目的 探讨妇幼保健机构营养服务现状及与母婴营养健康的关系。方法 于2020年利用网络信息检索的方式,对全国441家省级、直辖市市辖区、地级市妇幼保健机构的营养服务进行调查。基于中国0~17岁儿童青少年与乳母营养健康监测（2016-2017年）中部分儿童和乳母数据,分析有无营养服务地区的母婴营养健康状况差异。结果 246家地市级及以上妇幼保健机构设有官方网站,为孕产妇和儿童提供了营养服务的比例分别为49.6%和53.3%,仅3.3%的机构设置了专职营养服务人员。孕产妇营养服务隶属于保健科、妇产科和营养科的比例分别占45.9%、39.3%和14.8%;儿童营养服务主要隶属于儿童保健科,占93.9%。与没有为母婴提供营养服务的地区相比,妇幼保健机构为母婴提供营养服务的地区母亲孕期体重增长过多风险较低（P<0.05）,产后血脂异常、维生素D缺乏、血清白蛋白和总蛋白过低的风险较低（P<0.05）;儿童超重的风险较低（P<0.05）,6月龄内儿童基本纯母乳喂养的比例较高（P<0.05）。结论 妇幼保健机构营养服务覆盖率低,不利于母婴营养与健康。建议落实国家相关政策,完善营养科室设置与人员配置;建立营养服务相关标准,服务花费纳入医保支付体系;稳定、深化和拓展营养服务内容,促进母婴健康。
Abstract
Objective To explore the situation of nutrition services in maternal and child health institutions and their association with the nutrition and health status of mothers and children. Methods In 2020, we used an online information retrieval method to investigate the nutrition services of 441 maternal and child health institutions in provincial cities, municipal districts, and prefectural cities in China. Based on data from China Nutrition and Health Surveillance on Children and Adolescents Aged 0-17 Years and Postpartum Mothers (2016-2017), we compared the nutrition and health status of mothers and children among regions with and without nutrition services. Results There were 246 maternal and child health institutions having official websites, and the proportions of providing nutrition services accounted for 49.6% and 53.3% for women and children, respectively. Only 3.3% of the institutions hired full-time nutrition service staff. The proportions of nutrition services for women affiliated with health departments, obstetrics and gynecology, and nutrition departments accounted for 45.9%, 39.3%, and 14.8%, respectively. Nutrition services for children were mainly affiliated with child health departments, accounting for 93.9%. Compared with regions where there was no nutrition service for women and children, women in regions where there were nutrition services for women and children had a lower risk of excessive gestational weight gain, dyslipidemia, vitamin D deficiency, low serum albumin, and low serum total protein at postpartum (P<0.05); meanwhile, children in these regions had a lower risk of overweight (P<0.05), and children under six months of age were more likely to be predominantly breastfed (P<0.05). Conclusion The coverage of nutrition services is relatively low in Chinese maternal and child health institutions, which is not conducive to maternal and child health. We suggest implementing relevant national policies, improving department settings and staffing, establishing standards related to nutrition services and covering service costs in the health insurance payment system, and stabilizing, deepening, and expanding the content of nutrition services to promote maternal and child health.
关键词
营养服务 /
儿童营养不良 /
母亲健康 /
营养监测
Key words
nutrition service /
child malnutrition /
maternal health /
nutrition survey
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基金
中国工程院重大咨询研究项目整合医学理论与实践若干战略问题研究（No.2018-ZD-09-03）; 医改公共卫生专项资金中国0-17岁儿童青少年与乳母营养健康监测（No.2016-2017）
