| Objectives:To compare the differences in the use of services for prevention of mother-to-child transmission between cross-border married families and local Chinese married families,and cross-border married families in different countries,and then analyze their influencing factors to evaluate and improve the relevant policies and procedures for preventing mother-to-child transmission in cross-border married families in Yunnan Province which can provide basis and reference for other regions to carry out related work,and further promote China and Yunnan to achieve the goal of eliminating mother-to-child transmission.Methods:This study built the evaluation framework of this study based on the Accessibility Conceptual Framework of Health Services of Peters David’s and The Behavioral Model of Health Services Use of Andersen.A face-to-face questionnaire was conducted on cross-border married families in Longchuan,Mengla,and Jinping counties in Yunnan Province,and local Chinese married families who came from the same administrative villages and were within 5-year-age by using a multi-stage sampling method.Mean,rate and frequency were used to describe the data.Chi-square test and t test was used in single factor analysis;Logistic regression was used to analyze the influencing factors of service utilization related indicators and their influencing factors.Results:1.A total of 184 cross-border married families with 368 persons were investigated;and 176 Chinese married families with 352 persons were investigated.Among them,there are respectively 61 and 60 Chinese-Myanmar cross-border married families and local Chinese married families,60 and 60 Chinese-Lao and local Chinese married families,and 63 and 56 Chinese-Vietnamese and local Chinese married families.2.Cross-border married family’s wives were mainly farmers,illiterate/primary ethnic minorities.More than 50%of them had economic control at home,but most of them have no economic income.Husbands who were mostly ethnic minorities were farmers and junior high school and below education level.3.A total of 142 foreign wives had been tested for three-diseases during the early pregnancy,and 172 had been tested during all pregnancy.There were no significant difference of the testing services for the three-diseases between wives in cross-border married families’ wives and local Chinese wives,and between different foreign wives during the early and all pregnancy(P>0.05).4.During the wife’s pregnancy,The detection status of Chinese-Laotian spouses(26.67%)was lower than the local Chinese nationality(51.67%).The Chinese-Myanmar(83.16%).There was a significant difference among three foreign cross-border married families(P<0.05),with the highest number of Chinese-Burmese(83.61%),and the lowest(26.67%)of Chinese-Laos.In addition,Multivariate Logistic regression analysis showed that ethnicity,maternal and children’s workers/village doctors who usually concerned about the healthy of those wives,the wife’s purchase of medical insurance,and medical workers who informed of the three-diseases testing results were the influencing factors of the spouse’s HIV antibody detection.5.In the acceptability of the prevention of mother-to-child transmission services,the awareness rate of prevention of AIDS,syphilis and hepatitis B of foreign wives were lower than that of local Chinese wives(P<0.05).There was a significant difference of foreign wives on AIDS and syphilis.The proportion of wives of Myanmar nationality,Lao nationality and Vietnamese nationality was respectively lower than that of local Chinese wives about a positive attitude towards preventing mother-to-child transmission of AIDS,syphilis and hepatitis B(P<0.05).There were differences among foreign wives(P<0.05),with the highest of Myanmar families and the lowest of Vietnamese families.Maternal and children’s workers/village doctors showed different concerns between foreign wives and local Chinese wives(P<0.05);different foreign wives were different(P<0.05),with the highest of Myanmar families(83.61%)and the lowest of Lao families(51.67%).6.In the use of accessibility to prevent mother-to-child transmission services.there were respectively significant difference in main sources of income between Chinese-Myanmar,Chinese-Lao cross-border married families and local Chinese families(P<0.05)..About access to free maternity inspection services,cross-border married families were lower than local Chinese families(P<0.05);different cross-border families were different(P<0.05),with the highest number of Chinese-Burmese wives(70.49%),and the lowest number of China-Vietnam’s(6.35%).About acquiring the free policy of hospitalized childbirth,both Chinese-Myanmar and Chinese-Lao cross-border married families were lower than local Chinese families(P<0.05);there were differences in different cross-border married families,with the highest proportion of Chinese-Vietnamese families(76.19%),and the lowest membership of Chinese-Lao families(10.17%).About geographical accessibility,the proportion of knowing the three disease testing sites was lower in cross-border married families than local Chinese families(P<0.05).Different foreign wives were different(P<0.05)which Myanmar nationality(34.43%)higher than that of Vietnamese(7.94)%).7.Regarding the availability of services for preventing mother-to-child transmission,the proportion of Lao(52.54%)and Vietnamese(55.56%)wives who were reported test results by medical workers was different from that of local Chinese wives(P<0.05).Different foreign wives are different(P<0.05),Myanmar families was the highest(78.69%),Lao families was the lowest(52.54%).The proportion of wives from different cross-border married who had received doctors explaining the prevention of mother-to-child transmission related knowledge was lower than that of local Chinese wives(P<0.05),among which,the figures of Myanmar,Lao,and Vietnamese wives were respectively 29.51%,40.00%,and 50.79%.Conclusions:1.There is no difference in the detection rate of the three diseases during the early pregnancy and the pregnancy between foreign wives and local Chinese wives,and there is no statistical difference between the three foreign nationals,indicating that the border prevention and control policy of preventing mother-to-child transmission in Yunnan Province has an obvious effect,which providing foreign wives with the free three-diseases testing service becoming consistent with that of local wives during pregnancy period.2.The status of HIV antibody testing for spouses in different cross-border married families were different.It is recommended to strengthen the publicity and education of free pregnancy-related services for cross-border married families and the knowledge of PMTCT.We also should increase the village doctor’s concern about the wives health of cross-border married families which can promote the awareness of cross-border married to receive relevant services.Medical workers should improve service skills and service quality,summarize and learn from other regions’ effective measures to provide related services for cross-border married families,and carry out targeted services including increasing spouse testing which can increase spouse HIV antibody testing rates and the utilization of other PMTCT service.3.The use of services f for prevention of mother-to-child transmission in cross-border married families had been improved,but there were still some barriers to the use of services.Among them,the wife’s occupation,education level,ethnicity,the awareness rate of PMTCT,positive attitude towards PMTCT services,and village doctor’s concern about the wife’s health in a cross-border married family also influenced the acceptability of service utilization;cross-border married families’ wife who knowing the location of the three-diseases detection,the cost of pregnancy check-ups,the acquisition of free check-ups,and the reimbursement of hospital delivery expenses affected the availability of service utilization;medical staff who informed the three-diseases detection results and explained PMTCT related knowledge,and service quality affected the availability of service.Throughout the process of preventing mother-to-child transmission,the government or medical institutions should strengthen medical facilities,language and culture which can improve the chances of cross-border marriages to obtain health knowledge and seek the chance of health services,and cultivate village doctors and medical workers to study Burmese,Lao,and Vietnamese to improve the diagnosis and treatment environment and service skills.We also need to promote the high-quality and high-demand development of services related to the prevention of mother-to-child transmission which can improve the efficiency of the use of preventive mother-to-child transmission services. |
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