Inequality in health service utilization among migrant and local children: a cross-sectional survey of children aged 0-14 years in Shenzhen, China

Immunization coverage, knowledge, satisfaction, and associated factors of non-National Immunization Program vaccines among migrant and left-behind families in China: evidence from Zhejiang and Henan provinces

BACKGROUND

Migrant and left-behind families are vulnerable in health services utilization, but little is known about their disparities in immunization of non-National Immunization Program (NIP) vaccines. This study aims to evaluate the immunization coverage, knowledge, satisfaction, and associated factors of non-NIP vaccines among local and migrant families in the urban areas and non-left-behind and left-behind families in the rural areas of China.

METHODS

A cross-sectional survey was conducted in urban areas of Zhejiang and rural areas of Henan in China. A total of 1648 caregivers of children aged 1-6 years were interviewed face-to-face by a pre-designed online questionnaire, and their families were grouped into four types: local urban, migrant, non-left-behind, and left-behind. Non-NIP vaccines included Hemophilus influenza b (Hib) vaccine, varicella vaccine, rotavirus vaccine, enterovirus 71 vaccine (EV71) and 13-valent pneumonia vaccine (PCV13). Log-binomial regression models were used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the difference on immunization coverage of children, and knowledge and satisfaction of caregivers among families. The network models were conducted to explore the interplay of immunization coverage, knowledge, and satisfaction. Logistic regression models with odds ratios (ORs) and 95% CIs were used to estimate the associated factors of non-NIP vaccination.

RESULTS

The immunization coverage of all non-NIP vaccines and knowledge of all items of local urban families was the highest, followed by migrant, non-left-behind and left-behind families. Compared with local urban children, the PRs (95% CIs) for getting all vaccinated were 0.65 (0.52-0.81), 0.29 (0.22-0.37) and 0.14 (0.09-0.21) among migrant children, non-left-behind children and left-behind children, respectively. The coverage-knowledge-satisfaction network model showed the core node was the satisfaction of vaccination schedule. Non-NIP vaccination was associated with characteristics of both children and caregivers, including age of children (> 2 years-OR: 1.69, 95% CI: 1.07-2.68 for local urban children; 2.67, 1.39-5.13 for migrant children; 3.09, 1.23-7.76 for non-left-behind children); and below caregivers' characteristics: family role (parents: 0.37, 0.14-0.99 for non-left-behind children), age (≤ 35 years: 7.27, 1.39-37.94 for non-left-behind children), sex (female: 0.49, 0.30-0.81 for local urban children; 0.31, 0.15-0.62 for non-left-behind children), physical health (more than average: 1.58, 1.07-2.35 for local urban children) and non-NIP vaccines knowledge (good: 0.45, 0.30-0.68 for local urban children; 7.54, 2.64-21.50 for left-behind children).

CONCLUSIONS

There were immunization disparities in non-NIP vaccines among migrant and left-behind families compared with their local counterparts. Non-NIP vaccination promotion strategies, including education on caregivers, and optimization of the immunization information system, should be delivered particularly among left-behind and migrant families.

Perspectives on Migrant Children's Mental Health Needs and Existing Services: A Qualitative Study Among Psychological Service Providers of Chinese Social Organizations

Background

China is comprehensively promoting the construction of social psychological service system. Social organizations provide psychosocial care services to migrant children in China and hold important information and perspectives different from educators and parents on children's mental health. This study aims to analyze mental health service delivery to migrant adolescents for their psychological well-being, to explore how society responds effectively to their psychological needs and to support in better program implementation of mental health services for migrant children.

Methods

Following qualitative approach semi-structured interviews were conducted with community mental health service providers experienced in working with migrant children. The 15 individual interviews were conducted in Hubei province and Guangdong province, including professionals working with different social organization and social psychological service program in communities. The data were analysed through coding, comparing fragments, constant comparison and recognizing patterns.

Results

The analysis yielded 3 categories (Stimulate the internal strength, Reconstruct the support systems, Understanding and participate in social activities) and 6 sub-categories (Improve the understanding of "me" and explore excellent qualities, Clearly envision "my" future and clear career planning, Improve the parent-child relationship and understand the family environment, Improve subjective support and actively develop support system, Acquire reasonable cognition and behavior and interact with surrounding ecology, Take greater responsibility and cultivate a sense of ownership). The results found that individual traits, family, communities and multiple factors affect the mental health of migrant children and identified the urgent needs, and ways to improve mental health service in efficiently and economically. Social psychological service providers contribute in strengthening the psychological well-being of the migrant children.

Conclusion

Social psychological service sectors need to be strengthened to enhance the psychological well-being of the migrant children. The inherent gaps between the service required and service provided needs to be addressed through further studies on mental health needs of the migrant children.

Impact of migration on oral health outcomes of children in multi-beneficial kindergartens in Nanning, Southern China: a cross-sectional study

OBJECTIVE

To explore the effect of children's migration on their oral health outcomes in multi-beneficial kindergartens in Jiangnan District, Nanning, China, and to provide a basis for improving the oral health of migrant children.

METHODS

A cross-sectional study was conducted among 470 children aged 5 years in Jiangnan District, Nanning, Guangxi. A questionnaire was used to collect information on their demographic and socioeconomic background, migration experience, eating habits, oral hygiene behaviours and utilization of dental care services. Dental caries of primary teeth was examined using the decayed, missing, and filled teeth (dmft) index recommended by the World Health Organization. Dental caries experience and oral health-related behaviours were compared between migrant and resident children. The impact of children's migration attributes on their oral health outcomes was examined by univariate and multivariate analyses.

RESULTS

Among the examined children, 52.3% were migrant children. The prevalence of caries among the children in multi-beneficial kindergartens was 78.3%, and the mean number of dmft was 5.73 ± 5.00. The prevalence of caries was 81.7% for migrant children and 74.6% for resident children (p = 0.060). No significant difference was found in the mean numbers of DMFT between migrant children and resident children (5.96 ± 4.81 vs. 5.47 ± 5.20, p = 0.139). There were significant differences in the frequency of tooth brushing (p = 0.023) and parental help with tooth brushing (p = 0.008), typical use of fluoride (p = 0.012), regular dental check-ups (p = 0.003) and experience of dental fillings for caries (p < 0.001) between migrant and resident children. The multivariate logistic regression analysis showed that among the children with caries, the proportion of resident children who had regular dental check-ups was 1.720 times higher than that of migrant children (95% CI = 1.155 ~ 2.560), and resident children were more likely to have caries filled than migrant children (OR = 3.313, 95% CI = 1.585 ~ 6.927).

CONCLUSION

Oral health status and oral health behaviours were poor among children in multi-beneficial kindergartens in Nanning, China, and migration might be a significant predictive indicator for the poor utilization of dental care services by children. The government departments should make special policy to promote the children's oral health in multi-beneficial kindergartens, and invest more to cover the migrant children's utilization of oral health services.

Community nursing delivery in urban China: A social power perspective

Community nurses remain understudied in research on interactional power, especially in China where community healthcare is an emerging practice. Grounded in French & Raven's typology of social power, this article conceptualises the power of community nurses in a Chinese urban context. Through thematic analysis of textual data from 26 semi-structured interviews and two additional focus group discussions with community nurses in Shenzhen, we identified six power varieties, i.e. indirect reward, indirect coercion, legitimate position, peer reference, field expertise, and caring information. We classified these powers trichotomously, as nurse-to-doctor, nurse-to-nurse, and nurse-to-patient, to show the potential influences nurses bring to healthcare relationships. Our analysis indicated nurses' exercise of some powers was constrained by two elements, i.e. doctor-nurse power polarity and patient prejudices against nursing, which together contributed to nurses' adverse power loss. These power adversities permeated the community health environment, contributing to healthcare delivery dysfunctions by undermining nurses' self-improvement, self-assurance, enthusiasm, and cooperation in care. Our analysis, using the insights of social power, develops a novel reading of community nursing delivery in urban China. We argue that nurse empowerment could promote community healthcare delivery. Role enhancement and pro-nursing policy development would reduce adverse power scenarios for community nurses and help convert their potential power resources into practical powers in support of patients' needs.

How does domestic migration pose a challenge in achieving equitable social health insurance benefits in China? A national cross-sectional study

OBJECTIVES

To evaluate the benefit distribution of social health insurance among domestic migrants in China.

DESIGN

A national cross-sectional survey.

SETTING

348 cities from 32 provincial units in China.

PARTICIPANTS

1165 domestic migrants who used inpatient care services in the city of a new residence and had social health insurance.

PRIMARY AND SECONDARY OUTCOME MEASURES

The probability of receiving reimbursements from social health insurance, the amounts and ratio of reimbursement received.

RESULTS

Among migrants who used inpatient care in 2013, only 67% received reimbursements from social health insurance, and the reimbursement amount only accounted for 47% of the inpatient care expenditure. The broader the geographical scope of migration, the lower the probability of receiving reimbursement and the reimbursement ratio, but the higher the reimbursement amount. Specifically, the probability of receiving reimbursements for those who migrated across cities or provinces was significantly lower by 14.7% or 26.0%, respectively, than those who migrated within a city. However, they received significantly higher reimbursement amounts by 33.4% or 27.2%, respectively, than those who migrated within a city. And those who migrated across provinces had the lowest reimbursement ratio, although not reaching significance level.

CONCLUSIONS

The unequal benefit distribution among domestic migrants may be attributed to the fragmented health insurance design that relies on localised administration, and later reimbursement approach that migrating patients pay for health services up-front and get reimbursement later from health insurance. To improve the equity in social health insurance benefits, China has been promoting the portability of social health insurance, immediate reimbursement for inpatient care used across regions, and a more integrated health insurance system. Efforts should also be made to control inflation of healthcare expenditures and prevent inverse government subsidies from out-migration regions to in-migration regions. This study has policy implications for China and other low/middle-income countries that experience rapid urbanisation and domestic migration.

Oral Health in Migrants: An Observational Study on the Oral Health Status of a Migrant Cohort Coming from Middle- and Low-Income Countries

Introduction. The oral health conditions of migrants coming from middle- and low-income countries to developed countries have been shown to be poorer than those of the host population. Since the phenomenon of migration has continued to grow over the past five decades, the oral health status of migrant populations should be an issue of great concern. Objectives. The objective of our observational study was to analyse the periodontal health status and the prevalence of dental caries and lesions of the oral mucosa in a migrant cohort resident in Italy, assessing the association between the oral health status and the educational level of the included patients. Materials and Methods. Our research was conducted at the dental department of Policlinico Tor Vergata (Rome, Italy). A sample of 200 migrants coming from middle- and low-income countries, aged between 3 and 37, was included in our study. Each patient underwent a physical examination of the oral cavity, recording the DMFT/dmft index, Community Periodontal Index of Treatment Needs (CPI), and lesions of the oral mucosa. The one-way ANOVA test was used to establish the correlation between the oral health status and the educational level of the participants. Results. Many participants (62.5%) showed a DMFT/dmft Index ≥ 4; only 27% of the migrants had a DMFT/dmft Index lower than 4, and only 21 of them (10.5%) were recorded at 0. A CPI equal to 0 or 1 was observed in 131 patients (65.5%), while only 30 participants presented a CPI equal to or higher than 4 (15%), and 19.5% (39 patients) were assigned to code 2 and 3. Significant statistical differences were found in the CPI after adjusting data for the educational level of the included participants (p-value < 0.01). Conclusions. The data obtained in our research highlighted poor oral conditions among the analysed migrant population, recording a high prevalence of dental caries and inadequate oral hygiene habits.

Does integrated medical insurance system alleviate the difficulty of using cross-region health Care for the Migrant Parents in China-- evidence from the China migrants dynamic survey

BACKGROUND

Many internal migrants during the urbanization process in China are Migrant Parents, the aging group who move to urban areas to support their family involuntarily. They are more vulnerable economically and physically than the younger migrants. However, the fragmentation of rural and urban health insurance schemes divided by "hukou" household registration system limit migrant's access to healthcare services in their resident location. Some counties have started to consolidate the Urban Resident Basic Medical Insurance (URBMI) and the New Rural Cooperative Medical Scheme (NRCMS) as one Integrated Medical Insurance Schemes (IMIS) from 2008. The consolidation aimed to reduce the disparity between different schemes and increase the health care utilization of migrants.

RESULTS

Using the inpatient sample of migrant parents from China Migrants Dynamic Survey in 2015, we used Ordinary Least Squares (OLS) for regression models. We found that the migrant parents covered by the IMIS are more likely to choose inpatient services and seek medical treatment in the migrant destination. We further subdivide Non-IMISs into NCMSs and URBMIs in the regression to alleviate the doubt about endogenous. The results revealed that the migrant parents in IMIS use more local medical services than both of them in URBMI and NCMS.

CONCLUSIONS

The potential mechanisms of our results could be that IMIS alleviates the difficulty of seeking medical care in migrant destinations by improving the convenience of medical expense reimbursement and enhancing health insurance benefits.