Tapchi NCKH2012

YHC
ISSN 1859-1779
THNHPHHCHMINH
ChuynYTCngCng
TNGQUAN
Giitrnhtgenthhmi:cuccchmng
trongchnonvnghincuysinhhc
*PhmHngVn,NguynPhc
Cpnhtkhnngccxtnghimsinhhcphn
ttrongvimgansiuvimntnh
*PhmHngVn,VcXuynAn
45
Kinthcthchnhvvsinhantonthc
phmcangikinhdoanhthcnng
phtithnhphPhanRangThpChm
tnhNinhThun,nm2011
*MaiThPhngNgc,LHongNinh
51
Tltnghuytpvnhnghnhvinguyc
cacnbcngnhntrungtmckhtoaxe
ThpChm,TnhNinhThun,
*NguynTnKinhThi,LHongNinh
58
Ccyutxhinhhngsckhetrem6
10tuitithnhphScTrng,tnhScTrng
nm2011
*LHongNinh,VngThunAn
65
Hnhviphngngauinccangi
chmsctrdi11tuitihuynAnPh
tnhAnGiangnm2011
*NguynNgcDuy,LHongNinh,
NguynThLinhn
73
Nghincutrnghpnhimksinhtrng
strttrnkhtitnhBnhPhc
*LThnhng,TrnhNgcHi,
NguynVnHng,NgVitThnh
79
cimthnhphnloi,phnbvmc
nhycmcavctstrtmtsvngsinh
cnhkhuvcbingiiVitNamCampuchia
*LThnhng,HunhKhaThoHin
NGHINCUYHC
20
cimdchthccabnhtaychnming
20tnhthnhphaNamVitNamgiaion
20052011
*TrnNgcHu
26
Slantruynbnhtquabingiivccyu
tnguycbngphpdchtngbngsng
CuLongnm2010
*TrnNgcHu
31
Ccbnhtruynnhimangbngphtkhu
vcphaNamt20012011
*TrnNgcHu
38
Kinthc,thi,thchnhvphngchng
nhimkhunhhpcptnhcabmccon
<5tuinhpvintiKhoaNhibnhvinNinh
Phc,NinhThun
*NguynThThyHng,LHongNinh
(Xemtiptrang)
PhbncaTp16*S3*2012
IHCYDCTP.HCHMINH
LII NI
U
Y t Cngg cng - Y hc D phng ngy cng khng nh vai tr quan
trng trong s nghipp bo v v nnng cao s
c khe con ngi Vitt Nam.
l
vc Y tt Cng cnng - Y
Cc cng trnh nghinn cu khoa hc thuc lnh
BA
AN BIN T
TP
hc D phhng khngg ch gp phhn phng chng dch bbnh m cnn gip
PG
GS.TS. L H
Hong Ninh ((Ch bin) gim thiuu cc hnh vvi c hi choo sc khe, ko di tui th v nnng cao
BS
S. CKII. L V
Vinh
cht lngg cuc sng cho ngi dn.
BS
S. CKII. V Trng Thin
TS. BS. ng Vn Chnh
TS. BS. Trnh Hng Ln
Phc
TS. Nguyn
ThS. BS. Phnng c Nht
ThS. BS. Nguyyn ThyNggc
AN TH K
BA
ThS. Nguyn N
Ngc Duy
N. L Th Ngga
CN
CN
N. L Th Nggc nh
CN
N. Nguyn T
Th Tr My
Trong nh
ng nm gnn y, cc vvn lin qquan ti Y t Cng cnng - Y
hc D phhng
c ch trngg v u t nghin cu bi cc vin, cc
trng ii hc v ccc n v y t
t trn c n
c. Nhm to iu kin cho
cc nh khhoa hc c mt
m din n trao i hc thutt trong lnh vc Y
t Cng cng - Y hcc D phngg; ng thii tp hp v cng b ccc kt
u theo tnng giai onn, c hai nm
m mt
qu ca cc cng trnnh nghin c
ln, Vin V
V sinh - Y t Cng cng thnh phh H Ch M
Minh t ch
c Hi
ngh Khoaa hc K thhut Y t Cng cng - Y hc D pphng. Hii ngh
Khoa hcc K thutt Y t Cn
ng cng - Y hc D p
phng giai on
2010-20122 c t chc
c
vo nggy 24/08/2012, vi s tham gia ca cc
bo co viin n t ccc vin, ccc trng i hc v ccc n v Y t
t trn
c nc v gn 100 bi bo co c
c ch aa dng, phonng ph.
Chng tii xin chn thhnh cm
n s ng vvin qu bu, s h tr
nhit
tnh ca lnh o B Y t, T cchc Y t thh gii v ccc n v c
c lin
quan. Xinn chn thnhh cm n s
s tham giaa nhit tnh ca cc bo co
vin, s nn lc lm vvic ht mnh ca bann bin tp vv ban th kk hi
ngh trongg cng tc biin son choo tp san ny. Tt c nhhng ng ggp v
n lc qu bu ny
lm nn ss thnh cnng tt p cca Hi nghh, gp
phn cho ss nghip phht trin caa ngnh Y tt Vit Nam
m.
Xin trn trrng gii thhiu cc boo co kt quu nghin c
u trong Hi ngh
ti Qu c gi.
Vin trrng
Vin V
V sinh - Y t Cng cng thnh p
ph H Ch Minh
P
PGS.TS. L
HONG NINH
N
YHcTP.HChMinh*Tp16*PhbncaS3*2012
TngQuan
GIITRNHTGENTHHMI:CUCCCHMNG
TRONGCHNONVNGHINCUYSINHHC
NEXT GENERATION SEQUENCING: THE REVOLUTION IN DIAGNOSIS AND
BIO-MEDICAL RESEARCH
PhmHngVn*,NguynPhc**
TGIITRNHTSANGER
k c phng th nghim lm sng(5). Khng ch

vy,ngdngcagiitrnhtkhngchtrong
Gii trnh t l tm ra c th t sp xp
ca4loinucleotideA,T,CvG
trn mt on DNA. K thut
giitrnhtcaSangergmhai
giai on: (1) Giai on u gi
lgiaionphnnggiitrnht
l dng enzyme polymerase
nhn bn on DNA mun gii
trnhtthnhcconcchbit
nhauchcmtnucleotidetn
u 3 v nucleotide tn ny c
thnhndincnhkthut
nh du hunh quang trn
chnh nucleotide tn hay
nhduhunhquangtrnmi;
(2)Giaionkgilgiaion
indi gii trnh t l dng in
diphngiicao(indibn
gel polyacrylamide hay din di
mao qun) sp xp cc on
trnhtdingnkhcnhautheo
kch thc (ngn trc, di sau
d ch cch nhau c mt
nucleotide) v chnh nh th t
nymbitcthtspxp
Hnh1:
HaigiaioncagiitrnhtSangermt
ccnucleotidecatrnhton
ongene(DNA)vigiaionulgiaionphnng
DNA c gii trnh t ny
giitrnhtvgiaionklgiaionindigiitrnh
(hnh 1). K t khi c pht
minhbiF.Sangervonm1977
nghin cu m c trong chn on. Xin k ra
nnay(11,12,10),kthutgiitrnhtSangerc
ymtscccngdngcagiitrnht(5):(1)
nhngbctinvtbcvhachtchophn
Giitrnhtbitctrnhtnucleotideca
nggiitrnhtvthitbchoindigiitrnh
btcmtonDNAnovychnhlc
tdovymkthutgiitrnhtcthtrin
sccnhkhoahccthgiitrnhtgene
khaickhddngticcphngthnghim,
haybgenchoccnghincuclinquan;(2)
ihcYdcthnhphHChMinh**VinVsinhYtCngcngthnhphHChMinh
Tcgilinlc:Ts.Bs.PhmHngVn
T:0903698920
Email:phhvan.nkbiotek@gmail.com
ChuynYTCngCng
TngQuan
Giitrnhtphthinccthayicatrnh
tnucleotidecamtonDNAvylcs
pht hin cc t bin gene (lin quan n
ung th, n khng thuc), cc SNP (trong c
nhn ha cc liu php iu tr), cc kiu gene
(genotypecavirusgybnh);(3)nhdanh
vikhunhayvinmdatrngiitrnhtDNA
cagenequinhRNAcaribosome(16Scavi
khun v 28S ca vi nm) c bit l cc tc
nhn kh nh danh hay tht bi nui cy t
mu th; (4) Ngoi ra cng ngh in di
phngiicaocbitlcngnghindimao
quntngcsdngtronggiitrnht
cn c p dng trong phn tch on
(fragmentanalysis)tclphntchphnbit
c cc on DNA c kch thc khc bit
nhauchvinucleotidevpdngnycs
dngtrongxtnghimduvntayDNA(DNA
finger printing) nhn dng c nhn v mi
quanhcnhn(phpy),trongchnontin
sanh,trongphthinadngloi
NPYROSEQUENCING
Khc vi gii trnh t Sanger l k
thutgiitrnhtphichaigiaion
v giai on gii trnh t c thc
hinsauphnnggiitrnht;Trong
pyrosequencing,giitrnhtcthc
hinngaytronggiaiontnghpsi
DNAbsungchosikhuncgii
trnht,nghaltnghpsiDNAb
sung n u th gii trnh t n
m khng phi ch sau khi tng hp
sibsungrimiemindigii
trnh t. Pyrosequencing c Pl
NyrnvMostafaRonaghitiVinK
ThutHongGiaThuinphtminh
nm1996(4,8,7).Nguyntccakthut
gii trnh t trong pyrorequencing l
ghinhntnhiu pht quang t ging
phnngmikhisibsungdatrn
sikhunkodicmtnucleotide.
lmciuny,dungdchcha
ccloinucleotideA,hayT,hayC,hay
Gclptrnhchovogingphn
ng(cchaonDNAmungiitrnht,mi
gii trnh t, v cc thnh phn cho phn ng
tng hp si khun); v mi khi dung dch
nucleotidechovolngvinucleotidec
btcpvosikhuntnghpsibsung
th mt pyrophosphate (PPi) s c phng
thchracenzymesulfurylasetoramt
ATP, ATP ny s gip h thng pht quang
luciferinluciferase(cngcchovocnglc)
pht ra nh sng do men luciferase oxide ha
cluciferinthnhoxyluciferinvphtranh
sng (hnh 2). Vi s ghi nhn tn hiu pht
quang t ng phn ng theo trnh t b sung
dung dch cc loi nucleotide, thit b
pyrosequencing s dch ra trnh t cc
nucleotide trn on DNA c gii trnh t.
Do ATP c s dng lm h thng
luciferinluciferase pht quang nn trong dung
dch dNTP cho vo ging phn ng, dATPS
c s dng thay th dATP v dATPS
khngchottnhcaATP.Ngoira,cth
hucATPvccnucleotidetdocntha
sau mi ln b sung nucleotide, men apyrase
Hnh 2: Nguyn tc ca k thut pyrosequencing

(Hnh t Internet)
ChuynYTCngCng
cngcchovogingphnng sau khi tn
hiuphtquangcghinhn.
Pyrosequencing l mt bc ngoc v k
thuttronggiitrnht,chophpgiitrnht
ngaytrongqutrnhtnghpsibsungcho
on DNA gii trnh t, do vy
pyrosequencing chnh l cng ngh khi u
cho k thut gii trnh t bng tng hp
(sequencing by synthesis, SBS), nn tng ca
kthutgiitrnhtbgenehaycngilk
thutgiitrnhtthhmi(nextgeneration
Bnh thng: GCT GGT GGC G

t bin:
GCT GG/AT GGC G
Kt qu pht hin:
G (50%),
A (50%
TngQuan
sequencing)sauny.Viuththigiangii
trnh t nhanh, trnh t gii c rt chnh
xc, cng pht quang nh lng c
nn d trnh t gii uc khng di (khng
qu100bases)nhngpyrosequencingcngc
nhiu ng dng c u th hn k thut gii
trnhtSanger,cbitltrongphthinv
nh lng cc t bin l mt p dng rt
quantrngtrongchnon,tinondhu
vchnhiutrchphntungth(1,6).
Bnh thng: GCT GGT GGC G

t bin:
GCT GG/AT GGC G
Kt qu pht hin:
G (67%),
A (33%
Hnh 3 :KtquphthinvnhlngtbinKRASvihnhbntritltbincodon12(GGT
thnhGAT)l50%vcngphtquangcaGlgp150%sovicngphtquangbnhthng
cncngphtquangcaAtiptheocht50%bnhthngvhnhbnphitltbinl33%
vcngphtquangcaGlgp167%sovicngphtquangbnhthngcncngpht
quangcaAtiptheocht33%bnhthng(HnhtInternet)
ditruyn,vcbittrongvisinhlmsngl
Hnh 3 l mt v d cho thy
nh danh cc vi khun. Ngoi ra, k thut
pyrosequencing c th pht hin cc t l t
pyrosequencing l mt k thut m cho php
bin KRAS m k thut gii trnh t Sanger
ccnhnghincucththitkccquitrnh
khngthlmcvcnghunhquang
pyrosequencingchoccmcchkhcnhauty
ghi nhn c trong Sanger l khng nh
theoccncamnh.Chnhvalkthut
lngc.Hinnaycnhiubthucth
m,vacsnccbthucththngmi,do
c chp nhn IVD (InVitro Diagnosis)
vy pyrosequencing l mt k thut khng th
trong pht hin cc t bin gene ung th lin
thiutrongccphngthnghimsinhhcphn
quannchnhvtheodiiutrch,nh
t v va c th s dng cho cc dch v chn
lng cc CpG vi C b gn methyl (Cytosine
onlmsng,valmcngcchonghincu.
methylation) tin on ung th, pht hin
tbingenetrongchnonvsnglcbnh
ChuynYTCngCng
TngQuan
Tch ri v tm bt cc mnh
DNA c gii trnh t ln cc
gi bm
Dng PCR vi mi c hiu

adapter khuch i cc
mnh DNA trn gi bm thnh
tng clone
Thc hin gii trnh t bng tng hp (SBS)
Hnh 4: Ba giai on ca gii trnh t th h mi (1) Tch ri v tm bt cc
mnh DNA c gii trnh t ln cc gi bm; (2) Dng PCR vi mi c hiu

adapter khuch i cc mnh DNA trn gi bm thnh tng clone; (iii)
Thc hin gii trnh t bng tng hp
(P.H. Vn v 2012)
ChuynYTCngCng
TngQuan
Gii trnh t thh mi mt bc tin

nhyvtvcngngh
l nanowell v kch thc ny cho php mi

nanowellchchacmtvihtmthi.
y l mt cuc cch mng v cng ngh

giitrnhtvnu gii trnh t Sanger ch cho
php gii trnh t khng qu 1500bps, hay
pyrosequencingkhngqu100bps,thgiitrnh
t th h mi cho php gii c t 8Gbases
n 600Gbases, c ngha l cho php gii trnh
tnguynbgene.Do vy gii trnh t th h
micncgilgiitrnhtbgene(whole
genomesequencing).Vnguyntchotng,
kthutgiitrnhtthhmilgiitrnht
bng tng hp (SBS) bao gm cc giai on
chnhsauy(hnh4):
(3) Thc hin gii trnh t bng tng hp:

Nguyntccagiaionthchingiitrnht
nycnggngingnguyntcpyrosequencing,
tuy nhin c mt s im khc bit, l: (i)
ThayvphihubccthnhphnAT,C,vG
trong thuc th cho vo ging phn ng
trc khi cho thuc th mi vo nh
pyrosequencing th trong gii trnh t th h
mi,thucthgiitrnhtcthichyvo
chipnanowellhayvibntheochngtrnhv
saukhighinhnctnhiuththucthc
scthichyrathucthmilic
bm vo. (ii) Tn hiu tng hp c ghi nhn
saumilnbmthucthvocthltnhiu
pht quang da trn h thng luciferin
luciferase (454 ca Roche)(3,13), tn hiu in do
thay i pH (IonTolent hay IonProton ca
ABI)(9), tn hiu hunh quang c nh du
trn cc nucleotide A, T, C hay G (Solexa ca
Illumina)(2), hay cng c th l tn hiu hunh
quangcgnlnprobe(solidcaABI)(14).(iii)
Tng hp mch b sung da trn mch khun
cthlkodiu3camchbsungbng
ccnucleotide(A,T,ChayG)vcmikhimt
nucleotide c ko di th s c mt tn hiu
phtquang(Roche)hayhunhquang(Illumina)
cghinhn,haycthlkodiu3ca
mchbsungmiln2basenhskodiv
niprobedatrnsikhunvcmikhitng
hp c 2 base th s c mt tn hiu hunh
quang c ghi nhn (Solid ca ABI). Th t
cacclnthithucthgiitrnhtvochip
nanowellhayvovibncmytnhghili
ngthivithtvcngtnhiutng
hpsibsungcatngcloneDNAbmlnvi
bn hay trn vi ht, nh vy m s gii c
trnhtcaccmnhDNAtrntngclonebm
trn vi bn hay trn cc vi ht. V c n hng
chcngnnhngtrmngnclonennsc
hngchcngnnhngtrmngntrnhts
gii c tng ng vi hng chc ngn n
hng trm ngn mnh DNA t b gene s gii
c.CctrnhtcaccmnhDNAgiic
.(1) Tch ri v tm bt cc mnh DNA c

gii trnh t ln cc gi bm: Trc ht DNA b
gene c b gy thnh cc mnh DNA ngn
nhsiumhaynhkhdung,sauccmnh
DNAngnnycgnvohaiuccon
trnhtngngiladapter(chailoi:mtc
trnhtnhnbitbiccondcgntrn
ccgibm,mtcnhnbitbitrnhtmi
PCR).CcmnhDNAnysctmbttrn
ccgibmlcchtnano(RochehayABI)hay
trn cc vi bn (Illumina) nh cc on d c
hiu adapter gn sn trn cc gi bm ny.
PhiphalongccmnhDNAgnadapter
nngthchhpnugibmlccviht
thasschcmtmnhDNActmbt
haynugibmlvibnthccmnhDNAb
tmbtphicchxanhau.
(2) Dng PCR vi mi c hiu adapter
khuchiccmnhDNAtrngibmthnhtng
clone:NugibmlvibnththucthPCR
cbmtrilnvibnvkhithchinPCR
sctngclonesnphmkhuchictm
bttrnccvtrtchrinhautrnvibn;nu
gibmlccvihtthphinhhothucth
PCRasccgitnhlchchamtviht
nhvymkhithchinPCRmivihtsch
cmtclonesnphmkhuchibmln.Sau
khi gii b dng nh dch, cc vi ht s c
bmvomtbnchipcchahngchcngn
nhngtrmngngingkchthcnanogi
ChuynYTCngCng
TngQuan
scphnmmcathitbnilivinhau
bng cch so chui tm cc trnh t trng lp
nhauhaiuvnhvylscktquca
trnhtnguynbgene.
hmicththchincmtcchddng
vi cc thit b c cng sut nh khong 6 n
10Gbases ch khng cn phi n hng trm
Gbases.
Gii trnh t th h mi v cc ng dng

cchmngtrongchnonvnghincu
Giitrnhtthhmilmtcngcmnh
nht pht hin c cc tc nhn nhim
trng b mt v vi kh nng gii c hng
trm ngn mnh DNA c trong mu th th
cngnghnyrtddngliranhsngbtc
mttrnhtnucleicacidcabtctcnhng
c mt trong mu th ly t vt ch hay bnh
nhn.
Giitrnhtthhmithtslmtcuc
cch mng trong cng ngh gii trnh t ni
ring v trong cng ngh sinh hc phn t ni
chung.
Vicctinbvthitbvthucth,hin
naygiitrnhtbgenecamtcnhnkhng
cnlmtnghincuchthchincticc
trung tm gii trnh t ln trn th gii m c
th c thc hin ti cc phng th nghim
trung bnh c thit b gii trnh t th h mi
nhsolid,solexa,ionproton,454vthigian
cktqukhngphikodinhngnm
mchtrongvingy,thmchchtrong24gi
vi gi thnh khng phi n hng triu dolla
mchcnvingndolla.ivigiitrnht
bgenevikhunhayvirusthgiitrnhtth
Gii trnh t th h mi cng l cng c

nhycmnhtcthphthincctbin
chodtltbinhindintrongmuthl
rtthp,chvitbintrongcmtqunth
khngtbin,chnhvvygiitrnhtthh
milmtcngckhngththiuctrong
phthinvnhlngcctbintrongung
th,trongbnhditruyn.
Adapter c
barcode
Gn adapter
Gn adapter
PCR vi mi gn
barcode u 5
Sn phm a
vo SBS nh
du barcode
Hnh5:HaicchnhdubarcodeccmnhDNA(snphmPCR)trckhiavoSBS(giitrnhtbng
tnghp)(P.H.Vnv2012)
nhycaocakthut.Chnhnhngdng
Mtngdngcbitnacagiitrnht
nymtrongtnglaiccchnontinsanh
thhmi,lchnontinsanhphthin
phthindbitrongthainhikhngcnlmt
dbicathainhibngphntchDNAcabo
xtnghimxmlnphilymuchcnci
thaihindintrongmumdatrnuim
ChuynYTCngCng
na m ch cn xt nghim trn mu m m
thi.
Ngoira,mtcuhimnhiunhnghin
cutralliuSBScthgiitrnhtccsn
phmPCRphthintbinhaykhngv
liuSBScthphnbitcctrnhtcgiil
casnphmPCRno?Cuhinythtra
c k thut barcode (m vch) ca SBS gii
quyt,lgnlnadapterccmvchlth
tbitcaccnucleotide(A,T,C,vG)hay
s dng cc mi c c u 5 c thm cc
trnhtbarcodebitcaccnucleotide,nh
vy m vi mt hn hp ca nhiu sn phm
PCR c gii trnh t bi SBS, nh trnh t
nucleotidetrnbarcode,cthnhn din c
trnh t c gii l ca sn phm PCR no
(hnh5).
Chnhvcnhiungdngkhngchtrong
nghin cu m c trong chn on phc v
nhiu khoa lm sng khc nhau nh vy nn
chngtanhtthitphitrangbvthunthc
kthutgiitrnhtthhminy.
TILIUTHAMKHO
1.
Baysal BE et al (2004). Analysis of CHEK2 gene for ovarian

cancersusceptibility.GynecolOncol,Oct2004;95(1):6269.
ChuynYTCngCng
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
TngQuan
Mardis ER (2008). Nextgeneration DNA sequencing

methods.AnnuRevGenomicsHumGenet9:387402
MarguliesM,EgholmM,AltmanWEetal.(2005).Genome
Sequencing in Open Microfabricated High Density
PicoliterReactors.Nature437(7057):37680.
Nyrn, P. (2007). The History of Pyrosequencing. Methods
MolBiology373:114.
PhmHngVn(2009).PCRvrealtimePCRNhngvn
cbnvccpdngthnggp.NhXutBnYHc.
Poehlmann, A.et al (2007). Kras mutation detection in
colorectalcancerusingthePyrosequencingtechnique.Pathol
ResPract.203,48997.
Ronaghi et al.; Karamohamed, S; Pettersson, B; Uhln, M;
Nyrn,P(1996).RealtimeDNAsequencingusingdetection
ofpyrophosphaterelease.AnalyticalBiochemistry242(1):849
Ronaghi et al.; Uhln, M; Nyrn, P (19980717). A
sequencing method based on realtime pyrophosphate.
Science281(5375):363.
Rusk,N.(2011).Torrentsofsequence.NatMeth8(1):44
44
Sanger F (8 Dec 1980). Determination of nucleotide
sequencesinDNA.Nobellecture.
Sanger F, Coulson AR (1975). A rapid method for
determining sequences in DNA by primed synthesis with
DNApolymerase.J.Mol.Biol.94(3):4418.
Sanger F, Nicklen S, Coulson AR (1977). DNA sequencing
with chainterminating inhibitors. Proc. Natl. Acad. Sci.
U.S.A.74(12):54637.
SchusterSC.(2008). Nextgeneration sequencing transforms
todaysbiology.Nat.Methods5(1):168.
ValouevA,IchikawaJ,TonthatTetal.(July2008).Ahigh
resolution,nucleosomepositionmapofC.elegansreveals
alackofuniversalsequencedictatedpositioning.Genome
Res.18(7):105163.
TngQuan
CPNHTKHNNGCCXTNGHIMSINHHCPHNT
TRONGVIMGANSIUVIMNTNH
UPDATE THE POSSIBILITIES OF THE MOLECULAR TESTINGS
IN CHRONIC VIRAL HEPATITIS
PhmHngVn*,VcXuynAn**
XT NGHIM SINH HC PHN T TRONG

VIMGANB
XtnghimphthinvnhlngHBV
DNA
asngibnhimvirusvimganBths
ccpngmindchbov,tclsto
c khng th chng HBsAg (gi l anti
HBsAg) v tiu dit c virus vim gan B.
Ngi khi th mu s dng tnh anti
HBsAg.Tuynhincmtsngihmindch
likhngthtorackhngthbovny
nn th mu lc no cng dng tnh vi
HBsAg. Trong c th ca ngi c mt s
u tranh qua li gia h min dch v virus.
Nu h min dch cn bng c hay u th
hnthskimhmkhngchovirusnhnbn
c thnh cc virus hon chnh do vy m s
khng c hay s c rt t virus hon chnh vo
trongmu.Nhngtrnghpnycgil
ngi lnh mang virus, nu th mu s thy
HBsAgdngtnhnhngduhiuchothyc
virushonchnhlHBVDNA,tclacidnhn
cavirus,thngmtnhhaydngtnhvis
lng(scopies)rtthp(<105/ml).Nhngnu
hmindchkhngkimhmcmvirus
thng th th chng s nhn bn c nhiu
trong t bo gan to ra c nhiu virus hon
chnh vo mu ca bnh nhn v lc ny th
mu s thy HBsAg dng tnh ng thi c
virus hon chnh hin din trong mu vi s
lngcaophthinthngquaxtnghimHBV
DNAchoktqudngtnhvslngvt
trn 105 copies/ml. Trong trng hp ny cn
phi xc nh gan ngi bnh c b tn hi
* i hc Y dc thnh ph H Ch Minh
Tcgilinlc:Ts.Bs.Phm Hng Vn
khng,tclngicbvimganmntnh
khng?Nuxcnhlbvimganmntnhth
phi c iu tr c hiu. Do vy, nu mt
ngibHBsAgdngtnh,chngtacnphi
th mu xem HBVDNA c b dng tnh
khngvslngbaonhiu?ychnhlxt
nghim pht hin v nh lng HBV
DNA(22,8,21). Nu HBVDNA dng tnh vi s
lngqu105/mlthphitiptcxemmengan
(l th nghim ALT hay SGPT) ca h c cao
khng?Nucaovtngng2lnbnhthng
(ALT bnh thng l 19 IU n(29) v 33 IU
nam(29)) th c coi l vim gan mn tnh v
phiiutr.Numenganbnhthngthcn
phi chc chn l t bo gan c b thng tn
khngthngquaxtnghimvhnhthitbo
gan nh sinh thit gan hay fibroscan. Nu kt
qu cho thy c thng tn th h cng phi
cxemlangbvimganmntnhvphi
cniutrchiuchobnhnhndmengan
bnh thng. Xt nghim pht hin v nh
lng HBVDNA l mt loi xt nghim sinh
hcphnt,thngthngcthchinbng
kthutPCRnhlng,cgilqPCRhay
realtime PCR. V mt nguyn tc qPCR cng
ging nh PCR nhng c thm mt tnh nng
na l c th m c c bao nhiu bn gc
DNA trc khi c nhn bn nh mt h
thng quang hc c kh nng pht hin c
phn ng xy ra trong ng nghim trong khi
nhn bn xy ra. Do p dng c c im
PCR l mt k thut m hon ton, ngi lm
xt nghim c th t pha thuc th lm xt
nghimmkhngphiblthucvcckitxt
nghimmuatcchngncngoirtttin,
**Cng ty Nam Khoa

T: 0903698920
Email: phhvan.nkbiotek@gmail.com
ChuynYTCngCng
nn hin c nhiu phng xt nghim ti Vit
Namthchincxtnghimsinhhcphn
tny.Tuynhinnudatrnhthngmth
munktquxtnghimcchnhxc,ngi
lmxtnghimphithchinccchng
kimsotkhngchoccsstxyratrongqu
trnhlmxtnghimvccchngnyphihin
th trn kt qu xt nghim(39,41). i vi xt
nghim qPCR pht hin v nh lng HBV
DNAthtrongktquphihinthcng
biu din chun chng minh thao tc nh
lngtchunthngquahstngquan(R)
ca cc mu chun phi t trn 0.990 v hiu
qu phn ng (E) phi t 90105% v ng
thi chng minh kt qu nh lng l c
tnh ton t kt qu ca cc mu chun c
chy song hnh cng vi mu th ch khng
phi l c tnh ton t mt cng thc c
sn(41).Ngoira,numunktlunmtktqu
mtnhthtrongktqunhlngphihin
thcmudngtnhcvichngni
ti m bo m tnh ny l m tnh tht s
chkhngphimtnhgivphnngkhuch
ibcch.
Xt nghim qPCR pht hin v nh lng
HBVDNAcnphicdngtheodihiu
quiutrcaccthuckhngvirusmbcs
ch nh trn bnh nhn. Nu sau khi ch nh
iu tr khong 1 3 thng m kt qu xt
nghimchothylngvirus(cgilHBV
DNA copy hay IU) gim c 100 ln (gi l
gim2log)thbcsiutrcthnhgil
thuckhngviruschiuqu.Hinnayckh
nhiu thuc khng virus dnh cho vim gan B
mntnhrthiuqu,HBVbngnchnkhng
chonhnbnrtnhanh,chnhvvyHBVDNA
bin mt khi mu sm hn l HbeAg, s bin
mt khi mu chm hn. Chnh v vy HBV
DNAlmtdunrttttheodicp
ngkhsmcaiutrvhinnayccnhy
hctrnthgiivtiVitNamthngnht
sdngHBVDNAlmchstheodipng
iutrhnlHbeAg.
ChuynYTCngCng
TngQuan
Ngoiraxtnghimnycngphicch
nhcmi3thngtrongqutrnhiutr
nh gi hiu qu iu tr v nguy c khng
thuccavirustrnbnhnhn.Btckhino
ktquphthinvnhlngHBVDNAcho
thy c s xut hin tr li HBVDNA trn
ngngphthinthbcsiutrphiluv
y chnh l du hiu cho thy virus ang
khngthuciutrhaybnhnhnkhngtun
thliuphpiutrmbcsangchnh.
Xt nghim pht hin t bin khng

thuc
Mt ngi b xc nh l b vim gan
virus B mn tnh nu khng c iu tr c
hiuthvirusskhngbkhngchmslin
tcnhnbntrongtbogan v s tn ph t
bo gan vi hu qu s dn n x gan v t
thngtnxgan,bnhnhncthbidn
ntnhtrngxganmtbricht,haytx
gan c th b dn n ung th gan(48). Cng c
trnghpbnhnhnbungthganmkhng
cn thit phi b qua giai on x gan(48), y
chnh l nhng trng hp bnh nhn tnh c
qua khm sc kho thy b khi u trong gan
(quasiumchnon)risaubxcnhl
ung th gan, xt nghim mu cho thy HBV
DNAdngtnhviscopiescao(>105).Chnh
vvymnubchnonlbvimganB
mn tnh (tiu chun chn on l HBVDNA
trn 105 copies/ml, ALT cao gp 2 ln bnh
thnghayxtnghimsinhthithocfibroscan
thy t chc gan b tn thng) th nht thit
phiciutrchiukimchkhng
cho virus nhn bn gy tn thng gan.
Nhiunghincuchothynukhngc
iutrkhngchslngvirushonchnh
trong mu bnh nhn lun di ngng pht
hin th nguy c x gan hay ung th gan
nhngnginysrtcao(22,8,21).Thigianiu
tr bng thuc khng virus c th s ko di
trong nhiu nm v cho n nay cc nh y hc
chtnthnhcnglkhngchcvirus
khng cho nhn bn ch rt him khi loi tr
cvirus(22,8,21)vchngtntitrongtbogan
TngQuan
dng cccDNA (covalently closed circular

DNA)khngbtcngbithuckhngvirus.
Dophiiutrthuckhngvirusmtthigian
dinnviruscchitipxcvithuckhng
virusvnhvylchngcchibtbin
khngthuc.Dovynutrongthigianiu
tr,xtnghimtheodiviruslHBVDNAbng
nhinbtrlidngtnhvlngHBVDNA
btnglndnthychnhlduhiuchobit
virusckhnngkhnglithucangiutr.
Lcnycnphixtnghimphthinxem
thuc c b virus khng khng?. Hin nay
cng ty Nam Khoa pht trin c phng
php gii trnh t mt on gen 700bases trn
vnggenertcaviruscthphthinc
tt c im t bin gip virus khng c
lamivudine, adefovir, entecavir v tenofovir(2).
C th v k thut ny nh l k thut lm
khng sinh dnh cho HBV, vt tri hn
nhiu k thut khc ch c th pht hin tng
t bin mt cho tng thuc khng virus mt,
dovymscungcpchobcsnhiuthngtin
hnchoquytnhchnhxchnlliuc
nnthayithuckhng.
Xt nghim pht hin t bin precore v

corepromoter
Trong b gen (DNA) ca virus vim gan B
c mt gene c gi l gene tin li, m ha
thng tin di truyn gip virus sinh ra c
khngnguyne(HBeAg)vkhngnguynny
cvirustitrangoikhinnhnbn.Dovy
nu trong mu bnh nhn c s xut hin
HBeAgthcnghalcsnhnbncavirus
trongcth.Nubnhnhnciutrbng
thuc khng virus th virus s b chn li v
khngnhnbncngthihthngmin
dchnhndinHBeAgcabnhnhncchi
phttrindovymtrongmubnhnhnxut
hinckhngthchngHBeAg(gilanti
HBeAg).Trnghpnyyhcgilcchuyn
ihuytthanhchngminhchmindch
thng th vi cc kt qu xt nghim cho thy
HBeAg tr nn m tnh, antiHBeAg dng
tnh, v HBVDNA khng pht hin c hay
10
pht hin c nhng s lng rt thp. Tuy

nhintrongbnhnhnbvimganBmntnh,
qutrnhutranhgiavirusvihmindch
cacthcngthcyvirusvimganBc
nguy c to ra mt t bin ti vng precore
(codon1896)tonnmtmktthctrngene
nyhaytbintivngcorepromoter(codon
1762hay1764)dovymviruskhngthtng
hpckhngnguynHbeAg(17),lcnyvirus
c gi l b t bin precore v/hay core
promoter.tbinprecore,vcbittbin
corepromoter(4,16,18,26,47)clinhrtcaovinguy
cungthgantrnbnhnhnvimganBmn
tnh, do vy trn mt bnh nhn vim gan B
mnangciutrvithuckhngvirus,
nu kt qu xt nghim cho thy HBeAg m
tnh,AntiHBeAgdngtnh,nhngHBVDNA
lixuthindngtnh,ngthimengantri
st tht thng, th y chnh l du hiu bo
ngnguycvirustbinprecorev/haycore
promoter. Trong trng ny, cho ch nh xt
nghim pht hin t bin precore/core
promoterlrtcnthit.Xtnghimphthin
t bin precore/core promoter hin nay
c cng ty Nam Khoa thc hin bng gii
trnhtvinguyntcldngPCRkhuchi
mt on di 250 bases trn vng gene preC
chaccvtr(1762,1764v1896)rigiitrnh
ttrctipphthinxemctbintiv
tr ny hay khng(40). Mt kt qu pht hin c
tbinprecorev/haycorepromotertrnbnh
nhnbtbucbnhnhnphiciutrsut
ihayiutrchonkhiHBsAgbinmt.
XtnghimnhlngHBsAg
Thuc khng virus khng th l gii php
gipiutrkhihnbnhtrnccbnhnhn
vimganBmntnh.Dovyhinnayccnh
iu tr ang trng ch liu php interferon v
cnhiuchngcyhcchothyinterferon
phihpvithuckhngviruscthgiploi
tr HBV vnh vin ra khi bnh nhn chng
minhcquasbinmtHBsAgtrongmu,
tclxtnghimHBsAgtrnnmtnhtrong
qu trnh iu tr. Tuy nhin khng phi bnh
ChuynYTCngCng
nhnnociutrbngliuphptrnu
ccktqukhibnh.Chnhvvyphic
xtnghimgiptheoditinonchiu
qu iu tr bng interferon. Xt nghim pht
hin v nh lng HBVDNA khng th lm
ciunyvngaysaukhiiutrmtthi
gian ngn th HBVDNA trong mu ca bnh
nhntrnnmtnh.Ccnhnghincu
cho thy c mt s lin h rt r rng gia s
thay i v lng ca khng nguyn HBsAg
trongmucabnhnhnvihiuquiutr
interferon. Nu trong qu trnh iu tr, lng
HBsAgtrongmugimmtcchcnghas
chngminhcliuphpinterferonlchiu
qu trn bnh nhn(10,20). Chnh nh pht hin
nymmtxtnghimmindchcinlxt
nghim HBsAg quay tr li thnh mt xt
nghimkhng th thiu c nu bc s mun
chnhiutrinterferonkthpthuckhng
virustrn bnh nhn vim gan B mn tnh ca
mnh.Dlxtnghimcinnhngdophi
cktqunhlngtheoIU(nvquct)
nn ch c mt vi h thng kn c chp
nhn mi c th thc hin c v y cng
chnh l l do ti sao xt nghim nh lng
HBsAg hin nay cn kh t so vi cc xt
nghimmindchthngthngkhcnhnh
tnh HBsAg, antiHBsAg, HBeAg, antiHBeAg,
antiHBcAg
XtnghimnhlngcccDNAtrongsinh
thitganhaytrongmu
NgaysaukhiHBVDNAivonhntbo
gan, cccDNA c thnh lp v tr thnh cht
liuditruyntphinmthnhccgene
iukhinstnghpccthnhphncutrc
v chc nng ca HBV. S pht hin v nh
lng c cccDNA l rt c ngha chng
minhchiuquiutrchiucathuc
khng virus hay ca interferon l c loi tr
cvirusrakhibnhnhnhaykhng(46)].V
nguyntcthcccDNAchcthtmthytrong
t bo gan, tuy nhin cccDNA vn c th tm
thyctrongmu.XtnghimrealtimePCR
nhlngcccDNA(34)trongsinhthitganvc
ChuynYTCngCng
TngQuan
tronghuytthanhckhnngtrthnhmtxt
nghimrtcnthitnhgihiuquiu
tr c hiu bng thuc khng virus v
interferontrnbnhnhn.
XtnghimxcnhkiugeneHBV
Trcyccnhnghincuphidatrn
cc du n ca khng nguyn b mt (HBsAg)
caHBVphnbitccnhmHBV.Ngynay
nhshiubitcnkvtrnhtcabgene
HBV, cc nh nghin cu phn ra c 9
genotype khc nhau (AI)(23,24,27,28). S phn b
genotype l rt ty thuc vo a d, v d ti
MgenotypechyulA,CvsaulB(23),
cn ti Vit Nam th ch yu l C ri n
B(12,11,37,38,43). Genotype ca HBV lin quan kh
nhiu n tin trin bnh, t bin v khng
thuc.Nhiunghincuchothygenotype
Ccdhukm,pngkmvithuckhng
virus, nguy c t bin core promoter cao v
nguycungthgancaohngenotypeB(7).Do
nghanhvynnnhiunhlmsngchoch
nh xt nghim xc nh genotype HBV. TS.
Kenji Abe ca Vin Nghin Cu Bnh Nhim
Tokyo pht trin mt k thut nested
multiplexPCRxcnhgenotypeHBVcth
p dng ti cc phng th nghim c phng
tin PCR(24). i vi cc phng th nghim c
phngtingiitrnhtnhphngthnghim
cacngtyNamKhoa th ngoi phng php
caKenjiAbe,chngticngxydngxt
nghim va pht hin t bin precore/core
promoter va xc nh genotype(40), hay xt
nghimvaphthintbinkhngthucva
xc nh genotype da trn c s gii trnh t
pht hin cc t bin mun tm ri sau so
chui trn gene bank vi chng trnh blast
search xc nh genotype ca trnh t gii
c(2,43).Vigiiphpnythbcskhngcn
cho ch nh tm genotype nhng vn c c
thng tin v genotype i km vi kt qu pht
hincctbinprecore/corepromoterhayt
binkhngthuc.Ngoira,gipccphng
thnghimlmsngcphngtinPCRckh
nngthchincxtnghimnhtypeHBV,
11
TngQuan
cng ty Nam Khoa pht trin k thut real

time multiplex PCR (khng cn nestedPCR)
da trn cc cp mi c thit k bi Kenji
Abe. K thut ny t nhy tng ng
nested multiplex PCR ca Kenji Abe nhng c
uimhnlddngthchin,phntchkt
qumkhngcnphiindi(hnh1),vtrnh
c nguy c ngoi nhim v khng cn phi

thc hin nested PCR. Hin nay k thut real
timemultiplexPCRdocngtyNamKhoapht
trin ang c ph bin rng ri n cc
phngthnghimlmsngcthitbrealtime
PCR.
Hnh1:Hnhminhhacchcktqu:TypeBkhinhchy84oC;TypeCkhinhchy82oC,mnghim
khinhchy76oC
Xt nghim pht hin t bin mt on

trngenePreS2
Xt nghim pht hin t bin trn thot

vaccinecaHBV
TS.KenjiAbephthincltrncc
muungthganlytbnhnhibungthgan
tiVitNamlctlcaophthincHBV
DNA, v c n 36% l c t bin mt on
trngenePreS2.tbinnycxcnh
l c vai tr trong ung th gan(15) v qua cng
trnh nghin cu ca cc nh khoa hc ti i
Loan, nhm nghin cu gy ung th gan
thc nghim trn chut(33,45). Vi chng c ny,
cc nh y hc cng phi quan tm n xt
nghim truy tm t bin mt on PreS2 trn
cc bnh nhn vim gan B mn tnh c th
phthincsmnguycungthgan.Cng
tyNamKhoavishptccaTS.KenjiAbe
xydngcthnhcngkthutPCRri
giitrnhtphthintbingyungth
quan trng ny v sn sng hp tc cng cc
nh nghin cu v iu tr c c cc
nghin cu rng hn v cn nguyn ung th
gan,hincthngklungthhnguti
Vitnam.
MtngichchngavimganBvc
khngthbov(antiHBsAg) vn c nguy c
nhimHBVvdnnvimganmntnhcao
nusaukhichngngahbnhimbichng
virus mang t bin trn thot vaccine. Chng
tbintrnthotvaccinectbinticodon
145 (Gly145Arg/Lys) v chnh do s t bin
ny m virus thay i c tnh khng
nguyncaepitopeatrnthotckh
nngbovcakhngthchngHBsAgvnh
m nhim c trn bnh nhn v gy
bnh(3,14,13).
12
Vivtrtbinxcnhvvicch
gybnhrrngnhvy,chngticholcc
nh iu tr cng nh nghin cu phi quan
tm n vn pht hin t bin trn thot
vaccine trn cc bnh nhn tn ti song song
trong huyt thanh va antiHBsAg va
HBsAg,haytrnccbnhnhnsaukhichng
ngamtnhinlixuthinHBsAgvbin
mt antiHBsAg. TS. Kenji Abe v phng th
ChuynYTCngCng
nghimcacngtyNamKhoartsnsng
TngQuan
htrccnghincunhvy.
Hnh2:BgenecaHBVvccvngchmdavoccxtnghimsinhhcphntctrinkhaiti
phngthnghimNKBIOTEK
hp,virusvntnti,nhnbntrongtbogan
XT NGHIM SINH HC PHN T
vphngthchvirusvotrongmu.Dovy
TRONGVIMGANC
c th xc nh mt ngi c ang b nhim
XtnghimphthinvnhlngHCV
HCVhaykhng,bcsphichochnhlmxt
RNA
nghimphthinvnhlngHCVRNA,tc
l tm v nh lng c virus vim gan C
Mt ngi b nhim virus vim gan C th
trong mu. Nu xt nghim ny cho kt qu
thng h min dch ca ngi t khi to
HCVRNAdngtnhthcnghaltrongmu
cmindchbovchngcvirus,dovy
ca bnh nhn c hin din virus vim gan C,
s xut hin khng th c hiu HCV (anti
tc l bnh nhn ang b nhim HCV. Xt
HCV) khng c ngha l c th c c
nghim pht hin v nh lng HCVRNA
mindchbovloitrcvirus.Chcmt
chnhlmtxtnghimsinhhcphnt,thng
s t may mn s khi c nh cc h thng
thngcthchinbngkthutrealtime
chng khng c hiu khc ca c th loi
PCR.
Do b gene ca HCV l RNA, do vy
tr c virus, cn li trong a s cc trng
ChuynYTCngCng
13
TngQuan
lm xt nghim, RNA ca virus sau khi tch

chitctmucabnhnhnsphic
phin m ngc (reverse transcription) thnh
DNAbsung,gilcDNA,trckhithchin
realtime PCR pht hin v nh lng.
Chnhvvyxtnghimnycgimtcch
chnh xc hn l RTqPCR (RT l reverse
transcription). Cng ging nh xt nghim
qPCRphthinvnhlngHBVDNA,c
nhiuphngxtnghimtiVitNamthchin
cxtnghimsinhhcphntnydatrn
hthngmcakthutPCR.Cngchnhvl
h thng m nn cc kim sot v cht lng
phi c cc phng xt nghim quan tm
trnh cc sai lm trong qu trnh lm xt
nghim, tc l phi lun lun lm xt nghim
vi cc chng v chun kim sot c cc
nguycsstcthxyratrongqutrnhlm
xtnghimnhlchngtitrnhbytrong
xtnghimphthinvnhlngHBVDNA
trn(39,41).
MtngisaukhinhimvirusvimganC
ththngkhngctriuchnghaychcmt
t triu chng khng c hiu v m h. Tuy
nhinvirussmthmxmnhpvnhnbn
trong t bo gan v qu trnh ny din tin rt
lu,cthtrnhngchcnm,lmtboganb
tn ph dn dn, gy hu qu vim gan mn
tnhriinxgan,vcthtxgandn
n ung th gan. Nguy c ca ngi ang b
nhimHCVdnnvimganmntnhrix
gan v n ung th gan l kh cao (c th 17
20%).Dovy,khcvinhimvirusvimganB
cn phi xc nh l ang b vim gan B mn
tnh (ALT tng cao hay c bt thng t chc
ganphthinquasinhthithayfibroscan)mi
cnphiiutrchiu;mtngibxcnh
langnhimvirusvimganCthnncch
nhiutrchiumkhngcnphiccc
du hiu chng minh gan b thng tn v
vim gan mn tnh. Tuy nhin trc khi c
iutr,bnhnhnphinhtthitcchnh
lm hai xt nghim: nh lng HCVRNA v
nh genotype HCV bc s c th theo di
14
c hiu qu iu tr cng nh quyt nh

cthigianiutrchiu(25,31).
Ch cn 1 thng sau khi c iu tr c
hiu bng liu php interferon phi hp vi
ribavirin,bcsnncholichnhphthinv
nh lng HCVRNA xc nh bnh nhn
c p ng sm vi liu php iu tr hay
khng?NuktquHCVRNAtrongmubnh
nhntrnnmtnhchsau1thngiutrth
ylmttnhiurtvuichobnhnhn,chng
tbnhnhncpngsmviiutrvbc
s c th rt ngn thi gian iu tr cho bnh
nhn (c th ch cn 1/2 nm). Nu HCVRNA
trongmubnhnhnvnchabinmtthbc
s phi ch thm 2 thng na lm li xt
nghimphthinvnhlngHCVRNA,v
nuktqunhlnglnnychothylng
viruskhnggimhaygimthn100lnthbc
s phi cn nhc thay i phng thc hay c
thphingngiutrvbnhkhngpng
vi iu tr. Nu kt qu nh lng cho thy
lngvirusgimhn100ln(chuynmngi
l gim hn 2 log) th bc s c th nh gi l
phtiutrchiuchiuquvlcny
sphiquytnhthigianiutrlbaolu.
Quyt nh ny tu thuc vo genotype HCV
mbnhnhnbnhimlloino(bitct
ln xt nghim u tin trc khi quyt nh
iu tr cho bnh nhn). Nu khng may m
bnhnhnbnhimHCVgenotype1thbcs
sphiiutrchobnhnhnvitngthigian
tnht12thng.NubnhnhnbnhimHCV
khng phi genotype 1, m l 2 hay 6 (ti Vit
Nam,rttkhiphthincgenotypeHCV3,
4,v5)thbcschcniutrchobnhnhn
vitngthigian6thng.
Trckhiquytnhchmdtiutrcho
bnh nhn th bc s s phi ch nh li xt
nghimphthinvnhlngHCVRNA
xemvirusccntrongmucabnhnhnhay
khng. Nu xt nghim ny vn cho kt qu
dng tnh th bc s vn cha th ngng iu
tr m phi tip tc thm 3 thng na cho n
khi kt qu tr nn m tnh. Sau khi chm dt
ChuynYTCngCng
iutr,bcscngphithngxuyntheodi
xem bnh nhn c b ti pht hay ti nhim
khngbngxtnghimphthinvnhlng
HCVRNA trong mu ca bnh nhn mi 3
thngmtln.Btclcnoxtnghimtrnn
dng tnh th bc s s phi xem nh bnh
nhn b ti pht hay ti nhim v phi tr li
iutrchiunhbanu.
Bayer (sau ny l ca Siemen) v gii trnh t

vng 5 NC ca Trugene (m sau ny l ca
Siemen). Ti Vit Nam, cng ty Nam Khoa
pht trin k thut va nh lng HCVRNA
vaxcnhcgenotypecaHCVdatrn
vng5NC(32,42).Nguyntccakthutnyl
nh lng HCVRNA trc bng k thut
qPCR ri sau gii trnh t sn phm qPCR
ny xc nh genotype HCV bng cch so
chui vi th vin genotype HCV ca NCBI.
Nhvyvichnhxtnghimvaxcnh
genotype HCV, va nh lng HCVRNA m
bcschotrckhiquytnhiutrchiu,
bnh nhn ch phi tr chi ph cho xt nghim
xcnhgenotypeHCVmvnccktqu
nhlngHCVRNA.Ngoikthutgiitrnh
t v lai trn vch, k thut realtime PCR s
dng d Taqman cng c pht trin xc
nh genotype HCV da trn vng 5 NC v
cngtyNamKhoacnglmttrongcccngty
phttrinkthutny.
XtnghimxcnhgenotypeHCV
Genotype l cc kiu khc bit ca vi sinh
vt cng loi da vo s khc bit trnh t
nucleotidetrnbgenecavisinhvt.Cho
n hin nay y hc xc nh l HCV c th
c phn lm 6 genotype ln l 1 n 6, tuy
rng cng c khuynh hng cho l c n 11
genotype HCV. Trong tng genotype, HCV li
cphnthnhccditypenhgenotype1
cccditypel1a,1b,1c;genotype2ccc
di type l 2a, 2b, 2c... Xt nghim xc nh
genotypeHCVlmtloixtnghimsinhhc
phn t v nh trn trnh by, kt qu xc
nh genotype ca HCV trn bnh nhn rt c
gi tr gip bc s tin on c hiu qu
iu tr, xc nh c thi gian iu tr c
hiu,vliuribavirinsdngchobnhnhn.
Hnh 3: HCV ti Vit Nam ch yu l thuc
Genotype 6[46] v y l mt ch s
Trc y, genotype HCV c xc nh
davoskhcbitvtrnhttrnvng5NC
tc l vng khng m ho trn b gene ca
HCV, v cng chnh trn c s ny nhiu k
thutxtnghimxcnhgenotypeHCVra
i nh xt nghim inoLIPA lai trn vch ca
ChuynYTCngCng
TngQuan
Tuy nhin gn y cc nh nghin cu

chng minh l xt nghim xc nh genotype
HCVdatrnskhcbittrnhtcavng5
NC l khng sc phn bit c nhiu
subtypecagenotype6caHCVvigenotype
1(5,6), chnh v vy s c kh nhiu trng hp
c xc nh genotype 1 nhng tht ra l
genotype6.xcnhchnhxcgenotypeca
HCVthphidatrngiitrnhtvngNS5B
trnbgenecaHCV(6,19).Trongmtcngtrnh
nghin cu phi hp vi chng ti, TS. Kenji
Abe(44) ca Vin Nghin Cu Cc Bnh Nhim
Trng Tokyo pht trin phng php dng
PCR t khuch i mt vng c hiu trn
vng NS5B v sau gii trnh t sn phm
khuch i xc nh genotype HCV. Cng
trnhnghincunychophpchngtic
mt nhn nh mi v t l phn b genotype
HCVtrnccmuhuytthanhlytngiVit
NamnhimHCV,lctrn60%cctrng
hp l thuc genotype 6 ch khng phi l
genotype 1 nh nhiu cng trnh trc y
cngb. Ngoi ra, mt nghin cu so snh kt
quxcnhgenotypeHCVdatrngiitrnh
15
TngQuan
tvng5NCvigiitrnhtvngNS5Bcng
c chng ti thc hin vi kt qu cho
thytrn40%cctrnghpgenotype6bxc
nhlgenotype1nudatrntrnhtvng5
NC. Chnh v vy, hin nay vi s ng ca
TS. Kenji Abe, chng ti trin khai k thut
gii trnh t vng NS5B ti cng ty Nam Khoa
c th gip cc nh lm sng c thng tin
chnh xc hn v genotype HCV v chc chn
rngcckthutdatrngiitrnhtvng5
NCcaTrugene,hayrealtimePCRtrnch5
NC ca HCV hin ang c s dng ti Vit
Namlhontonkhngchnhxc.
Hnh4:asSNP(A)caIL28Blthuckiu
switchon,t2226%lkiuswitchoff(dliut
NKBIOTEK)
Hinnaytrnthgiiccnghincuvp
ng iu tr interferon trn genotype 6 l cn
kht.VitNamlqucgiamnhimHCVch
yulilgenotype6,dovyylmthng
rtmccnhnghincucthcccc
nghincumangtmquctvtiny.
Xt nghim xc nh cng tc interferon

(interferonswitch)
iu tr bnh nhn nhim HCV vi liu
phpInterferonkhngphilcnocngckt
qu thnh cng: bnh nhn khi bnh hon
ton.Dovyccnhiutrrtquantmllm
sao tin on c hiu qu iu tr interferon
trn bnh nhn. Trc y mt s nh nghin
cucholcthdoHCVbtbintrongqu
trnhiutrnnkhngcinterferon.Tuy
nhin hin nay, qua mt s cng trnh nghin
curtcngphusosnhvnhgicckhc
16
bitSNPcabgenengi,ccnhnghincu
phthincmtvivtrtrnvnggene
interleukin28B(IL28B) l c lin quan n kh
nngthnhcnghaynguyctiphttrnbnh
nhnnhimHCVciutrinterferon(9,30,35,36).
C 3 SNP ca IL28B c xc nh, l
SNP(A)rs12979860,SNP(B)rs8099917,vSNP
(C) rs12980275. SNP (A) chnh l cng tc
interferon: kiu gene C/C l cng tc bt
(switchon) v C/T l cng tc tt (switchoff).
Switchonchophptinonhiuquiutr
thnhcnginterferoncao(trn80%)vitnguy
c ti pht v tin trin mn tnh hn so vi
switchoff tin on hiu qu iu tr thp vi
nguyctiphtvtintrinmntnhcao.Ti
cngtyNamKhoa,chngtianglmnghin
cu xc nh cng tc interferon trn cc bnh
nhnnhimHCVbngkthutgiitrnht,kt
qu cho thy c khong 20% bnh nhn l
interferon swithoff. Kt qu nghin cu cng
chothytrnccmumchngtinghincu
(trn100mu)thbaSNPnylclinquanvi
nhau do vy ch cn lm xt nghim xc nh
SNP (A) l ch khng cn phi xc nh
thmSNP(B)vSNP(C)na.
Xt nghim xc nh cng tc interferon l
rtcnghavktquxtnghimcthgip
bcstvnkhnngthnhcngcaliuphp
interferon trn bnh nhn. Ngoi ra trn cc
bnhnhniutrviktquHCVRNA
mtnhmbcschalmxtnghimxcnh
genotypecaHCVtrnbnhnhn,bcscth
chochnhxcnhcngtcinterferonc
thquytnhcthigianiutrcngnh
tin on hiu qu iu tr thay th cho xt
nghimxcnhgenotypeHCVlcnykhng
th thc hin c v HCVRNA bin mt
trnbnhnhnri.Chnhvkhnnghudng
caocaxtnghimnynnchngtinghin
cu p dng thnh k thut realtime PCR s
dngdtaqmanxcnhcngtcinterferonvi
mong mun xt nghim ny c a ra s
dngrngritrnnhiuphngthnghimlm
sngcphngtinPCR.Nghincumilin
hgiaSNP(A)caIL28Bvipngiutr
ChuynYTCngCng
interferon cng l mt hng nghin cu nn
lmvhinnaychcccnghincutrnHCV
genotype1,chactrngenotype6.VitNam
TngQuan
chng ta vi a s bnh nhn nhim HCV l

genotype6,dovymnghincutheohng
nyrtlcnthit.
Hnh5:BgenecaHCVvccvngchmdavoccxtnghimsinhhcphntctrinkhaiti
phngthnghimNKBIOTEK
m cc nh iu tr hay nghin cu nn quan
Xt nghim pht hin t bin core trn
tm,ltmhiumilinquangiatbin
HCV
precore, cng tc interferon v genotype ca
Ngoi cng tc interferon, c ghi nhn
HCV i vi p ng iu tr interferon phi
t bin thay th aminoacid (aa) 70 v 91 trn
hp vi thuc khng virus. Phng th nghim
vngcorecaHCVthucgenotype1bcngc
NKBiotekhincphngtincth
lin quan n s p ng thnh cng vi liu
cngphihpnghincutrnlnhvcmi,th
phpinterferonphihpviribavirin(1).Ccghi
vvcngythchthcny.
nhn ny cng m ra mt hng tip cn mi
ChuynYTCngCng
17
TngQuan
KTLUN
3.
VitNamlmttrongccqucgiactl
nhim vim gan B cao nht th gii, i vi
vim gan C th Vit Nam b xp vo nhm cc
qucgiactlnhimtrongdnsnghng
nh. C l chnh v nh vy m ti Vit Nam
hin nay, ung th gan c xp vo u danh
schungth,caohncungthphi.
4.
Vim gan B mn v nhim vim gan C

khngphilccbnhlkhngthtrc,
lccbnhlkhngchiutrcmcnc
thtrkhic.Tuynhincthchoc
ch nh iu tr cng nh theo di c hiu
quiutrthccnhiutrcnphiccc
thng tin cn thit n t cc xt nghim sinh
hc phn t. Vi s tin b v k thut cng
nhshiubitcnkvbgenecaHBVv
HCV,ccxtnghimsinhhcphntphc
vchomcchchnonvtheodihiuqu
iutrvimganBmntnhvnhimHCVl
khngcgkhkhntiVitNam.Cthni
chngtacnhngphngthnghimckh
nnglttrntonbccbncabgeneHBV
vHCVtrnbnhnhn.Bivitnynhmmc
chgipccnhnghincuviutrrhn
vcckhnngnykhngchtndngm
cnmraccchptcnghincusuv
c trnh tng ng quc t v HBV v
HCVtiVitNam.Cschngtinivyv
hinnaychngtaangccmtshptc
rt cht ch v bnh ng vi mt chuyn gia
hngutronglnhvcny,lTS.KenjiAbe
ca Vin Nghin Cu Bnh Nhim Trng ti
Tokyo.
TILIUTHAMKHO
1.
2.
18
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19
NghincuYhc
CIMDCHTHCCABNHTAYCHNMING
20TNHTHNHPHANAMVITNAMGIAION20052011
TrnNgcHu*
TMTT
tvn:Nm2011,bnhtaychnmingcsgiatngtbinvcamcvtvongkhuvcpha
Nam.
Mctiu:MtcccimdchthccabnhtaychnmingkhuvcphaNamt20052011.
Phngphpnghincu:NghincudatrnccboconhkcaVinPasteurTPHCMt2005
2011, phiu iu tra ca bnh, kt qu xt nghim RTPCR v phn lp virt ng rut ca Vin Pasteur
TPHCM.
Ktqu:Ktqukhostchothynm2011csgiatngbtthngcabnhtaychnmingkhuvc
phaNamviscamcgp6ln,scatvonggp624lnsovigiaion20082010.Tlcht/mcl
0,2%.Tlmcbnhcaonhtnhmtrdi3tui(chim80%).Trcybnhtaychnmingchainh
dchtrongnm.Nm2011dchchc1nhvothng910.ThnhphHCMdnuvscamc,chttuyt
i.Tuynhin,tnhtrn100.000dn,ThnhphHCMnghngth14.Nmtnhcscamc/100.000cao
lBRaVngTu,ngThp,ngNai,BnhDng,BnTre.CsgiatngscanhimEV71ngthi
visgiatngscamcbnhkhuvcphaNam.
Kt lun:BnhtaychnminglbnhtruynnhimangbngphtVitNam,cbitlkhuvc
phaNam
Tkha:taychnming,sphnbtheonm,ma,tui,phi,tcnhn
ABSTRACT
EPIDEMIOLOGICALCHARACTERISTICSOFHANDFOOTMOUTHDISEASEIN20SOUTHERN
PROVINCESOFVIETNAM,PERIOD20052011
TranNgocHuu*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:2025
Background:In2011,therewasasharpincreaseinHandfootmouthdiseasemorbidityandmortalityin
SouthernpartofVietnam.
Objectives:Todescribeepidemiologicalcharacteristicsofthediseaseintheperiodof20052011.
Methods:AnalyzingdatafromperiodicalreportsofPasteurInstituteinHCMCintheperiodof20052011,
acaseinvestigationform,RTPCRtestandvirusisolationfromenteroviruslabofPasteurInstituteHCMC.
Result:Theresultsshowedthat,insouthernprovinces,casesincreased6timesanddeathsincreased624
timesin2011comparedwiththeperiodof20082010.Casefatalityratewas0.2%.Thehighestpercentageofthe
disease was in the group of children under 3 years old (80%). Before 2011, there had been two peaks of the
pandemiceachyear.In2011,therewasonlyonepeakinSeptemberandOctoberinrainyseason.HCMCrank
thefirstincasesanddeathsbutrankthe14thinmorbidity per 100,.000 population. Five provinces had high
percentagesofcasesper100,000wereBaRiaVungTau,DongThap,DongNai,BinhDngandBenTre.
ThereweretheincreasesinthenumberofEV71infectedcasesandthenumberofhandfootmouthdiseaseinfected
casesconcurrently.
*VinPasteurTPHChMinh
Tcgilinlc:Ts.TrnNgcHuT:0913700496
ChuynYTCngCng
Email:t.n.huu.vt@gmail.com
19
NghincuYhc
Conclusion:Handfootmouthdisease,acommunicabledisease,hasbeenoutbrokeninVietnam,especiallyin
theSouthofVietnam
Keywords:handfootmouthdisease,distributionbyyear,month,age,gender,pathogenicagent
169.KhuvcphaNamchim60%scamcv
TVN
85,8%scatvongtaychnmingcacnc.
Bnhtaychnmingcmtlnutin
Sphnbtheonm
tiMvonm1974(2).khuvcChuThi
Tronggiaiontnm2005nnm2007
Bnh Dng, nhiu v dch tay chn ming ln
s
ca
mc bnh tay chn ming di 3.000 ca.
cboconhiuqucgianhc,Trung
Nm 2008, khi bnh tay chn ming c a
quc, Nht bn, Malaysia, Mongolia, Hn quc,
vodanhschbnhtruynnhimbtbucphi
Singapore,vVitNam.Nm2009,Trungquc
khaibo,scamctnglnhn3lnsovigiai
lcabococ1.255.525camc,trong
on20062007.Nm2011,scamcgp6ln,
c13.810canng,v353catvong(4).
scatvonggp624lnsovigiaion2008
Bnhtaychnmingcghinhnlnu
2010.Tlcht/mcnm2005l2,95%.Trong
tintiVitNamvonm2003.Nm2008,BY
giai
on 2008 2011 t l ny dao ng trong
t chnh thc a bnh tay chn ming vo
khong0,060,23.
nhmccbnhtruynnhimbtbucphikhai
bo.Domicquantmtvinmgny
nn nhng thng tin c bn v bnh tay chn
ming Vit Nam cha c y . Mc ch
canghincunynhmmtnhngcim
dch t hc ca bnh tay chn ming khu vc
phaNamdatrnnhngsliuthuthpc
tnm2005n2011.
ITNGPHNGPHPNGHINCU
Sliucthuthp v phn tch da trn
cc bo co bnh truyn nhim hng thng ca
VinPasteurTPHCMtnm2005,bocotun
bnhtaychnmingtnm2008,phiuiutra
cabnh,ktquxtnghimRTPCRvphnlp
virt ca Labo vi rt ng rut, Vin Pasteur
TPHCM.
KTQU
Theo thng k ca Cc Y t d phng, nm
2011, c nc ghi nhn 112.370 trng hp mc
taychnmingti63tnhthnh.Scatvongl
20
Bng1:TnhhnhbnhtaychnmingtiKVPNt
20052011
Nm
Mc
Cht
CFR
2005*
441
13
2.95
2006*
2.284
13
0.57
2007*
2.988
14
0.47
2008
10.958
25
0,23
2009
10.640
23
0,22
2010
10.128
0,06
2011
67.396
145
0.20
(*)Ghich:ttrcnm2008,sliuthuthpchyu
tBVN1N2
Sphnbtheothng
Trong giai on 2008 2010, bnh tay chn
ming xut hin quanh nm vi 2 nh dch.
nh th nht trong khong t thng 56, nh
th hai trong khong t thng 911. Nm 2011
dchchc1nhvothng910.
ChuynYTCngCng
NghincuYhc
Hnh1:DintindchTCMtheothngtiKVPNnm2011
HCMnghngth14(140,1).Nmtnhcs
Sphnbtheoaphng
ca mc/100.000 cao l B RaVng Tu (331,5),
Thnh ph HCM dn u v s ca mc
ng Thp (318,3), ng Nai (316,0), Bnh
(9.462)vcht(30)tuyti,tiptheolcctnh
Dng(276,3),vBnTre(240,0).
ngNai,ngThp,BnTre,vBRaVng
Tu.Tuynhin,tnhtrn100.000dn,thnhph
Hnh2:TnhhnhdchTMCphnbtheoaphngtiKVPNnm2010
22
ChuynYTCngCng
Sphnbtheotuivgii
Nm 2011, nhm di 3 tui chim 80%,
trongcaonhtlnhm1tui(34,7%). Nm
NghincuYhc
2005, cc t l ny ln lt l 77,1 v 40,6. Nam

giichim57,6%scamc.
Hnh3:PhnbcamcTCMtheotuivgii,KVPN,nm2011
nghim dng tnh vi cc loi EV l 1.922 ca
Tcnhngybnh
(84,97%), trong EV71 l 1.380 ca (60,01%).
C s lu hnh ca c EV71 v cc loi EV
Tngscccatvongbnhtaychnmingc
khc ti KVPN. Tuy nhin s gia tng s ca
ktquxtnghimdngtnhviccloiEVl
nhim EV71 din ra cng thi im vi s gia
93ca(96,77%),trongEV71l76ca(81,72%).
tngmnhscamctaychnmingtiKVPN.
Trong nm 2011, tng s ca c kt qu xt
Hnh4:SluhnhccchngvirtgybnhtaychnmingtiKVPNnm2011
ChuynYTCngCng
23
NghincuYhc
Phnlmsng
Sphnbtheoaphng
Khng ging nh cc bnh truyn nhim

khc,bnhtaychnminglloibnhcptnh
nng, din tin rt nhanh. Kt qu phn tch
1.289 ca mc ti TPHCM c thng tin v
phnlmsngchothy1(chlotming
v/hoctnthngda):23,8%;2(binchng
thn kinh/tim mch mc trung bnh: 75,4%;
3(binchngnngvthnkinh,hhp,tim
mch):0,3%;4(binchngrtnngvthn
kinh,hhp,timmch):0,5%.
KhuvcphaNamchim82,4%scamcv
87,8%scatvongcacnc.Chacnhng
nghin cu gii thch cho s khc bit theo
vngmin.khuvcphaNamthTPHCMv
cctnhlncnnhngNai,BnhDng,B
RaVngTu,vLongAnchimhn60%ca
mc v 81,5% ca t vong ca ton khu vc. S
quantmvnnglcchnoniutrcacc
bnh vin nhi ca TPHCM c th l l do gii
thchchoscamcvchtcaocaTPHCMv
vnglncn.
BNLUN
Sphnbtheonm
Tnm20082010,scamctaychnming
hngnmtnghn3lnsovigiaion2006
2007.Sgiatngnyldounm2008BYt
quyt nh a bnh tay chn ming vo
danhschccbnhtruynnhimbtbucphi
khai bo. S liu v bnh tay chn ming trc
(20052007) do chng trnh hp tc nghin
cugiaVinPasteurTPHCMvbnhvinNhi
ng1caTPHCM.
V tnh chu k ca bnh tay chn ming,
cc quc gia Chu Thi Bnh Dng, mi 24
nm li bc pht dch ln(2). Vit Nam, do s
liu ch mi c thu thp c h thng t nm
2008 nn cha th kt lun v tnh chu k ca
bnh.Tuynhinnm2011ghinhnsgiatng
btthngcabnhviscamcgn6ln,
scatvonggp624lnsovigiaion2008
2010.
Sphnbtheothng
Ti liu ca T chc Y t Th gii khu vc
ChuTyThiBnhDng(WPRO)ghinhn
bnh lu hnh quanh nm nhng ma ma c
nhiuvdchtaychnminghn(2).VitNam,
datrnsliukhostnm2005,bcsPhan
VnTvcngs(3)ghinhnc2nhdch,mt
nhdchnhtthng35vmtnhcaohn
tthng912.Tuynhinnm2011dchbcpht
mnhvomamavlnnnhthng910,
phhpvinhnnhcaWPRO.
24
Sphnbtheolatuivphi
S ca mc tay chn ming tr di 5 tui
chim 94,85%, tp trung nhm 13 tui
(80,88%). S liu ny cng ph hp vi cc
nghin cu nc ngoi(5,1). Mt iu tra huyt
thanhhcSingaporetrnitngtrem12
tuitrxungchothytlckhngthkhng
EV71mucungrnl44%.Khngctrem
notrn1thngtuicnkhngthkhngEV71
dlconcaccbmckhngthkhng
EV71. T l c khng th khng EV71 nhm
tui123thngl0,8%;nhmtui24tuitng
khong 12% cho mi nm tui; nhm tui t 5
tui tr ln l 50%. Mt nghin cu ct ngang
thchiniLoancngchoktqutngt(4).
KhostcaPhanVnTnm2005(3)khng
ghinhnskhcbitgianamvn,tuynhin
sliunm2011chothytsutmccanam/n
1,4:1 tng t nh nghin cu ca Kowtong
Chen(1) v c im dch t hc bnh tay chn
mingiLoantnm19982005.Chacgii
thchnocaravskhcbitny.
Tcnhngybnh
Ti liu ca T chc Y t Th gii khu vc
Chu Ty Thi Bnh Dng (WPRO)(4) ghi
nhnthtypeC2gydchlniLoan nm
1998 vi 1,5 triu ca mc v 78 ca t vong; th
typeC4gydchlnTrungQucnm2009vi
1,1 triu ca mc v 353 ca t vong. khu vc
phaNam,trcnm2011thtypeC5chima
s; nm 2011 th type C4 chim a s vi 86%,
ChuynYTCngCng
v s ca mc cng tng cao. l nhng ghi
nhnbanuvsthayitcnhngybnh
v mc lan truyn bnh. Tuy nhin cha c
bngchngyvskhcbitclccacc
thtypegybnh(4).
KTLUN
Bnh tay chn ming l bnh truyn nhim
angbngphtVitNam.
KhuvcphaNamchim60%scamcv
85,8% s ca t vong ca bnh tay chn ming
trongcnc.Nm2011,bnhcsgiatngbt
thngkhuvcphaNamviscamcgp6
ln, v s ca t vong gp 6 24 ln so vi giai
on20082010.Tlcht/mcl0,2%.
Trc y bnh tay chn ming xut hin
quanhnmnhngchainh:nhthnhtxy
ra trong khong t thng 56, v nh th hai
trongkhongtthng911.Nm2011,bnhch
c1nhvothng910.
Nm2011,ThnhphHCMdnuvsca
mc,chttuyti.TiptheolngNai,ng
Thp,BnTre,BRaVngTu.Tuynhin,tnh
trn 100.000 dn, thnh ph HCM ng hng
NghincuYhc
th14.Nmtnhcscamc/100.000caolB
RaVng Tu, ng Thp, ng Nai, Bnh
Dng,vBnTre.
Nhmdi3tui chim 80%, trong cao
nhtlnhm1tui(34,7%).Nm2005,cctl
nylnltl77,1;40,6.Tsutnam:nl1,4:1.
CsluhnhcacEV71vccloiEV
khc ti KVPN. Tuy nhin s gia tng s ca
nhim EV71 din ra cng thi im vi s gia
tngmnhscamctaychnmingtiKVPN.
TILIUTHAMKHO
1.
2.
3.
4.
5.
KowTong C et al. Human Enterovirus 71 Disease: Clinical

Features, Epidemiology, Virology, and Management. The
OpenEpidemiologyJournal,2008,1,1016
Schmidt NJ, Lennette EH, Ho HH. An apparently new
enterovirusisolatedfrompatientswithdiseaseofthecentral
nervous system. Journal of Infectious Diseases, 1974,
Mar,129(3):304309.
Tu PV, et al. Epidemiologic and virologic investigation of
hand, foot, and mouth disease southern Vietnam, 2005.
EmergingInfectiousDiseases,2007,Nov,13(11):17331741.
WHO (2011). A Guide to clinical management and public
healthresponseforhand,footandmouthdisease(HFMD).
WPRO. Risk assessment of EV71 for the Western Pacific
region.
http://www.wpro.who.int/sites/crs/data/RAEV71inWPR.html
.
ChuynYTCngCng
25
NghincuYhc
SLANTRUYNBNHTQUABINGIIVCCYUTNGUYC
BNGPHPDCHTNGBNGSNGCULONGNM2010
TrnNgcHu*
TMTT
tvn:unm2010,nhiubnhnhnttCampuchianccbnhvincaVitNamc
iutr.
Mctiu:Mcchcakhostnynhmmtdintincaslantruynbnhtquabingiivcc
yutnguycbngphtdchtngbngsngCuLong.
Phngphpnghincu:Slantruynbnhtbingiicmtquavicphntchhnglotcabnh
tnm2010.Ccyutnguyccphntchdatrnnghincubnhchng.150muncsng,40mu
ncsinhhot,24muncthi,12muncung,41muthcphmcxtnghimphthinshin
dincavikhunttrongmitrngncvthcphm
Ktqu:Ktquchothynhngbngchngvsxmnhpcadchtquabingiibaogm:milin
hvthigian(cctnhcaCampuchiagipranhviAnGiangbcphtdchttcuithng12/2009),
bnhnhnttCampuchianiutrtibnhvinhuynAnPht2tuntrckhixuthinbnhnhnt
ngiVitNamutin.
Ktlun:Cshindincavikhuntmitrngncsng,ncsinhhot,ncthi,thcphm
tisng.Cmilinhgiathiquennung,tipxcbnhnhnvmcbnht.
Tkha:bnht,slantruyn,yutnguyc.
ABSTRACT
CHOLERATRANSMISSIONTHROUGHBORDERANDRISKFACTORSFORCHOLERA
OUTBREAKINMEKONGDELTARIVERIN2010
Background:InJanuary2010,manyKampucheancholerapatientscametoVietnamhospitalstobetreated.
Objectives:ThisstudyaimsatdescribingthetransmissionthroughborderVietNamKampucheaandrisk
factorsforcholeraoutbreakinMekongdeltaregion.
Methods:Thetransmissionthroughborderwasshowedthroughdescribingcaseseriesofcholerain2010.
Riskfactorsweredetectedthroughacasecontrolstudy.Watersamplesfromrivers(150),runningwater(40),
wastewater(12),food(41)wereanalyzedtodetectthepresenceofV.cholerae.
Result: The result showed proofs of cholera transmission through border: temporal relationship
(KampucheanprovincesboderingwithAnGiangoccurredcholerasinceDecember2009),Kampucheancholera
patientscametoAnPhudistricthospitaltogettreatment2weeksbeforethefirstVietnamesecholeracase.
Conclusion:V.choleraewasdetectedinriverwater,runningwater,wastewater,freshfood.Therehasbeen
relationshipbetweeneatinghabit,patientcontactandgettingcholera.
Keywords:cholera,transmission,riskfactors
26
ChuynYTCngCng
NghincuYhc
TVN
ITNGPHNGPHPNGHINCU
T l bnh dch lu hnh rng ri min

Namttrc1975vkodincuithpnin
90cathk20.Nhngnmuthpninca
thk21,bnhtcxuhnggimdnvn
nm2005khngcnghinhncano.Vocui
nm 2007 dch bng pht 19 tnh thnh pha
Bc vi hng nghn ca mc. Nm 2008, Thnh
phHChMinhghinhn2catxmnhpt
minBc.Ccbinphpchngchngdchkhn
cpctrinkhaigipngnchnslylan
racngng.Tuynhinnm2009bnhtc
ghinhnnhiutnhcaCampuchiatrong
c nhng tnh gip ranh vi Vit Nam. Nhiu
bnh nhn t t Campuchia n cc bnh vin
caVitNamciutrtoranguycly
lan dch t cho khu vc pha Nam. Trong iu
kinvsinhantonthcphmvvsinhmi
trngchambo,khnnglylandcht
lrtln.
Slantruynbnhtbingii c m t
qua vic phn tch hng lot ca bnh t nm
2010 v bo co v dch t Campuchuia nm
20092010caBYtCampuchia.
Mcchcakhostnynhmmtdin
tincaslantruyn bnh t qua bin gii v
cc yu t nguy c bng pht dch t ng
bngsngCuLong.
Mc
cht
94
588
4
95
1328
4
96
149
0
97
7
0
98
13
1
99
216
0
00
0
0
Slantruyntquabingii(5)
Theo bo co ca B Y t Campuchia, nm
2010, 37 huyn ca Campuchia c dch t. Cc
tnhcaCampuchiagipranhviAnGiang
bcphtdchttcuithng12/2009.
Ngy 15/1/2010 mt bnh nhn l ngi
Campuchia n Bnh vin huyn An Ph tnh
An Giang iu tr. Kt qu xt nghim dng
tnh vi vi khun t. Trong 3 thng u nm
2010 Bnh vin An ph tip tc nhn iu tr
bnhnhntiuchyngiCampuchiant2
ChuynYTCngCng
Ccyutnguyccphntchdatrn
nghincubnhchngbtcp(60cabnh,240
cachng;btcptheotuivgii).Shindin
cavikhunttrongmitrngcnhgi
qua xt nghim vi sinh, sinh hc phn t 150
muncsng,40muncsinhhot,24mu
nc thi, 12 mu nc ung, 41 mu thc
phm.
KTQU
Tnh hnh bnh t khu vc pha Nam t
nm1994n2010
Nm1995cmttdchtlnxyra11
tnh thnh ca khu vc pha Nam vi 1.328 ca
mc, 4 ca t vong. T nm 1996 bnh c xu
hng gim dn. Giai on t 1996 n 2004
bnh xut hin ri rc. Nm 2005 n 2007
khngcnghinhncano.Nm2008c2cat
xm nhp t min Bc nhng c ngn
chn kp thi khng ly lan ra cng ng.
Nm2010c158cat,khngctvong(4).
Nm
01
02
15
177
0
0
03
27
0
04
46
1
05
0
0
06
0
0
07
0
0
08
2
0
09 10
0 158
0
0
tnh gip ranh vi huyn An Ph ca tnh An

Giang l Takeo v Kandal v pht hin tng
cng12cadngtnhvivikhunt(Takeo:2;
Kandal:10).
Ngy30/1/2010xuthinbnhtngiVit
Nam u tin huyn An Ph. Trong vng 2
tun (30/1/2010 16/2/2010) c 5 bnh nhn
ngiVitNamctr4x,thtrncahuyn
An Ph (gip ranh vi Campuchia), tnh An
Giang c xc nhn dng tnh vi vi khun
t.
27
NghincuYhc
Hnh1.ScamcbnhthuynAnPh,phnbtheothigian
BnhnhchnhtnhAnGiang
T3/3/2010bnhtbtulantruynn6
tnhkhuvcngbngsngCuLong&3tnh
minngNamB,theotht:ThnhphH
ChMinh(t3/3/2010),TyNinh(30/4),BnTre
(9/5/2010), Tin Giang (11/6/2010,), Bc Liu
(1/7/2010), Cn Th 3/7, C Mau (13/7/2010),
LongAn(16/7/2010),ngNai(11/9/2010).
28
S hin din ca vi khun t trong mi

trng(3)
Kt qu xt nghim cc mu nc sng,
nc sinh hot, nc ung, nc thi, thc
phm ti sng do Vin Pasteur TPHCM tin
hnhlymuccdchthuctnhAnGiang
v Bn Tre pht hin s hin din ca vi
khunttrongncsng,ncsinhhot,nc
thi, thc phm cc mc khc nhau tu
theophngphpxtnghim,loimuth.
ChuynYTCngCng
Ktquxt nghim mi trng nc v thc
phmtisngAnGiang
Loi mu
S mu XN
Nc sng
61
Nc sinh hot
2
Nc ung
5
Mi tm
56
Thc phm
3
Nui cy +
1 (1,6%)
0
0
0
0
PCR* +
4 (6,5%)
0
0
5 (0,9%)
0
Ktquxt nghim mi trng nc v thc

phmtisngBnTre
Loi mu
Nc sng
Nc sinh
hot
Nc thi
Nc ung
Thc phm
S mu XN
150
Nui cy +
3 (2%)
PCR* +
13 (8,67%)
40
1 (2,5%)
1 (2,5%)
24
12
41
2 (8,33%)
0
1 (2,4%)
0
0
1 (2,4%)
*KthutPCRphthincvikhunsnglnvikhun
chtnncgitrcnhbo
Yutnguycmct(2)
Nghincubnhchngtrn60cabnhv,
240cachngdoVinPasteurTPHCMtinhnh
ticcdchBnTrechothymilinh
giathiquennung,tipxcbnhnhnv
mcbnht.
Yu t nguy c
Tip xc vi bnh nhn tiu chy
Ung nc tr
Ung nc ngoi ng
Ung nc sng khng x l bng
Chloramin B
Dng nc sng khng x l bng
Chloramin B ch bin thc n
OR
6,6
2,7
14,2
P-value
0,00001
0,009
0,02
2,9
0,03
2,9
0,001
BNLUN
Cc yu t nh hng n s lan truyn
bnhtquabingii
C th xc nh dch t huyn An Ph
tnhAnGiangcngungctCampuchiada
trnccyutsau:
C mi lin h v thi gian: cc tnh ca
CampuchiagipranhviAnGiangbcpht
dchttcuithng12/2009.
Sgiaoluthngxuynquabingii.
Vic tip nhn bnh nhn t t Campuchia
niutrtibnhvinhuynAnPhtgia
ChuynYTCngCng
NghincuYhc
thng1/2010
Nichung,khnnglantruynbnhtqua
bin gii Vit Nam Campuchia vng ng
bngsngCuLonglrtcaodosktnit
nhin ca h thng sng rch thuc ph lu
sng Mekong, s i li d dng qua ca khu
bingiicangidncchuynvngbin
gii,thiquencangidnCampuchiavng
bin gii thng n cc bnh vin huyn ca
VitNamkhmchabnh.
S thiu chia s kp thi thng tin v bnh
dchgiacctnhgipbingiikhinviccnh
bodchsmkhthchin.
Mtkhidchtxmnhpthdocciu
kinthunlivtnhin(sngrchchngcht),
tp qun (cu trn sng, dng nc sng rch
trongsinhhot)nndbcphtdchkodi
ngbngsngCuLong.
TPHCM l u mi giao lu ca c nc
nnkhngloitrngungcbnhtxmnhp
tCampuchiaquacctnhngbngsngCu
Long. Cc trng hp t qun 7 u xy ra
trncngngcdnsngtrnsngnc,a
phnntcctnhngbngsngCuLong.
S hin din ca vi khun t trong mi

trngvccyutnguycmcbnht
S pht hin vi khun t trong nc sng,
ncsinhhot,ncthi,thcphmtisng
chothycnnhanhchngcithinvsinhmi
trng (xa cu trn sng), m rng h thng
cungcpncsch,utchovicxlcht
thibnhvin,kimtraantonvsinhthc
phm, c bit l i vi thc n ng ph.
Victchcttkhucchlytrongbnhvinv
cnhngquinhvvicthmnuikhuvc
cch ly c th hn ch s ly lan do tip xc
bnhnhn(1,6).
Ktqukhostvccyutnguycmc
bnh t cho thy cn tng cng truyn thng
v thay i hnh vi lin quan n n ung v
chmscbnhnhn(nchnungchn,ratay
bngxphng).Nhngthayihnhvinyc
th phng c nhiu bnh nhim khc hin
29
NghincuYhc
angbcphtmnhnhtay chn ming, cm

giacm
KTLUN
dchtutinkhuvcphaNamnm
2010 xut hin mt huyn gip bin gii vi
Campuchia. Nhng bng chng v s xm
nhpcadchtquabingiibaogm:milin
h v thi gian (cc tnh ca Campuchia gip
ranh vi An Giang bc pht dch t t cui
thng12/2009),bnhnhnttCampuchian
iu tr ti bnh vin huyn An Ph t 2 tun
trc khi xut hin bnh nhn t ngi Vit
Namutin.
C s hin din ca vi khun t mi
trng nc sng, nc sinh hot, nc thi,
thcphmtisng.
Ccyutnguycchophttrincadcht
bao gm tnh trng dch t cha n nh
Campuchia v khu vc pha Bc, iu kin v
sinh an ton thc phm v v sinh mi trng
chambo.
Ci thin v sinh mi trng (xo cu trn

sng); M rng h thng cung cp nc sch;
u t cho vic x l cht thi bnh vin
huyn.
Tng cng kim tra an ton v sinh thc
phm.
PhihpphngchngdchtgiaBYt
VitNamvCampuchia;Khostvmtsinh
hcphnt tmmilinhgiacc chng
V.choleraecphthincctnhthnhpha
Nam,phaBcvCampuchia.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
Cc Y t d phng (2009). Cm nang phng chng bnh

truynnhim.HNi:nxbYhc,2009:6782.
Vin Pasteur TPHCM (2010). Kt qu iu tra nguy c mc
bnhttnhBnTrenm2010
VinPasteurTPHCM(2010).Ktquxtnghimvikhunt
2010
VinPasteurTPHCM(2010).Thngk24BTNt1994n
2010
Vin Pasteur TPHCM (2010). Tng kt hot ng phng
chngdchnm2010
WHO/CDS/CPE/ZFK/2004.4.Choleraoutbreak:Assessingthe
outbreak response and improving preparedness. Geneva
2004:1822,4453.
KINNGH
Tngcnggimstticakhu,cctrm
y t dc bin gii. Trao i thng tin gia cc
tnhbingiicaVitNamvCampuchia.
30
ChuynYTCngCng
NghincuYhc
CCBNHTRUYNNHIMANGBNGPHT
KHUVCPHANAMT20012011
TrnNgcHu*
TMTT
tvn:20tnhthnhphaNam,nhngbnhnhimangbngphtcquantmnhiutrong10
nmucathk21ltaychnming,stxuthuyt,cmA/H5N1,cmA/H1N1idch2009,t.
Mctiu:ThngkccbnhnhimangbngphtkhuvcphaNamtnm200120011.
Phngphpnghincu:TnghpccbocobnhnhimcaVinPasteurTPHCMt20012011,
ccbocoiutradch,gimstimphntchcimvdchthc,visinhhccanhngbnh
nhimangbngphtchyukhuvcphaNam.
Ktqu:Ktquchothybnhtaychnmingmicghinhntnm2003nhnghinlbnhcs
camc,chtnmtrongdanhsch5bnhtruynnhimcscamc,chtcaonht.Nm2011,scamccht
vtaychnmingcsgiatngtbinsovigiaion20082010(mctnghn6ln,chttnggp624
ln).Nm2011cngghinhncschuynithtpgydchcaEV71tC5sangC4.
Ktlun:Bnhstxuthuytvnlbnhcscamcvchtcao.Csthayivphnbtheotuiv
aphng.Nm2011,Stxuthuytngilnchimtl41%(26%vonm2001).Cctnhminng
Nam B chim 47,3% s ca mc (20,4% vo nm 2001). Bnh cm A/H5N1 c s mc thp nhng t l
cht/mcrtcao(87100%).BnhcmA/H1N1idch2009bcphtmnhnmutinvhinnayang
luhnhnhmtdngcmma.Bnhtcsmcvchtgimmnhsovinhngnm90cathk20.
TuynhinnhiutnhcangbngsngCuLongvncnnguycbngphtt.
Tkho:taychnming,stxuthuyt,cmA/H5N1,cmA/H1N1idch2009,t.
ABSTRACT
EMERGINGINFECTIOUSDISEASESINTHESOUTHOFVIETNAM,PERIOD20012011
Background:In20southernprovinces,leadingEmerginginfectiousdiseases(EIDs)inperiod20012011
are Handfootmouth diseases (HFMD), Dengue, Influenza A/H5N1, influenza A/H1N1 pandemic 2009,
Cholera.
Objectives:synthesizeddataonemerginginfectiousdiseasesinsouthernVietnamfrom2001to2011.
Methods: The authors synthesized scientific data of Pasteur Institute in HCMC, period 20012011,
including notifiable infectious disease reports, epidemic investigation reports, sentinel surveillance to identify
epidemiolgical,microbiologicalcharacteristicsofEIDsintheSouthofVN.
Result:TheresultsshowedthatHFMD,recordedsince2003,nowbecomethefiveleadingcausesofcases
anddeathsamong26notifiableinfectiousdiseases.In2011,therewasansuddenlyincreasingascomparedwith
20082010(casesincreased6times;deathsincreased624times).TherehasbeenachangeofsubtypeofEV71
fromC5toC4.
Conclusion:Denguefeverhasbeenstillhighmorbidityandmortality.Therehavechangesinageandplace
distribution.In2011,Denguefeverinadultgroupwas41%(26%in2001),ineasternprovinceswas47,3%
ChuynYTCngCng
31
NghincuYhc
(20,4% in 2001). Influenza A/H5N1 had low morbidity but case fatality rate was very high (87%100%).
Influenza A/H1N1 pandemic 2009 had big outbreak in 2009, now become seasonal influenza. Cholera deeply
reduced as compared with years of 20th century. However many provinces in Mekong delta has still risk of
epidemicoutbreak.
Keywords: handfootmouth disease, Dengue fever, H5N1 influenza, H1N1 influenza pandemic 2009,
cholera.
vcphaNam(BVNhitiTPHCM,bnhvin
TVN
Nhing1,BVCiBtnhTinGiang)phn
Bnhtruynnhimangbngphtlbnh
tch c im v dch t hc, vi sinh hc ca
truynnhimmixuthintrongmtqunth
nhng bnh nhim ang bng pht ch yu
hoc l bnh bit trc y nhng gia tng
khuvcphaNam.
nhanh chng v s ca mc mi hoc xut hin
KTQU
khuvcmi(1).
Nguyn nhn ca s bng pht c th lin
quannsbinicavisinhvthinhu,
stithpgiencaccchngviruskhcnhau
(Virus cm A/H1N1 i dch 2009), hoc do
virus lan n vng mi, qun th mi (West
Nilevirus),tibngphtdokhngthuc(Lao).
Sbinikhhunhhngnsphttrin
catrunggiantruynbnh.Dibinngdnc
vshnhthnhcckhuchutbncnhcc
khuthmidohuqucaphttrinkinht
xhikhngkmtheoquihochtt(2).
Hinnayccchuyngiayhcanglolng
vkhnngkthpgiaviruscmA/H5N1c
clccaoviviruscmA/H1N1idch2009
ckhnnglantruynnhanhchng.Nuiu
nyxyraththcslthmhachonhnloi.
20 tnh thnh pha Nam, nhng bnh
nhim ang bng pht c quan tm nhiu
trong 10 nm u ca th k 21 bao gm tay
chnming,stxuthuyt,cmA/H5N1,cm
A/H1N1idch2009,t.Ngoitrbnht,cc
bnh cn li c c im chung l bnh do vi
rt,chacthucctr,chacvcxinphng
nga,cngtcphngngagpnhiukhkhn.
ITNGPHNGPHPNGHINCU
Tcgitnghpccdliukhoahcca
VinPasteurTPHCMgiaion20012011,bao
gm cc bo co bnh nhim nh k; cc bo
co iu tra dch tay chn ming, st xut
huyt, cm A/H5N1, cm A/H1N1 i dch
2009,t;gimsttrngimhichngcmkhu
32
Bnhtaychnming
Vit Nam, ca tay chn ming u tin
cphthintikhuvcphaNamvonm
2003. Nm 2005 bt u c nhng s liu u
tinvbnhtaychnmingtktquhptc
nghin cu gia Vin Pasteur THCM vi Bnh
vinNhing1vBnhvinNhing2(mc:
441;cht:13).Nm20062007scamctaychn
ming c ghi nhn ngy cng nhiu. Nm
2008BYtabnhtaychnmingvodanh
schccbnhtruynnhimbtbucphikhai
bo v s ca mc, cht do tay chn ming tng
nhanh. Nm 2011, s ca mc cht v tay chn
ming c s gia tng t bin so vi giai on
20082010(mctnghn6ln,chttnggp6
24ln).Tlcht/mcdaongt0,57%2,95%
tronggiaion20052007vt0,06%0,23%
tronggiaion20082011(3).
Bng1:ScaMc&chtdotaychnming,giai
on20052011
Nm
Mc
Cht
Cht/mc (%)
2005
441
13
2,95
2006
2,284
13
0,57
2007
2,988
14
0,47
2008
10,958
25
0,2 3
2009
10,640
23
0,22
2010
10,128
0,06
2011
67,396
145
0,22
Vsphnbtheogii,nm2011,phinam
chim57,57%scamcv67,59%scacht.T
ChuynYTCngCng
NghincuYhc
sutcht/mc(CRF)canamgiicngcaohn
ngii(0,26%v0,17%).
on 2009 2010, t l dng tnh vi EV71 ln

ltl38%v14,7%.
Tr<3tuichim87,41%camcv84,83%
cacht.Nutnhtr<5tuithconslnltl
95,78%camcv97,03%cacht.
ThtpcaEV71luhnhtikhuvcpha
Nam l C4 (94,3% ca) v C5 (5,7%). Trong giai
on 20072010 ch pht hin th tp C5, giai
on 20052006, th tp C5 chim t 94,7%
93,9%(6).
Nhngnmtrcy,bnhtaychnming
xuthinquanhnmvi2nh,mtnhnh
vo thng 3 5 v mt nh ln vo thng 9
12(4).Tuynhinnm2011bnhcxuhngtng
tthng4vlnnnhvothng10sau
gimdn(5).
Vcimvisinhhc(6),trongnm2011,t
ldngtnhviccloiEVl84,97%,trong
EV71 l 60,01%, EV khc l 23,96%. Trong giai
25
St xut huyt(7)
Trong giai on 20012007, VN, st xut
huytnghngth5vscamcvhngth
nhtvscachttrongs26bnhnhimphi
khai bo. Khong 85% ca st xut huyt xut
hinKVPN.Trungbnh10nmlixuthin
caoimdch
Soca ma
c x 1000
20
15
10
0
12345678910
11212345678910
11212345678910
11212345678910
11212345678910
112
1 12345678910
11212345678910
11212345678910
11212345678910
11212345678910
11212345678910
11212345678910
11212345678910
112
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
1996
Nhmtrn15tuichim26%32%camc
st xut huyt trong giai on 20012003. T l
nyl35%41%tronggiaion20092011.S
phn b theo vng cng c s thay i. Nm
2001,7tnhminngNamBchim20,4%s
ca mc st xut huyt. Nm 2001 t l ny l
47,3%.
ChuynYTCngCng
BntphuytthanhcavirtDengueu
hin din khu vc pha Nam v lun phin
chimuth.D3chimuthtronggiaion
19971998, sau l D4 (2001), D2 (20032006),
D1(20072011).
33
NghincuYhc
CmA/H5N1
Ca cm A/H5N1 trn ngi c ghi nhn
utintikhuvcphaNamvonm2004.S
camckhngnhiu,rcrcnhiutnhnhng
tlchtmcrtcao(71%100%)(3).
a phng
TP HCM
2004
M
C
3
1
2005
M
C
1
1
2009
M
C
2010
M C
Hu Giang
Bnh Phc
ng Thp
1
3
Bnh Dng
Tng
14
10
13
13
Lm ng
ng Nai
Ty Ninh
Sc Trng
Tin Giang
Tr Vinh
Long An
Bc Liu
Bn Tre
34
Ttccamcultremhocthanhnin.
Nhmtr015tuichim41,6%scamc,la
tui 16 35 chim 58,2%. Cc yu t nguy c
mc cm A/H5N1 bao gm tip xc gia cm
bnh hoc cht (OR=3,39; CI = 0,9711,87), git
mgiacmbnhhoccht(OR=2,29;CI=0,24
19,56), m g (OR=7,45; CI = 0,49 218), c
nginhlmgbnhhoccht(OR=5,2;CI=
1,2222,7),nthtgbnhhoccht(OR=4,28;
CI = 1,06 17,45). Khng pht hin mu xt
nghim huyt thanh hoc ngoy hng dng
tnh vi vi rt cm A/H5N1 ngi tip xc,
nhnvinytciutrbnhnhn.
Cc ca cm A/H5N1 pht hin khu vc
pha Nam u thuc clade 1. Cha ghi nhn
clade2.3.4nhkhuvcphaBc.
CmA/H1N1idch2009(8)
Cm A/H1N1 i dch 2009 bt u xm
nhp vo Vit Nam ngy 30/5/2009. T
16/7/2009btughinhnnhngdchtrong
cng ng. Dch ln n nh trong thng
9/2009,saugimdn.Tngscaxtnghim
+/t vong nm 20092011 ln lt l 7.279/24;
44/2;427/11.
ChuynYTCngCng
NghincuYhc
DintincmA/H1N1idch2009trongnm2009
BnhcmA/H1N1idch2009thngxy
ratr615tui(49,5%)vthanhthiunint
16 25 (34,9%). T sut nam:n l 1,2:1. Ngi
sng thnh th c t l mc cm A/H1N1 i
dch 2009 nhiu hn ngi sng nng thn
(64,2%sovi35,8%).Bnhchbngphtmnh
trong2thng89/2009.Tnm2010nnay
cm A/H1N1 i dch 2009 tr thnh mt
dng ca cm ma thay th cho cm A/H1N1
trc y, vi s ca dng tnh di 500
ca/nm.
T sut tn cng cao nht l bui tic gia
nh (80,6), tip n l doanh tri qun i
(25%),trngchcsinhnitr(7,1%),trng
khngchcsinhnitr(1,11%3,13%).Trong
trnghc,lpchcsinhnitrtlmcln
n41,1%.
V c im sinh hc phn t, cc chng
cm i dch H1N1/2009 khu vc pha Nam
tngngcaovtrnhtnucleotidecngnh
trnh t axt amin so vi cc chng i dch
ChuynYTCngCng
H1N1/2009trnthgii.Tuynhinvncmt
skhcbit:ProteinH1,ngoicctbinquan
trng D225G, E227, cng vi vng hnh lang
lysineK133,K145,K156,vK222,cnxuthin
thm mt s cc t bin khc trong vng gn
kt th th nh L194I, I219V, Q226R. V tnh
khng thuc, cc chng ny vn nhy cm vi
nhmthuccchhottnhNeuraminidase.
T
Nm1995cmttdchtlnxyra11
tnh thnh ca khu vc pha Nam vi 1.328 ca
mc, 4 ca t vong. T nm 1996 bnh c xu
hng gim dn. Giai on t 1996 n 2004
bnh xut hin ri rc. Nm 2005 n 2007
khngcnghinhncano.Nm2008c2cat
xm nhp t min Bc nhng c ngn
chn kp thi khng ly lan ra cng ng.
Nm 2010 tnh An Giang xut hin ca bnh t
u tin c lin quan n bnh dch t t
Campuchia.Saubnhtlanra10tnhthnh
vi158camc,khngctvong(3).
35
NghincuYhc
Bng2:BnhtKhuvcphanamtnm19952011
Mc
cht
95
1328
4
96
149
0
97
7
0
98
13
1
99
216
0
00
0
0
01
15
0
Trong v dch t nm 2010, bnh t xy

mi la tui, trong nhm tui 015 chim
20,2%; nhm tui 1660 chim 63%; nhm > 60
chim16,4%.Namchimtl42,6%;n57,4%.
Bnh xy ra 7/13 tnh thuc ng bng sng
Cu Long v 3/tnh min ng Nam B. Bn
TrevAnGiangl2tnhcsmccaonht(70
v25).TPHCMngthbavi14camc(9).
V.cholaraeOgawalchngcphthin
bnhnhnt.Vikhuntcngctmthy
ccmuncsng,ncsinhhot,thcphm
tisng(tlt2%2,5%),ncthi(8,3%)(10).
BNLUN
Bnhtaychnming
Bnh tay chn ming xy ra ch yu la
tui nh tr mu gio do tr nh cha c
khng th khng EV71. Mt nghin cu
Singapore(11)chothytlkhngthkhngEV71
nhmtui123thngtuil0,8%.nhm24
tui t l ny tng khong 12% cho mi nm.
Nhmt5tuitrlnckhngthkhngEV71
trn50%.
SchuynithtpgydchcaEV71t
C5sangC4trnghpvisgiatngmnhca
cc ca mc cht do tay chn ming trong nm
2011, tuy nhin theo T chc Y t th gii th
chacbngchngyvskhcbit
clccaccthtpgybnh(11).
Stxuthuyt
S gia tng st xut huyt ngi ln cho
thyitngctphunvchnonv
iu tr st xut huyt cn m rng, khng ch
giihnchobcsviudngkhoanhi.
Sgiatngcastxuthuytcctnhmin
ng Nam B c th c lin quan n s pht
trin cc cm cng nghip khu vc ny thu
htmtlnglnnginhpcn t vng
dch lu hnh nng v nh v s pht trin
36
Nm
02
03
177
27
0
0
04
46
1
05
0
0
06
0
0
07
0
0
08
2
0
09
0
0
10
180
0
11
2
0
nhngkhunhtrchuttoiukinchos
lan truyn dch. S gia tng t l mc st xut
huytnhmtuitrn15cngcthlinquan
yutny.
Schuynitphuytthanhuthcng
clinquannsbcphtdchln.D3vD1
chim u th trong nhng nm xy ra v dch
ln (19971998 v 20072008). Tuy nhin s bc
phtdchcthcnlinquannccyutv
kh tng thu vn, mt vec t truyn
bnh
CmA/H5N1
Bnh cha c kh nng ly trc tip t
ngi sang ngi. Cc bng chng bao gm:
bnhchxuthinrircnhngngictip
xcvigiacmbnhhoccht,khngphthin
mu xt nghim huyt thanh hoc ngoy hng
dngtnhvivirtcmA/H5N1ngitip
xc,nhnvinytciutrbnhnhn.
Cckhostvsinhhcphntchothy
khuvcphaNamchacsbinichngvi
rtcmA/H5N1.Tuynhinvinhngcngb
v kh nng to vi rt cm A/H5N1 trong
phng th nghim, s lu hnh dch cm gia
cmVitNamthvictheodisbinica
virtcmA/H5N1lrtcnthit.
CmA/H1N1idch2009
Khng y 2 thng ri (18/3/2009
30/5/2009)ktkhicngbcacmA/H1N1i
dch 2009 u tin trn th gii, bnh xm
nhp vo Vit Nam cho thy s lan truyn
nhanhchngcaidchthngquaccphng
tingiaothng hin i. Cc a phng c s
camccaonhTP.HCM,Lmng,TyNinh
lnhngniccakhu,aimdulch,khu
cngnghip.
TrongnmutinxuthincmA/H1N1
i dch 2009, bnh xut hin ch yu nhm
ChuynYTCngCng
thanhthiuninvylnhmtuicsgiao
lulnquahchnh,dulch,lmvic.Sphn
btheolatuitrongnm2011lphhpvi
s phn b theo la tui ca cm ma (tp
trunglatui<15).
McdccchngcmidchH1N1/2009
khu vc pha Nam vn nhy cm vi nhm
thuc c ch hot tnh Neuraminidase nhng
khnngbinicavirtcml rt ln nn
cnthitphitheodisbinigiencavirt
cm.
T
Dotnhhnhcungcpncschcci
thin nn dch t kh bng pht mnh nh
nhngnmcathk20.Tuynhindchtc
khnnglantruynquabingiinnvicchia
s thng tin dch bnh gia cc tnh c chung
ngbingiilrtcnthit.Doabnsng
rchchngchtkmtheotpqunsdngcu
tiutrnsngcntntimtvngnngthn
v ngoi thnh nn cc tnh ng bng sng
CuLongvncnnguycxyradcht.Vic
pht hin vi khun t cc mu nc sng,
ncsinhhot,thcphmtisng,ncthi
cho thy s cn thit ci thin an ton v sinh
thcphmvcungcpncsch.
KT LUN
Trong s 5 bnh nhim ang bng pht
khuvcphaNam,chcbnhtldovikhun
gy bnh, c vc xin phng nga v khng
sinh iu tr c hiu. Cc bnh cn li c tc
nhn l vi rt, cha c vc xin phng nga v
thuc iu tr c hiu. Bnh tay chn ming
angnilnhnguviscamcvchtcao
NghincuYhc
trong khi nhng hiu bit v c im dch t

hc, lm sng, vi sinh min dch v bnh tay
chnmingcnrthnch.Bnhstxuthuyt
vncscamcvcht rt cao d c s tng
gim theo chu k. Bin php kim sot vec t
chactnhbnvng.Phunthucdinrngc
tcdnghnhdchnhngkhngctcdng
lu di. Bnh cm A/H1N1 tuy c s ca mc
thpnhngtlcht/mcrtcao.CmA/H1N1
i dch 2009 hin l mt dng ca cm ma
nhngcbngchngvkhnngtithp
viccchngvirtcmkhc.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Morse SS (1996). Factors in the Emergence of Infectious

Diseases.EmergingInfectiousDiseases,1996;1(1):715.
Taylor L et al.(2001).Risk factors for human disease
emergencePhilosophicalTransactionsoftheRoyalSocietyB,
356(1411):9839
TrnNgcHuvcngs(2012).cimdchthcca
dch cm A/H1N1i dch 2009 ti cc tnh khu vc pha
Nam, giai on 20092011. Tng hi y hc Vit Nam, Tp
XXII,s2(129)2012.Tr.59.
Trn Ngc Hu v cng s (2012) Nhng bin i v c
im dch t hc, vi rt hc v vector truyn bnh st xut
huytkhuvcphaNam,giaion20012011.Tnghiy
hcVitNam,TpXXII,s2(128)2012.Tr.163169.
TuPVetal.(2007).Epidemiologyandvirologicinvestigation
of hand foot mouth disease, southern Vietnam, 2005.
Emerginginfectiousdisease,2007,Nov,13(11):17331741.
VinPasteurTPHCM(2011).Danhschbnhnhntaychn
mingnm2011.
VinPasteurTPHCM(2010).DanhschBNtKVPN2010
Vin Pasteur TPHCM (2011). Kt qu xt nghim bnh tay
chnmingnm2011
VinPasteurTPHCM(2010)..Ktquxtnghimvikhunt
2010
VinPasteurTPHCM(2011).Thngk24BTNt20012011
WHO (2011). A Guide to clinical management and public
health response for hand, foot and mouth disease (HFMD).
WHO2011:1011;2829.
ChuynYTCngCng
37
NghincuYhc
KINTHC,THI,THCHNH
VPHNGCHNGNHIMKHUNHHPCPTNH
CABMCCON<5TUINHPVINTIKHOANHI
BNHVINNINHPHC,NINHTHUN
NguynThThyHng*,LHongNinh**
TMTT
tvn:Nhimkhunhhpcptnh(NKHHCT)lmttrongnhngnguynnhnchnhgybnh
tremdi5tui,cbitltrnhdi1tui,trongchyudovimphi,tptrungccncang
phttrin.NKHHCTcnglbnhthnggpnhtccphngkhmnhivkhoaNhicaccbnhvin.
Mc tiu:Xcnhtlbmccondi5tuinhpvintikhoaNhiBnhvinNinhPhc,Ninh
Thunckinthc,thi,thchnhngvphngchngNKHHCTvmilinquangiakinthc,thi
vthchnhngvicccimdnsxhicamvmilinquangiakinthcngvthchnh
ng.
Phng php nghin cu:Nghincuctngangmttrn219bmcconnhpvintikhoaNhi
BnhvinNinhPhcvNKHHCTtthng3nthng5nm2012
Kt qu: Nghin cu cho thy kin thc ng v phng chng NKHHCT l 65,3%, thi ng l
96,35%,thchnhngl44,3%.Ngunthngtinbmtipcnnhiunhtltruynhnh(79,45%),ngun
thngtinctincynhtlcnbYt(68,04%).Bmckinthcngckhnngthchnhnggp
1,71lnbmckinthckhngng.
Kt lun:CkhochgiodcsckhephhpchoccbmcconnhpvintikhoaNhivphng
chngNKHHCTcngnhcngtctruynthnggiodctrongcngng.
Tkho:Bmccondi5tui,kinthc,thi,thchnh,phngchngNKHHCT
ABSTRACT
KNOWLEDGE,ATTITUDEANDPRACTICEABOUTACUTERESPIRATORYINFECTION
PREVENTIONOFMOTHERSWHOHAVECHILDRENUNDERFIVEYEARSOLDADMITTEDAT
PEDIATRICSOFNINHPHUOCHOSPITAL,NINHTHUANPROVINCE
NguyenThiThuyHuong,LeHoangNinh
*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:3844
Background: Acuterespiratoryinfection(ARI)isoneofthemajorcausesofillnessinchildrenunderfive
years old, especially in infants under one year old, which is mainly due to pneumonia, concentrated in the
developingcountries.ARIisalsothemostcommoninfectionatpediatricclinicsandatthepediatricsofhospitals.
Objective:Todeterminetherateofmothershavingchildrenunder5yearsoldhospitalizedatPediatricsof
Ninh Phuoc Hospital, Ninh Thuan have right knowledge, attitude and practice about prevention of acute
respiratory infections and the relationships between right knowledge, attitude and practice with social
demographiccharacteristicsofthemothersandbetweenrightknowledgeandrightpractice.
*TrungtmythuynNinhPhc,tnhNinhThun
**VinVsinhYtCngcngthnhphHChMinh
Tcgilinlc:BS.NguynThThyHng
T:0919301156
38
Email:huongttytnp@gmail.com
ChuynYTCngCng
NghincuYhc
Methods:Crosssectionalstudydescribedabove219 mothers of under 5 yearold children hospitalized at

PediatricsofNinhPhuocHospitalbyARIfromMarchtoMay,2012
Results:ThestudyshowedthatrightknowledgeaboutpreventionARIwas65.3%,therightattitudewas
96.35%,andrightpracticewas44.3%.Sourceofinformationapproachedatmost79.45%wastelevision;trusted
source of information was health workers (68.04%). The mothers of right knowledge being able to practice
correctlywere1.71timeshigherthanthemothersofwrongknowledge.
Conclusion:Plananappropriatehealtheducationformothershavingchildrenhospitalizedinthepediatrics
aboutARIpreventionaswellasforcommunities.
Key words: Mothers having children under 5 years old, knowledge, attitude, practice, acute respiratory
infectionsprevention.
phi/NKHHCT l 63,8%. Ti Khoa Nhi TTYT
TVN
NinhPhc(cngiBnhvinNinhPhc),qua
Nhimkhunhhpcptnh(NKHHCT)l
s liu thng k 3 nm li y cho thy t l
bnhlphbintremvgytltvongcao
NKHHCT tr em di 5 tui nhp vin v
nhtsoviccbnhkhc.TheoTchcYtTh
NKHHCT kh cao t 4153% v t l vim
gii (WHO), hng nm c khong 4 triu ngi
phi/NKHHCTkhong4546%.
trnthgiichtvbnhhhpcpvi90%do
Mctiunghincu
nhimkhunnghhpdi.Tlt vong
Xc nh t l cc b m c con di 5 tui
cbitcaotrnhdi1tui,tremvngi
(6)
nhp
vin ti khoa Nhi Bnh vin Ninh Phc,
gi, v ch yu cc nc thu nhp thp .
NinhThunckinthcng,thing,v
NKHHCT cng l mt trong nhng nguyn
thchnhngvphngchngNKHHCT
nhn thng gp nht trong khm hoc nm
iutrticccsyt,cbitltrongchm
scnhi.ylnhmbnhctlmccao,tn
sutmcnhiulntrongnm(thngt46ln
trong nm). Bnh nh hng n sc khe v
tnhmngcatrnnnnhhngkhngnh
n ngy cng lao ng ca b m, lm tng
gnhnngchogianhvxhi(1)
VitNam,ccbnhNKHHCTnmtrong
10bnhctmccaonhtvtrong10bnhct
l t vong cao nht ton quc(2). T l tr b
NKHHCTnkhmtiKhoaHhpBnhvin
NhiTWnm2010chim55,97%tngstrn
khm bnh ni chung(3). T l NKHHCT trong
cng ng huyn Ch Mi, tnh Bc Kn l
40,46%(4).
TitnhNinhThun,chacnghincuno
vphngchngNKHHCTtremtrinkhaiti
cngngcngnhtibnhvin,trongkhit
ltremdi5tuinhpvinvNKHHCTkh
caosoviccbnhkhc.TheothngkcaSY
ttnhNinhThun,tltremdi5tuinhp
vin v NKHHCT l 30,2% v t l vim
ChuynYTCngCng
Xcnhccmilinquangiakinthcv
thchnhvicccimdnsxhicam.
ITNGVPHNGPHP
itngnghincu
Ccbmccondi5tuinhpvinvo
khoa Nhi Bnh vin Ninh Phc, tnh Ninh
ThunvNKHHCTtrongthigiantthng35
nm2012.
Phngphpnghincu
Nghincuctngangmt
Cmuvkthutchnmu
Lymulttcccbmccondi5tui
nhpvintikhoaNhitiuchunvlintc
t thng 03 5/2012. Trong thi gian iu tra,
tngsmuthuthpcl219.
Tiuchchnmu
nhnghaNKHHCT
NKHHCTbaogmccnhimtrngbtk
v tr no trn ng h hp, bao gm mi, tai,
hng,thanhqun,khqun,ph qun, tiu ph
39
NghincuYhc
qun, phi. Thi gian b bnh khng qu 30

ngy,ngoitrvimtaigiacpl14ngy(1).
DuhiutrbNKHHCT
Thng c 1 trong cc triu chng sau: ho,
st,khth,auhng,chyncmi,chym
tai(1). Trong triu chng ho thng hay gp
nht.
Tiuchchnvo
Bmccondi5tuinhpvinvokhoa
NhiBVNinhPhcvNKHHCT.
ngthamgianghincu
Tiuchloira
Bcm,ichocmcccbnhtmthn.
Ccbmccont5tuitrlnnhpvin
v b m c con di 5 tui nhp vin khng
phivNKHHCT.
Cc b m khng ng tham gia nghin
cu.
Xldkin
NhpdliubngchngtrnhEpiData3.01
Phntchdkin:bngphnmmStata11.
Thng k m t: Tn s v phn trm
Thng k phn tch: Php kim chi bnh
phng, PR
KTQUNGHINCUVBNLUN
Bng1:ctnhmunghincu
c im
Nhm tui
Ngh nghip
Hc vn
Hn nhn
S con
40
<25
25-29
30-34
35
CNV
Nng dn
Ni tr
Khc
M ch
Cp 1
Cp 2
Cp 3
Trn cp 3
C gia nh
c thn
Con
Tn s
32
73
69
45
20
167
20
12
16
78
93
19
13
217
2
153
T l %
14,6
33,3
31,5
20,6
9,1
76,3
9,1
5,5
7,3
35,6
42,5
8,7
5,9
99,1
0,9
70
c im
>2 con
Ngho
Kinh t
Khng ngho
Tn s
66
44
175
T l %
30
20,1
79,9
Quanghincu219bmccondi5tui
vphngchngNKHHCT,chothy:
Ccbmchyulatuit2534tui,
caonhtlnhmtui2529,chim33,3%.Ngh
nngchimas76,3%,iunyphhpvi
tnhhnhkinhtxhicahuynNinhPhc,
mthuynnngnghiptrngimcatnh,a
s ngi dn sng bng ngh nng. Phn ln
cc b m c trnh hc vn cc lp cp II
chimtl42,5%.Tlbmchcvntrncp
IIIlthpnht5,9%vtlmch7,3%.iu
ny cho thy b m c trnh thp cn cao,
chc chn s nh hng n vic tip thu cc
ngunthngtinvbnh,chmscsckhev
phngbnhchotr.Ccbmthuchngho
20,1%,khngnghognbng80%.
Bng2:Kinthccabmvphngchng
NKHHCT
Kin thc
ng
Bit DH
NKHHCT
Tn T l % Kin thc ng Tn T l %
s
s
195 89,04 Bit CS tr b 179 81,74
NKHHCT
Bit DH cn 177 80,22 Bit lm sch

82
em i khm
mi
Bit DH bnh 150 68,49 Bit lm kh tai 79
tr nng
Bit cc BPPN 197 89,95 KT ng chung
143
v PC NKHHCT
37,44
36,07
65,3
Kin thc ng khi b m tr li ng 5

trong7kinthctrn.
Cckinthcttlkhcao,trongkin
thc v cc BPPN t t l cao nht, gn 90%.
RingKTbitlmschmivlmkhtaictl
thp (37,44% v 36,07%), y l iu cn lu
trongvictuyntruyngiodcccbmcch
chmsctr.Kinthcngchungl65,3%,cao
hn nghin cu ca Nguyn Trn Tho Uyn
54,2%(5).Nghincucachngtitibnhvin
nndsaoccbmcngcNVYThng
dn cch chm sc con qua thm bnh hng
ngynnkinthcngcaohnnghincuca
NguynTrnThoUynticngng.
ChuynYTCngCng
Bng3:ThibmvphngchngNKHHCT
Thi ng
Tn s
T l %
Tr nh hay mc bnh NKHHCT
169
77,17
Chn ni khm khi ho nhiu, st, th

kh kh
Thc hin cc BPPN NKHHCT l
cn thit
Cho tr n DD khi tr mc bnh
NKHHCT
Cho tr ung nhiu nc hn khi tr
st hoc ho
HD ca NVYT v cch CS tr ti BV
l cn thit
Se mi bng giy thm su kn
214
97,72
211
96,35
189
86,3
197
89,95
214
97,72
203
92,69
T ng chung v PC NKHHCT
211
96,35
Thi ng khi b m tr li ng 5
cutrong7cutrn.
Hu ht cc thi u t t l ng cao.
Thictlngcaonhtlchnnikhm
khitrho,st,thkhkhvchpnhnhng
dncaNVYTvchmsctr,t97,7%.Tl
thi chp nhn vic tr nh hay mc bnh
NKHHCTthpnht77,2%.Thingchung
t 96,35%, tng ng vi nghin cu ca
NguynTrnThoUyn91,6%(5).Thing
v phng chng NKHHCT cao, ngha l c s
ng thun cao ca cc b m, to iu kin
thun li cho vic tuyn truyn gio dc sc
khesauny,hyvngtschuynic
hnhvicah.
Bng4:Thchnhcabmvphngchng
NKHHCT
Thc hnh ng
Tn s
Chn ni n khm u tin
210
Chm sc tr khi st cao
210
Cho tr ung nc khi st hoc ho
188
Cho tr n/b khi b NKHHCT
91
Lm sch mi
15
Lm sch m tai
9
Ht thuc l
98
Cho tr tim chng ng quy nh
211
Cho tr n ung sau mi ln bnh
108
Gi m cho tr khi thi tit lnh
212
Thc hnh ng khi tr chi ni nhiu
185
bi, khi
Khi c du hiu cn mang tr i ti
41
khm
ChuynYTCngCng
T l %
95,89
95,89
85,84
41,55
6,85
4,11
44,75
96,35
49,32
96,8
84,47
18,72
Thc hnh ng
TH ng chung
NghincuYhc
Tn s
97
T l %
44,29
Thc hnh ngkhitrling8trong

12thchnhtrn.
Thchnhngttlrtcaonhchotr
n ung sau mi ln bnh 96,8%, cho tr tim
chng ng qui nh 96,35%, chn ni khm
bnhutin95,89%vchmsctrkhistcao
95,89%. Theo Mai Anh Tun, nhm tr khng
c tim phng y c nguy c mc
NKHHCTcaogp7,92lnsovinhmchng(4).
Thc hnh t t l thp nh thc hnh khi c
duhiucnmangtritikhm18,72%,trong
khitlbmbitduhiucnemtri
khmcao80,22%.iunychothybmbit
nhng cha chc thc hin tt, CBYT cn
tng cng tuyn truyn v hng dn b m
cchnhgingccduhiucnemtri
tikhmkhiangiutrngoitr.Tlthc
hnhlmschmi6,85%vlmschtai4,11%,
rtthp,thphnnghincucaNguynTrn
Tho Uyn. y cng l im cn tng cng
tuyntruyngiodcccbmtrongchmsc
tr thay i hnh vi. Chnh v nhng thc
hnhctlthpnhnutrnnntlthc
hnh ng chung l 44,29%, thp hn NC ca
NguynTrnThoUyn.
Bng5:Ngunthngtinbmtipcn
Ngun thng Tn T l % Ngun thng Tn T l %
tin
s
tin ng tin
s
cy nht
Truyn thanh 33 15,07 Truyn thanh
3
1,37
Truyn hnh 174 79,45 Truyn hnh
64 29,22
Bo ch/sch 24 10,96 Bo ch/sch
0
0
v
v
Cn b y t 164 74,89 Cn b y t 149 68,04
Ngi
83
37,9
Ngi
3
1,37
thn/bn b
thn/bn b
Cc b m tip cn ngun thng tin nhiu

nhtltruynhnh79,45%,klCBYTchim
74,89%. Tuy nhin, cc b m tin cy nht vo
nhng g cn b y t t vn hoc hng dn,
chim 68,04%. Nh vy, cn trang b kin thc
y cho NVYT ti BV cng nh ti cng
ng v tng cng tham vn cho cc b m
41
NghincuYhc
cch nhn bit cc du hiu bnh gip bc s

trongiutrtthnvcchchmsctrkhib
bnhchkhngphichkhmvraylnhiu
trhocknthuc.
Bng6:Milinquangiakinthcngchungv
phngchngNKHHCTviccctnhcamu
nghincu
c im
Nhm
tui
KTC v PC NKHHCT P
ng
Khng
(n,%)
(n,%)
30 tui 70 (61,4) 44 (38,6) 0,21
< 30 tui 73 (69,52) 32 (30,48)
Nng 104 (62,28) 63 (37,73)
<
dn
0,001
Ngh
nghip
Khc
21 (65,63) 11(34,37)
Cng
18 (90)
nhn vin
Cp II tr 92 (73,6)
ln
0,03
33 (26,4) 0,003
Cp I tr 51(54,26) 43 (45,74)
xung
t con 106 (69,28) 47 (30,72) 0,06
S con
Nhiu 37 (56,06) 29 (43,94)
con
Khng 117 (66,86) 58 (33,14) 0,33
ngho
Ngho
0,88
(0,731,07)
0,69
(0,570,83)
0,73
(0,540,97)
2 (10)
Hc vn
Hon
cnh
kinh t
PR
1,36
(1,11,68)
1,24
(0,971,57)
1,13
(0,871,48)
Khngcmilinquangiakinthcng
ca cc b m vi nhm tui, s con v hon
cnhkinht(p>0,05).
Bng7:Milinquangiathingchungv
phngchngNKHHCTviccctnhcamu
nghincu
c im
TC v PC
P
NKHHCT
ng
Khng
(n,%)
(n,%)
30 tui
110
4 (3,51)
(96,49)
Nhm tui
0,9
< 30 tui
101
4 (3,81)
(96,19)
Nng dn
162
5 (2,99)
(97,01)
0,026
Ngh
nghip
B m c hc vn t cp II tr ln c t l
kinthcngcaohnbmchcvntcp
Itrxung(p=0,003).Rrngrng,bmCNV
v c trnh hc vn cng cao th kin thc
ng cng cao. iu ny ph hp vi nghin
cu ca Nguyn Trn Tho Uyn, b m c
trnh hc vn cp III tr ln c kin thc
ngcaohnbmctrnhhcvncpII
Khc
29
(90,63)
Cng
20 (100)
nhn vin
Cp II tr 120 (96)
ln
3 (9,37)
0,08
Cp I tr
xung
t con
91
(96,81)
148
(96,73)
5 (4)
Hon
cnh kinh
t
Khng
ngho
Ngho
1,00
(0,95
1,06)
0.97
(0,940,99)
0,91
(0,811,01)
0,75
0,99
(0,94
1,04)
0,64
1,01
(0,95
1,08)
0,72
1,01
(0,941,08)
3 (3,19)
5 (3,27)
S con
Nhiu con
PR
Hc vn
26(59,09) 18 (40,91)
Kin thc ng chung c mi lin quan

mangnghathngkvinghnghipvtrnh
hcvncam.Bmlmnghnngctl
kin thc ng chung v phng chng
NKHHCT km hn b m CNV (p< 0,001).
Tngt,bmlmnghkhcctlkinthc
ngkmhnbmCNV(p=0,03).
42
trxung(5).yliucnlutrongcngtc
GDSKvphngchngNKHHCTtremcho
ccbm.
63
(95,45)
169
(96,57)
3 (4,55)
42
(95,45)
2 (4,55)
6 (3,43)
C mi lin quan mang ngha thng k

gia thi ng chung v phng chng
NKHHCTvinghnghip.Bmlmnngc
thi ng chung km hn b m CNV
(p=0,026). Thi ng chung khng c mi
linquannoviccctnhkhccam,do
huhtccbmucthingrtcao.
Nh vy, nng dn l i tng cn phi tc
ng mnh trong cng tc TTGDSK, gip h
hiu v chp nhn cch chm sc v phng
chngNKHHCTtrem.
ChuynYTCngCng
Bng8:Milinquangiathchnhngchung
vphngchngNKHHCTviccctnhcamu
nghincu
c im
THC v PC
p
PR
NKHHCT
ng
Khng
(n,%)
(n,%)
30 tui 51 (44,74) 63 (55,26) 0,89 1,02 (0,76
Nhm
1,37)
tui < 30 tui 46 (43,81) 59 (56,19)
Nng dn 71 (42,51) 96 (57,49) 0,25 0,77 (0,501,19)
Ngh
Khc 15 (46,88) 17 (53,13) 0,56 0,85 (0,49nghip
1,47)
Cng
11 (55)
9 (45)
nhn vin
Cp II tr 58 (46,4) 67 (53,6) 0,47 1,12 (0,82
ln
1,52)
Hc
vn Cp I tr 39 (41,49) 55 (58,51)
xung
t con 66 (43,14) 87 (56,86) 0,6 0,92 (0,67
1,26)
S con
Nhiu con 31 (46,97) 35 (53,03)
Hon
cnh
kinh t
Khng
ngho
Ngho
82 (46,86) 93 (53,14) 0,13 1,37 (0,89

2,13)
15 (34,09) 29 (65,91)
Tlthchnhngchungl44,29%.Thc
hnh ng chung khng c mi lin quan no
viccctnhcam.Nhnvobngtrn,ta
thytlthchnhchunggiangvkhng
ng tng ng nhau (xp x 50%) tt c
ccctnhcam,nghalchngtacnphi
c k hoch TTGDSK cho mi i tng v
NKHHCT thng xuyn v rng ri, khng
nhng ti bnh vin m c trong cng ng v
cmtslnglntrndi50%bmthc
hnhkhngng.
Bng9:Milinquangiakinthcngchungv
thchnhngchung
Thc hnh ng
Kin thc
chung
ng
chung
ng (%) Khng (%)
ng
74 (51,75) 69 (48,25)
Khng
23 (30,26) 53 (69,74)
PR (95% CI)
0,002
1,71 (1,17
2,49)
C mi lin quan mang ngha thng k

giakinthcngchungvthchnhng
chung. B m c kin thc ng c kh nng
thchnhnggp1,71lnbmckinthc
khngng(p=0,002).Ktqunghincuny
ChuynYTCngCng
NghincuYhc
tngtktqucaNguynTrnThoUyn(5).
Theo Mai Anh Tun, b m c hiu bit chung
v NKHHCT km th con h c nguy c mc
NKHHCTcaogp1,54lnsovibmckin
thc trung bnh(4). V vy, chng ta cn TT
GDSK cho b m cch phng chng NKHHCT
cho tr <5 tui, gip h thy c mi e da
tnhmngtr;t,cthitt,chpnhn
mtcchtnguynvicchuynihnhvitt
vphngchngNKHHCT,gpphnlmgim
tlmcbnhvtltvongtrem.
KTLUN
T l b m c kin thc ng v phng
chngNKHHCTl65,3%,trongnhmccb
m l cn b cng nhn vin v cc b m c
trnh hc vn t cp 2 tr ln c kin thc
ngcaohnccnhmcnli(p<0,05).
Tlbmcthingvphngchng
NKHHCTl96,35%, trong b m lm nng
cthingchungkmhnbmlcng
nhnvin(p=0,026).
T l b m c thc hnh ng v phng
chng NKHHCT l 44,29%, khng c mi lin
quan gia thc hnh ng chung vi cc c
tnhcam.
B m c kin thc ng c kh nng thc
hnh ng cao hn b m c kin thc khng
ng(p=0,002).
KINNGH
KhoaNhicnckhochcthvvicgio
dcsckhechoccbmcconnhpvinv
phng chng NKHHCT cho tr em < 5 tui.
Phng thc truyn thng phi a dng, ph
hpvitngitng.
TTYTNinhPhccnkintonmngliy
tthuynnx,nytthnbnvphng
chngNKHHCT.
TILIUTHAMKHO
1.
2.
BYt(1994)Nhimkhunhhpcptnhtrem,HNi,
tr.57.
B Y t (2011) Tm tt s liu thng k y t 2006 2010. H
Ni.
43
NghincuYhc
3.
4.
oMinhTun(2010)Nghincuthctrngkhmviu
trNKHHCtikhoahhpBnhvinNhiTrungngtrong
nm2010.Yhcthchnh,BYt.
MaiAnhTun(2008)Thctrngvmtsyutnguycv
nhimkhunhhpcptnhcatrdi5tuitimtsx
minnitnhBcKan.LunvnThcsykhoa,ihcY
dcTP.HCM.
5.
6.
NguynTrnThoUyn(2006)Kinthcthithchnh
vphngbnhnhimkhunhhpcpcabmccondi
5 tui ti x Phc Ha, huyn Ph Gio, Bnh Dng nm
2006.Lunvnttnghipcnhnytcngcng,ihcY
dcTP.HChMinh.
WHO(2007)Phngchngvkimsotbnhhhpcpd
thnhdchvidchtrongchmscsckheHngdn
tmthicaWHO,tr.12.
44
ChuynYTCngCng
NghincuYhc
KINTHCTHCHNHVVSINHANTONTHCPHM
CANGIKINHDOANHTHCNNGPHTITHNHPH
PHANRANGTHPCHMTNHNINHTHUN,NM2011
MaiThPhngNgc*LHongNinh**
TMTT
tvn:Thcnngph(TAP)phongph,adng,rtinvthuntinchongitiudng.
Tuynhin,TAPrtdbnhimgyngcthcphmcngnhccbnhtruynquathcphm.Ngi
kinhdoanhTAPthiukinthcvthchnhvVSATTPtrongkinhdoanhchbinthcphmslmi
nguychosckhecngng.
Mctiu:XcnhtlngikinhdoanhthcnngphckinthcvthchnhngvVSATTP
ticccskinhdoanhthcnngphtiThnhphPhanRangThpChmtnhNinhThun,nm2011
vccyutlinquan.
Phngphpnghincu:Nghincumtctngangctinhnhtrongthigiantthng1112
nm2011ti06phngcaThnhphPhanRangThpChm,tnhNinhThun.290ngikinhdoanh
thcnngphtrongthigianthng1112nm2011cphngvnbngbngcuhivquansttrc
tip.
Ktqu:Tlngikinhdoanhthcnngphckinthcngchungvvsinhantonthcphm
l34,5%;cthchnhngchungvvsinhantonthcphml31,0%.Nghincuchothyngickin
thcngcthchnhngcaogp3,28lnngickinthckhngng;ngictrnhhcvncng
caothtlthchnhngcngcao.
Ktlun:Tlngikinhdoanhdchvthcnngphckinthcngchungvthchnhng
chungrtthp.Nghincuchothycnphitngcngcngtctphunchocskinhdoanhdchvthc
nngph;tngcngkimtra,gimstcccskinhdoanhdchvthcnngphhthchin
ttccquynhvVSATTPthcnngph.
Tkha:Kinthc,thchnh,thcnngph,ngikinhdoanh,vsinhantonthcphm.
ABSTRACT
KNOWLEDGEPRACTICEABOUTHYGIENEANDFOODSAFETYOFSTREETFOOD
BUSINESSPERSONSINPHANRANGTHAPCHAMCITY,NINHTHUANPROVINCE,2011
MaiThiPhuongNgoc,LeHoangNinh
Background:Streetfoodsareabundant,diversified,cheapandconvenientforconsumers.However,street
foodsareveryeasilycontaminatedandcausefoodpoisoningandfoodbornediseases.Streetfoodbusinesspersons
lackingtheknowledgeandpracticeofhygieneandfoodsafetyinfoodprocessingandbusinesswillbeathreatto
publichealth.
Objective: Determine the percentage of direct food processers having right knowledge and practice of
hygieneandfoodsafetyatthestreetfoodshopsinPhanRangThapChamCityofNinhThuanprovince,in
2011andassociatedfactors.
*ChiccAntonvsinhthcphmNinhThun
Tcgilinlc:BS.MaiThPhngNgc T:0918881166 Email:ngoctpdd@yahoo.com
ChuynYTCngCng
45
NghincuYhc
Methods:ACrosssectionaldescriptivestudywasconductedfromNovembertoDecemberin2011atsix
wardsofthePhanRangThapChamcityinNinhThuanProvince.290personsincludingfoodprocesserand
streetfoodbusinesspersons,wereinterviewedbyquestionnaireanddirectlyobserved.
Results: The percentage of street food businesspersons having generally correct knowledge and practice
about hygiene and food safety was 34.5% and 31.0% respectively. People of right knowledge having right
practicewere3.28timeshigherthanthoseofwrongknowledge.
Conclusion:Theratesofstreetfoodbusinesspersonsofthegenerallyrightknowledgeandgenerallyright
practicewereverylow.Therefore,strengtheningthetrainingforstreetfoodbusinesspersons;andtheinspection
andsupervisionofthestreetfoodshopsinordertoguidethemtopracticemoreproperlyregulationsoffoodsafety
forstreetfood.
Keywords:Knowledge,attitude,streetfood,businesspersons,hygieneandfoodsafety.
Rang Thp Chm ni ring v tnh Ninh
TVN
Thunnichung.chnhlldocnthit
Thc n ng ph (TAP) rt thun tin
thchinnghincuny.
chongitiudng,dosphongphadng,
Mctiunghincu
gi r, thch hp cho qung i qun chng.
Xc nh t l ngi trc tip ch bin thc
Cng vi qu trnh th ha, cc loi thc
phm ti cc c s kinh doanh TAP c kin
phm ch bin sn ngy cng nhiu, c bit l
thcngvVSATTP
dchvTAPcngphttrinrtnhanhchng,
toracngnviclm,thunhpchohngngn
laong(3).Tuynhin,TAPcngnhhngrt
nhiuticnhquanmitrngvvnminh
th.cbit,TAPrtdbnhim(2,5,1,4)gyng
c thc phm cng nh cc bnh truyn qua
thcphm.TnhtrngnhimTAPldothiu
h tng c s, cc dch v v sinh mi trng
nh:cungcpncsch,xlrc,chtthi,thit
bboqunthcphmkhngmbo,vdo
kinthc,thchnhcangikinhdoanhdch
vTAPcnhnch.
trin khai m hnh m bo v sinh an
tonTAP,lmttcngtcchmscvbov
sckhenhndnvtrinkhaithchincng
tcvsinhantonthcphm(VSATTP)tkt
qucnphicnhngsliuiutrabanuv
thc trng tnh hnh VSATTP, kin thc, thc
hnh v VSATTP ca ngi kinh doanh TAP
Do,vickhostiutrakinthc,thchnh
v VSATTP ca ngi kinh doanh TAP l cn
thit cho ngnh y t lm c s trin khai
nhngbinphpqunlvnngcaochtlng
VSATTPtrongthigianti,gpphnbovsc
khe ca ngi dn, y mnh cng cuc hin
i ha, cng nghip ha ca thnh ph Phan
46
Xc nh t l ngi trc tip ch bin thc

phmticccskinhdoanhTAPthchnh
ngvVSATTP
Milinquangiaccctnhnhtui,gii,
trnh vn ha v thc hnh v VSATTP ca
ngikinhdoanhTAP
Xcnhmilinquangiakinthcng
vthchnhngcangikinhdoanhTAP
vVSATTP.
ITNGPHNGPHPNGHINCU
itngnghincu
Ngitrctipchbin,kinhdoanhthcn
ngphcnhanghotngti6phng
ca Thnh ph Phan Rang Thp Chm, tnh
NinhThunnm2011.
Thitknghincu
Nghincuctngangmt
Munghincu
290 ngi kinh doanh thc n ng ph
thuc 6 phng ca Thnh ph Phan Rang
Thp Chm. thun tin cho vic qun l
VSATTPchngtitinhnhnghincutonb
mu ca 6 phng c chn ca Thnh ph
ChuynYTCngCng
NghincuYhc
PhntchsliubngphnmmEPIDATA
3.1, s liu sau khi nhp s chuyn sang phn
mmSTATA11.0phntch.
kinhdoanhkmcthdokhngctphun
kinthcvVSATTPhocdoccbuitphun,
tuyn truyn kin thc v VSATTP khng
mang li hiu qu nh mong i, ni dung tp
hun,tuyntruynchaphhp,chaemli
li ch cho c s, cha thc s hp dn ngi
nghe. iu ny t ra cho nh qun l c cn
phi t chc tp hun thng xuyn, trong tp
hun ch n phng php truyn thng c
th, sinh ng nhm cp nht kp thi cc quy
nhvVSATTPchonhngngichbinthc
phmmtcchyhn.
KTQUVBNLUN
Thchnhvvsinhantonthcphm
Bng1:ctnhmunghincu(n=290)
Bng3:Thchnhttchungvvsinhantonthc
phmcangikinhdoanhthcnngphti
thnhphPhanRang(n=290)
Phan Rang Thp Chm nm 2011 theo danh

schqunl.
Phngphpnghincu
iu tra qua bng cu hi v quan st trc
tip.Tphuniutravinmuphiuiutra
vthngnhtccnidungquanstnhgi
kinthcthchnhcaccitng.
Phntchsliu
c tnh
< 55 tui
55 tui
Gii
Nam
N
Trnh
M ch
hc vn
Cp I
Cp II
Cp III
Tui
Tn s
239
51
22
268
6
88
143
53
T l
82,4
17,6
7,6
92,4
2,1
30,3
49,3
18,3
Tuitrungbnhl44,79,97.
Quaktqukhost290ngikinhdoanh
cho thy tui di 55 tui chim t l l
82,4%,t55tuitrlnchimtll17,6%v
n chim 92,4% so vi nam l 7,6%. Hu ht
ngi ch bin thc phm c trnh vn ha
tcpIItrxungchim79,6%,trnhcpIII
chim18,3%,vcbitc2,1%ngimch.
Kinthcvvsinhantonthcphm
Bng2:Kinthcngchungvvsinhanton
thcphmcangikinhdoanhthcnngph
tithnhphPhanRang(n=290)
Kin thc
KT ng chung v v sinh an ton
thc phm
Tn s
100
T l
34,5
Tiuchunnhgikinthcchungng:
KinthcchungngvVSATTPlkhitrli
ng14trong20binskinthc.
Nhnxt:itngckinthcngchung
v v sinh an ton thc phm chim t l thp
34,5%. iu ny cho thy kin thc ca ngi
ChuynYTCngCng
Thc hnh
TH tt chung v v sinh an ton
thc phm
Tn s
90
T l
31,0
Tiuchunnhgithchnhchungng:
ThchnhchungngvVSATTPlkhitrli
ng7trong11binsthchnh.
Nhn xt: T l cc i tng thc hnh
chung ng v VSATTP t thp 31,0%. iu
nytrachoccnhqunlcnphiquantm
ncngtctphunkinthcvVSATTPcho
nhng ngi trc tip tham gia ch bin, bo
qun, kinh doanh TAP v cc mi nguy, cch
x l m bo yu cu v sinh an toncn tng
cngcngtckimtragimstvVSATTP
c s thc hnh tt m bo ATVSTP nhm
phngngaccvdchngcthcphmxy
ra.
Mi lin quan gia thc hnh v c tnh

mu
Bng4:Milinquangiactnhmuvthc
hnhvsdngngunnc(n=290)
c tnh
mu
TH v s dng
ngun nc
Khng tt
Tt (n,%)
(n,%)
Tui
< 55 tui
55 tui
Gii
235 (98,3)
51 (100,0)
4 (1,7)
0 (0,0)
PR
0,352 1,02
KTC
95%
1.00
1.03
47
NghincuYhc
c tnh
mu
TH v s dng
ngun nc
p
PR
Khng tt
Tt (n,%)
(n,%)
21 (95,5) 1 (4,5) 0,185 0,97
265 (98,9) 3 (1,1)
Nam
N
Trnh hc
vn
M ch
5 (83,3)
Cp I
85 (96,6)
Cp II
Cp III
143
(100,0)
53 (100,0)
1 (16,7)
3 (3,4)
0,006
1
1,16
0 (0,0)
1,20
0 (0,0)
1,20
KTC
95%
0.88
1.06
0.811.66
1.12
1.29
1.12
1.29
Nhnxt:Khngcmilinquangiacc
nhmtui,giivithchnhvsdngngun
nc,nhngcmilinquanvitrnhhc
vn.NgictrnhhcvncpII,cpIIIc
thc hnh tt v s dng ngun nc cao hn
ngimchl1,2ln(KTC95%=1.121.29).
S khc bit ny c ngha thng k vi
p=0,006.
Tuy vy ngi c trnh hc vn cp I
khngcmilinquancnghathngkvi
ngi m ch mc d p < 0,05 v KTC 95% =
0.811.66ccha1
hnhvngilmdchv(n=290)
c tnh
mu
Tui
< 55 tui
55 tui
Gii
Nam
N
Trnh
hc vn
M ch
Cp I
Thc hnh v ngi

lm dch v
Tt (n, %) Khng tt
(n,%)
61 (25,5) 178 (74,5)
0,390
1,23
0.78
1.95
0,113
1,61
0.94
2.77
0,023
NA
NA
0.31
0.87
0.40
0.93
16 (31,4)
35 (68,6)
9 (40,9)
13 (59,1)
PR
68 (25,4) 200 (74,6)
0 (0,0)
6 (100,0)
19 (21,6)
69 (78,4)
0,52
Cp II
36 (25,2) 107 (74,8)
0,61
Cp III
22 (41,5)
31 (58,5)
KTC
95%
nhmtui,giivithchnhvngilmdch
48
v,nhngcmilinquancvitrnhhc
vn. Ngi c trnh vn ha cp II c thc
hnh tt v iu kin ngi lm dch v thp
hnvingictrnhvnhacpIIIl0,61
ln(KTC95%=0.400.93),ngictrnhvn
hacpIcthchnhttvngilmdchv
thp hn ngi c trnh vn ha cp III l
0,52ln(KTC95%=0.310.87).Skhcbitny
cnghathngkvip=0,023.
hnhvbn,gichbinvbybnthcphm
(n=290)
c tnh
mu
Tui
< 55 tui
55 tui
Gii
Nam
N
Trnh
hc vn
M ch
Thc hnh v bn,

gi ch bin v by
bn thc phm
Tt (n, %) Khng tt
(n,%)
229 (95,8) 10 (4,2)
46 (90,2)
5 (9,8)
21 (95,5)
1 (4,5)
PR
KTC
95%
0,100
0,94
0.86
1.03
0,999
1,01
0.92
1.11
0,044
0,94
0.68
1.29
0.98
1.18
1.02
1.18
254 (94,8) 14 (5,2)
5 (83,3)
1 (16,7)
Cp I
84 (95,5)
4 (4,5)
1,08
Cp II
139 (97,2)
4 (2,8)
1,10
Cp III
47 (88,7)
6 (11,3)
nhm tui, gii vi thc hnh v bn, gi ch
binvbybnthcphm,nhngcmilin
quan vi trnh hc vn. Ngi c trnh
vnhacpIIcthchnhttvbn,gich
binvbybnthcphmcaohnvingic
trnh vn ha cp III l 1,10 ln (KTC
95%=1.02 1.18). S khc bit ny c ngha
thngkvip=0,044.
Tuy vy ngi c trnh hc vn cp I
khngcmilinquancnghathngkvi
ngi c trnh vn ha cp III mc d p <
0,05vKTC95%=0,981,18ccha1vngi
m ch khng c mi lin quan c ngha
thng k vi ngi c trnh vn ha cp III
ChuynYTCngCng
mcdp<0,05vKTC95%=0.681.29ccha
1
hnhvsdngthngngrc(n=290)
c tnh TH v s dng thng p
mu
ng rc
Tt
Khng tt
(n, %)
(n,%)
Tui
< 55 tui 126 (52,7) 113 (47,3) 0,294
55 tui 31 (60,8) 20 (39,2)
Gii
Nam
14 (63,6) 8 (36,4) 0,352
N
143 (53,4) 125 (46,6)
Trnh
hc vn
M ch
2 (33,3)
4 (66,7) 0,001
PR
KTC
95%
1,15
0.90
1.48
1,19
0,42
Cp I
36 (40,9)
52 (59,1)
0,52
Cp II
77 (53,9)
66 (46,1)
0,68
Cp III
42 (79,3)
11 (20,7)
0.85
1.67
0.13
1.32
0.39
0.69
0.55
0.83
nhmtui,giivithchnhvsdngthng
ng rc, nhng c mi lin quan vi trnh
hcvn.
Ngi c trnh vn ha cp II c thc
hnh tt v s dng thng ng thp hn vi
ngi c trnh vn ha cp III l 0,68 ln
(KTC 95%=0.55 0.83), ngi c trnh vn
ha cp I c thc hnh tt v s dng thng
ng rc thp hn ngi c trnh vn ha
cpIIIl0,52ln(KTC95%=0.390.69).Skhc
bitnycnghathngkvip=0,001.
Tuy vy ngi m ch khng c mi lin
quancnghathngkvingictrnh
vn ha cp III mc d p < 0,001 v KTC
95%=0,131,32ccha1.
hnhvvicthurc(n=290)
c tnh
mu
Tui
< 55 tui
55 tui
Thc hnh v vic

thu rc
Tt
Khng tt
(n,%)
(n,%)
28 (11,7) 211 (88,3) 0,435

8 (15,7) 43 (84,3)
ChuynYTCngCng
PR
1,34
KTC
95%
0.65
2.77
c tnh
mu
Gii
Nam
N
Trnh
hc vn
M ch
Cp I
NghincuYhc
Thc hnh v vic

thu rc
Tt
Khng tt
(n,%)
(n,%)
PR
KTC
95%
5 (22,7) 17 (77,3) 0,127

31 (11,6) 237 (88,4)
1,96
0.85
4.54
0 (0,0)
9 (10,2)
NA
0,39
NA
0.18
0.83
0.17
0.68
6 (100,0)
79 (89,8)
Cp II
13 (9,1) 130 (90,9)
Cp III
14 (26,4)
0,015
39 (73,6)
0,34
1
nhmtui,giivithchnhvvicthurc,
nhng c mi lin quan vi trnh hc vn.
Ngictrnhvnha cp II c thc hnh
tt v vic thu rc thp hn vi ngi c
trnh vn ha cp III l 0,34 ln (KTC
95%=0.170.68),ngictrnhvnhacpI
c thc hnh tt v vic thu rc thp hn
ngi c trnh vn ha cp III l 0,39 ln
(KTC 95%=0.18 0.83). S khc bit c ngha
thngkvip=0,015.
Milinquangiakinthcvthchnh
Bng9:Milinquangiakinthcvthchnh
vvsinhantonthcphm(n=290)
Kin thc
chung
Thc hnh chung

p
Tt
Khng tt
(n, %)
(n,%)
57 (57,0) 43 (43,0) 0,001
Tt
Khng tt 33 (17,4) 157 (82,6)
PR KTC 95%
3,28
2.30
4.68
Nhn xt: C mi lin quan gia kin thc

chungttvthchnhchungttvvsinhan
ton thc phm: Ngi c kin thc chung tt
thc hnh chung tt hn ngi c kin thc
chung khng tt l 3,28 ln (KTC 95%=2.30
4.68). S khc bit c ngha thng k vi p =
0,001.
KTLUN
TlngikinhdoanhTAPckinthc
ngchungngvthchnhchungngv
VSATTPThp
49
NghincuYhc
Cmilinquangiatrnhhcvnvi
thc hnh ng v s dng ngun nc; v
iu kin ngi lm dch v; v bn, gi ch
bin v by bn thc phm; v s dng thng
ngrc(p<0,05).
Khng tm thy mi lin quan gia thc
hnh ng v VSATTP vi cc nhm tui v
gii.
ngchtthi;cntrangbbohlaong
trongkhichbin,kinhdoanh..
Tngcngcngtctruynthngtrctip
nccnhmitngtiudng,truynthng
trnccphngtinthngtinichngvthc
trngTAP..
TILIUTHAMKHO
1.
KHUYNNGH
Ccngnh,cccpcbitlnhngngi
lmcngtcqunlvVSATTPcntngcng
cngtcthanhtra,kimtra,gimstcccs
kinh doanh dch v TAP h thc hin tt
ccquynhvVSATTPTAP.
Tng cng cng tc tp hun cho c s
kinh doanh dch v TAP v t l ngi kinh
doanh TAPc kin thc chung v VSATTP
thp.
Cc c s kinh doanh TAP cn u t
trangthitbnh:bnbybnthcn,dngc
2.
3.
4.
5.
HThAnho,ViVnSn,NguynMinhTrng(2008)
Thctrngvsinhcsdchvthcnngphkhuvc
chngXunvThanhXunBcHni.Kyuhingh
khoahcVSATTPlnth52009,NXBHNi,tr.19196.
Phan Th An, v cs (2004) Kho st tnh hnh nhim vi
khuncamtsloithcnngphtithnhph
Lt.KyuhinghkhoahcVSATTPlnth32005,NXB
Yhc,HNi,tr.325329.
Trnng(2005)Kimsotvsinhantonthcphmthc
nngph,NXBThanhNin,HNi,tr.940.
Trn Huy Quang, v cs (2005) Kho st tnh hnh nhim
thcnngphvyutlinquantithnhphThanh
Ha.KyuhinghkhoahcVSATTPlnth32005,NXB
Yhc,HNi,tr.197203.
Trn Vn Ch (2004) Kho st ban u dch v thc phm
thc n ng ph c a im c nh trn a bn tnh
QungTr,NXBYhc,HNi,tr.368376.
50
ChuynYTCngCng
NghincuYhc
TLTNGHUYTPVNHNGHNHVINGUYC
CACNBCNGNHNTRUNGTMCKHTOAXE
THPCHM,TNHNINHTHUN
NguynTnKinhThi*,LHongNinh**
TMTT
tvn:Tnghuytp(THA)lyutnguyctimmchrtphbinvcnglnguynnhnhng
ugytvongvmcbnhtrntoncu.TlngiTHAVitNamgnycxuhngtngnhanh.
VitNam,phngchngbnhTHAcchnhphavochngtrnhmctiuqucgia.Tuynhin,tnh
hnhTHAtrongngnhgiaothngvnchackhost,nhgi.
Mctiu:XcnhtlhinmcTHAcacnbcngnhnvinTrungtmCkhToaxe(TTCKTX)
ThpChm,milinquangiaTHAviccctrngvcchnhvinguyc;xcnhtlnhngngibit
mnhTHAvciutrTHAcnbcngnhnvinTTCKTXThpChmhinmcTHA.
Phngphpnghincu:CtngangmttonbmulCBCNVanglmvic,cngtctiTTCKTX
ThpChmtrongnm2011.
Ktqu:TlTHAchungcaCBCNVTTCKTXThpChml32,0%,trongnamchimtl37,7%
caohnnctll15,4%.TlTHAtngcaonamgii,ngibophvungru.nhngCBCNV
TTCKTXThpChmbTHA,cchnhvinguycctlkhcao,tlCBCNVbitbTHAviutrTHA
l44,8%.
Ktlun:Cntngcngcngtctruynthngdinhiuhnhthcnhmtraoi,cungcpkinthc
vgipnngcaonhnthccaCBCNVtrongngnhvdphngvkimsotbnhTHA.
Tkha:Tnghuytp,Hnhvinguyc,CBCNV,TTCKTXThpChm,
ABSTRACT
PREVALENCEOFHYPERTENSIONANDBEHAVIOURALRISKFACTORS
OFPERSONNELOFTHAPCHAMRAILROADWAGONMECHANICALCENTER
NguyenTonKinhThi,LHongNinh
Background:Hypertension(HT)isacommonriskfactorforcardiovasculardiseaseandalsothetopranking
cause of global deaths and diseases. Recently, the prevalence of HT in Vietnam tended to increase rapidly. In
Vietnam,theNationalTargetedProgrammeforHypertensionPreventionandControlhasbeenapprovedbythe
Prime Minister. However, hypertensive situation of the transport employees has not been investigated and
evaluated.
Objectives: To identify the prevalence of hypertension in personnel of Thap Cham Railroad Wagon
MechanicCenter,andtherelationshipsbetweentheHTandbehavioralriskfactors;Toidentifytheprevalenceof
hypertensiveswhoknowthemselvesandtreatedhypertensionamongpersonnelofThapChamRailroadWagon
MechanicCenter.
*BnhvinGTVTThpChm,NinhThun
Tcgilinlc:BS.NguynTnKinhThi T:0909965565 Email:bs.kinhthi@gmail.com
ChuynYTCngCng
51
NghincuYhc
Method:Crosssectionaldescription,samplingtheentireof153personnelofThapChamRailroadWagon
MechanicCenterin2011.
Results:TheoverallprevalenceofHTinpersonnelofThapChamRailroadWagonMechanicCenterwas
32.0%(37.7%inmenand15.41%inwomen).TherateofHTincreasedinmen,andinpersonnelwhowere
obesity and alcohol abuse. The risk behaviors in hypertensives make up a high rate, the proportions of
hypertensivesaware,treatedandcontrolledwerelow(44.8%).
Conclusion: Need to increase communication in various forms to provide knowledge and help raise the
awarenessofpersonnelinHTpreventionandcontrol.
Keywords: Hypertension; Behavioral risk factors ; Personnel; Thap Cham Railroad Wagon Mechanical
center;
TVN
Mctiunghincu
Tnghuytp(THA)lyutnguyctim
mchrtphbinvcnglnguynnhnhng
u gy t vong v mc bnh trn ton cu(14).
Mtnghincuquanstbnhnhnnhpvin
do Hi chng ng mch vnh cp trong nm
20082009VitNamchothyyutnguyc
timmchcaTHAchimn65%(7).THAnh
hng n cc nc trn tt c cc nhm thu
nhpcao,trungbnhvthp(13).Chiphiutr
THAhngnmchomingiTHAtiHoaK
l1.598USD.Chiphtnggpinuiutr
gimccyutnguyc(1).
Xc nh t l hin mc THA ca cn b
cngnhnvin(CBCNV)TTCKTXThpChm.
Tnm1960nnm1992,tlngiTHA
Vit Nam tng ln hn 11 ln. Theo mt
iutracaVinTimmchVitNamtinhnh
ngilnt25tuitrlnti8tnhvthnh
ph ca Vit Nam nm 2008 th t l THA
tng ln n 25,1%(8). Phng chng bnh THA
cChnhphVitNamavochng
trnh mc tiu quc gia v c trin khai
trn 63 tnh/thnh v m hnh d phng v
qun l bnh THA ti cng ng. Nm 2006,
trong mt nghin cu xy dng tiu chun
sckhenhnvinngsttrctipphcv
chytucghinhntlTHAl19,9%.T
nnaychacboconovtlTHAca
ccnvtrongngnhngst.tinyl
bcuthchincngvicnytrnmtn
v thuc ngnh ng st v do Bnh vin
GTVTThpChmqunllTrungtmC
khToaxe(TTCKTX)ThpChm.
52
XcnhmilinquangiaTHAvccc
trng: gii tnh, nhm tui, ngh nghip, hc
vn,boph
Xc nh mi lin quan gia THA v cc
hnhvinguyc:nmn,hotngTDTT,ht
thucl,ungru,bia,ungcph.
XcnhtlnhngngibitmnhTHA
vciutrTHACBCNVTTCKTXThp
ChmhinmcTHA.
ITNGPHNGPHPNGHINCU
Thitknghincu
S dng thit k m t ct ngang ton b
mu.
itngnghincu
Dnschnmu
Tt c CBCNV TTCKTX Thp Chm nm
2011
Tiuchavo
CBCNVTTCKTXThpChmngtham
gianghincu(invcungcpthngtinvo
bcuhi).
Tiuchloira
CBCNV TTCKTX Thp Chm khng ng
thamgianghincu,hockhinmtrongdin
phiohuytp(HA)lithkhngthchin.
ChuynYTCngCng
NghincuYhc
c tnh
Phngphpthuthpdliu
CBCNVcphtbcuhitin.Khi
khmsckhe,cngtcvino,ghinhnphn
s liu v trc tip in vo giy, ng thi
kimtra,phngvnhonthintheobcuhi.
Huyt p c o c hai tay theo Quy
trnh o huyt p ng ban hnh km theo
Quyt nh s 3192/QBYT ngy 31 thng 8
nm2010caBtrngBYt.
Mtsnhnghadngtrongnghincu
Tnghuytpkhimttronghaitaycchs
HA tm thu 140mmHg v/hoc HA tm
trng90mmHg.nmnlkhiitngc
n mn hn trong gia nh/bn b v/hoc
thngthmncmm/ncchmkhin.BMI
Theo khuyn ngh ca T chc y t th gii,
Chu,BMI25kg/m2ccoilboph(12),(13).
ChsphnBMIkhngphnbitgianam
vn.Htthuctnhtrong6thngtrli.Ung
ru,biatnhtrongvng12thngqua.
Dn tc
Tn gio
Hn nhn
nng
Cng nhn lao ng
ting n
CN khc
Kinh
Khng
Kt hn
Tn s
T l %
78
51,0
10
148
143
141
6,5
96,7
93,4
92,2
Munghincugmc153ngi,trong
74,5%lnamgii.tuiphbinl2554tui
v ch yu kt hn (92,2%). Hu ht l dn
tc Kinh v khng Tn gio. a s c trnh
cp 3 (97,6%). Nhm qun l v vn phng
chim19,6%,cnliaslcngnhnlmvic
trongmitrngnngnhcvtingn(73,9%).
Muccimchungcaccnvlaong
nng.Ktquctnhngdngcaochoccn
v, doanh nghip qun l s ng ngi lao
ng,nhtllaongnng.
T l hin mc THA v s phn b theo

ccctrng
Xlvphntchdliu
NhpliubngEpidata3.1,xlbngStata
11.1.
Dng phng php thng k m t ghi
nhncctnsut,tlphntrm.Mckt
hpcclngvitstlhinmcPR.
KTQUVBNLUN
Nhng c tnh chung ca i tng
nghincu
Bng1:Cccimvdnsxhicaitng
nghincu(n=153)
c tnh
Gii tnh
Nhm tui
Hc vn
Nhm ngh
nghip
Tn s
Nam
114
N
39
18 25 tui
6
25 34 tui
23
34 44 tui
36
45 54 tui
86
54 60 tui
2
Cp 1
2
Cp 2
14
Cp 3
121
Qun l v Vn phng
30
Cng nhn lao ng
35
ChuynYTCngCng
T l %
74,5
25,5
3,9
15,1
23,5
56,2
1,3
1,3
9,2
79,6
19,6
22,9
Hnh1:TlhinmcTHAcaCBCNVTTCKTX
ThpChm
Bng2:MilinquangiaTHAvccctrng
vdns,xhi
THA
c trng
Gii
tnh
Nhm
tui
Nam
N
18-34
35-44
T l %
C Khng THA
43
6
7
12
30
45-60
Nhm Qun l v
11
ngh Vn phng
Cng nhn
lao ng 9
nng
71
33
22
37,7
15,4
24,1
24
33,3
58
34,1
19
36,7
26
25,7
PR
(KTC
95%)
2,5
< 0,01
(1,1-5,3)
1,38
(0,6-3,1)
1,41
(0,7-2,9)
0,68
(0,4-1,3)
0,427
0,341
0,224
53
NghincuYhc
THA
c trng
T l %
C Khng THA
Cng nhn
lao ng 25
ting n
CN khc 4
Cp 1 & 2 7
Cp 3
Hc
vn
BMI
36
6
i hc
2
< 25kg/m 41
25kg/m2 8
53
6
9
32,1
40,0
43,8
85
29,8
9
98
6
40,0
29,5
57,1
PR
(KTC
95%)
0,91
(0,4-2,1)
0,833
0,70
0,345
0,87
0,645
(0,5-1,6)
1,09
0,849
(0,5-2,7)
2,83
0,035
(1,0-7,7)
T l THA ca CBCNV TTCKTX Thp

Chm l 32% (KTC 95%: 24,740,0), trong ,
naml37,7%,caohnnl15,4%.TlTHAl
32%ctincycaovphngphpchnmu
llytrnmuvsailchohuytpc
iuchnhtrcquavickimnhmyoHA
v tp hun li cho iu dng o HA. Hin
nay,ccnghincutiVitNamccngb
him c t l THA no c ghi nhn l trn
30%. Nghin cu ca nhm tc gi Phm Gia
Khi,NguynLnVit,PhmThiSnvcng
snm20012002ticctnhphaBcVitNam
ghi nhn t l THA cao nht l ti thnh ph
Vinh,chim31,9%(6).Khisosnhviccnghin
cu khc c mt s c im tng ng nh
caPhmVnHng(2006)trn4.017nhnvin
ng st phc v chy tu (THA: 19,9%)(5),
Nguyn Don Thnh, L Hong Ninh v cs
(2008)(4) 308 cng nhn Nh my Bia Si Gn
(THA:16,0%)hayTrnVnHng(2012)(11)trn
872 ngi ti huyn Ninh Hi, Ninh Thun
(15,1%)thtlTHAnghincunycngcao
hnhn(p<0,001).
TlTHAnamgiicaohnngii2,45
ln(KTC95%:1,135,31).Sovinhiunghincu
tiVitNamthtlTHAngiicanghin
cunylkhngcskhcbit.Tuynhin,t
l THA nam CBCNV TTCKTX Thp Chm
caohnnhiunghincukhcVitNam(2,6,8,9)
vcnghathngk(p<0,001).Nhvy,tl
THAchungcaCBCNVTTCKTXThpChm
cao hn cc nghin cu khc do t l THA
namgiicao.
54
TlTHAtngdntheonhmtuinhcc
nghincukhc,nhngnhmtui2544ctl
THAkhcaol30%,gphn3lnsovicc
nghin cu ca Vin Dinh dng Quc gia
(2006)(12),gp5lnvinghincutiTpHCh
Minh(2005)(10)vHoak(3).
Nhmhcvncp3ctlTHAthpnht
l29,8%.Tngt,tlTHAthpnhtnhm
cngnhnlaongnngnhcvi25,7%.Cha
tm thy mi lin quan gia THA vi trnh
hcvnvyutnghnghip(p>0,05).
TlTHAngiboph(BMI25kg/m2)
trnnghincunyl57,1%,caogp2,83lnso
vitlTHAnhmkhngboph(KTC95%
1,047,71),cnghathngkvip<0,05.Nh
vybophthtslmtyutcnhbomnh
canguycTHAngayckhixploiBMIca
ngi lao ng nng nh ngi lao ng bnh
thng.
THAvcchnhvinguyc
Bng3:MilinquangiaTHAvcchnhvi
nguyc(n=152)
Hnh vi
n mn
TDTT
C
Khng
C
THA
Khn
C
g
17 27
32 76
31 55
18
Khng
Ht thuc
Khng
24
pexact = Thnh thong
12
0,63
< 10
5
iu/ngy
10-20
4
iu/ngy
> 20
3
iu/ngy
Khng
23
Ung
ru Thnh thong 21
pexact = < 1 x/ngy
4
0,03
> 1 x/ngy
1
Ung bia
Khng
14
pexact = Thnh thong 28
0,065 < 3 lon /ngy 2
3-5 lon/ngy 4
> 5 lon /ngy 1
49
58
29
6
7
3
61
42
1
0
45
54
3
1
1
T l
PR
%
(KTC
95%)
THA
38,6
1,32
29,6 (0,80-2,19)
36,1
1,18
27,3
(0,90-1,57)
29,3
1,07
29,3
(0,61-1,88)
1,57
45,5
(0,76-3,27)
1,25
36,4
(0,53-2,95)
1,73
50,0
(0,72-4,13)
27,4
33,3
1,48
80,0 (1,1-2,0)
100
23,7
34,1
1,36
40,0
(1,1-1,7)
80,0
50,0
p
0,28
0,25
0,81
0,23
0,60
0,22
0,01
<
0,05
ChuynYTCngCng
THA
Khn
C
g
Khng
13 38
Ung c
ph
Thnh thong 26 52
pexact = < 1 ly/ngy
2
8
0,12
1-2 ly/ngy
6
6
> 2 ly/ngy
2
0
Hnh vi
T l
PR
%
(KTC
95%)
THA
25,5
33,3
20,0
50,0
100
1,25
(1,0-1,5)
<
0,05
SlinquangiaTHAvnmnkhngc
ngha thng k (p = 0,28). C th do Ninh
Thunltnhnngnngvckhhncao,
n mn l thi quen hu ht ca nhng ngi
dn y. V vy, vic xc nh n mn ti
nghincunychctnhtngi.
Vnngthlcthngxuynlmthnh
vittivingibnhTHAngthicngl
yutgimnguycTHA.TlTHAnhng
ngicTDTTl36%,caohn1,18lnngi
khngTDTT.Ktqutringcnycthdo
asccitngnghinculcngnhnlao
ng tay chn nn c hot ng th lc
thngxuynvdoskhcbitnykhng
chnhxc.Hnna,ylmtnghincuct
ngangmt,khngthxcnhnhnqugia
THAvTDTT.Cthmtsnhngngibit
hocnghingmnhcbnhTHAnnthamgia
hot ng TDTT ch khng phi hot ng
TDTTgyTHA.
KhngtmthymilinquangiaTHAv
htthuc.
nhm ung ru c t l THA bng
37,7%, gp 1,48 (KTC 95%: 1,102,00) ln so vi
nhmkhngungru(p=0,01)vckhuynh
hngtngtheomcung ru. Tng t
nh ung ru, t l ung bia CBCNV
TTCKTX Thp Chm cn cao hn vi t l
61,8%. T l THA nhng ngi ung bia l
37,2%,bng1,36ln(KTC95%:1,101,67)sovi
nhmkhngung.Lmdngru,bialhnh
vi nguy c cao ca THA, nhng iu ng lo
ngi l hin nay tnh trng ny kh ph bin
trongCBCNVnhnc.
NghincuYhc
khc. nghin cu ny ghi nhn c nhng

ngi ung c ph c t l THA l 35,3%, cao
hn nhng ngi khng ung c ph 1,25 ln
(KTC95%: 1,101,67). Tuy nhin, mi lin quan
nykhngcnghathngk.
T l cc hnh vi nguy c ca nhng CB

CNVTTCKTXThpChmbTHA
Bng4:Mttlcchnhvinguyctrnnhm
hinmcTHA(n=49)
c trng
Ht thuc l
Ung ru
Ung bia
Ung c ph
Ch n
TDTT
Khng
Thnh thong
Thng xuyn
Khng
Thnh thong
Thng xuyn
Khng
Thnh thong
Thng xuyn
Khng
Thnh thong
Thng xuyn
n mn
n bo
n ngt
n rau
C
Khng
THA
n
24
13
12
23
24
5
14
28
7
13
26
10
17
9
14
28
31
18
%
49,0
26,5
24,5
46,9
42,9
10,2
28,6
57,1
14,3
26,5
53,1
20,4
34,7
18,4
28,6
57,1
63,3
36,7
TrongsnhngngibTHA,tlnhng
ngi c hnh vi nguy c th cao hn ngi
khngchnhvinguyc.Hnhvinguycc
t l cao nht l ung c ph, chim 73,5%, k
nlungbiactl71,4%,ungruvit
l53,1%,vhtthuclctl51%.Trongs
nhng ngi hin mc THA, nhng ngi c
hnhvinmnchimt l thp (34,7%). T l
ngicthamgiaTDTTl63,3%.
Nhnchung,cchnhvinguycctlkh
cao nhm nhng CBCNV b THA. Nu
khngcstcnglmthayicchnhvi
nguycnytrnnhmbTHAskhkimsot
viutrTHAchoh.
Ung c ph l mt thi quen ca nhiu

ngi dn Ninh Thun. Ngi Ninh Thun
thng ung c ph m c hn nhiu vng
ChuynYTCngCng
55
NghincuYhc
Xc nh t l nhng ngi bit mnh

THAvciutrTHA
TrongsnhngCBCNVbTHA,tlbit
mnhbTHAl59,18%.nhmny,tlhnh
vinguycTHAcncao.TlCBCNVbitb
THAviutrTHAl44,8%.
KHUYNNGH
Tng cng cng tc truyn thng di
nhiu hnh thc nhm trao i, cung cp kin
thc v gip nng cao nhn thc ca CBCNV
trong ngnh v d phng v kim sot bnh
THA.
Hnh2:BiuthhintlCBCNVTTCKTX
ThpChmhinmcTHAbitmnhbTHA
Bng5:MilinquangiabitviutrTHAtheo
giitnh(n=29)
Gii
Nam
N
Cng
Bit v iu tr THA
n (%)
C
Khng
10 (41,7%) 14 (58,3%)
3 (60%)
2 (40%)
13 (44,8%) 16 (55,2%)
PR
(KTC 95%)
0,89 (0,621,27)
0,50
T l CBCNV bit b v iu tr THA l

44,8%.TrongsnhngnginbitbTHA,t
liutrTHAl60%.Trongkhi,sngi
nam bit b THA mc d cao hn, nhng t l
iutrTHAch41,7%.Tuynhin,skhcbit
nykhngcnghathngk(p>0,05).
Xc nh c tm quan trng ca vic

khm sc khe nh k ngi s dng lao
ng v ngi lao ng khng khm qua loa,
iph.Saukhmsckhe,phinhgikt
qu tnh hnh bnh tt ca CBCNV, nht l
THA,cxutgiiphpkimsot.
CncnhngnghincuthmvTHAsu
rnghnCBCNVtrongngnh,nghincuv
kinthcvthchnhvTHAtmnguyn
nhn t l THA cao trong CBCNV, thng qua
cxut,khuynnghcthccbinphp
gimtlTHAvtngtlbit,iutrTHA.
TILIUTHAMKHO
1.
KTLUN
2.
Vi phng php m t ct ngang ly trn

mu trn 153 ngi l CBCNV Trung tm c
kh Toa xe Thp Chm, nghin cu ny ghi
nhncnhngktqusau:
3.
TlTHAchungcaCBCNVTrungtmc
kh Toa xe Thp Chm l 32,0%. T l ny cao
hnnhmCBCNVlnamgiihocngib
boph.
TlTHAnhmungrul37,7%,gp
1,48lnsovinhmkhngungru(p=0,01)
v c khuynh hng tng theo mc ung
ru.
Cha tm thy mi lin quan gia THA v
cchnhvinguyckhcnhnmn,ungbia,
ungcph,htthuc,TDTT.
56
4.
5.
6.
7.
Chouihi R, Dakhlaoui F, Farhaoui SE (2012) Projet de

mdecine communautaire Lhypertension artrielle. Facult
demdecineibnalJazzarSousse
ChuHngThng(2009)NghincuthctrngbnhTHA
v mt s ri lon chuyn ho ngi THA ti x Ha
Thng,huynngH,tnhThiNguyn.LunvnThcs
Yhc.
FieldsLE.,BurtVL,CutlerJA.,HughesJ,RoccellaEJ,Sorlie
P.(2004) The burden of adult hypertension in the United
States1999to2000:arisingtide.Hypertension,44,(4),398404.
Nguyn Don Thnh, L Hong Ninh, Phng c Nht,
DngTiuPhng,PhanGiaCng(2008)Tnhtrngsc
khevccyuthnhvilinquancacngnhnnhmy
bia Si Gn nm 2008.Y hc Thnh Ph HCM, tp 12, ph
bns22008:229233.
PhmVnHng(2006)Xydngtiuchunsckhenhn
vinngsttrctipphcvchytu.tiNCKHcp
BGTVT.
PhmGiaKhi,Nguyn Ln Vit, Phm Thi Sn, Nguyn
Ngc Quang, Nguyn Th Bch Yn v cs (2003) Tn sut
tnghuytpvccyutnguyccctnhphaBcVit
Nam nm 2001 2002. Tp ch Tim mch hc Vit Nam, 33,
(thng3/2003),tr934.
PhmNguynVinh,NguynLnVit,TrngQuangBnh,
H Thng Dng, Nguyn Thanh Hin, Chu Ngc Hoa,
Phm Th Kim Hoa, Quang Hun, Phm Mnh Hng,
PhmThanhPhong,BiHuMinhTr(2011)NghinCu
Quan St iu Tr Bnh Nhn Nhp Vin Do Hi Chng
ChuynYTCngCng
8.
9.
10.
ng Mch Vnh Cp. Tp ch Tim mch hc Vit Nam, Hi

TimmchVitNam,58,tr1225.
SonPT,QuangNN,VietNL,KhaiPG,WallS,WeinehallL,
Bonita R, Byass P (2012) Prevalence, awareness, treatment
and control of hypertension in Vietnamresults from a
nationalsurvey.JHumHypertens,26,(4),26880.
TNgcCu(2008)iutratnsut,ccyutnguycv
ccgiiphpchatrbnhtnghuytptitnhVnhPhc.
tiNCKHcptnh.
TrnThinThun(2007)Hnhvivnhngyutlinquan
ntnghuytpngilntiThnhphHChMinh.
Lun n Tin s Y hc, i hc Y Dc Thnh ph H Ch
Minh.
ChuynYTCngCng
11.
12.
13.
14.
NghincuYhc
TrnVnHng(2012)nhhngcahnhvivlisng
lnbnhtnghuytpngitrngthnhtihuynNinh
Hi,tnhNinhThun.LunvnChuynkhoaIYTCC,ih
YdcTP.HCM.
VinDinhdng(2011),nhgivphnloitnhtrngdinh
dng ngi ln, http://viendinhduong.vn/news/vi/37/23/a/bangphan-loai-bmi.aspx,truycpngy15/6/2012.
WHO (2004) Appropriate bodymass index for Asian
populations and its implications for policy and intervention
strategies.TheLancet,363,157163.
WHO (2009) Mortality and burden of disease attributable to
selectedmajorrisks,925.
57
NghincuYhc
CCYUTXHINHHNGSCKHETREM610TUI
TITHNHPHSCTRNG,TNHSCTRNGNM2011
LHongNinh*,VngThunAn*
TMTT
t vn :Sckhetremlmtyuthtscquantrng,ycnglmttrongnhngchs
nhgisphttrincamtqucgia.ivitremt610tuithccthiquenvhnhvixunh
hngnsckhechanhiu,cucsngcaccemchyuphthucvochamhocnginuidng
trctipvgiodc,chucp,vcnhngtcngcamitrngxungquanh.Chnhvvy,ccyut
nhhngnsckhecatremcthchnhlbtnguntcciukinsnghayccyutxhilm
nhhng,theoccnghincuvtngktcaTchcYtthgii(WHO)tinhiuqucgiatrnkhp
ccChulcchothyccyutxhinhhngnhiunhtnsckheconnginhtlsckhetr
eml:snghoi,giodc,iukinmitrngsngvkhnngtipcnytkm.
Mc tiu nghin cu: Xcnhccyutxhinhhngnsckhetrem610tuitithnh
phScTrng,tnhScTrngnm2011.
Phngphpnghincu:Thitknghincu:ctngangmt,cmuctnhtheocngthcc
lngmttlvhsthitkk=1.5.
Kt qu: Kho st c thc hin vi 640 tr v cha, m hoc ngi nui dng trc tip ca tr.
26,1%tremcsckhechatt,25,9%tremcbnhttphthinquaqutrnhkhmbnhtngqut
titrng.Quaktqunghincu11,4%tremsuydinhdng,5,6%trembthacnv4,2%trb
boph.Cmilinquangiatnhhnhnhimxungquanhnhvitnhhnhbnhttcatr(p<0,05,
PR=1,4),trsdngncmyvncgingcsckhetthntremsdngncsnggp1,5ln.
Tremsinhsngtrongnhngdngnhkincnhnhgch/ngickhnnggimthiucbnhtt
1,3lnsovitremsngtrongnhl(p=0,01).
Ktlun:isngngidntithnhphScTrngcnhiuthayivphttrin.Tuynhin,
vncnrtnhiuyutxhinhhngnsckhengidnnhtlitngtremnhngun
nc,dngnh,tnhtrngnhim,thunhpkinhthgianhthp.Vvy,cnsquantmcithin
khngchchnhngidn,ccbcchammcncncsgipavohochnhthnhchnhsch
cachnhquynaphng.
Tkha:Ccyutxhinhhngsckhe,trem
ABSTRACT
SOCIALDETERMINANTSOFHEALTHSTATUSOFCHILDRENAGED610YEARSOLD
INSOCTRANGCITY,2011.
LeHoangNinh,VuongThuanAn
*YHocTP.HoChiMinh*Vol.16SupplementofNo32012: 58 - 64
Background:Childrenshealthisveryimportant;itisoneoftheindicatorsofacountrysdevelopment.
Children from 610 years old do not have many bad habits that affect their health. Their wellbeing,
VinVSinhYTCngCngTp.HCM
Tcgilinlc:CN.VngThunAn T:0946260107
58
Email:benhnghenghiep@gmail.com
ChuynYTCngCng
NghincuYhc
education and healthcare are taken careofmainlybytheirparentsorpatrons.Therefore,factorsthataffect

theirhealthcanbethelivingconditionsorothersocialdeterminantsofhealth.ResearchoftheWorldHealth
Organization (WHO) in different countries and continents show that the major social determinants of
childrens health are poverty, low levels of education, poor environmental sanitation, and limited access to
healthcare.
Objectives:TodeterminetheeffectofsocialdeterminantsonhealthstatusofchildreninSocTrangcity.
Methods: A crosssectional design based on a simple random sampling was applied, with design
coefficientk=1.5.
Results: A survey on 640 children with parents or caregivers was conducted. The proportion of
childrenhavingpoorhealthstatusaccountfor26.1%.Basedontheresultsofgeneralexaminationatschool,
25.9%ofchildrenhaddiseases.ResultoftheBMIstatusofchildrenshowedthat:11.4%underweight,5,6%
overweight,and4.2%obesity.Resultsshowedthattherewasastatisticallysignificantrelationshipbetween
inadequateenvironmental sanitation and childrens health(theproportionofchildreninpoorhealthstatus
inhouseholdswithpollutedsurroundingis1.4timeshigherthanthatofhouseholdslivingingoodsanitary
conditions(p<0,05;OR=1.4).Childrenlivinginbrickhouses,apartmentbuildings,andtileroofedhouses
havebetterhealththanchildrenlivinginthatchedhouses(p<0.05).Childrenwhosefamiliesusingtapwater
andwellwaterreduceddisease1.5timesthanchildrenusingwaterfromriver.
Conclusion: Despite much improvement in living standards of people in Soc Trang, there are still
severalsocialfactorsthataffectpeopleshealth,especiallythatofchildren,suchassourcesofwater,typesof
housing, levels of pollution surrounding their houses, income level of households. Efforts, therefore, are
required of not only the people themselves and parents but also of the local government, to integrate
improvementofchildrenshealthintolocalpoliciesandplans.
Keywords:socialdeterminantsofhealth,children.
TVN
Sckhetremlmtyuthtscquan
trng, y cng l mt trong nhng ch s
nhgisphttrincamtqucgia.Ngay
tnhnggiaionuikhitrt05tui,
tr la tui tiu hc (610 tui), tr la tui
trunghccs(1115tui)trchtrtt
pht trin y v c mt th cht ln
tinh thn s l ngun ng lc mnh m cho
trtrongnhnggiaiontiptheovtrongc
cuci.
Theo cc nghin cu v tng kt ca T
chc Y t th gii (WHO) ti nhiu quc gia
trnkhpccChulcchothyccyutx
hi nh hng nhiu nht n sc khe con
nginhtlsckhetreml:snghoi,
giodc,iukinmitrng,khnngtip
cnytkm.ivitremt610tuithcc
thi quen v hnh vi xu nh hng n sc
khe cha nhiu, cuc sng ca cc em ch
ChuynYTCngCng
yu ph thuc vo cha m hoc ngi nui

dng trc tip v gio dc, chu cp, nui
dngv c chm sc sc khe. Chnh v
vy, cc yu t nh hng n sc khe ca
tr em c th chnh l bt ngun t cc iu
kin sng hay cc yu t x hi lm nh
hng.Tuynhin,tiVitNamchacnhiu
nghin cu v vn ny, nht l trn i
tng tr em t 610 tui, la tui ca s
chuyn tip v to pht trin cho cc giai
onphttrintiptheocacuci.
Thnh ph Sc Trng l mt thnh ph
vamicthnhlpcatnhScTrng,l
mtthnhphadntc,ngoidntcKinh
chim65,3%,ngidntcycngchim
kh ng nh ngi Khmer chim 28,9%,
ngi Hoa chim 5,9%...chnh v s a vn
ha, a truyn thng cng to nn s khc
nhautrongcchthcnuidngvchmsc
con ci trong mi gia nh. C cu kinh t
chnhcatnhcngnhthnhphScTrng
59
NghincuYhc
llmnngnghipvngnghipkthpvi
mt s dch v. Kinh t ca tnh cng nh
thnhphcngpnhiukhkhn,giaothng
trong tnh cn cha thun li nht l cc
huyn, mc bao ph v tip cn vi y t
ca ngi dn cn thp. Tt c nhng yu t
trncthnhhngnsckhetremt
610tuitiy.
ITNGPHNGPHPNGHINCU
Ctngangmt
Cmuctnhtheocngthc:
n=Z
2
(1
2)
Sc khe ca tr
PR
Tt
Cha tt (KTC
95%)
Bnh tt ca m
25 (29,8%) 59 (70,2%)
1,2
140
410
(0,7-2,1)
(25,5%)
(74,6%)
0,4
Thi quen
KTQU
Tnhhnhsckhecatr
Bng 1. Tnh trng sc khe ca tr (n=640)
Tn s
T l %
BMI
504
73
36
27
78,8
11,4
5,6
4,2
C
Khng
114
526
17,8
82,2
Bnh tt
C
Khng
166
474
25,9
74,1
Nhp vin nm va qua
Ht thuc
Ung ru
Ht thuc v
ung ru
Khng ht
thuc, ung
ru
473
167
73,9
26,1
Qua kho st v ch s khi c th (BMI)

ca tr em cho thy, c 78,8% tr em c BMI
bnh thng, trong khi tn ti song song
tnhtrngsuydinhdngvthacnboph
ca tr, vn cn 11,4% tr em b suy dinh
dng, tnh trng tr em b tha cn v bo
phtrctllnltl5,6%v4,2%.Qua
qutrnhkhmbnhphthinc25,9%tr
em610tuicmcccbnhhocttchyu
1 (25%)
1 (33,3%)
3 (75%)
2 (66,7%)
0 (0,0%)
0 (0,0%)
163
(26,0%)
464
(74,0%)
Ngh nghip
Nng dn
21 (33,9%) 41 (66,1%)
CNVC
24 (27,6%) 63 (72,4%)
Doanh nhn 5 (29,4%) 12 (70,6%)
126
Bun bn
38 (23,2%)
(76,8%)
Cng nhn
4 (11,4%) 31 (88,6%)
152
Tht nghip 56 (26,9%)
(73,1%)
Lm thu
13 (32,5%) 27 (67,5%)
Khc
4 (19,1%) 17 (80,9%)
Hc vn
M ch
Cp 1
Sc khe chung
60
Bng2.Milinquangiatnhtrngcacham
vsckhecatr
Khng
Vi p = 0,5; d = 0,05 v h s thit k k =

1,5,tacN=640.
Tt
Cha tt
ctnhvtnhtrngcachamvsc
khecatr
p (1 p )
d2
Bnh thng
Suy dinh dng
Tha cn
Bo ph
l cc nhm bnh v rng hm mt, tai mi

hng, da liu, h hp v cc bnh tt do hc
ng nh: cn th, lon th, cong vo ct
sng.
Cp 2
Trn cp 3
S con
1-2 con
3 con
0,9
0,4
43 (34,4%) 82 (65,6%)
1
1,1 (0,85 0,5
12 (29,3%) 29 (70,7%)
-1,36)
171
1,1 (0,97 0,09
59 (25,7%)
(74,3%)
-1,30)
187
1,2 (1,03- 0,01
51 (21,4%)
(78,6%)
1,40)
134
397
0,3
(25,2%)
(74,8%) 1,2 (0,831,80)
31 (30,1%) 72 (69,9%)
Tltrcsckhetttrongnhmbm
chcvncp3vtrncp3caogp1,2ln
sovitltrcsckhetttrongnhmb
ChuynYTCngCng
m c trnh hc vn cp 1, vi p = 0,01,
(KTC95%:1,031,40).
iukinsngvsckhecatr
Bng 3. Milinquangiaiukinsngvsc
khecatr
Sc khe ca tr PR (KTC
Tt
Cha tt 95%)
nhim
Khng
C
363
(75,8%)
110
(68,3%)
116
(24,2%)
51
(31,7%)
1
1,5 (1,06Nc ging 55 (74,3%) 19 (25,7%)
1,98)
357
108
1,5 (1,13Nc my
(76,8%)
(23,2%)
1,99)
1,3 (0,91Nc ma 26 (66,7%) 13 (33,3%)
1,86)
1,4 (0,94Khc
11 (73,3%) 4 (26,7%)
2,17)
Bnh tt ca tr PR (KTC
95%)
C
Khng
nhim
C
0,02
<0,05
0,14
0,08
Khng
Nc sng
Nc ging
Nc ma
Nh gch/ngi
0,2
405
130
(75,7%)
(24,3%) 1,1 (1,02 - 0.02
1,20)
Tm tr
68 (64,8%) 37 (35,2%)
Khng gian sng
337
104
> 12 m2
(76,4%)
(23,6%) 1,2 (1,02
0,03
1,30)
136
12 m2
63 (31,7%)
(68,3%)
Thng tr
Cmilinquancnghathngkgia
ngunncgianhsdngvtnhhnhsc
khecatrvip=0,03.Trong,tltrem
csckhettticcgianhsdngnc
mynhiugp1,5lnsovitltremcsc
khettticcgianhsdngncsng(p
<0,05,KTC95%:1,131,99).Tngtnhvy
tathytlcsckhettcanhngtrem
trongccgianhsdngngunncging
caogp1,5lnsovitltremcsckhe
tt trong cc gia nh s dng ngun nc
sng(p=0,02,KTC95%:1,061,98).Khngtm
77
(47,8%)
172
(35,9%)
84
(52,2%)
307
(64,1%)
1,4
(1,101,87)
<0,01
Ngun nc
Nc my
Dng nh
ChuynYTCngCng
Bng4.Milinquangiaiukinsngvbnh
ttcatr
1,1 (0,981,23)
24 (51,1%) 23 (48,9%)
367
117
(75,8%)
(24,2%)
Nh chung c 18 (75,0%) 6 (25,0%)
Nh l
85 (66,9%) 42 (33,1%)
Nh sn
3 (60,0%) 2 (40,0%)
Tnh trng c tr
thyskhcbitcnghathngkvtl
tr em c sc khe tt gia cc gia nh s
dng ngun nc ma (p = 0,14) hay cc
ngunnckhctknhrch,ao,h(p=0,1)
vitltremkhemnhtrongccgianh
sdngngunncsng.
0,06
Ngun nc
Nc sng
NghincuYhc
Khc
35
(74,5%)
27
(36,5%)
165
(35,5%)
17
(43,6%)
12
(25,5%)
47
(63,5%)
300
(64,5%)
22
(56,4%)
10
5 (33,3%)
(66,7%)
1
0,5 (0,34<0,01
0,69)
0,5 (0,38<0,01
0,58)
0,6 (0,39<0,01
0,86)
0,4 (0,210,03
0,93)
Dng nh
68
1
(53,5%)
16
0,7 (0,39Nh chung c 8 (33,3%)
(66,7%)
1,30)
180
304
0,8 (0,64Nh gch/ ngi
(37,2%) (62,8%)
0,90)
0,8 (0,28Nh sn
2 (40,0%) 3 (60,0%)
2,56)
Tnh trng c tr
Nh l
59
(46,5%)
194
(36,3%)
55
Tm tr
(52,4%)
Khng gian sng
337
> 12 m2
(76,4%)
136
12 m2
(68,3%)
Thng tr
341
(63,7%) 0,8 (0,820,96)
50
(47,6%)
0,2
0,04
0,7
0,01
104
(23,6%) 1,2 (1,02
0,03
1,30)
63
(31,7%)
tnhhnhnhimxungquanhnhcatrv
tnhhnhbnhttcatrvip<0,01;PR=1,4
(KTC95%:1,101,87).Tlbnhttcanhng
61
NghincuYhc
tr em c nh b nhim xung quanh nh

caogp1,4lnsovinhngtremsngtrong
nhxungquanhkhngctnhtrngnhim.
Tltremcbnhttticcgianhs
dngngunncmyvncgingctl
bnhttgim2ln(p<0,01)sovitltrem
c bnh tt ti cc gia nh s dng ngun
ncsng.Tltremcbnhttticcgia
nh s dng ngun nc ma v nc khc
(ao, h) c t l bnh tt gim ln lt l 1,7
ln(p<0,00)v2,5ln(p=0,03)sovitltr
emcbnhttticcgianhsdngngun
ncsng.
khnggiansngvtnhhnhbnhttcatr
vip=0,02.iunychothytltremc
bnhttsngtrongccgianhckhnggian
sng<12m2caogp1,2lnsovitltrem
c bnh tt sng trong cc gia nh c khng
giansng12m2
Bng5.Milinquangiakinhtgianhv
bnhttcatr
Bnh tt ca tr PR (KTC
95%)
Khng
C
TNHT ca m
0-800.000
> 800.000
135
(58,2%)
253
(62,9%)
97
(41,8%) 1,2 (0,861,71)
149
(37,1%)
33
(70,2%)
353
(60,9%)
14
(29,8%) 0,6 (0,301,30)
226
(39,1%)
0,2
> 800.000
Kh
Trung bnh
Ngho
Rt ngho
19
8 (29,6%)
(70,4%)
69
51
(57,5%) (42,5%)
191
107
(64,1%) (35,9%)
87
50
(63,5%) (36,5%)
25
33
(43,1%) (56,9%)
1,6 (1,112,39)
1,3 (0,951,86)
1,5 (1,092,02)
1,5 (1,062,03)
0,2
0,01
0,09
0,01
0,02
T l tr em khng c bnh tt trong cc

gianhckinhtgiucaogp1,6lnsovi
t l tr em khng c bnh tt trong cc gia
62
Sc khe ca tr PR (KTC p
95%)
Tt
Cha tt
BHYT
Khng
C
44 (29,9%) 103 (70,1%) 1,2 (0,890,2

1,64)
123 (25,0%) 370 (75,0%)
0,9
Ni khm cha bnh
CSYT cng
CSYT t
T cha
CS YHCT
Khng cha
74 (24,8%) 225 (75,2%)

70 (26,8%) 191 (73,2%)
11 (28,9%) 27 (71,1%)
5 (29,4%) 12 (70,6%)
7 (28,0%) 18 (72,0%)
iukinhctpvsckhecatr:
Bng7.Milinquangiaiukinvsckhe
catr
Sc khe ca tr PR (KTC
95%)
Cha tt Tt
p lc hc tp
Khng
Tnh trng kinh t

Giu
Bng6.Milinquangiachmscytvbnh
ttcatr
TNHT ca cha
0-800.000
nh rt ngho vi p = 0,01, KTC 95% (1,11

2,39).Bncnh,cskhcbit c ngha
thng k v t l tr em khng c bnh tt
trongccgianhkinhttrungbnhvccgia
nhkinhtrtngho(p=0,01).iunycho
thy t l tr em khng c bnh tt trong cc
gianhckinhttrungbnhcaogp1,5ln
sovitltremkhngcbnhtttrongcc
gianhrtngho.
39
(34,5%)
128
(24,3%)
74
(65,5%)
399
(75,7%)
0,02
1,5 (1,062,10)
Quakhostchothycmilinquanc
nghathngkgiatnhtrngplchctp
(ctrcmnhn)vtnhhnhsckheca
tr (p = 0,02), t l tr c sc khe cha tt
trong nhm tr c p lc hc tp cao gp 1,5
ln so vi nhm tr khng c p lc hc tp,
viKTC95%:1,062,10.
BNLUN
KhostvchsBMIcatrchothyt
lsuydinhdngcatrem610tuivncn
mc cao 11,4%, tuy nhin tnh trng tha
cn, bo ph ca tr xut hin kh cao (5,6%
thacn v 4,2% bo ph). iu ny cho thy
ChuynYTCngCng
tnhtrngsuydinhdngvthacnboph
tr em ang tr thnh gnh nng kp
khngchccthlnnhThnhphH
ChMinh,HNimcnnhngthmi
nhthnhphScTrng.
Quaktqukhmbnhchothytlcc
emmcccbnhhocttkhcaol38,9%vi
nhiuloibnh/ttnh:taimihng,daliu,
rnghmmt,bnhvmt.Hin nay trn c
nc cha c s liu thng k v tnh hnh
bnhttcngnhmhnhbnhttcatrem
nichungvtremlatuitiuhcniring.
Tuy nhin, gn y B Y t v B Gio dc
o to va ban hnh thng t lin tch s
18/2011/TTLTBGDTBYT ngy 28/4/2011 v
vic nh gi cng tc t chc y t ti trng
hccquynhnhtrngphitchckhm
sc khe nh k cho cc em hc sinh, cho
thyccvnsckhecatremngycng
cquantmhn,ctchcthmkhm
quy m hn, nghim tc hn v c s gim
st.
Quakhostchothycn25,2%hgia
nh phi sng gn cc ngun nhim xung
quanhnhnhnhimsngngi,knhrch,
bircthi.Gnngunnhimmitrngc
thgyrabnhttchosckheconngim
trong i tng nhy cm nht l tr em.
Theo T chc Y t Th gii, nhim mi
trng,nhimvngunnc,cciukin
vsinhkm,nhimdoccchtchi,cc
vcttruynbnhlccnguycchnht
mi trng nh hng n sc khe tr
em(2)(3).
Vvnngunncsdngsinhhot,
nghin cu cho thy c 72,7% s tr em ti
thnhphScTrngcsdngncmy.
iunychothytlbaophncmy
c thnh ph Sc Trng ch trng. Tuy
nhin vn cn nhng h gia nh s dng
nhng ngun nc khc nh nc sng
(7,3%),ncging(11,6%)vccngunnc
khc nh nc knh rch trong sinh hot v
n ung, a s nhng h gia nh ny ven
ChuynYTCngCng
NghincuYhc
sng hoc nhng khu xa trung tm, hoc

chaciukinkinhtycths
dng c ngun nc my. Cc bnh t
ngunnhimncgyralbnhtiuchy,
hi chng l, cc bnh v da, vim kt mc(4).
Chnh v vy, khuyn khch v to iu kin
chongidnnhtltremtipcncvi
ngunncschlmtiuhtsccnthit
gipgimthiubnhttvnngcaosckhe
chotrem.
Tr em sinh sng trong nhng dng nh
kin c nh nh gch/ngi c kh nng gim
thiucbnhtt1,3lnsovitremsng
trongnhl(p=0,01).Nhngloihnhnhl
ny khng c xy dng bng nhng vt
liu vng chc v bn, thiu an ton v cht
chi.Sngtrongccloihnhnhnytrem
c th i mt vi nhng mi nguy v sc
khenhcthbccloicntrngcn,t
dnnccbnhnhstxuthuyt,ccbnh
ngoi da... Bn cnh nhng ngi nh ny
thng thiu cc iu kin sinh hot d l c
bn nht nh ngun nc sch s dng,
in sinh hot, nh v sinh tiu chun.
Ttcnhngyutnyucthnhhng
nsckhecaccemvvy,toccho
tremsngtrongmtnginhbnchcvan
ton s to iu kin rt nhiu cho s pht
trincatr.
Kho st cho thy c mi lin quan c
nghathngkgiatnhhnhbnhttcatr
c kho st v tnh trng kinh t ca gia
nh, tr em sng trong cc gia nh giu c
hoc trung bnh c th gim thiu c bnh
ttlnltl1,6v1,5lnsovitremsng
trongccgianhrtngho(p<0,05)(bng5).
Tremsngtrongccgianhnghokhchu
rtnhiuthitthitrongchmscyt,cth
cha m bn lm vic kim tin khng c thi
gianchmscsckhechoccem,khngc
iukinchoccemikhmbnhthngk
pht hin bnh tt, hoc c khi bit tr em
b mc bnh th iu kin v kinh t cng
khng cho php cha tr cho cc em n ni
63
NghincuYhc
n chn. Chnh v vy, h tr cho cc em

ngho c khm cha bnh min ph hoc
min gim l to iu kin gip tr em c
c tnh trng sc khe tt hn, nht l i
vi tr em trong nhng giai on pht trin
ui.
KINNGH
T nhng kt qu ca nghin cu, chng
ti a ra nhng khuyn ngh sau gp
phncithinchtlngcucsng,cithin
tnh trng sc khe ca tr em 610 tui ti
thnhphScTrng,tnhScTrng.
Thnh ph Sc Trng cn ci thin cht
lngdngnhchonhngtremangsng
trong nhng h gia nh c ng tm b ti
nhngnginhthiukincnhnhl,nh
chi.
Chnh quyn a phng v ph huynh
cn ch ng pht hin ngun nhim v c
bin php ngn nga nhim mi trng
xungquanhnh,nhtlccngunnhimt
rcthi,cngrnh,ncsng,knhrch
ThnhphScTrngcnkhuynkhchv
to iu kin cho ngi dn c s dng
ngun nc sch trong sinh hot nh nc
my t h thng thy cc, i vi nhng h
gianhsdngngunncsngtrongsinh
hot th hng dn h cc bin php n chn
ungsi,vkhkhunngunnctrckhi
sdngphngngabnhtt.
Tngngunthunhpkinhthgianh,
to thm cng n vic lm, nht l cho i
tngphnhcthmthunhpchobn
thnvgianh.
Nngcaotrnhhcvnchongiph
n h c kin thc chm sc tt cho con
nhtltrongchmscyt.
Tng cng cng tc y t ti trng hc:
mitrngnnc1nvyttrnghcc
cn b lm cng tc y t ring khng kim
nhim, khm cha bnh kp thi cho hc
sinh,kimtrakhmsckhenhkchohc
sinhminmphthinbnhttcngnh
tnhhnhsckhecahcsinh.Htrchotr
em 610 tui trong vn chm sc rng
ming ti trng, phng chng cc bnh nh
cc bnh v mt, tai mi hng, rng ming,
bnhvda.
Thng bo cho cc bc ph huynh bit v
tnhtrngdinhdngcaconci,nhtli
vi nhng tr ang mt cn bng trong tnh
trng dinh dng (suy dinh dng v tha
cnboph),vtvndinhdnghplnu
cn.
TILIUTHAMKHO
1.
2.
3.
4.
Cc Y t d phng Vit Nam, UNICEF (2007). Tm tt

iutrathctrngvsinhmitrngvvsinhcnhn
nngthnVitNam.
Tpchchnhschyt(2008),iukinvsinhkmnh
hngncucsngcatremnngthnVitNam
WorldHealthOrganizationWesternPacificRegion(2004),
Reaching the poor challenges for TB programmes in the
WesternPacificRegion
WorldHealthOrganizationWesternPacificRegion(2006),
Intergrating Poverty and gender into health
programmes.
64
ChuynYTCngCng
NghincuYhc
HNHVIPHNGNGAUINCCANGICHMSCTR
DI11TUITIHUYNANPHTNHANGIANGNM2011
NguynNgcDuy*,LHongNinh*,NguynThLinhn*
TMTT
tvn:uinclmttrongnhngnguynnhngytvonghngutremtrnthgiiv
VitNam.Trongccyutnguyclinquannuinctremthhnhviphngngauinccaba
mhocnhngngithntronggianhtrngvaitrhtscquantrng.cnhiunghincutrnth
giitmhiuvcchnhviny,tuynhintiVitNamvicnghincuvncnchacquantmng
mc.
Mctiu:Mthnhviphngngauincngichmsctrdi11tuitihuynAnPhtnh
AnGiangnm2011.
Phngphpnghincu:Ctngangmttrn453ngichmsctrdi11tuitihuynAnPh
tnhAnGiangtthng78/2011.Sdngphngphplymucmhaibcchnmuvbcuhison
snthuthpsliu.
Ktqu:Mtshnhviphngngactlthchincnthp(lmrochnkhuvcsngnc:27%;
hnhviphngngakhibnvicnh:28,3%;mcophaochotr:39%).Giahnhviphngngavccyut
nhkinthc,tuingichmsc,dntc,giitnhngichmsc,miquanhvitr,tuitr,vkinthc
vuinccmilinquancnghathngk(p<0,05).
Ktlun:Cntinhnhccnghincusuhntmhiumilinhgiahnhviphngngavcc
yutlinquanngthitngcngcngtcgiodctruynthngphngngauincnhmnngcao
kinthccangichmsctr.
Tkha:uinc,hnhviphngnga,ngichmsc
ABSTRACT
THEDROWNINGPREVENTIVEBEHAVIOUROFCAREGIVERSOFCHILDRENUNDER11YEARS
OLDINANPHUDISTRICT,ANGIANGPROVINCEIN2011.
NguyenNgocDuy,LeHoangNinh,NguyenThiLinhDon
Background:DrowningisoneofleadingcausesofdeathinchildrenallovertheworldincludingVietnam.
Of factors related to drowning, the drowning preventive behaviour of caregivers in family is particularly
important.Althoughtherehavebeenmanyworldwideresearchesconductedtostudythepreventivebehaviourof
caregivers,theunderstandingofthesekindsofbehaviourisstilllimitedinVietnam.
Objectives:Describethedrowningpreventivebehaviourofcaregiversofchildrenunder11yearsoldinAn
Phudistrict,AnGiangprovincein2011.
Methods:Acrosssectionalstudywasconductedon453caregiverswhotookcareofchildrenunder11years
oldfromJulytoAugust2011inAnPhudistrict,AnGiangprovince.Clustersamplingwasappliedtochoosethe
sampleandstructuredquestionnairewasusedtocollectdata.
Result: Respondents had a low percentage of doing some drowning preventive behaviours (making fence
around the part of house adjacent to river water: 27%; doing preventive behaviour when doing houseworks:
VinVSinhYTCngCngTPHChMinh
Tcgilinlc:Ths.NguynNgcDuy T:0908929001
ChuynYTCngCng
Email:duyngocnguyen1982@gmail.com
65
NghincuYhc
28.3%; putting lifejacket for children: 39%). There were statistical significant associations between some
drowning preventive behaviours and potential factors such as knowledge of drowning prevention, age of
caregivers,ethnic,sex,therelationshipwithchildren,ageofchildren,andknowledgeofdrowningprevention.
Conclusion:Itisneccessarytoconductfurtherstudiestoinvestigatetherelationshipsbetweenthesekinds
ofbehaviourandpotentialfactors.Moreover,localhealthpreventivecentershouldenhancehealthpromotionand
educationondrowningpreventionsothattheknowledgeofpeopleonthisisuecouldbeimproved.
Keywords:drowning,drowningpreventivebehaviour,knowledgeofdrowningprevention,caregivers
TVN
ITNGPHNGPHPNGHINCU
Trn th gii ui nc l mt trong nhng

nguynnhngytvonghngutrem.(12,13)
Ring ti Vit Nam, kt qu mt cuc kho st
ca trng i Hc Y T Cng Cng H Ni
ctinhnhtrntonqucvonm2001cho
thytlchtuitreml39,2/100.000tng
ng12.500cachtui.Tlnycaogp10
lnsoviccncphttrin(8,9,10).
Nghincusdngthitkctngangmt
trnitnglngichmsctrdi11tui
tihuynAnPhtnhAnGiangnm2011.
Trongccyutnguyclinquannui
nc tr em th hnh vi phng nga ui nc
cabamhocnhngngithntronggianh
trngvaitrhtscquantrng.cnhiu
nghincutrnthgiichrarngchtuitr
emaphnldochamhocngithnkhng
thchincchnhviphngngany(6,11,4,7).
Tuynhinti Vit Nam, vic nghin cu v
hnh vi phng nga ngi chm sc tr vn
chacquantmngmc.Ccnghincu
v ui nc thng tp trung vo cc yu t
dchthcuinctremhnlcchnhvi
phng nga ca ngi chm sc(2,3,5). iu ny
cho thy cn phi c mt nghin cu m t chi
tit,yhnvcchnhviphngngaui
ncngichmsctrvcnglmcch
chnhcanghincuny.
Nghin cu c trin khai ti huyn An
Ph tnh An Giang l mt huyn thng ngp
nngvomalvscachtuicngkhcao
so vi cc huyn khc ca tnh. Nh vy, vic
kho st cc thng tin lin quan n hnh vi
phngngacangichmsctrtiAnPhs
ckhnngchoktquchnhxcvcngha
hn.
66
Cmuctnhtheocngthc
n=Z2(1/2)
p (1 p )
d
pcchnl0,23.yltllmrochn
cacchgianhctr<5tuitrongnghin
cucangVnChnhvcngs(1).Vitin
cy l 95% th Z1/2 = 1,96. chnh xc (sai s
chophp)d=0,05.Nhnvihsthitkl1,4.
Nhvyn=384.Tng20%cmutrliucho
nhngsliubsaist,nhngtrnghptchi
trlihocvngmt.Nhvytngsmucn
thuthpln=384x120%=461ngi.
S dng phng php ly mu cm, mi
cm l mt p, chn 30 cm, tng ng 30 p.
lp danh sch cc h c tr di 11 tui trong
ttcccprichntheophngphpPPS
c c danh sch 30 p. Vi c mu l 461,
chiaucho30pcchn.Nhvy,mip
cchnsiutra15hoc16hgianhc
condi11tui.
Phng vn trc tip mt i mt vi i
tng iu tra thu thp thng tin bng b
cuhing.
S dng phn mm Epidata 3.1 nhp
liuvphnmmStata10phntchsliu.
mtnbinivicchnhviphng
nga, c tnh ngi chm sc, c tnh tr
v.v,sdngbngphnphi tn sut. m
tmiquanhgiahaibin,sdngbng2x
2trnhbyphnbtlngthisdng
phpkimchibnhphngkimnhmi
ChuynYTCngCng
lin quan v tnh PR (KTC 95%) o lng
mcquanhgiahaibin.
KTQUVBNLUN
Cc yu t lin quan n hnh vi phng
ngauinc
c, bit vit cng cao chim n 18,5%. iu

ny gi trnh hc vn ca ngi dn ti
huynAnPhvnchacaoviunycth
nhhngtrctipnkinthcvhnhvica
htrongvicphngngauinctrem.
Bng2:ctnhcatr(n=453)
Bng1:Ccctnhcangichmsc(n=453)
c tnh
Tui
Gii tnh
Dn tc
Trnh
hc vn
Ngh
nghip
Mi quan
h vi tr
Tn s
T l (%)
18-27
123
27,2
28-37
159
35,1
38-47
79
17,4
48-57
49
10,8
58-70
43
9,5
Nam
48
10,6
N
Kinh
Hoa
Chm
Khng bit c, bit vit
Cp I
405
438
2
13
84
202
89,4
96,7
0,4
2,9
18,5
44,6
Cp II
120
26,5
Cp III
i hc/C/TC
39
6
8,6
1,3
Sau i hc
0,4
Nng dn
101
22,3
Bun bn
Cng nhn
Cn b, vin chc
Ni tr
Lao ng ph thng
79
4
10
116
143
17,4
0,9
2,2
25,6
31,6
Cha/m
356
78,6
ng/b
Khc
Bit bi li
87
10
19,2
2,2
401
88,5
Kt qu nghin cu cho thy a s ngi

chmscctuit1837(62,3%).Tlny
tng t nghin cu ca ng Vn Chnh v
cngsvitlitngctuit1839l
74%(1).Tlmuctuicntrcaoldoa
sngichmsclchamcatrvlmcc
cng vic ti nh nn t l tham gia l rt cao.
iu ny c chng minh qua t l ngi
tham gia phng vn l cha m tr chim n
78,6%,tllaongphthngtinhl31,6%.
V trnh hc vn, cc i tng hc cp I
chim t l cao nht l 44,6%, t l khng bit
ChuynYTCngCng
NghincuYhc
Tui
Gii
tnh
c tnh
< 5 tui
5-<9 tui
9-11 tui
Nam
N
Bit bi li
Tn s
192
184
77
241
212
78
T l (%)
42,4
40,6
17,0
53,2
46,8
17,2
Ktqukhostchothytltr<5tuil
caonht(42,4%)vnamchimtlcaohnn
(53,2%sovi46,8%).iunychothydns
tr di 11 tui ca huyn An Ph a phn
thuc nhm nguy c cao d b ui nc v
nhiunghincuchngminhcrngtr
< 5 tui v tr nam l hai trong nhiu yu t
nguy c cao dn n t vong do ui nc
tr.(12,13).Ngoiradnstrdi11tuitiAn
Phcthmmtyutnguyckhc,chnh
lkhngbitbilikhitlbitbicatrch
c17,2%.
Bng3:Kinthcvphngngauinctrem
(n=453)
Kin thc
Tn s T l (%)
Kin thc v cc tnh hung nguy c dn

n ui nc
Bit tr khng bit bi d b ui nc
426
Bit tr chi a gn sng/ao/knh/rch d
410
b ui nc
Bit tr chi a gn cc dng c cha
393
nc khng c np y d b ui nc
Bit tr khng mc o phao khi i
thuyn/ghe/ph d b ui nc
Kin thc v tui d b ui nc nht
94
90,5
86,7
406
89,6
194
42,8
Kin thc v cc bin php phng nga

ui nc
Bit l cn i theo v quan st tr chi gn
440
sng/ao/knh/rch
Bit l cn lm np y chc chn cc dng
439
c cha nc
97,1
Bit tui t 0-5 tui d b ui nc
96,9
67
NghincuYhc
Kin thc
Bit l cn i vi tr n trng trong ma
ma, l
Bit l cn mc o phao/vt ni cho tr khi
i thuyn/ghe/ph
Bit l cn tp bi cho tr
Kin thc v cch thc s cp cu ui
nc
Bit cch thc thc hin s cp cu ui
nc
Tn s T l (%)
422
93,2
410
90,5
433
95,6
132
29,1
Ktqunghincuchothyhuhtcci
tngthamgianghincuuckinthclin
quan n ui nc kh cao. Tuy nhin kin
thcvtuitrdbuincnhtlithp,
chc42,8%itngbitltuit05
tui.Ngoirakinthcvscpcuuinc
rtthpcht29,1%.Nhvycththykin
thccangichmsctrvscpcuv
tuiduinccnthpcnphicccbin
phpcanthipnhmnngcaokinthcny.
Cc hnh vi phng nga ui nc ca

ngichmsctr
Bng4:Hnhviphngngauinccangi
chmsctr(n=453)
C
Tn s T l (%)
Lm ro chn sng/ao/knh/rch (n=285)* 77
27
y np dng c cha nc (n=410)**
357
87,1
C hnh vi phng nga khi i vng
383
84,5
C hnh vi phng nga khi bn cng vic 128
28,3
nh
Mc o phao cho tr khi tr i
66
39
ghe/thuyn/ph (n = 167)***
i theo v quan st tr chi gn
424
94
sng/ao/knh/rch
i theo v quan st tr chi gn dng c 453
92
cha nc
Tham gia lp tp hun/lp hc v s cp
42
9
cu ui nc
Hnh vi
:Sitngcnhgnao/sng/knh/rch
**
:Sitngcsdngdngcchanc(lu,thng
phuy,hchanc)
***
:Sitngtngchotrighe/thuyn/ph
Trongcchnhviphngngauinc,t
lngichmscthamgiacclptphun/lp
hcvscpcuuinclthpnht.iu
nychothycntngcngthmcngtctp
hunscpcuuinctiaphng.Tl
68
lmrochncngrtthpch27%chothyvic
lmrochncangidnvmtsldonh
tp qun sinh sng, thiu ti chnh v.v vn
chacquantmngmc.Tlngic
hnhviphngngakhibncngvicnh,tc
lkhilmvicnhthnhngikhctrngh
tr,cngthpcht28,3%.asngichm
sc u va lm va chm sc tr. y l mt
quannimsailmvhunhcccachtui
tremldochambnviclmvkhngquan
tm tr. T l mc o phao cho tr ca ngi
chmsccngkhngcaocht39%.Ktqu
c th l gii bng nhiu l do nh thiu ti
chnhnnccghe/thuyn/phkhngtrangbo
phao, khng c thi quen mc o phao khi i
ghe/thuyn/ph.lmrldokhngmco
phaocntinhnhthmccnghincucth.
Milinquangiahnhviphngngaui
ncvccyutlinquan
Nghin cu cng tm hiu mi lin quan
gia cc hnh vi phng nga ui nc ca
ngichmscviccctnhcangichm
sc, c tnh ca tr v kin thc c lin quan
nhnhviphngnga.
Quakhost,giahnhvilmrochnv
ccyutvanutrnkhngcmilinquan
cnghathngk(p>0,05).
Giahnhviynpdngcchancv
ccctnhngichmsc,ctnhtrkhng
cmilinquancnghathngk.Tuynhin
giahnhvinyvkinthcvynpchc
chnccdngcchanccmilinquanc
ngha thng k vi PR l 2,3 (KTC 95%: 1,2
4,6).Haynicchkhc,khingi chm sc c
kin thc h s c kh nng thc hin hnh vi
nycaohnngikhngckinthc.
Bng5:Milinquangiahnhviphngnga
uincchotrkhingichmsctrirakhi
nhvccyutlinquan
Yu t lin
quan
Tui
< 5 tui
Hnh vi phng nga

PR (KTC
khi i ra khi nh
p
95%)
C n (%) Khng n (%)
0,90
<
(0,8-0,96) 0,05
174 (90,6) 18 (9,4)
ChuynYTCngCng
Yu t lin
quan
5-<9 tui
9-11 tui
Hnh vi phng nga

PR (KTC
khi i ra khi nh
95%)
C n (%) Khng n (%)
150 (81,5) 34 (18,5)
59 (76,6) 18 (23,4)
Tr bit bi li
0,90
0,02
Bit
59 (75,6) 19 (24,4)
(0,8-0,99)
Khng bit 324 (86,4) 51 (13,6)
Kin thc v tnh hung nguy c dn n
ui nc tr em
1,10
0,03
C kin thc 312 (86,4) 49 (13,6)
(0,9-1,3)
Khng c kin
71 (77,2) 21 (22,8)
thc
Giahnhviphngngauincchotr
khingichmscrakhinhvccctnh
cangichmsckhngcmilinquanc
nghathngk(p>0,05).Ringctnhcatr,
hnh vi ny ch c mi lin quan c ngha
thng k vi tui tr cng nh vic tr bit
bi li. iu c ngha l tr c tui cng
caothitngcngtchnhviphngnga
uincchotrvtrbitbithitngs
tthchinhnhviphngngahnsovitr
khng bit bi. y l hai kt qu phn nh
quan nim, thi quen ca ngi dn khi cho
rngtrlnvbitbithkhngcnquantm
nhiutrongvicphngngachtuichotr.
Ngoiragiakinthcvtnhhungnguy
c dn n ui nc v hnh vi ny cng c
milinquancnghathngknhngchus
tngtccabindntc.Haynicchkhc,
ngi chm sc tr l ngi Kinh th nhng
ngickinthcsckhnngthchinhnh
vi phng nga gp 1,1 ln so vi nhng ngi
khngckinthc.Ktqunychothycntm
hiuldotisaodntckhc,cthyl
ngi Chm, vic bit kin thc li khng gp
phnvovicnngcaohnhviphngngaca
ngichmsctr.
Bng6:Milinquangiahnhviphngngaui
ncchotrkhiitngbnvicnhvccyut
linquan
Hnh vi phng nga
PR (KTC
khi bn vic
p
95%)
C n (%) Khng n (%)
18-27 48 (39)
75 (61)
0,91
0,05
28-37 39 (24,5) 120 (75,5) (0,8-0,99)
Yu t lin quan
Tui
ChuynYTCngCng
Yu t lin quan
Dn
tc
38-47
48-57
58-70
Kinh
Khc
NghincuYhc
Hnh vi phng nga
PR (KTC
khi bn vic
p
95%)
C n (%) Khng n (%)
16 (20,3)
63 (79,7)
15 (30,6)
34 (69,4)
10 (23,3)
33 (76,7)
120 (27,4) 318 (72,6) 0,53 (0,30,8)
8 (53,3)
7 (46,7)
0,03
Bng6chothyhnhviphngngakhii
tng bn vic nh ch c mi lin quan c
ngha thng k (p < 0,05) i vi tui ca
ngichmscvdntc.Vtui,ktqu
phntchchothyngichmsccnglntui
stckhnngthchinhnhviphngnga,
hay ni cch khc l s gi tr cho ngi khc
trng nom h, so vi ngi chm sc tr tui.
iunycthgiithchlngichmscln
tuithnglng/bcatrvvyhchorng
mnhckinhnghimtrngtrnnvalmvic
vacththeoditr.Dntccnglmtyu
tnhhngnhnhviphngnganykhi
ngiChmlickh nng thc hin hnh vi
phng nga cao gp 2 ln so vi ngi Kinh.
ylmtktqungquantmvlgii
ktqunycthcnlinhnnhngyut
thucvnhactrngcadntcChm.
Bng7:Milinquangiamcophaochotrkhi
ighe/thuynphvccyutlinquan
Yu t lin quan
Trnh hc vn
Khng bit c, vit
Cp I
T cp II tr ln
Tui
< 5 tui
5-<9 tui
9-11 tui
Mc o phao cho tr
PR
khi i thuyn
(KTC
Khng
95%)
C n (%)
n (%)
13 (59,1)
37 (44,6)
16 (25,8)
17 (25,8)
35 (52,2)
14 (41,2)
9 (40,9) 0,52
<
(0,346 (55,4) 0,8) 0,05
46 (74,2)
49 (74,2) 1,51
32 (47,8) (1,01- 0,04
20 (58,8) 2,3)
Hnh vi mc o phao cho tr khi i

ghe/thuyn/phchcmilinquancngha
thng k vi trnh hc vn ca ngi chm
scvtuicatr,ngoiraccyutkhc
ukhngcmilinquancnghathngk.
KtqutnhPRchothyngichmsccng
hc cao th cng t thc hin hnh vi mc o
phaochotr.ylmtktqungquantm
69
NghincuYhc
vthngthngtrnhhcvncaothngi
kmvitlthchincchnhviphngnga
cao,docnphitinhnhthmnghincu
tm hiu vn ny. Kt qu tnh PR cng
cho thy tr cng ln tui th kh nng ngi
chmscmcophaochotrcngcao.Cth
lgiiiunyldotrt511tuiangtrong
giaioninhtr,hocihctiuhc,do
cnilinhiutnhvtrnghc.Ngoira,
tr trn 6 tui bt u i hc v s dng
ghe/thuyn/phcaohntrdi5tuinntl
c mc o phao cao hn. Huyn An Ph li l
mthuyncnhiusngngi,knhrchvcc
claonmgiasngnnviciliaphngn
linvisngnc.Dovicngichmsc
tr trang b o phao cho tr khi i ghe thuyn
phliudhiu.
Giahnhviitheovquansttrchign
sng/ao/knh/rch v cc yu t lin quan u
khngcmilinquancnghathngk(p>
0,05). Nh vy c th thy hnh vi ny c th
cn ph thuc vo cc yu t khc chng hn
nhkhongcchtrchicchxanh,hocthi
giantrchignsng/ao/knh/rchv.v
Hnh vi i theo v quan st tr chi gn
dngcchancvccyutkhostcng
khng c mi lin quan c ngha thng k
ngoitrmiquanhvitr.Ktquphntch
cho thy nhng ngi chm sc l cha m c
khnngthchinhnhvinythphn0,9ln
so vi nhng ngi chm sc c mi quan h
khc. L gii iu ny, c th cha m cho rng
trtc kh nng b ui nc trong cc dng
cchancnntquantm,theoditrchi
gnccdngcchanc.
Bng8:Milinquangiathamgialptp
hun/lphcscpcuvccyutlinquan
Tham gia lp tp
PR
hun/lp hc v s
Yu t lin quan
p
(KTC
cp cu
95%)
C n (%) Khng n (%)
Nam
13 (27,1) 35 (72,9)
Gii
3,71
< 0,05
tnh
N
29 (7,2) 376 (92,8) (2,1-6,7)
Trnh hc vn
Khng bit c, vit
70
5 (6)
79 (94)
2,61
< 0,05
Tham gia lp tp
PR
hun/lp hc v s
Yu t lin quan
(KTC
cp cu
95%)
C n (%) Khng n (%)
Cp I
8 (4)
194 (96) (1,5-4,4)
T cp II tr ln
29 (17,4)
138 (82,6)
Khiphntchmilinquangiaccyut
vhnhvithamgialptphun/lphcvs
cpcu,chcgiitnhvtrnhhcvnca
ngi chm sc c mi quan h c ngha
thng k (p < 0,05). Nhng ngi chm sc l
namsckhnngtham gia cc lp tp hun
cao gp 3,7 ln so vi ngi chm sc l n.
iunycthldoquannimcangidn
cho rng ngi n ng l ngi c th thc
hincchotngnngnhcihisdng
nhiukthut,skholov.v,dokhicc
chngtrnh,dntchccclptphuns
cp cu, ngi n ng trong gia nh s l
ngithamgiacclphcny.
Cn v trnh hc vn, nhng ngi c
trnh cp I s c kh nng tham gia lp tp
hun s cp cu cao gp 2,6 ln so vi nhng
ngikhngbitcbitvithaynicchkhc
ngi khng bit c, bit vit c kh nng
tham gia lp tp hun ch bng 0,38 ln so vi
ngi c trnh cp I. iu ny c th gii
thch l do nhng ngi m ch thng quan
nimrngvicthamgiahccclpscpcu,
s gy kh khn cho bn thn trong vic nm
bt nhng k thut s cp cu, v vy hn ch
victhamgiacah.yliumccchng
trnhcanthiptphunscpcucncnnhc
thit k chng trnh sao cho ph hp vi
trnhhcvncaccitngcmigi
thamgiacclptphunny.
imhnch
Trongnghincunychngtichkhost
nhng ngi chm sc ch mt tr duy nht.
ylmtimhnchcatibivyut
chmscnhiutrcnglccthlyutgy
nhiu tc ng n cc mi quan h c
phntchtrongnghincuny.
Khikhosthnhviitheovquansttr
chi gn sng/ao/knh/rch, chng ti ch tp
ChuynYTCngCng
trung khai thc thng tin v hnh vi ny trong
cc trng hp tr chi gn sng/ao/knh/rch
gnnhcatr.Chngtikhngkhostthng
tinvhnhviphngngatrongcctrnghp
ngi chm sc dn tr ra khi nh v i n
mt a im khc cng c cc khu vc cha
nccthdnnuincchotr(cckhu
cngvinnc,hbi,nhngiquenckhu
vcchanc).ylmthnchvtrongcc
trnghpnutrnhnhviitheovquanst
trcthrrng,cthhnsovikhitrchi
gnsng/ao/knh/rchgnnh.
Do ch l nghin cu ct ngang m t nn
cc mi quan h c ngha thng k kho st
ctrongnghincuchmangtnhgithuyt,
docncmtnghincusuhnkhng
nhliccmiquanhny.
KTLUN
Kt qu nghin cu cho thy nhiu pht
hin mi v hnh vi ca ngi chm sc tr
trongphngngauinctrem.Cbnloi
hnhvictlthchinthpbaogmhnhvi
lmrochnkhuvcsng/ao/knh/rch(27%),
hnh vi phng nga khi bn vic nh (28,3%),
hnh vi mc o phao cho tr khi i
ghe/thuyn/ph(39%),vhnhvithamgialp
tphun/lphcvscpcuuinc(9%).
ylnhnghnhvirtngquantmbiv
chng nh hng n kh nng cht ui ca
tr.Vvy,victinhnhthmccnghincu
su tm hiu nguyn nhn ti sao t l thc
hin cc hnh vi trn cn thp l mt iu cn
thit.
Nghin cu cng cho thy cc yu t kho
st bao gm c tnh ca ngi chm sc, c
tnhcatrvkinthcphngngauinc
cng c mi lin quan vi hu ht cc hnh vi
kho st. Trong cc yu t trn, tui ngi
chmsc,tuitr,trnhhcvn,khnng
bilicatrlnhngyutcmilinquan
vinhiuhnhvivcngphnnhnhiuhnh
vi,quanim,suynghtrongthctcangi
dnvphngngauinc tr em. Ngoi
ra kin thc cng ng vai tr quan trng khi
ChuynYTCngCng
NghincuYhc
ktquchothynhiuhnhvichunhhng
cakinthc.Ccktqutrncthtonnc
s nn hu ch cho cc chng trnh can thip
cng ng nhm nng cao kin thc phng
ngauinccangidn.
KINNGH
Cn tin hnh thm cc nghin cu nh
tnhchuynsutmhiuthmnguynnhn
tlthchinmtshnhviphngngaui
nc cn thp ngi dn huyn An Ph ni
ring cng nh ngi dn tnh An Giang ni
chung.
ivitrungtmytdphnghuynAn
Ph, cn tng cng cng tc truyn thng
giodcvphngngauincchongi
dn. Trong qu trnh truyn thng, gio dc,
cn quan tm n cc yu t c th tc ng
n ngi dn nh tui, dn tc, trnh
hc vn v.v Khi cng tc truyn thng
giodcmitchiuqucaongthi
ngi dn cng c th nng cao c kin
thcphngngauinc.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
ngVnChnh,vcs(2008).Kinthc,thi v thc
hnhcangidnvchtuitremvngngbng
sng MEKONG. Y Hc Thnh Ph H Ch Minh, tp 12,
s4,2008,108115
Huong DL, Minh HV, Byass P (2003). Applying verbal
autopsy to determine cause of death in rural Vietnam.
Scand.J.PublicHealthSuppl.,62,1925
Hunh Thin S, Nguyn Nguyn (2009). c im
dchthccatvonguinctremtingThp.
LunvnttnghipCKIYTCngCng,ihcYdc
TP.HCM.
Landen MG, Bauer U, Kohn M. (2003). Inadequate
supervision as a cause of injury deaths among young
childreninAlaskaandLouisiana.Pediatrics,111,(2),328
31
LThanhHi,KhuThKhnhDung(2010).uinc
tr em ti bnh vin Nhi Trung ng. Y Hc Thnh Ph
HChMinh,tp14,s2,2010,193198.
LiY,QuanQuingN,ChunLingL,QiMingF,SingKaiL
(2007). Risk factors for drowning in rural regions of a
developing country: a casecontrol study. Injury
Prevention13,pp.178182
PetrassLA,BlitvichJD,FinchCF(2011).Lackofcaregiver
supervision: a contributing factor in Australian
unintentional child drowning deaths, 20002009. Med. J.
Aust.,194,(5),22831.
71
NghincuYhc
8.
9.
10.
72
Save The Children (2003). Effects of natural disasters on

children:theissueofchilddrowningintheMekongdelta
andtheCentralVietnam.
TASC(2008).FactsheetChildInjuryinAsia.
TrngiHcYTCngCngHNi(2003).Reportto
UNICEFontheVietnamMulticenterInjurySurvey.
11.
12.
13.
Water L (1998). A descriptive study of childhood

drowninginwesternAustralian:19871991.
WHO(2004)Worldreportonchildinjuryprevention.
WHO(2008).Worldreportonchildinjuryprevention.
ChuynYTCngCng
NghincuYhc
NGHINCUTRNGHPNHIMKSINHTRNGSTRT
TRNKHTITNHBNHPHC
LThnhng*,TrnhNgcHi**,NguynVnHng***,NgVitThnh*
TMTT
tvn:NhmtrinkhaixydngcctiNCKHvccbnhlytruyntngvtsangngi,
ccbnhdongoiksinh,thng4nm2011,trongmttiutrabanu,VinStrtKSTCTTP.H
ChMinhphthinhaiconkhctriuchngmcbnhstrttihuynPhcLong,tnhBnhPhc.
Mctiu:XcnhloiKSTSRtrnkhbnhimbnhstrt.
Phngphpnghincu:nghincumt,vicckthutsoiphthinksinhtrngstrt(KSTSR)
trnknhhinviquanghc,PCRlng(NestedPCR).
Ktqu:KtquxtnghimKSTSRdngtnh,tuynhinrtkhxcnhloiksinhtrngbngsoi
bngknhhinvi,dohnhthksinhtrngtngtccloiP.malariae,P.falciparumvP.vivax.Saukhi
thchinkthutPCR,ttcccloiKSTSRtrnumtnh.KtqugiitrnhtADNsequencingti
VinLmsngnhitiVngqucBxcnh96%tngngviP.inui.Vnquantmlcsly
truynksinhtrngstrttngvtsangngihaykhng?
Ktlun:ckhBnhPhcbnhimksinhtrngstrtPlasmodiuminui.
Tkha:KhnhimksinhtrngstrtBnhPhc.
ABSTRACT
ACASESTUDYOFMALARIAINFECTEDMONKEYINBINHPHUOCPROVINCE
LeThanhDong,TrinhNgocHai,NguyenVanHong,NgoVietThanh
Background: In preparation for development of a scientific theme on zoonotics and epizotic diseases, in
April 2011, Ho Chi Minh Institute of Malariology, Parasitology and Entomology conducted an initial
investigationandfound2monkeyswhichhavebeeninfectedwithmalariainPhuocLongdistrict,BinhPhuoc
province.
Objectives:Identificationtypeofmalariaparasiteinmalariainfectedmonkeys.
Methods:Acasedescribablestudy
Result:Thetestedsampleresultedthatitwaspositivewithmalaria.However,itisdifficulttoidentifywhich
typeofmalariaparasitebymicroscopeasitsshapeisasthesameasthoseofP.malariae,P.falciparumandP.
vivax.TheresearchershaveconductedPCRonthecollectedsamples.Theresultshasshownthatallsampleshave
beennegativewithmalariaparasites.ASNsequencingwasconductedthenbytheTropicalClinicofKingdomof
Belgiumconcludedthat96%wassimilartoP.inui.Theconcernisthatifthereisatransmissionofmalariafrom
animaltohuman?
Conclusion:ThemonkeyinBinhPhuocprovincehasbeeninfectedwithPlasmodiuminui.
Keywords:malariainfectedmonkeyinBinhPhuoc
*VinStrtKSTCTTPHChMinh
**VinStrtKSTCTTW
***nvNCLSihcOxford
Tcgilinlc:Ts.LThnhng T:0912009217
Email:lethanhdong@gmail.com
ChuynYTCngCng
73
NghincuYhc
TVN
ITNGPHNGPHPNGHINCU
TheoccbococaTchcYtthgii,
trong vng 4 thp k qua c trn 30 tc nhn
truyn nhim mi c pht hin, 75% c
ngun gc t ng vt (bnh ly t ng vt
sang ngi). Cc bnh truyn nhim mi xut
hin nh bnh st xut huyt ebola, marburg,
bnhbin,stthunglngriftvcbitgn
y l bnh vim ng h hp cp do vi rt
(SARS), bnh cm A phn tp H5N1, H1N1,
bnhtaychnmingucngungctng
vt. Nhn chung, cc bnh truyn nhim xut
hin hoc lu hnh thng lin quan n iu
kinmitrngsinhthi,phong tc, tp qun
sinhhot,tpquncanhtc,tnhchtlaong
v kh nng phng chng dch bnh ca con
ngi.VitNam,cbitlkhuvcNamB
Lmnghicciukinccbnht
ng vt c kh nng ly truyn v gy bnh
chongi.
itng
ivibnhstrt,gny,cnhiu bo
cocngbthmmtloiKSTSRvntlugy
bnhstrtchokh,ckhnnglynhimv
gy bnh cho ngi vi t l nhim tng i
cao,vnnycthtngthmgnhnngv
bnh st rt trong tng lai(2,1,6,3). Ti Vit Nam
nm2004,trongmttgimststrttitnh
Khnh Ha, Vin st rt KST CT T pht
hin 3 mu dng tnh vi P. knowlesi qua k
thutPCR(5).
Mumucthuthptkhcbiuhin
bbnhstrttihuynPhcLong,tnhBnh
Phc.
Phngphpxcnhksinhtrngstrt
SdngkthutsoiphthinKSTSRtrn
knhhinviquanghc(gitmngvgitdy).
K thut PCR lng (Nested PCR) theo
phngphpMallikaImwong,2009(4).
Mi: rPLU1, rPLU5, PkF 1060, PkF 1140,
PkF1550(4)
Chng: P.knowlesi (H strain) v P.cynomolgi
(Cambodiastrain)
Kthutgiitrnhtgen(sequencing).
KTQU
Ksinhtrngstrttrnlamgitmng
Hnh1:Thnhnvtdngsm
Trongkhunkhbcutipcnvxy
dngcctinghincukhoahcvccbnh
truynnhimcthlytruyntngvtsang
ngi, cc bnh do ngoi k sinh trng gy ra
chongi,VinStrtKSTCTTP.HCMtin
hnh ti nghin cu trng hp nhim k
sinhtrngstrttrnkhtitnhBnhPhc.
Mctiunghincu
Hnh2:Thtdngmun
XcnhloiKSTSRtrnkhbnhimbnh
strt.
74
ChuynYTCngCng
NghincuYhc
Hnh3:Thtdngmun
Hnh7:Thphnlit
Hnh4:Thtdngmun
Ksinhtrngstrttrnlamgitdy
Hnh8:Thgiaobo
Nhnxt:
HnhthgingP.falciparumgiaionsm:
hngcukhngbindng,cththyrccht
trong hng cu, th nhn nh, mnh (hnh 1 v
5).
Hnh5:Thnhnmnh
V ging P.malariae: nguyn sinh cht u,

dyc;sctphntnrng,muvngnht
th t dng mun (hnh 3,4, 6) hay di khn
qung(hnh2)hocthphnlit(hnh7)vth
giaoboviccsctth,rirc,phnbpha
ngoi(hnh8).
KtquPCR
mtnhviP.knowlesivP.cynomolgi
KtquSequencing
Sequence vi Cytochrom B theo phn on
gen l 810 bp v 816 bp, kt qu sequence ph
hp vi SSJ2010, A. number GU 930214.1, GU
930216. Sequnence trn Pubmid ghi
Hnh6:Thtdngmun
ChuynYTCngCng
75
NghincuYhc
Unclassified 96% tng ng vi P. inui, A.

numberAB444113.1.
BNLUN
iviconngi,chonnay,ngitacho
rng bnh st rt ngi ch yu do 4 loi k
sinh trng st rt gy ra, l P.falciparum, P.
vivax, P. malariae, P. ovale gy ra. Trong s
phn ln l hai loi P. falciparum v P. vivax
chimmttlcaotrongc cu k sinh trng,
ty tng vng a l m t l hai loi ny gy
nhimngickhcnhau.iviccloilinh
trng,chn26loi,trongccloiksinh
trngstrtkhlinquangnviccloigy
bnh ngi, l P.simium,P.brazilianum,P.
cynomolgi,P.inuivP.knowlesi(2,1,6,3).
Haiconkhtrongnghincuchngtic
phthintinhhngPhc,KhuphSnLong,
PhngSnGiang,thxPhcLong,tnhBnh
Phc, mt con ui ln (Pig tailed macaques)
vmtconkhuidi(Longtailedmacaques).
ylloikhthnggpngNam.
Triuchngbanu,khs1cbiuhinrt
run, t ly chn p ln ngi, hot ng
chmchp,biuhinbingn.Khs2mpmp
hn,hotnglinhhothnkhngrtrunnh
khs1.
Quanstksinhtrngdiknhhinvitrn
lam git dy v mng cho thy hnh th ging
P.falciparum giai on sm: hng cu khng
bindng,cththyrcchttronghngcu,
th nhn nh, mnh (hnh 1 v 5). V ging
P.malariae:nguynsinhchtu,dyc,sct
phn tn rng. mu vng nht th t dng
mun(hnh3,4,6)haydikhnqung(hnh2)
hocthphnlit(hnh7)vthgiaobovicc
sctth,rirc,phnbphangoi(hnh8).
Sau xc nh li bng k thut PCR th
hon ton m tnh. Kt qu ca chng ti ph
hpviktquphntchPCRtiVinLmsng
NhitiVngQucB.Dovy,khngnhk
sinh trng trn 2 con kh khng phi l P.
knowlesi.
76
Vi s gip ca cc nh khoa hc Vin

LmsngNhiti,VngQucB,giitrnht
sequencingcthchinngthivikthut
realTimePCR.
ThchincloningonANDcnthitc
nhn v gn vo vi khun Escherichiacoli, on
chnngviP.knowlesicxcnhtiGeno
Screen,cctrnhtnucleotidecaccdngsau
pht trin thnh colone, cc colone li c
kim tra li bng PCR xem c nhn ng
on gen hay khng, nhng clone no nhn
ng th c gii trnh t. Mi loi k sinh
trngucmtbngen(genemap)vsau
so snh trnh t nhn c vi bn gen.
NhngchuiNNNtrongtrnhtxuicsa
bngthngtinttrnhtngctheoquilutA
T,GC,onnothascctb,cngcth
sosnhtrnhtthucvitrnhttrongngn
hng gen (Gene Bank). Thng thng, trnh t
phiging100%soviGenBankthmicth
khng nh c. Trong cc mu ca chng ti
thucc4nucleotidkhcbit,dovykhng
nh96%lP.inui.
Nghincuksinhtrngstrttrnkh
Vit Nam ang cn hn ch, rt t thng tin
khoa hc v dch t hc, cn trng hc lin
quan n kh mang k sinh trng. T nhng
thp k 60 ca th k 20, William Chin
nghin cu thnh cng k sinh trng P. inui
truyntkhsangngi.
Chng ti cng ly mu mu ca kh
nuicytrongphngthnghim.KSTcra
3 ln bng mi trng nui cy RPMI 1640 vi
20%huytthanhABcangi.TuynhinKST
khngthnhnlnvxmnhphngcumi
vkhngtngthchnhmmunnhngcub
ngngkt.Sau5ngynuicyKSTliivcht
chcnthysctcaksinhtrng.
Kh nng ngi nhim k sinh trng st

rtkh
Nhtrncp,vtnhhnhstrttrn
kh, cho n nay, ngi ta ghi nhn c
cckhuvccccloiksinhtrngvvtch
cannhsau:
ChuynYTCngCng
Khu vc
Chu
Chu M
K sinh
trng
P. pitheci
P. inui
Thi
gian
1905
1905
P. cynomolgi
1905
P. eylesi
P. hylobati
P. jefferyi
P. youngi
P. fieldi
1965
1939
1964
1964
1962
P. simiovale
1965
P. coatneyi
1965
P. fragile
1965
P. knowlesi
1932
P. brasilianum 1908
P. simium
1951
P. gonderi
P. schwetzi
Chu Phi
P. rhodaini
P. reichenowi
Madagasc P. lemuris
a
P. girardi
1908
1920
1939
1922
1963
1952
Vt ch
i i (Orangutan)
Kh ui ngn
(Macaque)
Kh ui ngn
(Macaque)
Vn (Gibbon)
Vn (Gibbon)
Vn (Gibbon)
Vn (Gibbon)
Kh ui ngn
(Macaque)
Kh ui ngn
(Macaque)
Kh ui ngn
(Macaque)
Kh ui ngn
(Macaque)
Kh ui ngn
(Macaque)
Kh Nam M (Cacajao)
Kh r ui di (Howler
monkey)
Kh chu Phi (Mangaby)
Tinh tinh (Chimpanzee)
Vn co (Lemur)
Vn co (Lemur)
Theo thi gian, nm 1932, ngi ta gy

nhim P. knowlesi cho ngi tnh nguyn; nm
1948, ngi b nhim cc k sinh trng t tinh
tinh; nm 1960, ngi b nhim P.cynomolgi do
muittscphngxtnghim;nm1965,
nginhimP.knowlesitnhinMalaysia. T
nm 2000 2002, mt nghin cu ti Malaysia
cho thy trong s 208 ca c chn on bng
knh hin vi l nhim P.malariae nhng khi xt
nghimbngkthutPCRlngthcn120
cacxcnhlnhimP.knowlesi.nnm
2004, nhiu ngi Borneo (Malaysia) c
pht hin nhim P. knowlesi, trong nm ny,
ngitacngphthinmttrnghpnhim
P.knowlesikhuvcrngbingiiThiLanv
Myanmar v mt trng hp khc
Philippines.
C s truyn bnh st rt t loi kh n
ngivnginngiquatrunggianmui
haykhng?TrnghpBorneo(Malaysia)c
ChuynYTCngCng
NghincuYhc
mt s lng ln ngi nhim P.knowlesi phi

chngcslytruyntngisangngihoc
tkhsangngiquatrunggiantruynbnhl
mui?Cccuhinychacchngminh.
Ngi ta ch bit rng nhm mui
An.leucosphyrusckhnnglytruynksinh
trngP.knowlesicmtkhuvc,tuynhin
ngi ta cng cha xc nh chc chn l loi
muinytruynbnhhayloikhc.
Vit Nam, nhiu cng ng dn c hin
naysinhsngccvngrng,barng,nhiu
nhmngigiaoluvovngrngni,vng
st rt lu hnh, ni c nhiu ng vt linh
trng sng c th c nguy c nhim k sinh
trngstrttccngvtny?cbitlP.
Knowlesi k sinh trng c mt hu ht cc
qucgiangNam,naycngxuthinti
VitNam.
MtnghincutiKhnhPh(KhnhHo)
bt u t nm 2002 cho thy qun th mui
Anopheles dirus nhim k sinh trng th thoi
trngvitltngicao(12%)trnhng
ngncthmuicmtuynncbt.Cu
hitralccththoitrngnycthuccc
loi c kh nng nhim bnh cho ngi? Cc
nhnghincuxtnghimPCRivicc
DNA ca P. cynomolgi, P. knowlesi, P. inui, P.
simiovaleandP.coatneyi.ngthitheoditnh
trng nhim k sinh trng cc con kh c
nhttrongrngvthynhngconkhnyxut
hin nhim P. cynomolgi, nguyn nhn phn
nhiu c cho l do mui t truyn k sinh
trngchkhngphidotipht.Cuhitra
l liu P.cynomolgi c nhim sang ngi hay
khng? Trong khi cc primer ca P.vivax cng
chophnngchoviP.cynomolgi,dottc
ccmuxtnghimtrcycchnon
lP.vivaxkhuvcubnghing.Hnna,
muiAnophelesdirusloivctchnhduynht
castrtkhuvcnycphthindng
tnh vi P.cynomolgi. Vn k sinh trng st
rt ng vt hoang di c ly truyn sang
ngihaykhng,loino,vctnotruyncn
chacsngtvvictrachinlcloi
77
NghincuYhc
tr bnh st rt cng cn phi cn nhc kha

cnhny.
2.
KTLUN
3.
BngkthutgiitrnhtADNxcnh
khbtcPhcLongBnhPhcnhim
ksinhtrngstrtPlasmodiuminui.
4.
KINNGH
Cnphinghincutipxcnhcs
lantruynksinhtrngstrttngvtsang
ngi.
5.
6.
TILIUTHAMKHO.
1.
Bronner U, Divis PC, Farnert A, Singh B (2009). Swedish

traveller with Plasmodium knowlesi malaria after visiting
MalaysianBorneo.MalarJ.;8:15.DOI:10.1186/14752875815.
HnhA:Khangbstrt
78
ChinW,ContacosPG,CollinsWE,JeterMH,AlpertE(1968).
Experimental mosquito transmission of Plasmodium
knowlesitomanandmonkey.AmJTropMedHyg.17:3558.
CoxSingh J, Davis TM, Lee KS, Shamsul SS, Matusop A,
Ratman S, et al (2008). Plasmodium knowlesi malaria in
humansiswidelydistributedandpotentiallylifethreatening.
ClinInfectDis.;46:16571.DOI:10.1086/524888
Imwong M, Tanomsing N, Pukrittayakamee S, Day NPJ,
WhiteNJandSnounouG(2009).Spuriousamplificationofa
Plasmodium vivax smallsubunit RNA gene by use of
primers currently used to detect P.knowlesi..Journal of
ClinicalMicrobiology,p.41734175.
Nguyn Vn Hng v CS (2011). Trng hp u tin
nhim P.knowlesi ti Vit Nam. Cng trnh khoa hc bo
cotiHinghKsinhtrnglnth38,trang20052009.
SinghB,KimSungL,MatusopA,RadhakrishnanA,Shamsul
SS, CoxSingh J, et al (2004). A large focus of naturally
acquired Plasmodium knowlesi infections in human beings.
Lancet.;363:101724.DOI:10.1016/S01406736(04)158364
HnhB:Khbnhthng
ChuynYTCngCng
NghincuYhc
CIMTHNHPHNLOI,PHNBVMCNHYCM
CAVCTSTRTMTSVNGSINHCNH
KHUVCBINGIIVITNAMCAMPUCHIA
LThnhng*,HunhKhaThoHin*
TMTT
tvn:Nghincucthchinticcimidinccvngsinhcnh,kinhtxhilinquan
nlantruynbnhstrtgiabingiiVitNamvCampuchiatthng4nthng12nm2010.
Mc tiu: Mc tiu nhm: (1) nh gi c im thnh phn loi, s phn b mui Anopheles, mt
vectortngi,sinhthihotngvyutlinquanv(2)xcnhmcpngcavctstrtvi
cchachtangsdngtrongchngtrnhphngchngstrtqucgia.
Phngphpnghincu:Phngphpnghincungangmtvhicutiliuvsphnb,thnh
phnloiAnopheles.
Kt qu: Kt qu cho thy, v thnh phn loi c An.aconitus, An.barbirostris, An. campestris,
An.crawfordi, v An. dirus, An. jamesi, An. kochi, An.maculatus, An.nivipes, An.peditaeniatus,
An.philippinensis,An.sinensis,An.vagus.CsphnbccloiAnopheleskhngngnhtgiaccvng
sinh cnh i din (sinh cnh ng bng, bin gii nhiu sng, rch c 2 loi ch yu l An. vagus v
An.sinnensis;sinhcnhbingiinirng,giaoluqualibingiilncAn.aconitus,An.barbirostris,An.
campestris, An.crawfordi, An. jamesi, An. kochi, An.peditaeniatus, An.maculatus, An.nivipes,
An.philippinensis,An.sinensisvAn.vagus;sinhcnhbingiinirng,vngsu,vngxa,khngcgiao
lu qua li bin gii c An.crawfordi, An. dirus, An.maculatus, An.peditaeniatus, An. philippinensis, An.
sinensis,An.vagus.Mcnhycmcavctvihachtsdngtrongchngtrnhphngchngstrt
(PCSR)qucgia:MuiAn.sinensiskhngviLambdacyhalothrin0,05%,muiAn.dirusvncnnhycm
vihachtAlphacypermethrin30mghotcht/m2vitlmuichtsau24gil100%.
Ktlun:CsphnbccloiAnopheleskhngngnhtgiaccvngsinhcnhidin(sinhcnh
ng bng, bin gii nhiu sng, rch c An. vagus v An.sinnensis; sinh cnh bin gii ni rng c
An.aconitus, An.barbirostris, An. campestris, An.crawfordi, An. jamesi, An. kochi, An.peditaeniatus,
An.maculatus, An.nivipes, An.philippinensis, An.sinensis v An. vagus; sinh cnh bin gii ni rng, vng
su,vngxacAn.crawfordi,An.dirus,An.maculatus,An.peditaeniatus,An.philippinensis,An.sinensis,An.
vagus.Mcnhycmcavctvihachtsdng trong chng trnh PCSR: Mui An. sinensis
khngviLambdacyhalothrin0,05%,muiAn.dirusvncnnhycmvihachtAlphacypermethrin30mg.
Tkha:Vctstrtbingii
ABSTRACT
CHARACTERISTICSOFSPECIESCOMPOSITION,DISTRIBUTIONANDEXTENTOFSENSITIVITY
OFMALARIAVECTORALONGTHEBORDEROFVIETNAMCAMBODIA
LeThanhDong,HuynhKhaThaoHien
Background:Theresearchwasconductedinrepresentativeareasofhabitat,societyeconomyrelatingto
*VinStrtKSTCTTPHChMinh
Tcgilinlc:Ts.LThnhng T:0912009217
ChuynYTCngCng
Email:lethanhdong@gmail.com
79
NghincuYhc
spreadofmalariabetweentheborderofVietnamandCambodiafromApriltoDecember,2011
Objectives: (1) Assessment of species composition, distribution of Anopheles mosquitoes, vector density,
activityandecologyandrelatedfactors.(2)Determinetherespondlevelofmalariavectortothechemicalsusedin
nationalmalariacontrolprograms.
Methods:Crosssectionalstudyandretrospectivestudy.
Result: The results showed that species composition are An.aconitus, An.barbirostris, An. campestris,
An.crawfordi, and An. dirus, An. jamesi, An. kochi, An.maculatus, An.nivipes, An.peditaeniatus,
An.philippinensis, An.sinensis, An. vagus. There was the inhomogeneous distribution of Anopheles species
betweenrepresentativeareasofhabitat(characteristicsofplainareas,borderwithmanyriversandcanalswith
two main species: An. vagus and An.sinnensis; characteristics of mountainous border areas, cross border
exchanges with An.aconitus, An.barbirostris, An. campestris, An.crawfordi, An. jamesi, An. kochi,
An.peditaeniatus, An.maculatus, An.nivipes, An.philippinensis, An.sinensis and An. vagus; characteristics of
mountainous border areas, remote areas and no cross border exchanges wiht An.crawfordi, An. dirus,
An.maculatus, An.peditaeniatus, An. philippinensis, An. sinensis, An. vagus. Sensitive extent of the vectors
withchemicalsusedinnationalmalariacontrolprogram:An.SinensisresistanttoLambdacyhalothrin0,05%,
An.dirussensitivetochemicalsAlphacypermethrin30mgmainsubstance/m2withthedeadrateofmosquitoes
after24hourscameto100%.
Conclusion:TherewastheinhomogeneousdistributionofAnophelesspeciesbetweenrepresentativeareasof
habitat(theborderwithmanyriversandcanalswithAn.vagusandAn.sinnensis;themountainousborderareas
with An.aconitus, An.barbirostris, An. campestris, An.crawfordi, An. jamesi, An. kochi, An.peditaeniatus,
An.maculatus,An.nivipes,An.philippinensis,An.sinensisandAn.vagus;themountainousborderareas,remote
areas wiht An.crawfordi, An. dirus, An.maculatus, An.peditaeniatus, An. philippinensis, An. sinensis, An.
vagus. Sensitive extent of the vectors with chemicals used in national malaria control program: An. Sinensis
resistanttoLambdacyhalothrin0,05%,An.dirussensitivetochemicalsAlphacypermethrin30mg.
Keywords:Malariavectoralongborder
TVN
MuiAnophelesgivaitrtrunggiantruyn
bnhstrtchongi.Sphnbcamuic
linquanmtthitndchthcbnhstrt.
Phnlncctnhctnhhnhstrtdinbin
phc tp u nm trong khu vc st rt lu
hnh v nm dc theo bin gii Vit Nam
Campuchia.Mttrongnhngvnangc
quantmhinnylslantruyncadngk
sinh trng st rt khng vi artemisinin cc
tnh pha Ty Campuchia, s di dn t do ca
ccthnhphndncdctheobingiicng
vi vic vector st rt khng ha cht thuc
nhmpyrethroidvDDTlmchotnhhnh
strtkhuvcbingiiVitNamCampuchia
ang tim n mt nguy c bng pht dch rt
cao. Trong giai on t thng 4 n thng 12
nm2010,chngtitinhnhnghincuti
80
cimthnhphnloi,phnbvmc
nhycmcavctstrtmtsvngsinh
cnhkhuvcbingiiVitNamCampuchia.
Mctiuti
nhgicimthnhphnloi,sphn
b mui Anopheles, mt vector t ngi,
sinhthihotngvyutlinquan.
Xcnhmcpngcavctstrt
vi cc ha cht ang s dng trong chng
trnhphngchngstrtqucgia.
ITNGPHNGPHPNGHINCU
aim
Cc im i din cho cc sinh cnh dc
theobingiiVitNamCampuchia:ctrng
chosinhcnhngbng,bingiinhiusng,
rch (sinh cnh A: An Giang); c trng cho
sinh cnh bin gii ni rng, giao lu qua li
ChuynYTCngCng
bingiiln(sinhcnhB:TyNinh);ctrng
cho sinh cnh bin gii ni rng, vng su,
vng xa, khng c giao lu qua li bin gii
(sinhcnhC:BnhPhc).
Thigiantinhnh
Tthng04/2010nthng12/2010.
Phngphpnghincu:(2,3,5).
Nghincungangmt.
Hicutiliuvsphnb,thnhphn
loiAnopheles.
Vtliu
Dngcthnhycmtheotiuchunca
TchcYtthgii(WHO).
GiythnhycmLamdacyhalothrin0,05%
vAlphacypermethrin30mga.i/m2doihc
Penang,Malaysiasnxut.
BynCDCchypindoMsnxut.
iutrathca:thuthpmuvtmi
iu tra cn trng st rt v b gy theo
phngphpcaTchcYtthgii(WHO)
v Vin St rt K sinh trng Cn trng
Trungng.
Phntchmuvt
nhloidatrncccimhnhthi.
nhloimuivbgyAnophelesdavo
c im hnh th bn ngoi trn c s Bng
nhloimuiAnopheles.
Th nhy cm mui vi giy tm ha cht

ditcntrng
nh gi mc nhy cm ca mui vi ha
cht dit cn trng theo phng php ca t
chcYtthgiiWHO/CPC/MAL/98.12(6,1).
itngth:vectorchnhvvectorphbt
tithcacamivng.(nubtslng).
Ha cht th: Lambdacyhalothrin 0,05% v
Alphacypermethrin30mg/m2
Xlsliu
XlsliubngchngtrnhExcel.
NghincuYhc
KTQUVBNLUN
Bng1:Ktquthuthpmuivthnhphnloi
Anopheles
Sinh cnh Sinh cnh Sinh cnh
A
B
C
1
An.aconitus
13
2
An.barbirostris
24
3
An. campestris
36
4
An.crawfordi
4
5
5
An.dirus
55
6
An. jamesi
4
7
An. kochi
4
8
An.maculatus
6
16
9 An.peditaeniatus
47
2
10 An.philippinensis
4
4
11
An.nivipes
6
12
An.sinensis
1.758
43
9
13
An. vagus
12
92
18
STT Loi Anopheles
Thnh phn loi: ti thi im iu tra, kt

quiutrachothyTyNinhcthnhphn
loiAnophelesadng(12loi),thnhphnloi
Anopheles tnh Bnh Phc l 7 loi v thnh
phnloiAnophelesAnGiangc2loi.
S lng mui An.sinensis thu thp c
AnGiangl1.758con.
im nghin cu tnh Bnh Phc thu
thpcvctchnhcavnglAn.dirus,hai
imnghincuAnGiangvTyNinhcha
thu thp c vc t chnh, ch thu thp c
vctphcavng(An.sinensis,An.maculatus
vAn.aconitus).
Bng2:Ktquthuthpbgy
STT
1
2
3
4
Tn loi
Sinh cnh Sinh cnh Sinh cnh
A
B
C
Anopheles
An. Dirus
39
An.peditaeniatus
1
An.sinensis
48
An. Vagus
8
SliuthuthpbgycaccloiAnopheles
tng ng vi s lng mui thu thp c.
RingimnghincuTyNinh,vaxyra
mttrnmatovothiimthuthpbgy
nnlmchoncsuichymnhvlm
tribgy.Doslngbgythuthphu
nhkhngc(1con/100v).
Bng3:MtmuithucbngphngphpMNTNvMNNN
ChuynYTCngCng
81
NghincuYhc
Sinh cnh A
STT
Tn loi Anopheles
1
2
3
4
5
6
7
8
9
10
11
12
13
An.aconitus
An.barbirostris
An. campestris
An.crawfordi
An.dirus
An. jamesi
An. kochi
An.maculatus
An.peditaeniatus
An.philippinensis
An.nivipes
An.sinensis
An. vagus
MNTN
(c//ng)
MNNN
(c//ng)
Sinh cnh B
Sinh cnh C
MNTN
(c//ng)
MNNN
(c//ng)
0,5
0,17
MNTN
(c//ng)
MNNN
(c//ng)
1,17
0,33
6,16
0,15
0,33
68,5
94,5
2,5
0,16
Bngphngphpmingitrongnhv
ngoinhthucccloiAnophelessau:An.
aconitus, An. campestris, An. barbirostris, An.
crawfordi, An. dirus, An. kochi, An.maculatu,
An.philippinensis, An.nivipes, An. jamesi, An.
peditaeniatusvAn.sinensis,An.vagus.
Bng4:MtmuiAnophelesbngccphng
php:bynCDC,soichunggiasc,soitrongnh
banngy
im Bnh Phc mt An.dirus t

ngi ngoi nh cao hn trong nh (6,17/1,17
con/ngi/m).
An.aconitus
An.barbirostri
s
An.
campestris
An. dirus
An.crawfordi
An. jamesi
An. kochi
An.maculatu
s
An.peditaeni
atus
An.philippine
nsis
An.nivipes
An.sinensis
ccimAnGiangvTyNinhuthu
thp c vc t truyn bnh ph An.sinensis
bngphngphpmingitrongnh.
An Giang c mt An.sinensis t ngi
ngoi nh cao hn t ngi trong nh
(94,5/68,5con/ngi/m).
Ti thi im iu tra Ty Ninh thnh
phn loi mui Anopheles thu thp c bng
phng php soi chung gia sc kh phong
ph, tuy nhin mt khng cao (<1,7
con/gi/ngi)(Bng4).
AnGiangbngsoichunggiascvby
n ngoi nh ch thu thp c 2 loi
Anopheles, mt An.sinensis thu thp c
bngphngphp soi chung gia sc cao hn
mtAn.sinensisccimTyNinhvBnh
Phc.
Soitrongnhbanngythktquthuthp
c=0tic3imnghincu.
82
An. vagus
SCGS
BNN
Sinh cnh C
BTN
SCGS
BNN
BTN
SCGS
BNN
Sinh cnh A Sinh cnh B

BTN
Tn loi
Anopheles
0,24
0,37
0,67
1,3 2,3
0,07
0,05
0,07
0,05
0,1
0,27
0,81
0,03
0,07
0,07
0,22
14,2
771
7
12 0,2
0,29 0,3
0,13
1,7
0,33
Bng5:KtquthnhycmmuiAnophelesvi
hachtangsdngtrongchngtrnhPCSR
qucgia
im
NC
Loi
mui
Thi T l mui
gian cht sau 24g
Sinh
An.
cnh
23/6/10
sinensis
A
28 %
Sinh An.dirus 6/11/10
100 %
Tn ha
cht
Ghi
ch
Lambdacyhal T=
29oC,
othrin
RH =
0,05 %
72%
Alphacyperm T=27-
ChuynYTCngCng
im
NC
cnh
C
Loi
mui
Thi T l mui
gian cht sau 24g
Tn ha
cht
ethrin
30 mg/m2
Ghi
ch
28 oC
RH:8082%
KtquthnhycmmuiAn.sinensisvi
Lambdacyhalothrin 0,05%: t l mui An.
sinensischtsau24gil28%
KtquthnhycmchothyAn.dirusvn
cn nhy cm vi ha cht Alphacypermethrin
30 mg hot cht/m2 vi t l mui cht sau 24
gi l 100 %. Tuy nhin, v tng s mui th
nghim t hn 100 con, nn kt qu ny ch
mangtnhchtthamkho.
KTLUN
ThnhphnloiAnopheles
Thnh phn loi Anopheles ti cc im
nghin cu thuc cc vng sinh cnh ng
bng, bin gii nhiu sng, rch (sinh cnh A);
sinh cnh bin gii ni rng, giao lu qua li
bingiiln(sinhcnhB)vsinhcnhbingii
nirng,vngsu,vngxa,khngcgiaolu
qualibingii(sinhcnhC)phhpvicc
ktqunghincutrcy.
SinhcnhAc2loiAnopheleschyul
An.vagusvAn.sinnensis;sinhcnhBc12loi
l An.aconitus, An.barbirostris, An. campestris,
An.crawfordi, An.jamesi, An.kochi, An.maculatus,
An.peditaeniatus, An.philippinensis, An.nivipes,
An.sinensis,An.vagus;sinhcnhCc7loil
An.crawfordi,
An.
Dirus,
An.maculatus,
An.peditaeniatus, An. philippinensis, An. sinensis,
An.vagus.
Tivngsinhcnhbingiinirng,vng
su,vngxa,khngcgiaoluqualibingii
(sinh cnh C) mt An.dirus t ngi ngoi
nhcaohntrongnh;vngsinhcnhng
bng, bin gii nhiu sng, rch (sinh cnh A)
mtAnsinensistngingoinhcaohn
trongnh.vngsinhcnhbingiinirng,
giaoluqualibingiiln(sinhcnhB)mt
Ansinensistngingoinhvtrongnh
tngtnhau.
ChuynYTCngCng
NghincuYhc
Mc nhy cm ca vc t vi ha cht
sdngtrongchngtrnhPCSRqucgia
Mui An. sinensis khng vi
lambdacyhalothrin 0,05%, tuy nhin cn thc
hinthmnhiuthnghimmicthara
ktlunchnhxc.
Mui An. dirus vn cn nhy cm vi ha
chtalphacypermethrin30mghotcht/m2vi
tlmuichtsau24gil100%.Tuynhin,v
tngsmuithnghimthn100connnkt
qunychachcchn.
Kt Lun: C s phn b cc loi Anopheles
khng ng nht gia cc vng sinh cnh i
din(sinhcnhngbng,bingiinhiusng,
rchcAn.vagusvAn.sinnensis;sinhcnhbin
gii ni rng c An.aconitus, An.barbirostris, An.
campestris, An.crawfordi, An. jamesi, An. kochi,
An.peditaeniatus,
An.maculatus,
An.nivipes,
An.philippinensis, An.sinensis v An. vagus; sinh
cnh bin gii ni rng, vng su, vng xa c
An.crawfordi,
An.
dirus,
An.maculatus,
An.peditaeniatus, An. philippinensis, An. sinensis,
An.vagus.Mcnhycmcavctviha
cht s dng trong chng trnh PCSR: Mui
An. sinensis khng vi Lambdacyhalothrin
0,05%,muiAn.dirusvncnnhycmviha
chtAlphacypermethrin30mg.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
Bortel WV, H nh Trung, L Khnh Thun, Sochantha T,

SocheatD,SumrandeeC,BaimaiV,KeokenchanhK,Samlane
P, Roelants P, Denis L, Verhaeghen K, Obsomer V,
Coosemanns M (2008), The insecticide resistance status of
malariavectorsintheMekongregion,MalariaJournal2008.
Nguyn Quc Hng, Nguyn Ngc Thanh, V Th Long,
Ng Th Ph v CS (2004), Gim st vector 3 tnh Bnh
Phc,BnhDngVLmng,Kyucngtrnhnghin
cukhoahcVinSRKSTCTTP.HCM,19962003.
NIMPE HN, IMPE HCM, IMPE QN. (2000) Final report on
border malaria in the five borders pilot communes in
Vietnam.2000.
Potikasikorn J, Chareonviriyaphap T, Bangs MJ, Prabaripai
A (2005), Behavioral responses to DDT and pyrethroids
betweenanophelesminimusspeciesAandC,malariavectors
inThailand,Am.J.Trop.Med.Hyg.,73(2),2005,pp.343349.
SochanthaT,etal.(2000)Emtomologicalstudyinthe3border
pilotcommunesinCambodia.CMN,Cambodia.2000.
World Health Organisation (WHO) (1998). Test Procedures
forInsecticideResistancemonitoringinMalariaVectors,Bio
83
NghincuYhc
efficacy and Persistence of Insecticides on treated surfaces.

DocumentWHO/CDS/CPC/MAL/98.12.Geneva.
84
ChuynYTCngCng
NghincuYhc
XCNHLNGQUNGNGUNVKINTHC,
THCHNHPHNGBNHSTXUTHUYT:NHGIBANU
CHOCNGTCTRUYNTHNG
PhmThNhTrc*,NguynThanhPhng*,ngVnChnh**,PhmTrDng*
TMTT
tvn:TiVitNam,bnhstDengue/stxuthuytDenguelvnsckhecngcng.Smc
bnhhngnmlcao.Phngbnhlbinphpcanthipchnh.vicphngbnhmanghiuqucaothcn
hiurlngqungngunphttrintu,ngthicnbitrkinthc,thchnhcangidncn
nhnghnchgcnhngbinphptruynthngphhp.
Mctiu:Xcnhlngqungnguntruynbnhstxuthuytvtlngidnckinthc,thc
hnhphngstxuthuytnm2011.
Phngphpnghincu:Nghincumtctngangtthng69/2011trn384hgianh(HG)
sngtixPhongThnhTyB,huynPhcLong,tnhBcLiudatrnbcuhisonsn.
Ktqu:lngqungngunthngxuthintrongnh,tptrungccdngcchanc(DCCN)
trncmavncschsinhhotchim91,7%v37%clngqungtrongchnncchngkink
chntthcn;tuynhin,khngtmthylngqungtrongccDCCNkhc.Tlngidnbitnimui
vntrngthp(43,2%),ngthihiusaivccbinphpditlngqung(22,1%)vchabitcchy
knccDCCN.
Kt lun:Cngtctruynthngnntptrungvonhngimcnhnchcangidnnngcao
chtlngphngbnhticngng.
Tkha:StDengue/StxuthuytDengue(SD/SXHD),Stxuthuyt(SXH),KP,dngcchanc
(DCCN),hgianh(HG).
ABSTRACT
IDENTIFYTHESOURCEOFLARVAANDKNOWLEDGE,PRACTICEOFPEOPLEINPHONG
THANHTAYBVILLAGE,PHUOCLONGDISTRICT,BACLIEUPROVINCETOPREVENTDENGU
EHEMORRHAGICFEVERIN2011
PhamThiNhaTruc,NguyenThanhPhuong,DangVanChinh,PhamDungTri
Background: In Vietnam, Dengue fever/Dengue hemorrhagic fever (DF/DHF) is an viral disease that
challengestopublichealth.TheprevalenceofDF/DHFishigh.Novaccineisavailable;thereforepreventionisthe
mosteffectivemeasures.Itsnecessarytoknowthoroughlythelarvaldevelopmentsourceandclearlyidentifythe
limitationsofthepeoplesknowledgeandpracticetotaketheappropriatecommunicationmeasures.
Objectives:DefinethesourceofDenguemosquitolarvae,anddeterminatetheproportionofpeoplehavethe
knowledgeandaccuratepracticeforDenguepreventionin2011.
Methods:Acrosssectionalstudyof384householdslivinginPhongThanhTayB,PhuocLongdistrict,Bac
Lieuprovince.
*TrngCaongYTBcLiu
Tcgilinlc:Ths.PhmThNhTrc
ChuynYTCngCng
**:VinVsinhYtCngcngTp.HCM
T:0983897365
Email:tructhytbl@yahoo.com.vn
85
NghincuYhc
Result:Thelarvalsourcesaremainlyinthewatercontainersinthehouse.Thejarsofrainwateraccounted
for 91.7% and the ant traps for 37%;. In all, 67.4% households have knowledge and 60.9% people have
appropriatepracticeagainstDF/DHF.
Conclusion:Thewatercontainersneedtobecoveredtighlyandcleanedappropriatelyshouldbefocusedon
changinghouseholdsbehaviorstopreventDF/DHF.
Keywords:Denguefever,KAP,watercontainer,household,larva
kcaTrungtmYthuyn,nm2010huyn
TVN
PhcLongc211camcbnhSXH,tng
Vit Nam l nc nm trong khu vc c
soccnmtrcvsovicchuynkhcgp
dch SXH lu hnh nng. Bnh khng ch xut
23 ln(4). Trong , x Phong Thnh Ty B l
hinthmcvngnngthn,nicmui
mtxvngvencahuynPhcLongct
Aedes sp l vct truyn bnh. Mc trm
l mc bnh SXH cao nht huyn trong nhiu
trng ca bnh cng nh dch ngy cng gia
nmlin:nm 20 08 c 87 ca, nm 2009 c 71
tng.Tsutchttuycgimdocngtciu
cavnm2010c78ca(4).
trhiuquhnnhngtsutmcckhuynh
Mctiunghincu
hng tng dn. Bin php phng bnh hiu
Xc nh lng qung ngun truyn bnh
qu nht hin nay l cn lm gim ly truyn
(1)
SXH;2/XcnhtlngidntixPhong
bngcchditutrngcamuiAedessp .
ThnhTyB,huynPhcLong,tnhBcLiu
cthcttmcxchtrongbbatam
c kin thc, thc hnh ng v phng chng
gic truyn bnh, cng vic cn thit l phi
SXHnm2011.
xcnhlngqungphttrintu.ng
thicnhiurhnkinthc,thchnhca
ngidncnhnchnhngimnotrong
cng tc phng chng bnh. y l nhng
thng tin quan trng trong vic a ra quyt
nhlpkhochvtrinkhaiccbinphp
ci thin chng trnh kim sot SXH ti a
phng.Dovy,mcchcanghincuny
nhm xc nh lng qung ngun truyn
bnhSXHvxcnhtlngidnckin
thc,thchnhngvphngchngSXH
gip cc nh qun l y t c s liu nn, la
chngiiphpcanthipphhp.
Huyn Phc Long l mt huyn vng
su, vng xa ca tnh Bc Liu c a hnh
thp,cbitcnhiuknhrch,aot,nc
ng; tp qun lu tr nc ma trong sinh
hotcangidntntitlui.y
lmttrongnhngyutnguycquantrng
khin cho dch bnh SXH thng xuyn xut
hinvctnhsinhthicamuiAedesspl
thchtrngnhngnincsch.Tia
bn huyn Phc Long hng nm s ca mc
SXHluncaohncchuynkhc.Theothng
86
ITNGPHNGPHPNGHINCU
itngnghincu
Ch h gia nh (HG), hoc ngi c
quyn quyt nh nhng sinh hot trong gia
nh.
Thitknghincu
Nghincumtctngangvicmul:
n=[Z2(1/2).p(1p)]/d2
Ktqutacn=(1,96x0,5x0,5)/0,052=384
HG.
KTQU
ctnhchungcamunghincu
Bng1:ctnhcamunghincu(n=384)
c tnh mu nghin cu
Nam
Gii
N
35
Tui
> 35
Lm rung
Ngh nghip
Khc
Tn s T l %
337
87,8
47
12,2
52
13,5
332
86,5
353
91,9
31
8,1
ChuynYTCngCng
c tnh mu nghin cu
cp I
Trnh hc vn
> cp I
4 ngi
S ngi trong HG
> 4 ngi
Khng
HG c tr em < 5t
C
Khng
HG tng c ngi mc
bnh SXH
C
Tn s T l %
183
47,7
201
52,3
212
55,2
172
44,8
299
77,9
85
22,1
321
83,6
63
16,4
a s ch HG l nam chim 87,8%, tui

itrn35tuichimtlcaohnnhmdi
35tui(86,5%sovi13,5%).Nghnghipch
yu l lm rung (91,9%). Trnh hc vn
ca ngi dn ni y tng i thp; 47,7%
c trnh t cp I tr xung. C 5 5,2% gia
nhkhngqu4ngi/h.TlHGctr
em di 5 tui chim 22,1% v HG tng c
ngi
mc
bnh
SXH
chim16,4%.
Xc nh lng qung ngun ti a bn

nghincu
Bng2:Phnbccvtchanc
Vt cha nc
S lng
n
13
H cha nc
(> 500 lt)
Lu, khp, phuy
380
(< 500 lt)
Chn nc chng 236
kin k chn t thc
n
Bnh bng
56
Hn non b
0
Vt ph thi cha n 38
c
Tng s
723
C np y C thin
ch
(%)
n
(%)
n (%)
3,4
8
2,1
3
0,8
99,0
319 83,1
34
8,9
61,5
14,6
0
9,9
0
0
0
0
0
0
327
37
C83,1%gianhcsdngnpycc
DCCNnhngchc8,9%ccDCCNnyc
thc,tuynhinvicthcchyutptrung
voccDCCNcdungtch<500lt.Bncnh
, 61,5% HG c s dng chn nc chng
kin k di chn t thc n, 14,6% HG
thng cm hoa ti trong th cng hng
ngy v 9,9% vt ph thi c th cha nc
vncnbngidnvtraxungquanhnh.
ChuynYTCngCng
NghincuYhc
Bng3:lngqungnguntruynbnhSXH
Vt cha nc
H cha nc
(> 500 lt)
Lu, khp, phuy
(< 500 lt)
Chn nc chng kin
Bnh bng
Hn non b
Vt ph thi cha n c
Tng s
S lng
n
13
%
3,4
Vt cha c lng
qung Aedes sp
n
4
%
1,0
380 99,0
352
91,7
236 61,5
56 14,6
0
0
38
9,9
723
142
0
0
0
498
37,0
0
0
0
Quaquansttrctipccvtchancti
ccHG,ktqunghincuchothyc91,7%
HG c lng qung trong cc DCCN thng
dngnhlu,khp,phuytrncmasinh
hotv37%HGcchnncchngkindi
chntthcnclngqungAedesaegypti,mt
sthchanccngclngqungtuynhin
chchimtlthpnhtl1%.
Kinthc,thchnhcangidnvphng
chngSXH
Bng4:KinthcphngchngSXH(n=384)
Ni dung
Tn s T l %
tng nghe ni v bnh SXH
370
96,4
Hiu bit ng du hiu ca bnh SXH
338
88,0
Bit ng du hiu khi bnh chuyn
33
8,6
nng
Bit ng ly truyn ca bnh
370
96,4
Bit mui vn l trung gian truyn bnh
322
83,9
Bit thi im t ng i ca mui
113
29,4
Aedes sp
Bit ni trng ca mu i Aedes sp
166
43,2
Bit SXH c th phng trnh c
353
91,9
Bit bin php ph ng chng SXH tt
349
90,9
nht
Bit bin php ph ng trnh mui t
145
37,8
Bit bin php dit lng qung
85
22,1
Kt qu nghin cu cho thy 96,4% i

tngthamgiatngnghenivbnhSXH.
KhichivduhiunhnbitbnhSXH,
c 88% i tng hiu ng v bnh nhng
ngi dn bit c cc du hiu khi bnh
chuynnngchimrtthp8,6%.Kinthcv
phngbnhSXHcangidnniykhtt
vi91,9%itngbitbinphpphngchng
87
NghincuYhc
bnh tt nht v 90,9% bit cch phng trnh

muit.
HGctremdi5tuichim22,1%vHG
tngcngimcbnhSXHchim16,4%.
Bng5:ThchnhphngchngSXH(n=384)
lngqungngun
Ni dung
Tn s T l %
C ng mng
381
99,2
Ng mng c ngy ln m
89
23,2
C y np cc DCCN (lu, phuy, khp,
373
97,1
kiu, x, thng)
Sc ra ng cc DCCN
242
63,0
Vt b cc VDPT (t, chn b, go
244
63,5
da)
S dng cc bin php xua, dit mui
379
98,7
Quan st v sinh nh t
383
99,7
Quan st v sinh mi trng xung quanh 383
99,7
nh t
Qua phng vn kt hp vi quan st bng

kimchothyc97,1%HGcdngnpy
cc DCCN; 65,4% HG c sc ra cc DCCN
thngxuyn.C45,1%HGsc ranhk
cc DCCN 7 ngy/ln; 63% HG c sc ra
cc DCCN nh l cm hoa, chn nc chng
kindichntthcn;34,6%hscracc
DCCN ng hn nh ( 7 ngy/ln); 36,5%
HGvtbVDPTkhngngquinh;99,7%
HGcvsinhnhcatt,thngthong,sp
xpqunongnnp,mntreogngng,loi
bnitrncamui.Tuynhin,c3%HG
v sinh mi trng khng t, c VDPT cha
nc v ao t nc ng quanh nh. Kt qu
ny tri ngc vi quan st thc t trn cc
DCCN trong nh, c n 91,7% HG c lng
qung.
BNLUN
ctnhchungcamunghincu
a s ch HG l nam (87,8%), t l ny
phn nh ng thc t quan h trong gia nh
ca cc tnh khu vc pha Nam phn ln ch
HG l ngi cha, ngi chng, ngi ng
trong gia nh, ngi n ng c quyn quyt
nhccvnsinhhotvctuiitrn35
tui (86,5%). y l vng nng thn nn ngh
nghip ch yu l lm rung (91,9%), trnh
hcvncangidnniytngithp
(47,7% c trnh t cp I tr xung). T l
88
Hu ht cc HG v ng nng thn u c
thiquentrncmasinhhot,nhngch
c 83,1% gia nh c s dng np y cc
DCCN.Ccnpynythngclmbng
ximng,nhmvnha,tuynhinccloinp
nythngkhngknvthngcmtkhong
nh cho mui c th bay vo trong
trngnndcynpnhngtlccDCCN
clngqungvnchimtlkhcao (91,7%).
S DCCN c th c chim 8,9%, tuy nhin
victhcchyutptrungvoccDCCNc
dung tch < 500 lt nh lu, kiu, khp, phuy,
thng. Cc DCCN cha nc ln nh h th t
c th c hn do ngi dn quan nim h
lun y kn nhng thc t cc np h ny
thngchcybngccmitolhnn
khngkn,vvytlhchancvnthyc
lng qung nhng chim t l thp (1%). Tuy
nhin, t l ny c th cha chnh xc do h
cha nc ln v kh quan st nh gi
ngvobngkimquanst.
TrmYtcntngcngcngtcgiodc
truyn thng phng chng bnh SXH, c bit
tptrungvovichngdnynhthno
l y kn cc DCCN sinh hot hng ngy v
khinimykncangidnvncnhiu
sailchrtnhiu,ngthihngdnkcch
ngn nga mui c th trng vo cc vt
chanctrongnhnhchnncchngkin
di chn t thc n l mt loi DCCN rt
thngdngminNam.
Kin thc, thc hnh ca ngi dn v

phngchngSXH
Kt qu nghin cu cho thy hu ht i
tngthamgiatngnghenivbnhSXH
(96,4%), chng t hin nay SXH khng cn l
vnxaltrongcngng.Khi c hi v
du hiu nhn bit bnh SXH, c n 88% i
tnghiungvbnh(kctnht2du
hiustvxuthuyt).iunychothyvn
ChuynYTCngCng
cn t l rt nh cc i tng vn cha nhn
bitbnh,khngbitcchtheodivxtrkhi
gianhcngimcbnhSXH.Nguynnhn
ldonhngHGnysutrongngrung,
knhrchnnvictipcnnhngthngtinv
bnhSXHrthnch.Bncnh,ngidn
bit c cc du hiu khi bnh chuyn nng
chimrtthp8,6%nhngcn96,4%ngi
dn bit c nguyn nhn ly truyn bnh
SXH l mui. Kt qu ny khng khc bi t
nhiuvinghincuPhVinhnhQun
ng Nai ca Nguyn Vn Danh nm 2005 l
93,9%(2), c th do cc nghin cu cng c
thc hin trn a bn khu vc pha Nam, ni
thng xuyn xy ra dch bnh ny, ng thi
mtphndongidnthngcnghenhc
nnguynnhnlynhimbnhtrnccknh
phng tin truyn thng i chng. T l
ngidnbitnguynnhnvloimuitruyn
bnhkhcaonhngsngibitnitrng
(43,2%)vthiimtngicamuivnli
rt thp (29,4%). iu ny chng t ngi dn
cha hiu r ni sinh sn cng nh thi im
mloimuigybnhnyhotngmnhv
cthtruynbnhcbinphpphngchng
tt hn. Kin thc v phng bnh SXH ca
ngidnniykhttvi91,9%itng
bit bin php phng chng bnh tt nht v
90,9% bit cch phng trnh mui t, t l
ngi dn bit cc bin php dit lng qung
trong nghin cu ny vn cn thp (22,1%). V
vy, trong thi gian ti a phng cn tng
cngvnng,gimst,tiuditlngqung
hnchmuiphttrin.
V thc hnh, c 45,1% HG sc ra nh
kccDCCNmttunmt ln ; 63% HG c
sc ra cc DCCN nh l cm hoa, chn nc
chngkindi chn t thc n; 34,6% h sc
ra cc DCCN ng hn nh ( 7 ngy/ln);
36,5%HGvtbVDPTkhngngquinh;
99,7% HG c v sinh nh ca tt, thng
thong,spxpqunongnnp,mntreogn
gng,loibnitrncamuivc3%HG
v sinh mi trng khng t, c VDPT cha
ncvaotncngquanhnh.Tuynhin,
ChuynYTCngCng
NghincuYhc
ktqunytringcviquanstthctcc
DCCN trong nh, vn cn 91,7% HG c lng
qungtrongccDCCNny.
Qua nh gi cho thy ngi dn c kin
thc rt tt v thc hnh phng chng SXH
nhngtkinthcchuynquathayihnhvi
vn cn mt qung ng di dn n hu
quldchSXHvnlintcxyratrnabn
nghincutrongnhiunmlin.Nguynnhn
docngtcTTGDSKcaaphngchaxc
nhcnhngmthnchcangidndo
u.Bncnh,Trmytkhngkinhph
hotngthngxuyn,cngtcvincha
nhit tnh, chnh quyn a phng cha quan
tmvcngtcphngchngSXH,chaxhi
ha c cng tc y t, ch ni trn l thuyt
nhngthctvnchatrinkhaic.
KTLUN
lng qung ngun thng xut hin
trongnh,tptrungccDCCNctrnc
mavncschsinhhot(lu,khp,kiu)
chim91,7%v37%clngqungtrongchn
nc chng kin k chn t thc n, khng
thy lng qung trong cc DCCN khc. T l
ngi dn bit ni trng thp (43,2%) v
thi im t ngi ca mui vn rt thp
(29,4%). T l ngi dn bit cc bin php
dit lng qung thp (22,1%) v hiu sai v
vicyknccDCCNrtnhiu.
T l HG sc ra cc DCCN ng hn
nh(7ngy/ln)l34,6%;c3%HGvsinh
mitrngkhngt,ccVDPTchancv
aotncngvncnquanhnh.
KHUYNNGH
iviNgnhYt
Vn ng v gip ngi dn thng
xuynscraccDCCNnhlu,phuy,cbit
ccDCCNmatrongnh v chn nc chng
kindichnt.Bncnh,cntngcng
giodchnhvicangidn,cbitlcn
nhnmnhvaitrtrchnhimcahtrongvn
kimsotmui,lngqung,cthnh:gii
thchrnimuithngtrngvthiim
89
NghincuYhc
hot ng ca mui, hng dn cc bin php

ditlngqungdatrnktqunghincu
cthcttmcxchquantrngcavect.
2.
ivicngng
Nngcaosnhnthcvthayihnhvi
camicnhn,cngngphithngxuyn
kimsotccDCCNsinhhotloitrnh
hsinhcaccvecttruynbnh.
3.
4.
bnhstDengue/stxuthuytDengue,NhxutbnYhc,H
ni.
LLLan(2004),Khostkinthcthithchnhphng
chng SXH ca ng i dn qun 5, thnh ph HCM nm 2004,
lun vn tt nghip Bc s chuy n khoa cp 1 YTCC,
TP.HCM.
NguynvnDanh(2005),Kinthcthihnhvivphng
chngSXHcangidnxPhVinh,huynnhQun,tnh
ngNainm2005,lun vn tt nghip Bc s chuyn khoa
cp1YTCC,TP.HCM.
TTYT huyn Phc Long (2010), BocoTTYThuynPhc
Longnm2010.
TILIUTHAMKHO
1.
BYt,Chngtrnhmctiuqucgiaphngchngmts
bnh x hi, bnh dch nguy him v HIV/AIDS & d n
phngchngSD/SXHD(2003),Gimst,chnonviutr
90
ChuynYTCngCng
NghincuYhc
NGHINCUMTSCIMDCHTVYUTNGUYCNHIM
UTRNGGIUNTOXOCARASPPMTSIMTIBNHNHVGIA
LAI
BiVnTun*,NguynVnChng*
TMTT
tvn:Bnhgiunachmothucnhmbnhngvtlbnhtthcxngsnglytruyn
sangngi.NgibnhimbnhdotnhcnuttrngcutrngcaToxocarasppnhimtrongt,nc,
thcntphncanhngchconbnhimbnh.
Mctiu:1.XcnhtlngicxtnghimELISAnhimutrnggiunachticcimnghin
cu.2.Xcnhtlnhimgiunachtrnvtchchnh(ch)vtrnggiunach,momitrng
t.3.Xcnhmtsyutnguycnhimutrnggiunach/moticcimnghincu.
Phngphpnghincu:nghincuctngangmt:xcnhtlnginhimutrnggiunach
bngxtnghimELISA;xcnhtlnhimgiunachchbngkthutxtnghimphnchtmtrng
theophngphplytmlngcnviFormalinether;xcnhstntitrnggiunachngoicnhbng
xtnghimtRomanenko;xcnhmtsyutnguycnhimutrnggiunachbngbcuhiphng
vn
Ktqu:TlnhimutrnggiunToxocarasppngibngxtnghimhuytthanhhcticcim
nghincut13,116,8%.Tlchbnhimticcimnghincul41,3%.Cskhcbitvnhimu
trnggiunToxocarasppgianuivkhngnuichticcimnghincu(p<0,05vp<0,01).Nguyc
nhimutrnggiunToxocarasppnhngngitronghcnuichcaogp1,92,8lnsovinhngngi
tronghkhngnui.Tlnhimtrnggiunttinhnghcnuichccimnghincut35,7
42,9%,tinhnghkhngnuicht8,620,5%.NguycccmutbnhimtrnggiunToxocaraspp
nhnghcnuichcaogpt2,99,4lnnhnghkhngnuich(p<0,05vp<0,01).Mtnhim
trnggiunToxocarasppccmutticchcnuichdaongt5,57,3trng/100gamt,ticch
khngnuicht0,82,1trng/100gamt.Nhngngitipxct,bngbchmothngxuync
nguycnhimutrngToxocaraspp.
Ktlun:TlnhimutrnggiunToxocarasppngiticcimnghincut13,116,8%.Tl
chbnhimticcimnghincul41,30%.Tlnhimtrnggiunttinhnghcnuichcc
imnghincut35,742,9%,tinhnghkhngnuicht8,620,5%.Ccyutnguycnhimutrng
Toxocarasppngiltipxct,bngbchmothngxuyn.
Tkha:Bnhgiunachmo,dcht,tlnhimtrng
ABSTRACT
EPIDEMIOLOGICALCHARACTERISTICS&RISKFACTORSFORTOXOCARASPPINFECTIONIN
SOMESITESINBINHDINH&GIALAIPROVINCES.
BuiVanTuan,NguyenVanChuong
Background:Toxocariasisisoneofzoonosis.Humansgettoxocariasisbyingestionofembryonatedeggsof
*VinStrtKSTCTQuyNhn
Tcgilinlc:TS.NguynVnChng
90
T:0914004839
Email:chuongkst@yahoo.com.vn
ChuynYTCngCng
NghincuYhc
Toxocarasppwhicharereleasedinthefecesofinfectedanimalsandthenadheretocontaminatedsources.
Objectives:1.TodeterminetheproportionofpeopleinfectedwithToxocarasppusingELISAtestinstudy
sites.2.Todeterminetheratesofdogroundworminfectionindefinitivehosts(dogs)andToxocarasppeggsin
contaminatedsoil.3.ToidentifyriskfactorsforzoonoticToxocarasppinfectioninthestudysites.
Methods:ThiswasacrosssectionalstudycarriedouttodeterminetherateofToxocarasppinfectionby
ELISAtest,rateofdogroundworminfectionindogsbyexaminingdogexcrementforembryonatedeggsusing
the method of centrifugal sedimentation with Formalin ether, and existence of dogroundworm eggs in
environmentby Romanenko soil test, and to identiy some risk factors for Toxocara spp infection by interview
withthequestionnaire.
Result: The rate of Toxocara spp infection in humans in the study sites was from 13.1 to 16.8%. The
averagerateofinfecteddogsinstudysiteswas41.3%.ThedifferenceinToxocarasppinfectionwasfoundin
people who raise dogs and those who dont in study sites (p < 0.05 and p < 0.01). The risk of Toxocara spp
infection in people who raise dogs was from 1.9 to 2.8 times as high as those who dont. In dograising
households, the rate of Toxocara spp eggs contaminated soil was 35.742.9% compared with 8.620.5% in
households not raising dogs. Soil samples in households raising dogs was 2.99.4 times more likely at risk of
contaminationwithToxocarasppeggsthanthoseinhouseholdsnotraisingthem(p<0.05andp>0.01).Indog
raisinghouseholds,thedensityofToxocarasppeggsinsoilsampleswas0.82.1eggs/100gramofsoil,compared
with0.82.1eggs/100gramofsoilinhouseholdsnotraisingdogs.Peoplewhooftencontactedwithsoil,embraced
dogsorcatsweremorelikelytogetinfectedwithToxocaraspp.
Conclusion:theinfectionratesofToxocarasppin humans identified by serological surveys in the study
sites was from 13.1 to 16.8%, respectively. The average rate of infected dogs in the study was 41.30%., the
infectionrateofwormeggswasfrom35.742.9%indograisinghouseholdsand8.620.5%forhouseholdsthat
didnotraisedogs.TheriskofToxocarasppinfectioninpeoplewhooftencontactwithsoilwasfrom2.0to2.6
timesashighasinthosewhodont.Peoplewhooftenembracedogsorcatswerefrom2.0to3.3timesmorelikely
togetinfectedwithToxocarasppthanthosewhodont.
Keywords:toxocara,infection,prevalence,epidemiology
nghimticccsyt.Tuynhinhinnaycc
TVN
csytchquantmnkhm,xtnghimv
Bnh giun a ch mo thuc nhm bnh
iutr,thiuccnghincuvcimdch
ng vt tc bnh t th c xng sng ly
t v cc yu t nguy c. Vic nghin cu cc
truynsangngi.Ngibnhimbnhdotnh
c im dch t ca bnh u trng giun
c nut trng c u trng ca Toxocara spp
Toxocaraspp,phngthclantruyncngnh
nhim trong t, nc, thc n do cht phng
ccyutnguyclcnthit,trncss
u ba bi ca nhng ch con b nhim bnh.
xut nhng bin php can thip hu hiu
Cc u trng i vo rut, di chuyn n ni
nhmgimtlnhimtrongcngng.
tng, ti y chng c th sng nhiu nm
Mctiuti
dngtdohayhaknnhngskhngbaogi
1.XcnhtlngicxtnghimELISA
pht trin thnh giun trng thnh. Ngoi ra
nhimutrnggiunachbngticcim
ngicthnhimdonthtthvtnukhng
(2,6)
nghincu.
chn .
Nhngnmgnyslngbnhnhnc
chiuhngngycnggiatngcthdomm
bnh c pht tn nhiu ra ngoi cnh, mt
khc ngi dn c thc n khm v xt
ChuynYTCngCng
2.Xcnhtlnhimgiunachtrnvt
ch chnh (ch) v trng giun a ch, mo
mitrngt.
3.Xcnhmtsyutnguycnhimu
91
NghincuYhc
trnggiunach/moticcimnghincu.
I TNG V PHNG PHP

NGHINCU
itngnghincu
Ngidncchntrong4x.
Ch c chn trong 100 h gia nh. Mu
tthusn,vnca100hgianh.
aim
Chn2xthuchuynAnNhn,tnhBnh
nh v 2 x thuc th x An Kh tnh Gia Lai.
Ti An Nhn, chn x Nhn Phong l x c s
chnhiuvxctlnui ch t l x Nhn
Hng. Ti th x An Kh, chn x c t l nui
chnhiulxSongAnvxctlnuicht
lphngTySn.
Thigian
Tthng3/201112/2011.
Phngphpnghincu
Thitknghincu
Ctngangmt,mttlnhimutrng
giunachbngxtnghimELISA;mtt
lnhimgiunachchbngkthutxt
nghim phn ch tm trng theo phng php
lytmlngcnviFormalinether;mtstn
ti trng giun a ch ngoi cnh bng xt
nghim t Romanenko; m t mt s yu t
nguycnhimutrnggiunachbngb
cuhiphngvn.
KTQUVBNLUN
Kt qu iu tra nhim u trng giun
ToxocarasppngibngXNELISA
Bng1:Tlngichuytthanhdngtnhvi
Toxocaracanis
Tnh
X/phng S XN S (+) T l (%)

p
Nhn Phong 429
72
16, 8
Bnh nh
> 0,05
Nhn Hng
406
55
13,5
Song An
417
60
14,4
Gia Lai
> 0,05
Ty Sn
406
53
13,1
Cng
1.658 240
14,47
T l nhim u trng giun Toxocara spp

ngibngxtnghimhuytthanhhcticc
92
im nghin cu t 13,116,8%. Trong nghin

cu ny chng ti chn mt s im ti Bnh
nhvGiaLailhaiaphngc s lng
bnhnhnnhimutrngToxocarasppcaonht
(s liu ti Phng Khm Vin St rtKSTCT
Quy Nhn), tuy nhin so vi nghin cu ca
TrnThHngtixAnPh,huynCChi,TP
HCMtlhuytthanhdngtnhl38,4%(4)v
nghincucaTrnVinhHintihaixChP
v H Bng (Gia Lai) t l huyt thanh dng
tnh l 50%(5) th t l dng tnh trong nghin
cu ca chng ti thp hn. Khng c s khc
bit nhim u trng giun Toxocara spp ngi
gia im nui ch nhiu v im nui ch t.
Trong nghin cu ny chng ti chn x Nhn
PhongcaBnhnhvxSongAncaGiaLai
limnuichnhiu,xNhnHngcaBnh
nh v phng Ty Sn ca Gia Lai l im
nuicht.
Bng2:Mchuytthanhdngtnhctheo
mtquang(OD)
X/phng S (+)
1 - < 1,5
Nhn Phong 72
Nhn Hng 55
Song An
60
Ty Sn
53
Cng
240
OD/ngng
1,5 - < 2
46
45
43
36
170 (70,8%)
21
5
7
3
14
3
13
4
55 (22,9%) 15 (6,3%)
Mc huyt thanh dng tnh ch yu

mcthp(70,8%),mcOD/ngnglnhnhoc
bng2chchim6,3%.
Kt qu iu tra trng giun Toxocara spp

trnchvmitrngt
Bng3:Tlnuichcchgianhticcim
nghincu
Tnh
X/phng
S h S h
iu tra nui
ch
Nhn
Phong
100
56
Bnh
nh
Nhn Hng
100
30
Song An
100
55
Gia Lai
Ty Sn
100
28
Cng
400
169
T l
(%)
56,0
30,0
55,0
28,0
42,3
< 0,05
< 0,05
X Nhn Phong v x Song An c t l cc

h nui ch nhiu, x Nhn Hng v phng
TySnctlcchnuicht,skhcbitc
ChuynYTCngCng
nghathngk(p<0,05).
Bng4:TlchbnhimToxocaracanis
Tnh
X/phng
S ch S ch
xt
b nhim
nghim
60
28
Bnh Nhn Phong
nh Nhn Hng
32
11
Song An
58
25
Gia Lai
Ty Sn
34
12
Cng
184
76
T l
(%)
46, 7
34,4
43,1
35,3
41,3
> 0,05
> 0,05
T l ch b nhim ti cc im nghin cu
chungl41,30%.Khngcskhcbitgiatl
chnhimvinuichticcimnghincu.
Bng5:Linquangianhimutrnggiun
Toxocarasppngivnuich
X/phng
Nhn Phong
Nhn Hng
Song An
Ty Sn
Nhim
Nui ch
Khng nui
Nui ch
Khng nui
Nui ch
Khng nui
Nui ch
Khng nui
48
24
29
26
41
19
27
26
Khng
nhim
183
174
100
251
183
174
100
253
p/OR
< 0,05
OR = 1,9
< 0,01
OR = 2,8
< 0,05
OR = 2,0
< 0,01
OR = 2,6
C s khc bit gia nui ch v nhim u

trnggiunToxocarasppticcimnghincu
(p < 0,05 v p < 0,01). Nguy c nhim u trng
giun Toxocara spp nhng ngi trong h c
nui ch cao gp t 1,92,8 ln nhng ngi
tronghkhngnui.
Bng6:TlnhimtrnggiunToxocarasppt
X/phng
H nui
ch
S
S
mu mu
t XN (+)
Nui ch
56
24
Nhn Phong
Khng nui 44
9
Nui ch
30
12
Nhn Hng
Khng nui 70
6
Nui ch
55
23
Song An
Khng nui 45
8
Nui ch
28
10
Ty Sn
Khng nui 72
4
T l
(%)
p/OR
42,6
20, 5
40,0
8,6
41,8
17,8
35,7
5,6
< 0,05
OR = 2,9
< 0,01
OR = 7,1
< 0,05
OR = 3,3
< 0,01
OR = 9,4
Tlnhimtrnggiunttinhnghc
nuichccimNCt35,742,9%,tinhng
hkhngnuicht8,620,5%.Cskhcbit
gianuichvnhimtrnggiunToxocaraspp
t. Nguy c cc mu t b nhim trng giun
ChuynYTCngCng
NghincuYhc
Toxocarasppnhnghcnuichcao gp t
2,99,4lnnhnghkhngnuich(p<0,05
vp<0,01).
Cskhcbitgianuichvnhimtrng
giunToxocarasppt.Nguycccmutb
nhim trng giun Toxocara spp nhng h c
nuichcaogpt2,99,4lnnhnghkhng
nui ch (p < 0,05 v p < 0,01). Mt nhim
trnggiunToxocarasppccmutticch
c nui ch dao ng t 5,57,3 trng/100 gam
t, ti cc h khng nui ch t 0,82,1
trng/100 gam t. Mt nhim trng giun
chungtl3,8trng/100gamt,sovikt
qucaS.Dubnnm2006,iutranhimtrng
Toxocara spp vng thnh th v nng thn ti
Praha, Cng ha Sc cho thy s trng trung
bnhtrong100gamtl6,2trng(1)thnghin
cucachngtithphn.
Bng7:MtnhimtrnggiunToxocaraspp
t
X/phng H nui S mu S mu
S
ch
t xt
(+)
trngTB/mu
nghim
(100 g/mu)
Nhn Phong Nui ch
56
24
7,3
Khng
44
9
2,1
nui
Nhn Hng Nui ch
30
12
5,6
Khng
70
6
0,9
nui
Song An Nui ch
55
23
6,8
Khng
45
8
1,9
nui
Ty Sn Nui ch
28
10
5,5
Khng
72
4
0,8
nui
Cng
400
96
3,8
Mt nhim trng giun Toxocaraspp cc

mu t ti cc h c nui ch t 5,57,3
trng/100gamt,ticchkhngnuicht
0,82,1trng/100gamt.
Kt qu iu tra mt s yu t nguy c
nhimutrnggiunToxocaraspp
Bng8:Mtsyutnguycdothiquen,tp
qunsinhhot
X/phng
S
iu
tra
n rau Ung Tip xc Bng b

sng nc l t,
ch,
nghch mo
93
NghincuYhc
t
Nhn Phong 429
156
77
70
60
Nhn Hng 406
118
57
49
34
Song An
417
120
61
75
70
Ty Sn
406
108
60
55
33
Cng
1.658
502
255
249 (15
197
(30,3%) (15,4%)
%)
(11,9%)
Kt qu iu tra 1.658 ngi ti cc im

nghin cu cho thy t l ngi dn c n rau
sngl30,27%,ungncll15,38%,tipxc
t l 15,02%, bng b ch mo l 11,88%. Khi
phntchmilinquangianrausng,ung
nclvinhimutrnggiunToxocarasppcho
thykhngcmilinquan(p>0,05).
Ty Sn
xuyn
Thng xuyn
Khng thng
xuyn
10
43
23
330
2,1
< 0,01
OR =
3,3
NguycnhimutrnggiunToxocaraspp
nhngngibngbchmothngxuyncao
gp t 2,03,3 ln nhng ngi khng thng
xuyn.Skhcbitcnghathngkvip<
0,05 v p < 0,01. iu ny ph hp vi nghin
cucaPhanAnhTunvtcgincngoi
i Loan, Indonesia, Php. Khi nui, bng b
ch mo, nht l ch con, khi ch b nhim
Toxocaracanis,chlimhumn,limlnghoc
limngi,ngiscnguycmcbnh(2,3).
Bng9:Linquangianghcht,tipxctv
nhimutrngToxocaraspp
KTLUN
X/phng Nghch, tip xc Nhim Khng

t
nhim
Tl nhimu trng giun Toxocaraspp

ngiticcimnghincu
Nhn Phong
Nhn Hng
Song An
Ty Sn
Thng xuyn
Khng thng
xuyn
Thng xuyn
Khng thng
xuyn
Thng xuyn
Khng thng
xuyn
Thng xuyn
Khng thng
xuyn
21
51
49
308
12
43
37
304
17
43
58
299
13
40
42
311
p
OR
< 0,05
OR =
2,6
< 0,05
OR =
2,3
< 0,05
OR =
2,0
< 0,05
OR =
2,4
C s khc bit gia tip xc t thng

xuyn v khng thng xuyn vi nhim u
trnggiunToxocarasppticcimnghincu
(p<0,05).NguycnhimutrnggiunToxocara
sppnhngngitipxctthngxuyncao
gp t 2,02,6 ln nhng ngi khng thng
xuyn.
Bng 10: Linquangiabngbch,movnhim
utrnggiunToxocaraspp
X/phng
Bng, b ch,
mo
Thng xuyn
Khng thng
xuyn
Thng xuyn
Nhn Hng Khng thng
xuyn
Thng xuyn
Song An
Khng thng
Nhn
Phong
94
Nhim
Khng
nhim
p
OR
< 0,05
OR =
2,0
16
56
44
313
10
45
24
327
< 0,05
OR =
3,0
25
35
89
268
< 0,05
OR =
T l nhim u trng giun Toxocara spp

ngi bng xt nghim huyt thanh hc ti cc
im nghin cu t 13,116, 8%. Khng c s
khc bit nhim u trng giun Toxocara spp
ngi gia im nui ch nhiu v im nui
cht.
T l nhim giun a ch trn vt ch

chnh (ch) v trng giun a ch, mo
mitrngt
T l ch b nhim ti cc im nghin cu
chungl41,3%.Khngcskhcbitgiatl
chnhimvinuichticcimnghincu.
Cskhcbitgianuichvnhimutrng
giun Toxocara spp ti cc im nghin cu (p <
0,05vp<0,01).Nguycnhimutrnggiun
Toxocarasppnhngngitronghcnuich
cao gp t 1,92,8 ln nhng ngi trong h
khngnui.
Tlnhimtrnggiunttinhnghc
nuichccimnghincut35,742,9%,ti
nhng h khng nui ch t 8,620,5%. C s
khc bit gia nui ch v nhim trng giun
Toxocarasppt.Nguycccmutbnhim
trnggiunToxocarasppnhnghcnuich
caogpt2,99,4lnnhnghkhngnuich
(p<0,05vp<0,01).Mtnhimtrnggiun
ChuynYTCngCng
NghincuYhc
Toxocarasppccmutticchcnuich
daongt5,57,3trng/100gamt,ticch
khngnuicht0,82,1trng/100gamt.
TILIUTHAMKHO
Mtsyutnguycnhimutrnggiun
Toxocarasppticcimnghincu
2.
Khngcskhcbitgianrausng,ung
nc l thng xuyn v khng thng xuyn
vinhimutrnggiunToxocaraspp.
Cskhcbitgiatipxct,bngbch
mo thng xuyn v khng thng xuyn vi
nhim u trng giun Toxocara spp. Nguy c
nhimutrngToxocarasppnhngngitip
xc t thng xuyn cao gp t 2,02,6 ln
nhng ngi khng thng xuyn. Nguy c
nhimutrnggiunToxocarasppnhngngi
bngbchmothngxuyncaogpt2,03,3
lnnhngngikhngthngxuyn.Skhc
bitcnghathngkvip<0,05vp<0,01.
ChuynYTCngCng
1.
3.
4.
5.
6.
Dubna S. (2007). Contamination of soil with Toxocara eggs in

urban(Prague)andruralareasintheCzechRepublic.Veterinary
Parasitology.Volume144,issues12,15March,papes8186.
HayashiE.,TudaJ.,ImadaM.,AkaoN.,FujitaK(2005).The
high prevalence of asymptomatic Toxocara infection among
schoolchidreninManado,Indonesia.SoutheastAsianjTropMed
PublicHealth,36(6):399406;.10.
PhanAnhTun,TrnThKimDung,TrnPhMnhSiu,
TrnVinhHin(2009).Tlhuytthanhdngtnhvikhng
nguynToxocaracanistrnccbnhnhnctriuchngdng.
Tpchyhcquns.SCD91..ISSN18591655.CcQuny
xutbn.
Trn Th Hng, Vn Dng, Trn Th Kim Dung, Trn
Vinh Hin (2000). iu tra tnh hnh nhim giun a ch mo
ToxocaraspcngngdnxAnPh,huynCChi,TPHCh
Minh. Thng tin phng chng bnh st rt v cc bnh k
sinhtrngcntrngTrungng;s4,trang7479.
TrnVinhHin,TrnThKimDung,PhmVnLcvCS
(2008).XcnhtlhuytthanhdngtnhToxocaraspcac
dntihaixChPvHBngtnhGiaLai. Tp ch Y dc
hcQunsHcVinQunY,33(2),trang8993.
TrnXunMai(1992).Gpphnnghincungctksinhly
truyntphnchmosangngi.LunnPhTinsyhc,
ihcYdcTPHChMinh.
95
NghincuYhc
NGHINCUMTSTRIUCHNGLMSNGVHIUQUIUTR
BNHGIUNUGAIBNGTHUCALBENDAZOLETIBNHNH
NguynVnChng*,NguynHuGio*
TMTT
tvn:Bnhgiunugailmtbnhksinhtrngdonphic,ln,chcchautrngcha
cnuchn.Biuhincabnhnhiucquantrongcthvinhngtriuchngadng.
Mctiu:Nghincuti2imcatnhBnhnhvi3mctiu:1)Xcnhtlnhimcabnhgiun
ugaingitiimnghincubngkthutELISA;2)Mtmtstriuchngcabnhgiunugai
tiimnghincu;3)nhgihiuquiutrbnhbngthucAlbendazole400mg.
Phngphpnghincu:CtngangmtvtlnhimgiunugaibngkthutxtnghimELISA;
mtcctriuchnglmsngcabnh.Phngphpthnghimlmsngkhngichngchonhngbnh
nhnnhimgiunugaibngthucAlbendazole400mgliu15mg/kg/24hx21ngy.Theoditriuchnglm
sng,chcnnggan,thntrcvsau1thngiutr;theodilmsngvxtnghimELISAtrcvsau6
thngiutr.
Kt qu: T l nhim giun u gai c pht hin bng k thut min dch ELISA chung ca 2 im
nghincul6,33%;trongtlnhimngii(6,89%)caohnnamgii(5%)vip>0,05.Tlnhim
giunugaibngxtnghimmindchELISAchyuhiugikhngthmc1<1,5ODchim57,70%;
mc1,5<2ODchim28,85%;mc2ODchim13,46%.Triuchngauuchimtlcaonht35/52
(67,30%); triu chng nga, ni mn gp 42,30%; mt m chim t l 25%. Triu chng au bng gp
28,85%;rilontiuhogp7,69%.Cctriuchngkhcnhmtmi,tchn,chngmt,khth,nhc
mi,tcngc,aukhpgp50%.ThucAlbendazole(Azole)400mgviliu15mg/kg/24hchia2lncch
nhau8hx21ngy;Sau1thngiutr,triuchngmtm,aubngvrilontiuhogim100%;au
ugim97,14%;nga,nimngim45,45%;cctriuchngkhcgim76,92%.Ccchcnngganvchc
nngthnthayikhngngkvucxuhngtrvbnhthng.Sau6thngiutr;hunhcc
triuchnglmsngugimvkhi100%;cn2/52cacnga,nimnnhkhnglintc;3/52cacbiu
hinmtmi,kmn.Tcdngphcathucthnggpnhngngyulmtmi,auuchimtl
23,06%;dngmt,mtvnngbngchimtl7,69%;bnrnchntay5,77%;bunng3,85%;i
ngoiphnst,lng9,61%;nga,nimntngln17,08%.
Ktlun:Triuchnglmsngcabnhgiunugaiphthincngngchyulauu,nga
nimn,aubng,rilontiuho.ThucAlbendazole400mgviliu15mg/kg/24hx21ngy,sau6thng
100%khivlmsng;ELISAdngtnhgim86,54%.Tcdngphcathucvitlthp,tmtkhng
cncanthip.
Tkha:giunugai,Bnhnh
VinStrtKSTCTQuyNhn
Tcgilinlc:TS.NguynVnChng T:0914004839
96
Email:chuongkst@yahoo.com.vn
ChuynYTCngCng
NghincuYhc
ABSTRACT
SOMECLINICALSYMPTOMSOFHUMANGNATHOSTOMIASIS&THERAPEUTICEFFICACY
OFALBENDAZOLEINBINHDINHPROVINCE
NguyenVanChuong,NguyenHuuGiao
Background:Gnathostomiasisistheinfectionofhumanintestinalparasitesduetothehabitofeatingrawor
undercookedfishes,eelsorfrogsthatcontainfullydevelopedlarvae.Thediseasemanifestationscanbefoundin
manyinternalorgansofhumanbodywithdiversifiedsymptoms.
Objectives: The study was conducted in two sites of Binh Dinh province with 3 targets: 1) Identify the
infection rate of gnathostomiasis in humans by enzymelinked immusorbent assay (ELISA) test; 2) Describe
symptoms of gnathostomiasis in study sites.3) Evaluate the therapeutic efficacy of Albendazole 400mg for
gnathostomiasis.
Methods: A crosssectional descriptive study was conducted to evaluate the infection rate of
gnathostomiasisbyELISAandtodescribetheclinicalsymptomsofthedisease.Randomized,noncomparative
clinicaltrialswerecarriedoutongnathostomiasisinfectedpatientswithAlbendazole400mgat15mg/kgofbody
weightin24hoursx21days.Othermethodswereasloused,suchastomonitorclinicalsymptoms,thefunctions
ofliver,kidneypriortoandonemonthaftertreatment;toclinicallyfollowupandcarryoutELISApriortoand
sixmonthsaftertreatment.
Result:TheoverallinfectionrateofgnathostomiasisdiagnosedbyELISAintwostudysiteswas6.33%;of
whichfemales(6.89%)werelikelytobeinfectedwiththediseasethanmales(5%)withp>0.05.ByELISAtest,
theinfectionrateofgnathostomiasiswasmainlypresentedatantibodytitersat1<1,5OD(57.70%),1,5<2OD
(28.85%),2OD(13.46%).Ofclinicalsignsandsymptoms,headachehadthehighestratewith35outof52
cases (67.30%); itching and hives 42.30%; blurred vision 25%; abdominal pain 28.85%, digestive disorder
7.69%. Other symptoms such as fatigue, legnumbness, dizziness, dyspnea, aches and pains, chest pain,
arthralgiaoccurredin50%ofcases.Albendazole(Azole)400mgat15mg/kgofbodyweightin24hours,twicea
daywith8hourintervalsx21days.Afteronemonthoftreatmenttherewerereductionofsymptomssuchas
abdominal pain, digestive disorder (reduced by 100%); headache (97.14%); hives (45.45%), other symptoms
(76.92%).Thefunctionsoftheliverandkidneychangedinsignificantlyandtendedtogettingbacktonormal.
After6monthsoftreatment,mostoftheclinicalsymptomsdecreasedanddisappearednearly100%;2/52cases
hadstillintermittentmilditchandhives;3/52caseshadsignsoffatigueandlossofappetite.Thesideeffectsof
thedrugoftenappearedinfirstdaysoftreatment,includingfatigue,headache(23.06%);faceallergy,redfaceand
hotfeelinginabdomen(7.69%),flagginglimbs(5.77%),drowsiness(3.85%),viscousandliquidstools(9.61%),
andhives(+17.08%).
Conclusion: The clinical signs and symptoms of gnathostomiasis detected in the community include
headache,hives,abdominalpain,digestivedisorder.BytreatingwithAlbendazole400mgat15mg/kgofbody
weightin24hoursx21days,after6monthsoftreatment,100%patientsgetoverclinically;thepositivecasesof
ELISAtestdecreaseby86.54%.Thesideeffectsofthedrugoccurinlowrate,andusuallydisappearwithoutany
interventionneeded.
Keywords:Gnathostomiasis,BinhDinh
TVN
Bnhgiunugai(Gnathostomiasis)dogiun
Gnathostomasp.lmttrongnhngbnhksinh
ChuynYTCngCng
trng gy nh hng rt ln n sc kho ca

conngi.
Bnh giun Gnathostoma sp l mt bnh k
97
NghincuYhc
sinhtrngluhnhtimtsqucgiachu,
phn b nhiu Trung Quc, Nht Bn, ng
Nam , Philippine, Indonexia, Vit Nam.., ni
ngidnctpqunnthyhisnti sng.
Bnh gy ra do n phi c, ln, ch nu cha
chn nhim phi u trng giai on 3 ca giun
ugaiGnathostomaspp.Bnhcthbiuhin
nhiu c quan trong c th, mt trong s c
da, khi b bnh giun u gai da c mt s biu
hinlcchichngbantrnhayhichngu
trngdichuynhocbandichuyn(creeping
eruptionsmigrating erythema). T nm 1970,
mt s bnh nhn nhim dng nh gia tng
ccqucgiaTrungvNamMnhMexicov
Peru. Trc y, Gnathostomiasis c xem l
bnh him gp Vit Nam, thm ch cho n
cui nm 1998 bnh nhim Gnathostomasppvn
c xem l bnh him gp, d rng ti Vit
Nam pht hin ca bnh u tin vo nm
1963 v th gii c 4 loi Gnathostoma c
phthintrnngvttuthkXX.Trc
nm2000cnhiubnhdogiunGnathostoma
gyramtcthngbotiVinmtTrung
ng.Tthng6/2002nthng8/2003,Bmn
KsinhVinmthucTrungtmotocnb
ytTPHChMinhphthin30cabnhdo
giunGnathostomangilnbngkthutmin
dchELISAchnon.
Tnh Bnh nh, mt trong tnh khu vc
min Trung Ty Nguyn c t l nhim giun
ugaicaonhtsovicctnhtrongkhuvc.
Theo bo co ca Vin St rtK sinh trng
CntrngQuyNhntnm20062010pht
hin v iu tr cho 3.2004.600 bnh nhn
nhimgiunsnntcctnhminTrungTy
Nguyn;trongsbnhnhnnhimgiunu
gaichimtl6570%.
gip cho cng tc chn on v iu tr
giunugaingi,chngtitinhnhti:
Nghin cu mt s triu chng lm sng v
hiu qu iu tr bnh giun u gai bng thuc
albendazole400mgti2imcatnhBnhnh
vimctiu:
1.Xcnhtlnhimcabnhgiunugai
98
ngi ti im nghin cu bng k thut

ELISA.
2. M t mt s triu chng ca bnh giun
ugaiccbnhnhntiimnghincu.
3.nhgihiuquiutrbnhbngthuc
albendazole400mg.
I TNG V PHNG PHP

NGHINCU
itngnghincu
Ngidnsng2imnghincukhng
phn bit gii tnh, tui tc v ngh nghip;
bnhnhnnhimgiunugai.
Thuc iu tr Albendazole 400mg: Thuc c
tn bit dc l Azole c cha hot cht
Albendazole400mg;vinnndttrn,mutrng,
mtmtckhcchBP,mtkiacvchk.
ThucsnxuttBangladesh.
aimnghincu
ThtrnPhM,huynPhM,tnhBnh
nh.
X Phc Thun, huyn Tuy Phc, tnh
Bnhnh.
Thigiannghincu
4/201111/2011
Phngphpnghincu
Phngphpchnmu
Chn mu c ch ch, chn ni c t l
bnhnhncnguycnhimgiunugaicao.
Chn 2 x thuc huyn Ph M v Tuy Phc
catnhBnhnhiutrakhost.
Phngphpdchthcmt
M t t l nhim giun u gai bng xt
nghim ELISA v triu chng lm sng ca
bnh giun u gai trn ngi bng k thut
thmkhmlmsng.
Phngphpdchthccanthip
Thnghimlmsngkhngichng
Cmu:n50;tiuchunchnonbnh:
Lmsng
ChuynYTCngCng
Bnh nhn c triu chng nga, ni mn
hoccnhngbantrnngoida.
auukhngrnguynnhn.
Mtnhnmhockm.
Cnlmsng
Xt nghim ELISA dng tnh vi khng
nguyngiunugaivihiugikhngth1
OD. T chc iu tr bnh nhn giun u gai
bng thuc Albendazole (Azole) 400mg; liu
15mg/kgcnnng/24h,chia2lncchnhau8h
x21ngy;thucungsaukhinno.
KTQUVBNLUN
Xcnhtlnhimgiunugaibngxt
nghimmindch
Bng1:Tlnhimgiunugai2xbngxt
nghimmindch.
S
S XN ELISA
(+) tnh
1 TT Ph M - huyn 412
31
Ph M
2 Phc Thun - huyn 409
21
Tuy Phc
Cng
821
52
TT
T l
(%)
7,52
5,13
> 0,05
cngng.
Bng2:Tlnhimgiunugaitheogiitnh2
x.
X
Gii
TT Ph M
huyn Ph M
Nam
148
13
8,78
264
18
6,81
Phc Thun
huyn Tuy
Phc
Nam
132
0,76
277
20
7,22
Nam
280
14
5,0
541
38
6,89
Cng
S XN S (+) T l (%)
> 0,05
< 0,001
> 0,05
Nhnxt: Kt qu t l nhim giun u gai

chung ti 2 im nghin cu khng c s khc
bitgianamgiivngii(p>0,05).Tuynhin
xPhcThun,huynTuyPhct l nhim
giunugaingiicaohnnamgiivip<
0,001).Ktqunytngngktqunghin
cu ca Trn Th Hng nm 2003 ( n 63,33%;
nam36,67%)(5).
Bng3:McnhimtheohiugikhngthOD:
OD/ngng
X
1 <1,5
1,5 - < 2
TT Ph M
20
Phc Thun
10
Cng
30
(57,70%)
15
(28,85%)
7
(13,46%)
6,33
Nhnxt:Tlnhimgiunugaichungti
2 im nghin cu l 6,33%. Tuy nhin t l
nhim th trn Ph M cao hn x Phc
Thun, huyn Tuy Phc. Kt qu nghin cu
nythphnrtnhiusoviccktqucamt
stcginh:TrnThHng(2003)xtnghim
cho148bnhnhnnkhmtibmnKsinh
VinmTrungtmotovbidngcnb
ytTPHChMinhchothytlnhimgiun
u gai l 20,3%.(5) L Th Xun v CS t nm
19992004phthinc654canhimgiun
u gai TP H Ch Minh bng k thut
ELISA.(3)BococaphngKhmVinStrt
K sinh trngCn trng Quy Nhn 11 thng
nm2011phthin3437canhimgiunu
gai n t cc tnh trong khu vc min Trung
TyNguyn.Sdccktqunycaohniu
tra ca chng ti l do bnh nhn thng biu
hin triu chng lm sng nn ch ng i
khm,cnnghincucachngtil iu tra
ChuynYTCngCng
NghincuYhc
Ktqubngtrnchothytlnhimgiun
u gai mc hiu gi khng th 1<1,5 OD
chim 57,70%; mc 1,5< 2 OD chim 28,85%;
mc 2 OD chim 13,46%. Nh vy vic pht
hinsmnhimgiunugaicngngcng
thhinmchiugithpchimtlcaohn
so vi mc hiu gi trung bnh v nng. Mc
hiugicaothnggpnhngbnhnhn
cbiuhintriuchngbucphiikhmbnh.
Bng4:Tlbchcuitoanbnhnhnnhim
giunugai2x:
Mc BCAT (%)
6-8%
> 8%
S BN
TT Ph M
31
10
18
Phc Thun
21
Cng
52
19
26
2-5%
99
NghincuYhc
(13,46%)
(36,54%)
(50,0%)
Ktqubngtrnchothytrongs52bnh
nhndngtnhvihuytthanhgiunugaic
50% bnh nhn c t l bch cu i toan tng >
8%.Ktqunghincucachngtithphn
nghincucaLThXunvCStiTP.HCh
Minh trong s 446 ca nhim giun u gai c
92,2%ctlbchcuitoan>5%(t675%)(3).
M t mt s triu chng ca bnh giun

ugaiti2imnghincu
Bng5.TheodiTCLScaBNnhimgiunugai
ti2imnghincu.
TCLS
T. s au
BN u
T
T
Nga,
Mt au
RLTH
ni
m bng
mn
TC
Khc
X
1
TT Ph
M
31
17
13
11
Phc
Thun
21
18
10
15
Cng
52
4
7,69
26
50,0
35
22
13
15
67,30 42,30 25,0 28,85
Ghich:Triuchngkhcbaogm:mtmi,
tchn,chngmt,khth,nhcmi,tcngc,
aukhp.
Triu chng au u chim t l cao nht
35/52 (67,30%). Triu chng au u gp a
phn bnh nhn, cn au khng lin tc, v tr
aucngkhngcnh,cbnhnhnauvng
gy,hocvngnhuhayaunaukiu
auumigrain.Tuynhinktqunghincu
trn 30 bnh nhn ca Trn Th Hng, triu
chngauuchgp2/30(6,7%).Triuchng
nga,nimngp42,30%.Trongsbnhnhn
nhimgiunugainychngtichagpbnh
nhnnochichngutrngdichuynngoi
da.Ktqucachngtithphnsovinghin
cu ca Trn Th Hng (m ay mn tnh gp
43,5%). Triu chng mt m chim t l 25%.
Gnathostomacthgyvimmngbo,vim
mng mt, xut huyt trong mt, tng p lc
nhncu,sovngmc,dnngimthlc,
au,snhsngvm.Ktqucachngti
100
cngchothygiunugainhhngtith
lccabnhnhn.Nm2002c1gianh(2v
chng v 2 con) tr ti phng Ng My, TP.
QuyNhn,BnhnhphicpcutiTrung
tmBnhNhitiTP.HChMinhdonhim
giun u gai vi cc triu chng au u d
di,mtmi,nni,mmt,kmtheotrnb
mtdaccmgicbngrtnhbt.
Triuchngaubnggp28,85%,cnau
khngrrng,vtraukhngcnh;rilon
tiu ho gp 7,69%. Cc triu chng khc nh
mtmi,tchn,chngmt,khth,nhcmi,
tcngc,aukhpgp50%.
Nhn chung triu chng lm sng ca 52
bnhnhnnhimgiunugaiphthincng
ngkhnginhnhsovinhngbnhnhn
iutrticccsBnhvinvPhngkhm.
Nhng bnh nhn n bnh vin c biu
hinlmsnggynhhnghockhchucho
sckho,bucbnhnhnphiikhmiutr;
dovycctriuchng,duchnglmsngkh
phongphvinhnhhnsovibnhnhn
phthincngng.
nh gi hiu qu iu tr bnh ca
Albendazole400mg
Bng6:TheodixtnghimELISAsau6thngiu
tr
S (+)
OD/ngng
S XN tnh % gim 1 - <1,5 1,5 - < 2
2
TT Ph M
4
4
0
0
31
87,09
X
Phc
Thun
Cng
21
52
85,71
86,54
Ktqusau6thngtheodiiutrktqu
ELISAdngtnhgimtrungbnh86,54%.
Bng7:Theodichcnnggan,thncaBNsau1
thngiutr.
Ch s nh Tng s
gi
BN
Trc iu tr Sau iu % Tng

tr
(+)
Gim
(-)
Tng (%) Tng (%)
Urea
52
1,92
Creatinine
52
17,3
-100,0
1,92 -88,89
ChuynYTCngCng
SGOT
52
3,84
3,84
SGPT
52
11,53
7,69 -33,33
18
34,61
13,46 -61,11
Cng
Ktqubng3.7chothyccchsvchc
nnggan,thnudnchuynvbnhthng
sau1thngiutr.
Bng8.Theoditriuchnglmsngsau1thng
iutr:(n=52)
Triu chng Trc iu tr Sau 1 thng
lm sng
iu tr
au u
35
7
Nga, ni mn
22
12
Mt m
13
0
au bng
15
0
Ri lon tiu
4
0
ho
Khc
26
6
% tng (+)
Gim (-)
- 97,14
- 45,45
- 100,0
- 100,0
- 100,0
- 76,92
Nhng bnh nhn c xt nghim ELISA

1OD kt hp t nht c mt triu chng lm
sng tr ln c chn iu tr bng thuc
Albendazole (Azole) 400mg vi liu 15
mg/kg/24h chia 2 ln cch nhau 8h x 21 ngy.
Thuccungsaukhinnovtheodighi
nhntcdngphvhiuqucathucsau1
thng,6thngiutr.
Sau 1 thng iu tr, triu chng mt m,
au bng v ri lon tiu ho gim 100%; au
u gim 97,14%; nga, ni mn gim 45,45%;
cc triu chng khc gim 76,92%. Trong s 52
ca,c7catriuchngauuvngavncn,
chthuyngimkhong70%,chngtitiptc
iutrthm10ngynaviliu15mg/kgcn
nng chia 2 ln. Cc chc nng gan v chc
nngthnthayikhngngkvucxu
hngtrvbnhthng.
Bng9.Theoditriuchnglmsngsau6thng
iutr:(n=52)
Triu chng Trc iu tr Sau 6 thng
lm sng
iu tr
au u
35
0
Nga, ni mn
Mt m
au bng
Ri lon tiu
ho
22
13
15
4
2
0
0
0
ChuynYTCngCng
% tng (+)
Gim (-)
- 100,0
- 90,90
- 100,0
- 100,0
- 100,0
Khc
NghincuYhc
26
- 88,46
Ktqubng9chothysau6thngiutr,
cctriuchng:auumtm,aubng,ri
lon tiu ho u gim 100%; nga ni mn
gim90,90%;cctriuchngkhcgim88,46%.
Bng10:Theoditcdngphcathucsauliu
trnhiutr(n=52)
TT
Triu chng
S BN
T l %
Mt mi, au u
12
23,06
2
3
D ng mt, mt
Nng bng
4
4
7,69
7,69
Bn rn chn tay
5,77
Bun ng
i ngoi phn lng,
st
Nga, ni mn tng
ln
3,85
9,61
17,08
6
7
Tc dng ph ca thuc thng gp

nhngngyulmtmi,auuchimtl
23,06%;dngmt,mtvnngbngchim
t l 7,69%; bn rn chn tay 5,77%; bun ng
3,85%;ingoiphnst,lng9,61%;nga,ni
mn tng ln 17,08%. Triu chng nga, ni
mn tng ln thng sau 57 ngy ung thuc
doksinhtrngchtlygiikhngnguynlm
chongavnimntnglnsaulitrvbnh
thng.
KTLUNVKHUYNNGH
1.Tlnhimgiunugaicphthin
bng k thut min dch ELISA chung ca 2
imnghincul6,33%;trongtlnhim
n gii (6,89%) cao hn nam gii (5%). Tuy
nhin, s khc bit khng c ngha thng k
(p> 0,05). T l nhim giun u gai xc nh
bng xt nghim min dch ELISA ch yu
hiugikhngthmc1<1,5ODchim57,70%;
mc 1,5<2 OD chim 28,85%; mc 2 OD
chim13,46%.
2.Triuchngauuchimtlcaonht
35/52(67,30%);triuchngnga,nimngp
42,30% trng hp; mt m chim t l 25%.
Triuchngaubnggp28,85%;rilontiu
ho gp 7,69%. Cc triu chng khc nh mt
mi,tchn,chngmt,khth,nhcmi,tc
101
NghincuYhc
ngc,aukhpgp50%.
3. Thuc Albendazole (Azole) 400mg vi liu
15mg/kg/24hchia2lncchnhau8hx21ngy;
Sau 1 thng iu tr, triu chng mt m, au
bng v ri lon tiu ho gim 100%; au u
gim 97,14%; nga, ni mn gim 45,45%; cc
triu chng khc gim 76,92%. Cc chc nng
gan,chcnngthnthayikhngngkv
u c xu hng tr v bnh thng. Sau 6
thngiutr;hunhcctriuchnglmsng
u gim v khi 100%; cn 2/52 ca cn nga,
nimnnhkhnglintc;3/52cacbiuhin
mt mi, km n. Tc dng ph ca thuc
thnggpnhngngyulmtmi,au
uchimtl23,06%;dngmt,mtv
nngbngchimtl7,69%;bnrnchntay
5,77%;bunng3,85%;ingoiphnst,lng
9,61%;nga,nimntngln17,08%.
Kt lun: liu trnh iu tr nu trn c kt

qu tt v t tc dng ph cho bnh nhn, nn
csdngtrongiutrbnhgiunugai.
TILIUTHAMKHO
1.
2.
3.
4.
5.
Akahane H, Iwata K, Miyazaki I (1982). Studies on

GnathostomahispidumFedchenko,1872parasiticinloaches
importedfromChina,1982,J.parasitol.;Vol.3,pp.50716
Ando K., Tanaka H., Taniguchi Y at all (1988). Two human
cases of gnathostomiasis and discovery of a second
intermediate host of Gnathostoma nipponicum in Japan. J.
Parasitol.,1988,Vol.74.
L Th Xun, Phm Th L Hoa, Trn Th Hu Vn v CS
(2003). Bnh nhim Gnathostoma ngi ti TP. H Ch
Minh.TpchYhcthchnh,2003,s477,tr.117119.
Nguyn Quang Vinh (2001). Biu hin lm sng bnh giun
ugaingiln.TpchYhcTP.HChMinh,2001,tr.
100102.
Trn Th Hng (2004). Hnh nh lm sng bnh do giun
Gnathostomaspp.TpchYhcthchnh,2004,s477,tr.
99103.
102
ChuynYTCngCng
NghincuYhc
TNHHNHKHMCHABNHNHIMTRNGSAULLT
NM2009TIHUYNHILNG,TNHQUNGTR
HVnNh*
TMTT
tvn:BnhnhimtrngcnphbintiVitNam,nguycmcbnhnhimtrngtngsaullt
lmiquantmcacngngvngnhYtVitNam,tuynhinbngchngvbnhnhimtrngsaullt
tiVitNamcnrthnch.
Mc tiu: Xcnhsthayislngbnhnhnmcbnhnhimtrngnkhmticctrmyt
(TYT)xcahuynHiLng,tnhQungTrsaultnm2009.
Phngphpnghincu:Nghincuphntchsliutskhmbnhcattc18TYTxcahuyn
HiLng,tnhQungTrtrong3thngtrcvsaulltnm2009.
Ktqu:Sltkhmbnhnhimtrngtrong3thngsaulttng1,6ln.Bnbnhphbinnhtgm:
Vimnhimnghhp(47,2%);Hichngcm(19,1%);Bnhngrut(10,1%)vNhinkhunh
hpcptnhtremdi5tui(9,7%).Nchim56,0%tngsltngitikhm.Tltrn1000ngi
nhm5059tuilcaonht:220,1,tipnlnhmdi5tui:201,5..
Kt lun: S lt khm bnh nhim trng tng 1,6 ln so vi 3 thng trc lt. N nhiu hn nam.
Ngit50tuitrlnvtremdi5tuilhainhmcnguyccaonht.Cntinhnhnghincuda
trniutrahgianhxcnhchnhxchnsngibmnichungvbbnhnhimtrngniring
saullt.
Tkha:Bnhnhimtrng,lltnm2009,QungTr,VitNam
ABSTRACT
CONSULTATIONSDUETOCOMMUNICABLEDISEASESAFTERTHE2009FLOODINHAI
LANGDISTRICT,QUANGTRIPROVINCE,VIETNAM
HaVanNhu*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:104109
Background: Communicabledisease(CD)asaconsequenceofnaturaldisasterisnotwelldocumentedin
developingcountries,particularlyinVietNam.
Objectives:Thiscrosssectionalstudyexploreswhethercommoncommunicablediseasesincreasedafterthe
2009floodinthedistrictincentralVietNammostaffectedbythe2009flood.
Methods:Recordsofconsultationsatallcommunehealthcentres(CHC)ofHaiLangdistrict,QuangTri
province,intheperiodstartingthreemonthsbeforeandendingthreemonthsafterthe2009floodwerecollected
andanalyzed.
Result:Anincreaseinpatientconsultationsoccurredrapidlyafterthefloodandremainedelevatedduring
thethreemonthsaftertheflood.Thenumberofconsultationsduringthe three months after the flood was 1.6
times higher than the number during the three months before the flood. The most common causes for seeking
health care at the CHCs after the flood include: respiratory tract infection (47.2%), flu symptoms (19.1%),
gastrointestinalsymptoms(10.1%)andacuterespiratoryinfection(9.7%).Dermatitis,conjunctivitisandacute
diarrhoea accounted for 4.9%, 3.4% and 1.3%, respectively. Unknown causes accounted for 4.3%. Females
BmnPhngChngThmHa,TrngiHcYTCngCng
Tcgilinlc:TS.HVnNh T:0978762802 Email:hvn@hsph.edu.vn
ChuynYTCngCng
103
NghincuYhc
accountedfor56.0%ofthetotalnumberofpatientconsultationsduetoCDs.
Conclusion: Numbers of consultations due to communicable diseases increased by 1.6 times during 3
monthsaftertheflood.ThemostcommonCDwasrespiratorytractinfection(47.2%).Morefemalethanmale
who have seeking care at CHCs (56.0% vs. 44.0%). The most vulnerable groups include people from 50 and
aboveandchildrenunderfiveyears.
Keywords:Communicablediseases,naturaldisaster,2009flood,VietNam
Qung Tr l tnh b nh hng nng nht
TVN
billt sau bo s 9 nm 2009. Nghin cu
Malnsaucnbos9tngy29/09/2009
thuthpthngtincabnhnhnnTYT
gyralltvthithinghimtrngti14
x KCB t 01/01/2009 ti 30/09/2009 (9 thng
tnh min Trung ca Vit Nam. Theo thng k
trclt)v01/10/2009ti30/07/2010(9thng
ca Ban ch o phng chng lt bo Trung
sau lt). Thng tin v cc bnh nhim trng
ng(tnhnngy15/10/2009)c172ngit
ph bin sau c thu thp: vim ng h
vong, 12 ngi mt tch, 860 ngi khc b
hpngit5tuitrln,nhimkhunh
thng. Thit hi v kinh t c tnh ln ti
hp cp tnh tr em di 5 tui (ARI), tiu
14.312 t ng. Qung Tr l mt trong nhng
chy, bnh v ng rut, st rt, st xut
tnhbthithinngnhtvi10ngitvong,
huyt,nhimtrngdavaumt.
33 ngi b thng v 589 c s y t b thit
Phntchsliu:sliucnhpvophn
hi.(2) Mt s nghin cu trn th gii(5,9) v ti
mm EpiData sau c chuyn sang phn
VitNam(1,6)chothylltcnhhngtisc
mm SPSS 15.0 phn tch. Cc php tnh
khe ca cng ng, c bit l lt lm tng
thngkthngthng(tns,tl%)cs
nguycmcbnhnhimtrngdonhimmi
dng trong phn tch m t. Thut ton Khi
trng, thay i iu kin sng. Tuy nhin,
bnh phng (2) c s dng so snh s
thng tin v tnh hnh mc bnh nhim trng
khcbitgiamtsbins,mcsosnhthng
sau l lt ti Vit Nam cn rt hn ch. Do
kcngha(p<0,05)csdng.
chng ti tin hnh nghin cu ny nhm xc
KTQU
nhchaykhngcsgiatngsngimc
bnhnhimtrngsaulltnm2009nkhm
SlngKCBhngthngtrongthigian
chabnh(KCB)ticctrmyt(TYT)xca
9thngtrcvsaultnm2009
huyn Hi Lng, tnh Qung Tr v nu c th
Biu 1 cho thy tng s lt KCB v s
nhngbnhnolbnhphbinnhtvail
KCBdobnhnhimtrngnkhmticcTYT
i tng d b tn thng nht. Kt qu ca
x tng nhanh ngay sau lt v duy tr trong 3
nghin cu ny s gp phn cung cp thm
thngsault.Thngtinchititvsbnhnhn
bngchngvtcngcalltlnsckhe
mc bnh nhim trng c trnh by trong
cacngngbnhhngtiVitNam.
bng1v2.
ITNGPHNGPHPNGHINCU
Nghin cu m t ct ngang c thc

hin ti 18 TYT x ca huyn Hi Lng, tnh
Ccloibnhnhimtrngphbin
Bng1.Mtsbnhnhimtrngphbintrong3thngtrcvsault
Bnh nhim trng
Nhim trng ng h hp*
Hi chng cm
104
3 thng trc lt
S lng (%)
2.598 (24,9)
1.433 (19,3)
3 thng sau lt
S lng (%)
5.588 (47,2)
2.264 (19,1)
2
, (p)
276,2 (p=0,000)
0,11 (p=0,74)
ChuynYTCngCng
Bnh nhim trng
3 thng trc lt
S lng (%)
858 (11,5)
1.042 (14,0)
613 (8,2)
308 (4,1)
299 (4,0)
283 (3,8)
6 (0,08)
7.440 (62,3)
Hi chng d dy-rut
NKHH cp tnh tr em di 5 tui (ARI)
Nhim trng da
au mt
Nhim khun ng sinh sn
Tiu chy
Nhim trng khc
Tng s KCB nhim trng (%)
NghincuYhc
2
, (p)
3 thng sau lt
S lng (%)
1.196 (10,1)
1.154 (9,7)
580 (4,9)
399 (3,4)
385 (3,2)
305 (2,6)
3 (0,03)
11.874 (66,7)
10,26 (p=0,001)
83,42 (p=0,000)
88,82 (p=0,000)
7,88 (p=0,005)
4,32 (p=0,04)
23,64 (p=0,000)
60,09 (p=0,000)
(*)Khngbaogmtremdi5tui.
trongsKCBdobnhnhimtrngtng1,6
ln(11.847/7.440)(p<0,001).
KtqutrongBng1chothytngslt
KCBtiTYTxtrong3thngsaultl17.807,
tng 1,5 ln so vi 3 thng trc lt (11.941),
8000
Lt: 29/9/09
7000
S lt KCB
6000
5000
4000
3000
2000
1000
0
9tr
8tr
7tr
6tr
5tr
4tr
3tr
2tr
1tr
1s
2s
3s
4s
5s
6s
7s
8s
9s
Thng trc (tr) v sau (s) lt

Bnh nhim trng
Tng s KCB
Biu1:DinbinslngKCBtheothngtrong9thngtrcvsault2009
Nm bnh nhim trng c t l cao nht
gm: nhim trng ng h hp (47,2%), Hi
chng cm (19,1%), Hi chng d dyrut
(10,1%),nhimkhunhhpcptremdi
5 tuiARI (9,7%). v nhim trng da (4,9%).
Trongnmbnhctlcaonht,chcNhim
trngnghhpsault(47,2%),tnghn
so vi trc lt (34,9%) c ngha thng k
(p=0,001). Triu chng cm khng thay i.
Babnhtiptheoctlthphnsovitrc
lt.
Giivtui
Bng2:PhnbsltKCBdoccbnhnhim
trngtheogiitrong3thngtrcvsault
Thi gian
Nam n (%) N n (%) Tng n (%)
3 thng trc lt 3.285 (44,1) 4.155 (55,9) 7.440 (100)
3 thng sau lt 5.221 (44,0) 6.653 (56,0) 11.874 (100)
ChuynYTCngCng
Bng 2 cho thy t l KCB do bnh nhim

trng n cao hn t l ny nam c trc
(55,9% so vi 44,1%) v sau lt (56,0% so vi
44,0%).
Bng3:TlKCBdobnhnhimtrngtrn1000
ngitheonhmtui,trong3thngtrcv3
thngsault
Nhm tui
0-4
5-14
15-49
50-59
60+
T l KCB/1000 ngi
3 thng trc lt
3 thng sau lt
231,8
201,5
75,0
164,3
49,9
91,2
132,4
220,1
136,9
189,4
Bng3chothytlKCB/1000nhm50
59 cao nht (220,1), tip n nhm di 5 tui
(201,5).Trong3thngsault,sltKCBtnh
trn1.000ngicaohnsovitrclthu
105
NghincuYhc
ht cc nhm tui, tr nhm tui t 04 tui.

Mc tng ln nht (2,2 ln) nhm tui 514
(164,3/1000 so vi 75,0/1000). Tip n l nhm
1549:tng1,8ln,nhm5059tng1,7ln.
BNLUN
Kt qu nghin cu cho thy mc d s
bnhnhnKCBdobnhnhimtrngtiTYTx
trong3thngsaulttng1,6ln,khngcv
dchbnhnocxyra.Ktqucanghin
cunyphhpviktqumtsnghincu
tiVitNam(4,6,7)vmtsnghincutrnth
gii.(1,9,8)Ccnghincunyuchothykhng
c dch bnh truyn nhim xy ra trong khi s
bnhnhnmcbnhnhimtrngthngthng
tngsaullt.Nghincunychothyslt
KCB tng ngay sau khi lt xy ra v duy tr
mc cao trong 3 thng tip theo, sau gim
mnh vo thng th 4 sau lt (Biu 1).
NghincucaGuhaSapirvcngschothy
slngbnhnhnnKCBtimtbnhvin
BandaAceh,Indonesiatnglnnhanhchng
trong thng u tin sau thm ha sng thn
nm 2004.(5) Thay i mi trng sng v iu
kin v sinh trong hon cnh l lt c th l
nguynnhntrctipdntisbnhnhnmc
bnh nhim trng tng. Theo thi gian, tnh
hnh n nh dn, ngi dn cng dn thch
ngvinhngthayi,cngviccbinphp
phngchngbnhnhimtrngctrinkhai
nn s ngi mc bnh c xu hng gim i.
iunychothyvicthchinccbinphp
phng nga bnh nhim trng trc v ngay
saultsgpphngimsngimcbnhsau
lt.
KtqunghincunychothysKCBdo
ccbnhnhimtrngsaulltcaohn1,6ln
sovi3thngtrclt,thphnktqunghin
cucaHVnNh,nghincutimthuyn
catnhngThpchothysltKCBtrong
4 thng sau lt tng gp 3,6 ln so vi 4 thng
trc lt nm 2007.(6) S khc nhau v mc
tngslngKCBnhimtrngsaultcldo
cimringcallt,lltngbngsng
CuLongthngkodi3n4thng,trong
106
khi trong nghin cu ny, lt ti Qung Tr

chkodikhong10ngy.Lltkodicl
cnhhnglnhntinguycmcbnh
nhimtrng,tuynhinnhnnhnycnc
nghincusuhnviquimnghincurng
vthigiandihnmicthktlunc.
MtiungchltiVitNam,nhiu
ngikhngnTYTxkhmkhibbnh,thay
vohcthtchanhhocnccc
s y t khc nh: bnh vin, phng khm t
nhn,hocthylang.Ngidncngctht
muathuciutrbnh,doslngbnh
nhnnKCBticcTYTxcththphnso
visbnhnhnmcbnhnhimtrngthct
trong cng ng. V vy, nghin cu da trn
phngvnhgianhschoktquchnhxc
hn nh gi tnh hnh mc bnh nhim
trngticngngsaullt.
Ccloibnhnhimtrng
Ktqunghincunychothybnhnhn
nTYTxKCBdoccbnhnhimtrngtrong
3 thng sau lt chim 66,7%, cao hn t l ny
trong 3 thng trc lt (62,3%) (p<0,001). Cc
bnhnhimtrngphbinsaultgm:nhim
trnghhp(47,17%),triuchngcm(19.07%),
triu chng d dyrut (10,07%), ARI (9,72%).
y l nhng bnh ph bin nht xy ra cc
huyntrongnghincu,ctrongiukinmi
trng bnh thng cng nh iu kin mi
trngbnhimsaullt.
Nhimtrngnghhpchimti47,2%
tngsltKCBdoccbnhnhimtrng,tng
1,6lnsovi3thngtrckhil(p<0,01).Kt
qunytngtviktqucaccnghincu
ca H Vn Nh(2,7) v ca Le and Dang (10).
Trongthct,nhimtrngnghhpcng
lbnhphbinnhtticngngtrongiu
kin bnh thng ti nhiu khu vc ca Vit
Nam.KtqunghincutibnhvinBanda
Aceh,Indonesiachothynhimtrngngh
hpchimtllnnht(21,0%)trong1.188bnh
nhn ti khm sau trn sng thn ti n
Dngcuinm2004.(5)TheobococaBY
tPakistanvTchcYtthgii,nhimtrng
ChuynYTCngCng
h hp l nguyn nhn ln th 2 sau lt
Pakistannm2010.
Tiuchy: kt qu ca nghin cu cho thy
sltKCBdotiuchysaulltgimso
vi thi gian trc (p<0,001). Kt qu nghin
cu ny khc vi kt qu mt s nghin cu
khc cho thy bnh tiu chy l bnh ph bin
nhtsaullt.NghincucaHVnNhti
mt huyn min ni pha Bc cho thy mt
thngsaulqut,bnhtiuchytng6,3lnso
vi thng trc l. Tng t, theo bo co ca
BYtPakistan(3)vcaHisayoshiKondo(9),c
s gia tng ca bnh tiu chy sau l lt ti
Mozambique nm 2000. S khc nhau ny c
thdoskhcnhauvbnchtcallt,thi
gianngplt,iukinvsinhcbnviu
kinkhhutrongl,giallttiPakistanv
Mozambique. Tuy nhin, nh cp trn
y, mt s bnh nhn tiu chy c th khng
nTYTxmtchahocncccsyt
khcdnnslngbnhnhntiuchyghi
nhnctiTYTxthphnsbnhnhnti
cng ng. Do nghin cu iu tra h gia
nhcthgimnhngsaisny.
Bnhngoida/vimda:Trongnghincuca
chng ti, t l bnh nhn thm khm do cc
bnh ngoi da chim 4,9% tng s lt thm
khm, thp hn so vi bo co ca B Y t
Pakistan (19% bnh nhn vim da).(3) iu ny
cthcgiithchbiskhcbittrongbn
chtcalltvthigianthuthpsliu.L
lt Pakistan nm 2010 ko di v nh hng
trndinrnghnnhiusovillttiQung
Trtrongnghincutrongnghincuny.V
hnna,nhcptrny,trongbicnh
ca Vit Nam, mt s ngi bnh khng n
KCBTYTxdosngimcbnhnhim
trngdathcttrongcngngcthcaohn.
Nhmtuivgiitnh
Thngthng,trongnhngtrnghpthin
tai, ph n c kh nng d b tn thng hn
namgii(11).Theonghincucachngti,tl
nnKCBtrcltl55,9%,tngngvi
sault(56,0%).
ChuynYTCngCng
NghincuYhc
KtqunghincuchothytlKCBtrn
1000dntnglntrong3thngsaultttc
cc nhm tui, ngoi tr nhm tui 04 tui
trong 3 thng sau l. S gia tng ln nht l
trong nhm tui 514 tui (164.3/1000 v
75.0/1000). Sau l lt s bnh nhn thm khm
trn 1.000 ngi t t l cao nht cc nhm
tui5059tui(220.1/1000),tiptheolnhm0
4 tui (201.5/1000) v nhm 514 tui
(164.3/1000) (Bng 3). iu ny cho thy rng
nhngngi5059tuituiv04lnhmd
btnthngnht.
Hnchcanghincu
Thnhtlkhngphittcccbnhnhn
b bnh u n KCB ti TYT, do s lng
KCB ti TYT cha phn nh y tnh hnh
mc bnh nhim trng ti cng ng. Th hai,
thngtincghitrongskhmbnhcaTYT
khngphilunchnhxc,vicchnonch
yudatrnccduhiu/triuchnglmsng
hnlccxtnghimdovicphnloibnh
cthkhngchnhxc.
KTLUNVKHUYNNGH
Mc d s ngi KCB ti TYT x trong 3
thngsaulttng1,6lnsovi3thngtrclt,
nhngkhngcdchbnhtruynnhimnghim
trngtiabnnghincu.Nhngbnhnhim
trngphbinbaogm:nhimtrngngh
hp(47,17%),cctriuchngcm(19,67%),cc
triu chng d dy rut (10,07%) v nhim
nghhpcptnhtrem(9,72%).Vimda
(4,91%),vimktmc(3,36%),tiuchy(1,27%).
T l n (56,0%) n KCB cao hn t l nam
(44,0%).Nhmtui5059v04tuilhainhm
ctltrn1000ngicaonhtsault.
Cn tin hnh nhng nghin cu da trn
iutrahgianhvicmuphhpxc
nh c c nhng ngi b bnh khng n
KCB ti TYT x. Ci thin vic thc hin ng
phnloibnhtttheoICD10tiTYTcngsc
ch cho vic theo di v cung cp nhng thng
tin chnh xc v tnh hnh mc bnh trong iu
kinbnhthngcngnhsaullt.
107
NghincuYhc
TILIUTHAMKHO
1.
2.
3.
4.
5.
108
Ahern M, Kovats RS, Wilkinson, Few PR and Matthies F

(2005). Global health impacts of floods: Epidemiologic
evidence,EpidemiologicReviews,vol.27,pp.3646.
Banchophngchngltbotrungng(2010).Boco
tnghpthithidocnbos9gyra,tnhn15/10/2010.
Federal Ministry of Health, Government of Pakistan and
World Health Organization (WHO), Pakistan (2010). Flood
Response in Pakistan, Epidemiological Bulletin, vol. 1, issue 2
Monday30August2010.
Few R, Tran PG and Bui TTH (2004). Living with floods:
HealthriskandcoppingstrategiesoftheurbanpoorinViet
Nam, Research report, May 2004 (a research project funded
byBritishAcademy(CommitteeforSouthEastAsiaStudies)
May2003March2004)
GuhaSapir D, Gijsbert WP, Langoutte J (2007). Pattern of
chronic and acute disease after natural disasters a study
from the international Committee of the Red Cross field
hospitalinBandaAcehafterthe2004Indianoceantsunamis,
TropicalMedicineandInternationalHealth, vol. 12, No. 11, pp.
13381341.
6.
7.
8.
9.
10.
11.
HVnNh(2011).Tnhhnhbnhnhnmcbnhnhimtrng
nkhmtitrmytxHaLong,huynLaiVung,tnhng
Thptrongmalnm2007,TpchYhcthmhavBng,
s3/2011,tr.1116.
HVnNh(2011).Tnhhnhkhmchabnhtitrmytx
thuchuynVnChn,tnhYnbisaulqutthng9nm2005,
TpchYhcdphng,tpXXI,s6(124),tr.298306.
Ivers LC, Edward RT (2006). Infectious diseases of severe
weatherrelated and floodrelated natural disasters, Current
opinionininfectiousdiseases,vol.19,no.5,pp.408414
KondoHetal.,(2001).InfectiousDiseasesduringtheFlood
Disaster in Mozambique 2000, Prehospital Disaster Medicine,
vol.16,Supplement2,pp.3839
Le TT and Dang VC (2004). Report on morbidity and
mortality from flooding in Central Viet am 2003
(unpublished)
Nishikiori N, Abe T, Costa DG, Dharmaratne SD, Kunii O
andMojiK(2006).Whodiedasaresultofthetsunami?Risk
factor of mortality among internally displaced persons in
Srilanka:aretrospectivecohortanalysis,BMCPublicHealth
6,73.
ChuynYTCngCng
NghincuYhc
THCTRNGKINTHC,HNHVI,THCHNH
VPHNGLYNHIMHIVNGHNGHIPCANHNVINYTBNH
VINAKHOATNHYNBINM2011
LPhngLan*
TMTT
tvn:Nhnvinyt(NVYT)thnglngtngtrongvicxlvtthngtichvthchinqui
trnhxlsauphinhimkhixyratainnnghnghip.
Mc tiu: 1) M t kin thc, thi, thc hnh, yu t lin quan ndphng ly nhim HIV ngh
nghipcaNVYTBnhvinakhoatnhYnBinm2011.2)xutbinphpgiiquyt.
Phngphpnghincu:Mtctngang.itngnghincu:NVYTbnhvin.Thigiannghin
cu:Tthng1nthng12nm2011.
Ktqu:35%40%NVYTchackinthcxlsauphinhimvgiaionngibnhcnguyc
lynhimcao;50%chackinthcngvdphngphcp;20%ngichmscbnhnhnHIV.Vicd
phngphcpvxldphngsauphinhimchang.Cmilinquangia:otovkinthc,tnh
snccatrangbphnghhocvicthchinkimtraccquinhdphnglynhimHIVvitnhtgic
dphnglynhimHIVcaNVYT.
Ktlun:Bxungkinthc,otoquitrnhchmscngibnh,quitrnhxlchtthi.Cptrang
bphnghvccloihachtkhnhimcnthit.GiodcycvknnggiaotipchoNVYT.
T kha:Kinthc,thi,thchnh,phinhim,dphngphcp,dphngsauphinhim,nhn
vinyt,bnhnhn
ABSTRACT
DESCRIPTIONOFKNOWLEDGE,BEHAVIOURS,PRACTICES,ANDALLFACTORSRELATED
TOPREVENTIVEINFECTIONOFHIVFORALLHEALTHCARESTAFFSINGENERAL
HOSPITALOFYENBAIPROVINCEIN2011
LePhuongLan*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:110117
Background: Health care staffs are usually hesitant in first aid and in carrying out an initialtreating
procedureofexposuresafteraccidentalincidenttakesplacewhentreatingpatients.
Objectives:1)Descriptionsofknowledge,behaviours,practices,andallfactorsthatrelatedtopreventionof
infectionofHIVforallhealthcarestaffswhodirectlytreatandtakecareofpatientsinGeneralHospitalofYenbai
provincein2011.2)Suggestingsolutionsforthoseissues.
Methods:StudyMethod:Crosssectionalstudy.Studyobjects:Theentiremembersoftreatmentstaff.Study
duration:fromJanuarytoDecember2011.
Result:Ingeneral,35%40%ofstaffdonothaveknowledgeoftreatingprotocolafterexposureandstage
thatvictimshavehighchanceofbeinginfected;and50%ofstaffdonothaveafirmunderstandingofuniversal
precaution and 20% are afraid of infectious possibility in treatment. It appeared that knowledge on universal
precaution and of protection and treating after exposure are incorrect and misunderstood. There is relation
TrungtmYtDphngtnhngNai
Tcgilinlc:BS.CKII.LPhngLan T:0984239224
ChuynYTCngCng
Email:lelanssyb@gmail.com
109
NghincuYhc
betweentrainingandknowledgeofstaffs,availabilityofprotectiveequipmentandfacilities/examineandfollow
procedureinstructedinordertopreventinfectionfrommanyvariedsourcesandapperceptionofstaffsinHIV
treatments.
Conclusion:EncouragetrainingactivitiesforstaffstoimprovetheirownknowledgeinHIVprevention,in
stagesofgivingtherapiestopatients,andprocedureofsewagedisposal.Therearealsoneedsofprovidingstaff
withsufficientprotectiveequipments,chemicalsfordesinfectation.Mostimportanceistrainingonethicsofstaff
andcommunicationskillstocommunicatewithpatientswhomtheyaredirectlygivingtreatments.
Keywords:Knowledge,attitude,practice,exposure,compulsoryprevention,treatingafterexposure,health
staff,patients
ngang c phn tch, kt hp gia nghin cu
TVN
nhlngvnhtnh.itngnghincu
Bocot46tnh,thnhtrongcnccho
lttcnhnvinhngngytrctipchmsc
thynm2011c411caphinhimHIV.Theo
vphcvngibnhtronggiaioniutra.
s liu ca Trung tm phng chng HIV/AIDS
KTQU
tnhYnBitnhtnm2005nnm2010c
29 trng hp nhn vin Y t (NVYT) phi
Mtsthngtinchungcaitngnghin
nhimHIVnghnghip.Cctrng hp c
cu.
bocouctvn,iutrdphngsau
Bng1.Thngtinvtui,giitnh,dntc
phi nhim, khng c trng hp no HIV(+)
Nhm thng tin S T l (%) Biu 1. T l NVYT
lng
c o to
sauphinhim.Tuynhin,phnngtmlca
<
25
75
18,8
ngibphinhimlhtscnngnvko
25 - 29
96
24,0
di trong sut thi gian ch xc nh kt qu.
30 - 34
41
10,2
Nguynnhncanhngphnngbtlinyl
Tui
35 - 39
26
6,5
do NVYT cha hiu bit y v d phng
40 - 44
37
9,3
lynhimHIVsauphinhim.
45 - 49
65
16,2
ti nhm mc ch tr li cc cu hi:
Kin thc, thi , thc hnh v nhng yu t
lin quan n d phng ly nhim HIV ca
NVYTtrongkhitcnghip?
Mctiu
1.Mtthctrngkinthc,thivthc
hnh vdphng ly nhim HIV ngh nghip
caNVYTBnhvinakhoatnhYnBinm
2011.
2.Mtmtsyutlinquannphng
ly nhim HIV ngh nghip ca NVYT bnh
vinakhoatnhYnBi.
3.xutgiiphpnhmgimthiunguy
clynhimHIVnghnghipcaNVYT.
ITNGPHNGPHPNGHINCU
Phngphpnghincu
Nghin cu c tin hnh t thng 1 n
thng12nm2011bngphngphpmtct
110
50
Nam
Gii
N
Kinh
Thi
Mng
Ty
Dn
tc
Nng
Dao
H' Mng
Khc
Tng
60
132
268
331
7
8
43
4
3
1
3
400
15,0
33,0
67,0
82,8
1,8
2,0
10,8
1,0
0,7
0,2
0,7
100
Nhnxt:42,8%NVYTtuidi30,khng
c s chnh lch ln gia cc nhm tui. T l
n cao gp 2 ln s nam. Ngi dn tc Kinh
82,8%.Trnhsauihcchim7,3%,ihc
chim18,5%,trunghc v k thut vin chim
gn 60%. NVYT qua thi gian cng tc > 5
nm chim gn 60%. S NVYT cha c tp
hunvdphngphinhimHIVchimtl
tng i cao (60,8%). Kin thc, thi , thc
ChuynYTCngCng
hnhvphnglynhimHIVnghnghipca
NVYT.
Kinthcvnguyclynhimcaccloi
chtthiyt
64,3%93,3%ckinthcngvloicht
thi c kh nng ly nhim HIV; Vn cn 18%
chorngttcrcthisinhhotbungbnh,
chailthutinh/chailnhanghuytthanh,
ccloibtbtronggyxngknlngunly
nhimHIV;29,7%35,7%chorngchtthisau
phuthutnh:m,bphncthngi,rau
thai, bo thai, bng gc dnh mu v cht dch
cacthkhngphilngunlynhimHIV.
Nhng s liu trn cho thy kin thc ca
NVYTvccloircthilynhimHIVlcha
y.
Kinthcvnguyclynhimcaccloi
chtdchcth
94,5% hiu bit ng: Mu l ngun ly
nhim HIV cao. Trong khi tinh dch, cht tit
dchmovchttitdchtvtthngcng
l ngun ly nhim HIV cao nhng ch c
khong 50% tr li ng; Ch c 40,8% n
50,7%chiubitngvloidchthcnguy
c ly nhim HIV thp l dch mng tim, dch
mngbng,dchmngphi,dchmngnoty,
dchkhp,nci;26,5%chorngsaml
ngun ly nhim cao; 1,2% n 5,5% cho rng:
phn,nctiu,ncbt,ncmt,ncmi,
mhi,chtnnlngunlynhimcao.Tl
NVYT khng c hiu bit hoc hiu khng r
rng v mc ly nhim HIV ca tng loi
chtdchcthgiaongt3%n18,2%.
Kinthcvcctrnghpcnguycly
nhimHIVnghnghip
57,8% 70,3% xc nh ng v cc trng
hp c gi l c nguy c phi nhim HIV;
16,5%chorngnguycphinhimHIVcth
xyrakhimuvdchthcangibnhbn
vovngdalnh.RrngkinthccaNVYT
vphinhimnghnghiplchachcchn.
NghincuYhc
Giai on s nhim v giai on AIDS l 2

giai on ti lng vi rt cao, kh nng ly
nhim ca ngi bnh l ln nht. Tuy nhin
35,5% NVYT cho rng ngi bnh HIV giai
onbnhtintrinckhnnggylynhim
cao, iu ny cho thy nhiu NVYT cn cha
hiursinhlbnhHIV.
Kinthcvhoncnhxyraphinhim
lmtngnguycnhimHIV
C mi lin quan t l thun gia nguy c
caothpvislngmudchthnhiut,
thi gian tip xc nhanh lu, vt gy tn
thng to nh, tn thng su nng, tuy
nhin c n 41,3% n 63,5% NVYT khng
phnnhc.
Kin thc v x l sau phi nhim v vic
gim nguy c ly nhim HIV t sn ph sang
cnbyttrongkhi.
Biu2.Kinthcvxlsauphinhim
Biu3.Kinthcvgimnguyclynhim
HIVtsnphsangcnbyttrongkhi
Kin thc ca NVYT v kh nng ly

nhimcaocaccgiaionnhimHIV
ChuynYTCngCng
111
NghincuYhc
Kin thc ng ca NVYT v cc trng

hpbtbucphixtnghimHIV
Nhnxt:
74,7%NVYTchorngcnxtnghimHIV
nglotchomingibnh,chngphng
lynhimHIVchoNVYT.
TlNVYTtloschimphnln79%.
22,8%chorngnnchobnhnhnHIVv
nh ngi nh chm sc; 1,2 % khng th
hinquanim.
Biu4.KinthcngcaNVYTvcctrng
hpbtbucxtnghimHIV
Kinthcvnguyntcdphngphcp
Vnguyntcphicoimuvdchthca
tt c ngi bnh u c kh nng ly nhim
HIV, tuy nhin ch c 42% NVYT c kin thc
ng;gn1%schikhngbit/khngtr
li.
Kin thc v vic truyn mu khi khng c
snmucsnglcHIV:TlNVYThiu
bit ng v ngun mu c php truyn l
73,5%;khikhngcsnmucsnglc:
61,8% NVYT dng bin php mnh: truyn
dung dch thay th; 11,7% nht tr truyn mu
nginh.
Thi ca NVYT i vi ngi bnh

HIV/AIDS
Bng2.ThiivingibnhHIV/AIDS
Thi
S lng T l (%)
1. Mi bnh nhn cn c xt nghim sng lc HIV, ch
ng phng ly nhim cho NVYT
ng
299
74,7
Sai
93
23,3
Khng bit/khng tr li
8
2,0
2. Tm trng ca NVYT khi chm sc ngi bnh
HIV/AIDS.
Lo s b ly nhim
316
79,0
Khng lo s
79
19,8
Khng bit/khng tr li
5
1,2
3. phng ly nhim cho NVYT, tt c bnh nhn
AIDS nn chuyn v nh cho ngi nh chm sc ?
ng
91
22,8
Khng ng
304
76,0
Khng tr li
5
1,2
Tng
400
100
112
Bng3.Thivivicotongichmsc
bnhnhnHIV
Thi
S lng T l (%)
1. Vic o to cho NVYT v d phng ly nhim HIV
Khng cn thit
21
5,2
Cn thit
66
16,5
Rt cn thit
310
77,5
Khng bit/khng tr li
3
0,8
2. Vic o to nhm ngi nhim HIV, chuyn chm sc
bnh nhn HIV
Tuyn chn ngi nhim HIV, o
to h h chm sc bnh nhn
179
44,8
HIV
Khng nn thc hin cch trn v
212
53,0
to s k th qu mc
Khng bit/khng tr li
9
2,2
Tng
400
100
Nhn xt: Gn 80% cho rng vic o to

NVYTvphngphinhimHIVlrtcnthit.
TrongkhiktquiutratiBng1lichothy
60,8% NVYT cha c o to; 44,8% NVYT
munotonhmngnghchmsc
bnh nhn HIV; 2,2% s c hi khng t r
thi.
Ldochnhdngthucchongibnh
90%NVYTchorngnndngthucng
ungchongibnhHIV,vi3ldochnh:kn
o, d s dng, hn ch ly nhim; 4,3% cho
rng khi cn thit vn dng thuc ng tim
chongibnh.
ThicaNVYTtrongcngvic
98,8% cho rng vic s dng bo h lao
nglcnthit;80,5%trli:nusyraphi
nhimsbnhtnhxlngquitrnh.
Thc hnh ra tay v s dng phng tin
phngh
93,3%thchnhrataytrcvsauchm
ChuynYTCngCng
sc ngi bnh; 72,5% la chn phng tin
phnghphhptrongtngtnhhungchm
scbnhnhncth.
Nguynnhnkhngthchinccquinhv
phnglynhimHIVcaNVYT
Trong s NVYT khng thng xuyn thc
hin cc qui nh v phng chng ly nhim
HIVc93,2%trlildokhngcsnphng
tinphngh.
Lin quan ca o to n kin thc ca
NVYT
Bng4.Milinquangiaotovkinthcca
NVYT
o to
t
25
9
34
o to
Cha o to
Tng
Kin thc
Khng t
132
234
366
Tng
157
243
400
2 = 18,31; p = 0,001
Nhn xt:Cskhcbitvkinthcca
nhm NVYT c tp hun v cha c
tphunvdphnglynhimHIV,(p<0,05).
Bng5.Milinquangiathmnincngtcca
NVYTvithilolngblynhimHIV.
o to
Lo s b ly nhim
Khng lo s
Khng bit/khng
tr li
Tng
Thm nin cng tc

<= 5 nm
> 5 nm
141
175
27
52
Tng
316
79
169
231
400
2 = 3,946; p = 0,267
Nhnxt:ThilolngblynhimHIV
khng ph thuc vo thm nin cng tc ca
NVYT(p>0,05).
Bng6.Milinquangiaotovithchnh
phngchngHIV/AIDSnghnghipcaNVYT
o to
c o to
Cha c o to
Tng
t
2
1
Thc hnh
Khng t
155
242
Tng
157
243
400
2 = 0,95; p = 0,564
Nhn xt: Khng thy c mi lin quan

cnghathngkgiaotovithchnhca
ChuynYTCngCng
NghincuYhc
nhnvinyt.(p>0,05).iunycngphhp
vi kt qu quan st v phng vn mt iu
dngtikhoaNi:Vlthuytikhitikhng
nh,tuynhinquitrnhthchnhthchngtilm
thngxuynvthnglmtnging.iu
dng trng khoa cng thng xuyn kim tra,
nhcnhcciudngvincachngti. Tuy
nhin kt qu ti Bng 6 cng cho thy: T l
NVYT thc hin ng 100% cc qui trnh thc
hnhlrtt.
BNLUN
Mtscimcaitngnghincu
Vi tng tui ca NVYT bnh vin nh
hinnaysmboctnhkthavthay
th. 60,8% NVYT cha c tp hun v d
phng ly nhim HIV ngh nghip l iu rt
cnccnhqunlquantm.
Kin thc, thi , thc hnh phng ly

nhimHIVnghnghipcaNVYT
Gn40%NVYTchcnhgicvichtthil
dngcscnhn,chquanvinhngchtthi
khngckhnnglmtnthng,iunyc
thdnnvicchquantrongvicqunlv
tipxcviloichtthiny.
Ch c 57,8% 70,3% xc nh ng cc
trng hp c nguy c nhim HIV sau phi
nhim. y l mt trong nhng nguyn nhn
con s phi nhim HIV ngh nghip khng
cbocoy.Kinthcvsinhlbnh
HIVcanhiuNVYTcnrtmh,dnnh
ch quan vi giai on s nhim ca ngi
bnh,cbitvittcnhngtrnghpcha
xc nh c r rng tnh trng nhim, trong
khinguyntccadphngphcplphicoi
mingunmuvdchthcattcbnhnhn
ucnguyclynhim.
Kin thc v nguy c ly nhim cao thp
linquannhoncnhxyraphinhimca
nhiuNVYTcnmh.
Ch c gn 60% NVYT bit qui trnh x l
sau phi nhim l 7 bc v iu tr sau phi
nhimlkhncp,iunychothynuxyra
phi nhim, nhiu NVYT s lng tng trong
113
NghincuYhc
vicxlchobnthnvngnghip.
Kt qu thu c t nghin cu cho thy
nhnglhngvkinthccanhiuNVYT,
lpythvicbsungkinthclhtsccn
thit. Ngoi ra cng cn khch l NVYT t hc
tp nng cao trnh , bin php ny l bin
php lu di, bn b v mang li hiu qu bn
vng.
Ktqunghinculhnhnhnhiuchiu
phnnhthcchtnhiuNVYTngichmsc
ngibnhHIV/AIDS(Bng2,Bng3,Bng5),
tuynhin,kinvthitiucccaNVYT
vi ngi bnh khng gp trong tho lun
nhm v phng vn su. Kt qu kho st v
thichothymttmlkhngnnhvn
angtntimtsNVYT,ylvnrt
cn phi tho lun NVYT hiu v nu cao
hnnatinhthntrchnhimcngnhyc
ivingibnh.
Vic thc hin cc qui nh v d phng

lynhimHIV
Ti Quyt nh S: 3003 /QBYT ngy
19/8/2009, B Y t ban hnh Hng dn
chn on v iu tr HIV/AIDS trong
hng dn rt c th vic x l i vi tng
trng hp ngay sau khi xy ra phi nhim.
Trongkhihngngyphiimtvinguyc
phinhimnhngsNVYTccchxlsaivi
trng hp c th vn chim t 20% n trn
50%. iu ny chng t NVYT khng thng
xuyncpnhtkinthcmi,cngchattm
hiucpnhtnhngkinthcmhngngy
linquantrctipnvicbovvphngh
cho bn thn. Cn cung cp kin thc cho
NVYT.Cncsthngnhtliquitrnhvx
lsauphinhim.
Ccyutlinquannphnglynhim
HIVnghnghipcaNVYT
Phng tin phng h cho NVYT hin nay
cabnhvinchyupngnhucuvgng
tayyt,hpngdngcscnhnvccloi
dung dch st khun/kh nhim. Cc loi
phng tin phng h khc nh: Mt n, bao
114
chn,knhmt,onilngmipngct
37%47%,iunynhhngkhngnhn
vic thc hin d phng ly nhim HIV ngh
nghip ca NVYT. Bnh vin t chc kh
thng xuyn vic kim tra qui ch d phng
lynhimHIVnghnghip.iunyrtng
kch l v cn c tip tc lm tt trong thi
gianti.SNVYTcototyucuv
kinthccaogpgn3lnsovischac
oto(Bng4:p<0,05),trongkhicn60,8%
NVYTchacoto,rrngvicoto
v d phng ly nhim HIV ngh nghip cho
NVYT l rt c ngha. Thi lo lng b ly
nhim HIV khng ph thuc vo thm nin
cngtc(p>0,05).Khngcmilinquangia
o to vi thc hnh ca NVYT (Bng 6: p >
0,05).
Ktquiutracngchothy:TlNVYT
thc hnh ng 100% qui trnh chim t l rt
nh(Kcitngcotovchac
oto).Cuhitral:Tisaokinthcca
nhmcotocskhcbitnhngthc
hnh nhm c o to v cha c o
tolikhngcskhcbit,trlicuhi
nycncmtnghincusuhn.
Phntchccgiiphpgimthiunguyc
lynhimHIVnghnghip
NVYT l i tng c nguy c cao ly
nhimHIVdohngngyphitipxctrctip
vimu,dchthcangibnh,tuynhinvic
gimthiunguyclynhimchoNVYTlvn
rt kh khn, phc tp, c lin quan n
nhiuyut,cthl:
Yutkhchquan
Doiukinkinhtnctacnnhiukh
khnnncsvtcht,trangthitbkthut,
phng tin phng h cho NVYT cha tt.
Cngdokinhpheohpnncngtcgiodc,
truyn thng, o to cho NVYT v d phng
ly nhim HIV ngh nghip cng cha tht s
clmtt.ikhi,squantmtphacc
nhqunlivicngtcnycngchatht
ng mc, cc chnh sch bo him y t cho
ngibphinhimcngraichm,munv
ChuynYTCngCng
ikhichapngcyucu.iutrsau
phinhimHIVlmtiutrcpcunhng
vic tip cn vi thuc iu tr d phng cng
cnnhngbtcpHinnaysqutibnh
nhn ti cc bnh vin ni chung v bnh vin
a khoa tnh Yn Bi ni ring thng xuyn
xy ra, cng lm vic ca NVYT thng
xuynqusc,iunynhhngkhngnh
nchtlngcngvicvtnhcntrngtrong
khitcnghip.
Yutchquan
thc t gic chp hnh cc quy nh
chuyn mn ca nhiu NVYT cha cao, nhiu
NVYT cn ch quan trong vic d phng ly
nhimHIVtrongkhitcnghip...Tccktqu
nghin cu thu c v nhng phn tch
nguyn nhn k trn th cc gii php c tnh
khthihinnayl:
Giiphptrcmt
Cn c s quan tm ng mc t cc nh
qunl,cungcpchoNVYTykinthcv
d phng ly nhim HIV ngh nghip qua cc
lp o to, tp hun, gip h hiu c s
quantrng,cnthitvhiuqucavictgic
phng h cho bn thn. Trang b y cc
phngtinphnghtithiuchoNVYT,trn
cssdngphhp,trnhlngph.
Tchcgimstthngxuyn,unnn
NVYT thc hin ng cc qui trnh d phng
lynhimHIVniringcngnhccquitrnh
phngchngnhimkhunnichung.
Ticckhoalmsngcncquitrnhxl
sauphinhimctreo/dnniphhp
NVYT c th thc hin ng khi xy ra phi
nhim.mbotnhsnccathuckhngvi
rtNVYTcthsdngtrc6giuk
tkhixyraphinhim.
C gng b tr ph hp nhn lc gim
gnhnngcngvicchoNVYTnhtlvicc
bphncnguyclynhimcaovcng
lmvicln.
Thng xuyn gio dc y c v k nng
giaotipcaNVYTvingibnh,cbitl
ChuynYTCngCng
NghincuYhc
ngibnhHIV/AIDS.
Ccgiiphpludi
Cicchkhngngngccchbohim
ngh nghip ph hp v tha ng i vi
ngibphinhim.
KTLUN
Thctrngkinthc,thi,thchnhv
phng ly nhim HIV ngh nghip ca
NVYTbnh vin a khoa tnh Yn Bi
nm2011
Kinthc
Xc nh ng ngun ly nhim HIV ca
NVYTcbntyucu(64,3n93,3%).Tuy
nhinvitngloircthiytcnnhiuNVYT
cha xc nh ng l ngun ly nhim. Vi
tngloichtdchcth,nhiuNVYTxcnh
mc ly nhim cha chnh xc. Kh nng
nh gi nguy c ly nhim sau phi nhim
HIVcanhiuNVYTchang.Khong35%
40%NVYTchackinthcvxlsauphi
nhim v giai on ngi bnh c nguy c ly
nhimcao.Kinthcvdphngphcpca
khongtrn50%NVYTlchachcchn.
Thi
20% NVYT ngi chm sc bnh nhn HIV.
S NVYT lo s ly nhim HIV chim t l
ln(79%).Trn90%NVYTcthingvi
vic s dng bo h lao ng cng nh ng
tnh vi quan im dng thuc bng ng
ung cho ngi bnh HIV phng trnh ly
nhim. Gn 50% NVYT mun o to nhm
ng ng h chm sc bnh nhn
HIV/AIDS.
Thchnh
Cn thng nht li cc qui trnh thc hnh
dphngphcpvquitrnhxldphng
sau phi nhim, cng vic ny cn c gim
stvkimtrathngxuyn.
Mtsyutlinquannkinthc,thi
, thc hnh d phng ly nhim HIV ngh
nghipcaNVYT.
115
NghincuYhc
Vic tp hun nng cao trnh c nh

hngttnkinthccaNVYT(p<0,05).
Tnh sn c ca cc loi trang b phng h,
thng xuyn thc hin kim tra cc qui nh
dphnglynhimHIVsgpphnlmtng
tnh t gic ca NVYT trong d phng ly
nhimHIV.
GiodcycchoNVYTcithintnh
trngngichmscngibnhHIV/AIDS.
xutgiiphpnhmgimthiunguyc
lynhimHIVnghnghipchoNVYT.
Tchctphunkinthcvdphngly
nhim HIV/AIDS cho NVYT. Cp nht thng
xuyn kin thc mi v d phng v iu tr
HIV, bao gm c iu tr d phng sau phi
nhim. Tp hun li cc qui trnh chm sc
ngi bnh, qui trnh x l cht thi t ngi
bnh, rn luyn thi quen t bo v bn thn
choNVYTtheonguyntcdphngphcp.
TrangbchoNVYTgngtay,ngchn,
knh mt v cc loi ha cht kh nhim cn
thit. Coi trng gio dc y c v trang b k
nnggiaotipchoNVYTtrongchmscvtip
cnvibnhnhnHIV.
Citinliquitrnhxlccchtthivrc
thi bnh vin t khu thu gom, lm sch v
khnhimchothunlivkhoahc.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
8.
KINNGH
Qui trnh x l sau phi nhim phi c
treo/dnniphhpcatngkhoalmsng
NVYTthchinngkhixyraphinhim.
mbotnhsnccathuckhngvirt
NVYTcthsdngtrc6giukt
khixyraphinhim.
9.
10.
BYtBTichnh(2005), Thngtlintchhngdn
thc hin Quyt nh s 265/2003/QTTG ngy 16/12/2003
caThtngvch i vi ngi b phi nhim HIV
hoc b nhim HIV/AIDS do tai nn ri do ngh nghip,
Thngtlintchs10/2005/TTLTBYTBTCngy30thng3
nm2005,HNi.
B Y t (1996), Qui nh chuyn mn v x l nhim
HIV/AIDS, Quyt nh s 2557/QBYT ngy 26 thng 12
nm1996,HNi.
BYt(2009),HngdnchnonviutrHIV/AIDS,
Quytnhs3003/QBYTngy19thng8nm2009,H
Ni.
BYt(2009),ctnhvdbonhimHIV/AIDStiVit
Namnm20072012,HNi.
ChuQucn(2010),CpnhttnhhnhdchHIV/AIDStrn
th gii qua cc con s, (Online). www.hivquangtri.org.vn
(Accesed:23March2010).
ihcYHNi,vnphngCDCVitNamchngtrnh
AIDS ton cu, vn phng d n LIFEGAP B Y t (2005),
nhginhucuotovdphngphinhimHIVngh
nghipti8trngihcyVitNam,HNi,tr.2329
LngH,NguyncHin,CaoThThanhThy(1999),
Khostvhiubit,thi,thchnhchmscbnhnhn
HIV/AIDScanhnvinYttibnhvinvshiubit,
thivhnhvicabnhnhnAIDS,nginhchmsc
bnhnhnAIDS,Kyucngtrnhnghincukhoahcv
HIV/AIDS19971999,HNi,tr.183189.
Nguyn c Thnh (2001), Hiu bit, thi , thc hnh
phng chng ly nhim HIV/AIDS ca cn b y t ti cc
bnh vin tnh/thnh ph v huyn/qun thuc cc tnh
QungNinh,NghAn,Namnhnm2000,BocotiHi
thokhoahc2001HNi,HNi.
S Y t tnh Yn Bi, Trung tm phng chng HIV/AIDS
(2011),BococngtcphngchngHIV/AIDS6thngu
nm2011,YnBi.
ybanNhndntnhYnBi(2009),ntngcngcng
tcphng,chng,kimchsgiatnglynhimHIV/AIDS
ti tnh Yn Bi giai on 2010 2015, Quyt nh s
1591/QUBNDngy20thng10nm2009,YnBi.
116
ChuynYTCngCng
NghincuYhc
KHOSTSBTNHHNHRNGNHIMFLUORTI2X
CMFLUORITECATNHPHYN
NguynThThanhH*,TrnThuThy*
TMTT
tvn:TheobococatnhPhYn,ngidntiy,nhtlnhngngisngtihuynng
Xun,angrtquantmvlolngchotnhtrngrngencah,nhhngrtnhiutrongcngvicv
tronggiaotip.ycngchnhlhuyncshindincaccmchchaqungvmfluorite,trongx
XunLnhlmttrongnhngxcmqungfluoriteangckhaithc.
Mctiunghincu:Bcukhostsbtlvmctrmtrngcatnhtrngrngnhimfluor
ti2xcahuynngXuntr12tuisnglintcti2xnyttrckhisinhnnay.Tlmcs
lpkhochiutramtcchtondinhnvtnhtrngrngnhimfluorcangidnsngtrongmi
trnghotngcamfluorite,nhmxutnhngbinphpxlthchhpngnchnhintngny
chonhngthhsau.
Phng php nghin cu:Ctngangmt,khmnhgitlvmctrmtrngcatnhtrng
rngnhimfluorchohcsinhlp6(12tui)angtheohcvsinhsnglintcti2xXunLnhvXun
Phchuynngxun,cngnhngngidnsnglintctixXunPhc,theo2loichs:Deanv
TF.Nghincucthchinbi2BcscabmnNhakhoaCngcng,KhoaRngHmMt,ihcY
DcthnhphHChMinhvothng12nm2011.
Ktqunghincu:Tlrngnhimfluorcahcsinh12tuisnglintcti2xnyucao:80%
xXunPhcv84,6%xXunLnh.Chsnhimcngngtrem12tuic2xuthucloitrung
bnh(1,5).Tltrctonb(100%)rngnhimfluormcTF1l53,85%;TF2l26,92%;TF3l
7,69%;vTF4l3,85%.100%ngidnckhmctnhtrngrngnhimfluormc4v5theo
Dean,FCI=3,60,51(rtngk).
Ktlun:Ktqunghincuchothyhcsinhvngidnchaixuctlvmctrmtrng
carngnhimfuornhnhauvrtcao.iunychothytnhcnthitvcpbchcaviciutranghin
cuchititvtngquthnvtnhhnhsckherngmingcngnhyutmitrngarabinphp
iutrvphngngathchhpgipngidncmthmrngp.
Tkha:Rngnhimfluor,chsnhimFcngng
ABSTRACT
PRELIMINARYSURVEYOFDENTALFLUOROSISINTWOWARDSHAVINGFLUORITEMINES
INPHUYENPROVINCE
NguyenThiThanhHa,TranThuThuy
Background:AccordingtoareportofPhuYenprovince,people,especiallythosewholiveinDongXuan
district, really worry about their black teeth, that influence their works and communications. This is also the
districtwiththepresenceofthefluoritemines,inwhichXuanLanhwardisoneofthefluoritemineareasthatare
beingexploited.
BmnNhakhoaCngcngKhoaRngHmMtihcYDctp.HCM
Tcgilinlc:Ths.NguynThThanhH T:0938489911Email:nguyenthithanhha1964@yahoo.com.vn
ChuynYTCngCng
117
NghincuYhc
Objectives: To primarily evaluate the prevalence and the severity of dental fluorosis among children 12
yearoldlivingcontinuoslyfromprenataltopresentintwowardsinDongXuan.Theresultsachievedfromthis
studywillbeafoundationofmakingplansforacomprehensivesurveyofdentalfluorosisofpeoplelivinginthe
fluoritemineareaandproposeappropriatepreventionmethodsforfuturegenerations.
Research Methodology: Crosssectional method was applied. 61 students in grade 6 (12 years)
permanentlyresidentintwowards(XuanLanhandXuanPhuoc)andpeoplepermanentlyresidentXuanPhuoc
wardofngXundistrictareexaminedandassessedtheseverityofdentalfluorosis, using the two indices:
DeanandTF.ThestudywascarriedoutbytwodoctorsofDentalPublicHealthdepartment,FacultyofOdonto
Stomatology,UniversityofMedicineandPharmacyinDecember,2011.
Results: Therateofdentalfluorosisof12yearoldstudentspermanentlyresidentinthesewardswastoo
high,accountedfor80%inXuanPhuocand84.6%inXuanLanh.Fluorosiscommunityindicesinbothof2
commuitiesare1.5(inmoderate).Thepercentageofchildrenhave100%teethwithdentalfluorosisatlevelTF
1, TF 2, TF 3, and TF 4 were 53.85%, 26.92%, 7.69% and 3.85% respectively. 100% of inhabitants
examinedhavedentalfluorosisatlevel4and5accordingtoDeanindex,withFluorosiscommunityindexFCI=
3.60.51(remarkable).
Conclusion:Theresultsshowedthatstudentsandpeoplelivinginbothfluoriteminewardshavethehigh
rateandseverityofdentalfluorosis.Therefore,acomprehensiveinvestigationoforalhealthsituationaswellas
environmentalfactorsarerecommendedtofindoutappropriatetreatment and prevention methods in order to
bringniceteethforpeopleintheareas..
Keywords:Dentalfluorosis,Fluorosiscommunityindex
nc gy ra tnh trng ny l cn thit c
TVN
nhngbinphpgiiquytthchhp.
Fluor(F)lmtchthahcctrongthin
Ph Yn l mt tnh ven bin thuc vng
nhin, thng di dng hp cht. Fluor hp
duyn hi Nam Trung B Vit Nam, c nhiu
thvocthvimtmcphhpsctc
sui nc khong nng v nhiu ti nguyn.
dng phng nga su rng, nhng nu lng
ngXunlhuynminninmvphaTy
fluor hp th qu mc s gy ra tnh trng
BccatnhPhYn.ycnglhuyncs
nhim c cp hoc mn tnh. Tnh trng rng
hin din ca cc mch cha qung v m
nhim fluor l mt in hnh ca nhim c
fluorite,trongXunLnhlmttrongnhng
fluormntnh(11).
xcmqungfluoriteangckhaithc(9).
ncta,mtsnictlsurngcao,
Theo bo co ca a phng, ngi dn sng
lng fluor trong nc t hoc khng c, cn
tiPhYn,nhtltihuynngXunuc
phi fluor ho nc v s dng thm mt s
tnhtrngrngnuen,c,bmtlch.Dn
bin php F khc. Bn cnh , mt s ni ghi
chngyangrtquantmvlolngvtnh
nhn c hin tng rng nhim fluor, do nng
trngrngennynhhngrtlntrong
fluor trong nc cao. C mt s vng tnh
cngvicvtronggiaotiphngngy.Hthit
trngnyrttrmtrng,nhhngnhiun
thamongmuncsgipcithintnh
thm m, v c mnh danh l vng t
hnh,vngthihyvngthhconchuca
khng c n ci. Tnh trng nhim fluor
hskhnggpphihintngny.
thin nhin nht l do ngun nc khng ch
Nghincunylmtkhostbanu
nhhngntngcnhnmlvnca
nh gi v thc trng nhim fluor ca ngi
cngng.Dovicxcnhmtcngng
dntnhPhYn,cthl2xcahuynng
c nhim fluor hay khng, cng nh xc nh
Xun, ni nhn c phn nh nhiu nht v
nhngnguynnhn,trongchyulngun
tnhtrngrngen,maphngnghingl
118
ChuynYTCngCng
docmfluoriteangkhaithc.
FCI=((nw))/N
Mctiunghincu
n:Slngtrmimc
Khostsbtnhtrngrngnhimfluor:
tlvmctrmtrngtr12tuivmt
sdnsngti2xXunLnhvXunPhc,
l nhng x c m fluorite, thuc huyn ng
XuntnhPhYn.
w:Tnscamimc
ITNGPHNGPHPNGHINCU
itngnghincu
Tr 12 tui sng lin tc (t trc khi sinh
tinay)ti2xXunLnhvXunPhc(hc
sinhlp6ca2trngcpIIti2xny)thuc
huynngXun,tnhPhYn.
MtsngidnsnglintctithnPh
XunB,xXunPhc.
Phngphpnghincu
Khmghinhntnhtrngrngnhimfluor
cattcccitngnghincutheochs
Dean (1942)(7,1,2,12,3,4,13,8): Mi rng c khm v
nh gi t 1 n 6 mc . Rng c khm
dinhsngtnhinkhngcnlmschrng
vkhngthikhrngtrckhikhm.Mic
thcghinhnbngmts.Khixploith
davotnhtrngcprngbnhhngnhiu
nht, nu 2 rng khng tng ng nhau th
chnmstheorngbnhimthn.
Ms:
0:Bnhthng:menrngctrongbnhthng,nhn,
bng,mukemnht.
1.Nghing:bininhvtrongcamenrngtvi
mnvichmtrng.
2.Rtnh:vngnh,trngcrircnhng<25%b
mtrng.
3.Nh:Ccvngtrngctrn25%nhng<50%b
mtrng.
4.Trungbnh:tonbbmtrngbnhhngtrng
c.Mtrngcthnhimsc.
5.Nng:trngctonb,chindincchkhim
khuyt.
Tnhchsrngnhimfluorcacngng(FCI:fluorosis
communityindex):
FCIctnhchocngngtheocngthc:
ChuynYTCngCng
NghincuYhc
N:Tngscthckhm
FCI
ngha sc khe cng ng/Mc gy hi
0,0 - 0,4
m tnh (khng hi)
0,4 - 0,6
Gii hn (ranh gii hi v khng hi)
0,6 - 1,0
Nh
1,0 - 2,0
Trung bnh
2,0 - 3,0
ng k
3,0 - 4,0
Rt ng k
Khmghinhntnhtrngrngnhimfluor
cacchcsinhlp6thuc2xXunLnhv
XunPhchuynngXuntheochsTF
(Thylstrup v Fejerskov 1978)(7,1,2,12,3): Ghi nhn
chschotngrng,rngclmschvkh
trc khi khm. M t c im nhim fluor
trnrng,cspxpthnh10mc,t
09,phnnhsgiatngmctrmtrng.
Vtonbccmtrngubnhimnhnhau,
nn cch phn loi ny c th cn c vo mt
ngoinhlidinchottcccmtrngcn
li,Ghinhnmscamtngoi:
0:Menrngtrong,mukemnht.
1. Nhng ng trng c mnh chy
ngangtrnbmt,chnhnhnhtuyt.
2. Nhng ng trng c thy r hn v
toccmmynh.
3. Nhng ng trng hp li thnh cc
mmytrngclanrng.
4.Tonbbmtrngbtrngc.
5. C thm nhng h trn khim khuyt
mencngknhdi2mm.
6.Nhnghnhkthplithnhtngdy
cchiucao<2mm.
7. Mt men nhiu hn, nhng < 1/2 b mt
men.Phnmencnlicmutrngc.
8.Mtmen>1/2bmtmen.Phnmencn
litrngc.
9. Mt phn ln b mt men lm thay i
hnhdnggiiphucarng.
nh gi tnh trng rng nhim fluor nh,
trungbnh,vnngnhmtheoccmcca
119
NghincuYhc
trungbnh.
chsTF:
TF0:bnhthng
TF12:nh
TF34:trungbnh
TF59:nng
Phngvnhcsinhvngidnquabng
cuhibitthngtinvngunncsdng
vthigiansinhsngtiaphng.
X l kt qu bng phn mm Excel v
SPSS(6).
KTQUVBNLUN
Khiqutvmuchn:
Biu2:Tltr12tuinhimfluorti2xtheo
tngmccachsDean
Bng1:Slngtr12tuickhm
X
Xun Phc
Xun Lnh
Tng
Nam
15
12
27
N
20
14
34
Tng cng
35
26
61
Kt qu v tnh trng rng nhim fluor ca

hcsinh12tuisnglintctbnnayti2
xnytheochsTF.
Bng3:Tlrngnhimfluortngmcso
vitngsrngckhmtheochsTF
X
Bnh
Nh
Trung bnh
Nng
thng
(TF 3, 4) (TF 5 - 9)
(TF 1, 2)
(TF 0)
Xun
38,31%
38,18%
17,19%
6,32%
Phc (303/791R) (302/791R) (136/791R) (50/791R)
Xun
27,23%
46,55%
25,38%
0,84%
Lnh (162/595R) (277/595R) (151/595R) (5/595R)
Biu1:Tlnamvntrongtngsdn
ckhmtithnPhXunBxXunPhc.
Ktquvtnhtrngrngnhimfluor(tl
vmctrmtrng)cahcsinh12tuisng
lin tc t b n nay ti 2 x Xun Phc v
XunLnhhuynngXuntnhPhYn.
hcsinh12tuisnglintctbnnayti2
xnytheochsDean.
Bng2:Tltrctnhtrngrngnhimfluorv
chsnhimfluorcngng(FCI)
X
Xun
Phc
Xun Lnh
T l NF (%)
FCI
nh gi FCI
35
80
1,51,20
Trung bnh
26
84,6
1,51,16
Trung bnh
Biu3:Tlrngnhimfluortheotngmc
cachsTF
Khngcskhcnhauvtlnhimfluor
cngnhvchsnhimfluorcngnggia
2xXunPhcvXunLnh(p=1,0).C2x
ucchsnhimfluorcngngthucloi
120
ChuynYTCngCng
NghincuYhc

mtscthsngtithnPhxunB,xXun
Phc, huyn ng Xun, tnh Ph Yn: 100%
sdnckhmuctnhtrngrngnhim
fluor vi 2 mc 4 v 5 theo ch s Dean,
khngcnginonhimmcnhhn.
FCI = 3, 6 0,51: thuc loi nhim fluor rt
ngk.
Biu5:Tlnhimfluortheotngmcca
chsDeancanhngngidnckhm
BNLUN
Tlvmctrmtrngcatnhtrng
rng nhim fluor ca ngi dn ti 2 x
XunPhcvXunLnh
CmBiu4:Tltr12tuitngngvi
nhngtlrngbnhimfluorkhcnhaumc
TF1;2;3v4camitr.
T l tr c ton b (100%) rng b nhim
fluormcTF1l53,85%;TF2l26,92%;
TF3l7,69%;vTF4l3,85%..
ChuynYTCngCng
Tr12tuivngidnsngti2xnyc
t l rng nhim fluor kh cao, chim t l t
80% n 100%. Ch s nhim fluor cng ng
FCIcahcsinhuthuclaitrungbnh(1,0
2,0).Cchcsinhbnhimmc2v3nu
khmtheoc2loichsDeanvTFchimt
l cao. Nhng b c b mt men b khim
khuytctlkhngnh,mcdmcTF
7(lmthayihnhdngrng)khngghinhn
c,nhngTF5v6biuhinbicckhim
khuyt men rng t nhng h nh cho n
nhng dy khim khuyt di u ghi nhn
c.NhtldnsngtithnPhXunB,x
XunPhcuctnhtrngrngnhimfluor
t trung bnh n nng. Ton b b mt men
121
NghincuYhc
rngcattcrngtrncunghmubtrng
c,nhimsc,60%sdnckhmctnh
trngkhimkhuytmen,nhtlvngrngca,
do nh hng rt nhiu n thm m. y
cngchnhlmiquantmvlolngcangi
dn sng ti huyn ny cng nh ca cc cp
lnho.
Yutkhhu,mitrng
HuynngXuntnhPhYncshin
din ca cc mch cha qung v m fluorite,
trongxXunLnhlmttrongnhngxc
mqungfluoriteangckhaithc(9).
Tnh hnh s dng ngun nc v thi

giansinhsngtiaphng
TheongTrungThun,hmlngFtrong
ncbmtvtronglngtcahuynnyc
nngrtcao,cnilnn11,5mg/l,trong
ncmfluoritecnng5,1mg/l(9).
Ttctr12tuivnhngngidnc
khmucthigiansinhsngtiaphng
rt lu. Hu ht u s dng ngun nc ch
yu l nc ging o ti nh, hoc ca hng
xmnun,ungkcsinhhot;chc2tr
cphngvntrlilcsdngthmnc
ma v nc sui. iu ny t ra nhng
cu hi: Nng fluor trong ngun nc ca
ccgingticcxnynhthno,vnng
ny c ng u ti tt c cc ging nc hay
khng?Mfluoriteangckhaithctiy
c nh hng nh th no i vi tnh trng
ny?
Cc ngun nc khong nng c th vn

ngngmtheocchthngtgy,khent
trongccmangtheofluorctrongvpht
tn ra xung quanh. V vy cc ging nc gn
ni khai thc m hay gn cc ngun nc
khongnngchmlngFtngicao4,2
6,1mg/l, ni cao nht 11,5 mg/l. Nc ging ti
cc nh dn c nng dao ng rt ln t
0,1mg/ln11,5mg/l.cbittixXunLnh,
mtsgingdocchdnodctheong
lintnhLaHaiVnCanhtuynmtrnbmt
ahnhcao,nhngccginglunync,v
cnngF>1,5mg/l,cging56,1mg/l(9).
Sosnhviccktqunghincutrc
y
So snh tc ng ca nng fluor trong

ngunncsdngvtnhtrngrngnhimF
ti 2 x Xun Phc v Xun Lnh vi cc
nghincugnytiVitnam:
KhnhHavNinhThunl2tnhlncn
viPhYnckhostvtnhtrngrng
nhimfluorvitlvmctrmtrng rt
ngquantm.
Vng
T l nhim fluor
(Error! Reference
> 90%
Khnh Ha (1985)
source not found.)
FCI
1,76
Khnh
(Error!
Ha
Reference
Ninh thun (1999) (5,10)

Huyn Ninh Hi
Huyn Ninh Phc
>90%
>90%
1,68
1,62
Huyn ng Xun Ph Yn
X Xun Phc
X Xun Lnh
80%
84,6%
1,5
1,5
Huyn Ninh
Ha
Nng T l rng FCI

Fluor trong nhim
nc ging fluor (%)
(ppm)
0,1 20
96
1,76
source not
T l v ch s nhim fluor cng ng ca

ccninytngngnhau.Cctnhlncn
PhYnvngaytiPhYnctlvchs
nhimfluorcngngtngngvinhau
yu t a cht, mi trng c lin quan mt
thitntnhtrngnynhthno?
122
Vng
found.)
Thn Khnh
Hi-Huyn
Ninh Hi
Thn Phc
Ninh
(5,10) Dn-Huyn
Thun
Ninh Phc
Phng
Phc M-Th
x Phan Rang
X Xun
Ph Yn
Lnh-Huyn
ng Xun
0,15 4,8
97,8
2,69
0,1 3,2
97,5
2,03
0,05 3,4
73
1,22
0,1 6,1
84,6
1,5
KTLUN
ChuynYTCngCng
T l rng nhim fluor: a s hc sinh 12
tuisnglintcti2xnyuctnhtrng
rngnhimfluor:80%ivixXunPhcv
84,6% i vi x Xun Lnh. 100% ngi dn
sngtithnPhXunBxXunPhchuyn
ngXunubnhimfluortrnrng.
Mc trm trng ca tnh trng rng
nhimfluor:
Chsnhimcngngtrem12tuic
2 x u thuc loi trung bnh (1,5), ca ngui
dntithnPhXunB:3,6(rtngk).Mc
trm trng ca rng nhim fluor cng thay
inhiutbnhthngnnng,nhnghu
httrbnhimmc2v3.
Theo phn loi ca TF: S rng b nhim
fluor cc mc khc nhau theo TF cng c
khongthayirng,srngbnhimfluor
mcTFt1n4chimphnln.
Ttcngidnckhmucmc
nhimfluortheochsDeanl4v5,nghal
tonbbmtmenbtrngc,nhimscv
ccchkhimkhuytmenrng.
Trong qu trnh khm iu tra cng nhn
thyctnhtrngrngnhimfluorhrng
sa vi mc trm trng khng km g
ngiln.
Tnh trng rng nhim fluor c th c lin
quan cht ch vi nng fluor trong ngun
ncsdng,ychnhlngunncging
tinh.
M fluorite c th cng chnh l nguyn
nhnquantrnglgiatngnngfluortrong
NghincuYhc
ncging.
XUT
Cn c mt t khm iu tra chi tit hn,
phihpvivicphntchnguntaicng
vinngfluortrongncsdng.T
ra cc bin php khc phc nhm em li cho
ngidntiymthmrngp.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Fejerskov O (1988), Dental fluorosis (a handbook for health

workers),MunksgaardIntPubl,.
Fejerskov O (1996), Fluoride in dentistry, Munksgaard Int
Publ,.
Murray JJ (1996), Epidemiology and measurement of dental
fluorosis, Fluorides in caries prevention, Munksgaard Int
Publ,,222:261.
NgngKhanh(1997),iutrasckherngming,Vin
RHMTp.HCM,.
Nguyn Th Thanh H (1999), Kho st tnh trng nhim
FluortrnrngtiNinhThun,Lunvncaohc,ihcY
dcTp.HCM.
NguynXunPhch(1995),Thngkyhc,NhxutbnY
hc.
PereiraAC(1999),Analysisofthreedentalfluorosisindexes
usedinepidemiologictrials,BrazilDentJ,10(1):29:37.
Rozier RG (1994), Epidemiologic indices for measuring the
clinical manifestations of dental fluorosis; overview &
critique,AdvDentRes,,June,8(1):3955.
Thi V Bnh (2011), n kho st nh gi tnh hnh
nhimfluortixXunlnhvXunPhc.
Trn Th Phng an (2000), Kho st nng fluor trong
ngunncsinhhotvmilinquanntnhtrngrng
nhimfluortitnhNinhThun,Lunvncaohc,ihcY
dcTp.HCM.
VThQuang(1985),PhngbnhsurngbngFluor,Nh
xutbnYhc.
WHO (1994), Fluoride and oral health, Report of a WHO
ExpertCommunitteeonOralHealthStatusandFluorideUse
1994.
WHO(1997).Oralhealthsurvey.
ChuynYTCngCng
123
NghincuYhc
NHGITCNGMITRNGLAONGNHHNG
NSCKHEVBNHNGHNGHIPTICCKHUCNGNGHIP
TRONGTNHNGNAINM20092010
NgThHin*,PhanHiNam*
TMTT
tvn:nhnnhnthctrngvtnhhnhtcngcamitrngnhhngnsckhev
bnhnghnghipcangilaongticckhucngnghiptrntnhngNai,tivisliuthngkkt
qu kho st mi trng lao ng, khm sc khe nh k, khm pht hin bnh ngh nghip trong hai nm
20092010,tarakinnghcnthchinnhmgpphngimthiubnhnghnghipvcngtcchm
scsckhengilaongngycnghonthinhn.
Mc tiu: nhgitcngcamitrnglaongnhhngnsckhengilaongvbnh
nghnghipcacccngtytrongKCNtrnabntnhngNaitnm20092010.Taragiiphp
gimthiuccyutnguycnhhngtisckhengilaong.
Phngphpnghincu:Chnlyktqukhostmitrnglaongvktqukhmsckhenh
k,khmphthinbnhnghnghip,tainnlaongtrong2nm20092010doTrungtmbovsckhelao
ngvMitrngngNaithchin.iutrahicusliukthpviphngphpthngkboco.
Cchtipcn:DavoktqucthcacchotnghngnmcaTrungtm,thuthpsliu.
Ktqunghincu:Ktqumitrnglaongtrong2nm(20092010),Ktqukhmsckhenh
ktrong2nm(20092010),ktqukhmphthinbnhnghnghiptrong2nm(20092010),bococng
tcYtcacstrong2nm(20092010).
Ktlun:Quacngtchainmthchinkhostmitrnglaong,khmsckhenhk,khmpht
hinbnhnghnghip(20092010)mitrnglaongchaccithin,trongcbitlyutnv
bi,tlmuovttiuchunvsinhlaongsovimuokhnggim,sngimcbnhicngh
nghipvbnhbiphiSiliccxuhngtngticcdoanhnghiptrongcckhucngnghiptnhngNai,
taraccbinphp,kinnghcnthchin.
Tkha:Mitrng,khostmitrnglaong,khmsckhenhk,bnhnghnghip
ABSTRACT
EVALUATIONIMPACTENVIRONMENTWORKINGAFFECTSTOHEALTHAND
OCCUPATIONALDISEASESINTHEINDUSTRIALPARKSINONGNAIPROVINCEIN20092010
NgoThHien,PhanHaiNam
Background: To see the reality of the situation impact of environment affect health and occupational
diseasesintheindustrialparksinDongNaiprovincein20092010.Dataoftopicsarestatisticsfromtheresults
surveyofworkingenvironment,examinationhealthperiodic,examinationfordetectionofoccupationaldiseases
inthetwoyears20092010,makeproposalstoreducetheincidenceofoccupationaldiseasesandhealthcarefor
workersmoreandmorecomplete.
*PhngKHochTichnh,TrungtmBovsckhelaongvMitrngng Nai
Tcgilinlc:KS.NgThHinT: 0937041199 Email:ngohien63@gmail.com
124
ChuynYTCngCng
NghincuYhc
Objectives: Evaluation impact environment affects to health and occupational diseases in the industrial
parksinDongNaiprovincein20092010,makeproposalstoreduceriskfactorsaffecthealthofworkers.
Methods: Select survey results of working environment, examination health periodic, examination for
detectionofoccupationaldiseasesinthetwoyears20092010madebyCenterofEnvironmentandHealthcare
ofDongNaiprovince.Retrospectivestudydateassociatedwithstatisticalandreportingmethod.Approch:Based
onthespecificresultsoftheannualoperationofthecenter,tocollectdate.
Results: Resultofsurveyenvironmentworkingtin2years(20092010),resultsofexaminationhealth
periodicin2years(20092010),resultsofexaminationfordetectionofoccupationaldiseasesinthetwoyears
20092010.
Conclusion:Overthetwoyearssurveyedlaborenvironment,publichealthexamination,examinationfor
detectionofoccupationaldiseases(20092010)workingenvironmenthasnotimproved,inparticularfactorsthat
noise and dust, the sample rate exceeds occupational standards compared to the sample does not decrease, the
numberofpeoplewithoccupationaldeafnessandsilicosisdiseasetendstoincreaseinenterprisesintheindustrial
zoneinDongNaiprovince,whichgiventhemeasuresandproposalstomake.
Keywords: environment, survey environment working, Results of examination health periodic,
occupationaldiseases.
TVN
Tnh ng Nai l mt trong nhng tnh
trngimphaNamcnncngnghippht
trin mnh, cng vi pht trin ca cng
nghip ha, hin i ha t nc, trnh c
giihangycngnngcao,cngtcantonv
sinh lao ng ngy cng c cp v ch
trng nhiu hn v vy cng tc chm sc sc
khe, phng chng tai nn lao ng, phng
chng bnh ngh nghip cho ngi lao ng
phicncquantmhn.
Mi trng lao ng l mt phn quan
trng ca mi trng sng. Hng ngy ngi
lao ng phi lm vic theo thi qui nh l 8
tingnhngcngclctngcangyphilm
t1012ting.Nhvytrungbnh1/3thigian
trongngyltipxcvimitrnglaong,
tclckhnngtipxcviccyutnguy
cchi.
Nhng nm gn y cc doanh nghip
thc hin bin php ci thin mi trng lao
ng phn no nhng cha ng b, trang b
bo h lao ng cha c y , cha ph
hpvitnhchtcngvicdodnntnh
trngtainnlaong,nhhngtisckhe
ca ngi lao ng, v bnh ngh nghip c
chiuhnggiatng.
ChuynYTCngCng
Chnh v th cng tc kho st mi trng

lao ng, khm sc khe nh k, khm pht
hin bnh ngh nghip, tp hun v sinh lao
ngscpcutainnlaongdoTrungtm
Bo v sc khe lao ng & Mi trng ng
Nai thc hin(1) i vi cc doanh nghip mi
nmutng(cthlscs,smuohoc
ngilaongkhm)vchngtithngk
csliucth.
TheoBcsVThGiangtltingnvt
TCVSCP t 53,485,7%; t l gim sc nghe
chimn32,9%trongccngnhnghting
Nai(TNC20042005VThGiang)(4).
Tuy nhin nhn nhn thc trng v tnh
hnh tc ng ca mi trng nh hng n
sc khe v bnh ngh nghip ca ngi lao
ng ti cc khu cng nghip trn tnh ng
Nai,chngtithchintivisliuthng
ktronghainm20092010 (2)(3)vtara
nhng gii php v bin php ci thin mi
trng lao ng nhm gp phn gim thiu
bnh ngh nghip v cng tc chm sc sc
khengilaongngycnghonthinhn.
ITNGPHNGPHPNGHINCU
Mctiunghincu
Xc nh mc nhim mi trng i
125
NghincuYhc
vi ngi lao ng t cc doanh nghip trong

nm 2009 & 2010 (thng qua cc kt qu kho
stmitrnglaong).
Xc nh tnh hnh sc khe bnh tt ca
ngi lao ng trong nm 2009 & 2010 (thng
quaktqukhmsckhenhkvktqu
khmphthinbnhnghnghip).
Xc nh mt s yu t lin quan n t l
mcbnhnghnghip(yutn,bi).nhgi
tnh trng v iu kin mi trng nh hng
ntlmcbnhnghnghipcacngnhn.
Phngphpnghincu
Hicu,mt.
Cchtipcn
Da vo kt qu c th ca cc hot ng
hngnmcaTrungtm,thuthpsliu.
CngtcqunlhsVSLvkhost
MTL:
Bng1:ScslphsVSLKSMTLTS
muoMTL.
T l
TS mu mu
TS c
TS c
TS lao
s
s o TS mu o vt
Nm
ng
Vt
TC
qun
kim
o
qun l
TC
l
MTL
VSL
VSL
2009 513 308.885 259 31.445 4.848 15.42
2010 573 332.875 253 32.092 5.451 16.98
513
+ S c s lp h s v sinh lao ng
qun l nm 2010(573) tng 60 c s so vi
nm2009(513).
+ S lao ng trc tip c qun l nm
2010(332.875) tng 23990 CN so vi nm
2009(332.875).
+ S mu o kim mi trng lao ng
nm 2010(32.092) tng 647 mu so vi nm
2009(31.445).
+ Tng s mu o nm 2009 vt tiu
chunVSL:4.848;chimtl:15,42%.
+ Tng s mu o nm 2010 vt tiu
chunVSL:5.451;chimtl:16,98%.
Bng2:Ktquotngyuttrongmitrnglao
ngtronghainm20092010.
a.Nhit,m,tcgi.
KTQUNGHINCU
600
Nhnxt:
S
Nm c
s
Nhit
Tc gi
(1) (2) (%) (1) (2) (%) (1) (2) (%)

2009 259 6327 1236 19.53 6319 29 0.45 6304 268 4.25
2010 253 6234 1956 31.37 6223 59 0.94 6612 129 1.95
Ghich:(1)tngsmuo
(2)tngsmuovtTCVSL
b.nhsng,n,Bi.
S
Nm c
s
nh sng
(1)
573
(2)
(%)
(1)
(2)
Bi
(%)
(1) (2) (%)
2009 259 4006 961 23.99 3547 1560 43.98 2159 185 8.56
500
400
2010 253 4657 1096 23.53 3543 1593 44.96 2217 123 5.54
259 253
300
200
50
100
S c s sx
S c s thc
hin
2009
2010
43.98
40
T l %
30
23.99
19.53
8.56
4.25 1.95
Nhit
2009
2010
17
20.91
20.4
5.54
0.45 0.94
16.98
23.52
20
10
BiubiudinscsokimMTL
44.96
31.37
Vn
nh
tc gi sng
Bi
Hi
Kh
16.5
16
15.42
15.5
2009
2010
15
14.5
T l mu vt TC VSL
BiubiudintngsmuvtTCVSL
126
Biubiudintl%nhit,m,tcgi,
nhsng,n,bi,hikhnm20092010
Nhnxt:
+SmuvtTCVSLcaonhttrongc2
nm:ltingn,
ChuynYTCngCng
+Tngscskhmsckhetng
+ S mu khng t TCVSL thp nht

trongc2nmlm.
Cngtckhmsckhenhkphnloi
theoQ1613/BYT.
Bng3:Ktqutngscskhmvtngsngi
khmnm20092010.
Nm
S c s sn S c s khm
xut qun l
SKK
2009
2010
513
573
84
101
70000
60000
61072
Tng s cng
nhn c
khm SKK
61.072
62.854
513
2009
2010
573
84
101
S c s
KSK
+ Tng s cng nhn c sc khe loi 2, 3

chimtlcao,ivisckheloi4,5,chim
tlthp(nm2009loi5l:3,18%;nm2010
loi5:5,40%)vtlphnloisckhehainm
chnhlchkhngnhiu.
Bng5:Scs&cngnhnkhmbnhngh
nghip
62854
30000
20000
S c s SX
+TngscngnhnkhmSKKtng.
Cng tc khm pht hin bnh ngh

nghip
50000
40000
10000
0
s cng nhn
khm
TT
Ni dung
Nm 2009
01 S c s SX khm bnh
35
ngh nghip
02 Tng s ngi c khm
6.346
BNN
03 Tng s ngi c gim
11
nh BNN
Biubiudintnhhnhkhmsckhenhk
trong2nm20092010
C s khm
S ngi khm
Loi 1
% Loi 1
Loi 2
% Loi 2
Loi 3
% Loi 3
Loi 4
% Loi 4
Loi 5
% Loi 5
Nm 2010
101
62854
6666
8,21
23940
38,08
22344
41,35
8025
12,76
3379
5,40
Biubiudinphnloikhmsckhenhk
Sosnh2nm20092010:
ChuynYTCngCng
10.095
20
Biubiudinscsvscngnhnkhmpht
hinbnhnghnghip
Bng6:Ktqukhmbnhnghnghip
TT
01
50
41.35
38.08
40
35.54
35.62
30
2010.91
8.21
8.9112.765.4
10
3.18
0
Loi Loi Loi Loi Loi
1
2
3
4
5
2009
2010
Nm 2010
30
10095
12000
10000
8000
6346
6000
4000
2000
1120
30
0 35
S CS
TS
khm
ngi
2009
BNN
gim
nh
2010
Bng4:KtquKSKvphnloi,tl%.
Nm 2009
84
61072
6666
10,91
21755
35,62
25258
41,35
5446
8,91
1947
3,18
NghincuYhc
02
03
04
05
06
Nm 2009
Nm 2010
TS
TS
Phn loi
TS
TS
TS theo
TS
theo
bnh
gim
gim
khm di
khm di
nh
nh
mc
mc
Bnh bi
245
12
01
407
14
02
phi Silic
Nhim c
208
13
04
227
14
ch
Nhim c
328
46
Nicotin
Bnh ic
5762 112
02
8551
28
14
do ting n
Bnh xm
64
21
0
da NN
Bnh VG vi
04
04
04
04
04
04
rt NN
Tng cng 6.346 11 10.095
20
Nhnxt:
127
NghincuYhc
+ S c s khm BNN: nm 2009 cao hn

nm2010(nm2009:35cs;nm2010:30CS.
3
2
+ S lng cng nhn c KBNN: nm

2010 cao hn nm 2009 (nm 2010: 10.095 CN;
nm2009:6.346CN).
+ S cng nhn gim nh BNN: nm 2010
caohnnm2009(nm2009:11CN;nm2010:
20CN).
BnhbiphiSilic
a. S cng nhn khm BNN nm 2010 cao
hn nm 2009 (nm 2010: 407CN; nm 2009:
245CN)tng162cngnhn.
b.ScngnhncgimnhBNNnm
2010 cao hn nm 2009 l 1 CN ; t l s cng
nhncgimnhBNNnm2010:2/407t:
0,49%;nm2009:1/245t:0,41%.
245
200
100
2009
0
TS khm BNN
TS gim nh BNN
2010
BiubiudinbnhbiphiSilic
Bnhicnghnghip
a. S cng nhn khm BNN nm 2010 cao
hn nm 2009 l 2789 CN (nm 2010: 8551CN;
nm2009:5762CN);
b.ScngnhncgimnhBNNnm
2010 cao hn nm 2009 l 12 CN t l s cng
nhn c gim nh BNN nm 2010: 14/8551
chimtl:0,16%;nm2009:2/5762chimtl:
0,03%.
10000
8000
8551
5762
2009
6000
2010
4000
2000
14
0
TS khm BNN
TS gim nh BNN
Biubiudinbnhicnghnghip
Bnhvimganvirtnghnghip
Tng s CN khm BNN v tng s c
gimnhBNNtrong2nmnhnhau(04).
128
TS khm BNN
TS gim nh BNN
2010
BiubiudinbnhVimgansiuvinghnghip
Tnhhnhsckhevbnhtttrongcng
nhndocsboco
Bng7:Scngnhnnkhmticccsgi
boco
TT
Ni dung
2009
2010
1
Tng s c s sn xut bo co
85
32
2 Tng s cng nhn cc c s trn 72.343 46.908
3 Tng s trng hp khm bnh (ln) 98.881 85.929
Bng8:Tnhhnhnghm
TT
1
407
400
300
500
2009
3
4
5
Ni dung
2009
S c s bo co
85
Tng s cng nhn ca cc CS bo
72.343
co
Tng s ngi ngh m trong nm 15.499
Tng s lt ngi ngh m trong nm
Tng s ngy ngh m
37.323
2010
32
46.908
12.226
29.326
Bng9:Tnghpccnhmbnhcaccytcs
giboconm20092010.
Nm
Mt
Tai mi
hng
Tim
mch
Tiu ha
Ni tit
2009
4.615
22.390
6.899
4.776
98
2010
3.832
19.200
3.089
2.756
41
Nm
2009
2010
Xng
Bnh thn
Da Ph khoa
khp
kinh TW&NB
4.236 1.726
3.407
7.534
1.992
889
1.932
3.912
Bnh
khc
43.200
18.286
BNLUN
Thc hin xut sc nhim v v chc nng
c giao Trung tm BVSKLNN&MT tnh
ngNaihngnmckhochvchtiu
phnuvcngtcchmscsckhengi
lao ng trong v ngoi cc khu cng nghip
tontnh.Nhnchungtrnlnhvcmitrng
laong,khmsckhenhkvkhmpht
hinbnhnghnghipcphttrinhnsovi
nhngnmtrc.
Cng vi s pht trin cng nghip ha
hin i ha, cc doanh nghip trn a bn
ChuynYTCngCng
tnhngNai lun c nhng chuyn bin
ph hp vi yu cu i vi iu kin tng
cng ty, lnh vc sn xut.s bin i ch
yu l lc lng lao ng, trong c ngi
lmcngtcthngkbocovvyscs
bo co v Trung tm nm sau t hn nm
trc v s mu khng tng ng, cng tc
nggichtrnmttnghpchung.
Qua hai nm thc hin (20092010) cng
tc kho st mi trng lao ng, khm sc
khe ng k, khm pht hin bnh ngh
nghipchngtinhnthy:
Cngtckhmsckhenhk
Thc hin t thp so vi c s qun l,
nm2009cstchckhmsckhenhk
t 16,37 % ( 84/513), nm 2010 s c s t
chc khm sc khe nh k t 17.63 %
(101/573).ylvncccngtychatht
s quan tm ti cng tc chm sc sc khe
ngi lao ng, cn xem nh. V cng tc
qun l cc c s bo co cng tc chm sc
sckhengilaonggivTrungtmcn
t,nmsauthnnmtrc,tngscccs
gibococngtcchmscsckhengi
laongvTrungtmnm2010gim53cs
so vi nm 2009 (nm 2009: 85 c s gi bo
co, nm 2010: 32 c s), do nhiu c s
khm sc khe nh k nhng c s y t
khcchngtikhngqunlc.
Tnh hnh sc khe ngi lao ng qua
khm sc khe nh k c phn loi theo
Q 1613/BYT.Tng s cng nhn khm sc
khenhkcsckheloi2,3chimtl
cao,ivisckheloi4,5,chimtlthp
( nm 2009 loi 5 l: 3,18%; nm 2010 loi 5:
5,40%) v t l phn loi sc khe hai nm
chnh lch khng nhiu. Ch yu sc khe
loi IV v V do th lc l chnh v bnh v
nghhp(VFQ),taimihngchimtl
caohnsoviccbnhkhc,vnnylin
quannccyutmitrngvnhit,bi,
hi kh.....v cc ch t chc qun l ca
cngtychatheoshngdnquynhca
Byt,BLaong.
ChuynYTCngCng
NghincuYhc
Cngtckhostmitrnglaong
Trntngscshainmlinthchino
kim mi trng lao ng c gim 06 c s
nhngsmuotng647muvscslp
hsvsinhlaongqunlnm2010(573)
tng60cssovinm2009(513).
Ringyutnvbitrongnm20092010,
smuvttiuchunvsinhlaongcncao
(n: nm 2009 s mu vt tiu chun v sinh
laongchimtl43,98%sovimuo,nm
2010 s mu vt tiu chun v sinh lao ng
chimtl44,96%sovimuo).
Dotnhchtcthcacngvic,mts
doanh nghip thuc cc ngnh (khai thc ,
chbinsnxutcngnghipthcphm,gia
cng c kh...) khc phc cc yu t mi
trng vt tiu chun v sinh lao ng ch
tphnnoyucu.
Ngoiramtscskhngquantmn
ccyu t mi trng lao ng, khng c bin
phtcithiniukinlaong,ngkthc
hinomitrnglaongchlhnhthci
phvicccquanchcnnghocdoyucu
cakhchhngvvykhngthchintheo
nhngkinnghchngtixuttrongcckt
quokimhoctrongcngtcthanhkimtra
hngnm.
i vi cng tc khm pht hin bnh

nghnghip
Ch yu tp trung vo bnh ic ngh
nghip,bnhbiphiSilicvtptrungvocc
cssnxutcnguyccao.
Domitrnglaongcncyutvt
tiuchunvsinhlaong,nhtltingnv
bi,chonnbnhicnghnghipvbiphi
chim phn ln trong cc bnh ngh nghip
c pht hin. (nm 2009: bnh ic ngh
nghipcgimnh:02;nm2010bnhic
nghnghipcgimnh:14;Biphinm
2009 bnh bi phi Silic c gim nh: 01;
nm 2010 bnh bi phi Silic c gim nh:
02) iu ny cho thy ti cc doanh nghip,
nguy c mc bnh ic ngh nghip, bi phi
129
NghincuYhc
Siliccxuhngtng.
KINNGH
y mnh cng tc tuyn truyn, gio dc
vantonvsinhlaong,phngchngbnh
nghnghipchocccssnxuttrongch
trngtptrungccngnh,cccssnxutc
cc yu t c nguy c cao. Ngoi ra cn tng
cngcngtctuyntruyn,hitho,tphun
cngtcphngchngbnhnghnghipivi
csthucngnhyt.
Cn phi hp tt vi cc ngnh lin quan
ymnhcngtcthanhtra,kimtra,gimst
victhchincngtcantonvsinhlaong,
phng chng bnh ngh nghip ca cc c s
snxut,doanhnghip.onkimtralon
lin ngnh, cn c n v y t tham gia t
mi c kin v cng tc chm sc sc khe
ngi lao ng, v hiu qu kin ngh ca
ngnhmicchuynbintt.
Silic ngh nghip (theo Thng t 12/TTBYT

ngy10thng11nm2006caBYt).
Khmsckhetuyndng
Nhngngicbtrvovtrcting
n, bi cao cn c kim tra k v tai, mi,
hngvothnhlc,ochcnnghhp.
Khng b tr vo v tr c ting n, bi cao
cc i tng b bnh sau: vim mi, vim tai
gia nhiu ln, thn kinh khng bnh thng,
bnhtuynnitit,bnhtimmch,lonthgic,
bnhnghhp.
YtcngtyvcnbAntonphick
hochgimstchtchvicsdngphng
tin bo v c nhn. Ngoi ra cn thng
xuynkhuyncochongilao ng tc hi
ca ting n, bi, iu kin vi kh hu xu
.ivisckheconnginhmnngcao
hiu bit v thc v cng tc an ton v v
sinhlaongchoh.
i vi cc doanh nghip phi c cc bin

phpcithinmi trng lao ng, hng nm
phi thc hin kho st mi trng lao ng,
khm sc khe nh k, khm pht hin bnh
ngh nghip, tp hun cho ngi lao ng v
cngtcscpcutainnlaong,vsinhlao
ngvphngchngbnhnghnghip.
Gimthigianlmvicvlpthigianbiu
chongilaonglmvicnictingncao
hcthigiannghngihpl.
Trong h s sc khe ca ngi lao ng

lmvicccvtrcmcn,bicaocnphi
ghi r iu kin lao ng v thc hin nhng
binphpkhmbnhringbitnhphikim
trathngxuynvthnhlc,ochcnngh
hp chp X quang phim phi nhm pht hin
kp thi bnh ic ngh nghip, bnh bi phi
2.
TILIUTHAMKHO
1.
3.
4.
BYt(2007),Quytnhs15/2007/QBYTvBanhnh
kmtheoQuinhchcnng,nhimv,nhimv,quyn
hn v c cu t chc ca Trung tm Bo v sc khe lao
ngvMitrngtnh.
Trung tm Bo v sc khe lao ng v Mi trng ng
Nai(2009),Bocohotngnm2009.
Trung tm Bo v sc khe lao ng v Mi trng ng
Nai(2010),Bocohotngnm2010.
V Th Giang (2006), nh ga tc ng mi trng lao
ngnhhngnsckhevbnhnghnghip ti cc
khucngnghiptrongtnhngNainm 20042005, Tp
chYhcTP.HChMinhtp10(4),trang150155.
130
ChuynYTCngCng
NghincuYhc
MCHILNGCABNHNHNKHINKHMIUTR
TICCTRMYTXHUYNCNGIUCTNHLONGAN
NM20102011
PhmTrnThanhLch
TMTT
tvn:Knnggiaotipgianhnvinytvbnhnhn/thnnhnlmttrongnhiuyutquyt
nhtcngnshilngcabnhnhniviccdchvchmscytticsyt,nhtltrmytx
lniutintipxcvibnhnhn.Nghincunyctinhnhnhmkhostkinbnhnhnvk
nnggiaotipcanhnvinyttuyncstchnchnhccmttnti,phthuyccmttchcc,tos
hilngchongibnhnngcaochtlngchmscngibnh.
Mctiu:Xcnhtlbnhnhn/thnnhnhilngvimtskhacnhhotngtitrmytxnh
knnggiaotip,thigiankhmbnh,vmilinquangiashilngcabnhnhn/thnnhnviccbin
snnnhtui,gii,nghnghipv.v
Phngphpnghincu:Sdngthitkctngangmttrn800bnhnhn/thnnhnnkhmbnh
ti hai trm y t x Phc Hu v Phc Li ca huyn Cn Giuc, Long An t thng 23/2011. p dng
phngphplymuphntngchnngunhinmix400bnhnhn.Bcuhingciutravin
phngvnbnhnhntrongvng2tuntthhainchnht.
Ktqu:asbnhnhnhilngvicckhacnhhotngcatrmytcahaix(tlhilng>
60%).Tuynhintlhilngvihngdncaiudng,toathucck,trangthitbyttitrmvn
cnthp(58%,51%,47%).Giashilngchungcabnhnhnvccbinsnnkhngcmilinquanc
nghathngk(p>0,05).
Kt lun:Cctrmyttihaixcnthchinmtsiuchnhtrongcngtcnhmnngcaocht
lngdchvchmsctitrm.Cntphunchoiudngcchgiaotip,hngdnbnhnhn.Toathuc
cncithinvslngvchtlngsaochopngnhucucangidn.Cctrangthitbytcnc
bsung,muamiphcvtthnchongibnh.Trmytxcncmtschnhschnhmhtrngi
bnhngho,chacbohimyt.
Tkha:shilngcabnhnhn,trmytx,knnggiaotip
ABSTRACT
PATIENTSSATISFACTIONWITHHEALTHCARESERVICESOFCOMMUNEHEALTH
CENTERSATCANGIUOCDISTRICT,LONGANPROVINCEIN20102011
PhamTranThanhLich*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:132137
Background: Communication skills between health workers and patients or patients relatives is one of
determinantsaffectingpatientssatisfactionwithhealthcareservicesofhealthfacilities,inparticularcommune
health centers where patients visit at first. The study was conducted to evaluate patients opinion about
communicationskillsofhealthworkersofcommunehealthcentersandthefindingswereusedtofillthegapsin
ordertoimprovepatientssatisfactionandqualityofhealthcareservices.
Objectives: Identify the levels of patients satisfaction with some aspects of health care services such as
PhngKhmaKhoaTNhnPhmTrnThanhLch
Tcgilinlc:BS.PhmTrnThanhLchT:0989352151
ChuynYTCngCng
Email:thanhlich_pham1968@yahoo.com
131
NghincuYhc
communicationskillsofhealthworkers,waitingtimeforexamination,andfigureouttheassociationsbetween
overallpatientssatisfactionandpatientcharacteristicssuchasage,gender,occupation,etc.
Methods: Acrosssectionalstudywasconductedon800patients/patientsrelativeswhovisitedcommune
healthcentersatPhuocHauandPhuocLaicommunes,CanGiuocdistrict,LongAnprovincefromFebruaryto
March 2011. Stratified sampling was applied to enroll 400 objects from each commune and a structured
questionnairewasusedtocollectdataovertwoweeks(fromMondaytillSunday).
Result: Most of respondents satisfied with many aspects of health care services (the proportions of
satisfactionwereover60%).However,someaspectsincludingnursesinstructionmanner,drugprescriptions,
andmedicalequipmentshadalowlevelofpatientssatisfaction(58%,51%,and47%,respectively).Therewere
nostatisticalsignificantassociationsbetweenoverallpatientssatisfactionandotherpatientscharacteristics(p>
0.05).
Conclusion: The findings showed that commune health centers needed to make some improvements to
improve the quality of health care services. Nurses and other medical staff should be continuing trained of
communicationskills.Thedrugdescriptionsshouldbemodifiedtohavemoredrugsandmorehighqualitydrugs
tomeetthediverseneedsofpatients.Moreover,medicalequipmentsshouldbeupgradedornewlyboughttoserve
patientsbetter.Finally,thecommunehealthcentersshoulddevelopflexibleandappropriatepoliciestosupport
poorpatientsandpatientswithouthealthinsurance.
Keywords:patientssatisfaction,communehealthcanters,communicationskills.
, vn y c cng phi c ch trng,
TVN
nhng hnh ng, vic lm tiu cc ca nhn
Khmchabnhlmttrongnhngnhim
vin y t s nh hng rt ln n vn gn
vquantrngivihthngytvTrmyt
gi o c, phm cht ca ngi thy thuc,
lniutintipnhnbnhnhn,ltuync
docncbinphpkhcphc.Chnhvvy,
s hay tuyn u ca h thng y t. Trm y t
vicolngshilngcabnhnhntr
lunphnucitinllilmvic,nngcao
thnhmttiuchunquantrngnhmcithin
trnh chuyn mn, ng dng khoa hc k
cht lng dch v chm sc ti cc c s y t,
thut cng ngh hin i nhm rt ngn thi
nhtltrmytx.
gianiutr,emlisckhettnhtchobnh
Bn cnh , vn giao tip ca bc s,
nhn.Tuynhinvitnhtrngdnsngycng
iu dng vn cha lm cho ngi bnh hi
tng,bncnhbohimyttnguync
lngvlnguynnhncamitrchc,phin
trinkhai,lmtngnhanhslng ngi dn
h(1,3,8,9). Vy lm th no nng cao k nng
c bo him y t. Ngoi ra, c cu t chc m
giao tip, vn ha cng s cho bc s, iu
hnhkhmchabnhcnnhiubtcp,chnh
dng? (4,5,7) gii quyt vn trn, ngi
schbohimytangtngbchonthin,
nghincutinhnhkhostkinbnhnhn
csvtchtthiuthn,nhnlchnch,nn
vgiaotipcanhnvinyttuyncsnhm
nh hng khng t n nhu cu khm cha
chnchnhccmttnti,phthuyccmttch
bnhvlngtincangidn(2).
cc,toshilngchongibnhnngcao
BYtxcnhyclphmchtttp
chtlngchmscngibnh.
ca ngi lm y t, c biu hin bi lng
ITNGPHNGPHPNGHINCU
tm v trch nhim cao. Trong tnh hnh hin
nay,nhiuvnytquantrngangdinra
Nghin cu s dng thit k ct ngang m
nhvnquticctuyn,yccanhn
t trn i tng l bnh nhn/thn nhn n
vinyt,nhucucangidnnkhmcha
khmiutrt2/2011n3/2011ti2trmyt
bnhtngcao,mchilngbsuygim.Do
x Phc Hu v x Phc Li, huyn Cn
132
ChuynYTCngCng
Giuc,tnhLongAn.
Cmuctnhtheocngthc
n=Z2(1/2)
p(1 p)
d
pcchnl0,5.Vitincyl95%th
Z(1/2)=1,96.chnhxc(saischophp)d=
0,05. Nh vy n = 384. V nghin cu iu tra
trnhaix:1xvngthng1xvngh,nn
tngsmul768lmtrn800.
S dng phng php ly mu phn tng.
Chia huyn Cn Giuc thnh vng thng v
vngh.RtthmngunhinchnraxPhc
Hu thuc vng thng v Phc Li thuc
vngh.Timixchnttcbnhnhnn
khm ti trm y t x trong vng hai tun tr
thbyvchnht.
Phng vn trc tip mt i mt vi i
tngiutrathuthpthngtinbngbcu
hi ng vi cc cu hi c o bng thang
Likert5im.
Lm sch s liu v nhp liu bng phn
mmEpidata3.02.Phntchsliubngphn
mm R 2.13. i vi cc bin s nn s dng
bngphnphitnsut.iviccbinsph
thuc khng tun theo quy lut phn phi
chun s dng php kim Wilcoxon, Kruskal
Walliskhixtmilinquangiashilngv
ccbinsnn.
KTQUVBNLUN
Ccctnhcamunghincu
Bng1:Ccctnhcamunghincu(n=800)
c tnh
Gii
Nam
N
Nhm tui
15 - 30
31 - 45
46 - 60
> 60
Khch th nghin cu
Bnh nhn
Phc
Hu
n (%)
Phc Li
n (%)
Tng
n (%)
135 (34)
265 (66)
147 (37)
253 (63)
282 (35)
518 (65)
41 (10)
151 (38)
142 (35)
66 (17)
81 (20)
112 (28)
109 (27)
98 (25)
122 (15)
262 (33)
251 (31)
165 (21)
350 (88)
338 (84,5) 684 (86)
ChuynYTCngCng
Thn nhn
Ngh nghip
Cng nhn/doanh nghip
Cng nhn vin chc
Nng dn/lao ng t do
Ni tr/ngh hu
Hc sinh /sinh vin
Trnh hc vn
M ch
Tiu hc
Trung hc c s
THPT
Trn THPT
Tnh trng hn nhn
Cha lp gia nh
Lp gia nh
Ly hn/ga
Bo him y t
C th bo him y t
T chi tr
Tnh trng kinh t
Kh
sng
Ngho
NghincuYhc
50 (12)
62 (15,5)
116 (14)
35 (9)
32 (8)
264 (66)
67 (17)
2 (1)
80 (20)
7 (2)
148 (37)
148 (37)
17 (4)
115 (14)
39 (5)
412 (52)
215 (27)
19 (2)
12 (3)
142 (36)
157 (39)
72 (18)
17 (4)
53 (13)
176 (44)
133 (33)
30 (8)
8 (2)
64 (8)
317 (40)
289 (36)
102 (13)
25 (3)
15 (4)
361 (90)
23 (6)
26 (6,5)
348 (87)
26 (6,5)
42 (5)
708 (88)
50 (6)
215 (54)
185 (46)
48 (12)
321 (80)
31 (8)
290 (72,5) 505 (63)

110 (27,5) 295 (37)
23 (6)
268 (67)
109 (27)
71 (9)
589 (74)
140 (18)
Ktqunghincuchothyasitng
ln(65%).tuichimnhiunhtlt3160
tui (64%). Ti c hai x t l bnh nhn/thn
nhnlnngdnukhcao(PhcHu:66%;
PhcLi:37%).Vtrnhhcvn,xPhc
LictlmchcaohnxPhcHu(13%
so vi 3%). L do chnh l do Phc Li nm
trongvng su,cch1consngln,ilikh
khn, li l vng thiu in, nc sinh hot, v
vyviccihclmtkhkhncangi
dnthucmilatuitiPhcLi.
Tlchacbohimytcachaixcn
cao ln n 37%. iu ny t nhiu nh hng
n kt qu khm, iu tr bnh, v nhn thc
thi ca ngi dn. y cng chnh l hn
chcavictrinkhaichnhschytcngcng
cho ngi dn ti huyn Cn Giuc. T l h
nghocachaixcngcaolnn18%trong
Phc Li c t l h ngho ln n 27%.
iunydnnvictipcnviccchmsc
sc khe ca ngi dn s kh khn. Do
huynCnGiuccncchiphhtrchobnh
nhn qua chnh sch bo him y t, hay cc
133
NghincuYhc
chngtrnhytkhccaqucgia.
Mc hi lng ca bnh nhn v thn

nhnnkhmviutrtiTrmyt
Bng2:Mchilngcabnhnhnvthn
nhnnkhmviutrtiTrmyt(n=800)
Yu t
Phc Phc
Li
Hu
n (%) n (%)
Tng
n (%)
Hi lng v giao tip

T vn/ tham vn sc khe ca
321 (80) 261 (65) 582 (73)
Bc s
Hng dn/chm sc ca iu
257 (64) 237 (59) 494 (62)
dng/h sinh
Hi lng v quan h
Quan h thy thuc bnh
322 (81) 261 (65) 583 (73)
nhn
Thi ca bc s
344 (86) 187 (47) 531 (66)
Thi ca iu dng/N h
226 (57) 240 (60) 466 (58)
sinh/dc s
Hi lng v chuyn mn
Cht lng cch hi bnh/khm
265 (66) 329 (82) 594 (74)
bnh
Hi lng vi toa thuc iu tr 192 (48) 212 (53) 404 (51)
Hi lng v c s nh trm
Trang thit b y t
184 (46) 190 (48) 374 (47)
Nh v sinh/ khu vc v sinh
320 (80) 261 (65) 581 (73)
ca trm y t
Hi lng v qui ch
Gi gic lm vic ca nhn vin
221 (55) 263 (66) 484 (61)
y t
Thi gian ch khm bnh, hay
289 (72) 339 (85) 628 (79)
ch nhn thuc
Hi lng v chi ph
317 (79) 261 (65) 578 (72)
Mchilngchungcachaixivi
knnggiaotipcabcsviudnglkh
cao(73%v62%).Tuynhin vn cn trn 30%
itngkhnghilngvistvncabc
s hay hng dn/chm sc ca iu dng,
iu ny cho thy cn nghin cu su hn
tmhiuccvnlinquannknnggiao
tipcabcsviudng.
Vmiquanhgianhnvinytvbnh
nhn, t l bnh nhn hi lng vi thi ca
bcscaohnsovithicaiudng/n
h sinh (68% so vi 58%). T l bnh nhn
khnghilngviiudngcthxutpht
tvicbnhnhnbiudngthiutntrng
doiukinkinhtkm.
134
C 26% bnh nhn khng hi lng v cch

hibnhcabcs/nhnvinyt.Skhnghi
lng ny l do k nng hi cng nh cch hi
cabcskhngthhincsquantmca
mnhivinhucuvnguynvngchmsc,
khmviutrcabnhnhn.Vshilng
vitoathuc,cn49%itngkhnghi
lng vi toa thuc. l do toa thuc thanh
quyt ton cho bo him y t cha p ng
cnhucuiutrthctticccs,nhiu
loithucthngdngctcdngtt,girli
khngctrongdanhmcny.
T l hi lng vi trang thit b y t ch c
47%, trong khi t l bnh nhn cho l bnh
thng chim 43%. iu ny cho thy ngi
dn ti hai x c l t quan tm n my mc,
trangthitbythochkhngbitnhgiv
trangthitbyttitrmnhthnoltt,y
.Tlkhnghilngvinhvsinhtitrm
y t x l 10%. iu ny l do khun vin ca
trm nh, quy m u t thp do hn ch
nhiuviukinvsinh.Khikhost2trm
y t, khng thy c nhn vin v sinh, hu ht
iudngphiphtrchvsinh.Ktquny
thp hn trong nghin cu ca L N Thanh
Uyn,TrngPhiHngvnghincucaTrn
NgcHu,LCngMinh.(6,10)
Tlhilngvithigianchkhm,nhn
thucl79%,trongkhitlkhnghilngch
c7,8%.iunylgiildotrmytlng
bnhnhnnkhmtnncththigianch
i c rt ngn, v thi gian lm vic ca
trmytsm(trc7gisng),nnbnhnhn
tphichinhticcbnhvin.Chc61%
bnh nhn hi lng vi gi gic lm vic ca
nhnvin.Nguynnhncthldotrmyt
x, s lng bc s t nhng phi m ng
nhiucngvic,dobnhnhnmkhmc
thkhnggpcbcs.
T l hi lng v chi ph ch c 72%, trong
khi c 10% khng hi lng v chi ph. 10%
i tng khng hi lng c th nm trong s
36% i tng khng c bo him y t. Nh
vy,cncmtchnhschhplvchiphcho
ChuynYTCngCng
nhngngidnchacbohimyt.
Bng4:Milinhgiamchilngcabnh
nhn/thnnhnviccctnhmu(n=800)
Bng3:Sosnhccmchilngcabnh
nhn/thnnhncatrmytxPhcHuv
PhcLi
Yu t hi lng
Ph Ph
c Hu c Li
(TB) (TB)
Hi lng v giao tip

T vn/ tham vn sc khe ca Bc
0,58
s
Hng dn/chm sc ca iu
0,77
dng/h sinh
0,86
<0,00
1
0,53
0,04
1,08
0,9
0,9
0,4
0,003
<0,00
1
0,66
0,61
Hi lng v quan h
Quan h thy thuc/bnh nhn
Thi ca bc s
Thi ca iu dng/n h
sinh/dc s
0,6
Hi lng v chuyn mn:

Cht lng cch hi bnh/khm
bnh
Hi lng vi toa thuc iu tr
0,87
0,99
0,01
0,28
0,23
0,08
0,31
0,54 0,003
1,07
0,89 0,007
0,95
1,06
0,66
1,03
0,71 0,007
0,88
0,1
Hi lng v c s vt cht trm y t

Trang thit b y t
Nh v sinh/ khu vc v sinh ca
trm y t
Hi lng v qui ch
Thi gian ch khm bnh, hay ch
nhn thuc
Gi gic lm vic ca nhn vin y t
Hi lng v chi ph
0,01
Kt qu cho thy c 9 yu t hi lng gia

Phc Hu v Phc Li c s khc bit c
nghathngk(p<0,05).Trong9yutnyth
6yuthilngPhcLicaohnPhc
Hu bao gm: t vn ca bc s, cht lng
khm bnh, trang thit b, thi gian ch khm
bnh,gigiclmviccanhnvin.iuny
ldotrmytxPhcLiluncnhnvin
trctthhainchnht.Bncnhtrmy
tthngmcatrtsmkhmchobnh
nhn.iunydnnnhnvincnhiuthi
giandnhchobnhnhnnnchtlngtvn,
khm v cha bnh ca Phc Li cao hn
PhcHu.
Milinhgiamchilngcabnh
nhn/thnnhnvimtsctnhmu
ChuynYTCngCng
NghincuYhc
Gii
Nam
N
Nhm tui
15 - 30
31 - 45
46 - 60
> 60
Khch th
Bnh nhn
Thn nhn
Ngh nghip
Cng nhn/doanh nghip
Cng nhn vin chc
Nng dn/lao ng t do
Ni tr/ngh hu/
Hc sinh/sinh vin
Hc vn
M ch
Tiu hc
Trung hc c s
THPT
Cao ng, i hc
Bo him y t
C
Khng
Tnh trng hn nhn
Cha lp gia nh
Lp gia nh
Ly hn/ga
Kinh t
Kh
sng
Ngho
Mc hi
lng trung
bnh
282
518
9,4
9,5
122
262
251
164
10,4
9,2
8,9
10,1
684
110
9,5
8,8
115
39
412
215
19
8,8
10,4
9,2
10,1
10,8
65
318
290
102
25
10,2
9,7
9,3
9,1
7,8
504
295
9,2
10,0
42
708
49
10,0
9,4
9,3
71
589
140
9,5
9,2
10,3
0,4
0,11**
0,4
0,1**
0,3**
0,19
0,4**
0,13**
Kim nh phi tham s wilcoxon, kim nh

KruskalWallis
Kt qu nghin cu cho thy gia s hi
lngchungivitrmytvccctnhmu
cachaixkhngcmilinquancngha
thng(p>0,05).iunycththyrngmc
hi lng hay khng hi lng khng ph
thuc nhiu nhm tui, nhm ngh nghip,
tnh trng hn nhn, c bo him y t hay
khng. Hay ni cch khc bnh nhn hi lng
135
NghincuYhc
haykhngtythucvoyuttnhnviny
t,ccquinhbtbuccatrmytxhnl
cmnhnchquancabnhnhn.
Ngoiranghincucngkhostmilin
quangiashilngchungcaringtngx
viccctnhcamu.Ktqucngchothy
khngcmilinquancnghathngk(p>
0,05).
KTLUN
Nghin cu kho st mc hi lng ca
bnhnhn/thnnhntitrmythaixPhc
Hu v Phc Li ti huyn Cn Giuc, tnh
Long An v 6 kha cnh: hi lng v giao tip
ca nhn vin y t trm, hi lng v quan h
thythucbnhnhn,hilngvchuynmn
nhnvinyt,hilngvtrangthitbyt,hi
lngvquich,hilngvchiphiutr.Bnh
nhn/thnnhnashilngvicckhacnh
titrmyt(>60%).Tuynhinmtskhacnh
vn c t l hi lng thp v/hoc khng hi
lng cn cao bao gm: hng dn ca iu
dng(hilng:58%;khnghilng:23%),toa
thuc (hi lng: 51%, khng hi lng: 22%),
trang thit b (hi lng: 47%, khng hi lng:
12%).Nghincucngkho st mi lin quan
giashilngchungvccctnhcamu
nhtui,gii,nghnghip,bohimyt.Tuy
nhinktqunghincuchothykhngcmi
lin quan gia cc yu t ny v mc hi
lng ca bnh nhn/thn nhn n khm v
iutrtihaitrmytxPhcHuvPhc
Li.
trm.Cctrmcnthayi,iuchnhvquy
ch, quy trnh lm vic. Ngoi ra, cc trm cn
utthmvtrangthitbyt,nngcpkhu
vcvsinhcatrmyt,tuynthmhl
v sinh khu vc ny. i vi thi ca iu
dng, cc trng trm cn ch trng o to,
bidngvthi,hnhvi.Vchiphkhm
viutrtitrm,cntngphbohimy
txPhcLi,thmvophicccchnh
sch h tr kinh ph cho bnh nhn ngho i
kmviphdchvkhmviutrhpl.V
toa thuc, cc trm cn nng cao cht lng
thuc,slngthuctrongtoasaochophhp
hn vi bnh nhn bng cch iu chnh li
danhmcthucthityutitrmyt.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
8.
9.
KINNGH
Ktqunghincuscdnglmcs
t trm y t ca hai x Phc Hu v
PhcLiaramtsiuchnhtrongcng
tc nhm nng cao cht lng dch v y t ti
10.
BTT(2001).Quytnhvchgiaotiptrongcccs
khm,chabnh.
B Y T (2009). Chng trnh s 527/CTrBYT v nng cao
chtlngkhm,chabnhticccskhmchabnhv
mctiupngshilngcangibnhbohimyt.
HngNgc.(2000)Thythucvbnhnhn.NXBTng
HpTp.HCM.5861.
H Vn Hin (1999). Quan h bc s v bnh nhn.
http://www.advite.com/bshien.htm
LHongSn(2010).Ccmchilngcabnhnhnni
trtibnhvinYhcDnTc.LunvnchuynKhoaII.
ihcYDcTp.HChMinh.
L N Thanh Uyn, Trng Phi Hng (2005). Mc hi
lng ca bnh nhn v dch v y t ti bnh vin Bn Lc
huynBnLctnhLongAn,thng5nm2005.TpchY
HcTP.HChMinh,10,(1),4347.
LThnhNi(2010).Mchilngcabnhnhnnitr
v dch v y t ti BV. Ch Ry. Lun vn chuyn Khoa II.
ihcYDcTp.HChMinh
L Thu Hoa, ng Th Kim Lan, Hong S Qunh, (2006).
K nng giao tip ca iu dng ti Bnh vin a khoa
BnhDng.
PhngLuQuang,PhngLin.(2008)Nhngiucnbit
v ngh thut khm cha bnh dnh cho bc s v bnh
nhn.NXBYHcTP.HChMinh,2425.
TrnNgcHu,LCngMinh(2006).nhgishilng
ca ngi bnh ti 3 bnh vin tnh Long An Nm 2005.
TpchYhcTp.HChMinh,10,(4),1216.
136
ChuynYTCngCng
NghincuYhc
STUNTHPHCVCXINDPHNGBNHDI
SAUPHINHIMTITHXSAC,NGTHP
PhngMinhTr ,NguynKimThy*
TMTT
tvn:Bnhdilmtbnhvimnocplytruyntngvtsangngivhunhlungyt
vong,dodphngsauphinhim(PEP)lrtquantrng.Khnghonttphcvcxinlmtnguyn
nhngythtbitrongvicphngbnhdi.
Mctiu:XcnhtlbnhnhniutrPEPhonttphcvcxin,smitimtrungbnhthc
hintheotngphcvccyutlinquannvichonttccphchinhnh.
Phngphpnghincu:Nghincuctngangmt.Mugm9519bnhnhniutrPEPtrong2
nm20102011bng3phc:phctimbp5mi(TB5)phctimtrongda5mi(TTD5)phctim
trongda4mi(TTD4).
Ktqu:Tlhonttphcchungl60,64%.Tlbnhnhnhonttphcvcxinphngdisau
phinhimcatngphcTB5,TTD5vTTD4lnltl61,98%,48,50%v66,47%.Vicbaphc,s
mitimtrungbnhmibnhnhnthchinl3,75mi.Tlhonthnh3mitimtrlntnhchungl
83,32%.Yutlmtngkhnnghonttphchinhnh(TB5vTTD4)lbnhnhnn,nhmtui<15.
Yutnguyckhnghonttphclbnhnhncngtrongthxvbnhnhnsdngphctim
bp.
Kt lunTlhonttphcPEPtrongnghincunycnthphncckhostmtsnc.S
dngphctimtrongdagiptngtlhonttphcphngdi.
Tkha:Bnhdi,dphngsauphinhim,PEP,tunth
ABSTRACT
PATIENTCOMPLIANCEWITHRABIESVACCINATIONREGIMENSFORPOSTEXPOSURE
PROPHYLAXISINSADECTOWN,DONGTHAP.
PhungMinhTri,NguyenKimThuy
Background:Rabiesisaviralzoonosisthatcausesacuteencephalitisinhumansandalmostinvariablyfatal.
Hence, postexposure prophylaxis (PEP) is extremely important to prevent the disease. Failure to complete
prophylaxisvaccinationregimensmayresultindeath.
Objectives:Todeterminetheratesofpatientswhocompleterabiesprophylaxisvaccinationregimens,the
meaninjectionsperpatientofeachregimenandsomerelatedfactorsofcompletingcurrentregimensinSaDec
town,DongThap.
Methods: Descriptive, crosssectional method was used. Data included total of 9,519 patients treated by
three PEP regimens: 5dose intramuscular (5dose IM), Thai Red Cross intradermal (TRCID) or 2site
intradermal(2siteID)during20102011.
Result: The PEP vaccination regimen completion was 60.64%. With 5dose IM, TRCID and 2site ID
regimens,therateswere61.98%,48.50%and66.47%respectively.Themeaninjectionsperpatientwas3.75.
TrungtmytTXSac,ngThp
Tcgilinlc:Bs.PhngMinhTr
ChuynYTCngCng
T:0673861339
Email:bs_phmtri@yahoo.com
137
NghincuYhc
Onaggregate,83.32%ofpatientstookthreeormoreinjections.Withtwocurrentregimens(5doseIM,2site
ID), the dependent risk factors of not completing the vaccination regimen included local patients and
intramuscularregimen. The dependent protective factors of completing the regimens were female patients and
under15patients.
Conclusion:Theratesofvaccinationregimencompletioninthissurveywaslowerthanthatofcompletion
inothers.Usingtheintradermalpostexposureprophylaxisregimenmayincreasecompletionrate.
Keywords:Rabies,postexposureprophylaxis,PEP,compliance
hng n hiu qu iu tr d phng bnh
TVN
dibngvcxinlvictunthccphc.
Bnh di l mt bnh vim no cp, do vi
Vic tun th ny chu nh hng tng hp
rt di (RABV), mt vi rt thuc ging
canhiuyutnh:sthuntinili,chi
Lyssavirus,hRhabdoviridaegyra.ylmt
phthuc,tvncangichnhvnhiu
bnh ly truyn t ng vt sang ngi, ch
yutkhngthdonkhc,nhngrrng
yu qua vt cn hay vt co ca con vt b
cvaitrquantrngtrongiutrdphng,
nhim(aslchnh)trndahaynimmc
vkhnghonttphclmttrongnhng
nn nhn. Thi gian bnh thng t 13
nguyn nhn tht bi trong vic phng bnh
thng, tuy nhin c th t 2 tun n hn 1
di(9,10).Mcdcnhiunghincuchng
nm, ty vo nhiu yu t v khi c triu
minh hiu qu cng nh an ton ca vc
chnglmsng,hunh100%cabnhut
xindi(1,3,8),tuynhin,chacnghincuno
vong.Dovy,khcviccnhimtrngkhc,
trong nc v vic tun th lch tim ca cc
bnhdicnthitphngngavcthphng
phc iu tr PEP vi vc xin di th h
nga bng cch iu tr vt thng v tim
mi,cthdokhkhntrongvictheodiv
phngkpthisaukhiphinhim(10),gild
cp nht d liu bnh nhn khi phc ko
phng sau phi nhim (postexposure
di.Mtnghincu ti H Tnh nm 1993 c
prophylaxisPEP)haynhnhiutcgigil
8660 ngi tim phng di vi vc xin m
iu tr sau phi nhim (postexposure
thn kinh trc y (Fuenzalida), c lng
treatmentPET)(5,7).TheoTchcYtthgii
c 80% cc trng hp tim 68 mi, v
(WHO),tichuvchuPhihinnay,PEP
20% tim 4 mi tr xung. Cng trong nm
ctnhngnngac272000catvongdo
, c 14 ca t vong do di H Tnh, tt c
bnhdiminm(5).
ukhngctimvcxin(6).
nvtimphngTrungtmytthxSa
Dtnm2009nht2011khngcca
c cung cp dch v iu tr PEP khng ch
tvongdobnhdinotithxSac,vic
cho bnh nhn c ng trn a bn, m cn
nhgistunthphciu tr PEP v
cho bnh nhn ca nhiu huyn ln cn v
ccyutlinquanvnlcnthit.Nhng
mttbnhnhnvnglaitcctnhkhc.T
dngcsdliumytnhlutr,qun
u nm 2008, n v loi b hn vc xin
l bnh nhn iu tr d phng bnh di t
ditmthnkinhchuynhontonsangs
nm2009,chngtithchintinynhm
dngvcxinthhmiphhpvikhuyn
csliucbnvstunthccphcd
cocaWHO(9).Chonthng3/2012,vcxin
phng bnh di sau phi nhim bng vc xin
duy nht chng ti s dng l Verorab
(nghin cu ny gi l PEP hay TDPSPN),
(SanofiPasteur,Php),mtloivcxintbo
gip nng cao hiu qu chng trnh phng
Verotinhch,vtrong2nm20102011c
chngbnhdinichungvhiuqutvn
9820trnghpiutrPEPvivcxinny.
timphngdiniring.
Mt trong nhng yu t quan trng nh
138
Mctiunghincu
ChuynYTCngCng
XcnhtlbnhnhniutrTDPSPN
honttphc.
Xc nh s mi tim trung bnh thc
hintheotngphc.
Khostccyutlinquannvictun
thccphchinhnh.
ITNGPHNGPHPNGHINCU
Vithitkmtctngang,chngtic
tnh c mu da trn t l hon tt phc
50%, sai s 2% c kt qu n=2500 bnh
nhn. kho st y phc , chng ti
ly s liu bnh nhn TDPSPN trong thi
giantrn2nm,tthng1/2010nhtthng
12/2011.Trongthigianny,ttcbnhnhn
cha tim vcxin di trc y u c ch
nhmttrongbaphc:
Phc tim bp 5 mi (TB5), cn gi l
phc5liu(5doseIM)voccngy0,3,7,
14v28,mingy1liu0,5mL.
Phc tim trong da 5 mi (TTD5), cn
gi l phc Hi Ch thp Thi Lan
(TRCID)voccngy0,3,7,28v90,bangy
u mi ngy 2 liu 0,1mL 2 v tr, 2 ngy
saumingy1liu0,1mL.
Phc tim trong da 4 mi (TTD4), cn
gilphc2vtr(2siteID)voccngy
0,3,7v28,mingy2liu0,1mL2v tr.
Phc ny thay th hon ton cho phc
TTD5tthng11/2010.
Tt c bnh nhn TDPSPN bng 3 phc
ktrncthunhntrongthigianny
vctimtnhtmtmivcxinua
vonghincu.Nhvy,bnhnhncch
nh phc khc hoc bnh nhn ch dng
huytthanhkhngdimkhngdngvcxin
s khng a vo nghin cu ny. Trong
nghincuny,chngtinhnghamtmi
timhaymtngytimlkhibnhnhnn
vctim1hay2liuvcxintytheophc
.Viclachnphctuthucvo:tui,
ca,thigiantrhonsauphinhim,tnh
trngvtthngtheohngdncanhsn
xut km theo sn phm v hng dn ca
ChuynYTCngCng
NghincuYhc
WHO(9).
Cng vi 3 phc trn, chng ti chia
theo nhm nh gi s tun th: nhm
tim bp (TB5) so vi nhm tim trong da
(TTD4 hay TTD5), nhm 4 mi (TTD4) so vi
nhm 5 mi (TB5 hay TTD5), nhm 28 ngy
(TB5hayTTD4)sovinhm90ngy(TTD5).
DliucattcbnhnhnTDPSPNt
2009nnayucnhpvomtcsd
liu do chng ti t thit k bng MS Visual
Foxpro 9.0 lu tr, qun l, cp nht sau
mimitim(tcmingytim).Sliuca
nghin cu ny c lc ra t c s d liu
trnvchuynixlbngchngtrnh
Stata/SE10.0forWindows.
KTQUVBNLUN
cimmu
Tng s bnh nhn TDPSPN tiu
chun trong nghin cu ny l 9519 ngi,
trongsbnhnhnciutrbngcc
phc TB5, TTD5, TTD4 ln lt l 3035,
2332 v 4152 ngi, tng ng vi t l ln
lt l 31,88%, 24,50% v 43,62%. Cc c
imkhccamuctrnhbytrongbng
1vbng2.
Bng1:Phnbcimdchttheophc
N
Nam (%)
N (%)
Tui <15 (%)
Tui >=15
(%)
BN trong th
x (%)
BN ngoi th
x (%)
Ch cn (%)
Sc vt khc
(%)
VT nng (%)
VT khng
Phc
TB5
1695
(55,85)
1340
(44,15)
1801
(49,34)
1234
(40,66)
1092
(35,98)
1943
(64,02)
2500
(82,37)
535
(17,63)
511
(16,84)
2524
TTD5
1147
(49,19)
1185
(50,81)
689
(29,55)
1643
(70,45)
1012
(43,40)
1320
(56,60)
1904
(81,65)
428
(18,35)
TTD4
2008
(48,36)
2114
(51,64)
1253
(30,18)
2889
(69,82)
1721
(41,45)
2431
(58,55)
3335
(80,32)
817
(19,68)
Chung
4850
(50,95)
4669
(49,05)
3743
(39,32)
5776
(60,68)
3825
(40,18)
5694
(59,82)
7739
(81,30)
1780
(18,70)
522
7 (0,30) 4 (0,10)
(5,48)
2325
4148
8995
p(2)
0,000
0,000
0,000
0,079
0,000
139
NghincuYhc
N
Phc
TB5
TTD5
nng (%) (83,16) (99,70)
C tim HT 311
2 (0,09)
(%)
(10,25)
Khng tim 2724
2330
HT (%)
(89,75) (99,91)
p(2)
Chung
TTD4
(99,90) (94,52)
316
3 (0,07)
(3,32)
4149
9203
(99,93) (96,68)
0,000
(BN:bnhnhn;VT:vtthng;HT:huytthanhkhng
di)
S bnh nhn trong nghin cu cha th

hin s vt tri v gii tnh, nhng r rng,
nhm di 15 tui chim t l cao (39,32%).
iunyphhpvinhnnhcaKnobel(5)
v WHO v tnh hnh phi nhim ti chu
vchuPhi(10),theo,khong40%sPEPl
trem514tui.Mtnghincutincho
thy:trong916trnghpphinhim,cn
68%lnamgii,91,5%ldochcn(7),chait
l ny u khc bit rt c ngha thng k
vinghincucachngti(p=0,0000).
D sc vt cn khng lin quan n vic
ch nh phc ti n v ca chng ti,
nhng do thi quen ch nh theo hng dn
ca nh sn xut, bnh nhn c vt thng
nngthngciutrphcTB5(cng
vi s dng huyt thanh khng di), nn t
bnh nhn c vt thng nng hoc c dng
huyt thanh iu tr bng phc tim trong
da.Khuynco2010 ca WHO, phc tim
trongdacsdngchottc cc mc
nng nh ca vt thng, v nh vy, thi
quen ch nh ny nn c thay i. Tuy
nhin, s dng huyt thanh cho vt thng
nngvnlkhuyncoquantrngcaWHO
trong PEP(10).T l s dng huyt thanh trong
nghincunyl3,32%sovinghincuti
n l 2,1% trong s 439 ca PEP(7) v cng
rt khc bit vi t l ti H Tnh l 16,41%
trongs8660bnhnhnTDPSPN(6).
Bng2:Thngkmtccctnhmu(n=9519)
Sngytrhon:tngyphinhimnngytim
mivcxinutin
Bin s
Trung bnh
Tui (nm)
S ngy tr hon
28,35
1,48
140
lch
chun
21,52
1,90
Min Max
1
0
99
26
(ngy)
i vi bnh di, vic tr hon TDPSPN

cthdntinguyctvongvkhivirtdi
xmnhpdythnkinhngoibin,hiuqu
TDPSPN s hn ch(4,11). Tuy nhin, cha c
tiliunochothysngytrhontia
bo m hiu qu TDPSPN, c l do thi
gian bnh rt dao ng v tnh nguy him
cabnhihiiutrdphngbtckhi
nocth.Vvy,sngytrhontrungbnh
l 1,48 ngy ca nghin cu ny cng cha
thtscngha,dsao,bngphntchbch
phn v ng vi s ngy tr hon cho ta ci
nhn c th hn: trong s bnh nhn c tim
vcxin,chc21%bnhnhncdngliu
vc xin u tin ngay trong ngy b phi
nhim,v94%lctimtrong5ngyu
(bng3).
Bng3:Bchphnvtheosngytrhontrckhi
timvcxin(n=9519)
S ngy
Phn v
0
21
1
72
2
85
3
92
4
94
5
96
Tlbnhnhnhonttphc
Theotngphcvtngnhmphc,
chng ti c t l hon tt phc (tim
mi)trnhbytrongbng4.
Bng4:TlhonttphcTDPSPN
Phc
mi (%)
TB5 (n=3035)
TTD5 (n=2332)
TTD4 (n=4152)
Phc tim bp
Phc tim trong
da
Phc 5 mi
Phc 4 mi
Phc 28 ngy
Phc 90 ngy
Chung
61,98
48,50
66,47
61,98
60,01
56,12
66,47
64,57
48,50
60,64
Khng mi
2
p( )
(%)
38,02
0,000
51,50
33,53
38,02
0,067
39,99
43,88
33,53
35,43
51,50
39,36
0,000
0,000
T l hon tt khc nhau c ngha thng

k gia cc phc , c th do c im ca
phc:TTD5cmicuicchxasovimi
trc,TB5cchiphmimicaohnvc5
ln tim, cn TTD4 c nhiu u im: gi
thnh thp, t ln i tim, ngn ngy. T l
ChuynYTCngCng
NghincuYhc
hon tt cng khc nhau c ngha thng k

gia cc nhm phc , ngoi tr gia nhm
timbpvtimtrongda(p=0,067),vphc
tim trong da bao gm mt phc c t l
hon tt cao hn hn (TTD4) v mt phc
c t l thp hn hn (TTD5). Nu ch xt hai
phchinhnhlTB5vTTD4,tlhon
ttchungsl4641/7187,tc64,57%.
bnh mi tim: Knobel c tnh s mi tim

trungbnhl3miviphcTB5(thayv5
mi)vcng3miviphcTTD5(thayv
5 mi) c tnh gnh nng chi ph ca
PEP(5). Nu s dng kt qu ca nghin cu
ny,chiphctnhscnhiuthayi.Chi
tit t l theo tng s mi tim c trnh
bytrongbng6.
t c d liu kho st v t l hon tt cc

phc . Mt nghin cu n (7) vi 439
bnhnhndngphcTB5chothy,chc
42,7% l hon tt phc ( 5 mi). Hai s
liukhcchacngbchothytiNewYork
(M), t l hon tt phc TB5 l 87% trong
s 1132 bnh nhn; ti Puerto Rico, t l hon
tt phc TB5 l 84% trong s 191 bnh
nhn(2).TtcukhcbitsoviphcTB5
trongnghincuny(61,98%).
Bng6:TlbnhnhnTDPSPNtheosmi
timvphc
im yu ca nghin cu ny l sai st
trongqutrnhcpnhtmitim.Nudtr
thiuht10%dokhngcpnhtmicui
cnglnmytnh,tlhontt2phchin
hnh c lng c th t 71,03%, t l hon
ttphcTTD4clngt73,12%vtl
hon tt phc TB5 c lng thc t t
68,18%, vn thp hn so vi New York v
Puerto Rico. C th cc khc bit l do iu
kinkinhttunthphc,mtldo
WHO khuyn co nn dng phc tim
trongdaticcncangphttrin(10).
Vsmivcxintim
Bng5:Smitimtrungbnhtheotngphc
(nv:mi)
Phc
TB5
TTD5
TTD4
Chung
3035
2332
4152
9519
Trung
bnh
4,08
3,88
3,44
3,75
lch
p
Min Max
chun
(ANOVA)
1,41
1
5
0,0000
1,35
1
5
0,93
1
4
1,24
1
5
Cng nh t l hon tt cc phc , s

khcbitcasmitimtrungbnhldoc
imcaphc.nghacaccgitrtrung
bnh trong bng 5 l n cho ta c s tnh
tonchiphcaTDPSPNtrndinrng.Cc
tcgitrcythngphngonstrung
ChuynYTCngCng
Phc S liu
TB5
TTD5
TTD4
1
n
352
T l (%) 11,59
n
224
T l (%) 9,61
n
328
T l (%) 7,90
S mi tim
Cng
2
3
4
5
199 197 406 1881 3035
6,56 6,49 13,38 61,98 100
194 352 431 1131 2332
8,32 15,09 18,48 48,50 100
4152
291 773 2760
7,01 18,62 66,47
100
Trong tng lai, phc TB5 c th s

cthaythbiphctimbp4mi(b
mi tim sau cng ngy 28), theo khuyn co
mi nht(2,10). Phc mi ny (TB4) s rt
ngnchiphvthigian,do,tlhontt
s cao hn. Da trn bng 6, ta c th c
lng t l hon tt ca phc TB4 s l
13,38%+61,98%= 75,36% (thay v ch 61,98%
nh hin nay), s tr thnh phc c t l
hon tt cao nht, vt tri so vi phc
TTD4hinnay,dchiphvncaohn.
Tlhonthnht3mitimtrln
gimthiunhhngcayutkhc
bit v thi gian hon tt v s mi ca tng
phcPEPvcphctrongnghincu
nyuc3miutinvoccngy0,3,7
chng ti tnh t l bnh nhn hon tt t 3
mitrlnchotngphcnhtrongbng
7.
Bng7:Sliutim>=3mitheophc
Tim <3 mi
Tim >=3
mi
n
%
n
%
TB5
551
18,15
2484
81,85
Phc
TTD5
418
17,92
1914
82,08
Chung p(2)
TTD4
619
1588
14,91 16,68
0,000
3533 7931
85,09 83,32
Mtnhnxtl:chodloitrskhc
141
NghincuYhc
nhauvsmivthigiancaccphc,t
lhontt3mivnkhcbitrtcngha
thngk(p=0,000).Nhvy,khngchcthi
gianhaysmitimnhhngnvichon
ttccphcPEP.
Nhiutiliuchothy,vivcxinphng
di th h mi, nng khng th trung ha
virtdistmcbovvongyth14,
tchonthnh3mitimdsdngng
timbphaytrongda(1,3,8,11).ngthi,sko
di nng mc bo v ny li khng ty
thucsmitim(2,11).cnglthiim
c th ngng iu tr PEP nu con vt lin
quancnsng(sau10ngytkhicn)(10).Nh
vy, vic hon thnh 3 mi tim c ngha
quantrngtrongTDPSPNvvickhostt
lhonthnht3mitimtrlnslcs
gip nh gi mc bo v ca vc xin. Nu
nhnnhsliutheoquanimny,sliu
bng7schotatlbovcaccphcc
thtn83,32%,dbnhnhnchontt
phchaykhng.
Ccyutlinquannvichonttphc
hinhnh
PhcTTD5cthigianhonttkodi
nngy90,iunynhhnglnntl
hon tt phc . Hn na, phc ny
khngcnnmtrongkhuyncocaWHOt
nm 2007(9,10), v thc t, chng ti khng
cn s dng t thng 11/2010. V vy, kt
qucnghathcthn,chngtichkho
st cc yu t lin quan n vic hon tt hai
phcangsdnglTB5vTTD4,tngs
ln=7187bnhnhntrongcngthigian.
Cc yu t d on c th lin quan n
vichontthaiphcckhostgm:
n, tui <15, c ng trong th x, sc vt cn,
s ngy tr hon, mc vt thng (loi III
hay category III theo hng dn ca WHO(9)
c xem l vt thng nng). y cng l
nhng yu t hnh chnh, dch t, c khai
thckhilmthtcTDPSPNtinv(bng
8).
Bng8:Tns,tlccyutlinquanhontt
142
phc.
Tn s (%)
Khng hon
Hon tt
tt
N
2303 (33,90) 1181 (66,10)
Gii
Nam
2338 (63,14) 1365 (36,86)
<15
2189 (71,68) 865 (28,32)
Tui
>= 15
2452 (59,33) 1681 (40,67)
Trong th x 1752 (62,28) 1061 (37,72)
C ng
Ngoi th x 2889 (66,05) 1485 (33,95)
Ch
3807 (65,24) 2028 (34,76)
Sc vt cn
Khc
834 (61,69) 518 (38,31)
S ngy tr 0-1 ngy 3334 (64,95) 1799 (35,05)
hon
>1 ngy 1307 (63,63) 747 (36,37)
Nng
340 (66,02) 175 (33,98)
Mc vt
thng Khng nng 4301 (64,46) 2371 (35,54)
TB5
1881 (61,98) 1154 (38,02)
Phc
TTD4
2760 (66,47) 1392 (33,53)
Yu t
Gi tr
p(2)
0,009
0,000
0,001
0,014
0,290
0,477
0,000
Sliubng8chotathycmilinquan
ca5/6yutckhostvivichontt
cc phc (ngoi tr yu t vt thng
nng).Phntchnhlngccmilinquan
nybngOR(bng9)cngchoktqutng
t,tuynhinkhiphntchabinvicngc
hiquilogistic,ktqucthayi:vtthng
nngcnglyutlinquanvivichontt
phc , nhng yu t sc vt cn th khng
lin quan. Nh vy, c s tc ng ln nhau
giaccyut.
Bng9:KtquORccyutlinquanhontt
phc(n=7187)
*CcgitrORcp>0,05
Yu t
Gii n
Tui <15
C ng trong th x
Do ch cn
n tim sau >1
ngy
Vt thng nng
Phc TB5
OR (95%CI)
n bin
a bin
1,14 (1,03-1,25) 1,26 (1,14-1,39)
1,73 (1,57-1,92) 2,06 (1,85-2,30)
0,85 (0,76-0,94) 0,85 (0,77-0,94)
1,17 (1,03-1,32) 1,07 (0,94-1,21)*
0,94 (0,85-1,05)*
0,94 (0,84-1,05)*
1,48 (1,20-1,81)
0,62 (0,56-0,70)
1,07 (0,89-1,29)
0,82 (0,75-0,91)
Chng ti nhn thy: nhm <15 tui c

nguy c b ch cn cao hn nhm >=15 tui
(p=0,000;OR=2,07),nhm<15lithngc
ch nh phc TB5 (p=0,000; OR=3,38).
Nhmbchcncngctlhonttkhng
khc bit vi nhm cn li (p=0,301; 95%CI
ChuynYTCngCng
OR:0,941,21).
TheoktquphntchORccyutnguy
c c lp trn, bnh nhn n c kh nng
hon tt phc bng 1,14 ln bnh nhn
nam,nhmtui<15ckhnnghonttphc
bng 1,97 ln nhm bnh nhn >=15 tui,
bnhnhncngtrongthxlickhnng
honttphcchbng0,85lnbnhnhn
ngoi th x v phc tim bp TB5 c kh
nng hon tt phc ch bng 0,82 ln phc
TTD4.
KTLUN
Qua hi cu 9519 bnh nhn iu tr d
phng bnh di sau phi nhim trong 2 nm
20102011,chngtinhnthy: s bnh nhn
c iu tr bng cc phc TB5, TTD5,
TTD4 ln lt l 3035, 2332 v 4152 ngi,
tngngvit l ln lt l 31,88%, 24,50%
v 43,62%. T l bnh nhn hon tt phc
vcxinphngdisauphinhimlnltca
tng phc l 61,98%, 48,50% v 66,47%. T
l hon tt phc chung ca ba phc l
60,64%. Vi hai phc hin hnh, t l hon
ttchung64,57%.
Vicbaphc,smitimtrungbnh
mi bnh nhn thc hin l 3,75 mi, vi
haiphcangsdnglTB5vTTD4th
mi tim trung bnh mi bnh nhn thc
hin ln lt l 4,08 mi v 3,44 mi. T l
hon thnh 3 mi tim tr ln tnh chung l
83,32%,theohaiphcangsdnglTB5
v TTD4 th t l ny ln lt l 81,85% v
85,59%.
Khost7187bnhnhnsdnghaiphc
hinhnhlTB5vTTD4trongcngthi
gian,chngtinhnthy,nhmbnhnhnn
c kh nng hon tt phc bng 1,14 ln
bnh nhn nam, nhm tui <15 c kh nng
hon tt phc bng 1,97 ln nhm bnh
nhn>=15tui,bnhnhncngtrongthx
NghincuYhc
ckhnnghonttphcchbng0,85ln
bnh nhn ngoi th x v phc tim bp
TB5 c kh nng hon tt phc ch bng
0,82lnphcTTD4.
Vicmrngsdngphctimtrong
da4mi,pdngphctimbp4mimi
cng vi tng cng t vn, nhc nh tim
ng lch, c bit trn i tng c nguy c
khng hon thnh iu tr, s gip tng ng
ktlhonttphctimphngbnhdi.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Briggs
DJ,
Banzhoff
A
et
al
(2000).
Antibodyresponseofpatientsafterpostexposurerabies
vaccination withsmallintradermalosesofpurified chick
embryo cell vaccine or purified Vero cellrabiesvaccine.
BulletinoftheWorldHealthOrganization,78(5):693698.
CDC (2010). Use of a reduced (4dose) vaccine schedule for
postexposure prophylaxis to prevent human rabies.
Morbidityandmortalityweeklyreport,RR2(59):17
inhKimXuyn(2003).Nghincupngkhngthv
an ton ca vacxin di Verorab sn xut ti Php, theo
phngphptimbpvtimtrongdatrnngiVitNam
tnhnguyn.Yhcdphng,6(13):134139.
Jackson AC, Johannsen EC (2008). Rabies and other
Rhabdovirus infections. In: Fauci AS, Braunwald E (eds).
HarrisonsPrincipleofInternalMedicine,Part7,17thed,pp
12221226.McGrawHillCompanies,Inc,eBookedition,New
York.
Knobel DL, Cleaveland S et al (2005). Reevaluating the
burden of rabies in Africa and Asia. Bulletin of the World
HealthOrganization,83(5):360368.
Nguyn Huy Thnh, Thi Hoch (1995). Nhn xt v s
ngi tim phng di v cht v bnh di ti H Tnh nm
1993.Vsinhphngdch,1(5):8487.
SudarshanMK,RahmanSA(2004).Assessingtheburdenof
rabiesinIndia:WHOsponsorednationalmulticentricrabies
survey 2003. http://rabies.org.in/rabiespublications/who
surveyreport.Accessed04/2012:2728.
Sudarshan MK. et al (2005). Assessing the relationship
between antigenicity and immunogenicity of human rabies
vaccines.HumanVaccines,1(5):187190.
WHO(2007).Rabiesvaccines:WHOpositionpaper.Weekly
epidemiologicalrecord,No.49/50:425435.
WHO(2010).Rabiesvaccines:WHOpositionpaper.Weekly
epidemiologicalrecord,No.32:309320.
WHO Immunization, Vaccines and Biologicals (2010).
Immunity to rabies. In: The Immunological Basis for
Immunization Series, Module 17: Rabies, pp 39. World
HealthOrganization,Geneva.
ChuynYTCngCng
143
NghincuYhc
TNHHNHBNHNHNNHPCNHVOVITNAM
QUACCCAKHUTYNINH
TrnPhcon ,LHongSan**
TMTT
Mu:Trongnhngnmgny,trnthgiicngnhccnctrongkhuvc,dchbnhangdin
binphctpvphtsinhngycngnhiuccbnhtruynnhimnguyhimmi.
Mctiu:NghincunhmkhostmhnhbnhtttnhngngiCampuchianhpcnhvoVit
NamkhmviutrquacccakhuTyNinhvxcnhtlbnhcmA(H5N1)vbnhttrn
nhngbnhnhnny.
i tng v phng php nghin cu: Mt nghin cu ct ngang m t c thc hin t thng
9/2009nthng8/2011ticccakhuTyNinh.Ttcbnhnhnnhpcnh,lunnhngtriuchng:
st,ho,khth,tiuchyvcphngvnthngquabcuhithuthpmtsthngtinclinquan
nbnhtt.
Kt qu:Trongtngs1796itngiutra,1503itngmcbnhkhngtruynnhimvchn
thng,chimtl83,7%,trongnibtlchnthngdotainngiaothnghaytainnsinhhot(chim
17,8%),taibinmchmuno(15,6%)v huyt p cao (5,6%). Trong s 55 mu xt nghim t i tng
nghincubtiuchy,c4mudngtnhVibriocholeraeO1,chimtl7,3%(khongtincy95%:0,4%
14,1%).Trongtngs238mulmxtnghimbnhcmtrongnghincuny,ktqudngtnhchim
12,6% (khong tin cy 95%: 8,4% 16,8%), trong dng tnh vi cm A/H3N2 l 24 mu, chim t l
10,1%vdngtnhvicmA(H1N1)idchnm2009l6mu,chimtl2,5%.
Ktlun:Nhmbnhnhpcnhchyulnhmbnhkhngtruynnhim,trongbaloibnhctl
caomccaonhtltainntronggiaothngvtrongsinhhot,taibinmchmunovcaohuytp.ivi
ccbnhtruynnhim,chaphthintrnghpmccmA(H5N1)nhngcabnhcmA(H1N1)idch
nm2009chimtl10,2%trntngsnhmbnhtruynnhimv12,6%trntngscanghicm.Ngoira,
cabnhtchimtl1,4%trntngsnhmbnhtruynnhimv7,3%trntngscatiuchy.
Tkha:bnhtruynnhim,mhnhbnh,cakhu,bnht,bnhcm,kimdchyt,TyNinh
ABSTRACT
SITUTATIONOFPATIENTSENTERINGVIETNAMTHROUGHTAYNINHBODERGATE
TranPhuocDoan,LeHoangSan
Background: For recent years, epidemic diseases have developed in complicated ways and many new
dangerousinfectiousdiseasesappearintheworldaswellasinregionalcountries..
Objectives: To SurveythediseasemodelofpeopleenteringfromCambodiaintoVietnamforexamination
andtreatmentthroughTayNinhbordergatesandtoidentifytheratioofavianinfluenzaA(H5N1)andcholera
overimmigrantpatients.
Methods:AcrosssectionalstudywasconductedfromSeptember2009toAugust2011atTayNinhborder
gates. All immigrant patients, paid special attention to symptoms: fever, cough, dyspnea, cholera, and
TrungtmKimdchYtQuctTyNinh**:VinPasteurTp.HCM
Tcgilinlc:BS.TrnPhcon
T:0913822478
Email:tranphuocdoankd@gmail.com
144
ChuynYTCngCng
NghincuYhc
interviewedthroughaquestionnairetogetinformationrelatedtodiseases..
Result: Among 1796 immigrant patients surveyed, 1503 patients got noncommunicable diseases and
injuries,accountedfor83.7%,ofwhichthreediseasesholdingthehighestratioweretraumaintrafficordomestic
accidents ( 17.8%), cerebrovascular accident (15.6%) and hypertension (5.6%). Among 55 cholera testing
samples from 55 research subjects, there were four samples positive for Vibrio cholerae O1, taking 7.3%
(confidencerange95%:04%14.1%).Among238flutestingsamplesintotal,positiveresultsoccupied12.6%
(confidencerange95%:8.4%16.8%),ofwhich24sampleswerepositiveforA/H3N2fluequalto10.1%and6
samplesarepositiveforA(H1N1)idchnm2009equalto2.5%.
Conclusion:Twomajorgroupsofimmigrantdiseasesareuninfectiousat83.7%andinfectiousat16.3%.
Forinfectiousdiseases,althoughtheresearchhasnotfoundanycasesofA(H5N1)flu,casesofA(H1N1)idch
nm2009flufoundoccupy10.2%overtotalnumberofinfectiousdiseasesand12.6%oversuspectedcasesofflu.
Moreover,casesofcholeraoccupy1.4%overtotalnumberofinfectiousdiseasesand7.3%overcasesofcholera.
Foruninfectiousdiseases,threediseasesholdingthehighestratioaretrafficaccident,domesticaccident(17.8%),
cerebrovascularaccident(15.6%),hypertension(5.6%).
Keywords:infectiousdisease,modelofdisease,bordergate,cholera,flu,healthquarantine,TayNinh
nghipvbunbnnh,chnnuicthhgia
TVN
nh,giascgiacmasthrong,liukin
Trong nhng nm gn y, trn th gii
dch bnh d pht trin. in hnh l bnh
cng nh cc nc trong khu vc, dch bnh
cm A (H5N1) xy ra trong nm 2007 vi 01
angdinbinphctpvphtsinhngycng
trng hp t vong ti huyn Mmt tnh
nhiu cc bnh truyn nhim nguy him mi.
Kngpongchm gip vi tnh Ty Ninh. Theo
Ccnghincuchothymttrongnhngbin
thng bo ca B Y t Campuchia ngy
phphuhiunhtphngchngdchbnh
02/12/2008, c 08 trng hp mc cm A
lylanvoVitNamvngcliltngcng
(H5N1)trnngivc07trnghptvong
gimstvxltritdchbnhngaytu.
tiCampuchia(2).
lmciuny,kimdchytticcca
Chnhvvy,cthnhhnhhthng
khu cn hon thnh tt nhim v sng lc
thuthpthngtindbodchbnhvlmc
trongvicbovsckhequcgia.Tuynhin,
s cho vic lp k hoch phng chng dch,
mc d y t ca khu c u t v pht
chngtithchinnghincuTnhhnhbnh
trintrongnhngnmvaqua,nhngchon
nhnnhpcnhvoVitNamquacccakhu
nay ti Ty Ninh vn cha c mt quy trnh
TyNinh.Nghincunynhmkhostm
chun nhm gim st, nh gi v x l cc
hnh bnh tt t Campuchia nhp cnh vo
bnhtruynnhimivoVitNamquaccca
Vit Nam khm v iu tr qua cc ca khu
khu. Mt trong nhng nguyn nhn cho vic
Ty Ninh v ng thi kt hp tm sot t l
cha nh hnh quy trnh l do s thiu ht
bnh cm A(H5N1) v bnh t i vi nhng
thng tin v cha c nghin cu khoa hc no
bnhnhnnhpcnhvoVitNamquaccca
cthchintiy.
khu ti Ty Ninh. Nghin cu sau khi hon
Tnh Ty Ninh c 240 km ng bin gii
thnh khng nhng gip nh khoa hc, nh
gip vi Campuchia. Cng ng dn c cc
qun l hiu hn v tnh hnh bnh truyn
huynvngbingiicaCampuchiagipvi
nhim nhp cnh qua cc ca khu Ty Ninh
VitNamcnnkinhtcnthp,trnhdn
mcngiphnh thnh quy trnh x l khi c
trviukinvsinhkm,ngidncthi
dch.
quenkhngnchnungsi,ytcsgnnh
khngc.isngngidnchyulmnng
ChuynYTCngCng
145
NghincuYhc
ITNGPHNGPHPNGHINCU
Mtnghincuctngangmtcthc
hintrongthigiant9/2009n8/2011ticc
ca khu Ty Ninh. V nghin cu nhm tm
sottlbnhtvcmnhpcnhquang
bin gii nn c mu c xc nh da vo
cng thc c lng t l bnh ca Cochcran
(1977)trongtlktcuccnhl3%,sai
s chp nhn trong nghin cu ny l 2%, xc
sut sai lm loi 1 l 5%. C mu tnh c l
279vdtrmtmuthnghincunychn
300 mu xt nghim trong 60 mu xt
nghimbnhtv240muxtnghimcm.
Trong thi gian nghin cu, ti cc ca
khuTyNinh,nghincuvin(ngthil
kimdchvinyt)stinhnhiutrattc
bnhnhnnhpcnhbaogm:bnhnhnc
giy chuyn vin, bnh nhn t i khm v
iutrcnhngtriuchng:st,ho,khth,
tiuchytCampuchiavoVitNamqua
cccakhuTyNinh.Nghincuvinquan
st th trng v khm pht hin nhng triu
chngtrnvsautinhnhlymubnh
phmivinhngbnhnhnctriuchng
trn v chuyn mu bnh phm i lm xt
nghim chn on xc nh bnh cm, t.
Ngoi ra, nghin cu vin cng tin hnh
phng vn i tng nhm khai thc mt s
thng tin lin quan n cc triu chng bnh
thngquaphiuiutra.
Phiuiutralmtbcuhigm30cu
hikhaithcthngtinnh:tinsbnh,vsinh
trong sinh hot (n ung, ngun nc, v sinh
tay chn), ni c tr ca i tng trong thi
gian bnh, vic chn nui gia cm. S liu sau
khi thu thp v c kim tra tnh y v
ph hp ca thng tin. Nhng phiu iu tra
khngthngtin s c loi ra. Phiu iu
trasaucnhmsvcnhpvo
my tnh v c phn tch bng phn mm
thngkEpiinfo6.0.Ccchsthngkmt
chyusdngtnsvtlphntrm.
Sai lch trong nghin cu ny c kim
sotttbngcchtphuncnthnchoiutra
146
vin trc khi tin hnh nghin cu. iu tra

vinlnhngngickinhnghimnghincu
v ng thi l cc kim dch vin y t ti cc
cakhunnsmbokhaithcttccthng
tin t i tng nghin cu. Ngoi ra, b cu
hicthitkngvimctiunghincu,
cchdngtngrrng,ngngn,dhiuv
d tr li nn cng gp phn hn ch sai lch
thng tin khi tin hnh thu thp d liu. Hn
na,mboitngcthhiungcc
thngtincnkhai thc th phiu iu tra c
thhinbnghaingnngltingVitvting
Anh.Tuynhin,nghincuvincthgiaotip
viitngbngtingKhmekhicnthit.
Khngnhngth,sai lch chn la c kim
sotttnhvicbm st cc tiu ch nhn vo
v tiu ch loi ra trong nghin cu. Ngoi ra,
iu tra vin cng c tp hun tt v cch
chnitngv bt buc phi tun th theo
danhschcchnla.Victinhnhiu
tracncsgimstcanghincuvinchnh
nn s gim thiu c sai s do chn la i
tng.
KTQUVBNLUN
Trong thi gian nghin cu, c tng cng
1796itngthacctiuchchnlatrong
nghincuvngthamgianghincu.
Bnh khng phi bnh truyn nhim c 1503
bnhnhn,chimtl83,7%trongnibtl
3loibnhchimtlcaolchnthngdotai
nngiaothnghaytainnsinhhot(chimtl
17,8%),taibinmchmuno(15,6%)vhuyt
pcao(5,6%).
Bng1:Tnhhnhccloibnh(N=1796)
STT
1
2
3
4
5
6
Tn bnh
Chn thng do tai nn giao thng + tai
nn sinh hot
Tai bin mch mu no
Huyt p cao
Tiu ng
Tim mch (suy tim, h van tim, nhi
mu c tim)
ng tiu ha (Xut huyt bao t,
vim d dy, au bng, ri lon, tc
rut)
S
T l %
ca
267
14,9
235
84
74
13,1
4,7
4,1
64
3,6
62
3,5
ChuynYTCngCng
Ung th (gan, phi, xng)

Bnh ng h hp (lao phi, trn dch
mng phi)
Bnh v khp xng (vim khp dng
thp, cp)
U no, lao mng no
ng tit niu (b tiu, suy thn, si
thn)
Bnh gan mt (si mt, si ng gan)
Bnh v mu (bch cu, suy ty, thiu
hng cu)
Bnh ph khoa (rong kinh, xut huyt
m o, u x t cung)
Khc (ho ra mu, tm thn phn lit,
au u, vim xoang, tr, suy nhc c
th, vim thanh qun, vim tai)
Tiu chy (nghi bnh t)
Nghi cm
Tng cng:
8
9
10
11
12
13
14
15
16
17
S
T l %
ca
60
3,3
Tai bin MMN
57
3,2
48
2,7
30
46
2,6
20
42
2,3
42
2,3
38
2,1
26
1,4
356
19,8
TNGT+TNSH
35
30
s ca
25
20
15
10
5
0
2
thng
ChuynYTCngCng
35
25
10
11
12
15
10
5
0
1
10
11
12
thng
Biu2:scabnhtaibinmchmunonhp
cnhtheothigian
Cao H/A
55
3,1
238 13,3
1796 100
Bnh nhn nhp cnh mc bnh ph khoa

vccbnhvmuchimtlthpnhtvitl
ln lt l 1,4% v 2,1%. Cc t l bnh tt ny
phhpvitnhhnhthctticctrmkim
dchytquctcakhu.Tuy nhin, t l cc
loibnhnycngdaongtyvothiim
trongnm.Vd,nginhpcnhviccchn
thng do tai nn giao thng v tai nn sinh
hottngcaovoccthnggianm(thng5,
6, 7) v cao nht l vo thng cui nm (thng
12)trongkhitlitngnhpcnhmcbnh
taibinmchmunolibinngtrongsut
nm nhng cao nht l vo khong thng 7.
Chnhv vy, vic hiu c m hnh bnh tt
nyvdintintheomasgipchokimdch
ytqucttiTyNinhcchngtrnhhtr
vngphkpthi.
Biu1:scabnhdotainngiaothngvtai
nnsinhhotnhpcnhtheothigian
s ca
Tn bnh
12
10
8
s ca
STT
NghincuYhc
6
4
2
0
1
10
11
12
thng
Biu3:scabnhdocaohuytpnhpcnhtheo
thigian
S bnh nhn nghi ng mc bnh truyn
nhiml293,chimtl16,3%trongtngsi
tngtrongnghincu,trongsnghicml
238bnhnhn(chim81,2%)vnghibnhtl
55 bnh nhn (chim 18,8%). Trong tng s 55
muxtnghimbnhtt55itngnghin
cu, c 4 mu dng tnh Vibrio cholerae O1,
chim t l 7,3% (khong tin cy 95%: 0,4%
14,1%). Qua kho st 30 ca dng tnh c 50%
tip xc vi gia cm trong vng 7 ngy qua.
ngthicsbnhnhnnthtgiacmtrong
vng7ngyvaquaktngyphthintriu
chng, chim t l 46,7%. Tuy nhin, iu ny
ch c ngha nu ca cm do virt cm
A(H5N1) t gia cm ly qua ngi, vi cm
mangichlytruyntngisangngi
th vic tip xc gia cm khng lm tng nguy
cnhimcmma(5).Tuyvy,vivicsng
ngi gn khu chn nui gia cm, thng
147
NghincuYhc
xuyn tip xc gia cm, git m gia cm th

nguy c mc cm gia cm A(H5N1) l rt ln
nu c mm bnh trn gia cm, ng thi gia
tng nguy c ti t hp yu t di truyn gip
cm A(H5N1) c kh nng ly truyn d dng
tngisangnginhcmma,cthkhi
uchomtidchcmmi(t3tin
gyidchcmcaWHO)(3).
Trongtngs238mulmxtnghimbnh
cmtrongnghincuny,ktqudngtnh
chim12,6%(khongtincy95%:8,4%16,8%),
trong dng tnh vi cm A/H3N2 l 24
mu, chim t l 10,1% v dng tnh vi cm
A(H1N1)idchnm2009l6mu,chimtl
2,5%. Khng pht hin trng hp cm
A(H5N1) no. Kt qu ny l ph hp vi cc
consthngkcacccquanqunl.Vd,
theobocos 510/BCBYT th mc d t u
nm 2011 n 20/6/2011 c nc c 498 trng
hpmccmA(H1N1)idchnm2009ti40
aphng,trongc13trnghptvong
ti 10 a phng nhng t u nm 2011 ti
nay,VitNamchaghinhncabnhnhncm
A(H5N1)no.Ktqutnghincunycng
chothy,tngtnhccaphngkhc,ti
cccakhutiTyNinhvntiptcghinhn
ri rc trng hp nhim virus cm A(H1N1)
idchnm2009nhngkhngghinhncc
dchlntrongcngng(2).
Ngoi ra, t l dng tnh vi bnh cm
trong nghin cu ny (12,6%) cng tng t
nhtheothngknhktiTyNinh.Vd,
theobococaTTKDYTQTTyNinh9thng
u nm 2009 th trong tng s hnh khch
nhp cnh (425.746 lt) pht hin c 243
khchctriuchngnghing.Ktquc28
trng hp dng tnh vi cm A(H1N1) i
dchnm2009iquacakhuMcBi,chim
t l 11,5%. Tuy nhin, t l ny li thp hn so
vinghincuticakhuqucttisnbay
Tn Sn Nht. Theo bo co ca Trung tm
KDYTQT Tp.HCM, trong tng s khch nhp
cnhconhittisnbayTnSnNht
t ngy 26/4/2009 n ngy 10/9/2009 l:
148
1.127.962ngi,phthin1.458canghing,c
317 ca dng tnh vi cm A(H1N1) i dch
nm2009,chimtl21,7%(4).
Nguyn nhn ca s khc bit ny l quy
mtipnhnnginhpcnhvoVitNamti
Ty Ninh v ti Tp.HCM c khc nhau. Nu
nhtiTyNinhchyulngiCampuchia
nhpcnhquangbhocngidntrong
khuvcChu(mchyulngNam)
thtiTp.HCMnginhpcnhcth n t
nhiuqucgiakhcnhautrnthgiibaogm
cChu,Chuu,ChuPhi,ChuMvc
Chu c vi s lng ln. Ngoi ra, cc c
im v v sinh phng bnh, li sng cc
nhm i tng cng khc nhau (gia ngi
Campuchia v cc nc khc trn th gii).
Hnna,bnhcmA(H1N1)idchnm2009
xut pht t Chu M nn khi Tp.HCM tip
nhnnhiunginhpcnhtChuMsc
tlcaohntiTyNinh.
Tuy nhin, nu so snh t l 12,6% trong
nghincunyvicctnhkhcnhAnGiang,
QungTr,LngSn,LoCai,QungNinhtht
lnylirtngquantm.Biv,theoboco
cacctrungtmKDYTQTticctnhtrnth
nm2009,cakhucctnhnyvnchapht
hincadngtnhvibnhcmnonhpcnh
vo Vit Nam. Tuy nhin, iu cn quan tm
khc li l vic cc tnh ny cha c quy trnh
kimtravgimstbnh(1).
Qua phn tch cho thy bnh cm ch yu
din ra t thng 5 n thng 10, cao im l
thng 8 hng nm. iu ny cng tng i
ph hp vi kt qu gim st cm trng im
khuvcphaNamcaVinPasteurTp.HCMl
cm A (H3N2) gia tng t thng 4, t nh
thng67vxungthpvothng9hngnm.
ChuynYTCngCng
16
15
14
12
S ca
10
8
6
4
2
0
0
3
0
4
0
6
10
0
11
0
12
Thng
Biu4:Cabnhcmxmnhpquacakhutheo
thigian
KTLUN
Hai nhm bnh nhp cnh ch yu: nhm
bnh khng truyn nhim chim t l 83,7% v
nhmbnhtruynnhimchimtl16,3%.i
viccbnhtruynnhim,mcdnghincu
cha pht hin trng hp no mc cm
A(H5N1)nhngcabnhcmA(H1N1)idch
nm 2009 chim t l 10,2% trn tng s nhm
bnhtruynnhimv12,6%trntngscanghi
cm.Ngoira,ca bnh t chim t l 1,4% trn
tng s nhm bnh truyn nhim v 7,3% trn
tngscatiuchy.ivibnhkhngtruyn
nhimthbaloibnhctlcaonhtltainn
giaothngvtainntrongsinhhot(17,8%),tai
binmchmuno(15,6%),vbnhcaohuyt
p(5,6%).
KINNGH
NghincuYhc
ch ng phng chng dch xm nhp

vlylan,cngimstttccccakhugip
viCampuchia,hnchtianguyclylan
mmbnhbngcchxydngphngnsn
sng phng chng dch bnh, tng cng hot
ng KDYTBG, gim st cht cc trng hp
cm A(H1N1) pdm2009, cm A (H5N1), bnh
t... cn c quy trnh gim st c th; chun b
snsngcsvtcht,trangthitb,thuciu
tr ch ng phng nga trng hp dch
xyra.
Duy tr v tip tc nng cao nng lc h
thng thu thp thng tin dch bnh ti cc ca
khu, kp thi lm c s d bo dch kim
sot,khngccdchbnhtruynnhimxm
nhpvoVitNamquacccakhuTyNinh.
TngcngcngtctruynthngGDSKti
cc ca khu v phng, chng dch cm
A(H1N1) i dch nm 2009, cm A(H5N1) v
ccbnhdchkhc(cbitdchtiuchycp
nguyhim).
TILIUTHAMKHO
1.
2.
3.
4.
5.
BYt(2011),Hinghvcngtckimdchytbingii
visthamdcaccchuyngiayt,idinSYtcc
tnh,thnhphtrongcnc,ngy1612tiTp.HChMinh.
TchcYtThgii(2005),iulYtQuct.
TchcYtThgii(2011),Hngdnchnonphngth
nghimvgimstvirushcbnhcm.Mngligimst
cmtoncu.Geneva.
TrungtmKimdchYtQuctTp.HChMinh(2010),
Bocotngkthotngnm2010vkhochnm2011.
VinVsinhYtcngcng(2009),CpnhtkinthcYt
Dphngs1,qu1/2009.
ChuynYTCngCng
149
NghincuYhc
PDNGPHNMMWHOANTHRONHGI
TNHTRNGDINHDNGCATRDI1TUI
MTSPHNGTHUCTHNHPHHU
NguynVnt*,HongThCmNhung*,LThNhung*,VThNgcDiu*,inhThanhHu*,
HongThBchYn*
TMTT
tvn:nhgitnhtrngdinhdnglcngvicthngquyivicnbcngtctronglnh
vcdinhdngvnhikhoa.VitNam,vicnhgitnhtrngdinhdngdavoqunththamkho
NCHScpdngngaytunhngnm1980.Nm2006TchcYtthThgiikhuyncos
dngqunththamkhomi.Nghincunycthchinnhmhaimctiu.
Mctiu:SdngphnmmWHOAnthronhgitnhtrngdinhdngcatrdi1tuimt
sphngthnhphHu.nhgimitngquangiaccchscnnngtheotui,chiuditheotui,
cnnngtheochiudi.
Phngphpnghincu:pdngphngphpnghincumtctngang,nhgitnhtrngdinh
dngca387trdi1tuihinangsinhsngtithnhphHu.Sdngphngphpnhntrchcdinh
dngthuthpcnnng,chiudinmcatr,sausdngphnmmWHOAnthrocaTchcYt
Thgiitnhtonccchscnnngtheotui;chiucaotheotui;cnnngtheochiucaonhmnhgi
tnhtrngdinhdngcatr.Ccthngtinkhccthuthpthngquaphngvnbmtthng6/2009
nthng4/2010.
Kt qu:DngphnmmWHOAnthrochoktquchnhxc,thunlivnhanhchngvitlsuy
dinhdngthnhcn,thpci,gycmlnltl2,84%,5,68%v3,61%.2.Cmitngquangiacn
nng theo tui vi chiu di theo tui (r=0,659, p<0,001); cn nng theo tui vi cn nng theo chiu di
(r=0,612,p<0,001);chiuditheotuivicnnngtheochiudi(r=0,142,p<0,05).
Ktlun:PhnmmWHOAnthromanglinhiulichtrongnhgitnhtrngdinhdngtrem,d
dng,thuntin,chnhxc,giploibsaiskhitnhtui,vnthngxyrakhikhngcsthngnhtgia
cciutravintrongcciutranhgitrnhtrngdinhdngcatr.2.PhnmmWHOAnthrochogi
trZscorecth,ngthihinthgitrZscorecatrtrnbiu.
Tkha:WHOAnthro,tnhtrngdinhdng,trdi1tui,thnhphHu.
ABSTRACT
APPLYINGWHOANTHROSOFTWAREFORASSESSINGNUTRITIONALSTATUSOFINFANTSIN
SOMEPRECINTS,HUECITY
NguyenVanDat,HoangThiCamNhung,LeThiNhung,VoThiNgocDieu,DinhThanhHue,
HoangThiBachYen*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:151156
Background: Assessing nutritional status is a common activity of pediatricians and nutritionists. In
Vietnam, the National Center for Health Statistics (NCHS) reference had been used from beginning of
1980s. In 2006, the World Health Organization recommended to use WHO standards for assessing
*ihcYDcHu
Tcgilinlc:BS.NguynVnt
150
T:0945528776 Email:vandatht@gmail.com
ChuynYTCngCng
NghincuYhc
nutritionalstatusofchildren.Thisstudywasconductedwithtwoobjectives.
Objectives: Using WHO Anthro software for assessing nutritional status of infants in some precints in
Huecity.Findingouttherelationshipbetweenweightforage,lengthforage,andweightforlength
Methods: A crosssectional study was conducted from June 2009 to April 2010. 387 infants who were
livinginHuecitywereinvolvedinthestudy.Theweight,length,ageoftheinfantswasmeasuredandothers
informationwerecollectedbyinterviewingtheirmothers.WHOanthrosoftwarewasusedtocalculateweightfor
age,lengthforage,andweightforlengthforassessingtheirnutritionalstatus.
Result:WHOAnthrosoftwarehelpedtoassessnutritionalstatusofinfantsrapidlyandconvenientlywith
highaccuracy.Prevalenceofunderweight,stuntingandwastingwere2.84%,5.68%and3.61%respectively.
Therewerecorrelationsbetweenweightforageandlengthforage(r=0.659,p<0.001);betweenweightforage
andweightforlength(r=0.612,p<0.001);betweenlengthforageandweightforlength(r=0.142,p<0.05).
Conclusion: WHO Anthro software is very useful for assessing nutritional status of children. It is very
simple,convenience,andprecisetousethesoftware.Italsohelpstopreventacommonerrorcausedbycollectors
whencountingageofthechildren.WHOAnthrosoftwaredisplaysexactZscorevalueinnumberanddisplays
thescoreingraph.
Keywords:WHOAnthro,nutritionalstatus,infants,Huecity
nng theo tui, chiu di theo tui, cn nng
TVN
theochiudi.
Hinnay,suydinhdngngvaitrtrc
tiphocgintipn4050%trnghpca
10,9 triu trng hp t vong hng nm tr
emdi5tuitrntonthgii(6).nhgitnh
trng dinh dng l cng vic thng quy i
vi cn b cng tc trong lnh vc dinh dng
v nhi khoa, gip pht hin, chn on cc ri
londothiu,thadinhdngtcbin
phpcanthipkpthi.VitNam,vicnh
gi tnh trng dinh dng da vo qun th
tham kho NCHS (National Center for Health
Statistics)cpdngngaytunhng
nm 1980. Nm 2006 T chc Y t Th gii
khuyn co s dng qun th tham kho mi
caTchcYtThgiivylqunthp
ng c nhiu tiu ch nht cho tt c tr em
trn ton th gii(1). Phn mm WHO Anthro
caTchcYtThgiiraitnm2006,s
dngqunththamkhoWHOlcngchu
chgipnhgitnhtrngdinhdngcatr
em t 0 n 60 thng tui(4). Nghin cu ny
cthchinnhmhaimctiu:
ITNGPHNGPHPNGHINCU
S dng phn mm WHO Anthro nh

gitnhtrngdinhdngcatrdi1tui
mtsphngthnhphHu.
Phngphpchnmu
Sdngphngphpchnmutngtl.
nhgimitngquangiaccchscn
ChuynYTCngCng
itngnghincu
Trdi1tuitithnhphHu.
Phngphpnghincu
Thitknghincu
Nghincumtctngang.
Cmu
Tnhtheocngthc(3)
n = Z 2
p (1 p )
d2
Vitincy95%(=0,05)thZ/2=1,96.
p:Tlsuydinhdngcatrdi5tui
trntonqucnm2008(p=19,9%)(5).
d:mcchnhxcmongmun,chnd=0,04
T tnh c c mu ti thiu cn t
c l n = 382,72. Thm 1% d phng, tnh
ccmutrongnghincunyl387.
Thnh ph Hu c 27 n v hnh chnh,

gm 24 phng v 3 x. Chng ti tin hnh
151
NghincuYhc
chnchnh2phngv2x(1phng,1x
pha Bc v 1 phng, 1 x pha Nam Thnh
phHu).ChngtichncxHngLong,
phngPhThun,xThyXun,phngPh
Hi. Ti mi x, phng c chn, da vo
danhschtr<1tuicqunltitrmyt,
chngtitnhtonccscthcnthit
chomitngvitlmitnglnltl0,271;
0,209;0,266;0,253,saulyhscamitng
nhn vi c mu ca nghin cu chng ti c
cscthcamitnglnltl105;81;
103; 98. Cui cng chng ti tin hnh chn
ngunhincccthtrongmitngcc
mucnthit.
Thigiannghincu
Tthng6/2009nthng4/2010.
Phngphpvkthutthuthpsliu
S dng phng php nhn trc hc dinh
dngthuthpcnnng,chiudinmca
tr, sau s dng phn mm WHO Anthro
caTchcYtThgiinhgitnhtrng
dinhdngcatr.
PhnmmWHOAnthrosdnghaiqun
thsosnhlNCHSvqunththamkhomi
caTchcYtThgiinhgitnhtrng
dinhdngtnhtrngdinhdngcatr.Nm
2007, Hi Nhi khoa Vit Nam a ra khuyn
ngh v nhu cu dinh dng cho tr em Vit
Nam v khuyn ngh s dng chun tng
trng2006caTchcYtThgii(2).
PhnmmWHOAnthrochophpnhgi
ttcccchtiulinquanntnhtrngdinh
dngcatrnhcnnngtheotui,cnnng
theo chiu cao/chiu di (chiu di i vi tr
di2tuivchiucaoivitrt2tuitr
ln), chiu cao/chiu di theo tui, BMI theo
tui, chu vi vng u theo tui, chu vi vng
cnh tay theo tui, np gp da c tam u v
npgpdadixngbvaitheotui.
Trong nghin cu ny, chng ti s dng
cc ch s: cn nng theo tui, chiu di theo
tui, cn nng theo chiu di nh gi tnh
trngdinhdngtheotiuchuncaTchcY
152
t Th gii c lp trnh trong phn mm

WHOAnthronhsau:
Bng1:Ccchsphttrin(8)
lch
chun
(SD)
Trn 3
Trn 2
Trn 1
Cc ch s pht trin
Chiu di
Cn nng Cn nng theo
theo tui
theo tui
chiu di
(Xem ch thch 1)
Bo ph
Bnh thng
Tha cn
(Xem ch
thch 2) C nguy c tha
Bnh thng
cn (Xem ch
thch 3)
0
(trung v)
Bnh thng
Bnh
thng
Bnh thng
Di -1
Bnh thng
Bnh
thng
Bnh thng
Thp ci
Nh cn
(Xem ch thch 4)
Rt nh
Thp ci nng
cn
Di -3
(Xem ch thch 4) (Xem ch
thch 5)
Di -2
Gy cm
Gy cm nng
Chthch:
atrtrongnyrtcao.Chiucaohim
khilvn,trtrnghpqucaocthdo
rilonnitit,vdnhmtkhiusnsinh
hormon tng trng. Nu nghi ng a tr c
ri lon ni tit th nn chuyn a tr n
chuyngiacnhgi(vdtrqucao
sovituitrongkhib,matrcchiucao
bnhthng).
Mtatrccnnngtheotuithuccc
nycthcvnvtngtrngnhngtt
hnnnnhgicnnngtheochiudi/chiu
caohocBMItheotui.
Nuchmcnnngtheochiuditrn1th
c th c nguy c. ng biu din hng ln
pha2SDxcnhnguyc.
Mtatrbthpcihocthpcinngc
thtrnnthacn.
ny lin quan n thut ng rt nh cn
trong chng trnh Lng ghp chm sc tr
bnh (IMCI: Integrated Management of
ChildhoodIllness).
Phntchvxlsliu
SdngphnmmWHOAnthro,SPSS15.0
vMedCalcphntchvxlsliu.
ChuynYTCngCng
NghincuYhc
KTQU
i tng nghin cu gm 387 tr di 1
tui(cchtnhthngtuitheoquynhcaT
chcYtThgii),trongc208namv179
n,tlnam/n=1,16.
Phnbthngtuicatr
Phn b theo thng tui ca nhm tr
nghincutngingu.Nhm0thng
tuichimtlthpnht(1,0%),nhm2thng
tuichimtlcaonht(12,7%).
Bng1:Tnhtrngdinhdngcatr
Tnh trng dinh dng
Cn nng theo tui

Rt nh cn
1,29
Nh cn
1,55
Bnh thng
376
97,16
Biu1:Tngquangiacnnngtheotuivi
chiuditheotui
C mi tng quan nghch chiu gia cn
nngtheotuivichiuditheotuir=0,659
(p<0,001).
Tng quan gia cn nng theo tui vi

cnnngtheochiudi
Chiu di theo tui

Thp ci nng
11
2,84
Thp ci
11
2,84
Bnh thng
365
94,32
Cn nng theo chiu di

Rt gy cm
1,03
Gy cm
10
2,58
Bnh thng
353
91,21
Tha cn - bo ph
20
5,17
Tng
387
100,0
nh gi da vo cn nng theo tui th

trongs387trcnghincuc11(2,84%)
trbsuydinhdng(SDD)thnhcn.
T l SDD th thp ci (stunting) l 5,68%,
trongc2,84%trbthpcinng.
Biu2:Tngquangiacnnngtheotuivi
cnnngtheochiudi
C mi tng quan thun chiu gia cn
nng theo tui vi cn nng theo chiu di r =
0,612(p<0,001).
Tng quan gia chiu di theo tui vi

cnnngtheochiudi
C 14 (3,61%) tr b SDD th gy cm
(wasting), trong c 1,03% tr b gy cm
nng.inghchvitnhtrng,c20(5,17%)
trbthacnvboph.
Nhn xt v mi tng quan gia cc ch

s
Tngquangiacnnngtheotuivichiu
ditheotui
ChuynYTCngCng
Biu3:Tngquangiachiuditheotuivi
153
NghincuYhc
cnnngtheochiudi
VphnmmWHOAnthro
C mi tng quan thun chiu gia chiu

di theo tui vi cn nng theo chiu di r =
0,142(p<0,05).
SdngphnmmWHOAnthrocmts
uimnhsau:
BNLUN
Vtlsuydinhdngtrdi1tui
ncta,trongnhngnmgnyc
s phn u n lc nhm gim t l suy dinh
dngtremdi5tui,cbitltrdi3
tuivyitngdmcccbnhtt,tl
ccbnhlvdinhdngtptrungchyu
itngnynukhngcquantmchm
scngmc,hnnaitngnycth
angphttrin,cnphicnhngnghincu
theo di nh gi tnh trng dinh dng,
pht trin tm vn ng ca tr, t c bin
phpcanthipkpthichocngng.
TheoktquTngiutradinhdngnm
2000, t l SDD nhm tr di 12 thng tui
cc th nh cn, thp ci, gy cm trn tng
ng l 12,9%, 19,0% v 6,0% (7), cao hn c
nghathngksovinghincucachngti
(p<0,001).Nguynnhncthdo:
Nghincucachngtithchintrni
tngtrdi1tuilatuicnbmnn
cn chu nh hng tt ca sa m, ng thi
thi gian ny cha di c th c nhng
nhhngmntnhncnnng,chiudica
tr.
Tc ng tch cc ca cc hot ng nhm
nlclmgimtlsuydinhdngtremca
cctchc,cnhntrongvngoinc.
Nghincucachngticngghinhnc
20 (5,17%) tr b tha cn v bo ph da theo
cnnngtheochiudi.ylimcnlu
v hin nay tha cn v bo ph cng ang l
vn dinh dng cng ng quan trng bi
mtvnmixuthintmynmgny
mtscngng(khuvcthnhthcmc
sngcaohn)ltnhtrnggiatngmtsbnh
mn tnh c lin quan ti dinh dng khng
hplnhboph,timmch,ithong,
tnghuytp.
154
Xcnhchnhxcthngtui,ngytuica
tr, gip hn ch sai s gia cc iu tra vin,
vnrtthnggptrongcciutralinquan
nuthiusthngnhtngaytu.
ChogitrZscorecth,ngthihinth
gi tr Zscore ca tr trn biu . Nh vy
chngticthtnhtonctngquangia
ccchsmtcchchnhxcvbitcvtr
cc ch s ca tr trn biu mt cch trc
quan.
Phn mm ny c s dng cc ch s nh
gitnhtrngdinhdngmicaTchcYt
Th gii nh BMI theo tui, chu vi vng u
theo tui, chu vi vng cnh tay theo tui, np
gpdactamuvnpgpdadixngb
vai theo tui (khng c khi s dng qun th
NCHS). y mi ch l nghin cu bc u,
chng ti s s dng phn mm ny tin
hnhnghincusuhnviyccchs.
S dng phn mm ny thun tin, nhanh
chng,ddng,cthpdngchocngng.
KTLUN
Dng phn mm WHO Anthro trong nh
gi tnh trng dinh dng ca tr di 1 tui
choktquchnhxc,thunlivnhanhchng
vitlsuydinhdngthnhcn,thpci,
gycmlnltl2,84%,5,68%,v3,61%.
S dng phm mm ny d dng, thun
tin,chnhxc,giploibsaiskhitnhtui,
vnthngxyrakhikhngcsthngnht
giacciutravintrongcciutranhgi
trnhtrngdinhdngcatr.
Cmitngquangiacnnngtheotui
vichiuditheotui(r=0,659,p<0,001);gia
cnnngtheotuivicnnngtheochiudi(r
=0,612,p<0,001);giachiuditheotuivicn
nngtheochiudi(r=0,142,p<0,05).
KINNGH
PhnmmWHOAnthrongin,dthc
ChuynYTCngCng
hin,nghphbinvtphunrngri.c
bitlitngcnbphtrchDnsvK
hochhagianh.
4.
5.
TILIUTHAMKHO
1.
B Y t (2008), Suy dinh dng protein nng lng, Dinh

dngcngngvantonvsinhthcphm,HNi,Nh
xutbnGiodc,tr.146159.
BYt,VinDinhDng,(2000),Tngiutradinhdng
nm2000.
BYt(2008).Thngkytvcngtcchmscsckhe
bmvtrem
(http://www.cimsi.org.vn/THONGKE.aspx?action=detail&th
ongke_id=86)
2.
3.
6.
7.
8.
NghincuYhc
inhThanhHu(2005),Phngphpdchthc,Nhxut
bnYhc.
Hi Nhi khoa Vit Nam (2007), Khuyn ngh mi ca Hi
NhikhoaVitNamvnhucudinhdngchotremVit
Namvkhuynnghsdngchuntngtrng2006caT
chcYtThgii.
NguynCngKhn(2006),Cchnhnmivnuidngtr
s sinh v tr nh theo khuyn ngh ton cu ca
WHO/UNICEF,Tpchdinhdng&thcphm,2(2),tr.15.
WHO (2007), WHO Anthro Software for assessing growth
anddevelopmentoftheworldschildren.
WHO (2008), Training course on child growth assessment,
Interpretinggrowthindicators.Geneva,WHO;2008.
ChuynYTCngCng
155
NghincuYhc
NHY,CHIU,KHNNGPHHPCHNON
VDNGTNHKODICATESTNHANHCOMBO
TRONGCHNONSTRTTIXCDRAM,
HUYNKRNGBNG,TNHAKLAK,NM2010
HVnHong*,HunhHngQuang*
TMTT
tvn:TestnhanhCombovicimchoktqunhanh,ngincvaitrquantrngtrongchn
on,iutrstrttinhngxkhngcimknhhinvi.
Mc tiu:Xcnhnhy,chiu,khnngphhpchnoncatestnhanhCombosovik
thutGimsavnhgikhnngdngtnhkodicatestsauiutrstrt.
Phngphpnghincu:Nghincuctngang,nhgimtnghimphpchnon.
Ktqu:KtquphntchchothynhycatestnhanhCombol95,45%;chiul97,98%.Gi
trdondngtnhcatestl84%vgitrdonmtnhl99,49%.Khnngphhpcaoca2test
chnonviKappa=0,88.TestCombo(+)kodinngy28saukhiciutrschksinhtrngst
rtbngArtecan.Tl(+)catestvongyD7l77,42%,ngyD14l50%,ngyD21l20%vngyD28
l3,33%.
Ktlun:TestnhanhCombocnhyvchiucao,ngindsdng.Vvycncungcptest
nychovngkhngcimknhhinvigipchnonviutrstrt.
Tkha:Ksinhtrngstrt,testchnonnhanh.
ABSTRACT
THESENSITIVITY,SPECIFICITY,AGREEMENT,ANDPROLONGEDPOSITIVITYOFCOMBOTEST
INDIAGNOSINGMALARIAATCUDRAMCOMMUNE,KRONGBONGDISTRICT,DAKLAK
PROVINCE,2010
HoVanHoang,HuynhHongQuang
Background: Malaria Combo test with rapid and simple results play an important role in the malarial
diagnosisandtreatmentatthecommuneswithoutmicroscopepoints.
Objectives:Todeterminethesensitivity,specificity,andagreementofCombotestcomparedtogiemsatest
andtoevaluateprolongedpositivityofCombotestaftersuccessfulmalariatreatment.
Methods:CrosssectionalstudyandDiagnostictechniqueevaluation.
Result: The analysis of the results showed that the sensitivity of test was 95.45%; the specificity was
97.98%.Thepositivepredictivevalueandnegativepredictivevaluewere84%and99.49%,respectively.Thereis
a strong degree of agreement between Combo test and giemsa test (Kappa=0.88). Combo test has showed a
prolongedpositivitytillday28thaftersuccessfultreatmentwithArtecan.Theproportionofpositivetestby7th
day,14thday,21stday,and28thdaywere77.42%,50%,20%,and3.33%,respectively.
Conclusion: Combo test has high sensitivity and specificity, simple and easy to use. Therefore, it is
nessesarythatmalariacontrolprogramshouldprovidethesetestsforthosecommuneswithoutmicroscopepoints
*VinStrtKSTCTQuyNhn
Tcgilinlc:Ts.HVnHong
156
T:0914004629
Email:ho_hoang64@yahoo.com
ChuynYTCngCng
NghincuYhc
tohelpindiagnosisandtreatmentofmalariacases.
Keywords:Malariaparasite,rapiddiagnostictest.
TVN
Hin nay, st rt (SR) c mt v lu hnh
trn100qucgia,trongcVitNamlmt
trong nhng nc cn t l mc cao(6,7). Trc
thc trng SR nghim trng v phc tp nh
th,ChngtrnhQucgiaphngchngstrt
ccncnucaoquanimchnonsm
viutrkpthibnhSR,nhmhthptl
bnh,tvongdoSRnmctia.Thchnh
chn on st rt sm bng knh hin vi cc
im knh l mt phn chnh trong vic nng
cao khng ch chn on m cn gip iu tr
kpthibnhnhnstrt(BNSR).
Phng php chn on bng knh hin vi
(KHV) c nhiu u im tuy nhin cht lng
ph thuc nhiu yu t: nng lc xt nghim
vin (XNV), kinh nghim pht hin k sinh
trng st rt (KSTSR) mt thp,m bo
chtlngvslngtrangthitb,chakc
cu t chc v qun l nhn vin tt,... hn
chmtsnhcimcaphngphpKHV,
mt lot k thut khc ra i, ng ch l
cng ngh que nhng hay th nghim chn
onnhanh,giphtrKHVtrongchnon
strtmanglihiuqucaotimtsvngc
SR,nhyvchiucatestchnon
nhanh c nhy cm v mt a l, ngha l kt
quvntimiqucgiackhcnhau(1,3,7).
D vy, cc test ny cn c nh gi ti
cc tuyn, nht l y t c s, nhng ni ang
thiuvnhnlcvthitbKHVcngnhyu
v cht lng, kinh nghim chn on KHV.
Vi ngha , ti: Xc nh nhy,
c hiu, kh nng ph hp chn on v
dngtnhkodicatestnhanhCombotrong
chnonstrttixCDram,huynKrng
Bng, tnh ak Lak nm 2010 nhm mc tiu
sau:
Xc nh nhy, c hiu, kh nng
ph hp chn on ca test nhanh Combo so
vikthutGimsa.
ChuynYTCngCng
nh gi kh nng dng tnh ko di ca

testsauiutrstrt.
I TNG
NGHINCU
PHNG
PHP
aimnghincu
XCDram,huynKrngBng,nmtrong
vngstrtluhnhnng.
itng
Tt c cc ca bnh st rt (bao gm ca xc
nh l st rt v ca st rt lm sng theo tiu
chunchnon)hoccanghistrtangsng
ticcxnghincu.
Thigian
Nm2010
Vtliunghincu
CcbKITquethCombo.
Cc lam ly mu nhum Gim sa (cng
mt mu mu ly mu lm c git c v git
n), cc gi kh lam v hp bo qun lam
mu.
Thitknghincu
Nghin cu ct ngang nh gi nghim
phpchnon.
Cmunghincu
Theocngthc
n =
z 12
/2
p (1 p )
d 2
Trong : 1/ 2 = 1,96 (h s tin cy vi

tincy95%),p=0,95:nhytheoccnghin
cu trc, d = 0,03 (sai s tuyt i), tnh ra
n=203
Kthutnghincu
K thut xt nghim Gim sa c in, Soi
lamdiknhhinviquanghc.
KthutxtnghimchnonCombo.
157
NghincuYhc
K thut CareStartTM Malaria HRP2/pLDH

Combo Test do Cng ty Access Bio, Inc. New
Jersey, ca M sn xut. K thut Combo Test
dng chn on nhanh st rt khi b nhim
KSTSRvittcccchngloiP.falciparum,P.
vivax,P.malariaevP.ovalebngcchnhndng
nhanhProteine2vpLDHtrongmucangi
bnhbmcstrt.
cktqu
mtnh:chc1vchmutivtrCca
phncktqu.
Khng c kt qu: khng xut hin vch
mu no trn test hoc khng c vch mu
vtrC.Trnghpnynucxyra,phi
lmlitestkhc.
Dng tnh vi Plasmodium falciparum: xut
hin 2 vch mu ti v tr C v ti v tr 1;
Dng tnh vi Plasmodium vivax: xut hin 2
vchmutivtrCvtivtr2.
Dng tnh vi Plasmodiumfalciparum v c
Plasmodiumvivax,thnggilnhimphihp:
xuthinc3vchmuticcvtrC,vtr
1vvtr2.
Khithyxuthin2vchmutivtrC
v ti v tr 2 trn test, thng chn on l P.
vivax.Ktqunycngxuthinkhibnhnhn
b nhim c k sinh trng st rt chng loi P.
malariae hoc P. ovale. Hai chng loi k sinh
trngnytgptiVitNam.
Ccchsnhgi(5)
nhycatesthaytldngtnhthtl
khnngphthinbnhcatestkhibnhnhn
cbnhthts.nhy=a/(a+c).
chiucatesthaytlmtnhthtl
khnngphthinngikhngmcbnhca
test.chiu=d/(b+d).
Gi tr d on dng tnh hay t l bnh
nhndngtnhctnhtrngtestdngtnh=
a/(a+b).
Gitrdonmtnhhaytlbnhnhn
cktqumtnhsovitngstrnghpc
testmtnh=d/(c+d).
Mcphhp2loichnon(Kappa).
Test Combo
Dng tnh
m tnh
Tng
Chun vng Gim sa

Dng tnh
m tnh
a
b
c
d
a+c
b+d
Tng
a+b
c+d
n
GitrKappactnhnhsau:
Phhpquanst:(a+d)/n
Ph hp ngu nhin: (a+b)*(a+c)/n +
(c+d)*(b+d)/n
Phhpthcti=phhpquanstph
hpngunhin.
Phhptimn(khngdongunhin):(1
ph hp ngu nhin) hoc (100% ph hp
ngunhin(%).
Phhpthcti
ChsKappa=
Phhptimn
nhgichsKappa:
00,2:Phhprtthp
0,20,4:Phhpthp
0,40,6:Phhpva
0,60,8:Phhpcao
0,81,0:Phhprtcao
X l v phn tch s liu: S liu c
phntchtheochngtrnhEpiInfo6.04.
158
ChuynYTCngCng
NghincuYhc
KTQU
GitrKappactnhtheosau
Thnh phn, t l loi KSTSR ca 2

phngphpxtnghim
Ph hp quan
(21+194)/220=97,73%
Bng1:TlKSTSRxcnhbngkthutnhum
GimsavtestCombo.
Phn S
TT
g php XN
(+)
S % S % S %
ln
ln
l
g
g
ng
10,4
81,8
13,6
18
3
8
2
4
4,55
Test
11,9
80,0
12,0
210 25
20
3
Combo
0
0
0
8,00
1 Gim sa 210 22
2
P.
falciparu P. vivax Phi hp
m
KtqutrnchothykthutnhumGim
sa pht hin c 18 ca nhim KSTSR t l
10,48%. Trong c 81,82% l P. falciparum,
13,64%lP.vivaxv4,55%lphihp.
st:
(a+d)/n
Ph hp ngu nhin: (a+b)*(a+c)/n +

(c+d)*(b+d)/n=(25*22)/220+(195*198)/220=2,5+
175,5=178
Ph hp ngu nhin = (178/220)*100% =
80,91%
Phhpthcti=Phhpquanstph
hpngunhin=97,73%80,91%=16,82%
Ph hp tim n (khng do ngu nhin)=
(100% ph hp ngu nhin(%)) = 100%
80,91%=19,09%
Phhpthcti16,82
ChsKappa===0,88
Phhptimn19,09
Nh vy Kappa = 0,88, cho thy kh nng
phhprtcaoca2testchnon(0,81,0).
Test nhanh Combo pht hin c 25 ca

dngtnhtl11,90%.Trongc80%lP.
falciparum,12%lP.vivaxv8%lphihp.
Thi gian dng tnh ca test Combo sau

khiiutrthucstrtArtecanliu
nhy, chiu,gitr d on ca
testnhanhCombo
Bng4:Tnhtrngtest(+)saukhiiutrsch
KSTSR.
Bng2:nhy,chiu,gitrdonca
testnhanhCombo.
TT
Test Combo
Chun vng Gim sa
Tng
Dng tnh
m tnh
21
25
m tnh
194
195
Tng
22
198
220
Dng tnh
nhy(%)=(11/22)*100%=95,45%
chiu(%)=(194/195)*100%=97,98%
Gi
tr
d
on
(%)=(21/25)*100%=84%.
dng
tnh
1
2
3
4
5
Ngy xt K thut Gim sa Test nhanh Combo

nghim
Xt
Xt
%
(+)
%
theo di nghim (+)
nghim
D0
31
31 100.00
31
31 100.00
D7
31
0
0.00
31
24 77.42
D14
30
0
0.00
30
15 50.00
D21
30
1
3.33
30
6 20.00
D28
30
1
3.33
30
1 3.33
Ktquphntchtrnchothy,testnhanh
Combocth(+)kodinngy28saukhi
ciutrschksinhtrngstrt.Tl(+)
ca test vo ngy D7 l 77,42%, ngy D14 l
50%,ngyD21l20%vngyD28l3,33%.
Gitrdonmtnh(%).=(194/195)*100%
=99,49%.
BNLUN
Bng3:Khnngphhpca2phngphp.
nhy,chiuvkhnngphhp
chnoncatestCombo
Test Combo
Chun vng Gim sa

Dngtnh mtnh
Tng
Dngtnh
21(a)
4(b)
25(a+b)
mtnh
1(c)
194(d)
195(c+d)
Tng
22(a+c)
198(b+d)
220(n)
ChuynYTCngCng
Nghin cu tin hnh phm vi 1 x, xt

nghim 220 ngi, xt nghim song hnh 2 k
thut trn 1 bnh nhn, kt qu cho thy k
thut nhum Gim sa pht hin c 22 ca
159
NghincuYhc
nhimKSTSRtl10,48%,trongc81,82%l
P.falciparum,13,64%lP.vivaxv4,55%lphi
hp. Test nhanh Combo pht hin c 25 ca
dng tnh t l 11,90%, trong c 80% l P.
falciparum,12%lP.vivaxv8%lphihp.V
c cu KSTSR hin nay theo cc bo co th P.
falciparum chim 76,45%85,28%, P. vivax t
13,70%21,98%, phi hp t 0,90%1,36%. Nh
vy ti im nghin cu t l nhim phi hp
dotestnhanhCombocaohn.
y l mt nhc im ca test nhanh
Combo.Ktqunychothytlnhimphi
hp ca test Combo cao hn so vi k thut
Gimsa.ylmtvncnquantm.Kt
qutestCombo khi c s xut hin c 3 vch
th c th l nhim n P. falciparum hoc l
nhim phi hp. Nhim trng phi hp P.
falciparumviccloikhngphiP.falciparum
khng th phn bit vi tnh trng nhim P.
falciparum n thun. Trong trng hp test
dngtnhvxuthinc3vchthlmth
no phn bit ch l nhim n thun
loiP.falciparumhaynhimphihpvimt
loi khc khng phi P. falciparum. V ti cc
vng st rt ca Vit Nam, c cu k sinh
trngstrtchyulP.falciparum,knl
P.vivax(chimtlthnrtnhiu)vcnli
lP.malariae.Do,vicxuthincnglc3
vchsrtnhiu,lmphnbitiuch
cn cch l lm thm mt lam mu nhum
GimsaphnbittheokhuyncocaD
nphngchngstrtVitNam.
KtquphntchsosnhvikthutGim
sachothynhycatestCombol95,45%,
chiul97,98%.Ccnghincutrnth
gii v Vit Nam v test chn on nhanh
Comboangsdngthvisliucanhsn
xut cho bit nhy v c hiu rt cao
(ut95hay96%trln)(1,3,4).
Cc loi test nhanh khc trong nhng nm
gn y cng cho kt qu v nhy, c
hiukhcao.TestDiaMedOptiMalnghincu
ti Bnh Phc (2003) cho nhy l 87%,
chiu98,6%.TestnhanhParacheckP.fnghin
160
cutimtstnhNamBvLmng(2003)
cngchonhy80,7%,chiu96,8%.Ti
khu vc min Trung v Ty Nguyn, nghin
cu test nhanh HRP2 (2006) cho thy nhy
98,7%, c hiu 93,7%. Nh vy cc test
nhanh chn on st rt hin nay cho thy
nhy v c hiu cao trong chn on st
rt(1,3).
Gi tr d on dng tnh ca test nhanh
Combo l 84% v ga tr d on m tnh ca
testl99,49%.
Kt qu phn tch kh nng ph hp chn
oncatestnhanhvchunvngGimsavi
chsKappa=0,88,chothykhnngph hp
cao ca 2 test chn on (nm trong phm vi
0,81,0). Vi kh nng ph hp chn on cao,
nhyvchiucaonncthngdng
test nhanh ny cho nhng vng c st rt lu
hnh nhng khng c im knh hin vi hot
nghocthiuxtnghimvin.Hnnatrong
mtstrnghpnhtlstrtctnhvimt
KSTSRmungoibinthpsoiknhhin
victhbstthcthsdngtestnhanhny
gipchochnonstrt.
Tnh trng dng tnh ko di ca test

Combo
S dng test nhanh Combo chn on st
rt v theo di 31 bnh nhn st rt c test
Combo(+)ciutrviccloithuctheo
phccaBYttrong7ngyuchothy
c29trnghpkhngsttrlichim93,55%;
c 2 trng hp st tr li (1 ca test (+) vi P.
falciparumv1catest(+)phihp)chim6,54%.
Haitrnghpsttrlinycngcly
mu xt nghim KSTSR vi k thut Gim sa
cho kt qu (+) vo ngy th 7. iu ny cho
thyKSTSRchahttrongmu,cthdotnh
trng dung np thuc bnh nhn khng bnh
thnghocmtsldokhctronggiaion
hinnaynhnguyctlthtbicaocacc
thucstrt.
Nghin cu tnh trng dng tnh ko di
catestParacheckFcngchothyctnhtrng
dngtnhkodisauiutrschKSTSR.T
ChuynYTCngCng
l dng tnh ca test sau khi iu tri vi
chloroquinvongy28l18,18%.Saukhiiu
tr vi Artequick ngy 21 t l dng tnh vi
testl23,33%,vongy28khngcdngtnh
no(2,4).
Hin tng dng tnh ko di ny c th
gii thch l do khng nguyn ca KSTSR vn
cn lu hnh trong mu nn test huyt thanh
mindchvnchoktqudngtnh.Kthut
test Combo chn on nhanh st rt khi b
nhimksinhtrngstrtvittcccchng
loiP.falciparum,P.vivax,P.malariaevP.ovale
bng cch nhn dng nhanh HRP 2 v pLDH
trong mu ca ngi bnh b mc st rt. Tuy
nhin cng c mt t l nh c th do KSTSR
cnlivimtrtthpmcdkhnggyra
st nhng vn c s hin din ca khng
nguyn trong mu nn test vn cho kt qu
dng tnh. Vi tnh trng dng tnh ko di
nynntrongvngstrtluhnhtl(+)ca
cc loi test nhanh thng cao hn k thut
Gimsa.Hnnavicxcnhchnontrong
mtstrnghpcncnnhcvnucnthit
phikimchngvikthutchunGimsa.
T l (+) ca test vo ngy D7 l 77,42%,

ngyD14l50%,ngyD21l20%vngyD28
l3,33%.
KINNGH
Test Combo c nhy v c hiu >
95%,khnngphhpchnonKappa=0,88,
pht hin c cc loi KSTSR nn c th s
dnghtrchnonchoccvngstrt
luhnhkhngcimknhhinvi.
Trongnhngtrnghpstrtctnhin
hnhnhngxtnghimmuvikthutGim
sa vn khng pht hin KSTSR c th s dng
testCombonhhngchnon.
Test Combo ch cho kt qu nh tnh nn
cn ly mu nhum Gim sa xt nghim knh
hin vi xc nh mt KSTSR trong mu
giptinlngvtheodidintinbnh.
Tlphihpcaodohnchcatest nn
trongtrnghpnhimphihpcnlymu
nhumGimsaxcnhthnhphnloiKSTSR
chnhxchn.
TILIUTHAMKHO
1.
KTLUN
nhy,chiutestCombosovik
thutGimsatrongchnonstrt.
2.
nhy(%)=(11/22)*100%=95,45%
chiu(%)=(194/195)*100%=97,98%
Gi tr d on dng tnh (%) =
(21/25)*100%=84%
Gitrdonmtnh(%)=(194/195)*100%
=99,49%
3.
4.
Khnngphhpcaoca2testchunon
viKappa=0,88
Khnngdngtnhkodicatestsau
khiiutrstrt
TestCombo(+)kodinngy28saukhi
ciutrschksinhtrngstrt.
NghincuYhc
5.
6.
7.
HunhHngQuang,TriuNguynTrung(2007).Gitrchn
onnhanhHRP2trongvicphthinvchnonstrtP.
falciparummtstnhkhuvcminTrungTyNguyn,K
yu cng trnh nghin cu khoa hc (20012006). Vin st rt
KSTCTQuyNhn.Nhxutbnyhc,tr.242249.
L Nguyn Bnh, Nguyn B Nn (1996). ParasightF dng
tnh ko di sau khi k sinh trng sch do iu tr bng
artemisinin.Thngtinphngchngbnhstrtvccbnhk
sinhtrng.VinstrtKSTCTHNi,(4),tr.2335.
PhngcThun,TrnThnhLoan(2011).DiaMedOptiMal
trongchnonbnhstrttimtvngstrtluhnhca
tnhBnhPhc.Kyucngtrnhnghincukhoahc(2001
2006),VinstrtKSTCTHChMinh,Nhxutbnyhc,
tr.106110.
Triu Nguyn Trung, Nguyn Tn, Nguyn Tn Thoa (2007).
nhgikhnngdngtnhkodisauiutrstrtdoP.
falciparumbngChloroquinvArtequickcatestParacheckti
mtxstrtluhnhnngPhcChin,NinhThun.Kyu
cng trnh nghin cu khoa hc (20012006), Nh xut bn y
hc,tr.218224.
Trng i hc Y H Ni (1998). Phng php nghin cu
khoahcyhc.Nhxutbnyhc,tr.167188.
WHO(2009),MalariaReport,pp.2728
WHO (2009), Guidelines for the treatment of malaria, 2th
edition,pp.124.
ChuynYTCngCng
161
NghincuYhc
XCNHTLNHIMKSINHTRNGSTRTVKINTHC,
THI,THCHNHNGIDNNGRYTIXVNHKIM,
HUYNVNHTHNH,TNHBNHNHNM2010
HVnHong*,NguynDuySn*
TMTT
tvn:McdtlmcvtvongstrttiminTrungTyNguyngimnhngnguycmcv
tvongcangidnngryvnrtcao.
Mc tiu:Xcnhtlnhimksinhtrngstrtvnhgimchiubit,thivthchnh
(KAP)cangidnngryvphngchngstrt.
Phngphpnghincu:Thitknghincuctngangmtvixtnghimmumuviutrabng
cuhiKAPtixVnhKim.
Ktqu:Ktquiutractngangvothng9/2010tixVnhKimchothy:tlnhimksinhtrng
strtngidnngryl6,73%(95%CI:4,529,58),trongP.falciparrumchimuthvi89,29%.
Phntchktquiutrakinthc,thivthchnhchothy61,78%ngidnbitmuilnguynnhn
gybnhstrt.Viphngphpquansttrctipchothychc58,41%ngidnngmnbanm
nh.Phngvntrctipchothy42,79%ngidnngmnkhingry.
Ktlun:Nguycmcstrtticngngdnngryrtcao,tlngmnkhingrythpnncn
cnhngbinphpqunlvphngchngstrtthchhpchoitngny.
Tkha:Ksinhtrngstrt,ngry.
ABSTRACT
THEPROPORTIONOFMALARIAPARASITEINFECTIONANDKAP
INTHEPEOPLESLEEPINGATFIELDHUTSINVINHKIMCOMMUNE,
VINHTHANHDISTRICT,BINHDINHPROVINCE2010
HoVanHoang*,NguyenDuySon
Background: Although malaria morbidity and mortality rates in central Vietnam reduced considerably
comparedwithpreviousyears,theriskofmalariainfectionisstillhighinpeoplesleepingatfieldhuts.
Objectives: To determine the proportion of malaria parasite infection and to evaluate KAP on malaria
diseaseofpeoplesleepingatfieldhuts.
Methods: Crosssectional study using blood examination and KAP survey conducted in Vinh Kim
commune.
Result: The results of crosssectional studies in September, 2010 showed that the infection of malaria
parasite in people sleeping at field huts was 6.73% (95%CI: 4,529,58), P. falciparum was dominant with
89.29%oftotalmalariaparasitecases.TheKAPsurveyshowedthat61.78%ofthembelievedthatmalariacould
betranssmittedthroughthebitesofthemosquitoes.Therewere58.41%ofthemsleepingunderbednetsduring
stayingathomewiththenightbydirectobservationmethod.Only42.79%ofthemsleepingunderbednetduring
stayinginthefieldhutsbydirectinterviewmethod.
*VinStrtKSTCTQuyNhn
162
T:0914004629
ChuynYTCngCng
NghincuYhc
Conclusion:Thereisstillhighrisksofmalariainfectioninpeoplesleepingatfieldhuts,lowproportionof
sleepingunderbednets;therefore,weshouldapplyappropriatemalariacontrolsolutionsforthosepeople.
Keywords:Malariaparasite,sleepingatfieldhuts.
TVN
Strt(SR)vntiptclvnsckhe
cacngng,nhhnglnnsckhov
thithilnvkinht,xhi(5,6).Theoboco
ca T chc Y t Th gii nm 2008, mi nm
th gii c khong 247 triu ca mc v hn 1
triu ngi cht do SR(6). Vit Nam, theo s
liu ca Vin St rtK sinh trngCn trng
Trungngnm2009c16,6%dnscnc
sng trong vng SR lu hnh. Ring min
TrungTy Nguyn c 40% dn s nm trong
vngstrtluhnh(5).Trongnhngnmqua
Chngtrnhphngchngstrt(PCSR)Vit
Namdcnhngthnhcngnhngtinhiu
vng c dn i rng ng ry nh huyn Vnh
Thnh, tnh Bnh nh cng tc PCSR vn cn
mtskhkhn,nguycmcvtvongdoSR
rtcao(1,4,3,2).
VicxcnhtlhinmcSRcngng
dn ng ry vo giai on ny l rt cn thit
cho cng tc PCSR. Hn na nh gi ng
mckinthc,thi,thchnhcangi
dnsgipchocngtctruynthnggiodc
sckhochiuquhn.Trncskhoahc
vthc tin ca hot ng PCSR, ti ny l
rtcnthitnhmccmctiusau:
Xcnhtlnhimksinhtrngstrt
cng ng dn ng ry sng ti x Vnh Kim,
huynVnhThnh,tnhBnhnhnm2010.
Tiu chun chn mu: C hot ng i ry

vnglitrongryltiuchunbtbuc,t15
tuitrlnvngthamgianghincu.
Tiuchunloitr:Nhngngikhngth
tr li phng vn, ngi bnh nng, tm thn,
cm,ic.Nhngngitchithamgianghin
cu.
Phngphpnghincu
Phngphpdchthcmt.
Thit k nghin cu ct ngang nhm xc
nh t l nhim k sinh trng st rt (KSTSR)
trong cng ng. v kin thcthi v thc
hnhvPCSR.
Cmutheocngthctnhchoiutract
ngangticngng:
n =
z 12
/2
p (1 p )
d 2
Trong 1 / 2 = 1,96 (h s tin cy vi

tincy95%),p=0,10ltltheoccnghincu
trc, d = 0,03 ( chnh xc tuyt i). Tnh
tonchoktqun=385ngi.mboc
mutithiu,bvosngitchithamgia
nghincuvqutrnhlmschsliu,tac
lng thm 5% s ngi vo c mu, cn iu
tran=400ngi.
Phngphpiutratlngmn:Quan
sttrctip.
nhgimchiubit,thivthc
hnh ca cng ng dn ng ry v phng
chngstrt.
Chnngunghin51nhdnxcnht
l ngi/mn v ng mn bng phng php
quansttrctipbanm.
ITNGPHNGPHPNGHINCU
Kthutnghincu
XVnhKim,huynVnhThnh,tnhBnh
nh.
XtnghimKSTSRtrongmubngphng
php nhum Gim sa(5). Phng vn kin thc,
thi , thc hnh v quan st st trc tip
ngidnngmn.
itngnghincu
octrongnghincu
aimnghincu
Ngidnchotngngry.
ChuynYTCngCng
Ngidncgiithchrrngmcch
nghin cu. K thut xt nghim c lm
163
NghincuYhc
ngquytrnh.Nucbnhscthamvn
iutrkpthi.
Phntchsliu
S dng phn mm Epi Info 6.04 phn
tchsliu.
Nghincuctinhnhnm2010.
KTQU
Bng1:TlnhimKSTSRtrongcngngdn
ngryVnhKim.
1
2
3
Thn S iu tra
Thn 1
Thn 2
Thn 3
Tng
131
138
147
416
KSTSR
T l % 95% CI
(+)
9
6,87 3,19-12,64
9
6,52 3,03-12,02
10
6,80 3,31-12,15
28
6,73
4,52-9,58
Kt qu iu tra 416 ngi ng ry trn 15

tuiti3thncaxnghincuchothytl
KSTSRl6,73%(95%CI:4,529,58).Tlnhim
thn 1 l 6,87%, thn 2 l 6,52%, thn 3 l
6,80%.
Bng2:Tlgiaobovlchsngngidnng
ry.
TT
Thn
1 Thn 1
2 Thn 2
3 Thn 3
Tng cng
Giao bo
Lch sng
S iu
tra S lng T l % S lng T l %
131
3
2,29
3
2,29
138
5
3,62
5
3,62
147
4
2,72
4
2,72
12
416
2,88
12
2,88
Kt qu iu tra cho thy t l nhim giao

bochungl2,88%.Tlnytithn1l2,29%,
tithn2l3,62%,tithn3l2,72%.Tllch
sngchungcangidnl2,88%.Lchsng
thn1l2,29%,thn2l3,62%,thn3l
2,72%.
Bng3:CcuKSTSRtrongcngngdnng
ry.
TT
1
2
3
Loi KSTSR
P.falciparum (P.f)
P.vivax (P.v)
Phi hp (P.f+P.v)
Tng
S lng
25
2
1
28
T l %
89,29
7,14
3,57
100%
P.falciparum chim t l cao nht 89,29%,

P.vivaxchim7,14%v3,57%phihp.
164
Kin thc ngi

TT
dn
Kt qu tr Kt qu tr li
li ng
sai
S T l % S T l %
lng
lng
Mui l nguyn nhn

257
lan truyn bnh st rt
KSTSR l nguyn nhn
2
251
gy bnh st rt
Bnh st rt c thuc
3
354
iu tr lnh bnh
1
Thigian
TT
Bng4:Kinthcngidnngryvnguyn
nhntruynbnh.
61,78
159
38,22
60,34
165
39,66
85,10
62
14,90
Ktquphngvnchothyc61,78%trli
ngnguynnhnlantruynbnh SR, 60,34%
tr li ng nguyn nhn gy bnh do KSTSR,
v85,10%ngidnbitrngbnhSRcthuc
iutrlnhbnh.
Bng5:Thingidnngryvbnhvbin
phpphngbnhSR.
Thi chp Thi khng
nhn
chp nhn
S
%
S
%
lng
lng
1 Bnh SR nguy him 319 76,68
97
23,32
Nm ng mn phng
2
bnh SR
356 85,58
60
14,42
Phun ha cht phng
3
bnh SR
371 89,18
45
10,82
Thi ngi
TT
dn
Kt qu trn cho thy c 76,68% cho rng

bnhSRnguyhimnconngi,85,58%cho
ngmnsngacSR,89,18%nging
phunhochtditmuisphngngamcSR.
Bng6:Thchnhngmncangidnngry.
TT
Thc hnh ng
mn
Ng mn
Khng ng mn
S
%
lng
%
S lng
Ng mn khi nh
347
83,41
69
16,59
Ng trong mn khi i
ry
178
42,79
238
57,21
T l ngi dn ng mn khi nh chim

83,41%, nhng khi i ry t l c ng mn
thngxuynchl42,79%.
Bng7:Tlngmnquaquansttrctipban
mkhinh.
TT
1
2
Ch s
S h quan st
S khu
S lng
51
214
T l
4,20 ngi/h
(214/51)
ChuynYTCngCng
3
S mn
76
S ngi ng
trong mn
125
2,81 ngi/mn
(214/76)
58,41% ng trong
mn
Tlngidnthctngmnquaquan
st trc tip chim 58,41% thp hn khi phng
vn (60,58%). T l mn trong dn trung bnh
2,81ngi/mn.
Bng8:Thchnhkhinghingmcstrtca
ngidnngry.
TT
Thc hnh ngi dn
1
2
3
4
5
n c s y t
T iu tr
n y t t nhn
Dng thuc dn gian
Cng bi
Tng s
S lng
238
65
47
21
45
416
%
57,21
15,63
11,30
5,05
18,67
100,00
Khinghingbnthnb st rt ngi dn
n c s y t chim 57,21%, hoc n y t t
nhn(11,30%).Tuynhin,cchnhvikhcca
ngi dn khi c du hiu nghi ng b st rt
cn kh cao: t iu tr (15,63%), dng thuc
dngiannh(5,05%)v18,67%cngbi.
BNLUN
V t l mc st rt trong cng ng dn
ngryxVnhKim
Kt qu iu tra ngi dn c hot ng
ngrytixnghincuchothytlKSTSR
l 6,73%. Nghin cu v nhim KSTSR ca
ngidnngrytihuynVnhLinh,Qung
Trchothytlnhiml6,95%.Mtsiutra
t 20032004 ti cc im c dn i rng, ng
rychothytlnhimcngrtcao:NgcLy
(KonTum)l8,85%;IaO(GiaLai)l7,08%,Sn
Thi(KhnhHo)l29,77%,Thanh(QungTr)
l6,77%(4,3,2).
Nhngktquiutranychothy,ngi
dnirngngrycnguycmcstrtcao
hn nhng i tng khc v cc bin php
PCSR thng quy cho thy cha c hiu qu
cng nh ngi dn cha c thc cao v t
bovkhiivorng,ry.Victlngmn
thpcngchngminhthmchokinny.C
cu KSTSR ti cc im ny ch yu vn l
ChuynYTCngCng
NghincuYhc
P.falciparum chim u th 89,29%, sau n

P.vivaxchim7,14%.CcuP.falciparumuth
cng ph hp vi c cu loi cc vng khc
cakhuvcminTrungTyNguyn(5).
Kt qu iu tra cho thy t l mang giao
bo ti im nghin cu l 2,88%. Giao bo l
thKSTSRmcdkhnggystnhnglth
lmlantruynbnhtrongcngngkhics
hin din ca cc loi mui st rt. T l lch
sngquaiutrangidnngryl2,88%.
Lchsnglduhiuthngikmvibnh
strt.
VKinthcThiThchnhphng
chngstrt
C 61,87% ngi dn tr li ng nguyn
nhn truyn bnh l mui, 85,10% ngi dn
bitbnhstrtcthuciutrlnhbnh.Tuy
nhinchc60,34%ngidnbitnguynnhn
gybnhstrtldoKSTSR.iunychothy
cn nng cao cht lng v hiu qu ca hot
ng truyn thng gio dc sc khe hn na
trong thi gian n cho i tng nguy c cao
ny. Ngoi ra t l ny thp c th do phng
php truyn thng cha hp l trong khi kh
nngtipthucangidnnhngvngsu
vngxanhthnycnhnch.
iutrachothy76,68%ngidncthi
xembnhstrtlnguyhimvitnhmng
caconngicnphiphng chng. H cng
c thi chp nhn v ng thc hin cc
binphpphngchngstrtvitlkhcao:
thi chp nhn v ng mn phng st rt
(85,58%), thi chp nhn phun thuc dit
mui(93,99%).
Thc hnh v ng mn khi nh: c
83,41% ngi dn tr li c nm mn thng
xuynkhinhv42,79%ngtrongmnkhi
i ry. C mt khong cch kh xa gia thi
hng ng ng mn ca ngi dn
(83,41%)sovithctngmn58,41%(quan
sttrctipbanmngidnngmn).Vi
phng php quan st trc tip th chnh
xccaohn,iunycngharngtlng
mntrongdnvncnthp.
165
NghincuYhc
y l vn rt ng quan tm, bi v
hnh vi khng ng mn nh v ry l iu
kinhtscthunlichosnhimbnh,cng
nhlmchocngtcPCSRcaaphnggp
rtnhiukhkhn.
C57,21%itngncsytkhinghi
ngmcbnhstrt.ylhnhvittrtcn
duytrvlmchongidntintnghnna.
Tuynhin,vncnmtsngidnchncch
t iu tr (15,63%), n y t t nhn (11,30%),
c bit l vn cn cng bi khi b bnh
(18,67%).Mcdtlcngbikhngcaonh
trc y nhng cng cn p dng cc bin
phptruynthnggiodcsckhengi
dn hiu r hn v nguyn nhn, cch phng
bnhvcchiutrbnh.
KTLUN
T l nhim k sinh trng st rt cng
ngdnngryxVnhKim
T l nhim k sinh trng st rt l 6,73%
(95%CI:4,529,58),tlnhimthn1l6,87%,
thn2l6,52%,thn3l6,80%.
Tlnhimgiaobol2,88%.Tlnyti
thn1l2,29%,tithn2l3,62%,tithn3l
2,72%.Tllchsngca ngi dn l 2,88%.
Lchsngthn1l2,29%,thn2l3,62%,
thn3l2,72%.
Loi P.falciparum chim t l cao nht
89,29%,P.vivaxchim7,14%v3,57%phihp.
Kin thc Thi Thc hnh cng

ngdnngryxVnhKim
Bitmuilnguynnhnlylanbnhstl
61,87%,bitcksinhtrngstrtlnguyn
nhngybnhl60,34%,bitcbnhstrt
cthiutrlnhcl85,10%.
Ngi dn chp nhn ng mn s ngn
nga c st rt l 85,58%; ngi dn chp
nhn phun ho cht dit mui phng bnh st
rtl89,18%v76,68%chorngbnhSRnguy
himnconngi.
Ng mn thng xuyn qua quan st trc
tipkhi nh 58,41%, tr li nm mn thng
xuynkhiinngry42,79%.
Khi nghi ng bn thn b st rt 57,21%
ngidnncsytckhmviu
tr bnh, t iu tr (15,63%), n y t t nhn
(11,30%),dngthucdngiannh(5,05%)v
18,67%cngbi.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
B Y t (2009). Hng dn chn on v iu tr st rt. Q

4605/QBYT,24/11/2009,HNi,tr.110.
HVnHong(2003).cimdchthctvongdostrt
tikhuvcminTrungTyNguynnm2003.TpchYhc
thchnh,s477/2004,tr.3946.
HVnHong(2004).Thctrngvnguycgiatngstrt
cngngdndictdotnhakLaknm2003.TpchY
hcthchnh,s477/2004,tr.3642.
HVnHong(2006).Dictdo,ngryvnguycgiatng
strtcctnhminTrungTyNguyn.TpchYhcthc
hnh,s3(537)/2006,tr2327.
Vin St rt KSTCT TW (2012). Hi ngh tng kt cng tc
phng chng st rt nm 2011 v trin khai k hoch PCSR
2012.
WHO(2008).WorldMalariareport2008,pp:12.
166
ChuynYTCngCng
NghincuYhc
TLNHIMKSINHTRNGSTRT,THCTRNGMN
VSDNGMNCNGNGDNXEALP,HUYNEASOUP
TNHDAKLAKNM2011
TMTT
tvn:tcmctiugimcht,gimmcdostrtmttrongnhnggiiphputinhng
ulngmnphngchngstrt.Vicnhgithctrngmnvsdngmncangidnsgipcho
viclpkhochphngchngstrt.
Mctiu:XcnhtlnhimksinhtrngstrtcngngdnsngtixEaLp,huynEaSoup,
tnhDakLaknm2011vnhgithctrngmnvsdngmncangidntrongphngchngstrt.
Phngphpnghincu:Nghincuctngangmt,iutratlnhimksinhtrngstrt,khost
thctrngmnvsdngmncangidnxEaLphuynEaSoup,tnhakLaknm2011.
Ktqu:TlnhimksinhtrngstrtngidnxEaLpl6,15%;trongP.falciparumchim
uthvi79,17%.Tlngi/mntixnghincul2,3.Tlmnctmhachtchim97,37%.Tl
ngidnngmnchim88,46%,sngikhngngmnchim11,54%.Tlmncthngvrchchim
50%.Tlmncboqunngchimtl42,11%.
Ktlun:Truynthnggiodcngidnngmnvboqunmnngnngcaohiuquphng
chngstrt.
Tkha:Ksinhtrngstrt,mn.
ABSTRACT
THEPROPORTIONOFMALARIAPARASITEINFECTION,THESITUATIONOFBEDNETSAND
THEUSAGEOFTHEBEDNETSATTHECOMMUNITYOFEALOPCOMMUNE,EASOUP
DISTRICT,DAKLAKPROVINCE2011
Background:Inordertoachievethetargetsofreducingmalariamortalityandmorbidity,sleepingunder
bednetsformalariacontrolisoneofthetoppriorities.Theevaluationofbednetstatusandpeoplesbednetusage
willbehelpfulformakingmalariacontrolplans.
Objectives:ToidentifytheproportionofmalariaparasiteinfectioninthecommunityresidinginEaLop
commune, Ea Soup district, Dak Lak province in 2011 and to evaluate the bednet situation and usage of the
peopleformalariacontrol.
Methods:Crosssectionaldescriptivestudy,investigatingmalariaparasiteinfectionrate,surveyingbednet
situationandusageofthepopulationsinEaLopcommune,EaSoupdistrict,DakLakprovincein2011.
Result:TheproportionofmalariaparasiteinfectioninEaLopcommunewas6.15%;ofwhichP.falciparum
infectiondominatedwith79.17%.Theproportionofperson/bednetinthestudycommunewas2,3.Thebednets
treated with insecticides accounted for 97.37%. The rates of inhabitants sleeping under bednets and sleeping
*VinStrtKSTCTQuyNhn
ChuynYTCngCng
T:0914004629
167
NghincuYhc
withoutbednetswere88.46%and11.54%,respectively.Thetornbednetsoccupied50%.Theproportionofwell
preservedbednetswas42.11%.
Conclusion:Increasingratesofbednetusageandproperbednetmaintenancethroughhealthinformation,
communicationandeducationtoenhancetheeffectivenessofmalariacontrol.
Keywords:Malariaparasite,bednet.
TVN
Mc d t l mc bnh st rt (SR) gim
nhngnguyctvongdostrtcngng
dnsngtrongvngstrtluhnhnngvn
rt cao, bng pht st rt c th xy ra nu
khngphngchngstrt(PCSR)mtcchc
hiuqu(6,7).ChngtrnhPCSRVitNamd
c nhng thnh cng ng k nhng ti khu
vcMinTrungTyNguyn(MTTN)cngtc
PCSR vn cn mt s kh khn(5). t c
mc tiu gim cht, gim mc, khng ch dch
SR,mttrongnhnggiiphputinhngu
lngmnctmhachtPCSR.Vicxcnh
tlhinmcSRcngnhnhgithctrng
mnvsdngmncangidnsgipcho
phng chng SR t hiu qu hn. Trn c s
khoahcvthctincngtcphngchngst
rt ti: T l nhim k snh trng st rt,
thc trng mn v s dng mn cng ng
dn x Ea Lp, huyn Ea Soup tnh Dak Lak
nm 2011 l rt cn thit nhm cc mc tiu
sau:
Xcnhtlnhimksinhtrngstrt
cng ng dn sng ti x Ea Lp, huyn Ea
Soup,tnhDakLaknm2011.
nh gi thc trng mn v s dng mn
cangidntrongphngchngstrt.
ITNGPHNGPHPNGHINCU
aimnghincu
XEaLp,huynEaSoup,tnhakLakl
vngstrtluhnhnng.
itngnghincu
NgidnvmnctrongdnxIaLp.
Thigian
Nghincuctinhnhnm2011
168
Phngphpnghincu
Phngphpnghincudchthcmt.
Thitknghincuctngangxcnhtl
nhimksinhtrngstrt(KSTSR).
C mu theo cng thc tnh cho iu tra
ngangcngng(4).
z 12 / 2 p ( 1 p )
n =
d2
Trong:nlcmucnchonghincu.Z
(1/2) = 1,96. p = 0,10 l t l theo cc nghin
cutrc.d=0,03(saistuyti).Tnhton
choktqun=385ngi.
iviiutrasdngmnchiutras
ngitrn15tui.Phngvnttchgianh
cchntrongnghincu ngang iu tra
thctrngmnvsdngmn.
Kthutnghincu
K thut xt nghim lam mu tm KSTSR
trongmu.
Kthutkhmvkpnhitnch.
Kthutphngvntrctip,iutrahgia
nh.
Phntchsliu
SliucxlbngphnmmSTATA
8.0.
KTQU
Bng1:TlmcnhimKSTSRcngngdn
sngtixEalp.
TT Thn S iu tra KSTSR (+) T l %
1 Thn 1
2 Thn 2
3 Thn 3
Tng cng
128
130
132
390
7
9
8
24
5,47
6,92
6,06
6,15
95% CI
2,23-10,94
3,21-12,74
2,65-11,59
3,98-9,02
Ktquiutra390ngidnxEaLp
cho thy t l KSTSR l 6,15% (95% CI: 3,98
ChuynYTCngCng
9,02). T l nhim thn 1 l 5,47%, thn 2 l
6,92%,thn3l6,06%.Trongs24trnghp
KSTSR(+)c19trnghpnhimP.falciparum,
chimtlcaonht79,17%;4trnghpnhim
P.vivaxchim16,67%;v4,17%nhimphihp
(P.f+P.v).
Bng2:Tlgiaobovlchsngcngngdn.
Giao bo
S iu
TT Thn
S lng
tra
T l
(SL)
1 Thn 1
128
4
3,13
2 Thn 2
130
6
4,62
3 Thn 3
132
4
3,03
Tng cng
390
15
3,85
Lch sng
S
T l
lng
2
1,56
3
2,31
2
1,52
5
1,28
Kt qu iu tra cho thy t l nhim giao

bo l 3,85%. T l ny ti thn 1 l 3,13%, ti
thn 2 l 4,62%, ti thn 3 l 3,03%. T l lch
sngcangidnl1,28%.Lchsngthn
1l1,56%,thn2l2,31%,thn3l1,52%.
Bng3:TlnhimKSTSRtheogiitrongcng
ng.
TT
1
c im
Gii
Nam
N
198
192
14
10
7,07
5,21
05
136
4,41
142
112
242
8
10
18
5,63
8,93
7,44
148
4,05
186
14
7,53
204
10
4,90
2 La tui > 5 15
> 15

3 Dn tc
Khc
4
Hot
ng
S iu tra KSTSR (+) T l %
i rng,
ng ry
Khc
TlnhimKSTSRnaml7,07%,vn
l 5,21%. T l nhim KSTSR tr 05 tui l
4,41%, t 515 tui l 5,63% v trn15 tui l
8,93%. T l nhim KSTSR ngi l
7,44%,vccdntckhcl4,05%.Ngic
i rng ng ry t l nhim KSTSR l 7,53%;
nhm ngi khng c hot ng ny nhim
4,90%.
Bng4:Loikchcmnctrongdnimiu
tra.
TT
Thn
Tng
s mn
1
2
Thn 1
Thn 2
60
64
Mn i
SL
48
50
%
85,71
87,72
ChuynYTCngCng
Mn n
SL
12
14
%
14,29
12,28
Thn 3
Tng
NghincuYhc
66
190
52
150
91,23
78,95
14
40
8,77
21,05
Phntch190mniutratrong390ngi
dntixnghincuchothyc150mni
chim 78,95%, mn n c 40 chic chim
21,05%.
Trong190mnc31mnngidntmua
chim 16,32% v 159 mn do D n Qu ton
cu cp chim 83,68%. Phn tch mu ca mn
iutrachothyc167mncmuxanhchim
87,89%v23mncmutrngchim12,11%.
Bng5:Tlmnvngmntrongcngngdn.
TT
Ni dung
S lng
1
2
3
4
S h iu tra/s khu
S mn (quy thnh i)
T l ngi/mn
S ng mn
96/390
170
2,3
345
88,46
S khng ng mn
45
11,54
Phntchsmnctrong86hiutracho
thytlngi/mntixnghincul2,3.S
ngi dn ng mn chim 88,46%, s ngi
khngngmnchim11,54%.
Bng6:Sosnhtlngmncaccnhmdntc.
TT
1
2
Dn tc

Khc
Tng
iu tra
242
148
390
Ng mn
207
138
345
T l %
85,54
93,24
88,46
Kt qu iu tra ng mn ngi dn ti x
nghin cu cho thy t l ng mn nhm
ngil85,54%,tlngmnnhmdn
tckhccaohnl93,24%.
Bng7:Mcchsdngmncangidnti
imnghincu.
TT Thn
iu
tra* treo ng
S dng mn
Khng s
p
Bt c
dng
1 Thn 1
88
74 84,09 2 2,27
7,95 1 1,14
2 Thn 2
75
65 86,67 3 4,00
6,67 2 2,67
3 Thn 3
82
70 85,37 3 3,66
7,32 3 3,66
Tng
245 209 85,31 8 3,27 18 7,35 6 2,45
*(>15tui)
Kt qu iu tra cho thy c 85,31% ngi
tr li dng mn treo ng, 3,27% ngi dng
169
NghincuYhc
mn p, 7,35% khng s dng mn v 2,45

ngicsdngmnbtc.
Bng8:Tlmnrchvhngtrongdn.
TT
1
2
3
Thn
S mn
Thn 1
Thn 2
Thn 3
Tng
60
64
66
190
Mn rch v
hng
29
37
29
95
Bng12:Tlmnctmhachtphngchng
nhimstrt.
TT
T l %
48,33
57,81
43,94
50,00
1
2
3
Dn tc
Thn 1
Thn 2
Thn 3
Tng
S mn
60
64
66
190
S mn c
tm ha cht
57
63
65
185
T l %
95,00
98,44
98,48
97,37
Kt qu trn cho thy s mn c thng v

rchchim50%smniutra.
Tlmnctmhachtchim97,37%.
T l mn c tm ha cht thn 1 l 95%,
thn2l98,44%vthn3l98,48%.
Bng9:Hnhthcmnhngtrongdn.
BNLUN
S Thng
TT Thn
mn
1 Thn 1 60
2 Thn 2 64
3 Thn 3 66
Tng
190
SL
12
15
9
36
%
20.00
23.44
13.64
18.95
Rch
SL
6
8
6
20
%
10.00
12.50
9.09
10.53
Mt 1 Rch
mng gc
mn
mn
SL
4
3
2
9
%
6.67
4.69
3.03
4.74
SL
9
11
12
32
%
15.00
17.19
18.18
16.84
Phn tch s mn hng trong dn cho thy

trongs190mnc18,95%mnthng,10,53%
mn rch, 4,74% mn c mng rch v 16,84%
mncrchgcmn.
Bng10:Dintchlthngvmngrchcamn.
Loi
hng
TT
1 L thng
2 Mng rch
S
Trung bnh Trung bnh din
S l
mn
l thng tch thng/mng
thng
2
rch (cm )
thng / rch (mng
lch
rch/mn
/ rch
36
9
72
17
2,00
1,89
9,917,80
17,183,15
Ktquphntchchothytrungbnhc2l
thng/mncthngvidintchlthngtrung
bnh9,91cm2.ivimngrch,trungbnhc
1,89 /mn c mng rch, trung bnh din tch
mngrchl17,18cm2.
Bng11:Tlboqunmnngcangidn.
TT Thn
S
mn
1 Thn 1
2 Thn 2
Bo qun ng
60
SL
26
%
43,33
64
26
40,63
Bo qun sai
SL
%
34
56,67
38
59,38
3 Thn 3
66
28
42,42
38
57,58
Tng
190
80
42,11
110
57,89
Kt qu iu tra cho thy c 80 mn c

bo qun ng chim t l 42,11% v 57,89%
mnboqunkhngng.
170
V t l nhim KSTSR trong cng ng

dnxEaLp
Ktquiutraxnghincuchothytl
KSTSRl6,15%.TlnhimKSTSRcciu
traticngngdntixnycaohnnhiu
so vi t l nhim chung ca khu vc MTTN
ch1,14%(nm2010)v0,90%(nm2011)cng
nh ti cc cng ng dn sng c nh trong
vng st rt lu hnh(5). T l nhim KSTSR
ycaohncthldocnhiungidn
x ny c hot ng i rng ng ry. Nghin
cu v nhim KSTSR ngi dn ng ry ti
QungTrchothytlnhiml6,95%(1).Mt
s iu tra t 20032004 ti cc im c dn i
rng,ngrychothytlnhimrtcao:Ngc
Ly(KonTum)l8,85%,IaO(GiaLai)l7,08%,
SnThi(KhnhHo)l29,77%,Thanh(Qung
Tr)l6,77%(2).CcbinphpPCSRthngquy
cha c hiu qu v ngi dn cha c thc
cao v t bo v khi i vo rng, ry. Kt qu
iu tra cng cho thy nhm ngi c hot
ng i rng ng ry t l nhim KSTSR l
7,53%,nhmngikhngchotngnych
nhim4,90%.
TlnhimKSTSRcaonhtngitrn15
tui l 8,93%. iu ny c gii thch do i
tng ny thng xuyn c cc hot ng i
rngngry.
V t l nhim theo dn tc, t l KSTSR
nhmngil7,44%,tlnhimKSTSR
nhm dn tc khc thp hn ch chim 4,05%.
iunyldokinthcvthchnhtbov
ChuynYTCngCng
PCSRcanhmdncnhnch.Ktqu
phntchchothytlngmncangidn
ch chim 85,54% so vi 93,24% ngi
nhmkhc.
CcuKSTSRtiimny ch yu vn l
P.falciparum chim u th 79,17%, sau n
P.vivaxchim16,67%.CcuP.falciparumuth
cng ph hp vi c cu loi cc vng khc
cakhuvcMTTN(giaion20062010,vc
cu KSTSR khu vc ny th P.falciparum vn
chimuthvitlt76,45%n85,28%)(5).
T l nhim giao bo ca ngi dn l
3,85%.GiaobolthKSTSRmcdkhnggy
stnhnglthlmlantruynbnhtrongcng
ng. V vy trong phc iu tr cn ch
ccthucditthgiaobohnchlylantrong
cngng,nhtlkhicsgiatngmtcc
loimuistrt,cnguycxydch.
Thctrngmnvsdngmncangi
dn
Phntchsmniutrachothymni
chimphnln78,95%.Vicsdngmnn
trong cng ng dn hin nay thp hn mn
i.Hinnay,xEaLpcDnQuton
cu h tr v mn PCSR. Tuy nhin cng c
6,32% s mn do ngi dn t mua b sung
trong qu trnh s dng. V mu sc, cho thy
c mn mu xanh chim a s vi 87,89% v
mnmutrngchchim12,11%.
Tlngi/mntixnghincul2,3.V
l tng th mi ngi mt mn n hoc 2
ngi/mn i nhng vi t l 2,3 ngi/mn
cngpngcsbovcangidnkhi
ng mn trnh mui t. Mt s iu tra khc
cho thy t l ngi/mn l 2,65 ti x Thanh
(Qung Tr); 2,71 ti x Tr Don (Qung Nam)
v2,73tixIaO,GiaLai.Soviccxnyth
t l ngi/mn ca Ia Lp m bo hn, c
nghalmtmnbaophcho2,3ngi(3).
Tuynhiniuquantrnglngidnc
ngtrongmnhaykhng.Ktquiutracho
thysngingmnchim88,46%,skhng
ng mn chim 11,54%. Kho st ti Hng
ChuynYTCngCng
NghincuYhc
Ha,DakRng(QungTr)cngchothytl
ngmncngchtdi75%.Nghincuti
NamTrMynm2001tlngi/mnl3,29,
t l treo mn 32,68%(3). Nh vy mc d t l
mn c tng cao nhng thi quen ng trong
mn vn cha tng, mt trong nhng nguyn
nhnlmchotnhhnhstrtphctp.
Vsdngmn,chc85,31%ngitrli
dngmntreong,3,27%ngidngmnp,
7,35%khngsdngmnv2,45ngics
dngmnbtc.Vicdngmnbtchoc
khng dng hn ch hiu qu s dng ca
mnchngmui.Vicboqunmncvaitr
rtquantrngtrongvickodituithvkh
nngsdngcamn.Trongiutranymn
c thng v rch chim 50% do vic bo qun
khng c tt (57,89% mn bo qun khng
ng chim t l). Phn tch cng cho thy
nhngngikhngngmnvngstrtc
nguy c nhim st rt gp 15,13 ln so vi
nhng ngi thng xuyn ng mn, s khc
bitcnghathngkvip<0,001.
KTLUN
T l nhim k sinh st rt trong cng
ngdnxEaLp
T l nhim k sinh trng st rt ngi
dnxEaLpl6,15%.
Nam gii nhim KSTSR 7,07%, t l nhim
KSTSRnl5,21%.
TlKSTSRtr05tuil4,41%,515tui
l5,63%v>15tuil8,93%.
TlKSTSRngil7,44%,nhm
dntckhcl4,05%.
Ngi c hot ng i rng ng ry t l
nhim KSTSR l 7,53%, nhm ngi khng c
hotngnynhim4,90%.
T l lch sng ngi dn l 1,28%; t l
giaobol3,85%.
LoiP.falciparumchimu th vi t l cao
nht 79,17%, P.vivax chim 16,67% v 4,17%
nhimphihp(P.falciparum+P.vivax).
171
NghincuYhc
Thc trng mn v s dng mn PCSR

ngidnxIaLp
Tlmnil78,95%,mnnl21,05%.
Mnngidntmual16,32%vdoD
ncpchim83,68%.
T l mn c mu xanh chim 87,89% v
mutrngchim12,11%.
Tlngi/mntixnghincul2,3.T
l ngi dn ng mn chim 88,46%, s ngi
khngngmnchim11,54%.
Tlngmnnhmngil85,54%,
t l ng mn nhm dn tc khc cao hn l
93,24%.
T l mn c thng v rch chim 50%;
trong 18,95% mn thng, 10,53% mn rch,
4,74%mncmngrchv16,84%mncrch
gcmn.
Tlmncboqunngchimtl
42,11%;57,89%mnboqunkhngng.
nhm iu tr sm v lm gim t l hin mc

trongcngngdn.
Tngcngtruynthnggiodcsckho
vchngtrnhphngchngstrt,tptrung
vohnhthctrctipthngquanhnvinyt
nhm nng cao hn na t l ng mn v bo
qunmntrongdn.
TILIUTHAMKHO
1.
2.
3.
4.
5.
Tlmnctmhachtchim97,37%.
Ngi khng ng mn vng st rt c
nguy c nhim st rt gp 15,13 ln so vi
nhngngithngxuynngmn(p<0,001).
6.
7.
onHnhNhn,NngThTin(2007).Mtsyutxhi
hc lin quan dn lan truyn st rt dai dng 2 huyn Dak
Rng,HngHatnhQungTr.Tpchphngchngbnh
st rt v cc bnh k sinh trng, Vin st rt KSTCT Trung
ng,s4/2007,tr.1016.
strtcctnhminTrungTyNguyn.Tpchyhcthc
hnh,s3(537)/2006tr.2327.
HVnHong,TriuNguynTrung(2011).Nghincuyut
nguycmtsxcstrtdaidngticctnhQungTr,
Qung Nam, Gia Lai v p dng mt s bin php nng cao
hiuquphngchngbnhstrt.Tpchyhcthchnh,s
796)/2011,tr.1620.
TrngihcYHNi(1999).Dchthcvthngkng
dngtrongNCKH,tr.98114.
VinstrtKSTCTQuyNhn(2011).nhgicngtcphng
chng st rt 20062010, nh hng k hoch 2011, khu vc
min Trung Ty Nguyn. Vin st rt KSTCT Quy Nhn,
2011.
VinstrtKSTCTTW(2011).TngktcngtcPCSRvgiun
sn20062010vtrinkhaikhoch2011.
WHO(2009).MalariaReport,pp.2728
KINNGH
Tchchthnggimstthngquypht
hinKSTSR,chngqunlcccamcstrt
172
ChuynYTCngCng
NghincuYhc
THCTRNGBNHSTRTVMTSYUTNHHNGN
PHNGCHNGSTRTTIVNGBINGIIVITLO
HUYNHNGHA,TNHQUNGTRNM2010
TMTT
tvn:Strtbingiilmtvncpthitcnnhgicbinphpcanthipnhmgimtl
mcvchtngidnsngtivngbingii.
Mctiu:nhgithctrngbnhstrttivngbingiiVitLohuynHngHa,tnhQungTr
vmtmtsyutnhhngnphngchngstrtvngbingii.
Phngphpnghincu:Nghincuctngangmtdchthc.
Ktqu:TlnhimksinhtrngstrtticngngdnvngbingiiVitLol4,22%.Tlng
mncangidnvngbin gii cn thp, chim 72,10%. T l n c s y t khm xt nghim 61,19%
89,87%.Sngigiaolubingiinhnthuctiutr60,20%75,15%.Ngmntrongqutrnhgiaolu
quabingii52,74%59,39%.Ngicgiaolubingiinhimstrtcaogp5,37lnngikhnggiaolu
bingii(p<0,001).
Kt lun:NguycmcstrtngidnvngbingiiVitLortcao,cnpdngccbinphp
phngchngstrttchccgimmcvchtdostrttivngbingii.
Tkha:Strtbingii.
ABSTRACT
MALARIASITUATIONANDSOMEFACTORSAFFECTINGMALARIACONTROL
ALONGVIETLAOBORDERINHUONGHOADISTRICT,QUANGTRIPROVINCEIN2010
Background: Border malaria is one of the urgent problems which need to be evaluated and applied
interventionalmeasurestoreducemorbidityandmortalityforpeoplelivingintheborderarea.
Objectives:ToevaluatemalariasituationintheborderareaofVietLaoinHuongHoadistrict,QuangTri
provinceanddescribesomefactorsaffectingmalariacontrolinVietLaoborderarea.
Methods: A crosssectional descriptive study was conducted to identify the infection rate of malaria
parasitesandtoanalysesomeriskfactorsformalariainfectioninthecommunityalongVietLaoborder.
Result:TheproportionofmalariaparasiteinfectioninVietLaoborderareawas4.22%.Theproportionof
borderpeoplesleepingunderbednetswasstilllow,accountedfor72.10%.Thepatientsgoingtohealthfacilities
for medical examination occupied from 61.19% to 89.87%. The rate of bordercrossing people receiving
antimalarial drugs for selftreatment was 60.20%75.15%. The people sleeping under bednets when crossing
bordermadeup52.74%59.39%.Thepeoplewhocrossborderwere5.37timesmorelikelytogetinfectedwith
malariathanthosewhodonot(p<0.001).
Conclusion:TheriskofmalariainfectioninthecommunityalongVietLaoborderwasveryhigh,soitis
necessarytoapplyactivemalariacontrolmeasurestoreducemortalityandmorbidityduetomalariaintheboder
*VinStrtKSTCTQuyNhn
ChuynYTCngCng
T:0914004629
173
NghincuYhc
area.
Keywords:Bordermalaria.
TVN
So snh vi khu vc khc, chng trnh
phng chng bnh st rt ca min TrungTy
Nguynvncnnhiuthchthc,cbitcc
vng bin gii VitLo. Ti khu vc bin gii
viLo,giaolucadnckhuvcbingii
thngxuynxyratiynnvickimsot
bnhrtkhkhn(4,5).Ticcvngny,ccbin
php phng chng st rt thng quy cha
manglihiuqucao,sbnhnhnstrtvn
duytrvisgimkhngngktrongnhiu
nmnhHngHa,tnhQungTr(2).
t c cc mc tiu ny cn c nh
hng u tin tm cc gii php thch hp cho
nhng vng bin gii v xut p dng cc
binphphiuqunhmduytrthnhqu
t c, vic tin hnh ti ny l rt cn
thitnhmccmctiusau:
nh gi thc trng bnh st rt ti vng
bin gii VitLo huyn Hng Ha, tnh
QungTrnm2010.
Mtmtsyutnhhngnphng
chngstrtvngbingiiVitLo.
I TNG
NGHINCU
PHNG
PHP
aimnghincu
Huyn Hng Ho, tnh Qung Tr l mt
huyn st rt nng gm 22 x, dn s 75.000
ngi; trong 11 x bin gii 2 nc Vit Lo
chn3x:Thanh,Xy,LaoBocnhiudngiao
lu qua bin gii nhiu nn tnh hnh st rt
lunlunbinngphctpnghincu.
itngnghincu
Ngidnsngti3xXy,Thanh,LaoBo.
NgiLosangtmtrhocgiaolusangVit
Nam.Ksinhtrngstrt(KSTSR).
Mui Anopheles, sinh cnh vng nghin

cu.Ytthnbnvx.
Thigiannghincu
Nm2010.
Phngphpnghincu
Phngphphicu.
Hi cu s liu bnh nhn st rt (BNSR),
strtctnh,tvongstrtticcxnghin
cut20062010.
Phngphpmtdchthc
Thit k nghin cu ct ngang m t xc
nhtlmcbnh,KSTSR,giaobo,lchsng.
C mu theo cng thc nghin cu ct
ngang(3).
n=
z12 / 2 p q
d2
Trong:vi=0,05,thZ(1/2)=1,96.pl
tlKSTSRngidnvngbingiimin
TrungTy Nguyn khong 10%, q =(1 p)=1
0,10= 0,90. d: chnh xc tuyt i, chn
d=0,03. Tnh ton, nghin cu cn s mu 385
ngi,bsungchocctrnghpkhngthu
thp c s liu, cng thm 10% vo mu, v
vymixcniutra430ngi.
Cckthutnghincu
KthutxtnghimmutmKSTSR.
K thut khm lm sng pht hin st v
lchsng.
Kthutphngvn,quanst.
Phntchsliu
SdngphnmmSTATA8.0phntch
sliu.
KTQU
174
ChuynYTCngCng
NghincuYhc
Bng1:Dinbinmcstrttheoccthngt20062010ticcxbingii.
Thng
X
Xy
Thanh
Lao Bo
Trung bnh
7,40
10,00
lch
4,93
Trung bnh
11
12
13,60 13,40 20,40 24,80 24,20 23,40 31,20 37,20
18,60
11,00
4,58
4,39
16,16
9,58
3,32
6,40
7,20
11,20 14,40 17,60 18,20 11,80 18,80 22,00 24,80
21,60
7,60
lch
1,67
2,05
2,17
5,08
4,77
3,83
0,45
2,86
4,06
3,27
11,76
2,07
Trung bnh
6,00
6,20
10,00
7,80
9,00
8,40
7,40
12,80 12,20
9,80
6,80
5,80
lch
1,00
1,10
1,22
1,64
5,29
1,82
1,14
0,84
6,72
2,49
1,79
3,58
3,29
2,17
2,05
6,99
10
5,93
2,77
Phn tch s BNSR theo cc thng trong 5

nm 20062010 ti 3 x bin gii cho thy mc
strtxyraquanhnm,c tt c cc thng
nhng tng cao vo cc thng 8910 to thnh
nhcaocamabnhstrttrongnm.
Kt qu iu tra ct ngang cho thy t l

bnhnhnstrtl4,36%,nhimKSTSR3x
bingiil4,22%.TrongtlKSTSRxXy
l 4,79%; x Thanh l 4,04% v x Lao Bo l
3,85%.
Bng2:TlmcbnhvnhimKSTSRticcx
bingii.
Tlgiaobo3xl2,37%(CI95%:1,62
3,33).TlgiaoboxXyl1,42%;xThanh
l2,24%;xLaoBol2,14%.
TT
S
khm
1
Xy
2 Thanh
3 Lao Bo
Tng
438
446
468
1352
BNSR
SL
22
19
18
59
KSTSR
%
5,02
4,26
3,85
4,36
SL
21
18
18
57
%
4,79
4,04
3,85
4,22
CI95%
2,99-7,24
2,41-6,30
2,30-6,01
3,21-5,43
Phn tch c cu KSTSR cho thy loi

P.falciparum chim u th n 75,44%; P.vivax
chim21,05%vphihpchim3,51%.
Bng3:PhnbnhimKSTSRtheoitngccxnghincu.
TT
KSTSR (+)
1
2
3
Xy
21
18
18
57
Thanh
Lao Bo
Tng
Ti ch
S lng (SL)
10
8
8
26
C sang Lo
%
47,62
44.44
44,44
45,61
SL
4
4
3
11
%
19,05
22,22
16,67
19,30
Ngi Lo
SL
6
4
5
15
%
28,57
22,22
27,78
26,32
X khc
SL
1
2
2
5
%
4,76
11,11
11,11
26,98
Phntchktquiutractngangchothytrongs57KSTSRc45,61%nhimtich,19,30%
nhimngiVitcgiaolusangLov,26,32%lngiLosangVitNamv26,89%lngit
ccxkhcn.
ngi i theo ng tiu ngch, ch c 26,92%
Bng4:NhimKSTSRtheonggiaoluccx
nhimKSTSRquangcakhu.
nghincu.
TT
1
2
3
Nm
Xy
Thanh
Lao Bo
Tng
KSTSR
(+)
10
8
8
26
Khng qua ca
Ca khu c
khu (Tiu
kim sot
ngch)
SL
%
SL
%
8
80,00
2
20,00
5
62,50
3
37,50
6
75,00
2
25,00
19
73,08
26,92
Phn tch s nhim KSTSR ngi c giao

lu bin gii cho thy 73,08% nhim KSTSR
ChuynYTCngCng
Bng5:Milinquangiagiaolubingiiv
nhimstrt.
Giao lu
C giao lu bin gii
Khng giao lu bin gii
Tng
KSTSR(+) KSTSR(-) Tng

26
175
201
31
1120 1151
57
1295 1352
OR=5,37 (3,01-9,57) 2=44,45, p<0,001
Kt qu bng trn cho thy ngi c giao

lubingiinguycnhimstrtgp5,37ln
ngikhngcgiaolubingii(p<0,01).
175
NghincuYhc
Bng6:Milinquangiangmnkhigiaolu
bingiivnhimstrt.
Ng mn
KSTSR(+)
Khng ng mn khi qua
18
bin gii
C ng mn khi giao lu
8
bin gii
Tng
26
KSTSR(-)
79
Tng
97
96
104
175
201*
OR= 2,73 (1,05-7,28), =5,26, p<0,05
*Chtnhsngicgiaolubingii.
Ktqubngtrnchothyngikhngng
mnkhigiaolubingiicnguycnhimst
rtgp2,73lnngicngmnkhigiaolu
bingii(p<0,05).
Phn tch kh nng tip cn y t ca ngi
dnticcxnghincu.
Ytxkhngthngxuynphthinbnh
tithnbn.Ngidnchtipcncviy
t thn bn; c bit v ma ma, rt kh tip
cnytx.
Trongtngs28ytthnbnti3xchc
5/28ytthnbncoto3thng,cnli
23/28 nhn vin ch c o to 1 tun. T l
tr li ng cc cu hi lin quan n triu
chng bnh, s dng thuc st rt ch t t
50%n83,33%.Vknng,thchnhtyu
cu ly lam v kp nhit ch t 66,66% n
75%.Lmlamgitctyucut66,6670%.
Bng7:Chtlngxtnghimcaxtnghimvin
imknhhinvi.
TT
1
2
Lam
Loi sai st
im
S sai st m tnh Dng tnh Sai
kim
knh
tra
gi
gi
chng
Thanh 10 2 (20%) 1 (50%) 1 (50%)
0
1
Xy
10 1 (10%)
0
0
(100%)
3 Lao Bo 10
Tng s
30
1 (10%) 1(100%)
4
2 (50%)
(13,33%)
1 (25%)
1 (25%)
Ktqukimtrachtlngxtnghimcho
thytlsaistcakthutvinimknh3
imknhl13,33%.TlsaistxThanhl
20%,xXyl10%vxLaoBol10%.Ssai
st ch yu l m tnh gi (khng pht hin
cKSTSRkhilammucKSTSR)chim50%
(2/4)ssaist.
176
Bng8:Kinthc,thivthchnhcangi
dnticcxnghincu.
Thanh
(n=201)
SL %
Mui l nguyn nhn lan 14 70,6
1
truyn bnh st rt
2 5
KSTSR l nguyn nhn gy
48,7
2
bnh st rt
98 6
Tc hi xu ca bnh SR 14 73,6
3
i vi sc kho
8 3
14 72,1
4
Bnh SR nguy him
5 4
16 81.5
5 Ng mn phng c SR
4 9
14 72,1
6 Thng xuyn ng mn
5 4
12 61,1
7 n c s y t khi b bnh
3 9
Bnh SR c th phng 13 66,6
8
chng c
4 7
Nhn thuc t iu tr khi 12 60,2
9
giao lu bin gii
1 0
Khi qua bin gii, ng ry c 12 62,6
10
mang mn
6 9
Ng mn khi i ry v qua 10 52,7
11
bin gii
6 4
TT
Kin thc, thi v

thc hnh ngi dn
Xy
(n=198)
SL %
73,2
145 3
43,4
86 3
73,2
145 3
74,7
148 5
70,2
139 0
64,1
127 4
63,1
125 3
71,7
142 2
62,6
124 3
62,6
124 3
49,4
98 9
Lao Bo
(n=186)
SL %
62,3
116 7
54,8
102 4
68,2
127 8
73,1
136 2
65,0
121 5
63,9
119 8
76,3
142 4
73,1
136 2
51,6
96 1
60,2
112 2
46,2
86 4
Phn ln ngi dn bit mui l nguyn

nhn lan truyn bnh st rt (73,43%87,88%);
ngi dn tin tng ng mn phng chng
cbnhstrt(>76,58%84,24%).Tlnc
s y t khm xt nghim 61,19%89,87%. S
ngigiaolubingiinhnthuctiutr
60,20%75,15%. Ng mn trong qu trnh qua
bingii52,74%59,39%.
BNLUN
Thctrngbnhstrttivngbingii
VitLohuynHngHa,tnhQung
Tr
Hng Ha l 1 huyn bin gii VitLo,
viabnrtphctpvgiaoluca2pha
to nn s di bin ng phc tp ti khu vc
bingiiny.Thngk2.721bnhnhnstrt
ca3xnytrong5nm20062010chothyc
13,78%ngiphaVitNammcstrtcgiao
luquabingiiv7,35%lbnhnhnngi
Lo. Bn cnh c 23,30% s mc st rt l
ngi t cc x khc n. S liu iu tra ct
ChuynYTCngCng
ngangtrn1.325ngidnti3xbingiicho
thytlnhimksinhtrngstrtl4,22%.
Trongs57trnghpnhimKSTSRc19,30%
l ngi Vit c sang Lo v, 26,32% l ngi
LosangVit.
iutracaHongH(QungTr)ti3x
Xy,Thanh,ThuncahuynHngHav14
thncaLogipvi3xtrnchothyvpha
Vit Nam t l hin mc st rt l 1,81%; pha
Lotlhinmcl5,20%.TlphaLomc
strtcao hn pha Vit Nam. Trong s BNSR
cho thy 92% ngi Lo v 17% ngi Vit c
qua li bin gii trong 12 thng va qua, 39%
ngiLov34%ngiVitchobitcngi
mcstrttrong12thngvaqua(2).
i vi nhng i tng ny nguy c gia
tng st rt vn tim n ti cc vng c st rt
lu hnh v c ngi vng khng c st rt
luhnh.
V c cu KSTSR, kt qu phn tch cho
thy ti cc im iu tra ny ch yu vn l
P.falciparum chim u th 75,44%. Vi t l
P.falciparum u th cng ph hp vi c cu
loiccvngkhccakhuvcminTrung
TyNguyn.P.falciparumuthlyutgy
nn st rt c tnh v t vong cao nhng
ngi di bin ng, giao lu bin gii khi b
nhimstrt(4).
T l nhim KSTSR cc iu tra ti cng
ngdngiaolubingiicaohnnhiusovi
tlnhimchungcakhuvcMTTNch0,93%
(nm 2007) v 0,69% (nm 2008), 1,14% (nm
2010)v0,90%(nm2011)cngnhticccng
ng dn sng c nh trong vng st rt lu
hnh(4).
Mtsyutnguycnhhngdnn
strtgiaolu.
H thng y t vi cht lng hn ch nh
hngrtlnnchtlnghotngphng
chng st rt. Ti c 3 x ny do a bn vng
su vng xa, vng bin gii rt kh khn
cung cp cc dch v y t n cho cng ng.
Giao thng i li cng l mt tr ngi ln cho
ChuynYTCngCng
NghincuYhc
hotngchmscsckhenhndntikhu
vcbingii.
Ytthnbnmcdcnhngcht lng
lnghotnghnch,thcsytthnbn
ch c vai tr tham gia hot ng, v c ti
82,14%ytthnbnchcoto7ngyv
phng chng st rt. Nhng y t thn bn ny
thchnhkpnhitcngchtyucut
66,66%75%; ly lm mu git c ch t
66,66%70%.
Mt l do khc cng gp phn nh hng
chtlngiutrlknngsoicaxtnghim
vin im knh hin vi. Kt qu kho st cho
thy,chtlngxtnghimcaxtnghimvin
imknhti3xnyvncnmtssaist,t
lsaistn13,33%(10%20%).
Nghincuticcvngstrtdaidngti
mtsvngkhuvcMTTNcngchonhnxt
lhthngytvislngvchtlnghn
chnhhngrtlnnchtlnghotng
phngchngstrt.
Nhngdnliutrnchothyhotngca
hthngytphcvchophngchngstrt
cht lng cn nhiu hn ch. Nghin cu ca
onHnhNhnti2huyncstrtdaidng
Hng Ha v Dak Rng cng cho nhn xt
rnggimstvhotngPCSRcatuynx,
thnbncnhnch,thiubcs,ytxtham
giaqunhiuhotng(1).
Bncnhkinthc,thi , thc hnh
cangidnvngbingiicnhnch.Kt
quiutrati3xnychothychc48,76%
n64,56%bitnguynnhngybnhstrt
l KSTSR, 73,42% n 88,75% bit mui l
nguyn nhn lan truyn v c bit ch c
61,69% n 89,87% n c s y t khm khi
nghimcbnhstrt.iutracaonHnh
Nhn ti cc vng st rt bin gii ny cng
chothychc61%trlingnguynnhn
lan truyn bnh l mui st rt, 69% tr li
ngbiuhinbnhstrt,bitsdngmn
phngchngmuich49%(1).
Phn tch s mc st rt cng cho thy
ngi c giao lu bin gii VitLo c nguy
177
NghincuYhc
cmcstrtcaogp5,37lnngikhngc
giaolubingii(p<0,001).Ngicgiaolu
bin gii khng ng mn nguy c nhim st
rtgp2,73lnngikhngcgiaolubin
gii(p<0,05).
Nhng s liu trn c th l gii nhng
vngngbodntc,vngxuvngxavng
bingii,trnhnhnthcngidncnhn
chnnvicthayihnhvicngpnhiutr
ngi.Tuynhincngcthdoccphngtin,
phng php truyn thng chng ta cha t
hiu qu nn ngi dn cha thay i c
nhn thc v hnh vi v phng chng st rt.
y cng l mt trong nhng thch thc m
chng trnh PCSR cn c cc gii php nng
cao nhn thc v ci thin thi quen ng mn
cangidncbitchocngngdntct
ngitrnhcnthp.
KTLUN
Thc trng bnh st rt ti vng bin gii
VitLohuynHngHa,tnhQungTr
BnhstrttivngbingiiVitLoca
huyn Hng Ha lu hnh quanh nm, pht
trinnhcaothng8910.
TlnhimKSTSRticngngdnvng
bingiitihuynHngHal4,22%(CI95%
t 3,215,43). S KSTSR l ngi Vit c sang
Lovchim19,30%,26,32%lngiLosang
Vit.
Ngi dn bit mui l nguyn nhn lan

truynbnhst rt (73,43%87,88%); ngi dn
tintngngmnphngchngcbnhst
rt (76,58%84,24%). T l n c s y t khm
xt nghim 61,19%89,87%. S ngi giao lu
bingiinhnthuctiutr60,20%75,15%.
Ngmntrongqutrnhquabingii52,74%
59,39%.
Ngicgiaolubingiinhimstrtcao
gp 5,37 ln ngi khng giao lu bin gii
(p<0,001). Ngi c giao lu bin gii khng
ng mn nguy c nhim st rt gp 2,73 ln
ngikhngcgiaolubingii(p<0,05).
KINNGH
Tngcngcngtctruynthnggiodc
sckhevccbinphptbov(mangtheo
mn,nhnthuctiutr)cangidnkhi
giaolubingiicngnhirngvng li
trongrng.
Ytxvytthnbntngcngqunl
i tng giao lu bin gii: ch pht hin
nhimksinhtrngstrtsaukhigiaolubin
giikhng ch st rt c tnh v t vong do st
rt.
Cncsphihpytgia2tnhbingii
cng nh s gip ca qun y bin phng
gipqunlngigiaolubingii.
TILIUTHAMKHO
1.
Tlgiaoboticngngdnvngbin
giil2,37%(CI95%t1,623,33).
P.falciparum l loi chim u th vi t l
75,44%trongtngsksinhtrngstrt.
Mtsyutnguycmcstrtngi
giaolubingii
Tipcncangidnvihthngytti
ccthnbingiicngpkhkhn.
im knh hin vi soi pht hin KSTSR sai
st13,33%.
2.
3.
4.
5.
ng,s4/2007,tr.1016.
HongH,inhThHa(2011).Hptcnghincubnhst
rtvngbingiigia2 tnh Savanakhet (Lo) v Qung Tr
(VitNam).CngtrnhkhoahcHinghKSTln38.Nhxut
bnyhc2011,tr.241249.
2011.
Tlngmnticcxvngbingiicn
thp,chim72,10%.
178
ChuynYTCngCng
NghincuYhc
HIUQUMTSBINPHPPHNGCHNGSTRT
CHOCNGNGDNVNGBINGIIVITLOHUYNHNGHA,
QUNGTRNM20102011
TMTT
tvn:NguycmcstrtngidnvngbingiiVitLolmtvncpthitcnpdng
ccbinphpcanthipgimtlmcvchtitngny.
Mctiu:nhgihiuququnlstrtivingigiaolubingiiVitLohuynHngHa,tnh
QungTrvktqucatruynthnggiodctrongphngchngstrtchongivngbingiiVitLo.
Phngphpnghincu:Nghincucanthipnhmnhgihiuqucabinphpphngchngst
rtchongidnvngbingiiVitLo.
Kt qu:Gimtlnhimksinhtrngstrtnhngngigiaolubingii.TixXyt8,64%
(4/2010)xung4,40%)(9/2011);xThanht9,52%(4/2010)xung3,85%(9/2011);xLaoBot6,41%
(4/2010)xung3,57%(9/2011).Nngcaotlngmnvngbingii.TixThanhtngt71,01%ln
86,82%;xXytngt72,34%ln87,02%;xLaoBotngt80,16%ln90,77%.
Ktlun:NguycmcstrtngidnvngbingiiVitLortcao,pdngccbinphpphng
chngstrttchccgimmcvchtdostrttivngbingii.
Tkha:Strtbingii,ksinhtrngstrt.
ABSTRACT
THEEFFECTIVENESSOFSOMEMALARIACONTROLMEASURESFOR
THECOMMUNITYALONGVIETNAMLAOBORDERINHUONGHOADISTRICT,QUANGTRI
PROVINCEIN20102011
Background: The risk of malaria infection in populations along the border area of VietLaois an urgent
problem which needs to be applied intervention measures to reduce malaria morbidity and mortality in these
subjects.
Objectives:ToevaluatethemalariamanagementeffectivenessofpeoplecrossingVietLaoborderinHuong
Hoadistrict,QuangTriprovinceandresultsofhealthinformation,communicationandeducationpertainingto
malariacontrolforthepeopleinVietLaoborderarea.
Methods:Interventionstudydesign.Comparisonofoutcomesfromstudyparticipantsbeforeandafteran
interventionwasintroducedtoevaluatetheeffectivenessofmalariacontrolmeasuresforthecommunityinViet
Laotborderarea.
Result:Themalariainfectionrateofbordercrossingpeopledecreased;particularly,inXycommunefrom
8.64% (April 2010) to 4.40% (September 2011); in Thanh commune from 9.52% (April 2010) to 3.85%
(September 2011); and in Lao Bao commune from 6.41% (April 2010) to 3.57% (September 2011). The
*VinStrtKSTCTQuyNhn
ChuynYTCngCng
T:0914004629
179
NghincuYhc
proportionofbednetusageinboderarearaisedfrom71.01%to86.82%inThanhcommune,from72.34%to
87.02%inXycommune,from80.16%to90.77%inLaoBaocommune.
Conclusion: The population living in VietnamLao border area are still at very high risk of malaria
infection.Theapplicationofactivemalariacontrolmeasuresreducedmortalityandmorbidityduetomalariain
theboderarea.
Keywords:Malaria,controlmeasures,VietnamLaoborder.
TVN
ITNGPHNGPHPNGHINCU
Bnhstrtvnlmtbnhxhiphbin
nhiuvngtrnthgiivnhngncthuc
vng nhit i nh Vit Nam, nh hng ln
n sc khe con ngi v thit hi to ln v
kinh t, x hi(7,8). So snh vi khu vc khc,
cng tc phng chng bnh st rt ca min
TrungTy Nguyn vn c mt s kh khn.
Mtshuyndocckhkhnvmngliy
t, giao lu bin gii, di bin ng dn s lm
cho tnh hnh st rt mt s vng c din bin
phc tp(6). Ti cc vng ny, cc bin php
phngchngstrtthngquychamangli
hiu qu cao. nhiu huyn, s lng bnh
nhn vn duy tr vi s gim khng ng k
trongnhiunmnhHngHa(QungTr)(2).
aimnghincu
Qung Tr l mt tnh c st rt lu hnh

thuckhuvcminTrungTyNguyn.Tnhc
ng bin gii vi Lo, giao lu ca dn c
khu vc bin gii thng xuyn xy ra ti y
nn vic kim sot bnh rt kh khn. t
c cc mc tiu kim sot bnh ti khu vc
ny, cn c nh hng u tin v tm cc gii
php thch hp cho nhng vng bin gii, ni
sgiaoludibinngrtln,bnhstrtvn
duytrmcluhnhcao.Trncskhoahc
vthctincacngtcphngchngbnhst
rt (PCSR) vic tin hnh ti ny l rt cn
thitnhmccmctiusau:
nh gi hiu qu qun l st rt i vi
ngi giao lu bin gii VitLo huyn
HngHa,tnhQungTr.
nh gi kt qu ca truyn thng gio
dc trong phng chng st rt cho ngt
vngbingiiVitLo.
180
Huyn Hng Ho, tnh Qung Tr l mt

huyn st rt nng gm 22 x, dn s 75.000
ngi; trong 11 x bin gii 2 nc Vit Lo.
C3x:Thanh,Xy,LaoBocnhiudngiao
luquabingii.
itngnghincu
Ngidnsngti3xXy,Thanh,LaoBo.
NgiLosangtmtrhocgiaolusangVit
Nam.Ksinhtrngstrt.Ytthnbnvx.
Thigiannghincu
2nm20102011.
Phngphpnghincu
Phngphpnghincucanthip.
Thit k nghin cu can thip thc a,
khngcichng,theoditrcsau.
Cmutheocngthcsau(5):
Z2(,)[P1(1P1)+P2(1P2)]
n=
d2
[0,10(10,10)+0,04(10,04)]
=10,5x=374
(0,100,04)2
Trong:Z2(,)ngvigitrca=0,05
v =90% th Z2(,) =10,5. P1: T l k sinh
trng st rt (KSTSR) trc can thip, P1=0,10.
P2: T l KSTSR sau can thip, P2= 0,04. d:
chnh gia 2 t l. Chn vo mu nghin cu
374ngi.dphngmtmucngthm5%
nghincucn400ngichoiutra.
Ccbinphpcanthip:otoliytx
v thn bn v phng chng st rt. Qun l
bnhnhnkhigiaolubingii.Truynthng
ChuynYTCngCng
gio dc sc khe cho ngi dn v PCSR khi
giaolubingii.
Cckthutnghincu
Kthutxtnghim (XN) mu tm k sinh
trngstrt.Kthutkhmlmsng.Kthut
phng vn v quan st. Phng vn trc tip:
iutranhngngidnt15tuitrln
iutrashiubit,hnhvivPCSRcacng
ng. Quan st trc tip ngi dn ng mn
vobanmtinh.
NghincuYhc
Phntchsliu
SdngphnmmSTATA8.0phntch
sliu.
KTQU
Ccbinphpcanthippdng
Truyn thng trc tip: Y t thn bn l
ngichutrchnhimtruynthng,vnng
trctipngidnngmn,tmmnviha
cht,nhnthuctiutrkhiirngngry,
giao lu bin gii. Cp t ri v tranh tuyn
truynchocchgianh.
Bng1:Tlcpthuctiutrchongidngiaolubingii.
Thng iu
tra
iu tra
Thanh
Nhn thuc
iu tra
Xy
Nhn thuc
iu tra
Lao bo
Nhn thuc
4/2010
81
36
44,44
42
22
52,38
78
45
57,69
7/2011
9/2011
4/2011
7/2011
9/2011
65
74
57
82
91
27
35
42
64
69
41,54
47,30
73,68
78,05
75,82
37
35
44
42
52
21
22
31
30
38
56,76
62,86
70,45
71,43
73,08
98
86
87
93
84
58
52
61
68
71
59,18
60,47
70,11
73,12
84,52
cp thuc st rt t iu tr cho nhng

ngi c giao lu bin gii t 52,35% n
72,60%.
Bng2:SosnhchtlngcnbtrcvsautphunnngcaovPCSR.
t yu cu
TT
1
2
3
Trc o to
Xy
Thanh
Lao Bo
Tng
SL
4
5
6
15
Khng t yu cu
Sau o to
%
40,00
50,00
60,00
50,00
SL
8
8
9
25
Trc o to
%
80,00
80,00
90,00
83,33
Phntchktquotochothy,sauo
to t l YTTB t yu cu tng t 50% ln
SL
6
5
4
15
%
60,00
50,00
50,00
50,00
Sau o to
SL
2
2
1
5
%
20,00
20,00
10,00
16,67
83,33%. S khng t yu cu sau o to ch

chim16,67%.
Bng3:SosnhtlKSTSRquacctiutratixThanh.
Ln 1 (thng 4)
KSTSR(+)
Ln 2 (thng 7)
iu tra
KSTSR(+)
TT
Nm
2010
446
18
4,04
454
2011
414
17
4,11
406
iu tra
p>0,05
KtqubngtrnchothytlKSTSRgim
vo cng thi im iu tra so vi nm trc.
T l KSTSR thng 4 nm 2011 l 4,11% so vi
cngthiimnm2010l4,04%(p>0,05).Tl
ChuynYTCngCng
Ln 3 (thng 9)
KSTSR(+)
iu tra
39
8,59
410
39
9,51
24
5,91
456
16
3,51
p>0,05
P<0,01
KSTSR thng 7 nm 2011 l 5,91% so vi cng

thiiml8,59%(p>0,05).TlKSTSRthng9
nm 2011 l 3,51% so vi cng thi im l
9,51%(p<0,05).
181
NghincuYhc
Bng4:SosnhtlKSTSRquacctiutratixXy.
Ln 1 (thng 4)
KSTSR(+)
Ln 2 (thng 7)
iu tra
KSTSR(+)
Ln 3 (thng 9)
iu tra
KSTSR(+)
TT
Nm
2010
438
22
5,02
440
30
6,86
408
32
7,84
2011
393
16
4,07
412
24
5,83
420
22
5,24
iu tra
P>0,05
P>0,05
p>0,05
5,02%(p>0,05).TlKSTSRthng7nm2011l
5,83% so vi cng thi im l 6,86% (p>0,05).
T l KSTSR thng 9 nm 2011 l 5,24% so vi
cngthiiml8,09%(p>0,05).
Phn tch t l nhim qua cc t iu tra

chothytlKSTSRgimvocng thi im
iutrasovinmtrc.TlKSTSRthng4
nm 2011 l 4,07% so vi cng thi im l
Bng5:SosnhtlKSTSRquacctiutratixLaoBo.
TT
Nm
2010
468
2011
366
iu tra
Ln 1 (thng 4)
KSTSR(+)
iu tra
18
3,85
364
14
3,83
410
Ln 2 (thng 7)
KSTSR(+)
p>0,05
Ln 3 (thng 9)
KSTSR(+)
iu tra
26
7,14
386
26
6,74
16
3,90
384
16
4,17
P<0,05
Ktquphntchtlnhimksinhtrng
st rt (KSTSR) x Lao Bo cho thy t l
KSTSRgimvocngthiimiutrasovi
nm trc. T l KSTSR thng 4 nm 2011 l
3,83% so vi cng thi im l 3,85%. T l
P<0,05
KSTSR thng 7 nm 2011 l 3,90% so vi cng

thi im l 7,14%. T l KSTSR thng 9 nm
2007 l 4,17% so vi cng thi im l 6,74%
(p<0,05).
Bng6:TlKSTSRngigiaolubingii.
TT
1
2
3
4
5
6
Thng
4/2010
7/2010
9/2010
4/2011
7/2011
9/2011
iu tra
81
65
74
57
82
91
Xy
KSTSR (+)
7
5
5
4
5
4
%
8,64
7,69
6,76
7,02
6,10
4,40
Thanh
iu tra KSTSR(+)
42
4
37
3
35
2
44
3
42
2
52
2
TlnhimKSTSRnhngngigiaolu
bingiigimdn.TixXyt8,64%(4/2010)
xung 4,40%) (9/2011); x Thanh t 9,52%
%
9,52
8,11
5,71
6,82
4,76
3,85
iu tra
78
98
86
87
93
84
Lao Bo
KSTSR (+)
5
6
5
4
4
3
%
6,41
6,12
5,81
4,59
4,30
3,57
(4/2010) xung 3,85% (9/2011); x Lao Bo t

6,41%(4/2010)xung3,57%(9/2011).
Bng7:Tlngidnnxtnghimqunlsaukhigiaolubingiitrv.
Thng iu tra
4/2010
7/2011
9/2011
4/2011
7/2011
9/2011
iu tra
42
37
35
44
42
52
Xy
C XN
15
14
20
34
36
41
%
35,71
37,84
57,14
77,27
85,71
78,85
iu tra
81
65
74
57
82
91
Kt qu trn cho thy, t l ngi dn n

xt nghim pht hin KSTSR sau khi qua bin
182
Thanh
C XN
32
29
52
48
71
80
%
39,51
44,62
70,27
84,21
86,59
87,91
iu tra
78
98
86
87
93
84
Lao bo
C XN
31
42
36
41
61
51
%
39,74
42,86
41,86
47,13
65,59
60,71
giitrvchimtlcao2xXyvThanh,
tixLaoBotlnythphn.iutrathng
ChuynYTCngCng
9/2011, t l ngi giao lu bin gii n xt
nghim chim 78,85% x Xy, 87,91% x
NghincuYhc
Thanhv60,71%xLaoBo.
Bng8:Hiuqutruynthngnngcaokinthc,thi,thchnhngidnvbnhstrt.
Ch s
Mui l nguyn nhn lan truyn bnh SR
KSTSR l nguyn nhn gy bnh st rt
Tc hi xu ca bnh SR vi sc kho
Bnh SR nguy him
Ng mn phng c bnh st rt
Thng xuyn ng mn
n c s y t khi b bnh
Bnh SR c th phng chng c
Nhn thuc t iu tr khi qua bin gii
Khi qua bin gii, ng ry c mang mn
Ng mn khi i ry v qua bin gii
Thanh
Xy
Trc can Sau can Trc can Sau can
thip
thip
thip
thip
n=201
n=162
n=198
n=161
70,65
93,83
73,23
91,93
60,20
83,95
56,57
81,99
73,63
95,06
73,23
92,55
72,14
92,59
74,75
93,79
81,59
96,30
70,20
81,37
72,14
80,86
64,14
88,20
61,19
90,12
63,13
85,09
66,67
87,65
71,72
87,58
60,20
85,80
62,63
88,20
62,69
87,65
62,63
85,71
52,74
84,57
49,49
85,78
Lao Bo
Trc can Sau can
thip
thip
n=186
n=167
62,37
65,27
61,29
86,83
68,28
92,22
73,12
88,02
65,05
82,63
63,98
89,82
76,34
91,62
73,12
88,02
51,61
86,83
60,22
90,42
46,24
87,43
So snh kt qu iu tra trc v sau p

dngbinphpgiodctruynthngchothy
ccchstheodiutngcao.
Bng9:Hiuqutruynthnggiodcnngcaotlngmncangidn.
TT
Ch s theo di
1
2
3
4
5
6
S h quan st
S khu
S mn
T l ngi/mn
S ng mn
T l ng mn
Thanh
Trc can
Sau can
thip
thip
34
31
138
129
58
52
2,34
2,48
98
112
71,01
86,82
Ktququansttrctipchothytlng
mntng3xnghincuvothiimsau
can thip. Ti x Thanh tng t 71,01% ln
86,82%;xXytngt72,34%ln87,02%;xLao
Botngt80,16%ln90,77%.
BNLUN
Hiu qu ca qun l bnh nhn v cng
cmngliphngchngnhimstrt
nhngngigiaolubingii
Tuytriquanhiuchinlcphngchng
cnbnhstrttlunhngchonnaybin
phpnochiuqupdngchoitng
giaolubingiicngnhngiirngng
ryvnanglthchthcivichngtrnh
phng chng st rt ca Vit Nam v c th
ChuynYTCngCng
Xy
Trc can
thip
35
141
62
2,27
102
72,34
Sau can
thip
32
131
54
2,43
114
87,02
Lao Bo
Trc can
Sau can
thip
thip
32
32
126
130
52
54
2,42
2,41
101
118
80,16
90,77
gii(1,2,3,7,8).itnggiaoluticcvngbin
giilictnhtrngkinhtkhkhn,nhnthc
v phng chng st rt cha cao, trnh vn
ha hn ch nn vic xut cc gii php
phngchngvncnnhiukhkhn.Tytheo
ccvngkhcnhau,thiquenkhcnhau,iu
kinkinht,xhimngidnckhcquan
nimtbovkhigiaolubingii.Nichung
phnlnngidnchacthctbovkhi
iqualibingii(1,4).
Trongnghincunypdngbinphp
cp thuc t iu tr cho ngi giao lu bin
gii nhm gim nguy c st rt c tnh v t
vong.Theodichothyso vi iu tra c bn
thsngiqualibingiinnhnthuct
183
NghincuYhc
iutrticctrmytxchim73,08%84,52%
trongsngigiaolubingii.
Bn cnh bin php trn, nghin cu cng
pdngotolichocnbytthnbn.Kt
qu cng cho thy cht lng hot ng y t
thnbncithintrongqutrnhhotng.
Bin php truyn thng gio dc lm
tngtlngmnkhigiaolubingii cng
nh tng t l ng mn khi nh. T l ng
mnkhigiaolubingiichim75,78%87,43%
sngiiutra.Tlngmncangidn
khi ti nh chim 86,82%90,77%. y l
nhngthchnhttgipgimtlmcbnh
strt.
Tuy nhin t l n nhn thuc t iu tr
ca i tng ny cha cao. iu tra nhng
ngikhiirngngryvgiaolubingii
mtsxthucminTrungTyNguyncho
thy t l nhn thuc t iu tr mc 30%
50%(3).
Trong nghin cu ny, cc bin php bao
gm o to nng cht lng hot ng y t
thn bn, cp thuc t iu tr ngn ngy
(Arterakin), s dng test nhanh chn on
sm nhng trng hp nghi mc st rt v
truyn thng gio dc ngi dn ng mn,
nhnthuctiutrkhiquabingii.
Phntchktquccbinphpchothy,t
l nhn thuc ca ngi dn khi qua bin gii
tnglntic3x73,08%84,52%sovitrc
ch44,44%57,69%.Kinthc v k nng ca y
tthnbntyucutngt50%ln83,33%
sauoto.
Vtcngcaccbinphpchothy,tl
nhim KSTSR 3 x cho thy sau 1 nm p
dngbinphptlnhimKSTSRgimc3
xvothiimsaunghincu:
Ti x Thanh t l KSTSR gim vo cng
thiimiutrasovinmtrc,tlKSTSR
thng9nm2011(sau1nmcanthip)l3,51%
sovicngthiiml9,51%(p<0,05).
184
Ti x Lao Bo, t l KSTSR thng 9 nm

2011 l 4,17% so vi cng thi im l 6,74%
(p<0,05).
Nhng ti x Xy, t l nhim qua cc t
iu tra cho thy t l KSTSR gim vo cng
thiimiutrasovinmtrcnhngcha
cskhcbit.TlKSTSRthng9nm2011
(saucanthip)l5,24%sovicngthiiml
8,09%(p>0,05).
Nhvyti3xnghincu,tlKSTSRc
gimnhngchcskhcbitxThanhvx
Lao Bo. Ti x Xy c th do a bn phc tp
hn, tnh hnh giao lu qua li v s ngi i
rngln,kmtheosluhnhstrtx
Xynnghn,hthngytxnycchtlng
kmhnxkhc(khngcbcs).
Phntchringitnggiaolubingii
cho thy t l nhim KSTSR c gim: 3,57%
4,40%sovitrc1nml6,41%9,52%.
Theo di dc cc trng hp giao lu bin
giinycngchothytlnhimstrtgim
dn theo thi gian ngi dn cc x. Sau 1
thngpdngbinphp,quatheodicayt
thnbnticngngchothytlmcbnh
strtgimticcxnyxXy(t10,32xung
6,68;xThanh(t7,98xung3,32);xLaoBo
(t2,41xung1,32).
Nh vy t l nhim qua theo di dc cc
trng hp giao lu bin gii ngi dn cc
xbingiigimsovitrccanthip.
Hiuqucatruynthnggiaodctrong
PCSRchongivngbingiiVitLo
Mc d ti cc x nghin cu t l mc st
rtgim,tlngmnctnglnnhnghiu
qu ca cc bin php cha thc s r rng
cngnhccyutbnvngkhngchs
gia tng mc bnh l cha c. Ti cc khu vc
bingiivicgiaolurtphctp,vldokinh
tngidncthchpnhnbnhttstrt
kimsng.
Vicqunlngidncnggpkhkhn
nn nh hng n kt qu nghin cu. T l
ngidnnxtnghimphthinKSTSRsau
ChuynYTCngCng
khiquabingiitrvchchimtl<90%.Ti
xXytlnyt78,85%;xThanhl87,91%;x
LaoBol60,71%.Sovi2xkhc,tlnxt
nghim ca ngi giao lu bin gii thp hn.
iunycthldoabnrngcaLaoBo,
ccthngnbingiixaTrmytxngthi
hthngyttnhnycnghotngmnh
hnccxkhc.
Vitlnhvy,cnmtslnngidn
khngkimsotcsaukhiqualibingii,
nu nhim bnh s l ngun ly lan cho cng
ng.
tidcmtsktqunhngcnccc
nghin cu tip tc cng nh s hp tc ca
chnhph2nckimsotbnhstrtqua
ngbingii.
KTLUN
Hiuqucabinphpqunlstrti
vingigiaolubingiiVitLo
Gim t l nhim KSTSR vng nghin cu:
TixThanhsau1nmcanthipl3,51%sovi
cngthiiml9,51%(p<0,05),tixLaoBo,
t l KSTSR l 4,17% so vi cng thi im l
6,74% (p<0,05). Ti x Xy, t l nhim KSTSR
gimnhngchackhcbit.
T l nhim KSTSR gim nhng ngi
giao lu bin gii. Ti x Xy t 8,64% (4/2010)
xung 4,40% (9/2011); x Thanh t 9,52%
(4/2010) xung 3,85% (9/2011); x Lao Bo t
6,41%(4/2010)xung3,57%(9/2011).
Hiuqucatruynthnggiodctrong
PCSRchongivngbingiiVitLo
Nngcaotlngmn3xnghincu:
Ti x Thanh tng t 71,01% ln 86,82%; x Xy
tng t 72,34% ln 87,02%; x Lao Bo tng t
80,16%ln90,77%.
NghincuYhc
T l ngi dn n xt nghim pht hin

KSTSRsaukhiqua bin gii tr v chim t l
78,85%tixXy;xThanhl87,91%;xLaoBo
l60,71%(9/2011).
KINNGH
Tngcngcngtctruynthnggiodc
sckhevccbinphptbov(mangtheo
mn,nhnthuctiutr)cangidnkhi
giaolubingiicngnhirng,ngry.
Ytxvytthnbntngcngqunl
i tng giao lu bin gii: ch pht hin
nhimksinhtrngstrtsaukhigiaolubin
giikhngchstrtctnhvtvongdost
rt.
Cncsphihpytgia2tnhbingii
cng nh s gip ca qun y bin phng
gipqunlngigiaolubingii.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
8.
ng,s4/2007,tr.1016.
strtcctnhminTrungTyNguyn.Tpchyhcthc
hnh,s3(537)/2006tr.2327.
H Vn Hong (2009). Nghin cu tnh trng nhim k sinh
trngstrtvsdngthuctiutrstrtcacngng
dnngry.TpchyhcQuns,sC1/2009,tr.4247.
HongH,inhThHa(2011).Hptcnghincubnhst
rtvngbingiigia2 tnh Savanakhet (Lo) v Qung Tr
(VitNam).CngtrnhkhoahcHinghKSTln38.Nhxut
bnyhc2011,tr.241249.
2011.
WHO(2009).MalariaReport,pp.2728
ChuynYTCngCng
185
NghincuYhc
TLSAISTVYUTNHHNGNCHTLNGXTNGHIM
KSINHTRNGSTRTCAIMKNHHINVIX
TNHQUNGNGINM2012
HVnHong*,NguynThLHuyn*
TMTT
tvn:imknhhinvixcvaitrquantrngtrongchnon,iutrstrttituynx.
Mctiu:Xcnhtlsaistcaxtnghimvintiimknhhinvixtrongphthinksinhtrng
strttnhQungNginm2012vphntchmtsyutnhhngntlsaisttrongkthutpht
hinksinhtrngstrt.
Phngphpnghincu:Nghincungangmtcphntch.
Ktqu:KhostchtlngccimknhhinvitiQungNginm2012chothytlsaistcaxt
nghimvinxl22,33%;tlmtnhgicaonhtchim28,56%.Xtnghimvinototcccskhng
chuynctlsoisaigp4,95lnxtnghimvinototcctrngchuynkhoa(p<0,001).Xtnghim
vin c knh hin vi khng t cht lng soi sai gp 3,52 ln so vi ni c knh hin vi t cht lng
(p<0,001).SaistcaxtnghimvinsdngncphagimsacpHphmvi<7,00v>7,20gp2,31lnso
vixtnghimvinsdngnccpHphmvi7,007,20(p<0,05).
Ktlun:Tlsaisttrongxtnghimksinhtrngstrtcncao.
Kinngh:Cngimstchtlnghotngcaccimknhhinvixvcungcpdungdchm
phagimsanhumlammu.
Tkha:imknhhinvi.
ABSTRACT
THEERRORPROPORTIONANDTHEFACTORSAFFECTINGTHEQUALITYOFMALARIA
PARASITEEXAMINATIONOFTHECOMMUNALMICROSCOPEPOINTSINQUANGNGAI
PROVINCEIN2012
HoVanHoang*,NguyenThiLeHuyen
Background:Malariamicroscopepointsplayanimportantroleinthemalariadiagnosisandtreatmentat
thecommunelevel.
Objectives:Todeterminetheerrorproportionofmalariaexamination of microscopists at commune level
and to analyze the some factors affecting to the error proportion of malaria examination of microscopists at
communelevelinQuangNgaiprovincein2012.
Methods:Thecrosssectionalstudyandtheanalysisofsomeaffectingfactors.
Result:Thesurveyonthequalityofparasitedectectionofcommunalmicroscopistsshowedtheerrorrateof
malariasmearslideswas22.33%.Theerrorrateoffalsenegativitywashighest(28.56%).Theno.oferrorslides
ofmicroscopiststrainedfromnonprofessionalschoolswas4,95timesincomparisonwiththatfromprofessional
schools (p<0.001). The no. of error slides of microscopists used low quality of microscopes was 3.52 times in
comparisonwiththatfromgoodqualitymicrocopes(p<0.001).Thenooferrorslidesofmicroscopistsusedwater
*VinStrtKSTCTQuyNhn
186
T:0914004629
ChuynYTCngCng
NghincuYhc
withpHfrom<7and>7.2was2.31timesincomparisonwiththatpHrangingfrom7to7.2(p<0.05).
Conclusion:theerrorproportionofmalariaexaminationofmicroscopistsatcommunallevelwashigh.
Recommendations: The microscopists at communal level should be supervised continuously to enhance
theirjobperformanceandprovidingthebufferedsolutiontoasusreastandardpHofGiemsastain.
Keywords:Microscopepoint.
TVN
Bnhstrtlmtbnhxhiphbintrn
th gii, nh hng rt ln n sc khe con
ngi, c bit cc nc vng nhit i(1,8).
Chnonxcnhcccabnhcksinhtrng
strt(KSTSR)(+)lrtquantrng,ihiphi
thitlpccimknhhinvi(KHV)ngayti
tuyn x l gp phn iu tr sm bnh st
rt,ngthigpphnvocngcmngliy
tcslmtnhucucpthitthchinv
bovthnhqucachngtrnhphngchng
st rt. Vic pht hin k sinh trng st rt
(KSTSR) bng k thut gim sa soi di knh
hinviltiuchunttnhtxcnhbnh,
nhng vic p dng k thut ti tuyn y t x
vncmttlsaistdonhiuyut(5,3,7).Do
vyxemxtccchnonsaisttrongvic
phthinKSTSRtiyttuynx,chngtitin
hnh kho st cht lng ca knh hin vi, tay
ngh k thut vin cng nh dung dch nc
phagimsanhhngnhthnonkt
quxtnghimvimctiu:
TtcccxtnghimvincaccKHVv
cnbytcacsytnicimknhhin
vi.
H thng s sch, h s lu tr lin quan
nxtnghimKSTSR.
Thigiannghincu
Nm2012.
Phngphpnghincu
Phngphpdchthcmt.
Thitk nghin cu m t ct ngang nhm
m t thc trng hot ng v vai tr ca cc
KHVphcvcngtcphngchngstrt
Kthutsdngtrongnghincu
Phng vn v quan st cn b y t v xt
nghimvin.
opHnc.
XNVbcthmngunhinmtblammu
soivtrliktqutrong1githeoblam
muphthinKSTSRgm10lamvimtv
loiKSTSRkhcnhau.
Xcnhtlsaistcaxtnghimvinti
im knh hin vi x trong pht hin k sinh
trngstrttnhQungNginm2012
Phngphpxlsliu
Phntchmtsyutnhhngntl
saisttrongkthutphthinksinhtrngst
rt.
KTQU
ITNGPHNGPHPNGHINCU
aimnghincu
Tonb30KHV,nicstrtluhnh
ccxthuchuyn:SnTy,SnH,TrBng,
TyTr,BaT(QungNgi).
itngnghincu
30KHVticcxthuccchuyntrn.
ChuynYTCngCng
Phn mm trn cc chng trnh EPI.INFO

6.04phntch.
Bng1:Tlsaistcaxtnghimvintrongpht
hinKSTSR.
TT Huyn
1
Ba t
Sn
2
Ty
3 Sn H
4 Ty Tr
5
Tr
Bng
Tng
S x S lam
kho st soi
S lam soi
sai
SL*
%
S lam soi
ng
SL
%
80
20
25,00
60
75,00
60
16
26,67
44
73,33
70
15
21,43
55
78,33
30
16,67
25
83,33
60
11
18,33
49
81,67
30
300
67
22,33 233
77,67
187
NghincuYhc
*SL:slng
Ktqukhostvchtlngsoichothy,
300 lam mu ca 30 XNV c 233 lam c cc
XNVtrlingktquchim77,67%(CI95%:
72,5382,25)vtlsaistchungl22,33%(CI
95%:17,7527,47).
Bng2:Phntchccloisaistkhixtnghimlammu.
TT
Huyn
S sai
st
1
2
3
4
5
Ba T
Sn Ty
Sn H
Ty Tr
Tr Bng
Tng
20
16
15
5
11
67
m tnh gi
SL
%
6
30,00
5
31,25
4
26,67
1
20,00
3
27,27
19
28,56
Dng tnh gi
SL
%
5
25,00
3
18,75
3
20,00
2
40,00
3
27,27
16
23,88
Phn tch cc loi sai st cho thy t l m

tnhgi(khngphthincKSTSR)chimt
l 28,56%, cao nht trong cc loi sai st. T l
dng tnh gi chim 23,88%, sai chng chim
9,56%, st tha th chim 22,39% v st phi
hpchim16,42%.
Bng3:Sosnhtlsaistkhisoilammvlam
dng.
Soi sai (m Soi sai
Soi ng
S v dng chng v
Loi lam
TT
lam
tnh gi)
st
soi
soi
SL
%
SL
%
SL
%
1 Lam m 120 16 13,33 0
0
104 86,67
Lam
2
180 19 10,56 32 17,78 129 71,66
dng
Tng cng 300 35 11,67 32 10,66 233 77,67
Tlsoisaicalamml13,33%.Tlsai
st ca lam dng l 28,34% bao gm 10,56%
mtnhgiv17,78%saichng,stthath.
Bng4:PhntchsaistrongmmtcaXNV
tuynx.
TT
lch
1
lch
m
lch
dng
Lam
mu
XNV
m
Lam
mu
XNV
m
Trung bnh
lch Sai s
(KSTSR/l chun
%
mu)
1261
422
584
272
976
710
1572
815
St, tha th
SL
%
4
20,00
5
31,25
2
13,33
1
20,00
3
27,27
15
22,39
St phi hp
SL
%
4
20,00
2
12,50
2
13,33
1
20,00
2
18,18
11
16,42
Bng5:nhhngniotonktquxt
nghim.
Ni o to
S lam sai S lam ng Tng s
Khng chuyn khoa
25
25
50
C s chuyn khoa
42
208
250
Tng s
67
233
300
OR =4,95, 2= 26,48 (CI95% ca OR: 2,47- 9,94), p <

0,001
XNV c o to t cc c s khng
chuynctlsoisaigp4,95lnccXNVt
cctrngchuyn(p<0,001).Tlsaistcacc
XNVtccc s khng chuyn l 50% (25/50)
trongkhisaistcaccxtnghimvintcc
cschuynkhoal22,33%(67/300).
Bng6:SosnhtlsaistgiaXNVlYsvcn
bscp.
Trnh
S lam sai S lam ng
Cn b s cp
48
152
(Y t, n h sinh...)
Y s
19
81
Tng s
67
233
Tng s
200
100
300
OR = 1,35 (CI95% ca OR: 0,71-2,55), 2 = 0,96; p >0,05

P
-53,69 <0,05
+61,07 <0,05
PhntchsaiskhiXNVtuynxmmt
KSTSRchothyivicctrnghpc
lchmsaisn53,69%,vilchdngsai
sn61,07%(p<0,05).
188
Sai chng
SL
%
1
5,00
1
6,25
4
26,67
0
0
0
0
6
9,56
Ktquphntchchothykhngcskhc
bitvtlsaistdoXNVlyshocdoXNV
lscpsoi(p>0,05).TlsaistcaXNVc
trnhchuynmnscpl24%(48/200)v
t l sai st ca XNV c trnh chuyn mn
trungcpl19%(19/100).
Bng7:Linquangiatlsaistvchtlng
knhhinvi.
Cht lng knh S lam sai S lam ng Tng s
Khng t
32
48
80
Tt, t yu cu
35
185
220
Tng s
67
233
300
ChuynYTCngCng
OR = 3,52 (CI95% ca OR: 1,91-6,52)2 =19,63; p <0,001
T l sai st ca XNV c cht lng knh

hinvikhngtyucucaogp3,52lnsovi
nicknhhinvityucu(p<0,001).
Bng8:MtKSTSRnhhngntlsaist
caXNV
Mt KSTSR
Lam +
Lam ++, +++
S lam sai S lam ng Tng s

26
34
60
25
95
120
Tng s
51
129
180
OR = 2,91 (CI95% ca OR: 1,40-6,03) 2 =9,97; p <0,001
T l sai st khi XNV soi lam c mt

KSTSRthpcaogp2,91lnsovikhisoilam
mucmtt++trln(p<0,001).Tlsai
stkhiXNVsoilammucmtKSTSR+l
43,33% (26/60), t l sai st khi soi lam mu c
mtKSTSRt++,+++l20,83%(25/120).
Bng9:nhhngcapHncphagimsavt
lsaistkhisoilammu.
pH
S lam sai S lam ng
<7,00 v >7,20
55
155
7,00-7,20
12
78
Tng s
67
233
Tng s
210
90
300
OR = 2,31, CI95% ca OR: 1,12 -4,84, 2 = 6,0; p < 0,05
TlsaistcaccXNVticcimknh
c nc pH phm vi <7,00 v >7,20 gp 2,31
lnsovitlsaistticcimknhcnc
pHphmvi7,007,20(p<0,05).
BNLUN
TlsaisttrongxtnghimKSTSRcc
KHVx
ChngtrnhPCSRVitNamcnhng
nhhngthitlpccKHVnhlmtgii
phpgipchochnonbnhstrtsm,iu
trngvqunlbnhnhntuynytcs
tgiaionucachngtrnhtiudit st
rt(1,5,4). Kt qu kho st v cht lng soi 300
lam mu ca 30 XNV cho thy XNV soi pht
hinchnhxcktquchim77,67%vtlsai
stchungl22,33%.
Sovikhostnm19951996catonkhu
vcMinTrungTyNguyn(MTTN)thtl
saistcaccXNVQungNgithphnnhiu
ChuynYTCngCng
NghincuYhc
(t l sai st tuyn x nm 19951996 l

34,49%)(5). Gn y nht nm 2009, kho st v
cht lng soi lam ca XNV khu vc MTTN
cho thy t l sai st ca tuyn x l 24,35%;
tuyn huyn l 18,21% v tuyn tnh thp nht
l10,97%(4).
TheoElizabethStreatgiihnsaisttuyn
x nn di 20%(2). Nh vy thc trng chung
caXNVtuynxQungNgivcctnhkhc
trong vic soi pht hin KSTSR l t l sai st
cncaocnckhochgimst,theodilin
tchthngxtnghimKSTSR.
Phn tch cc loi sai st cho thy t l m
tnhgi(khngphthincKSTSR)chimt
l 28,56%, cao nht trong cc loi sai st. y
cnglloisaistquantrngnhttrongccloi
sai st. T l dng tnh gi chim 23,88%, sai
chng chim 9,56%, st tha th chim 22,39%
vstphihpchim16,42%.
Theo iu tra hot ng im knh hin vi
xnm19951996tikhuvcMTTNchothy
chothytlmtnhgichimtl30,17%,cao
nhttrongccloisaist(5).Khostnm2009,
t l m tnh gi cng chim t l 26,61%, cao
nhttrongccloisaist.Tldngtnhgi
chim21,77%,saichngchim15,32%,sttha
th chim 20,97% v st phi hp chim
15,32%(4).
V k nng m, cc XNV tuyn x tnh
Qung Ngi vn cn nhiu sai st. i vi cc
trnghpclchmsaisn53,69%,vi
chnhdngsaisn61,07%;skhcbit
cnghathngkp<0,05.
Yu t nh hng n t l sai st ca
XNVtrongkthutphthinKSTSR
Phn tch cho thy c mt s yu t nh
hngnknngsoilamcaXNVnhsau:
YutthnhtlniotocaXNV.S
lamsaistcaXNVcotocctrng
khngchuynkhoavstrtgp4,95lnkhiso
viXNVcotocccschuynkhoa
(p<0,001).Nguynnhncthdotrongoto
cctrngkhngchuynchcthigianngn
189
NghincuYhc
thc hnh v k thut st rt, trong khi

ccXNVimknhchctrong2thngch
chuyn v k thut xt nghim mu pht hin
KSTSR.Ktquphntchnychothycntrin
khai cc kho o to li nng cao trnh
choxtnghimvin.
YutthhailpHnccsdng
pha dung dch giem sa nhum lam mu. Phn
tch sai st ca cc xt nghim vin s dng
nc sui v nc ging vi 3 nhm pH khc
nhaul<7,00;7,007,20v>7,20chothy:saist
canhmxtnghimvinsdngpH<7,00v
pH>7,30caogp2,31lnsovinhmsdng
pH=7,007,20 (p<0,05). Kt qu ny cho thy
cungcpdungdchmcpHnnhchocc
KHV l rt quan trng c th hn ch cc
saist.
Yutthbalchtlngcaknhhin
vi. Kt qu phn tch cho thy cc KHV c
chtlngknhhinvikhngtyucutht
lsaistcaogp3,52lnnicknhhinvi
tt (p<001). Trong nghin cu ny, c n
16,67%KHVboqunknhhinvikhngtt.
Bncnhnumtksinhtrngthpcng
nhhngtlsaisttrongsoiphthin.Tl
saistkhiXNVsoilamcmtKSTSRthp
caogp2,91lnsovikhisoilammucmt
t++trln(p<0,001).
SaiskhiXNVmmtKSTSRivi
lchml53,69%(p<0,05),vilchdng
saisl61,07%(p<0,05).
Mtsyutnhhngntlsaist
caxtnghimvin
Xt nghim vin c o to t cc c s
khng chuyn c t l soi lam sai gp 4,95 ln
ccxtnghimvincototcctrng
chuyn(p<0,05).
SaistdoXNVlyshocdoXNVlscp
soikhngcskhcbit(p>0,05).
SaistcaKHVcchtlngknhhinvi
khng t yu cu gp 3,52 ln so vi ni c
knhhinvityucu(p<0,001).
Sai st khi XNV soi lam c mt KSTSR
thpgp2,91lnsovikhisoilammucmt
t++trln(p<0,001).
SaistcaccXNVsdngncphagim
sapHphmvi<7,00v>7,20gp2,31lnso
vixtnghimvinsdngncpHphmvi
7,007,20(p<0,05).
KINNGH
Tip tc thc hin hot ng gim st cht
lnghotngcaccKHV.
o to li cc xt nghim vin c t l sai
stcao.
y l nhng vn m Chng trnh

PCSRcnccchthnggimstvbom
chtlngnhmnngcaohnnachtlng
hotngtrongnhngnmn(7).
nghtintisdngdungdchm
phadungdchgimsanhumlammu.
KTLUN
TILIUTHAMKHO
Tlsaistcaxtnghimvnimknh
x
1.
T l sai st chung ca xt nghim vin

tuynxl22,33%(CI95%:17,7527,47).
T l m tnh gi chim t l 28,56%, cao
nhttrongccloisaist.Tldngtnhgi
chim 23,88%, sai chng chim 9,56%, st tha
thchim22,39%vstphihpchim16,42%.
Cung cp knh hin vi mi cho cc im

knhcknhbhng.
2.
3.
4.
5.
190
BYt(2009).Hngdnchnonviutrbnhstrt.
DnPCSRQutoncu,HNi.
ElizabethS(1995).Chnonlabbnhstrt:Slnghay
cht lng, Kho o to quc t v pht trin nghin cu y
sinhhc,Amsterdam,tr.231(Tiliudch).
HoVanHoang(2000).Studyontheroleofmalariamicroscope
pointsformalariacontrolprogrammeinBinhThuanprovince,
19941998.Mekongmalariaforum,No.6.
HVnHongvCTV(2009).nhgithctrnghotng
ccimknhhinviphcvchngtrnhphngchngst
rttikhuvcminTrungTyNguynnm2009.Yhcthc
hnh,BYt,s7962011,tr.1115.
HVnHong,NguynTn(1996).Thctrngtnhhnhhot
ngcaccimknhhinviphcvPCSRtikhuvcmin
TrungvTyNguyn.Thngtinphngchngbnhstrtv
ChuynYTCngCng
6.
ccbnhksinhtrng,VinstrtKSTCTHNi,(4),tr.11
18.
HVnHong,NguynTn(1997).Nhngyutnhhng
nhotngcaimknhhinviphcvPCSRtikhuvc
7.
8.
NghincuYhc
MTTN. Thng tin phng chng bnh st rt v cc bnh k

sinhtrng,VinststrtKSTCTHNi,(2),tr.3641.
WHO (2009), Malaria Microscopy Quality Assurance Manual,
pp.616.
WHO(2009),WorldMalariareport2009,pp.2728.
ChuynYTCngCng
191
NghincuYhc
HICHNGTNGNHIMVIUTRNGGIUNLNINHNH:
BOCOCABNHVTNGHPYVN
HunhHngQuang*,HVnHong*
TMTT
tvn:Hichngtngnhimutrnggiunlnlmttrongnhngcimlmsngnngca
bnhgiunlnvitltvonghn85%.Hichngcctrngbibnhnhnmangmtlnglnu
trngtchutrnhtnhimvthnggptrnccbnhnhnsuygimmindch.
Mctiu:Trnhbymttrnghpchichngtngnhimutrnggiunln(HCTNATGL)vibiu
hinlmsngmitrnngi.
Phngphpnghincu:Bococabnhchichngtngnhimngthivibnhlsuygimmin
dch.
Ktqu:TheotnghpvghinhnyvnycthlcabnhutincHCTNATGLvvimphido
Pneumocystisjiroveci.
Ktlun:Doctnhgytvongcaocabnh,HCTNATGLphiclutrongchnonphnbit
vicctnhtrngsuyhhpkhckhicnhiutcnhngybnhtrnccbnhnhnsngtivngluhnh
bnh.
Tkha:Hitrngtngnhim,Pneumocystisjiroveci,vimphi,utrnggiunln.
ABSTRACT
TYPICALHYPERINFECTIONSYNDROMEBYSTRONGYLOIDIASIS:ACASEREPORTAND
MEDICALLITERATUREREVIEW
HuynhHongQuang,HoVanHoang
Background: Strongyloides hyperinfection syndrome is one of several clinical manifestations of
strongyloidiasisand has a mortality rate exceeding 85%. The syndrome is characterized by a high organism
burdenowingtoautoinfectionrouteandismostcommoninimmunocompromisedhosts.
Objectives: To describe a case of Strongyloides hyperinfection syndrome with a novel clinical feature in
human.
Methods:CasereportwithhyperinfectionsyndromeduetohumanStrongyloidesstercoralishadcoinfected
Pneumocystisjirovecipneumonia.
Result: According to literature review, this might be the first case having hyperinfection syndrome and
Pneumocystisjirovecipneumoniasimultaneously.
Conclusion:Owingtoitsextremelyhighmortalityrate,Strongyloideshyperinfectionsyndromemustbe
considered early in the differential diagnosis for respiratory failure when multiple pathogens are recovered in
patientsfromendemicareas.
Keywords:Strongyloidiasis,hyperinfectionsyndrome,Pneumocystisjiroveci,pneumonia
*VinStrtKSTCTQuyNhn
Tcgilinlc:Ths,BS.HunhHngQuang.
192
T:0905103496Email:huynhquangimpe@yahoo.com
ChuynYTCngCng
TVN
Bnhutrnggiunlnlhichnggyra
bi nhim trng Strongyloidesstercoralis, mt k
sinhtrng(KST)luhnhccvngnhitiv
cnnhiti.cimlmsngcabnhbao
gm:tngimangmmbnhkhngctriu
chngnbiuhinbnhlmntnhccc
quan nh da tiu ha v phi. Hi chng ny
c c trng bi nhim trng, thng do
nhiu tc nhn gy bnh ng rut v ri
lon chc nng cc c quan giai on cui do
mtlnglnutrnggiunln.HCTNATGL
ctltvongcao(>85%),nucschnon
smsquytnhssngcnchobnhnhn(3).
TRNHBYCABNH
Mt bnh nhn nam 69 tui biu hin kh
th tin trin vi nguyn nhn khng r rng,
Bnhnhnctinsbnhphitcnghnmn
tnh (COPD) v mt bnh l c chn on
gnylrilontboBadng.Khong3
tuntrckhinhpvinvsaukhihontt
liu trnh iu tr 4 tun vi rituximab v
cyclophosphamide,bnhnhnbiuhinst,run
lnh,iphnlngvgimoxyhuytkmtheo
thm nhim phi nng. Mc d c dng
thuchtr,songtnhtrngbnhnhnvnxu
ivcchuynnvinnhgi.
Tin s y khoa khc ng ch l bnh l
mch vnh a nhnh, cao huyt p, i tho
ng, thuyn tc mch phi v bnh l thiu
mu tan mu lin quan n bnh l c tnh t
bo B. Cc thuc dng hin ti l
Methylprednisolone, Clopidogrel, Omeprazole,
Aspirin, Metformin, Isosorbide mononitrate,
Diltiazem v Cephalosporin. Bnh nhn c tin
shtthuclnng.
Vothiimnhpvin,bnhnhnctnh
trnghuytngnnh,tnhto,nhhng
tt, khng c biu hin suy h hp (huyt p
138/60mmHg;mch101/pht,thnnhit36.20C
vnngHbO2boha90%trongiukin
nhit phng). Khm thy nhu m phi c
hnhnhranlanta;vtxuthuytdngchm
ChuynYTCngCng
NghincuYhc
hoc mng trn da bng v bn trn hai chi

di.Xtnghimmucmbchcultrong
gii hn bnh thng. Chp Xquang phi cho
thy hnh nh thm nhim k hai bn, so vi
phimXquangtrc30ngylctthn.
Trongvng12gikhinhpvin,tnhtrng
bnhnhnsuyspdn,khth,thiuoxymu,
st cao run lnh, tnh trng thn kinh thay i
v hnh nh vim phi k nng hn trn phim
chpXquang.Bnhnhncchnhtni
kh qun v dn lu dch ph qu. Bnh nhn
c iu tr tch cc bng trimethoprim
sulfamethoxazoletimtnhmch,Ciprofloxacin
vTicarcillinclavulanatevchnon ban u
nghnvimphiPneumocystisjirovecivvim
phidonhimtrngbnhvin.
Mu dch ph qun gm nhiu tc nhn
Strongyloides stercoralis, Pneumocystis jiroveci,
Pseudomonas aeruginosa, Cytomegalovirus, Herpes
simplexvirus,vAspergillusspecies.Cymucho
thynhiuloiEnterococcusvSalmonella,huyt
thanhchnondngtnhvikhngnguyn
Cytomegaloviruspp65.ChnonHCTNATGL
c ngh n v ch nh thuc Ivermectin,
Voriconazole, Ganciclovir cho bnh nhn km
liu php Corticosteroid. Sau d bnh nhn
khngcnthngkhchcsau11ngyiutr
v ra vin vi s tr gip ca khoa phc hi
chcnngvongyth27.
MTSBNLUN
Chu k sinh hc ca bnh u trng giun
ln
Nhimtrngbanuxyrakhith nhim
chnhlutrnggiaionfilariformivoc
th vt ch qua ng da do tip xc vi t
hoc phn nhim bnh. Sau khi KST tip cn
n dng mu thng qua dn lu h bch
huyt, chng di chuyn n phi xuyn qua
hngromaomchphnang,ivophnang,
i ln cy ph qun n hu, n tip tc
c nut vo h tiu ha. Trong khi ng
tiu ha, cc u trng s pht trin thnh giun
trng thnh v bt u sinh sn. Giun ci i
193
NghincuYhc
xuyn qua nim mc t trng v on hng

trnggn,tichngtrngvcthtnti
trong nhiu nm. Con giun c b o thi ra
ngoitheophn.Trngtrngthnhthnhth
n mi khng tnh nhim gi l th u trng
rhabditiform, th ny sau phng thch ra
phn,trngthnhtrongt,sinhsnvnhim
vo cc vt ch khc, hoc trng thnh sang
dng u trng filariform trong vt ch ngi.
utrngfilariformcthquaytrlimuca
vt ch, bng cch xuyn qua nim mc i
trnghaydaquanhhumnvtntimtchu
k nhim thng qua tin trnh t nhim
ny(3,5,4,6).
c im lm sang nhim u trng giun

ln
Triu chng lm sng ca nhim u trng
giunlnthayitythucvokhnngp
ng vt ch. Phn ln bnh nhn nhim giun
ln khng c bin chng, c khi n 50% l
khngctriuchng(5,8).Saugiaioncptnh,
hu ht cc bnh nhn c triu chng trong
vng34tunvibiuhintihtiuha,phi
v da. c im trn h tiu ha chim u th
hncnhtiuchyvaubng,ngoiracn
cchnn,bunnn,nnma,ngahumn,
si bng v bnh l rut km hp thu(2). Cc
triu chng phi in hnh l ho khng r
nguyndo,khkhvkhth.Hnhnhthm
nhimdichuynlantadoutrngdichuyn
trong phi tm thy trn phim chp X quang(7).
TivtrKSTivo(thnglbnchn)c
th c phn ng da nh vim, ph n, chm
xuthuyt,vtutrngmyaydichuyn(5).
Mtstriuchngtngtcthgptrn
cc bnh nhn nhim trng mn tnh, nhim
trngkhngctriuchngnhngcxuhng
tng ln ri gim xung, i khi n vi nm.
Ngclivigiaioncptnhhtiuhav
phi c triu chng ni tri th giai on mn
tnh c trng triu chng da. Hi chng u
trng di chuyn c xem l mt c trng
bnhcabnhutrnggiunlnmntnhvi
cc biu hin u trng di chuyn ngon ngho
194
kmtheomyaytivtrngvocaKST;
chngthngbiuhinthongqua,kodivi
ginvingyvlinquannvngmng,
i, chi di(5,4,7). Th mn tnh, c bin chng
baogmbnhutrnggiunlnrirc,ikhi
cxemlbnhutrnggiunlnhnglot
hoctrnngphochichngtngnhim.
Hi chng tng nhim (Hyperinfection

Syndrome/MassSyndrome)
Trn cc c nhn suy gim min dch, t l
din ra chu trnh t nhim khng khng ch
c,dnnmtlngthpKSTtnti.Tuy
nhin,mindchcavtchsuyyuhocthi
gian i qua h tiu ha chm li, s cn bng
bnh thng gia u trng phng thch vo
phnvstrngthnhcaccthnytrong
ng tiu ha b thay i. Kt qu ny lm
tng thm chu trnh t nhim, lng KST cao
hnvphtsinhhichngtngnhim(3,5,4,6).
Linquangiamindchvtchsuyyuv
tng nhim c m t ln u tin bi
RogersvNelsonvonm1966vicatvong
t nhng ca nhim giun cng vi nhim trng
ng rut bi vi khun gram () trn 2 bnh
nhn ang dng liu php Corticosteroid liu
caoiutrbnhc tnh v mu. Tng t,
mtstcgikhcmtmilinquangia
mindchvtchsuyyuvstngnhim(3,4).
Trongmttnghp103cabnh,IgraSiegman
vcngs(2)chothyrng89bnhnhnc
suygimmindch,huhtdokhiuctnhh
muhocbchhuythocangdngthucc
ch min dch, c bit Corticosteroids. Cc
bnhkhcccchbovcavtchthayi
cng c lin quan n s pht trin hi chng
tng nhim, gm c nghin ru, suy dinh
dng, bng nng, gim bch cu, gim
gammaglobulin mu(3,5) v nhim virus HTLV1
hayHIV1.
Ngclicctriuchngvduchngca
nhim u trng giun ln cp hay mn tnh
khng bin chng c th tin on t chu k
phttrincaKST,hichngtngnhimdin
ra phc tp hn v min dch suy yu v lin
ChuynYTCngCng
quannnhiucquan.Ccbocotrnhby
gmccctriuchngvduchngsau,cth
nlhocphihp(3,5,8,4,1,7,6).
H tiu ha: au bng nghim trng, bun
nn,nnma,tiulng,tcrut,litrut,km
hpthu,xuthuyttiuha,vimphcmclan
ta.
Hhhp:hokmtheotngmdi,hora
mu, kh kh, suy h hp, thm nhim thy
hoc hai phi lan ta, xut huyt tng , xut
huyt ph nang phi, vim phi v hi chng
suyhhpcptnh.
H thn kinh: thay i tnh trng tm thn
kinh,cogit,ngkinh,vimnovabcesno.
Cccquankhc:vimgantouht,vim
ganvsxmnhpcaKSTvotrongcquan
tim, thn, phc mc, hch lympho, ty, tuyn
gipvcngip.
Nhim trng th pht thng xy ra trong
hi chng tng nhim. Nhim trng huyt tn
ti xy ra khi nhim vi vi khun ng rut
(nh vi khun gram m, enterococci, streptococci
nhmDvnmCandida)cthdnnvim
mngno,vimphcmcvvimnitmmc.
Ba c ch c ngh gii thch mi lin
quannygm:(1)Tnhtonvncanimmc
rutbhv,chophpccvikhunngrut
HC.utrngdichuyn
ChuynYTCngCng
i vo mu, (2) Cc tc nhn gy bnh ng

rutivomuktdnhviutrnggiunln
v (3) Vi sinh vt trong rut i vo mu khi
chng c o thi ra bi KST sn c trong
tunhonmu(6,7).TrongbitnghpcaIgra
Siegmanvcngs (2),khngcskhcbitc
nghanovtlnhimtrngthphtgia
bnh nhn suy gim min dch v bnh c h
thng min dch tt, cho thy nhim trng th
phtdnnhichngtngnhimhnlhi
chngsuygimmindch.
Chnonviutr
Mt chn on xc nh nhim u trng
giunlncththitlpnhvophthinu
trngStrongyloidestrongphnhaytrongdchc
th. Cc phng php nui cy trn a thch
agarmicnhycaohnccphngphp
c in, nh l phng php soi trc tip hay
nuicytrngiylc(6).Tuynhin,utrngsinh
trongphnchlrirc,vthkhngcphng
phpnotrongsnycnhybaoph.
Thchinlymtlotmuphnlkhuynco
nn lm lm tng nhy, iu ny gn
100%nuc7hocnhiuhnmuphnc
a vo phn tch.. Xt nghim trc tip dich
ht t trng qua ni soi c th lm nhng
nhychc4090%(8).
Hnhnhthmnhim
mbchcuitoantngn80%trongs
ccbnhnhncmindchbnhthngnhim
trng khng bin chng; song trong hi chng
tng nhim th bch cu i toan thng khng
tng.Khitrnlmsngnghingcaovnhim
u trng giun ln m xt nghim phn m
tnh,ohiugikhngthbngELISActhc
chtrongchnonnhimtrngtrnbnhnhn
NghincuYhc
utrngS.stercoralis
c triu chng v khng c triu chng. Mt

isotypegimsttiudithaycha,songsau
khi iu tr bng thuc giun, nng
immunoglobulinhuytthanhgimvicctl
khcnhau.
iu tr u bnh trng giun ln c th l
mtthchthc.Vmtlchs,thucPyrvinium
pamoate c xem l la chn iu tr, nhng
195
NghincuYhc
thucctltiuditch3085%vkhngsn
xut
t
nm
1989.
Benzimidazoles
(thiabendazole, mebendazole, albendazole) l
cc thuc iu tr giun sn tip theo, cc thuc
ny c hot tnh giun sn ph rng lm gim
sinh nng lng bn trong KST. Con ng
thng dng cui cng ca nhm
Benzimidazolel c ch [beta]tubulin
polymerase, gy ging ha s hnh thnh
cytoplasmic Microtubule. Cc thuc giun sn
nykhngchgitKSTgiaioncntrongrut
mcnlmvtrngccgiaiontrngvu
trng. Thiabendazole c chp nhn s dng
trnngit nm 1962, s dng rng ri nht
trongnhmthucny,thucctlchakhi
rt cao, gn 100% trong mt lot ca bnh. Tuy
nhin,saunythucltsdng v mt s tc
dngngoinhrilonchcnnggan,chng
mt,bunnn,chnn(6).
gpnhtllitrut,hichngkmhpthu,hi
chng thn, sinh cn nng thp(6). Cc bnh
nhnsuygimmindch,ngoinguyccaovi
ccbinchngnythcngctngnguycb
vimphi,nhimtrng,vimmngno, abces
hnh thnh, bnh u trng giun ln lan ta
hocHCTNATGL(8).Tvongthngxyrado
nhimtrngvikhungrammvgramdng
ng rut nh Escherichia coli, Klebsiella
pneumoniae,Enterococcusxyrahn80%scac
suygimmindchcnghichngtngnhim.
Trckhibtuliuphpthuccchmin
dch,nnsnglcnhimutrnggiunlnl
khuyn co vi nhng bnh nhn khng triu
chng c nguy c, nh tng bch cu i toan
khng r nguyn nhn, c tin s tn thng
dida,utrngdichuynnhrnbhocc
phi nhim vi t hoc phn ngi bnh
nhimtrongvngluhnh.
Ivermectin, mt loi khng sinh ln u s

dngtronglnhvcthyiutrnhimgiun
trn, song sau c dng trn ngi vo
cuinhngnm1980.Thuccchdntruyn
thnkinhtrongccgiuntrnvngvtchn
khp thng qua kch thch ly gii [gamma]
aminobutyricacidtcconcuisithnkinh
tin synap v c ch dn truyn thn kinh l
thuc acide [gamma]aminobutyric acid. T l
tiudithainmsauiutrbngivermectinrt
cao97%(6).Mtsbocochothycctcdng
ph tng t nh cc thuc thuc nhm
benzimidazoles, nhng nhn chung chng xy
ravitnsutthnvtnghimtrnghn.T
chc Y t th gii lit k Ivermectin nh thuc
cchnhiutrhichngtngnhimv
nhimgiunlnlanta.
Trn nhng bnh nhn bnh nng t cc

vngluhnhcbiuhincctriuchnglan
takhngpngviccliuphpkinhin,
nhng trn lm sng c nghi ng HCTNATGL
th nn ngh n v tip cn chn on cng
nh iu tr sm. Trong ca bnh ny c nhim
rt nhiu u trng giun ln trn bnh l suy
gim min dch, c l y l ca bnh rt him
gp xy ra HCTNATGL v vim phi do
Pneumocystisjirovecingthi.
Tiu dit hon ton gnh nng KST trn

nhngcacbinchngtrckhisdngliu
phpthuccchmindchlcnthitm
borngHCTNATGLskhngphttrintrong
sut qu trnh iu tr. T l cha khi trn
nhngcanhimtrngmntnhkhngctriu
chnggn100%.Ccbinchngtrnccbnh
nhnsuygimmindchkhngiutrthng
4.
196
TILIUTHAMKHO
1.
2.
3.
5.
6.
7.
Boyd WP, Campbell FWJ, Trudeau WL (1978). Strongyloides

stercoralishyperinfection.AmJTropMedHyg1978;27(Pt1):39
41.
IgraSiegman Y, Kapila R, Sen P, et al (1981). Syndrome of
hyperinfection with Strongyloides stercoralis. Rev Infect Dis
1981;3:397407.
Longworth DL, Weller PF (1986). Hyperinfection syndrome with
strongyloidiasis.CurrClinTopInfectDis1986;7:126.
Nagaraj P, Czachor JS, Hawley B (2000). Strongyloides
hyperinfectionwithpulmonaryhemorrhageandARDS. Infect Med
2000;17:20812.
Scowden EB, Schaffner W, Stone WJ (1987). Overwhelming
strongyloidiasis:anunappreciatedopportunisticinfection. Medicine
(Baltimore)1978;57:52744.
Upadhyay D, Corbridge T, Jain M, et al (2001). Pulmonary
hyperinfection syndrome with Strongyloides stercoralis. Am J Med
2001;111:167169.
Wehner JH, Kirsch CM (1997). Pulmonary manifestations of
strongyloidiasis.SeminRespirInfect1997;12:122129.
ChuynYTCngCng
8.
ZahaO,HirataT,KinjoF,etal(2000).Strongyloidiasis:progressin
ChuynYTCngCng
NghincuYhc
diagnosisandtreatment.InternMed2000;39:695700.
197
NghincuYhc
SOSNHHIULCPHCTHUC
DIHYDROARTEMISININE+PIPERAQUINEVICHLOROQUINE
TRONGIUTRSTRTDOPLASMODIUMVIVAX2011
HunhHngQuang*,TriuNguynTrung,HVnHong
TMTT
tvn:StrtdoPlasmodiumvivax(P.vivax)eda40%dnsthgii,khong250triucamc
minm,baogmstrtctnh(SRAT)vtvong.P.vivaxphnbrtrng,vi2.5tngicnguyc
mcbnh.StrtdoP.vivaxkhngchloroquinecboconhiunitrnthgii,ngoitrVitNam.
Mctiu:SosnhhiulcphcCQviDHA+PPQtrongiutrstrtdoP.vivax.
Phngphpnghincu:Thnghimlmsngngunhincichng.
Ktqu:TrongkhihiulcACPR(pnglmsngvksinhtrngy)caCQvnbnvng
mccao(93.6%)iviP.vivaxvctlthtbiKSTmun(LPF)l6.5%.Ngcli,ACPRcaphc
DHA+PPQiviP.vivaxtuyti(ACPR=100%),chacthtbiiutrETF,LPF,LCF.Thigian
FCT2phckhngkhcbit,nhngPCTngnhnnhmDHA+PPQsoviCQ(38.112.2giv62.2
12.2 gi), s khc bit c ngha thng k. Din tin, tc gim v thi gian lm sch giao bo ca
DHA+PPQnhanhhnsoviCQsaumi24gi.
Ktlun:HinP.vivaxvncnnhyvithucchloroquine.Nutrongtnglai,khngthucxyrav
lanrngthkhichinlcthucACTssllachnphhpchoccvngcluhnhP.vivax.
Tkha:Plasmodiumvivax,chloroquine,dihydroartemisinine,piperaquine.
ABSTRACT
EFFICACYCOMPARISONOFCHLOROQUINEANDDIHYDROARTEMISININE+PIPERAQUINE
REGIMESINTREATMENTFORPLASMODIUMVIVAXMALARIAIN2011
HuynhHongQuang,TrieuNguyenTrung,HoVanHoang
Background:Plasmodiumvivax(P.vivax)threatensalmost40%oftheworldspopulation,resulting in
250millionclinicalinfectionseachyear,includingseverediseaseanddeath.P.vivaxisgeographicallythemost
widelydistributed,withupto2.5billionpeopleatrisk.Chloroquineresistantvivaxmalariahadreportedinthe
world,butnotinVietnam.
Objectives:TocompareofDHA+PPQefficacyandCQintreatmentforvivaxmalaria.
Methods:Controlledrandomizedclinicaltrialstudydesign.
Result: While ACPR (Adequate Clinical and Parasite Respons) efficacy in CQ was high (93.6%) for
P.vivaxandLPFrateof6.5%.ACPRefficacyinDHA+PPQforP.vivaxwashighlyabsoluted(ACPRof100%),
without any ETF, LPF, LCF. The FCT in two regimes were not significantly different, but the PCT was
statisticallysignificantshorterthaninDHA+PPQtoCQregimeintime(38.112.2hrsvs.62.212.2hrs).
RateofprogressioningametocyteclearanceinDHA+PPQgroupwasmorerapidthanCQafterevery24hrs.
Conclusion:Pvivaxremainssensitivetochloroquine,withriseandspreadofchloroquineresistantPvivax,
*VinStrtKSTCTQuyNhn
Tcgilinlc:BS.HunhHngQuang. T:0905103496
198
Email:huynhquangimpe@yahoo.com
ChuynYTCngCng
NghincuYhc
theremightbeacompellingrationaleforaunifiedACTbasedstrategyforvivaxmalariainendemiczones.
Keywords:Plasmodiumvivax,chloroquine,dihydroartemisinine,piperaquine.
khuyn co ca WHO khi tht bi iu tr vi
TVN
thuc u tin CQ v mt s trng hp bt
Mcdphnlncctrng hp SR, SR c
dung np CQ, tt c vn khin chng ta
tnh (SRAT), t vong u do P. falciparum,
cnphicthucthaythkhiphcCQgim
nhng P. vivax cng nh hng n gn 100
pngnmccnhbo(5,6).
triungiminmtrntoncu.1020%sca
Mc tiu nghin cu: So snh hiu lc
P. vivax tp trung chu Phi, nam Sahara; ti
thuc dihydroartemisinine + piperaquine vi
vngngvNamPhichothyP.vivaxchim
chloroquine trong iu tr SR do Plasmodium
khong 10% v ring ti Ty v Trung Phi, P.
vivax.
vivaxchimdi1%(2,1).NgoichuPhi,P.vivax
ITNGPHNGPHPNGHINCU
chimtrn50%vtrong8090%scal
nm cc quc gia Trung ng, chu , Ty
aimnghincu
ThiBnhDngv1020%lnm cc quc
X Phc Chin, huyn Thun Bc, tnh
gia Trung v Nam M. Cng vi P.falciparum,
NinhThun.
th P.vivax gp phn vo qu trnh i ngho,
itngnghincu
tng t l bnh trong m hnh bnh tt ti cc
qucgia;vdkhngnhiu,nhnggnySR
Tiuchunchnbnh
do P.vivax c ghi nhn gy nn cc bnh cnh
Tuit6thngtrln.
SRATvTVSR,cbittin,gins
Nhim n thun KSTSR Plasmodium vivax
gimpngcaP.vivaxvithuc(2,1).
cphthinbngknhhinvi.
Chloroquine (CQ) l mt thuc dit th v
MtthvtnhcaKSTSRP.vivaxtrong
tnh c hiu qu hn 60 nm qua trong vic
mu250/lmu.
phngbnhviutrSRdoP.vivax.Chon
Nhit nch 37.5 C hoc tin s c st
thpktrcthucCQvncnnhyviloik
trongvng48gitrckhivonghincu.
sinhtrngny.Song,tlkhngcaoviCQ
Bnhnhnckhnngnutvungthuc.
c bo co ln u tin ti Papua New
Guinea, tip ti Indonesia khong 10% v
Cha dng bt k loi thuc SR no trc
naynhiubocochobitbnkhngCQdo
(nhhngndcnghcthucnghin
P.vivaxlanrngkhpthgii.Trctnhhnh
cu).
,WHOkhuyncochosdngccnhm
Bnhnhnv/hocgianh,ngigimh
thucphihpcartemisinine(ACTs)khicca
ng hp tc nghin cu, tham gia liu
bnhSRdoP.vivaxkhngviCQ(WHO.,2009
trnhiutrvtheodibnhnhntrongsut
2011). Hn na, mt s bnh nhn c c a
28/42ngy.
khngdungnpviCQ(5).
Tiuchunloitr
Tng t cc quc gia ng Nam khc,
Nhhn6thngtuivlnhn70tui.
VitNamcngsimtvinguyclanrng
Phncthai(testthmtnh)hocang
timtngP.vivaxkhngviCQ(5).Do,song
choconb.
song vi hot ng theo di p ng k sinh
trng P.falciparum, chng ta cn phi theo di
thng quy vn hiu lc ca CQ i vi P.
vivax,tchngxtrvthayiphc
thch hp. Vi 3 l do v khng thuc CQ
trnthgii,vgimnhyviCQ,kthpvi
ChuynYTCngCng
BnhnhnSRdoP.vivaxcbiuhin bin
chngnng(hnm,rilonthc,hichng
suyhhp,thiumunng)ihiphinhp
vin,hocnntrmtrnghocthtrngkhng
199
NghincuYhc
hp thu c thuc v cc thnh phn 4

aminoquinolein.
Hinangmcbnhnhimtrngphihp
khcnhtiuchynng,vimhhpcp,si,
bnhnnsncnngnhgan,thn,timmch,
HIV/AIDS,cmnng,suydinhdng.
Nhim SR phi hp P.vivax + P.falciparum
hocP.malariae.
Phngphpnghincu
Thitknghincu
Th nghim lm sng ngu nhin, c i
chng.
Th nghim in vivo theo di 28/42 ngy
nhgitheoquynhWHO2009.
Cmunghincu
Chn t l tht bi iu tr CQ/DHA+PPQ
khong 10% vi khong tin cy CI 95%,
chnhxc(d)10%.Khicmutithiucn
nghin cu hiu lc CQ/DHA+PPQ l 35. C
muphiiuchnhdphngmtmu(c
tnh20%trong1nghincutheodi28hoc42
ngy).
KTQUNGHINCU
c im chung ca 2 nhm bnh nhn
nghincu
Bng1.Mtscimdnshcca2nhm
nghincu.
c im v hai
nhm nghin cu
Thi im bt u vo nghin cu
D0
DHA + PPQ
CQ
p
(n = 36)
(n = 32)
Gii tnh
Nam/n
Nam
N
Tr em
Ngi ln
Nhm tui
<5
5 <15
15
27/9
27 (75%)
9 (25%)
12 (33.3%)
24 (66.7%)
30/2
30 (93.8%)
2 (6.3%)
6 (18.8%)
26 (81.3%)
2 (5.6%)
10 (27.8%)
24 (66.7%)
0 (0%)
6 (18.8%)
26 (81.3%)
0.034
0.77
0.85
Kthutnghincuvquytrnhtheodi
Tngs68trnghpnhimnthunP.
vivax tiu chun a vo nghin cu, cho
ung thuc theo hai nhm DHA+PPQ v CQ,
phn tch cho thy t l phn theo gii c s
khcbitcngha(p=0.034).Tltremv
ngi ln khng c s khc bit c ngha
thngk.
Theo cng ca T chc Y t th gii

(2009).
Bng2.cimlmsngtrnhainhmbnhnhn
nghincu.
Cckhacnhoctrongnghincu
Thc hin y v cc bc: s chp
thuncaHingocysinh,thchnh
lm sng tt (GCPs), cam kt tham gia nghin
cu thng qua k bn chp thun, bo mt
thngtinvsliunghincuvdchvchm
scyttia.
Phnloinhgihiuquiutr
TheoquitrnhnhgicaTchcYtth
giinhcaP.falciparum(2009).
Phntchvxlsliu
SliuthuthpcphntchtheoInvivo
Exelsheet7.1,PascalRingwaldcaWHO,2009.
c im lm sng
2 nhm nghin cu
Thn nhit v cn nng

Thn nhit trung bnh
(0C)
Cn nng trung bnh
(kg)
S ngy st trc iu
tr (ngy)
S ca c st v tin s
c st
Nhit 37.50C
Tin s c st (trong 48
gi)
Lch ln
I + II
III
Thi im bt u vo nghin
cu D0
DHA + PPQ CQ (n = 32)
p
(n = 36)
37.3 (27.237.4)
30 (12 - 69)
2.1 1.1
37.3 (37.237.4)
35 (8 - 59)
2.4 1.3
0.89
0.74
0.59
26 (72.2%)
6 (16.7%)
26 (81.3%)
3 (9.4%)
>
0.05
16 (41.7%)
15 (93.8%)
1 (6.3%)
18 (56.3%)
17 (94.4%)
1 (5.6%)
>
0.05
Sngycsttrckhibnhnhnniu
tr, thn nhit vo thi im thm khm ban
200
ChuynYTCngCng
u, cn nng trung bnh, tnh trng lch ln
hay bnh thng v s bnh nhn c xut hin
stcaocogitnhgiahainhmbnhnhn
nghin cu khng c s khc bit c ngha
thngk.
Bng3.cimvksinhtrngstrthai
nhmbnhnhn
c im nhm
nghin cu
Thi im bt u vo nghin
cu D0
DHA + PPQ
CQ
p
n = 36)
(n = 32)
KSTSR th v tnh
MKSTSR th v tnh 3.2 (3 - 3.6)
3.101 (3.2 - > 0.05

3.4
KSTSR th hu tnh
S trng hp c giao 24/36 (66.7%) 23/32 (71.9%)
bo
75/ l (35 - > 0.05
77/ l (26 MKST giao bo trung
115)
128)
bnh
Phntchvthvtnhvhutnh,chobit
mtthvtnhlnltgia2nhml3.2(3
3.6)/lv3.1(3.23.4/l,khngcskhcbit
cnghathngk.Strnghpcgiaobo
gia 2 nhm ln lt l 24/36 (66.7%) v 26/32
(81.3%).MtTBthgiaobocngtngi
gia2nhm,lnlt77v75/lmu.
Hiu lc phc chloroquine v

DHA+PPQivistrtdoP.vivax
Bng4.PhnloihiulcphcDHA+PPQv
CQivistrtP.vivax.
Mt mu
Hiu lc
Ch s nh gi
ETF
LCF
LPF
ACPR
Tng s phn tch
Rt khi nghin
cu
Mt theo di, gin
on
Tng s nghin
cu
DHA+PPQ
(n = 36)
S
lng
T l
%
0
0
0
33
33
0
0
0
100%
CQ
(n = 32)
S
T l %
lng
0
0
2
29
31
36
32
0
0
6.5%%
93.6%
HiulcphcctlACPRt100%
nhmdngDHA+PPQv93.6%nhmdng
CQv2cathtbiKSTmunvongyD28,v
ChuynYTCngCng
NghincuYhc
D42c3trnghpmttheoditrongqutrnh
nghin cu nhm dng DHA+PPQ v 1
trnghpnhmdngCQ.
Bng5.nhloiksinhtrngtrongphnloitht
biksinhtrngmun(LPF).
M
Pht
hin
D0
D28/D42 Phn loi

in vivo
Xc nh li
RDTs
Loi: nonfalciparum
LPF
NTCQ16
(vch 2 (+)
(P. vivax) c hiu loi
(D0-28) Giao
0
12
P.vivax hoc
bo
pan-species
Loi: P.
Th
250/L 284/L
LPF
falciparum
v tnh
NTCQ29
(vch 1 (+)
(P.
(D0-42) Giao
34
17 falciparum) c hiu loi
bo
P. falciparum
Th
276/L 105/L
v tnh
Trong nhm bnh nhn dng phc CQ,

c2trnghpxuthinliKSTSRloiP.vivax
v P. falciparum (qua kt qu soi knh hin vi,
quethnhanh).
Hiu lc ct st v ct k sinh trng P.

vivaxcaphcCQvDHA+PPQ
Bng6.HiulcctstvlmschKSTSRP.
vivaxcaphcDHA+PPQ.
So snh gia hai phc
Ni dung phn tch
DHA+PPQ
(n = 33)
Ngy st TB trc khi iu

2.1 1.1
tr (ngy)
Thn nhit trung bnh ngy 37.3 (27.2D0 (0C)
37.4)
Mt KSTSR trung bnh 3.2 (3 - 3.6)
ngy D0
Thi gian ct st TB (FCT)
24.5 8.4
theo gi
Thi gian sch KSTSR TB
38.1 12.2
(PCT)
Xut hin li trong 28 ngy
0
theo di
Xut hin li trong 42 ngy
0
theo di
CQ
(n = 31)
2.4 1.3
> 0.05
37.3 (37.2> 0.05

37.4)
3.1 (3.2 > 0.05
3.4
28.3 5.2 > 0.05
62.2 12.2 0.003
1
1
Thi gian ct st (FCT) ln lt 2 nhm

DHA+PPQvCQl24.58.4giv28.35.2,
khngcskhcbitcngha.Thigiansch
KSTSR (PCT) ln lt 2 nhm DHA+PPQ v
CQl38.112.2giv62.212.2gi,skhc
bitcnghathngk.
201
NghincuYhc
Bng7.TlgimgiaobotrcvsauiutrCQ
vDHA+PPQ.
So snh gia hai phc
Ni dung phn tch
Mt KSTSR th giao bo
TB D0
S trng hp c giao bo
Din tin giao bo sau mi 24
gi
Ngy D0
Ngy D1
Ngy D2
Ngy D3
Ngy D7
Ngy D14
Ngy D21
Ngy D28
Ngy D35
DHA+PPQ
(n = 33)
CQ
(n = 31)
77/L
75/L
23/33
(69.7%)
22/31
(70.9%)
23 (69.7%)
28 (84.9%)
28 (84.9%)
16 (48.5%)
2 (6.1%)
0 (0%)
22 (70.9%)
24 (77.4%)
26 (83.9%)
26 (83.9%)
27 (87.1%)
12 (38.7%)
3 (9.7%)
1 (3.2%)
1 (3.2%)
>
0.05
Din bin hnh thnh v gim i giao bo

giahainhmbnhnhndngthuckhcbit
cnghathngk.
BNLUN
Hiu lc phc DHA+PPQ v CQ liu
trnh3ngyiviSRdoP.vivax
HiulccatngphcDHA+PPQvCQ
TltACPR100%nhmDHA+PPQv
khngthytnhtrngETF,LCFvLPF.Ngc
li,nhmbnhnhndngthucCQchohiu
lc ACPR l 93.55%, vi 2 ca tht bi k sinh
trngmun(LPF)vongyD28vD42.Phntch
v2trnghpLPFnhmCQ,xuthinli
KSTSR loi P. vivax v P. falciparum (qua lam
nhum gim sa v test nhanh). V kt qu xc
nhtipht/tinhimbngPCR,nnayvn
chanhncktquphnhi,nnchath
khng nh y l ti pht hay ti nhim ca
NTCQ16 nh gi mt cch thu o cng
nhvaitruthtngphctrongtcng
lmgimnhimmihocgimtinhim.
Tlthtbinytngtnhmtnghin
cucanhmtcgiNngThTinvcngs
tin hnh ti x Phc Thnh, huyn Bc i,
tnhNinhThunchothypngACPRcaP.
202
vivaxviCQchcnl94.3%vtlthtbik
sinhtrngmunLPFl5.7%cnglmtcnh
bosm(N.T.Tinvcs.,2007)hoccdin
tingimnhythngquathigianschksinh
trng v thi gian ct st ko di qua cc nm
2005 2007 (H.H. Quang v N.T. Thoa v cs.,
2008;H.H.Quangvcs.,2010)haykhngCQdo
P. vivax ln lt c cng b ti n ,
Myanmar, Guyan, Nam Phi v Indonesia (J.
Kevin Baird v cs., 2004) trn y vn th gii.
im th v v phc tp nht l tnh trng th
ngtronggantihotngsauthigianiu
trsrtkhphnbittiphttinhimti
pht sm trn bnh nhn, nht l bnh nhn
nghin cu nm trong vng SR lu hnh cng
nhvnglantruyncaosnysinhnhiuyu
tnhiu(1,4).
Mt khc, trong 2 trng hp tht bi k
sinhtrngmun(LPF)uxyrasaungyD21
nnchngticngkhnggimuinhgi
v o nng cht CQ v cht chuyn ha
desethychloroquine nh gi tht bi/xut
hinksinhtrngcngvithiimnng
vt ngng hay khng v thi gian bn hy
o thi thuc khng cn na nh mt nghin
cutnglmtrongmtnghincutrncmu
ln(n=333)ctinhnhtiIndonesialt
D17D30,trungbnhlD23,cmtstxuthin
saungyD30(Bairdvcs.,1997).
HiulcctstvctksinhtrngP.vivax
caphcchloroquinevDHA+PPQ
Thigianctsttrungbnh(FCT)lnlt
hai nhm dng DHA+PPQ v CQ l rt ngn
24.458.36 gi v 28.325.15, khng c s khc
bitcngha.Doctstnhanhnncithin
tngthtnhtrnglmsngcabnhnhn.
Ngc li thi gian lm sch KSTSR trung
bnh(PCT)hainhmDHA+PPQvCQcs
khc bit r 38.1212.20 gi v 62.2412.24 gi.
Phn tch v hiu lc trn kh nng lm sch
KSTcnchothystixuthinKSTtrongthi
gian theo di trong 28 ngy u, c th c 1
trng hp nhm CQ xut hin li P.vivax v
ChuynYTCngCng
tiptc theo di n D42 th nhm ny li xut
hintiptc1trnghpcP.falciparum.
Hiulcvgimnguyctinhim,tipht
vschKSTtrongvsauiutr
im quan trng trong nghin cu ny l
vaitrcatngphctrongkimsotvlm
gimkhnngtiphtvnhimmi.Davo
bng7.cthnhnthymtgiaoboca2
nhmdngthuctrciutrcmtnh
nhauvscabnhcgiaobongthivith
vtnhtrongmucngtngng(69.7%v
70.97%). D phc DHA+PPQ v CQ, trong
thnh phn khng c cht no c hot tnh
chngvditthgiaobo,songccnghincu
v dc ng hc artemisinine v dn sut
(artesunate, dihydroartemisinine, artemether,
arteeter,arteolane)uktlunrngchngtc
ngmnhvnhanhtrncP.falciparumvP.
vivax, c bit dit nhanh cc th t dng v
phnlittgiaioncnnonntrngthnh,
do vy n cng gin tip ct gim nhanh th
giaobongk(3,6).Tuynhin,dochukpht
trin ca P.vivax khc vi P.falciparum im
tntithngtrongganP.vivax,nnkhcth
nh gi thu o v r rng v tc dng ca
tngphcthuctrnvntiphtthts,
tinhimvschgiaobosaukhiiutrvc
thbmtsyutnhiulmnhhngn
nhnnhvothiimcuicng(6).
Din tin v c mt giao bo, hnh thnh
giao bo trc, trong v sau iu tr hai nhm
thucliutrnh3ngycskhcbitrrttheo
tng ngy theo di (sau mi 24 gi). Din tin
cho thy nhm bnh nhn dng phc
DHA+PPQ c s tng nhanh t l mang giao
botrongvsauiutr3ngy,nhngsau
li gim i rt nhanh k t ngy D3, n D7 v
sch giao bo vo thi im D14 (D0: 23 (69.7%)
D1: 28 (84.85%) D2: 28 (84.85%) D3: 16
(48.48%)D7:2(6.06%)D14khngcn).iu
ny c th hoc l ngoi tc ng nhanh lm
chtccthvtnh,thchngcngyhiung
lm bng n hay phn ng di giao bo
cng nh th v tnh do tc ng ca thuc
ChuynYTCngCng
NghincuYhc
liu ban u (v cc ngy u l liu cao, tn

cng trn dung khi KST) nhanh, sau li
gimdn.Gicthlmtimmiivi
thucACTs.
Ngcli,phcCQlicdintincng
lmtngtlngimanggiaoboP.vivaxln
trongvsauqutrnhiutrtrongvng7ngy
u(D0:22(70.97%)D1:24(77.42%)D2:26
(83.87%) D3: 26 (83.87%) D7: 27 (87.10%),
nhngsautngyD14nD35mibtu
gimtlmanggiaobo(D14:12(38.71%)D28:
3 (9.68%) D35: 1 (3.22%) D42: 1 (3.22%). So
vi thuc DHA+PPQ th phc ny cho t l
gimsinhvtngschgiaobonhanhhnphc
CQ.Tuynhin, nghin cu ny vi c mu
nh,thigiantheodichadivchngta
chphthin2caxuthinliKSTvphc
DHA+PPQlicpngACPRl100%,khng
ctltiphthaythtbinososnhv
chngtichanhginguyctchlycati
xuthinksinhtrng,tsHazard,cngnh
phn tch nguy c tht bi tng phc nh
mtsnghincuthchintiatrungtm
v s mu rt ln (Nateghpour M v cs., 2009;
GhulamRahimAwahvcs.,2010).
KTLUN
HiulcphcDHA+PPQivistrt
do P. vivax tuyt i (ACPR = 100%), cha c
mttlthtbiiutrETF,LPF,LCFno.
HiulccaCQvncnbnvngvduy
trmccaoiviSRdoP.vivax,tlACPR
l93.55%,songvncmttlnhthtksinh
trngmun(LPF)l6.45%.
Hiu lc v din bin thi gian ct st ca
haiphctngngnhau.Hiulcvtc
lm sch KSTSR theo thi gian ngn hn
nhm dng DHA+PPQ so vi CQ (38.1212.20
gi so vi 62.2412.24 gi), s khc bit c
nghathngk.
Dintin,tcgimvthigianlmsch
giaobocaphcDHA+PPQnhanhhnso
viphcCQtheothigianmi24gi.
203
NghincuYhc
Vi cc d liu nu trn, cho thy hiu lc

phcDHA+PPQttuyti.Hiulcphc
CQ vn cn bn vng, ACPR cao trn 90%
quanhiunmsdngtivngny,thigian
lmschKSTSRchmhnsoviDHA+PPQv
cbitdintingiaobocnhcimtng
ln v ko di hn so vi DHA+PPQ(1,2,3). D
thuc CQ vn cn hiu lc cao, song cc bng
chngvthtbiiutr(LPF)kthpvithi
gianlmschKSTkodicngnilnvn
gim nhy, hay gim p ng ca P.vivax vi
CQ,cthxemnhmtchimcnhbo
nguy c xut hin khng nu khng gim st
thngquychngxtrthayiphc
theo tng giai on, chng hn dng thuc
DHA+PPQnhWHOkhuynco(WHO,2011).
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
Baird JK (2009). Resistance to therapies for infection by

Plasmodiumvivax.ClinMicrobiolRev,2009Jul;22(3):50834
Bruno BA, Antonio RF, Sebastiao et al., (2010). Severe
Plasmodium vivax malaria exhibits marked inflamatory
imbalance. Malaria Journal 2010, 9:13 doi:10.1186/147528759
13
Ketema T, Bacha K, Birhanu T (2009). Chloroquineresistant
PlasmodiumvivaxmalariainSerbotown,Jimmazone,south
westEthiopia.Malariajournal,2009jul30;8:177
Price RN, Douglas NM, Anstey NM., (2009). New
developmentsinPlasmodiumvivaxmalaria:severediseaseand
the rise of chloroquine resistance. Curr Opin Infect Dis, 2009
Oct;22(5);4305.
TrungTN,QuangHH,GuoqiaoLvcs.,(2009).nhgihiu
lcccphcthucphihpcgcArtemisininetrongiu
trSRdoP.falciparumchabinchng.Tpchydchcqun
s,ISSN18591655,SC1/2009,trang3236.
WHO (2010). Global report antimalarial drugs efficacy and
drugsresistance20002010.
204
ChuynYTCngCng
NghincuYhc
CIMDCHTHCLMSNG
BNHUTRNGGIUNGNATHOSTOMASPINIGERUM
TIMTSTNHMINTRUNGTYNGUYN
HunhHngQuang*,TriuNguynTrung*,HVnHong*,HunhBnhPhc*
TMTT
tvn:BnhdoutrngG.spinigerumlbnhtruyntngvtquangthcndoutrng
giaion3caGnathostomaspp.Bnhcphthinnhiuvngnhitivcnnhiti,luhnh
ngNam,NhtBnvanggiatngtichuMLatin.Trcy,bnhhimkhigpngoivnglu
hnh;nhnghn10nmquascaticcqucgianibnhkhngluhnhtngln.
Mctiu:MtcimdchthclmsngtrnbnhnhnnhimutrngG.spinigerum.
Phngphpnghincu:Mthnglotca.
Ktqu:Tngs77bnhnhnphntchchothymhnhyutnguyccaophhptrnyvn.c
imlmsnggmutrngdichuyndanimmcvthphtngvicctriuchngkhngchiu.
Kt lun:BnhutrnggiunugailuhnhchyutingNam,kcVitNamvccnh
nghincugnychobittlmcmicabnhtngngi.Nhimutrngnybiuhincctriu
chngkhngchiuvihichngutrngdichuyndavphtng,dnhmlnvbsttrongchn
on.
Tkha:Hichngutrngdichuyn,Gnathostomaspinigerum.
ABSTRACT
CLINICALEPIDEMIOLOGYMANIFESTATIONSINHUMANGNATHOSTOMIASISINCENTRAL
HIGHLANDPROVINCES,VIETNAM
HuynhHongQuang,TrieuNguyenTrung,HoVanHoang,HuynhBinhPhuoc
Background: Gnathostomiasis is a foodborne zoonosis caused by the thirdstage larvae of the helminths
Gnathostomaspp.ThisdiseaseiscommonintropicalandsubtropicalregionsanhhasendemicinSoutheastAsia,
Japan,andLatinAmerica.However,thenumberofcaseshasincreasedinareaswithoutepidemic.
Objectives:Describeepidemiologicalaspectsbypatientswithgnathostomiasiswhotreatedinourinstitute.
Methods:Describeaseriesofpatients.
Result: A total of 77 patients analysis showed a plausible epidemiologic risk model suitable for medical
literature. The clinical manifestation included mucocutaneous form (cutaneous larva migrans syndrome/
creepingeruption)andvisceralmigrationformwithnonspecificsymptoms.
Conclusion:GnathostomiasisisendemicinSoutheastAsia,includingVietnam.researchershavenoticedan
increase in incidence of human gnathostomiasis. Human gnathostomiasis infestation showed that initial
nonspecific symptoms followed by cutaneous and/or visceral larva migrans, it is easy to misdiagnosis or
underdiagnosiswith.
Keywords:Cutanneouslarvalmigranssyndrome,Gnathostomaspinigerum.
*VinStrtKSTCTQuyNhn
Tcgilinlc:BS.HunhHngQuang. T:0905103496
ChuynYTCngCng
205
NghincuYhc
TVN
Bnhdoutrnggiunugailmtbnh
k sinh trng (KST) truyn t ng vt sang
ngi vi mt s loi c chng minh c
linquan(Gnathostomadoloresi,G.spinigerum,G.
nipponicum,G.hispidumvG.binucleatum).Trong
s , G. spinigerum c xem nh mt loi
chnhgybnhchongikhuvcchuni
chungvVitNamniring(3,1).Vsphnb
ca bnh v thi quen n ung ca con ngi,
nhtlitngidulchnccvngclu
hnh bnh, c bit Thi Lan v Nht Bn, to
iu kin thun li cho s ca bnh ngy mt
tng.
Bnh do giun u gai trn ng vt c th
rtnghimtrngtrongdintinbnh,thmch
c th dn n t vong do cc bin chng,
ngc li th bnh trn ngi, c bit i vi
loi Gnathostomaspinigerum,hnh thi lm sng
biuhinnhiunhtlhichngbantrn,u
trngdichuyndidavthbnhphtng
himgphn.Khibiuhinkhnginhnhd
chnonnhmvimtsbnhnikhoavda
liu khc. Th thn kinh ca giun u gai biu
hinlmsngvicctriuchngvbinchng
(vim no mng no, vim r ty, vim mng
no, xut huyt nhu m no hoc di nhn,
nhi mu no) kh c th nh phn gia cc
bnhlnithnkinhkhc,nndbstbnh
vtvonglcthxyra.Dichngcthln
n825%(2,4).
Hinti,ngoiccvngdchtbittrc
y nh Nht Bn, Thi Lan, Myanmar, rt
nhiubococabnhcghinhntinhiu
qucgiangNam.iungquantml
cctriuchngbiuhincaphnlnbnhk
sinhtrnggiunsntngtviccbnhlni
khoa v da liu khc nn kh c mt s thng
nhtvtiuchunchnon(2).Dovy,nghin
cu dch t hc lm sng nhm xc nh cc
triuchngphbin,khuynnghmttiu
chunchnonchunglcnthit.
Mc tiu nghin cu:nhgicimdchthcvbiuhinlmsngtrnbnhnhn

nhimutrnggiunG.spinigerum.
Hnh1.SiucutrcbmtGnathostomaspinigerum(http://www.Stanford.edu)
ITNGPHNGPHPNGHINCU
itngnghincu
aimvthigiannghincu
Cc bnh nhn mc u trng giun u gai

Gnathostomaspp.chacbinchng.
VinStrtKSTCTQuyNhn,thigian
tinhnh1/2011n12/2011.
Phngphpnghincu
Thitkvcmunghincu
Nghincungangmt.
206
ChuynYTCngCng
Kthutnghincu
nh gi v cc bin s dn s hc, yu t
nguyclinquandchthc.
nh gi v cc triu chng lm sng trn
cccquancngnhccxtnghimsinhha,
huythc,chnonhnhnhtithiimbt
unhpvin.
Phntchvxlsliu
Phn tch da theo t l v cc kim nh
thngk.
KTQU
Mt s c im v dch t hc lm sng
canhmbnhnhnnghincu
Bng1.Mtscimvdnshccanhm
nghincu.
c im nhm nghin
cu
(n = 77)
Gii tnh
Nam
N
Nhm tui
Tui trung bnh
2.5 - < 6
6 < 12
12 - < 15
15 - < 50
50 - 60
Dn tc
Kinh
Jarai
Thi im bt u vo
nghin cu D0
S lng (%)
Hoa
a ch sinh sng v lm
vic
Bnh nh
2 (2.6%)
30 (38.9%)
47 (61.1%)
34.3 (2.5 - 66)
2 (2.6%)
2 (2.6%)
11 (14.3%)
52 (67.5%)
10 (13%)
74 (96.1%)
1 (1.3%)
19 (24.7%)
Gia Lai
Qung Ngi
Khnh Ha
Nng
Ph Yn
k Lk
12 (15.6%)
7 (9.1%)
11 (14.3%)
6 (7.8%)
16 (20.8%)
4 (5.2%)
Lm ng
2 (2.6%)
Ngh nghip
Nh, nh
i hc
Cn b vin chc
2 (2.6%)
15 (19.5%)
47 (61 %)
ChuynYTCngCng
c im nhm nghin
cu
(n = 77)
Mua bn, kinh
doanh
NghincuYhc
Thi im bt u vo
nghin cu D0
S lng (%)
13 (16.9%)
Tng s 77 trng hp nhim u trng G.

spinigerumchothynchimcaohnnam.Tui
trung bnh l 34 tui, nhm tui t 15 < 50
chim 67.5% cao nht, phn ln sinh sng
minTrungTyNguyn.96.1%ldntcKinh,
scnbvinchcmccaonht(61.1%).
Bng2.Mtsyutnguycgpphnnhim
bnhutrngG.spinigerum
c im nhm nghin cu (n = 77)
Thi im
trc nghin
cu
Thi quen n, ung

n c nc ngt (nhiu loi c)
Tht vt, g hp, g hp mui
Tht rn lm gi, ung huyt rn
Tht ch um, xo cha chn hoc gi
56 (72.7%)
15 (19.5%)
2 (2.6%)
21 (27.2%)
Vm, s huyt m tt
Tm, c thi mng chm m tt
Tht heo hun khi
5 (6.5%)
32 (41.6%)
2 (2.6%)
Ung nc sng, ging cha un si

Mc thng xuyn phi nhim thc n
Thnh thong n thc n ti, sng
8 (10.4%)
41 (53.3%)
Thng xuyn n ti - sng

Xem nh mn khoi khu (ti - sng)
t n nhng tip xc thng xuyn
27 (35.1%)
5 (6.5%)
4 (5.2%)
CcbnhnhnnhimutrngG.spinigerum
ctriuchngchothyhcthiquenn/hoc
phi nhim ngun tht ng vt c nguy c
nhimbnh.
Tnh trng bnh nhn vo vin & triu

chnglmsng,cnlmsng
Bng3.Tnhtrngbnhnhnlcvovintrckhi
iutrutrngG.spinigerum.
c im nhm nghin cu (n = 77) Thi im trc
khi nhp vin
S ngy biu hin bnh trc khi vo
vin
< 7 ngy
22 (28.6%)
7 - < 30 ngy
36 (46.8)
30 - < 60 ngy
14 (18.2%)
60 ngy
5 (6.5%)
Cn nng trung bnh
46 (14 - 78)
Tng trng chung bnh nhn
2 (2.6%)
207
NghincuYhc

khi nhp vin
Suy kit
75 (97.4%)
Khng suy kit
Mt ng
C mt ng mn tnh
26 (33.8%)
Thnh thong mt ng
12 (15.6%)
Thigianbiuhintriuchngnhtrc
khinkhmtiVinchyult7di30
ngy (46.8%). Ton trng bnh nhn vo vin
khng suy kit (97.4%). C 26 (33.8%) ca bnh
biuhinmtngmntnhv12(15.6%)thnh
thongmtng.
Bng4.Tamchngchnontrnmtcabnhu
trngG.spinigerum.
nhp vin
tam chng: (i) Vt ban trn/ u
trng di chuyn, sng phng tng t;
58 (75.3%)
(ii) Tng bch cu i toan; (iii) Yu t
dch t v c n ti sng
Cha tam chng
6 (7.8%)
Tn thng ph tng chung
13 (16.9%)
CabnhutrngGnathostomaspinigerum,s
catamchngchnon58ca(75.3%).
Bng5.cimlmsngcautrnggiunu
gaitng,cquankhc.
BNLUN
Mtscimvdchthccanhm
bnhnhnnghincu
Mu nghin cu 77 trng hp nhim n
thun u trng giun u gai G. spinigerum n
giichimtlcaohnsovinamgii(61.1%
sovi38.1cthvphnmangvaitrnitr
thng phi nhim vi cc thc n cn sng,
c bit tht ca thy cm, thy sn d nhim
bnh(3,1,5).Vachnictr,phnlnBNlm
nsinhsngcctnh,thnhminTrungTy
Nguyn,trongBnhnhchim24.7%,Ph
Yn 20.8%, Gia Lai 15.6%, Khnh Ha 14.3%,
QungNgi9.1%,Nng7.8%,kLk5.2%,
Lmng2.6%.
Lin quan gia bnh nhn nhim u trng
G.spinigerumnnghnghip,chothyscn
b vin chc mc vi t l cao nht (61.1%),
nhm i tng cn i hc l 19.5%, nhm
ngi mua bn kinh doanh chim t l 16.9%.
y c th l v tnh cht cng vic, giao tip
khchticcnhhngcsnvthiquenn
ung ca ngi ln. Nhm tui t 15 < 50
chim 67.5% cao nht, ngha l ri vo tui
ln,ngilaong.
c im nhm nghin cu (n =
77)
C quan tiu ha
au bng khng r rng
au vng thng v - mi c
Thi im bt u
Mt s yu t nguy c nhim u trng

cagiunG.spinigerum
16 (20.8%)
4 (5.2%)
au vng h sn (P)
Ri lon tiu ha, phn st lng
(t)
au dng co tht ng mt tng
cn
C quan h hp
au ngc
Kh th
Khc m c mu
C quan th gic
Ph di chuyn mi mt trn
Nhn m kiu song th
2 (2.6%)
2 (2.6%)
Cc bnh nhn nhim u trng G.

spinigerum,cthiquennccthcntngun
tht ng vt c nguy c nhim u trng giai
on3nhghinhntrongyvnviccloi
cncngt(cbitlclc,cqu,cchch),
tht vt, tht g hp hnh, g hp mui (19.5%),
thtrnlmgi,thmchungchuytrnti
pha t ru nhm vo mc ch cha bnh
(2.6%),lmthtchum,xochuangt,cha
chnhocgithtch(27.3%),nccngvtc
v nh vm, s huyt chm m tt vi ti
chanh, x du (6.5%), hoc n tm, c thi lt
mng chm m tt (41.6%), tht heo hun khi
(2.6%), danh mc cc thc n c nguy c v
ng vai tr vt ch trung gian ca bnh u
trnggiunugaiG.spinigerumchothy t
3 (3.9%)
4 (5.2%)
1 (1.3%)
1 (1.3%)
2 (2.6%)
1 (1.3%)
utrnggythngtntimtscquan
nhtiuha,h hp v th gic vi nhiu ph
lmsngkhcnhau.
208
ChuynYTCngCng
NghincuYhc
nhiu h c phi nhim vi u trng giai

on3caG.spinigerumcmttrongccphn
ththtdocnsnghocxlchachn(.c
bit,nghincunycngchothyc8trng
hp thng ung nc cha un si ngui
tccsng,gingchanusivitlngk
(10.4%),tngtnhtrongbnhsnlganln
thkhnngcautrnggiaion2cagiun
u gai G. spinigerum c th vo c th ngi
quangtiuhavgybnh(3,1,5).
nhn, kh nng p ng vim vi s tham gia

cacctbomast,immunoglobulinemindch
IgG, IgE, bch cu i toan, ngay c thn nhit
ca bnh nhn cng l mt yu t nh hng.
tontrngchungbnhnhnvovinkhngsuy
kit (97.4%), khe mnh ch c phn nn kh
chu v mt sinh hot do phn ng my ay,
nga ni ln lin tc v hi chng ban trn
khinhkhngcnttinkhigiaotip(2).
Vtnhchtvmcthngxuynphi
nhim vi cc thc n c nguy c cao trn
nhimmmbnhutrnggiungiaion3,cho
thycn6.5%sngixemlmnkhoi
khu (thch n dng ti sng) mi khi i nh
hng,qunn,hocthnhthonghnthcn
ti,sng(53.3%),thngxuynnhisnhoc
c nc ngt, sng, h dng tisng (35.1%),
thmchcnsngtivcbitcnhmi
tngrttnnhngtipxcthngxuynvi
ccthcphmtisngnytrckhiavo
chbin(5.2%),lccbnhnhnlubp
caccqunn,nhhng,vathumuatm,c,
hisnccloibnticcnhhnghocqun
ntrongthnhph.
Hichngutrngdichuynhocbantrn
nhgivcctriuchnglmsng,cn
lmsngtrnbnhnhn
Tngtrngchungvthigiankhiphtbnh
nkhivovincabnhnhn
Din tin bnh c th thay i theo tng
bnhnhn,thigianbiuhintriuchngtrn
cthbnhnhnnhtrckhinkhmti
vinthayitdi1tun(28.6%),nt<30
ngy(46.8%)vt1thngn2thngl18.2%
vtrn2thngl6.5%,nhiutrnghpy
bnhnhnmtxuthintriuchngtrn3
thng, thm ch nhiu nm nhng khng i
khm.Cnhiubnhnhnkhivokhmgy
ngivtriuchngmtngmntnh(33.8%)
v12trnghp(15.6%)thnhthongmtng
dongavnimyaynhiu(3,2,4).
Dintinbnhcthigiandihayngncn
tythucvocavthtrngcatngbnh
ChuynYTCngCng
Biuhinlmsngahnhthi
Vbiuhinlmsng,trnccbnhnhnb
bnh u tng giun u gai G. spinigerum biu
hin di nhiu hnh thi khc nhau, song cc
tc gi trong v ngoi nc u quy kt thnh
haithbnhchnhcaloiksinhtrngny:(i)
Thtnthngvngda,nimmcthngxut
hinvinhiuhnhthilmsngadng,hoc
bannthundngvt,vnvonihocn
di da mng hoc hin ln vng c hnh nh
nhbnvitlcaonht67.5%,tipnl
dubantrnicngvihichngutrngdi
chuyn(49.4%),banikmduvimqung
(32.5%), mt t l thp hn vi biu hin dng
bancngvihichngbantrn/utrng
di chuyn ng thi (11.7%), rt c trng cho
bnhutrnggiunugaiG.spinigerumm
trtnhiuqualotcabnhbocotrongyvn
(H.H.Quangvcs.,2011).Hnhnhvimphn
m m di da cng l mt triu chng ng
ch,dtkhibocotrncctpchchuyn
ngnhksinhtrng(5.2%).imcbitlcc
duhiubantrnhochichngutrngdi
chuyn to nn hnh nh sng phng di da
rtrvdintintngttheoghinhnbnh
nhn(2,4). Mi t thng ko di khong 710
ngyvc1520ngylaixuthinlnna.Tc
di chuyn ca u trng c th nhanh trung
bnh 12 cm mi gi. Dc theo cc ng di
chuyn to hm l cc mn nc nh i km
theo,gyngavnhit t bi nhim lm m
chodabnhnhn.
Cngnhcctcgikhctrnthgii,c
bit ti Nht Bn, trong nghin cu ny c ti
209
NghincuYhc
61.1%scanycbiuhinvtbantrnhoc
u trng di chuyn km theo du chng my
ay,ngadctheongicachng,mts
trnghpcbiuhinphnngvimtich
hoclantarahaibnhoctothnhm,ni
cchtlitidctheongicavtbantrn
(27.3%),scakhngkhngcphnngviml
33.8%.iunycntythucvotnhtrngv
sinh ca ngi bnh v thc i khm bnh
smhaymun.
Biuhinthngtncquan
Lmtbnhtruyntngvtsangngi,
nnvicgythngtntimtscquancaG.
spinigerumcngrthimgp,nucthcthdo
qutrnhutrngG.spinigerumdichuynvgy
thngtntichvlantatrnnhiucquan.
Cngnhmtsbnhgiuntrntiuhanhu
trng giun ln S.stercoralis, u trng giun a
ch/ mo Toxocara canis/ cati trong nghin cu
ny,utrngG.spinigerumnhhngtic
quan tiu ha do u trng giun u gai G.
spinigerumvibiuhinaubngkhngrrng
l20.8%,auvngthngvmic5.2%,au
co tht ng mt tng cn 3.9%, au vng h
sn(P)l2.6%vcrilontiuhadngphn
st,phnlngtngt(2.6%).
i vi c quan h hp, triu chng gp
bnhnhnkhnginhnhmgingnhbnh
phi khc, trong du au ngc (5.2%), kh
thvkhcmcsimutrncngmtbnh
nhnxpphithyrtr1.3%,saukhiiutr
khong10ngy,bnhnhncithinngk
c lm sng v hnh nh X quang phi thng.
Ticquanthgic,duhiuphmimttrn
rtinhnhvcdichuyntheothigiannh
yvnmtvitl(2.6%),hocnhnmkiu
songth(1.3%).Tngtnhtrnyvn,chng
ti khng pht hin thm cc triu chng khc
nodavosdichuyncautrng(3,2,5).
KTLUN
Mt s c im v dch t hc v yu t
nguy c ca bnh nhn nhim G.
spinigerum
Bnh nhn n chim cao hn nam, nhiu
nht n t tnh Bnh nh, cn b vin chc
mccaonht(61.1%)vtuilaongchim
caonht(67.5%).
Bnhnhncthiquennhocphinhim
thcntngunthtngvtcnguycnh
c nc ngt, tht gia cm, thy cm cha nu
chn.
Triu chng lm sng, cn lm sng trn

bnhnhnutrnggiunugai
Biu hin vng da nim mc hay gp nht
vi hi chng u trng di chuyn hoc ban
trn c tam chng (75.3%) hoc cha
tamchng(7.8%).
V l mt bnh vn d truyn ng vt
sangngi,nnscacbiuhinthngtn
ticccquantiuha,hhpvthgicc
phnthn.
TILIUTHAMKHO
1.
2.
3.
4.
5.
HermanJS,ChiodiniPL(2009).Gnathostomiasis,anotheremerging
importeddisease.ClinMicrobiolRev.2009Jul;22(3):48492.
HunhHngQuang,TriuNguynTrung(2010).Tnghplot
cabnhbantrn/hichngutrngdichuyndidadoksinh
trng ti huyn o L Sn, tnh Qung Ngi, Vit Nam (2006
2010).KyucngtrnhNCKH,VinYhcbinVitNam,Hi
YhcbinVitNam.
HunhHngQuang,TriuNguynTrung(2011).Giunugai
bnhgiunmini,Cpnhtyvnvtnghpthngtinv12bnh
nhngiunugai.Availablefrom:http://www.impeqn.org.vn
QuangHH,TrungNTetal.(2010).Humanhelminthicsdiseases:A
reviewandupdateofanemergingzoonosisnowcrossingCentraland
highland of Vietnam.Monography of International seminar of
ResearchableIssuesinEcosystemApproachestoHealthManagement
ofEmergingInfectiousDiseasesinSoutheastAsiainBali,Indonesia,
October,2010.
Sawanyawishuth JK et al., (2011). Neurognathostomiasis, a
negected parasitosis of the Central nervous system. Emerging
InfectiousDiseases.www.cdc.gov/eid.vol17.No7,July2011.
210
ChuynYTCngCng
NghincuYhc
HIUQUTHIABENDAZOLETRONGIUTRHICHNGUTRNGDI
CHUYNDOGNATHOSTOMASPINIGERUM2011
HunhHngQuang*,TraThanhPhc
TMTT
tvn:Hichngutrngdichuyn(CLM)vbantrn(CE)thnghaygpticcvngnhit
ivcnnhiti,kcvitNam,vccrilonvdamcphiticcvngnhiticngcthdou
trngGnathostomaspp.
Mc tiu: Xcnhphlmsng,cnlmsngvhiu qu ca thuc thiabendazole trong iu tr hi
chngCE/CLMdoG.spinigerum.
Phngphpnghincu:Nghincungangmtvthnghimlmsngkhngichng.
Ktqu:HichngCE/CLMbiuhinlmsnglmtphtriuchngadngviccban,ngon
ngoonhrnb,nga,sngphngdichuyndidagyradosxuyndanimmctnhcvtipsau
u trng G. spinigerum di chuyn, c bit trn th c tam chng in hnh (> 95%). Hiu qu ca thuc
thiabendazolengungrtcaovdungnpttviliuduynht(tlchakhi91.3796.55%)khngc
tcdngngoinghimtrng.
Ktlun:CE/CLMlmttnthngdanimdonhimutrngG.spinigerum.cimlmsngvi
phadng,dchnonnhmvibnhdavnhimtrng.iutrbngthiabendazoleliuduynhtctl
chakhicao.
Tkha:Gnathostomaspinigerum,utrngdichuyndida,Bantrn.
ABSTRACT
THIABENDAZOLEEFFECTIVENESSINTREATMENTFORCUTANEOUSLARVAMIGRANSDUE
TOGNATHOSTOMASPINIGERUMIN2011
HuynhHongQuang,TraThanhPhuc
Background: Cutaneouslarvamigrans(CLM)andcreepingeruption(CE)arethemostcommonlyfound
intropicalandsubtropicalgeographicareas,includingVietnam,andthesearetropicallyacquireddermatosisby
gnathostomaspp.larvaaswell.
Objectives: To highlight this CE/CLM syndromes clinical, laboratory findings, and thiabendazole
effectivenessinCE/CLMduetoG.spinigerum.
Methods:CrosssectionalstudyandNoncontrolledclinicaltrial.
Result:CE/CLMsyndromemanifestsasadiversifiedsymptomesandsignsmodelwithanerythematous,
serpiginous, pruritic, cutaneous eruption caused by accidental percutaneous penetration and subsequent
migration of larvae of G. spinigerum, specially in typical triad forms (> 95%). Oral thiabendazole is high
effectiveness and well tolerated when given as a single dose (cure rate of 91.3796.55%) without severe side
effects.
Conclusion:CE/CLMisamucocutaneouslesionresultingfromexposureoftheskintoinfectivelarvaeof
G. spinigerum. Clinical manifestations as diversified symptom broads, easy to misdiagnosis of other
*VinStrtKSTCTQuyNhn
Tcgilinlc:Ths.BS.HunhHngQuang.
ChuynYTCngCng
T:0905103496Email:huynhquangimpe@yahoo.com
211
NghincuYhc
dermatologicalandinfectiousdiseases.Treatmentwithsingledosethiabendazolewashighefficacyincurerate.
Keywords: Gnathostoma spinigerum (G. Spinigerum), Cutaneous Larval Migrans (CLM), Creeping
Eruption(CE)
TVN
Bnh k sinh trng (KST) do u trng
Gnathostomaspinigerum(G.spinigerum)gybnh
ng vt c th rt nghim trng trong din
tin bnh, thm ch c th dn n t vong do
cc bin chng, ngc li th bnh trn ngi
nht l khi nhim G. spinigerum, ph hnh thi
lmsngbiuhinnhiunhtlphnngban
trn(creepingeruption),hichngutrngdi
chuyndida(cutaneouslarvamigrans_CLM)
v him hn l th ph tng (VLM) v khi
biu hin li khng in hnh d chn on
nhm vi mt s bnh khc(3,5). Th thn kinh
ca G. spinigerum biu hin lm sng vi cc
binchngnghimtrng(vimnomngno,
vimrty,xuthuytnhumnohocdi
nhn, nhi mu no,), kh c th phn nh
vi cc bnh l thn kinh khc nu thy thuc
lmsngkhngnghn,nndbstbnhv
tvonglcthxyra.Dichngcthlnn
825%nuchnonvxtrbnhkhngkp
thi(3,6).
Vi phn b dch t hc v gnh nng ca
bnhbaophnhiuvngngNamchu,
song thuc c hiu vn cn b ng, mt s
thucchchiulc8087%nhIvermectinev
Albendazole(H.H.Quangvcs.,2011).Dovy,
vic th nghim mt phc thuc mi nhm
rt ngn liu trnh dng v ci thin hiu lc
iu tr l cn thit. Do vy, ti tin hnh
nhm:
Tthng3/201112/2011.
itngnghincu
Ttcbnhnhncchnonnhimu
trngG.spinigerumchacbinchng.
Tiuchunchnbnh
Da vo hoc ca bnh tam chng chn
on ca CLM: (i) Vt ban trn/ u trng di
chuyn + (ii) tng bch cu i toan trong mu
ngoi vi + (iii) C nm trong vng dch t v
phinhim mm bnh. Hoc ca bnh u trng
dichuynnhngchatamchngtrn.
XtnghimELISAphthinkhngthIgG
chngliutrngG.spinigerum(+)vihiugi
khngth1/1.600hocchsS/Co1.0.
Bnhnhnckhnngnutvungthuc,
chadngbtkloithucchnggiunsn.
Bnh nhn hoc gia nh, ngi gim h
nghptcnghincu.
Tiuchunloitr
Nhim u trng G. spinigerum nhng c
binchngthnkinh,cquankhc.
Ph n c thai (test th thai +) hoc ang
choconb.
Bnh nhn c xt nghim ELISA (+) vi G.
spinigerumkmccloigiun,sn,nbokhc
(Toxocara
spp,
Neurocysticercosis,
Strongyloides stercoralis; Fasciola gigantica,
Angiostrongylus cantonensis; Paragonimus
spp).
nh gi c im hi chng u trng di
chuyndoutrngG.spinigerum.
Thuc v liu lng s dng trong nghin

cu.
nhgihiuquThiabendazoletrnbnh
nhnnhimutrngG.spinigerum.
Thuc Thiabendazole (bit dc Niczen)

vin nn 500mg, do cng ty N.I.C Pharma
Co.Ltdsnxut,lSX:203040,HSD:15.03.2015,
hpnggi7vx4vin.
ITNGPHNGPHPNGHINCU
aimvthigian
TiVinstrtKSTCTQuyNhn.
212
ChuynYTCngCng
NghincuYhc
Bng1.LiuthucThiabendazole(Niczen)dngtheocnnngcabnhnhn.
Cn nng (kg)
13.60 - < 22.6
22.6 - < 34
34.0 - < 45
45 - < 56
56 - < 68
68
Ngy 1 - 2 (hoc 17)

Gi 0
Gi th 12
250mg
250mg
500mg
500mg
750mg
750mg
1.000mg
1.000mg
1.250mg
1.250mg
1.500mg
1.500mg
Phngphpnghincu
Thitkvcmunghincu
Thit k nghin cu: (i) Nghin cu ngang
mtv(ii)Thnghimlmsngtchng.
Chn t l tht bi lm sng ca
thiabendazole i vi hi chng CLM do G.
spinigeruml p = 20%, tin cy 95% v
chnh xc (d) khong 10%, th c mu n = 61.
Song,trnhtnhtrngmtmukhitheodithi
giandinncntng20%cmu73bnh
nhn.
Kthutnghincu
nhgicctriuchnglmsngtonthn
v trn c quan vo thi im bt u nghin
Mt s lu
Vi hi chng CLM l 2 ngy v hi chng u trng di
chuyn ph tng l 7 ngy
Nu sau 2 ngy kt thc liu trnh tnh trng thng tn cn
nng c th ch nh thm liu 2;
Khng dng vt 3000mg/ ngy.
cu (Do) cng nh vo cc ngy D60, 180 (sau 2

thngv6thng).
CcbnhnhnucXNyvchc
nnggan,thn,CTMtonphn,mindchvo
thi im bt u nghin cu (Do) cng nh
voccngyD60v180(sau2thngv6thng).
Chn on hnh nh (ni soi tiu ha v
chpxquang)khicnthit.
Phntchvxlsliu
Midliulmsngvcnlmsngphi
cghilivoCRFs.
Phn tch theo chng trnh EPIINFO 6.04
phntchvkimnhktqunghincu.
KTQU
Biuhinlmsngcahichngutrngdichuyn(CLM)vbantrn(CE)
Bng2.TamchngchnonCLMtrncabnhutrngG.spinigerum.
TT
c im nhm nghin cu
Thi im bt u nghin cu
- tam chng CLM

(i) Vt ban trn/ u trng di chuyn, sng phng tng t;
(ii) Tng bch cu i toan;
(iii) Yu t dch t v c n ti sng
- Cha tam chng (iCLM)
- Tn thng ph tng chung
58 (75,32%)
Trong s 77 trng hp nhim u trng G.

spinigerum, s ca tam chng CLM l 58
6 (7,79%)
13 (16,88%)
(75.32%),scachatamchng7.79%,scn
liltnthngphtng16.88%.
Bng3.cimvtnhchtcahichngCLMvngda,nimmc.
TT
c im nhm nghin cu
Triu chng biu hin a dng
- Ban theo vt, vng hnh nh khng r
- Ban + vim qung
- Ban cng vi ban trn ng thi
- Du ban trn v u trng di chuyn
- Vim m m di da
V tr hin ban ca CLM
- Vng mt, c
ChuynYTCngCng
Thi im bt u D0
52 (67.53%)
25 (32.47%)
9 (11.69%)
38 (49.35%)
4 (5.19%)
6 (7.79%)
213
NghincuYhc
TT
c im nhm nghin cu
Thi im bt u D0
- Bng, ngc 1 bn
- Bng, ngc 2 bn
- Lng v tht lng
- Mng sn (phi v tri)
- Chi trn
- Chi di
Tnh cht v thay i thng tn CLM
- Xut hin thng xuyn
- Xut hin tng t
- Xut hin sau tm m, i ma v, m hi
Phn ng CLM km phn ng vim
- Vim dc theo ng i ca ban trn
- Khng c vim nhim
- C nga, my ay, kin b
Mu sc ca ban trn v vt di chuyn
- Ban trn mu (hng sm mu)
- Vt di chuyn v ban trn sm mu
47 (61.03%)
3 (3.89%)
12 (15.58%)
6 (7.79%)
28 (36.36%)
12 (15.58%)
Vlmsng,hichngCLMbiuhinmt
phlmsngadng,nhiunhtlbann
thundngvthocdngbn(67.53%),vt
ban trn/ CLM (49.35%), ban i km vim
2 (2.6%)
40 (51.95%)
16 (20.78%)
21 (27.27%)
26 (33.77%)
47 (61.04%)
8 (10.39%)
30 (38.96%)
qung(32.47%).Chyultibng,ngc1bn
thn. Ch yu xut hin tng t (51.95%).
Vimchc33.77%,asccvtnychuyn
muthngsangsm(38.96%).
Bng4.ThngscnlmsngtrnbnhnhnnhimutrngG.spinigerum.
Nhm nghin cu
S nghin cu (n = 77)
1/1.600
SL
74
Nhm nghin cu
S nghin cu (n = 77)
%
96.1
7 - 10%
SL
4
%
5.19%
Ngng hiu gi khng th

1/3200
1/6.400
SL
%
SL
%
3
3.89
0
0
T l bch cu i toan
11 - 25%
26 - 35%
SL
%
SL
%
46
59.74
19
24.68
Huyt thanh chn on ca cc bnh nhn

CLM ch yu gp l 1/1600 cao nht (96.1%).
Trn 90% s ca c biu hin tng bch cu i
toantrongmungoivi.
1/12.800
SL
0
SL
8
%
0
36 - 78%
%
10.39
Hiuquiutrbnhutrnggiunugai
bngthucThiabendazole(Niczen).
Bng5.Hiuquiutrnhgisau2thng,6thngiutr.
Trc . tr
TT
1
2
3
1
2
3
4
214
Triu chng lm sng v cn lm sng

Ci thin v mt lm sng
Ca tam chng C.on giun u gai
Ca khng in hnh v tam chng
Ca bnh biu hin ph tng
Ci thin v cn lm sng
Tng BCAT (> 10%) bnh thng
ELISA dng tnh 1/1600
Ni soi tiu ha (d dy t trng)
X- quang phi (xa hnh nh)
SL
58
6
13
75.32
7.79
16.88
53
2
5
73
77
12
4
94.81
100
15.58
5.19
68
9
10
2
SL
Sau iu tr (D60 - D180)

2 thng
6 thng
%
SL
%
Ci thin: gim hoc mt
91.37
56
96.55
33.33
5
83.33
38.46
8
61.54
Ci thin: bnh thng
93.15
71
97.26
11.69
63
81.82
83.33
11
91.67
50.0
4
100
ChuynYTCngCng
Hiu qu ci thin v lm sng v cn lm
sngsau2thngivicatamchnggim
91.37%,ngcliscakhnginhnhvph
tnggimthn(33.33%v38.46%).
Sau6thng,catamchngpngn
96.55%vcakhnginhnhvphtngci
thinn83.33%v61.54%.RingvmtXN
v C hnh nh, ngoi tr ELISA din tin
chuyn t (+) sang () chm sau 2 thng v 6
thng (11.96% v 81.82%), cc thng s khc
cithintt.
MtstcdngngoicaThiabendazole
(Niczen)khiiutrCLMcaG.spinigerum.
* nh gi ci thin trc v sau iu tr
theothitknghinculmsngtchng.
Bng6.Mtstriuchngnghingtcdngngoi
.
n = 77
SL
%
Kh chu d dy rut v bun 5
6.5
nn
Du chng & triu chng
Thi im biu
hin (ngy)
1-2
NghincuYhc
Du chng & triu chng

Chng mt, nhc u
Phn ng JarischHerxheimer
n = 77
SL
%
1
1.3
2
2.6
Thi im biu
hin (ngy)
2-3
1-2
Tcdngngoihaygpnhtl kh chu
d dy rut v bun nn (6.5%), chng mt v
nhcu1.3%vcbitcphnngJarisch
Herxheimerl2.6%.Ccbiuhinnyhayxy
ra vo 14 ngy ng trong v sau khi ung
thuc.
Bng7.Mtsbiuhintrnccbnhnhncphn
ngJarischHerxheimer.
Biu hin Jarisch-Herxheimer
SL Thi im biu
hin
St nh c ngy, kh chiu tiu ha 2 Trong vng1-4
Nhp tim nhanh, th nhanh, ra m hi 1 ngy trong v
sau dng
Kh ng, nht l ban m
2
Thiabendazole
da, kh da, nng da
2
Phn ng JarischHerxheimer (Herx) xut

hintrnccbnhnhntronghocsaukhidng
thuc (14 ngy) vi nhiu triu chng nh y
vnmt.
Bng8.ThngssinhhavhuythctrcvsauiutrThiabendazole.
Sau 2 thng
Sau 6 thng
9.7- 12.5
10.7 1.56
10.0 - 12.5
11.6 1.16
11.0 - 14.5
12.2 1.51
6.020 - 12.250
7.700 1.640
4.520 - 10.360
6.800 1.960
6.300 - 12.350
6.700 2.290
32 86
27.50 16.5
38 - 99
33.54 44.85
32 - 74
32.50 42.5
10 - 66
18.90 16.9
16-84
20.0 18.20
15 - 86
17.90 34.9
Cc thng s sinh ha v huyt hc khng

thay i trc v sau iu tr liu trnh
thiabendazole(Niczen)vip>0,05(CI=95%).
BNLUN
nhgivcctriuchnglmsng,cn
lm sng trn bnh nhn c hi chng
CE/CLM.
Vbiuhinlmsng,trnccbnhnhn
mc CLM do G. spinigerum biu hin di
ChuynYTCngCng
P > 0.05
Ngy D0
P > 0.05
Thng s cn lm sng
Haemoglonin (g/l)
Range
Mean s
Bch cu/mm3
Range
Mean s
SGPT (BT: 5-34UI)
Range
Mean s
SGOT (BT: 0-38UI)
Range
Mean s
nhiuhnhthikhcnhau:Bannthun
dng vt, vn vo ni hoc n di da mng
hoc hin ln vng c hnh nh nh bn
chim nhiu nht (67.53%), du ban trn i
cng vi CLM (49.35%), ban i km du
vim qung (32.47%), phi hp ban cng
CLMl11.69%,rtctrngbnhutrngG.
spinigerummttrongy vn (H.H.Quang
v cs., 2011). Hnh nh vim ph n m m
di da cng l mt triu chng ng ch ,
215
NghincuYhc
dtkhiboco(5.19%).imcbitlcc
du hiu CLM/CE to nn hnh nh sng
phng di da rt r v din tin tng t.
Mitthngkodikhong710ngy,tc
di chuyn ca CLM c th nhanh trung
bnh 12 cm/ gi(2,1,5). Dc theo ng di
chuyn to hm l mn nc nh km theo,
gy nga v nhiu t bi nhim. V tr xut
hin ca CLM/CE di chuyn theo ng rt
ctrng,himkhigpvngbngvngc
hai bn ng thi (3.89%), vng mt c
(7.79%), nhiu nht l vng bng v ngc 1
bnthnmnh(61.03%),tipnltihaichi
trn(36.36%),tipvngthtlngcngnh
chi di (15.58%), mng sn (7.79%), im
c bit khc l vt di chuyn cng bn chi
ngckhnhiu.
c tnh thay i ca thng tn do u
trng G. spinigerum di chuyn cng rt c
trng,chngcthxuthintngtdngban
/ ban trn 51.95%, c bit cc vt CLM c
v thch nghi vi nhit mt ca da, chng
thng ni ln vo chiu hoc ban m, na
mvsng,hocsaukhibnhnhntmxong
lau kh thn mnh (20.78%). Tng t tc gi
khc ti Nht Bn, y c ti 61.04% c biu
hin vt CE/CLM km theo chng my ay,
nga dc theo ng i ca CE/CLM, mt s
khcbiuhinphnngvimtichhoclan
tadc2bnhoctothnhm,nicchtli
tidctheongicavtCL/CLM(27,27%),
lphnngvim.MusccavtCE/CLM
cthchuyntmuti(vtthngmi)
n mu sm nhn thy d nhm vt chm
ha do din tin di, khng iu tr, dng cc
chphmccorticosteroidesthoalintcv
c qu trnh nhim trng i km theo (38.96%)
trc.
Xt nghim huyt thanh min dch ELISA
u(+)viG.spinigerum,phnlnnmngng
hiu gi 1/1600 (96.1%) hay OD dao ng [1.0
1.6], t l BCAT hu ht cc bnh nhn tng >
10%, c bit c hi chng tng nhim BCAT
nhutrnggiunlnS.stercoralisl10,39%.
216
Hiu qu ca Thiabendazole (Niczen)

trongiutrhichng.
Trong nghin cu ny, chng ti khng
phn tch c th s thay i ca tng triu
chng ca th CLM da nim mc v cc triu
chngcabnhnhncthtrnglptrnmt
bnh nhn c th nhiu triu chng hoc bao
gmcthdanimvphtngngthi.Do
vy,phntchnhgidintinLSvCLSqua
2 thng (D60) v 6 thng (D180) theo tng nhm
bnhnhn:nhmtamchnginhnhvnhm
khnginhnh.Ktquchothyscithin
triuchnglmsngtrnnhmbnhnhn
tamchngcathdanimgimn91.37%
(sau2thng)vn96.55%(sau6thng),ngc
liscakhnginhnhvtamchngcithin
chmhncngha.
PhnngELISAdintinchuynihuyt
thanht(+)sang()cnchmsau2thngv6
thng (11.96% v 81.82%), nhng cc ch s
BCATtrvbnhthngrtnhanhsau2thng
v6thng(93.15%v97.26%).Ktqunycho
thytlcithintriuchngvcnlmsng
c v cao hn cc tc gi khc khi dng
Albendazole (Punyagupta S v cs., 1961;
Maleewong W v cs., 1992; Mimori T v cs.,
1987),hoctngtIvermectine(KesensuthiR
v cs., 1981, Nuchprayoon S v cs., 2003), hoc
thiabendazole liu nh trn (Caumes E v cs.,
2000, Yakohama v cs., 2002). Khng nhng
thuccithintrnhichngCE/CLMmcn
cithinrtttthphtng (3,2)sau2thngiu
tr nhng phi dng n 23 liu trnh mi ht
(sau6thng).
Trong nghin cu ny, khng th ghi nhn
c thng tin v tc dng ngoi t tr em
nh v mt s trng hp khng c thng tin
phnhihockhnggibnnhgitcdng
ngoi.Nhnchungcctcdngngoichl
thong qua v nu c khng cn gin on
nghin cu v chng t khi sau khi kt thc
liu trnh(3). c bit, trong nghin cu ny 2
bnh nhn (2,6%) c phn ng Jarisch
Herxheimertrongthigiandngthucvc1
ChuynYTCngCng
bnhnhnbiuhinrtsmtrongcuingy1
dng thuc. JarischHerxheimer (Herx) biu
hin tng t nh khi mt s khng sinh hay
albendazole, c xem nh cn cha lnh
(healing crisis) hoc cht u trng (dieoff)
theo qu trnh kh c qu nhanh khi mt
lng ln u trng cht. Bnh nhn lo lng v
quay tr li khm, cm gic bnh t hn lc
cha dng thuc, biu hin st nh c ngy,
nhptimnhanh,khngvkhchudaton
thn (2 bnh nhn), ng da vng CE/CLM
nhiuhn,dakhvtngnhit,cbithaibn
gmvhai cng tay, nga nhiu. Nhn nh
cccduhiucaphnngHerxdothuc
tc ng ln cc u trng giai on 3 ca G.
spinigerum,aralikhuyndoylmtp
ng vim tt, trng c v t hn nhng s
mangliktqutthn,trnanbnhnhnc
gngchungthmvingynadngthm
nchoaqu,ncchanhcam,vthctcc
phnngnygimisau37ngy,khngli
mtbinchngg.
KTLUN
Hiuquiutrbnhutrngdichuyn
cathiabendazole(Niczen)
Hiuqucithintriuchnglmsngtrn
nhm bnh nhn tam chng th da nim
mc gim n 91.37% (sau 2 thng iu tr)
v n 96.55% (sau 6 thng) v s khng in
hnhvtamchngcithinlnltsau2thng
v6thngl33.33%v83.33%(chmhn).Ch
sELISAchuynihuytthanhvBCATtr
v bnh thng sau khi iu tr 26 thng c
nghaquantrngvhiulccathuc.
Tc dng ngoi khng ng k, c bit
chvgiithchchobnhnhnvphnng
JarischHerxheimer (s cho kt qu tt hn)
trongqutrnhdngthuc.
TILIUTHAMKHO
1.
2.
3.
Lmsngvcnlmsngtrnbnhnhn
chichngCE/CLMcaG.spinigerum
HichngCE/CLM,cbittrnccca
tamchng biu hin ph lm sng a dng v
tnh cht, dng ban trn, di chuyn, v tr v
mu sc. Trong , dng ban n thun
dng vt, vn vo ni hoc n di da mng
hochnhbnvitlcaonht.
Trn95%scacchsBCATtrn10%v
ELISA(+)vihiugi1/1.600.
NghincuYhc
4.
5.
6.
Bussaratid V et al., (2010). Predictive factors for Gnathostoma

seropositivity in patients visiting the gnathostomiasis clinic at
thehospitalfortropicaldiseasesinThaiLan,during20002005.
JHelminthol.Vol41,number6,2010
Herman JS, Chiodini PL (2009). Gnathostomiasis, another
emerging imported disease. Clin Microbiol Rev. 2009 Jul;
22(3):48492.
Hunh Hng Quang, Triu Nguyn Trung (2010). Tng hp
lotcabnhbantrn/hichngutrngdichuyndida
doksinhtrngtihuynoLSn,tnhQungNgi,Vit
Nam (20062010). KyucngtrnhNCKH,VinYhcbinVit
Nam,HiYhcbinVitNam.
HunhHngQuang,TriuNguynTrung(2011).Giunugai
bnhgiunmini,Cpnhtyvnvtnghpthngtinv12
bnhnhngiunugai.http://www.impeqn.org.vn
Nawa Y et al., (2008). An overview of Gnathostomiasis in the
world. Southeast Asian Journal of Tropical medicine and public
health,Vol35(supp.1):8791.
negected parasitosis of the Central nervous system. Emerging
InfectiousDiseases.www.cdc.gov/eid.vol17.No7,July2011
ChuynYTCngCng
217
NghincuYhc
HIULCARTERAKINEIVISTRTCHABINCHNG
DOPLASMODIUMFALCIPARUM
TIVNGGIAOLUBINGIIVITLO
HunhHngQuang*,TriuNguynTrung*,HVnHong*
TMTT
tvn:Dihydroartemisininpiperaquine(DHA+PPQ)lmttrongnmphihpthucchahn
viuimhiuqucaovdungnpttngitheoTchcYtthgii.
Mctiu:nhgihiulcphcArterakinetrongiutrstrtdoP.falciparum.
Phngphpnghincu:thnghimlmsngkhngngunhin,tchng.
Ktqu:TlpnglmsngvKSTysauhiuchnhbngphngphpkhuchichui(PCR)
vphntchKaplanMeierngy42lt97.4%(trchiuchnhPCR)n100%(sauhiuchnhPCR)v
imcbitkhngcthtbiiutrsm.
Ktlun:PhihpthucDHA+PPQchiulccao,liutrnhngnngykhiiutrtivngbingii
VitLohinvnanglmtngcvinhahnnht.
Tkha:Plasmodiumfalciparum,hiulc,Arterakine
ABSTRACT
EFFICACYOFARTERAKINEINTREATMENTFORUNCOMPLICATEDFALCIPARUMMALARIA
INVIETNAMLAOPDRCROSSBORDER
HuynhHongQuang,TrieuNguyenTrung,HoVanHoang
Background: Dihydroartemisininpiperaquine (DHA+PPQ) is one of five promising new artemisinin
combinationwithhighlightsofeffectiveandwelltoleranceinhumanbyWHO.
Objectives:ToassessofDHA+PPQefficacyintreatmentforuncomplicatedfalciparummalaria.
Methods:Nonrandomizedclinicaltrialstudydesign.
Result: The PCR adjusted cure rate by Kaplan Meier analysis at day 42 was from 97.4% (before PCR
correct)to100%(95%CI:76.997.4),andspecialpointswithoutETF.
Conclusion: A shortcourse regimes, effective and highly efficacy, fixed DHA+PPQ combination on the
VietNamLaoPDRbordercurrentlylooksthemostpromisingcandidate.
Keywords:Plasmodiumfalciparum,Efficacy,Arterakine
nhiu loi mi hin dng. T nm 1990, thuc
TVN
artemisinine v dn cht artesunate c tin
K sinh trng Plasmodium falciparum a
hnh th nghim lm sng v chnh thc a
khngthuclanrngnghimtrngtrnthgii
vo s dng trong Chng trnh Quc gia
vcbittingNamnhmtthchthc
Phng chng st rt (CTQGPCSR) Vit Nam
ln cho vic la chn thuc st rt(3,8)(TSR).
gp phn ngha trong vic h thp st rt c
Vit Nam, P. falciparum khng cao vi hu ht
tnh(SRAT)vtvongdostrt(TVSR).Song,
cc thuc st rt c in v gim p ng vi
vic s dng artemisinine v dn cht c thi
*VinStrtKSTCTQuyNhn
Tcgilinlc:Ths.BS.HunhHngQuangT:0905103496 Email:huynhquangimpe@yahoo.com
ChuynYTCngCng
219
NghincuYhc
gianbnhyngn,liutrnhdingytrnmt
phm vi rng, ph bin s to iu kin tim
nng cho qu trnh hnh thnh v thc y
khngthuccthxyra(4,5,6).Quvy,dintin
gim nhy vi thuc artemisinine v dn cht
artesunate, artemether trn invitro cho thy
iu (WHO, 2011). Gn y, c nhng
du hiu ng lo ngi khu vc min ty
Campuchia, khu vc bin gii Thi Lan
CampuchiavMyanmardostrtP.falciparum
p ng chm vi artesunate hn nhng quc
gia khc trn ton th gii (WHO, 2009;
Dondorp v cs., 2009), cng nh s tn ti
KSTSR P. falciparum sau 72 gi(3,8) iu tr bng
thuc ACTs dihydroartemisinine + piperaquine
(DHA+PPQ) nh mt ch im lm sng gin
tip tht bi iu tr. Vit Nam chia s mt di
bingiidiviccqucgiaCampuchiavLo,
vimts lng ln ngi i qua li giao lu
giaVitNamv2qucgianysgiaothoa
chng k sinh trng st rt (KSTSR) khng
thuclrtln,nnvicgimsthiulcthuc
thng xuyn v a ra bin php ngn chn
khnglcnthit.
Nu xem t l tht bi lm sng trn qun

th ca loi thuc Arterakine l p = 20%, vi
khongtincy95%,chnhxcd=10%.Khi
cmutithiucnnhgihiulcl61.
Dkinsbnhnhnmtmul20%.Vyc
mucuicngln=73(bnhnhn).
Kthutnghincuvquytrnhtheodi
Theo cng ca T chc Y t th gii
(2009)(9)
Thc hin y v cc bc: s chp
thuncaHingocysinh,thchnh
lm sng tt (GCPs), cam kt tham gia nghin
cu thng qua k bn chp thun, bo mt
thngtinvsliunghincuvdchvchm
scyttia.
Phnloinhgihiuquiutr
TheoquitrnhnhgicaTchcYtth
giinhcaP.falciparum(2009)(9).
Phntchvxlsliu
SliucphntchvxltheoInvivo
Exelsheet7.1,PascalRingwaldcaWHO,2009.
Mctiunghincu
KTQUNGHINCU
nhgihiulcArterakineivistrt
doP.falciparum.
c im ca nhm bnh nhn tiu

chunnghincu
ITNGPHNGPHPNGHINCU
Bng1.Mtscimvdnshctrnnhm
bnhnhnnghincu
aimvthigiannghincu
Chn a bn x Xy thuc vng st rt lu
hnhnngvvnggiaolubingiiVitLo;
Tthng5/201112/2011
itngnghincu
Cc bnh nhn st rt nhim n thun P.
falciparumtiuchuncngWHO2009.
TT c im nhm bnh nhn Thi im bt u ngy

(n = 76)
D0
1
Gii tnh
- Nam
45 (59.21%)
2
Phngphpnghincu
Thitknghincu
L mt th nghim lm sng khng ngu
nhin,tchng.
Cmunghincu
- N
Nhm tui (nm)
- Tui trung bnh
- Nhm tui:
<5
5 n = 15
31 (40.79%)
> 15
Cn nng trung bnh (kg)
57 (75%)
40.2
34 (5 - 63)
0
19 (25%)
Trongnhmbnhnhnavonghincu,
nam chim t l cao hn n. Nhm tui trung
bnhl34,ngicaotuinhtl63vthptui
220
ChuynYTCngCng
nhtl5,nhmtuitrn15chimuthvi57
bnhnhn(75%).
Bng2.cimlmsngvksinhtrngP.
falciparumtrnbnhnhnnghincu
TT
Thi im bt u
nghin cu (D0)
c im nhm bnh nhn

0
Thn nhit ( C)
- S bnh nhn c st trn
37.50C
- S ca c st trong vng 48 gi
qua
- Khng c tin s/ hoc st hin
ti
- Nhit trung bnh bnh nhn
- S ngy c st trung bnh trc
D0
2 Mch, huyt p v nhp th TB
- Mch
- Huyt p
- Nhp th
3
Lch ln
- Bnh nhn c lch ln
- Bnh nhn khng c lch ln
4
Mt KSTSR P. falciparum
- MKSTSR th v tnh/L
- S bnh nhn c giao bo ngy
D0
- MKST th giao bo
51 (67.11%)
20 (26.32%)
5 (6.57%)
38.60C
2.5
71.5
113/ 87
31.0
34 (44.74%)
42 (55.26%)
NghincuYhc
LPF:LateParasitologicalFailure(Thtbiksinh
trngmun);ACPR:AdequateClinicaland
ParasitologicalResponse(pnglmsngvksinh
trngy)
Tng s 76 ca P. falciparum iu tr bng

Arterakine cho thy khng c tht bi iu tr
sm(ETF),tlpnglmsngvKSTy
(ACPR) l rt cao (97.4%), 1 (1.3%) trng
hp tht bi lm sng mun (LCF) v 1 (1.3%)
thtbiKSTmun(LPF).
Bng4.Phntchcctrnghpthtbimunv
lmsngvKSTSR
M
bnh nhn
11QTAK
33QTAK
Tui
Phn loi
Phn loi
theo
in
n
ngy theo di
Nam N
vivo
D42
x
LCF
Xut hin li
KSTSR D42
x
LPF
Xut hin li
KSRSR D42
Hai ca tht bi lm sng (LCF) v k sinh

trng(LPF)munuln,thiimxuthin
28.244
8 (10.53%)
304 (8 - 600)
Vmtlmsng,phnlnbnhnhncst
hoctinssttrckhinghincu,ccthng
s chc nng sng khc bnh thng. S bnh
nhnstrt(BNSR)clchln(IvII)chim
44.74%. mt KSTSR trung bnh th v tnh
28.244/L, mt trung bnh giao bo 304 (8
liKSTv/hockmtheostliuvongy
D42.
Phntchchitittrnghpthtbiiu
trtrninvivovphntchPCR
Bng5.Phntchchititvcctrnghpthtbi
iutrdatrninvivo
M
bnh
nhn
Mt
KSTSR
Do
D xut
D xut
hin KST
hin
600).
11QTAK 65,967 1.400 D42
HiulcphcDHA+PPQtrongiutr
bnhnhnstrtdoP.falciparum
33QTAK 29,352 384
Bng3.Phnloihiulcphc
Dihydroartemisininepiperaquine
T l (%)
0
1.3%
1.3%
97.4%
ETF:EarlyTreatmentFailure(Thtbiiutrsm);
LCF:LateClinicalFailure(Thtbilmsngmun);
ChuynYTCngCng
Phn loi
theo in vivo
LCF
(P.
falciparum)
LPF
(P.
falciparum)
Phn loi
theo PCR
Nhim mi
P.
falciparum
Nhim mi
P.
falciparum
C11QTAKv33QTAKucMKSTSR
Ghi ch
S liu trn
cha hiu chnh
PCR
Hiu lc
Ch s nh gi
S lng
ETF
0
LCF
1
LPF
1
ACPR
74
Tng s phn tch
76
D42
Phn loi v hiu chnh
P. falciparum ngy D0 mc va ch khng

cao (65,967/L v 29,352/L). C 2 u xut
hin KSTSR li vo D42, u nhim n P.
falciparum theo xc nh lam mu, test nhanh
vPCRchothylnhimmiP.falciparum.
221
NghincuYhc
Hiu lc ct st v lm sch KSTSR P.

falciparumcaDHA+PPQ
thcngvischngcnstlintckhinlch
tngsinh,snglch.
falciparumcaphcDHA+PPQ
Lin quan n mt KSTSR P.falciparum,

thvtnhP.falciparumkhichaiutrkhong
28.244/L,scacgiaobol8(10.53%)vimt
giaobovoD0304/L.
Kt qu phn tch
Thng s thi gian
(gi tr trung bnh)
Tng s ca phn tch (n = 76)
Nhit c th trung bnh ngy Do
38.60C
Mt KSTSR trung bnh ngy D0
28.244/L
Thi gian ct st trung bnh (FCT)
30 gi (12-48)
Thi gian sch KSTSR trung bnh
36 gi (12-60)
(PCT)
Thi gian sch giao bo trung bnh
42 gi (24-60)
(gi)
Thi gian ct st trung bnh l 30 gi; hiu

lc lm sch KST ch trong 36 gi, s giao bo
xuthincthkoditD0nD5,songtrung
bnhthigianschgiaoboch42gi.
BNLUN
c im ca nhm bnh nhn tham gia
nghincu
Trong nhm bnh nhn tiu chun a
vonghincu,namgiichimtlcaohnso
vingii(59.21%sovi40.79%),vnnyl
ph hp v a s ngi i rng, khai thc lm
sn,snbtth,iquarngLomtthigian
di phn ln l nam gii trng thnh. Nhm
tuitrungbnhcabnhnhnl34,ngicao
tuinhtl63vthptuinhtl5.Trong,
nhm tui trn 15 chim u th vi 57 bnh
nhn (75%) v nhm 5< 15 tui l 25%, khng
thycanonhmtuidi5tiuchunvo
nghincu.
V mt lm sng, a s BNSR c st hoc
tinssttrong48gitrckhivonghincu
(93.43%),thnnhittrungbnh38.30C,nhiuca
bhthnnhitnh,hocqucao410C.Ccdu
hiuchcnngsngkhc(mch,huytp,nhp
th) bnh thng. Tin s cha c bnh nhn
nomcbnhtimmchhocsuyganthn.Lch
lnchyulIvIIchim44.74%.Vkha
cnh lch ln l tt yu vi gn 50% s ca
(44.75%) v phn ng bnh nhn l dn a
phng,thngxuynbstrt,cnm34ln
mc st rt, sng trong vng SRLH nng nh
222
Hiu
lc
phc
Dihydroartemisinine
phosphate(DHA+PPQ)
thuc
piperaquine
Qua phn tch, nh gi 76 trng hp st

rt do P. falciparum cha bin chng iu tr
bngthucDHA+PPQ(Arterakine),vthigian
bnhyPPQdinnttcuctheodit
nht 42 ngy. Kt qu phn tch cho thy t l
ACPR cao 97.4%, iu ny cho thy d thuc
DHA+PPQnichungvArterakinedngti
xXyvimcchiutrcabnh,cptiu
tr,thmchmtscnbytcnchocpd
phng,songhiulciviP.falciparumvn
cncao,tlthtbichungchc2.6%(<10%
theoquynh),trongthtbiLCF(1.3%)v
LPF(1.3%),cbitchaphthintrnghp
nothtbiiutrsm(ETF).
Sau khi hiu chnh PCR xc nh li cc
ca tht bi LCF v LPF, nng t l p ng
lm sng v KST y (ACPR) ln t 97.4%
n 100%. S liu ny tng t nh mt s
nghin cu a trung tm do WHOSigmaTau
tng hp qua 14 th nghim lm sng vi
DHA+PPQ vi nhiu bit dc khc nhau
(WHO, 2011) vi c mu l 2.636 bnh nhn
iu tr DHA+PPQ, hiu lc trn chng P.
falciparumakhngrtcao,vitlchakhi
sau 28 ngy theo di, c tnh KaplanMeier
9798%tiTrungQuc,Campuchia,Myanmar,
Lo,ThiLanvVitNam.Bsungvols
liu t nghin cu so snh hiu lc ca
DHA+PPQ tt hn thuc artesunate +
amodiaquine.T20072010,mtsnghincu
(GrandeTvcs.,2007;KarunajeewaHAvcs.,
2008; Arinaitwe E v cs 2009; Adam I v cs.,
2010)bocochoktqutngt(1,2,3,8).
ChuynYTCngCng
Ngoira,mtlotccthnghimlmsng
cbocognyviDHA+PPQtrnhby
tihinghlnth59caHiyhcnhitiv
v sinh ca M (DAlessandro U v cs., 2010)
tngkt4.116bnhnhichuPhi<5tuibst
rt P. falciparum cha bin chng, iu tr vi
ACTs: 1.226 bnh nhn vi thuc A/L, 1.002
bnhnhnviAS/AQ,413bnhnhnviCDA
v1.475bnhnhnviDHA/PPQ.imnghin
cu l 10 trong 7 quc gia chu Phi (Burkina
Faso,Nigeria,Gabon,Zambia,Uganda,Rwanda
vMozambique).Tlchakhisauhiuchnh
PCRvongyth63(D63)chothykhngcs
khcbitgiaphcDHA+PPQ,Artemether/
lumefantrine(A/L)vArtesunate/amodiaquine
(AS/AQ), trong khi 3 loi thuc phi hp
ACTssosnhviCDAlicaohnnhiu.Tl
chakhilcchahiuchnhPCRvongyD63
chothyDHA+PPQcaohnsoviA/L,AS/AQ
(DAlessandroUvcs.,2010).
Kt qu nghin cu ca chng ti cng
tngtnhktqutrongmtsthnghim
trnthgiiticcvngluhnhstrt;chng
hn, DHA+PPQ c th nghim nhiu
nghin cu lm sng pha III tin hnh theo
nhm nghin cu v tinh ca WHO trn cc
bnhnhnstrtP.falciparum.Thnghimu
tin tin hnh bi Sigma tau (2010) trn tr em
vbnhnhnchuvnghincuthhaitrn
cc tr em chu Phi ( 6 thng, 5 tui). Th
nghim phase III ti chu (Valecha Nv cs.,
2010) l mt th nghim ngu nhin, c i
chng nh gi hiu lc v tnh an ton ca
DHA + PPQ so snh vi phc Artesunate +
Mefloquine(AS+MQ)trntremvngiln.
Tngs769bnhnhniutrbngDHA+PPQ
v 381 bnh nhn dng Artesunate +
Mefloquine(AS+MQ).Ktquphntchchra
tlchakhivongy63chiuchnhPCRl
97.0% i vi DHA+PPQ v 95.3% i vi
AS+MQ, v 98.7% i vi DHA+PPQ v and
97.0% i vi AS+MQ, ch ra cc kt qu cao
ngangnhauvhiulciutrcahaiphc.
ChuynYTCngCng
NghincuYhc
Nhn chung, kt qu ny (97.4%) ph hp

vi cc nghin cu v hiu lc phc
DHA+PPQ u cho kt qu t l cha khi
ACPR>95%,vitnhdungnptuytvitrong
iutrtrncitngtremvngilnb
st rt P. falciparum (Denis v cs., 2002;
Karunajeewa v cs., 2004; Tangpukdee v cs.,
2005;Mayxayvcs.,2006;Hasugianvcs.,2007;
Kamyavcs.,2007).Haitrnghpthtbilm
sng(LCF)vksinhtrng(LPF)munul
bnhnhnn,msnghincul11QTAKv
33QTAKvthiimxuthinliKSTrivo
ngyD42.
Hai trng hp tht bi mun u c
MKSTSR P. falciparum thp vo ngy D0, ln
lt l 65.967/L v 29.352/ L mu ngoi vi.
ViclgiisxuthinliKSTtrongqutrnh
theodimtsnghincuinvivochothyi
vinhmartemisinine,artesunatehocACTsc
lin quan n tnh trn ng ng m thut
ng ny t lu ch dng i vi st rt do P.
vivax(Michelle Wykes v cs., 2011). Do mt
c hai ca u thp v liu dng DHA+PPQ
y theo liu khuyn co, nn kh nng xut
hinliKSTdothigianngngtrongtbo
hnhcycalchsaumtthigiannmynsau
iutrvtiphtlidomtKSTSRlnu
cao nh mt s nghin cu ch ra l khng
th. Mt nghin cu khc cng cho thy s
ti pht KST ng qun (Dormant parasite
recrudescence) c lin quan v lm cho nh
gi nhm l tht bi iu tr P. falciparum
(Teuscher v cs., 2011) sau iu tr bng
artesunate,P.falciparumthnhntrnnngv
khong0.0011.313%phchiphttrinli
nhnglthucvostrain.Trongccnghincu
, KST phc hi t trng thi ng qun tm
thy c lin quan n l thuc liu dng ca
thuc(dosedependent)(6).
khng nh li cc ca 11QTAK v
33QTAKltiphthaytinhim,chngtiu
lylammuvgiythmchoxcnhlibng
lammusoidiKHV,testRDTsvPCR.C3
kthutuphthinKSTSRvongyD42u
223
NghincuYhc
nhim n loi P. falciparum, c bit kt qu

PCRchothynhimmi,nghalttctrng
hputACPR100%.
t100%trongnhiunghincuthliurngc
thkhngcndngnthucprimaquinena
haykhng?
Hiu lc ct st v ct KSTSR P.
falciparumcaphcDHA+PPQ
KTLUN
Chi tit v hiu lc lm sch KSTSR ch

trongvng36gi(chan2ngy).Din tin
ctksinhtrngstrtP.falciparumnhanhtheo
thi gian v c th sau mi 12 gi, s ca c
lm sch k sinh trng P. falciparum tng ln
ngk,cthsau12gic28.95%bnhnhn
schKSTsau24gic46.05%77.63%(36
gi)98.68%(sau48gi)vsau60gilm
sch100%.Sliunytngtnhnghincu
trn P. falciparum c iu tr DHA+PPQ
(Artekin)cngchoPCT<2ngy(MyintHYv
cs.,2007;MarcusJ.Rijkenvcs.,2011).
Dintinvschgiaobogintipcngrt
cbittrn8bnhnhncgiaobongyD0,
sau 12 gi cha c trng hp no sch giao
bo,n24gic25%scaschgiaobo,sau
36gicn50%sschgiaobo,n48gi
sautrn87.50%scaschvngith60
tonb8caukhngcngiaobo.iuny
mramthngnghincumirngchngta
cn tip tc hiu chnh tng liu iu tr phi
hp DHA+PPQ v hin nay nhiu nghin cu
nhgihiulccaDHA+PPQtinhiuquc
gia trong khu vc ng Nam (Thi Lan,
Campuchia, Myanmar v 2 tnh thnh c tnh
hnhSRkhngthuctiVitNamlBnhPhc
vGiaLai)chothytltntivdngtnh
KSTSRngyD3rtcao(7,8),vitldaong7
30% (H. H. Quang v cs., 2011; T.T.Tnh v cs.,
2011;MarcusJ.Rijkenvcs.,2011).
TheonhnghacaWHOminht(2011)
cho thy, nu t l KSTSR th v tnh dng
tnh ngy D3 trn 10% l nghi ng tnh trng
khng thuc? Do , vic hiu chnh liu tng
ln l cn thit v khi hiu chnh c liu
thuc cho ph hp th hy vng rng thi gian
lm sch giao bo gin tip s cng rt ngn
hn, thm ch ch trong 3 ngy u dng liu
trnh DHA+PPQ nh Arterakine , nu iu
224
HiulcchungcaphcDHA+PPQ
T l p ng lm sng v KST y
(ACPR)sauhiuchnhPCRl100%.
Tlthtbichungch2.6%(trongLCF
l1.3%vLPFl1.3%).
Hai trng hp LCF v LPF u vo thi
imD42vlnhimmiP.Falciparum.
HiulcctstvlmschP.falciparum
caphcDHA+PPQ
Thigianctsttrungbnh(FCT)l30gi,
tcctstnhanhvsau48gikhngcnca
sttrnlmsng(khong2ngy).
Thi gian lm sch KSTSR ch 36 gi, din
tinlmschP.falciparumnhanhtheothigian
mi12gi.Sau60gilmsch100%sbnh
nhn(<3ngy).
Thi gian lm sch giao bo l 42 gi (< 2
ngy), cho thy t l ngi mang giao bo sau
iutrDHA+PPQrtthpvnguyclylans
hnch.
Bn cnh , vic giao lu bin gii gia
Vit Nam v Lo, gia Lo v Campuchia v
CampuchiaviThiLan,cthlmdichuyn
v pht tn dng KSTSR khng sang quc gia
lng ging, k c Vit Nam. Mt ln na, vic
gimsthiulcthucgiaccvnggipranh
nh vy s l rt quan trng cnh bo sm
tnh hnh nhy khng ca thuc, ra chin
lcphngchngvthayichnhschthuc
cngnhphcphhp.
TILIUTHAMKHO
1.
2.
Adam I, et al (2010). Dihydroartemisininpiperaquine versus

artemetherlumefantrine, in the treatment of uncomplicated
Plasmodium falciparum malaria in central Sudan. Ann Trop
MedParas;104(4):319326.
DAlessandro U, et al. (2010). Artemisinin based
combinations for treating uncomplicated malaria in African
children: the 4ABC Trial Presentation at the 59th congress of
ASTMH.
ChuynYTCngCng
3.
4.
5.
6.
Harald N, Youry S et al., (2009). Evidence of Artemisinin

ResistantMalariainWesternCambodia,N.EnglJMed,2008,
Dec11;359(24)261920,ePub2008
Marcus JR , McGready R et al., (2011). Dihydroartemisinin
Piperaquine Rescue Treatment of Multidrugresistant
Plasmodium falciparum Malaria in Pregnancy: A Preliminary
Report.Plos.Medicine2011
Sigmatau SA (2010). Application for inclusion of
dihydroartemisinin plus piperaquine (DHA+PPQ) fixed dose
combination tablets. Application for Inclusion in the 17th
WHOModellistofessentialmedicines,15november2010
T.N.Trung, H.H. Quang et al., (2011). Antimalarial drugs
efficacy of Arterakine ans Artequickprimaquine in the
ChuynYTCngCng
7.
8.
9.
NghincuYhc
treatment for uncomplicated falciparum malaria: A pilot

study with clinical in Gia Lai, 2010. Journal of practical
medicine,ISSN18591663,vol.7962011:125133
T.N.Trung, H.H.Quang, Li Guoqiao v cs., (2008). nh gi
hiulcccthucACTstrongiutrstrtchabinchng
doP.falciparumticcvngstrtluhnh,minTrungTy
Nguyn,VitNam(20042008).TpchYhcthnhphH
ChMinh,Vol.12phbns4:2834.
WHO (2010), Global report antimalarial drugs efficacy and
drugsresistance20002010.
WHO (2009), Methods for surveillance of antimalarial drugs
efficacy2009
225
NghincuYhc
KTQUGIMSTVTCHVVCTCABNHDCHHCH
TIGIALAIVKLKNM2011
NguynLMnhHng*,ngTunt*,PhmCngTin*,PhannhThun*,TrnLang*
TMTT
tvn:Dchhchlmtbnhtruynnhimtinguyhim,tintrincptnh,lylanmnhvitl
tvongcao,cxpvodinphikimdchvkhaiboquct.Trongcngtcphng,chngbnhdchhch,
vicgimstnhkvtchvvctcabnhdchhchlrtquantrng.Vth,nghincunynhmnh
gi cng tc gim st vt ch v vc t bnh dch hch ti hai tnh Gia Lai v k Lk thuc khu vc Ty
Nguyntrongnm2011
Mctiu:Xcnhthnhphnloivtchvvctcabnhdchhch,nhgichsphongphcavt
ch,vxcnhtlnhimbchtcavtchbnhdchhchtiaimnghincu.
Phngphpnghincu:Dchthcmtctngang,itngnghinculccloigmnhmvb
chtthuthpuctrongqutrnhiutra,thigiannghincuctrinkhainhktheoqutrongnm
2011,aimnghincuti02tnhGiaLaivkLk.
Ktqu:TitnhGiaLaithnhphnloivtchdchhchlchutLt(Rattusexulans)53,28%,chut
Ch(Suncusmurinus)41,8,3%,chutBng(Rattusnitidus)2,46%,chutngLn(Rattusargentiventer)
1,6%,vchutRng(Rattusrattus)0,86%.TitnhkLkthnhphnloivtchlchut Lt (Rattus
exulans)75,2%,chutCh(Suncusmurinus)24%vchutBng(Rattusnitidus)0,8%.TixIapet,huyn
koa,tnhGiaLaivothng04ctlnhimbchtcaonhtl78,57%vvothng09ctlnhimb
chtthpnhtl9,09%.TixEaHiao,huynEaHleo,tnhkLkvothng03cchsphongphcao
nhtl16%vvothng05cchsphongphthpnhtl07%.
Ktlun:NghincuchothythnhphnloivtchtihaiimnghincuTyNguynltngi
ging nhau, ch khc nhau v mt s thnh phn nh cc loi bn hoang di nh chut ng Ln v chut
Rng.Tuynhinsbinngvchsphongphvtlnhimbchtcavtchdchhchltngiln
vkhdon.Dovycntiptcgimstnhkvtchvvctbnhdchhchvitnsutcaohnti
ccdchc,nhngnicnguycbngphtbnhtrli,vcnmrngmtsimgimstminhlcc
imhoangdivbnhoangdiphcvchocngtcnghincu,vphng,chngbnhdchhchkhuvc
TyNguyn.
Tkha:Bnhdchhch,vtch,vct,chsphongph,tlnhimbcht.
ABSTRACT
STUDYONHOSTANDVECTOROFPLAGUEINGIALAIANDDAKLAKPROVINCESIN2011
NguyenLeManhHung,DangTuanDat,PhamCongTien,PhanDinhThuan,TranLang
Background: Plague is an infectious disease, acute and rapid spread with very high mortality rate,
especiallyplagueisclassifiedasquarantineandinternationaldeclarations.Intheplaguecontrolandprevention,
theregularsupervisionofthehostandvectorofplagueisveryimportant.Therefore,thisstudywastoassessthe
monitoringhostandvectorofplagueintwoprovincesofGiaLaiandDakLakCentralHighlandsregionin2011.
*VinStrtKSTCTQuyNhn
Tcgilinlc:ThS.NguynLMnhHngT:0905411832 Email:lehungnguyen80@yahoo.com
226
ChuynYTCngCng
NghincuYhc
Objectives: Determine the species composition of host and vector of plague, evaluate host density, and
determinethefleaindexwhichinfectedonplaguehostsatresearchsites.
Methods:Epidemiologicalcrosssectional study, study subjects are rodents and fleas collected during the
investigation,researchtimeisdeployedquarterlyin2011,localresearchsitesin02provincesofGiaLaiandDak
Lak.
Result: In Gia Lai province host species of plague is Lat (Rattus exulans) 53.28%, shrews (Suncus
murinus) 41,8,3%, cotton rats (Rattus nitidus) 2.46 %, The Great Mouse (Rattus argentiventer) 1.6%, and
forestrats(RattusRattus)0.86%.InDakLakprovincehostspeciesareLatrats(Rattusexulans)75.2%,shrews
(Suncusmurinus)24%andcottonrats(Rattusnitidus)0.8%.InIapetCommune,DakDoaDistrict,GiaLai
ProvinceinMayfleaindexwas78.57%thehighest,andinSeptemberfleaindexwas9.09%lowest.InEaHiao
Commune,EaHleoDistrict,DakLakProvinceinMayhasthehighestfleaindexis16%andatMaywiththe
lowestabundanceindexis07%.
Conclusion:StudyshowthathostspeciescompositionattworesearchsitesintheCentralHighlandsare
relativelysimilar,differingonlyinasmallnumberofcomponentstosellwildspeciessuchasratsandmiceThe
GreatForest.However,thevariationinrodentdensityandfleaindexarerelativelylargeandunpredictable.So,
wecontinuetomonitorperiodicallythehostandvectorofplaguewithhigherfrequency,andextendsomenew
monitoringpointsisthewildandsellthewildforresearch,control,andpreventplagueintheCentralHighlands.
Keywords:Plague,host,vector,rodentdensity,fleaindex.
TVN
Dch hch l mt bnh truyn nhim ti
nguyhim,tintrincptnh,lylanmnhvi
tltvongcao,cxpvodinphikim
dch v khai bo quc t. Bnh do trc khun
Yersinia pestis gy ra, lu hnh trong qun th
ngvtthucnhngloigmnhm,chyu
lchut.T,bnhlytruynsangngiqua
trunggianlbchtnhimkhun(5).Timts
nc trn th gii tng c bnh dch hch
cghinhnchonnay,thccloithucb
gm nhm (Rodentia), trong h chut
(Muridae) ng vai tr ch yu v l vt ch
chnh.VitNam,vtchcabnhdchhch
cng ch yu l cc loi chut. H chut c 43
loiphnbtrntonlnhth.Trong,nhiu
loichutmangmmbnhdchhchvtruyn
cho con ngi thng qua cc loi b cht, ch
yu l Xenopsylla cheopis. Ti khu vc Ty
Nguyn, thnh phn vt ch bnh dch hch
trong nhiu nm qua ch yu l chut Lt
(Rattus exulans), chut Bng (Rattus nitidus),
chut Ch hay cn gi l chut X (Suncus
murinus)(2,3,6).
ChuynYTCngCng
Trong cng tc phng, chng bnh dch

hch,vicgimstnhkvtchdchhchl
rt quan trng. V th, nghin cu ny nhm
nh gi cng tc gim st vt ch bnh dch
hchtihaitnhGiaLaivkLkthuckhu
vc Ty Nguyn trong nm 2011 vi ba mc
tiucthsau:
Xcnhthnhphnloivtchbnhdch
hchtiaimgimst.
nh gi ch s phong ph ca vt ch
bnhdchhchtiaimgimst.
Xc nh t l nhim b cht ca vt ch
bnhdchhchtiaimgimst.
ITNGPHNGPHPNGHINCU
itngnghincu
Ccloigmnhmthuthpuctrongqu
trnhiutra.
Ccloibchtthuthpctrnccloi
gmnhm.
Phngphpnghincu
Phngphpnghincu:Dchthcmt
ctngang(4).
227
NghincuYhc
Gim st vt ch v vc t dch hch theo

Thng quy gim st v phng, chng bnh
dch hch ban hnh km theo quyt nh s
33/2003/QBYTngy07thng01nm2003ca
BYT(1).
aimnghincu
Gm04xtiDakLakvGiaLainitngl
nhngdchhchc:
Ti tnh Gia Lai: X Iapet, huyn k oa;
XIaKnh,Tp.Pleiku.
Ti tnh k Lk: X EaHiao, huyn Ea
Hleo.
Thigiannghincu
Trinkhaigimstnhktheo qu trong
nm2011.
KTQUVBNLUN
Kt qu gim st vt ch bnh dch hch
titnhGiaLai
Bng01:Thnhphnloivtch
Stt
01
02
03
04
05
Thnh phn loi vt ch

Tng s T l %
Rattus exulans (Chut Lt)
65
53,28
Suncus murinus (Chut Ch)
51
41,8
Rattus nitidus (Chut Bng)
03
2,46
Rattus rattus (Chut Rng)
01
0,86
Rattus argentiventer (Chut ng
02
1,6
Ln)
Tng s
122
100
Nhn xt: Kt qu gim st ti x Iapet,

huyn k oa v x Ia Knh, thnh ph
Pleiku, tnh Gia Lai trong nm 2011 cho thy
thnhphnloivtchthuthpcchyu
l chut Lt (Rattus exulans) 53,28% v chut
Ch (Suncusmurinus) 41,8%. Ngoi ra, cn ghi
nhn mt s lng nh s c mt ca cc loi
chut Bng (Rattus nitidus) 2,46%, chut ng
Ln (Rattus argentiventer) 1,6%, v chut Rng
(Rattusrattus)0,86%.Ktqutrncskhcbit
vthnhphnloivtchsoviktqugim
stcanm2010.
Bng02:Ccchsgimstcavtch
Thi gian
a im
03/ 2011
Ia Knh
04/ 2011
Iapet
07/ 2011
Ia Knh
07/ 2011
Iapet
09/ 2011
Ia Knh
09/ 2011
Iapet
Trung bnh
Exulans
20
09
10
01
13
12
Murinus
13
05
14
01
12
08
Thnh phn loi

Nitidus
Rattus
0
0
0
0
0
01
01
0
0
0
02
0
0
0
(CSPP%:Chsphongph)
(TlnhimBC%:Tlnhimbcht)
Nhnxt:TiccthiimgimstxIa
Knh trong nm 2011 u ghi nhn cc ch s
phong ph ca vt ch dch hch > 07. T l
nhimbchtcavtchdchhchvonhng
thng ma kh l cao hn so vi nhng thng
mama.TiccthiimgimstxIapet
cchsphongphthphnsovixIaKnh.
228
Argentiventer
0
0
0
0
02
0
0
CSPP%
T l nhim
BC%
11
07
8,3
01
13,5
7,33
69,69
78,57
44
33,33
11,11
9,09
Kt qu gim st vt ch bnh dch hch

titnhkLk
Bng03:Thnhphnloivtch
Stt
01
02
03
Thnh phn loi vt ch

Rattus exulans (Chut Lt)
Suncus murinus (Chut Ch)
Rattus nitidus (Chut Bng)
Tng s
Tng s T l %
94
75,2
30
24
01
0,8
125
100
Nhn xt: Kt qu gim st ti dch x

EaHiao, huyn Ea Hleo, tnh k Lk trong
nm2011chothythnhphnloivtchthu
ChuynYTCngCng
NghincuYhc
thpcchyulchutLt (Rattusexulans)
75,2%vchutCh(Suncusmurinus)24%,ngoi
racghinhnscmtcachutBng(Rattus
nitidus)nhngvitlrtnh.Tktqugim
sttrn,chngtinhnthykhngcskhc
bit v thnh phn loi vt ch cng ti im
iutrasovinm2010.
igingnhau,chkhcnhauvmtsthnh
phn nh cc loi bn hoang di nh chut
ngLnvchutRng.
Bng04:Ccchsgimstcavtch
Ti x EaHiao, huyn Ea Hleo, tnh k

Lkvothng03cchsphongphcaonht
l16%vvothng05cchsphongphthp
nhtl07%.
Thnh phn loi

T l
Thi
a
R.
S.
R. CSPP% nhi
gian im exulans murinus nitidus
m
BC%
03/2011EaHiao 45
03
0
16 52,08
04/2011EaHiao 20
03
0
7,67 65,22
08/2011EaHiao 17
06
0
7,67 26,1
11/2011EaHiao 12
08
01
07
40,9
Trung bnh
24
04
0
9,59 46,08
(CSPP%:Chsphongph)
(TlnhimBC%:Tlnhimbcht)
Ti x Iapet, huyn k oa, tnh Gia Lai

vothng04ctlnhimbchtcaonhtl
78,57% v vo thng 09 c t l nhim b cht
thpnhtl9,09%.
KINNGH
Kt qu gim st vt ch dch hch ti cc
tnh k Lk v Gia Lai trong nm 2011 cho
thysbinngvchsphongphvtl
nhim b cht ca vt ch dch hch l tng
ilnvkhdon.Dovycn:
Nhn xt: Ti im gim st x EaHiao

trongnm2011,ttcccchsphongphu
>hoc=07(TheoTchcYtThGiich s
phongph>07%ccoilbong)(6).Cng
titiimgimstxEaHiaongoitrthng
08ctlnhimbchtl26,1%lchpnhn
c,ccthiimgimstcnliuctl
nhimbchttngicao.
Mrngmtsimgimstvtchbnh
dchhchminhlccimhoangdivbn
hoang di phc v cho cng tc nghin cu,
gimstvphng,chngbnhdchhchkhu
vcTyNguyn.
KTLUN
TILIUTHAMKHO
Quacngtcgimstvtchdchhchti
cctnhGiaLaivkLktrongnm2011cho
ktqu:
1.
TitnhGiaLaithnhphnloivtchdch
hchlchutLt(Rattusexulans)53,28%,chut
Ch (Suncus murinus) 41,8,3%, chut Bng
(Rattus nitidus) 2,46%, chut ng Ln (Rattus
argentiventer)1,6%,vchutRng(Rattusrattus)
0,86%.TitnhkLkthnhphnloivtch
l chut Lt (Rattus exulans) 75,2%, chut Ch
(Suncus murinus) 24% v chut Bng (Rattus
nitidus)0,8%.Chothythnhphnloivtch
tihaiimnghincuTyNguynltng
ChuynYTCngCng
Tiptcgimstnhkvtchbnhdch
hch theo tn sut cao hn ti cc dch c,
nhngnicnguycbngphtbnhtrli.
2.
3.
4.
5.
6.
BYt(2003).Thngquygimstvphng,chngbnhdch
hch. Ban hnh km theo quyt nh s 33/2003/QBYT
ngy07thng01nm2003caBYT.Trang8688.
Cao Vn Sung, ng Huy Hunh, Bi Knh (1980), Nhng
loi gm nhm Vit Nam; 1980, NXB Khoa Hc K Thut,
trang0568.
ngTunt,PhmVnHuvcs(2002).Mtsnhnxt
v dch t hc, gim st v phng chng dch hch Vit
Namt1991n2000.TpchYhcDphng2002;54(3);
Trang5660.
Dng nh Thin, L V Anh (2003), Thc Hnh Dch T
Hc.NXBYhc,HNi;Trang212216.
Nguyn Tng m, Cao Minh Tn, Nguyn Duy Thanh
(1982). Bnh dch hch: Dch t hc v lm sng. H Ni; Nh
XutbnYhc;1982.Trang0305.
World Health Organization (1999). Plague Manual:
Epidemiology, Distribution, Surveillance and Control.
WHO/CDS/CSR/EDC/99.2;Page135153.
229
NghincuYhc
NHGITNHHNHNHIMVIRUSVIMGANBVMTSYU
TLINQUANCANHNVINYTTIBNHVIN
TNHGIALAIVKONTUM,20102011
NgThHiVn*,PhmThThyHoa*,TrnTChu*
TMTT
tvn:VimganB(VGB)lmttrongnhngbnhnguyhimngidovirusvimganB(HBV).
Trnthgii,trongs2tnginhimHBVthhn350triubmcVGBmntnh,cnguyctintrinx
ganvungthgan,hngnmckhong1triutrnghptvong(tngngvi2800camingy,115
camigi,hoc12camipht)vungthganhocsuygandoHBV.ycnglvnnicmcangnhy
t.
Mctiunghincu:XcnhtnhhnhhinnhimvirtvimganBvtmhiumtsyutnguyc
nghnghiplinquanntlnhimvirusvimganBcanhnvinyttibnhvintnhGiaLaivKon
Tum.
Phngphpnghincu:Mtctngangtrn342nhnvinytthucbnhvintnhGiaLaivbnh
vintnhKonTum,tthng5nm2010nthng5nm2011.
Ktqu:TlnhnvinyttibnhvintnhGiaLaivKonTumdngtnhvixtnghimHBsAgl
7,3%;antiHBsl14,9%vantiHBcl12,8%;tlnhimHBVchungl35,0%;trongtlnhimHBV
caonhm30n50tui(38,3%44,3%),thphnnhm<30tui(25,0%);nhmlmvictikhoatruyn
nhimvcckhoahngoicngctlnhimcao(38,3%40,0%).TlnhimHBVcskhcnhautheothi
giancngtc.NhmNVYTbscnghnghipc t l nhim HBV (47,7%) cao hn so vi nhm NVYT
khngbsc(20,6%)(p<0,001);ktqucngchothytlnhimHBVcanhmbsckimm(38,2%)
caohnnhmbscdnhmuvdchthcabnhnhn(7,9%).Tlnhnvinytthngxuynlmcng
vicradngc(35,0%),chchthuc,lymu(39,4%)ctlnhimHBVcaohnnhmkhnglmcngvic
ny(16,3%).
Ktlun:PhngchnglynhimHBVtrongNVYTcncquantmvchngdnthchincth,
cbitluiviccitngcnguyccaogm:NVYTcthmninlmviclunmtrongngnhyt,
NVYTthngxuynphithchincccngviccnguyctnthngdovtscnhncaonhyt/iu
dngvbcshayccnhnvinthugomrcthiyt.
Tkha:VimganB(VGB),virusvimganB(HBV),nhnvinyt(NVYT)
ABSTRACT
ANAPPRAISALOFHEPATITISBVIRUSINFECTIONANDRELATINGFACTORSINMEDICAL
WORKERSATPROVINCIALHOSPITALSATGIALAIANDKONTUM,20102011
NgoThiHaiVan,PhamThiThuyHoa,TranToChau
Background:HepatitisBisadangeroushumandiseasecausedbyhepatitisBvirus.Intheworld,among2
billion people infected with hepatitis B, more than 350 million suffer from chronic hepatitis B with risks of
cirrhosisandlivercancer.About1millionpeopledieoflivercancerorliverfailure(thisrepresents2,800casesa
*VinVsinhdchtTyNguyn
Tcgilinlc:BS.NgThHiVnT:0914111196
230
Email:ngovan57@yahoo.com.vn
ChuynYTCngCng
NghincuYhc
day,115casesanhouror12casesinoneminute).Thisisaproblemthatthehealthsectorhastocopewith.
Objectives:ThisstudyiscarriedouttodeterminetheprevalenceofhepatitisBinfectionandexplorefactors
relatingtoprofessionalrisksinhepatitisBinfectionamongmedicalworkersatprovincialhospitalsinGiaLaiand
KonTum.
Methodology:Crosssectionalstudyof342medicalworkersworkingatGiaLaiandKonTumprovincial
hospitals.ThesurveywasdonefromMay2010toMay2011.
Results:Theprevalenceofpositivetestamongmedicalworkersattwohospitalsis7.3%forHBsAg,14.9%
forantiHBs,and12.8%forHBs;TheinfectionprevalenceforHBVis35.5%.Thisprevalenceishighestamong
3050agegroup(38.3%44.3%),lowerinthebelow30agegroup(25.0%);itisalsohighamongthoseworking
in the Department of Infectious Diseases (38.3%40.0%). It varies with the length of service rendered. Those
sufferedfromworkincidentsboasthigherrateat47.7%thanincidentfreeworkersat20.6%(p<0.001).The
studyalsoshowsthatthisprevalenceishigheramongthosesufferingfromneedleinjectedincidentsat38.2%
thanthosesufferingfrombloodandfluidexposureat7.9%.Thoseengagedinwashingutensils,givinginjection,
andtakingbloodsamplehaveprevalenceat35.0%and39.4%respectivelyhigherthanthosewhodonothaveto
dosoat16.3%.
Conclusion: The prevention of HBV infection in medical workers should receive greater attention and
concreteguidanceshouldbeformulatedwithspecialattentiontohighriskgroupwhichincludemedicalworkers
whohaveservedforalongtime,thosewhoseregularlytasksatjobswithhigherrisksofexposingtosharpand
pointedutensilssuchasmedicalassistantsanddoctorsorcollectorsofmedicalwaste.
Keyword:HepatitisB,HepatitisBvirus(HBV),medicalworkers
ngthitrnhnhngnguyclynhimcho
TVN
cho cng ng. T thc t chng ti tin
VimganvirusBlmttrongnhngbnh
hnhnghincuvihaimctiusau:
nguyhimngidovirusvimganB(HBV)
Mctiunghincu
gy ra v l mt bnh ph bin hu ht cc
XcnhtlhinnhimvirusvimganB
nctrnth gii, nhng ngi mang HBV c
canhnvinyttibnhvintnhGiaLaiv
thchtdovimgancp,vimganmn,xgan
KonTum,nm20102011.
vungthgantinpht.Mtcimrtquan
trng l hn 90% ca nhim HBV hon ton
khngcbiuhinlmsngvbnhdinbin
thmlng,chbcphtkhibnnghocgiai
on cui. T l nhim HBV cng khc nhau
gia cc nhm yu t nguy c nh: yu t gia
nh, s dng dch v y t v thi quen sinh
hot (dng chung bn chi, dao co...)...Mt
trong nhng nhm nguy c cao thng gp l
nhnvinyt.Trongcccsytnhnviny
tllclnglaongthngxuyntipxc
viccyutnguycnghnghip(mu,dch
th...cabnhnhn)vitnsutcao,quac
nguy c cao ly nhim virus vim gan B. Nh
vy cng tc kim sot cc trng hp nhim
HBVtrongnhnvinytlcnthit,gpphn
vocngtcchmscsckhongilaong,
ChuynYTCngCng
Phn tch mt s yu t nguy c ngh

nghiplinquanntlnhimvirusvimgan
B ca i tng ny ti bnh vin tnh Gia Lai
vKonTum.
ITNGPHNGPHPNGHINCU
itngnghincu
342nhnvinytcngtctibnhvintnh
GiaLaivKonTum
Phngphpnghincu
Mtctngang
Ccitngnghin cu c phng vn
bng b cu hi son sn vi cc thng tin
chungvccthngtinvtipxcyutnguy
c. Sau ly 5ml mu/ngi, cc mu mu
231
NghincuYhc
c ly tm tch b cc mu ng xt
nghimtmccdunvimganB:HBsAg,anti
HBsvantiHBc,ccxtnghimnycthc
hin bng cc b kt chn on tng ng ca
tponACONBiotech(vinhy>99,0%v
c hiu: 99,7%), cc xt nghim khng r
rng(equivocal)cxemnhlmtnh.
Kon Tum (n=

172)
Tng s
(n = 342)
HBsAg (+): L tnh trng mang HBsAg

tronghuytthanhchngtangb nhim cp
hocmntnhvivimganB.
AntiHBs(+):Ltnhtrngckhngth
bovchngtinhimHBV.
AntiHBc (+): L tnh trng tng b
nhimHBV.
Nhim virus vim gan B (HBV): L tnh
trng c 1 trong cc du n min dch HBsAg
hocantiHBshocantiHBcviiukincha
timvcxin.
DngEPIINFO6.4vccbng,biu,ha
trongEXCEL
KTQUNGHINCU
TnhtrnghinnhimvirtvimganB
Bng1:TlxuthintngdunmindchHBV
caNVYTtibnhvintnhGiaLaivKonTum
Gia Lai (n=

170)
232
13,9
25
7,3
51
14,9
44
12,8
(*)
HBsAg
(+)
(%)
Anti-HBs
(+)
(%)
Anti-HBc
(+)
(%)
04
3,5
15
13,3
09
8,0
08
8,1
15
15,3
21
21,4
09
9,0
17
17,1
12
12,1
04
12,1
04
12,1
02
6,0
Nhnxt: T l mang cc du n min dch

cskhcnhaugiaccnhmtui.cbitt
lnhimantiHBccaonhmNVYTtuit30
n di 40 (21,4%), thp hn l nhm 40 n
di50(12,1%)vnhmtuidi30(8,0%),
nhm50chc6,0%(p<0,05).
44,8%
45
40
38,3%
35
30
25
30,3%
25,0%
20
15
10
5
0
< 30
30 - < 40
40 - < 50
>= 50
Xlsliu
Tnh
24
< 30 tui
(n= 112)
30- < 40 tui
(n= 98)
40 - < 50 tui
(n= 99)
50 tui
(n= 33)
Bc2:TmantiHBsNu:
nhgiktquxtnghim
9,3
Nhm tui
+mtnh:XtnghimtipantiHBs
Bc3:TmantiHBc
16
Bng2:TlxuthinccdunHBVphntheo
nhmtui
+ Dng tnh: Khng xt nghim tip anti

HBsvantiHBc
+mtnh:XtnghimtipantiHBc
5,8
Ghich:antiHBs(+)(*)lcaccNVYTchatim
phng
Cc xt nghim ln lt c tin hnh nh

sau
Bc1:TmHBsAgNu:
+ Dng tnh: Khng xt nghim tip anti

HBc
10
(*)
HBsAg
(+)
(%)
Anti-HBs
(+)
(%)
Anti-HBc
(+)
(%)
15
35
20
8,8
20,5
Biu1:TlnhimHBVca2bnhvinphn
theonhmtui
Nhnxt:TlnhimHBVcaonhtnhm
tui30ndi40(44,8%)tiptheolnhm40
n di 50 tui (38,3%), nhm >= 50 tui
(30,3%) v thp nht nhm di 30 tui
(25,0%),vip<0,05.
Bng3:TlnhimHBVchungca2bnhvin,
phntheogiivdntc
11,7
ChuynYTCngCng
Gii tnh Dn
tc
Nam
( n=63)
N
( n= 279)
AntiNhim
(*) Anti-HBc
HBs
HBV
(+) (%) (+) (%) (+) (%) (+) (%)
1. Gii tnh
HBsAg
11,
12,
08
22 34,9
1
6
07 11,1 07
18 6,4 44 15,7 36 12,9 98 35,1

p > 0,05
2. Dn tc
Kinh
( n= 322)
Dn tc
( n= 20)
13,
14,
114 35,4
42
0
9
15,
01 5,0 03
02 10,0 06 30,0
0
24 7,4 48
p > 0,05
Nhn xt: T l ca tng du n v t l

nhimHBVchunggianamvn,giangi
Kinhvngidntcthiuskhcbitkhng
cnghathngkvip>0,05.
TlnhimHBVtheocngvic
38,3% 40,0%
40
33,7% 33,9%
35
30
28,0% 29,6%
NghincuYhc
40
35
28,2%
31,7%
33,3%
34,2%
37,3%
30
25
20
15
10
5
0
N h sinh
Bc s
K thut vin
H l
iu dng, y
t
Biu3:TlnhimHBVcaNVYTphntheo
cngvic
Nhnxt:TlnhimHBVcaonhtnhm
iudng,yt(37,3%),tiptheolnhmhl
(34,2%),nhmkthutvin(33,3%),nhmbc
s (31,7%), thp hn c l nhm n h sinh
(28,2%).TuynhinskhcbittlnhimHBV
giaccnhmphntheocngvickhngc
nghathngk,vip>0,05.
Mts yu t ngh nghip lin quan n

tlmangdunvimganB
25
Bng4:Milinquangiathmnincngtcvi
tlmangdunHBV
20
15
10
5
0
K/Phng Xt
khc nghim
H ni
CK l
H ngoi Truyn
nhim
Biu2:TlnhimHBVphntheokhoa/phng
cngtc
Nhnxt: Nghin cu cho thy t l nhim
HBV ca NVYT ti hai bnh vin: cao nht
khoatruynnhim(40,0%),tiptheolcckhoa
h ngoi (38,3%), chuyn khoa l (33,9%), cc
khoahni(33,7%),vctlthphnlkhoa
xt nghim (29,6%) v cc khoa phng khc
(28,0),skhcnhaunykhngcnghathng
k,vip>0,05.
AntiNm
S HBsAg HBs(*)
cng tc mu
(+) (%) (+) (%)
< 5 nm
10,
99 05 5,0 10
1
5 - < 10
18,
54 02 3,7 10
nm
5
10 - < 15
12,
39 05 12,8 05
nm
8
15 - 20
19,
51 05 9,8 10
nm
6
> 20 nm
16,
99 08 8,0 16
1
AntiHBc
(+) (%)
12,
12
1
12,
07
9
17,
07
9
13,
07
7
11,
11
1
Nhim
HBV
(+) (%)
27 27,2
19 35,1
>
17 43,5 0,05
22 43,1
35 35,3
Nhnxt:TlmangHBVchungphntheo
thm nin cng tc cho thy t l cao nht
nhm1520nmvnhm10<15nm(43,1%
v43,5%),nhm>20nmvnhm5<10nm
ctlthphn(35,3%v35,1%),thpnht
nhmcthmnincngtc<5nm(27,2%),s
khcbitnykhngcnghathngk,vip>
0,05.
Bng5:Milinquangiascnghnghipvit
lnhimHBV
ChuynYTCngCng
233
NghincuYhc
S c
C s c
Khng c
s c
S mu Nhim HBV T l %
182
87
47,8
160
33
20,6
p
p < 0,001
Nhnxt:Nghincuchothyskhcnhau
c ngha thng k v t l nhim HBV gia
NVYTbscvitl47,8%caohnnhiuso
vinhmNVYTkhngbsc20,6%,vip<
0,001.
Bng6:Milinquangiaviclmthngxuyn
vitlnhimHBV
S HBsAg Anti- Anti- Nhim
(*)
HBc
HBV
HBs
Cng vic mu
(+) (%) (+) (%) (+) (%) (+) (%)
Ra dng c 20 03 15,0 00 00 04 20,0 07 35,0
Chch thuc,
261 19 7,3 48 18,3 36 13,7 103 39,4
ly mu
Khng
thng
xuyn
<
0,01
61 03 4,9 03 4,9 04 6,5 10 16,3
Nhnxt:TlnhimHBVtrongccnhm
NVYT theo nguy c phi nhim vi tnh cht
cng vic thng xuyn: cao nht nhm chch
thuc, ly mu (39,4%), sau n nhm
thngxuynradngc(35,0%),vthpnht
l nhm khng thng xuyn lm nhng cng
vic trn (16,3%), s khc bit gia cc nhm
phi nhim thng xuyn v khng thng
xuynlcnghathngk,vip<0,01.
nghincukhc(7).TlnhimHBVcaNVYT
cskhcnhaugiaccnhmtuicaonht
i tng t 30 n di 40 tui (44,8%), tip
theo l nhm 40 n di 50 tui (38,3%) thp
nht l nhm < 30 tui, (p < 0,05). Kt qu cho
thy s khc bit khng c ngha thng k
gia nam v n qua pht hin c 3 du n
(HBsAg,antiHBs(*)vantiHBc)caHBV,vip
> 0,05. Mt s tc gi khc cng cho kt qu
tngt(5,6,1).Tuynhinkhngthyskhcbit
c ngha gia ngi Kinh v ngi dn tc
thius.KhiphntchvtlnhimHBVphn
theo khoa/phng cng tc ti nghin cu ca
chng ti khng pht hin s khc bit c
nghathngk(p>0,05)(biu2),tlnhim
HBVcaonhtlnhmyt,iudng(37,3%).
Mt s yu t lin quan n t l hin

nhimvirusvimganB
BNLUN
Kt qu nghin cu cho thy t l mang

HBVcxuhngtngdntheothmnincng
tcvcskhcbitgianhmNVYTbsc
nghnghip(47,8%)vinhmNVYTkhngb
s c (20,6%), vi p < 0,001. Nhm thng
xuyn lm cng vic chch thuc, ly mu, ra
dngc...ctlnhimHBVl39,1%,caohn
nhm khng thng xuyn lm cng vic ny
(16,3%),(p<0,01),ssaikhcnycngphhp
vimtsnghincukhc(5).
TnhtrnghinnhimvirusvimganB:
KTLUN
TlmangHBsAgtrongNVYTtihaibnh
vin l: 7,3%. Kt qu ny tng t vi nghin
cucatrngihcYtCngcng(2008),
nhng thp hn so vi 1 s nghin cu
khc(2,4,3,7).Nghincughinhntlmanganti
HBs l 14,9%, t l ny khng bao gm nhng
ngi mang antiHBs tim phng vcxin
vimganB,ktqucachngtithphnca
NguynQuangTpvcs(2007)nghincutrn
nhmnhnvinyttimtsbnhvinHi
Phngvitll16,4%(5),vcngthphnso
vinghincucaVinChinhChin(52,9%)(7).
VtlmangantiHBc:nghincuchothyt
lmangantiHBcl12,8%,cngthphnsovi
Qua nghin cu 342 nhn vin y t ti 2

bnhvintnhGiaLaivKonTumchngtic
mtsktlunsau:
234
TnhtrngnhimHBV:Tlnhnvinyt
ti bnh vin tnh Gia Lai v Kon Tum mang
HBsAgl7,3%;antiHBsl14,9%vantiHBcl
12,8%. T l nhim HBV chung l 35,0%; T l
nhimHBVcanhnvinyttiBnhvintnh
Gia Lai (41,1%) cao hn nhn vin y t Bnh
vintnhKonTum(29,0%).TlnhimHBVc
skhcnhautheotngnhmtui.Khngpht
hin s khc bit c ngha thng k v t l
nhimHBVtheogiitnh,dntc.Tlnhim
HBVcaonhmlmvictikhoatruynnhim
ChuynYTCngCng
vcckhoahngoi,songkhngthcskhc
hnsovicckhoaphngkhc.
2.
Ccyutnguycnghnghiplinquan
ntlnhimHBVtrongnhnvinyt:T
l nhim HBV c s khc nhau theo thi gian
cngtc,caonhtlnhmcthmnincngtc
1020nm,thpnhtlnhmdi5nm.C
skhcbitrrnggianhmcvkhngc
scnghnghip:tlnhimHBVcanhm
bsckimm(38,2%)caohnnhmbsc
dnhmuvdchthcabnhnhn(7,9%).T
l nhim HBV nhn vin y t thng xuyn
lmcngvicradngc(35,0%),chchthuc,
ly mu (39,4%) cao hn nhm khng lm cc
cngvicny(16,3%).
3.
TILIUTHAMKHO
1.
4.
5.
6.
7.
NghincuYhc
HongCngLong(1995)TlmangHBsAgtrongnhng
nhmngikhcnhautnhLmng,TpchVsinh
phngdch,HiVSPDVitNam,tpV,s1(19),tr.7476.
KhcXuyn,NguynThTonvcngs(2003):iutra
c bn thc trng sc khe ngi lao ng tip xc vi vi
sinh vt nguy him (vi rt vim gan B), ti NCKH cp
B,2003.
Nguynnhng,Ngcnh,VXunNgha,Nguyn
ThHuyn,HongVnLng(2009),Bcuxcnht
lnhimvirtvimganBmtsitngtrnabn
tnhVnhPhc,tinghincukhoahccptnh,2009.
NguynQuangTp,PhmTrungKin(BnhvinKinAn
Hi Phng) v Phm Vn Trng (i hc Y Thi Bnh)
(2007)XcnhtlnhimvirusvimganB,HBsAg,Anti
HBs, HBeAg ca cn b y t ti mt s bnh vin Hi
Phng,TpchYhcthchnh,s12/2007,tr.6871.
Nuvati T (1994) Pective of viral Hepatitis in Thailand,
Proeedings of the ISVHLD, Tokyo, May 1014, 1993. Viral
Hepatitisanddisease,1994,403405.
VinChinhChin,NguynThThTrm,inhSHinv
cngs(1996)iutravtnhhnhnhimvirtvimgan
BtrongnhnvinyttimtstnhminTrung,Tpch
Vsinhphngdch,tp6(4)1997,tr.3439.
GohKT,DoraisinghamS,TanKL.etal(1989):TheHepatitis
B immunization programe in singapore, Bulletin of WHO,
67(1),1989,6570.
ChuynYTCngCng
235
NghincuYhc
NHGIKTQUIUTRLAOPHIMITITNHCMAU
NM2009VCCYUTLINQUAN
TrnNgcDung*,TrnHinKha**,NguynVnSn**
TMTT
tvn:Cngtcqunliutrlaomiqucgia,mikhuvc,miaphngphthucrtnhiu
yutvthayitheotngnm.Vicnghincusuvnnycmtnghartln,giphiucthc
trngktquiutrlaotiaphng.
Mctiu:nhgiktquiutrlaophimivccyutlinquan
Phngphpnghincu:Nghincuctngang
Ktqu:Ktquiutr1.020bnhnhnlaophi:thnhcng984,chim96,5%.Trong,khibnhca
AFB(+)mil759/786(96,6%),honthnhiutrAFB()mi225/234(96,2%).iutrkhngthnhcngl
36(3,5%),baogmthtbi01(0,1%);btr04(0,4%);tvong31(3,0%).Tliutrkhngthnhcng
mcthp.
Ccyutlinquanniutrkhngthnhcng:tuit60trln(6,8%);ctcdngphcathuc
(22,9%);mcsngkinhtthp(9,3%);khngtunth(9,1%).
Chathycmilinquangiabnhkthp,thigiannkhmphthin(munkhngmun),thi
quendngrubia,thucl,nictr,khongcchtnhnninhnthuciutrvmchiubitv
iutrviktquiutrkhngthnhcngcalaophiAFB(+)mi.
Ktlun:Ktquiutrlaophimi:tliutrthnhcngl96,5%;tliutrthnhcngAFB(+)
mil96,6%;tlhonthnhiutrAFB()l96,2%.
CcyutlinquannktquiutrlaophiAFB(+)mivAFB()mi:tui,tcdngphca
thuc,kinhtgianhvtunthtrongiutr
Kinngh:Trongqunl,Dnphngchnglaocatnhcnchnccnhmitngctliu
trkhngthnhcngcao.
Ccngnhchcnng,cngngcnquantmgipbnhnhnlaolngingho
Tkha:AFB(+),ktquiutrAFB(+),yutlinquaniutrbnhlao
ABSTRACT
STUDYONRESULTSOFNEWLYPULMONARYTUBERCULOSISTREATMENTIN
CAMAUPROVINCEIN2009ANDRELATEDFACTORS
TranNgocDung,TranHienKhoa,NguyenVanSon
Background:ThemanagementofTBtreatmentineachcountry,eachregionandeachlocalitydependson
manyfactorsandchangeseveryyear.StudyofTBhasagreatsignificance,forunderstandingtheoutcomeofTB
treatmentatlocallevel
Objectives:Tostudyresultsofnewlynotifiedtuberculosistreatmentandrelatedfactors
Method:Crosssectionalstudy.
*TrngihcYDcCnTh,**TrungtmphngchngccbnhXhiCMau
Tcgilinlc:Ths.TrnHinKhaT:0913653361
Email:bshienkhoa@gmail.com
236
ChuynYTCngCng
NghincuYhc
Results: Results of treatment of 1,020 newly notified TB patients: 984 cases was succesful (96.5%); in
which success of AFB (+) was 759/786 (96.6%), completed treatment of newly notified TB patients AFB(
)225/234 patients (96.2%). Unsuccessful cases were 36 patients (3.5%), including failure 1case (0.1%), non
adherence4cases(0.4%),deaths31cases(3.0%).Therateofunsuccessfultreatmentislow.
Factorsrelatedtotreatmentfailureareagegroupofover60(6.8%),sideeffectsofdrugs(22.9%),lowsocio
economicstatus(9.3%);notcomplywithtreatmentornonadherence(9.1%).
Therewerenorelationshipsbetweenconcomitantdisease,timeofdiseasedetection(lateorearly),drinking
habit,smoking,placeofresidence,distancefromhometohealthcarefacilitytogettreatment,andknowledgeon
treatmentwithunsuccessfultreatmentofnewlynotifiedpulmonarytuberculosisTBpatientsAFB(+)
Conclusion: Result of newly notified pulmonary TB cases treatment showed that successful rate was
96.5%;successfulrateforAFB(+)was96.6%;andsuccessfulrateforAFB()was96.2%.Factorsrelatedto
treatment outcome of new case TB AFB (+) and new case AFB () were age group, side effects of drugs,
householdseconomy,andadherencetotreatment.
RecommendationsInmanagementofNationalTBPrograminCaMauprovincethemanagershouldpay
attentiontogroupswithhighrateofunsuccess.Hence,therelevantagenciesandcommunitiesshouldpaymore
attentiontopoorTBpatients
Keywords:AFB(+),outcomeoftreatmentTBwithAFB(+),factorsrelatedtoTBtreatment
nghin cu su vn ny c mt ngha rt
TVN
ln,gipccnhqunl,hochnhchnhsch
Dxuthintrntritthngngnnm
nmcthctrngktquiutrlaotia
trcCngNguynvbitrnguynnhngy
phngmnhtcccgiiphpphhp
bnh l do vi trng lao (Mycobacterium
nhm t c hiu qu cao trong cng tc
tuberculosishominis)t1882,bnhlaotung
chnglao.TtrcnnayCMauchac
c khng ch, tng bc y li v i n
tinghincuvvniutrbnhlao,vvy
thanh ton. Nhng n nay, bnh lao vn cn
chngtitinhnhnghincuti:nhgi
dinbinrtphctp(3,4,12).
kt qu iu tr lao phi mi ti tnh C Mau
TheoTchcYtThgii,sbnhnhnlao
nm 2009 v cc yu t lin quan, nhm cc
tngdnquaccnm,boconm2007cho
mctiusau:
thy,cn1/3dnsthgii(2,2tngi)
Mctiunghincu
nhimlao.Cngtheobocony,nm2006,t
nhgiktquiutrlaophimitnh
l iu tr thnh cng ca lao phi dng tnh
CMaunm2009
mitoncut85%.Trong,cmtsquc
Phn tch cc yu t tc ng n kt qu
gia t t l cao nh Trung Quc 94%,
iutrlaophiAFB(+)mi.
Campuchia93%(13).
Nm 2007, theo bo co ca D n phng,
chnglaoQucgia,tliutrkhicabnh
nhn lao phi dng tnh mi nm 2006 t
89,8%vlaophimtnhmil91,3%(2).Trong
khi,tliutrthnhcngtiCMauc
s bin ng qua cc nm v c chiu hng
gim.
Cngtcqunliutrlaomiqucgia,
mi khu vc, mi a phng ph thuc rt
nhiu yu t v thay i theo tng nm. Vic
ChuynYTCngCng
ITNGPHNGPHPNGHINCU
itngnghincu
Ttcbnhnhnlaophimi,cqunl
iutrtrongmnglichnglaotnhCMau
tngy01/01/2009n31/12/2009.
Tiuchchnitngnghincu
Bnh nhn sng thng tr trong tnh C
Mau,nutmtr,ththigiantmtrphi>3
thng (tnh n thi im bnh nhn ng k
237
NghincuYhc
chung
iutr);
Bnhnhncxcnhllaophimi;
Tiuchloitr
Bnh nhn khng c qun l v iu tr
trong mng li d n phng chng lao quc
giatiaphng;
Phiu thu thp thng tin, phiu bnh l,
phiutheodiiutrkhngghi nhn y
cc chi tit (do bnh nhn t chi tr li hoc
nhnviniutraghichpkhngy).
Lao phi AFB (+)

mi
Lao phi AFB (-)

mi
Phngphpnghincu
Thitknghincu
Mtctngang
Cmu
Chn mu ton b tha tiu ch chn v
khngphmtiuchloitr.Trongnghincu
ny,chnccmul1.025bnhnhn(791
laophiAFB(+)v234laophiAFB().
Ccthngtincnthuthp
c im chung (i tng nghin cu):
tui,giitnh,dntc,nictr,nghnghip,
trnh hc vn, tnh trng kinh t, tnh trng
hnnhn,
Phnlinquanniutr:phthinmun,
chmtrtrongiutr,tcdngphcathuc,
tunthiutr,bnhkthp
nh gi kt qu iu tr theo hng dn
caDnphng,chnglaoQucgia
KTQUNGHINCU
Ktquiutrbnhnhnlaophimi
Bng1:Ktquiutrcabnhnhnlaophimi
(n=1.020)
Loi bnh
Kt qu nh
gi
S bnh
nhn
T l %
Lao phi mi
Thnh cng
984
96,5
Tht bi
0,1
T vong
31
3,0
B tr
Tng s nh
gi
Khi
Tht bi
T vong
B tr
Tng s nh
gi
Hon thnh
iu tr
T vong
B tr
Tng s nh
gi
0,4
1.020
100
756
1
24
2
96,6
0,1
3,1
0,2
786
100
225
96,2
7
2
3,0
0,4
234
100
Trongs1.025bnhnhnlaophimic
thu nhn iu tr c phng vn thu thp
thng tin, c 1.020 bnh nhn c theo di,
iutrlintcnliucuicng;05bnhnhn
chuynnnvtnhbntiptciutrc
phiu phn hi tip nhn ca ni bnh nhn
n.Nntrongphnnhgi,chngtikhng
phntch05bnhnhnchuyni.
Tngs1.020bnhnhnciutrtheo
diiutrhtliutrnh(baogm786AFB(+),
234AFB())cktqunhsau:
iutrthnhcng(baogmkhivhon
thnh iu tr) l 984 bnh nhn, chim 96,5%.
Trong,khibnhcalaophiAFB(+)mil
759/786bnhnhn(96,6%),honthnhiutr
AFB() mi 225/234 bnh nhn (96,2%). y l
mttlthnhcngkhcao.
iutrkhngthnhcngl36bnhnhn,
chim3,5%.Baogmthtbi1(chim0,1%);b
tr4(chim0,4%);tvong31(chim3,0%).Tl
iutrkhngthnhcngmcthp.
CcyutlinquannktquiutrkhngthnhcngcalaophiAFB(+)mi
Bng2.KtquiutrlaophiAFB(+)mikhngthnhcng,linquannmtsctrngvcnhnca
bnhnhn
Yu t
238
Kt qu iu tr lao phi AFB (+) mi

Khng thnh cng
Tng s
S lng
%
ChuynYTCngCng
Tui
Gii
Tnh trng
hn nhn
Hc vn
Ngh nghip
Ni c tr
Khong cch t
nh
n ni iu tr
< 60
> 60
Nam
N
C gia nh
c thn, go
Tiu hc
THCS
CCVC-HSSV
NN-TS
Ngh khc
Thnh th
Nng thn
< 5 Km
5 10 Km
> 10 Km
13
14
21
6
20
7
18
9
4
12
11
10
17
7
11
9
2,2
6,8
3,5
3,3
3,2
4,5
3,5
3,3
6,8
2,9
3,5
3,6
3,3
3,0
4,8
2,8
Cmilinquangianhmtuivktqu
iutr:nhmtuit60trlnctlkhng
thnhcngl6,8%;trongkhinhmdi60
tuictliutrkhngthnhcngl2,2%.
S khc bit ny c ngha thng k vi p <
0,05.
NghincuYhc
580
206
602
184
632
154
517
269
59
416
311
276
510
233
228
325
9,49
< 0,05
0,02
> 0,05
0,71
> 0,05
0,01
> 0,05
2,38
> 0,05
0,05
> 0,05
1,89
> 0,05
Chathycmilinquangiaccyut
nh:giitnh,tnhtrnghnnhn,trnhhc
vn,nghnghip,nictrvkhongccht
nhnninhnthuciutrviktquiu
tr khng thnh cng ca lao phi AFB(+) mi,
vip>0,05
Bng3:MtsyutlinquannktquiutrkhngthnhcngcabnhnhnlaophiAFB(+)mi
Yu t
Bnh
Kt hp
Thi gian n khm pht
hin
Tc dng ph khi dng thuc
Thi quen dng ru - bia

Thi quen
ht thuc l
Kinh t
gia nh
Hiu bit v iu tr lao
Tun th
iu tr
Kt qu iu tr
lao phi AFB (+) mi
Khng thnh cng
Tng s
S lng
%
5
4,9
102
Khng
Mun
22
16
3,2
2,9
684
550
Khng mun
C
Khng
> 2 ln/tun
< 2 ln/tun
Khng dng
Khng nghin
Nghin
Ngho
Khng ngho
Tt
Cha tt
C
Khng
11
11
16
5
17
5
16
11
7
20
6
21
23
4
4,7
22,9
2,2
2,5
4,1
2,8
3,5
3,4
9,3
2,8
2,2
4,1
3,1
9,1
236
48
738
198
412
176
463
323
75
711
271
515
742
44
C mi lin quan gia tc dng ph ca

thuc v kt qu iu tr: t l iu tr khng
thnh cng bnh nhn c tc dng ph ca
thucl22,9%,tliutrkhngthnhcng
ChuynYTCngCng
0,76
> 0,05
1,53
> 0,05
58,42
< 0,05
1,27
> 0,05
0,00
> 0,05
8,68
< 0,05
1,86
> 0,05
2,87
< 0,05
bnhnhnkhngctcdngphcathucl
2,2%.Skhcbitnycnghathngk,vip
<0,05.
239
NghincuYhc
Cmilinquangiamckinhtgianh
vi kt qu iu tr: bnh nhn c mc kinh t
gianhthucloinghoctliutrkhng
thnhcngl9,3%;trongkhihkhngnghot
lkhngthnhcngl2,8%.Skhcbitnyc
nghathngkvip<0,05.
C mi lin quan gia tun th trong iu
tr vi kt qu iu tr: bnh nhn khng tun
th c t l iu tr khng thnh cng l 9,1%;
trong khi nhm bnh nhn tun th tt, t l
khngthnhcngl3,1%.Skhcbitnyc
nghathngkvip<0,05.
Cha thy c mi lin quan gia bnh kt
hp, thi gian n khm pht hin (mun
khng mun), thi quen dng ru bia, thuc
l,nictr,khongcchtnhnninhn
thuciutrvmchiubitviutrvikt
qu iu tr khng thnh cng ca lao phi
AFB(+)mi,vip>0,05.
BNLUN
Ktquiutrlaophimichung
Tbng1chothytngs1.020bnhnhn
cktqunhsau:
iutrthnhcngl984bnhnhn,chim
96,5%.Trong,khibnhcalaophiAFB(+)
mi l 759/786 bnh nhn (96,6%), hon thnh
iu tr AFB() mi 225/234 bnh nhn (96,2%).
ylmttlthnhcngkhcao.
Ch c 36 bnh nhn (3,5%) iu tr khng
thnh cng. T l tht b, b tr, t vong u
mcrtthp
Kt qu nghin cu ca QingSongBao ti
QungChu(TrungQuc)chothy:tlthnh
cngl86%;tvong2,8%vbtr5,9%(13).
Kt qu iu tr ti Bnh vin Trng i
hcGondar,bcEthiopia(ChuPhi)chothyt
lthnhcngchungl29,5%;tvong10,1%;b
tr18,3%(1).
Kt qu iu tr lao phi mi ti cc tnh
pha Nam nm 2008: thnh cng l 93,3%. Mt
s tnh chung quanh C Mau c kt qu nh
240
CnTh92,9%;KinGiang93,5%vBcLiul
90,9%.
Nhvy,ktquiutrtiCMautchcc
hnsoviQungChuvtthnrtnhiuso
vibnhvinTrngihcGondar,Ethiopia
(ChuPhi)
KtquiutrlaophiAFB(+)mi
KtquiutrlaophiAFB(+)mitiC
Maunm2009
TBng2chothyktquiutrcabnh
nhnlaophiAFB(+)minm2009tiCMau
nhsau:thnhcngl96,6%;thtbil0,1%;t
vongl3,1%;btrl0,2%.
T l khi ca lao phi AFB(+) mi ti C
Maul96,6%;cacctnhphaNaml93,5%;
mtstnhlncnCMaunm2008nhsau:
Bc Liu 91,6%; Kin Giang 93,7%; Sc Trng
96,7%vHuGiang96,5%.Ktqulnhchung
cacncquaccnmnhsau:90,6%(2004);
90,2%(2005);89,8%(2006);89,2%(2007)(4,6).Nh
vy,ktquiutrkhicaCMaucaohnt
l chung ca c nc v cao hn mt s tnh
bn.
C Mau khng c hon thnh iu tr ca
lao phi AFB(+) mi. Trong khi , t l ny
mt s tnh bn nh sau: Kin Giang 0,1% v
Bc Liu 0,2% (2008); c nc qua cc nm l:
2,1% (2004); 2,1% (2005); 2,3% (2006); 2,4%
(2007)(4,5).Nhvy,vickimsotmnhgi
ktquiutrCMauthchintthnc
ncvmtstnhbn
TlthtbicalaophiAFB(+)mitiC
Mau l 0,1%. Nm 2008, ti Bc Liu 0,4% v
Kin Giang 0,7%..., chung c nc dao ng
0,9%(2004)1,1%(2007)(4,6).Nhvy,tltht
bitrongiutrcalaophiAFB(+)mitiC
Mauthphnmtstnhbnvcnc.
TltvongcaCMaul3,1%.Tlny
thphnCnTh3,9%,vBcLiu5,0%(2008).
SosnhchothytltvonglaophiAFB(+)
micaCMauthphn mc t vong chung
cacncl3,3%(20042007)(4,6).
ChuynYTCngCng
T l b tr ca lao phi AFB(+) mi ti C
Maul0,2%.Tlnynm2008caKinGiang
1,4%; Bc Liu l 0,5%; Cn Th l 1,5%... t l
btrchungcacncdaong1,4%(2004)
1,8%(2007)(4,6).Nhvy,tlbtrtiCMau
thphntlchungcacncvmtstnh
bn
Mtsyutlinquannktquiu
tr khng thnh cng ca lao phi AFB(+)
mi
QuaktquphntchBng2,Bng3cho
thycmilinquangiamtsyutvikt
qu iu tr khng thnh cng ca lao phi
AFB(+)mi:
Vtui:cmilinquangiatuiv
ktquiutrthnhcngcalaophiAFB(+)
mi.Nhmtui<60tliutrkhngthnh
cng l 2,2%; nhm tui t 60 tr ln c t l
iutrkhngthnhcngl6,8%.iunyc
th l gii l bnh nhn ln tui p ng vi
thuc iu tr km hn, tc dng ph nhiu.
Hn na ngi ln tui thng tim n hoc
xuthinnhngbnhkthp,thuckhnglao
cthlmchoccbnhnybcphthocnng
thm,ckhiphiginoniutrhocbnh
nhn t vong (do suy kit hoc bnh kt hp).
Chnh nhng yu t ny lm cho t l iu tr
khngthnhcngnhmbnhnhn>60tui
caohn.
Vtcdngphcathuc:bnhnhnlao
phi AFB(+) mi, nhm c tc dng ph ca
thuc, t l iu tr khng thnh cng ln n
n22,9%sovinhmkhngctcdngph
cathuc,(p<0,05).Mcdktqunghincu
nychghinhntltcdngphcathucl
6,6%,thphnnghincucaccngnghip
Bnh nh l 13,8% (8), ca Nguyn Th Thy
v o Uyn l 34,92%(10), nhng r rng tc
dngphcathuckhnglaolmcntrqu
trnhiutrcabnhnhn.Tytheomc,
tc dng ph ca thuc c th lm bnh nhn
chnn,mtmi,suygimsckhngcac
th, nn s tun th iu tr ca bnh nhn
khng cao. Nhng nu tc dng ph nghim
ChuynYTCngCng
NghincuYhc
trng buc phi ngng thuc, thi gian ngng

thuctythucvotnhtrnglmsngvcn
lmsngcabnhnhn.Cthngngmtthi
gian ngn, i khi phi i thucChnh
nhngldonylmchohiuquiutrca
bnh nhn c tc dng ph ca thuc khng
cao.Dovy,cntheodisttcdngphca
thucxlkpthinhmhnchtiakt
quiutrkhngthnhcngcabnhnhn(9).
Vmckinhtgianhvktquiutr
lao:tktqunghincunhnthybnhnhn
lao phi chung c mc thu nhp xp vo loi
nghotliu tr khng thnh cng l 11,8%
caohnnhmbnhnhnkhngnghoctl
iutrkhngthnhcngl2,9%.Cnivi
bnhnhnlaophiAFB(+)mi:nhmbnhc
mcsngngho,tliutrkhngthnhcng
l 12,3%. Trong khi nhm c mc sng khng
ngho,tliutrkhngthnhcngl2,6%(
p<0,05).iutrtktqutt,ngoiyut
quytnhlthuccncccyutquantrng
khc l dinh dng v ngh ngi. Nhng
bnh nhn thuc nhm c mc sng thp
(ngho) trong cc ba n thng khng m
boydinhdng.Mtkhc,nhmbnh
nhnnythngkhngcnghngihpl,
philaongsnxutsmkhichabnhphc
honton.Chnh2ldonylmchoviciu
trtktqukhngcao.
Vtunthtrongiutr:nhmbnhnhn
lao phi AFB(+) mi tun th iu tr c t l
iu tr khng thnh cng l 3,1%, trong khi
nhm khng tun th iu tr c t l khng
thnh cng l 10,5% (p < 0,05). Trong iu tr,
yuttunthrtquantrng.Vickhngtun
th iu tr rt d a n bnh lao khng
thuc.Laokhngthuciutrrttnkmm
hiuqukhngcao(7).Tuynhin,donhiuldo,
sbnhnhnkhngtunthtrongiutrcn
caovtlthnhcngthp.Dovy,cncs
phihpgiagianh,nhnvinchnglaov
cng ng trong gim st vic dng thuc ca
bnhnhn.
241
NghincuYhc
KtquiutrlaophiAFB()mi
QuaktquphntchBng1,chothyt
l hon thnh iu tr chim 96,2%; t vong
chim2,9%vbtrchim0,9%.
Kt qu iu tr lao phi AFB() mi nm
2008tikhuvcngbngsngCuLongc
tlhonthnhiutr92,2%;tvong5,4%;b
tr1,2%.Mtstnh:BcLiu:honthnhiu
tr89,4%;tvong7,2%vbtr0%;KinGiang:
honthnhiutr89,4%;tvong4,3%vbtr
1,5%.
Nh vy, kt qu iu tr thnh cng lao
phiAFB()micaCMautthnkhuvcv
mtstnhbn.
cbitccyutnhmtuitcdngph
ca thuc, mc kinh t gia nh, tun th iu
trclinquannktquiutrkhngthnh
cngcalaophiAFB()mivhontonph
hp vi kt qu iu tr khng thnh cng ca
laophiAFB(+)mitiCMaunm2009.iu
ny ni ln rng kt qu iu tr lao phi mi
chung (AFB(+) v AFB()) c lin quan n cc
yutnh:nhmtui,tcdngphcathuc,
mckinhtgianh,tunthtrongiutr
KTLUN
Tktqunghincutrn,cthktlun
sau:
tgianhvtunthtrongiutrviktqu
iu tr khng thnh cng ca bnh nhn lao
phimi.
KINNGH
Quaktqunghincuti:nhgicc
yuttcngnktquiutrlaophimi
titnhCMaunm2009,chngticmts
kinnghsau:
Kt qu iu tr khng thnh cng c mi
lin quan n tui, tc dng ph ca thuc v
mckinhtgianhcabnhnhnvtunth
trong iu tr. V vy, trong qun l, D n
phngchnglaocatnhcnchncci
tng ny m bo iu tr t kt qu tt
nht nhm duy tr v tng t l iu tr thnh
cngcabnhnhn,gpphntngbckhng
chbnhlaotrongcngngtiaphng.
Mckinhtgianhnhhngnktqu
iu tr, bnh nhn thuc nhm ngho c t l
iutrkhngthnhcao.Dovyccngnhchc
nng v cng ng cn c nhng gii php c
thgipccitngnykhihmcbnh
lao
TILIUTHAMKHO
1.
2.
KtquiutrlaophimitiCMau
Kt qu iu tr chung: T l iu tr thnh
cngl96,5%.Tlliutrkhngthnhcng
l: 3,5% (t vong 3,0%; tht bi 0,1%; b tr
0,4%).
KtquiutrlaophiAFB(+)mi:Tliu
tr thnh cng l 96,6%. T l iu tr khng
thnhcngl:3,4%(thtbi0,1%,tvong3,1%;
btr0,2%).
KtquiutrlaophiAFB()mi:Tlhon
thnh iu tr l 96,2%. T l iu tr khng
thnhcngl:3,8%(tvong2,9%;btr0,9%).
Ccyutlinquannktquiutrlao
phi AFB(+) mi v AFB() mi: c mi lin
quangiatui,tcdngphcathuc,kinh
242
3.
4.
5.
6.
7.
8.
Belay T, Abebe M, Assegedech B, et al (2009), Treatment

outcome of tuberculosis patients at Gondar University
Teaching Hospital, Northwest Ethiopia. A five year
retrospectivestudy,BCMPulicHealth.2009;9:371.
Chng trnh chng lao quc gia (2008), Bo co tng kt
Chngtrnhchnglaoqucgianm2007vphnghng
hotngnm2008.
Chngtrnhchnglaoqucgia(2008),Hngdncngtc
truynthngHuyngxhitrongChngtrnhchnglao
qucgia,tr.1216.
Chngtrnhchnglaoqucgia(2009),Hinghtngktd
nphng,chnglaogiaion20072008.Tngkthotng
chotuyn2008vsinhhotkhoahc.HNi01/2009.
Chngtrnhchnglaoqucgia(2009),Hngdnqunl
bnhlao,NxbYhc,HNi.
Chng trnh chng lao quc gia (2010), Bo co tng kt
Chngtrnhchnglaonm2009vnhgigiak2007
2011.
DnphngchnglaoqucgiaBnhvinLaovBnhphi
trungng,Bnh vin Phm Ngc Thch (2008), Tnh hnh
bnhlaovcngtcchnglaotiVitNamgiaion2007
2011,Hithotngcngcngtcphngchnglaokhuvc
ngbngsngCuLong,tr.1011.
inh Vn Thng, Phc Thanh, Nguyn Anh Tun v cs
(2009), Nghin cu c im tnh hnh tc dng ph thuc
khng lao trn bnh nhn iu tr lao ti bnh vin Lao v
BnhphiBnhnh,KyuHinghkhoahcbnhphi
ChuynYTCngCng
9.
10.
ton quc ln th III, Hi lao bnh phi Vit Nam, tr. 525
532.
HongLongPht(2003),ThucchabnhLao,NxbYHcH
Ni,2003.
Nguyn Th Thy, o Uyn (2009), nh gi tc dng
khng mong mun ca thuc chng lao v cch x tr trn
bnhnhniutrlaotibnhvinLaovBnhphitrung
ng,KyuHinghkhoahcbnhphitonquclnth
III,HilaobnhphiVitNam,tr.544553.
ChuynYTCngCng
11.
12.
13.
NghincuYhc
Qing Song B, Yu Hua D, Ci Yong L (2007), Treatment

outcomeofnewpulmonarytuberculosisinGuangzhou,China
19932002:aregisterbasedcohortstudy,BCMPublicHealth,
2009;9:371.
TrngihcYHNi,BmnLao(2002),BnhhcLao,
NxbYhc,HNi,tr.6872.
WHO(2008),TuberculosiscontrolintheWesternPacific,p.XI
XV,124
243
NghincuYhc
TLBNHICNGHNGHIPVCCYUTLINQUAN
TICNGTYTRCHNHIMHUHNTUTHYS.G
TPHCMNM2011
HunhTnTin*,HunhBoTrn**
TMTT
tvn:TiTp.HCMtrongnhngnmgny,icnghnghiplbnhnghnghipcphthin
nhiunht,nghincutlbnhicnghnghipvccyutlinquanticngtyTNHHTuThyS.G
nm2011nhmnhgibnhicnghnghipvccmilinquancbinphpphngbnhmtcchch
nghiuqu.
Mc tiu:Xcnhtlbnhicnghnghipvccyutlinquancngnhnlmvictrongmi
trngctingncaoticngtyTNHHmtthnhvincngnghiptuthuS.G.
Phngphpnghincu:mtctngangctinhnhtrn324cngnhnlmvictrongmitrng
ctingncaoticngtyTNHHmtthnhvincngnghiptuthuS.G6thngunm2011.
Ktqu:C271cngnhntipxcvitingn>85dBA
Mcnhimtingnkhcaovi85,2%cngnhnlmvicti11bphntipxcvimitrng
tingn>85dBAtrongtngs19bphncacngty.Phthin20ngiNN,chimtl7,3%.Kinthc
chung ng thp, chim 49,6%. Trong s , kin thc NN khng th cha c ng l thp nht
(69,6%).100%cngnhncphtnttaichngnnhngtlsdngbohchngnngthp,chim
49,6%.
Nguynnhnchyucngnhnkhngthngxuynsdngnttaichngnl:cheokhiqun
(80,1%),bohchngngykhchu(43,3%),cntrcngvic(41,9%).
Khuynngh:Cnphitchctphun,tuyntruynvkimtracngnhntgicmangccphng
tinchngnphngNNhiuquhn.
Tkha:icnghnghip,mitrngtingntrn85dBA,nttaichngn,tphuntuyntruynv
kimtra,phngngaicnghnghip.
ABSTRACT
OCCUPATIONALDEAFNESSANDRELATEDFACTORSINS.G.SHIPYARDCOMPANYINTHE
FIRSTSIXMONTHS2011
HuynhTanTien,HuynhBaoTran
Background:OccupationaldeafnesshasthehighestproportionamongtheoccupationaldiseasesinHoChi
Minhcity.Theresearchonthepercentageofthediseaseanditsrelationshipwithemployeeswasperformedinthe
firstsixmonths2011inordertopreventtheoccupationaldeafnessintheshipyardcompanies.
Objectives:Findoutpercentageofthediseaseanditsrelatedfactorstopreventtheoccupationaldeafness
effectively.
Methods:Acrosssectionalstudywasconductedon324employeeswhoworkwithnoiseintheshipyard
*TrungtmbovsckhelaongvmitrngTPHCM,**BVakhoaqun8TPHCM
Tcgilinlc:TSHunhTnTinT:0903357523
Email:drhuynhtantien@yahoo.com
244
ChuynYTCngCng
NghincuYhc
company,inthefirstsixmonths2011.
Result:Thereare271of324employeesworkwithnoiseexceeds85dBA,in11/19workplaces.
There are 20 patients with the percentage 7.3%. The correct general knowledge is low (49.6%) while the
correctknowledgeofoccupationaldeafnesscantcureisthelowest(69.6%).100%employeesreceivehearing
protections,butonly49.6%usingcorrectly.80.1%employeeswearhearingprotectionsonlywhenthenoiseis
tooloud,43.3%hearingprotectionscauseannoyance,41.1%ofthemmakeworkingnoteasy.
Comment::Employeesmustbeeducated,communicatedandcheckedgraduallysothatallofthemcanuse
hearingprotectionseffectively.
Keywords:Occupationaldeafness,noiseexceeds85dBA,hearingprotections,beeducated,communicated
andchecked,preventtheoccupationaldeafness.
TVN
ITNGPHNGPHPNGHINCU
Hin c 28 bnh ngh nghip c Nh
nc cng nhn v c bo him. nhim
ting n l vn cn c quan tm v mi
trng n v bnh ic ngh nghip vn cn
nhiu.Khngchgyraskhchutcthiti
ni lm vic, ting n cn nh hng n mi
trng, hot ng sn xut v c bit l sc
kholudicangilaong.Hinnay,theo
HichngtingnThgiisngilaong
lmvictrongccngnhngh,cssnxutc
cngtingncaoangngycnggiatng
vitlln.TiTp.HCMtrongnhngnmgn
y,icnghnghiplbnhnghnghipc
phthinnhiunht.Nghincutlbnhic
nghnghipvccyutlinquanticngty
TNHH Tu Thy S.G nm 2011 nhm nghin
cubnhicnghnghipvccmilinquan
cbinphpphngbnhmtcchchng.
itngnghincu
Nghincuctngangmtctinhnh
tiCngtyTNHHmtthnhvincngnghip
tuthySG6thngunm2011.
Cng nhn trc tip sn xut, tip xc vi
tingn(trn85dBA)caCngtyTNHHmt
thnhvincngnghiptuthuS.G.
Nghincuctinhnhvikthutly
mutonbtrnnhngcngnhntrctipsn
xuttipxcvitingnbaogm331laong.
Phngphpnghincu
Tiuchunchnmu
Cng nhn cng ty TNHH mt thnh vin
cngnghiptuthuSGlmvictrnccphn
xng tip xc ting n ang hot ng bnh
thng.
Mctiunghincu
Lmvictrn6thng.
Mctiutngqut
Xcnhtlbnhicnghnghipvcc
yu t lin quan ti Cng ty TNHH mt thnh
vincngnghiptuthuS.G6thngunm
2011.
ngthamgianghincu.
Mctiuchuynbit
XcnhcngtingntiCngty
Xcnhtlcngnhnbicnghnghip
tiCngty
Xcnhmilinquangiatlicngh
nghipvccyutlinquan.
ChuynYTCngCng
C kh nng tr li tt c cc cu hi c
phngvn.
ng cho nhm nghin cu o thnh lc
sbvhonchnhnucyucu.
Tiuchunloitr
Cng nhn cng ty TNHH mt thnh vin
cngnghiptuthySG
Khngngthamgianghincu.
Lmvicdi6thng.
Vng mt vo thi im kho st s c
yucunTTBVSKLMTphngvnvkhm
245
NghincuYhc
thnhlc.Nusaukhimi2lnmcngnhn
khngnsbqua.
cimvkinthc:
Bng4:Kinthccngnhn:
Kin thc
KTQU
Lm vic trong mi trng

n lu ngy gy NN
ctnhyutmitrng:
Nghincutrn324cngnhnlmvicti
19 b phn ti Cng ty TNHH mt thnh vin
cngnghiptuthuSG6thngunm2011.
TlNNvccyutlinquantrn276cng
nhntipxcvitingntrn85dBA.
Bng1:Phnbntheocngnhntipxc(n=
324)
n (dBA)
85
> 85
Tng
Tn s
48
276
324
T l (%)
14,8
85,2
100
Kin thc chung
Bng2:Phnbnticcbphn(n=19)
85
> 85
Tng
Tn s
8
11
19
NN c th phng c
Thit b bo h phng c
NN
Nhn xt: Mu ban u c 324 cng nhn.

Trong 85,2% cng nhn lm vic trong mi
trng > 85 dBA. 14,8% cng nhn lm vic
trongmitrng85dBA
B phn
Bnh NN khng th cha

c
T l (%)
42,1
57,9
100
ng
Sai
Tn s T l (%)
252
91,3
24
8,7
ng
192
69,6
Sai
84
30,4
ng
253
91,7
Sai
23
8,3
ng
219
79,3
Sai
57
20,7
ng
137
49,6
Sai
139
50,1
Nhn xt: T l cng nhn c kin thc

chungngl49,6%,thphnkinthcchung
sai.
c im v thc hnh s dng bo h

chngn
100%cngnhnccpbohchngn.
100%ccpnttai,0,4%ccpcnttai
vchptai.
Nhn xt: Trong s 19 im o ti cc b

phn, 57,9% vt tiu chun cho php, ch c
42,1%ttiuchun.
Ktqubnhnghnghip
Bng3:Tnhhnhicnghnghip
ic ngh nghip Tn s
Tng
20
T l (%)
7,3
Tng
276
Biu2:Thiquensdngthitbchngntrong
cngnhn
Nhn xt: T l cng nhn s dng thit b
bo h thng xuyn v khng thng xuyn
xpxnhau.
Biu1:KtqukhmbnhNN
Nhn xt:SlngcngnhnNNchim
7,3%tngscngnhnckhm.
246
Nhmkhngbaogisdngcslngt
nht.
Bng5:Milinquangiatuii&NN
Tui
ic ngh nghip
Tn s T l (%)
Tng
ChuynYTCngCng
20 - 30
31 40
41 50
51 60
Tng
5
5
6
4
20
2,8
10,0
19,4
28,6
7,2
181
50
31
14
276
Tng
22,2
p < 0,05
Nhnxt: Skhcbitcnghathngk
(p<0,05)trongmilinquangiatuiivt
licnghnghip.Skhcbitctnhkhuynh
hng, nhng ngi tui t 2030 tui c
nguy c b NN khi tip xc ting n l 2,8%,
tui3140l10,0%,tui4150l19,4%,
tui5160l28,6%.
Bng6:MilinquangiatuinghvtlNN
Tui
ngh
15
6 10
11 15
16 20
21
Tng
ic ngh nghip
Tn s
T l
5
3,2
4
5,7
2
12,5
3
15,0
6
50
20
7,2
Tng
158
70
16
20
12
276
39,2
p < 0,05
(p<0,05)trongmilinhgiatuinghvt
l NN. S khc bit c tnh khuynh hng,
cng nhn c tui ngh 15 nm c nguy c b
NNl3,2%,610nm5,7%,1115nm12,5%,
1620nm15%,21nm50%.
Bng7:Milinquangiathigiantipxcvtl
NN:
Tui
8
<8
Tng
ic ngh nghip
Tn s T l(%)
18
11,0
2
1,8
20
7,2
Tng
163
113
276
8,5
p < 0,05
(p< 0,05) trong mi lin quan gia t l ic v
thigiantipxctingn.Nhmtipxc8gi
c nguy c b NN l 11,0%, cao hn nhm <
8gi,cnguycl1,8%.
Bng8:MilinquangiahcvnvtlNN:
Trnh hc
NN
vn
Cp 1
1
Cp 2
5
Cp 3
12
T cp 3 tr
2
ln
Khng
NN
4
46
185
21
Tng
5
51
197
2,2
p > 0,05
23
ChuynYTCngCng
20
NghincuYhc
256
276
Nhn xt: S khc bit khng c ngha

thngktrongmilinquangiatlNNv
trnhhcvn(p>0,05).
BNLUN
ntrongmitrnglmvic:
Kt qu c 11/19 im (58%) c cng
ting n vt TCCP (>85dBA). S cng nhn
lmvicticcbphnctingnvtchun
kh cao. Nghin cu ca Hunh Chung ti cc
cngtyinmcnhimtingnl50%, s
cngnhntipxcl56%.Theonghincuca
Nguyn Th Thoi v cng s ti nh my xi
mng Hn Chng, t l ny l 37,1%(4). Nghin
cucangXunHngghinhnc64%.
Qua kho st thc t ti c s nhn thy
rng mc d mc nhim ting n v t l
cngnhntipxctingncaonhngcngvic
lmticsmangtnhthiv,khnglintc
trong nm v cc b phn lm vic theo cng
onnntipxctingnkhnglintc.
ctnhmunghincu:N=276
Nghincutrn276cngnhn(85,2%)trc
tiplmvicvitingnvttiuchun.
Tuiitrungbnhcacngnhnl31tui,
kh tr. Tui ngh trung bnh kh thp l 7,2
nm,trongnhm15nmchimas57,3%.
100% cng nhn tham gia nghin cu l nam.
Dntckinhchimasvitl97,5%.Trnh
hcvnchimuthltrnhcp3,chim
71,4%.ngthhailcp2(8,3%),trncp3
chim8,3%.Tlcngnhntipxctingn8
gimtngyl60%.
TlNN
TlNNl7,3%.Tlnyckhcvimt
stcgikhc,LTrung(3)nghincuti11nh
my vi t l NN l 10,9%, Nguyn Th Ton
nghincutrn1498cngnhnvitlNNl
10%(5).Vktqunythphnnghincuca
Hunh Chung (16,5%), v Nguyn ng Quc
Chn(17%).iunyclgiiltlNN
ngoivicdotipxctingnmncnthay
247
NghincuYhc
iphthucvomtsctnhcamunh
tui i, tui ngh, mc tip xc ting n,
mc s dng thit b bo v chng n v
ngnhngh.
TlNNvccyutlinquan:Tuii
cmilinquanvitlNN,skhcbitc
ngha thng k (p < 0,05) v c tnh khuynh
hng. Tui ngh c mi lin quan vi t l
NN,skhcbitcnghathngk(p<0,05)
v c tnh khuynh hng, tch ly theo thi
gian,cngtipxctingnlungynguycb
NNcngtng.Ccnghincutrcyu
ghi nhn mi lin quan gia gii tnh v t l
NN. Tuy nhin nghin cu ca chng ti c
100% cng nhn l nam. S khc bit v thi
giantipxctingntrongngyvtlNN
cnghathngk(p<0,05),nhngngilm
vic tip xc ting n 8 gi trong ngy d b
NN.Khngcskhcbitvtrnhhcvn
vtlNN,nhngngictrnhhcvn
cao hay thp u b NN nh nhau. S khc
bit khng c ngha thng k gia kin thc
chungvbnhNNvtlNN(p>0,05).
T l kin thc, thi , thc hnh trong

cngnhn
Tlkinthcchungngthp(49,6%),tl
kinthcngvbnhNNkhngthcha
c thp (69,6%). Do cn nng cao kin
thcchoNLtrongtphuncnchtrng
v kin thc NN khng th cha c d
ngngtipxctingn.
Cng nhn 100% u c cp bo h
chng n nhng ch 49,6% cng nhn s dng
thng xuyn. iu ny chng t c kh
khntrongvicsdngthitbbovtai.
KTLUN
mitrngtingn>85dBAtrongtngs19
bphncacngty.
Phthin20ngiNN,chimtl7,3%.
TlNNvccyutlinquan:
Cmilinhgiatuii,tuingh,thi
giantipxcvtlNN.
NN tp trung nhm tui t 41 50,
chim30%cngnhnvctnhkhuynhhng.
NN tp trung nhm tui ngh 21
nm,chim30%vcngctnhkhuynhhng.
NNchima s khi cng nhn tip xc
tingn8gi/ngy,chim90%.
Khngcmilinhgiatrnhhcvn
vtlNN.
100% cng nhn c pht nt tai chng
n nhng t l s dng bo h chng n ng
thp,chim49,6%.
XUT
ivingnhyt:
Trinkhaittccquinhhinhnhvmi
trng lao ng, v sinh an ton lao ng v
chmscsckhengilaong.
Phihplinngnhtrongvicqunl,kim
trathngxuyncccngty,csnghingv
mcnhimtingnvchphnhccquy
nhNhncvantonlaong.
T chc tp hun nh k cho cc c s v
kinthc,quynhantonlaong,cchthc
v tm quan trng ca vic phng nga bnh
NN.
ivicccssdnglaong:
Tunthccquynhvantonlaong,
tchckhmsckhonhk
Nghin cu c tin hnh trn 324 cng

nhn trong c 271 cng nhn tip xc vi
tingn>85dBA.
Tchctphunantonlaongnhk,
nng cao kin thc v bnh NN, tm quan
trng v cch s dng bo h chng n ng
cchchocngnhn.
Quanghincu,chngtirtramts
ktlunnhsau:
Thng xuyn kim tra, nhc nh cng

nhnsdngbohchngn.
Mc nhim ting n kh cao: 85,2%

cngnhnlmvicti11bphntipxcvi
Lngnghekinnggpcacngnhn,
quantmcithiniukinsnxut.
248
ChuynYTCngCng
ivingilaong:
2.
Hiuctmquantrngcavictunth
quynhantonlaong,vaitrphngnga
NN,vtgicbovsckhochobnthn.
3.
4.
Hiu vai tr ca bo h chng n v thc

hnhsdngbohchngnngcch mi
khitipxctingnkhilmvic.
Quantmniukinlaongvmnh
dnxutnhngcithinhudng.
TILIUTHAMKHO
1.
5.
NghincuYhc
Industrial Injuries Advisory Council (2002). Occupational

deafness. Department for work and pensions social security
Administration.[cited25].
LTrung(1997).21bnhnghnghipcbohim:HNi:
BYT,VinYHcLaongvVSinhmitrng.
NguynThThoi,TrnhHngLnvCngs(2006).Thc
trngvmtsyutlinquannbnhicnghnghip
ca cng nhn nh my xi mng Hn Chng huyn Kin
Lng tnh Kin Giang. Tp ch Y hc Thnh ph H Ch
Minh.10:17378.
NguynThTon(2003).Tnhhnhscnghecacngnhnti
mtscsvtliuxydng.HiNghkhoahcquctY
hclaongvVsinhmitrngln1nhxutbnYhc.
p.194.
HunhTnTin(2007).Bnhicnghnghip.Tiliunng
cao sc khe ni lm vic. Trung tm sc khe lao ng v
mitrng:SytthnhphHChMinh;2007.p.3738.
ChuynYTCngCng
249
NghincuYhc
KINTHCTHITHCHNHVPHNGNGAUINC
CANGICHMSCTRDI5TUI
TIHUYNPHCTNHHNGYN,NM2011
DonNgcnh*,TrnThThuThy*
TMTT
tvn:uincvnanglmtvnytcngcngnghimtrng,lmttrongnhngnguyn
nhnchnhgytvong,thngttchotrem.onolmtxvngngbngchimtrng,ahnhca
xcnhiuaoh,nguycuinclunthngtrcvitrnh,cbitlvitrdi5tui.
Mctiu:Mtkinthc,thivthchnhcangichmsctrchnhvphngchnguinc
chotremdi5tuivxcnhmtsyutlinquannkinthc,thchnhvphngchnguinc.
Phngphpnghincu:Nghincuctinhnhtheophngphpmtctngang.Thngtinthu
thpbngphngvnbnghinhlngvi216ngichmscchnhcatrdi5tuikthpvibng
kimquansthgianhtixono,huynPhC,tnhHngYnt11/2011n5/2012,sliuc
nhpviphnmmEpidata3.1vcphntchviphnmmSPSS16.0.
Ktqu:Tlitngnghincuckinthctvphngchnguinccnthp,cht13,9%,t
lcthchnhtvphngchnguincl24,5%trongcthchnhrochnbaoknhmngl
27,7%,lpcangnantonl25,7%.
Kt lun:Tlngichmscchnhcatrckinthc,thchnhtvphngchnguinccn
thp.Ktqunghincugicnphithitlpmtchngtrnhtruynthngvccbinphpphngchng
uincchotrdi5tui.
Tkha:uinc,tremdi5tui,phngchnguinc
ABSTRACT
KNOWLEDG,ATTITUDEANDPRACTICEOFPRIMARYCAREGIVEROFCHILDRENUNDER5
YEARSOLDONDROWNINGPREVENTIONINDOANDAOCOMMUNE,PHUCUDISTRICT,
HUNGYENPROVINCE
DoanNgocDinh,TranThiThuThuy
Background: Drowning is a major global public health problem and a leading cause of death and injury
amongchildren.DoanDaoislocatedinalowlyingdeltaarea.Theterrainofcommunehasmanywaterbodies
whichareanimportantrisk,theriskofdrowningforyoungchildrenalwaysstanding,especiallywithchildren
under5yearsold.
Objectives:Describetheknowledge,attitudeandpracticeofprimarycaregiversofchildrenunder5years
oldandidentifysomeelementsrelatedfactors
Methods:Acrosssectionalstudydesignwascarriedout.Thequantitativeinformationwascollectedfrom
216primarycaregiversbyusingquestionairesandchecklistsforhouseholdobservationinDoanDaocommune,
*TrngihcYtcngcngHNi
Tcgilinlc:CN.DonNgcnhT:01696923897 Email:doandinhytc@gmail.com
PhuCudistrict,HungYenprovincefrom11/2011to5/2012.
250
ChuynYTCngCng
NghincuYhc
Result: The subjects with good knowledge practice of drowning prevention was low, only 13,9% had
adequateknowledgeondrowningprevention,therateofgoodpracticeondrowningpreventionwas24,5%.
Conclusion: The rate of caregivers with good knowledgepractice on drowning prevention was low. The
findingssuggesttheneedofacommunicationprogramonmeasuresofdrowningpreventionforchildrenunder5
yearsoldinthecommune
Keywords:Drowning,childrenunder5yearsold,preventionofdrowning.
tr la tui ny, do s hiu bit v thi
TVN
cangitrngtrvphngchnguinc
uinctremlvnytcngcng
chotrngvaitrquantrngtrongbovs
ngquantmtrntonthgii.Theoboco
antonchotr.
v thc trng ui nc ca T chc Y t Th
Mctiunghincu
gii (WHO) nm 2008 th ui nc l mt
M t kin thc, thi , thc hnh ca
trong13nguynnhngytvongchotrdi
(9)
ngichmsctrchnhvphngchngui
19 tui , hng nm ton th gii c khong 2
ncchotremdi5tuivxcnhmts
triu tr t vong do ui nc. S liu t cc
yu t lin quan n kin thc, thc hnh v
nghincucthchintingNamcho
phngchnguinc.
thy ui nc chim 90% tng s t vong do
thngtchtremt14tui.(9)
Ti Vit Nam, vn ui nc tr em
cha bao gi li nhn c s quan tm ca
cngngnhhinnay.TheothngkcaB
Yttrongnm2007cncc3786trng
hptrtvongdouinc(2).Mcdych
lnhngsliuthuthpchathcsy
nhng n cng th hin mt thc t ng lo
ngivvnuinctrem.Cngging
nhnhiuqucgiakhc,tnscctrnghp
tvongdouincphnbcaonhtnhm
trdi5tuichimti48%cctrnghpt
vongdouinccatrdi19tui.(1)
onolmtxcahuynPhC,tnh
Hng Yn vi dn s l 10.042 ngi trong
tng s tr di 5 tui nm 2010 ca x l 672
chu. Ngh nghip chnh ca ngi dn trong
xllmrungvchn nui. Vng c mt
ao,hkhcao vi din tch chim ti gn 20%
dintchttnhincax.Theothngkca
trmytxtrong3nmtrliytonxc5
trng hp tr di 19 tui t vong do ui
nctrongc3trnghptrdi5tuit
vongdotainnuinccghinhn.
Nhm tr di 5 tui l nhm d b tn
thng bi tai nn thng tch ni chung v
uincniringdocimtmsinhlca
ChuynYTCngCng
ITNGPHNGPHPNGHINCU
Nghin cu c thc hin bng phng
phpctngangvctinhnhti6thnca
xono,PhC,HngYn
C mu nghin cu c tnh theo cng
thcchnmucanghincuctngang,tng
s c 216 ngi chm sc tr di 5 tui c
chnvonghincu
Tiu chun la chn i tng tham gia
nghinculngichmscchnhcatr,c
thigiantrngnom,chmsctrnhiunht,
sc khe tr li phng vn v t nguyn tham
gianghincu
iu tra vin s dng bng hi phng
vn ngi chm sc tr v bng kim quan
stthchnhphngchnguinctihgia
nh
c im ca i tng tham gia nghin

cu
Bng1:Ccctnhcangichmsctr
c tnh
Gii tnh
Nam
N
Trnh hc vn
M ch
Bit c, vit
Tn s
T l (%)
72
144
33,3
66,7
1
4
0,5
1,9
251
NghincuYhc
Tiu hc
THCS
THPT
TC/C/H
Tui
<30
30-39
40-49
50-59
>60
Ngh nghip
Nng dn
Cng nhn
Cn b/cng chc
Kinh doanh/bun bn
Ngh t do/tht nghip
Khc
S h ngho
C
Khng
8
99
73
31
3,7
45,8
33,8
14,4
Nhnbitvaimxyrauincca
ngi chm tr ph hp vi c im ca a
bnnghincukhign20%dintchtnhin
caxlao,h,sng,knh
55
73
22
45
21
25,5
33,8
10,2
20,8
9,7
Bng3:Kinthcvnguynnhnxyrauinc
141
31
15
9
12
8
65,3
14,4
6,9
4,2
5,6
3,7
29
187
13,4
86,6
Nghincu c tin hnh trn 216 h gia

nh c tr em di 5 tui trong mu nghin
cu. T l n trong nghin cu cao hn nam
(66,7% so vi 33,3%); trnh hc vn ca i
tng nghin cu vi 94,0% cc i tng
nghincuctrnhtTHCStrln;tui
ca i tng nghin cu ch yu tp trung
tui3039;nghnghipchyulnngdn
chim65,3%;shcshnghotrongnghin
cul13,4%
Kin thc ca i tng nghin cu v

phngchnguinc
Bng2:Kinthcvaimxyrauinc
a im
Ao h
Sng, mng
B nc
Bn tm
Dng c cha nc
Tn s
208
134
118
116
105
T l
96,3
62,0
54,6
53,7
48,6
H vi
B bi
Khc
95
88
2
44,0
40,7
0,5
aimxyrauinccngichm
sc chnh ca tr u bit nhiu nht l ao, h
vi (96,3%) tip n l sng, mng mng
(62,0%)
252
Nguyn nhn
NCST thiu cn thn/thiu ch
Tn s
144
T l
66,7
a nghch x y nhau
118
54,6
Tr khng bit bi
Tr khng ch
Khng c ro chn
116
107
87
53,7
49,5
40,3
Tr khng c ngi chm sc
78
36,1
Cc dng c cha nc khng an ton.

Khng c bin bo xung quanh cc ao,
h.
Khng c thit b bo h trn cc
phng tin giao thng ng thy
Khng bit/khng kin
67
50
31,0
23,1
47
21,8
0,5
Phn ln TNC cho rng ngi ln khng

ch l mt nguyn nhn ch yu gy ui
nc cho tr (66,7%), cc nguyn nhn khc
c NCST cp nh: do tr khng bit bi
(53,7%), do tr a nghch x y nhau xung
nc (54,6%), do tr khng ch trt ng
xungnc(49,5%).Tuynhin,tlitng
nghincunhnnhrngdokhngcrochn
ao h,cc dng c cha nc khng an ton,
chimtlcnthpvilnltl:40,3%,31,0%,
tlngidnchorngkhngcthitbboh
trnccphngtingiaothngngthychl
21,8%.
Bng4:Kinthcvccbinphpphngchng
uinc
Bin php phng chng
Dy bi cho tr trn 4 tui.
y np dng c cha nc
Lp hng ro xung quanh ao, h
t bin bo
Lp ao/h v cc h vi xung
quanh nh.
Khng bit/khng kin
Tn s
119
126
150
77
51
T l
55,1
58,3
69,4
35,6
23,6
11
5,1
T l i tng nghin cu c kin thc

ng v nhng bin php phng chng ui
nccnthp:69,4%bitcvbinphplp
hngroxungquanhaoh;58,3%bitcv
bin php y np cc dng c cha nc;
55,1% bit c v bin php dy bi cho tr;
ChuynYTCngCng
35,6%bitcvbinphptbincnhbo;
23,6% bit c v cc bin php lp ao h v
cchvixungquanh.
Bng5:Thicaitngnghincuvphng
chnguinc
Nghe n vn ui nc
tng nghe n
Cha nghe n bao gi
Khng nh
Tn s
164
45
7
T l
75,9
20,8
3,2
TlNCSTnghenvnuincti
aphngl75,9%,iunylhpldovn
uinccatrnhthtslmtvny
t cng cng ng quan tm ca vng, theo
thngkcatrmytxtrong3nm20082011
c5trnghptrtvongdouinc,trung
bnh hng nm x c t 12 trng hp tr t
vongdouinc,khngkcctrnghptr
sutuincvuincccusng.
Tuy nhin, nhng thng tin m NCST thu
nhn c li xut pht t ch yu nhng
trng hp tr cht ui xut hin ti a
phng,thmchcncmtsthngtinthiu
tnh khoa hc, thiu c s do c th nh
hng tiu cc n kin thc ca NCST v
phngchnguinc.
Bng6:Nhnnhcaitngnghincuvvn
uinctiaphng
Vn ui nc ti a phng Tn s
Rt nghim trng
132
Nghim trng
67
t nghim trng
12
Khng nghim trng
4
T l
61.1
31.0
5.6
1.9
TlTNCchornguincrtnghim
trng (61,1%), nghim trng (31,0%), t nghim
trng(5,6%),khngnghimtrng(1,9%).Nhn
nhtrncaNCSTphhpvitnhhnhui
nctiabnnghincuvccyutnguy
cuinclunthngtrctrongmitrng
sngcatr.
Tthctchothy,vnuinctia
phng tht s l mt vn y t cng cng
ngquantmtiaphngviconstrt
vongdouinctrungbnhhngnmt12
trvmtao,h,snglunmccao.
ChuynYTCngCng
NghincuYhc
Thi ca NCST v vn ui nc ti
a phng c tc ng n thc hnh ca
NCST,hschtrnghnvonhnghnhvi
bo v con, chu ca h khi nguy c ng
xungnc
Bng7:SsnsngthamgiacaNCSTvicc
chngtrnhphngchnguinctiaphng
S sn sng tham gia chng trnh ca
TNC
Rt sn sng
Tham gia nu c thi gian
Khng tham gia
T l
62,5
24,5
13,0
Mc d t l NCST bit n chng trnh

truyn thng phng trnh tai nn thng
tch/ui nc l thp (38,4%). Tuy nhin khi
c hi nu c chng trnh phng chng ui
nc, anh/ch c tham gia khng? th 62,5% cc
TNCusnsngthamgiav24,5%stham
gianucthigian,tltchithamgiac
xcnhl13,0%.
Bng8:Thchnhcaitngnghincuv
phngchnguinc
Thc hnh trng tr
Khng phi lm vic khc
tr t chi mt mnh
tr trong tm quan st
Khc
T l
8,8
20,4
73,1
1,8
a s cc TNC chn hnh ng tr

trongtmquansttrong khi phi kt hp vic
trngtrvivickhc(73,1),tuynhinc20,4%
TNCchnhnhngtrtchimtmnh
khiphicvickhc.
Bng9:Thchnhccbinphpphngchngui
nc
Bin php phng chng
Trong nh
y np cc dng c cha nc.
Khng tr t tm mt mnh
B nc/ging khi lm np y an ton.
Lp hng ro xung quanh ao/h
Khng bit/khng kin
Ngoi nh
Dy bi cho tr (tr >4 tui)
Ro chn ao, h, h vi/ h do ngi o
t bin cnh bo
Lp ao h, h vi
Khc
T l
69,4
67,1
66,7
49,5
56,0
57,9
32,9
21,3
0
253
NghincuYhc
V thc hnh cc bin php phng trnh

uinccaTNC,69,4%ccTNCthng
xuyn p np cc dng c cha nc ; 67,1%
ccTNCkhngtrttmmtmnh;66,7%
TNClmnpyantonbnc,gingkhi;
57,9%tinhnhrochnao,h,hvidongi
o; 56,0% dy bi cho tr; 49,5% lp hng ro
xung quanh ao, h; 32,9% t bin cnh bo
nhng ni nc su, nguy him; 21,3% lp ao
h,hvi.
36.10%
63.90%
C dy bi cho tr
Khng dy bi cho tr
Biu1:ThchnhdybichotrcaTNC
Dy bi cho tr l mt trong nhng bin
php d phng ui nc c khuyn ngh
trong nhng can thip v phng chng ui
nc. Trong nghin cu ny, 63,9% TNC
tngdybichoconmnhkhitr>4tui.Tuy
nhin, t l h gia nh khng dy bi cho tr
vncnkhcaochim36,1%.
Bng 10:Thchnhccbinphpgimthiunguy
cuinctmitrng
Thc hnh
Ro chn b ao, knh mng
Lp ca ngn an ton
Lp lan can
Ro lp h vi
Xy cao/y np ging
y np cc dng c cha nc
T l
27,7%
25,7%
46,3%
26,4%
32,4%
76,2%
Kt qu qua tin hnh quan st bng kim,

thchnhynpccdngcchancc
thc hnh ph bin nht ti cc h gia nh c
tr di 5 tui (76,2%); thc hnh c thc
hintnhtllpcangnanton(25,7%).
254
Ccyutlinquan
Nghincuxcnhcmilinquangia
nghnghipcaTNCvikinthcvphng
chng ui nc OR= 1,9 vi 95%CI (1,22,9);
mi lin quan gia kin thc vi thc hnh v
phng chng ui nc ca NCST OR= 13,75
vi 95%CI ( 5,633,6); mi lin quan gia kin
thcvccbinphpphngchnguinc
tr nh vi thc hnh cc bin php ca
ngichmsctr;kinthcvdybivthc
hnh dy bi cho tr OR= 16,8 vi 95%CI (8,5
33,1);milinquangiakinthcvlphng
ro v thc hnh lp hng ro OR=12,0 vi
95%CI (5,924,4); mi lin quan gia y np
dngcchancvthchnhynpdng
cchancOR=4,09vi95%CI(2,27,5);kin
thc v lp ao/h hoc cc h vi xung quanh
vi thc hnh lp h vi, ao h OR= 12,0 vi
95%CI(5,924,4)
BNLUN
Nghin cu c tin hnh trn 216 ngi
chmscchnhtrdi5tuitihgianh
x on o, huyn Ph C, tnh Hng Yn.
iutravintinhnhphngvnngichm
scchnhtihgianhctrdi5tui.y
l nhng ngi c thi gian trng nom, chm
sc bn tr nhiu nht chnh v vy h c nh
hng nhiu nht khng ch ti tr m cn ti
ccthnhvinkhctronggianh.ycngl
im khc bit so vi mt s nghin cu v
phng chng tai nn thng tch cho tr: ch
yutptrungvoitngmcatr (8,5)nh
thsbstmtnhmkhlnNCSTlng,b
hocbcatr.
Kinthcchungvphngchnguinc
ca TNC cn thp, trong tng s 216 TNC
chc30itng(13,9%)ckinthctv
phngtrnhtainnuincchotr.Ktqu
nghincunythphnsovinghincuca
onHngMinhchc4%kinthctt,10,5%
ckinthckh,85,5%ckinthctrungbnh
vkm(5).iunycthlgiidonghincu
cachngtitptrungvomttainnthng
tch c th l ui nc v th c th khai thc
ChuynYTCngCng
suhnkinthccaTNCvvnnydo
tlTNCckinthctkhngcao.
Trong thc hnh phng chng ui nc,
thc hnh cc bin php ro chn b ao knh
mng ch chim 27,7% s h gia nh trong
nghin cu thc hnh bin php ny. Kt qu
canghincunycaohnsovinghincu
ca ng Vn Chnh(4) vi t l l 24,0%; iu
ny cng tng ng vi kt qu nghin cu
ca Nguyn Ngc Duy vi t l l 27%(6), tuy
nhin t l ny li thp t l ny trong nghin
cucaDngKhnhVnvitll38,2%.
T l thc hnh ro chn b ao, knh,
mngtrongnghincucnthp,cha
cthxydngmtmitrngantonvui
ncchotr.Trongkhithcttlcchgia
nhgnao/knh/hncsutrongnghincu
nychimti83,8%thtlcthchnhphng
nganguyccht1/3tngshgianhc
yutnguycvgnao/knh/hncsu
Thc hnh ro chn b ao/knh/mng
c nh gi l mt bin php phng nga
uinchuhiu.Trongmtnghincuca
Phan Thanh Ha v Kho st thc trng ui
nctingbngsngCuLongchrarng
nibuincaslkhngcrochn97%
vcrochnmtphnchim3%(7).
KHUYNNGH
Tng cng truyn thng, ph bin cc
thng tin v phng chng tai nn thng
tch/uincchoitngngichmsctr
di 5 tui ti a phng. Lng ghp nhng
ni dung phng chng ui nc vi cc ni
dung nm trong chng trnh ca cc hi ph
n,onthanhnin.
Thit lp mt b phn thuc trm y t x
phtrchccvnvtainnthngtch/ui
nc.
Hng nm cn c mt chin dch v gim
thiunhngyutnguycgyuincxung
quanhmitrngsngcatr.
Tngcngccchngtrnhtphun,nng
caoknngscpcubanuchongidn
trong x, c bit l vi i tng ngi chm
scchnhcatr.
TILIUTHAMKHO
1.
2.
3.
4.
KTLUN
5.
Tlngidnckinthcngvphng
chng ui nc cho tr cn thp, t l t v
kinthcchchim13,9%.Kinthccangi
dnvuincchatondin.
6.
Thchnhloib/gimthiunguycui
nc t mi trng ca NCST cn thp, cha
tomitrngantonuincchotr.
Thchnhynpccdngcchancc
NCST thc hin nhiu nht vi 76,2%, thc
hnhtcthchinnhtllpcangnan
ton ti cu ao/ni gn ngun nc vi ch
25,7%.
NghincuYhc
7.
8.
9.
BLaongThngBinhXHi&Unicef(2010),Boco
tng hp v phng chng tai nn thng tch tr em Vit
Nam
B Y t (2008), Bo co v tnh hnh tai nn thng tch ca
tonqucnm2007
Brenner RA (2003), Prevention of drowning in Infants,
children,andadolescent,Prediatrics,112(2),pp.440445
ng Vn Chnh v cs, (2008), Kin thc, thi v thc
hnh ca ngi dn v cht ui tr em vng ng bng
sngMekong,TpchYhcTP.HChMinh,12(4),tr.108
onHngMinh(2004),Mtkinthc,thchnhcacc
bmvdphngchnthngtremdi5tuitihuyn
ThanhMin,tnhHiDngnm2004,lunvnthcsyt
cngcng,trngihcYtCngcngHNi
Nguyn Ngc Duy v cs (2011), Kin thc, thc hnh ca
NCSTdi11tuivphngchnguinctihuynAn
Ph,tnhAnGiang,2011,lunvnthcsYtcngcng,i
hcY.DcTP.HChMinh.
PhanThanh Ha v cs (2011), Thc trng v mt s yu t
lin quan n ui nc tr em di 18 tui ti vng ng
bngsngCuLong,nm2010,lunvnthcsytCng
cngHNi,ihcYtCngcngHNi.
TrnTunAnh,(2007),FactorsrelatedtoPreventiveBehavior
on home injury among mothers with children under 5 years
oldatcommunesofHungyenprovince,Vietnam,Journalof
PublicHealthandDevelopment,5No.2
WHO,(2008),Bocothgiivphngchngthngtch
trem,
www.who.int/violence.../Cover_and_front_matter_vietnamese
.pdf
ChuynYTCngCng
255
NghincuYhc
XYDNGQUIRNHPHTHINNOROVIRUS
BNGKTHUTREALTIMEPCR
NguynPhc*,NguynAnHuy*,PhmHngVn*
TMTT
t vn : Norovirus l mt trong nhng tc nhn gy tiu chy ngi. Hin nay vic pht hin
Norovirusbngkthutsinhhcphntcngdngnhiuphngkimnghimtrnthgii.Kthut
RealTimePCRphthinNorovirusvnchactrinkhaiticcphngkimnghimvisinhvtthcphm
tiVitNam.pngnhucunychngtinghincuxydngquytrnhRealTimePCRphthin
NorovirustpGIvGIIlhaitpgybnhtiuchychnhngivimcchgimstvxcnhccmi
nguyvnhimNorovirustrongccvngcthcphm.
Mctiunghincu:XydngquitrnhRealTimePCRphthinNorovirus.
Phngphpnghincu:Lachncccpmithchhp,tochngdng,chittchRNA,tocDNA
viccthnhphnvquitrnhcaphnngRealTimePCRthchhpphthinNorovirusnhmGIvGII.
Ktqunghincu:lachnccccpmivtochngdngthchhpviccthnhphnca
phnngRealTimePCRphthinNorovirustrongccnhuynthhaimnhv.Ktqungdngqui
trnhRealTimePCRbanuchothyc12/40munhuynthhaimnhvphthinNorvirusnhmGIv
GII.
Kt lun:thitlpcquitrnhRealTimePCR phthinNorovirustrongccnhuynthhai
mnhv.
Keyword:RealTimePCR,Norovirus
ABSTRACT
SETUPTHEPROCEDUREFORDETECTIONNOROVIRUSBYREALTIMEPCRTECHNIQE
NguyenDoPhuc,NguyenAnHuy,PhamHungVan
Background: Norovirus is the one of common agents causing gastroenteritis in humans. Recently, the
diagnosticmethodsbaseonthemoleculartechniqueapplyinginmanylabsin the world. The RealTime PCR
usedfordetectionNorovirusisnotstillappliedinlabsatVitNam.Thatsthereasons,Westudytosetupthe
procedureofRealTimePCRfordetectionNorovirusgenogroupGIandGIIthattwogroupsrelevanttohuman
diseasewithpurposeofmonitoringanddeterminethecauseoffoodpoisoningoutbreaks.
Objectives:SetuptheprocedurefordetectionNovorirusbyRealTimePCRtechnique.
Method: Selectionofspecificprimer,productonpositivecontrolandextractionRNAandmakecDNAfor
runningRealTimePCRfordetectionNorovirusgroupGIandGIIinmolluseoftwoshell.
Results: Procedure of detection Norovirus have already set up and applied for detection Norovirus in
molluseoftwoshell.Theresultsshowthat12/40samplesofmolluseoftwoshellcontaiminatedNorvirusGIand
GII.
Conclusion:TobesucessfulforsetupprocedureofdetectionNorovirusGIandGIIbyRealTimePCRin
molluseoftwoshell.
*VinVsinhYtcngcngTPHCM
Tcgilinlc:TSNguynPhcT:0907669008
256
Email:nguyendophuc@ihph.org.vn
ChuynYTCngCng
NghincuYhc
Keyword:RealTimePCR,Norovirus
TVN
Noroviruses (NoVs) c pht hin ln u
tin bi Kapikian v cng s vo nm 1972(3).
NoV c coi l nguyn nhn chnh gy vim
ddyrutcptnhtremvngiln.Bnh
do NoV thng xy ra v tm thy cc ni
khcnhau:nhhng,trnghc,cctrungtm
chmscsckhe,bnhvin,nhiudng,
vtudulch.Hngnmchn267triunhim
doNoVtrntonthgii(6,7).Conngtruyn
chnh ca virus ny thng lan truyn qua
ng thc phm, ng nc, khng kh, v
lan truyn t ngi sang ngi(1,4,5). Hin nay,
NoVscphnloithnhnmnhmgenkhc
nhau:GInGV(2).NoVsngithucGI,GII
v GIV, nhng hu ht cc chng gy bnh
ngi thuc u thuc nhm gen GI v GII.
Triu chng chung ca bnh do NoVs l nhc
u, nn ma, au bng, tiu chy, au nhc
ccbpc,stnhvnng lnh. Bnh thng
khi sau hai ba ngy. Tr em thng nn ma
nhiuhnngiln.Norovirusckhnngly
nhimrtcao.Virushindinctrongphnv
ncimacabnhnhn.
Hin nay cc phng php dng pht
hinNoVsvnchapdngtiVitNam,vi
mc ch tm hiu v thit lp qui trnh Real
TimePCRphthinNorovirustrongnhuyn
thhaimnhv,pngchocngtcgimst
cc bnh tiu chy cp v ng c thc phm,
TrungTmKimnghimATVSTPkhuvcpha
NamVinVsinhYtCngcngTP.HCh
Minh tin hnh ti nghin cu: Xy dng
quy trnh pht hin Norovirus bng k thut
RealTime PCR, vi cc ni dung nghin cu
sau:
Chn cc cp mi ph hp cho phn ng
RealTimePCRphthinNoVsGIvGII.
Tochngdng(kimtraquitrnhvthay
thnhmtchngchng),thitkprobepht
hinNoVsGIvGII.
ChuynYTCngCng
ThitkthnhphnbktRealTimePCR
phhpvsdngchngdngkimtra
quy trnh RealTime PCR pht hin NoVs GI
vGII.
Thit lp qui trnh RealTime PCR v ng
dng kho st nh gi kh nng pht hin
NoVstrnccmunhuynthhaimnhvvi
quitrnhRealTimePCRcthitlp.
ITNGPHNGPHPNGHINCU
Vtliunghincu
Munhuynthhaimnhv
Mu nhuyn th hai mnh v mua t cc
ch ti TP.HCM vi s lng trn mt mu:
300g/mu.Chn50muccloi,miloi5mu,
bao gm: Nghu, S huyt, S lng, S , S
vo,Hu,Chemchp,Mngtay.
Cc cp Primer c c a vo la chn
trongnghincu
Davotrnhtcccpmicngbtrn
Gen Bank vi cc m hiu: NoVs GI: M87661,
GII:X86557
Thitkchngdng
Trong nghin cu ny, s dng phn mm
BioEdit sequence Alignment Editor ver 7.5
to chng dng. Trn c s trnh t Primer
clachn,sdngprimernytmkim
trn ngn hng gen NCBI on RNA chng
dngchoNoVsGIvGII,sdngphnmm
Blastkimchng.
ThitkProbedngtrongphnngReal
TimePCR
Probe l nhng oligonucleotide c trnh t
b sung vi mt trnh t c hiu trn cDNA
ch (da trn trnh t RNA ca NoVs GI v
GII). u 5 ca cc probe c gn cht pht
hunh quang (FAM/HEX) cn u 3 c gn
chthpphtngnghpphc nh
sng hunh quang pht ra t u 5 (BHO).
onProbegnmuhunhquangFAMsbt
cpchiuphthinNoVsGIvProbegn
257
NghincuYhc
mu hunh quang HEX s bt cp c hiu

phthinNoVsGII.
Toclonechngdng
Chngdngsaukhithitk,sdngquy
trnh RealTime PCR thu c lng sn
phmDNA,theothnhphnmix:
RealTimePCRmixphthinNoVsGIv
GII: PCR master mix 2X (1x), mi GI: JJV1 F
(12pm),miJJV1R(12pm),JJV1Probe(5pm),
mi GII JJV2 F (12pm), mi COG2 R (12pm),
RING2 Probe (5pm), MgCl2 (3,5M), Fluo
(10mM), UNG (0,1U/l), miliQ water va
20l.
Chu trnh nhit chy RealTime PCR c
thitlp:1chuk960Ctrong3pht,tiptheol
40 chu k 950C trong 15 giy, 600C trong 1
phtvchpRealTime.
QuitrnhkthutRealTimePCR
ChunbcDNAtmuthcphmphthin
NoVs
Ccmuctchchitringbit,slng
tithiu5con/mu,cctnh,chovomy
nghin,dpumugiiphnghtvirusra
khi t bo. Ht dch lng ca mu 200l, cho
vongeppendorfloi1,5mlvtinhnhtch
chitmuthuRNAbngbktchittchmu
NKRNAPREPcaCngtyNamKhoa.
TchchitRNAtonphnbngbthucth
NKRNAPREP
DatrnphngphpdoChomczynskiv
Sacchisngch.Nguyntcldngguanidine
14M v ure, phi hp vi phenol v cht ty
khc lm cc cht gy bin tnh cc protein,
kt qu l cc protein trong mu th s b vn
li,DNAstantrongphaphenol,cnRNAth
nmtrongphasencvsctchkhipha
phenolnhthmvochloroformvquaylytm
lng tch. RNA trong phase nc sau s
ckttanhisopropanol.
Tng hp cDNA bng b thuc th NKcDNA
synthesis
258
Phngphpnysdngmingunhin6
nucleotides (Random hexamer primers) m
khngcndngmichiutnghpton
bRNAtmuththnhcDNAtRNAnh
men Reverse Transcriptase. Ngoi ra trong h
thngphnngcncmenRNAseHctb
RNA b bt cp vo cDNA sau khi phin m
ngcthnhcDNA.
KTQUNGHINCU
Ktqulachnmivchngdng
Miclachntrncscccngtrnh
nghincuvNoVscanhiutcgic
cng b nh cp phn phng php.
Sau khi la chn cc cp mi cho ph hp vi
nghincu, chng ti s dng cp mi ca
Narayanan Jothikumar v cs (2004)(8) c sa
chabsungchophvckimchngkt
qu trn ngn hng gen pht hin NoVs nhm
GIvGIInhsau:
GIJJ_V1F
GI
JJ_V1R
GII
GIIJJ_V2F
CO_G2Ra
GCC ATG TTC CGI TGG ATG

TCC TTA GAC GCC ATC ATC
AT
CAA GAG TCA ATG TTT
AGG TGG ATG AG
TCG ACG CCA TCT TCA TTC
ACA
Trnhtchngdngcthitlptrnc
s trnh t cc mi xui v mi ngc pht
hin NoVs nhm GI v GII cng b trn
NCBI bng chng trnh Blast search xc
nh tng ng vi cc trnh t gen cho
NoVs GI v GII c xc nh ti vi tr
nucleotide cho trnh t gen virus Norwalk GI
(M87661) v Lordsdale GII (X86557). Kt qu
nhsau:
TrnhtchngdngphthinNoVsGI
GCCATGTTCCGCTGGATGCGCTTCCAT
GACCTCGGATTGTGGACAGGAGATCGCAA
TCTCCTGCCCGAATTCGTAAATGATGATG
GCGTCTAAGGA
TrnhtchngdngphthinNoVsGII
CAAGAGCCAATGTTCAGATGGATGA
GATTCTCAGATCTGAGCACGTGGGAGGGC
ChuynYTCngCng
GATCGCAATCTGGCTCCCAGCTTTGTGAA
TGAAGATGGCGTCGA
Bng1:KtquCtkhikimtraccnngchng
dngchnvoplasmid
Nng pha
long
10-4
10-5
10-6
10-7
10-8
10-9
KtquthitkProbe
Trn c s chng dng c thit lp,
ProbephthinNoVsGIcugnhunh
quangFAMvprobephthinNoV GII c
ugnhunhquangHEX,ctrnhtsau:
Genogroup
GI
GII
Oligonucleot
ide
JJV1P
RING2-P
Trnh t (5' 3')

TGT GGA
CAG GAG
ATC GCA
ATC TC
TGG GAG
GGC GAT
CGC AAT CT
V tr
5319
5341
NghincuYhc
Ct chng (+) NoVs

GI
23,40
26,59
30,03
32,44
35,27
35,30
10-4
5048
5067
10-5
10-6
Ktqutodngchngdng
KtqutnghpontrnhtchNoVGI
vGII
Trnh t chng dng cho NoVs GI v GII
c khuych i to sn phm DNA, v
kimtratinhschvngkchthctrc
khichnvoplasmidvtodng.Ktqukim
trasnphmPCRcachngdng.
98bp
(NoV GII)
Hnh1.Ktquindicachngdng
NoVsGIvNoVGII
Ktquindihnh1chothy2band:band
96bp tng ng vi chng dng NoVs GI v
band 98bp tng ng vi chng dng NoV
GIInhthitk.
Ct chng (+) NoVs

GII
23,58
27,09
30,17
32,87
34,04
34,86
10-7
96bp
(NoV GI)
Hnh2.ChngdngNoVsGI,GIIclonevo
plasmidkhisdngmin
Chng dng NoVs GI v GII vi pha
longt104chon107,choktquCttttheo
ngnngphalong,cthchnccnng
ny lm chng dng trong qu trnh xt
nghimNoVsnhimtrongthcphm.Nng
DNA chng dng c xem l 1 copy ti
phalongtrnmtnngchoktquCtm
tnh,tcthtnhcslngcopy ban
ucachngdng.
Ktqukimtraendpointchngdng
Chngdngcphatnng104cho
n109,vkimtrakhnngphthincab
ktRealTimePCR,ktqutrnhbybng1.
ChuynYTCngCng
259
NghincuYhc
QuitrnhRealTimePCRphthinNoVstrongnhuynthhaimnhv
Mu nhuyn th
10 con/mu, nghin
nt, s dng 200l
NK
RNAPREP ca
Cng ty Nam Khoa
Tch RNA
NK
cDNA synthesis
Cng ty Nam Khoa 5 pht: 25oC,
-30 pht: 42oC,
-5 pht: 85oC,
4oC94oC
-- Gi
3 pht
Tng hp cDNA
Real Time PCR
Chy 40 chu k
- 15 giy 96oC
- 60 giy 60oC
Chp Real Time
Gi 4oC
Kt qu phn tch NoVs GI v GII mu

nhuynthhaimnhv
Bng2:KtquphthinNoVsGI,GIItrnccnn
munhuynthhaimnhv
TT
1
2
Mu (tng s
mu)
Nghu (5)
S huyt (5)
GI (S mu GII (S mu GI+GII (S
+/tng s +/tng s mu +/tng
s mu)
mu)
mu)
3/5
3/5
3/5
3/5
3/5
3/5
3
4
5
6
7
8
S lng (5)
Chem chp (5)
S vo (5)
S (5)
Mng tay (5)
Hu (5)
1/5
0/5
1/5
0/5
0/5
1/5
1/5
0/5
1/5
0/5
0/5
4/5
1/5
0/5
1/5
0/5
0/5
4/5 (*)
Ghich:4/5(*)trongc1muphthinng
thiNoVsGIvGII
260
ChuynYTCngCng
Nghu
NghincuYhc
S huyt
S lng
Chem chp
S vo
Mng tay
S
Hu
Hnh3.KtquxtnghimNoVstrnmunhuynthhaimnhv
Nhn xt: ng dng qui trnh RealTime
PCRthitlpxtnghim40munhuyn
thhaimnhv,ktquchothy:
Trong s 40 mu a vo xt nghim, cho
thyc12/40muphthinNoVs.
ChuynYTCngCng
Trong s mu c nhim NoVs nhm GI

v GII l: Nghu, S huyt, S lng v S vo.
Ring mu Ho, c 1 mu nhim Norovirus
nhmGIvGIIv3muchnhimNorovirus
nhmGII.
261
NghincuYhc
CcmukhngtmthyNoVs:Chemchp,
S,Mngtay.
KTLUN
lachnccccpmichiudng
phthinNoVsGIvGIIchophnngReal
TimePCR.
KINNGH
Thnghimnhgisosnhkhnngpht
hinNoVsbngkthutRealTimePCRtimt
sphngthnghim.
GiitrnhtccmuphthinnhimNoVs
nhmGIvGIIxcnhgitrphngphp.
to c chng dng. Cc chng

dngchnvoplasmidcphalongt104
n107chotnhiuRealTimePCRtuyntnh
giaccnng.Cthsdngchngdng
trong phn ng RealTime PCR pht hin
hocnhlngNoVsGIvGII.
TILIUTHAMKHO
Xy dng qui trnh pht hin NoVs GI v

GIItrongnhuynthhaimnhv.
3.
ng dng qui trnh RealTime PCR v xt

nghim 40 mu nhuyn th hai mnh v, kt
qu cho thy c 12/40 mu pht hin NoVs.
Trong cc mu Chem chp, S v Mng
taykhngtmthynhimNoV.NghuvS
huytcsmunhimNoVschainhmGIv
GIIl3/5;SlngvSvocsmunhimc
hailaiNoVsGIvGIIl1/5.ivimuhu
csmunhimNoVl4/5,trongc1mu
nhimchailoiNoVsGIvGIIv3much
tmthynhimNoVsGII.
4.
1.
2.
5.
6.
7.
8.
Galllimore, et al. (2005), Multiple norovirus genotypes

characterised from an oysterassociated outbreak of
gastroenteritis,Int,J.Food.Microbiol.,103,323.
GreenYK.,Caliciviridae(2007),Thenoroviruses,Chapter28in
Fields Virology, eds. B. N. Fields, D. M. Knipe, and P. M.
Howley .Wolters Kluwer Health/Lippincott Williams &
Wilkins,Philadelphia,PA.
Kapikian AZ, et al.(1972), Visualization by immune electron
microscopyofa27nmparticleassociatedwithacuteinfectious
nonbacterialgastroenteritis,J.Virol.,10,1075.
Lopman B, et al. (2004), Increase in viral gastroenteritis
outbreaks in Europe and epidemic spread of new norovirus
variants,Lancet,363,682.
Marks PJ, et al.(2000), Evidence for airbone transmission of
Norwalklike(NLV)inahotelrestaurant,Epidemiol.Infect.,120,
481.
McEvoyM,etal.(1996),Anoutbreakofviralgastroenteritison
acruiseship,Commun.Dis.Rep.CDR.Rev.,6,188.
McIntyreLetal.(2002),Gastrointestinaloutbreaksasscociated
with Norwalk virus in restaurants in Vancouver, British
Columbia,Can.Commun.Dis.Rep.,28,197.
Narayanan J, James AL, Kathleen H, David NL, Vincent RH
andFanV(2004),RapidandSensitivedetectionofNorovirus
by using TaqmanBased onestep RTPCR assay and
Aplication to naturally contaminated Shellfish samples.
AppliedandEnvironmental.Microbiology,p.18701875.
262
ChuynYTCngCng
NghincuYhc
TNHTRNGNHNLCYTVCNGSUTSDNG
GINGBNHCABNHVINTUYNHUYN
NguynBchH*
TMTT
tvn:Bnhvin(BV)huynlnvytthuctuynytcscnhimvchyulkhmcha
bnhvphnlnlngbnhnhn(BN)ctptrungtiy.Tuynhin,hinangnicmtnhtrngqu
tiBNccBVtuyntnhvtuyntrungngnncnthitphinhgithctrngngunnhnlcvcng
suthotngcaBVhuyn.
Mctiunghincu:nhgithctrngnhnlcytvcngsutsdng(CSSD)gingbnh(GB)
caBVtuynhuyn.
Phngphpnghincu:Nghincuctngangmt,lymutonb44BVhuynthuc5tnhln
cnTP.HCM.HicusliukimtraBVnm2010.
Ktqunghincu:PhnlnBVtuynhuynkhngtyucuvtlvccunhnlcyt:84,1%
khngttsnhnvinyt(NVYT)/gingbnhkhoch(GBKH)v93,1%khngtNVYT/gingbnh
thck(GBTK);T7593,2%khngtvtlcckhichuynmn.Tlkhilmsng(LS)thngvt
mcquynhtrongkhikhihnhchnhgimtlvkhicnlmsng(CLS)dcthiunghimtrng.Ts
bcs(BS)viudng(D)nhsinh(NHS)kthutvin(KTV)khngtvvtmcquynh
chimtlcaotrongkhitsdcs(DS)ihcvBSrtthp.CSSDGBphnlnkhngtmctiu
(85%90%).C56,8%dimcnyv25%vtmc(CSSDGBTK).Cmttlngk(29,5%)BV
huynchatrinkhaiphngmhoccphngmnhngkhngthchincm.Tlphuthutrt
thp.Ththutcthchinnhngphnlnmc3,mccaohnthtlthchinthp.
Ktlun:CnutintptrungngunlcutchoBVtuynhuyn,khngchiviBSmkc
DS,KTV.CcBVtuynhuyncnphttrincbnvngoikhoavhisccpcupngcuchatt
giaionucanhngtnhtrngsckhexucngnhtngcngchtlngkhmchabnhakhoaban
unhmthuhtbnhnhn,gimtnhtrngvttuyngyqutiBVtuyntrn.
Tkha:tnhtrngnhnlcyt,bnhvinhuyn,cngsutsdnggingbnh
SUMMARY
HEALTHWORKERRESOURCESANDCAPACITYOFSICKBEDUTILIZATION
OFDISTRICTHOSPITALS
NguyenBichHa*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:265274
Background:Adistricthospitalisaunitbelongingtothebasiclevelofthehealthsystem.Theessentialtasks
ofadistricthospitalareexaminationandtreatment,thus,agreatamountofpatientsoughttohaveconcentrated
in there. However, there is status of the overloads of patients in the province and central hospitals recently.
Therefore,astudyofhealthworkerresourcesandcapacityofsickbedutilizationofdistricthospitalsisnecessary.
Objectives: To evaluate the situation of health workers and capacity of sickbed utilization of district
hospitals.
Method:Crosssectionaldescriptivestudy,takingtheentiresampleof44districthospitalsinfiveprovinces
Tcgilinlc:Ths.NguynBchHT:0908877820
ChuynYTCngCng
Email:nguyenbichha@ihph.org.vn
263
NghincuYhc
aroundHoChiMinhcity.
Results:Mostofdistricthospitalsdidnotmeetrequirementoftheratiosandstructureofhealthstaffs:the
ratiobetweenhealthstaffsandsickbedsinplannednumber(84,1%)andintherealbednumber(93,1%);the
ratioamongspecialgroups(7593,2%).Therateofclinicalgroupusuallyexceededtheregulationswhereasthe
rateofadministrativegroupandofparaclincalandpharmaceuticalgroupdidnotreachregulationstandards.The
ratiobetweendoctorsandnursesmidwivestechniciansexceededthestandardsandwashigh,whiletheratio
betweenpharmacistsanddoctorswasquitelow.Thecapacityofsickbedutilizationsinmostofthesehospitalsdid
notachieveatoptimalperformance(85%90%).Therewas56.8%hospitalslowerand25%upperthanthis
level(fortherealbednumbers).Therewasanoticeablerateof29.5%hospitalsnotgettingoperatingroomsor
performingtocaesareansection.Surgeryratewasverylow.Mostofmedicalskillsperformedwereinthegrade3.
Conclusion:Prioritizingtodevelopdistricthospitalsintermsofhumanandfinancialresourcesincluding
pharmacists and technicians. The district hospitals should be invested basically in surgery and emergency
resuscitationskillstoearlydiagnoseandtreattheworsehealthproblems.Besides,thedistricthospitalsshouldbe
rainforcedthequalityofprimarilygeneralpracticestoattractlocalpatients,thatmightreducetheoverloadof
upperlevelhospitals.
Keywords:statusofhealthworker,districthospital,capacityofsickbedutilization
nhimvkhmchabnhakhoabanunh
TVN
thno?Thctrngcckthutytctrin
Khm cha bnh l cu phn quan trng
khai ra sao? V thc t cng sut s dng
trong cng tc chm sc sc khe nhn dn.
gingbnhtuynhuynlbaonhiu?
TheomhnhtchccangnhytVitNam,
Mctiunghincu
tuynytcslgndnnhtvcslng
nh gi tnh trng nhn lc y t ti bnh
nhn vin y t v c s vt cht ti ch nhiu
vintuynhuynvs lng v phn b theo
nhtvtrirngtheonvhnhchnhnhm
cckhichuynmn.
pngkhilngcngvickhmchabnh
banuy(10).Sovitrmytxphngc
nhim v tng hp va khm cha bnh va
lmccchngtrnhytthBVakhoahuyn
(hocbphnchcnngkhmviutrnm
trong trung tm y t (TTYT) huyn, sau y
cgichunglBVhuyn)cnhimvchnh
l khm cha bnh. Ti BV tuyn huyn phi
khmchakhicbnhthngthngcc
c quan b phn c th bng iu tr ni khoa
hocngoikhoa.Bncnh,theoquynhBV
tuynhuynvcctrmytxphnglni
ngkkhmchabnhbanuchophnln
i tng(1), nn l ra s ngi dn n khm
chabnhthngthngbnhvinscao.Tuy
nhin,trnthcttnhtrngqutiBVtruyn
trn vn ko di, lng ngi dn vt tuyn
chkhmchanhngbnhthngthngm
tuyn trc c th gii quyt c chim n
67,7%(7).Vntral:BVtuynhuynhin
nay c mt lc lng cn b y t thc hin
264
nhgicngsutsdnggingbnhv
cc hot ng khm cha bnh ca bnh vin
tuynhuynnm2010.
ITNGPHNGPHPNGHINCU
itngnghincu
Ccbnhvintuynhuynvtngng
thuccctnhkhuvcphaNamlncnTP.H
ChMinh.
Thitknghincu
M t ct ngang. Ly mu ton b, gm 44
bnh vin tuyn huyn ti 5 tnh: 2 tnh min
ngv3tnhminTycchnngunhin
t 8 tnh ln cn TP.H Ch Minh. Hi su s
liunhnsvcngsutgingbnhvhot
ngbnhvintbnkimtrabnhvinnm
2010doSYtcungcp.
ChuynYTCngCng
KTQUNGHINCUVBNLUN
Bng1.SlngccBVhuynvTTYThuyn
ckhost
Trung tm y t huyn
Bnh vin huyn
Tng
Tng
S lng
T l %
18
40,9
26
59,1
44
100
T 2005, theo thng t 11/2005 ca lin b

BYTvBNiv,cctrungtmythuyntch
rathnhBVhuynvtrungtmytdphng
huyn.Sauthngt03/2008/BYTBNiv
tiptchngdncchuynthtytnhtrng
thch hp v m hnh bnh, a l, nhn s
gi t chc l trung tm y t hay bnh vin
huyn,trongtrungtmythoctrungtmy
t d phng qun l cc trm y t v phng
khm khu vc. Do vy, ti cc tnh c kho
stcsanxenc2mhnhtchcny.C
tnhtchtonbTTYThuynthnhbnhvin
huynvtrungtmytdphng(ngNai),
ctnhginguynccTTYThuyn(TyNinh),
c tnh tch, sau li sp nhp li 1 s trung
tm,mtslBVvTTYTchcnngdphng
(Long An, Tin Giang, Bn Tre). Mt s huyn
xatrungtm,bncnhTTYTcncBVkhuvc
ph trch. BV khu vc c quy m ln hn BV
huyn (trn 200 ging) nhng c BV khu vc
lcptnh(hngII),cBVkhuvccphuyn
(hng III). Cc BV khu vc hng III cng c
khosttrongnghincuny.C26BVhuyn
v18TTYTtrongtngs44nv,t100%s
n v l i tng nghin cu. Trong c
nhngBVvTTYTnmthphcatnhhoc
cngthuntintitrungtmthnhph
HChMinh.
Bng2.Sgingkhochvsgingthck
S ging k
hoch
Trung tm y t
Thp
nht
Cao
nht
Bnh
qun
44
30
290
103
18
30
130
78
huyn
Bnh vin
huyn
S ging
thc k
Trung tm y t
huyn
Bnh vin
huyn
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
NghincuYhc
26
50
290
120
44
30
290
109
18
30
216
108
26
36
290
110
4.4
53.9
50
34.6
40.9
11.5
9.1
90
5.6
n=18
n=26
n=44
Trung tm
t
Bnh vin
Huyn
BV huyn v
TTYT
Bng
Tng
Gim
Biu1.Phntchtlthayigingbnhtheo
loihnhtchc
Bng3.Mcthayisgingthcksovik
hochtnhtheotl%
Gim
Tng
Bng
S
lng
4
18
22
Ti
thiu
23.00
2
Ti a
38,00
100
Trung
bnh
29,6
31,2
Theo bng 2 v biu 1, s ging bnh

thckca50%BVvTTYTcthayi,ch9%
gim s ging cn 41% l tng; mc gim v
tngcngxpxnhau(29,6 v 31,2% so vi s
gingkhochtheobng3).VictngsGB
thng p ng lng BN ngy cng tng,
cng th hin kh nng hot ng tt ca BV.
Tuy nhin, thc t, cc BV c s ging tng
khnghnvldoBNnmvinngmcn
doBVcxymirnghn,kgingnhiu
lnnunhngsgingKHchac
duyt iu chnh kp; ngc li, cc BV hoc
TTYT gim ging (4 BV v TTYT) thng ch
do vic xy mi v c duyt GB tng ln
nhngbnh vin vn duy tr s GB thc k c
phhpvimchotnghinti.
Tnhtrngnhnlcyt
Tsvccunhnvinyt
ChuynYTCngCng
265
NghincuYhc
T l khng NVYT/GBTK
TlkhngttsNVYT/GBKH
Bnh vin
huyn
Bnh
vin
huyn
Trung tm
y
t h
84.6
Trung tm y
t huyn
83.
Bv huyn v
TTYT huyn
8
83.5
84.
96.1
88.9
18-20%
Bv huyn v
TTYT huyn
84.
82.
60-65%
93.1
15-22%
84
86
88
90
92
96
94
Biu2.a,b:TlkhngttsNVYT/GBsoviquynhBVhng3khuvcBSCL
V t s NVYT/GB, v c s khc bit v
chc nng ca BV huyn v TTYT huyn c
gingbnhnnphixtnskhcnhauv
t s ny. Theo bng 4, c s khc bit c
ngha thng k vi p < 0,05: t s NVYT/GB
TTYThuynthcaohnBVhuyn.ngch
ltlkhngtvkmquynhcngcao
tuyt i BV huyn. Nh vy nu ch xt t
chcBVhuynthchcdi5%sBVhuyn
tyucuquynhvtsNVYT/GB,as
cnlichaththeokpquynhcathngt
08/2007 ca BYT. iu ny chc chn lm hn
ch cho vic thc hin nhim v trong c
cngtckhmchabnhcabnhvin.Ts
NVYT/GBKH trong nghin cu ny (t 0,79
1,92) th thp hn trong nghin cu cc BV t
nhn TP.HCM (trung bnh NVYT/GB 2,39)(4),
tuyvyckhquanhnsovinghincuca
Khng Anh Tun nm 2007 ti mt s BV
tuynTWnicht0,571,09(3).
T l khi lm sng, khi hnh chnh, khi

CLSvdc
10
6.
9.
8
6
4
93.2
90.9
2
0
266
Khi lm Khi hnh Khi CLS v

sng
chn
Dc
t
Khng t
Biu3.Tlkhilmsng,khihnhchnh,khi
CLSvdcsoviquynh
VccuNVYTtheoccbphn,khilm
sngctltrungbnhcao(73,21%)vmcny
cao hn so vi nghin cu BV t nhn ti
TP.HCM (trung bnh 61,75%)(4). Cc BV tuyn
huyn c t l cao (93,2%) khng t v vt
quy nh chng t c s ch trng nhiu ti
nhnlclmchuynmnlmsng.
Bng4.Phntchslngkhngtvtllm
sng,hnhchnh,CLSvdc
Khi
lm
sng
Khi
hnh
chnh
Khi
CLS v
dc
Quy
nh
Khng t v
vt quy nh
Khng t v
km quy nh
n
S
S lng T l %
T l %
lng
(60
65%)
41
41
100,0
0,0
(18
20%)
40
7,5
37
92,5
(15
22%)
33
0,0
33
100,0
Ngc li t l khi hnh chnh (t trung

bnh13,78%)thiunhnlcn92,5%trongs
90,9 cc n v khng t. Kt qu ny hon
ton khc vi BV t nhn c khi hnh chnh
qun l trung bnh vt quy nh (t 25,8 so
viquynh1820%)(4).KhiCLSvdctrung
bnh t 13,06% v c 75% s BV thiu so quy
nh cng tng t nh nghin cu ti BV t
nhnTP.HCM(trungbnh12,46)(4).Nhvybn
cnh vic t nhn lc hnh chnh v lc lng
nycthchpngcngvicvitchc
ChuynYTCngCng
ngoi vin th nhn lc chuyn mn CLS v
dcthiutngisovikhilmsng.
NghincuYhc
Biu4.Tltccccuccchcdanhchuyn
mnsoviquynh
Ccuccchcdanhchuynmn
100
90
80
70
60
50
40
30
20
10
0
20.5
79.5
TsDS
ihc:
BS
6.8
93.2
18.2
81.8
tt
Khng t
TsDSi TsBS:
hc:Dstrung DNHS
KTV
hc
Bng5.Phntchslngctsccuchuynmnkhngt
Quy nh
T s dc s i hc : BS
1/8 1/1,5
T s DS i hc : DS trung hc
1/2 1/2,5
T s BS : iu dng-n h sinh-KTV 1/3 1/3,5
35
41
36
Smtcnitrncngthhin c cu
cc chc danh chuyn mn (bng 6 v biu
5):tsBS:dcsihckhcao,trungbnh
l 13,67, trong khi quy nh l t 1,5 8, thm
chc8nvkhngcdcsihc(chim
18,2%),tuynhintsnycnthphntrong
nghincuBVtnhn(trungbnht21,37)(4);
tsiudngnhsinhkthutvin:bc
slithp,chttrungbnh2,81trongkhiquy
nht33,5,sliunythtngngviBV
tnhntiTP.HCMcngctrungbnhtmc
Khng t v vt quy nh
S lng
T l %
0
0,0
4
9,8
30
83,3
Khng t v km quy nh
S lng
T l %
35
100,0
37
90,2
6
16,7
thpl2,45(4).TccsliutrnchothytiBV
huyn lng bc s tuy thiu nhng vn nhiu
tng i so vi cc chuyn mn h tr bc s
khmviutrbnh.Nuthiulngchuyn
mn ny ng thi vi thiu ngun lc khc
(thitb,htng)thmtskthutcngkh
c trin khai v BS phi vn dng k nng
lmsnglchnh,cctrnghpcncanthip
phuthhut,ththuthaykthutchnon
tthnngnhinkhnggiiquytcti
BVhuyn.
Ccchskhcvnhnlcyt
Bng6.Cctskhcvtnhtrngnhnlcyt
T l nhn vin chuyn
mn hp ng
T s y s : bc s
T l bc s sau i hc
T l i hc iu dng,
h sinh v KTV
Ti thiu
Ti a
Trung bnh
26
1,0
41,1
14,5
11
10,46
72,14
34
44
0.08
16,7
2.21
71,4
0.86
45,4
0,8
42,1
0.62
12,65
72,09
27,86
39
0,1
51,1
7,9
6,6
8,26
104,56
Trongnghincucngkhostmtstl
khc gn lin vi thc t hot ng ca bnh
vin, s liu trong bng 7. Theo cc BV
thng phi hp ng vi mt lng cn b
chuyn mn, s ny cng c tnh trong s
nhn lc y t. T l cn b chuyn mn hp
ChuynYTCngCng
Trung v lch chun
H s bin thin
(%)
ng thay i kh rng t 1% n 41,1%, t

trungbnh14,5%;tuynhintrungvl11%.T
l cn b chuyn mn hp ng cng thp th
nhnlcBVcngnnh,totinhotng
tt.Mtkhc,cmtlngcnbchuynmn
267
NghincuYhc
hpngcngchngtslinhhotthchng
caBVtrongbicnhchungthiunhnlcyt.
Tlbcssauihckhcao,trungbnh
t 45,4%, v y cng chnh l lng bc s
chcdanhqunlvlchchtcacckhoa
phnghoctrongbanlnho.Mcdyl
mtchbongmngchotrnhbcsBV
tuyn huyn cng nh tuyn y t c s ni
chung, nhng cc bc s mt khi phn ha
chuyn khoa r rng (t CK1 tr ln) s ch
mun lm chuyn khoa , trong khi nhim
vcamtBVhuynlkhmchabnhtuyn
u,cnkinthcvngvngvakhoa.Nu
c mt lng bc s chuyn khoa m thiu s
utcsvtcht,trangthitbthcngkh
khnhphthuynnglcchuynmnca
mnh.
Bn cnh s iu dng i hc, n h
sinh i hc v k thut vin i hc cng c
mttrong39/44BV.SlngccNVYTihc
nytuynhuyntuychchimmttlnh
nhng rt qu gi, v chnh h c nng lc tt
hn gip nng cao cht lng khm chn
on,iutrvchmscbnh.
Cngsutsdnggingbnh
Bng7.Cngsutsdnggingbnhkhochv
gingbnhthck
H s
Ti
Trung Trung lch bin
n
Ti a
thiu
bnh
v
chun thin
(%)
CSSD
GBKH
CSSD
GBTK
44 42,0 152,3 87,65
88,3
23,74
27,08
44 42,0 123,7 80,48
82,2
19,04
23,66
CSSD GBKH trung bnh t 87,65% l mc

tt, ring CSSD GBTK trung bnh v trung v
udi85%tcthhinsditi.Sovicc
BV tuyn tnh v trung ng th CSSD GB ca
BV tuyn huyn thp hn nhiu. Theo nghin
cu nm 2009 ca Vin Chin lc v Chnh
schytthCSSDGBBVtuyntrungngt
165 200%(3), theo kt qu trin khai thc hin
ch th 06 v chng qu ti BV th CSSD GBTK
tnhtrungbnhtrntonqucBVtuynTWt
268
117,3%, tuyn tnh t 105,2% v tuyn huyn

t103,6%(8).Tuynhinktquditiivi
gingthckcaBVtuynhuyncngtng
tviBVtnhntiTP.HCM(4).
90
80
70
77.3
81.8
60
50
CSSD GBKH
CSSD GBTK
40
30
20
22.
10
0
Khng t
18.2
t (85 - 90%)
Biu5.TlBVtuynhuyncCSSDging
bnhtmc8590%
Bng8.PhntchsBV,TTYTccngsuts
dnggingbnhkhngt
n
CSSD
GBKH
CSSD
GBTK
Khng t v
vt 90%
S
T l
lng
%
Khng t v
di 85%
S
T l %
lng
34
18
52,9
16
47,1
36
11
30,6
25
69,4
PhntchtlkhngtchothyCSSDGB
dimc85%chimtl69,4%(CSSDGBTK)
cntrnmc90%chimtl30,6%.Cccons
chngt1thctadngvmchotng
caccBVhuyn.CnhngBVhuynvnqu
ti bn cnh phn ln nhng BV di ti v
trongmctibnhthng.
Bng9.CSSDGBKHticcBVtuynhuync
thayiGB
n
Cc BV,
TTYT gim 4
GB
Cc BV,
TTYT tng 18
GB
Cc BV,
TTYT khng
22
thay i s
GB
Ti
Trung
Ti a
thiu
bnh
Trung lch
v
chun
44,8
86
58,85
55,6
18,6
52,9
152,3
95,41
93,4
23,7
42
126,7
86,99
88,3
20,9
CSSD GBKH trung bnh ca cc BV gim

ging l thp (58,9%) hn nhiu so vi mc
ChuynYTCngCng
85%,cnCSSDGBKHcaccBVtngging,
trungbnhl95,4%caohnmc90%.
Nh vy CSSD GB tuyn huyn trong
nghincunythphnkcsovitrungbnh
tuyn huyn trn ton quc. Thc t cc BV
tuyn huyn thng nm trung tm mt a
giihnhchnhcphuyn,tikhuvccctnh
nghincutrungtmhuyncbnknhgnti
cc khu dn c ch di 10km, nh ngi
dncththunlitiBVhocTTYThuynv
ivtrongngy,nncthBNkhnglachn
nm vin nhiu. ch l mt kh nng bn
cnhkhnnglnnhtl5tnhckhost
NghincuYhc
llncnTP.HCM,ngidnkhibbnhphi
nm vin thng vt tuyn iu tr BV
tnhhocccBVlnTP.HCM.Nghincuca
NguynVnCchobitct43,677,1%BN
n khm ti mt s BV ln TP.HCM c th
iu tr c tuyn c s(7). Nghin cu ca
VinchinlcvChnhschytthct60
95% BN n thng BV tuyn TW m khng c
giy chuyn bnh ca tuyn trc(3). Chnh v
thmtlkhibnhnitrrtcaovtlt
vong rt thp ti cc BV tuyn huyn trong
nghin cu ny khng th ni c l cht
lngiutrtt.
Bng10.Mtschsvktquhotngkhmchabnh
T l khi bnh ni tr (%)
Trung tm y t huyn
Bnh vin huyn
BV v trung tm y t
T l t vong th (%)
Trung tm y t huyn
Bnh vin huyn
BV v trung tm y t
S ngy iu tr trung bnh ca BN ni tr
Trung tm y t huyn
Bnh vin huyn
BV v trung tm y t
Ti thiu Ti a Trung bnh Trung v
17
26
43
28,3
36,3
28,3
96,5
90,7
96,5
64,17
66,76
65,74
61,2
66,0
65,4
14
17
31
0.01
0,01
0,01
0.31
0,30
0.31
0.09
0,09
0,09
0.05
0.06
0,06
0.08
0,08
0.08
88,89
88,89
88,89
18
26
44
2,02
2,75
2,02
8,50
8,75
8,75
4,96
5,76
5,43
4,90
5,72
5,30
1,44
1,40
1,46
29,03
24,31
26,89
T l khi bnh ni tr trung bnh t

65,74%,tltvongthl0,09%,trongkhi
theosliuktquiutrnm2009trnton
quccctlnyl64,8%v0,26%(8).Sngy
iu tr trung bnh ca BN ni tr nghin
cu ny cng thp (5,43 ngy) so vi s liu
quc gia BV huyn (6,2 ngy nm 2008)(2).
NgyiutrtrungbnhBNnitrthpnhn
chungccoiltt,nutnhringtngloi
bnh th chng t s tin b trong iu tr
bnh, tuy nhin nu xt trn bnh din mt
khuvcvchottcccloibnhthcthl
domhnhccbnhvovinlcptnh,nh,
dchatrtuynny(BVhuyn).
ChuynYTCngCng
lch H s bin thin

chun
(%)
18,50
28,83
16,84
25,22
17,34
26,38
100
90
80
70
60
50
40
30
20
10
0
29.5
22.6
70.5
77.4
n=44
n=31
6.8
41.5
45.2
93.2
58.5
54.8
n=31
Phu FT loai
thut 2,1,c
bit
c thc hin
n=44
Th
thut
n=41
Th
thut
2,1,c bit
khng thc hin
Biu6.TlBVhuynthchinphuthut,th
thutvm
V phu thut, theo danh mc phn tuyn
k thut km quyt nh 23/2005 ca BYT, BV
huyn phi m c ly thai ln u, phu
thut cp cu vim rut tha, thng d dy,
thot v bn nght, ct lch chn thng v.v...
Theobiu6,c n 29,5% BV huyn khng
269
NghincuYhc
cthchinphuthutnotrong1nm,chng
tchatrinkhaicphngm.Trongs31
BVhuyncthchincphuthutthch
24BV(chim77,4%)thchincphuthut
tloi2trlnv17BV(chim54,8%).M
theo ch nh thng thng l mt cp cu

tng ng phu thut loi 2, nu BV huyn
khngsnsngthngidnschunb
tuyncaohncyntmvscnuc
cacuc.
Bng11.Tlcccaphuthut,ththutvm
T l phu thut
T l phu thut loi 2,1v c bit (%)
T l m (%)
T l th thut
T l th thut 2,1v c bit (%)
Ti thiu
Ti a
31
24
17
41
24
0,001
2,8
0,3
0,007
5,7
0,50
99,9
27,2
1,66
67,2
Ti cc BV huyn c thc hin m th

trungvttl8,8%sca,tlnyrtthp
sovisliuqucgianm2009l26,6%(8),tuy
nhin cc BV ny thc hin c c bn
nhimvcaBVtuynhuyn.
Tng t nh vy i vi nhng bnh
iu tr ngoi khoa tuyn huyn nhng BV
vin cha thc hin c hoc cha c s
tin tng ca BN nn s lng v t l thc
hin rt thp: trong 100 ca nm vin trung
bnhchc9caphuthutnhngtrungvl2
ca.Ktqunycngtngngvinghin
cucaNguynThHuynLinhnm2004ti
Ninh Bnh v ca Nguyn Th Thanh Hng
nm 2005 Lo Cai(6,5). C mt s BV huyn
tuy s lng v t l phu thut thp nhng
trong phu thut loi 2 tr ln rt cao (ti
a l 99,9%) c th do n v ny mi trin
khaimtskthutvcshtrchuyn
mn t tuyn trn theo chng trnh d n
1816, iu quan trng l vic duy tr tip tc
cckthuttrongthigiansau.
Vththutcngcnhgitngt,
cBVtlththutkhcaot1,66ththut
trn1BNnhngmctrungbnhchl0,33v
trungvlchtribng0,21.
Trung
bnh
0,09
40,08
10,58
0,33
30,49
Trung v
0,02
22,3
8,8
0,21
26,8
lch
chun
0,14
35,73
9,05
0,34
17,71
H s bin
thin (%)
155,56
89,15
85,54
103,03
58,08
7
6
65.
52.
4
3
33.
2
1
0
Trung tm y
t huyn
Bnh vin
huyn
BV huyn v
TTYT huyn
Biu7.PhnbtlBVvTTYTcnisoichn
on
Cngtheodanhmckthuttiquytnh
23/2005 ca BYT, ti BV huyn phi thc hin
cnisoichnonmtsphncbnca
ngtiuhavmixoang.Cthninisoil
mtidinchocckthutlmsngmi,i
hi u t ng k v thit b v con ngi
tuyn huyn. Nu BV huyn trin khai c
chn on ni soi v duy tr tt th cht lng
chnonscnngcaovcuytnhnvi
ngidn.C33,3%TTYThuynv65,4%BV
huyncnisoichnon.
Bng12.Scanisoichnon
Trung tm y t
Bnh vin
BV v TTYT
270
Ti thiu
Ti a
Trung bnh
Trung v
6
17
23
23
5
5
5409
6036
6036
1151,3
445,8
629,9
621
79
84
lch
chun
2104,1
1443,7
1619,3
H s bin thin
(%)
182,79
324,26
257,39
ChuynYTCngCng
Slngnisoica1sBVcnrtkhim
tn, ch vi ca n vi chc ca 1 nm, nhng
cngcBVvTTYTthngnghnca,chng
tshotngnnhvpngttnhucu
khmbnh.
Cn lm
84.1
Lm sng
88.6
81
82
83
84
85
86
87
88
89
Biu8.TlccBVvTTYTctrinkhaik
thutmi
Bng13.Skthutmictrinkhaitrongnm
n
S k
thut lm 39
sng mi
S k
thut cn
37
lm sng
mi
H s
Ti Ti Trung Trung
lch
bin
thiu a bnh
v
chun thin (%)
1
5,21
1,69
32,44
4,84
1,80
37,19
Tnhtrngtrinkhaicckthutmivlm
sng v cn lm sng trung bnh mi BV v
TTYT t t 5 6 k thut. Vic trin khai k
thut mi ang c s gip sc t chng
trnh d n 1816 nhng cng do s ch ng
pht trin nng lc ca mi n v. Vn c
nhngBVhocTTYTkhngtrinkhaick
thutnotrong1nmqua(biu8).
Bng14.TlBNkhmchabnhbngbohimy
tBVhuyn
H s
Ti Ti Trung Trung
bin
n
lch
thiu a bnh
v
thin
chun
(%)
Trung
tm y t 18 15,4 78,9 47,41 38,3 22,81 48,11
huyn
0,0985
Bnh
vin 26 21,4 88,7 54,84 53,9 14,88 27,13
huyn
BV v
trung 44 15,4 88,7 51,80 53,1 18,66 36,02
tm y t
ChuynYTCngCng
NghincuYhc
MckhmchabnhbngBHYTcc
BV v TTYT huyn kh cao, t trung bnh
51,8%. BHYT l mt trong nhng ngun thu
chnhmbotichnhBV.Tuynhin,mc
ny TTYT huyn th thp hn BV huyn
nhng khng c ngha thng k. Nhng BV
huyn thng vng pht trin cng nghip,
dchv,ningidncBHYTtheocctchc
x hi, ngh nghip nhiu hn, cn cc TTYT
huyn thng cc huyn a bn rng, xa,
phttrinnngnghipvngidncBHYTt
hn, ch yu l i tng chnh sch. T l
khmchabnhBHYTcngphhpvitl
ngidncBHYTkhuvcngbngsng
CuLongldi50%(9).
KTLUN
PhnlnBVhuynkhngtyucuvt
lvccunhnlcyt.84,1%khngtts
NVYT/GBKHv93,1%khngtNVYT/GBTK;
T 75 93,2% khng t v t l cc khi
chuynmn.
T l khi lm sng thng vt mc quy
nh trong khi khi hnh chnh gim t l v
khicnlmsngdcthiunghimtrng.
T s bc s v iu dng h sinh k
thut vin khng t v vt mc quy nh
chimtlcaotrongkhitsdcsihcv
bcsrtthp.
Cng sut s dng ging bnh phn ln
khngtmctiu.C56,8%dimcny
v25%vtmc(CSSDgingbnhthck).
Cmttlngk(29,5%)BVhuyncha
trinkhai phng m hoc c phng m nhng
khngthchincm.Tlphuthut
rtthp.Ththutcthchinnhngphn
lnmc3.mccaohnthtlthc
hinthp.
KINNGH
Ccaphngcnutintptrungngun
lc tng cng u t cho BV huyn: y
mnhotongunnhnlcyttheoach
i vi u ra l bc s cng nh dc s, k
thutvin;dnhccuivchimitrng
271
NghincuYhc
lmviccngnhthunhpttchonhnviny
t.
3.
CcBVhuyncnphttrincbnvngoi
khoa v hi sc cp cu p ng cu cha
ttgiaionucanhngtnhtrngsckhe
xu, ng thi tng thu ht ngi bnh bng
cht lng thc s khm cha bnh a khoa
ban u nhm tng CSSD GB, gim tnh trng
vttuyngyquticcBVtuyntrn.
4.
Licmn:Chngtixintrntrngcmnschophptip
cnsliucabanlnhoSYtcctnhngNai,Ty
Ninh,LongAn,TinGiang,BnTrevscngtcnhittnh
ca cc cn b chuyn vin ca S gip chng ti hon
thnhcbocony.
5.
6.
7.
8.
TILIUTHAMKHO
1.
2.
BYt(2009).Thngts10/2009/TTBYTNgy14thng08
nm2009vHngdnngkkhmbnh,chabnhban
uvchuyntuynkhmbnh,chabnhbohimyt.
CcQunlkhmchabnh(2008).Sliuhotngbnh
vin20072008.
http://www.kcb.vn/ShowNews.aspx?lang=vn&cat=027&nid=7
0
272
9.
10.
KhngAnhTun(2007).nhgitnhtrngquticamt
sbnhvintiHNivTP.HChMinhvxutgii
phpkhcphc.www.hspi.org.vn
Nguyn Bch H (2010). Cng sut hot ng bnh vin t
nhn ti TP.HCM. Bn tin cc yu t x hi quyt nh sc
khe.WHO.Tp3,2011
NguynThHuynLinh(2004).Nghincungunnhnlcy
tvhotngcaccbnhvinhuyncaNinhBnhtrong
4 nm (2000 2003). Lun vn tt nghip c nhn y t cng
cng.TrngihcYHNi
NguynThThanhHng (2005). Nghin cu ngun lc v
hot ng ca cc bnh vin huyn Lo Cai trong 5 nm
(1999 2003). Lun vn tt nghip c nhn y t cng cng.
TrngihcYHNi
NguynVnC(2004).Xcnhnguynnhnvxutbin
phpgiiquytqutibnhvintithnhphHChMinh.
Lunntinsyhc,ihcYdcTp.HCM
Vincngnghthngtinthvinyhctrungng(2009).
Thngknm2009.
http://www.cimsi.org.vn/THONGKE.aspx?action=thongke&la
ng=vi
VinKhoahcLaongvXhi(2010).Thctrngansinh
xhi20012010.
http://www.ilssa.org.vn/NewsDetail.asp?NewsId=129&CatId=
32
V khoa hc v o to (2006). Qun l v t chc y t. H
thngtchcngnhytVitNam.NXBYhc.2006
ChuynYTCngCng
NghincuYhc
KHOSTBCUVMCKHILNGVPLCCNG
VIC,TNHTRNGOTOLINTCVCHUYNMNYIVI
CCYS,BCSTIMTSBNHVINHUYN
NguynBchH*,NguynThThy*
TMTT
tvn:Bnhvinhuynlnvytcchcnngkhmchabnhakhoacngoitrvnitr
caonhtcatuynytcs,ckhnngtoranhngplcnhtnhvkhilngcngnhchtlng
cngvic.Tuynhinvithctrngcngsutsdnggingbnhthpvthiunhnlcytticcbnhvin
huynthccy,bcsycnhnnhnhthnovkhilngvplccngviccngnhtnhtrng
cotolintcvchuynmnpngyucucngvic.
Mctiu:Khostmckhilngvplccngvicvtnhtrngotolintcvchuynmnca
ingy,bcstimtsbnhvinhuyn.
Phngphpnghincu:Ctngangmt.Lymutonbccitnglys,bcslmvictibnh
vinhuyn.Sliucthuthpthngquabncuhitinkhuytdanh.
Ktqu:C284/335y,bcsca12bnhvinhuynckhost.tuitrungbnhcay,bcskh
cao,trungvl44tui(n)v46tui(nam).C70%y,bcschorngkhilngcngvicnhiuhocqu
nhiuv62%chorngplccngviclcngthnghocrtcngthng.C21,8%y,bcscotolin
tctrongvng1nmqua,trongchyulotodihnihchocsauihc(88,7%).Hinc20,8%
bcsv27%yslakhoa,cnlilchuynkhoatsbtrln,ringbcsc50,3%chcvsauihc
tCK1trln.Trongsccys,bcsangcngtcvchaihctrongmtnmquath51%cnhucuhc
nngcaoln1hcvhochcchuynkhoasu,32%mongmunhcchuynkhoasbhochcngnhncp
nhtchuynmnvngoing.
Ktlun:NncnghincusuhnvmcutotochuynkhoachoBVtuynhuynkha
cnhlichcngng.Khostthmvcckhacnhplcvmchilngtrongcngvic,ngthicn
cngcmnhmvaitrkhmchabnhakhoatuynbanucaccbnhvinhuyn.
Tkha:Ybcs,bnhvinhuyn,khilng,plccngvic,otolintc,chuynmny
ABSTRACT
PRIMARYSURVEYONWORKLOAD,WORKPRESSUREANDSTATUSOFTRAINING
CONTINUOUSLYMEDICALSKILLSFORPHYSICIANSANDMEDICALDOCTORSINSOME
DISTRICTHOSPITALS
NguyenBichHa,NguyenThiThuy
Background:Thedistricthospitalisamedicalagencyfunctionstoexamandtreatgenerallybothoutpatient
andinpatienultimatelyofbasicmedicallevel.Thus,itispropablymadetheparticularpressureofworkloadand
workquality.However,asthestatusofcapacityofutilizationofsickbedsinlowrateandinsufficienceofhealth
workersindistricthospitals,thereforethephysiciansandmedicaldoctorsthereconsiderhowaboutthevolume
and pressure of works as well as the status of training continuously medical skills to meet to demands of the
Tcgilinlc:Ths.NguynBchHT:0908877820 Email:nguyenbichha@ihph.org.vn
ChuynYTCngCng
273
NghincuYhc
missions..
Objectives:Tosurveythevolumeandpressureofworks,thestatusoftrainingcontinuouslymedicalskills
forphysiciansandmedicaldoctorsinsomedistricthospitals.
Methods:Descriptivecrosssectionalstudy.Subjectsarephysiciansandmedicaldoctorsworkingindistrict
hospitals.Interviewingthroughanonymousquestionairs.Samplingtotallyin12hospitals.
Result:Therewere284of335healthstaffworkingfor12districthospitalsenrolledinthisstudy.Theageof
thesesubjectswasrelativelyhigh;themedianagewas45years.Therewere70%ofhealthstaffreportedthattheir
workloadwasheavyorextremelyheavyand62%claimedthattheworkingpressurewashighorextremelyhigh.
Therewere50%ofmedicaldoctorsgetIspecialistdegreeorabove,51%ofmedicaldoctorswhodidnotbetrained
withinonelastyearwanttostudyhigheracademictitleoradvancedspeciality,and32%ofthemwantedtobe
trainedonprimaryspecialityorattendedshortcoursesontheirspecialityorEnglish.
Conclusion:Itshouldbedonemoredetailedstudyoflevelofinvestmenttoeducationspeecialityformedical
doctorsindistricthospitalsataspectofcommunityusefulness.Needtosurveymoreaboutthesidesofpressure
and not satisfied with works simultaneously need to consolidate strengthly functional role to exam and treat
primarietyforpatientsofdistricthospitallevel.
Keywords:Physicians,medicaldoctors,districthospitals,trainingmedicalskills,pressureofworks
nhngcitinphhpsdngnhnlcyt
TVN
hplvmbochtlngcngvictthn.
Bnh vin (BV) huyn l n v y t thuc
Mctiunghincu
tuyn y t c s. Nhim v ch yu ca BV
nh gi mc tham gia cc hot ng
huynlkhmchabnhakhoabanu,gii
khm
cha bnh v khi lng mt s v tr
quytccvncbnvcctrnghpcp
lmviccays,bcs.
cunivngoikhoa.MtbcsiutrtiBV
huyn i hi phi c kh nng chuyn mn
rng thc hin tt nhim v trn. Bn cnh
, quy nh BV huyn v cc trm y t x
phng l ni ng k khm cha bnh ban
uchophnlnitng(1),nnsngidn
nkhmchabnhthngthngBVhuyn
scao.Vthscplcnhtnhdoyucu
phi m bo c s lng v cht lng khm
cha bnh t ln vai cc bc s iu tr. Bn
cnh,tnhtrngthiunhnlcytchcht
vmtsbcsvalmcngtcchuynmn
valmcngtcqunlthngxyraccBV
tuyn huyn gy kh khn trong vic hon
thnhttnhimvkhmchabnh.Mtkhc
nhucucncotonngcaovcpnht
thng xuyn v chuyn mn th cha c
trin khai mnh m cho cc i tng ny. Do
vy,thctkhilngvplccngviccng
nhnhucuotolintccaccys,bcs
tiBVhuynlmtvncnclnggi.
Nh gip cho ngi qun l bnh vin c
274
nhgimcplctkhilngcng
vickhmchabnhcngnhtonbcccng
vickhcmyshocbcsmtrch.
Xc nh tnh trng o to lin tc v
chuynmnyvnhucucotocacc
ys,bcs.
ITNGPHNGPHPNGHINCU
itngnghincu
Tonbnhnvinytlys,bcslmvic
ticcBVhuyn
Thitknghincu
Mtctngang.Thigian:thng8thng
11/2011. a im: Cc BV huyn ti cc tnh
ng Nai, Ty Ninh, Long An, Tin Giang v
BnTre.
Mi tnh min Ty chn ngu nhin 2 BV
huyn,mitnhminngchnngunhin3
BVhuyn(BVhuyncththuctrungtmyt
huyn).Tngcngc12BVhuynvisys,
bc s l 335. Ly mu ton b v s mu sau
ChuynYTCngCng
cngl284ys,bcs,t85%,scnliihc
xa,icngtc,nghm,nghhusn.
Thitkbcuhitinkhuytdanhv
tnh trng chuyn mn c o to v nhn
nh ca h v khi lng v p lc cc cng
victheonhimv.Gibncuhitiys,bc
s theo danh sch ca 12 bnh vin c chn,
saunhmnghincutitngbnhvin
gimst,hngdninyccthngtin
vthunhnbntrlihonchnh.
KTQUNGHINCU
Ccctnhcamunghincu
NghincuYhc
100,0
Chuyn khoa
Ni, Nhi, Nhim
Ngoi, sn, chn thng chnh
hnh
Gy m, hi sc cp cu
Cn lm sng
TMH, RHM, ng y, da liu
Qun l y t, y t cng cng
Khng chuyn khoa (a khoa)
Hc v
Bc s, chuyn khoa s b
Chuyn khoa I, thc s
Chuyn khoa II
47
29
27,8
17,2
2
7
37
12
35
1,2
4,1
21,9
7
20,8
100,0
84
83
2
49,7
49,1
1,2
100,0
Bng1.Tuicays,bcscphngvn
i
tng
Bc s
Y s
n
169
115
Ti
Trung
Ti a
thiu
bnh
22
59
44,18
21
59
39.4
Trung lch
v
chun
45
6.14
45
11.23
Bng4.PhnloitheochuynkhoacaYs
Chuyn khoa Y s
Tn sut
(n=115)
31
22
10
6
20
26
a khoa
Sn
Nha
Tai mi hng
ng y
Khc
T l
(%)
27
19
8,8
5,3
17,3
22,6
100,0
Bng5.Phnbvtrlmviccays,bcs
(n=284)
Thuc khoa
phng
Biu1.Phnbtuicays,bcscphng
vn
Bng2.Giitnhcays,bcscphngvn
Nam
i tng Tn
T l
sut
(%)
Y s v Bc 123
43,3
s
Y s
34
29,6
Bc s
89
52,7
N
Tn
sut
161
T l
(%)
56,7
81
80
70,4
47,3
Tng
284 100,0
115 100,0
169 100,0
Bng3.Phnloitheochcdanh,chuynmnv
hcvcabcs
Phn loi chc danh, chuyn

mn, hc v
Tn sut
(n=169)
Chc danh qun l
Ban lnh o
27
Trng/Ph khoa chuyn mn
90
Trng/Ph phng chc nng
12
Bc s nhn vin
40
ChuynYTCngCng
T l
(%)
Ban lnh o v
cc phng chc
nng
Khoa hi sc cp
cu
Khoa ni, nhi,
nhim, ng y
Khoa ngoi sn,
chn thng chnh
hnh
Khoa khm bnh
Khoa cn lm
sng
Y t d phng,
phng chng
nhim khun
Cng
Bc s
S
T l
lng (%)
Y s
S
T l
lng (%)
Cng
39
23,1
7,8
48
15
8,9
10
8,7
25
34
20,1
22
19,1
56
28
16,6
18
15,6
46
33
19,5
35
30,4
68
4,7
6,1
15
12
7,1
14
12,2
26
169
100,0
115
100,0
284
16
53,2
7
23,8
275
NghincuYhc
Khilngcngviccays,bcs
Y s
8.7
n=115
23.5
Bc s nhn vin
n= 40
Trng/ ph phng
n= 90
16.7
Trng ph khoa 0
73.3
Lnh o
n= 27
20
40
66.7
18
38.5
7.4
80
100 (%)
10
20
30
Qu nhiu
Hi sc cp cu
43.6
44.4
48.2
70.4
60
iu tr ni tr
70
16.7
n= 90
63
0
Trng ph phng 0
n= 12
83.3
61.1
14.8
Khm bnh v iu tr ngoi tr
22.5
7.5
87.5
58.3
35.6
Lnh o n= 27
Bc s nhn vin
n=4
57.5
33.3
n= 12
44
40.7
13.5
47.8
25
Trng/ ph phng
1.7
n=115
40
50
Nhiu
60
70
80
Biu4.Tnhnxtvmckhilngcng
Biu2.Tlthamgiakhmchabnhtrongsy
s,bcscphngvn(n=284)
Hnh chnh
Ti Ti Trung Trung
n
thiu a bnh
v
33
7
Cn lm sng
Hi sc cp cu
8.7
iu tr ni tr
23.5
47.8
0
10
20
30
40
50
60 (%)
Biu3.Tlysthamgiaccloicngvickhc
nhau(n=115)
Bng6.Tnhnxtvmckhilngcngvic
cay,bcs
Mc khi
lng cng vic
Tn sut
T l
(n=284)
(%)
Thi lng khm cha bnh so vi tng lng cng vic
Di 25%
13
4,4
T 25 di 50%
35
12,4
T 50 di 75%
78
27,5
T 75- 100%
158
55,8
100,0
T nhn xt v tng khi lng cng vic chung
Qu nhiu
74
26,1
Nhiu
125
44
t vic
3
1
Va
82
28,9
100,0
Mc p lc cng vic chung
Rt cng thng
43
15,2
Cng thng
133
46,8
Va phi
99
34,8
Khng p lc g
9
3,2
100,0
276
Bng7.SBNtrungbnhmys,bcsphtrch
khmiutrtrong1ngycthamgiaKCB
22
iu
Khm v iu tr
ngoi tr
viccatheochcdanh
S BN
khm iu
tr ngoi
120
tr trung
bnh mt
ngy
S BN
iu tr ni
tr hoc 102
hi sc
cp cu
H s
bin
lch
thin
chun
(%)
200 62,11
55
45,81
73,76
55
20
12,20
58,35
20,91
Mcplccngviciviys,bcs
Bng8.Tnhgimcplccngviccay
s,bcs(n=284)
Mc
Rt cng thng
Cng thng
Va phi
Khng p lc g
Tn s
43
133
99
9
T l (%)
15,1
46,8
34,9
3,2
ChuynYTCngCng
Y s
5.2
40.9
8.7
Bc s nhn vin
n=40
Bng12.Ccldochnhkhinys,bcskhng
thamgiahcnngcao
45.2
n=115
7.5
30
L do
55
7.5
Trng ph phng
n=12
33.3
50
Cha thm nin, ln tui

Hon cnh ring
Cng vic qu nhiu
Khng c kha hc thch hp
L do khc
16.7
0
Trng ph khoa
n=90
27.8
46.7
25.5
Lnh o
22.2
n=27
55.6
22.2
0
10
Rt cng thng
20
Cng
30
40
Va phi
50
60 (%)
Biu5.Tnhgimcplccngvictheo
chcdanh
Bng9.Tnhgimckhnngmnhim
cngvicKCBcgiao
Tn s
(n=284)
17
20
65
182
Di 25%
T 25 di 50%
T 50 di 75%
T 75 100%
T l (%)
6,0
7,0
22,9
64,1
100,0
Lnh o
20
BV/TTYT
Trng/Ph khoa
68
chuyn mn
Trng/Ph
11
phng chc nng
Bc s nhn vin 23
Y s
100
Cng
222
74,1
25,9
27
100,0
75,6
22
24,4
90
100,0
91,7
8,3
12
100,0
57,5
86,9
78,2
17
15
62
42,5
13,1
21,8
40 100,0
115 100,0
284 100,0
Bng11.Tlccloikhahcchnhcthamgia
Kha hc
Thc tp sinh tuyn trn
Chuyn khoa s b
i hc (BS chuyn tu)
Chuyn khoa I/cao hc
Chuyn khoa II/NCS
Tn s
(n=62)
7
16
6
30
3
ChuynYTCngCng
T l (%)
11,3
25,8
9,7
48,4
4,8
100,0
32,0
23,0
25,2
5,8
14,0
100,0
Bng13.Ccloihnhotocnthittheonhucu
cngviccaccys,bcs
Loi hnh o to
Ngn hn cp nht chuyn
mn, ngoi ng
Nng ln mt hc v
Nhiu loi chuyn khoa s b
Mt s chuyn khoa su
Qun l y t/qun l nh
nc/y t d phng
Tn s
(n=154)
25
T l (%)
54
25
30
20
35,1
16,2
19,5
13,0
16,2
BNLUN
Bng10.Phntchtlys,bcscthamgiahc
nngcaochuynmn
Khng
C
Tn T l
T l Tng
Tn s
s
%
%
T l (%)
100,0
Tnhtrngys,bcschcnngcaov
nhucucotolintc
i tng
Tn s
(n=222)
71
51
56
13
31
Khng p lc g
Kh nng m nhim
NghincuYhc
Ccys,bcscphngvn
C284ys,bcscthamgianghincu
trntngs335ys,bcsca12BVvTTYT
cchn,t85%lngmucnly.Bcsc
tui trung bnh cao hn 40 v trung v qu 45,
y l la tui c nng lc lm vic n nh,
kinhnghimttnhngmctuitrdi30tui
ct(bng1vbiu1)cngchngtthiu
lp tha k v tip cn k thut mi. Kt qu
ny cng gn ging nh nghin cu ca
PhngThoti3BVhuyncaHNi(2).Ys
ctuitrungbnhthphnnhngc2nhca
agictns:mtmctr<25tuivmt
mc qu trung nin >45 tui. Nh vy, vn c
mtlngkhnhiuystrcvlmvic
tuynhuyn,yllclngckhnnghc
chuyntulnthnhBSpngnhucutia
phng.
Giitnhcabcstngiutrongkhi
yslngiinhiuhnsovinamgii(70,4%
v 29,6%) (bng 2). Y s l n chim t l cao
cngphhpvictrngkhilachnngh
nghip.
277
NghincuYhc
Theo s liu bng 3, bc s c chc danh

qun l nhiu nht cc khoa chuyn mn
(53,2%)ylnhmchcdanhcvtrnngct
v c chuyn mn v qun l; BS c chuyn
khoachimphnlntrongkhichc20,8%bc
slakhoa;ringhcvcaBSlchuynkhoa
1hocthcschim49,1%,chuynkhoa2l1%,
khng c tin s. Nh vy bc s chuyn khoa
sau i hc chim n 50%, y l nhm c
nnglcchuynmncaomnhimttcc
nhimvtuynBVhuynxtvkhacnhnhn
lc.
Ch27%yslakhoa,cnlilccchuyn
khoa, cc y s c b tr nhiu nht phng
khm,bphnngycakhoanivkhoa
ngoisn;ccvtrcayscngtngngvi
chuyn khoa l ca h c s dng khm
bnh(bng4).
Vkhilngcngviccays,bcs
Vic tham gia cng tc KCB khng ch c
chc danh bc s, cc bc s trng ph khoa
chuyn mn m cn c ban lnh o v cc
trng ph phng (biu 2). Trong vic
KCBngoitrcthamgianhiunhthu
ht cc chc danh ngoi tr ban lnh o th
thp hn. Bc s trong ban lnh o tham gia
iu tr ni tr t l cao (70,4%) v c ngi
thamgiachisccpcu(14,8%).Ccbcs
trngphphngchcnngcngcthamgia
KCBgingnhcckhoachuynmn.Nhvy
dvtrhnhchnh,qunlnhngcccnb
chuyn mn y vn tham gia trc tip cng tc
KCB.CcysthamgiaKCBvitlthn,c
mt lng y s lm cng vic nh iu dng
hocchlmhnhchnh(biu3).
Xtvthilngcngvicthchc55,8%
s y s, bc s cho rng cng vic chuyn mn
KCBchimt75100%,v27,4%chorngKCB
chim5075%cngvic(bng6).Scnlicho
rngcngvicKCBchchim1phndi50%
vtt nhin h c nhng cng vic khc thuc
qunlhochnhchnh.
Vtnhgikhilngcngviccays,
bc s theo s liu bng 6 c s bin thin rt
278
khc bit gia cc chc danh: Cho rng cng

vic qu nhiu c t l cao nht l ban lnh
o, sau gim dn ti cc trng ph khoa
chuyn mn, gim nhanh trng ph phng
chcnng,tiysrinbcs;chorngcng
vic nhiu chim t l cao mi chc danh;
chorngcngvicvaphithnhiunhtl
y s ri gim dn bc s v thp nht l ban
lnh o, c bit ch c 1,7% y s cho l c t
vic.Tuynhinsnhnnhnykhngchl
khilngcngvicthctmcnphthuc
khnngspxpgiiquytcngviccatng
cnhn.
Thc t ti BV tuyn huyn a s BN
khmbnhvobuisng.Ccysbcstrong1
ngythamgiakhmbnhcthcndnhthi
gian lm nhng cng vic khc sau khi lng
bnh ht. Lng bnh mi ngy do ngi
cphngvnctnhkhilmnhimvti
phng khm hoc bnh phng nh trong bng
7.Sghinhnnytuykhngphilconso
mtuytinhngcngchobitmclu
lngbnhnhnvkhilngcngvictiB
tuynhuyn.Construngvcakhmiutr
bnhngoitrl55vcanitrl20.Trong
iu kin bnh thng th y l lng bnh
nhn l tng cho bc s c thi gian xem
bnh cn k, tm hiu la chn phng n tt
choiutr,tvnchobnhnhn(mtgiBS
chnnkhmviutrt4n8BN(5)).Tuy
nhin,trongtnhtrngquticcBVtnhv
trung ng nh hin nay mi BS khm hng
trm BN mt ngy (ch 3 5 pht 1 BN(3), th
lng BN hng ngy 1 BS khm BV tuyn
huynlkhthp).
TuylngBNtnhngasys,bcsvn
cho rng khi lng cng vic l nhiu v
qu nhiu do tnh trng t s nhn vin y t
chiachogingbnhkhngtkmquynh
l ph bin, vi 90,3% s bnh vin ca 5 tnh
kho st khng t t s ny i vi ging
bnh thc k(4). C th v l do ny m mt
ngi nhn vin y t phi lm nhiu vic
honthnhnhimvchung.ycthcngl
ChuynYTCngCng
mt sc p tm l i vi y s bc s nn t l
cngthngvrtcngthngcaovhtcc
hidnhtonthigianthcschobnhnhn
v t trau di chuyn mn nng cao cht
lngiutr.
Vplccngviciviys,bcs
Tng t i vi t l t nhn nh v p
lccngviccays,bcs(biu5vbng
8): c mt t l bc s chc danh lnh o
(22,2%)chorngplccngvicvaphivt
l tng dn ti cc trng ph khoa, cc bc s
ncctrngphphngvys;cmttl
nhbcsvyschorngkhnghcplcg,
ngclicmttlasccchcdanhcho
rng cng vic l cng thng (t 45,2 55,6%)
cngvimttlthnchorng cng vic l
rtcngthng(t7,522,2%).ycnglc
trngtnhchtcngvicngnhykhngngoi
trBVtuynhuyn.
T nh gi mc kh nng m nhim
cng vic khm cha bnh c giao th a s
(64%)chorngmnhimttt75100%,c
23%strlichorngmnhimttc50
75%, s cn li (13%) cho rng ch m nhim
tt di 50% (bng 9). Tm l khng th m
nhim tt hon ton cng vic chuyn mn s
thc y ngi ta lun phi hc hi nng cao
kh nng theo kp yu cu ca i tng
phcv.Dovy,vicotolintcnhnvin
ytlkhngththiutrongngnhy.Rtnhiu
hnhthcotochoccbchccduytr
pngnhucu.
V o to lin tc nng cao nng lc

chuynmn
Theobng10,c21,8%ys,bcstrlic
tham gia hc nng cao, cp nht chuyn mn
vi cc kha hc t 3 thng tr ln k t nm
2010tithiimiutra.Bcsiutrctl
c o to cao nht, sau n ban lnh o,
trngphkhoachuynmn,ysvthpnht
ltrngphphngchcnng.Nhvybcs
iu tr vn c ch trng nng cao nng lc
chuyn mn nhiu nht. C n 48,4% (cao
ChuynYTCngCng
NghincuYhc
nht)trongs22%k trn l c o to cao

hc v chuyn khoa I v 4,8% c o to
chuynkhoaII(bng11).Tlnylrtttcho
vic nng cao cht lng ngun nhn lc y t
ca BV tuyn huyn. Cng vi l cc hnh
thc o to chuyn khoa s b, bc s chuyn
tu, thc tp sinh vi BV tuyn trn. Tuy nhin
trongnghincunychathngkclng
nhnvinytchuynikhicssaukhic
otonngcaohcvkhinBVhuynlitr
nnthiunhns,cnglmtbcxclnca
aphng.
i vi cc y s, bc s khng tham gia hc
nngcaotrongthigianktrn,ngoitrldo
chathmninhocqutuithldocng
vicqunhiuchimtlcaonht(25,2%)sau
mi n hon cnh ring, khng c kha thch
hpvldokhc.iunycngphhpvi
nhnnhkhilngcngviccays,bcs
trn(bng12).
Nhu cu c o to nng ln 1 hc v l
caonht(bng13),sauncotomt
s chuyn khoa su nh hi sc ni khoa, tim
mch can thip, phu thut ni soi, phu thut
mt Phaco , chng t phn ng cc bc s
mongmuntinxahntheomtchuynkhoa
nhtnh.iunykhnggingnhcchtip
cnlthuytvchcnngnhimvBVtuyn
huynlkhmchabnhakhoabanu,gii
quytcccabnhthngthngvnhnbitcc
ca kh chuyn BV chuyn khoa hoc tuyn
trn. Bn thn nhu cu ca ngi trong cuc
cng c kh nng to ra 1 hng i khc vi
thitkban u ca t chc, hng c lm
cho t chc BV huyn ph hp vi cng ng
haykhngtrongtnglaithcnphicnhng
nghincutiptheo.
Bncnhckhong16,2%ccys,bcs
cnhucuhcngnhncpnhtchuynmn,
ngoinghocnhiuCKsb,cchnycth
phhphnmbonhimvcbnca
BVtuynhuynhinnaycngnhdtipcn
hn i vi mi c nhn. c bit c 13% i
tngtrlicnhucucotovqunl
279
NghincuYhc
yt,ytdphngvqunlnhnc,chng
tcngtcqunl,ytdphngcngrtc
quan tm pht trin BV huyn v TTYT
huyn.
KTLUN
tui trung bnh ca bc s, y s cao t
trungv45tui.
C70%bcs,yschorngkhilngcng
vic nhiu hoc qu nhiu v 62% cho rng p
lccngviclcngthnghocrtcngthng.
C 50% cc bc s c hc v sau i hc t
CK1 tr ln. C 51% cc y s, bc s ang cng
tc v cha i hc trong thi gian iu tra c
nhu cu hc nng cao ln 1 hc v hoc hc
chuynkhoasu,32%mongmunhcchuyn
khoasbhochcngnhncpnhtchuyn
mn,ngoing.
Nncnghincusuhnvmcu
tchuynkhoachoBVtuynhuynkhacnh
li ch cng ng. Trc cn cng c mnh
mvaitrkhmchabnhakhoabanuca
tuyn BV ny. ng thi cn c thm nhng

kho st v cc kha cnh ca cng vic to
nhng p lc hay nhng s khng tha mn
cays,bcscngnhccnhnvinytkhc.
Nhraccgiiphptchcqunlph
hp hn thu ht cn b y t lm vic ti
tuyn y t c s ni chung v BV huyn ni
ring.
TILIUTHAMKHO
1.
2.
3.
4.
5.
BYt(2009).Thngts10/2009/TTBYTNgy14thng08
nm2009vHngdnngkkhmbnh,chabnhban
uvchuyntuynkhmbnh,chabnhbohimyt.
ThPhngTho(2011).Nghincuthctrngnhnlc
y t v hot ng khm cha bnh ca mt s bnh vin
huynnm20082010.Lunvnttnghipbcsykhoa.
TrngihcYHNi
Khng Anh Tun (2007). nh gi tnh trng qu ti ca
mtsbnhvintiHNivTP.HChMinhvxut
giiphpkhcphc.www.hspi.org.vn
NguynBchH(2011).Tnhtrngnhnlcytvcngsut
sdnggingbnhcabnhvintuynhuyn.ticp
csVinVsinhYtcngcngTP.HCM
Nguyn Phi Hng (2009). Cc ch s nh gi hot ng
bnhvin.BigingTchcqunlY t. i hc Y dc
TP.HCM
280
ChuynYTCngCng
NghincuYhc
TNHTRNGSCKHECANGILAONG
CNGTYTHUCLSIGN(20052009)
NguynBchH*,NguynThThy*
TMTT
tvn:Snxutthucllmphtsinhccyutchinmitrngxungquanhvtcngn
sckhecangilaong.TchictrnglgybnhnhimcNicotinnghnghip,ngoiracncctc
hisckhekhc.
Mctiu:Xcnhtnhtrngmitrnglaongvsckhebnhttcangilaongcngtythuc
lSiGntrongccnm20052009.
Phngphpnghincu:Ctngangmt.Hicusliuhskhmsckhenhk,hskhmbnh
nghnghipcangilaong,ktquomitrngcacngtythuclSiGn(cs1)tnm2005
2009.
Kt qu:Mitrnglaongcscithinngknhnhngcanthipkpthicacngtyquacc
nmnh:nngNicotinkhngkhnmtronggiihnchophp,ccyutvikhhu,nhsng,bittiu
chunvsinhlaong,ringyuttingnvnchackhcphc.Tnhtrngsckhengilaongdn
dnccithinsoviccnmtrc.Huhtngilaongmcccbnhthucnitngqut:tunhon
(3661%);tiuha,ganmt(1361%);cxngkhp(8,713,5%);taimihngvhhp(di
8%).PhnloisckhephnlnloiI(716%)vloiII(4451%).Tnhtrngmcbnhnghnghipcng
cxuhngttln:bnhsmdanghnghip,icnghnghipvbnhnhimcNicotinthpsovinhng
nmtrcvgimthnhlchaitaichchimtlrtthpdi4%.
Ktlun:Ktquomitrngvtnhtrngsckhecangilaongccithinrtnhiusovi
nhngnghincutrc.iunyphnnhvicthchincngtccitomitrngvtrangbbohlao
ngchongilaongrttt.Tuynhinnhmycnphitinhnhpdngnhngkthuthinihn
trongsnxuthnchtingn.
Tkha:Tnhtrngsckhengilaong,thuclnhhngsckhecngnhn
ABSTRACT
STATUSOFHEALTHOFEMPLOYEESINSAIGONTOBACCOCOMPANYFROM20052009
NguyenBichHa,NguyenThiThuy
Background:Productionoftobaccoreleasesharmfulfactorsintosurroundingenvironmentandhasadverse
effects on workers health. Nicotine in cigarettes causes occupational Nicotine poisonning and other adverse
effectsintobaccoworkers.
Objectives:ToidentifyconditionsofworkingenvironmentandhealthstatusofworkersofSaiGontobacco
companyfrom2005to2009.
Methods:Crosssectionalstudy.retrospectdataofperiodichealthexaminationrecords,occupationalhealth
examinationrecords,andenvironmentalmeasurementresultsofSaigontobaccocompany(base1)from2005to
2009.
Tcgilinlc:Th.sNguynBchHT:0908877820 Email:nguyenbichha@ihph.org.vn
ChuynYTCngCng
281
NghincuYhc
Result:Theworkingenvironmentwasimprovedsignificantlyoveryears,.TheNicotineconcentrationinthe
air was in acceptable limits and the elements of microclimate the light, and dust met the occupational health
criteriaHowever the noise was not improved yet. The health conditions of workers has gradually improved
comparedwithseveralyearsago.Mostworkerssufferedgeneraldiseases,namelycirculatorydiseases(3661%);
gastrointestinalandhepatobiliary(1361%),musculoskeletaldisease(8.713,5%),ear,noseandthroatdiseases
andrespiratorydiseases(lessthan8%).Theproportionsofworkerswhohadhealthstatusclassifiedintofirstand
secondclasswererelativelyhigh:firstclasssoccupied716%andsecondclassocuupied4451%.Occupational
diseases among workers also decreased: the proportions of occupational sunburnt, occupational deafness, and
Nicotinepoisoningwerelowcomparedwithpreviousyearsandtheproportionofearsmalfunctionwasunder4b
Conclusion: The results of environmental measurement and the health conditions of workers were
significantly improved compared with preceding studies. These showed that environmental improvement and
provisionoflaborprotectionequipmentsforworkershadbeendonewell.However,thecompanyshouldapply
moremoderntechniquestoreducenoise.
Keywords:healthconditionsofworkers,tobaccoeffectsworkershealth
TVN
ITNGPHNGPHPNGHINCU
Snxutthuclgyratnhtrngnhim
mi trng, tnh trng thm nhim v nhim
cNicotinmntnhcngviccrilonchc
nng sinh l c th ca cng nhn sn xut
thuc l t khu hi n thnh phm xut
xng.Btchpnhngbtlican,victrng
v sn xut thuc l vn tng ln hng nm v
nhng li ch kinh t trc tip v c vn
khng trit ca chnh sch cm thuc l.
Nhiubnhnghnghipvccvnlinquan
phtsinhttipxcviccchtnhimkhng
khnhkhibi,tingn,m,nmmc,v
cbitlcchachtchitrongmitrng
lmvicvntiptctnti.Bithucllyu
tgynnccbnhvhhpcptnhvmn
tnh,nhimcquadadocccchtctrong
n(6).Nghincumhnhsckhebnhttca
ngilaongsnxutthucllcnthit
cthcungcpthmthngtinvmtcchtng
qut v nhn nh thm v cn cn li hi ca
vicutnhiuvongnhsnxutthucl.
itngnghincu
Mctiunghincu
nhgimtsyutmitrnglaong
ctrngtinisnxutthucCngtythucl
SiGnt20052009.
Xc nh t l cc bnh thng mc ca
ngilaongCngtythuclSiGnt2005
2009.
282
NgilaongcacngtythuclSiGn
(csI)tnm20052009.
Mi trng lao ng ca cc x nghip sn
xutthucCngtythuclSiGn.
Thitknghincu
Nghincuctngangmt.Lymuton
bivingilaongcthamgiakhmsc
khe nh k v khm bnh ngh nghip t
20052009.
Hicusliutheotngnmtnm2005
nnm2009.
Nidungnhngsliuhicu:
Hskhmsckhenhktrong5nm
Hsvsinhlaongxnghip
Ktquointm,siumtngqut,
o thnh lc v o chc nng h hp trong 5
nm.
KtquphntchNicotintrongnctiu
trong5nm.
KTQU
PHN I: CC YU T MI TRNG
NILMVIC
HiNicotintrongkhngkh
ChuynYTCngCng
Bng1.KtquohiNicotintrongkhngkhqua
ccnm
Kt qu o hi
Nicotin
Trong nh my
Khu vc cp liu
Phn xng si
2005 2006 2007 2008 2009

0,27 0,56
0,58 0,37
TCVS
L
0,5
0,54
0,33
Nhn chung cc kt qu o cc phn

xng bao mm, bao cng, phn xng bao
NghincuYhc
nhn 555 v khu vc xung quanh nh my

u nm trong gii hn cho php theo tiu
chun v sinh lao ng. Hi Nicotin trong
khng kh c chiu hng gim dn trong
nhngnmtiptheo.Tuynhintikhuvccp
liuvphnxngsihiNicotinvtgiihn
chophpnhngkhngngkdi0,1.
Yutmitrngccphnxng
Bng2Ktquoyutvikhhu
Yu t
Si
Vn iu v ng gi
bao mm
Vn iu v ng gi
bao cng
Vn iu v ng gi
bao nhn 555
Vn iu v ng gi
bao nhn Marboro
Vi kh hu
2007
2008
2009
Mu vt
Mu vt
Mu vt TCVS
Mu o
Mu o
Mu o
TCVS (%)
TCVS (%)
(%)
87
29 (33,33)
51
0 (0,00)
24
8 (33,33)
2006
Mu vt
Mu o
TCVS (%)
57
15 (26,31)
87
7 (8,04)
93
20 (21,50)
153
0 (0,00)
53
1 (1,88)
75
0 (0,00)
72
18 (25,00)
117
0 (0,00)
31
0 (0,00)
15
1 (6,66)
0 (0,00)
21
0 (0,00)
30
0 (0,00)
Bng3:Ktquoyuttingn
Yu t
Si
Vn iu v ng gi
bao mm
Vn iu v ng gi
bao cng
Vn iu v ng gi
bao nhn 555
Vn iu v ng gi
bao nhn Marboro
Ting n
2007
2008
Mu vt
Mu vt
Mu o
Mu o
TCVS (%)
TCVS (%)
26
7 (26,92)
17
2 (11,76)
2006
Mu vt
Mu o
TCVS (%)
17
2 (11,76)
2009
Mu vt
Mu o
TCVS (%)
31
5 (16,12)
29
24 (82,75)
26
25 (96,15)
46
42 (91,30)
53
43 (81,13)
20
20(100,00)
29
22 (75,86)
33
24 (72,72)
40
36 (90,00)
2 (66,67)
5 (62,50)
5 (100,00)
11
10 (90,90)
Bng4Ktquoccyuthahckhc
Yu t
Si
Vn iu v ng gi
bao mm
Vn iu v ng gi
bao cng
Vn iu v ng gi
bao nhn 555
Vn iu v ng gi
2006
Mu vt
Mu o
TCVS (%)
13
0 (0,00)
Yu t ha hc khc
2007
2008
Mu vt
Mu vt
Mu o
Mu o
TCVS (%)
TCVS (%)
21
12 (57,14)
16
0 (0,00)
2009
Mu vt TCVS
(%)
0 (0,00)
Mu o
24
0 (0,00)
15
9 (60,00)
16
0 (0,00)
10
0 (0,00)
12
0 (0,00)
13
8 (61,53)
12
0 (0,00)
0 (0,00)
1 (50,00)
0 (0,00)
0 (0,00)
ChuynYTCngCng
0 (0,00)
283
NghincuYhc
Yu t
2006
Mu vt
Mu o
TCVS (%)
Yu t ha hc khc
2007
2008
Mu vt
Mu vt
Mu o
Mu o
TCVS (%)
TCVS (%)
Mu o
2009
Mu vt TCVS
(%)
bao nhn Marboro
Nhnchung,ktquovyutnhsng
vbiticcphnxngnyuttheotiu
chunvsinhlaong.Yutvikhhu,nv
yuthahckhckhngttheotiuchun
vsinh.Tiphnxngvniunggibao
mm, bao cng, phn xng nhn quc t
Marboro ting n chim t l khng t rt
caohn61%vcthcaognnhnmcti
a100%.Ringphnxngsithyutting
n di 27%. Tnh trng ting n ti cc phn
xng c ci thin nhng khng ng k qua
ccnmiutra.
Qua cc nm ti cc phn xng th nm
2007cyutvikhhuchimtldi30%,
cc yu t ha hc khc chim t l khng t
caodaongt5062%vhaichtiunyt
tiuchunhainmtiptheo2008,2009.iu
nychothyhiuqucascanthipcithin
mitrng.
PHN II. TNH TRNG SC KHE

NGILAONG
ctnhmunghincu
Bng5ctnhmunghincu,tns(%)
2005
2006
2007
(n=1496) (n=1920) (n=1932)
Gii
Nam
757
966
994
(50,60) (50,31) (51,45)
N
739
954
938
(49,40) (49,69) (48,55)
Tui
18 32
245
375
331
tui
(16,38) (19,53) (17,13)
33 47
1000
1194
1184
tui
(66,84) (62,19) (61,28)
48 tui
251
351
417
(16,78) (18,28) (21,58)
2008
2009
(n= 1967) (n= 1911)
1023
(52,01)
944
(47,99)
1006
(52,64)
905
(47,36)
316
(16,07)
1176
(59,79)
475
(24,15)
315
(16,48)
1071
(56,04)
525
(27,47)
Qua tng nm, s phn b gii tnh gia

namvnkhngkhcnhaunhiu.
Vnhmtuicangilaongquabng
sliutrntathynhmtuilaongchyu
284
l3347tuichimtlt6167%,nhmtui
chimtlthpnhtlnhm1832tuidao
ngt1620%.
Tnh trng sc khe ca ngi lao ng qua

tngnm
Bng6Ccbnhvmtcangilaong,tns
(%)
2005
Tnh trng
(n =
v mt
1496)
Bnh
1467
thng (98,06)
Bnh v
mt
29
(1,94)
2006
(n =
1920)
1896
(98,75)
24
(1,25)
2007
(n =
1932)
1904
(98,55)
28
(1,45)
2008
(n =
1967)
1947
(98,98)
20
(1,02)
2009
(n =
1911)
1905
(99,69)
6
(0,31)
Tnhtrngbnhvmtcangilaong
chimtlrtthpchyulmngthtt0,1
2%,ktiplbnhvgicmctlt0,051%
quatngnm.Nhngbnhcnlirthimxy
ra.
Bng7Ccbnhvtaimihngcangilao
ng,tns(%)
Tnh trng
2006
2007
2008
2009
v
2005
(n =
(n =
(n =
(n =
tai mi (n = 1496)
1920) 1932) 1967) 1911)
hng
Tnh trng v tai
Bnh thng
1451
1878
1865
1896
1861
(96,99) (97,81) (96,53) (96,39) (97,38)
Vim tai
Gim thnh
lc
Bnh khc
Bnh thng
Bnh v mi
Bnh thng
Bnh
29(1,94) 21(1,09) 35(1,81) 45(2,29) 35(1,83)

0 (0,00)
1(0,05) 3(0,16) 4(0,20) 9(0,47)
16(1,07) 20(1,04) 29(1,50)
22
6(0,31)
(1,12)
Tnh trng v mi
1363
1735
1726
1786
1786
(91,11) (90,36) (89,34) (90,80) (93,46)
206
181
125
1133
185
(8,89)
(9,64) (10,6) (9,2) (6,54)
Tnh trng v hng
1376
1731
1739
1718
1709
(91,98) (90,16) (90,01) (87,34) (89,43)
249
202
189
193
9120
(8,02)
(9,84) (9,99) (12,66) (10,57)
ChuynYTCngCng
Tnh trng thnh lc ca ngi lao ng
tng i tt trn khm lm sng, t l gim
thnh lc mt tai hoc hai tai rt thp < 1% v
chyulbvimtaichimtl<3%.Trongs
nhng ngi lao ng b vim tai th v tr b
vimchyultaigiachimtl>90%.
Tnhtrngvmithasngilaong
thngchimtlgn>90%.Chcstlb
bnh vim mi d ng v vo vch ngn dao
ngtrongkhong36%.Nhngbnhkhcv
mikhccngchimtlkhngngk.
Tnhtrngbnhvhngcangilaong
thcmtstlbbnhvimhngmntnhv
vimamydalechimtl<8%.
Biu1Tnhtrngmcccbnhvnitngqut
cangilaong
100
90
80
83,25%
80,63%
77,80%
75,10%
71,79%
T l (%)
70
60
50
40
30
28,1%
24,90%
22,20%
20
19,37%
16,75%
10
0
Nm 2005
Nm 2006
Nm 2007
Nm 2008
Bnh thng Bt thng
Nm 2009
Quabiutrntathycsgimdnv
tlmcbnhnitngquttheotngnmiu
tra.Nm2005 chim t l 28,1% n nm 2009
tlnychcn16,75%.
Biu2.Nhngbnhltheophnkhoanitng
qutcangilaong
80
T l %
60
40
20
0
Nm 2005
Nm 2006
Nm 2007
Tiu ha, gan mt
Tun hon
Tm thn- TK
Tit niu
C, xng,khp
Ni tit
Nm 2008
Nm 2009
H hp
Trong s nhng ngi mc bnh ni tng

qut th t l bnh chim cao nht l bnh v
ChuynYTCngCng
tun hon t 34,97 58,38% v c hin tng

tngdnnhngnmtiptheo.Knlbnh
v tiu ha, gan mt chim t l dao ng t
13,47 35,20%, gim dn nhng nm tip
theo.Bnhvcxngkhpvnititchimt
lthpt8,7413,17%.Trongbnhchimt
lthpnhtlhhp,tmthnthnkinhv
titniudi9%.
Bnhcththeophnkhoanitngqutca
ngilaongtnm20052009
Bng8Tnhtrngmcccbnhvtiuha,gan,
mt,tns(%)
2009
Bnh v tiu 2005 2006 2007
2008
ha, gan, mt (N=157 (N=128 (N=132
(N =
(N= 73)
45)
)
)
)
Hi chng d
87
92
70
41
23
dy
(55,41) (71,88) (53,03) (56,16) (51,11)
Vim/lot d dy 54
26
49
25
15
(34,39) (20,31) (37,12) (34,25) (33,33)
Vim gan
2(1,27) 2(1,56) 3(2,27) 1(1,37) 4 (8,8)
Si ti mt
0 (0,00) 1(0,78) 1 (0,76) 3 (4,11) 0 (0,00)
Vim i trng 6 (3,82) 3 (2,34) 5 (3,79) 2 (2,74) 3 (6,67)
Gan nhim m 5 (3,18) 3 (2,34) 2 (1,52) 1 (1,37) 0 (0,00)
Bnh khc 3 (1,91) 1 (0,78) 2 (1,52) 0 (0,00) 0 (0,00)
Trong s ngi lao ng bnh v tiu ha,

ganmtthtrongtlmcbnhhichng
ddycaonhtchimtrn50%,bnhvim/lot
ddychimtldaongt2035%.Nhng
bnhkhccnlithchimtlkhngcaodi
9%.
Bng9Tnhtrngmcccbnhthuchtunhon,
tns(%)
Bnh v tun
hon
Cao huyt p
100
NghincuYhc
Ri lon nhp
tim
Suy tim
Bnh van tim
Thiu mu c
tim
Bnh v thiu
mu
Dn tnh mch
chi
Bnh khc
2009
2005
2006
2007
2008
(N =
(N =
(N = 254) (N = 181) (N= 193)
195)
156)
100
141
129
127
106
(61,10) (55,51) (71,27) (65,80) (54,36)
7 (4,49) 2 (0,79) 7 (3,87) 5 (2,59) 2 (1,03)
0 (0,00) 1 (0,39) 0 (0,00) 0 (0,00) 0 (0,00)
2 (1,28) 3 (1,18) 2 (1,10) 2 (1,04) 1 (0,51)
1 (0,64) 2 (0,79) 0 (0,00) 0 (0,00) 1 (0,51)
1 (0,64) 0 (0,00) 0 (0,00) 0 (0,00) 0 (0,00)
41
104
40
58
85
(26,28) (40,94) (22,10) (30,05) (43,59)
4 (2,56) 1 (0,39) 3 (1,66) 1 (0,52) 0 (0,00)
285
NghincuYhc
theo di si
thn
Nang thn 2(22,22) 0 (0,00) 0 (0,00) 0 (0,00) 1(33,33)
Si bng
1
0 (0,00)
0 (0,00) 0 (0,00) 0 (0,00)
quang
(14,29)
Bnh khc
2
0 (0,00)
0 (0,00) 1 (9,09) 0 (0,00)
(28,57)
Trong s nhng ngi mc bnh v tun

honthchyulbnhcaohuytpchimt
lhn50%;bnhdntnhmchchichimtl
dao ng t 22 44% v nhng bnh khc
chimtlthpkhngngkdi1%.
Bng10Tnhtrngmcccbnhvtmthnthn
kinh,tns(%)
Bnh v tm 2005
2006
2007 2008 2009
thn thn
(N
=
21)
(N
=
11)
(N
= 12) (N= 9) (N = 5)
kinh
Ri lon tin
10(47,62) 4(36,36) 1(8,33) 4(44,44)2(40,00)
nh
Hi chng suy
nhc thn 3(14,29) 3(27,27) 4(33,33)2(22,22)1(20,00)
kinh
Vim dy thn
3(14,29) 2(18,18) 6(50,00)2(22,22)1(20,00)
kinh
Bnh khc 5(23,81) 2(18,18) 1(8,33) 1(11,11)1(20,00)
Trong s ngi lao ng mc bnh v tm

thnthnkinhthchyulbnhrilontin
nhchimtltrn37%,hichngsuynhc
thn kinh chim t l dao ng t 14 34%,
bnh vim dy thn kinh v mt s bnh khc
thchimtldaongt824%,ringnm
2007 t l bnh vim dy thn kinh chim n
50%.
Bng11:Tnhtrngmcccbnhvhhp,tns
(%)
2009
(N = 14)
7(50,00)
Bnh c 2005
2006
2007
2008
2009
xng
(N
=
39)
(N
=
45)
(N
=
53)
(N=
49)
(N
= 44)
khp
Thoi ha
6(15,38) 8(17,78) 19(35,85)14(28,57) 5(11,36)
ct sng
au
khp/vim 19(48,72)28(62,22) 1 (35,85) 25(51,02)17(38,64)
khp
Thoi ha
6(15,38) 6(13,33) 1 (18,87) 9(18,37) 18(40,91)
khp
au c 1(2,56) 1 (2,22) 2 (3,77) 0 (0,00) 3(6,82)
Bnh khc 7(17,95) 2 (4,44) 3 (5,66) 1 (2,04) 1 (2,27)
Hu ht ngi lao ng mc bnh au

khp/vimkhpchimtlcaodaongt35
63%, bnh thoi ha ct sng v thoi ha
khp cng l bnh thng mc ca ngi lao
ngchimtldaongt1141%.
100
5(35,71)
2 (14,29)
0 (0,00)
Nhn chung phn ln ngi lao ng bnh

hhpchyulhenphqun,chimtldao
ngt2050%.Knllaophichimtl
daongtrongkhongt3668%.Bnhvim
ph qun chim t l khng ng k di 6%,
ringnm2009chimtl14,29%.
Bng12Tnhtrngmcccbnhvtitniu,tns
(%)
Bnh v tit 2005
2006
2007
2008
2009
niu
(N = 9) (N = 7) (N = 9) (N= 11) (N = 3)
Si thn hoc 7(77,78) 4(57,14)9(100,00) 10(90,91) 2(66,67)
286
Bng13Tnhtrngmcccbnhvcxng
khp,tns(%)
90
80
70
T l (%)
Bnh v h 2005 2006

2007
2008
hp
(N = 22) (N = 22) (N = 34) (N= 23)
Lao phi
11
8(36,36) 7(20,59) 8 (34,78)
(50,00)
Hen ph
1
9(40,91)
23(67,65) 11(47,83)
qun
(50,00)
Vim ph
0 (0,00) 1 (4,55) 2 (5,88) 0 (0,00)
qun
Bnh khc 2 (9,09) 2 (9,09) 2 (5,88) 4 (17,39)
Phn ln ngi lao ng mc bnh v tit

niuchyulsithnvcntheodisithn
chim t l dao ng trong khong 57 100%.
Nhngbnhkhcchimtlthpkhngng
k.
75,00%
72,46%
71,93%
78,79%
73,91%
60
50
40
30
20
28,07%
27,54%
26,09%
25,00%
21,21%
10
0
Nm 2005
Nm 2006
Nm 2007
Tiu ng
Nm 2008
Nm 2009
Bnh v tuyn gip
Biu3Tnhtrngmcccbnhvnitit
Nhnvobiutathytlmcbnhv
tuyngipcangilaongrtcaotrn71%.
Trong s ngi mc bnh ni tit, bnh tiu
ngchimtlt2129%.
ChuynYTCngCng
Bng14Ktqubnhvtuyngip,tns(%)
Bnh c th
2005
2006
2007 2008 2009
v
(N = 42) (N = 44) (N = 37) (N= 41) (N = 28)
Tuyn gip
Bu gip n
30
36
29
36
23
thun/ theo di
(81,82) (78,38) (87,80) (82,15)
(71,43)
bu gip
Nhn gip
10
4
2
2
2
(23,81) (9,09) (5,40) (4,87) (7,14)
Cng gip
2
4
6
3
3
(4,76)
(9,09) (16,22) (7,31) (10,71)
Trong s nhng ngi mc bnh v tuyn

gip th ch yu l bnh bu gip n thun
hoctrongtnhtrngtheodibugipchim
tltrn71%.
Bng15Tnhtrngmcccbnhvdaliu,tns
(%)
Bnh v da 2005
liu
(n=1496
)
Bnh thng 1409
(94,18)
Sm da 14 (0,94)
Bnh khc
73 (4,88)
2006
(n=1920)
1809
(94,22)
11 (0,57)
100(5,21)
2007
2009
2008
(n=1911
(n=1932
(n=1967)
)
)
1864
1890
1862
(96,48) (96,09) (97,44)
2 (0,10) 2 (0,10) 1 (0,05)
66
75(3,81) 48(2,51)
(3,42)
V bnh ny nhn chung th t l mc ca

ngi lao ng rt thp di 5%, ring bnh
smdanghnghipchimtlthpvcchiu
hnggimdnnhngnmtiptheo.
Bng16Ktquphnloisckhecangilao
ng,tns(%)
Phn
2005
2006
2007
2008
2009
loi
(n =
(n =
(n =
(n =
(n =
sc
1496)
1920)
1932)
1967)
1911)
khe
Loi I 171(11,43 265(13,80
290(15,18
149(7,71) 189(9,61)
)
)
)
Loi II 719(48,06 845(44,01 906(46,89 948(48,20 965(50,50
)
)
)
)
)
Loi III 548(36,63 750(39,06 820(42,44 764(38,84 598(31,29
)
)
)
)
)
Loi IV 47(3,14) 58(3,02) 55(2,85) 47 (2,39) 41(2,15)
Loi V 11(0,74) 2(0,10) 2 (0,10) 19 (0,97) 17(0,89)
V phn loi sc khe ngi lao ng qua

ccnmtanhnthytnhtrngsckheloiI
ch chim t l dao ng trong khong t 7
16%. Phn ln ngi lao ng tp trung trong
nhmsckheloiIIchimtldaongt44
51%vcchiuhngtngdnnhngnm
ChuynYTCngCng
NghincuYhc
tiptheo.Tlngilaongthucnhmsc
kheloiIIIcngkhcaodaongt3143%.
Kt qu o chc nng h hp, thnh lc,

Nicotinniu
Bng17Ktquochcnnghhp,tns(%)
Kt qu
Bnh thng
2005
2006
(N=1365
(N=1729)
)
1297
1696
(95,02) (98,10)
2007
2008
2009
(N
(N=1254 (N=1270
=1495)
)
)
1437
1199
1229
(96,12) (95,63) (96,78)
Ri lon thng
68 (4,98) 33 (1,90) 58 (3,88) 55 (4,37) 41 (3,22)
kh hn ch
Nhn vo bng trn nhn thy phn ln

ngi lao ng ch yu b ri lon thng kh
hnchvchimtlrtthpdi5%..
Bng18Ktquothnhlc,tns(%)
Kt qu
Bnh
thng
2006
2007
2005
2008
2009
(N=1656 (N=1215
(N=1313)
(N=1224) (N=1273)
)
)
1250
1612
1180
1167
1189
(95,20) (97,34) (96,05) (95,30) (93,38)
Gim thnh
0 (0,00) 0 (0,00) 23 (1,90) 36 (2,82 )
lc 1 tai
63 (4,80)
Gim thnh
44 (2,66) 48 (3,95) 34 (2,80) 48 (3,80 )
lc 2 tai
N = 39 N = 39
ic ngh
19
17 (43,58)
nghip
(48,71)
Cha pht
17
hin ic
4 (10,27)
(43,58)
ngh nghip
Theo di
gim sc
3 (7,71) 18 (46,15)
nghe do n
Trong s nhng ngi lao ng c o

thnhlcthtlbgimthnhlcchimtl
thpvsngigimthnhlchaitaichimt
l t 2 4% cao hn so vi s ngi b gim
thnhlcmttaichimtlt13%.
Vicnghnghiptrongs39bnhnhn
c o ic ngh nghip th t l mc bnh
chimrtcaodaongtrongkhong4349%.
Bncnhthtltheodigimscnghedo
nnm2009caohnnm2008.
Bng19KtquxtnghimNicotinniu,tns
(%)
Kt qu
2005
(N=144)
2006
(N=611)
2008
(N=346)
2009
(N=
847)
287
NghincuYhc
Bnh thng
Vt mc
bnh thng
96
(66,67)
48
(33,33)
407
(66,61)
204
(33,39)
297
(85,84)
49
(14,16)
708
(83,59)
139
(16,41)
a s nhng ngi lao ng c xt

nghimNicotintrongnctiukhngugia
cc nm. Trong t l ngi lao ng c kt
qu vt mc bnh thng chim t l t 14
34%.
BNLUN
Yutmitrng
KtquoNicotintrongkhngkhchothy
phnlnccphnxnguttiuchunv
sinhlaongvcnngNicotinnmtrong
gii hn cho php. Ring phn xng si th
nng vt gii hn cho php nm 2005 v
gim dn n ngng cho php nhng nm
tiptheo.SoviktquiutracaHongVn
Bnhtnm1985n1995thnngNicotin
phnxngnylunluncaohnnngcho
php v nng Nicotin trong khng kh cao
gp23lntiuchunquynh,nngbi
thiimnghincurtcaogp510lntiu
chunchophp(1,6).Ktquoyuttiuvikh
hu,tingnvyuthahckhckhngt
ccphnxng.
Tnhtrngsckhecangilaong
Bnh v mt ch yu l cc bnh thng
thngvimktmc,mngthtvcngchim
tlrtthpkhngngkdi1%sovikt
qu nghin cu ca Phan B Nhun v Hong
Vn Bnh th tnh trng gim th lc v bnh
vim kt mc lu khi t 16 26%(6) v so vi
nm 1995 th t l bnh ny l 13,2%(2). mt
nghincukhctrnitng203cngnhn
cng ty c phn giy Hi Dng th bnh mt
chim t l rt cao trong vim kt mc l
82,1%vmngmt7,7%(5).Bnhmichyul
vimmidngvvovchngnmichimt
lkhngcaodi6%vgimdnnhngnm
tip theo; tng t bnh v hng ch yu l
vim hng mn tnh v vim amydal di 8%,
c khuynh hng gim dn nhng nm tip
theosoviktqunghincucaHongVn
288
Bnh giai on 1985 1995 th t l bnh ny

c thng k l rt cao 56 71%(6) v kt qu
ca Mai Tun Hng th kt qu ny l 14,3%
cngnhnmcbnhvtaimihng.Nhvy
vicpdngcctrangbbohlaongvci
tinmitrngemlihiuqungktrong
vicbovsckhecangilaong
Bnh v ni tng qut m ngi lao ng
mc nhiu nht l bnh tun hon chim t l
caodaongt34,9758,38%vchintng
tngdnnhngnmtiptheo.Bnhcthl
cao huyt p trn 50% v k n l gin tnh
mchchichimtldaongt2244trong
snhngngimcbnhtimmch.Sovikt
qukhostcaHongVnBnhthtlbnh
tim mch ni chung cao hn giai on ng
thngkchchimtlt3245%sngilao
ngmcbnhny.Knlbnhvtiuha,
gan mt chim t l dao ng t 13 36% v
gimdnnhngnmtiptheo.Bnhchyu
l hi chng d dy trn 51% v vim lot d
dy chim t l t 20 38% trong s ngi b
mc bnh v tiu ha, gan mt. So vi kt qu
caHongVnBnhgiaion19851995tht
lnyl1423%.Nhnchungngilaong
ckhuynhhngbnhvtimmchvtiuha,
gan mt rt cao v c chiu hng gia tng.
Bnh v tm thn thn kinh ch yu l bnh
ri lon tin nh chim t l di 40% v suy
nhcthnkinhchimtldi34%trongs
nhngngilaongmcbnhny(6).
Vbnhhhpngilaongchchim
tldi8%trongsngimcbnhvh
hpchyulhenphqunchimtlt35
68%vlaophichimtlt2050%.Ngoi
ra kt qu o chc nng h hp cn cho thy
phn ln ngi lao ng b ri lon thng kh
hnchchimtldi4%.
Bnh v ni tit th a s ngi lao ng
mc bnh tiu ng chim t l kh cao trn
73%vcchiuhngtngdnnhngnm
tiptheo.Ngcli,bnhvtuyngipcchiu
hng gim dn t l mc bnh cao nht l
28,07%nm2005;chyulb bu gip n
ChuynYTCngCng
thunhoctrongtnhtrngtheodibugip
v k n l cng gip so vi kt qu nghin
cu ca Mai L Hip(4) th t l bnh v tuyn
gipgimngk.
Bnhvdaliuchyuldngdavnm
da chim t l thp di 3, ring bnh sm da
ngh nghip chim t l di 1%, t l ny so
viktqunghincucaHongVnBnhv
Phan B Nhun th tnh trng sm da ngh
nghip gim ng k vi t l 4,2% nm
2005(6).Vsoviccnhmykhcthtlsm
da ngh nghip ca cng ty ny vn rt thp
(nhmyLotabasmdanghnghipl12,97%,
nh my Thng Long 12,5%, nh my Bc Sn
12,5%)(6).
Phnloisckhecangilaongqua
sliutnghpcnhnchungthsckhe
loiIchimtldi16%,chyutptrung
loiIIchimtlt4451%vloiIIIt31
40%gimsoviktquiutracaHongVn
Bnhgiaion19851995sckheloiIvloi
II chim 85,73% v th lc loi A v B chim
86,74%(2,1)vsoviktqucaMaiTunHng
thtcngnhncsckheloiIrtthp2,0%,
loi II 50,7%.(5) Qua kt qu ny cho thy nu
phntchtngbnhcthcangilaong
th tnh trng sc khe ca h c ci thin
ngksovithikkhostgiaion10nm
caHongVnBnhnhngnunhgitng
ththtnhtrngsckhechungthgimnhiu
so vi giai on trc v tiu chun nh gi
tnh trng sc khe hin ti khc hn thi k
trc.
NghincuYhc
theodiicnghnghipnytnhtrntngs
cng nhn o thnh lc th t l ln lt l
0,013%, 0,014% nm 2009 v 0,015%, 0,002%
nm 2008 thp so vi kt qu ca Mai Tun
Hngtlicnghnghipl0,5%vtheodi
icnghnghipl5,1%.(5)
KTLUN
Vmitrnglaongcscithinng
k,nngNicotintrongkhngkhnmtrong
giihnchophp,cmtvikhuvcchat
nhng t l vt gii hn rt thp so vi tiu
chun.Mtschtiuvvikhhu,nhsng,
bi ci thin r rt qua nhng nm iu tra,
ring ch tiu ting n cha t tiu chun v
sinhlaong
Tnhhnhsckhecangilaongdn
dn c ci thin so vi nhng nm trc.
Trongbnhthngmcchyulbnhv
tunhonchimtl3661%vtiuhagan
mtchimtl1336%.Knlbnhvc
xngkhp.Bnhnititchimtldi12%.
Bnhvtaimihngcngthngkhph
binitngnychimtldi8%,bnh
vhhpthchimtlrtthpdi8%.Ring
vbnhsmdanghnghip,icnghnghip
v bnh nhim c Nicotin cng thp so vi
nhng nm trc. Tnh trng sc khe c
nh gi chung ca ngi lao ng thng qua
vicphnloisckhethsckhethucloiI
chimtl716%vIIchimtl4451%.
KINNGH
TlnhimNicotinnhngngilaong
c xt nghim Nicotin niu cho thy t l b
nhimcl1434%soviktqunm1985
1995tlnyl33,9%(1,6).
Vmitrngnhngnimangtnhchi
caocntheodichtchvnhgihiuqu
ccbinphpcithinmitrnglmvicmt
cch kp thi c nhng nh hng khc
phchocphthuy.
Ktquothnhlc:chyulgimthnh
lchaitaidi5%vbnhicnghnghipth
sliuchthngkcvonm2008v2009,
trong39cngnhngimthnhlchaitaic
o th t l ic ngh nghip ln lt 48,71%,
43,58% v theo di gim sc nghe do n l
46,15%nm2009.Ktquicnghnghipv
Cnaranhngchnhschvbinphp
chm sc sc khe dnh cho nhng lao ng
thngxuyntipxcviccyuchinh
ting n, Nicotin, bi v nhng lao ng mc
bnhicnghnghip,theodigimscnghe
do n v nhng lao ng c nng Nicotin
niu vt mc bnh thng; nn tuyn truyn
ChuynYTCngCng
289
NghincuYhc
vtphunchohmtsbinphptgign,
bovsckhechoringmnh.
3.
4.
TILIUTHAMKHO
1.
2.
HongVnBnhvcngtcvin(1992)Mitrnglaong
vsckhecngnhnnhmythuclSiGnsaukhii
mi,Hinghkhoahckthut19911992,VinvsinhY
tCngcngTP.HChMinh,trang12.
Hong Vn Bnh v cng tc vin (1996) nh gi mi
trnglaongvsckhecngnhnnhmythuclSi
Gntrong10nmqua(19851995),Hinghkhoahckthut
19951996,VinvsinhYtCngcngTP.HChMinh,trang
110.
5.
6.
Journal of Occupational Health.(2005), http://joh.med.uoeh

u.ac.jp/pdf/E47/E47_2_13.pdf,ngytruycp22/10/2010.
MaiLHipvcccngs(1992),Tnhhnhbuccng
nhnnhmythuclSiGn.Hinghkhoahckthut
1991 1992, Vin V sinh Y t Cng cng TP.H Ch Minh,
trang30.
Mai Tun Hng (2011), Thc trng mi trng v tnh hnh
sckhecngnhntipxcvidungmihucticngty
cphnHiDngnm2010,lunvnttnghipbcsa
khoa20052011,trngiHcYHNi,
TrungtmytVsinhlaongBcngnghipnh(1995),
Cng nghip thuc l Vit Nam, vn thm nhim v
nhimcNicotinmntnh,Hithoqucgiavchinlc
phngchngtchithucllnth3.
290
ChuynYTCngCng
NghincuYhc
XYDNGQUYTRNHXCNHHMLNGACIDAMIN
TRONGNCMMBNGSCKLNGHIUNNGCAO
ChuVnhTh*,TrniNgha*,PhanNguynThTrungHng*
TMTT
tvn:Hinnay,chtlngcancmmcnhgibngchtiunittng,thngcgi
lmcancmm(6).Cchnhginhvychaphnnhchnhxcchtlngcancmmvcth
blidnglmgiccmcchtlngnybngcchthmvoccchtcchanitkhngphiprotein(ure,
melamin).
Mctiu:Xydngquytrnhxcnhhmlngacidamintrongncmmnghincunggitr
dinhdngcasnphmny.
Phngphpnghincu:Khostvictch20loiacidaminLalanine(Ala),Larginine(Arg),Laspartic
acid(Asp), Lcystine(Cyt), Lglutamicacid (Glu), Lglycine (Gly) LHistidine (His), Lisoleucine (Ile), L
leucine(Leu), Llysine(Lys), Lmethionine(Met), Lphenylalanine(Phe),Lproline(Pro), Lserine(Ser), L
threonine(Thr),Ltyrosine(Tyr),Lvaline(Val),LCystein(Cys),LTryptophan(Try),Taurin(Tau)trongnc
mmbngctPrimesep100trnhscklnghiunngcao(HPLC)ktniudMS.Sau,khost
phngphpxlmuloitptrongncmmvthmnhquytrnhphntch.
Ktqu:Xydngcquytrnhphntch20acidamintrongncmmcccgitrhiunngnh
sau: khong lm vic t vi ppm cho n 100 ppm, ring Cystin (3 21 ppm); gii hn pht hin trn my
(ILOD)tvippb(Arginin)n400ppb(Serin),tlphchiulnhn88%,lchthcnghimca
tngacidamindaongt2%chon12%(lysin).
Ktlun:CthngdngctPrimesep100phntchcngmtlc20acidamintrongncmmtrnh
thngscklnghiunngcaoghpniviudMS.
Tkha:Xydngquytrnh,hmlngacidamin,ncmm,scklnghiunngcao
ABSTRACT
DEVELOPMENTOFHIGHPERFORMANCELIQUIDCHROMATOGRAPHYWITHMSDETECTOR
METHODTODETERMINEACIDAMINSCONCENTRATIONINFISHSAUCE
ChauVinhThi,TranDaiNghia,PhanNguyenThiTrungHuong
Background: Nowadays, the quality of fish sauces quality is evaluated by the concentration of total
nitrogen,alsocalledtheproteinlevelinfishsauce.Thiscriterioncouldnotevaluateproperlythequalityoffish
saucesandcouldbecouterfeitedbyaddingnonproteinsubtances(urea,melamin).
Objectives:Todevelopanewmethodforidentifyingconcentrationof20acidamincontainedinfishsauce
inorderevaluateproperlythequalityofthisproduct.
Methods:evaluatetheseparationof20aminoacidsincluding:Lalanine(Ala),Larginine(Arg),Laspartic
acid(Asp), Lcystine(Cyt), Lglutamicacid (Glu), Lglycine (Gly) LHistidine (His), Lisoleucine (Ile), L
leucine(Leu), Llysine(Lys), Lmethionine(Met), Lphenylalanine(Phe),Lproline(Pro), Lserine(Ser), L
threonine(Thr), Ltyrosine (Tyr),Lvaline(Val), LCystein (Cys), LTryptophan (Try), Taurin(Tau) using
*VinVSinhYTCngCngThnhPhHChMinh
Tcgilinlc:Ths.DS.ChuVnhTh
T:0983723529
292
Email:chauvinhthi@yahoo.com.vn
ChuynYTCngCng
NghincuYhc
Primesep100colunmcombinewithhighperformanceliquidchromatography(HPLC)andMSdetector.After
that, investigate sample processing method to eliminate interference subtances and validate the establishing
method.
Result:Estabishingamethodtoanalyze20aminoacidcontainedinfishsaucewithfollowingefficiencies:
workingrangewasfrom2ppm100ppmvarydepenteachacidamin;thelinearityofresponserangedfrom5ppm
to100ppm(especiallyCystin(321ppm),instrumentlimitofdetection(LOD)was1ppb(Arginin)to400ppb
(Serin),methodexperimentalbiasarevarydepentoneachacidaminfrom2%to12%percent(Serin),method
accuracywas2.10percentandmethodrecoverywas97.90percent.
Conclusion:Thisstudyestablishedamethodtoanalyze20aminoacidsimultaneouslyinfishsaucesusing
Primesep100colunmcombinewithhighperformanceliquidchromatography(HPLC)andMSdetector.
Keywords: fish sauce, acid amin, to develop method analysis, high peformance liquid
chromatography.
(Try), Taurin(Tau) c phn tch trong mu
TVN
ncmmbngkthutscklnghiunng
Nc mm l mt sn phm truyn thng
cao(HPLC)viudMS,ctPrimesep100.
csdngrngritrongbanhngngy
ITNGPHNGPHPNGHINCU
VitNam.Theocctiliunghincuchobit
thnh phn tng qut ca nc mm bao gm
Nguynliu
ccchtiucbnnh(3)pH(t5,56,5),muin
Chtchun
(1823g/100ml),m(t60%70%).Ngoira
Bng1:Hnhpchungccaccacidaminv
trongncmmcnchn20acidamintdo
nngtngacidaminHngsnxut:Sigma;M
nh taurine, aspartate, threonine, glutamate,
s:AAS18
methionine,tyrosine,phenylalanine,tryptophan
Nng (mol/ml)
Cc loi acid amin
vlysine
(4%)
Hin nay trong cng tc kim tra nh gi
chtlngncmmchdatrnchtiuhm
lng nit tng c cng b l m ca
nc mm. Gi tr ny cng cao th nc mm
cng t tin. Tuy nhin nu da vo ch tiu
ny th cha phn nh chnh xc gi tr dinh
dng ca nc nm v c th b li dng
avoccchtchanitokhngphim(ure,
melamin)nngcaogitrny.
Do , chng ti xy dng quy trnh xc
nhhmlngacidamintrongncmm
nghin cu ng gi tr dinh dng ca sn
phm ny. 20 loi acid amin Lalanine(Ala), L
arginine(Arg), Laspartic acid(Asp), L
cystine(Cyt), Lglutamicacid (Glu), Lglycine
(Gly) LHistidine (His), Lisoleucine (Ile), L
leucine(Leu), Llysine(Lys), Lmethionine(Met),
Lphenylalanine(Phe),Lproline(Pro),
L
serine(Ser),Lthreonine(Thr),Ltyrosine(Tyr),L
valine(Val), LCystein (Cys), LTryptophan
ChuynYTCngCng
l-alanine
l-arginine
l-aspartic acid
l-cystine
l-glutamic acid
glycine
l-histidin
l-isoleucine
l-leucine
l-methionine
l-phenylalanine
l-proline
l-serine
l-threonine
l-tyrosine
l-valine
89,09
174,2
133,1
240,3
147,1
75,07
155,2
131,2
131,2
149,2
165,2
115.1
105,1
119,1
181,2
117,2
2,50
2,50
2,50
1,25
2,50
2,50
2,50
2,50
2,50
2,50
2,50
2,50
2,50
2,50
2,50
2,50
itngnghincu
Nc mm ct do cng ty Vit Hng Hi
(NguynDuy,Phng9,Qun8,TPHCM)
Dngc,trangthitb,hacht
Dngc
293
NghincuYhc
Khostccthngssck:
Cc dng c thy tinh v khng thy tinh

thngsdngtrongphngthnghim.
Ccthngscnh
Trangthitb
Hphang:
Myctnc2ln
Cn phn tch 4 s l ( nhy 0,1 mg)
Sartorius
Mylytm
H thng my sc k lng hiu nng cao:
HiuShimadzu
+BmLC20ADXR
Pha ng A: Acetonitrile H2O (30:70), b

sungTFA=0,05%
Pha ng B: Acetonitrile H2O (30:70), b
sungTFA=0,3%
Tcdng:1,2mL/pht
Ct phn tch: Ct Primesep 100: 250x 4,5
mm,ngknhht5m.
+AutosamplerSIL20ADXR
Thtchtim:10mcl
+DegasserDGU20A5
Ccthngskhost:
+InterfaceCBM20A
Khost2chngtrnhgradientnng:
+ Ct sc k phn tch: Ct chuyn dng

phntchacidaminPrimesep100(250x4,6mm)
+udkhiph1ln(MS)Shimazdu
+udEDSL
Thi gian (Pht)
S kin
T l th tch (%)
0.01
Dng A
100
Dng B
Dng A
Dng B
Dng A
Dng B
Dng A
Dng B
Kt thc
0
0
100
100
0
100
0
22.00
Hacht
Bng2:Ccdungmi,hachtsdngtrong
nghincu
Dung mi, ha
cht
Methanol
Acetonitrile
Trifluoracetic acid
Nc ct 2 ln
Bng3:Chngtrnhgradientnngth1
tinh khit
Hng sn xut
HPLC grade
HPLC grade
AR grade
J.T.Baker
J.T.Baker
Merck
22.01
30.00
30.00
Bng4:Chngtrnhgradientnngth2
Thi gian (Pht)
0.01
Phngphpnghincu
5.00
Bc1:Khostvtiuhacciukin
tchccacidamintrnhthngscklng
ctPrimesep100,udEDSL.
20.00
Bc 2: Kho st hai quy trnh x l, tch

chitccacidamintrnnnmuncmm.
22.00
22.01
Bc3:Thmnhquytrnhnhlngcc
acidaminbngccphngphpthngk
30.00
Bc 4: p dng phng php c xy

dngphntch6muncmmtrnthtrng
30.00
Kho st cc thng s pha ng trn h

thngHPLCEDSL
Ccthngscnh:
u d EDSL: nhit : 750C, gas flow:
1,5l/pht;Gain:4
294
S kin
Dng A
Dng B
Dng A
Dng B
Dng A
Dng B
Dng A
Dng B
Dng A
Dng B
Dng A
Dng B
T l th tch (%)
100
0
100
0
0
100
0
100
100
0
100
0
Kt thc
Khostccthngskhiph
Ccthngscnh
Ch chy: API (+),API (); Curtain Gas:
2,5l/pht;Hiuinth:15KV
ChuynYTCngCng
NghincuYhc
CDL
Ccbcthchinchungchoccquytrnh:
Kho st cc thng s v thi gian lu ca

ccmnhioncaccacidamin:bmtngacid
aminvohphntchkhostthigianlu
caccmnhionctrng.
Chy mu nc mm thc t x l theo

tngquytrnhtchchit,chymuvictphn
tch xc nh hiu qu: hiu qu phn tch
tpcht,hiusutthuhi,lpli,nnh
caphngphp.
Interface
temperature:
temperature:2500C
4000C;
Bng5:Ccthngsvphkhilng
ID
Q1(m/z)
Event
Arg
175
His
156
Leu
132
Ile
132
Lys
147
Met
150
Phe
166
Thr
120
Val
118
Gly
76
Ala
90
Ser
106
Pro
116
Asp
134
Glu
148
Tyr
182
Trp
188
Cys
122
Cyt
241
Tau
124
Kho st cc quy trnh loi tp trong nc

mm
phntchccacidamintrongncmm
chng ta phi loi b cc tp cht trong nc
mm mu phn tch c sch, trnh lm
thoihactphntch,trnhcchintngnh
hngnn(matrixeffect)nhhintnggim
ion(ionsuppression)nqutrnhphntch
Cc tp cht c trong nn mu nc mm
cnphiloib:
Ccprotein,ccpeptitcnsttronglitrong
qutrnhthyphn.
Cc hp cht bo trong c cn st li., cc
hp cht mu,cc loi ph gia to v, cht bo
qun,ccloimui
ChuynYTCngCng
Quytrnhkhosttchacidamintrongnc
mm:
Khost2quytrnh:
Quytrnh1
Nc mm 2ml +
HCl 0,1N 30 ml
Bnh nh
mc 50ml
Nh tng git acid

triclo acetic 10%
Cho n
ht ta
+ HCl 0,1N
va 50 ml
Ht 10 ml + 30
ml Ethanol
Ly tm 5000 vng/pht
trong 10 pht
ng nghim c
np
Ta trng
Ly dch trong lc qua
mng lc 0,45 m
Ly tm
Vial: dch em
phn tch
Quytrnh2
Nc mm 2ml +
HCl 0,1N 30 ml
Bnh nh
mc 50ml
Nh tng git acid

triclo acetic 10%
Cho n
ht ta
+ HCl 0,1N
va 50 ml
Ly tm 5000 vng/pht
trong 10 pht
Ht 10 ml + 30
ml Methanol
ng nghim c
np
Ta trng
Ly dch trong lc qua
mng lc 0,45 m
Ly tm
Vial: dch em
phn tch
Thuytminh2quytrnh:
Ht2mlmuncmmcnphntchvo
bnhnhmc50mlthm30mlHCl0,1N.
Thm t t dung dch tricloacetic 10%, va
lcchonkhinothyhttatrng
nh mc ti 50 mL bng dung dch HCl
0,1N.
Lytm5000vng/phttrong10pht.
295
NghincuYhc
Ht 10ml dch trong sau ly tm thm 30

Ethanol hoc Methanol s thy xut hin ta
trngtiptclytm.
1. Lcdungdchquafilter0,45mvovial.
Tmttquytrnh:
Mu nc mm c ha tan trong dung
dchdungdchHCl0,1Ntngtnhphncc
ca cc acid amin. Thm acid tricloacetic 10%,
mc ch l to ta protein v peptid. Sau
mucloitabnglytm.Dchtrongc
tiptcloimuibngcnethanolvmethanol.
Tip tc ly tm v em dch lc i phn tch.
Vnylkhostloimuibngethanol
haymethanolthhiusutthuhitthn.
Thm nh quy trnh nh lng bng cc

phngphpthngk
Khongtuyntnh(Linearrange)
chnhxc(Precision)
ng(Accuracy)
Giihnphthinvgiihncaphng
php(MLOD,MLOQ)
KTQUVBNLUN
Ktqutchccacidaminbng2chng
trnhgradientphang:
Sau khi chy kho st 2 chng trnh
gradient trn chun hn hp cc acid amin vi
ctphntchPrimesep100,ktquthucl
ccsck
Chng trnh 1: Theo chng trnh ny
tchc20acidamincnquantmtkhong
thigiant6phtn20phtnhngktqu
chora16peak.Nhvyc3cpacidamincn
chnglnnhau.
Hnh1:Sckca20acidaminphntchbngchngtrnhgradient1
Chngtrnh2:Theochngtrnhny,
tchcht20acidaminthnh18peak.Nh
vy c 02 cp acid amin cn chng ln nhau.
296
ChuynYTCngCng
NghincuYhc
Hnh2:Sckca20acidaminphntchbngchngtrnhgradient2
li thnh 01 peak nn khng th nh lng
pdngchngtrnhchyth2chyring
bngudEDSLc:
tngchunacidaminxcnhthigianlu
AspSer
catngacidamintrongsckktquth
CysCyt
tccacidaminnhsau:
Bng6:Thigianluca20acidaminchybngchng
trnhgradientth2
TT
ACID AMIN
Rt (phut)
Taurin (124)
2,292
Aspartic(134)
5,419
Serine(106)
5,44
Threonin(120)
5,764
Glutamic(148)
5,918
Glycin(76)
Alanine (90)
6,599
Proline(116)
7,007
Valine(118)
8,5
10
Tyrosine(182)
8,937
11
Methionin(150)
9,17
12
Isoleucin(132)
11,196
13
Leucin(132)
11,679
14
Cystein(122)
12,5
15
Cystin(241)
12,511
16
Phenylalanin(166)
12,868
17
Histidin(156)
17,783
18
Tryptophan (188)
18,337
19
Lysine(147)
18,338
20
Arginin(175)
19,988
Do,phisdngudMSvkthut
select ion chn tng ion mi c th nh
lngmtlc20acidamin
Ktqusckcacciontrnud
MS
Sckselectionca20acidaminchun
Hnh3:Sckcaccmnhionca20acidamin
Kt qu sc k EDSL vn cn cc cp
peakmcdcthigianlukhcnhaunhng
qustnncccppeaksauyvncnchp
ChuynYTCngCng
297
NghincuYhc
298
ChuynYTCngCng
NghincuYhc
nnhcaccmnhionctrngchotngacidamin.
Bng7:nnhthigianlucaccmnhiontrong6lnphntch
TT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Acid amin
Alanine (90)
Arginin(175)
Aspartic(134)
Cystin(241)
Glutamic(148)
Glycin(76)
Histidin(156)
Isoleucin(132)
Leucin(132)
Lysine(147)
Methionin(150)
Phenylalanin(166)
Proline(116)
Serine(106)
Threonin(120)
Tyrosine(182)
Valine(118)
Taurin (124)
Tryptophan (188)
Cystein(122)
1
6,599
19,988
5,419
12,511
5,918
6
17,783
11,196
11,679
18,338
9,17
12,868
7,007
5,44
5,764
8,937
15,518
2,292
18,337
17,867
Thi gian lu ca 6 ln chy chun

2
3
4
5
6,567
6,567
6,567
6,593
19,95
19,955 19,988 19,998
5,41
5,4
5,419
5,436
12,484
12,5
12,511 12,551
5,899
5,9
5,918
5,938
6
6,033
6
6,033
17,835 17,837
17,8
17,9
11,147 11,199 11,896 11,249
11,648 11,678
11,67
11,758
18,332 18,342
18,33
18,342
9,13
9,131
9,16
9,202
12,801 12,833
12,86
12,922
6,999
6,993
7
7,043
5,428
5,433
5,442
5,46
5,749
5,755
5,758
5,779
8,906
8,875
8,905
8,988
15,433 15,433 15,467 15,589
2,267
2,267
2,28
2,294
18,309 18,321
18,32
18,336
17,833 17,867
17,8
17,9
Nhnxt:Hthngsckviccthngs
sckvudkhiphchoccsckca
tngioncthigianlurtnnhclch
ChuynYTCngCng
6
6,764
19,933
5,424
12,499
5,884
6,067
17,774
11,151
11,656
18,2
9,124
12,744
6,754
5,443
5,789
8,873
15,367
2,297
18,2
17,8
Trung
bnh
SD
RSD%
6,610
19,969
5,418
12,509
5,910
6,022
17,822
11,306
11,682
18,314
9,153
12,838
6,966
5,441
5,766
8,914
15,468
2,283
18,304
17,845
0,077
0,026
0,012
0,023
0,019
0,027
0,046
0,291
0,039
0,056
0,030
0,061
0,105
0,011
0,015
0,043
0,077
0,014
0,052
0,040
1,166
0,131
0,226
0,181
0,322
0,453
0,261
2,576
0,338
0,306
0,331
0,476
1,513
0,201
0,266
0,485
0,499
0,594
0,284
0,227
chun tng i u di 2% (tr isoleucin

2,567%).iunychothyhthngscknh
trnnnhphntch20acidamin.
299
NghincuYhc
Kt qu kho st cc quy trnh x l loi

tp
Phn tch cng mt mu nc mm Vit
Hng Hi vi 2 quy trnh x l mu, kt qu
chothy:
Bng8:Ktquhmlngccacidamincaquy
trnh1vquytrnh2
Acid amin (ppm)
Alanine (90)
Arginin(175)
Aspartic(134)
Glutamic(148)
Glycin(76)
Histidin(156)
Isoleucin(132)
Leucin(132)
Lysine(147)
Methionin(150)
Phenylalanin(166)
Proline(116)
Serine(106)
Methanol
11.545,53
2.409,12
11.668,69
15.055,77
2.020,75
7.114,58
2.490,72
2.492,35
19.098,60
2.967,10
6.638,66
1.112,44
3.367,10
Ethanol
11.637,62
918,94
4.874,19
9.745,86
1.185,27
6.454,91
2.790,49
2.773,25
16.562,15
2.791,69
6.540,04
603,46
2.824,02
Acid amin (ppm)

Threonin(120)
Tyrosine(182)
Valin (118)
Taurin (124)
Tryptophan (188)
Cystein(122)
Tng cng
Methanol
8.004,17
2.176,48
25.028,14
1.142,54
193,64
396,16
124.922,53
Ethanol
6.370,69
2.447,02
23.869,20
939,33
204,94
434,55
106.967,63
Nhnxt:
Khisdngdungmimethanolphalongth
tchcuicngvimcchloimuithktqu
phntchccacidamincaohnsovisdng
ethanol. Do quy trnh s dng methanol
cchn.
Thmnhquytrnhnhlng
Khongtuyntnh
Dungdchchunca20acidamincpha
longccnngkhcnhautthpncaoc
nngtheobng:
Bng9:Dychunccacidamindngxcnhkhongtuyntnh
TT
Acid amin
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Arginin(175)
Aspartic(134)
Cystin(241)
Glutamic(148)
Glycin(76)
Histidin(156)
Isoleucin(132)
Leucin(132)
Lysine(147)
Methionin(150)
Phenylalanin(166)
Proline(116)
Serine(106)
Threonin(120)
Tyrosine(182)
Valine(118)
Taurin (124)
Tryptophan (188)
Cystein(122)
NNG (PPM)
1,34
4,36
3,00
3,68
1,88
3,88
3,28
3,28
3,66
3,73
4,13
2,88
2,63
2,98
4,53
2,93
5
5
5
6,68
4,01
13,07
9,01
11,03
5,63
11,64
9,84
9,84
10,97
11,19
12,39
8,63
7,88
8,93
13,59
8,79
15
15
15
11,13
6,69
21,78
15,02
18,39
9,38
19,40
16,40
16,40
18,28
18,65
20,65
14,39
13,14
14,89
22,65
14,65
25
25
25
15,58
9,36
30,49
21,03
25,74
13,14
27,16
22,96
22,96
25,59
26,11
28,91
20,14
18,39
20,84
31,71
20,51
35
35
35
Ccdungdchchunclnltbm
vomyodintchpeakvtnhtuyn
tnhtheophngtrnhhiquykt qu cho
tuyntnhtheodynngtrn.ChcCystin
300
22,25
13,37
43,55
30,04
36,78
18,77
38,80
32,80
32,80
36,55
37,30
41,30
28,78
26,28
29,78
45,30
29,30
50
50
50
29,67
17,83
58,07
40,05
49,03
25,02
51,73
43,73
43,73
48,73
49,73
55,07
38,37
35,03
39,70
60,40
39,07
60
60
60
37,08
22,29
72,58
50,06
61,29
31,28
64,67
54,67
54,67
60,92
62,17
68,83
47,96
43,79
49,63
75,50
48,83
70
70
70
44,50
26,75
87,10
60,08
73,55
37,54
77,60
65,60
65,60
73,10
74,60
82,60
57,55
52,55
59,55
90,60
58,60
80
80
80
59,33
35,66
116,13
80,10
98,07
50,05
103,47
87,47
87,47
97,47
99,47
110,13
76,73
70,07
79,40
120,80
78,13
90
90
90
74,17
44,58
145,17
100,13
122,58
62,56
129,33
109,33
109,33
121,83
124,33
137,67
95,92
87,58
99,25
151,00
97,67
100
100
100
ckhongtuyntnhrtngnt3ppmn21
ppmcnccacidamincnlickhongtuyn
tnhrtrngtvippmchontrndi100
ppm
ChuynYTCngCng
do tuyen tinh Alanin
y = 6650,4x + 29054
R2 = 0,987
500000
Dien tich peak
Do tuyen tinh Aspartic

D ien tich peak
600000
400000
300000
200000
100000
3000000
2000000
20
40
60
y = 14569x - 96814
2
R = 0,9965
1000000
0
0
0
0
NghincuYhc
50
80
100
150
200
Ham luong (ppm)
Ham luong (ppm)
Hnh4:thbiudinkhongtuyntnhca2acidamin
mu nc mm 6 ln s liu thu c dng
lplicaphngphp
tnhchnhxc,sailchRSD(%).Ktquthu
Trn mu nc mm Vit Hng Hi,
ctheobng:
tinhnhpdngphngphpthphntch
Bng10:Ktqulpli
ACID AMIN
Alanine (90)
Arginin(175)
Aspartic(134)
Glutamic (148)
Glycin(76)
Histidin(156)
Isoleucin(132)
Leucin(132)
Lysine(147)
Methionin
Phenylalanin
Proline(116)
Serine(106)
Threonin(120)
Tyrosine(182)
Valin (118)
Taurin (124)
Tryptophan
Cystein(122)
TNG
Hm lng ca cc acid amin (ppm)

Ln 1
Ln 2
Ln 3
Ln 4
Ln 5
Ln 6
9.751,09
9.951,17
9.983,97 9.416,64
8.945,15
9.303,05
9,76
9,04
9,86
9,97
10,26
9,40
20.679,80 21.294,66 21.254,72 19.504,42 20.767,38 20.925,63
9.252,19
9.036,79
9.105,43 8.385,54
8.793,31
9.244,28
2.841,53
3.063,66
2.979,97 2.775,36
2.821,51
2.777,01
6.686,49
6.587,75
6.775,02 6.660,45
6.972,27
7.066,80
5.003,22
5.041,87
4.959,91 4.959,91
5.038,04
5.061,60
5.314,47
5.212,30
5.285,07 5.714,11
5.655,02
5.665,26
6.221,17
5.851,63
6.261,81 6.205,58
6.415,99
6.768,74
3.784,42
3.601,58
3.701,10 3.663,64
3.778,23
3.713,26
13.054,41 13.592,56 13.131,22 12.729,88 13.776,37 13.651,60
5.660,49
5.573,29
5.519,73 5.468,83
5.625,79
5.521,33
9.290,33
8.670,52
8.750,71 9.127,69
8.872,30
8.705,92
14.301,63 13.955,06 14.244,93 13.298,70 13.877,61 13.918,49
882,85
804,36
839,32
780,84
813,96
863,72
1.628,69
1.773,10
1.799,30 1.672,37
1.827,04
1.852,50
364,41
383,70
395,84
374,28
369,37
355,85
732,88
725,87
659,20
659,18
729,75
723,16
524,52
558,39
517,58
553,27
550,88
523,52
115.984,34
115.687,31
116.174,68
111.960,65
Ktquca6lnphntchtrnmunc
mmVitHngHitrongcngmtngycho
ra hm lng ca 19 loi acid amin (khng c
cystin)clchchuntngi(RSD)trong
khongt0,87%n5,06%
115.640,25
116.651,11
SD
Trung bnh
9.558,51
9,71
20.737,77
8.969,59
2.876,51
6.791,46
5.010,76
5.474,37
6.287,49
3.707,04
13.322,67
5.561,58
8.902,91
13.932,73
830,84
1.758,83
373,91
705,01
538,03
408,38
0,43
653,92
331,80
118,41
188,92
43,65
226,55
299,95
69,48
411,56
72,13
252,00
357,57
38,33
89,08
14,24
35,64
18,02
tin RSD %
cy
428,48
0,45
686,09
348,13
124,24
198,21
45,79
237,70
314,71
72,90
431,81
75,68
264,40
375,16
40,21
93,47
14,94
37,40
18,91
4,27
4,46
3,15
3,70
4,12
2,78
0,87
4,14
4,77
1,87
3,09
1,30
2,83
2,57
4,61
5,06
3,81
5,06
3,35
115.349,72
tchccacidamintnhthuhisovigi
trlthuyt.Minngcphntch3ln,
tnhsailchRSD(%)vlchthcnghim
(experimentalbias)
Xcnhtlthuhi,ngcaphng
php
T mu nc mm Vit Hng Hi c
phalongranng80%v60%emphn
ChuynYTCngCng
301
NghincuYhc
Bng11:Ktquhmlngacidaminphntchtrnmuphalong80%v60%
Acid amin
Alanine (90)
Arginin(175)
Aspartic(134)
Glutamic(148)
Glycin(76)
Histidin(156)
Isoleucin(132)
Leucin(132)
Lysine(147)
Methionin(150)
Phenylalanin(166)
Proline(116)
Serine(106)
Threonin(120)
Tyrosine(182)
Valin (118)
Taurin (124)
Tryptophan (188)
Cystein(122)
Hm lng mu 80%
Mu 1
Mu 2
Mu 3
7.800,87 8.159,96 7.887,34
7,81
7,41
7,79
16.543,84 17.461,62 16.791,23
7.401,75 7.410,17 7.193,29
2.273,23 2.512,20 2.354,17
5.349,19 5.401,96 5.352,26
4.002,57 4.134,33 3.918,33
4.251,58 4.274,09 4.175,20
4.464,96 4.491,15 4.434,85
3.027,54 2.953,30 2.923,87
10.443,53 11.145,90 10.373,67
4.528,39 4.570,10 4.360,59
7.432,27 7.109,83 6.913,06
11.441,30 11.443,15 11.253,49
706,28
659,58
663,06
1.302,95 1.453,94 1.421,45
291,53
314,64
312,71
586,30
595,21
520,77
419,61
457,88
408,88
Hm lng mu 60%
Mu 1
Mu 2
Mu 3
5.850,65 6.269,24
5.790,70
5,86
5,70
5,72
12.407,88 13.415,63 12.327,74
5.551,31 5.693,18
5.281,15
1.704,92 1.930,11
1.728,38
4.011,89 4.150,28
3.929,51
3.001,93 3.176,38
2.876,75
3.188,68 3.283,75
3.065,34
3.527,91 3.276,95
3.222,27
2.270,65 2.269,00
2.146,64
7.832,65 8.563,31
7.616,11
3.396,29 3.511,18
3.201,44
5.574,20 5.462,43
5.075,41
8.580,98 8.791,69
8.262,06
529,71
506,75
486,81
977,21
1.117,05
1.043,59
218,65
241,73
229,59
439,73
457,30
382,34
314,71
351,79
300,19
Da vo cc kt qu phn tch ny tnh

ton t l phc hi (recovery) v lch thc
nghimcatngacidamin.Ktqutlphc
HL l thuyt
80%
HL l thuyt
60%
7.646,81
7,77
16.590,21
7.175,67
2.301,20
5.433,17
4.008,61
4.379,50
5.029,99
2.965,63
10.658,14
4.449,26
7.122,33
11.146,19
664,67
1.407,07
299,13
564,00
430,42
5.735,11
5,83
12.442,66
5.381,76
1.725,90
4.074,88
3.006,45
3.284,62
3.772,49
2.224,22
7.993,60
3.336,95
5.341,75
8.359,64
498,51
1.055,30
224,35
423,00
322,82
hivlchthcnghimctrnhbitrong
bng12.
Bng12:Ktqutlthuhivlchthcnghim
Acid amin
Alanine -90
Arginin-175
Aspartic
Glutamic
Glycin(76)
Histidin
Isoleucin
Leucin (132)
Lysine(147)
Methionin
Phenyalanin
Proline-116
Serine(106)
Threonin
Tyrosine
Valin (118)
Taurin
Tryptophan
Cystein
302
T l phc hi mu
80%
Mu 1 Mu 2 Mu 3
102,01 106,71 103,15
100,47 95,38 100,27
99,72 105,25 101,21
103,15 103,27 100,25
98,78 109,17 102,30
98,45 99,43 98,51
99,85 103,14 97,75
97,08 97,59 95,34
88,77 89,29 88,17
102,09 99,58 98,59
97,99 104,58 97,33
101,78 102,72 98,01
104,35 99,82 97,06
102,65 102,66 100,96
106,26 99,23 99,76
92,60 103,33 101,02
97,46 105,19 104,54
103,95 105,53 92,33
97,49 106,38 95,00
T l phc hi mu 60% T l lch mu 80% lch mu 60% lch

phc
thc
Mu 1 Mu 2 Mu 3 hi tb Mu 1 Mu 2 Mu 3 Mu 1 Mu 2 Mu 3 nghim
102,01 109,31 100,97 104,03 2,01 6,71 3,15 2,01 9,31 0,97 4,03
100,47 97,70 98,15 98,74 0,47 4,62 0,27 0,47 2,30 1,85 1,66
99,72 107,82 99,08 102,13 0,28 5,25 1,21 0,28 7,82 0,92 2,63
103,15 105,79 98,13 102,29 3,15 3,27 0,25 3,15 5,79 1,87 2,91
98,78 111,83 100,14 103,50 1,22 9,17 2,30 1,22 11,8 0,14 4,31
98,45 101,85 96,43 98,85 1,55 0,57 1,49 1,55 1,85 3,57 1,76
99,85 105,65 95,69 100,32 0,15 3,14 2,25 0,15 5,65 4,31 2,61
97,08 99,97 93,32 96,73 2,92 2,41 4,66 2,92 0,03 6,68 3,27
93,52 86,86 85,41 88,67 11,2 10,7 11,8 6,48 13,1 14,6 11,33
102,09 102,01 96,51 100,15 2,09 0,42 1,41 2,09 2,01 3,49 1,92
97,99 107,13 95,28 100,05 2,01 4,58 2,67 2,01 7,13 4,72 3,85
101,78 105,22 95,94 100,91 1,78 2,72 1,99 1,78 5,22 4,06 2,92
104,35 102,26 95,01 100,48 4,35 0,18 2,94 4,35 2,26 4,99 3,18
102,65 105,17 98,83 102,15 2,65 2,66 0,96 2,65 5,17 1,17 2,54
106,26 101,65 97,65 101,80 6,26 0,77 0,24 6,26 1,65 2,35 2,92
92,60 105,85 98,89 99,05 7,40 3,33 1,02 7,40 5,85 1,11 4,35
97,46 107,75 102,34 102,46 2,54 5,19 4,54 2,54 7,75 2,34 4,15
103,95 108,11 90,39 100,71 3,95 5,53 7,67 3,95 8,11 9,61 6,47
97,49 108,98 92,99 99,72 2,51 6,38 5,00 2,51 8,98 7,01 5,40
ChuynYTCngCng
NghincuYhc
hthngsckchycc6sckchotng
loiioncatngacid amin.Sdngphnmm
camyscktnhtltnhiu/nhiu(S/N)
ca6lnchymu,sautnhtrungbnhtl
S/N.Dnggitrtrungbnhnytnhgiihn
phthinvgiihnnhlngtrnthitbv
caphngphp.Ktqunhsautheobng:
Kt qu xc nh gii hn pht hin LOD v

gii hn nh lng ca thit b phn tch v
caphngphp.
SdngmuncmmVitHngHi
phntchbitchmlngtngacidamin,
tnh ton pha long n hm lng khong 1
2ppmchomiloixlmuvbm6lnvo
Bng13:Ktqugiihnphthinvgiihnnhlng
ACID AMIN Hm lng
(ppm)
ln 1 Ln 2
2,23
23,00
23,46
Alanine (90)
1,34
914,30 932,59
Arginin(175)
4,36
36,79
37,53
Aspartic(134)
3,68
122,64
125,09
Glutamic(148)
1,88
18,23
18,59
Glycin(76)
3,88
52,85
53,91
Histidin(156)
3,28
113,72 115,99
Isoleucin(132)
3,28
113,72 115,99
Leucin(132)
3,66
98,50 100,47
Lysine(147)
3,73
203,89 207,97
Methionin(150)
4,13
157,49 160,64
Phenylalanin
2,88
76,55
78,08
Proline(116)
2,63
19,90
20,30
Serine(106)
2,98
48,27
49,24
Threonin(120)
4,53
159,21 162,39
Tyrosine(182)
2,93
50,00
51,00
Valin (118)
0,50
184,27
187,96
Taurin (124)
0,50
94,12
96,00
Tryptophan
0,50
6,98
7,12
Cystein(122)
ln 3
T L S/N
ln 4 ln 5
23,69
22,31
23,92
21,39
22,96
0,29
0,97
21,8
72,6
941,73
886,87
950,87
850,30
912,78
0,00
0,01
0,33
1,10
37,89
35,69
38,26
34,21
36,73
0,36
1,19
26,6
88,9
126,32
118,96
127,55
114,06
122,44
0,09
0,30
6,76
22,5
18,78
17,68
18,96
16,95
18,20
0,31
1,03
23,2
77,3
ln 6
ILOD ILOQ MLOD MLOQ

(ppm)
(ppm) (ppm) (ppm)
Trung bnh
54,44
51,26
54,96
49,15
52,76
0,22
0,74
16,5
55,1
117,13
110,31
118,27
105,76
113,53
0,09
0,29
6,50
21,6
117,13
110,31
118,27
105,76
113,53
0,09
0,29
6,50
21,6
101,46
95,55
102,44
91,61
98,34
0,11
0,37
8,36
27,8
210,01
197,77
212,05
189,62
203,55
0,05
0,18
4,12
13,7
162,21
152,77
163,79
146,47
157,23
0,08
0,26
5,91
19,7
78,85
74,25
79,61
71,19
76,42
0,11
0,38
8,47
28,2
20,50
19,30
20,70
18,51
19,87
0,40
1,32
29,7
99,1
49,72
46,82
50,20
44,89
48,19
0,19
0,62
13,9
46,3
163,99
154,43
165,58
148,07
158,94
0,09
0,29
6,41
21,3
51,50
9,91
52,00
9,50
37,32
0,24
0,79
17,6
58,8
189,80
178,74
191,64
171,37
183,96
0,01
0,03
0,61
2,04
96,94
91,30
97,88
87,53
93,96
0,02
0,05
1,20
3,99
7,19
6,77
7,26
6,49
6,97
0,22
0,72
16,1
53,8
Nhnxt:Giihnphthintrnmyca
cc acid amin khc nhau t vi chc n cao

nhtlAsparticacid360ppb.
ncmmphichiuchnhphalong
sau cho nng cht phn tch nm trn gii
hnnhlngcathitb.
Gii hn pht hin ca phng php ty

thucvohsphalongmu,dotyloi
pdngquytrnhnhlngccacidamintrongmtsmuncmm
Bng14:Ktquphntchhmlngccacidamintrong6muncmm
ACID AMIN (mg/l)
Alanine (90)
Arginin(175)
Aspartic(134)
Glutamic(148)
Glycin(76)
Histidin(156)
Isoleucin(132)
Leucin(132)
Lysine(147)
Methionin(150)
Phenylalanin(166)
Ho Hip
859,42
56,18
3.266,25
604,46
165,84
338,29
956,31
1.136,88
1.078,84
220,20
350,88
ChuynYTCngCng
Mc nh
7.330,12
3,08
514,97
8.322,02
63,10
1.804,34
1.296,03
2.245,55
3.030,32
726,88
1.000,88
Y Phng
2.626,78
14,24
3.787,05
702,05
178,24
4.014,34
3.530,40
5.446,51
6.411,27
2.077,76
2.450,17
Hng hnh
10.586,75
52,52
8.479,83
1.765,53
787,10
15.020,06
6.285,92
7.220,26
20.695,06
4.493,47
7.070,88
Hng thnh
11.240,67
71,78
8.044,97
1.991,18
801,07
18.554,69
6.242,95
6.761,37
21.863,74
4.799,38
7.498,86
Nam ng
8.355,45
13,19
6.384,41
4.327,95
154,43
204,76
1.851,34
2.092,11
8.274,02
1.273,30
2.213,33
303
NghincuYhc
ACID AMIN (mg/l)
Proline(116)
Serine(106)
Threonin(120)
Tyrosine(182)
Valin (118)
Taurin (124)
Tryptophan (188)
Cystein(122)
TNG CNG
Ho Hip
300,87
3.841,31
247,70
339,41
2.992,07
48,48
3,53
0,00
16.806,91
Mc nh
22,77
3.068,88
935,20
180,22
1.461,14
24,89
10,76
0,00
32.041,15
KTLUNVKINNGH
Tccktquthuctrn,chngti
xut quy trnh nh lng cc acid amin trong
nnmuncmmtrnmyLC/MSnhsau:
Mu nc mm c lm sch vi dung
dch acid tricloroacetic 10% v methanol trc
khiemphntchtrnmy.
S dng pha ng Acetonitrile nc ct
(70:30) b sung TFA cng vi chng trnh
gradientnngtchccacidamintrnct
phntchPrimesep100.
SdngudMSthunhntnhiuch
SIMMODEAPCI()(+).
Kt qu ca vic thm nh quy trnh nh
lng,chngtithucnhsau:
Khong tuyn tnh: 1,34ppm cho n 137
ppm tr cystin c khong tuyn tnh rt
ngn.
Gii hn pht hin ca thit b t 0,04ppp
chon136ppp
chnhxcvngdi20%.
Y Phng
546,77
1.319,90
2.290,51
408,23
3.897,63
64,84
67,88
163,85
39.998,40
Hng hnh
4.912,79
5.464,23
7.969,12
835,78
13.625,89
169,01
152,06
908,00
116.494,28
Hng thnh
5.930,82
5.777,86
9.658,76
1.108,31
16.032,22
136,24
200,53
1.761,74
128.477,12
Nam ng
1.720,19
2.834,34
3.560,52
296,03
4.732,51
49,37
44,43
116,03
48.497,72
ngh: T kt qu phn tch trn nc

mmstrinkhaithmccquytrnhphntch
acid amin trong cc dng mu khc nh sa,
thc phm chc nng v cc dng sn phm
dinhdngkhc.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
B Thu Sn (2005). Quyt nh s 18/2005/QBTS ngy

116/5/2005caBThySnvvicbanhnhquynhtm
thi28TCN230:2006vsnxutncmmmangtngi
xutxPhQuc.
Clark S (2007), Determination of urea using HPLC with
fluorescence detection after automated derivatisation with
xanthydrol, Journal of Chromatography A, Volume 1161,
pp,207213,
JiangJJ,ZengQX,ZhuZWandZhangLY(2007),Chemical
and sensory changes associated Yulu fermentation processA
traditional Chinese fish sauce, Food Chemistry, Volume 104,
Issue4,pp,16291634.
Masudo T (1995 ), Determination of urea and citrulline in
fermentedfoodandbeverages,JournalofBioscienceBiotechnology
Biochemistry,Volume59,Issue5pp,827830,
ParkJN,FukumotoY,FujitaE,TanakaT,WashioT,Otsuka
S, Shimizu T, Watanable K and Abe H (2001), Chemical
composition of fish sauces produced in southeast and east Asian
country, Journal of Food Composition and Analysis,
Volume14,Issue2,pp,113125.
Trng Th K (1999), Aminoacid,peptid,protid, Ha Hc
HuC,tr,4558.
Hiu sut thu hi cc acid amin u trn

85%.
304
ChuynYTCngCng
NghincuYhc
KHOSTKINTHC,THI,THCHNHVVSINHANTON
THCPHMCANGISDNGTHCNNGPH
TITHNHPHSCTRNG,TNHSCTRNGNM2011
uHinS*,BiThThyNgn*
TMTT
tvn:Thcnngph(TAP)timnnhngnguycgyngcthcphm,edansc
khevtnhmngcangisdng.
Mctiunghincu:Xcnhtlkinthc,thi,thchnhngvantonthcphmcangi
sdngTAP,vxcnhmitngquangiakinthc,thi,thchnhcangisdngTAP.
Phngphpnghincu:Mtctngang,iutra577ngitiudngthcnngphtithnh
phScTrng,tthng10/2011nthng12/2011.
Ktqunghincu:Ktquchothy,ngisdngthcnngphckinthcngvvsinhan
tonthcphmchimtlkhttvi77,8%,tuynhin,thivthchnhctlkhngcaovithi
ngl50,4%,thchnhngl50,8%.Cstngquangiakinthc,thivthchnhcangis
dngTAP.
Ktlun:Cnnngcaokinthc,thivthchnhvvsinhantonthcphmcangisdng
TAP.
Tkha:Kinthc,thi,thchnhng,ngisdngthcnngph
ABSTRACT
SURVEYOFKNOWLEDGE,ATTITUDE,ANDPRACTICEONFOODHYGIENEANDSAFETYOF
STREETFOODUSERSINSOCTRANGCITY,SOCTRANGPROVINCEIN2011
AuHiensi,BuiThiThuyNgan
Background:Streetfoodentailstheriskoffoodpoisoningthatthreattothehealthandlivesofusers.
Objectives:Toindentifytheproportionofstreetfoodusershavingrightknowledge,attitude,andpracticeof
hygieneandfoodsafetyrelationshipsbetweentheknowledge,attitude,andpracticeofstreetfoodusers.
Method: A crosssectional method was conducted among 577 of street food users in Soc Trng city
from10/2011to12/2011.
Results: The results showed that the percentage of 77.8% having right knowledge were quite high,
accounting for 77.8%. However, the proportion of street food users having right attitude (50.4%) and right
practice(50.8%)werenothigh.Thereiscorrelationofknowledge,attitude,practiceofstreetfoodusers.
Conclusion:Needtoenhanceknowledge,attitudeandpracticeonfoodhygieneandsafetyofstreet
foodusers.
Keywords:rightknowledge,attitude,practice,streetfoodusers
ChiccAntonvsinhthcphmtnhScTrng
Tcgilinlc:Ths.BiThThyNgn T:0918.410404
ChuynYTCngCng
Email:thuynganks@yahoo.com.vn
305
NghincuYhc
TVN
Thnh ph Sc Trng l trung tm kinh t,

vn ha, x hi ca tnh Sc Trng, do tp
trung phn ln cng ty, x nghip, trng hc,
c s sn xut, cc h kinh doanh bun bn
phn phi... ca tnh, nn lt ngi lm vic,
hctp,kinhdoanh,ilivlutrmingy
rt ln, dn n nhu cu v thc n nht l
TAP cng tng theo. Tuy nhin, do tp qun
snxutnhl,ding,bybnnhngnic
ngunnhimcao...,gykhkhntrongqun
lvkimsot,dnnnguycngcthc
phm,edasckhechongisdng.
Vvy,ChiccAntonvsinhthcphm
tnhScTrng,tinhnhkhostkinthc,thi
,thchnhcangisdngthcnng
ph ti thnh ph Sc Trng, nhm nng cao
kinthc,thi,thchnhcangisdng
TAP, ng thi a ra nhng bin php ci
thinvsinhantonthcphmTAP.
Mctiunghincu:
Xcnhtlkinthc,thi,thchnh
ng ca ngi s dng TAP ti thnh ph
Sctrng,tnhScTrngnm2011.
Xcnhmitngquangiakinthcv
thi,thchnhcangisdngTAP.
I TNG
NGHINCU
PHNG
PHP
Trung bnh mi cm phng vn t 19 20

ngi,nkhicmu577ngisdng.
Phngphpthuthpvxlsliudliu:
S liu c thu thp qua phng vn trc
tipbngbngcuhi.Trongthigiannghin
cutthng10/2011n12/2011.
Phngphpxlsliu:Nhpvxls
liubngphnmmEpiInfo2002.
Phngphpkimsotsailchthngtin:
Tphuniutravinthngnhtvni
dung iu tra v k thut phng vn. iu tra
vinphiphngvnkhchquan,khnggi.
Thchiniutrath5% tng s mu,
rtkinhnghimvhiuchnhcuhichoph
hptrckhiiutrachnhthc.
Btrgimstvintrongqutrnhthuthp
thngtin.
KTQUVBNLUN
c im chung ca ngi s dng thc n
ngph
Bng1:cimchungcangisdngthcn
ngph(n=577)
c tnh
Nhm tui
Gii tnh
Trnh hc vn
itngnghincu:
Ngi s dng TAP ti thnh ph Sc
Trng,t16tuitrln.
Phngphpnghincu:
Dn tc
Thitknghincu:
Ctngangmt.
Cmuvkthutchnmu:
Cmuctnhtheocngthcmungu
nhinnvihsthitkk=1,5,vin=577.
Kthutchnmu:Chn30cmtptrung
nhiu ngi tiu dng ti cc khu vc ch,
trnghc,cngtytithnhphScTrng.
306
Ngh nghip
Tr li
T 16 29 tui
T 30 55 tui
T 56 tui tr ln
Nam
N
M ch
Cp 1
Cp 2
Cp 3
TC, C, H, SH
Kinh
Hoa
Khmer
Khc
Lm rung, vn
Lm thu
Cng nhn
Bun bn, dch v
Hc sinh, sinh vin
CBCNV
Khc
Tn s T l (%)
290
50,3
204
35,3
83
14,4
260
45,1
317
54,9
7
1,2
97
16,8
192
33,3
194
33,6
87
15,1
395
68,4
73
12,7
108
18,7
1
0,2
13
2,3
32
5,5
113
19,6
157
27,2
142
24,6
48
8,3
72
12,5
ChuynYTCngCng
Ktqubng1chothy,asngic
iutraphnlntrongtuilaongt16
55tuichim85,6%,ngiichim54,9%,trnh
hcvncp2(33,3%)vcp3(33,6%)chim
uth,mchchimtlthpnht(1,2%),y
l iu kin thun li cho vic ph bin tuyn
truyn, cp nht kin thc ATVSTP v ngh
nghip tp trung l bun bn dch v (27,2%),
hcsinh,sinhvin(24,6%)vcngnhn.
Kin thc v v sinh an ton thc phm

(VSATTP)cangisdngTAP
Bng2:KinthcvVSATTPcangisdng
thcnngph(n=577)
Ni dung
Tn s T l (%)
Ni by bn thc n gn ngun nhim 510
88,4
(cng, rnh...) khng m bo v sinh
Ni by bn cn dng c ng rc
566
98,1
Ngi bn dng tay bc thc n khng
m bo an ton v sinh thc phm
Ngi bn dng chung dng c (dao,
tht, gp thc n) cho thc phm chn
v sng, gy nhim thc phm
Ngi bn thc n chn cn mc bo
h (gng tay, tp d, khu trang...)
529
91,7
394
68,3
488
84,6
Ngi bn cn phi ra tay bng nc

sch v x phng trc khi ch bin v
bn thc n
Ngi bn cn kim tra sc khe nh
k
566
98,1
418
72,4
Ngi bn cn tp hun v kin thc

ATVSTP
448
77,6
Thc n chn cn by trong t knh

Thc n chn cn by trn gi cao > 60
cm
S dng nc sch ch bin, m
bo ATVSTP
545
494
94,5
85,6
569
98,6
TAP c th gy ra ng c thc phm

(au bng, nn i, tiu chy...)?
448
77,6
Kin thc ng (tr li ng t 10 cu

tr ln)
449
77,8
Quaktqubng2chothy,ngisdng
ckinthcngvVSATTPTAPchimtl
khttvi77,8%,trongkinthcvsdng
ncschtrongchbin,nibybncndng
cngrc,ratayschtrckhichbin,bn
thc n chim t l rt tt trn 90%. Mc khc,
kinthcvnibybnthcncnbytrong
t knh chim t l cao (94,5%), v trong cuc
ChuynYTCngCng
NghincuYhc
iutracngchothyhuhtthcnuc
bybntrongtknh,ycnglnlccacc
ngnh qun l cng tc ATVSTP ti thnh ph
ScTrng.
Ngoi ra, 88,4% ngi tiu dng bit rng
ni by bn thc n gn ngun nhim (nh
cng, rnh, nh v sinh, bi bn...) th khng
m bo VSATTP, s liu tng ng vi
nghin cu ca L Thnh Minh, khi iu tra
ngisdngTAPtithxBnTre,tnhBn
Trenm2007,vi87,1%,85,6%chorngthcn
cnbytrnbn,gicaocchmtttnht60
cm, gn bng vi nghin cu ca L Thnh
Minh (2007) vi 88,8%; v 98,1% cn dng c
ngrcthi,caohnnghincucaLThnh
Minh(2007)vi83,2%.Ccktqunghincu
cho thy, mt s kin thc ca ngi s dng
TAP ti thnh ph Sc Trng khng chnh
lchnhiusovingitiudngtithxBn
TretheonghincucaLThnhMinh(2007).
Tuynhin,kinthcvngibncnkim
tra sc khe nh k chim t l 72,4%, 77,6%
cntphunkinthcVSATTPvTAPcth
gyngcthcphmt77,6%,chimtl
thpsovinhngkinthckhc,cbitthp
nht l kin thc v ngi bn dng chung
dng c cho thc phm chn v sng gy
nhim thc phm chim 68,3%, y l nguyn
nhndnntlkinthcngcangis
dng t 77,8%. V vy, nng cao hn na
kin thc ca ngi s dng TAP ti thnh
ph Sc Trng, cn tp trung tc ng tch cc
vonhngkinthcny.
Thi v VSATTP ca ngi s dng

thcnngph
Bng3:ThivVSATTPcangisdng
thcnngph(n=577)
Ni dung
Khi s dng TAP, c quan tm n tnh
trng v sinh ca ngi ch bin v phc
v
Khi s dng TAP, c quan tm n tnh
trng v sinh ca phng tin phc v
Khng an tm khi s dng TAP
Tn
s
504
T l
(%)
87,4
530
91,9
32
55,6
307
NghincuYhc
Thi ng (tr li ng t 3 cu tr ln)
291
50,4
Kt qu bng 3 cho thy, t l ngi s

dng TAP c thi ng v VSATTP l
50,4%chtmctrungbnh.Trong,ngi
s dng c thi rt tt khi quan tm n
tnhtrngvsinhcangichbinvphc
vvi87,6%vtnhtrngvsinhcaphng
tin phc v n 91,9%. Tuy nhin, ch c
55,6% ngi s dng khng an tm khi s
dng TAP, thp hn nghin cu ca L
Thnh Minh (2007) th x Bn Tre, tnh Bn
Trevi74,1%,ylthicnphicci
thin ca ngi s dng TAP thnh ph
Sc Trng, qua cho thy vic s dng
TAP tr thnh thi quen hng ngy,
khng th thiu trong cuc sng hng ngy
cangithnhth,vinhnguimvs
thun tin, gi c ph hp(1)(2), nn mt b
phnngisdngcmthybnhthngkhi
s dng TAP. V vy, nng cao thi
ca ngi s dng TAP ti thnh ph Sc
Trng,cntcngtchccvonhngthi
ny.
T l (%)
87,2
87,5
Tuynhin,thchnhrataytrckhis
dng thc n chim t l thp ch t 57,7%,
do thc ca ngi s dng, cha to c
thi quen ra tay sch trc khi n ung.
Ngoi ra, t l thp nht l 52,2% ngi s
dng khi ngi bn dng tay trc tip bc
thcn,gpphnlmgimtlthchnh
ngca ngi s dng s dng TAP, y
cngltlphn nh c thc t khc bit
gia thc hnh v kin thc ca ngi s
dng TAP, vi kin thc c 91,7% ngi s
dng bit rng ngi bn dng tay trc tip
bc thc n bn th khng m bo
VSATTP (bng 1), nhng khi thc hnh n
ungthkhngththchnhng,dongi
sdngkhngcthchnhkinquytkhis
dng TAP. V vy, nng cao thc hnh
ng ca ngi s dng TAP, cn a ra
c nhng tc hi c th ca vic gy
nhim thc n, gy bnh cho ngi s dng
khi khng thc hnh tt bn tay trc khi n
unghaybnthcn.
90,3
Mi tng quan gia kin thc, thi ,

thchnhcangisdngTAP
ThchnhvVSATTPcangisdng
thcnngph(Bng4)
Bng4:ThchnhvVSATTPcangisdng
thcnngph(n=577)
Ni dung
Chn qun n sch s, v sinh
Khng n thc n ti sng trong
cc qun TAP (tit canh, hi sn,
gi c)
Xem nhn mc trc khi s dng
thc n ng gi, thc ung thc
ung ng chai
Tn s
503
505
Khng s dng, khi pht hin TAP

c mi v l
548
Khng s dng thc n c mu

sc qu sc s
Khng s dng thc n, khi ngi
bn dng tay bc trc tip bn
C ra tay trc khi s dng TAP
427
74
301
52,2
333
57,7
293
50,8
Thc hnh ng (tr li ng t 6

cu tr ln)
521
95
Bng5:Mitngquangiakinthcvthi
cangisdngTAP
Kin thc
Quaktqubng4chothy,tlngi
sdngcthchnhngvVSATTPTAP
308
l50,8%,ttltrungbnh.Trong,ngi
s dng TAP thc hnh tt v vic chn
qunnschs,vsinhvi87,2%,n87,5%
khng n thc n ti sng, n 90,3% xem
nhn mc trc khi s dng thc phm bao
gi,95%khngsdngthcphmcmiv
l,ylnhngthchnhtchcccangi
sdng.
ng
Khng ng
Thi
ng
Khng ng
271 (60,4%)
178 (39,6%)
20 (15,6%)
108 (84,4%)
p
< 0,05
Cmitngquangiakinthcvthi
vVSATTPcangisdngTAP, vi
s khc bit c ngha thng k (P < 0,05),
ngi c kin thc ng th c thi ng
caohn.
ChuynYTCngCng
Bng6:Mitngquangiakinthcvthc
hnhcangisdngTAP
Kin thc
ng
Khng ng
Thc hnh
ng
Khng ng
290 (64,4%)
159 (35,4%)
3 (2,3%)
125 (97,7%)
p
< 0,05
C mi tng quan gia kin thc v thc

hnh ca ngi s dng vi s khc bit c
ngha thng k (p < 0,05), ngi c kin thc
ngththchnhngcaohn.
Bng7:Mitngquangiathivthchnh
cangisdngTAP
Thi
ng
Khng ng
Thc hnh
ng
Khng ng
290 (64,4%)
159 (35,4%)
3 (2,3%)
125 (97,7%)
p
< 0,05
C mi tng quan gia thi v thc

hnhcangisdngTAPviskhcbit
c ngha thng k (p < 0,05), ngi c thi
ngththchnhngcaohn.
Ktqutnghpbng5,6,7chothy,c
mitngquangiakinthc,thivthc
hnhVATTPcangisdngthcnng
ph, ngi s dng c kin thc ng th c
thingvthchnhngcaohn,ng
thingicthingththchnhng
vsdngTAPcngcaohn.
KTLUN
Kt qu iu tra, kho st v VSATTP ca
ngi s dng TAP ti thnh ph Sc Trng
cho thy kin thc ng ca ngi s dng
TAPkhttchimtl77,8%,tuynhinthi
vthchnhchimtlkhngcao,ngic
thingvVSATTPTAPchim50,4%v
50,8%ltlngisdngcthchnhng
vVSATTPTAP.
C mi tng quan gia kin thc v thi
, kin thc v hnh ng, thi v hnh
ngvVSATTPcangisdngTAPti
NghincuYhc
thnhphScTrng,ktqucnghathng
k(P<0,05).
KINNGH
Cnduytrvnngcaotlkinthcng
v VSATTP TAP, bng cch tuyn truyn
thng xuyn kin thc VSATTP trn cc
phng tin truyn thng, kt hp vi cc ban
ngnh on th t chc cc lp tp hun, ni
chuynvchuynATTPchomingi.
cbit,cnnngcaotlthingv
thc hnh ng v VSATP ca ngi s dng
TAP ti thiu khong 70%, bng cch a ra
nhng khuyn co, cnh bo nhng mi nguy
caTAPvnibybn,phngtinphcv,
conngi...,ccphngphphng dnthc
hnhcthnhthchnhttbntay...khis
dngthcphm,kthpcngtctruynthng
gio dc VSATTP nng cao kin thc, v
nng cao kin thc l tt yu trong vic gp
phn nng cao thi i vi TAP, v
ngitiudngthchnhngvkinquyt
hn,khngsdngnhngTAPkmvsinh.
ThchintiiutraKAPmrngtrn
tontnhScTrng,khngnhngchoitng
ngitiudngmcngikinhdoanhTAP,
quacthnhgicthkinthc,thi,
thc hnh v VSATTP ca ngi s dng v
ngi kinh doanh, ng thi a ra nhng
phng php ci thin hiu qu hn, v ngi
kinhdoanhTAPckinthc,thivthc
hnhngvVSATTPthTAPsngycng
antonhn,gpphnnngcaokinthc,thi
vthchnhcangisdng.
TILIUTHAMKHO
1.
2.
Trn ng (2006), Thc n ng ph v i sng vn ha

sckhe,NhxutbnHNi.
Trnng(2007),Antonthcphm,NhxutbnHNi
ChuynYTCngCng
309
NghincuYhc
CIMBNHTAYCHNMINGTITNHNGNAINM2011
TrnMinhHa*CaoTrngNgng*
TMTT
tvn:DchtaychnmingbngphttikhuvcphaNamVitNamnm2011vi67.396camc
v145catvong(2).TingNaicngchn5000camcbnhtaychnming(TCM)v26catvong(7).
Ccbinphpphngchngtrachahiuqu.Tnhtuvdchtinaychacnghincunovcim
lmsng,cnlmsng,dchtbnhTCMccngb.DochacnghincurvbnhTCMnnccbin
phpphngchngchahiuqu.Nghincunygiiquytvncpbchnhanhchnggpphnkhng
chbnhTCM,bovsckhetnhmngngidn,cbitltrem.
Mctiu:Xcnhtlcccimdcht,lmsng,cnlmsngcacabnhTCMtingNainm
2011.
Phngphp:Nghincuctngang,mt.1.025hscchnttonb5.125bnhnhnTCMti
bnhvinNhingngNaihicu,thuthpthngtinvdcht,lmsng,xtnghim.Ccbinsc
mtbngtnsvtlphntrm,cctlcsosnhbngphpkimchibnhphng.
Ktqu:C99%bnhnhnTCMnhmtui6.TlmcbnhTCMcaonhtnhm2tui.Giitnh
nammcbnhTCMcaohnn.Thigiantrungbnhtkhikhiphtnkhinhpvinl1,91 1,42ngy.
Gn10%bnhnhnTCMcachningoitnh.BmlmcngnhncconmcTCMchimtlcao
nht.CctriuchnglmsngchnhcabnhTCMlphtbandngphngnc,st,gitmnhlcng.Cc
triuchnglmsngtgplrunggit,inglongchong,thtiu,gitmnhlckhm,rungchi.Ccxt
nghimthnggpnhtcacchnonTCMlbchcutng,phnngCPR,nghuyttng.
Ktlun:TrongphngchngTCMcntptrungvonhm6tui,cckhunhtrcngnhn.Cnkhai
thckphnhnhchnh,nictrtipcntrinkhaichngdchtrnhbstitng.McdTCMl
bnhccholdchnonnhngthctkhngphinhvydocctriuchngkhngyttccc
bnhnhn,khnginhnh.Cnthchinxtnghimnhanhchnonxcnh.
Tkha:Bnhtaychnming,cimdcht,lmsng,xtnghim
ABSTRACT
CHARACTERISTICSOFTHEHANDFOOTANDMOUTHDISEASEATDONGNAIPROVICEIN
2011
TranMinhHoa,CaoTrongNguong
Background:In2011,theepidemicofhandfootandmouthdisease(HFMD)hasoutbreakinsouthernof
Vietnamwith67.396casesand145deaths(2).ongNaiprovincehasmorethan5.000casesofHFMDand26
deaths(7).Thepreventionmeasuresarenoteffective.Fromthebeginoftheoutbreakuntilnow,thereisnotany
researchaboutclinical,paraclinicaltests,epidemiologyofHFMDhaspublished.
Because there are no specific studies about this disease, therefore, prevention measures are not very
*
TrungtmYtDphngngNai
Tcgilinlc:BS.TrnMinhHaT:0903714702Email:ckdn04@gmail.com
310
ChuynYTCngCng
NghincuYhc
effective.ThisstudyaimstosolvetheurgentissuesinordertocontributetoHFMDcontrol,toprotecthealth
andlivesofcitizens,especiallychildren.
Objectives:Identitytheproportionofepidemiologicalcharacteristics,clinical,paraclinicaltestsofHFMD
casesin2011inDongNaiprovince.
Methods: Crosssectional study, 1.025 records were selected from 5.125 patients records at Dong Nai
ChildrensHospitalforretrospectivedescriptivestudy.Informationwascollectedonepidemiological,clinical,and
paraclinical.Variablesaredescribedbyfrequenciesandpercentages,ratioswerecomparedbychisquaredtest.
Results:About99%ofHFMDcaseswere6yearsofageoryounger.Theagespecificincidenceratewas
highestinthoseagedatorlessthan2years.Boyincidencewashigherthanthatofgirl.Themediantimefromthe
onsetofsymptomstohospitaladmissionwas1.91 1.42days.Nearly10%ofHFMDcaseswereoriginatedfrom
peoplewiththeiraddressesoutsideofDongNaiprovince.Thehighestincidenceratewasfoundinchildrenwhose
parentswereworkers.ThemainclinicalsymptomsofHFMDwerefever,rashwithvesicles,andsleepingstartle.
Rarer clinical features are limb shaking, limb cramps,...Test results of HFMD cases showed that the most
frequentcharacteristicswerepositiveCPR,increasedwhitebloodcell,sandhighbloodglucose.
Conclusions:InordertomanageHFMD,itisimportanttofocusinterventionmeasuresmainlyonchildren
undersixyearsoldandthosewholiveinworkersrentedrooms.HFMDissupposedtobeeasilydiagnosed.In
fact,itisnotthateasybecausenospecificclinicalfeatureswasidentifiedtoreliablydiagnose and not all cases
presentedwithtypicalHFMDsyndromes.Therefore,itisnecessarytousetestsasearlyaspossibletodiagnose
HFMD.
Keywords:Handfootandmouthdisease,characteriticsepidemiology,clinic,paraclinicaltests.
TVN
Dch Tay chn ming ti Vit Nam bng
phtmnhtthng5nm2011,mcvchtdo
TCM vn tip tc tng ln mt cch bo ng.
chngchcngncamcvhngtrmcat
vongdoTCM(2).Ccbinphpphngchngt
ra cha hiu qu. Tnh t u v dch ti nay
chacnghincunovcimlmsng,
cnlmsng,dchtbnhTCMccngb.
DochacnghincurvbnhTCMnn
cc bin php phng chng cha hiu qu.
Nghin cu ny gii quyt vn cp bch
nhanh chng gp phn khng ch bnh TCM,
bovsckhetnhmngngidn,cbit
ltrem.
Mctiu:Xcnhcccimdcht,lm
sng,cnlmsngcabnhTCMtingNai,
nm2011.
ITNGPHNGPHPNGHINCU
Thitknghincu:Ctngangmt.
itngnghincu
Dnsmctiu:tremtnhngNai
ChuynYTCngCng
Dnschnmu:5.125tremtitnhng
NaibbnhTCMnm2011cnhpviniu
trtiBnhvinNhingngNaicy
hsbnhn.
C mu: Theo cng thc s dng c
lngcmuchomtnghincumtvik
thutchnmungunhin:
Z 2 (1 / 2 ) (1 p)
n
=
2p
Trongzltrstphnphichun,z=1.96
:XcsutsailmloiI,chn=0,05.
p:Trsmongmuncatl,p=0,60
:Saistngi,=0,05
n=1.025
Kthutchnmu:chnmungunhin.
Phngphpthuthpdkin:Hicuh
s,ghivophiuiutrasonsn.
S dng Epidata nhp d liu, s dng
Stata8,SPSSxlsliu.
Tnsvphntrmlnhngsthngkcn
tnhmtvtlcccimvdchtca
311
NghincuYhc
munghincu,tlcctriuchnglmsng,
tlcccimcnlmsng.
Phpkim2vimcngha5%cdng
sosnhcctl,giaccnhmtui,gii,nic
tr,nihc,dntc,nghnghipbm...
Binsvdchtbnhtaychnminggm
tui,gii,dntc,nictr,nghnghip,hc
vnbm,ngykhipht,ngyvovin,thi
gianvng.
BinsvlmsngbnhTCMgmc:st,
nn,tiuchy,lotming,phtbandngphng
nc,runggit,inglongchong,nhptim
nhanh.
Binsvxtnghimbnhtaychnming,
gmc:slngbchcu,proteinCphnng
(CRP),nghuyt,khmu,intim,Xquang
phi,chcnngthn,RTPCR,PLVR.
KTQU
Bng1:cimvdcht(n=1025)
c im
Nhm 1
Tui:
2,73
Nhm 2
1,16
Nhm 3
Nhm 4
Nhm 5
Nhm 6
Nhm 7
Nhm 8
Nhm 9
Nhm 10
Nhm 11
Gii
Nam
N
T =0
Thi gian
vng (T):
T =1
1,91 1,42
T =2
T =3
T =4
T =5
T >5
Dn tc
Kinh
Hoa
Choro
Ty
Khc
Ni c tr
Bin Ha
Cm M
312
Tn s
84
422
307
150
42
9
5
3
1
1
1
577
448
205
154
373
191
64
22
16
966
39
2
4
14
323
35
T l % 2 (p value)
8,2
41,2
30,0
14,6
4,1
2 = 2234,98
0,9
(p<0,01)
0,5
0,3
0,1
0,1
0,1
56,3
2 = 16,24
43,7
(p < 0,01)
20
15
36,4
18,6
6,2
2,1
1,6
94,2
3,8
0,2
0,4
1,4
3,15
3,4
c im
Tn s
nh Qun
52
Long Khnh
18
Long Thnh
55
Nhn Trch
8
Tn Ph
11
Thng Nht
80
Trng Bom
200
Vnh Cu
85
Xun Lc
58
Ni khc
100
Ngh
Cng nhn
472
nghip b
Nng dn
198
Gio vin
30
Cng chc
21
Khc
304
Ngh
Cng nhn
503
nghip m Nng dn
249
Gio vin
41
Cng chc
19
Khc
313
2
(p value)
T l %
5,1
1,8
5,4
0,8
1,1
7,8
19,5
8,3
5,7
9,8
46
19,3
2,9
2,0
29,7
49,1
14,5
4,0
1,9
30,5
Nhnxt:Nhm2tuichimtlcaonht(41,2%),
3tuichim79,4%,5tui(98,1%)v6tuil
99%. S khc bit gia cc nhm tui c ngha
thngk.TlnammcTCMcaohnn.Skhc
bit gia 2 gii v t l mc bnh TCM c ngha
thngk.Thigiantrungbnhtlckhiphtn
khinhpvinl 1,91 1,42,smnhtlnhpvin
trongngy,munnhtl9ngy.
Dn tc Kinh chim a s, tip theo l dn
tcHoavBinHacscaTCMnhiunht,
cgn10%cabnhTCMchkhungoitnh
ngNai.Nhngtrcblmnghcngnhn,
conbbnhTCMchimtlcaonht,tiptheo
l nng dn; m lm ngh cng nhn, con b
bnhTCMtlcaonht.
Bng2:cimvlmsng(n=1025)
Ni dung
St
Nn
Tiu chy
Lot ming
Pht ban
Rung git
Git mnh lc ng
Git mnh lc khm
Rung chi
Tht iu
Tn s
726
82
46
714
872
0
688
44
17
2
T l %
70,8
8,0
4,5
69,7
85,1
0
67,1
4,3
1,7
0,2
ChuynYTCngCng
Ni dung
i ng long
chong
Nhp tim nhanh
NghincuYhc
Tn s
8
T l %
0,8
con s thc t trong nghin cu ny c thp

hn(6,4,9).
56
5,5
TiTrungQuc,nm2008,trongs6.049ca
TCMthtsnam/nl1,9:1vtrongnm2009
tsnyl1,8:1(n=1.155.525).
Nhnxt:haygpnhtbnhnhnTCMltriu
chngphtban,tiplst,gitmnhlcng.
Triuchngrunggitkhngghinhncano
Bng3:Cccimvcnlmsng
Ni dung
Bch cu tng
Protein C phn ng (CRP)
ng huyt tng
Kh mu thay i
Siu m tim
X-Quang phi thay i
Chc nng thn thay i
RT-PCR
PLVR
Tn s
244
143
119
1
5
29
1
2
10
T l %
23,8
14
11,6
0,1
0,5
2,8
0,1
0,2
1
Nhnxt:haygpnhtltriuchngbchcu
tng,tiplphnngCRP.
BNLUN
Tui:Ktqunghincuchothytlmc
bnh TCM cc nhm tui c khc bit r rt,
skhcbitcnghathngk.Nhm2tuic
t l mc TCM cao nht, chim 41,2%. Bnh
nhn 6 tui chim t l 99% s ca mc TCM.
Cng ln tui, t l mc TCM cng gim. Kt
qunyphhpviktqunghincucacc
tc gi khc ti Singapore, Malaysia, i Loan,
Trung Quc(5,4). Theo on Th Ngc ip, 91
%bnhnhnTCMdi3tui(6)
So snh vi cc nghin cu khc v bnh
TCM, nhm 5 tui trong nghin cu ny c
caohn.
Ti i Loan, nm 1998, trong s 1.548 ca

TCM th t s nam/n = 1,5:1 v ti Malaysia
nm2005,tsnam/nl1,4:1(n=4.290).
Theo on Th Ngc ip, t s nam/n l
1,45/1(6).
Nhvygianamvnvncskhcbit
v kh nng mc TCM song ti Vit Nam s
chnhlchvtsnythphnccnckhc.
Thigiantkhikhiphtnkhivovin
C90%cabnhTCMnhpvintrongvng
3 ngy k t ngy khi pht triu chng u
tin,cbitc20%scaTCMnhpvinngay
trongngyutinkhiphttriuchng.iu
nychngtbnhTCMrtcquantm
dotnhchtlylanvtvongnhanhcabnh
vdocngtctruynthngvbnhnyn
cngidn.Khiphthintriuchngnghi
bnhTCM,bnhnhncnhpvinsm.Tuy
nhin, vn c nhng trng hp bnh TCM
cnhpvintrsaukhikhipht9ngymi
nhpviniutr(8).
Dntc
T l ca bnh TCM thuc dn tc Kinh
chimas,iunycngphhpviccu
dnstrnabntnhngNai.
Nictr
Vgiitnh
Ca bnh TCM phn b theo ni c tr ti

Bin Ha cao nht, kt qu ny cng ph hp
vi qui m, mt dn s tng a phng.
iu ny cng ph hp v bnh TCM l bnh
truynnhim,lytrctipngingidotip
xc.Nhngnicmtdnccao,tipxc
nhiuscnguycmccaohnnikhc.Bin
Hacnglnicnhiucngnhnnhttnh.
GiitnhnamctlmcTCMcaohnn,
s khc bit c ngha thng k. Kt qu ny
tng t vi kt qu cc nghin cu khc ti
TrungQuc,iLoanvMalaysiatuynhinv
iungquantmlcngn10%sca
TCMtingNaicachnilngoitnh,
yliurtkhkhnchocngtciutra,
x l dch(7). Mc d b, m lm cng nhn v
Quc gia
Nm nghin S ca TCM (n)

cu
Nht
2003-2005
378.024
2007
1.149
Trung Quc
2008
34.539
2009
1.155.525
ng Nai-VN
2011
1.025
ChuynYTCngCng
T l 5
tui (%)
90
84,4
92
93
98,1
313
NghincuYhc
sinhconngNailunhnghkhu,a
chcaconvntnhkhccchuynbo
himyttheophnb.
chng vim no mng no, kt qu ny cng

ph hp vi kt qu nghin cu ca on Th
Ngcip(6).
Nghnghipcab,m
Th nht, pht hin nhng triu chng

nycntheodistbnhnhnvylnhng
duhiuccholquantrngnhgic
chuyn,binchngthnkinh,tuynhindo
qutibnhvin,nhtltrongthiimnh
dch,thchinvicnyrtkhkhn.
CccaTCMcbm lm ngh cng nhn

chimtlcaonht,tipnlnngdn.iu
nycthdotingNaitlcngnhncao
hnngnhkhchnnacngnhnascng
nhntnikhcn,thngtr,thiuthn
cc iu kin v sinh, sc khng thp, iu
kinchmscconcichathtstt.
Triuchnglmsng
ThnggpnhtbnhnhnTCM(3,1)
lphtban,tiptheolst,gitmnhlc
ng.
Theo on Th Ngc ip, cc triu chng
nng,haygpvdtvongcabnhTCMl
st cao v i. C 66,4% tr khi pht bnh vi
triuchngst.Sangthngdanimlccdu
hiu r rng nhn din bnh nhng ch c
23,2%trkhiphtlsangthngdav7,4%l
bnhaylming(6).
Mc d bnh tay chn ming l mt bnh
truyn nhim ly lan nhanh, t l t vong cao
nhng triu chng lm sng nh m t ca y
vnthngkhngy.
Cc triu chng c nng thng t gp lc
khm,chghinhnqualikhaicanginh
bnhnhncthcsailch,phthucvokin
thccah.
Cctriuchngthcththngkhngy
,khnginhnh,xuthinmun.
y l nhng kh khn trong cng tc
khm,chnon,pht hin sm ca bnh TCM
lmchoktquiutrbhnch.
Cc triu chng lm sng c m t trong y
vnnhngthockhnggp.
lrunggit,inglongchong,tht
iu,gitmnhlckhm,rungchi.
T l bnh nhn TCM c triu chng rung
git nghin cu ny l 0%, cho thy: co git
khngphilbiuhinnibttrTCMbin
314
Thhai,bnthnvicnhnghacctng
m t triu chng nh tht iu, rung chi, i
ng long choang cng kh hiu, kh m t,
kholngdovyvicghinhnskhkhn
vcthbbqua.
Cnthitphicnghincusuthm,thm
ch chnh sa c nh ngha ca bnh chun
choTCM.
Ccxtnghimthnggpnhtcac
chnonTCM
lbchcutng,phnngCPR,ng
huyttng
Mc d khng phi l tiu chun vng
chnonxcnhcaTCMnhngthnggp
hnccxtnghimkhccthdoylnhng
xt nghim d dng thc hin ti ch, kt qu
nhanh,pngkpthichoiutrnnthng
clmnhiu(8,7).
Cc xt nghim c hiu cho chn on

TCM
Theo qui nh, cc ca chn on xc nh l
TCM cn c xt nghim RTPCR hoc PLVR(3).
Tuynhin,ktqunghincuchothyccxt
nghimnylirttcthchin,iviRT
PCRl0,2%vPLVRl1%.Kt qu ny cha
chothytlcctypeEVgybnhkhuvc.
TheobocothtlEV71l72%,EVkhcl
13% v c 15% mu xt nghim c kt qu m
tnh(2). Cn theo T chc Y t th gii (WHO)
trongccvdchTCM,EV71cngchimtl
cao,tnhtrnglmsngnng,tltvongcao
hnsoviCoxsackievirusA16vccEVkhc(9).
ChuynYTCngCng
Theo V Th Qu Hng, Trng Hu Khanh
t l dng tnh vi EV 71 cc trng hp
TCMcaohnsoviccEVkhc(8)
Theo qui nh nhng ca nng t 2b tr
ln,nhngcatvongphiclymulm
xt nghim nhng do cc ca nng thng din
binnhanh,khngkplymu.
Mt khc, ti bnh vin cha trin khai cc
xt nghim ny m phi chuyn mu n labo
caVinPasteurTP.HCMqungngkhxa
vcngphimt23ngythmchluhn,kt
quxtnghimvthbnhnhnravinhoc
tvongvvybnhvinkhngthcstchcc
trongviclymu.
KTLUN
Kt qu iu tra ca nghin cu ny cho
thynhsau:
Tui trung bnh cc bnh nhn TCM l
2,73 1,16.C99%bnhnhnTCMnhmtui
6. T l mc bnh TCM cao nht nhm 2
tui. Cc nhm tui khc nhau th t l mc
TCMkhcnhau,skhcbitcnghathng
k.
Gii tnh nam mc bnh TCM cao hn n,
skhcbitcnghathngk.
NghincuYhc
Cc xt nghim c hiu cho chn on

TCMlRTPCRhocPLVRrttcthchin
tituyntnh.
Kinngh
CcbinphpphngchngbnhTCMcn
tptrungvonhm6tui,cbitnhmt3
tuitrxung.
Cnkhaithcrachnihinticacc
caTCM.
Quan tm, chm sc tt hn na i sng
chocngnhn,cbitlvncungcpnc
sch, v sinh mi trng c th gp phn lm
gim nguy c mc bnh TCM cho con em ca
h.
Trnh cc trng hp nhp vin tr bng
cchphthinsmduhiubnh,truynthng
rngrihnchongidnvduhiubnh.
Cn theo di bnh nhn TCM st sao, k
lng trnh b st cc triu chng. c bit
quan tm cc trng hp c pht ban dng
phngnc,st,gitmnhlcng.
nghccbnhvincntngcngthc
hinxtnghimRTPCR,PLVRnhiuhnna
chnonxcnhcabnhTCM.
Thi gian trung bnh t khi khi pht n

khi nhp vin l 1,91 1,42 ngy, sm nht l
nhpvintrongngy,munnhtl9ngy.
ngh B Y t sm c Hng dn chn

on,iutrTCM,Hngdngimst,phng
chngbnhTCM,HngdnxldchTCM
mi,phhpthctvhiuquhn.
Gn 10% bnh nhn TCM c a ch ni

ngoitnh.
TILIUTHAMKHO
B m lm cng nhn c con mc TCM

chimtlcaonht.
Cc triu chng lm sng khng y ,
khng in hnh, hay gp nht cc ca c
chnonTCMlphtbandngphngnc,
st,gitmnhlcng.
Cctriuchnglmsngtgplrunggit,
i ng long chong, tht iu, git mnh lc
khm,rungchi.
Ccxtnghimthnggpnhtcac
chn on TCM l bch cu tng, phn ng
CPR,nghuyttng.
ChuynYTCngCng
1.
2.
3.
4.
5.
6.
B Y t (2008), Hng dn chn on, iu tr bnh taychn

ming,banhnhkmtheoQuytnhs1732/QBYTngy
16/5/2008caBtrngBYt.HNi.
B Y t (2011), Bocotngktcngtcphngchngdchnm
2011, ti liu hi ngh ngy 08 thng 02 nm 2012 ti Vin
PasteurTP.HCM.TP.HChMinh.
B Y t (2011), Hng dn chn on, iu tr bnh taychn
ming, ban hnh km theo Quyt nh s 2554, ngy
10.07.2011caBtrngBYt.HNi.
Centers for Disease Control and Prevenetion (1984), Deaths
among children during an outbreak of hand, foot, and mouth
disease.Taiwan, Republic of China, AprilJuly 1998, MMWR
Morb.Mortal.Wkly.Rep.1998;47:62932.
ChenKT,ChangHLetal(2007),Epidemiologicfeaturesofhand
footmouthdiseaseandHerpaginacausedbyEnterovirus71in
Taiwan,19982005.PediatricsAugust2007,120:e253e261
onThNgcip,TrngHuKhanh,TrngThChit
Ng (2007), cimbnhTCMtibnhvinNhingInm
315
NghincuYhc
7.
8.
316
2007.TpchYhcThnhphHChMinh,tp11,s42007,
tr.3544..
Trung tm Y t d phng ng Nai (2011), Bocotngkt
cngtcphngchngdchnm2011,tiliuhinghngy16
thng02nm2012tingNai.ngNai.
V Th Qu Hng, Hunh Th Kim Loan, Phan Vn T,
Nguyn Th Thanh Tho, Trng Hu Khanh, Vincent D,
9.
KouichiM(2006),Bnhvimnomngnocpdovirttr
emtiBnhvinNhingITP.HCM,nm2005, Bo co hi
nghkhoahcnm2006,VinPasteurTP.HCM.Trang22.
WHO(2011),AGuidetoClinicalManagementandPublicHealth
responsforHand,FootandMouthDisease.WHOpublication.
ChuynYTCngCng
NghincuYhc
CCYUTNGUYCCAPHNMANGTHAIVISANHNONTI
BNHPHCT01/2011N07/2011
NguynVnKhoa*
TMTT
tvn:Sanhnonhinvnlmtnguynnhngyranhiuvntrmtrngthmchtvongcon
cao.Tmracccyutnguyctngvngminkhcnhaulcnthithnchphnnotlsanhnon.
Mctiu:XcnhccyutnguyccaphnmangthaivisanhnontitnhBnhPhctthng1
nm2011nthng7nm2011.
Thitknghincu:Bnhchng
Phng php:Nghincutrn244thaiphnsanhtibnhvinakhoatnhBnhPhctthng
01/2011n7/2011.Chnmungunhinhthng.Nhmbnh:Ttcccsnphsanhnondochuyndt
nhintibnhvinakhoatnhBnhPhctthng01/2011n7/2011.Nhmchng:ngvimisnph
sanhnon,chngtichnmtsnphsanhthngtrongcngthiim.
Ktqu:Ccyutnhhngnsanhnoncghinhn:tuimangthaidi20thnguycsanhnon
caogp3,3ln(OR=3,3viKTC95%(1,2010,80)),snphctinssanhnonthnguyccaogp3,16ln
(OR=3,16viKTC95%(1,1310,16)),snphcnghnghiplmrythnguycsanhnoncaogp3,48ln
(OR=3,48viKTC95%(1,926,34)),nhngsnphlmmthnguycsanhnoncaogp3,81ln(OR=3,81
viKTC95%(1,639,66)).
Ktlun:Cncshtrhnnachonhngsnphcnghnghiplmry,trongthigianmangthai
khngnnilmbanm.Nhngsnphmangthaiqusmhocctinssanhnonnncchchmsc
tinthaicbitnhmgimnguycsanhnon.
Tkha:Sanhnon,yutnguyc
ABSTRACT
RISKFORTORSOFPREGNANTWOMENWITHPRETERMBIRH
INBINHPHUOCBETWEENJAN,2011ANDJUL,2011
NguyenVanKhoa
Background:Pretermbirthisamajorcauseforserioushealthproblemsorevenbefatalforthebaby.Finding
theriskfactorsofprematurebirthineachregionisessentialforreducingpretermprevalence.
Objective:TodeterminefactorsassociatedwithpretermlaborinBinhPhuocprovincefromJanuary,2011
toJuly,2011.
Design:Casecontrolstudy
Methods:Casecontrolstudyinwhichinterviewed224pregnantwomeninBinhPhuocGeneralhospital
deliveredfromJanuary,2011tillJuly,2011.Inwhich112pregnantwomenwerehavinggestationageunder37
weeksand112pregnantwomenhavinggestationagefrom37to41weeks.Samplesizewasselectedrandomly
systematic.
Results: Risk factors associated with preterm in Binh Phuoc consist of: age of mother under 20 OR=3.3
TrngtrungcpYtBnhPhc
Tcgilinlc:Ths.Bs.NguynVnKhoaT:0914101263Email:bacsikhoa@gmail.com
ChuynYTCngCng
317
NghincuYhc
CI95%(1.2010.80),historyofpretermbirthOR=3.16CI95%(1.1310.16),farmerOR=3.48CI95%(1.926.34),
nightworkinginpregnanttimeOR=3.81CI95%(1.639.66).
Conclusion: Thereisagreatneed to support pregnant farmers, not to do night work in pregnant time.
There should be special prenatal care for young mothers and pretermhystory women to reduce the risk of
pretermlabor.
Keyword:Pretermbirth,riskfactors
TVN
Sanhnonhinvnlmtnguynnhngy
ranhiuvntrmtrngthmchtvongcon
cao.Trs sinh non thng c t l t vong chu
sinhcaohnsovitrssinhthng.Vn
vsckhecngnhsphttrinvtinhthn
saunycngcnhiuhnch.Ccbinchng
casanhnonrtnhiu,nhngngknhtl
ccbinchngsuyhhpsausinh,bngtdo
thiu cht Surfactan gy bnh mng trong, nh
hng di chng thn kinh ko di, ch s IQ
thp, nhim trng s sinh cao(4,5,6,13) y l
gnhnngchogianhvxhi.
T l sanh non trn th gii hin vn cn
cao v khc nhau ty theo tng quc gia v
vnglnhth(1,9).TiccncthucchuM
La tinh nm 2003 l khong 9%, ti M nm
2004l12,5%.
Mtsnguynnhndnnsanhnonnh:
heotcung,mbtinsngitnng,tcung
d dng, a thai, nhim trng i(1,4,2) Tuy
nhincnkhong40%n50%cctrnghp
sanhnonkhngtmranguynnhnmchc
ccyutnguyclinquannsanhnonnh:
tuim,tinssanhnon,tnhhnhkinhtgia
nh,cnnngm,trnhhcvn,cngvic,
tnhchtcngvic(1,4,3,7)Tm ra c cc yu
tnguyctngvngminkhcnhaulcn
thithnchphnnotlsanhnon,qua
cithincucsngchotremvphn,gp
phn ci thin cht lng cuc sng cho gia
nhvxhi.
Bnh Phc l mt tnh min ni, dn tc,
bin gii c din tch 6.853,35 km2. Dn s
894.172ngi,trongc41dntcsinhsng,
dn tc t ngi chim 20% dn s, t l ngi
ngho10%dns(15).Tnhhnhkinht,vnha
xhicnmcthp,phongtctpqunca
318
mtsdntcthiuscnrtlchu.Csh
tng, giao thng i li cn kh khn, iu kin
lmviccaiasngidncnnhiuhn
ch. L mt tnh m t l mt s bnh cn lu
hnhkhcaonhstrt,lao,buc(15),tltr
em suy dinh dng di 5 tui nm 2007 l
23,5%(14),tlsanhcnmccao2,1%(14).Hin
naytitnhBnhPhc,tlsanhnonvncn
cao(14). Yu t nguy c no lin quan n sanh
nontiBnhPhc?Trongyutnoctc
ng mnh v c th can thip? Bit c
nhngiuny,chngticthiuchnhcho
vicqunlthainghnctthn.Vnhng
ldotrn,chngtitinhnhnghincuti:
Cc yu t nguy c lin quan n sanh non
ph n tnh Bnh Phc t thng 1 nm 2011
nthng7nm2011.
Mctiunghincu
Mc tiu tng qut: Xc nh cc yu t
nguyclinquannsanhnontiBnhPhc.
Mc tiu chuyn bit: Xc nh cc yu t
nguy c mang tnh c th ti Bnh Phc vi
sanh non nh: ngh nghip ca thai ph, tnh
chtcacngvic,tuimangthai,thigianlm
victrongthaik,lmvicvobanm
ITNGPHNGPHP
Thitknghincu:
Bnhchng
itngnghincu
Dnsmctiu:
TtcccsnphsausanhtiBnhvina
khoa tnh Bnh Phc t thng 01/2011 n
thng7/2011
Dnschnmu
ChuynYTCngCng
Nhmbnh:Ttcccsnphctrsanh
non do chuyn d t nhin ti Bnh vin a
khoa tnh Bnh Phc t thng 01/2011 n
thng7/2011
NghincuYhc
nh, tnh trng sc khe cho php tin hnh

cucphngvn,chpnhnthamgiavonghin
cu.
Tiuchunloitr
Nhm chng: ng vi mi sn ph sanh
Ttcccsnphctrsanhrakhngxc
non chng ti chn ngu nhin mt sn ph
nhcchnhxctuithai(khngnhngy
sanhthngvocngthiim
kinhcuihockhngcktqusium3thng
Cmuctnhtheocngthcsau:
u thai k), nhng tr non khng phi do
2chuyn d t nhin m v nhng l do khc
{Z (1 / 2 ) [ 2 P2 (1 P2 )] + Z (1 ) [ P1 (1 P1 ) + P2 (1 P2 ) ]}
n=
nh: thai d dng, thai cht lu, tin sn git
( P1 P2 ) 2
nng, a thai, a i, nhau tin o, nhau bong

OR. P2
P1
=
non
OR. P2
+ ( 1 P2 )
:xcsutsailmloiII
Kimsotsailch
Chng ti hun luyn cho 2 n h sinh
phng vn sn ph, hai n h sinh ny khng
bitmctiunghincumchphngvnda
trnbngcuhi.
1:scmnhcaphpkim
KTQUNGHINCU
ViZ:trstphnphichun
:xcsutsailmloiI
P1=xcsutphinhimtrongnhmbnh
P2=xcsutphinhimtrongnhmchng
OR:tschnh
Vi=0,05;Z0,975=1,96;1=0,80;Z0,8=
0,84;OR=2;P2=0,25;P1=0,4
Tnhcn=122trnghpchominhm
Bng1:cimcaitngnghincu(n=224)
Bin s
Tui
Dn tc
Chng ti ly p2= 0,25 v theo nghin cu

ca tc gi Ellen L. Mozurkewich t l sanh
non do thi gian ng lm vic trong nhm
chngl22,2%.
Tin s sanh
non
Kthutchnmu
Cng vic lc
mang thai
S ln sanh
pdngkthutchnmungunhinh
thng
Tiuchchnmu
ivinhmbnhchngtichnttccc
sn ph sinh sng ti Bnh Phc c tr sanh
non(tuithaittunth22ntrctunth
37 c tnh theo kinh cui hoc siu m 3
thng u)(11,8) n sanh ti bnh vin a khoa
tnh Bnh Phc t thng 01 nm 2011 n
thng 7 nm 2011. i vi nhm chng chng
tichnccsnphctrsanhthng(tui
thaittunth37nhttun41).Nhngsn
ph trong c hai nhm phi c tinh thn n
ChuynYTCngCng
Thi gian lm
vic trong thai
k
Thi gian lm
vic trong tun
Thi gian n
ni lm vic
trong ngy
Lm vic ban
m
Thi gian ng
lm vic trong
Dch t
Tn sut/T l
(n=224)
Di 20
24 (10,71)
20-30
161 (71,87)
Trn 30
39 (17,42)
Kinh
177 (79,00)
Khc
47 (21, 00)
Con so
25 (11,16)
Con r
199 (88,84)
C
23 (10,27)
Khng
201 (89,73)
Lm ry
95(42,41)
Lm trong khu cng nghip 23 (10,27)
Cng nhn vin chc
31 (13,84)
Ni tr
46 (20,54)
Khc
29 (12,95)
Di 3 thng
94 (41,96)
T 3 thng tr ln
130 (58,04)
T 40 gi tr xung
Trn 40 gi
Di 60 pht
T 60-120 pht
Trn 120 pht
C
Khng
Di 2 gi
T 2 6 gi
120 (53,57)
104 (46,43)
139 (62,05)
62 (27,68)
23 (10,27)
37 (16,52)
187 (83,48)
93 (41,52)
97 (43,30)
319
NghincuYhc
Bin s
Dch t
ngy
Trn 6 gi
Di 5 kg
T 5 50 kg
Trn 50 kg
C
Khng
Rt hi lng
Hi lng
Khng hi lng
Cng vic c
mang vt nng
Lm vic theo
dy chuyn
Mc hi lng
vi cng vic
Tn sut/T l
(n=224)
34 (15,18)
0 (0)
142 (63,39)
82 (36,61)
17 (7,59)
207 (92,41)
55 (24,55)
132 (58,92)
37 (16,52)
Nhnxt:Tuich yu tp trung nhm

2030 (60,99%). S sn ph sanh con ln u
(11,16%). T l ngi Kinh (79%) cao hn so
vi dn tc thiu s (21%). Tin s sanh non
(10,27%). Ngh nghip lm ry chim a s

(42,41%).Thigianlmvictrongthaikt3
thng tr ln (58,04%). Thi gian lm vic
trongtuntrn40gi(46,43%).Thigiann
ni lm vic di 60 pht (62,05%). Sn ph
trong mu nghin cu i lm vo ca m
(16,52%).Thigiannglmvicttrn6gi
trong ngy (15,18%). S sn ph trong mu
nghincuphimangvtnngt5kg50kg
trongcngviccamnh(63,39%),mangtrn
50 kg (36,61%). Lm vic theo dy chuyn
(7,59%). Khng hi lng vi cng vic
(16,52%).
Bng2:Ccyutnguycivisanhnon(n=224)
Yu t
Tui
Dn tc
S ln sanh
Tin s sanh non
Ngh nghip
Thi gian lm vic trong thai
k
Thi gian lm vic trong tun
Thi gian n ni lm vic
Lm vic ban m
Thi gian ng lm vic
Mang vt nng
Hi lng vi cng vic
<20
20
Kinh
Khc
Con so
Con r
C
Khng
Lm ry
Ngh khc
Di 3 thng
> 3 thng
< 40 gi
>40 gi
< 60 pht
> 60 pht
C
Khng
<2 gi
> 2 gi
550 kg
>50 kg
C
Tn sut/T l%
Sanh non
Sanh thng
18 (75,00)
6 (25,00)
94 (47,00)
106 (53,00)
24 (51,06)
23 (48,94)
88 (49,72)
89 (50,28)
13 (52,00)
12 (48,00)
99 (49,75)
100 (50,25)
17 (73,91)
6 (26,09)
95 (47,26)
106 (52,74)
64 (67,37)
31 (32,63)
48 (37,21)
81 (62,79)
46 (48,94)
48 (51,06)
66 (50,77)
64 (49,23)
66 (55,00)
54 (45,00)
46 (44,23)
58 (55,77)
63 (45,32)
76 (54,67)
49 (57,65)
36 (42,35)
28 (75,68)
9 (24,32)
84 (44,92)
103 (55,08)
46 (49,46)
47 (50,54)
66 (50,38)
65 (49,62)
70
72
42
40
89
98
Khng
Nhn xt: Theo phn tch cho thy trong

ccyutclachnnghincuthcc
yu t c s khc bit c ngha v phng
dinthngkl:tuimang thai, tin s sanh
non,lmry,lmvicvobanmviORln
ltl3,3;3,16;3,48v3,81.
320
14
OR(KTC95%)
3,3 (1,21-10,79)
1,06 (0,53-2,12)
1,09 (0,44-2,76)
3,16 (1,13-10,16)
3,48 (1,92-6,34)
0,93 (0,53-1,64)
1,54 (0,88-2,71)
0,61 (0,34-1,09)
3,81 (1,63-9,66)
0,96 (0,55-1,70)
0,93 (0,52-1,65)
1,49 (0,69-3,34)
23
BNLUN
Hin nay, tui sanh c khuyn
co l t 20 n 30 tui, sanh qu sm hoc
qumunucnhngnguycchocmv
con(10).Vvy,trongnghincunychngti
chia tui ca sn ph ra lm ba nhm l
ChuynYTCngCng
NghincuYhc
di20tui,t20n30tuivtrn30tui.
Trongnghincucachngti,latuidi
20chimtlkhcao(10,71%),ylvn
ph bin Bnh Phc do tnh trng kt hn
t kh sm ca cc c gi la tui v thnh
nin,latuinycthcaccbmcha
pngychosphttrincabothai,
h cha kin thc cng nh kinh nghim
trongvicchmscthai,ngoiraccbmtr
tuiBnhPhccnphilmvicrtnhiu
trongqutrnhmangthai,hphilmnhng
cng vic nng nhc m l ra khng nn lm
trongqutrnhmangthainhcomcaosu,
phunthucditc,thuctrsu.Tlsanh
non nhm sn ph c tui di 20 cao
hnhnsovi2nhmcnli.Phntchthng
kchothynhngsnphnhmtuidi
20 th t l sanh non cao gp 3,3 ln so vi
nhmcnli(OR=3,3;KTC95%:1,2110,79).
Theo tc gi Nguyn Xun V khi nghin

cu mt s yu t nguy c sanh non ti a
bnThnhphHChMinh cho thy nhng
sn ph c lm ca m th t l sanh non cao
hn so vi nhm khng lm ca m(9). Trong
nghin cu ca chng ti th t l sn ph c
lm ca m chim 16,52%, nhng ngi ny
thngphiilmt2gisngmingydo
cthcacngviccomcaosu.Tlsanh
nonnhmcilmbanmcaohnsovi
nhmcnli.Kimnhcnghavphng
dinthngk(OR=3,81;KTC95%:1,639,66).
Nguyctiphtsanhnonchim2550%.
Nguyccngcaonucngcnhiulnsanh
nontrc(1).Trongnghincunytlsn
ph c tin s sanh non l 10,27%. T l sanh
nonnhmctinssanhnoncaohnnhiu
so vi nhm cn li (72,74% so vi 47,26%).
Phn tch thng k cho thy nhm c tin s
sanhnonthtlsanhnoncaogp2,97lnso
vi nhm cn li (OR=2,97; KTC95%: 1,05
9,63).
Nhng sn ph c tin s sanh non

(OR=2,97;KTC95%:1,059,63).
Tlsanhnoncaonhmsnphctnh
trng kinh t x hi thp, cng vic c tnh
cht nng nhc, cc kh(5,10). Cng vic c
nhng tnh c th ring, Bnh Phc cng
vic chim t l cao nht l lm ry (42,41%).
Nhngngilmrythngphilmnhng
cngvicnngnhcvthigianlmvicko
di, h thng lm cng vic co m cao su,
khai hoang t, trng trt.H l nhng
ngi thng tip xc vi nhng yu t c
hichosckhenhthuctrsu,thucdit
c,muitTlsanhnontrongnhmcc
snphlmrycaohnsoviccnhmkhc.
Kim nh c ngha v phng din thng
k(OR=3,48;KTC95%:1,926,34).
ChuynYTCngCng
KTLUN
Qua nghin cu bnh chng trn 224 sn
ph sau sanh, chng ti tm ra mt s yu t
nguycivisanhnonBnhPhcl:
Nhng thai ph sanh tui di 20
(OR=3,3;KTC95%:1,2110,79).
Sn ph c cng vic trong thai k l lm

ry(OR=3,48;KTC95%:1,926,34).
Sn ph lm vic ban m (OR=3,81;
KTC95%:1,639,66).
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
8.
Goldenberg RL, Culhane JF, Iams JD, Romero R (2008).

Epidemiology and causes of preterm birth.The Lancet371: pp
7584.
Hunh Nguyn Khnh Trang (2006) Lnhaudyrnthai
nonthng,SnPhKhoatpI,NhxutbnYHcTP.H
ChMinh,tr.6980.
Kaempf JW, Tomlinson M, Arduza C,et al.(2006). Medical
staffguidelinesforperiviabilitypregnancycounselingandmedical
treatmentofextremelyprematureinfants.Pediatrics117:pp. 22
29.
L Dim Hng (2006) Trssinhnonthng, Sn Ph Khoa
tpII,NhxutbnYHcTP.HChMinh,tr.565570.
MathewTJ,MacDormanMF(2006).InfantMortalityStatistics
from the 2003 period linked birth/infant death data set.National
VitalStatisticsReports54.
MorganMA,GoldenbergRL,SchulkinJ(2008).Obstetrician
gynecologists practices regarding preterm birth at the limit of
viability.Journal of MaternalFetal and Neonatal
Medicine21,pp.123134.
Nguyn Nguyn.(2005) Phng php nghin cu khoa hc
trongykhoa,tr.3451.
Nguyn Duy Ti (2006) nhtuithai,Sn Ph Khoa tp II,
NhxutbnYHcTP.HChMinh,tr.370376.
321
NghincuYhc
9.
10.
11.
322
Nguyn Xun V (2009) Mi lin quan gia cng vic v tnh

chtcngvicvisanhnontimtskhucngnghiptrnabn
TP.HCM,LunvnttnghipBcSnitrYkhoa,ihc
YdcTP.HChMinh,tr.5254.
Reichman NE, Pagnini DL (1997), Maternal age and birth
outcomes: data from New Jersey. Fam. Plann. Perspect. 1997
NovDec,pp.26872,295.
Simhan HN, Caritis SN (2007). Prevention of Preterm
Delivery.NewEnglandJournalofMedicine357:pp.477487.
12.
13.
14.
15.
Steer P (2005). The epidemiology of preterm labour.British

JournalofObstetrics&Gynaecology112,pp.15715585.
TrnThLi(2006)Thainonthng,SnPhKhoatpI,Nh
xutbnYHcTP.HChMinh,tr.412415.
Trung tm chm sc sc khe sinh sn tnh Bnh Phc
(2010),Boconm2010.TnhBnhPhc.
Trung tm phng chng cc bnh x hi tnh Bnh Phc
(2010),BocophngchngccbnhxhitnhBnhPhc
nm2010.TnhBnhPhc.
ChuynYTCngCng
NghincuYhc
PHNTCHKHNNGHINTHNMTSCNGNG
TITHNHPHHCHMINH
HongThDimThy*,TrnNgcSinh,LHongNinh*
TMTT
tvn:Trongbicnhchungcannytthgii,VitNamcnganggnhchuhuqucacc
bnhmntnhansuythngiaioncui.Tuynhin,kinthc,thivhnhvivhinthncangi
dncnnhiuhnch,ansmtcnbngcungcutrmtrng.
Mctiu:phntchkinthc,thi,hnhvivhinthnvccyutclinquanvihnhvihinthn
ngitrn18tuitiTP.HChMinh.
Phngphpnghincu:Phngvn1068ngitrn18tuidavobcuhitin.
Ktqu:77%nghinthnsaucht,v63,8%nghinthnngithnsaucht.Tlngic
kinthcchangvbnhthnvchtnochim536%;21%cncthikhngtchcc.Ccyutc
tngquanvihnhvihinthn:nghnghip,kinht,kinthcngvsthiuhtngunhintng,vcht
no,quanimnhnotchcc,vicbnbcvingithn.Ldochnhcavictchihinlsnginh
khngng.Yucuchnhsaukhihinlscngbng.
Ktlun:Ktqunghincuchothyasngidnnghhinthn,ccchinlctuyntruyn,can
thiplrtcnthit,vlnntngchokhoahcghptngnctaphttrinbnvng.
Tkho:kinthc,thi,hinthn,chtno
ABSTRACT
ANALYSISOFKIDNEYDONATIONPOTENCYINSOMECOMMUNITIESATHOCHIMINHCITY
HoangThiDiemThuyTranNgocSinh,LeHoangNinh
Background: As well as other countries all around the world, Viet Nam has been undergoing the
consequencesofchronicdiseasesthatleadtoendstagekidneydisease.However,thepublicknowledges,attitude,
andbehaviorstillberestricted.Thisfacthasinducedanimportantimbalancebetweensupplyanddemandinthis
field.
Objectives: To explore knowledge, attitude, behavior about kidney donation after death and factors
associatedwiththedecisiontodonateamongtheselectivepopulationsinHoChiMinhcity.
Methods: Interviewing of 1,068 people from 18 years old by questionnaire, the interviewees filled in
themselves.
Result:77%and63.8%agreedtodonatetheirownkidneyandthekidneyoftheirrelativesrespectively
afterdeath.536%hadincorrectknowledges.21%hadnegative attitude over donation. The factors associated
withdonationcomprisedofprofession,economicstatus,goodknowledgeaboutorganshortagefordonation,and
braindeath,humanitypointofview,especiallytheconversationwithfamilymembers.
The main reason of refusal was the family members disagreement. The main requirement when a person
donateswastheequalityoforganusing.
BnhvinNhing2TP.HChMinh
Tcgilinlc:BSHongThDimThyT:Email:thuydiemhoang@yahoo.com.vn
ChuynYTCngCng
323
NghincuYhc
Conclusion:MostpeopleagreedwithdonationatHCMcity.Weneededucationcampaigntoamelioratethe
public point of view on organ donation. The public education must be the background for the sustainable
developmentoftransplantationinourcountry.
Keywords:knowledge,attitude,kidneydonation,braindeath
TVN
TcuithkXX,sbngncasuythn
mntrntonculmchongnhyhcphi
iuvimttnhtrngmtcnbngcung
cu trm trng ca thn ghp mt hin trng
ang ng hnh vi cc tin b khng ngng
cakhoahcghpthn.Vn ny , ang
v s tr nn mt thch thc i vi sc kho
cng ng trn ton th gii. V th, cng vi
vic pht trin k thut ghp, hu ht cc quc
giauquantmnkhacnhxhivphp
lcavnnyitmgiiphpchongun
thnghp,tocsthcykhoahcghp
thnphttrinbnvng.Mttrongnhngro
cn quan trng ca cng tc ghp thn l tnh
trng thiu ht ngun thn ghp. Ngun
thntngichosngrtgiihntrongkhi,
ngun thn t ngi cho cht no cha c
huynght.
Ngy29.11.2006,tiVitNamLuthin,ly,
ghp m, b phn c th ngi c Quc
hithngqua...Tuynhin,nhnthccacng
ng v hin thn ni ring v cc b phn c
th ni chung cn rt hn ch. C ro cn no
khcvkinht,vnha,xhitrongvichin
thnngiVitNam?
Trncsny,chngtithchinkhost
KinthcThiHnhvivvichinthn
ca mt s cng ng ti thnh ph H Ch
Minh,t,gpphnrachinlccth
vnnghinthntrongdnchng.
ITNGPHNGPHPNGHINCU
Thitknghincu
Nghin cu ct ngang m t v phn tch
trn 3 nhm i tng: sinh vin, Thin Cha
gio,Phtgio.
Cmu
Thigian:thng46nm2011
aimnghincu
Thinchagio:tinhthThc:250
Phtgio:tichaThinLmQun8:250
Sinhvin:trngHLutTP.HChMinh,
HYkhoaPhmNgcThch:568
Phngphp
Phtphiucuhi35cutin
KTQU
cimitngnghincu:
Tuivgii
Tui trung bnh: 28 12,86 (tui thp nht
15,tuicaonht73)
Gii:nam413(39,04%);n:615(60,96%)
Hcvn
Phthng260(24.62%);ihc782(74.05
%);sauihc14(1.33%)
Dntc
Kinh: 986 (93,82% ); Hoa: 37 (3,52 %);
Khmer:16(1,52%),khc:Chm:12(1,14%).
Tngio
Pht:292(25,6%);ThinCha:281(24,6%);
th ng b: 330 (28,9 %); khng theo mt tn
giono:227(19,9%);khc:10(0,8%).
Tnhtrnghnnhn
C gia nh: 231 (21,73 %), c thn: 832
(78,27%).
Kinht
Giu: 37 (3,51%); kh: 225 (21,37 %); trung
bnh:681(64,67);ngho:110(10,45%).
Lytrn1068ngi.
324
ChuynYTCngCng
Nghnghipnhmitngnghincu
Bng1:Phnbnghnghipcanhmitng
nghincu(n=1068)
Ngh nghip
HSSV
CNV
Ni tr
Bun bn nh
Lao ng ph thng
Ch doanh nghip
Khc
Nng dn
S lng
707
135
59
52
39
29
29
3
%
67,14
12,82
5,6
4,94
3,7
2,75
2,75
0,28
Phng tin tip cn thng tin v hin

thn
Bng2:Phngtintipcnthngtin
Phng tin
Truyn hnh
Sch
Bo
Ngi khc
Ngi thn b bnh
Radio
Cha bao gi nghe
S lng
649
544
539
338
158
105
38
%
61
51
50,5
31,6
14,8
9,8
3,6
Ktquvkinthc
Kinthcvnhucuhinthncaxhi
Cu 13. Suy thn nng s cht nu khng
clcmuhayghpthn
Cu 14. Nhng ngi b suy thn hin nay
angrtcncnhngngichothnc
cusng.Anh/ch,ng/bcbitvthngtin
ny
Bng3:Ktqukinthcvnhucughpthn
Cu
Cu 13
Cu 14
S tr li
(%)
1049 (98,2%)
1051 (98,4%)
ng : S
lng (%)
Sai: s lng
(%)
988 (94,2%)
905 (86,1%)
61 (5,8%)
12 (13,9%)
Kinthcvchtno
Cu 15. Cht no l tnh trng tim cn p
nhng no hon ton h hi, khng cn kh
nngphchi
Cu16.Chtnothngxyratrongnhng
ci cht bt c k t nh: tai nn, tai bin
mch mu no, Anh/ch c bit iu ny
khng?
ChuynYTCngCng
NghincuYhc
Bng4:Ktqukinthcvchtno
Cu
S tr li (%)
Cu 15
Cu 16
1046(97,9%)
1052 (98,5%)
ng: S
lng (%)
880(84,1%)
856 (81,4%)
Sai: s lng
(%)
166(15,9%)
196 ( 18,6%)
Ktquvthi
Quanimnhno
Cu 18. Vic cho thn cho ngi b bnh l
mtnghacnhno?
Cu 20. Khi ngi ta cht i nhng cn
mt b phn trn c th em cho li cho mt
ngi khc th ging nh thn xc vn cn
trn ci i ny. ng/b, anh/ch ngh sao v
quanimny?
Bng5:Ktquthivquanimnhno
Cu S tr li Rt ng ng Khng Rt khng
ng
ng
18
1064
364
654 38 (3,6%) 6 (0,56%)
(99,4%) (34,3%) (61,2%)
20
1054
231
573
230
20 (5,1%)
(98,7%) (21,9%) (54,4%) (21,8%)
Quanimtuyntruyn,chias
Cu22.Victuyntruyngiodchinthn
trnccphngtinthngtinichngccn
khng?
Cu 23. Vic hin thn s d dng hn nu
c bn bc trc vi ngi thn. ng/b,
anh/chcnghrngmnhsbnbcvingi
thnkhiquytnhkhng?
Cu24.ng/b,anh/chcnghrngmnh
cngcthclccncngikhcchothn
khng?
Bng6:Ktquthivtuyntruynhinthn
Cu
Cu 22
Cu 23
Cu 24
S tr li
C : S lng Khng: s
(%)
lng (%)
(%)
1056 (98,9%) 957 (90,6 %)
99 (9,4%)
1057 (99 %)
971 (91,9%)
86 (8,1%)
1044 (97,7%) 893 (85,4%)
151 (14,6%)
Cu25:Vitngcnctuyntruyn
hinthn
207(19,64%)ngingnnbtui
hc.
700(66,41%)ngingnnbtucp
3.
325
NghincuYhc
147 (13,95%) ngi khng ng tuyn

truyn.
Ktquvhnhvi
Bng7:Ktquvhnhvihinthn
Cu
S tr li
ng
Khng ng
785 (77%)
235 (23%)
30 Hin thn 1020 (95,5%)

ca bn thn
31 Hin thn lc 1032 (96,7%) 812 (78,7%) 220 ( 21,3%)
cn sng
33 Hin thn 1005 (94,1%) 641 (63,8%) 364 (36,2 %)
ca ngi thn
Ldokhngnghinthn
Bng8:Ktquldotchihinthn
L do khng hin thn
Gia nh khng ng
S
Khc
Tn gio
S lng
185
115
70
20
%
44,8
27,8
19,6
4,8
Tngquanvivicnghinthn
Hnh vi hin thn v cc ch s kinh t x
hi
Bng9:Tngquanhnhvinghinthnvi
ccyutdns
p
0,41
0,836
0,158
0,02
1
0,45
0,022
Hnhvihinthnvkinthc,thi:Cc
cuctngquanthngkvihnhving
hinthn.
Bng10:Tngquanvihnhvinghinthn
vicutrlithun
Cu
11 Nghe v bnh thn
13 Cht nu khng c lc mu
14 Kin thc v cht no
15 Rt cn c nhng ngi cho thn
20 Ging nh thn xc vn cn trn ci i
326
<0.005
< 0.005
<0.005
< 0.005
Ccyucukhihinthn(cu34):
Tichnh:30(19,8%)
Cngbng:69(45,4%)
Khc: 53 (34,8 %): Cng bng, b mt, bo
mthnhcngchonginhn,nulngi
cho sng, cn bo m c chm sc tt sau
khihin.
BNLUN
Ccldokhc:Munginguynvncth,
s mai tng chm tr, s s dng khng ng
mcch.
Bin s
Tui ( <30 v 30)
Gii
Tnh trng hn nhn
Kinh t
Hc vn
Tn gio
Ngh nghip
21 Vic tuyn truyn gio dc hin thn trn

cc phng tin thng tin
22 Bn bc trc vi ngi thn,
24 Ngi khc cho thn
32 Hin thn ca thn nhn
p
0.014
<0.005
0,019
0.026
<0,005
ncta,trungbnhmingyc30ngi
tvongvtainngiaothng.Nhngnginy
tvongtrongtnhtrngchtno,nghalhon
ton khng c kh nng phc hi d tim vn
cnpvtuiicnrttr.Nunnnhnv
gianhnghintng,yslnguntng
qugicusngnhngngisuythngiai
oncuiniring,vsuytngmnnichung.
Tuy nhin, nhn thc ca cng ng v hin
thnniringvccbphncthnichung
cnrthnch.
V cha c nhiu thng tin v hin tng ti
Vit Nam, chng ti chn 3 i tng trn
khost v mc ch thun tin, vi gi thuyt
rng y l 3 i tng d tip cn nht c
chngtrnhcanthipsauny.Dns nghin
cucachngtichactnhidinchodn
s Vit Nam, y l kho st bc u to
tin cho cc nghin cu khc quy m hn.
Nhiu tc gi trn th gii(1,2, 3) cng chn sinh
vinvitngtngiocanthip,cbit,
theoWeaver(5),sinhvinlnhmitngtr,
cttngthongvdtohiungthpht
docmctraoicao.
Kin thc ng v bnh thn v cht no
khngthphnngksoviktqunghin
cuccncphttrin.Theokhostaquc
giacaManninen(1),c92,7%ngickinthc
vsthiuhtmtngghp;66,5%ng
rngbnthnhcthlngiphinhnthn;
64%ckinthcngvchtno.
ChuynYTCngCng
Trongnghincucachngti,tlngi
nghinthncao,khngkhcbitgiahin
lccnsnghaycht.Tlnghinthn
ca ngi thn thp hn, ph hp vi cc
nghin cu khc. Kt qu ca chng ti cng
ph hp vi nhiu tc gi nhn thy hnh vi
hinthnctngquanvinghnghip,mc
kinht,kinthcngvchtnovsbn
bcvingithn(4).Trongsnhngngi
tngbnbcvhinthntronggianhc77%
ngihin,trongkhichc42%nghin
nhmchatngtholun(4).
Hnh vi hin thn trong nghin cu ny
thc cht ch l hnh vi o. Theo cc tc gi,
consthtcahintngchcn1/31/4cons
khostcdostcngchyutngi
nh(4).Tuynhin,ktqutrncngchothy
snnhncangiVitNamvhintng
kh tt, l ng lc thc y cc chng trnh
vnnghintnghotng.Ngoira,ihi
chnh ca nhng ngi ng hin tng l
cngbng,trongkhiihivtichnhch
chim19,8%,thphncctcgitrnthgii(3).
NghincuYhc
hinthnchothyccktqukhquanvi77%
nghinthnsauchtv63.8%nghin
thn ngi thn sau cht. C trn 80% ngi
c kho st c kin thc ng v tnh hnh
bnh thn hin nay trong dn s v nhu cu
ghpthn.Chn80%ngickhostc
kin thc ng v cht no. C 6090% ngi
ckhostngviquanimnhno
khi hin thn. Cc yu t c tng quan vi
hnh vi hin thn: ngh nghip, kinh t, kin
thc ng v cht no, hiu bit v tnh hnh
thiu thn, quan im nhn o tch cc, vic
bn bc vi ngi thn. Chng ta cn c thm
nhiu nghin cu trn nhiu i tng khc
trong dn chng c nghin cu c tnh i
din hn cho ngi Vit Nam. Kt qu nghin
cuchothyasngidnnghhinthn,
ccchinlctuyntruyn,canthiplrtcn
thit, v l nn tng cho khoa hc ghp tng
nctaphttrinbnvng.
TcgixinchnthnhcmnsgipcaPGS.TS.
NguynNguyntrongvicthchincngtrnhny.
TILIUTHAMKHO
Vitngcnctuyntruynhin
thn,asngavogiodctcp3,
tuynhinsngikhngngtuyntruyn
cn cao (14,6%). y cng l nhm cn c
quan tm kho st su, tuy khng phi l a
s, nhng h c th to nh hng khng tt
chocngng.
KTLUN
1.
NghincucachngtitithnhphH
Ch Minh v kin thc, thi v hnh vi v
5.
2.
3.
4.
Manninen R, Evans W. Public attitudes and behavior

regardingorgandonation.JAMA.1985;253(21):311115
Matas AJ, David E, Sutherland R. The importance of
innovative efforts to increase organ donation. JAMA.
2005;294(13):16911693
PriceD.LivingkidneydonationinEurope:Legalandethical
perspectivestheEUROTOLDProject.Transpl.Int.(1994)7(
Suppl.1):S665S667
Siminoff LA., Gordon N, Hewlett J: Factors influencing
familiess consent for donation of solid organ for
transplantation.JAMA.2001;286(1):7177
Weaver M, Spigner C, Pinela M, Rabun KG, Allen MD.:
Knowledgeandopinionsamongurbanhighschoolstudents:
pilottestofahealtheducation.JAMA2001;286:7177.
ChuynYTCngCng
327
NghincuYhc
CIMDCHTBNHNHNUNVNIUTRTI
BVBNHNHITITP.HCM
NguynDuyPhong*,VThinn**,LmMinhYn***,PhanTrngLn***,HongMinhHin****
TMTT
Mctiu:MtcimdchtcacctrnghpunvniutrtiBVBnhNhitiTp.HCM
trong2nm20072008.
Phngphp:Nghincumthnglotcctrnghp.
Ktqu:389bnhnhnunvnnhpvintrongtui1660,tlnam/nl2,93/1.Sbnhnhnlao
ngchntaychimtl51,4%.100%bnhnhnchatngtimchngvnhpvintrong7ngyuca
bnh.C19,8%bnhnhnsngTp.HCM.Khngckhcbitvtlmcbnhgiaccthngtrongnm.
Huhtttccctrnghpunvnnhpvintrong7ngyucabnh.Vtthngkhngrngvo
chim24,94%cctrnghpvvtrvtthngngvothnggpnhtlchidi(54,8%).
Ktlun:Tlunvncaonhngbnhnhn>60tuivkhngctimngavtimnhcy.
Cntrinkhaichngtrnhtimchngnccaphng,nhtlchonngdnvccitnglaong
chntay.Timchngbtbuctrongccxnghip,cngtrngchocngnhn.Cngtctuyntruyngiodc
sckhevphngchngbnhunvncncchtrngnnidungchmscvtthngvccduhiu
nhnbitsmbnhunvn.
Tkha:UnvncimDchtYutnguycnghnghipVtthngngvo.
ABSTRACT
EPIDEMIOLOGICALFACTORSOFTETANUSPATIENTTREATEDATHOSPITALFORTROPICAL
DISEASESATHCMCITY
NguyenDuyPhong,VuThienAn,LamMinhYen,PhanTrongLan;HoangMinhHien
Objective: To characterize the epidemiological factors of tetanus patients treated in HTD in HCM city
duringtwoyears20072008.
Method:Caseseriesstudy.
Results:Thestudysubjectsincluded389tetanuspatientsaged1660.Themaletofemaleratiowas2.9/1.
The percentage of patients whose jobs were manual labor was 51.4%. All of patients have never been
vaccinatedagainst tetanus and were admitted to hospital in the first 7 days of illness. Out of every hundred
participants,198%livedinHCMcity.Theincidenceshavenotchangedbymonths..Theentrywoundswere
usuallyfoundinpatientslegs(54,76%)andsometimesnotfound(24,94%).
Conclusions: The rate of tetanus patients over 60 years old was high because either vaccination or
boosterwasnotdone:Itisnecessarytoimplementthetetanusvaccinationprogramsforfarmersandmanual
laborers.andworkersTheprimarycareforskinwoundssandrecognizingclinicalsignsofatthebeginning
periodoftetanusarecritical.
KhoaYTCngCngtrngihcYdcTPHChMinh*BnhvinNhing2Tp.HCM
BnhvinNhitiTp.HCM***CcYtDphngBYt****SYtHNi
Tcgilinlc:PGs.Ts.NguynDuyPhongT:0913155993Email:nguyenduyphongvn@yahoo.com
**
328
ChuynYTCngCng
NghincuYhc
Key words: Tetanus Epidemiology Professional Risk Factors Entry Wounds .
TVN
Ccbinsphntch
Vit Nam thc hin chng trnh tim

chng m rng bao gm vaccin nga un vn
chotremvchothaiph(5)di1tuivitl
baophhn95%tnm1990.Nhvy,tl
unvngimt11,1%(1993)cn5,6%(2003)
2. Tuy nhin, Vit Nam vn cha th loi tr
bnh un vn, Bnh vin bnh nhit i Tp.
HCM (BVBN) cng b 2.422 trng hp
unvntrongthigiant19932002.
Thngtincnhncabnhnhn(tui,gii,
nghnghip,nicng,tincn)
Mctiunghincu
Mtcimdcht:ccyutdns,x
hihc,thigiannhpvincacctrnghp
mc bnh un vn nhp vin iu tr ti bnh
vinBnhNhitiTp.HCMtrongthigian2
nm20072008.
Tnhtrngtimchngcabnhnhn.
Phntchdliu
Nhp d liu bng Epidata 3.1, Phn tch
bngSPSS16.0.
KTQU
Chng ti ghi nhn c 389 trng hp
nhp vin ti BVBN trong vng 2 nm: t
01/01/2007 n 31/12/2008 vi chn on xc
nhlunvn.Ktquvcccimdcht
vyuttinlngnhsau:
Bng1:Tnsvtlbnhnhnphnbtheoc
tnhdnsxhihc
c tnh
ITNGPHNGPHPNGHINCU
Thitknghincu
Mthnglottrnghp
Gii
Tui
Nithchinnghincu
KhoaUnvnBVBN.
itngnghincu
Tonbccbnhnhnnhpviniutrti
BVBNvichnonlmsngxcnhlun
vn.
Phngphpchnmu
Tiuchunnhnvo
Bnhnhntrn28ngytui,nhpvinti
BVBNt01/01/2007n31/12/2008vichn
onxcnhlunvn.
Tiuchunloitr
Bnhnhinhhn28ngytui(unvns
sinh).
Cchthctinhnhnghincu
Nghincuhicu,thuthpccdliut
hsbnhnlubngbngthuthpsliu.
ChuynYTCngCng
Ngh nghip
Tn s
T l (%)
290
99
0
27
276
86
111
82
53
34
23
22
64
75
25
0.0
6.9
71.0
22
28.53
21.08
13.62
8.74
5.91
5.66
16,45
Nam
N
28 ngy 6 tui
7 15 tui
16-60 tui
Trn 60 tui
Nng dn
Hu tr
Cng nhn
Hc sinh SV
Cng nhn XD
Tht nghip
Khc
Tnhtrngtimchng
100%cctrnghpunvnuchatng
ctimchng.
Bng2:TnsvtlBnhnhnphnbbnhtheo
nicng
Ni c ng
TPHCM
B Ra Vng Tu
ng Nai
An Giang
Ty Ninh
Tin Giang
ng Thp
Long An
Tn s
77
33
31
30
24
24
21
20
T l %
19.79
8.48
7.97
7.71
6.17
6.17
5.40
5.14
329
NghincuYhc
Ni c ng
Bn Tre
Tr Vinh
Bnh Phc
Bnh Thun
Bnh Dng
Khc*
Tn s
17
16
15
14
13
54
T l %
4.37
4.11
3.86
3.60
3.34
13.88
BNLUN
Tuivgii
Tlmcbnhtngdntheoccnhmtui:
Tlunvnthpnhtnhmtuit1thng
n6tui,ylnhngitngcbov
bichngtrnhtimchngmrngnntl
mcbnhthp.Nhmbnhnhntrongtui
t 16 n 60 tui chim a s (71%). y l
nhmtuilaong,cnhiunguycbccvt
thngnntlunvncaohnccnhmtui
khc.Nhmtui>60tuichimtlcaoth2
vi21,08%.ylnhmtuihutr,tlaong
nngnntcnguycbnhngvtthngng
vo. Tuy nhin, nhm tui ny t c bo v
bi vc xin do t l tim nhc thp nn d c
nguycphttrinthnhunvn.
(*)Khc:Cctnhngoidanhschtrnctnst
hn10bnhnhn.
Slngbnhnhn
50
45
40
35
30
25
20
15
10
5
0
46
41
33
30
37
35
37
34
20
9 10 1
th1:Slngtchlybnhnhnphnbtheo
thngtrongnm
Bng3:TnsvtlBnhnhnphnbbnhtheo
thigiannhpvinktlcctriuchngbnh
Thi gianc triu chng trc nhp vin
< 3 ngy
3 -7 ngy
> 7 ngy
Tn
s
271
118
0
%
69.67
30.33
0
(*)Thigianctriuchngtrcnhpvin:Khongthi
giantlcxuthintriuchngutincabnhun
vn (mi hm, nut sc, hm h hn ch, cng hm )
chonthiimnhpvin.
T l % bnh nhn
60
54.76
50
40
30
24.94
20
11.57
10
0
8.23
0.51
Chi
di
Chi
trn u mt, c
Biu1:Tlbnhnhnphnbtheovtrvt
thngngvo
330
Xtvgii,t l nam/n l 2,93/1 tng t

vinghincutiThiLan,tlmcbnhgia
2 gii nam/n l 2,14/1 (1,2); Hn na, ti Vit
Namtrinkhaichngtrnhtimchngcho
ngiitrongtuisinhsnnnntrong
tuinycbovbngvcxin.Ngcli,t
l b un vn gia 2 gii trong nhm tui > 60
tui khng chnh lch nhiu (42 bnh nhn so
vi 43 bnh nhn) v la tui ny tnh trng
cbovbngvcxingia2giicngnh
tnhchtcngvicca2giikhngcskhc
bitln.
Nghnghip
51,4 % bnh nhn mc bnh un vn lm
cng vic lao ng chn tay. c bit nhm
nng dn c nguy c mc bnh cao nht vi
28,53%.iunyldonngdnthngxuyn
tipxcvitmClostridiumtetanililmtvi
khunymkhthngctrongt.Tuynhin,
tlnngdnbunvntiVitNamgim
nhiunusosnhvimtnghincutngt
tiBVBNnm2004(28,53%sovi71.7%)(p
< 0,001)(5). Hin nay, mt s ngnh ngh d b
un vn nh cng nhn vi 19,53%, trong
cng nhn xy dng chim t l cao vi hn
30,26%.Nhvy,vicbohlaongchocng
ChuynYTCngCng
nhnvnchathtspngngmcan
ton.
Tnhtrngtimchng
100%cctrnghpunvnuchatng
tim chng. iu ny cho thy chng trnh
tim chng hin nay vn cha ch n vic
timchngvtimnhcvcxinchongiln.
Nicng
Ch c 19,79% bnh nhn sng Tp.HCM.
Tuy nhin, xt ring tng a phng, s bnh
nhncngtithnhphHChMinhchim
t l cao nht v hu ht l dn nhp c, cha
tngcchngngaunvntrcy.
Thiimmcbnhtrongnm
TheonghincucaC.Louis,vomakh
(t thng 11 n thng 4), s bnh nhn nhp
vin cao hn trong ma ma (t thng 5 n
thng10)(4).Tuynhin,trongnghincuny,s
bnhnhnnhpvinvomakhl194bnh
nhn, gn nh tng ng vi s bnh nhn
nhp vin vo ma ma l 195 bnh nhn.
Ngoira,khngckhcbitnhiuvtlmc
bnh gia cc thng trong nm. iu ny ph
hpvitnhhnhthctnhngnmgny
minNamVitNamhunhkhhunngm
quanh nm ph hp cho s pht trin ca
Clostridium tetani. Hn na, nhm dn s c
nguyccaonhtlnngdn.Ccnmgny,
nng dn min Nam Vit Nam lm v la
quanhnm(34v)nnnguycmcbnhun
vnhunhcmithiimtrongnm.Cc
ngnhnghnguyckhcnhcngnhncng
ctnsutlmvicnhnhaumithng.
Thiimnhpvin
Huhtttccctrnghpunvnnhp
vintrong7ngyucabnh.Tuynhin,nu
lymcthigianl3ngyukhiphtbnh
thtlnhpvintrc3ngyl69,67%.y
l mt yu t tt v theo y vn: un vn nu
ciutrchiusmthtinlngbnh
stthn.iunytravncnymnh
giodcsckhevnidungnhnbitccdu
hiusmcabnh.
ChuynYTCngCng
NghincuYhc
Vtrvtthngngvo
Trongs389bnhnhnnhpvinc66,58%
trng hp c ng vo l cc vt thng phn
mm v 24,94% khng r ng vo. Cc s liu
nyphhpvinghincucaThwaitesCL(6)
vHungNHtiBVBNnm20041nhngthp
hn Thi Lan (30%) trng hp khng tm
thyngvo)(1,2).
Ch c 4 trng hp c ng vo l ng
timchch(1,03%)v1trnghpcngvol
vt thng phu thut (0,26%). T l ny thp
hn nhiu so vi nghin cu trc y ca
Thwaites CL trong giai on 19932002(6)(p <
0,001). iu ny chng t tnh trng v trng
trongccththut,phuthut,snscykhoa
ccithin.
Tuy nhin, cn ch n t l un vn c
ng vo l vim tai gia (3,08%) v su rng
(2,06%). Theo y vn, y khng phi l nhng
ngvothnggpcabnhunvn.Ktqu
ny cho thy ngi dn cha c nhn thc tt
vvicchatrccnhimtrngtaivrngsu.
V tr vt thng thng gp nht l vt
thngchidi(54,76%)vkhngrngvo
(24,94%).iunyphhpviktqucacc
nghin cu trc y ca Thwaites CL l 41,5
%6vHungNHl49,8%(3).
KINNGH
Ktqunghincuchothytlunvn
ngi trn 60 tui ti Vit Nam cao v khng
ctimngavtimnhcy.Nhvy,
gimtlmcbnh:
Song song vi vic tim tc chng trnh
tim chng cho tr em v thai ph, cn y
mnhvictimchngvtimnhcchodns
cn li, nht l nhm dn s trong tui lao
ng v ngi gi > 60 tui nhm gim tn s
un vn trong nhm i tng ny. Cn p
dngccbinphpsau:
Trinkhaitimchngchonngdnvcc
itnglaongchntay,chodnnhpc.
Tim chng bt buc trong cc x nghip,
cngtrngchocngnhn.
331
NghincuYhc
Ngoira,cngtctuyntruyngiodcsc
khe v phng chng bnh un vn cn c
chtrngnnidungchmscvtthngc
nguyclngvocabotvitrngunvn
vnidungvccduhiunhnbitsmbnh
unvn.
3.
4.
5.
TILIUTHAMKHO
1.
2.
332
Chatchatee P, Chatproedprai S, Warinsathien P. (2007).

SeroprevalenceoftetanusantibodyintheThaipopulation:a
national survey. Asian Pac J Allergy Immunol. 2007 Dec;
25(4):21923.21.
KanchanapongkulJ.(2001).Tetanusinadults:areviewof85
cases at Chon Buri Hospital. J Med Assoc Thai. 2001 Apr;
84(4):4949.41.
6.
NguynHuyHng(2005).Khostlmsng,cnlmsng,
binchngvsktiutrbnhunvntiBVbnhnhit
i TPHCM. Lunvnttnghipbcsykhoa,ihcYdc
ThnhphHChMinh.
OladiranI,MeierDE,OjeladeAA.(2002).Tetanus:continuing
problem in the developing world. World J Surg 2002 Oct;
26(10):12825.Epub2002Sep6.58.
Thwaites CL et al.(2004). Impact of improved vaccination
programme and intensive care facilities on incidence and
outcomeoftetanusinsouthernVietnam,19932002.TransR
SocTropMedHyg.2004Nov;98(11):6717.20.
ThwaitesCL,YenLM,GloverC.(2006).Predictingtheclinical
outcome of tetanus: the tetanus severity score. TropMedInt
Health.2006Mar;11(3):27987.71.
ChuynYTCngCng
NghincuYhc
KHOSTTHCTRNGKHMVIUTRSTDENGUE,
STXUTHUYTDENGUECA15BNHVINAKHOA
TITHNHPHHCHMINH
ngMinhXun*,NguynVTrngGiang*,HLVit*
TMTT
tvn:ThnhphHChMinhcnglmttrongcctnhthnhphcluhnhstxuthuyt
(SXH)mccao(1),bnhlixyraquanhnmvgiatngvoccthngmama(2).Chnhvvycngtc
khmviutrstDengue,stxuthuytDengue(SXHD)lmtvnytcngngcncquantm.
Nghincuctinhnhti15nvytcaThnhPhHChMinhnhmccsgipccbnhvin
lmttcngtcgimsthtrkthutvhunluynchuyngiaokthuttrongcngtcchnonviu
trstxuthuyt.
Mc tiu:KhostthctrngkhmviutrstDengue,stxuthuytDengueca15bnhvina
khoatiThnhPhHChMinh.
Phngphpnghincu:Ctngangmt.
Ktqu:TrongcccastDengue,SXHDthstDenguechim30,2%,SXHI,IIchimtlcaonht
67,7%.KhngccastxuthuytIV.TrongcccachuynvinthSXHI,IIchim38,1%,IIIchim
61,9%.CcbnhvinkhngcphngkhmSXHring.ascphnglu,ctiuchunnhpvin,cnhc
duhiukhmngayvchntikhm.60%bnhvinckhoaNhi,13,3%bnhvinckhoaNhim,40%c
khoasnsctngcngvkhngctipnhniutrSXHIV.Ccbnhvinthchinttcngtctruyn
thngvihnhthcbmvtranhnhtuyntruyn,100%bnhvinctrangbmyohuytp,46,7%c
cbrassardccc.93,3%cxtnghimcngthcmutiucumv53,3%cmyquayHcttich,
nhngbnhvinckhnngtipnhnviutrcctrnghpSXHnngIIIctrangbkhy
thuc,dchtruynvphngtinhisc(trn50%).80%cphciutrSXH,86,7%ctiuchundch
truyn,tiuchunxutvin;86%cngthoxy2mi;67%cmaskthoxycti;80%cbngmaskccc,
nnikhqunlicongthngvmygipthmy.Trungbnhckhong5bcsv11iudngtham
giatrongcngtciutrchmscbnhnhnSXH.Vkhong4bcsv4iudngcthamgiatp
huntrongnmvcngtciutrSXH.54%bnhvinckhnngchchCVP,47%cthtCatheter,20%
ckhnngbcltnhmch.
Ktlun:ThctrngkhmviutrstDengue,SXHticcnvvncnnhiukhkhnvcsvt
cht,phngtiniutr,nhnlcvtrnhchuynmn.
Tkha:stDengue,stxuthuytDengue.
ABSTRACT
SURVEYOFTREATMENTSTRATEGYDENGUEFEVERHEMORRHAGEFEVERAT15
GENERALHOSPITALSINHOCHIMINHCITY
DangMinhXuan*,NguyenVuTruongGiang,HoLuViet
Background: Ho Chi Minh City is one of the cities that have high dengue endemicity. This desease
*Bnh vin Nhi ng 2 Tp.HCM
Tc gi lin lc: CN. ng Minh Xun
ChuynYTCngCng
T: 0909279204
Email: xuan0271984@yahoo.com
333
NghincuYhc
usually occurs from January to December every year. So, this is a public health problem. This study was
conductedin15gerneralhospitalsinHoChiMinhCitytohelphospitalsimprovethediagnosisandtreatment
forDenguefever(DF)andDenguehemorrhagicfever(DHF).
Objective:EvaluatingtreatmentstrategyforDF/DHFin15generalhospitalsinHoChiMinhCity.
Methods:Thiswasacrosssectionaldescriptivestudy.
Result: There were 30.2% DF cases, 67.7% Grade III DHF cases, and no Grade IV DHF cases.
Amongcasestransferredfromotherhospitals/healthcarecenters,GradeIIIDHFcasesaccountedfor38.1%
andGradeIIIDHFcases61.9%.These15generalhospitalsdonthaveoutpatientclinicsforDF/DHFpatients
only . In almost hospitals, there are inpatient wards for DHF patients hospital admission criteria ; training
parentsaboutemergencysigns,andfollowups.60%hospitalshavePediatricDepartment,,40%haveICU,
andjust13.3%haveDepartmentofInfectiousDiseases.AlmosthospitalsdonttreatGradeIVDHFcases.There
areDF/DHFeducationpostersinalmosthospitals.Only20%hospitalshaveeducationvideoclips.Allhospitals
areequippedwithsphygmomanometers,46.7%equippedwithbrassardsinallsize.93.3%hospitalscandoblood
count test with platelet counting, 53.3% hospitals equipped hematocrit centrifuge. Some of hospital can cure
GradeIIIhemorrhagefeverhasequippeddrugs,meanofrecoveringandinfusionfluid(morethan50%).80%
hospitals have management protocol for Dengue hemorrhage fever, 86.7% hospitals have infusion standards,
dischargestandards;86%hasoxygencannula,67%hasoxygenwithmaskandreservedbag,80%allsizebag
masks,intubationtools.Thereare5doctorsand11nursesinmanagingseverehemorrhagefeverperhospital,and
4nurseswastrainedeveryyear.Thereare53.3%hospitalscanmakeCVP,46.7%canmakecatheter,20%cando
venousintervention.
Conclusion: It still doesnt have enough facilities, human resourse and skillful staff in treatment of
DF/DHFin15generalhospitalsinHoChiMinhCity
Keywords:Denguefever(DF),Denguehemorrhagefever(DHF).
stDengue,SXHlmtvnytcngng
TVN
cncquantm.
Dchbnhtruynnhimangdinraphc
Stxuthuytlbnhchacthuciutr
tp ti nhiu nc trn th gii c bit khu
c hiu, ch yu l iu tr triu chng, pht
vcChuThiBnhDngtrongcVit
hin sm chuyn , iu tr kp thi sc
Nam.ThnhphHChMinhvidnsng,
gim t l t vong(3).Tuy nhin hin nay vn
mt dn s cao trong ni thnh cng thm
cha c mt nghin cu chnh thc no c
mt lng ln dn nhp c v vng lai t cc
thchinkhostthctrngcngtckhm
tnh thnh khc trong c nc, cng thm
viutrstDengue,SXHD,donghincu
nhngthayilnvcshtngthc
nybcuctinhnhbngvickhost
nhiu nh hng quan trng n vn sc
ti15nvytcaThnhPhHChMinh
khe c bit l tnh trng dch bnh trn a
nhmccsgipccbnhvinlmttcng
bn thnh ph H Ch Minh t ngy cng
tc gim st h tr k thut v hun luyn
phtsinhnhuculnhnvytvchmsc
chuyngiaokthuttrongcngtcchnon
sckhe.
viutrSXHchoccbnhvintuyntrc.
ThnhphHChMinhcnglmttrong
Mctiunghincu
cc tnh thnh ph c lu hnh st xut
Mctiutngqut
huyt mc cao(1), v bnh li thng xy ra
quanh nm v gia tng vo cc thng ma
Kho st thc trng khm v iu tr st
(2)
ma . Chnh v vy cng tc khm v iu tr
Dengue,SXHDti15bnhvinakhoatrna
bnThnhphHChMinh.
334
ChuynYTCngCng
Xcnhthctrngvcsvtchttrong
cngtctikhmviutrstDengue,SXHD.
Xcnhthctrngvphngtiniutr
stDengue,SXHD.
Kho st v nhn s v kh nng chuyn
mntrongkhmviutrstDengue,SXHD.
ITNGPHNGPHPNGHINCU
itngnghincu
Cc khoa khm v iu tr st Dengue,
SXHDti15bnhvinkhuvcphangthnh
ph.
Phngphpnghincu
Ctngangmt.
Thigian
T07/06/2010n24/08/2010.
KTQUNGHINCU
Tnh hnh st Dengue, st xut huyt
Dengue
2 000
S lng bnh nhn
Mctiuchuynbit
KhostvtnhhnhstDengue,SXHD.
67,7%
1 500
S\ t Dengue
30,2%
2,1%
500
Phngphpthchin
Phng vn ban lnh o cc bnh vin v
ccnhnvinytcthamgiacngtckhmv
iutrstxuthuytdatheonhngtiuch
trnphiukhostthctrngkhmviutr
stDengue,SXHD.
Gimstthctkimtralingunthngtin
phng vn c nhm kim sot sai lch
thngtin.
ChuynYTCngCng
SXH Dengue IV
Tnh trng bnh
Biu1.Slngbnhnhnphnbtheotnh
trngbnh
Nhn xt: St Dengue chim 30,2%, SXHD
III chim t l cao (67%), cc trng hp
SXHDIIInkhmviutrchimtlrt
thp(2,1%)tptrungmtvinv.
61,9%
40
S ca chuyn vin
Bnh vin qun 1, bnh vin qun 2, bnh

vinqun4,bnhvinqun7,bnhvinqun9,
bnhvinqun12,bnhvinqunBnhThnh,
bnh vin qun Th c, bnh vin a khoa
khuvcThc,bnhvinAnSinh,bnhvin
Hon M, bnh vin Ngc Linh, bnh vin a
khoaSiGn,bnhvinNhnDnGianhv
bnhvinQucTColumbiaAsiaGianh.
SXH Dengue I,II

SXH Dengue II I
1 000
aim
Ti 15 bnh vin khu vc pha ng thnh
phgm:
NghincuYhc
30
38,1%
SXHDengueI,II
20
SXHDengueIII
10
0
Chuyn vin
Biu2.Scachuynvintheo
Hu ht cc ca chuyn vin ln tuyn trn
ulSXHDIII(61,9%).Tuynhincmtt
lkhngnh38,1%cctrnghpSXHDI
IIchuynvinlntuyntrn.
Bng1:Thctrngcsvtchttrongkhmiu
trstDengue,SXHD
C s vt cht
Phng khm SXH ring
Phng lu
Tiu chun nhp vin
Du hiu khm ngay
Hn ti khm
Tranh nh tuyn truyn
Video tuyn truyn
Bm tuyn truyn
C
Khng
T l
T l
n = 15
n = 15
%
%
0
0
15
100
13
86,7
2
13,3
12
80,0
3
20,0
13
86,7
2
13,3
13
86,7
2
13,3
11
73,3
4
26,7
3
20,0
12
80,0
10
66,7
5
33,3
335
NghincuYhc
C
Khng
T l
T l
n = 15
n = 15
%
%
Khoa nhi SXH I, II
9
60,0
6
40,0
Khoa nhim SXH I, II
2
13,3
13
86,7
Khoa SSTC SXH III, IV
6
40,0
9
60,0
C s vt cht
Cc bnh vin khng c phng khm SXH

ring. a s u c phng lu, c tiu chun
nhp vin, c nhc du hiu khm ngay v c
hn ti khm. i vi cc phng tin truyn
thngthasccbnhvincbmvtranh
nh tuyn truyn. Tuy nhin t l bnh vin c
video tuyn truyn cn thp (20%). 60% bnh
vin c khoa Nhi ring v 13,3% bnh vin c
khoaNhim,40%ckhoasnsctngcngc
khnngtipnhnviutrSXHIII.
Bng2:Thctrngvphngtiniutrst
Dengue,SXHD
Phng tin iu tr
My o huyt p
Brassard cc c
Xt nghim CTMTC m
My quay Hct ti ch
Phc iu tr SXH I, II
Tiu chun truyn dch
Tiu chun xut vin
Phc iu tr SXH III, IV
Dextrostix
X quang ti ch
Siu m ti ch
ng th oxy 2 mi
Mask th oxy c ti
Bng mask cc c
n ni kh qun, li cong
thng
CPAP
My gip th.
My o HAXL, Cable o HAXL,
b dy o HAXL
Dy truyn 60 git
Kim lun 22-24G, 14-18G
Catheter TMTW
Bm tim t ng
My m git
Lactacringer, gelatin, dextran
40-70, mu ti
Hng cu lng
FFP
336
C
Khng
n = T l n = T l
15
15
%
%
15 100
0 0,00
7 46,7
8 53,3
14 93,3
1 6.70
8 53,3
7 46,7
12 80,0
3 20,0
13 86,7
2 13,3
13 86,7
2 13,3
12 80,0
3 20,0
8 53,3
7 46,7
8 53,3
7 46,7
8 53,3
7 46,7
13 86,7
2 13,3
10 66,7
5 33,3
12 80,0
3 20,0
12
80,0
20,0
7
12
46,7
80,0
8
3
53,3
20,0
0,00
15
100
9
10
8
13
11
60,0
66,7
53,3
86,7
73,3
6
5
7
2
4
40,0
33,3
46,7
13,3
26,7
10
66,7
33,3
8
2
53,3
13,3
7
13
46,7
86,7
Phng tin iu tr
Kt ta lnh
Tiu cu m c
Dopamine
Dodutamine
Lasix
Risordan
C
Khng
T l n = T l
15
%
%
5 33,3 10 66,7
4 26,7 11 73,3
14 93,3
1
6.7
13 86,7
2 13,3
14 93,3
1 6.70
10 66,7
5 33,3
n=
15
Chthch:CPAP:thplcdngcuikthra,
HAXL:huytpxmln,TMTW:tnhmchtrung
ng,FFP:huyttngtinglnh
100% bnh vin c trang b my o
huyt p, 46,7% c Brassard cc c. C 93,3%
bnh vin c xt nghim cng thc mu tiu
cum.asccbnhvin(80%)cphc
iu tr st xut huyt cc , 86,7% c tiu
chun truyn dch v tiu chun xut vin.
53%bnhvincmyquayHct,Dextrostix,X
quang,siumtich.
C86%bnhvincngthoxy2mi,80%
c bng mask cc c, 67% c mask th oxy c
ti, 80% c n ni kh qun li cong thng,
80%cmygipth.Trn50%ckimlun22
24g, 1418g, dy truyn 60 git, Catheter tnh
mch trung ng, 86% c bm tim t ng,
74% c my m git., 76% c Lactacringer
GelatinDextran4070vmuti,34%ckt
ta lnh, 27% c tiu cu m v 13% c FFP,
trn50%bnhvincDopamine,Dobutamine,
Lasix,Risordan.
Bng3:Tnhtrngnhns
Nhn s
Bc s tham gia iu tr SXH
iu dng tham gia trong chm sc
bnh nhn SXH
Bc s c tp hun v SXH trong nm
S iu dng c tp hun v SXH
trong nm
S lng/
15 bnh vin
78
170
54
57
Bnhqunmibnhvinckhong 5 bc
s tham gia iu tr SXHD v khong 11 iu
dng tham gia chm sc bnh nhn SXH,
trungbnhtrongnmckhong4bcsv4
iu dng c tham gia tp hun v cng
tciutrstSXHxuthuyttituyntrn.
ChuynYTCngCng
Bng4:Khnngchuynmn
Phng tin iu tr
Kh nng chch CVP
Kh nng bc lTM
Kh nng t Catheter
C
Khng
n = 15 T l% n = 15 T l %
8
53,3
7
46,7
3
20,0 12
80,0
7
46,7
8
53,3
Chthch:CVP:plctnhmchtrungtm,TM:
tnhmch
54% bnh vin c kh nng chch CVP,
47% c th t Catheter v 20% c kh nng
bcltnhmch,khngbnhvinnocmy
o huyt p xm ln, cable o huyt p xm
ln v b dy o huyt p xm ln v y l
mt k thut cao ch mi c thc hin
nhngbnhvinhng1.
BNLUN
VtnhhnhstDengue,SXHD
Chng ta d dng nhn thy cc bnh vin
u c tip nhn khm v iu tr st Dengue,
SXHDI,II,IIIringcctrnghpSXH
IVthhintichacnvnotipnhniu
tr m ch tin hnh x tr ban u v chuyn
vinngaylntuyntrn.
Vcsvtcht
Cc bnh vin u khng c phng khm
SXHringmsdngphngkhmchung
khm,thctnythyhuhtccbnhvin
cng v t trong tng s 15 bnh vin c
khost.Nuiunyccithinthcng
tc khm sng lc bnh nhn SXH s c hiu
quhn.
Vncnmttlthpccbnhvinkhng
c phng lu (13,3%), khng c tiu chun
nhp vin (20%), khng c du hiu khm
ngay (13,3%), khng c hn ti khm (13,3%),
ylmttrongnhngyutnhhngn
vic chm sc v theo di cc trng hp c
dintinnng.
V phng din truyn thng gio dc sc
khe th a s c t bm v tranh nh tuyn
truyn,tuynhintlbnhvincvideotuyn
truyn cn thp (20%) m y li l hnh thc
truyn thng d nh cho bnh nhn v thn
ChuynYTCngCng
NghincuYhc
nhnbnhnhnnkhm.Nuhnhthcny
c c tng cng ti cc phng khm, ti
phngchkhmvphngngkkhmbnh
th vic truyn thng phng chng SXH s t
hiuqucaogipgimbtgnhnngchovic
iutrcngnhgimtnhtrngnhpvintr
(5).iunyhontoncththchincnu
csquantmcaccbnhvinvshtr
ca Trung Tm Truyn Thng Gio Dc Sc
KheThnhPhHChMinh.
Victhnhlpkhoanhi,nhimringnhm
khmviutrttcctrnghpSXH,cng
nhutchokhoasnsctngcngc
khnngiutrcctrnghpSXHnng
IIIIVvnchactrinkhaingb,cth
do nhiu nguyn nhn nh thiu s u t,
thiunhnscbitlccbnhvint.
Vphngtiniutr
Ccbnhvinucmyohuytp,tuy
nhin ch c 46,7% bnh vin c trang b
Brassardccc,iunycncluvvic
trangbykchcccBrassardchoccn
v l rt cn thit gip cho vic chn on v
phnSXHcchnhxchn.
C 93,3% bnh vin c xt nghim cng
thcmuvmtiucu,nhngchc53,3%
bnh vin c trang b my quay Hct y l
mt trong nhng kh khn ca cc bnh vin
trongvicchnonSXH.
asccbnhvincphciutrSXH
cc,ctiuchuntruyndchvtiuchun
xutvin.Mcdvyvncnmttlthpcc
bnhvinchactptrungccbnhvin
tdokhitipnhnnhngtrnghpnghi
ngSXHschuynvinlntuyntrn.
T l bnh vin c my quay Hct cha cao
(53%),iunynhhngphnnoncng
tctheodiviutrchobnhnhnSXH.V
trang b thuc, dch truyn cc loi v cc
phngtinhisctrongiutrSXHnnga
s bnh vin u c trang b tuy nhin hin
vn cha s dng hiu qu do cc n v hu
nh khng gi iu tr cc trng hp SXH
337
NghincuYhc
nngIII,IV.Ththutohuytpxmln
hin nay vn cha c n v no trin khai
cngphhpvitnhhnhtipnhnviutr
cctrnghpSXHnngticcnv.
Scnbytthamgiatphuncnt,mt
sbnhvincnchacccphngtink
thuttrongchnonxcnhSXH,cbitl
ticcbnhvint.
Vnhnsvkhnngchuynmn
KINNGH
Trung bnh ti mi bnh vin c khong 5

bc s tham gia iu tr SXH v 11 iu dng
tham gia chm sc, theo di bnh nhn SXH,
yqulmtconskhngcao.Trongtrng
hp dch bnh din ra, s bnh nhn gia tng,
bnh nng nhiu th tnh trng qu ti s d
dngxyralmnhhngnchtlngiu
tr, khi vic chuyn tuyn li cng gia tng
gyqutichoccbnhvintuyntrn(4).
Cnphncptrongchnonviutrst
Dengue,SXHD,quinhrmtsnvcn
c phng khm tip nhn theo di st cc
trng hp st Dengue v st xut huyt
DengueI,IIvicctrangthitbcbncn
thit. Tng cng hun luyn cho ng
chuyn mn v phc iu tr st Dengue,
SXHD.ngthitrangbthmquitrnhvk
nng chuyn vin an ton i vi bnh nhn
SXH. Mt s bnh vin c khoa sn sc tng
cng cn c h tr v trang thit b, hun
luynchuynmnchuyngiaomtskthut
ckhnngiutrcctrnghpstxut
huytnnggpphnnngcaochtlngiu
tr ti tuyn trc v gip gim ti cho tuyn
sau.
Slng4bcsv4iudngtham
giatphunvcngtcSXHtrongnmlmt
con s qu t. Chnh v vy nng cao cht
lng cng tc khm cha bnh v cp nht
kinthcmiccbnhvincnquantmnhiu
hntrongvicccnbthngxuynvlun
phin i hc cc lp tp hun do tuyn trn t
chc. Bn cnh cc bnh vin cng cn t
chc tp hun ti ch cho cc cn b y t
thngxuyncpnhtkinthctrongcngtc
chnonviutrSXH.
Khnngtipnhniutrcctrnghp
SXHnngcaccnvcntlthpvtl
bnhvinckhnngchchCVPl54%,cth
t Catheter 47% v c kh nng bc l tnh
mch l 20%, y l nhng con s phn nh
ngthctrnghintitrongviciutrSXH
nngticcnv.
KTLUN
Quakhostthctrngkhmviutrst
Dengue,SXHDti15bnhvinakhoatrni
bnthnhphHChMinh,nhnthyrngcc
nvcnnhiukhkhnnhchacphng
khm ring, thiu nhn s, mt s bnh vin
cha thnh lp khoa nhi, khoa nhim ring do
vnchyutipnhnkhmviutrcc
trng hp SXH I v II. Cc khoa sn sc
tngcnghintivnchackhnnggiv
iutrcctrnghpSXHnngIV.
338
Hin nay, tnh hnh dch bnh st Dengue,

SXHDngycnggiatng,chnhvvyccbnh
vincnchccnbyttrctipthamgia
iutrtheodibnhstxuthuytdcclp
hunluyn,cpnhtphcmidoccbnh
vintuyntrntchccngnhgicnbyt
lnhctpvthchnhiutrngaytibnh
vin tuyn trn c th nng cao nng lc
chuynmnvmbochmscviutrtt
hnchobnhnhnSXH.
Cc bnh vin qun/huyn cn c nng
cao nng lc v uy tn trong cng tc iu tr
SXHD.Tngcngvnhnsvchuynmn
cng nh c s vt cht cho khoa nhi, khoa
nhim thu ht bnh nhn trong c bnh
nhi n khm v ng iu tr ti cc bnh
vin qun/huyn nhm trnh s qu ti khng
cnthitchoccbnhvintuyntrn.
Trc mt, trong nhng trng hp kh
khnviutrhocchuynvinccnvcn
tng cng trao i thng tin h tr trc tip
cngtckhmviutrstxuthuytquas
ChuynYTCngCng
in thoi ng dy nng 24/24 ca cc bnh
vintuyncuigmbnhvinNhing2,Nhi
ng1vbnhvinNhiti.
3.
4.
TILIUTHAMKHO
1.
2.
Cc Qun L Khm Cha Bnh B y t (2009). Rt kinh

nghim t vong. Rt kinh nghim cng tc iu tr st
DenguestxuthuytDengue2009,96102
HMnhTun(2008).Chnon,iutrstDenguevst
xuthuytDengue.Phciutrnhikhoa2008,587598.
NhxutbnyhcThnhPhHChMinh.
5.
NghincuYhc
NguynThXuyn(2009).Hngdnchnon,iutrst
DenguestxuthuytDengue,1327.NhxutbnyhcH
Ni
Vin Pasteur Tp. HCM, d n phng chng st Dengue st
xuthuytDenguekhuvcphanam(03/2010).Nhnnh
tnhhnhstxuthuyt2009dbonm2010.Bocotng
kt hot ng 2009 v k hoch 2010 phng chng st xut
huytkhuvcphaNam,3839
Vin Pasteur Tp. HCM, d n phng chng st Dengue st
xuthuytDenguekhuvcphanam(08/2010).Nhngkh
khn trong chn on v iu tr st xut huyt tuyn x,
,huyn, tnh Bn Tre. Phi hp gia d phng v iu tr
trongcngtcgimst,thngkbocobnhDenguekhu
vcphaNam2010,2444
ChuynYTCngCng
339
NghincuYhc
CCYUTLINQUANVIHNHVIDNGCHUNGBMKIMTIM
NAMNGHINCHCHMATYTNHNGNAI
NguynVThng*,NguynDuyPhc*,KhuVnNgha*,
HHongCnh**,TrnNguync***,TrnPhcHu*,TrnNgcHu*
TMTT
Mctiu:Xcnhtldngchungbmkimtim(BKT)vccyutlinquannamnghinchchma
ty(NCMT)tingNai.
Phngphpnghincu:Mtnghincuctngangctinhnhtrn400namNCMTtingNai
trongnm2010.NgiNCMTcphngvnvmtsyutxhivhnhvinguyclynhimHIV.
Ktqu:TldngchungBKTl14,3%.PhntchhiquiabinchothyNCMTctuit2529,theo
1tngionovckinthccnthitvHIVthckhuynhhngtdngchungBKThn.Tuynhin,
NCMTtngnxtnghimHIV,tnhnthcmnhthucnhmcnguyc,nhnkhngyBKThoc
nhnnhngcbtinmuathmthcxuhngdngchungBKTnhiuhn.
Ktlun:Cnduytr,tngcngccchngtrnhgiodcvcanthipgimtchi(BKTsch)ngi
NCMT,cbitchtrngnccyutlinquanvidngchungBKTctmthytrongnghincuny.
Tkha:NCMT,dngchungBKT,HIV
ABSTRACT
CORRELATESOFNEEDLESHARINGAMONGMALEINJECTINGDRUGUSERSINDONGNAI
NguyenVuThuong,NguyenDuyPhuc,KhuuVanNghia,HoHoangCanh,TranNguyenDuc,
TranPhucHau,TranNgocHuu*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:341
345
Objectives: To determine the prevalence of needle sharing and its correlates among male injecting drug
users(IDUs)inDongNai.
Methods: A crosssectional study recruited 400 male IDUs living in Dong Nai in 2010. Facetoface
interviewswereconductedforcollectingsociodemographicalcharacteristicsandHIVriskbehaviordata.
Results:Theprevalenceofneedlesharingwas14,3%.Age2529(versus1624),being religious, having
necessaryHIVknowledgewerelesslikelytoshareneedles.However,beingevertestedwithHIV,perceivinghigh
risk,receivinginsufficientamountofsyringesorpaymentforsyringesweremorelikelytoshareneedles.
Conclusions:Itisnecessarytostrengthenhealtheducationandharmreductionprograms(cleansyringes)
inIDUs,especiallyconsideringthecorrelatesofneedlesharingfoundinthisstudy.
Keywords:IDU,needlesharing,HIV
TVN
Tim chch ma ty vn tip tc gp phn
quan trng vo i dch HIV trn ton cu,
trong Vit Nam vi t l hin nhim HIV
ngiNCMTrtcao,chimtlcaonhttiHi
Phng(66%)vQungNinh(59%)(2).Thchnh
timchchclinquannlytruynHIVgm
dngchungBKTvthitbtimchchnhbng
bng, nc ra BKT. Trn th gii, cc yu t
linquanntimchnhkhngantongmcc
c tnh c nhn, tin s dng ma ty, tui v
loithuc.(1,3,5,8)Mtnghincutrn630NCMT
VinPasteurTp.HCM **:TTPCHIV/AIDSngNai
***:BQLDAPCHIV/AIDStnhngNai
Tcgilinlc:Ths.BS.NguynVThngT:0903121112Email:nguyenthuong@yahoo.com
340
ChuynYTCngCng
Tp. HCM cho thy nhng ngi chch ngoi
nghoccngibnmatychchcxu
hng hay dng chung BKT(6). Trong nghin
cu514namv6nNCMTHiPhng,61%
i tng c chch ma ty trong 68% dng
chungBKT.Ccyutclinquannnhim
HIV l dng chung BKT (OR:4,12), chch MT
trn 31 ln/thng (OR: 2,37)(10). Nghin cu 398
NCMT n dng heroin i Loan cho thy
75,1%dngchungBKT,54,8%chungBKTtrong
thng trc khi c phng vn, 27,1% chung
BKT trong ln dng heroin gn y nht. i
tng dng heroin ln u khi cn tr c
khuynhhngxichungBKTnhiuhnngi
dngheroinmun(4).
GimsttrngimkhuvcphaNamcho
thyngNailmttrongnhngtnhctl
hin nhim HIV cao trong nhm NCMT cao
nhtkhuvc(11).CccanthiptrnnhmNCMT
ccquanchcnngtnhtrinkhairng
khp nhng hin cha c kho st no v cc
yutlinquanvihnhvidngchungBKT
qun th ny. Do , vic tm hiu cc yu t
linquanvihnhvidungchungBKT qun
th NCMT ti ng Nai l ht sc cn thit,
nhm cung cp cc thng tin quan trng trong
vicxydngccbinphpcanthiphiuqu
hn.
PHNGPHPNGHINCU
Nghin cu ct ngang, c thc hin trn
400namNCMTtingNaitrongthigian7
12/2010.VicvbncctimNCMTc
thchinnhmctnhsngiNCMTcc
t im thuc Bin Ha, Long Khnh, Long
Thnh v Trng Bom. C mu iu tra ti mi
huynthcphnbtheotlkchcqun
th NCMT ti tng huyn th v c mu phn
bchotnghuyn/thscphnbchott
ccctimtheotlkchcqunthNCMT
titngtim.
NgiNCMTcphngvnvccyut
dnsxhivhnhvilinquanHIV,cbit
hnh vi tim chch ma ty. S liu c nhp
bng phn mm Epidata 3.1, phn tch bng
ChuynYTCngCng
NghincuYhc
Stata10.Phntchhiqui n bin v a bin

cdngxcnhccyutlinquanvi
vicdngchungBKT.
KTQUNGHINCU
Mtsctnhxhivhnhvinguyc
namNCMT
Bng 1, m t c tnh x hi v hnh vi
namNCMT.Hn2/3namNCMTtingNai
di30.Khongctrnhhcvnthpv
gn75%angsngcthnhoclythn/lyd.
Gn41%cthunhpdi2triung/1thng.
Gn97%namNCMTtingNaicnghe
ni v HIV nhng ch hn 55% l c kin thc
cnthitvphniquannimsailmvHIV.
S dng ma ty NCMT cng kh phc tp.
Loimatyphbinnhtvnlhrin(89%)
vthucphin(11%).Thigiansdngmaty
trung bnh l hn 5 nm. Tn sut tim chch
trung bnh 1 ln/ngy; 14,3% dng chung BKT
trong 6 thng qua. Loi BKT 3ml c thch
nht(76%).Tlbitvgpg5bnchchln
ltl70%v53,3%.
Khong 1/3 nam NCMT c QHTD vi
PNMD v t l dng BCS trong ln gn y
nhtl76,3%viPNMD,43,3%vibntnhbt
chtv32,3%viv/ngiyu.
Ch60%NCMTnhnBKTvkhngphi
bthmtinmuatrong1thngquav36%
c nhn nhng c lc phi b tin mua BKT.
NguncungcpBKT&BCSminphchyu
l ng ng vin (hn 65%). T l ngi
NCMT c nhn c cc thng tin, ti liu v
timchch&tnhdcantonchl35%trong6
thng qua. Hn 1/2 nam NCMT ti ng Nai
khng bit c cc im t vn xt nghim
HIV min ph trn a bn ca tnh. Ch 13,8%
tnglmxtnghimticcim.
MtsccctnhnamNCMTtnhngNai,
2010
c tnh
Tui
16-24 tui
25-29 tui
30-59 tui
n
399
T l
(%)
45,4
22,8
31,8
341
NghincuYhc
c tnh
Trung bnh
Bin thin
Trnh hc vn
M ch/cp 1
Cp 2
T cp 3 tr ln
Tn gio
C o/th ng b
Khng theo o no
Tnh trng gia ang c v/sng chung
nh
khng hn nhn
c thn/Ga/Ly d/Ly
thn
Hin ang sng Ngi thn/v/bn gi
cng
Mt mnh/bn b/lang
thang
2 triu
Thu nhp trung
bnh hng thng
< 2 triu
(triu ng)
Trung bnh
Ung ru bia
trong thng qua
Khng ung
Ung t hn 1 ln/ngy
Ung hng ngy
C
C kin thc cn
thit v HIV
(CSDP-21)
S bn chch bit
<5 ngi
c
5 ngi
Trung bnh
Thi gian tim
< 5 nm
chch
5 nm
Trung bnh
Tn sut tim
< 2 ln
chch/ngy
2 ln
Trung bnh
Loi ma ty tim
H r in
chch/thng qua
Thuc phin
Khc (gim au, an thn)
1ml
Loi BKT thch
dng nht/thng
3ml
qua
5ml
Dng chung
C
BKT/6 thng qua
Khng bao gi
Lun s dng
S dng BCS khi
QHTD vi PNMD S dng khng thng
trong 12 thng
xuyn
qua
Khng QHTD/khng QH
vi MD
tng xt
nghim HIV ti
cc c s t
nguyn ti ng
Nai
c tuyn
truyn v TCAT/6
342
T l
(%)
26,9
16 59
400 25,0
47,8
27,3
400 75,7
24,3
400 25,0
n
75,0
400
90,0
10,0
376
59,0
41,0
2,2
397
400
400
386
400
400
400
400
400
26,2
62,7
11,1
56,5
30,5
69,5
11,4
57,8
42,2
4,7
78,3
21,8
1,0
89,0
11,0
5,4
23,5
76,0
0,5
14,3
85,8
28,0
6,0
66,0
400
13,8
400
49,0
c tnh
thng qua
400
c nhn t ri
v TCAT/6 thng
qua
Tnh trng nhn Nhn v khng b tin 355
BKT/thng qua
mua
400
Khng c nguy c
C nguy c thp
C nguy c cao
Khng bit
34,8
59,2
36,3
nhng cng c lc b
tin mua
Nhn khng y
tng vo trung
tm cai nghin
T nhn thc
nguy c nhim
HIV ca bn than
T l
(%)
400
4,5
12,3
32,8
29,0
30,0
8,3
Ghich:1ngiNCMTccholckinthc
cnthitvHIVkhitrling5cusau:
QHTD chung thy vi mt bn tnh lm
gimnguyclynhimHIV;
LunsdngBCSngcchkhiQHTDc
thlmgimnguyclynhimHIV;
Nhnmtngicbngoikhemnhth
khng th bit ngi c b nhim HIV hay
khng;
Mui hay cn trng cn khng lm ly
truynHIV;
nchungvinginhimthkhngbly
nhimHIV
Ccyutlinquanvihnhvidngchung
BKTnamNCMT
PhntchhiquiabinchothyNCMTc
tui t 2529 (so vi 1624: OR=0,2; KTC 95%:
0,10,6), theo 1 tn gio no (OR=0,3;
KTC95%:0,10,8),ckinthccnthitvHIV
(OR=0,3; KTC95%: 0,10,7) c xu hng dng
chung BKT t hn. Nam NCMT tng n xt
nghim HIV (OR=3,5; KTC95%: 1,012,6), t
nhn thc mnh thuc nhm c nguy c thp
(OR=20,1;KTC95%:4,0100,5)hocnguyccao
(OR=26,8; KTC95%: 4,7151,4), nhn khng y
BKT(OR=60;KTC95%:10,5344,1)hocnhn
nhng c b tin mua thm (OR=4,1;
KTC95%: 1,610,7) c xu hng dng chung
BKTnhiuhn.
ChuynYTCngCng
CcyutlinquannvicdngchungBKT
namNCMTtitnhngNai
Bin c lp
Tui
n bin
ORth
(95% CI)
1
0,6(0,31,3)
0,7(0,41,3)
1
1,2(0,62,3)
0,9(0,41,9)
1
1,3(0,72,6)
16 - 24 tui
25 - 29
tui
30
tui
Trnh hc THPT/H/C
vn
Trung hc c
s
M ch/tiu
hc
Tnh trng C v/sng chung
gia nh
khng hn nhn
c thn/ga/ly
thn/ly d
1
Tn gio
Khng theo tn
gio no
0,8(0,41,5)
Theo 1 tn gio
no
1
Hin ang Ngi thn/v/bn
sng
gi
1,1(0,71,7)
Mt mnh/bn
b/lang thang
Thu nhp
2 triu
1
< 2 0,8(0,4triu
1,4)
1
Ung ru
bia/thng
Khng ung
1,1(0,6qua
2,2)
Ung t hn 1
ln/ngy
1,0(0,42,8)
Ung hng ngy
< 5 nm
1
Thi gian
tim chch
5 0,8(0,4ma tu
nm
1,4)
S ln
1
chch/ngy
< 2 ln
1,5(0,8 2 ln
2,8)
1
Lun s dng
S dng
BCS khi
2,6(1,0S dng khng
QHTD vi
7,0)
thng xuyn
PNMD/12
0,7(0,4Khng
thng qua QHTD/khng QH
1,3)
vi MD
S bn chch
1
bit c
<5 ngi
1,8(0,9 5 ngi
3,5)
Khng
1
Kin thc
cn thit v
0,6(0,3HIV
C
1,1)
Cha tng
1
Tng xt
nghim HIV
1,0(0,5ti ng Nai
tng
2,3)
ChuynYTCngCng
a bin
ORHC
p
(95% CI)
1
0,2(0,1- 0,00
7
0,6)
0,4(0,1- 0,1
1,2)
1
2,5(0,8- 0,1
7,9)
0,06
3,5(0,913,1)
-
1
0,3(0,1- 0,02
0,8)
-
1
0,9(0,42,2)
0,8
NghincuYhc
Bin c lp
n bin
1
T nhn Khng c nguy c
thc nguy c
C nguy c 12,9(3,8nhim HIV
44,0)
thp
ca bn thn
C nguy c 9,1(2,631,2)
cao
Khng 9,5(2,240,3)
bit
1
Tnh trng Nhn v khng
b tin mua
nhn
2,9(1,4BKT/thng nhng cng c
6,1)
qua
b tin mua
15,2(4,9Nhn khng y 46,9)
1
c tuyn
truyn v
0,4(0,2Khng
TCAT/6
0,7)
thng qua
C
1
c nhn
t ri v
0,4(0,2Khng
TCAT/6
0,8)
thng qua
C
S dng
1
heroin
Khng
3,8(0,9C
16,3)
Vo trung
1
tm cai
Khng
1,9(0,9nghin
C
4,0)
Loi BKT
1
thch dng
1ml
0,5(0,33ml/5ml
0,9)
a bin
1
20,1(4,0- <0,0
100,5) 01
26,8(4,7- <0,0
151,4) 01
7,3(0,9- 0,06
57,1)
1
4,1(1,6- 0,00
4
10,7)
60,0(10,5 <0,0
-344,1) 01
-
Chthch:HC=Hiuchnh,:Khngnmtrongm
hnhcuicng;KTC=Khongtincy
BNLUN
1
0,5(0,21,4)
1
2,2(0,85,6)
-
0,2
0,1
1
2,6(0,9- 0,08
7,3)
1
0,3(0,1- 0,00
0,7)
8
1
3,5(1,0- 0,05
12,6)
DngchungBKTlhnhvinguyccao
trong vic lan truyn HIV trong nhm NCMT.
Ti ng Nai, t l dng chung BKT trong 6
thngquahn14%vtronglntimchchgn
gnynhtl3,3%,thphnnhiusovicc
tnhTp.HCM,CnTh,AnGiang.(2)
Trong nghin cu ny, tui tr dng nh
dngchungBKTnhiuhn.Victheomttn
gio no cng lin quan vi vic t dng
chung BKT nam NCMT l mt yu t gi
vic phi hp vi tn gio trong gio dc sc
khe, gim nguy c ly nhim HIV ngi
NCMT.
ChhnmtnanamNCMTtrongnghin
cu ny c kin thc cn thit v HIV mc
dkinthcnytralyutbovgipcho
nam NCMT t dng chung BKT hn. iu ny
343
NghincuYhc
chothycntngcnghnnatrongvicgio
dc tuyn truyn kin thc phng chng HIV
chongiNCMT.VictngxtnghimHIVv
nhn thc c nguy c nhim HIV u c xu
hngdngchungBKTnhiuhn,iunyc
th do ngi NCMT khi dng chung BKT
nhnthcmnhcnguycnhimHIVhnv
ixtnghimHIVnhiuhn.
cbittrongnghincuny,namNCMT
nhnBKTkhngyvhoccnhnnhng
b thm tin ti mua th c nguy c rt cao
dngchungBKT.Ktqunycngkhtng
ng vi mt s nghin cu khc.(7,12) Mc d,
chng trnh phn pht BKT ti ng Nai
baophkhtondinvign90%nhnc
BKTminphtrong1thngqua.Tuynhin,hn
40%chanhnhayphibthmtinti
muaBKT,cngliucnluvcnguyc
dngchungBKTnhiuhn.
Thit k ct ngang c s dng trong
nghincunygpphimtshnchdokh
giithchccmilinquanmangtnhnhnqu.
Vicchnmudatrnbnimnngcn
ty thuc nhiu vo bao ph ca bn
im nng. Mt s NCMT c th khng nm
trongtimhaymtstimchacpnht
c.
KTLUN
TlnamNCMTdngchungBKTting
Nai vn mc trn 10%. Vic khng nhn
BKTlyutlinquanmnhnhtvihnhvi
dngchungBKT.Cncnnhcnccyut
linquanvihnhvidngchungBKTctm
thy trong nghin cu ny khi trin khai can
thipgiodctruynthngthayihnhvi
ngiNCMT.
344
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Battjes RJ, Leukefeld CG, Pickens RW (1992). Age at first

injectionandHIVriskamongintravenuosdrugusers.Am
JDrugAlcoholAbuse,18:263273
B Y t (2006). Kt qu chng trnh gim st kt hp
hnhvivccchssinhhcHIV/STI(IBBS)tiVitNam
20052006
Koester S, Booth RE, Zhang Y (1996). The prevalence of
additional injectionrelated HIV risk behaviors among
injection drug users. J Acquir Immune Defic Syndr Hum
Retrovirol,12:202207
Lee TSH (2005). Prevalence and Related Factors of
NeedleSharing Behavior among Female Prisoners. J Med
Science,25:027032
Marmor M, Des Jarlais DC, Cohen H, et al (1987). Risk
factors for infection with human immunodeficiency virus
amongintravenousdrugabusersinNewYorkCity.AIDS,
1:3944
NguyenTranHien,LeTruongGiang,PhanNguyenBinh
&WolffersI.(2000).ThesocialcontextofHIVriskbehavior
by drug injectors in Ho Chi Minh City, Vietnam. AIDS
Care,12:483495
PoudelKC,PoudelTandukarK,YasuokaJ,JoshiAB, Jimba
M(2010).Correlatesofsharinginjectionequipmentamong
maleinjectingdrugusersinKathmandu,Nepal.IntJDrug
Policy,21(6):50710
Strathdee SA, Galai N, Safaiean M, et al (2001). Sex
differences in risk factors for HIV seroconversion among
injection drug users: a 10year perspective. Arch Intern
Med,161:12811288
Todd CS, Abed AM, Scott PT, Botros BA, Safi N, Earhart
KC, Strathdee SA (2008). Correlates of receptive and
distributive needle sharing among injection drug users in
Kabul,Afghanistan.AmJDrugAlcoholAbuse,34(1):91100
TuanAnhNguyen,LongHoangThuy,VinhQuocPham,
Roger Detels (2001). Risk factors for HIV1 seropositivity
in drug users under 30 years old in Haiphong, Vietnam.
Addiction,96:405413
Vin Pasteur Tp. HCM & Ban iu hnh Phng chng
HIV/AIDS khu vc pha Nam (2010). Hi ngh giao ban
tngktcchotngnm2009vnhhngkhoch
hot ng nm 2010 ca Ban iu hnh Phng chng
HIV/AIDSkhuvcphanam.
WoodE,TyndallMW,SpittalPM,LiK,HoggRS,Montaner
JS, OShaughnessy MV, Schechter MT (2002). Factors
associatedwithpersistenthighrisksyringesharinginthe
presence of an established needle exchange programme.
AIDS,16(6):9413.
ChuynYTCngCng
NghincuYhc
NHN2TRNGHPBNHUTRNGGIUNUGAITHTHNKINH:
TNGHPYVNVBNHLTHNKINHDOLOIKSINHTRNG
ANGBLNGQUN
HunhHngQuang,TriuNguynTrung*
TMTT
tvn:BnhdoutrngGnathostomaspp.(Gnathostomiasis)lbnhnhimtrngtruyntng
vtsangngi.Vixuhngtngdulchquctvdndicnccvngluhnhbnhnhitidn
nxuthinccbnhlnytrongiukinthititnha.Bnhcthchiarathnhthdanim,phtngv
mt,tythucvovtrutrngdichuynn.cimlmsngnghimtrngnhtkhilininhthn
kinhtrungng.
Mctiu:MtcimlmsngvcnlmsngbnhnhnnhimGnathostomasppthnkinh.
Phngphpnghincu:Bococabnhvtnghpdliunghincuyvn.
Ktqu:Davo2cabnhvtnghpyvnquaphntchvmtdchthc,phngthcxmnhph
thnkinhtrungng,sinhlbnh,hnhthilmsng,dliuchnonhnhnhvlachniutr.
Ktlun:Hinti,tlnhimutrngGnathostomaspinigerumVitNamkhphbin,ccthythuc
nnchvnchnonphnbitdatrnnnkhungtiuchunchnonnghchobnhutrnggiun
ugaiththnkinh.
Tkha:Bnhutrnggiunugaiththnkinh,Gnathostomaspinigerum
ABSTRACT
HUMANNEUROGNATHOSTOMIASISCASESREPORT:MEDICALLITERATUREREVIEWONA
NEGLECTEDPARASITOSISOFTHENERVOUSSYSTEM
HuynhHongQuang,TrieuNguyenTrung
Background:GnathostomiasisisazoonotichelminthicinfectioncausedbylarvaeofGnathostomaspp
Increased international travel to areas endemic for these foodborne parasites and migration from tropical
areashaveledtotheemergenceofthesediseasesintemperateclimates.Gnathostomiasiscanbedividedinto
cutaneous, visceral, and ocular forms, depending on the site of larval migration. The most severe
manifestationinvolvesinfectionofthecentralnervoussystem(CNS).
Objectives:Todescribecasesofneurognathostomiasiswithclinicalandparaclinicalfeatures
Methods:humanneurognathostomiasisreportandmetaanalyzedstudiesreview.
Result:Byourtwocasesreport,wereviewedthemedicalliteratureonneurognathostomiasisandanalyzed
epidemiological aspects, modes of CNS invasion, pathophysiology, clinical features, neuroimaging data, and
treatmentoptions.
Conclusion:Nowadays,Vietnamwithmanyplaceswheresuchinfectionsarenotrarelyseenbyphysicians
and thus should be considered in differential diagnoses on the basis of proposed diagnostic criteria for
neurognathostomiasis.
VinStrtKSTCTQuyNhn
Tcgilinlc:Ths.Bs.HunhHngQuangT:0905103496
ChuynYTCngCng
345
NghincuYhc
Keywords:Neurognathostomiasis,Gnathostomiasis,Gnathostomaspinigerum
spinigerumlloithnggpnhttichu.
TVN
Nhim trng ngi vi G. hispidum, G.
Bnh do u trng giun u gai
doloresi v G. nipponicum c tm thy ch
(Gnathostomiasis) l bnh truyn t ng vt
Nht Bn. Ti chu M, loi G. binucleatum
sang con ngi do nhim phi u trng giai
c chng minh l tc nhn gy bnh duy
on 3 ca Gnathostomaspp. Thng qua ng
nhtngi.Nginhimphiccutrng
thcphm.Huhtcctriuchngnngclin
donsnghocthcnnuchachntc
quan n th bnh l thn kinh trung ng
ncngt,gvch.Ngilvtchtnhc
thng gi l neurognathostomiasis. Mc d
khng thch hp giun pht trin n giai
bnh lu hnh chu v chu M Latinh,
ontrngthnh,dovybnhlthngdo
songhuhtnhngtrnghpbnhutrng
utrngdichuyn.
giunugaiththnkinh(GGTTK)lic
TRNHBYCABNH
bo co t Thi Lan. D t l mc bnh v t
Cabnhthnht
vongcao,nhngGGTTKlichaclu
BnhnhnTngT.S,nam,52tuilmngh
so vi bnh nhim Gnathostoma spp th da
thucbc,vovinvitriuchnglitnh2chi
nimmc,iunycthvGGTTKvncha
ditrongvng2ngy trc khi nhp vin v
c ch trng v t c bo co. Tuy nhin,
c
du hiu xut huyt no khng r nguyn
thigiangnybnhcboconhiutrn
nhn.TinsdulchnnhiuqucgiaTrung
nhngngichuuidulchticcqucgia
Quc, Thi Lan, Singapore, Php, c, B, Ty
bnhluhnh.Bncnh,chngtitnghp
BanNha,HLanvcbitkhngccaohuyt
yvnvbnhlGGTTKvphntchvmt
p. Lm sng khng biu hin ri lon thc,
dch t hc cng nh phn b a l, phng
khngst;ccthngscnlmsngkhngc
thc xm nhp vo h thn kinh trung ng
gcbitngoitrtngchsbchcuitoan
(TKT), sinh l bnh, c im lm sng, d
lnn22.6%,xtnghimdchnotycgim
liu hnh nh chn on thn kinh v cc la
nh ng v tng bch cu i toan 17.5%
chniutr.Datrnnndliudchthc,
nn c chn on s b ban u l bnh do
triu chng lm sng, chn on hnh nh v
ksinhtrnghthnkinh.ChpMRIvCT
ccthngscnlmsng,nhmarangh
chohnhnhvtdichuynvnhiubiphnh
tiuchunchnonbnhGGTTK.
mchnis,chuynbnhnhnvotuyntrn,
Nhim k sinh trng (KST) qua ng
xc
nh tc nhn qua ELISA vi G.spinigerum
thc phm thng gp cc quc gia vng
dngtnhviOD=2.34,nngIgEtnggp
nhitinicbnhluhnhvthiquen
5 ln tr s bnh thng. Thuc la chn
n cc tht, c nc ngt cn sng hoc cha
(albendazole
+ dexamethasone), bnh nhn hi
nuchn,cbitlqunthdnaphng.
phchontonsau78ngyiutr(1,2).
Tro lu du lch quc t n cc vng lu
hnhbnhvsdidntvngnhitin
ni khc dn n vic xut hin cc bnh l
ny ti cc vng n i vn d bnh rt him
xuthin,vthccthythuclmsngtkhi
nghnbnhtrachnonphnbit,
bnh giun u gai do n phi u trng giai
on 3 ca Gnathostoma spp. n ny, c t
nht13loigiunugaicxcnh,vi5
loi ghi nhn gy bnh ngi. Loi G.
346
Cabnhthhai
Bnhnhnn,26tuilmnghtc,sngti
QuiNhn,ctriuchngmtvtphnhtng
t mi mt (T) khong 3cm, au nhng khng
nga, khng trong 6 thng trc khi nhp
vin. Thi quen hay n cc loi hi sn sng
cng vi m tt, k c c. Hai ngy trc khi
nhpvincnhcunhiu,mmt,songth,
bun nn, i tin phn thng, sau 24 gi c
ChuynYTCngCng
biu hin ri lon thc, yu t tay (P). Khm
lmsngchothytrigicum,spmi(P),yu
nhchitrn(P),khngcngc,bunnn,huyt
p100/55mmHg,mchquayr70ln/pht,st
nh380C.Chnonsb:TDvimnomng
no do virus. Xt nghim cn lm sng: CTM
ton phn c tng bch cu chung ln 14.000,
trong eosin chim u th 35.6%, glucose v
protein mu mu bnh thng, bilan gan mt,
lipid trong gii hn. Xquang phi v siu m
bng khng bt thng, ngoi tr c si nh
thn (P). Dch no ty cho dch trong sut, hi
vng, khng thy vi khun v ch s bch cu
tngcao27.9%.Tuynhin,sau38giktkhi
nhpvinbnhnhnmtthcchuynsang
chnonbnhdoKST,xtnghim6loigiun
sn,ktqudngtnhviG.spinigerum1/3200
chuyniutrhisctchcc,chpCTcho
hnh nh ph no nh, hnh nh di chuyn v
gingcalcihati2bncu.Phcthucla
chn (albendazole + dexamethasone +
hydrocortisone + khng sinh ph rng), bnh
nhntnhtosau14ngyvhiphchonton
sau5thngktkhiiutr(4,5).
BNLUNVTNGHPYVN
Bnh do u trng giun u gai c th chia
thnh nhiu th: da, ph tng v mt l thuc
vo v tr di chuyn ca u trng v cc triu
chng v hi chng tip sau. c im lm
sng c cp n nhiu nht l th da
nimmc,ctrngbicchnhnhvtsng
phng di chuyn, tng t, thng lin quan
n au, nga v ban ti ch di chuyn.
Linquannthtngcthlbtkcquan
v phn no trong c th. Lm sng nghim
trng nht ca th tng chnh l th thn kinh
trungng,cngilGGTTKvphnlns
cabocothnydoloiG.spinigerum.Chng
tighinhntngs24bocotrn y vn vi
248 bnh nhn b GGTTK v tin hnh tng
hp v dch t hc, kha cnh lm sng, con
ngxmnhpvohthnkinhtrungng,
sinh l bnh, d liu chn on hnh nh trn
hthnkinhvccliuphpiutr(3).
ChuynYTCngCng
NghincuYhc
Lch s ca th bnh giun u gai th thn

kinh
Ca bnh u tin vim no mng no do
nhim G. spinigerum c bo co bi
Daensvang vo nm 1949. Sau 18 nm, tc gi
ChitanondhvRosentrnhbybngchngxm
nhp vo h TKT ca u trng G.spinigerum
tccktqugiiphutthicamtphn
ThiLan34tui.Trongnghincutthitca
h, Boongird v cng s m t ra triu
chnglmsngcaGGTTK,iunyh
trrtnhiuchoccnghincutincuvhi
cu sau ny. Vi s tin b ca cc k thut
chn on hnh nh hin i v phn gii cao
cho thy cc ng i ca u trng
Gnathostoma spp. di chuyn trong bnh
GGTTK.
Dchthcgiunugaiththnkinh
Hu ht (241/248) ca c xc nh
GGTTKtrongyvntThiLan.Trong,2
bnh nhn nhim Lo, 1 Nht Bn, 1
Myanmarv2HnQuc.Mtbnhnhnc
idulchnngNamvNhtBn,vth
ngundchtnhimcatrnghpnykhng
th xc nh. Thi gian bnh ca bnh
GGTTKcthdin10nmvstntiko
di ca u trng trong cc m mm trc khi
xm nhp vo h TKT, iu ny c ngha
chng c th xy ra trn nhng ngi dn di
binngtrongmtqucgiamkhngclu
hnhbnhny.Ttcbnhnhnbocoy
unhimloiG.spinigerum.Chodbnhgiun
ugaingycngphthinnhiungoichu
,cbitMexico,nhngkhngthycbo
cocabnhticcvngkhc.Sxuthinca
ccloiGnathostomakhcchuMLatinh,c
tnlG.binucleatumslnguynnhnchogii
thchhintngny(2,5,3).
Bnhgiunugaiththnkinhtrnngii
dulchtrv
Ca bnh u tin GGTTK trn ngi du
lch c bo co vo nm 2003. K t , 4
bnhnhnchuutrv t vng lu hnh
bnh c bo co. Hai bnh nhn i du lch
347
NghincuYhc
n Thi Lan, 1 bnh nhn n Lo, 1 bnh

nhnnMyanmar.Ccbnhnhnbococ
n cc loi thc n a phng nu theo cch
caqucgia,nhnsngtm,c.Bnhgiun
u gai gn y c bo co trn nhiu du
khchtrvtNamPhi.Tuynhin,bnhnhn
ch biu hin nhim u trng Gnathostomaspp.
thdamkhngclinquannhTKT.
Sinhlbnhhccabnhlgiunugaith
thnkinh
Gnathostomaspp.lmtloiksinhtrngc
tnh xm nhp cao. Sau khi n phi, u trng
giai on 3 xuyn qua thnh nim mc ca h
tiuha.utrngcthivotronghTKTU
bng cch xm nhp trc tip qua cc m lin
ktmmlnglocacclthnkinhtrnnn
s dc theo cc dy thn kinh s no v mch
muhocthngquacclgiacctsngdc
theothnkinhtysngvmchmu.utrng
blygiimtlnglnphntvotrongmi
trng xung quanh h tr cho s xuyn v
xmnhpcautrng.Proteaseslloiphnt
quantrngtrongsccsnphmtit,cvs
lnglnchtlng.TrongsGnathostomaspp,
thnh phn metalloproteinases c cht ng
mtvaitrquantrngchoqutrnhxmnhp
vomvtch.
Gnathostomaspp.inhnhivotysng
song theo cc si r thn kinh, gy nn tnh
trngvimrtythnkinh.Tiputrng
cthilntysngvnno.Hnhtrnh
ny c th mt vi nm v c minh
chng trn mt bnh nhn ngi Thi thng
quachpnhlintc.Chiudidichuynca
utrngtrungbnh3.0mm,khidichuynu
trngnTKTU,sgyracctnthngc
hc trc tip v chng x rch cc m thn
kinh.DuhiuvngcabnhlGGTTKl
bngchngnhiuvtxuthuyt;ccvtny
cnhnthykhpontysngvm
no qua phn tch gii phu t thi, cng nh
qua hnh nh chp thn kinh. Xut huyt
dinhncthlhuqucautrngo
biquamttiungmchno.Vimmng
348
notngbchcuitoandoGnathostomaspp.
c trng bi xut hin hng cu trong dch
no ty, iu ny gi c thng tn c hc
do u trng. Ngoi tn thng v cu trc,
pngvimvisudichuynutrnggp
phnthmchoqutrnhphhynhum(5,6).
cimlmsnglinquannhthn
kinh
Hi chng lm sng chnh ca bnh l
GGTTK l vim ty r thn kinh/ vim no
ty r thn kinh (radiculomyelitis/
radiculomyeloencephalitis) vim mng no/
vim
no
mng
no
(meningitis/meningoencephalitis) v xut
huyt ni s hoc xut huyt di nhn. Mi
hichngphnnhlnmtmbthngtn
dogiundichuyn.Vutrngdichuyn,nn
cngbnhnhncthbiuhincchichng
thn kinh khc nhau. Chng hn, trong mt
bnhnhnLo,vimnotytintrin,theo
sau bi mt tnh trng xut huyt di nhn.
Vim mng no, xut huyt di nhn v ri
ccthngtntrongnhumnotiptheosau
trn mt bnh nhn ng bc Thi Lan(6,3).
Cctriuchngthnggpnhtcboco
gnnhbimibnhnhnlau:aurthn
kinhtrongnhngcaclinquanntysng
(thng ko di 15 ngy) hoc nhc u
trongnhngcavimnomngno.cim
lmsnghaygpnht,bnhltysngchim
55%cchichnglmsng.
Bng1.cimlmsngtrn248bnhnhngiun
ugaiththnkinh
Hi chng
ng xm
Du chng v
S
nhp vo h triu chng lm lng
thn kinh (c
sng
(%)
th)
au r thn kinh t
ngt v hi chng
i qua cc l
ty sng (lit 2
gia cc t
Vim ty
chn, lit 1 chi, lit 4
sng dc theo
r/vim
chi, ri lon chc 140 (55)
ty/vim no thn kinh v
nng bng quang,
mch mu ty
ty
ri lon cm gic);
sng
c th tin trin n
no (vim no ty).
Vim mng L thn kinh au u nghim
77 (30)
no/ vim no ca nn s trng, cng c, lit
ChuynYTCngCng
Hi chng
NghincuYhc
ng xm
Du chng v
S
nhp vo h triu chng lm lng
thn kinh (c
sng
(%)
th)
mng no dc theo thn TK s no, ri lon
kinh v mch thc, du TK nh
v.
mu s no
L thn kinh
au u, du thn
Xut huyt ni
hoc l gia
21 (8)
kinh khu tr
s
cc t sng
au u kinh
L thn kinh
Xut huyt
hoc l ng khng, du mng 16 (7)
di nhn
no
sng
*
V u trng di chuyn, bnh nhn c th c du chng v
triu chng lin tc; do vy, tng s triu chng lm sng
vt qu con s bnh nhn bo co
gitrtrungbnhl40%(n=24)v54%(n=39)
ln lt trong nghin cu ca Boongird v
Schmutzhard cng cng s. Trn 109 (67%)
bnhnhnbocobiPunyagupta(1),slng
bch cu i toan trong dch no ty l > 30%.
Dchnotycboconhchuynmusc
vnghocmumutrn134bnhnhn(64%s
cacnbn.Lngnghuytthng
ch gim nh nhng bo co khong 11mg/dL
(9%gitrhuyttng)trn1bnhnhn.
c im chn on hnh nh trn h thn
kinh
Bnh l ty trong bnh giun u gai c

trng bi au r theo sau bi mt du d cm
hoc lit nh cm gic hng ln ca cc chi
di hoc d cm c t chi km theo ri lon
chc nng bng quang. Mt mc cm gic
cho tt c phng thc gm c rung v cm
nhntrongcthhaygp,thngnhvtrong
vng ngc. Lin quan n no v mng no,
bnh c c trng bi cc du mng no v
gimthc.Litdythnkinhth6lhaygp
nhttrongccdythnkinhsno.Xuthuyt
trongnocphthinkhiphttngtm
khngthyduthnkinhnhvnhlitnh
ngihocyungi.
Bnhlthnkinhbitlp
Chn on hnh nh v thn kinh trn 11

bnh nhn c bnh l GGTTK c bo co
trn y vn. Chp CT s no, xut huyt di
nhn v xut huyt ni s l cc hnh nh hay
gp. Trn mt bnh nhn pht hin c xut
huytdimngcng.Ductrngcabnh
l giun u gai no trn phim chp MRI l
phthinvtxuthuyt(track).Duhiucng
hngtcathngtnxuthuytthayi
tytheo cc tn thng th cp, bn cp v
mn tnh. Do , trn hnh nh T1 v T2 c
gim t trng v tng t trng u pht hin.
Khng thy di chng gradientecho T2 c
bo co. Tuy nhin, du hiu ny rt nhy vi
cccckhimuttichkhngngnhtv
c th tr thnh mt chui tip ni trong nh
gi chn on hnh nh ca bnh giun u gai
thno.
c im lm sng hay gp nht ca bnh

giunugailtnhtrngsngphngdi da
dichuyntngt.Tuynhin,mtlotnbn
ln nht ca bnh l GGTTK trn 162 bnh
nhn,chc11(7%)ctinstnthngdi
da nim. Sng phng mt mt bn, mt du
in hnh khc ca bnh giun u gai, xy ra
trn6bnhnhn(4%).Boongirdvcngsbo
co ch c 3 bnh nhn b sng phng di da
trong s 24 bnh nhn c th GGTTK; giun
ugaithdanimpht trin trn tt c bnh
nhnnysaukhikhiutriuchngcathn
kinh.
Nghincuphntchvmtdchnoty
Tngbchcuitoanlmtductrng
trongxtnghimcnlmsng.Tngbchcui
toan trong dch no ty bnh nhn thng r,
ChuynYTCngCng
Sng phng ty sng a on lan ta km

theotngttrngT2lhnhnhhaygpnht
trn chp ty sng. Tng gadolinium ca cc
thngtncbocotrongphimMRIchp
snovtysngca4bnhnhnnhlhnh
nhnt,sngvngnht(1,6).
Chnonhuytthanhmindch
Pht hin khng th trong huyt thanh l
mt thang o quan trng ca chn on min
dch ca bnh giun u gai. Hai phng php
cthitlpcholmsngthngquy:ELISA
vWesternblotsdngcckhngnguynth
caGnathostomaspp.tchttitcautrngly
ra. Di band v tr 24kD ca xt nghim
349
NghincuYhc
Westernblotchrachiugn100%ivi
bnh giun u gai(1, 3). Thc hnh chn on
huytthanhhintildngELISA(chnghn,
multipledotELISA)nhlbcutinvxc
nhccktqulibngWesternblot.tnht2
bnh nhn chuyn o huyt thanh trong qu
trnh bnh l thn kinh, iu ny nhn mnh
vic cn phi xt nghim li huyt thanh trong
nhng trng hp lm sng nghi ng cao. Xt
nghimhuytthanhcthlmtimtslab,
nh ti Thi Lan (Bangkok, Khon Kaen), Nht
Bn (Miayzaki) v chu u (Basel, Thy S) v
tiVitNam(QuyNhn,TP.HChMinh)
Bng2.cimchnonhnhnhtrnthnkinh
cabnhgiunugaiththnkinh
Phng thc
Phn tch hnh nh trn h thn kinh
chn on
No b
CT
Nhu m no (n im hoc a
im) tng t trng vng di mng
cng hoc di mng nhn tng
ng vi xut huyt trong no
MRI
a im (ging giun) tng t trng T2
hoc gim t trng trong c hai bn
cu no v tiu no ng knh
3mm (vt xut huyt) c hoc khng
c tng thnh phn gadolinium.
Ty
MRI
Dn hoc sng phng ty sng km
sng
theo tng t trng a on T2,
thng tng ngm gadolinium (nh
n trung bnh) trn hnh nh sau
tim cht cn quang T1
*
CT_CTomputed tomography; MRI: Magnetic Resonance
Imaging
V tr
Chnonphnbit
Chnonphnbitchnhvibnhl
GGTTKlbnhnhimtrngdogiuntrn
Angiostrongylus cantonensis. Tuy nhin, nhim
trng Angiostrongylus spp. thng biu hin
bnhlvimmng no tng bch cu i toan
t gii hn v ch l nguyn nhn him khi
gy nn bnh l nghim trng c lin quan
ntysngvnob(1,6).Vmtchnon
min dch, xt nghim dng tnh vi khng
nguyn c hiu chng li 24kDca G.
spinigerum v m tnh vi di band 29kD
v31kDtrnphnngImmunoblotivi
khng nguyn A. cantonensis s gip chng
tachnonphnbitAngiostrongylusspp.c
gitrcao.Ccnguynnhnksinhtngkhc
350
gy bnh h thn kinh trung ng, nh u

trngsndyln,utrnggiunachmo,
sn mng, baylisascariasis, hoc bnh sn l
phicthphnbitdavophnbal,
triu chng lm sng, hnh nh hc v xt
nghimhuytthanh.
Thixtr
Hinchacmtthnghimlmsngno
v liu php thuc chng giun sn thc hin
trnbnhlGGTTK.Chngtixcnhc9
bo co iu tr bnh GGTTK bng liu php
albendazole;5bnhnhnhiphchonton,
2 bnh nhn hi phc mt phn v 2 bnh
nhnkhnghiphc.Ktquiutrcth
phnnhtintrnhtnhincabnhhnl
hiuquiutr.Trongmtviboco,iu
tr bng thuc giun sn c xem l bt li
timtngvchimgivtcbncavic
cho gim ph no do giun cht t ngt. 3
ngi du lch tr v t Thi Lan c iu tr
bng albendazole (800 mg/ngy x 1 thng, 800
mg/ngytrong3tunv400mgx2ln/ngyx
4 tun v phc hi hon ton. Trong tt c
bnh nhn ny, dexamethasone (ng ung
hoc tim) hoc predinsolone c ch nh
thm vo liu trnh iu tr. Mt nh gi hi
cu gn y v hiu lc lu di trn 13 bnh
nhn Php b giun u gai do nhp khu
bo co 2 bnh nhn c lin quan n thn
kinh,1cvimtyv1cvimno(C.Strady,
tiliucnhn).Bnhnhnvimtyphchi
hon ton sau liu php albendazole v bnh
nhnvimnobococ4ttiphtd
kthpliuphp(ivermectin+albendazole).
Corticosteroidscsdngtrongiu
tr bnh GGTTK iu tr ph no v ph
ty sng. Chng c th ngn nga hoc lm
gim nh o nghch tnh trng nng sau khi
khi u iu tr thuc giun sn. Tuy nhin,
chacmtktlunnovhiulccthch
ratccdliuhincvkhngcthnghim
lm sng i chng ngu nhin v cc s liu
hi ci th qu hn nh nh gi so snh
ChuynYTCngCng
gia cc nhm. n nay, cha c mt khuyn
conocbngchngcara(4,1,6).
Tltvongcatronglotcabnhutin
ca24bnhnhnl25%.Ccnghincusau
bocotltvonglt712%.Tuynhin,khi
cctcgin,thtltvongcabnh
nyhunhnhgichangmcvnhiu
bnhnhntrongtnhtrngtihnccho
vnhcht.Vtngs,ktquca247bnh
nhn c bo co trong y vn, mt kt qu
cha thun li, chng hn, cht hoc c nhng
bt li mt kh nng tn ti c bo co
trn 78 bnh nhn (32%). Song, cc bo co ca
bnhgnychrarnghngtinlnghin
ticthtthn.Trongs15bnhnhnbbnh
GGTTK c chn on sau nm 2001, hiu
qu ngho nn c bo co trn 3 bnh nhn
(20%).Trongttc4calmsngngiidu
lchtrvcvimty,sphchilttsaukhi
dngliuphpthucgiunsn(1,3).
KTLUN
Chnonxcnhnhimtrnggiunsn
hTKTUthquthtlkh.Tlphchica
sntdchnotythpvquytrnhchnon
cxmlnlhimkhihpl.BnhlGGTTK
lmtngoil;trongs248cabnhdngti,
chc27ca(11%)cxcnhbngsphc
hi u trng. Ngoi ra, du hiu sng phng
di da tng t, c xem l du phn bit
cabnhgiunugai,tmthychtrnmts
t ca bnh GGTTK(4, 1, 6). V nhng kh khn
ny, cc tiu chun lm sng l c ch thc
hnhvnghincu.Datrnktquphntch
tccnphmcabnh,chngtinghtiu
chun chn on nh hng cho mt thy
thuc lm sng nu trong iu kin chn on
giiphubnhhckhngththchinc.
Bng3.Tiuchunchnonnghchobnh
giunugaiththnkinh
Tiu chun dich t hc
Du lch n hoc nh c trong vng lu hnh bnh
V phi nhim vi cc thc n s, vm, tm, cua, c v
gia cm cha nu chn;
Hi chng lm sng
au kiu ty r thn kinh/vim no ty r thn kinh
ChuynYTCngCng
NghincuYhc
HOC vim mng no/ vim no mng no

HOC xut huyt di nhn
Bng chng xm nhp ca h thn kinh trung ng gin
tip
Dch no ty: tng bch cu i toan trong dch
HOC hnh nh thn kinh: vt xut huyt trong nhu m
no ( 3mm)
Chn on min dch
Pht hin khng th chng li thnh phn khng nguyn
ca Gnathostoma spinigerum 24kDa qua xt nghim
Immuno blot;
Khng c phn ng dng tnh vi thnh phn 29-31kDa
ca giun Angiostrongylus cantonensis trn test Immunoblot
*Tt c cc tiu chun nn c chun ha chn
on lm sng ca bnh GGTTK
BnhlGGTTKlmtbnhksinhtrng
hTKTUluhnhnhiungNam,c
bit ti Thi Lan. V s pht trin ca du lch
quctcadukhchcngnhdidnncc
vngluhnhbnh,nnsbnhnhntichu
u v Bc M ngy cng tng. Bnh GGTTK
nn c ngh n trn nhng bnh nhn c
biu hin vim ty r, vim no ty, vim no
mngnotngbchcuitoanvctinsi
du lch n cc vng lu hnh bnh giun u
gai.nsnghocnuchachnccgiacm,s,
vm, cua, tm, c nc ngt l iu kin rt
thunlichonhimmmbnh;tuynhin,vcc
thng tin nh th khng phi lc no cng t
bnhnhnnira,nnthythuclmsngphi
hitrctipvthcntrongsutqutrnhdu
lch ca bnh nhn(2, 4,5,3). Xt nghim huyt
thanhhc,kcxtnghimWesternblot,chra
c c hiu cao v c th ng gp khng
nh vo chn on ph hp vi yu t lm
sngvdchthc.Khngccngchun
datrnbngchngsniutr;songmt
liu trnh thuc albendazole 34 tun km
prednisolone hoc dexamethasone(1, 6) l mt
trongnhnglachnliuphphaydngnht.
Ccthythuc lm sng khuyn bnh nhn i
du lch hoc ang sng trong vng lu hnh
bnh nn trnh n cc c, gia cm v s vm,
tmcuacnsnghocchachn.
TILIUTHAMKHO
1.
Herman JS, Chiodini PL et al., (2009). Gnathostomiasis,

another emerging imported disease. Clin Microbiol Rev.
2009;22:48492.
351
NghincuYhc
2.
3.
4.
352
Huynh Hong Quang et al., (2010). Human helminthics

diseases:Areviewandupdateofanemergingzoonosisnow
crossing Central and highland of Vietnam.Monography of
International seminar of Researchable Issues in Ecosystem
Approaches to Health Management of Emerging Infectious
DiseasesinSoutheastAsiainBali,Indonesia,October,2010.
Hunh Hng Quang v cs., (2011). c im lm sng, cn
lm sng v hiu qu phc Albendazole trn bnh nhn
nhimutrnggiunugai2011(sliucnhn,chacng
b)
Hunh Hng Quang v Triu Nguyn Trung (2010). Tng
hp lot ca bnh ban trn/ hi chng u trng di chuyn
5.
6.
didadoksinhtrngtihuynoLSn,tnhQung
Ngi,VitNam(20062010).KyucngtrnhNCKH,Vin
YhcbinVitNam,HiYhcbinVitNam.
Hunh Hng Quang v Triu Nguyn Trung (2011). Bnh
giun mi niCp nht y vn v tng hp thng tin v 12
bnhnhngiunugai.http://www.impeqn.org.vn
negectedparasitosisoftheCentralnervoussystem.Emerging
InfectiousDiseases.www.cdc.gov/eid.vol17.No7,July2011
ChuynYTCngCng
NghincuYhc
HIULCPHCARTESUNATENTRLIU
TIVNGSTRTLUHNHKHNGCGIAOLUBINGII,MIN
TRUNGVITNAM
HunhHngQuang*,TriuNguynTrung*,NguynTnThoa*
TMTT
Giithiu:Artesunatelmttrongnhngthucstrtquantrng,vhiuqucachngchnglik
sinhtrngvndkhngviccthuccintiVitNamvonhngnm1990.Gny,csgimhiu
lccaphcArtesunatentrliutikhuvcbingiiThiLanMyanmarvThiLanCampuchia.Liu
chng mt vng SRLH khng c giao lu bin gii ca min Trung, Vit Nam c th tn ti mt chng P.
falciparumnitikhngArtesunatekhng?chnhlcuhicntrachonghincuny.
Mctiunghincu:nhgihiulcArtesunatentrliutrongiutrstrtchabinchngdo
P.falciparum.
i tng & Phng php: BNSRchabinchngdoP.falciparumvthitktheothnghimlm
sngkhngngunhin,tchng.
Ktqu:HiulcphcntrliuArtesunateliutrnh7ngydungnptt,khngctcdngngoi
,chotlpnglmsngvksinhtrngy(ACPR)gimxungcn87,2%,thtbiLCFl8,5%,
LPFl4,3%,khngcthtbiiutrsm(ETF).
Ktlun:Liutrnhntrliu7ngycaASchiulcchakhigim(<90%)trongiutrbnh
nhnstrtchabinchngdoP.falciparumtiNinhThun,vitNam.
Tkha:Plasmodiumfalciparum,Artesunatentrliu,Hiulc
ABSTRACTS
EFFICACYOFARTESUNATEMONOTHERAPYINMALARIAHYPERENDEMICZONEWITHOUT
CROSSBORDERINCOASTALCENTRAL,VIETNAM
HuynhHongQuang,TrieuNguyenTrung,NguyenTanThoa.
Backgrounds:Artesunateisoneofthemostimportantantimalarialagentsavailable,sinceitiseffective
against parasites that have developed resistance to conventional antimalarials in Vietnam in 1009s. Recently,
therewasdeclininginefficacyof7dayregimenofArtesunateinThaiMyanmarandThaiCambodiaborders.
We asked whether it was resistance true in an area without border of Central Vietnam due to indigenous P.
falciparum.Itisaresearchquestioninthis.
Objectives: To assess of Artesunate monotherapy efficacy in treatment for uncomplicated falciparum
malaria.
Methods:Theuncomplicatedfalciparummalariapatientsandnoncontrolledrandomizedclinicaltrial
Results: Artesunatealone7daysregimenwaswelltolerated,andnosevereadverseeventwasreported.
ThePCRcorrectedcurerateorACPRbyday28droppedto87.2%,LCFof8.5%,andLPFof4.3%,without
ETF.
*VinStrtKSTCTQuyNhn
Tcgilinlc:Ths.Bs.HunhHngQuangT:0905103496 Email:huynhquangimpe@yahoo.com
ChuynYTCngCng
353
NghincuYhc
Conclusions:The7daycourseofArtesunatealonefailstoachievesufficientlyhighcurerates(<90%)for
uncomplicatedfalciparummalariapatientsinNinhThuanprovince,Vietnam.
Keywords:Plasmodiumfalciparum,Artesunatemonotherapy,Efficacy
cha bin chng P.falciparum ti mt vng st
TVN
rt lu hnh khng c giao lu bin gii min
Tnhng1990,Artemisinine(ART)vdn
Trung,VitNamctinhnh
chtArtesunate(AS)ctinhnhthnghim
Mc tiu nghin cu: nh gi hiu lc
lm sng v chnh thc a vo s dng rng
Artesunate (AS) n tr liu trn BNSR cha
ri trong Vit Nam, gp phn quan trng
binchngdoP.falciparum.
trongvichthptlSRATvTVSR.Mcd
ITNGPHNGPHPNGHINCU
viliutrnh7ngycaARTvAS,tlkhi
bnh SR do P. falciparum ln n 8090%, song
aim,thigian
nhcimlnnhtcathuclthigianbn
X Ma Ni, huyn Ninh Sn, tnh Ninh
hy ngn, iu tr n thun cho t l ti pht
Thun;
sm sau iu tr qu cao (2035%). Thnh qu
Tthng3/201012/2010;
cngnhvaitrcaARTvASkhngthph
nhnvgipchoVitNamgimngkv
itngnghincu
smcSRvtvonglmtdliukhcth
BnhnhnstrtdoP.falcipparumcha
thucSRnosnhc.Song,vicsdngvi
binchng
mt TSR c thi gian bn hy ngn, liu trnh
Tiuchunchnbnh:
dingytrnmtphmvirng,khkimsot
Tuit6thngtuitrlnndi70tui;
vphbinnhASstoiukintimnng
Nhim n thun P. falciparum v
cho qu trnh hnh thnh v thc y khng
MKSTSRthvtnh1.000/lmu;
thuclcthxyra.Quvy,dintingim
nhy vi thuc ART v dn cht AS trong in
vitro cho thy iu (6). T nm 2003 n
2010,WHOcboconhiutrnghplm
sngkhngpngvithucAScngvi
thng bo khng thuc vi ART gn y trn
ccbnhnhntikhuvcbingiiThiLan
Camphia (WHO, 2009) l mt bng chng c
gi tr v cnh bo quan trng c th lan sang
ccqucgialngging,kcVitNam(4,5,6).
Liu chng vn gim nhy hay khng
thucARTvAScachngP.falciparumchl
phttnquabingiihaycncthlchng
nitimtvngSRLH(khngcgiaolubin
giinhNinhThun)cngcthphtsinhgen
khng?(3)Do,mtnghincunhmnhgi
hiulcAStrongiutrSRdoP.falciparuml
ht sc quan trng ti mt vng t lu p
dng phc AS n tr liu trong mt thi
gian di, c th dn n tng p lc thuc v
khng thuc. Trn c s , ti Hiu lc
phc AS n tr liu trong iu tr st rt
354
Nhitnch37,5Chocnhitdi
li/itrng38C;
Chadngmtloithucstrtno(thng
quakimtranctiu);
Bnh nhn, hoc ngi gim h v thn
nhngianhnghptcnghincu.
Tiuchunloitr:
Nhhn6thngtuihoclnhn70tui;
Phnangcthai,hocangchoconb,
angcbnhrilontmthnkinh;
Nn ma, tiu chy trm trnghoc th
trngkhnghpthucthuc;
St rt c bin chnghoc mc cc bnh
nhimtrngphihp;
Nhim st rt phi hp P. falciparum + P.
vivaxhocloiksinhtrngkhc;
Phngphpnghincu:
Thitknghincu:
ChuynYTCngCng
Thitknghinculmtthnghimlm
sngkhngngunhin,tchng.
TT
Kthutnghincu
nhgithngslmsng,othnnhit
Xtnghimlammuvmmtksinh
trng
Phn tch v gen hc ca KSTSR khng
thuc
Phnloihiulciutr:theohngdn
phnloiinvivocaTchcYtthgii2009
Xlsliu:phntchvxltheophn
mminvivophinbn7.1,WHO(2009).
Thuc AS trong th nghim ny c thi
giandngtrongCTQGPCSRnncthng
quaHingocysinhhccaVinSt
rtKSTCTQuyNhn;
c im bnh nhn
5 n = 15
Cmunghincu:
Nutlthtbicaloithucstrtphi
hp AS khng bit trc, 20% l t l tht bi
lmsngqunthctnhp(20%),khongtin
cy:95%,chnhxc(d):10%.Khicmu
tithiucnnghincunhgi:n=61bnh
nhn,cngthm20%mtmun=73
NghincuYhc
> 15
Ngh nghip
- Nng, ry, khai thc lm sn
- Ngh nghip t do
- i hc
- Cng nhn, nhn vin
Thi im bt u
vo nghin cu (D0)
36 (36,0%)
53 (53,0%)
78 (78,0%)
4 (4,0%)
16 (16,0%)
2 (2,0%)
Nhn xt: Trong s trng hp tiu

chun nghin cu, nam thp hn n; Tui
trung bnh ca bnh nhn l 23,5; Dn tc
Ragleychimasvchyulmnng,ry,
khaithclmthsn.
Bng2.cimvksinhtrngstrtP.
falciparumtrnbnhnhn
TT
c im bnh nhn
Ch s thi im bt
u nghin cu (D0)
Mt trung bnh KSTSR P.

falciparum trn 100 bnh nhn
- MKSTSR th v tnh
19,201 10,270 /l
1
- S bnh nhn c giao bo D0
7/100 (7,0%)
- MKST th giao bo
28,4 5,2/ l
Lch ln:
- Bnh nhn c lch ln
2 - Bnh nhn khng c lch ln
- Bnh nhn ct lch ton/bn
phn
12/100 (12,0%)
88/100 (88,0%)
0
KTQUNGHINCU
Nhnxt:MtthvtnhP.falciparum
19,20110,270/l,scacgiaobochimrt
thp;bnhnhnclchlnthp(chyuI,
II);khngclchlnchim88,0%.
c im ca nhm bnh nhn tham gia

nghincu
Hiu lc phc thuc Artesunate n

trliuivistrtdoP.falciparum
Bng1.cimvdnshctrnnhmbnh
nhnnghincu
PhnloihiulcphcthucAtesunate
theoWHO2009
Bng3.PhnloihiulcphcASntrliu
ivistrtP.falciparum
c im bnh nhn
Gii tnh - Nam

- N
Dn tc - Ragley
Thi im bt u
vo nghin cu (D0)
62 (62,0%)
38 (38,0%)
88 (88,0%)
- Chm
8 (8,0%)
- Kinh
Nhm tui
4 (4,0%)
- Tui trung bnh

- Nhm tui:
<5
23,5 (2 - 45)
ChuynYTCngCng
11 (11,0%)
Ch s nh gi
ETF
LCF
LPF
ACPR
Tng s phn tch
Rt khi nghin cu
Mt theo di (sau D7)
Tng s nghin cu
S lng T l (%) Ghi ch

0
8
4
82
94
0
6
100
0
8,5%
4,3%
87,2%
0
6,0%
S liu trn cha hiu

chnh PCR
TT
Hiu lc
Th nghim c tin hnh di s gim

sttrctipcacccnbchuynmn.
355
NghincuYhc
Nhnxt:TlpngACPRl82(87,2%),LCF
l8(8,5%),LPFl4(4,3%),chathytrnghp
thtbiiutrsm(ETF).Smttheodil6.
Bng4.Phntchcctrnghpthtbimunv
lmsngvKSTSR
M NC
Tui
Nam
25NTAS
34NTAS
40NTAS
41NTAS
62NTAS
63NTAS
73NTAS
88NTAS
Tng cng
17
3
8
23
25
14
6
Phn loi
Phn loi
theo in vivo n ngy theo
N
di
6
LCF*
D28
LCF
D21
LCF
D28
LCF
D28
LCF
D28
LCF
D21
12
LCF
D7
LCF
D21
2
8
D7 (1); D21 (3);
D28 (4)
*LCF:lateclinicalfailure_Thtbilmsngmun
Nhnxt:Trong8trnghpLCF,phnlnsca
phthinvongyD28vD21.
Phntchchitittrnghpthtbiiutr
trninvivovktquphntchPCR
Bng5.Phntchchititvcctrnghpthtbi
iutrdatrninvivo
Mt KSTSR
D xut hin
M BN
Do
11NTAS 7.598
15NTAS 11.396
55NTAS 13.050
67NTAS 34.517
D xut hin
KST
1.655
1.362
567
2.122
D21 (P.f)
D14 (P.v)
D14 (P.v)
D21 (P.f)
Phn loi v hiu

chnh
Phn loi Phn loi
theo in theo PCR
vivo
LPF
Ti pht
LPF Ti nhim
LPF Ti nhim
LPF
Ti pht
Nhnxt:Trongs4trnghpthtbiKSTSR
mun(LPF)theoinvivo,saukhihiuchnhbng
PCRchothy2catinhim(P.vivax)v2cati
pht(P.falciparum).
Hiu lc ct st v ct KSTSR P.
falciparumcaphcASntrliu
falciparumcaphcArtesunate
Kt qu phn tch
Thng s thi gian

(gi tr trung bnh)

S ngy c st trung bnh trc D0 3,20 1,20 ngy
Mt KSTSR trung bnh ngy D0 19,201 10,270 /l
356
Kt qu phn tch
Thi gian ct st trung bnh (FCT)
Thi gian sch KSTSR trung bnh
(PCT)
Thi gian sch giao bo trung bnh
(gi)
Thng s thi gian

(gi tr trung bnh)
30,55 15,25 gi
36,70 7,50 gi
28,5 gi (18 39)
Nhn xt: Thi gian ct st v lm sch k

sinhtrngP.falciparumrtngn,lnlt30.55
15.25giv36.707.50gi.
Bng7.Phntchchitithiulcctstvlmsch
ksinhtrng
Tng s phn tch (n = Tc ct st Tc sch
94)
KSTSR
Din tin theo di thi gian S lng (%) S lng (%)
- Sau 12 gi
42 (44,68)
32 (34,04)
- Sau 24 gi
78 (82,98)
67 (71,28)
- Sau 36 gi
94 (100)
89 (94,68)
- Sau 48 gi
94 (100)
Nhnxt:Quaphntch,tcctstvlmsch
KSTSRrtnhanhtheosaumi12gi;Thiim36
gibnhnhnkhngcnstv48gischk
sinhtontonb94ca.
BNLUN
cimcanhmbnhnhn tham gia
nghincu
Vi tng s 100 trng hp tiu chun
nghincu,vgiitnhthnamgiicaohnn.
TuitrungbnhBNl23,5,trongsBNnh
hn5tuichim11%,nhmtui5n15l36
trnghp(36,0%),cbitnhmngiln(
15tui)chimtln53%.Dntcchima
s l Ragley (88%), hu ht l ngi dn a
phng,sinhsngbnglmnng,lmry,khai
thc lm th sn theo ma v nh trng ng,
uxanh,ma,(78,0%),sbnhnhnang
tui i hc chim 16,0%, dn lm ngh t do
(4,0%)vcngnhn,nhnvinravolmin.
BNSRdoP.falciparumtiuchuncmt
KSTSRthvtnh19,20110,270/l,scac
giao bo chim t l rt thp (7,0%), c l ph
hpvivngnhiunmcanthipviutr
bngTSRhiulccaoAS/ART/DHAPPQ.Sca
c lch ln chim t l thp 12,0%, trong vng
ChuynYTCngCng
SRLHnngnhxMaNi,victinhimhay
chngcnnnmttllchlnlcth.So
vi cc vng SRLH nng v rt nng ti chu
PhivNamMthtllchlncthlnn
30% v mc lch ln cao hn nhiu so vi
nghincuny.
Hn na, qua thm khm khng pht hin
bnh nhn no c tin s ct lch s gip cho
qu trnh nh gi din tin ct st v ct
KSTSR,cngnhhnhthihccaKSTSRtrn
lamsaukhihonttliutrnhAS,vvnd
lchchnhlmchncacchngcuvh
li ni m trong lch khi b ct lch i, s
gimitnhnngbtcphngcunhim,nn
KSTSR vn cn lu hnh mt thi gian di
trongmu,khinchonhgihiulcvmt
KSTSR s khng cn chnh xc v xem nh
mtyutnhiuktqunghincu.
Hiu lc phc n tr liu AS vi st

rtP.falciparumchabinchng
Hiu lc phc n tr liu Artesunate
theophnloicaWHO2009
Vi tnh hnh SR a khng thuc 10 nm
qua,cbitktnm2006,WHOlnting
cnhbonguycgimnhyvkhngthucvi
liuphpASntrliuthhn70qucgiac
SRLHtipcnvsdngccthucphihp
ACTs. Cnh bo ny qu tht khng tha v
thctxytrnghpSRdoP.falciparumti
bin gii Thi Lan Campuchia biu hin
khngthucviARThocAS(thcchtca
vnlthtbiiutr/gimnhyvitiuch
do WHO a ra khi thi gian lm sch KSTSR
kodingyD3chchacbngchngxc
thcnokhngART/ASdigcphnt).
Songycnglcnhbochoccqucgialng
ging, trong c Vit Nam v hu qu c th
edanudngKSTSRkhngnydithc
sangccvngkhctrongphmvitoncu.
llolngsphttndngKSTSRP.falciparum
khng t giao lu qua bin gii vi nhau, liu
chngcstntidngKSTSRP.falciparumni
atiminTrung,VitNam(nimtlu
n cha v tim nng nhiu KSTSR khng
ChuynYTCngCng
NghincuYhc
thuc)liumnghincunytinhnh
giithchcuhitrn.
BtkTSRno,dtrchaysau,smhay
muncnguc th xut hin gim nhy v
dn n khng l kh trnh khi, do vy vic
gimsthiulcTSRangdngrngrilcn
thit.ARTvdnsut,cbitASlmttrong
nhng thuc st rt y ha hn trong phng
chngstrtdocnhiuuimvmtdc
hc: (i) lm gim lng ln KSTSR nhanh; (ii)
hiu qu chng li KSTSR a khng; (iii) gii
quyt nhanh triu chng lm sng; (iv) gim
ngimanggiaobo;(v)chiutrnccgiai
on KSTSR v liu trnh dng thuc an ton.
Tuy nhin, nhiu nghin cu a ra bng
chngtltiphtsmkhisdngASntr
liu qu cao (3050%) l mt tr ngi ln v
nguy c cho hnh thnh khng. Do vy, th
nghim invivo 7 ngy liu c biu hin khng
png?haychltiphtsm?
Tng s 94 bnh nhn, khng ca no biu
hin tht bi iu tr sm (ETF); t l p ng
lm sng v KSTSR y (ACPR) l 87,2%,
tht bi lm sng mun (LCF) l 8,5%, tht bi
KSTSR (LPF) l 4,3%. Trong 8 trng hp tht
bi LCF, c n 7/8 ca c pht hin sau D7,
tht bi LCF vo ngy D28 (4 trng hp) v
ngyD21(3trnghp),chc1trnghpvo
ngyD7.Tuynhin,khinhgivsosnhi
chiu vi phn loi hiu lc WHO (2009),
nghincunyc2caxploikhngphhp
viLCFhonton(vciukinnyththiu
iukinkiavngcli).Btkmtphnloi
no d c tp trung v chi tit n my cng
khngtrnhkhimtstrnghpngoil,so
viphnloicaWHO(2009,2010).
Sosnhmtsnghincutrongvngoi
ncchothyhiulcASntrliucphn
thay i r, nht l thi gian ct st v ct
KSTSR u ko di. nh gi 84 BNSR do
P.falciparumcchnngunhinvo2nhm
sdngntrliuAS5ngyv7ngyth
nghiminvivo28ngy,chothytlACPRt
88,10(phc5ngy)n95,24%(7ngy),t
357
NghincuYhc
l tht bi KSTSR mun (LPF) trung bnh t

4,76% (phc 7 ngy) v 11,90% (5 ngy)
khcbitcnghathngk(p<0,01)vc2
phcukhngcETFvLCF(T.N.Trung
vcs.,2008);sliunytng ng vi kt
qunghincuN.T.Tinvcs.,(2005)khitin
hnhnhgihiulcphcASntrliu
5ngytiBnhPhcchoACPRl92,7%,LPF
l3,65%vLCFl3,65%.
Ngoi ra, cc nghin cu ti chu Phi v
NamMhocngNamchobittngthi
imthhiulcthucASkhcbit,songcha
cbocokhngthucASquaccnghincu
vicmukhcnhau(n=5279;ACPR=85%,
96%v100%;Bunnagvcs.,2005);hocnghin
cuASntrliu5ngytiTanzania(n=63;
ACPR = 80%; Hassan v cs.,2006)(1,5,6); hoc n
trliuAS4ngy(ACPR=8084%;Alinvcs.,
2006);hocnghincuGabondngASntr
liu 3 ngy (n = 50; ACPR = 72%; Steffen
Borrmann vcs.,2003)vliu trnh 5 ngy

(n=50;ACPR=90%;NorbertG.Schwarzv
cs.,2005).
C 4 trng hp tht bi KSTSR mun
(LPF),c2cacghinhntiD14v2cati
D21.nhginyphhpviphnloiWHO
(2009) l c mt KSTSR (+) trong thi gian t
D7 n D28. Qua theo di kt qu 100 trng
hptrnthnghiminvivo,bnhnhnd
sch KSTSR trong vng thi gian t ngy D3
ntrcngyD14,theoditiptcthyvn
xut hin li KSTSR vo ngy D14 v D21. Kt
qusoilammuvongyDthtbichothy4ca
xuthinlinthunP.vivax(D14)vD28
c 2 ca nhim P.falciparum. Kt qu phn tch
PCR hiu chnh phn loi LPF cho thy
trongc2trnghpti nhim v loi P.
vivax n thun (mu 15NTAS v mu
55NTAS) v 2 mu ti pht v loi P.
falciparum n thun (mu 11NTAS v mu
67NTAS). Kt qu ny ph hp vi phn loi
cathnghiminvivo.
Hiu lc ct st v lm sch KSTSR P.
falciparumcaphcASntrliu
358
Thi gian ct st v lm sch KSTSR trung

bnh(FCTvPCT)caphcASngn30,55
15,25giv36,707,50gi.ThigianthucAS
lm sch 7/100 trng hp c giao bo dao
ng t 18 n 39 gi, trung bnh l 28,5 gi
(cui ngy D1 sch giao bo). Tc chi tit
qua mi 12 gi s BN khng cn st tng dn
ln,cthsau12gic42/94(44,69%)ctst
82,98%(sau24gi)100%(sau36gi)khng
cnst.Sosnhvinghincuctinhnh
ti 1 vng SRLH nng khc ca Ninh Thun,
nhmtcgiT.N.Trungvcs.,2008dng2phc
ntrliuAS5v7ngy(n=84),ktqu
choFCTl28,5013,70gi(phc5ngy)v
26,40 12,60 (phc 7 ngy). Tc ct st
nhanh mi 12 gi v ht hn sau 4860 gi,
khngthyskhcbitcnghavctstca
2 phc (p > 0,05). Do vy, s liu y c
FCT30,5515,25gickodihn.
Hiu lc lm sch KSTSR P. falciparum ca
thucASchothyPCTcaASchaqu2ngy
(36,70 7,50 gi), tuy c ko di so vi mt s
nghincukhctrcy,songtclmsch
sinh khi KSTSR chi tit qua mi 12 gi rt
nhanh: 34,04% (sau 12 gi) sch KSTSR
71,28%(24gi)94,68%(36gi)100%(sau
48gi)khngcnKSTSRtrnlammu.Tng
tnhFCT,sovisliucaT.N.Trungvcs.,
(2008)vPCT, hiu lc ct KSTSR P.falciparum
trongnghincunygimvbiuhinko
dithigianhn(n=84;FCT=27,709,70gi
(phc5ngy)v26,808,60gi(phc7
ngy);T.N.Trungvcs.,2008)vs.36,707.50gi
(nghincuny).
Vidliu2thngsvFCTvPCTcng
viACPRchcn82%,chothyhiulcASi
vi P. falciparum theo hng dn ca WHO
(2006)vBYt(2007)gimdnhiulcv
ct st, v sch KSTSR so vi trc y(4,6). D
cha bng chng no khng nh khng thuc
ART/AS, nhng hiu lc trn thc nghim m
hnh ng vt thy khng do P. berghei,
P.yoeliivP.chabaudi(WHO,2006);ktqudng
ntrliuAStrong15nmquanghincu
ChuynYTCngCng
invitrochothynngcch(IC50)phitng
lngp3vnngcchtithiu(MIC)phi
tnglngp2michiuqu.Ringmts
qucgiachu,kcVitNam,nngIC50
t19982001nnhkhnghthayi,nhng
IC90vIC99phitngln24ln(WHO,2006).
BivthucASntrliucthigianbn
hyrtngn,sctiphtsmnudngn
tr liu v ngn ngy, c ch pht trin khng
thuctimtng.NhiunghincuTrungQuc
v Vit Nam cho bit nu dng ART/AS n
thunchogimnhytrninvitro(WHO,2006).
Dovy,viccdliuvktqutrongnghin
cunygmACPR=82%,LCF=8%vLPF=
4% cho thy t l p ng P.falciparum vi AS
gim i nhiu. ng thi, cng da trn cc
bngchngbocotrnyvnrng(i)tl
tht bi qua nghin cu ny 18% (nm trong
khong10%theoquynhWHO),(ii)thigian
bn hy ngn; (iii) bng chng gim nhy in
vitro vi IC50, IC90 v IC99 v EC50, EC90 v EC99
phitnggp234ln;(iv)tnhtrngkhng
thuctrn m hnh thc nghim; (v) hn 10 ca
SRdoP.falciparumtrnlmsngthtbithts
Thi Lan, Cambodia, Vit Nam; (vi) th vic
dngphcntrliunylcnthittrc
khi hu qu din ra, chuyn sang dng dng
ACTs tr hon pht trin khng thuc. Vic
gim st v nh gi v mt hiu lc phc
cc thuc st rt trn phm vi ton cu, cng
nhticcvngSRLHtiVitNamlhtsc
cn thit m bo hiu lc TSR bn vng
trongtnglai(GuerinPJvcs.,2009)(5,6).
NghincuYhc
KTLUN
HiulcphcntrliuASliutrnh7
ngyctlACPRl87,2%,LCFl8,5%,LPFl
4,3%,chaccanothtbiiutrsm(ETF).
ChacbngchngvkhngcaP.falciparum
viAS; c 2 thng s FCT v PCT u ko di
hnsovitrcy;
nthiimny,dchacmttiliu
no khng nh khng thuc ART/AS, song v
mtsbngchngyvncptrntrn,nn
phcnyskhngpngviuquan
trngchuynsangdngthucACTslphhp
nht,cnghavatrhonqutrnhphttrin
khng thuc, va ph hp vi khuyn co ca
WHOhinnaytrnphmvitoncu(6).
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
NoedlH,YourySEetal.,(2009).EvidenceofArtemisinin
ResistantMalariainWesternCambodia,Volume359:2619
2620.
SchwarzNG.etal.,(2005).5daynonobservedArtesunate
monotherapy for treating uncomplicated falciparum
malaria in young Gabonese children. The American
SocietyofTropicalmedicineandhygiene.
T.N. Trung, H.H. Quang, et al., (2001). Treatment of
falciparum malaria in Vietnamese children: the need for
combination therapy and optimised dosage regimes.
Anals. of paediatrics tropical medicine, University of
WesternAustralia,p27.
Triu Nguyn Trung, Hunh Hng Quang, Nguyn Tn
Thoa, Cao Vn nh v cs., (2009). Nghin cu nh gi
hiulcphcchloroquine,Artesunatentrliu,CV
8, Artequick i vi k sinh trng Plasmodium
falciparum.tiNCKHcpB,20052008.
WHO (2006). The threat of resistance to artemisinine
derivatives. WHO briefing on malaria treatment
guidelines and Artemisinine monotherapies, Geneva,
2006.pp.1317.
WHO(2010).Globalreportantimalarialdrugsefficacyand
drugsresistance20002010,pp.2635.
ChuynYTCngCng
359
NghincuYhc
THNHPHNLOIRUIVMUITIMTSVNQUCGIA
VKHUBOTNTHINNHINNAMB
NguynVnChu*,VcChnh*,NguynVnDng*,NguynThBchLin*,HnhTrung*,
THuyThnh**,LThnhng***
TMTT
tvn:Ruivmuinichungngvaitrquantrngtruynmtsbnhnguyhimtrnthgii
cngnhVitNam.KhuvcNambnmtrongvngnhitigima,ckhhunngvmquanhnm
phhpvicntrngphttrin,trongcruivmui.Vvy,nghincuthnhphnloirui,muiti
mtsVnQucgia(VQG)vkhuBotnThinnhin(BTTN)Namblcnthit,nhmdbokh
nngxyramtsdchbnh,bovsckhechocngng,gpphnphttrinkinhtvdulchcaa
phng.
Mctiu:Xcnhthnhphnloirui,muivchraccloicvaitrdchtNamb.
Phngphpnghincu:iutractngang,mt,phntch.
itngnghincu:ruignngi(linhMuscoidea)vmui(hCulicidae).aimvthigian
nghincu:Vn quc gia (VQG) Ct Tin, khu Bo tn Thin nhin (BTTN) Cn Gi, VQG Cn o v
VQGPhQuc.Thigiannghincu:nm20042011.
Kt qu: thu thp c 1.053 mu rui, thuc 72 loi, 28 ging, 3 h (Muscidae, Calliphoridae,
Sarcophagidae)v15.365mumui,thuc112loi,14ging,1h(Culicidae).Trong,57loiruiv22loi
muicvaitrdchtVitNam.
Ktlun:Thnhphnloirui,muiticcimnghincuNambkhphongph,trongcmts
loicvaitrdchtquantrngVitNam.Vicgimstthngxuynthnhphn,mtccloiruiv
muisgpphntmbinphpphngchngccbnhdochngtruyn.
Tkha:thnhphnruivmuic,vnqucgia,khubotn
ABSTRACT
SPECIESCOMPOSITIONOFTHEFLIESANDMOSQUITOESINSOMENATIONPARKSAND
NATURERESERVEOFSOUTHERNOFVIETNAM
NguyenVanChau,VucChinh,NguyenVanDung,NguyenThiBichLien,HoDinhTrung,
TaHuyThinh,LeThanhDong*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:361368
Background:Fliesandmosquitoesincommonlyplaytheimportantrolefortransmisionsomedangerous
diseaseinovertheWorldandVietnam.SouthernofVietnamisintropicalregion,whichhothumidclimateis
favorable condition for developing of flies and mosquitoes. Thus study on species composition of flies and
mosquitoesinthislocationisnecessary,wichcontributestopredicttheriskofdiseaseinordertopreventtimely.
Objectives: To determine of species composition of flies and mosquitoes and specify the species with are
vectors.
Methods:Crosssectionalsurvey,describleanalysis.Fly(superfamilyMuscoidea)andmosquitoes(family
Culicidae).Locationandtimestudy:CatTienNationalPark,ConDaoNationalPark,PhuQuocNationalPark
*VinStrtKsinhtrngCntrngTrungng**:VinSinhThivTiNguynSinhVt
***:VinStrtKsinhtrngCntrngTP.HChMinh
Tcgilinlc:PGS.TS.NguynVnChuT:0982331949
Email:vanchaunimpe@yahoo.com
360
ChuynYTCngCng
NghincuYhc
andNatureReserveCanGio;studyperiodtime:20042011.
Result:Total18pointsin4localities1,053flysampleswerecollected,belongingto72species,28genus,3
families.And15,365mosquitosampleswerecollected,belongingto112species,14genus,2subfamily.Among
collectedspecies,thereare57flyspecies,22mosquitospeciesareplaythepidemiologicalroleinVietnam.
Conclusion: Species composition of flies and mosquitoes in 4 locations in Southern of Vietnam is rather
diversityandalsonumbersofthemareplaytheimportantepidemiologicalrole.Themonitoringofdensityand
species composition of flies and mosquitoes in the areas will be contribute to find out control measure disease
transmitedbyfiliesandmosquitoes.
Keywords: species composition of the flies and mosquitoes, National Park, Nature Reserve
TVN
itngnghincu
Nhiuloirui,muicvaitrquantrng,
truyn mt s bnh nguy him trn th gii
cng nh Vit Nam. Vit Nam nm trong
vng nhit i c kh hu gi ma, nng v
m. Khu vc Nam b c kh hu nng v m
quanh nm rt ph hp vi nhiu nhm cn
trngphttrin,trongcruivmui.Theo
kt qu nghin cu ca nhiu tc gi cho thy,
hnglotccmmbnhlynhimctrncth
ruinhbnhdovirus,ccbonangnm,mt
sbnhksinhtrng,bnhlao,bchhu,au
mt v.v... Nhiu loi mui ng vai tr truyn
bnhstrt,stxuthuyt,vimnoNhtBn,
giun ch bch huyt v.v Do vy, vic nghin
cuthnhphnloiruignngivmuiti
mt s Vn quc gia v khu Bo tn Thin
nhinNamblcnthit.Vlnhngni
c nhiu tim nng pht trin kinh t, du lch,
nghin cu khoa hc v.v... Kt qu nghin cu
thnhphnloirui,muislcsdbo
mt s dch bnh do chng lan truyn; ng
thicnglmtchsnhginhhng
ca bin i kh hu v gp phn vo vic
nghincuadngsinhhcVitNam.
Rui nh (Muscidae), nhng (Calliphoridae),

rui xm hay rui n xc ng vt
(Sarcophagidae)vhmuiCulicidae.
aimvthigiannghincu:
Vnqucgia(VQG)CtTin:khuTLi,
BnC,t(xTnPh)(6/2005)vXTin
Hong(NamCtTin)(11/2004)(8).
Khu Bo tn Thin nhin Cn G: Dn
Xy,PhnKhuI(thnAnPhc,xTamThn
Hip),pLongThnh,xLongHa(thng4v
9/2007)(6).
VQGCno:Khu2,Khu5,NhBnv
Bingng(11/2005)(11).
VQG Ph Quc: th trn Dng ng, x
BiThn,xCaDng(pBnTrm)(4/2010);
th trn An Thi, Hm Ninh (p Cy Sao)
(6/2011), Dng T (p Sui ), Ca Dng
(pPhTng)vCaCn(pBa)(11/2011)(7).
Mctiunghincu
Xc nh thnh phn loi rui, mui v ch
ranhngloicvaitrdchtNamb.
ITNGPHNGPHPNGHINCU
Hnh1:Vtrccimnghincu
Phngphpnghincu
Phngphpnghincu
iutractngang,mtvphntch.
ChuynYTCngCng
iu tra thu thp mui theo k thut

thngquycaVinStrtKsinhtrng
Cn trng Trung ng (Vin St rtKSTCT
361
NghincuYhc
T). nh loi mui ch yu da vo c

im hnh thi(5). Mt s nhm loi Anopheles
c thm nh bng k thut sinh hc phn
t (PCR polymerase chain reaction). Rui
cthuthpbngvtvphnloibngc
im hnh thi theo ti liu ca Fan, 1965,
1992; T Huy Thnh, 2000. Danh sch thnh
phnloicxptheovnalphabeta.
KTQUNGHINCU
thu thp c 1.053 mu rui v 15.365
mumui,sauylktquphnloi.
TT
21
22
23
24
25
26
27
Thnhphnloivphnbruivmui
ccimnghincu
28
Bng1.Danhschccloiruivimthuthp
29
TT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
362
Tn loi rui
H rui nh Muscidae
Atherigona atripalpis*
Malloch,1925
Ath. biseta* Karl, 1939
Ath. falcata* (Thomson,
1869)
Brontea subtilis* (Stein,
1909)
Dichaetomyia bibax* (Weid.,
1824)
Graphomyia rufitibia* Stein,
1918
Haematobia irritans* (Linne,
1758)
Hydrotea chalcogaster*
(Wied., 1824
Limnophora albonigra *
Emden, 1965
Lim. fallax* Stein, 1920
Lispe leucospila* (Wied.,
1830)
Lis. longicollis * Meigen, 1826
Lis. manicata* Wied., 1830
Lis. orientalis * (Wied., 1824)
Musca bezzi * Patton et
Cragg, 1913
Mus. conducens* Walker,
1860
Mus. confiscalta* Speiser,
1942
Mus. convexifrons *
Thomson, 1868
Mus. craggi * Patton, 1922
Mus. crassirostris* Stein,
Cn Ct Cn Ph
Gi Tin o Quc
x
30
31
32
x
x
33
34
35
36
x
x
x
37
38
x
39
x
40
x
x
41
42
43
x
x
x
x
x
x
x
x
44
45
46
47
48
49
Tn loi rui
1903
Mus. domestica* Linnaeus,
1758
Mus. fletcheri * Patton et al.,
1824
Mus. formosana * Maloch,
1925
Mus. pattoni * Austen, 1910
Mus. seniowhitei * Patton,
1922
Mus. sorbens* Wiedemann,
1830
Mus. ventrosa* Wiedemann,
1830
Myospila argentata* (Walker,
1856)
Myo. bina* (Wiedemann,
1830)
Myo. laevis* (Stein, 1900)
Myo. lenticeps * (Thomson,
1869)
Neomyia lauta *
(Wiedemann, 1830)
Neo. timorensis * (Rob.Desvoidy, 1830)
Neo. yunnanensis * (Fan,
1965)
Ophyra chalcogaster
(Wied.,1824)
Stomoxys calcitrans * (Linn,
1758)
Sto. indicus * Picard, 1908
Sto. sitiens * Rondani, 1873
H nhng Calliphoridae
Bengalia emarginata *
Malloch, 1927
Calliphora vomitoria* (Linne,
1758)
Chrysomyia megacephala *
(Fab., 1794)
Ch. pinguis* (Walker, 1858)
Ch. rufifacies* (Macquart,
1842)
Ch. villeneuvi* Patton, 1922
Cosmina bicolor* (Walker,
1856)
Dexopollenia yuphae
Kurahashi, 1995
Hemipyrellia ligurriens*
(Wied., 1830)
Hem. pulchra* (Wiede.,
1830)
Hypopygiopsis fumipennis*
(Wal., 1857)
Cn Ct Cn Ph
Gi Tin o Quc
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
ChuynYTCngCng
TT
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
Cn Ct Cn Ph
Gi Tin o Quc
Hyp. imfumata* (Bigot, 1877)
x
x
Lucilia cuprina* (Wiedemann,
x
x
1830)
Luc. papuensis * Macquart,
x
1842
Luc. porphyrina* (Walker,
x
x
1875)
Luc. sericata* (Meigen, 1826)
x
Rhyncomyia setipyga*
x
Villeneuve, 1929
H rui n tht
Sarcophagidae
Blaesoxipha rufipes*
x
(Macquart, 1839)
Boettchensica peregnina* (Rx
D., 1830)
Boe. javanica* Lopes, 1961 x
Boe. nathani* Lopes, 1961
x
Lioproctia patton* (S-W.,
x
1924)
Miltogramma iberica*(Vill.,
x
1913)
Parasarcophaga albiceps*
x
x
x
x
(Mei., 1826)
Par. brevicornis * (Ho, 1934) x
Par. dambiensis* (shino. et
x
Thinh, 2003)
Par. Doleschali* (Johnston et x
Tiegs, 1921)
Par. javana (Macquart, 1851)
x
Par. knabi* (Parker, 1917)
x
Par. misera (Walker, 1949)
x
x
x
Tn loi rui
Par. orchidea (Boet., 1913)
70
Par. ruficornis* (Fabricius,

x
x
1794)
71 Par. taenionota (Wiedemann,
x
1919)
72
Senotainia navigatrix
x
(Meijere, 1920)
S loi/s ging tng im 16/9 25/11 23/13 46/19
nghin cu
*:CcloicnghayhcquantrngVitNam.
Ti cc im nghin cu thu thp c
72 loi rui, chim 24,64% (72/318) tng s loi
ruignnhhinbitVitNam;gm3h:h
Muscidaec13ging,38loi;hCalliphoridaec
9ging,17loivhSarcophagidaec6ging,17
loi.Trong56loinghayhcquantrng
Vit Nam(10). S lng ging v loi rui mi
im khc nhau. S lng c th cc loi rui
ChuynYTCngCng
NghincuYhc
thuthpticcimkhngnhiu(<100cth)
(Bng1).
Bng2.DanhschccloimuiAnophelinaeticc
imnghincu
TT
Tn loi
Cn Ct Cn Ph
Gi Tin o Quc
x
x
Anopheles aconitus *
Doenitz,1902
2 An. argyropus Swell.,1914
3 An. barbirostris # Van., 1884
4 An. campestris Reid, 1962
5 An. crawfordi Reid, 1953
6
An. dirus * Peyton and
Harrision, 1979
7 Anopheles epiroticus* (Lin. & xxxx
Harb., 2005) (=Anopheles
sundaicus Rodenwaldt,
1925)
8 An. jamesii Theobal, 1901
9 An. karwari (James,1902)
10 An. kochi Doenitz,1901
11 An. maculatus* Theobald,
1901
12 An. minimus* Theobald,
1901
13 An. nigerimus Gles, 1900
14 An. nimpe Nguyen, Tran,
x
Harbach, 2000
15
An. nitidus Harrison et
al.,1973 (= Anopheles
indiensis Reid, 1953).
16 An. nivipes (Theoball, 1903)
17 An. pampanai Buttiker &
Beales, 1959
18
An. peditaeniatus
Leicesster,1908
19 An. philippinensis Ludlow,
1902
20 An. sawadwongporni Ratta.
& Reen, 1986
21 An. sinensis *# Wiedmann,
x
1928
22 An. tesellatus* Theoball,
1901
23 An. vagus * Doenitz,1902
24 An. umbrosus (Theobald,
1903)
S loi tng im
3
1
xx
x
x
x
x
(x)
x
x
x
x
x
x
x
x
x
x
x
21
Ghich:*Ccloitruynbnhstrt;#truynbnh
giunchbchhuyt;(+)bgyx:1100cth;xx:101
500cth;xxx:5011000;xxxx:>1000cth.

24loiAnopheles,chimtl38,71%sovitng
363
NghincuYhc
sloihinbitVitNam(62loi)(4).Trong
7loitruynstrt,1loitruyngiunchbch
huyt, 1 loi truyn st rt v giun ch bch
huyt Vit Nam. Ti Cn Gi An. epirotitus
chimuth,CnoAn.diruschimuthv
lngcth(Bng2).
Bng3.DanhschccloimuiCulicinaevim
thuthp
TT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Tn loi mui
Cn Ct Cn Ph
Gi Tin o Quc
xx
x
x
xx
Aedes aegypti
(Linnaeus,1757)
Ae. albopictus (Skuse,
x
1894)
Ae. amesii (Ludlow, 1903)
Ae. andamanensis Edwards,
1922
Ae. annandalei (Theobald,
1910)
Ae. caecus (Theobald,1901)
Ae. cancricomes Edwards,
(x)
1922
Ae. desmotes (Giles, 1904)
Ae. dux Dyar & Shanno, 1925
Ae. eldriger (Reinert, 1973)
Ae. helenac (Reinert, 1973)
Ae. imprimens (Walker,1861)
Ae. laniger (Weidmann, 1821)
Ae. lineotopennis (Ludlow,
1903)
Ae. maclalanei (Edwards,
1914)
Ae. mediolineatus (Theobald,
1901)
Ae. niveus (Ludlow,1903)
Ae. poicilius (Theobald,1903) x
Ae. pulcheiventer (Giles, 1901)
Ae. vexans (Meigen, 1830)
Ae. vigilax (Skuse, 1889)
xx
Ae. vittatus (Bigot, 1866)
Aedes sp1
Aedes sp2
Armigeres anulitarsis
(Leicester, 1908)
Ar. aureolinaetus (Leicester,
1908)
Ar. durhami (Edwards, 1917)
Ar. flavus Leicester, 1908
Ar. kuchingensis (Edwards,
1915)
Ar. longipalpis (Leicester,
1904)
364
xxx
x
x
x
x
x
(x)
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
xx
Cn Ct Cn Ph
Gi Tin o Quc
31 Ar. magnus (Theobald, 1908)
x
32 Ar. moutoni Edwards, 1914
x
33 Ar. pectinatus (Edwards, 1914)
x
34 Ar. subalbatus (Coquill., 1908)
x
x
x
35 Coquillettidia crassipes (Van
x
der Wulp, 1881)
36 Culex bitaeniorhynchus * Giles,
x
x
x
1901
37
Cx. bernardi Borel,1926
(xx)
38 Cx. brevipalpis (Giles, 1902)
(x)
x
39
Cx. fuscocephala*
x
x
x
Theobald,1907
40
Cx. fragilis Ludlow,1903
x
41 Cx. gelidus * Theobald, 1901
x
x
x
xx
42 Cx. halifaxi Theobald,1903
x
43 Cx. khazani Edwards, 1922
x
x
44 Cx. malayi (Leicester, 1908)
x
45 Cx. minor (Leicester, 1908
x
(x)
46
Cx. mimeticus Noe,1899
x
47 Cx. nigropunctatus Edwards,
x
1926
48 Cx. pallidothorax Theobald,
x
1905
49 Cx. pseudovishnui* Colles,
x
x
x
1955
50 Cx. quinquefasciatus * # Say, x
x
x
x
1823
51 Cx. raptor (Edwards,1922)
x
x
52 Cx. rubitthoracis Leicester,
x
1908
53 Cx. sinensis # Theobald, 1903
x
54 Cx. sitiens Wiedmann, 1828 xxxx
x
55 Cx. tritaeniorhynchus * Giles,
x
x
x
x
1901
56 Cx. vishnui * # Theobald, 1901 x
x
x
xxx
57 Cx. vorax (Edwards, 1921
x
58 Cx. whitmori (Giles, 1904)
x
x
59
Cx. whitei Barraud,1928
x
60
Culex sp1
x
x
61
Culex sp2
(x)
62
Heizmania communis
(x)
(Leicester, 1908)
63
Heizmania thelmae
x
Mattingly,1970
64
Heizmania sp
(xx)
65 Lutzia fuscana Wiedmann,
(x)
1820
66 Malaya genurostris Leicester,
(x)
1908
67
Mansonia annulifera #
x
(Theobald, 1901)
68 Man. bonnae Edwards, 1930
x
TT
Tn loi mui
ChuynYTCngCng
TT
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
Cn Ct Cn Ph
Gi Tin o Quc
Man. indiana # Edwards, 1930
x
Man. ocharacea Theobald,
x
1903
Man. uniformis # (Giles, 1904)
x
x
Mansonia sp
x
x
Mansonia sp2
x
Mansonia sp3
x
Mimomyia chambelaini
x
(Ludlow, 1904)
Mim. fusca (Leicester, 1908)
x
Ochlerotatus ganapathi
x
(Colless, 1958)
Och. khazami (Edwards, 1922
x
Och. mikrokopion (Knight and
x
Harrison, 1987
Och. novoniveus (Barraud,
x
x
x
1934)
Och. vigilax (Skuse, 1889)
x
Orthopodomya albipes
x
x
Leicester, 1904
Toxorhynchites splendens,
x
(x)
(x)
(Weid., 1819)
Tripteroides aranoides
x
x
(Theobald, 1901)
Tri. proximus (Edwards., 1915)
x
x
Tripteroides sp
x
Uranotaenia bimaculata
x
Leicester, 1908
Uranotaenia sp1
(x)
S loi/s ging tng im 21/6 41/8 29/8 53/11
Tn loi mui
Ghich::truynstxuthuyt;*:truynvimno
NhtBn;#:truyngiunchbchhuyt;(x):nhngloi
chbtcbgy.

88 loi mui thuc phn h Culicinae, gm 13
ging;bng66,16%tngsloiCulicinaebit
Vit Nam(9). Ging Culex 25 loi, ging Aedes
24loi,gingArmigeres10loi,ccgingkhc1
9 loi. Trong 2 loi truyn st xut huyt, 5
loi truyn vim no Nht Bn, 4 loi truyn
giun ch bch huyt v 2 loi va truyn vim
novatruyngiunchbchhuytVitNam
(Bng3).
BNLUN
Tiliunghincuvthnhphnloirui
Nam b cn t, ngoi 2 cng trnh ca T Huy
Thnh,2000v,2007(10).Trongcccngtrnhny
tc gi iu tra c 49 loi rui thuc 3 h
ChuynYTCngCng
NghincuYhc
Muscidae, Calliphoridae v Sarcophagidae phn b

mtsimthucTp.HChMinhvcctnh
Long An, ng Nai, Tin Giang, Kin Giang,
CnTh,CMau.
Ti liu nghin cu v mui Anophelinae
Nambkhphongph.inhnhccngtrnh
caBorel(1930)(1);PhmVnTng(2001)iu
tra Ph Quc; Nguyn Long Giang v Cs.
(1980)iutratiBnhChnh,TP.HChMinh
trong nm 1976. Trn c Hinh v Cs. (2001)
iu tra ti huyn m Di, tnh C Mau t
nm 19972000. Phm Xun nh v Cs. (2011)
iutraBnTretnm20062007.ngch
,nghincucaNguynThVinvCs(1980)
tingNai(1978)(5)vcaLXunHivCS.
(2004) ti U Minh (20022003)(3), thu thp
c cc loi: An. aikenii, An. annularis, An.
baezai,An.jeyporiensis,An.indefinitus,An.lesteri,
An. letifer, An. paraliae, An. separatus, An.
splendidus, An. subpictus v An. varuna. Nhng
loi ny chng ti cha thu thp c ti cc
imnghincu.NhvychonnayNam
bghinhn36loimuiAnophelinae.
Nghin cu v thnh phn loi Culicinae
Nam b cn t. Borel (1930) cng b 72 loi
Culicinae Nam b;(1) Stojanovich v Cs.(1965)
nghin cu mui Culicidae Vit Nam, nhng
khng tch ring mui Culicinae Nam b; V
c Hng v Cs. (2005) iu tra c 14 loi
muiCulicinaetnhLongAn.
Rui nhng ng vai tr quan trng trong
viclantruynnhiubnhtruynnhimvk
sinh cho ngi. Chng c th mang mt s
lng cc ln cc mm bnh trn c th. Theo
DerbenevaUkhova (1952) trn 1 con rui nh
(Musca domestica) c khong 6 triu vi sinh vt
bmv28triuvisinhvttrongngtiuho.
Trong s cc loi vi sinh vt c 44 loi gy
bnh.Cako(1892)phnlpcphykhun
ttphnruinh.GaliValerio(1902)tmthy
trc khun l trong c th rui nh v 2 loi
nhng. Cc nghin cu cho rng, c ti 90%
trng hp bnh ng rut do rui tham gia
lantruyn.Nhiuloimmbnhlynhimqua
365
NghincuYhc
ngmingxcnhcruinhbnh
do virus (bi lit, vim gan), cc bnh nhim
khun (l trc trng, thng hn, t) cc bo
nang nm; cc bnh k sinh trng(amip, giun
kim, giun a, sn dy)cng nh nhiu mm
bnh ngoi ng tiu ha nh lao, bch hu,
aumt,vimdav.v...VitNam,HongXun
n v Cs.(1970) tm thy bo nang l amip
Entamoebahystoloticatrncthvbmy tiu
ha ca rui nhng. Nguyn Vn Hiu v Cs.
(1983) phn lp c phy khun t Vibrio
cholera eltor trn rui trong v dch t Hi
Phng. on Tr Thng v Cs. (1978) phn lp
c14loivikhungyngrut,trong
c Vibrio parahaemolyticus t rui nhng. Trn
Thnh (1973), Dng Thi (1976) xt
nghim thy trng giun a trn rui v.v... T
Huy Thnh (1993) xt nghim thy trng giun
tc (Trichiuris trichiura) v trng giun a trn
ruinhMuscadomestica,ruichMuscasorbens
vnhngxnhChrysomyiamegacephala.Nhvy
khnngmangmmbnhtruynnhimvk
sinhtrngcaruinhngVitNamc
chng minh. Tuy nhin, trong mt s nghin
cu cha xc nh chnh xc tn khoa hc loi
ruixtnghim(10).
Vaitrtruynbnhcamui
Nhiu ti liu nghin cu khng nh
mt s loi mui Anophelinae Vit Nam nh:
Anopheles aconitus, An. dirus, An. epiroticus, An.
indefinitus, An. jeyporiensis, An. minimus, An.
maculatus,An.sinensis,An.subpictusvAn.vagus
nhim t nhin bo nang (trong d dy) v
thoatrngPlasmodium(trongtuynncbt)(2).
Mt s loi mui Culicinae nh: Culex
tritaeniorhynchus, Cx. gelidus, Cx. vishnui, Cx.
pseudovishnui, Cx. fuscocephala v Cx.
quinquefasciatustiabnTyNguynphn
lp c vius vim no Nht Bn (ng Tun
tvCs.(2009).Culexpseudovishnui,Cx.gelidus,
Cx. fatigans (= Cx. quiquefasciatus) v Cx.
tritaeniorhynchus ti Ninh Kiu, Cn Th
phnlpcvirusvimnoNhtBn(HTh
KimThuvCs.,2005).
366
Cc loi mui xc nh truyn giun ch

bchhuytVitNamgm:Mansoniaanulifera,
Masonia indiana (theo Iyengar, 1953); Anopheles
barbumbrosus, An. letifer, Cx. quiquefasciatus, Cx.
vishnui (theo Nguyn Th Bch Ngc v Cs.,
2001)(2).
KTLUNNGH
1. Thnh phn loi rui gn ngi
(Culicoidea) ti cc im nghin cu khng
phongph,gm72loi,28ging,3h.Hrui
nh (Muscidae) 38 loi, 13 ging; h nhng
(Calliphoridae) 17 loi, 9 ging v h rui xm
(Sarcophagidae)17loi,6ging.Trong56loi
cnghayhcquantrngVitNam.
2. Thnh phn loi mui (Culicidae) ti cc
imnghincukhphongph,gm112loi,
14 ging, 2 phn h. Phn h Anophelinae 1
ging(Anopheles),24loi;trong9loicvai
tr truyn bnh (7 loi truyn st rt, 1 loi
truyngiunchbchhuyt,1loivatruynst
rtvgiunchbchhuyt).PhnhCulicinae13
ging,88loi;trong13loicvaitrtruyn
bnh(2loitruynstxuthuyt,5loitruyn
vimnoNhtBn,4loitruyngiunchbch
huytv2loivatruynvimnovgiunch
bchhuyt)VitNam.
3.Cngimstthnhphn,mtccloi
rui, mui c vai tr dch t nhng ni mi
trngthunlichosphtsinh,phttrinca
chng v nhng ni c bnh truyn nhim.
Kp thi pht hin cc loi rui, mui l nhp
nismcbinphpphngnga.
TILIUTHAMKHO
1.
2.
3.
4.
BorelE.(1930).LesmoustiquesdelaCochinchineetduSud
Annam.MonographieIII:403pp(Pub.InsPasteurIndochine).
H c Ton (2010). Mui Culicidae: phn loi v vai tr
truynbnh.http://www.impeqn.org.vn/impe.
L Xun Hi, Nguyn nh Lc, Nguyn Vn Hng, L
Trung Kin v cng s (2004). Thng bo kt qu iu tra
thnhphn,phnbccloimuiAnophelestheosinhcnh
khuvcrngUMinh.TpchPCSR&KST,s6:5057.Vin
StrtKSTCTT.
NguynMnhHng,VKhc, V c Chnh, Nguyn
cMnh,HnhTrung,BiLDuy,LXunHi(2008).
Bng nh loi mui Anopheles Vit Nam. NXB Y hc: 68.
VinStrtKSTCTT.
ChuynYTCngCng
5.
6.
7.
Nguyn Th Vin, Nguyn Long Giang, L Vn Hnh,

Nguyn Khc Tn v CTV(1980). Mt s nhn xt v tnh
hnh st rt tnh ng Nai (min ng Nam B). K yu
CTNCKHVinStrt,KSTvCT:6570.NXBYhc,HNi.
Nguyn Vn Chu, Th Hin, Nguyn Th Kha, Phng
XunBch,NguynThBchLin,NguynThHngBnh,
LAnhTh,LTunKit(2008).Ktquiutrachnty
hc ti Khu bo tn Thin nhin rng ngp mn Cn Gi..
Tpchphngchngbnhstrtvccbnhksinhtrng
(PCSR&KST). S 3: 6168. Vin St rtK sinh trng Cn
trngTrungng(VinStrtKSTCTT).
NguynVnChu,HnhTrungvCTV(2012).iutra
thnhphnloichntyhcvxcnhnhycmca
mui Aedesaegypti v Aedesalbopictus vi ha cht dit cn
trngPhQuc,tnhKinGiangtrongnm20102011.Tp
chPCSR&KST,s2:7184.VinStrtKSTCTT.
8.
9.
10.
11.
NghincuYhc
NguynVnChu,HnhTrung(2005).Danhschccloi
chntyhcVnqucgiaCtTin.BocoKhoahc
ti Hi ngh ton quc 2005, nghin cu c bn trong khoa
hcssng,trang:8085.Nhxutbn(NXB)KH&KT,H
Ni,
PhuongBui&DarsieRF.,JR.(2008).Tentativecheclistofthe
mosquitoesofVietnamemployingnewclassficationfortribe
Aedini(Diptera,Culicidae).JournaloftheAmericanMosquito
ControlAssocation,24(2):187193.
THuyThnh(2007).RuicnghayhcquantrngVit
Nam (Muscidae, Calliphoridae, Sarcophagidae): 260 trang. NXB
KhoahcTnhinvCngngh,HNi.
VcChnh,HnhTrung,NguyncMnh,Nguyn
Vn Chu, Nguyn Th Bch Ngc, Nguyn Th Kha, Trn
NguynHng,NguynMnhHng,VVitDng,BoBn
(2006).Ktquiutraadngtittc y hc ti Cn o.
TpchPCSR&KST,s4:6674.VinStrtKSTCTT.
ChuynYTCngCng
367
NghincuYhc
KHOSTTHNHPHNHAHCVHOTTNHKHNGKHUN
CATINHDUNGR(CoriandrumsativumL.)
PhanBchH*,NguynPhc*,TnHong**,LNgcThch**
TMTT
tvn:Ngynay,dcphmcngungcthodcrtcquantmbiantoncaokhis
dng.Crtnhiunghincuchothykhnngkhngkhuncatinhdung,nhtltinhdulcacy
ng.CyngrctrngkhphbinVitNamnhngchyulyllmgiav.Nhmgpphnnngcao
skhaithcvngdngcacyngVitNam,chngtitinhnhkhostthnhphnhahcvhottnh
khngkhuncatinhdutlvthnngr.
Mctiunghincu:Khostthnhphnhahcvhottnhkhngkhuncatinhdungr.
Phngphpnghincu:Lytrchtinhdutl,thnngrbngphngphpchngcthincun
nngcin.Thnhphnhahcmutinhducphntchbngthitbsckkhudionhangnla
(GC/FID)vsckkhghpkhiph(GC/MS).Sdngphngphpkhuychtntrnthchkhosthot
tnhkhngkhuncacctinhdulytrchc.
Ktqunghincu:Tinhdutlvthnngcmuvngnht,mitnhin.Sau06gichngct,
hmlngtinhdult0,06%,hmlngtinhduthnl0,03%.Tinhdulngccuphnchnhgm
decanal,(E)2decenal,(E)2decen1ol,(E)2dodecenal,(E)2tetradecenal.Cuphnchnhtinhduthnng
gmdecanal,(E)2decenal,1decanol,(E)2dodecenal,(E)2tetradecenal.Khosttrn09chngvisinhvt
cho thy tinh du ng ly trch c khng xut hin vng khng khun trn Bacillus subtilis, Pseudomonas
aeruginosa,Escherichiacoli,Salmonellatyphi.
Ktlun:Thnhphntinhdutlvthnngchyulccaldehidchiphng.Tinhdungchot
tnhditkhuniviccvikhungytiuchy(Vibriocholerae),gyngcthcphm(Staphylococcus
aureus,Bacilluscereus)vnmngi(Candidaalbicans).
Tkha:Tinhdu,ngr,decanal,(E)2decenal,(E)2tetradecenal,(E)2dodecenal.
ABSTRACT
SURVEYCHEMICALCOMPOSITIONANDANTIMICROBIALACTIVITYOFESSENTIALOILSOF
CORIANDER(CoriandrumsativumL.)
PhanBichHa,NguyenDoPhuc,TanHoang,LeNgocThach
Background:Today,pharmaceuticalproductsfrommedicinalherbsaretakencareofbyhighlysafetouse.
Therearemanystudiessuggestingthepossibilityofantimicrobialactivityofcorianderoil,especiallyoilcoriander
leaves.CorianderplantgrownquitepopularinVietnambutmostlyleavesasaspice.Tocontributetoimproving
the exploitation and application of cilantro plants in Vietnam, we surveyed chemical composition and
antimicrobialactivityofessentialoilsofcorianderleavesandstems.
Objectives:Surveychemicalcompositionandantimicrobialactivityofessentialoilsofcoriander.
Method: Essential oil extracted from leaves, stems coriander by conventional heating hydrodistilation.
*
VinVsinhYtCngcngTPHChMinh
Tcgilinlc:ThS.PhanBchH T:0978883710
368
**
ihcKhoahcTnhinTP.HCM
Email:phbiha@yahoo.com
ChuynYTCngCng
NghincuYhc
The chemical composition of leaf and stem oil was identified by GC/MS and was quantified by GC/FID.
Usingtheagardiskdiffusiontesttoexaminetheantimicrobialactivityofessentialoilsareextracted.
Results:Essentialoilscilantroleavesandstemsarepaleyellow,likethenaturalsmell.After06hoursof
distillation, essential oil content of leaves reached 0,06%, body oil content is 0,03%. Decanal, (E)2decenal,
(E)2decen1ol, (E)2dodecenal, (E)2tetradecenal were the main constituents of leaf oil and the major
constituents of the stem oil were decanal, (E)2decenal, 1decanol, (E)2dodecenal, (E)2tetradecenal.
CorianderessentialoilextractedisnotappearingonsterileroundBacillussubtilis, Pseudomonas aeruginosa,
Escherichiacoli,Salmonellatyphi.Zonediametersissmalleratreducedoildilutions.
Conclusion:Corianderessentialoilhasantimicrobialactivityagainstbacteriathatcausediarrhea(Vibrio
cholerae), which causes food poisoning (Staphylococcus aureus, Bacillus cereus), and fungy in humans
(Candidaalbicans).
Keywords: Essential oil, Coriandrum sativum L., decanal, (E)2decenal, (E)2tetradecenal, (E)2
dodecenal.
TVN
NgrctnkhoahclCoriandrumsativum
L., thuc h Hoa tn (Umbellifrae hay
Apiaceae). Ng c cc tn thng gi khc l
mi,ngta,raumai,htuy,hngtuy,nguyn
tuy, ng r, ng,... l cy tho, sng hng nm.
Nglloiraugiav,raunphbin,lngun
thuc qu, tinh du ca chng c nhiu ng
dngquantrngtrongcngnghiphngliu,
thcphm,dcliu(3,11,17).
Ngy nay, dc phm c ngun gc tho
dcrtcquantmbiantoncaokhi
sdng.Crtnhiunghincuchothykh
nngkhngkhuncatinhdung,nhtltinh
dulcacyng(6).
Kt qu tra SciFinder v tinh du ng cho
thy nhiu ni trn th gii c nghin cu v
tinhdunynhCanada(9,10);n(7,14);M(15);
Kenya(6); Trung Quc(18). Vit Nam ch yu
cngbnghincuvtinhduhtng.(4,12,16)
Cy ng c trng kh ph bin Vit
Namnhngchyulyllmgiav.(3,17)
Nhm gp phn nng cao s khai thc v
ng dng ca cy ng Vit Nam, chng ti
tinhnhkhostthnhphnhahcvhot
tnhkhngkhuncatinhdutl,thnngr.
Mctiunghincu
Lytrchtinhdutlvthnngr
ChuynYTCngCng
Kho st thnh phn ha hc v hot tnh

khngkhuncatinhdutlvthnngr.
ITNGPHNGPHPNGHINCU
Vtliunghincu
Mungrdnglytrchlytinhdu
Cyng89tuntui(angrahoa)cly
tvnrauphngTnBin,thnhphBin
Ha,tnhngNai:br,tchringlvthn.
Vicxcnhtnkhoahcvgiiphuhc
tuyntinhducalvthncthchinti
BmnThcvt,KhoaSinhhc,ihcKhoa
hc T nhin TP. HCM. Kt qu cho thy b
phn cha tinh du l v thn ng l xoang
tittoratheocchlytiubo.
Ccchngvisinhvt
03vikhungram(+):Staphylococcusaureus,
Bacillussubtilis,Bacilluscereus
05 vi khun gram (): Pseudomonas
aeruginosa, Escherichia coli, Shigella flexneri, Vibrio
cholerae,Salmonellatyphi
01vinm:Candidaalbicans
Quitrnhkthut
Lytrchtinhdu
Tinhduclytrchbngphngphp
chngcthincunnngcin.Sdng
b ly trch Clevenger 2000 ml, ng gn tinh
dunh(5,8).
369
NghincuYhc
Rp h thng chng ct v tin hnh trong

06gi(tnhtgitngngtutin).
+L:Sdng300glctnhvthm900
mlncvonguynliu.
+Thn:Sdng400gthnctnhvthm
800mlncvonguynliu.
ngui, trch ly tinh du trong ng gn
bng dietil eter. Lm khan dung dch ly trch
bng Na2SO4 khan. Thu hi dung mi di p
sutkmthutinhdusnphm.
Khostthnhphnhahc
Mu tinh du c phn tch bng thit b
sckkhudionhangnla(GC/FID)v
sckkhghpkhiph(GC/MS).
Phn tch GC/FID c tin hnh trn my
Agilent GC 7890AFID. Ct HP5 (30 m, 0,32
mm, 0,25 m film). S dng nitrogen lm kh
mang p sut 8,7 psi. Nhit bung tim
250oC. Nhit u d 300oC. T l chia dng
1/20, th tch tim 1 l. Chng trnh nhit:
Nhitu60oC,tng3oC/phtn240oC.Sc
k thu c dng xc nh hm lng
(%)cccutctrongmutinhdu.
Phn tch GC/MS c tin hnh trn my
Agilent,GC7890AMS5975C.CtTR5MS(30
m,0,25mm,0,25mfilm).Sdngheliumlm
khmangpsut19,248psi. Nhit bung
tim250oC.Tlchiadng1/20,thtchtim1
l.Chngtrnhnhit:Nhitu60oC,tng
3oC/pht n 240oC. Ghi nhn khi ph m/z
trongkhong30500,nnglngionha70eV.
S dng sc k ca dy ng ng nalkan
tnhtonchsshc,AI(ArithmeticIndex)
theo Adams, kt hp vi th vin ph NIST
2008 ca my nhn danh cc cu t trong
tinhdu(13).
Khosthottnhkhngkhun(2)
Hot tnh khng khunc th nghim
theo phng php khuych tn trn thch: tri
u vi sinh vtvi mt s lng nht nh ln
trnmtthch.tagiy(d=6mm)tm
tinhdu,theoccnngtnguynchtn
pha long dn, ln b mt thch. Tinh du s
370
khuychtnvotrongthchvcchstng
trngcavisinhvttoravngkhngkhun
trnuchungquanhagiy.Kchthcca
ng knh vng trn ny cho bit kh nng
khngkhuncatinhdu.
Tinh du th nghim bao gm tinh du
nguynchtvtinhduphalongtheotht:
C0: Tinh du nguyn cht. C1: Tinh du pha
long10ln.C2:Tinhduphalong100ln.C3:
Tinhduphalong1000ln.C4:Tinhdupha
long10000ln.C5:Tinhduphalong100000
ln.
nhgiktqu:
ng knh vng khng khun < 10 mm:
xemlkhng.
ng knh vng khng khun 20 mm:
xemlnhycm.
KTQUNGHINCU
Ktqulytrchtinhdu
Tinhdulngcmuvng,migingt
nhin. Chng ct lu th mu vng cng sm
dn chuyn sang mu vng nu m. Hm
lngtinhduthuc0,06%sau6gichng
ct.
Tinhduthnnglytrchcmuvng,mi
ging t nhin. Hm lng tinh du thu c
0,03%sau6gichngct.
Hnh1.Hmlngtinhdulvthnngr
Nhnxt:Hmlngtinhdungrtrong
lnhiuhntrongthn.Tuykhngthitb
xcnhchnhxckchthcvmtm
cha tinh du nhng theo nh gi cm quan,
kchthcvmtmchatinhduquanst
ChuynYTCngCng
c t vic gii phu hc ph hp vi hm
lnglytrch.
Ktqukhostthnhphnhahc
Bng1.Thnhphnhahccatinhdulng
Stt AI(13)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
AI tnh da Hm lng
(13)
(%, GC/FID)
theo
Cu phn
(GC/MSD)
998
Octanal
1095
Linalol
1100
Nonanal
1165
1-Nonanol
1193
(Z)-4-Decenal
1196
(E)-4-Decenal
1201
Decanal
a
1250
(Z)-2-Decenal
1260
(E)-2-Decenal
1268b (E)-2-Decen-1-ol
1272b
1-Decanol
1305
Undecanal
1357
(E)-2-Undecenal
1365 trans-2-Undecen-1ol
1408
Dodecanal
1464
(E)-2-Dodecenal
1469 trans-2-Dodecen-1ol
1509
Tridecanal
1567
(E)-2-Tridecenal
1611
Tetradecanal
1620
Dill apiol
1674 (E)-2-Tetradecenal
1711
Pentadecanal
1820
Hexadecanal
Thamkhottiliu(1).
1009
1104
1110
1174
1194
1198
1206
1250
1266
1271
1274
1309
1368
1373
0,34
0,09
0,27
0,20
0,06
0,12
7,53
0,49
21,19
17,06
3,79
1,27
3,31
1,77
1411
1473
1475
4,58
9,85
4,32
1514
1573
1613
1624
1677
1718
1823
0,63
1,02
2,54
0,89
12,29
0,12
0,10
Thamkhottiliu(6).
Nhn xt: Tinh du l ng c 24 cu phn

chimkhong94%.Ngoiracncmtshp
chtkhckhngnhnbitcdohmlng
qu thp hoc ch dng vt. Cu phn chnh
catinhdulnggmdecanal,(E)2decenal,
(E)2decen1ol,
(E)2dodecenal,
(E)2
tetradecenal.Trong(E)2decenalchimhm
lngcaonht.
Bng2.Thnhphnhahccatinhduthnng
Stt AI(13)
Cu phn
(GC/MSD)
AI tnh da
(13)
theo
Hm lng
(%, GC/FID)
1 1100
2 1196
3 1201
4 1250a
Nonanal
(E)-4-Decenal
Decanal
(Z)-2-Decenal
1111
1197
1206
1250
0,27
0,09
24,06
0,17
ChuynYTCngCng
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
1260
(E)-2-Decenal
1268b (E)-2-Decen-1-ol
1272b
1-Decanol
1282
(E)-Anetol
1305
Undecanal
1357 (E)-2-Undecenal
1365 trans-2-Undecen1-ol
1367
1-Undecanol
1408
Dodecanal
1464 (E)-2-Dodecenal
1469 trans-2-Dodecen1-ol
1509
Tridecanal
1567 (E)-2-Tridecenal
1611
Tetradecanal
1620
Dill apiol
1674
(E)-2Tetradecenal
1711
Pentadecanal
NghincuYhc
1263
1269
1272
1291
1307
1366
1371
6,95
2,55
7,89
0,66
4,91
5,80
1,49
1374
1409
1470
1474
0,89
5,70
12,04
2,37
1512
1571
1611
1622
1675
0,80
1,04
2,15
0,66
13,37
1715
0,11
Thamkhottiliu(1).
tiliu(6).
a
Thamkhot
Nhnxt:Tinhduthnngc21cuphn
chimkhong94%.Ngoiracncmtshp
chtkhckhngnhnbitcdohmlng
qu thp hoc ch dng vt. Cu phn chnh
ca tinh du thn ng gm decanal, (E)2
decenal, 1decanol, (E)2dodecenal, (E)2
tetradecenal. Trong decanal chim hm
lngcaonht.
Cuphnchnhcatinhdukhostsovi
cc nghin cu trc tng i ging nhau.
Thnhphntinhdulvthnngchyul
cc aldehid chi phng. Chnh cc aldehid ny
quytnhmithmnngctrngcalv
thnng.
Ktqukhosthottnhkhngkhun
Bng3.Ktquhottnhkhngkhuncatinhdu
lng
Vi sinh vt
S. aureus
Bacillus subtilis
Bacillus cereus
P. aeruginosa
Escherichia coli
Shigella flexneri
Vibrio cholerae
ng knh vng khng khun (mm)

C0
C1
C2
C3
C4
C5
25
9
6
6
>30 >30
6
6
6
6
6
6
22
10
8
6
>30 >30
6
6
6
6
6
6
8
6
6
6
6
6
11
10
6
6
6
6
10
8
6
6
>30 >30
371
NghincuYhc
Salmonella
typhi
Candida
albicans
>30
>30
16
10
Nhn xt : Tinh du l ng ly trch c

khngxuthinvngkhngkhuntrnchng
Bacillus subtilis, Pseudomonas aeruginosa,
Escherichiacoli,Salmonellatyphi.
Sdngngunngrtrngccvngkhc
khosthottnhkhngkhuncatinhdu
lytrchc.
TILIUTHAMKHO
1.
2.
Bng4.Ktquhottnhkhngkhuncatinhdu
thnng
Vi sinh vt
ng knh vng khng khun (mm)

C0
>30
6
>30
6
6
10
>30
S. aureus
Bacillus subtilis
Bacillus cereus
P. aeruginosa
Escherichia coli
Shigella flexneri
Vibrio cholerae
Salmonella
6
typhi
Candida
>30
albicans
C1
>30
6
>30
6
6
6
>30
C2
26
6
29
6
6
6
8
C3
10
6
12
6
6
6
6
C4
8
6
8
6
6
6
6
C5
8
6
8
6
6
6
6
>30
18
10
10
Nhnxt:Tinhduthnnglytrchc
khngxuthinvngkhngkhuntrnchng
Bacillus subtilis, Pseudomonas aeruginosa,
Escherichiacoli,Salmonellatyphi.
3.
4.
5.
6.
7.
8.
9.
10.
KTLUNKINNGH
Ktlun
11.
Hmlngtinhdungrtrongl(0,06%)
nhiuhntrongthn(0,03%).
12.
Thnhphntinhdulvthnngchyu
l cc aldehid chi phng (decanal, (E)2
decenal, 1decanol, (E)2dodecenal, (E)2
tetradecenal).
13.
Tinhdunglytrchctphngphp
chng ct hi nc c in ch c hot tnh
khng khun: Vibrio cholerae nng pha
long10ln,Staphylococcusaureusnngpha
long 100 ln, Bacillus cereus nng pha
long100lnvCandidaalbicansnngpha
long10ln.
Kinngh
14.
15.
16.
17.
18.
Carunchia MEW, Croissant AE, Drake MA (2005).

Characterization of dried whey protein concentrate and
isolateflavor.J.DairySci.88:38263839.
Clinical and Laboratory Standards Institute (2011).
Performance Standards for Antimicrobial Susceptibility
Testing,TwentyFirstInformationalSupplement,Vol.31No.
1.CLSIdocumentM100S21(ISBN1562387421).
TtLi(2005).NhngCyThucvVThucVitNam,.
NhxutbnYhc,HNi.Tr.417418
Hong Vn Phit, Mai Nghi (1980). V thnh phn ha hc
catinhduhtMi(CoriandrumsativumLinn.).TpchHa
hc,18(1):3032.
LNgcThch(2003).Tinhdu,.NhxutbnihcQuc
GiaTpHCM,TpHCM.Tr.80103
Matasyoh JC, Maiyo ZC, Ngure RM., Chepkorir R (2009).
Chemical composition and antimicrobial activity of the
essentialoilofCoriandrumsativum.FoodChemistry113:526
529.
Minija J, Thoppil JE (2001), Volatile oil constitution and
microbicidal activities of essential oils of Coriandrumsativum
L.JournalofNaturalRemedies,1(2):147150.
NguynQunhTrang,LNgcThch(2008).Khosttinh
du sao nhi hng (Cosmos caudatus HBK.). Tp ch Pht
trinKhoahcvCngngh11(7):6772.
PascalJD,KareenS(2004).AntilisterialpropertiesofCilantro
essentialoilJournalofEssentialOilResearch,16(5):409411.
PascalJD,KareenS,BenoitG,MazzaG.(2002).Antimicrobial
activity of individual and mixed fractions of dill, cilantro,
corianderandeucalyptusessentialoils.InternationalJournal
ofFoodMicrobiology,74(12):101109.
PhmHongH(2000).CyCVitNamquyn2,pp481.
NhxutbnTr,TpHCM.
PhanBchH,LNgcThch(2010).Khosttinhduht
ng(CoriandrumsativumL.).TpchPhttrinKhoahcv
Cngngh13(3):2938.
RobertPA(2007).IdentificationofEssentialOilComponents
by Gas Chromatography/Mass Spectrometry, 4th Edition, pp
1029.AlluredPublishing,CarolStream,6.
ShrivashankaraKS,RoyTK.,VaralakshmiB,Venkateshwarlu
G, Selvaraj Y (2003). Leaf essential oils of coriander
(CoriandrumsativumL.)cultivars.IndianPerfumer,47(1):35
37.
Thomas LP (1996), Essential Oil Composition of Cilantro
(1996).J.Agric.FoodChem.44(7):18241826.
TrnThuHng,TrnThMinh(2005).Thnhphnhahc
tinhduhtMiVitNam.TpchHahcvngdng,
1:3538.
V Vn Chi (2005). 250 Cy Thuc Thng Dng, Nh xut
bnHiPhng,HiPhng,tr.282283
ZhanguoL,HongzhuanG,WeiL(2006).GC/MSanalysisof
chemical components of essential oil from coriander leaf.
ShipinYuFajiaoGongye,32(2):9698.
Kho st thm hot tnh khng khun trn

ccchngkhc.
372
ChuynYTCngCng
NghincuYhc
ChuynYTCngCng
373
NghincuYhc
KHOSTHMLNGNICOTINNIUCACNGNHNTRONG
NHMYTHUCLTITHNHPHHCHMINH
NguynThTrcLy*,PhanBchH*,TrnThKiuAnh**
TMTT
tvn:VitNam,nhimcNicotinlmttrongnhngbnhnghnghipcbohim(4).Theo
thngkcaccnhnghincu,cngnhntipxcnghnghipviNicotinctlungthphil4%,cao
hnrtnhiusovicngnhnlmvictrongmitrngkhngtipxcviNicotin(1).cnhbotrnhtrng
nhimcNicotincacngnhntipxcviNicotin,vicxtnghimhmlngNicotintrongnctiul
mtchnhxtnghimcnlmsngcnthitvmangtnhchtthngqui.
Mctiunghincu:KhosthmlngNicotintrongnctiucacngnhntrongnhmythucl
tiTP.HChMinhnm2011.
Phng php nghin cu:Nghincumtctngangtrn251cngnhn(cvkhngchtthuc)
lmvictrongnhmythuclbphntipxctrctipviNicotin.XtnghimNicotinniuvnhgi
mcnhimNicotinniutheothngquykthutcaVinYhclaongvVsinhmitrng(5,4).
Ktqunghincu:147/251trnghp(58,6%)chmlngNicotin0,3mg/L(dingngnng
chophp)v104/251trnghp(41,1%)chmlngNicotin>0,3mg/L.55/251trnghp(21,9%)phi
theodithmnhimNicotinivibnhnghnghip.Tuinghctngln1nmthnguycbtheodi
Nicotintngln1,04ln.ThigianhtthucctnglnmtnmthnguycbtheodithmnhimNicotin
tngln1,09ln.
Kt lun:KtqunghincuchothytltrnghpchmlngNicotinniuvttiuchuncho
phpkhcao.NhngtrnghpchmlngNicotincaophnlnlnhngmucacngnhnctins
htthucl.Doanhnghipcntngcngtrangbbohlaongchocngnhntrongqutrnhlmvic.
Tkha:Thucl,Nicotin,nhimcNicotin.
ABSTRACT
SURVEYNICOTINECONTENTINURINEOFWORKERSINTOBACCOFACTORYATHOCHI
MINHCITY
NguyenThiTrucLy,PhanBichHa,TranThiKieuAnh
Background:InVietnam,Nicotinepoisoningisoneoftheoccupationaldiseasesarecovered(4).According
to the researchers, workers with occupational exposure Nicotine lung cancer rate is 4%, much higher than
workers in noncontact with Nicotine(1). To warn the Nicotine poisoning of workers exposed to Nicotine,
Nicotinecontenttestinginurineisaspecifiedclinicaltestsnecessaryandroutine.
Objectives:SurveyNicotineconcentrationsinurineofworkersinthetobaccofactoryatHCMCin2011.
Method: Crosssectional descriptive study on 251 workers (with and without smoking) working in the
tobacco plant parts in direct contact with Nicotine. Nicotine urine testing and assess Nicotine exposed level
accordingtotechnicalregulationsofInstituteofLaborHealthandEnvironmentalHygiene.
*VinVsinhYtCngcngTPHChMinh
**ihcBchKhoaTP.HChMinh
Tcgilinlc:KTV.NguynThTrcLy
T:0975361276
Email:truclylab2000@yahoo.com
374
ChuynYTCngCng
NghincuYhc
Results: 147/251cases(58.6%)Nicotineconcentrations0.3mg/L(belowtheallowableconcentrations)
and104/251cases(41.1%)concentrationofNicotine>0.3mg/L.55/251cases(21.9%)mustmonitorNicotine
exposed for occupational diseases. For seniority continue ascend 1 year then the risk must monitor Nicotine
exposedincreased1.04times.Timesmokecontinueascend1yearthenriskmustmonitorNicotineexposed
increased1.09times.
Conclusion:ResearchresultsshowthattheratecaseNicotineurinaryconcentrationsexceededpermitted
standards high. These cases have much higher levels of Nicotine is the sample of workers with a history of
smoking.Enterprisesneedtostrengthenlaborprotectionequipmentforworkersintheworkprocess.
Keywords:Tobacco,Nicotine,Nicotinepoisoning
TVN
Mctiunghincu
Nicotin l mt ancaloit ch yu trong cy

thuc l c tn ha hc l 3(1methyl2
pyrrolidinyl)cccnhkhoahcngic
tm thy u tin vo nm 1828. Nicotin trong
thnhphncythuclvihmlngthayi
t0,05%n8%,thngthnghmlngny
l23%.(2,3,4)
XcnhhmlngNicotintrongnctiu
cacngnhn.
Cc nghin cu cho thy Nicotin tc ng

vonogyramtstcngnhtnh.Tnh
gynghinldokhiNicotinkchhotccnhn
xmvnotoracmgicthamnvhng
phn. Nicotin xm nhp vo c th qua da,
ngtiuhavnghhp.Thigianhp
thNicotintphinnochmttrungbnh7
giy. c tnh ca Nicotin rt cao nn d gy
nhimcnghimtrnghoctvong. Nicotin
chpthnhanhquanimmc,quahhp,
mt phn b ph hy gan. N c o thi
qua nc tiu, nc bt, phi, m hi nhng
khngquamt.(4,3)
Nhim c Nicotin ngh nghip l nhim
c mn tnh xy ra trong qu trnh thng
xuyn tip xc vi bi thuc l, hi Nicotin c
nngcaovttiuchunchophphocdo
htthuclchnghaythng.
Vin V sinh Y t Cng cng TP. H Ch
Minh thc hin xc nh hm lng Nicotin
niuchoccnhmysnxutthucltikhu
vc pha Nam. Vic tng kt, nh gi cc kt
qu xc nh ny l ht sc cn thit c
nhng kt lun, cnh bo kp thi cho doanh
nghip trong vic bo v sc khe ngi lao
ng.
ChuynYTCngCng
Xcnhtlcngnhnphitheodithm
nhimNicotinivibnhnghnghip.
Phn tch mi lin quan gia kt qu phn
tch Nicotin vi i tng cng nhn nghin
cu.
ITNGPHNGPHPNGHINCU
itngnghincu
Ngi lao ng tip xc trc tip vi
Nicotin ti nh my sn xut thuc l TP.
HCM.
Thitknghincu
Mtctngang
Kthutlymu
Cngnhnnhmythuclctipxctrc
tipvinicotin.Scngnhnnycthuthp
thng tin lin quan n ngh nghip trc khi
clymunctiu.
Kthutpdng
XtnghimNicotinniutheothngquyk
thut ca Vin Y hc lao ng v V sinh mi
trng(5).
Phntchsliu
D liu thng tin c nhp bng chng
trnhEpiDatavsauktqucphntch
bngphnmmStata10.0.
nh gi mc nhim Nicotin niu theo
thngquykthutcaVinYhclaongv
Vsinhmitrng(4).
375
NghincuYhc
0,3mg/L:Giihnbnhthng.
>0,3mg/L:TheodinhimcNicotini
vingikhnghtthucl.
>1,2mg/L:TheodinhimcNicotini
vingihtthucl.
KTQUNGHINCU
ctnhcaitngnghincu
Bng1:Tuicacngnhn
n
Trung
bnh
37,1
9,6
Tui
251
Tui ngh 251
lch
chun
8,8
7,3
Min
Max
21
1
56
36
tuitrungbnhcngnhnl37,1.Ngi
c tui thp nht l 21 v ngi c tui
caonhtl56.Tuinghtrungbnhl9,6nm,
trong,ngilmthpnhtl1 nm v cao
nhtl36nm.
Bng2:Giitnh,tnhtrnghtthuccacng
nhn
Bin s
Gii tnh
Tnh trng ht
thuc
Nam
N
C
Khng
n = 251
198
53
91
160
T l (%)
78,9
21,1
36,3
63,7
Vgiitnhcacngnhnthcti78,9%l
namgii,cnngiichchim21,1%.Sngi
c ht thuc tham gia vo nghin cu l 91
ngi chim 36,3%, trong khng c n gii
nohtthuc.
Bng3:Thigianhtthucvslngiuthuc
httrongngycanhngngihtthucl
n
S iu/ngy
Thi gian ht
(nm)
91
91
Trung
bnh
13,1
13,3
lch
chun
6,8
7,4
Min
Max
3
2
40
37
S iu thuc ht trung bnh ca nhng

ngihtthucl13,1iu,trongcngi
ht t nht l 3 iu/ngy, ngi ht nhiu
nht l 40 iu/ngy. Thi gian ht thuc
trungbnhl13,3nm,thigianhttnhtl
2nmvnhiunhtl37nm.
KtquphntchhmlngNicotintrong
nctiucacngnhn
Bng4:KtquphntchNicotinniu
n
Nng trung lch

bnh, mg/L
chun
Nicotin
251
0,40
0,48
C ht thuc l 91
0,65
1,65
Khng ht
160
0,25
0,25
thuc l
Min Max
0,07 3,39
0,08 3,39
0,07 1,72
Ktquphntchchothynhngtrng
hpchtthucthtrungbnhmcnhim
Nicotin l 0,65 mg/L, cao hn so vi nhng
ngikhnghtthuc(0,25mg/L).Ktqutrn
chothyngibnhimthpnhtl0,07mg/L
vcaonhtl3,39mg/L.
Bng5:Phnnhmktquphntchnicotin
Bin s
0,3 mg/L
> 0,3 mg/L
Kt qu Nicotin
n = 251
147
104
T l (%)
58,6
41,4
Theobng5,tathytlnhngngiphi
theodithmnhimNicotinl41,4%.
Bng6:Phnnhmktqunicotintrongtheodi
bnhnghnghip
Bin s
n = 251 T l (%)
78,1
Kt qu Khng theo di thm nhim* 196
Nicotin
Theo di thm nhim
55
21,9
*KhngtheodithmnhimNicotin:nngNicotin
0,3mg/Livinhngngikhnghtthucv1,2
mg/Livinhngngichtthuc.
Ktquphntchchothyc56trongtng
s 251 bnh nhn phi theo di thm nhim
Nicotinivibnhnghnghip(chim21,9%).
Mi lin quan gia kt qu phn tch

Nicotinviitngcngnhnnghincu
Bng7:MilinquangiaktquNicotinvgii
tnh
Gii tnh
Nam
N
n (%)*
n (%)*
Bnh thng
104 (52,5)
43 (81,1)
Theo di thm nhim
94 (47,5)
10 (18,9)
Tng cng
198
53
P = 0,0002; T s chnh: 2,52
Khong tin cy 95%: 1,41 - 4,48
Kt qu Nicotin
*n(%):nlslngcngnhn(chimtl%)
376
ChuynYTCngCng
Kt qu phn tch cho thy t l theo di
thmnhimnamgiil47,5%,caohnsovi
ngii(18,9%).Namgiicnguycb nhim
Nicotin cao gp 2,52 ln so vi n gii (C
nghathngkvip=0,0002,vikhongtincy
95%l1,414,48).
Bng8:Milinquangiaktquphntch
Nicotinnhmcngnhnkhnghtthucvgii
tnh
Gii tnh
Nam
N
n (%)
n (%)
Bnh thng
73 (68,2)
43 (81,1)
Theo di thm nhim
34 (31,8)
10 (18,9)
Tng cng
107
53
p= 0,085
Kt qu Nicotin
Xt ring i vi nhng trng hp khng

ht thuc, mc d nam gii c t l theo di
thmnhimcaohnsovingii(31,8%sovi
18,9%).Tuynhinktqunykhngcngha
thng k (p = 0,085 > 0,05) hay ni khc hn
khngcskhcbitgiahaigiitnh.
Bng9:Milinquangiatuinghvktqu
phntchNicotin
Kt qu Nicotin
Bnh thng
Theo di thm
nhim
Tng cng
Tui ngh
T 1-10 nm 11-20 nm Trn 20 nm
n (%)
n (%)
n (%)
96 (67,1)
41 (48,2)
10 (43,5)
47 (32,9)
44 (51,8)
13 (56,5)
143
85
p = 0,006 < 0,05
23
Tuinghcngcaothtltheodithm
nhim Nicotin cng cao t 110 nm (32,9%);
t1120nm(51,8%);trn20nm(56,5%).Kt
qukhcbittrncnghathngkvip=
0,006<0,05.
Bng10:Milinquangiatuinghvktqu
Nicotintrongtheodibnhnghnghip
Tui ngh
Kt qu Nicotin T 1-10 nm 11-20 nm
Bnh thng
Theo di thm
nhim
Tng cng
n (%)
117 (81,8)
26 (18,2)
n (%)
63 (74,1)
22 (25,9)
Trn 20
nm
n (%)
16 (69,6)
7 (30,4)
143
85
23
ChuynYTCngCng
NghincuYhc
p = 0,23 > 0,05
Kt qu phn tch cha tm thy mi lin

quan gia tui ngh v kt qu Nicotin trong
theodibnhnghnghipviP=0,23>0,05.
Bng11:MitngquangiaktquNicotinvi
tuingh,siuthuchtvthigianhtthucl
Tn
bin
Tui ngh
S iu ht
Thi gian ht
thuc
T s
chnh
1,04
1,02
1,09
lch
P
chun
0,018
0,03
0,034
0,56
0,040 0,017
Khong tin
cy 95%
1,003-1,073
0,950-1,090
1,016-1,174
Kt qu phn tch cho thy tui ngh cng

cao th nguy c b theo di Nicotin cng cao.
Tuinghctngln1nmthnguycbtheo
diNicotintngln1,04ln(P=0,03<0,05).Ta
cngtmthymilinquangiathigianht
thucvtheodithmnhimNicotin.Thigian
htctnglnmtnmthnguycbtheodi
thmnhimNicotintngln1,09ln(p=0,017<
0,05). Kt qu phn tch cha tm ra c mi
linquangiasiuhtthuctrongngyvi
mctheodithmnhimNicotin.
KTLUNKINNGH
Ktlun
Ktqunghincuchothy251munc
tiucphntchchmlngphthint
0,07mg/Ln3,39mg/L.Tlmunctiuc
hm lng Nicotin vt tiu chun cho php
kh cao. Nhng trng hp c hm lng
Nicotin cao phn ln l nhng mu ca cng
nhnctinshtthucl.
Kinngh
ohmlngNicotintrongmitrnglao
ngngnhkkimsotmitrngt
pdngccbinphpgimtithiustip
xcbovsckhengilaong.
Doanh nghip cn lp danh sch ngi lao
ngchtthuclhockhnghtthucl
chn ra nhng ngi cn theo di nhim c
Nicotincnckhmbnhnghnghip.
377
NghincuYhc
TILIUTHAMKHO
3.
1.
4.
2.
378
ChiaKSandLeeHP(1996).Occupationalcancers.Textbook
of Occupational Medicine Practice, 2nd edition, World
ScientificPublishingCo.Pte.Ldt,pp.319337.
ngNgcTrc,PhmcThy,PhmMinhKhi(1997).
Hngdngimnh21bnhnghnghipcbohim.
Vingimnhykhoa,BYT,tr.128134,320326.
5.
LTrung(1987).NhimcNicotinnghnghip.Bnhngh
nghip,tpI,NhxutbnYhc,tr.241250.
VinYhclaongvVsinhmitrngBYT(1997).
21bnhnghnghipcbohim,tr.399416.
VinYhclaongvVsinhmitrngBYT(1996).
Thngquikthut.
ChuynYTCngCng
NghincuYhc
KTQUCAMHNHTRUYNTHNGGIODCSCKHO
THNGQUACNGTCVINAPHNGVNCSCH
VVSINHMITRNGNGPHVIBINIKHHU
TIHUYNCAOLNH,TNHNGTHP
ngNgcChnh*,LNgcDip*,NguynQucThng*,NguynTrnBoThanh*
TMTT
tvn:VitNamlnccdnsangsinhsngtrongnhngvngdbnhhngdobinikh
hunghngthttrnthgii,vbnhhnglnnhtlkhuvcngbngsngCuLong.CaoLnh
thuctnhngThplmthuynhngnmchunhhngcalMKng.Cngtctruynthngvnc
schvvsinhmitrnglchatt,vccnidungvtcngcabinikhhucnggiiphpngph
chacphbinnngidn.
Mctiu:Thmdhiuqucamtmhnhimvtruynthngnhmnngcaonhnthccangi
dnvchnhquynaphngvcngtcxydng,sdngnhtiuhpvsinh,xlnc,sdngnc
antontrc,trong,vsaulngphvibinikhhu.
Phngphp:ylmtnghincumtdc,vidnsmctiulngidn,ingcngtcvin
truynthng,cnbytvchnhquynaphngti10ximthuchuynCaoLnh,tnhngThp
trongnm2011.Cchotngcanthipbaogm3nidungchnhltphunnngcaonhnthccacnb
ytdphngtnh,tchchinghtrinkhaimhnhtruynthngim,vxydngmhnhtruynthng
ti10ximvtinhnhtruynthng3thiimtrc,trong,vsaul.Nidungtruynthngbaogm
ccvnvncsch,vsinhmitrng;xlchtthinngthn,sdngnhtiuhpvsinhtngng
viccgiaiontrc,trongvsaul,cctcngcabinikhhuvgiiphpngph.Phngphp
truynthnglsdngtiliutruynthng,phtthanh,vtuyntruyntrctiptihgianh.Dkin
cthuthp2thiimtrongvsaul;thngquabcuhitinnhgivkinthcvthchnh
truynthngcacngtcvin.Kinthcvthchnhcangidncthuthpquaphngvntihgia
nh,viitngphngvnlchhhocidinchh.
Ktqu:nhngitnglcngtcvin,tltnhgikinthcphcvchovictruynthng
thiimsaullcaohnsovitrongl.Nhngktqutngtcngcghinhnngidn,vis
giatngkinthcngvbinikhhu,kcngtngica2/4loimhnhnhtiuhpvsinh,nu
cccbinphpbovngunnc.Tlthchnhngcangidncngtnggiaionsaul,bao
gmgilitrinhntcngtcvin,cnhtiuhpvsinhvcsdng,boqunngcch,s
dngnpyccvtdngchancsinhhot,cgingrc,brcvoxethugom.
Ktlun:Mhnhtruynthngthngquacngtcvinlkhthivchiuqu,tuynhincncmt
nghincucanthipcnhmchngxcnhhiulccamhnh.
T kho: Gio dc sc kho, m hnh truyn thng, cng tc vin a phng, nc sch, v sinh mi
trng,binikhhu.
KhoaSckheMitrng,VinVsinhYtCngcngThnhphHChMinh
Tcgilinlc:Ths.ngNgcChnhT:0903704532 Email:dangngocchanh@ihph.org.vn
ChuynYTCngCng
379
NghincuYhc
ABSTRACT
RESULTSOFACOMMUNCATIONMODELUSINGLOCALCOLLABORATORSINHEALTH
EDUCATIONINSAFEWATERANDENVIRONMENTALSANITATIONCOPINGWITHCLIMATE
CHANGEATCAOLANHDISTRICT,DONGTHAPPROVINCE
DangNgocChanh,LeNgocDiep,NguyenDoQuocThong,NguyenTranBaoThanh
Background: VietNamhasbeenrankedfourthintheworldintermsoftheproportionofpeoplelivingin
affectedareasbytheconsequencesofclimatechange,withthemostaffectedareaistheMekongdelta.CaoLanhat
DongThapprovinceisadistrictannuallyaffectedbyMekongflood,buthealtheducationactivitiesinsafewater
andenvironmentalsanitationarenotyetproperlydone,andinformationofclimatechangeandcopingmeasures
hasneverbeendeliveredtothepeople.
Objective:Toexploretheeffectivenessofastandardcommunicationmodelinhealtheducationtoimprove
theawarenessofinhabitantsandlocalauthoritiesaboutusingsafewater,sanitarylatrinesattheperiodsbefore,
duringandafterfloodinordertocopewiththeeffectsofclimatechange.
Methods: This is a longitudinal descriptive study with the target population of inhabitants, health
education collaborators, health personals, and local authorities at 10 standard villages of Cao Lanh district of
DongThapprovincein2011.Interventionmeasuresincludetrainingoftrainersandhealtheducationforpeople
usingastandardcommunicationmodelsetupateachvillage.Throughleaflets,radiobroadcasting,anddirect
counseling at household, people were delivered information in safe water, environmental sanitation, waste
disposal, sanitary latrine in the periods before, during, and after flood; and climate change effects and coping
measures. Data regarding knowledge and practices were collected during and after flooding time via a self
administeredquestionnaireforcollaborators,anddirectinterviewathouseholdforvillagers.
Results: Theproportionofcollaboratorsselfratedashavingadequateknowledgeforhealtheducationwas
increasedattheafterfloodperiodcomparedtotheduringone.Similarfigureswerefoundamongvillagerswith
theincreasingofcorrectknowledgeregardingclimatechange,correctlyciting2/4typesofsanitarylatrinesand
propermeasurestoprotectwatersources.Alsoincreasingwastheproportionofcorrectpracticesofkeepingthe
leafletsfromcollaborators,havingasanitarylatrine,coveringwatercontainers,andproperwastedisposal.
Conclusions: Health education by collaborators was found a feasible and effective model; however its
efficacyhastobeidentifiedinaninterventionstudywithacontrolgroup.
Keywords: Health education, communication model, collaborator, safe water, environmental sanitation,
climatechange.
vng duyn hi c cao trnh thp, c nh
TVN
nghalkhuvclinkdctheobbinc
Binikhhuvnhngtcngdobin
cao so vi mc nc bin t hn 10m ng
ikhhugyraedassngcattc
hng th t sau Trung Quc, n , v
ccloi,cchsinhthi;vconngiphii
Bangladesh,vihn43triungi,chim55%
mt vi nhiu vn nghim trng lin quan
dns(38%trongsnyldnsthnhth)(5);
n cc yu t c bn ca i sng nhn loi
v ng bng sng Cu Long l mt trong ba
nhnc,lngthc,sckhe,vmitrng.
ng bng trn th gii d b tn thng nht
Vit Nam l mt trong s nhng nc b tc
doncbindng(3,6).
ngnngnnhtdobinikhhu,cbit
Nhnghuqucancbindngckh
l do nc bin dng. T l dn s ang sinh
nng rt thm khc v cn c k hoch thch
sngtrongnhngkhuvcdtnthngcc
380
ChuynYTCngCng
ng ngay lp tc(5). C th khi nc bin dng
1mctnhsc10,8%dns,10%GDPbnh
hng; v khi nc bin dng 5m, c n 16%
lnhth,32%38%dns,v30%36%GDPs
bnhhng(4).Ringkhuvcngbngsng
Cu Long, khi nc bin dng 1m c tnh c
n37,8%dintch(15.000km2n20.000km2)
b ngp(1); ngoi ra, khong 1.000 km2 din tch
nui trng thy sn s tr thnh cc m ly
nc mn(4); v trong nhng nm gn y, cc
cnboccngmnhxuthinnhiuhn
vcduhiudchchuyndnvphaNam(2).
Cnhiugiiphpngphvibinikhhu
ang c thc hin trn phm vi ton cu,
songthchngvibinikhhulmtgii
php v cng quan trng. Ti Vit Nam, trong
bicnhtrnhdntrcnthp,truynthng
lmttrongnhnggiiphpngphcnc
utin.
Huyn Cao Lnh, tnh ng Thp l mt
huynhngnmchunhhngdoltsng
M Kng v. D khng c s liu thng k
song trong qu trnh trin khai chng trnh
mc tiu quc gia nc sch v v sinh mi
trngnngthntiaphngchothycng
tc truyn thng v nc sch v v sinh mi
trngchatt,vccnidungvtcngca
bin i kh hu cng gii php ng ph cha
cphbinnngidn.Tthctrng,
nghincunycthchinnhmmcch
thm d hiu qu ca mt m hnh im v
truyn thng nhm nng cao nhn thc ca
ngidnvchnhquynaphngvcng
tcxydng,sdngnhtiuhpvsinh,x
lnc,sdngncantontrc,trong,v
saulngphvibinikhhu.Binphp
canthiplmtmhnhimvtruynthng
s dng nh tiu hp v sinh, s dng nc
schtrongiukinngplt.
ITNGPHNGPHP
ylmtnghincumtdc,vidns
mc tiu l ngi dn, i ng cng tc vin
truyn thng, cn b y t v chnh quyn a
phng ti 10 x im thuc huyn Cao Lnh,
ChuynYTCngCng
NghincuYhc
tnh ng Thp trong nm 2011. Tiu ch la

chn cc x im l c mng li giao thng
thuntin;ctrmphtthanh,mnglicng
tcvintruynthngyt;vsthamgianhit
tnh ca chnh quyn a phng. Cc hot
ngcanthipbaogm3nidungchnhl:1)
Tphunnngcaonhnthccacnbytd
phng tnh ng Thp (tnh, huyn, th x,
thnh ph), 2) T chc hi ngh trin khai m
hnhtruynthngim(cnbytdphng,
cngtcvin,onthanhnin,hiphnca
19x/thtrnthuchuynCaoLnh);v3)Xy
dng m hnh truyn thng ti 10 x im v
tinhnhtruynthng,canthip3thiim
trcmal(thng6v7/2011),trongmal
(thng8v9/2011),vsau khi l rt (thng 10
v11/2011).Tchcmhnhtruynthngc
thng nht cho 10 x im theo trc dc, Vin
VsinhYtcngcngthnhphHChMinh
chutrchnhimchungvtchckhoch,ni
dung truyn thng, gim st; sau phi hp
cngccnvtuynditrinkhaithchin.
Trung tm Y t d phng tnh ng Thp (2
ngi), trung tm Y t huyn Cao Lnh (4
ngi)cngctrchnhimgimsthotng
caccthnhvinthamgiacpx;cpxlcc
thnh phn trc tip trin khai ti a phng
gmcUbanNhndnx(1ngiidinl
ph ch tch x/chnh vn phng y ban x),
trm y t (trng trm/ph trm), i pht
thanh,vcccngtcvin(4ngi/x).
Nidungtruynthngbaogmccvn
vncsch,vsinhmitrng;xlchtthi
nngthn,sdngnhtiuhpvsinhtng
ng vi cc giai on (trc, trong v sau l);
cctcngcabin i kh hu v gii php
ngph.Phngphptruynthnglsdng
ti liu truyn thng, pht thanh v tuyn
truyntrctiptihgianh.VinVsinhY
tcngcngthnhphHChMinhcungcp
tiliutruynthng,tri,pphch;Trungtm
Y t d phng tnh v Trung tm Y t huyn
CaoLnhvitbiphtthanh,cungcpchoi
phtthanhccxphttheolchtrnhquynh
(3 ln/ngy); cng tc vin thc hin truyn
381
NghincuYhc
thngcngngthngquaccbuihp t/p
v ti h gia nh; trm y t v U ban Nhn
dnxgimsthotngcacngtcvinv
iphtthanh,hpnhkhngthngnh
gi hot ng trong thng v trin khai cho
thng k tip; vic gim st tng th cc hot
ngdoVinVsinhYtcngcngthnhph
H Ch Minh, Trung tm Y t d phng tnh,
TrungtmYthuynCaoLnhphihpthc
hin2thng/ln.
Dkincthuthp2thi im trong
vsaul,thngquabcuhinhgiv
kin thc v thc hnh truyn thng ca cng
tcvin,docngtcvintin,vitngcng
40 cng tc vin. Kin thc v thc hnh ca
ngidncphngvntihgianh,vi
i tng phng vn l ch h hoc i din
chh(>18tui).Shgianhphngvnl87
h. D kin c phn tch bng phn mm
Stata10.Sthngkmtgmtnsvphn
trm.
KTQU
Bng1:Nhngctnhcacngtcvin,tnsv
(%),(n=40)
c tnh
Gii
Tui
Trnh hc vn
Nam
N
18-29
30-39
40-49
50-59
60
Trung hc c s
Trung hc ph thng
Tn s (%)
8 (20)
32 (80)
0 (0)
9 (22)
21 (53)
10 (25)
0 (0)
9 (22)
31 (78)
Bng2:Kinthcvthchnhtruynthngca
cngtcvin,tnsv(%),(n=40)
Ni dung
T nh gi c tp hun
kin thc cho cng tc
truyn thng
Hiu cc ni dung trong t ri
C s ghi chp, nht k truyn
thng
C lp k hoch ving thm h
gia nh
C hng dn cch s dng
382
Giai on
trong l
21 (53)
Giai on
sau l
38 (95)
38 (95)
40 (100)
38 (95)
40 (100)
40 (100)
40 (100)
40 (100)
40 (100)
Ni dung
Giai on
trong l
Giai on
sau l
ti liu truyn thng cho ngi

dn
Bng3:Kinthcvthchnhcangidn,tn
sv(%)
Ni dung
Giai on trong Giai on sau

l
l
(n=87)
(n=87)
50 (57)
63 (72)
Tr li ng v bin i kh
hu v cc nh hng ca
bin i kh hu
69 (79)
75 (86)
K c tn 2/4 m hnh
nh tiu hp v sinh trong
t ri
Nu c cch bo v
66 (76)
77 (89)
ngun nc
C gi li t ri sau khi
62 (71)
73 (84)
nhn t cng tc vin
C nh tiu hp v sinh
51 (59)
62 (71)
Nh tiu sch s, khng c
25 (29)
39 (45)
mi hi, thi
Vt dng cha nc c
81 (93)
86 (99)
np y
87 (100)
87 (100)
Vt dng cha nc
khng c rong ru, cn
bn
C gi ng rc
87 (100)
87 (100)
B rc vo xe thu gom
13 (15)
33 (38)
T thu gom v t pha
37 (43)
35 (40)
sau nh
T thu gom v chn pha
37 (43)
19 (22)
sau nh
Bng4:Shgianhsdngnhtiuhpvsinh
ti10ximvtonhuynCaoLnh,dkinth
cp
Ni dung
a im
Trc can
thip
16.511
S h gia nh c 10 x im
nh tiu hp v
sinh *
69
T l h gia nh Huyn Cao
Lnh
c nh tiu hp v
sinh **
Sau can
thip
17.669
70
*Bococacctrmytx
**BococaTrungtmYthuyn
a s cng tc vin l n, tui trong nhm

4049,hcvntrunghcphthng(bng1).So
snhgia2giaion(trongmalvsauma
l), tt c cng tc vin u c lp k hoch
vingthmhgianh;csghichp,nhtk
truyn thng; v khi truyn thng (hp t/p,
ChuynYTCngCng
NghincuYhc
trctiptihgianh)chngdncchs
dngtiliutruynthngchongidn.Tl
t nh gi kin thc phc v cho vic
truyn thng chuyn bin tt. Giai on sau l
ch cn 5% cho rng cn c tp hun, cung
cptiliunhiuhn.Khinhgimchiu
cc ni dung trong ti liu truyn thng cung
cp cho cng tc vin bng b cu hi t in,
giai on sau ma l c tng, d t l tng l
khngnhiu(bng2).
victruynthng,cbitthiimsaulch
cn5%chorngcnctphun,cungcpti
liu nhiu hn. Hiu qu truyn thng cng
c ghi nhn ngi dn, th hin qua t l
cckinthcvthchnhngutnggiai
onsaumal.Tlnhtiuhpvsinhc
tng sau can thip, tuy nhin, tnh gi tr ca
nhng d kin ny l hn ch v l nhng d
kinthcp,vcchtnhtoncngchachnh
xc.
ivingidn(bng3),xtvkinthc
ngvbinikhhuvccnhhngca
binikhhu,kcngtngica2/4
loimhnh nh tiu hp v sinh trong t ri,
nucccbinphpbovngunnc,kt
qu cho thy t l tr li ng u tng giai
onsaumal.Vthchnh,tlhgianh
cn gi li t ri nhn t cng tc vin khi
cphngvngiaionsaumalltngso
vigiaiontrongmal.aphnngidn
c chuyn bin tt. T l h gia nh c
phngvncnhtiuhpvsinhvc s
dng, bo qun ng cch, sch s, khng c
mi hi thi l tng so vi trc. V vt dng
chanctihgianh,tlsdngnpy
tng ln. i vi cch thc x l rc sinh
hot,100%cchgianhucgingrc
chaithiim;vcschuynbintttrong
ccbinphpxlrccangidn,tlb
rcvoxethugomtngln,trongkhitlt
thugomvthocchngim(bng3).Ngoi
ra,sliuthngkchothytlhgianhc
nhtiuhpvsinhti10ximsaucanthip
tng 5% so vi trc; t l tng tng ng
chotonhuynCaoLnhl1%(bng4).
Kt qu thc hin m hnh truyn thng

im cho thy vn cn mt s im cn lu .
Binikhhulkhinimmiivicng
tcvinvngidn,nnkhiktniccvn
vncschvvsinhmitrngvibini
kh hu, th phn ln ngi dn khng nm
c.ingcngtcvincskhcbitv
trnh,knngtruynthng,dovyvictp
hun nng cao kin thc v k nng cho cng
tc vin l cn thit. Tt c cng tc vin tham
giahotngtruynthngcnmnhncng
lcnhiuchngtrnhkhcnhaucangnhy
t,do,cncbocogimstringnh
gi.Sthayicangidnvkinthcv
thc hnh l tt, tuy nhin, i vi thc hnh,
donhngkhkhnvkinht,ngidncnc
nhng s h tr v kinh ph xy dng nh
tiuhpvsinh.
BNLUN
a s cng tc vin l n, trong tui lao
ng,vtrnhhcvntrunghcphthng
l nhng im thun li cho hot ng. iu
nycthhinquanhnghotngrttch
cccahtrongcngtctruynthngchai
thi im trong ma l v sau ma l. Chnh
bnthncahcngcnhngchuynbinrt
tt khi t nh gi kin thc phc v cho
ChuynYTCngCng
Nghincunycmtshnch.nh
gihiuqucabinphpcanthip,cnnh
gitrcvsaucanthip,trongkhinghincu
ny khng nh gi c giai on trc can
thipmchnhgigiaioncanthipth
haivthba.Ngoira,cmucclng
chachnhxc,vitng phng vn ti h
gianhlkhngcnhgia2lnphngvn,
dnnnhiusailchkhinhgihiuquca
s can thip truyn thng. D c mt s hn
ch, nhng nhng kt qu bc u cho thy
mhnhtruynthngthngquacngtcvinl
kh thi v c hiu qu, tuy nhin cn c mt
nghin cu can thip c nhm chng xc
nhhiulccamhnh.
383
NghincuYhc
TILIUTHAMKHO
1.
2.
3.
4.
BTinguynvMitrng(2008).Chngtrnhmctiu
qucgiangphvibinikhhu.
B Ti nguyn v Mi trng (2009). Kch bn bin i kh
hu,ncbindngchoVitNam.
BTinguynvMitrng(2011).Chinlcqucgiav
binikhhu.
Dasgupta S, Laplante B, Meisner C, Wheeler D and Yan J
(2007).Theimpactofsealevelriseondevelopingcountries:A
5.
6.
comparative analysis, In World Bank Policy Research

WorkingPaper4136,February2007.
International Institute for Environment and Development
(2007). The rising tide: assessing the risks of climate change
and human settlements in low elevation coastal zones.
EnvironmentandUrbanization,Vol19No1April2007.
ParryML,CanzianiOF,PalutikofPJ,.LindenvanderJPand
HansonCE(2007).ContributionofWorkingGroupIItothe
FourthAssessmentReportoftheIntergovernmentalPanelon
ClimateChange,Chap10,p.485,2007.
384
ChuynYTCngCng
NghincuYhc
CHTLNGNCUNGVTHCTRNGVSINHSDNG
NGUNNCTIMTSTRNGMMNONVTIUHC
TRNABNQUN8THNHPHHCHMINH
NguynXunThy*
TMTT
tvn:tiChtlngncungvthctrngvsinhsdngngunnctimtstrng
mmnonvtiuhcbntrtrnabnqun8,TP.HChMinhctinhnhtmhiuhintrngv
chtlngncungsdngticctrnghctrnabnqun8.
Mc tiu: Khostchtlngncungvthctrngvsinhsdngngunnctimtstrng
mmnonvtiuhcbntrtrnabnqun8thnhphHChMinh.
Phngphp:Khostvlymuthnghim.
Ktqu:Tlmuncungcccchtiuvisinhkhngtlyt30trngmmnonvtiuhctrn
abnqun8thnhphHChMinhl56,67%theoQCVN01:2010/BTNMT.
Ktlun:Ktqunghincuttichothythctrngnhimvisinhvttrongncungdnhcho
tremticc trng mm non v tiu hc trn a bn qun 8. Cc c quan chc nng cn c s kim tra
nghimngtvthngxuynvvnvsinhngunncgimthiutiatnhtrngncungkhng
tchunticctrngmmnonvtiuhc.
Tkha:Ncung,trem
ABSTRACT
DRINKINGWATERQUALITYANDTHECURRENTFINDINGSONHYGENEINWATERUSAGEAT
ANUMBEROFDAYCARECENTERSANDDAYBOARDINGELEMENTARYSCHOOLSIN
DISTRICT08OFHOCHIMINH
NguyenXuanThuy
Backgound: ThisresearchtopicofDrinkingwaterqualityandthecurrentfindingsonhygieneinwater
usageatanumberofdaycarecentersanddayboardingelementaryschoolsinDistrict08HoChiMinhcity
wasconductedtohelpsendwarningsignalsaboutpotentialrisksofdrinkingwaterconsumedatvariousschools
intheareaofDistrict08.
Objective: Toconductasurveyondrinkingwaterqualityandthecurrentsituationsofhygieneinwater
usageatanumberofdaycarecentersanddayboardingelementaryschoolsindistrict8,HoChiMinhCity.
Methodology:Surveyingandcollectingsamplesforanalysis.
Results: The percentage of samples whose microbiological readings failed to meet standards among the
samplescollectedfrom30daycarecentersandelementaryschoolsinDistrict08ofHChMinhcitywas56.67%
accordingtothestandardssetbyQCVN01:2010/BTNMT.
Conclusion:Theresultsfromthisresearchindicatethatthereiscurrentlymicroorganismcontaminationin
drinkingwaterforyoungchildrenatvariousdaycarecentersandelementaryschoolsindistrict08.Therelated
KhoaScKheMiTrng,VinVSinhYTCngCngTPHChMinh
Tcgilinlc:CN.NguynXunThyT:0946220484Email:nguyenxuanthuy@ihph.org.vn
ChuynYTCngCng
385
NghincuYhc
authoritiesshouldconductvigorousandfrequentinspectionsonthishygieneissueofdrinkingwatersourcesin
order to reduce to the minimal this current problem of substandard drinking water at daycare centers and
elementaryschools.
Keywords:drinkingwater,children.
TVN
Ncunglmtphnkhngthiucas
sng, mi hot ng sng ca con ngi u
cnnngunnc.Nclmttrongnhng
thnhphnquantrngduytrvphttrin
v mt th cht cho con ngi. Tr em c nhu
cuungnccaodoqutrnhhctpvvui
chi,vth,trcncncbsungncung
viyucuvslngvmboanton
v cht lng. Cc em trong tui t 3 11
tui u c phn ln thi gian hc tp v sinh
hottitrnghc,vthchdinhdngti
trng cho cc em ng vai tr quan trng,
trong,viccungcpncungmbocht
lnglmttrongnhngyucutithiuphi
c quan tm(2). Nc ung cho cc em hc
sinh ti trng hc lun c kim sot cht
lngbilnhotrnghc,vTrungtmy
tdphng(TTYTDP)aphng.
Theo thng tin do TTYTDP Qun 8 cung
cp, c 24 trng mm non v 21 trng tiu
hc trn a bn Qun 8, nc ung cho hc
sinh c ly t nhiu ngun khc nhau, c
trngsdngccloincungngchaic
sntrnthtrng,hocncunsi,hocc
trngtrangbhthnglcncchohcsinh(4).
HngnmTTYTDPQun8uckimtra
tnh hnh v sinh v nc sch ti cc trng
mmnonvtiuhctrnabnvcccbo
co. Tuy nhin, cc bo co v nc ch xoay
quanh2chtiuvisinhlE.colivColiformtng
svmtsccchtiuhal,cnccchtiu
v kim loi nng v c cht th cn hn ch.
Bncnhcngchacnhiunhngnghin
cukhostvncungdnhchoitng
hcsinhtuimmnonvtiuhc.
gipchovictmhiuvhintrngcht
lng nc ung s dng ti cc trng hc
trnabnqun8,tiKhostchtlng
386
ncungvthctrngvsinhsdngngun
nctimtstrngmmnonvtiuhcbn
trtrnabnqun8,TP.HChMinhc
tinhnhnghincu.
Mctiunghincu
nh gi cht lng nc ung (l ho, vi
sinhvccht)dnhchohcsinhtiuhcv
mmnonbntrtrnabnqun8thnhph
HChMinh
Kho st thc trng v sinh ngun nc
ungdnhchohcsinhticctrngtiuhc
vmmnonbntrtrnabnqun8,TP.H
ChMinh.
PHNGPHPNGHINCU
Nghincumtctngang.
C mu: Nhm nghin cu la chn 30
trng trn tng s 45 trng (chim 66,67%),
trongc23trngmmnonv7trngtiu
hc bn tr trn a bn qun 8 thnh ph H
ChMinhkhost,timitrngtinhnh
ly01muncung(hcsinhungtrctip)
tin hnh phn tch nh gi cht lng v
ng thi s dng bng kim kho st tnh
trngvsinhsdngngunncchohcsinh.
Lachnaimlymu:chnmukho
stsaochophnbrngtrnkhpabn,t
phng2nphng16Qun8.
Binsnghincu
+Ngunncungtrctipcahcsinh:
Ncungqualc
Ncunsingui
Ncungngchai
+Ccchtiulho:pH,TDS,Clorua,Mu,
c,Nitrit,Nitrat,Amoni,Sulfat,Florua
+ Cc ch tiu kim loi nng: st, mangan,
ch,Arsen,thyngn,ng,crm,nhm
ChuynYTCngCng
+ 5 ch tiu vi sinh: Coliform tng s, E.coli,
Clostridium perfringens, Streptococcus feacalis v
Pseudomonasaeruginos.
+ Tiu chun nh gi: TCVN 6096 : 2004
Ban hnh theo quyt nh s 23/2004/Q
BKHCN ngy 25 thng 8 nm 2004 ca B
trngBKhoahcvCngngh(2).
+ Cc tiu ch v v sinh (da trn hng
dn lin s s 6231/SYTSGD&T ngy
03/11/2009)(1).
Nibnchanc:Cnpykn,an
ton,vsinhhnhk(khngngcndi
yvquanhh).Bntronghltgchmeni
vi h xi mng. C xt nghim vi sinh 1
ln/nm.Cxtnghimhal1ln/2nm.
Caungnc:Khngchintngdng
chung.
Bnh ng nc ung: khng ng cn,
khng c nht bn, khng b ng ru, vng
hocrst.
KTQUBNLUN
Hin trng s dng nc ti cc trng
mmnonvtiuhcbntrtrnabn
qun8thnhphHChMinh
Kt qu kho st cho thy c 96,67% cc
trng s dng nc cp lm ngun nc n
ung sinh hot chnh. Mt s trng cn s
dngngunnccpthyqualclmnc
ung cho cc em hc sinh, chim t l 33,33%;
hoc un si ngui cho cc em ung, loi
nc ung un si ngui ny chim t l
16,67%trntngstrngckhost.
Strngsdngncungngchailm
ngunncungtrctipchoccemhcsinh
chim t l 50,00%. Cc nhn hiu nc ung
ngchaimcctrngsdnguphic
phpcungcpvthngquaskimduytca
PhngotovgiodcQun8.
C33,33%strngckhostctrang
bhthnglcnchockhtrngncbng
tiaUV.
ChuynYTCngCng
NghincuYhc
C6/7trngtiuhcckhost(chim
85,71%)ccsdnghthnglcncbngtia
UVvlcncchocc emhc sinh ung trc
tip.
Ktqukhostiukinvsinhngun
nc
a s cc trng u c bn hoc h cha
sdngchonungsinhhottitrng(26/30
trng)chim86,67%,cctrngcnliths
dngngunncmytrctip.Vtliuchnh
lccloibnbngnha,Inox,hochbngxi
mng,cltgchmenbntrong.
V cc loi bnh cha nc ung trc tip
chohcsinh,aslloibnhnha21Ldocc
hng NUC cung cp. Mt s nh tr t nhn
nh s dng bnh lc nc t lc nc ri b
vo bnh nha 21L cho cc em ung. Cc loi
bnhnyccctrngtisdngnhiuln,
qua cm quan thy bnh c, c nhiu bi bn
bn ngoi, v c nht trong bnh; mt s bnh
Inox c hin tng b ng vng, c cn v c
nhttrongbnh,snychimtl26,67%.
Quanstcaungnccahcsinh,vtliu
chyulcanha,hoccaInox.Ticctrng
mm non ln v va th a s u c ghi tn
mi em ln ca trnh dng chung ca ung
nc; nhng ti cc trng t thc nh l, c
hin tng s dng chung ca ung nc, hoc
c ca ring nhng khng ghi tn v hnh thc
cc ca u ging nhau, kh phn bit. V cm
quan, ch c 56,62% s ca ung nc cho tr l
schs,khngbnhtbn.
Ktqunhgichtlngncungly
ticctrngmmnonvtiuhcbntr
trnabnqun8TPHCM
Bng1:Tmttslngmu,chtiunghincu
Mm non
23
Tng s ch tiu
Tiu hc Tng s
bn tr
mu
L ha Vi sinh Kim loi
7
30
300
150
240
Ktquthnghimccchtiulha:
Chc3trntngs30mu,chim10%s
mu c th nghim khng t tiu chun
nc ung ng chai TCVN 6096:2004. Cc ch
387
NghincuYhc
tiukhngtlpH(2/30 mu) v Nitrit (1/30

mu) ri vo cc trng s dng nc ung
ng chai v nc ung qua lc lm ngun
ncungtrctipchoccem.
Kt qu th nghim cc ch tiu c cht,
kimloinng:Khngphthinthyccchtiu
kimloinngCh(Pb),Thyngn(Hg),Arsen
(As)trongccmuncungcxtnghim.
Ktquthnghimccchtiuvisinhcho
thy: c 57% tng s mu kho st c l
khng t tiu chun v vi sinh ca TCVN
6096:2004.
Bng2:Tlkhngtgiaccchtiuvisinh
Tn ch tiu
T l khng t
Coliform tng s
E.coli
30,00%
6,67%
Cc loi nc khng t tiu chun vi

sinh bao gm cc loi nc nh: Nc ung
ng chai, nc un si ngui, nc ung
qualc.Chtiuvisinhbnhimnhiunhtl
ch tiu Pseudomonas aeruginosa, c mu b
nhim ti 3x104/100 mL vt 30000 ln tiu
chunchophp.
asccmukhngtrivocctrng
mm non, ch c 02 trng tiu hc s dung
nc thy cc qua lc c cc ch tiu vi sinh
khngt.
Ktquthnghimhmlngccchtiu
c cht kim loi nng cho thy khng pht
hinthyccchtiunytrongccmunc
ungckhost.Tuynhin,ylnhng
yu t nguy c tim n cho cc vn sc
khe, do chng vn l nhng ch tiu cn
phictheodinhkchcchnrng
nc ngun nc ang c s dng khng
bnhimccccht.
VicsdngncungbnhimColiform
tng s, E.coli, Clostridium perfringens,
Streptococcus feacalis hay Pseudomonas aeruginosa
s gy ra cc bnh ng rut nh: tiu chy,
tiuchycp,dchtChnhvth,tiuchun
Vit Nam TCVN 6096:2004/BTNMT cng nh
quychunVitNamQCVN01:2010/BTNMT
quy nh khng c c s hin din ca
Coliform tng s, E.coli, Clostridium perfringens,
Streptococcus feacalis hay Pseudomonas aeruginos.
Tuynhin,ktqukhostnychothycn
gn57%muncungtitrnghccala
tui mm non v tiu hc b nhim cc vi sinh
vtnitrn.
388
Pseudomonas
aeruginosa
40,00%
Streptococcus
feacalis
13,33%
Clostridium
perfringens
3,33%
KTLUN
Ktqukhostthctrngvsinhsdng
ngun nc cho thy nh trng c nhiu
binphptchcctrongvicchmlosckhe
chohcsinh,100%trngcphngyt,nhn
vinphngytctphunykin v
v sinh hc ng; c 26/30 trng chim
86,67%uttrangthitb,xydngbcha
nc,bnchanctheongyucucayt
trnghcphcvchonhucusinhhot,vui
chivhctpcaccemhcsinh.
Kt qu nghin cu t ti cho thy c
20/30 mu, chim 66,67% nc ung c xt
nghimkhngttiuchunvccch tiu l
ha, vi sinh, kim loi nng. Trong , c 17/30
mu, chim 56,67% mu khng t tiu chun
vvisinhvt.Ktqunychothythctrng
nhimvisinhvttrongncungdnhchotr
emticctrngmmnonvtiuhctrna
bnqun8vncnlmtvncnphic
quantmvsmcbinphpkhcphc,gim
thiutiatnhtrngsdngncungcha
mbotiuchun.
TILIUTHAMKHO
1.
2.
3.
4.
BanchoyttrnghcthnhphHChMinh(2010).
Khochcngtcyt,antontrnghcnmhc2009
2010.
B Khoa hc v Cng ngh (2004). Tiu chun nc ung
ngchaidngchomcchgiikht.
Gray N.F.(1994). Drinking Water Quality Problem and
Solutions, John Wiley and Sons Ltd, Baffins Lane,
Chichester,WestSussexP0191UD.1994.ISBN047194817
9
TrungTmYTDPhngQun8TPHCM(2010).Boco
kimtranhkvvsinhtrnghc.
ChuynYTCngCng
NghincuYhc
NHGITCNGCANHIMMITRNGTICCCS
SNXUTSNPHMTHCNGMNGHTDANSC
KHONGIDNTIHUYNCHUTHNH,TNHBNTRE
ngNgcChnh*,LNgcDip*,NgKhn*,LVitAnh*,NguynTrnBoThanh*
TMTT
tvn:Cclngnghthcngmnghmtmtemlilinhunvkinhtchotnc,to
viclmchongidnnhngmtkhclitcngxunmitrngvsckheconngiquacchot
ngxthikhngquaxl.
Mctiunghincu:nhginhhngcaccngunthigynhimmitrngnsckhe
ngilaongvngidnxungquanhcclngngh,cssnxuthngthcngmngh,snphm
tdatihuynChuThnh,tnhBnTre.
Phngphpnghincu:Nghincumtctngang.
Ktqu:Tlcccsthugomvcbinphpxlchim61,90%.Ccchcschacbin
phpxlncthikhcao(42,86%).ascngnhnccctriuchngauuchngmt(65,79%),
khthtcngckhilmviclu(43,42%).Cchgianhxungquanhchunhhngnhiuttingn
vkhibithotngsnxutcacccsvcmilinquangiatnhhnhmcccbnhlinquan
n ng h hp ca ngi dn vi tnh hnh x kh v bi ra mi trng ca cc c s (PR=1,66,
KTC:1,042,63).
Ktlun:Nhnchungcchotngsnxutcacccsmnghcnhngtcngnhtnhi
visckhecacngnhntrctiplmvicvngidntrongkhuvc.
Tkha:nhimmitrng,thcngmngh,snphmda,sckhe.
ABSTRACT
ASSESSMENTOFENVIRONMENTALPOLLUTIONCAUSEDBYMANUFACTURINGOF
HANDICRAFTPRODUCTIONMADEBYCOCONUTTOWARDHEALTHSTATUSOFPEOPLE
LIVINGINCHAUTHANHDISTRICT,BENTREPROVINCE
DangNgocChanh,LeNgocDiep,NgoKhan,LeVietAnh,NguyenTranBaoThanh
Background: Although handcraft villages have good effectiveness which makes country income can raise
andlaborforcecanbeused,ontheotherhand,wastewithoutbeingprocessedcancauseenvironmentalpollution
andaffecttopeopleshealth.
Objectives: Assess the impact of environmental pollution on health of laborers and people who living
aroundhandcraftvillages,handicraftproductionfacilitiesandproductsofcoconutinChauThanhdistrict,Ben
Treprovince.
Results:Thereare61.9%offacilitieswhichhavecollectedandtreatedwaste.Percentageoffactoriesdonot
havesewagetreatmentisquitehigh(42.86%).Surroundinghouseholdsaremostaffectedfromnoiseanddust
*
KhoaSckheMitrng,VinVsinhYtCngcngTP.HCM
Tcgilinlc:Ths.ngNgcChnh T:090370453233Email:dangngocchanh@ihph.org.vn
ChuynYTCngCng
389
NghincuYhc
whichcomefromoperating.Thereisrelationshipbetweenespiratorycasenumberandthestatusofgasanddust
dischargedfromfacilities.(PR=1.66,CI:1.042.63).
Conclusion:Productionactivitieshavecertainaffectiontoheathstatusofworkerandpeoplelivingaround.
Keywords:Environmentalpollution,handicraftproductionfacilities,coconutproduct,health.
TVN
Mctiunghincu
Lngnghlmttrong nhng c th ca
nng thn Vit Nam. Trong vi nm gn y,
cc hot ng sn xut tiu th cng phc v
tiudngtrongncvxutkhu.Theosliu
thngktHiphilngnghVitNam,hin
nc ta c khong 2.790 lng ngh, thu ht
khong 1,35 triu lao ng chnh v hng triu
laongphtronglcnngnhn(1).Mtkhc,
song hnh cng nhng li ch v kinh t, vn
ha l cc tc ng tiu cc n mi trng
sng v lm vic, gy nh hng trc tip n
sckhengilaongvngidnsinhsng
xungquanhcclngngh.Ktqukhost52
lngnghinhnhtrongcncdoVinCng
ngh v Mi trng thc hin cho thy 100%
muncthicclngnghckhostc
thngsvttiuchunchophp(4).Ncmt,
ncngmucduhiunhimmc
khcnhau.Mitrngkhngkhbnhimc
tnh cc b ti ni trc tip sn xut, nht l
nhimbivttiuchunchophp.Ccbnh
nhaumt,bnhngoida,bnhvngh
hp, ng rut ca ngi dn lng ngh cao
hn cc lng thun nng...Ti tnh Bn Tre,
thctrngnhimmitrnglngnghcng
angtrongtnhtrngngbong.Theobo
co hin trng mi trng nm 2005, ton tnh
hinckhong22lngnghtrongchyul
cc lng ngh sn xut cc sn phm t da(2).
Huhtcccsuthiuvn,mtbngv
thc bo v mi trng trong hot ng sn
xut cn nhiu hn ch. Cht thi pht sinh
trongqutrnhhotngcacskhngqua
x l m c thi trc tip ra mi trng.
Nghincucthchinnhmtmhiuhin
trngvxutmtsgiiphpgimthiu
nhimmitrng,nngcaosckhechongi
laong,ngidnxungquanhcclngngh
tihuynChuThnh,tnhBnTre.
nhgihintrngmitrngsnxutca
cccs.Xcnhcccloihnhsnxut,
quy trnh sn xut sn xut hng th cng m
ngh,snphmtdatihuynChuThnh,
tnhBnTre.
390
Xc nh c cc ngun thi chnh gy

nhimmitrng;hintrngqun l v x l
cht thi ti cc c s. nh gi tc ng ca
hot ng sn xut v cht thi pht sinh n
sckhengilaong.
iu tra tnh hnh sc khe ca ngi dn
sinh sng khu vc xung quanh cc c s sn
xuthngthcngmnghsnphmtda.
xutgiiphplmgimthiungungy
nhimcacccssnxutmnghtda.
ITNGPHNGPHPNGHINCU
Phngvntrctip300itngbaogm
cng nhn trc tip lm vic ti cc c s v
ngidnsinhsngtrongbnknh100mxung
quanhkhuvcnhxngcccssnxutm
ngh.Bncnhkthptinhnhkhostti
cccsdatrnbngkhost.
KTQUVBNLUN
Hintrngqunlvxlchtthiticc
c s th cng m ngh huyn Chu
Thnh
Bng1:cimcacccsmnghckho
sttihuynChuThnh
c im
Cc c s
Nm hot ng trung bnh
10 nm
Nhn cng trung bnh
8-10 ngi
Din tch nh xng trung bnh
<150 m
Doanh thu trung bnh
200 triu/nm
Tin hnh kho st ti 8 c s ti th cng

mngh2xTinThy,TnThchtrntngs
ChuynYTCngCng
hn20cscatonhuyn.Huhtcccs
ycsnmhotnglntihn10nm,
thucloihnhcsthcngnhl.Hotng
viscngnhntrungbnhkhongt8n10
ngilmvicthngxuyn.Dotnhchtnh
lcanhngcsny,nnvicquantmn
vnbovmitrngcnrthnch.Tuy
cccslmbncamktbovmitrng
nhnghunhchathngkclngcht
thiphtsinhhngngy,chacbinphpx
l i vi cc loi ha cht nguy hi v cng
nhchathugomvxlncthi.Quaquan
st nh gi bng cm quan mi trng xung
quanhnhxngthhuhtccphphm,g
dadthabqungbabixungquanhcs;
bi g bm y trn tng cng nh trn trn
nh xng, ting n bi v hi ha cht trong
nhxngkhnngncgycmgickhchu;
ncthicmuvngcdochanhiumn
cavhuhtthchaxlvcchocha
trong ao t hoc thi thng trc tip ra knh
mng. Nhn chung do quy m ca cc c s
nh,phntn,anxenvicckhuvcdnc
sinhhotnnvnnhimmitrngcc
lng ngh ti huyn Chu Thnh l dng
nhimphntnkhquyhochvkimsot.
X g thnh
tng ming
h
Tin thnh
cc chi tit
Phun PU hoc
sn bng
Ghp cc chi
tit li vi
nhau
NghincuYhc
vim thy phi.... ng lu l ch v thy

ngn, rt c hi i vi c th. Ch c trong
btchngg,btmuv c lm cho mu sc
ti hn (nht l cc mu , cam, vng v
trng),ctcngtchccnqutrnhlm
khmtsn.Thyngnctcdngboqun,
chng vi khun v ru mc(3). Vic ht th
nhiubisnngoinhngtchicabini
chung cn c kh nng nhim c ha cht
(ch,thyngn...).Ngoira,ncthicacc
cscngchmlngdumcngnghip
cao v hu ht c thi trc tip vo knh
mng,cnguycgynhimngunnc.
nhginhhngcacccssnxut
thcngmnghnsckhengilao
ng
Kho st v cc triu chng gp phi trong
qutrnhlmvic,hunhcccngnhnc
hi c cc triu chng au u chng mt
(65,79%).Cctriuchngkhthtcngccng
thng xuyn xut hin khi lm vic lu
(43,42%). Triu chng ho v ht hi cng
thngxuynxuthintrongqutrnhlmvic
(30,26%). mt s t cng nhn cn xut hin
mt s triu chng kh nghim trng nh sc
(11,84%)vngatonthn(2,63%).Ch27,63%
scngnhnchichorngtrongqutrnh
lmvicticssnxutmnghchactriu
chngxuthin.
nh bng v
phi kh
Hnh1:Squytrnhsnxutcaccsmngh
datihuynChuThnh
Bng2:Ccdngchtthicacccsmngh
Cc dng cht thi
Kh thi
Thnh phn nhim

Bi, hi xng, dung mi, hi sn
PU
Nc thi
Du m cng nghip
Cht thi rn
G da d tha, cn ha cht
Cc dng cht thi khc
Ting n
Dngchtthichyucaccsmngh
da huyn Chu Thnh ch yu l bi g
dacthgydngphi,gyhensuyn,
ChuynYTCngCng
Biu1:Tlccbnhthnggpcngnhn
T l ca vic xut hin cc triu chng
nhm cng nhn n (59,26%) cao hn nhm
cngnhnnam(40,74%),tuynhinskhcbit
gia 2 nhm ny khng c ngha thng k
391
NghincuYhc
(p=0,07). Vi nhm tui th vic xut hin cc

triu chng li tp trung nhm t 15 n 30
tui(48,15%)vtnhtnhmt47n62tui
(18,52%). Vic xut hin cc triu chng theo
nmlmvictptrungnhmcngnhnlm
vic t 5 n 10 nm (42,59%), nhm cng
nhn lm vic trn 1 nm t l thp (18,52%).
iu ny cng phn no cho thy vic cng
nhntipxclunmviccyutnhim
cc c s m ngh c kh nng xut nhiu cc
triuchngchichosckhehn.Tuynhin,
c 2 s khc bit trn u khng c ngha
thngk(p>0,05).
Bng5:Vicxuthintriuchngvccyutlin
quancngnhn
c im
Gii tnh
Nhm tui
Nm lm
vic
Nam
N
15-30 tui
30-46 tui
47-62 tui
< 1 nm
1 -5 nm
5- 10 nm
>10 nm
Xut hin cc triu

P
chng
(95% CI)
n
%
22
40,74
0,07
32
59,26
26
48,15
0,412
18
33,33
10
18,52
10
18,52
0,254
14
25,93
23
42,59
7
12,96
-
nhmcngnhnnamtlmcmttrong
ccbnhktrncaohnsovinhmcngnhn
n (51,35% v 48,65%), tuy nhin s khc bit
gia 2 nhm ny cha mang ngha thng k
(p>0,05).Trongccnhmtuithvicmcmt
trongccloibnhtptrungchyunhmt
15n30tui(48,65%),tipnlnhmt31
n46tui(35,14%)vtnhtnhmt47n
62 tui (16,22). Theo thc t kho st, nguyn
nhnchnhcaccbnhtptrungnhmtui
t15n30tui,biynhmitngch
yulmvicticccsmngh.Theosnm
lmvic,tlmcmttrongccbnhtrnth
vic xut hin cc triu chng trn tp trung
nhmcngnhnlmvict1n5nmv5
n 10 nm (42,59%), nhm cng nhn lm
vic trn 10 nm th t hn (12,96%), xt trn
cng mt nhm th nhng ngi lm vic trn
10nmctlcbnhkhcao(54,55%)sovi
392
nhmdi1nm(31,25%)vt5n10nm
(48,15%).
Bng6:Viccmcbnhvccyutlinquan
cngnhn
c im
Nam
N
15-30 tui
Nhm tui
30-46 tui
47-62 tui
< 1 nm
1 -5 nm
Nm lm vic
5- 10 nm
>10 nm
Gii tnh
C mc 1 trong cc
loi bnh
N
%
19
51,35
18
48,65
18
48,65
13
35,14
6
16,22
5
13,51
13
35,14
13
35,14
6
16,22
p
(95%
CI)
0,498
0,773
0,383
-
Bng7:Tlcbnhivisnmlmvicca
cngnhn
Nm lm vic
< 1 nm
1-5 nm
Bnh (%)
Khng bnh (%)
31,25
68,75
59,09
40,91
5- 10
nm
48,15
51,85
>10 nm
54,55
45,45
nhginhhngcacccssnxutth
cngmnghnsckhengidnquanh
khuvc
Khostvngunncsdngtrongsinh
hot, do cn kh khn trong vn a nc
myvosdngticchgianhkhuvc
vngsu,ckhong30%cchgianhtiy
s dng nc my; 3,6% s dng nc ma;
1,36% s dng nc ging v c bit c n
66%sdngncsng,ao,htrongsinhhot.
i vi ngun nc s dng cho n ung,
dotpqunthiquensdngnccngnh
asngidntiyvncnsdngnc
machonung(chimkhong54%),45% s
dng nc ung ng bnh, ch c 13,64% s
dng nc my v c bit vn cn 13,18% s
dngncbmtlsng,ao,hchonung.
Mt iu ng ch l mc d c cung
cpncmyvotnnh(63h)nhngchc
42,86%sdngncmychonungvtm
git, mt s h vn cn gi thi quen s dng
ncma(16h,chim25,4%)hocncung
ng bnh (47,62%) cho n ung. T tnh hnh
trn,tacththycnguyctimnivi
ChuynYTCngCng
sckhe.Bitheotpqunsuynghcangi
dn, nc ma l ngun nc c sn v sch
nht trong tt c cc ngun nc, tuy nhin
trong iu kin khng kh b nhim do cc
hotngsnxutcngnghipvsinhhotca
con ngi hin nay th trong nc ma c th
cha bi bn v cc ha cht tn lu c hi
khc.
Khostcctriuchngxuthincch
gia nh, c 29% h gia nh c kho st c
thnhvintronggianhcbiuhinauu
dotingn;9%hcbiuhincakhth,tc
ngc do ht phi mi kh chu pht sinh trong
sutqutrnhsnxutv24%hcngibiu
hinthngxuynhohochthi.Bncnh
theo thng tin cung cp, c 4 h c thnh vin
trong gia nh b sc.V tnh hnh bnh tt ca
ngidnsnggnkhuvccssnxut,c
23,18%hmcccbnhvtaimihng,16,82%
h mc cc bnh v ng h hp, 10,91% b
mc cc bnh ngoi da v 8,18% mc cc bnh
linquanvngtiuha.
Bng8:Cctriuchngbnhbiuhincangi
dndobnhhngbicccssnxut
Triu chng
au u
Kh th, tc ngc
Ho, ht hi
Sc
Khng c ai c triu chng
N
64
20
53
4
121
%
29,09
9,09
24,09
1,82
55,0
Bng9:Tnhhnhbnhttcangidngnkhuvcc
ssnxut
Tnh hnh mc cc bnh trong
gia nh
Tai mi hng
Bnh v ng h hp
Bnh ngoi da
Bnh lin quan n ng tiu
ha
Ung th
51
24
18
37
23,18
16,82
10,91
8,18
Tlmcbnhnhnghdnchorngh
cchunhhngcamivhihachtcng
nhvicxbitrongqutrnhgiacngcaogp
1,66lnsovinhngngichornghkhng
chunhhngdoxakhuvcnhxngca
cc c s m ngh v kt qu ny c ngha
ChuynYTCngCng
NghincuYhc
thng k (p = 0,036). Ring kho st v nh

hng ca vic gy nhim ngun nc sinh
hotntnhhnhmcbnhngoidathkhng
cmilinquan.
Bng10:Milinquangiatnhhnhmcbnhv
nghhpvtnhhnhxthitrongkhngkh
Tnh trng x thi
trong khng kh
C
Khng
Mc bnh v ng
PR
h hp
P
(95% CI)
C
Khng
22
31
1,66
(41,51%) (58,49%)
(1,04- 0,036
44
123
2,63)
(26,35%) (73,65%)
KTLUN
Huhtcccschathngkclng
cht thi pht sinh hng ngy, cha c bin
phpxliviccloihachtnguyhiv
cngnhchathugomvxlncthi.
a s cc cng nhn xut hin cc triu
chng l au u chng mt (65,79%), kh th
tcngccngthngxuynxuthinkhilm
viclu(43,42%).Loibnhchyucngnhn
mcphilbnhvhhp(43,42%).Loibnh
thng gp th hai cc cng nhn l tai mi
hng(34,21%).
29% h dn c xung quanh c thnh vin
tronggianhcbiuhinauudotingn;
9%hcbiuhincakhth,tcngcv24%
hcngicbiuhinthngxuynhohoc
ht hi. 23,18% h mc cc bnh v tai mi
hng,16,82%hmcccbnhvnghhp,
10,91%bmcccbnhngoidav8,18%mc
cc bnh lin quan v ng tiu ha. C mi
linquangiatnhhnhmcccbnhlinquan
nnghhpcangidnvitnhhnh
xkhvbiramitrngcacccs.Tl
mc bnh nhng ngi chu nh hng ca
tnhtrngnygp1,66lnsovinhngngit
chunhhng(p<0,05).
KINNGH
Qua kt qu nghin cu, cng vi vic tm
hiucckin,nhucuthngtincahainhm
itngcngnhntrctiplmvicvngi
393
NghincuYhc
dnsngxungquanhcccsmnghtda.
Mtsxutkinnghcaranhsau:
ivicccsmngh
ivichnhquynaphngtrctip
qunlcccs
Cnthngklnghachtvchtthica
csmnhthirahngthngcbinphp
hnchgimthi.
Tin hnh cc hot ng kim tra gim st

thngxuynvrngkhpvvnxlthu
gomrcthivncthiticccsmngh.
Cn quan tm hn n vn x l cc
nguyn vt liu tha, trnh tnh trng vt ba
bi.
ng vin cc ch c s m ngh trang b

dng c bo h khu trang cng nh ci thin
mitrnglaongchocngnhn.Chnhc
nhvicchechnbixungquanhkhuvcsn
xut.
ivicngnhntrctiplmticcc
s
ivi cctrung tmythuyn,trmy

tx
Tngcngcchotngtuyntruynph
binkinthc.
Tuyn truyn ph bin kin thc vn ng
trnhnhngquan nim sai lm ca cc ch c
s m ngh v mc nhim ca cc hot
ngsnxutthcngmngh.
Tuyntruynvcchphngchngccbnh
cthgyradonhimmitrnglngngh
tiaphng.
Cntthchntrongvicsdngboh
laong.
Tmhiuthmcctriuchng,cngnhcc
bnhcthbdonhhngcavnnhim
mitrng.
TILIUTHAMKHO
1.
2.
3.
4.
Phm Khi Nguyn (2005), Bo co hin trng mi trng

qucgia,BTinguynmitrng.
S Ti nguyn v Mi trng tnh Bn Tre (2005), Bo co
hintrngmitrng.
TrnhThThanh(2000),chcmitrngvsckhecon
ngi,NXBHQGHNi.
VinCngnghvMitrngTrngihcBchKhoa,
(2010)Nghincucskhoahcvthctinchovicxy
dng cc chnh sch v bin php gii quyt vn mi
trnglngnghVitNam.
394
ChuynYTCngCng
NghincuYhc
MILINQUANGIAVECTORSTXUTHUYT
VBINIKHHUTI4XVENBINTNHBNTRE2011
ngNgcChnh*,LNgcDip*,LVitAnh*
TMTT
tvn:Hinnay,tnhtrngbinikhhuangngycngthhinrtrnthgiivVitNam
vgyranhiutcngxunconngivmitrng.Nhngtcngcahintngnngmtoncu,
mrngnhngvngcnhittrungbnhtrn160ClyutkhinvngphnbcamuitruynbnhSXH
ngycngmrng.
Mctiunghincu:tnhhnhvvctgybnhstDengue/stxuthuytDenguevmilinquan
giasgiatngslngvctvihintngbinikhhutibnxvenbintnhBnTre.
Phng php nghin cu: iu tra ct ngang s mui ci Aedes aegypti trng thnh, mt long
qung4xthuc2huyncatnhBnTrevo2ma.
Ktqunghincu:Trongmanng,chsDI(SmuiciAedesaegyptitrungbnhtrong1gianh
khost)ca4xthuc2huynBaTrivhuynThnhPhl2,65.ChsHI(TlnhcmuiciAedes
aegyptitrngthnh)l83,5%.ChsBI(VsnhcphthinLQAedesaegypti)48,25%.ChsCI(S
dngcchanccLQAedesaegypti)l23,78%.tkhostvomamaccchsnycphntngln
ngkDI(3,24),HI(85%),BI(58,25%)vCI(15,85%).
Ktlun:Cschnhlchv2chsDIvHIca4xvenbinthuctnhBnTretrongmamav
manng.
Tkha:Stxuthuyt,vct,chsmt,dngcchanc.
ABSTRACT
THERELATIONSHIPBETWEENDENGUEVECTORANDCLIMATECHANGEAT4COASTAL
COMMUNESINBENTREPROVINCE2011
DangNgocChanh,LeNgocDiep,LeVietAnh
Background: Nowadays, the climate change is becoming more and more obviously in all over the world
includingVietnam.Thiscausesbadeffectsforhumanbeingsandtheenvironment.Globalwarmingincreasesthe
areaswiththeaveragetemperaturesabove16CwhichmakesthequicklygrowthofDenguemosquitoes.
Objectives:ThesituationofDenguefevervector/Denguehemorrhagicfeverandassociationbetweenthe
increaseinthenumberofvectorswiththephenomenonofclimatechangeinfourcoastalcommunesofBenTre
province.
Methods: Crosssectional survey to get the amount of adult mosquitoes, mosquitoes larva density in 4
communesunder2districtsofBenTreintwoseasons.
Results:Duringthedryseason,theindexDI(TheaveragefemalemosquitoesAedesaegyptiinahousehold
surveyed)inthedryseasonof4communesin2districtsofBaTriandThanhPhudistrictis2.65mosquitoesper
house. HI index (the rate of the mosquito Aedes aegypti adult) is 83.5%. BI Index (The home having Aedes
*
KhoaScKheMiTrng,VinVSinhYtCngCngTPHChMinh
Tcgilinlc:Ths.ngNgcChnh T:0903704532
Email:dangngocchanh@ihph.org.vn
ChuynYTCngCng
395
NghincuYhc
aegypti LQ) is 48.25%. Total investigation DCCN 2810, CI index (number of water containers with Aedes
aegyptiLQ) is 23.78%. In the rainy season, these index increase significantly, for example, the DI (3.24), HI
(85%),BI(58.25%)vCI(15.85%).
Conclusion:ThereisdisparityindexDIandHI2of4communescoastalprovinceofBenTreduringthe
rainyseasonanddryseason.
Keywords:Dengue,vector,theindexdensity,wartercontainer.
mnhti5xcahuynBaTri.Xctlmc
TVN
bnh cao nht l Tn Thy vi t l mc 705
Hin nay, tnh trng bin i kh hu ang
ca/100.000dn;tlmcthpnhtcngmc
ngy cng th hin r trn th gii v Vit
cao137/100.000dn.cbitc2trnghp
Nam,gyranhiutcngxunconngi
t vong do SXH ca huyn ch trong thng
v mi trng(7). Nhng tc ng ca hin
6/2010.Ngoira,quakhostcaTrungtmy
tngnngmtoncu,mrngnhngvng
tdphngtnh,cn90%nhdncmui
cnhittrungbnhtrn16oClyutkhin
truynbnhvhn80%hdnsdngccvt
vngphnbcamuitruynbnhSXHngy
chancclngqung(5).
(2)
cngmrng .
Tnhhnhdinbincadchngycnglan
St Dengue/St xut huyt Dengue
rng v phc tp. Hn na, SD/SXHD khng
(SD/SXHD) l bnh nhim virus Dengue cp
ch nh hng ln sc khe c nhn m cn l
tnh do mui truyn. SD/SXHD ang tr thnh
vn y t cng cng cn quan tm, c nh
dchtihn100qucgiachuPhi,chuM,
hng ti kinh t v x hi(4). Hin ti trn th
ngaTrungHi,ngNamvTyThi
gii cha c vc xin phng bnh v cng cha
Bnh Dng(4). Trong ng Nam v Ty
cthuciutrchiu,dobinphpngn
ThiBnhDnglbnhhngnghimtrng
ngahiuquduynhtchnhlkimsotvc
nht. C khong 2,5 t ngi sng trong vng
t truyn bnh trong c 2 loi mui Aedes
nguyc(9).idchSD/SXHDbtutnhng
aegyptivAedesalbopictuslvctchnh(8).Trc
nm cui th k 20 vi s ca mc hng nm
tnh hnh trn, Vin v sinh Y t cng cng TP
khong 100 triu trng hp, 500.000 trng
HChMinhtinhnhiutravctSD/SXHD
hpSD/SXHDcnnhpvintrongc90%l
ti hai x Thnh Ph, Ba Tri, nhm cung cp
tremdi15tui.Tltvongtrungbnhdo
thm cc s liu v tnh hnh nh hng ca
SD/SXHDl5%vikhong240.000trnghp
bin i kh hu ti Bn Tre ni ring v Vit
minm(3).
Namnichung.
Ti Vit Nam, c s mc v cht do
Mctiunghincu
SD/SXHD gia tng k t nm 1994 tr li y,
Mctiuchung
bnhvangtrthnhvnytnghim
TnhhnhvvctgybnhstDengue/st
trng.Nm1998smcvtvongdobnhrt
xuthuytDenguevmilinquangiasgia
caovi234.920trnghpmc,337trnghp
tngslngvctvihintngbinikh
t vong ti 56/61 tnh/thnh ph. Trc tnh
hutibnxvenbintnhBnTre.
hnh,ThtngChnhPhcquytnh
s 196/1998/Q TTg a d n phng chng
Mctiucth
SD/SXHDtrthnhmtmctiutrongChng
Tnh hnh vc t gy bnh st Dengue/st
trnhmctiuQucgiathanhtonmtsbnh
xut huyt Dengue ti 4 x ca 2 huyn Ba Tri
x hi v bnh dch nguy him(1). Ti tnh Bn
vThnhPh.
Tre,theokhuyncocaVinPasteurTP.HCM
Tm hiu mi lin quan gia s gia tng
thhindchstxuthuyt(SXH)anggiatng
vectSD/SXHDvisthayinhit,lng
396
ChuynYTCngCng
madobinikhhu.
PHNGPHP,AIMNGHINCU
NghincuYhc
cn li 8,2% l mui Culex v 8,1% l cc loi

muikhc.
Phngphpnghincu
Trong ti ny, chng ti iu tra ct
ngang mt mui ci Aedes aegypti trng
thnhvxcnhsdngcchancccha
long qung 4 x thuc 2 huyn Ba Tri v
Thnh Ph 2 ln/nm. Mi ln iu tra 100 h
gia nh (phn b ngu nhin) trong tng x,
1lnthchinvomama,1lnthchinvo
makhnm2011(6).
aimnghincu
Cc x nghin cu l cc x ven bin c ti
ni c iu kin thun li cho s sinh sn v
phttrincaAedesaegyptititnhBnTrel:
Huyn Thnh Ph: x Thnh Hi, x
ThnhPhong.
Biu2:Phnloimuivomama
Manng
Bng1:Ccchsvmtmuicitrngthnh
Ae.aegyptivomanng.
Ch s Thnh Hi
DI
HI (%)
2,12
82
Thnh
Phong
1,76
80
Bo Thun An Thy
3,8
88
2,92
84
TnhhnhvctSXH/SD
Kt qu tnh ch s DI (s mui ci Aedes

aegyptitrungbnhtrong1gianhkhost)ti
100 h ca mi x cho thy ch s DI ca 2 x
ThnhPhonglthpnht(1,76).ChsDIca2
xcahuynBaTricphncaohn:BoThun
(3,8)vAnThy(2,92).
Trong tng s 2815 mu mui thu c

trong t iu tra ma nng, loi mui chim
ch yu l mui Anopheles sp (39,74%), mui
Ae.aegygti chim th 2 (37,28%). Mui Culex
chim th 3 (8,87%) v thp nht l mui
Ae.albopictus(3,64%).Cnli10,47%smuibt
clccloimuikhc.
ChsHI(tlnhcmuiciAedesaegypti
trngthnh)gia2xcahuynThnhPhl
ThnhHi82%,ThnhPhong80%thphnso
vi2xcahuynBaTrilBoThun88%,An
Thy 84%. iu ny cho thy vc t ca mui
Aedes aegypti ti 2 x thuc huyn Ba Tri ph
binhn2xthuchuynThnhPh.
HuynBaTri:xBoThun,AnThy.
KTQUNGHINCU
Bng2:Ccchsvmtbgy(longqung)
Ae.aegyptivomanng.
Ch s Thnh Hi Thnh Phong
BI (%)
CI (%)
Biu1:Phnloimuivomanng
Tngslngmuithucti4xtrong
tiutramamal3149con.Trong,t
l mui Ae.aegypti vo ma ny tng kh cao
(41,1%), t l mui Anophelessp cao th 2 (39,8
%), Mui Ae.albopictus ch chim khong 2,8%,
ChuynYTCngCng
64
31,7
60
21,1
Bo
Thun
51
19,1
An Thy
72
23,2
Ch s BI (v s nh c pht hin LQ Aedes

aegypti) x Thnh Phong trong 100 nh kho
st c 60% l pht hin thy long qung,
ThnhHil64%,AnThylcaonhtvi72%
snhckhostphthinlongqungv
BoThunthpnhtlvi51%.
Trong tng s 679 dng c cha nc
(DCCN)iutraxThnhHithsdngc
397
NghincuYhc
pht hin thy long qung l 31,7%; tng s

DCCNiutracaxThnhPhongl707dng
ctrongc21,1%sdngclcphthin
thylongqung;tngsDCCNiutracax
Bo Thun l 684 dng c trong 19,1% s
dngclphthinthyclongqung;tng
DCCNiutracaxAnThyl740dngc
trong 23,2% s dng c l pht hin thy
longqung.
T l cc h gia nh cn cc vt dng
chancngquanhnhccxucnkh
thp,chcxThnhHilcnmc34%gia
nhcvtdngngncquanhnh.Cch
gianhhunhucsdngccbinphp
dit mui n gan (vt mui, nhang mui,
thuc xt). T l ny kh cao hai x Bo
Thun(78%)vAnThy(76%).ivicngtc
tm mng th s h gia nh c tm mng
trong400hkhostcngkhcaovutrn
50%.cbitxBoThuncahuynBaTri,
trong100hchithshctmmng
tti65%.
Mama
Bng3:Ccchsvmtmuicitrngthnh
Ae.aegyptivomama.
Ch s
Thnh Hi
DI
HI (%)
3,03
84
Thnh
Phong
3,19
83
Bo Thun An Thy
3,53
87
3.2
86
KtqutnhchsDIti100hcamix
vo ma ma ti 4 x Thnh Hi, Thnh
Phong, Bo Thun v An Thy c th hin
trongbng3.Chs DI Bo Thun cao hn
hnccxcnli,chothytnsutxuthin
camuiciAedesaegyptitrong1hgianh
BoThunlkhcao.
ChsHIgia2xcahuynThnhPh
l Thnh Hi (84%), Thnh Phong (83%) thp
hn2xcahuynBaTrilBoThun(87%),
An Thy (86%). S chnh lch v ch s ny
vnchothyhuynBaTricphbinvc
tSXHcaohnhnhuynThnhPh.
398
Bng4:Ccchsvmtbgy(longqung)
Ae.aegyptivomama.
Ch s Thnh Hi
BI (%)
CI (%)
68
17,2
Thnh
Phong
74
24,4
Bo Thun An Thy
38
9,2
53
12,6
ChsBItrong100nhkhostvoma
ma x Thnh Hi th c 68% l pht hin
thylongqung,ThnhPhongl74%,Bo
Thunlthpnhtvi38%vcuicnglAn
Thyl53%.
Tng s DCCN iu tra x Thnh Hi l
973dngcthsdngcphthinthylong
qungl17,2%;tngsDCCNiutracax
ThnhPhongl909dngctrongc24,4%
s dng c l c pht hin thy long qung;
tngsDCCNiutracaxBoThunl827
dngctrong9,2%sdngclphthin
thyclongqung;tngDCCNiutracax
AnThyl811dngctrong12,6%sdng
clphthinthylongqung.
Tlcchgianhcvtdngngnc
quanhnhccxcaohnmanng:xThnh
Hi (38%); Thnh Phong (58%); Bo Thun
(43%);AnThy(47%).Tlnykhcaohaix
Bo Thun (67%) v An Thy (68%). i vi
cngtctmmngvcbitxBoThun,
An Thy ca huyn Ba Tri, trong 100 h c
hi th s h c tm mng t ti 88% v
81%.
Mi lin quan gia s gia tng vc t

SXH/SDvhintngbinikhhu
Nhm nghin cu tin hnh kho st s
thay i ca c yu t nhit v lng ma
theotngthngtrong5nm.Ktquchothy
trong nhng thng ma kh (t thng 12 nm
trcnthng4nmsau),nhittrungbnh
trong5nmdaongt24,50Cn29,20C.Vo
thng4hngnm,nhittrungbnhvocui
makhucaohn280C,nm2010mcnhit
trungbnh29,20Ccaohnnhit5nmtrc
(nm 2005) l 0,40C. Tip tc kho st h s
tngquangiasthayinhitnyvs
giatngslngvectvomamaz=0,67.
ChuynYTCngCng
ivilngmathtrongmakhhng
nm ti huyn Thnh Ph, lng ma trung
bnhtiachc73,5mm.cbit,vothng2
v thng 3 hu nh khng c ma. Vo ma
ma,lngmaocthpnhttrong5nm
t2006n2010l8,5mm(vothiimthng
11nm2009)vcaonhtl412,1mm(vothi
im thng 10 nm 2008). H s tng quan
giasthayicalngmavsgiatng
slngvctlz=0,89.
TheomhnhcaDanaFocks,sbini
vlngmavnhittheomaccho
lnhngyutquantrngnhhngtis
pht trin ca vct SD/SXHD. Theo kt qu
canhmnghincuthcschnhlchv2
chsDIvHIcaccxthuchuynBaTri
v huyn Thnh Ph trong ma ma v ma
nng. Vo ma ma, th cc ch v mt
mui ci Aedes aegypti c xu hng tng cao
hn. Tuy nhin vn cha c bng chng
thngkchngminhgithuynnydocc
hstngquanuln0,05.
KTLUN
Tthktrc,tcngcahiungnh
knhdnnsthayikhhutoncutr
thnh mt nguy c sinh thi nghim trng c
nh hng ti i sng ca loi ngi v cc
mitngtcviccloikhc.Hintngny
cnccoinhlmtnglcchnhchiphi
mitngtcgiatcnhngybnhvtly
truyn/mi trng sinh vt ch ca hu ht
cc bnh do nhim khun bao gm c st
Dengue/st xut huyt Dengue (SD/SXHD). V
haiyutcchocnhiunhhngnhiu
nhtnhintngnylsbinivlng
ma v nhit theo ma. Tuy nhin, ti Vit
Nam nhng nghin cu gn y phn tch
thng k cho thy khng c mi tng quan
ngkgiascaSD/SXHDhngnmvitng
lng ma trong giai on 19962007. Nhng
triquaccnm,scaSD/SXHDluntngvo
mama(thng4nthng10).ivinghin
cu ca nhm tc gi cng pht hin ra c s
chnhlchv2chsDIvHIcaccxthuc
ChuynYTCngCng
NghincuYhc
huyn Ba Tri v huyn Thnh Ph trong ma

mavmanng.Vomama,thccchv
mtmuiciAedesaegypticxuhngtng
cao hn. Tuy nhin vi h s tng quan l
z=0,67vz=0,89thvnchabngchng
khng nh mi lin quan khng nh mi
lin quan gia s gia tng vc t SD/SXH vi
hintngbinikhhu.
KINNGH
T nhng kt qu t c trong nghin
cudiylmtskhuynnghchochng
trnhphngchngSD/SXHDcngnhngph
viBKH:
Khi c hin tng thay i v nhit bt
thng hoc ma ko di th cn ch ng
phng trnh kh nng gia tng dch bnh
SD/SXHD.
Cithinhthngcungcpncsch:Vic
cung cp nc sch khng y s lm tng
tnhtrngtrncmchnhccloiDCCNl
nisinhsnchomui.
Cnhuyngsthamgiatchcccacng
ng vo chng trnh ng ph BKH cung
nhphngchngSD/SXHD.
Nngcaokinthccacngtcvin,cnb
hthngytvcnbchnhquynvBKH
vccnhhngcaBKH.
Cncsphntchythngtinxc
nhbgynguntccanthiphiu
quvochnhngun.
Trin khai v m rng m hnh PC
SD/SXHD da vo cng ng c s dng
Mesocyclops v duy tr tnh bn vng ca
chngtrnh.
Cng tc ng ph BKH v PC SD/SXHD
cn c s phi hp lin ngnh gia cc ban
ngnh tt c cc lnh vc c lin quan trong
tnh,huynvx.
Cnctinhnhthmnhngnghincuv
nhng nh hng ca bin i kh hu trong
nhngnmti.
399
NghincuYhc
TILIUTHAMKHO
5.
1.
6.
2.
3.
4.
400
B Y T (2006), Gim st, chn on v iu tr bnh St

Dengue/StxuthuytDengue,Nhxutbnyhc,HNi.
GublerDJ.(1997),DengueandDenguehemorrhagicfever;its
historyandresurgenceasaglobalpublichealthproblem,IN
Kuno DGG. (Ed.) Dengue and Dengue Hemorrhagic Fever,
CABInternational,NewYork.
Gubler,DJ(1998),DengueandDengueHemorrhagicFever,
ClinicalMicrobiologyReviews,11(3),pp.480496.
OoiE,GohK.&GublerDJ(2006),Denguepreventionand35
years of vector control in Singapore, Emerging Infectious
Diseases,12(6),pp.887893.
7.
8.
9.
SyttnhBnTre(2009,2010,2011),Bocotngktcng
tcphngchngstxuthuyt.
VinPasterTPHCM(2009),Tiliuhngdntphuniu
tracntrng.
WHO (1995), Guideline for Dengue surveillance and
mosquitocontrol,WorldHealthOrganiztion.
WHO (1997), Dengue haemorrhagic fever: diagnosis,
treatment,prevention,andcontrol,Geneva.
WHO (2008), Asia Pacific Dengue program managers
meeting,WorldHealthOrganization.
ChuynYTCngCng
NghincuYhc
MHNHXLARSENTRONGNCNGM
PDNGCHOCPNCTPTRUNGTIXTNLONG,
HUYNTHANHBNH,TNHNGTHP
ngNgcChnh*,NguynTrnBoThanh*,NguynQucThng*
TMTT
tvn:HintngnhimArsentrongncngmtingThpvnhhngcanlnsckhe
ngidnccnhbo.MttrongnhngiuquantrngnhthinnaylxlArsentrongncngm
bovsckhengidn.Do,nghincunycthchinnhmadnghaccloihnhxl
Arsentrongngunnc,ngthigimthiutchicaArsenvcungcpngunncsch,antoncho
ngidnvichiphxlthp.
Mctiunghincu:XydngmhnhxlncngmnhimArsenpdngchohgianhvng
nngthnkhuvcngbngsngCuLong.nhgihiuqucamhnhxlArsenpdngchohgia
nh.
Phngphpnghincu:Nghincungdng:mhnhxlArsencnghincuxydngtix
TnLong,huynThanhBnh,tnhngThpnictrmcpnctptrungdi500ngicngunnc
tncgingbnhimArsenvihmlng500ppb.
Ktqunghincu:MuncgingkhoansaukhixlcccchtiulhacphntchtQuy
chunkthutqucgiavchtlngncnungdoBYtbanhnh.Hiuquxlccchtiukimloi
nng t trn 99%, hiu qu x l st l 99,53%, Arsen l 100%; cc kim loi nng khc, phenol v PAHs
khnghindintrongmusauxl.
Ktlun:MhnhxlArsentrongncngmpdngphngphpoxyhokthpkeottobng,
lngvlcchothiuquxlcao,cchiphxlthpvphhpviaphng.
Tkha:MhnhxlArsen,Arsentrongncngm.
ABSTRACT
THEMODELOFREMOVINGARSENICINTHEUNDERGROUNDWATERAPPLIEDFORTHE
WATERSUPPLYATTANLONGCOMMUNE,THANHBINHDISTRICT,DONGTHAPPROVINCE
DangNgocChanh,NguyenTranBaoThanh,NguyenDoQuocThong
Background:Arseniccontaminationofundergroundwateranditseffectonpeopleshealthhasbenwarned.
Currently, one of the most important thing is to remove Arsenicfrom groundwater sources to protect human
health. Therefore, this study was conducted to identify a proper model of removal Arseniccontaminated
underground water applied for the water supply at Tan Long Commune, Thanh Binh District, Dong Thap
Province.ThefindingswereusedtominimizetheharmfuleffectsofArsenicandsupplycleanandsafewaterfor
localpeoplewithlowestprocessingcost.
Objectives:FormulateapropermodelofremovalArseniccontaminatedundergroundwaterandapplythis
modelfortheruralhouseholdsintheMekongDeltaarea.Theeffectivenessofthemodelwasalsoassessedinthis
study.
*
KhoaSckhemitrng,VinVsinhYtCngcngTp.HCM
Email:dangngocchanh@ihph.org.vn
ChuynYTCngCng
401
NghincuYhc
Method: ThiswasanappliedstudyinwhichamodelofremovalArsenicwas made at Tan Long Ward,

ThanhBinhDistrict,DongThapProvince,wherethewatersupplythatprovidedwaterforapproximately500
peoplecontaminatedwith500ppbArsenic.
Results:Thewatersamplesfromthedrillingwells,afterbeingtreated,hadthephysicochemicalparameters
meeting the national technical standards issued by the Ministry of Health. The effectiveness of treating heavy
metal, iron and Arsenic were significant high (over 99%, 99.53%, and 100%, respectively). After treatment,
therewasnoexistenceofheavymetals,phenolandPAHsinthesamples.
Conclusion:ThemodelofremovingArsencontaminatedundergroundwaterthatutilizedtheoxidization
method in combination with flocculation, accumulation and filtering has high effectiveness of removing heavy
metal,lowcostandsuitabletolocalconditions.
Keyword:Arsenicremovalmodel,Arsenicinundergroundwater.
b nh hng bi nhim Arsen trong nc
TVN
ngmcao (tlsmutcchmlngArsen
VnnhimArsentrongncngmv
vttiuchunchim48%)(5).ticthc
nhhngcanlnsckheconngiang
hin nhm gp phn a dng ha cc phng
lsquantmcanhiuqucgiatrnthgii
php x l Arsen trong nc, ng thi gim
trongcVitNam.HinnaytiVitNams
thiutchicaArsenvcungcpngunnc
ngi c nguy c mc bnh do tip xc vi
sch, an ton cho ngi dn vi chi ph x l
Arsenlnti17triungi(chim21,5%dn
thp.
sVitNam)(1).
nhim Arsen trong nc ngm Vit
Nam c cnh bo. Theo nghin cu ca
Trng S (1997), hm lng Arsen trong
ncngmmtsvngminBcl0,001
0,32mg/lvmtsninhVitTr,HNi,
Hi Phng c hm lng Arsen trong nc t
0,0140,034mg/l(3).MtnghincukhccaL
HongNinh(20052006)choktqunhsau:
tnhLongAnc420mu(8,61%);ngThpc
369 mu (12,47%); An Giang c 545 mu
(20,18%);KinGiangc115mu(3,79%)chm
lng Arsen vt mc tiu chun cho php l
10ppb(4).Vvy,vnnghincumhnhx
l Arsen trong nc ngm p dng cho cp
nctptrungtikhuvcngbngsngCu
Long l cn thit. Chng ti tin hnh nghin
cu th im ti x Tn Long, huyn Thanh
Bnh,tnhngThp.NgidnxTnLong
gp rt nhiu kh khn do khan him ngun
nc sch cho sinh hot v n ung do ngun
ncmtvncngmubnhim.Xc
tlsmuncngmbnhimArsenvimc
nhim l t 70 650 ppb l 62,50%(4). c bit
TnLonglmttrongnhngxmngidn
402
Mctiunghincu
Xy dng m hnh x l nc ngm

nhim Arsen p dng cho h gia nh vng
nngthnkhuvcngbngsngCuLong;
nhgihiuqucamhnhxlArsen
pdngchohgianh.
ITNGPHNGPHPNGHINCU
itngnghincu
Trmcpnctptrungkhuvcnngthn
cngunncngmbnhimArsen.
abnnghincu
ChnxTnLong,huynThanhBnh,tnh
ng Thp ni c trm cp nc tp trung
di500ngicngunncngmbnhim
Arsenvihmlng500ppb(0,5mg/l).
Phngphpnghincu
Nghin cu ng dng: Xy dng m hnh
x l Arsen p dng thc t v nh gi hiu
qucamhnh.Nghincugm2giaion:
Khostaimthchin,nhgicht
lngnctrcxl:thng7nm2011.
ChuynYTCngCng
Tnh ton thit k, xy dng m hnh v
nhgihiuquxlArsencamhnh:t
thng8nthng9nm2011.
Ly mu, phn tch mu nc nh gi
trcvsaucanthipviccchtiu:musc,
c,sunfate,pH,cngtngcng,clorua,
st tng s, ch s Permanganate, Amoni,
Mangan, Nitrite, Nitrate, Nhm, Crom, km,
ng, Phenol, Arsen, ch, Cadimi, thy ngn,
PAHs.
Tiu chun nh gi cht lng nc:
QCVN01:2009/BYTQuychunkthutquc
giavchtlngncnungdoBYtban
hnh(2).
Chiphxl1m3nc=Tngchiphlu
lngxl(vn/1m3nc).Trong,tngchi
ph=(Chiphuththngninhnthit
k)+(Chiphinvhacht)
KTQUNGHINCUVBNLUN
c im a im xy dng m hnh v
ngunnctrccanthip
MhnhxlArsencxydngtih
NguynVnMinhviquymcpncchogia
nhvkhong20hngidnsdngxung
quanhtixTnLong,huynThanhBnh,tnh
ngThp.Ngunncthdngcpncl
nctgingkhoancbmlnbchav
cpchocchdnxungquanh,khngqua x
l.
NghincuYhc
Cloramin, clorua vi, cc hp cht cha clo,

KMnO4,oxalic,brom,iod,...Saukhixemxttnh
cht ha hc v kh nng p dng thc t.
NhmnghincuchnCloruavivylhp
chtoxyhamnhvckhnngnnhpH
canc,dtmtrnthtrng.
Cchpchtkeotthngdnggm:phn
nhm, phn st, PAC, polymer anion, polymer
cation,... Trong s cc hp cht k trn, phn
PACckhnngkeottrongiukinkhong
pHrng,khngnhhngnchtlngnc
saukhikeot.
XcnhlngCloruavitiu
Cc th nghim c tin hnh 3 ln
khng nh chnh xc. Kt qu th nghim
cho thy, vi hm lng Arsen trong nc t
0,102,00mg/lth300mgCloruavischuyn
ha hon ton As (III) thnh As (V) v hm
lng clo d trong nc sau 10 pht l 0,30
mg/l, p ng theo QCVN 01:2009/BYT Quy
chunkthutqucgiavchtlngncn
ung.
Bng1:KtquthnghimxcnhlngClorua
vitiu
Hm
lng As
chun
(mg/l)
0,10
0,20
0,30
0,40
0,60
0,80
1,00
1,20
1,40
1,60
2,00
Lng Clorua vi cn thit

(mg)
20
25
100
150
200
300
+
-
+
+
-
+
+
+
-
+
+
+
+
+
-
+
+
+
+
+
+
+
+
+
+
+
Kt qu phn tch mu nc ging khoan

trccanthipchothy,muncgingkhoan
cccchtiu:musc,c,hmlngst
tngs,hmlngamonivhmlngArsen
vt qu gi tr gii hn cho php theo Quy
ung QCVN 01:2009/BYT. C th, hm lng
Arsentrongngunncngmkhostl0,453
mg/l, vt 45,3 ln so vi tiu chun cho php
caBYtl0,01mg/l.
(+):As(III)chuynhahontonthnhAs(V).
Ktquchnlahacht
XcnhlngphnPACtiu
C rt nhiu hp cht oxy ha c th la

chn s dng cho nghin cu: Cloramin B, bt
Thc hin th nghim Jartest xc nh

lng phn ti u. Da vo bng kt qu th
ChuynYTCngCng
Ghich:
():As(III)khngchuynhathnhAs(V).
403
NghincuYhc
nghim(Bng2),chnlngphnPACcns
dngl200mg(ngvi1ltnc).
Bng2:KtquthnghimlngphnPACtiu
Thi gian keo
t
(pht)
1
2
3
4
5
20
-
Lng phn PAC cho vo

(mg)
50
100
200
+
-
PhngnxydngmhnhxlArsen
chotrmcpnc
T kt qu phn tch mu nc trc can
thip, nhm nghin cu ra phng n xy
dngmhnhxlArsenchotrmcpncti
hNguynVnMinhviscngnghnh
sau:
Nc ging khoan
b nhim Arsen
Ca(OCl)2
Ginma
Bcha
PAC
Cn lng
Bkeotkthp
2ctlcplc
Nc ra
Ncsauxl
tQCVN01:2009/BYT
Ghi
ch:
ngicanc
ngicahacht
trnh oxy ha st. Nc t gin ma s chy

xungbchavithigianlucnthitqu
trnhoxyhadinrahonton.
Saubcha,nccbmsangbkeot
kt hp lng. Cht keo t s dng l PAC
(polyaluminumchloride)dotnhchttlmthay
i pH ca nc. Mc ch ca b ny l hnh
thnhccbngcn,kttalngArsen(V),st
cngcccnbnllngkhcctrongnc.B
gm c 4 ngn: ti ngn u tin s tin hnh
chmPACvkhuytrn,ncsaungntrns
tchysangngnth2,tiyxyraqutrnh
phnng,hnhthnhbngcn,phnlnbng
cnhnhthnhslngxungytingnth2;
sau nc tip tc t chy sang ngn th 3,
mtphnbngcncnstlislngxungy
ditcdngcatrnglc.Nctngnth3
schysangngnth4(ngncuicng)ctc
dngnhbchatrunggian,nctngnny
scbmsang2ctlcplc(ctlcctv
ct lc than hot tnh) loi b hon ton
lng cn l lng cn li trong nc trc khi
c bm ln bn cha nc tp trung v cp
chocchgianh.
nhktinhnhxbcntingnth2,
3,4cabkeotkthplng.
Tinhnhralcnhkti2ctlcplc
mbohiuquxlcablc.
Kt qu thu c t th nghim Jartest cho
liulnghachtsdngnhsau:Ca(OCl)2:
0,3g/20lt;PAC:0,2g/20lt.
Hnh1:ScngnghxlArsenchotrmcp
nctptrung
Cht oxy ha mnh l Clorua vi Ca(OCl)2
c s dng chuyn ha Arsen (III) thnh
Arsen (V). Clorua vi c chm trc tip vo
ngngtinhnhhatrntrckhic
bmlnginmanhmtndnglngoxyc
trongkhngkhtnghiuqucaqutrnh
oxy ha Arsen (III) thnh Arsen (V) v c qu
404
Hnh2:MhnhcngnghxlArsenchotrm
cpnc
ChuynYTCngCng
Bn cnh , kt qu phn tch mu nc

cnchothygitrpHtrcvsauxlkhng
cs khc bit, pH ca nc n nh, nc c
tnhtrungtnh,tgitrgiihntheoquynh
caQuychunkthutqucgiavchtlng
ncnungcaBYt(QCVN01:2009/BYT).
Ccchtiulhacamugingkhoansaukhi
x l nh mu sc, c, sunphat, cng
tngcng,clorua(mn),oxyha(Chs
permanganate),amoni,NitritvNitratcngt
Quychun.
0.5
100
0.45
90
80
70
0.3
60
0.25
50
0.2
40
0.15
30
0.1
20
0.05
10
Hm lng As
Hiu qu x l
H i u q u x l (% )
0.4
0.35
0
u vo
Ngn 1
Ngn 2
Ngn 3
Ngn 4 Sau khi lc

nc
Hnh3:nhgihiuquxlhmlngAs
trongnc
300
100
90
250
80
60
150
50
40
100
H i u q u x l ( % )
70
200
H m l n g ( m g /l)
Mu nc ging khoan trc x l c hm

lng Arsen ln hn gi tr gii hn ca Quy
ungQCVN01:2009/BYTn45,3ln.Saukhi
c oxy ha bng gin ma, nc c dn
chy vo ngn 1 (ngn chm phn PAC v
khuytrn).TiyhmlngArsenoc
tingn1l0,40mg/l.Ncsaungn1tchy
qua ngn 2 (hnh thnh bng cn v lng cn)
hmlngArsentrongnctingn2cnli
l0,25mg/lvhiuquxltigiaionnyl
44,81%. Sau , cc bng cn cn st li s va
vo vch ngn v lng xung y b ti ngn
th 3, hm lng Arsen trong nc ti ngn 3
ocl0,10mg/l,hiuquxltingnny
tng ln l 77,92%. Nc t ngn 3 tip tc t
chy sang ngn 4, kt qu kim tra hm lng
Arsen trong nc ti ngn 4 l 0,02 mg/l, ln
hngitrgiihnchophp2ln.Hiuqux
l giai on ny l 95,58%. Nc ti ngn 4
cbmquahthngctlcplc,lymu
ncsaukhiquahthngctlckimtrahm
lngArsen,ktquchothykhngcshin
dincaArsentrongmunc.Hiuquxl
t100%.
H m l n g A s (m g / l)
nhgihiuquxlcamhnh
NghincuYhc
30
20
50
10
0
0
Mu
Cng
Clorua
Amoni
Trc x l
Sau x l
Hiu qu x l
Hnh4:nhgihiuquxlccchtiulha
nc
So snh kt qu phn tch cho thy, mu
nc trc x l c ch tiu mu sc, c,
amoni c gi tr ln hn tiu chun nhng sau
khi qua h thng x l gi tr ca cc ch tiu
trnuthphnsovitiuchun.ngthi,
hthngxlcnckhnngloibc
cng v mn ca nc. Hiu qu x l cc
chtiulhaltrn90%.Cth,hiuqux
l ch tiu mu sc l 100%, c l 96,5%,
amonil90,83%,cngl95%vmnca
ncl99,83%.
Mu nc ging khoan trc x l c hm
lngsttngsl4,29mg/llnhngitrgii
hn ca Quy chun 14,3 ln. Sau khi qua h
thngxl,hmlngsttrongnccnlil
ChuynYTCngCng
405
NghincuYhc
0,02mg/l,hiuquxlstl99,53%.Cckim
loi nng khc (Mn, Al, Cr, Zn, Cu, Pb, Cd v
Hg),phenolvPAHskhngcxuthintrong
musauxldocthnirnghochts
dngchoxlnclanton.
100
90
3.5
80
70
2.5
60
50
1.5
40
30
0.5
20
10
Fe
Mn
Cr
Zn
Cu
As
Pb
Cd
Hg Phenol PAHs
Nh vy, chi ph x l 1 m3 nc =
22.962.0008.760=2.612ng/m3
KTLUN
M hnh x l Arsen trong nc ngm p
dngchohgianhvngnngthnkhuvc
ng bng sng Cu Long s dng phng
phpoxyhokthpkeottobng,lngv
lcchohiuquxlArsent100%.
H iu qu x l (% )
H m l ng (m g/l)
4.5
Tng chi ph = (114.500.000 5) + 62.000 =

22.962.000ng
Hiuquxlccchtiulha(musc,
c,sunphat,cngtngcng,clorua(
mn),oxyha(Chspermanganate),amoni,
NitritvNitrat)ltrn90%.
Trc x l
Sau x l
Hiu qu x l
Hnh5:nhgichtlngccchtiukimloi
nngvcchtcanc
Nh vy, ngun nc ging khoan sau khi
c x l m bo an ton v mt ha hc,
thamnccnhucuvncnungphcv
sinhhotcaccitngdngnc.
Chiphxl
Hiuquxlloibstcahthngxl
l 99,53%. ng thi, cc kim loi nng khc
(Mn, Al, Cr, Zn, Cu, Pb, Cd v Hg), phenol v
PAHs khng pht hin thy trong ngun nc
saukhiquahthngxl.
TILIUTHAMKHO
1.
2.
3.
Mhnhxlcccthngsnhsau:
Ninhnthitk:N=5nm
Lu lng x l: Q = 1 m3/gi = 8.760
m3/nm
Chi ph u t xy dng h thng x l =
114.500.000ng.
4.
5.
BYt(2008),TnhhnhnhimArsentrongncngm,H
Ni.
B Y t (2009), Quy chun k thut quc gia v cht lng
ncnung,sQCVN01:2009/BYT,HNi.
TrngS(1997),Bocohintrngnhimngunnc
biArsenHNivmtsvngphcn,Vinnghincu
achtvkhongsn.
L Hong Ninh (2006), Kho st nhim Arsen trong nc
ngmti4tnhngbngsngCuLong,Nhxutbny
hc.
LHongNinh(2010),nhimArsentrongncngmti
cctnhkhuvcngbngsngCuLong,Nhxutbny
hc.
Chiphinvhacht=62.000ng/nm
406
ChuynYTCngCng
NghincuYhc
BINIKHHUVTNHHNHSCKHECANGIDNTI
MTSXVENBINTNHBNTRE
ngNgcChnh*,LNgcDip*,NgKhn*
TMTT
tvn:Trongccthpkgny,ccthintainhbo,lt,xmnhpmn...xyrathngxuyn
hnvkhdon.Trong,BnTrecnhgilmttrongnhngtnhbnhhngnngvngidn
ticcvngvenbinschunhhngtrctipvnngnnht.Do,nghincuvtcngcabini
khhu,cthltcnglntnhtrngsckhecangidnhinangsinhsngtrnkhuvcvenbinl
mtiuhtsccnthittctharaccchnhschchinlcphhpnhmngphkpthivi
nhngthayitrn.
Mctiu:nhgimcbinithititvtnhtrngsckhocangidnticchuynvenbin
tnhBnTre.
Phng php nghin cu:Phngvnthngquabngcuhikthpvithuthpsliutitrmkh
tngthyvntnhBnTre.
Ktqu:SliucungcpttrmkhtngthyvntnhBnTrechothymcnhittrungbnhcatnh
BnTrehinnaycaohn5nmtrct0,20,50C.Mcncti2khuvcsngHmLungvsngC
Chinangckhuynhhngdnglnvmcnhimmngiatngrrt.Tlmcccbnhclinquan
haychunhhngdotnhtrngbinikhhuticcxuchimtrn80%,cbitmtsbnhnh
tiuchy,cmvtaimihng.
Ktlun:Ktquphntchkhtngthyvnchothydinbincakhhuthititcsthayiqua
ccnm,tlmcccbnhclinquanhaychunhhngdotnhtrngbinikhhuticcxvenbinti
ykhcao.
Tkho:binikhhu,tnhhnhsckho,vngvenbin.
ABSTRACT
CLIMATECHANGEANDHEALTHSTATUSOFPEOPLELIVINGINCOASTALCOMMUNES
OFBENTREPROVINCE
DangNgocChanh,LeNgocDiep,NgoKhan
Background: Inrecentdecades,naturaldisasterssuchasstorm,floods,salinizationoccurmoreoftenand
difficulttopredict.BenTreisoneoftheprovinceswhicharemostaffected,andsocoastalcommunityisaffected
directly and most severely. Therefore, research on the impacts of climate change, particularly effects on health
statusofpeoplewholivingincoastalareasisverynecessary.Baseonthisresearch,somepolicieswhichmaybe
appropriateforclimatechangeadaptationcanbegivenout.
Objectives:AssesstheweatherchangesandhealthstatusofpeoplewholiveincoastalcommunesofBenTre
province.
Method:InterviewingwithdesignedquestionnairesandcollectingdatafromBenTremeteorologicalcenter.
KhoaScKheMiTrng,VinVSinhYTCngCngTPHChMinh
Email:ngngocchanh@ihph.org.vn
ChuynYTCngCng
407
NghincuYhc
Results:MeteorologicaldatashowthatthecurrentmeantemperatureofBenTreis0.20Cto0.50Chigher
than5yearsago.WaterlevelsinHamLuongriverandCoChienriveraretendingtoriseandsalinitylevels
increasedmarkedly.Theincidenceofdiseaseswhicharerelatedoraffectedbyclimatechangeismorethan80%,
especiallyinsomediseasessuchasdiarrhea,cold,ear,noseandthroatdiseases.
Conclusion: The analysis shows that meteorological evolution of climate has changed from years. The
incidenceofdiseaseswhicharerelatedoraffectedbyclimatechangeincoastalcommunescommunityishigh.
Keywords:climatechange,healthstatus,coastalarea.
sccnthit,tctharaccchnhsch
TVN
chinlcphhpcthngphkpthi
Binikhhungycngtrthnhvn
vinhngthayitrn.
thch thc to ln c ton cu quan tm, cc
Mctiunghincu
nh khoa hc tm ra mi lin quan cht ch
Mctiutngqut
giakhhuaphngnhhngnsxut
hinhaymcnghimtrngcamtsbnh
nh gi mc bin i thi tit v tnh
v cc mi e da khc i vi sc khe con
trngsckhocangidnticchuynven
ngi.TchcYTThGiictnhrng1/4
bintnhBnTre.
gnh nng bnh tt ca th gii l do nhim
Mctiucth
khngkh,t,ncvthcphm,cckhuvc
nhgimcbinithititthayi
b nh hng nng n nht bao gm chu Phi,
trong5nmt20062010.
tiulcanvtingNam(2).TiVit
Khosttnhtrngsckhocangidn
Namtrongkhong50nmqua,nhittrung
ti4xvenbinthuchuynThnhPhvBa
bnh nm tng ln khong 0,30,50C, mc
Tri,tnhBnTre.
(4)
ncbindnglnkhong20cm .Bini
khhulmchoccthintai,cbitlbo,
l,hnhnngycngclit.Nhngyut
s lm gia tng ngp lt, xm nhp mn, lan
trnchuaphnvdntinhnghlykhc
nhlmgiatngccrirovsckhedocc
tnngnnggaygt.Mtnghincuchothy
numcncbindngcao1msnhhng
khong 5% din tch t ca Vit Nam v 11%
dn s c nc(3). Trong cc thp k gn y,
yu t kh tng thy vn ti vng ng bng
sng Cu Long tip tc thay i theo chiu
hngxu.Ccthintainhbot,ltli,xm
nhpmn...xyrathngxuynhnvkhd
on. Kho st ca Vin Khoa hc Kh tng
thyvnvmitrngchobittiBnTremc
nc bin dng ln khong 20cm, nhim
mntnglnkhong20%sovitrc10
nm(nm1990)vhintngthititccoan
xuthinngycngnhiu(4).Nghincuvtc
ngcabinikhhu,cthltcngln
tnh trng sc khe ca ngi dn hin ang
sinhsngtrnkhuvcvenbinlmtiuht
408
Kho st tnh hnh thc hnh v sinh gip

phng nga bnh ca ngi dn ti 4 x ven
binthuchuynThnhPhvBaTri,tnhBn
Tre.
ITNGPHNGPHPNGHINCU
aimnghincu
Huyn Ba Tri: X Huyn Thnh Ph: x
ThnhHivThnhPhong.
HuynBaTri:xBoThunvAnThu
Phng vn trc tip ngi dn thuc 4 x
venbinca2huynBaTrivThnhPhtnh
Bn Tre. i tng phng vn l nhng ngi
hinangsinhsngtitnhBn Tre t 16 tui
tr ln, u tin ph n c tui nhm cung cp
ythngtinvtnhhnhsckhocacc
thnhvintronggianh.
ChuynYTCngCng
Thng 3 nm 2006 huyn Ba Tri chu nh

hng ca cn bo s 9 hot ng trn bin
nggyramatonnlmtnglngma
vothiimnylnn92,8 mm. Cc thng
cnlitrongmakhhunhkhngcma.
Theosliubococacctrmytx,tix
Bo Thun ca huyn Ba Tri t nm 2007 n
2009 u b thit hi v ngi do thin tai. C
th,trongnm2006tixc11ngibthng,
1ngicht.Nm2007l36ngibthngv
4 ngi cht. Nm 2008 c 12 ngi b thng
v1ngichtvtrongnm2009l4ngib
thngv2ngicht.
KTQUNGHINCUVBNLUN
Tnhhnhkhtngthyvn
Sliucungcpttrmkhtngthyvn
tnhBnTrecngchothytnhhnhdinbin
thay i ca kh hu thi tit qua cc nm. So
snhvinhitticaotrungbnht2001n
2005 th mc nhit ti cao trung bnh trong
khong thi gian t 2006 n 2010 cao hn
6,4 0C. Mc nhit trung bnh ca tnh Bn Tre
caohntrct0,20,5 0C.cbitvocui
ma kh 2009, nhit tng cao n 36,50C.
ng thi mt din bin bt thng khc vo
gia ma ma nm 2010 nhit cao nht l
36,2 0C, y l mc nhit cao nht vo nhng
thngmamatrong5nmt2006n2010.
Mamanm2009vnm2010huynBa
Triclulngmathpnhttrong5nmt
2006 2010 ch c 78,5 mm. Trong thi im
gia ma ma t 2006 2009 (t thng 5 n
thng9hngnm),lulngmathpnhto
c l 200 mm v cao nht l 358 mm. Tuy
nhin trong nm 2010 lng ma din bin c
phn bt thng hn, c th l vo thi im
giamama,lngmaocthpnhtl
78,5mmvcaonht288,2mm.
31
30
29
N hit (oC )
NghincuYhc
28
27
26
25
24
1
10
11
12
Thng
2006
2007
2008
2009
2010
Hnh1:Binthinnhittrungbnhthngtrong5nmt20062010titnhBnTre
Ngun:TrungtmkhtngthyvntnhBnTre
450
400
400
350
350
L n g m a (m m )
450
300
L n g m a (m m )
300
250
250
200
200
150
150
100
100
50
50
0
1
5
2006
6
2007
7
2008
8
2009
10
11
12
2010
HuynThnhPh
5
2006
6
2007
7
2008
8
2009
9
2010
10
11
12
HuynBaTri
Hnh2:Binthinlngmati2huynt20062010
Ngun:TrungtmkhtngthyvntnhBnTre
ChuynYTCngCng
409
NghincuYhc
Kt qu thu c ti trm quan trc Hm

Lung v C Chin cho thy mc nc bnh
qun t nm 2006 n 2010 c khuynh hng
tngdnvbindaongtrongnmngy
cng gim dn. Ti trm quan trc C Chin
(huynThnhPh),mcnctrungbnhthp
nht trong nm 2006 l 23cm v cao nht l
36cm;nnm2010mcncthpnhtl10
cm v mc nc cao nht trong nm l 42 cm.
Tng t, ti trm quan trc Hm Lung, t
nm2006nnm2010mcncthpnhtl
tng ln ng k t 25cm ln 8cm v mc
nc trung bnh cao nht tng t hn, t 41cm
ln43cm.iunychothymcncti2khu
vcsngHmLungvsngCChinangc
khuynh hng dng ln, gy nguy c xm ln
nh hng n i sng ca ngi dn ti
huynBaTriniringvngidnticcvng
venluvcsngnichung.
50
40
40
30
30
20
20
10
10
2006
2007
2008
2009
2010
Cm
Cm
50
-10
-10
-20
-20
-30
-30
HuynThnhPh
TihuynThnhPh,mncaonhtxy
ravokhongt thng 3 v thng 4 mi nm,
daongt26,1(nm2009)n29,6(nm
2007). c bit trong nm 2010 mc nhim
mnckhuynhhngtngvttritthng5
n thng 7 trong khi mc nc sng gim
khngngksoviccnmtrc.Sovi
huynThanhPh,tiBaTrimcnhimmn
tiykhcaovcngtngdnrrttheocc
nm.Trongmntnhcaonhttrong
sut 5 nm kho st l 30 vo thng 3 nm
2010, tng 6,1 so vi thng nhim mn cao
nhtcanm2006.Vitnhhnhtipdinnh
trnsgynhhngkhnghimtrngivi
hsinhthingthcvt,ngthibncnh
snhhngnisngkinhtcangi
dntiy.Chnhvvyngidnvcccp
chnh quyn cn c cc bin php khc phc
ph hp, thay i c cu sn xut kinh t, h
sinhthingthcvtnhmthchngvgim
thiu tc hi vi tnh hnh bin i nh trn.
HuynBaTri
Hnh3:Mcncbnhqunti2huyntnm2006n2010(Ngun:TrungtmkhtngthyvntnhBn
Tre)
35
30
25
20
15
10
5
0
2
Thng
HuynThnhPh
410
HuynBaTri
ChuynYTCngCng
NghincuYhc
Hnh4:Dinbinmnlnnhtcathngtnm20062010(Ngun:TrungtmkhtngthyvntnhBnTre)
Tnhhnhbnhtt
Tinhnhnhgichtlngngunnc
ngmtixThnhHivThnhPhongcdu
hiunhimArsen.Cth,xThnhHic5
mu nc ngm c ngi dn s dng cho
mc ch sinh hot b nhim Arsen vi hm
lngthpnhtl0,086mg/l,caonhtl0,267
mg/lvxThnhPhongc1muncngmb
nhimArsenvihmlngl0,061mg/l.Trong
khi , gii hn cho php s hin din ca
Arsen trong nc sinh hot theo QCVN
02:2009/BYT l di 0,05 mg/l. Bn cnh ,
ngunncngmdngchomcchsinhhot
chmlngNitritvNitratlkhcao,haicht
Nitrat v Nitrit u c kh nng to hp cht
Methaemoglobin,tcnhngybnhthiumu,
xanh xao. Ti x Thnh Phong c 15/20 mu
nc ngm c gi tr CNitrat/GHTNitrat +
CNitrit/GHTNitrit>1,tronggitrnythpnht
l 1,08 v cao nht l 9,70. X An Thy l 8/20
mu,xThnhHi7/20muvxBoThunl
5/20mu.
Tuy nhin, thi quen trong s dng
ncnungcangidnngun nc ma
vnngvaitrchyu,t l h ch s dng
nc ging cho mc ch n ung chim 8,8%
tihuynThnhPhv5,8%tihuynBaTri.
100
huynThnhPhcaogp1,6ln,taimihng
caogp1,8lnvtiuchygp1,9lnsoviBa
Tri(hnh6).Sngimcccbnhvngh
hpnhcmvtaimihngchimkhlntrn
mhnhbnh,ccbnhlinquanntimmch
nh cao huyt p v cc chng bnh tim khc
cng chim t l tng i ln trn m hnh
bnhthuthpctiy.Theoccchuyngia
nghincu,cctnngnngkodi,nhit
khngkhtnggynnnhngtcngtiucc
i vi sc kho con ngi, to c hi cho
chnghensuyn,ccbnhvnghhptn
cngvbncnhcngiatngmtsnguy
cnhhngntnhtrngcangibnhtim
mch(1).Ktqukhtngthyvnthuc
trn cng cho thy rng qua cc nm nhit
ang tng ln r rt, tng lng ma trong
nhng nm t 2006 n 2008 tng cao v
gim xung t ngt trong nm 2009 v 2010.
Nh vy, vi din bin thi tit nng nng gia
tngkthpvisthayivlngmatng
vomamavgimvomakhstcng
nsckhecaconngi.Nhtlticckhu
vc ven bin, tc ng ca bin i kh hu s
gynhhnglnhnnanccitng
ny, c bit l hn ch v mt dinh dng v
iu tr cc i tng c iu kin kinh t
thp.
250
87.5 85.67
80
200
60
Thnh Ph
Ba Tri
%
40
150
100
13.67
11.33
Thnh Ph
Ba Tri
122
19.67
20
203
0.17
7.83 11.5
0 0.17
55
38
50
21
Nc my
Nc ma
Nc ging
Nc ung Nc ao. h
ng bnh
Hnh5:Tnhhnhsdngncchomcchn
ung
i vi tnh hnh bnh tt, nhn chung s
lng ngi dn mc bnh ti cc x ven bin
ca huyn Thnh Ph cao hn ng k so vi
huyn Ba Tri. C th, t l mc bnh cm ti
ChuynYTCngCng
86
85
Cm
28
22
7 2
Tai mi Tiu chy Da liu

hng
54
25
Vim C xng Huyt p

xoang
khp
24
25
Tim
Hnh6:Tnhhnhmcbnhcacangidnti
huynThnhPhvBaTri
Tuynhintlmctiuchytrongvng1
nm trc thi im kho st c 2 huyn
tng i thp (chim 2,27% ti Thnh Ph v
411
43
NghincuYhc
3,67% ti Ba Tri), iu ny mt phn do tnh

hnhsdngncdngchomcchnung
u l nc ma hoc nc ging qua un
nu.Thmvo,ccthiquenxtrthcn
thahngngycangidn(hnh7)chothy
rngasutunthkhtt,phnlnthc
n tha c hm nng trc khi n hoc
khng thc n tha vo cc ngy k tip,
ring ch c 2 h ti mi x Thnh Phong, Bo
ThunvAnThuchambocvn
trn.
80
58.83
57.17
60
Thnh Ph
40
20
19.83
11.67
18.67
13.50
Ba Tri
17.00 24.33
0.33 0.67
Khng c
thc n tha
B i
Cho sc vt n
Hm li vo
bui k tip
n li khng
cn hm
Hnh7:Thiquenxtrthcnthahngngy
cangidn
T bng 1 cho thy trn s ngi dn
sng ti cc x ven bin trn 2 huyn chn la
nkhmchabnhltrmyt,mcdlni
ctrangbmymcthitbnhiuhnnhng
tlnkhmtitrungtmythuynvbnh
vinlikhthp.Nguynnhndoylccx
venbincchxatrungtmhuyncngnhth
x,ivingidntihuynThnhPhc
th n bnh vin hay trung tm y t huyn
khm cha bnh phi di chuyn qua ph gy
kh khn trong vic i li. Vic ngi dn tp
trungnkhmtitrmytbncnhvicgip
qunlctnhhnhbnhttcaaphng,
gim c hin tng qu ti cho cc c s
tuyn trn nhng mt khc t ra yu cu cn
phinngcaonnglcchuynmntituynx
cthtmsotchunonbnhkpthi.
Bng1:Tnhhnhchnlaloihnhkhmcha
bnhcangidn
Loi hnh khm
cha bnh
Bnh vin
Trung tm y t
huyn
Trm y t x
Phng khm t
Khc
Thnh Ph
Tn s
T l
(%)
(n= 600)
Ba Tri
Tn s
T l (%)
(n= 600)
92
15,33
32
5,33
44
7,33
35
5,83
513
85,5
76,5
29
1
4,83
0,17
459
72
5
12
0,83
TihuynThnhPh,ascchuc
t nht mt thnh vin trong gia nh mc
bnhvkhong1/6trntngshkhostti
c2xctnht2ngitrongcngmtnh
mc bnh trong nm. i vi huyn Ba Tri,
nhnchungtnhtrngsckhecangidn
ti y kh tt, c khong 60% h ch c 1
thnhvintronggianhmcbnhvkhong
1115% h c t 2 thnh vin trong nh mc
bnh.Tnhhnhbnhttticcxcahuyn
Thnh Ph cao gp 1,3 ln so vi ti Ba Tri,
trong t l mc cc bnh c lin quan hay
chunhhngdotnhtrngbinikhhu
chim trn 80%, cha k n s ln mc ca
cngmtloibnhxyratrongnm.Nh
vytycthphnnothycnguyc
cng nh nh hng ca tnh trng bin i
khhulnsckhecangidntiy.
Bng2:Tnhhnhbnhttcahgianhticcxvenbinca2huynThnhPh,BaTri
X Thnh Hi
X Thnh
Phong
Huyn Thnh
X Bo Thun X An Thu Huyn Ba Tri
Ph
Tng s ngi mc bnh trong

360
374
734
266
291
557
nm
Tng s ngi cc mc bnh c
lin quan/nh hng do bin i 309 (85,83%) 320 (85,56%) 629 (85,69%) 215 (80,83%) 240 (82,47%) 455 (81,69%)
kh hu
Xt mi lin quan gia tnh trng mc cc

bnh c lin quan n tnh trng bin i kh
hu (cm, tai mi hng v cc bnh khc nh
tiuchy,daliuvvimxoang), sovinhm
412
di40tui,tlmcbnhnhmtrn40n
60 tui cao gp 1,16 ln v t l mc bnh
nhm trn 60 tui cao gp 1,85 ln nhng s
khcbitnykhngcnghathngk.Cs
ChuynYTCngCng
khcbitgiatnhtrngkinhtgianhvtnh
hnhmcbnh,nhmcnnghoctlmc
bnhcaogp1,84lnvnhmhnghoctl
mcbnhcaogp1,16lnsovinhmciu
kin kinh t t trung bnh tr ln. iu ny c
th do nhng ngi thuc nhm cn ngho t
c h tr v mt chm sc sc kho hn so
viccnhmcnli.Tuynhinnhngskhc
bitnykhngcnghathngk(p>0,05).
Bng3:Ccyutlinquanvitnhtrngccmc
bnhclinquanntnhtrngbinikhhu
Bnh
Khng
bnh
Tn s (%) Tn s (%)
Tui
T 16 40
177
tui
(36,12%)
313
(63,88%)
T 41 60
183
tui
(37,20%)
309
(62,80%)
PR KTC 95%
NghincuYhc
mcdaonggiamcncbnhqunca
thngcaonhtvthngthpnhtgimdnqua
ccnmkhost.
Mcnhimmnthuctitrmquan
trc Hm Lung v C Chin kh cao v tng
dnrrttheoccnm.
Phnlnngunncsdngchomcch
nungticcxulncmahoc nc
ging.Tlungncunsiticcxkhcao
(chimtrn90%).
Loihnhkhmchabnhthngca
sngidnlachnltrmytx.
Tnhhnhbnhtt:
0,26
1,16 0,89-1,52
Trn 60
76
142
0,16 1,85 0,79-4,32
tui
(34,86%) (65,14%)
Tnh trng kinh t gia nh
T trung
299
553
1
bnh tr ln (35,09%) (64,91%)
Cn ngho
11
11
0,156 1,84 0,79-4,32
(50%)
(50%)
Ngho
126
200
0,256 1,16 0,89-1,52
(38,65%) (61,35%)
Tnh hnh thc hnh v sinh
Tt
207
354
(35,84%) (63,10%)
Cha tt
229
410
0,7 1,024 0,90-1,16
(36,90%) (64,16%)
KTLUN
McnhittrungbnhcatnhBnTrehin
nay cao hn 5 nm trc t 0,2 0,5 0C. C
nhng din bin bt thng vo cui ma kh
2009vgiamamanm2010.
Tnm2006nnm2008,lngmaca
huynThnhPhvhuynBaTrinmsauu
nhiu hn nm trc. Ti huyn Thnh Ph,
lngmanm2009nhiuhnsovinm2010
tuy nhin ti huyn Ba Tri th lng ma din
binngcli.
Mcncti2khuvcsngHmLungv
sngCChinangckhuynhhngdngln,
ChuynYTCngCng
Tlmcccbnhclinquanhaychunh
hngdotnhtrngbinikhhuticcx
u chim trn 80%. S lng ngi dn mc
bnh ti cc x ven bin ca huyn Thnh Ph
cao ng k so vi huyn Ba Tri (gp 1,3 ln).
cbitmtsbnhnhtiuchy,cmvtai
mihng.
Khngcslinquanc ngha thng k
gia tnh hnh mc bnh vi cc yu t nh
nhm tui, tnh trng kinh t gia nh v tnh
hnhthchnhvsinh.
XUTKINNGH
Ccbanngychcnngcnbmstvos
ch o ca Trung ng, hon chnh c cu t
chcngphBKHcatnh.
Tng cng u t cc m hnh im ng
ph BKH; lng ghp thch ng v gim nh
BKH vo cc chng trnh, d n pht trin
kinhtxhicatnh.
Tng cng nng cao nng lc ng ph
BKH cho cc cp, ngnh v n v on th;
tuyntruyn,tphuncckinthccbnv
BKHchocngngdnc.
Xy dng chnh sch h tr v ph bin
rngkhpncchgianhciukinkinh
tkhkhntrongvictipcnviccdchv
chm sc sc kho ti a phng nhm gim
bt gnh nng bnh tt cng nh trnh tnh
trnglylantrongcngng.
413
NghincuYhc
Cn c cc k hoch chnh sch a nc

my vo s dng ti cc h gia nh, khuyn
khchtngtlsdngschtrongnungv
sinhhottrongdn.
Mcclpotongnhnchonhnvin
tuynxnhmnngcaonnglcchuynmn,
mtmttoiukinthunlichongidn
khm cha bnh ti a phng gip gim ti
chocctuyntrn,mtkhcgipchnonv
tmsotbnhkpthichuynlncctuyntrn
khicnthit.
Tngcnghthngqunlcsdliu
v tnh hnh mc bnh ti a phng nhm
cungcpthngtinbanucho vic ng ph
vitnhhnhthayimhnhbnhtttrong
tnglai.
Tngcngtruynthnggiodcsckhe,
lngghpvoccbuisinhhotnhmnhhp
tcap,tnhndntqunnhmnngcao
nhn thc ca ngi dn, phng trnh v ng
phvikhnngphtsinhccdchbnhtrong
tnglai.Cnchnccnidungnh:
Tothiquensdngccngunncsch,
tng t l s dng nc my k c trong n
ung sinh hot, trnh tnh trng ngi dn s
dng nc my trong sinh hot v nc ma
trongnungnhhinnay.
S dng nc hiu qu v tit kim nhm
ngphvitnhtrngkhanhimncdohot
ngnnglncatrittrongtnglai.
Tuyntruynthchnhphngchngbnh
st rt v st xut huyt, loi b cc vt cha
nc quanh nh, khai thng cng rnh v ng
mngkcbanmlnbanngy.
Tch cc ch ng tuyn truyn phng
trnh cc dch bnh c nguy c bng pht ti
aphng.
TILIUTHAMKHO
1.
2.
3.
4.
CDC
(2009),
Health
effects,
http://www.cdc.gov/climatechange/effects/default.htm
Climate
Institute
(2010),
Human
health,
http://www.climate.org/topics/health.html,22/09/2011.
GreetRP(2007),ClimatechangeandhumandevelopmentinViet
Nam:CaseStudyfortheHumanDevelopmentReport2007/2008.
Phm Khi Nguyn (2009), Kchbnvbinikhhu,nc
bindngchoVitNam,BTinguynvMitrng,HNi.
414
ChuynYTCngCng
NghincuYhc
NHGIBINPHPCANTHIPPHNGNGATHACN,
BOPHHCSINHMUGIOTITRNGMUGIO
QUN4,THNHPHHCHMINH,NM2010
PhngcNht*
TMTT
tvn:Thacn,bophlvnytcngcngnitri,cncquantmnhiu.Hinnay,tnh
trngnykhngchgiihnngilnmtlthuctrnhcngngbong.Viccungcpcc
binphpphngngathacn,bophtrvlnggilicvaitrquantrngtrongcngtcylii
dchny.
Mctiunghincu:Xcnhtlthacn,bophvccyutlinquantranghctihaitrng
mmnonqun4,Tp.HCMvnhgitcngcabinphpcanthipphngngathacn,boph
Phngphpnghincu:Nghincucanthipcngng,tinhnhqua3giaion:iutractngang
thuthpsliu,canthip,nhgitcngcanthip.Thigianthchint6/20106/2011,nghincutin
hnhbngcchphtphiuhichophhuynhtmhiunhnnhcahvtnhtrngdinhdngtr.
Ktqunghincu:Tltrbthacn,bophghinhncsaucanthip(38,6%)caohnbanu
(33,8%).Ccyutnhgiitnh,khilp,tcnvnthcnchinxoclinquanntlthacn,
boph(p<0,05).Tlkinthcngcaphhuynhvdinhdngvthacn,bophtrthucsaucan
thipcaohnbanu.
Ktlun:Cnduytrccbinphpcanthipphngngathacn,bophthchin
Tkha:Thacn,boph,binphpcanthip
ABSTRACT
ASSESSMENTOFINTERVENTIONMEASURESTOPREVENTCHILDRENSOVERWEIGHTAND
OBESITYINSOMEKINDERGARTENS,DISTRICT4,HOCHIMINHCITY,2010
PhungDucNhat*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:416420
Background: Overweight and obesity are becoming significant public health problems that should be
paidmoreattentionfromcommunity.Theseissuesarecommonlyrecordedinadults,however,thechildrens
overweightandobesitystatushasbeenincreasingatanalarmingrate.Theinterventionmeasurestoprevent
overweight and obesity status in children and assessment after conducting intervention have played an
importantroleindebatingtheseissues.
Objectives:Todeterminethechildrensoverweightandobesityratestudyingintwokindergartensin
district 4, Ho Chi Minh city and the association between this proportion and risk fators that are likely to
causeoverweightandobesity.Theimpactofinterventionmeasurestopreventoverweightandobesityshould
besubsequentlyassessed.
Method: Community intervention study has been implemented through three stages: cross sectional
surveytocollectdata,implementationofintervention,impactevaluationofintervention.Thestudy,carried
outfromJune2010toJune2011andwasconductedbydistributingquestionnairestoparentssothatthey
VinVsinhYtCngcngthnhphHChMinh
Tcgilinlc:Ths.BS.PhngcNht T:0918103404
ChuynYTCngCng
Email:phungducnhat@ihph.org.vn
415
NghincuYhc
canseftassessthenutritionstatusoftheirchildren
Results: The childrens overweight and obesity rate recorded at postintervention was 38.6%, higher
thanthepreinterventionfigure(33.8%).Therewereassociationbetweengender,grade,eatingspeed,greasy
food consuming and overweight and obesity rate, with p value was lower than 0.05. The proportion of
parentshavingtherightknowledgeofnutrition,overweightandobesitypostinterventionwashigherthan
preintervention
Conclusion: Effective intervention measures to prevent overweight and obesity issues in children
shouldbemaintained
Keywords:Overweight,obesity,interventionmeasures
dngvthacn,bophcaphhuynhtr
TVN
trcvsaucanthiptitrngSM12.
Tha cn, bo ph hin ang l i dch
ITNGPHNGPHPNGHINCU
c th gii quan tm(4). Hin nay, tha cn,
bo ph khng ch l vn nghim trng
itngnghincu
thng gp ngi ln m tnh trng ny
Hc sinh trng mm non Sao Mai 12 v
mrngranitngtremvngycng
SaoMai13tiqun4thnhphHChMinh.
giatng.
Nghin cu tnh trng tha cn v bo ph
cadncthnhphHChMinht1996n
2001,TrnThHngLoanghinhnsgiatng
tlthacncatrdi5tui:2,0%nm1996;
2,1%nm1999;3,1%nm2000;3,4%nm2001.
Ringhcsinhnhtr,mugiotrongninhc
2000 2001 qun ven G Vp c t l bo ph
7,9%.CnhcsinhcpI(611tui)qun1ni
thnhnm1997ctlboph12,2%(2).
Cc chng trnh can thip phng nga
tha cn, bo ph cc trng mu gio trong
thigianquacngcthchin,tuynhin
nh gi hiu qu chng trnh can thip ny
th cha c quan tm nhiu, iu ny thc
ychngtitinhnhnghincutiny.
Mctiunghincu
Xcnhtltrthacn,bophanghc
titrngSaoMai12(SM12),SaoMai13(SM
13).
Xcnhmilinquangiatlthacn,
bophtrhctitrngSM12,SM13vcc
yutnguyclinquantnhtrngthacnbo
ph.
nh gi tc ng ca bin php can thip
phng nga: da trn kin thc ng v dinh
416
Phngphpnghincu
Thit k nghin cu: nghin cu can thip

cngng.
Cmuvcchchnmu
Cngthctnhcmu:
Z1/ 2 2P(1P) +Z1 P1(1P1) +P2(1P2)
n=
(P1 P2)2
P = ( P1 + P2 ) / 2
n=sitngcniutra
=0,05
z (1/2) = 1,96 (tra bng phn phi bnh
thng)
z (1 ) = 1,28 (tra bng phn phi bnh
thng).
P1 ltlthacnbophtheobococa
trngmmnonSaomai12tithiimthng
4/2010l11%=> P1 =0,11.
P2 ltlthacnbophmongmunt
c sau khi p dng cc bin php phng
ngathacnbophvotrngmmnonSao
mai12l3%=> P2 =0,03.
Tatnhcn=210tr.
ChuynYTCngCng
Mu c chn theo phng php chn
mutheonvtrngnghincu.Smucn
thitcnhn2vistrngnghincu.Ta
c,smunghincuchomitl210x2=
420 tr. S ln iu tra l 02 t, nn tng s
mul420x2=840tr.
Tiu chun chn i tng vo nhm

nghincu
Giai an 1: Nghin cu ct ngang nh gi
ccsliucbnbanu
Tiuchunchnvonhmnghincu:
ivitrng:nghchncctrng:01
trng can thip (Mm non Sao mai 12), 01
trngichng(MmnonSaomai13).
C s ng tham gia ca Ban gim hiu
nh trng, s gii thiu ca Phng Gio dc
qun4.Haitrngnutrnlhaitrngcc
svtchtkhtt,phhpchovictrinkhai
tngcngvnngchotr.
Trng Mm non c khong 45 tr/1 lp
mm;55tr/1lpchi;50tr/1lpl(Trng
MmnonSaomai12).Nhvytaschnngu
nhin35trtrongmilp.Tachntngcngl
06lp(02mm;02chi;02l)c210trvph
huynh c iu tra ti trng can thip v
tng ng vi khong 210 tr v ph huynh
trngkhngcanthip.
Mu c chn theo phng php chn
mutheonvtrngnghincu.Smucn
thitcnhn2vistrngnghincu.Ta
csmunghincuchomitl210x2=
420tr.Slniutral2tnntngsmu
l420x2=840tr.
Giaion2:Canthiptitrngnghincu:
Truyn thng dinh dng v phng chng
bo ph trong nh trng bng cc ti liu
truyn thng nh t bm, cc thng tin nh
k dn trn bng thng tin ti trng, khuyn
NghincuYhc
khchnhtrngtngcnghotngthlc
chotr.
Truynthngchophhuynh,khuynkhch
gianhtngcnghotngthlcchotr.
Giaion3:nhgitcngcanthip
nhnghathacn
Nguy c tha cn v tha cn l thut
ngcdngchtnhtrngtremccn
nng vt qu mc bnh thng. ngi ln,
o lng tnh trng trn da vo ch s BMI
(body mass index), ta tnh bng cch ly cn
nng tnh bng kg chia bnh phng chiu cao
tnh bng mt(1). Tuy nhin, khi tnh ton trn
i tng tr em, c nhiu khuyn co nn s
dngchsBMItheotuivgiivtnhtrng
thacnhaybophcatrbphthucbitc
ngcayuttuivgii.Theophnloica
Tchcytthgii(5):
Tha cn: >+ 1 SD (tng ng vi BMI
25kg/m2tui19).
Bo ph: >+ 2SD (tng ng vi BMI 30
kg/m2tui19).
KTQU
Bng1:Tlthacn,boph(TCBP)haitrng
mmnonqun4
TCBP
Mm non SM 13
Mm non SM 12 (n=420)
(n=420)
Trc iu Sau iu Trc can
Sau can
tra (n=210) tra (n=210)
thip
thip
(n=210)
(n=210)
C 81 (38,6%) 72 (34,3%) 71 (33,8%) 81 (38,6%)
Khng 129 (61,4%)
138
139 (66,2%) 129 (61,4%)
(65,7%)
TitrngmmnonSM12,tltrbtha
cn, bo ph sau can thip l 38,6% cao hn so
vi t l thu c ban u (33,8%). Trong khi
,ktquthuctrngmmnonSM13
chothytltrbthacn,bophthuc
lniutrasau34,3%thphnsovitlghi
nhncbanu(38,6%).
Bng2:Thacn,bophvccyutlinquan
Yu t nguy c
Gii
Nam
Trng Mm non Sao Mai 13

(trng chng)
Bnh thng
TCBP
65 (51,6%)
61 (48,4%)
ChuynYTCngCng
Trng Mm non Sao Mai 12

(trng can thip)
Bnh thng
TCBP
57 (55,9%)
45 (44,1%)
417
NghincuYhc
N
Lp
Tc n
Thc n
chin xo
64 (76,1%)
20 (23,8%)
26 (24,1%)
Mm
Chi
L
2 = 9,41, p=0,002
55 (74,3%)
19 (25,7%)
50 (68,5%)
23 (31,5%)
34 (53,9%)
29 (46,1%)
Nhanh
Bnh thng
Chm
2 =4,18, p=0,124
15 (34,9%)
28 (65,1%)
62 (60,2%)
41 (39,8%)
52 (81,2%)
12 (18,8%)
2 =6,56, p=0,038
17 (54,8%)
14 (45,1%)
70 (61,4%)
44 (38,6%)
52 (80,0%)
13 (20,0%)
C
Khng
2 = 23,4, p=0,000
50 (52,1%)
46 (47,9%)
79 (69,3%)
35 (30,7%)
2 = 8,49, p=0,014
58 (60,4%)
38 (39,6%)
81 (71,1%)
33 (28,9%)
2 = 6,51, p=0,011
Cskhcbitcnghathngkgiat
l tha cn, bo ph ca tr v cc yu t nh:
gii tnh, khi lp, tc n v thc n chin
xo(p=0,000<0,05).
TitrngSM12(trngcanthip):Tl
nambthacn,bophtrngSM12chim
44,1% trong khi n t l ny ch c 24,1%.
Tr lp mm, chi, l c t l tha cn, bo
ph ln lt l 25,7%, 31,5% v 46,1%. Nhng
tr c tc n nhanh c t l tha cn, bo
phbng45,1%caohnsovinhngtrctc
nbnhthng(38,6%)vchm(20,0%).
Ti trng SM 13 (trng i chng): tr
n thc n chin xo hng ngy (trn 5 ln/
tun) b tha cn, bo ph chim 47,9% trong
khitrkhngnthcnchinxovkhngb
thacn,bophl30,7%.
Bng3:Kinthcngvdinhdngcaph
huynh(n=420)
Kin thc
Trng mm non Sao Mai 12
dinh
Trc can thip Sau can thip
dng
(n=210)
(n=210)
ng
Tn s T l (%) Tn s T l (%)
C
129
61,4
152
72,04
Khng
81
386
59
27,96
0.25
Tlphhuynhckinthcngvdinh
dngsaucanthipl72,04%caohnsovi
ban u (61,4%). Tuy nhin, khng tm c
skhcbitcnghathngkgiakinthc
dinh dng ng trc v sau can thip
(p=0,25>0,05).
Bng4:Kinthcngvthacn,bophcaph
huynh(n=420)
418
82 (75,9)
2 = 12,8, p=0,000
39 (54,9%)
32 (45,1%)
49 (71,0%)
20 (29,0%)
41 (58,7%)
29 (41,3%)
2 = 2,63, p=0,105
Kin thc
Trng mm non Sao Mai 12
dinh
dng
(n=210)
(n=210)
ng
C
176
83,1
183
87,2
Khng
34
16,2
27
12,8
0,725
Tlphhuynhckinthcngvtha
cn, bo ph sau can thip l 87,2% cao hn so
vitrccanthip(83,1%).Skhcbitkhng
cnghathngk(p=0,725>0,05).
BNLUN
Kho st ln u, t l tha cn, bo ph
trngSM13vSM12lnltl38,6%;33,8%.
Saucanthip,tlthuctrngcanthip
tngln38,6%,caohnsovibanu(33,8%).
iunycthdokinthcvdinhdngv
thacn,bophcaphhuynhccithin
nnvictmsotsmtrthacntthn.
Tnh trng tha cn, bo ph ca tr ang
hctrngmmnonSM12trngcanthip
clinquannccyutvgiitnh,khilp
hc,tcn.Trnamctlthacn,boph
l 44,1% cao gn gp i so vi tr n 24,1%
(p=0,002<0,005).Tnhtrngthacn,bophgia
tng theo khi lp (p=0,038< 0,05) theo
nhng tr hc lp mm c t l tha cn, bo
ph (25,7%), lp chi (31,5%) v lp l (46,1%).
KtqunyphhpvinghincuKhost
tnh trng dinh dng v mt s bnh hc
ngcctrngmugioqun4,nm2006
canhmtcgiVNgcThyvPhmLAn,
vitlnambbophcaohnnvtlbo
ph tng theo khi lp(3). Tr n nhanh c t l
ChuynYTCngCng
thacn,bophbng45,1%caohnsovitr
n bnh thng (38,6%) v chm (20,0%). Thi
quennnhanhcatrlyutnguycdnn
tnhtrngthacn,boph.
Tlphhuynhckinthcngvdinh
dngvthacn,bophsaucan thip cao
hn so vi ban u. iu ny cho thy c s
chuyn bin trong nhn thc ca cc ph
huynh v cng phn no phn nh hiu qu
ca cc bin php truyn thng nh t vn
dinhdngchophhuynhcconbthacn,
bophvvicphttri,tbm.Datrn
nhngkinthcthunhncphhuynhc
nhng bin php hu hiu gip tr nh:
gimdumtrongnunng,hnchchotr
n cc loi thc n nhanh, thc n ch bin
sn,khuyntrtngvnngthlc,chotr
vnngngoitri
KTLUN
Tlthacn,bophtrngSaoMai13
vSaoMai12trccanthiplnltl38,6%
v33,8%.
Tnh trng tha cn, bo ph ca tr ang
hctrngmmnonSaoMai12trngcan
thip c lin quan n cc yu t v gii tnh,
khilphc,tcn.Thiquennnhanhca
tr l yu t nguy c dn n tnh trng tha
cn,boph.Nghincuchatmthymilin
quan c ngha thng k gia tnh trng tha
cn,bophcatrviccyutthucvgia
nhtr:trnhhcvncha,m;nghnghip
cha,m;ccthiquen n ung v s thch ca
tr nh: thi quen n vt, s thch n thc n
bo,thcnngt,thcnnhanh.(p>0,05).
Ph huynh c kin thc ng v dinh
dngsaucanthipl72,04%caohnhnso
vibanu(61,4%).Tlphhuynhckin
NghincuYhc
thc ng v tha cn, bo ph sau can thip

l 87,1% cao hn so vi trc can thip
(83,1%).Sphhuynhcconbthacn,bo
phckinthcngvthacn,bophsau
can thip l 87,20%, cao hn hn so vi trc
canthip(83,81%).
KHUYNNGH
Nh trng cn thng xuyn cung cp
thngtinvcnnng,chiucaocatrchogia
nh ph huynh cho tr n ung theo mt
chphhp.
T chc cc hot ng t vn dinh dng
chophhuynh,cbitlphhuynhtrcvn
vdinhdng.
Tngcchnhthchotngthdcticc
trngmmnon.
Nh trng nn dnh din tch trong
khunvintrngxydngsnchingoi
trichotr.
XinchnthnhcmnstitrcaTchc
Y t th gii (WHO) trong vic thc hin nghin
cuny.
TILIUTHAMKHO
1.
2.
3.
4.
5.
CDC.
Overweight
children
and
adolescents:
Recommendationstoscreen,assessandmanage.
www.cdc.gov/nccdphp/dnpa/.../module3print.pdf
TrnThHngLoan(2003).Tnhtrngthacnvboph
cctnglpdncthnhphHChMinhnm19962001.
TrungtmDinhDngthnhphHChMinh.
VThNgcThy,PhmLAn(2008).Khosttnhtrng
dinh dng v mt s bnh hc ng cc trng mu
gio qun 4 nm 2006. Y Hc TP H Ch Minh. Tp 12 (1)
2008,tr.8691.
WHO. Controlling the global obesity epidemic.
http://www.who.int/nutrition/topics/obesity/en/
WHO. Growth reference 519 years. BMI for age.
http://www.who.int/growthref/who2007_bmi_for_age/en/ind
ex.html
ChuynYTCngCng
419
NghincuYhc
NGHINCUVNGHO,CNGBNGYT
VCANTHIPNNGCAOSCKHECHONGINGHO
KHUVCVNGXA,VITNAM,2010
LHongNinh*,PhngcNht*,LCngMinh
TMTT
tvn:Nghincuvmiquanhgianghovsdngdchvytvcchmnghonhhng
nsckhecaccnhmdtnthngnhphn,trem,ngigitikhuvcngbngsngCuLong
lquantrng.
Mctiunghincu:Xcnhnghodnnbnhttvccyuttrunggian.Canthiplmgiatng
tunthiutrvibnhtnghuytp.
Phngphpnghincu:Nghincuctngangvnghincucanthip.
Ktqunghincu:Cmilinquangianghovchmscsckhe,nhmkhngnghokhmsckhe
nhknhiuhnnhmngho/cnngho(p<0,05).Cmilinquangianghnghipvkhmsckhen,
cngnhchoconsdngdchvyt.Cmilinquangiatrnhhcvnvkhmphkhoaphn.
NgiTHAsaucanthipcscithinkinthcvTHAvkhnngtunthiutr.
Kt lun:Nghoclinquanvisdngdchvyt,ccnhmphnvtrem.Thchintruyn
thnggipnngcaokinthccangibnhTHAnhkinthcvtriuchngbnh,nguyhimcabnh,
thigianiutrbnhvcckinthcvtunthtrongiutrbnhTHA.
Tkha:ngho,cngbngyt,sdngdchvyt
ABSTRACT
RESEARCHONPOVERTY,HEALTHEQUITYANDINTERVENTIONTOIMPROVEHEALTHFOR
POORAREASINVIETNAM,IN2010
LeHoangNinh*,PhungDucNhat*,LeCongMinh
Background:Researchontherelationshipbetweenpovertyandhealthservicesuseandhowpovertyaffects
vulnerablegroupshealthsuchaswomen,children,theelderlyintheCuuLongareaisimportant.
Objectives:Todeterminewhetherpovertyislikelytoresultindiseaseandidentifysomeintermediatesocial
determinants.Interventiontoincreasehypertensiontreatmentadherence
Method:Crosssectionalandinterventionstudy.
Results:Nonpoorgrouphadmoreperiodichealthexaminationthanpoor/nearpoorgroups(p<0.05).There
wasarelationshipbetweenpovertyandhealthcareserviceutility.Therewasarelationshipbetweenoccupation
andperiodichealthexamminationinwomenandhealthcareutilityoftheirchildren.Therewasarelationship
between educational level and having gynecologic examination in women. After intervention for poor
hypertensives, there was an improvement in their knowledge on hypertansion and ability to adhere to their
treatment.
Conclusion:Povertyisassociatedwithhealthservicesutilityonwomenandchildren.Implementationof
*VinVsinhYtCngcngthnhphHChMinh
420
ChuynYTCngCng
NghincuYhc
communicationhelpedtoimproveknowledgeofhypertensivessuchasknowledgeaboutsymptoms,riskofdisease,
durationoftreatment,andtheknowledgeofadherencetotreatmentofhypertensives.
Keyword:poverty,healthequity,useofhealthcareservice.
TVN
Mctiunghincu
Chnh ph Vit Nam c cam kt mnh m

trong vic gim ngho v cng bng x hi.
Chng trnh gim ngho c xem l mt
trongccchngtrnhthnhcngnhtcaVit
Nam trong hai thp k t nhng nm 1990 v
nhngnm2000.Gimnghocnglmttrong
ccmctiulncachnhphvichngtrnh
qucgiaxaigimngho.
Xc nh cc yu t hnh vi thi quen lin

quan n ngho v bnh tt ti khu vc ng
bngsngCuLong.
Song song vi mc tiu gim ngho, cng

bngtrongchmscytcngcxemlmt
trong cc u tin ca quc gia. Mc tiu ny
cng c phn nh trong trong chnh sch
cng bng trong chm sc sc khe cho ngi
nghotheochngtrnh139(Quchmscsc
khengingho)vchngtrnh135(chng
trnh gim ngho cho vng su, vng xa). Cc
chngtrnhnysgipgimdnkhangcch
hng th dch v y t gia ngi giu v
ngingho, ch yu thng qua bin php tr
gi / gim gi dch v trong dch v chm sc
sc khe cho ngi ngho hoc bng cch cp
thbohimytminphchongingho.
Nghin cu v t l h gia nh ngho cho
thytlnghocctnhngbngSngCu
Long vn cn cao. T l ngho tan quc theo
iu tra Quc gia H gia nh nm 2008 (da
trnchunnghomicachnhph)l13,4%,
trong t l ngho ca khu vc min ng
Nam B l 3,7% v khu vc ng bng sng
CuLongl11,4%.
Nghincuvmiquanhgianghov
s dng dch v y t v cch m ngho nh
hng n sc khe ca cc nhm d tn
thng nh tr em, ph n, ngi gi ti cc
tnh pha Nam nht l khu vc ng bng
sngCuLonglquantrngtrongvictmra
ccyutxhitrunggiannilinnghov
sckhekm.
ChuynYTCngCng
Xcnhnghocphilyuttrunggian
tonnmtrocnchovictipcndchvy
tcangingho.
Lng gi mt chng trnh can thip lm
giatngtunthiutrvibnhtnghuytp
ngigihocvinhmbnhnhntquti
cngngviccvtliutruynthngphhp
vbnhtnghuytp(THA)vtqudotng
huytp.
ITNGPHNGPHPNGHINCU
itngnghincu
NgidnhaitnhScTrngvTrVinh.
Phngphpnghincu
Nghincuctngang
Mitnhchn350hnghincukhuvc
ngho (nng thn) v 350 h nghin cu khu
vc khng ngho (thnh ph). S mu nghin
cu cho hai tnh l 350*2*2 = 1.400. Tin hnh
nghincuvnghovsdngdchvytti
cctnhngbngsngCuLongtmmt
s yu t trung gian gia ngho v sc khe
km. Cc yu t s nghin cu gm thu nhp,
ngh nghip, gio dc, s dng dch v y t
trongcchgianh,chmscsckhetrem.
Nghincucanthip
C 210 h c chn vo nghin cu, iu
tratrccanthipvsaucanthip,tngmul
210*2=420h.Tinhnhcanthipnhmtngt
l tun th iu tr THA v lng gi kt qu
canthip.Canthipnysctinhnhbng
cch gio dc sc khe v nng cao sc khe
cng ng v bnh THA v cc hu qu ca
THA (nh t qu), cch iu tr THA v cch
chmscbnhnhntqu.
421
NghincuYhc
c im dn s
Bun bn
Cng nhn
Ni tr
Khc: lm mn, th may, un tc,
ph h, cn nh, gi
Tnh trng kinh t (t nhn xt)
Rt giu
Giu/kh
Cn ngho/ngho
Rt ngho
KTQUNGHINCU
Bng1:cimdnsmunghincuctngang
(n=1400)
c im dn s
Ngi cao tui
Ph n
Tr em
Trnh hc vn
M ch
Cp 1
Cp 2
Cp 3
TH/C/H
Ngh nghip
Lm rung
CBVC
Doanh nghip
Tn s
440
480
480
T l (%)
31,4
34,3
34,3
165
599
386
211
39
11,8
42,8
27,6
15,1
2,7
415
51
10
29,6
3,6
0,7
Tn s
301
56
398
169
T l (%)
21,5
4,1
28,4
12,1
17
803
488
92
1,2
57,4
34,9
6,5
Nghincuchnc440itngngi
caotui,480phn,480tremvonghincu.
Vkinhtgianh,quatnhnxtc1,2%t
nhn xt rt giu; 57,4% giu hoc kh; 34,9 l
cnnghohocngho;6,5%lrtngho.
Bng2:Milinquannghnghipvkhmsckhenhkngicaotui(n=440)
Ngh nghip
Khm SK nh k
C N (%) Khng N (%)
124 (78,0)
35 (22,0)
32 (58,2)
23 (41,8)
66 (54,1)
56 (47,9)
54 (51,9)
50 (48,1)
Lm rung
Bun bn
Ni tr
Khc (CBVC, Doanh nghip, Cng nhn, th may, lm tc)
PR
KTC 95%
0,02
<0,001
<0,001
1
0,75
0,69
0,67
0,6 0,9
0,6 0,8
0,5 0,8
nh k thp hn khong 0,69 n 0,67 ln

(p<0,001).
So vi nhm lm rung, nhm ni tr v

nhmnghnghipkhcctlkhmsckhe
Bng3:Milinquantnhtrngkinht,nghnghipvsdngdchvtrongthngquanhmngicao
tui(n=440)
Ngh nghip
S dng DVYT trong thng
Lm rung
Bun bn
Ni tr
Khc (CBVC, Doanh nghip, Cng nhn, th may, lm tc)
C N, (%)
44 (27,7)
33 (60,0)
48 (39,7)
63 (60,6)
Khng N, (%)
115 (72,3)
22 (40,0)
73 (60,3)
41 (39,4)
PR
KTC 95%
<0,001
0,03
<0,001
1
2,2
1,4
2,2
1,5 3,0
1,03 2,0
1,6 2,9
Nhm bun bn c t l s dng dch v

trong thng va qua gp 2,2 ln so vi nhm
lmrung(p<0,001).
Bng4:Milinquangiathiquenhtthuc,ungruuvccctnhcangicaotui(n440)
c im
Ht thuc l
Gii: Nam
N
Ung ru bia
Gii: Nam
N
Trnh hc vn: M ch
422
C N, (%)
Khng N, (%)
44 (35,2)
10 (3,2)
81 (64,8)
305 (96,8)
<0,001
21 (16,8)
8 (2,5)
5 (5,3)
104 (83,2)
307 (97,5)
94 (94,7)
<0,001
PR
KTC 95%
ChuynYTCngCng
c im
Cp 1
Cp 2
Cp 3
TH/C/H
C N, (%)
13 (5,1)
6 (9,7)
5(22,7)
0(0,0)
Khng N, (%)
243 (94,9)
56 (90,3)
17(77,3)
1(100,0)
Yutgiicnhhngnthiquenht
thuc, ung ru, nam gii chim 35,2% t l
htthucsovingiich3,2%(p<0,001).T
lcungrunaml16,8%soviph n
p
0,9
0,3
0,01
0,9
NghincuYhc
PR
1,005
1,92
4,5
//
KTC 95%
0,4 2,7
0,6 6,01
1,4 14,2
ch2,5%.Nhmctrnhhcvncp3ung
nhiurubiahngp4,5lnsovinhmm
ch(p=0,01).
Bng5:Milinquangianghnghip,thunhpvkhmsckhenhkcaphn(n=480)
Khm SK nh k
c im
Ngh nghip: Lm rung
Bun bn
Ni tr
Khc (CBVC, Doanh nghip, Cng nhn,
th may, lm tc)
Thu nhp: Khng ngho
Cn ngho/ ngho
Rt ngho
Phnnhmnitrkhmsckhenh
k t hn 0,7 ln so vi nhm lm rung (p =
0,005). Nhm ph n cn ngho/ ngho khm
sc khe nh k thp 0,8 ln so vi nhm
C N, (%)
78 (53,8)
59 (42,7)
46 (36,2)
28 (40,0)
Khng N, (%)
67 (46,2)
79 (57,3)
81 (63,8)
42 (60,0)
128 (46,5)
60 (35,7)
23 (62,3)
147 (53,5)
108 (64,3)
14 (37,8)
PR
KTC 95%
0,06
0,005
0,07
1
0,8
0,7
0,7
0,6 1,01
0,5 0,9
0,5 1,03
0,03
0,04
1
0,8
1,3
0,6 0,9
1,007 1,77
khngngho(p<0,05).Nhmrtnghokhm
sckhenhkhn1,3lnsovinhmkhng
ngho(p<0,05).
Bng6:Milinquangiatrnhhcvnvvicikhmphkhoatrongnmcaphn(n=480)
Trnh hc vn
M ch
Cp 1
Cp 2
Cp 3
TH/C/H
i khm ph khoa/nm
C N, (%)
17 (37,8)
95 (55,2)
74 (47,4)
54 (61,4)
7 (36,8)
Khng N, (%)
28 (62,2)
77 (47,8)
82 (52,6)
34 (38,6)
12 (63,2)
ph n nhm c trnh cp 3 i khm

ph khoa trong nm qua nhiu gp 1,6 ln
nhmmch(p=0,02<0,05).
Bng7:Milinquangiagiicatr,ngichm
scchnhvvictrcchobsam(n=480)
c im
Gii: Nam
N
B sa m
C N, (%) Khng N, (%)
39 (81,3)
9 (18,7)
414(95,8)
18 (4,2)
PR
KTC 95%
0,06
0,3
0,02
0,9
1
1,5
1,3
1,6
0,97
0,9 2,2
0,8 1,9
1,07 2,4
0,5 1,9
Nungichmsctrlnamgii,tltr
khngcbsaml18,7%,caosovitl
trkhngcb sa m khi ngi chm sc
trln4,2%(p=0,001).
0,001
Bng8:Milinquannghnghipmvsdngdchvytchotrtrongnmvaqua(n=480)
Ngh nghip m
S dng DVYT trong nm va qua
Bun bn nh
CBVC
ChuynYTCngCng
C N, (%)
56 (43,4)
15 (48,4)
Khng N, (%)
73 (56,6)
16 (51,6)
PR
KTC 95%
0,6
1
1,1
0,7 1,7
423
NghincuYhc
S dng DVYT trong nm va qua
Ngh nghip m
C N, (%)
8 (20,0)
9 (17,6)
23 (38,3)
76 (45,0)
Cng nhn
L ph thng
Ch doanh nghip
Ngh t do
Khng N, (%)
32 (80,0)
42 (82,4)
37 (61,7)
93 (55,0)
Sovinhmbunbn,nhmlaongph
thng cho con s dng dch v y t ch 0,4 ln
(p=0,005) v nhm cng nhn ch 0,5 ln
(p=0,02).
Ngi d b THA (n=210)

- Ngi c ngi thn b
THA
- Ngi bnh T
- Ngi ht thuc
- Ngi ung ru nhiu
- Ngi n nhiu m
- Ngi n mn
- Ngi t vn ng
- Ngi cao tui
- Ngi mp
- Ngi hay lo u, suy
ngh cng thng
- Ngi ngho
- Tt c mi ngi
- Khng bit
Ngi bnh THA d b
nhng nguy him
(n=210)
- Tai bin mch mu no
- Thiu mu c tim
- Suy tim
- Tn hi n mt, gim
th lc
- Suy thn
- D cht
- Khng bit

N
%
N
%
8
3,8
3,3
5
8
17
6
68
18
76
48
20
2,4
3,8
8,1
2,9
32,4
8,6
36,2
22,9
9,5
3
28
26
38
186
51
138
63
15
1,4
13,3
12,4
18,1
88,6
24,3
65,7
30
7,1
5
4
82
2,4
1,9
39,2
2
0
1
0,9
0
0,5
140
10
7
2
67
4,8
3,3
0,9
198
29
5
2
94,3
13,8
2,4
0,9
1
135
31
0,5
64,6
14,7
0
195
0
0
92,8
0
Trccanthipc39,2%itngkhng
bit ai l ngi d b THA, sau can thip s
ny gim cn 0,5%. Ngi dn c kin thc
ng v cc nhm d b THA c tng ln
tng ng: ngi ht thuc (3,8% ln 13,3%);
ngi ung ru (8,1% ln 12,4%); n nhiu
m (2,9% ln 18,1%); n mn (32,4% ln
424
PR
KTC 95%
0,02
0,005
0,5
0,8
0,5
0,4
0,9
1,04
0,2 0,9
0,2 0,7
0,6 1,3
0,8 1,3
88,6%);tvnng(8,6%ln24,3%);ngicao
tui(36,2%ln65,7%).
Bng10:Victunthiutrcangidnv
bnhTHAtrcvsaucanthip(n=210)
Ni dung
Bng9:KinthccangidnvbnhTHA
trcvsaucanthip(n=210)
Ni dung

N
%
N
%
Nhn li khuyn n mn t bc s (n=210)
C
188
89,5
208
99,1
Khng
22
10,5
2
0,9
Nhn li khuyn gim cn t bc s (n=210)
C
107
15,9
156
34,3
Khng
103
74,1
54
65,7
Nhn li khuyn khng ht thuc l t bc s (n=210)
C
78
17,1
125
29,5
Khng
132
82,9
85
70,5
Nhn li khuyn hn ch ung ru bia t bc s (n=210)
C
77
16,7
122
28,1
Khng
133
83,3
88
71,9
Nhn li khuyn tp th dc t bc s (n=210)
C
124
59,1
155
73,8
Khng
86
40,9
55
26,2
Sau can thip, mc ngi dn c

khuyntunthiutrTHAgiatng.Bnh
nhn nhn li khuyn gim cn t 15,9% ln
34,3%; t l nhn li khuyn khng ht thuc,
hn ch ung ru tng tng ng (17,1% ln
29,5%;16,7%ln28,1%).
BNLUN
nh gi lin quan ngho, cc yu t x
hivsckhe
Nghincuchoktqunhmngicao
tuicmilinquangianghnghip(phn
nh mt phn ca vn thu nhp) v s
dngdchvyt.Ngilm nghbun bn
s dng dch v y t trong thng va qua
nhiuhnnhmnngdn,nhnglitkhm
sckhenhkhn(bng2,bng7).Cth
do nhm ny c kinh t kh hn nhng bn
rnhnnntkhmsckhenhkmch
khmkhicbnh.
ChuynYTCngCng
ngicaotui,tlnamgiihtthucv
ung ru bia cao hn n gii (bng 4). iu
nycthlmchotlccbnhkhnglykhc
bit theo gii, cn c nghin cu thm v m
hnhbnhtttheogii.Hcvnlyutxhi
c lin quan n thi quen s dng ru bia,
nhm c hc vn cao (cp 3) c t l s dng
rubiacaohnnhmmch(bng4).Yut
hcvncthlinquannnghnghipvthu
nhpdonhmhcvncaothngcthunhp
tthnnhmmch.
Ngh nghip v thu nhp c lin quan n
vic khm sc khe nh k ph n. Nhm
bun bn v ni tr khm sc khe nh k t
hnnhmnngdn.Nhmnghovcnngho
khm sc khe nh k t hn 0,8 ln so vi
nhmkhngngho.Nghocthlrocncho
vic tip cn s dng dch v y t. Tuy nhin,
nhmrtnghokhmsckhenhkcaohn
nhm khng ngho. Nhm ny c cp th
bohimytnhmtchnhschvcngbng
y t. Cc chnh sch h tr i tng ngho s
gip cc i tng ny gia tng kh nng tip
cn dch v y t v gim bt ro cn chi ph
khm cha bnh. iu ny ph hp vi cc
nghin cu ca Ngn hng Th gii ti H
Giang ti hai huyn V Xuyn v ng Vn t
nm1996n2003vchnhschchngtrnh
139 h tr ngi ngho trong khm cha bnh
shtrnhmnghotrongsdngdchvy
t nht l cho i tng ph n v tr em(1).
NghincunghovdchvyttihuynHi
Lng v huyn Gio Linh tnh Qung Tr cho
thy ngi dn cn thiu thng tin v vic h
tr ngi ngho khi m au, khong cch xa,
gi dch v cao, cht lng km l cc cn tr
quan trng trong chnh sch y t cho ngi
ngho. Nhiu ph n ti y mc bnh ph
khoa,chyulphnngho.Mtsphn
ti nh v khng c tin (50.000 70.000
ng/1 ca ) ng cho chi ph dch v(2).
NghincutiPhilippinechothyphnthn
qu(nghohn)tnchiphgpichovicn
ccsytsanhsoviphnsngth
ttrungtmCebu(4).Vvy,chiphytsnh
ChuynYTCngCng
NghincuYhc
hng n vic cc nhm ph n ngho v

khngnghotipcndchvyt.
Ph n c trnh hc vn quan tm hn
nsckhevctlkhmphkhoacaohn
nhm ph n m ch (bng 6). Theo nhm
nghnghip,mlcngnhnchoconsdng
dchvytchbng0,5lnsovimlmngh
bunbn,nhvynghnghiphocthunhp
camcthnhhngnsdngdchvy
tcatr.BococaTchcYtThgiinm
2004tiVitnamchothychia theo nhm thu
nhp gia nh nhm tr em thu nhp cao tm
kim dch v y t cao hn 45% trong iu tr
vim h hp trn cp tnh so vi nhm ngho
nht(3). Ngoi ra, nu m l ngi chm sc tr
th t l tr c b sa m cao hn khi ngi
chmsclnamgii,khngphimtr.Vaitr
camlrtquantrngtrongvicchmsctr
vthchinnuiconbngsam.
Nghincucan thip bng cng tc truyn
thng cho nhm i tng THA, khu vc
ngho,chothyctcdngtrongviclmgia
tngkinthcvTHA.Saucanthip,itng
bit nhiu hn v cc yu t gy THA v vic
tunthiutrtheolikhuynnhnvinyt.
Nucchinhschphhptrongqunlnhm
itngccbnhkhngly,tltunthiu
trcthcaohnnhtlnhmitngngho.
KTLUN
Nghincuchothyngholyutctc
nglnsckheccnhmphn,ngigi.
Nhm thu nhp cao s dng dch v khm
bnhcaohnnhmthunhpt.Yuthcvn
caonhmngigiclinquannvics
dng ru bia nhiu hn v nh vy l c tc
dngxulnsckhe.iunycthhin
rnhmnamgiingicaotui.
phnnhmnghovcnnghokhm
sckhenhkthnnhmkh,chothychi
phdchvytcthlrocnsdngdch
vnhmngho.Chnhschhtritng
ngholrthuchhcthtipcndch
vyttthn.Hcvnlyutgipphn
425
NghincuYhc
quan tm hn n sc khe v i khm ph

khoa.Nhmphncthunhpgianhthpt
tmkimsdngdchvytchotremtrong
gianhsovinhmthunhpcao.
Khicanthipgiatngkinthcvimt
bnhkhnglycthnhTHA,ccitng
ccithinkinthcvckhuynhhngtun
thiutrcaohn.Nhngbinphphtrv
kinh t (nh cp th BHYT) s gip d b ro
cn chi ph vi cc trng hp cn iu tr lu
di(cacbnhmntnhngicaotui).
KINNGH
Cncithinthunhpvnngcaotrnh
hcvncaphnhquantmvciu
kin hn trong vic chm sc sc khe, khm
sckhenhk,khmphkhoavchoconi
khm bnh ti c s y t. Cc yu t ngh
nghip v hc vn c nh hng n s dng
dchvytphn.
gpphnvthcytngtltunth
trongiutrbnhTHAcangibnh,chng
ticmtsnghnhsau:
Xy dng mng li truyn thng trong
cng ng. Tip tc thc hin, duy tr thng
xuyncchatngtruynthngtrongiutr
bnhTHA.
Tphunchocnbytxvcngtcvin
vnggiavknngvnngngibnhthc
hin thay i hnh vi, cn ch trng phng
phpnngcaokinthcvknngtruyn
thngvnnghckhnngvnng
ngibnhTHA.
Cn ch trng gia l thuyt v thc hnh
cangibnhtrongiutrbnhTHA.
XinchnthnhcmnstitrcaTchcY
t th gii (WHO) trong vic thc hin nghin cu
ny.
TILIUTHAMKHO
1.
2.
3.
4.
World Bank (2003). Bo co cui k nh gi ngho c s

thamgiacacngngtiHGiang.WorldBank.2627.H
Ni.
World Bank (2003). Bo co cui k nh gi ngho c s
thamgiacacngngtiQungTr.WorldBank.2834.H
Ni.
World Health Organization (2007). Reaching the poor
challengesforchildhealthintheWesternPacificregion.pp.
1518.PublicationOffice.Manila.
World Health Organization (2008). Intergrating poverty and
genderintohealthprograms.Foundationmoduleongender.
pp.2636.PublicationOffice.Manila.
426
ChuynYTCngCng
NghincuYhc
CHTLNGCUCSNGCANGIDN
TIQUNNINHKIU,THNHPHCNTH,NM2011
PhngcNht*,DipThThyVn*,HVVnAnh*.
TMTT
tvn:Chtlngcucsnglmtkhacnhquantrngmxhivcccpchnhquynangrt
quantm.NghincuvchtlngcucsngtithnhphCnThnhmaracinhntngqutvgip
cccpchnhquyncnhngchnhschnngcaochtlngcucsngcangidn.
Mc tiu nghin cu:nhgichtlngcucsngcngvi4khacnhchnh(sckhethcht,sc
khetmthn,quanhxhivmitrng)cngviccyutdnsxhi(tui,gii,trnhhcvn,thu
nhpnnh...).
Phngphpnghincu:Ctngangmtvi383ngidntrn18tuisngti5phngcaqun
NinhKiu,thnhphCnThcphngvntthng6/2011nthng07/2011.
Ktqunghincu:Trongtngs383ngithamgianghincu,n(54,6%)chimashnnamvi
tuitrungbnhl40,761,37.itnghchttrunghccschimas(2,0%),vinghnghipbun
bnchimcaonht(18,3%).itngtnhgithunhpbnthnnnh(54,6%).Vchtlngcuc
sng,asngidnhilngvimctrungbnh(38,6%)vttcngkhcao(32,9%).asngi
dnhilngvisckhehinti(43,6%).Vmitngquangiacckhacnhcachtlngcucsngvi
cccimdnsxhi,tui,trnhhcvnvthunhpnnhctngquanmnhvittc4khacnh
(sckhethcht,tmthn,quanhxhivmitrng).Trongkhi,chcgiivtnhtrnghnnhnc
tngquanmnhchvikhacnhsckhetmthn.
Ktlun:NgidnthnhphCnThcchtlngcucsngttvimcttvtrungbnh.Sosnh
vinghincutiTPHCM,ngidnThnhphCnThcimsquanhxhithpsoviTPHCM,
nhngimssckhethcht,tmthnvmitrngcaohnTPHCM.
Tkha:chtlungcucsng,CnTh
ABSTRACT
QUALITYOFLIFEOFPEOPLELIVINGINNINHKIEUDISTRICT,CANTHOCITY,2011
PhungDucNhat,DiepThiThuyVan,HaVoVanAnh
Background: Quality of life is an important aspect which has been most considered by society and
government. Study on quality of life at Can Tho city was conducted to have an indepth vision and help
governmenttomakepoliciestoimprovequalityoflifeofCanThopeople.
Objectives:todeterminequalityoflifewithitsfouraspects(physical,psychological,socialrelationshipand
environment)andsomedemographicsinformation(age,gender,educationalstatus,stableincomestatus...)
Method:acrosssectionalstudywasapplied.383participantswhowasagedat18andoverandlivingat5
wardsofNinhKieudistrict,CanThocity,wereinterviewedfromJunetoJuly,2011.
Results:Ofthetotal383participants,female(54,6%)wasmoreprevalentthanmale,withameanageof
ChuynYTCngCng
427
NghincuYhc
40,7616,37.Mostrespondentsparticipatinginthisstudygraduatedsecondaryschool(24,0%),andwasdoing
business(18,32%).Moreover,54,6%ofparticipantsselfassessedstableincome.Mostparticipantssatisfiedtheir
qualityoflifewithaverageandgoodlevel(38,6%and32,9%,respectively),aswellastheirhealthwithhigh
proportion (43,6%). In terms of the correlation between four aspects of quality of life and some demographic
characteristics, age, educational and stable economic status had a strong correlated with all four aspects. In
addition,therewasasignificantdifferencebetweengender,marriagestatusandthepsychologicalaspect.
Conclusion:PeoplelivingatCanThocityhadgoodandaveragelevelofqualityoflife.Incomparison
with the quality of life at Ho Chi Minh city, while people living at Can Tho city had a lower score of social
relationshipthanthoselivingatHoChiMinhcity,thescoreofphysical,psychologicalandenvironmentwere
higherthanHoChiMinhcity.
Keyword:qualityoflife,CanTho
TVN
Cht lng cuc sng l nhng cm nhn
ca tng c nhn v v tr ca bn thn trong
cuc sng, da trn hon cnh vn ha v h
thng cc gi tr sng, c lin h vi cc mc
ch,kvng,tiuchunvmilinquanca
c nhn . nh ngha ca T chc Y t Th
gii (WHO) nhn mnh s a dng v khc
nhau v gc nhn cht lng cuc sng tng
cnhn,cngnhkhnngtnticaccyu
tnhhngnchtlngcucsng.Nhm
thchindnnhgichtlungcucsng
inktlunrngcclnhvcsckheth
cht, tm thn, mi quan h x hi v mi
trng l mt trong s cc lnh vc chnh khi
nhgichtlngcucsng(7).
NghincugnyKuwaitbngcchs
dng Bng nh gi cht lng cuc sng thu
gn(WHOQOLBREF)bocorngtrmcml
quantrngnhtdonchtlngcucsng
(chim hn 77%) tng phng sai quan st(8).
Tuynhin,mtnghincucaHnQucpht
hin ra rng sc khe th cht ng gp phn
lnchochtlngcucsngtrongkhilnhvc
x hi l ng gp t nht(6). Ngoi ra, mt
nghincuctngangngilntiNhtBn
(2008)vmiquanhgiatintngcnhnv
WHOQOLBREF. S tin tng c nh gi
bng cch s dng ba quy m tin tng con
ngi, s cng bng trong con ngi v bn
chtconngi(12).
428
Nm 2005, Vit Nam c xp th 61 v

chtlngcucsng(13).Tuynhin,thcosc
khechdatrnkvngsnglcsinh.Do,
nghin cu v cht lng cuc sng da trn
nh ngha ca WHO nm 1998 v cht lng
cucsngnutrncthgpphnaragc
nhn rng hn v cht lng cuc sng ca
ngidntngvngkhcnhautiVitNam.
Nm 2009 v 2010, nghin cu cht lng
cucsngcthchinlnlttithnhph
HChMinhvtnhBnhDngdatrnnh
ngha ca WHO v cht lng cuc sng. S
thay i khng ngng ca cc yu t x hi
quytnhsckhehngnmchothyscn
thit trong tip tc nh gi cht lng cuc
sngcangidntrongnm2011tikhuvc
phaNam.
Theonghincuvchtlngcucsng
qun 5, TPHCM nm 2009(3), n ng nh gi
cao cht lng cuc sng hn ph n. T l
nhng ngi n ng ng rng cht lng
cucsngcttl84,3%,sovi80,8%sph
ncmthynhnhau.nngcnghilng
hnvisckhecamnhsoviphn(84%
sovi71,2%).Skhcbitnycnghathng
k(p<0,05).Ccnhmc trnhhcvni
hccchtlnggicngthpsoviccnhm
c trnh hc vn cp 1 (81,8% so vi 70%).
iu ny cho thy trnh hc vn cao c xu
hnggyramccaohncaslolngv
cucsngvlmvic.Skhcbitlngk(p
<0,05). Cc c nhn c hc thc cao hn c xu
hnghilngvichtlngcucsngnhiu
ChuynYTCngCng
hnvcmthychngcucsng mt
mc tha ng hn cc nhm cn li. S
khcbitnycngcnghathngk(p<0,05).
Theonghincuminhtctinhnh
Th x Th Du Mt, tnh Bnh Dng nm
2010(9)chothy:
Nhm i tng c trnh gio dc cao
hn th c cm gic au n v th xc l
nguyn nhn ngn cn h thc hin iu h
mun lm cao hn (97,9% so vi 89,2% v
77,3%)skhcbitnycnghathngk(p=
0,007).
Trnhhcvntlnghchvishilng
vivictipcnccdchvyt,nghaltrnh
hcvncngcaothshilngvivictip
cn cc dch v y t cng gim (58,9% so vi
61,0%v82,7%),khcbitnycnghathng
k(p=0,01).
Nhn chung nhng ngi c thu nhp n
nhcisngtinhthntthnngicthu
nhp khng n nh. Ngi c thu nhp n
nhnhnthccucsngcamnhcngha
hnngikhngcthunhpnnh(38%so
vi 12,7%), c kh nng tp trung cao hn
(85,7% so vi 50,0%) v cm thy hi lng vi
chnh mnh hn (85,6% so vi 67,1%). V h
thngtccmxctiucchn(86,9%sovi
75,0%). S khc bit c ngha thng k (p <
0,05).
Vi tnh hnh ngy cng y mnh th
ha khin ngi dn cng tp trung nhiu v
ccthnhphln.Do,tnhiucnglmnh
hngnchtlngcucsngcangidn
ti khu th. Nhm nghin cu, tm hiu v
nhgivchtlngcucsngcangidn
tikhuvcthnhthtcgithchinnghin
cutinytiThnhphHChMinhnm
2009vtithxThDuMttnhBnhDng
nm 2010. Nm 2011 tip tc nghin cu thm
ti thnh ph Cn Th l mt trong nhng
thphttrinthuckhuvcminTyNamb
nhmbsungvkhngnhthmnhnglun
cunghincutrcy.
ChuynYTCngCng
NghincuYhc
ThnhphCnThl1trongccthtrc
thucqunlcaTrungngkhuvcng
bngsngCuLongvitcthha,hin
ihacao.Vitcphttrinkinhtxhi,
chtlngcucsngcangidntikhuvc
thnhthcaCnThcth04lnhvcsc
khethcht,sckhetmthn,ccmiquan
hxhivmitrngnhthno?Liurng
cmilinhgiachtlngcucsngvcc
c im dn s c th ti Cn Th khng?
Xut pht t l do , nhm nghin cu thc
hin ti Nghin cu cht lng cuc sng
cangidnqunNinhKiu,thnhphCn
Thnm2011.
Mctiunghincu
nh gi cht lng cuc sng ca ngi
dn sng ti qun Ninh Kiu thnh ph Cn
Thnm2011,trn4lnhvc:
Th cht: c tn thng, c cm thy thoi
mi,cnnglngchocucsnghngngy,
cmgicmtmi,gicng,nghngi,khnng
vnnghngngy.
Tm thn: cm gic m tnh, suy ngh, tr
nh, s tp trung tinh thn, cm nhn v hnh
thcnhn,cmgicdngtnh,trngthitinh
thn.
Nhngmiquanhxhi:miquanhc
nhn, h tr v mt x hi, i sng tnh dc
(miquanhvibntnh).
Mitrng:mcantonvthcht,mi
trng sng, an ton v ti chnh, tip cn s
dngdchvsckhe,khnngcpnhtthng
tin,hotnggiitr,thoimivgiaothngv
ili.
Xc nh mi lin quan gia c tnh mu
nghincuv04lnhvcchtlngcucsng:
sckhethcht,sckhetmthn,quanhx
hivmitrng.
ITNGPHNGPHPNGHINCU
Dnsmctiu
Ttcngidntrn18tuisngtithnh
phCnTh.
429
NghincuYhc
Dnschnmu
Ngi dn trn 18 tui sng ti qun Ninh
Kiu,thnhphCnTh.
Nghincucthchintthng6/2011
nthng12/2011.
Vi c mu l 382 c tnh t cng thc
tnh c mu mt t l (p = 0.46), Chn ngu
nhin5phngcaqunNinhKiuthnhph
CnTh,gmphngCiKh,AnNghip,An
Ph,HngLivAnKhnh.Miphngchn
77hvphngvn01ngitrn18tuicah
.
B cu hi cu trc gm 26 cu dch t b
cuhiWHOQOLBREF,nguynbntingAnh
ca WHO trong c 4 kha cnh ca cuc
sng.Nhngkhacnhnybaogm:sckhe
thcht, sc khe tm thn, quan h x hi v
mitrng.
NhpliubngphnmmEpiData3.02.
PhntchsliubngphnmmSPSS13.0,
m t s liu bng tn s, t l phn trm (%).
Dngkimnhchibnhphng,ANOVAmt
chiu, Cronbachs alpha, trong thng k phn
tchsdngPR,PRcnghakhip<0,05vi
khongtincy(KTC)95%.
KTQUNGHINCU
Trongtngs383mungunhinchnt5
phng ca qun Ninh Kiu, 209 i tng l
n,chimas(54,6%),caohnsovinam.
tuitrungbnhcadn s mu nghin cu ti
thnh ph Cn Th l 40,76 16,37, vi i
tnglntuinhtthamgianghincurivo
tui 83. V trnh hc vn, i tng ch
t bc Trung hc c s chim a s (24,0%).
Ngoi ra, vn cn 4,2% ngi c phng vn
cha tng i hc trc (hay m ch). i
tng ang bc trnh cao ng tr ln
chim t l kh cao (22,7%). V tnh trng hn
nhn,ngikthnchimtlcaonhtgn
60%,knlngicthn(32,6%),cnlil
ccitngchimtlrtthpnhga,lyd,
sngchungchachnhthc,vlythn.Vngh
nghipcaccitngthamgiatrongnghin
cuny,chimcaonhtlbunbn(18,3%),k
nlnltlnhnvinvnphng(17,5%)v
nitr(17,2%).Tlitngthamgianghin
cuthtnghipkhngcao(2,1%).Trongnghin
cu, i tng t nh gi thu nhp bn thn
nnh(54,6%)chimtlcaohnitngt
nh gi thu nhp bn thn khng n nh
(45,4%).
V kha cnh t nh gi cht lng cuc
sngcabnthntrongvng04tunvaqua,
asngitrliphngvntnhgimc
trung bnh (38,6%). Trong khi , t l i
tng nh gi cuc sng bn thn c cht
lngttkhcao(32,9%).nglulccc
nhntnhgichtlngcucsngbnthn
mckml14,1%,rtkml4,2%.
V tnh trng sc khe ca bn thn, a s
ngidnhilngvisckhehinti(43,6%).
Tuyvy,nglulvnctlkhcaocc
itngkhnghilngvsckhebnthn
(28,9%).
Bng1:imstrungbnhWHOQOLBREF04
lnhvcchtlngcucsng(n=383)
Lnh vc
Sc khe th cht
Sc khe tm thn
Quan h x hi
Mi trng
Trung bnh SD
57,13 11,12
54,93 12,45
66,43 16,99
58,56 14,78
Tbngsliutrnchothyimstrung
bnhlnhvcquanhxhi(66,4316,99)cao
hn cc lnh vc khc. Trong khi , lnh vc
sc khe tm thn c im s trung bnh thp
nht (54,93 12,45). im s trung bnh lnh
vcsckhethcht(57,1311,12)gntng
tviimstrungbnhlnhvcmitrng
(58,5614,78).
Bng2:Mitngquangiactnhmuvimsthuc4lnhvcchtlngcucsng(n=383)
c tnh
Tui
Pearsons r
430
Sc khe th cht Sc khe tm thn

*
***
-0,116
-0,217
Quan h x hi
***
-0,162
Mi trng
-0,014
ChuynYTCngCng
c tnh
Gii
Nam
N
Trnh hc vn
Khng i hc
Cp 1 (Tiu hc)
Cp 2 (THCS)
Cp 3 (PTTH)
Trung hc ngh
Cao ng/ H
Tnh trng hn nhn
c thn
Kt hn/ Sng chung
cha chnh thc
Ly thn/ Ly d/Ga
Tnh trng
thu nhp n nh
C
Khng
Trung bnh SD
Trung bnh SD
Trung bnh SD
Trung bnh SD
Sc khe th cht Sc khe tm thn

***
56,32 (10,62)
57,23 (11,90)
57,81 (11,50)
53,01 (12,59)
*
***
53,12 (13,97)
43,75 (15,96)
55,67 (11,67)
52,60 (13,49)
55,86 (11,05)
52,58 (10,44)
60,01 (9,42)
55,43 (12,22)
55,02 (13,57)
55,60 (12,90)
58,83 (9,93)
60,92 (9,99)
***
58,46 (10,07)
57,87 (10,45)
NghincuYhc
Quan h x hi
Mi trng
67,48 (15,97)
65,55 (17,79)
***
50,00 (21,73)
64,58 (16,27)
66,58 (14,69)
67,21 (18,02)
65,62 (20,16)
70,59 (15,08)
*
68,67 (14,98)
57,47 (15,45)
59,46 (14,17)
*
48,24 (19,99)
58,51 (14,94)
57,88 (14,26)
59,00 (12,47)
56,54 (20,05)
61,57 (12,98)
60,77 (13,67)
56,65 (11,25)
53,95 (12,64)
65,95 (17,70)
57,34 (15,10)
55,08 (11,12)
49,52 (16,34)
59,94 (18,26)
58,77 (16,15)
***
***
***
***
59,04 (10,24)
54,84 (11,72)
57,56 (10,65)
51,77 (13,68)
69,02 (14,69)
63,31 (18,98)
62,36 (12,62)
53,99 (15,88)
***<p=0,001;**<p=0,01;*<p=0,05.
Thngquahstngquanrbiuhinr
mi tng quan nghch gia tui v cc lnh
vc. C th l, khi s tui tng, im s cc
lnhvcsckhethcht,sckhetmthnv
quanhxhigim,vngcli.
Nam gii c im s trung bnh trong lnh
vc sc khe tm thn (57,23) cao c ngha
thngkhngiin(53,01).Ngoira,khngc
s khc bit no mang ngha thng k gia
imstrungbnhcacclnhvccnligia
namvn(p>0,05).
Khng c s khc bit no mang ngha
thngkvimssckhethchtgiabt
k2nhmtrnhhcvnno.
Cskhcbitmangnghathngkgia
im s Sc khe tm thn v tnh trng hn
nhn.Trong,itngcthncims
sc khe tm thn ln lt cao hn nhm Kt
hn/ Sng chung cha chnh thc, v nhm ly
thn/lyd/ga.
imsccmiquanhxhivtnh
trng hn nhn c s khc bit mang ngha
thngk.Trong,itngcthncim
s Quan h x hi cao mang ngha thng k
hnitnglythn/lyd/ga.
ChuynYTCngCng
Xtvtnhtrngtichnhnnh,ims
trungbnhtrong04lnhvcsckhethcht,
sc khe tm thn, quan h x hi v mi
trng ca nhm thu nhp khng n nh c
tnh khc bit mang ngha thng k so vi
nhmchorngthunhpbnthnnnh(p<
0,05).Nhmcthunhpkhngnnhcim
ssckhethcht,sckhetmthn,quanh
x hi v mi trng ln lt thp hn so vi
nhmcthunhpnnh.
BNLUN
Xt v gii v cht lng cuc sng, ti
thnhphCnTh,namgiicxuhnghi
lng v sc khe tm thn cao hn so vi n
gii. Tht vy, trong nghin cu thc nghim
ti 23 nc ca T chc Y t Th gii (WHO)
cho kt qu tng t nh ti thnh ph
Cn Th(10). Tuy nhin, khng tm thy mi
linhvgiivSckhetmthntrongmt
s nghin cu khc nh ti H Lan v i
Loan(14,2) trn nhng bnh nhn ang iu tr
ngoitrti1trungtmsckhetmthn
H Lan v trong nghin cu trn i tng
ngi chm sc tr thiu nng ti i Loan.
Vickhcnhauvimssckhetmthn
431
NghincuYhc
giahaigiitithnhphCnThcthdo
mc hon thnh cc mc tiu trong cuc
sng gia hai gii khc nhau. Cc yu t nh
hng cho s khc nhau ny l vn ha, s
khc nhau trong tip cn cc ngun lc v c
hi(12).NgiitithnhphCnThcth
c t ngun lc v c hi hon thnh cc
mctiutrongcucsngcahhnnamgii,
do km hi lng hn trong lnh vc Sc
khetmthn.
Xt v tui v cht lng cuc sng, ngi
lntuihncxuhngkmhilnghnv
mt Sc khe th cht, Sc khe tm thn v
Quanhxhi.Tngt,Trompenaarsvcng
s (2005) cng a ra mi tng quan nghch
giatuiv02lnhvc:sckhethcht,quan
hxhi.Skevingtonvcngs(2004)cngtm
thyktqurngimtrungbnhc04lnh
vccxuhnggimdnnhmngic
tuicaohn;cbitxuhngnythyrnht
lnhvcSckhethcht.
Xtvtrnhhcvnvchtlngcuc
sng,itngbctrnhhcvncaonht
cchtlngcucsngcthlsckhetm
thn tt so vi cc trnh hc vn thp hn.
Nghin cu ca Skevington v cng s (2010)
cngchoktqutngt,cthlchtlng
cucsngcaitngttnghipcaong/i
hc tt hn so vi i tng tt nghip trung
hc (t 11 tui n 18 tui) ti cc nc km
phttrin.TrongnghincucaSkevingtonv
cng s nm 2010 ny, kt qu cho thy nhm
khngquabcgiodcnocchtlngcuc
sngthphnbtknhmtrnhhcvn
caohn,baogmcnhmitngtrnh
tng ng tiu hc ti Vit Nam. iu ny
tngtviktqutmthytrongnghincu
v cht lng cuc sng ngi dn ti qun
NinhKiu;cthlnhmkhngihccquan
hxhikmhnsoviccnhmctrnh
hc vn cao hn. Lnh vc mi trng v sc
khe th cht gia cc nhm trnh hc vn
khcnhau.Nhvy,trnhhcvnlyut
432
quytnhsckhetmthnvccmiquan
hxhi.
Xt v tnh trng hn nhn v cht lng
cuc sng, ch c s khc bit mang ngha
thngkgiatnhtrnghnnhnvsckhe
tm thn. Nhng ngi kt hn thng c
i sng sc khe tm thn tt hn so vi cc
nhm khc(1,5). Trong mt nghin cu trn i
tng ang iu tr ngoi tr bnh trm cm,
tnhtrnghnnhncngctmthylyu
t nh hng n im s lnh vc mi
trng(11). Gi thuyt c th t ra rng tnh
trnghnnhncthcithinquanimnhn
thccacnhn ngi bnh trm cm v mi
trng(11) v qua cng ci thin vn sc
khetmthnchocngngnichung.Nhng
nghin cu xa hn c th tip tc thc hin
nhm xc nh nhng nhm tnh trng hn
nhnnocimssckhetmthncaohn
soviccnhmkhc.
Theo Longford v Pittau (2006), tnh trng
nnhltngcathunhpkhimctngthu
nhphngnmcatngcnhntngng
trung bnh lm pht ca quc gia (4). Do ,
nhiu nghin cu chn mc thu nhp nh
gi ti chnh ca c nhn hay gia nh(2); a s
chnthunhplbinthhng:thp,trungbnh
v cao; mt s trng hp chn bin khong
chia da trn s lng tin thu nhp c tnh.
Tuy nhin, trong nghin cu ti thnh ph H
ChMinh(3),BnhDngnm2010(9)vCnTh
nm2011,tichnhcacnhncnhgi
thng qua s n nh ca thu nhp, v tnh
trngnnhphthucvonhnthccnhn.
Ktqutmtsnghincutrcchothy
thu nhp c tm thy c lin quan n cht
lngcucsng,cthlviccmiquanh
xhi.Tngt,ktqunghincuti thnh
phCnThcngchothynhmthunhpn
nh c sc khe th cht, sc khe tm thn,
quan h x hi v mi trng cao hn so vi
nhmcthunhpkhngnnh.Nhvyti
chnhhaythunhpcnhn/hgianhlyu
ChuynYTCngCng
NghincuYhc
tquantrngvnnhtrongvicquytnh
chtlngcucsngcatngcnhn.
chngtrnhchmscsckhe,vccchng
trnhphclixhikhc
KINNGH
Mctiunngcaochtlngcucsngca
ngi dn ti thnh ph Cn Th i hi tnh
dihn,chinlcmangtnhbnvngvis
hptccduytry,xuynsutcacc
ban ngnh lin quan, khng ch ring ngnh y
t.
Qua kt qu nghin cu nu trn, nhm

nghincucaraccxut:
Kt qu cho thy yu t gio dc l quan
trng trong nng cao cht lng cuc sng
ngidn.Ccgiiphpcicchvutv
gio dc cho ngi dn gp phn nng cao
cht lng cuc sng ha hn kh thi v hiu
qu.
Yu t quan trng nht nh hng cht
lng cuc sng v mt sc khe th cht, sc
khetmthnlmbothunhpchonhu
cucucsng.Ngicthunhpnnhcxu
hng c cht lng cuc sng cao hn hn
ngicthunhpkhngnnh.Vvynhm
nghin cu xut a phng c chin lc
di hn trong hoch nh chnh sch lin quan
nvnansinhxhinhtocngnvic
lmnnh,htrhthngchmscsckhe
banu,htrthunhpnnhcholaong
hpphp,duytrvcitinphcaccqu
xaigimngho,cngnhcchotng,c
s vt cht phc v nhu cu gii tr tip cn
thngtincaccitngkhcnhau.
Mitrngthngquacckhacnhnhto
cm gic an ton cho ngi dn, tng tnh tip
cntrongcitinchtlngdchvyt,van
sinhxhi,citinmitrngthchtvni
sinh sng cho cng ng cng l yu t quan
trngtrongcucsngngidn.Khithitk
thtiqunNinhKiu,cnchcckhacnh
camitrngnutrnnhmtoiukincho
ngi dn ch ng nng cao cht lng cuc
sng.
Chnhquynvccbanngnhonth
ti thnh ph Cn Th cn bo m tnh cng
bng trong cht lng cuc sng gia cc gii,
nhm tui v nhm iu kin kinh t x hi
khc nhau cn c nh gi ng mc trong
vic ln k hoch pht trin v ci cch cc
ChuynYTCngCng
ny
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Dupree ME. & Meadows SO. n.d. (2011), Decomposing the

effects of marital trajectories on health: A discretetime
analysis of transitions, duration, sequencing and timing
acrossthelifecourse,viewed7Dec.
JinDing L, Hu J, ChiaFeng Y, ShangWei H, LanPing L,
ChingHuiL,MeiHuaC,ShengRuW,ChuCM,JiaLingW
(2009), Quality of life in caregivers of children and
adolescents with intellectual disabilities: Use of WHOQOL
BREFsurvey,ResearchinDevelopmentalDisabilities,vol.30,
pp.14481458.
LHongNinhvcngs(2009),Nghincuvchtlng
cuc sng ti thnh ph H Ch Minh Vit Nam nm 2009,
ChuynCcyutxhiquytnhsckhe2009.
Longford NT. & Pittau MG. (2006), Stability of household
income in European countries in the 1990s, Computational
Statistics&DataAnalysis,vol.51,pp.13641383.
MarksNF.&LambertJD.(1998),Maritalstatuscontiuityand
changeamongyoungandmidlife adults, Journal of Family
Issues,vol.19,no.6,pp.65286.
MinSK,KimKI,LeeCI,JungYC,SuhSY.&KimDK.(2002),
DevelopmentoftheKoreanversionsofWHOQualityofLife
scaleandWHOQOLBREF,Qualityoflife research, vol. 11,
no.6,pp.593600.
MurphyB,HerrmanH,HawthorneG.,PinzoneT.&EvertH.
(2000),AustralianWHOQOLinstruments:UsersManualand
Interpretation Guide, Australian WHOQOL Field Study
Centre,Melbourne,Australia.
Ohaeri JU, Awadalla AW. & Gado OM. (2009), Subjective
quality of life in a nationwide sample of Kuwaiti subjects
using the short version of the WHO quality of life
instrument,SocialPsychiatryandPsychiatricepidemiology,
vol.44,no.8,pp.693701.
Phng c Nht v cng s (2010), Nghin cu v cht
lng cuc sng ti tnh Bnh Dng, Vit Nam nm 2010,
Bo co kt qu ti nghin cu khoa hc cp c s nm
2010,VinVsinhYtcngcngTP.HChMinh.
SkevingtonSM(2010),Qualitiesoflife,educationalleveland
humandevelopment:aninternationalinvestigationofhealth,
SocPsychiatEpidemiol,vol.45,pp.9991009.
SuChingS,MeiYuY(2007),Factorsrelatedtoqualityoflife
indepressiveoutpatientsinTaiwan,PsychiatryandClinical
Neurosciences,vol.61,pp.610615.
433
NghincuYhc
12.
13.
434
Tokuda T, Jimba M, Yanai H, Fujii S, Inoguchi T. (2008),

Interpersonal Trust and Quality of Life : A Cross Sectional
studyinJapan,PLoSOne,vol.3,iss.12,e3985,pp.110.
The economist intelligence unit (2005), The Economist
IntelligenceUnitsqualityoflifeindex,viewed10Dec2011.
14.
Trompenaars FJ, Masthoff ED, Van HGL, Hodiamonth PP.,

De VJ (2005), Relationships between demographic variables
andqualityoflifeinapopulationofDutchadultpsychiatric
outpatients, Soc Psychiatry Psychiatr Epidemiol, vol.40,
pp.588594.
ChuynYTCngCng
NghincuYhc
NHGICNGBNGYTVCNGCPNG
TIBRAVNGTU,NM20092010
LHongNinh*,PhngcNht*
TMTT
tvn:UrbanHEART(nhgicngbngytvcngcpngtithnhth)lcngchuch
gipccnhhochnhchnhsch,chnhquynaphng,ccnhqunlchngtrnhtrongtintrnh
hochnhchnhschyt.BRaVngTucchnlaimtiptheotrinkhainghincu(sau
TPHChMinh,CnThvBnhDng).
Mc tiu nghin cu: Phthinkhcbittrongthchinchmscsckhe4qun,huynthucB
RaVngTuvhtrccqunphthincckhongtrng,yutquytnhsckhe,nguycvsckhe,
ccutinvcanthipcnthitvisthamgiacacngng.
Phng php nghin cu: Sdngcngcnhgicngbngytvcngcpngtithnhth
phinbn2caTrungtmphttrinytKobe(Nht)caTchcYtthgii(WHO).
Ktqunghincu:Bngmatrn,bngtheodisosnhgia4huyncaBRaVngTuvbng
pngringchotnghuyn.
Ktlun:Cngcnhgicngbngytvpngtithnhthhuchchongnhytvngi
lpchnhschtrongvicvnngnghvtorachnhschttchosckhe.
Tkha:nhgicngbngytthnhth,cngbngyt.
ABSTRACT
HEALTHEQUITYASSESSMENT&RESPONSETOOLINBARIAVUNGTAU,2010
LeHoangNinh,PhungDucNhat
Background:UrbanHEART(UrbanHealthEquityAssessmentandResponseTool)isaneffectivetool
tohelppolicymakers,localauthorities,programmanagersintheirpolicymakingprocesstodecidehealthy
policies.BaRiaVungTauprovincehasbeenchosenthenextcitytoconductthesecondversionofUrban
HEART.
Objectives: Identifydifferencesinperformancesin4districtsinBaRiaVungTauprovince
and assist these districts to identify gaps, health determinants and health risks, priorities and
requiredinterventionswiththecommunityparticipation.
Method: Using the second version of Urban Health Equity Assessment and Response Tool of WHO
KobeCenterofTheWorldHealthOrganization(WHO).
Results:Matrix,monitorcompare4districtsinBaRiaVungTauprovinceandResponsetool
foreachdistrict.
Conclusion: UrbanHEARTisausefultoolforhealthsectorandpolicymakerinadvocateandcreate
healthypolicies.
Keyword:UrbanHEART,healthequity.
Tcgilinlc:Ths.BSPhngcNht
T:0918103404
ChuynYTCngCng
435
NghincuYhc
TVN
Urban HEART (nh gi cng bng y t
vcngcpngtithnhth)lcngchu
ch gip cc nh hoch nh chnh sch, chnh
quyn a phng, cc nh qun l chng
trnhtrongtintrnhhochnhchnhschyt.
Cngbngytlmttrongnhngmc
tiuquantrngmdchvchmscsckhe
hng ti, Vin V sinh Y t cng cng thnh
ph H Ch Minh (VVSYTCC) thc hin
nhiu nghin cu lin quan n cc yu t x
hi quyt nh sc khe, tp trung vo cng
bng y t. Nm 2009, VVSYTCC trin khai
nghincuUrbanHEARTthnhphHCh
Minhtthng3nthng9nm2009.Khost
ban u Urban HEART thnh ph H Ch
Minhtnhiuktqukhquan,gpphn
vovicraiphinbnthhaiUrbanHEART
(WHO2009).
BRaVngTucchnlaim
k tip trin khai tip tc nghin cu ca
phinbnthhai,btutthng7vktthc
vo thng 12 nm 2010. a s cc hot ng
thuc nghin cu s tp trung nh gi cng
bng y t ti 4 huyn/thnh ph ca B Ra
Vng Tu: TP Vng Tu, th x B Ra, huyn
LonginvhuynTnThnh.
Mctiunghincu
1. Phthinkhcbittrongthchinchmsc
sckhe4huyncaBRaVngTu.
2. Haicngcchnhlbngmatrnvbng
theodicsdng.
3. Htrccqunphthincckhongtrng
trongchmscsckhe,yutquytnh
sc khe, nguy c v sc khe, cc u tin
v can thip cn thit vi s tham gia ca
cngng.
4. Gipnhhochnhchnhschvccbn
linquanchiubitvyutxhiquyt
nhsckhevyutnguyc.
I TNG PHNG PHP NGHIN

CU
436
itng:ccsliulinquanncng
bngyttiaphng.
Phng php: lp bng ma trn theo

hng dn ca T chc y t th gii thc hin
ccbcsau:
Bc 1: Xy dng nhm cng tc vi

chuyngiatcccquanbnngoi.VVSYTCC
thnhlpnhmlmviccho.Vinmicc
chuyngia t cc ban ngnh a phng tham
giavonhmlmviccanghincu.
Bc 2: Xc nh tp hp cc ch s v
mc chun theo a phng. Bc ny c
thc hin bng cch mi cc chuyn gia n
buihputingiithiuvkhinimmi
(UrbanHEART)vgiithiuvcchotng
canghincu.
Bc 3: Tp hp s liu lin quan v c

gi tr. c chia thnh ba nhm i tng:
chnh quyn a phng, trung tm y t d
phngqun,Slaongthngbinhvxhi.
Bc4:ChuyngiacaVincnhimv
chun b s liu v to Bng ma trn cng vi
Bng theo di. Bng ma trn v Bng theo di
datrnsliucsnthuthpgiaion
utbnqun.BngmatrnvBngtheodi
phcthosctrnhbytrongbuigpmt
cc chuyn gia B Ra Vng Tu. Vic xem
xtlisliulhotngquantrngcadn
ny, m bo s liu thu thp chnh xc v c
gitr.
Bc5:nhgivxcnhcckhong
trng trong vic chm sc sc khe v chnh
lchtnhtrngsckhecadncticcqun
huyn trn a bn. Chuyn gia t Vin tho
lunvichuyngiaccqunvcctiuchun
(gmchunthnhph,chunqucgia)vcch
thcnhgiBngmatrnvBngtheodi.
Bc 6: Tho lun nhm tm cc bin
php p ng. Ly kin ng gp ca cc
chuyn gia a phng hon thin bo co.
Tchchithotrnhbybocovthunhn
phnhitchuyngia.
KTQUNGHINCU
ChuynYTCngCng
NghincuYhc
Bng1:BngmatrnnhgicngbngyttiBRaVngTu,VitNamnm2010
Tsutchttremdi1
tui
Csh
tng
v
mi
trng
Huyn
Huyn
Longin TnThnh
T sut chttr emdi5

tui
T l cc trng hp mc
lao v c iu tr khi
bngppDOTS
S ca mi mc Lao
/100.000dn
S ca t vong Lao
/100.000dn
S ca hin mc HIV/AIDS
/100.000dn
S ca t vong HIV/AIDS
/100.000dn
S ca hin mc Tm
thn/100.000dn
Svtainngiaothng
/100.000dn
Sngibthngdotai
nngiaothng/100.000
dn
Sngitvongdotai
nngiaothng/100.000
dn
Tlhgianhsdng
ncsch
Tlhgianhsdng
cutiuhpvsinh
Tlhgianhxlrc
ngquynh
TlphcpTHCS
Tschtm
Ccchs
urasc
khe
TPVng
Thx
Tu
BRa
ChuynYTCngCng
437
NghincuYhc
Spht
trin
con
ngiv
xhi
Tlsanhdonhnvin
yt
Tltremctim
chngy
Bitcbitvit
Tltrdi5tuibsuy
dinhdng
Nuiconbngsam
Sinhcontui<19
Nhcnlcsinh
Khngc Khngc
sliu
sliu
Khngc
sliu
Tlthtnghip
Kinh
t
Quntr
Tlhnghotheochun
qucgia
Tlphntinilm
vic
Tlngnschdnhchoy
t
Tlngnschdnhcho
giodc
Tlthamgiabohimy
t
Quynhmuscbngmatrn
Muxanh(mutrungbnh):khichstvt
mctrungbnhcaqucgiavkhuvc
Muvng(munht):khichsnmgiamctrung
bnhqucgiavkhuvc.
Mu(mum):khichsthphnmc
trungbnhqucgiavkhuvc
Bng2:CngcpngtiTPVngTu
CHS
Chsura
sckhe
Cshtng
vmitrng
438
CCCHSCN
CNGCPNG
CANTHIP
Tlcctrnghpmc Tlchatdo:
lao v c iu tr khi Chuyntrchchngtrnhchcmtys,slnvnggiat.
bngppDOTS
Bnhnhnbiutrdothayinictr.
Giiphp:
Tngnhnlcchophngkhmlao.
Tuyntruynphngphpphngngalaochongidn.
Tlhgianhsdng Lpbnccvngnimmcbaophncschv
ncsch
vsinhthpvarautinchodnthnhphkhe
ChuynYTCngCng
CHS
CCCHSCN
CANTHIP
NghincuYhc
CNGCPNG
Sphttrin
conngiv
xhi
Kinht
mnh.
Tngcnguttrmcpncchocckhudnc.
Tiptctuyntruynvnngngidndngncsch.
Htrkinhphchongingho.
Bitcbitvit
Tiptctuyntruynvnngmingibittcdng
cavichctp.
Htrchogianhnghotronghctp.
T l tr di 5 tui b Tchcccchngtrnhchotrn,dinhdng,bsungvi
suydinhdng
chtvIthamuin.
Trmytccphngxtchctphunchoccbmv
cchphngchngsuydinhdng,cchnunbom
dinhdngchotrem.
Tlhnghotheochun Tomitrngchnhschnhmkhuynkhchvtou
qucgia
ivhtrcachnhquynaphngchoccqutn
dngnh.
Chohgianhvayvnnngcpnh(baogmnhng
khonvaynhviphngthchonvnlinhng)hoch
trchinlctndngcpcngng.
Khuynkhchvhtrthnhphvcchnhquynkhu
vcphttrinchngtrnhbohimytticngngcho
cckhuvcngho.
Htrvayvn,giiquytviclm.
Cchngtrnhhtrbohimytticngngcho
ngingho.
Bng3:CngcpngtithxBRa
CHS
CCCHSCN
CANTHIP
Tsutchttremdi
1tui
Tsutchttremdi
5tui
Tschtm
Chsura
sckhe
Scamimc
Lao/100.000dn
ScahinmcTm
thn/100.000dn
ChuynYTCngCng
CNGCPNG
Nguynnhn:dodttbmsinh.
Giiphp:tuyntruyn,giodckhmthainhkchoph
ncthai.
Vnngngidnatrikhmchabnh.
Nguynnhn:dotaibinsnkhoa,bnghuyt,thiumu
mn,uno.
Giiphp:
+Tuyntruyn,giodcccbm(phntuisinh,v
thnhnin)khmthainhk.
+utnhnlc,vtlcchobnhvin.
Nguynnhn:nhimHIV,tiung
Giiphp:
+TuyntruynphngtrnhHIV.
+Tmsot,tuyntruynphthinviutrtiung.
Nguynnhn:chnthngsno(tainngiaothng,tai
nnlaong).
439
NghincuYhc
CHS
Cshtng
vsc
khemi
trng
Sphttrin
conngiv
xhi
CCCHSCN
CANTHIP
Tlhgianhsdng
ncsch
T l tr em c tim
chngy
T l tr di 5 tui b
suydinhdng
Tlhnghotheochun
qucgia
Kinht
Tlphntinilm
vic
CNGCPNG
Giiphp:phihpccbanngnh,chnhquyntuyn
truyngiodclutgiaothng,lutlaong
Lpbnccvngnimmcbaophncschv
vsinhthpvarautinchodnthnhphkhe
mnh.
Tngcnguttrmcpncchocckhudnc.
Htrchngtrnhtimchngvthuc,csvtcht,
kinthc
Tchcccchngtrnhchotrn,dinhdng,bsungvi
chtvIthamuin.
Tuyntruyngiodc,htrvn,htrviclmchocc
itnglhnghovcchminhctikhuvc.
Tomitrngchnhschnhmkhuynkhchvtou
ivhtrcachnhquynaphngchoccqutn
dngnh.
Chohgianhvayvnnngcpnh(baogmnhng
khonvaynhviphngthchonvnlinhng)hoch
trchinlctndngcpcngng.
Tocnganviclmchophnbngcchtoiukinv
utinchophnchcngh.
Bng4:CngcpngtihuynLongin
CHS
Chsura
sckhe
440
CCCHSCNCAN
CNGCPNG
THIP
Tsutchttremdi1
Tuyntruynvnngphnmangthaikhmnhk
tui
hngthngvtimchngy.
Tvntitrmchophnmangthaivsckhethai
ph.
Tsutchttremdi5
Qunlchtchcngtctimchngccbnhtruyn
tui
nhimchotr.
Tuyntruynvtvnchoccbmvchmscsc
khetremdi5tui.
ScamimcLao/100.000 Tngcngcngtctuyntruynvphngchnglaotrn
dn
abnchottcccitngcbitlngigi,ngi
bsuynhc,nginhimHIV,ngisngtrongmi
trngnhim...
Kimsotcngtctimchngngabnhlaobngcch
thngxuynkimtragimstcngtctimchnglaocho
trssinh,tchckhmphthinviutrkpthicc
canhimbnh.
ScahinmcTm
Tchckhmphthinvqunliutrbnhnhntm
thn/100.000dn
thn.Thngxuyntheodidinbinbnh,cppht
thuciutrvtvnchothnnhnbnhnhnvcch
chmsciutrbnh.
ChuynYTCngCng
CHS
Cshtng
vsc
khemi
trng
CCCHSCNCAN
THIP
T l h gia nh s dng
ncsch
TlphcpTHCS
Tltremctim
chngy
Bitcbitvit
Sphttrin
conngiv
xhi
Tltrdi5tuibsuy
dinhdng
Sinhcontui<19
Nhcnlcsinh
Kinht
Quntr
Tlhnghotheochun
qucgia
Tlngnschdnhchoy
t
Tlngnschdnhcho
ChuynYTCngCng
NghincuYhc
CNGCPNG
Tngcnguttrmcpncchocckhudnc
chacngunncmy;xutybannhndnhuyn
htrkinhphxydngngngncnkhuvcdn
c.
Mingimhcphchohcsinhngho.Xydngquhc
bngchocchcsinhnghohiuhc.
Tchcvnngccgianhtomiiukinchocon
cntrng.
Tngcngcngtctuyntruynkinthcvlichca
timchngccbnhtruynnhimchotr.
Hngthngdtrthuctheodanhschqunltr
emtrongtuitimchng.
Vnngphhuynhatrntimytheolch.
CcHionthtchccclpxamchtithnp
ccx,thtrn.cbitiviccxthtrnvngbin,
nngthn.
Kinnghxemxtliquynhtrn15hcsinhmit
chclphc.
Tchcccbuithchnhdinhdngchoccbmc
condi5tui.
Tvnvdinhdngtitrmytx.
Hngthngtchccntr,cpsachotrsuydinh
dng.
utingiodcsckhesinhsnchobgitrng
trunghccs,trunghcphthngtrnabn.
Cithinchtlngvdtipcnccdchvvthng
tinkhochhagianh.
Tchcccchngtrnhchuynsckhechothanh
nin(sckhesinhsn,phngngaHIV/AIDS,kimsot
htthuclvphngnganghinruvmaty).
Phttrinccchinlcvssngcncatremcbit
th,baogmnuiconbngsamvqunlcc
nhmbmcnguyccaovtrgicnguyc.
Chohgianhvayvnnngcpnh(baogm
nhngkhonvaynhviphngthchonvnlinh
ng)hochtrchinlctndngcpcngng
Khuynkhchvhtrthnhphvccchnhquynkhu
cckhuvcngho.
xutybannhndntnhquantm,ymnhvic
htrkinhphchongnhythuyntrongcngtcphng
chngdch,thchinccchngtrnhytqucgia,cng
tckhmchabnhngingho,ngiccngvicch
mng,ngicaotui,tremdi6tui...
Tngngnschdnhchogiodchtrchonngcao
441
NghincuYhc
CHS
CCCHSCNCAN
CNGCPNG
THIP
giodc
nnglcvcsvtcht.
Tlthamgiabohimyt cckhuvcngho.
TuyntruynvlichthamgiaBHYT.
Htrngingho,cnnghotinmuabohim.
Bng5:CngcpngtihuynTnThnh
CHS
Chsurasc
khe
Cshtngv
sckhemi
trng
Sphttrincon
ngivxhi
442
CCCHSCN
CANTHIP
Tsutchttremdi
1tui
Tsutchttremdi
5tui
CNGCPNG
ymnhcngtcvnggiasausinhvphngchngsuy
dinhdngchotrdi1tui.
ymnhcngtctuyntruyn,phbinkinthcv
chmscsckhotremchophnt18tuitrln,c
bitlccbmangmangthaivcconnh.
T l cc trng hp Tngcngqunlbnhnhnbiutr.
mc lao v c iu Htrthmkinhphchocnbchuyntrchtuynx,
trkhibngppDOTS phng.
Tngcngnnglcchoytvxtnghimvkhmpht
hinLao.
Scamimc
Tngcngkimtragimstvsinhantonlaong
Lao/100.000dn
yucuccdoanhnghipcungcpthitbbohlaong
chocngnhn.
T l h gia nh s Lpbnccvngnimmcbaophncschv
vsinhthp.
dngncsch
Tngcnguttrmcpncvngngcpnc
chocckhudnc.
Cntptrungcithincckhudncxaquclbng
ccgingkhoanvccthitblcncchocchgianh.
Tngcnggiodcthngxuynvhctpcngng
choitngltrbbhcdohoncnhgianhkh
TlphcpTHCS
khn,bngcchtchccclphcminphchtr
trangthitbhctptrcthihc.
Htrchngtrnhtimchngbngcchcungcp
Tltremctim
thucvkpthi,htrkinhphchocngtctuyntruyn
chngy
vkinthcchocngng.
Tngcnghctpcngngchoccitngt35
Bitcbitvit
tuitrln.
Giodcdinhdngvsckhetremchoccbm
nhmlpdynuntikhuph/pchophnccon
Tltrdi5tuib
<5tui,tchcnichuynticclpmugio,mmnon
suydinhdng
vsckhotrem,cchnuidytrchoccbmlph
huynhcaccchu.
Sinhcontui
Cithinchtlngvdtipcnccdchvvthng
<19
tinkhochhagianh.
ChuynYTCngCng
CHS
CCCHSCN
CANTHIP
Kinht
Tlhnghotheo
chunqucgia
Quntr
Tlngnschdnh
choyt
NghincuYhc
CNGCPNG
Phthinvvbiucckhuvctmc(khuvcnh
trcacngnhnsngxagianh)nimthanhnind
dngchnhviquanhtnhdctrchnnhnvkhng
csdngccbinphptrnhthai.
cckhuvcngho.
Cntngtlngnschhtrthmkinhphhot
ngchoccchngtrnhytqucgia;phcpchocnb
ytcsvnhnvinytthnp.
BNLUN
nhmccchsurasckhe:
ChothycskhcbitBraVngtuv
cc nhm bnh cn quan tm. Cc ch s sc
khetiychactttheoccchun.Lao
vHIVvnlccvncnquantm.Tsut
chtmcncaotithxBRa.Ringtainn
giaothngvncnlvnsckhenibtti
khu vc ny. S v tai nn giao thng, s b
thngvchtdoTNGTucao.
nhmccchscshtngvmitrng:
Tlhgianhsdngncschcnthp
cchuynLongin,TnThnhvcncnci
thinthxBRavthnhphVngtu.Ti
thxBRavhuynTnThnhtlhxl
rcngquinhcndi90%.ylvn
cncaphngquantmgiiquyt,nht
lkhinhhngphttrinBRathnhtrung
tm hnh chnh v ln thnh ph trong tng
lai.Vvnhagiodc,tlphcptrunghc
csticchuynLonginvTnThnhcn
chacao.Tngngvitlbitcbitvit
haininycngthp.Tremsuydinhdng
vn cn l vn vi t l trn 10% ti cc a
phng:thxBRa,huynLongin,huyn
TnThnh.
nhmccchskinht:
TihuynTnThnh,tlthtnghipcaovt
lhnghocncaophnnolgiiccvn
sckhechatttininy.Ccnghincuti
cc thnh ph nh TP.HCM, Bnh Dng, Cn
ChuynYTCngCng
Thuchothychtlngcucsnggnlin
viviccngunnthunhpnnh,nghalc
nghnghipnnh.Tlphnthamgiavo
cng vic ti th x B ra thp hn ng k so
viccaphngkhctrongtnh.
nhmccchsquntr:
TiTP.VngtuvhuynTnThnhtlngn
schdnhchoytkhtt,nhngtithxB
Ra t l ngn sch dnh cho y t cn thp. C
hai a phng m bao ph bo him y t
cnthplhaihuynLonginvTnThnh.
ylnicnnhiuhngho,dovyccchnh
schxhichmscsckhengingho
tihaininycncymnh.
KTLUN
Cngcnhgicngbngytvp
ngtithnhthctcdnghuchchocnb
qun l ngnh y t trong vic tham mu vn
ngchnhschclicho sc khe, vn ng
chovicutytvongnhucunhm
gim bt cng bng trong chm sc sc khe.
Cng c gip nh hoch nh chnh sch c
bngchngcthharaccquytschyt
phhphn,manglianninhxhi.
Xin chn thnh cm n s ti tr ca T
chc Y t th gii (WHO) trong vic thc hin
nghincuny.
TILIUTHAMKHO
1.
BLaongthngbinhxhi(2009),Hinghtngkt
cngtcbotrxhinm2008vtrinkhainhimv
nm2009,
443
NghincuYhc
http://www.molisa.gov.vn/details.asp?mbien2=&mbien4=1
3481&ambien3=(6286568C1DED482C865B
80AC6BEAEC3E>&tdngytruycp27/7/2009.
2.
3.
Btichnh(2008),phnthbaphlc9tngsnphm
trongnctheogithctphntheokhuvckinht,
http://www.mof.gov.vn/Default.aspx?tabid=5991&ItemID=
59186truycpngy27/7/2009.
SkhochvutthnhphTP.HCM,2008,boco
tnhhnhKinhtxhinm2008
http://www.dpi.gov.vn/data/news/2009/5/799/all2008.htm,
truycpngy22/7/2009.
4.
SkhochvutthnhphTP.HCM,2008,Quy
hochphttrinkinhtxhi20012010TP.HCMccch
tiuxhiThunhpbnhqunungi,
http://www.dpi.gov.vn/vie/news_detial.asp?period_id=1&c
at_id=3&news_i....htm,truycpngy20/7/2009.
5.
SYTTP.HCM(2008),CTsckhe,
http://www.medinet.hochiminhcity.gov.vn/tintuc/news_det
ail.asp?period_id=1&cat_id=28...,truycpngy27/7/2009.
6.
Vin V sinh Y t Cng cng TP HCM. Bo co kt qu

nhgicngbngytvcngcpngthnhthnm
2009tiTPHCM.
7.
WHO(2009).UrbanHEART.WHOKobecenter.
444
ChuynYTCngCng
NghincuYhc
TNHHNHSDNGDCHVYTTHNHTHVNNGTHN
TIHAITNHCNTHVHUGIANGNM2010
PhngcNht*,DngThMinhTm*
TMTT
tvn:mbothchincngbngtrongchmscsckhenhndncnchtrngntnhcng
bngtrongtipcnvsdngdchvyt(DVYT),cbitcnquantmrtngnkhongcchchnhlch
trongtipcn,sdngdchvytkhuvcthnhthvnngthn.
Mctiunghincu:Mtthctrngcungcpvsdngdchvyttithnhthvnngthnthuc
haitnhCnThvHuGiangvccyutquytnhxhilinquan.
Phngphpnghincu:Ctngangmt,cphntch,kthpnghincunhlngvnhtnh.
Kt qu nghin cu:TlngimcbnhtrongsuthngquatiCnThvHuGianglnltl
24,5%,19,2%.trem,bnhhhpchimtlcaonht(26%),ngilnthbnhthnggplxng
khp(28,4%),ngitrn60tuithtnghuytpchimtlcao(35,8%).Thigianvkhongcchntrm
yt2niungnhnsovintrungtmythuyn.Khicbnhthngthng,asngidnntrm
ytvthuntin,gnnh(15,1%HuGiangv35,1%CnTh),dgpnhnvinyt(28,1%Hu
Giangv30,3%CnTh).Tuynhin,khicbnhnng,ngidnckhuynhhngtmnccbnhvin
tuyntrnnhiuhn.Theonhnnhcahthcti31,7%v31,5%nhnvintrungtmytckhnng
iutr,trongkhitlnytrmytchchim21,3%v17,3%.
Ktlun:Ktqunghincugimtsgiiphpchongnhytvccbanngnhclinquantrong
vicmbotnhcngbngtrongtipcnvsdngdchvytcangidntiCnTh,HuGiang.
Tkha:Sdngdchvyt,CnTh,HuGiang
ABSTRACT
RESEARCHANDANALYSISOFUTILIZATIONOFHEALTHCARESERVICEINURBANAREACAN
THOCITYCOMPAREDTORURALAREAHAUGIANGPROVINCE,2010
PhungDucNhat,DuongThiMinhTam
Background:Toassuretheequityinhealthcareforpeople,theequityinutilizationandsupplywithhealth
careservicemustbepaidmuchattentionto.Especially,thegapbetweenruralandurbanareasinusinghealth
serviceshouldbeshorten.
Objective:DescribeutilizationandsupplywithhealthcareserviceinurbanandruralareasofCanThocity
andHauGiangprovinceandsocialdeterminantsrelatedtothissituation.
Methodology: Combined quantitative and qualitative study, in which quantitative study is a cross
sectionalstudy.
Result: TheproportionofpeoplegotillnesswithinsixmonthsinCanThocityandHauGiangprovince
wererespectively24.5%and19.2%.Inchildren,respiratorydiseasehadhighestpercentage(26%),thecommon
diseaseinadultwasachingofjointandbone28.4%,hypertensionhadhighproportioningroupofpeopleover
Tcgilinlc:Ths.DngThMinhTmT:0903172012
ChuynYTCngCng
Email:duongtam8lus@yahoo.com
445
NghincuYhc
than60yearsold35.8%.Timeandtraveldistancefromhometolocalhealthstationintwoareaswereshorter
thantodistricthealthcenter.Whenpeoplegotnormalillness,theyusuallycametolocalhealthstation.Itdueto
theadvantage,nearly15.1% in Hau Giang and 35.1% in Can Tho, easy to meet health staff (28.1% in Hau
Giang and 30.3% in Can Tho). However, when they got serious illness, the upper level hospital was health
facility that people prefered to access. In opinion of respondents, there were 31.7%, 31.5% of health staff in
districthealthcenterhadtreatmentcapacity,whilethisproportioninlocalhealthstationwasonly21.3%and
17.3%,respectively.
Conclusion:Theresultsfromthisstudyrevealsomesolutionstohealthsectorandstakeholdersofassuring
theequityinultilizationandsupplywithhealthcareservicebetweenruralandurbanareasinCanThoandHau
Giang.
Keywords:Healthcareserviceutilization,CanTho,HauGiang
TVN
Trong nhng nm gn y, vn cng
bngtrongchmscsckhe(CSSK)nhndn
c ng v Chnh ph Vit Nam quan tm
nhiuhn.thchincngbngtrongCSSK
th iu ct yu l m bo c cng bng
trongtipcnvsdngdchvytcangi
dn(2).Tuynhin,ditcngcannkinht
thtrng,schnhlchgiunghogiavng
thnhthvnngthncnhhngsuscti
tnhhnhsdngdchvchmscsckhe(3).
Cn Th v Hu Giang l hai tnh thuc Ty
Nam B, c v tr a l gip ranh nhau. Vic
khosttnhhnhsdngdchvytti hai
khuvcnyscungcpmtcinhntngqut
vskhcbitvmctipcncngnhs
dngdchvyttiniy.Trncsc
nhngnhnnhngnhnvaragii
phphtrthchincngbngtrongchmsc
sckhenhndn.
Mctiunghincu
Mctiutngqut
Mtthctrngcungcpvsdngdch
vyttithnhthvnngthnthuchaitnh
CnThvHuGiang.
Mctiucth
M t thc trng cung cp dch v khm
chabnh(KCB)tihaivngthnhthvnng
thn.
446
Xc nh t l mc bnh, vic s dng v

tip cn cc loi hnh dch v KCB ca ngi
dntithnhthvnngthn.
Xcnhmtsyutlinquannvics
dng dch v KCB ca ngi dn ti thnh th
vnngthn.
ITNGPHNGPHPNGHINCU
Thitknghincu
S dng thit k m t ct ngang c phn
tch, kt hp nghin cu nh lng v nh
tnh.
Thigianvaimnghincu
04/201011/2010tiCnThvHuGiang.
itngnghincu
Phacungcpdchvkhmbnhvphas
dngdchvkhmchabnh.
Chnmu
Vinghincunhtnh
Sdngphngphpphngvnsu,tho
lun nhm. Trong tho lun nhm tp trung,
ngi tham gia s c hi theo bng hng
dnphngvn.mitnh,sthchin02cuc
tholunnhmviidinphasdngdch
vkhmchabnh(6ngithngnkhm
chabnhtitrmyt,6ngikhngntrm
ytiutr).iviphacungcpdchv
khm bnh, cng t chc 2 cuc tho lun vi
idintrmyt(trongchialmhainhm
cn b trm y t: mt nhm c s ngi n
khm bnh cao nht v mt nhm c s ngi
ChuynYTCngCng
nkhmbnhthpnht).Phngvnsuthc
hintrn10idin(2gimctrungtmyt,
2idinchnhquyn,2lnhotrmyt).
Vinghincunhlng
TithnhphCnTh:1quniincho
khuvcthnhthcchn(theoquynhca
a phng) l Bnh Thy. Qun ny c 8
phng,thchinkhosttrn105hgianh
ca mi phng ngu nhin theo danh sch
ccungcpbichnhquynaphng.
NghincuYhc
chim t l 56,4%. Ngh nghip ch yu ca

ngidnCnThvHuGiangllmnng
29,6%,nhmlmvicnitrchimtl26,9%.
iunylphhpbivtlncaohnnam.
Vtrnhhcvn,aslhchttiuhcv
trunghccs(37,8%;34,3%),tlngidn
ctrnhcaong,ihc,sauihcthp
(7,2%;2%),khngbitch4,7%.
Ti tnh Hu Giang: 1 huyn i din cho

khu vc nng thn (theo quy nh ca a
phng)cchnlVThy.Huynnyc8
phng,thchinkhosttrn105hgianh
ca mi phng ngu nhin theo danh sch
ccungcpbichnhquynaphng.
14.9
15.7
Hu Giang
Cn Th
KTQUNGHINCU
Ktqunghincunhlng
Bng1:Thngtincbnvhgianh(n=1692)
c tnh
Dn tc
Gii
Ngh
nghip
Trnh
hc vn
Tn s
T l
Kinh
1658
98,0
Hoa
15
0,9
Khc
19
1,1
Nam
738
43,6
954
56,4
Ni tr
455
26,9
Cn b cng chc
116
6,9
Lm rung
501
29,6
Hu tr
100
5,9
Tiu th cng nghip
32
1,9
Cng nhn
80
4,7
Ngh khc
408
24,1
Khng c i hc
79
4,7
Tiu hc
639
37,8
Trung hc c s
580
34,3
Trung hp ph thng
269
15,9
Trung hc/cao ng/i

hc
121
7,2
0,2
Sau i hc
Nghincutinhnhtrn1692itngti
CnThv Hu Giang, trong dn tc Kinh
chimasvi98%,dntcHoavnhmdn
tc khc chim t l thp ch khong 1%. Phn
lnitngtrongnghincunylngii,
ChuynYTCngCng
Biu1:Tlhgianhcsdngthbohim
yt
Tlhgianhcsdngthbohimy
tl30,6%,trong t l c th bo him y t
(BHYT)tiHuGiangl14,9%thphnsovi
tiCnThl15,7%.
Bng2:Tlngidncnghethngtinvchm
scsckhe
C
Khng
Thnh
thong
Tng
Nng thn
(Hu Giang)
N
%
618
36,5
184
10,9
Thnh th
(Cn Th)
N
%
535
31,6
202
11,9
Ton mu
N
1153
386
%
68,1
22,8
50
3,0
103
6,1
153
9,0
852
50,4
840
49,6
1692
100
Kt qu nghin cu cho thy trong vng 1

thngqua,tlngidntipcnthngtinv
CSSK Hu Giang li cao hn so vi ti Cn
Th(36.5%v31.6%).
TlngidntipcnthngtinvCSSK
ttruynhnh,iphtthanhchim80,2%,tl
nyCnThl44,1%,HuGiang36,1%.
T l ngi dn n trm y t khm cha
bnh l 30,9%, trong t l ngi dn n
trm y t khm Hu Giang v Cn Th ln
ltl18,4%v12,5%.
447
NghincuYhc
90
T l ngi mc bnh trong su thng qua

ti Cn Th l 24,5%, trong khi t l mc
bnhtiHuGiangl19,2%.
80.2
80
Cn b y t
70
Tivi, i
60
44.1
50
Loa phng thanh
36.1
40
Bng3:Ccloibnhtrem,ngiln,ngi
trn60tui
T ri, sch bo
30
Pano, p phch
20
Khc
10
0
Hu Giang
Cn Th
Total
Biu2:Tlngunthngtinvchmscsc
khemngidntipcn
Biu3:Tlngidnntrmytkhmcha
bnh
19.2
24.5
Hu Giang
Cn Th
Biu4:Tlngibnhtrongsuthngqua
Bnh
H hp
Bo ph
Tiu ha
Tr em
Nhim trng
Suy dinh dng
Huyt hc
Bnh xng khp
Cm cm
Tim mch
Tiu ha
Bnh thn
Ngi ln
Bnh ph khoa
Bnh phi
Nhim trng
Chn thng
Tiu chy
Bnh ngoi da
Ngi trn 60
Tng huyt p
tui
Bnh xng khp
Bnh tim
Bnh phi
Bnh tiu ng
Cm cm
Bnh thn
Chn thng
Tn s
70
241
21
16
8
4
114
89
48
43
28
26
21
17
11
8
8
95
64
39
24
20
10
10
2
T l (%)
26,0
14,2
8,6
6,5
3,3
1,6
28,4
23,1
12,9
11,3
7,6
7,1
5,7
4,6
3,0
2,2
2,2
35,8
24,2
15,5
9,6
8,0
4,1
4,0
0,8
Tltrembccbnhvhhpchimt
l cao nht 26%, tip l bo ph 14,2%. Cc
bnhvtiuha,nhimtrnglnltchimt
l 8,6% v 6,5%. T l bo ph chim 14,2%,
trongkhitlsuydinhdngl3,3%.
Bng4:Thigiantnhntrmytvtrungtmytcahgianh
<15 pht
15-30 pht
30-45 pht
>45 pht
Tng
Hu Giang
N
%
567
33,5
219
12,9
40
2,4
26
1,5
852
50,4
Trm Y T
Cn Th
N
%
729
43,1
97
5,7
8
0,4
6
,4
840
49,6
Tng
N
1296
316
48
32
1692
itnhntrmytngidn2ni
u mt khong 15 pht, t l ny Cn Th,
HuGiangtngngl43.1%,33.5%.Thigian
448
%
76,6
18,7
2,8
1,9
100
Hu Giang
N
%
237
14,0
341
20,2
106
6,3
168
9,9
852
50,4
Trung tm y t huyn
Cn Th
Tng
N
%
N
%
300
17,7
537
31,7
498
29,4
839
49,6
33
2,0
139
8,2
9
,5
177
10,5
840
49,6
1692
100
ititrungtmythuynthasmtkhong
1530 pht, t l ny tng ng Cn Th v
HuGiangl20,2%v29,4%.
ChuynYTCngCng
NghincuYhc
Bng5:Khongcchtnhntrmytvtrungtmythuyn
< 1 km
1-5 km
5-15 km
15-60 km
Tng
Hu Giang
312
18,4
490
29,0
50
3,0
Trm Y T
Cn Th
458
27,1
372
22,0
10
,6
Tng
770
45,5
862
50,9
60
3,5
852
840
1692
50,4
49,6
n trung tm y t huyn, a s ngi

dnphii15km,tlnycaocCnTh
vHuGiang.Sosnhvkhongcchilit
nhntrmyt2ni,tathyCnThth
100
Hu Giang
98
5,8
359
21,2
278
16,4
117
6,9
852
50,4
Trung tm y t huyn
Cn Th
Tng
107
6,3
205
12,1
401
23,7
760
44,9
324
19,1
602
35,6
8
,5
125
7,4
840
49,6
1692
100
khong cch i li l gn hn so vi Hu
Giang.
Bng6:Gpcnbyttitrmytvtrungtmyt
D
Bnh thng
Kh
Khng bit
Tng
Hu Giang
N
%
476
28,1
276
16,3
9
0,5%
91
5,4
852
50,4
Trm Y T
Cn Th
N
%
513
30,3
274
16,2
5
0,3
48
2,8
840
49,6
Tng
N
989
550
14
139
1692
%
58,5
32,5
0,8
8,2
100
Khi hi v vic gp cn b y t v khm

chabnhnhthnothc43,3%ngidn
tr li l d gp, 40,8% tr li l bnh thng,
6,1%cholkhgpcnbytvckhkhn
khikhmchabnhtitrmvtrungtmyt.
Hu Giang
N
%
392
23,2
330
19,5
37
2,2
93
5,5
852
50,4
Trung tm y t huyn
Cn Th
Tng
N
%
N
%
340
20,1
732
43,3
360
21,3
690
40,8
67
4,0
104
6,1
73
4,3
166
9,8
840
49,6
1692
100
CnTh,tlngidncholdgpcnb
ytvkhngkhkhngkhikhmchabnh
trmytxchimtl30,3%,tlnyHu
Giangl28,1%.
Bng7:Nhnnhcangidnvkhnngiutrcacnbyttiaphng
TrmYT
HuGiang
C
Khng
Chiutrmt
vibnhthng
thng
Khc
Tng
CnTh
Trungtmythuyn
Tng
HuGiang
CnTh
Tng
364
21,5
293
17,3
657
38,8
536
31,7
533
31,5
1069
63,2
45
2,7
25
1,5
70
4,1
16
0,9
12
0,8
28
1,7
384
22,7
485
28,7
869
51,4
246
14,5
243
14,4
489
28,9
59
3,5
37
2,2
96
5,7
54
3,2
52
3,1
106
6,3
852
50,4
840
49,6
1692
100
852
50,4
840
49,6
1692
100
a s ngi dn u cho l cn b y t
trungtmythuynckhnngiutrbnh
tt, t l ny kh cao 63.2%. Tuy nhin, vn c
ChuynYTCngCng
28,9%cholcnbytaphngchcthtr
c vi bnh thng thng. Cn Th, c
17,3%ngidncholcnbyttrmckh
449
NghincuYhc
nngiutrtrongkhitlnyHuGiang
l21,5%.Tngtnhvy,c31,5%ngidn
CnThv31,7%ngidnHuGiangchol
cnbyttitrungtmythuynckhnng
iutrbnhtt.Drngtrmytdtipcnv
gn nh, d gp cn b, thun li khi khm
cha.Tlngidncholcnbyttitrm
ch cha c bnh thng thng vn kh cao
(22,7%v28,7%).
Bng8:Phnbnikhmviutrkhibbnh
Nng thn
(Hu Giang)
N
%
44
6,6
Trm y t x
Phng khm t
34
nhn
Thy thuc ng
5
y
Bnh vin huyn 122
Bnh vin tnh/
82
trung ng
C s y t khc 4
Tng
291
Thnh th
(Cn Th)
N
%
73
11,0
Ton mu
N
117
%
17,6
5,1
29
4,4
63
9,5
0,8
,2
18,4
93
14,0
215
32,4
12,3
163
24,5
245
36,9
0,6
43,8
14
373
2,1
56,2
18
664
2,7
100
T l ngi bnh n bnh vin tnh, bnh

vintrungngcaonht,chim36,9%.Ktip
lnbnhvinhuyn32,4%,tlngibnh
ntrmytkhmchabnhchchim17,6%.
Bng9:Milinquangiagiitnhvsdng
DVYT
C s y t
Tng
khc
N
%
N
%
N
%
Nam
277 38,1 450 61,9 727 100
N
293 31,3 644 68,7 937 100
Tng
570 34,3 1094 65,7 1664 100
2 =8,4, P value : 0,004,OR (95%CI): 1,3 (1,1- 1,6)
Trm y t
Bng9trnhbymilinquangiagiitnh
v s dng DVYT ca cc i tng tham gia
nghincu,tathycmilinquancngha
thngkgiagiitnhvsdngdchvyt.
Tlnamgiisdngdchvytcaohnn
1,3ln
Bng10:Milinquangiaviccsdngth
BHYTvnisdngDVYT
Trm y t
N
450
C s y t
khc
N
%
Tng
N
C
Khng
Tng
165 32,0 350

68 515 100
405 35,2 744 64,8 1149 100
570 34,3 1094 65,7 1664 100
2 = 1,6, P value : 0,2
Bng10trnhbymilinquangiavicc
sdngthBHYTvcchsdngDVYTca
cc i tng tham gia nghin cu, khng c
milinquancnghathngkgiavicc
s dng th BHYT v ni s dng DVYT l
trmythaytuynkhc.
Ktqunghincunhtnh
Chngtitinhnhtholunnhm(ngi
dn,nhnvinyt)vphngvnsu(lnho
x,cnbtrungtmythuyn,phngyt)ti
huyn V Thy, tnh Hu Giang v qun Bnh
Thy,tnhCnThvvicsdngDVYTni
chung v dch v ca trm y t x ni ring.
Chngtinhncccktquv:kin,
nhn xt ca cn b lnh o x, phng y t,
trng trm y t v tnh hnh s dng DVYT
cngnhnguynvng,nhucuvcchxtr
khi trong gia nh c ngi bnh. Nhn chung,
khicbnhthnhucuckhm,chabnh
vchmscsckhocangidnlrtln.
Miquantmcangidnivicccsy
tlvncncquantm.
ascctrmytccsvtchtngho
nn, trang thit b thiu thn so vi nhu cu
khmchabnhtiaphngTivxth
nucy,ucsiumchphnhny
kia n, th khi bnh nhn x mi ra
huyn(Nam58tui).ascnbytuc
nhn xt m hnh cung cp dch v cha ph
hp v cha p ng c nhu cu chm sc
sckhengidntiaphngmnh.
Vlachnnikhmbnhutin,khic
bnhthphnngutincattcmingi
l n khm trm y t. Kt qu nghin cu
nhlngchothytlngidnntrmy
t Cn Th l 12,5%, Hu Giang l 18,4 %.
Ngidn nhn nh khmygimc
bnh, gim c 80% (N 52 tui). Tuy nhin,
cng c nhiu ngi n trung tm y t, bnh
vin tuyn trn, thy thuc t hoc mua thuc
ChuynYTCngCng
vtcha.Trnmtabnx/phngcrt
nhiuachlachnkhmchabnh.Vic
ngidnncsnokhmbnhcntu
thuc vo nhiu yu t: kh nng p ng v
mtyt,ningkbohim.Trckiakhm
ngoiakhoaBnhThy,saunybohimcacon
rmuangkkhmy,tuibmtrongmucao.
Tuikhmngoivyththybcscngrtl
tt(N57tui).Tuynhin,chtlngvkh
nngiutr vn l yu t quyt nh vic la
chn ni khm bnh ca ngi dn. Nhiu
ngi chp nhn ng thm tin c cht
lngcngnhcphcvyttthn.Thi
quentintngvohthngyttuyntrn
sdngttrccngnhhngnvicla
chnnikhmchabnhKhibnhaunnchn
nhngcsytnhnccmbokhmtt
vmuathuccchtlngmbo.
Trmytchathcslningibnhtin
tngtmnkhicbnh.Khibnhaunhth
chcnnnhngnignvthuntinnhytx,
yttnhnhaylmuathuctiutr.Chkhino
tht s nng v cn thit th mi nn i khm
nhngniciukinkhmviutrtt,c
chnonngbnhviutrtt,nhmtitkim
tin,trnhlngphkhngcnthit.
Vlachnnikhmchabnhltrmyt
x:Viclachnkhmchabnhtitrmyt
x hay khng ph thuc vo nhiu yu t:
khong cch, trnh chuyn mn ca nhn
vintrm,trangthitb,ccyutkinhtxhi
vningkkhmchabnhbanutrong
th bo him y t ca ngi dn. Khong cch
tnhntrmytxlyutquantrngnh
hng n vic la chn ni khm cha bnh
ca ngi dn Ti t ra trm y t khm bnh v
trmytcchxanhti(Nam54tui),nh
tuinilcbanuthtrmytylhonho,
schs,thucmenthtuykhngnhiu,nhngquan
trngchlcnbytcnhittnhkhng.Bnh
nhntimngitanhittnhkhmrihngdn
thucchungsaosao...iulquantrng,[c
s] vt cht i khi khng tt nhng m ngi ta
nhittnhlmttikhicnhayhn(N63tui).
ChuynYTCngCng
NghincuYhc
CngnhkhnngiutrtitrmTrnh
chuynmnytt,khmchoembcngkhi
bnh(N30tui).
Ngoira,nhiuyu t c nhn cng c
linquannh:thiquen,nimtinvchtlng
c s khm cha bnh. Khi ngi dn thc s
bnhnng,hsncsckhnngiutr
ttnht.Trongtrng hp bnh thng thng
thchyuhtiniiutrmmnhathch.
Ldochnnikhmchabnhcngrtkhc
nhau mi ngi. Ngi cao tui th mong
mun c phc v ti ch Ti khng n
huyn v ti mun c phc v ti x cho
thun tin. kin ca ngi dn s dng
DVYTtiyBcskhuynrrng,chothuc
gip lm gim bnh tnh ca ti (N 49 tui),
hocCnhnhticmtthythucttilun
lun cha (Nam 49 tui), Ti a chu
nkhm trm v cha y quen ri (N
27 tui). Khi ngi bnh c th bo him y t
(thng ng k khm cha bnh ban u ti
trm y t x), h s la chn ni khm cha
bnhltrmytxTicbohimdovyti
khmbnhtrmytx.Tmli,cnhiu
kinkhcnhauvtnhhnhsdngccdchv
khm cha bnh ti trm y t x. Kt qu cho
thy, trm y t cha thc s l ni ngi dn
tmnkhicbnhnhnvinyttnhng
trangthitbykhng(Nam57tui).
BNLUN
Nghincutinhnhtrn1692itngti
CnThv Hu Giang, trong dn tc Kinh
chimasvi98%,dntcHoavnhmdn
tc khc chim t l thp ch khong 1%. Phn
lnitngtrongnghincunylngii,
chim t l 56,4%. Ngh nghip ch yu ca
ngidnCnThvHuGiangllmnng
29,6%,nhmlmvicnitrchimtl26,9%.
iunylphhpbivtlncaohnnam.
Vtrnhhcvn,aslhchttiuhc
v trung hc c s (37,8%; 34,3%), t l ngi
dn c trnh cao ng, i hc, sau i hc
thp(7,2%;2%),khngbitch4,7%.
451
NghincuYhc
Trongvng1thngqua,tlngidnc
nghe thng tin v chm sc sc khe kh cao,
chim68,1%, trong t l ngi dn tip cn
thng tin v chm sc sc khe 2 ni tng
ng nhau (36,5% v 31,6%). iu ny c th
do Cn Th v Hu Giang c v tr a l gip
ranhnnbaophcaccphngtinthng
tinichngcbnncvingidn.
Hin nay, cc thng tin v chm sc sc
khe c ph bin ti mi ngi di nhiu
hnhthcadng,phongph.Cngmtthng
tinnhngngidncthbitcquanhng
ngunkhcnhaunh:cnbyt,truynhnh,
pht thanh, loa phng thanh, t ri, sch bo,
pano,pphchKtqutnghincunycho
thyngunthngtinvchmscscctip
cn nhiu nht l t truyn hnh, pht thanh
chim 80,2%. So snh gia 2 ni, ta thy a s
ngidnCnThbitthngtinvchmsc
sc khe qua truyn hnh, pht thanh l 44%
nhiuhnHuGiang(36,1%).Tuynhin,vcc
thng tin c cn b y t cung cp th t l
HuGianglicaohn.iunyphhpbiv
ngidnyntrmytkhmbnhnhiu
hnCnTh(18,4%v12,5%)nncph
binthngtinvytnhiuhn.
Khichivccloibnhgpphitrong
1thngqua,tremghinhnc26%strmc
cbnhhhp.Bnhnghhpthngph
bintrnhnntlcaonht.nhmngi
ln, ta thy t l mc bnh xng khp trong
mtthngquacaonht28,4%,klcmcm
23,1%.Tnghuytpvbnhxngkhpkh
phbinngigidotlghinhnc
t nghin cu l ph hp (35,8%, 24,2%). So
snh vi kt qu t nghin cu iu tra thc
trng sc khe v nhu cu chm sc sc khe
ngi cao tui phng c Ngha, thnh ph
Phan Thit(1), ta thy rng bnh l v xng
khp,tnghuytpngycngphbin,vit
l42,5%, 46%. Trng hp bnh tng huyt p

caongicaotuikhngchcghinhn
CnTh,HuGiangmcnnhngnikhc.
KTLUN
T l c th BHYT ti Hu Giang l 14,9%
thphnsovitiCnThl15,7%.
TlngidntipcnthngtinvCSSK
HuGianglicaohnsovitiCnTh(36,5%
v31,6%).
TlngidnntrmytkhmHu
GiangvCnThlnltl18,4%v12,5%.
Tltrembccbnhvhhpchimt
l cao nht 26%, tip l bo ph 14,2%. Cc
bnhvtiuha,nhimtrnglnltchimt
l 8,6% v 6,5%. T l bo ph chim 14,2%,
trongkhitlsuydinhdngl3,3%.
T l ngi bnh n bnh vin tnh, bnh
vintrungngcaonht,chim36,9%.Ktip
lnbnhvinhuyn32,4%,tlngibnh
ntrmytkhmchabnhchchim17,6%.
Trongnghincunycmilinquanc
ngha thng k gia gii tnh v s dng dch
vyt.Tlnamgiisdngdchvytcao
hn n 1,3 ln, tuy nhin khng c mi lin
quancnghathngkgiaviccsdng
thBHYTvnisdungDVYT.
ny.
TILIUTHAMKHO
1.
2.
3.
DipThMinhPhc,QuchTonThng,BiiLch(2005),
iutrathctrngsckhevnhucuchmscsckhe
ngicaotuiphngcNgha,thnhphPhanThit.Y
hcthnhphHChMinh,tp9,phbn12005,tr.143146.
Dng nh Thin (1996), Cc cp nghin cu sc kho
cngng,NXBYhc,HNi.
Trng Vit Dng, Nguyn Thanh Tm (1995), Cht lng
DVYTcngcngvnhngquytnhcacchgianhv
CSSK4xthuctnhQungNinh.
452
ChuynYTCngCng
NghincuYhc
NGDNGKTHUTSCKLNGGHPKHIPH
TRONGVICXCNHHMLNGAXTAMIN
TRNNNMUNCMM
NguyncThnh*,TrniNgha*
TMTT
tvn:NcmmlmtloithcphmphbintiVitnam.Hmlngccaxtaminchothy
chtlngcasnphmncmm.
Mctiu:Sdngscklngghpkhiphphntchaxtaminkhngdnxuttrnnnmuncmm.
Phngphpnghincu:Nghincuthcnghim.
Kt qu: ngcaphngphpt80,59%n94,66%.lplicaphngphpchsbin
ng(RSD%)t1,03%n2,69%.tilpnibcaphngphpchsbinng(RSD%)t4,21%
n7,19%.Giihnnhlngcaphngphpt0,05mol/gn0,10mol/g.khngmbooca
phngphpt8,44%n21,34%.
Ktlun:Phongphpscklngghpkhiphlphngphpnginphntchaxtamintrnnn
muncmm.
Tkha:Scklng,khiph,axtamin,ncmm.
ABSTRACT
APPLICATIONOFLIQUIDCHROMATOGRAPHYCOUPLEDWITHMASSSPECTROMETRYTO
DETERMINEAMINOACIDSINFISHSAUCESAMPLE
NguyenDucThinh,TranDaiNghia
Bacground:FishsauceisapopularfoodinVietnam.Aminoacidscontentshowthequalityoffishsauce
product.
Objectives:Usingliquidchromatographymassspectrometryanalysisofunderivativeaminoacidsonthe
fishsaucesamples.
Methods:EmpiricalResearch.
Results:Theaccuracyofmethodfrom80.59%to94.66%.Repeatabilityofthemethodwithacoefficientof
variation(RSD%)from1.03%to2.69%.Internalreproducibilityofthemethodwithacoefficientofvariation
(RSD%)from4.21%to7.19%.Thelimitofquantificationmethodfrom0.05mol/gto0.10mol/g.The
measurementuncertaintyofthemethodfrom8.44%to21.34%.
Conclusions:Liquidchromatographymassspectrometrymethodissimpletoanalyzeaminoacidonthefish
saucesamples.
Keywords:liquidchromatography,massspectrometry,aminoacid,fishsauce.
csdngrngriticcncngNam
TVN
trong c Vit Nam. Nc mm l mt
Hinnayncmmlmtloincchm
dung dch mu nu hoc mu nu m c
Tcgilinlc:Ths.NguyncThnh T:0905166759
ChuynYTCngCng
Email:nguyenducthinh@ihph.org.vn
453
NghincuYhc
hnh thnh t qu trnh thy phn ca c vi

mui.Tlmuivctrongqutrnhsnxut
ncmmthayit1:6n1:2tythucvo
tngncsnxut.Ncmmcnhiutngi
khc nhau ty theo mi nc nh nc mm
ca Vit nam, nampla ca Thi lan, patis ca
Philppin, bakasangca Indonesia hay budu ca
Malaysia.Ccnckhcnhaussnxutnc
mmtheocc qui trnh khc nhau v vy nc
mm s c cc hng v khc(4,2). Nhn chung
qu trnh sn xut nc mm l mt qu trnh
gmccbcchnhltrnhnhpcvimui,
sau ln men ti p sut bnh thng trong
thng kn ti nhit t 30oC n 40oC trong
khong thi gian t 6 n 12 thng. Sau qu
trnhlnmennyclcsaucththm
vo ng, sodium glutamate, v cc cht to
hngtrthnhsnphmcuicng(4,2).
Do qui trnh sn xut, cng nh thnh
phn cc cht thm vo nc mm rt a
dng. V vy trong vic nh gi cht lng
ca nc mm ch tiu hm lng cc axt
amin trong nc mm l mt ch tiu ni ln
chtlngdinhdngcngnhhngvca
snphmncmm.
phn tch hm lng axt amin trong
nc mm trc y cc qui trnh phn tch
thng thng s dng cc h thng phn tch
axt amin chuyn dng da trn nguyn tc l
ccaxtaminctrongncmmutinc
tch bng sc k ion vi ct tch v pha ng
chuyndngsaucdnxuthasauct
vi ninhdrin v xc nh bng u d UV hay
dnxuthaviOPAsauxcnhbngu
d hynh quang. Vic phn tch bng k thut
dn xut ha sau ct l mt qu trnh i hi
thi gian phn tch di t 90120 pht cho mt
mu phn tch, cc ha cht dung mi dung
phntchuphithngcancngaica
ncngaidogithnhphntchrtcao(2).
Hinnayvisphttrincakthutkhi
phnhiuphngphpphntchmicp
dngchovicphntchccaxtamindatrn
kthutsckkhghpkhiph(GCMS)hay
454
sc k lng ghp khi ph (LC MS)(4,1,5). Vic

phn tch cc axt amin bng sc k ghp khi
phctincycaonhtnhchtchnlcca
khi ph c th nhn din c cc axt amin
khcnhaumcdchngccngthigianlu
gitrnct.Dokhiphntchtacthiu
chnht l thnh phn pha ng rt ngn thi
gianphntchquastitkimchiph, thi
giannngcaokhnngphntchmu.
Nhn chung cc phng php phn tch
bng k thut sc k ghp khi ph hin nay
u da trn k thut dn xut ha trc ct.
Dokthutphntchnyqutrnhchunb
muphctp,tnthigian,githnhcao(2,3).
khc phc cc nhc im ca phng
php phn tch axt amin trc tip bng sc k
lngghpkhiphchngtitinhnhnghin
cu phng php phn tch trc tip cc axt
amin trong nn mu nc mm bng cch la
chn ct phn tch v pha ng thch hp cho
cttchcngnhquitrnhxlmutiucho
nn mu ny. Trong nghin cu ti phng th
nghimchngtitinhnhkhostvicphn
tch 09 axt amin bao gm: Threonine, Valine,
Methinone, Leucine, Isoleucine, Phenylalanine,
Histidine,Lysine,Arginine.
ITNGPHNGPHPNGHINCU
HachtDungdch
Cht chun hn hp axt amin (AAS18
Sigma), trifluroacetic acid (T62200 Sigma),
trichloroaceticacid(T6399Sigma),kmsulphate
(Z4750Sigma), potassium ferrocyanide (P9387
Sigma), acetonitrile (34998Sigma), methanol
(34860Sigma), bt silicagel C18 (59821382
Agilent),btthanhottnh(59824482Agilent).
Dung dch chun gc axt amin c hm lng
2,5mol/mlcboqunnhit4oC.
Chunbdydungdchchunlmvicca
cc axt amin vi cc nng 0,5 mol/L, 1
mol/L, 2,5 mol/L, 10 mol/L, 25 mol/L, 50
mol/L,100mol/Lv250mol/Ltdungdch
chungc2,5mol/mlvidungmiphachun
lmethanol.
ChuynYTCngCng
Thitb
H thng sc k lng ghp khi ph LC
MS/MS bao gm khi ph ba t cc ABCiex
TripleQuad5500vibngunionhaTurboV
ghpniviscklngShimadzuUFLCXRbao
gm bm Shimadzu 20ADXR, b tim mu
Shimadzu SIL20ACXR, b n ct Shimadzu
CTO20AC,biukhinShimadzuCBM20A.
Tonbhthngsckvkhiphckim
sot,iukhinbiphnmmAnalyst1.5.1ca
hng ABCiex. Ct tch chit s dng l ct
Primesep 100: 250x 4,6 mm, ng knh ht 5
m v ct bo v c cung cp bi hng
SIELCHoak.
Xlmu
nghincuquitrnhxlmuchonn
ncmmchngtitinhnhthnghimvic
lm sch cc tp cht trong nn theo cc qui
trnh khc nhau bao gm: lm sch nn mu
bng dung dch trichlor acetic acid 10%; lm
schnnmubnghnhpdungdchCarrez1
v 2; lm sch nn mu bng k thut
QuEChERS.
Xc nh cc thng s ca phng php

phntch
Tinhnhkhostccthngstiuqu
trnhtchchitcasckcngnhccthngs
cakhiphvkhongtuyntnh,ng,
chnh xc, gii hn pht hin, gii hn nh
lng,khngmboocaphngphp
phntch.khosttuyntnh,tinhnh
dng ng chun ca cc axt amin vi cc
nng 0,5 mol/L, 1 mol/L, 2,5 mol/L, 10
mol/L, 25 mol/L, 50 mol/L, 100 mol/L v
250 mol/L. kho st ng ca phng
php, tin hnh phn tch mu nc mm c
thm chun ti cc nng 2,5 mol/L, 5
mol/L v 10 mol/L. Mi nng c tin
hnhphntch06ln.khostchnhxc
caphngphpthngthngcxcnh
bngccthngs:lplir(Repeatability),
ChuynYTCngCng
NghincuYhc
chnhxctrunggian(interprecision)haycn
gi l ti lp ni b phng th nghim Rw
(withinlaboratoryreproducibility)vtilp
R (Reproducibility) gia cc phng th nghim.
Trong iu kin nghin cu chng ti ch tin
hnh kho st hai thng s lp li r v
chnh xc trung gian Rw. lp li tin hnh
phn tch 06 mu nc mm c cng chun
trong cng mt ngy th nghim. ti lp
trung gian tin hnh phn tch 06 mu nc
mmnhtrnmtngyphntchkhc.Gii
hn pht hin (LOD) v gii hn nh lng
(LOQ) ca phng php, tin hnh pha long
muncmmchaccaxtaminnnng
mthitbphthincchtphntchcng
nhtltnhiutrnnhiunncachng.Gii
hnphthinlgiihnmtltnhin/nhiu
nn3vgiihnnhlnglgiihnmt
ltnhin/nhiunn10.khngmboo
ca phng php c tnh da trn ti liu
SANCO/2004/2726rev4.
KTQUVBNLUN.
Ti u ha iu kin ca sc k v khi
ph
Tiuhaiukintchccaxtaminc
thc hin trn ct tch Primesep100. Qua qu
trnh nghin cu chng ti xc nh c
thnhphnphangvchngtrnhchyti
u c th tch hon ton hn hp cc axt
amin. Chng trnh chy ca qu trnh sc k
nhsau:chchylchgradientvihai
thnhphnphangbaogmacetonitrile:H2O
(30:70)cha0,05%trifluroaceticacid(phang
A) v acetonitrile: H2O (30:70) cha 0,3%
trifluroacetic acid (pha ng B). Chng trnh
gradient nh sau: t 05 pht chy 100% dng
A,t520phtgradientt100%dngAv0%
dng A, t 2022 pht 0% dng A, sau
chuynv100%dngA.Qutrnhphntchkt
thcsau30pht.Vithnhphnphangnh
trnhn
455
NghincuYhc
Hnh1:QutrnhtchccaxtamintrncttchPrimesep100.
Sau mu c lc qua giy lc th loi
Khi ph ABciexTriple Quad 5500 chy
bccthnhphnktta.Lytonbdchlc
ch phn tch MRM vi ch ion dng
sauthmvo1,2grambtC18.Lcu,sau
c ti u vi cc thng s cho cc ion phn
lytm3.000vng/10pht.Tiptcchuyn
tchnhbng1.
ton
dung dch sang ng nha cha 300 mg
Bng1:Ccthngscbncachphntchcc
btthanhottnh.Lcu,saulytm3000
axtaminbngkhiphABciexTripleQuad5500.
vng/10pht.Chuyntonbdungdchsang
Axt amin
Ion m Ion con
DP
CE
bnhnhmc50ml,sautiptcnhmc
(m/z)
(m/z)
Arginine
175
70
70
28
nvchbngmethanol.Lcdungdchbng
Histidine
156
110
60
19
phin lc nylon 0,45 m vo l phn tch
Leucine
132
86
65
15
trnscklng.
Isoleucine
Lysine
Methinone
Phenylalanine
Threonine
Valine
132
147
150
166
120
118
86
84
104
120
74
72
65
90
50
50
50
50
15
21
16
19
15
15
Xlmu
Vicxlmubngccphngphpkt
ta truyn thng s dng dung dch
trichloroatetic acid 10% hay hn hp dung
dchCarrezchohsthuhithp.Hsthu
hi thp ny c th xy ra do qu trnh ng
kttaccaxtamincnphntchvicccht
tp v k thut x l mu bng QuEChERS
chohsthuhittnht.Qutrnhxlmu
bngQuEChERSctinhnhnhsau:cn
khong0,5grammuncmmchovotube
nha50ml,thmtip50mlmethanol,lcu.
456
Ccthngscaphngphpphntch
Khongtuyntnhcaphngphpphntch
Khong tuyn tnh ca hn hp cc axt
amin vi nng t 0,5 mol/L n 250
mol/Lchohstngquancatonbcc
axtamin0,99.
ngcaphngphpphntch
ng ca phng php phn tch c
khostticcnng2,5mol/L,5mol/Lv
10mol/L.Quaqutrnhthcnghimchngti
nhnthyhsthuhitrungbnhcaccaxt
amint80,59%n94,66%.Hsthuhitrung
bnhcaonhtlarginine(94,66%)vthpnht
llysine(80,59%).Ktquchititctrnhby
trongbng2.
chnhxccaphngphpphntch
ChuynYTCngCng
lplicaphngphp
Quaqutrnhphntchmuxcnhlp
li ca phng php trong cng mt ln th
nghim, chng ti nhn thy lp li ca
phng php c h s bin ng (RSD%) nm
trongkhongt1,03n2,69.Chtphntchc
h s bin ng (RSD%) thp nht trn cng
mtthnghimllysine(1,03)vchtchs
binngcaonhttrncngmtthnghiml
isoleucine(2,32).Ktquchititctrnhby
trongbng32
tilpnibphngthnghim
Quaqutrnhphntchmuxcnhti
lp ni b ca phng php ti phng th
nghim trong cc ngy phn tch khc nhau,
chng ti nhn thy ti lp ni b ca phng
php c h s bin ng (RSD%) nm trong
khongt4,21n7,19.Chtphntchchs
binng(RSD%)thpnhttrnccngyphn
tchkhcnhaulphenylalanine(4,23)vchtc
hsbinngcaonhttrnccngyphntch
NghincuYhc
khcnhaulvaline(7,19).Ktquchititc
trnhbytrongbng2.
Giihnphthinvgiihnnhlngca
phngphp
Qua thc nghim chng ti thu c gii
hnphthin(LOD)caphngphpt0,02
0,03mol/gvgiihnnhlngcaphng
php t 0,05 0,10 mol/g vi t l tn
hiu/nhiu nn (S/N) trung bnh ca gii hn
nhlngt10,90n17,36choccchtphn
tch.Ktquchititctrnhbytrongbng
2.
khngmboo
Da trn cc s liu ca qu trnh xc nh
cc thng s ca phng php phn tch
khngmboocaccchtphntchc
trnh by trong bng 2. khng m bo o
ca cc cht phn tch nm trong khong t
8,44%n21,34%.
Bng2:Bngthngsng,chnhxc,tilp,giihnphthin(MLOD),giihnnhlng
(MLOQ)vkhngmboocaphngphpphntch.
Cht phn tch
Threonine
Valine
Methinone
Leucine
Isoleucine
Histidine
Lysine
Arginine
Phenylalanine
ng (%) lp li (RSD%)
89,69
90,55
88,83
90,98
91, 36
89,74
80,59
94,66
93,81
2,09
2,10
2,69
1,19
2,32
1,25
1,03
1,34
1,89
ti lp
(RSD%)
4,34
7,19
4,21
5,16
5,71
4,34
5,06
4,98
4,23
KTLUN
Quanghincuchngtixydngc
mtphngphpngin,ctincycao
xc nh trc tip hm lng axt amin trong
nn mu nc mm. Phng php phn tch
ny tin hnh nhanh chng, c tin cy cao
nhsdngcccngcphntchhinilh
thngsckghpkhiphbatcc.Quitrnh
phntchcngchoccchtt80,59%n
94,66%.lplichsbinng(RSD%)t
1,03%n2,69%.tilpnibchsbin
ChuynYTCngCng
Gii hn pht Gii hn nh khng m

hin (mol/g) lng (mol/g) bo o (U%)
0,03
0,10
13,22
0,03
0,10
13,78
0,03
0,10
12,79
0,02
0,05
11,33
0,02
0,05
11,64
0,03
0,10
12,20
0,03
0,10
21,34
0,03
0,10
8,44
0,02
0,05
8,83
ng(RSD%)t4,21%n7,19%.Giihnnh
lng t 0,05 mol/g n 0,10 mol/g.
khngmboot8,44%n21,34%.
KINNGH
ngdngkthutscklngghpkhi
phphntchaxtaminkhngdnxuttrn
nnmuncmmticclabophntchthc
phmhinnaychthngLCMS/MSbaogm
khiphbatcc.
457
NghincuYhc
TILIUTHAMKHO
1.
2.
Dauner M and Sauer U (2000). GCMS Analysis of Amino

Acids Rapidly Provides Rich Information for Isotopomer
Balancing,BiotechnologyProgress,Volumne16,642649.
Ibrahim SM (2010). Utilization of Gambusia (Affinis affinis)
For Fish Sauce Production, Turkish Journal of Fisheries and
AquaticSciences10:169172.
3.
4.
5.
Jinzhong X, Shen J, Yiyu C, and Haibin Q (2009). GCMS

AnalysisofAminoAcidsinExtractofCornusCapraeHircus,
ChemicalResearchinChineseUniversities,25(6),812816.
Mohamed HN, Man YC, Manap SMYA (2012). Tentative
Identification of Volatile Flavor Compounds in Commercial
Budu,aMalaysianFishSauce,UsingGCMS,Molecules,17,
50625080.
Thiele B, Stein N, Oldiges M, Hofmann D (2012).Direct
analysisofunderivatizedaminoacidsinplantextractsbyLC
MSMS,MethodsinMolecularBiology,828,31728.
458
ChuynYTCngCng
NghincuYhc
XYDNGQUITRNHNHLNGVIKHUNBIFIDOBACTERIUM
SPP.TRONGCCSNPHMTRSINH(PROBIOTIC)
HongHoiPhng*,NguynPhc,NguynThAnho
TMTT
tvn:Bifidobacteriumspp.lmttrongnhngvikhunclithngcsdngtoccsn
phm probiotic. Tuy nhin hin nay ch c ISO 29981: 2010 l phng php dng nh lng
Bifidobacterium spp. trong sa v cc sn phm t sa. Do vy, vic xy dng qui trnh nh lng
Bifidobacteriumspp.trongsnphmprobioticlcnthitnhmphcvchocngtckimnghimccsnphm
probiotichinnay.
Mc tiu nghin cu: Xy dng qui trnh nh lng Bifidobacterium spp. trong sn phm tr sinh
(probiotic).
Phngphpnghincu:nhlngBifidobacteriumspp.theoISO29981:2010csaibsungv
mi trng nui cy, thi gian x l mu trong sn phm tr sinh (probiotic) v xc nh gi tr s dng
phngphptheoISO16040:2003vngvchm(lplivtilp).
Kt qu nghin cu:QuitrnhnhlngBifidobacteriumspp.trongsnphmprobioticbngphng
phpmasdngccmitrngthchthchhpvitngsnphmprobiotic:thchTOSMUP(sa,sn
phmtsavsnphmprobioticcbsungBifidobacteriumspp.cngviE.faecium);thchTOSMUPhoc
RAF 5.1 (sn phm probiotic c b sung Bifidobacterium spp. cng vi vi khun Lactobacillus spp. v
S.thermophillus);thchTOS(snphmchbsungduynhtBifidobacteriumspp.).Thigiancnthitchox
lmul:snphmprobioticdngvinnn,dngcmvvinnang:30pht;snphmprobioticdngbt:20
30pht.ngcaphngphpt>96%trongttcccmitrngnuicy.lpliSr0,07(t
yucutheoISO29981:2010viSr=0.08(snphmbt)andSr=0,071(snphmrn).tilpSR0,144
(tyucutheoISO29981:2010viSR=0,189(snphmbt)vSR=0,144(snphmrn).
Ktlun:QuitrnhnhlngBifidobacteriumspp.bngphngphpmaxydngthchhpcho
nhlngBifidobacteriumspp.trongsnphmprobiotic.
Tkha:Bifidobacteriumprobiotic
ABSTRACT
SETUPTHEPROCEDUREFORTHEENUMERATIONOFBifidobacteriumspp.INPROBIOTIC
PRODUCTS
HoangHoaiPhuong,NguyenDoPhuc,NguyenThiAnhao
Bacground: Bifidobacterium spp. are the usefull bacteria that using to make the probiotic products.
However,uptonow,thereisonlyusedISO29981:2010forenumerationofBifidobacteriumspp.inmilkand
milk products. Therefore, set up procedure for enumeration of Bifidobacterium spp. in probiotic products is
necessary.
Objectives:SetupprocedureforenumerationofBifidobacteriumspp.inprobioticproducts.
Methods:DeterminetheenumerationofBifidobacteriumspp.basedonISO29981:2010withmanykindsof
Tcgilinlc:Ths.HongHoiPhng T:0976586438Email:hoanghoaiphuong@ihph.org.vn
ChuynYTCngCng
459
NghincuYhc
culture medium and time of sample treatment in probiotic products. Validation of method based on ISO/TS
16140:2003fordetermindtherecoveryandprecision(repeatabilityandreproducibility).
Results:DeterminetheenumerationofBifidobacteriumspp.inprobioticproductsbyplatecountonTOS
MUPagar(milk,milkproductsandprobioticproductssupplementBifidobacteriumspp.andE.faecium);TOS
MUP agar or RAF 5.1 agar (probiotic products supplement Bifidobacterium spp., Lactobacillus spp. and
S.thermophillus);TOSagar(forprobioticcontainsonlyBifidobacteriumspp.).andtimeofsampletreatmentfor
capsule,tabletandgranulateproductsis30minutesandpowderproductsis2030minutes.Therecoveryismore
than96%inallculturemedia.The repeatability Sr 0.07 (meet the requirement of ISO 29981:2010 with Sr
=0.08(powderproducts)andSr=0.071(solidproducts).ThereproducibilitySR0.144(meettherequirementof
ISO29981:2010withSR=0,189(powderproducts)vSR=0.144(solidproducts).
Conclusions:CanbeappliedtheprocedureenumerationofBifidobacteriumspp.byplatecountforprobiotic
products.
Keywords:Bifidobacteriumprobiotic
TVN
Bifidobacterium spp. (ngoi tr B. denticum) l
vikhunclichongtiuhavngvai
trquantrngivisckhengibichng
cchsnhnlnvctrcavikhunchi
rutgibngcchtothnhacidlacticvaicd
acetic.Ngoira,Bifidobacteriumspp.cnchot
tnhchngungth,gipgimcholesteroltrong
huyt thanh, lm gim huyt p, tng s dung
np ng lactose, kch thch h min dch c
th,tnghpccvitaminvgipnhanhchng
bnhphcsaukhimcccbnhtiuchyvs
dngnhiukhngsinh(7,9).Vth,Bifidobacterium
spp. c s dng nhm sn xut cc ch
phmvisinhvtsng(probiotic)avoc
thngiemlinhnghiuquclichoc
th.
Thngthng,ccsnphmprobioticc
nhng tc dng mong mun th cn phi phi
m bo s lng t bo cn sng st (>106
CFU/g hoc ml) trong sn phm sut thi gian
tntrvtiuth(8).Vth,vicsnxutccsn
phm c cha vi khun Bifidobacterium spp. cn
phimbomcsngstcavikhunny
>106CFU/gthiimdngsnphm.Chnh
v th, cn phi c mt phng php ng tin
cyxcnhslng Bifidobacteriumspp. c
trongsnphmprobiotic.
Hin nay, nh lng v nh danh
Bifidobacteriumspp.ctrongsnphm probiotic
460
cthsdngccphngphpnhma,
phngphpsinhhcphnt(ccthnghim
da trn mu d DNA, PCR v realtimePCR)
vphngphpenzyme(1,3,6).PhngphpISO
29981: 2010(5) ang c p dng ph bin
nhlngBifidobacteriumspp.trongsavcc
snphmtsa.Nhngthcthinnaynhiu
sn phm khc sa c b sung Bifidobacterium
spp. v mt s vi khun c li khc cha c
phng php chun. Chnh v l do nh vy,
trn c s ca phng php ISO 29981: 2010,
chng ti tin hnh kho st thm mt s mi
trngkhc,vimcchtmcmitrng
tiutrongxtnghimBifidobacteriumspp.trn
nhiusnphmprobioticvxcnhgitrs
dngcaquitrnhcthpdngchocng
tc kim nghim hin nay. Do vy, chng ti
thchintiXydngquitrnhnhlng
Bifidobacterium spp. trong sn phm tr sinh
(probiotic).
Mctiunghincu
Thitlpquitrnhxlmuvsosnhkh
nng phn lp Bifidobacterium spp. trn mt s
loi mi trng thch t xut mt qui
trnh hon chnh nh lng s vi khun
sngBifidobacteriumspp.trongccsnphmtr
sinh.
Xcnhgitrsdngcaquitrnhnh
lngBifidobacteriumspp.trongccsnphmtr
sinh
ChuynYTCngCng
ngdngquitrnhcxydngkho
st s lng vi khun sng Bifidobacterium spp.
trongmtsloisnphmtrsinh.
ITNGPHNGPHPNGHINCU
itngnghincu
Chngvikhun:BifidobacteriumbreveATCC
15700, B. bifidum ATCC 11863 (hng
MicrobiologicsM).
Cc sn phm probiotic: sa bt v sn
phmtsa(07mu),thcphmchcnng(19
mu).
Phngphpnghincu
Trn c s nh lng Bifidobacterium spp.
trong sa v cc sn phm t sa theo ISO
29981: 2010(5), c b sung mt s mi trng
chnlckhcMRScitin,TOS,MRSNPNLv
mitrngEcobion2.
NghincuYhc
Xcnhgitrsdngtheophngphp
16140:2003(4)vguidelineFAO(2).
KTQUVBNLUN
Kho st qui trnh nh lng
Bifidobacterium spp. vi cc mi trng
thchkhcnhaubngccchngvikhun
ichng
S dng huyn dch vi khun i chng
(BifidobacteriumbreveATCC15700hayB.bifidum
ATCC 11863) vi nng vi khun khong 1
2,0x108 CFU/ml, tin hnh nh lng
Bifidobacterium spp. ng thi trn cc mi
trngthchsau:MRScitin,TOS,TOSMUP,
MRSNPNL,Columbiacitin(mitrngRAF
5.1vmitrngEcobion2). Kt qu c
trnhbytrongbng1.
Bng1:KtqunhlnghuyndchvikhunichngBifidobacteriumbreveATCC15700vB.bifidum
ATCC11863
Chng i chng
Kt qu (logCFU/ml)
TOS-MUP
MRS-NPNL
MRS ci tin
TOS
RAF 5.1
Ecobion 2
B. breve ATCC 15700
6.700,2
8,440,05
8,310,03
5,860,09
8,310,10
5,360,32
B. bifidum ATCC 11863
7,320,15
8,170,06
8,040,08
5,720,12
8,030,10
5,090,19
Chthch:miktqutrnlktqutrungbnh(n=3)SDlogCFU/ml.
Ktqubng1chothy:tcngmihuyn
dch vi khun i chng Bifidobacterium breve
ATCC15700vB.bifidumATCC11863banu
nhngchoktqunhlngBifidobacterium
spp. khc nhau. Mi trng thch TOS, TOS
MUP v mi trng RAF 5.1 cho kt qu nh
lngBifidobacteriumspp.caohnsoviccmi
trng nh MRS ci tin, MRSNPNL, v mi
trngEcobion2.
Khostthigiancnthit choqutrnh
xlmusnphmprobiotic
i cc sn phm probiotic dng vin nn,
vinnangvbt,khostthigianxlmul
10,20,30v40phttrongdungdchkkhv
trngvsdngmitrngTOSMUPnui
cy.Ktquctrnhbytrongbng5.
Bng2:Ktqukhostthigiancnthitchoqutrnhxlmusnphmprobiotic
Stt
1
2
3
4
5
6
M s mu
B1.1
B1.2
B3
B8
B2
B19
Dng mu
Vin nn
Ht cm
Vin nang
Bt
10 pht
7,0x104
2,0x105
3,0x106
1,3x105
5,6x105
4,9x104
Kt qu (CFU/g)
20 pht
30 pht
1,5x106
6,0x106
8,8x105
1,8x106
1,0x108
5,0x108
5
7,9x10
2,0x106
6
2,1x10
3,4x106
5
5,0x10
4,2x105
40 pht
1,0x106
1,0x106
2,1x108
2,0x106
1,0x106
3,2x105
Nhvy,ktqutrongbng2chothy:
ChuynYTCngCng
461
NghincuYhc
i vi mu sn phm probiotic dng vin

nn,dngcmvvinnang:thigiancnthit
choqutrnhxlmul30phtcktqu
nh lng vi khun sng Bifidobacterium spp.
caonht.
i vi mu sn phm probiotic dng bt:
thigiancnthitchoqutrnhxlmul20
30phtcktqunhlngvikhunsng
Bifidobacteriumspp.caonht.
Xcnhgitrsdngcaphngphp
Xcnhng(thuhi)
Gy nhim chng i chng Bifidobacterium
breveATCC 15700 vo 2 loi sn phm probitic
(sabtvbtthcphmchcnngkhngc
b sung Bifidobacteriumspp. v cc vi khun c
likhc)vinngvikhunl106vikhun/g
mu xc nh ng. Mi sn phm ny
c thc hin nh lng Bifidobacterium spp.
trn 2 mi trng thch l TOSMUP v RAF
5.1.Thchintngtnhvyvichngi
chngB.bifidumATCC11863.Ktqutrnhby
trongbng3.
Bng3:Ktquxcnhng(%)caquitrnh
nhlngBifidobacteriumspp.trongccsnphm
cgynhimBifidobacteriumbrevevB.bifidum
Chng i chng (%)
B. breve ATCC B. bifidum ATCC
15700
11863
Sa bt TOS-MUP
98,07
100,48
RAF 5.1
97,42
98,30
97,89
99,91
Bt thc TOS-MUP
phm chc RAF 5.1
96,84
99,03
nng
bng 3 cho thy: ng ca qui trnh

nh lng Bifidobacterium spp.trong sn phm
probiotic ny khi thc hin nh lng
Bifidobacterium spp. trn 2 mi trng thch l
TOSMUPvRAF5.1utyucu(>80%).
Xcnhchm
Xcnhlpli
lp li ca qui trnh nh lng
Bifidobacterium spp. trong sn phm probiotic,
cthchintrnccnnmutnhin (sn
phm probiotic bn trn th trng) l sa v
462
thc phm chc nng. Mi loi mu trn c

phn tch t nht 3 mc vi khun (CFU/g)
khcnhau(tnngthp,trungbnhvcao
nht), mi nng vi khun trong mu phn
tch lp li 5 ln trn c hai mi trng TOS
MUPvRAF5.1.Ktquctrnhbytrong
bng4.
Bng4:Ktquxcnhlplicaquitrnh
nhlngBifidobacteriumspp.trongsnphm
probiotic
Mc
4
10
Sa
TOS0,06
MUP
RAF 5.1 0,07
TOSThc
/
MUP
phm
chc nng RAF 5.1
/
Kt qu tnh lp li Sr
Mc
Mc
Mc
Mc
105
106
107
108
/
0,05
0,05
0,05
0,04
0,03
0,07
0,02
0,07
0,07
0,06
bng 4 cho thy: lp li ca qui trnh

nhlngBifidobacteriumspp.trongmtssn
phmprobiotictrn2mitrngthchlTOS
MUPvRAF5.1tngignnhauvuc
gi tr Sr Sr 0,07 (t so vi yu cu theo ISO
29981:2010 l Sr =0,08 (sn phm bt) v Sr
=0.071(snphmdngrn).
Xcnhtilp
Chn 2 nn mu t nhin (sn phm
probiotic bn trn th trng) l sa v sn
phm t sa; thc phm chc nng. Mi mt
nn mu chn 110 sn phm khc nhau, c
phntchbi2kimnghimvinvsdnghai
mi trng thch: TOSMUP v mi trng
RAF5.1.Ktquctrnhbytrongbng5.
Bng5:Ktquxcnhtilpcaquitrnh
nhlngBifidobacteriumspp.trongsnphm
probiotic
Loi mu
Mi trng
Sa
TOS-MUP
RAF 5.1
TOS-MUP
RAF 5.1
Thc phm chc

nng
Kt qu tnh ti lp
SR
0.06
0.06
0.10
0.11
bng 5 cho thy: ti lp ca qui trnh

nh lng Bifidobacterium spp. gn bng nhau
v u c gi tr SR 0,144 (t so vi yu cu
ChuynYTCngCng
theoISO29981:2010lSR=0,189(snphmdng
bt)vSR=0,144(snphmdngrn).
Kho st s lng vi khun sng

Bifidobacteriumspp. trong mt s loi sn
phmprobiotic
TT
16
17
18
M
S lng
s Bifidobacterium
mu spp. (theo cng
b ca nh sn
xut)
B. bifidum
8
B12
2x10 /0.45g
B. bifidum
B13
B14 B.longum 1,0x108/g
6
B15 B. bifidum 3,0x10 /g
NghincuYhc
Kt qu (logCFU/g hoc
ml)
Mi trng Mi trng
TOS-MUP
RAF 5.1
<10
<10
4,32 0,06
<10
4,38 0,07
<10
ng dng qui trnh nh lng

Bifidobacteriumspp.trongmtsloisnphm
probiotic nh sau: sa bt v sn phm t sa
(07mu),thcphmchcnng(19mu).Biv
26 sn phm probiotic ny u c b sung
Bifidobacteriumspp. v cc vi khun c li khc
(theo cng b ghi trn nhn sn phm ca nh
snxut)nnmisnphmprobioticnyc
tin hnh nh lng Bifidobacterium spp. ng
thitrnhaimitrngthchsau:TOSMUPv
mi trng RAF 5.1. Kt qu c trnh by
bng6.
Chthch:miktqutrnlktqutrungbnh(n3)
SDlogCFU/mlhocml.
Bng6:Ktqukhostslngvikhunsng
Bifidobacteriumspp.trongmtsloisnphm
probiotic
Kt qu bng 6 cho thy mi trng TOS

MUP thch hp cho nh lng Bifidobacterium
spp.tronghuhtccsnphmProbiotic.
TT
1
2
M
S lng
s Bifidobacterium
mu spp. (theo cng
b ca nh sn
xut)
10
B1.1 B. longum 5x10 /g
11
B1.2 B. infantis 10 /g
Kt qu (logCFU/g hoc
ml)
Mi trng Mi trng
TOS-MUP
RAF 5.1
6,76 0,08
<10
6,17 0,06
<10
6,52 0,04
<10
8,72 0,02
10
B. longum 5x10 /g
B2 B. longum 5x1010/g
B. longum
9
B3
1,0x10 /2,1g
B4.1
10
B4.2 B. breve 5x10 /g
10
B4.3 B. breve 5x10 /g
8
9
B4.4
B5
10
11
B6
B7
12
B8
13
B9
3
4
5
6
14 B10
15 B11
B. bifidum/10mg
B. longum
9
2x10 /10g
B. longum /10g
B. longum
8
0.4x10 /0.3g
B. bifidum
1,5x108/0.3g
B. bifidum
8
2x10 /0.45g
B. bifidum
8
2x10 /0.45g
B. bifidum
8
2x10 /0.45g
6,44 0,05
6,62 0,05
20 B16
B. lactis BB12
6,65 0,05
6,64 0,03
21 B17
B. lactis BB12
6,41 0,15
6,76 0,02
7,51 0,18
7,06 0,08
5,72 0,03
5,61 0,07
7,19 0,05
<1
7.41 0,04
<1
6,69 0,09
6,94 0,02
19
6
22 B18 B. lactis 1,0x10 /g
B. longum 1x108
23 B19
CFU/g
7
B.
lactis
1,0x10 /g
24 B20
25 B21
B. lactis
B. longum
7
26 B22
1,0x10 /g
KTLUN
Trn c s qui trnh nh lng
Bifidobacterium spp. trong sa v sn phm t
sa theo ISO 29981:2010, chng ti xy
dng c qui trnh nh lng Bifidobacterium
spp.trongsnphmprobiotic,trongcnch
:
5,28 0,05
8,26 0,06
<10
5,36 0,06
<10
6,14 0,13
<10
6,17 0,06
<10
<10
Snphmprobioticdngbt:2030pht
<10
<10
Mi trng thch s dng cho nh lng

Bifidobacteriumspp.:
<10
Sa,snphmtsavsnphmprobiotic
(c b sung Bifidobacterium spp. cng vi E.
faecium):thchTOSMUP.
6,23 0,07
<10
Sn phm probiotic c b sung

Bifidobacterium spp. cng vi vi khun
Lactobacillus spp. v S.thermophillus: thch TOS
MUPhocRAF5.1(nnsdngthchRAF5.1
v c gi thnh r hn 2 ln so vi thch TOS
MUP).
<10
<10
6,36 0,07
<10
<10
<10
<10
<10
ChuynYTCngCng
Thigiancnthitchoxlmu:
Sn phm probiotic dng vin nn, dng
cmvvinnang:30pht.
463
NghincuYhc
Sn phm ch b sung duy nht

Bifidobacteriumspp.:thchTOS.
KINNGH
3.
4.
5.
6.
pdngquitrnhnhlngBifidobacterium
spp. trong sn phm probiotic trn c s ISO
29981:2010csaibsung.
Cnphigimstchtlngcasnphm
probiotichinnaytrnthtrng.
TILIUTHAMKHO
1.
2.
464
Corry JE. et al., (2003). Handbook of Culture Media for Food

Microbiology,ElservierScienceB.V,p.147158.
FAO/WHO, (2002). Guidelines for the Evaluation of
Probiotics in Food. 30/4/2002 v 1/5/2002. London Ontario,
Canada.
7.
8.
9.
Hattingh AL, Viljoen BC, (2001). Yogurt as probiotic carrier

food.InternationalDairyJournal11:117.
ISO16140:2003.
ISO29981:2010.
Requena T, Burton J, Matsuki MK, Simon MA, Tanaka R,
WatanabeK,RannockGW,(2002),Identification,detectionand
enumeration of human Bifidobacterium species by PCR targeting
the transaldolase gene, Applied and environmental
Microbiology,68(5),p.24202427.
RichardKR,CarlAB,PradipDP,(2000),EncyclopediaofFood
Microbiology,Volume1,p.210217.
RichardKR,CarlAB,PradipDP,(2000),EncyclopediaofFood
Microbiology,Volume2,p.13561360.
Vlkova E, Rada V, Trojanova I, (2004), Enumeration,isolation
and identification of Bifidobacteria from dairy products, Acta
agriculuraeslovenica,84(1),p.3136.
ChuynYTCngCng
NghincuYhc
NGDNGKTHUTLAMPPHTHIN
LISTERIAMONOCYTOGENESTRONGTHCPHM
NguynThAnho*,NguynPhc,HongHoiPhng,LThHin
TMTT
tvn:HinnayvicphthinListeriamonocytogenesbngkthutsinhhcphntcng
dngnhiuphngkimnghimtrnthgiivVitNam.Nhngcckthutsinhhcphntthngi
hiccthitbttinvtrnhkthutcao,cnkthutLoopMediatedIsothermalAmplification(LAMP)
lmtkthutkhuychinucleicacidmikhngcnthitbttin,cchiu,nhycaovnhanh
diiukinngnhit.ngdngkthutLoopMediatedIsothermalAmplification(LAMP)phthin
ListeriamonocytogenestrongthcphmvimcchgimstvxcnhccminguyvnhimListeria
monocytogenestrongccvngcthcphmlhtsccnthit.
Mctiunghincu:KhostnhitvthigiantiucaphnngLAMP,nhgiquitrnh
kthutLAMPphthinListeriamonocytogenestrongthcphm.
Phngphpnghincu:KthuttchchitDNAtheoIntagenesvnhgiquitrnhkthutLAMP
theoISO/TS16140:2003.
Ktqunghincu:NhitvthigiantiucaphnngLAMPl63oCtrong60pht.Giihn
phthin:nnmusa(03CFU/25mlhocg),nnmutht(47CFU/25g).Ccthngskthutcaphng
phpLAMPtrn2nnmuthcphm:nnmusa(AC:98,33%,SP:100%,SE:96,67%),nnmutht
(AC:95%,SP:96,67%,SE:93,33%).
Ktlun:CthngdngkthutLAMPphthinListeriamonocytogenestrongthcphm.
Tkha:LAMP,Listeriamonocytogenes
SUMMARY
APPLICATION LOOP MEDIATED ISOTHERMAL AMPLIFICATION (LAMP) METHOD FOR
DETECTION Listeria monocytogenes IN FOOD
NguyenThiAnhDao,NguyenDoPhuc,HoangHoaiPhuong,LeThiHien
Background:Nowadays,thedetectionListeriamonocytogenesbymolecularbiologytechniqueshavebeen
applied in many laboratories around the world and in Vietnam. But molecular biology techniques requires
expensive equipments and high technical level, Loop Mediated Isothermal Amplification (LAMP) method is a
novelnucleicacidamplificationtechniquethatdonotrequireexpensiveequipments,butithadahighspecificity,
sensitivity and rapidity under isothermal conditions. Application of LAMP method for detection Listeria
monocytogenesinfoodforthepurposeofmonitoring and identification the hazards of Listeria monocytogenes
contaminationinfoodpoisoningcasesatpresentisnecessary.
Objectives:SurveyoptimaltemperatureandtimesofLAMPreactionandvalidationofLAMPmethodfor
detectionListeriamonocytogenesinfood.
Method:DNAExtractionbyIntagenes.ValidationofLAMPmethodbasedonISO/TS16140:2003.
Vin V sinh Y t Cng cng thnh ph H Ch Minh

Tc gi lin h: KTV. Nguyn Th Anh o T: 0907775142
ChuynYTCngCng
Email: daocherry82@yahoo.com
465
NghincuYhc
Results:OptimaltemperatureandtimesofLAMPreactionis63oCabout60.Limiteddetection:dairy(0
3CFU/25mlorg),meat(47CFU/25g).TechnicalparametersofLAMPmethodintwofoodmatrix:dairy(AC:
98,33%,SP:100%,SE:96,67%),meat(AC:95%,SP:96,67%,SE:93,33%).
Conclusion:CanapplyLAMPmethodfordetectionListeriamonocytogenesinfood.
Keyword:LAMP,Listeriamonocytogenes
TVN
ITNGPHNGPHPNGHINCU
BnhListeriosisxyranhiuloingvt,
baogmconngi,vasnhhngnt
cung ca ngi mang thai, h thng thn kinh
trung ng, hoc l mu, nghim trng hn l
edantnhmng(sythai,sinhnon,vim
mngno,..).PhnlnbnhListeriosisngi
l do Listeria monocytogenes gy ra. Theo thng
kl3,8%bnhListeriosisgyradothcphm
( bnh vin), nhng loi vi khun ny l
nguyn nhn ca khong 27,6% cc ca t vong
do tiu th cc loi thc phm b nhim
khun(2,1).
Vtliunghincu
HinnayphthinListeriamonocytogenes
trong thc phm, cc labo vn dng phng
php nui cy truyn thng, nhng phng
phpnybhnchvthigian(57ngy).Vi
mcchgimstvxcnhtcnhngyng
c do Listeria monocytogenes trong thc phm,
chngtitmhiuvnghincu:ngdng
k thut LAMP pht hin Listeria
monocytogenes trong thc phm, vi cc ni
dungnghincusau:
Muthcphm(72muthtv72musa)
:MucmuaticcsiuthtrongTp.HCM.
Cc chng vi sinh: Bacillus cereus ATCC
10876, Escherichia coli ATCC 25923, Enterobacter
sakazakii BCRC 14122, Listeria monocytogenes
ATCC 13936, Salmonella typhimurium ATCC
13511, Shigellasonnei ATCC 9290, Staphylococcus
aureus ATCC 25922, Vibriocholerae BCRC 14142,
VibrioparahaemolyticusATCC17802.
Phn ng LAMP : Buffer Bst 10X, primer
mix, dNTP(25mU), Bst (8U/l), Betaine (0,8M),
dH2Ovitngthtchl2400l.
Ha cht cho in di: Agarose 2% (Biorad),
m ti mu in di (0,15% bromophenolblue,
30% glycerol), 200 mM Tris, 20 mM EDTA
(Biorad),mTBE0,5X,EthidiumBromide(Bio
rad),thangDNAchun100bp(Biorad).
Phngphpnghincu
TchchitDNAtheoIntagenes.
Thmdiukinnhitvthigian
caphnngLAMP.
PhnngLAMP:85oC/5pht(tchmch),
6065oC/4575 pht v ngng phn ng
80oC/2pht.
Kho st tnh loi tr ca phng php

LAMP.
Phng php nui cy truyn thng: theo

ISO112901:1996/AMD.1:2004.
nh gi qui trnh LAMP pht hin

Listeriamonocytogenestrongthcphm.
Khostccthngskthutcaphng
phpLAMPtheoISO/TS16140:2003.
Giihnphthin(LOD).
chnhxctngi(AC).
chiutngi(SP).
nhytngi(SE).
Tldngtnhgi(PD).
Tlmtnhgi(ND).
466
Phng php pha long chng Listeria

monocytogenesxcnhLOD:vi5mcgy
nhim.
Mc1(Lo)lchngm.
Mc2(La),mc3(Lb),mc4(Lc):lccmc
khosttmLODcaphngphp.
ChuynYTCngCng
Mc 5 (L50) l pht hin theo l thuyt
/25g,khigynhim100%muphicktqu
dngtnh.
KTQUNGHINCU
Ktquthmdnhitvthigian
caphnngLAMP
DchkhunsaukhictchchitDNAs
cthchinphnngLAMPccnhit
khc nhau: 60oC, 63oC v 65oC v cng cng
iu kin v thi gian l 60 pht. Sau khi c
c nhit ti u, chng ti s tip tc
khostthigianl45,60v75pht.
NghincuYhc
Ging 8, 9 v 10 vi nng L.monocytogenes ln lt

tngngl103,102v101CFU/mlv75pht.
Nhn xt: Qua cc th nghim kho st v

nhitvthigiancaphnngLAMPcho
thythigian60phtvnhit63oClti
unhtcaphnng.
Kho st tnh chn lc ca phng php

LAMP
S dng cc vi khun khng mc tiu
(Salmonella, Shigella, E.coli, Staphylococcus
aureus,
Bacillus
cereus,
Vibrio
paraheamolyticus,
Vibrio
cholerae
v
Enterobacter sakazakii) v vi khun mc tiu
Listeria monocytogenes tng sinh trn mi
trng canh thang TSB, 37oC/24h. Thu ly
dch, em tch chit v thc hin phn ng
LAMP.
Hnh1.1.Ktqukhostnhitcaphnng
LAMP
Chthch:MK:ThangDNAchun100bp.
Ging1,2,3,4,5v6:60oC.
Ging7,8,9,10,11v12:63oC.
Hnh1.3.KtqukhostchiucaLAMP
viccvikhunkhngmctiu
Ging13,14,15,16v17:65oC.
Chthch:MK:ThangDNAchun100bp;():chngm;
L.mono:Listeriamonocytogenes;Sal:Salmonella;Shi:
Shigella;E.coli;Sta:Staphylococcusaureus;Ba:Bacillus
cereus;V.para:Vibrioparaheamolyticus;VC:Vibrio
choleraevE.sakazakii:Enterobactersakazakii.
Hnh1.2.Ktqukhostthigiancaphnng
LAMP
Chthch:MK:ThangDNAchun100bp.
Ging1:ChngL.monocytogenes(+).
Ging2,3,4vinngL.monocytogeneslnlttng
ngl103,102v101CFU/mlv60pht.
Nhnxt:Quathnghimtnhchnlcca
phng php LAMP vi cc chng vi khun
khng mc tiu v vi khun mc tiu, kt qu
cho thy ch c vi khun Listeria monocytogenes
mitovchsng,cnccvikhunkhngmc
tiuukhngxuthinvch,nhvykthut
LAMP rt c hiu pht hin Listeria
monocytogenes.
Ging5,6v7vinngL.monocytogeneslttng
ngl103,102v101CFU/mlv45pht.
ChuynYTCngCng
467
NghincuYhc
Kt qu xc nh gii hn pht hin ca

phngphpLAMPtrn2nnmusav
tht
chiutngi(SP) =100%.
Bng1:KtqugiihnphthincaLAMPtrn
nnmusa
Tlmtnhgi(ND)=3,33%.
Nng
Lo= (-)
La= 3 CFU/25g
Lb= 5 CFU/25g
Lc= 8 CFU/25g
L50= 42 CFU/25g
Kt qu (+/-)
5/6
6/6
6/6
+
T l % (+)
83,33
100
100
Nhn xt: LOD ca phng php LAMP

trnnnmusavokhong03CFU/25ghoc
ml.
Bng2.KtqugiihnphthincaLAMPtrn
nnmutht
Nng
Lo= (-)
La= 4 CFU/25g
Lb= 7 CFU/25g
Lc= 10 CFU/25g
L50= 45 CFU/25g
Kt qu (+/-)
2/6
4/6
5/6
+
T l % (+)
33,33
66,67
83,33
Nhn xt: LOD ca phng php LAMP

trnnnmuthtvokhong47CFU/25g.
Ktqunhgiccthngskthutca
phngphpLAMP
T kt qu gii hn pht hin trn cc nn
musavtht,nnggynhim10xLOD
nhgiccthngsk thut (AC, SP, SE,
PDvND)caphngphpLAMP.
Bng3:KtquxcnhgitrsdngcaLAMP
trnnnmusa
Kt qu ca phng php nui
cy
Dng tnh (+)
m tnh (-)
+/+ Dng tnh -/+ Dng tnh
Kt qu
Dng tnh
ph hp
gi
ca
(+)
phng
(PA) = 29/30
(PD) =0/30
php
-/- m tnh ph
+/- m tnh gi
LAMP
hp
m tnh (-)
(ND) =1/30
(NA) =30/30
Tccgitrtrnbng1.3,ktqugitrcc
thngskthutcaphngphpLAMPtrn
nnmusal:
nhytngi(SE)
=96,67%.
Tldngtnhgi(PD)
=0%
Bng4:Ktquxcnhgitrsdngcaphng
phpLAMPtrnnnmutht
Kt qu ca phng php nui
cy
Dng tnh (+)
m tnh (-)
Kt qu ca Dng tnh +/+ Dng tnh ph -/+ Dng tnh
(+)
hp
gi
phng
php LAMP
(PA) = 28/30
(PD) =1/30
m tnh (-)
-/- m tnh ph
+/- m tnh gi
hp
(ND) =2/30
(NA) =29/30
Tccgitrtrnbng1.4,ktqugitrcc
thngskthutcaphngphpLAMPtrn
nnmuthtl:
chnhxctngi(AC)
=95%.
chiutngi(SP)
=96,67%.
nhytngi(SE)
=93.33%.
Tldngtnhgi(PD)
=3,33%.
Tlmtnhgi(ND)
=6,67%.
KTLUN
Nhit v thi gian ti u ca phng
phpLAMP:
Nhit:63oC.
Thigian:60pht.
TnhchnlccaphngphpLAMP:ch
phthinchiuchoListeriamonocytogenes.
GiihnphthincaphngphpLAMP
trnmuthcphm.
Nnmusa:LODvokhong03CFU/25g
(ml).
Nn mu tht: LOD vo khong 47
CFU/25g.
nh gi cc thng s k thut AC, SP,
SE, ND, PD ca phng php LAMP trn nn
musavtht.
chnhxctngi(AC)=98,33%.
468
ChuynYTCngCng
KINNGH
Thc hin ti vi quy m ln hn v s
lng mu, chng loi mu b sung thm
chovicnhgikthutLAMP.
Kho st thm v 2 cch c kt qu khc:
SYBERGREENIvoc.
Thnghimnhgisosnhkhnngpht
hin Listeria monocytogenes trong thc phm ti
mtsphngthnghim.
NghincuYhc
ngdngrngrikthutnychocclabo
tthitbsinhhcphnttrongqutrnhgim
stthcphm.
TILIUTHAMKHO
1.
2.
Batt CA (2000), Listeria, Encyclopedia of Food

Microbiology,pp.11941152.
Bhunis AK (2008), Listeria monocytogenes, Foodborne
microbial pathogens: mechanisms and pathogenesis,
Springer,pp.164182.
ChuynYTCngCng
469
NghincuYhc
KINTHC,THCHNHBNHNHNT40TUITNGHUYT
PTIXLONGTHUN,HUYNBNCU,TNHTYNINH
TQuct*,NguynThHip*,NguynThThu**
TMTT
tvn:Tnghuytp(THA)lmtbnhphbinvcxuhngngycngtng.BnhTHAkhng
ckimsotsannhiuhuqunghimtrngnhnhimuctim,taibinmchmuno.
Mctiu:Xcnhtlbnhnhnt40tuibTHAckinthcng,thchnhngtrongiutr
bnhTHAvxcnhmilinquangiakinthcngvthchnhngvicccimdnsxhi
ngit40tuibTHAtixLongThun,huynBnCu,tnhTyNinhnm2011.
Phng php nghin cu: ylmtnghincuiutractngangvkinthcvthchnhng
trongiutrTHAca360ngidntuit40trln.
Kt qu:.Trongtngsmu,21,7%bitbnhnhnTHAphiungthucsuti,chc27,5%ngi
bnhangungthuchp,29,2%ngianghtthuclv21,9%ngiTHAclmdngrubiatrong
thngqua.76,1%ngibnhTHActhiquennmn.60,3%ngiccngvicthotngthlcCmi
linquancnghathngkgiatui,hcvnvikinthcvbinchngcabnh,kinthcphngnga
bnhTHA.
Kt lun:Xydngmtchngtrnhcanthipvtruynthnggiodcsckhenhmnngcaokin
thc,thchnhthayilisngcangibnhtrongiutrTHA.
Tkha:Kinthc,thchnh,phngnga,tnghuytp.
ABSTRACT
KNOWLEDGE,PRACTICEINHYPERTENSIVEPATIENTSAGED40OROLDERINLONGTHUAN
COMMUNE,BENCAUDISTRICT,TAYNINHPROVINCE.
TaQuocDat,NguyenThiHiep,NguyenThiThu
Background: Highbloodpressure(THA)isaincreasingdisease.hypertensivemayleadstomanyserious
consequences.
Objectives: Determinethepercentageofpatientswithhypertension40yearsoldandoverwiththeright
knowledge,rightpracticeinthetreatmentofhypertensioninLongThuancommune,BenCaudistrict,TayNinh
provincein2011.
Methods:Thisisacrosssectionalsurveyresearchabouttrueknowledgeandproperpracticeintreatmentof
hypertension on 360 people aged 40 or older interviewing people with hypertension directly according to the
questionnairewereprepared.
Results:.Inall,21.7%ofpatientssaidhypertensivepatientshavetotakemedicationinlifelong.27.5%of
patients taking antihypertensive drugs, 29.2% of people are smoking and 21.9% hypertensive patients abuse
alcohol in the past month. 76.1% of patients have a habit of eating hight salt diet. 60.3% patients have work
whichislessphysicalactivityCorrelationisstatisticallysignificantbetweenage,educationwithknowledgeabout
complicationsofthedisease,hypertensivediseasepreventionknowledge.
* Vin V sinh Y t Cng cng Tp.HCM

Trung tm Y t huyn Bn Cu, tnh Ty Ninh
Tc gi lin lc: CN. T Quc t
T:0907959900
Email: taquocdat@ihph.org.vn
470
ChuynYTCngCng
NghincuYhc
Conclusion:Buildinganinterventionprogramonhealtheducationcommunicationtoimproveknowledge
andpracticallifestylechangesofpatientsabouttreatinghypertension.
Keywords:Knowledge,practice,prevention,hypertension.
TVN
Tng huyt p l mt bnh ph bin v l
mtvnquantrngcasckhecngng
nhiu ni trn th gii v bnh c xu hng
ngycngtng.BnhTHActhphngviu
tr c, mun trnh tin trin n cc bin
chngthiuquantrngliuchnhlisng
c nhn nh khng ht thuc l, hn ch n
mn,ungruva phi, kim sot cn nng,
tng hot ng th lc. iu chnh li sng
ccngnhnlmgimchuytpvnn
p dng cho tt c bnh nhn gm gim cn
nng,hnchungru,gimnmuivtng
hat ng th lc(11). Mt vn ct li trong
iutrttbnhTHAlihibnhnhnphi
nhn thc c tm quan trng ca bnh v
tunthychiutr.LongThunl
xvngsu,bingiicahuynBnCu tnh
Ty Ninh, a s ngi dn sng bng ngh
nngnghipvbunbnnhl.Theoktqu
khmtmsotcaVinVsinhYtcngcng
TP.HCMvothng8/2011khost1730ngi
ctuit40trlnchothy36,6%ngib
THA(8).TlnychothybnhTHAangngy
cngtrthnhvnsckhecngngquan
trng.Trncs,chngtitinhnhnghin
cumtnhmnhgiKinthc,thchnh
ngibnhTHAt40tuitrlntixLong
Thun, huyn Bn Cu, tnh Ty Ninh nm
2011tgipxydngcchotngtruyn
thnggiodcvhngdnngibnhphng
ngaccbinchngmtcchhiuqu.
ITNGPHNGPHPNGHINCU
Thigiannghincu
Thng1011/2011.
aimnghincu
X Long Thun, huyn Bn Cu, tnh Ty
Ninh
ChuynYTCngCng
Cmu
Cmumuctnhtheocngthc:
n =
2
1 / 2
P (1 P )
d 2
Trong: 0,975 =1,96;=0,05;d=0,04;Nghin

cu ca Hunh Th Tin v kho st s tun
th iu tr bnh nhn THA ti Hu Ngha,
Long An c t l l 17,5%. Thay vo cng thc
tnhccmu360ngi.
Phng php nghin cu v i tng

nghincu
y l mt nghin cu iu tra ct ngang
m t. Nghin cu c tin hnh bng cch
phngvntrctipngidnt40tuiv
c chn on b THA. Kt hp vi vic o
huyt p, cn nng, chiu cao ca ngi c
phngvnvghivomuinsn.
B cu thit k c tin hnh nghin cu
th v chnh sa trc khi nghin cu chnh
thc.iutravinctphuntrckhithu
thpsliu.
NhpliudngEpidata3.0sliucx
ldngStata8;tnhtlphntrm,dngts
PR, khong tin cy 95% v php kim chi bnh
phng.
Nghincuctinhnhccitng
cgiithchrvngthamgia.
KTQUVBNLUN
cimdnsxhi
Bng1:cimdnsxhicamunghincu
Ni dung
Gii: Nam
N
Tui: 40-49 tui
50-59 tui
60-69 tui
T 70 tui
Tn s
164
196
107
93
65
95
T l(%)
45,6
54,4
29,7
25,8
18,1
26,4
471
NghincuYhc
Ni dung
Trnh hc vn: M ch
Tiu hc
THCS
THPT v trn
Ngh nghip:Lao ng chn tay
Khng lm g
Ni tr
Bun bn
CNVC
Kinh t h gia nh:Khng ngho
Ngho
S dng BHYT:C
Khng
Tn s
73
187
68
32
170
93
63
22
12
242
118
151
209
T l(%)
20,3
51,9
18,9
8,9
47,2
25,8
17,5
6,1
3,3
67,2
32,8
41,9
58,1
V gii, t l n trong mu nghin cu cao

hnsovinamgii(54,4%sovi45,6%). T l
ngi thuc nhm tui 40 49 chim t l cao
nhtvi29,7%vthpnhtnhmngic
tuit6069chim18,1%.Tlngichc
vndibcTHCSchim72,2%.Trongtl
hc tiu hc l 51,9% v m ch 20,3%. Long
Thunlxnngnghip,trongmunghincu
c 47,2% ngi dn lm rung, lm thu, bn
cnh c th do i tng nghin cu l
nhngngittrungnin(40tui)vbTHA
nnc25,8%nginhkhnglmgv17,5%
ngi nh lm cng vic ni tr. V vy nn
kinhthngngyphisngphthucvogia
nh.
T l ngi dn c hon cnh kinh t kh
khnl32,8%.
Tlngidncbohimytl41,9%.
KinthcvcabnhTHA
Bng2:kinthcvccyutnguyccaTHA
Ni dung
Ch n mn gy THA (n=360):
Bit
Khng bit
Ht thuc l gy THA (n=360):
C
Khng bit
Kin thc ng v cc yu t nguy c
Tn s T l(%)
290
70
80,6
19,4
161
199
149
44,7
55,3
41,4
TlngidnbitnmncthgyTHA
l 80,6% v 44,7% ngi bit ht thuc l gy
THA.
472
Bng3:kinthctriuchngvbinchngbnh
THA
Ni Dung
Tn s T l (%)
Triu chng bnh THA (n=360)
Nhc u
242
67,2
Chng mt
221
61,4
tai
74
20,6
Hoa mt
96
26,7
Tc ngc
48
13,3
Kin thc ng chung v triu chng
93
25,8
THA gy ra nhng bin chng (n=360)
Bit
215
59,7
Khng bit
145
40,3
Ngi THA b nhng nguy him(n=215)
D b tai bin mch mu no
193
89,8
D b thiu mu c tim, suy tim
35
16,3
D cht
61
28,4
T l ngi c kin thc ng triu chng

ca bnh THA l 25,8%. Trong ngi bnh
bittriuchngnhcul67,2%vchngmt
l61,4%.
59,7%ngibnhbitbinchngcabnh
THA. Bin chng ca bnh THA ngi bnh
bitnhiunhtltaibinmchmunochim
89,8%.
Bng4:KinthcphngngaviutrbnhTHA
Ni dung
Tn s T l
(%)
Thi gian ung thuc h p (n=360)

Ung mt khong thi gian
Ung ht triu chng th ngng
Ung thuc sut i
Khng bit
Kin thc v thi gian ung thuc(n=360)
ng
106
126
78
50
78
29,4
35,0
21,7
13,9
21,7
Khng ng
282
78,3
T l ngi bnh bit bnh THA cn phi

ung thuc sut i l 21,7% v 78,3% ngi
bnhckinthckhngngvthigiancn
ung thuc iu tr bnh khi cho rng bnh
THAchcn ung thuc mt khong thi gian
hay ung thuc khi no thy khe ri ngng
hoc khng bit bnh THA cn iu tr trong
thigianbaolu.
ChuynYTCngCng
ThchnhiutrbnhTHA
Bng5:ThchnhungthuciutrbnhTHA
Ni dung
Tn s T l (%)
Hin ang ung thuc h p (n=360)
C
99
27,5
Khng
261
72,5
Mua thuc h p (n=99)
T mua
32
32,3
Toa ti khm hng thng
32
32,3
Toa ti khm 2-3 thng
16
16,2
Toa ti khm trn 3 thng
18
18,2
Toa ca ngi khc
1
1,0
L do khng ung thuc h p (n=261)
Khng c tin mua thuc
41
15,7
Thy ht triu chng
160
61,3
Kh chu khi dng thuc
3
1,2
Do b bnh khc
6
2,3
S ung thuc nhiu khng tt
56
21,5
Ngng khng l do
21
8,1
C 27,5% ngi bnh THA hin nay ang

ung thuc h p. Trong 32,3% ngi bnh
c thc hin ti khm hng thng v 67,7%
ngi bnh t mua thuc m khng cn toa
hocmuatheotoachaytoacangikhc.
Trong nhng ngi ngng ung thuc c
61,3% ngi ngng v thy ht triu chng,
21,5% ngi ngng v s ung thuc nhiu
khngtt.
Bng6:Thchnhthayilisngtrongiutr
bnhTHA
Ni dung
Tn s
T l
(%)
Ht thuc l (n=360)
Khng ht
ang ht
Ung ru bia tun qua (n=360)
255
105
C ung
Khng ung
Ung ru bia trn 5 n v/ngy thng
91
269
25,3
74,7
C
Khng
n mn (n=360)
79
281
21,9
78,1
274
76,1
ChuynYTCngCng
70,8
29,2
NghincuYhc
Ni dung
Tn s
Khng
Hot ng th lc(n=360)
86
T l
(%)
23,9
C
Khng
i b hay i xe p lin tc t 10 pht
217
143
60,3
39,7
C
Khng
Tp th dc
205
155
56,9
43,1
C
Khng
53
307
14,7
85,3
Cng vic ng mt ch
Trong nhng ngi THA c 29,2% ngi

bnhhinanghtthucl.25,3%ngibnh
c ung ru trong tun qua. T l lm dng
(ung bt k ngy no trong thng qua t 5 ly
chuntrlnivi nam v t 4 ly chun tr
lnivin)nhngngicungrul
86,8%. T l ny cho thy mc d ngi bnh
THAtungrunhnglngrutrongmi
lnungthngnhiu.iunysnhhng
khngttnsckhecangibnh.
76,1% ngi bnh THA c ch n mn
(nccmnmnnhccloimm,damui,
tng chao, trng mui, tht mui t 3
ngy/tun hoc c ngi nh cho rng n
mn).
39,7%ngibnhchotngccngvic
phivnngthngxuyntrn10pht/ln.
Bng7:NguncungcpthngtinvbnhTHA
Ni dung
Ngun cung cp thng tin bnh THA
(n=360)
Nhn vin y t
i pht thanh
Tivi
Ti liu truyn thng
Ngi quen
Tn s T l (%)
245
68
140
0
134
68,1
18,9
38,9
0
37,2
NgidnbitthngtinvbnhTHAqua
nhnvinytchimtl68,1%,38,9%bitqua
tivi,37,2%bitquangithn,hngxm.
473
NghincuYhc
Milinquangiakinthc,thchnhthayilisngvicccimdnsxhi.
Bng8:Milinquangiatui,gii,trnhhcvn,kinhtgianh,nghnghipvikinthcbinchng
vbnhTHA
Gii: Nam
N
Tui : 40 49 tui
50 59 tui
60 69 tui
> 69 tui
Trnh hc vn M ch
Tiu hc
THCS
PTTH
Kinh t gia nh Khng ngho
Ngho
Ngh nghip Lao ng tay chn
Bun bn
CBVC
Ni tr
Khng lm g
Kin thc ng
Tn s T l (%)
42
25,6
37
18,9
27
25,2
26
28,0
11
16,9
15
15,8
9
12,3
36
19,2
24
35,3
10
31,2
58
24,0
21
17,8
39
22,9
6
27,3
6
50,0
19
25,4
12
12,9
C mi lin quan c ngha thng k gia

trnh hc vn vi kin thc ca ngi bnh
v bin chng trong iu tr THA (p < 0,05)
(bng8).Nhngngichcvncngcaoth
ckinthcngvbinchngcabnhcng
cao. C s khc bit c ngha thng k gia
Kin thc sai

Tn s T l (%)
122
74,4
159
81,1
80
74,8
67
72,0
54
83,1
80
84,2
64
87,7
151
80,8
44
64,7
22
68,8
184
76,0
97
82,2
131
77,1
16
72,7
6
50,0
47
74,6
81
87,1
PR (KTC 95%)
0,124
1,22 (0,96 1,57)
0,186
0,001
0,002
0,184
1
1,15 (0,61 2,16)
0,60 (0,27 1,33)
0,55 (0,27 1,13)
1
1,69 (0,77 -3,74)
3,88 (1,59 9,48)
3,23 (1,12 9,28)
0,77 (0,52 1,14)
0,653
0,036
0,696
0,049
1
1,26 (0,46 3,45)
3,36 (1,01 11,2)
1,14 (0,58 2,24)
0,50 (0,24 1,01)
0,664
0,204
0,099
kinthcvbinchngcabnhTHAvicc
ngh nghip ca mu nghin cu. Theo ,
nhng ngi CBVC c kin thc ng v bin
chng bnh cao hn 3,36 ln so vi ngi lao
ngchntayvip=0,036vKTC95%(1,01
11,2).
Bng10:Milinquangiatui,trnhhcvn,nghnghipvithchnhungthuchp
Gii : Nam
N
Tui: 40 49 tui
50 59 tui
60 69 tui
> 69 tui
Trnh hc vn: M ch
Tiu hc
THCS
PTTH
Kinh t gia nh: Khng ngho
Ngho
Ngh nghip: Lao ng tay chn
Bun bn
CBVC
Ni tr
Khng lm g
474
Thc hnh ng
Thc hnh sai
41
25,0
123
75,0
58
29,6
138
71,4
24
22,4
83
77,6
28
30,1
65
69,9
19
29,2
46
70,8
28
29,5
67
70,5
21
28,8
52
71,2
53
28,3
134
71,7
17
25,0
51
75,0
8
25,0
24
75,0
65
26,9
177
73,1
34
28,8
84
71,2
36
21,2
134
78,8
9
40,9
13
59,1
4
33,3
8
66,7
21
33,3
42
66,7
29
31,2
64
68,8
PR (KTC 95%)
0,331
0,88 (0,67 1,15)
0,945
0,616
0,692
0,697
1
1,49 (0,79 2,82)
1,43 (0,71 2,89)
1,44 (0,76 2,73)
1
0,98 (0,54 1,78)
0,82 (0,39 1,75)
0,83 (0,32 2,14)
1,07 (0,77 1,47)
0,040
0,327
0,056
0,073
1
2,58 (1,01 6,59)
1,86 (0,53 6,57)
1,86 (0,97 3,55)
1,67 (0,95 3,01)
0,218
0,319
0,254
ChuynYTCngCng
nghnghipvivicungthuciutrTHA.
Nhng ngi t lm ch c thc hnh ung
thuctthnnhngngilaongchntay(p
=0,04).Nhngngitlmchlnhngngi
thng c iu kin kinh t tt hn nn h c
th tun th vic ung thuc tt hn nhng
ngi lao ng chn tay. Khng c mi lin
NghincuYhc
quancnghathngkgiathchnhung
thuchpvingilmcccngvickhc(p
>0,05).Khngcmilinquancnghathng
kgiathchnhungthuchpvgiica
ngi bnh (p = 0,331), vi hon cnh kinh t
ca ngi bnh (p = 0,697), vi tui ca
ngi bnh (p > 0,05) v vi trnh hc vn
cangibnh(p>0,05).
Bng11:Milinquangiatui,gii,trnhhcvn,nghnghipvithchnhnlt
Gii: N
Nam
Tui: 40 49 tui
50 59 tui
60 69 tui
> 69 tui
Trnh hc vn: M ch
Tiu hc
THCS
PTTH
Kinh t gia nh: Khng ngho
Ngho
Ngh nghip: Lao ng tay chn
Bun bn
CBVC
Ni tr
Khng lm g
Thc hnh ng
Tn s T l (%)
42
21,4
44
26,8
30
28,0
23
24,7
13
20,0
20
21,1
19
26,0
36
19,3
23
33,8
8
25,0
58
24,0
28
23,7
43
25,3
4
18,2
4
33,3
12
19,1
23
24,7
Thc hnh sai

Tn s
T l (%)
154
78,6
120
73,2
77
72,0
70
75,3
52
80,0
75
78,9
54
74,0
151
80,7
45
66,2
24
75,0
184
76,0
90
76,3
127
74,7
18
81,8
8
66,7
51
80,9
70
75,3
Khngcmilinquancnghathngk
giathchnhnltvgiicangibnh(p
=0,231),vituicangicphngvn(p>
0,05), vi ngh nghip ca ngi c phng
vn (p >0,05), vi trnh hc vn ca ngi
bnh (p > 0,05) v vi hon cnh kinh t ca
ngibnh(p=0,960)(bng3.13).
BNLUN
T l n trong mu nghin cu cao hn so
vi nam. Kt qu ny cng ph hp so vi
nghincucaMBuCmtrnnhngngi
bTHAt40tuitibnhvinNguynTrith
tlngiil54,4%(3).
Tlngidncbohimytl41,9%.T
l ny thp hn so vi nghin cu ca Hunh
ThTintibnhvinHuNgha,LongAn,tl
ngi c bo him y t l 60,4%(2). C s khc
bitvtlsdngBHYTnycthdonghin
ChuynYTCngCng
PR (KTC 95%)
0,231
0,86 (0,67 1,09)
0,230
0,313
0,912
0,960
1
1,18 (0,63 2,24)
1,56 (0,74 3,28)
1,46 (0,76 2,81)
1
1,47 (0,78 2,80)
0,69 (0,33 1,43)
1,05 (0,4 2,76)
1,01 (0,71 1,43)
0,466
0,539
0,319
0,920
1
1,52 (0,49 4,77)
0,68 (0,19 2,37)
1,44 (0,70 2,96)
1,03 (0,57 1,85)
0,598
0,239
0,252
cucaHunhThTincthchintibnh
vin nn ngi bnh s dng BHYT khm
bnhscaohnsoviiutratrongdns.
n mn l yu t nguy c ca bnh THA
c nhiu ngi bit nht l 80,6%. Kt qu
nytngngsovinghincucaMBu
Cm trn nhng ngi b THA t 40 tui ti
bnhvinNguynTrictlbit83%(3).iu
nyphhpvithctvbcsthnghng
dnngibnhhnchnmnkhibTHA.
Kin thc v triu chng bnh THA, 67,2%
bit triu chng nhc u v 61,4% bit triu
chngchngmt.Tlnytngngsovi
nghin cu ca Hunh Th Tin kho st
ngi t 35 tui tr ln ti bnh vin Hu
Ngha,LongAnc71,1%ngibittriuchng
chngmt,62,4%lnhcu(2)v59,7%ngi
bnh bit bin chng ca bnh THA. T l ny
475
NghincuYhc
tng ng so vi nghin cu ca Nguyn

HuHnhnhngngit18tuibTHAti
mDi,CMauctlngibitbinchng
cabnhl58,4%(5).Cctlnythphnsovi
nghin cu ca Trn Thin Thun nhng
ngi ln THA ti TP.HCM c 76% ngi bit
bnh THA c th gy tai bin(1). S chnh lch
ny c th do nghin cu cc qun th khc
nhau,viskhcbitnhauvvnha,trnh
hcvn,tuivcchotngtruynthng
vbnhTHA.Trongnghincucngtmthy
milinquankinthcvbinchngcabnh
vitrnhhcvnvnghnghipcangi
bnh.
C 21,7% ngi bnh bit bnh THA cn
phiungthucsuti.Tlnythphnrt
nhiu so vi nghin cu ca Hunh Th Tin
kho st ngi t 35 tui ti bnh vin Hu
Ngha,LongAnc64,8%ngibnhbitphi
ung thuc sut i (2). C s khc bit ny c
thdonghincucaHunhThTincthu
thptibnhvinnnngibnhscbcs
nhcnhphiungthuchpthngxuyn
hnvvytlngibnhckinthcngv
thigianiutrscaohnsoviiutratrong
dns.
27,5%ngibnhTHAhinnayangung
thuchp.Trong32,3%ngibnhcthc
hintikhmhngthng.Theonghincuca
VBoNgcnhngngiTHAtiTp.HCM
66%khngtikhmhocchtikhmkhicm
thymt(10).iunycthnhhngnvic
kim sot huyt p ca ngi bnh mc n
nh.Ktqutrongnghincucngkhngtm
thy mi lin quan gia thc hnh ung thuc
vi tui, gii, hc vn, hon cnh kinh t ca
ngi bnh. V vy cn s hng dn tch cc
cacnbytngibnhcthungthuc
yvhpl.
39,7%ngibnhchotngccngvic
phi vn ng thng xuyn trn 10 pht/ln.
T l ny cao hn nghin cu ca Trn Thin
ThunngilnbTHAtiTp.HCMthtl
nyl34,3%(6).Skhcbitnycthdonghin
476
cu c tin hnh nhng a im khc

nhau. Nu vng thnh th c th ngi dn
chyulmvnphngtrongkhivngnng
nghip i hi ngi dn phi lm nhiu vic
laongchntay.
29,2%ngibnhhinanghtthucl.T
lnytngngnghincucaTrnThin
Thunnhngngi ln b THA ti Tp.HCM
c t l ht thuc l l 30%(6). Theo nghin cu
ca Trnh Th phng Tho ngi trng
thnh b THA ti Q.5, Tp.HCM c t l ngi
anghtthucl27,3%(7).Theoktqutrncho
thy t l ht thuc l ca ngi bnh THA l
kh cao. V theo iu tra quc gia nm 2001
2002tlhtthuclnamgiil56,1%v
n l 1,8%. Mc d hin nay c nc trin
khai mt s hot ng phng chng ht thuc
l. Tuy nhin vic can thip mi ch tp trung
vo vic cung cp kin thc cho ngi dn v
tchicathuclnnchalmgimtlht
thuclnhiu.
80,6% ngi bnh bit n mn c th gy
THA.Tuynhinthct76,1%ngibnhTHA
cchnmn(nccmnmnnhccloi
mm, da mui, tng chao, trng mui, tht
mui t 3 ngy/tun hoc c ngi nh cho
rng n mn). iu ny cho thy thi quen n
mnrtkhthayi.Vvycnsngvin
tchcccacnbytngibnhthchnh
n lt mt cch ng n v hp l. Ngoi ra
khngtmthymilinquangiathchnhn
lt v gii, tui, ngh nghip, hc vn, hon
cnhkinhtcangibnh.iunyphhp
viccnghincukhctrcy(9,4).
KTLUN
Quakhost360ngit40tuibTHAti
XLongThun,huynBnCu,tnhTyNinh
chngtiaraktlunnhsau:
KinthcngcabnhnhnvbnhTHA
cn thp. 25,8% ngi bnh c kin thc ng
v cc triu chng ca bnh; 21,9% ngi c
kinthcngvbinchngcabnhvbin
chngcabnh;35,3%ngibnhckinthc
ChuynYTCngCng
ng yu t nguy c ca bnh; 38,9% ngi
bnh cho rng bnh THA c th phng nga
c; 21,7% ngi bnh c kin thc ng v
thi gian dng thuc khi cho rng ngi bnh
THAcnphiungthucludi,suti.
V thc hnh iu tr THA, 27,5% ngi
bnhhinangungthuchp.Trongch
c32,3%ngibnhctikhmnhkhng
thng. 29,2% ngi bnh ang ht thuc l;
76,1% ngi bnh c thi quen n mn; 60,3%
ngi bnh c cng vic ng mt ch; 25,3%
ngi bnh c ung ru trong tun qua v
21,9%ngibnhclmdngru,bia(ung
btkngynotrongthngquat5lychun
trlnivinamvt4lychuntrlni
vin)trongthngqua.
trnh hc vn vi kin thc v bin chng
bnh(p=0,003)vkinthcphngngabnh
(p < 0,001). Nhng ngi c hc vn t bc
Trunghccstrln,nhngngichcvn
cngcaothkinthcvbinchngbnh,kin
thcvphngchngbnhcngtt.
Xy dng m hnh im ti x nh trin

khai m hnh hp nhm, lng ghp cc hot
ng truyn thng trong cc cuc hp ca p
hngthnggimcchnhvichichosc
khe cho nhng ngi b THA t 40 tui. Cn
chtrngnccnidungnhungru,ht
thuc,chnnhiurauxanh.
Cn b y t hng dn ngi bnh c th
trong vic ung thuc h p nh cch ung
thuc,thigianungthuc.
TILIUTHAMKHO
1.
2.
3.
4.
5.
KINNGH
T cc kt qu nghin cu, chng ti nhn
thygpphnnngcaonhnthccangi
bnh, nhm ngn chn cc bin chng nguy
himcaTHAtheohngdphng,chngti
xinnghmtsbinphpsau:
Xy dng cc hot ng truyn thng gio
dcsckhequaphtthanhtrnloai,tri,
sch nh nhm cung cp kin thc cho ngi
dntrongphngviutrTHA.Trongcn
chncckinthcvbinchng,nguyc
cabnh,thigianngibnhphiungthuc
iutrTHA.
Tphunchocnbythuyn,x,ytp
v k nng truyn thng vn ng ngi dn
trongiutrbnhTHA.
NghincuYhc
6.
7.
8.
9.
10.
11.
Hunh Th Tin (2007) Kho st s tun th iu tr ca

bnhnhntnghuytptiphngkhmbnhvkhoani
tnghpbnhvinakhoakhuvcHuNgha,tnhLong
An.LunvnthcsYkhoa,ihcYdcTP.HCM.
M Bu Cm (2004) Thc hnh thay i li sng bnh
nhnTHAt40tuitrlntibnhvinNguynTri.Lun
vnttnghipcnhnytcngcng,ihcYdcTP.HCM.
NguynHuHnh,NguynNguyn(2001)Tsuthin
mcTHAvkinthc,thi,thchnhvkimsotTHA
ngit18tuitrlntixTnTin,mDi,CMau.
YhcthnhphHChMinh,tp5,(4),Tr.7379.
NguynVnNnh(2010)Ccyutlinquanntlbnh
nhn tun th iu tr THA ti bnh vin a khoa huyn
Phongin,thnhphCnTh.LunnchuynkhoacpII
Qunlyt,ihcYdcTp.HCM.
PhanNhtL(2009)Kinthc,thi,thchnhvkim
sotTHAcabnhnhnkhmBHYTtibnhvinqun3,
Tp.HCM.LunvnchuynkhoacpIYtcngcng,ihc
YdcTp.HCM.
TrnThinThun(2005)CcyutnhhngKinthcv
thc hnh ngi ln v bnh THA ti Tp.HCM. y hc
Tp.HCM,ihcYdcTp.HCM,11,(1),tr.118126.
Trn Thin Thun (2006) Xc nh yu t nh hng n
kin thc, thi , thc hnh ca bnh nhn THA ti Q.9,
Tp.HCM.YhcTp.HCM,ihcYdcTP.HCM,11,(1),tr.
127135.
TrnThinThun(2007)Hnhvivnhngyutlinquan
nTHAngilntiTp.HCM.LunnTinsYhc,i
hcydcTp.HCM.
TrnhThPhngTho(2009)nhhngcahnhvivli
sng ln bnh THA ngi trng thnh ti qun 5,
Tp.HCM.LunnchuynkhoacpIIQunlyt,ihcY
dcTp.HCM.
VinvsinhYtcngcngTp.HCM(2011)Ktqutmsot
bnhkhnglychocngngtiLongThun,BnCu,Ty
Ninh.Luhnhnib.
VBoNgc,LHongNinh(2004)Cccimvnhn
bit, iu tr v kim sot huyt p ca bnh nhn THA
qun4,Tp.HCM.YhcTp.HCM,ihcYdcTp.HCM,
9,(1),tr.132138.
ChuynYTCngCng
477
NghincuYhc
KINTHC,THI,THCHNHV
BNHLYQUANGTNHDCVCCBINPHPTRNHTHAI
CAHCSINHTRNGPTTHNGUYNHIN,QUN11
TP.HCHMINH,NM2011
LcHnh*,HunhHNgcQunh**,TrnNhtQuang**
TMTT
Mu:Sckhesinhsn(SKSS)lvncanhiulatuinhngvthnhnin(VTN)llatui
chimphnlndns,ctcngmnhmntnglaitncvmtiutbit,yllatui
angmpmbnlcatnhdcvchactipnhnyccthngtinlinquanvnny.
Mctiu:Nghincuctngangmtkinthc,thi,thchnhvbnhlyquangtnhdc(STIs)
vccbinphptrnhthai(BPTT)cahcsinhtrngtrunghcphthng(THPT)NguynHinQun11
TPHChMinh,nm2011vccmilinquan.
Phngphp:Nghincuctngangmttrn402hcsinhcchnngunhinphntngtitrng
THPTNguynHinQun11TPHChMinh,nm2011.Dliucthuthpvibcuhitin.
Ktqu:Tlhcsinhckinthcngl51%.ashcsinhcthiphhp,thichungvSTIs
phhp(94%),thichungvBPTTphhp(71%),tuynhintlhcsinhngtnhviquanhtnhdc
(QHTD) trc hn nhn chim t l cao (47%). Hc sinh tham gia nghin cu tng QHTD chim
12%.TrongshcsinhcthchnhQHTDthtlhcsinhcthchnhngvsdngbinphpphng
ngaSTIsvBPTTkhngcao,tltngngl35%v43%.ashcsinhmongmuntipnhnthngtin
vSTIsvBPTT(82%).
Ktlun:Tlhcsinhckinthcng,thiphhpvthchnhngvSTIsvBPTTcnthp.
Cncsnhnnhnnghimtc,hnhngkpthivphihpgiattcccbanngnhlinquantrongvic
giiquytvnlinquanSTIsvBPTTVTNlmttrongnhngvnquantrngcnhhngkhng
nhncmtthhtrongtnglai.
Tkha:STIs,Binphptrnhthai,Vthnhnin.
ABSTRACT
KNOWLEDGE,ATITUDE,PRACTICEOFSTIsANDCONTRACEPTIVESOFSTUDENTSIN
NGUYENHIENHIGHTSCHOOLINDISTRICT11,HOCHIMINHCITY,IN2011
LeDucHanh,HuynhHoNgocQuynh,TranNhatQuang
Background:Reproductivehealthisaproblemofeveryone.However,adolescents,whoareaccountedforthe
majority of the population and have strong impact on the future of the country, have not received sufficient
informationaboutthismatter.
Objectives: To describe the knowledge, atitude, and pratice of STIs and contraception of students in
NguyenHienhightschoolindistrict11,HoChiMinhcity,in2011andtodeterminerelationships.
Methods: This was a crosssectional study. on 402 students in Nguyen Hien hight school were selected
*KhoaGDNCSKVinVSYTCCTp.HCM
Minh
478
**KhoaYtcngcngihcYDcTP.HCh
ChuynYTCngCng
NghincuYhc
usingrandomstratifiedsamplingmethod..Datawerecollectedfromselfadministeredquestionnaires.
Results: The proportion of students awared of the matter was 51%. Most students had appropriate
attitudes. but the proportion of students approving premarital sex was high (47%). The proportion of study
subjects having sexual experience was accounted for 12%. Among these students, the proportion of students
usingrightpreventivemeasureswasnothigh(35%forSTIsand43%forcontraception).Moststudentswanted
toreceiveinformationaboutSTIsandcontraception(82%).
Conclusion:Theproportionofstudentswithknowledge,appropriateattitudeandrightpracticeofSTIsand
contraception is low. There should be serious consideration, timely action and good coordination among all
departmentsrelatedtoSTIsandcontraceptionissuesamongadolescents.
Keywords:STIs,Contraception,Adolescent.
TVN
PHNGPHPITNGNGHINCU
Vthnhnin(VTN)lgiaionchuyntip
casphttrinthcht,xhivtmlmt
cchnhanhchng,nhdumtimduynht
trong cuc i khi mt c nhn khng cn l
mtatrnhngchaphilngiln.Thi
kchuyntipnytranhngthchthccho
sckheVTNvcngiln.Mtcnhnn
tuiVTNthhvtquaccnguyhimca
thiktrssinhvthithu,thngc
xemlkhemnh.Tuynhin,nhiumieda
nsckhevsphttrincahvncntn
ti,mhcnphicchunbvcbo
v.
Thitknghincu
Ngy nay cng vi s gia tng t l nhim

bnhlyquangtnhdc(STIs),cbitl
HIVlstngvtcatlnophthai(NPT)
VTN. T vong do ph thai khng an ton gn
13%stvongm,huhtlccncang
pht trin(9). Trong mi nm c 4,5 triu n
VTN ph thai khng an ton trn ton th gii
(3).
Ccskinxhi,kinhtvsinhhcnh
hng su sc n tui VTN v s nh hnh
cucsngcangilntrongtnglai.VTNl
la tui chim phn ln dn s, c tc ng
mnh m n tng lai t nc v la tui
angmpmbnlcatnh dc. tm hiu
v kin thc, thi , thc hnh v STIs v cc
BPTT trong la tui VTN chng ti tin hnh
nghincuny.
ChuynYTCngCng
Ctngangmt.
Cmuvitngnghincu
402 hc sinh trng THPT Nguyn Hin,
Qun11,Tp.HCM.
Thigiannghincu
03/201107/2011.
Phngphpvcngcnghincu
Sdngbcuhitin.
Kimsotsailchthngtin
Thit k b cu hi vi nhng t ng r
rng,dhiu.
Tinhnhnghincuthvismu5%so
vi c mu v chnh sa b cu hi ph hp
trckhitrinkhainghincuchnhthc.
Phntchvxlsliu
Nhp liu: Epidata 3.1. X l s liu: Stata
10.
VnYc
Kt qu nghin cu ch c s dng cho
mc ch khoa hc, nhng thng tin m i
tng cung cp s hon ton c gi b mt.
Chtinhnhnghincutrnitngng
thamgianghincu.
KTQU
Tlhcsinhnamthamgianghincuthp
hn so vi hc sinh n v a s hc sinh sng
chungvicham,anhchem.Trongnhnghc
479
NghincuYhc
sinhbityu,tuibityutrungbnhl14,6(8
18)vilchchunl1,80.
vsdngbinphpphngngaSTIsvBPTT
khngcao,tltngngl35%v43%.
Bng1:Ccctnhcamunghincu(N=402)
Trong402itngnghincuc330hc
sinh c nhn c thng tin lin quan STIs v
BPTT,chim82%.itngcchnchia
s nhiu nht l t vn vin (48%) v 25% hc
sinh tham gia s khng ni vi bt k ai,
phng tin ph hp s dng c chn
nhiu nht l Internet v 98% cc em mong
muntipnhnthngtinvvnny.
c im
Gii: Nam
N
Trnh hc vn: Lp 10
Lp 11
Lp 12
Sng chung
Sng chung vi cha, m, anh, ch, em
Sng chung vi h hng, ngi quen
Sng mt mnh
Sng chung vi bn b
/ ang c ngi yu: C
Cha
Tn s T l (%)
184
46
218
54
130
32
148
37
124
31
372
24
4
2
195
207
92
6
1
1
49
51
Bng2mttlhcsinhckinthcng
miloikinthc,tlhcsinhckinthc
ngvbinphpphngngaSTIslcaonht,
thp nht l kin thc v STIs v tip theo l
kinthcvBPTT.
Bng2:Tnghpkinthc(N=402)
Ni dung
Kin thc v STIs
Kin thc v bin php phng nga
STIs
Kin thc v BPTT
Kin thc v an ton tnh dc
Tn s
162
T l (%
40
361
90
186
289
46
72
ashcsinhcthiphhpchimtl
cao nhng mc ng tnh v QHTD trc
hnnhntronghcsinhvnchimtlcao.
Bng3:Tnghpthi(N=402)
Thi ph hp
Mc nguy him ca STIs
Mc nh hng ca STIs
S dng bin php phng
nga STIs
S dng BPTT
Mc ng tnh v QHTD
trc hn nhn
Mc ng tnh v NPT
Tn s
390
366
T l
97
91
383
95
343
85
212
53
330
82
Trong402hcsinhthamgianghincuc
49 hc sinh tng quan h tnh dc, chim
12,2%. Hc sinh QHTD ln u rt sm, tui
QHTDlnutrungbnhl15,5(1217)vi
lch chun l 1,29. Trong s hc sinh c thc
hnhQHTDthtlhcsinhcthchnhng
480
Bng4:Phngtintruynthngsdngv
phhpsdng(N=402)
Phng tin truyn
s dng
Ph hp s
thng
dng
Ni dung
Sch bo
246
75
231
58
Internet
242
74
352
88
Nh trng
237
72
247
61
Tivi
145
44
208
52
Bn b
101
31
98
24
Gia nh
91
28
155
39
p phch, t ri
61
19
73
18
Radio
43
13
109
27
Bng5:MilinquangiathchnhQHTDvi
ctnhmu.(N=402)
c tnh
Tui
16
17
18
Gii
Nam
N
Hc vn
10
11
12
Sng chung
Cha m,
anh ch em
Khc
Ngi yu
C
Khng
Quan h tnh
dc
C
Khng
P value
PR (KTC 95 %)
0,13
0,31
1,06(0,98-1,15)
0,96(0,89-1,04)
0,0034
2,23(1,28-3,88)
14(11) 116(89)
26(18) 122(82)
9(7) 115(93)
0,082
0,39
1,07(0,99-1,16)
0,97(0,89-1,05)
46(12) 325(88)
1,00*
1,28(0,42-3,88)
0,0002
2,94(1,61-5,37)
15(11) 117(89)
25(17) 120(83)
9 (7) 116(93)
32(17) 152(83)
17(8) 201(92)
3(10)
28(90)
36(19) 159(81)
13(6) 194(94)
*
:KimnhFisher.
ChuynYTCngCng
Bng6:Milinquangiakinthc,thivi
thchnhsdngBPTT,binphpphngnga
STIs.
S dng BPTT/Bin
php phng nga
P
PR (KTC
Ni dung
STIs
value
95 %)
ng
Sai
Kin thc chung BPTT
ng
18(46)
21(54)
1,54 (0,56Sai
3(30)
7(70)
0,36
4,21)
Thi chung v BPTT
Ph hp
11(37)
19(63)
0,70 (0,40Khng ph hp
10(53)
9(47)
0,27
1,31)
Kin thc phng STIs
1,92 (0,52ng
15(38)
24(62) 0,46*
7,08)
Sai
2(20)
8(80)
*
KimnhFisher.
Bng7:Milinquangiamongmuntipnhn
thngtinvigii,kinthcvthi(N=402)
c tnh
Gii
Nam
N
KT chung
ng
Sai
T chung
Ph hp
Khng ph
hp
Mong mun tip

P
PR (KTC 95 %)
nhn thng tin
value
C (%) Khng (%)
177(96)
217(99)
7(4)
1(1)
0,03* 0,97(0,94-1,00)
204(99)
190(96)
1(1)
7(4)
0,03* 1,03(1,00-1,06)
325(98)
69 (96)
5(2)
3(4)
0,16* 1,03(0,98-1,08)
*
KimnhFisher.
BNLUN
Kt qu nghin cu cho thy, hc sinh c
ngiyuchimtlkhcao49%hcsinhtham
gia nghin cu, cao hn so vi nghin cu ca
tc gi Dip T M nm 2004 l 23,2%, v
nghincucatcgiNgcTnvHong
KinTrungl16,2%,tuidythngycngsm
ko theo s quan tm n ngi khc gii ca
ccnamsinh,nsinhngycngsmvnhiu
hn.Theonghincunychobittuibityu
ChuynYTCngCng
NghincuYhc
ngy cng sm v sm nht l 8 tui, tui bit

yutrungbnhl14,6tui,.
KinthcvSTIsvBPTThcsinhtrng
THPTNguynHincnthp,cbitkinthc
ngvSTIsl40%,thphnsovinghincu
catcgiDipTM(68,9%)(6),chanphn
nahcsinhckinthcng.
a s hc sinh c thi ph hp tr thi
v QHTD trc hn nhn VTN. Trong
nghin cu ny c ti 47% hc sinh chp nhn
vicQHTDtrchnnhn.iunyphhp
vi bo co SAVY 2, QHTD trc hn nhn
ngycngc chp nhn trong gii tr v c
44%thanhnincthihinivcaohn
0,8%soviSAVY1(2,4).
Nghincuchothyc12%hcsinhtham
gia nghin cu tng QHTD, t l ny thp
hnsovinghincucaMohammaditiIran
(28%)nhnglicaohnsovibocoSAVY2
(7,6%)(1,5). a s hc sinh quan h tnh dc ln
utrn15tuinhngtlhcsinhQHTDln
u tui 15 tui tr xung chim t l
khngnh4%.TheobococaUNICEFnm
2011:Ccsliukhosthgianhchothy
cc quc gia ang pht trin (tr Trung Quc),
khong 11% n gii v 6% nam gii tui
1519chobittngcquanhtnhdctrc
15 tui(7). Tuy t l QHTD trc 15 tui ca
nghin cu ny thp hn so vi bo co ca
UNICEFnhngcthdoitngnghincu
hphn,cht16n18tui.Cngvituibit
yuthtuiQHTDngycngsm,tuiquanh
tnh dc ln u tin nh nht l 12 tui v
trungbnh15,5tui.
Hc sinh nam c thc hnh QHTD nhiu
hn hc sinh n, tuy n sinh thng dy th
smhnnamsinhnhngcthgithuytcc
bn nam c th thng hiu k, t m, mun
khm ph bn thn qua phim nh, sch bo,
Internet.Trongnhnghcsinhtngquanh
tnhdcthchc43%hcsinhcthchnhs
dng BPTT, cao hn so vi bo co ca WHO
(34%)nhngconsnykhngcaovnghin
481
NghincuYhc
cu cho thy ch c 35% s dng bin php

phngngaSTIskhiQHTD(8).
Hc sinh c kin thc ng v STIs th c
thc hnh ng v s dng bin php phng
ngaSTIskhiquanhtnhdccaohnhcsinh
c kin thc sai v STIs. Nhng kin thc v
BPTTkhngclinquannviccthchnh
sdngBPTThaykhng,ktquSAVY2cng
chothyibphnthanhthiuninctip
nhn thng tin v BPTT nhng thi v s
dnglikhngtlthunvivicnhnbit(4).
LdokhinhcsinhkhngsdngBPTTkhi
quanhtnhdcnhiunhtldokhngcsn,
sau l do bn thn khng thch, ri do bn
tnhkhngthch,cuicngmilkhngbitv
BPTT.
Trong thi k hin i nh hin nay, con
ngi s dn dn sng khp kn, iu ng lo
ngi l mt phn t hc sinh tham gia nghin
cuchnkhngnivibtkaikhigpnhng
vnlinquanSTIsvBPTT,cngcthvl
domphngtinccemchnlphhp
nhtvimnhccnhngthngtinlin
quanSTIsvBPTTlInternet(88%).iung
longilnhngkinthctrnInternetrtkh
kimsotchnhxccathngtin.
hcsinhTHPT,nhngtthnlgiodcsm
cho cc em ngay t trung hc c s. Cng vi
nh trng, gia nh l ni gn gi vi cc em
nht.Ccbcchamcthchiasviccemv
vnSKSS.
Ngoivickthpvingnh giodc,cc
cquanytcnmbocungcpycc
dch v y t, c t vn ln chm sc sc khe
cho VTN. c bit ti cc c s t vn, khng
nn qu ng ngi, mi trng t vn cn
thn thin v vic cung cp thng tin cn tht
yvchnhxc.Bncnhcngvicchuyn
mn, cc c quan y t cn bin son nhng ti
liuvvnlinquanSTIsvBPTTsinhng,
dhiu,tocshngthvcnhngbui
gpgccemcchigiipthcmcca
mnh.
TILIUTHAMKHO
1.
2.
3.
4.
5.
KTLUN
TlhcsinhckinthcngvSTIsv
BPTTcnthp,tlhcsinhcthingtnh
vi QHTD trc hn nhn cao (47%). Trong
munghincu,hcsinhtngQHTDchim
tlkhngnh(12,2%),nglongiltrongs
nhng hc sinh c QHTD th hn phn na
khngcthchnhngvsdngBPTTv
binphpphngngaSTIs.ashcsinhbit
yulnutrungbnhl14,6vtuiQHTDln
usm,trungbnhl15,5tui.
KINNGH
6.
7.
8.
9.
10.
BoScKheViSng(2009),NophthaituiVThnh
Nin:Chuynaulng!,suckhoedoisong.vn/.../naophathaio
tuoivithanhnienchuyendaulong!.htm
B Y t, Tng cc thng k, UNICEF, WHO (2005) iutra
qucgiavvthnhninVitNamln1.
Ghana News Agency (2008) Research reveals high number
adolescentsundergoingunsafeabortion.
MOH, GSO, UNICEF, WHO (2010) Survey assessment on
Vietnameseyouthround2,NXBHNi.
Mohammadi MR, Mohammad K., Farahani FK, Alikhani S.,
Zare M., Tehrani FR., Ramezankhani A, Alaeddini F (2006)
Reproductive knowledge, attitudes and behavior among
adolescent males in Tehran, Iran. Int Fam Plan Perspect, 32,
(1),3544.
Nguyn Vn L, Dip T M (2004) Kinthc,thi , thc
hnh v sc khe sinh sn ca hc sinh trung hc ph thng
TP.HCM,Tp ch Y hc Tp.HCM, tp 9, ph bn ca s 1.
trang6871.
UNICEF(2011)Thestateoftheworldschildren2011,
Vietnamplus(2009)11%vthnhninVitNamcquan
hsm.
WHO
(2003),
Unsafe
abortion,
www.who.int/reproductivehealth/publications/unsafe_aborti
on/9789241596121/en/20k,
WHO Reproductivehealth,childandadolescenthealth,nutrition,
andhealthforolderpersons
www.wpro.who.int/.../rdonlyres/D37ABCE4A9C04CA2
A4CE
FC7815ADC55E/0/14a_Chapter9Reproductivehealth.pdf
Nhtrngcnxydngmtchngtrnh
gio dc v SKSS c bit l STIs v BPTT cho
482
ChuynYTCngCng
NghincuYhc
NHGIHOTNGTRUYNTHNGCANTHIPTHAYI
KINTHCVTHCHNHCANGIDN
TRONGPHNGCHNGSTXUTHUYTTI2X
TNHTINGIANG,NM2011
LCngMinh*
TMTT
t vn : Stxuthuyt(SXH)lmttrongnhngnguynnhnhngugybnhnngvnhp
vintiVitNam(3).ChngtrnhphngchngSXHtiVitNamcthchintnm1999,nhngn
naytlmcvchtkhngcxuhnggim.Trongnm2009,cccaSXHchyutptrungcctnhpha
Nam.cbitlcctnhthucngbngsngCuLong,nivicdtrnccnrtphbinvccyut
vsinhmitrngthunlichosphttrincamui(1).TinGianglmttrongnhngtnhcscamc
hngnmcaovcchiuhnggiatngtrongnhngnmgny(4,5).
Mctiu:XcnhhiuqucahotngtruynthngtrongthayihnhviphngchngSXHsau6
thngthchinti2xcatnhTinGiang.
Phngphpnghincu:Nghincucanthipcngng.XTnLngcchnlxcanthip,
xTnLTycchnlxchng.C2xthuchuynChuThnh,tnhTinGiang.
Ktqu:Saukhicanthip,tlngidntixTnLngdngnhangmuiditmuigp2ln
trckhicanthipvip<0,001.Tlngidnthayncvscradngcchancdi7ngysaukhi
canthiptnggp1,6lntrccanthipvip<0,001.Nhnchungtrckhicanthip,thchnhvphng
chngSXHcangidngiahaixkhngcskhcbit.Saukhicanthip,tlhynpdngccha
nc(DCCN)knhontontixTnLngcaogp1,14lnxTnLTyvip=0,004.Quaquanstti
xTnLng,saucanthiptlhclngqungbng0,57lntrccanthipvip<0,001vquaquanst
gia2xTnLngvTnLTythtlhcthctrongccdngcchancvtlhykncc
dngcchancxTnLngcaohnTnLTy.Nghincuchothyloihnh/hotngtruyn
thngmanglihiuqutrongtruynthngthayihnhvicangidnlcngtcvinnhdnvn
ng.
Ktlun:ThchnhcangidnvphngchngSXHthayinhiusaukhitruynthngcanthip.T
lngidndngnhangmui,tlngidnthchnhthaync,scraludi7ngytnghntrccan
thip.SovixTnlTy(xchng)thiutravquanstsaukhicanthip,ngidntixTnLng
(xcanthip)cthchnhngvphngchngSXH(dngquttrnhmuit,ynpdngccha
ncknhonton,thctrongdngcchanc)caohn.Cngtcvinnhdnvnnglhotng
truynthngmanglihiuqutiaphng.
Tkha:PhngchngStxuthuyt,truynthngcanthip.
ABSTRACT
ASSEESSMENTOFKNOWLEDGEANDBEHAVIORCHANGECOMMUNICATIONFORDENGUE
PREVENTIONFORPEOPLESINTWOCOMMUNESINTIENGIANGPROVINCE,IN2011
LeCongMinh*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:481485
*KhoaGiodc&NngcaoSckhe,VinVSinhYTCngCngTPHChMinh
Tcgilinlc:Ths.LCngMinh T:0918712374
Email:lecongming@ihph.org.vn
ChuynYTCngCng
483
NghincuYhc
Background: DengueisoneoftheleadingcausesofsevereillnessinVietnam(3).TheDengueprevention
programinVietnamhavebeenconductedsince1999,butthemorbidityandmortalityratehavenotdecreased.In
2009,denguecasesmainlyoccurredinSouthernprovincesespeciallyinMekongDeltaprovinces,wherewateris
usuallystoredandenvironmentalfactorsfacilitatethedevelopmentofmosquitoes(1).TienGiangprovinceisoneof
theprovinceswheretheprevalenceofDenguecaseswashighandhasincreasedinrecentyears(4,5).
Objectives: To determine the effectiveness of behavior change communication activities to for Dengue
preventionafterthe6monthinterventionintwocommunesinTienGiangprovince.
Methods: This is a community intervention study.. Tan Ly Dong commune was the interventional
communeandTanLyTaycommunewasthecontrolcommune.BothcommunesbelongtoChauThanhdistrict
inTienGiangprovince.
Results:Afterintervention,therewasatwofoldincreaseinthenumberofpeopleinTanLyDongcommune
using incense to kill mosquitoes.. The number of people who changed and cleaned water containers in under
seven days increased 1.6 times. The rate of households in Tan Ly Dong commune that tighly covered water
containers was 1.14 times higher than Tan Ly Tay commune (p = 0.004). The number of households having
mosquito larvae in water containers decreased 0.57 times. The rate of households at Tan Ly Dong commune
wherewatercontainersweretightlycoveredandhadfishwashighterthanTanLyTaycommune.
Conclusion: The intervention has brought positive changes in practice on Dengue control. Volunteer
programeducatornetworkhasworkedeffectively.
Keywords:Dengueprevention,communicationintervention
TVN
ITNGPHNGPHPNGHINCU
SXH l mt nguyn nhn hng u gy

bnh nng v nhp vin ti Vit Nam(3). Bnh
SXHnhhngnsckhevcucsng
caconngi,gyrasmcvtvongcaoti
nhiunctrnthgii.TheoTchcYtth
gii(WHO),ctnhminmckhong50n
100 triu ngi mc bnh ny, xp x 2,5 t
ngi sng ti cc quc gia lu hnh dch
SXH(7,6). Ti Vit Nam cc ca SXH ch yu tp
trungcctnhphaNam. c bit l cc tnh
thuc ng bng sng Cu Long, ni vic d
trnccnrtphbinvccyutvsinh
mi trng thun li cho s pht trin ca
mui(1). Tin Giang l mt trong nhng tnh c
scamchngnmcaosovicctnhtrongc
nc v c chiu hng gia tng trong nhng
nmgny(4,5).
Thitknghincu
Phng php nghin cu can thip cng
ng.
TnLngcchnlxcanthip,Tn
L Ty c chn l x chng. C 2 x thuc
huynChuThnhtnhTinGiang.
Phntchvxlsliu
Nhp liu: Epidata 3.0. X l s liu: Stata
10.
KTQUVBNLUN
Khng c s khc bit c ngha thng k
vcimcaitngtrcvsaukhost
gia2xvgii,hcvn,nghnghip,sngi
ctrongh,strctronghvphngtini
li,sinhhotvnghenhnvkinhthcai
tngtrcvsaucanthip.
S khc bit v kin thc v thc hnh phng chng SXH ca ngi dn ti x Tn L
ngtrcvsaukhicanthip
Bng1:Kinthccangidnvditmuittrcvsaucanthip(CT)tixTnLng
Lm g dit mui
484
Sau CT
Trc CT
(n=212)
(n=210)
RR (95%KTC)
ChuynYTCngCng
NghincuYhc
Khng
Khng
t nhang mui
105 (49,5%)
107 (50,5%)
52 (24,8%)
158 (75,2%)
<0,001
2,00 (1,52-2,63)
Phun thuc xt mui
63 (29,7%)
149 (70,3%)
97 (46,2%)
113 (53,8%)
<0,001
0,64 (0,50-0,83)
Vt in
63 (29,7%)
149 (70,3%)
43 (20,5%)
167 (79,5%)
0,02
1,45 (1,04-2,03)
Dng tay, dng c p

mui
4 (1,9%)
208 (98,1%)
21 (10%)
189 (90%)
<0,001*
0,19 (0,07-0,54)
Khc
3 (1,4%)
209 (98,6%)
3 (1,4%)
207 (98,6%)
1,00*
0,99 (0,20-4,85)
*KimnhFisher
Ngi dn dng nhang mui dit mui

saukhicanthiptixTnLngcaogp2
lnsovitrckhicanthipvip<0,001.Sau
canthip,tnhangmuiclachnnhiu
nhtvitll49,5%.
Bng2:ThchnhcangidnvditlngqungbngcchscraDCCNcangidntixTnL
ng
Sc ra DCCN
Sau CT
Trc CT
(n=212)
(n=210)
RR (95%KTC)
Khng
Khng
C sc ra cc DCCN
212 (100%)
0 (0,0%)
133 (63,3%)
79 (37,6%)
Thi gian thay nc, sc ra DCCN di

7 ngy
177 (83,5%)
35 (16,5%) 143 (68,1%)
67 (31,9%) <0,001 1,61 (1,2- 2,14)
Th c dit lng qung trong tt c cc

DCCN
54 (25,5%)
158 (74,5%) 63 (30,0%)
147 (70,0%)
T l h dn y np DCCN kn hon ton

sau khi can thip gp 1,14 ln t l h dn y
npDCCNknhontontrckhicanthipvi
p=0,004.Ktquchothysaucanthipngi
dn bit cch y np DCCN ng hn so
vibanu.Tlngidnbitcchynp
DCCNngtng5,8%sovitrccanthip.T
lnytngngvinghincucatcgi
NguynLm(2009)tiQun8tp.HChMinh,
t l y kn cc DCCN ti phng im v
phngchngtngngl65%,55%.
Skhcbitvthayikinthcvthc
hnh phng chng SXH ca ngi dn
trcvsaucanthiptihaix
Bng3:1SosnhthchnhphngchngSXHca
ngidnquaquansttihaixtrccanthip
Ni
dung
Tn L ng Tn L Ty
n=210
N=208
Khn
Khn
C
C
g
g
S h
209
1
205
3
c dng
c tr
nc (99,5) (0,5) (98,6) (1,4)
RR
KTC
95%
0,31* 1,01
1,991,02
ChuynYTCngCng
Ni
dung
Tn L ng Tn L Ty
n=210
N=208
Khn
Khn
C
C
g
g
S h 93
c lng
qung (44,3)
S h
69
c th
c trong
cc (32,9)
DCCN
S h
173
y np
kn cc
DCCN (82,4)
S h
209
sc lu <
=7
ngy (99,5)
117
100
108
0,29
0,8 (0,71-1,11)
RR
KTC
95%
0,43 0,92
0,741,13
0,003 1,62
1,172,26
<0,001 1,21
1,091,36
0,12* 1,02
0,991,04
(55,7) (48,1) (51,9)

141
42
166
(67,1) (20,2) (79,8)

37
141
67
(17,6) (67,8) (32,2)

1
203
(0,5) (97,6) (2,4)
*KimnhFisher
Quaquanstsaukhicanthipthtihaix
thtuytlhdnclngqungtixTnL
TycaohnxTnLngl4,2%,vtlh
dnthctrongDCCNtixTnLngcao
hnxTnLTyl12,7%vtlhdntix
Tn L ng y kn DCCN cao hn t l h
dntixTnLTyl14,6%.
485
NghincuYhc
Loihnh/hotngtruynthngmanglihiuqutrongvictruynthngthayihnh
vicangidn
Bng4:NgunthngtinvphngchngSXHnngidntihaix
Bit cc thng tin v SXH nh vo
i, tivi
C ngi n nh vn ng
Ti liu truyn thng
Hp dn ti p, x
Ngi quen
Nghe xe c ng trong cc chin dch
Con chu l hc sinh
Hp ph huynh
Khc
Tn L ng
Trc CT
Sau CT
n= 210
n=208
Tn s
T l (%)
159
95
39
26
25
13
11
3
3
75,7
45,2
18.6
12,4
11,9
6,2
5,2
1,4
1,4
Ngun cung cp thng tin cho ngi dn

vothiimsaucanthiptixTnLng
ch yu l CTV n nh ngi dn, k n l
i,tivi.Trongkhinguncpthngtincho
ngidnvothiimsaucanthiptixTn
L Ty ch yu l i, ti vi v k n l CTV.
Ngidnchobithcngheccthngtin
vphngbnhSXHquacccuchpnhmdn
tix,p,tng5lnsovikhostbanu.Kt
qunghincutngngviktqunghin
cu ca tc gi Nguyn Lm (2009) ti tp, H
ChMinh,NguynVnTi(2009)tingNai,
Bch Th Chnh (2009) ti Tin Giang cho thy
tipcnthngtinquatruynthngichngl
rt cao v kin thc ng ca ngi dn trn
80%. Tuy nhin, ngi dn c kin thc ng
caonhngtlthchnhvncnthp(1).
KTLUN
S khc bit v kin thc v thc hnh
phng chng SXH ca ngi dn ti x
TnLngtrcvsaukhicanthip
C s thay i r rt v thc hnh sc ra
dngcchanctihgianhvthigian
scradngcchanctheohngdn(<7
ngy)trcvsaucanthip.Tlthayiny
cnghathngkvip<0,001.
Tn L Ty
Trc CT
Sau CT
n=212
N=211
Tn
Tn s T l (%)
T l (%) Tn s T l (%)
s
184
88,5
152
71,7
181
85,8
193
92,8
100
47,2
163
77,3
93
44.7
55
25.9
99
46.9
130
62,5
24
11,3
71
33,6
1
0,5
39
18,4
11
5,2
1
0,5
38
17,9
10
4,7
0
0,0
6
2,8
1
0,5
0
0,0
7
3,3
0
0,0
0
0,0
3
1,4
0
0,0
Skhcbitvthayithchnhphng
chngSXHcangidntrcvsaucan
thiptihaix
TlthchnhphngchngSXHbngcch
ditmui,ditlngqungvscraccDCCN
ca ngi dn c hai x c tng so vi trc
can thip nhng s khc bit ny khng c
nghathngkgiahaix.
S h c lng qung gim ng k so vi
trc can thip ti hai x. Nhng s khc bit
nykhngcnghathngk.
Loihnh/hotngtruynthngmangli
hiuqutrongvictruynthngthay i
hnhvicangidn
TlnginnhvnngtixTnL
ngsaucanthiptnggpivcaohnx
TnLTy14%.iunychothytnhtnhcc
v hiu qu vn ng ca CTV ca x Tn L
ngsaucanthip.
TILIUTHAMKHO
1.
2.
3.
486
Bch Th Chnh (2009) Hiu qu hot ng truyn thng

trongthayikinthcthchnhcangidnvphng
chng bnh st xut huyt ti x Vnh Hu, G Cng Ty,
tnhTinGiang.YhcThnhphHCM,tp4(2)2010,tr.54
60.
BYt(2011)Quytnh1499vvicHngdngimst
vphngchngbnhstxuthuyt.
H.V.Pham,H.T.Doan,T.T.Phan,N.N.TranMinh(2011)
Ecological factors associated with dengue fever in a central
highlandsProvince,Vietnam.BMCInfectDis,11,172.
ChuynYTCngCng
4.
Trung tm Y t d phng Tin Giang (2009) Bo co Hot

ngphngchngstxuthuytnm2009
Vin Pasteur Tp.HCM (2009) Bo co tng kt hot ng
phngchngStxuthuytkhuvcphaNam.
5.
6.
7.
NghincuYhc
WHO (1999) GuidelinesforTreatmentofDengueFever/Dengue

HaemorrhagicFeverinSmallHospitals
WHO
Impact
of
Dengue,
http://www.who.int/csr/disease/dengue/impact/en/,
ChuynYTCngCng
487
NghincuYhc
BMITRONGTREMVITNAM615TUITRONGNM2000
ngVnChnh*,RSDay**,BSelwyn***,YMMaldonado****,NguynCngKhn*****,
LDanhTuyn*****,LThBchMai*****
TMTT
Mctiunghincu:Xcnhmilinquancaccyutnhnkhuhcvtnhtrngkinhtxhivi
chsBMIcatremVitNamt615tuitrongnm2000.
Phng php nghin cu: Trchsliutcuciutra dinh dng nm 2000. Gm tt c l 28.528
ngithamgiaiutratrongsc9870tremt615tui.Phntchmilinquangiaphnloichs
BMIcatremt615tuiviccyutnhnkhuvccyutkinhtxhibnghiquyLogistic.
Ktqu:TlsuydinhdngtrungbnhtremVitNamt615tuil10,7%46,9%btraiv
13,4%50,3%bgi.Thnhthl25,7%,nngthn34,8%,gianhkinhtkh23,5%,gianhckinht
khkhn35,2%.Tltremcnguycthacnvthacntheotuivgiil0,8%3,7%btraiv0,5%
3,5%trgi,tuicngbthkhnngbnguycthacnvthacncngcao.Tltrcnguycthacn
vthacnkhuvcthnhth6,2%vnngthn1,2%,nhmtrckinhtgianhkh4,9%vkinhtgia
nhkhkhn1,2%.Tremkhitngthm1tuithckhnngbsuydinhdngtng3%.Trgicnguyc
bsuydinhdngthphntrtrai14%.Tremthnhthcnguycbsuydinhdngthphntrnng
thn21%,tremnhnggianhciukinkinhtkhtnguycsuydinhdnghntrsngtronggia
nhckinhtkhkhn38%.
Ktlun:TnhtrngsuydinhdngtremvntiptcbongvnvchdinhdngVit
Nam,cbitlccvngnngthn.Do,thngtinvcchotngcanthipcncthitkphhp
vinhucucacccimkinhtxhicakhuvcnngthn.
Tkha:BMI,tremVitNam,tnhtrngkinhtxhi
ABSTRACT
BMIAMONGOFCOHORTOFVIETNAMESECHILDREN615YEARSOFAGE,2000
DangVanChinh,RSDay,BSelwyn,YMMaldonado,NguyenCongKhan,LeDanhTuyen,
LeThiBachMai*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:486491
Objectives:Determinetherelationshipofdemographicfactorsandsocioeconomicstatus(SES)toBMI
amongVietnamesechildren615yearsoldin2000.
Method:The data used in this study came from the General Nutrition Survey of 2000 (2000 GNS)1.
28.528 individuals were included; about 9.870 of those were children 615 years old. The relationships
between BMI categories of children aged 615 years and demographic and socioeconomic factors were
determinedbymultinomiallogisticregressions.
Results: ThemeanprevalenceofunderweightamongVietnamesechildrenaged615werefrom10,7%
KhoaDchtvkimsotbnh,ihcTexas,ihcYtCngcngHouston
KhoaQunl,chnhschvsckhecngng,HTHTexas,ihcYTCCHouston
KhoaTon,ihckthutMichigan
VinDinhdngQucgiaHNi
Tcgilinlc:Ts.ngVnChnh
T:0908414986 Email:dangvanchinh@ihph.org.vn
ChuynYTCngCng
485
NghincuYhc
to46,9%inboysand13,4%to50,3%ingirls.Theprevalenceofatriskofoverweightandoverweightbyage
andgenderwas0.8%3.7%forboysand0.5%3.5%forgirls;lowerageshadahigherprevalenceofatriskof
overweight and overweight. The prevalence of at risk of overweight and overweight was nearly fivefold
higherinurban(6,2%)thaninruralareas(1,2%),andfourfoldhigherintheveryrichhouseholds(4,9%)
thanintheverypoorhouseholds(1,2%)
Aschildrenagedoneyearoldertheywere3%morelikelytobeunderweight.Girlswere14%lesslikely
tobeunderweightthanboys.Childreninurbanareaswere21%likelytobeunderweightthanchildrenin
ruralareas.Childrenintheveryrichhouseholdswere38%lesslikelytobeunderweightthanchildreninthe
verypoorhouseholds.
Conclusion: Underweight children continued to signal an important nutrition problem in Vietnam,
especiallyinruralareas.Therefore,interventioninformationandactivitiesneedtobetailoredtotheneedof
socioeconomiccharacteristicsofruralareas.
Keyword:BMI,Vietnamesechildren,socioeconomicstatus.
ngithamgiaiutratrongsc9870tr
TVN
emt615tui.
Vitnam,lmtqucgiamtnhtrngsuy
Thuthpsliu
dinhdngtlulvnquantrnghng
Quymhgianhcphnlpthnhba
uhcsinhtiuhc,lqucgiatriqua
nhm:bangihocthn,bnngivnm
hai thp k vi cc bin i ln v pht trin
ngi hoc nhiu hn. Tui hin ti, trnh
kinhtxhivthayimitrng.Ccquc
hcvncachhcphnloigmtiuhc
giaChukhcvinnkinhtphttrinc
hocthphn,cp2vcp3,caong,ihc;
nhngbngchngvvictngtlboph
(3)
tnh
trng kinh t x hi ca h gia nh da
ngiln .Hinnayvicnlcngnchn
trnchunnghochungcaVitNam.
s gia tng tha cn v bo ph tr em Vit
Namvhuqucabnhmntnhngiln
ccoilkhnthit,mcdsliuvchs
BMIcatremVitNamsnc,nhngcha
c phn tch cho n thi gian gn y; v
vy, nhng hiu bit v BMI ca tr em Vit
Namrthnch,cngnhmhnhchskhi
c th BMI ca tr em, hoc cc yu t quyt
nh ch s khi c th nh kinh t x hi v
nhnkhuhc.Mcchcanghincuny
xcnhmilinquancaccyutnhnkhu
hcvtnhtrngkinhtxhivichsBMI
ca tr em Vit Nam t 615 tui t nh gi
mt ct ngang bng cch s dng tiu chun
thamchiuquctnm2000(3).
PHNGPHPNGHINCU
Phntchthngk
Musliucatr615tuihonchnhtt
cccbinctphpli.Phntchmilin
quangiaphnloichsBMIcatremt6
15 tui vi cc yu t nhn khu v cc yu t
kinhtxhibnghiquyLogistic.
KTQU
ctnhmu
Bng 1. T l suy dinh dng, cn nng bnh
thng,nguycthacnvthacntremVit
Namtheogiitinhvtngtuitrongnm2000.
Tui Gii
(nm) tnh
6
Thitknghincu
Trch s liu t cuc iu tra dinh dng
nm 2000 (2000 GNS)(7). Gm tt c l 28.528
486
7
8
Nam
N
Nam
N
Nam
Suy dinh
Cn nng
Nguy c tha
dng bnh thng cn v tha cn
% (SE)
% (SE)
% (SE)
10,7 (1,8)
20,2 (2,4)
23,3 (2,3)
30,5 (2,4)
24,9 (2,4)
86,5 (1,9)
76,5 (2,4)
73,1 (2,4)
68,4 (2,5)
72,8 (2,5)
2,8 (1,8)
3,3 (0,1)
3,7 (1,1)
1,1 (0,8)
2,2 (0,8)
ChuynYTCngCng
Tui Gii
(nm) tnh
Suy dinh
Cn nng
Nguy c tha
% (SE)
% (SE)
% (SE)
N
9
Nam
N
10
Nam
N
11
Nam
N
12
Nam
N
13
Nam
N
14
Nam
N
15
Nam
N
Tng Nam
N
Tng
37,5 (2,6)
60,8 (2,7)
34,8 (2,8)
62,5 (2,9)
34,7 (2,6)
62,1 (2,5)
44,2 (2,4)
52,3 (2,4)
50,3 (2,7)
48,8 (2,6)
46,4 (2,5)
52,4 (2,4)
39,3 (2,7)
57,2 (2,8)
46,9 (2,4)
50,6 (2,4)
33,0 (2,3)
66,4 (2,3)
41,5 (2,5)
55,7 (2,6)
36,5 (2,6)
62,4 (2,7)
38,0 (2,7)
61,2 (2,7)
19,9 (2,1)
78,8 (2,1)
30,8 (2,4)
68,2 (2,4)
13,4 (1,8)
85,4 (2,0)
34,8 (1,0)
62,9 (1,0)
31,9 (1,1)
66,4 (1,1)
33,4 (0,9)
64,6 (0,8)
SE: sai s chun
1,7 (0,1)
2,7 (0,8)
3,2 (1,4)
3,5 (1,4)
0,9 (0,4)
1,1 (0,4)
3,5 (1,2)
2,5 (0,8)
0,5 (0,3)
2,8 (0,9)
1,1 (0,8)
0,8 (0,6)
1,3 (0,6)
1,0 (0,5)
1,1 (0,7)
2,3 (0,4)
1,7 (0,4)
2,0 (0,4)
ctnhvtrnglngcthvtnhtrng
suydinhdngcamunghincutrongdn
s,cthuthpbaogmtui,gii,khuvcc
tr,vtnhtrngkinhtxhitrongbng1.T
ltrungbnhvsuydinhdngtremt615
tui Vit Nam kh cao, t l suy dinh dng
chim 10,7%46,9% b trai v 13,4% 50,3%
bgi(bng1).Sgiatnglintccasuydinh
dng b nam t 612 tui v c tnh trng
gimdnnhngnmsau.Tlsuydinh
dngcabgicngcmhnhtngtb
trai, nhng tui nh im ca suy dinh
dngbgismhnbtraivkhongmt
na cc b trai t 1415 tui. T l suy dinh
dng cao nht quan st c tr trai l 12
tui(46,9%)vbgil10tui(50,3%).
NghincuYhc
Namt615tuitheokhuvcctrvtnhtrng
kinhtxhitrongnm2000.
c tnh
Thnh th
Nng thn
Rt ngho
Ngho
Trung bnh
Giu
Rt giu
Suy dinh Cn nng

Nguy c tha
% (SE)
% (SE)
% (SE)
Khu vc c tr
25,7 (1,6)
68,2 (1,2)
6,2 (1,8)
34,8 (1,0) 64,0 (0,9)
1,2 (0,2)
Tinh trng kinh t gia nh
35,2 (1,7) 63,6 (1,7)
1,2 (0,2)
37,8 (1,6) 60,6 (1,6)
1,6 (0,6)
33,0 (1,5) 65,4 (1,5)
1,5 (0,3)
31,9 (1,7) 65,5 (1,7)
2,6 (1,5)
23,5 (1,5) 71,6 (1,6)
4,9 (0,9)
SE: sai s chun
T l trung bnh ca suy dinh dng tr

emVitNamtrongnghincunythnhth
(25,7%)thphnnngthn(34,8%)(bng2)
nhnggianhkinhtrtkh(23,5%)thphn
nhng gia nh c kinh t kh khn (35,2%).
Nhnchung,tlsuydinhdng,bnhthng,
cnguycthacnvthacnchimtlln
ltl33,4%,64,6%,2%(bng2).Tltremc
nguycthacnvthacntheotuivgii
chim t l thp (0,8%3,7%) b trai v 0,5%
3,5%trgi,nhngtuicngbthkhnng
bnguycthacnvthacncngcao.Tl
trungbnhcanguycthacnvthacnca
tr em 615 tui Vit Nam c t l cao hn
nhm tr sng thnh th so vi tr nng
thn,vchimtlnhnggianhkinhtkh
hnnhmckinhtgianhkhkhn(bng2).
Tltrcnguycthacnvthacn
khuvcthnhth(6,2%)gp5lnkhuvcnng
thn (1,2%), v nhm tr c kinh t gia nh
kh (4,9%) th gp 4 ln nhm c kinh t gia
nhkhkhn(1,2%).
Bng 2. T l suy dinh dng, cn nng bnh

thng,nguycthacnvthacntremVit
Phntchnbin
Bng3.MiquanhgiacccimdnsvtnhtrngkinhtxhivichsBMIcatremVitNam
t615tuitrongnm2000.
c tnh
Phn tch n bin

Nguy c tha cn v
Suy dinh dng
tha cn
OR th
p
OR th
p
(KTC 95%)
( KTC 95%)
ChuynYTCngCng
Phn tch a bin*

Nguy c tha cn v
Suy dinh dng
tha cn
OR hiu chnh
p
OR hiu chnh
p
(KTC 95%)
(KTC 95%)
487
NghincuYhc
c tnh
Tui
Gii: Nam
N
Phn tch n bin

Phn tch a bin*
Nguy c tha cn v
Nguy c tha cn v
Suy dinh dng
Suy dinh dng
tha cn
tha cn
OR th
p
OR th
p
OR hiu chnh
p
OR hiu chnh
p
(KTC 95%)
( KTC 95%)
(KTC 95%)
(KTC 95%)
1,02 (1,01,04) 0,01 0,91 (0,860,97) 0,01 1,03 (1,011,05) 0,01 0,91 (0,860,96) 0,01
1,0
1,0
0,87 (0,790,96) 0,01 0,71 (0,461,1)
Khu vc c tr
Thnh th
1,0
1,0
0,12 0,86 (0,780,95) 0,01 0,74 (0,481,13)
0,69 (0,580,82) 0,01 4,67 (2,39,4) 0,01

Nng thn
1,0
1,0
Tinh trng kinh t gia nh
Rt ngho
1,0
Ngho
1,12 (0,93,1,37) 0,24 1,37 (0,623,06) 0,44
Trung bnh
0,91 (0,751,11) 0,36 1,27 (0,792,04) 0,32
Giu
0,88 (0,711,08) 0,22 2,14 (0,647,22) 0,22
Rt giu
0,59(0,480,72) 0,01 3,68 (2,196,18) 0,01
0,79 (0,660,95)
0,01 3,82 (1,847,92)
1,0
0,16
0,01
1,0
1,0
1,09 (0,891,33) 0,37
0,89 (0,731,09) 0,24
0,88 (0,711,1) 0,24
0,62 (0,490,77) 0,01
Trnh hc vn ca ch h gia nh
Tiu hc
1,0
1,0
1,0
Cp 2 v cp 3
1,08 (0,941,23) 0,27 1,85 (1,222,79) 0,01 1,1 (0,981,27)
Cao ng v hc ngh 0,82 (0,561,2) 0,31 2,65 (1,275,55) 0,01 1,02 (0,701,47)
i hc
0,67 (0,431,07) 0,01 3,5 (1,627,56) 0,01 1,05 (0,641,71)
1,0
1,2 (0,542,64)
0,98 (0,591,64)
1,28 (0,493,34)
1,67 (0,923,03)
0,65
0,94
0,61
0,09
0,11
1,0
1,62 (1,042,53)
0,03
0,94
0,86
1,38 (0,642,95)
1,2 (0,532,69)
0,41
0,66
Quy m h gia nh
3 ngi
1,0 (0,771,31) 0,96 2,26 (1,214,22) 0,01 1,15 (0,891,47) 0,28 1,19 (0,62,36)
0,63
4 ngi
0,93 (0,821,07) 0,31 1,34 (0,82,3) 0,26 1,01 (0,891,15) 0,82 0,78 (0,431,43) 0,42
5 ngi
1,0
1,0
1,0
1,0
* a bin: tui, gii tnh, khu vc c tr, tnh trng kinh t x hi, trnh gio dc ca ch h gia nh v quy m h gia nh;
: Bc tiu hc bao gm tiu hc, cha hc xong tiu hc v khng bit ch; i hc bao gm sinh vin cha tt nghip v
t nghip; BMI (ch s c th) phn loi thnh: nh cn, cn nng bnh thng, nguy c tha cn v tha cn; OR: T s
chnh,
Suydinhdng
Tremkhitngthmmttuithkhnng
nhcntngln2%(bng3).Nhngbgic
kh nng t b nh cn hn cc b trai 13%,
nhngbsngkhuvcthnhthtbnhcn
hnccbsngkhuvcnngthn31%,cc
bciukinkinhtgianhkhgitbnh
cn hn nhm tr sng trong gia nh c iu
kinkinhtkhkhn41%.
Nguycthacnvthacn
Tr em tng ln mt tui th kh nng b
nguycthacnvthacngim9%(bng3).
Tremthnhthcnguycthacnvtha
cn gp 5 ln tr em nng thn. C s khc
bitcnghathngkvnguycthacnv
thacnnhmtremtronggianhkhgi
vnhmciukinkinhtkhkhn.Nhm
ciukinkinhtkhcnguycbnguyc
488
tha cn v tha cn cao hn gp 4 ln so vi

nhmciukinkinhtkhkhn.
Trnh hc vn ca ch h cng c lin
quanntnhtrngthacn,nguycthacn
tlcngvitrnhhcvn,tremnhng
gianhcchhctrnhhcvnlcp2,
cp3,trungcpnghhoccaong,ihcln
ltctlvnguycthacnvthacncao
hnsovinhmtrtronggianhcchhc
hcvncp1.
Phntchabin
Tremkhitngthm1tuithckhnng
b suy dinh dng tng thm 3% (OR =1,03;
95%,KTC=1,011,05,p=0,01).Trgicnguyc
b suy dinh dng thp hn b trai 14% (OR
=0,86; 95%, KTC = 0,780,95, p 0,01). Tr em
thnh th c nguy c b suy dinh dng thp
hntrnngthn21%(OR=0,79;KTC=0,66
ChuynYTCngCng
0,95, p =0,01), tr em nhng gia nh c iu
kinkinhtkhtnguycsuydinhdnghn
trsngtronggianhckinhtkhkhn38%
(OR = 3,82; KTC= 1,847,92, p 0,01). Tr em
tronggianhcchhctrnhhcvnl
cp2vcp3thckhnngbnguyctha
cnvthacngp1,62ln(KTC=1,042,53,p
=0,03)tremsnggianhcchhctrnh
hcvnlcp1.
BNLUN
Nghincuchothy,ngoituicd
on s nh hng n nguy c tha cn v
thacnthcnchaiyutkhcl:ctrti
thnhthvchhgianhctrnhhcvn
ttrunghccstrln.Nghincucngch
rabayutcthdonctnhtrngsuy
dinh dng l: gii tnh, c tr ti vng nng
thn v tnh trng kinh t gia nh mc rt
ngho. Nhn chung, khi tng tui th nh
hngntnhtrngsuydinhdng,nguyc
thacnvthacn.Khituitngmtnv
th s lm tng nguy c b suy dinh dng v
gimnguycthacnmtnv.
Cctremsngthnhthcnhiuyut
nguycdnn b nguy c tha cn hn tr
emvngnngthn.Skhcbitnycthl
doktqucanguncungcpnnglngv
kh nng tiu th nng lng gia hai nhm
tr em ny. Hai yu t nh hng mnh m
n tnh trng tha cn l tng ngun cung
cpnnglngvlisngtvnng,ccd
liutcucnghincuqucgiatnm2000
chothytremsngthnhthtiuththc
ncnhiuchtbo,ngvthtnhiuhn
so vi tr em vng nng thn (9). Thm vo
, so vi tr em nng thn th tr em thnh
th c xu hng vui chi gii tr trong nh
nhiuhn,cchotngtrongnhnhxemti
vi, chi game, chi t t ng lm tng
thmccyutdnntnhtrngbnguyc
thacnvthacn.Ktqunyphhpvi
ccbocovtnhtrngthacntrem(11,6)
Trong nghin cu ny, tr em vng thnh th
bnguycthacnvthacnviORl3,82
ChuynYTCngCng
NghincuYhc
tngtnhktqunghincucaWangv
cngstinhnhtiTrungQuc(10).
NhngnghincukhcvdnsVitNam
chothycmilinquangiatnhtrngbo
phkhuvcthnhthtrongitngdns
trhnvgihnsovinghincuny:tl
tha cn ngy cng tng cao ngi trng
thnhtrongtuit1865,vngycngtng
itngdncthnhth(8).Quanghincu
ctngangkhostccbcphhuynhchothy,
tlthacnvbophtithnhphHCh
Minh trong i tng tr 45 tui tng ln
nhanh chng trong nm 2002 (n=492) v nm
2005(n=670) (2).Trntonthgii,TchcYT
Th Gii cng nhn rng t l tha cn v
bophtngcaotrongkhuvcthnhthcc
nccthunhpthpvthunhptrungbnh
(11).
Cc b trai c nguy c b suy dinh dng
nhiuhnccbgi,iunychothyskhc
bitvgiitnhtronghotngthcht,ngun
thunnglngvngunnnglngtiuhao.
Nhng a tr sng khu vc nng thn
thngchoncnhgianhkhkhn,vvy
ckhnngtccungcpychtdinh
dngcngnhdmcccbnhtruynnhim
nn c th dn n tnh trng b suy dinh
dng.Hnna,nhngbtraivngnngthn
thngthamgialaongcngvigianhnn
tbhnchirangoihnccbgi,ycng
c th l l do cc b trai tiu hao nng lng
nhiuhn.Tuynhin,chacdliunovs
khc bit trong hot ng th cht ca tr em
VitNamnhgigithuytny.
Nhngatrsngtronggianhgiuc
thscnguycbsuydinhdngthphn
nhngtrkhc.Milinquangiatnhtrng
kinhtgianhvtnhtrngdinhdngca
tremnhngncangphttrinchothy
khi kinh t x hi pht trin s ci thin tnh
trng BMI tr em(9,10). V vy, cng khng
ngcnhinkhiktqucanghincunycho
thy thu nhp gia nh thp l mt yu t
489
NghincuYhc
quan trng d on tnh trng suy dinh

dngtrem(11).
yutdbomnhnhttnhtrnhbnguyc
thacnvthacntrem.
Nhngtremnhngchhgianhc
trnhhcvnltrunghccshoctrung
hcphthngthckhnngbnguyctha
cn v tha cn nhiu hn nhng tr em
nhngchhgianhctrnhhcvnbc
tiu hc. iu ny ph hp vi mt nghin
cutiArapSaudiphthinrarngtltha
cn s cao hn nhng tr em vi cc b m
cgiodc(9).
Tlsuydinhdngcaotiptc cho thy

tm quan trng ca vn dinh dng khu
vc nng thn v cho thy s chnh lch v
trnhphttrinkinhtxhigiakhuvc
nng thn v thnh th vn cn tn ti. Do ,
thng tin v cc hot ng can thip cn c
thi k ph hp vi nhu cu ca cc c im
kinhtxhicakhuvcnngthn.Ngoira,
mt chng trnh y t quc gia kim sot suy
dinh dng v tha cn tr em 6 tui v
nhng tr ln hn nn c cung cp cho tr
em,ccbcchamvchoccngng
Mc d quy m h gia nh ln thng c

lin quan n vic gim nguy c tha cn v
tng nguy c suy dinh dng tr em, bi v
thng thng nhng gia nh c nhiu thnh
vinthihithunhpphicchiaucho
nhu cu ca nhiu ngi nn cc gia nh ny
thngcxuhngkhkhn.Tuynhin,trong
nghincunykhngcdliunohtrcho
kvngtrn.
Nghin cu ny cho thy quy m h gia
nhkhngcmilinquanvinguycbsuy
dinhdngcngnhnguycthacnvtha
cn. V cc h gia nh Vit Nam thng c 2
hoc 3 th h chung sng vi khong 5 thnh
vinhocnhiuhn,nhngquymhgianh
ny khng tm thy mi lin quan c ngha
thng k vi cc tnh trng cn nng. im
mnh ca nghin cu ny l ly mu xc sut
vi mt c mu ln trong ton th dn s Vit
Namvcungcpmtnhgitngthv
tnhtrngBMIcatremVitNam.
KTLUN
Tui, gii tnh, vng c tr v tnh trng
kinhtgianhlnhngyutcthdon
nh hng n tnh trng suy dinh dng ca
tremVitNamt615tui.Nhngchctui,
vngctrvtrnhgiodccachhgia
nhcthdontnhtrngbnguyctha
cnvthacn.Ctrkhuvcthnhthl
TILIUTHAMKHO
1.
AlSaeedWY,AlDawoodKM,BukhariIA,BahnassyA(2007).
Prevalence and socioeconomic risk factors of obesity among
urbanfemalestudentsinAlKhobarcity,EasternSaudiArabia,
2003.ObesRev;8:9399.
2. Dieu HT, Dibley MJ, Sibbritt DW, Hanh TT(2009). Trends in
overweightandobesityinpreschoolchildreninurbanareasof
HoChiMinhCity,Vietnam,from2002to2005. Public Health
Nutr;12(5):7029.
3. DrewnowskiA,PopkinB(1997).Thenutritiontransition:New
trendsintheglobaldiet.NutrRev;55:3143.
4. Hesketh T, Ding QJ, Tomkins AM(2002). Disparities in
economicdevelopmentinEasternChina:impactonnutritional
statusofadolescents.PublicHealthNutr;5(2):313318.
5. KrugerR,KrugerHS,MacintyreUE(2006).Thedeterminantsof
overweight and obesity among 10 to 15yearold
schoolchildren in the North West Province, South Africathe
THUSABANA(TransitionandHealthduringUrbanizationof
South Africans; BANA, children) study. Public Health
Nutr;9:351358.
6. MalinaRM,PeaReyesME,LittleBB(2008).Secularchangein
thegrowthstatusofurbanandruralschoolchildrenaged613
yearsinOaxaca,southernMexico.AnnHumBiol;35(5):47589.
7. National Institute of Nutrition. General nutrition survey 2000.
Hanoi:MedicalPublishingHouse,2003.
8. TuanNT,TuongPD,PopkinBM(2008).Bodymassindex(BMI)
dynamicsinVietnam.EurJClinNutr;62(1):7886.
9. ThangNM,PopkinBM(2004).Patternsoffoodconsumptionin
Vietnam: effects on socioeconomic groups during an era of
economicgrowth.EurJClinNutr;58(1):145153.
10. WangY,GeK,PopkinBM(2000).Trackingofbodymassindex
fromchildhoodtoadolescence:a6yfollowupstudyinChina.
AmJClinNutr;72:10181024.
11. WorldHealthOrganization.Obesityandoverweight.Retrieved
from
http://www.who.int/mediacentre/factsheets/fs311/en/index.htm
l
490
ChuynYTCngCng
NghincuYhc
CCYUTXHINHHNGSCKHETMTHN
CANGITRNGTHNHTHXTHDUMT,
TNHBNHDNGNM2011
ngVnChnh*,NguynThBchNgc,HHuTnh*
TMTT
tvn:Vnsckhetmthn(SKTT)gynhhngnhuhtccqucgiatrnthgii.Tuy
nhinVitNamctnghincuvSKTTvccyutxhilinquan.
Mctiunghincu:Xcnhtlhinmcca6mcSKTTvccyutxhilinquanngi
dnthxThDuMt(TDM),tnhBnhDng(BD).
Phng php nghin cu: NghincuctngangdatrnphngvntrctipvibngcuhiGWB.
itngnghinculngidntui1860vsinhsngthxTDM,tnhBDt1nmtrln.
Kt qu nghin cu: TlngictngimGWBt060,6172v73100,cmtlcch
nng,cchtrungbnhvkhemnhlnltl13,9%,59,8%v26,3%.Tllolngvsckhe,hi
lngthamn,sinhlc,trmcm,tkimsotvloulnltl74,7%,99,2%,96,1%,71,6%,20,9%,v
88,3%.
Kt lun: TnhtrngSKTTkmchimtlcaonhmitngtkimsotkm,lolngvsckhe
nhiu,vtrmcm.CmilinquangiaSKTTvitngio,hotngthlc,vnicng.
Tkha:Sckhetmthn(SKTT);yutxhi;bngcuhiGWB.
ABSTRACT
SOCIALDETERMINANTSANDTHEMENTALHEALTHOFADULTPOPULATIONATTHUDAU
MOTCITY,INBINHDUONGPROVINCEIN2011
DangVanChinh*,NguyenThiBichNgoc*,HoHuuTinh*
Background: The mental health problems affect almost all countries in the world. In Vietnam, however,
therehasbeenlittleresearchonmentalhealthandsocialdeterminantsrelatedtoit.
Objectives:Toestimatetheprevalenceofsixdimensionsofmentalhealthandtoidentifytherelationships
betweensocialdeterminantsandmentalhealthamongpeopleinThuDauMottowninBinhDuongprovince.
Method: This was a crosssectional survey based on direct interviews with the GWB questionnaire. The
studyincludedpeopleaged1860yearslivinginthetownatthetimeperiodof12monthsorover.
Results: The percentage of adults with total GWB score from 0 to 60, 6172 and 73110, described as
severely distressed, moderately distressed and positive wellbeing are 13.9%, 59.8% and 26.3%,
respectively.Themeanprevalenceofgeneralhealth(healthconcern),positivewellbeing,vitality,depression,self
controlandanxietywas74.7%,99.2%,96.1%,71.6%,20.9%andanxiety88.3%,respectively.
Conclusion:Theprevalenceofpeoplewithlowgeneralwellbeingishigherinadultswithlowselfcontrol,
highhealthconcernandbeingdepressed.Therewasarelationshipbetweenmentalhealthandreligion,physical
VinVsinhytcngcngthnhphHChMinh
ChuynYTCngCng
T:0908414986
Email:dangvanchinh@ihph.org.vn
491
NghincuYhc
activityandresidence.
Keywords:Mentalhealth;socialdeterminants;GeneralWellBeing(GWB).
TVN
Mctiu
Tnh trng sc khe tm thn nh hng

nhngtriungitrnthgii.TchcYt
th gii (WHO) c tnh rng c n 154 triu
ngimcchngtrmcmv25triungib
tmthnphnlit;91triungibrilondo
ung ru v 15 triu ngi b ri lon do s
dngccloidcphmkhc(4).Cn50triu
ngibngkinh,24triungibAlzheimer
v cc chng sa st tr tu khc(3). Khong
877.000 ngi cht do t t mi nm(5). Ti cc
qucgiacthunhpthp,trmcmlmtvn
lnchim3,2%tnggnhnngbnhtt(2).
Mctiu1:ctnhtlhinmccasu
mc sc khe tm thn bao gm lo lng
(anxiety), c ch (depression), lo lng v sc
khe(healthconcern),hilng(satisfaction),t
kimsot(selfcontrol)vyscsng(vitality)
nhngngi1860tuithxThDuMt
tnhBnhDng.
ccnccthunhpcao,trmcmchim
t l cao nht trong tng gnh nng bnh tt(1).
c tnh khong 23 triu ngi M hin ang
mcchngrilonnghimtrnghocrilon
hnhvi.Chiphchobnhtmthntrongcng
ng ngi M hng nm xp x 73 t la,
khongmtnaschiphnyphnnhsmt
khnngsnxut.Tngt,khong20%ngi
cbnhhngbivnsckhetmthn
trong khong thi gian 12 thng, vi hn 25%
ngitrtui(18n24)btnhtmtdngri
lontmthntrongsutthikny.
Tcngcngthngcamitrngthng
dnnsbnchn,lolng,cngthng,gin
d,bcbi,cchvtrmcm.Nhngrilon
hnhvinycthdntivictt,lmdng
cht gy nghin v nhng hnh thc gin d
kchngkhc.
VitNamcrttnghincuvsckhe
tmthnvccyutxhilinquan.Nguyn
nhndothiungunnhnlcvcngcnh
gi sc khe tm thn cho ngi dn. Do ,
mc ch ca nghin cu ny nhm nng cao
nhnthcvhiubitvtcngcaccyu
t x hi ln sc khe tm thn v tnh trng
khe mnh, s dng bng tnh trng sc khe
tngqut(GWB)cxydngchocuckho
stiutravdinhdngvsckhecaM.
492
Mctiu2:Xcnhmilinquangiacc
yutxhi:tui,gii,tnhtrngkinhtxhi,
quymhgianh,hotngthlc,trnh
hcvn,nghnghip,tnhtrnghgianhvi
sc khe tm thn nhng ngi 1860 tui
thxThDuMttnhBnhDng.
PHNGPHPNGHINCU
S dng thit k nghin cu ct ngang
ctnhtlhinmccasumcsckhe
tmthnngit1860tuitithxThDu
Mt tnh Bnh Dng. Cuc iu tra ny da
trnphngvntrctipvccyuttnhtrng
kinh t x hi, hot ng th lc v tnh trng
sc khe tm thn. C mu c tnh l 768
ngituit18trlnvikthutchnmu
cm.NgidncngtiBnhDng,tui18
60 v sinh sng th x Th Du Mt hn 1
nm;tthng6/2010nthng6/2011sc
chnvonghincu.Khungmuldanhsch
dncccxphng(phnglmtnv
qunlxcaVitNam).Cccthlnv
chn mu c ly theo ngy v p ng yu
cucanghincu.
KTQU
ctnhmu
Bng1:Cccimxhinhnkhuhccamu
nghincu(n=768).
c tnh
89
200
204
174
11,6
26,0
26,6
22,7
Tui
18-24
25-34
35-44
45-54
ChuynYTCngCng
55-60
Gii Nam
N
101
354
414
Hc vn
M ch v cp mt
179
Cp 2
302
Cp 3
181
i hc v sau i hc
106
Tn gio: C
287
Khng
481
Ngh nghip
Cng nhn
291
Kinh doanh
142
CNVC
109
Ni tr
150
Khc
76
Kinh t x hi
Ngho
176
Trung bnh
439
Giu
153
Hat ng th lc
t
146
Trung bnh
369
Cao
253
S hu nh
Khng
162
C
606
Ni c tr
Ngoi
Ni thnh
295
473
13,1
46,1
53,9
23,3
39,3
23,6
13,8
37,4
62,6
37,9
18,5
14,2
19,5
9,9
22,9
57,2
19,9
19,0
48,1
32,9
21,1
78,9
38,4
61,6
itngnghincuc46,1%lnamgii,
53,9%lngii.Hnitngnmtrong
tuit2554.Ngictrnhhcvncp2v
cp3chimkhong65%vtlngictrnh
tiuhchocmchchimkhong23%.T
lhgianhnghovgiugntngng
nhau,khong20%(bng1).
Bng2:TlvthangimtnhtrngSKTTca
ngidn1860tui,thxTDM,tnhBD(n=768).
c im
n
%, KTC 95%
Tnh trng sc khe (TTSK)
c ch nng
107
13,9(10,5-17,3)
c ch trung bnh
459
59,8(55,2-64,3)
Khe mnh
202
26,3(21,6-31,0)
Thang im (im cng cao=TTSK cng tt)
Lo lng v sc khe
10
194
25,3(20,3-30,2)
>10 (TTSK tt hn)
574
74,7(69,8-79,6)
Hi lng, tha mn
ChuynYTCngCng
NghincuYhc
5
>5 (TTSK tt hn)
6
0,7(0,1-1,4)
762
99,2(98,6-99,8)
Sinh lc
10
28
3,6(1,6-5,7)
>10 (TTSK tt hn)
740
96,1(94,3-98,4)
c ch
15
218
28,4(24,0-32,8)
>15 (t c ch hn)
550
71,6(67,2-75,9)
Kim sot (kim sot cm xc)
10
607
79(72,6-85,5)
>10
161
20,9(14,5-27,4)
Lo u
15
90
11,7(9,2-14,2)
>15 (t lo u hn)
678
88,3(85,8-90,8)
TlngictngimGWBt060,6172
v73100,cmtlcchnng,cch
trungbnhvkhemnhlnltl13,9%,
59,8%v26,3%.
Tllolngvsckhe,hilngthamn,
sinhlc,cch,tkimsotvloulnltl
74,7%,99,2%,96,1%,71,6%,20,9%v88,3%.
3 trong 6 thang im c im TTSK khe
mnh cao nht l tha mn (khe mnh khe
mnh) chim t l cao nht (99,2%), th hai l
sinhlc(96,1%)vloul88,3%.Ngcli,3
trong 6 thang im c t l TTSK khe mnh
thp nht ln lt l t kim sot (79%) (mt
kim sot), c ch (28,4%), v lo lng v sc
khe(25,3%)(Bng2).
Bng3:TlTTSKvccyutnguycngi
1860ttithxTDM,tnhBD(n=768).
Khe mnh
c im
n
18-24
25-34
35-44
45-54
55-60
Nam
N
M ch v cp
mt
Cp 2
Cp 3
cc ch nng
v trung bnh
n
%
%
Tui
23
25,8
66
51
25,5
149
61
29,9
143
48
27,6
126
19
18,8
82
Gii
95
26,8
259
107
25,9
307
Trnh hc vn
38
21,2
1441
82
50
27,2
27,6
220
131
Chisquare
74,2
74,5
70,1
72,4
81,2
4,5
73,2
74,1
0,1
78,8
72,8
72,4
3,5
493
NghincuYhc
i hc v sau
i hc
C
Khng
Cng nhn
Kinh doanh
CNVC
Ni tr
Khc
Ngho
Trung bnh
Giu
t
Trung bnh
Cao
Khng
C
Ngoi (0)
Ni thnh(1)
32
30,2
74
69,8
Tn gio
60
20,9
227
79,1
142
29,5
339
70,5
Ngh nghip
81
27,8
210
72,2
35
24,7
107
75,3
29
26,6
80
73,4
39
26,0
111
74,0
18
23,7
58
76,3
Tnh trng kinh t x hi
51
29,0
125
71,0
113
25,7
326
74,3
38
24,8
115
75,2
Hot ng th lc
51
34,9
95
65,1
92
24,9
277
75,1
59
23,3
194
76,7
S hu nh
51
31,5
111
68,5
151
24,9
455
75,1
Ni c ng
65
22,0
230
78,0
137
29,0
336
71,0
6,9*
0,8
0,9
7,1*
2,8
4,5*
C s khc bit c ngha thng k trong

imsGWBccitngnghincuhot
ngthlct,trungbnhvnhiu.TlGWB
khemnhccitnghotngthlct
th cao hn cc i tng hot ng th lc
trung bnh v nhiu: 34,9% so vi 24%. T l
GWB khe mnh cc i tng c tn gio
thphnccitngkhngtngio(20,9%so
vi 29,5%). T l GWB khe mnh cc i
tng sng thnh th cao hn cc i tng
sngvngngoi(29%sovi22%)(Bng3).
Bng4:Phntchabinccyutnguycnh
hngSKTTccitng1860tuitithx
TDM,tnhBD(n=768).
OR
KTC 95%
Tn gio
1
Khng
C
t
1,57
1,1-2,2
Hot ng th lc
1
Trung bnh v nhiu
494
1,66
1,1-2,4
Ni c ng
Ni thnh
0,67
0,47-0,95
0,02
Bng4chothyphntchabingmtn
gio,hotngthlc,nicngvSKTT.Cc
itngctngiobcchcaogp1,5ln
itngkhngctngio(OR=1,57;KTC95%
=1,12,2).Tngt,ccitnghotngth
lctrungbnhvnhiubcchcaogp1,6ln
nhngitngthotngthlc(OR=1,66;
KTC95%=1,12,4).Nhngitngsngni
thnh t b c ch hn cc i tng sng
ngoi0,67ln.
BNLUN
*:p0,05
Bin c lp
Ngoi thnh
0,01
0,01
Tnhtrngsckhetmthn(GWB)
CctiuchunthamkhocaMchothy
71% ngi trng thnh trong tnh trng
khemnh,15%cchtrungbnhv13,5%
cchnghimtrng.Ktqutmunghin
cu nhng ngi trng thnh mt th x
cng nghip ha nhanh ti Vit Nam cho thy
SKTT km hn rt nhiu so vi tiu chun ca
M, vi 26,3% cc i tng c mc khe
mnh,59,8%cchtrungbnh,v13%c
chnng.Tlcchtrungbnhvnngcao
ngitrngthnhtrongnghincugirng
vn sc khe tm thn l mt vn y t
cng cng nghim trng trong dn s trng
thnhVitNam.
Tlkhemnhrtthpccitng
trong mu nghin cu ny l do mc mt
kim sot bn thn, c ch v lo lng v sc
khecao.Ccitngctngiocmc
tkimsotcaohnnhngitngkhngc
tngio;tuynhinnhngitngctngio
li c tnh trng c ch v lo lng v sc khe
nhiuhnnhngitngkhngctngio.
Ccitnghotngthlctrungbnhhoc
nng c mc c ch cao hn nhng i
tng t hot ng th lc. Nhng i tng
sng ngoi d mt kim sot bn thn hn
nhng i tng sng khu vc ni thnh.
Nhnbitnhngimngchnylquan
ChuynYTCngCng
trngdochngclinquanntlbnhtt,
tvongvtuith.
S liu t mu nghin cu ny tri ngc
vi gi nh rng mc hot ng th lc
cao c mi lin quan chc chn vi SKTT tt.
iukhngmonginycthdomudn
s nghin cu c t l cao cc i tng l
cngnhn,bunbnnhvnitrlnhng
ngi c hot ng th lc nhiu nhng c
tnhtrngkinhtxhithp.McSKTT
nhm c tn gio th thp hn c ngha so
vinhmkhngctngio.Tuynhin,ldo
dn n kt qu ny khng r rng; c th l
donhngngictngioctnhtrngcng
thng v mi lo lng v sc khe nhiu hn.
Nhngitngnghincusngnithnh
c t l sc khe tt cao hn nhng ngi
sngkhuvcngoi.iunycthc
giithchldonhngngisngngoic
nhiu mi lo lng v sc khe hn nhng
ngisngnithnhbivkhongcchv
alvvtrkinhtxhithphn.Nhng
nghin cu trc cho thy rng nhng ngi
c v tr kinh t x hi thp hn chu ng
nhiu vn sc khe hn v t c kh nng
sdngccdchvytdphnghocpht
hinbnhttgiaionchactriuchng.
ylnghincuutincthchin
trn mt mu dn s a phng i din v
aramtsktlunidincngnhbc
lvaitrccyutxhilinquanntnh
trngSKTT.
Tuynhin,sliutrongnghincunyc
nhiu hn ch. Th nht, y l thit k ct
ngang nn ch a ra mt ci nhn mt thi
imvtnhtrngkinhtxhivsckhe
tm thn trong dn s nghin cu. iu ny
cngcnghalkhththitlpmiquanh
nhnqutntigiaccyutxhivsc
khe tm thn. Th hai, d liu trong nghin
cukhngmnhxcnhmilinquan
NghincuYhc
giaGWBvccyutnguycbivcmu
nh khng phn tch cc nhm khng
ng nht. Th ba, d liu thu thp c
trongnghinculstghinhnquaphng
vn, do cc cu tr li c th ch l s th
hin mong mun ca ngi c phng vn.
Cui cng, kt qu phi thn trng khi
qutchoccdnskhcVitNam.
Mc d c nhng gii hn, kt qu gi
rng nghin cu su hn v ch ny l cn
thit. C mu ln hn c th gip lm r mi
lin quan gia cc yu t x hi, trm cm v
sckhe.Hiubitnhngmiquanhnyc
th quan trng pht trin thnh cng can
thip d phng v iu tr nhm duy tr khe
mnhvngnngastintrinttnhtrnglo
utrungbnhvnh,cchvcngthngn
tnh trng trm cm nghim trng cc i
tngnghincu.
KTLUNVKHUYNNGH
Nghin cu cho thy tnh trng SKTT km
chimtlcaonhmitngtkimsot
km, lo lng v sc khe nhiu, v trm cm.
Hiu bit nhng mi quan h ny c th c
nghaytcngcngsusc.Vvy,cnxemxt
ccnguynnhndnnnhngktqunyv
cc phng tin, phng php gip nhm
itngny.
TILIUTHAMKHO
1.
2.
3.
4.
5.
Hyman S et al (2006). Mental disorders. In: Disease control

priorities related to mental, neurological developmental and
substance abuse disorders, 2nd ed. Geneva, World Health
Organization,:120.
Mathers CD, Loncar D (2006), Projections of global mortality
and burden of disease from 2002 to 2030, Public Library of
ScienceMedicine,,3:e442.
World Health Organization (2006), Neurological disorders:
publichealthchallenges,Geneva,2006.
World Health Organization (2002), Revised Global Burden of
Disease(GBD)2002estimate,Geneva,2004.
WorldHealthOrganization(2003),WorldHealthReport2003,
Shapingthefuture,Geneva,2003.
ChuynYTCngCng
495
NghincuYhc
THI,KINTHCVTHCHNH
IVILNHCMHTTHUCLNICNGCNG
TIIMGIAOTHNGCNGCNGTHNHPHHCHMINH
ngVnChnh*,NguynThBchNgc*,BiThKiuAnh*,HHuTnh*
TMTT
tvn:Khithucllmttrongnhngnguynnhngytvonghngu,cmi6giycmt
ngitvongvkhithucl.Minmtrnthgiic5triungichtvkhithuclvconsnycth
ln8triuvonm2030.VitNamlncctlhtthuclcaotrnthgii,40.000trnghpchtlin
quannthucltrongnm2008.Khithuclkhngchgyhisckhechongihtmcnnhhng
nnhngngihtphin(3).Dogimtlhtthuclvhtthuclthnglmttrongnhngvic
lmhtsccnthit.
Mctiunghincu:Xcnhkinthc,thivthchnhiviquynhcmhtthuccangi
dnsdngphngtingiaothngcngcngsnbayTnSnNht,gaSiGn,bnxeMinngvbn
xeMinTy.
Phngphpnghincu:Quanstticcaimchnvphngvntrctipbngbcuhison
sn.
Ktqu:Tlhtthuclcaitngnghincul25%,htthuclticcbnxe/snbayl58%.
Hn30%itngnghincukhngnhnthccrnghtthuccthgyraccbnhtimmchvt
qy.90%itngnghincubitvquynhcmhtthuclnicngcngnhng16%ngikhnght
thuckhngphnnggkhbhtthuclthng.itnghtthucchyulhnhkhch.Hn2/3
hnhkhchkhngnhnthybngcmhtthucticcbnxe/snbay.Nhngngikhnghtthuclc
tlhiubittchicakhithuclcaohnnhngngihtthucl.
Ktlun:Cmhtthucnicngcngcncthcthivkimsotticckhuvcccanthipcng
smcngtt.
Tkha:Kinthc;thi;thchnh;nghnhcmhtthuclnicngcng.
ABSTRACT
KNOWLEDGE,ATTITUDEANDPRACTICEOFPUBLICSMOKINGBANATPUBLIC
TRANSPORTATIONSITESINHOCHIMINHCITY
DangVanChinh*,BuiThiKieuAnh*,NguyenThiBichNgoc*,HoHuuTinh*
Background: Cigarette smokeiswellknowntobethesinglemostpreventablecauseofdeathintheworld
today,killingonepeopleeverysixseconds.Cigarettesmokecausesover5milliondeathseachyearandisexpected
tocauseover8milliondeathsyearlyby2030.VietNamisamongthecountrieswiththehighestsmokingratesin
the world, nearly 40,000 deaths were attributed to smoking in 2008. Cigarette smoke is harmful to not only
smokersbutalsopassivesmokers.
Objectives:Toidentifypassengersknowledge,attitudeandpracticeofthesmokingbandecreeatTanSon
496
T:0908414986
ChuynYTCngCng
NghincuYhc
Nhatairport,SaiGonrailwaystation,EasterncoachstationandWesterncoachstation.
Method:Thiswasacrosssectionalsurveybasedonobservationanddirectinterview.
Results:25%ofthestudysubjectsweresmokersand58%ofthemadmittedthattheyhadsmokedatpublic
transport stations /airports. More than a third of respondents were not aware that smoking could cause heart
diseaseandstroke.Around90%hadawarenessofpublicsmokingbandecree.Passengersweremainlysmokers.
66%ofthestudysubjectsreportedthattheydidntseenosmokingsignsatpublictransportstations/airports.
Nonsmokershadahigherprevalenceofknowingsmokingharmthansmokers.
Conclusion:Publicsmokingbanneedstobeimplementedandenforcedinpublictransportationsettingsas
soonaspossible.
Keywords:Knowledge;attitude;practice;publicsmokingbandecree.
dng phng tin giao thng cng cng cc
TVN
ni c trin khai d n bao gm: sn bay Tn
VitNamlqucgiactlhtthucl
SnNht,gaSiGn,bnxeMinngvbn
nam gii cao nht trn th gii, vi 56,1% nam
xeMinTy.
giiv1,8%ngiihtthuc.Tlhtthucl
PHNGPHPNGHINCU
thngtinilmvicl49%v71%nh.
Theo WHO nu khng c cc bin php can
Phng vn 792 hnh khch ti cc n v
thip kp thi, n nm 2020 s c 10% dn s
trinkhaidnbngbcuhisonsn.Quan
VitNamchtvlinquannkhithucl(3).
stticcaimchnnhgistun
th ca h vi cc yu cu ca chng trnh,
Thnh ph H Ch Minh l thnh ph tr,
quanstccbinhiu khng ht thuc, v ghi
nngngvngdnnhtVitNamvidn
(2)
nhn bng chng ca vic ht thuc trong cc
s trn 7 triu ngi . T l ht thuc l
khuvccmhtthuc.
Thnh ph H Ch Minh cao, 53% nam v 2%
n. Mc s dng phng tin giao thng
cng cng n Thnh ph H Ch Minh c
ngbvngthyctnht400triu
ln/nm.GaSiGnchuynch1,1triuhnh
khchminmvi10chuynravomingy.
ShnhkhchnsnbayTnSnNhtcth
t 15 triu mi nm. Lng hnh khch n
bnxeminngvminTycthlnn20
triuminmvikhong2500xechomibn(1).
D n hng ti vic h tr nhm cng c
vic thi hnh khng khi thuc cc khu vc
giaothngvnti,baogmtchcchnhquyn
diskimsotcaSGiaothngvnti,hai
bnxelnchyu,gaSiGn,taxi,snbayTn
SnNhttithnhphHChMinh.Victhc
hinhiuqudnnysctcngngk
nthnhphvcnc.
Mctiu
Khostkinthc,thivthchnhi
vi quy nh cm ht thuc ca ngi dn s
KTQU
Bng1:ctnhmucaitng(n=792).
c im
Tui
18-34
35-54
55-84
Gii
Nam
N
Trnh hc vn
Tiu hc
Trung hc c s
Trung hc ph thng
Trung cp tr ln
481
223
88
60,7
28,2
11,1
525
267
66,3
33,7
57
178
237
320
7,2
22,5
29,9
40,4
Hn mt na i tng nghin cu nm
trong tui 1834 tui. Nam gii nhiu gp 2
lnngii.Ccitngcphngvnch
yuctrnhhcvnttrunghcphthng
trln.
Bng2:Kinthcvtchicathucl.
c im
ChuynYTCngCng
497
NghincuYhc
Kin thc v ht thuc l gy tn hi sc khe (n=792)

748
94,4
C
Khng
44
5,6
Kin thc v nhng cn bnh do thuc l gy ra
(n=748)
Bnh h hp
734
98,1
Ung th
671
89,7
Bnh tim mch
536
71,7
t qu
493
65,9
Cao huyt p
493
65,9
Khc
29
3,9
Tc hi ca ht thuc l th ng i vi sc khe (n=792)
724
91,4
C
Khng
68
8,6
Gia ht thuc l v ht thuc l th ng, ci no c hi
hn (n=724)
Ht thuc l th ng
410
56,6
Nh nhau
153
21,1
Ht thuc l
134
18,5
Khng kin
27
3,8
Ht thuc l th ng gy ra nhng cn bnh (n=724)
Bnh h hp
709
97,9
Ung th
648
89,5
Bnh tim mch
521
72
t qu
483
66,7
Cao huyt p
491
67,2
Khc
15
2,1
Hnmtphnbasngichikhng
nhnthccrnghtthuccthgyracc
bnhtimmchvtqu.Khong1/5sngi
chichornghtthuc l l t c hi hn
htthuclthng(Bng2).
Bng3:Tnhtrnghtthuclti4imnghin
cu.
c im
Tnh trng ht thuc (n=792)
Cha bao gi ht thuc
Hin ang ht thuc
b ht thuc
L do b ht thuc (n=100)
Lo lng cho sc khe bn thn
Lo lng cho sc khe gia nh
Ht thuc tn nhiu tin
Quy nh cm ht thuc l ni cng cng
S iu thuc ht trung bnh trong 1 ngy
(n=201)
Tui trung bnh bt u ht thuc (n=201)
a im thng ht thuc (n=201)
Qun c ph
Ti nh
498
491
201
100
62,0
25,4
12,6
88
88,0
5
5,0
5
5,0
2
2,0
12,5 (9,7)
20,9 (5,7)
82
45
40,8
22,4
c im
n
%
Ni lm vic
38
18,9
Ni cng cng
36
17,9
Nu bn ang ht thuc ni cng cng v c yu cu
ngng ht thuc th bn s lm g? (n=201)
Ngng ht thuc ngay lp tc
118
58,7
i ch khc ht thuc
57
28,4
Vn ht thuc
7
3,5
Khc
12
5,9
25,4% cc i tng tham gia nghin cu

ang ht thuc v ht trung bnh khong 12.5
iuthucmingyvbtuhtthuctui
21.Gnnatrongshthngxuynhtthuc
ltrongnhhnghocquncph,22%nh,
19%tinilmvicv18%ticckhuvccng
cng.Nunhngngianghtthuclc
yu cu ngng ht thuc th khong hn mt
na trong s h (58,7%) s ngng ht ch c
3,5%trongshvntiptchtthucltini
(Bng3).
Bng4:Thiiviquynhcmhtthucni
cngcng(n=792).
c im
n
%
715
90,3
Bit v quy nh cm ht thuc ni
cng cng
Ngi khng ht thuc lm g khi ngi ngi bn cnh
h ht thuc l? (n= 591)
Ri khi ch ngi, m ca hoc bt qut
316
53,5
Yu cu h ngng ht thuc
107
18,1
96
16,2
Yu cn h i ch khc ht thuc
Khng lm g c
94
15,9
Khc
2
0,3
Mc tn thnh quy nh cm ht thuc ni cng cng
26
3,3
Hon ton khng tn thnh
Khng tn thnh
47
5,9
Khng bit
124
15,7
104
13,1
Tn thnh
Hon ton tn thnh
491
62
Mc tn thnh vic x pht nhng ngi ht thuc l
ni cng cng?
163
20,6
Hon ton khng tn thnh
Khng tn thnh
104
13,1
Khng bit
112
14,1
93
11,7
Tn thnh
Hon ton tn thnh
320
40,4
Bn c ngh rng nhng ngi ht thuc l
ni cng cng chp nhn tr tin khi b
pht? C
302
38,1
Khng
692
61,9
ChuynYTCngCng
Bng4chothyhuht(90,3%)bitvquy
nhcmhtthucnicngcng.Hnmtna
sngichi(53,5%)trlirnghsri
khichngicah,mcahocchuynsang
ch ngi khc hoc bt qut khi bn cnh c
ngi ht thuc l. Khong mt phn su
(15,9%)ngikhnghtthuckhnglmg
nhng b ht thuc l th ng. Ba phn t
(75%)sngichingh quy nh cm
htthucnicngcng.1/5sngichi
khngngviquynhxpht.
Bng5:Tnhtrnghtthuclthng(n=792).
c im
n
%
S ln trung bnh mi tun b ht thuc l
13,3 (23,0)
th ng
a im i tng nghin cu thng b ht thuc l th
ng
Ni cng cng
456
64,9
Ni lm vic
148
21,1
Ti nh
99
14,1
Nhngngitrliphngvnchorngh
tip xc vi khi thuc l th ng trung bnh
13,3lnmitunnhngnicngcng,hoc
ni lm vic v nh. Hn mt na s ngi
cphngvn(64,9%)tipxcthngxuyn
vikhithuclthngnicngcng.
Bng6:Hnhviivivichtthuctrncc
phngtingiaothngcngcng(n=792).
c im
n
%
Chuyn i cui cng ca bn gn y nht
cch ngy phng vn?
< 1 tun
399
50,4
1-4 tun
127
16,0
1-3 thng
123
15,5
> 3 thng
143
18,1
Bn s dng phng tin giao thng cng cng g cho
chuyn i gn y nht?
Xe bus/ xe
632
79,8
My bay
81
10,2
Tu la
79
10,0
Bn c thy bng Cm ht thuc trn cc phng tin
giao thng cng cng khng?
C
597
75,4
Khng
195
24,6
Bn c thy ngi ht thuc l trn cc phng tin giao
thng cng cng khng?
C
275
60,6
Khng
517
39,4
Ai ht thuc l trn nhng phng tin giao thng cng
ChuynYTCngCng
NghincuYhc
c im
n
%
cng? (n=275)
Hnh khch
262
95,3
Ti x
43
15,6
L xe
18
6,6
c ai yu cu ngi ht dng vic ht thuc l khng?
C
142
51,6
Khng
133
48,4
Ai l ngi yu cu dng vic ht thuc? (n=142)
Hnh khch
84
59,2
Ti x
42
29,6
L xe
29
20,4
Bn c ht thuc l trn cc phng tin
39
19,4
giao thng cng cng khng? (n=201)
Vic bn thuc l trn phng tin giao thng cng cng
C
92
11,6
Khng
700
88,4
Xe but c s dng nhiu nht (80%).

Mt phn t (24,6%) s ngi c hi tr li
rng h khng nhn thy cc bin bo cm
ht thuc l trn phng tin giao thng. 60%
nhn thy c ngi ht thuc l trn cc
phngtingiaothngcngcngmhs
dnggnymchyulhnhkhch(95%).
Nhng ngi ht thuc trn cc phng
tingiaothngcngcngcyucukhng
htthuclbihnhkhch(59%),tixvlxe
(50%).Chc12%chobitthuclbntrncc
phngtingiaothngcngcng.
Bng7:Hnhviivivichtthuclticcbn
xe/snbay(n=792).
c im
N
%
Nhng ngi ang ht thuc ht thuc ti cc bn xe/ sn
bay (n=201)
C
116
57,7
Khng
85
42,3
C ngi ht thuc l cc bn xe/sn bay khng?
C
550
69,4
Khng
242
30,6
Ti c ai yu cu h ngng ht thuc khng? (n=550)
C
46
8,4
Khng
504
91,6
Ti cc bn xe/sn bay c bin hiu
cm ht thuc khng?
C
523
66,0
Khng
269
34,0
Ti cc bn xe/sn bay c bn thuc l khng?
C
601
75,9
Khng
191
24,1
499
NghincuYhc
Khong 58% ngi ht thuc tha nhn c

htthuclticcbnxe/snbaymhci
n gn y. Ch c 8,4% nhng ngi nhn
thy c ngi ht thuc l yu cu h ngng
ht. Khong 66% s ngi c hi cho bit
rng h khng nhn thy bng cm ht thuc
lticcbnxe/snbay.Nhiungitrongs
h(76%)trlirngccbnxe/snbaycbn
thucl.
Bng8:Skhcbittrongkinthcvthivtc
hicahtthuclvquynhcmhtthucca
ngihtthucvkhnghtthuc.
c im
Ht thuc l
n (%)
Kin thc v tc hi ca thuc l
C
182 (90,6)
Khng
19 (9,4)
Kin thc v quy nh cm ht thuc
C
184 (91,5)
Khng
17 (8,5)
Hnh vi ht thuc l ni cng cng
Rt khng ng
23 (11,4)
Khng ng mt phn 28 (13,9)
Khng bit
41 (20,4)
ng mt phn
32 (15,9)
Rt ng
77 (38,3)
Khng ht
thuc l
n (%)
566 (95,8)*
25 (4,2)
531 (89,8)
60 (10,8)
3 (0,51)*
19 (3,2)
83 (14)
72 (12,2)
414 (70,1)
*:p<0,01
Bng8chothyskhcbittrongkinthc
v tc hi ca vic ht thuc, kin thc v thi
i vi quy nh cm ht thuc ni cng
cng ca ngi ht thuc v khng ht thuc.
Hunhngihtthucvkhnghtthucl
uckinthcvtchithucl.Tuynhin,
nhngngikhnghtthucctlhiubit
caohnsovingihtthuc.Skhcbitny
c ngha thng k (p <0,01). Nhng ngi
khnghtthucnghquynhcmhtthuc
nhiuhnnhngngihtthuc.
BNLUN
Mu nghin cu bao gm 792 hnh khch
c chn ngu nhin ti bn a im giao
thngcngcngtrongthnhphHChMinh.
Huhtnhngngitrlihiurnghtthuc
c hi cho sc khe v c th gy ra cc bnh
500
ng h hp v ung th. Tuy nhin, khong

mtphnbatrongsnhngngitrlikhng
bitrnghtthuclcthgyraccbnhtim
mch,tquvccvnsckhekhc.Mt
trongsuhnhkhchnghrnghtthuclth
ngtchihnhtthuclchng.
Thiu kin thc v nguy c nh hng sc
khe lin quan n ht thuc l v nh b
thuclnhngngihtthuccnthpcho
thyscnthitphitngcngnhnthcca
cng ng v nhng nguy him ca vic ht
thucvnhnglichcavicbhtthucl.
Hu ht i tng nghin cu tr li c quy
nhcmhtthuclnicngcng.Trongtt
cnhngnginy,75%sngiching
hlnhcmhtthuclnicngcng.Sliu
ny ph hp vi nhiu nghin cu cc nc
ang pht trin khc. C mt mi lin h gia
tnhtrnghtthucvthiiviquynh
cm ht thuc l ni cng cng. Kt qu t
nghincunychothycngngmongmun
c mt mi trng khng khi thuc l nhng
tltipxcvikhithuclnicngcng
vncnrtcao.
Trongsccphngtinvnticngcng,
xebut/xecsdngnhiunht.Tuy
nhin, t l hnh khch khng nhn thy bin
hiu cm ht thuc l trn phng tin giao
thngcngcngnhxebutvtuhacncao.
Hnhaiphnbasngichichobith
khngnhnthybinhiucmhtthucl
ticctrmgiao thng cng cng. Hu ht cc
hnhkhchtrlirngthuclcbnti
cctrmgiaothngcngcngvmingic
thmuanmtcchddng.
Khong 60% ngi c hi cho bit
thycngihtthucltrnccphngtin
giao thng cng cng. Nhng ngi ht thuc
baogmcchnhkhch,tixvlxe.Trong
snhngngihtthuchinti,khong14%
tha nhn rng h ht thuc l trn cc
phngtingiaothngcngcngv58%ticc
bn xe/ sn bay trong chuyn i gn y nht.
Huhttrongs ny tr li rng khng c bt
ChuynYTCngCng
k ngi no nhc nh ngi ht thuc l
khngnnhtthuckhuvccngcng.
Tlngihtthuchinnaytrongtngs
nhngngithamgianghincul25,4%.Hn
mtnasngihtthuchintikhngc
nhbhtthuc.Trongsnhngngiht
thuchinticnhbthucl,63%trli
rng h s b ht thuc trong hn 6 thng ti.
Cc l do ph bin l quan tm n sc khe
ca h (86%) v cho sc khe ca gia nh
(20%).
KHUYNNGH
Cn tng cng hiu bit ca cc hnh
khch s dng phng tin giao thng cng
cng v cc mi nguy hi sc khe lin quan
nvichtthucvhtthucthng.
Thng ip phng chng thuc l ca cc
vnsckhekhcnhaunncthngbo
rng ri tt c cc a im ca d n hng
ngy.
NghincuYhc
Cmhtthucnicngcngcncthc
thi v kim sot ti cc khu vc c can thip
cng sm cng tt. Bin hiu cm ht thuc
nnctticctrmgiaothngcngcng.
Thc hin thc y v tng cng thng bo
thng xuyn cc tc hi ca thuc l nhm
nngcaoschpnhncaxhivhtrlnh
cmhtthuclnicngcng.
Nhngnicngcngcmichevnilm
viccacckhuvccadncnhiungi
tipxcvikhithucthngcncch
trng nhiu hn trong vic thi hnh quy nh
cmhtthucl.
TILIUTHAMKHO
1.
2.
3.
SgiaothngvntithnhphHChMinh(2008).Boco
caSgiaothngvntiThnhphHChMinh,nm2008
Tngccdnskhochhagianh(2009),Bocotngiu
tradnsvnh1/4/2009.
World Health Organization (2010), Global adult tobacco survey
(GATS)VietNam2010,page11.
ChuynYTCngCng
501
NghincuYhc
NHNTHCNGHNHCMHTTHUCL
TICCNIGIAOTHNGCNGCNG
THNHPHHCHMINHMTNGHINCUNHTNH
ngVnChnh*,NguynThBchNgc*,BiThKiuAnh*,HHuTnh*,NguynTuytNgc*
TMTT
tvn:VitNamlqucgiactlnamgiihtthuclcaonhttrnthgii,vkhong2/3ph
n,hnmtnatremlitngthngxuynhtthuclthng.Htthuclthngthngxyra
nhvnicngcng,cbittrnccphngtingiaothngcngcng.
Mctiunghincu:Mtnhnthcivinghnhcmhtthuccangiqunl,nhnvin
nhngnicdntngcngthcthicmhtthuclticccsgiaothngcngcngthuclbtu
trinkhaibaogmsnbayTnSnNht(TSNA),gaSiGn(SGRS),bnxeminng(ECS),bnxemin
ty(WCS),cngtytaxiMaiLinh(MLTC)vcngtytaxiVinasun(VSTC).
Phngphpnghincu:Sdngbnphngvnbncutrctmhiunhnthcvsnguyhim
cahtthucl,scnthitvgitrcanhngquynhcmhtthucl.
Ktqunghincu:Ttcnhnvinnhnthcctchicathuclivisckhevcclnh
cmhtthucnicngcng.Huhttrongshcngnhnthcchtthucthnggyhichosckhe
cah.Tuynhin,ccnhnvinkhngcshiubityvsnguyhimcavichtthucvlmthno
thcthiccquynhcmhtthuclnicngcng.Khngccngtynocbngkimtramitrng
khngkhithuc.Nhngngicphngvntnthnhvhtrccnghnhcmhtthuclvmun
thihnhnghnh.Tuynhin,hkhngcbtknguntichnhnocthsdngchovicthchinngh
nhny.
Ktlun:dnthnhcngcncshptcchtchviSgiaothngvntivybannhndn
thnhphHChMinhtrongvicthchinccdnmitrngkhngkhithuc.
Tkha:Htthucl;htthuclthng;nigiaothngcngcng;nghnhcmhtthuclni
cngcng
ABSTRACT
PERCEPTIONOFPUBLICSMOKINGBANATPUBLICTRANSPORTATIONSITES:AQUALITATIVE
STUDY
DangVanChinh*,BuiThiKieuAnh*,NguyenThiBichNgoc*,HoHuuTinh*,NguyenTuyetNgoc*
Background: Vietnam is a country with the highest smoking rates for men in the world, and about two
thirds of women and more than half of children exposed to passive smoking. Passive smoking often occurs at
homesandpublicplaces,especiallypublictransportationsites.
Objectives: To describe the perception of the smoking ban decree of managers, and staff at public
transportation sites, including Tan Son Nhat airport (TSNA), Sai Gon railway station (SGRS), East coach
station (ECS), Western coach station (WCS), Mai Linh taxi company (MLTC) and Vina Sun taxi company
(VSTC).
502
T:0908414986
ChuynYTCngCng
NghincuYhc
Method:Asemistructuredinterviewformatwasusedtoexploretheawarenessofdangersofsmoking,and
necessity,andvalueofthesmokingbanregulations.
Results:Allemployeeswereawareofsmokingharmtohealthandthepublicsmokingbanregulations.Most
ofthemwerealsoawareoftheharmofpassivesmoking.However,staffsdidnothavethefullunderstandingof
thedangerofsmokingandhowtoenforcethepublicsmokingbanregulations.Inpractice,nocompanieshada
checklistforsmokefreeenvironment.Intervieweesapprovedandsupportedthesmokingbandecreeandwantedto
enforcethepublicsmokingbandecree.However,theydidnothaveanyfinancialsourcesthatcouldbeusedto
implementthisdecreeatpublictransportationsites.
Conclusion:TheclosecooperationwiththeDepartmentofTransportationandHCMPeoplesCommittee
isnecessarytoimplementthesmokefreeprojectssuccessfully.
Keywords:Smoking;passivesmoking;publictransportationsites;publicsmokingbandecree
TVN
VitNamlqucgiactlhtthucl
nam gii cao nht trn th gii, vi 56,1% nam
gii v 1,8% n gii ht thuc(3). Theo mt s
nghincugny,khong2/3phnvhn
mt na tr em l i tng ht thuc l th
ngkhngchnhngnicngcngmcn
tigianh.Nhngngihtthuccthht
thuc hu nh mi ni bao gm c cc
phngtingiaothngcngcng.
ThnhphHChMinhcxemnhmt
thnhphtr,nngngvngdnnhtVit
Nam vi dn s trn 7 triu ngi(2). T l ht
thuc l Thnh ph H Ch Minh cao, 53%
nam v 2% n. Mc s dng phng tin
giao thng cng cng n Thnh ph H Ch
Minhcngbvngthyctnht
400triuln/nm(.GaSiGnchuynch1,1
triuhnhkhchminmvi10chuynravo
mingy.ShnhkhchnsnbayTnSn
Nhtctht15triuminm.Lng hnh
khchnbnxeminngvminTycth
lnn20triuminmvikhong2500xecho
mibn(1).
Dntngcngthcthicmhtthucl
ticccsgiaothngcngcngthucsc
trinkhaiccaimtrnnhmthcthi
viccmhtthuclccaimgiaothng
cngcng,baogmtngcngbnghiucm
ht thuc l. i thc thu nhm nhc nh
nhnghnhkhchtthucvtphunvtc
hicathucl
ChuynYTCngCng
D n hng ti vic h tr nhm cng c

vic thi hnh khng khi thuc cc khu vc
giaothngvnti,baogmtchcchnhquyn
diskimsotcaSGiaothngvnti,hai
bnxelnchyu,gaSiGn,taxi,snbayTn
SnNhttithnhphHChMinh.Victhc
hinhiuqudnnysctcngngk
ntrinkhainghinhkhnghtthuclnoi
cngcngthnhphniringvcncni
chung.
Mctiu
Mtnhnthccnbqunlivingh
nh cm ht thuc nhng ni c giao
thong cng cng m trin khai d n cm ht
thuclnicngcngctrinkhaibaogm
sn bay Tn Sn Nht (TSNA), ga Si Gn
(SGRS), bn xe min ng (ECS), bn xe min
ty (WCS), cng ty taxi Mai Linh (MLTC) v
cngtytaxiVinasun(VSTC).
PHNGPHP
Sdngbnphngvnbncutrctm
hiunhnthcvsnguyhimcahtthuc
l, s cn thit v gi tr ca nhng quy nh
cmhtthucl.
Thitknghincukhostcsdng
bng cch quan st cc a im ca d n
nhgivictunthquynhcmhtthuc,
quan st vic treo dn cc bin hiu cm ht
thuclvghinhnbngchngbtkcavic
htthuctikhuvccmhtthuc.Bncnh
lphngvn5nhqunl,21nhnvinti
aimbngcchsdngbngcu hi. Cc
503
NghincuYhc
cuctholunnhmtptrungvonhnthcv
snguyhimcavichtthuc,mc tun
th cc quy nh cm ht thuc l, nhng kh
khnvkvngtrongvicthchindn.
Tuynhin,hkhngcbtknguntichnh
nocthsdngchovicthchinNgh
nhnytinicngcng.
Bng kim mi trng khng khi thuc

nhngnicngcngcmichecsdng
nhgichngccavichtthucvmc
tunthccquynhcmhtthuclca
miaimtrinkhaidn.
Banchomitrngkhngkhithuc
c thnh lp ti SGRS, MLTC, WCS v ECS.
Tuynhin,huhtccnhqunlvnhnvin
bocornghkhngbitvccubanvcc
hot ng ca h, iu ny cho thy rng cc
hotngcahvncnhnch.Haitrongs
sucngtythnhlpccithcthiquinh;
l SGRS v MLTC. Nhm thc thi qui nh
SGRSbaogmsunhnvinanninhchutrch
nhim nhc nh hnh khch khng c ht
thuc ti cc trm trong khi nhm thc thi qui
nhMLTCbaogmccnhqunlchutrch
nhimgimstcctixngnngahht
thuctrongkhuvccm
KTQU
Munghincugm26ngi,baogmc
nhn vin v nh qun l ca su cng ty.
tuitrungbnhl37tui.Namgiichimtl
caohnn.Tlcaccitngnghincu
ttnghipcp3hoccaohnl17/26.5trn26
itngnghincuchtthuc,9trongs26
itngnghincutrlitnghtthuc
l.
Ttcnhnvin(26/26)nhnthcc
tc hi ca thuc l cho sc khe v cc lnh
cmhtthucnicngcng.Huhttrongs
hcngnhnthcchtthucthnggy
hi cho sc khe ca h. Tt c cc i tng
nghincuphnivichtthuclthng.
Tt c ng rng mi ngi nn ngn chn
vic ht thuc l th ng. Mc d mi ngi
bit tc hi ca vic ht thuc cng nh ht
thuclthng.
Banchomitrngkhngkhithuc
Tuynhinkinthcchungcahvtchi
ca ht thuc l v ht thuc l th ng vn
cn gii hn. Hn na, h khng nhn c
nhiuquynlitrongvicgimstvtunth
ngh nh cm ht thuc ni cng cng. Tt c
nhng ngi tham gia nghin cu cn phi
ccungcpthmnhiuthngtin,knngv
nhng c ch php l c th bt buc hnh
khchtunthccquynhcmhtthuc.
Cchotngvmitrngkhngthuc
l
Tuynhin,huhtcc nhn vin khng c

s hiu bit y v s nguy him ca vic
ht thuc v lm th no thc thi cc quy
nh cm ht thuc l cng cng. a s hiu
rng ht thuc l cng nh ht thuc l th
ngcthgyraccbnhnghhp,ung
th.Tuynhin,hkhngbithtthucvht
thuclthngcngcthgyraccvn
sc khe khc chng hn nh cc vn sc
khebmvtrem.
Thng bo v mi trng khng thuc l

qua loa phng thanh c thc hin mi
ngy mt ln ti SGRS, c bit l 4 ln mt
ngy ti ECS. Vn mi trng khng khi
thuc thng c cp trong cuc hp trc
tuyn hng tun c t chc ti MLTC. Ht
thuclbcmnhngnicngcng,nhng
victhcthicnyukm.
Trongthct,khngccngtynocbng
kimtramitrngkhngkhithuc.Huht
ngi c phng vn tn thnh v h tr
cc ngh nh cm ht thuc l v mun thi
hnhNghnhcmhtthuclnicngcng.
Phnghtthuclringbitdnhchohnh
khcchcxydngtiSGRSvTSNA.Tuy
nhin, phng ht thuc l ti SGRS rt nh.
SGRSlnhgangstduynhtthnhph
H Ch Minh. Nhiu ngi n v i SGRS
504
Hotngchnghtthucl
ChuynYTCngCng
mingy.lldotisaonhiuhnhkhch
ht thuc bn ngoi phng ht thuc l chng
hn nh trong cngtin hoc hnh lang v h
cmthykhngthoimikhihtthucltrong
cnphngnhnhvy.Tuynhin,hhimkhi
cnhcnhphihtthuctrongphnght
thuc.
Gim st s tun th lnh cm ht thuc
cng cng c thc thi kh tt ti MLTC.
MLTCcmtigimstchovictunth
quynhcmhtthuclcacctixtaxiv
mtngdynngbocokhitixtaxi
ht thuc. Tuy nhin, khng c cc hot ng
nhvyivihnhkhch,bivhsmtli
ch.Nuhnhkhchhtthuclthcnhc
nhkhnghtthuctrongkhuvccngcng,
h c th phn ng bng cch i mt xe taxi
khccacngtykhc,ktqullichgim.
Trongkhi,SGRScmtigimst
gmsungigimstvictunthlnhcm
ht thuc ti ni cng cng. H thng nhc
nhhnhkhchkhnghtthuctrongkhuvc
cngcng.Tuynhin,nhm gim st gm su
ngilkhng.Rrnglqutgimst
mtslngngkhnhkhchSGRS.
Ngithamgiaphngvnbaogmcnhn
vinvngiqunluhyvngrngktqu
cadnnyscnhiuhahn,manglili
ch v sc khe cho mi ngi. iu kin lm
vicstthn,trnhccnhccnhnvint
tp ni chuyn v ngn chn chy, n do ht
thuc l. Ngi tham gia phng vn cho rng
d n s mt nhiu thi gian thc hin v
duy tr. bt buc hnh khch tun th quy
nhcmhtthuccngcng,ccithihnh
nnlchskhinhcnhhnhkhchkhnght
thuclnicngcng.Tthnlnnchcho
hnh khch thy cc ti liu v ngh nh cm
htthucnicngcngtrongkhihnhcnh
vsaupdngphttintrnngiviphm.
i tng nghin cu nhn vin v nh
qun l thy kh khn trong vic a ra hnh
pht cho nhng ngi vi phm lnh cm ht
thucnicngcngvkhngcbtkhng
ChuynYTCngCng
NghincuYhc
dn c th ca chnh ph v hnh pht cho

nhngngiviphm.Tixvlxecngthy
kh khn trong vic nhc nh hnh khch
ngnghtthucltrnxebivcchnhkhch
c th khng thc hin theo quy nh v b
chuynxe,vthcctixbmtlich.
Ngoi ra, php lut khng ch nh r ai l
ngi chu trch nhim a ra hnh pht cho
hnhkhchviphm.Bncnh,hnhkhch
qunhiutrongkhi s lng cc nhn vin ti
nhng ni ny th rt t. Trng hp cc hnh
khch vi phm l nhng ngi ngho h s t
chitrtinpht.
Mt s lng ln cc ti x v ph xe l
nhngngihtthuc.iunyslmchod
n kh khn hn trong vic thc hin mi
trngkhngkhithucbivhchorngcn
phi ht thuc trnh b ng trn nhng
chuynidi.iunycthldothiukin
thc v nguy c sc khe lin quan n ht
thuc,dnnktqunhbthucltrong
snhngnginylrtthp.
KTLUNKINNGH
Nhnchungbngchngvskmtunth
cttcccaimcadn.Ngic
phng vn khng mun nhc nh hnh
khch ht thuc l khng ht thuc l ni
cng cng bi v h s s gy hn hoc khng
tunthcanhngngihtthuc.
dnthnhcngcncshptccht
ch vi S giao thng vn ti v y ban nhn
dn thnh ph H Ch Minh trong vic thc
hinccdnmitrngkhngkhithuc.
mbothchinthnhcngquynh
cm ht thuc ni cng cng, nhng iu sau
ycncthchin:
Thc y rng ri lnh cm ht thuc l
cngkhaiivinhnvin.
Tngcnglclngthcthidn.
Phbinccthngipchnghtthucv
cmhtthucnhngnicngcngticca
imcanthip.
505
NghincuYhc
Nhnvincncotophbincc
thngipvsnguyhimcahtthuclcho
hnh khch. D n cn cung cp cc bin bo,
tiliugiodc,video,vhnhnhvsnguy
himcavichtthucnhmlmtngshiu
bitcahnhkhch.Vicbnthuclc
nghcnphibcmtinicngcng.iu
nycthlphngtinmnhmgimht
thucltiaimdn.Nhnvintrongtt
ccccngtyviphmquynhvlnhcmht
thuc ni cng cng s b xp hng thp trong

vn khen thng. Hot ng ca lnh cm
ht thuc ni cng cng c nh gi theo
bngkimtramitrngkhngkhithuc.
TILIUTHAMKHO
1.
2.
3.
SgiaothngvntithnhphHChMinh(2008).Boco
caSgiaothngvntiThnhphHChMinh,nm2008
Tngccdnskhochhagianh(2009),Bocotngiu
tradnsvnh1/4/2009.
World Health Organization (2010), Global adult tobacco survey
(GATS)VietNam2010,page11.
506
ChuynYTCngCng
NghincuYhc
BMITRONGQUNTHTREMVITNAM610TUI
TRONG19921997
ngVnChnh*,RSDay2**,BSelwyn3***,YMMaldonado4****
TMTT
Mctiunghncu:TheodichsBMItrongqunthtremVitNamt610tuitrongkhongthi
gian5nmt199293n199798.
Phngphpnghincu:Ccdliucsdngtrongnghincucctkhostmcsngdn
cVitNam(VLSS)tinhnht19921993v19971998,sdngthitkmucmnhiubcxcnh
muidinqucgiacatremVitNamt610tui.ctnhsphbinvxuhngcachsBIMtr
em,bngcchsdngccngngBMIcxutbitchcquctvboph.
Ktqu:SgiatngcnghathngkcnhnthychsBMIcatremVitNam.TngBMI
thnhthcaohnnngthn.TltremVitNamcnguycbthacnvbophtngngkt0,4%
nm1992n0,8%vonm1997.Giiviukinkinhtxhilnhngyutdboquantrngnh
hngnchsBMIcatremt610tui.
Ktlun:TnhtrngsuydinhdngtremvntiptcbongvnvchdinhdngVit
Nam,cbitlccvngnngthn.Cnnngthithuckhnngnhhngngkntronglng
calatuisauny,vvycccanthipsmvdinhdngchotremlrtquantrng.
Tkha:BMI(chskhicth),ngngBMI,SES(tnhtrngkinhtxhi).
ABSTRACT
BMIAMONGCOHORTOFVIETNAMESECHILDREN610YEARSOFAGE,19921997
DangVanChinh,RSDay,BSelwyn,YMMaldonado
Objectives:TotrackBMIamongacohortofVietnamesechildren610yearsofageatonsetinthe5years
timeperiodfrom19921993to19971998.
Methods:ThedatausedinthisstudycamefromtheVietnamLivingStandardSurvey(VLSS)conducted
from19921993and19971998usingmultistageclustersampledesigntoproducenationallyrepresentative
samples of Vietnam children ages 6 10 years. The prevalence and trends of BMI for children were estimated,
usingBMIcutoffpointsproposedbyInternationalObesityTask.
Results:TherewerestatisticallysignificantincreasesinBMIamongVietnamesechildren.IncreasesinBMI
in urban were more than those in rural areas. The mean prevalence of at risk of overweight and overweight
among Vietnam children significantly increased from 0.4% in 1992 to 0.8% in 1997. Gender and SES were
significantpredictorsofBMIamongchildren610yearsold.
Conclusions: Underweight children continued to signal an important nutrition problem in Vietnam,
KhoaDchtvkimsotbnh,ihcTexas,ihcYtCngcngHouston
KhoaQunl,chnhschvsckhecngng,HTHTexas,ihcYTCCHouston
KhoaTon,ihckthutMichigan
ChuynYTCngCng
T:0908414986
507
NghincuYhc
especiallyinruralareas.Theweightstatusofchildrenatearlieragesislikelytosignificantlyinfluencethatat
laterages,makingearlynutritioninterventionsforchildrenveryimportant.
Keywords:BMI(BodyMassIndex),cutoffpoints,SES(socioeconomicstatus).
TVN
Khunglymu
Ccnghincugnychothythacn
tremanggiatngccncangphttrin,
nhngqucgiaangcnhngthayinhanh
chngvphttrinkinhtxhi(5,4),chnghn
nh Vit Nam, phi i mt vi nhng thch
thcludicavicgiiquytvnsuydinh
dngvngnngthn,bncnhphigii
quyt cc vn v tnh trng tng t l tha
cnkhuvcth.Sliulcnthitlm
dliuxcnhphmvivyutquytnh
thacn.Do,mcchcanghincunyl
theo di ch s BMI trong qun th tr em
VitNamt610tuitrongkhongthigiant
199293(2)n199798(3).
Thit k c s dng l mu cm nhiu

bc.Khunglymucdatrncuciutra
dn s ti Vit Nam nm 1989 do Tng cc
Thng k thc hin c 4.800 h gia nh c
lachntheoktqukhostmcsngdnc
Vit Nam VLSS nm 1992, v 4350 c la
chn trong ln kho st mc sng dn c Vit
Nam VLSS nm 1997, mu trong nghin cu
ny c la chn trong 4.800 h c
nghincuvonm1992.Do , tr em trong
cchgianhcthckimtrahailn,mi
lntrongtngcuciutra.
PHNGPHP
Thitknghincu
ylnghincuphntchmtdatrn
dliutcuckhokhostmcsngdnc
VitNam(VLSS)thchintronggiaion1992
1993(1992VLSS)(2),vgiaion19971998(1998
VLSS)(3).VnphngTngccthngkcung
cpccdliucsnvcpgiyphpchos
dngccdliuchonghincuny.
KhostmcsngdncVitNam
VLSS u tin (19921993)(2) c thc hin
biBKHochvuT,TngccThngk
tiHNi.VLSSlnthhai(19971998)(3)c
tin hnh ch bi DSO. C hai cuc iu tra
VLSS c ti tr bi chng trnh thng nht
phttrinqucgiavcquanphttrinquct
ca Thy in. Cc cuc iu tra l mt phn
canghincuolngtiuchuncucsng,
iutrahgianhctinhnhtrongmts
nc ang pht trin vi s h tr k thut t
Ngn Hng Th Gii. Chi tit cc khung ly
muvthuthpdliutrongngytrongnm
19921993VLSSvnm2000GNScm
ttrc(27).
508
Binphpkhost
Bcuhichohgianhtrongchaicuc
khostudatrncngnhdngcs
dngbiNgnHngThGiitrongcuciu
tranghincuvkhostmcsngtrongdn
c,nhnghiuchnhphhpviVit
Nam v thc hin kho st th ti a
phng.Ttccccdliukhosthgianh
ca2cuciutraiucqunlbinhn
vinyt.KhostVLSSchthchinmtlnv
lnghincutheochiudc(bngiukhin),
kho st 4.305 h gia nh c thc hin hai
ln.
nhnghasuydinhdng
Ngng BMI phn loi gia nhm suy
dinh dng v bnh thng tr em 610 tui
datrnphnloiBMIcphttrinbiMust
vcngs,vdatrndliuNHANESIdnh
choitng618tui.csdngrngri
hnxcnhsuydinhdngthithuv
thiunin,cnghpdngchonhm
tremt1019tuibichuyngiacaTchc
Ytthgii(9).
Kimsotchtlngdliu
Nhmkhost,baogm c nhn vin y t
v gim st vin, tri qua o to. Bao gm
thuthpdliuticchgianh,khuvc
ChuynYTCngCng
th v khu vc nng thn. Bi kim tra tiu
chun c thc hin nh gi xem cc
hc vin c thc hin ng cc php o nhn
trchctheocngthcchunchosn.
Phntchthngk
Kthphaimtctngangcadliu,VLSS
nm 1992(2) v VLSS nm 1997(3) thit lp
bng iu tra d liu cho cc phn tch theo
chiudc,trongthitknghincuny,trem
trongnhmt610tuiclachntrongc
haicuciutraVLSSnm1992 v 1997 c
xcnh.Do,phntchctinhnhcp
cth,sdngphntchGEEthitlps
ngnhtquansttrongtngcm.BMIcatr
emtrongnm1992cphnloidatrntiu
chun phn loi ca IOTF vo cc nhm suy
dinhdng,bnhthng,nguycthacnv
thacn.
KTQU
ctnhcaqunthnghincu
Bng1:ctnhcatremVitNamt19921997.
c tnh
1992
n
6
7
8
9
10
Nam
N
Thnh th
Nng thn
Rt ngho
Ngho
1997
%
Tui
20,2
370
19,4
355
21,4
392
18,71
342
20,2
369
Gii
919
50,3
919
909
49,7
909
Khu vc c tr
1553
85
1522
275
15
306
441
24,1
419
424
23,2
370
370
355
392
342
369
20,2
19,4
21,4
18,71
20,2
Trung bnh
Giu
Rt giu
NghincuYhc
416
341
282
22,8
18,7
15,4
1025
560
208
56,1
30,6
11,4
35
1,9
35
Quy m h gia nh
3 ngi
100
5,5
78
4 ngi
291
15,9
307
5 ngi
1437
78,6
1443
Phn nhm BMI trong nm 1992
Suy dinh dng
525
28,7
644
Bnh thng
1294
70,8
1169
Nguy c tha cn
9
0,5
15
v tha cn
1,9
Tiu hc
Cp 2, cp 3
Trung cp ngh,
cao ng
i hc
Tng
391
21,4
301
16,5
271
14,8
Hc vn ca ch h
1025
56,1
560
30,6
208
11,4
1828
100
1828
4,3
16,8
78,9
35,2
64,0
0,8
100
tiuhc,ditiuhcvmch;ihc
baogmihcvsauihc
c im dn s x hi ca 1.828 tr em
trong tui t 610 giai on 19921997 c
trnh by trong Bng 1. Cn nng trung bnh,
chiucao,chsBMIphnbtheotui,thi
gian,baogmsthayingktonbchs
BMIcaccbtraivbgi,trungbnhBMIc
sthayimtcchngk,ghinhncch
sBMInm1997lnhnnm1992l2,1kg/m2
(p=0,04).(Bng1)
Miquanhgiactnhnhnkhuhc
vdnsvichsBMI
50,3
49,7
Phn tch dc xc nh cc yu t tham gia

vosthayichsBMIdinratnm1992
nnm1997.Mhnhnhginhmtui,gii
tnh, vng c tr, tnh trng kinh t gia nh,
trnhhcvncacham,slngccthnh
vin trong gia nh theo cc phn nhm BMI
trongnm1992.
83,3
16,7
22,9
20,2
Phntchnbin
Bng2:Skhcbitvtrnglngtrungbnh,chiucaovBMItheogiitnh,khuvcctrvtnhtrng
kinhtgianhtrongqunthtremVitNam610tuit19921997.
c tnh
1992
Cn nng
(M, SE)
1997
ChuynYTCngCng
S khc
bit
1992
Chiu cao
(M, SE)
1997
S khc
bit
1992
BMI (kg/m2)
(M, SE)
1997
S khc
bit
509
NghincuYhc
c tnh
Tui
6
16,0 (,1)
7
17,5 (,1)
8
19,3 (,1)
9
21,2 (,2)
10
23,0 (,2)
Gii
Tr trai 19,6 (,1)
Tr gi
19,1 (,1)
Khu vc c tr
Thnh th
20,5(,2)
Nngthn
19,2(,1)
Rt ngho
18,5(,2)
Ngho
19,2(,2)
Trung bnh
19,3(,2)
Giu
19,8(,2)
Rt giu
20,7(,3)
Tng
19,4 (,1)
Cn nng
(M, SE)
26,6 (,2)
30,0 (,3)
33,7 (,3)
38,0 (,4)
41,2 (,3)
33,5 (,3)
34,2 (,2)
10,6 (,2)
12,5 (,2)
14,4 (,2)
16,8 (,3)
18,2 (,2)
13,8 (,2)
15,1 (,2)
36,6(,5)
33,4(,2)
31,8(,3)
33,2(,4)
33,7(,4)
35,1(,5)
36,9(,5)
33,8(,2)
26,6 (,3)
27,0 (,3)
26,5 (,3)
26,9 (,4)
26,3(,3)
26,5 (,2)
26,8 (,2)
BMI (kg/m2)
(M, SE)
14,2 (,1) 15,1 (,1)
14,0 (,1) 15,5 (,1)
14,2 (,1) 16,4 (,1)
14,3 (,1) 17,2 (,1)
14,7 (,1) 17,9 (,1)
14,5 (,03) 16,2 (,1)
14,1 (,04) 16,6 (,1)
0,8 (,1)
1,5(,1)
2,2 (,1)
2,8 (,1)
3,2 (,1)
1,7 (,1)
2,5 (,1)
147,0(,6)
141,9(,3)
27,1(,3)
26,5(,1)
14,2(,07)
14,3(,03)
16,7(,1)
16,3(,1)
2,5(,1)
2,0(,04)
139,1(,5)
142,0(,5)
142,8(,5)
144,9(,6)
146,9(,6)
142,7(,2)
26,4(,3)
26,2(,2)
26,6(,3)
27,4(,3)
26,9(,3)
26,6(,1)
14,5(,1)
16,2(,1)
14,2(,1)
16,2(,1)
14,2(,1)
16,3(,1)
14,2(,1)
16,5(,1)
14,2(,1)
17,0(,1)
14,3(,03) 16,4(,05)
1,8(,1)
2,0(,1)
2,1(,1)
2,3(,1)
2,7(,1)
2,1(,04)
106,1 (,3)
111,4 (,3)
116,6 (,3)
121,4 (,4)
125,0 (,4)
116,2 (,3)
115,9 (,3)
Chiu cao
(M, SE)
132,7 (,4)
138,4 (,4)
143,0 (,4)
148,3 (,4)
151,3 (,4)
142,7 (,4)
142,7 (,3)
16,0(,3)
14,2(,1)
119,9(,6)
115,4(,2)
13,3(,2)
14,0(,2)
14,5(,3)
15,2(,3)
16,2(,3)
14,5(,1)
112,7(,4)
115,8(,4)
116,2(,4)
117,6(,5)
120,0(,6)
116,1(,2)
:M:trungbnh;SE:lchchun.
:skhcbitgiactnhtheothigian
T nm 1992 n nm 1997, ch s trung
bnh BMI tng ln 0,42 kg/m2(p < 0.001),
nhngsthayichxyratrnhainhmv
chthayingktrncchgianhgiuc
(=0,27kg/m2,p<0,049)(Bng3).Sosnhchs
BMIcatremcchgianhctrnhhc
vn thp vi cc tr em cc gia nh c trnh
hcvntcphaitrlnthcskhcbit
ngkvchsBMI(=0,16kg/m2,p<0,04).
Sau5nm,tremt610tuinhmcnnng
bnh thng, nguy c tha cn v tha cn
cmtsthayichstrungbnhBMInhiu
hnsovinhmtremsuydinhdng(=1,15
kg/m2, p<0,001,v =3,81kg/m2, p<0,001, tng
ng).
Phntchabin
Bng3:Miquanhgiaccyutnhnkhuhc,
kinhtgianhvivichsBMItrongqunthtr
emVitNam610tui,t19921997.
Phn tch n
bin
Th SE p
Tui
Gii
510
0,42
Phn tch a bin
Hiu SE
p
chnh
0,02 0,000 0,57 0,01 0,000
7
Phn tch n
bin
Th SE p
Phn tch a bin
Hiu SE
p
chnh
Tr trai
0,0
0,0
Tr gi
0,04 0,07 0,58
0,2
0,05 0,000
Khu vc c tr
Thnh th
0,13 0,11 0,25 0,04 0,08 0,66
Nng thn
0,0
0,0
Rt ngho
0,0
0,0
Ngho
-0,11 0,1 0,31 -0,02 0,07 0,82
Trung bnh
-0,06 0,1 0,6
0,03 0,08 0,65
Giu
0,02 0,11 0,85 0,02 0,09 0,81
Rt giu
0,27 0,14 0,049 0,34 0,10 0,001
Hc vn ca ch h
Tiu hc
0,0
0,0
Cp 2, cp 3
-0,16 0,08 0,04 -0,12 0,06 0,03
Trung cp ngh, -0,003 0,12 0,98 -0,08 0,08 0,33
cao ng
i hc
0,36 0,37 0,33 0,05 0,25 0,84
Kch c h gia nh
3 ngi
-0,20 0,17 0,24 -0,20 0,11 0,08
4 ngi
-0,006 0,11 0,96 -0,01 0,08 0,9
5 ngi
0,0
00
Phn nhm BMI trong nm 1992
Suy dinh dng 0,0
0,0
Bnh thng
1,15 0,06 0,000 1,6
0,05 0,000
2
Nguy c tha cn, 3,81 0,74 0,000 4,3
0,01 0,000
ChuynYTCngCng
Phn tch n
bin
Th SE p
Phn tch a bin

Hiu SE
chnh
tha cn
SE: lch chun
Trong5nm(t1992n1997),trungbnh
BMIhiuchnhcanhmtremt610tui
tng 0,57kg/m2 (p<0,001). Trung bnh BMI hiu
chnhcaccbgitng0,2kg/m2soviccb
trai(p<0,001).Trongnm1997,cctremcc
gianhgiucthctrungbnhBMIcaohn
cctremsngtrongccgianhrtngho(
hiuchnh=0,34,p<0,001)saukhihiuchnh
ccbinkhc.Vcnnng,tremnhmcn
nngbnhthng,cnguycthacnvtha
cn th c thay i trung bnh BMI cao hn so
vi nhm tr em nh cn sau 5 nm (t nm
1992 n nm 1997) ( hiu chnh= 1,6kg/m2,
p<0,001. hiu chnh= 4,3kg/m2, p<0,001. tng
ng).
Mi lin quan gia cc nhm BMI trong

nm1992vtrongnm1997
Bng4:MiquanhgiachsBMItronghainm
1992v1997catrem610tuiVitNam.
Phn tch n Phn tch a bin
bin
Th KTC
p Hiu KTC p
chnh 95%
OR 95%
OR
M hnh 1
Nhm BMI
Khng c nguy c
tha cn
C nguy c tha cn
v tha cn
M hnh 2
Nhm BMI
Suy dinh dng
Khng tha cn
1,0
1,0
16,1 1,8- 0,01 18,4 2,9- 0,00

142,7
115,0 2
1,0
3,1
1,0
2,4- 0,000 6,6
3,8
5,0- ,000
8,6
:(1)Khngcnguycthacn:suydinh
dng v cn nng bnh thng (2) nguy c
thacnvthacn.
: (1) suy dinh dng (2) khng suy dinh
dng:cnnngbnhthngvcnguycb
thacnvthacn.
ChuynYTCngCng
NghincuYhc
Saukhihiuchnhccbinkhc,nhng
atrkhngbnhcntrongnm1992ths
ckhnngkhngbnhcntrong5nmtiso
vi nhng a tr b nh cn khc (OR hiu
chnh=6,6,KTC95%:5,08,6).
BNLUN
BMIvccnhmBMI
NghincunychothychsBMItngln
theo nhm tui v trung bnh BMI gia cc
nhm tui tng 0,42kg/m2 sau 5 nm. Kt qu
nyphhpviktqunghincuctin
hnh ti Trung Quc(6). Hai nh nghin cu
TrungQuclLuovHuphthinratrem
trong tui 26 c ch s BMI tng 0,2 kg/m2
minmvngthnhthv0,1kg/m2minm
vng nng thn t nm 1989 n nm 1998.
iuquantrnglcnlurngccphthin
tnhngnghincuchrarngvicgiatng
trongsphnphichsBMIcthlinquan
tivictngtlnguycthacnvthacn
(1).
Hnna,ccphthintphntchonh
trongnghincunychothytremVitNam
trong nhm tui 610 nhm cn nng bnh
thng,cnguycthacnvthacnckh
nngchsBMIcaohnsau5nmsovinhm
tr cng tui b suy dinh dng. iu ny
ph hp vi nhng pht hin trc y cho
rngtremtrongnhmcchsBMIcaothc
kh nng tip tc c ch s BMI cao trong
khongthigiansau(1).
Giatngchiucao,cnnngvchsBMIl
mtpngchungcasphttrinxhiVit
Namtrongthpkqua,tuynhingiatngnguy
cthacnvthacntremkhuvcthnh
thcthlmtpngiviisngtvn
ngvkhngtiuthhtnnglngdtha.
Trong nghin cu ny, cc b gi c trung
bnhBMIcaohnccbtrai,phthinny
c cn nhc trong mt nghin cu khc ti
Chu . iu ny c th c lin quan n giai
ondythcaccbtraivccbgi.Ccb
gicxuhngdythsmhnsoviccb
511
NghincuYhc
trai v vy ch s BMI ca cc b gi cng cao

hnccbtraitronggiaonny(8).
Tremvngnngthncchorngsc
chsBMIthphntremvngthnhth,tuy
nhin,khngcskhcbitcnghathngk
v ch s BMI gia tr em thnh th v nng
thn trong phn tch on h ca nghin cu
ny. iu ny gi rng mc tr em tham
giavolaongnngcs khc bit gia hai
nhmlmnhhngnmiquanhny.Bi
v,chsBMIcnhgidatrnskthp
gia lng m trn c th v kh nng hot
ngthcht.
Pht hin ca nghin cu ny cho thy, tr
emcchamctrnhhcvnditiuhc
s tham gia lao ng nhiu hn cc tr em c
cha m c trnh hc vn t trung hc c s
tr ln, bi v nhng a tr ny thng sng
trongccgianhnghohocsngvngnng
thn.Nhngtremnythngcchiucaov
cnnngthphnccnhmtremkhc,vvy
chsBMIcachngcngthphnmtchtso
viccnhmtngng.
immnhcanghincunyldatrn
VLSSthchintrnchaimtngangvdc
nh gi tnh trng dinh dng ca tr em
Vit Nam. Tuy nhin, nghin cu ny cng c
im hn ch l khng thu thp c y
thngvhotngthchtcngnhccyut
nguycchnhnhhnglncnnng.Do,
hot ng th cht l mt yu t c kh nng
gynhiulnchsBMItrongphntchny.
KTLUN
Bi v tnh trng cn nng trong giai on
ucnhhngrtlnncnnngsauny
ca tr em nn vic sm cung cp y cht

dinhdngchotremlrtquantrng.Vvy,
mt chng trnh y t quc gia kim sot suy
dinh dng v tha cn tr em 6 tui v
nhng tr ln hn nn c cung cp cho tr
em,ccbcchamvchoccngng.Trem
b suy dinh dng vn l mt vn dinh
dngquantrngtiVitNam,cbitlvng
nng thn, chnh lch v trnh pht trin
kinhtxhigianngthnvthnhthvn
cn tn ti, do , thng tin v cc hot ng
canthipcncthitkphhpvinhucu
ca cc c im kinh t x hi ca khu vc
nngthn.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
8.
9.
FlegalK,TroianoR(2000).Changesinthedistributionofbody
mass index of adults and children in the US population. Int J
ObesRelatMetabDisord;24:807818.
General Statistical Office of Vietnam (1993). VietNam Living
StandardsSurvey199293.1993.
General Statistical Office of Vietnam (1999). VietNam Living
StandardsSurvey199798.HanoiPublisher1999.
Gillespie S, Haddad LJ, Allen L (2001). Attacking the double
burdenofmalnutritioninAsiaandthePacific.Washington,DC:
InternationalFoodPolicyResearchInstitute;
JacksonM,SammaM,AshleyD(2001).Nutritionalstatusof11
12yearoldJamaicanchildren:coexistenceofunderandover
nutritioninearlyadolescence.PubHealthNutr;5(2):281288.
Luo J, Hu FB (2002). Time trends of obesity in preschool
children
in
China
from
1989
to
1997.
Int.J.Obes.Relat.Metab.Disord.04;26(4):553558.
MustA,JacquesP,DallalG,BajemaC, Dietz W (1992). Long
term morbidity, and mortality of overweight adolescents. A
followupoftheHarvardGrowthStudyof1922to1935.NEngl
JMed;327:13501355.
Wang Y (2002). Is obesity associated with early sexual
maturation?AcomparisonoftheassociationinAmericanboys
versusgirls.Pediatrics11;110(5):903910.
WorldHealthOrganization(1995).Physicalstatus:theuseand
interpretation of anthropometry. Report of a WHO Expert
Committee. World Health Organization Tech Rep Ser
1995;854:1452.
512
ChuynYTCngCng
NghincuYhc
TNHTRNGBMICATR1114TUITHNHTHV
NNGTHNVCCYUTXHILINQUAN
ngVnChnh*,NguynThBchNgc*,BiThKiuAnh*
TMTT
tvn:ThchthcmiiviccqucgiaangphttrinnhVitNamltiptcgiiquytvn
suydinhdng(SDD),trongkhiphingnchntlthacnanggiatngkhuvcthnhth.
Mctiunghincu:XcnhtlvccyutlinquanntnhtrngBMIcatrVitNam1114
tuiBinHatnhngNaivhuynCuNgangtnhTrVinh,sdngchunthamkhoquct.
Phng php nghin cu: Thu thp s liu da trn phng vn trc tip: tnh trng kinh t x hi
(KTXH),hotngthlcvnhntrchc.
Kt qu nghin cu: TlhinmcSDDtrungbnhthnhth(11,9%)thphnsovinngthn
(17,9%).Tui,gii,vngcng,tnhtrngKTXH,hotngthlcvavnnglcnghathngktrong
vicdonBMItrungbnhsaukhihiuchnhccbinskhctrongphntch.
Ktlun:Nghincunychothytlhinmcnguycthacnvthacncaohnthnhth,vt
lSDDngchtr1114tuivngnngthn,chaivntrnlnhngvndinhdngquantrng
cncquantm.
Tkha:BMI,trem,ngNai,TrVinh,suydinhdng,thacn.
ABSTRACT
BMISTATUSOFRURALANDURBANCHILDRENAGES11TO14YEARSOLDANDITSSOCIAL
DETERMINANTS
NguyenThiBichNgoc*,BuiThiKieuAnh*,DangVanChinh*
Background: The new challenge for developing countries like Vietnam is to continue to address the
underweightproblem,whiletacklingtherisingprevalenceofoverweightinurbanareas.
Objectives:TodeterminetheprevalenceanddeterminantsofBMIamongVietnamesechildrenages11to
14yearsinBienHoacityinDongNaiandCauNgangdistrictinTraVinhprovince,usinganinternational
referencestandard.
Method:Thisinvestigationwasbasedondirectinterviewsthatincludedasocioeconomic,physicalactivity
andbodyanthropometrywasmeasured.
Results:Themeanprevalenceofunderweightwaslessinurban(11.9%)thaninruralareas(17.9%).Age,
gender, area of residence, SES, and moderate and vigorous physical activity were statistically significant in
predictorsofmeanBMIafteradjustingtheothercovariatesinanalysis.
Conclusion:Thisstudyindicatesahigherprevalenceofatriskofoverweightandoverweightinurbanareas,
andthenotableprevalenceofunderweightamongchildrenwhoare1114yearsoldinruralareas,bothofwhich
areimportantnutritionalproblemsthatneedtobeaddressed.
Keywords:BMI,children,DongNai,TraVinh,underweight,overweight.
VinVsinhYtcngcngthnhphHChMinh
ChuynYTCngCng
T:0908414986
513
NghincuYhc
TVN
Suydinhdngtremvncnlmtvn
lnccqucgiaangphttrin,ningho
ivncnnhhngln(1).TiVitNam,mc
dthchinnhiunlcnhmcithinsc
khe nhng suy dinh dng tr di 5 tui
vn cn cao. Nhng tr suy dinh dng ny
khngphnbngukhpcnc,tbit
vngnngthn;trongkhibophtrl
vn ang ngy cng c quan tm khu
vcthnhth(2).
Mt s cc nghin cu nh gi t l suy
dinh dng v tha cn tr di 5 tui v
ngi ln c thc hin trong khi ch c
mtstccnghincuvtnhtrngcnnng
trVitNamlatuit6tuitrln(3).Do
,nghincuphmvivccyutquytnh
nvnsuydinhdngvthacntrem
t6tuitrlnthnhthvnngthnlcn
thit.Mcchcanghinculxcnhtl
vccyutquytnhntnhtrngBMIca
tr em Vit Nam t 11 n 14 tui Bin Ha
tnhngNai(N)v huyn Cu Ngang tnh
TrVinh,sdngchunthamkhoquct(1,3).
4%,cmutnhcl400.Cmuchiu
chnhbngkthutchnmucmvihiung
thitk1.6;dovycmul800tr.Tngcng
c1600trthamgianghincu2khuvc.
Cculymu
Tin hnh chn mu cm t danh sch cc
trngtiuhcthnhphBinHavhuyn
Cu Ngang trong nin hc 20092010. Kt qu
1600 tr t 8 n 10 tui c chn mu ngu
nhin.
Tiuchavovloitr
Ttchcsinhcthcchnnucmt
titrngvongyiutra.3nhmtuic
chnbivnhngtrt11tuitrlntrlicc
cuhihotngthlcctnhtin cy nhiu
hn.Nhnghcsinhhocphhuynhhcsinh
tchithamgiavocuciutrascloi
tr. Nhng hc sinh li lp, vng mt hoc
hcnhylpsbloitr.
KTQU
Bng1:ctnhmucatremVitNam1114
tuiTp.BinHavTrVinh.
c im
Mctiu
Mctiu1:ctnhtlsuydinhdngv
nguycthacntr11n14tuitithnh
phBinHavhuynCuNgang.
Mctiu2:Xcnhccyutxhiquyt
nh(tnhtrngKTXH,hotngthlc,trnh
hcvn)linquannBMItr11n14
tui ti thnh ph Bin Ha v huyn Cu
Ngang.
PHNGPHP
Thitknghincu
Sdng2nghincuctngang.
Cmunghincu
S dng cng thc chn mu ngu nhin
n:S=Z1/2p*(1p)/d2
p dng cng thc trn vi p= 0,3 t l
phn trm tr nh cn ti Tr Vinh c c
tnh khong 30%; = 0,05, d: gi tr tuyt i=
514
Tui (nm)
11
12
13
14
Gii tnh
Nam
N
Ngho
Trung bnh
Giu
Dn tc
Kinh
Khmer
cp 2
Cp 3
Trung hc tr
ln
Vng thnh th
ng Nai
n
%
198
201
201
200
24,8
25,1
25,1
25,0
Vng nng thn

Tr Vinh
n
%
198
200
206
196
24,8
25,0
25,7
24,5
355
44,4
322
445
55,6
478
Tnh trng kinh t x hi
85
10,6
485
379
47,4
268
336
42,0
47
40,3
59,7
800
100,0
497
0
0
303
Trnh hc vn ca cha
406
50,8
612
320
40,0
164
74
9,2
24
60,6
33,5
5,9
62,1
37,9
76,5
20,5
3,0
Trnh hc vn ca m
ChuynYTCngCng
c im
cp 2
Cp 3
Trung hc tr
ln
Vng thnh th
ng Nai
n
%
488
61,0
262
32,8
50
Vng nng thn

Tr Vinh
n
%
711
88,9
82
10,2
6,2
0,9
Ngh nghip ca cha

Lm vic nh
nc
Kinh doanh
Cng nhn
Bn hng
Lm nng c
lng
Nng dn
T lm ch
Lm vic nh
nc
Kinh doanh
Cng nhn
Bn hng
Lm nng c
lng
Nng dn
T lm ch
Tng
6,9
69
8,6
118
369
124
14,8
46,1
15,5
11
23
41
1,4
2,9
5,1
78
9,8
91
11,4
15
1,9
543
41
5,1
22
Ngh nghip ca m
67,9
2,7
32
4,0
24
3,0
41
226
167
5,1
28,2
20,9
5
15
129
0,6
1,9
16,2
11
1,4
69
8,6
3
320
800
0,4
40,0
100,0
445
113
800
55,6
14,1
100,0
Tltremginhiuhncctremtrai,t
ltremsngtrongccgianhgiucng
NaicaohnsoviTrVinh.Cstngphn
v trnh gio dc ca cha m gia vng
thnh th v nng thn. 32,8% cha m thnh
thhcn trung hc so vi cc b m vng
nngthn(10,2%)vcha(20,5%).Nghnghip
chnh ca cha m nng thn l nng dn,
trong khi nng dn chim t l rt nh khu
vcthnhth(bng1).
Bng2:Skhcnhauvtrungbnhchiucao,cn
nngvBMITPHCMvTinGianglatui11
14theogiitnhvKTXH.
Khu vc
Thn Nn
h th g
thn
c
n
Tr
tnh
gNai Vinh
Khu vc
Thn Nng
h th thn
Khu vc
Th Nn
nh g
th thn
n Tr
n Tr
g Nai Vinh
g Vinh
Nai
Khc
Cnnng Khc
Chiu
Kh
BMI
2
(kg)
bit cao(cm)
c (kg/cm ) bit
bit
ChuynYTCngCng
(M, SE+)
11
12
13
55
NghincuYhc
14
Nam
Ngh
o
Trung
bnh
Giu
Tng
(M, SE)
(M, SE)
Tui (nm)
37,7 32,2 5,5 144,5 140,7 3,8 17,9 16,1 1,7
(0,7) (0,4) (0,8)** (0,5) (0,5) (0,7) (0,3) (0,2) (0,3)
**
**
42,2 36,5 5,7 150,7 146,5( 4,2 18,4 16,9 1,6
(0,7) (0,4) (0,8) (0,5) 0,5) (0,7) (0,2) (0,1) (0,3)
**
**
**
45,2 39,9 5,3 154,3 150,6 3,7 18,9 17,5 1,4
(0,7) (0,5) (0,9) (0,5) (0,5) (0,7) (0,3) (0,2) (0,3)
**
**
**
46,9 44,1 2,9 157,4 155,2 2,2 18,9 18,2 0,7
(0,6) (0,5) (0,8) (0,5) (0,5) (0,7) (0,2) (0,2) (0,3)*
*
**
Gii
44,7 38,2 6,5 153,7 149,5 4,2 18,7 16,9 1,8
(0,6) (0,5) (0,8) (0,6) (0,6) (0,8) (0,2) (0,1) (0,2)
**
**
**
41,7 38,1 3,6 150,2 147,4 2,8 18,4 17,4 1,0
(0,4) (0,3) (0,5 (0,3) (0,3) (0,5) (0,1) (0,1) (0,2)
**
**
)**
Tnh trng KTXH
38,4 37,0 1,3 147,7 147,1 0,7 17,5 17,0 0,5
(0,8) (0,3) (0,9) (0,9) (0,4) (1,0) (0,3) (0,1) (0,3)*
41,6 39,9 1,7 150,9 150,3 0,6 18,2 17,5 0,6
(0,5) (0,5) (0,7) (0,4) (0,5) (0,7) (0,2) (0,2) (0,2)*
45,7 39,6 6,2 153,8 149,3 4,5 19,2 17,6 1,6
(0,6) (1,2) (1,6)** (0,5) (1,4) (1,4) (0,2) (0,4) (0,5)*
*
42,9 38,1 4,8 151,7 148,2 3,5 18,5 17,1 1,3
(0,3) (0,2) (0,4) (0,3) (0,3) (0,4) (0,1) (0,1) (0,1)
**
**
**
: M: Trung bnh; SE: Sai s chun; :c

lng v s khc nhau gia N v TV; *: p
<0,05,**p<0,001(ttest)
+
Bng2chothycskhcbitvcnnng
trungbnh,chiucaovchsBMIcatrem
tui1114giatremthnhthvnngthn
theogiitnh,tuitcvtnhtrngkinhtgia
nh.Tremthnhthnng(4,8kg)vcaohn
tremnngthnchaigiivtrongnhm
gianhgiu(3,5cm).Ngoira,giacctrem
thnhthchsBMIcnglnhn(1,3kg/m2).
Bng3:Tnsutsdngthcncatrem1114
tuimitnh.
N =800
Tht
Gia cm
Tht ln
Thnh th
Nng thn
ng Nai (mi tun) Tr Vinh (mi tun)
4
1-3
1
4
1-3
1
%
%
%
%
%
%
15,6
89,1
54,0
10,9
30,4
0
7,1
89,4
46,7 46,3
10,6
0
515
NghincuYhc
Tht b
C v hi sn
Trng
Sa v cc
phm t sa
Bnh ngt v
ko
Nc gii kht
Cc loi u
Rau c
Tri cy
17,6
29,1
27,9
53,0
58,3
48,3
56,6
20,8
24,1
22,6
15,5
26,2
1,2
57,0
16,7
14,5
28,9 69,9
37,0 6,0
56,8 26,5
26,4 59,1
Nam
47,1
24,1
28,8
48,9
35,5 15,6
Nam
44,2
18,9
90,5
87,4
29,8
34,5
7,1
10,2
26,0
46,6
2,4
2,4
45,0
13,2
77,9
50,0
35,9 19,1
37,3 49,5
19,6 2,5
39,8 10,2
Tnstiuththt4lntrongmttun
thnhthcaohnkhuvcnngthn,cbitl
thtb(17,6%sovi1,2%)vthtgiacm(15,6%
sovi7,1%).Tuynhin,tremkhuvcnng
thn li tiu th nhiu c v cc loi hi sn
nhiu hn tr em thnh th (57,0% so vi
29,1%).Nhnchung,tremchaikhuvcu
sdngrauvthtlntrongccbannhiu
hnccloithcphmkhc(bng3).
Bng4:Tlthiucn,cnnngtrungbnh,nguy
cthacnvthacncatrem1114tuikhu
vcthnhthvnngthntheogiitnh,SESv
trnhhcvncacham.
Thnh th
Nng thn
ng nai
Tr Vinh
Thiu Cn Nguy c Thiu Cn Nguy c
cn nng tha cn cn nng tha cn
c im
bnh v tha
bnh v tha
th
cn
th
cn
ng
ng
%,
%,
%, SE
%, %, SE %, SE
+
SE
SE
SE
Tui
11
Nam
16,3 58,7
25,0
29,4 67,6
2,9
(3,6) (3,9)
(4,9)
(8,6) (8,7)
(1,6)
N
12,3 74,5
13,2
20,0 73,1
6,9
(2,8) (6,0)
(4,1)
(3,8) (4,0)
(2,1)
12
Nam
10,6 69,4
20,0
25,3 72,3
2,4
(3,9) (1,6)
(5,1)
(7,3) (6,9)
(1,7)
N
5,2 84,5
10,3
9,4 88,0
2,6
(2,5) (1,8)
(1,9)
(3,1) (3,2)
(1,0)
13
Nam
17,0 65,9
17,0
27,1 68,2
4,7
(6,1) (6,5)
(4,1)
(5,3) (6,6)
(2,1)
N
9,3 78,5
12,1
11,6 87,6
0,8
(3,9) (2,7)
(1,9)
(3,2) (3,9)
(0,8)
14
516
Kinh
Khmer
16,7
(3,1)
10,3
(2,9)
69,0
(3,5)
85,3
(2,5)
15,2
(3,6)
9,2
(0,7)
65,6
(2,8)
80,9
(1,7)
Cp 2
14,0
(2,2)
Cp 3
10,3
(2,5)
Cao ng 6,7
v i hc (4,0)
Cp 2
13,3
(1,9)
Cp 3
10,3
(1,3)
Cao ng 6,0
v i hc (3,7)
Ngho
16,5
(2,8)
Trung bnh 14,5
(3,1)
Giu
7,7
(1,1)
Tng
11,9
(1,8)
22,1
(4,2)
8,2
(2,1)
75,6
(4,5)
88,2
(3,2)
2,3
(1,4)
3,6
(1,7)
25,8
(3,5)
12,5
(1,7)
71,1
(4,0)
83,9
(2,2)
3,1
(1,2)
3,6
(1,3)
20,5 75,2
(2,2) (2,1)
13,5 84,4
(1,9) (1,1)
Hc vn ca cha
74,1
11,8
18,0 78,9
(1,6)
(1,3)
(2,6) (3,1)
75,3
14,4
17,1 78,6
(3,6)
(3,0)
(1,6) (1,3)
68,9
24,3
20,8 75,0
(5,3)
(6,6)
(3,2) (5,9)
Hc vn ca m
76,4
10,2
18,1 79,0
(1,2)
(1,9)
(2,3) (2,7)
69,8
19,8
15,9 76,8
(3,2)
(2,6)
(3,6) (5,5)
74,0
20,0
14,3 71,4
(5,2)
(5,6) (13,3) (14,1)
Kinh t gia nh
77,6
5,9
19,4 78,4
(3,6)
(3,4)
(2,9) (3,2)
73,9
11,6
14,2 81,0
(3,8)
(3,4)
(1,4) (1,6)
73,5
18,8
23,4 70,2
(2,5)
(2,0)
(7,8) (7,4)
74,1
14,0
17,9 78,
(1,9)
(2,4)
(2,2) 8(2,5)
4,2
(1,0)
2,0
(1,4)
14,3
(2,2)
4,3
(2,4)
Gii tnh
19,1
(3,0)
9,9
(2,2)
Dn tc
-
3,1
(1,2)
4,3
(1,6)
4,2
(4,4)
2,8
(1,1)
7,3
(3,7)
14,3
(13,3)
2,3
(0,7)
4,9
(1,7)
6,4
(2,5)
3,4
(1,0)
khu vc thnh th, t l thiu cn, trng

lngbnhthngvnguycthacnvtha
cncatrem1114tuil11,9%,74,1%,14,0%
tngngkhuvcnngthnl:17,9%,78,8%
v3,4%(bng4).
Bng5:Milinquanhiquytuyntnhcaphn
loiBMIvccyutnhnkhuhc,kinhtxhi
tremVitNamtrongtui1114.
Phn tch n bin Muphn tch a bin
Nh cn Nguy c Nh cn
Nguy c
tha cn
tha cn
c tnh
v tha
v tha
cn
cn
ORth P OR th P OR
P OR
P
ChuynYTCngCng
(95%
CI)
(95%CI
)
hiu
chnh
(95%CI)
hiu
chnh
(95%
CI)
Tui (nm) 0,93 0,34 0,77 0, 0,95 0,4 0,71 0,00
(0,80,
(0,70, 00 (0,84, 1 (0,62,
1,09)
0,85)
1,08)
0,82)
Gii
Nam
1,0
1,0
1,0
1,0
N
0,47 0,01 0,43 0, 0,48 0,0 0,47 0,00
(0,32,
(0,35, 00 (0,33, 1 (0,37,
0,70)
0,55)
0,70)
0,61)
Khu vc c tr
Thnh th 0,71 0,16 4,41 0, 0,77 0,1 1,65 0,32
(0,42,
(1,88, 01 (0,53, 5 (0,56,
1,18)
10,34)
1,12)
4,86)
Nng thn 1,0
1,0
1,0
1,0
Dn tc 0,90 0,63 0,14 0, 0,62 0,0 0,34 0,12
(0,56,
(0,03, 03 (0,37, 6 (0,08,
1,45)
0,73)
1,03)
1,44)
Tnh trng kinh t
Ngho
1,0
1,0
1,0
1,0
Trung bnh 0,82 0,50 2,99 0, 0,84 0,5 1,88 0,32
(0,44,
(0,75, 11 (0,47, 2 (0,48,
1,55)
11,93)
1,51)
7,32)
Giu
0,49 0,02 5,33 0, 0,50 0,0 2,70 0,03
(0,28,
(2,43, 01 (0,36, 1 (1,13,
0,83)
11,70)
0,69)
6,48)
Trnh hc vn ca cha
cp 2
1,0
1,0
1,0
1,0
0,73 0,31 1,42 0, 0,77 0,3 0,65 0,13
Cp 3
(0,38,
(0,91, 11 (0,40, 9 (0,36,
1,41)
2,20)
1,49)
1,18)
0,57 0,25 2,67 0, 0,89 0,8 0,89 0,77
Trung hc
(1,45, 01 (0,23,3, 6 (0,38,
tr ln (0,20,
1,61)
4,94)
50)
2,08)
Trnh hc vn ca m
cp 2
1,0
1,0
1,0
1,0
0,80(0 0,17 2,56(1, 0, 0,88(0,6 0,3 1,67(1 0,01
90, 00 5, 1,20) 8 ,23,
Cp 3
,57,
2,28)
3,44)
1,12)
0,45(0 0,18 1,56(1, 0, 0,52(0,1 0,3 0,51(0 0,18
Trung hc
56, 01 3, 2,01) 0 ,77,
,13,
tr ln
2,90)
4,21)
1,56)
Ngh nghip ca cha
Lm vic 1,0
1,0
1,0
1,0
nh nc
1,28(0 0,58 0,59(0, 0, 1,08(0,3 0,8 0,58(0 0,08
34, 06 6, 3,25) 7 ,31,
Kinh doanh ,48,
1,08)
1,03)
3,40)
1,63(0 0,26 0,12(0, 0, 1,06(0,3 0,9 0,23(0 0,01
04, 01 8, 2,97) 1 ,09,
Cng nhn ,64,
0,57)
0,36)
4,11)
1,20(0 0,35 0,22(0, 0, 0,85(0,4 0,5 0,30(0 0,04
08, 01 8, 1,49) 2 ,10,
Bn hng ,78,
0,90)
0,60)
1,84)
ChuynYTCngCng
NghincuYhc
0,85(0 0,78 0,87(0, 0, 0,90(0,2 0,8 0,77(0

25, 80 4, 3,39) 6 ,26,
,23,
2,32)
3,00)
3,16)
1,22(0 0,59 0,61(0, 0, 1,09(0,4 0,8 0,74(0
35, 09 3, 2,78) 3 ,32,
Nng dn ,53,
1,70)
1,09)
2,80)
1,63(1 0,04 0,11(0, 0, 1,41(0,7 0,2 0,16(0
01, 09 2, 2,78) 7 ,01,
T lm ch ,02,
2,48)
1,57)
2,59)
Ngh nghip ca m
Lm vic 1,0
1,0
1,0
1,0
nh nc
1,65(0 0,21 0,55(0, 0, 1,10(0,3 0,8 0,74(0
23, 16 2,3,74) 6 ,25,
Kinh doanh ,70,
2,18)
1,34)
3,88)
2,39(0 0,07 0,08(0, 0, 1,07(0,3 0,9 0,37(0
02, 01 4, 3,39) 0 ,07,
Cng nhn ,90,
2,10)
0,31)
6,36)
2,42(0 0,08 0,30(0, 0, 1,47(0,4 0,5 1,14(0
08, 06 1, 5,33) 1 ,29,
Bn hng ,85,
4,54)
1,09)
6,89)
1,08(0 0,93 1,01(0, 0, 0,95(0,0 0,9 0,80(0
Lm nng
32, 99 9, 9,91) 6 ,10,
,16,
c lng
6,33)
3,15)
7,34)
1,82(0 0,28 0,74(0, 0, 1,27(0,2 0,7 1,04(0
33,1,66 41 6, 6,20) 4 ,36,
Nng dn ,56,
3,03)
)
5,88)
1,26(0 0,10 0,66(0, 0, 1,61(0,3 0,5 0,77(0
32,1,35 22 4, 7,55) 0 ,31,
T lm ch ,82,
1,95)
)
6,25)
Hot ng th cht
Ti thiu 0,92 0,02 0,99 0, 0,94(0,9 0,0 1,01(0
(gi/ tun) (0,87,
(0,95, 71 0, 0,99) 2 ,98,
1,04)
0,98)
1,04)
Lm nng
c lng
0,60
0,43
0,16
0,54
0,22
0,83
0,81
0,93
0,53
0,54
0,99 0,83 1,06 0, 0,97 0,5 1,06 0,07

Va v
mnh m (0,90,
(1,00, 06 (0,86, 6 (1,00,
(gi/ tun) 1,09)
1,35)
1,09)
1,04)
iu chnh theo cc bin s c lit k;

phn loi BMI: Thiu cn, cn nng bnh
thng,andnguycthacnvthacn.
Phntchnbin
Thiucn
Gii tnh, tnh trng kinh t gia nh, ngh
nghipcachavhotngthchtlccyu
txhiquytnhtitnhtrngthiucntr
em. Cc tr em gi t c kh nng b thiu cn
hncctremtrail53%(OR=0,47;KTC95%:
0,320,70)(Bng8).Tremcchathtnghipth
ctlthiucncaohncctremcchalm
quan chc nh nc (OR=1,63; KTC 95%: 1,02
2,59).Tremchotngthchttithiumi
517
NghincuYhc
tunth8%tckhnngbthiucn(OR=0,92;
KTC95%:0,87,0,98).
Phntchabin
Thiucn
Cctremgi(ORth=0,48;KTC95%:0,33
0,70)tckhnngbthiucnhncctrem
trai l 55% (Bng 8). Tr em sng trong cc h
gianhgiuth50%tckhnngbthiucn
(OR iu chnh =0,50; KTC 95%: 0,360,69). Tr
emchotngthchttithiumitunth
8% t c kh nng b thiu cn (OR=0,92; KTC
95%:0,90,0,99).Tuynhin,tui,khuvcctr,
nhmdntcthiusKhmer,hcvncacha
mvnghnghipcachamchatmthyc
milinquancnghathngkvitnhtrng
thiucntrem.
Nguycthacnvthacn
Nhngtremlnthm1tuithkhnng
bnguycthacnvthacngim29%(OR
hiu chnh=0,71,KTC 95%: 0,620,82) (Bng 8).
Cctremgithcnguycthacnvtha
cn t hn cc tr em trai 53% (OR hiu chnh=
0,47; KTC 95%: 0,370,61). Tr em trong cc h
gianhgiuckhnngthacnvthacn
gp 3 ln cc tr em trong h gia nh ngho
(ORhiuchnh=2,70;KTC95%:1,136,48).
Nhng tr em c m c hc vn cao th c
nguy c tha cn v tha cn 1,67 (adjusted
OR=1,67;KTC95%:1,23,2,28)sovicctrem
cmhctiuhchoctrunghc.
Nhngtremcchalmcngnhnthtc
khnngbnguycthacnvthacnhn
nhngtremcchalmquanchcnhncl
77%(OR=0,23,KTC95%:0,090,57).
Khu vc c tr, nhm dn tc thiu s
Khmer,tnhtrngkinhtgianh,hcvnca
cha,nghnghipcacham,hotngthcht
lnhngyutchatmthymilinquanc
nghathngkvinguycthacnvtha
cncatrem(bng5).
518
Bnlun
Tlthiucntrem1114tuirtcao
khu vc nng thn v vn cn ng k trong
khu vc thnh th. T l nguy c tha cn v
thacncaotrongchaikhuvcthnhthv
nngthn,cbitlivicctremtrai.C
haiyutthiucnvnguycthacnvtha
cntremuchothyvnytcngcng
ti Vit Nam, ging nh cc nc ang trong
thikqutrnthgii.
T l tr em thiu cn tui 1114 vn
cn cao cc vng nng thn cng nh trong
khuvcthcthcgiithchmtphn
doccchngtrnhdinhdngqucgiacha
ch trng cc vn dinh dng trong tng
nhmtui.
Mi lin quan gia tnh trng kinh t gia
nhvdinhdngcatremcnghin
cu trn nhiu quc gia v kt qu cho thy
rng,phttrinkinhtxhicithinchs
BMIcatrem.Nghincuca chng ti cho
thycmilinquanquantrnggiatnhtrng
dinhdngvtnhtrngkinhtgianh.Vic
giatngnguycthacnvthacntrongs
nhngtremsngtikhuvcthcthl
mtphnngvicctnhcacucsng,kh
nngcungcpthcphm,khnngtipcnv
khnnggimtiuth.
Kt qu t vic phn tch s liu tng hp
cho thy bn yu t c th d on trc tnh
trngthiucn,baogm:giitnh,tuitc,tnh
trng kinh t gia nh v hot ng th cht.
Nu l n, cng ln tui, gia nh giu c v
hotngthlcthngxuynthtcnguyc
bthiucn.
Ktqucngchothynmyutcthd
on trc nguy c tha cn v tha cn, bao
gm:giitnh,tui,tnhtrngkinhtgianh,
hcvncachamvnghnghipcacham.
Cc tr em gia nh ngho th c nguy c b
thiucncaohncctremsngtrongccgia
nh giu c. S khc bit ny c th do khu
phnnhngngykhcnhaucctremny.
Tremtrongccgianhgiustiuthnhiu
ChuynYTCngCng
thcphmdinhdng,dnntckhnng
b thiu cn v c nhiu nguy c tha cn v
thacn.
Nguycthiucnvthacncctrem
traithcaohncctremgi,chothymts
khcbitvgiitrongvicchiphnnglng.
Ldocharrangnhngiunycthgii
thchmtphndocctremtraitronggianh
ngho t c kh nng c cung cp thc
phmhndnnbthiucn.Ngoira,cth
h cn phi lao ng th lc nhiu hn, tham
gia vo cc cng vic ngoi tri phi tiu hao
nhiu nng lng hn. Cc tr em trai sng
trong cc gia nh giu c s c cung cp
lng thc y hn, nhng cc tr em trai
nylitvnngcthdnnnguyctha
cnvthacn.
NghincuYhc
Nghincunytinhnhdatrnvicly
muxcsutvicmulnthaiqunth.V
vy,nghincucngdatrntnhidinch
sBMItremtrongcckhuvcny.Ktqu
chothycskhcbitngktnhtrngdinh
dng ca tr em gia khu vc thnh th v
nngthn,cbitcanhngtremthiucn
vthacn.
TILIUTHAMKHO
1.
2.
3.
GillespieS,HaddadLJ,AllenL(2001).Attackingthedoubleburden
ofmalnutritioninAsiaandthePacific. International Food Policy
ResearchInstitute:Washington,D.C
MalinaRM,PeaRME,LittleBB(2008).Secularchangeinthe
growthstatusofurbanandruralschoolchildrenaged613years
inOaxaca,southernMexico.AnnHumBiol;35(5):47589.
Neovius M, Linn Y, Barkeling B, Rssner S (2004).
Discrepancies between classification systems of childhood
obesity.ObesRev;5:105114
ChuynYTCngCng
519
NghincuYhc
KINTHC,THIVTHCHNHVPHNGBNH
ITHONGCANGIDNT35TUITRLN
TIHABNHXUYNMCBRAVNGTUNM2011
HongThBchYn*,NguynNguyn**,ngVnChnh*
TMTT
tvn:Bnhmntnhkhnglyangtngnhanhtrongcithong(T).Ccyutlin
quannbnhkhnglytrongcbnhTllisng,thiquennung,vnng.
Mctiunghincu:Xcnhtlvkinthc,thi,thchnhvccyutclinquanvphng
bnhTtp2cangidnt35tuitrlntiHoBnhXuynMcBRVT.
Phngphp:Nghincuctngangmtdatrnphngvntrctip530ngi.
Ktqu:Tlngidnckinthc,thi,thchnhttvphngbnhTl21%,25%,16%.C
milinquangiakinthc,thivphngbnhvihcvn,giakinthc,thi,thchnhvingh
nghip,vgiathchnhvphngbnhvinhmtui,gii.
Ktlun:Tlngidnckinthc,thi,thchnhttvphngbnhTcnthp.Vthcnphi
tng cng cng tc truyn thng nhm nng cao kin thc cho ngi dn, ng thi y mnh thc hnh
phngbnhcbitxtnghimnghuytnhk.
Tkha:Kinthc;thi;thchnh;bnhtiungtup2.
ABSTRACT
KNOWLEDGE,ATTITUDE,ANDPRACTICERELATEDTOCONTROLLINGDIABETESMELLITUS
INHOABINHCOMMUNE,XUYENMOCDISTRICT,BARIAVUNGTAUPROVINCE,2011
HongThBchYen,NguyenDoNguyen,DangVanChinh
Background: Chronicnoncommunicablediseasesincludingdiabeteshavebeenincreasingquickly.Risky
factorsrelatedtononcommunicablediseasesarelifestyle,eatinghabits,andphysicalactivity.
Objectives: To determinetherateofknowledge,attitude,practiceofresidentsabove35yearsoldinHoa
BinhXuyenMocBRVTandfactorsrelatedtothepreventionoftype2diabetes.
Method: ThiswasacrosssectionalstudyoftheKAPofdiabetesproventionamong530residentsinHoa
Binhcommune.
Results:TheproportionsofpeoplewithgoodKAPofdiabetespreventionwerestilllow(21%,25%,16%,
respectively). There was a significant relationship between knowledge, attitude and educationl, between
knowledge,attitude,practiceandjobs,andbetweenpracticeandagegroup,sexinthisstudy.
Conclution: The proportions of people with good KAP of diabetes prevention were still low. Therefore,
communication needs to be enhanced to improve knowledge for people, and diabetes prevention practice,
especiallyperiodicmonitoringofbloodsugarlevels,shouldbereinforced.
VinVsinhYtcngcngthnhphHChMinh.
KhoaYtCngcngihcYdcTPHCM
520
T:0908414986
ChuynYTCngCng
NghincuYhc
Keywords:Knowledge;attitude;practice;type2diabetes.
TVN
Vonhngnmcuithk20vuthk
21, i tho ng (T) l mt trong nhng
bnhkhnglyphttrinnhanhnht.TheoT
chcYtThgii(WHO),nm2000c157,3
triungimcbnh,dbonm2025cons
nyl300triuchim5%dnsthgii(4).
Vit Nam khng xp vo 10 nc c t l
mc T cao nhng li l quc gia c tc
pht trin bnh nhanh(4). Trong 10 nm qua, s
bnhnhnTtng34lnkhuvcthnh
th. Khu vc nng thn trc y thng rt
himgpbnhTthnaybnhtrnnph
bin(4).
TnhBRaVngTu(BRVT),trongnhng
nmgny,cngvisphttrinvkinht
thtlbnhnhnTticccskhmcha
bnhangngymtgiatng.Theoktquiu
tra dch t T ti tnh BRVT nm 20042005,
ca Tiu Vn Linh, Trn Thanh Bnh, V Vit
Dng trn nhm i tng t 3064 tui. T l
T4%,tlrilondungnpglucose4,6%(5).
Mtkhcmtnghincuvonm2008ticc
thnh ph ln ca Vit Nam c khong 65%
trongsngibbnhTkhngbitmnh
b mc bnh, v rt nhiu trng hp khi pht
hin c, th bnh c nhng bin chng
nghimtrng(1).Quathyrngkinthcca
ngidnvbnhcnrthnch,vvicthiu
kin thc mang li nhiu thit hi nghim
trngvkinhtcngnhsckho.Nghincu
ny tin hnh nhm xc nh Kin thc, thi
,thchnhvbnhTcangidnHo
Bnh Xuyn Mc BRVT. c nhng bin
php can thip ph hp v gp phn ci thin
vnsckhochoaphng.
Mctiunghincu
Nghin cu ny nhm mc ch tm hiu
KAPcangidnaphngvphngbnh
T.Ccmctiucth:
Xc nh t l ngi dn c kin thc v
bnhTtp2.
ChuynYTCngCng
Xcnhtlngidncthivphng
bnhTtp2.
Xc nh t l ngi dn c thc hnh v
phngbnhTtp2.
Xcnhmilinquangiakinthc,thi
, thc hnh v phng bnh T tp 2 vi
gii,hcvn,nghnghip,tui,hnnhn.
Xc nh mi lin quan gia kin thc vi
thchnhphngbnhTtp2.
Xcnhmilinquangiathivithc
hnhphngbnhTtp2.
I TNG
NGHINCU
PHNG
PHP
Thitknghincu
Nghincuctngangmt.
Cmu:pdngcngthc
Cngthclymutrongnghincu
Z21/2p(1p)
N=k
d2
Vi:Z=1,96(tincy95%),d=0,05,=5
%. p=0,363trscmuncatlngidn
c kin thc ng v bnh T (tham kho
nghin cu iu tra dch t bnh T tnh
BRVT20042005TiuVnLinh,VVitDng,
TrnThanhBnh)
,
Hsthitkk=1,5N=530ngi
Chnmu theo phng php xc xut t l
vi kch thc dn s (PPS Probability
proportionate to size), chn 30 cm mi cm
phngvn18ngi.
KTQU
Bng1.KinthcvbnhT(n=530).
Kin thc
Tn s
T l (%)
Bit xt nghim ng huyt
355
67
Bit v yu t nguy c
139
26
Tha cn, bo ph
Li sng t vn ng
Tng huyt p
Ung nhiu ru bia
427
376
216
193
81
71
41
36
521
NghincuYhc
Kin thc
Tn s
T l (%)
Ngi trn 40 tui
179
34
Ht thuc l
121
23
Bit v du hiu ca bnh
65
12
Tiu nhiu
328
62
n nhiu
St cn nhanh
287
249
54
47
Ung nhiu
141
27
Bit v bin chng ca bnh

Bnh tim mch
Suy thn
64
300
252
12
57
48
Lot bn chn
249
47
M lo
175
33
Tai bin mch mu no
154
29
T vong
157
29
Bng3.ThivphngbnhT(n=530).
Thi
Khostkinthc:Bitcchphthinbnh
bng xt nghim ng huyt chim t l kh
cao67%,nhngbncnhshiubitvcc
yutbinchngcabnh,duhiucabnh
vccyutnguyccabnhctltngi
thpt1226%.Trongbinchngcbit
n nhiu nht l bnh tim mch chim 57%,
yutnguyccbitnnhiunhtltha
cnbophvi81%(Bng1).
Bng2.KinthcvphngbnhT(n=530).
Kin thc v phng bnh
Bit tng cng vn ng th lc
Bit xt nghim ng huyt nh k
Tn s T l (%)
381
72
330
62
Bit n nhiu rau
336
63
Bit hn ch ngt
Bit hn ch du m
Bit hn ch ung ru bia
Bit hn ch ht thuc l
296
229
209
172
56
43
39
32
Kim sot huyt p

Bit v phng bnh chung
136
112
26
21
Kin thc v tng cng vn ng th lc

chim t l cao nht 72%, t l c kin thc v
kim sot huyt p thp nht (26%). Kin thc
v hn ch n ngt, n nhiu rau xanh, xt
nghim ng huyt nh k tng i cao, t
chnh lch vi cc t l dao ng t 5662%.
Phn ln ngi dn khng c kin thc v
phng bnh, t l kin thc chung ch chim
(21%) ngi tham gia nghin cu c kin thc
chungvphngbnh.Quaktqunghincu
522
cho thy kin thc v phng bnh ca ngi

dntiiphngrtthp,nhnghiubitv
phng bnh cn cha y , hu ht ch bit
nviyutnguyc,tlbityvbin
phpphngbnhcnrtkhimtn(Bng2).
Tn s T l (%)
ng bnh nguy him

ng kim tra ng huyt nh k
472
393
89
74
ng bnh c th phng nga
181
34
Thi v phng bnh chung
132
25
Trongccitngthamgianghincu,t
lcthitchccchimtlkhcao.Thi
cho rng bnh nguy him chim t l cao nht
89% tuy nhin t l khng c thi chung v
phngbnhchimasgp3lnnhmcthi
tchcc(25%)(Bng3).
Bng4.ThchnhvphngbnhT(n=530).
Thc hnh
Tn s
T l (%)
Hn ch n ngt
355
67
Tng cng vn ng th lc
324
61
Khng ht thuc l
Tng cng s dng rau xanh
301
289
57
55
Hn ch s dng ru bia
287
54
Hn ch s dng du, m
277
52
Kim sot huyt p
157
30
Kim tra ng huyt 1-2 ln/nm
57
11
Thc hnh chung v phng bnh
86
16
Trongsccitngthamgianghincu,
t l ngi dn c thc hnh chung v phng
bnhTchimtlthpchchim16%bhn
5,7 ln so vi nhm khng c thc hnh v
phngbnh.Trongtlthchnhtngi
ttnhngphnhnchnngt,hnchdu
m, tng cng vn ng th lc, tuy nhin
nhngbinphpphngbnhclinquann
mt thit n y t th t l thc hnh ng rt
thp thc hnh xt nghim ng huyt nh
k(11%),thchnhkimsothuytpl30%
(Bng4).
Bng5.Milinquangiakinthcvithchnh
vphngbnhT(n=530).
Kin thc
kim tra
Thc hnh kim tra

ng huyt
PR
ChuynYTCngCng
ng
huyt nh
k
C (%)
Khng (%)
12
ln/nm
(KTC
95%)
0 ln/nm
51 (15)
279 (85)
<0,001
6 (3)
194 (97)
Kin thc Thc hnh hn ch thc
n ngt
hn ch
p
thc n ngt
C
Khng
C %)
Khng (%)
Kin thc
kim sot
huyt p
C (%)
Khng (%)
Kin thc
chung
C (%)
Khng (%)
213 (72)
83 (28)
142 (61)
92 (39)
Thc hnh kim sot
huyt p
C
Khng
55 (40)
81 (60)
102 (26)
292 (74)
Thc hnh chung
C
Khng
29 (26)
57 (14)
83 (74)
361 (86)
5,2
(2,3-11,8)
PR
(KTC
95%)
0,006
1,2
(1,04-1,3)
PR
(KTC
95%)
0,001
1,7
(1,2-2,0)
p
0,001
PR
(KTC
95%)
1,9
(1,3-2,8)
Milinquangiathchnhvikinthc
vxtnghimnghuytnhkcngha
thngk,nhmckinthcctlthchnh
v s ln xt nghim trong nm bng 5,2 ln
nhmkhngckinthc,(p<0,001)(Bng5).
vhnchnngtcnghathngk,nhmc
kinthcctlthchnhvhnchthcn
ngtbng1,2lnnhmkhngckinthc,(p=
0,006)(Bng5).
v kim sot huyt p c ngha thng k,
nhm c kin thc c t l thc hnh ng v
kim sot huyt p bng 1,7 ln nhng ngi
khngckinthc,(p=0,001)(Bng5).
Mi lin quan gia thc hnh chung vi
kin thc chung v phng bnh c ngha
thngk,nhngngickinthcchungct
l thc hnh chung bng 1,9 ln nhng ngi
khngckinthcchung,(p=0,001)(Bng5).
BNLUN
Kinthc
Tlngidnckinthcchungvphng
bnhrtthp(21%),tlnythphnnhiuso
vinghincuti4TPlnHNi,Hu,TP.H
ChMinh,HiPhng(36%)(4),xtnghimng
ChuynYTCngCng
NghincuYhc
huytnhklyutquantrngphthin
smbnh62%chorngnnxtnghimng
huyt12ln/nm.Kinthcvhnchnngt
khcao(56%),tlnytngitchnhlch
so vi kt qu nghin cu ca T Vn Bnh v
cngsnm2001(4).Vyktqunghincuny
ph hp vi thc trng bnh T ang c xu
hng ph bin trong cng ng, dn n s
lngngichiubitvbnhcaovbnh
thu ht nhiu s quan tm t pha ngi dn.
Ch 26% ngi cho rng, kim sot huyt p
gipphngbnhT.ylvnrtquan
trng,vnhhngnhiubitcangidn
v c hai cn bnh hin ang ph bin trong
cngng.Khichivccbinchngca
bnh, ngi dn tr li khng r lm hoc
khngbitvkinthcchyultsch,bo,
rthimtrnghpccungcpthngtint
NVYT.Tlbitvbinchngcabnhchim
12%.Kinthcvbinchngcabnhcnrt
thp,chothyngidnchabitcmc
nguy him ca bnh, cha tht s thy c
tm quan trng ca vic phng bnh. T
chacthctttrongvicphngtrnhbnh.
Thchnh
Kim tra ng huyt nh k l vic lm
tht s quan trng v cn thit, n gip pht
hinsmbnh,titkimtinbc,titkimthi
gian,khnngchabnhcaovtgytnph
ngvi phng chm phng bnh hn cha
bnh(4).Tuynhintlthchnhngvkim
tranghuytnhkl11%cons ny rt
khimtnsovitlthivkinthctng
ng,iunychothyrngtuyckinthcv
thittnhngtlthchnhngvncha
cao. V khng ch trng n vic xt nghim
ng huyt nn khong 65% ngi dn Vit
Nam khi mc bnh T m hon ton
khng bit g, n khi bnh c nhng bin
chng nguy him mi tm n dch v y t
nhng lc th qu mun. iu ny cho
thy cha c s ch ng phng bnh trong
cngng.Cthvhchathycmc
nguyhimcabnhchnghntrongvic
523
NghincuYhc
phngnga,cbitlxtnghimnghuyt
nh k. Kim sot huyt p l mt vic lm
quantrngkhngchgipphngbnhTv
phngcnhiubinchng nguy him khc
ca bnh THA. Thc hnh kim sot huyt p
trong cng ng l 30%, phn nh thc trng
cha c s quan tm ng mc n sc kho
trongcngng,vicohuytprtngin
v ngi dn c th t thc hin c. Ngy
nayvimyohuytpinttoiukin
rt tt cho ngi dn t kim tra huyt p ti
nh.Cngtcytcncsquantmhnna
nvickimsothuytpcangidn,nn
khuyn khch vic o huyt p ti nh trong
cng tc truyn thng gio dc sc kho, vic
lmsmanglischnghntrongvic
nngcaotlthchnhtttrongcngng.
Mi lin quan kin thc v phng bnh

vithchnhvphngbnh.
Quanghincuchothy,cmilinquan
gia c kin thc v xt nghim ng huyt
nhkvthchnhxtnghimnghuyt
nh k (bng 5), nh vy c kin thc nh
hngttnthchnh,kimtranghuyt
nh k l vic lm rt quan trng trong vic
kim sot cng nh pht hin sm bnh. Hu
htccnghincuthchintiVitNamct
l kin thc v hn ch n ngt kh cao(4),(5), v
theo kt qu nghin cu th c mi lin quan
gia nhm c kin thc vi thc hnh v hn
chnngt,tnhiungmngtrongcng
tc phng bnh T. C mi lin quan gia
kin thc kim sot huyt p vi thc hnh
kim sot huyt p, nhm c kin thc c t l
thchnhbng1,7lnnhmkhngckinthc
(bng 7), vic kim sot huyt p cng rt cn
thittrongvicphngbnhT,nnphttrin
nhiu chng trnh lng ghp gia vic truyn
thng v bnh T v THA, v c bit l
nhngitngmcbnhTHA,cntchc
cc bui ni chuyn chuyn v t vn v
bnhTchonhngbnhnhnnkhmti
bnhvinhoc trung tm y t v nguy c mc
bnh ca ngi bnh, nhm nng cao s cnh
524
gic, phng bnh nhm i tng nguy c

ny. C mi lin quan gia kin thc phng
bnh chung vi thc hnh phng bnh chung,
nhm c kin thc phng bnh chung c t l
thchnhphngbnhbng1,9lnnhmkhng
ckinthcchung(bng8).Mcdkhngphi
ttccctrnghpkhickinthcthcthc
hnhphngbnh,nhngtktqunghincu
tathycvicckinthcchothycs
khc bit kh r rng v thc hnh ca ngi
dn. Qua cho thy vic cung cp kin thc
cho ngi dn thc s cn thit nng cao
nhnthccngnhthchnhngtrongcng
ng.
KTLUN
Nghincumt,itngl530ngiti
HoBnhXuynMcBRVT.
Nhn chung t l ngi dn c kin thc,
thivthchnhvphngbnhlrtthp
lnltl21%,25%,16%.
Cmilinquangiakinthc,thiv
phng bnh vi hc vn, hc vn cao c t l
kinthctt,thitchcccaohnnhmhc
vnthp.
C mi lin quan gia kin thc, thi ,
thc hnh v phng bnh vi ngh nghip.
NhmCNVCctlkinthc,cthivic
thc hnh v phng bnh cao hn nhm cng
nhn.
Cmilinquangiathchnhvphng
bnh vi nhm tui, Nhm 45 c t l thc
hnhcaohnnhmtui<45.
C mi lin quan gia thc hnh ng vi
gii,nctlthchnhcaohnnam.
KINNGH
Quakhostnyxintrnhbymtskin
ngh:
Vbnhcxuhngtrhonnccchng
trnhcanthipcngcngcnmrnghnna
nhmitngch.
Trinkhaixtnghimnghuyttituyn
ytcsbngphngphpthnghuyt
ChuynYTCngCng
NghincuYhc
maomchngidnckhmnhkv
phthinsmbnhT.
khuyn khch ngi dn tham gia xt nghim

nghuytnhk.
Truynthng
TILIUTHAMKHO
Cngtctruynthngphicthchin
rngri,ngoiviccungcpkinthcvbnh
chonhngnginkhmtitrungtmytv
bnh vin, cn tng cng thm cc loi hnh
thng tin (c bi trn loa pht thanh, treo p
phch, pht t ri) ngi dn c nhiu c
hi nm bt thng tin v bnh hn. hin lc
chungcavicphngngatptrungvotuyn
truyn, gii thch ngi dn hiu r v cc
yutnguyc,thayithiquennung,sinh
hotthlcnhmloibccyutnguycgy
T c th thay i c. Nhn mnh tm
quan trng ca xt nghim ng huyt v
1.
2.
3.
4.
5.
Alister AMC et al(2001): Management of Hypertension in

Canada:arewiewofcurrentguidelines.CNAJ,Fed20,164.
AmosA,McCD,ZimmetP(1997)Thesisingglobatburdenof
diaberter,anditscomplications:estimatesandprojectiontothe
year2010.DiabeticMed11,pp.8589
Jardim PCBV., Gondim MRP., Monego ET., Moreira HG.,
Oliveira VPV., Souza WKSB., Scala LCN. (2007) High blood
pressureandsomeriskfactorsinaBraziliancapital.Arquivos
BrasileirosdeCardiologia,Brazil,88,(No.04).
TVnBnh(2003)Dchthcbnhithong,ccyu
tnguycvccvnlinquannqunlbnhitho
ngtikhuvcnithnh4thnhphln.NXBYhcH
Ni.
TiuVnLinh,TrnThanhBnh,VVitDng(2006)iutra
dchtbnhTtitnhBRaVngTu20042005.Yhc
Tp.HChMinh,phbn,tp4,s10.
ChuynYTCngCng
525
NghincuYhc
HNHVIPHNGCHNGSTXUTHUYTCANGIDN
XMHNHTRUNGCAILYTINGIANG
ngVnChnh*,NguynThBchNgc*,BiThKiuAnh*
TMTT
tvn:StxuthuytDengue(SXHD)vanglvnthiscanctavitlmccao.
Mc tiu nghin cu:XcnhccyutkinhtxhilinquannhnhviphngchngSXHca
ngidnxMHnhTrung,CaiLy,TinGiang.
itngvphngphpnghincu:Nghincuctngangkthpcphngphpnhlngv
nhtnhnhmmthnhviphngchngSXHcangidnxMHnhTrung,CaiLy,TinGiang.
Ktqunghincu:CcyutlmcntrhnhviphngchngSXHgm:ngidnnhgithptc
hicabnh,vicdtrnccnphbin,cngtcvsinhmitrngchatt,vaitrlnhocachnh
quyntrongcngtcphngchngSXHchakinquyt.Hn90%hgianhusdngtnhtmtbin
phpxuaditmuinhngccbinphpdphngxahnnhditbgyvvsinhmitrngchatt,dng
cchancchalngqungkhcao(60,3%).
Ktlun:Cnymnhcngtctuyntruynvmcnghimtrngcabnhchongidn,huyng
sthamgiangbcacngngtrongcngtcvsinhmitrng.
Tkha:Stxuthuyt,Tingiang,behavior,control,Aedesaegypty.
ABSTRACT
BEHAVIORINCONTROLLINGDENGUEHEMORRHAGICFEVEROFPEOPLEATHANHTRUNG
COMMUNE,CAILAYDISTRICT,TIENGIANGPROVINCE,2010.
NguyenThiBichNgoc*,BuiThiKieuAnh*,DangVanChinh*
Backgound:Denguefever(DF)/Denguehemorrhagicfever(DHF)isadiseasewithhighmorbilityand
mortality.
Objectives:TodeterminesocioeconomicfactorsrelatedtothebehaviorsofcontrollingDenguefeveramong
people.
Methods: A crosssectional study was conducted using both quantitative and qualitative methods to
describethebehaviorsofcontrollingDH/DHFamongpeopleatHanhTrungcommune,CaiLayDistrict,Tien
Giangprovincein2010.
Results:ThisstudyfoundthatpeopleunderestimatedtheharmfuleffectsofDF/DHF;thehouseholdshad
manywatercontainers;thesanitationwasinsufficient;mostofwatercontainershadAedeslarvae(60.3%);the
communegovernmentleadersneedtoparticipatemoreactivelyincontrollingDF/DHF.
Conclusions:EducationshouldbefocusedontheseverityofDF/DHFandtheparticipationofcommunities
insanitationandcontrollinglarva.
VinVsinhytcngcngthnhphHChMinh.
526
T:0908414986
ChuynYTCngCng
NghincuYhc
Keywords:DF/DHF,TienGiang,behavior,control,Aedesaegypty.
TVN
Theo c tnh T chc y t th gii c
khong 50 triu trng hp nhim st
Dengue/stxuthuytDengueminm (2).Vit
NamlnicdchSXHluhnhviscamc
hng nm rt cao nm 2009, tng s ca st
Dengue/st xut huyt Dengue l 105.370
(122/100.000),trongc87catvongchimt
l0,1%(1).
Trongnhngnmqua,huynCaiLylun
nm trong s cc huyn c s ca mc SXH cao
tontnhvcchiuhnggiatng,tngt627
canm2006ti1162canm2008.Trong,x
M Hnh Trung thuc huyn Cai Ly c s ca
mc cao ng th ba ton huyn. M Hnh
Trunglmtxnngnghip,cnhiuimc
trngcavngnngthnngbngsngBn
cnhcchgianhtiytccungcp
nc sch v c thi quen tr nc trong ma
ma.Vvy,victinhnhnghincuhnhvi
phngchngxuthuytvccyutlinquan
ca ngi dn x M Hnh Trung, Cai Ly,
TinGianglcnthitvgpphnquantrng
choviccithinhotngchngtrnhphng
chngSXHchoaphngcngnhcccng
ngtngtcctnhphaNam.
Mctiutngqut
Xcnhccyutkinhtxhilinquan
nhnhviphngchngSXHcangidnx
M Hnh Trung, huyn Cai Ly, tnh Tin
Giang.
Mctiucth
Xcnhtlngidnthchincchnh
viphngchngSXH(dndpxungquanhnh,
s dng bin php xua dit mui, y np v
scrathngxuyndngcchanc).
Xcnhmiquanhgiaccyutkinht
x hi (kinh t h gia nh, trnh hc vn,
ngh nghip, h gia nh c tr < 15 tui) lin
quanvihnhvidndpxungquanhnhvs
dngbinphpxuaditmuicangidn.
ChuynYTCngCng
Xcnhmiquanhgiaccyutkinht
x hi lin quan vi s dng c cha nc c
lngqung.
M t l do lm cn tr hnh vi phng
chngSXH.
I TNG
NGHINCU
PHNG
PHP
Nghin cu ct ngang kt hp c phng

phpnhlngvnhtnhnhmmthnh
viphngchngSXHcangidnvxcnh
ccyutthcyhoccntrhnhviny.C
muctnhtheophngphpchnmucm
l282.Quanstvphngvnchhhoci
din ch h. ng thi tin hnh 02 cuc tho
lun nhm trn 02 nhm i tng l cn b
lmcngtclinquannphngchngSXHv
itngidinhgianh.
KTQU
Bng1:cimcadns(n=282).
c im
Tui
20-40
41-60
> 60
Gii tnh
Nam
N
Ngh nghip
Nng dn
Kinh doanh
Khc
Trnh hc vn
cp 1
Cp 2
cp 3
Kinh t h gia nh
Thu nhp thp
Thu nhp trung bnh
Thu nhp giu
H c tr < 15 tui
C
Khng
103
128
51
36,5
45,4
18,1
99
183
35,1
64,9
191
17
74
67,7
6,0
26,3
144
86
52
51,1
30,5
18,4
103
98
81
36,5
34,8
28,7
140
142
49,6
50,4
N gii chim t l cao gn gp i so vi

namgii(65%sovi35%);tuitptrungla
tui 4160 tui. Nng dn chim hai phn ba
527
NghincuYhc
tngccngnhngh.Bncnh,phnnai
tng c phng vn m ch hoc trnh
cp1.Khong70%hgianhthuchcthu
nhpthpvtrungbnh.Tlhgianhcv
khng c tr di 15 tui tng ng nhau
(Bng1).
Bng2:Ngunnchgianhangsdng
(n=282).
Ngunnc
Ncmy
230
81,6
Ncgingo
3,2
Ncgingkhoan
56
19,9
Ncsng
2,1
Ncma
135
47,9
Bn phn nm ngi dn dng h thng

nc my. Tuy nhin, gn mt na h vn s
dng nc ma cho mc ch sinh hot v n
ung(Bng2).
Bng3:Kinthcvphngchngstxuthuyt.
Ni dung
Bit v bnh SXH (n=282)
Khng
C
Nh vo u (n=250)
C ngi n nh vn ng
Hp dn ti p, x
Ti liu truyn thng
Xe c ng trong chin dch
i, loa pht thanh, tivi
Khc (bnh vin)
Bnh SXH c th cha khi(n=250)
Khng
C
Khng bit
Bnh SXH gy t vong
Khng
C
Khng bit
i tng b bnh SXH
Tr em
Ngi ln
C hai
Khng bit
Thit hi ca SXH
Mt ngi thn
Hao tn tin ca
528
32
250
11,4
88,6
148
19
36
2
177
16
59,2
7,6
14,4
0,8
70,8
6,4
28
200
22
11,2
80,0
8,8
16
230
4
6,4
92,0
1,6
111
3
133
3
44,4
1,2
53,2
1,2
64
189
25,6
75,6
Ni dung
Mt ngy cng lao ng
Khc
N
51
28
%
20,4
11,2
Bng 3 cho thy hu ht ngi dn u c

kin thc v bnh st xut huyt (89%), nhng
kin thc m h c c ch yu t ngun
thngtinbo,i,tivivtnhnvinytn
nh tuyn truyn vn ng (70% v 59%).
Khong phn na ngi dn cho rng bnh
SXHcthxyrangilnvtrem.
Bng4:nhgicangidntrongcngtc
phngchngstxuthuyt.
Ni dung
Trch nhim chnh phng chng SXH
Chnh quyn
Gia nh
Khng bit
nh gi cng tc phng chng SXH
Ca chnh quyn
Rt tt
Tt
Trung bnh
Km
Rt km
Khng bit
Ca gia nh
Rt tt
Tt
Trung bnh
Km
16
225
11
5,7
90,4
3,9
13
177
79
10
1
2
4,6
62,8
28,0
3,6
0,4
0,7
12
165
101
3
4,3
58,5
35,8
1,1
Rt km
Khng bit
Tng cng
1
282
0,3
100
Theoquanimngidn,cngtcphng
chng st xut huyt chnh yu phi da vo
bn thn cc h gia nh (90,4%). Bn cnh ,
hn 50% ngi dn nh gi chnh quyn v
bnthnhgianhuthchinttchng
trnh phng chng st xut huyt (62,8% v
58,5%)(Bng4).
Cchnhviphngchngstxuthuyt
Bng5:Hnhvidndpxungquanhnh.
Mi trng
Sch
Trung bnh
Km
n
89
108
85
%
31,6
38,3
30,1
ChuynYTCngCng
Tng cng
282
100
*:DngkimnhFisher.
Bng 5 m t t l hnh vi dn dp xung

quanh nh h gia nh. Trong , hai phn ba
mi trng xung quanh nh cc h gia nh
cnhgimckmvtrungbnh.
Bng6:Mtdngcchanc(n=282).
c tnh
DCCN
T l DCCN c lng qung (n,%)
DCCN c lng qung
y np DCCN
Khng y np DCCN
Sc ra khng thng xuyn
M (SD)*
7,6(5,9)
170 (60,3)
1,3(1,6)
3,8 (2,8)
2,1 (1,1)
2,3 (2,3)
*M:trungbnh,SD:lchchun
Bng 6 m t v dng c cha nc trong
cchgianh.Trungbnhmigianhc7,6
dng c cha nc v t l cc h gia nh c
dng c cha nc cha lng qung kh cao
(60,3%).
Trung bnh mi h gia nh c khong 4
dngcchanccynpkn,khong2
dngcchanckhngynp.Trongscc
dng c cha nc khng y np th trung
bnh 2 dng c cha nc/h gia nh khng
scrathngxuyn.
Bng7:Milinquangiayutkinhtxhivi
hnhvisdngbinphpditmui.
c tnh
Hc vn
cp 1
Cp 2
Cp 3
Kinh t h gia nh
Thp
Trung bnh
Cao
Ngh nghip
Nng dn
Kinh doanh
Khc
H gia nh c tr
<15 tui
C
Khng
S dng bin php xua

dit mui
C
Khng
n (%)
n (%)
p
0,5*
133 (92,4)
82 (95,4)
50 (96,1)
11 (7,6)
4 (4,6)
2 (3,9)
0,029*
93 (90,3)
97 (98,9)
75 (92,6)
10 (9,7)
1 (1,1)
6 (7,4)
0,678*
181 (94,8)
16 (94,1)
68 (91,9)
10 (5,2)
1 (5,9)
6 (8,1)
0,435*
130 (92,9)
135 (95,1)
10 (7,1)
7 (4,9)
ChuynYTCngCng
NghincuYhc
Bng7thhinmilinquangiaccyu
tkinhtxhivihnhvisdngbinphp
xua dit mui. Hn 90% h gia nh u s
dngtnhtmtbinphpxuaditmui.Tl
hgianhckinhtthpkhngsdngbt
kbinphpxuaditmuicaonhtso vi h
c kinh t trung bnh v cao ln lt vi t l
9,7%, 1,1%, 7,4%. C mi lin quan c ngha
thng k gia kinh t h gia nh vi vic s
dngccbinphpditmuivip=0,029.
Khng c mi lin quan gia trnh hc
vn,nghnghipvhgianhctrnhhn
15tuivibinphpxuaditmui.
Mtnidung02cuctholunnhmv
nidungldolmcntrhnhviphng
chngSXH
Mthotngphngchngstxuthuyt
angdinratiaphng
Chng trnh phng chng SXH x M
Hnh Trung trin khai nhiu nm bao gm
cchotngnhtchcchindchditlng
qung, mng li cng tc vin, phng chng
SXHtrongtrnghc,xldchnh(ODN).
Tuy nhin s ca mc SXH x kh cao. Trong
ccnm2007,2008,2009bnhqunminmx
c50ca,ringtunmncuithng9nm
2010l9ca.
Trongcng tc phng chng SXH, ngnh y
tgivaitrcho.Ngnhgiodcthamgia
rttchccvhiuqu.Chibpcngthng
xuynthchincngtctuyntruyn.Ngoira
hiphnlbphntrctipthchincng
tcphngchngSXH.Minmhiphnu
ln k hoch hp t nhm tuyn truyn, vn
ng phng chng SXH. on thanh nin, hi
nngdncnhnch,chthamgiakhicpht
ngphongtro.
NhngthithidoSXH
Ngi dn nh gi thp tc hi ca bnh
stxuthuyt,chyuchlthithivkinht,
mt cng n vic lm ca gia nh. Hu ht
ngi dn c phng vn cho rng SXH kh
529
NghincuYhc
t vong nu c nhp vin kp thi. Trung

bnhmttnhpviniutrSXHtnkhong
1.000.000ng.ivitrdi6tuistintr
bnhsthphndocchbohim.
HnhviphngchngSXH
Cc h gia nh ch c th v sinh xung
quanh nh, vn tc nhng ni cng cng
khngcngithchin.Thmchmthgia
nh v sinh trong v xung quanh nh rt tt
nhngvncnguycmcbnhSXHdohng
xmkhngthchin.Hotngchnnuica
ngidnthngradincxungmng,
rnhdnnvicngnc.Vicscradng
cchanctronggianhcnggpkhkhn
do lu h cha nc thng nng, v vic sc
ra ch yu l do ph n thc hin; sc ra
thngxuynddnnhhng.ylccl
docthgiithchtisao,dngcchanc
chalngqung.
nhgicngtc phng chng SXH ca gia
nhvchnhquyn
Phng chng SXH, trch nhim l ca c
chnh quyn v ngi dn v ngi dn chu
trchnhimchnh.Mcd,chindchditlng
qungc thc hin vi s tham gia tch cc
tphachnhquynvccbanngnhonth,
tuynhinsauchindchcchotngditlng
qungkhngcduytr.
Nhng xut cho hot ng phng chng
SXH
Chnh quyn ch o cc ban ngnh on
ththamgiatchccthcngtcphngchng
SXH s thnh cng. Cc hot ng c th bao
gm xc nh a bn, phn cng cn b hay
ngvinphtrchphihpvicngtcvin,
t nhn dn t qun; cc hot ng ny phi
c duy tr thng sau mi c chin dch.
Cnbcngnhnvinchcslnhngngi
i u. Khen thng trong cng tc phng
chngSXHphincchoccp.
Ngh nh 45/2005/NCP p dng hnh
thcphttinrtkhthchinaphng.
530
BNLUN
Theoktqunghincu,huhtcchdn
u bit v bnh SXH 88,6%, trong 70,8%
ngi c phng vn bit thng tin v SXH
quaccknhtruynthngnhbo,ihocti
vi.Tlnycaohnsoviccnghincunh
nghincungThptlngidnbitst
xuthuytquaknhtruynthngl58,8%.Hu
ht ngi dn tip cn thng tin qua cc knh
truynthngdonhgihiuqucngtc
truyn thng thng qua kh nng tip thu ca
ngi dn qua cc knh truyn thng l cn
thit.Mtkhc,cngtcvnggiacncch
trngvkhong60%ngidnnhnkinthc
stxuthuyttcngtcvin.Hinnay,mng
licngtcvinchabaophhtccxtrong
huynvmtscngtcvinhatngcha
thtshiuqu.
Milinquangiahnhvis dng bin

phpxuaditmuivccyutxhi
Khng ghi nhn s khc bit gia hc vn
vsdngccbinphpxuaditmuicch
gianh.Giacchgianhcskhcnhau
vhcvnthschnhlchvtlsdngcc
binphpxuaditmuikhngngk,do
khngghinhnskhcbitcnghathngk
trongtrnghpny.
C s khc bit c ngha thng k gia
kinh t h gia nh v vic s dng cc bin
phpxuaditmuicchgianh(p=0,029).
Nhng h gia nh c kinh t trung bnh hoc
giu d dng tip cn cc bin php xua dit
muihncchgianhngho.
M t l do lm cn tr hnh vi phng
chngSXH
Th nht, ngi dn nh gi thp tc hi
cabnhstxuthuyt,bnhxuthuytkhng
philbnhnguyhimchtngi.Huhtcho
rngcccabnhSXHltrem,ngilnrtt
bnh SXH. Tr di 6 tui li c bo him nn
khnglothithivtinbc.
Thhai,vicdtrnccangidncn
ph bin, c bit vo ma ma. Vic d tr
ChuynYTCngCng
nc mt phn l do h thng cung cp nc
cha n nh, mt phn l gim chi ph s
dng nc. Dng c cha nc nhiu nhng
vic y kn np cha c thc hin trit .
Binphpthcvodng c cha nc c
thchinrthnch.Huhtngidnkhng
thcvodngcchanc,cbitlnc
ung.
Th ba, cng tc v sinh mi trng cha
c thc hin tt. Do c im vng nng
nghip,khngchthngthugomrcthinn
nhngvtphthithngctptrungbn
ngoi nh. Vo ma ma rt d xy ra ng
ncvlngunchalngqung.Nghincu
nhtnhchothycngtcvsinhmitrng
chacthchintritdocngtctuyn
truynchathtshiuqu,ngidnkhng
quantmtiningnc.
Th t, vai tr lnh o ca chnh quyn
trongcngtcphngchngSXHchatchcc
v thng xuyn. Nghin cu nh lng cho
thymtphnbangidnnhgicngtc
phng chng SXH ca chnh quyn l trung
bnh,kmvrtkm.Nghincunhtnhch
ra rng chin dch dit lng qung c thc
hin tch cc vi s tham gia tch cc t pha
chnh quyn v cc ban ngnh on th, tuy
nhinsauchindchtnhtrngditlngqung
khng c duy tr thng xuyn. Lnh o
chnhquynchanchotrctipcngtc
phng chng SXH trong cng ng. Vic x
pht theo Ngh nh 45/2005/NCP cha p
dng do vic x pht phc tp, ngi dn
nghovsmttnhlngnghaxm.
KTLUNVKHUYNNGH
NghincuYhc
dngcchanc,vsinhmitrngthp.a
s ngi dn c s dng cc bin php dit
muivxuaditmuicao,nhngccbinphp
dphngxahnnhditlngqungvvsinh
mi trng cha tt. Do vy, cn huy ng s
thamgiangbcacngngtrongcngtc
vsinhmitrng.
Theo kt qu nghin cu, ph n l ngi
sc ra lu thng xuyn v vy cn tp trung
hngdnknngscraluphhpvith
chtcaphn.Bncnh,chnhquyncn
gii quyt vn cung cp in cho nh my
ncnnhvnngcaonngsutcpncl
mtbinphphiuqutrongphngchngst
xuthuyt.
V mc bnh st xut huyt, ngi dn
chaxemstxuthuytlbnhnngcnquan
tm.Dovy,cnymnhgiodcvmc
trmtrngcabnhchongidn.
Theo nh gi ca ngi dn, lnh o
chnh quyn cha ch o trc tip cng tc
phngchngSXHtrongcngng.Cncvn
bn phn cng trch nhim c th cho tng
thnh vin ban ch o chng trnh, tng ban
ngnhonthmtcchrrng.Tronglnh
o chnh quyn chu trch nhim chnh trong
hotngphngchngSXH.
TILIUTHAMKHO
1.
2.
FernandezEA,LeontsiniE,ShermanC,ChanAST,ReyesCE,et
al (1998). Trial of a communitybased intervention to decrease
infestation of Aedes aegypti mosquitoes in cement washbasins in El
Progreso,Honduras.ActaTropic,;70(2):171183.
Leontsini E, Gril E, Kendall C, Clark GG(1993). Effect of a
communitybasedAedesaegypti control program on mosquito larval
production sites in El Progreso, Honduras. Transactions of the
RoyalSocietyofTropicalMedicineandHygiene,;87:267271.
Ngidnctlhiubitcaovstxut
huytnhngccthchnhvscra,ynp
ChuynYTCngCng
531
NghincuYhc
HIUQUMNGLICNGTCVINPHNGCHNG
STXUTHUYTNM2011
NguynThBchNgc*,HHuTnh*,ngVnChnh*
TMTT
tvn:HotnggimstphngchngSD/SXHDcaVinVsinhYtCngcngtimtstnh
givntnhhiuqutrongvickimsotcntrngtrongxcmnglicngtcvinvxkhngc
mnglicngtcvin.
Mctiu:Xcnhhiuquhotngphngchngstxuthuytgiaxcmnglicngtcvinso
vixkhngcmnglicngtcvin.
Phngphp:Thitknghincuctngang,phngvntrctipquabcuhivquanstccvtdng
chanc.
Ktqu:HuhtscamcxcCTVthphnxkhngcCTV.ChsBIxkhngcCTVcaohn
1,3lnsovixcCTV.86,4%itngphngvnxkhngcCTVbitvbnhSXH,tlnythphn
xcCTV(91,6%).CskhcbitcnghathngkvvicCTVtuyntruynditlngqungvnhgi
trchnhimPCSXHcachnhquyn.Tuynhin,khngcskhcbittrongvicdndpDCCNlinhtinhx
cCTVvxkhngcCTV.
Ktlun:HiuqucaCTVmanglimtsktqungkhchl;tuynhinkhnghngnh.duy
trhiuqucnphicnnhcncimtngaphng.Bncnh,cntngcngcngtctruyn
thngthayihnhvi.
Tkha:CTV,phngchngSXH.
ABSTRACT
EVALUATINGTHEEFFECTIVENESSOFVILLAGEHEALTHVOLUNTEERS(VHVs)ONDENGUE
HAEMORRHAGICFEVERPREVENTIONIN2011
NguyenThiBichNgoc*,HoHuuTinh*,DangVanChinh*
Background:AccordingtotheDF/DHFpreventionsurveillanceinsomeSouthernprovincescarriedbythe
Institute of Hygiene and Public Health (IHPH), it is suggested that Breteau Index (BI) of communes having
programeducators(PEs)andwithoutprogrameducatorswerenotconsiderablydifferent.
Objectives:ToevaluatetheeffectivenessofprogrameducatorsonDenguehaemorrhagicfeverprevention.
Method:Thiswasacrosssectionalsurveybasedondirectinterviewsandobservation.
Results:ThecommunesinwhichtherewerenotPEshadmoreDF/DHFcases.BIincommuneswithoutPE
was1.3timeshigherthanthatincommuneswithPE.TheprevalenceofintervieweesawareofDenguefeverin
communeswithPEswashigherthanthatincommuneswithoutPEs(91.6%vs86.4%).Therewasstatistically
significantdifferenceinVHVscommunicateforpeopletokilllaviarandevaluatetheresponsibilityofauthority.
Conclusion: VHVs network has brought some encouraging results but not constant.To maintain the
VinVsinhytcngcngthnhphHChMinh.
Tcgilinlc:CN.NguynThBchNgc
532
T:0946486422
Email:bichngoc95@yahoo.com
ChuynYTCngCng
NghincuYhc
effectivenessofVHVsnetworkandtoreplicateittoothercommunes,localcharacteristicsshouldbeconsidered
andeducationshouldbereinforced.
Keywords:Villagehealthvolunteers,Denguehaemorrhagicfeverprevention
Hinnayhotngcamnglicngtcvin
TVN
cngchmitrinkhainhngxtrngim
St Dengue/ St xut huyt Dengue
vhiuquhotngvnchacnhgi
(SD/SXHD)lbnhtruynnhimdomuiAedes
y.
Aegyptyvlvnytcngcngtrnthgii.
Cc hot ng gim st phng chng
Hinnay,SXHlnguynnhnnhpvinvt
SD/SXHD ca Vin V sinh Y t Cng cng ti
vong hng u tr em nhiu nc ng
mtstnhgichsBreateau(BI)vngc
Nam.
cngtcvinvvngkhngcmnglicng
Ti Vit Nam, s ca mc v cht do
tcvinkhngcskhcbitng k. V vy
SD/SXHDgiatngktnm1994trliy.
vic nh gi hiu qu hot ng ca cng tc
Bnh dch SD/SXHD lu hnh a phng
vinnhmnngcaohiuquphngchngdch
rngrivtnsmcbnhhngnmrtln:
SXHlrtcnthit.
nmcsmcthpnhttrn50nghntrng
Mctiu
hp (1992), nm c s mc cao nht 354.517
M t hot ng phng chng st xut
trng hp (1987). Ring trong nm 2010 c
huyt x c mng li cng tc vin v x
128.831trnghpmcSD/SXHDtrongc
(7)
khng c mng li cng tc vin v cc hot
109catvong .
ngditlngqung,vthamgiaxldch
Chng trnh phng chng SD/SXHD bt
nh.
utrinkhaitiVitNamtnm1998.Nhng
hotngphngchngSD/SXHDctrin
khai nh dit mui trng thnh qua phun xt
hachtditmui,ditlngqungnhscra
ccvtdngchanc,thcvoccvtcha
nc,xabmitrngtoiukinchomui
sinh sn v pht trin nh hot ng v sinh
mi trng, loi b cc vt dng cha nc c
lng qung. Tt c cc hot ng ny u cn
nvaitrcaingcngtcvin(1).
Nhim v ca cc cng tc vin bao gm
trong4hotngchnh.Thnht,vnggiat
5060hgianhtrongabnqunltnht1
ln/thng tuyn truyn vn ng v phng
chng st xut huyt (PCSXH), kim tra vt
cha nc, theo di thng bo kp thi cc
trnghpnghingmcDengue.Thhai,phi
hp cng vi nh trng trong vic tuyn
truyn, kim tra lng qung. Th ba, tham d
y cc lp tp hun, chin dch dit lng
qung, xc minh ca bnh v x l dch nh
(ODN).Cuicnglthchinvicbocohot
ng hng thng v Trm Y t theo qui nh.
ChuynYTCngCng
Sosnhtlmc,chtSXHcaaphng
t1/2011n9/2011.
So snh ch s Breteau (BI), ch s nh c
lng qung (HI), ch s dng c cha nc c
lng qung (CI) gia x c cng tc vin v x
khngccngtcvin.
PHNGPHP
Thitk nghin cu ct ngang nhm m t
hiuquhotngphngchngstxuthuyt
camnglicngtcvin.Nghincuc
thc hin ti tnh Tin Giang, Cn Th, ng
ThpvBnhDng.Mitnhiutra2xc
CTV SXH v 2 x khng c CTV SXH vi k
thut ly mu cm. S liu c thu thp qua
phngvntrctip784chhvquanstcc
dngcchanc(DCCN).
533
NghincuYhc
KTQU
Mthotngditlngqungvx l
ODNxcmngliCTVvxkhng
cCTV
Cng tc x l ODN x c CTV v x
khngcCTVkhngcskhcbitngkv
tt c cc ODN xy ra trn a bn cc x u
cTrmyt(TYT)phihpviTrungtmy
t (TTYT) huyn, UBND x v cc ban ngnh
on th x l theo qui nh ca B Y t. Khi
ODNcghinhnvbocovaphng,
TYTstinhnhiutraxcminhcabnh.K
tip chnh quyn x huy ng cc Ban ngnh
onth(BNT)(hiphn,thanhnin)tham
giacchotngditlngqungvvsinhmi
trng.TTYThuynthamgiacngtcgimst
vphunhachtditmui.
Trongcctchindchditlngqung
c Trung tm y t phng (TTYTDP) tnh
trinkhaitrongnm2011.Ttcccxnghin
cuuthamgiathchinchindchvis
thamgiacaingCTV(nhngxcCTV),
s tham gia ca chnh quyn v cc BNT.
ccxkhngcingCTVsccngtcvin
t cc chng trnh Y t khc h tr thm cho
cngtcPCSXH.
Bng1:cimmunghincu.
c im
Khng CTV
n
%
C CTV
n
%
Tui
60
> 60
334
56
85,6
14,4
326
65
83,4
16,6
255
135
65,4
34,6
273
118
69,8
30,2
Gii tnh
N
Nam
Trnh hc vn
cp 1
Cp 2
cp 3
162
161
67
41,5
41,3
17,2
158
160
73
40,4
40,9
18,7
152
78
18
99
43
39,0
20,0
4,6
25,4
11,0
104
110
25
110
42
26,6
28,1
6,4
28,1
10,8
Ngh nghip
Nng dn
Kinh doanh
CBVC
Ni tr
Khc
534
Phnbtuitrongmunghincucc
xcCTVvkhngc CTV gn tng ng
nhau.Tlngiicaogngpisovinam
gii. T l ngi c phng vn c trnh
hc vn cp 1 cao gp i nhng ngi c
trnhhcvncp3.itngiutralm
nghnngxkhngcCTVcaohn1,5lnso
vixcCTV(39,0%sovi26,6%).
Bng2:Kinthcphngchngstxuthuyth
gianhxccngtcvinvxkhngccngtc
vin.
c im
Khng CTV
C CTV
n
%
n
%
Bit bnh SXH
Khng
53
13,6
33
8,4
C
337 86,4 358 91,6
Bit bnh SXH do mui t
Khng
10
3,0
14
3,9
C
327 97,0 344 96,1
Loi mui gy SXH
Mui vn
218 66,7 261 75,0
Mui khc
55
16,8
37
10,6
Khng bit
54
16,5
50
14,4
SXH xy ra nhiu nht
Tr em
267 79,2 297 83,0
Mi la tui
46
13,7
39
10,9
Khng bit
24
7,1
22
6,1
0,02
0,50
0,03
0,42
NgidnxkhngcCTVkhngbitv
bnh SXH cao gp 1,6 ln v khng bit hoc
nhm ln loi mui gy bnh SXH cao gp 1,3
ln so vi x c CTV. S khc bit c ngha
thngk.
Bng3:Thchnhphngchngstxutxc
cngtcvinvxkhngccngtcvin.
c im
Khng CTV C CTV

n
%
n
%
Bng cam kt PCSXH
Khng
280 100,0 146 40,7
C
69
0,0 213 59,3
Bao lu sc ra DCCN 4,5 6,8 5,6 8,9
Dp DCCN linh tinh tun qua
Khng
30
7,7
24 6,1
C
360 92,3 367 93,9
Mui trong nh tun qua
Khng
39 10,1 40 10,2
C
349 89,9 351 89,8
<0,001
0,06
0,73
0,93
ChuynYTCngCng
VicdnbngcamktPCSXHxcCTV
c thc hin tt hn x khng c CTV, s
khcbitcnghathngk,p<0,001.Tns
sc ra cc dng c cha nc x c CTV
nhiuhnxkhngcCTV.Tuynhin,skhc
bitnykhngcnghathngk.
Khng CTV C CTV

n
%
n
%
Trch nhim chnh PCSXH
Chnh quyn
10
2,6
22
5,6
Gia nh
362 92,8 359 91,8
Khng bit
18
4,6
10
2,6
Chnh quyn thc hin PCSXH
Tt
323 82,8 350 89,5
Trung bnh
60 15,4 39 10,0
Km
7
1,8
2
0,5
Gia nh thc hin PCSXH
Tt
343 88,0 358 91,6
Trung bnh
43 11,0 32
8,2
Km
4
1,0
1
0,2
TlngidnxcCTVnhgichnh
quynthchinttcngtcPCSXHcaohnso
vixkhngcCTV(89,5%sovi82,8%).
Bng5:Scamc,chtstxuthuytcaa
phng9thngunm2011.
S ca mc
S cht
X khng X c X khng X c
CTV
CTV
CTV
CTV
a im
Bng4:nhgicangidnvtrchnhim
phngchngstxutxccngtcvinvx
khngccngtcvin.
c im
NghincuYhc
0,03
0,02
0,16
Tnh Cn Th
Qun Bnh Thy
Huyn C
Tnh Tin Giang
Huyn G Cng Ty
Th x G Cng
Tnh ng Thp
Huyn Tam Nng
TP Cao Lnh
Tnh Bnh Dng
Huyn Tn Uyn
TX Th Du Mt
25
3
8
2
0
0
0
0
8
10
4
10
0
0
0
0
9
25
4
19
0
0
0
0
90
30
146
14
0
0
0
0
HuhtccxcCTV4tnhcscamc
9 thng u nm 2011 thp hn x khng c
CTV ngoi tr huyn Tn Uyn tnh Bnh
Dng.
Bng6:ChsBreteau(BI),chsnhclngqung(HI),chsdngcchancclngqung(CI)xc
cngtcvinvxkhngccngtcvin.
a im
Tnh Cn Th
Qun Bnh Thy
Huyn C
Tnh Tin Giang
Huyn G Cng Ty
Th x G Cng
Tnh ng Thp
Huyn Tam Nng
TP Cao Lnh
Tnh Bnh Dng
Huyn Tn Uyn
TX Th Du Mt
Trung bnh
Ch s BI
Ch s HI
CI
X khng c CTV X c CTV X khng c CTV X c CTV X khng c CTV X c CTV
20
39
38
35
16
26
21
25
6
9
7
10
53
27
29
20
26
16
20
18
7
4
4
3
69
29
16
11
41
22
16
11
23
16
6
4
18
39
37
57
22
29
14
23
23
27
16
19
14
23
13
39
12
11
ChsBItrungbnhxkhngcCTVcao
hnxkhngcCTV(29sovi37).Tuynhin
Tn Uyn, Bnh Dng x c CTV c ch s BI
caogphnxkhngcCTV.VBnhThy,
CnThxcCTVcchsBIcaogngpi
xkhngcCTV.
ChuynYTCngCng
ChsHItrungbnhkhngcskhcbit
ngk,xcCTVl19vkhngcCTVl
23. Ngoi tr ti Bnh Thy, Cn Th v Tn
Uyn,BnhDng.
CItrungbnhxkhngcCTVgntng
ng x c CTV (11 so vi 13). Ring ng
535
NghincuYhc
ThpchsCIxkhngcCTVcaogp4ln
xcCTV.TnhBnhDngcskhcbitch
s CI 2 huyn, Tn Uyn x khng c CTV
thp hn gn 3 ln x c CTV; ngc li Th
DuMtxkhngcCTVchsCIcaogngp
ixkhngcCTV.
Bng7.Miquanhgiasnhcdngccha
ncclngqungxccngtcvinvxkhng
ccngtcvin.
C CTV
Khng CTV
n
%
n
%
Tnh Cn Th
Qun Bnh Thy
10
21,3
8
16
Huyn C
12
24,5
13
26,5
Tnh Tin Giang
Huyn G Cng Ty 10
20
13
26,5
Th x G Cng
9
18,7
8
16,3
Tnh ng Thp
Huyn Tam Nng
9
18,4
20
40,8
TP Cao Lnh
7
14
10
21,7
Tnh Bnh Dng
Huyn Tn Uyn
13
26,5
8
16,3
TX Th Du Mt
8
16,3
11
22,5
Tnh
p
0,51
0,82
0,45
0,76
0,02
0,33
0,22
0,45
Trong s 8 huyn ca 4 tnh, ch c huyn

TamNng,tnhngThplcskhcbitc
nghathngk.
BNLUN
Mthotngditlngqungvx l
ODNxcmngliCTVvxkhng
cCTV
Khng c s khc bit ng k gia hot
ngPCSXHxcCTVvxkhngcCTV
trong cng tc x l ODN v tham gia chin
dchditlngqung.iunyldocstham
giacachnhquyn,ccbanngnhonthv
tbitlcaccCTVcaccchngtrnhYt
khc nhng x khng c CTV. y l im
khc bit so vi nghin cu nh gi chng
trnh gim st v kim sot SXH nm 2009(3).
Vothiimnhginm2009,sthamgia
ca cc ban ngnh on th vo cng tc kim
sotSXHcnrthnch,chyullclng
nhnvinyt.Bncnhccchindchdit
lng qung vn cha thc hin tt. Tuy nhin
hinnayphnlnnhngimhnchtrn
536
ciuchnhvcngtcPCSXHtuynx
angngymttthn.
cimmunghincu
Huhtccitngnghincuctui
60vchimtlgntngngnhaux
khng c CTV v c CTV. C s khc bit v
nghnghipxcCTVvxkhngcCTV.
itngiutralmnghnngxkhngc
CTV cao hn ln so vi x c CTV. N gii
chimtlcaohnsovinamgiixkhng
cCTVvxcCTV.Tlnytngtvit
lnghincuvhnhviPCSXHCaiLytnh
TinGiangnm2010(2).
Tlngicphngvnctrnhhc
vncp1caogpinhngngictrnh
hc vn cp 3 cho thy y l iu kin kh
khn cho vic tuyn truyn PCSXH n cc h
gianh.
KinthcPCSXH
asngidnckinthcvbnhSXH.
Khong90%ngidncbitvbnhSXH,tuy
nhin t l x c CTV cao hn x khng c
CTV.Ktqunytngtvimtnghincu
khcTinGiangvitl88,6%ngidnbit
vbnh SXH(4). T l ny thp hn nghin cu
KAPCnThnm2007vitl98,8%ngi
dntngnghenivSXH(5).Bncnh,gi
dn x c CTV bit chnh xc mui vn gy
bnhSXHcaohnxkhngcCTV.
ThchnhPCSXH
Cskhcbitcnghathngkvtl
h gia nh c CTV n tuyn truyn dit
lngqungtrongthng.71,0%hgianhx
c CTV c tuyn truyn trong khi t l x
khng c CTV l 60,8%. Nhng x khng c
CTVnhngvnctuyntruynvPCSXHl
dolngghptrongnhngttrinkhaicct
chin dch dit lng qung v hot ng x l
ODN.Tuynhin,vicdndpDCCNlinhtinh
trongtunquakhngghinhnskhcbitx
c CTV v khng c CTV. iu ny cho thy
rng, mc d ngi dn c CTV tuyn
ChuynYTCngCng
truyn nhng hnh vi PCSXH cha c s thay
i.
nhgitrchnhimphngchngSXH
asngidnxcCTVnhgichnh
quyntiaphngthchinttvrttt
cngtcphngchngSXH.iunycthgi
xcCTVngidncchorngvsquan
tm ca cc cp chnh quyn, cc ban ngnh
on th n n chng trnh kim sot SXH
nhiuhn.
ScamcSXH
KhngkhcbitngkscamcSXHx
c CTV thp hn x khng c CTV. Tuy nhin
vitiuchchnxcCTVlnhngxtrng
im SXH, s ca mc thp x c CTV gi
CTV c th c tc ng n hiu qu ca
chng trnh. Tuy nhin cn so snh thm vi
cc m hnh PCSXH khc chng hn nh m
hnh PCSXH trong trng hc v nh gi v
nhiumtnhhiuquvmtchiph,nhnlc
cthnhnrngmhnhhocthayim
hnh ph hp vi tnh hnh thc t tng a
phng.
ChsBI,HIvCI
CnTh
Quaiutra4xCnTh,ngoitr1x
khngcCTVcchsBI=20,ccxcnlic
chsBItrongkhong3540.Mcdxkhng
cCTVnhngchsBInmtronggiihncho
phpvxvatriquatditlngqungx
lODN.Bncnhlhotngtchccca
trmYtxvsnhittnhcacngtc vin
ccchngtrnhytkhc.
TinGiang
Ti Tin Giang ch s BI x c CTV thp
hnxkhngcCTV(26sovi40)vthphn
ch s BI trung bnh do tnh gim st (BI=54)(2).
Cc ch s HI cng tng t, ch s HI trong
nghin cu thp hn nhiu so vi ch s gim
sttrungbnhcatnhlnltl19,4%xc
CTV,21,4%xkhngcCTVsovi36%ca
tnh. (5).Tuyvychsnylphhpvitnh
hnhthctvccxcchslngqungthp
ChuynYTCngCng
NghincuYhc
ccxctuyntruynditlngqungqua
cc t x l dch nh v cc chin dch dit
lngqung.
Trong4xiutracn3xcchsBI
vt ngng d bo dch (BI>20). Ch s HI
tt c cc x u vt ngng d bo dch
(HI>5%).TheoTChcYTThGiiKhuVc
Ty Thi Bnh Dng th khi HI>5% v/hoc
BI>20% cho bt k cng ng no l du hiu
cho bit vng c nguy c xy ra dch
SD/SXHD(6).Dovytrong4xiutrac3
xcnguycxyradch.
ngThp
HiuquhotngcaingCTVphng
chngSXHtingThpcthhinrqua
chsBIkhthp(16v11).khuvcThnh
ph,chsBIthphnkhuvchuyn,cbit
lxkhngcCTVvichsBIthphn2,4
lncthlsauchindchditlngqung.Sau
khi thc hin xong chin dch dit lng qung
th ngi dn khng ch n dn dp nh
ca,scradngcchanc.
C s khc bit c ngha thng k v s
nhcDCCNclngqunghuynTamNng
dokhcbitvtnhtrngdtrncmaca
ngidnhaixny.
BnhDng
Quaiutra4x,chc1xcchsBI<20
thuc v x khng c CTV huyn Tn Uyn.
Cng ti Tn Uyn, ch s BI x c CTV cao
gp3lnxkhngcCTV.Cthiunyl
do t l s dng nc my x c CTV thp
hnxkhngcCTV.
KTLUNVKINNGH
ScamcxcCTVthphnscamc
xkhngcCTV.Mcdscamckhngcs
chnhlchngk.Nghincunytimtthi
imnnkhnhgihiuqudomngli
CTV trong vic lm gim s ca mc SXH. Tuy
nhin m hnh CTV c mt s hn ch nht
nh.Thnht,kinhphsdngchomiCTV
lrtthpnhngkinhphchochthngCTV
lrttnkm.Thhai,schocacachnh
537
NghincuYhc
quynvphihpgiaytvccngnhngh
khc c nh hng rt ln n hiu qu hot
ngcaCTV.
Mc d a s ngi dn u bit v bnh
SXHtuynhinccchsgimstcntrngu
dch vt ngng cho thy cng tc truyn
thngPCSXHngidncnphithayithch
hp,nhmthayihnhvicangidn.
TnhhiuqucamngliCTVvncha
hngnh,cnphthucvonhiuyutkhc.
Tuy nhin nng cao hiu qu phng chng
dchSXHcnxemxtsphhpcamhnh
vitngaphng.
TILIUTHAMKHO
1.
BYt(2001).HngdnphngchngstDenguevstxut
huytDengue.NhxutbnyhcHNi.2001.
2.
3.
4.
5.
6.
7.
Bi Th Kiu Anh, Nguyn Th Bch Ngc, ng Vn Chnh.

(2010).HnhviphngchngstxuthuytngidnxM
HnhTrunghuynCaiLytnhTinGiangnm2010.ti
cpcsVinVsinhYtcngcngTp.HCM
ngVnChnh,LHongNinh,BiThKiuAnh,Bic
Thnh Nam, Nguyn Th Bch Ngc, Dng Tiu Phng,
(2010).nhgigimstvkimsotStxuthuytDengue
ticctnhminNamVitNamnm2009.Yhc Thnh ph
HCM,tp14(2)2010,tr.3847.
LngNgn(2011).Bocohotngphngchngstxut
huyttnhTinGiang9thngunm2011.p.9.
LThnhTi,NguynThKimYn(2008).Kinthc,thi,
thchnhvmtsyutlinquannphngchngstxut
huytDenguecangidnxMKhnhhuynPhongin
thnhphCnThnm2007.YhcThnhphHChMinh,
tp12(4)2008,tr.3944.
T chc Y t th gii khu vc Ty Thi Bnh Dng (2002).
Hng dn gim st Dengue v phng chng vc t. NXB Y
hcHNi.2002.tr.18.
VinStrtKSinhtrngCntrngQuyNhn(2010).Tnh
hnhdchbnhstxuthuyttrongnm2010vnhngvn
cn quan tm gii quyt. Available from: http://www.impe
qn.org.vn,22/02/2011.
538
ChuynYTCngCng
NghincuYhc
TNHHNHSCKHEHCSINHTRNGTRUNGHCCS
NGUYNVNNXLONGTHUNHUYNBNCU
TNHTYNINHNM2011
NguynDonThnh*,DngTiuPhng*,NgNgcThyNhin*
TMTT
tvn:XLongThun,huynBnCu,tnhTyNinhhinlmttrongnhngaphngcnhiu
khkhnvkinht.Sckhehcsinhlvncncquantm
Mctiunghincu:Xcnhtnhtrngsckhehcsinh,tlbnhttphbin,bnhhcnghc
sinhtrngtrunghccs(THCS)NguynVnn,xLongThun,huynBnCu,tnhTyNinhnm
2011vmtsyutlinquannbnhhcng.
Phngphpnghincu:ctngangmttinhnhtrn496hcsinhtlp6nlp9trngTHCS
NguynVnn,xLongThun,huynBnCu,tnhTyNinh.
Ktqunghincu:SckhehcsinhloiAchim14,92%,loiBchim77,02%vloiCchim8,06%.
Tlcnthl4,44%;tlcongvoctsng(CVCS)l24,19%;Tlsurngl37,9%.Cmilinquan
giacnthvithigianhcbinh,thigianhcthm,thigiansdngmyvitnh.Nghincucngtm
thycmilinquangiaCVCSvigiitnh,khilpvthigiansdngmyvitnh.Ttccclphcu
ttiuchunvnhsngnhngukhngtvtiuchunkchthcbngh,tuynhin,nghincuny
cngchatmthymilinquangiaiukinnhsng,kchcbnghvittcnthvCVCS.
Ktlun:Dinhdngkmdnnthlckmhcsinhlvncncquantm.Tuytlcnth
thphnnhiuaphngkhcnhngCVCSvbnhvrngmingchimtlcao.Vvy,chmlottsc
khehcsinh,ihiphicsphihpchtchgianhtrngvgianhchovnny.
Tkha:tnhtrngsckhehcsinh,THCSNguynVnn,sckhetrnghc
ABSTRACT
HEALTHSTATUSOFPUPILSSTUDYINGATNGUYENVANANSECONDARYSCHOOLINLONG
THUANVILLAGEBENCAUDISTRICTTAYNINHPROVINCE2011
NguyenDoanThanh*,DuongTieuPhung*,NgoNgocThuyNhien*
Background:Thepupilsheathandschoolrelateddiseasesareveryconcernedissues,especiallyinruralsites
witheconomicdifficultiessuchasLongThuanvillage,BenCaudistrictTayNinhprovince.
Objectives:Determiningthehealthstatusofpupils,theprevalenceofcommondiseasesandschoolrelated
diseasesatNguyenVanAnsecondaryschoolinLongThuanvillage,BenCaudistricTayNinhprovincein2011
andsomerelationfactorstoschoolrelateddiseases.
Method:Crosssectionalstudyconductedon496pupilsfrom6thto9thgradesatNguyenVanAnsecondary
schoolinLongThuanvillage,BenCaudistrict,TayNinhprovince.
Results: The rate of pupils with level A in health classification, which is assessed as good health status,
consistsof14,92%,levelBfairlygoodis77,02%,andlevelCis8,06%.Themyopiarateis4,44%;scoliosis
curve(SC)rateis24,19%;toothdecayrateis37,9%.Thereisasignificantrelationshipbetweenmyopiawith
Tcgilinlc:BS.CKII.NguynDonThnh T:0989028559 Email:nguyendoan_thanh@yahoo.com
ChuynYTCngCng
539
NghincuYhc
timeforstudyingathome,timeforattendingprivatetuition,timeforusingcomputer.Thestudyalsofounda
correlationbetweenSCwith:gender,grade,andtime for using computer. All classes meet the requirement of
lightingstandardsbutdidnotmeetthestandardoftablesandchairssize.Thestudyalsofoundnoassociation
betweenlightconditions,sizeoftablesandchairswithmyopiaandSC.
Conclussion:ThepoornutritionstatusisaconcernedissueatNguyenVanAnsecondaryschool.Although
therateofmyopiaislessthantheoneatotherlocalities,theSCandperiodontaldiseasesacquireratherhighrates.
Therefore,itisnecessarytohaveastrongcoordinationbetweenschoolandfamiliesinordertohaveagoodcarein
pupilhealth.
Keywords:healthstatusofpupils,NguyenVanAnsecondaryschool,schoolhealth.
TVN
Mctiunghincu
Vit Nam hin ang phi i mt vi hai

gnhnngsuydinhdngvthacnboph
hc sinh. Mt khc, tui hc ng l giai
on cc em d b tc ng bi cc yu t mi
trng. Hin nay, cc bnh hc ng hc
sinhangcxuhnggiatng,cbitlcn
th v cong vo ct sng (CVCS)(4,8,2,5,1). Cn th
lmgimthlcnhnxa,gimkhnnghctp
vthmchcthgymlmgimchtlng
cuc sng (10). Bnh CVCS nh hng n s
pht trin c th ca tr, l mt trong nhng
nguyn nhn dn n bnh l v h hp, tun
hon,vnngvcthlmlchkhungchu,
nhhngnkhnngsinhncaccemn
khi lm m sau ny(3,6). C nhiu nguyn nhn
dnngiatngtlcnthvCVCS,trong,
yut x hi cng nh mi trng hc ng
ngvaitrrtquantrng.
Xcnhtnhtrngsckhehcsinh,tl
bnh tt ph bin, bnh hc ng hc sinh
trng Trung hc C s Nguyn Vn n x
LongThunhuynBnCutnhTyNinhnm
2011vmtsyutlinquannccbnhtt
hcng.
Sc khe hc ng hin l mt trong

nhngvnytcngcngangcChnh
phquantm.Tuynhin,vicphngngacc
bnh tt hc ng vn cn l mt thch thc
ln.LongThunlxctlhnghocaonht
trong huyn Bn Cu tnh Ty Ninh, cng tc
chm sc sc khe hc sinh v cng tc y t
trng hc cn rt nhiu tr ngi. V vy, tm
hiusckhehc sinh ti trng trung hc c
sNguynVnnlviclmthitthc,bc
ugpphnhtrvngkhkhn,hngng
thngvtremhngnmvcnglhngng
Chng trnh Mc tiu Quc gia Sc khe hc
ngnm2011.ycnglcstinhnh
cchotngcanthipsauny.
Lymutonbhcsinhanghctlp6
nlp9cmttrongthiimiutra.
540
ITNGPHNGPHPNGHINCU
Thitknghincu
Ct ngang m t tin hnh t thng 7/2011
nthng7/2012.
aimvitngnghincu
TonbhcsinhanghctitrngTHCS
Nguyn Vn n, x Long Thun, huyn Bn
Cu,tnhTyNinhcmttrongthiimiu
tra.
Cmuvkthutchnmu
Ccbinscanghincu
Binphthuc:Cnth,congvoctsng,
surng,ccbnhthngthngkhc.
Bin c lp: Gii, tui, tin s gia nh b
cnth,mangknhiuchnhkhcx,thigian
hctpvgiitr,loicpsch,cngchiu
sngtrongphnghc,kchthcbngh...
Phngphpthuthp
Sdngbcuhisonsnvthchin
thaotckthuttheo thng quy k thut Y
hc lao ng V sinh mi trng (YHL
VSMT)vSckhetrnghcthuthpcc
thngtinv:
ChuynYTCngCng
c tnh
- Khc
iukinvsinhphnghc.
Chiucao,cnnnghcsinh.
Khmmt,khmCVCS,khmnikhoa.
Xlvphntchsliu
Nhp liu bng phn mm EpiData 3.1, x
lbngphnmmStata8.0.Xcnhtlphn
trmcnth,CVCS,surngvccbnhkhc.
Xcnhmilinquangiacnth,CVCSvi
cc yu t khc bng php kim t v chi bnh
phngngngngha0,05.
KTQU
ctnhmunghincu
Bng1.ctnhhcsinhtheokhilp,gii,ngh
nghipcham(N=496)
Khi lp
Gii tnh
Ngh
nghip
cha
Ngh
nghip
m
c tnh
- Khi 6
- Khi 7
- Khi 8
- Khi 9
- Nam
- N
- Lm rung
- Lao ng t do
- Bun bn
- Khc
- Lm rung
- Lao ng t do
- Bun bn
NghincuYhc
Tn s (n) T l %
163
32,8
125
25,2
102
20,6
106
21,4
246
49,6
250
50,4
285
57,5
77
15,5
26
5,2
108
21,8
240
48,4
67
13,5
72
14,5
Tn s (n) T l %
117
23,6
Nhn xt: Khi 6 c lng hc sinh ng

nht vi 32,8%, thp nht l khi 8 vi 20,6%.
Cha m ch yu l ngh nng, tip theo l lao
ngtdovbunbn.
cimvbnghvnhsnglphc
Bngh
Theo Quyt nh s 1221/2000/QBYT v
phn loi kch c bn gh, 100% bn gh u
KHNGTtiuchun.
nhsng
Theo thng t lin tch s 18/2011/TTLT
BGDTBYT ngy 28/4/2011, 100% phng hc
ttiuchunviukinchiusng:lpc
chiu sng t nhin y , m bo chiu
sngngukhngdi100lux.
Tnh trng sc khe hc sinh, t l bnh

tt,bnhhcngvmtsyutlin
quan
Phnloisckhehcsinh
Bng2:Ktquphnloisckhehcsinh(n=496)
Phn loi sc khe
Loi A
Loi B
Loi C
Tn s
74
382
40
T l (%)
14,92
77,02
8,06
Ktquthlchcsinh
Bng3:Tnhtrngdinhdngcahcsinh(N=496)
Lp 6
Lp 7
Lp 8
Lp 9
N
88
66
44
48
BMI
16,36 2,45
17,02 2,44
17,68 2,25
18,93 3,26
Nam
Chiu cao
138,32 6,78
144,16 8,81
150,63 7,89
156,81 8,71
Cn nng
31,55 6,72
35,83 8,63
40,48 8,05
46,96 10,61
n
75
59
58
58
BMI
16,58 2,59
17,77 2,85
18,46 2,42
18,81 2,12
N
Chiu cao
141,8 6,41
146,94 5,89
150,37 5,13
152,13 4,96
Cn nng
33,55 6,78
38,57 7,81
41,81 6,04
43,58 5,31
Nhnxt:cnamvn,chsBMIvchiucaoutngdntheokhilp,tuynhinBMI
hcsinhkhi6vkhi7tptrungmcnhcnsovichunBMIcaWHO(di18,5).
Ktqubnhtthcsinh
Bnhttnichung
Bng4.Tnhhnhbnhtthcsinh(N=496)
Tnh hnh bnh tt
Cn th
Cong vo ct sng
ChuynYTCngCng
n (%)
22 (4,44)
120 (24,19)
Su rng
Tai Mi - hng
Da liu
Bu c
Tim phi
Tiu ha
Tit niu
188 (37,9)
44 (8,87)
28 (5,65)
4 (0,81)
0
0
0
541
NghincuYhc
Thn kinh
Bnh n (%)
Bnhcnthvyutlinquan
Bng5:Milinquangiacnthviccyut:
giitnh,khilp,tinsgianhcngibcn
th,thigianhctpvgiitr(N=496)
Bnh n (%)
p
C (%) Khng (%)
7 (2,85) 239 (97,15)
0,088
15 (6,0) 235 (94,0)
4 (2,45) 159 (97,55)
10 (8,0) 115 (92,0)
0,171*
4 (3,92) 98 (96,08)
4 (3,77) 102 (96,23)
Yu t
Gii tnh
Khi lp
Tin s
gia nh
c ngi
b cn
Yu t
thi gian
Nam
N
Khi 6
Khi 7
Khi 8
Khi 9
C ngi thn b
3 (13,64) 19 (86,36)
cn
0,067*
Khng c ngi
19 (4,01) 455 (95,99)
thn b cn
Hc bi
nh/tun
Hc thm/tun
<0,001**
S dng my vi
tnh
Yu t
C (%)
Khng (%)
PR
(KTC
95%)
Cm gic kh chu khi mang cp

101
288 (74,04)
(25,96)
0,079
C
19 (17,76)
88 (82,24)
Yu t thi gian
S dng my
0,01*
vi tnh
*
Khng
*:PhpkimFisher.
**:PhpkimphithamsWilcoxonranksumtest.
Nhnxt:CmilinquangiaCVCSv
Giitnh,vip<0,001,theo,tlhcsinh
nam b CVCS cao hn hc sinh n 6,86 ln
(PR=6,86;KTC95%:4,0511,93).
Khilp(p=0,015<0,05),quamikhilp,
tlnylitngln.Khi8ctlCVCScao
nhtvi29,41%,thpnhtlkhi6vi15,34%.
*:PhpkimFisher.
Thigiansdngmyvitnh,vip=0,01<
0,05.
**:PhpkimphithamsWilcoxonranksumtest.
BNLUN
Nhn xt:Cmi lin quan gia cn th v

thigianhcbi,thigianhcthm,thi gian
sdngmyvitnh,vip<0,001.
BnhCVCSvyutlinquan
Bng6:MilinquangiaCVCSvigiitnh,khi
lp,loicpsch,cmgickhchukhimangcp,
thigianhctpvgiitr(N=496)
Bnh n (%)
Yu t
C (%)
Khng (%)
PR
(KTC
95%)
Gii tnh
98 (39,84) 148 (60,16)
< 6,86 (4,05
22 (8,80) 228 (91,20) 0,001 11,93)
Khi lp
Khi 6
25 (15,34) 138 (84,66)
1
2,23 (1,24
Khi 7
36 (28,80)
89 (71,20)
4,00)
0,015 2,30 (1,24
Khi 8
30 (29,41)
72 (70,59)
4,24)
2,07 (1,12
Khi 9
29 (27,36)
77 (72,64)
3,82)
Loi cp
Cp mt quai
120
372 (75,61)
(24,39)
1,00*
Cp hai quai
0
2 (100)
Cp xch tay
0
2 (100)
Nam
N
542
Vvndinhdng
Kt qu BMI v chiu cao trung bnh cho
thy, tng theo khi lp c nam v n. Tuy
nhin, theo phng php phn loi ca cng
trnhKC10.10chohocsinhcaVitNam,phn
loi chiu cao v cn nng hc sinh iu tra
ny l thp v thc t cng thp hn cc em
cng la khu vc ngoi thnh TP HCM(7).
Thct,ylaphngcnnhiukhkhn
kinht,cnhiugianhngcon(trungbnh
2,3 con/gia nh) nn cha m thiu iu kin
quantmngmcnvndinhdngcho
cc em. V th lc km, dn n phn loi sc
khe hc sinh ch yu tp trung loi B (loi
trungbnh),chim77,02%,ngngihnlc
8,06%hcsinhcthlcloiC(loikm).
Vtnhhnhbnhtthcsinh
Vcnthvyutlinquan,chothy,tlc
tt khc x chim 5,24% trong cn th l
4,44%,vthphnnhiusovinghincuca
TrnMinhTm(7).ycthdokhcbitva
imnghincu,skhcnhaugianngthn
ChuynYTCngCng
vi thnh th v vng kinh t. Mt iu ng
lulc16/22emkhngbitmnhbcn,tl
63,64%.Vvy,nukhngphthinsm,sem
nysdbtngcnth,hngnvichc
tp v hn ch sinh hot. Cc yu t lin quan
n cn th l thi gian hc bi, thi gian hc
thm, thi gian s dng my vi tnh trong
nghin cu ny cho thy ph hp vi nghin
cukhccachnhtcgivTrnMinhTm(7,9).
Vcongvoctsngvmilinquan, ta thy,
c 24,19% hc sinh b CVCS, thp hn kt qu
nghincutrnitnghcsinhtiuhcca
PhmKimAnh(5)nhngylmtconsng
lo ngi v trung bnh 10 em c hn 2 em b
CVCS, ch yu l vo hnh ch S v ch C,
chim 20,77%. Bnh CVCS trong iu tra ny
chothy,namvncskhcbitcngha
thng k, trong t l nam b CVCS cao hn
n 6,86 ln (Bng 6). Kt qu ny cho thy, c
thdoccemnthngxuyntmhncc
emnamviuchnhtthkhingihc,c
sch, xem tivi Mt khc, cc em nam nng
thn thng m nhn nhng vic nng hn,
nntthlmvicckhnngnhhngn
sphttrincactsng.Ngoira,cmilin
quangiaCVCSvkhilp,nghalkhilp
cng ln th t l b CVCS cng tng. Hnh vi
ngisaitththnghnhthnhtnhnglp
nh,dnlnlnsthnhthiquen,vvyngy
qua ngy nguy c CVCS cng tng ln. Trong
nghin cu ny, cha xc nh c mi lin
quangiacnth,CVCSvibayutnhsng
lphc,kchcbnghvthigianhctp
trngcahcsinh.
Vccbnhkhctuihcng
Cha pht hin ca bnh no v tim phi,
tiuha,titniu,thnkinh;tlbnhdaliul
5,65%viungnil,tuytlthp(0,81%)
nhngtnhtrngbucvncn.Vbnhrng
ming, tuy y khng phi l bnh hc ng
nhnglbnhtuihcng, chimt l cao
nht trong cc loi bnh, trong su rng
chim37,9%,phnnophnnhtnhtrngsc
kherngmingcaccemvihicny
ChuynYTCngCng
NghincuYhc
mnhhnnahotngtuyntruyn,giodc
sckhechoccemnhtrngvgianh.
Vbnhnykhngchnhhngnsckhe,
thm m m sc khe rng ming cn l mt
trongnhngyutquantrngquytnhn
thnhcngtronghotnggiaotip.
KTLUN
Mitrnghcng:100%phnghct
chunviukinchiusng.Tuynhin,kch
thcbnghttcccphnghcukhng
tchun.
Tnhtrngthlccahcsinhcnkm,tm
vccnthpb,dnnphnloisckhech
yu l loi B chim 77,02%, loi A ch chim
14,92%,ngquntmlc8,06%hcsinhc
sckheloiC.
Tlcnthl4,44%,cmilinquan vi
ccyut:thigianhcbi,thigianhcthm,
thigiansdngmyvitnh.
TlCVCSl24,19%,chyulvo dng
chSvchC.Ccyutlinquanlgii,khi
lp,thigiansdngmyvitnh.
Tlsurngcahcsinhl37,9%.
KINNGH
Nhtrngcnnhanhchngsachahoc
btrlibnghchophhpvitmvcca
cc em. (theo Thng t lin tch 26/2011/TTLT
BGDTBKHCNBYT hng dn tiu chun
bnghhcsinhtrngtiuhc,trunghcc
s,trunghcphthngdoBGiodcvo
to B Khoa hc v Cng ngh B Y t ban
hnh).
Trangbgctruynthngvthngxuyn
anidunggiodcsckhevoccbuini
chuyn u tun, sinh hot tp th; khuyn
khch hc sinh khm rng nh k v v sinh
rngminghngngy.
T chc khm sc khe nh k hng nm
nhmphthinsm,tvnviutrkpthi
cctrnghpmibcnth,CVCS,bnhrng
ming.
543
NghincuYhc
Gia nh cn quan tm n ch dinh

dngvvnngcaccem nhiu hn na
vccemchcthphttrintondinkhic
s phi hp cht ch gia gia nh v trng
hc.
Tuy nghin cu khng kho st v t th
ngi nhng vic nh trng phi hp vi gia
nhhngdn,thngxuynnhcnhccem
iu chnh t th ngi ng, khng ch
trng,khingihcmckhictruyn,sch
bo, xem tivi, s dng my vi tnh v khi lao
nglrtcnthit.
TILIUTHAMKHO
1.
2.
3.
544
HashimSE,TanHK,WanHazabbahWH,IbrahimM(2008)
Prevalence of refractive error in malay primary school
childreninsuburbanareaofKotaBharu,Kelantan,Malaysia.
Ann.Acad.Med.Singapore,37,(11),9406.
Ng Vn Hong., L Th Kim Oanh. (2006) Tnh trng sc
khe ca hc sinh tiu hc ti tnh Long An. TpchYhc
thnhphHChMinh,10:179183.
NguynHuyNga(2001)Staythchnhyttrnghc,Nh
xutbnYhc,HNi,2876.
4.
5.
6.
7.
8.
9.
10.
PadhyeAS,KhandekarR,DharmadhikariS,DoleK,Gogate
P,DeshpandeM(2009),Prevalenceofuncorrectedrefractive
errorandothereyeproblemsamongurbanandruralschool
children.MiddleEastAfr.J.Ophthalmol.2009Apr;16(2):6974.
Phm Kim Anh., L Th Th. (2006) Cn th, cong vo ct
sngvmtsyutlinquanhcsinhtiuhcqun2
Thnh ph H Ch Minh. Tp ch Y hc thnh ph H Ch
Minh,10:143149.
PhmNngCng(1998)Phngchngbnhcongvoctsng
tronghcsinh,NhxutbnYhc,1015.
TrnMinhTm,VnDng(2006)Tnhhnhttcnth
hcnghcsinhcphaitiqun9ThnhphHCh
Minh nm 2006. Tp ch Y hc thnh ph H Ch Minh,
11:(1)160167
Uzma N, Kumar BS, Khaja MSBM., Zafar MA, Reddy VD
(2009) A comparative clinical survey of the prevalence of
refractive errors and eye diseases in urban and rural school
children.Can.J.Ophthalmol.,44,(3),32833.
Vin V sinh Y t Cng cng thnh ph H Ch Minh T
chcYtthgii(2010)Ccyutx hi nh hng n
cnthhcsinhtiuhcvtrunghcphthngtnhng
Nainm2010.ticpcsVinVsinhYtcngcng
Tp.HCM
World Health Organization (2010), Visual impairment and
blindness,http://www.who.int/mediacentre/factsheets/fs282/
en/
ChuynYTCngCng
NghincuYhc
TNHTRNGDINHDNGHCSINHTIUHC
QUN5THNHPHHCHMINH
NguynDonThnh*,DngTiuPhng*,NgNgcThyNhin*
TMTT
tvn:VitNamangphiimtvihaignhnng,tiptcgiiquytvnsuydinhdngv
iphvitlthacnbophanggiatngticcthnhph,cbitiviitnghcsinh.
Mctiunghincu:Xcnhtlvccyutlinquanntnhtrngdinhdnghcsinhtiuhc
qun5,TP.HCM.
Phngphpnghincu:Ctngangmt.
Ktqunghincu:Tlhcsinhsuydinhdngl2,3%,21,2%hcsinhcnguycbthacn.Tl
namsinhcnguycthacnvthacncaohnsovinsinh.Khngcmilinquangiatnhtrngdinh
dngvithigianhctp,thigiandnhchocchotngtnhti,hotngvuichivthigianlmcng
vicnh.
Kt lun: Ktqunghincuslcsgipchonhtrngvcccquanytxydngccchng
trnhgiodcsckhecngnhccchngtrnhcanthipnngcaosckhechohcsinhngycnghiuqu
hn.
Tkha:Tnhtrngdinhdng,hcsinhtiuhc
ABSTRACT
NUTRITIONALSTATUSAMONGSCHOOLCHILDRENINDISTRICT5HOCHIMINHCITY
NguyenDoanThanh,DuongTieuPhung,NgoNgocThuyNhien
Background: Vietnamconfrontstwoburdens,continuestoaddresstheunderweightproblemandtodeal
withincreasingprevalenceofoverweightandobesityinurbansettings,especiallyinstudents.
Objectives: Determine the prevalence and determinants of nutritional status among primary school
childrenindistrict5HoChiMinhcity.
Results:Thepercentageofunderweightamongschoolchildrenwas2,3%and21,2%forriskofoverweight.
The proportion of overweight and obesity was higher in male students compared to female. There was no
significantassociationbetweennutritionalstatusandtimeforstudy,sedentaryactivities,recreationalactivities,
andtimeforhouseholdwork.
Conclusion: Theresultswillbebasictohelpeithertheschoolsorthehealthorganizationstogivehealth
educationprogramsaswellasinterventionprogramstoimprovestudentshealthmoreandmoreeffective.
Keywords:nutrionalstatus,schoolchildren
TVN
Hinnay,thacnvbophkhngchgia
tng cc quc gia pht trin m cn l mi
quantmccqucangphttrin,cbitl
ticckhuvcthnhth(12).5%stvongton
cucxcnhldothacn,boph(10).
Tcgilinlc:BS.CKII.NguynDonThnh T:0989028559 Email:nguyendoan_thanh@yahoo.com
ChuynYTCngCng
545
NghincuYhc
Thacnbophtranggiatngvtr
em c bit chu nguy him t n. Vo nm
2010, gn 43 triu tr di 5 tui tha cn v
khong35triutrlccqucgiaangpht
trin.Trbophcnguycbmcbophkhi
trngthnh.Do,trbophcnguycd
mc nhiu bnh nguy him nh cao huyt p,
tiungtype2,ungth,ccbnhtimmch
v cc vn v c xng. Theo T chc Y t
Th gii (WHO) c khong 36 triu (63%) cc
trnghptvongtonculdonhngbnh
khng ly v c tnh s tng ln n 52 triu
vonm2030(11,13).
Trong nhng nm gn y, c s gia

tng t l tha cn bo ph tr em ti Vit
Nam, c bit l cc thnh ph. Mt
nghin cu ca Trn Th Hng Loan ti
TP.HCMchothytlthacngiatngt
nm1999nnm2011.
S pht trin kinh t x hi dn n s
gia tng cc hot ng tnh ti lm nh
hng n m hnh hot ng th lc ca
tr.Thiuvnngthlcctmthyl
mttrongnhngyutnguycchnhca
tha cn, bo ph(12) v l yu t nguy c
ng hng th 4 ca cc trng hp t
vong trn ton th gii v l nguyn nhn
ca6%cctrnghptvongtoncu(10).
HintiVitNamphiimtvihaignh
nng,tiptcgiiquytvnsuydinhdng
v i ph vi t l tha cn bo ph ang gia
tngticcthnhph.Thacnbophlmt
thchthcmiiviVitNam.Tuynhinc
tnghincuvvnnyvthacnboph
hc sinh tiu hc vn cha c ch thch
ng. V vy vic xc nh t l tha cn, bo
ph cng nh suy dinh dng hc sinh v
nhngyutlinquanlrtquantrngnhm
cung cp c s gp phn gip cho nh trng
v cc c quan y t a ra cc chnh sch y t
hc ng v chm sc sc khe cho hc sinh
cng nh cc chng trnh gio dc th cht
546
da vo trng hc v cc chng trnh can

thipnngcaosckhechoccemhcsinh.
Mctiunghincu
Mctiutngqut
Xc nh t l v cc yu t lin quan n
tnhtrngdinhdnghcsinhtiuhcqun
5TP.HCM.
Mctiucth
Xcnhtlsuydinhdng,thacn,bo
phhcsinhtiuhcqun5TP.HCM.
Xcnhccyutlinquannsuydinh
dng, tha cn, bo ph hc sinh tiu hc
qun 5 TP. HCM: hot ng th lc, tui gii,
dntc,nghnghipcacham.
ITNGPHNGPHPNGHINCU
Thitknghincu
Ctngangmt.
Thigianvaimnghincu
Tthng612/2011tiqun5TP.HCM.
itngnghincu
Hc sinh ang hc tp ti cc trng tiu
hcqun5TP.HCM.
Phngphpchnmu
iu tra c tin hnh ti qun 5. Chn
ngunhin3trngtiuhctrongqun.Mi
trngchn145hcsinh.Chnngunhin5
lp/trng.Ctngs435hcsinhciu
tra.
Cngcvphngphpthuthpdkin
Tnhtrngdinhdngcnhgibng
BMI.
BMI=cnnng(kilograms)/chiucao2(m).
BMIcnhgidavoqunththam
chiuquct.
iutravinochiucaovcnnnghc
sinhbngthcvcnchuyndng.
Hotngthlc:Phngvntrctiphc
sinh.
Bcuhibaogmnhngmcsau:
ChuynYTCngCng
Tnhtrngdinhdng:cnnng,chiucao,
BMI.
c tnh ca hc sinh: tui, gii, dn tc,
nghnghipcacham.
Hot ng th lc: hc ti trng, phng
tinntrng,thigianintrng,hcti
nh, hc thm, xem truyn hnh, c
sch/truyn,chitrchi in t, tham gia cc
hotnggiitrtitrngvtinh,lmvic
nh.
iutrathtinhnh20hcsinhtiuhc
tiqun5TP.HCMiuchnhbcuhicho
phhp.
KTQUVBNLUN
c dim v tnh trng dinh dng ca
hcsinh
Ktqunghincuchothytlnamsinh
(51,9%) cao hn n sinh (48,1%). Phn ln hc
sinh l ngi Kinh (76,0%), c 22,8% hc sinh
thuc dn tc Hoa. Ngh nghip ca cha ch
yulkinhdoanh(24,4%)vbunbn(20,2%).
Tngt,phnlnnghnghipcamlbun
bn(24,8%)vnitr(23,2%),rttngitrong
shlcngnhn(3,2%).
Ch c 2,3% hc sinh b di cn trong khi
t l hc sinh c nguy c tha cn v tha
cn cao gp hn 10 ln so vi di cn (t l
nguycthacnl21,2%v31,9%lthacn).
Ktqunghincuphhpvixuhnggia
tng tha cn trn th gii, c bit l ti cc
qucgiaangphttrin.Tlnguycthacn
ca hc sinh qun 5 thnh ph H Ch Minh
trongnghincunycaohnktqucamt
NghincuYhc
nghin cu v tnh trng BMI ca tr em t 8

n 10 tui ti thnh ph H Ch Minh nm
2010 (15,3%). Theo mt cuc iu tra ti thnh
phHChMinh,tlthacnvbophca
trdi5tuivonm2009caogp4lnsovi
nm1999(8,8%vonm2009v2,2%vonm
1999)(3).
Tuynhintldicncahcsinhtrong
nghin cu thp hn so vi nghin cu ca
Nguyn Thanh H v Nguyn Vn Thng ti
trng tiu hc thuc tnh Vnh Phc vo nm
2005(8).Nguynnhncaskhcbitnycth
doitngthamgiatrongnghincunyl
hcsinhthnhthtrongkhiitngtrong
nghin cu ca Nguyn Thanh H v Nguyn
Vn Thng l hc sinh nng thn. Mt vi
nghincuchrarngtldicnhcsinh
nng thn cao hn hc sinh thnh th. T l
dicncahcsinhnngthncaohnthnh
thcngctmthytrongnghincuvtnh
trngBMIcahcsinhthnhphHChMinh.
Ktqunghincuchothytlthacnbo
ph ngy cng tr thnh vn quan trng
hcsinh,cbitlhcsinhsngticcthnh
th.HintiVitNamcnphiimtvihai
gnhnng,tiptc gii quyt vn suy dinh
dinhdngtivngnngthnviphvi
s gia tng t l tha cn v bo ph ti thnh
th.Vvy,lnhonhtrngvphhuynh
nn quan tm n tnh trng dinh dng ca
cc em v ci thin ch n hng ngy mt
cchphhpvkhuynkhchtrthamgiath
dcththaonhiuhntrnnkhemnh.
Tlsuydinhdng,cnnngbnhthng,nguycthacnvthacnhcsinhtheo
giitnh,tui,tngiovnghnghipcacham
Bng1.Tlsuydinhdng,cnnngbnhthng,nguycthacnvthacnhcsinhtheotui,gii,
tngiovnghnghipcacham(n=435)
c tnh
Gii tnh
Tui
Nam
N
6 tui
7 tui
SDD
No.
%
3
1,3
7
3,4
2
13,3
2
2,6
ChuynYTCngCng
Cn nng bnh thng

No.
%
78
34,5
116
55,5
5
33,3
31
40,8
Nguy c tha cn
No.
%
49
21,7
43
20,6
1
6,7
17
22,4
Tha cn
No.
%
96
42,5
43
20,6
7
46,7
26
34,2
P
<0,0001
547
NghincuYhc
c tnh
Dn tc
Ngh
nghip
ca cha
Ngh
nghip
ca m
8 tui
9 tui
10 tui
11 tui
Kinh
Hoa
Khc
CB cng nhn
vin chc
Kinh doanh
Bun bn
NV vn phng
Lao ng t do
Cng nhn
Tht nghip
Khc
CB cng nhn
vin chc
Kinh doanh
Bun bn
NV vn phng
Lao ng t do
Cng nhn
Tht nghip
Khc
SDD
No.
%
3
2,9
1
1,2
1
1,3
1
1,3
7
2,1
3
3,0
0
0,0
3
2.8
Cn nng bnh thng

No.
%
41
40,2
34
40,0
40
51,3
43
54,3
137
41,3
54
54,6
3
75,0
45
42,5
Tha cn
No.
%
36
35,3
28
32,9
24
30,8
18
22,9
116
34,9
22
22,2
1
25,0
34
32,1
1
3
0
2
0
0
1
1
1,8
3,4
0,0
3,0
0,0
0,0
8,3
1,4
24
47
20
31
19
2
6
34
42,1
53,4
31,8
46,9
50,0
40,0
50,0
47,2
13
12
18
12
12
0
1
15
22,8
13,6
28,6
18,2
31,6
0,0
8,3
20,8
19
26
25
21
7
3
4
22
33,3
29,6
39,7
31,8
18,4
60,0
33,3
30,6
0
2
4
0
1
1
1
0,0
1,9
6,9
0,0
7,1
1,0
7,7
19
52
20
13
4
50
2
50,0
48,2
34,5
41,9
28,6
49,5
15,4
7
24
15
3
3
20
5
18,4
22,2
25,9
9,7
21,4
19,8
38,5
12
30
19
15
6
30
5
31,6
27,8
32,8
48,4
42,9
29,7
38,5

tnhtrngdinhdngcahcsinhvgiitnh.
Kt qu ny ph hp vi kt qu ca mt vi
nghincuchothyrnggiitnhlyutlin
quan vi tnh trng dinh dng. Nghin cu
chothytlthacnnamcaohnsovin,
vitllnltl42,5%v20,6%.Tngt,t
l nam sinh c nguy c tha cn (21,7%) cng
caohnnsinh(20,6%).Ktqunycngph
hpviktqucamtvinghincu(8,3).Bn
cnh,nsinhdicnnhiuhnsovinam
sinh, vi t l ln lt l 3,4% v 1,3%. Do
nhngcanthipnngcaosckhechotr,c
bitlvtnhtrngdinhdngnnxemxtvn
giitnhcanthiptrnnhiuquhn.
Ngoira,ktqunghincucngchothy
khngcmilinquancnghathngkgia
tnhtrngdinhdngvtuicahcsinh.Kt
qunytringcvimtvinghincu.Mi
linquangiasuydngvtuictmthy
trongnghincuvtnhtrngBMIcahcsinh
548
Nguy c tha cn
No.
%
22
21,6
22
25,9
13
16,6
17
21,5
72
21,7
20
20,2
0
0,0
24
22,6
P
0,165
0,117
0,353
0,215
ti Thnh ph H Ch Minh nm 2010(2). Mt

nghincuvsuydinhdngvthacntr
emvtrvthnhnintichothycmilin
quan gia tnh trng dinh dng v tui(9).
Tng t, khng c mi lin quan c ngha
thngkgiatnhtrngdinhdngvdntc.
Kt qu ny tng t vi kt qu ca mt
nghincuvthacnhcsinh6n11tui
tithnhphHChMinh(6).Tuynhintngio
li c tm thy l yu t lin quan vi tha
cntrongmtnghincuvtnhtrngthacn
ti thnh ph H Ch Minh(7). V th cn c
nghincuthmlmsngtmilinquan
gia tnh trng dinh dng vi tui, dn tc
nhmxydngnhngcanthipnngcaotnh
trng dinh dng theo tng nhm tui v tn
gio.
Milinquangiatnhtrngdinhdng
vcchotngthngngy
Ktqunghincuchothyhc sinh tha
cn dnh nhiu thi gian hc tp trng,
ChuynYTCngCng
nhmitunhnhcsinhdicnvhcsinh
c cn nng bnh thng. Tuy nhin khng c
mi lin quan c ngha gia tnh trng dinh
dngvthigiandnhchocchotngtnh
tinhhctp,xemtruynhnh,sdngmy
vitnhvchitrchiintcmtay.Nhng
ktqunykhcvimtvinghincu(4).Li
sngtnhtictmthylmttrongnhng
yutnguycchnhcathacn.Mtnghin
cuvtnhtrngthacnhcsinhtiMcho
thyvicxemtruynhnhqumcclinquan
ntnhtrngthacn(9).
Tng t, mt vi hot ng th lc bao
gm hot ng vui chi trng, nh, lm
cng vic nh c tm thy khng lin quan
vitnhtrngdinhdng.Ktqunytngt
vimtnghincuvtnhtrngBMIctin
hnhtithnhphHChMinhvonm2010.
Mi lin quan gia hot ng th cht v tnh
trngcnnngcngkhngctmthytrong
nghin cu ny. Tuy nhin, so vi mt vi
nghin cu trc y, kt qu nghin cu ca
chng ti ngc li vi kt qu ca nhng
nghincuny.Thiuhotngthchtlmt
trong nhng yu t nguy c ca tha cn(5,9,4).
Mtnghincukhcvccyutnguycca
thacntiBcKinh,TrungQucchothyc
mi lin quan gia hot ng th cht v tha
cn(5).Milinquangiatnhtrngdinhdng
vhotngthchtcnhiuktquchar
rng.Vth,cncnhngnghincusuhn
lmrccmilinquanny.
KTLUN
T l tha cn hc sinh l 31,9% v t l

hcsinhcnguycthacnl21,2%.giitnh
ctmthylyutlinquanntnhtrng
dinh dng trong nghin cu ny. T l tha
cnvnguycthacnnamsinhcaohnn
sinh.Nsinhbdicnnhiuhnnamsinh.
Ktqunghincuchothykhngcmilin
quan gia tnh trng dinh dng vi tui, dn
tc v ngh nghip ca cha m. Khng c mi
lin quan gia thi gian hc tp ti trng, ti
nh,thigianhcthmmitunvitnhtrng
ChuynYTCngCng
NghincuYhc
dinh dng. Nghin cu cng khng tm thy

mi lin quan c ngha thng k gia tnh
trng dinh dng vi thi gian dnh cho cc
hot ng vui chi gii tr trng v nh,
thigianlmcngvicnh.
KINNGH
Cnxemxtvngiitnhkhinhmn
i tng hc sinh trong cc chng trnh
phng nga tha cn, suy dinh dng v
nhngcanthipnngcaosckhe.
Nh trng v gia nh nn hng dn v
nhc nh hc sinh cc em c thi gian hc
tp,xemtruynhnh,sdngmyvitnhhp
lngaykhiccemcnnh.Bncnh,ccem
cnckhuynkhchvnhcnhtngcng
thamgiacchotngthchtnhmnngcao
sckhecaccem.
Chngtrnhphngngathacn,cbit
lticcthnhthnncavotrnghc
giodchcsinhcchphngngathacn
bo ph ngay khi cc em cn nh. Cc chng
trnh phng nga nn hng n tng cng
cc hot ng th cht v gim cc hot ng
tnh ti ca hc sinh nhm ci thin tnh trng
cnnnghintivtnglaichoccem.
Cn c nhng nghin cu su hn xc
nh r mi quan h nhn qu tnh trng dinh
dngvihotngthchtvhotngtnh
ti.
TILIUTHAMKHO
1.
2.
3.
4.
5.
CDC (2010). Dinh dng, hot ng th cht v bo ph,

http://www.cdc.gov/Features/ObesityAndKids/
ngVnChnhvcngs(2010)TnhtrngBMIcatr
emvngthnhthvnngthnt8n10tuivccyut
xhilinquan..TpchYhcthnhphHChMinh,14,(2),
360365.
Gabriel CG, Corso AC., Caldeira GV., Gimeno SG., Schmitz
BA., Vasconcelos FA (2010), Cc yu t lin quan n tha
cnvbophhcsinhbangSantaCatarina,Brazil,2010.
Arch.Latinoam.Nutr.,(60),4.
JanssenI,Katzmarzyk PT. (2005) So snh t l tha cn v
bophhcsinhti34qucgiavmilinquancachng
vimhnhhotngthchtvchn.Obes.Rev.,6,
(2),12332.
JiangJ.,RosenqvistU.,WangH.,GreinerT.,MaY.,Toschke
AM.(2006)Ccyutnguyccathacntr26tuiti
BcKinh,TrungQuc.Int.J.Pediatr.Obes.,1,(2),1038.
549
NghincuYhc
6.
7.
8.
9.
550
LazzeriG.,RossiS.,PammolliA.,PilatoV.,PozziT.,Giacchi
MV.(2008)Suydinhdngvthacntr em v tr v
thnhnintiTuscany().J.Prev.Med.Hyg.,49,(1),1321.
LKimQu(2010)Xuhngtnhtrngdinhdngvcc
bnhlinquantithnhphHChMinhnm20012010.
Tpchdinhdngvthcphm,6,(34),79.
NgVnQuang(2010)Thacnvccyutlinquan
hc sinh tiu hc ti Nng. Tp ch Dinh dng v thc
phm,6,(34),7783.
RoseD.,Bodor.JN.(2006)Skhngantonvthcphm
hgianhvthacnhcsinh:Nhngktqutnghin
cu theo chiu dc tr giai on sm. Pediatrics, 117, (2),
46473.
10.
11.
12.
13.
T chc Y t Th gii (2005). 10 s tht v bo ph,

http://www.who.int/features/factfiles/obesity/facts/en/index6.
html,
T chc Y t Th gii (2009). t t do cc bnh khng ly,
http://www.who.int/gho/ncd/mortality_morbidity/ncd_prem
ature_text/en/index.html,
T chc Y t th gii (2010). Tha cn v bo ph,
http://www.who.int/mediacentre/factsheets/fs311/en/index.ht
ml,
T chc Y t Th gii (2010). T vong do cc bnh khng ly
http://www.who.int/gho/ncd/mortality_morbidity/ncd_total/
en/index.html,
ChuynYTCngCng
NghincuYhc
KHOSTTHCTRNGNHNLCCAYTDPHNG
THNHPHCNTH,NM2010
NguynHongLn*,LVinh*,NguynVLinh*
TMTT
tvn:Nhnlcytdphnglmtyutquantrngtrongcchotngchmscsckhe.Kho
stnhnlcytdphng(YTDP)lmtviclmcnthittotinchovichochnhchnhschv
phttrinhthngytdphngtheongvisphttrincaxhivnhucunngcaosckhechongi
dn.
Mctiu:XcnhccunhnlccahYtdphngtuyntnh,tithnhphCnThnm2010.
Phngphpnghincu:Thitknghincumtctngang;Kthpphngphpnghincunh
lngvnhtnh.
Ktqu:Ccunhnlcchahpl:TlcnbYTDPrtthp(1/10.000dn).Sovicnctlbc
sYHDPthphn6%,cnbydcthphn6,3%;Chc30%cotongchuynngnh.Chinlc
otochaphhp:Tlcnbcotortthp(30%),chc5%lotongchuynngnh.
Ktlun:CncchnhschchohYTDPgiatngthuhtcangnh:tnglng,nngcaophcp
cth.Xydngchinlcotonngcaochtlngcnb:tngchtiuotonhtlBSYTDP;Tng
cngototheoach.
Tkha:Nhnlc,ytdphng
ABSTRACT
ASSESSMENTOFHUMANRESOURCEINPREVENTIVEMEDICINESECTOR,
CANTHOCITYIN2010
NguyenHoangLen,LeVinh,NguyenVuLinh
Background:Humanresourceofpreventivemedicinesectorisoneofthemostimportantcomponentsfor
health care services. Assessment of its human resource is a fundamental activity for planning policy and
developing strategy of preventive medicine system to keep pace with the developing of society and health care
demand.
Objectives: To determine the human resource structure in terms of quantity and quality of preventive
medicinesectoratprovinciallevelofCanThoCityin2010.
Methods: The crosssectional study design was used with combined quantitative and qualitative
approaches.
Result:Structureofpreventivemedicinesectorisunreasonableintermsofbothqualityandquantity:The
proportion of preventive medicine staff is very low (1/10,000 population). The proportion of medical doctor
havingpreventivemedicinespecialistandtheproportionofmedicalpharmacologystaffsarelessthan6%and
6.3% respectively compare to the whole country statistics; in which there have been only 30% of them were
trained in preventive medicine field. Training strategies are irrelevant: the proportion of trained staff is low
(30%),andonly5%ofthemhavebeentrainedinthefieldofpreventivemedicine.
Conclusion:Relevantpoliciesshouldbedevelopedforpreventivemedicinesectortogetmoreattractiveto
Tcgilinlc:BS.CKII.NguynHongLn T:0903909409 Email:nguyenhoanglen@ihph.org.vn
ChuynYTCngCng
551
NghincuYhc
their workers, for instance, increase in staffs salary and preventive medicine specific allowances/incentives.
Training strategies should be developed to increase the capacity of human resource e.g. increasing quota of
preventivemedicalstudentenrollmenttoUniversity,moretrainingforareawherethereisalackoftrainedstaffs.
Keywords:Humanresource,preventivemedicine
TVN
Conngilthnhtquantrngcamit
chc, c quan nhm m bo cc hot ng
cthchintcccmctiu
ra ca c quan. Theo T chc Y t Th gii
(WHO), nhn lc y t l ngun lc trung tm
camihthngyt,ngunnhnlclyut
cbnchomithnhtucangnhyt(4).
Ti cc quc gia thuc khu vc Chu
ThiBnhDng,thiuhtngunnhnlcyt
anglmtvnnghimtrngcnphic
xemxtnhmtphnkhngthtchritrong
tngthviccngchthngyt(2).
VitNamcngangnguvisthiu
ht v cc ngun lc y t, c bit s mt cn
igiacchchuynngnhvphnbgia
cc vng min.(3) Hn na, cng vi s pht
trinnnkinhtthtrng,angcschuyn
dchngunnhnlctkhuvccnglpsang
khuvcngoicnglp.Trongngnhytvi
ch trng x hi ho y t, nhu cu chm sc
sckhegiatng,nnngunnhnlcytngy
cngthiu.
Donhucucthcangnhnghytd
phngvtnhtrngthiunhnlc,nhiunv
ytdphngcccuthnhphncnbcha
hp l, nhiu cn b c o to cc chuyn
ngnhchaphhpviyucucacngvic.
Ngoiracnbcnggimhngth,chayn
tm gn b vi cng tc y t d phng. Cc
nguyn nhn bao gm tin lng v thu nhp
cacnbcngtctronglnhvcytdphng
thp, cc ch ph cp, i ng cha tho
ng(1).
tngcngkintonmngliyta
phng, nht l mng li t chc h y t d
phng,cnthitphixcnhcthctrng
ingcnbangcngtctronglnhvcny
trongxemxtthctrngthnhphncnby
552
tdphng,xcnhnhucuhctpphttrin
nghnghip,nhucuvtrcngtcvccnhu
cu ngh nghip khc. Cu hi hin nay ang
c nu ra cho qui hoch pht trin ngun
nhnlcyt,cbitlcnbytangcng
tcticcnvytdphngaphng
ltronghytdphngtuyntnhthccu
nhnlchinnaycathnhphCnThnh
thno?
lmrvnnycncmtnghincu
lmrccvntronghytdphng:Cn
b y t ang cng tc c o to t cc
ngunno?Vinhngchuynngnhg?v
ang c phn cng lm g? c hi lng vi
nhimvangcgiaokhng?cnhngnhu
cu g trong cng vic hin nay? V th, chng
titinhnhtinghincuCcunhnlc
vccnhucucacnbytdphngthnhph
CnTh,nm2010.
ITNGPHNGPHPNGHINCU
itngnghincu
Cnbvinchcngilaongcngtc
ti cc trung tm thuc h y t d phng ca
thnh ph Cn Th nm 2010 (theo Thng t
lin tch s 03/.2008/TTLTBYTBNV ngy 25
thng4nm2008)baogm:TrungtmYtd
phngthnhphCnTh,TrungtmSckho
Lao ng v Mi trng thnh ph Cn Th,
Trung tm Phng chng HIV/AIDS thnh ph
Cn Th, Chi cc V sinh An ton thc phm
thnhphCnTh.
Thitkvphngphpnghincu
Thit k nghin cu m t ct ngang, kt
hp phng php nghin cu nh lng v
nghincunhtnh(tholunnhmctrng
tmvphngvnsu).
Cmu
Cmunghincunhlng
ChuynYTCngCng
Khosttonbcnbvinchcngilao
ngca04Trungtm.
Cmunghincunhtnh
Phngvnsu04GimchocPhGim
cca04trungtmthuchyhcdphng
thnh ph Cn Th v 32 cn b Qun l cc
khoachuynmnca04trungtmthuc h y
hcdphngthnhphCnTh.
itngloitr
Nhngitngkhngngthamgiav
khng c mt hoc bnh trong thi gian kho
st.
Thigianaimnghincu
Nghin cu c tin hnh ti Thnh
ph Cn Th t thng 05/2010 n thng
12/2010.
Phng php thu thp v phn tch x l

sliu
Tp hun cho ngi kho st: Cn b Vin
VSYTCC.
Thu thp s liu ca nghin cu nh
lng bng cch phng vn trc tip bng
bngcuhisonsn,bncuhiphngvn
c s dng cho phng vn su, tho lun
nhmctrngtm.
Lm sch s liu v s dng phn mm
thng k Epi Data 3.2 v Stata 8.0 nhp v
phntchsliuchonghincunhlng.
Xp nhm cc nguyn nhn v cc gii
php thu thp theo t l % v trch dn cc
kinidin.
Tho lun nhm, phng vn su lit k cc
nguyn nhn gii php theo th t u tin
(thngktheoPhngphpPileSort).
KTQUVBNLUN
Cccimvdnsxhihc
V tui ca nhn lc YTDP, tui trung
bnhcahl40,15.yltuicnhiuvn
sng v kinh nghim trong cng vic. Tuy
nhin, h s gp khng t kh khn trong vic
hchnhnngcaotrnhchuynmn.
ChuynYTCngCng
NghincuYhc
Bng1:Nhngctnhchungcamunghincu
(n=99)
c tnh
Tn sut T l %
< 30
23
23,23
30 39
17
17,17
Nhm tui
40 49
36
36,36
50 60
23
23,23
N
50
50,51
Gii tnh
Nam
49
49,49
Tiu hc
1
1,01
Ph thng c s
3
3,03
Ph
thng
trung
hc
6
6,06
Trnh
hc vn
Trung cp Cao ng
28
28,28
i hc v sau i hc
61
61,62
Tng
99
100
Y s
14
14,28
Bc s
18
18,37
Dc s Trung cp
1
1,02
Dc s i hc
0
0,00
iu dng Y t cc loi
1
1,02
Chc danh
C nhn Y cc loi
8
8,16
ngh K thut vin Y Dc cc
8
8,16
nghip
loi
Trung hc cao ng cc
13
13,27
ngnh khc
C nhn - K s cc
35
35,71
ngnh khc
Tng
98
100
C gia nh/sng nh v
73
73,74
Tnh trng
chng
hn nhn
c thn/ly hn/ly thn/ga
26
26,26
7
7,07
Tm
57
57,58
Kinh t gia
nh
Thiu
35
35,35
Tng
99
100
Vkinh t gia nh, a s nhn vin YTDP

(93%) t cho rng thu nhp tm v thiu
thn. So vi thu nhp hng thng t c quan,
khong60%thunhpt3triutrxung,35%
cthunhpt35triuvcbitchc5%
thunhphn5triu.Vimcthunhpnym
phitrangtrichocucsngtimtthloi
mtthnhnnhcah,tmvthiuthn
lhontontrungthc.
Cc c im thnh phn ngh nghip

hinti
Bng2:cimthnhphnnghnghiphinti
caCBYT(04Trungtm)
c tnh
Tn sut T l %
553
NghincuYhc
c tnh
Tn sut
Tin s chuyn khoa II
2
Thc s chuyn khoa I
5
Bc s dc s i hc
13
C nhn Y/dc
6
Y t, iu dng
1
Chc danh
Y
s,
dc
s
trung
hc,
16
hin ti
h l
C nhn/k s khc
33
Trung cp khc
13
Lao ng khc
10
Tng
99
Ni
0
Ngoi
2
Sn
0
Nhi
3
Nhim
1
a khoa
18
Chuyn khoa khc
26
Chuyn ngnh Chuyn ngnh ho l
0
Chuyn ngnh sinh hc
0
Chuyn ngnh thc
5
phm
Chuyn ngnh mi
0
trng
Chuyn ngnh khc
44
Tng
99
Chnh quy
55
Chuyn tu
16
H o to
Ti chc
24
Khc
4
Tng
99
< 2 nm
4
2 nm
17
3 nm
24
Thi gian o
to
4 nm
37
> 4 nm
16
Tng
98
29
Trng THCN ti
tnh/TP khng phi TP.
HCM
Trng H ti tnh/TP
52
khng phi TP. HCM
Ni o to Trng THCN ti TP.
3
HCM
Trng H ti TP. HCM
12
Trng THCN ni khc
1
Tng
97
< 1 nm
4
1-3 nm
13
tt nghip
4-6 nm
22
> 6 nm
59
554
T l %
2,02
5,05
13,13
6,06
1,01
16,16
33,33
13,13
10,10
100,00
0,00
2,02
0,00
3,03
1,01
18,18
26,26
0,00
0,00
5,05
0,00
44,44
100,00
55,56
16,16
24,24
4,04
100,00
4,08
17,35
24,49
37,76
16,33
100,00
29,90
53,61
3,09
12,37
1,03
100,00
4,08
13,27
22,45
60,20
c tnh
c o to
i hc v sau
i hc sau khi
tt nghip
Chuyn ngnh
Tng
1-3 nm
4-6 nm
> 6 nm
Tng
Nhi
a khoa
Chuyn khoa khc
Thc phm
chuyn ngnh khc
Tn sut
98
4
6
19
29
1
2
10
3
13
T l %
100,00
4,04
6,06
19,19
29,29
1,01
2,02
10,10
3,03
13,13
Vchuynngnh:chc30%lmvictheo
ngchuynngnhcotottrnglp.
Tlcnbcotochuynmnngnhn
rtcao,(84%coto<4nm).
T l cn b c c i hc chuyn mn
(H, sau H) nhm nng cao trnh nghip
vt30%.Tuynhin,ch5%trongsc
otochuynngnhyvthcphm.Vicc
sliunutrn,chothymngYTDPCnTh
c lc lng chuyn ngnh cng nh hoch
nhchinlcotochaphhp.
S hi lng ca CBYT vi cng vic hin

ti
Bng3:ShilngcaCBYTvicngvichinti
(04Trungtm)
c tnh
Tn sut
C
89
Phn cng cng vic
ng chuyn ngnh
Khng
10
Cng vic ng vi
C
91
s thch
Khng
8
S hi lng vi v tr
Rt hi lng
9
cng tc hin nay
Hi lng
59
Tm chp nhn
31
Thu nhp bnh qun
<2 triu
8
thng do c quan cp
2-3 triu
51
>3-4 triu
21
>4-5 triu
14
>5-6 triu
1
> 6 triu
4
7
Thu nhp nh hin
nay sinh hot
Tm
57
gia nh
Thiu
35
Lm thm tng
C
28
ngun thu nhp
Khng
71
Cng vic lm thm
Bun bn
10
Khm bnh
5
Khc
13
T l %
89,90
10,10
91,92
8,08
9,09
59,60
31,31
8,08
51,52
21,21
14,14
1,01
4,04
7,07
57,58
35,35
28,28
71,72
10,10
5,05
13,13
ChuynYTCngCng
c tnh
Tn sut
Ph hp
29
Ch ph cp c
th cho h y t d Khng ph hp
70
phng
Ph hp
34
Ch chnh sch
khc cho h y t d Khng ph hp
65
phng
T l %
29,29
70,71
34,34
65,66
Mtiutngchngnhbthplla
s(92%)chorngcngvicngvisthchv
90% cho rng h c phn cng cng vic
ngchuynngnhtrongkhitlcoto
ngchuynngnhch30%.Tmhiusuhn
cthlgiiiubthplnyldotnhhiu
hc v kh nng vt kh trong vic hc hi
nngcaotrnhnghipvtngnghip
honthnhcngvic.Vtheothigian,trnh
chuynmnctchly t kinh nghim lm
vic v hng dn t ng nghip thc
hinttcngvic.Mtldonagiithchiu
nylnhittmvtnhgnbcacnb i
vingh.
Vshilngivicngvichinti,ch
c 9% cho rng rt hi lng vi cng tc hin
nay,60%chornghilngv31%chorngch
tm chp nhn. iu ny d dng gii thch v
vi thu nhp nh trn cng vi ch u i
nghnghipchattlm(71%chorngch
ph cp c th khng ph hp v 66% cho
rngchchnhschkhngphhp)thmt
tlcaocnbhilngvicngvicskht
Nhucuhctpphttrinnghnghip
Bng4:Nhucuhctpphttrinnghnghip(04
Trungtm)
c tnh
C
Khng
Ngn hn
Thi gian mun o
Trung hn
to
Di hn
Hc H
C nhu cu o to
Hc SH
nng cao
Khng c nhu cu
Tp trung
Hnh thc mun o
Va hc va lm
to
Hc theo tn ch
C nhu cu o to
lin tc
Tn sut
71
28
15
28
28
26
25
28
20
40
11
T l %
71,72
28,28
15,15
28,28
28,28
26,26
25,25
28,28
20,20
40,40
11,11
Khong72%cnbcnhucuotonng
caonghnghip.iunyhontonhplvi
ChuynYTCngCng
NghincuYhc
thctrngch30%cnbcotong
chuynngnh.Khong56%muncoto
theohnhthcvahcvalmylcons
thhintrchnhimcngnhtnhgnbvi
ngnhvtnhyunghcacnb.Cccons
saumtlnnakhngnhsgnbny.C
94,95% cn b khng c mong mun c
chuyn i phng ban trong cng c quan v
ch2,02%cnhucuchuyncquankhc.
Nhucunicngtc
Bng5:NhucunicngtccaCBYT(04Trung
tm)
c tnh
Nhu cu chuyn cng tc
qua Khoa/Phng khc
trong Trung tm
C nhu cu to thm iu
kin lm vic
C nhu cu chuyn cng
tc qua c quan khc
Tn sut
5
T l %
5,05
Khng
94
94,95
C
Khng
C
Khng
73
26
2
97
73,74
26,26
2,02
97,98
Nhucutothmiukinlmvicrtcao,
c73,74%cnbcmongmuncithiniu
kinlmvic.iunycnguynnhn tng
irrngltrongnm2009,cctrungtmnu
trnvactchra.Vvy,vnphng,cs,
iu kin lm vic cn thiu thn l iu d
hiu.
Nguyn nhn v gii php m bo

ngunnhnlcccloittholunnhm
vphngvnsu24cnblnhoTrung
tm,khoa,phng
Nguyn nhn gy kh khn trong vic tuyn
dngcnb
ascccnbchorngthunhpcacn
bytdphnghinnaythpsoviccngnh
khc;sovibcsiutrlicngthphn.
Cnbthuclnhvcytdphngphii
cngtcnhiuhn.
asccbcssaukhittnghipratrng
thchlmcngtciutrhn,lmcngtcyt
d phng ngh nghip bc s khng c
cao, tay ngh chuyn mn khng c pht
trin.
555
NghincuYhc
Cha c nh hng ngh nghip cho sinh

vintcctrngihcY.
Milinquangiaccyutnhnlcv
ccctnhmu
ChchnhschvingcaNhnc
ivicnbytthuclnhvcytdphng
chathang.
Gia phn cng cng vic ng chuyn

ngnh v trnh hc vn, chc danh ngh
nghipcmilinquancnghathngk(p<
0,05), trong ngi c trnh hc vn tiu
hc li c kh nng phn cng ng chuyn
ngnh cao hn so vi nhng trnh hc vn
khc.Ngoirangicchcdanhtins/CKII
c kh nng c phn cng ng chuyn
ngnhsoviccchcdanhnghnghipkhc.
Ch u i hc hnh nhm nng cao

trnhchuynmnchacquantmng
mc.
Trongcngtctuyndngnhnsgprt
nhiukhkhntSnivdochtiuchung
catontnh,tphnbchtiuchoytcn
hn ch cho nn s lng bin ch cho php
tuyndngcnthiusoviyucuthct.
Ngnschcpchohotngtronglnhvc
ytdphngchapngkpthivcha
hotng.
Giiphp
Sauylmtsgiiphpmascnb
ng:
nhmthuhtcnbcngtctronghy
t d phng ngh tng lng, tng ph cp
nghnghip.Cchnhschthuhtnhnti.
Nngcaochnhschuichocnblm
YTDP trong mi lnh vc, c bit trong vic
otonngcao,cthnh:hchunuvo,
m rng o to sau i hc h YTDP cho cc
itnglcnbihckhngthucngnh
y.
Duytrotochuyntubcsh4nm
cctrngihcY,ototheonhucuca
aphng.
Tng ch tiu o to hng nm cho h
YTDPmcthlBSYTDP.
Phnquyntuyndngnhnschongnh
yt,hnchtcngtSniv.
Tngchtiubinchhngnmchongnh
YTDP.
Tng kinh ph hot ng cho lnh vc y t
dphng.
556

phn cng cng vic ng s thch v trnh
hc vn. Ngi c trnh hc vn trung
cp/caongcphncngcngvicngs
thch bng 0,92 ln ngi c trnh hc vn
tiuhc(p=0,024).Ngictrnhhcvni
hc/sauihccphncngcngvicng
sthchbng0,86lnngictrnhhcvn
tiuhc(p<0,001).
phncngcngvicngsthchvchcdanh
nghnghip.Ngicchcdanhcnhn/ks
c phn cng cng vic ng s thch bng
0,87 ln ngi c chc danh tin s/CKII
(p=0,010).
phncngcngvicngsthchvkinhtgia
nh. Ngi c iu kin kinh t tm c
phncngcngvicngsthchbng0,92ln
ngiciukinkinht(p=0,001).Ngi
ciukinkinhtthiucphncngcng
vic ng s thch bng 0,79 ln ngi c iu
kinkinht(p=0,002).
s hi lng vi v tr hin nay v kinh t gia
nh.Ngickinhtgianhthiucshi
lngvivtrhinnaybng0,60lnngikinh
tgianh(p=0,002).
ch ph cp c th v trnh hc vn.
NgictrnhhcvnPTTHcchph
cpcthbng0,48lnngictrnhhc
ChuynYTCngCng
vn tiu hc (p=0,070). Ngi c trnh hc
vn trung cp/cao ng c ch ph cp c
thbng0,44lnngictrnhhcvntiu
hc (p<0,001). Ngi c trnh hc vn i
hc/sauihccchphcpcthbng
0,14 ln ngi c trnh hc vn tiu hc
(p<0,001).
ch chnh sch khc v trnh hc vn.
Ngi c trnh hc vn PTTH c ch
chnhschkhcbng0,48lnngictrnh
hc vn tiu hc (p=0,070). Ngi c trnh
hcvntrungcp/caongcchchnhsch
khc bng 0,51 ln ngi c trnh hc vn
tiuhc(p<0,001).Ngictrnhhcvni
hc/sauihccchchnhschkhcbng
0,19 ln ngi c trnh hc vn tiu hc
(p<0,001).
KTLUN
NghincuYhc
72% cn b c nhu cu c o to nng

cao.
Ch c khong 5% mong mun chuyn
phngbanv2%mongmunchuynsangc
quankhc.
Nguynnhngynnhnchngunnhn
lc
Thunhpthp.
Thiunhhngnghnghip.
Ch u i ngh nghip v chnh sch
ngnhthp.
C ch tuyn dng cn nhiu bt cp; s
lngbinchhnch.
KINNGH
Giiphpbomngunnhnlc
Tnglng,nngcaophcpnghnghip
vuihchnh
TlcnbYTDPl1/10.000dn,chimt
trng 4,38% tng s cn b y t ngnh (so vi
tng s CBYT khu vc ng bng sng Cu
Long).
Duy tr h chuyn tu v ti chc, o to

theonhucu.
T l bc s l 0,15/10.000 dn, chim t

trng 3.75 % tng s cn b y t ngnh (so vi
tng s CBYT khu vc ng bng sng Cu
Long).
nhhngnghnghipchosinhvin.
30% cn b YTDP c o to ng
chuynngnh.
69% cn b YTDP hi lng vi cng vic
hin ti v 90% thch cng vic ang lm, 92%
cho rng mnh c phn cng ng chuyn
ngnh.
Tng ch tiu o to hng nm cho h

YTDPmcthlBSYTDP.
TILIUTHAMKHO
1.
2.
3.
4.
BYt(2009).DthoQuyhochphttrinnhnlcvh
thngotoytnnm2020.
Lyn N. Henderson & Jim Tulloch (2008), Incentives for
retainingandmotivatinghealthworkersinPacificandAsian
countries,HumanResourcesforHealth2008.
NguyenBachNgoc,NguyenBichLien&NguyenLanHuong
(2005), Human Resource for Health in Vietnam and
mobilizationofmedicaldoctorstocommunehealthcenters,
AsiaPacificActionAllianceonHumanResourcesforHealth.
WHO(2006),Theworldhealthreport2006:workingtogether
forhealth,WHOPress,Geneva2006.
ChuynYTCngCng
557
NghincuYhc
MTSYUTXHINHHNGNSCKHE
CNGNHNNHPCTIXBNHHA,THXTHUNAN,
TNHBNHDNGNM2011.
LHongNinh*,TrnhHngLn*,TrnThcThin*
TMTT
tvn:Shnchtrongvictipcnccdchvchmscsckhe,iukinsngcckhunhtr
chtchi,titn,tnhtrngdinhdngkmctcngkhngnhntnhtrngsckhocangilaong
nhpc.Ngoirangilaongcnchunhhngbiccyutnguyc,tchinghnghiptinilm
vic,cbitivinhngngicthulmtinhhocnhngphnxnglmvictchbitvibn
ngoi.
Mctiunghincu:Xcnhtlcatngyutxhivnhhngcaccyutnynsckhe
cacngnhnnhpcxBnhHa,thxThunAn,tnhBnhDngnm2011.
Phngphp:nghincuctngangmttrn400itnglcngnhnnhpcanglmvictrn
abnxBnhHa,thxThunAnbngbcuhithitksn.
Kt qu v phn tch:Ktqunghincuchothyaslcngnhntr78,5%ctuit30tr
xungv61%llaongn.Vtrnhhcvn,chyultrunghccsctl41%vtrunghcph
thngctl32%.Huhtcngnhnthuphngringcnhvsinhring(71%).Cngnhnchtthucl
12,3%vsdngrubial25,5%..Tlcngnhnctipxcviccyutchil14%,tlcngnhn
ckhmsckhenhktinilmvicl72,5%;tlcngnhnckhmbnhnghnghiptinilm
vicl51,5%.Vchmscsckhevtipcndchvchmscsckhe,khostghinhnc33,3%scng
nhnkhngkimtrasckhe,tlcngnhnkhngcthbohimytl13,5%.Trongmiquanhxhi
vingidntiaphng,cn92,5%cngnhncngidnaphngixthnthin,bncnh
95,7%cngnhncmthyantonkhisngtiniy.Ngoiranghincucntmthycmilin
quancnghathngkgiatnhtrngsckhevimtsyutxhinh:tnhtrnghnnhn,gianhc
connh,iukinsngxungquanh,thigianlmvic,mccngthng,mtmitrongcngvic,khmbnh
nghnghipvcmthyantonkhisngtiaphng.
Ktlun:Ktqunghinculcsccnhhochnhchnhschcnhngphnghng,khoch
htrcngnhn,cbitlcngnhnnhpcnnhisngsngvtcngnhtinhthn,gpphn
nngcaonnglcsnxuttrongbicnhhinihacatnc.
Tkha:cngnhnnhpc,ccyutxhinhhngsckhe
ABSTRACT
SOCIALDETERMINANTSAFFECTEDTOIMMIGRANTLABORSHEALTHINBINHHOA
VILLAGE,THUANANTOWN,BINHDUONGPROVINCE,2011.
LeHoangNinh,TrinhHongLan,TranThucThien
Background: The limited accessibility to health care service, bad life condition in the narrow boarding
house, and low nutrition condition of laborers influence health of the immigrants in city. In addition, the
Tcgilinlc:BS.CKII.TrnhHngLn
T:0903736894 Email:trinhhonglan@ihph.org.vn
558
ChuynYTCngCng
NghincuYhc
immigrants are isolated from the unfamiliar society, block their approach to local community. Moreover, they
havegotworkinginjury,womanviolenceespeciallywiththeworkerswhoarerentedtoworkathomeorinthefar
awayandseparatedfactories..
Objectives:TodetermineproportionofsocialfactorsandtheinfluencetoimmigrantworkerhealthinBinh
Hoavillage,ThuanAntown,BinhDuongprovince.
Methodology: This was the crosssectional study among 400 immigrant workers in Binh Hoa village,
Thuan An twon, Binh Duong province. Data was collected though direct interviews using structured
questionaire.
Result: Most of workers aged younger than 30 years old with 78,5% and 61% for female. As regard
education,thenumberofworkershadjuniorhighschoolandhighschoolsdegreeaccountedfor41%and32%
respectively. Survey on housing conditions in the boarding rooms/ houses revealed that most of workers had
roomswithprivatetoilet(71%).Theproportionofworkerssmokingwere12,3%andusingalcoholwere25,5%.
Workersexposedtotheriskfactorsintheworkingsettingswere14%.Theproportionofworkersreceivedpediodic
healthexaminedandoccupationaldiseaseexaminedatworkplaceswere72,5%and51,5%respectively.Asregard
thehealthcareandtheaccesstohealthcareservices,surveyindicatedthat33,3%ofworkerswerenotpediodically
medical checked, the percentage of workers without health insurance card were 13,5%. In social relationships
withthelocalpeople,studyshowedthatupto92,5%ofworkerswereinafriendlyneighbourhoods.Inaddition,
95,7% of workers felt safe as living in this local. In addtion, there was a statistically significant association
betweenhealthofworkerandsomesocialcomponentssuchas:maritalstatus,havingchildren,livingconditions,
workingtime,thelevelofstress,fatigue,occupationaldiseaseexamined,andfeltsafeaslivinginthis.
Conclusion:Studyresultsarethefoundationtobringouthealthierpolicies,setupplantohelptheworker,
especiallytohelpimmigranttoimprovetheirmentalandphysicallife,andcontributetoimprovetheproductive
capacityinVietNammodernizationbackground.
Keyword:immigrantworker,socialdeterminantsonthehealthstatus
nhngphnxnglmvic tch bit vi bn
TVN
ngoi. Bn cnh vic thiu quan tm n cc
Theo kt qu mt s iu tra, nghin cu
bnhmntnh,nhngngilaongnhpc
chothynhiungidnnhpckhngc
c th khng n cc ni chm sc y t v
tipcnviiukinnhtt,ncschv
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vsinhmitrng.Hnnacngvicviu
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hn ch trong vic tip cn cc dch v chm
trincngnghipcakhuvcphanamvi28
scsckhe,iukinsngcckhunhtr
khucngnghipanghot.BnhDngthu
cht chi, ti tn, tnh trng dinh dng km
ht rt nhiu dn nhp c t cc a phng
ctcngkhngnhntnhtrngsckho
khc.
cangilaongnhpc.Thmvo,s
Vin V sinh Y T Cng Cng thnh ph
clpcaxhitrongmitrngsngxal
H
Ch Minh phi hp vi vn phng T
cng l yu t gy cn tr vic tip cn, ha
Chc Y T Th gii (WHO) ti Vit Nam ph
nhp vi mng li cng ng ngi dn ti
trch cc chc nng v cc yu t x hi nh
a phng(10. Ngoi ra ngi lao ng cn
hng n sc khe nhm ci thin tnh trng
chunhhngbiccyutnguyc,tchi
sckhecangiVitNam,trongbaogm
ngh nghip ti ni lm vic, c bit i vi
ngilaong.Ktqunghinculcs
nhng ngi c thu lm ti nh hoc
ChuynYTCngCng
559
NghincuYhc
cc nh hoch nh chnh sch c nhng

phng hng, k hoch h tr cng nhn,
cbitlcngnhnnhpcnnhisng
sngvtcngnhtinhthn,gpphnnngcao
nng lc sn xut trong bi cnh hin i ha
catnc.
Mctiunghincu
Xcnhtlcatngyutxhivnh
hng ca cc yu t ny n tnh trng sc
khecacngnhnnhpcxBnhHa,th
xThunAn,tnhBnhDng.
I TNG
NGHINCU
PHNG
PHP
Thitknghincu
Ctngangmt.
Dnsmctiu
Cng nhn nhp c ti x Bnh Ha, th x
ThunAn,tnhBnhDng.
NghincuthchintixBnhHa,thx
ThunAn,tnhBnhDng.
Cmu
400itng.
Nghin cu c tin hnh bng cch
phngvntrctipitngngaytinhtr
hocphngtr.
An,tnhBnhDngtnht1nm(tthng4
nm2010).
KTQUVBNLUN
Tnhtrngsckhecacngnhn
Bng1:Tnhtrngsckhecamukhost(N=
400)
c tnh
Tn s T l (%)
C b bnh
54
13.50
Khng b bnh
346
86.50
Bnh ng h hp
106
26.6
Bnh ng tiu ha
97
24.4
Tin s bnh tt
Bnh tai mi hng
49
12.3
Bnh khc
148
36.7
Tnh trng bnh
tt hin ti
Tnh trng bnh tt hin ti ca cng nhn

chimtll13,5%;ccbnhhinmcchyu
ca cng nhn nh vim d dy, vim xoang,
vimhngylccbnhchyulinquan
tilisngvmitrngsng.
Ccyutxhinhhngnsckhe
cngnhn
cimdnshc
Bng2:Milinquangiacimdnsvitnh
trngsckhe.
Tng
Cc c
(N= 400)
im
N (%)
Kthutchnmu
Lymuhaibc
Chnra4ptrongtngs8pcaxBnh
Ha.
Lp danh sch cc h dn c trong mi p
chn, chn ra 100 h nh tr trong mi p
cm.Hnhtrutincchnngunhin,
h nh tr tip theo c chn theo phng
phpcnglincngchonkhicmu.
itngchnvonghincu
Tnh trng sc
khe chung
ca cng nhn
Tt
N (%)
Khng
Tt
N (%)
Gii tnh
Nam
156 (39) 128 (82) 28 (18)
0.93
N
201
43
244 (61)
(82.4) (17.6)
Nhm tui
18 24
25 30
Trn 30
PR (KTC 95%)
1.01
(0.91 1.1)
176 (44)
147
(83.5)
29
(16.5)
138
(34.5)
114
(82.6)
0.86
24 0.66 (0.62 1.21)
(17.4)
86 (21.5)
68
(79.1)
18
(20.9)
Trnh
hc vn
Ngi c phng vn phi l cng nhn

nhp c ang sinh sng ti phng tr v
ngthamgianghincu.
M ch
Tiu hc
Cng nhn c chn t 1850 tui v c

thigianlaongtixBnhHa,thxThun
Trung hc
c s
164
(41.0)
134
(81.7)
30
(18.3)
Trung hc
128
103
25
560
2 (0.5)
1 (50)
54
66 (16.5)
(81.8)
1 (50)
1.2
12
0.54*
(0.92 1.55)
(18.2)
ChuynYTCngCng
Tng
Cc c
(N= 400)
im
N (%)
ph thng
Trung cp
(32.0)
23 (5.7)
Cao ng
8 (2.0)
Tnh trng sc
khe chung
ca cng nhn
Khng
Tt
Tt
N (%)
N (%)
(80.5) (19.5)
21
2 (8.7)
(91.3)
7 (87.5)
PR (KTC 95%)
i hc
9 (2.3)
Tnh trng
hn nhn
9 (100) 0 (0.0)
c thn
186
(46.5)
48
(67.6)
0.88
23
0.009
(0.81 0.97)
(32.4)
c gia
nh
213
(53.5)
166
(50.5)
163
(49.5)
*Kimnhfisher
Mu nghin cu c 39% l nam v 61% l

n,aslcngnhntr(78,5%ctuit
30trxung,trongnhmtuithanhnintr
1824 tui chim ti 44%. V trnh hc vn,
chyultrunghccsctl41%vtrung
hcphthngctl32%.iunyphhp
vi thc t hin nay ca cc doanh nghip i
hicngnhnctuicntr,nhngkhng
ihitrnhhcvnphicao.
tnhtrngsckhevitnhtrnghnnhnca
cngnhn,vip=0,009vPR=0,88;KTC95%=
0,810,97.Theo cng nhn lp gia nh
c tnh trng sc khe tt ch bng 0,88 ln so
vicngnhncthn.
cimhgianh,phngtr
Bng3:Milinquangiacimhgianhvi
tnhtrngsckhe.
Tnh trng sc
khe chung
Thng tin h Tng ca cng nhn
gia nh/ (N= 400)
Khng
phng tr N (%)
Tt
Tt
N (%)
N (%)
PR
(KTC 95%)
H gia nh
c con nh
C
81
(22.6)
58
(71.6)
0.84 (0.73
23
0.005
0.97)
(28.4)
Khng
278
(77.4)
271
(84.9)
48
(15.1)
ChuynYTCngCng
Tnh trng sc
khe chung
Thng tin h Tng ca cng nhn
gia nh/ (N= 400)
Khng
phng tr N (%)
Tt
Tt
N (%)
N (%)
Mc sng
D d
1
(12.5)
NghincuYhc
15 (3.8)
PR
(KTC 95%)
13
2 (13.3)
(86.7)
Va
188
(47.0)
169
(89.9)
Thiu cht t
123
(30.7)
95
(77.2)
Khng chi
74
tiu
(18.5)
52
(70.3)
1.04 (0.84 1.3)

19
1
(10.1) <0.00
0.86
(0.77
1
28
0.95)
(22.8)
0.78 (0.6722
0.91)
(29.7)

tnhtrngsckhevimcsngcacngnhn
(p<0,05). Nhng cng nhn c mc sng tng
thiu, khng chi tiu a phn l c gia
nh, thu nhp thp, bn cnh cc chi ph
sinhhotinncvimcgicaohnvphi
cu nh in, tr ly tin theo phn vt gy
nn nhiu kh khn v mc sng cho cng
nhn.
Kho st cn cho ta thy c 22,56% cng
nhn c con nh. C mi lin quan c ngha
thng k gia tnh trng sc khe vi h gia
nhcconnhcacngnhn(p<0,05).
iukinnh
Bng4:Milinquangiaiukinnhvitnh
trngsckhe.
Tnh trng sc
Tng khe chung ca
PR
cng nhn
iu kin nh (N=
P
(KTC
400)
Khng
Tt
95%)
Tt
N (%)
N (%)
N (%)
Loi hnh
phng tr
Phng ring c
284
228
56
phng v sinh
1.12
(71)
(80.3) (19.7)
ring
0.023 (1.03
1.21)
Phng ring c
116
101
15
phng v sinh
(29)
(89.9) (10.1)
chung
iu kin sng
1
t nh gi
3.08
Kh khn
91
28
(1.71
63 (69.2)
(22.8)
(30.8) <0.001 5.56)
1.7
Bnh thng
262
229
33
(0.71
(65.5) (87.4) (12.6)
561
NghincuYhc
Tnh trng sc
Tng khe chung ca
cng nhn
iu kin nh (N=
400)
Khng
Tt
Tt
N (%)
N (%)
N (%)
Thun li
47
10
37 (78.7)
(11.7)
(21.3)
N (%)
P
PR
(KTC
95%)
3.79)
S dng ru
bia (n=400)
C
Khng
*Kimnhfisher
cng nhn
Khng
Tt
Tt
N (%)
N (%)
0.95
102
21
(0.85
81 (79.4)
(25.5)
(20.6) 0.385
1.06)
298
248
50
(74.5) (83.2) (16.8)

tnhtrngsckheviloihnhphngtrca
cng nhn (p=0,023). Theo cng nhn thu
phngringnhngcnhvsinhchungctnh
trng sc khe tt hn so vi cng nhn thu
phngringcnhvsinhring.
Mc s
dng ru bia
(n=102)
Ung t

tnhtrngsckheviiukinsngcacng
nhn (p<0,001 v PR = 3,08 ; KTC 95% = 1,71
5,56).Theocngnhnciukinsngbnh
thng c tnh trng sc khe tt hn 3 ln so
vicngnhnciukinsngkhkhn.
Tlcngnhnsdngrubial25,5%
vi mc t (t 1 n 2 chai bia) chim t l
chyul64,7%.Tlccyutnguyctng
ithpcndomunghincuc39%lnam
gii.
Mtsyutvlisng
Bng7:Milinquangiamitrnglaongvi
tnhtrngsckhe.
Bng5:cimhtthuclcacngnhn.
Tnh trng sc
khe chung ca
cng nhn
Tng N
(%)
Khng
Tt N
Tt N
(%)
(%)
Ht thuc l
(n=400)
C
Khng
PR
1.01
41
(0.89
49 (12.3)
8 (16.3) 0.781
(83.7)
1.16)
351 (87.7) 288 (82) 63 (18)
Ht thuc l
mi ngy
(n=49)
C
1.00
(0.68
0.678
36
43 (87.7)
7 (16.3) *
1.47)
(83.7)
6 (12.3) 5 (83.3) 1 (16.7)
Khng
Trung bnh s iu c ht trong 1 ngy: 9 iu 5 iu
*Kimnhfisher
Tlcngchtthucll12,3%.Trongs
c n 87,7% cng nhn ghi nhn l ht
thuc l mi ngy vi s iu c ht trung
bnhmingyl9iu.
Bng6:Tnhhnhsdngrubiacacngnhn.
Tng
562
Tnh trng sc
khe chung ca
PR
Ung va
1.19
66
17 0.209 (0.99
49 (74.3)
1.44)
(64.7)
(25.7)
35
32 (88.6) 4 (11.4)
(35.3)
iukinlaong
Tnh trng sc
khe chung ca
Tng
PR
cng nhn
Mi trng
(N= 400)
P
(KTC
lao ng
Khng
95%)
N (%)
Tt N (%) Tt N
(%)
Ngnh ngh
chnh
Ha cht, m
19 (4.7) 18 (94.7) 1 (5.3)
phm
in, in t 59 (14.8) 55 (93.2) 4 (6.8)
C kh, my
12
0.85
53 (13.3) 41 (77.4)
mc
(22.6) 0.21
(0.67
Dt may, da
46
1.07)
202 (50.5) 156 (77.2)
giy
(22.8)
Nng sn
7
51 (12.7) 44 (86.3)
(13.7)
Khc (bo v,
tp v, li xe 16 (4.0) 15 (93.7) 1 (6.3)
)
Mc lm
1
vic
1.18
Nng nhc
21
59 (14.8) 38 (64.4)
(35.6) <0.00 (0.51
2.72)
1
Kh khn
14
44 (11.0) 30 (68.2)
1.37
(31.8)
(1.13
Bnh thng 297 (74.2) 261 (88.1) 36
1.66)
(11.9)
ChuynYTCngCng
Tnh trng sc
khe chung ca
Tng
cng nhn
Mi trng
(N= 400)
lao ng
Khng
N (%)
Tt N (%) Tt N
(%)
Tip xc cc
yu t c hi
trong mi
trng lao
ng
C
Khng
Khm sc
khe nh k
hng nm
C
Khng
PR
(KTC
95%)
49 (87.5)
1.07
(0.96
0.268 1.2)
290 (72.5) 242 (83.5)
1.06
(0.94
0.308 1.17)
7
(12.5)
64
344 (86) 280 (81.4)
(18.6)
56 (14)
110 (27.5)
87 (79)
48
(16.5)
23 (21)
Ngnh ngh ch yu ti a phng l

ngnhdtmaychimtlas50,5%.
Ktqukhostviukinlaongcn
cho thy cng nhn tha nhn c tip xc vi
ccyutchicn14%.
Khostcntmthycmilinquanc
ngha thng k gia tnh trng sc khe vi
mclmviccacngnhn(p<0,001).Tl
cngnhnckhmsckhenhktini
lmviclkhcao(72,5%.).
Chmscsckhevccdchvsckhe
Bng8:Milinquangiachmscsckhevi
tnhtrngsckhe.
Tnh trng
sc khe
chung ca
Chm sc sc Tng (N= cng nhn
p
khe
400) N (%)
Khng
Tt
Tt
N (%)
N (%)
S dng th
BHYT
C
286
60
346 (86.5)
0.588
(82.7) (17.3)
Khng
43
11
54 (13.5)
(79.6) (20.4)
Ni khm bnh
thng s dng
0.143
Dch v cng
145
38
183 (45.7)
(79.2) (20.8)
ChuynYTCngCng
PR
1.03
(0.89
1.19)
1
1.07
(0.97
1.17)
Dch v cng
theo ch nh
Dch v t
Thi quen khi
mc bnh
Khng lm g c
T mua thuc
n c s y t
NghincuYhc
50
13
(79.4) (20.6)
134
154 (38.5)
20 (13)
(87)
63 (15.8)
1.09
(1.0 1.19)
5 (1.3)
5 (100) (0)
1.24
170
46 0.11* (0.95
216 (54)
1.6)
(78.7) (21.3)
154
179 (44.7)
25 (14)
(86)
*Kimnhfisher
T l cng nhn t i kim tra sc khe
hngnml66,7%.Tlcngnhncbohim
y t l 86,5%. Ni khm cha bnh m cng
nhn thng xuyn s dng l dch v cng
(45,7%)bncnhdchvtcngtlng
k(38,5%).Vthiquenkhimcbnhngch
ltlcngnhntmuathucchimtlkh
cao(54%).
Quanhxhi
Bng9:Milinquangiaquanhxhivitnh
trngsckhe.
Tnh trng
sc khe
Tng chung ca
Quan h x hi (N= 400) cng nhn
P
Khn
N (%)
Tt
g Tt
N (%)
N (%)
Thn thin vi
ngi dn a
phng
C
370
306
64
(92.5) (82.7) (17.3) 0.405
Khng
23
7
30 (7.5)
(76.7) (23.3)
Cm thy an ton
ti a phng
C
383
322
61 (16) <0.001*
(95.7) (84)
Khng
17 (4.3) 7 (41) 10 (59)
PR
(KTC
95%)
1.07
(0.88
1.32)
2.04
(1.15
3.6)
Cngnhncmthycantonkhisng
tiaphngctnhtrngsckhetthn2
ln so vi cng nhn cm thy khng an ton
(p<0,001; PR=2,04; KTC 95% =1,15 3,6). Cho
thy chnh quyn a phng cn tng cng
cngtcmboanninhaphng,vcng
tc truyn thng thay i hnh vi, can thip
563
NghincuYhc
gimtchichonhmitngcnguyccao
nhnghinchchmaty,midm
CcbnhSTDsvthchinkhochgia
nh
Bng10:MilinquangiaccbnhSTD,khoch
hagianhvitnhtrngsckhe.
Tng
STDs,HIV/AIDS v
(N=
K hoch ha gia
400)
nh
N (%)
Bit v mt s
bnh STDs
C
Khng
S dng dng c
trnh thai
C
Khng
253
(63.3)
147
(36.7
Tnh trng
sc khe
chung ca
pcng nhn
value
Khn
Tt
g Tt
N (%)
N (%)
Phnlncngnhnsngcngvigianh
ca mnh (62,3%). Bn cnh c 22,56% s
cng nhn c con nh. C mi lin quan c
nghathngkgiatnhtrngsckhevih
gianhcconnhvmcsngcacngnhn
(p<0,05).
iukinnh
PR
0.97
206
47
0.57 (0.88
(81.4) (18.6)
1.06)
123
24
(83.7) (16.3)
0.89
71
54 (76) 17 (34) 0.097 (0.77
(29.1)
1.03)
173
147
26 (15)
(70.9)
(85)
TlcngnhnbitvmtsbnhSTDsl
63,3%vtlcngnhnncsdngdngc
trnhthail29,1%.Ccdngctrnhthaiang
csdngchyulbaocaosu,thucung
v t vng. Phn ln cng nhn nhp c c
tui i rt tr, sng t do, trnh vn ha
thp,chyulaongphthngnntciu
kintipcncccphngtintruynthng
gio dc sc khe nn kin thc v phng
chngccbnhStdsvHIV/Aidsivihrt
m m, thm ch cha nhn thc c tc hi
canhngbnhlytruyn.
KTLUN
ctnhmunghincuc39%lnamv
61% l n, a s l cng nhn tr 78,5% c
tuit30trxung,trongnhmtuithanh
nintr1824tuichimti44%.Vtnhtrng
hnnhnthcti53,5%cngnhnlpgia
nh.Cmilinquancnghathngkgia
tnh trng sc khe vi tnh trng hn nhn:
cngnhnlpgianhctnhtrngsckhe
ttthphn0,88lnsovicngnhncthn.
564
Thngtinphngtrcacngnhn
Huhtcngnhnthuphngringcnh
v sinh ring (71%) v phng ring c nh v
sinhchung(27,3%)Cmilinquancngha
thngkgiatnhtrngsckheviloihnh
phng tr ca cng nhn (p<0,05). C mi lin
quan c ngha thng k gia tnh trng sc
kheviiukinsngcacngnhn(p<0,05).
Mtsyutlisng
Phntrmnhngcngnhnhinanght
thucl12,3%;nhngtrongscn87,7%
cng nhn ghi nhn l ht thuc l hng ngy
vi s iu c ht trung bnh mi ngy l 9
iu5iu.Cn25,5%scngnhnhin
c s dng ru bia. Khng tm thy mi lin
quan gia tnh trng sc khe vi li sng ca
cngnhn.
iukinlaong
C 14 % cng nhn lm vic c tip xc
thngxuynviyutchitinilmvic.
Cmilinquancnghathngkgiatnh
trng sc khe vi mc lm vic ca cng
nhn(p<0,05).
Chm sc sc khe v tip cn dch v

chmscsckhe
T l cng nhn khng kim tra sc khe
hng nm l 33,3%. T l cng nhn khng c
thbohimytl13,5%nguynnhnchyu
l do c quan ch qun khng cung cp. T l
cng nhn s dng dch v cng l 45,7%; k
n dch v t l 38,5%. Khng tm thy mi
linquangiatnhtrngsckhevichmsc
vtipcndchvchmscsckhe.
ChuynYTCngCng
NghincuYhc
Quan h x hi vi ngi dn ti a
phng
c bit l cung cp bo him y t, khm bnh

nghnghipnhkchocngnhn.
Nghin cu ghi nhn c c n 92,5%

cng nhn c ngi dn a phng i x
thn thin ha nh, bn cnh 95,7% cng
nhncmthyantonkhisngtiniy.C
mi lin quan c ngha thng k gia tnh
trng sc khe vi s an ton ti a phng
cacngnhn(p<0,001;PR=2,04;KTC95%=1,15
3,6).
Cc doanh nghip nn thng xuyn t

chcccbuinichuynvantonvsinhlao
ng, bnh ngh nghip gip ngi lao ng
nhn r nhng yu t nguy c nh hng sc
khe nh cc yu t c hi trong mi trng
lao ng, cng nh quyn li khi khm bnh
nghnghip.
TILIUKHAMKHO
Cc bnh ly nhim STDS, HIV v thc

hinkhochhagianh
TlcngnhnbitvmtsbnhStdsl
63,3% v cc bin php phng nga tng i
cao(97%chorngquanhchungthystrnh
cccbnhlynhim,72%chorngsdng
bao cao su) T l cng nhn n c s dng
trnhthail29,1%,ccdngctrnhthaiang
csdngchyulbaocaosu,thucung
vtvng.
1.
2.
3.
4.
5.
KINNGH
Trchtcnnngcaonhnthcchongi
laongnhpc,trongcncngnhnlao
ngvivictptrungvonidungphplut,
kinthcxhi,hpnglaong,bohim
xhi,bohimyt,antonvsinhlaong
vchnhschlaongn.
Tng cng cc hot ng t vn, tuyn
truyn lu ng ti doanh nghip khu cng
nghip, khu ch xut gip ch doanh nghip
nhn thc r hn vic thc hin nghim chnh
phplut,cbitlthchinttvicqunl
sckhecngnhnvvsinhantonlaong,
6.
7.
8.
9.
10.
11.
GwatkinDvcngs.(2000).Skhcbitvkinhtxhi
trongdinhdng,sckhevdnsVitNam.Chuyn
inghocaNgnhngThGii.
Joan B, Carles M, Vilma S (2007). iu kin lm vic v bt
cngyt.WHO,2007.
LHongNinh,LVinh,VTrngThinvcngs(2007).
Ccyutxhilinquannsckhe.WHObulettinon
socialdeterminants,WHO&VinVsinhYtcngcngtp
HChMinh,2007.
L Hong Ninh, Phng c Nht, Dng Th Minh Tm.
(2010).Nghincuhnhvisckhevtnhtrngsckhe
cdntnhBnhDngnm2009.TpchYHcTP.HCh
Minh,Tp14phbns22010:trang8691.
OrielleS,AlecIvcngs(2005).Hngnkhinimc
cutrongphntchvhnhngtrongccyutxhinh
hng sc khe. U ban cc yu t x hi nh hng sc
khe,2005.
Richard W, Michael M (2003). Cc yu t mi trng v x
hi lin quan n sc khe. Trung tm sc khe v x hi
quc t. Trung tm sc kho thnh th Vn phng i din
WHOtikhuvcChuunm2003.
Tchclaongquct(2004).Hngnmtthathun
cngbngchongilaongnhpctrongnnkinhtton
cu. Hi ngh lao ng quc t, k hp th 92, bo co VI,
nm2004.
TchcYTThgiikhuvcTyThiBnhDng.(2006).
Hanhpinghovgiitnhvochngtrnhyt.Phn
hcbnvingho,1315.
Tngccthngk,QuDnsLinHpQuc(2004).Cht
lngcucsngcangidictiVitNam.Khostvdi
cVitNamnm2004:Nhngphthinchyu.
Trung Tm Bo V Sc Khe v Mi Trng Bnh
Dng.(2010),Bocotngktnm2008,2009,2010.
y ban Kinh T v X Hi v Chu Thi Bnh Dng
(2003). Di c v i ngho Chu : Bangladesh, Trung
Quc,PhilippinesvVitNam.Bangkok,nm2003.
ChuynYTCngCng
565
NghincuYhc
KHUPHNMUINCANGITRNGTHNHTIHNI,
THATHINHUVTHNHPHHCHMINH
VThThuHin*,LThHp*,NguynThLm*,ThNgcDip**,PhanThLinHoa***
TMTT
tvn:Khuphnmuin(NaCl)cchngminhlmttrongnhngyutnguyccabnh
tnghuytp(THA).Tuynhin,hnmtthpkqua,chacnghincunhgilngtiuthmuica
ngiVitNamtrnquymln,trongkhitlTHAanggiatngncta.
Mc tiu:XcnhkhuphnmuiNaCltronggiavcangitrngthnhtiHNi,ThaThin
Hu,vthnhphHChMinh.
Phngphpnghincu:nghincuctngangmtctrinkhaitrongnm20082009.Tngs
1518ngit20tuitrlnthamgianghincu.Khuphngiavcthuthpbngphngphpcn
ongtigianh.HmlngNatritrongtnggiavcphntchbngphngphpscklngcaop,t
tnhchmlngmuintronggiavdavotrnglngphntcaNaCl.Khuphnmuin
ctnhtonbngkhuphngiavxhmlngmuintronggiav.
Ktqu:Khuphnmuitrungbnhitngnghincul11,75,5g/ngy,khngcskhcnhau
gianngthnvthnhth.Khuphnmuitrungbnhnam(12,7g/ngy)caohncnghathngkso
vin(10,5g/ngy),p<0,05.KhuphnnycaonhtThaThinHu(12,3g/ngy),saunthnhph
HChMinhvHNi(tngngl11,1v10,7g/ngy).
Ktlun:Khuphnmuicangitrngthnhticcaimnghincuucaohngp2lnso
vikhuyncocaTchcYtThgii.Cncnhngnghincucanthiptrongnhngnmtigim
khuphnmui,gpphndphngtnghuytpchocngng.
Tkha:Khuphnmuin,ngitrngthnh.
ABSTRACT
SODIUMSALTINTAKEINADULTSINHANOI,THUATHIENHUE,ANDHOCHIMINHCITY
VuThiThuHien,LeThiHop,NguyenThiLam,oThiNgocDiep,PhanThiLienHoa
Background: Sodiumsaltintakehasbeenwidelyknownasoneoftheriskfactorsofhighbloodpressure.
However,therehasnotbeenanylargesurveyonsodiumsaltconsumptioninwholecountrysinceover10years,
whileprevalenceofhighbloodpressurehasbeenincreasinginVietnam.
Objectives: toassesssodiumsaltintakeinseasoningsinadultslivinginHanoicapital,ThuaThienHue
province,andHoChiMinhcity.
Methods:Acrosssectionalstudywasconductedin20082009.Atotalof1518subjectsparticipatedinthe
study. Seasoning intake was evaluated by weighing method at household. Sodium content in seasonings was
assessedbyHighperformanceliquidchromatography(HPLC)method,thensodiumsaltcontentintheseasoning
was calculated based on molecular weight of NaCl. Therefore, sodium salt intake was equal to amount of
VinDinhDng
TrungtmDinhDngTp.HChMinh
TrungtmYtDphngThaThinHu
Tcgilinlc:TS.VThThuHin
T:0983640470 Email:hienvuthithu@yahoo.com
566
ChuynYTCngCng
NghincuYhc
seasoningsmultiplywithcontentofsodiumsaltintheseasonings.
Results: Mean sodium salt intake in studied subjects was 11,7 5,5 g/ day. There was no significant
difference of salt intake between urban and rural areas. Mean sodium salt intake in males (12,7 g/ day) was
higher than that in females (10,5 g/ day), p< 0,05. The intake was highest in Thua Thien Hue (12,3 g/ day),
followedbyHoChiMinhcity(11,1g/day)andHaNoi(10,7g/day).
Conclusion: In conclusion, sodium salt intakes in adults in studied sites were 2 times higher than
recommendationofWorldHealthOrganization.Interventionstudiesshouldbeconductedinfuturetoreducesalt
intakeinordertocontrolhighbloodpressureincommunity.
Keywords:Sodiumsaltintake,adult.
TVN
KhuphnmuiNatri(haycngilmui
n,ccngthchahclCloruaNatri:NaCl),
tlucthanhnlmtyutnguyc
ng k vi bnh tim mch v tng huyt p
(THA)(8). V vy, gim khu phn mui Natri
ckhuyncolgiiphpkhngdngthuc
hiu qu nht trong iu tr v d phng
THA(7,1). Khuyn co ca T chc Y t Th gii
(WHO)lkhuphnmuiNatringitrng
thnh nn hn ch mc < 5g/ ngy (tng
ng vi < 2g Natri) gp phn gim nguy
cTHA,bnhtimmchvtqu(10).
MuiNatritlucdngiansdng
nhlmtgiavlmtngsngonmingvv
m ca mn n. Tuy nhin, nghin cu
nhgithctrngkhuphnnmuiNatri
ngi Vit nam cn rt t, do vic nh lng
muitrongkhuphnrtkhkhnvcnhiu
sai s. Kt qu nghin cu ca tc gi L Vit
nh nm 1990 ti tnh Khnh Ha cho thy:
lng NaCl trung bnh l 9,5 2,0 g/ ngy/
ngi. Theo tc gi Phan Th Kim v cng s
nm 1993 th khu phn ny ngi trng
thnh t 15 tui tr ln l 13,9 1,7 g/ ngy/
ngi, cao hn nhiu so vi mc khuyn co
ca T chc Y t Th gii(4,5). T n nay
cng cha c nghin cu nh gi lng tiu
thmuicangiVitnamtrnquymln,
trongkhitlTHAanggiatngncta(9,2).
Vvy,chngtitinhnhnghincutmhiu
v khu phn n mui Natri ca ngi trng
thnht20tuitrln,tiHNi,ThaThin
Hu, v Thnh ph H Ch Minh, nhm cung
ChuynYTCngCng
cp s liu cho cc can thip cng ng d

phngtnghuytp.
I TNG
NGHINCU
PHNG
PHP
Thitknghincu
Ctngangmt.
Thigianvaim
Tthng10/2008thng2/2009,tiHNi,
ThaThinHu,Tp.HChMinh.
itngnghincu
Ngi trng thnh t 20 tui tr ln,
thngxuyndngbantigianh.Khng
chnnhngphnmangthai/angchoconb
vngiangcchnking,hocangc
nhimtrngcptnhtithiimiutra.
Cmuvphngphpchnmu:
Cmu
Tnhtheocngthcctnhkhuphn:
N=Z21/2(2/e2)
Trong:nlcmu,z=1.96vi=0.05,
llchchun(ctnh=2,0davonghin
cu trc), e l sai s c lng gia gi tr
trungbnhcamusoviqunth,ctnhl
0,26.
Do , tng s i tng cn thit cho
nghincul227ngi/cmiutra.Saukhi
cng thm khong 10% cho nhng i tng
khngtyucuvviclcdliuthtngs
i tng nghin cu l 255 ngi/ cm iu
tra.Nhvy,tngsitngnghincucn
thitcho3tnhthnhl:255ngi/cmx6cm
=1530(ngi).
567
NghincuYhc
Phngphpchnmu:
Ti mi tnh, chn 1 phng i din cho
thnhthv1xidinchonngthntin
hnhiutra.
Sdngphngphpchnmunhiugiai
onlachnhgianhvccitng,
viccbcnhsau:
Bc1:Chn3tnhthnhlHNi,Tha
ThinHuvTp.HChMinh.
Bc 2: Ti mi tnh thnh, tin hnh chn
ngu nhin mt x nng thn v 1 phng
thnhthtdanhschccphng/xcatnh
tinhnhnghincu.
Bc3:Lpdanhschcchgianhtrong
phng/xcchnvnhmschotng
hgianh.Tdanhsch,chnhgianh
utinbngcchchnmtmsngunhin.
Tt c ngi trng thnh t 20 tui tr ln
tronghgianh,pngcctiuchun
chn mu, c mi tham gia nghin cu.
Sau,dngphngphpvtduloang
tipcnvchncchgianhtiptheochoti
khilachnc250ngitrngthnht
20tuitrlnchomiphng/x.
Phngphpvkthutpdng
Tui, trnh hc vn, ngh nghipc
thuthpbngphngphpphngvn
Khuphnccchtdinhdngcnh
gibngphngphphighi24giquatrong
3ngylintip.
Khu phn gia v: thu thp bng phng
php cn ong ti gia nh trong 3 ngy lin
tip, s dng loi cn thc phm vi chnh
xc 1g. Nghin cu vin n nh i tng
cnttccclgiavtrckhichbinmnn
vsaukhigianhnxongba.Khuphn
gia v ca c gia nh c tnh bng hiu s
trng lng ca l gia v trc v sau. Khu
phngiavcaitngctnhbngkhu
phn gia v ca c gia nh x h s n ca i
tngsovicgianh.
Xc nh hm lng mui Natri trong cc
gia v: nghin cu vin thu thp tt c cc loi
568
giavmitngsdngvgisangNht
phn tch hm lng Natri bng phng
php sc k lng cao p (HPLC). Sau tnh
hm lng mui Natri trong gia v da vo
trnglngphntNaClvhmlngNatri,
theo cng thc: hm lng mui Natri = hm
lngNatrix2,54.
Khu phn mui Na = khu phn gia v x
hmlngmuiNatritronggiav.
Ghich
Trongnhngngyiutra,lngmui/gia
v m gia nh thng dng nu thc n
ngvt,vlngmui/giavdngchocc
mc ch khc nh: ra dao, ra c, nh
rngcyucuring.
Trongnhngngyiutra,itngc
yu cu n ti gia nh. Trong trng hp i
tng v l do khch quan m phi n ba n
ngoi gia nh th i tng c loi b
khiphntchthngk.
Xlvphntchsliu
S liu c nhp bng phn mm EPI
INFO, khu phn c nhp v c tnh bng
phn mm ACCESS. X l s liu bng phn
mm SPSS. Trc khi s dng php phn tch
thngk,sliuckimtraxemcphnb
chun hay khng. Vi nhng bin phn b
khng chun, php bin i Log c s
dnghiuchnh.DngTestTsosnhcc
strungbnhvvTestKhibnhphngso
snhcctl.
KTQUNGHINCU
C12itngnngoigianhtrong
qutrnhiutra.Nhvy,ktquctrnh
byvitngs1518itngthamgianghin
cu,trongc702namv816n.
Bng1:cimchungcaitngnghincu
Bin s
Tui (nm)
Trnh hc vn < lp 5 (%)
Ngh nghip chnh l lao ng
nng (%)
Nng lng khu phn (Kcal)
Thnh th Nng thn

(n = 716)
(n = 802)
45,7 (15.6) 45.5 (15.6)
13.4
27.0**
13.7
21.6**
1966 (510) 1898 (463)*
ChuynYTCngCng
SliuctrnhbydidngTrungbnh(SD)hoc
%.SosnhgianngthnvthnhthbngTestThoc
TestKhibnhphng.*:p<0,05**:p<0,01.
nTp.HChMinh(11,1g/ngy)vHNi
(10,7g/ngy).
Tuitrungbnhcaitngl45,6(nm).
TheoktquBng1,khngcskhcnhauc
nghathngkvtuigiakhuvcthnhth
v nng thn. Nng lng khu phn nng
thn thp hn c ngha so vi thnh th (p<
0,05).Tlitngctrnhhcvnthp(<
5 nm i hc) v c ngh nghip chnh l lao
ngnngnngthncaohnsovithnh
th(p<0,01).
Bng2:KhuphnmuiNatritheoaimnng
thnthnhth(g/ngy)
Thnh th (n = 716)
11,5 (5,8)
Nng thn (n = 802)

12,0 (5,1)
Chung
11,7 (5,5)
SliuctrnhbydidngTrungbnh(SD).
Khu phn mui Natri trung bnh c 3

tnh/ thnh l 11,7 5,5 g/ ngy, khng c s
khcnhaucnghathngkgianngthn
vthnhth(Bng2).
Bng3:KhuphnmuiNatritheogii(g/ngy)
Nam (n = 702)
12,7 (5,6)
N (n = 816)
10,5 (6,4)
P
0,04
SliutrnhbydidngTrungbnh(SD).Sosnh
gianamvnbngStudentTtest
KtquBng3chothy:Khuphnmui
trungbnhnaml12,7g/ngy,caohnc
nghathngksovin(10,5g/ngy),vip<
0,05.
Khu phn m ui (g/ ngy)
12.5
12
12.3
11.7
11.5
11.1
11
10.7
10.5
10
9.5
Chung
H Ni
TT Hu
Tp. HCM
Hnh1:KhuphnmuiNatritheotnh/thnhph
Hnh1chothy:KhuphnmuiNatricao
nht Tha Thin Hu (12,3 g/ ngy), sau
ChuynYTCngCng
NghincuYhc
BNLUN
Khu phn mui Natri trung bnh i
tngnghincul11,75,5g/ngy,thphn
so vi nghin cu trc ngi trng thnh
Vit nam(5), nhng vn cao gp i so vi
khuyn co ca WHO(10). y l mt gi d
bominguycngkivibnhtimmch
vcaohuytpVitnam.Ktqucachng
ti cng ng thun vi cc nghin cu cc
nckhcl:KhuphnmuiNatrinamgii
caohncnghathngksovingii(3).
So vi cc nc xung quanh, khu phn mui
Natri ca ngi nam trng thnh Vit nam
(12,7 g/ ngy) thp hn ngi cng tui
HnQuc(13,6g/ngy), tng ng vi Bc
Kinh Trung Quc (12,7 g/ ngy), cao hn
OsakaNhtBn(10,7g/ngy)(3).
im mnh ca nghin cu l: c mu
ln, c chn theo phng php ngu nhin
phntngti3tnh/thnhidincho3min
Bc,Trung,Nam.Phngphpthuthpsliu
sdngcnthcphmvichnhxcti1g.
Hnna,ylnghincuutinVitnam
s dng phng php phn tch trong Labo
(phng php HPLC) phn tch hm lng
Natri trong tng loi gia v m i tng s
dng,tkthp vi cn ong lng gia v
mitngsdngtigianhtnhton
khuphnmuiNatri.ylimmnhnht
canghincu.
Tuy nhin, phng php nh gi khu
phn mui Natri n vo bng cn ong lng
muichbinvthmvobanchaphil
phng php l tng nht c tnh khu
phn Natri v nguy c bnh tim mch. Mt
lng khng nh Natri t cc thc phm cng
gp phn lm tng nguy c ca bnh ny.
PhngphpnhlngNatritrongnctiu
24 gi s gip c tnh c chnh xc khu
phn Natri v mi lin quan vi bnh tim
mch(6).Nhngphngphpsrttnkm
vkhkhthicngngvicmuln.V
569
NghincuYhc
vy, chng ti tin rng, vi c mu ln v cc

phngphpphntch/thuthpsliuchun
xc ti c Labo v cng ng, s liu ca
nghincunymangtnhidincao,cthl
csdliuchocccanthipdphng.
Mc d vy, nghin cu cng c hn ch l
khng nh gi c hm lng mui trong
da/ c mui sn. Tuy nhin, s i tng n
da/ c mui sn trong nhng ngy iu tra
khngngknnkhngnhhngnhiun
ktqunghincu.
2.
3.
4.
5.
KTLUN
Khu phn mui Natri trung bnh i
tng nghin cu l 11,7 5,5 g/ngy, cao hn
gp2lnsovikhuynnghcaWHO.
Khu phn mui nam (12,7 g/ ngy) cao
hnsovin(10,5g/ngy),p<0,05.
6.
7.
KHUYNNGH
Cn c nhng nghin cu can thip v
truyn thng cho cng ng hn ch s dng
gia v c mui cho ba n d phng tng
huytp.
8.
9.
TILIUTHAMKHO
1.
570
HeFJ;MarciniakM;VisagieE,etal(2009).EffectofModest
Salt Reduction on Blood Pressure, Urinary Albumin, and
Pulse Wave Velocity in White, Black, and Asian Mild
Hypertensives.Hypertension;54:482.
10.
HoangVM,ByassP,DaoLH,NguyenTK,WallS(2007).Risk
factors for chronic disease among rural Vietnamese adults
and the association of these factors with sociodemographic
variables: findings from the WHO STEPS survey in rural
Vietnam,2005.PrevChronicDis;4(2):A22.
JoossensJV,HillMJ,ElliottP,etal(2010)DietarySalt,Nitrate
andStomachCancerMortalityin24Countries.International
JournalolEpidemiology;Vol.25,No.3;2010,pp.49450.
LVitnh(1991).iutralngmuintrongkhuphn
hngngyviaphngvngngbngminbintnh
KhnhHo/LKhnhHoNikhoaNm1991,s3,tr.6
10.
PhanThKim,NguynThLm,HongThYt,TrnNgc
H,NguynThanhH(1993).Tmhiulngmuinvo,
thiratheonctiu24givbnhtnghuytpmts
aphng.Tpchvsinhphngdch,tpIII,s3(11);47
50.
Polnia J, Maldonado J, Ramos R, Bertoquini S, Duro M,
AlmeidaC,FerreiraJ,BarbosaL,SilvaJA,MartinsL(2006).
Estimation of salt intake by urinary sodium excretion in a
Portuguese adult population and its relationship to arterial
stiffness.RevPortCardiol.;25(9):80117.
Sacks FM, Svetkey LP, Vollmer WM, et al (2001). Effects on
blood pressure of reduced dietary sodium and the Dietary
Approaches to Stop Hypertension (DASH) diet. DASH
Sodium Collaborative Research Group. NEnglJMed; 344:3
10.
Schrder H, Schmelz E, Marrugat J (2002). Relationship
between diet and blood pressure in a representative
Mediterraneanpopulation.EurJNutr;41(4):1617.
TranTM,KomatsuT,NguyenTK,NguyenVC,YoshimuraY,
TakahashiK,WariishiM,SakaiT,YamamotoS(2001).Blood
pressure, serum cholesterol concentration and their related
factorsinurbanandruralelderlyofHoChiMinhCity.JNutr
SciVitaminol(Tokyo);47(2):14755.
World Health Organization (WHO), 2007. Reducing salt
intakeinPopulation.ReportofaWHOforumandTechnical
meeting,Geneva.
ChuynYTCngCng
NghincuYhc
RILONCXNGNGHNGHIPVCCYUTLINQUAN
NCNGNHNTICNGTYCHBINTHYSNTNHB
RAVNGTUNM2011
LThHiYn*,TrnhHngLn
TMTT
tvn:RLCXlmtloibnhlgyracmgicaunhc,mtmichocngnhnlmvictrongt
thgbtrongmtthigiandi,tnhhngnhiusutlmviccah.Ngnhchbinthysnl
ngnhmtrongcngnhnphilmvicvitthngtrongthigiandi,vvycnguycmcRLCX
cao.TiBRaVngTuccnghincuvRLCXcngnhnchbinthysnchac,vvynghincu
ctinhnhtmhiuthctrngcngnhtmragiiphpphngngaRLCXcngnhn.
Mctiu:XcnhctlbnhRLCXnghnghipvccyutlinquanncngnhncngtych
binthysnBRaVngTu.
Phngphpnghincu:Tinhnhnghincuctngangmttrn419ncngnhnticngtych
binthysnBRaVngTu.Nghincusdngbcuhingphngvntrctipccncngnhn.
Kt qu: T l RLCX ca cng nhn rt cao ln n 85,4%. Cc RLCX ch yu l au nhc vai phi
(48%),vaitri(46,5%),cngchnphi(42,2%)vvngthtlng(33,2%).Ccyutnguyccthlmtng
nguycRLCXcngnhnchbinthysnbaogm:mkhngtchun,thigianlmvic,tthlm
vic,thigiannghgiaca,tnhchtcngvic.
Ktlunvkinngh:CngtychbinthysnBRaVngTucnthchinccbinphpsauci
thiniukinlaongvphngchngRLCXchongilaong:nntchccckhongnghngn(510
pht)saumikhongthigianlaongkhong120pht;tchctpthdcchocngnhn10pht/ln;to
iukinchocngnhnthngxuynthayitth,cthbtrghngicaochocngnhntrongcalm
vic.
Tkha:Riloncxngnghnghip,cngnhnchbinthysn
ABSTRACT
OCCUPATIONALMUSCULOSKELETALDISORDERSANDRELATEDFACTORSAMONG
SEAFOODPRODUCTIONFEMALEWOKERSOFBARIAVUNGTAUSEAFOODPROCESSING
FACTORYIN2011
LeThiHaiYen,TrinhHongLan
Background: Occupationalmusculoskeletaldisorders(OMDs)areconditionsthatcausesachesandpains
forworkerswhoworkwithrestrictedpostureforalongtimeandresultsinadecreaseofworkersperformance.
Seafoodprocessingisanindustryinwhichworkershavetoworkinstandingpostureforalongtime,sotheyhave
ahighpossibilityofacquiringOMDs.InBaRiaVungTauprovince,therearenotanystudiesonOMDsamong
seafood production workers. Hence, this study is carried out to explore the prevalence of OMDs among these
workerssothattheauthoritiescanfigureoutpropermeasurestopreventOMDsamongthem.
Objectives:IdentifytheprevalenceofOMDsandrelatedfactorsamongseafoodproductionfemaleworkers
ofBaRiaVungTauseafoodprocessingfactory.
Tcgilinlc:BS.LThHiYn
T:0972164497 Email:bshaiyen@gmail.com
ChuynYTCngCng
571
NghincuYhc
Methods: A crosssectional study was conducted on 419 female workers of BaRiaVungTau seafood
processingfactory.Astructuresquestionnairewasusedtocollectdatathroughfacetofaceinterviews.Thedata
wasentriedwithEpi.Dataver3.12andanalysedwithStataver10.0.
Result: The proportion of OMDs of female workers was extremly high (85.4%). Main OMDs symtoms
wererightshoulderpains(48%),leftshoulderpains(46.5%),rightlegpains(42.2%),andwaistpains(33.2%).
FactorsthatincreasedtheriskofOMDsincludedhighmoisture,workingtime,workingpostures,breakstime
betweenshifts,andkindsofwork.
Conclusion:ThefactoryshouldimplementfollowingmeasurestopreventOMDsfortheirworkers:short
breaks(about510minutes)shouldbeappliedbetween120minutesshifts,workersshouldhavetimetochange
theirposturefrequently,andworkersshoulddo10minutesexercisesineachshift.
Keywords:Occupationalmusculoskeletaldisorders,seafoodproductionworkers.
T nhng bt cp ny cng vi thc t l ti
TVN
tnh B Ra Vng Tu cha c cng trnh
Cc cng trnh nghin cu trn th gii v
nghincunovRLCXtrongngnhchbin
ri lon c xng (RLCX) cho thy RLCX l
thy sn, chng ti nhn thy cn thit phi
bnh l thng gp nhng ngi phi lm
tinhnhnghincuvtnhtrngRLCXngh
vic nhng t th lao ng kh khn, g b
nghipcngnhnchbinthusnt
kodilintc,trongtththnggpnht
a ra mt s gii php phng chng RLCX
ltthnghocngilintctrongnhiugi
cho cng nhn, ng thi gp phn mang li
lin.nhhngcaRLCXhimkhigyracc
s n nh sc kho cho ngun nhn lc
trnghptainnlaongnnghaytvong,
ngnhchbinthysntiBRaVngTu.
nhng n lm cho ngi lao ng phi chu
ITNGPHNGPHPNGHINCU
ng s au mi nhiu v tr trn c th.
BirtishColumbia,ctihn50%ccvnv
ylmtnghincuctngangmtvi
sckhocangilaongldoRLCX(12,3).
i tng l n cng nhn c tui ngh trn 1
nmanglmvicticngtychbinthysn
Ngnh ch bin thu sn l ngnh cng
tnh B Ra Vng Tu c mt ti thi im
nghiptrongcngnhnlunphigitth
nghincutngy09/413/4/2011.
hai cnh tay gn nh c nh thao tc bc
tmhocccthaotctvnnghnnhnglp
i lp li nhiu ln sut ca lm vic cng gy
au mi vai, cnh tay, c tay, cng tay, c v
ngntay.iunydnncngnhncnguy
ccaomcRLCX.
TitnhBRaVngTu,ngnhchbin
thusnc10cngtyvihn4000ngilao
ng.Trongnhngnmqua,cngtychbin
thusnBRaVngTuchphnhy
vickhmsckhenhk,khmbnhngh
nghip cho cng nhn. Trong cc t khm
sc khe nh k, tnh trng RLCX ca cng
nhnchacthngky,tronghs
khmsckhonhkchghinhnmtcch
chung chung mt vi triu chng ca c
xngkhpmkhngcchnoncth.(13)
572
Cmunghincu
Lymutonbivicngnhn.Ngoi
ra nghin cu cn ly mu mi trng trong
cngty.
Sdngphngphpphngvntrctip
vi b cu hi ng i vi cng nhn. Ring
ivimitrnglaong,sdngcccng
c o lng chnh xc o lng cc ch s
nhit,m,vntcgi,tingn,bi,nh
sng,inttrng,ticcvtrlmvicvn
phngvsnxutcacngty.
KTQUVBNLUN
Cc c tnh dn sx hi hc ca mu
nghincu
Bng1:Ccctnhcamunghincu(n=419)
ChuynYTCngCng
c tnh
Tn s (n)
Tui
20
26
21-30
264
31-40
93
>40
36
Trnh hc vn
Cp 1
11
Cp 2
208
Cp 3
158
THCN, C, H
42
C s lm vic
C s 1
85
C s 2
334
Thm nin lm vic
1-5 nm
224
6-10 nm
96
10-15 nm
22
>15 nm
77
T l (%)
6,2
63,0
22,2
9,6
2,6
49,7
37,7
10,0
20,3
79,7
53,5
22,9
5,2
18,4
tuichimtlnhiunhtl2140tui
(85,2%) trong nhm tui 2130 chim n
63%. Kt qu ny tng t vi mt s nghin
cu trong v ngoi nc.(11,1,10,7) Kt qu cng
phhpvithctvngnhchbinthusn
lmtngnhihicngnhnphictui
tr,nhanhnhn,thchhpvicngvicihi
s kin nhn v kho lo. C n 87,4% i
tngctrnhtcp3trxung.iuny
cng ph hp thc t v trong ngnh ch bin
thu sn, cng nhn ch yu l lao ng th
cng nn khng i hi trnh hc vn cao
trckhivolm.
V thm nin lm vic, c n 76,4% i
tnglmvict110nmnhngasl15
nm (53,5%). Kt qu ny tng t vi mt s
nghincutiVitNam(11,10).
Ccyutviukinlaongvchm
scsckhecamunghincu
Bng2.Ccyutviukinlaongvchmsc
sckhecngnhn(n=419)
Yu t
Tn s (n)
Mi trng lm vic
Qu lnh
39
Lnh
316
Bnh thng
64
Bo h lao ng
y
310
ChuynYTCngCng
T l (%)
9,3
75,4
15,3
74,0
NghincuYhc
Tng i y
102
Khng y
7
Thi gian lm vic
8h
190
>8h
229
Khm sc khe nh k
C
419
Khng
0
Khm bnh ngh nghip
C
393
Khng
26
Tnh trng sc khe
Tt
166
Kh
153
Trung bnh
100
Yu
00
o to, hun luyn v ATVSL
C
401
Khng
18
24,3
1,7
45,4
54,6
100,0
0,0
93,8
6,2
39,6
36,5
23,9
0,0
95,7
4,3
Kho st v cc yu t lin quan n iu

kin lao ng bao gm mi trng lm vic,
trangbbohlaong,iukinnilmvic,
miquantmcithinmitrnglmvicca
cng ty u cho thy kt qu kh quan. iu
nychothy,mcdccyutnycnh
gidatrnssnhnnhncaphangilao
ng, song phn no ni ln s quan tm ca
ngisdnglaongtrongviccithiniu
kinnilmvic.
T l nhn cng lm vic > 8 gi/ngy cao
hn < 8 gi/ngy (54,6% so vi 45,4%). L gii
iu ny l do thi im kho st l vo ma
caoimccnthngnhiunnnhncng
philmtngca>8gi/ngy.ylmttrong
nhngyutnguycgyRLCXchonhncng
vlmtngthigianthchinccthaotctnh
cacngnhn.
Tlkhmsckhenhk,laongbnh
ngh nghip, v tp hun v ATVSL rt cao
(ln lt l 100%, 93,8%, 95,7%). iu ny cho
thysquan tm n sc khe ca nhn cng
cng nh s tun th cc quy nh ca php
luttrongsdnglaongticngtychbin
thy sn B RaVng Tu. Hng nm, cng ty
u t chc khm sc khe v o to v
ATVSLchocngnhn(2,13).
573
NghincuYhc
Cc yu t khc lin quan n cng vic

camunghincu
c im mi trng lao ng ca hai c

ssnxut
Bng3.Ccyutlinquanncngvic(n=419)
Bng4.Ktquokimtramitrnglaongti
2cscacngtychbinthusn
Yu t
Tn s (n)
T th lao ng ch yu
ng
356
Lun thay i
63
Cc t th lao ng kt hp
Ci
239
Vn mnh
34
Nhoi ngi
189
Tnh cht cng vic
n iu, lin tc
260
n iu, ngt qung
32
a dng, lin tc
127
Ngh gia ca
C
419
Khng
00
Tp th dc gia ca
C
0
Khng
100
T l (%)
85,0
15,0
57,0
8,1
45,1
62,1
7,6
30,3
100
0,0
0
100
Tthlaongchyucaccitngl
tthngchimn85%.Laongtth
ng i hi s cng thng c nhiu hn km
theokchthcvngvnngkhngthchhp
cthdnnmtsbnhltthny.Mt
khc,dophiduytrtthngtrongmtthi
giandinnngi lao ng s chng mt mi
hnsovilaongtthngi.Bncnh,
tnh cht cng vic n iu (69,7%) gp phn
gy nn s nhm ln nh hnh v thi gian,
khincngnhnscmthythigiandihn,
tcthrivotrngthicchthnkinh
vbunnglmgimnngsutlaong(8).
Thi gian ngh gia ca ca cng nhn trc
tip<60phtchimtllnn93,8%.yl
qui nh chung v thi gian ngh hin nay ca
cccssnxutchbinthyhisn.Ngoi
ra,100%cngnhnkhngtpthdcgiaca,
nguynnhnldocngtychatchctpth
dctpthtrongcalmvic.ychnhlhai
yutnguyccthnhhngnsckhe
cngnhgynnRLCXcng nhn ch bin
thysn.
574
C s 1
C s 2
Khng t t n Khng t
t n (%)
n (%)
(%)
n (%)
Nhit (n=25) 25 (100)
0 (0)
25 (100)
0 (0)
m (n=25) 25 (100)
0 (0)
22 (88)
3 (12)
Vn tc gi
35 (100)
0 (0)
35 (100)
0 (0)
(n=25)
nh sng (n=25) 35 (100)
0 (0)
25 (100)
0 (0)
n (n=25)
41 (100)
0 (0)
41 (100)
0 (0)
Bi (n=25)
10 (100)
0 (0)
10 (100)
0 (0)
in t trng
10 (100)
0 (0)
10 (100)
0 (0)
(n=25)
c tnh
Cc yu t nh nhit , vn tc gi, nh
sng,n,bi,inttrngclyti25
vtrtics1v2uttiuchunvsinh
chophp.Tuynhinvmc3mukhng
t ti khu ch bin 4, 6, 8 thuc c s 2. Cc
nghin cu khc ch ra rng m cao c tc
ng rt bt li cho hot ng iu nhit, dn
tiphtsinhmtsbnhnghnghip.(5)
TnhtrngRLCXnghnghip
Bng5.Tlriloncxngvtlccvtrau
mincngnhn(n=419)
RLCX
Tn s (n)
C
358
Khng
61
au mi ch yu cc v tr
C
153
Vai tri
195
Vai phi
201
Cnh tay tri
48
Cnh tay phi
56
Cng tay tri
51
Cng tay phi
59
C tay tri
97
C tay phi
92
Bn tay tri
80
Bn tay phi
77
Tht lng
139
Cng chn tri
173
Cng chn phi
177
Bn chn tri
131
Bn chn phi
136
T l (%)
85,4
14,6
36,5
46,5
48,0
11,5
13,4
12,1
14,1
23,2
22,0
19,1
18,4
33,2
41,3
42,2
31,3
32,5
ChuynYTCngCng
T l cng nhn n c RLCX trong nghin
cunylrtcaolnn85,4%.Bncnh,v
tr b au mi nhiu nht chnh l vai tri
(46,5%), vai phi (46,5%), cng chn phi
(42,2%), cng chn tri (41,3%). Cc t l trn
uthphnsoviccnghincutrongnc,
nhnglicaohnnghincuncngoi(6,1,4).
iu ny c th do cc nguyn nhn c lin
quanntthngvlmviclintcbng
hai tay gy nn nhng v tr au nhc mi
ny.Ngoiracthdoplcvlngthng,
iukinlmvicqumivibntay,gng
tay v bao tay khng va kch c cng c th
gpphnlmgimlccmnm,sgb,lp
liccthaotc trong khi lm vic, t th ng
gb,kodinhhngnsaumi
ccvtrtrn.
Nghin cu cng so snh v tr au mi
cc giai on khc nhau gm u ca, gia ca,
cuica.Ktquchothyuca,cngnhnau
mi c (18,1%), vai tri (16,7%) v vai phi
(16%).Tuynhinchongiaca v cui ca v
tr au mi li l cng chn phi (36,5% v
53,9%), cng chn tri (50,8% vo cui ca). So
snhskhcbitvtlaunhcmiccv
trvoucavcuica,ktquuchothyc
skhcbitcnghathngkvip<0,05.
nh hng ca RLCX n cng vic v

gicng
Bng6.Vtraumigytrnginhiunhtn
cngvicvgicng
c tnh
Tn s (n)
T l (%)
Mc gy tr ngi n cng vic (n=358)
Khng tr ngi
10
28
Tr ngi t
100
53,1
Phi ngh vic
158
44,1
Thi gian phi ngh vic (n=158)
3 ngy
104
65,8
>3 ngy
54
34,2
Mc gy tr ngi n gic ng (n=358)
Khng tr ngi
20
5,6
Tr ngi t
204
57,0
Gy tr ngi mi m
134
37,4
ChuynYTCngCng
NghincuYhc
Kt qu kho st cho thy t l cng nhn

chorngRLCXnhhngncngvicvgic
nglrtcao(96,3%v94,4%).
Mi lin quan gia RLCX v cc yu t

khost
Bng7.Milinquancnghathngk(p<0,05)
giariloncxngviccyutkhost
(n=419)
RLCX
PR
p
(KTC 95%)
C (%) Khng (%)
B phn lm vic
Gin tip
9 (34,6)
17 (65,4)
2,56 (1,51
<0,001
4,35)
Trc tip
349 (88,8) 44 (11,2)
m
Khng t 235 (88,4) 31 (11,6)
0,91
0,03
(0,83-0,99)
t
123 (80,4) 30 (19,6)
Mi trng lm vic
Bnh thng 47 (73,4) 17 (26,6)
1,19
0,003
(1,02-1,39)
Lnh/Qu lnh 311 (87,6) 44 (12,4)
Thi gian lm vic
8h
151 (79,5) 39 (20,5)
1,13
0,002
(1,05-1,23)
>8h
207 (90,4) 22 (9,6)
c tnh
T th lm vic ch yu
Lun thay i 43 (68,3) 20 (31,8)
1,29 (1,09
<0,001
1,54)
ng
315 (88,5) 41 (11,5)
GiaRLCXvbphnlmviccmilin
quan c ngha thng k trong cng nhn
lm vic trc tip c kh nng mc RLCX cao
gp2,56lnsovicngnhnlmvicgintip
(bng 7). Kt qu ny tng t vi mt s
nghincutrongnckhosttrncngnhn
ngnhchbinthysn(7,11,2).
i vi cc yu t lin quan n iu kin
lm vic, ch c yu t m, mi trng lm
vic v iu kin ni lm vic l c mi lin
quan c ngha thng k vi RLCX (p < 0,05)
(bng 7). Hay ni cch khc, cng nhn lm
mitrngcmkhngtchun,lnhu
c kh nng mc RLCX cao hn so vi cng
nhn lm mi trng c m t chun.
iunycngcchngminhquanhiu
nghincu(10,7).
Phn tch mi lin quan gia thi gian lm
vicvRLCXchothycnghathngk(p<
0,05)trongcngnhnlmvic>8gisc
kh nng mc RLCX cao gp 1,13 ln so vi
575
NghincuYhc
ngilmvic8gi.Ktqunyphhpvi
nghin cu ca Trnh Hng Ln khi cho rng
nukhngcsnghngigia cc chu k ca
mt cng vic no s lm tng nguy c
RLCX.(14)Ktqunghincucngtngtvi
ktqucaNgThTuytAnh(6).
Ktquphntchcngchothycmilin
quan c ngha thng k gia t th lao ng
vRLCX(bng7).Cngnhnlmvictth
ngsckhnngmcRLCXcaogp1,29ln
so vi cng nhn c t th thng xuyn thay
i. Kt qu ny cng ph hp vi nhn nh
caDuLeeP.EstvellavAnjaliNag,PKNag(1,14).
khongthigianlaongkhong120phtgia
cccalaong;tchctpthdc10pht/ln;
toiukinchocngnhnthngxuynthay
i t th, c th b tr gh ngi cao cho cng
nhntrongcalmvic.
TILIUTHAMKHO
1.
2.
3.
4.
KTLUN
Nghin cu c tin hnh trn 419 cng
nhn n ti cng ty ch bin thy sn B Ra
Vng Tu nhm nh gi tnh trng RLCX
cngnhn.Ktqunghincuchothy,cngty
chbinthysnBRaVngTucsquan
tm dnh cho cng nhn khi t l cng nhn
c khm sc khe nh k, khm sc khe
bnhnghnghip,vcotovATVSL
rt cao (> 90%). Tuy nhin kt qu nghin cu
cngchothytlRLCXcacngnhncnrt
cao ln n 85,4%. Cc RLCX ch yu l au
nhcvaiphi(48%),vaitri(46,5%),cngchn
phi(42,2%)vvngthtlng(33,2%).Ccvtr
au mi ny u nh hng n cng vic v
gicngcacngnhnttcngnsc
khe cng nh hiu sut lm vic ca h. Cc
yutnybaogm:mkhngtchun(3
muti3khuvcchbin),thigianlmvic,
tthlmvic,thigiannghgiaca,cngnh
tnhchtcngvic.
KINNGH
Da trn kt qu nghin cu, cng ty ch
bin thy sn B RaVng Tu cn thc hin
cciusaucithiniukinlaongv
phngchngRLCXchongilaong:nnt
chccckhongnghngn(510pht)saumi
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
AnjaliN,NagPK(2005).Tlaumicxngncng
nhntrongccxnghipchbinc..Bocokhoahctmtt,
NXBYHcHNi,tr61.
BYt,Vingimnhykhoa(1997).Tiuchunsckhe
phnloikhmtuyn,khmnhk.HNi.
CanadianCenterfor Occupational Health and Safety (2005),
WorkrelatedMusculoskeletaldisorders
http://www.ccohs.ca/oshanswers/diseases/rmirsi.html,4/7/2011.
HarnChe C, YinChing K, ShunShen C, HsinSu Y (1993)
Prevalence of shoulder and upperlimb disorders among
workersinthefishprocessingindustry.ScandJWorkEnviron
Health,19,1231.
HongVnBnh(2010).Vsinhlaong,NXBKhoahcvk
thut,HNi,tr13622.
Lan Anh, Bo Tui Tr Onine. Bnh v... ng.
http://www.baomoi.com/Home/SucKhoe/tuoitre.com.vn/Benhvi
dung/2977957.epi,24/7/2011.
LQuangLim,BiLVChinh,MaiMinhThy(2011),Kt
qunghincuvmitrnglaong,ccubnhtt,bnhlc
tnhchtnghnghipcacngnhnchbinthusnnglnh
Bnhnh.
http://www.dostbinhdinh.org.vn/MagazineNewsPage.asp?TinTS_I
D=871& TS_ID=86, tp ch Khoa hc cng ngh, s KHCN
Bnhnh,4/5/2011.
NguynBchNgc,cngs(2000)Ecgonomitrongthitkv
snxut,Nhxutbngiodc,HNi.
Nguyncn(2001)Antonsckhotinilmvic.
TpchLaongxhiHNi,1,tr3233.
Nguyn Trng Sn, Phm Vn Thc, Trn Qunh Chi,
NguynThNgn(2007)Nghincucimmitrng
laong,ccubnhttvmtsbnhlctnhchtngh
nghip ca cng nhn ch bin Thu sn Hi Phng. Cng
trnhNCKHvphttrinYtbinln2,tr123138.
TrnAnhTun,LThnhTi(2010)Tnhtrngmitrng
laongvsckhoncngnhnxnghipchbinThy
SnTrKhatnhBcLiunm2009.TpchYHocTp.HCh
Minh,14,(Phbns2),tr134139.
TrnhHngLn(2008).Ecgonomivnhngngdngcan
trong ci thin iu kin lm vic. Lun n tin s Chuyn
ngnhDchthc.HYDc.TPHChMinh.
TrungtmYTDPtnhBRaVngTu(2011).Bocotng
kt hot ng 2010 v k hoch hot ng nm 2011 v
chngtrnhVsinhlaong.
VXunTrung(bindch)(2001).Riloncxngngh
nghipvntoncu.Bntinsckhevantonlaong.
Vin nghin cu khoa hc k thut bo h lao ng Vit Nam,
02/2001,tr89.
576
ChuynYTCngCng
NghincuYhc
KINTHCTHITHCHNHANTONVSINHTHCPHM
CANGIKINHDOANHTHCNNGPHTIPHNG
BNHHNG,TP.PHANTHIT,TNHBNHTHUNNM2011
NguynVnThnh*,NguynNguyn**
TMTT
tvnPhngBnhHng,thnhphPhanThitcatnhBnhThun,lphngcscskinh
doanhthcnngphnhiunhttrongtonthnhph,vlcangumigiaolubunbnhisn
tisng.iukinvsinhtimtscskinhdoanhlkm,vnhiungikinhdoanhchamboy
nhngnguyntcquinhvantonvsinhthcphm.
Mc tiu Xcnhtlckinthc,thi,thchnhngvantonvsinhthcphmcanhng
ngikinhdoanhthcnngphtiphngBnhHng,thnhphPhanThit,tnhBnhThun,nm
2011.
PhngphpMtnghincuctngangmtctinhnhtrntonb151ngikinhdoanhthcn
ngph.itngnghincucphngvntrctipvkinthc,thi,vthchnhvantonv
sinhthcphm.Mtbngkimcngcsdngquanstnhngiukinvsinhcacskinhdoanh
vnhngthchnhcangichbin.Nhngcuhivkinthc,thi,vthchnhcxydngda
theonhngtiuchuncaBYtvantonthcphmthcnngph.
KtquTlckinthcngvantonvsinhthcphmlrtcao,trnhngkinthcvdngc
ngringchothcnsngvchn;mngtpd,khutrang,vimchptc;cbitchc1%ckin
thcngvtmquantrngcavicchnnguynliuthcphmphicngungcrrng.Thivan
tonvsinhthcphmltt,nhngtlngvvicmangtpd,khutrang,vmchptclthp.Tl
thchnhngvantonthcphmlcao,nhngchc50%ngikinhdoanhcgiychngnhntphun
vantonvsinhthcphm,vgiychngnhnsckhocnhiulc.Chc17%chonchngminh
ngungcnguynliuthcphm,vnhngthchnhsdngtpd,khutrang,vimlrtthp.
KtlunKinthc,thi,vthchnhantonvsinhthcphmcangikinhdoanhthcnng
phtiphngBnhHng,thnhphPhanThitlkhtt.Tphunvgimstvnlcnthitcngc
vlmtthnnanhngthnhqutc.
TkhaAntonvsinhthcphm,thcnngph,thnhphPhanThit
ABSTRACT
KNOWLEDGE,ATTITUDES,ANDPRACTICESCONCERNINGFOODHYGIENEANDSAFETY
AMONGSTREETFOODHANDLERSATBINHHUNGWARDOFPHANTHIETCITY,BINHTHUAN
PROVINCEIN2011
NguyenVanThanh,NguyenDoNguyen
BackgroundBinhHungisthewardhavingthemoststreetfoodservicesinPhanThietcityofBinhThuan
ChiccAntonVsinhthcphmtnhBnhThun
BMnDchT,KhoaYTCngCng,iHcYDcTp.HChMinh
Tcgilinlc:BS.CKINguynVnThnh
T:0918073785 Email:bsthanh785@gmail.com
**:
ChuynYTCngCng
577
NghincuYhc
province,andalsothemainmarketoffreshseafooddistribution.Thesanitaryconditionofsomeserviceswasbad,
andmanystreetfoodhandlersdidnotstrictlyfollowfoodhygieneandsafetyregulations.
Objectives To identify the proportion of street food handlers having correct knowledge, attitudes, and
practicesconcerningfoodhygieneandsafety.
Methods Adescriptivecrosssectionalstudywasconductedamongall151streetfood handlers. Subjects
weredirectlyinterviewedaboutknowledge,attitudes,andpracticesconcerningfoodhygieneandsafety.Sanitary
conditionandpracticeswerealsomeasuredbyobservingusingachecklist.Thequestionnairewasconstructed
basedontheMinistryofHealthcriteriaforstreetfoodsafety.
Results The proportion of street food handlers having correct knowledge was very high, except the
knowledgerelatingtostoringcookedandrawfoodseparately;wearingapron,mask,andcap;andonly1%knew
thenecessityofpurchasingonlyrawfoodmaterialswithanidentifiedorigin.Mostsubjectshadpositiveattitude,
buttheproportionagreeingtowearapron,mask,andcapwaslow.Mostsubjectshadproperpractices,butonly
50% had a certificate of attending a training course in food hygiene and safety, and a valid health certificate.
Only17%showedareceiptidentifyingtheoriginofrawfoodmaterialspurchased,andfewsubjectsworeapron,
mask,orcap.
ConclusionsStreetfoodhandlersatBinhHungwardofPhanThietcitywerefoundtohaverelativelygood
knowledge,attitudes,andpracticesconcerningfoodhygieneandsafety.Trainingandsupervisionactivitieswere
stillnecessarytoimprovethecurrentstatus.
Keywordsfoodhygieneandsafety,streetfood,PhanThietcity
licungcpthcphmvadng,tinli,v
TVN
gicphhpviasngilaongcthu
Trongthigian qua, Vit Nam c nhiu
nhp thp. Kinh doanh thc n ng ph
n lc trong cng tc bo m an ton thc
to vic lm cho s ng ngi lao ng. Bn
phm, v an ton thc phm c nhng
cnhvictinlicngxuthinnhiunguyc
chuyn bin tch cc nhiu a phng, c
tim n gy ng c thc phm v cc bnh
bitnhngthnhphln.Tuynhin,vncn
truynquangthcphm,dongichbin
nhng thch thc ln. Ng c thc phm v
thiu kin thc v thc hnh cha ng v an
cc mi nguy e da mt an ton thc phm
ton v inh thc phm, h tng c s v iu
tiptclnhngvnquantmhngui
kin v sinh mi trng km. y l vn
visckhecngng,ansinhxhi,vtng
ang c cc nh qun l v khoa hc y t
trngkinht.Ccgiiphpgiiquytvn
quantm,vanglmilongichongitiu
nyangctrartcpbch(2).Theothng
dngvtnhanton.
kcaCcAntonVsinhthcphm,BYt,
Phng Bnh Hng, thnh ph Phan Thit
ktthng1,2010nngy15/8/2010,trnton
catnhBnhThun,lphngcscskinh
qucxyra123 v ng c (trong c 34
doanhthcnngphnhiunhttrongton
vngctrn30ngi)lm4.387ngimc,
thnhph,vlcangumigiaolubun
3.078ngiivin,v37 trng hp t vong.
bnhisntisng.Scskinhdoanhthc
So snh vi cng k nm 2009, s v ng c
nngphl133,vhn18csbnrong.
tng23v(23%),smctng658ngi(17,6%),
Qua quan st, c th thy iu kin v sinh ti
sngiivintng99ngi(3,3%),vst
mtscskinhdoanhlkm,vnhiungi
vong tng 19 ngi (27,6%). Cn nhiu kh
kinh doanh cha m bo y nhng
khntrongvickimsotantonvsinhthc
nguyn tc qui nh v an ton v sinh thc
phm, c bit i vi thc n ng ph(2).
phm. Theo bo co ca trm y t phng t
Thcnngphrtquantrngtrongmng
nm 2005 tr li y cha c v ng c thc
578
ChuynYTCngCng
phmlnnoxyra,tuynhin,trongbicnh
cadphng,mtkhostvantonvsinh
thcphmtimtabncnguyccaolcn
thit.Mctiucanghincunylxcnht
l c kin thc, thi , thc hnh ng v an
ton v sinh thc phm ca nhng ngi kinh
doanh thc n ng ph ti phng Bnh
Hng, thnh ph Phan Thit, tnh Bnh Thun,
nm2011.Kt quca nghincuslnhng
thngtinhuchchonhngchngtrnhgim
stvgiodcsckhovantonvsinhthc
phmtiaphng.
ITNGPHNGPHP
Mt nghin cu ct ngang m t c tin
hnhtrntonb151ngikinhdoanhthcn
ng ph ti phng Bnh Hng, thnh ph
PhanThit,tnhBnhThun,nm2011.Tiuch
a vo l nhng ngi ch c s ang kinh
doanhthcnngpht15tuitrln,c
sckhebnhthng,ckhnngtrliphng
vn, v ng tham gia nghin cu. Nhng
ngi c chn nhng vng mt sau ba ln
tip cn s b loi. i tng nghin cu c
phngvntrctipvimtbcuhicutrc
chtchtmhiukinthc,thi,vthc
hnh v an ton v sinh thc phm. Mt bng
kim cng c s dng quan st nhng
iu kin v sinh ca c s kinh doanh v
nhng thc hnh ca ngi ch bin. Nhng
cuhivkinthc,thi,vthchnhc
xy dng da theo Quyt nh s
3199/2000/QBYT ngy 11/9/2000 ca B Y t
v nhng tiu chun c s t v sinh an ton
thcphnthcnngph(1).Nhmbins
vkinthclnhngbinsnhgi(ng,sai)
v nhng ni dung: chn nguyn liu thc
phm c ngun gc r rng; s dng ngun
ncmychbinthcphm,radngc;
ni ch bin thc phm v ni by bn thc
phm phi cch xa ngun nhim 5 mt; v
sinh dng c trc v sau ch bin bng nc
schvixphng;dngcchangringcho
thc phm sng hoc chn; bo qun thc n
chn ch bin trong t knh; thi gian bo
ChuynYTCngCng
NghincuYhc
qun thc n chn 4 gi; bn ch bin thc

phm v ni by bn thc phm phi k cao
cchmttt60cmtrln;rataytrckhi
chbinhocsauivsinhvincschvx
phng; khng c eo nhn hoc sn mng
tay,mangtpd,eokhutrang,imchp
tckhichbinthcphmvbnthcn;dng
kpgplythcn;phictphunv
an ton v sinh thc phm; v phi khm sc
khenhkhngnm.
Nhmbinsvthiolngxemi
tngnghincucngvnhngnidung:
khi mua nguyn liu thc phm phi c ha
n, chng t chng minh c ngun gc
xut x r rng; tp hun v an ton v sinh
thcphm;khmsckhenhk hng nm;
vmangtpd,eokhutrang,vimchp
tckhichbinthcphm.
Nhmbinsvthchnhlnhngbins
nhgi(ng,sai)khostnhngnidung:x
l rc thi, cht thi, cht thi (nc ra chn
bt,dngc)phichngngy,khngs
dngcht phgiathc phm nm ngoi danh
mcchophpcaBYt;dngtinylon,hp
nha sch ng thc phm; chi ra dng
cbngncschvixphngsaumilnch
bin.Nhngthchnhcolngquaquan
st gm c: c ha n chng t chng minh
nguyn liu thc phm c ngun gc; thc
phm chn, sng c ng ring bit; bn v
githcncao60cm;nibnhngcchxa
cngrnh,nhvsinht5mtrln;ctknh
cha ng thc phm; c dng c ch bin
thc n (dao, tht, thau) ring cho thc phm
sng,chn;thcphmnsngcradi
vincchy,loibvtnhimbn;cthng
ngrc,vthngngrccnpy;thng
ng thc n tha c np y; cho nc thi
vocngrnh;ngichbin,bnhngratay
sch,khngeotrangsc,khngsnmng
tay,lythcnbngkpgp,khngbcbng
tay trn, c eo tp d, mang khu trang, i
m; c giy chng nhn khm sc khe cn
579
NghincuYhc
hiu lc; c giy chng nhn tp hun v an

tonvsinhthcphm.
Nhngbinsnngmnhmtui(15<30,
30<50,v50tuitrln),gii (nam, n), trnh
hcvn(cp1,cp2,vcp3trln),thi
gianhnhngh(di24thng,t24thngtr
ln),thcnkhngdngla(lloithcphm
c th n ngay m khng cn nu do c
lmchntrchoclloithcndngn
sng)hocthcncdnglavlmchnti
ch(lloithcnmngibnphichbin
bng cch nu chn ti ni bn hng). D kin
cphntchbngphnmmStataphinbn
10.0.Thngkmtgmctnsvtlphn
trm.
Bng1.ctnhcamunghincu,tnsv(%)
(N=151)
13 (9)
103 (70)
32 (21)
100 (68)
25 (17)
71 (48)
51 (35)
111 (77)
117 (79)
Bng2.Kinthcngvantonvsinhthc
phm,tnsv(%),(N=151)
Kin thc
S dng ngun nc sch ch bin
Ra tay trc khi ch bin v sau khi i v sinh
Khng sn mng tay
Bo qun thc n chn ch bin trong t knh
S dng ngun nc sch ra dng c
Khng eo nhn
V sinh dng c trc v sau ch bin
Ni by bn thc phm cch mt t 60cm
Ni by bn cch xa ngun nhim
V tp hun kin thc an ton v sinh thc
phm
Khm sc khe nh k
Bn ch bin cch mt t 60cm
Ni ch bin xa ngun nhim
580
72 (82)
123 (82)
52 (34)
42 (28)
1 (1)
Bng3.Thivantonvsinhthcphm,tns
v(%),(N=151)
Thi ng
Tp hun v an ton v sinh thc phm
Khm sc khe nh k hng nm
Chn nguyn liu thc phm c ngun gc
Mang tp d, khu trang, m chp tc khi ch
bin
Mang tp d, khu trang, m chp tc khi bn
hng
136 (90)
134 (89)
130 (86)
61 (40)
43 (29)
Bng4.Thchnhngvantonvsinhthc
phm,tnsv(%),(N=151)
KTQU
c tnh
Nhm tui (nm)
15-<30
30-<50
50
N
Trnh hc vn
Cp 1 tr xung
Cp 2
Cp 3 tr ln
Thi gian hnh ngh 24 thng (n=145)
Kinh doanh thc n khng dng la (n=149)
Kin thc
Thi gian bo qun thc n 4 gi
Dng kp gp ly thc n
Dng c ng ring cho thc phm sng, chn
Mang tp d, khu trang, m chp tc
Chn nguyn liu thc phm c ngun gc r
rng
150 (99)
149 (99)
148 (99)
149 (99)
148 (98)
147 (98)
147 (97)
144 (95)
140 (93)
141 (93)
139 (92)
139 (92)
129 (85)
Thc hnh
Chi ra dng c sau mi ln ch bin
Bn v gi thc n cao 60cm*
Ngi ch bin ra tay sch*
Nc thi cho vo cng rnh*
C thng ng rc*
Ra thc phm n sng c loi b vt bn*
ng thc phm sng, chn ring bit*
S dng bao gi sch ng thc phm
Ly thc n bng kp gp*
C dng c ring ch bin thc phm sng,
chn*
Bn hng cch xa cng rnh 5m*
Np y thng thc n tha*
Khng sn mng tay*
Np y thng rc*
C t knh ng thc phm*
Khng eo trang sc*
Giy chng nhn sc khe cn hiu lc*
Giy chng nhn tp hun an ton v sinh
thc phm*
Thc phm n sng ra di vi nc
chy*
Ha n nguyn liu thc phm c ngun gc*
eo tp d*
Bc thc n bng tay trn*
S dng cht ph gia
Mang khu trang*
i m*
151 (100)
146 (98)
144 (98)
144 (97)
144 (97)
129 (96)
138 (95)
143 (95)
134 (93)
128 (90)
132 (89)
130 (88)
130 (86)
113 (79)
113 (78)
118 (78)
74 (50)
75 (50)
29 (21)
25 (17)
22 (15)
19 (13)
13 (9)
7 (5)
2 (1)
*Quaquanst
ChuynYTCngCng
Phn ln ngi kinh doanh thc n ng
ph ti phng Bnh Hng, thnh ph Phan
Thit c tui t 30<50 tui, a s l n, c
trnhhcvncp2vcp3trln,cthi
gian hnh ngh t 24 thng tr ln, v kinh
doanhthcnkhngdngla(bng1).Tlc
kinthcngvantonvsinhthcphml
rt cao, tr nhng kin thc v dng c ng
ring cho thc n sng v chn; mng tp d,
khutrang,vimchptc;cbitchc
1%ckinthcvtmquantrngcavicchn
nguyn liu thc phm phi c ngun gc r
rng (bng 2). Thi v an ton v sinh thc
phmltt,nhngtlngvvicmangtp
d,khutrang,vmchptclthp(bng3).
Tlthchnhngvantonthcthcphm
l cao, nhng ch c 50% ngi kinh doanh c
giy chng nhn tp hun v an ton v sinh
thc phm, v giy chng nhn sc kho cn
hiulc(bng4).Chc17%chonchng
minh ngun gc nguyn liu thc phm, v
nhngthchnhsdngtpd,khutrang,v
imlrtthp.
BNLUN
Nhng c tnh ca ngi kinh doanh
thc n ng ph ti thnh ph Phan
Thit
asngikinhdoanhthcnngph
l n, trong tui lao ng, iu ny cho thy
kinhdoanhchbinthcnngphlmt
ngnhnghthchhpviphnhnnamgii,
vylcngvicphthngmangtnhnitr.
Trnh hc vn t cp 3 tr ln chim t l
35%,tcp2trxungl65%,tlnycaohn
kt qu nghin cu ca Trng Ngc Ton ti
phng13,qunBnhThnhnm2006(49%)(4).
Vitrnhhcvnhnchhkhcthtm
cngvickhccthunhpnnhticckhu
resorthocccnhmyxnghipaphng,
vkinhdoanhthcnngphlmtngh
dlm,thitthccithiniukinkinht
gianh.
ChuynYTCngCng
NghincuYhc
ascthigianhnhnght24thngtr
ln, iu ny cho thy kinh doanh thc n
ngphlcngvicmuabnnhtvn,ph
hpvinhngngicthunhpthpnnkh
nng h s gn b lu di. Loi thc phm
khng dng la chim t l 79%, cao hn kt
qu nghin cu ti phng Hip Thnh, qun
12, thnh ph H Ch Minh nm 2006 (58%)(4).
Cthdoscpvcngvicvthigianca
ngilaong,vsphttrincacngngh
thc phm bao gi sn nn a s h dng sn
phmchbinsn.
Kinthc,thi,vthchnhvanton
v sinh thc phm ca ngi kinh doanh
thc n ng ph ti thnh ph Phan
Thit
Kin thc ng v s dng ngun nc
sch ch bin thc phm chim t l 99%,
tngngviktqunghincutiphng
Hip Thnh, qun 12, thnh ph H Ch Minh
nm 2006(3). iu ny th hin s hiu bit v
miquantmvsdngngunncsch
ch bin thc phm. Hu ht nhng kin thc
khc lin quan n an ton v sinh thc phm
cng rt cao. Nhng d kin ca bng 4 cho
thythchnhnglinquannnhngkin
thcnylcaotngng,trongkhichc50%
i tng nghin cu c giy chng nhn tp
hun v an ton v sinh thc phm. Nh vy
kin thc m h c c khng phi t tp
hunchnhquimdottmhiu,hocctht
nhngnhcnhcaccongimstnhk.
So vi mt nghin cu ti Thun An, Bnh
Dng,nm2004th kin thc ca ngi kinh
doanhthcnngphtiBnhHng,Phan
Thitltthn(5).Bnchtmtaimdulch
cathnhphPhanThit,vkhchhngmh
phc v hu ht l khch du lch c th lin
quannktquny.
Chc34%ckinthcngvvickhng
nnngchungthcnsngvchn.Cuhi
linquannnidungnyTheoanh/chthc
phm chn c nn cha ng chung vi thc
phm sng? vi ba p n c, khng, v
581
NghincuYhc
khngbitcthlkmgitrvansai
lchthngtin.Tlckinthcngvmang
tp d, khu trang, m chp tc cng thp, c
th v i tng nghin cu ngh n s cn
thitcacctrangbnynhmbohchobn
thn h hn l bo m vic trnh ly nhim
chothcphm.Cththytlcthing
vinhngnidungnycngthptngng
(bng 3), t , t l i tng c eo tp d,
mangkhutrang,hocmchptclrtthp
(bng 4). Mt l gii khc cho t l thc hnh
thp ca nhng ni dung ny l a s ngi
kinhdoanhthcnngphphilmchai
vic ch bin v phc v, do , nhng loi
trangphcnycthgycntrchovictip
xcvdichuynkhiphcvkhchhng.
Ch1%ckinthcngvscnthitca
vicchnnguynliuthcphmcngungc
rrng,cthvcuhilinquanlkmgitr
vkhkhngngmc(Theoanh/chchn
nguynliuthcphmcngungcantonth
cncnhngloigiytg?). Trong khi , cu
hi v thi tng ng vi ni dung ny
(Anh/ch c ng khi mua nguyn liu thc
phmphicgiytchngminhthcphm
cngungcrrngkhng?)ldhiuhnv
cphngi,vktqutngngl86%c
thing(bng3).Tuynhin,quaquanst
chc17%itngnghincuchon
chng nhn ngun gc ca nguyn liu thc
phm (bng 4). Thi ng l cao nhng
thchnhlikmchothytnhchpnhnc
ca thc hnh ny l khng cao v vic mua
nguynliukmhonchngtlphctp,
hoccgimc.Tnhchpnhnccamt
loi thc hnh cng c th gii thch cho t l
thp ca thc hnh ra thc phm n sng
divincchy,lmtviclmmt nhiu
thigian.
Nhngimmnhvhnchcanghin
cu
Vi mu nghin cu c chn ton b
nhngktqucanghincumtngthc
trng v an ton v sinh thc phm ca vic
582
kinhdoanhthcnngphtiphngBnh
Hng, thnh ph Phan Thit. Nhng d kin
thc hnh c nh gi qua quan st c tnh
khchquanvchnhxc.
Sailchthngtincthxyratrongnghin
cu ny do mt s cu hi phng vn, nh
bn lun bn trn. Bn cnh , i tng
nghin cu thng l nhng ngi ch c s
hoc ngi trc tip ch bin nn h ngi tip
xckhiccnbytnvtngrngcon
kim tra an ton v sinh thc phm, do ,
nhng thng tin c cung cp c th khng
trung thc. Vic nh gi thc hnh qua quan
stlkhchquan,tuynhin,vncnchquan
trong mt s trng hp, th d, nh gi v
khongcchgianichbinthcphmvcc
ngun nhim, cao so vi mt t ca ni
bythcphm.Mtsbinsbmtdkin,
c bit vi phn quan st, c th nh hng
ntnhchnhxccaktqu.
Dcnmtshnch,ktqucanghin
cuchothykinthc,thi,vthchnhan
ton v sinh thc phm ca ngi kinh doanh
thc n ng ph ti phng Bnh Hng,
thnh ph Phan Thit l kh tt. Tp hun v
gimstvnlcnthitcngcvlmtt
hnnanhngthnhqutc.
TILIUTHAMKHO
1.
2.
3.
4.
5.
BYt(2010),Banhnhtiuchuncstvsinhantonthc
n ng ph. 2000, Quyt nh s 3199/2000/QBYT: H
Ni. Quc hi, Lut An ton thc phm. 2010 Lut s
55/2010/QH12:HNi.
Cp nht thc trng an ton v sinh thc phm v cc gii
php.(2010);Availablefrom:
http://thucphamvadoisong.vn/diendannhaquanly/
HunhThVitHng,NguynNguyn(2007).Kinthc,
thi,thchnhvsinhantonthcphmcangikinh
doanhthcnngphtiphngHipthnh,qun12,
TP.HCMnm2006.YHcTP.HCM.2007.Tp11.Phbn
s1.2007:4145.
TrngNgcTon(2006).KinthcvThchnhvanton
vsinhthcphmngitrctipchbinthcnng
ph ti phng 1, qun Bnh thnh. Tiu lun CK1, Khoa
YTCC.2006,ihcYDcTP.HCM:TP.HChMinh.
VThQu(2010).KinthcvThchnhantonvsinh
thcphmcangitrctipchbinthcnngph
tixBnhChun,huynThunAn,tnhBnhDng.Tiu
lunCK1,KhoaYTCC.2010,ihcYDcTP.HCM.
ChuynYTCngCng
NghincuYhc
ChuynYTCngCng
583
NghincuYhc
TLTHCHNHNGBINPHPTRNHTHAIHINIV
CCYUTLINQUANCAPHNLATUISINHC
CHNGTIHUYNHCMN,TP.HCHMINH
ChuThAnh*,LHongNinh*
TMTT
t vn : Giatngdnslvncquantmtrntonthgii.Hinnay,bnhqunminm
tnghn80triungi.Trongkhitai,ngunncsch,cciukinmitrngsngthchnthm
chcnbsuygimvvickhaithc,sdngqumccctinguynthinnhinphcvchocchatng
snxutcngnghip,nngnghip,phttrinkinht,iunylinhhngnchtlngmitrngsng.
SdngngBPTThinichiuqusgipgimsinhvgipgincchgiacclnsinhCngnhvic
tngtlsngisdngbinphptrnhthaisgiptlphttrindnstnhinchthpDo,vic
tmhiugiathchnhngccBPTTvnhngyutlinquanlcnthit.
Mctiu:Xcnhtlthchnhngbinphptrnhthai(BPTT)hinivccyutlinquanca
phnlatuisinhcchngtihuynHcMn,Tp.HChMinh.
Phng php nghin cu: Ctngangmtvphntchtrn890phncchngsdngbinphp
trnhthaihinitihuynHcMn,Tp.HCM.Ccitngcphngvnbngbcuhivccyut
dnshc,iukinkinht,ngunthngtinvkhochhagianh,thchintthng2nthng3nm
2010.
Ktqu:Tlthchnhngivingisdngdngctcung(DCTC)l52,70%;ivingi
sdngthucvintrnhthai(TVTT)l92,30%;ivingisdngbaocaosu(BCS)l82,30%.ivi
DCTC:Cmilinquancnghathngkgiahcvn,nhmnghlaongtrccav,nhmnghlao
ngtrccachng,iukinnh,ckinthcngvthchnhng.iviTVTT:Cmilinquan
cnghathngkgialatuit35trlnsovilatuidi25vthchnhng.Khngcmilinquan
giathchnhngvcctvntrckhisdngTVTTnhngnungitvnlngithnhoc
nhnthuctcngtcvindnsthcmilinquancnghathngkvithchnhng.iviBCS:
CmilinquancnghathngkgiactngiolThinchagiocavvchng,cctvntrc
khisdng,ngitvnlcngtcvindns,ckinthcngvithchnhng.
Ktlun:TlthchnhngccBPTThinictllnltl52,70%;82,30%v92,30%(DCTC,
BCS,TVTT).Mtsyutlinquanchungnhtnvicthchnhnglvictvntrckhisdng
BPTT,ckinthcngvBPTTththchnhsnghn.
Tkho:tlthchnhngDCTC,TVTT,BCS;milinquan.
ABSTRACT
THEPREVALENCEANDFACTORSASSOCIATEDWITHTHERIGHTPRACTICEOFMODERN
CONTRACEPTIVEMETHODSAMONGCURRENTLYMARRIEDWOMENOFREPRODUCTIVE
AGEGROUP(1549YEARS)INHOCMONDISTRICTHOCHIMINHCITY.
ChauThiAnh,LeHoangNinh
Tcgilinlc:BS.CKII.Chu Th Anh
T:0938662121 Email:anhchau1960@yahoo.com
584
ChuynYTCngCng
NghincuYhc
Background: Population growth is a global issue and cause for concern for the entire human race. The
global population annually increases to more than 80 million people, on average, while land, clean water and
environment are limited and depleted byoverusing natural resoursces for industrializing, farming and
developingeconomics,leadingtoadiminishedqualityoflife.Usingtherightpracticeofmoderncontraceptive
effectivelywilldecreasethebirthrateandbirthspacing.Aswell,risingtherateofusingmoderncontraceptive
methodswilldiminishtherateofpopulationgrowth.Therefore,estimatingtheprevalenceandfactorsassociated
withrightpracticeofmoderncontraceptivemethodsisnecessarily.
Objective: To estimate the prevalence and factors associated with right practice of modern contraceptive
methodsamongcurrentlymarriedwomenofreproductiveagegroup(1549years)inHocMondistrictHoChi
Minhcity.
Methods:AcommunitybasedcrosssectionalsurveywasconductedfromFebruary2010toMarch2010.
Weinterviewed890currentlymarriedwomenofreproductiveagegroup(1549years)inHocMondistrict,Ho
ChiMinhcity.Informationregardingsociodemographicfactors,economiccondition,theirsourceofinformation
forthemessageoffamilyplanningandreasonofusinganymoderncontraceptivemethod.
Results: The prevalence of right practice on using the intrauterine device (IUD), oral contraceptive pills
(OC), condom were 52.70%, 92,30%, 82,30%, respectively. To IUD: Thereis astatistically significant
relationshipbetween the respondents educational status, the groups of wifes mental work, the groups of
husbandsmentalwork,livingstatus,andtherightknowledge,therightpracticeofusingIUD.ToOC:Thereis
astatisticallysignificantrelationshipbetweentheagegroupgreaterthan35,comparedtotheagegroupodless
than25,andtherightpractice.Thereisnostatisticallysignificantrelationshipbetweentherightpracticeandthe
respondents who were consulted before using OCs. However, if the respondents were consulted from closed
relatives or received OCs from health workers, thereis astatistically significant relationshipwith the right
practice. To Condom: Thereis astatistically significant relationshipbetween religion (Cathollics), the
respondents who were consulted, the consultants who are family planning volunteer workers and the right
knowledge,therightpractice.
Conclusions: The prevalence of right practice on using the intrauterine device (IUD), oral contraceptive
pills(OC),condomwere52.70%,92,30%,82,30%,respectively.Themostcommonfactorassociatedwiththe
right practice is that the respondents were consulted before using modern contraceptive methods. Having the
rightknowledgeofusingmoderncontraceptivemethodswillleadtotherightpractice.
Key words:rightpracticeonusingtheintrauterinedevice(IUD),oralcontraceptivepills(OC),condom;
association.
thin nhin phc v cho cc hat ng sn
TVN
xutcngnghip,nngnghip,phttrinkinh
Gia tng dn s l vn c quan tm
t li nh hng n cht lng mi trng
trntonthgii.Thcvy,ngy11.07.1987l
sng(6).
ngy th gii k nim em b th 5 t ra i
TiHcMn,theosliuboco5nmgn
NamT,nnaychc24nmdnsthgii
y t sut sinh cn kh cao t hn 15 n
gn 7 t ngi, tng 2 t ngi, bnh qun
hn16minm,tlsinhconthbavncn
tngminmhn80triungi.Trongkhi
cao chim n 7%; dn s tng nhanh so vi
t ai, ngun nc sch, cc iu kin mi
trc y, t 246.683 ngi nm 2004 n
trngsngchnthmchcnbsuygimv
345.003 ngi nm 2010, tng gn 100.000 dn.
vickhaithc,sdngqumccctinguyn
Hngnmct3.700n4.500chubcra
ChuynYTCngCng
585
NghincuYhc
i,cnccchotngchmscytvthai
sn,timchngmrng,chmscbnhttcho
tr(8).
VicsdngccBPTThinichiuqu
sgipgimsinhvgipgincchgiaccln
sinh.Cngnhvictngtlsngisdng
binphptrnhthaisgiptlphttrindn
stnhinchthp.
Nhvy,victmhiuxcnhtlngi
c s dng BPTT hin i ng cng nh cc
yutclinquannvicsdngBPTThin
ikhngngslcskhoahcchoccnh
lp k hoch y t a phng xem li cc hat
ngthngtingiodctruynthngchocc
itngnguyc,cngnhviccungcpcc
dchvkhochhogianh(KHHG)cah
thng dn s y t c k hach hot ng st
hp nhm mc ch: gim sinh, gim t l sinh
conthba,mbophttrinkinhtgianh
vaphngtthn,givngansinhxhi.
Mctiunghincu:
Xc nh t l ph n la tui sinh c
chngsdngbinphptrnhthaihiniti
huynHcMn.
Xc nh t l ph n c chng s dng
ngccBPTThinitihuynHcMn.
Xcnhccyutlinquannvicph
n c chng s dng ng cc BPTT hin i:
ctrngcanhmnghincuvccdchv
khochhogianhtiaphng.
I TNG
NGHINCU
PHNG
PHP
itngnghincu
Ph n c chng tui sinh c s dng
mt BPTT ph bin bao gm: t DCTC, s
dng BCS, s dng vin ung trnh thai, sng
tiHcMnt6thngtrln.
Phngphpnghincu
Ctngangmtvphntch.
KTQUNGHINCU
Bng1:cimcaitngnghincu(n=890)
586
c im
< 25
25-29
30-34
35-39
40+
<= Cp 1
Cp 2
Cp 3
Trn cp 3
Kinh
Hoa
Khc
Tn gio
Pht gio
Thin Cha gio
Khc
Tn s(n=890)
Nhm tui
53
166
237
226
208
Hc vn:
186
449
203
52
Dn tc
877
7
6
T l (%)
651
109
130
Ngh nghip
Nhm lao ng chn tay
807
Nhm lao ng tr c
83
Kinh t gia nh
Ngho
243
Khng ngho
647
6,00
18,70
26,60
25,40
23,30
20,90
50,50
22,80
5,80
98,50
0,80
0,70
73,20
12,20
14,60
90,70
09,30
27,30
72,70
S ph n nhm tui 3034 v 3539

chimtlnhiunht(26,6%v25,4%),chim
hnsphnkhost.
Trnh hc vn cp 2 chim a s
(50,5%).
DntcKinhchimtuytias(98,5%).
Nghnghiplaongchntaychimi
as(87,2%),nhmlaongtrcchimthp
(8,8%).
Kinhtnghochimgn1/3dnsnghin
cu(27,3%),khngnghochim72,7%.
Bng2.TnhtrngsdngBPTTn=890
Bin s
Tnh trng s dng BPTT
C
Khng
Loi BPTT ang s dng
Thuc vin trnh thai
Thuc tim
Thuc cy
Bao cao su
Vng trnh thai
Tn sut
T l
691
78,00
183
17
04
183
278
26,50
2,00
0,60
26,50
40,00
ChuynYTCngCng
Bin s
Trit sn n
Trit sn nam
Khc
Tn sut
12
02
12
T l
1,70
0,30
2,40
CcutlsdngccBPTTnhsau
*DCTCchimnhiunht40,0%.
*KBCSvTVTTungctlsdng
bngnhau=26,50%
* Thuc tim trnh thai c s dng cn
thp2,5%
*Tritsnn,thuccyvtritsnnamc
tlrtthp.
Bng3.ThchnhchungvDCTC(n=277).
Thc hnh chung
ng - chnh xc:
Khng ng :
NghincuYhc
ng Khng
(KTC 95%)
Ngh nghip ca chng
Thuc nhm lao ng 25
13
tr c.
(65,79) (34,21)
Thuc nhm lao ng 108
131 0,01 1,4 (1,1 1,9)
chn tay
(45,19) (54,81)
iu kin nh
82
119
1,00
(40,80) (59,20)
chung nh chng
51
25 0,001 0,60 (0,48
(67,10) (32,90)
0,76)
ring
V ngh nghip ca chng: Nhng ngi

cnghnghipthucnhmlaongtrcct
lthchnhngl1,4ln(KTC95%:1,11,9
vip=0,01)sovinhmlaongchntayv
skhcbitnycnghathngk(p<0,05).
T l ngi tr li cha ng v thc hnh

DCTCl47,30%.
V iu kin nh : Nhng ph n c
chngmchungvigianhchamctlc
kinthcngbng0,60ln(KTC95%:0,48
0,76 vi p =0,001) ph n c chng m c nh
ring v s khc bit ny c ngha thng k
(p<0,05).
Bng4.MilinquangiathchnhDCTCvc
tnhmu
Bng6.Linquangiakinthcngvthchnh
ngvDCTC
146
131
52,70
47,30
Tlngitrlingchnhxcc3cu
vthchnhDCTCchc52,70%.
c tnh
Kin thc DCTC

P
KTC 95%
ng
Khng
Hc vn
Cp 1 15 (31,90) 32 (68,10) **
1,00
Cp 2
53 (33,30) 106 (66,70) 0,85 1,04 (0,65 1,67)
Cp 3
25 (43,90) 32 (56,10) 0,22 1,37 (0,82 2,28)
Trn cp 3 7 (50,00) 7 (50,00) 0,18 1,56 (0,80 3,06)
V thc hnh ng v trnh hc vn:

Nhngngictrnhvnhotrncp3ct
lthchnhngcaohn1,68ln(KTC95%:
1,052,68vip=0,03)sovingictrnh
vn ho cp 1. S khc bit ny c ngha
thngk.
V ngh nghip: Nhng ngi c ngh
nghipthucnhmlaongtrcctlthc
hnhngl1,5ln(KTC95%:1,12,1vip=
0,03)sovinhmlaongchntayvskhc
bitnycnghathngk(p<0,05).
Bng5.LinquanthchnhngDCTCvyut
chng.
c tnh
Thc hnh
DCTC
ChuynYTCngCng
PR
c tnh
Kin thc DCTC

P
ng
Khng
Thc hnh
ng
61 (61,00) 39 (39,00)
Cha ng 72 (49,68) 105 (59,52) 0,001
PR (KTC
95%)
1,00
1,50
(1,18 -1,90)
NhngngickinthcngvDCTCc
t l thc hnh ng bng 1,50 ln (KTC 95 %:
1,18 1,90 vi p = 0,001) so vi ngi c kin
thc cha ng. S khc bit ny c ngha
thngk(p<0,05%).
Bng7.ThchnhcchungTVTT(n=183)
im thc hnh
Tn s
Nhm thc hnh ng chnh xc (5
117
im)
Nhm thc hnh ng c bn (4
52
im)
Nhm thc hnh cha ng (0 3
14
im)
T l (%)
63,90
28,40
07,70
Tlngicthchnhngchnhxcv
TVTTt63,90%.
Tlngicthchnhngcbntr
lnvTVTTchimtlrtcaol92,30%.
587
NghincuYhc
Tlngithchnhchangchimtl
thp7,70%.
Bng8.LinquanthchnhVUTTvngunthng
tin
c tnh
Thc hnh v P
PR(KTC
TVTTU
95%)
ng Khng
Trc khi s dng TVTTU, c c t vn
C
21
2 (8,70)
(91,03)
Khng
148
12 0,84
1,01
(92,5) (7,50)
(0,88 1,16)
Chc danh ngi t vn
Nhn vin y t
71
9
1,00
(88,75) (11,25)
Cng tc vin dn s
63
3 (4,55) 0,13
1,10
(95,45)
(0,89 1,18)
Ngi thn (bn b,
14
0 (0,0) 0,00
1,20
gia nh)
(100,0)
(1,1 1,3)
Nhn thuc t
Nhn vin y t
18
6
(75,00) (25,00)
Cng tc vin dn s
48
2 (4,00) 0,04
1,30
(96,00)
(1,01 1,6)
T mua ti nh thuc
100 5 (4,76) 0,05
1,30
(95,74)
(1,01 1,6)
Ngi c t vn v thuc vin trnh

thaitngithnctlthchnhngbng
1,20ln(KTC95%:1,11,30vip=0,001)sovi
ngi c t vn t nhn vin y t. S khc
NginhnthuctCTVdn s c t l
thc hnh ng v thuc vin trnh thai bng
1,30ln(KTC95%:1,011,6vip=0,04)sovi
nginhnthuctnhnvinyt.Skhcbit
nycnghathngk(p<0,05).
Ngitmuathuctnhthucctl
thc hnh ng v thuc vin trnh thai bng
1,30ln(KTC95%:1,011,6vip=0,05)sovi
nginhnthuctnhnvinyt.Skhcbit
Bng9.LinquangiathchnhvTVTTung
viccctnhmu.
c tnh
< 25
25-29
588
Thc hnh TVTT

P
KTC 95%
ung
ng
Khng
Tui*
11 (100)
00
1,00
34 (91,90) 03 (08,10) 0,08 0,87 (0,80 0,97)
30-34
35-39
40 +
39 (92,90) 03 (07,10) 0,05 0,89 (0,82 0,96)

45 (93,80) 03 (06,30) 0,003 0,89 (0,83 0,96)
40 (88,90) 05 (11,10) 0,002 0,85 (0,76 0,94)
*nhmtui3539,tlcthchnhng
bng 0,89 ln (KTC 95 %: 0,83 0,96 vi p =
0,003) so vi nhm tui di 25. S khc bit
* nhm tui t 40 tr ln, t l c thc
hnhngbng0,85ln(KTC95%:0,760,94
vip=0,002)sovinhmtuidi25.Skhc
Bng10.Milinquangiakinthcvthchnh
trongsdngthucvintrnhthaiung
c tnh
Kin thc TVTT

P
ng
Khng
Thc hnh
ng 29 (100,0) 0 (0,0)
Khng 140 (90,9) 14 (9,1) 0,09
KTC 95%
1,1 (1,05- 1,15)
NhngngickinthcngvTVTTc
thc hnh ng bng 1,1 ln (KTC 95 %: 1,05
1,15 vi p = 0,09) so vi nhm c kin thc
khngng.Skhcbitnykhngcngha
thngk.
Bng11.ThchnhngvBCStrnhthai
im
Thc hnh ng chnh xc
Thc hnh ng c bn
Thc hnh cha ng
Tn s
36
113
32
T l
19,90
62,40
17,70
*Gomnhm:TlphncthchnhngvBCSt
82,30%.
Tlphncthchnhngchnhxc
vBCSchim19,90%.
Tlphncthchnhngcbnv
BCSchim62,40%.
TlphncthchnhchangvBCS
chim17,70%.
Bng12.Linquangiathchnhvbaocaosuv
ctnhmu
c tnh
Pht gio
Thin Cha gio
Thc hnh BCS P

PR(KTC
95%)
ng Khng
Tn gio
97
25
(79,50) (20,50)
30
00
0,001
1,32
(100,0) (00.00)
(1,20 -1,44)
ChuynYTCngCng
Khc
22
(75,90)
07
(24,10)
0,68
0,95
(0,76 1,19)
V Tn gio: T l c thc hnh ng

ngi theo o Thin Cha v ngi theo tn
giokhcsovingitheooPhtl:1,32ln
(KTC 95 %: 1,20 1,44 vi p < 0,0001), 0,95 ln
(KTC95%:0,761,19vip=0,68).
Bng13.Linquangiathchnhvbaocaosuvyut
tngiocachng
c tnh
Thc hnh v BCS

P
KTC 95%
ng
Khng
Tn gio ca chng
Pht gio
93 (83,78) 18 (16,22)
1,00
Thin Cha 30 (100,00) 00 (00,00) 0,001 1,25 (1,15gio
1,36)
Khc
26 (66,67) 13 (33,33) 0,58 0,80 (0,631,00)
Phn ny ch ct 1 phn ca bng nn b

lunphnkimTlthchnhngngic
chngtheoThinChagiosovingingi
cchngtheoPht gio l 1,25 ln (KTC 95 %:
1,151,36vip=0,001).Skhcbitcngha
thngk.
Bng14.ThchnhBCSvcngtccungcpdchv,
thngtin,tvn.
c
tnh
Thc hnh v BCS

P
KTC 95%
ng
Khng ng
Trc khi s dng bao cao su, c c t vn k v
bin php nga thai ny khng
C 126 (86,90) 19 (13,10)
Khng 15 (57,70)
11 (42,31) 0,003 1,50 (1,07-2,12)
Tlthchnhngngicctvn
vBCStrckhisdngbng1.50ln(KTC95
%:1,072,12vip=0,0003)sovingikhng
ctvn.Skhcbitnycnghathng
k.
Bng15.MilinquankinthcthchnhBCStrnh
thai
c
tnh
Thc hnh v BCS

P
PR (KTC
95%)
ng
Khng ng
Kin thc
ng 113 (87,60) 16 (12,40) 0,003 1,30 (1,041,53)
Khng 36 (69,23)
16 (30,77)
Ngi c kin thc ng th c thc hnh

ngbng1,30ln(KTC95%:1,041,53vip=
0,003)sovingickinthcchang.S
khcbitnycnghathngk(p<0,05).
ChuynYTCngCng
NghincuYhc
Bng16.ThchnhBCSvcngtccungcpdchv,
thngtin,tvn.
Thc hnh v BCS
P
KTC 95%
ng
Khng ng
Trc khi s dng bao cao su, c c t vn k v
bin php nga thai ny khng:
C 126 (86,90) 19 (13,10)
1,50 (1,07-2,12)
Khng 15 (57,70)
11 (42,31) 0,003
c
tnh
Tlthchnhngngicctvn
vBCStrckhisdngbng1,50ln(KTC95
%:1,072,12vip=0,0003)sovingikhng
ctvn.Skhcbitnycnghathng
k.
BNLUN
Nhngcimchungcadnsnghin
cu
C890ngicchntqunthphn
c chng tui sinh Hc Mn.Trong s
ph n c s dng phng php nga thai
chim 78,10 % (n=691) l tng ng vi mt
bng chung ca thnh ph. T l ph n s
dng cc bin php trnh thai hin i l
98,30%.
Mc hc vn ph bin l cp 2 v 3
chimias73,30%nnkhnngtipnhn
ccBPTTlphhp.Trnhtihctrln
chimrtthp5,80%.
V ngh nghip: nhm lao ng chn tay,
ginnchimas90,7%iunyphnnh
ngiukinkinhtxhitiHcMn,l
mtvngnngthnangtronggiaionth
ho..
iu kin kinh t gia nh ngho theo qui
nh ca thnh ph chim 27,3 % phn nh
huynHcmnlmttrongnhngaphng
cnnghocathnhph.
y l nhng thch thc i vi s pht
trinkinhtxhihuynHcMnnichung
vivicngtcDSKHHGniring.
TnhhnhsdngccBPTT
T l ph n la tui sinh c s dng
BPTT hn 78%. Trong BPTT hin i chim
97,6%,cnlilccbinphptruynthng.
589
NghincuYhc
Loi BPTT c s dng nhiu nht l l

DCTC chim 40,5% ngi c s dng; 2 bin
php trnh thai cn li c t l bng nhau v
bng26,25%.
Theo phn b ngi c s dng cc BPTT
theonhmtui:phntuit2534chim
t l c s dng BPTT nhiu nht 45,30 %, v
cngllatuickhnngththaicaonht.
ThchnhchungvDCTC
Tlngitrlingvthchnhchung=52,7%.
nghincucatictlthchnhng
caohnnghincuCnThcthchin
nm 2003 c th do thc bo v sc kho v
bn thn ngi ph n c nng cao hn
trc y v cc phng tin truyn thng i
chng pht trin nhanh chng, iu kin sng
cangidncngcnngln,victruyn
thngvchmscsckhesinhsncngc
cc ngnh hu quan y mnh nn cng tc
ng rt nhiu n thc hnh ng v DCTC.
Sosnhvinghincukhc:
Ni dung
HcMn (2011)
Kin thc ng DCTC

Thc hnh ng DCTC
36,10
52,70
Cn Th
(2003)[1]
40,00
16,80
Ccyutlinquan
Qua phn tch n bin mi lin quan vi
thchnh:
Cmilinquangiahcvnvthchnh.
Cmilinquangia nhm ngh lao ng tr
c v thc hnh. C mi lin quan gia nhm
nghnghipllaongtrccachngvthc
hnh.Cmilinquanviukinnh vi
thchnhng.Cmilinquanvict
vntrckhitDCTCvthchnhng.C
mi lin quan vi kin thc v DCTC v thc
hnh ng. C mi lin quan gia kin thc
ng v thc hnh ng. y l iu hin
nhin, do vy cng tc thng tin gio dc
truynthngcngphicnngcaovckin
thcngththchnhming.
iukinnhvthchnhDCTCng:
chungvichamvhocchngthnggp
cccpvchngtrkhiiukinkinhtcha
590
cthmuanhhocmtscldo
chungvigianhthringctlthchnh
ngthphnchung.iunycthcl
giithngquavictvncangithnthay
v l nhn vin y t thng qua vic trao i
thngxuynviukinchung.
Mt nghin cu Nigeria (2008)(1). Phiu
khostcattccckhchhngcdngct
cungchnphngkhmkhochhagianh
trong mt thi gian su nm c xem xt.
Ktqu:Trongthigiannghincu,c852
ngi chp nhn bin php trnh thai mi ra
trong 39,7% chp nhn dng c t cung
trnh thai. Tui nhm khch hng l 2529
(32,5%). Chp nhn s dng dct cung trnh
thai lph bin nht trong s cc khch hng
(65,1%). a s kt hn (90,0%), Thin Cha
gio(98,8%)v72,8%ctrnhgiodctrung
hc. Ngun cung cp thng tin v DCTC t
phng khm (65,7%) v bn b / ngi thn
(21,3%) l nhng ngun ph bin nht ca
thngtinvngathai.Huht(93,5%)cacc
khchhngcthitbtrnhthaitrongtcung.
au bng di (5,5%), nga m o (5,3%) l
binchngthnggpnht.Ktlun:Ccchp
nhncadngctcungtrnhthainghincu
cgiitrchpnhn,cntngcnggio
dcphn.Tngcngphngtinthngtin
i chng tham gia trong vic ph bin thng
tin chnh xc v cc thit b trnh thai trong t
cung chung dn chng, vic gii thiu sau
sinh v sau ph thai bng cch s dng DCTC
trnhthai(1).
Vthucvintrnhthai
Sosnhgiakinthcvthchnhvcch
ungthuctrongnghincu:
Quaytathy:nhngngickinthc
ng cng cao th s c thc hnh ng cng
caovngcli.
Thchnhvcngtcthngtintvn:
ngictvnvthucvintrnh
thaitngithnctlthchnhngbng
1,2ln(KTC95%:1,11,30vip=0,001)sovi
ChuynYTCngCng
ngi c t vn l nhn vin y t. S khc
bitnymangnghathngk(p<0,001).iu
nycthclgiidonhngngithncn
c thi gian tip xc vi i tng nhiu hn
nnknngthchnhcaitngctt
hnsoviiukintipxcvinhnvinyt.
Cngcthlgiildonhnvinytangb
qutivnhimvkhilmvicnntcthi
giantvn.
ngi nhn thuc t CTV dn s v
mua t hiu thuc c t l thc hnh ng v
thuc vin trnh thai bng 1,3 ln (KTC 95 %:
1,01 1,6 vi p = 0,04) v 1,30 ln (KTC 95%:
1,011,60 vi p = 0,05) so vi ngi nhn thuc
t nhn vin y t. S khc bit ny c ngha
thngk(p<0,05).Talgiitngtnhtrn
vvaitrgngicanhngngithn,ngi
mctipxcthngxuyn.
Thchnhbaocaosuvccmilinquan
Thchnhngvccyutlinquan
TlphncthchnhngvBCSt
82,30%.
Qua phn tch n bin c mi lin quan
nhsau:
Giakinthcngvthchnhng.
C mi lin quan gia thc hnh ng v

ngitvnchngtvaitrquantrngtrong
cngtcgiodc,truynthngcanhnviny
tvCTVdns,ngithn.
Vic t vn cho ngi s dng BPTT rt
quan trng. Waren M. cho rng, khng c
cungcpythngtinthngiphns
thngchorngnhngtriuchngkhnglin
quanldophngphptrnhthaigyra.
Vaitrcanhnvinyt,cngtcvindn
s v ngi thn i vi vic t vn BPTT c
thayi.Nutrcyvaitrcanhnviny
tlchotrongcngtctvnthhinnay
vi cc phng tin truyn thng i chng
nh:phtthanh,truynhnh,internet,schbo,
ti liu.. cng gp phn quan trng vo vic
cung cp cc thng tin v phng php trnh
thainhngsthncngngicangithn
tronggianh,caCTVdns,..lquantrng
hnnhphntchtrn.
TILIUTHAMKHO
1.
2.
c t vn v BCS trc khi s dng v

thchnhng.
3.
c t vn l t cng tc vin dn s v
thchnhng.
4.
Ktlun
Ti l ph n s dng cc BPTT l 78,10 %,
trongsdngBPTThinil98,30%.Cn
gn 22 % ph n la tui sinh khng s
dngbtkBPTTno.
VthchnhDCTCngthchtmc
50%,thchnhsaichyulvntikhm
v gi s theo di t DCTC. Cc BPTT khc
nhTVTT,BCStlthchnhnglnltl
92,30%v82,30%.
Quaphntchmilinquanvithchnh
ngth:
ChuynYTCngCng
NghincuYhc
5.
6.
7.
8.
9.
10.
Abasiattai M, Bassey EA, Udoma EJ (2008) Profile of

intrauterine contraceptive device acceptors at the University
ofUyoTeachingHospital,Uyo,Nigeria.Ann.Afr.Med.,7,
(1),15.
Cc Thng k (2010) Nin gim thng k giai on 2005
2009.NXBHNi.
ihcYdc,bmnphsnSnphkhoaYdcTP.
H Ch Minh (2000) Bi ging Sn Ph khoa. TP. H Ch
Minh.
Hall KS, Castano PM, Stone PW, Westhoff C (2010)
Measuring oral contraceptive knowledge: a review of
research findings and limitations. Patient Educ. Couns., 81,
(3),38894.
NguynNguyn(2006)Phngphpnghincukhoa
hctrongykhoa,tiliuluhnhnib.
NguynVnL(2006)BigingDnshc.
PhanHuThuNga(2003)KinthcThiThchnh
v Dng c t cung trnh thai ca ph n chp thun s
dng ti khoa sn, ti cp c sBnh vin a khoa Cn
Thnm2003.
Phng Y t huyn Hc Mn (205, 2006, 2007, 2008, 2009,
2010)Bococngtckhochhogianh.
Sarina S, Sarab HBS. (2008) Women s Knowledge of
Commonly Used Contraceptive methods. Wisconsin
Medicaljournal,107,2008,pp327320.
Stanton L. Deveaux S. Lunn S. Yu N. Brathwaite X, Li L.
CottrellC,HarrisR,ClemensS,Marshall(2009)Condomuse
skillschecklist:aproxyforassessingcondomuseknowledge
andskillswhendirectobservationisnotpossible.J.Health
Popul.Nutr.,27,(3),40613.
591
NghincuYhc
11.
12.
592
TrnThinThun(2010)BigingKhoahchnhvi,tiliu
luhnhnib.
UbanThngvquchi(2003)Phplnhdns.
13.
Xiao M, Wang (1983) Birth control techniques in China.

ChinaPopul.Newsl.,1,(2),17.
ChuynYTCngCng
NghincuYhc
MTSYUTNGUYCVTCHINGHNGHIPCNG
NHNNGNHMAYCNGNGHIPTIMTSTNHPHANAM
TrnhHngLn*
TMTT
tvn:Nghincuccyutnguycvtchinghnghipctrinkhairtrngriccnc
cngnghipphttrinnhM,NhtBn,Tyu.Tuyvy,VitNamnhnghngnghincuvng
dngtrinkhaitronglnhvcnylirthnch.Dovy,vicnghincungdngccnguyntccgnmi
thmdchcnngvnhgiccyutnguycticcvtrlaongcangnhmaylmtvnrtmi
hinnayivittccctnhthnhphaNam.
Mctiuti:Xcnhccyutnguyc,tchinghnghipcacngnhnmaycngnghipmts
tnhkhuvcphaNamtronggiaion20072008.
Phngphpnghincu:Nghincumtctngang.
Ktqunghincu:Ghngichocngnhnmaychaphhpviccnguyntccacgnmi:gh
bnggcng,khngctalng,khngiuchnhcchiucao.Toranguyccaoauthtlngchocng
nhnkhiphingilintc,kodi.Cnglaongrtcaovthigianlaongkodi,khngccckhong
thigiannghngntrongsutcalaongtonguyccngthng,mtmivriloncxng(RLCX)cho
ngilaong.Mitrnglaongticcphnxngmayvoccthiimkhosttntichyulgnh
nngnhit(vikhhunng)nhtlvobuichiuvmakh.Dgycmgicmtmi,cngthngchongi
laong,gystressnhit.Tlstressnghnghiplkhcaovitlchungcacngnhnmayl71%vc
milinquangiatui,vthmnincngtcvitnhtrngstressnghnghip.Nhngcngnhnctui
i31tui,thmnincngtccaoctlbstressnghnghipthphnhnsoviccnhmcngnhnc
tuitrhnvcthmnincngtcthphn.(p<0,001).TlRLCXnghnghipchungcacbacngtyl
83%.NhngcngnhnngimymaycngnghiptrongccdychuynmayctlRLCXnghnghip88%,
caohnhnsovicngnhnlaonggintip(73%)vcngnhnctvi(64%).(p<0,001).Nhngcng
nhnlmviclunthayitthtbRLCXhncngnhnphingilinlchaynglintc(p<0,05).
Khuyn ngh:Cngtynntrangbloighngimm,ciuchnhcchiucaovctalngcho
cngnhnmaycngnghiphnchauthtlngchocngnhn.gimmccngthng,mtmiv
phngchngriloncxngchongilaong,cccngtynnxemxtpdngchnghngnkhong5
7pht(45ln/calaong),kthpviccbitpthdc/vnngngaytivtrlaong.
Tkha:ccyutnguyc,tchinghnghip,RLCX,stressnghnghip.
ABSTRACT
SOMERISKFACTORSANDOCCUPATIONALHAZARDSATGARMENTINDUSTRYWORKERSIN
SOMESOUTHERNPROVINCESOFVIETNAM
TrinhHongLan*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:593599
Background: Study on risk factors and occupational hazards to be implementated widely in industrial
developmentcountriessuchastheU.S.,Japan,WesternEurope.However,theresearchandapplicationsdeployed
in this field is very limited in Vietnam. Therefore, the study of the principles of Ergonomics to explore the
Tcgilinlc:TS.TrnhHngLn
T:0903736894
ChuynYTCngCng
Email:trinhhonglan07@gmail.com
593
NghincuYhc
functionandevaluateofriskfactorsintheworkplacesofgarmentworkersisacurrentissueforallthesouthern
provinces.
Objectives: Determine risk factors, occupational hazards at garment industry workers in some southern
provincesofVietNamintheperiod20072008.
Method:crosssectionalstudy.
Results:Seatsforworkersmaynotconformtotheprinciplesofergonomics.Hardwoodenseatshaveno
backrest,heightunadjustable.Riskofbackpaincausedtoworkersassittingcontinuouslyprolonged.Working
environmentinthegarmentfactoriesinthesurvivaltimeofthesurveyismainlythermalburden(microclimate
ishot)especiallyintheafternoonandthedryseason.Easilycausingfeelingsoffatigue,stressforworkers,heat
stress.Proportionofoccupationalstressishighwiththeoverallincidenceofgarmentworkerswas71%andthere
wasanassociationbetweenageandseniorityhighstressoccupationratelowerthanintheagegroupofworkers
youngerandlowerworkseniority.(p<0.001).Proportionofoccupationalmusculoskeletaldisordersofthewhole
three companies is 83%. The workers sit in the industrial sewing machine sewing lines rates occupational
musculoskeletal disorders 88%, much higher than indirect workers (73%) and workers cut fabric (64%) (p
<0.001).Theworkers,alwayschangingpositions,arelessmusculoskeletaldisordersthanworkerstositorstand
continuously(p<0.05).
Recommendations:Thecompanyshouldequipsoftseat,withadjustableheightandbackrestforgarment
workerstominimizeoccupationalbackpainforworkers.Ordertoreducestresslevels,fatigueandpreventionof
musculoskeletal disorders for workers, companies should consider application of a short break for about 57
minutes (45 times / shift) associated with the exercise at work place. Highly labor intensity and prolonged
durationoflabor,withouttheshortbreakperiodduringtheworkshifttheriskofcreatingtension,fatigueand
musculoskeletaldisordersforworkers.
Keywords:riskfactors,occupationalhazards,occupationalmusculoskeletaldisorders,occupationalstress
vy,iukinlaongngnhmaycngnghip
TVN
vncntimnnhiunguycgytchicho
Trong qu trnh cng nghip ha, hin i
sckhengilaong.
hatnc,ngnhmayccoilmtngnh
Trnthgii,nhngnghincuvtmsinh
kinhtminhn,chimmtvtrhtscquan
llaongvcgnminhgiccyut
trng trong nn kinh t quc dn. Ngnh may
nguycvtchinghnghipctrinkhai
mcvitngsnlngtrn2tsnphmmi
rt rng ri cc nc cng nghip pht trin
nm mang v cho nn kinh t nc ta ngun
nh M, Nht Bn, Ty u. Tuy vy, Vit
ngoitrtln.Tnm2007,ngnhdtmay
Nam nhng hng nghin cu v ng dng
vt qua c du th v tr thnh mt hng
trinkhaitronglnhvcnylirthnch.Do
manglikimngchxutkhulnnhtchot
vy, vic nghin cu ng dng cc nguyn tc
nc. Ngnh may mc cn c ng gp to ln
cgnmivsdngccnghimphptmsinh
choxhikhingiiquytcmtslng
llaongthmdchcnngvnhgi
rtlncngnviclmchonhiulaongtr,
cc yu t nguy c ti cc v tr lao ng ca
trongasllaongn.
ngnhmaylmtvnrtmihinnayi
Trong nhng nm gn y, cc ch doanh
vittccctnhthnhphaNam.
nghip u t nhiu k thut v cng ngh
ti nghin cu khoa hc ny c thc
tin tin trn th gii nhm tng nng sut v
hinvimctiutngqut:Xcnhccyu
cht lng sn phm, ng thi gp phn ci
tnguyc,tchi ngh nghip ca cng nhn
thiniukinmitrnglaong,hnchcc
tc hi ngh nghip cho ngi lao ng. Tuy
594
ChuynYTCngCng
maycngnghipmtstnhkhuvcphaNam
tronggiaion20072008.
NghincuYhc
Phngphpphntch
Ccphngphpthngk.
Nhmgiiquytbamctiucthsau:
Thngkmt
1. Xcnhccyutnguyc,tchingh
nghipticcphnxngmay.
Tn s v t l phn trm i vi cc bin

nhtnh.
2. Xcnhctlhinmcmtstriu
chngbnhlthnggpcngnhn
ngnhmaycngnghip:ccrilonc
xng ngh nghip v stress ngh
nghip.
Trung bnh v lch chun vi cc bin

nhlng.
3. Xc nh mi lin quan gia cc yu t

nguycvnhngnhhngcanln
sckhengilaong.
ITNGPHNGPHPNGHINCU
itngnghincu
Ngilaong:
Cc phn xng may, qui trnh cng ngh,
vthitblaong.
aimvthigiannghincu
Cc cng ty may cng nghip trn a bn
khu vc Tp. H Ch Minh, ng Nai v Bnh
Dngtrongkhongthigian20072008.
Thngkphntch
Xc nh s khc bit gia hai mu nghin
cu trc lao ng (u ca) v sau lao ng
(cui ca) ca cng nhn bng php kim ttest
bt cp sau khi kim nh tnh ng nht
phng sai hai nhm nghin cu. Cc s khc
bitcnghathngkkhip<0,05.
Php kim chi bnh phng c s dng
xcnhmilinquangianhngbinc
lp Mi lin quan c xc nh bng t s
chnhORvkhongtincy95%.
Phntchhiquyabinbngmhnhhi
quylogisticxcnhmilinquangiacc
yutclinquanntnhtrngsckhe.
KTQUNGHINCUVBNLUN
Thitknghincu
Mtctngangcphntch.
Ktquiutranhgiviukinlao
ng
Cmuvcchchnmu
Snvckhost:3xngmaythuc
3cngtymay.
cimmuiu tra, nghin cu : tui

caitngnghincu
Tui i cng nhn ngnh may mc nhn
chunglkhtr,cti65%cngnhnctui
i35tui.Trongringnhmcngnhnc
tuii<26tuichimtl30%.
Cmuchnlmthnghimnhgitm
sinhllaong:180ncngnhn(chntheo
thtdanhschcngnhn,theotht1,3,5
Cmuchnlmnhgicgnmivtr
laong:30vtrlaong.
S lng cng nhn c iu tra phng
vn c tnh theo cch ly c mu ton b :
Trnthctscngnhnchngti la chn
c1009cngnhnngnhmaycngnghip.
Phngphpphntch,xlsliu
Xlsliu
S dng phn mm EPI2000
STATISTICAnhpvxlsliu.
ChuynYTCngCng
Thmnincngtccaitngnghincu
Bng1:Thmnincngtc(n=1009)
Thm nin cng tc
1 5 nm
6 10 nm
11 15 nm
Trn 15 nm
Tng cng
N
396
219
218
176
1009
%
39
22
22
17
100
Giitnhcaitngnghincu
Cng nhn ngnh may thuc 3 Cng ty a
phnlngii(89%),namcngnhnchchim
595
NghincuYhc
tlnh(11%),namgiichyulmbphn
lhivct.Nhngctnhnykhphhp
vi ngh may mc hin nay ni chung. Mt
khc,maycngnghiplmtcngvicrttnh
ti,tmnncngrtphhpvilaongn.
Vvy,trongccdychuynmaycngnghip
chng ta thy a phn l n cng nhn (89%).
Cc s liu iu tra v tui, gii ny cng kh
ph hp vi cc iu tra ca Nguyn nh
Dng,(20002003)(4,3).
Ktqunhgicgnmivtrlaong
Kchthcccbnghmaycngnghip:
Bng2:Kchthcccbnghmaycngnghip,n
=30
Cc thnh phn v
tr lao ng
Kch thc (cm) SD

Chiu di
1. Bn may
108 1
55 1
75 1
2. Gh ngi
100 2
30 1
45 3
Chiu rng Chiu cao
Cc bn my may ny phn ln c ngun

gctcchngmycaNhtBn.Dovy,kch
thcbnmymaycngnghipcacccngty
may hin nay l tng i chun ha theo
nguyntccgnmitrongthitk.nglu
lhuhtccbnmymayckhnngiu
chnh chiu cao ph hp vi tng ngi. Cc
mp gh nhn chung cng u c bo trn,
khng c cnh sc. Tuy vy, gh c thit k
khngngbvibnmymay.Nclm
bng g cng, khng c m, khng c ta
lng, li l nhng im cha ph hp vi cc
nguyn tc ca cgnmi trong thit k gh
ngichocngnhnmay.iunysgpphn
lmtngnguycaumicxngchongi
laongngilmviclintc.
Vngthaotccacngnhnmaycngnghip
Bng3:Vngthaotccacngnhnmay,n=30
Vng thao tc
Vng 1 : vng hot ng thng xuyn
Su (cm) SD
Vng 2 : vng hot ng chnh

Vng 3: vng vi xa nht (vng t vn
ng)
40 10 (trc)
30 4
70 5 (ra sau)
Vngthaotccacngnhnmay (Bng 3)
cngcthitkkhphhpvivnghot
ngthngxuyn,vngthaotcchnhngay
596
trcmt(vng1,2),vngtvnng(vng3).
Khong cch mt vt cn quan st ca cng
nhnmaynmtrongkhong352,honton
ph hp vi tnh cht cng vic i hi chnh
xccaocanghmaycngnghipvcngrt
phhpviTCVSLcaBYt.
Cnglaong,tptrungquanstca
cngnhn
Bng4:Cnglaong,tptrungquanst(n
=30)
Ch tiu nh gi
1. Cng lao ng
2. tp trung quan st
T l % trong 1 ca lao ng
90 1
95 3
Ngilaonghunhphingilaong
lin tc bn chic my may cng nghip vi
khong trn di 90% tng thi gian lao ng
trong ngy (10 % thi gian cn li l ngh n
giaca,igiiquytvsinhcnhn,dndp,
nhnbngiao).Cngnhnmayphilintc
quanstccngkim,michhunhtrong
sutcalaong.Mctptrungquanstkhi
thc hin cc thao tc l khong 95% thi gian
laong.ycthchnhlnhngnguyccao
gyratnhtrngcngthngvRLCX.
Ktqukhostcachngtivcng
lao ng v tp trung quan st cng hon
ton ph hp vi kt qu iu tra nghin cu
camtstcginghincukhc(5,2).
Ktqunhgimitrnglaongca
3cngty:Ktqukhostvikhhu
Tithiimkhostvomakhhuht
ccmuocaphnxngmaycacccngty
c nhit cao vt tiu chun v sinh cho
phpt0,16,3oC,nhittngcaonhtticc
phnxngmaycacngtyvobuichiuv
vomakh.Nhnchungnhitkhostvo
makhcaohnmama.Ccktqunghin
cu, kho st VKH ca chng ti v vo ma
khkhphhpviccktqunghincuca
Nguyn Trinh Hng(6), Nguyn nh Dng(3).
NguynThuH(2).
ChuynYTCngCng
NghincuYhc
KtqunhginhhngcaKLti
sckhecngnhn
Cng nhn
135.3
may
Gin tip 150.8
nhhngcaKLtitnsnhptim
Bng5:Binitnsnhptimcaccitng
nghincutrcvsaulaong(n=180)
c 2 nhm cng nhn may v nhn vin

vn phng thi im sau lao ng u tng
kh nhiu so vi thi im kho st trc lao
ng.Skhcbitcnghathngkvip<
0.001 v p < 0.05. Nhng s khc bit v thi
gianthchinvothiim sau lao ng ny
c th c hiu l do mc cng thng ca
nhm cng nhn may c phn no cao hn so
vinhmnhnvinvnphng.
Tn s nhp tim
i tng kho Trc lao ng Sau lao ng
p
st
Trung
Trung
LC
LC
bnh
bnh
Cng nhn may
74.5
0,58
85.9 0,70 < 0.05
Gin tip
75.6
0,48
80.6 0,40 < 0.05
Tithiimsaulaonguthycstng
rrtcatnsnhptimsovitrclaong.
nhhngcaKLtihuytp
Bng6:BiniHAcaccitngnghin
cu.(n=180)
Huyt p ti a
Trc lao ng Sau lao ng
Trung
Trung
LC
LC
bnh
bnh
Cng nhn may 103.8
1,11
110.1 1,31
Gin tip
107.5
1,27
112.4 1,38
Huyt p ti thiu
Cng nhn may 68.6
0,98
73.6
0,86
Gin tip
69.2
0,98
73.6
0,89
i tng
kho st
p
< 0.05
< 0.05
< 0.05
< 0.05
nhhngcaKLtikhnngtptrung
chcacngnhn
Bng7:Binithigianthchinthnghimch
Platonoptrcvsaulaong(n=180)
ChuynYTCngCng
3,31
175.5
4,92
< 0.001
29.7
161.8 3,44 < 0.05
7.3
nh gi nh hng ca KL ti sc
khecacngnhn
Tnhhnhstressnghnghip3cngty
Bng8:Stressnghnghipcaccitngnghin
cu,(n=1009)
Khoststhayicatnsnhptimv
HA ca cng nhn may v nhn vin vn
phngchothytithi im sau lao ng c
tn s nhp tim v HA tng nhng khng
nhiu so vi ch s bnh thng. Tuy vy,
chngtavnthycstngrrtcatns
nhptimvHAvothiimsaulaongso
vitrclaong.(p<0.05).iunythhin
ngnh may mc l mt ngnh khng i hi
gng sc nhiu ti mc lm tng cao ch s
HA v mch ngi lao ng. Khc vi kt
qunghincucaNguynBchNgc(2).
Thi gian thc hin

Trc lao
i tng
Sau lao ng
ng
kho st
Trung
Trung
LC
LC
bnh
bnh
3,61
Thi gian
th
nghim
tng (%)
Stress ngh nghip

Cng
Stress
Khng stress
Cng ty
Tn T l Tn T l Tn s T l
s
(%)
s
(%)
(%)
Cty May N. 277
67
136
33
413
100
Cty May PP. 225
66
116
34
341
100
Cty May HW. 219
86
36
14
255
100
Cng
721
71
288
29
1009 100
Kt qu iu tra cho thy t l stress ngh

nghipcngnhnngnhmaycngnghipca
3 cng ty may l kh cao 71%. Trong , ring
Cng ty HW. (cng ty c vn u t ca nc
ngoi)ctlstresscaonhtl86%.Cthlp
lccngtyncngoiccaohnlcngty
trongnc.Nhngnghincuvstresscng
nhnngnhmaycngnghipchothycngrt
phhpviccnghincunhgicanhiu
nhkhoahckhc(5).
TnhhnhRLCXnghnghip3cngty
Bng9:RLCXnghnghipcaccitng
nghincu.(n=1009)
RLCX ngh nghip
RLCX
Khng RLCX
Cng ty
Tn s T l Tn s T l
(%)
(%)
Cty May N. 356
86
57
14
Cty May PP. 290
85
51
15
Cty May HW. 195
76
60
24
Cng
841
83
168
17
Cng
Tn
s
413
341
255
1009
T l
(%)
100
100
100
100
597
NghincuYhc
TlRLCXtrongkhostcachngtinhn
chunglkhcao(7686%)nhngvncnthp
hnsoviktqunghincucaNguynThu
H(1998)(5)vJinK,SorockG.S(2006).
nh gi mi lin quan ca KL vi
sckhecngnhn
Phn tch xc nh mi lin quan gia
stress ngh nghip vi cc c tnh ca
mu
Bng10:Stressnghnghiphiuchnhtheonhm
tuii,thmnincngtcvtnhtrnghnnhn.
(n=1009)
c im
Nhm tui 25 tui
Nhm tui t 26-30 tui
Nhm tui t 31-35 tui,
Nhm tui trn 35 tui,
Thm nin t 1-5 nm
Thm nin 6-11 nm,
Thm nin 11-15 nm,
Thm nin trn 15 nm,
c thn
lp gia nh,
OR hiu
chnh
1
0,8
0,42
0,39
1
1,49
1,08
1,1
1
0,96
KTC 95%
Gi tr
p
0,47 - 1,37
0,22 0,8
0,21 0,77
0,42
0,009
0,007
0,88 2,51
0,6 1,93
0,58 2,1
0,13
0,79
0,76
0,68 1,36
0,83
C mi lin quan gia stress ngh nghip

vi nhm tui ca cng nhn (p<0,05). C mi
linquangiatuivtnhtrngstressngh
nghip.Theocngnhncnhmtuit31
35tuickhuynhhngtbstressnghnghip
thncngnhndi25tui0,42ln(p=0,009;
OR=0,42; KTC 95% = 0,22 0,8); cng nhn c
nhmtuitrn35tuicckhuynhhngtb
stressnghnghiphncngnhndi25tui
0,39 ln (p=0,007; OR=0,39; KTC 95% = 0,21
0,77).Nhngcngnhnctuiithpthng
l nhng ngi mi vo ngh, trong s h a
phnmixutthntccminqu,chathc
kinh nghim sng v cng cha th thch
nghittcvicciukinlaongviu
kinsngnhnhngcngnhnctuicao
hnticckhucngnghiptrongccthnhph
ln.Vvy,hcnguycbstressnghnghip
nhiuhncngliudhiu.
Nhng nghin cu v stress cng nhn
ngnhmaycngnghipchothycngrtph
598
hpviccnghincunhgicanhiunh
khoahctrongnc(5).
Kt qu phn tch nh gi mi lin quan

caKLviRLCXnghnghip
Bng11:Riloncxnghiuchnhtheoccyu
tthmninlmvic,cngvic,tthlaongv
tnhchtcngviccacngnhn.(n=1009)
OR hiu
KTC 95%
chnh
Thm nin 1-5 nm,
1
Thm nin 6-11 nm,
2,67 1,61 4,42
Thm nin 11-15 nm,
2,34 1,44 3,78
Thm nin trn 15 nm,
3,39 1,96 5,87
Th may
1
Th ct,
0,27 0,12 0,61
Th l,i,
0,86 0,30 2,43
Gin tip,
0,37 0,21 0,64
T th ng
1
T th ngi,
0,54 0,28 1,05
T th lun thay i,
0,64 0,34 1,19
Cng vic n iu - lin tc
1
Cng vic n iu - ngt
0,83 0,49 1,39
qung,
Cng vic a dng,
0,35 0,22 0,54
c im
Gi tr
p*
<0,001
0,001
<0,001
0,003
0,46
0,001
0,071
0,158
0,483
<0,001
Kt qu kho st tm mi lin quan gia

RLCXnghnghipvictnhmuchothy:
c mi lin quan gia thm nin cng tc v
RLCXnghnghip.Theocngnhncthm
nin t 610 nm c xu hng b RLCX ngh
nghipnhiuhncngnhncthmnindi
5 nm 2,67 ln (p<0,001; OR=2,67; KTC 95% =
1,614,42);cngnhncthmnint1115nm
c xu hng b RLCX ngh nghip nhiu hn
cng nhn c thm nin di 5 nm 2,34 ln
(p<0,001; OR=2,34; KTC 95% = 1,44 3,78); cng
nhncthmnintrn15nmcxuhngb
RLCX ngh nghip nhiu hn cng nhn c
thm nin di 5 nm 3,39 ln (p<0,001;
OR=3,39;KTC95%=1,965,87).Nhngktqu
nghin cu ny cng ph hp vi nghin cu
caNguynThuH(1998)(5).
KTLUN
Qua cc kt qu nghin cu, chng ti c
mtsktlunsau:
ChuynYTCngCng
NghincuYhc
ngnhmaycngnghip,chngtixincmts
xut kin ngh cc cng ty nn u tin thc
hinmtsgiiphpcithinsau:
Vccyutnguyccangnhmaycng
nghip
Ghngichocngnhnmaychaphhp
viccnguyntccacgnmi:ghbngg
cng,khngctalng,khngiuchnhc
chiucao.Toranguyccaoauthtlngcho
cngnhnkhiphingilintc,kodi.
Cngtynntrangbloighngimm,c
iu chnh c chiu cao v c ta lng cho
cngnhnmaycngnghiphnchautht
lngchocngnhn.
Cng lao ng rt cao v thi gian lao

ngkodi,khngccckhongthigianngh
ngn trong sut ca lao ng to nguy c cng
thng,mtmivRLCXchongilaong.
Cng ty PP may nn trang b ng b cc

h thng lm mt bng mn nc cng vi
qutgicngnghipchophnxngmay
gim nhit trong phn xng vo nhng
ngynngnng.
Mi trng lao ng ti cc phn xng

mayvoccthiimkhosttntichyu
lgnhnngnhit(vikhhunng)nhtlvo
bui chiu v ma kh. D gy stress nhit
chongilaong.
gim mc cng thng, mt mi v

phng chng ri lon c xng cho ngi lao
ng,cccng ty nn xem xt p dng ch
ngh ngn khong 5 7 pht (4 5 ln/ca lao
ng),kthpviccbitpthdc/vnng
ngay ti v tr lao ng theo phng php
YOGAchovnguc,haibvai,2ctay,v
ctsnglng.
Nhngnhhngcaiukinlaong
tisckhecngnhn
C s tng r rt ca tn s nhp tim, tng
huytptiavtithiu,tngthigianthc
hin v s li mc khi thc hin nghim php
Platonop vo thi im sau lao ng so vi
trclaong.Ttcnhngthayinyc
nghathngk(p<0,05).
Tlstressnghnghiplkhcaovitl
chungcacngnhnmayl71%vcmilin
quan gia tui, v thm nin cng tc vi
tnhtrngstressnghnghip.(p<0,001).
T l RLCX ngh nghip chung ca c ba
cng ty l 83%. Trong t l RLCX nhm
cng nhn lao ng trc tip trong cc dy
chuynmaycngnghipl86%chimtlcao
hn nhm lao ng gin tip vi t l 73%. C
milinquangiathmnincngtcvRLCX
nghnghip(p<0,05).
KHUYNNGH
cithiniukinlmvicvnhmbo
mnngsut,chtlngsnphmngthi
gignsckheludichongilaongca
CncccnghincusuhnvccRLCX
a vo nhm cc bnh ngh nghip c
bohimVitNam.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
EastmanKodakCompany(1990),Laonglpli,Chuyn
YHLtp2.VinYHLvVSMT,tr.128146.
Nguyn Bch Ngc v C.S (1994), nh gi Ecgonomi
KLtimtphngmy vi tnh, Tp san Vin YHL v
VSMT,s7,tr.3538.
NguynnhDngvCS(2003).iukinlaongvgnh
nnglaongcngnhnticcCngtymaythucTng
cngtyDtMayVitNam.tiNCKHcpB.
NguynnhDng,TrnhHngLnvCS(2000).Bcu
tm hiu tnh hnh au tht lng cng nhn may cng
nghipthucTngcngtydtmayVitNam.tiNCKH
cpB.
Nguyn Thu H v CS (1998). Tnh hnh au tht lng ca
cngnhnlmvicvitthbtlitimtcs.Boco
tiNCKH,VinYHL.
NguynTrinhHng(2001),nhgiiu kin lao ng
trongngnhmaycngnghipVitNamvxutnhng
binphpcithin,TpsanAntonSckhe&MTL,
(S
1,2),
tr.
11
16..
H
Ni.
ChuynYTCngCng
599
NghincuYhc
NHGIMTSCHTIUTMSINHLLAONG
VERGONOMICSMTSCNGTYMAYCNGNGHIP
TIMTSTNHPHANAM
TrnhHngLn*
TMTT
tvn:nhgiccchtiutmsinhllaongvcgnmiccvtrlaongxcnhccyu
tnguycvtchinghnghiplhtsccnthitkhithchincngtcomitrnglaong(MTL)ti
ccdoanhnghip.iunycquinhtrongThngt19/2011caBYt.Tuyvy,hinnayVit
Namvictrinkhainhgiccchtiuhunhchacthchin.Dovy,vicnghincungdngnh
giccchtiutmsinhllaongvcgnmiccvtrlaonglmtvnrtmivcnthithinnay.
Mctiuti:Xcnhmtschtiutmsinhllaongvcgnmiccvtrlaongtimts
cngtymaykhuvcphaNamtronggiaion20072008.
Phngphpnghincu:nghincumtctngang.
Ktqunghincu:Ghngichocngnhnmaychaphhpviccnguyntccacgnmi:gh
bnggcng,khngctalng,khngiuchnhcchiucao.Ccbnmymaycngnghipuc
thitkckhongtrngchochncacngnhnmaykhphhpvichiusukhong401cmvvichiu
cao63 2cmhontonphhpvitiuchunvsinhlaong(TCVSL)trongvicthitkkhnggian
chn.Vngthaotccacngnhnmaycthitkkhphhpvithitkvnghotngthngxuyn,
vngthaotcchnhngaytrcmt(vng1,2),vngtvnng(vng3),hontonphhpvitnhcht
cngviccanghmaycngnghipvcngrtphhpviTCVSL.Ccchsnhntrccacngnhnmay
nmtronggiihntrungbnhcangng95%canVitNam.Gcnhncthitkphhp.Cstng
rrtcatnsnhptim(TSNT),tnghuytp(HA)tiavtithiu,tngthigianthchinvslimc
khithchinnghimphpPlatonopvothiimsaulaong(SL)sovitrclaong(TL),Nghim
phpBourdonchothyslngchcitmcvothiimSLgimkhnhiusoviTL.Ttcnhng
thayinycnghathngk(p<0.05).Clcbntaycac2nhmitngkhostchothyucs
suygimrvothiimSLsoviTL.Sthayikhcbitnycnghathngkvip<0.05.
Khuyn ngh:Cngtynntrangbloighngimm,ciuchnhcchiucaovctalngcho
cngnhnmaycngnghiphnchauthtlngchocngnhn.gimmccngthng,mtmiv
phngchngriloncxngchongilaong,cccngtynntoiukinchocngnhnthngxuyn
thayitthlmvic(khngngiqulu),xemxtpdngchnghngnkhong510pht(45ln/ca
laong),kthpviccbitpthdc/vnngngaytivtrlaong.
Tkha:Mitrnglaong,tmsinhllaong,cgnmi,ccyutnguyc,tchinghnghip
ABSTRACT
ASSESSMENTOFSOMEINDICATORSOFLABOURPSYCHOPHYSIOLOGYANDERGONOMICS
ATSOMEGARMENTINDUSTRIALCOMPANIESINTHESOUTHERNPROVINCES
TrinhHongLan*YHocTP.HoChiMinh*Vol.16SupplementofNo32012:600605
Background:Assessmentoflabourpsychophysiologyandergonomicindicatorsatworkplacestodetermine
theriskfactorsandoccupationalhazardsisessentialformeasuringtheperformanceoftheworkingenvironment
Tcgilinlc:TS.TrnhHngLn
T:0903736894
600
Email:trinhhonglan07@gmail.com
ChuynYTCngCng
NghincuYhc
atthecompanies.ThiswasstipulatedintheCircular19issuedin2011oftheMinistryofHealth.Therefore,the
research and applications assessment of labour psychophysiology and ergonomics indicators at workplaces is
necessaryatpresent.
Objectives:DeterminesomeindicatorsoflabourpsychophysiologyandErgonomicsatworkplacesinsome
garmentcompaniesintheSouthernduringtheperiod20072008.
Results: Seats for workers may not conform to the principles of ergonomics. Hard wooden seats have no
backrest,heightunadjustable.Theindustrialsewingmachinesaredesignedwithspaceforgarmentworkersfeet
quitesuitablethedepthofabout401cmandwithaheightof632cmentirelyconsistentwithlaborhygiene
standards.Manipulatesectorofgarmentworkersarequiteconsistentwiththedesignforregularactivities,the
mainmanipulateinfront(sector1,2),thesectoroflessactive(sector3)completelyconsistentwithfeaturesofthe
work of industrial sewing and also consistent with labor hygiene standards. The anthropometric indicators of
garmentworkersintheaveragelimitedthreshold95%offemaleVietnam.Viewingangleisproperlydesigned.
Therewasasignificantlyincreasedfrequencyofheartrate,highbloodpressure,increaseimplementationduration
andmistakeswhenperformingPlatonoptestatthetimeafterworkingcomparedwithpreviousworking.Bourdon
test that measures the number of letters found at the after working dropped in comparison with the previous
working.Allthesechangesarestatisticallysignificant(p<0.05).Strengthmuscleofhandatthetwogroupsof
respondentsthathaveacleardeclinecomparedwiththeafterworkingandthepreviousworking.Thechangeof
thisdifferencewasstatisticallysignificantwithp<0.05.
Recommendations: Companies should equip softseat, with adjustable height and backrest for garment
workerstominimizeoccupationalbackpainforworkers.Ordertoreducestresslevels,fatigueandpreventionof
musculoskeletal disorders for workers, companies should facilitate workers change working posturefrequently
(notsittingtoolong),considerapplicationofashortbreakforabout510minutes(45times/shift)associated
withtheexerciseatworkplace.
Keywords: Workplace Environment, labour psychophysiology, ergonomics, risk factors, occupational
hazards
ocmitrngttcccloihnhdoanh
TVN
nghip, n v. Do vy, vic nghin cu v s
Trn th gii, nhng nghin cu, nh gi
dngccnghimphptmsinhllaong
ccchtiuvtmsinhllaongvcgnmi
thmdchcnngvnhgiccyutnguy
nh gi cc v tr lao ng nhm xc nh
c ti cc v tr lao ng ca ngnh may l rt
ccyutnguycvtchinghnghipc
cnthitivittccctnhthnhphaNam.
trin khai rt rng ri nhiu nc trn Th
ti nghin cu khoa hc ny c thc
gii. Tuy vy, Vit Nam vic trin khai nh
hinvimctiu:Xcnhmtschtiutm
gi cc ch tiu tm sinh l lao ng v
sinhllaongvcgnmiccvtrlaong
cgnmi khi o c MTL ti cc doanh
timtscngtymaykhuvcphaNam.
nghip,nvhunhchacthchinti
ITNGPHNGPHPNGHINCU
ttccctnhthnhdonnglccccnbyt
laongcacctnhtronglnhvcnylirt
itngnghincu
hnch.Mtkhc,theoquinhhinhnhca
Ngi lao ng: Cc phn xng may, qui
B Y t, cc ch tiu tm sinh l lao ng v
trnhcngngh,vthitblaong.
cgnmiphickhostocngthi
viccchtiuMTLkhc(ccchtiulhc,
hahc,bivchtiusinhhc)khitinhnh
ChuynYTCngCng
601
NghincuYhc
Cmuvcchchnmu
cngnhnmaylmbnggcng,khngcta
lng. Chiu di gh khong 108 1 cm, chiu
rng551cm,chiucaocnhkhong751
cm. Cc mp ngh nhn chung cng u c
bo trn, khng c cnh sc.. Nh vy, cc bn
my may c thit k hon ton ph hp
vitiuchunVSLtrongthitkchiucaob
mtlmvicchocngvicngimaycacnam
vncngnhnmay(1).
C mu chn lm th nghim nh gi
tmsinhllaong:180ncngnhn
Bng2:Khongtrngchochncacngnhnmay
(SD),n=30
aimvthigiannghincu
Nghincuti03cngtymaycngnghip
trn a bn khu vc Tp. H Ch Minh, ng
NaivBnhDngtrongkhongthigian2007
2008.
Thitknghincu
Mtctngang.
Cmuchnlmnhgicgnmivtr
laong:30vtrlaong.
Phngphpphntch,xlsliu
Xlsliu
:S dng phn mm EPI2000 v
STATISTICAnhpvxlsliu.
Phngphpphntch
Ccphngphpthngk:
Trung bnh v lch chun vi cc bin
nhlng.
Xc nh s khc bit gia hai mu nghin
cu trc lao ng (u ca) v sau lao ng
(cui ca) ca cng nhn bng php kim ttest
bt cp sau khi kim nh tnh ng nht
phng sai hai nhm nghin cu. Cc s khc
bitcnghathngkkhip<0,05
KTQUNGHINCUVBNLUN
Ktqunhgiccthnhphnchnhca
vtrlaong
Bng1:Kchthcccthnhphnvtrlaong
(SD),n=30
Cc thnh phn
Kch thc (cm)
v tr lao ng Chiu di Chiu rng Chiu cao
1. Bn may
108 1
55 1
75 1
2. Gh ngi
100 2
30 1
45 3
Kch thc bn my may cng nghip ca

hu ht cc cng ty may hin nay l tng i
chunhatheonguyntccgnmitrongthit
k.Tuynhin,vighngicacngnhnmay
liaskhngcchunhatheoccnguyn
tc ca cgnmi VTL. Cc ngh ngi cho
602
Cc khong trng
Kch thc
(cm)
1. Khong trng cho u gi (theo chiu su)
40 1
2. Khong trng cho i (mt gh - mp di

bn)
3. Chiu cao khng gian chn
20 2
63 2
Cc bn my may cng nghip u c

thitkckhongtrngchochncacngnhn
may kh ph hp vi chiu su khong 40 1
cmvvichiucao632cm.Nhnchunglto
chocngnhncthcngvdichuynchn
kh thoi mi khi ngi. Nhn chung l to cho
cngnhncthcngvdichuynchnkh
thoi mi khi ngi v hon ton ph hp vi
tiuchunVSLtrongvicthitkkhnggian
chn(1). Nhng kt qu iu tra v bn gh
lm vic ca cng nhn may trong nghin cu
ny cng rt ph hp vi cc nghin cu gn
ycaNguynThuH(1998)(4)vnghincu
NguynTrinhHng(2001)(5)viukinlm
viccamtscngtymayphaBc.
Bng3:Vngthaotccacngnhnmay(SD),n=30
Vng thao tc
Vng 1 : vng hot ng thng xuyn
Su (cm)
Vng 2 : vng hot ng chnh
40 10 (trc)
Vng 3: vng vi xa nht (vng t vn

ng)
70 5 (ra sau)
30 4
Vng thao tc ca cng nhn may cng

c thit k kh ph hp vi thit k vng
hotngthngxuyn,vngthaotcchnh
ngay trc mt (vng 1, 2), vng t vn ng
(vng 3). Vng thao tc ca cng nhn may
cng c thit k kh ph hp vi thit k
vng hot ng thng xuyn, vng thao tc
chnhngaytrcmt(vng1,2),vngtvn
ChuynYTCngCng
ng(vng3),hontonphhpvitnhcht
cngviccanghmaycngnghipvcngrt
phhpviTCVSLcaBYt(1).
Bng4:Trsgcgiacconcthtthngi
may(SD)n=90
Tn cc gc
Tr s gc Tr s gc
thc t () ti u ()
35
35,0 4,6
1. Gc gia u - mnh
2. Gc gia u - ng thng
ng
3. Gc dng cnh tay khi may
26,5 3,2
25
21,4 7,9
4. Gc khuu tay
90,5 6,2
95
5. Gc gia cng tay v bn tay

(gp c tay)
6. Gc gia cng tay - bn tay
(dui c tay)
7. Gc thn - i
22,5 1,5
25,2 5,1
110,5 5,7
115
8. Gc i - cng chn
102,0 7,8
115
9. Gc gia cng chn - bn chn
84,5 18
118
10. Gc nhn
35,5 3,0
15 45
Kt qu phn tch v nh gi t th lao

ng ca cc cng nhn may cho thy, nhn
chungngicngnhnctthngikhthoi
mi. Ch c c tay ca ngi cng nhn l
thngxuynphigpduithchincc
thaotccnthitkhimayccchititovimt
gctrongkhongt2225ovgcdngcnh
taythngduytrvimtgc21,47,9,gyra
gnh nng c tnh cho vng vai gy. Gc nhn
ca ngi cng nhn may cng c thit k
khphhpmbochongilaongquan
stddng(khong35,5o),cngrtphhpvi
TCVSLcaBYt(1).
Bng5:Trsnhntrcmtsoncthncng
nhnmaytthngi(SD);n=90
Tn kch thc
Tr s o
Tr s o
thc t (cm) ngng 95%*
1. Chiu cao ngi (t np
40,6
42 1
khoeo)
2. Chiu cao sn nh nh
118,8
115 3
u
3. Cao t u gi
48,1
47 1
4. Cao mt gh - mo chu
21 1
21,6
5. Chiu rng mng
37 1
38,0
6. Cao gh - khyu tay
25 1
25,6
7. Khong cch vi ti a ra
trc (nm tay)
8. Khong cch t lng
vi ti a ra trc
70 2
69,4
77 2
78,5
ChuynYTCngCng
NghincuYhc
Tn kch thc
Tr s o
Tr s o
thc t (cm) ngng 95%*
55,7
54 2
9. Di mng u gi
47 2
10. Chiu di mng - khoeo
47,6
(2)
*(theoBiThvCTV,1983
Do cng nhn may chim hu ht (khong

90%) nn chng ti ch chn cc n cng nhn
may nh gi. Phn tch nhn trc ngi
cngnhnmaycngnghipchothyccchs
nhntrccahcngnmtronggiihntrung
bnhcangng95%canVitNam.Cckt
qu nghin cu ny cng hon ton ph hp
vi nghin cu ca Nguyn Thu H, Trn
ThanhH(1998)(4),TrnhHngLn(1998)(6).
Ktqunhginhhngcaiukin
laongtitmsinhllaongcacng
nhn
Bng6.:Binihuytp(HA)caccitng
nghincutrclaongvsaulaong,n=180
Huyt p ti a
i tng kho
TL
SL
st
Trung
Trung
LC
bnh
bnh
Cng nhn may 103.8
1,11
110.1
Nhn vin VP
107.5
1,27
112.4
Huyt p ti thiu
Cng nhn may
68.6
0,98
73.6
Nhn vin VP
69.2
0,98
73.6
p
LC
1,31 < 0.05
1,38 < 0.05
0,86 < 0.05
0,89 < 0.05
Khost,nhgi v nhng thay i ca

huytp(HA)ca2nhmcngnhnmayv
nhnvinvnphngtrclaong(TL)v
saulaong(SL)chothy:c2nhmSL
u c HA ti a v ti thiu u nm trong
giihnbnhthng.iunythhinngnh
maymclmtngnhkhngihigngsc
nhiutimclmtngcaochsHAngi
lao ng. Tuy nhin, c 2 nhm i tng
nghincuucHAtiavtithiuSL
utngcaohnsoviTL.Sthayiny
cnghathngkvip<0.05.(Thhintnh
cht cng vic khc nhau nhng u c s
cngthngnhtnh).
Bng7:Binitnsnhptim(TSNT)cacci
tngnghincuTLvSL(n=180)
i tng kho
Tn s nhp tim
603
NghincuYhc
st
Cng nhn may

Nhn vin VP
TL
Trung
LC
bnh
74.5
0,58
75.6
0,48
SL
Trung
LC
bnh
85.9
0,70 < 0.05
80.6
0,40 < 0.05
Kho st s thay i ca TSNT ca cng

nhnmayvnhnvinvnphngchothyti
thi im SL u thy c s tng r rt ca
TSNT so vi TL. S thay i ny c ngha
thngkvip<0.05.TheoThngquikthut
ca B Y t, 2002 th cng vic lm cho TSNT
trong lao ng khong 90 nhp/pht ch c
xploignhnngthlcloiI(trong6loi)(7).
Nhvy,chngtacththyvimctngca
TSNTcacngnhnngnhmayvnnmtrong
giihntiachophp,thmtrltrongvng
trstiu.iunychngtnghmaycng
nghipkhngihinhiuvthlc.
Bng8:Biniclcbntaytiacacci
tngnghincuTLvSL(n=180)
i tng kho
st
Cng nhn may
Nhn vin VP
Cng nhn may
Nhn vin VP
C lc bn tay phi
TL
SL
P
Trung
Trung
LC
LC
bnh
bnh
27.1
0,58
23.8 0,51 < 0.05
32.4
1,23
30.9 1,23 < 0.05
C lc bn tay tri
24.1
0,52
21
0,45 < 0.05
28.9
1,15
27.6 1,14 < 0.05
Ktqukhostbiniclcbntayca
c2nhmitngkhostchothyucs
suygimrvothiimSLsoviTL.S
thayikhcbitnycnghathngkvip
<0.05.Nhngiunychngtmcdngnh
maykhngihiclcnhiu,nhngmc
gngsccacngnhnmayvncaohnsovi
cc lao ng gin tip. N c th hin bng
mcsuygimclcvothiimSLca
cng nhn may hn hn so vi nhn vin vn
phng. Kt qu nghin cu ca chng ti ph
hpviktqunghincucaTrnhHngLn
(1998)(6)vNguynBchNgc(1994)(3).
Bng9:Binithigianthchinthnghimch
PlatonopTLvSL(n=180)
i tng
kho st
604
Thi gian thc hin

TL
SL
Thi
gian th
nghim
Trung
Trung
LC
LC
tng (%)
bnh
bnh
Cng nhn
3,61
4,92
135.3
175.5
< 0.001
29.7
may
Nhn vin
3,31
3,44
150.8
161.8
< 0.05
7.3
VP
S li khi khi thc hin
Cng nhn
1.3
0,04
3.3
0,2 <0.001
may
Nhn vin
1.08 0,01
3.2
0,2 <0.001
VP
Khostvkhnngchthngquath
nghimPlatonopchothy,thigianthchin
nghim php c 2 nhm cng nhn may v
nhn vin vn phng thi im SL u
tngkhnhiusovithiimkhostTL.
Trong , ng ch l nhm cng nhn
maycthigianthchinnghimphpSL
tng cao hn so vi TL ti 29,7 %. t mc
cng thng loi III theo hng dn ca
Thng qui k thut ca B Y t, 2002 (mc
cng thng cao nht l loi IV)(7) (mc cng
thngcaonhtlloiIV).Nhngskhcbit
v thi gian thc hin th nghim ch
Platonop l c ngha thng k vi p < 0.001
v p < 0.05. Nhng s khc bit v thi gian
thc hin v s li thc hin vo thi im
SLnycthchiulcthdomc
cngthngcanhmcngnhnmaycphn
no cao hn so vi nhm nhn vin vn
phng.
Bng10:Binislngchcitrongbapht
canghipphpBourdonTLvSL
S lng ch ci tm c
i tng kho
TL
SL
p
st
Trung
Trung
LC
LC
bnh
bnh
Cng nhn may 98.0
2,47
88.5
1,99 <0.05
Nhn vin VP
102.2 2,19
95.6
2,20 <0.05
S li khi khi thc hin
Cng nhn may
1.9
0,18
5.6
0,39 <0.001
Nhn vin VP
2.28
0,18
5.02
0,38 <0.001
Kt qu kho st nh gi mc cng
thng thn kinh ca hai nhm cng nhn may
cngnghipvnhnvinvnphngthngqua
nghim php Bourdon cho thy : s lng ch
citmcvothiimSLgimkhnhiu
so vi TL ca c 2 nhm cng nhn may v
ChuynYTCngCng
nhn vin vn phng. S khc bit ny l c
nghathngk(p<0.05).Mtkhc,nhmnhn
vinvnphngdtmcnhiuchcihn
sovinhmcngnhnmaycthiimTL
v SL. V mc mc li khi thc hin
nghim php Bourdon cho thy, vo thi im
SL,cngnhnc2nhmitngkhost
umcnhiulihnsovithiimTL.S
khc bit ny l c ngha thng k vi p <
0.001.
KTLUN
Qua cc kt qu nghin cu, chng ti c
mtsktlunsau:
Ghngichocngnhnmaychaphhp
viccnguyntccacgnmi:ghbngg
cng,khngctalng,khngiuchnhc
chiucao.Toranguyccaoauthtlngcho
cngnhnkhiphingilintc,kodi.
Cc bn my may cng nghip u c
thitkckhongtrngchochncacngnhn
may kh ph hp vi chiu su khong 40 1
cm v vi chiu cao 63 2 cm hon ton ph
hp vi tiu chun VSL trong vic thit k
khnggianchn.
Vngthaotccacngnhnmaycthit
k kh ph hp vi thit k vng hot ng
thngxuyn,vngthaotcchnhngaytrc
mt(vng1,2),vngtvnng(vng3),hon
ton ph hp vi tnh cht cng vic ca ngh
may cng nghip v cng rt ph hp vi
TCVSL.
Cc ch s nhn trc ca cng nhn may
nmtronggiihntrungbnhcangng95%
ca n Vit Nam. Gc nhn c thit k ph
hp.
C s tng r rt ca tn s nhp tim, tng
huytptiavtithiu,tngthigianthc
hin v s li mc khi thc hin nghim php
Platonop vo thi im sau lao ng so vi
trclaong,NghimphpBourdonchothy
NghincuYhc
s lng ch ci tm c vo thi im SL
gimkhnhiusoviTL.Ttcnhngthay
inycnghathngk(p<0.05).
C lc bn tay ca c 2 nhm i tng
khostchothyucssuygimrvothi
imSLsoviTL.Sthayikhcbitny
cnghathngkvip<0.05.
KINNGH
cithiniukinlmvicvnhmbo
mnngsut,chtlngsnphmngthi
gignsckheludichongilaongca
ngnhmaycngnghip,chngtixincmts
xut kin ngh cc cng ty nn u tin thc
hinmtsgiiphpcithinsau:
Cngtynntrangbloighngimm,c
iu chnh c chiu cao v c ta lng cho
cngnhnmaycngnghiphnchautht
lngchocngnhn.
hn ch gnh nng c tnh cho vng
lng v vng vai gy d gy ri lon c
xng,ccCngtynncgngtoiukin
chongilaongthngxuynthayit
thtrongcalmvic,tchctpthdcgia
gi,chongilaongnghngn510pht
saumi2gilmvic.
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
BYt(2003).TiuchunVsinhlaong,NXBYhc,2003.
BiTh(1983).NhntrcEcgonomi.NhxutbnYhc
Nguyn Bch Ngc v C.S (1994), nh gi Ecgonomi
KLtimtphngmy vi tnh, Tp san Vin YHL v
VSMT,s7,tr.3538.
Nguyn Thu H v CS (1998). Tnh hnh au tht lng ca
cngnhnlmvicvitthbtlitimtcs.Boco
tiNCKH,VinYHL.
NguynTrinhHng(2001),nhgiiu kin lao ng
trongngnhmaycngnghipVitNamvxutnhng
binphpcithin,TpsanAntonSckhe&MTL,
HNi.(S1,2),tr.1116.
TrnhHngLn(1998).Canthipecgonomicithiniu
kinlmvictimtsVtrlaong.LunvnThcsy
hc1998.ihcYHNi.
VinYHLvVSMT(2002),ThngquikthutYHLv
VSMT,BYt.NhxutbnYhc,HNi.
ChuynYTCngCng
605
NghincuYhc
KLEBSIELLAPNEUMONIAEVENTEROBACTERHORMAECHEI
SHUGENblaKPCKHNGCARBAPENEMTIVITNAM
TrnNhtPhng*,PhmHngVn**
TMTT
tvn:Carbapenem,khngsinhdtrcuicngchoccbnhtruynnhimnghimtrngbv
hiuhabimtsvikhungramm.SbngphtdchbnhdoK.pneumoniaevmtsvikhunng
rutcmanggenmhacholactamaseKPCanglmtvnquanngitronglmsngtrntonthgii.
Mctiunghincu:BocoghinhnskhngcarbapenemtiVitNamtrnK.pneumoniaevEnt.
hormaecheildoshugenmhachoenzymelactamaseKPC(blaKPC).
Phng php nghin cu: nhykhngsinh(KS)caccK. pneumoniaenycthchintheo
phngphpMICvkthutgiitrnhtxcnhgenblaKPC.
Ktqu:ThnghimnhycmtheoCLSI,xcnhMIC,xcnhngenblaKPCbngkthutPCRv
giitrnhtccgenny,9chngK.pneumoniaev1chngEnt.hormaecheitrongs21munghincumang
genblaKPC2.
Kt lun:cnhbovnguyctimncasgiatngkhngcarbapenembitcnhnnyngthi
cnglmtvnngquantmtrongkimsotslylancadchbnhtrndinrng.
Tkha:K.pneumoniae,Ent.hormaechei,KPC,carbapenem,khngthuc
ABTRACT
CARBAPENEMRESISTANTKLEBSIELLAPNEUMONIAEANDENTEROBACTERHORMAECHEI
POSSESSINGBLAKPCGENESINVIETNAM
TranNhatPhuong,PhamHungVan
Backgroud:Havingreservedasalastlineantimicrobialofdefenseagainstseriousandinvasiveinfection,
carbapenemsareusedtotreatlifethreateninginfectionsofextremelydrugresistant gram negative pathogens.
The emergence of epidemics causing by K. pneumoniae possessing KPC blactamase is worldwide clinical
concerns.Theencodinggenesforthisenzymehavebeenconfirmedonconjugatedplasmidthatcanbetransmitted
from one species to another. Routine testing based on existing breakpoints may make false identify of KPC
producersassusceptibleones.Thiscanberiskpotentialofincreasingillness,deaths,longerstayinhospitaland
spreadingofinfection.
Objectives:ReportaboutresistanceantibioticscarbapenemofK.pneumoniaeandEnt.hormaecheiinViet
Namcausingbygenescodedenzyme lactamaseKPC(blaKPC).
Methods: the sensitivily of antibiotics for K. pneumoniae by MIC and determine gen blaKPC by
sequencingtechnique.
Results:9strainsofK.pneumoniaeand1strainofEnterobacterhormaecheiamong21strainsresistanceto
carbapenem were confirmed positive with both carbapenemase activity and blaKPC gene. Amplicons were
bidirectionallysequencedonABI3130XLGeneticAnalyserbyBigDyeterminatormethodandallareKPC2.
CngtyNamKhoa
**TrngihcYdcthnhphHChMinh.
Tcgilinlc:Ths.TrnNhtPhng T:0913881887
Email:sunphuong2000@yahoo.com
606
ChuynYTCngCng
NghincuYhc
Conclusion:KPCproducingK.pneumoniaeandEnt.Hormaecheiinthisreportshowthatitisapotential
riskforclinicaldiseasesandinfectioncontroliftheyaretospreadinhospitalorcommunity.
Keywords:K.pneumoniae,Ent.hormaechei,KPC,carbapenem,antimicrobialresistance
TVN
ITNGPHNGPHPNGHINCU
Carbapenem l loi khng sinh d tr cui

cngiutrbnhnhimtrngnghimtrng
hay nhim trng do xm ln e da n tnh
mngcabnhnhngyrabiccvikhungy
bnhgramm(9).Sbngphtdchbnhnhanh
chng do Klebsiella pneumoniae tit men K.
pneumoniaecarbapenemase(KPC),lmtvn
nangiihinnay(1,10).EnzymelactamasesKPC
thuc nhm enzyme serine carbapenemases v
thng c pht hin K. pneumoniae v
Escherichia coli. Enzyme ny thy phn v lm
gim hot lc ca hu ht cc KS lactam v
hinnayucphthincnhiunhmVK
ng rut nh K. oxytoca, Enterobacter spp.,
Salmonella spp., Citrobacter freundii, and Serratia
spp.vPseudomonasaeruginosa(9).
nhyKScaccK.pneumoniaenyc
thchintheophngphpnghbiCLSI[1].
MIC c xc nh bng phng php pha
long nng khng sinh s dng cc chng
chun E. coli ATCC 25922 v K. pneumoniae
ESBL(+) ATCC 700603. Cc chng i chng
c s dng trong xc nh phenotype bng
k thut Hodge test l K. pneumoniae KPC (+)
ATCC 1705 v K. pneumoniae KPC() ATCC
Cc
on mi a nng(7)
1706(2).
blaKPCuF:5CAGCTCATTCAAGGGCTTTC
3;blaKPCuR:5AGTCATTTGCCGTGCCATAC
3; v mi chuyn bit(8) blaKPCF:
5TGTCACTGTATCGCCGTCTAG3;
blaKPCR:5TACTGCCCGTTGACGCCCAATCC
3 m ha cho gen blaKPC, c khuch i vi
chu trnh nhit: 950C/5 pht ; 40 chu k
940C/30giy, 550C/30 giy, 720C/1 pht v
720C/10phttrnmyPCRMyCycler(BioRad,
M). Cc sn phm PCR c gii trnh t hai
chiu bng phng php BigDye Terminator
trnmyABI3130XLGeneticAnalyser(Applied
Biosystem,M).Ktqugiitrnhtcphn
tchsosnhtrctuynvicctrnhtchun
c cng b trn chng trnh BLAST ca
NCBI.Ktqucthngkmtvphntch
trnphnmmexcel.
Gen blaKPC c xc nh hin din trn

plasmid do vy chng c th c chuyn t
nhmVKnysangnhm VK khc, y l vn
ngngitrongkimsotlynhim(5).Crt
tthucKScdngtrongiutrccbnhdo
cc nhm VK tit men lactamases ny, l
aminoglycosides, glycylcyclines, polymyxins,
haykthpKS(9).Miquantmhnguhin
naylccphngphpphthinccnhmVK
titKPCdatrnimgiihn(breakpoint)c
nhnghnchdovycthgynnvngia
tngtlbnhvtvong,hayphiiutrlu
dicngnhlslantruyncabnhtrongBV
vcngng.
Thng 6 nm 2010 n thng 6 nm 2011,
phngthnghimNghincuvTrinkhaica
Cng ty Cng Ngh Sinh Hc Nam Khoa, TP.
HChMinhnhncccmubnhphmti
ccbnhvinVitNamtnhngbnhnhn
nhimtrnghuytvxcnhncyl
ccchngK.pneumoniaetitmenKPC.Ccbnh
nhncxcnhnkhngidulchhaycha
bnh ti cc khu vc c s hin din KPC trn
thgiiccngb.
ChuynYTCngCng
KTQUVBNLUN
Trong thi gian 12 thng t thng 6 nm
2010nthng6nm2011,18trongs21chng
phnlptbnhphmnhiubnhvinc
nghin cu khng vi t nht mt
carbapenemnhngchc9chnglccchng
c ESBL dng tnh. 1 chng l E. absureae
dngtnhvihottnhcarbapenemasenhng
m tnh vi gen blaKPC; 9 chng Klebsiella
pneumoniae v 1 chng Enterobacter hormacheii
c xc nhn dng tnh vi c th nghim
HodgevgenblaKPC.
607
NghincuYhc
Bng1:cimkhngakhngsinh,ESBLvckiuhnhKPC(+)caccchngkhngakhngsinhphn
lptiVitNam
ID
Kt qu nh danh
ESBL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
K. pneumoniae
K. pneumoniae
K. pneumoniae
K. pneumoniae
Enterobacter asbureae
K. pneumoniae
K. pneumoniae
K. pneumoniae
E. hormaechei
K. pneumoniae
K. pneumoniae
K. pneumoniae
K. pneumoniae
K. pneumoniae
Shigella boydii
K. pneumoniae
K. pneumoniae
K. pneumoniae
K. pneumoniae
K. pneumoniae
K. pneumoniae
+
+
+
+
+
+
+
+
+
-
Bin lun theo ng Bin lun theo Nng c

knh vng v khun
ch ti thiu (MIC)
Hodge
Imi
Mero
ERT
MERO
DORI
R
R
R
R
R
R
R
R
R
R
+
R
R
R
R
R
+
R
R
I
I
R
+
R
I
R
I
R
+
R
R
R
R
R
+
R
R
R
R
R
+
S
S
S
S
R
R
R
R
R
R
+
R
R
R
R
R
S
S
S
S
S
R
R
R
R
R
+
R
R
I
I
R
+
S
S
S
S
S
+
S
S
S
S
R
R
R
R
R
R
+
S
S
S
S
S
R
R
I
R
R
+
R
R
R
R
R
S
I
R
S
R
+
R
R
R
S
R
-
Trc khi gii trnh t, sn phm PCR

dngtnhvigenblaKPCctinhschbng
QIAquickPCRpurification(Qiagen,M)vxc
nhnngcngnhtinhschbngin
ditrnchip(Agilent2100Analyser)choktqu
tinhschcaoviccsnphmkchthcn
inhtrongkhong408411bp.
Kt qu gii trnh t cc gen blaKPC ny
c so snh vi cc trnh t tham kho trn
ngn hng NCBI vi tng ng 98 100%
so vi trnh t mang m s GI23484176 ca K.
pneumoniaeATCC1705.
phn bit 3 loi blaKPC1,2,3 Justin M.
Cole v cng s(3) da trn kt qu in di sn
phmPCRcagenblaKPCsaukhivi2loi
enzyme ct gii hn BstNI v RsaI. Nu sn
phmindichchomtvchduynhtlKPC
1; nu sn phm cho l 2 hoc 3 vch th s l
KPC2vKPC3theotht.Ngoira,khix
lbngenzymeBstNI,nutrnhtmhabla
KPC b ct nucleotide C ti cc v tr trong
608
blaKPC
KPCu
+
+
+
+
+
+
+
+
+
+
-
KPC
+
+
+
+
+
+
+
+
+
+
-
khong359bpthcthxcnhenzymec
m ha l KPC2. Trn c s , chng ti s
dng phn mm Primer Premier 5.0 (Premier
Biosoft, M) tm v tr ct gii hn ca
enzyme ny trn cc gen blaKPC dng tnh
nhmxcnhkiugennytrongnghincu.
Kt qu cho thy ch c duy nht mt trnh t
ct bi BstNI ti cc v tr t 358 362bp cc
chng c cha gen blaKPC. Nh vy c th
khng nh cc chng c blaKPC dng tnh
trongnghincucachngti thuc kiu gen
KPC2(hnh1).
K.pneumoniaetitmenKPCcphthin
ln u tin ti mt bnh vin Bc Carolina
nm 2001, v lan trn ln n 35 tiu bang
cancM(6).Saucphthinticc
quc gia, vng lnh th khc nh Php nm
2005, Nam Phi nm 2006 (Villegas), Israel
(Leavit, 2007), Hy Lp (Cuzon, G. 2008), Trung
Qucnm2008(ZeQingWei,vcs)(4).
ChuynYTCngCng
NghincuYhc
c hot tnh carbapenemase nhng khng pht

hin gen blaKPC. iu ny l do phng php
cloverleaf (MHT) ch dng pht hin hot
tnh carbapenemase ch khng phn bit c
ccloienzymecarbapenemases.
KTLUN
Cnhbovnguyctimncasgiatng
khng carbapenem bi K. pneumoniae v
Enterobacter mang gen blaKPC, l mt vn
ng quan tm trong kim sot s ly lan ca
dchbnhtrndinrng.
Hnh1:1imctgiihncaenzymeBstNItiv
tr358bpv361bptrntrnhtblaKPCdng
tnh.
Mc d cha c iu kin thc hin vic
kim tra tng ng v di truyn, s hin
din ca gen m ha cho enzyme KPC2 trong
nghin cu ca chng ti 9 chng K.
pneumoniae v 1 chng Ent.hormaechei cho thy
skhngvicarbapenemtrongccvikhun
gy bnh Vit Nam cng l mt vn cn
quantmtronglmsngbivgenkhngny
cng c pht hin do lan truyn t K.
pneumoniaechoccvikhungrammkhctrn
th gii nh ti M: K. oxytoca (Yigit, 2003),
Sallmonella (Miriagou, 2003), E. coli, Israel
(Navonvenezia, 2006), Pseudomonas aeruginosa,
Acinobacter baumannii (Landman, 2007),
Enterobacter Anh (Woodford, 2007), Serratia
marcescensTrungQuc(Zhang,2007),E.coliv
Enter.cloacaePhp(Petrella,2008)(4).
Nguyctimncaslantruynccchng
tit men blaKPC v mt s gii hn trong vic
phthin(doMICivicarbapenemthphn
so vi chun ngh bi CLSI) l mt vn
cn t ra trong vic pht trin phng php
phthinchnhxcenzymeny.Vcthxyra
hin tng ng biu hin vi cc lactamase
khc nh trong trng hp nghin cu ca
chng ti vi s hin din ca 1 chng Ent.
absureae(5)v2chngK.pneumoniae(14v16)
ChuynYTCngCng
TILIUTHAMKHO
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Bradford PA, Bratu S, Urban C, Visalli M, Mariano N,

Landman D (2004), Emergence of carbapenemresistant
Klebsiella species possessing the class A carbapenem
hydrolyzing KPC2 and inhibitorresistant TEM30
lactamasesinNewYorkCity.ClinInfectDis.39:5560.
Clinical and Laboratory Standard Institute (2010),
Performance Standards for Antimicorbial Susceptibility
Testing:TwentyInformationSupplement,30,M100S20.
Cole,JM.,etal.(2009).Developmentandevaluationofareal
time PCR assay for detection of Klebsiella pneumoniae
carbapenemasegenes,Journalofclinicalmicrobiology.47(2),
322326.
GootzTDetal.,2009,GeneticOrganizartionofTransposase
regions surrouding blaKPC carabapenemase genes on
plasmids from klebsiella strains isolated in a New York city
hospital, Antimicrobial Agents and Chemotherapy, 53, 5:
19982004.
Grobner S et al. (2009).Emergence of carbapenemnon
susceptible extendedspectrum {beta}lactamaseproducing
Klebsiella pneumoniae isolates at the university hospital of
Tubingen,Germany,Journalofmedicalmicrobiology.58(7),
p.912922.
NaasT,CuzonG,VillegasMV,etal(2008),Geneticstructures
at the origin of acquisition of the lactamase blaKPC gene.
AntimicroAgentsChemother.52:125763.
PournarasS,ProtonotariouE,VoulgariE,etal(2009),Clonal
spread of KPC2 carbapenemaseproducing Klebsiella
pneumoniae strains in Greece Journal of Antimicrobial
Chemotherapy.
SternbergS,USATODAY,2010,Drugresistantsuperbugs
hit
35
states,
spread
worldwide
http://www.usatoday.com/yourlife/health/medical/20100917
1Asuperbug17_ST_N.htm).
WaltherRasmussen J, Hiby N. (2007), Class A
carbapenemases.JAntimicrobChemother.2007;60:47082.
WoodfordN, Tierno PMJr, Young K, Tysall L, Palepou MF,
WardE(2004),OutbreakofKlebsiellapneumoniaeproducing
anew carbapenemhydrolyzing class A lactamase, KPC3,
in a New York medical center. Antimicrob Agents
Chemother.48:47939.
609
NghincuYhc
DCHTHCPHNTVIRTCACMA(H3N2)v
UTINTRNNGITIVITNAM
NguynThanhLong*,TrnNgcHu*,NguynThuNgc*,NguynHongAnh*,NguynTrungHiu*,
HongMinh*,NguynThThanhThng*,NguynThNgcTho*,ngThanhGiang*,
PhmThNhung*,NguynThMinhPhng
TMTT
tvn:TiHoaKslynhimvirtcmtheosangngivntiptccghinhn,virtcm
chngA(H3N2)vphnlptrnngimiythahng7gentvirtcmH3N2tithp(TRSH3N2)
BcMvgenMtvirtcmidchA(H1N1)2009.Tonbvirtcmtithp(H3N2)vcctnh
khngnguynrtgnvichngvirtcmA/Minnesota/11/2010lchngcarachnlalmvcxin
(reassortantX203)(2)..Mcdslynhimvirtcmtheosangngilkhngthngxuynnhngs
phthinrachngcmminychramtkhnngtithphnnacavirtcmnydnnshnh
thnhchngmickhnnglantruyntngisangngi.TiVitNam,mtnghincunm2010pht
hin6cacngchngH3N2tithptrnheo(2).NhmmcchxemchngcmnycngitiVit
Namhaycha,TrungTmCmQucGiaVinPasteurTP.HChMinhxtnghimhicutonbca
H3N2phnlpctiminnamVitnamtrongnm2011.
Mctiunghincu:XcnhshindinchngvirtcmmitiVitNam.
Phng php nghin cu: Mt,saukhinhnccnhbovvirtcmA(H3N2v)caTrungtm
kinsotccbnhnhimHoak(CDC)ngy26/11/2011,Thng12nm2011tonb14cangiVitnhim
A(H3N2)cphthintthng1nthng11nm2011timinnamVitNamcxtnghimthmtheo
kinnghcacaTrungtmkimsotccbnhnhimHoak(CDC)(LaboratorydetectionofSwineOrigin
TripleReassortantInfluenzaA(H3N2)withtheA(H1N1)pdm09virusMgene(SOIVtrH3N2M)(1).
Ktqunghincu:Phthin01caA(H3N2)v
Ktlun:CmA(H3N2)vcxcnhtrnngitiVitNam.
Tkha:A(H3N2)v;(TRSH3N2);A(H1N1)2009;ReassortantX203;SOIVtrH3N2M
ABSTRACT
BIOLOGYMOLECULEOFTHEFIRSTCASEINFLUENZAA(H3N2)vINVIETNAM
NguyenThanhLong,TranNgocHuu,NguyenThuNgoc,NguyenHoangAnh,NguyenTrungHieu,
HoangMinh,NguyenThiThanhThuong,TranNgocThao,DangThanhGiang,PhamThiNhung,
NguyenThiMinhPhuong,PhanCongHung
Background: HumancasesofswineinfluenzainfectionhavebeenoccurringintheUnitesStates.H3N2v
viruses isolated from human cases recently inherited 7 gene segments from trH3N2 North American swine
virusesandtheMgenefromahumanH1N1pdm09virus.AllH3N2vvirusestestedareantigenicallycloseto
A/Minnesota/11/2010 vaccine candidate (reassortant X203). Although the infections appear infrequently, the
isolationofSwineoriginvirusesfromhumansrepeatedlydemonstratesthepotentialoffurtherreassortmentof
VinPasteurthnhphHChMinh
Tcgilinlc:BS.NguynThnhLong T:0918126554
610
Email:longpasteurhcm@yahoo.com
ChuynYTCngCng
NghincuYhc
suchviruswithotherviruseswhichmayberesultedinefficienttransmissionofnovelvirusesamonghumans.
Strengtheninginfluenzasurveillanceplaysakeyroleinearlydetectionanddentificationofnovelinfluenzavirus.
InVietNam,astudyidentified6casesofSwineA(H3N2)vin2010(2).InordertoindentifywhetherA(H3N2)v
influenzavirusappearinhuman,theNationalInfluenzaCentreofHoChiMinhcityPasteurinstituteconducted
thisstudyin2011.
Objectives:DeterminingthepresencenewstrainofinfluenzainVietnam.
Method:Descriptivestudy.AfterreceivedthewarningofCDCaboutH3N2viruson26November,2011,
allof14VietnamesecasesinfectedwithH3N2whowereidentifiedfromJanuarytoDecember2011insouthern
Vietnam were tested by laboratory detection of SwineOrigin Triple Reassortant Influenza A(H3N2) with the
A(H1N1)pdm09virusMgene(SOIVtrH3N2M)(1).
Results:onenewstrainofA(H3N2)wasisolatedfromthe14isolationsofA(H3N2)in2011.
Conclusion:ThefirstHumancaseofinfluenzavirusA(H3N2)vhavebeendetectedinVietNamin2011.
Keyword:A(H3N2)v;(TRSH3N2);A(H1N1)2009;ReassortantX203;SOIVtrH3N2M
TVN
Mctiunghincu
Vi rt cm H3N2 lu hnh trn ngi t
1968vcmilinhvinhngcabnhphc
tpngitrtui,hnnadchgynnbi
H3N2cbnhcnhtrmtrnghnsovicm
ma H1N1 v cm B. Nm 19971998 vi rt
cmngiH3N2nhimvoheovlantruyn
rngritrnheotiBcM,chngH3N2ny
c tn l TRS H3N2 (Triplereassortant swine
H3N2). Chng cm TRSH3N2 c c im:
genPB1cachngnycngungctvirt
cmngi,genPB2vPAcngungctvi
rt cm gia cm, ba gen NP, M v NS c
ngun gc t vi rt cm heo, chng ny
cphnlptrnheotiHoaK.
Ti Hoa K T 1990 n 2010 mt bin chng

cavirtA(H3N2)xuthinvitnA(H3N2)v
cboco,chngnylculantruync
tnhgihntrnheo,chc1caduynhttrn
ngi c bo co, nhng ch trong vng hai
thng9v10nm2010phthinc5ca,
c5canyusngst,2trong5caphinhp
vin. Ch c 12 ca A(H3N2)v ti Hoa K trong
nm2011lbngchngvlytruyntngi
sangngirtgiihn.
Vi rt A(H3N2)v 2011 gn nh ng nht
viccvirtA(H3N2)vphthintrchai
nm ch c gen M l c ngun gc t
A(H1N1)pdm2009, c tnh khng nguyn ca
A(H3N2)v c nhiu khc bit vi cm ma
H3N2 ca nhng nm 1990 tr v trc tuy
nhinvncmttlnhphnngchogia
hai chng ny. a s cc ca trn ngi u c
tinstipxcviheo.
Ti Vit Nam trong nm 2010 pht hin
ra6catitnhBnhDng(2).
ChuynYTCngCng
611
NghincuYhc
Cu hi c t ra l chng ny c trn
ngitiVitNamcha?
ITNGPHNGPHPNGHINCU
itngnghincu
Tt c cc ca dng tnh vi vi rt cm
A(H3N2) trn ngi ti Vit Nam c pht
hintrongnm2011tiTrungTmCmQuc
GiaVinPasteurTP.HChMinh.
Phngphpnghincu
Hi cu l phng php c vn dng
trong nghin cu ny.Ton b 14 ca H3N2
cphthintrongnm2011cxtnghim
thmtheothngquickhuyncocaT
chc Y T th Gi(WHO) v trung tm Kim
Sot Bnh Truyn Nhim Hoa K(CDCUS)
bng phng php Realtimes RtPCR s dng
bn b mi v probe cho H1,H3,pdminfA v
pdmH1caCDC4.
Phng php xt nghim ti Trung Tm
Cm Quc Gia Vin Pasteur TP.HCM l
Realtime RTPCR, ti CDC Hoa K l Realtime
RTPCRvSequencing.
KTQUVBNLUN
Trongtngs14caH3N2,phthinra01ca
A(H3N2)v trn ngi u tin ti Vit Nam
lmtbgisinhnm2009sngtithnh ph
HChMinh.
Chng A(H3N2)v 20052010 ca Hoa k c
bagen(HA,NA,PA)cngungctchngcm
nguynthyH3N2ngi,haigen(PB1,PB2)c
ngun gc t gia cm Bc M, ba gen
(NP,M,NS) c ngun gc t cm heo nguyn
thy.
Chng A(H3N2)v Hoa k 2011 c 7

gen(HA,NA,PB1,PB2,PA,NP,NS) ging vi
chng A(H3N2)v 20052010 Hoa k,gen M ca
chng A(H3N2)v 20052010 c ngun gc t
chng cm heo nguyn thy cn gen M ca
chng A(H3N2)v Hoa k 2011 li c chung
ngun gc vi gen M ca chng A(H1N1)pdm
2009(cmheou)
ChngA(H3N2)vVitNam2011ctonb
8gencngungcgingvichngA(H3N2)v
2011caHoak,Tonb7genes(HA,PB2,PB1,
PA, NP, M, NS) c ngun gc ging vi virt
A(H1N1)pdm20009,Ch c duy nht gen NA l
cngungckhcbit.
KTLUN
Quaxtnghimhicutonb14caH3N2
(cphnlptiTrungTmCmQucGia
VinPasteurTP.HCMnm2011)bngphng
php Realtime RTPCR ti Trung Tm Cm
QucGiaVinPasteurTP.HCMvSequencing
ti CDC Hoa K pht hin ra chng
A(H3N2)vtrnngitiVitNam.
XinchnthnhcmnAlexanderKlimov,XiyanXu,Stephen
LindstromTrungtmkimsotbnhtruynnhim(Centers
for Disease Control and Prevention) Hoa K). BK Kapella
CDCVitNam.MendsaikhanJamsranVnphngTchcY
TthgitiVitNam.
TILIUTHAMKHO
1.
2.
Guidance to laboratories using CDC realtime RTPCR

diagnostic kitsLaboratory detection of SwineOrigin Triple
Reassortant Influenza A(H3N2) with the A(H1N1)pdm09
virusMgene(SOIVtrH3N2M)
http:/www.who.int/influenza/resources/document/manual
dianosissurveillanceinfluenza/en/index.html
Long TN, Yasuaki H, Vu PP, Ha TH Le, Ha TN,Vu TL,
Nobuhiro T, Takehiko S (2010) Isolation of novel triple
reassortant swine H3N2 influenza viruses possessing the
hemagglutinin and neuraminidase genes of a seasonal
influenza virus in Vietnam in 2010.Influenza and Other
RespiratoryVirusesDOI:10.1111/j.17502659.2011.00267.x.
612
ChuynYTCngCng
NghincuYhc
THCTRNGCITHINIUKINLMVICCACCNV
SDNGLAONGTITNHBNHDNGTNM20052010
HHongVn*,NguynVnChinh*
TMTT
tvn:Ktquokimmitrnglaongccccnvsdnglaonglmcsci
thiniukinlmvichayhchthchintheoquynhlchar.
Mctiunghincu:Xcnhscithinccchtiukhngttiuchun3733/QBYTvvikh
hu,nhsng,tingn,bi,hikhccaccnvsdnglaongthchinkimtramitrnglao
ngtiTTScKheLaongMiTrngtnhBnhDngtnm2005nnm2010.
Phng php nghin cu: Thitksosnhtrcsauctinhnhtrnnhngnvsdnglao
ngthchinkimtramitrnglaongtiTTScKheLaongMiTrngtnhBnhDng.
Ktqu:Ccnvsdnglaongkimtramitrnglaongy(minmunhkkim
tramtln)khngcithinccchtiukhngttiuchunvvikhhu,nhsng,tingn,bi,hikh
ctheonhngkhuynnghmcquanchcnngcungcp.Nhngnvsdnglaongtunth
khngy(kimtramitrnglaongnhngkhnglintcquaccnm)chcithinchtiukhng
tvm,tcginhngligiatngtlkhngtvnhsng(p<0,05).
Ktlun:Ccnvsdnglaongchasdngktqukimtramitrnglaonglmcs
cithiniukinlaong.
Tkha:Mitrnglaong,vikhhu,nhsng,tingn,bi,hikhc
ABSTRACT
IMPROVEMENTOFWORKINGENVIRONMENTOFLABOREMPLOYERS
ATBINHDUONGPROVINCEFROM2005TO2010.
Ho Hoang Van, Nguyen Van Chinh
Background:Thequestionforthelaboremployersthatdotheybaseontheresultsofannualcheckingin
ordertoimprovetheworkingenvironmentortheyjustmadeprescribedwithoutregardtotheimprovement
ofworkingconditionsisknownofthemotivationunderlyingthesepractises.
Objectives:Toverifytheimprovementofworkingenvironmentfromuncompletedtargetsofstandard
no. 3733/QBYT such as microclimate, light, noise, dust, toxic gas that do checking of working
environment at Center for occupational and environmental health at Binh Duong province from 2005 to
2010.
Method: A comparative study was conducted among the labor employers checked up working
environmentatcenterforoccupationalandenvironmentalhealthatBinhDuongprovince.
Results:Laboremployershadagoodcompliancewiththeregulationsofcheckingupbuthadfailedin
theimprovingworkingenvironmentsuchasmicroclimate,light,noise,dust,toxicgaswhichwerereminded
bytheauthorities.However,theotherswithamediancompliancejusthadcompliedwiththehumidityand
TrungtmScKheLaongMiTrngBnhDng
Tcgilinlc:BS.CKI.HHongVnT:0913639018
ChuynYTCngCng
Email:hovan@yahoo.com.vn
613
NghincuYhc
windspeedimprovingbutagainstthelight(p<0.05).
Conclusion:Laboremployershavenotappliedtheresult of checking up working environment for the
improvingworkingenvironment.
Keyword:Workingenvironment,microclimate,light,noise,dust,toxicgas
20052008cchnvonghincu.Tiuch
TVN
loi ra l nhng n v s dng lao ng
Nghin cu ti Bnh Dng nm 2009
khng kim tra mi trng lao ng nm
chothyccnvsdnglaongchkim
2010.
tra mi trng lao ng khi h nhn thc
i tng tham gia nghin cu c
ngvccquynhcanhncvvsinh
thutuynbngphnmmExceldatrnbo
an ton lao ng, ang p dng tiu chun
co hng nm ti TTSKLMT tnh Bnh
qun l cht lng, s lng ngi lao ng
Dngxcnhnhngnvtunthy
ca n v s dng lao ng trn 300, thanh
(minmunhkkimtramtln)v
tra lin ngnh yu cu, c bit c i tc
tun th khng y quy nh v kim tra
kinhdoanhyuculiukintinquyt
mitrnglaong(kimtramitrnglao
h tun th cc quy nh ca php lut(2)(4).
ngnhngkhnglintcquaccnm).Trn
Tuy nhin, nhng khuyn ngh trn c s kt
csdliuccstinhnhphntchs
qu o kim mi trng lao ng hng nm
ci thin v t l cc yu t khng t tiu
m c quan chc nng cung cp c c cc
chun Q 3733/2002/QBYT nh vi kh hu,
nvsdnglaonglmcscithin
nh sng, ting n v hi kh c t ln u
iu kin lm vic hay h ch thc hin theo
kimtramitrnglaongsovilnkim
quy nh m khng quan tm n vic ci
travonm2010(1).
thin iu kin lm vic l cha r. Do
DkincnhpbngphnmmExcel
nghincuctinhnhtrnnhngnv
vxlbngStata10.0quaphntchbtcp
s dng lao ng tun th quy nh v kim
(WilcoxonSignedRankTest)mcngha5%.
tramitrnglaongtnm20052010.Kt
KTQU
qu nghin cu s l nhng c s vng chc
tr li nhn nh cc n v s dng lao
cimmunghincu
ngc tht s s dng cc kt qu kim tra
mi trng lao ng hng nm lm c s
choviccithiniukinlmvic
Mc tiu: Xc nh s ci thin cc ch tiu
khngttiuchun3733/QBYTvvikh
hu, nh sng, ting n, bi, hi kh c ca
cc n v s dng lao ng thc hin kim
tra mi trng lao ng ti TT Sc Khe Lao
ng Mi Trng tnh Bnh Dng t nm
2005nnm2010.
Biu1.cimmunghincu
ITNGPHNGPHPNGHINCU
Nghin cu so snh trc sau c

tinhnhtrnnhngnvsdnglaong
kimtramitrngtiTTSKLMTtnhBnh
Dng.Ttcccnvsdnglaongbt
u kim tra mi trng lao ng t nm
614
S lng cc n v s dng lao ng

kim tra mi trng lao ng tng theo tng
nm(tnm20052008)nhngtlccnv
s dng lao ng kim tra li mi trng lao
ngvonm2010ktlnkimtrautin
ChuynYTCngCng
hu nh khng tng theo tng s nm theo
di,chkhong20%.
Phn b cc n v s dng lao ng tun
th kim tra mi trng lao ng theo a
imkinhdoanhtnhnnm2010
NghincuYhc
T l khng t qua cc nm
(%)
Cc yu t
6 nm 5 nm 4 nm 3 nm
Nhit Trc 0.22
Nm
2010 0.10
0.21
Trc
Nm
2010
Trc
Nm
2010
Trc
Nm
2010
Trc
Nm
2010
Trc
Nm
2010
Trc
Nm
2010
Trc
Nm
2010
Trc
Nm
2010
Trc
Nm
2010
Trc
Nm
2010
Kim tra mi m
trng lao ng
y
Tc
(mi nm u
gi
nh k kim tra
mt ln)
nh
sng
Biu2.Tlnvsdnglaongtunth
nnm2010theoaimkinhdoanh
Soviccnvsdnglaonghot
ng trong khu cng nghip th cc n v s
dng lao ng ngoi khu cng nghip c t l
kimtralimitrnglaongvonm2010
k t ln kim tra u tin theo tng s nm
theodic(3v4nm)caohn.
Phnbccnvsdnglaongtunth
kimtramitrnglaongtheongnhngh
tnhnnm2010
Ting
n
Bi
Hi kh
c
Nhit
Kim tra mi Tc
trng lao ng gi
khng y
(kim tra mi
nh
trng lao ng sng
nhng khng lin
tc qua cc nm)
Ting Trc
Nm
n
2010
Trc
Bi
Nm
2010
0.02
0.11
0.14
0.32
0.08
0.07
0.03
0
0.05
0
0.01
0
0.02
0
0.04
0
0.07
0
0.02
0
0.01
0
0.09
0.02
0.11
0.08
0.02
0.17
0.12
0.10
0.15
0.08
0.01
0.18
0
0.17
0
0.15
0
<0.01
0.16
0
0.125
0.01
0
0
0.54
0.34
0.16
0
0.19
0.06
0.24
0.52
0.20
0.18
0
0.16
0.05
0.20
0.04
0.19
0.10
0.15
0.18
0.25
0.07
0.09
0.03
0
0.01
0.01
0.21
0
0.03
0
0.06
0
0.09
0.19
0.09
0.12
0.09
0.17
0.05
0.10
0.16
0.20
0
0.06
0
0.11
0
0.14
<0.01
0.01
0
0.19
0.46
0.34
0.44
0.14
<0.01
0
Hi kh Trc
Nm 0.27
c
2010
Biu3.Phnbslngnvsdnglao
ngtunthnnm2010theongnhngh
Nhngnvsdnglaongtunth
kimtramitrnglaongnh k ch yu
thuclnhvcmaymc.
T l cc ch tiu khng t tiu chun ca
nhngnvsdnglaongtunthkim
tramitrnglaongtnhnnm2010
Bng1.Tlccchtiumitrnglaongkhng
ttheotiuchun3733
ChuynYTCngCng
Tlccmuokhngttiuchunv
mitrnglaongquaccnmtheodilin
tipvncntntidnvsdnglaong
c tun th y kim tra mi trng lao
ng hay khng, trong t l khng t vn
cn mc cao cc ch tiu v nhit , nh
sng,tingn,hikhc
S ci thin cc ch tiu mi trng lao ng
khngttiuchuntnhnnm2010.
Bng2.Scithinccchtiumitrnglaong
tlnukimtramitrnglaongsovinm
2010
615
NghincuYhc
Kim tra
mi
trng
lao ng
6
nm
lin tip
Nhit
m
Tc
gi
nh sng
Ting n
Bi
Hi
kh
c
5
nm
lin tip
Nhit
m
Tc
gi
nh sng
Ting n
Bi
Hi
kh
c
4
nm
lin tip
Nhit
y (mi nm u nh k Khng y ((kim tra mi

kim tra mt ln)
trng lao ng nhng khng
lin tc qua cc nm)
Trung bnh (khong t
Trung bnh (khong t
v)
v)
[t l khng t tiu
[t l khng t tiu
chun]
chun]
N Trc
Sau
p N
Trc
Sau
p
Nm
Nm 2010
Nm 2005
Nm
2005
2010
0 (0-0,28) 0,03 (0-0,54) 0,7
0,03 (0-0,23) 0 (0-0,30) 0,5
7
0
0
0
0 (0-0)
0 (0-0) 0,3
2
0,04
0 (0-0)
0,0
0,12 (0,03- 0 (0-0) <0,
(0,016
0,23)
01
0,20)
5
19
0,08 (0- 0,02 (0-0,02) 0,5
0,13 (0-0,30) 0,16
0,8
0,08)
8
(0,036
0,30)
0,08 0,03 (0-0,07) 0,2
0 (0-0,38) 0 (0-0,38) 0,5
(0,01-0,1)
7
6
0 (0-0)
0 (0-0)
0,8
0 (0-0)
0
0,3
7
2
0,09 (0- 0,35 (0,32- 0,1
0,19)
0,38)
8
Nm
Nm 2010
Nm 2006
Nm
2006
2010
0,23 (0- 0,19 (0-0,30) 0,4
0 (0-0)
0 (0-0) 0,0
0,52)
2
8
0
0
0 (0-0)
0 (0-0) 0,1
6
0
0
0 (0-0,14)
0
<0,
01
6
16
0 (0-0) 0,05 (0-0,22) 0,0
0 (0-0,04) 0,06 (0- 0,1
8
0,11)
1
0 (0-0) 0,25 (0-0,35) 0,0
0 (0-0,08) 0 (0-0,12) 0,4
5
1
0
0
0
0
0
0
Nm
2007
0 (0-0)
0 (0-0)
Tc
gi
9
nh sng
0 (0-0)
Ting n
0,05 (00,18)
0 (0-0)
Bi
0 (0-0)
Hi
kh
c
3
nm
lin tip
Nhit
Nm
2008
0 (0-0)
0 (0-0)
Tc
0 (0-0)
gi
13
nh sng
0,06 (00,18)
Ting n
0,03 (00,29)
Bi
0
Hi
c
kh
0,33 (00,73)
Nm 2010
Nm 2007
Nm
2010
0 (0-0,4) 0,3
0 (0-0,35) 0 (0-0,40) 0,7
0
4
0
0,1
0 (0-0)
0 (0-0) 0,3
6
4
0 (0-0)
0,9
0 (0-0)
0
0,0
3
1
31
0 (0-0,07) 0,1
0 (0-0,13) 0,09 (0- <0,
9
0,23)
01
0 (0-0,36) 0,9
0,02 (0-0,1) 0,02 (0- 0,5
5
0,12)
9
0 (0-0)
0,1
0
0
5
0
0,37 (0,16- 0,16 (0- 0,2
0,6)
0,40)
2
Nm 2010
Nm 2008
Nm
2010
0 (0-0)
0,5
0 (0-0,28) 0 (0-0,20) 0,9
6
7
0 (0-0)
0,1
0 (0-0)
0
0,0
6
4
0 (0-0)
0,1
0 (0-00
0
0,1
6
5
22
0,04 (0-0,17) 0,9
0,06 (0-0,14) 0,05 (0- 0,8
4
0,18)
5
0 (0-0,30) 0,4
0,04 (0-0,11) 0 (0-0,11) 0,0
6
6
0
0 (0-0)
0 (0-0) 0,9
7
0,33 (0,1- 0,8
0,47 (0,17- 0 (0-0) 0,0
0,67)
5
0,50)
2
Cc n v s dng lao ng tun th

yquynhkimtramitrnglaong
hunhkhngcscithincnghathng
616
k(p>0,05)ccchtiukhngtvmitrng
laong.Tuynhintrnnhngnvsdng
lao ng khng kim tra mi trng lao ng
ychcithincnghathngk(p<0,05)
tlkhngtvtcgi,hikhcnhng
tlkhngtvnhsngligiatng.Ngoi
ratlccchtiukhngtkhcnhnhit,
m , ting n hi kh c (ngoi tr nhng
n v s dng lao ng kim tra mi trng
laongkhngy3nmlintip) khng
cscithincnghathngk.
BNLUN
Stunthkimtramitrnglaong
n nm 2010 cho thy nhng n v s dng
laonghotngtrongkhucngnghiptun
th thp hn nhng n v s dng lao ng
hot ng ngoi khu cng nghip k t nm
2007. Tuy nhin, cc n v s dng lao ng
kimtramitrnglaonglitptrungch
yuthucccngnhmaymc,giyda,g.Cl
sn phm ca nhng ngnh ngh ny thng
hngtixutkhu,doyucucaitc
ncngoicngcaohnnnslngnvs
dnglaongnytunthkimtramitrng
laongcngcaohn(2)(4).
Ktquvokimmitrnglaong
cng nh nhng kin ngh t c quan chuyn
mn l c s cho vic ci thin iu kin lm
vic nhng cc n v s dng lao ng cha
quan tm n vic ci thin cc ch tiu khng
t tiu chun . Mt d mi nm TTSKLMT
lunnhncnghtccnvsdng
laongokimmitrnglaongvlun
cung cp nhng gii php chuyn mn ci
thiniukinlmvicv.v.nhngnhngn
v s dng lao ng kim tra mi trng lao
ng y 6 nm, 5 nm, 4 nm, 3 nm lin
tip u khng c s ci thin ng k no
(p<0,05) nhm gim cc ch tiu khng t v
iukinlmvic(tlkhngtvnhit,
nh sng, ting n, hi kh c vn cn kh
cao)(bng 2). Hu qu l ngi lao ng vn
phitipxcvinhiuyutchiquanhiu
nmchodngilaonganglmvictrong
ChuynYTCngCng
nhngnvsdnglaongtunthy
ccquynhcaphplut.
Mt s ch tiu d khc phc v mt
hnhthcnhm,tcgithcsci
thinnhngnvsdnglaongkimtra
mi trng lao ng khng y qua cc
nm.Thctnhngchtiunyrtdcithin
vmtcons,bilkhikhngtvcciu
kinvmthhcthyucucccquan
chcnngokimlivobuichiuv.v(thc
t cho thy kim tra m ti cc n v s
dnglaongvo buisnghocnhngngy
cmathasccchtiunyskhngt,
hocchtiuvtcgikhikhngttimt
vtrnothhskhcphcbngcchtrang
bthmquttinhngvtrkhngtvyu
cucquanchcnngphctralinhngvtr
trnv.v.).lnhnggiiphptnhth,do
ngilaongkhngchnglinhiut
vicokimmitrnglaongcanvs
dnglaong.Trnnhngnvsdnglao
ngtunthkhngy3nmlintipth
c s ci thin t l khng t v hi kh c
(p<0,05)(bng2),tuynhinscithinnyldo
sdngtiuchunnhgihikhcnm
2008ltiuchuntrungbnh8givnm2010
ltnglntia,iunydnnscithin
gitodotiuchunnhginnghikh
clkhcnhau(tiuchuntnglntiacho
phpnnghikhctrongmitrnglm
vic l cao hn so vi tiu chun trung bnh 8
gi).V vy, cc ch tiu v nhit , nh sng,
n,hikhcvnskhngttheotiuchun
tnmnyquanmkhcbtknvsdng
lao ng c kim tra mi trng lao ng y
theoquynhhaykhng.
n v s dng lao ng qun o
kimmitrnglaonghngnm,khngcn
cithiniukinlmvickhiktqukimtra
mi trng lao ng khng t yu cu vn
c mc nhin tip tc hot ng. Trong khi
TTSKLMTvnphiarahng lot kin
ngh,giiphp,tngcnggimstnhngn
v s dng lao ng ny m cha nhn c
thin ch ci thin iu kin lm vic. H ch
ChuynYTCngCng
NghincuYhc
thc hin quy nh mt cch hnh thc nhm

hpthchavthtchnhchnhiph
vicccquanchcnng.Cthmcxpht
hnh chnh nhng n v s dng lao ng
khng thc hin theo quy nh ca php lut
thphnrtnhiusovinhngchiphmh
thchincngvicokimhngnm(3)(5).ng
thi,tlccnvsdnglaongkimtra
mitrnglaongquaccnmrtthp,as
h khng kim tra mi trng lao ng theo
lut nh, hoc ch kim tra mt ln(5). Nhng
TTSKLMTtnhBnhDnglcquanchuyn
mnvlnhvcvsinhlaongvbnhngh
nghipnhngnhngyucuvgiiphpa
ra trn c s kt qu o kim mi trng lao
ng cha tc ng n s tun th cc quy
nh cng nh s ci thin iu kin lm vic.
y l mt thc trng ph bin v kh chp
nhn.
Chngtachacnhngchtisc
hng n v s dng lao ng thc hin
nghimngtccquynhvvsinhlaong.
khcphcccchtiukhngtyucuv
mitrnglaonggpkhngtkhkhnnu
khng c nhng gii php cn c v ng b.
Giiphpbtbucnvsdnglaongxy
dnglinhxng,imicngnghsnxut
ngay lp tc v.v i li mt iu kin lm
vic an ton hn l khng th thc hin. Cng
nh chng ta thiu hn nhng l trnh v mt
phplutnhmnhgicctiuchunviu
kin lm vic trc khi xy dng ni lm vic.
Trongkhicquanchuynmnvytvnch
dnglivicgimstmchacnhngbin
phpchtihiuqunhmthayinhnthc
vtcngmtcchhuhiutoramtni
lmvicanton.
KTLUN&KINNGH
Mc d cc n v s dng lao ng
thchinnghimchnhccquynhvokim
mitrnglaonghaykhngthccchtiu
khngtvvikhhu,nhsng,tingn,hi
khcvncntntitheothigian.
Dovy,cquanytcntngcnghp
tc vi cc c quan chc nng hon thin h
617
NghincuYhc
thngphplutvvsinhlaong,tp trung
gimstcngnhbtbucnvsdnglao
ngnhgitcngcaquytrnhcngngh
v nh xng ln iu kin lm vic trc khi
tinhnhxydngnhxng.
3.
4.
TILIUTHAMKHO
1.
2.
BYT(2002)Quytnhs3733/2002/QBYT
Nguyn Vn Chinh, Hunh Thanh H, Nguyn Th Ngha,
NguynNguyn,TrnhHngLn(2010)Ccyutlin
quanntunthquynhvkimtramitrnglaong,
khmsckhenhkcaccnvsdnglaongti
5.
BnhDngnm2009.YhcthnhphHChMinh,14,(2),
199206.
TrnThNgcLan(2008)Hthngccvnbnphplutv
vsinhantonnilmvicvchmscsckheChongi
laong,NXBLaongXHi,
Trungtmphttrinvhinhpquntr(2010),Trchnhim
xhicadoanhnghip,
http://www.vietnamforumcsr.net/default.aspx?portalid=1&tab
id=17&itemid=5840v,truycpngy01/01/2010
Trung tm sc khe lao ng mi trng tnh Bnh Dng
(2010).Bocotngktnm2006,2007,2008,2009,2010.
618
ChuynYTCngCng

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YHC

hc D phhng khngg ch gp phhn phng chng dch bbnh m cnn gip

k c phng th nghim lm sng(5). Khng ch

Hnh 2: Nguyn tc ca k thut pyrosequencing

Bnh thng: GCT GGT GGC G

Bnh thng: GCT GGT GGC G

Dng PCR vi mi c hiu

Thc hin gii trnh t bng tng hp (SBS)

Hnh 4: Ba giai on ca gii trnh t th h mi (1) Tch ri v tm bt cc

mnh DNA c gii trnh t ln cc gi bm; (2) Dng PCR vi mi c hiu

Gii trnh t thh mi mt bc tin

l nanowell v kch thc ny cho php mi

y l mt cuc cch mng v cng ngh

(3) Thc hin gii trnh t bng tng hp:

.(1) Tch ri v tm bt cc mnh DNA c

Gii trnh t th h mi v cc ng dng

Gii trnh t th h mi cng l cng c

Baysal BE et al (2004). Analysis of CHEK2 gene for ovarian

Mardis ER (2008). Nextgeneration DNA sequencing

XT NGHIM SINH HC PHN T TRONG

**Cng ty Nam Khoa

Xt nghim pht hin t bin khng

dng cccDNA (covalently closed circular

Xt nghim pht hin t bin precore v

pht hin c nhng s lng rt thp. Tuy

cng ty Nam Khoa pht trin k thut real

c nguy c ngoi nhim v khng cn phi

Xt nghim pht hin t bin mt on

Xt nghim pht hin t bin trn thot

lm xt nghim, RNA ca virus sau khi tch

c hiu qu iu tr cng nh quyt nh

Bayer (sau ny l ca Siemen) v gii trnh t

Hnh 3: HCV ti Vit Nam ch yu l thuc

Tuy nhin gn y cc nh nghin cu

Xt nghim xc nh cng tc interferon

chng ta vi a s bnh nhn nhim HCV l

Vim gan B mn v nhim vim gan C

AkutaN,SuzukiF,et al (2010). Amino Acid Substitution in

Leung N (2002).Treatment of chronic hepatitis B: case

2005, cc t l ny ln lt l 77,1 v 40,6. Nam

Khng ging nh cc bnh truyn nhim

KowTong C et al. Human Enterovirus 71 Disease: Clinical

T l bnh dch lu hnh rng ri min

tnh gip ranh vi huyn An Ph ca tnh An

S hin din ca vi khun t trong mi

Ktquxt nghim mi trng nc v thc

S hin din ca vi khun t trong mi

angbcphtmnhnhtay chn ming, cm

Ci thin v sinh mi trng (xo cu trn

Cc Y t d phng (2009). Cm nang phng chng bnh

on 2009 2010, t l dng tnh vi EV71 ln

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