本文選題：中西部 + 孕產(chǎn)婦死亡��； 參考：《復旦大學》2013年碩士論文

【摘要】：一、研究背景與目標 孕產(chǎn)婦死亡率是反映一個國家或地區(qū)經(jīng)濟社會發(fā)展水平的重要指標,我國在《聯(lián)合國千年宣言》中承諾到2015年將孕產(chǎn)婦死亡率降低到22.2/10萬。2010年我國孕產(chǎn)婦死亡率為30.0/10萬,與國際承諾的目標還存在一定差距。但是不可忽視的是中西部地區(qū)整體的孕產(chǎn)婦死亡率高于全國平均水平,要實現(xiàn)千年目標,中西部是重點。政府也一直很重視中西部地區(qū),采取政策干預和項目干預來改善孕產(chǎn)婦死亡率狀況,中西部孕產(chǎn)婦死亡率在干預下總體呈現(xiàn)下降趨勢,但是近年來下降速度趨緩,2010年10多個省份孕產(chǎn)婦死亡率甚至出現(xiàn)了反彈。這可能是因為措施針對關鍵因素發(fā)揮針對性的效力后,對象因措施的推進調(diào)整了自己的行為和發(fā)展方向,原來影響孕產(chǎn)婦死亡的關鍵因素發(fā)生變化,因此,若要使孕產(chǎn)婦死亡率保持繼續(xù)下降的趨勢,需重新審視現(xiàn)階段關鍵影響因素,制定針對性干預措施。本研究的目的是在了解中西部孕產(chǎn)婦死亡率和住院分娩的基本情況和變化趨勢基礎上,分析降低孕產(chǎn)婦死亡率和提高住院分娩率的關鍵影響因素,制定相應的干預策略,進一步降低孕產(chǎn)婦死亡率,為實現(xiàn)千年發(fā)展目標提供依據(jù)。 二、材料與方法 根據(jù)漸進主義政策模型和孕產(chǎn)婦死亡生存分析框架,構建降低孕產(chǎn)婦死亡率的理論模型。運用系統(tǒng)論,矛盾分析法,漸進主義理論及利益相關者理論對中西部地區(qū)影響因素及干預策略進行分析。主要的資料來源包括文獻評閱、現(xiàn)場調(diào)查、專家咨詢和定性訪談等。通過文獻歸納分析法對文獻的外部特征進行定性及半定量分析,以明確婦幼保健干預策略和模式的研究現(xiàn)狀。通過專家咨詢及現(xiàn)場調(diào)查法了解中西部地區(qū)、典型調(diào)查地區(qū)的孕產(chǎn)婦死亡現(xiàn)存問題、影響因素及需要的支持。調(diào)查收集的資料采用QSR NVivo8、Excel2007建立數(shù)據(jù)庫和數(shù)據(jù)錄入,用SPSS18.0及QSR NVivo8進行統(tǒng)計分析。 三、主要研究結果 (一)國內(nèi)研究多以現(xiàn)狀描述為主 孕產(chǎn)婦死亡是研究熱點,目前國內(nèi)在降低孕產(chǎn)婦死亡率的研究中,多以地區(qū)為單位進行描述性分析,以孕產(chǎn)婦死亡卡和醫(yī)院死亡病例為資料結合孕產(chǎn)婦死亡評審分析孕產(chǎn)婦死亡的流行病學特征,并探討孕產(chǎn)婦死亡的原因及策略,卻少見對這些建議和措施的實施及實施效果的評價。 (二)中西部地區(qū)部分省份孕產(chǎn)婦死亡率出現(xiàn)反彈 中西部地區(qū)近年來孕產(chǎn)婦死亡率下降趨緩,部分省份出現(xiàn)反彈。對典型調(diào)查地區(qū)甘肅省和新疆生產(chǎn)建設兵團進行分析,甘肅省孕產(chǎn)婦死亡率降低明顯,但下屬市級甘南州孕產(chǎn)婦死亡率出現(xiàn)反彈,并且其住院分娩率低于全省平均水平。新疆生產(chǎn)建設兵團住院分娩率較高,但孕產(chǎn)婦死亡率出現(xiàn)反彈。 (三)孕產(chǎn)婦死亡率的影響因素分析 運用矛盾分析法分析地區(qū)差異,運用利益相關者法分析不同對象的訴求,可得出甘肅省和新疆生產(chǎn)建設兵團孕產(chǎn)婦死亡率的關鍵影響因素。甘肅省婦幼衛(wèi)生狀況的影響因素以社會因素為主,山高路遠、經(jīng)濟條件差和信仰活佛的習俗使得住院分娩率一直處于低位。住院分娩率不高,交通不便急救轉(zhuǎn)診不暢,產(chǎn)科急救水平差等綜合因素則造成了孕產(chǎn)婦死亡。兵團的住院分娩率已經(jīng)達到較高水平,孕產(chǎn)婦死亡率反彈的主要原因在于流動人口和計劃外生育者孕產(chǎn)婦的死亡。兵團人口基數(shù)較少,孕產(chǎn)婦死亡絕對數(shù)的較小變化引起了孕產(chǎn)婦死亡率的較大變化,導致遠高于全國平均水平。 (四)降低孕產(chǎn)婦死亡率的實施策略研究 利用孕產(chǎn)婦死亡生存分析理論框架,并結合文獻及實證中對干預措施的收集,本研究針對孕產(chǎn)婦死亡形成了三大維度九大干預策略。對于每個地區(qū),干預措施和干預策略分為兩類,一類是在針對原有影響因素在原有措施或策略上的繼續(xù)推進,一類是針對新的關鍵影響因素采取的新的措施或策略。 干預模式的制定思路是,基于孕產(chǎn)婦影響因素的研究,利用專家評分法確定孕產(chǎn)婦死亡的關鍵影響因素,然后評價關鍵影響因素在孕產(chǎn)婦死亡生存分析框架中所處的模塊,根據(jù)模塊即可對應相應的策略,最后,集合這些策略,就形成了適宜當?shù)氐母深A模式。甘肅模式主要是采用策略4、策略6、策略7、策略8,進一步提高保健意識及暢通急救綠色通道。兵團模式主要是采用策略3、策略5,提升基層醫(yī)院及市區(qū)綜合醫(yī)院產(chǎn)科綜合救治能力,并抓好流動人口和計劃外生育者的孕產(chǎn)婦管理。將典型調(diào)查地區(qū)干預模式研究的思路外推到中西部其他區(qū)域,即可形成中西部地區(qū)進一步降低孕產(chǎn)婦死亡率的策略。 四、研究主要結論 (一)降低孕產(chǎn)婦死亡率需要差異化管理,分類指導；各地區(qū)選擇策略時需深入分析關鍵影響因素,探索最適合當?shù)氐母深A模式。 (二)合理配置人員,并完善人才激勵機制。 (三)加強各個利益相關者之間的協(xié)調(diào),最大化發(fā)揮社會效益；全社會努力,提高孕產(chǎn)婦文化素質(zhì),優(yōu)化保障體系。
[Abstract]:I . Background and Objectives

The maternal mortality rate is an important indicator reflecting the economic and social development level of a country or region . In the United Nations Millennium Declaration , the maternal mortality rate is reduced to 22.2 per 100,000 . In 2010 , the maternal mortality rate in the central and western regions is higher than the national average . In the middle and western regions , the maternal mortality rate is higher than the national average . In the middle and western regions , the key influencing factors of the maternal mortality rate have been improved . The aim of this study is to improve the maternal mortality rate and increase the rate of maternal mortality . The aim of this study is to develop corresponding intervention strategies to further reduce maternal mortality and provide the basis for achieving the Millennium Development Goals .

II . MATERIALS AND METHODS

Based on the progressive policy model and the analysis frame of maternal mortality survival analysis , the paper constructs a theoretical model for reducing maternal mortality . The main sources include literature review , field investigation , expert consultation and qualitative interview . The main sources include literature review , field investigation , expert consultation and qualitative interview . The main sources include literature review , field investigation , expert consultation and qualitative interview .

III . Main research results

( 1 ) The domestic research is mainly described in the current situation

Maternal mortality is a hot spot . At present , in the study of reducing maternal mortality , a descriptive analysis is carried out in many areas . The maternal mortality rate and the hospital death cases are combined with maternal mortality review to analyze the epidemiological characteristics of maternal mortality , and the causes and strategies of maternal mortality are discussed . However , the evaluation of the implementation and implementation of these recommendations and measures is rare .

( II ) Maternal mortality in some provinces of the central and western parts of the country rebounded

In the middle and western regions , the maternal mortality rate has declined in recent years , and some provinces have rebounded . In the typical survey area , Gansu Province and Xinjiang Production and Construction Corps carried out the analysis , the maternal mortality rate in Gansu Province decreased obviously , but the rate of maternal mortality in Gansu Province was lower than the average of the province average . The hospitalization rate of the Xinjiang Production and Construction Corps was higher , but the maternal mortality rate rebounded .

( III ) Analysis on the Influencing Factors of Maternal Mortality

Using the contradiction analysis method to analyze the regional difference , the key influencing factors of maternal mortality in Gansu and Xinjiang Production and Construction Corps were analyzed by means of stakeholder method . The factors affecting maternal and child health in Gansu Province were mainly due to social factors , high mountain road , poor economic conditions and living Buddha ' s customs , which resulted in the death of maternal mortality . The hospitalization delivery rate of the regiment had reached a higher level , and the rate of maternal mortality was mainly due to the death of the floating population and the unplanned fertility . The small change of the absolute number of maternal deaths resulted in a greater change in maternal mortality , which resulted in a much higher level of maternal mortality .

( IV ) Study on the Implementation Strategy of Reducing Maternal Mortality

Based on the theoretical framework of maternal mortality survival analysis and the collection of intervention measures in combination with literature and demonstration , this study has formed a three - dimensional nine - dimensional intervention strategy for maternal deaths .

The development of intervention model is based on the study of maternal influence factors , the key influencing factors of maternal mortality are determined by using expert scoring method , and then the key influencing factors are evaluated in the framework of maternal mortality survival analysis .

IV . Main conclusions of the study

( i ) Reducing maternal mortality requires differentiated management and classification guidance ;
In each region selection strategy , the key influencing factors should be analyzed in depth , and the most suitable intervention mode is explored .

( 2 ) reasonably allocate personnel and improve the talent incentive mechanism .

( 3 ) To strengthen coordination among various stakeholders and maximize social benefits ;
Full - society efforts to improve the cultural quality of pregnant women and optimize the guarantee system .
【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R173

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