Integrated prevention of mother-to-child transmission for human immunodeficiency virus, syphilis and hepatitis B virus in China.

PROBLEM: China continues to face challenges in eliminating mother-to-child transmission of human immunodeficiency virus (HIV), syphilis and hepatitis B virus (HBV). APPROACH: In 2010, a programme that integrated and standardized prevention of mother-to-child transmission (PMTCT) efforts for HIV, syphilis and HBV was implemented in 1156 counties. At participating antenatal care clinics, pregnant women were offered all three tests concurrently and free of charge. Further interventions such as free treatment, prophylaxis and testing for mothers and their children were provided for HIV and syphilis. LOCAL SETTING: China's national PMTCT HIV programme started in 2003, at which time there were no national programmes for perinatal syphilis and HBV. In 2009, the rate of maternal-to-child transmission of HIV was 8.1% (57/702). Reported congenital syphilis was 60.8 per 100,000 live births. HBV infection was 7.2% of the overall population infected. RELEVANT CHANGES: Between 2010 and 2013 the number of pregnant women attending antenatal care clinics with integrated PMTCT services increased from 5.5 million to 13.1 million. In 2013, 12.7 million pregnant women were tested for HIV, 12.6 million for syphilis and 12.7 million for HBV. Mother-to-child transmission of HIV fell to 6.7% in 2013. Data on syphilis transmission are not yet available. LESSONS LEARNT: Integrated PMTCT services proved to be feasible and effective, and they are now part of the routine maternal and child health services provided to infected women. The services are provided through a collaboration between maternal and child health clinics, the national and local Centers for Disease Control and Prevention, and general hospitals.

A preliminary cervical cancer screening cascade for eight provinces rural Chinese women: a descriptive analysis of cervical cancer screening cases in a 3-stage framework.

BACKGROUND: Cascade analysis is an effective method to analyze the processing data of an event, such as a provided service or a series of examinations. This study aimed to develop a primary cervical cancer screening cascade in China to promote the quality of the screening process. METHODS: We designed a cervical cancer screening cascade in China according to the program flow chart. It had three stages, each with two steps and one result. Data from 117,522 women aged 35 to 64 years in the Rural Cervical Cancer Surveillance Project from January 1, 2014, to December 31, 2014, were collected to analyze the main results of the cascade. The data and proportion are used to describe the follow-up of cervical cancer and pre-cancer detection rate. RESULTS: In 2014, 117,522 (80.94% of all cases reported by the Rural Cervical Cancer Surveillance Project) women aged 35 to 64 years had not received cervical cytology in the previous 3 years. The pre-cancer and cancer detection rates were 256.12/100,000 and 16.16/100,000, respectively. A total of 3031 cases failed to follow-up through the screening process, and 1189, 1555, and 287 cases were lost at cervical cytology, colposcopy, and histopathological screening stages, respectively. The estimated cases of pre-cancer and cancer cases would have been 544 and 34, respectively, and the estimated detection rates of pre-cancer and cancer would have been 462.89/100,000 and 28.93/100,000, respectively. CONCLUSION: In order to increase the detection rate of cervical cancer, cervical cancer screening staff should focus on increasing the rate of follow-up of those who are positive for cervical cancer screening (ie, those with positive cytology results), especially for the 40 to 44 years age range.

Knowledge of Cervical Cancer Screening among Health Care Workers Providing Services Across Different Socio-economic Regions of China.

BACKGROUND: China carries a heavy burden of cervical cancer (CC) and substantial disparities exist across regions within the country. In order to reduce regional disparities in CC, the government of China launched the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in 2009. Critical to the success of the program are the health care workers who play a pivotal role in preventing and managing CC by encouraging and motivating women to use screening services and by providing identification and treatment services. This study aimed to assess cervical cancer knowledge among these health care workers at the county level in maternal and child health (MCH) hospitals across different socio-economic regions of China. MATERIALS AND METHODS: A cross-sectional survey was conducted and self-administered questionnaires were sent to all health care workers (a total of 66) providing cervical cancer screening services in 6 county level MCH hospitals in Liaoning, Hubei and Shaanxi provinces, representing eastern, central and western regions of China; 64 (97.0%, 64/66) of the workers responded. ANOVA and Chi-square test were used to compare the knowledge rate and scores in subgroups. RESULTS: The knowledge level of the respondents was generally low. The overall combined knowledge rate was 46.9%. The knowledge rates for risk factors, prevention, clinical symptoms, screening and diagnostic tests and understanding of positive results were 31.3%, 37.5%, 18.1%, 56.3% and 84.4%, respectively. Statistically significant differences in scores or rates of CC knowledge were seen across the different regions. The total and sectional scores in the less developed regions were statistically significantly lower than in the other regions. CONCLUSIONS: The majority of the health care workers who provide CC screening service in NCCSPRA at county level MCH hospitals do not have adequately equipped with knowledge about CC. Given the importance of knowledge to the program's success in reducing CC burden in rural women in China, efforts are needed to improve the knowledge of health care workers, especially in less developed regions.

Domestic abuse on women in China before, during, and after pregnancy.

BACKGROUND: Some researchers found that partner-perpetrated physical violence increased in frequency and severity during the postpartum period compared with the antenatal period, however, limited data exists describing abuse of women in China. The purpose of this study was to examine patterns of abuse in China before, during, and after pregnancy, and explore possible factors related to abuse. METHODS: A community-based face-to-face survey of a representative group of women who had a child aged 6 to 18 months in 32 communities of Tianjin, Liaoning, Henan, and Shaanxi provinces was carried out between November 1, 2001 and February 28, 2002. RESULTS: The prevalence of domestic abuse (emotional, sexual, or physical) occurring in any period (before, during, or after pregnancy) was 12.6%. The prevalence of abuse during the approximate 9 months of pregnancy (4.3%) was relatively lower compared with the prevalence of abuse during the 12 months before pregnancy (9.1%) and after delivery (8.3%) during the mean 11-month postpartum period studied. Abuse before pregnancy was a strong risk factor for abuse during pregnancy and abuse after pregnancy, and abuse during any previous period was a strong risk factor for subsequent abuse. Many women who suffered abuse of any kind generally experienced multiple acts over time and most acts were not severe. The results of logistic regression analysis showed that the factors associated with abuse during pregnancy included women previously witnessing domestic violence, a poor relationship with the partner, socioeconomic level, alcohol consumption, and smoking. CONCLUSIONS: It is necessary to do in-depth training and to raise awareness of partner abuse among all health professionals. Routine screening of abuse in maternity clinics is advocated to decrease the adverse impact of abuse on women and fetuses.

[Investigation on the patterns and knowledge regarding domestic violence among married women in rural areas of China].

OBJECTIVE: To understand the knowledge and prevalence of domestic violence (DV) among married women in rural China. METHODS: Proportional to Population Size(PPS) sampling method was conducted to select 3998 women aged 18 years old and above from Jilin, Anhui and Chongqing. All the women were interviewed using a standardized questionnaire during Nov. 2004-Jan. 2005. RESULTS: The prevalence of spousal violence against women was 64.8 % in a lifetime and 42.6% in the past 12 months before the survey. Psychological violence was the most common type, followed by physical violence and sexual abuse. The prevalence rates for psychological, physical and sexual violence in a life time were 58.1%, 29.7%, 16.7%, while 37.2%, 14.0%, 7.7% in the past 12 months before the survey. All the total DV, psychological violence and sexual violence were more commonly seen in Jilin province, while physical violence was more prevalent in Chongqing city. The prevalence rate of violence was different among people with different social-demographic characteristics. Sexual abuse became more common with the improvement of education. In total, about 1/3 women suffered two or three categories of violence at the same time. Most sexually abused women suffered one kind of violence, while half of the physically and psychologically abused women suffering two and more kinds of violent behaviors at the same time. Married women had relatively little knowledge on domestic violence and 75.2 % of the women did not even know what domestic violence was referring to and some women suffered from DV themselves but knowing nothing about its implication. In general, physical violence was better understood among interviewed women while the knowledge about psychological violence was relatively poor. Conclusion Domestic violence, psychological violence in particular, was very common in rural China, while the knowledge of DV among married women was poor, effective actions should be taken to stop DV at no time.

[Study on the perception of gender role and decision-making regarding family affairs among married women and its impact on the utilization of perinatal care].

OBJECTIVE: To understand the perception on roles of gender and decision-making regarding family affairs among married women and its impact on the utilization of perinatal care. METHODS: Clustering sampling was conducted to select 1227 married women with at least a child aged from 0 to 7 years old, from Hebei, Hubei and Sichuan provinces. All women were interviewed using a uniform questionnaire during Nov.-Dec. 2004. RESULTS: The overall proportion of women who had relatively poor perception of gender role was 65.1%. 59.3% of the women agreed that "husband's health is more important than wife's in the family" versus 39.7% of interviewed women agreed that "man is more suitable for leadership than woman". In 46.2% of the families, wife and husband shared the responsibility of decision making on family affairs. In 16.2% of the families women played a decisive role, while 67.1% of interviewed women had to get the approval of her husband when spending money on daily necessities. When there were different opinions between the couples, husband usually made the final decision in 20.5% of all the families versus 17.4% of families where wife made the final decision. In total,the proportion of women who had somehow rights on family affairs was 64.1%. The coverage rate of antenatal care was 91.0%, and 65.3% women who received antenatal care got the first antenatal visit during the first trimester and the proportion of women who had at least five antenatal visits was 39.7%. The institutional delivery was 59.3% among all the women. Perception of gender role was not a predictor for antenatal care utilization, but it was predictive of institutional delivery. Education was quite a significant predictor on perinatal care utilization. CONCLUSION: Efforts should be strengthened to improve women's awareness and to increase their perception on gender role in the families so that more women could achieve quality perinatal care.

[Domestic violence against women before, during and after pregnancy].

OBJECTIVE: To examine patterns of abuse before, during, and after pregnancy and the possible factors related to abuse. METHODS: A community-based face-to-face survey of a representative group of women having a child aged 6 to 18 months in 32 communities of Tianjin, Liaoning, Henan and Shaanxi provinces was carried out between November 1, 2001 and February 28, 2002. RESULTS: The prevalence rate of domestic violence (emotional, sexual and physical) occurred in any period (before, during and after pregnancy) against women was 12.6%. The prevalence of domestic violence against women during the approximate 9 months of pregnancy (4.3%) was relatively lower than that during the 12 months before pregnancy (9.1%) and during the mean 11 months postpartum period (8.3%). Domestic violence against women before pregnancy was a strong risk factor for abuse during and post pregnancy. Abused women and perpetrators were more likely to be in lower social class were smoking cigarettes and drinking alcohol. Abused women were more likely to be witnessing violence in the past and having poor relationship with partner. CONCLUSION: The prevalence of domestic violence against women was high which called for in-depth training and improving awareness for all health professionals.