benh v§n cdn d mirc thap nhu giai doan I (83,8%); d vimg nuhn nui cao cd ty le thap hon giai doan I (95,8% so vdi 96,8%) Tuy su khac biet chua cd y nghia thdng ke, nhung chiing tdi nhan thay cd su cai thien cac tieu chi sau ap dung trien khai md hinh cac giai phap can thiep, de dat dugc muc tieu ben vimg can trien khai thudng xuyen lau dai va c6 nhiing nghien ciiu danh gia tiep theo 2.4 Kien thuc cua ngudi ddn ve tdc dung ciia iot vd tdc hgi thieu idt Qua nghien ciru danh gia, toan tinh cd 91,53% ddi tugng dugc phdng van hieu day du ve tac dung cua idt va cac tac hai cua thieu idt, cdn 8,47% ddi tugng hieu khdng day du Ty le hieu biet day du cao nhat d vimg ddng bang - ven bien (94%), tiep den la viing mien niii thap (90,6%) va thap nhat d viing mien niii cao (90%) Ket qua phii hgp vdi cac nghien cuu cua Ta Van Binh va cs o Van Chin - Yen Bai (2004), Vd Xuan Lilu va cs d Ddng Nai (2005) Sau trien khai md hinh cac giai phap can thiep, ty le nhan thiic, hieu biet day du cua cac ddi tugng toan tinh, vimg ddng bang - ven bien, viing mien nui thap da cd cai thien tang len (tuong img lin lugt la 91,53%, 94%, 90,6%) so vdi giai doan I (tuong ling lin lugt la 90,6%, 91,5%, 90,1%), su khac biet la cd y nghia d vimg ddng bing - ven bien (p0,05) Nliu vay, sau ap dung trien khai md hinh cac giai phap can thiep lam giam ty le buou co hpc sinh 8-10 tudi thi mirc dp hiiu biit cua ngudi dan da co sir cai thien d khuynh hudng tdt, la mpt tieu chi d i danh gia hieu qua cua md hinh cac giai phap can thiep thdi gian tiip theo SO U / Sir di^ng chl phSm c6 idt la giai phap quan tr^ng de phong chdng CRLDTI Hieu qua kinh te - xa hoi dat dtrffc trien Idiai mo hinh Md hinh cac giai phap can thiep giai doan II da mang lai nhieu hieu qua, lgi ich kinh te - xa hgi to Ion: - Giiip nhiing ngudi lam cdng tac y te du phdng, dac biet cdng tac phdng chdng CRLDTI dup€ tiep can, tiep thu kien thiic chuyen mdn, nang cao trinh ve lmh vuc dieu tra cgng ddng, nang cao trinh quan ly va chi dao th^c hien cdng tac xa hpi hda ve phdng chong CRLDTI - Giiip cho cac nha quan ly cd them nhiing co sd, can cii khoa hpc de de cac hoach dinh chien luoc kinh te, chien luge cham sdc siic khde pham vi dia phuong hang nam La co sd de tuyen truyen van ddng xa hdi hda cdng tac phong chdng CRLDTI ndi chimg va du phdng benh ndi rieng - Giiip cho nhan dan nang cao nhan thiic va hieu biet ve tac hai cua viec thieu idt gay budu cd va cac rdi loan thieu iot, tac dung phong chdng budu cd cua viec sii mudi i dt thudng xuyen cac bila an hang ngay, tir chuyen bien nhan thiic sang hanh vi tu giac thuc hanh - Giiip cho xa hdi va gia dmh giam dugc nhifiu chi phi ton kem khic phuc hau qua hoac diSu tri bang phuang phap khac Qua triln khai thuc tiin va tii nhiing kit qua, danh gia kiim chirng hen, chiing toi nhan thay mo ~ Tgp chi (j^i KH-CN Nehg An ' ^ HOATDONG KH-CN hinh trien khai cac giai phap can thiep la diy du va cd tinh kha thi, can dugc tri thucmg xuyen, lau dai de lam giam ty le buou cd hgc sinh 8-10 tudi tren dia ban tinh Nghe An in KET LUAN He thdng cac giai phap va md hinh ly thuyet can thiep nhim lam giam ty le budu cd hgc sinh d dp tudi 8-10 tren dia ban tinh Nghe An la phii hgp voi thuc tien Hoan thien va thdng nhat trien khai cac giai phap can thiep lau dai tren ca tinh: * Cdc gidiphdp can thiep todn tinh: - Tiep tuc cung cd lai td chiic va quy che hoat dpng Clia Ban chi dao phong chdng CRLDTI toan tinh - Tang cudng ciing co chan chinh lai he thong cung ling mudi idt toan tinh - Ban chi dao cac cap chi dao nghiem tiic cong tac xa hpi hda ve phdng chdng cac rdi loan thieu idt cgng ddng - Tap trung co che tham muu cui^ ling dii nguyen lieu hda chat KIO3 cho cac xi nghiep san xuat che bien mudi idt - Tap tnmg phat Men va dieu tri scan cac the buou cd d cdng ddng ndi chung va d tre em ndi rieng - Tang cuong cdng tac chi dao, tra Idem tra, giam sat cdng tac trien khai viec phdng chdng cac rdi loan thieu idt tai noi san xuit cac che phim cd idt va cgng ddng * Md hinh trien khai cdc gidiphdp can thiep: - Ve lmh vyc du phdng; -I- Kien toan lai Ban chi dao hoat ddng phdng chong CRLDTI cac cap tir tinh den huyen, xa, lay Sd Y ti la CO quan chii dao giiip lanh dao tinh trien khai thuc hien cdng tac xa hpi hda va dua vao ke hoach hoat ddng thudng xuyen -I- Td chiic hpp lien nganh de tdng ket, danh gia nhiing uu diem, tdn tai viec phdi hgp lien nganh thuc hien xa hdi hda phdng chdng CRLDTI cua nam truoc, nit bai hgc kinh nghiem de trien khai cho nam sau hieu qua hon Danh gia viec thuc hien Nghi dinh I63/2005/ND-CP 29/12/2005 cua Chinh phu vS san xuat va cung ling muoi idt cho nguoi an Chii tri hdi nghi la UBND cac cap tir tmh, den huyen va xa/phuong/thi tratL Sau hpp, cd van ban chi dao cho tit ca cac ban, nganh lien quan thuc hien S6 11/2014- •+• Diy manh truyen thdng bang mpi hinh thiic ve tac hai ciia viec thieu idt va tac dung cua viec sir dung mudi idt va cac che pham cd idt dii tieu chuan phdng benh cac bua an hang + Tiep tuc tri giir vung va day manh ban nixa cac chi sd da dat dugc thdi gian qua tren cac mat: nhan thiic, san xuat, luu thdng phan phdi muoi idt, ca cdng tac kiem tra, giam sat + Tang cudng cdng tac kiem tra, tra ciia Sd Y te, Sd Cdng thuong, Quan ly thi trudng; ciia cac cap, nganh, dac biet cua Hgi ddng nhan dan cac cap viec thuc hien Nghi dinh I63/2005/ND-CP 29/12/2005 ciia Chinh phii -1- Tang cudng giao due hgc dudng ve tac hai cua thieu idt va tac dung cua viec su dung mudi idt va cac che phim cd idt dii tieu chuan phdng benh cac bfta an hang thay mudi thudng (khdng tron idt) -I- Sd Y te, Benh vien Ndi tiet Nghe An, Sd Cdng thuong, Sd Giao due va Dao tao, Sd Thdng tm va Truyen thdng So Van hda The thao va Du lich, Dai Phat - Truyen hinh, Bao Nghe An theo chiic nang cua minh cimg tham gia chi dao viec tri thuc hien Nghi dinh 163/2005/ND-CP 29/12/2005 cua Chinh phu + Tiep tuc nang cap labo xet nghiem cua Chuong trinh tai Benh vien Npi tiet Nghe An -t- Tang cudng cdng tac chan chinh cac Phdng xet nghiem kiem tra chat lugng san xuit (KCS) Clia cac xi nghiep san xuat muoi idt tren dia ban toan tinh - Ve linh vuc dieu tri: + Kiem soat, dinh ky dieu tra, danh gia benh budu cd de trien khai dieu tri ndi khoa hoac ngoai khoa cho cac truong hgp co chi djnh + Benh vien Ndi tiet bao cao Sd Y ti di trien khai thudng xuyen cdng tac dao tao, tap huln vi chi^'en mdn cho cac can bd chi^en khoa toan tinh; tham muu de r^hi UBND tinh va cac nganh tao dieu kien sdm nang cap cac trang thiit bi, co sd tang de du dieu kien dieu tri cho benh nhan Md hinh se cdng neu dugc ho trg ciia cac cap chinh quyin va su phdi kit hgp lien nganh tdt, se la giai phap dn dinh, lau dai trien khai tai tinh Nghe An./ Tgpchi , KH-CN Nehe An ^ ^ ... kien toan Ban chi dao hoat ddng phdng, cim di xudt gidi phdp gidm ty le budu co hpc sinh achdng CRLDTI va ban hanh quy che hoat ddng tudi 8- 10 tren dia bdn tinh Nghe An" giai doan IIClia Ban chi... Ndi tiet Nghe An va tai cac xi toan CRLDTI va benh budu cd hien tren nghiep san xuat mudi idt dia ban ca nude va Nghe An dang la van de lo ngai Md hinh cac giai phap can thiep nhan Bien phap chuyen... trang tren, md hinh giai phap khai tap huan, dao tao ve chuyen mdn thudng can thiep lam giam ty le buou cd hgc smh d tudi xuyen cho cac can bd chuyen khoa tham gia cdng 8- 10 tren dia ban Nghe An