Healthcare providers' perceived barriers to providing breastfeeding support in Northwest rural China.

BACKGROUND: Healthcare providers play important roles in supporting breastfeeding. Although there has been insufficient actual breastfeeding support from healthcare providers in China, little research has been conducted to understand Chinese healthcare providers' perceived barriers to providing breastfeeding support, especially in rural China. This study aims to identify these perceived barriers to providing breastfeeding support in Northwestern rural China. METHODS: This study was conducted during the period from March 2018 to December 2018. Forty-one healthcare providers were recruited through purposive sampling in two rural counties in Northwest China that are in close proximity to each other and share similar demographic features. Participants included obstetrician-gynecologists, midwives, nurses, "village doctors", and township and village maternal and child health workers. Qualitative data were collected through one-on-one in-depth semi-structured interviews and focus group discussions. Transcripts were thematically analyzed. RESULTS: Analysis of interview data resulted in four themes that the participants perceived as barriers to supporting breastfeeding: (1) lack of medical resources, within which inadequate staffing, and lack of financial incentives were discussed, (2) lack of clear and specific responsibility assignment, within which no one takes the lead, and mutual buck-passing were discussed, (3) healthcare providers' lack of relevant expertise, within which lack of knowledge and skills, and low prestige of village healthcare providers were discussed, (4) difficulties in accessing mothers, within which medical equipment shortages reduce services utilization, mothers' housing situation, mothers' mobility, and cultural barriers were discussed. CONCLUSIONS: The study identified HCPs perceived barriers to providing breastfeeding support. Unique to China's Tri-Level Healthcare System, challenges like staffing and financial incentives are hard to swiftly tackle. Recommendations include mHealth enhancement and clarified responsibilities with incentives and tailored training. Further research is crucial to evaluate these strategies in rural Northwestern China and comparable underdeveloped areas nationwide.

[Commentary on "group and organization: a dimension of collaboration of anthropology and epidemiology" by Song LM and Wang N].

Epidemiology, as the study of occurrence and distribution of diseases or health events in specified populations and the application of the study to control health problems, is not just a method to study determinants of diseases at individual level through analysis of mass data based on individuals. To achieve the aims on the control of health problems in specified populations, Epidemiology should be public health-oriented to reduce incidence, prevalence and mortality, and should include study on determinants at the population level. Interdisplinarity and systems science will facilitate the breakthrough in improving health of the populations.

[Relationship between gender, experience of migration and premarital sex among out-of-school youths in rural Hainan, China].

OBJECTIVE: To assess pre-marital sex behavior and its relationship with gender and experience of migration among 16 - 24 years-old out-of-school youths in rural Hainan province, China. METHODS: 160 eligible youths from each of the 2 townships in County A and 80 from each of the 6 townships in County B were recruited, under equal proportion on gender, age distribution and experience of migration. An interviewer-administered, standardized questionnaire was used. RESULTS: 760 eligible participants (with each gender of 380) were interviewed. There were no significant differences in the proportions of reporting as sexually active (56.8% and 57.9%) or having premarital sex (54.5% and 50.0%) between male and female youths. However, among those sexually active participants, the average age at first sexual intercourse was (18.2 ± 1.9 years or 19.2 ± 1.8 years, P < 0.01), the average age of first-time leaving hometown for work (18.0 ± 2.3 years or 16.5 ± 1.9 years P < 0.01) and the percentage of having first sexual intercourse before 18 years old (59.3% vs. 35.5%, P < 0.01) were different between males and females. 31.2% of the male youths reported that their sexual debut happened before they left their hometown for work and 45.9% of the sex debut appeared within 1 year after they left hometown. However, 78.5% of the sexually active female youths reported their sexual debut happened 1 year after leaving their hometown. Data from the multivariate analysis showed that being away from hometown for more than 3 months and having more friends who presumably had presumably pre-marital sex experiences were more likely to report pre-marital sex behavior. Older men were more likely to report pre-marital sex behavior than the younger ones. Married women were more likely to report pre-marital sex behavior than the unmarried ones. Through multivariate analysis on unmarried men, data showed that those having had experience on migration and at older age were associated with experiencing premarital sex. CONCLUSION: Gender difference was identified on the pattern of migration and its relationship with premarital sex among out-of-school rural youths in Hainan province. When prevention program is developed for rural youth, these differences should be taken into account.

A life-skills-based HIV/AIDS prevention education for rural students of primary schools in China: what changed? What have we learned?

OBJECTIVE: To evaluate a four-hour life-skills-based HIV/AIDS prevention curriculum among 5th grade students in rural primary schools of Hainan province. METHODS: The study included two stages. Stage one (September 2006-May 2007) was a pre-post-quasi experimental design; a total of 2,413 students aged 9 to 14 years from fifth grade classes of nine primary schools completed a baseline survey (1,720 students were in the intervention group, 693 in the control group), and over 98% of them took part in a short survey. The experimental curriculum was provided to the intervention group. At stage two (September 2008), a cross-sectional questionnaire was administered to 6,923 students in 7th grade classes of eight middle schools in the same study sites. There were 1,437 students in the intervention group when the curriculum was conducted. RESULTS: Students tended to score higher in areas of HIV/AIDS related knowledge and attitudes, if they were younger than average, lived in the county seat, had access to the internet, and their parents had completed higher levels of education. Path analysis showed that, after controlling for characteristics such as family and community factors, the total effects of curriculum on knowledge in the short-term model increased remarkably compared with the baseline, and maintained major contributions to knowledge in the mid-term model. The positive effect of knowledge on attitudes was significantly improved in the short-term model as well. CONCLUSION: A life-skills based curriculum can improve HIV/AIDS related knowledge and self-perceived level of life-skills among primary school students in rural areas in a short time, and these positive effects can still be observed at least 2 years post participation in the curriculum.

Acceptability of hypothetical microbicides among women in sex establishments in rural areas in Southern China.

OBJECTIVES AND GOAL: The objectives of this study were to measure the potential acceptability of a hypothetical microbicide among women in sex establishments in rural areas of Southern China and demographic, behavioral, and social context factors likely to affect microbicide acceptability. STUDY DESIGN: This was a cross-sectional survey, using a quota sampling, among 300 women from sex establishments in 3 rural towns. An interviewer-administered standardized questionnaire was used to measure the acceptability score of hypothetical microbicides' characteristics, as well as sexual relationships and behaviors and other contextual factors. RESULTS: Findings showed a generally positive response to microbicides, indicated by an acceptability index score of 2.89 (SD, 0.56, scale of 1-4) in the overall sample. Multivariate analysis shows that the acceptability score varied significantly by study sites, type of sex-work establishments, marital status, sex partner type, vaginal product experience, locus of control by partners, and locus of control by chance. CONCLUSIONS: Microbicides may be acceptable among sex workers in rural settings in China; however, contextual factors should be carefully considered in education and promotion of microbicides in the future.

Working to prevent HIV/STIs among women in the sex industry in a rural town of Hainan, China.

We evaluated a two-phase HIV/STIs prevention intervention for female sex workers in a resource-limited rural town in Hainan Province, China. The primary intervention strategy, conducted from 1997 to 2000, was a condom promotion campaign conducted through outreach to sex workers. Four serial cross-sectional surveys were carried out before and after the intervention. Over a period of 2 years, reported condom use during the most recent sexual encounter increased from about 50% to more than 70%; and condom use in more than 50% of sexual acts during the past 6 months increased from less than 40% to near 80% of respondents. Controlling for education, ethnicity and age, reading of educational materials (our intervention variable) was a significant contributor to a higher knowledge score, motivation to use condoms, and reported condom use. This study demonstrates that outreach to female sex workers, if appropriately tailored to local settings, can increase condom use in a resource-limited rural area.

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.

[A questionnaire-based survey on attitude and behavior of sex among rural women in Hainan province].

OBJECTIVE: To define the profile and risk factors of sexual attitude and behavior of rural women. METHODS: Using stratified cluster sampling, tape-recorded interviews and face to face interviews were carried out among 606 rural women. RESULTS: 24.6% of the women being studied accepted the idea of "premarital sexual intercourse" and thought "premarital sexual intercourse between a couple" acceptable accounted for 34.2%, 14.7% and 4% of the women reported having had premarital sexual intercourse and premarital induced abortion respectively. 5.0% of the women admitted having had sexual intercourse during menstruation. 4% and 3% of the women under study accepted "extramarital sexual intercourse" and "paid sexual intercourse" if they were in need of money. None of the women reported ever having had extramarital sex or paid sex. The results derived from two different methods did not differ significantly. Logistic rgression suggested that age, education and ethnicity were associated with attitude towards premarital sex, and age was associated with premarital sexual behavior. CONCLUSION: Sex education need to be promoted and targeted among rural population at early age. "Tape-recorded interview" method did not show a better validity in this study.

Sex-related health risks and implications for interventions with hospitality women in Hainan, China.

This article describes the living situations of sex workers (hospitality girls) in a typical rural town in southern China; their personal, social, financial, and psychological needs and expectations; and the social and economic factors that place them at risk for STIs/HIV and unwanted pregnancy, based on the qualitative and quantitative data collected prior to and during a preventive intervention. Though some similarities to knowledge, attitudes, and behaviors of sex workers reported in other Asian countries were identified, this study identified some differences distinctive to the China context, such as how economic factors, kinship, and friendship networks function in the service industry, and how the culture of reproduction and birth control policy interact with and affect sex workers' health and decision-making options. Understanding these factors is critical for design of a culturally and contextually tailored intervention for the reduction of sex-related health risks of women in the sex service industry.

Long-term effectiveness of infancy low-dose hepatitis B vaccine immunization in Zhuang minority area in China.

AIM:To observe the long-term effectiveness of low-dose immunization strategy and risk factors of HBsAg carriers in immunized children of Zhuang minorities of Longan County in the 9th year after infancy immunization.METHODS:Two epidemiologic methods,a cross-sectional follow-up study and a case-control study,were used for the evaluation of the serological effect and the determination of the risk factors. Hepatitis B virus markers were detected with radioimmunoassay.RESULTS:The protective anti-HBs-positive rate was 43.8% in 1183 children aged 1-9 years,who were immunized with three doses of 10&mgr;g hepatitis B vaccine in infancy according to 0, 1 and 6 months schedul.It declined from 87.9% in the first year to 37.1% in the 9th year after vaccination.The HbsAg-positive rate was 1.6%, not increasing with age during 9 years after the infant immunization program. Compared with 14.0% of HbsAg-positive rate of the baseline survey in 1985, the effectiveness of hepatitis B vaccine immunization was 88.6%. Of 36 immunized children with positive HBsAg, 89.1% were likely attributable to HBsAg positivity of their mothers.CONCLUSION:The long-term effectiveness of infancy low-dose hepatitis B vaccine immunization is high,and the booster is not needed 9 years after the vaccination in the Zhuang minority area where hepatitis B is highly endemic.A high-dose immunization strategy should be recommended in order to further decrease the current HbsAg-positive rate.

Survey of coverage, strategy and cost of hepatitis B vaccination in rural and urban areas of China.

AIM:In order to understand the coverage, immunization strategy and cost of hepatitis B (HB) vaccination of China in recent years.METHODS:A two-stage household random sampling method was used in the survey.RESULTS:The survey carried out at 112 Disease Surveillance Points (DSPs) of 25 provinces, autonomous regions and municipalities of China in 1996, showed that the coverage rates of HB vaccination among neonates were 96.9% in the urban DSPs and 50.8% in the rural DSPs in 1993-1994,while in students aged 7-9 years, they were 85.8% and 31.5% in 1994, respective-ly. Up to 1994, 97.5% of the urban DSPs and 73.9% of the rural DSPs on a neonate vaccination against HB program were included in EPI. About 93% of the urban DSPs and 44% of the rural DSPs did HBsAg and HBeAg screening for all or part of pregnant women. The neonates received the regimen of high-dose HB vaccine in combination with hepatitis B immune globin (HBIG) if their mothers were HBsAg and/or HBeAg positive in pregnancy,otherwise they received the low-dose vaccine (10&mgr;gX3). Part of DSPs had a lower neonate coverage due to unreasonable allocation of the vaccines (used for adults not at risk) or higher cost or insufficient supply of the vaccines. It is necessary to evaluate the quality of serological lab test to HBVMs in the maternal prescreening.CONCLUSION:Remarkable achievements have been made according to the national planning and policy of HB immunization in China.

Persistence of hepatitis B vaccine immune protection and response to hepatitis B booster immunization.

AIM:To identify the persistence of immune protection of China-made, plasma derived hepatitis B vaccine after infancy immunization and the time table of booster immunization.METHODS:A cross-sectional follow-up study and an experimental study on booster were used for the evaluation of the serological effect 7 years after vaccination and the antibody anamnestic response. Radioimmunoassay was used for the detection of hepatitis B virus markers. RESULTS:The protective anti-HBs positive rates of 1018 children, who were vaccinated according to the regimen of three doses of 10 &mgr;g hepatitis B vaccine in their infancy, declined from 75.0% during the first two years to 48.2% in the 7th year after the first dosage, however, the positive rates for HBsAg and anti-HBc always fluctuated at a low frequency. A total of 144 subjects aged 6 or 7 years, who were negative for both HBsAg and anti-HBc before booster, were selected from 1018 children of the follow-up study, and boosted with 1&mgr;g intradermally or 2&mgr;g hypodermically hepatitis B vaccines. Their anti-HBs GMT and anti-HBs positive rates were 190.6mIU/ml and 89.6% in the first month after booster,significantly higher than 14.7mIU/ml and 54.9% before booster (P < 0.01), and declined back to 25.3mIU/ml and 75.5% in the 12th month; among 65 children with the anti-HBs negative before booster, 40 had a level of anti-HBS< = 100mIU/ml one month after booster, suggesting retention of immune memory in most of them.CONCLUSION:No need for revaccination against hepatitis B in the 7th year after the initial immunization due to better persistence of immune protection of the vaccine and retention of immune memory to hepatitis B virus in the vast majority of the vaccinees.