The allocation and fairness of health human resources in Chinese maternal and child health care institutions: a nationwide longitudinal study.
BMC health services research
BACKGROUND:In response to an aging population, the Chinese government implemented the three-child policy in 2021 based on the comprehensive two-child policy. With the implementation of the new birth policy, people's maternal and child health (MCH) needs will also increase. The allocation and fairness of MCH human resources directly affect people's access to MCH services. The purpose of this study is to analyze the allocation of health human resources in Chinese maternal and child health care institutions, evaluate the fairness of the allocation, to provide a reference for the rational allocation of MCH human resources. METHODS:The data of health technicians, licensed (assistant) physicians, and registered nurses in maternal and child health care institutions nationwide from 2016 to 2020 were included. The health resource density index (HRDI) is used to evaluate the allocation level of MCH human resources. The Gini coefficient (G) and Theil index (T) are used to evaluate the fairness of the allocation of MCH human resources from the perspectives of population and geographic area. RESULTS:From 2016 to 2020, the average annual growth rate of the number of health technicians, licensed (assistant) physicians, and registered nurses in Chinese maternal and child health care institutions was 7.53, 6.88, and 9.12%, respectively. The Gini coefficient (G) of the three types of MCH human resources allocated by population were all below 0.23, and the Gini coefficient (G) allocated by geographical area were all above 0.65. The Theil index (T) of the three types of MCH human resources allocated by population was all lower than 0.06, and the Theil index (T) allocated by geographical area was all higher than 0.53. In addition, the three types of MCH human resources allocated by population and geographic area contributed more than 84% of the Theil index within the group (T) to the Theil index (T). CONCLUSIONS:China's MCH human resources were fair in terms of population allocation, but unfair in terms of geographical area allocation. In the future, more attention should be paid to the geographical accessibility of MCH human resources, and the allocation of resources should comprehensively consider the two factors of serving the population and geographical area.
10.1186/s12913-023-09076-5
The history of China's maternal and child health care development.
Guo Yan,Bai Jing,Na Heya
Seminars in fetal & neonatal medicine
The history of maternal and child health (MCH) development in China can be divided into six stages: before 1949 when the People's Republic of China was founded, traditional Chinese medicine shielded women's and children's health while modern medicine began to bud; 1949-1966, the MCH system was established and gradually improved; 1966-1976, the decade of the Cultural Revolution, the road to improve MCH twisted and turned along with the political instability; 1976-1990, especially after the "Reform" and "Opening Up", China's MCH care had been booming and the MCH status continued to improve with the rapid social and economic development; 1990-2008, with the booming economy, MCH care gained increasingly national and international attention. Through improving legislation and investment, China made great strides in the improvement of MCH. After 2009, the comprehensive health care reform laid an institutional basis for the development of MCH and promotion of health equity.
10.1016/j.siny.2015.07.006
Male involvement as a significant contributor for enhancing maternal and child health-care services: A scoping review.
Indian journal of public health
Men have conventionally been excluded from Maternal and Child Health (MCH) services, thereby reinforcing the erroneous notion that pregnancy and the processes leading to childbirth and child-rearing are the preserve of women. Participation of men in MCH is crucial for the reduction of infant and maternal mortality. This scoping review focuses on the contribution of male involvement to MCH care and explores the feasible strategies to improve it. Studies on male involvement in the crucial timelines of the MCH and strategies for implementing and improving male involvement in MCH care in India and other developing countries were obtained through a review of literature in PubMed databases using the medical subject headings (MeSH) terms and unpublished, grey literature during the year 1990-2020. Nearly 50 of the eligible articles were included and synthesized into a scoping review report. Findings revealed that the men's participation had a beneficial impact on all crucial timelines of MCH care. Yet, women perceived low male participation in most of the studies. Several different factors that influence have been identified, including education, socioeconomic status, traditional practices, negative stereotyping among males, and lack of male friendly health-care system. Utilization of community volunteers, male peer educators, workplace-based or mass media education, and men-friendly policy changes or health-care provider initiatives could be crucial in improving male involvement in MCH care. Despite worldwide acceptance as an essential contributor to enhancing MCH care, the scoping review revealed low male involvement levels in developing countries and identified strategies to address this lacuna.
10.4103/ijph.ijph_1749_22
Integrating Mental Health In Perinatal Care: Perspectives Of Interprofessional Clinicians.
Health affairs (Project Hope)
Despite the prevalence of perinatal mental health issues in the United States, gaps in care persist. To address this, perinatal health care settings are asked to focus on patients' mental health by administering standardized screening and, increasingly, by integrating mental health teams in their clinics. Using in-depth interviews and ethnographic observations, I investigated these emerging practices, exploring the experiences of certified nurse-midwives, obstetricians, and mental health clinicians. I found that certified nurse-midwives and obstetricians lack time, resources, and expertise, restricting their ability to address patients' mental health. Integrated mental health clinicians are constrained by the stratified organization of health care and structural deprioritization of mental health. Redesigning perinatal health care and de-siloing mental health training are necessary to increase clinicians' effectiveness and to improve perinatal health outcomes.
10.1377/hlthaff.2023.01427
Maternal and perinatal risk factors associated with congenital syphilis.
Tropical medicine & international health : TM & IH
OBJECTIVE:Mother-to-child transmission of syphilis remains an important global public health problem. Untreated intrauterine infection may result in adverse events for the fetus or newborn (NB). Maternal risk factors, such as prenatal care, early diagnosis, and appropriate treatment, significantly impact the likelihood of vertical transmission of syphilis. The purpose of this review is to evaluate maternal risk factors for congenital syphilis and the characteristics of exposed NB. METHODS:A total of 14 studies were evaluated, including 8 cohort studies, 4 cross-sectional and 2 control cases. A total of 12,230 women were included, with confirmed or highly probable congenital syphilis outcome, and 2285 NB. The studies evaluated risk factors for congenital syphilis, which were maternal, demographic, obstetric factors and characteristics of the exposed NB. RESULTS:Included in the risk factors studied, inadequate prenatal care and late onset, as well as inadequate or late treatment of maternal syphilis were significant risk factors for the outcome of congenital syphilis. When the time set of maternal diagnosis was correlated with neonatal infection, there was a tendency to worsen prognosis (more infected NB) in women diagnosed later in pregnancy, as well as in women who underwent few prenatal consultations and inadequate treatment. Women with recent syphilis with high VDRL titres had a higher rate of vertical transmission. The prior history of syphilis with adequate treatment was identified as a protective factor, resulting in lower rates of congenital syphilis. Among the epidemiological and demographic aspects surveyed, it was observed that young age, lower schooling, unemployment, low family income and no fixed residence were associated with higher risk of congenital syphilis. CONCLUSIONS:The association of syphilis with adverse socio-economic conditions and inadequate prenatal care suggests that the improvement of the population's living conditions and equitable access to quality health services may have an impact on the reduction of congenital syphilis.
10.1111/tmi.13881
Effects of perinatal mental disorders on the fetus and child.
Stein Alan,Pearson Rebecca M,Goodman Sherryl H,Rapa Elizabeth,Rahman Atif,McCallum Meaghan,Howard Louise M,Pariante Carmine M
Lancet (London, England)
Perinatal mental disorders are associated with increased risk of psychological and developmental disturbances in children. However, these disturbances are not inevitable. In this Series paper, we summarise evidence for associations between parental disorders and offspring outcomes from fetal development to adolescence in high-income, middle-income, and low-income countries. We assess evidence for mechanisms underlying transmission of disturbance, the role of mediating variables (underlying links between parent psychopathology and offspring outcomes) and possible moderators (which change the strength of any association), and focus on factors that are potentially modifiable, including parenting quality, social (including partner) and material support, and duration of the parental disorder. We review research of interventions, which are mostly about maternal depression, and emphasise the need to both treat the parent's disorder and help with associated caregiving difficulties. We conclude with policy implications and underline the need for early identification of those parents at high risk and for more early interventions and prevention research, especially in socioeconomically disadvantaged populations and low-income countries.
10.1016/S0140-6736(14)61277-0
Effective interventions to address maternal and child malnutrition: an update of the evidence.
Keats Emily C,Das Jai K,Salam Rehana A,Lassi Zohra S,Imdad Aamer,Black Robert E,Bhutta Zulfiqar A
The Lancet. Child & adolescent health
Malnutrition-consisting of undernutrition, overweight and obesity, and micronutrient deficiencies-continues to afflict millions of women and children, particularly in low-income and middle-income countries (LMICs). Since the 2013 Lancet Series on maternal and child nutrition, evidence on the ten recommended interventions has increased, along with evidence of newer interventions. Evidence on the effectiveness of antenatal multiple micronutrient supplementation in reducing the risk of stillbirths, low birthweight, and babies born small-for-gestational age has strengthened. Evidence continues to support the provision of supplementary food in food-insecure settings and community-based approaches with the use of locally produced supplementary and therapeutic food to manage children with acute malnutrition. Some emerging interventions, such as preventive small-quantity lipid-based nutrient supplements for children aged 6-23 months, have shown positive effects on child growth. For the prevention and management of childhood obesity, integrated interventions (eg, diet, exercise, and behavioural therapy) are most effective, although there is little evidence from LMICs. Lastly, indirect nutrition strategies, such as malaria prevention, preconception care, water, sanitation, and hygiene promotion, delivered inside and outside the health-care sector also provide important nutritional benefits. Looking forward, greater effort is required to improve intervention coverage, especially for the most vulnerable, and there is a crucial need to address the growing double burden of malnutrition (undernutrition, and overweight and obesity) in LMICs.
10.1016/S2352-4642(20)30274-1