山东省儿童保健服务利用及公平性评价

目的 对山东省儿童保健服务的利用及公平性进行评价, 以便了解儿童保健服务的均等化程度。方法 采取分层随机抽样的方法对于989名儿童进行调查, 运用集中曲线、集中指数等方法进行公平性评价。结果 儿童保健服务多项指标的利用率偏低, 且存在不同程度的不公平现象, 其中不同收入组新生儿访视、儿童健康管理、儿童系统管理三项儿童保健指标的服务利用的集中指数分别为0.014 29、0.019 97和0.038 27。结论 加强对公平性差的儿童保健服务项目的 关注, 提高儿童保健服务利用的公平性。     

儿童保健服务利用受益归属分析

目的对儿童保健服务利用进行受益归属分析,了解儿童保健服务的受益人群和受益程度。方法共调查989名儿童。运用Kakwani指数、利用需要比和集中指数等方法进行受益归属评价。结果儿童保健各项服务利用总体上是低经济收入组受益多。不同保健服务项目在不同母亲文化程度组间受益不同,产后访视低母亲文化程度组受益更多。在儿童健康体检服务利用上农村儿童受益更多。结论加强对儿童保健服务利用受益较少人群的关注,从经济政策支持和健康教育等方面入手,提高低收入家庭和低文化程度家庭儿童保健服务的利用率,促进利用均等化。     

广州市白云区儿童保健服务利用状况及影响因素研究

目的明确广州市白云区儿童保健服务利用现状及其相关影响因素。方法回顾性问卷调查流动和户籍6岁以下儿童保健服务利用状况。结果研究对象中新生儿访视率、儿童保健系统管理率分别为39. 51%、73. 87%,母亲妊娠期在社区医院建立围产卡、儿童出生的助产机构医务人员告知儿童家长社区医院将进行新生儿访视和儿童定期体检、家长知晓新生儿访视和定期健康检查为影响儿童保健服务利用的主要因素,户籍不是影响儿童保健服务的主要因素。结论注重孕期建卡,在助产机构对新生儿家长进行的儿童基本保健服务内容宣传和教育等有助于进一步提高儿童保健服务。     

甘肃省会宁县贫困家庭0~6岁儿童保健服务影响因素分析

目的 了解甘肃省会宁县贫困家庭0~6岁儿童保健服务现状,找出影响贫困家庭0~6岁儿童保健服务利用的因素,为改善贫困家庭儿童健康水平提供依据。方法 在甘肃省会宁县的6个乡镇随机抽取533名贫困家庭儿童看护人,对其进行问卷调查,并对部分家长进行小组访谈,获取儿童、家庭基本情况及儿童保健服务等信息。结果 会宁县贫困家庭0~6岁儿童保健覆盖率仅为75.4%,影响贫困家庭0~6岁儿童保健覆盖率的主要因素为看护人文化程度、家庭年人均收入、是否接受新生儿随访、是否接受健康教育。结论 会宁县贫困家庭0~6岁儿童保健覆盖率有待提高,经济因素、看护人的健康知识和保健意识是影响贫困家庭儿童接受保健服务的重要因素。     

四川省凉山州甘洛县0～6岁儿童保健服务利用及家长保健知识知晓情况

目的 了解四川省凉山州甘洛县0～6岁儿童保健服务利用情况,调查家长对儿童保健常见知识的知晓情况并进行原因分析。方法 选取凉山州甘洛县8名管理、保健和儿科业务人员进行专题访谈,采用随机抽样的方法选取甘洛县海棠镇坪坝乡作为调查地点,坪坝乡下辖12个村庄,每个村庄随机抽取10名儿童家长作为调查对象进行问卷调查,采用描述性统计方法、χ2检验对家长的儿童保健知识知晓情况和服务利用情况进行比较分析。结果 调查地区存在缺少儿童保健相关设备设施、儿童保健相关专业人员不足的情况。在预防接种方面,95%的家长带儿童按时接种了疫苗,但其中35%的家长完全不知道儿童预防接种前后的注意事项。家长对常见儿童保健知识的总体知晓率为65.15%。家庭孩子的数量、经济水平以及儿童家长文化程度等因素是影响家长对儿童保健态度以及参与程度的重要原因。结论 四川省凉山州甘洛县0～6岁儿童家长对儿童保健的利用率较低,家长的儿童保健素养还有待提高。应着力建设稳定的儿童保健医疗队伍,完善基层儿童保健设备设施,提高家长的儿童保健意识,更好地保障儿童健康。     

产后保健服务利用及影响因素分析

目的了解孕产妇产后保健服务需求和利用情况,探讨影响产后保健服务利用的关键因素。方法应用自行设计的调查问卷对孩子40天至6个月的妇女进行调查,利用多元logistic回归分析方法,对产后保健服务利用的影响因素进行分析,并探索关键因素。结果多元logistic回归分析结果显示,孕产妇的居住地、医疗费用的支付方式、就医距离以及对产后访视的重视程度等是影响孕产妇产后保健服务利用的重要因素。结论:孕产妇产后保健服务利用率低,孕产妇的产后保健服务有待加强。     

江苏,安徽,江西3省计划免疫服务利用影响因素分析

几十年来,我国的计划免疫工作取得了长足的进展。研究影响服务利用的因素将有助于进一步扩大计划免疫覆盖面,减少可预防疾病的发生,促进儿童健康。本文对不同经济条件、医疗保健制度下,农村儿童计划免疫覆盖的现况和因素分析得出:医疗保健制度、父母受教育程度和家庭经济收入等是影响服务利用的主要因素。建议从建立适宜的保健制度和进行健康教育两大环节着手,进一步提高服务利用率。     

北京市朝阳区《卫生部/WH0/UNICEF城市流动人口妇幼保健服务项目》基线调查报告

目的:了解北京市朝阳区流动孕产妇和儿童的健康、营养、保健服务利用情况,以及医疗保健服务机构的管理水平和服务质量情况.方法:采用社区及医疗保健机构调查、个人问卷调查、访谈和座谈的方法,调查朝阳区的经济、社会、人口等基本情况;对1100名5岁以下流动儿童监护人及孕产妇进行问卷调查;对卫生部门和流动人口管理部门工作人员进行访谈,与街道、社区工作人员座谈.结果:在京流动儿童<母子健康档案>或定期体检卡的建卡率为59.1%,监护人的文化程度和家庭经济收入影响儿童建卡率(P<0.001);流动孕产妇文化程度和经济收入水平低是影响孕妇建册率的主要因素(P<0.05);流动妇女儿童的保健服务已纳入本地管理,但保健机构的人员、房屋及设备配比不足,对流动人口信息掌握不够准确.结论:流动人口孕产妇和儿童监护人文化程度低,相对贫困,缺乏卫生保健的知识,保健意识淡薄,影响保健服务质量,应加强健康教育,提高保健意识,实现资源共享,准确掌握流动人口信息.同时还需加大医疗保健设备及人员的投入,以满足流动人口妇幼保健服务的需求.     

孕产妇孕期保健服务利用的多因素分析

目的了解我国孕产妇孕期保健服务需求和利用现状,探讨影响孕产妇孕期保健服务利用的关键因素。方法应用自行设计的调查问卷对2009年7—12月之间分娩的妇女进行调查,利用多元Logistic回归分析法对我国孕产妇孕期保健服务利用的影响因素进行分析,并探讨关键因素。结果多元Logistic回归分析结果显示,孕产妇的文化程度、居住地、民族、对孕期检查的重视程度以及对产前保健知识咨询的重视程度等是影响孕产妇孕期保健服务利用的重要因素。结论孕产妇孕期保健服务利用受到多方面因素的影响。     

农村育龄妇女孕前保健服务利用影响因素分析

目的调查农村育龄妇女孕前保健服务利用现状及影响因素,为进一步完善农村孕前保健实施策略提供依据。方法采用分层抽样方法,选取1 227名农村育龄妇女为研究对象,采用自制问卷进行入户调查获取孕前保健服务利用相关情况。结果孕前保健服务利用率为37.5%;妇科检查、白带常规、血型、血常规、B超、TORCH感染监测、输血前3项、染色体监测等检查项目利用率分别为36.6%、35.4%、30.1%、31.5%、28.4%、24.0%、19.2%、1.2%;多因素Logistic回归分析显示,年龄、经济收入、医疗保障状况、就医便利程度、孕前保健意识、孕前保健知识及知识获取途经对孕前保健服务利用率有明显影响(P<0.05)。结论农村孕前保健服务利用率较低;人口学因素、孕前保健意识及认知因素、孕前保健宣传途径是农村育龄妇女利用孕前保健服务的重要影响因素。     

Determinants of the use of maternal health services in rural Bangladesh

Utilization of health services is a complex behavioral phenomenon. Empirical studies of preventive and curative services have often found that use of health services is related to the availability, quality and cost of services, as well as to social structure, health beliefs and personal characteristics of the users. In this paper an attempt is made to examine the factors associated with the use of maternal health care services in Bangladesh on the basis of data from a survey of maternal morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). The results from both the bivariate and multivariate analyses confirmed the importance of mother's education in explaining the utilization of health care services. Female education retains a net effect on maternal health service use, independent of other women's background characteristics, household's socioeconomic status and access to healthcare services. The strong influence of mother's education on the utilization of health care services is consistent with findings from other studies. Women whose husbands are involved in business/services also positively influenced the utilization of modern health care services. However, the study results are inconclusive with respect to the influence of other predisposing and enabling factors, such as women's age, number of previous pregnancies and access to health facilities. Multivariate logistic regression estimates do not show any significant impact of these factors on the use of maternal health care. The influence of severity of disease condition in explaining the utilization of maternal health care appears to be significant. Multivariate analysis indicate that women having had a life-threatening condition are little over two times more likely to seek care from a doctor or nurse to treat their maternal morbidities.     

非户籍妇女孕产期保健服务利用影响因素的定性研究

目的:了解非户籍妇女孕产期保健服务利用状况,并分析其影响因素,为研究孕产期保健服务的可及性和公平性提供依据。方法:通过个别深入访谈的方法,选择在上海市南汇区分娩的非户籍人口孕产妇进行调查。结果:非户籍妇女孕产期保健服务利用不足。社会经济地位、本人及她人既往分娩经历、妇女的角色与孩子的性别均不同程度影响非户籍妇女的孕产期保健服务利用。结论:应针对非户籍妇女进行形式多样的孕产期保健宣传教育,包括其家庭成员的教育,在城市建立流动人口平产分娩点对非户籍妇女孕产期保健具有积极意义,政府应支持多部门协作,对非户籍人口实行综合管理,同时在财政上予以支持。     

Health care provision for illegal migrants: may health policy make a difference?

Illegal migrants in Europe are, generally, only entitled to emergency care and services for children and pregnant women. In 2002 legal changes in Spain made accessible medical cards and free medical care for illegal migrants in similar terms than the legal migrants or the Spanish population. We interviewed 380 migrants to assess whether there were differences on health services utilization by legal status. We did not find differences in the utilization of health services when ill between legal and illegal migrants. However, a significantly lower utilization of health services was associated with less education (RP = 0.4; 95% CI: 0.2-0.9).     

山东省农村老年人卫生服务利用现状及影响因素分析

目的了解农村老年人卫生服务利用情况,并探讨其影响因素。方法采用分层随机抽样方法,从山东省不同经济发展水平的11个地、市随机抽取610名农村老年人,采用国家卫生服务调查问卷对农村老年人卫生服务进行现场调查,了解农村老年人卫生服务利用状况,采用单因素分析和多元Logistic回归分析方法对农村老年人卫生服务利用的影响因素进行分析。结果本次调查共发放调查问卷610份,回收有效问卷603份,农村老年人两周患病率为26.20%,两周就诊率为13.27%,患病而未就诊者占49.37%,多元Logistic回归分析发现影响农村老年人两周就诊率的因素有:医疗保险、抚养人口数、健康自评和居住地等。结论农村老年人对卫生服务利用率较低,应大力发展农村经济,不断完善医疗保障制度,并加强农村老年人的健康教育,逐步提高其卫生服务利用率。     

健康素养对妇女儿童基本公共卫生服务利用的 影响研究

摘要:目的　了解城市妇女儿童的基本公共卫生服务利用情况和儿童母亲的健康素养状况,探索儿童母亲的健康素养对其基本公共卫生服务利用的影响。方法　采用多阶段整群随机抽样方法,对北京、宁波和厦门三城市的1 048名0～6岁儿童母亲进行问卷调查。使用卡方检验和多因素Logistic回归分析健康素养与基本公共卫生服务利用之间的关系。结果　所调查的母亲健康素养水平为低、中、高的比例分别为38.27%、29.00%和32.73%。34.26%的母亲建立了健康档案,36.27%的能够利用健康教育服务,孕12周参加免费体检者为47.10%,进行产前筛查者占85.24%;能按时接受产前检查者占92.94%,分别有81.01%和97.52%的儿童规范参加了健康管理和疫苗接种;Logistic回归结果显示,健康素养与建立健康档案（OR＝0.446,95%CI:0.329～0.604）、接受健康教育（OR＝1.451,95%CI:1.100～1.914）、产前检查（OR＝2.094,95%CI:1.089～4.026）、儿童健康管理（OR＝1.891,95%CI:1.246～2.872）存在关联。结论　健康素养水平能够影响到妇女儿童基本公共卫生服务的利用,建议针对儿童母亲开展更多旨在提高其健康素养水平的活动,进而促进妇女和儿童对基本公共卫生服务的利用。     

The effects of geography and spatial behavior on health care utilization among the residents of a rural region

OBJECTIVE: This analysis determines the importance of geography and spatial behavior as predisposing and enabling factors in rural health care utilization, controlling for demographic, social, cultural, and health status factors. DATA SOURCES: A survey of 1,059 adults in 12 rural Appalachian North Carolina counties. STUDY DESIGN: This cross-sectional study used a three-stage sampling design stratified by county and ethnicity. Preliminary analysis of health services utilization compared weighted proportions of number of health care visits in the previous 12 months for regular check-up care, chronic care, and acute care across geographic, sociodemographic, cultural, and health variables. Multivariable logistic models identified independent correlates of health services utilization. DATA COLLECTION METHODS: Respondents answered standard survey questions. They located places in which they engaged health related and normal day-to-day activities; these data were entered into a geographic information system for analysis. PRINCIPAL FINDINGS: Several geographic and spatial behavior factors, including having a driver's license, use of provided rides, and distance for regular care, were significantly related to health care utilization for regular check-up and chronic care in the bivariate analysis. In the multivariate model, having a driver's license and distance for regular care remained significant, as did several predisposing (age, gender, ethnicity), enabling (household income), and need (physical and mental health measures, number of conditions). Geographic measures, as predisposing and enabling factors, were related to regular check-up and chronic care, but not to acute care visits. CONCLUSIONS: These results show the importance of geographic and spatial behavior factors in rural health care utilization. They also indicate continuing inequity in rural health care utilization that must be addressed in public policy.     

Barriers to the utilization of maternal health care in rural Mali

This study used data from the 2001 Demographic and Health Survey and multilevel logistic regression models to examine area- and individual-level barriers to the utilization of maternal health services in rural Mali. The analysis highlights a range of area-level influences on the use made of maternal health services. While the dearth of health facilities was a barrier to receipt of prenatal care in the first trimester, transportation barriers were more important for four or more prenatal visits, and distance barriers for delivery assistance by trained medical personnel and institutional delivery. Women's odds of utilizing maternal health services were strongly influenced by the practices of others in their areas of residence and by living in close proximity to people with secondary or higher education. Household poverty and personal problems were negatively related to all outcomes considered. The results highlight the importance of antenatal care and counseling about pregnancy complications for increasing the likelihood of appropriate delivery care, particularly among women living 15-29 km from a health facility. Area-level factors explained a greater proportion of the variation in delivery care than in prenatal care However, significant area variation in the utilization of maternal health services remained unexplained.     

Family structure, socioeconomic status, and access to health care for children

OBJECTIVE: To test the hypothesis that among children of lower socioeconomic status (SES), children of single mothers would have relatively worse access to care than children in two-parent families, but there would be no access difference by family structure among children in higher SES families. DATA SOURCES: The National Health Interview Surveys of 1993-95, including 63,054 children. STUDY DESIGN: Logistic regression was used to examine the relationship between the child's family structure (single-mother or two-parent family) and three measures of health care access and utilization: having no physician visits in the past year, having no usual source of health care, and having unmet health care needs. To examine how these relationships varied at different levels of SES, the models were stratified on maternal education level as the SES variable. The stratified models adjusted for maternal employment, child's health status, race and ethnicity, and child's age. Models were fit to examine the additional effects of health insurance coverage on the relationships between family structure, access to care, and SES. PRINCIPAL FINDINGS: Children of single mothers, compared with children living with two parents, were as likely to have had no physician visit in the past year; were slightly more likely to have no usual source of health care; and were more likely to have an unmet health care need. These relationships differed by mother's education. As expected, children of single mothers had similar access to care as children in two-parent families at high levels of maternal education, for the access measures of no physician visits in the past year and no usual source of care. However, at low levels of maternal education, children of single mothers appeared to have better access to care than children in two-parent families. Once health insurance was added to adjusted models, there was no significant socioeconomic variation in the relationships between family structure and physician visits or usual source of care, and there were no significant disparities by family structure at the highest levels of maternal education. There were no family structure differences in unmet needs at low maternal education, whereas children of single mothers had more unmet needs at high levels of maternal education, even after adjustment for insurance coverage. CONCLUSIONS: At high levels of maternal education, family structure did not influence physician visits or having a usual source of care, as expected. However, at low levels of maternal education, single mothers appeared to be better at accessing care for their children. Health insurance coverage explained some of the access differences by family structure. Medicaid is important for children of single mothers, but children in two-parent families whose mothers are less educated do not always have access to that resource. Public health insurance coverage is critical to ensure adequate health care access and utilization among children of less educated mothers, regardless of family structure.     

The health care access and utilization of homeschooled children in the United States

Although the population of homeschooled children in the United States is large and growing, little is known about their access to and utilization of preventive health care services. This paper compares the health care access and utilization of homeschooled children and public school children in the United States using data from the nationally-representative 2007 National Survey of Children's Health. Using logistic regression models, this study finds that homeschooled children were significantly less likely than public school children to have access to a medical home, to visit a health care professional annually, and to receive the Human Papillomavirus vaccine. They were not statistically less likely to have health insurance, to receive annual dental care, or to receive Tetanus or Meningitis vaccinations. This research suggests that public health practitioners, medical providers, researchers, and educators should be attentive to the health care needs of homeschooled children.