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1.  Postpartum practices of puerperal women and their influencing factors in three regions of Hubei, China 
BMC Public Health  2006;6:274.
Background
'Sitting month' is a Chinese tradition for women's postpartum custom. The present study aims to explore the postpartum dietary and health practices of puerperal women and identify their influential factors in three selected regions of Hubei, China.
Methods
A cross-sectional retrospective study was conducted in the selected urban, suburban and rural areas in the province of Hubei from 1 March to 30 May 2003. A total of 2100 women who had given birth to full-term singleton infants in the past two years were selected as the participants. Data regarding postpartum practices and potentially related factors were collected through questionnaire by trained investigators.
Results
During the puerperium, 18% of the participants never ate vegetables, 78.8% never ate fruit and 75.7% never drank milk. Behaviour taboos such as no bathing, no hair washing or teeth brushing were still popular among the participants. About half of the women didn't get out of the bed two days after giving birth. The average time they stayed in bed during this period was 18.0 h. One third of them didn't have any outdoor activities in that time periods. The educational background of both women and their spouses, location of their residence, family income, postnatal visit, nutrition and health care educational courses were found to be the influencing factors of women's postpartum practices.
Conclusion
Traditional postpartum dietary and health behaviours were still popular among women in Hubei. Identifying the factors associated with traditional postpartum practices is critical to develop better targeting health education programs. Updated Information regarding postpartum dietary and health practices should be disseminated to women.
doi:10.1186/1471-2458-6-274
PMCID: PMC1636040  PMID: 17087836
2.  The effect of health and nutrition education intervention on women's postpartum beliefs and practices: a randomized controlled trial 
BMC Public Health  2009;9:45.
Background
'Sitting month' is the Chinese tradition for postpartum customs. Available studies indicate that some of the traditional postpartum practices are potentially harmful for women's health. However, no intervention study aiming at postpartum practices has been performed. In this paper we evaluated the effect of a health and nutrition education intervention, which focused on improving postpartum dietary quality and optimal health behaviors.
Methods
The study design was a randomized controlled trial conducted in both urban and rural area of Hubei between August 2003 and June 2004. A total of 302 women who attended the antenatal clinic during the third trimester with an uncomplicated pregnancy were recruited. Women randomized to the education intervention group in both urban and rural area received two two-hour prenatal education sessions and four postpartum counseling visits. Control group women received usual health care during pregnancy and postpartum period. Women were followed up until 42 days postpartum. Outcome measures were nutrition and health knowledge, dietary behavior, health behavior and health problems during the postpartum period.
Results
Women in the intervention groups exhibited significantly greater improvement in overall dietary behaviors such as consumption of fruits, vegetables, soybean and soybean products as well as nutrition and health knowledge than those in the control groups. Significantly more women in the intervention groups give up the traditional behavior taboos. The incidence of constipation, leg cramp or joint pain and prolonged lochia rubra was significantly lower in the intervention groups as compared with the control groups.
Conclusion
The study shows that health and nutrition education intervention enable the women take away some of the unhealthy traditional postpartum practices and decrease the prevalence of postpartum health problems. The intervention has potential for adaptation and development to large-scale implementation.
Trial registration number
klACTRN12607000549426
doi:10.1186/1471-2458-9-45
PMCID: PMC2640472  PMID: 19183504
3.  Differences in health care seeking behaviour between rural and urban communities in South Africa 
Objective
The aim of this study was to explore possible differences in health care seeking behaviour among a rural and urban African population.
Design
A cross sectional design was followed using the infrastructure of the PURE-SA study. Four rural and urban Setswana communities which represented different strata of urbanisation in the North West Province, South Africa, were selected. Structured interviews were held with 206 participants. Data on general demographic and socio-economic characteristics, health status, beliefs about health and (access to) health care was collected.
Results
The results clearly illustrated differences in socio-economic characteristics, health status, beliefs about health, and health care utilisation. In general, inhabitants of urban communities rated their health significantly better than rural participants. Although most urban and rural participants consider their access to health care as sufficient, they still experienced difficulties in receiving the requested care. The difference in employment rate between urban and rural communities in this study indicated that participants of urban communities were more likely to be employed. Consequently, participants from rural communities had a significantly lower available weekly budget, not only for health care itself, but also for transport to the health care facility. Urban participants were more than 5 times more likely to prefer a medical doctor in private practice (OR:5.29, 95% CI 2.83-988).
Conclusion
Recommendations are formulated for infrastructure investments in rural communities, quality of health care and its perception, improvement of household socio-economical status and further research on the consequences of delay in health care seeking behaviour.
doi:10.1186/1475-9276-11-31
PMCID: PMC3419677  PMID: 22691443
Accessibility; Health care seeking behaviour; Quality; Rural community; Urban community
4.  Who Was He? Reflections on China’s First Medical ‘Naturalist’ 
Medical History  2012;56(3):366-389.
This paper examines the reasons why Physician He (Yi–He, sixth century BCE) was regarded as a founder in the classical medical tradition of China. By most accounts, Physician He’s importance owes much to his theoretical innovations. In contrast to earlier healers, Physician He purportedly framed the aetiology of illnesses solely in terms of natural causes, as opposed to attributing sickness to gods or demons. In this paper, I reread a famous episode in the Commentary by Zuo, which is often cited as evidence of the physician’s naturalism. By paying close attention to the formal elements of the narrative as well as its larger discursive context, I argue that the standard reading of Physician He falls short. The episode provides little evidence of any secular challenge to religious conceptions of illness, and Physician He was, in fact, patterned after occult experts. A careful look moreover at the reception of Physician He in premodern histories of medicine reveals that the physician was extolled for his attunement to the will of the spirits as well as his powers of examination. Physician He’s reputation as a naturalist furthermore represents a modern interpretation, one that reflects efforts to defend the indigenous medical tradition against its biomedical detractors.
doi:10.1017/mdh.2012.20
PMCID: PMC3426973  PMID: 23002305
5.  Dengue Fever in Mainland China 
Dengue is an acute emerging infectious disease transmitted by Aedes mosquitoes and has become a serious global public health problem. In mainland China, a number of large dengue outbreaks with serious consequences have been reported as early as 1978. In the three decades from 1978 to 2008, a total of 655,324 cases were reported, resulting in 610 deaths. Since the 1990s, dengue epidemics have spread gradually from Guangdong, Hainan, and Guangxi provinces in the southern coastal regions to the relatively northern and western regions including Fujian, Zhejiang, and Yunnan provinces. As the major transmission vectors of dengue viruses, the biological behavior and vectorial capacity of Aedes mosquitoes have undergone significant changes in the last two decades in mainland China, most likely the result of urbanization and global climate changes. In this review, we summarize the geographic and temporal distributions, the serotype and genotype distributions of dengue viruses in mainland China, and analyze the current status of surveillance and control of vectors for dengue transmission.
doi:10.4269/ajtmh.2010.09-0755
PMCID: PMC2929067  PMID: 20810836
6.  Local Perceptions, Cultural Beliefs and Practices That Shape Umbilical Cord Care: A Qualitative Study in Southern Province, Zambia 
PLoS ONE  2013;8(11):e79191.
Background
Global policy regarding optimal umbilical cord care to prevent neonatal illness is an active discussion among researchers and policy makers. In preparation for a large cluster-randomized control trial to measure the impact of 4% chlorhexidine as an umbilical wash versus dry cord care on neonatal mortality in Southern Province, Zambia, we performed a qualitative study to determine local perceptions of cord health and illness and the cultural belief system that shapes umbilical cord care knowledge, attitudes, and practices.
Methods and Findings
This study consisted of 36 focus group discussions with breastfeeding mothers, grandmothers, and traditional birth attendants, and 42 in-depth interviews with key community informants. Semi-structured field guides were used to lead discussions and interviews at urban and rural sites. A wide variation in knowledge, beliefs, and practices surrounding cord care was discovered. For home deliveries, cords were cut with non-sterile razor blades or local grass. Cord applications included drying agents (e.g., charcoal, baby powder, dust), lubricating agents (e.g., Vaseline, cooking oil, used motor oil) and agents intended for medicinal/protective purposes (e.g., breast milk, cow dung, chicken feces). Concerns regarding the length of time until cord detachment were universally expressed. Blood clots in the umbilical cord, bulongo-longo, were perceived to foreshadow neonatal illness. Management of bulongo-longo or infected umbilical cords included multiple traditional remedies and treatment at government health centers.
Conclusion
Umbilical cord care practices and beliefs were diverse. Dry cord care, as recommended by the World Health Organization at the time of the study, is not widely practiced in Southern Province, Zambia. A cultural health systems model that depicts all stakeholders is proposed as an approach for policy makers and program implementers to work synergistically with existing cultural beliefs and practices in order to maximize effectiveness of evidence-based interventions.
doi:10.1371/journal.pone.0079191
PMCID: PMC3820671  PMID: 24244447
7.  Dietary Intake and Food Habits of Pregnant Women Residing in Urban and Rural Areas of Deyang City, Sichuan Province, China 
Nutrients  2013;5(8):2933-2954.
Micronutrient deficiencies and imbalanced dietary intake tend to occur during the reproductive period among women in China. In accordance with traditional Chinese culture, pregnant women are commonly advised to follow a specific set of dietary precautions. The purpose of this study was to assess dietary intake data and identify risk factors for nutritional inadequacy in pregnant women from urban and rural areas of Deyang region, Sichuan province of China. Cross-sectional sampling was applied in two urban hospitals and five rural clinics (randomly selected) in Deyang region. Between July and October 2010, a total of 203 pregnant women in the third trimester, aged 19–42 years, were recruited on the basis of informed consent during antenatal clinic sessions. Semi-structured interviews on background information and 24-h dietary recalls were conducted. On the basis of self-reported height and pre-pregnancy weight, 68.7% of the women had a pre-pregnancy body mass index (BMI) within the normal range (18.5 ≤ BMI < 25), 26.3% were found to be underweight with a BMI <18.5 (20.8% in urban vs. 35.6% in rural areas), while only 5.1% were overweight with a BMI ≥30. In view of acceptable macronutrient distribution ranges (AMDRs) the women’s overall dietary energy originated excessively from fat (39%), was low in carbohydrates (49.6%), and reached the lower limits for protein (12.1%). Compared to rural areas, women living in urban areas had significantly higher reference nutrient intake (RNI) fulfillment levels for energy (106.1% vs. 93.4%), fat (146.6% vs. 119.7%), protein (86.9% vs. 71.6%), vitamin A (94.3% vs. 65.2%), Zn (70.9% vs. 61.8%), Fe (56.3% vs. 48%), Ca (55.1% vs. 41%) and riboflavin (74.7% vs. 60%). The likelihood of pregnant women following traditional food recommendations, such as avoiding rabbit meat, beef and lamb, was higher in rural (80%) than in urban (65.1%) areas. In conclusion, culturally sensitive nutrition education sessions are necessary for both urban and rural women. The prevalence of underweight before conception and an insufficient supply of important micronutrients were more pronounced in rural areas. Therefore, attention must be given to the nutritional status, especially of rural women before, or at the latest, during pregnancy.
doi:10.3390/nu5082933
PMCID: PMC3775236  PMID: 23912325
food habits; 24-h dietary recall; pregnancy; urban; rural; China
8.  Universal Precautions in the Era of HIV/AIDS 
AIDS and behavior  2007;12(5):806-814.
With a rising HIV/AIDS epidemic, it has become especially important for health service providers in China to understand and correctly adhere to universal precautions. Using qualitative interview data, perspectives from both health administrators and service providers working at all levels of China’s health care system were examined. Service providers admitted selective adherence and non-adherence to universal precautions in their daily medical practice, and gave their explanations for such behaviors. Lack of time to put on protective gear, gear’s interference with medical procedures, lack of administrative support, heavy workload in hospitals, inaccurate risk assessment, and beliefs that compliance with universal precautions is unnecessary, time consuming and costly were mentioned as reasons behind noncompliance. Effective universal precaution interventions need to target both administrators and providers, and address both structural barriers and individual attitudinal and behavioral factors.
doi:10.1007/s10461-007-9278-8
PMCID: PMC2736060  PMID: 17641967
Universal precautions; China; HIV/AIDS; Qualitative research
9.  Practices related to postpartum uterine involution in the Western Highlands of Guatemala 
Midwifery  2012;29(3):225-232.
Background
Guatemala has the third highest level of maternal mortality in Latin America. Postpartum haemorrhage is the main cause of maternal mortality. In rural Guatemala, most women rely on Traditional Birth Attendants (TBAs) during labour, delivery, and the postpartum period. Little is known about current postpartum practices that may contribute to uterine involution provided by Mam- and Spanish-speaking TBAs in the Western Highlands of Guatemala.
Methods
a qualitative study was conducted with 39 women who participated in five focus groups in the San Marcos Department of Guatemala. Questions regarding postpartum practices were discussed during four focus groups of TBAs and one group of auxiliary nurses.
Results
three postpartum practices believed to aid postpartum uterine involution were identified: use of the chuj (Mam) (Spanish, temazcal), a traditional wood-fired sauna-bath used by Mam-speaking women; herbal baths and teas; and administration of biomedicines.
Conclusions
TBAs provide the majority of care to women during childbirth and the postpartum period and have developed a set of practices to prevent and treat postpartum haemorrhage. Integration of these practices may prove an effective method to reduce maternal morbidity and mortality in the Western Highlands of Guatemala.
doi:10.1016/j.midw.2011.12.009
PMCID: PMC3799972  PMID: 22762787
Guatemala; Maternal mortality; Postpartum haemorrhage; Traditional birth attendant
10.  Medicinal plants used by Tibetans in Shangri-la, Yunnan, China 
Background
Medicinal plants used by the local people in Xizang (Tibet) have been investigated since the 1960s. The others out of Xizang, however, have been less understood, although they may be easily and strongly influenced by the various local herbal practices, diverse environments, local religious beliefs and different prevalent types of diseases. In 2006, two ethnobotanical surveys were organized in the county of Shangri-la, Yunnan Province, SW China, to document the traditional medicinal plants used by the Tibetan people.
Methods
After literature surveying, four local townships were selected to carry out the field investigation. Three local healers were interviewed as key informants. The methods of ethnobotany, anthropology and participatory rural appraisal (PRA) were used in the field surveys. Plant taxonomic approach was adopted for voucher specimen identification.
Results
Sixty-eight medicinal plant species in 64 genera of 40 families were recorded and collected. Among them, 23 species were found to have medicinal values that have not been recorded in any existing Tibetan literatures before, and 31 species were recorded to have traditional prescriptions. Moreover, the traditional preparations of each species and some folk medicinal knowledge were recorded and analyzed. These traditional prescriptions, preparations, new medicinal plants and folk medicinal knowledge and principles were discovered and summarized by local traditional Tibetan healers through times of treatment practices, and were passed down from generation to generation.
Conclusion
As a part of the cultural diversity of Tibetan community, these traditional medicinal knowledge and experiences may provide data and information basis for the sustainable utilization and development of Tibetan medicine, and may contribute to the local economic development. However, for many reasons, they are disappearing gradually as time goes by. Our study showed that there were abundant traditional Tibetan medicinal prescriptions and using methods. It implies that more Tibetan medicinal plants and traditional knowledge can be discovered. Further research should be done to save the wealth of these traditional medicinal knowledge and experiences before they are dying out.
doi:10.1186/1746-4269-5-15
PMCID: PMC2684741  PMID: 19416515
11.  Body Massage Performance Investigation by Brain Activity Analysis 
Massage has been widely applied to improve health and reduce stress. However, the performance difference between hands-on treatment and treatment by mechanical devices has been little mentioned. Therefore, the main aim of this paper is to investigate a subject's EEG performance under massage treatment applied by hand and treatment applied by mechanical devices. Massage was applied to four acupoints for three minutes each. The massage acupoint sequence was from left Jian-wai-yu, right Jian-wai-yu, left Zuo-fei-yu, and finally right Zuo-fei-yu. An EEG system of 32 channels was used. Twenty-four volunteers, mainly college students, were enrolled. EEG rhythm powers of each massage sessions were derived. Two-way ANOVA revealed that there were also significant interactions between the massage stage and the massage type on delta (P < 0.01), theta (P < 0.05), and beta rhythms (P < 0.01), and there were significant differences at different stages for the mechanical massage group (F = 5.557, P < 0.01). The mechanical massage group had more significant differences than the hands-on group for stage coherence of around coherence on alpha rhythm. Further rhythm power scalp topography between two massage methods is also investigated.
doi:10.1155/2012/252163
PMCID: PMC3317228  PMID: 22518194
12.  The Contribution of Dietary Factors to Dental Caries and Disparities in Caries 
Academic pediatrics  2009;9(6):410-414.
Frequent consumption of simple carbohydrates, primarily in the form of dietary sugars is significantly associated with increased dental caries risk. Malnutrition (under or over nutrition) in children is often a consequence of inappropriate infant and childhood feeding practices and dietary behaviors associated with limited access to fresh, nutrient dense foods substituting instead, high-energy low cost and nutrient poor sugary and fatty foods. Lack of availability of quality food stores in rural and poor neighborhoods, food insecurity, and changing dietary beliefs resulting from acculturation including changes in traditional ethnic eating behaviors, can further deter healthful eating and increase risk for Early Childhood Caries and obesity.
America is witnessing substantial increases in children and ethnic minorities living in poverty, widening the gap in oral health disparities noted in the Surgeon General's Report, Oral Health in America. Dental and other care providers can educate and counsel pregnant women, parents and families to promote healthy eating behaviors and should advocate for governmental policies and programs that decrease parental financial and educational barriers to achieving healthy diets. For families living in poverty, however, greater efforts are needed to facilitate access to affordable healthy foods, particularly in urban and rural neighborhoods in order to effect positive changes in children's diets and advance the oral components of general health.
doi:10.1016/j.acap.2009.09.008
PMCID: PMC2862385  PMID: 19945075
Diet and pediatric caries
13.  Diet and lifestyle interventions in postpartum women in China: study design and rationale of a multicenter randomized controlled trial 
BMC Public Health  2010;10:103.
Background
"Doing the month", or "sitting month", is a traditional practice for postpartum women in China and other Asian countries, which includes some taboos against well-accepted healthy diet and lifestyles in general population. Previous studies have shown this practice may be associated with higher prevalence of postpartum problems. The current multicenter randomized controlled trial (RCT) aims to evaluate outcomes of diet and lifestyle interventions in Chinese postpartum women.
Methods/Design
The current multicenter RCT will be conducted in three representative areas in China, Shandong province, Hubei province and Guangdong province, which locate in northern, central and southern parts of China, respectively. Women who attend routine pregnancy diagnosis in hospitals or maternal healthcare centers will be invited to take part in this study. At least 800 women who meet our eligibility criteria will be recruited and randomly assigned to the intervention group (n > = 400) and the control group (n > = 400). A three-dimension comprehensive intervention strategy, which incorporates intervention measures simultaneously to individual postpartum woman, their family members and community environment, will be utilized to maximize the effectiveness of intervention. Regular visiting and follow-up will be done in both group; nutrition and health-related measurements will be assessed both before and after the intervention.
Discussion
To our knowledge, this current study is the first and largest multicenter RCT which focus on the effectiveness of diet and lifestyle intervention on reducing the incidence rate of postpartum diseases and improving health status in postpartum women. We hypothesize that the intervention will reduce the incidence rates of postpartum diseases and improve nutrition and health status due to a balanced diet and reasonable lifestyle in comparison with the control condition. If so, the results of our study will provide especially important evidence for changes in both the concept and action of traditional postpartum practice in China.
Trial Registration
ClinicalTrials.gov ID NCT01039051.
doi:10.1186/1471-2458-10-103
PMCID: PMC2837853  PMID: 20187965
14.  The Distribution of Infectious Related Symptoms in an Internet-based Syndromic Surveillance System in Rural China 
Objective
To describe the distribution of the infectious related symptoms in an internet-based syndromic surveillance system reported by doctors in village health stations, township and county hospitals in rural Jiangxi Province, China, and to identify the major infectious diseases for syndromic surveillance in different levels of health facility.
Introduction
Syndromic surveillance system, which collects non-specific syndromes in the early stages of disease development, has great advantages in promoting early detection of epidemics and reducing the burden of disease confirmation (1). It is especially effective for surveillance in resource-poor settings, where laboratory confirmation is not possible or practical (2). Integrating syndromic surveillance with traditional case report system may generate timely, effective and sensitive information for early warning and control of infectious diseases in rural China (3). A syndromic surveillance system (ISSC) has been implemented in rural Jiangxi Province of China since August 2011.
Methods
Doctors and health workers in the healthcare surveillance units of ISSC, including village health station, township hospital and county hospital, used an internet-based electronic system to collect information of daily outpatients, which included 10 categories of infectious disease related symptoms, i.e., cough, fever, sore throat, diarrhea, headache, rash, nausea/vomit, mucocutaneous hemorrhage, convulsion and disturbance of consciousness. The data from August 1st to December 31st 2011 were extracted from database and analyzed using SPSS 16.0. The combination of symptoms was also analyzed to identify patients with the syndrome of influenza-like illness (ILI) and fever-gastrointestinal syndrome (FGS). ILI were composed by fever (>=38 degree centigrade) plus cough or fever plus sore throat, and FGS were defined as fever plus vomit or diarrhea.
Results
Two county hospitals (CH), 4 township hospitals (TH) and 50 village health stations (VHS) were selected as surveillance unites in the pilot study during 2011/8/1 to 2011/12/31. In total, 152270 outpatient visits were reported, and 35395 patients had a chief complain of at least one surveillance symptom. Of these symptomatic patients, 24130 (68.2%) were from VHS, 4995 (14.1%) from TH and 6810 (19.2%) from CH. The proportion of patients with targeting symptom accounted for 15.5%, 66.4% and 23.9% of total outpatients in CH, TH and VHS respectively. The first 3 reported symptoms were cough (61.8%), fever (28.4%), and sore throat (23.4%), whereas mucocutaneous hemorrhage, convulsion and disturbance of consciousness were the least frequently reported symptoms in all surveillance units. Overall 3582 ILI and 1160 FGS cases were reported accounting for 35% and 11% of fever cases respectively. Of the reported ILI and FGS cases, 75% ILI and 55.9% FGS cases were reported by health workers in the VHS.
Conclusions
Cough, fever and sore throat were the top surveillance symptoms, and the respiratory infectious diseases had more chance to be reported in syndromic surveillance system in rural Jiangxi Province. Training on infectious disease diagnosis especially respiratory diseases for village health workers should be enhanced since large numbers of patients are likely to visit the village health stations.
PMCID: PMC3692925
Syndromic surveillance; rural; influenza-likes illness; fever-gastrointestinal syndrome
15.  Understanding preventive behaviors among mid-Western African-American men: a pilot qualitative study of prostate screening 
Journal of men's health  2011;8(2):140-151.
Background
African-American men bear a disproportionate burden for disease compared to other ethnic and racial groups. Due to gender differences in socialization and lifestyle practices, men are more likely to adopt attitudes and beliefs that undermine their health and well-being, including beliefs related to masculinity. The purpose of this study was to explore and understand the contextual factors in the attitudes and beliefs of African-American men's view of health in general, and as related to prostate cancer in particular.
Methods
Qualitative data from 15 African-American men were collected from two focus groups and analyzed for common themes using a qualitative descriptive design.
Results
Three themes emerged that focused on the beliefs and attitudes regarding general health and prostate cancer screening: (i) traditional beliefs about masculinity; (ii) psychosocial impact from family medical history; and (iii) sexual mores regarding digital rectal exams.
Conclusions
The socialization of African-American men and masculinity ideologies may be significant factors in the focus group member's decisions to seek preventive health behavior changes. Further research is needed to examine the determinants of African-American men's health seeking behavior, in particular on the influence of masculine beliefs.
doi:10.1016/j.jomh.2011.03.005
PMCID: PMC3129985  PMID: 21743817
Preventive health behaviors; Focus groups; African American; Men's health
16.  Outpatient prescription practices in rural township health centers in Sichuan Province, China 
Background
Sichuan Province is an agricultural and economically developing province in western China. To understand practices of prescribing medications for outpatients in rural township health centers is important for the development of the rural medical and health services in this province and western China.
Methods
This is an observational study based on data from the 4th National Health Services Survey of China. A total of 3,059 prescriptions from 30 township health centers in Sichuan Province were collected and analyzed. Seven indicators were employed in the analyses to characterize the prescription practices. They are disease distribution, average cost per encounter, number of medications per encounter, percentage of encounters with antibiotics, percentage of encounters with glucocorticoids, percentage of encounters with combined glucocorticoids and antibiotics, and percentage of encounters with injections.
Results
The average medication cost per encounter was 16.30 Yuan ($2.59). About 60% of the prescriptions contained Chinese patent medicine (CPM), and almost all prescriptions (98.07%) contained western medicine. 85.18% of the prescriptions contained antibiotics, of which, 24.98% contained two or more types of antibiotics; the percentage of prescriptions with glucocorticoids was 19.99%; the percentage of prescriptions with both glucocorticoids and antibiotics was 16.67%; 51.40% of the prescriptions included injections, of which, 39.90% included two or more injections.
Conclusions
The findings from this study demonstrated irrational medication uses of antibiotics, glucocorticoids and injections prescribed for outpatients in the rural township health centers in Sichuan Province. The reasons for irrational medication uses are not only solely due to the pursuit of maximizing benefits in the township health centers, but also more likely attributable to the lack of medical knowledge of rational medication uses among rural doctors and the lack of medical devices for disease diagnosis in those township health centers. The policy implication from this study is to enhance professional training in rational medication uses for rural doctors, improve hardware facilities for township health centers, promote health education to rural residents and establish a public reporting system to monitor prescription practices in rural township health centers, etc.
doi:10.1186/1472-6963-12-324
PMCID: PMC3554588  PMID: 22988946
17.  Relation of sexual risks and prevention practices with individuals’ stigmatising beliefs towards HIV infected individuals: an exploratory study 
Liu, H | Li, X | Stanton, B | Fang, X | Mao, R | Chen, X | Yang, H
Sexually transmitted infections  2005;81(6):511-516.
Objective
To investigate how an individual’s stigmatising beliefs towards people living with HIV are related to his or her own sexual risk and protective behaviours.
Methods
A cross sectional survey was conducted to assess HIV related stigmatising beliefs, risk sexual behaviours, and preventive practices among sexually experienced rural to urban migrants aged 18–30 years in 2002 in Beijing and Nanjing, two large Chinese cities.
Results
Among 2153 migrants, 7.2% reported having had more than one sexual partner in the previous month, 9.9% had commercial sex partners, and 12.5% had an episode of a sexually transmitted disease (STD). Only 18% reported frequently or always using condoms, with 20% sometimes or occasionally using them. 57% of the Chinese migrants were willing to take a voluntary HIV test, and 65% had HIV related stigmatising beliefs towards people living with HIV. Multiple logistic regression analysis depicts that individual’s stigmatising beliefs towards people with HIV were positively associated with having had an episode of an STD, having multiple sex partners, or having had commercial sex partners, and were negatively associated with condom use and the willingness to accept an HIV test.
Conclusion
The finding that one’s own stigmatising belief is a potential barrier to HIV related preventive practices highlights the difficulties and challenges in implementing behavioural interventions.
doi:10.1136/sti.2005.014977
PMCID: PMC1745054  PMID: 16326857
18.  Urban women’s use of rural-based health care services: The case of Igbo women in Aba city, Nigeria 
This study addresses the quest for rural-based health care services among women in urban Nigeria relying on a large qualitative database obtained from 63 Igbo women living in Aba, Nigeria. Results indicate that urban Igbo women of different socioeconomic and demographic characteristics utilize the services of different rural-based health care providers—indigenous healers, traditional birth attendants (TBAs), faith/spiritual, western-trained doctors and nurses as well as chemist shopkeepers—for conditions ranging from infertility, through child birthing and abortions, to swollen body, epilepsy, bone setting, and stubborn skin diseases. Major attractions to rural-based therapists were the failure of urban-based health services to provide cure, perceived mystical nature of conditions, need to conceal information on therapeutic progress and/or the nature of specific disease conditions, belief in rural-based therapists’ ability to cure condition, and affordability of the services of rural-based health care providers. Findings underscore the critical implications of service characteristics, cultural beliefs, and the symbolic content of place(s) for care seekers’ patterns of resort. We suggest that need exists for policies and programs aimed at making health care services in urban Nigeria more responsive to care seekers’ socioeconomic and cultural sensitivities, integrating informal health care providers into Nigeria’s health care system, and strengthening public health education in Nigeria.
doi:10.1093/jurban/jti013
PMCID: PMC3456635  PMID: 15738330
Igbo; Nigeria; Rural-based health care services; Urban women
19.  Identifying priorities to improve maternal and child nutrition among the Khmu ethnic group, Laos: a formative study 
Maternal & child nutrition  2012;9(4):452-466.
Chronic malnutrition in children remains highly prevalent in Laos, particularly among ethnic minority groups. There is limited knowledge of specific nutrition practices among these groups. We explored nutritional status, cultural beliefs and practices of Laos’ Khmu ethnic group to inform interventions for undernutrition as part of a Primary Health Care (PHC) project. Mixed methods were used. For background, we disaggregated anthropometric and behavioural indicators from Laos’ Multiple Indicator Cluster Survey. We then conducted eight focus group discussions and 33 semi-structured interviews with Khmu villagers and health care workers, exploring beliefs and practices related to nutrition.The setting was two rural districts in Luang Prabang province, in one of which the PHC project had been established for 3 years. There was a higher prevalence of stunting in the Khmu than in other groups. Disaggregation showed nutrition behaviours were associated with ethnicity, including exclusive breastfeeding. Villagers described strong adherence to post-partum food restrictions for women, while little change was described in intake during pregnancy. Most children were breastfed, although early introduction of pre-lacteal foods was noted in the non-PHC district. There was widespread variation in introduction and diversity of complementary foods. Guidance came predominantly from the community, with some input from health care workers. Interventions to address undernutrition in Khmu communities should deliver clear, consistent messages on optimum nutrition behaviours. Emphasis should be placed on dietary diversity for pregnant and post-partum mothers, encouraging exclusive breastfeeding and timely, appropriate complementary feeding. The impact of wider governmental policies on food security needs to be further assessed.
doi:10.1111/j.1740-8709.2012.00406.x
PMCID: PMC3496764  PMID: 22515273
beliefs; child feeding; community based; education; Laos; Khmu; maternal nutrition
20.  Identifying priorities to improve maternal and child nutrition among the Khmu ethnic group, Laos: a formative study 
Maternal & Child Nutrition  2012;9(4):452-466.
Chronic malnutrition in children remains highly prevalent in Laos, particularly among ethnic minority groups. There is limited knowledge of specific nutrition practices among these groups. We explored nutritional status, cultural beliefs and practices of Laos' Khmu ethnic group to inform interventions for undernutrition as part of a Primary Health Care (PHC) project. Mixed methods were used. For background, we disaggregated anthropometric and behavioural indicators from Laos' Multiple Indicator Cluster Survey. We then conducted eight focus group discussions and 33 semi-structured interviews with Khmu villagers and health care workers, exploring beliefs and practices related to nutrition. The setting was two rural districts in Luang Prabang province, in one of which the PHC project had been established for 3 years. There was a higher prevalence of stunting in the Khmu than in other groups. Disaggregation showed nutrition behaviours were associated with ethnicity, including exclusive breastfeeding. Villagers described strong adherence to post-partum food restrictions for women, while little change was described in intake during pregnancy. Most children were breastfed, although early introduction of pre-lacteal foods was noted in the non-PHC district. There was widespread variation in introduction and diversity of complementary foods. Guidance came predominantly from the community, with some input from health care workers. Interventions to address undernutrition in Khmu communities should deliver clear, consistent messages on optimum nutrition behaviours. Emphasis should be placed on dietary diversity for pregnant and post-partum mothers, encouraging exclusive breastfeeding and timely, appropriate complementary feeding. The impact of wider governmental policies on food security needs to be further assessed.
doi:10.1111/j.1740-8709.2012.00406.x
PMCID: PMC3496764  PMID: 22515273
beliefs; child feeding; community based; education; Laos; Khmu; maternal nutrition
21.  POSTPARTUM DOULAS: MOTIVATIONS AND PERCEPTIONS OF PRACTICE 
Midwifery  2010;27(6):e214-e221.
Objective
To describe the perceptions of a United States cohort of experienced birth doulas who were among the first in the country to be trained to provide postpartum support.
Design
A qualitative, longitudinal study using ethnographic methods; participant observation and semi-structured interviews.
Setting
Midwestern, urban, US; postpartum homecare over three months
Participants
Four postpartum doulas; 13 families
Measurements
Participant observation during six postpartum home visits per family; thirteen semi-structured interviews with doulas at the completion of each family’s care; four summative interviews with doulas at the end of the study.
Findings
When describing their postpartum practice, four themes emerged: supporting women, taking the mother’s perspective, empowering women, and empowering families. When speaking of the motivations three themes emerged: being “called” to practice, interest in preventing negative experiences, and career development.
Key conclusions and implications for practice
In the US, new mothers see midwives and physicians sporadically after discharge from the hospital. Postpartum doulas fill this gap in continuity of care by providing support for families as they transition to life with their new infant. Understanding the beliefs, values, and practices of these important paraprofessionals will help midwives effectively integrate postpartum doula care into the care of women and infants.
doi:10.1016/j.midw.2010.09.006
PMCID: PMC3048903  PMID: 21055853
postpartum doula; qualitative analysis; United States; postpartum support; maternal health services
22.  An exploratory study of community factors relevant for participatory malaria control on Rusinga Island, western Kenya 
Malaria Journal  2007;6:48.
Background
Capacity strengthening of rural communities, and the various actors that support them, is needed to enable them to lead their own malaria control programmes. Here the existing capacity of a rural community in western Kenya was evaluated in preparation for a larger intervention.
Methods
Focus group discussions and semi-structured individual interviews were carried out in 1,451 households to determine (1) demographics of respondent and household; (2) socio-economic status of the household; (3) knowledge and beliefs about malaria (symptoms, prevention methods, mosquito life cycle); (4) typical practices used for malaria prevention; (5) the treatment-seeking behaviour and household expenditure for malaria treatment; and (6) the willingness to prepare and implement community-based vector control.
Results
Malaria was considered a major threat to life but relevant knowledge was a chimera of scientific knowledge and traditional beliefs, which combined with socio-economic circumstances, leads to ineffective malaria prevention. The actual malaria prevention behaviour practiced by community members differed significantly from methods known to the respondents. Beside bednet use, the major interventions implemented were bush clearing and various hygienic measures, even though these are ineffective for malaria prevention. Encouragingly, most respondents believed malaria could be controlled and were willing to contribute to a community-based malaria control program but felt they needed outside assistance.
Conclusion
Culturally sensitive but evidence-based education interventions, utilizing participatory tools, are urgently required which consider traditional beliefs and enable understanding of causal connections between mosquito ecology, parasite transmission and the diagnosis, treatment and prevention of disease. Community-based organizations and schools need to be equipped with knowledge through partnerships with national and international research and tertiary education institutions so that evidence-based research can be applied at the grassroots level.
doi:10.1186/1475-2875-6-48
PMCID: PMC1871595  PMID: 17456231
23.  Study on the Factors Associated with Postpartum Visits in Rural China 
PLoS ONE  2013;8(2):e55955.
Background
Postpartum visits (PPVs) have been advocated as a way to improve health outcomes for mothers and their infants, but the rate of PPVs is still low in rural China. This study aims to investigate the utilization of PPVs and to explore the factors associated with PPVs in rural China. Parity is the most concerned factor in this study.
Methods
A cross-sectional household survey was performed in two counties of Zhejiang province. Questions include socio-economic, health services and women's delivery data. Chi-square tests and multivariate logistic regression analyses were performed to identify factors associated with PPVs.
Results
223 women who had a delivery history in the recent five years were enrolled in analyses. 173 (78%) of them were primiparous. Among the primiparous women, 43 (25%) had not received any PPVs. The majority, 27 (55%) of the 49 multiparous women, had not received any PPVs. Multiparous women were less likely to receive PPVs than primiparous women. Among 223 puerperal women, 47 (21%) had been compensated for delivery fee expenses. Women who received compensation were found to be more likely to receive standard (at least 3) PPVs.
Conclusions
It was found that women with “second babies” were less likely to use PPVs. This could be an unintended consequence of the “one-child policy”, due to fear that contact with public health facilities could result in sanctions. This phenomenon should be taken seriously by government in order to improve the health of babies and their mothers. Financial compensation for delivery fee charges can improve the use of PPVs, thus free-of-charge delivery should be promoted.
doi:10.1371/journal.pone.0055955
PMCID: PMC3584099  PMID: 23460789
24.  Rural-urban differences of neonatal mortality in a poorly developed province of China 
BMC Public Health  2011;11:477.
Background
The influence of rural-urban disparities in children's health on neonatal death in disadvantaged areas of China is poorly understood. In this study of rural and urban populations in Gansu province, a disadvantaged province of China, we describe the characteristics and mortality of newborn infants and evaluated rural-urban differences of neonatal death.
Methods
We analyzed all neonatal deaths in the data from the Surveillance System of Child Death in Gansu Province, China from 2004 to 2009. We calculated all-cause neonatal mortality rates (NMR) and cause-specific death rates for infants born to rural or urban mothers during 2004-09. Rural-urban classifications were determined based on the residence registry system of China. Chi-square tests were used to compare differences of infant characteristics and cause-specific deaths by rural-urban maternal residence.
Results
Overall, NMR fell in both rural and urban populations during 2004-09. Average NMR for rural and urban populations was 17.8 and 7.5 per 1000 live births, respectively. For both rural and urban newborn infants, the four leading causes of death were birth asphyxia, preterm or low birth weight, congenital malformation, and pneumonia. Each cause-specific death rate was higher in rural infants than in urban infants. More rural than urban neonates died out of hospital or did not receive medical care before death.
Conclusions
Neonatal mortality declined dramatically both in urban and rural groups in Gansu province during 2004-09. However, profound disparities persisted between rural and urban populations. Strategies that address inequalities of accessibility and quality of health care are necessary to improve neonatal health in rural settings in China.
doi:10.1186/1471-2458-11-477
PMCID: PMC3144461  PMID: 21682907
25.  Traditions and Alcohol Use: A Mixed-Methods Analysis 
An integrative mixed-methods analysis examined traditional beliefs as associated with beliefs about self-care during pregnancy and with alcohol abstinence among young adult women from two rural U.S.–Mexico border communities. Quantitative (measured scale) variables and qualitative thematic variables generated from open-ended responses served as within-time predictors of these health-related outcomes. A weaker belief that life is better in big cities was associated with stronger self-care beliefs during pregnancy. Also, a weaker belief that small towns offer tranquil environments was associated with total abstinence from alcohol. Regarding the Hispanic Paradox, these results suggest that a critical appreciation of cultural traditions can be protective, as this avoids stereotypical or idyllic views of urban or rural lifeways, and promotes self-protective beliefs and behaviors.
doi:10.1037/1099-9809.13.4.269
PMCID: PMC3235530  PMID: 17967095
family traditions; rural lifestyle; mixed methods; Hispanic paradox; alcohol use

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