摘要目的 了解孕产妇保健服务现状和存在的问题,找出其影响因素.方法 于2016年9至12月采用整群随机抽样的方法,从成都市21个区(市)县按照经济水平的高低分为高、中、低3个层次中随机抽取9个区市县,在被抽取的9个区市县中随机抽取18个社区卫生服务中心或乡镇卫生院,从18个社区卫生服务中心的孕期系统保健登记册上共随机抽取1 066名产妇进行调查.采用描述性统计分析方法、x2检验及多因素Logistic回归等方法对孕产期服务现状及影响因素进行分析.结果 问卷有效应答率为93.81％.1 000名被调查产妇年龄为(28.82±4.43)岁;文化程度以高中及大专为主(55.50％);家庭年收入在3万～的有420人(42.00％),8万～20万的412人(41.20％).早孕建卡率(88.90％)、产后访视率(90.20％)以及孕产妇系统管理率(78.60％)调查值低于2016年成都市年报统计上报数据有统计学差异(x2=6.28、7.79、15.34,P均＜0.01).医务人员态度(OR:2.16,95％CI:1.04～4.48),认为怀孕3个月内要到医院检查并建卡(OR:2.88,95％CI:1.03～8.14),孕产妇通过医院医生(OR:0.29,95％ CI:0.13～0.64)、社会活动(OR:0.40,95％ CI:0.23 ～0.70)、宣传广告(OR 3.42,95％CI:1.54～7.58)、网络(OR:l.71,95％CI:1.08～2.71)、报刊杂志(OR:3.80,95％CI:1.30～11.11)等途径获悉孕产期保健知识是影响早孕建卡的主要因素;孕产妇年龄在31～35岁(OR:0.26,95％CI:0.08～0.87)、孕妇选择产前检查医院[区级医院(OR:3.21,95％CI:1.26～8.19),区级妇幼保健院(OR:4.33,95％CI:1.72～10.91),市、省级妇幼保健院(OR:4.24,95％CI:1.38～12.99)]以及选择产前检查医院的决定因素是离家近(OR:0.51,95％CI:0.31～0.82)是影响产后访视的主要因素;医务人员态度好(OR:1.69,95％CI:1.04～2.73)、认为怀孕3个月要到医院检查并建卡(OR:2.58,95％CI:1.04～6.42)、孕产妇通过网络获悉孕产期保健知识(OR:1.63,95％CI:1.20～2.23)以及孕妇选择乡镇卫生院或社区卫生服务中心(OR:6.60,95％CI:1.27～34.48),区级妇幼保健院(OR:2.40,95％CI:1.07～5.39),市、省级妇幼保健院妇幼保健院(OR:3.72,95％CI:1.41～9.79)作为产前检查医院是影响孕产妇系统保健管理的主要因素.结论 成都市孕产期系统保健管理率不高,同上报数据差距较大;医务人员态度好坏,孕产妇孕产期保健知识获得渠道以及对产检医院的选择直接影响孕产期保健服务.

abstractsObjective To investigate the status and associated factors with maternal health service in Chengdu China.Methods A cross-sectional survey was conducted in Chengdu between September to December in 2016;1 000 delivery women were recruited to finish the questionnaire and informed consents were obtained by investigators face to face.Cluster random sampling was adopted to select subjects from public health centers of different townships in Chengdu.The multivariate logistic regression model was used to analyze the associated factors with maternal health service.Results The record rate of early pregnancy,the postpartum visit rate and the maternal system management rate were 88.9％,90.4％ and 78.6％ respectively.The survey rates were significantly lower than the reported rates (x2=6.28,P＜0.01).The attitude of medical staff (OR=2.16,95％ CI:1.0d-4.48),perceived making the record of the first trimester of pregnancy (OR=2.88,95％ CI:1.03-8.14),pregnant women receiving maternal knowledge through doctors (OR=0.29,95％CI:0.13-0.64),through social activities (OR=0.40,95％CI:0.23-0.70),through advertisements (OR=3.42,95％ CI:1.54-7.58),from internet (OR=1.71,95％ CI:1.08-2.71) and from newspapers and magazines (OR=3.80,95％ CI:1.30-11.11) were associated with record filing during early pregnancy.Delivery women who were in the maternal age between 31 to 35 (OR=0.26,95％CI:0.08-0.87) and choosing hospitals close to home is the determinant of prenatal examination (OR=0.51,95％ 6I:0.31-0.82) were less likely to accept the postpartum visit.Delivery women who chose district hospitals(OR=3.21,95％ CI:1.26-8.19),provincial (OR=4.33,95％ CI:1.72-10.91) and municipal (OR=4.24,95％CI:1.38-12.99) maternal and child care service centers to do prenatal examination were more likely to receive the postpartum visit.The attitude of medical staff (OR=1.69,95％ CI:1.04-2.73),perceived making the record of the first trimester of pregnancy (OR=2.58,95％CI:1.04-6.42),pregnant women getting maternal knowledge by internet (OR=1.63,95％ CI:1.20-2.23),Delivery women who chose township health center (OR=6.60,95％ CI:1.27-34.48),provincial (OR=2.40,95％CI:1.07-5.39) and municipal (OR=3.72,95％CI:1.41-9.79)maternal and child care service centers to receive prenatal examinations might affect the maternal system management.Conclusion The maternal system management rate was low and there was significant difference between the survey rates and the reported rates.The attitude of medical staff,the channel of getting maternal knowledge and the choices of hospitals for receiving prenatal examinations affected the maternal health service.