| Objective:To understand implementation situation of supplement folic acid to prevent neural tube defects project in jiangxi province; To master knowledge-attitude-practice( KAP) of the medical staff and target groups on the project, and its influencing factors; From the project managers, service providers and service receivers' opinion, evaluate comprehensivly the quality of project and put forward strategies to improve the effect of folic acid supplementation projects. Methods:Selected the scene: all 11 cities in Jiangxi province, 29 counties(city/area), 87 townships(town/street) and subordinate village clinics Using stratified random sampling method; interviewed relevant project managers at all levels respectively with interview outline individual in-depth qualitative interviews; investgated county(city/area) medical care personnel and maternals by quantitative questionnaire survey, described their KAP of project. Analyzed the influencing factors of KAP with c2 test and unconditioned Logistic regression analysis. Study the project implementation quality in hierarchical analysis method. Results:1. The rate of taking folic acid was 90.30%, taking folic acid compliance rate was 78.79%, knowing rate was 90.86% in 2011 to 2014 in Jiangxi province. Pregnancy rate of unmarried was above 40%, while rate of premarital examination was only 12.7%, planned fertility rate was 7.6%. Project implementation management of some regions was loose, which publicity was not enough and follow-up work basically become a mere formality. Project implementation was shortage of funds, human resources, and grass-roots staff's work enthusiasm was not high. The floating population management was difficult, and unmarried pregnancy phenomenon was common. These problems had negative effects on the effect of implementing project.2. The relevant knowledge of maternal and child health care personnel about the project in Jiangxi province tertiary network levels was generally good, but for people at high risk of neural tube oaf(antiepileptic drug users) awareness was relatively low(75.4%), and the lowest was in village(neighborhood) level of awareness(71.6%, P < 0.05). The awareness rate of rural, older, lower literacy doctors who work more than eight years without training in the village was lower(P < 0.05). Multiariable Logistic regression analysis showed that the awareness of medical staff working the county(city/area) level was 2.447 times as much as that of village(service) level(P < 0.05). The awareness of risk factors for trained staff was 2.488 times as much as that for untrained staff.3. There was a good knowledge about supplementary folic acid for maternals in general. 93.6% of maternal expressed a willingness to take free folic acid, while actually about 70.2% received free folic acid. The awareness of taking folic acid in the right time was low(84.3%). The rate of taking correctly accounted for only 47.3%. According to the survey, the reason for taking folic acid after pregnancy was mainly that they haven't heard of folic acid before pregnancy and there was no a maternal family planning. Failure to adhere to a daily folic acid every day was because the medication was too much trouble. Maternal residence, age, level of hospital, profession, educational level, spouse's educational level, family income per capita and the number of pregnancies was associated with maternal taking folic acid condition(P < 0.05). Multiariable analysis found that taking correctly rate at county level was 0.599 times as much as that at village level. Preparing to pregnancy(OR = 10.899, P < 0.05) had a positive effect on taking correctly rate.4. Work quality comprehensive evaluation of the project: Comprehensive score index GI of Shangrao city was the highest(84.43%), which of Yingtan city was the lowest(63.98%). Conclusion and Suggestions:1. Self-reported policy enforcement of Folic acid supplement folic acid project in Jiangxi province was high, while some problems appeared in the process of implementation which need improve implementation plan.2. The status of KAP of staff was good, but the knowledge of risk factors still need to strengthen. It is necessary to definite work responsibility of medical staff at all levels for the intervention project, strengthening the working sense of responsibility, especially the training work at the village level. In order to further implement the intervention project, according to the influence factors develop the targeted training project.3. The correct rate of taking folic acid for maternal was low. Awareness of folic acid before pregnancy, family planning, and taking the trouble were the main reasons for taking folic acid correctly. Surveyed at village level and ready pregnant had a positive effect on correct rate of taking folic acid. It suggested that should explore convenient way to take, strengthen health education project, and shall pass in advance. |
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