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Boing AF, Boing AC, França AP, de Moraes JC. Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2024; 33:e20231216. [PMID: 39194084 PMCID: PMC11346768 DOI: 10.1590/s2237-96222024v33e20231216.especial2.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/29/2024] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. METHODS Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. RESULTS 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. CONCLUSION There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil. MAIN RESULTS Marked racial inequalities were found in the obstacles to vaccination of children under 24 months in Brazil and to timely vaccination at 5 months and in the first year of life. IMPLICATIONS FOR SERVICES Racial inequalities in the occurrence of vaccination shortcomings in health services, in the objective restrictions faced by families in taking their children to vaccination centers and in incomplete vaccination in a timely manner need to be addressed by the Brazilian National Health System. PERSPECTIVES Equal public policies to address barriers to vaccination and qualification of health services need to be implemented. Studies need to deepen understanding of the structural determinants that lead to racial disparities.
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Affiliation(s)
- Antonio Fernando Boing
- Universidade Federal de Santa Catarina, Programa de Pós-graduação em Saúde Coletiva, Florianópolis, SC, Brazil
| | - Alexandra Crispim Boing
- Universidade Federal de Santa Catarina, Programa de Pós-graduação em Saúde Coletiva, Florianópolis, SC, Brazil
| | - Ana Paula França
- Faculdade de Ciências Médicas Santa Casa de São Paulo, Departamento de Saúde Coletiva, São Paulo, SP, Brasil
| | - José Cássio de Moraes
- Faculdade de Ciências Médicas Santa Casa de São Paulo, Departamento de Saúde Coletiva, São Paulo, SP, Brasil
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Sudarsan A, V V. Unraveling the Determinants of Maternal Well-Being Among Tribal Populations of Kerala: A Systematic Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02032-x. [PMID: 38809468 DOI: 10.1007/s40615-024-02032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Despite Kerala's noteworthy achievements in health indices, the tribal population in the state continues to face significant challenges in achieving optimal health outcomes. This is particularly evident in the realm of maternal health, where tribal communities struggle. In light of this paradox, a systematic review was conducted to identify the factors influencing the quality of tribal maternal health and their determinants. METHOD A comprehensive search strategy was employed, utilizing computer-backed searches of eminent bibliographic databases, along with the exploration of additional cited references and hand-searching of relevant journals. The methodological quality of the selected studies was rigorously assessed through a transparent cataloguing system and analysis by reviewers, resulting in the inclusion of thirty studies following the filtering process. The selected studies were subjected to detailed analysis to identify the determinants of maternal health among tribal populations. RESULTS Thematic analysis of thirty studies that met the inclusion criteria resulted in four sets of determinants that contribute to maternal health among tribal women; biological/demographic determinants, psychological determinants, social determinants, and cultural determinants. CONCLUSIONS This review provides a comprehensive picture of tribal maternal health in Kerala, shedding light on their multifaceted challenges. The study provides a basis for the formulation of initiatives by addressing the broader determinants of health and accounting unique socio-cultural factors influencing well-being of tribal communities.
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Affiliation(s)
- Amala Sudarsan
- Department of Applied Psychology, School of Behavioural Sciences, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, 610101, India
| | - Vithya V
- Department of Applied Psychology, School of Behavioural Sciences, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, 610101, India.
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Yang S, Feng C, Fei T, Wu D, Feng L, Yuan F, Fu Y, Ma H, Yu B, Liu L, Li Y, Li Y, Huang Y, Su L, Pei X, Yang W, Yang Y, Zeng Y, Ye L, Yang H, Gong Y, Zhang L, Yuan D, Liang S, Jia P. Mortality risk of people living with HIV under hypothetical intervention scenarios of PM2.5 and HIV severity: a prospective cohort study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 916:169938. [PMID: 38199346 DOI: 10.1016/j.scitotenv.2024.169938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
This study estimated and compared mortality risks among people living with HIV (PLWH) under the real-world and hypothetical scenarios of PM2.5 concentrations and HIV severity. An open cohort from all PLWH receiving antiretroviral therapy in Sichuan during 2010-2019 was constructed, resulting in 541,515 person-years. Annual mean concentrations of PM2.5 were estimated and linked to PLWH by their residential address. The parametric g-formula were used to assess 3- and 5-year mortality risks under the real-world and hypothetical scenarios of PM2.5 (10-35, 35-50, 50-75 μg/m3) and CD4 concentrations (0-200, 200-500, 500-800, 800-1100 counts/μl). The estimated 3- and 5-year mortality risks among the PLWH were 14.43 % and 19.38 %, respectively, which would decrease substantially when annual PM2.5 concentration were reduced to between 10 and 35 μg/m3 (risk difference [RD] = -3.23 % and - 4.06 %) and would increase when PM2.5 concentration were elevated to between 50 and 75 μg/m3 (RD = 3.59 % and 5.04 %). The mortality risk would increase when CD4 concentration were reduced to <200 counts/μl (RD = 15.90 % and 20.27 %) and would decrease when CD4 concentration were ≥ 200 counts/μl, especially to between 800 and 1100 counts/μl (RD = -9.01 % and - 11.75 %). The elevated concentration of PM2.5 may disproportionately affect individuals with immune deficiency, especially those with more severity. The findings would serve as justifications for future intervention design and policy making to alleviate air pollution and improve environmental justice and health equity.
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Affiliation(s)
- Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Chuanteng Feng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China
| | - Teng Fei
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
| | - Dan Wu
- London School of Hygiene and Tropical Medicine, London, UK
| | - Liao Feng
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Fengshun Yuan
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Yao Fu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Hua Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bin Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Li Liu
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Yizhuo Li
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
| | - Yiping Li
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Yuling Huang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Ling Su
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Xiaodi Pei
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Wei Yang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Yihui Yang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Yali Zeng
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Li Ye
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Hong Yang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Yi Gong
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Linglin Zhang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Dan Yuan
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China.
| | - Shu Liang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China.
| | - Peng Jia
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; Hubei Luojia Laboratory, Wuhan, Hubei, China; School of Public Health, Wuhan University, Wuhan, China.
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Lai AHY, Lam JKH, Yao H, Tsui E, Leung C. Effects of students' perception of teachers' ethnic-racial socialization on students' ethnic identity and mental health in rural China's schools. Front Psychol 2024; 14:1275367. [PMID: 38425347 PMCID: PMC10903739 DOI: 10.3389/fpsyg.2023.1275367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/07/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction Using students in the Liangshan Yi autonomous prefectures of southwestern China (n = 585; 13-15 years old), we examined (i) the effects of students' perception of their teachers' ethnic-racial socialization on their ethnic identity and mental health outcomes of depressive and stress symptoms; (ii) the effects of students' ethnic identity on their depressive and stress symptoms; (iii) the differential associations among these factors in Yi ethnic minority versus Han cultural majority students. Methods We conducted a cross-sectional survey and used multistage sampling to collect the information. Chinese-validated standardized measures were used: the Patient Health Questionaires-9, Children's Revised Impact of Event Scale-8, Multigroup Ethnic Identity Measure, Cultural Socialization Scale, and Teachers' Attitude on Adoption of Cultural Diversity Scale. Multigroup confirmatory factor analysis and multigroup structural equation modeling were employed. Results Comparing the findings in Yi and Han students, their perception of teachers' ethnic-racial socialization had dissimilar effects on their ethnic identity and mental health outcomes. Three key findings comparing the differences between Yi and Han students were as follows: (i) students' perception of their teachers' multicultural socialization practices positively affected the ethnic identity of both Yi and Han young people; however, their perception of their teachers' socializing them to their own cultures did not exert any effect; (ii) students' perception of teachers' multicultural socialization practices had different mental health effects on Yi versus Han students; and (iii) ethnic identity affected the mental health of Yi ethnic minority students only. Conclusion The findings underscore the importance of teachers' multicultural socialization in the ethnic identity development of both Yi ethnic minority and Han majority students. Ethnic identity serves as a linking variable bridging perceived teachers' multicultural socialization practices and mental health in Yi ethnic minority students but not among the Han cultural majority youths. Research, practice, and policy implications relevant to the global context are also discussed.
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Affiliation(s)
| | - Jason K. H. Lam
- Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Hong Yao
- Minzu University of China, Beijing, China
| | - Elaine Tsui
- School of Continuing Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Cynthia Leung
- Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Zeng Q, Zhou J, Meng Q, Qian W, Wang Z, Yang L, Wang Z, Yang T, Liu L, Qin Z, Zhao X, Kan H, Hong F. Environmental inequalities and multimorbidity: Insights from the Southwest China Multi-Ethnic Cohort Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 908:167744. [PMID: 37863237 DOI: 10.1016/j.scitotenv.2023.167744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
Multimorbidity is an increasingly significant public health challenge worldwide. Although the association between environmental factors and the morbidity and mortality of individual chronic diseases is well-established, the relationship between environmental inequalities and multimorbidity, as well as the patterns of multimorbidity across different areas and ethnic groups, remains unclear. We first focus on analyzing the differences in environmental exposures and patterns of multimorbidity across diverse areas and ethnic groups. The results show that individuals of Han ethnicity residing in Chongqing and Sichuan are exposure to higher levels of air pollutants such as PM2.5, PM10, and NO2. Conversely, Tibetans in Tibet and Yi people in Yunnan face elevated concentrations of O3. Furthermore, the Dong, Miao, Buyi ethnicities in Guizhou and Bai in Yunnan have greater access to green spaces. The key multimorbidity patterns observed in Southwest China are related to metabolic abnormalities combined with digestive system diseases. However, significant differences in multimorbidity patterns exist among different regions and ethnic groups. Further utilizing the logistic regression model, the analysis demonstrates that increased exposure to environmental pollutants (PM2.5, PM10, NO2, O3) is significantly associated with higher odds ratios of multimorbidity. Conversely, a greater presence of green spaces (NDVI 250, NDVI 500, NDVI 1000) significantly reduces the risk of multimorbidity. This large-scale epidemiological study provides some evidence of a significant association between environmental inequalities and multimorbidity. By addressing these environmental inequalities and promoting healthy environments for all, we can work towards reducing the prevalence of multimorbidity and improving overall population health.
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Affiliation(s)
- Qibing Zeng
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Jingbo Zhou
- Lab of Computational Chemistry and Drug Design, State Key Laboratory of Chemical Oncogenomics, Peking University Shenzhen Graduate School, Shenzhen, 518055, China
| | - Qiong Meng
- School of Public Health, Kunming Medical University, Kunming, 650500, China
| | - Wen Qian
- Chengdu Center for Disease Control and Prevention, Chengdu, 610044, China
| | - Zihao Wang
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - La Yang
- High Altitude Health Science Research Center of Tibet University, Lhasa, 850013, China
| | - Ziyun Wang
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Tingting Yang
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Leilei Liu
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Zixiu Qin
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China.
| | - Haidong Kan
- School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
| | - Feng Hong
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China.
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Yang XY, Schieman S. Racial disparities in Death rates and Death incidences in Xinjiang: A study of multilevel ecological mechanisms. Soc Sci Med 2024; 340:116405. [PMID: 37992614 DOI: 10.1016/j.socscimed.2023.116405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/08/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Abstract
Health disparities based on racial status are well-researched by social scientists, but this field of knowledge has rarely been investigated beyond the Western context. As the largest province in China, Xinjiang has over 50% non-Han populace-and this group is subjected to various forms of inequalities. The current study is the first to quantitatively demonstrate the disparity in mortality between the Han majority and Turkic minority in Xinjiang. We have developed a theory-driven framework to approach race as a fundamental cause of mortality disparity through both individual and context-level pathways that trigger the proximate determinants of death. We compiled the 2015 China Microcensus with the Sixth Decennial Census (2010) and web-extracted point-of-interest information for data at different ecological levels. The results reveal that the mortality rate is significantly pronounced for Turks at the county-level and Turks' death incidence is elevated at the household level. The inclusion of variables at the individual- and context-level explains about 38% of the mortality disparity between Han and Turks, but the significant disparity remains strong after considering the covariates, the "healthy migrant" scenario, geographical clustering, and exposure risk. We cautiously suggest the remaining unexplained portion of the mortality disparity may be due to unobserved racial inequity and urge the academic community to further investigate this underexplored subject.
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Kuru Alici N, Ogüncer A. Knowledge, Beliefs, and Cultural Practices of Sexual and Reproductive Health Among Afghan Refugee Women in Türkiye. J Transcult Nurs 2024; 35:30-40. [PMID: 37933749 DOI: 10.1177/10436596231209042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Limited research on experiences of women, who constitute a double vulnerable group in both women and refugee status, regarding sexual and reproductive health. The purpose of this study is to examine the knowledge, beliefs, and cultural practices of Afghan women living in Türkiye regarding sexual and reproductive health. METHOD This descriptive phenomenological study was conducted with 18 Afghan refugee women. In-depth, semi-structured interviews were conducted to collect data. RESULTS Four themes emerged from interviews: cultural practices and beliefs related to pregnancy and postpartum, use of contraceptive methods, gender-based violence, and access to health services. CONCLUSIONS Afghan women have different cultural practices regarding prenatal, pregnancy, and postpartum and lack of knowledge about sexual and reproductive health. Considering individual differences in sexual and reproductive health, providing sensitive, supportive, and informative services is recommended.
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Affiliation(s)
| | - Ali Ogüncer
- Refugee Support Association, Eskisehir, Türkiye
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He S, Shi Y, Wang F, Li C, Kang J, Zhang G, Zhou K, Yu Z, Yao Y, Peng H. Short-term prognosis of very-preterm infants of ethnic minorities and Han nationality at high altitude: a single-center, retrospective study. J Matern Fetal Neonatal Med 2023; 36:2228455. [PMID: 37380346 DOI: 10.1080/14767058.2023.2228455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/31/2023] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE We aimed to analyze the perinatal care of very-preterm infants (VPIs) in plateau areas of China and to explore any differences in short-term outcomes between ethnic minorities and Han nationality. METHODS VPIs with gestational age (GA) <32 weeks admitted to Qinghai Red Cross Hospital from 1 January 2018 to 31 December 2020 were enrolled. Maternal information, neonatal information, perinatal care and discharge outcomes were retrospectively collected and analyzed. RESULTS A total of 302 VPIs were examined, including 143 (47.4%) ethnic minority infants and 159 (52.6%) Han infants. Mothers of ethnic minority infants were significantly younger than those of Han infants (27 y vs. 30 y, p < .001). There were no differences in the incidence of assisted reproduction, multiple pregnancies, maternal hypertension, clinical chorioamnionitis or premature rupture of membranes >18 h between ethnic minority mothers and Han mothers. Lower proportions of cesarean section and incidence of maternal diabetes were observed in ethnic minority mothers than in Han mothers [(9.1 vs.17.6%, p < .05) and (42.7 vs. 57.9%, p < .05, respectively)]. Meanwhile, fewer antenatal steroids were used in minority group than Han group (65.7 vs. 81.1%, p < .05). No significant differences in rates of death, active treatment, necrotizing enterocolitis stage ≥2, moderate-to-severe BPD, and incidence of severe retinopathy of prematurity in VPIs were found between the two groups and in all GA subgroups. Severe neurological injury was significantly less common in the minority newborns than in the Han infants (1.2 vs. 6.1%, p < .05). Compared with Han group, no excess risk of death, death or major morbidity, death despite active treatment, death or major morbidity despite active treatment was observed in ethnic minorities, with or without adjusting for gestational age and prenatal steroids. CONCLUSIONS Short-term prognosis of VPIs of ethnic minorities were similar to those of Han nationality.
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Affiliation(s)
- Shengnan He
- Department of Neonatology, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Yanling Shi
- Department of Neonatology, Qinghai Red Cross Hospital, Xining, China
| | - Fei Wang
- Department of Neonatology, Qinghai Red Cross Hospital, Xining, China
| | - Cungui Li
- Department of Neonatology, Qinghai Red Cross Hospital, Xining, China
| | - Jing Kang
- Department of Neonatology, Qinghai Red Cross Hospital, Xining, China
| | - Guofei Zhang
- Department of Neonatology, Qinghai Red Cross Hospital, Xining, China
| | - Kanghua Zhou
- Department of Neonatology, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Zhangbin Yu
- Department of Neonatology, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Yanli Yao
- Department of Neonatology, Qinghai Red Cross Hospital, Xining, China
| | - Haibo Peng
- Department of Neonatology, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
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Huang Y, Xiao X, Wan Y, Ye Q, Yang Z, Xu L, Chen S, Li H, Wang F, Chen Y, Zhao D, Zhang Q, Zheng J, Guo G, Li Y. Tracking progress towards equitable maternal and child health in Yunnan: a systematic assessment for the Health Programme for Poverty Alleviation in China during 2015-2020. BMJ Open 2023; 13:e070809. [PMID: 37821133 PMCID: PMC10583063 DOI: 10.1136/bmjopen-2022-070809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES To inform the impacts of health programmes which aimed at preventing women and children from being trapped in or returning to poverty because of illness in Yunnan, the main battlefield against poverty in China. DESIGN The longitudinal comparative evaluation design. DATA COLLECTION AND ANALYSIS National and Yunnan policy documents related to maternal and child health programmes for poverty alleviation during 2015-2020 were analysed. The changes in disparities in maternal and child health system inputs, service coverage, and health outcomes between poor and non-poor areas, as well as out-of-pocket payments between poor and non-poor populations were assessed before and after 2017. RESULTS In total 12 policies and 15 programmes related to poverty alleviation for poor women and children in Yunnan were summarised. As a result of health system strengthening in Yunnan, the densities of licensed doctors, nurses, obstetricians, midwives, township health workers and female village doctors had been increased substantially in poor areas, with the annual rates of 14.3%, 22.5%, 21.8%, 23.9%, 14.1% and 7.1% separately. Although disparities existed in some of service coverage between poor and non-poor areas, the health programmes had narrowed the gaps in utilisation of facility birth, caesarean section, prenatal screening and newborn screening across Yunnan (p<0.01). The out-of-pocket payments for inpatient care for serious illnesses among women and children with poverty registration had been considerably decreased to 10.0%. Paralleling the universal coverage, maternal deaths per 100 000 livebirths and child deaths per 1000 livebirths had further declined in both poor and non-poor areas, and the impacts of health programmes on closing the gaps in child survivals across Yunnan were significant (p<0.01). CONCLUSIONS Remarkable progress in equitable maternal and child survival has been achieved in Yunnan. The practices in Yunnan have shown the Chinese model in ending poverty by strengthening health system and implementing universal coverage with firm commitment, determined leadership, detailed blueprint and social participation.
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Affiliation(s)
- Yuan Huang
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Xia Xiao
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Ying Wan
- Information Centre, Yunnan Maternal and Child Health Care Hospital, Kunming, Yunnan, China
| | - Qingyun Ye
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Zhongting Yang
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Lingling Xu
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Shuqi Chen
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Huifang Li
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Fangfang Wang
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yurong Chen
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Dandan Zhao
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Qian Zhang
- Information Centre, Yunnan Maternal and Child Health Care Hospital, Kunming, Yunnan, China
| | - Jiarui Zheng
- Health Care Centre, Yunnan Maternal and Child Health Care Hospital, Kunming, Yunnan, China
| | - Guangping Guo
- Health Care Centre, Yunnan Maternal and Child Health Care Hospital, Kunming, Yunnan, China
| | - Yan Li
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
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Soman B, Lathika AR, Unnikrishnan B, Shetty RS. Tracing the Disparity Between Healthcare Policy-Based Infrastructure and Health Belief-Lead Practices: a Narrative Review on Indigenous Populations of India. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01810-3. [PMID: 37787946 DOI: 10.1007/s40615-023-01810-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
Most Indian tribes have limited access to healthcare facilities and rely heavily on traditional healing practices. This narrative review aimed to identify the disparities in the implementation of healthcare services and in accessing and availing these services by the indigenous population in India. We also have tried to throw light on the plausibility in strengthening the efficiency and efficacy of the public health system, by utilizing the available resources to its maximum potential, so that there will be a measurable outcome in the health status of these populations in India, coherently with the relevant sustainable development goals (SDG). The evidence from published literatures supports the fact that the disparity exists in the health status of indigenous populations in India as compared to the general populations. It emphasizes the need to address the key determinants such as the lack of knowledge, traditional healing practices and poor utilization of healthcare services provided to them. Various factors such as accessibility to healthcare resources, traditional healing practices, lack of awareness regarding healthcare services and schemes provided by the government, insufficient data regarding their issues and challenges and cultural and language barriers worsen the health status of indigenous people. However, our review reiterates that a well-structured and sustainable policy with reframed infrastructure and administration of healthcare system might bring a positive change in the health status of indigenous population in India.
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Affiliation(s)
- Biju Soman
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ashwathi Raj Lathika
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - B Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 575001, India
| | - Ranjitha S Shetty
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
- Centre for Indigenous Population, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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Kota K, Chomienne MH, Geneau R, Yaya S. Socio-economic and cultural factors associated with the utilization of maternal healthcare services in Togo: a cross-sectional study. Reprod Health 2023; 20:109. [PMID: 37488593 PMCID: PMC10367352 DOI: 10.1186/s12978-023-01644-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/02/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Proper utilization of maternal healthcare services plays a major role on pregnancy and birth outcomes. In sub-Saharan Africa, maternal and child mortality remains a major public health concern, especially in least developed countries such as Togo. In this study, we aimed to analyze factors associated with use of maternal health services among Togolese women aged 15-49 years. METHODS This study used data from third round of nationally representative Demographic and Health Survey conducted in Togo in 2013. Analysis included 4,631 women aged 15-49 years. Outcome variables were timely first antenatal care (ANC) visits, adequate ANC4 + visits, and health facility delivery. Data were analyzed using Stata version 16. RESULTS Overall, proportion of maternal healthcare utilization was 27.53% for timely first ANC visits, 59.99% for adequate ANC visits, and 75.66% for health facility delivery. Our multivariable analysis showed significant differences among women in highest wealth quintile, especially in rural areas with increasing odds of timely first ANC visits (Odds ratio (OR) = 3.46, 95% CI = 2.32,5.16), attending adequate ANC visits (OR = 2.19, 95% CI = 1.48,3.24), and delivering in health facilities (OR = 8.53, 95% CI = 4.06, 17.92) compared to those in the poorest quintile. Also, women with higher education had increased odds of timely first ANC visits (OR = 1.37, 95% CI = 1.11,1.69), and attending adequate ANC visits (OR = 1.73, 95% CI = 1.42,2.12) compared to those with no formal education. However, having higher parity and indigenous beliefs especially in rural areas decreased odds of using healthcare services. CONCLUSIONS Findings from this study showed that socio-economic inequality and socio-cultural barriers influenced the use of maternal healthcare services in Togo. There is therefore a need to improve accessibility and the utilization of maternal healthcare services through women's economic empowerment and education to reduce the barriers.
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Affiliation(s)
- Komlan Kota
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON Canada
| | - Marie-Hélène Chomienne
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Robert Geneau
- Applied Research Division, Public Health Agency of Canada, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5 Canada
- The George Institute for Global Health, Imperial College London, London, UK
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12
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Experiences and needs of women from ethnic minorities in maternity healthcare: A qualitative systematic review and meta-aggregation. Women Birth 2023; 36:30-38. [PMID: 35717372 DOI: 10.1016/j.wombi.2022.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/13/2022] [Accepted: 06/08/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To consolidate the available evidence around ethnic minority women's experiences and needs when accessing maternity care. METHODS A qualitative systematic review and meta-aggregation of qualitative data were conducted. Nine electronic databases were searched for qualitative or mixed-methods studies from the inception of each database until January 2022. Using the Nested-Knowledge software, meta-aggregation was conducted according to the Joanna Briggs Institute (JBI) data synthesis approach to identify all potential intersections between different themes. Methodological quality of included studies was assessed using the JBI Qualitative Assessment and Review Instrument (JBI-QARI) and the mixed-methods appraisal tool (MMAT) checklists for qualitative and mixed-methods studies, respectively. RESULTS Twenty-two studies (nineteen qualitative and three mixed-methods) were included. All studies were of good methodological quality. An overarching theme 'the struggles and fears of ethnic minority women' was identified. The negative experiences with maternity care were attributed to barriers including ineffective communication, cultural and religious insensitivity, inattentiveness and disregard for women's needs, and isolation-related impact due to the COVID pandemic. CONCLUSIONS Overall, our review highlighted several significant gaps between the care provided and the expected care among ethnic minority women accessing maternity care services. This mismatch between their expectations and care resulted in negative experiences, as the women reported being discriminated against and disrespected. There is an urgent need to develop and implement maternity care policies that are inclusive of needs of the ethnic minority women to optimize their maternity care experience.
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13
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Chen Y, Sylvia S, Dill SE, Rozelle S. Structural Determinants of Child Health in Rural China: The Challenge of Creating Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13845. [PMID: 36360724 PMCID: PMC9654689 DOI: 10.3390/ijerph192113845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Over the past two decades, the literature has shown a clear gradient between child health and wealth. The same health-wealth gradient is also observed among children in China, with a large gap in health between rural and urban children. However, there are still unanswered questions about the main causes of China's rural-urban child health inequality. This paper aims to review the major factors that have led to the relatively poor levels of health among China's rural children. In addition to the direct income effect on children's health, children in rural areas face disadvantages compared with their urban counterparts from the beginning of life: Prenatal care and infant health outcomes are worse in rural areas; rural caregivers have poor health outcomes and lack knowledge and support to provide adequate nurturing care to young children; there are large disparities in access to quality health care between rural and urban areas; and rural families are more likely to lack access to clean water and sanitation. In order to inform policies that improve health outcomes for the poor, there is a critical need for research that identifies the causal drivers of health outcomes among children. Strengthening the pediatric training and workforce in rural areas is essential to delivering quality health care for rural children. Other potential interventions include addressing the health needs of mothers and grandparent caregivers, improving parenting knowledge and nurturing care, improving access to clean water and sanitation for remote families, and most importantly, targeting poverty itself.
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Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sarah-Eve Dill
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA
| | - Scott Rozelle
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA
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Zhao F, Tang B, Yang H, Wu J, Chen Q, Zhang L, Liu X. A comparative examination of the health status of earthquake-affected and non-earthquake-affected adolescents in Yushu. Front Public Health 2022; 10:976075. [PMID: 36388266 PMCID: PMC9645053 DOI: 10.3389/fpubh.2022.976075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/03/2022] [Indexed: 01/25/2023] Open
Abstract
Background Yushu, Qinghai Province, which is located in the remote Tibetan Plateau in western China, was struck by a disastrous earthquake in 2010. Methods This study aimed to compare the health status of adolescents who had (Exp-Group) and had not (Non-Group) experienced the Yushu earthquake, 7 years after it occurred; additionally, group-specific predictors of health status were identified. A cross-sectional study was adopted among students from two junior schools in Yushu, whereby two groups were compared. Descriptive statistics, t-tests, Wilcoxon rank-sum tests, Kruskal-Wallis H tests, and stepwise linear regression were used to analyze data. Results Exp-Group scored higher than Non-Group on Physiological Component Summary (PCS) but not on Mental Component Summary (MCS). Among Exp-Group participants, lower PCS scores were predicted for "house damaged," "injured," "family member injured," and "family member or friend dead." Lower MCS scores were predicted by "family member or friend dead." Among Non-Group participants, PCS scores were predicted by "residence" and "family member or friend dead." Lower MCS scores were predicted by "not living with parents." Conclusion Lower PCS and MCS scores of Exp-Group adolescents mainly contributed to earthquake-related injuries, while lower PCS and MCS scores of Non-Group are related to poor living conditions and the fact of the left-behind child.
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Affiliation(s)
- Fangjie Zhao
- Department of Health Service, Second Military Medical University, Shanghai, China
| | - Bihan Tang
- Department of Health Service, Second Military Medical University, Shanghai, China
| | - Hongyang Yang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Wu
- School of Nursing, Second Military Medical University, Shanghai, China
| | - Qi Chen
- Department of Health Statistic, Second Military Medical University, Shanghai, China
| | - Lulu Zhang
- Department of Health Service, Second Military Medical University, Shanghai, China,*Correspondence: Xu Liu
| | - Xu Liu
- Department of Health Service, Second Military Medical University, Shanghai, China,Lulu Zhang
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Yang S, Liang X, Dou Q, La Y, Cai J, Yang J, Laba C, Liu Q, Guo B, Yu W, Wang Q, Chen G, Hong F, Jia P, Zhao X. Ethnic disparities in the association between ambient air pollution and risk for cardiometabolic abnormalities in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:155940. [PMID: 35580681 DOI: 10.1016/j.scitotenv.2022.155940] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Long-term exposure to ambient air pollution has been associated with cardiometabolic abnormalities (CAs), which, however, may be stronger in vulnerable populations, such as minorities. The variation of the association between ambient air pollution and CAs between the majority (Han) and minority populations in China have been poorly studied. OBJECTIVES We aimed to estimate and compare the Hans' and minorities' risks for CAs associated with long-term exposure to ambient air pollution in Southwest China. METHODS A cross-sectional study was conducted on the basis of the China Multi-Ethnic Cohort. CAs were defined by the presence of at least three pre-defined metabolic dysfunctions (central obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose). The concentrations of ambient air pollutants, including particulate matters (PM1, PM2.5, and PM10) and nitrogen dioxide (NO2), were generated from random forest models on the basis of multi-source data. One- and two-pollutant regression models were fit to assess associations between air pollutant exposure and CA risks. Sensitivity analyses were performed to examine the robustness of the associations. RESULTS The final sample included 51,037 Hans and 28,702 minority participants. The prevalence of CAs was 25.0%, slightly higher in the minorities (25.5%) than the Hans (24.4%). The higher risks for CAs in the overall population were associated with each 10 μg/m3 increase in the exposure to PM1 (OR = 1.07 [1.05-1.09]), PM2.5 (OR = 1.11 [1.06-1.17]), PM10 (OR = 1.04 [1.03-1.06]), and NO2 (OR = 1.04 [1.03-1.07]). Compared to the Hans, the higher risks for CAs were observed in the minorities for PM1 (OR = 1.35 [1.18-1.53]), PM2.5 (OR = 1.61 [1.34-1.93]), and PM10 (OR = 1.15 [1.07-1.23]). The associations of metabolic dysfunctions (CA components) with ambient air pollution also varied between the Han and minority populations. CONCLUSIONS The associations between exposure to ambient air pollution and CA risks were stronger in the minorities than Hans. Our findings provide a better understanding of ethnic disparities in CA risks when being exposed to ambient air pollution in China, which also have important implications for other low- and middle-income countries where less health resources (e.g., cohort populations) are available to conduct such studies.
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Affiliation(s)
- Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Xian Liang
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Qingyu Dou
- National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Yang La
- Tibet University, Lhasa, China
| | - Jiaojiao Cai
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Jun Yang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Ciren Laba
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Qiaolan Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bing Guo
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wanqi Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qinjian Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gongbo Chen
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Feng Hong
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China.
| | - Peng Jia
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; School of Resource and Environmental Sciences, Wuhan University, Wuhan, China.
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
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Wang Q, He Y, Long F, Li C, Shen Z, Guo D, Zhaxi D, Bumu L, Hua Z, Sun Z, Jiang N, Han X, Li J, Yan K, Bai S, Tao M, Xu X, Xiao Z. Cervical cancer screening in high-altitude areas in China: A large cross-section study of 25,173 women in northern Tibet. Front Oncol 2022; 12:841547. [PMID: 36091127 PMCID: PMC9452642 DOI: 10.3389/fonc.2022.841547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background Cervical cancer has become a worldwide concern owing to its high incidence and mortality rates. To date, high-altitude areas of Tibet have not benefited from any large-scale cervical cancer screening programs. Therefore, we initiated a screening program to investigate the prevalence of human papilloma virus (HPV) and HPV genotype distribution to reveal cervical cancer and its precursor which lead to morbidity among women in the city of Nagqu in northern Tib3et. Methods A total of 25,173 women were recruited to undergo HPV genotype tests between June and December 2019. Women infected with HPV 16 and/or 18 underwent colposcopy and histological examination. Women with other high-risk HPV type (hr-HPV) underwent cytological tests to determine whether to conduct further colposcopy and histological examination for diagnosis. HPV prevalence was calculated in the total population and further stratified according to various parameters, such as age group, area location (altitude level), and single or mixed infection status. The HPV genotype distribution was also investigated accordingly. Cervical lesions revealed by further colposcopic findings were also analyzed; high-grade and malignant lesion morbidities were calculated in total and in each county. Most data were collected and analyzed using descriptive and consistency check statistical methods, and a risk factor investigation for HPV infection was performed using logistic regression models. Results The total HPV infection rate among women in Nagqu was 13.42%. Of the 25,173 women in the study, 999 (3.97%) were HPV 16/18 positive, 2,379 (9.45%) were other hr-HPV-positive, and 21,795 (86.58%) were HPV-negative. The five most common HPV genotypes, accounting for more than 60% of all HPV infections in Nagqu people, were HPV 16, 58, 31, 18, and 52. Tibetan women younger than 20 years and older than 60 years were the two age groups with the highest rates of HPV infection, 26.7% and 19.8%, respectively. Among the HPV-positive women, 2,656 (78.33%) were infected with a single strain and 732 (21.67%) were infected with multiple strains (more than two genotypes). HPV prevalence increased in high-altitude areas (positive rate highest in Nyima with an altitude of 5,000 m, 23.9%) and decreased in relatively low-altitude areas (positive rate lowest in Lhari with an altitude of 4,000 m, 6.6%). Multiple analyses showed that age, parity, age at first delivery, and altitude of residence were independent factors facilitating HPV infection in Tibetan women. High-grade and malignant cervical lesions revealed by histological findings were different among living locations, with the highest rates in Xainza, Baingoin, and Nyainrong, these being 2.019%, 1.820%, and 1.116%, respectively, among women in these areas. Conclusion Our survey provides an overall perspective on HPV genotype infection and cervical lesions in women in northern Tibet. The data not only provide useful information for the treatment of cervical lesions but also has great value in terms of the primary and secondary prevention measures that can be taken for women living in these regions. Clinical Trial Registration www.chictr.org.cn, indentifier ChiCTR2000035061.
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Affiliation(s)
- Qimin Wang
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Pathology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yingying He
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Pathology, Dalian Maternal and Child Medical Group, Dalian, China
| | - Fang Long
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Obstetrics and Gynecology, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
| | - Chaoran Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Performance and Quality Management Department, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhuowei Shen
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dongxing Guo
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Obstetrics and Gynecology, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
| | - Duoji Zhaxi
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
| | - Lamu Bumu
- Department of Obstetrics and Gynecology, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
| | - Zhengyu Hua
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhigang Sun
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Nan Jiang
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xu Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jing Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Keqing Yan
- Department of Pathology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Siqi Bai
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Muhan Tao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaoguang Xu
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Neurosurgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhen Xiao
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Obstetrics and Gynecology, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
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Cao G, Yuan Y, Kong C, Liu J, Liu M, Ye H. Ethnic differences in preterm birth in Southwest China, 2014-2018: A population-based observational study. Front Med (Lausanne) 2022; 9:972917. [PMID: 35991656 PMCID: PMC9386050 DOI: 10.3389/fmed.2022.972917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivePreterm birth is a major healthcare problem and has been rising gradually in the past three decades in China. Yet the ethnic differences in the rates and distributions of preterm birth remain largely unknown in China. This study used data from Yunnan, a multiethnic province, to explore the differences in preterm birth across ethnicities.MethodsA population-based observational study was conducted based on data from the National Free Preconception Health Examination Project in rural Yunnan from Jan 1, 2014 to Dec 31, 2018. Pregnancies with at least one livebirth were included in this study. We estimated the rates and 95% confidence intervals (CIs) of overall preterm birth (born < 37 weeks’ gestation), moderate to late preterm birth (born between 32 and <37 weeks’ gestation), very preterm birth (born between 28 and 31 weeks’ gestation), and extremely preterm birth (born < 28 weeks’ gestation) across maternal ethnicity and compared them using log-binomial regressions. Multivariable log-binomial regressions were used to assess the association between maternal ethnicity and preterm birth with adjustment for potential confounders, including year of delivery, maternal age at delivery, education, occupation, pre-pregnancy body mass index, history of chronic disease, history of preterm birth, smoking and drinking alcohol during early pregnancy, and parity and multiple pregnancy of current pregnancy.ResultsAmong 195,325 women who delivered at least one live baby, 7.90% (95% CI, 7.78–8.02%) were born preterm. The rates of moderate to late preterm birth, very preterm birth, and extremely preterm birth were 6.20% (95% CI, 6.09–6.30%), 1.18% (95% CI, 1.13–1.23%), and 0.52% (95% CI, 0.49–0.56%), respectively. The rates of overall preterm birth, moderate to late preterm birth, very preterm birth, and extremely preterm birth differed across maternal ethnicity. The preterm birth rates in Dai (10.73%), Miao (13.23%), Lisu (12.64%), Zhuang (11.77%), Wa (10.52%), and Lagu (12.34%) women were significantly higher than that in Han women, and the adjusted relative risks were 1.45 [95% CI, 1.36, 1.54], 1.74 (95% CI, 1.62, 1.86), 1.60 (95% CI, 1.47, 1.75), 1.60 (95% CI, 1.46, 1.75), 1.40 (95% CI, 1.22, 1.60), and 1.67 (95% CI, 1.50, 1.87) respectively. There was no difference in preterm birth rate between Han women and Hani, Bai, or Hui women.ConclusionThis study found notable differences in the rates of preterm birth and its sub-categories across maternal ethnicities, which were especially higher in ethnic minority women. The findings suggest that greater efforts to reduce ethnic inequalities in preterm birth. Future studies are warranted to understand the drivers of ethnic inequalities in preterm birth in China.
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Affiliation(s)
- Guiying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yanling Yuan
- Yunnan Population and Family Planning Research Institute, Kunming, China
| | - Cai Kong
- Yunnan Population and Family Planning Research Institute, Kunming, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- *Correspondence: Min Liu,
| | - Hanfeng Ye
- Yunnan Population and Family Planning Research Institute, Kunming, China
- Hanfeng Ye,
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18
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Cata-Preta BO, Santos TM, Wendt A, Hogan DR, Mengistu T, Barros AJD, Victora CG. Ethnic disparities in immunisation: analyses of zero-dose prevalence in 64 countries. BMJ Glob Health 2022; 7:e008833. [PMID: 35577393 PMCID: PMC9114867 DOI: 10.1136/bmjgh-2022-008833] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/25/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The Sustainable Development Goals (SDGs) recommend stratification of health indicators by ethnic group, yet there are few studies that have assessed if there are ethnic disparities in childhood immunisation in low-income and middle-income countries (LMICs). METHODS We identified 64 LMICs with standardised national surveys carried out since 2010, which provided information on ethnicity or a proxy variable and on vaccine coverage; 339 ethnic groups were identified after excluding those with fewer than 50 children in the sample and countries with a single ethnic group. Lack of vaccination with diphtheria-pertussis-tetanus vaccine-a proxy for no access to routine vaccination or 'zero-dose' status-was the outcome of interest. Differences among ethnic groups were assessed using a χ2 test for heterogeneity. Additional analyses controlled for household wealth, maternal education and urban-rural residence. FINDINGS The median gap between the highest and lowest zero-dose prevalence ethnic groups in all countries was equal to 10 percentage points (pp) (IQR 4-22), and the median ratio was 3.3 (IQR 1.8-6.7). In 35 of the 64 countries, there was significant heterogeneity in zero-dose prevalence among the ethnic groups. In most countries, adjustment for wealth, education and residence made little difference to the ethnic gaps, but in four countries (Angola, Benin, Nigeria and Philippines), the high-low ethnic gap decreased by over 15 pp after adjustment. Children belonging to a majority group had 29% lower prevalence of zero-dose compared with the rest of the sample. INTERPRETATION Statistically significant ethnic disparities in child immunisation were present in over half of the countries studied. Such inequalities have been seldom described in the published literature. Regular analyses of ethnic disparities are essential for monitoring trends, targeting resources and assessing the impact of health interventions to ensure zero-dose children are not left behind in the SDG era.
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Affiliation(s)
- Bianca O Cata-Preta
- Department of Social Medicine, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Thiago M Santos
- Department of Social Medicine, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Andrea Wendt
- Department of Social Medicine, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | | | - Aluisio J D Barros
- Department of Social Medicine, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- Department of Social Medicine, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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19
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Chen N, Pan J. The causal effect of delivery volume on severe maternal morbidity: an instrumental variable analysis in Sichuan, China. BMJ Glob Health 2022; 7:bmjgh-2022-008428. [PMID: 35537760 PMCID: PMC9092146 DOI: 10.1136/bmjgh-2022-008428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Findings regarding the association between delivery volume and maternal health outcomes are mixed, most of which explored their correlation. This study aims to demonstrate the causal effect of delivery volume on severe maternal morbidity (SMM) in China. Methods We analysed all women giving birth in the densely populated Sichuan province with 83 million residents in China, during the fourth quarters of each of 4 years (from 2016 to 2019). The routinely collected discharge data, the health institutional annual report data and road network data were used for analysis. The maternal health outcome was measured by SMM. Instrumental variable (IV) methods were applied for estimation, while the surrounding average number of delivery cases per institution was used as the instrument. Results The study included 4545 institution-years of data from 1456 distinct institutions with delivery services, reflecting 810 049 associated delivery cases. The average SMM rate was approximately 33.08 per 1000 deliveries during 2016 and 2019. More than 86% of delivery services were provided by a third of the institutions with the highest delivery volume (≥143 delivery cases quarterly). In contrast, less than 2% of delivery services were offered by a third of the institutions with the lowest delivery volume (<19 delivery cases quarterly). After adjusting the confounders in the IV-logistic models, the average marginal effect of per 1000 cases in delivery volume was −0.162 (95% CI −0.169 to –0.155), while the adjusted OR of delivery volume was 0.005 (95% CI 0.004 to 0.006). Conclusion Increased delivery volume has great potential to improve maternal health outcomes, while the centralisation of delivery services might facilitate maternal health promotion in China. Our study also provides implications for other developing countries confronted with similar challenges to China.
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Affiliation(s)
- Nan Chen
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China.,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, People's Republic of China
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China .,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, People's Republic of China
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20
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Ye R, Wu Y, Sun C, Wang Q, Mao Y, Chang W, Zhou H. What Prompted the Adoption of Self-Protective Behaviors in Response to COVID-19? Evidence From Women Living in the Rural Areas of Western China. Front Public Health 2022; 9:756933. [PMID: 35155337 PMCID: PMC8831835 DOI: 10.3389/fpubh.2021.756933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background Self-protective behaviors, such as handwashing and mask-wearing, are effective to reduce the spread of coronavirus disease (COVID-19), but few studies have focused on women living in rural areas who bear the brunt of the impacts of the pandemic due to their economic and social vulnerabilities. This study explores what prompted the adoption of self-protective behaviors in response to COVID-19 among women living in rural areas of western China. Methods The study sample consisted of 1,524 women from 116 townships across 10 counties in rural western China. We collected data in May and August 2020 on women's socioeconomic characteristics, exposure to COVID-19-related information, psychological response to COVID-19, and adoption of self-protective behaviors. Structural equation modeling (SEM) analyses were conducted to analyze the relations among the variables. Results During the lockdown, 1,221 (80.12%) of the 1,524 women in the study sample reported wearing a mask every time when they went outside and 1,021 (66.99%) reported handwashing with soap every time after they came home. Perceived efficacy had the strongest association with self-protective behaviors (β = 0.38; p < 0.001). Receiving public health guidance (β = 0.18; p < 0.001) was indirectly associated with more self-protective behaviors via greater perceived efficacy. Higher socioeconomic status was also directly associated with increased adoption of self-protective behaviors (β = 0.24; p < 0.001). Other variables, such as receiving surveillance and risk information, communication channels, perceived risks, and fear, were indirectly associated with the adoption of self-protective behaviors with smaller effect sizes (all β were lower than 0.10). Conclusions Not all women were able to adopt self-protective behaviors, such as mask-wearing and handwashing, during the COVID-19 pandemic in western China. To further encourage behavioral changes in response to public health crises, the government should develop clear and actionable guidelines and adopt targeted health communication strategies to reach the most disadvantaged groups of society. These findings may inform tailored responses to COVID-19 in other low- and middle-income countries.
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Affiliation(s)
- Ruixue Ye
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Yuju Wu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Chang Sun
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Qingzhi Wang
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Yuping Mao
- Department of Communication Studies, College of Liberal Arts, California State University Long Beach, Long Beach, CA, United States
| | - Wei Chang
- Harvard Chan School of Public Health, Boston, MA, United States
| | - Huan Zhou
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Chengdu, China
- *Correspondence: Huan Zhou
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21
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Feng XL, Wang Y, Chen Z, Carine R. Factors affecting the frequency and contents of routine antenatal care in remote rural China in 2009-2016: an observational study. BJOG 2021; 129:1062-1072. [PMID: 34860444 DOI: 10.1111/1471-0528.17037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 08/27/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We assessed factors associated with frequency and contents of antenatal care (ANC) in remote rural China, including province of residence and individual level factors. DESIGN Survey-based cross-sectional study. SETTING Remote rural China, Five provinces- Jilin, Shaanxi, Hunan, Guizhou, and Ningxia. SAMPLE 3,918 women with a live birth in 2009-2016. METHODS Poisson regression. MAIN OUTCOME MEASURES ANC frequency- 5+ visits starting in the first trimester. ANC contents- co-coverage of six care components, and overuse of ultrasound. MAIN RESULTS Three quarters (72.9%) of women had 5+ visits starting in the first trimester, 68.8% received all six care components, and 94.5% had 3+ ultrasounds. Only 30.9% women sought ANC from township hospitals, paying between $3.8 and 25.8 per-visit. ANC frequency and contents were associated with women's socio-economic characteristics, but provincial effects were much stronger, even after adjusting for individual factors. Women living in Guizhou and Ningxia, the two poorest provinces with high proportions of ethnic minorities, were particularly underserved. Compared to women in Shaanxi, women in Guizhou were 33% (adjusted RR 0.67, 95%CI 0.61-0.74) less likely to receive 5+ ANC starting in the first trimester; women in Ningxia were 17% less likely (adjusted RR 0.83, 95% CI 0.76-0.90) to receive all six care components. CONCLUSION The province of residence was a stronger predictor of ANC frequency and contents than women's individual characteristics in China, suggesting that strengthening the decentralised system of financing and organisation of ANC at province level is crucial to achieving success. Future efforts are warranted to engage sub-regional administrations.
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Affiliation(s)
- Xing Lin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, UK
| | - Ying Wang
- Department of Health Policy and Management, School of Public Health, Peking University, UK
| | - Zhengchao Chen
- Department of Health Policy and Management, School of Public Health, Peking University, UK
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22
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Wang Z, Yang G, Guo Y. Harnessing the opportunity to achieve health equity in China. Lancet Public Health 2021; 6:e867-e868. [DOI: 10.1016/s2468-2667(21)00211-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
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23
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Sserwanja Q, Mukunya D, Musaba MW, Kawuki J, Kitutu FE. Factors associated with health facility utilization during childbirth among 15 to 49-year-old women in Uganda: evidence from the Uganda demographic health survey 2016. BMC Health Serv Res 2021; 21:1160. [PMID: 34702251 PMCID: PMC8549198 DOI: 10.1186/s12913-021-07179-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 10/15/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Almost all maternal deaths and related morbidities occur in low-income countries. Childbirth supervised by a skilled provider in a health facility is a key intervention to prevent maternal and perinatal morbidity and mortality. Our study aimed to establish the factors associated with health facility utilization during childbirth in Uganda. METHODS We used the Uganda Demographic and Health Survey 2016 data of 10,152 women aged 15 to 49 years. The study focused on their most recent live birth in 5 years preceding the survey. We applied multistage stratified sampling to select study participants and we conducted multivariable logistic regression to establish the factors associated with health facility utilization during childbirth, using SPSS (version 25). RESULTS The proportion of women who gave birth at a health facility was 76.6% (7780/10,152: (95% confidence interval, CI, 75.8-77.5). The odds of women aged 15-19 years giving birth at health facilities were twice as those of women aged 40 to 49 years (adjusted odds ratio, AOR = 2.29; 95% CI: 1.71-3.07). Residing in urban areas and attending antenatal care (ANC) were associated with health facility use. The odds of women in the northern region of Uganda using health facilities were three times of those of women in the central region (AOR = 3.13; 95% CI: 2.15-4.56). Women with tertiary education (AOR = 4.96; 95% CI: 2.71-9.11) and those in the richest wealth quintile (AOR = 4.55; 95% CI: 3.27-6.32) had higher odds of using a health facility during child birth as compared to those with no education and those in the poorest wealth quintile, respectively. Muslims, Baganda, women exposed to mass media and having no problem with distance to health facility had higher odds of utilizing health facilities during childbirth as compared to Catholic, non Baganda, women not exposed to mass media and those having challenges with distance to access healthcare. CONCLUSION Health facility utilization during childbirth was high and it was associated with decreasing age, increasing level of education and wealth index, urban residence, Northern region of Uganda, ANC attendance, exposure to mass media, tribe, religion and distance to the nearby health facility. We recommend that interventions to promote health facility childbirths in Uganda target the poor, less educated, and older women especially those residing in rural areas with less exposure to mass media.
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Affiliation(s)
| | - David Mukunya
- Department of Public Health, Busitema University, Tororo, Uganda.,Sanyu Africa Research Institute, Mbale, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynecology, Busitema University, Tororo, Uganda.,Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda
| | - Joseph Kawuki
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Freddy Eric Kitutu
- Pharmacy Department, Makerere University School of Health Sciences, Kampala, Uganda. .,Sustainable Pharmaceutical Systems (SPS) Unit, Makerere University School of Health Sciences, PO Box 7072, Kampala, Uganda.
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24
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Qiao J, Wang Y, Li X, Jiang F, Zhang Y, Ma J, Song Y, Ma J, Fu W, Pang R, Zhu Z, Zhang J, Qian X, Wang L, Wu J, Chang HM, Leung PCK, Mao M, Ma D, Guo Y, Qiu J, Liu L, Wang H, Norman RJ, Lawn J, Black RE, Ronsmans C, Patton G, Zhu J, Song L, Hesketh T. A Lancet Commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China. Lancet 2021; 397:2497-2536. [PMID: 34043953 DOI: 10.1016/s0140-6736(20)32708-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Jie Qiao
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Ministry of Education Key Laboratory of Assisted Reproduction, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
| | - Yuanyuan Wang
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Ministry of Education Key Laboratory of Assisted Reproduction, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance of China, National Center for Birth Defect Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Fan Jiang
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yunting Zhang
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Ma
- Institute of Child and Adolescent Health, Key Laboratory of Reproductive Health, School of Public Health, Peking University, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, Key Laboratory of Reproductive Health, School of Public Health, Peking University, Beijing, China
| | - Jing Ma
- China Program for Health Innovation & Transformation, Department of Population Medicine, Harvard University, Boston, MA, USA
| | - Wei Fu
- China National Health and Development Research Centre, Beijing, China
| | - Ruyan Pang
- China Maternal and Child Health Association, Beijing, China
| | - Zhaofang Zhu
- China National Health and Development Research Centre, Beijing, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xu Qian
- School of Public Health & Global Health Institute, Fudan University, Shanghai, China
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiuling Wu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hsun-Ming Chang
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Ministry of Education Key Laboratory of Assisted Reproduction, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Peter C K Leung
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Ministry of Education Key Laboratory of Assisted Reproduction, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Meng Mao
- National Office for Maternal and Child Health Surveillance of China, National Center for Birth Defect Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Duan Ma
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University, Shanghai, China
| | - Yan Guo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Jie Qiu
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Li Liu
- Department of Population Family and Reproductive Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Robert J Norman
- Robinson Research Institute, Fertility SA, University of Adelaide, Adelaide, SA, Australia
| | - Joy Lawn
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert E Black
- Department of Population Family and Reproductive Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - George Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, National Center for Birth Defect Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
| | - Li Song
- Department of Women and Children Health, National Health Commission of the People's Republic of China, Bejing, China.
| | - Therese Hesketh
- Center for Global Health, School of Medicine, Zhejiang University, Hangzhou, China; and Institute for Global Health, University College London, London, UK
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25
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Timeliness, completeness, and timeliness-and-completeness of serial routine vaccinations among rural children in Southwest China: A multi-stage stratified cluster sampling survey. Vaccine 2021; 39:3236-3249. [PMID: 33966907 DOI: 10.1016/j.vaccine.2021.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/31/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Vaccination coverage is widely used as metric of vaccination programme performance. However, VPDs outbreaks were reported in areas with high vaccination coverage. Timeliness and completeness have been considered more important assessment indicators of routine vaccination than overall vaccination coverage, but little is known in rural China. This study aimed to assess the timeliness and completeness of serial routine vaccinations among children in rural Southwest China. METHODS A multi-stage stratified cluster survey was conducted among 1062 children aged 18-48 months in rural Guangxi. Vaccination status was obtained from child's vaccination certificate. We calculated timely vaccination coverage, complete vaccination coverage, timely-and-complete vaccination coverage and 95% CI for routine vaccination through weighted estimation analysis. Weighted Kaplan-Meier analyses were applied to estimate the median delay periods for each dose of serial routine vaccines, including one-dose BCG, three-dose HepB, three-dose OPV, four-dose DTP, two-dose MCV, two-dose JEV and two-dose MPV-A. Complete coverage, and timely-and-complete coverage for combined 5-vaccine series were calculated. RESULTS For each dose of routine vaccines, overall vaccination coverages were over 90%, but timely vaccination coverage ranged from the lowest of 44.4% for JEV1 to the highest of 92.5% for MPV-A1. For multi-dose routine vaccines, complete vaccination coverages varied from the lowest of 92.9% for MCV to the highest of 100% for HepB, and timely-and-complete vaccination coverages were lower than 80%, ranging from the lowest of 30% for JEV to the highest of 77.2% for MPV-A. For combined 5-vaccine series, complete coverage was 77%, while timely-and-complete coverage was 12.1%. MPV-A1 had the longest median delay of 176 days, but BCG and HepB1 had the shortest of 1 day. CONCLUSIONS The overall coverages of serial routine vaccinations were high, but the timeliness and completeness were poor. Relevant agencies of vaccination service should address timeliness-and-completeness into the assessment indicators of routine vaccination service quality.
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Feng BY, Peng Y, Liang J, Wu L, Jiang QJ, Liu S, Zeng XY, Huang DP, Qiu XQ, Li H. Risk Factors for Adverse Pregnancy Outcomes among Zhuang Ethnic Pregnant Women: A Cohort Study in Guangxi, China. Curr Med Sci 2021; 41:219-227. [PMID: 33877538 DOI: 10.1007/s11596-021-2339-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
Risk factors for adverse pregnancy outcomes among Zhuang ethnic pregnant women are unclear. This study analyzed the incidence and risk factors related to preterm birth (PB), low birth weight (LBW) and macrosomia in Zhuang population. We conducted a prospective cohort study of 9965 Zhuang pregnancy women in Guangxi, China. Information on mothers and newborns was obtained by using questionnaires and referring to medical records. Multivariate logistic regression analyses were used to evaluate the association between related factors and adverse pregnancy outcomes. Our results showed that the incidence of PB, LBW and macrosomia in Zhuang people was 5.55%, 5.64% and 2.19%, respectively. Maternal age ≥36 years (OR=2.22, 95% CI: 1.51-3.27) was related to a higher incidence of PB. Those with pre-pregnancy body mass index (BMI) <18.5 kg/m2 (OR=1.91, 95% CI: 1.45-2.51), and had a female fetus (OR=1.74, 95% CI: 1.36-2.23) were more likely to have LBW infants. Maternal age between 31 and 35 years (OR=1.76, 95% CI: 1.03-2.99) and pre-pregnancy overweight or obesity (OR=1.79, 95% CI: 1.15-2.80) were associated with a higher risk of macrosomia. The protective factors of macrosomia were maternal pre-pregnancy BMI <18.5 kg/m2 (OR=0.30, 95% CI: 0.15-0.60) and female fetus (OR=0.41, 95% CI: 0.28-0.59). Our study provided a reference for maternal and childcare administration among Zhuang population.
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Affiliation(s)
- Bao-Ying Feng
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Yang Peng
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Jun Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Li Wu
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Qun-Jiao Jiang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Shun Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Xiao-Yun Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Dong-Ping Huang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Xiao-Qiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Han Li
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, China.
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Gipson JD, Moucheraud C, Gyaltsen K, Tsering L, Nobari TZ, Gyal L. Nomadic Tibetan women's reproductive health: findings from cross-sectional surveys with a hard-to-reach population. Reprod Health 2021; 18:63. [PMID: 33731153 PMCID: PMC7972222 DOI: 10.1186/s12978-020-01052-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022] Open
Abstract
Background Western China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas. Methods We report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298). Results On average, sexual debut preceded marriage among study participants, with fertility near replacement levels (2.7 and 2.1 in 2014 and 2016, respectively). Contraceptive use was common, and dominated by use of IUDs and female sterilization. Although over three-quarters (76%) of 2016 survey participants reported ever having at least one sexually transmitted infection (STI) symptom, there was low awareness of STIs (59%) and action to prevent STIs (21%). Younger women (< 40) were more likely to report having had had an STI symptom, as compared to older women (84% versus 71%; p < 0.05). Conclusions We demonstrate feasibility of collecting data with this hard-to-reach population. Reporting of STI symptoms warrants further investigation to identify and address health conditions in this population of Tibetan nomadic women, especially amidst broader social and contextual changes that may affect the Tibetan population. Western China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas. We report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298). On average, sexual debut preceded marriage among study participants, with fertility near replacement levels (2.7 and 2.1 in 2014 and 2016, respectively). Contraceptive use was common, and dominated by use of IUDs and female sterilization. Although over three-quarters (76%) of 2016 survey participants reported ever having at least one sexually transmitted infection (STI) symptom, there was low awareness of STIs (59%) and action to prevent STIs (21%). Younger women (less than 40 years old) were more likely to report having had had an STI symptom, as compared to women over 40 years old (84% versus 71%; p < 0.05). We demonstrate feasibility of collecting data with this hard-to-reach population. Reporting of STI symptoms warrants further investigation to identify and address health conditions in this population of Tibetan nomadic women, especially amidst broader social and contextual changes that may affect the Tibetan population.
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Affiliation(s)
- Jessica D Gipson
- Fielding School of Public Health, University of California, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA.
| | - Corrina Moucheraud
- Fielding School of Public Health, University of California, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA
| | - Kunchok Gyaltsen
- Tso-Ngon (Qinghai) University Tibetan Medical College, No. 251 Ningda Road, Xining, 810000, Qinghai, People's Republic of China
| | - Lumo Tsering
- Tso-Ngon (Qinghai) University Tibetan Medical College, No. 251 Ningda Road, Xining, 810000, Qinghai, People's Republic of China
| | - Tabashir Z Nobari
- Department of Public Health, California State University, 800 North State College, Boulevard, KHS 131, Fullerton, USA
| | - Lhusham Gyal
- Tso-Ngon (Qinghai) University Tibetan Medical College, No. 251 Ningda Road, Xining, 810000, Qinghai, People's Republic of China
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Li F, Qin J, Zhang S, Chen L. Prevalence of hypertensive disorders in pregnancy in China: A systematic review and meta-analysis. Pregnancy Hypertens 2021; 24:13-21. [PMID: 33626437 DOI: 10.1016/j.preghy.2021.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Hypertensive disorders in pregnancy (HDP) are associated with various maternal and fetal adverse outcomes and become an increasingly significant threat to Chinese pregnant women. Yet, the prevalence of HDP in China is not clear. We conducted this meta-analysis to estimate the prevalence of HDP and specific subtypes in China. We searched PubMed, Embase, Web of Science, CNKI, Wangfang, and CMB for studies on prevalence of HDP and specific subtypes, published from 1990 to Jan 21, 2020, without language restrictions. We included all studies reported the prevalence of HDP and specific subtypes in Chinese pregnant women. We excluded qualitative studies, case reports, reviews, conference presentations, and studies only provided abstracts. We using a standard self-developed form to extract information from eligible studies. We did meta-analyses by random-effect models and estimated the pooled prevalence of HDP and specific subtypes. In order to explore potential sources of heterogeneity and subgroup effects, we did and meta-regression and subgroup analyses by pre-specified covariates. This study is registered with PROSPERO, number CRD42020166001. We initially identified 4179 records, of which 92 studies with 1,377,448 participants were eligible in the final systematic review and meta-analyses. The pooled prevalence (95% CI) of HDP, gestational hypertension, preeclampsia, mild preeclampsia, severe preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia were 7.30% (6.60%-8.00%), 3.30% (2.90%-3.70%), 4.50% (4.00%-5.00%), 2.00% (1.70%-2.30%), 2.60% (2.10%-3.00%), 0.11% (0.08%-0.15%), 0.60% (0.30%-0.90%), and 0.60% (0.40%-0.80%), respectively. No publication bias was identified, although heterogeneity was high (I2 statistics: 92.0%-99.3%). High prevalence of HDP and the subtypes frequently reported in Western and Northern China. Pregnant women who were aged 35 years and above had high prevalence of HDP and subtypes; women who were overweight or obese had high prevalence of HDP, gestational hypertension and preeclampsia. The prevalence of HDP and the subtypes vary in different areas in China. Given to increasingly prevalent of the risk factors, such as overweight, obesity, and advance maternal age, strategies to prevent and manage HDP need to be improved, especially for women living in Western and Northern China.
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Affiliation(s)
- Fang Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China.
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Zhao Q, Chen J, Li F, Li A, Li Q. An integrated model for evaluation of maternal health care in China. PLoS One 2021; 16:e0245300. [PMID: 33507961 PMCID: PMC7842919 DOI: 10.1371/journal.pone.0245300] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/25/2020] [Indexed: 11/18/2022] Open
Abstract
In recent years, in the context of China’s continuous medical and health reforms, the health status of Chinese women and children has been significantly improved through the continuous efforts of staff at all levels of maternal and child health care institutions. Many indicators in maternal health care have improved significantly, but the speed and magnitude of changes have varied. The purpose of this study is to evaluate the dynamic changes in China’s maternal health status from 2004 to 2018, in order to determine whether China’s medical and health reform measures in recent years have improved maternal health. A total of 6 evaluation indicators from the data of China Health Statistics Yearbook 2019 were selected. Then, based on the multi-criteria decision-making (MCDA) methodology, the entropy weighted technique for order preference by similarity to an ideal solution (TOPSIS), entropy weighted rank-sum ratio (RSR) method and the fuzzy comprehensive evaluation were employed in this study. In addition, sensitivity analysis was engaged to validate the stability and accuracy of the achieved results. The study results shows the ranking values of various methods were not exactly the same, but the overall trend was consistent. Overall, the maternal health care in China improved from 2004 to 2018 year by year, of which the top four were ranked from 2015 to 2018, and relatively poor from 2004 to 2006. This means that the policies and measures implemented in China’s medical and health reform in the past few decades have effectively promoted China’s maternal health care, and this will also provide a theoretical basis for future decisions to promote maternal health care.
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Affiliation(s)
- Qianlong Zhao
- Child and Adolescent Physical Examination and Health Management Center, Lanzhou University Second Hospital, Lanzhou, China
- * E-mail:
| | - Junyi Chen
- Department of Clinical Blood Transfusion, Lanzhou University Second Hospital, Lanzhou, China
| | - Fulun Li
- Department of Child Psychology and Behavior, Lanzhou University Second Hospital, Lanzhou, China
| | - Aishu Li
- Child and Adolescent Physical Examination and Health Management Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Qian Li
- Child and Adolescent Physical Examination and Health Management Center, Lanzhou University Second Hospital, Lanzhou, China
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Wu Y, Pan J, Han D, Li L, Wu Y, Liao R, Liu Z, You D, Chen P, Wu Y. Ethnic disparities in stillbirth risk in Yunnan, China: a prospective cohort study, 2010-2018. BMC Public Health 2021; 21:136. [PMID: 33446168 PMCID: PMC7807874 DOI: 10.1186/s12889-020-10102-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Racial and ethnic disparities in stillbirth risk had been documented in most western countries, but it remains unknown in China. This study was to determine whether exist ethnic disparities in stillbirth risk in mainland China. Methods Pregnancy outcomes and ethnicity data were obtained from the National Free Preconception Health Examination Project (NEPHEP), a nationwide prospective population-based cohort study conducted in Yunnan China from 2010-2018. The Han majority and other four main minorities including Yi, Dai, Miao, Hani were investigated in the analysis. The stillbirth hazards were estimated by life-table analysis. The excess stillbirth risk (ESR) was computed for Chinese minorities using multivariable logistic regression. Results Compared with other four minorities, women in Han majority were more likely to more educated, less multiparous, and less occupied in agriculture. The pattern of stillbirth hazard of Dai women across different gestation intervals were found to be different from other ethnic groups, especially in 20-23 weeks with 3.2 times higher than Han women. The ESR of the Dai, Hani, Miao, and Yi were 45.05, 18.70, -4.17 and 12.28%, respectively. Adjusted for maternal age, education, birth order and other general risk factors, the ethnic disparity still persisted between Dai women and Han women. Adjusted for preterm birth further (gestation age <37 weeks) can reduce 16.91% ESR of Dai women and made the disparity insignificant. Maternal diseases and congenital anomalies explained little for ethnic disparities. Conclusions We identified the ethnic disparity in stillbirth risk between Dai women and Han women. General risk factors including sociodemographic factors and maternal diseases explained little. Considerable ethnic disparities can be attributed to preterm birth. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10102-y.
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Affiliation(s)
- Yanpeng Wu
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Jianhong Pan
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Dong Han
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510515, China
| | - Lixin Li
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Yanfei Wu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Rui Liao
- School of Public Health, Kunming Medical University, NHC Key Laboratory of Periconception Health Birth in Western China, Kunming, 650500, China
| | - Zijie Liu
- The First Affiliated Hospital of Kunming Medical University, Kunming, 650500, China
| | - Dingyun You
- School of Public Health, Kunming Medical University, NHC Key Laboratory of Periconception Health Birth in Western China, Kunming, 650500, China.
| | - Pingyan Chen
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
| | - Ying Wu
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
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Lai F, Pei L, Yue S, Cao X, Xiao H, Li Y, Li J. Translation and validation of the Chinese version of medical maximizer-minimizer scale: a cross-sectional study. BMJ Open 2021; 11:e042432. [PMID: 33408206 PMCID: PMC7789444 DOI: 10.1136/bmjopen-2020-042432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Medical overutilisation and underutilisation affect optimal healthcare. The Medical Maximizer-Minimizer Scale (MMS) was developed to assess individual medical maximising and minimising tendencies. Despite significant improvement in the healthcare system over the past four decades, no psychometric scales to examine treatment maximising and minimising preferences are available in China. This study aimed to translate the MMS into Chinese and examine its reliability and validity in a Chinese population. DESIGN This cross-sectional study was conducted in December 2019 through an online survey panel. METHODS The MMS was translated into a Chinese version (CN-MMS) using a forward-backward translation procedure. Next, a random online survey of the general population in China was conducted. Exploratory factor analysis (EFA) and confirmatory factor analysis were performed to examine the underlying factor structure of the CN-MMS. The internal consistency reliability of the scale was determined using Cronbach's α coefficient and corrected item-total correlation. A multivariate linear regression analysis was used to examine associations between medical maximising and minimising preferences and demographic variables in the Chinese population. RESULTS This study included 984 participants aged 18-80 years. The CN-MMS retained 10 items, and the EFA supported a two-factor structure. The model fit for this two-factor structure of the CN-MMS was acceptable with χ2/df=3.7, comparative fit index=0.958, goodness-of-fit index=0.951, Tucker-Lewis Index=0.944 and root mean square error of approximation=0.074. The scale had a Cronbach's α coefficient of 0.864, corrected item-total correlation of 0.451-0.667, and test-retest reliability of 0.815. Significant predictors of CN-MMS total score were nationality and household monthly income. CONCLUSIONS The CN-MMS showed satisfactory psychometric properties. Therefore, it can be used to investigate the individual medical maximising and minimising tendencies among the general Chinese population.
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Affiliation(s)
- Fenghua Lai
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ling Pei
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shufan Yue
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaopei Cao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jin Li
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Yan C, Tadadej C, Chamroonsawasdi K, Chansatitporn N, Sung JFC. Ethnic Disparities in Utilization of Maternal and Child Health Services in Rural Southwest China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8610. [PMID: 33228187 PMCID: PMC7699543 DOI: 10.3390/ijerph17228610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies in China on ethnic disparities in access to health care in remote and rural population remain insufficient. This study aimed to assess the disparities in utilization of maternal and child health (MCH) services, including antenatal care (ANC), hospital birth, child growth monitoring, and immunization compliance between Han and ethnic minority women in Yunnan Province. METHODS A multi-stage sampling scheme was used to randomly recruit women from 40 townships in 14 remote prefectures of extremely remote areas in Yunnan. From birth records, we identified and recruited 303 Han women and 222 ethnic minority women who had given birth to a child within 3 years for an interview. RESULTS Overall, 96% of women used the ANC checkups and more than 95% had infants born in hospitals. However, the proportion of women compliant with early ANC visits (having antenatal care in the first trimester) was 22.5% lower in minority women than in Han women (61.3% vs. 83.8%, p < 0.001) with an adjusted odds ratio (aOR) of 2.04 (95% confidence interval (CI) of 1.13-3.66) for the minority group. The proportion of children under one year old with immunizations completed in a timely manner was also lower in minority families than in Han families (80.2% vs. 86.8%, p < 0.05) with an aOR of 1.99 (95% CI = 1.16-3.40). CONCLUSIONS Ethnic disparities remain in utilization of early ANC visits and timely immunization completion for newborns. Ethnic minority women tended to lag behind for both. Further intervention should focus on assisting minority women living in extremely rural areas to comply with the MCH policy. Culturally-sensitive policies and skills are needed, and priority should be given to improve utilization of early ANC and timely immunization completion.
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Affiliation(s)
- Chaofang Yan
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Charuwan Tadadej
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Kanittha Chamroonsawasdi
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Natkamol Chansatitporn
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - John FC Sung
- Institute of Health and Development Studies, School of Public Health, Kunming Medical University, Kunming 650500, China;
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Wang X, Lin L, Xuan Z, Xu J, Wan Y, Zhou X. Risk communication on behavioral responses during COVID-19 among general population in China: A rapid national study. J Infect 2020; 81:911-922. [PMID: 33144190 PMCID: PMC7605843 DOI: 10.1016/j.jinf.2020.10.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 12/05/2022]
Abstract
Exposed to risk communication messages were positively associated with engaging in preventive behaviors. Believing in misinformation were negatively associated with wearing masks. Inadequate supplies of personal protection materials were negatively associated with outdoor hygiene behaviors.
Objectives To describe the risk perception and behavioral responses among Chinese adults and to assess the associations of risk communication, risk perception, and behavioral adherence during the COVID-19 epidemic. Methods A national cross-sectional survey was conducted in 31 provinces in China with a total number of 5039 effective questionnaires collected. The questionnaire included sociodemographic characteristics, COVID-19 risk communication factors, mask and soap supply, and engagement in preventive behaviors during the epidemic. Multivariable Logistic regression was used. Results An overwhelmingly high prevalence of Chinese people was exposed to COVID-19 related risk communication messages (86.5%) and an overwhelming majority of respondents reported engagement in preventive behaviors (88.3%). Exposed to risk communication messages were positively associated with engaging in preventive behaviors, whereas, believing in misinformation were negatively associated with wearing masks when in public (p < 0.01). Respondents encountered an inadequate supplies of personal protection materials were negatively associated with their outdoor hygiene behaviors. People who were male, in an older age group, minorities, with lower education, with lower income, and lived in rural area showed lower exposures to risk communication messages. Conclusions Future risk communication practices are recommended to better monitor population risk perceptions and pay attention to socio-demographically disadvantaged people.
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Affiliation(s)
- Xiaomin Wang
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7TH, UK.
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Jiayao Xu
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
| | - Yuling Wan
- School of Public Health, Dalian Medical University, 9 West Section of Lvshun South Road, Dalian 116044, China
| | - Xudong Zhou
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
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Tao Z, Cheng Y, Du S, Feng L, Wang S. Accessibility to delivery care in Hubei Province, China. Soc Sci Med 2020; 260:113186. [PMID: 32683160 DOI: 10.1016/j.socscimed.2020.113186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/11/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
Accessibility to delivery care is crucial for improving maternal health, which is an important policy goal to ensure healthy lives and promote well-being in China and worldwide, especially with the change of the family planning policy in China in 2016. This study develops a set of methods to project the population of women of child-bearing age and birth population and assess the accessibility to delivery care services in Hubei Province. The Cohort-Component projection method with various scenarios was applied to project the population of women of children-bearing age in 2030. A Gravity-based Variable Two-Step Floating Catchment Area (GV2SFCA) method is developed, which takes into account the heterogeneous catchment areas and distance decay effects for different regions and various levels of delivery care services. The parameters are calibrated by using medical records with patients' addresses. The traditional Supply-Demand Ratio method is also applied. The results demonstrate an overall decreasing trend of birth population in Hubei in all scenarios, but with significant disparities across regions. In 2016, 28% of districts fail to reach the policy goal with 17 beds per thousand births. In 2030, accessibility to delivery care is projected to increase in 98% of districts, while there are still 22% of districts that fail to reach the policy goal. The accessibility scores are further combined with the densities of birth population to identify shortage areas of delivery care. 7% and 6% of districts are classified as Major Shortage Areas in 2016 and 2030, respectively. The findings shed lights on the distributions and future changes of accessibility to and shortage areas of delivery care in Hubei, which can provide evidence-based recommendations for planning and policymaking. It also provides innovative methods for more accurately assessing accessibility to delivery care.
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Affiliation(s)
- Zhuolin Tao
- Faculty of Geographical Science, Beijing Normal University; No.19, XinJieKouWai St., Haidian District, Beijing, 100875, China.
| | - Yang Cheng
- Faculty of Geographical Science, Beijing Normal University; No.19, XinJieKouWai St., Haidian District, Beijing, 100875, China.
| | - Shishuai Du
- Faculty of Geographical Science, Beijing Normal University; No.19, XinJieKouWai St., Haidian District, Beijing, 100875, China; Shandong Experimental High School, Jinan, Shandong, 250001, China.
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China.
| | - Shaoshuai Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China.
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Association between ethnicity and under-5 mortality: analysis of data from demographic surveys from 36 low-income and middle-income countries. LANCET GLOBAL HEALTH 2020; 8:e352-e361. [PMID: 32087172 PMCID: PMC7034191 DOI: 10.1016/s2214-109x(20)30025-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/02/2019] [Accepted: 01/10/2020] [Indexed: 01/04/2023]
Abstract
Background The UN Sustainable Development Goals (SDGs) call for stratification of social indicators by ethnic groups; however, no recent multicountry analyses on ethnicity and child survival have been done in low-income and middle-income countries (LMICs). Methods We used data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys collected between 2010 and 2016, from LMICs that provided birth histories and information on ethnicity or a proxy variable. We calculated neonatal (age 0–27 days), post-neonatal (age 28–364 days), child (age 1–4 years), and under-5 mortality rates (U5MRs) for each ethnic group within each country. We assessed differences in mortality between ethnic groups using a likelihood ratio test, Theil's index, and between-group variance. We used multivariable analyses of U5MR by ethnicity to adjust for household wealth, maternal education, and urban–rural residence. Findings We included data from 36 LMICs, which included 2 812 381 livebirths among 415 ethnic groups. In 25 countries, significant differences in U5MR by ethnic group were identified (all p<0·05 likelihood ratio test). In these countries, the median mortality ratio between the ethnic groups with the highest and lowest U5MRs was 3·3 (IQR 2·1–5·2; range 1·5–8·5), whereas among the remaining 11 countries, the median U5MR ratio was 1·9 (IQR 1·7–2·5; range 1·4–10·0). Ethnic gaps were wider for child mortality than for neonatal or post-neonatal mortality. In nearly all countries, adjustment for wealth, education, and place of residence did not affect ethnic gaps in mortality, with the exception of Guatemala, India, Laos, and Nigeria. The largest ethnic group did not have the lowest U5MR in any of the countries studied. Interpretation Significant ethnic disparities in child survival were identified in more than two-thirds of the countries studied. Regular analyses of ethnic disparities are essential for monitoring trends, targeting, and assessing the impact of health interventions. Such analyses will contribute to the effort towards leaving no one behind, which is at the centre of the SDGs. Funding Bill & Melinda Gates Foundation, UNICEF, Wellcome Trust, Associação Brasileira de Saúde Coletiva.
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Zhou H, Wu Y, Liu C, Sun C, Shi Y, Zhang L, Medina A, Rozelle S. Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China. BMC Public Health 2020; 20:870. [PMID: 32503554 PMCID: PMC7275386 DOI: 10.1186/s12889-020-08996-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/27/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China. METHODS We designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT). RESULTS Overall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes. CONCLUSIONS The CCT program generated modest improvements in the uptake of MCH services and mothers' knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities.
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Affiliation(s)
- Huan Zhou
- West China School of Public Health and West China Forth Hospital, Sichuan University, Chengdu, China
| | - Yuju Wu
- West China School of Public Health and West China Forth Hospital, Sichuan University, Chengdu, China
| | - Chengfang Liu
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing, China.
| | - Chang Sun
- West China School of Public Health and West China Forth Hospital, Sichuan University, Chengdu, China
| | - Yaojiang Shi
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Linxiu Zhang
- Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resource Research, Chinese Academy of Sciences, Beijing, China
| | - Alexis Medina
- Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, California, USA
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, California, USA
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The role of education in maternal depressive symptoms among different ethnic groups: A cross-sectional study in rural western China. J Affect Disord 2020; 262:359-365. [PMID: 31735406 DOI: 10.1016/j.jad.2019.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/03/2019] [Accepted: 11/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the maternal depressive symptoms (MDS) rates in different ethnic groups, and to explore possible reasons especially the role of education for its ethnic differences. METHODS A community-based cross-sectional survey was conducted in 20 rural counties of 8 provinces in western China. The possible influencing factors of MDS were collected. The Edinburgh Postpartum Depression Scale (EPDS) was used to assess MDS. Univariate and multivariate logistic regression models were used to analyze the risk factors of MDS. Two multivariate logistic regression models that separately containing and not containing the factor of educational level were used to explore the role of education in the ethnic differences of MDS. RESULTS A total of 3,163 mothers were included in the analysis, and the MDS rate was 15.6%. In multivariate analysis, educational level of primary school and below (adjOR1: 1.47, 95%CI: 1.07-2.03), delivery at home (adjOR1: 1.66, 95%CI: 1.11-2.47) and diarrhea of youngest child in the past two weeks (adjOR1: 1.31, 95%CI: 1.03-1.67) remained as independent predictors of MDS after adjusting all the factors significant in univariate analysis. If educational level was not adjusted in above multivariate model, women from Yi ethnic group (adjOR2: 1.39, 95%CI: 1.03-1.89) would additionally become significant. LIMITATIONS EPDS is a screening tool and some possible risk factors for MDS were not included. CONCLUSION The ethnic differences in MDS were largely due to the ethnic differences in educational level. To reduce the high risk of MDS among Yi mothers, further popularizing nine-year compulsory education could be effective.
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Devkota B, Maskey J, Pandey AR, Karki D, Godwin P, Gartoulla P, Mehata S, Aryal KK. Determinants of home delivery in Nepal - A disaggregated analysis of marginalised and non-marginalised women from the 2016 Nepal Demographic and Health Survey. PLoS One 2020; 15:e0228440. [PMID: 31999784 PMCID: PMC6992204 DOI: 10.1371/journal.pone.0228440] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 01/16/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In Nepal, a substantial proportion of women still deliver their child at home. Disparities have been observed in utilisation of institutional delivery and skilled birth attendant services. We performed a disaggregated analysis among marginalised and non-marginalised women to identify if different factors are associated with home delivery among these groups. MATERIALS AND METHODS This study used data from the 2016 Nepal Demographic and Health Survey. It involves the analysis of 3,837 women who had experienced at least one live birth in the five years preceding the survey. Women were categorised as marginalised and non-marginalised based on ethnic group. Bivariate and multivariable logistic regression analysis were performed to identify factors associated with home delivery. RESULTS A higher proportion of marginalised women delivered at home (47%) than non-marginalised women (26%). Compared to non-marginalised women (35%), a larger proportion of marginalised women (64%) felt that it was not necessary to give birth at health facility. The multivariable analysis indicated an independent association of having no or basic education, belonging to middle, poorer and the poorest wealth quintile, residing in Province 2 and not having completed of four antenatal care visits per protocol with home delivery among both marginalised and non-marginalised women. Whereas residing in a rural area, residing in Province 7, and at a distance of >30 minutes to a health facility were factors independently associated with home delivery only among marginalised women. CONCLUSION We conclude that poor education, poor economic status, non-completion of four ANC visits and belonging to Province 2 particularly determined either group of women to deliver at home, whereas residing in rural areas, living far from health facility, and belonging to Province 7 determined marginalised women to deliver at home. Preventing mothers from delivering at home would thus require focusing on specific geographical areas besides considering wider socio-economic determinants.
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Affiliation(s)
- Bikash Devkota
- Policy Planning and Monitoring Division, Ministry of Health and Population, Kathmandu, Nepal
| | - Jasmine Maskey
- DFID Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
- * E-mail: ,
| | - Achyut Raj Pandey
- DFID Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Deepak Karki
- UK Department for International Development Nepal, Kathmandu, Nepal
| | - Peter Godwin
- DFID Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Pragya Gartoulla
- DFID Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Suresh Mehata
- Policy Planning and Monitoring Division, Ministry of Health and Population, Kathmandu, Nepal
| | - Krishna Kumar Aryal
- DFID Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
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Liu X, Wang F, Ding X, Chen Y, Wang L. Strengthening the maternal and child health system in remote and low-income areas through multilevel governmental collaboration: a case study from Nujiang Prefecture in China. Public Health 2020; 178:23-30. [PMID: 31605805 PMCID: PMC7045275 DOI: 10.1016/j.puhe.2019.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/02/2019] [Accepted: 08/22/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of the study was to assess the effects of the maternal and child health (MCH) system strengthening through multilevel governmental collaboration in Nujiang Prefecture, China. STUDY DESIGN A case study design was applied. METHODS Guided by the logical framework of the Nujiang MCH Comprehensive Intervention Project, national, provincial, and prefecture government sectors jointly implemented comprehensive health system strengthening (HSS) interventions in Nujiang Prefecture. In this case study, we conducted the end point surveys (November 2015 and January 2016) with 33 local MCH facilities. We also interviewed 35 MCH providers, government officials, leaders of MCH facilities, and project specialists. The thematic framework method was used to analyze the interview data, and descriptive analysis was performed to analyze the survey data. RESULTS The three levels of governmental collaboration contributed to increased government investment in the local MCH system and ensured the successful implementation of the project. Participatory training methods and appropriate HSS interventions tailored to the local context were crucial to improve MCH providers' knowledge and skills, with the proportion of qualified MCH providers increasing from 70% in 2011 to 96% in 2015. Owing to this increase in knowledge and the increase in needed equipment, more MCH hospitals could provide inpatient obstetric services, and more town health clinics were capable of providing basic MCH services. The development of a reimbursement policy tailored to the local context promoted in-hospital delivery. At the conclusion of the project, percentages of antenatal care, in-hospital delivery, and newborn screening increased by 20.71%, 18.12%, and 278.62%, respectively. Growth monitoring coverage for children younger than three years remained stable at around 90%. However, the MCH system was negatively impacted by the workforce shortage. Those shortages were caused by a lack of positive recruitment and retention and incentive policies. CONCLUSIONS Implementation of comprehensive HSS interventions through multilevel governmental collaboration improves the MCH system in remote and low-income areas.
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Affiliation(s)
- X Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - F Wang
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - X Ding
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Y Chen
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - L Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Chen J, Huang J, Ooi S, Lin L, Chen C, Liu Y, Yao S. Effect of flexible patterns of health education on enhancing the compliance of pregnant women from Tibet, China. Medicine (Baltimore) 2020; 99:e18447. [PMID: 31895773 PMCID: PMC6946550 DOI: 10.1097/md.0000000000018447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Prenatal examination is a pivotal measure to prevent high-risk pregnancy and to ensure the safety of both mother and infant. However, pregnant women in Linzhi Prefecture in the Tibet Autonomous Region (TAR) often cannot obtain regular prenatal examinations due to limited accessibility of healthcare facilities, shortage of medical staff, and lack of medical equipment. Health education is an important approach to solve this ever-growing issue of pregnant women in rural Tibet.To evaluate the efficacy of flexible methods of health education programs on improving compliance among pregnant women from Tibet, China.In May to November of 2018, a total of 168 pregnant women receiving prenatal examination in a tertiary referral hospital in Linzhi Prefecture were recruited and randomly assigned to a control (n = 85) and intervention group (n = 83). All pregnant women were followed up until delivery. The pregnant women in the control group received regular prenatal examination and health education programs. Other than receiving routine prenatal care, participants of the interventional group also voluntarily joined the WeChat Social Messaging platform. Online resources posted by the maternity schools provided convenience and flexibility for the pregnant woman. The number of prenatal examinations was statistically significant between the 2 groups. The effect of flexible patterns of health education programs on improving the compliance of pregnant women in Tibet was assessed.The number of prenatal examinations in the intervention group was 2.646 times, which was higher than that in the control group (P < .01). Multivariate analysis demonstrated that interventional measures and ethnicity were the influencing factors of the number of prenatal examinations for pregnant women in Linzhi after the adjustment of age, history of adverse pregnancy, education level, ethnicity, multiparity, gestational complications, and medical history. The number of prenatal examinations for the pregnant Tibetan women was 0.535 times lower compared with that of the pregnant Han women (95% CI: -0.089, 1.157, P = .091).Flexible forms of health education during the antenatal period can effectively increase the compliance of pregnant women in Tibet.
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Affiliation(s)
- Jiebing Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiaming Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shiyin Ooi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Lin
- Department of Obstetrics and Gynecology, Linzhi People's Hospital, Tibet, China
| | - Chun Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanwu Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Jin P, Gao Y, Liu L, Peng Z, Wu H. Maternal Health and Green Spaces in China: A Longitudinal Analysis of MMR Based on Spatial Panel Model. Healthcare (Basel) 2019; 7:E154. [PMID: 31810235 PMCID: PMC6956252 DOI: 10.3390/healthcare7040154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/14/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
The positive impact of green spaces on public health has attracted increasing attention, and maternal health has also been shown to be related to green spaces. However, there are different kinds of green space indicators that represent different mechanisms for mitigating maternal health, and few studies have investigated the different relevance amongst them with longitudinal data. This study explores the correlation between various green space indicators and maternal health using spatial panel models with provincial data from China from 2007 to 2016. The results indicate that all kinds of green spaces could decrease maternal mortality, wherein public green spaces may play a key role. In terms of spatial correlation, an increase in green space coverage in adjacent provinces may also result in a slight decline in maternal mortality. This paper provides valuable insight into the correlation between maternal health and green spaces.
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Affiliation(s)
- Ping Jin
- Department of Graphics and Digital Technology, School of Urban Design, Wuhan University, Wuhan 430072, China; (P.J.); (Y.G.); (Z.P.); (H.W.)
| | - Yushu Gao
- Department of Graphics and Digital Technology, School of Urban Design, Wuhan University, Wuhan 430072, China; (P.J.); (Y.G.); (Z.P.); (H.W.)
| | - Lingbo Liu
- Department of Urban Planning, School of Urban Design, Wuhan University, Wuhan 430072, China
| | - Zhenghong Peng
- Department of Graphics and Digital Technology, School of Urban Design, Wuhan University, Wuhan 430072, China; (P.J.); (Y.G.); (Z.P.); (H.W.)
| | - Hao Wu
- Department of Graphics and Digital Technology, School of Urban Design, Wuhan University, Wuhan 430072, China; (P.J.); (Y.G.); (Z.P.); (H.W.)
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Zhang J, Mou Y, Liao J, Xiong H, Duan Z, Huang Y, Ronsmans C. Uptake of maternal care and childhood immunization among ethnic minority and Han populations in Sichuan province: a study based on the 2003, 2008 and 2013 health service surveys. BMC Pregnancy Childbirth 2019; 19:250. [PMID: 31311501 PMCID: PMC6636102 DOI: 10.1186/s12884-019-2371-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/24/2019] [Indexed: 12/14/2022] Open
Abstract
Background China has made remarkable progress in maternal and child health (MCH) over the last thirty years, but socio-economic inequalities persist. Ethnicity has become an important determinant of poor MCH outcomes, but little rigorous analytical work has been done in this area. To understand the socio-economic factors that explain ethnic variation in uptake of MCH care, we report the findings from an analysis in Sichuan province. Methods We linked data from the 2003, 2008 and 2013 National Health Service Surveys in Sichuan Province. The ethnic disparities in uptake of maternal care (completing 5 antenatal visits, giving birth in hospital and receiving a caesarean section) and childhood immunization (Bacillus Calmette Guerin (BCG), three doses of diphtheria (DPT) and measles immunization) were examined by geographical (Han district/county vs. ethnic minority county) and individual-based (Han women/children vs. ethnic minority women/children) comparisons. We also examined variation by distance to township and county hospitals, women’s education, parity and age using weighted multilevel Poisson regressions with random intercept at district/county level. Results Ethnic inequalities in maternal care were marked, both at the geographical (district/county) and the individual level. The % of births in hospital was 90.7% among women in Han districts, compared to 83.3% among women living in Han counties (crude RR 0.93; 95% CI 0.75–1.15), 53.8% among Han women living in ethnic minority counties (crude RR 0.57; 95% CI 0.36–0.93), and 13.5% among ethnic minority women living in ethnic minority counties (crude RR 0.18; 95% CI 0.06–0.57). Adjusting the analysis for survey year, education, parity and distance to county level hospital weakened the association between geographical/individual ethnicity and uptake of maternity care, but associations remained remarkably strong. Coverage of childhood immunization was much higher than uptake of maternity care, and inequalities by ethnicity were much less pronounced. Conclusion Lessons can be learned from China’s successful immunization programme to further reduce inequalities in access to maternity care among ethnic minority populations in remote areas. Bringing the services closer to the women’s homes and strengthening health promotion from the township to the village level may encourage more women to seek antenatal care and give birth in hospital. Electronic supplementary material The online version of this article (10.1186/s12884-019-2371-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juying Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuchan Mou
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jiaqiang Liao
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huaying Xiong
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhanqi Duan
- Sichuan Health Information Center, Chengdu, Sichuan, China
| | - Yuan Huang
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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McKinn S, Linh DT, Foster K, McCaffery K. A qualitative analysis of factors that influence Vietnamese ethnic minority women to seek maternal health care. BMC Pregnancy Childbirth 2019; 19:243. [PMID: 31299937 PMCID: PMC6626358 DOI: 10.1186/s12884-019-2375-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 06/24/2019] [Indexed: 12/02/2022] Open
Abstract
Background Dien Bien Province in northwest Vietnam is predominantly populated with ethnic minority groups, who experience worse maternal and child health outcomes than the general population. Various factors are associated with maternal health care utilisation in Vietnam, including ethnic minority status, which is recognised as a key determinant of inequity in health outcomes. The aim of this study is to explore how and why ethnic minority women utilise maternal health services, and the factors that influence women and families’ decisions to access or not access facility-based care. Methods We used a qualitative approach, interviewing primary health care professionals (n = 22) and key informants (n = 2), and conducting focus groups with Thai and Hmong women (n = 42). A thematic analysis was performed. Results There were three main themes. 1. Prioritising treatment over prevention: women talked about accessing health services for health problems, such as unusual signs or symptoms during pregnancy, and often saw limited utility in accessing services when they felt well, or for a normal physiological event such as childbirth. Health professionals also saw their role as being mainly treatment-oriented, rather than prevention-focused. 2. Modernisation of traditional practices: health professionals and ethnic minority women discussed recent improvements in infrastructure, services, and economic circumstances that had increased access to health services. However, these improvements were less pronounced in Hmong communities, suggesting inequity. 3. Perceptions of quality influenced service utilisation: both health professionals and ethnic minority women perceived primary care facilities to be of lower quality compared to hospital, and some women made decisions about accessing services based on these perceptions, preferring to travel further and spend more to access higher quality services. Health professionals’ perceptions of low service quality appeared to influence their referral practices, with even uncomplicated cases referred to higher level services as a matter of course. Conclusions Primary health care facilities were technically available and accessible to ethnic minority women, however these services were likely to be underutilised if they were perceived to be of low quality. Some women had the means to access higher quality facilities, but others were limited to lower quality facilities, potentially reinforcing inequities in health outcomes. Electronic supplementary material The online version of this article (10.1186/s12884-019-2375-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shannon McKinn
- Sydney School of Public Health, Edward Ford Building (A27), The University of Sydney, Sydney, NSW, 2008, Australia
| | - Duong Thuy Linh
- Faculty of Nursing and Midwifery, Hanoi Medical University, 1 Ton That Tung, Dong Da, Hanoi, Vietnam
| | - Kirsty Foster
- Office for Global Health, Sydney Medical School, Edward Ford Building (A27), The University of Sydney, Sydney, NSW, 2008, Australia.,Kolling Institute at Northern Clinical School, Sydney Medical School, Royal North Shore Hospital, St Leonard, NSW, 2065, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, Edward Ford Building (A27), The University of Sydney, Sydney, NSW, 2008, Australia.
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Huang Y, Martinez-Alvarez M, Shallcross D, Pi L, Tian F, Pan J, Ronsmans C. Barriers to accessing maternal healthcare among ethnic minority women in Western China: a qualitative evidence synthesis. Health Policy Plan 2019; 34:384-400. [PMID: 31219555 DOI: 10.1093/heapol/czz040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 12/20/2022] Open
Abstract
Quantitative evidence suggests that ethnic disparities in maternal healthcare use are substantial in Western China, but the reasons for these remain under-researched. We undertook a systematic review of English and Chinese databases between January 1, 1990 and February 23, 2018 to synthesize qualitative evidence on barriers faced by ethnic minority women in accessing maternal healthcare in Western China. Four English and 6 Chinese language studies across 8 provinces of Western China and 13 ethnic minority groups were included. We adapted the 'Three Delays' framework and used thematic synthesis to categorize findings into six themes. Studies reported that ethnic minority women commonly held traditional beliefs and had lower levels of education, which limited their willingness to use maternal health services. Despite the existence of different financial protection schemes for services related to delivery care, hospital birth was still too costly for some rural households, and some women faced difficulties navigating reimbursement procedures. Women who lived remotely were less likely to go to hospital in advance of labour because of difficulties in arranging accommodation; they often only sought care if pregnancies were complicated. Poor quality of care in health facilities, particularly misunderstandings between doctors and patients due to language barriers or differences in socio-economic status, and clinical practices that conflicted with local fears and traditional customs, were reported. The overall evidence is weak however: authors treated different ethnicities as if they belonged to one homogeneous group and half of the studies failed in methodological rigour. The current evidence base is very limited and poor in quality, so much more research elucidating the nature of 'ethnicity' as a set of barriers to maternal healthcare access is needed. Addressing the multiple barriers associated with ethnicity will require multi-faceted solutions that adequately reflect the specific local context.
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Affiliation(s)
- Yuan Huang
- School of Public Health, Kunming Medical University, No. 1168 Chunrong West Road, Kunming, China.,London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.,West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, China
| | - Melisa Martinez-Alvarez
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.,MRC-Gambia at the London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, Gambia
| | - David Shallcross
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Li Pi
- West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, China
| | - Fan Tian
- West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, China
| | - Jay Pan
- West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, China.,West China Research Center for Rural Health Development, Sichuan University, No. 16 Renmin South Road, Chengdu, China
| | - Carine Ronsmans
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.,West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, China.,West China Research Center for Rural Health Development, Sichuan University, No. 16 Renmin South Road, Chengdu, China
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Victora CG. On Health Priorities, BRICS Countries, and Equity. Am J Public Health 2018; 108:1601-1602. [PMID: 30403510 DOI: 10.2105/ajph.2018.304777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Cesar Gomes Victora
- Cesar Gomes Victora is with the International Center for Equity in Health, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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