A Study of Field-based Methods for Diagnosing Reproductive Tract Infections in Rural Yunnan Province, China

The association between the vaginal microenvironment and fecundability: a register-based cohort study among Chinese women

OBJECTIVE

To evaluate the association between the vaginal microenvironment and fecundability among women.

DESIGN

Register-based nationwide cohort study.

SETTING

Chinese National Free Pre-conception Check-up Project from 2015 to 2018.

POPULATION

Our study included a total of 3 388 554 eligible women who were attempting to become pregnant.

METHOD

We assessed the vaginal microenvironment at baseline by considering four indices: vaginal pH, clue cell examination, whiff test and vaginal cleanliness grading. If any of these indicators was abnormal, the vaginal microenvironment was defined as poor. Propensity score matching was used to control for potential confounders and reduce bias. Logistic models were used to estimate the fecundability odds ratios (FORs) after adjustment for covariates.

MAIN OUTCOME MEASURES

Achievement of a pregnancy within 1 year.

RESULTS

Of the total study population, 379 718 women (11.2%) had a poor vaginal microenvironment and their pregnancy rate after 1 year was significantly lower than the group with a normal microenvironment (71.8% versus 76.1%, P < 0.001). After adjusting for potential confounders, the women with a poor vaginal microenvironment were associated with a 9% reduction in fecundability compared with the normal microenvironment group (FOR 0.91, 95% CI 0.90-0.92). The adverse effects of a poor vaginal microenvironment were stronger among multipara (FOR 0.89, 95% CI 0.87-0.90) or women with irregular menstruation (FOR 0.86, 95% CI 0.84-0.89).

CONCLUSION

There was a negative association between a poor vaginal microenvironment and the fecundability of women. These findings highlight the significance of assessing the vaginal microenvironment during pre-pregnancy health examinations.

TWEETABLE ABSTRACT

Women with a poor vaginal microenvironment were associated with a reduction in fecundability.

Reproductive health status and related knowledge among women aged 20-39 years in rural China: a cross-sectional study

Background

Reproductive health is the core science of human life and is critical to the healthy and sustainable development of human society. Since 1980, China has enforced a “one child” policy. With the implementation of the Universal Two-Child Policy in 2016, every couple is allowed to have two children instead of one, which will lead to more pregnancies, births, and advanced maternal age. Thus, women aged 20–39 years, at the peak of sexual activity and fertility, will face more reproductive health problems related to pregnancies and births. This study aimed to investigate the current reproductive health status, knowledge, and factors associated with reproductive health knowledge among women aged 20–39 years in rural China.

Methods

A cross-sectional study was conducted in five villages of five cities in China. The data were collected using pre-tested and structured questionnaires through face-to-face interviews. The data were entered into Epidata version 3.0, and analyzed using SPSS version 18.0. A descriptive summary of the data and logistic regression were used to identify associated factors.

Results

One-third of the participants reported that they had suffered from gynecopathy, and 38.89% of participants with gynecopathy-related discomfort did not seek medical treatment. Condoms and intrauterine devices were the main contraceptive measures used, and 28.70% of women had a history of induced abortion. Over half of the respondents (53.00%) were classified as having a low reproductive health knowledge score. Factors associated with lower knowledge levels were lower education, no history of gynecopathy, and lack of acquiring knowledge from medical staff, WeChat/micro-blog, or the internet.

Conclusion

A poor reproductive health situation and low level of health knowledge were found among women aged 20–39 years in rural China. More specific interventions promoting reproductive health and targeting rural women aged 20–39 years are needed.

Improving reproductive health in rural China through participatory planning

China's new health reform initiative aims to provide quality accessible health care to all, including remote rural populations, by 2020. Public health insurance coverage for the rural poor has increased, but rural women have fared worse because of lower status and lack of voice in shaping the services they need. Use of prenatal care, safe delivery and reproductive tract infections (RTIs) services is inadequate and service seeking for health problems remains lower for men. We present findings from a study of gender and health equity in rural China from 2002 to 2008 and offer recommendations from over a decade of applied research on reproductive health in rural China. Three studies, conducted in poor counties between 1994 and 2008, identified problems in access and pilot tested interventions and mechanisms to increase women's participation in health planning. They were done in conjunction with a World Bank programme and the global Gender and Health Equity Network (GHEN). Reproductive health service-seeking improved and the study interventions increased local government commitment to providing such services through new health insurance mechanisms. Findings from the studies were summarised into recommendations on gender and health for inclusion in new health reform efforts.

Sexual and reproductive health status and related knowledge among female migrant workers in Guangzhou, China: a cross-sectional survey

OBJECTIVE

The objective of this study was to investigate the current sexual and reproductive health (SRH) status including SRH-related knowledge and associated factors, self-reported symptoms of reproductive tract infection (RTI), medical assistance seeking behavior, sexual experience and contraceptive use, reproductive information approach and reproductive service utilization among female migrant workers in Huangpu district, Guangzhou city, China.

STUDY DESIGN

A cross-sectional study was conducted in 2008 in eight factories, which were selected randomly from 32 eligible factories in the Huangpu district in Guangzhou. Descriptive statistics were used to describe the SRH status of migrant workers. Factors associated with the level of SRH knowledge were determined by a logistic regression model.

RESULTS

Of 1346 female migrant workers, 831(61.7%) were unmarried and 515 (38.3%) were married. 27.2% of the unmarried respondents and 40.2% of the married respondents had suffered self-reported RTI symptoms. Among unmarried respondents, the median knowledge score was 5 points, compared to 8 points for the married. For unmarried migrant workers, factors associated with the knowledge level were age, education level, access to SRH information and service, sexual experiences and RTI symptoms. For married migrant workers, factors associated with the knowledge level were age, education level, access to SRH services and RTI symptoms.

CONCLUSIONS

A high prevalence of self-reported RTI symptoms and a low knowledge level were found among young female migrant workers. Unmarried migrant workers are more vulnerable to SRH problems. Those findings demand more specific interventions targeting female migrants and in particular the unmarried.

Gaps remain in China's ability to detect emerging infectious diseases despite advances since the onset of SARS and avian flu

Early detection of emerging infections in China is critical to the health of the 1.3 billion Chinese people and to the world. China's surveillance system for endemic infectious diseases has improved greatly since 2003, but the country's ability to conduct surveillance for laboratory-confirmed infections remains underdeveloped. This is dangerous for China, the world's most populous country, which has been the focus of global attention since outbreaks of severe acute respiratory syndrome (SARS) and avian influenza. We describe China's public health advances since the 2003 SARS outbreak and conclude that China must now invest far more in pathogen-based surveillance. An enhanced disease-detection system in China will help prevent and contain outbreaks before they cause substantial illness and death in China and other countries.

The interrelationship of men's self-reports of sexual risk behavior and symptoms and laboratory-confirmed STI-status in India

This paper describes the interrelationship among men's self-reports of symptoms, unsafe sexual behavior, and biologically tested sexually transmitted infections (STIs). Data are drawn from the baseline survey of six-year (2001-2007) research and intervention project on men's sexual health and HIV/STI risk reduction conducted in three urban poor communities in Mumbai, India. The survey collected a wide range of demographic, attitudinal, knowledge, and behavioral data. In addition, men were tested for common STIs by selecting a systematic random sub-sample of 816 men (assuming 20% non-response). Data in this paper are based on 641 men who had completed the survey interview and for whom the testing of blood and urine samples was conducted. Results suggest that the self-reported STI-like symptoms and unsafe sexual behavior taken together as a predictor of confirmed STIs improve the sensitivity to a significantly greater degree (χ² = 2.83, p<0.05) as compared to the sensitivity of self-reported STI-like symptoms or unsafe sexual behavior alone as a predictor of confirmed STIs. In addition, the consistency of self-report was found to vary among socio-demographic and behaviorally defined sub-groups. These results provide preliminary support for the importance of population-based surveys, which collect all the three types of data such as reported behavior, symptoms and laboratory confirmed STIs for a full understanding of sexual risk and STIs and for identification of sub-groups within communities that vary in their ability to identify STI symptoms.

Thresholds of morbidity among women in a peri-urban community of Maharashtra, India: conceptual and methodological issues

While data on perceived morbidity often correlate poorly with clinical morbidity, they can provide an indicator for how women's concepts of health change in the context of larger transitions in gender and health systems. Drawing on multiple sources of data on perceived morbidity among women in a peri-urban settlement of Maharashtra, India, this article examines variations in women's thresholds for articulating illness conditions. Data on women's health were collected from married women aged 15-49, using four different instruments: focus group discussion guides; general illness narrative guidelines; individual open-ended questions about morbidity; and a highly structured checklist. Comparing the data and the assumptions underlying these instruments, the article identifies four different thresholds relating to situational, agency, prototypical and dimensional aspects of women's experience and subsequent reporting of morbidity.

Self-Reported Symptoms of Reproductive Tract Infections Among Rural Women in Hainan, China: Prevalence Rates and Risk Factors

OBJECTIVES AND GOAL

The goal of this study was to examine risk of reproductive tract infections (RTIs) among women in rural China, including prevalence, influence of sociodemographic characteristics, knowledge, hygienic practices, attitudes, and behaviors related to premarital and extramarital sex, and abortion.

STUDY

During 2000, a stratified cluster sample of 606 rural married women in Hainan province completed an interviewer-administered standardized questionnaire.

RESULTS

Overall, 39% of participants reported at least 1 RTI symptom in their lifetime and 20% during the past 6 months. Having had premarital sex, having sex during menstruation, belonging to an ethnic minority, being knowledgeable about RTIs, and living in a village at medium economic level were all related to having RTI symptoms.

CONCLUSION

Among married women in rural China, the prevalence of RTI symptoms was high, indicating the need for health education, particularly targeting women from ethnic minorities and resource-poor areas.

Privatisation of health services and the reproductive health of rural Chinese women

China's rural health care system has undergone major changes since the early 1980s, when the country began privatising rural health services. Following fiscal devolution, the rural primary health service was transformed into a fee-for-service system, dependent on the availability of local resources. This article reports some of the results of a study undertaken in 1994-96 to examine the impact of privatization on financing, provision and use of reproductive health services by women in two rural counties in Yunnan Province, China. The most common self-reported symptoms of reproductive morbidity were abnormal vaginal discharge and vaginal tears during home delivery, which went mostly untreated. Hospital-based delivery and use of antenatal care was very low, adversely affected by costs and perceived low quality. Service quality was affected by low investment in training, maintenance and supervision of workers. Most of the burden for maternal and child health care fell on local health workers, yet resources for these services had declined from 1985 to 1995. Only support for family planning services, which were funded and provided separately, had increased. Rural women's reproductive health needs were inadequately attended to by rural health services following reforms. Our data has helped to increase attention to those needs within planned reform efforts.

Alternative study designs for research on women's gynaecological morbidity in developing countries

Although community-based studies are considered to be the 'gold standard' for research on gynaecological morbidity among women, there is growing appreciation of the significant challenges to successfully undertaking such studies in developing countries. In this review, the constraints to undertaking community-based studies are discussed and alternative study designs are evaluated. Our review suggests that these alternative designs have both limitations as well as strengths compared to community-based designs. An important limitation concerns possible selection bias in the populations studied and the extent to which findings can be generalized to the broader population. Important advantages include higher feasibility, lower respondent refusal rates especially for medical procedures, lower costs, and potentially a more direct link between research and utilization. We conclude that the alternative study designs considered provide researchers with an expanded array of tools for investigating the issue of women's gynaecological morbidity in developing countries.

Surveys on sexual health: recent developments and future directions

The increasingly widespread adoption of the term sexual health reflects a move away from the medicalisation of this specialty. The focus has shifted from clinical practice to lifestyle and behaviour; from clinician to client, and from treatment to prevention. This article discusses these themes, identifying their implications for sexual health research. Recent times have seen, for example, a growing number of studies combining biological and behavioural measures conducted by interdisciplinary teams able to combine biomedical measurements of morbidity with insights into the subjective interpretations of symptoms and consequences. Considerable progress has been made, too, in mounting community based studies, and much has been achieved in gaining compliance and refining sampling methods. Integrated sexual health services, encompassing more than contraceptive or prophylactic service provision, have provided the impetus to investigation of the costs and benefits of coordinated family planning and genitourinary medicine services. Despite its broader focus, there remain opportunities for sexual health research to expand its remit. Studies to date may have focused too narrowly on pathological, to the neglect of health enhancing, consequences of sexual behaviour.

Methodological issues in community-based studies of gynecological morbidity

This report describes the lessons learned from a series of community-based studies of gynecological morbidity among young married women in Karnataka State, India. Women's self-reports of symptoms of illness were found to be responsive to the context of the interview and the nature of questioning. In particular, women appeared much readier to report symptoms to lay interviewers after being invited to undergo a clinical examination in the near future than they were if no examination were offered. Little consistency was found in the results obtained from interviews, clinical examinations, and laboratory tests. Apparently, no alternative exists to the collection of biological specimens for laboratory analysis when estimates of disease prevalence are needed. Use of generic health-related quality-of-life assessments is recommended for future surveys. Prospective studies will yield more valuable data on these topics than will cross-sectional surveys.