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Beijing, China

Hutin Y.,WHO China Country Office | Hennessey K.,WHO Western Pacific Regional Office | Cairns L.,WHO China Country Office | Zhang Y.,Qinghai Province CDC | And 8 more authors.

Background: Delivery of a timely (within 24. h) hepatitis B vaccine birth dose (TBD) is essential to prevent the long-term complications of hepatitis B virus (HBV) infection. China made substantial progress in hepatitis B immunization coverage, however, in 2004, TBD coverage was lower in Western, poorer provinces. Methods: We reviewed five demonstration projects for the promotion of TBD in rural counties in Qinghai, Gansu and Ningxia. Interventions consisted of (1) work to increase TBD coverage in hospitals, including training of health-care workers, (2) information, education and communication [IEC] with the population and (3) micro-plans to deliver TBD for home births. We evaluated outcome through measuring TBD coverage for home and hospital births. Results: These projects were implemented in the context of national efforts to promote institutional deliveries that lead to increases ranging from 10% to 17% to reach 43-97% proportion of institutional births at the end of the projects. Among institutional births, TBD coverage increased by 2% to 13% to reach post implementation coverage ranging from 98% to 100%. Among home births, TBD coverage increased by 7% to 56% to reach post implementation coverage ranging from 29% to 88%. Overall, TBD coverage increased by 4% to 36% to reach post implementation coverage ranging from 82% to 88%. Conclusions: Demonstration projects based on combined interventions increased TBD coverage. Increases in institutional births amplified the results obtained. Use of standardized indicators for such projects would facilitate evaluation and identify intervention components that are most effective. © 2013 Elsevier Ltd. Source

Huang Y.,Guizhou CDC | Li L.,China CDC | Sun X.,Guizhou CDC | Lu M.,China CDC | And 4 more authors.

Background: In China, in 2010, a high proportion of pregnant women were tested for hepatitis B surface antigen (HBsAg). However, the preventive actions taken following screening were unclear. We followed up infants who were born to HBsAg positive mothers to describe the management that took place after screening. Methods: We selected eight counties with a probability proportional to population size in the Qiandongnan prefecture, Guizhou province. In each county, we selected a hospital at random. In each hospital, we (a) reviewed records to estimate the proportion of pregnant women who had been screened for HBsAg in 2010 and (b) sampled 10 screened women at random to assess management after one year in 2011. We calculated proportions and confidence intervals (CI) using standard formulae. Results: Among the 7232 women who delivered in 2010 in the 8 hospitals, 98% (95% CI: 97%-99%) had been tested for HBsAg. Among 82 HBsAg women sampled for follow-up, 45 (55%; 95% CI: 44%-65%) knew they had been tested during pregnancy and 60 (73%; 95% CI: 63%-82%) knew they were HBsAg positive. The 82 infants had received three doses of hepatitis B vaccines and 79 (96%; 95% CI: 90%-99%) had received the first dose within 24. h. However, only 11 infants (13%; 95% CI: 9%-25%) had received HBIG in addition to hepatitis B vaccine and 16 (20%; 95% CI: 12%-29%) had been tested for HBsAg upon completion of the vaccine series as part of their routine management. Conclusions: HBsAg testing of pregnant women was common in Qiandongnan, Guizhou, but post-screening management was limited. There is a need to ensure continuity of care through engaging women in HBsAg testing and following up infants with comprehensive management, including immunoprophylaxis and serological testing. © 2013 Elsevier Ltd. Source

Chunxiang F.,U.S. Center for Disease Control and Prevention | Bike Z.,U.S. Center for Disease Control and Prevention | Lijie Z.,U.S. Center for Disease Control and Prevention | Hutin Y.,WHO China Country Office | And 5 more authors.
International Health

In 2009, an assessment of injection practices in Fumeng County (Liaoning Province) and Wulong County (Chongqing Municipality) (random sample of 29 hospitals, 40 village clinics and 400 villagers) was conducted and the results were compared with a prior 2001 assessment (same area, same WHO assessment tool). In 2009, all facilities in Fumeng and Wulong used new, disposable syringes compared with 34% in both counties in 2001. Moreover, 59% (95% CI 37-80%) and 74% (95% CI 55-94%) of providers in Fumeng and Wulong, respectively, collected used sharps safely compared with 33% (95% CI 20-45%) and 36% (95% CI 20-53%) in 2001. In Fumeng and Wulong, respectively, 5% (95% CI 0-15%) and 50% (95% CI 25-76%) of facilities discarded injection devices in the regular trash compared with 7% (95% CI 2-12%) and 64% (95% CI 47-80%) in 2001. Between 2001 and 2009, the annual average number of injections per person increased from 1.8 to 6.3 (95% CI 4.5-8.1) in Fumeng and was stable [3.4 and 3.1 (95% CI 1.9-4.3)] in Wulong. Overall, between 2001 and 2009, sterilisable injection devices disappeared and disposal practices improved. However, unsafe practices persisted, which should be improved. Use of injections to administer medications may be increasing and must be reduced. © 2012 Royal Society of Tropical Medicine and Hygiene. Source

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