Study On Maternal Health Services For Floating Population In Ethnic Minority Regions

Objective:The floating population is non-negligible group and is of an important labor productivity in contemporary society.The pregnant and lying in women is a special group of floating population,occupying a large proportion of pregnant women in this region.It is of great significance to improve the local maternal health care quality and realize eugenics and good breeding by doing a good job of health care service for floating population pregnant and lying in women.Therefore,to understand their utilization of health care services and delivery outcomes,analyze the existing problems,and put forward improvement measures,so as to provide reference for the local government and relevant departments to formulate maternal health policies,so as to improve the quality of maternal health care services for floating population,we take the pregnant and lying in women as the research subjects.We will focus on the Youjiang District of Baise City,which is a national minority area,to improve the quality of the population born in the old revolutionary area and share the fruits of the development of the motherland.Methods:(1)Sample surveys.Using cluster sampling method,from Guangxi National Health Information Platform--Guangxi population health information business application sub platform,all singleton delivery pregnant women registered in 2 streets,4 towns,2 townships and1 ethnic township in Youjiang District of Baise City from January 2016 to December 2018 were selected as the research objects The medical records of hospitalized childbirth were matched,and the related information such as delivery was exported.The incomplete main information was deleted and the data of pregnant and lying in women were integrated.The research objects are divided into two groups,one group is the floating population group,that is,the nonregistered population group;the other group is the household registration population group,namely,the household registration of Youjiang district.Logistic analysis was used to analyze the causes of death,perinatal complications and perinatal complications between the two groups.(2)Questionnaire and interview.The self-made questionnaire was used to investigate the subjects.The basic information of pregnant women and the utilization of health care services were collected.Logistic regression analysis was used to analyze the related factors affecting the number of prenatal examination;the pregnant and lying in women,maternal and child health care staff and health care management personnel were interviewed respectively to investigate the health care knowledge,health care service awareness and health management of relevant personnel.Results:(1)18403 singleton pregnant women were included in this study.Among them,there were12108 cases of pregnant and lying in women registered,accounting for 65.79%;6295 cases of pregnant and lying in women floating,accounting for 34.21%.The proportion of minority nationalities in the two groups was more than 70%,and the proportion of Zhuang nationality was the highest,which reflected the regional characteristics of ethnic areas.(2)The proportion of subjects taking folic acid and using medical insurance reimbursement in the registered group was higher than that in the floating group.52.8% of the floating population group had more than or equal to three pregnancies,which was higher than that of the household registration group.The difference between the two groups was significant(P < 0.05).The proportion of maternal and child health care manual established before 13 weeks of gestation,the number of times of birth examination more than 5 and the number of postpartum follow-up greater than or equal to 2 times in the floating population group were higher than those in the floating population group,and the difference between the two groups was significant(P < 0.05).In the comparison of pregnancy complications and complications,the floating population group had higher incidence of pregnancy induced hypertension,preeclampsia,gestational diabetes,intrahepatic cholestasis of pregnancy,hepatitis B virus infection,anemia,premature rupture of membranes,polyhydramnios,placental abruption,placenta previa,placenta accreta and postpartum hemorrhage in the floating population group were higher than those in the household registration group(P < 0.05).(3)Pregnancy outcome: the proportion of cesarean section in the registered group was higher than that in the floating group,and the neonatal asphyxia rate in the registered group was lower than that in the floating group,with significant difference(P < 0.05).There were significantdifferences between the two groups in the gestational weeks of delivery and the distribution of neonatal birth weight(P < 0.05).The perinatal mortality rate decreased gradually.Among the causes of perinatal death,fetal factors and maternal factors were the top two.Logistic regression analysis of high risk factors of perinatal death showed that perinatal adverse outcomes were significantly correlated with maternal age,times of birth examination,birth weight,gestational weeks,gestational diabetes and anemia.(4)Questionnaire survey and interview found that the situation of early pregnancy registration,economic income,Internet application evaluation score were the influencing factors of maternal health service utilization of floating population;significant association was found in age,education background,health service knowledge,early pregnancy registration situation,government health education service,economic income(P < 0.05).subjects with older age,more than 8 times of prenatal examination,better education background,higher family monthly income,the richer the health care knowledge,better health education and other government services,had higher frequency of prenatal examination.The interview also found that many pregnant women did not fully accept the professional health education provided by maternal and child health institutions before delivery,and the awareness rate of migrant pregnant women on health service related policies was relatively low,and the accessibility of health care services was poor.The work intensity of maternal and child health care personnel was high,while the service initiative was and the information management level of maternal health care was not high.Results:(1)Youjiang District of Baise City,as an ethnic minority area,has achieved good results in maternal health services and management of floating population.However,there are still weak links in the construction of early pregnancy books,health education,post-natal visits and so on,which need to be further improved in the future.(2)Maternal and child health care institutions need further improvement of the quality of health care services,especially in floating population pregnant women,to reduce the incidence of maternal gestational hypertension,gestational diabetes,anemia and other complications and complications.(3)We recommend maternal and child health institutions further strengthen maternalhealth services and management of the floating population,in particular maternal health awareness-raising and pre-pregnancy health education,especially for the less educated floating population,in order to improve compliance with maternal health services.(4)We suggest that local governments should play a leading role in further improvement of the medical insurance system and initiative of primary maternal and child health care personnel and responsibilities of all relevant departments,to realize the scientific management of grass-roots health care organizations such as community health service institutions and establish a unified maternal health care management system.Efforts should be made to promote the informatization of maternal health services,and to speed up the construction of a new model of "Internet plus" medical association,and to break the institutional constraints of the existing organizational structure of administrative subordinate medical management institutions,and to carry out extensive and close business cooperation between diagnosis and treatment hospitals,improve the level of comprehensive diagnosis and treatment services in urban and primary health care institutions,and to improve the accessibility and quality of maternal and child health care services,and to improve the quality of the birth population.