| objective:By researching the health status and health care services utilization of children aged0to6in poor families in Huining County of Gansu Provence, we want to find out problems and main factors influencing the health service utilization of these children, to provide basis for health and civil affairs department making policy to promote health care services utilization of children and to improve their health level.Methods:(1) Questionnaire:Based on comprehensive consideration of geography, traffic, economic level, maternal and child health work and the number of children aged0to6in poor families, six townships were extracted according to typical sampling method. Matched1:1scale,533children’s caretakers in poor and nonpoor families were respectively investigated.(2) Qualitative interview:In-depth interview was conducted with the charge of health and civil affairs bureau and heads of township health center. Focus group discussion was conducted with medical staff of pediatrics and obstetrics in county health station for women and children and People’s Hospital and children’s guardians in poor families.2administration officers,6heads of township health center,12health facility staff and24caretakers in poor families were interviewed.(3) Analysis Method:For questionnaire survey materials, we build a database through EpiData3.1with double input, and then analyze data with SPSS17.0. The median comparision use rank test, and the rate comparision use pearsonx2test, while the influencing factors adopt Logistic regress analysis The theme framework method is used for analyzing the qualitative materials.Results: 1.533children’s caretakers respectively in poor and nonpoor families were investigated in this investigation and the0-to-3age group which has the largest number, respectly accounted for80.7%and87.4%of the total. The mother has the the largest number, respectly accounted for95.1%and95.9%of the total.2. The caretakers in poor families had lower literacy than those in nonpoor families (P=0.013). Both annual income (P=0.000) and medical fees (P=0.019) of poor families were lower than nonpoor families.3. The nutrient levels of children aged0to6in poor families was lower than the children in nonpoor families, and the overall level was low. The prevalence of stunting of children in poor and nonpoor families were respectively27.7%and28.3%, which both were higher than the national average9.9%. The prevalence of underweight were respectively7.2%and6.4%, which also both were higher than the national average3.6%.4. The prevalence of infants follow-up in poor and nonpoor families were respectively70.4%and70.7%. In the reasons why didn’t undergoing follow-ups, about14.6%of caretakers thought it was no need or harmful, which was higher than that in nonpoor families6.4%(P=0.044).5. The rate of physical examination of children aged0to6in poor and nonpoor families were respectively69.6%and68.1%. The standard-reaching rate of physical examination of children in poor families was21.0%, which was lower than that in nonpoor families28.0%(P=0.016).The consciousness of caretakers in poor families to voluntarily accepte physical examination was poor, and they couldn’t come to township hospitals with their children for the purpose of physical examination because of their own conditions.6. The rate of establishing immunization card of children aged0to6both in poor and nonpoor families was over99.0%and the rate of getting DPT, polio, HBV and BCG vaccine was95%or so. But the rate of getting measles vaccine was low, which were recpectively89.6%and84.9%in poor and nonpoor families, bellowing the data95%prescribed by The campaign about strengthened immunization of measles vaccine over the country in2010.7. The two-week prevalence of diarrhea, cough, fever were respectively10.5%,16.0%and17.9%among children aged0to6in poor famiies. The two-week prevalence of diarrhea had no difference between different sets, and the rate of cough or fever in poor children was higher than that of nonpoor children. But the two week visiting rate of these diseases had no diffirent.8. The awareness rate of the caretakers in poor and nonpoor families didn’t know the policy that the state provides free health care service for children aged0to6were respectively11.1%and11.3%. The rate of early suckling were respectively16.5%and23.1%(P=0.007), and buth the adequate complemental food rate and the time of weaning were low. The rate of the caretakers in in poor and nonpoor families received no health education in any form were respectively10.0%and6.2%(P=0.024), and the form of promotional literature, television and lecture were the main channel that they hoped to accepte.9. Taking whether to undergo physical examination as the result variable that children aged0to6whethe to accept health care sevices, the analysis of influence factors was used. Improving the cultural level of caretakes, improving annual per capita income, accepting the infants follow-up and accepting health education were protective factors for children aged0to6in poor families to accepting health care service.10. The fund into maternal and child healthand human resources and equipment facilities in primary medical organizations, the health consciousness of caretakers and geography and traffic were main causes influencing thechildren’utilization of health care service.Conclusions:1. The nutritional level of children aged0to6in poor families was behind the children in nonpoor families, and the nutritional level of the tow sets belowed that of national average level.2. The health service utilization level of children aged0to6in poor families was poor than those in nonpoor families. The whole level was not high.3. The main influencing factors on child aged0to6years old in poor families are as follows:The offering capability of child health care service, the cultural level of caretakers, the level of health knowledge of caretakers, economic factors, geographical and traffic factors.Suggestions1. Increasing government investment and strengthening the basic medical institutions and talent development to improve service ability, Clearing understanding of organization division in medical institutions at all levels, while health institutions at county level should strengthen the guidance to basic medical institutions.2. Developing policy propaganda and health education of children’s caretakers in poor families to improve their health consciousness, Strengthening medical personnel training about basic skills to improve the effect of health education.3. Reinforcing the cooperation between department of health and Civil Affairs, and reinforcing the exchange of information and business cooperation to enhance resource-pooling about medical assistance and to perfect subsidy policies for poor families.4. Implementing the nutritional interventions, strengthening the promotion of nutritional knowledge on children’s guardians and spread scientific feeding knowledge, while establishing nutritional surveillance systems to reinforce surveillance. |
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