Analysis Of Influencing Factors On Utilization Of Prenatal Screening Service For Down's Syndrome In Zhejiang Province

[BACKGROUND]Prenatal screening for Down's syndrome has been included in standard practice in many western countries. However, prenatal screening for Down's syndrome is not offered as a component of prenatal care routinely in China. And there are few researches to inverstigate the utilization of prenatal screening. The reasons and influencing factors for prenatal screening are unknown. Therefore, it is necessary to explore underlying reasons for or against prenatal screening and the factors that facilitate/impede use of prenatal screening service for Down's syndrome.[OBJECTIVE]This study aims to find out the factors that facilitate/impede the use of prenatal screening service for Down's syndrome from the demand viewpoint, and provide policy suggestions for the health administration to improve maternal and child health in Zhejiang province.[CONTENTS]1. Analyse the influencing factors that facilitate/impede use of prenatal screening service for Down's syndrome2. Analyse the willingness to accept prenatal screening and prenatal diagnosis services for Down's syndrome after the knowledge of prenatal screening for Down's syndrome was educated3. Study on the willingness to pay for the prenatal screening for Down's syndrome4. Qualitive interviews were adoptted to further understand the influencing factors that facilitate/impede use of prenatal screening service for Down's syndrome and the reasons that accept/decline prenatal screening service for Down's syndrome[METHODOLOGY]Typical investigation was carried out in Huzhou and Quzhou of Zhejiang province. 15 health insitutions were selected as field sites and 1416 parturients were surveyed. Data collection methods included questionnaire survey and focus group discussion. Epidata2.0 was used to do data entry and SPSS11.5 software was used to do data analysis. The major statistics are Pearson X~2, Wilcoxon two sample test, Kappa test and Logistic regression analysis.[RESULTS]1. Research on the use of prenatal screening service for Down's syndrome in investigation sitesOn the whole, only 49.68 %(1416) of parturients had accepted the prenatal screening for Down's syndrome. And the number of people who received prenatal screening services in Huzhou was more than that in Quzhou. Awareness of serum prenatal screening for Down's syndrome in Huzhou was higher than that of Quzhou. Prenatal screeing knowledge and information was gained mainly from the medical personnel both in Huzhou and Quzhou.The primary reason for accepting was ' in order to have a healthy baby, screening was very important' , accounting for 97.56%. The top three reasons for not accepting prenatal screening for Down's are 'have not heard of (74.39%), 'screening time has passed'(10.48%) and 'Heard, but feel that there was no need to do' (9.92%). The top three reasons for not accepting prenatal screening for Down's syndrome in the two investigation sites are as same as those of urban and rural household registration. Of the 10 parturients who not received prenatal amniotic diagnosis, the main reason for not accepting are ' considering a risk, fear of abortion' (50.00%).2. Research about the influencing factors that facilitate/impede use of prenatal screening service for Down's syndromeThe results showed that prenatal examination, household registration, attitude toward prenatal screening, investigation sites, health education and receiving advice from health care providers are significant predictors of prenatal screening for Down's syndrome. Receiving advice from health care providers was the most significant predictors of prenatal screening for Down's syndrome. Age, household registration, attitude toward prenatal screening and receiving advice from health care providers are significant predictors of prenatal screening for Down's syndrome in Huzhou and attitude toward prenatal screening was the most significant predictors of prenatal screening for Down's syndrome. Education, prenatal examination, attitude toward prenatal screening and receiving advice from health care providers are significant predictors of prenatal screening for Down's syndrome in Quzhou and receiving advice from health care providers was the most significant predictors of prenatal screening for Down's syndrome.3. Study on the willingness to accept prenatal screening service for Down's syndromeAfter the knowledge of prenatal screening for Down's syndrome was educated by the investigators, the respondents were asked the reason for accepting or declining the prenatal acreening and prenatal diagnosis for Down's syndrome. We found that 1292(91.12%) parturients were willingness to accept prenatal screening and 124 parturients will not accept. The main reason for accepting was 'in order to have a healthy baby, screening is very important' . The reasons for refusing were 'not applicable/necessary' (87.90%), 'too far away to access the hospital' (15.32%) and 'not affordable' (13.71%). Of the 155 parturients who will not received prenatal diagnosis, the top three reasons for not accepting were 'considering a risk, fear of abortion' (91.61%), 'There is no need to do' (31.61%) and 'familiy memebers not agree' (16.77%).4. The willingness to pay for the prenatal screening for Down's syndromeThe willingness to pay data for prenatal screening services showed that 82.49 percent of the respondents were willingness to pay higher than the current price of 120 yuan. An average amount of WTP of prenatal screening for Down's was 256.87 yuan in Huzhou and 218.16 yuan in Quzhou. Based on the current price for screening, parturients and their families can afford. Investigation sites, attitude toward prenatal screening, awareness of prenatal screening and average monthly household income were significant predictors of their WTP for prenatal screening.[ RECOMMENDATION ]Policy suggestions: 1) The health administration should pay more attention to prenatal screening and increase financial input for prevention and treatment of birth defects; 2) strengthen medical education and cultivate the professional talents to meet the social demands; 3) Increase the coverage of prenatal screening to improve the accecibility of prenatal screening service; 4) Doctors should play their roles in the process of providing prenatal screening services to facilitate the use of prenatal screening service; 5) Actively carry out health education to improve awareness of prenatal screening for pregnant women.