Reproductive Health Status And Its Affecting Factors Of Rural Population In Ningxia

Objective: It is well known that reproductive health is considered to be one of the fundamental human rights,which has gained wide attention from the field of public health.Currently,there are few studies investigating the status of reproductive health in Ningxia Province,especially in rural areas.The population involved in this study are male infants aged between 0-3,male and female adolescents,as well as male and female adults of reproductive age in rural areas of Ningxia.Focusing on the different reproductive health status in different physiological stages,we conducted a comprehensive assessment of growth and development characteristics,reproductive health status and its affecting factors on people of different age groups.This research aims to reveal the latest status of reproductive health in the population of rural Ningxia and provides a thorough understanding of people's demand for reproductive health services and the effect of current service by the relevant health providers,thus exploring a pathway to formulate an optimal strategy of reproductive health management in rural Ningxia,which would provide a theoretical reference for health policy makers.Method: The reproductive health status of rural population in Ningxia was investigated by using the random sampling method.After sampling,4477 male infants of 0-3 years old were enrolled and examined mainly by questionnaire,physical examination and external reproductive organs.1847 adolescents(male and female)were enrolled and investigated by questionnaire survey and physical examination and measurement pubertal secondary sexual stage.1990 adults(male and female)of childbearing age were enrolled and investigated by questionnaire survey,physical and laboratory examinations.919 rural childbearing adults were enrolled and investigated by questionnaire of knowing-attitude-participation on reproductive health.Results:(1)The reproductive health status and its affecting factors in infants of 0-3 years oldThe mean height of 4477 male infants aged 0-3 years investigated in this study was higher than that of the national standard of China,and the mean weight was comparable to that of the national standard.The body length and weight of male infants aged 2-9 months were equivalent to the national standard.The mean body length of 12-36 month old male infants was lower than the national standard,while their mean weight was above the national standard.Among the investigated male infants,0.83% had birth defects in the external reproductive organs,of which 0.01% had hypospadias,0.42% had unilateral cryptorchidism,0.38% had bilateral cryptorchidism,0.02% had hermaphrodites,and 0.07 % had malformation of external reproductive organs.Poisson regression showed that the incidence of birth defects in term infants was lower than that in infants with preterm birth(OR = 0.958,P< 0.05).The incidence of birth defects in underweight infants was higher than that of infants with normal birth weight(OR = 1.042,P < 0.05).(2)Reproductive health status and its affecting factors in adolescents of rural areas in NingxiaComparing with the historical data collected in 1985,1995 and 2005,the current research data obtained in 2016 revealed that the average height of male teenagers aged 11-18 years was significantly higher,except for that of boys aged 13 and 17 years.Meanwhile,the mean height of female adolescents obtained currently was also higher compared to the old data.Furthermore,the average weight of both male and female teenagers had increased compared to historical data(P < 0.05),except for that in 16-year-old boys and 10-year-old girls.The increase in the height and weight of male and female adolescents in rural Ningxia during 1985-2016 decreased with time,indicating that the increasing trend of height and weight gradually slowed down with time.The mean age of the first spermatorrhea in male adolescents was 13.07±0.95 years and the mean age of male to reach a Gardner G2 level of reproductive organs was 12.60 ± 2.60 years.The mean age of male adolescents for their testicular volume(TV)to reach above 4 ml(sign for the start of puberty)was 12.40 ± 0.85 years.Pubic hair was developed to Tanner stage PH2 at an average age of 13.49 ± 1.05 years.Among the male adolescents,61.2% were classified as premature because their first age of spermatorrhea was before 13.2 years while only 4.6% of them had delayed growth(first age of spermatorrhea ? 16.5 years).Multivariable analysis showed that the incidence of premature puberty in Hui and other minority groups was higher than that of Han ethnics(OR = 1.905,P < 0.001).The incidence of premature puberty in boys with a grip strength of 32-38.4 kg was lower than that in boys with a grip strength of 14.9-31.9 kg(OR = 0.615,P < 0.05).The incidence of delayed puberty in Hui and other minority groups was lower than that in Han ethnics(OR = 0.431,P < 0.05).Abnormal foreskin was seen in 66.1% of male adolescents investigated in this study.The incidence of atypical prepuce in male aged 14 years was lower than that in male adolescents aged 11-12 years(OR = 0.339,P <0.001).The incidence of abnormal prepuce was higher in male adolescents with poorer self-rated life status than those with better self-rated life status(OR = 3.189,P <0.05).Varicose veins(VC)was seen in 14.1% of the male adolescents.The incidence of VC in male adolescents aged 14,15 and 16-18 was higher than that in boys aged 11-12 years(OR = 0.343,0.212 and 0.09,respectively,P < 0.001).The mean menarche age of female adolescents was 12.60 ± 1.20 years among the population evaluated in this study.They reached to a female pubertal secondary sexual stage of SSC2 at a mean age of 11.17 ± 0.81 years.The mean age to reach stage B2 of breast development was 12.38 ± 1.89 years and 14.82 ± 2.03 to reach stage Tanner ? of pubic hair.Among the participants,13.1% were found to be premature(age of menarche ? 11.5 years)while 5.5% had delayed puberty(age of menarche ?14.3 years).The incidence of premature puberty was lower in female adolescents aged 13-14,15-16 years than that in girls aged 11-12 years(OR = 0.034,OR = 0.021,OR = 0.01,P < 0.001).The incidence of delayed puberty in girls with the age of 17 and 18-21 were higher than that in girls aged 11-16 years old(OR = 2.861,OR = 25.377,P < 0.001).The incidence of delayed puberty in adolescent girls in high school was higher than those in primary school(OR = 3.876,P < 0.001).The incidence of delayed puberty in self-rated extroverts and neuter were lower than those self-rated as introverts(OR = 0.47 and 0.191,P < 0.05).(3)Reproductive health,KAP(Knowledge-attitude-practice)and their affecting factors among the population of child-bearing age in rural NingxiaAmong the population of male child-bearing age investigated,8.2 % had VC,4.3% had redundant foreskin,0.1% had phimosis,and 0.4% were Treponema palladium positive.Multivariable analysis of VC revealed that participants with an educational background of high school or technical school were less likely to have VC compared to those with junior school degrees or below(OR = 0.045 and 0.088,P < 0.001).The incidence of VC was lower in meat-eating people compared with meat-and-egg vegetarians(OR = 0.049,P < 0.05).Univariate analysis of men with redundant prepuce showed that the possibilities of having abnormal foreskin were higher in those who reported stress in life and work compared with those who did not report stress(P < 0.05).Poisson regression on participants with positive Treponema palladium revealed that those who had exposure to risk factors during living and working had a higher probability to get positive Treponema palladium test(OR=1.300E-06,P<0.001),and those with normal resting heart rate was less likely to have positive Treponema palladium test than those with abnormal resting heart rate(OR=9.310E-07,P <0.001).Abnormal vaginal cleanliness was seen in 32.5% of women with childbearing age.Multivariable analysis revealed that women who are 21-30,31-40,and 41-50 years old were more likely to have an abnormal vaginal cleanliness screening test compared to those ? 20 years old(OR = 6.593,22.936 and 10.972,P < 0.05).The incidence of positive vaginal cleanliness screening in Hui and other ethnic groups was lower than that in women of Han ethnic(OR = 0.533,P < 0.05).Women who had junior high school,high school/secondary school/secondary technical school,college degrees or above had a lower positive rate than those with primary school degree or below(OR = 0.398,0.414 and 0.395,P < 0.05).Women with reported exposure to passive smoking had higher incidence of positive vaginal cleanliness screening(OR = 0.043,P <0.05).Women who reported stress from life had a higher incidence of positive vaginal cleanliness screening(OR = 4.273,P < 0.001).Positive vaginal cleanliness screening was less likely to occur in women with dysmenorrhea(OR = 0.055,P < 0.001).Women who used intrauterine device(IUD)as contraceptive measure had a higher probability of having positive vaginal screening(OR = 1.890,P < 0.05).Among the investigated population,9.5% had a history of abortion,of which 7.4% had once,2.0% had twice and 0.1% had 3 times of abortion.Multivariable analysis showed that women with the age of 21-30,31-40 and 41-50 had higher rate of abortion than women with age ? 20(OR=2.559,4.513 and 8.911,P < 0.05).Women of Hui ethnicity had lower rate of abortion than those of other ethnicities(OR=0.481,P < 0.05).The largest proportion of the population(63.0%-66.5%)took IUD as a contraceptive approach in rural Ningxia,followed by tubal ligation(13.4%,22.1%).Condom(3.6%,0.0%)was the least adopted approach.Contraceptive measures were determined by husbands in 14.0% of males and 7.0% of females investigated and determined by wives in 35.3% of males and 17.6% of females.Contraceptive measures were determined by the couple in consensus in 29.4% males and 58.2% females investigated.There was a statistical difference between male and female in the decision of contraceptive methods(P < 0.001).Female participants were more knowledgeable than men in the principals and matters that needed to be noticed(P < 0.001),4.7% and 74.9% of the males and females were very familiar with these knowledge,respectively.Female participants were more satisfied than men with current birth-control methods used(P < 0.001),with satisfaction rate among men and women to be 71.8% and 83.9%,respectively.Multiple mediating effect analysis showed that "education" and "whether the knowledge about contraceptive methods was previously introduced" played an intermediary role in "female contraceptive satisfaction"(LLCI=0.042,ULCI=0.257;LLCI=-0.189,ULCI=-0.011).In addition,"Education level" played an important role in "satisfaction with male contraceptive methods"(LLCI=-0.003,ULCI=0.012)as an intermediary variable.Conclusions:(1)In rural Ningxia,infants aged birth to 12 months had a similar growth status to the Chinese national standard.However,infants aged 13-36 months had a shorter body length and a heavier body weight than the national standard,showing a stout body stature.(2)The growth and development of adolescents in rural Ningxia showed a long-term growth trend,which slowed down in recent years.The secondary sexual characteristics also showed the similar pattern,which was associated with delayed puberty.Pubertal developmental abnormalities occurred in a certain proportion of population in both genders.The main affecting factors of adolescent development were ethnic groups,as well as physical and psychological factors.(3)The incidence of VC and redundant foreskin in males of childbearing age in rural Ningxia were 8.2% and 4.3%,respectively.The incidence of syphilis(determined by positive Treponema palladium test)was 0.4%(400/100 thousand).The main affecting factors were education level,psychological factors,and life habits.The incidence of reproductive tract infections(RTIs)among women in rural Ningxia was 32.5%,and its affecting factors were age,ethnics,education level,and psychological factors.(4)The types of contraceptive measures adopted by married men and women of childbearing age in rural Ningxia were relatively simple.The combined utilization rate of IUD and tubal ligation reached 76%-89%,while other contraceptive methods only accounted for 4%-11% of the total utilization rate.(5)Married men of childbearing age in rural Ningxia did not fully fulfill their responsibilities and obligations in reproductive health,and were still more likely to be bystanders rather than active practitioners.The recognition and conception of reproductive health among the rural population in Ningxia are still primitive and remains to be improved.Despite the public education programs,the actual effect on the improvement of reproductive health still cannot meet the actual needs of this population.Educational level and the detailed introduction of the principle and mechanism of the method for birth control birth had an intermediary effect on the satisfaction of the contraceptive methods used by adults of child-bearing age.