Effectiveness Evaluation Of Screening Of Down Syndrome In China

BackgroundDown syndrome (DS) is chromosomal disease. Until now, there is no effective therapy to cure people with DS; the only meaningful way is to carry out prenatal intervention of DS so as to avoid DS birth. Although there is best evidence to show the effectiveness in other settings, there are few domestic researches enabling to evaluate the effectiveness of interventions and also helps to develop an integrated model of preventive interventions in the settings of China.ObjectivesThe study aims to explore the enabling and impeding factors of intervention effectiveness from both the service provider and the demander, provides suggestions for establishing an integrated model of preventive interventions to improve the intervention in various areas in China.Study contents1. To analyze the status quo of providing DS interventions from the service provider2. To explore the status quo and influencing factors of DS interventions from the service demander3. To evaluated the current effectiveness and cost-effectiveness of domestic DS interventions in various areas by the decision tree modelStudy Methods1. Multi-stage stratified cluster sampling was applied to select 12 cities from six provinces in the study.2. Field surveys on the service providers included typical investigation, sampling investigation and key informant interview.3. Field surveys on the service demanders included structured questionnaire survey and qualitative interview.4. Build up a decision tree model to analyze influencing factors of DS screening effectiveness. 5. Data were recorded by the software of Epidata3.0, statistical analysis was conducted with SPSS15.0, and decision tree model was built up with DATA3.5.Main Findings1. The status quo of providing DS interventions from the service providerThe study investigated 407 hospitals at all levels in 12 cities. The hospitals with lisensures for providing institutional delivery were dominated by not-for-profit institutions. There were 147 hospitals providing services related to DS screening, such as blood collection, prenatal screening testing or prenatal diagnosis. In year 2006 and 2007, more than 120 thousand cases received screening, among which second trimester double test accounted for 71.54%.In all cities, hospital selected amniocentesis as a common diagnosis strategy of prenatal diagnosis. The diagnosis provided a positive rate of 1.6% for DS case and a positive rate of 1.66% for other chromosomal diseases.2. The status quo of using DS interventions from the service demanderOf all 8103 women, women aged more than 35 years old accounted for 6.6%. The respondents didn't have a good command of knowledge about DS or DS screening. The screening rate was about 34%, ranging from 3.6% to 68.7% among cities. Willingness-to-pay level in all women is about CNY 150, and varied among cities. Women thought insufficient knowledge about DS as the most common reason when they didn't determine to take the screening.The results of multi-logistic analysis showed that there were several factors influencing women's choice, such as their ages, places of residency, education, household registration, income and knowledge about DS as well.3. Analysis of DS screening with decision tree modelIn the setting of benchmarking,7.8 DS cases could be prevented in every 10000 pregnant women. However, in the real circumstance, the effectiveness was lower than the benchmarking scenario. The city of Zhuhai, Guangzhou and Huzhou took the leads in the effectiveness among 12 cities. The cost-effectiveness ratio in the benchmarking setting was 183213 Yuan. Zhuhai took the lead and acquired a lower cost effective ratio compared with benchmarking. Suggestions1. The construction of prenatal screening and diagnosis institution should be strengthened, and medical technicians should be further trained with DS knowledge, so as to improve the ability to carry out prenatal screening and diagnosis.2. The price of prenatal screening should be properly controlled to improve the accessibility of screening services.3. It is very essential to emphasize health education and distribute correct information with proper use of all media to help to shape right idea of screening.4. The screening model with great effectiveness should be highly developed, and great efforts should be taken to build up screening network.5. The appropriate screening standard for Chinese people should be studied and developed, and it is important to build up scientific management system for prenatal screening.6. Different development strategies and paths could be chosen to achieve the goal of improving screening effectiveness in China.