1
2010
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BOYTE
BAG CAO KET QUA NGHIEN
ClTU
DE TAI
CAP
BQ
Ten de
tai:
XAC DEVH MAM BENH
KY
SINH
TRUNG GAY
BENH CHO
NGU'CM
TRONG RAU VA THUY
SAN
DUOC
NUOI

CAO
KET QUA NGHIEN
CtTU
DE
TAX
CAP
BO
rri
A
J.
A
.
>
•
Ten de
tai:
XAC DINH
MAM
BENH
KY
SINH TRUNG GAY
BENH CHO
NGlTCXl
TRONG RAU VA THUY SAN
Dirac
NUOI TRONG
TlT
NGUON
NUdC
THAI

kinh
phi
thuc hien
de tai
1.400
trieu dong
Trong
do:
kinh
phi
S>iKH
1.400
trieu ddng
Nguon khac (neu c6) trieu dong
Ha Noi
4/2010
BOYTE
CONG
HOA
XA
HOI
CHU NGHIA VIET NAM
Dpc lap
Tir
do Hanh phiic
So:
/iHIJ
/QD-BYT
Hd Npi, ngdy
o2^

thai tai mot sd thanh phd va
ndng thdn Mien Bac"
- Dan vi chu
tri
thue hien: Trudng Dai hoe Y Ha Ndi.
- Thdi gian thue hien: 2008-2009.
- Kinh
phi
thuc hien: 1.400.000.000d (Mdt ty bdn tram trieu dong chan)
trr
nguon
su nghiep mdi trudng.
Dieu 2. Thu truang dan vi chu tri thuc hien nhiem vu cd trach nhiem: ehi dao,
trien khai thuc hien cac ndi dung nhiem vu bao ve mdi trudng theo de cuang da duae
Hpi dong tham dinh thdng qua (de cuang chi tiet kem theo); thuc hien diing eac quy
dinh hien hanh cua nha nude ve hoat ddng bao ve mdi trudng va chi tieu tai ehinh; dinh
ky bao cao ket qua thuc hien ve
Cue
Y te du phdng va Mdi trudng de tong hap bao cao
Lanh
dao
Bd.
Dieu 3. Quyet dinh nay cd hieu luc ke tii ngay ky ban hanh.
Dieu 4. Cac Ong, Ba: Cue trudng
Cue
Y te du phdng va Mdi trudng, Vu trudng
Vu Ke' hoach Tai chinh, Thu trudng dan vi chu tri thuc hien nhiem vu va cae dan vi
lien quan chiu trach nhiem thi hanh
Quye't
dinh nay./.

1.
Ten De tai/nhiem vu: Xdc dfnh mam
b^nh
ky sinh
triing
gdy
b$nh
cho
ngu&i
trong rau vd thuy sdn
du^c
nuoi trong
tir
nguon
nu&c
thdi tgi mpt
sd
thdnh pho va
nong thon mien Bdc
• Md so:
2.
Thuoc
ChuoTig
trinh
(neu
c6):
3.
Thdi gian
th\rc
hien: Tu thang

Truong Thi Kim Phuang
KTVY. Do Duong Thang
TS.
Pham Ngpc Minh
CN. Pham
VSn
Khiem
CN. Nguyen Thj Hau
CN. Cao Van Huyen
Chitky
^Jj^u^j/lU/^fZ/t
~^S^
Thu
truOTig c(y
quan chu tri de tai/nhiem vu
jfTOr^u'
ky vaiddng
d^u)
BO
Y TE CONG HOA XA
HQI
CHU NGHIA VIET NAM
TRUONG
DAI
HOC Y HA
NOI
Dpc lap - Tu do - Hanh phiic
Ha Npi, ngay 30 thang
12
nam 2009

rO
.
l^X)
\ -y
Cac hoat ddng chi tieu
ciia
de tai dam bao diing theo de cuang da duyet va dam bao
qui
dinh
ve
tai chinh
ciia
Nha
nude.
F •> \ F
Sd kinh
phi
cdn lai: (chi
de
khoang 20 - 25 trieu ddng) phuc vu cho nghiem thu cap
CO
sd va nghiem thu
c4p
BYT:
^
XAC NHAN CUA PHONG TAI CHINH
TRUONG
DAI HOC Y
HA
NOI

de
tai:
Xdc dinh mdm benh ky sinh
triing
gdy
b$nh
cho
ngu&i
trong rau
vd thuy sdn duoc nudi trdng
tie
ngudn
nu&c
thdi tgi mpt
sd
thdnh pho
vd
ndng
thdn miin Bdc
2.
Chii
nhiem dl
tai:
PGS.TS. Nguyin Van
DI
3.
Co quan
chii
tri dl
tai:

Thanh Hda Vien Cdng nghe sinh hpc
- Phung
Die
Cam Vien Ve sinh Dich te Trung uong
Tmong Thi Kim Phuang Trudng Dai hpc Y Ha Ndi
- Tap
thi
Bd mdn Ky sinh tning, Trudng Dai hpc Y Ha Ndi
8. Cac dl tai nhanh (dl muc)
ciia
de tai (neu cd)
(a)
DI
tai nhanh
1
(de muc 1)
Tdn
de
tai nhanh:
- Chu nhiem de tai nhanh:
(b) Dl tai nhanh 2
-
Ten
dl tai nhanh
Chii
nhiem dl tai nhanh
9. Thdi gian thuc hien
dh
tai tu thang
01

Bdmdn
Cdng su (cdng tac vidn)
Clonorchis
sinensis
Tning giun dGa
Ky sinh tning
Haplorchis pumilio
Haplorchis
taichui
Trung/Su
trung giun mdc
Nghien cuu khoa hpc
Au tning giun luan
Angiostrongylus
Polymerase Chain Reaction
Spirometra erinacei
San la mdt nhd
San la gan nhd
Thanh phd
Tning giun tdc
World Health Organization
Muc luc
Noi dung Trang
Bao cao
kdt
qua nghien
ciiu de
tai cap Bd 3
Nhirng chu
vidt

31
Chuang
5:
Ban luan 37
Chuang
6:
Kit
luan 43
Khuyin nghi 46
Tai lieu tham
khao 47
Phu
luc:
Mdt sd hinh anh sinh dia canh va
Ky sinh triing trong nghien cuu 49
CAC
SAN PHAM DAT DlTQC CUA
DE
TAI/NHIEM
VU
1.
Bang ket qua sd lieu nghien cuu (xem
kit
qua bao cao kem theo)
2.
Bao cao ket qua xac dinh loai
ciia
mam benh ky sinh tning trong thiiy san va rau
tuoi
sdng sir dung nude thai (xem ket qua

hoc Qudn su. Sd 9/ 2009. Tr.29-32
- Le Thanh Phuang, Nguyen Van Dd, Pham Ngpc Minh, Phan Thi Huong lien,
Truang Thi Kim
Phugng
va cs. Mam benh ky sinh tning
tren
rau duac tudi bang
nude
thai tai thanh phd va ndng thdn tinh Nam Dinh. Tgp chi
YDiepc
hpc Qudn
su.
Sd 9/ 2009. Tr.29-32
4.
Cac khda luan tdt nghiep Y khoa
vd
van de
lien
quan
den
nhiem vu.
Hai khoa luan tdt nghiep
Cii
nhan Y hpc (Le Thi Thanh Loan va Dinh Cdng
Tru) bao ve nam 2009 (cd ban phd td bia kem theo) va se cd 2 khda luan tdt
nghiep bao ve nam 2010.
5.
DI
xuat cac giai phap phii hgp.
r

KH&CN
cip bp
1.
Tgn dg
tai:
Xdc dinh mdm benh ky sinh
tritng
gay benh cho
ngieoi
trong rau
vd
thuy
san
dupe
nudi trong
tir nguon nu&c
thdi
tai mpt
so thanh phd vd nong than
mien
Bdc
Masd:
2.
TTiupc
Chuong trinh (ngu cd):
3.
Chu nhiem dl
tai:
Nguygn Van Dg
4.

djnh
cac mam
benh
k>'
sinh
triing
(giun,
san va don
bao) trong san pham phuc
vv con ngudi (rau, thuy san) dupe nudi trong bang
nude
thai tai mpt sd thanh phd
va
ndng thdn mign Bic.
- Djnh loai cac
mam
benh
k)''
sinh tning nay bang hinh thai hpc va sinh hoc
phan tir.
- Dg xuat mdt sd giai phap nham bao vg ngudi
sir diing mpt
so thue pham cd nguy
CO
nhigm ky sinh trimg
Kgt qua thvc hien
la:
a) Xgt nghigm cho 2.700 ca thg ca, luon, torn, cua, gch va
1.800
dc tai 6 digm nudi

phd va ndng thdn kdt qua cho thay:
Rau tuai sdng
dupe
tudi bang
nude
thai ca d
ndng
thdn va thanh phd
diu
bj
d
nhilm
bdi mam benh ky sinh trung gay benh nguy hilm cho ngudi. Thanh
phin
loai
mim
benh ky sinh trung trong rau va
nude
duac xac dinh la trung giun
diia Ascaris
lumbricoides,
giun
tdc Trichuris
trichiura,
san
la
gan nhd
Clonorchis
sinensis,
san la

F F
tri:
nude bd mat,
nude
b day va bun) tai 6 diem d thanh phd va ndng thdn kdt qua
F
cho thay:
F
y
ov
>
Trong
nude
thai ca d
ndng
thdn va thanh phd cung ddu bi
d
nhidm bdi mam benh ky
sinh trung gay benh nguy hiem cho ngudi. Thanh phan loai mam benh ky sinh trung
trong
nude dugc
xac dinh
la
tning giun diia
Ascaris
lumbricoides,
giun tdc
Trichuris
trichiura,
san la gan nhd

thai ca b ndng thdn va
thanh phd dl nudi trdng thiiy san va tudi rau dd dam bao an toan thuc
phim.
Cin
cd
quy trinh
xur
ly
nude
thai dam
bao chit
lugng chuyen mdn vl
y
tl.
Giai phap cho ngudi tieu diing la
vi
hien nay viec
sii
dung
nude
thai chua qua
xii
ly
con phd bidn nen ngudi tieu dung khdng
ndn
an thiiy san sdng hay an rau sdng
(chua nlu chin).
7.2/ Ve cac
ydu
cau khoa hpc va chi tieu co ban

yeu cac thdng tin vd hda chat va vi
khuan. Dac biet cd ca sd khoa hgc cho nganh thiiy san va ndng nghiep khac phuc
trong
nudi
trdng thiiy san sach va trdng rau sach phuc vu ddi sdng dan sinh.
8.1/
ve
giai phap khoa hgc - cdng nghe:
Dua ra dugc giai phap cu the va cd tinh kha thi cho cac nganh chuyen mdn, cac nha
quan ly cung vdi cdng ddng can phai thuc hien quan ly va
xii
ly ngudn
nude
thai.
8.2/
ve
phuang phap nghien
ciiu:
t F F F
Phuang phap chuan qudc gia va qudc td dam bao do chinh xac cao.
8.3/
Nhung ddng gdp mdi khac:
F
y
- Mdt sd loai ky sinh triing da dugc xac dinh bang sinh hgc phan
tii
so sanh vdi
chiing chuin qudc td vdi do chinh xac cao.
- Ddng gdp cho khoa hgc va cho dao tao, trong dd cd 4 khda luan tdt nghiep
cii

VA THUY
SAN DU^OC NUOI
TRONG
TlT
NGUON
NU^OfC THAI TAI MQT SO
THANH PHO VA NONG
THON
MIEN
BAG
Chirong
1
DAT VAN DE
F
r
F
y
Mdi
trudng sdng ludn ludn tac dgng ddn cudc sdng con ngudi d nhieu khia
canh va
miic
dg khac nhau. Mdi tmdng tdn tai vd sd nhirng tac nhan gay benh tac
ddng ldn con
ngudi,
lam con ngudi nhidm bdnh va gay anh hudng ldn ddn
siic
khoe,
tham chi cdn gay
tii
vong.

bidn phap
khdng chd kip
thdi,
dac
biet cd nhieu
benh,
mam benh rat san cd d
Viet
Nam nhung gidi y hgc lai khdng quan tam day
dii
dan den chan doan nham dang
tile.
>
F F F
Nhung mam benh d dau? Loai gi? Cach phdng chdng ra sao? Khdng chd hay
F
y
tidu diet nhu thd nao cho phu hgp vdi tiing dia phuang ca vd chuyen mdn va kinh
tl? Dd la
nhung
cau hdi
cin
dugc giai dap vdi nhimg con sd biet ndi thd hien trong
dl tai nay.
Ndu chiing ta cd dugc nhiing thdng tin day dii va cu thd ve cac mam bdnh
tang trii, luu hanh trong mdi trudng tai cac tilu vung dia ly trong
timg
qudc gia,
trong tiing viing miln hay trong
timg

10
F F
mac va hang nam bi
tii
vung 60 trieu ngudi; benh giun tdc vdi 1,4 ty ngudi mac va
hang nam
tii
vong 10 trieu ngudi; benh giun mdc vdi 1,5 ty ngudi mac va
tii
vong
hang nam 65 trieu ngudi; bdnh san mang vdi hon 200 trieu ngudi mac; cd trdn 40
trieu ngudi nhidm san la tmyen qua thiic an; cd trdn 100 trieu ngudi nhidm san day
/au triing san lgn; cd hang ty ngudi mac cac bdnh don bao va bdnh ky sinh tning
khac tren toan
thi
gidi (Td chiic Y tl
thi
gidi, 1995). Nhilu tac gia trdn
thi
gidi nhu
M.V.K. Sukhdeo va cs, 1994; R. C. Tinsley & L. H. Chappell, 2000 da nghidn
ciiu
mam benh ky sinh tning tii mdi tmdng tac dpng ldn
siic
khoe con ngudi.
Giun san
tmyIn
qua ddng vat thuy sinh (ca, cua, tdm, luan, Ich) gay benh
cho ngudi bao gdm
chii

trong toan qudc. Tinh hinh nhilm giun diia va giun tdc d miln Bac cao han miln
Nam, cd noi d miln
BIC
ty le nhilm 2 loai giun nay
Id
80-90%. Tinh hinh nhilm
giun mdc cao tren pham vi ca nude, cd noi 70-80%. San
Id
gan nhd phan bd d it
nhit
32 tinh, cd dia phuang ty
Id
nhidm tren 30% nhu Nam Dinh, Ninh Binh, Ha
Tay, Thanh Ho4
Phii
Yen,
Binh Dinh; cd noi benh luu hanh
tren
toan tinh nhu Hod
u
Binh.
san
la gan
Idn
phan bd d it nhat trgn 47 tinh vdi so luong benh nhan tren
5.000
ngudi, cd ncri
tyle
nhiem
ll,l%nhudKhanhHoa.

7,2% (Nguyin Van Dg
va
cs,
1998-2006).
Giun diu gai
Gnathostoma
cung da duoc phat hien hang tram ca
trgn ngudi (Lg Thj Xuan
va
cs, 2003). Hang chuc benh nhan nhiim giun
luon
nao
gay viem mang nao tang bach ciu ai toan trong nhimg nam gan
day
(Pham Nhat
An, 2004
va
Nguyen Van Dg, 2005) do an phai iu triing tir moi trudng. Hang
chyc
trieu ngudi nhilm
cac
loai don bao tir mdi traong sdng. Da cd mpt s6 digu tra d
nhigm thue pham bdi
mam
bgnh ky sinh triing nhung chua day du. Thit
Ion
nhiim
iu triing san day 0,02-0,9%
(Kilu
Timg Lam). Thit bd nhiim iu triing

ngudn bao gdm nude thai sinh boat,
nude
thai benh vien, nha may,
nude
thai tu
nhign dgu chira dvng trong do nhigu nguygn nhan gay benh cho ngudi.
Nhigm vu
nay
danh gia d nhiem mam benh ky sinh trimg trgn rau, thuy san
dupe
nudi trong tir nguon nude thai mpt sd thanh pho
va
ndng thdn mign Bic sg gdp
phan tra
idi
cho cau hdi: i)trong
nirdc
thai thanh phd va ndng thdn chira mam
b|nh
ky sinh trimg
nao
truygn cho ngudi; ii) trong moi loai thirc pham lign quan dgn
nude
thai (rau, ca, torn, cua, dc )
chiia
mam bgnh gi
gay
nhiim cho ngudi; iii)
bing phuong phap nao, truygn thong hay hien dai hay phdi hpp de xac dinh chinh
xac tac nhan

ngudi tidu
dung^
bdo ve
siic
khde.
MUC TIEU
\
7
Xdc dinh cdc mam benh ky sinh triing (giun, sdn vd don bdo) trong sdn pham phuc
A >
F F
VU
con ngudi (rau, thuy sdn) dugc nudi trdng bang
nude
thdi tai mgt sd thdnh phd vd
\
F
ndng thdn mien Bac.
Dinh loai cdc mam benh ky sinh tning ndy bang hinh thai hgc vd sinh hgc
phan
tii.
-
De
xuat mot sd giai phap nham bao
ve
ngudi
sii dung
mot sd
thuc
pham cd nguy ca

ngirdi^
1.
Dircmg
truyen lay mam benh ky sinh triing voi con nguoi
Bdnh ky sinh tning tmydn lay tu mdi tmdng vdo ngudi cd thd true tiep hoac qua
vat
chii
trung gian va dugc phan nhdm mdt each tuong ddi dua vdo dudng lay
>
7
F
tmyen dd thirc hien cdc bidn phap phdng chdng cd hieu qua.
1.1.
Benh ky sinh triing
Uuyin
qua thuc dn
Id
thit (Foodbome Parasite by meat
products).
Nhdm ndy cd bdnh sdn day Taeniasis {Taenia
solium,
Taenia
saginata.
Taenia
F
asiatica);
bdnh giun xoan Trichinelliasis; bdnh Sarcocystosis, bdnh dan bdo
Toxoplasmosis.
1.2. Benh ky sinh triing truyen qua thuc dn cd nguon gdc thuy sdn (Foodbome
Parasite by aquatic products).

Benh ky
sinh
triing truyin qua thuc vgt (Plantbome Parasite).
Nhdm ndy cd benh sdn la mgt ldn Fasciolopsiasis; sdn
Id
gan ldn Fascioliasis;
Paramphistomeiasis;
Philophthakniasis.
1.5.
Benh ky
sinh triing
truyin
qua ddt
(Soil-transmitted Parasite).
/
y
F
Nhdm nay
chii yeu Id
giun sdn tmyen qua dat (Soil-transmitted Helminthiasis) vd
don bdo (Protozoa) gdm benh giun diia ngudi Ascariasis, bdnh giun tdc Trichuriasis,
F F
bdnh au tning san lgn Cysticercosis cellulosae; Bdnh au tning sdn chd
Echinococcosis
(Hydratidosis),
Coenurosis; bdnh au trung san day
ciia
lgn
t
Cysticercosis tenuicollis; bdnh giun phdi cdo Capillariasis; bdnh giun luon

bdnh ve ky sinh, benh ghe Scabies; benh Gastrophilid myiasis; benh Hypodermatid
myiasis.
1.7.
Binh ky sinh triing
truyen
qua khdng khi (Air-bome diseases). Nhdm nay cd
benh
Pneumocystosis
carinii.
Dircmg lay nhiem cua Icy sinh triing truyen lay giira ngirdi
v^
dong vat the
hien moi lien quan giira ngirdi
v^
dQng
vat dugc sa do hoa nhu sau:
a) Ngudi vd dgng vat
diu
bi lay nhilm
mim
benh tu mdi tmdng. Vi du giun
>
F
tmydn qua dat
ciia
ngudi vd dgng vat.
NGUdl
DONG VAT
MOITRUtiNG
m^

CHU TRUNG GIAN
e) Ngudi vd ddng vat bi nhidm
b?nh
ky sinh tning thai mam
b^nh
ra mdi
y
i-v
y
tmdng, mam benh nhiem vdo
v$t chii
trung gian rdi gidi phdng vdo mdi
F
tmdng vd au trung xam nhap vdo ngudi (ddng
vat).
Vi du: sdn mdng.
MOI
TRUdNG
VAT
CHU TRUNG GIAN
MOITRUtJNG
fv
y
f
f)
Ngudi va ddng vat bi nhiem bdnh ky sinh trung, mam bdnh
true
tiep vdo
^
F

CHU TRUNG GIAN
DONG VAT
VAT
CHU TRUNG GIAN
VAT CHU TRUNG
GLVN
F
y F
h) Mdt sd ky sinh tning lay tmyen tryc tiep giiia ngudi vd ngudi. Vi du benh
ghe,
benh trung roi am dao.
2.
Thuc trang ve benh ky sinh triing lay tir moi tnrcmg vao con ngirdi
2.1.
Tinh
hinh benh tren
the
gi&i
y
F
Benh ky sinh triing tmyen lay
tir
mdi tmdng vdo con ngudi phan bd rdng rai
trdn
thi
gidi, thudng phan bd theo dia ly, khi hau vd dilu kien kinh
tl-xa
hdi
ciia
con

cd gan 4 ty ngudi nhiem giun dua, giun tdc vd giun
mdc;
cd trdn 200 trieu ngudi nhidm sdn mang; cd trdn 40 trieu ngudi nhilm sdn
Id
tmyen qua thiic an; cd
tren
100 trieu ngudi nhiem sdn day/au tning san lgn; cd
120
trieu ngudi d 80
nude
nhilm benh giun chi
b^ch
huyet vd 1,1 ty ngudi (khodng 20%
F F \
dan sd) sdng trong vung cd bdnh luu hdnh; cd 2,4 ty ngudi d
100
nude nam trong
vung luu hdnh sdt ret va hang nam cd 300 500 trieu ngudi mac sdt ret, ldm chet
1,2-2,7
trieu ngudi; benh Leishmaniasis luu hdnh d 82
nude
(trong dd cd
10
nude
phdt trien vd 72
nude
dang phdt trien) vdi khoang
12
trieu ngudi mac vd 350 trieu
ngudi nam trong vung nguy co nhiem benh; vd cd hang ty ngudi mac cdc benh dan

F
r
cd ty
Id
nhidm thap nhat (dudi
10%).
Tu tmdc ddn nay, da ghi nhan 14 tinh cd bdnh
giun chi bach huyet vdi 6.339 ngudi nhilm nhu Hd Nam Ninh ty
Id
nhiem 13,37%,
Hai Hung 9,94%, Quang Binh
11,70%,
Ha Ndi 5,40%, Thdi Binh 4,90%, Qudng
Ninh 2,50%, Ha Bdc 2,30%, Hd Son Binh
2,01%,
Bdc Thdi
1,50%,
Nghe Tinh
1,10%,
VTnh
Phii
0,30%, Hd Tuyen 0,13%, Khdnh Hod 9,3-13,3%, Ninh Thuan 2%
(Nguydn Duy Todn, 2000). San la gan nhd phan bd d it nhat 24 tinh, cd dia phuang
ty
Id
nhidm tren 30% nhu Nam Dinh, Ninh Binh, Hd Tay, Thanh Hod,
Phii
Ydn,
Binh Dinh; cd nai bdnh luu hdnh trdn todn tinh nhu Hod Binh (Nguyen Van
DI

tning sdn lgn luu hdnh d it
nhit
50 tinh, cd noi ty
Id
nhidm sdn day 12% vd nhilm lu tning san lgn 7,2% (Nguydn Vdn Bh vd cs,
f
F F
2001).
Cd 43,4 trieu ngudi sdng trong viing sdt ret, trong dd cd
15
trieu ngudi sdng
trong vung sdt ret nang;
tir
nam 1991-2000 cd
10.184
ngudi
chit
vi sdt ret vdi 309
F
VU
dich sdt ret (Ld Xuan Hung vd cs, 2005). Benh Leishmaniasis da phdt hien 3
tmdng hgp d Qudng Ninh ndm
2001
(Nguyin Nggc Ham vd cs, 2001), da phdt hien
dc trung gian tmydn benh sdn mdng d Viet Nam (Nguyen Van
De
vd cs, 2000).
Benh giun xoan trichinelliasis da gay ra 4 vu dich: tai Mu Cdng Chdi (Yen Bdi) nam
1970
cd 26 ngudi mdc vd

mat ngudi (Nguyen Van
DI
vd
cs,
2007, 2008).
3.
Nguyen tac phong chong benh ky sinh trung truyen
lay
tir moi
trirong
vao
con
ngiroi
Mudn phdng chdng bdnh ky sinh tning tmyen lay
tir
mdi tmdng vdo con
ngudi cd hieu qua,
cin
dua
vdo
dac tinh sinh ly, sinh thai
ciia
ky sinh trung, tinh
/*^ ^
y F
trang d nhidm mam bdnh d mdi tmdng vd didu kien sdng
ciia
vat
chii.
3.1.

sinh trung thudng keo
ddi,
dai ddng vd dl
tdi
nhilm.
^
y
F
3.6.
Kdt hop
chat che nhidu bidn
phdp
phdng chdng vdi nhau.
\ f ^ ,
3.7. Ldng ghep cdng tac phdng chdng ky sinh trung vdi nhieu boat dgng
Y
te vd van
hoa-xa hdi khdc, dac biet dua cdng tac phdng chdng ky sinh trung vdo chuang trinh
cham sdc
siic
khoe ban dau,
nhit Id
d myln co sd.
3.8.
Xa hgi hod cdng tac phdng chdng ky sinh tning, ldi cudn cgng ddng ty gide
tham gia.
F F F
3.9. Phdi hgp phdng chdng ky sinh tning trong
y
td vdi cdc ngdnh lien quan nhu

uang
din
tan ca sd dl ndm
bit
nhiing kdt qud cap nhat, kip thdi bd sung nhiing bat
\
F y y F
cap,
nham nang cao hieu qua phdng chdng. Ddng thdi dd cap
chidn luge
mdt cdch
9
y
F^
F F
tdng hgp va cd phan tich vd dich td hgc, ca hdi, vat lyc hien cd vd cdc
yeu
td dnh
hudng
din
tinh
bin vung ciia
hoat ddng phdng chdng de qudn ly chuang trinh cd
hieu qua nhat.
21