南通市通州区已婚妇女妇幼保健知识知晓情况调查分析

目的了解辖区内已婚妇女妇幼保健知识掌握情况及需求现状,探讨其存在的主要影响因素,以便为今后开展有针对性的干预措施提供依据。方法采用个人问卷调查的方法,现场入户逐一进行测试。结果当前辖区内已婚妇女已了解一定的妇幼保健知识,但掌握水平有待进一步提高;宣传教育及保健服务方面还存在着一些问题,在一定程度上困扰着妇女儿童的身心健康。结论必须加大对妇幼保健知识的宣传力度,加强妇幼卫生保健服务工作,促进家庭和谐,社会稳定。     

Utilization of Maternal Health Care Services among Married Adolescent Women: Insights from the Nigeria Demographic and Health Survey, 2008

BackgroundAn ongoing social catastrophe of very poor performance in maternal health coupled with an unacceptably high number of maternal deaths is evident in Nigeria, especially among adolescent women. This study examines the factors associated with selected maternity services—married adolescent women who have had at least four antenatal care (ANC) visits, those who have undergone safe delivery care, and those who received postnatal care within 42 days of delivery.MethodsData from Nigeria Demographic and Health Survey, 2008, were used. An eligible sample of 2,434 married adolescent (aged 15–19 years) women was included in the analysis. Pearson chi-square test and binary logistic regression were performed to fulfill the study objective.ResultsIt was found that about 35% of adolescent women had at least four ANC visits, a little over 25% had undergone safe delivery care, and nearly 32% received postnatal care within 42 days of delivery. Women's education, husband's education, wealth quintile, and region of residence were documented as the most important factors associated with maternal healthcare service utilization. The ANC visit was found to be vital in the utilization of safe delivery and postnatal care.ConclusionFindings indicate that programs to improve maternal healthcare have not succeeded in overcoming the socioeconomic obstacles in the way of adolescents' utilizing maternity services. In the long run, the content and service delivery strategy of maternity programs must be designed in keeping with the socioeconomic context with special attention to adolescent women who are uneducated, poor, and residing in rural areas.     

Factors Associated With the Utilization of Maternal Health Care Services Among Adolescent Women in Malawi

The poor maternal health care service utilization among adolescent women remains an intimidating challenge in Malawi. This study examines the factors associated with the utilization of selected maternal health care services among married adolescent women (aged 15–19 years) using data from the Malawi Demographic and Health Survey, 2010. Maternal age, household economic status, and status of the child were found to be significant factors associated with at least four antenatal care visits; whereas personal barriers, birth order and interval, religion, and ethnic group explain the variation in the utilization of postnatal care within 42 days of delivery.     

Health Needs and Health Care Utilization Among Rural,Low-Income Women

ABSTRACT

This study examined the correlates of health service utilization in a sample of low-income, rural women. Self-reported data were from Rural Families Speak (N = 275), a multi-state study of low-income, rural families in the U.S. collected in 2002. Findings indicated that women with health insurance, a regular doctor, and poorer overall physical health had higher incident rates of physician visits. Women who were divorced, separated or widowed and had more chronic health problems had higher incidence rates of emergency department (ED) use, while women living in counties with higher primary care physician rates had lower incidence rates of ED use. Future research and policies should focus on improved access to health insurance, increasing physician availability in rural areas, and providing rural women with a usual source of care, so as to reduce emergency services utilization for non-emergent needs and improve health status for this population.     

Utilization of Maternal Health Care Among Immigrant Mothers in New York City, 2016–2018

Immigrant women represent half of New York City (NYC) births, and some immigrant groups have elevated risk for poor maternal health outcomes. Disparities in health care utilization across the maternity care spectrum may contribute to differential maternal health outcomes. Data on immigrant maternal health utilization are under-explored in the literature. We conducted a cross-sectional analysis of the population-based NYC Pregnancy Risk Assessment Monitoring System survey, using 2016–2018 data linked to birth certificate variables, to explore self-reported utilization of preconception, prenatal, and postpartum health care and potential explanatory pathways. We stratified results by maternal nativity and, for immigrants, by years living in the US; geographic region of origin; and country of origin income grouping. Among immigrant women, 43% did not visit a health care provider in the year before pregnancy, compared to 27% of US-born women (risk difference [RD] = 0.16, 95% CI [0.13, 0.20]), 64% had no dental cleaning during pregnancy compared to 49% of US-born women (RD = 0.15, 95% CI [0.11, 0.18]), and 11% lost health insurance postpartum compared to 1% of US-born women (RD = 0.10, 95% CI [0.08, 0.11]). The largest disparities were among recent arrivals to the US and immigrants from countries in Central America, South America, South Asia, and sub-Saharan Africa. Utilization differences were partially explained by insurance type, paternal nativity, maternal education, and race and ethnicity. Disparities may be reduced by collaborating with community-based organizations in immigrant communities on strategies to improve utilization and by expanding health care access and eligibility for public health insurance coverage before and after pregnancy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-021-00584-5.     

Contextual Determinants of Maternal Health Care Service Utilization in Nigeria

Despite the high maternal mortality ratio in Nigeria, the use of maternal health care services is very poor. Attempts to explain this situation has focused on individual level factors and the influence of community contextual factors have not received much attention. This study examined the relation of community factors to the use of antenatal care in Nigeria, and explored whether community factors moderated the association between individual characteristics and antenatal care visits. Data were drawn from the 2008 Nigeria Demographic and Health Survey among 16,005 women aged 15–49 years who had had their last delivery in the five years preceding the survey. Results from multi-level models indicated that living in communities with a high proportion of women who delivered in a health facility was associated with four or more antenatal care visits. Residence in high-poverty communities decreased the likelihood of antenatal care attendance. Living in communities with a high proportion of educated women was not significantly related to antenatal care visits. Community factors acted as moderators of the association between educational attainment and antenatal care attendance. Improvement in antenatal care utilization may therefore be enhanced by targeting poverty reduction programs and increasing health facility delivery in disadvantaged communities.     

The Effects of Prenatal Care Utilization on Maternal Health and Health Behaviors

While many economic studies have explored the role of prenatal care in infant health production, the literature is sporadic on the effects of prenatal care on the mother. This research contributes to this understudied but important area using a unique large dataset of sibling newborns delivered by 0.17 million mothers. We apply within‐mother estimators to find robust evidence that poor prenatal care utilization due to late onset of care, low frequency of care visits, or combinations of the two significantly increases the risks of maternal insufficient gestational weight gain, prenatal smoking, premature rupture of membranes, precipitous labor, no breastfeeding, postnatal underweight, and postpartum smoking. The magnitude of the estimates relative to the respective sample means of the outcome variables ranges from 3% to 33%. The results highlight the importance of receiving timely and sufficient prenatal care in improving maternal health and health behaviors during pregnancy as well as after childbirth. Copyright © 2016 John Wiley & Sons, Ltd.     

卫生Ⅷ项目对孕产期保健服务利用公平性的影响

目的探讨卫生Ⅷ项目在实现孕产期保健服务利用公平性目标中的作用。方法利用"卫生Ⅷ项目/卫生Ⅷ支持性项目对母婴保健与健康影响"专项评估中的孕产妇入户调查数据库,分析项目县和非项目县不同家庭收入妇女利用孕产期保健服务的差异。结果综合试点县和一般项目县的各项产前、产时和产后保健服务利用率的"最高收入组-最低收入组"的极差都不同程度地低于对照县,且随收入变化的等级趋势也明显弱化。结论乡镇卫生院建设和住院分娩费用减免等项目措施的综合实施,有效地提高了贫困孕产妇利用基本孕产期保健服务的可及性和可负担性,从而改善了孕产妇医疗保健服务利用的公平性。     

新疆生产建设兵团已婚育龄妇女孕产期保健状况调查

目的：了解新疆生产建设兵团1971-2006年间孕产期保健状况。方法：采取分层整群、四阶段、概率比例随机抽样方法,调查员入户面对面问卷调查。结果：共调查有活产已婚育龄妇女6624人,2001年以来,产前检查率、孕早期（妊娠≤12周）检查率、师直≥8次产前检查率、团场≥5次产前检查率、住院分娩率分别达到了86.60％、66.64％、58.70％、65.19％、82.01％,在家分娩率降到14.10％,而产后访视率仅为32.01％。育龄妇女的分娩时期、民族、受教育程度、生育史、家庭年收入、职业与是否参加产前检查有关。结论：近几年孕产期保健状况有明显改善,但产前检查率、孕早期检查率和产后访视率偏低,应特别加强对文化程度低、从事农业、少数民族孕妇的健康教育,普及孕产期卫生保健知识,规范产后访视,提高孕产期保健服务质量和服务利用率。     

非户籍妇女孕产期保健直接医疗费用调查

目的 通过对非户籍妇女孕产期保健的直接医疗费用进行调查,了解非户籍妇女产前保健和住院分娩经济负担,探讨非户籍妇女孕产期保健筹资的公平性.方法 选取2006年7月至2007年6月间单月在上海市某二级综合医院分娩的所有非户籍人口产妇,共475例,对孕产期保健经济负担进行调查.结果 475例研究对象住院天数平均为5.93天,研究对象平均产前检查直接医疗费用为897.03元.阴道分娩组住院直接医疗费用平均为1 378.26元,各项费用构成占前3位的是手术费、检验费、西药费:剖宫产组住院直接医疗费用平均为3 169.64元,各项费用占前3住的是手术费、西药费、检验费.家庭年收入<2万元组孕产期保健直接医疗费用占家庭年收入的比例最高.占家庭年收入的22.17％.结论 相对于低收入的非户籍人口家庭来说,非户籍妇女的孕产期保健费用仍偏高,而较高的孕产期保健费用可降低非户籍妇女的孕产期保健的可及性.     

Update: Health Insurance and Utilization of Care Among Rural Adolescents

CONTEXT: Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences. PURPOSE: To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents. METHODS: Cross-sectional design using data from the 1999-2000 National Health Interview Survey, a nationally representative sample of US households. Analysis was restricted to white, black, and Hispanic children aged 12 through 17 (8,503 observations). Outcome measures included health insurance, ambulatory visit within past year, usual source of care (USOC), and well visit within past year. Independent variables included race, residence, demographics, facilitating/enabling characteristics, and need. RESULTS: Across races, rural adolescents were as likely to have insurance (86.8% vs 87.7%) but less likely to report a preventive visit (60.1% vs 65.5%) than urban children; residence did not affect the likelihood of a visit or a USOC. Minority rural adolescents were less likely than whites to be insured, report a visit, or have a USOC. Most race-based differences were not significant in multivariate analysis holding constant living situation, caretaker education, income, and insurance. Low caretaker English fluency, limited almost exclusively to Hispanics, was an impediment to all outcomes. CONCLUSIONS: Most barriers to care among rural and minority youth are attributable to factors originating outside the health care system, such as language, living situation, caretaker education, and income. A combination of outreach activities and programs to enhance rural schools and economic opportunities will be needed to improve coverage and utilization among adolescents.     

Health Care Access and Utilization Among US-Born and Foreign-Born Asian Americans

Despite efforts to eliminate inequality in health and health care, disparities in health care access and utilization persist in the United States. The purpose of this study was to compare the access to care and use of health care services of US-born and foreign-born Asian Americans. We used aggregated data from the National Health Interview Survey (NHIS) from 2003 to 2005, including 2,500 participants who identified themselves as Asian. Associations between country of birth and reported access and utilization of care in the previous 12 months were examined. After controlling for covariates, being foreign-born was negatively related to indicators of access to care, including health insurance (OR = 0.29, 95%CI = 0.18-0.48), routine care access (OR = 0.52, 95%CI = 0.36-0.75), and sick care access [OR = 0.67, 95%CI = 0.47-0.96)]. Being foreign-born was also negatively related to all indicators of health care utilization (office visit: OR = 0.58, 95%CI = 0.41-0.81; seen/talked to a general doctor: OR = 0.69, 95%CI = 0.52-0.90; seen/talked to a specialist: OR = 0.42, 95%CI = 0.28-0.63) but ER visit (OR = 0.84, 95%CI = 0.59-1.20). There are substantial differences by country of birth in health care access and utilization among Asian Americans. Our findings emphasize the need for developing culturally sensitive health services and intervention programs for Asian communities.     

Intimate Partner Violence and the Utilization of Maternal Health Care Services in Nigeria

Our aim in this study is to examine the association between women's lifetime experiences of physical, sexual, and emotional intimate partner violence (IPV) and the use of maternal health care services. We used data from the 2008 Nigeria Demographic and Health Survey. Analysis was based on responses from 17,476 women (for antenatal care [ANC]) and 17,412 (for delivery assisted by a skilled health provider) who had had deliveries in the 5 years preceding the survey. We found an overall IPV prevalence rate of 33.4%. Physical IPV was associated with low use of ANC. Emotionally abused women were less likely to use delivery assistance from skilled health care providers. Based on our findings, we suggest the importance of designing interventions to address the health care needs of women who have experienced violence from their partners.     

上海市普陀区孕产期卫生服务利用研究

目的了解普陀区本市产妇和外来产妇孕产期卫生服务利用情况,分析孕产期卫生服务利用的影响因素。方法通过对产妇的问卷调查,了解产妇及家庭一般情况、孕产期卫生服务利用情况。数据由Epidata2.1软件建立数据库,使用SPSS11.0软件对录入资料进行统计分析。结果 1、本市、外来产妇在孕产期卫生服务利用方面差异有统计学意义。2、本市、外来产妇在产时、产后卫生服务利用方面差异有统计学意义。3、产妇年龄、丈夫户籍、丈夫文化程度、家庭经济状况是孕产期卫生服务利用的影响因素。结论 1、本市产妇孕产期卫生服务利用情况优于全国其他地区,且近几年有所提高。2、外来产妇孕产期卫生服务利用情况有所改善,但与本市产妇比较仍有明显差距。3、外来、本市产妇在产时卫生服务利用方面存在差异。4、调整卫生服务策略,提高孕产期卫生服务利用。     

Health,Health Behaviors,and Health Care Utilization Among Adults with Serious Psychological Distress Who Receive Federal Housing Assistance

The Journal of Behavioral Health Services & Research - Using newly available U.S. Department of Housing and Urban Development (HUD) administrative data linked with National Health Interview...     

Differential Effects of Mental Health Problems Among Truant Youths

Research indicates at-risk youth are more likely to experience emotional and psychological problems. Young people who are often truant from school represent a group of at-risk youth, but one for which mental health issues are understudied. This study examined heterogeneity of mental health problems among a sample of 300 truant adolescents using latent class analysis (LCA). LCA indicated the sample of truants was best represented by four latent subgroups of youth with low mental health problems; high depression, low mania; high mania, low depression; and high depression and mania. These subgroups were examined in relation to sociodemographic and psychosocial measures at baseline and after truancy offenses. Results indicated general and unique differences in these covariates across the four latent classes. Service and practice implications of better understanding mental health issues of truant youth are discussed.     

The Relationships Among Maternal Health Locus of Control Beliefs and Expectations,Pediatrician-Mother Communication,and Maternal Satisfaction With Well-Infant Care

The objective of this study was to assess the relationship among mothers' perceptions of control over the health of their children, mothers' expectations about and satisfaction with their infants' pediatric well-child care visit, and selected attributes of pediatrician-mother interaction during these well-care visits. Results suggest that pediatrician-mother interaction during well-child visits is responsive to mothers' locus of control beliefs with regard to their children's health and expectations regarding physician interactive behavior. Moreover, pediatrician-mother interaction was predictive of maternal overall satisfaction. These results are discussed both theoretically and within an applied perspective.     

基层医疗保健机构孕产妇保健服务利用现状与相关因素分析

目的 探究影响孕产妇利用保健服务的相关因素,并结合地区实际,提出了相关建议和措施.方法 对在我院进行保健服务的1558名孕产妇进行调查分析,结合实际情况用SPSS 18.0统计学软件进行系统分析.结果 文化程度、家庭年收入水平、居住地距离、职业和医保等因素对孕产妇保健服务利用影响较大;同时,在1 558名受访者中,接受孕前保健指导的比率相对较低,早孕检查、5次以上产检率和住院分娩率结果相对较高,说明近几年来孕产妇对保健服务利用的意识有所提高,但产后访视比例仅为21.76％,比例较低.结论 针对当前现状,研究认为,个人、基层医疗保健机构及卫生管理部门等各方应当分别在提高认识水平、提高服务水平及加强基层系统建设等方面进行改善,以提高孕产妇保健服务的利用,提高优生优育水平.     

Effects of Welfare and Maternal Work on Recommended Preventive Care Utilization Among Low-Income Children

Objectives. We examined how maternal work and welfare receipt are associated with children receiving recommended pediatric preventive care services.Methods. We identified American Academy of Pediatrics–recommended preventive care visits from medical records of children in the 1999–2004 Illinois Families Study: Child Well-Being. We used Illinois administrative data to identify whether mothers received welfare or worked during the period the visit was recommended, and we analyzed the child visit data using random-intercept logistic regressions that adjusted for child, maternal, and visit-specific characteristics.Results. The 485 children (95%) meeting inclusion criteria made 41% of their recommended visits. Children were 60% more likely (adjusted odds ratios [AOR` = 1.60; 95% confidence interval [CI] = 1.27, 2.01) to make recommended visits when mothers received welfare but did not work compared with when mothers did not receive welfare and did not work. Children were 25% less likely (AOR = 0.75; 95% CI = 0.60, 0.94) to make preventive care visits during periods when mothers received welfare and worked compared with welfare only periods.Conclusion. The Temporary Assistance for Needy Families maternal work requirement may be a barrier to receiving recommended preventive pediatric health care.The Personal Responsibility and Work Opportunity Reconciliation Act was enacted in 1996, replacing Aid to Families With Dependent Children with a new program, Temporary Assistance for Needy Families (TANF). Sometimes called “welfare reform,” TANF is now in its 15th year, and another reauthorization is anticipated in 2013. Whereas Aid to Families With Dependent Children provided welfare cash assistance (“welfare”) for low-income mothers with young children and did not permit receipt of additional income through work, TANF requires most mothers receiving welfare to work or to participate in job-training programs.The impact of welfare reform on children’s health care access, utilization, and outcomes has been much debated. Several studies examined the consequences of welfare reform on children’s health and reported that TANF’s maternal employment requirements may negatively affect children’s health.1–5 In a previous study, we found that mothers working during periods when mothers were receiving welfare resulted in negative effects on the timely administration of childhood immunizations.6aWe sought to understand the association of welfare receipt and maternal work with recommended preventive pediatric health care visits. The American Academy of Pediatrics (AAP) provides recommendations for the ages at which a child should receive preventive care visits and, for each recommended visit, a “window,” or period of time, when the visit should be received.6b Preventive pediatric health care visits are critical during the vulnerable first years of a child’s life for monitoring growth and development and for providing timely immunizations.7–9 Also, previous research has shown that receipt of preventive pediatric health care is associated with reduced avoidable hospitalizations, reduced emergency department visits, and better health outcomes.10–12 Nevertheless, there is good evidence that many preventive care visits are delayed or missed entirely and, among low-income children, this is of particular concern because of their increased risks for poor growth and development.13–15 We hypothesized that maternal work required for welfare receipt was associated with reduced preventive health care visits.