From Sydney to Shaanxi: New Survey Method to Help Pregnant Women in China

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September 2010

An innovative survey method is part of a study that will help save the lives of pregnant women and their newborn babies in western China.

Nestled in the frontier of north-western China, the province of Shaanxi is at a turning point. It is at the beginning of expanding economic development and for Associate Professor Michael Dibley and his collaborators, they hope their research will end the deaths of newborn babies caused by iron deficiency.

Associate Professor Dibley, a nutritional epidemiologist at the University of Sydney, Professor Yan Hong, Dean of Xi’an Jiaotong School of Medicine and Dr Zeng Lingxia, a lecturer in health statistics at Xi’an Jiaotong University, devised a new screening method to identify whether an elevated neonatal mortality rate existed in the counties of Shaanxi. The University of Sydney’s Dr Mu Li also contributed to the design of the study.

While such a survey usually requires a very large sample size, they used a method that only required a smaller sample size of 1000 women who had a baby in the past three years. “This sample size allowed us to reach a decision on whether or not there was a high rate of neonatal mortality, as well as identifying counties with the poorest perinatal health care services,” Associate Professor Dibley said. The findings of the survey will ascertain suitable counties to undertake a large scale community trial of iron supplements, with the aim of reducing the deaths of newborn babies during pregnancy.

Iron deficiency is a common occurrence in western China. Without iron supplementation, about 65% of women become anaemic in the final stages of pregnancy. Severe anaemia increases the risk of death to the mother during delivery. The risk of premature rupture of membrane and babies that are born prematurely also increases. Associate Professor Dibley said that the province of Shaanxi is an area that is likely to have nutritional deficiencies because of the large number of poor, rural counties. “Even though there are adequate amounts of staple food like wheat, there is less dietary diversity and they can’t afford to buy much meat and vegetables. That’s what fuels this deficiency in micronutrients in these populations.”

Unique Study in Western China

The survey is part of an ongoing study on the effects of iron supplements in pregnancy. The study is unique because while many countries have existing programs to distribute micro-nutrient supplements, there was no program in western China. The survey will build on the findings from the first study in Shaanxi between 2000 and 2006. “We were able to show that there was a significant reduction on rates of neonatal deaths for women who had an adequate dose of iron,” Associate Professor Dibley said. Following the survey’s analysis, a new and larger study will identify whether the early application of the iron supplements or the total amount of iron is the critical factor.

Another use of the survey’s finding will be to describe the change in health services in Shaanxi. During the past two years, the government has implemented a form of health insurance, resulting in 80% of women delivering their newborn in the county hospitals. This is in marked contrast to the time of the first study, where 40% of women delivered their child at home because they could not afford going to a health facility.

Growing Partnership

The ongoing collaboration between Sydney University and Xi’an Jiaotong University has enabled a unique research partnership. As well as being one of the leading medical schools in the country, Xi’an Jiaotong University is also “a gateway to western China”. It is situated in an area of China that is undergoing rapid economic development but the counties beyond the city are still relatively poor. “It’s an interesting place where you’re at the interface between all of this transition and where new problems are emerging but old problems still exist,” Associate Professor Dibley said.

The relationship has enabled an opportunity to exchange skills and further Australia’s engagement with the growing science hub in Asia. “The amount of scientific output coming out of China is increasing rapidly. So I guess if you look in the next 10 to 15 years, you’ll begin to see a lot more science having its origins in China.”

Philip Chan

For more information contact Louise Freckelton
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