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Wang W, Zhu Y, Cheng Y, Chen X, Luo Y. Levels and trends of maternal death in Baoan district, Shenzhen, China, 1999-2022. Front Public Health 2023; 11:1051717. [PMID: 37139359 PMCID: PMC10149838 DOI: 10.3389/fpubh.2023.1051717] [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: 09/23/2022] [Accepted: 03/31/2023] [Indexed: 05/05/2023] Open
Abstract
Background China had achieved impressive success in improving maternal health, while the progress of reducing maternal mortality ratio (MMR) varied across regions. Some studies had reported maternal mortality from national or provincial perspective, but researches of the MMR on long-term period at the city or county level rare been reported. Shenzhen has experienced significant socioeconomic and health changes, reflecting the typical development of China's coastal city. This study mainly introduced the levels and trends of maternal death in Baoan district, Shenzhen from 1999 to 2022. Methods Maternal mortality data were extracted from registration forms and the Shenzhen Maternal and Child Health Management System. Linear-by-Linear Association tests were used to evaluate the trends of MMR among different groups. The study periods were divided into three stages by 8-year interval and χ2 test or Fisher's test was used to test the difference in maternal deaths of different periods. Results During 1999-2022, a total of 137 maternal deaths occurred in Baoan, the overall MMR was 15.91 per 100,000 live births, declined by 89.31% with an annualized rate of 9.26%. The MMR declined by 68.15% in migrant population, with an annualized rate of 5.07%, faster than that in permanent population (48.73%, 2.86%). The MMR due to direct and indirect obstetric causes shown a downward trend (P<0.001) and the gap between them narrowed to 14.29% during 2015-2022. The major causes of maternal deaths were obstetric hemorrhage (4.41 per 100,000 live births), amniotic fluid embolism (3.37 per 100,000 live births), medical complications (2.44 per 100,000 live births) and pregnancy-induced hypertension (1.97 per 100,000 live births), the MMR due to the above causes all shown decreasing trends (P < 0.01), pregnancy-induced hypertension became the leading cause of deaths during 2015-2022. The constituent ratio of maternal deaths with advanced age significantly increased by 57.78% in 2015-2022 compared with in 1999-2006. Conclusions Baoan district had made encouraging progress in improving maternal survival, especially in migrant population. To further reduce the MMR, strengthening professional training to improve the capacity of obstetricians and physicians, increasing the awareness and ability of self-help health care among elderly pregnant women were in urgent need.
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Affiliation(s)
- Wei Wang
- Department of Health Care, Shenzhen Baoan Women's and Children's Hospital, Shenzhen Guangdong, China
| | - Yuanfang Zhu
- Office of Hospital Director, Shenzhen Baoan Women's and Children's Hospital, Shenzhen Guangdong, China
| | - Yuli Cheng
- Department of Health Care, Shenzhen Baoan Women's and Children's Hospital, Shenzhen Guangdong, China
| | - Xu Chen
- Office of Hospital Director, Shenzhen Baoan People's Hospital, Shenzhen Guangdong, China
| | - Yali Luo
- Department of Health Care, Shenzhen Baoan Women's and Children's Hospital, Shenzhen Guangdong, China
- *Correspondence: Yali Luo
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Wang X, Zhu Y, Liu J, Ma Y, Birch S. Equity in maternal and child health care utilization in Guangdong province of China 2009-2019: A retrospective analysis. Front Public Health 2022; 10:963344. [PMID: 36176519 PMCID: PMC9513387 DOI: 10.3389/fpubh.2022.963344] [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: 06/07/2022] [Accepted: 08/18/2022] [Indexed: 01/24/2023] Open
Abstract
Background Equity is the principal challenge of maternal and child health care (MCH) across the world, especially in China. Existing researches focused on equity in MCH resources and outcomes. There is an evidence gap regarding equity of MCH services utilization, revealing the black box between equity in MCH resources and MCH outcomes. In the study, we evaluate the changes of equity in integrated MCH service utilization in Guangdong province of China during 2009-2019. Methods Data used in this study are from the Guangdong Maternal and Child Health Routine Reporting System and the Guangdong Health Statistical Yearbook (2009-2019). The Gini coefficient (G) and Theil index (T) were employed to assess equity and source of inequity in four geographic regions of Guangdong province. Results Generally, among the integrated MCH care, coverage of pre-pregnancy care (<50%) is lower than in other stages. In the past decade, inequity of MCH care in the Equalization of Essential Public Health Service (EEPHS) program has gradually reduced to G < 0.1. Screening of genetic metabolic disease and of hearing showed largest reductions of inequity (G reducing from 0.3-0.4 to 0.03-0.04). Inequity in reproductive health tests for brides-to-be, psychological assessment and consultation, education classes for mother-to-be and health management of children under 3 were mainly contributed by intra-region disparities in 2019. Conclusion Equity has gradually improved in the last decade in Guangdong. The national EEPHS program and the Integrated Prevention of Mother-to-Child Transmission of HIV, Syphilis and HBV of Guangdong have played important roles in reducing inequity in MCH service utilization. Further strategies, targeting pre-pregnancy reproductive healthcare, psychological assessments and consultations for the pregnant and education classes for mothers-to-be, should be taken to promote coverage and equity.
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Affiliation(s)
- Xin Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yingxian Zhu
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Jia Liu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuanzhu Ma
- Guangdong Women and Children Hospital, Guangzhou, China,*Correspondence: Yuanzhu Ma
| | - Stephen Birch
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, Australia
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Chen L, Feng P, Shaver L, Wang Z. Maternal mortality ratio in China from 1990 to 2019: trends, causes and correlations. BMC Public Health 2021; 21:1536. [PMID: 34380436 PMCID: PMC8359022 DOI: 10.1186/s12889-021-11557-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Background Maternal mortality ratio is an important indicator to evaluate the health status in developing countries. Previous studies on maternal mortality ratio in China were limited to certain areas or short periods of time, and there was a lack of research on correlations with public health funding. This study aimed to assess the trends in the maternal mortality ratio, the causes of maternal death, and the correlations between maternal mortality ratio and total health financing composition in China from 1990 to 2019. Methods Data in this longitudinal study were collected from the China Health Statistics Yearbooks (1991–2020) and China Statistical Yearbook 2020. Linear regression analysis was used to assess the trends in the maternal mortality ratio in China. Pearson correlation analysis was used to assess the correlations between national maternal mortality ratio and total health financing composition. Results The yearly trends of the national, rural and urban maternal mortality ratio were − 2.290 (p < 0.01), − 3.167 (p < 0.01), and − 0.901 (p < 0.01), respectively. The gap in maternal mortality ratio between urban and rural areas has narrowed. Obstetric hemorrhage was the leading cause of maternal death. The mortalities ratios for the main causes of maternal death all decreased in China from 1990 to 2019. The hospital delivery rate in China increased, with almost all pregnant women giving birth in hospitals in 2019. Government health expenditure as a proportion of total health expenditure was negatively correlated with the maternal mortality ratio (r = − 0.667, p < 0.01), and out-of-pocket health expenditure as a proportion of total health expenditure was positively correlated with the maternal mortality ratio (r = 0.516, p < 0.01). Conclusion China has made remarkable progress in improving maternal survival, especially in rural areas. The maternal mortality ratio in China showed a downward trend over time. To further reduce the maternal mortality ratio, China should take effective measures to prevent obstetric hemorrhage, increase the quality of obstetric care, improve the efficiency and fairness of the government health funding, reduce income inequality, and strengthen the medical security system.
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Affiliation(s)
- Lu Chen
- Division of Prevention and Community Health, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, no. 15 (Lin), Fengcunxili, Mentougou District, Beijing, 102308, China
| | - Penghui Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Lance Shaver
- Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Zengwu Wang
- Division of Prevention and Community Health, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, no. 15 (Lin), Fengcunxili, Mentougou District, Beijing, 102308, China.
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Zhao Y, Zhou Z, Fan X, Nawaz R, Zhao D, Xu T, Su M, Cao D, Shen C, Lai S. Comparison of inequity in health-related quality of life among unemployed and employed individuals in China. BMC Public Health 2021; 21:52. [PMID: 33407307 PMCID: PMC7789144 DOI: 10.1186/s12889-020-10038-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In China, achieving health equity has been regarded as a key issue for health reform and development in the current context. It is well known that unemployment has a negative effect on health. However, few studies have addressed the association between unemployment and inequity in health-related quality of life (HRQOL). This study aims to compare the inequality and inequity in HRQOL between the unemployed and employed in China. METHODS The material regarding this study was derived from the Chinese National Health Services Survey of Shaanxi Province for 2013. We controlled for confounding factors by utilizing the coarsened exact matching method. Finally, 7524 employed individuals and 283 unemployed individuals who were 15 to 64 years old in urban areas were included in this study. We used HRQOL as the outcome variable, which was evaluated by using the Chinese version of EQ-5D-3L. The health concentration index, decomposition analysis based on the Tobit model, and the horizontal inequity index were employed to compute the socioeconomic-related equity between the unemployed and employed and the contribution of various factors. RESULTS After matching, unemployed people tended to have poorer EQ-5D utility scores than employed people. There were statistically pro-rich inequalities in HRQOL among both employed and unemployed people, and the pro-rich health inequity of unemployed people was substantially higher than that of employed people. Economic status, age, education, smoking and health insurance were the factors influencing inequality in HRQOL between employed and unemployed individuals. Education status and basic health insurance have reduced the pro-rich inequity in HRQOL for unemployed people. CONCLUSION It is suggested that unemployment intensifies inequality and inequity in HRQOL. According to policymakers, basic health insurance is still a critical health policy for improving health equity for the unemployed. Intervention initiatives aiming to tackle long-term unemployment through active labour market programmes, narrow economic gaps, improve educational equity and promote the health status of the unemployed should be considered by the government to achieve health equity.
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Affiliation(s)
- Yaxin Zhao
- School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Xiaojing Fan
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Rashed Nawaz
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Dantong Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Tiange Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, No. 235 College Road, Hohhot, 010021, Inner Mongolia, China
| | - Dan Cao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
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Liu Y, Qin Q, Xiao Y, Li H, Guang S, Tao S, Hu Y. Changes of second-time mothers and their infants under the universal two-child policy in Changsha, China. Midwifery 2019; 77:32-36. [PMID: 31252314 DOI: 10.1016/j.midw.2019.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND China announced the implementation of the universal two-child policy in Oct, 2015; every couple was allowed to have two children. However, its influences on maternal well-being and infants' outcomes are still to be discovered. OBJECTIVES To detect influences of the universal two-child policy. To provide information for maternal health care under the new policy. STUDY DESIGN This study enrolled 859 and 1230 women who delivered their second child (hereafter second-time mothers) before and after the policy's implementation, respectively, and the data included maternal demographic characteristics, gestational complications, delivery mode and infants' outcomes. RESULTS After the policy's implementation, the proportion of second-time mothers with advanced age increased significantly. The advanced gestational age is well acknowledged to correlate with higher risk during the pregnancy, both for pregnant women and their babies. However, in our study, the incidence of hypertensive disorders in pregnancy, placenta previa and postpartum haemorrhage decreased significantly after the introduction of the policy and no differences were noted in other gestational complications. Moreover, the hospitalization time was shortened, and caesarean delivery was chosen less frequently. As for the infants, foetal distress exhibited an alleviation and the incidence of premature labour and low birth weight decreased as well. CONCLUSIONS Even though the age of second-time mothers increased after the introduction of the universal two-child policy, their general gestational health condition improved and their infants also exhibited a better outcome, which might be attributed to the improvement of China's maternal medical care system.
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Affiliation(s)
- Yuhao Liu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China.
| | - Qilin Qin
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China
| | - Ying Xiao
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China
| | - Herui Li
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China
| | - Shiqi Guang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China
| | - Sifan Tao
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China
| | - Yun Hu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China.
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