Western Rural Areas Research Articles

Epidemiology of Elderly Burn Patients in the United States: Mortality Patterns and Risk Factors Revealed by CDC Wonder Database

IntroductionBurn-related fatalities pose a significant global public health challenge, with a substantial impact on the elderly population. This study examines two decades of burn-related mortality data in the United States, aiming to understand the trends, disparities, and contributing factors among adults aged 65 and older.ObjectivesThe primary objectives of this study are to (1) analyze the trends in burn-related mortality rates among older adults, (2) investigate disparities based on gender, race and geographic regions, and (3) identify comorbidities and complications associated with burn-related deaths in this demographic.MethodsData were obtained from the Centers for Disease Control and Prevention (CDC) using the National Center for Health Statistics database. The study cohort consists of individuals aged 65 and older who experienced burn-related deaths between 1999 and 2020. Various demographic variables, including age, sex, race/ethnicity, and location of death, were considered. The study also examined urban-rural classifications and regional differences. Mortality rates were calculated and adjusted for age. Joinpoint regression analysis was employed to assess trends in age-adjusted mortality rates over time. Modes of death and common comorbidities and complications were analyzed.ResultsBetween 1999 and 2020, a total of 96,498 older adults succumbed to burn injuries in the United States. Analysis revealed a concerning increase in burn-related mortality rates from 2012 onwards. Demographic disparities were evident, with older men consistently exhibiting higher mortality rates compared to women. Racial disparities were observed, with Black individuals experiencing the highest mortality burden. Geographic analysis indicated elevated mortality rates in Western states and rural areas. Accidents emerged as the leading cause of death, with ischemic heart disease and hypertensive diseases being prevalent comorbidities. Complications, with septicemia being the most common, contribute significantly to mortality.ConclusionOur analysis of 20 years of burn-related mortality data from the CDC reveals alarming trends in the United States. Unlike global trends, mortality rates have stagnated from 1999 to 2020, indicating a persistent public health challenge. Black individuals aged over 65 bear the brunt of burn-related mortality, facing the highest age-adjusted rates among all racial groups. Regional disparities are stark, with states in the top 90% exhibiting significantly higher age-adjusted mortality rates compared to those in the bottom 10%. Moreover, rural areas consistently report higher mortality rates than urban areas. Ischemic heart disease, hypertensive diseases, and other heart-related conditions emerge as prevalent comorbidities. To effectively reduce burn-related injuries and fatalities, targeted public health policies are imperative. These interventions must prioritize high-risk populations and adopt culturally sensitive approaches to promote safety. Additionally, enhancing access to healthcare and fire safety education is vital for mitigating the burden of burn-related mortality among the elderly population.

Spatial distribution and factors associated with HIV testing among adolescent girls and young women in Sierra Leone

BackgroundSierra Leone faces a significant challenge in addressing HIV/AIDS, particularly among adolescent girls and young women. This age group is considered highly vulnerable due to biological factors and social inequalities. Understanding the prevalence of HIV testing in this demographic is crucial for designing effective prevention and treatment strategies. This study investigated the spatial distribution of HIV testing and its associated factors among adolescent girls and young women in Sierra Leone.MethodsData from the 2019 Sierra Leone Demographic and Health Survey was used for the study. The sample comprised 6,062 adolescent girls and young women between the ages of 15 and 24. Spatial autocorrelation and Moran’s I statistic were employed to analyze the spatial distribution of HIV testing. An analysis utilising mixed-effect multilevel binary logistic regression was performed to determine the factors associated with HIV testing. The findings were presented as adjusted odds ratios (aOR) and a 95% confidence interval (CI).ResultsThe national prevalence of HIV testing among adolescents and young women in Sierra Leone was 42.1% [40.3,43.9]. Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts were found to be statistically significant hotspot for HIV testing. Whereas, Karene, Falaba, Bo, kenema, and some parts of Pujuhun were statistically cold spot districts. Adolescent girls and young women aged 20–24 [aOR = 1.63, 95% CI = 1.29, 2.07] had higher odds of HIV testing than those aged 15–19. Those with secondary/higher education [aOR = 1.87, 95% CI = 1.40, 2.51] had higher odds of HIV testing than those with no education. The odds of HIV testing was higher among adolescent girls and young women who use the Internet [aOR = 1.75, 95% CI = 1.32, 2.33] than those who did not use internet. Adolescent girls and young women with one [aOR = 16.56, 95% CI = 12.31, 22.29] and two or more parity [aOR = 16.37, 95% CI = 10.86, 24.68] had higher odds of HIV testing than those with no parity. The likelihood of HIV testing was higher among adolescent girls and young women who had sex below 18 [aOR = 4.54, 95% CI = 3.25, 6.34] and those who had sex at 18+ [aOR = 5.70, 95% CI = 3.84, 8.45] compared to those who had never had sex. Adolescent girls and young women who visited health facilities in the past 12 months [aOR = 1.82, 95% CI = 1.46, 2.26] had higher odds of HIV testing than those who did not.ConclusionDespite some positive trends, HIV testing rates among adolescent girls and young women in Sierra Leone remain moderate. Spatial autocorrelation analysis consistently revealed hotspots and cold spots for HIV testing, with Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts remaining persistent hotspots. Age, education, internet use, sexual history, parity, and healthcare access are significant factors influencing testing behaviour. To improve testing rates, the government and policymakers should prioritize educational campaigns, expand internet access, integrate HIV testing into routine healthcare, and address stigma associated with HIV.

The impact of soil transmitted helminth on malaria clinical presentation and treatment outcome: A case control study among children in Bagamoyo district, coastal region of Tanzania.

Parasitic infectious agents rarely occur in isolation. Epidemiological evidence is mostly lacking, and little is known on how the two common parasites Plasmodium and soil transmitted helminths (STH) interact. There are contradictory findings in different studies. Synergism, antagonism and neutral effect have been documented between Plasmodium and STH. This study investigated the impact of STH on clinical malaria presentation and treatment outcome. A matched case control study with a semi longitudinal follow up according to World Health Organization (WHO) antimalarial surveillance guideline was done among children aged 2 months to 9 years inclusively living in western rural areas of Bagamoyo, coastal region of Tanzania. Cases were children with uncomplicated and severe malaria enrolled from the health facilities while controls were children with asymptomatic Plasmodium parasitemia enrolled from the same community. In simple conditional regression analysis there was a tendency for a protective effect of STH on the development of clinical malaria [OR = 0.6, 95% CI of 0.3-1.3] which was more marked for Enterobius vermicularis species [OR = 0.2, 95% CI of 0.0-0.9]. On the contrary, hookworm species tended to be associated with increased risk of clinical malaria [OR = 3.0, 95% CI of 0.9-9.5]. In multiple conditional regression analysis, the overall protective effect was lower for all helminth infection [OR = 0.8, 95% CI of 0.3-1.9] but remained significantly protective for E. vermicularis species [OR = 0.1, 95% CI of 0.0-1.0] and borderline significant for hookworm species [OR = 3.6, 95% CI of 0.9-14.3]. Using ordinal logistic regression which better reflects the progression of asymptomatic Plasmodium parasitemia to severe malaria, there was a 50% significant protective effect with overall helminths [OR = 0.5, 95% CI of 0.3-0.9]. On the contrary, hookworm species was highly predictive of uncomplicated and severe malaria [OR = 7.8, 95% (CI of 1.8-33.9) and 49.7 (95% CI of 1.9-1298.9) respectively]. Generally, children infected with STH had higher geometric mean time to first clearance of parasitemia. The findings of a protective effect of E. vermicularis and an enhancing effect of hookworms may explain the contradictory results found in the literature about impact of helminths on clinical malaria. More insight should be gained on possible mechanisms for these opposite effects. These results should not deter at this stage deworming programs but rather foster implementation of integrated control program for these two common parasites.

Representations of mental presence in three mental powers, a vision in Hazem Al-Qartajani’s view

The present study attempts to pinpoint the strategies which are followed by the males of Anbar rural dwellers in complimenting. For the purpose of this study, thirty males from the western rural areas (they are mainly agrarian workers and workers in the building sector) are chosen randomly. The compliments are studied with reference to their definition, how to compliment, the purpose of the compliment and the main strategies used by those rural dwellers of Anbar Western area. The data for this study are collected via a questionnaire which is designed for this purpose. The results which are obtained from the questionnaire showed that the majority of people under investigation prefer compliments of skills (probably because they are skilled workers and they like their jobs), appearance, possession and behavior. The results are discussed analyzed and compared according to a yardstick prepared by (Chen:1993). The findings of the study revealed that the majority of the rural dwellers resorted to the use of agreeing strategy and the use of extra explanation and prayers while complimenting. The final goal of complimenting is to achieve modesty and to maintain good will via soft words such as /ɘju:ni/ (my eyes) or /aỊa:h jxǝli:k/ (may Allah save you) .

An Exploration of Rural Elderly Care Models under the Rural Revitalization Strategy: A Case Study of Ningxia

With the deepening of aging, elderly care has become a focus of attention in various countries. China is also facing a serious aging issue, and how to reasonably solve the elderly care problems has become one of the key research topics for Chinese experts and scholars. China has vast territory with significant regional disparities between the east and west, leading to unbalanced urban and rural development. The aging issue in western rural areas is more severe, yet their development is relatively lagging behind, with serious population loss challenging traditional family care models. Addressing the elderly care problem requires targeted measures based on practical considerations. Taking Ningxia as a case study, this paper finds that the material living standards of elderly rural residents in Ningxia are low, and their spiritual life is relatively lacking. By analyzing the deficiencies in rural elderly care in Ningxia from the perspectives of family care and institutional care, corresponding solutions are proposed. Currently, rural family care in Ningxia faces difficulties, institutional care development is immature, and public acceptance is low. Therefore, suggestions are made to improve rural infrastructure to retain labor, enhance the operation and internal environment of care institutions, and increase public acceptance, aiming to improve the living conditions of elderly rural residents in Ningxia and meet their care needs.

Determinants of health poverty vulnerability in rural areas of Western China in the post-poverty relief era: an analysis based on the Anderson behavioral model

BackgroundAlthough China has eliminated absolute poverty, the effects of sickness still pose a threat to the prospect of returning to poverty in western rural areas. However, poverty governance extends beyond solving absolute poverty, and should enhance the family’s ability to resist risks, proactively identify the existence of risks, and facilitate preventive measures to reduce the probability of falling into poverty again. This study aimed to assess the health poverty vulnerability of rural households in western China and decompose its determinants.MethodsBased on survey data from 2022, the three-stage feasible generalized least squares method was used to calculate the health poverty vulnerability index. Then, Anderson’s health behavior theory model was extended to analyse various influencing factors using binary logistic regression, and the contribution of each influencing factor was decomposed using the Shapley index. Finally, Tobit regression and the censored least absolute deviations estimation (clad) method were used to test the model’s robustness.ResultsA total of 5455 families in the rural Ningxia region of western China were included in the study. The health poverty vulnerability index of the sample population in 2022 was 0.3000 ± 0.2223, and families with vulnerability ≥0.5 accounted for 16.9% of the sample population. From the Anderson behavioral model, the three models including propensity, enabling, and demand factors had the best fit, and the AIC and BIC values were the smallest. The Shapley decomposition showed that the dimensions of the propensity factor, number of residents, age and educational level of the household head, and dependency ratio were the most important factors influencing vulnerability to health poverty. Tobit regression and the clad method proved the reliability of the constructed model through a robustness test.ConclusionRural areas still face the risk of becoming poor or falling into poverty owing to residents’ health problems. Health poverty alleviation should gradually change from a focus on treatment to prevention, and formulate a set of accurate and efficient intervention policies from a forward-looking perspective to consolidate the results of health poverty alleviation and prevent widescale poverty return.

西部乡村地区中小学心理健康教育现状及思考——基于云南省2247名教师的调查

西部乡村地区中小学心理健康教育现状及思考——基于云南省2247名教师的调查

Limited Development Space: Evaluation of the Main Obstacles for Chinese College Students' Unwillingness to Teach in Western Rural Areas

Limited Development Space: Evaluation of the Main Obstacles for Chinese College Students' Unwillingness to Teach in Western Rural Areas

Prevalence of Vitamin A Deficiency in Children Aged 6 to 17 Years - Western and Central Rural Areas, China, 2012-2021.

Vitamin A deficiency (VAD) is a leading global nutritional concern, ranking among the top four major nutritional deficiencies worldwide. The prevalence of VAD is unevenly distributed across various regions, both within China and globally. The report adds valuable insights into the vitamin A nutritional status of rural students aged 6-17 years who participated in the Nutrition Improvement Programme for Rural Compulsory Education Students (NIPRCES). Over the decade from 2012 to 2021, there was a modest improvement in vitamin A status. The prevalence of VAD and sub-clinical VAD (SVAD) declined as the students aged. Throughout the majority of the survey years, the incidence of VAD was higher among males and western regions compared to females and central regions, respectively. A comprehensive approach, incorporating dietary diversification, nutrition education, and food fortification, should be implemented to prevent VAD and SVAD especially in males, younger children and children in western areas.

Supporting and retaining competent primary care workforce in low-resource settings: lessons learned from a prospective cohort study

ObjectiveAssess whether local health facilities can adequately support the performance of general practitioners (GPs) trained by China’s national compulsory services programme (CSP).DesignProspective cohort study.SettingHealth facilities in middle and western rural...

Barriers to Utilization of Postnatal Care Services within the First 48 Hours of Birth in North West Syria: A Barrier Analysis Study

Objectives: The objective of this study is to identify barriers to the utilization of postnatal care services among mothers and neonates in a conflict-affected area. Methods: This study involves a cross-sectional survey utilizing the Barrier Analysis (BA) approach, which is based on the Health Belief Model and the Theory of Reasoned Action. It explores up to 12 recognized determinants of behavior adoption. The survey was conducted in six communities located in Idlib and western rural Aleppo, representing both urban and rural areas for host and displaced populations in northwest Syria (Selwa, Abin Samaan, Sahara, Tal Elkaramej, Boz Ghaz, Koknaya). Data collection took place from 7th to 11th November 2021. Initially, screening questions were used to verify participants' eligibility for the survey. The interviewed mothers were then classified into two main groups: the first group consisted of mothers of newborns who attended postnatal care within the first 48 hours after birth (DOERS), while the second group comprised mothers of newborns who did not attend postnatal care within the first 48 hours after birth (NON-DOERS). From both groups, a random sample of 90 mothers of newborns aged 0-6 months was selected (45 DOERS and 45 NON-DOERS) out of a total of 418 respondents. Their answers were analyzed based on the 12 determinants included in the questionnaire. All collected data, including coded qualitative data and closed-ended questions, along with their frequencies, were entered into the Standard Barrier Analysis Tabulation Sheet Excel (SBATS). The odds ratio and P-value were calculated, considering results to be "significant" if the P-value was less than 0.05. Results: All demonstrated significant results are being compared between doers (mothers who attend postnatal care within the first 48 hours after birth) and non-doers (mothers who did not attend postnatal care within the first 48 hours after birth) according to the determinants and based on their recurrence, not their percentage. A total of 90 mothers with newborns aged 0-6 months (45 DOERS and 45 NON-DOERS) were interviewed, the findings revealed that 68% of the interviewed mothers had a normal delivery at health facilities, while 20% had a cesarean delivery, and 12% had a normal delivery at home. The barriers to PNC services included the long distance of the health facilities and the absence of transportation, social norms and traditions that prevent women from leaving home after childbirth, overcrowding at health facilities, fear of COVID-19 infection when visiting health facilities, absence of accompanying people, and the perception among mothers that they were unlikely to experience immediate post-birth problems. On the other hand, the enablers for accessing postnatal care services included community-based health support through community health workers, awareness of the available services, the mother's level of education, and a perceived understanding of the risks associated with medical complications that may arise after birth. Additionally, the availability of transportation and economic resources played a facilitating role in accessing postnatal care services. Conclusion: This study examines the low uptake of postnatal care (PNC) services for mothers and neonates in a conflict-affected area. Findings highlight barriers including limited maternal knowledge, inadequate health service coverage, transportation challenges, and social norms.

Regional with urban–rural variation in low birth weight and its determinants of Indian children: findings from National Family Health Survey 5 data

BackgroundLow birth weight is a key indicator for child health, especially a concern in low-middle-income countries. However, health and medically-related reforms are being actively implemented in some middle-income countries like India. Identifying low birth weight (LBW) babies with their determinants across the whole country is essential to formulate regional and area-specific interventions. The objective of this study was to find out the burden and determinants of LBW on the regional and residential (rural–urban) divisions of India.MethodsThe present study was based on the NFHS-5 dataset (2019–21), a nationally representative survey in India. A total of 209,223 births were included in this study. A newborn weighing less than 2500 g was considered as LBW. According to the objectives, we used frequency distribution, chi-square test and binary logistic regression analysis for analysing the data.ResultsAbout 18.24% of the babies were LBW in India, significantly higher in rural areas than in urban areas (18.58% vs 17.36%). Regionally prevalence was more frequent in western (20.63%) and central (20.16%) rural areas. Regarding maternal concerns, in the eastern and southern regions of India, mothers aged 25–34 were less likely to have LBW children than mothers aged 35–49 years. It was found that the risk of LBW was more likely among the children born out of unintended pregnancies in almost all regions except for eastern part. In rural India, women who delivered children at home were more likely to have LBW children in India (AOR = 1.19, CI: 1.12–1.28, p < 0.001) and its central, northern, and southern regions than those who gave birth in institutions. The study indicates that LBW coexists with lower maternal education levels and poor household wealth index across all regions. About 58% and 57% of cumulative effects of independent variables on LBW can be distinguished in urban and rural India, respectively.ConclusionsTargeted-specific strategies need to be undertaken as per region and geographical variations. Then only India should be able to decline LBW as proposed by National Health Policy.

The influence of strong social ties on the choice of long-term care model for middle-aged and older adults in China.

With the acceleration of population aging in China, the care of middle-aged and older adults has become the focus of social attention. As China is an "acquaintance society," strong social relations play an important role in residents' access to information and resource allocation, which has an impact on the choice of long-term care models for middle-aged and older adults. Therefore, based on the 19,728 samples from the 2018 CHARLS Phase I data, an empirical analysis was conducted using a logistic dichotomous model, which showed that both kinship (p < 0.01) and friendship (p < 0.01) among social relationships positively influenced the choice of social care models for middle-aged and older adults. The analysis of the heterogeneity showed that the choice of long-term care models was significantly influenced by strong social relationships in the central and western regions and rural areas (p < 0.01). On the basis of this, the transmission mechanism of strong social relationships was further analyzed in conjunction with the further construction of the SIRS Contagion Model, which was used to describe the information transmission process. The results showed that residents who attached importance to strong social ties were more likely to incur medical transfer expenditure, thus further increasing their own demand for the formal care model. The policy implications of this study are to promote the coordinated development of long-term formal care and strong social relations, to further promote the socialization of the formal care model while relying on traditional family care, and to build a multi-level and diversified long-term care system for middle-aged and older adults.

Primary assessment of the diversity of Omicron sublineages and the epidemiologic features of autumn/winter 2022 COVID-19 wave in Chinese mainland.

With the recent ongoing autumn/winter 2022 COVID-19 wave and the adjustment of public health control measures, there have been widespread SARS-CoV-2 infections in Chinese mainland. Here we have analyzed 369 viral genomes from recently diagnosed COVID-19 patients in Shanghai, identifying a large number of sublineages of the SARS-CoV-2 Omicron family. Phylogenetic analysis, coupled with contact history tracing, revealed simultaneous community transmission of two Omicron sublineages dominating the infections in some areas of China (BA.5.2 mainly in Guangzhou and Shanghai, and BF.7 mainly in Beijing) and two highly infectious sublineages recently imported from abroad (XBB and BQ.1). Publicly available data from August 31 to November 29, 2022 indicated an overall severe/critical case rate of 0.035% nationwide, while analysis of 5706 symptomatic patients treated at the Shanghai Public Health Center between September 1 and December 26, 2022 showed that 20 cases (0.35%) without comorbidities progressed into severe/critical conditions and 153 cases (2.68%) with COVID-19-exacerbated comorbidities progressed into severe/critical conditions. These observations shall alert healthcare providers to place more resources for the treatment of severe/critical cases. Furthermore, mathematical modeling predicts this autumn/winter wave might pass through major cities in China by the end of the year, whereas some middle and western provinces and rural areas would be hit by the upcoming infection wave in mid-to-late January 2023, and the duration and magnitude of upcoming outbreak could be dramatically enhanced by the extensive travels during the Spring Festival (January 21, 2023). Altogether, these preliminary data highlight the needs to allocate resources to early diagnosis and effective treatment of severe cases and the protection of vulnerable population, especially in the rural areas, to ensure the country's smooth exit from the ongoing pandemic and accelerate socio-economic recovery.

Love and Gender Relations from the Perspective of Familism: Based on Fieldwork in Contemporary Rural North Zhejiang

Abstract In response to the academic debate about the “individualization” of the patterns of love and marriage in contemporary China, this article takes the spousal selection and marriage and love practices of peasants in northern Zhejiang since China’s reform and opening up as the basis of field study, and explores the roles and functions of love and gender relations and their relationship to ethical factors in the overall process of “spousal selection→marriage→family→giving birth.” We also find that although the “love” factor has become more and more important in the marriage practice of recent generations (especially among rural women) and has even become an indispensable key to starting marital family life, it has not fully established its own independent space and value. It has in fact been boosted, guided, and controlled by, and incorporated into, the traditional marriage and family pattern. This traditional pattern, with its own unique resilience, has integrated love into the family life cycle, gradually pulling it into the orbit of traditional marriage and family, and successfully carrying on the “sacred undertaking” of the ancestors. This overall characteristic is more pronounced in developed eastern coastal villages (among young women) than in less developed central and western rural areas (among young women). In terms of theory and methodology, the “individualization” of love and marriage among contemporary Chinese peasants needs to be put back into the framework of “familism” for in-depth reflection, rather than simply being understood from the standpoint of “individualization” and from the binary opposition between “individualism” and “familism.”

Plasma selenium level and its influencing factors in Chinese child-bearing-aged women in 2015

To assess the plasma selenium(Se) level of child-bearing-aged women and discuss the influence factor for low-Se level. Using the muti-stage stratified and population proportional cluster random sampling method, 1881 child-bearing-aged women aged 18 to 44 years were selected from China Adult Chronic Disease and Nutrition Surveillance(2015) Data. The basic information of the subjects was collected by unified electronic questionnaires and equipments were used for field survey, measurement and record. Plasma Se concentration was detected by inductively coupled plasma mass spectrometry. Plasma low-Se level were assessed using lower limit of plasma/serum Se established by the Mayo Clinic Laboratory and our laboratory, respectively. Influence factors of low-Se level were analyzed by the multivariate logistic regression model. The M(P25, P75) plasma Se concentration for Chinese child-bearing-aged women was 89.52(74.21, 105.03)μg/L. Nationality, location, urban-rural type and education level difference had influence on plasma Se level in this population(P&lt;0.05). According to the lower limit of plasma/serum Se concentration established by the Mayo clinical laboratories(&lt;70 μg/L) and our laboratories(&lt;73.81 μg/L), the low-Se rate were 20.47% and 24.51%, respectively. There were significantly differences in low-Se rate among nationality, location, urban-rural type, education level and marital status(P&lt;0.05). The multivariate logistic regression model showed that location and urban-rural type had significant effects on low-Se rate of child-bearing-aged women(P&lt;0.05). The plasma low-Se rate of Chinese women of childbearing age is relatively high and higher prevalence low-Se was found in western and central regions and rural areas in China.

Prevalence trend of malnutrition among Chinese Han children and adolescents aged 7-18 years from 2010 to 2019

Objective: To analyze the prevalence trend of malnutrition among Chinese Han children and adolescents aged 7-18 years from 2010 to 2019. Methods: Based on the data from the Chinese National Surveys on Students' Constitution and Health in 2010, 2014 and 2019, about 215 102, 214 268 and 212 713 Han students aged 7-18 years were included in this study. According to the National Screening Standard for Malnutrition of School-age Children and Adolescents, the detection rate of malnutrition among Chinese Han children and adolescents aged 7-18 was calculated, and the prevalence trend of malnutrition from 2010 to 2019 was analyzed. Results: In 2019, the detection rate of malnutrition among Chinese Han students aged 7-18 years was 8.64% (18 381/212 713), of which the rate of growth retardation, moderate-to-severe wasting and mild wasting was 0.50% (1 062/212 713), 3.25% (6 914/212 713) and 4.89% (10 405/212 713), respectively. In 2019, the detection rate of malnutrition in these boys was higher than that of girls (9.97% vs. 7.31%), and the detection rate in rural areas was higher than that in cities (9.30% vs. 7.98%). The detection rates were 9.74% (5 252/53 916), 8.17% (4 408/53 937), 7.29% (3 885/53 310), and 9.38% (4 836/51 550) in 7-9, 10-12, 13-15, and 16-18 years groups, and 8.14% (6 563/80 618), 7.61% (4 237/55 694) and 9.92% (7 581/76 401) in the eastern, central, and western regions. Malnutrition among students in China was mainly caused by mild wasting, and the detection rate of growth retardation accounted for only 5.78% (1 062/18 381). Malnutrition was mostly concentrated in the southwest region, and the rate was relatively low in eastern provinces. In three surveys from 2010 to 2019, the detection rate of malnutrition among Han students aged 7-18 in China decreased gradually, and the differences were statistically significant (P<0.05). Among them, the detection rates in western rural areas decreased significantly, as well as the gap between urban and rural areas. Compared with that in 2014, the detection rate of malnutrition in Shandong, Hunan, Qinghai and Hainan provinces in 2019 decreased significantly (P<0.05). Conclusion: In 2019, the malnutrition of Chinese children and adolescents aged 7-18 years is dominated by wasting malnutrition. The detection rate shows a downward trend from 2010 to 2019, with regional differences.

Disparities and determinants of maternal health services utilization among women in poverty-stricken rural areas of China: a cross-sectional study

BackgroundReducing maternal mortality ratio (MMR) has been a worldwide public health challenge for a long time. Utilization of maternal health services including antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC) is vital to prevent maternal mortality. China has made significant improvements in maternal health during the past 30 years, however, disparities in maternal health service utilization still exist among regions and the western rural areas had the lowest utilization rate. This study aims to assess the inequality and determinants of maternal health service utilization in western poverty-stricken rural areas based on Anderson’s Behavioral Model of Health Service Use and provide evidence-based suggestions to improve equity and coverage of maternal service utilization in China.MethodsA cross-sectional study was conducted in Gansu and Yunnan Province, Western China using primary data (n = 996) collected by the research team. A multistage, judgment, quota sampling procedure was employed to select the participants of the survey. Trained local health staff formed an interview team to help respondents answer a structured, pre-tested questionnaire designed based on Anderson’s model. Data collected through interviews were used for descriptive analysis, range analysis, and univariate and multivariate binary logistic analysis to identify influencing factors of 5 + ANC, 8 + ANC, ID, and 2 + PNC utilization.ResultsPlace of residence, age, education level, annual income, and health education during ANC were influencing factors of 5 + ANC; place of residence, education level, per capita household income, conditional cash transfer (CCT) participation, and distance to health facilities were influencing factors of 8 + ANC; place of residence, education level, and availability of financial incentive programs were influencing factors of ID; number of children, health education during ANC, CCT projects participation, and self-rated health status were influencing factors of 2 + PNC.ConclusionsInequalities in maternal service utilization exist between Yunnan and Gansu provinces. This study shows a strong association between both predisposing and enabling factors and maternal services utilization. Predisposing factors such as place of residence, education level, and number of children, enabling factors such as CCT participation, annual income, health education during ANC, and distance to health facilities along with need factor self-rated health status all contribute to maternal services utilization.We conclude that many factors influence maternal service utilization and interventions targeted at various levels should be considered. Therefore, we suggest more health resources should be invested in underutilized areas, financial incentive projects targeting pregnant women should be implemented, and health education should be provided to improve women’s health literacy.

Urbanization, green development and residents' happiness: The moderating role of environmental regulation

The fundamental goal of development is to continuously improve people's well-being. Studying the relationship between urbanization, green development and well-being can better promote people's happiness index. This paper matches the Chinese General Social Survey (CGSS)2017 data with the urbanization data of 28 provinces and the inter-provincial green development index and employs the Ordered Probit model to examine the relationship between urbanization, green development and residents' happiness (RHAP). On this basis, the mediating effect of green development and the moderating effect of environmental regulation intensity are further studied. The research results indicate that the level of economic urbanization and social service urbanization significantly promote the RHAP, while the level of population urbanization has a significant negative impact. There are significant differences in the level of RHAP needs due to the heterogeneity of regions, urban and rural areas, and income levels. The social service level has a stronger role in promoting the RHAP in eastern regions and cities, and the level of economic development is more obvious for residents in central and western regions and rural areas. Moreover, green development plays a partial mediating role in the relationship between urbanization and RHAP, and environmental regulation positively regulates the relationship between urbanization and green development. This study provides new ideas for the government to effectively formulate policies and improve RHAP.

Health Inequalities in the Elderly with Different Socioeconomic Status in China

This study aims to examine socioeconomic inequalities in health status and health service of the elderly in China to provide basis for health promotion. The data of China Health and Retirement Longitudinal Study (CHRLS) in the year 2015 was used. Adults aged 60 and over (n=8001) were included in the analytic sample. Socioeconomic status (SES) of the elderly was assessed by annual per capita consumption expenditure, education, and regional and rural/ urban status. Health status was measured by self-rated health, activities of daily living (ADL), the prevalence rate of chronic diseases and the 1-month prevalence rate; while health service was measured by the utilization of both outpatient service and inpatient service. Overall, the elderly with higher economic level had better health status and higher ADL disability rate, but lower prevalence rate of chronic diseases, 1-month outpatient visit rate and annual hospitalization rate. The elderly with lower education level had higher self-rated "poor" health, ADL disability rate, 1-month prevalence rate and 1-month non-visit rate. The elderly in eastern region or urban areas had better health status than those in central and western regions or rural areas. However, for health service utilization, the elderly in western region used both outpatient and inpatient services more frequently. The rural elderly had higher 1-month outpatient visit rate, while the urban elderly had higher annual hospitalization rate. Socioeconomic inequalities in health existed in Chinese elderly. To promote health equity among the elderly, the government should improve health insurance and medical assistance policies, optimize health resources allocation, and narrow economic gaps between western and eastern regions, and between rural and urban areas.