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II. Children's Health
and Care
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The Chinese Government and various circles in Chinese society have paid great attention to the health and care of its children. Much painstaking work has been done in protecting children's lives and health. As a result of these efforts, remarkable success has been achieved. Birth and Death In 1995, China's birthrate was 17.12 per thousand and 20.63 million children were born, the natural growth rate being 10.55 per thousand. The mortality of children under five years old is an important indication of the situation of children in a country. According to a national maternity and child-care monitoring report in 1994, the infant mortality of China decreased to 37.79 per thousand from 200 per thousand in the early 1950s and the mortality rate for children under five years old to 46.74 per thousand. From 1950 to 1980, the annual decrease rate of China's infant mortality was above five percent, higher than the annual decrease rate (2.5 percent) of the average infant mortality of developing countries in the same period and also higher than that (4.6 percent) of developed countries. In the 1990s, the annual rate of decrease of infant mortality in China is 6.50 percent and that of children under five years old is 5.85 percent. So far, no other country in the world enjoying an annual per capita income approximate to China has reached such a high level. Medical Care In order to realize the global strategic target whereby everybody would enjoy health care by the year 2000, a maternity and child hygiene service system commensurate with its national conditions has been established in China and a three-level network of medical treatment, prevention and health care has been developed in its rural and urban areas, providing health care and planned immunity services for children. Using vaccines for children is an economical and effective way for preventing epidemic diseases and reducing children's deathrate. From the 1950s, China began to popularize the bovine vaccine and in the early 1960s, smallpox, an infectious disease seriously endangering children's health, was eliminated. After the 1960s, China began to inoculate BCG, pertussis, diphtheria, tetanus, measles and poliomyelitis vaccines. In the 1970s, activities for immunity from diseases were carried out during winters and springs; and in 1978 work on planned immunity for children was started on a nationwide scale. All this has led to a great drop in the incidence of the relevant infectious diseases and the mortality from such diseases. In the 1980s, readily responding to the proposal of the WHO to expand the country's immunity program, China unified children's immunity procedures, initiated the system of issuing inoculation certificates, established the Specialists Committee for Planned Immunity and strengthened technical guidance for planned immunity work. At the same time, China cooperated with the UNICEF in the cold chain development, carrying work in this respect further. In 1985, the Chinese Government announced officially that its target for immunizing children would be realized in two steps, i.e. the inoculation rate of children would be 85 percent by 1988, counted at the provincial level, and again 85 percent by 1990, counted at the county level. In 1989 and 1991, the UNICEF, the WHO and the Ministry of Public Health of China jointly carried out two evaluations of China's work of planned immunity. The results showed that China had fulfilled, on schedule, its target on children's immunity and the inoculation rate of various vaccines was over 90 percent, counted at the county level. In order to eliminate poliomyelitis, while strengthening regular work on immunity and the monitoring of poliomyelitis, China performed nationwide six rounds of reinforced inoculations on children under four years old, on December 5 and January 5 separately in each of the three years 1993-96, each round involving about 80 million children. In this way the timetable for eliminating poliomyelitis has been shortened. Since the implementation of China's immunization program, great achievements have been made and the incidence of infectious diseases has sharply declined. A national report on the country's epidemic situation reveals that the number of cases of measles, diphtheria, pertussis and poliomyelitis in 1994 dropped by 96.4, 99.4, 99.3 and 97.5 percent respectively compared with 1978; the death rate decreased by 97.4, 99.3, 96.5 and 97.7 percent respectively. In 1994, the number of incidences of the above-mentioned four epidemic diseases fell by about 3.517 million and the number of deaths by about 13,000 as compared with 1978. In 1995, only one strain of a wild virus was found in the stool of a child suffering from poliomyelitis who came from abroad to Yunnan for medical treatment. No other poliomyelitis wild viruses were found in Acute Flaccid Paralysis cases. China's immunization achievements have been highly praised by the international community. On October 16, 1989, a silver medal was awarded to the Chinese Health and Antiepidemic Department of the Ministry of Public Health by the then UNICEF executive director, James P.Grant, to commend China's achievements made in children's immunity work. On November 24, 1994 and August 8, 1995, Dr Hiroshi Nakajima, Director General of the WHO, and Dr S.T.Han, Director of Western Pacific Regional Office of the WHO, successively wrote letters to Li Peng, Premier of the State Council of the People's Republic of China, and Qiao Shi, Chairman of the Standing Committee of the National People's Congress, in which they spoke highly of these achievements and, on behalf of the WHO, expressed their great satisfaction with China's work in eliminating poliomyelitis. They held that China had played an important role in the world public health field. China considers reducing children's mortality caused by pneumonia and diarrhoea as an important and urgent task of its medical and health work for children. For this purpose the Chinese Ministry of Public Health has formulated the National Plan on Controlling Infection Children's Respiratory Tract (1992-95) and the Plan on Controlling Diarrhoea (1990-94) and implemented a series of measures, such as popularizing proper techniques, personnel training, health education and monitoring systems. These have all served to reduce infant mortality, especially rural infant mortality. Management projects on standard AIR cases had been expanded to 53 counties in 24 provinces, autonomous regions and municipalities and diarrhoea control projects had covered 17 provinces, autonomous regions and municipalities by 1994. And at the same time, 360,000 township and village doctors from 300 poor counties have been trained on managing standard AIR cases and controlling diarrhoea. Before 1949, tetanus was one of the main causes of death in China's newborn babies. Health centers for women and children were set up throughout China from the 1950s to the 1960s and new methods for child delivery as a major measure for controlling puerperal fever and tetanus neonatorum have been crowned with remarkable success. In 1993, the Ministry of Public Health of China put forward a new task to further reduce infant mortality caused by tetanus, so as to meet the 2000 international standard for eliminating tetanus. In 1995, the Ministry of Public Health promulgated the National Action Plan on Eliminating Tetanus Neonatorum. Basing on data gathered from investigation and monitoring, it designated areas highly susceptible to tetanus neonatorum attacks and, while continuing to popularize the new methods of child delivery and encourage hospital childbirths, strove to rapidly develop immunization work among women of childbearing age. Nutritional Status China has paid great attention to improving children's nutritional status and various medical and health measures have been adopted. In the early period after the founding of the People's Republic of China, the government handed out infant foodstuffs in some areas. From the 1960s to the 1970s, a scientific diet for children was popularized in China. The nutritional status of Chinese children has gradually improved since the supplementary food was developed in the 1980s and since breastfeeding was advocated and dietary scheme was optimized in the 1990s. Now it is rare to find cases of serious malnutrition caused by shortage of food or cases of serious vitamin-A deficiency. Since the 1980s, a chart has been used in some areas of China to monitor children's natural growth and a community nutrition monitoring program introduced. If something abnormal is detected by such monitorings, timely guidance and treatment are given. Experience has proved that this is a proper method to maintain the health of children. In response to the proposals of the WHO and UNICEF, various activities to promote breastfeeding and build "baby friendly hospitals" have been developed. China planned to bring the breastfeeding rate on the provincial level up to 80 percent by the year 2000 as a major target for the Outline of the Program for Chinese Children's Development in the 1990s and it also promised to build 1,000 "baby friendly hospitals" by 1995. To this end, the Ministry of Public Health issued the Notice on Strengthening the Work on Breastfeeding in May management of the sale of mother's milk substitutes, so as to impose restrictions on the sale of such substitutes. Under the leadership of governments at various levels, a "baby friendly program" with the establishment of baby friendly hospitals as the main part was carried out in a big way. By the end of 1995, 2,957 baby friendly hospitals had been constructed, ranking first in number in the world-a significant contribution to the world baby friendly program. These efforts have won for China the high opinion of the UNICEF and WHO. At the same time, in order to improve the level of medical treatment and health care and the nutritional status of children in rural areas, measures for promoting the building of township clinics, county antiepidemic stations and county health centers for women and children have been adopted by the state. Since 1991, 300 million yuan from central finance has been allocated and 8.65 billion yuan from local financial administrations, collective economy and peasants had been pooled for input that direction. By the end of 1994, the conditions at 36 percent of the township clinics, 29.8 percent of the county antiepidemic stations and 27.7 percent of the county health centers for women and children have been improved by various degrees. Investigations show that childer's nutritional status in China has improved considerably. Compared with 1990, the rate of malnutrition in children under five years old dropped by 23.82 percent in 1995, fulfilling, ahead of the time, the medium-term target envisaged in the Outline of the Program for Chinese Children's Development in the 1990s.
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