Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

Ren, Yan; Qian, Ping; Duan, Zongshuan; Zhao, Ziling; Pan, Jay; Yang, Min

doi:10.1186/s12889-017-4765-y

Cited by 16 publications

(17 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Guo and Huang 2019 [8] note the challenge of looking at county level data due to the instability of birth rates considering the small size of county populations; qualitative data can be helpful to understand and assess factors rather than relying on quantitative data which may not be reliable. Our quantitative data showed that maternal deaths are disproportionately likely to be Yi ethnic minority women, confirming prior research that shows minority-prevalent counties have higher MMR than nonminority prevalent counties [32] and the need for further rsearch to understand this discrepancy [33].…”

Section: Discussionsupporting

confidence: 84%

High maternal and under-five mortality in an ethnic minority predominant area in rural China: a mixed-methods study exploring mother and health-provider experiences

Wong

Xin

Jiang

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: China as a country met Millennium Development Goals regarding maternal mortality rate (MMR) and under 5 mortality rate (U5MR), but high MMR and U5MR persist in various counties, especially rural areas of Western China with predominantly ethnic-minority populations. This study aims to understand multiple factors impacting MMR and U5MR in Xide and Mianning counties in Liangshan Area of Sichuan Province with majority Yi ethnic minority population, as well as the experiences of healthcare providers and mothers in these counties. Methods: Quantitative birth and mortality data from 2012 to 2014 were derived from public and hospital databases. Qualitative methods were used to identify factors which impact MMR and U5MR. We administered structured close-ended surveys to 60 mothers with neonates and 60 healthcare providers and administrators and conducted semi-structured interviews with 26 recently-pregnant mothers regarding their delivery and peri-natal care experiences and with 23 healthcare providers regarding health behaviors and factors driving health disparities. Results: MMR in Xide (72.02 per 100,000) and Mianning (68.10) county are significantly higher than the average MMR for the overall Liangshan Area (43.41), Sichuan (24.40) or the national average (21.8). U5MR in Xide County (12.7%) is consistently higher than in Mianning (7.29%). Of 22 cases of maternal deaths occurring between 2012 and 2014, a disproportionate number (59.9%) were non-hospital births, and 81.81% of those deaths were of Yi ethnic minority women. 73% of medical providers have less than a Bachelor degree and only 40.74% (Xide) or 68.52% (Mianning) scored >80% on evaluations of obstetric and perinatal knowledge and skill. Only 57% of mothers were advised to take folic acid. Mothers who participated in prenatal care programs were more likely to have hospital deliveries (p=0.033) and participate in post-natal care (p=0.05). Significant barriers to care exist due to limited of resources, transportation, cost, health literacy, and cultural norms. Conclusions: MMR and U5MR are higher in Xide and Mianning County and Yi women are disproportionately likely to die in childbirth. Policy changes are necessary to address these inequities, to increase access to quality medical care and improve knowledge and skill-based training for existing medical personnel.

show abstract

Section: Discussionsupporting

confidence: 84%

High maternal and under-five mortality in an ethnic minority predominant area in rural China: a mixed-methods study exploring mother and health-provider experiences

Wong

Xin

Jiang

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Sichuan Province consists of 67 minority counties and 116 nonminority counties [17]. Data for this study were obtained from the population-based Direct Report System of Maternal and Child Health(DRSMCH)in Sichuan.…”

Section: Data Sourcesmentioning

confidence: 99%

“…Although the proportion of children treated in provincial/municipal hospitals has increased (p<0.001), it only increased by 13.6% in the minority counties in 2017 ( Figure 3). The decline of PU5MR was due to social and economic growth, an increase in health and human resources, the improvement of child nutrition, and an increase access to child healthcare [17,18].…”

Section: Ethnic Disparity In Pu5mrmentioning

confidence: 99%

See 1 more Smart Citation

Ethnic disparity in pneumonia-specific mortality among children under 5 years of age in Sichuan Province of Western China from 2010 to 2017

Luo

Zhao

et al. 2019

Preprint

Self Cite

View full text Add to dashboard Cite

Background: To reveal the ethnic disparity in the pneumonia-specific mortality rates of children under the age of five years(PU5MRs) and provide suggestions regarding priority interventions to reduce preventable under-five-years-of-age deaths. Methods: Data were obtained from the Direct Report System of Maternal and Child Health in Sichuan. The Cochran-Armitage trend test was used to assess the time trend. The Cochran-Mantel-Haenszel test and Chi-square test were used to examine the differences in the PU5MRs among different groups. Results: The PU5MRs in the minority and nonminority counties decreased by 53.7% and 42.3% from 2010 to 2017, respectively. The PU5MRs of the minority counties were 4.81 times higher than those of the nonminority counties in 2017. The proportion of pneumonia deaths to total deaths in Sichuan Province increased from 11.7% in 2010 to 15.5% in 2017. The pneumonia-specific mortality rates of children in the categories of 0-28 days, 29days-11 months, and 12-59 months were reduced by 55.1%, 38.8%, and 65.5%, respectively, in the minority counties and by 35.5%, 43.1%, and 43.7%, respectively, in the nonminority counties. Conclusions: PU5MRs declined in Sichuan, especially in the minority counties, while ethnic disparity still exists. Although the PU5MRs decreased more for the minority counties as a fraction of all mortality the absolute number of such deaths were higher, and therefore more children in these counties continue to die from pneumonia than from the non-minority counties. Priority should be given to strategies for preventing and controlling child pneumonia, especially for postneonates, in the minority counties.

show abstract

“…The research of Sichuan is important for China. Ren found that health human resources explained part of the difference in maternal mortality rate between minority and non-minority counties in Sichuan [19]. Sichuan province has issued a series of policies and measures to strengthen the construction of health human resources team, such as increasing investment in health human resources, strengthening education and training, and promoting various talent projects, which had achieved effective results.…”

Section: Introductionmentioning

confidence: 99%

Spatio-temporal Clusters of Health Workforce Distribution in Sichuan Province, China: a county-level analysis

Zhang¹,

Ning²,

Xie³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The health workforce is a key determinant in achieving health equity. As a southwestern province of China, Sichuan confronted with the geographical variation of health workforce in recent years. The misdistribution of health workforce in Sichuan is severe for its complex terrain, uneven population distribution and huge economic differences. The study of Sichuan province is of great significance to other regions of China. Methods This study applied time-series analysis, spatial autocorrelation and space-time scan analysis to explore and visualize the spatial changing patterns of different types of health workforce (health technicians, licensed doctors, registered nurses, pharmacists, technologists, and intern) at the municipal and county level in Sichuan. Results The box plots displayed the temporal trend of health workforce from 2009 to 2018 via the county-level data. All types of health workforce were in rising generally especially the registered nurses. The space-time analysis and Global Moran' I revealed the distinctive geographical clusters among all the counties. The local Moran' I detected that HH clusters mainly in the capital and some rich places of Sichuan, while some mountain areas in eastern Sichuan displayed LL clusters. Four main findings should be paid attention to the whole health workforce of Sichuan province had an upward trend. Comparing with other provinces, the growth rate also was in a high rank; the areas with the scarcest resources were eastern place, including areas of Tsinling Mountains, Yunnan-Guizhou Plateau, Hengduan Mountains and the transition zone of mountains and basins; misdistribution of health workforce had two levels, among the province and cities; the Qinghai Tibet Plateau has enough intern while being short of other health technicians. Conclusions The policies makers should pay more attention to the eastern Sichuan. As to the intern-related policies, the primary health tasks did not achieve, Qinghai Tibet Plateau areas needed to find practical ways to attract the interns

show abstract

Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

Cited by 16 publications

References 20 publications

High maternal and under-five mortality in an ethnic minority predominant area in rural China: a mixed-methods study exploring mother and health-provider experiences

High maternal and under-five mortality in an ethnic minority predominant area in rural China: a mixed-methods study exploring mother and health-provider experiences

Ethnic disparity in pneumonia-specific mortality among children under 5 years of age in Sichuan Province of Western China from 2010 to 2017

Spatio-temporal Clusters of Health Workforce Distribution in Sichuan Province, China: a county-level analysis

Contact Info

Product

Resources

About