HFMD outbreaks expose weak link in China's health system
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Recent outbreaks of hand, foot, and mouth disease (HFMD) in China have highlighted poor health care in the country's vast rural areas -- the weak link in the health care system.
HFMD is not a highly contagious disease, but deaths resulting from it have surged this year in China.
Forty children died from the disease in March alone, double the total of the first three months last year, according to statistics from the Ministry of Health (MOH).
Altogether 192,344 cases had been reported this year as of April 12, up 38 percent from a year earlier, including 94 death cases.
HFMD typically strikes infants and children under the age of five in spring and autumn. Normally it runs its course in seven to ten days. In a few cases, however, infection can lead to high fever, meningitis, encephalitis, pulmonary edema and paralysis, which can be fatal.
It usually starts with a slight fever followed by blisters and ulcers in the mouth and rashes on the hands and feet. It is spread through contact with saliva or feces of the infected.
The disease started to cause alarm in 2008 when it killed 22 children in central China' s Anhui Province from March to May.
However, despite the government's increasing efforts to curb outbreaks, deaths from HFMD have continued to rise. In 2009, 353 children died from the disease, up from 2008's 126. Meanwhile, the number of HFMD cases in 2009 was 1.15 million, up from 480,000 year on year, according to MOH.
Statistics showed rural areas and urban fringe zones were the worst hit regions, which experts said was due to poor hygiene and medical care as well as weak health awareness in those regions.
POOR MEDICAL CONDITIONS IN RURAL AREAS
HFMD infections were reported in both cities and rural areas; however,
"Most of the more than 2,100 severe cases and deaths reported so far have happened in rural areas," said Feng Zijian, director of the emergency response department of the Center for Disease Prevention and Control of China.
Quanzhou County, a badly hit area in the southwestern Guangxi Autonomous Region, reported 14 child deaths from infectious diseases this year as of April 12, among which four were confirmed HFMD cases and the other ten were very likely killed by the disease. All of the 14 children were from villages.
"Most of the 1,200 rural doctors in Quanzhou County have only nursing training while some just received a short medical training course after finishing high school," said Wang Zhongyun, president of the Quanzhou Renmin Hospital.
The case of Xiao Min, an 18-month-old baby from the County, illustrates the problems with the health system. She had a fever on April 7 and was sent to the clinic in Bailu Village, Shitang Town, where she was treated like a common cold patient by a doctor who has been working there for nearly 20 years.
Two days later, she started to have difficulty breathing, and was diagnosed with HFMD after being rushed to the county hospital. She died two hours later.
The HFMD outbreaks exposed the incompetence of rural areas in dealing with medical emergencies and infectious disease, as when the sick children were rushed to county hospitals, the epidemic had already started to spread, and the best time for treatment had passed, according to Wang Qun, head of the outpatient department of the affiliated hospital to Guilin Medical University.
Wang called on the government to strengthen training for rural medical staff.
"Rural medical staff are the nerve endings of China's disease prevention and control system. We have to make the endings acute to nip infectious diseases in the bud," he said.
Besides medical staff, experts are also calling on government to install more medical equipment in village clinics and hospitals.
Only one breathing machine was available in the whole Quanzhou County when the disease broke out, which severely hampered doctors' efforts to save lives.
URBANIZATION ALSO BEHIND OUTBREAK
Experts said outbreaks of HFMD were also related to China's fast pace of urbanization as urban fringe zones, where a lot of migrants live, had been hard-hit by the disease.
China has seen a leap in urbanization in the past half century, with urban population increasing to 46 percent of the country's total from the 7 percent in 1949.
The fast urbanization has increased environmental degradation and pollution which poses a severe threat to people's health, especially in migrant suburbs with poor access to local health care.
Four of the HFMD deaths reported in Dongguan this year, Guangdong Province, were all from suburban migrant families, said Wangbo, vice director of the province's HFMD expert panel.
Dongguan has the largest floating population in the province as the pillar industry of the city, manufacturing business, has absorbed masses of migrants.
A survey showed that from January 2008 to the middle of 2009, HFMD cases from the three urban fringe zones accounted for 78 percent of the city's total for that period.
"Poor living conditions and hygiene, low economic status as well as substandard nutrition among kids are the reasons for the outbreak in urban fringe zones," said Wang Quanyi, an official with the Beijing Disease Control Center.
Migrant parents usually do not pay enough attention to their children as they are too busy earning money to support the family, so they are unlike to pickup early symptoms of some diseases, said Wang.
According to a survey among residents in urban fringe zone conducted by Shandong University of Traditional Chinese Medicine, 83.7 percent of those surveyed said they had never considered having health checks and only 9.2 percent of them had not received any treatment when sick.
PREVENTION: THE TOP PRIORITY
Prevention is the "top priority" as currently there is no vaccine or specific treatment for the HFMD virus, said Zhao Minggang, deputy director of the medical administration department under the MOH.
Vice Premier Li Keqiang in April also called for stronger prevention and control efforts as well as more research into vaccines and drugs, to fight the disease.
The MOH Thursday distributed a clinical guideline on HFMD treatment to doctors across the country to fully equip doctors, especially those in rural areas, with HFMD knowledge.
Training sessions had been organized for health care workers as well, according to Zhao.
Many provinces, including north China's Henan, have organized disease control experts to tour around the provinces providing needed expertise.
The health bureau in Quanzhou County has handed out 140,000 flyers introducing basic HFMD knowledge to parents.
Parents, particularly those in rural areas, are urged to practice good hygiene to help prevent the infection. Kindergartens and schools across Henan have been asked to step up health checks among children.
Shenzhen City also has been keeping an eye on communities with large floating populations, schools and factories.
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