Health Disparities among the Western, Central and Eastern Rural Regions of China after a Decade of Health Promotion and Disease Prevention Programming

Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.

Regional ecosystem health assessment using the GA-BPANN model:a case study of Yunnan Province,China

Background:Regional ecosystem health assessments are the basis for the sustainable development of society.However,an ecosystem is a complex integration of ecosystem mosaics and subsystems that influence each other,making it difficult to evaluate them using traditional assessment methods of linear and explicit functions.We introduce a back-propagation neural network model optimized by a genetic algorithm to evaluate ecosystem health in 16 districts in Yunnan Province.Result:(1)The model required fewer inputs to evaluate complex and nonlinear systems,avoided the need for subjective weights,and performed well in this practical application to regional ecosystem health assessment.(2)The ecosystem health in Yunnan Province was increasing,and there was a significant positive spatial autocorrelation during 2000-2020,showing that districts with high Ecosystem Health cluster together and the ecological protection policy of the region has produced a diffusion effect,leading to continuous improvement of the ecological health of the surrounding areas.High-low outlier areas of ecosystem health should be paid more attention,because of the increasing instability of local health levels.Conclusion:This study provides a methodological exploration for assessing spatial mosaics of different ecosystems at a regional scale.

Implementing uterine balloon tamponade(UBT)device for immediate postpartum hemorrhage management:Leveraging resource allocation and highlighting noteworthy experiences

Background The use of uterine balloon tamponade(UBT)devices for intrauterine packing and management of vaginal bleeding by uterine atony has shown promising results in improving the quality of care and reducing maternal mortality.Objective This report aims to provide an overview of progress made in implementing UBT devices in northern Cote d'Ivoire.Material and methods A four-year retrospective study was conducted in the North-East(163,645),North-Center(351,909),and North-West(57,983).In 2017,UBT was adopted by members of the healthcare system.Subsequently,5 national and 32 regional trainers have been trained.The training session was a theoretical and practical program with a low simulator.UBT is a male condom tied to a urinary catheter,filled with liquid.Positive outcomes included stopping bleeding,avoiding the need for surgery,and preventing maternal deaths(MD).In 2018,3,515 UBT devices were distributed.In 2019,monitoring tools and transmission circuits of the data were validated.In 2020,the collection of data and local manufacturing was launched.Results During the process,978 health workers,mainly midwife(52.0%)and nurses(32.2%)out of the 1,295 assigned were trained.The number of trained individuals decreased from 209 in 2019 to 160 in 2020.A total of 1,715 UBT devices were locally manufactured,adding to the existing gift of 5,080 devices,with total availability of 6,795.The distribution of devices increased from 2017 to 2019 but decreased in 2020.Success rates increased from 87.3%in 2017(365/418)to 95.0%in 2019(556/585)and slightly decreased in 2020 to 98.0%(681/695).Adverse outcomes(144/2,193),included MD(35/2,193)and medical evacuation to the surgical center(109/2,193).Conclusion The implementation of UBT in northern Cote d'Ivoire successfully reduced maternal death rates caused by immediate post-partum hemorrhage(IPPH).However,to ensure sustainability,further improvements are needed,including increased monitoring,ongoing training,and device availability.