Project Counties Research Articles

Do impoverished regions benefit from climate change mitigation measures? Evidence from the Forest Carbon Sink Project in China

ABSTRACT Forests play a crucial role in achieving global climate change mitigation goals. The Forest Carbon Sink Project (FCSP) was initially proposed by the Clean Development Mechanism under the Kyoto Protocol, aiming to address externalities in climate governance through ecological compensation mechanisms. For impoverished regions, the FCSP is more attractive than the mandatory administrative approaches to forest protection. This Currently, due to the lack of empirical research, there is still debate in the academic community about whether the FCSP can produce overall positive economic benefits in poor areas. Based on panel data from 634 impoverished counties in China from 2002 to 2019, this study attempts to address this issue using a multi-period Difference-in-Differences (DID) model. The results demonstrate that, compared to non project counties, the implementation of the FCSP led to an increase in actual GDP and per capita GDP of 8.40% and 11.10% in project counties, respectively. That is, the FCSP can expand the economic scale while also promoting economic growth of project counties. The results of the dynamic model show that the economic benefits generated by the FCSP in these counties are long-term and sustainable. Based on the results of theoretical analysis and mechanism testing models, this study concludes that the FCSP generates short-term economic benefits through capital investment. It generates long-term economic benefits by improving the productivity of the primary industry labour force, increasing the level of fixed asset construction, and optimizing the industrial structure in poverty-stricken counties. Additionally, this study also conducted a heterogeneity analysis. In summary, this study concludes that the FCSP is a climate change mitigation measure worthy of promotion in impoverished regions.

Characterization of Existing Rural Finance Markets that can Enhance Participation in Climate Smart Agricultural Technologies in Kenya

Purpose: In Kenya, small holder farmers face climate change related challenges. It is therefore imperative to enhance adaptive capacity through climate smart agricultural (CSA) technologies. Access to finance is a significant enabler for adoption of CSA technologies yet small holder farmers, especially women, have an acute financing gap for agriculture. The purpose of the study was to characterize existing rural finance markets that can enhance adoption of Climate smart agricultural technologies among small holder farmers in Kenya and also improve the participation of other agricultural value chain actors in climate smart agricultural technologies. This was to enhance a better understanding of existing rural financial services available to agricultural value chain actors and the potential of the financial institutions to increase credit access to the value chain actors.
 Methodology: The study used cross sectional data gathered through questionnaires administered on farmers, rural financial institutions and other actors in eight, Kenya Climate Agricultural Project (KCSAP) counties in Kenya. Data was analyzed using Stata statistical package and presented using tables and figures.
 Findings: Rotating and savings credit associations (ROSCAs) were the main credit source for most households. Findings revealed that farmers rarely access insurance for their farming activities. Unlike farmers, other actors for instance, agro processors and agro dealers get loans through mobile phones where short term loans were borrowed from different providers. Majority of financial institutions were serving agricultural sector.
 Unique Contribution to Theory, Practice and Policy: The study had presumed that access to rural financial market services by value chain actors in climate smart technologies for crops and livestock will be enhanced and this will increase adoption in the target Counties. The theory or assumption was validated in a workshop by all stakeholders which was followed up by linking up the value chain actors and the financial institutions through capacity building forums. Financial institutions could leverage on existing models used by ROSCAs to increase access to rural financial services especially by women and youth. A gender-transformative approach should be considered to increase women access to rural financial services.

Assessing clinicians' Post-Exposure Prophylaxis recommendations for rabies virus exposures in Hunan Province, China.

BackgroundTimely and appropriate administration of post-exposure prophylaxis (PEP) is an essential component of human rabies prevention programs. We evaluated patient care at rabies clinics in a high-risk county in Hunan Province, China to inform strategies needed to achieve dog-mediated human rabies elimination by 2030.MethodsWe collected information on PEP, staff capacity, and service availability at the 17 rabies clinics in the high-risk county during onsite visits and key staff interviews. Additionally, we conducted observational assessments at five of these clinics, identified through purposive sampling to capture real-time information on patient care during a four-week period. Wound categories assigned by trained observers were considered accurate per national guidelines for comparison purposes. We used the kappa statistic and an alpha level of 0.05 to assess agreement between observers and clinic staff.ResultsIn 2015, the 17 clinics provided PEP to 5,261 patients. Although rabies vaccines were available at all 17 clinics, rabies immune globulin (RIG) was only available at the single urban clinic in the county. During the assessment period in 2016, 196 patients sought care for possible rabies virus exposures. According to observers, 88 (44%) patients had category III wounds, 104 (53%) had category II wounds and 4 (2%) had category I wounds. Observers and PEP clinic staff agreed on approximately half of the assigned wound categories (kappa = 0.55, p-value< 0.001). Agreement for the urban county-level CDC clinic (kappa = 0.93, p-value<0.001) was higher than for the township clinics (kappa = 0.16, p-value = 0.007). Using observer assigned wound categories, 142 (73%) patients received rabies vaccinations and RIG as outlined in the national guidelines.ConclusionRabies PEP services were available at each town of the project county; however, gaps between clinical practice and national rabies guidelines on the use of PEP were identified. We used these findings to develop and implement a training to rabies clinic staff on wound categorization, wound care, and appropriate use of PEP. Additional risk-based approaches for evaluating human rabies virus exposures may be needed as China progresses towards elimination.

Access to quality diagnosis and rational treatment for tuberculosis: real-world evidence from China\u2013Gates Tuberculosis Control Project Phase III

BackgroundChina has successfully reduced tuberculosis (TB) incidence rate over the past three decades, however, challenges remain in improving the quality of TB diagnosis and treatment. In this paper, we assess the effects of the implementation of “China National Health Commission (NHC) and Gates Foundation TB Prevention and Control Project” on the quality of TB care in the three provinces.MethodsWe conducted the baseline study in 2016 and the final evaluations in 2019 in the 12 selected project counties. We obtained TB patients’ information from the TB Information Management System and reviewed medical records of TB cases in the TB designated hospitals. We compared TB diagnosis and treatment services with the national practice guideline and used Student’s t-test and Pearson χ2 tests or Fisher’s exact tests to compare the difference before and after the project implementation.ResultsThe percentage of sputum smear-negative (SS–) patients taking culture or rapid molecular test (RMT) doubled between 2015 and 2018 (from 35% to 87%), and the percentage of bacteriologically confirmed pulmonary TB cases increased from 36% to 52%. RMT has been widely used and contributed an additional 20% of bacteriologically confirmed TB cases in 2018. The percentage of TB patients taking drug susceptibility tests (DST) also doubled (from 40% in 2015 to 82% in 2018), and the proportion of TB patients receiving adequate diagnosis services increased from 85% to 96%. Among all SS– TB patients, over 86% received the recommended diagnostic services at the end of the study period, an improvement from 75% prior to the project implementation. However, the proportion of TB patients treated irrationally using second-line anti-TB drugs (SLDs) increased from 12.6% in 2015 to 19.9% in 2018. The regional disparities remained within the project provinces, albeit the gaps between them narrowed down for almost all indicators.ConclusionsThe quality of TB diagnosis services has been improved substantially, which is attributable to the coverage of new diagnosis technology. However, irrational use of SLDs remains a concern after the project implementation.Graphic abstract

Analysis of the reported data of National Cervical Cancer Screening Program in Rural Areas in China from 2009 to 2018

Objective: To analyze the effectiveness of the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in China. Methods: Data were collected in the form of quarterly statistical tables reported by NCCSPRA counties in 30 provinces (Hong Kong, Macao and Taiwan province of China were not included into the NCCSPRA, and Tibet Autonomous Region carried out the program but did not reported the data) from 2009 to 2018. The women aged 35-64 years with sexual behavior and the identity (Hukou) of rural area in these project counties were included into the NCCSPRA, and women receiving hysterectomy for non-cervical cancer or non-cervical lesions were excluded. The following indicators were analyzed: the positive rates of different screening methods, the abnormality rates of colposcopy and histopathology, the detection rate of precancerous lesions, the detection rate of cervical cancer and the rate of early diagnosis. Results: A total of 85 041 490 women aged 35-64 in rural areas received free cervical cancer screening and diagnosis if necessary. On the whole, the abnormality rate of cytology, HPV testing, VIA/VILI, colposcopy and histopathology was 3.71%(2 567 610), 9.91%(331 158), 10.10%(1 167 930), 28.85%(1 420 847), and 21.20%(303 068) respectively. The detection rate of cervical precancerous lesions was 153.88/100 000, and increased from 106.85/100 000 in 2012 to 223.89/100 000 in 2018 (P<0.001). Regionally, the east (207.37/100 000) reached higher rate than the middle (177.65/100 000), and the middle higher than the west (108.65/100 000) (P<0.001). The detection rate of invasive cervical cancer was 21.58/100 000, and increased from 18.02/100 000 in 2012 to 26.54/100 000 in 2018 (P<0.001). Regionally, the middle of China (25.46/100 000) reached the higher rate than the east (19.62/100 000) and the west (19.30/100 000) (P<0.001). The rate of early detection was 91.24%(136 140), which increased from 89.60% (11 883)in 2012 to 92.80%(26 962) in 2018 (P<0.001). Regionally, the east of China (94.02%, 37 600) reached the higher rate than the middle(91.06%, 56 488), and the middle higher than the west (89.12%, 42 052) (P<0.001). Conclusions: There are obvious difference in terms of the detection rate of cervical precancerous lesions and the rate of early diagnosis reflecting cervical cancer screening capacity among the eastern, middle and western regions,which showed service inequity among different areas indirectly. The middle and western regions, especially the western regions, are still the focus of future works.

Effect on 6-23 months infants by Yingyangbao intervention in impoverished regions of Henan Province

To observe the effect of 6-23 months infants by Yingyangbao(YYB) intervention in impoverished areas of Henan Province. A multi-stage random sampling method was used to select infants aged 6-23 months from 51 project counties in Henan Province from September to November 2019. Physical anthropometric measurement and hemoglobin detection were performed, and face-to-face questionnaires surveyed with caregivers of the children. Children in 12 regions covered by YYB were defined as intervention group, and controls were selected from the baseline survey of children in 39 regions not covered by YYB according to the 1∶1 matching principle. The analysis between YYB and control groups were analyzed by χ~2 or t test. χ~2 test for trend to compare trend of children health status. A total of 7738 subjects were selected in the study, including 3869 in the intervention group and 3869 in the control group. The average length, weight and hemoglobin level of YYB group were 1. 1 cm, 0. 67 kg and 3. 8 g/L, respectively, which were higher than that of the control group. The anemia rate, underweight rate, stunting rate and wasting rate in intervention group were 13.1%, 1.7%, 2.1% and 1.9%, respectively, significantly lower than control group. Compared with the control group, the two-week prevalence of fever and diarrhea in the intervention group decreased by 5. 6% and 7. 2%, respectively. In addition, nutrition knowledge score of the parents, minimum dietary diversity rate, minimum meal frequency rate and minimum acceptable diet rate of intervention group were 62. 4%, 71. 1%, 73. 7% and 55. 8%, respectively, significantly better than that of control group. From 2015 to 2019, the anemia rate, underweight rate, stunting rate of children in regions covered by YYB showed a downward trend. YYB can effectively improve the nutrition, physical development and health status of 6-24 months infants. Through the implementation of the project, the knowledge and skills of scientific feeding in impoverished regions were significantly improved.

Technology Transfer and Early Industrial Development: Evidence from the Sino-Soviet Alliance

This paper studies the short and long-run effects of international technology transfer on early industrial development, using evidence from the Sino-Soviet Alliance. Between 1950and 1957, the Soviet Union supported the so-called “156 technology transfer projects” in China, that involved the construction of large capital-intensive plants in heavy industries, the transfer of state-of-the-art Soviet machinery and equipment, as well as technical assistance and know-how diffusion from Soviet engineers to the Chinese counterpart. We hand-collected archival data on the 156 projects that we complemented with plant, firm and provincial-level information from 1949 to 2013. To estimate the causal effect of the program we exploit that, due to unanticipated political tensions between the two countries, some projects were built as planned with Soviet machinery and technical assistance (treated projects), while others were eventually realized by China only without any Soviet technology or assistance (comparison projects). We find that: 1) plants in treated projects had better performance that plants in comparison projects in both the short and the long run; 2) Soviet technical assistance diffused industry-specific knowledge through the training of Chinese engineers that further increased plant outcomes; 3) the program generated local horizontal and vertical spillovers; 4) there was a substantial reallocation of production in treated project counties from state owned to privately-owned companies after the waves of privatization started in 2005.

Cultural Resources Intensive Pedestrian Survey within the Dayton Loop Pipeline Project, Harris and Liberty Counties, Texas

Gray &amp; Pape, Inc., of Houston, Texas, conducted an intensive pedestrian cultural resources survey of jurisdictional portions of survey corridor within a proposed pipeline alignment measuring a total of approximately 30 kilometers (18.5 miles) located in Harris and Liberty Counties, Texas. The pipeline route is on privately-owned property; therefore, a Texas Antiquities Permit was not required prior to survey. In total, the surveyed property totals approximately 2.8 hectares (7 acres) which defines the Area of Potential Effects. The goals of the survey were to establish whether or not previously unidentified archaeological resources were located within the project area, also defined as the project’s Area of Potential Effects, and whether the pipeline alignment would affect any previously identified cultural resources. The lead agency for the project has been identified as the United States Army Corps of Engineers, Galveston District. The procedures to be followed by the United States Army Corps of Engineers to fulfill the requirements set forth in the National Historic Preservation Act, other applicable historic preservation laws, and Presidential directives as they relate to the regulatory program of the United States Army Corps of Engineers (33 CFR Parts 320-334) are articulated in the Regulatory Program of the United States Army Corps of Engineers, Part 325 -Processing of Department of the Army Permits, Appendix C -Procedures for the Protection of Historic Properties. All fieldwork and reporting activities were completed following accepted standards set forth by the Texas Historical Commission and the Council of Texas Archeologists and in accordance with Section 106 of the National Historic Preservation Act. Fieldwork took place in March 2019 and required 32 work hours to complete. Field investigation consisted of intensive pedestrian inspection, subsurface shovel testing, photographic documentation, and mapping. A total of 20 shovel tests were excavated, of which none were positive for buried cultural materials. No historic structures were identified as a result of survey. Based on the results of the survey, Gray &amp; Pape, Inc. recommends that no further cultural resources work be required and that the project be cleared to proceed as currently planned.

Can a results-based bottom-up reform improve health system performance? Evidence from the rural health project in China.

In 2008, the Rural Health Project (Health XI) was initiated in 40 Chinese counties to pilot interventions aimed at improving local health systems. Performance targets were pre-specified (results-based), and project counties were allowed to tailor their interventions (bottom-up) in recognition of the substantial regional variations. Using household data from the China National Health Services Survey in a difference-in-differences strategy combined with matching, we find that project counties have improved outcomes (both incentivized and not-directly-incentivized) in all three domains examined-medical care, public health services, and self-rated health-by 2013. In particular, the decrease in outpatient intravenous drip use and financial strain and the increase in all four components of public health services provision are robust to a variety of tests and alternative matching strategies. Results for not-directly-incentivized indicators suggest that results-based payment did not lead to multitasking problems but rather to positive spillovers. On the other hand, little improvement in inpatient-related indicators suggests that the Health XI interventions did not successfully redress the perverse incentives driving the bulk of providers' income. In general, however, our results indicate that interventions adopted in the results-based bottom-up approach generated substantial benefits given the investment.

Population-based study on infection and genotype distribution of high-risk human among women in rural areas of China, 2014

Objective: To explore the epidemiologic characterization of high-risk human papillomavirus (HR-HPV) infection and genotype distribution of HR-HPV among women in rural areas of China. Methods: This study used multiple layers of stratified cluster random sampling method. During January to December in 2014, 117 counties of 27 provinces were selected as the HPV test screening pilot project counties. The women aged 35-64 years with rural areas Hukou in these project counties were selected as the study subjects. A total 457 799 women received HPV DNA test. Among them, 118 237 women from 32 counties in 11 provinces received qualified HPV DNA test by fluorescent PCR to detect HPV genotypes. Results: Among 118 237 rural women, the overall HR-HPV positive infection rate was 7.8% (9 249/118 237). The infection rate increased with age and reached an infection peak at the 60-64 age groups (9.9%, 831/8 394). The HR-HPV positive infection rate in western regions (6.9%, 2 144/31 130) was statistical significantly lower than in central regions (8.2%, 1 894/23 023) and eastern regions (8.1%, 5 211/64 084) (χ(2)=51.46, P<0.001). Among 9 249 women with specific genotypes of HR-HPV, 6 496 (97.6%) cases were infected with single HR-HPV type, and 163 cases (2.4% ) were infected with multiple types. HR-HPV type 52, 16 and 58 were the most common infection types in rural areas of China. The single infection rates were 20.9% (1 355/6 496), 18.7% (1 215/6 496), and 11.2% (725/6 496), respectively. The multiple infection rates were 47.2% (77/163), 17.8% (29/163), and 18.4% (30/163), respectively. Conclusion: The HR-HPV positive infection rate in rural areas of Chinese woman was 7.8%, western region has lower infection rate compared with central and eastern regions. HPV 52 was first of the most common genotypes in rural areas of China.

Household survey analysis of the impact of comprehensive strategies to improve the expanded programme on immunisation at the county level in western China, 2006–2010

ObjectiveTo evaluate interventions to improve routine vaccination coverage and caregiver knowledge in China's remote west, where routine immunisation is relatively weak.DesignProspective pre–post (2006–2010) evaluation in project counties; retrospective comparison based...

Knowledge of Cervical Cancer Screening among Women across Different Socio-Economic Regions of China.

Background and ObjectiveChina has a high burden of cervical cancer (CC) and wide disparities in CC burden exist among different socio-economic regions. In order to reduce these disparities, China’s government launched the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in 2009. Understanding the factors associated with underutilization of CC screening among target populations is important to improve the screening participation rate, and a high participation rate is key to achieving the goals of a screening program. However, data on the knowledge of CC among target populations in program areas is lacking in China. This study will investigate the knowledge of CC prevention and control among women in specific project counties to develop a better understanding of factors that might influence CC screening participation in order to improve the implementation of the NCCSPRA.Materials and MethodsA cross-sectional survey was conducted and face-to-face interview questionnaires were completed by 308 women who received CC screening services in 6 project counties of NCCSPRA across different socio-economic regions of China. ANOVA and Chi-square tests were used to compare the knowledge rates and scores across the different subgroups. Logistic regression was conducted to examine factors associated with knowledge level.ResultsThe overall CC knowledge rate of the target population was only 19.5%. Regional socio-economic level, advice from doctors, age, and educational status were strong predictors of knowledge level of CC screening. Significantly lower knowledge rates and scores were identified in older women (55–64 years old), less educated women (with primary school or illiterate), women in less developed regions and women who did not receive any advice about screening results from doctors.ConclusionThe knowledge of CC screening among women in the project counties of NCCSPRA was found to be very poor. Given the importance of knowledge in encouraging women to participate in screening is key to reducing CC burden in rural women in China, it is urgent that a targeted health promotion intervention is developed and implemented in project counties, especially targeting older women, women with less education and women in less developed regions, and focus on improving their CC knowledge and encouraging them to communicate with health care providers. The health promotion intervention targeting health care providers is also important to improve their knowledge of CC and provide best advice to women.

The Reform and Development of the Research on the Management System of Small Scale Water Conservancy Project Counties Taking Jiangsu Suqian County as an Example of a Water Conservancy Pro-ject Management

With the rapid development of social economy, small water conservancy projects have become an important infrastructure for social development [1]. Jiangsu Suqian County’s water conservancy project management is relatively backward therefore; the existing infrastructure lacks maintenance and has been constantly attenuated. The lack of water conservancy project management has brought great hidden dangers for the national economy, therefore, in order to fundamentally solve the problem, a huge sum of money is required to fully utilize the facilities of small water conservancy project. Therefore, it is an urgent need to promote small-scale water conservancy project management system reform. This paper mainly focused on Jiangsu Suqian County’s water conservancy project management as an example, and analyzed the management situation and the existing problems. Moreover, the study also improved the management system of small water conservancy project, by making necessary reforms in the project , and by putting forward principles, objectives and key measures which have practical significance .

An investigation of current prevalence situation of dilated cardiomyopathy in non-keshan disease areas of Yunnan Province in 2011

Objective In order to master the current prevalence situation of dilated cardiomyopathy in Yunnan Province.Methods An investigation of dilated cardiomyopathy was carried out in 17 counties from August to December in 2011 in non-Keshan disease areas.Two townships (towns) that similar to Keshan disease areas in natural environment,pattern of production and lifestyle in non-Keshan disease areas were selected in each project county,and 1 village was selected as surveillance site in each selected township(town).The number of resident in each village no less than 500 people was appropriate and deficiency was supplemented from neighboring villages.The sampling rate was no less than 80％.Clinical examination and electrocardiographic tracings were carried out.The patients with suspected dilated cardiomyopathy and latent Keshan disease were taken anteroposterior chest X-ray in accordance with the Non-Keshan Disease Area Dilated Cardiomyopathy Condition Survey Program.The surveillance was carried out based on National Investigation Scheme of Dilated Cardiomyopathy in Non-Keshan Disease Areas.Cases were diagnosed based on the diagnostic standard of dilated cardiomyopathy and suspected latent Keshan disease.Results In the 34 villages of 17 selected counties,14 545 people were investigated.Twenty-six cases of latent dilated cardiomyopathy and suspected latent Keshan disease were detected,and the total detection rate was 17.88/million.One case was dilated cardiomyopathy,and 25 cases were suspected latent Keshan disease,detection rates were 0.69/million and 17.19/million,respectively.Male and female cases were 15 and 11,respectively.The ratio of people aged 65 and older accounted for 42.31％(11/26),among them suspected latent Keshan disease accounted for 44.00％(11/25),and 1 case of dilated cardiomyopathy was in the 45 to 54 years old group.Electrocardiographic examination of 14 519 people,the abnormal rate was 8.13％(1 180/14 519).Among 112 chest X-ray films,104 cases had a cardiothoracic ratio less than or equal to 0.50,4 cases from 0.51 to 0.55,3 cases from 0.56 to 0.60,and 1 case more than or equal to 0.61.Conclusion The detection rate of dilated cardiomyopathy cases is lower in non-Keshan disease area of Yunnan Province,but suspected latent Keshan disease is detected. Key words: Dilated cardiomyopathy; Keshan disease; Investigation of situation

Growth and health care status of children under five years old in project counties of Chongqing and Sichuan

Objective To understand the growth and health care status of children under five years old in project counties of Chongqing and Sichuan,so as to provide evidence for establishing scientific and effective measures for health care of children.Methods The non-probability sampling method was used to select the children under five years old from 54 villages in 6 project counties in Chongqing and Sichuan.The parents were investigated by questionnaire;the height(length) and weight of children were examined;and the hemoglobin of 6-35 months old children was determined.Multivariable logistic regression analysis was conducted to examine the factors influencing the growth status of children under five years old.Results Totally 1 089 caretakers of children under five years old were investigated;82.1%(894/1 089)of them had an educational background of primary school or middle school;and the median net per capita income of their family was 2 500 yuan(RMB) in 2009.For the youngest children in the families,the hospital delivery rate was 86.6%(933/1 077),the colostrums feeding rate was 96.4%(1 050/1 089),and the average of weaning months was(11.6±5.6) months.The prevalence of diarrhea of the children was 19.6%(213/1 089) within the past two weeks,and 264 children had cough(24.2%).A total of 1 197 children under five years old were investigated,the rates of stunting,underweight and wasting were 17.4%(200/1 152),4.7%(55/1 173)and 2.2%(25/1 148),respectively.The underweight rate of boys was significantly higher than that of girls(5.9%[38/645] vs 3.2%[17/528];χ2=4.638,P=0.031),and the wasting rate of boys was also significantly higher than that of girls(3.0%[19/634] vs 1.2%;χ2=4.460,P=0.035).The detection rate of low hemoglobin among the 6-35 months old children was 38.4%(272/709).Multiple variable logistic regression analysis showed that male sex,born at home,and low birth weight might be the influence factors on the low growth status of children under five years old.Conclusion The caretakers of children under five years old in rural areas of Chongqing and Sichuan have a low cognitive level on the health care of children,and the children have developmental delay and malnutrition to various extents.Measures should be taken to improve child health care knowledge and health education.

Survey on behaviors of health in poverty area from the mid-west four provinces of China

To understand ways of life among poverty-stricken farmers from western areas of China. Questionnaires on ways of life were designed, using cluster random sampling method to study 5516 rural residents, aged 15 - 69, from 84 administrative villages, 42 project townships and 16 project counties in Shanxi and Gansu, Qinghai, Xinjiang provinces. 5343 valid questionnaires included 2178 males and 3165 females, with the average age as 43.4 years old. 2965 people were with minority ethnicities and another 2378 were Hans. Most of the respondents had received junior high school (37.7%) or primary school (32.1%) education with 62.1% of the respondents working in the agricultural areas. The overall smoking rate among them was 22.4%. The rates of smoking in males in Qinghai and Shanxi provinces were obviously higher than those in other provinces, with the highest seen in Shanxi. The overall rate of alcohol intake was 13.9%, and the highest seen in Shanxi and Qinghai. The alcohol intake in males was higher in Shanxi and Qinghai, than in other provinces while in female it was significantly lower in Shanxi than in the other three provinces. The health related habits were different in the four provinces, including the amount of weekly intake of milk or dairy products, fresh vegetables, bean products, animal viscera, fried food, pickled or smoked food products and livestock meat, with statistically significant differences. Life styles of farmers living in the poverty-stricken areas in Gansu, Qinghai, Shanxi and Xinjiang were different. Strategies related to the real situation on each province need to be developed which would include effective health education and with the aid of '12320 hotline services' to help the residents build up a healthy lifestyle.

Drinking-water type of fluorosis in Shaanxi province in 2009: an analysis of surveillance results

Objective To investigate running conditions of water improvement projects and role of these projects in reducing fluoride in drinking-water type of fluorosis in Shaanxi province, and provide a scientific basis for prevention and control of disease. Methods Forty-eight villages of 16 counties in Xi'an, Baoji, and Yulin cities of Shaanxi province were monitored in 2009. Five water samples were collected randomly in water unimproved monitoring villages by position of east, west, south, north, and center parts. In water improved monitoring villages, 3 tap water and one source water samples were collected. fluoride was tested using fluoride ion selective electrode method according to Standard Testing Methods for Drinking Water (GB/T 5750-2006). All school children aged 8 to 12 in monitored villages were examined their dental fluorosis using Dean criteria. All people over 16 years old were examined clinical skeletal fluorosis, and 30% of project counties were randomly selected, then randomly selected one village among these counties, clinically diagnosed patients with skeletal fluorosis were examined again by X-ray using Diagnostic Criteria of Endemic Skeletal Fluorosis(WS 192-2007). Urine samples of 30 children aged 8 to 12 and of 20 adults over age of 16 were randomly collected, urinary fluoride was tested according to the Determination of Urinary Fluoride by Ion Selective Electrode Method (WS/T 89-19%). Results Of 22 water improvement projects that in normal operation, fluoride level of 8 source waters exceeded standard, accounting for 36.36%(8/22), and projects scrapped 5. Two hundred and two water samples were tested. In water improved historical diseased areas, median of water fluoride of source water and tap water were 0.72,0.62 mg/L, respectively, and average rate of water fluoride exceeded standard ere 36.36%(8/22) and 31.94%(23/72), respectively. In water unimproved historical diseased areas, median of water fluoride was 1.00 mg/L, and average rate of water fluoride exceeded standard was 39.81%(43/108). Detection rate of dental fluorosis among children aged 8 to 12 was 16.06% (367/2285), dental fluorosis index was 0.30, and prevalence was negative. Detection rate of clinical skeletal fluorosis among adults over 16 years old was 5.09%(1542/30 272), a totally of 198 people had X-ray film taken, positive 68, positive detection rate was 34.34%(68/198). One thousand and fifty-one copies of children's urine samples were tested, geometric mean of urinary fluoride was 0.95 mg/L; nine hundred and fourteen copies of adults urine samples were tested, geometric mean of urinary fluoride was 1.16 mg/L Conclusions Drinking-water type of fluorosis affects a large area in Shaanxi province, disease is still serious, and task of prevention remains very arduous. Further intensify water improvement project in diseased areas, and strengthen disease monitoring, health education and water improvement project management is key to prevention and control of endemic fluorosis. Key words: Fluoride poisoning; Drinking; Urine; Fluorosis, dental; Osteofluorosis

Evaluation of the effectiveness of health education on iodine deficiency disorders in Hebei province in 2009

Objective To evaluate the effectiveness of health education on iodine deficiency disorders (IDD) in Hebei, and to provide basic information for development of control strategies. Methods A total of 34 project counties were selected in Hebei province, and 3 townships were chosen in each project county. Heath educational activities were carried out in the classes of grade 5 in the central primary school of each selected township. In the meantime, 3 villages were chosen in each selected township where the health education for women of childbearing age in the community was carried out. Sureys on knowledge of IDD control were conducted in the 34 project counties before and after the health educational activities. Results The knowing rates of IDD control among pupils in all 34 project counties increased from 71.10%(7835/11 019) to 94.84%(10 840/11 430) after health education, with a average increase of 23.74%. The knowing rates of IDD control among housewives increased from 77.02%(4531/5883) to 95.32%(5902/6192), with a average increase of 18.30%. Of which, the knowing rates of IDD control among pupils in Hengshui city increased from 55.56% (750/1350) to 94.89% (1281/1350),with a average increase of 39.33%. The knowing rates of IDD control among housewives in Handan city increased from 65.68%(532/810) to 96.50%(909/942), with a average increase of 30.82%. Conclusions The knowing rates of IDD control among pupils and housewives are remarkably increased after implementing the health education projects. They have better life and health habits, and the project achieves desired effect. Key words: Iodine; Deficiency diseases; Goiter, endemic; Health education

Surveillance analysis of drinking water borne fluorosis in Tibet autonomous region in 2009

Objective To find out the dynamics of drinking water borne fluorosis in Tibet's, to evaluate the effect of control measures, and to provide a scientific basis for the timely adjustment of control strategies. Methods During september to october 2009, according to the 2008 Central Government Special Funds to Subsidize Local Public Health in Drinking Water Borne Fluorosis in Tibet, Xigaze Xietongmen and Nyingchi Zayu were selected as project counties, three project villages were selected with simple random sampling method in each county, the functioning of water improvement projects, drinking water fluoride content, children's dental fluorosis and adult skeletal fluorosis were investigated. Water fluoride was detected by the standard examination methods for drinking water the non-metallic targets(GB/T 5750.6-2006) determination of fluoride; urinary fluoride was tested by ion selective electrode (WS/T 89-1996); dental fluorosis was diagnosed using Deans method; adult skeletal fluorosis was diagnosed by endemic skeletal fluorosis clinical diagnostic criteria (WS 192-2008). Results Mean water fluoride was 0.18 - 0.34 mg/L in drinking water changed areas, and 0.70 - 2.13 mg/L in not changed areas; prevalence of dental fluorosis of children 8 - 10 was 50.78% (65/128), dental fluorosis index was 1.04,mean urinary fluoride was 1.64 mg/L in drinking water changed areas; prevalence of dental fluorosis of children 8 -10 years old was 80.65%(25/31 ) in not changed areas, dental fluorosis index was 1.50, mean urinary fluoride of children was 2.08; adult clinical skeletal fluorosis was 38.7%(104/269) in drinking water changed areas, the mean urinary fluoride was 1.61 mg/L, prevalence of skeletal fluorosis was 15.4% (18/117) in not changed areas, mean urinary fluoride was 3.54 mg/L. Conclusions The method of change the water to reduce fluoride decreases dental fluorosis to control levels, and severity is also reduced, urinary fluoride is decreased. However, the prevalence of skeletal fluorosis is higher than that of drinking water not changed areas. Key words: Fluoride poisoning; Change the water; Data collection

Community health committee: A mechanism innovation of public participation in grassroots health service management

Community Health Committee (CHC), an innovative public participation mechanism of grassroots health service management, established a bottom-up communication channel between the public and government to communicate health related problems and opinions, and set up a grassroots community health services supervision system. The rural residents were endowed with opportunities to take part in grassroots health care decision making and management by CHC. CHC changed the top-down model of traditional health management, improved the grassroots medical services, and increased governance capability of local government We introduced the CHC practice in Zhejiang project counties, exhibited the primary effects and experience of this pilot program, and explored new mechanism and model for rural community residents to participate in grassroots health service management Key words: Community Health Committee; Public participation; Governance model