Utilisation of maternity care in rural China : Affordability and Quality

Objective: China, like other transitional countries, is encountering socioeconomic-related inequality in maternal and child health. The principal aim of this study was to investigate the utilisation, contents, and costs of maternity care and its related financial burden on households in rural China, particularly in relation to a rural health insurance established in 2003. Materials and methods: This study was conducted in the context of the project Structural hinders to, and promoters of, good maternal care in rural China-CHIMACA . Data were obtained from the National Household Health Services surveys and its additional western surveys in ten western provinces in 2003 and 2008, and a population-based survey on women giving birth in 2008-2009 in five rural counties in three central and western provinces, and qualitative interviews in one of the five study counties. Logistic and linear regressions were used to study factors associated with the use of maternity care and out-of-pocket expenditure. Results: Between 2002 and 2007, the use of maternity care increased, particularly facility-based delivery rising from 45% to 80% in less developed western rural China; the difference in the use of maternity care between income groups became smaller. In 2002-2007, the out-of-pocket expenditure on facility-based delivery increased too, which was 13% of annual household income for the low-income household in 2007. The health insurance was associated with reduced out-of-pocket expenditure for caesarean section (CS), but not for vaginal delivery. The contents of prenatal care were studied in three of the five study counties. In all three counties, the proportions of women having the number of hemoglobin and urine tests recommended by the national guidelines were low, but 90% of women received two or more ultrasound examinations. The qualitative interviews were conducted in one county, which included prenatal care in the health insurance. Several women reported that doctors suggested them to take expensive examinations. In the five rural counties studied, 46% of all births were by CS with 13% occurring as an (self-reported) emergency CS and 33% of a non-emergency CS. Women reported that half of the non-emergency CSs were recommended by a doctor and half were requested by themselves. The health insurance was associated with having CS, in particular having non-emergency CS. Conclusion: Coinciding with the rural health insurance development, the use of maternity care in rural China has greatly improved. Nevertheless, more expensive examinations or procedures were often recommended by doctors. The financial burden relating to the use of maternity care for the rural poor remained high. The current health insurance lacks the tools required to control costs and to encourage good quality of care.Tausta: Kiinassa sosioekonomiset erot äitien ja lasten terveydessä ovat suuret. Suuri este äitiysterveyden parantamisessa on laadukkaiden äitiyshuoltopalveluiden puuttuminen maaseudun naisilta. Vuonna 2003 maaseudun sairausvakuutus laajentui valtakunnalliseksi. Siihen kuuluu äitiyshuollon etuuspaketti, joka kattaa sairaalasynnytykset. Muutamissa lääneissä järjestelmään kuuluu myös raskaudenaikainen hoito. Tavoitteet: Tämän tutkimuksen tavoitteena oli selvittää äitiyshuoltopalveluiden käyttöä, sisältöä ja kustannuksia Kiinan maaseudulla, erityisesti suhteessa sairausvakuutukseen. Aineisto: Tutkimuksessa käytettiin useita tietolähteitä: 1) kansallisia haastattelututkimuksia vuosilta ja 2) erityiskyselyjä Länsi-Kiinassa vuosina 2002 ja 2007 synnyttäneille maaseudun naisille, 3) väestöpohjaista kyselytutkimusta vuosina 2008 2009 synnyttäneille naisille kolmessa läänissä ja 4) laadullista haastatteluaineistoa. Tulokset: Vuosien 2002 ja 2007 välillä Länsi-Kiinan vähän kehittyneellä maaseudulla raskaudenaikaisia palveluja käyttämättömien naisten määrä laski 25 %:sta 12 %:iin ja sairaalasynnytysten osuus kasvoi 45 %:sta 80 %:iin. Erot eri tuloryhmien välillä kapenivat. Vuosien 2002 2007 aikana laitossynnytysten kustannukset maaseudun kotitalouksille lähes kaksinkertaistuivat. Kolmessa tutkimusläänissä riippumatta siitä, sisältyikö raskausajan hoito sairausvakuutukseen vai ei, yli 70 % naisista kävi neuvolassa kahdentoista raskausviikon kuluessa ja yli 60 %:lla naisista oli vähintään viisi käyntiä. Naisten kustannukset (osuus tuloista) olivat paljon suuremmat pienituloisilla kuin muilla naisilla. Korvauksella oli vain vähän vaikutusta naisten päätöksiin käyttää äitiyshuollon palveluja raskausaikana. Raskauden aikaisten käyntien sisältö vaihteli. Suositusten mukaisten veri- ja virtsatutkimusten määrä oli vähäinen, mutta 90%:lle naisista oli tehty kaksi tai useampi ultraäänitutkimus. Kalliit tutkimukset ja hoitotoimet olivat usein lääkäreiden suosittelemia. Lähes puolet (46 %) kaikista lapsista syntyi keisarileikkauksen avulla. Puolet suunnitelluista keisarileikkauksista oli lääkärien suosittelemia ja puolet naisten itsensä pyytämiä. Lääneissä, joissa keisarileikkausten määrä oli keskitasoa (28 % - 63 %), vakuutus oli yhteydessä lisääntyneeseen keisarileikkausten määrään, etenkin suunniteltujen keisarileikkausten määrään. Päätelmät: Kiinan maaseudulla äitiyshuoltopalveluiden käyttö lisääntyi huomattavasti vuosien 2002 ja 2007 välillä. Kansallisia ohjeita hoidon sisällössä ei noudatettu. Äitiyshuoltoon ja synnytykseen liittyvä taloudellinen taakka maaseudun köyhien keskuudessa pysyi korkeana. Nykyisessä vakuutusjärjestelmässä ei ole välineitä, joilla voidaan hallita kustannuksia ja edistää laadukasta hoitoa

A New RSSI-based Centroid Localization Algorithm by Use of Virtual Reference Tags

A good design of node location is critical for efficient and effective wireless communications. This paper presents an improved algorithm, in order to solve the low localization accuracy caused by traditional centroid algorithm. The improved algorithm combined with VIRE system and traditional centroid algorithm. The VIRE algorithm is introduced and the signal propagation model is utilized to construct virtual reference tags in the location area. Simulation shows that this further developed algorithm has further improved the accuracy of positioning up to 35.12% compared to the traditional centroid algorithm. It is concluded that this algorithm can further improve the locating accuracy in comparison with the original centroid algorithm

Economic Analysis of the Driving Mechanism of Japan Cement industry Development and Enlightenments

As one of the nations with well-developed cement industry, Japan cement industry has experienced three developing stages since the 1980s under the influence of macroeconomics, resources, and energy. The cement industry in Japan has achieved remarkable results owning to the proper adjustments of its structures and the low-carbon technology innovations. Here, the author aims to unearth the key of success of Japan cement industry by analyzing the driving mechanism of its development from an economic perspective, and thus provide some insights and enlightenments for improving the international competitiveness of China cement industry

The Anthropocene Catastrophe: The Mystery of the Disappearance of Matacao in Through the Arc of the Rain Forest

The Japanese-American writer Karen Tei Yamashita’s first novel Through the Arc of the Rain Forest discloses the tremendous impact of technological activities on the natural environment in the Anthropocene. Centering on the mystery of the disappearance of Matacao in this novel, the present paper expounds that its disappearance is an environmental catastrophe of the Anthropocene resulting from the retaliation of nature for the replacement of it by human technological activities under the domination of the scientific and technological rationality. Yamashita’s presentation of the disappearance of Matacao serves as a warning to the world, aiming to advocate that the technological activities should not be controlled only by the scientific and technological rationality, but should recognize and respect the irreplaceability of nature, otherwise these activities will be retaliated by nature, triggering environmental disasters in the Anthropocene, bringing destruction to the Earth and the technological civilization.