Web-Based Training for Primary Healthcare Workers in Rural China: A Qualitative Exploration of Stakeholders’ Perceptions

BackgroundEquitable access to basic public health services is a priority in China. However, primary healthcare workers’ competence to deliver public health services is relatively poor because they lack professional training. Since the availability of web-based training has increased in China, the current study explored stakeholders’ perceptions of a web-based training program on basic public health services to understand their thoughts, experiences, and attitudes about it.MethodsSix focus group discussions with primary healthcare workers and three with directors of township hospitals, county-level Health Bureaus, and county-level Centers for Disease Control and Prevention were conducted in Yichang City during 2013. Semi-structured topic guides were used to facilitate qualitative data collection. Audio recordings of the sessions were transcribed verbatim and theme analysis was performed.ResultsMost of the study’s participants, especially the village doctors, had insufficient knowledge of basic public health services. The existing training program for primary healthcare workers consisted of ineffective traditional face-to-face sessions and often posed accessibility problems for the trainees. Most of the study’s participants had a positive attitude about web-based learning and expressed a strong desire to receive this novel training approach because of its flexibility and convenience. The perceived barriers to utilizing the web-based training method included poor computer literacy, lack of personal interaction, inadequate infrastructure, and lack of time and motivation. The facilitators of this approach included the training content applicability, the user-friendly and interactive learning format, and policy support.ConclusionsWeb-based training on basic public health services is a promising option in rural China. The findings of the study will contribute knowledge to implementation of web-based training in similar settings.     

The Financial Impact of the ‘Zero-Markup Policy for Essential Drugs’ on Patients in County Hospitals in Western Rural China

Objective

With a quasi-experimental design, this study aims to assess whether the Zero-markup Policy for Essential Drugs (ZPED) reduces the medical expense for patients at county hospitals, the major healthcare provider in rural China.

Methods

Data from Ningshan county hospital and Zhenping county hospital, China, include 2014 outpatient records and 9239 inpatient records. Quantitative methods are employed to evaluate ZPED. Both hospital-data difference-in-differences and individual-data regressions are applied to analyze the data from inpatient and outpatient departments.

Results

In absolute terms, the total expense per visit reduced by 19.02 CNY (3.12 USD) for outpatient services and 399.6 CNY (65.60 USD) for inpatient services. In relative terms, the expense per visit was reduced by 11% for both outpatient and inpatient services. Due to the reduction of inpatient expense, the estimated reduction of outpatient visits is 2% among the general population and 3.39% among users of outpatient services. The drug expense per visit dropped by 27.20 CNY (4.47 USD) for outpatient services and 278.7 CNY (45.75 USD) for inpatient services. The proportion of drug expense out of total expense per visit dropped by 11.73 percentage points in outpatient visits and by 3.92 percentage points in inpatient visits.

Conclusion

Implementation of ZPED is a benefit for patients in both absolute and relative terms. The absolute monetary reduction of the per-visit inpatient expense is 20 times of that in outpatient care. According to cross-price elasticity, the substitution between inpatient and outpatient due to the change in inpatient price is small. Furthermore, given that the relative reductions are the same for outpatient and inpatient visits, according to relative thinking theory, the incentive to utilize outpatient or inpatient care attributed to ZPED is equivalent, regardless of the 20-times price difference in absolute terms.     

Rural–urban gradient in seasonal forcing of measles transmission in Niger

Seasonally driven cycles of incidence have been consistently observed for a range of directly transmitted pathogens. Though frequently observed, the mechanism of seasonality for directly transmitted human pathogens is rarely well understood. Despite significant annual variation in magnitude, measles outbreaks in Niger consistently begin in the dry season and decline at the onset of the seasonal rains. We estimate the seasonal fluctuation in measles transmission rates for the 38 districts and urban centres of Niger, from 11 years of weekly incidence reports. We show that transmission rates are consistently in anti-phase to the rainfall patterns across the country. The strength of the seasonal forcing of transmission is not correlated with the latitudinal rainfall gradient, as would be expected if transmission rates were determined purely by environmental conditions. Rather, seasonal forcing is correlated with the population size, with larger seasonal fluctuation in more populous, urban areas. This pattern is consistent with seasonal variation in human density and contact rates due to agricultural cycles. The stronger seasonality in large cities drives deep inter-epidemic troughs and results in frequent local extinction of measles, which contrasts starkly to the conventional observation that large cities, by virtue of their size, act as reservoirs of measles.     

Conservation of Orchids in China

China, as one of the most important Range States of orchids in the world, has about 1300 species withabundant varieties of orchids. However, owing to over, abuse harvest and illegal trades, the wild populations ofthese species have declined dramatically, even bringing some species to the edge of extinction. In response to such challenges, the Chinese government has put conservation of orchids as a priority agenda, taking a series of Innovative and effective measures to protect the orchids in the wild.[第一段]     

Conservation of Orchids in China

China,as one of the most important Range States of orchids in the world, has about 1300 species with abundant varieties of orchids. However, owing to over, abuse harvest and illegal trades, the wild populations of these species have declined dramatically, even bringing some species to the edge of extinction. In response to such challenges, the Chinese     

Association of Serum Calcium and Hypertension Among Adolescents Aged 12–17 Years in the Rural Area of Northeast China

Calcium plays an important role in regulating body homeostasis. Several studies have reported the association between serum calcium and cardiovascular disease in adults. However, studies assessing the relationship between serum calcium and hypertension were limited, especially in subject populations of adolescents. The aim of the present study was to examine the association of serum calcium levels and blood pressure levels among adolescents in the rural area of Northeast China. A total of 2,023 students participated in this study, including 894 boys and 1,129 girls, aged from 12 to 17 years old. We measured the body weight, height, systolic blood pressure (SBP), diastolic blood pressure (DBP), and serum calcium concentrations of all eligible subjects, and the body mass index (BMI) was calculated from body weight and height. Childhood hypertension was defined as SBP and/or DBP ≥95th percentile for age and gender. According to the results of multivariable linear and logistic regression analysis, we found that higher serum calcium levels were positively associated with childhood hypertension. In comparison with serum calcium levels ≤2.37 mmol/L, the multivariable odds ratio (95 % confidence interval) of hypertension among adolescents with serum calcium levels ≥2.53 mmol/L was 1.89 (1.41–2.53; P trend?<?0.001). In addition, higher serum calcium levels were also positively associated with average difference in SBP and DBP; the average differences (95 % confidence interval) were 4.22 (2.74–5.83; P trend?<?0.001) and 2.23(1.00–3.46; P trend?<?0.001), respectively. In conclusion, higher serum calcium concentrations were found to have an association with higher blood pressure levels and higher prevalence of hypertension in the young population.     

Catastrophic Health Expenditure and Rural Household Impoverishment in China: What Role Does the New Cooperative Health Insurance Scheme Play?

Objective

To determine whether the New Cooperative Medical Insurance Scheme (NCMS) is associated with decreased levels of catastrophic health expenditure and reduced impoverishment due to medical expenses in rural households of China.

Methods

An analysis of a national representative sample of 38,945 rural households (129,635 people) from the 2008 National Health Service Survey was performed. Logistic regression models used binary indicator of catastrophic health expenditure as dependent variable, with household consumption, demographic characteristics, health insurance schemes, and chronic illness as independent variables.

Results

Higher percentage of households experiencing catastrophic health expenditure and medical impoverishment correlates to increased health care need. While the higher socio-economic status households had similar levels of catastrophic health expenditure as compared with the lowest. Households covered by the NCMS had similar levels of catastrophic health expenditure and medical impoverishment as those without health insurance.

Conclusion

Despite over 95% of coverage, the NCMS has failed to prevent catastrophic health expenditure and medical impoverishment. An upgrade of benefit packages is needed, and effective cost control mechanisms on the provider side needs to be considered.     

Maternal Chronic HBV Infection Would Not Increase the Risk of Pregnancy-Induced Hypertension – Results from Pregnancy Cohort in Liuyang Rural China

The relationship between maternal HBV (hepatitis B virus) infection and pregnancy-induced hypertension (PIH) is inconclusive. Few studies have been conducted in rural areas of China. In order to examine the association between maternal chronic HBV infection and risk of PIH in Liuyang rural area China, we enrolled 6,195 eligible pregnant women in 2010–2011 in selected 14 towns of Liuyang on their first prenatal visit to local maternity care unit. A total of 461 subjects (7.44% (95%CI: 6.79%, 8.10%)) were identified with positive HBsAg status (exposed group) and 5734 were non-HBV carriers (unexposed group). Multivariate log-binomial regression models were used to estimate the risk of PIH, gestational hypertension (GH), and preeclampsia (PE) in relation to maternal chronic HBV infection. There are total of 455 subjects diagnosed with PIH (7.34% (95%CI: 6.70%, 7.99%)), including 371 GH (5.99% (95%CI: 5.40%, 6.58%)) and 81 PE (1.31% (95%CI: 1.07%, 1.64%)). The crude risk ratio between PIH, GH, PE and maternal HBV infection were 1.20 (95%CI: 0.88, 1.64), 1.30(95%CI: 0.93, 1.81) and 0.79 (95%CI: 0.32, 1.93), respectively. After adjustment for gravidity history, abortion history, family history of Diabetes Mellitus (DM) and family history of hypertension, positive HBsAg status was still not significantly associated with PIH (RR = 1.18, 95%CI: 0.87, 1.62), GH (RR = 1.27, 95%CI: 0.91, 1.78) or PE (RR = 0.79, 95%CI: 0.32, 1.95). Additional adjustment for maternal age, marital status, parity history, family history of DM, Body Mass Index at first antenatal visit, folic acid supplementation, smoking status during pregnancy and economic status of living area, multivariate analysis provided similar results. In conclusion, our study found that maternal chronic HBV infection prevalence rate is 7.4% among Liuyang rural area and there is no significant association between maternal HBV infection and the risk of PIH, GH or PE.     

Snapshot of HIV pathogenesis in China

Several reviews have focused on the nature of HIV infection and its spread in various geographical regions of China. In contrast, this review provides a comprehensive update on the prevalence of multiple HIV- 1 subtypes, consequent emergence of recombinant and novel forms of HIV- 1 in China, and the implications this may have on HIV diversity and the development of effective vaccines. In addition it also examines the dissemination of primary drug resistance in therapy naive patients, as well as co-infections with two other important viruses-hepatitis B and C. The main purpose of this review is to provide a current snapshot of HIV-1 pathogenesis in China and possibly shed some light on the future of HIV evolution, and potential challenges for future vaccine and anti-retroviral therapeutics against HIV strains in this area.     

Care of HIV-infected patients in China

INTRODUCTION Compared with other areas with high HIV infection rate in the world, the total HIV infection rate in China is rela- tively low. Nonetheless, in light of China’s vast territory and large population, the potential infection risk must be taken …     

Snapshot of HIV pathogenesis in China

INTRODUCTION A recent report by the National Intelligence Council es- timates that by 2010 five countries, India, China, Nigeria, Ethiopia and Russia, cumulatively, will harbor the largest number of individuals infected with the Human Immuno- deficiency V…     

How Can Childbirth Care for the Rural Poor Be Improved? A Contribution from Spatial Modelling in Rural Tanzania

Introduction

Maternal and perinatal mortality remain a challenge in resource-limited countries, particularly among the rural poor. To save lives at birth health facility delivery is recommended. However, increasing coverage of institutional deliveries may not translate into mortality reduction if shortage of qualified staff and lack of enabling working conditions affect quality of services. In Tanzania childbirth care is available in all facilities; yet maternal and newborn mortality are high. The study aimed to assess in a high facility density rural context whether a health system organization with fewer delivery sites is feasible in terms of population access.

Methods

Data on health facilities’ location, staffing and delivery caseload were examined in Ludewa and Iringa Districts, Southern Tanzania. Geospatial raster and network analysis were performed to estimate access to obstetric services in walking time. The present geographical accessibility was compared to a theoretical scenario with a 40% reduction of delivery sites.

Results

About half of first-line health facilities had insufficient staff to offer full-time obstetric services (45.7% in Iringa and 78.8% in Ludewa District). Yearly delivery caseload at first-line health facilities was low, with less than 100 deliveries in 48/70 and 43/52 facilities in Iringa and Ludewa District respectively. Wide geographical overlaps of facility catchment areas were observed. In Iringa 54% of the population was within 1-hour walking distance from the nearest facility and 87.8% within 2 hours, in Ludewa, the percentages were 39.9% and 82.3%. With a 40% reduction of delivery sites, approximately 80% of population will still be within 2 hours’ walking time.

Conclusions

Our findings from spatial modelling in a high facility density context indicate that reducing delivery sites by 40% will decrease population access within 2 hours by 7%. Focused efforts on fewer delivery sites might assist strengthening delivery services in resource-limited settings.     

Are Metals Accumulated in Human Hair Affected by Naturally Occurring Asbestos Fiber Contamination? A Case Study from a Rural Area of China

Little is known about the link between metals accumulated in human and asbestos fiber contamination in the environment. Therefore, hair samples of 368 subjects (128 males and 240 females) from a rural area contaminated by crocidolite asbestos fibers were collected to investigate the distributions of 17 metals accumulated in human. The results showed that the mean concentrations of As, Al, Ba, Cd, Co, Cr, Cu, Fe, Hg, Mg, Mn, Mo, Na, Ni, Pb, Sr, and Zn in hair of the total subjects were 0.23, 23.36, 4.33, 0.11, 0.05, 0.70, 10.53, 29.74, 0.37, 241.57, 3.52, 0.08, 153.21, 0.72, 4.26, 10.96, and 113.35 mg/kg, respectively. Moreover, approximately 86.14, 52.17, 73.91, 85.05, 80.98, 74.46, and 53.80 % of the hair samples of the total subjects contained much higher concentrations of Al, Ba, Fe, Mg, Mn, Na, and Sr compared with the highest reference values, respectively. The mean concentrations of the determined metals (except for As, Co, Cr, Hg, and Mo) significantly varied among different age groups for both male and females. The results of correlation analysis and cluster analysis revealed that strong correlations were found between Al, Fe, Zn, Mg, and Na accumulated in human from the study area. These might suggest that Al, Ba, Fe, Mg, Mn, Na, and Sr were significantly derived from contamination of crocidolite asbestos fibers. Zn, Mg, and Na might also originate from diet. However, Cd, Mo, Co, As, Cr, Hg, Ni, Mn, Pb, and Ba accumulated in human seemed to be mainly derived from soil. It can be concluded that metals accumulated in human hair have a link with asbestos fiber contamination in the environment.     

International non-governmental actors in HIV/AIDS prevention in China

International non-governmental organizations were among the first international actors that responded to the emergence of AIDS crisis in China. Since 1994, the number of international non-governmental organizations and charitable foundations working in AIDS related issue areas in China has grown steadily and substantially. Despite their organizational differences, most of these non-governmental actors present the characteristics of independent mission, localized practice and diverse working focus. Even though they are constrained by financial and other factors compared with multilateral and bilateral official assistance agencies, they have still played a unique role in fighting against AIDS in China as technical experts, public educators, and civil society supporters.     

International non-governmental actors in HIV/AIDS prevention in China

INTRODUCTION This research examines a group of international non- governmental organizations (NGOs) and private founda- tions that have worked and/or are still working in HIV/ AIDS prevention related issue areas in China. Main char- acteristics of this tr…     

Recent Progress in Arabidopsis Research in China： A Preface

In 2002, a workshop on Arabidopsis research in China was held in Shanghai, when a small group of Chinese plant scientists was working on this model species. Since then, we have witnessed the rapid growth of Arabidopsis research in China. This special issue of Journal of Integrative Plant Biology is dedicated exclusively to the Fourth Workshop on Arabidopsis Research in China, scheduled on November 30, 2005, in Beijing. In addition to reports collected in this special issue, the Chinese Arabidopsis community has been able to make significant contributions to many research fields. Here, I briefly summarize recent advances in Arabidopsis research in China.     

Governmental policies on HIV infection in China

This article is a general review of the evolvement of HIV/AIDS-related public policies in China since 1980＇s. It tracks the important laws, regulations and other governmental documents in regard to HIV/AIDS prevention mainly at central level.