Utilization of mother-to-child transmission prevention service and its influencing factors among migrant pregnant women with syphilis infection in Zhejiang province
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摘要:
目的 了解浙江省梅毒感染流动孕产妇预防母婴传播服务利用情况及其影响因素,为优化“消除先天梅毒”策略提供参考依据。 方法 收集浙江省预防艾滋病、梅毒和乙肝母婴传播直报信息系统2013年1月1日 — 2017年12月31日上报的3 738例梅毒感染流动孕产妇相关数据,分析其抗梅毒治疗和规范治疗情况及其影响因素。 结果 浙江省3 738例梅毒感染流动孕产妇中,抗梅毒治疗者3 081例,抗梅毒治疗率为82.4 %;3 081例抗梅毒治疗梅毒感染流动孕产妇中,规范治疗者2 038例,规范治疗比例为66.1 %。多因素非条件logistic回归分析结果显示,少数民族、非在婚、孕早期进行检测、合并感染和产次 ≥ 1次的浙江省梅毒感染流动孕产妇更不易进行抗梅毒治疗;年龄≥ 30岁的浙江省抗梅毒治疗梅毒感染流动孕产妇更易进行规范治疗,非在婚和产次 ≥ 1次的浙江省抗梅毒治疗梅毒感染流动孕产妇更不易进行规范治疗。 结论 浙江省梅毒感染流动孕产妇抗梅毒治疗,尤其是规范治疗仍需提高;婚姻状况和产次是浙江省梅毒感染流动孕产妇抗梅毒治疗和规范治疗的共同影响因素。 Abstract:Objective To examine the utilization of mother-to-child transmission prevention service and its influencing factors among migrant pregnant women with syphilis infection in Zhejiang province and to provide a reference for optimizing the strategies on prevention of mother-to-child transmission (PMTCT) of syphilis. Methods We extracted the data on 3 738 migrant pregnant women with syphilis infection registered in Zhejiang province between January 1, 2013 to December 31, 2017 from national direct network report system for PMTCT of AIDS, syphilis and hepatitis B. The status and associated factors of anti-syphilis treatment and standardized therapy among the pregnant women were analyzed. Results Among all the pregnant women, 3 081 (82.4%) had anti-syphilis treatment and of the women with the treatment, 2 083 (66.1%) received standardized therapy. Multivariate logistic regression analysis revealed that the pregnant women being ethnic minorities, unmarried, having early pregnancy detection, with co-infection of human immunodeficiency virus (HIV) or hepatitis B virus (HBV), and having one or more parities were less likely to have anti-syphilis treatment; for the women with anti-syphilis treatment, those aged 30 years and above were more likely to have standardized therapy, while those unmarried or having one or more parities were less likely to have standardized therapy. Conclusion The anti-syphilis treatment, especially standardized therapy, needs to be improved and both the anti-syphilis treatment and standardized therapy are mainly influenced by marital status and the parity number among the migrant pregnant women with syphilis in Zhejiang province. -
表 1 浙江省不同特征梅毒感染流动孕产妇抗梅毒治疗情况比较
特征 调查数 抗梅毒治疗数 抗梅毒治疗率(%) χ2 值 P 值 年龄(岁) < 20 238 191 6.20 5.158 0.271 20~24 1 048 848 27.52 25~29 1 258 1 057 34.31 30~34 729 606 19.67 ≥ 35 465 379 12.30 民族 汉族 3 295 2 740 88.93 10.299 0.001 少数民族 443 341 11.07 文化程度 a 小学及以下 819 651 21.37 6.385 0.041 中学/中专 2 750 2 291 75.21 大专及以上 127 104 3.41 婚姻状况 非在婚 749 584 18.95 12.822 < 0.001 在婚 2 989 2 497 81.05 工作情况 a 无固定工作 3 154 2 601 88.92 5.045 0.025 固定工作 372 324 11.08 梅毒分期 非隐性 791 648 21.03 0.175 0.676 隐性 2 947 2 433 78.97 初次检测时血清学滴度 非高滴度 2 791 2 297 82.30 0.116 0.733 高滴度 947 784 82.79 孕早期检测情况 a 未检测 2 333 1 988 68.29 47.573 < 0.001 检测 1 217 923 31.71 合并感染情况 未合并感染 3 693 3 054 99.12 15.809 < 0.001 合并感染 45 27 0.88 胎数 单胎 3 706 3 055 99.16 0.031 0.861 双胎/多胎 32 26 0.84 孕次(次) 1 636 535 17.36 1.521 0.217 ≥ 2 3 102 2 546 82.64 产次(次) 0 1 438 1 273 41.32 119.702 < 0.001 1 1 531 1 270 41.22 ≥ 2 769 538 17.66 现有子女数(个) 0 1 596 1 397 45.34 110.506 < 0.001 1 1 504 1 245 40.41 ≥ 2 638 439 14.41 有无孕期异常 无 3 050 2 516 81.66 0.053 0.818 有 688 565 18.34 既往梅毒感染史 未感染 2 494 2 080 67.51 4.932 0.026 感染 1 244 1 001 32.49 注:a 有缺失值。 表 2 浙江省不同特征抗梅毒治疗梅毒感染流动孕产妇规范治疗情况比较
特征 抗梅毒治疗数 规范治疗数 规范治疗率(%) χ2 值 P 值 年龄(岁) < 20 191 108 5.30 12.331 0.015 20~24 848 560 27.48 25~29 1 057 726 35.62 30~34 606 404 19.82 ≥ 35 379 240 11.78 民族 汉族 2 740 1 822 89.40 1.347 0.246 少数民族 341 216 10.60 文化程度 a 小学及以下 651 368 18.25 34.765 < 0.001 中学/中专 2 291 1 574 78.08 大专及以上 104 74 3.67 婚姻状况 非在婚 584 342 16.78 18.517 < 0.001 在婚 2 497 1 696 83.22 工作情况 a 无固定工作 2 601 1 717 88.37 3.822 0.148 固定工作 324 226 11.63 梅毒分期 非隐性 648 412 20.22 2.415 0.120 隐性 2 433 1 626 79.78 初次检测时血清学滴度 非高滴度 2 297 1 535 75.32 1.858 0.173 高滴度 784 503 24.68 孕早期检测情况 a 未检测 1 988 1 362 70.46 12.486 < 0.001 检测 923 571 29.54 合并感染情况 未合并感染 3 054 2 018 99.02 0.764 0.382 合并感染 27 20 0.98 胎数 单胎 3 055 2 024 99.31 1.772 0.183 双胎/多胎 26 14 0.69 孕次(次) 1 535 358 17.57 0.171 0.679 ≥ 2 2 546 1 680 82.43 产次(次) 0 1 273 931 45.68 78.520 < 0.001 1 1 270 829 40.68 ≥ 2 538 278 13.79 现有子女数(个) 0 1 397 1 006 49.36 75.082 < 0.001 1 1 245 814 39.94 ≥ 2 439 218 10.81 有无孕期异常 无 2 516 1 654 81.16 1.020 0.312 有 565 384 18.84 既往梅毒感染史 未感染 2 080 1 368 67.12 0.409 0.523 感染 1 001 670 32.88 注:a 有缺失值。 表 3 浙江省梅毒感染流动孕产妇抗梅毒治疗影响因素多因素非条件logistic回归分析
因素 参照组 β $S_{\overline x}$ Wald χ2 值 P 值 OR 值 95 % CI 民族 少数民族 汉族 0.319 0.134 5.641 0.018 1.376 1.057~1.791 婚姻状况 非在婚 在婚 0.291 0.112 6.799 0.009 1.338 1.075~1.666 孕早期检测情况 检测 未检测 0.690 0.095 52.289 < 0.001 1.994 1.654~2.404 合并感染情况 合并感染 未合并感染 1.240 0.336 13.578 < 0.001 3.454 1.786~6.679 产次(次) 1 0 0.296 0.147 4.056 0.044 1.345 1.008~1.795 ≥ 2 0.817 0.239 11.663 0.001 2.263 1.416~3.616 表 4 浙江省抗梅毒治疗梅毒感染流动孕产妇规范治疗影响因素多因素非条件logistic回归分析
因素 参照组 β $S_{\overline x}$ Wald χ2 值 P 值 OR 值 95 % CI 年龄(岁) 20~24 < 20 – 0.046 0.208 0.049 0.825 0.955 0.635~1.436 25~29 – 0.397 0.212 3.496 0.062 0.672 0.443~1.019 30~34 – 0.579 0.227 6.500 0.011 0.561 0.359~0.875 ≥ 35 – 0.562 0.239 5.541 0.019 0.570 0.357~0.910 婚姻状况 非在婚 在婚 0.441 0.095 21.566 < 0.001 1.554 1.290~1.871 产次(次) 1 0 0.381 0.149 6.514 0.011 1.464 1.092~1.962 ≥ 2 0.925 0.242 14.649 < 0.001 2.523 1.571~4.052 -
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