Analysis On Health Status And Care Services Of Maternal And Children In Lanzhou City

ObjectivesBy analyzing the trend of the main indicators of maternal and children health and health care services in Lanzhou City as well as the main problems consist in the health and care work. To understand the outstanding issues affecting the maternal and children health. The results will provide scientific basis for developing and improving the health and care policy and the related interventions in Lanzhou City.MethodsThis study combined quantitative with qualitative research method.1. Collecting the annual report data of maternal and children health from 2003 to 2015 in Lanzhou City. Analyze the changes and trends of core indicators, such as maternal mortality rate and under-5 mortality rate, as well as the health indicators, such as the maternal system management rate, children under-3 system management rate, children under-7 health care coverage rate and other indicators. To understand the health and care services situation in Lanzhou City.2. Collecting the data of maternal mortality report cards, children under-5 death report cards and birth defects report cards. To analyze the death situation and the main causes of death from 2010 to 2015 in Lanzhou City.3. Using qualitative interview research methods, and according to the interview outline drafted in advance to interview people faced to face, whom from maternity and children care institutions in five district and three county of Lanzhou City. The interviewees include the main managers and professional technical workers(eight each), and 20 pregnant woman of high school education. To understanding the problems exist in the health and care work and measures taken to further development.4. Using estimated percentage change(Estimated Annual Percent Change, EAPC) to evaluate change tendency of maternal mortality rate, under-5 mortality rate and the birth defects rate. Using the years of potential life lost(YPLL) and the working years of potential lost(WYPLL) to evaluate the loss of life and years of work of pregnant woman due to early death. Thereby to reflect the severity of the disease.Results1. Analysis on the maternal health and health care service situation in Lanzhou City:(1): The maternal death situation:1Maternal mortality rate and tendency: The maternal mortality rate was declined, falling from 40.79/100 000 in 2003 to 15.63/100 000 in 2015, decreased by 61.68%.2The lost years of potential life and potential working of death maternal: The YPLL and WYPALL of death maternal were dropped respectively from 408.33 and 297 years in 2010 to 193.48 and 144 years in 2015, had dropped by 52.62% and 51.52% respectively. 3Causes of maternal death: The top three causes of maternal death were obstetric hemorrhage, medical complications, amniotic fluid embolism. Leading to the lost years of potential life were 532.44, 450.33 and 278.22 years respectively.(2)The analysis on health and care services status and tendency of maternal: Compared with 2003, antenatal examination rate, post-natal visits rate, system management rate, hospital delivery rate, new delivery rate and high-risk maternity hospital delivery rate in 2015 increased by 12.90%, 12.72%, 35.83%, 27.83%, 0.07%, 0.82% respectively. Antenatal examination rate, post-natal visits rate, system management rate and hospital delivery rate increased year by year from 2003 to 2015, which annual percentage change were 1.16%, 1.62%, 4.23%, 1.86% respectively, EAPC are valid(all P <0.05), and suggesting a steady growth trend.2. Analysis on the children health and health care services situation:(1) The children death situation: 1Under-5 children mortality and change tendency: Neonatal mortality, infant mortality, under-5 children mortality showed a declining trend, which decreased from 15.63‰, 18.31‰, 19.89‰ in 2003 to 3.32‰, 4.73‰, 5.74‰ in 2015, which decreased by 78.76%, 74.17%, 71.14% respectively. By rank correlation testing, neonatal mortality, infant mortality, under-5 children mortality were negatively correlated(rs =-0.977,-0.984,-0.951 respectively, all P<0.05) with years. Its annual percentage change were 14.02%, 11.94%, 10.92% respectively, EAPC are valid(all P<0.05), which suggest that the three rate had a steady downward trend. 2Causes of under-5 children death: The top three death causes were preterm or low birth weight, birth asphyxia and congenital heart disease. 3Dead children receiving related treatment situation: Under-5 children before died receiving treatment accounted for 80.54%, a large proportion untreated(accounting for 19.46%). In many untreated reasons, too late sent to hospital for the largest proportion(accounting for 23.14%), followed by the parents think that the condition is not serious and economic difficulties.(2) Children health and care situation: Pediatric visits rate, under-3 children system management rate and under-7 children health care coverage rate were overall upward year by year from 2003 to 2015. Its annual percentage changes were 1.62%, 6.91%, 3.51% respectively, and all EAPC were effective(P<0.05), which suggesting a steady growth trend.3. Birth defects situation in Lanzhou city:(1) Incidence rate and order of birth defects: Incidence rate of birth defects in 2010-2015 was 124.16/10 000 and the overall incidence rate had increase trend. The annual percentage change of birth defects incidence rate was 11.94%, EAPC was effective(P<0.05), which suggest that the upward trend is stable exist. The top three of birth defects incidence rate in six years were cleft lip(cleft lip, cleft palate, cleft lip and cleft palate), congenital heart disease and multiple defects.(2) Mortality rate and order of birth defects: Birth defects mortality rate was 54.82/10 000, and the mortality increasing year by year from 2010 to 2015. Its annual percentage change(EAPC) was 22.74%, EAPC was effective(P<0.05), showed steady upward trend.4. The results of qualitative interviews:(1)The overall development of MCH work in Lanzhou City showed better, but restrict factors for further development are much more, which focus on: The coordination degree between health sector and other sectors is not enough, lack of development funds, lack of professional and technical personnel, low quality of personnel, outdated infrastructure, lack of basic health care facilities, lack of effective incentive mechanism, and so on.(2) The ways of gathering information in the MCH organization are unreasonable in Lanzhou City, exist in unnecessary duplication report, lack of someone to gather information in grass roots, lack of information and reporting system in villages and towns, the problems of omission report and management highlighted, accuracy of the information is not high. The workload and work way of grassroots MCH staff are unreasonable, exist in heavy workload, heavy tasks, and inefficient.(3)The free pre-marital medical examination in Lanzhou City carried out better. The case of anemia during pregnancy are more, and pregnant woman take folic acid is better, but specification take is not well enough.Conclusions1. In recent years, maternal and children health care situation is significantly improved in Lanzhou city.2. Obstetric hemorrhage, medical complications and maternal amniotic fluid embolism are the main dead reasons for maternal in Lanzhou. Preterm or low birth weight, birth asphyxia and congenital heart disease are the leading cause for under-5 children death in Lanzhou City.3. Cleft lip, congenital heart disease and multiple defects are the top three in perinatal birth defects in Lanzhou City.4. MCH work has developed better in Lanzhou City. However,in terms of gathering the information, management and regularly taking folic acid are still not good enough, which need to be improved.