Differences in reporting of maternal and child health indicators: A comparison between routine and survey data in Guizhou Province, China

Figures & data

Figure 1 The structure of maternal and child health reporting system in China.

Figure 2 Flow chart of sampling framework and study population in Guizhou province.

Table 1 Definitions of main selected indicators

Indicator	Definition
Live birth	As defined by the WHO, a live birth is any baby who upon delivery from its mother breathes or shows any other evidence of life, such as a heartbeat, pulsation of the umbilical cord, or definite movement of voluntary muscles, irrespective of duration of the pregnancy. In China, a live birth is defined as any newborn with a gestational age of ≥ 28 weeks or birth weight > 1000 g, who upon delivery from its mother has any of the four vital signs (heartbeat, breath, pulsation of the umbilical cord, and voluntary muscle contraction).^Citation8,Citation16
Maternal death	Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by pregnancy or its management, but not from accidental or incidental causes.^Citation8
MMR	Number of maternal deaths during a given time period per 100,000 live births during the same period.^Citation17
IMR	Number of infant deaths during a given time period per 1000 live births during the same period.^Citation3
U5MR	Number of child deaths under five years during a given time period per 1000 live births during the same period.^Citation3
Hospital delivery rate	Number of births attended by skilled health personnel in medical institutions at the township level and above in a given time period per 100 live births in the same period.^Citation8
Antenatal care rate	Number of women with a live birth who received antenatal care provided by skilled health personnel at least once during pregnancy in a given time period per 100 live births in the same period.^Citation8
Postnatal visit rate	Number of women with a live birth who received postnatal visit provided by skilled health personnel at least once during the first 28 completed days after delivery in a given time period per 100 live births in the same period.^Citation8

Abbreviations: WHO, World Health Organization; IMR, infant mortality rate; MMR, maternal mortality ratio; U5MR, under-five mortality rate.

Table 2 Basic characteristics of study areas in Guizhou for 2008 from routine dataset

	Area (km^2)	Total population	Children under five years	Live births	Maternal deaths		Infant deaths		Child deaths under five years
					n	Rate (MMR)	n	Rate (IMR)	n	Rate (U5MR)
Pingtang county	2815	313,287	16,204	2973	5	168.2	110	37.0	138	46.4
Ganzhai township (rural area)	–	9252	438	94	0	0	6	63.8	7	74.5
Honghuagang district	624	476,514	23,290	4846	2	41.3	55	11.4	71	14.7
Beijing street (urban area)	–	13,745	884	96	0	0	0	0	1	10.4

Abbreviations: IMR, infant mortality rate; MMR, maternal mortality ratio; U5MR, under-five mortality rate.

Table 3 Basic characteristics of study areas in Guizhou for 2008 from survey dataset

	Rural area		Urban area
Total population	9346		13,762
Children under five years	488		900
	n	%	n	%
Gender
Male	282	57.8	485	53.9
Female	206	42.2	415	46.1
Ethnicity*
Han	79	16.2	862	95.8
Minority	409	83.8	38	4.2
Migrant status**
No	484	99.2	561	62.3
Yes	4	0.8	339	37.7
Birth registration
Yes	470	96.3	869	96.6
No	18	3.7	31	3.4
Annual family income per capita* (CNY)
<2000	407	83.4	466	51.8
2000–3999	73	15.0	137	15.2
4000–8000	8	1.6	174	19.3
>8000	0	0.0	123	13.7
Pregnant women	77		136
Ethnicity*
Han	21	27.3	128	94.1
Minority	56	72.7	8	5.9
Age groups, years
20–24	35	45.5	47	34.6
25–29	17	22.0	53	38.9
30–34	16	20.8	21	15.5
35–39	4	5.2	6	4.4
≥40	0	0.0	5	3.7
Unknown	5	6.5	4	2.9
Marital status*
Married	69	89.6	134	98.5
Unmarried	8	10.4	2	1.5
Educational background*
Primary school and below	37	48.1	8	5.9
Junior high school	39	50.6	72	52.9
Senior high school	1	1.3	26	19.1
Junior college and above	0	0.0	30	22.1
Annual family income per capita* (CNY)
<2000	57	74.0	56	41.2
2000–3999	16	20.8	38	27.9
4000–8000	4	5.2	18	13.2
>8000	0	0.0	24	17.6
	n	Rate	n	Rate
Live births	68	–	106	–
Maternal deaths	1	1470.6	0	0
Infant deaths	8	117.7	1	9.4
Child deaths under five years	9	132.4	3	28.3

Notes:

* Significant difference between rural and urban area using Chi-square testing, P < 0.01;

** migrant status means a person coming from another province to live in the current province for less than a year, according to the definition of the routine reporting system.

Abbreviation: CNY, Chinese Yuan.

Table 4 Comparison of routine and survey data on selected indicators in selected areas for Guizhou in 2008

Indicators	Rural area			Urban area
	Routine data	Survey data	Difference between survey and routine data	Routine data	Survey data	Difference between survey and routine data
Demographics
Live births (n)	94	68	−26	96	106	10
Infants (n)	88	127	39	209	234	25
Children under 3 years (n)	264	300	36	505	530	25
Children under 5 years (n)	438	488	50	884	900	16
Maternal and child deaths
Maternal deaths (n)	0	1	1	0	0	0
Neonatal deaths (n)	3	5	2	0	1	1
Infant deaths (n)	6	8	2	0	1	1
Child deaths under 5 years (n)	7	9	2	1	3	2
Maternal and child health
Maternal and newborn health
Antenatal care (at least one visit) rate (%)	80.65	84.42	3.77	100.00	96.12	−3.88
Hospital delivery rate (%)	65.59	72.73	7.14	100.00	97.09	−2.91
Clean delivery rate (%)	100.00	91.04	−8.96	100.00	99.03	−0.97
Highrisk pregnancy management rate (%)	58.33	50.00	−8.33	100.00	100.00	0.00
Postnatal visit rate (%)	81.91	75.00	−6.91	90.80	53.27	−37.53
Child health and nutrition
Systematic management rate for children under 3 years (%)	37.55	9.60	−27.95	92.67	83.99	−8.68
Breastfeeding rate (<6 months, %)	100.00	93.75	−6.25	90.10	77.36	−12.74
Exclusive breastfeeding rate (<6 months, %)	97.53	84.38	−13.15	68.81	69.81	1.00

Table 5 Over-reporting and under-reporting of routine data compared with survey data between rural area and urban area of Guizhou in 2008

	Rural area (over/under reporting compared with survey data) %	Urban area (over/under reporting compared with survey data) %	Chi-square P value
Live births (n)	38.24	−9.43	0.001a
Infants (n)	−30.71	−10.68	0.000a
Children under 3 years (n)	−12.00	−4.72	0.000a
Children under 5 years (n)	−10.25	−1.78	0.000a
Maternal deaths (n)	−100.00	0	–
Neonatal deaths (n)	−40.00	−100.00	1.000
Infant deaths (n)	−25.00	−100.00	0.333
Child deaths under 5 years (n)	−22.22	−66.67	0.236
Antenatal care (at least one visit) rate (%)	−4.47	4.04	0.133
Hospital delivery rate (%)	−9.82	3.00	0.282
Clean delivery rate (%)	9.84	0.98	0.019a
High-risk pregnancy management rate (%)	16.66	0	0.000a
Postnatal visit rate (%)	9.21	70.45	0.000a
Systematic management rate for children under 3 years (%)	291.15	10.33	0.000a
Breastfeeding rate (<6 months) (%)	6.67	16.47	0.095
Exclusive breastfeeding rate (<6 months) (%)	15.58	−1.43	0.002a

Notes:

a P value < 0.05 means significant difference between rural and urban areas. Village health workers are responsible for maintaining monthly records of births and deaths in the village, the number of pregnant women and the number of children under five years. Charts with the data are displayed on the walls of the village clinic. This chart is from a village clinic in the Guizhou province.

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