Supplementary appendix - The Lancet · Supplementary appendix ... or Shui or Nakhi or Naxi or Qiang or Tu or Monguor or Mulao or Xibo or Xibe or Sibe or Kyrgyz or Kirgiz or Jingpo

Supplementary appendixThis appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors.

Supplement to: Huang Y, Shallcross D, Pi L, Tian F, Pan J, Ronsmans C. Ethnicity and maternal and child health outcomes and service coverage in western China: a systematic review and meta-analysis. Lancet Glob Health 2017; published online Nov 16. http://dx.doi.org/10.1016/S2214-109X(17)30445-X.

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Supplementary Appendix A1. Search strategies and terms used for the systematic review on ethnicity and access to maternal and child health in Western China A1.1 English databases search Search strategies Search terms Embase search up to 7 November 2016 to include studies reporting data from 1990 onwards 1.Health utilisation ((exp health care utilization/ or exp health care system/ or exp health care delivery/ or exp child health care/ or exp maternal

care/ or exp rural health care/ or exp health care, postnatal/ or exp health care, primary/ or exp health care, rural/ or exp health center/ or exp home delivery/ or exp transcultural care/ or exp child health/ or exp minority health/ or exp womens health/ or exp reproductive health/ or exp health service/ or exp maternal mortality/ or exp childhood mortality/ or exp pregnancy/ or exp prenatal care/ or exp prenatal screening/ or exp named groups by pregnancy/ or exp infant mortality/ or exp parameters concerning the fetus, newborn/) and pregnancy/) or exp perinatal mortality/ or exp cesarean section/ or exp immunization/ or exp hepatitis B vaccine/ or exp measles vaccine/ or exp measles vaccination/ or exp BCG vaccine/ or exp BCG vaccination/ or exp diphtheria pertussis tetanus vaccine/ or maternal health*.mp. or child health*.mp. or neonat* health*.mp. or infant health*.mp. or MCH.mp. or MNH.mp. or MDG4.mp. or MDG5.mp. or millennium development goal*.mp. or maternal death*.mp. or maternal mortality.mp. or infant mortality.mp. or infant death*.mp. or neonat* mortality.mp. or neonat* death*.mp. or safe motherhood.mp. or perinatal mortality.mp. or perinatal death*.mp. or prenatal.mp. or pre-natal.mp. or antenatal.mp. or ante-natal.mp. or postnatal.mp. or post-natal.mp. or c-section*.mp. or caesarean section*.mp. or cesarean section*.mp. or facility deliver*.mp. or facility-based deliver*.mp. or hospital* deliver*.mp. or hospital-based deliver*.mp. or homebirth.mp. or home birth.mp. or home childbirth.mp. or home deliver*.mp. or skilled deliver*.mp. or institutional* deliver*.mp. or pregnancy complication*.mp. or vaccin*.mp. or immuniz*.mp. or immunis*.mp. or EPI.mp.

2.Ethnic minorities exp ethnic group/ or exp minority group/ or ethnic*.mp. or minorit*.mp. or nationalit*.mp. or Zhuang.mp. or Hui.mp. or Manchu.mp. or Uyghur.mp. or Uighur.mp. or Miao.mp. or Yi.mp. or Lolo.mp. or Tujia.mp. or Tibetan.mp. or Mongol*.mp.

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or Dong.mp. or Kam.mp. or Bouyei.mp. or Puyi.mp. or Buyi.mp. or Buyei.mp. or Yao.mp. or Mien.mp. or Bai.mp. or Baip.mp. or Korean.mp. or Chaoxian*.mp. or Chosen.mp. or Hani.mp. or Ho.mp. or Li.mp. or Hlai.mp. or Kazakh.mp. or Kazak.mp. or Dai.mp. or She.mp. or Lisu.mp. or Dongxiang.mp. or Gelao.mp. or Gelo.mp. or Lahu.mp. or Wa.mp. or Sui.mp. or Shui.mp. or Nakhi.mp. or Naxi.mp. or Qiang.mp. or Tu.mp. or Monguor.mp. or Mulao.mp. or Xibo.mp. or Xibe.mp. or Sibe.mp. or Kyrgyz.mp. or Kirgiz.mp. or Jingpo.mp. or Kachin.mp. or Daur.mp. or Salar.mp. or Blang.mp. or Bulang.mp. or Bulong.mp. or Maonan.mp. or Tajik.mp. or Pumi.mp. or Primi.mp. or Achang.mp. or Ngac'ang.mp. or Maingtha.mp. or Nu.mp. or Evenki.mp. or Ewenki.mp. or Gin.mp. or Jing.mp. or Jino.mp. or Jinuo.mp. or Palaung.mp. or De'ang.mp. or Deang.mp. or Bonan.mp. or Bao'an.mp. or Baoan.mp. or Russian.mp. or Yugur.mp. or Yugu.mp. or Uzbek.mp. or Monpa.mp. or Monba.mp. or Menba.mp. or Oroqen.mp. or Orochen.mp. or Orochon.mp. or Drung.mp. or Derung.mp. or Dulong.mp. or Nanai.mp. or Hezhen.mp. or Hezhe.mp. or Gaoshan.mp. or Lhoba.mp. or Luoba.mp. or Tatar*.mp.

3.Western China exp china/ or ((west* adj4 china) or (west* adj4 chinese) or (china adj4 region*) or (southwest* adj4 china) or (south-west* adj4 china) or (northwest* adj4 china) or (north-west* adj4 china) or (southwest* adj4 chinese) or (south-west* adj4 chinese) or (northwest* adj4 chinese) or (north-west* adj4 chinese) or Tibet or Qinghai or Xinjiang or Gansu or "Shaan’xi" or Shaanxi or Sichuan or Guizhou or Guangxi or Yunnan or Chongqing or Ningxia or Inner Mongolia or Lhasa or Xining or Urumqi or Lanzhou or "Xi’an" or Xian or Chengdu or Guiyang or Nanning or Kunming or Yinchuan or Hohhot or autonomous count* or autonomous prefecture* or autonomous region* or autonomous banner* or (border* adj4 china) or (border* adj4 chinese) or (rural adj4 china)).mp.

4. 1 and 2 and 3 1 and 2 and 3 Medline search up to 7 November 2016 to include studies reporting data from 1990 onwards 1.Health utilisation exp "delivery of health care"/ or exp "pregnancy complication"/ or exp "cesarean section"/ or exp "nursing, maternal child"/

or exp "midwifery"/ or exp "obstetric nursing"/ or exp "pediatric nursing"/ or exp "health centers, maternal child"/ or exp "home childbirth"/ or exp "health service, maternal"/ or exp "prenatal care"/ or exp "prenatal education"/ or exp "prenatal diagnosis"/ or exp "child health services"/ or exp "maternal health"/ or exp "infant death"/ or exp "infant mortality"/ or exp "perinatal mortality"/ or exp "perinatal death"/ or exp "care, perinatal"/ or exp "infant, newborn"/ or exp "infant, newborn, diseases"/ or exp "child care"/ or exp "infant health services"/ or exp "intensive care, neonatal"/ or exp "child mortality"/

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or exp "child health"/ or exp "vaccination"/ or exp "immunization"/ or exp "BCG Vaccine"/ or exp "measles vaccine"/ or exp "diphtheria-tetanus-pertussis vaccine"/ or exp "Hepatitis B Vaccines"/ or maternal health*.mp. or child health*.mp. or neonat* health*.mp. or infant health*.mp. or MCH.mp. or MNH.mp. or MDG4.mp. or MDG5.mp. or millennium development goal*.mp. or maternal death*.mp. or maternal mortality.mp. or infant mortality.mp. or infant death*.mp. or neonat* mortality.mp. or neonat* death*.mp. or safe motherhood.mp. or perinatal mortality.mp. or perinatal death*.mp. or prenatal.mp. or pre-natal.mp. or antenatal.mp. or ante-natal.mp. or postnatal.mp. or post-natal.mp. or c-section*.mp. or caesarean section*.mp. or cesarean section*.mp. or facility deliver*.mp. or facility-based deliver*.mp. or hospital* deliver*.mp. or hospital-based deliver*.mp. or homebirth.mp. or home birth.mp. or home childbirth.mp. or home deliver*.mp. or skilled deliver*.mp. or institutional* deliver*.mp. or pregnancy complication*.mp. or vaccin*.mp. or immuniz*.mp. or immunis*.mp. or EPI.mp.

2.Ethnic minorities exp "Ethnic Groups"/ or ethnic*.mp. or minorit*.mp. or nationalit*.mp. or Zhuang.mp. or Hui.mp. or Manchu.mp. or Uyghur.mp. or Uighur.mp. or Miao.mp. or Yi.mp. or Lolo.mp. or Tujia.mp. or Tibetan.mp. or Mongol*.mp. or Dong.mp. or Kam.mp. or Bouyei.mp. or Puyi.mp. or Buyi.mp. or Buyei.mp. or Yao.mp. or Mien.mp. or Bai.mp. or Baip.mp. or Korean.mp. or Chaoxian*.mp. or Chosen.mp. or Hani.mp. or Ho.mp. or Li.mp. or Hlai.mp. or Kazakh.mp. or Kazak.mp. or Dai.mp. or She.mp. or Lisu.mp. or Dongxiang.mp. or Gelao.mp. or Gelo.mp. or Lahu.mp. or Wa.mp. or Sui.mp. or Shui.mp. or Nakhi.mp. or Naxi.mp. or Qiang.mp. or Tu.mp. or Monguor.mp. or Mulao.mp. or Xibo.mp. or Xibe.mp. or Sibe.mp. or Kyrgyz.mp. or Kirgiz.mp. or Jingpo.mp. or Kachin.mp. or Daur.mp. or Salar.mp. or Blang.mp. or Bulang.mp. or Bulong.mp. or Maonan.mp. or Tajik.mp. or Pumi.mp. or Primi.mp. or Achang.mp. or Ngac'ang.mp. or Maingtha.mp. or Nu.mp. or Evenki.mp. or Ewenki.mp. or Gin.mp. or Jing.mp. or Jino.mp. or Jinuo.mp. or Palaung.mp. or De'ang.mp. or Deang.mp. or Bonan.mp. or Bao'an.mp. or Baoan.mp. or Russian.mp. or Yugur.mp. or Yugu.mp. or Uzbek.mp. or Monpa.mp. or Monba.mp. or Menba.mp. or Oroqen.mp. or Orochen.mp. or Orochon.mp. or Drung.mp. or Derung.mp. or Dulong.mp. or Nanai.mp. or Hezhen.mp. or Hezhe.mp. or Gaoshan.mp. or Lhoba.mp. or Luoba.mp. or Tatar*.mp.

3.Western China exp "China"/ or ((west* adj4 china) or (west* adj4 chinese) or (china adj4 region*) or (southwest* adj4 china) or (south-west* adj4 china) or (northwest* adj4 china) or (north-west* adj4 china) or (southwest* adj4 chinese) or (south-west* adj4 chinese) or (northwest* adj4 chinese) or (north-west* adj4 chinese) or Tibet or Qinghai or Xinjiang or Gansu or "Shaan’xi" or Shaanxi or Sichuan or Guizhou or Guangxi or Yunnan or Chongqing or Ningxia or Inner Mongolia or Lhasa

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or Xining or Urumqi or Lanzhou or "Xi’an" or Xian or Chengdu or Guiyang or Nanning or Kunming or Yinchuan or Hohhot or autonomous count* or autonomous prefecture* or autonomous region* or autonomous banner* or (border* adj4 china) or (border* adj4 chinese) or (rural adj4 china)).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier]

4. 1 and 2 and 3 1 and 2 and 3 Web of Science search up to 9 November 2016 to include studies reporting data from 1990 onwards 1.Health utilisation TOPIC: (maternal health* or child health* or neonat* health* or infant health* or MCH or MNH or MDG4 or MDG5 or

millennium development goal* or maternal death* or maternal mortality or infant mortality or infant death* or neonat* mortality or neonat* death* or safe motherhood or perinatal mortality or perinatal death* or prenatal or pre-natal or antenatal or ante-natal or postnatal or post-natal or c-section* or caesarean section* or cesarean section* or facility deliver* or facility-based deliver* or hospital* deliver* or hospital-based deliver* or home birth or home birth or home deliver* or skilled deliver* or institutional* deliver* or pregnancy complication* or vaccin* or immuniz* or immunis* or EPI) DocType=All document types; Language=All languages;

2.Ethnic minorities TOPIC: (ethnic* or Zhuang or Hui or Manchu or Uyghur or Uighur or Miao or Yi or Lolo or Tujia or Tibetan or Mongol* or Dong or Kam or Bouyei or Puyi or Buyi or Buyei or Yao or Mien or Bai or Baip or Korean or Chaoxian* or Chosen or Hani or Ho or Li or Hlai or Kazakh or Kazak or Dai or She or Lisu or Dongxiang or Gelao or Gelo or Lahu or Wa or Sui or Shui or Nakhi or Naxi or Qiang or Tu or Monguor or Mulao or Xibo or Xibe or Sibe or Kyrgyz or Kirgiz or Jingpo or Kachin or Daur or Salar or Blang or Bulang or Bulong or Maonan or Tajik or Pumi or Primi or Prmi or Achang or Ngac'ang or Maingtha or Nu or Evenki or Ewenki or Gin or Jing or Jino or Jinuo or Palaung or De'ang or Deang or Bonan or Bao'an or Baoan or Russian or Yugur or Yugu or Uzbek or Monpa or Monba or Menba or Oroqen or Orochen or Orochon or Drung or Derung or Dulong or Nanai or Hezhen or Hezhe or Gaoshan or Lhoba or Luoba or Tatar*) DocType=All document types; Language=All languages;

3.Western China TOPIC: (china or (west* near4 china) or (west* near4 chinese) or (china near4 region*) or (southwest* near4 china) or (south-west* near4 china) or (northwest* near4 china) or (north-west* near4 china) or (southwest* near4 chinese) or (south-west* near4 chinese) or (northwest* near4 chinese) or (north-west* near4 chinese) or Tibet or Qinghai or Xinjiang

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or Gansu or "Shaanxi" or Shaanxi or Sichuan or Guizhou or Guangxi or Yunnan or Chongqing or Ningxia or Inner Mongolia or Lhasa or Xining or Urumqi or Lanzhou or "Xian" or Xian or Chengdu or Guiyang or Nanning or Kunming or Yinchuan or Hohhot or autonomous count* or autonomous prefecture* or autonomous region* or autonomous banner* or (border* near4 china) or (border* near4 chinese) or (rural near4 china)) DocType=All document types; Language=All languages;

4. 1 and 2 and 3

1 AND 2 AND 3 DocType=All document types; Language=All languages;

A1.2 Chinese databases search Search strategies Search terms China National Knowledge Infrastructure (CNKI) search up to 1 September 2016 to include studies reporting data from 1990 onwards 1.Health utilisation SUBJECT=妇幼保健+孕期卫生服务利用+孕产期保健+孕产妇+围产期保健+围生保健+围产期死亡+围产儿死亡+

剖腹产+剖宫产+分娩方式+妊娠并发症+产科并发症+产科护理+住院分娩+孕期保健+孕前保健+产前保健+孕前

护理+产前护理+产前检查+建卡率+儿童健康+儿科护理+儿童保健+婴儿卫生服务+婴儿死亡+新生儿死亡+儿童

死亡+接种+疫苗+计划免疫+免疫规划+卡介苗+麻疹疫苗+百白破+乙肝+脊髓灰质炎+脊灰 Translation: SUBJECT=maternal health care+ maternal health care utilization+ pregnancy health care + pregnant women+ perinatal health care+ perinatal care+ perinatal mortality+ perinatal death+ caesarean section+ cesarean section+ delivery+ pregnancy complication+ obstetric complication+ obstetric care+ hospital delivery+ pregnancy care+ pre-pregnancy health care+ prenatal health care+ pre-pregnancy care+ prenatal care+ prenatal test+ health care card+ child health+ pediatric care+ child health care+ infant health care+ infant death+ neonatal death+ child death+ vaccination+ vaccine+ planned immunization+ immunization programme+ BCG+ measles vaccine+ DPT+ hepatitis B+ poliomyelitis+ polio

2.Ethnic minorities SUBJECT=民族+蒙古族+回族+苗族+傣+傈僳+藏族+壮族+纳西+布朗+阿昌+怒族+鄂温克+鄂伦春+门巴+白族+保安族+布依+达斡尔+德昂+东乡+侗+独龙族+俄罗斯族+哈尼+哈萨克+基诺+京族+景颇+柯尔克孜+拉祜+珞巴+

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满族+毛南+仫佬+普米+羌+撒拉+水族+塔吉克+塔塔尔+土家+佤+维吾尔+乌孜别克+锡伯+瑶族+裕固+彝+赫哲

族+黎族+畲族+朝鲜族+高山族

Translation: SUBJECT=Ethnicity+Mongol+Hui+Miao+Dai+Lisu+Tibetan+Zhuang+Naxi+Blang+Achang+Nu+Ewenki+Oroqen+ Monba+Bai+Bonan+Buyei+Daur+De’ang+Dongxiang+Dong+Derung+Russian+Hani+Kazak+Jino+Gin+Jingpo+ Kyrgyz+Lahu+Lhoba+Manchu+Maonang+Mulao+Pumi+Qiang+Salar+Sui+Tajik+Tatal+Tujia+Va+Uyghur+Uzbek+ Xibe+Yao+ Yugur+Yi+Hezhen+Li+She+Korean+Gaoshan

3.Western China SUBJECT=西部+西南+西北+西藏+青海+新疆+甘肃+陕西+四川+贵州+广西+云南+重庆+宁夏+内蒙古+自治州+自治县+自治区 Translation: SUBJECT=West+Southwest+Northwest+Tibet+Qinghai+Xinjiang+Gansu+Shaanxi+Sichuan+Guizhou+Guangxi+ Yunnan+Chongqing+Ningxia+Inner Mongolia+autonomous prefecture+autonomous county+autonomous region

4. 1 and 2 and 3 1 AND 2 AND 3 VIP search up to 1 September 2016 to include studies reporting data from 1990 onwards 1.Health utilisation KEYWORD=孕产妇 OR 儿童死亡 OR 新生儿死亡 OR 婴儿死亡 OR 住院分娩 OR 免疫规划 OR 计划免疫 OR

接种 OR 产前检查 OR 剖宫产 Translation: KEYWORD =pregnant women OR child death OR neonatal death OR infant death OR hospital delivery OR immunization programme OR planned immunization OR vaccination OR prenatal test OR caesarean section

2.Ethnic minorities KEYWORD =民族 Translation: KEYWORD =Ethnicity

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3.Western China KEYWORD =西部 OR U=西南 OR U=西北 OR U=西藏 OR U=青海 OR U=新疆 OR U=甘肃 OR U=陕西 OR U=四川 OR U=贵州 OR U=广西 OR U=云南 OR U=重庆 OR U=宁夏 OR U=内蒙古 Translation: KEYWORD =West OR U=Southwest OR U=Northwest OR U=Tibet OR U=Qinghai OR U=Xinjiang OR U=Gansu OR U=Sha’anxi OR U=Sichuan OR U=Guizhou OR U=Guangxi OR U=Yunnan OR U=Chongqing OR U=Ningxia OR U= Inner Mongolia

4. 1 and 2 and 3 1 AND 2 AND 3 Wanfang search up to 9 November 2016 to include studies reporting data from 1990 onwards 1.Health utilisation 主题：（妇幼保健+孕期卫生服务利用+孕产期保健+孕产妇/+围产期保健+围生保健+围产期死亡+围产儿死亡+

剖腹产+剖宫产+分娩方式+/妊娠并发症+产科并发症+产科护理+住院分娩+孕期保健+孕前保健+产前保健+孕前

护理+产前护理+产前检查+/建卡率+儿童健康+儿科护理+儿童保健+婴儿卫生服务+婴儿死亡+新生儿死亡+儿童

死亡+/接种+疫苗+计划免疫+免疫规划+卡介苗+麻疹疫苗+百白破+乙肝+脊灰+脊髓灰质炎） Translation: TOPIC: (maternal health care+ maternal health care utilization+ pregnancy health care + pregnant women/+ perinatal health care+ perinatal care+ perinatal mortality+ perinatal death+ caesarean section+ cesarean section+ delivery+/ pregnancy complication+ obstetric complication+ obstetric care+ hospital delivery+ pregnancy care+ pre-pregnancy health care+ prenatal health care+ pre-pregnancy care+ prenatal care+ prenatal test+/ health care card+ child health+ pediatric care+ child health care+ infant health care+ infant death+ neonatal death+ child death+/ vaccination+ vaccine+ planned immunization+ immunization programme+ BCG+ measles vaccine+ DPT+ hepatitis B+ poliomyelitis+ polio)

2.Ethnic minorities 主题：（民族+蒙古族+回族+苗族+傣+藏族+壮族+布朗+阿昌+布依+达斡尔+德昂+东乡+侗+独龙族+俄罗斯族+哈尼+哈萨克+基诺+京族+景颇+柯尔克孜+拉祜+珞巴+满族+毛南+仫佬+普米+羌+撒拉+水族+塔塔尔+土家+佤+维吾尔+锡伯+瑶族+彝+黎族+畲族+朝鲜族+高山族）

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Translation: TOPIC: (Ethnicity+Mongol+Hui+Miao+Dai+Tibetan+Zhuang+Blang+Achang+Buyei+Daur+De’ang+Dongxiang+ Dong+Derung+Russian+Hani+Kazak+Jino+Gin+Jingpo+Kyrgyz+Lahu+Lhoba+Manchu+Maonang+Mulao+Pumi+ Qiang+Salar+Sui+Tatal+Tujia+Va+Uyghur+Xibe+Yao+Yi+Li+She+Korean+Gaoshan)

3.Western China 主题：（西部+西南+西北+西藏+青海+新疆+甘肃+陕西+四川+贵州+广西+云南+重庆+宁夏+内蒙古+自治州+自治县+自治区） Translation: TOPIC: (West+Southwest+Northwest+Tibet+Qinghai+Xinjiang+Gansu+Sha’anxi+Sichuan+Guizhou+Guangxi+Yunnan +Chongqing+Ningxia+Inner Mongolia+autonomous prefecture+autonomous county+autonomous region)

4. 1 and 2 and 3 1 AND 2 AND 3

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A2 Effect estimates comparing MCH indicators between ethnic groups (Individual comparisons)

Reference Coverage or mortality

rate Crude OR (95% CI) Adjusted OR (95% CI)

Han Other ethnicity Han Other ethnicity Han Other ethnicity

MATERNAL HEALTH

Maternal mortality ratio (per 100,000)

Feng 2011 (C) 27 66.7 Hui: 186.2 Tibetan: 239.4

1.00 Hui: 2.80 (1.30-6.02) Tibetan: 3.60 (1.82-7.12)

Du et al 2015 (E) 33

1996-2002 114.0 Other: 131.1 1.00 Other: 1.15 (1.08-1.22)

2003-2009 70.2 Other: 84.4 1.00 Other: 1.20 (1.11-1.31)

>=1 antenatal visit (%)

Li 2004 (E) 19 1.00 Other: 1.05 (0.70-1.58)

Fang et al 2005 (C) 20 67.7 Other: 39.7 1.00 Other: 0.76 (0.65-0.88)

Cui et al 2009 (C) 23 95.4 Other: 96.2 1.00 Other: 1.47 (1.24-1.75)

Zhu et al 2009 (C) 24 Sui: 1.00 Miao: 0.36 (P=0.015) Dong: 0.15 (P<0.001) Buyei: 0.18 (P<0.001) Qilao: 0.41 (P=0.047)

Long et al 2010 (E) 26 1.00 Other: 0.63 (0.38-1.05)

Ren 2011 (E) 29 1.00 Hui: 0.46 (0.22-0.96)

Chen et al 2013 (C) 31 78.6 Other: 51.2 1.00 Other: 0.29 (0.17-0.47)

>=3 antenatal visits (%)

An et al 2004 (C) 16 59.5 Hui: 45.5 Uyghur: 58.1 Other: 34.9

1.00 Hui: 0.57 (0.49-0.67) Uyghur: 0.94 (0.82-1.08) Other: 0.37 (0.32-0.41)

1.00 Other (Hui/Uyghur/Other): 0.76 (0.65-0.88)

>=5 antenatal visit (%)

Lu et al 2000 (C) 15 25.4 Hui: 27.1 Uyghur: 22.0 Tibetan: 11.7

1.00 Hui: 1.09 (0.92-1.30) Uyghur: 0.83 (0.70-0.97) Tibetan: 0.39 (0.28-0.56)


Lei et al 2010 (C) 25 1.00 Other: 0.18 (0.12-0.26)

Long et al 2010 (E) 26 1.00 Other: 0.69 (0.50-0.96)

Liu et al 2011 (E) 28 1.00 Other: 0.92 (0.75-1.12)

Ren 2011 (E) 29 1.00 Hui: 0.32 (0.14-0.71)


First antenatal visit in first trimester (%)

Lu et al 2000 (C) 15 12.7 Hui: 8.5 Uyghur: 18.7 Tibetan: 1.8


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Long et al 2010 (E) 26 1.00 Other: 0.69 (0.49-0.97)

Ren 2011 (E) 29 1.00 Hui: 0.32 (0.18-0.54)


>=5 antenatal visits and first antenatal visit in first trimester (%)

Ren 2011 (E) 29 1.00 Hui: 0.11 (0.04-0.31)

Births in health facilities (%)

Lu et al 2000(C) 15 18.3 Hui: 11.5 Uyghur: 13.5 Tibetan: 14.6


An et al 2002 (C) 16 41.0 Hui: 30.8 Uyghur: 48.2 Other: 23.8

1.00 Hui: 0.64 (0.54-0.76) Uyghur: 1.34 (1.17-1.53) Other: 0.45 (0.39-0.51)

Yan et al 2003 (C) 17 92.6 Hui: 52.9 Uyghur: 55.7 Kazak: 91.5 Mongolian: 95.4 Other: 71.1

1.00 Hui: 0.09 (0.05-0.15) Uyghur: 0.10 (0.07-0.14) Kazak: 0.85 (0.52-1.41) Mongolian: 1.71 (0.40-7.37) Other: 0.20 (0.10-0.37)

Li et al 2008 (C) 21 45.2 Other: 35.2 1.00 Other: 0.66 (0.44-0.98)

Chang et al 2009 (C) 22 Kazak: 53.8 Hui: 20.6 Uyghur: 27.8 Kyrgyz: 27.0 Other:74.5

Kazak: 1.00 Hui: 4.66 (2.70-8.03) Uyghur: 3.08 (1.73-5.45) Kyrgyz: 3.56 (2.36-5.37) Other: 0.52 (0.26-1.03)

Zhu et al 2009 (C) 24 Sui: 1.00 Miao: 0.41 (P=0.035) Dong: 0.26 (P=0.008) Buyei: 0.45 (P=0.036) Qilao: 0.08 (P<0.001)

Long et al 2010 (E) 26 1.00 Other: 1.01 (0.65-1.56)

Liu et al 2011 (E) 28 1.00 Other: 0.61 (0.46-0.79)

Rong et al 2011 (C) 30 66.4 Other: 51.4 1.00 Other: 0.53 (0.35-0.82)

Du et al 2015 (E) 33

1996-2002 32.1 Other: 18.0 1.00 Other: 0.46 (0.46-0.47)

2003-2009 61.5 Other: 49.6 1.00 Other: 0.62 (0.61-0.62)

Caesarean section (%)

Jiang XX et al 2014 (C)

32 15.6 Yi: 6.0

Tibetan: 0.7 Other: 100.0

1.00 Yi: 0.35 (0.17-0.73) Tibetan: 0.04 (0.00-0.30) Other: 36.68 (1.78-754.87)*

1.00 Other (Yi/Tibetan/Other): 0.38 (0.15-0.97)

CHILD HEALTH

Neonatal mortality (per 1000)

Yang 2008 (C) 37 7.4 Yi: 11.2 Hani: 16.7 Dai: 5.1 Bai: 7.0

1.00 Yi: 1.51 (0.82-2.79) Hani: 2.27 (1.34-3.84) Dai: 0.69 (0.27-1.76) Bai: 0.94 (0.22-4.08)

11

Other: 0.0 Other: 0.98 (0.06-16.41)*

Infant mortality (per 1000)

Yang 2008 (C) 37 10.0 Yi: 30.5 Hani: 33.7 Dai: 6.9 Bai: 7.0 Other: 0.0

1.00 Yi: 3.10 (1.93-4.98) Hani: 3.43 (2.21-5.33) Dai: 0.68 (0.30-1.53) Bai: 0.69 (0.16-2.95) Other: 0.73 (0.04-12.07)*

Mortality of children under five years old (per 1000)

Long 1996 (C) 34 Zhuang/Han: 40 Miao/Yao/Dong: 104.94

Zhuang/Han: 1.00 Miao/Yao/Dong: 2.62 (1.35-5.12)

Yang 2008 (C) 37 14.0 Yi: 35.7 Hani: 41.1 Dai: 11.2 Bai: 10.5 Other:0.0

1.00 Yi: 2.61(1.73-3.94) Hani: 3.02 (2.07-4.41) Dai: 0.80 (0.42-1.52) Bai: 0.75 (0.23-2.45) Other: 0.52 (0.03-8.62)*

Gao et al 2009 (C) 38

2003 15.5 Yi: 25.0 Dai: 71.6 Hani: 55.4 Yao: 204.7

1.00 Yi: 1.63 (0.47-5.63) Dai: 4.89 (2.14-11.20) Hani: 3.72 (1.56-8.90) Yao: 16.33 (6.90-38.67)

2004 17.6 Yi: 12.3 Dai: 50.3 Hani: 34.3 Yao: 193.5

1.00 Yi: 2.50 (0.89-7.01) Dai: 2.95 (1.31-6.68) Hani: 1.98 (0.81-4.83) Yao: 13.38 (5.84-30.65)

2005 15.4 Yi: 41.2 Dai: 53.8 Hani: 24.5 Yao: 187.5

1.00 Yi: 2.74 (0.95-7.92) Dai: 3.62 (1.55-8.46) Hani: 1.60 (0.60-4.23) Yao: 14.70 (6.17-35.04)

2006 16.7 Yi: 5.4 Dai 34.3 Hani 15.8 Yao:144.9

1.00 Yi: 0.32 (0.04-2.56) Dai: 2.09 (0.89-4.89) Hani: 0.94 (0.34-2.62) Yao: 9.96 (4.28-23.17)

2007 11.6 Yi: 9.6 Dai: 27.6 Hani: 24.8 Yao: 104.6

1.00 Yi: 0.82 (0.16-4.11) Dai: 2.41 (0.93-6.26) Hani: 2.16 (0.80-5.79) Yao: 9.91 (3.80-25.80)

Hepatitis B Vaccine (Hep B)

Hep B coverage (not defined) (%)

Wei et al 2005 (C) 35 65.0 Miao: 25.8 Dong: 37.5 Other:30.8

1.00 Miao: 0.19 (0.13-0.27) Dong: 0.32 (0.23-0.46) Other: 0.24 (0.10-0.58)

Zhou et al 2009 (E) 40 82.8 Tibetan: 95.6 Zhuang: 76.2 Other: 95.8

1.00 Tibetan: 4.53 (3.15-6.52) Zhuang: 0.67 (0.54-0.83) Other: 4.79 (2.98-7.69)

Ding et al 2014 (C) 42

2009 100.0 Hui: 98.8 1.00 Hui: 0.15 (0.01-2.45)*

2012 100.0 Hui: 100.0 1.00 Hui: 1.85 (0.22-15.76)

Hep B full coverage (%)

12

Zhou et al 2007 (C) 36 89.1 Other: 68.4 1.00 Other: 0.26 (0.11-0.61)

Liang et al 2009 (E) 39

1992-2001 53.6 Hui: 50.6 Uyghur: 2.0 Tibetan: 6.4 Mongolian: 70.2 Zhuang: 19.0 Other: 25.0

1.00 Hui: 0.89 (0.75-1.04) Uyghur: 0.02 (0.01-0.03) Tibetan: 0.06 (0.05-0.08) Mongolian: 2.04 (1.62-2.58) Zhuang: 0.20 (0.15-0.28) Other: 0.29 (0.26-0.32)


2002–2005 92.9 Hui: 79.6 Uyghur: 55.7 Tibetan: 38.5 Mongolian: 97.1 Zhuang: 65.5 Other: 61.8


Hep B timely full coverage (%)

Jiang Z et al 2014 (C) 43 1.00 Other: 0.84 (0.66-1.06)

Qi et al 2015 (C) 44 97.1 Other: 90.4 1.00 Other: 0.28 (0.21-0.38)

Hep B timely first dose coverage (%)

Zhou et al 2007 (C) 36 32.1 Other: 3.5 1.00 Other: 0.08 (0.01-0.57)

Liang et al 2009 (E) 39

1992-2001 37.7 Hui: 45.5 Uyghur: 2.0 Tibetan: 3.9 Mongolian: 26.2 Zhuang: 11.3 Other: 13.2



2002–2005 78.0 Hui: 70.5 Uyghur: 15.1 Tibetan: 8.4 Mongolian: 75.3 Zhuang: 37.4 Other: 41.0


Zhou et al 2009 (E) 40 52.8 Tibetan: 24.5 Zhuang: 11.0 Other: 35.0




2009 66.7 Hui: 73.1 1.00 Hui: 1.33 (0.72-2.44)

2012 91.7 Hui: 92.7 1.00 Hui: 1.03 (0.30-3.53)

Diphtheria, Pertussis & Tetanus Vaccine (DPT)

DPT coverage (not defined) (%)


2009 96.0 Hui: 95.4 1.00 Hui: 0.78 (0.18-3.48)

2012 97.3 Hui: 98.6 1.00 Hui: 3.80 (0.74-19.47)

DPT timely full coverage (%)



Oral Polio Vaccine (OPV)

OPV coverage (not defined) (%)

13


2009 98.0 Hui: 96.0 1.00 Hui: 0.18 (0.02-1.32)

2012 91.9 Hui: 95.9 1.00 Hui: 1.92 (0.63-5.84)

OPV timely full coverage (%)



Bacillus Calmette–Guérin Vaccine (BCG)

BCG coverage (not defined) (%)


2009 98.0 Hui: 95.7 1.00 Hui: 0.12 (0.02-0.89)

2012 100.0 Hui: 99.5 1.00 Hui: 0.41 (0.05-3.08)

BCG timely full coverage (%)



Measles Vaccine (MV)

MV coverage (not defined) (%)


2009 86.0 Hui: 80.6 1.00 Hui: 0.40 (0.18-0.86)

2012 75.7 Hui: 81.4 1.00 Hui: 1.09 (0.51-2.30)

MV timely full coverage (%)



Expanded Programme on Immunisation (EPI, including DPT, OPV, BCG and MV)

EPI timely full coverage (%)

Zhou et al 2016 (E) 45 1.00 Tibetan: 0.75 (0.45-12.51) Zhuang: 1.83 (0.91-3.67) Buyei: 0.82 (0.42-1.61) Miao: 0.47 (0.27-0.84) Other: 1.85 (0.89-3.85)

Childhood Immunisation (CI)

CI coverage (not defined) (%)

Li 2004 (E) 19 1.00 Other: 1.46 (0.82-2.62)

Wang et al 2012 (C) 41 91.6 Other: 63.4 1.00 Other: 0.16 (0.09-0.30) 1.00 Other: 0.22 (0.11-0.44)

CI timely full coverage (%, including Hep B, DPT, OPV, BCG, MV, MPV-A, JEV, Hep A)

Qi et al 2015 (C) 44 89.9 Other: 73.5 1.00 0.31 (0.26-0.37) 1.00 0.54 (0.44-0.67) Note: *For calculating the crude ORs, the zero cells have been adjusted to 0.5. Abbreviation: C=Chinese Paper, E=English Paper, EPI=Expanded Programme on Immunisation by WHO, Hep B=Hepatitis B Vaccine, DPT=Diphtheria, Pertussis & Tetanus Vaccine, OPV=Oral Polio Vaccine, BCG=Bacillus Calmette–Guérin Vaccine, MV=Measles Vaccine, MPV-A=group A Meningococcal Vaccine, JEV=Japanese Encephalitis Vaccine, Hep A=Hepatitis A Vaccine.

14

A3 Summary measures of effects between ethnicity and each MCH outcome A3.1 Pooled crude OR for health outcome

Tibetan

15

A3.2 Pooled crude OR for antenatal care utilisation

Tibetan Uyghur Hui

Tibetan Uyghur Hui

16

A3.3 Pooled crude OR for facility delivery care utilisation

Tibetan

17

A3.4 Pooled crude OR for Hep B immunisation coverage

18

A3.5 Pooled crude OR for other immunisation coverage

19

A3.6 Pooled adjusted OR for antenatal care utilisation

20

A3.7 Pooled adjusted OR for facility delivery care utilisation

21

A3.8 Pooled adjusted OR for Hep B immunisation coverage

22

A3.9 Pooled adjusted OR for other immunisation coverage

Tibetan

23

A3.10 Pooled OR between Hui ethnicity and each MCH outcome

24

A3.11 Pooled OR between Tibetan ethnicity and each MCH outcome

Tibetan Tibetan

Tibetan

Tibetan

Tibetan Tibetan

Tibetan

Tibetan

25

A3.12 Pooled OR between Uyghur ethnicity and each MCH outcome

26

A4 Funnel plot and Begg’s test for publication bias assessment A4.1 Funnel plot and Begg’s test on health outcome

Begg's test p=0.1143

27

A4.2 Funnel plot and Begg’s test on antenatal care utilisation


0.1

.2.3

.4.5

s.e.

of o

dds

ratio

.5 1 1.5 2odds ratio

Funnel plot with pseudo 95% confidence limits

28

A4.3 Funnel plot and Begg’s test on facility delivery care utilisation


0.2

.4.6

.8

s.e. o

f odd

s rat

io

.5 1 1.5 2 2.5odds ratio


29

A4.4 Funnel plot and Begg’s test on Hep B immunisation coverage


0.5

1

s.e. o

f odd

s rat

io

1 2 3 4 5odds ratio


30

A4.5 Funnel plot and Begg’s test on other immunisation coverage


0.2

.4.6

.81

s.e. o

f odd

s rat

io

1 2 3 4odds ratio


31

1.00 1.50 1.11 1.88 2.16

Feng (2011) Feng (2011)

Du (2015) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Yang (2008) Gao (2009) Gao (2009) Gao (2009) Gao (2009)

Lower CI Limit Estimate Upper CI Limit Meta-analysis estimates, given named study is omitted

A5 Sensitivity analyses and meta-regressions A5.1 Sensitivity analysis and meta-regression on health outcome Meta-regression showed that publication year (p=0.274) and sample size (p=0.227) were not significantly associated with the pooled odds ratio.

32

0.49 0.61 0.52 0.71 0.73

Li (2004) Fang (2005)

Cui (2009) Long (2010) Ren (2011)

Chen (2013) An (2004) An (2004) An (2004) An (2004) Lu (2000) Lu (2000) Lu (2000)

Cui (2009) Long (2010)

Lei (2010) Ren (2011) Liu (2011)

Chen (2013) Lu (2000) Lu (2000) Lu (2000)

Cui (2009) Long (2010) Ren (2011)

Chen (2013) Ren (2011)


A5.2 Sensitivity analysis and meta-regression on antenatal care utilisation Meta-regression showed that publication year (p=0.100) was not significantly associated with the pooled odds ratio, but the study with bigger sample size more likely provided an OR close to 1 (p=0.039).

33

0.36 0.58 0.42 0.74 0.78

An (2002) An (2002) An (2002)

Yan (2003) Yan (2003) Yan (2003) Yan (2003) Yan (2003)

Li (2008) Long (2010)

Liu (2011) Rong (2011)

Du (2015) Lu (2000) Lu (2000) Lu (2000)


A5.3 Sensitivity analysis and meta-regression on facility delivery care utilization Meta-regression showed that publication year (p=0.908) and sample size (p=0.999) were not significantly associated with the pooled odds ratio.

34

0.22 0.29 0.24 0.34 0.38

Zhou (2007) Liang (2009) Liang (2009) Liang (2009) Liang (2009) Liang (2009) Zhou (2007) Zhou (2009) Zhou (2009) Zhou (2009) Liang (2009) Liang (2009) Liang (2009) Liang (2009) Liang (2009) Ding (2014)

Jiang Z (2014) Qi (2015)

Wei (2005) Wei (2005) Wei (2005)

Zhou (2009) Zhou (2009) Zhou (2009) Ding (2014)


A5.4 Sensitivity analysis and meta-regression on Hep B immunisation coverage Meta-regression showed that publication year (p=0.687) and sample size (p=0.487) were not significantly associated with the pooled odds ratio.

35

0.32 0.50 0.37 0.64 0.74

Jiang Z (2014)

Qi (2015)

Ding (2014)

Jiang Z (2014)

Qi (2015)

Ding (2014)

Jiang Z (2014)

Qi (2015)

Ding (2014)

Jiang Z (2014)

Qi (2015)

Ding (2014)


A5.5 Sensitivity analysis and meta-regression on other immunisation coverage Meta-regression showed that sample size (p=0.229) was not significantly associated with the pooled odds ratio. The calendar effect could not be estimated by meta-regression, because all studies were published in 2014 or 2015.

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Supplementary appendix - The Lancet · Supplementary appendix ... or Shui or Nakhi or Naxi or Qiang or Tu or Monguor or Mulao or Xibo or Xibe or Sibe or Kyrgyz or Kirgiz or Jingpo