Study On Effect Evaluation For Comprehensive Down’s Syndrome Screening Intervention At Pudong District In Shanghai

I.BackgroundDown’s syndrome (Down’s syndrome, DS) also known as trisomy21, is a chromosomal condition caused by the presence of all or part of a third copy of chromosome21. Down syndrome is the most common chromosome abnormality in humans. It brings heavy mental and economic burden to family and society. So far there is no medicine to cure, primary and secondary prevention which reduce the number of defective baby birth become the fundamental measure to control the disease. Since1970’s, the Down’s syndrome screening and diagnosis as kind of economic and effective birth defects prevention and control measures, has been widely used in the world. Some developed countries have put Down’s syndrome screening into the routine prenatal care program or provide special national free screening program. Many studies indicated that social, economic, cultural and other factors may affect the popularization and application of prenatal screening technology. There are little researches aiming at carrying out intervention on these factors. Therefore, it is significant to implement a comprehensive community intervention based on understanding the local District Down’s syndrome prenatal screening service status and influence factors.Ⅱ.Study goalThe study is designed to implement a comprehensive Down’s syndrome screening intervention which based on health belief model, to increase the cognitive level of target population on Down’s syndrome and prenatal screening service, enhance their intention to use screening service, and finally to increase the Down’s syndrome screening coverage in Pudong district Shanghai. Ⅲ.Study contents and methodologies1. Cross sectional survey method and non randomized stratified cluster sampling techniques were used in the study.10towns were selected as study sites.1397postpartum women who lived in Pudong district more than6months were surveyed after they left hospital in one week. Community general practitioner (GP) interviewed every participator with constructed questionnaire. Questionnaire content included demography, attitude, knowledge, intention to attendance of prenatal screening for Down’s syndrome, actual utilization of screening service and relative social resource etc.2. Framework approach was used to analyze the qualitative data and to find the demands for Down’s syndrome screening service and possible measures for intervention on providing screening services. Then based on Health Belief Model, a comprehensive intervention was developed.3towns were selected as intervention communities,3towns as control communities where provided the routine prenatal service. After1year intervention, the Down’s syndrome screening cognition, intentions to attendance of screening and actual screening attendance rate were compared between intervention and control groups.Ⅳ.Main study results1.1397postpartum women were included in this survey, their average age is28.97±3.64years, and all of them are permanent residents.887(63.72%) women are local residents,431women are migrant women (36.28%).1279women (91.55%) said they heard of Down’s syndrome before, but49.79%of them did not understand the nature and harm of this disease. Down’s screening awareness rate is78.42%.863women (61.78%) participated in prenatal screening for Down’s syndrome. Among534women who did not attended prenatal screening for Down’s syndrome during pregnancy,118(22.10%) women of them had never heard of a Down’s syndrome,276women (51.67%) did not know prenatal screening,96women (17.98%) missed the suitable time for screening,44women (8.23%) did not think it is necessary, or the distance was too far or the examination fees was too expensive. 2. Univariate analysis results showed that prenatal Down’s syndrome screening attendance was associated with educational level, occupation, household register, family income, whether have insurance, whether to participate in the school for pregnant women. The results of multivariate analysis showed the attendance of prenatal Down’s syndrome screening was associated with household registration in the city (OR=1.91), bachelor degree (OR=1.51), company staff (OR=1.39), income of4000-8000yuan per month (OR=2.01), income of more than8000yuan per month (OR=3.20), insurance (OR=1.40) and participated in the school for pregnant women (OR=1.55).3.1339pregnant women who are permanent residents participated in this research, including695women in the intervention group,644women in the control group. Two groups of subjects showed no differences in the basic characteristics of household register, age, education and medical insurance except some differences in occupation structure (P=0.01). In the intervention group88.35%pregnant women knew prenatal screening for Down’s syndrome when they registered in early pregnancy, while79.97%women knew it in the control group, the difference between two groups was statistically significant (p<0.001). Multivariate Logistic regression model analysis showed that, after adjusted by other factors (age, household registration, education, occupation, income, whether Medicare) intervention still has significant effect (OR=1.86) on increasing cognitive level on prenatal screening for Down’s syndrome. In the intervention group614(89.25%) women who knew prenatal screening said they would attend prenatal screening for Down’s syndrome during pregnancy, in contrast this proportion was80.58%in the control group, the difference was statistically significant (p<0.001). Multivariate analysis showed that after adjusted other factors, the intention to attend prenatal screening for Down’s syndrome in the intervention group was still higher than that in control group (OR=2.12). In Intervention group the rate of pregnant women attend to prenatal screening for Down’s syndrome was64.14%, in contrast to56.83%in the control group, the difference was statistically significant (p=0.006).The results of multivariate analysis showed, after adjusted by the relevant factors, the attendance rate of the intervention group Down’s syndrome prenatal screening is still higher than that of the control group (OR=1.30). V.Policy recommendation1. Enhancing community responsibility, constructing service network for prenatal screening for Down’s syndrome, popularizing community comprehensive intervention.According to the results of this study, the Down’s syndrome prenatal screening community intervention based on the theory of health belief model has definitely intervention effect. The community-based service model which has the functions of coordination and management, information system, health education and multiple functions is feasible, is recommended to be popularized in district. It is necessary to provide prenatal screening services to satisfy pregnant women health demand, then it will increase newly-married, before pregnancy and pregnant women’s awareness on prenatal screening for Down syndrome gradually, improve the target population using of prenatal screening service, make full use of health resources, and ultimately to reduce birth defects, improve the birth population quality.2. Health administration plays a good lead role and strengthens the construction of prenatal screening service network in Pudong district.On the basis of district health planning, Health administration should strengthen the construction of the prenatal screening service network, increase the number of service stations, and improve screening service geographic accessibility. The district MCH institute will be in charge of coordination, according to the actual needs of the local hospitals, to reach an agreement with the prenatal diagnosis center, to arrange a weekly scheduled time to provide pregnant women prenatal screening service and to improve the equity of prenatal screening services.