| [Background]Birth defects are the leading causes of infant and child deaths. It was estimated that the number of newly increased birth defects every year globally was over8,000,000in Global Birth Defects Report by United America in2006, in which90%occurred in low-and middle-income countries. China was one of the highestincidence areas of congenital developmental defects among the nations in the world. When the infant mortality rate dropped to about40%in a certain country or region, birth defects will be highlighted to be important health issues. With the infectious diseases have been gradually controlled, birth defects turn out to become a major public health issue in the field of maternal and child health in China. Birth defects are becoming the important causes for child mortality, morbidity, disability and poor life quality and the new challenge of health care service system in our nation.WHO recommended "tertiary prevention" strategy for birth defects prevention.Primary prevention has drawn growing concerns due to itseffective, proactive, economical and acceptable characteristics. Traditional birth defects prevention model focused on genetic factors, while ignoring social, environmental and behavioral factors. The key problem of primary prevention is to develop intervention programs in accordance with the local economic, cultural and social environment. However, there are few studies conducted aiming at Shanghai. Moreover, most of the domestic studies focus on one particular aspect in the service process. Comprehensive study in terms of clients, health service providers and administration is needed.[Objective]To describe the current status of primary prevention of birth defects inFengxian District, explore the possible influencing factors and propose strategies to improve or enhance primary prevention in terms of providers, clients and administrators through quantitative survey and qualitative interviews.[Methods]1. Quantitative survey:From January to June2012,760pregnant women (gestational age more than13weeks) who were newly diagnosed with pregnancy and had lived in Fengxian District for more than one year were investigated in obstetrics and gynecology clinics in all Community Health Service Centers in Fengxian District.115health care providers who had devoted themselves to clinical work in obstetrics and gynecology and maternal health care in recent3yearswere investigated.2. Qualitative study:Individual in-depth interviews were conducted to16pregnant women (8with and8without Shanghai household register),5health care providers on different levels and4administrators in relevant government and agencies.[Results]1. Current status of birth defects primary preventionCurrently relatively various birth defects primary prevention services were available in Fengxian District, including premarital health care, prenatal checkups, folic acid for all during periconceptional stage and health education through population school, newly marriage school, pregnancy school, etc. However, the survey showed that proportion of premarital examination was31.4%;35.3%of subjects took folic acid in three months before pregnancy and the first3months after pregnancy;28.6%participated in preconception examinations and12%in preconception counseling;22.1%of the subjects received eugenics training services; and55.3%established pregnancy cards before12gestational weeks. The situation of birth defects primary prevention utilization was not optimistic.2.Statistical analysis of influencing factors ofknowledge and behavior of clients(1) Statistical analysis of influencing factors of eugenicknowledge level of pregnant women:The overall situation of eugenic knowledge of subjects was good, but the knowledge of prevention congenital heart disease, poison understanding and cognitive level of folic acid was lacking. The results of Logistic regression model showed that pregnant women with Shanghai household register, higher education level and who had participated in the eugenics training programs had higher eugenic knowledge level.(2)Primary prevention and influencing factors’analysis:Logistic regression model of premarital checkups indicated that subjects who hadnon-local household register and higher household income, whose husbands were older and who believed the relationship of premarital checkups and eugenics, were more likely to receive premarital checkup services. Preconception checkup Logistic regression model pointed that pregnant women who were older, had participated in premarital examination and planned to get pregnant were more likely to receive preconception checkup services.(3) Demands:It was found that the demand for health education of eugenic health care was huge. The main sources for accessing eugenic knowledge were friends and family, books and advertising, and internet. The proportion of obtaining knowledge from medical staff was low. Subjects receiving services didn’t speak highly of the current services. More than1/3of the subjects believed that improvement with varying degrees was required.3. Eugenic knowledge and service status of health service providersThe total score of eugenic knowledge of health service providers was good, but the knowledge in folic acid, drug safety, genetics and congenital heart disease was insufficient. More than half of the medical personnel hadn’t participated in training programs for birth defects primary prevention and eugenics since they started their career. Human resources in medical institutions were strained. Maternal and child health care staff took several tasks at once in medical agencies on primary level and faced arduous clinical work in medical agencies on secondary level. The work mode mainly focused on prenatal-perinatal mode.[Conclusions]1.Primary prevention of birth defects was lack of interdepartmental effective coordination mechanisms and scientific guidance.The investigations showed that hygiene department and family planning departments are responsible for the primary prevention of birth defects,but they are lack of effective coordination mechanisms.Family planning department is mainly responsible for the primary prevention by carrying out the pregnant examination for the childbearing age couples.Hygiene department, while trying to implement a premarital-progestation-first trimester intervention,is difficult to substantive spread out, because of lack of the information and the population service network.2.Primary prevention of birth defects was lack of resources and service ability. Because of health human resource shortage and mainly taking on a large number of outpatient and management,the maternity and child care department was difficult to carry out a wide range of large primary prevention. Because of lack of medical background and adequate training, family planning staff had limited ability for the healthcare service.3.The service object was the lack of knowledge of eugenics, dissatisfied with existing services, which was affecting service utilization. The survey showed that the service object had cognitive deficiency and lower compliance for the knowledge of maternal periconceptional folic acid supplementation,There’s no significant difference of the eugenic knowledge cognitive level in the pre-marital check and pre-pregnancy check performers, which suggested the presence phenomenon of "value check over health education".The presence of health education and health promotion should be improved.It is recommended to take comprehensive measures to improve birth defects primary intervention services in accordance to key problems.1. Establish coordination mechanism on district level to improve scientific management level:2.Enhance service capacity:Increase financial input and support intervention in birth defects, including human resources and financial support. Add staffs of healthcare institutions, carry out the training of relevant knowledge, enhance the service capacity, open a counseling clinic or hotline to provide services for the object.3.Improve service use:Explore the cooperation forms for the health and family planning branch, In order to improve the healthy birth cognitive level, the health education and health promotion activities which was based on the community and the crowd-targeted, should be carried out deeply. Improve the service utilization and compliance. Further broaden the publicity channels, rich health education form, and expand the benefits to the floating population. |
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