Study On Health Services Needs, Utilization And Intervention For Reproductive System Diseases In Disadvantaged Married Women In Changning Distircit, Shanghai

Reproductive system diseases are harmful to women health and as well affect the harmonized development of society. Only limited portion of disadvantaged married women, including retired women and poverty-stricken women, may use health services when they have reproductive system diseases. So far, few interventional studies are focus on this population.The objectives of this study are to describe the prevalence of reproductive system diseases,as well as the health services needs and utilization of disadvantaged married women in Shanghai, to analyze the problems and factors, to discuss the intervention on reproductive health of the population, and to provide a suggestion to control reproductive system diseases in disadvantaged married women in Shanghai.Part I Cross-sectional study on health services needs and utilization for reproductive system diseases in poverty-stricken women in Changning District, ShanghaiObject To describe the KAP and prevalence of reproductive system diseases, as well as the health services needs and utilization of married poverty-stricken women in Changning District,Shanghai. To provide a suggestion to control reproductive system diseases in disadvantaged married women in Shanghai.Methods1487married poverty-stricken women in Changning District were selected for the gynecological census and questionnaire investigation. The gynecological census included gynecological and breast examination, transvaginal ultrasonography, infrared breast examination,vaginal secretion samples detection, and cervical cytological examination. The questionnaire included social demography, KAP related reproductive system diseases, as well as health needs and utilization for reproductive system diseases.Result There are totally1487married poverty-stricken women took part in the gynecological census, and1073among these answered the questionnaire. The average score for the knowledge of reproductive system diseases is66.4±14.3. The women with educational level above senior high school has much higher score than those women with lower educational level, which is below junior high school (P <0.001). There is only16.1%of the objects who got instructions from doctors and other professional persons. Most objects had a positive attitude to reproductive health care, but their related health habits needs to be improved.24.1%of the objects self-reported at least one kind of abnormal reproductive symptoms during the past2weeks.26.7%of the objects self-reported at least one kind of abnormal reproductive symptoms during the past6months. The awareness on reproductive health knowledge was negatively associated with the prevalence of abnormal reproductive symptoms during the past2weeks (P=0.007) and6months(P=0.040).50.6%of the objects who had abnormal reproductive symptoms during the past2weeks and62.1%of the objects who had abnormal reproductive symptoms during the past6months did not seek for treatment. The main reasons were financial difficulties and self-feeling well. There is46.3%of the objects did not have periodic gynecological examination. The main reasons were financial difficulties.time constraint and no need. The detection rate of gynecological census was86.1%, and61.2%of them did not have self-report symptoms. Top three diseases were lobular hyperplasia of mammary gland, abnormal cervical pap smear, and uterine myoma. Generally, most objects has big demand for general gynecological examination and76.1%of them claimed the cost need to be paid by the government.Part II Feasibility study of intervention on clinic visiting rate of disadvantaged married women (retired or poverty-stricken women) with reproductive system diseases after gynecological census in Jiangsu Community of Changning DistrictObject To evaluate the effectiveness and feasibility of intervention measures on improving chinic visiting rate of disadvantaged married women (retired or poverty-stricken women) with reproductive system diseases after gynecological census. To provide a suggestion on enhancing the rate for clinic visiting.Method Retired or poverty-stricken women who took part in the gynecological census and had positive result in Jiangsu Community of Changning District were selected. Baseline survey was done half year after the gynecological census. Followed by took comprehensive intervention measures and surveyed one year after the intervention. And the community doctors were also invited for the appraisal.Result Totally1569retired or poverty-stricken women took part in the gynecological census,and774were detected with disease, the rate was49.33%. The clinic visiting rate was36.27%half year after the gynecological census and was54.48%one year after the intervention. The baseline clinic visiting rate of retired women was higher than that of poverty-stricken women. The education level was positive related to the clinic visiting rate after intervention. Both baseline clinic visiting rate and clinic visiting rate after intervention were positive related to self-reported severity of diseases.Conclution Disadvantaged married women had a positive attitude towards reproductive heath, but their knowledge and behaviors should be improved. This population had a high prevalence of reproductive system diseases and with low utilization of health service.The intervention on supervising clinic visiting by community doctors could increase the clinic visiting rate.