Chinese School -

II. Children's Health and Care

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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