Examining clinical capability of township healthcare centres for rural health service planning in Sichuan, China: an administrative data analysis.

OBJECTIVE: This study aimed to examine the clinical capability of township healthcare centres (THCs), the main primary care providers in rural China, as a basis for rural health service planning. DESIGN: Observational study of quantitative analysis using administrative data. SETTING: Three counties with low, middle and high social economic development level, respectively, in Sichuan province western China. PARTICIPANTS: 9 THCs and 6 county hospitals (CHs) were purposively selected in the three counties. Summary of electronic medical records of 31 633 admissions from 1 January 2015 to 30 December 2015 of these selected health institutions was obtained from the Health Information Centre of Sichuan province. MAIN OUTCOME MEASURES: Six indicators in scope of inpatient services related to diseases and surgeries in the THCs as proxy of clinical capability, were compared against national standard of capability building of THCs, among counties, and between THCs and CHs of each county. RESULTS: The clinical capability of THCs was suboptimal against the national standard, though that of the middle-developed county was better than that in the rich and the poor counties. THCs mainly provided services of infectious or inflammatory diseases, of respiratory and digestive systems, but lacked clinical services related to injuries, poisoning, pregnancy, childbirth and surgeries. A large proportion of the top 20 diseases of inpatients were potentially avoidable hospitalisations (PAHs) and were overlapped between THCs and CHs. CONCLUSIONS: The clinical capability of THCs was generally suboptimal against national standard. It may be affected by the economics, population size, facilities, workforce and the share of services of THCs in local health systems. Identification of absent services and PAHs may help to identify development priorities of local THCs. Clarification of the roles of THCs and CHs in the tiered rural health system in China is warranted to develop a better integrated health system.

Mediating Effect of Work Stress on the Associations Between Psychological Job Demands, Social Approval, and Workplace Violence Among Health Care Workers in Sichuan Province of China.

Objective: The aim of this study was to investigate the prevalence of workplace violence against health care workers, to explore the combined association of work stress, psychological job demands, and social approval with workplace violence and their respective mechanisms among health care workers. Methods: Using data from the Chinese Sixth National Health Service Survey (NHSS) in 2018 conducted among 1,371 health care workers in Sichuan province of China. A self-administered structured questionnaire was used to collect data on health care workers' socio-demographic and work-related characteristics, work stress, psychological job demands, social approval, and workplace violence. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. Results: The results showed that a total of 77.0% health care workers were exposed to workplace violence. Work stress was directly related to workplace violence (ß = 2.167, 95%CI: 1.707, 2.627), while psychological job demands and social approval had indirect associations with workplace violence via work stress [ß = 0.427, 95%CI: 0.297, 0.557; ß = -0.787, 95%CI: (-0.941)-(-0.633)]. Both psychological job demands (ß = 0.197, 95%CI: 0.139, 0.255) and social approval [ß = -0.346, 95%CI: (-0.399)-(-0.294)] had direct associations with work stress, while social approval had direct association with psychological job demands [ß = -0.085, 95%CI: (-0.136)-(-0.034)]. Psychological job demands mediated the relationship between social approval and work stress. Conclusion: Overall, decreasing workplace violence among health care workers requires to promote interventions to reduce work stress and psychological job demands by improving social approval.

Spatiotemporal assessment of health burden and economic losses attributable to short-term exposure to ground-level ozone during 2015-2018 in China.

BACKGROUND: Ground-level ozone (O3) pollution is currently the one of the severe environmental problems in China. Although existing studies have quantified the O3-related health impact and economic loss, few have focused on the acute health effects of short-term exposure to O3 and have been limited to a single temporal and spatial dimension. METHODS: Based on the O3 concentration obtained from ground monitoring networks in 334 Chinese cities in 2015-2018, this study used a two-stage exposure parameter weighted Log-linear exposure-response function to estimate the cause-specific mortality for short-term exposure to O3. RESULTS: The value of statistical life (VSL) method that were used to calculate the economic loss at the city-level. Our results show that in China, the national all-cause mortality attributed to O3 was 0.27(95% CI: 0.14-0.55) to 0.39 (95% CI: 0.20-0.67) million across 2015-2018. The estimated economic loss caused by O3 was 387.76 (95% CI: 195.99-904.50) to 594.08 (95% CI: 303.34-1140.65) billion CNY, accounting for 0.52 to 0.69% of total reported GDP. Overall, the O3 attributed health and economic burden has begun to decline in China since 2017. However, highly polluted areas still face severe burden, and undeveloped areas suffer from high GDP losses. CONCLUSIONS: There are substantial health impacts and economic losses related to short-term O3 exposure in China. The government should pay attention to the emerging ozone pollution, and continue to strengthen the intervention in traditional priority areas while solving the pollution problem in non-priority areas.

Regional-level risk factors for severe hand-foot-and-mouth disease: an ecological study from mainland China.

BACKGROUND: Severe hand-foot-and-mouth disease (HFMD) is a life-threatening contagious disease among young children and infants. Although enterovirus A71 has been well acknowledged to be the dominant cause of severe HFMD, there still remain other unidentified risk factors for severe HFMD. Previous studies mainly focused on identifying the individual-level risk factors from a clinical perspective, while rare studies aimed to clarify the association between regional-level risk factors and severe HFMD, which may be more important from a public health perspective. METHODS: We retrieved the clinical HFMD counts between 2008 and 2014 from the Chinese Center for Disease Control and Prevention, which were used to calculated the case-severity rate in 143 prefectural-level cities in mainland China. For each of those 143 cities, we further obtained city-specific characteristics from the China City Statistical Yearbook (social and economic variables) and the national meteorological monitoring system (meteorological variables). A Poisson regression model was then used to estimate the associations between city-specific characteristics (reduced by the principal component analysis to avoid multicollinearity) and the case-severity rate of HFMD. The above analysis was further stratified by age and gender to examine potential modifying effects and vulnerable sub-populations. RESULTS: We found that the case-severity rate of HFMD varied dramatically between cities, ranging from 0 to 8.09%. Cities with high case-severity rates were mainly clustered in Central China. By relating the case-severity rate to city-specific characteristics, we found that both the principal component characterized by a high level of social and economic development (RR = 0.823, 95%CI 0.739, 0.916) and another that characterized by warm and humid climate (RR = 0.771, 95%CI 0.619, 0.960) were negatively associated with the case-severity rate of HFMD. These estimations were consistent across age and gender sub-populations. CONCLUSION: Except for the type of infected pathogen, the case-severity rate of HFMD was closely related to city development and meteorological factor. These findings suggest that social and environmental factors may also play an important role in the progress of severe HFMD.

Spatio-temporal analysis of socio-economic characteristics for pulmonary tuberculosis in Sichuan province of China, 2006-2015.

BACKGROUND: The disease burden caused by pulmonary tuberculosis (TB) in Sichuan province still persisted at a high level, and large spatial variances were presented across regional distribution disparities. The socio-economic factors were suspected to affect the population of TB notification, we aimed to describe TB case notification rate (CNR) and identify which factors influence TB epidemic are necessary for the prevention and control of the disease in Sichuan province. METHODS: A retrospective cross-sectional study and an ecological spatial analysis was conducted to quantify the presence and location of spatial clusters of TB by the Moran's I index and examined these patterns with socio-economic risk factors by hierarchical Bayesian spatio-temporal model. RESULTS: A total of 630,009 pulmonary TB cases were notified from 2006 to 2015 in 181 counties of Sichuan province. The CNR decreased year by year since 2007, from 88.70 to 61.37 per 100,000 persons. The spatial heterogeneities of CNR were observed during the study periods. Global Moran's I index varied from 0.23 to 0.44 with all P-value < 0.001. The Bayesian spatio-temporal model with parametric spatio-temporal interactions was chosen as the best model according to the minimum of Deviance Information Criterion (DIC)(19,379.01), and in which the quadratic form of time was taken. The proportion of age group and education year were all associated with CNR after adjusting the spatial effect, temporal effect and spatio-temporal interactions. TB CNR increased by 10.2% [95% credible interval (CI): 6.7-13.7%] for every 1-standard-deviation increase in proportion of age group and decreased by 23% (95% CI: 13.7-32.7%) for every 1-standard-deviation increase in education year. CONCLUSIONS: There were spatial clusters of TB notification rate in Sichuan province from 2006 to 2015, and heavy TB burden was mainly attributed to aging and low socioeconomic status including poor education. Thus, it is more important to pay more attention to the elderly population and improve socioeconomic status including promoting education level in Sichuan province to reduce the TB burden.

Estimating health burden and economic loss attributable to short-term exposure to multiple air pollutants in China.

Existing studies focused on the evaluation of health burden of long-term exposure to air pollutants, whereas limited information is available on short-term exposure, particularly in China. Air pollutant concentrations in 338 Chinese cities in 2017 were used to estimate the air pollutants related health burden which was defined as premature mortalities from all-cause, cardiovascular and respiratory disease as well as hospital admissions for cardiovascular and respiratory disease. Log-linear model was used as the exposure-response function to estimate the health burden attributable to each air pollutant. The value of statistical life and cost of illness methods were used to estimate economic loss of the premature mortalities and hospital admissions, respectively. The national all-cause premature mortalities attributable to all air pollutants was 1.35 million, accounting for 17.2% of reported deaths in China in 2017. Among all-cause premature mortality, contributions of PM2.5, PM2.5-10, NO2, SO2, O3 and CO were11.1%, 5.2%, 28.9%, 9.6%, 23.0%, and 22.2%, respectively. The national cardiovascular and respiratory premature mortalities were 0.77 and 0.21 million, respectively. About 7.8 million cardiovascular and respiratory disease hospital admissions were attributed to short-term exposure to all air pollutants. The economic loss of the overall health burden (premature mortality and hospital admissions) was 2065.54 billion Yuan, which was equivalent to 2.5% of the national GDP in 2017. The health burden and economic loss attributable to short-term exposure to ambient air pollutant are substantial in China. It suggested that the adverse health effects attributable to short-term exposure to air pollutant should not be neglected in China. In order to reduce the health impact of air pollution, each city should develop air pollution prevention and control measures based on existing scientific evidence.

Uptake of maternal care and childhood immunization among ethnic minority and Han populations in Sichuan province: a study based on the 2003, 2008 and 2013 health service surveys.

BACKGROUND: China has made remarkable progress in maternal and child health (MCH) over the last thirty years, but socio-economic inequalities persist. Ethnicity has become an important determinant of poor MCH outcomes, but little rigorous analytical work has been done in this area. To understand the socio-economic factors that explain ethnic variation in uptake of MCH care, we report the findings from an analysis in Sichuan province. METHODS: We linked data from the 2003, 2008 and 2013 National Health Service Surveys in Sichuan Province. The ethnic disparities in uptake of maternal care (completing 5 antenatal visits, giving birth in hospital and receiving a caesarean section) and childhood immunization (Bacillus Calmette Guerin (BCG), three doses of diphtheria (DPT) and measles immunization) were examined by geographical (Han district/county vs. ethnic minority county) and individual-based (Han women/children vs. ethnic minority women/children) comparisons. We also examined variation by distance to township and county hospitals, women's education, parity and age using weighted multilevel Poisson regressions with random intercept at district/county level. RESULTS: Ethnic inequalities in maternal care were marked, both at the geographical (district/county) and the individual level. The % of births in hospital was 90.7% among women in Han districts, compared to 83.3% among women living in Han counties (crude RR 0.93; 95% CI 0.75-1.15), 53.8% among Han women living in ethnic minority counties (crude RR 0.57; 95% CI 0.36-0.93), and 13.5% among ethnic minority women living in ethnic minority counties (crude RR 0.18; 95% CI 0.06-0.57). Adjusting the analysis for survey year, education, parity and distance to county level hospital weakened the association between geographical/individual ethnicity and uptake of maternity care, but associations remained remarkably strong. Coverage of childhood immunization was much higher than uptake of maternity care, and inequalities by ethnicity were much less pronounced. CONCLUSION: Lessons can be learned from China's successful immunization programme to further reduce inequalities in access to maternity care among ethnic minority populations in remote areas. Bringing the services closer to the women's homes and strengthening health promotion from the township to the village level may encourage more women to seek antenatal care and give birth in hospital.

The burden and challenges of tuberculosis in China: findings from the Global Burden of Disease Study 2015.

To achieve the End Tuberculosis (TB) Strategy, it is important to understand the characteristics of TB in China, which may provide the government with important clues for controlling TB by 2030. Data from the Global Burden of Disease Study 2015 (GBD 2015) and Institute for Health Metrics and Evaluation (IHME) were reviewed and analysed. The age-standardized death rate decreased by 83.79% [95% uncertainty interval (UI) 73.06-87.10] from 1990 to 2015. The age-standardized prevalence of TB in males decreased steadily by 33.88% (95% UI 29.35-37.67) but nearly increased by 6.24% (95% UI -2.02-15.07) in females from 1990 to 2015. Disability-adjusted life years (DALYs) were higher in males than in females, and the highest TB burden was found in the elderly (70+ years of age). Over the period 1990-2015, the attributable age-standardized DALY rates for smoking decreased by 12.98% (95% UI 2.40-24.27), but increased for alcohol use and high fasting plasma glucose (HFPG). Greater attention should be paid to females especially in the under 5 years of age group, and more latent reasons explaining TB DALYs should be explored in future studies.

Spatial-temporal mapping of hand foot and mouth disease and the long-term effects associated with climate and socio-economic variables in Sichuan Province, China from 2009 to 2013.

BACKGROUND: Hand, foot and mouth disease (HFMD) is a common infectious disease caused by enteroviruses. The annual HFMD incidence increased from 37.6/100,000 in 2008 to 139.6/100,000 in 2014 in mainland China. In this study, we try to model spatial-temporal association between HFMD incidence and climate and socio-economic variables. METHODS: The annual numbers of reported cases of HFMD and populations from 2009 to 2013 were obtained from the Chinese infectious disease surveillance system. The climate data were obtained from a data sharing website hosted by the China Meteorological Administration. The socio-economic data were obtained from the statistic Yearbook of Sichuan province. Moran's I statistics were used to detect the counties' global spatial clusters. The hierarchical Bayesian spatial temporal interactive models were used to analyze the association between the annual HFMD incidence rate and climate variables. RESULTS: An increasing trend in the annual HFMD incidence was detected in south-western counties. Spatial temporal clusters existed in Sichuan Province. A highly county level spatial structured RR (relative risk, RR) of HFMD incidence was detected in the northern and central of Sichuan Province. Annual HFMD incidence of counties were positively associated with the average annual temperature (RR:1.171, 95%CI:1.0435-1.3134), the second quartile of the per capital of GDP (reference: the first quartile of GDP, RR: 1.258, 95%CI: 1.0418-1.5200), the third quartile of per capital of GDP (RR:1.7726, 95%CI:1.3709-2.2907) and the fourth quartile of the per capital GDP (RR:1.9026, 95%CI1.3318-2.7086). CONCLUSION: The HFMD incidence exhibited a heterogeneous spatial-temporal distribution in Sichuan Province. In the counties with greater wealth, the temperature was the primary risk factor, whereas in the counties with less wealth, GDP was the primary risk factor attributed to the spatial structured of HFMD incidence. Different preventive measures should be implemented in counties with different economic conditions.

Outpatient prescription practices in rural township health centers in Sichuan Province, China.

BACKGROUND: Sichuan Province is an agricultural and economically developing province in western China. To understand practices of prescribing medications for outpatients in rural township health centers is important for the development of the rural medical and health services in this province and western China. METHODS: This is an observational study based on data from the 4th National Health Services Survey of China. A total of 3,059 prescriptions from 30 township health centers in Sichuan Province were collected and analyzed. Seven indicators were employed in the analyses to characterize the prescription practices. They are disease distribution, average cost per encounter, number of medications per encounter, percentage of encounters with antibiotics, percentage of encounters with glucocorticoids, percentage of encounters with combined glucocorticoids and antibiotics, and percentage of encounters with injections. RESULTS: The average medication cost per encounter was 16.30 Yuan ($2.59). About 60% of the prescriptions contained Chinese patent medicine (CPM), and almost all prescriptions (98.07%) contained western medicine. 85.18% of the prescriptions contained antibiotics, of which, 24.98% contained two or more types of antibiotics; the percentage of prescriptions with glucocorticoids was 19.99%; the percentage of prescriptions with both glucocorticoids and antibiotics was 16.67%; 51.40% of the prescriptions included injections, of which, 39.90% included two or more injections. CONCLUSIONS: The findings from this study demonstrated irrational medication uses of antibiotics, glucocorticoids and injections prescribed for outpatients in the rural township health centers in Sichuan Province. The reasons for irrational medication uses are not only solely due to the pursuit of maximizing benefits in the township health centers, but also more likely attributable to the lack of medical knowledge of rational medication uses among rural doctors and the lack of medical devices for disease diagnosis in those township health centers. The policy implication from this study is to enhance professional training in rational medication uses for rural doctors, improve hardware facilities for township health centers, promote health education to rural residents and establish a public reporting system to monitor prescription practices in rural township health centers, etc.

Social health assistance schemes: the case of Medical Financial Assistance for the rural poor in four counties of China.

BACKGROUND: Economic transition which took place in China over the last three decades, has led to a rapid marketization of the health care sector. Today inequity in health and poverty resulting from major illness has become a serious problem in rural areas of China. Medical Financial Assistance (MFA) is a health assistance scheme that helps rural poor people cope with major illness and alleviate their financial burden from major illness, which will definitely play a significant role in the process of rebuilding Chinese new rural health system. It mainly provides assistance to cover medical expenditure for inpatient services or the treatment of major illnesses, with joint funding from the central and local government. The purpose of this paper is to review the design, funding, implementation and to explore the preliminary effects of four counties' MFA in Hubei and Sichuan province of China. METHODS: We used an analytical framework built around the main objective of any social assistance scheme. The framework contains six 'targeting' procedural 'steps' which may explain why a specific group does not receive the assistance it ought to receive. More specifically, we explored to what extent the targeting, a key component of social assistance programs, is successful, based on the qualitative and quantitative data collected from four representative counties in central and western China. RESULTS: In the study sites, the budget of MFA ranged from 0.8 million Yuan to 1.646 million Yuan in each county and the budget per eligible person ranged from 32.67 Yuan to 149.09 Yuan. The preliminary effects of MFA were quite modest because of the scarcity of funds dedicated to the scheme. The coverage rate of MFA ranged from 17.8% to 24.1% among the four counties. MFA in the four counties used several ways to ration a restricted budget and provided only limited assistance. Substantial problems remained in terms of eligibility and identification of the beneficiaries, utilization and management of funds. CONCLUSIONS: MFA needs to be improved further although it evidences the concern of the government for the poor rural people with major illness. Some ideas on how to improve MFA are put forward for future policy making.

Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China.

BACKGROUND: China has been experiencing the largest rural to urban migration in history. Rural-to-urban migrants are those who leave their hometown for another place in order to work or live without changing their hukou status, which is a household registration system in China, categorizing people as either rural residents or urban residents. Rural-to-urban migrants typically find better job opportunities in destination cities, and these pay higher salaries than available in their home regions. This has served to improve the enrollment rates in the New Cooperative Medical Scheme (NCMS) of rural families, protecting households from falling into poverty due to diseases. However, current regulations stipulate that people who are registered in China's rural hukou can only participate in their local NCMS, which in turn poses barriers when migrants seek medical services in the health facilities of their destination cities. To examine this issue in greater depth, this study examined the associations between migration, economic status of rural households, and NCMS enrollment rate, as well as NCMS utilization of rural-to-urban migrants. METHODS: A multistage cluster sampling procedure was adopted. Our sample included 9,097 households and 36,720 individuals. Chi-square test and T-test were used to examine differences between the two populations of migrants and non-migrants based on age, gender, marriage status, and highest level of education. Ordinal logistic regression was used to examine the association between migration and household economic status. Binary logistic regression was used to examine the associations between household economic status, migration and enrollment in the NCMS. RESULTS: Migration was positively associated with improved household economic status. In households with no migrants, only 11.3% of the population was in the richest quintile, whereas the percentage was more than doubled in households with family members who migrated in 2006. Among those using in-patient medical services, 54.3% of migrants in comparison with 17.5% of non-migrants used out-of-county hospitals, many of which were not designated hospitals (Designated hospitals refer to hospitals where, if people use in patient health care, could receive reimbursement from the NCMS.); and 55.2% of migrants in comparison with 24.6% of non-migrants, who had the NCMS in 2006, received no reimbursement from the NCMS. The three main reasons of not receiving reimbursement were: staying in a hospital not designated by the NCMS, lack of knowledge of NCMS policies, and encountering difficulties obtaining reimbursement. CONCLUSION: Migrants to urban centers improve the economic status of their rural household economic of origin. However, obtaining reimbursement under the current NCMS for the cost of hospital services provided by undesignated providers in urban centers is limited. Addressing this challenge is an emerging policy priority.

Modelling and Monte Carlo organ dose calculations for workers walking on ground contaminated with Cs-137 and Co-60 gamma sources.

A pair of walking phantoms was developed from deformable mesh phantoms to represent individuals walking on contaminated ground. The Monte Carlo N-particle extended version code was used to calculate organ doses from ground contamination scenarios involving parallel and isotropic planar sources of Cs-137 and Co-60 with concentrations of 30 kBqm(-2). For the parallel plane source case, the organ doses were up to 78 % greater for walking phantoms than those for the standing phantoms. The dose difference is because the widely open legs during walking provide less shielding to several organs, especially the kidneys, ovaries and liver, from parallel sources. The effective doses of the walking phantoms were on average 15 % higher than the standing phantoms. On the other hand, when isotropic planar sources were considered, no significant dose difference was observed. This study demonstrated the feasibility of using deformable phantoms to represent realistic postures for organ dose calculations in environmental dosimetry studies.

Deformable adult human phantoms for radiation protection dosimetry: anthropometric data representing size distributions of adult worker populations and software algorithms.

Computational phantoms representing workers and patients are essential in estimating organ doses from various occupational radiation exposures and medical procedures. Nearly all existing phantoms, however, were purposely designed to match internal and external anatomical features of the Reference Man as defined by the International Commission on Radiological Protection (ICRP). To reduce uncertainty in dose calculations caused by anatomical variations, a new generation of phantoms of varying organ and body sizes is needed. This paper presents detailed anatomical data in tables and graphs that are used to design such size-adjustable phantoms representing a range of adult individuals in terms of the body height, body weight and internal organ volume/mass. Two different sets of information are used to derive the phantom sets: (1) individual internal organ size and volume/mass distribution data derived from the recommendations of the ICRP in Publications 23 and 89 and (2) whole-body height and weight percentile data from the National Health and Nutrition Examination Survey (NHANES 1999-2002). The NHANES height and weight data for 19 year old males and females are used to estimate the distributions of individuals' size, which is unknown, that corresponds to the ICRP organ and tissue distributions. This paper then demonstrates the usage of these anthropometric data in the development of deformable anatomical phantoms. A pair of phantoms--modeled entirely in mesh surfaces--of the adult male and female, RPI-adult male (AM) and RPI-adult female (AF) are used as the base for size-adjustable phantoms. To create percentile-specific phantoms from these two base phantoms, organ surface boundaries are carefully altered according to the tabulated anthropometric data. Software algorithms are developed to automatically match the organ volumes and masses with desired values. Finally, these mesh-based, percentile-specific phantoms are converted into voxel-based phantoms for Monte Carlo radiation transport simulations. This paper also compares absorbed organ doses for the RPI-AM-5th-height and -weight percentile phantom (165 cm in height and 56 kg in weight) and the RPI-AM-95th-height and -weight percentile phantom (188 cm in height and 110 kg in weight) with those for the RPI-AM-50th-height and -weight percentile phantom (176 cm in height and 73 kg in weight) from exposures to 0.5 MeV external photon beams. The results suggest a general finding that the phantoms representing a slimmer and shorter individual male received higher absorbed organ doses because of lesser degree of photon attenuation due to smaller amount of body fat. In particular, doses to the prostate and adrenal in the RPI-AM-5th-height and -weight percentile phantom is about 10% greater than those in the RPI-AM-50th-height and -weight percentile phantom approximating the ICRP Reference Man. On the other hand, the doses to the prostate and adrenal in the RPI-AM-95th-height and -weight percentile phantom are approximately 20% greater than those in the RPI-AM-50th-height and -weight percentile phantom. Although this study only considered the photon radiation of limited energies and irradiation geometries, the potential to improve the organ dose accuracy using the deformable phantom technology is clearly demonstrated.

An investigation of voxel geometries for MCNP-based radiation dose calculations.

Voxelized geometry such as those obtained from medical images is increasingly used in Monte Carlo calculations of absorbed doses. One useful application of calculated absorbed dose is the determination of fluence-to-dose conversion factors for different organs. However, confusion still exists about how such a geometry is defined and how the energy deposition is best computed, especially involving a popular code, MCNP5. This study investigated two different types of geometries in the MCNP5 code, cell and lattice definitions. A 10 cm x 10 cm x 10 cm test phantom, which contained an embedded 2 cm x 2 cm x 2 cm target at its center, was considered. A planar source emitting parallel photons was also considered in the study. The results revealed that MCNP5 does not calculate total target volume for multi-voxel geometries. Therefore, tallies which involve total target volume must be divided by the user by the total number of voxels to obtain a correct dose result. Also, using planar source areas greater than the phantom size results in the same fluence-to-dose conversion factor.