[Association Between Dietary Diversity and Caregiver Self-Efficacy for Complementary Feeding Among Infants and Young Children Aged 6-23 Months in Rural Nanchong City,Sichuan Province].

Objective To analyze the current situation of dietary diversity and caregiver self-efficacy for complementary feeding among infants and young children aged 6 to 23 months in rural Nanchong city,Sichuan province,and to explore the relationship between dietary diversity and caregiver self-efficacy. Methods Multi-stage randomized cluster sampling method was used to select infants and young children aged 6 to 23 months and their caregivers in rural areas of Nanchong city,Sichuan province as the subjects.A structured questionnaire was designed to collect the basic information of the subjects,dietary diversity,and caregiver self-efficacy for complementary feeding.Multivariate Logistic regression was adopted to analyze the relationship between the dietary diversity and caregiver self-efficacy for complementary feeding of infants and young children. Results A total of 770 pairs of infants and young children and their caregivers were included.The minimum pass rate of dietary diversity was 61.56%(474/770) for all the infants and young children and 45.00%(108/240),69.16%(287/415),and 68.70%(79/115) for the infants and young children aged 6 to 11,12 to 17,and 18 to 23 months,respectively.The results of regression analysis showed that the caregiver self-efficacy of complementary feeding was a contributing factor for qualified dietary diversity of infants and young children in the case of other confounders being controlled(OR=1.42,95%CI=1.17-1.73,P<0.001). Conclusion The dietary diversity for infants and young children in rural Nanchong city,Sichuan province needs to be improved,and caregivers with higher self-efficacy of complementary feeding are more likely to provide diversified complementary feeding for infants and young children.

Diffusion of a micronutrient home fortification program for infants and toddlers in a multi-ethnic population in rural western China.

BACKGROUND: The micronutrient home fortification programs contribute to the prevention of childhood anemia. WHO suggested applying culturally appropriate strategies to implement the micronutrient home fortification programs in various communities. However, there is little knowledge on evidence-based effective diffusion strategies of the micronutrient home fortification programs in multi-ethnic populations. This study aims to examine the diffusion of a micronutrient home fortification program with micronutrient powder (MNP) in a multi-ethnic population by investigating factors associated with being an 'early' or a 'later' adopter of MNP. METHODS: We conducted a cross-sectional study in rural western China. Multistage sampling was used to select children's caregivers in Han, Tibetan, and Yi ethnic communities (N = 570). The diffusion of innovations theory informed the data collection on caregivers' decision process and was applied to classify participants into the MNP adopter categories of 'leaders', 'followers', 'loungers', and 'laggards'. The ordered logistic regression model estimated the factors associated with the MNP adopter categories. RESULTS: Caregivers from the Yi ethnic subgroup were likely to adopt MNP relatively late (AOR = 1.67; 95%CI = 1.09, 2.54) compared with Han and Tibetan ethnic subgroups. Caregivers with more knowledge regarding the MNP feeding method (AOR = 0.71; 95%CI = 0.52, 0.97) and those with stronger self-efficacy in adopting MNP (AOR = 0.85; 95%CI = 0.76, 0.96) were more likely to adopt MNP earlier than others. The following messages and channels also tend to make caregivers adopt MNP earlier: hearing that 'MNP was free' from villagers (AOR = 0.45; 95%CI = 0.20, 0.98), and learning 'MNP feeding method' from township doctors (AOR = 0.16; 95%CI = 0.06, 0.48). CONCLUSIONS: Disparities in adopting MNP existing among different ethnic groups require more effective diffusion strategies in disadvantaged minority ethnic groups. Enhancing self-efficacy in adopting MNP and knowledge on feeding method of MNP have the potential to make caregivers adopt MNP earlier. Peer networks and township doctors can be effective agencies to facilitate the diffusion and adoption of MNP.

[Association between Yingyangbao cognition and feeding behavior of caregivers in rural areas of Sichuan Province:the mediating effect of self-efficacy].

OBJECTIVE: To describe the current situation of Yingyangbao feeding in rural areas of Sichuan, and to explore the mechanism among micronutrient powder cognition, self-efficacy and feeding behavior. METHODS: The multi-stage cluster sampling method was adopted. In October 2019, in 2 Han counties, 2 Tibetan counties, and 2 Yi counties in Sichuan Province, a total of 108 villages in 36 townships in 6 sample counties were included in the cluster. Caregivers of infants and young children aged 6-24 months were selected as the research subjects, and a face-to-face interview survey was conducted using a self-designed structured questionnaire. RESULTS: A total of 765 caregivers of infants and young children aged 6-24 months were included in this study. The effective feeding rate of the Yingyangbao was 54.43%. The average scores of caregivers Yingyangbao cognition, self-efficacy and feeding behavior were 3.80±1.16, 7.96±1.53 and 0.83±0.38, and there was a significant positive correlation between them. Self-efficacy played a partial mediating effect between caregivers' Yingyangbao cognition and feeding behavior, and the mediating effect accounted for 23.37% of the total effect. CONCLUSION: Yingyangbao cognition directly affects feeding behavior and indirectly affects feeding behavior through self-efficacy.

[Factors Associated With Coronary Heart Disease Among Adult Residents in Jinjiang District,Chengdu City].

Objective To analyze the prevalence of coronary heart disease among community residents over 18 years old in Jinjiang district of Chengdu city,Sichuan province,and explore its associated factors,so as to provide a reference for the prevention and control of coronary heart disease in communities.Methods From October 15 to November 10 in 2021,a total of 5220 adult residents from 33 communities in Jinjiang were selected by multi-stage stratified random sampling for face-to-face questionnaire survey,physical examination,and laboratory blood test.Binary Logistic regression was employed to predict the factors associated with coronary heart disease among adult residents in Jinjiang.Results The crude and standard prevalence rates of coronary heart disease among 5220 adult residents were 3.39% and 2.11%,respectively.Logistic regression analysis showed that age (OR=1.068,95%CI=1.051-1.086,P<0.001),depressive symptoms (OR=1.639,95%CI=1.037-2.591,P=0.034),regular exercise (OR=0.584,95%CI=0.378-0.902,P=0.015),elevated blood pressure (OR=3.529,95%CI=2.344-5.312,P<0.001),dyslipidemia (OR=2.152,95%CI=1.291-3.587,P=0.003),and core knowledge score of chronic diseases (OR=1.144,95%CI=1.066-1.228,P<0.001) were associated with coronary heart disease among adult residents in Jinjiang.Conclusions The prevalence of coronary heart disease is high among adult residents in Jinjiang district of Chengdu.The urban residents who are older,have depressive symptoms,lack of exercise,elevated blood pressure,dyslipidemia,and score higher on core knowledge of chronic diseases are prone to coronary heart disease.

[Relationship Between Maternal Negative Emotions and Feeding Patterns of Infants Aged 0-6 Months in Remote Rural Areas of Sichuan Province].

Objective To investigate the status of exclusive breastfeeding and bottle feeding in remote rural areas of Sichuan province and explore the relationship between negative emotions of mothers and feeding patterns of infants.Methods Multistage cluster sampling was employed to select the infants aged 0-6 months and their mothers in remote rural areas of Sichuan province.A self-designed questionnaire was used to collect the demographic characteristics of mothers and infants and the basic family information.The Chinese version of Depression Anxiety Stress scale was used to evaluate mothers' negative emotions,and the Breastfeeding Self-efficacy scale to assess the confidence level of mothers' behavior of adhering to exclusive breastfeeding.Results Totally 723 pairs of infants and their mothers were included.The exclusive breastfeeding and bottle feeding rates were 34.16% (247/723) and 57.54% (416/723),respectively.Mothers with depression tendency were less likely to adopt exclusive breastfeeding (OR=0.532,95%CI=0.291-0.974,P=0.041) and more likely to adopt bottle feeding (OR=1.877,95%CI=1.054-3.344,P=0.033).Further subgroup analysis of breastfeeding self-efficacy showed that in the group of low self-efficacy,the mothers with depression tendency were less likely to adopt exclusive breastfeeding (OR=0.461,95%CI=0.236-0.902,P=0.024) and more likely to adopt bottle feeding (OR=1.968,95%CI=1.047-3.701,P=0.036) than the mothers without depression tendency.In the group of high self-efficacy,mothers' depression,anxiety,and stress tendency had no significant correlation with infant feeding patterns (all P>0.05).Conclusions The mothers in the remote rural areas of Sichuan province are more likely to employ bottle feeding than exclusive breastfeeding.The mothers with stronger depression tendency demonstrate lower possibility of exclusive breastfeeding and higher possibility of bottle feeding.Breastfeeding self-efficacy may affect the association between maternal depression and infant feeding patterns.

[Current Situation and Influencing Factors of Delay in Seeking Medical Treatment Among Residents in Rural Areas of Sichuan Province].

Objective To understand the current situation and explore the influencing factors of delay in seeking medical treatment for common symptoms of residents in the rural areas of Sichuan province. Methods In July 2019,multi-stage random sampling was carried out in Zigong city,Sichuan province,and the data were collected by face-to-face questionnaire interview.The residents who had lived at hometown for more than half a year in the past year and had seen a doctor in the most recent month were surveyed.Logistic regression was adopted to predict the influencing factors of delay in seeking medical treatment. Results A total of 342 subjects were enrolled,and the incidence of delay in seeking medical treatment was 13.45%(46/342).Compared with the young and middle-aged(<65 years)people,the elderly(≥65 years)people were more likely to have delay in seeking medical treatment (OR=2.187,95%CI=1.074-4.457,P=0.031).The rural residents who gave higher score of the overall quality of township health centers were less likely to have delay in seeking medical treatment (OR=0.854,95%CI=0.735-0.992,P=0.039). Conclusions The occurrence of delay in seeking medical treatment for common symptoms of rural residents in Sichuan province is low.Age and the overall quality evaluation of township health centers affect the occurrence of delay in medical treatment among the rural residents in Sichuan province.Efforts should be made to improve the awareness of disease prevention among the elderly in rural areas.The investment in health resources in township health centers should be increased to strengthen the introduction and training of talents.These measures can improve the health services in township health centers,guide residents to make timely use of health resources,and reduce the occurrence of delay in seeking medical treatment.

Provider competence in hypertension management and challenges of the rural primary healthcare system in Sichuan province, China: a study based on standardized clinical vignettes.

BACKGROUND: Improving primary care providers' competence is key to detecting and managing hypertension, but evidence to guide this work has been limited, particularly for rural areas. This study aimed to use standardized clinical vignettes to assess the competence of providers and the ability of the primary healthcare system to detect and manage hypertension in rural China. METHODS: A multi-stage random sampling method was administered to select target health facilities, providers, and households. The clinical vignette script was developed to evaluate provider competence in managing first-visit patients with symptoms of hypertension. Logistic regression was used to explore the factors correlated with provider competence. Provider referral and management rates were combined with patients' facility sorting behaviors to assess the ability of the rural healthcare system to manage hypertension in three policy scenarios. RESULTS: A total of 306 providers and 153 facilities were enrolled in our study. In the 306 clinical vignette interactions, 25.9% of providers followed the national guidelines for hypertension consultation. The correct diagnosis was achieved by only 10.1% of providers, and 30.4% of providers were able to prescribe the correct treatment. Multi-variable regression results showed that younger providers (OR = 0.85, 95%CI: 0.73, 0.98) and those who work in township health centers (OR = 4.47, 95%: 1.07, 18.67) were more likely to provide a correct diagnosis. In a free-selection scenario, 29.8% of patients with hypertension were managed correctly throughout the rural system. When all patients first visit village clinics, system-level correct management is reduced to 20.5% but increases to 45.0% when all patients first visit township health centers. CONCLUSIONS: Rural primary care providers do not have enough competence to detect and treat hypertension cases in China to an acceptable degree. Policy constraints may limit the competence of the rural healthcare system. Research to improve detection and treatment competence in hypertension and optimize health policy is needed.

Association of COVID-19 Lockdown during the Perinatal Period with Postpartum Depression: Evidence from Rural Areas of Western China.

COVID-19 lockdown has posed unique challenges to postpartum women, but its association with postpartum depression is not well understood in the Global South. This study aims to evaluate the association between COVID-19 lockdown and postpartum depression in rural areas of western China. A multi-stage random cluster sampling method was used to select a cohort of pregnant and postpartum women with infants aged 0-6 months. We conducted an in-person survey before the COVID-19 lockdown and a phone survey right after the lockdown ended. We used multivariate regression models to evaluate the association between lockdown and postpartum depression. Subgroup analysis was performed to explore the role of social support. The overall prevalence of postpartum depression was 13.3%. Postpartum women who experienced the lockdown were less likely to be depressed than those who did not (adjusted odds ratio (aOR) = .43, 95% confidence interval (CI) = [.27, .70]). Lockdown was negatively associated with postpartum depression among postpartum women with low level of social support (aOR = .30, 95% CI = [.18, .51]). COVID-19 lockdown was associated with lower likelihood of postpartum depression, potentially due to increased support from family. Future research is needed to explore targeted interventions to prevent postpartum depression among women from migrant worker families in rural China.

[Evaluation of Accuracy and Influencing Factors for Diagnosis of Two Chronic Diseases by Primary Healthcare Providers in Sichuan Rural Areas Based on Standardized Patients].

Objective We used standardized patients to evaluate the accuracy and explore the influencing factors of the diagnosis of unstable angina pectoris and type 2 diabetes by primary healthcare providers in Sichuan rural areas,aiming to provide a scientific basis for improving the diagnosis accuracy of primary healthcare providers for the two chronic diseases. Methods A multi-stage stratified random cluster sampling method was adopted to select 100 villages from 50 townships in 5 districts/counties in Zigong city,Sichuan province. General and internal medicine practioners who were on duty on the survey day were enrolled in the survey.Two rounds of data collection were conducted.In the first round,the basic information of providers from township health centers and village clinics was collected.One month after the the first survey,standardized patients were used to collect the information related to the diagnosis of unstable angina pectoris and type 2 diabetes by rural primary providers.Logistic regression was carried out to analyze the factors influencing the diagnosis accuracy. Results A total of 172 rural primary healthcare providers were enrolled in the survey,who completed 186 standardized patient visits and showed the correct diagnosis rate of 48.39%.Specifically,the correct diagnosis rates of unstable angina pectoris and type 2 diabetes were 18.68%(17/91) and 76.84%(73/95),respectively.The providers with medical practitioner qualifications were more likely to make correct diagnosis(OR=4.857,95%CI=1.076-21.933, P=0.040).The providers who involved more necessary consultation and examination items in the diagnosis process had higher probability of correct diagnosis(OR=1.627,95%CI=1.065-2.485, P=0.024).Additionally,the providers were more likely to make a correct diagnosis for type 2 diabetes than for unstable angina pectoris(OR=6.306,95%CI=3.611-11.013, P<0.001). Conclusions The overall diagnosis accuracy of unstable angina pectoris and type 2 diabetes was relatively low among primary healthcare providers in Sichuan rural areas.The training of diagnosis process can be taken as a key for improving providers' practice ability so as to increase the diagnosis accuracy of chronic diseases.

[Association of Dietary Diversity with Growth and Development of Children in Multi-ethnic Rural Areas of Sichuan Province].

Objective To understand the growth and dietary diversity status of children in multi-ethnic areas of Sichuan province,and to explore the associations of dietary diversity with growth and development indicators. Methods Children of 18-36 months old and their primary caregivers were selected with multi-stage cluster random sampling method from rural areas of Han,Tibetan,and Yi ethnic groups in Sichuan province. The sociodemographic information of children and their caregivers was collected using self-designed questionnaire.The dietary diversity score(DDS)was calculated according to the criteria in the Guidelines for Measuring Household and Individual Dietary Diversity released by the Food and Agriculture Organization of the United Nations.The body height(length)and body weight of each child were measured by standard equipment for anthropological measurement,and the height for age Z score(HAZ),weight for age Z score(WAZ),and weight for height Z score(WHZ) were calculated.Multivariate linear regression was performed to analyze the relationship between dietary diversity and growth indicators of children. Results A total of 1092 children were enrolled in this study,and the prevalence of stunting(HAZ<-2),underweight(WAZ<-2),and wasting(WHZ<-2)was 21.1%,4.9%,and 2.5%,respectively.The children had the mean DDS of 4.8±1.7,and 45.3% of children had poor dietary diversity(DDS≤4).The children of Han ethnic group(5.8±1.4)had higher DDS than those of Tibetan ethnic group(4.9±1.6)and Yi ethnic group(3.9±1.6)(P<0.001).The results of multivariate linear regression indicated that DDS was positively correlated with HAZ(ß=0.206,95%CI=0.158-0.254,P<0.001)after adjustment of sex,age,birth weight,preterm birth,and parental body height.After further adjustment of family fixed assets,ethnic group,caregiver's type,and caregiver's education background,the correlation between DDS and HAZ remained significant(ß=0.077,95%CI=0.026-0.128, P=0.003). Conclusions The children in the multi-ethnic rural areas of Sichuan province showed troublesome growth and development status and low dietary diversity,which were conspicuously different between ethnic groups,especially in the rural areas of Yi ethnic group.The dietary diversity was positively associated with HAZ.It is recommended to carry out nutrition and health education according to the local dietary characteristics and thus improve the growth and development of children in multi-ethnic rural areas in Sichuan.

[Ethnic differences in influencing factors of caregivers' first complementary food addition behavior in western rural areas].

OBJECTIVE: To investigate the status quo and influencing factors of the first-time complementary food addition behavior of caregivers in the multi-ethnic background in the western rural areas. METHODS: In 2019, a multi-stage stratified cluster random sampling was used to selecting research subjects in western rural areas. A structured questionnaire was designed by ourselves with literature review and expert consultation method, and information such as sociodemographic characteristics, feeding knowledge, and complementary food addition of 1290 caregivers and infants were collected, ordered multi-classification Logistic regression was used to analyze the influencing factors of the first complementary food addition behavior of the Han nationality and the minority nationality. RESULTS: In the western rural areas, only 8.22% of the caregivers had better behavior of first complementary food addition, and 16.31% of the caregivers in the Han group had a good behavior of first complementary food addition. In the minority population, only 3.64% of infant caregivers had a good behavior of first complementary food addition. In Han, parents, as caregivers, had better first complementary food addition behavior than grandparents(OR=1.7829, 95% CI 1.1651-2.7283). Among ethnic minorities, education(OR=1.753, 95%CI 1.190-2.581), family fixed assets(OR=3.870, 95%CI 1.959-7.645)and feeding knowledge(OR=3.396, 95%CI 2.749-4.195) were the promoting factors for the first complementary food addition behavior. CONCLUSION: In western rural areas, caregivers' behavior of adding complementary food for the first time is generally poor.

[Effect of Information Communication on Micronutrient Powders (or Yingyangbao) Feeding Behaviors of Different Generations of Baby Caregivers in Rural Areas].

Objective: To evaluate the status of information communication concerning micronutrient powders (MNP), or yingyangbao in Pinyin, the Chinese Romanization system, in areas covered by the Child Nutrition Improvement Project in a province in southwest China, and to investigate the effect of different communication channels and message communicated on the feeding behaviors of different generations of caregivers. Methods: In October 2019, 6 counties, including two counties with predominantly Han population, two counties with substantial Tibetan population, and two counties with substantial Yi population, were selected from a province in southwest China through multistage random cluster sampling. A total of 816 pairs of babies and their caregivers from 108 villages in 36 townships were enrolled for the study. The age of the babies ranged between 6 months to 24 months. A structured questionnaire concerning the demographic data of the babies and their caregivers, the communication channel of information on MNP and the message communicated, and the caregivers' MNP feeding behaviors was designed to collect data through face-to-face interviews. Logistic regression was done to analyze the effect of MNP information communication on the feeding behaviors of caregivers from different generations. Results: Caregivers acquired information on MNP from village and township physicians (85.66%), surrounding populations (15.81%), and brochures and mass media (4.78%). The messages they received included the free availability of MNP (37.50%), feeding methods (49.26%), and the benefits of giving babies MNP (57.84%). Among the caregivers, 89.95% knew about the availability of MNP, 69.73% were aware of the benefits, and 84.07% actually received MNP. The correct feeding rate was 68.26% and the total effective feeding rate was 49.14%. The effective feeding rate of caregivers of the grandparents' generation (59.07%) was higher than that of the caregivers of the parents' generation (45.08%) ( P<0.05). Logistic regression analysis suggested that, for caregivers of the parents' generation, information communication channel of village and township physicians (odds ratio [ OR]=2.20, 95% confidence interval [ CI]: 1.13-4.31) and communication messages on feeding methods ( OR=1.80, 95% CI: 1.19-2.73) and benefits of MNP ( OR=2.40, 95% CI: 1.61-3.57) facilitated their effective feeding behavior, while communication message concerning the free availability of MNP ( OR=0.58, 95% CI: 0.38-0.87) inhibited their effective feeding behavior. For caregivers of the grandparents' generation, information communication channel of village and township physicians ( OR=2.95, 95% CI: 1.12-7.76) and communication messages on the feeding methods ( OR=2.86, 95% CI: 1.34-6.09) were facilitating factors of their effective feeding behaviors. Conclusion: The main channel of MNP information delivered to caregivers from the areas covered by the study was face-to-face explanation by doctors. The message communicated mainly involved three aspects--the administration method, the benefits and free availability of MNP. The channel and message of MNP information communnication had different effects on the feeding behaviors of caregivers of the parents' and grandparents' generations. Future research should focus on developing targeted information communication strategies according to the characteristics of populations from different generations, so as to improve the caregivers' feeding behavior.

Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China.

BACKGROUND: Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China. METHODS: We designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT). RESULTS: Overall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes. CONCLUSIONS: The CCT program generated modest improvements in the uptake of MCH services and mothers' knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities.

Use of maternal health services among women in the ethnic rural areas of western China.

BACKGROUND: The use of maternal health services can markedly promote the maternal health and safety, but there has been a low utilization rate in the ethnic rural areas of western China. Furthermore, the correlated factors have not been well studied. This study aims to assess factors related to the use of maternal health services among women in these areas. METHODS: A cross-sectional study of 68 villages in China's western Sichuan province was conducted in September 2014. All qualifying women from each sample village were involved. A structured questionnaire was administrated in households through face-to-face interviews by trained enumerators to obtain information of use of maternal health services and related factors. Structural equation modeling (SEM) was used to evaluate the direct and indirect relationships between use of maternal health services and correlated factors. RESULTS: A total of 760 women from 68 villages were enrolled. The proportion of antenatal care (ANC), hospital delivery and postpartum visits were 68.94, 48.29 and 28.42% respectively. The SEM analysis demonstrated that social economic status (SES) (ß= - 0.75, ß< 0.01), ANC (ß=0.13, ß< 0.01), and time from home to the nearest hospital (ß= - 0.09, ß< 0.05), were positively correlated to hospital delivery and postpartum care visits, while maternal care knowledge and perceived quality of hospital care did not have direct correlation. For ANC, SES (ß= - 0.36, ß< 0.01), time from home to the nearest hospital (ß= - 0.13, ß< 0.05), knowledge on maternal care (ß=0.12, ß< 0.01) and perceived quality of hospital care (ß=0.10, ß< 0.01) were all directly correlated factors. Treating ANC as an intermediate variable showed the indirect relationship that perceived quality of hospital care (ß=0.01, ß< 0.01) and maternal care knowledge (ß=0.02, ß< 0.01) had with hospital delivery and postpartum care rates. CONCLUSIONS: Use of maternal health services is low among women in ethnic rural areas. ANC has important direct and intermediate effects on subsequent use of hospital delivery and postpartum care. Improving ANC behavior should be a priority of maternal health care reforms. Given the long travel times for these women, reforms must also prioritize breaking down practical barriers that prevent this population from accessing care.

[Effect of utilization of child health services on the nutrition and growth status of infants in poor rural areas in Sichuan and Gansu Province].

OBJECTIVE: To investigate the current situation of the utilization of infant and young child health services in pool rural areas where minorities gathered in Sichuan and Gansu Province and analyze its effect on infant nutrition and growth. METHODS: We choosed 1065 infants and young children aged≤24 months with their mother as the subjects by multistage cluster random sampling in October to November 2014 in poor rural areas where ethnic minorities gathered in Sichuan and Gansu Province. Questionnaires were used to obtain the data of demography and utilization of maternal and child health services, physical examination to obtain the data of growth status, and hemoglobin detection to obtain the hemoglobin level. The relationship between the nutrition and growth status and maternal and child health service utilization was analyzed by the unconditioned Logistic regression analysis. RESULTS: Among the surveyed infants and young children, the underweight rate was 3. 38%, the stunting rate was 10. 52%, and the wasting rate was 2. 25%, the malnutrition prevalence was 12. 58%, and the anemia prevalence was 52. 68%. The children's physical examination rate was 37. 09%, and the systematic management( frequency of physical examination reached the standard) rate of children was 12. 68%. The rate of prophylactic inoculation was 92. 30%, and the rate of reaching the standard of vaccination frequency was 48. 73%. After adjusting the confounding factors, the result showed that utilization of vaccination( OR = 0. 41, 95% CI0. 23-0. 74) and vaccination frequency reaching the standard( OR = 0. 58, 95%CI 0. 36-0. 92) were protective factors for infant malnutrition. Children 's physical examinations frequency reaching the standard( OR = 0. 52, 95%CI 0. 35-0. 79) was a protective factor for infant anemia. CONCLUSION: Reasonable utilization of health services can reduce the poor result of nutrition and growth of infants in poor rural areas where ethnic minorities gather in Sichuan and Gansu provinces.

[Factors analysis on caregivers' compliance behaviors in nutrition packages feeding by PRECEDE theory in poor rural areas of Southern Shaanxi Province].

OBJECTIVE: To explore the main factors on caregivers' compliance behaviors in nutrition packages feeding in poor rural areas of Southern Shaanxi Province based on PRECEDE theory in terms of the predisposing factors( related knowledge and intentions of themselves), the enabling factors( social conditions and skills of behavior fulfillment) and the reinforcing factors( attitude of the important people around and rewards for persistent behavior). METHODS: The target villages were selected using multistages random sampling method( county-township-village) in the poor counties of Southern Shaanxi Province. Then we investigated all of the main caregivers whose family have an infant aged 6-12 months in these sampling villages. A follow-up investigation was conducted 6 months after the nutrition packages were given. A structured questionnaire was applied to collect data, which including the information about the nutrition packages feeding behavior of the caregivers and the related factors to their behaviors based on the PRECEDE theory, and the social demographic information of infants and their caregivers. Information about the questionnaire by the face-to-face interview at their home was collected. At the same time, we counted empty nutrition packages by the method of onsite enumeration, and checked with the questionnaire to obtain the information of caregivers' feeding behavior. Single factor analysis and multivariate Logistic regression analysis was used to analyze the factors associated with caregivers 'compliance to feed their infants nutrition packages. RESULTS: A total of 910 samples were interviewed, and the rate of caregivers' compliance to feed their infants nutrition packages was 64. 0%. The willing of caregivers to feed their infants nutrition packages( OR = 1. 582, 95% CI1. 117-2. 242) was a favorable predisposing factor to promote caregivers feed their infants nutrition packages. The preference of infants to nutrition packages( OR = 5. 116, 95% CI4. 064-6. 441), villages' encouragement( OR = 1. 527, 95% CI 1. 094-2. 132) as well as infants' changes in health status( OR = 1. 615, 95% CI 1. 231-2. 118) were positive reinforcing factors of feeding nutrition packages compliance of caregivers. CONCLUSION: The compliance of caregivers feed nutrition packages to their infants is low. The reinforcing factors are the key factors that affected the feeding behavior of caregivers' nutrition packages.

[A Social Network Perspective on the Transmission of Cysticercuscellulose Infections in Tibetan School Children in Sichuan].

OBJECTIVE: To determine the transmission characteristics of Cysticercuscellulose infections from a social network perspective in Tibetan school children in Sichuan. METHODS: A cluster sampling strategy was adopted to select two primary schools with high level of Cysticercuscellulose infections in the Tibetan agriculture areas of Liangshan prefecture, Sichuan province. All of the students from the selected schools were enrolled in the study. Their social network data, including classroom seating, dormitory roommates, best playmates, and those who shared meals and snacks etc, were collected by trained investigators. Stool and blood samples of the students were collected for parasite detection. The transmission network of Cysticercuscellulose infections and the overall social network of school children were analysed. RESULTS: A total of 644 children participated in the study. Taenia solium were found in 6.11% of the stool samples and 13.25% blood samples returned with seropositive. The transmission was centered around the sources of infections: dormitory-clustering in the boarding school and playmate-clustering in the day school. The overall social network analysis revealed "core people" (more relationships), "information disseminators" (closer to other nodes) and "information hubs" (between two nodes) in both schools. CONCLUSION: Close contacts in dormitories and playgrounds are the main sources of transmission of cysticercosis in the Tibetan schools. The "core people" "information disseminators" and "information hubs" are critical for the prevention and control of cysticercosis in the future.

[Impact of the neglected Cysticercus cellulose infection on mental health among school-aged children in Tibetan agricultural areas].

OBJECTIVE: To determine the impact of Cysticercus cellulose (C. cellulose) infection on mental health among school-aged children in Tibetan agricultural areas of Sichuan Province.
 Methods: In October 2015, all primary schools located in Tibetan agricultural areas in Yajiang, Ruoergai, and Muli county of Sichuan Province were selected as the research sites. All school-aged children at five- and six-grade were enrolled for the study by a multistage stratified cluster sampling method. Antibodies against C. cellulose were detected. Mental Health Test and questionnaire survey were conducted for school-aged children to collect data. The impact of C. cellulose infection on mental health among school-aged children was analyzed with the multilevel linear regression.
 Results: A total of 2 453 school-aged children were investigated. The C. cellulose seropositive rate was 6.03% (148/2 453). There were 0.16% (4/2 453) patients with seropositive accompanied by seizure, 2.28% (56/2 453) with seropositive accompanied by headache, 2.08% (51/2 453) with seropositive accompanied by frequent weak, and 0.41% (10/2 453) were seropositive accompanied by frequent nausea. The rate of C. cellulose infection was 4.53% (111/2 453). The mean score of the mental health test was 6.59±2.61. There were significant difference in score of mental health test in children whose demographic characteristics were different. The mental health scores of school-aged children were clustered at the school level. After controlling the factors of demographic characteristics, the result of multilevel model demonstrated that the factor of school-aged children with C. cellulose seropositive accompanied by headache was statistically significant (ß=1.14, P=0.017).
 Conclusion: The status of C. cellulose infection among school-aged children in Tibetan agricultural areas is not optimistic. C. cellulose infection has impacted on mental health of local school-aged children. It is necessary to strengthen the prevention and control of C. cellulose infection in epidemic area.

[The Effects of a Biosensing Game on the Physical Health-Related Fitness of Chronic Schizophrenic Patients].

BACKGROUND: Being overweight is a common problem among chronic schizophrenic patients. However, these patients lack related exercise interventions that are both effective and convenient. PURPOSE: To explore the effects of a biosensing game intervention on the health-related fitness of chronic schizophrenic patients. METHODS: Two rehabilitation wards at a psychiatric hospital in New Taipei City were selected as the study sites. Simple random sampling was used to recruit participants. Participants in the experimental group received a 12-week biosensing game intervention, while participants in the control group received routine nursing care only. The study instruments included a demographic data sheet and anthropometric measurements. In addition, health-related fitness variables including cardiovascular endurance, muscular endurance, flexibility, and body composition (e.g., body mass index (BMI), waist-hip ratio, and body fat) were used as outcome indicators. RESULTS: A total of 35 patients participated in the experimental group and 35 patients participated in the control group. The results showed that the mean differences between the pre-test and post-test values for body weight (t=6.07, p<.01), BMI (t=5.79, p<.01), and waist-hip ratio (t=2.87, p<.05) differed significantly, with the experimental group performing better than the control group on all three indicators. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results indicate that this 12-week intervention holds the potential to help chronic schizophrenic patients improve their health-related fitness, especially in terms of body weight, BMI, and waist-hip ratio. This study may be used as a reference for the promotion of health-related fitness programs in psychiatric institutes in the future.

[Research on maternal health behaviors for Yi-nationality women in poor rural areas based on the theory of reasoned action].

OBJECTIVE: To analyze the status of maternal health behaviors and it's risk factors for Yi-nationality women in poor rural areas of Sichuan province. METHODS: In 2012, multi-stage stratified cluster sampling method was used to select 14 villages of two poor counties in Liangshan Yi-nationality autonomous prefecture Sichuan province. At least 10 women who have infants aged 0-12 months were selected in each simple villages, a total of 284. The structured questionnaire was developed on the basis of the theory of reasoned action. Yi-nationality female college students were trained as investigators. Research indicators included prenatal care rate, hospital delivery rate, postpartum examination rate, socio-demographic characteristics, maternal health care knowledge. χ² test was used to compare the differences of above indicators among different groups. The structural equation model were used to statistical analyze. RESULTS: In the 284 subject women, 51.7% (147/284) women owned more than 2 children, 41.6% (118/284) women were more than 30 years old, 87.3% (248/284) women were illiteracy. The prenatal care rate was 69.7% (197/284), the hospital delivery rate was 26.8% (76/284), and the postnatal check rate was 22.9% (65/284). The influence factors of maternal health behaviors included the number of children, age and education (χ² were 10.92, 13.24, 9.58; P values were 0.027, 0.004, 0.008, respectively).The structural equation model analysis results showed that the maternal health behaviors were directly or indirectly affected by subjective norms (ß = 0.236, P < 0.001), women's cognition (ß = 0.226, P = 0.020) and women's attitudes on maternal health behavior (ß = 0.157, P = 0.001). Among subjective norms, women have high compliance to their husbands (ß = 0.850, P < 0.001), their peers (ß = 0.708, P < 0.001), and their mothers-in-law (ß = 0.636, P < 0.001). CONCLUSION: There were still serious problems in maternal health behaviors for Yi-nationality women in poor rural areas. The main factors included not only the women's cognition and attitudes for maternal health, but also the attitudes of important social relationships.