Child health and care services in China.

China, one of the world's most populous countries, enjoys an expansive network of health care practitioners, services, and facilities which emphasize preventive and primary health care. Rural women are served by 400,000 barefoot doctors, and 700,000 modern midwives, integrated by a 4-level care network of production teams, brigade cooperative medical stations, commune hospitals, and country maternity centers. 100 medical colleges and 30,000 trained pediatricians are in the country. Preventive care, extensive immunizations, barefoot doctors' efforts to educate rural women, and the combined application of traditional herbs and modern medicine have brought about reductions in infant mortality and families' desires to bear large numbers of children. China has vaccination coverage of 85-90%. Late marriage, birth control, and serious financial disincentives for couples who bear more than 1 child also serve to leave China with a growth rate of almost zero, and a family norm of 1 child. Female marriage age is 20 years, male marriage age is 22 years, divorce rate is very low, and abortion is legal.     

Breast Feeding of Infants Between 0-6 Months Old in 20 Provinces, Municipalities and Autonomous Regions in the People's Republic of China

This investigation was designed as an overall study of breast feeding rates and corresponding influencing factors in urban and rural communities in the People's Republic of China. In all 95,578 infants between 0 and 6 months old who lived within 20 different provinces or autonomous regions were subjects for the study which was conducted from March 1983 to August 1985. The findings revealed that breast feeding rates for urban areas were significantly lower than the rates for the rural areas.     

Prevention of drowning in infants,children, and adolescents

Drowning is a leading cause of injury-related death in children. In 2000, more than 1400 US children younger than 20 years drowned. Most (91%) of these deaths were unintentional and were not related to boating. For each drowning death, it is estimated that at least 1 to 4 children suffer a serious nonfatal submersion event, many of which leave children with permanent disabilities. Environmental strategies, such as installation of 4-sided fences around swimming pools, and behavioral strategies, such as increased supervision of children while around water, are needed to prevent these tragedies.     

Epilepsy in children and the risk of drowning.

To clarify the risks of drowning for children with epilepsy we have studied the records of the 306 children who drowned or nearly drowned in the UK in 1988 and 1989. Ten children with incidents related to epilepsy presented over the study period, four of whom drowned. Children with epilepsy had a higher incidence of submersion accidents but no child participating in supervised swimming drowned. Two children died in the bath. Five children had special needs. We conclude that children with epilepsy can enjoy swimming with a friend in a lifeguard supervised swimming pool. They should be encouraged to shower in a non-glass cubicle rather than have a bath. The bathroom should remain unlocked. Children with poorly controlled epilepsy or associated learning difficulties are at a higher risk from all accident trauma. They need a very high level of supervision while swimming and advice should be given on an individual basis according to what is considered realistic for that child.     

Prevalence of traumatic injuries in drowning and near drowning in children and adolescents

OBJECTIVE: To determine the prevalence of traumatic injuries in children involved in drowning and near-drowning accidents. DESIGN/METHODS: Ten-year retrospective medical chart review of patients at an urban tertiary care pediatric facility. Included patients had International Classification of Diseases, Ninth Revision, Clinical Modification codes for fatal/nonfatal drowning or E codes for fall into water, accidental drowning, and submersion. We recorded demographics, event characteristics, diagnostics, and outcome data. We used the chi(2) or the Fisher exact test to compare patients with and without injuries. RESULTS: One hundred forty-three patients met inclusion criteria. Of these, 95 (66.4%) were male. Median age was 3.8 years, and 30 (23.4%) of 128 had preexisting conditions. Site of drowning was the pool (70.6%), the bathtub (19.0%), or natural water (10.4%). The prevalence of traumatic injury was 4.9% (95% confidence interval, 0%-28%). The predominant mechanism of injury was diving, and all injuries were to the cervical spine. Patients with injury were more likely to be older (mean age, 13.5 vs 5.1 years; P<.001) and to have a history of diving (85.7% vs 2.2%; P<.001). The presence of injury was not associated with sex, preexisting condition, or site of drowning (P>.05). CONCLUSIONS: The prevalence of traumatic injury in drowning and near drowning is low. We identified only cervical spine injuries, and all but 1 patient had a clear history of diving. Use of specialized trauma evaluations may not be warranted for patients in drowning and near-drowning accidents without a clear history of traumatic mechanism.     

Mortality among children in rural areas of the People's Democratic Republic of Yemen

A prospective study on health and mortality of children under 7 years of age was conducted in rural parts of PDR Yemen during 1982-84. Altogether, 2071 children and 976 mothers were followed for 1 year and visited twice. The infant mortality rate (IMR), child mortality rate and under-5 mortality rate were 86, 11 and 129 per 1000, respectively. Sixty per cent of all deaths occurred during infancy. Diarrhoea commonly preceded death during infancy, and symptoms of measles during the 2nd year of life. The mothers of the deceased children were younger than the average rural mother (P less than 0.05) and more often primiparae, whereas illiteracy rates and median income did not differ from families which had not experienced death of a child. The risk of dying within 1 year was three times greater for wasted children in general, but 24 times greater for 1-2-year-olds. No increased risk was found for stunted children at any age. The prevalence of bottle feeding up to 18 months of age was high, and exclusive breastfeeding below 6 months of age was rare in the villages with the highest IMR (P less than 0.05). Infections seemed to be the trigger factor for death, but wasting predisposed to death at least after infancy.     

The challenge of cross-cultural collaborative research: lessons learnt from a pilot case-crossover study of severe occupational hand trauma in the People's Republic of China.

OBJECTIVE: A pilot epidemiologic study was conducted in the People's Republic of China to assess the feasibility of applying the study protocol from a US case-crossover study on transient work-related exposures and the risk of an acute occupational hand injury. DESIGN: Injured workers were recruited from a hand surgery center in Ningbo, Zhejiang, People's Republic of China. A structured face-to-face interview questionnaire was administered. RESULTS: 156 workers with hand injury completed the study (73% men). The enrollment rate was 91%. Of those who refused participation, most indicated their reluctance was due to the requirement to sign the written consent form. Considerable variability was found among interviewers in ascertaining responses from participants to important exposure questions (21.3% v 97%). CONCLUSIONS: Recommendations include the following: (1) exploring effective oral-consent protocols that reduce participant concern and still meet human participant protection requirements; (2) using non-physician interviewers; and (3) increasing the intensity and standardization of interviewer training.