Study on the Status of Health Service Utilization among Caregivers of Left-Behind Children in Poor Rural Areas of Hunan Province: A Baseline Survey

Abstract

Background: The caregivers of left-behind children (CLBC) in China’s poor, rural areas are mostly elderly and women. Their health status and access to health services have not been previously characterized. This study aims to explore the status of CLBC in terms of their health service utilization and to provide a scientific basis for guiding effective implementation of health policy in rural Hunan. Methods: Random cluster sampling was used to survey CLBC in two rural counties. Face-to-face interviews and questionnaires were used to collect data, including socioeconomic status and health service utilization. The two-week prevalence rate was used to reflect health service needs, while the two-week visiting rate, annual hospitalization rate and participation in basic public health services were used to evaluate health service utilization. Results: Of the 518 respondents in the study, 95.9% were farmers and 88.4% were over 40 years old. The two-week prevalence rate was 36.1%. Furthermore, 40.1% of ill caregivers’ activities were partly restricted by illness and 3.7% needed to be on bed rest. The two-week visiting rate was 21.0%. The main reasons for not seeing a doctor were “self-medication” (39.1%) or “financial difficulties” (32.6%). The annual hospitalization rate of the CLBC was 22.6% and the non-hospitalization rate of those who needed hospitalization was 41.5%. “Lack of time” (22.3%) and “financial difficulties” (50.5%) were the major factors affecting the utilization of hospitalization services. In terms of participation in basic public health services, only 35.1% CLBC clearly knew that township hospitals have established health records for them. Only 50.6% of caregivers received free health examinations in village clinics or township hospitals and 81.3% of the caregivers did not participate in health education or lectures organized by local health institutions in 2014. Conclusions: The utilization rate of health services was extremely low, which may affect the quality of care for left-behind children. Better public health education through multi-sector cooperation is urgently needed to improve health cognition among CLBC in rural China.

Effect of a Conditional Cash Transfer Program on Nutritional Knowledge and Food Practices among Caregivers of 3–5-Year-Old Left-Behind Children in the Rural Hunan Province

“…Even though health education is included in Chinese primary health care, the resources to receive health knowledge are limited. In our study, no doctor had received nutritional training before and less than a fifth of caregivers had participated in health education workshop organized by local health institutions [ 4 ]. Lack of transport facilities and cost of transport were the barriers for caregivers to access health services, including health education.…”

“…The nutritional knowledge and food practice behaviors of caregivers of LBC (CLBC) directly affect children’s health. Our baseline data showed that about 75% of LBC are separated from both parents (with both parents having migrated) and that most of the caregivers are elderly grandparents (83%), or sometimes distant relatives or neighbors [ 4 ], who are less-educated and do not pay sufficient attention to dietary diversity, nutrition, and food sanitation. They have difficulties in providing children with a reasonable and nutritious meal supply.…”

Study on the Status of Health Service Utilization among 3–5 Years Old Left-Behind Children in Poor Rural Areas of Hunan Province, China: A Cross-Sectional Survey

“…“Caregivers thought the treatment in hospitals was ineffective” and “Inconvenient transportation” were the two main barriers to the health service utilization of LBC. Low-education levels may affect caregivers’ ability to cultivate children scientifically and to access child health services [14,15,16]. When seeking health care in rural areas, people have to face the challenge of accessibility and high transportation cost [17].…”

Health Seeking Behavior among Rural Left-Behind Children: Evidence from Shaanxi and Gansu Provinces in China

“…The left-behind phenomenon is driven in large part by China’s rapid development and urbanization, and in particular by the migration of large numbers of rural residents from their rural homes to urban areas in search of better job opportunities [ 2 ]. It is common for migrant parents to leave their children behind with a caregiver—typically the paternal grandparents—in their home communities [ 1 , 3 , 4 ]. This has created a new, large, and potentially vulnerable subpopulation of left-behind children in rural areas.…”

“…One possible mechanism for lower health outcomes is that elderly surrogate caregivers may not be as proactive as parents in seeking health remediation for children. This may be especially true when considering health conditions that are not acute or have few obvious symptoms, but for which treatment can yield important gains in wellbeing and/or productivity [ 3 , 15 ]. For such conditions, preemption on the part of caregivers may factor highly in uptake of remediation.…”