China Movie 1996
Phuong Fulsom
GENERAL Distr.
Original: CHINESECommunication of 1 August 1996 Received from the Permanent Mission of the People's Republic of China to the International Atomic Energy Agency
- On 2 August 1996, the Director General received a communication of 1 August 1996 from the Resident Representative of the People's Republic of China transmitting the text of a statement made on 29 July 1996 by the Government of the People's Republic of China about the latest test of a nuclear weapon conducted by China and its announcement of a nuclear testing moratorium.
- As requested in the communication of 1 August 1996, the statement of the Government of the People's Republic of China is being circulated for the information of Member States of the Agency.
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Context: As the world's largest producer and consumer of tobacco products, China bears a large proportion of the global burden of smoking-related disease and may be experiencing a tobacco epidemic.
Design and setting: A population-based survey consisting of a 52-item questionnaire that included information on demographics, smoking history, smoking-related knowledge and attitudes, cessation, passive smoke exposure, and health status was administered in 145 disease surveillance points in the 30 provinces of China from March through July 1996.
Participants: A nationally representative random sample of 128766 persons aged 15 to 69 years were asked to participate; 120298 (93.8%) provided data and were included in the final analysis. About two thirds of those sampled were from rural areas and one third were from urban areas.
Conclusion: The high rates of smoking in men found in this study signal an urgent need for smoking prevention and cessation efforts; tobacco control initiatives are needed to maintain or decrease the currently low smoking prevalence in women.
Maternal deaths occur mostly in developing countries and the majority of them are preventable. This study analyzes changes in maternal mortality and related causes in Henan Province, China, between 1996 and 2009, in an attempt to provide a reliable basis for introducing effective interventions to reduce the maternal mortality ratio (MMR), part of the fifth Millennium Development Goal.
This population-based maternal mortality survey in Henan Province was carried out from 1996 to 2009. Basic information was obtained from the health care network for women and children and the vital statistics system, from specially trained monitoring personnel in 25 selected monitoring sites and by household survey in each case of maternal death. This data was subsequently reported to the Henan Provincial Maternal and Child Healthcare Hospital. The total MMR in Henan Province declined by 78.4%, from 80.1 per 100 000 live births in 1996 to 17.3 per 100 000 live births in 2009. The decline was more pronounced in rural than in urban areas. The most common causes of maternal death during this period were obstetric hemorrhage (43.8%), pregnancy-induced hypertension (15.8%), amniotic fluid embolism (13.9%) and heart disease (8.0%). The MMR was higher in rural areas with lower income, less education and poorer health care.
There was a remarkable decrease in the MMR in Henan Province between 1996 and 2009 mainly in the rural areas and MMR due to direct obstetric causes such as obstetric hemorrhage. This study indicates that improving the health care network for women, training of obstetric staff at basic-level units, promoting maternal education, and increasing household income are important interventional strategies to reduce the MMR further.
Copyright: You et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This study was funded by the Health Department of Henan Province and the Chinese Ministry of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Reducing the MMR came into focus when it became one of the eight Millennium Development Goals (MDGs). The fifth MDG (MDG 5) includes 2 sub-goals: first, reducing the MMR by three-quarters from 1990 to 2015 and, second, achieving universal access to reproductive health by 2015 [5]. Reliable information about the rates, trends, causes and factors associated with maternal mortality is essential for resource mobilization, and for planning and assessment of progress towards achieving MDG 5 [6].
Following major economic growth in China during the past two decades, increased government investment in health care has improved the overall Chinese health status. Interventions such as prenatal care, hospitalized delivery, skilled staff attendance at delivery and post-partum care have contributed substantially to reducing the MMR in China [7], [8]. However, the economic development differs among different geographic regions in China, with a vast gap between rural and urban areas in the whole country, which in turn affects maternal health care and mortality. Knowledge of how this unbalanced socioeconomic development and reformed rural health care system affect the MMR is vital, since MMR reduction in rural areas is a major challenge faced by government, health professionals and policy-makers aiming at realizing MDG 5. Henan Province, located in central China and with over 100 million mainly Han inhabitants, has the largest population and is the biggest agricultural province in the country. There are pronounced differences between urban and rural areas in the province, closely resembling those found in the whole nation due to multi-ethnicity and unbalanced economic development [7], [9], [10].
The aim of this study was to investigate the dynamic changes in MMR in Henan Province, and to compare the differences in MMR between urban and rural areas, as well as to evaluate the effect of maternal educational level, family income, prenatal health care, planned pregnancy and delivery location on the MMR.
Every pregnant woman who had an official registered permanent residence in the surveillance area, including those not participating in the family planning system, was a study subject. All pregnant women dying from the start of pregnancy until 42 days after termination of pregnancy (including abortion related deaths) between January 1, 1996 and December 31, 2009, were classified as maternal deaths. In accordance with the International Classification of Diseases and Related Health problems, 10th Revision (ICD-10),maternal death is defined as resulting from any cause related to or aggravated by pregnancy or its management, classified as direct obstetric causes and indirect obstetric causes, but not from accidental or incidental causes [11]. All the pregnancies, live births and maternal deaths were identified by trained and licensed professionals.
The data collection procedures were similar in the whole country, according to Chinese Ministry of Health directives [7]. The data were collected and reported by trained and licensed health care providers, based on an organization with three vertical levels of quality control within the maternity and child health care systems across the province (community, county and city), via 1) quarterly report forms for live birth and maternal death reports, 2) health care cards, medical records and regular hospital staff meetings and 3) household surveys conducted by specifically trained staff. The vital registration system registered all the births and deaths of the residencies within each administration region (community or street) with the certification from licensed health care providers. Pregnancies were identified by trained maternal health providers or doctors based on early pregnancy symptoms and pregnancy tests. All the pregnancies were registered in the maternity and child health care system and family plan system. In short, the health care providers collected the number of maternal deaths and live births and reported to local authorities monthly, who examined and summarized data (using standardized quarterly report) to hospitals/stations at district or county level to be reviewed, corrected and verified. The number of pregnancies and live births as well as maternal deaths was compared with the vital registration system and family plan registration system. People who have migrated were found, by comparing the numbers of live births among the systems; and also through the household surveys provided in the migrated areas. The detailed information for maternal death was investigated further by trained obstetricians from the county/district hospital. For deaths inside the hospital, the hospital record and other related information was collected by document reviews or personal interviews. For deaths outside the hospital, the information was collected by household visits. All data were then finally reported to the Henan Provincial Maternity and Child Care Hospital (HPMCCH) as part of the maternal care and mortality reporting system. Annual quality control and missing report investigations were organized by the HPMCCH and randomly performed in the surveillance areas. HPMCCH doctors visited facilities related to maternal death surveys, including the vital statistics system, health care institutions, family planning clinics and household registration authorities to conduct independent retrospective quality investigations of the reported data, in order to verify the number of live births as well as maternal deaths and their causes and correct underreporting or misdiagnoses. Misreporting of numbers of live births decreased from 4.6% (4.76% in rural areas and 0.36% in urban areas) in 1996 to 0.58% (0.72% in rural areas and 0.13% in urban areas) in 2009. According to WHO recommendations, HPMCCH saw to it that all maternal death data were assessed by experts every six months in order to determine causes of death and preventability as well as to identify associated factors. The death data were evaluated very carefully and all uncertain data were reinvestigated to make sure the causes of death were reliable. The factors associated with preventable maternal death involve knowledge/skills, attitude, resources and management [12] in individuals/families, health care facilities and community services such as transportation, family planning and the working committee on women and children. The MMR was calculated by comparing the total number of maternal deaths with the total number of live births during the same year and all MMRs are thus expressed as number of deaths per 100 000 live births.
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