Elsevier

Public Health

Volume 129, Issue 9, September 2015, Pages 1304-1306
Public Health

Short Communication
Newborn screening and the relaxation of one-child policy in mainland China

https://doi.org/10.1016/j.puhe.2015.07.027Get rights and content

Highlights

  • In light of the relaxation of the one-child policy, the Chinese government would need to be ready to cover screening costs for potentially 400 million newborns in the next 30 years.

  • Our recommendation for the government is to create one entity that is responsible for establishing, evaluating, and implementing newborn screening programs throughout the different regions in China

  • A unified, systematic, and supervisory review of the quality control and quality assurance in newborn screening programs in different regions will be necessary to maintain analytical and clinical validity.

Introduction

Neonatal screening identifies a number of life-threatening disorders in newborns within a few days of life, which can then prompt immediate effective treatment to yield optimal survival and health. In 1981, China began regional neonatal screenings to test for phenylketonuria (PKU) and congenital hypothyroidism (CH).1 The Chinese Ministry of Health implements the neonatal screening recommendations at the provinces level. On June 1, 2009, the China Neonatal screening management supported three neonatal screening tests for PKU, CH and hearing for all newborns,1 and since then have offered to add additional diseases beyond the recommended panel of three diseases (PK, CH and hearing).1

Neonatal screening is an important prevention measure in identifying metabolic disorders, such as PKU and CH, which can lead to mental retardation and developmental delay if the disorder is left unidentified and untreated. The Singapore health care system offers neonatal screening for six metabolic diseases. In Europe and America, most screening programs detect between 5 and 30 metabolic and genetic disorders.1 In 2006 and 2007, a national questionnaire was conducted to collect information on the number and type of diseases that are covered in the different regions in China. From the 185 screening centers in China participating in the study, the researchers concluded that screening coverage increased from 39.1% in 2006 to 46.7% in 2007 in China.1 The low screening coverage in China may be due to the large number of births; in 2011, China had the second largest number of births (16,364,000 births) in the world, which was about 4 times more the annual births in the U.S (4,322,000 births).2 With a screening coverage of about 47%, China identifies about 7.6 millions babies born in China annually, which is about 1.8 times more than the U.S. China's one-child policy has prevented 400 million births in China in the past three decades.3 The new celebration of lives' will bring a number of new challenges to China's neonatal screening programs, such as capacity, costs and health services to support the new population.

Here we discuss the reasons for the past low neonatal screening coverage rate in China, and explore the potential challenges of China's neonatal screening programs. Our goal is to identify barriers to expanding neonatal screenings. We will conclude with new neonatal screening recommendations to yield optimal screening outcomes for the China Ministry of Health. Our paper will help raise government's awareness of prompt preparations to meet the neonatal screening service needs of babies in the near future.

Section snippets

Geographic diversity

In China, less than half of newborns have gone through neonatal screenings. Research illustrated a large geographic diversity of neonatal screenings among different regions exists and the current disparity in screenings may result in further severe implications in the future under the relaxed one-child policy. Between the year 2006–2007, neonatal screening programs slightly increased in screening coverage: in the East Region of China, screening increased from 76.5% to 80.3%; in the Middle

Out-of-pocket costs

Neonatal screening costs are currently not covered by insurance, although certain subsidies are offered by the government and screening fees vary between provinces and within cities.5 For example, at Shanghai Children's Hospital and Hubei Children and Women's hospital, testing for the Thyroid Stimulating Hormone level (TSH, a test for CH) is 20 rmb ($3.24) and testing for the Phenylalanine level (PHE, a test for PKU) is 30rmb ($4.86). On the other hand, if both tests were offered, the total

Province-level centralized screening system

In China, the screening tests are performed at designated neonatal screening centers and are located dispersedly in the province, where there are two to four centres. Parents in China need to be proactive in obtaining screening results by making/receiving phone calls or by receiving text messages. In large provinces, such as Beijing, Guangzhou, and Yunnan, many screening centers utilize a centralized web portal, where parents are able to log on and check the screening results by themselves.

Impact of relaxation of one-child policy

Capacity building, human capital, and technology investment will need to be further outlined. A number of challenging questions remains unclear on how to optimize management of screening and health services for all affected newborns. First, the health care system needs to assess the current capacities of hospitals and screening centres and to strategize resource allocation to meet the demanding needs for neonatal screening programs and to deliver prompt follow-up services. A recent study

Ethical approval

None sought.

Funding

None declared.

Competing interests

None declared.

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References (9)

  • X. Gu et al.

    Newborn screening in China: phenylketonuria, congenital hypothyroidism and expanded screening

    Ann Acad Med Singap

    (2008 Dec)
  • 2011 UN data: annual number of births:...
  • Time is running out for China’s one-child policy:...
  • L. Mei et al.

    Current situation and prospects of newborn screening and treatment for Phenylketonuria in China — compared with the current situation in the United States, UK and Japan

    Intractable Rare Dis Res

    (2013 Nov)
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