中文摘要：

目的：降低5岁以下儿童死亡率是儿童保健的主要内容之一,分析恩施州5岁以下死亡儿童生前卫生服务利用和未就医的原因,为降低儿童死亡率提供依据。方法：收集2000-2011年恩施州5岁以下儿童死亡报告卡共5775份,采用描述性分析方法和卡方检验对资料进行分析。结果：5岁以下儿童在医院死亡的比例由2000年的30.8%增至2011年的53.7%。死前利用住院和门诊服务的比例分别从2000年的43.6%和5.1%增至2011年的63.8%和17.7%,未治疗或未就诊的比例由2000年的51.3%降至2011年的18.5%。来不及送医是2000-2011年死亡儿童未就医的最主要原因,由2000年的65.0%增至2011年的84.0%。死前未治疗或未就诊的儿童首位死因2000-2004年为出生窒息,2005年及以后主要为意外窒息。结论：儿童死亡前卫生服务利用率明显提高;儿童在医院死亡的比例上升;死于意外伤害未及时得到治疗的儿童增加;加强意外伤害的防范是降低恩施州儿童死亡率的重要措施。

英文摘要：

Objective： Reducing the mortality rate of children under 5 is one of the main contents of children＇s health care. To describe healthcare services utilization of children under five years the causes for no health care-seeking of children under five yearscan provide a basis for reducing child mortality. Methods： Routinely collected 5775 children death certificates from 2000 to 2011. The data were analyzed using descriptive analysis and chi square test. Results：From 2000 to 2011, the proportion of children under five who died in hospital increased from 30.8% to 53.7%. The inpatient healthcare service and outpatient healthcare service increased from 43.6% and 5.1% to 63.8% and 17.7%, and the proportion of untreated children dropped from 51.3% to 18.5%. Delay and late to hospital was the mast inportment reason for the death of Children, which increased from 65.0% to 84.0%. The leading death causes of those children transmitted from neonatal asphyxia to accidental asphyxiation.Conclusion： The rate of health service utilization before death had increased. Because the incidence and death rate of accidental injury increased, it must be prevented by strengthen health education and health promotion.