| ObjectiveTo understand the provision of health management services,utilization of maternal health management services and maternal health level in medical institutions in different ethnic areas of the central and western regions and analyze the influencing factors,and to improve their medical system,improve the medical environment,and improve the compliance of health management behaviors during pregnancy by comparing the differences between different ethnic areas.To provide corresponding data support for the health management of pregnant and lying-in women in central and western regions of China,especially in ethnic minority areas.Promote the government to formulate appropriate maternal and child health management policies and improve the quality of maternal and child health services in all regions of China.MethodThis study conducted cross-sectional studies in Henan Province,Sichuan Liangshan Yi Autonomous Prefecture,and Xigaze Region in Tibet from August to October 2016,mainly using probability sampling by capacity ratio(PPS).In terms of medical institutions,a total of 4county-level medical institutions and 22 township health centers under the jurisdiction of Henan Province;2 county-level medical institutions and 10 township health centers under the jurisdiction of Shi Ka Ze City,Tibet;and4 county-level medical institutions and 22 township health centers under the jurisdiction of Liangshan Prefecture,Sichuan Province were selected.In terms of pregnant women,8 pregnant women from each natural village in Henan and Sichuan were selected for investigation;5 pregnant women from each administrative village in Tibet were selected for investigation.A total of 948 women who have had a childbirth history in the past 5 years were selected for the questionnaire survey.Results1.Prenatal service provision of medical institutions: In terms of the number of maternal and child health care personnel,there were 109county-level medical institutions in Henan Province,including 39 full-time women’s health care workers;64 in township hospitals and 37 full-time women’s health care workers.There were 16 people in county-level medical institutions in the Tibet Autonomous Region,including 9 people in full-time women’s health care;12 people in township health centers and 8people in full-time women’s health care.There were 62 people in county-level medical institutions in Sichuan Province,including 25 people in full-time women’s health care;38 people in township health centers and14 people in full-time health care.From the perspective of academic qualifications,the maternal and child health care personnel of county and township medical institutions in Henan Province were mainly college graduates accounting for 62.5% and 54.1% respectively.In the county-level medical institutions in Tibet,66.7% of the maternal and child health personnel had a college degree,56.3% of the township level had a technical secondary school degree;78.9% of county-level medical institutions in the Sichuan survey area had a college degree,and 59.7% of township-level medical institutions had a technical secondary school degree.The major was a college degree,accounting for 59.7%.Regarding the allocation of 14 prenatal health care items,the allocation rates of medical institutions at the county and township levels in Henan survey area were 98.2% and 77.9%,respectively;the allocation rates of medical institutions at the county and township levels in Tibet survey area were 92.9% and 70.1%,respectively;those in Sichuan survey area were 94.6% and 58.1%,respectively.2.Provision of services during childbirth in medical institutions:90.1% of the counties in Henan province were hospitalized for delivery,and 34.8% were cesarean section.None of the county and township medical institutions in the Tibet survey area carried out cesarean section,and the county’s hospital delivery rate was 46.2%.The cesarean section in the counties in the survey area of Sichuan Province accounted for 11.33%;the county’s hospital delivery rate was 84.9%.In terms of obstetric first aid,all county-level medical institutions in the Henan can provide six obstetric first aid services including parabolic delivery and emergency cesarean section.The township health center does not provide enough other services except for the delivery of normal delivery.Medical institutions at the county and township levels in the Tibet Autonomous Region can provide delivery services and corresponding emergency medications within 24hours;50.0% of county-level medical institutions in the surveyed areas of Sichuan Province can provide 6 obstetric emergency services including paranatal and emergency cesarean section.All township health centers cannot provide emergency cesarean section services.In terms of personnel,the total number of obstetricians in county-level medical institutions in Henan was 62,and the ratio of obstetrics to nurses was 1:1.15;the total number of obstetricians in county-level medical institutions in Tibet is 8and the ratio of physicians to nurses was 1:0.25;the total number of obstetricians in county-level medical institutions in Sichuan Province was27 People,the ratio of doctors to nurses was 1:0.70.A survey was conducted on 16 items of equipment and facilities for production and childbirth.The allocation rates of medical institutions at the county and township levels in the Henan survey area were 98.4% and 43.2%,respectively;the allocation rates at the county and township levels in the Tibet survey area were 78.1% and 36.9%;in Liangshan,Sichuan,the allocation rates at the county and township levels was 50.0% and 9.1%respectively.3.Postpartum service provision of medical institutions: In terms of the configuration of equipment and facilities required for 12 postpartum wards,the allocation rates of county and township medical institutions in the Henan survey area were 93.8% and 57.2%,respectively;the overall allocation rate of county-level medical institutions in Tibet The rate was66.7%,and that of the township health center was 40.8%.The overall allocation of production and delivery articles in county-level medical institutions and township health centers in Sichuan survey area was 79.2%,the township health centers was 21.3%.In terms of postpartum visits,86.6% of postpartum visits were in county-level medical institutions and45.5% were in township health centers in Henan Province.The medical institutions at the county and township levels in Tibet were 80.2% and 30%,respectively.The county and township institutions in Sichuan Liangshan area accounted for 63.7% and 18.2% respectively.In terms of the 42-day postpartum visit rate,Henan county-level medical institutions accounted for 75.0%,township hospitals accounted for 18.2%,Tibet county and township medical institutions were 50.0% and 20.0%,and Sichuan Liangshan area county and township institutions were 50.0% and 9.1%.Postpartum visit related services,the three regions of the county,township level medical institutions related to 5 services can not be provided.4.Utilization of maternal health management services: In this survey,the prenatal checkup rate was 89.3%,the standardized prenatal checkup rate was 33.5% and the average number of prenatal checkups was 4.6.The hospital delivery rate of survey subjects was 82.9%,and that of Henan,Sichuan,and Tibet was 91.8%,77.7%,and 84.6%,respectively.In terms of delivery methods,723 subjects chose natural delivery,and 225 chose cesarean section.The rate of cesarean section was 23.7%.The utilization rate of postpartum visits was 72.3%,and the incidence of postpartum depression was 18.4%.41% of pregnant women were not aware of relevant health knowledge and 19.8% of pregnant women had not supplemented relevant nutritional preparations during pregnancy.Low birth weight infants accounted for 13.5%,and the incidence of postpartum depression was 18.4%.5.Multivariate logistic regression analysis showed that the main factors that affect pregnant women’s prenatal checkups include: per capita net annual income,age,to the nearest medical institution It takes time,whether to participate in medical insurance;different ethnic groups,education level,whether to participate in medical insurance and number of deliveries was the main influencing factor for standard prenatal examination.The main factors affecting the hospital delivery of pregnant women were: educational level,per capita net annual income,age,time to the nearest medical institution.The main factors that affect pregnant women receiving postpartum visits were: education level,per capita net annual income,until recently The time required by the recent medical institution.The main factors affecting the occurrence of postpartum depression in pregnant women were region,age,mode of delivery,postpartum visits and health knowledge;The main influencing factors of low birth weight infants were: health behavior and health knowledge.ConclusionThe maternal health level in the survey area needs,especially the health knowledge and health behavior of the Yi ethnic group in Sichuan and Tibetan areas in Tibet need to be improved,and there are significant regional differences.And postpartum depression and low birth weight of newborns are more serious.It is necessary to focus on women from ethnic minorities in Sichuan and Tibet and focus on women with negative emotions during pregnancy.Perinatal attention combined with related factors to carry out a variety of forms of health and nutrition guidance.The allocation of equipment and facilities required for maternal health management services in medical institutions at the county and township levels in the investigated areas was generally poor.In particular,compared with Henan investigation area,Tibet Autonomous Region and Sichuan Liangshan Yi Autonomous Prefecture urgently need to improve the allocation rate of health care articles,the allocation rate of obstetric-related production and delivery articles and the allocation rate of postpartum ward articles.The quantity and quality of women’s health personnel and obstetric medical personnel need to be improved urgently.In terms of the provision of maternal health management services,the county-level institutions in the three places are generally better than the township health centers,but the overall service level and service quality of the two-level medical institutions still need to be further improved,especially the basic obstetric service level and emergency service capacity.The overall utilization of maternal health management services in the surveyed areas is generally insufficient.There are still some pregnant women who cannot regularly perform prenatal check-ups as required,and their awareness of actively acquiring health management is not strong.In addition,the hospital delivery rate still has a certain gap from the national requirements.It is necessary to further improve the hospital delivery situation based on the main influencing factors in different regions. |
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