Study on Main Measures and Effect to Prevent HBV Transmission from Mother to Child during Pregnancy
|School||Huazhong University of Science and Technology|
|Course||Child and adolescent health and maternal and child health science|
|Keywords||Hepatitis B Hepatitis B immune globulin Mother-to-child transmission Blocking measure Economic Evaluation|
Objective To investigate the impact the hepatitis B PMTCT interventions selected factors and the real effect of the interventions; economic evaluation, to provide a scientific basis to select the best interventions to prevent hepatitis B mother-to-child transmission of different blocking measure intervention effects . Research methods to extract Wuhan hospital delivery in 2004, to accept the system of prenatal check HBsAg positive pregnant women and their babies the retrospective scene investigation and follow up; method of investigation for households face-to-face questionnaire survey and one-on-one telephone interviews . All information use Spss10.0 descriptive analysis, t test, χ ~ 2 test, nonparametric hypothesis testing, statistical analysis of single factor non-conditional logistic regression and multivariate non-conditional logistic regression. Results, blocking measures and effect: the study of maternal HBsAg positive rate was 8.67%. 232 (71.83%) of the 323 cases surveyed pregnancy injected HBIG, more than 90.00% of the first injection the HBIG time in the third trimester, more than 80.00% of the injected 3 times; injection of HBIG baby 293 (90.71%), 276 (94.20%) 1 injection. 258 (79.88%) of the mode of delivery cesarean section, of which 29.84% cesarean section due to hepatitis B factors; infant artificial feeding of 153 (47.37%), 81.70% of the hepatitis B factors artificial feeding. Incidence of HBsAg positive pregnant women with premature rupture of membranes, cesarean section rate, and artificial feeding were higher than the normal group, maternal, and the difference was statistically significant (P <0.05). 323 pairs of mother and son in the investigation, only pregnant women during pregnancy injection of hepatitis B immune globulin (HBIG), 23 pairs (7.12%); injected HBIG (active and passive immunization) only infants after birth, 84 pairs (26. 00%); maternal and infant injected HBIG (mother-to-child combined immunodeficiency), 209 pairs (64.71%); pregnant women and their babies were not injected 200IU of HBIG, 7 pairs (2.17%). Intrauterine infection and 22 (6.81%) after blocking, full vaccination, 10 were overcast, including three antibodies, seven full shade. Baby chronic infection, and 15 (4.64%), intrauterine infection, of whom 10 are 3 people late infection. Baby 6 months after HBV markers detection antibody (47.68%) 154. 2, HBeAg and hepatitis B: mother-to-child transmission of The HBsAg positive merger hepatitis B e antigen (HBeAg)-positive pregnant women and 63 (19.51%). The Shuangyang cesarean section rate (90.48%) is higher than the single-positive group (77.31%), the difference was statistically significant (χ to 2 = 5.4709, P = 0.00193); cesarean section due to hepatitis B factors production of proportional the Shuangyang group (63.16%) was significantly higher than the single-positive group (20.40%), the difference was statistically significant (χ to 2 = 38.7788, P <0.0001). Higher proportion of single-male group of breastfeeding (61.54%), the Shuangyang mostly artificial feeding (84.13%), the difference between the two groups of feeding patterns are statistically significant (χ to 2 = 42.4181, P <0 .0001). Artificial feeding due to hepatitis B factors, and Shuangyang group (98.11%) was significantly higher than the single-positive group (73.00%), the difference was statistically significant (Fisher'Exact Test, P <0.0001). Shuangyang intrauterine infection and chronic infection rate was 25.40% and 14.29%, significantly higher than 2.31% of the single-male group, the difference was statistically significant (χ ~ 2 = 42.5934,16.4303 , P <0.001). Blocking measure the impact and effectiveness of the factors: univariate analysis, factors and blocking the way, the number of pregnant maternal age, of perinatal occupation, education level, family income, husband, career and educational level, the initial prenatal check the time and place of delivery time and place; related to the blocking effect of the pregnant maternal HBV infection status, pregnancy whether injection of HBIG, childbirth age, initial prenatal examination time, baby injection of HBIG the number and duration of breastfeeding and childbirth Year. Multivariate analysis results showed that maternal childbirth older (OR = 2.205), the higher the education level of maternal (OR = 3.275), more per capita household income (OR = 1.693), childbirth the shorter the duration of hospitalization (OR = 0.543), (OR = 0.380) when childbirth Year earlier and husband career employee class (staff / Business Services / workers / migrant workers) (OR = 2.205), more maternal injection 200IU of HBIG during pregnancy tend to choose; baby injection of HBIG number of more (OR = 3.873), the longer the duration of breastfeeding (OR = 9.815), six months after the baby more prone to anti-HBs. Economic Analysis: intrauterine infection reduction of mother-to-child joint blocking cost - effectiveness ratio of less than only during pregnancy blocking to reduce infant chronic infection joint blocking cost - effectiveness ratio is below only baby block, increasing the rate of antibody protection costs The effect of joint blocking better than only during pregnancy blocked only baby better than blocking. Three measures the DALY and costs to restore - utility blocking measures than the United optimal conclusions unchanged, sensitivity analysis and incremental cost - effectiveness (efficacy) analysis. Conclusions, in recent years, Wuhan maternal hepatitis B virus carrying rate of the overall rising trend. 2, HBeAg positive impact of hepatitis B mother-to-child transmission of important factors, the maternal their degree of attention is clearly insufficient. 3, HBsAg-positive pregnant women, especially those with HBeAg positive, tend to cesarean section and artificial feeding, the study has not been seen cesarean section and artificial feeding or not the difference in the effect of hepatitis B PMTCT statistically significant, cesarean section and artificial feeding is not blocking HBV mother-to-child transmission of the necessary conditions. Select and effect of hepatitis B PMTCT measures not only by the individual, family factors, and is also closely related to the medical environment. 5, from an economic point of view, a comprehensive comparison of the mother during pregnancy injection of HBIG and after birth combined injection to reduce maternal and child HBIG and hepatitis B vaccine joint blocking measures not only in the same total cost more intrauterine infection and infant chronic infection rate restore more DALY, it can more effectively improve the baby antibody protection rate is better than the other measures, is the optimal measures in recent years, Wuhan hepatitis B PMTCT measures is recommended.