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The Institute for Global Health and Development

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Author: search.filters.author.Chai, Jing

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    Pathways of healthcare and antibiotics use following reported gastrointestinal illness: A cross-sectional study in rural Anhui, China
    (BMJ, 2019-08-20) Shen, Xing Rong; Xie, Maomao; Chai, Jing; Feng, Rui; Cheng, Jing; Liu, Rong; Kadetz, Paul; Wang, DeBin
    Objective To document the factors, and their pathways, that influence healthcare and antibiotics use following reported gastrointestinal illnesses in Anhui province, China. Study design This study uses cross-sectional design, descriptive statistical analysis, pathway mapping and multivariate logistic regression modelling. Setting Households in 12 villages in Anhui province, China. Participants A total of 3659 residents who: (1) held a registered rural residence and were actually living in the sampled villages when this study was conducted; (2) were aged 18 years and older and (3) were willing to participate and able to answer the survey questions. Outcome measures Planned and measured variables included the occurrence of gastrointestinal illness, professional care seeking and antibiotic use due to the illness and factors influencing these measures. Results Of the 3659 informants, 29.0% reported gastrointestinal illness episodes in the past year. Of these episodes, 50.2% led to professional care seeking and 65.4% of antibiotic use. Multivariate logistic modelling identifies that: (1) reported gastrointestinal illnesses were more frequent in north compared with middle (OR 0.569, 95% CI 0.472 to 0.686) and south (OR 0.588, 95% CI 0.492 to 0.702) Anhui, and were positively associated with age (B=0.123, p<0.05), knowledge concerning (B=0.248, p<0.05) and practice of (B=0.184, p<0.05) prevention; (2) seeking professional care and antibiotic use following the illness was linked to the severity of symptoms and geographical locations, rather than to specific pathogenic features. Conclusions Reported gastrointestinal illnesses are quite prevalent in the sample population and a large proportion of these have resulted in professional care and antibiotics use. The factors associated with the reported illnesses and pathways of healthcare and antibiotic use, as identified in this study, should inform future research and intervention efforts.
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    Pathways to optimising antibiotic use in rural China: Identifying key determinants in community and clinical settings, a mixed methods study protocol
    (BMJ, 2019-08-10) Zhao, Linhai; Kwiatkowska, Rachel Marie; Chai, Jing; Cabral, Christie; Chen, Meixuan; Bowker, Karen; Coope, Caroline; Shen, Jilu; Shen, XingRong; Cheng, Jing; Feng, Rui; Kadetz, Paul; MacGowan, Alasdair; Oliver, Isabel; Hickman, Matthew; Wang, Debin; Lambert, Helen
    Introduction This study aims to investigate patterns of antibiotic treatment-seeking, describe current levels of and drivers for antibiotic use for common infections (respiratory tract and urinary tract infections) and test the feasibility of determining the prevalence and epidemiology of antimicrobial resistance (AMR) in rural areas of Anhui province, in order to identify potential interventions to promote antibiotic stewardship and reduce the burden of AMR in China. Methods and analysis We will conduct direct observations, structured and semistructured interviews in retail pharmacies, village clinics and township health centres to investigate treatment-seeking and antibiotic use. Clinical isolates from 1550 sputum, throat swab and urine samples taken from consenting patients at village and township health centres will be analysed to identify bacterial pathogens and ascertain antibiotic susceptibilities. Healthcare records will be surveyed for a subsample of those recruited to the study to assess their completeness and accuracy. Ethics and dissemination The full research protocol has been reviewed and approved by the Biomedical Ethics Committee of Anhui Medical University (reference number: 20170271). Participation of patients and doctors is voluntary and written informed consent is sought from all participants. Findings from the study will be disseminated through academic routes including peerreviewed publications and conference presentations, via tailored research summaries for health professionals, health service managers and policymakers and through an end of project impact workshop with local and regional stakeholders to identify key messages and priorities for action.
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    Health service utilization following systematic upper respiratory tract infections and influencing factors among urban and rural residents in Anhui, China
    (Cambridge University Press, 2019-12-10) Xu, Shiyu; Dong, Xuemeng; Zhou, Rongyao; Shen, Xingrong; Feng, Rui; Cheng, Jing; Chai, Jing; Kadetz, Paul; Wang, Debin
    Aim: This study seeks to identify healthcare utilization patterns following symptomatic respiratory tract infections (RTIs) and the variables that may influence these patterns. Background: RTIs are responsible for the bulk of the primary healthcare burden worldwide. Yet, the use of health services for RTIs displays great discrepancies between populations. This research examines the influence of social demographics, economic factors, and accessibility on healthcare utilization following RTIs. Methods: Structured interviews were administered by trained physicians at the households of informants selected by cluster randomization. Descriptive and multivariate binary logistic regression analysis was performed to assess healthcare utilization and associated independent variables. Findings: A total of 60 678 informants completed the interviews. Of the 2.9% informants exhibiting upper RTIs, 69.5–73.9% sought clinical care. Healthcare utilization rates for common cold, influenza, nine acute upper RTIs, and overall RTIs demonstrate statistically significant associations with the variables of age, type of residence, employment, medical insurance, annual food expenditure, distance to medical facilities, and others. The odds ratios for healthcare utilization rates varied substantially, ranging from 0.026 to 9.364. More than 69% of informants with RTIs sought clinical interventions. These findings signify a marked issue with the large amount of healthcare for self-limited RTIs.