中国部分地区7岁及以下农村留守儿童看护人营养知识、态度和行为及其影响因素调查

目的 了解中国7岁及以下农村留守儿童看护人营养知识、态度和行为(KAP)及影响因素,为开展营养知识健康教育提供科学依据.方法 采用询问调查方法,对随机选择的1691名留守儿童看护人进行问卷调查;采用logistic回归分析方法筛选营养KAP的影响因素.结果 单亲外出留守儿童看护人的营养知识知晓率、积极态度持有率和正确行为形成率均较低,分别为59.9%、59.5%和41.8%,而双亲外出留守儿童看护人更低,分别为47.8%、55.4%和38.0%;多因素logistic回归分析结果显示:留守儿童看护人营养KAP与看护人的年龄、文化程度、家庭人均收入、看护意愿及儿童年龄等因素有关.结论 农村留守儿童看护人营养KAP水平较低,应开展留守儿童看护人营养KAP健康教育.     

中国农村留守儿童营养状况及影响因素研究

目的 探讨中国农村7岁及以下留守儿童的营养状况及其影响因素.方法 采用多阶段分层整群随机抽样的方法,对随机选择的7585名7岁及以下留守儿童和7557名对照组儿童进行调查.调查方法包括问卷调查、体格测量和实验室检查.结果 单亲、双亲外出留守儿童和对照儿童生长迟缓率分别为14.9%、17.9%和16.3%;低体重率分别为7.2%、8.3%和7.6%;消瘦率分别为3.1%、3.4%和3.3%;贫血检出率分别为18.9%、20.6%和18.7%.双亲外出留守儿童生长迟缓率高于单亲外出留守儿童,贫血检出率留守儿童高于对照组儿童,差异均有统计学意义.多因素非条件logistic回归分析结果显示:儿童年龄、低出生体重、散居、独生子女、母亲文化程度、每周吃早餐次数、每周吃零食次数、看护人意愿、主要看护人类型等因素与留守儿童生长迟缓有关;儿童年龄、低出生体重、每周吃零食次数、看护人意愿、佝偻病等因素与留守儿童低体重有关.结论 农村留守儿童,尤其双亲外出留守儿童,营养状况不容乐观,应进行营养干预,以改善营养状况.     

农村≤5岁留守儿童身长与体重质量影响因素

目的分析农村地区≤5岁留守儿童生长发育影响因素,为促进留守儿童健康成长提供依据。方法2016年从全国第五次卫生服务调查家庭健康询问调查河北省数据库提取≤5岁农村儿童信息,分析留守儿童(270人)与非留守儿童(752人)身高、体重发育情况;以库中留守儿童中发育异常者为病例组,正常者为对照组,采用病例对照研究分析留守儿童身高、体重发育影响因素。结果河北省农村地区≤5岁留守儿童生长发育迟缓构成比为78.15%,高于非留守儿童的18.88%(X~2=374.90,P=0.000);营养不良构成比(53.33%)高于后者(9.07%)(x~2=262.01,P0.01)。多因素有序多分类logistic回归分析显示,母亲外出务工(OR=26.05,P=0.006)、体重异常(OR=3.85,P0.01)是留守儿童身长发育的危险因素;留守儿童家庭年人均纯收入较高可以促进儿童体重的增长(OR=0.46,P=0.004),儿童身长异常是体重正常增长的危险因素(OR=2.60,P0.01)。结论农村地区≤5岁留守儿童中,母亲外出务工尤其不利于其身长发育,家庭经济状况较好有利于其体重增长,婴幼儿身高与体重质量互相影响。     

农村贫困地区12～35月龄不同类型留守儿童养育行为分析

目的分析河北省平山县、河南省卢氏县、江西省于都县、贵州省三穗县和四川省通江县贫困农村地区12≤月龄≤35仅父亲外出打工和父母均外出打工的儿童看护人养育行为差异。方法在上述5个贫困县,采用分层抽样获得调查村,对村中所有12≤月龄≤35留守儿童养育行为采用自编问卷进行调查,并应用单因素和Logistic回归分析方法,分析不同留守家庭类型对看护人养育行为的影响。结果研究共纳入留守儿童680人,其中68.5%的调查儿童父母均外出务工,祖辈看护人占73.0%。在儿童12≤月龄24和24≤月龄≤35,在控制了看护人性别、民族、是否抑郁、地区及经济情况等因素后,仅父亲外出打工家庭的留守儿童接受"早期启蒙和回应性养护"养育行为分别是父母均外出打工家庭留守儿童的2.81倍(95%CI=1.67～4.73)和3.16倍(95%CI=1.81～5.49),仅父亲外出打工家庭的留守儿童接受至少2种积极养育行为的情况分别是父母均外出打工家庭留守儿童的2.59倍(95%CI=1.55～4.35)和2.77倍(95%CI=1.57～4.92)。在儿童24≤月龄≤35,仅父亲外出打工家庭的留守儿童看护人实施"儿童拥有图书"行为是父母均外出打工家庭儿童的1.89倍(95%CI=1.09～3.29)。结论不同的留守类型对儿童看护人养育行为存在影响,父母均外出打工的儿童的看护人养育行为劣于仅父亲外出打工儿童。     

河北农村≤5岁留守儿童两周患病率及影响因素

目的掌握河北省农村地区≤5岁留守儿童两周患病情况,分析其影响因素,为促进留守儿童健康成长提供依据。方法 2015年9月从全国第五次卫生服务调查家庭健康询问调查数据库提取河北省农村地区所有≤5岁儿童信息(1022人),描述留守与非留守儿童两周患病率特征,采用1:2条件logistic回归分析其影响因素。结果河北省农村地区≤5岁留守儿童270人(26.42%),两周患病率为15.19%(41/270),高于非留守儿童的10.51%(X~2=4.20,P=0.040)。母亲单独外出务工(OR=1.87,P=0.034)、双亲外出务工(OR=2.74;P=0.041)、祖父母抚养(OR=1.31,P=0.043)、亲戚抚养(OR=3.96,P=0.017)、非安全卫生饮用水(OR=9.09,P=0.008)易致≤5岁农村留守儿童两周患病。家庭人口4~6人(OR=0.37,P=0.042)、7~9人(OR=0.15,P=0.027)可降低该人群两周患病。结论父母长期外出务工、隔代或亲戚抚养与不安全的饮用水源易致农村地区≤5岁留守儿童两周患病,而家庭人口较多是其保护因素。     

看护人营养行为对农村留守儿童膳食摄入的影响的调查

目的了解看护人营养行为现况及其对农村留守儿童膳食摄入的影响,为农村留守儿童膳食营养干预提供科学依据。方法对随机选择的1261名2～7岁农村留守儿童及其看护人进行调查,调查方法包括问卷调查和食物摄入频率调查。结果看护人中几乎每天为儿童准备早餐者占56.4%;准备牛奶/豆浆者占14.5%;注意提供含钙丰富的食物者占1.5%;吃饭时提醒儿童不偏食、挑食者占9.9%;注意改变儿童食谱以加强营养者占2.7%。多因素Logistic回归分析结果显示:看护人的营养行为对农村留守儿童肉禽水产类、蛋类及其制品、乳类及其制品、水果类食物的摄入有一定的影响。结论看护人营养行为对农村留守儿童膳食摄入产生影响。     

父母外出务工对0～3岁留守儿童早期发展的影响

目的了解父母外出务工对0～3岁儿童早期发展的影响。方法利用2013年在山西省和贵州省农村贫困地区的调查资料,共收集2 648名0～3岁儿童及其看护人的信息,使用WHO的儿童生长发育标准和《年龄与发育进程问卷-第三版》评价儿童早期发展状况。结果只有父亲外出务工的儿童的生长迟缓和低体重发生风险为非留守儿童的0.60和0.68倍,父母双方均外出务工儿童的沟通、粗大动作、精细动作、解决问题能力和总可疑发育迟缓的风险是非留守儿童的1.95、1.57、1.67、1.61和1.39倍(P0.05)。父母均外出务工的儿童在过去3 d内进行读书、讲故事、唱歌、带出户外、一起玩、认东西等早期刺激活动的可能性约为非留守儿童的三分之一,拥有图书的比例为非留守儿童的0.63倍,而受到暴力管教和看护人抑郁的风险是非留守儿童的1.49和1.71倍。结论父母双方外出务工不利于0～3岁儿童早期心理行为发育,父亲一方外出务工对0～3岁儿童早期体格发育有正面影响。父母外出务工能通过改变看护人的养育行为和看护人的精神状态来影响0～3岁儿童早期发展。     

湖南农村双亲留守儿童生长发育影响因素分析

目的 探讨湖南省农村＜7岁双亲留守儿童生长发育状况及其影响因素.方法 按照分层整群随机抽样原则,对随机选择的湖南省4县市695名＜7岁农村留守儿童和592名对照儿童进行调查.结果 双亲留守儿童与对照儿童的生长迟缓率分别为18.7％、16.4％,低体重率为2.0％、2.2％,超重率为1.0％、0.5％,肥胖率为3.7％、2.9％,差异均无统计学意义(x2=1.184,P=0.276;x2=0.015,P=0.821;x2=1.038,P=0.358;x2=0.748,P=0.387);双亲留守儿童贫血检出率(33.4％)高于对照儿童(26.0％)(x2=8.265,P=0.004);多分类logistic回归分析结果显示,出生体重较重、不贫血、不挑食、家庭人口数较多、母亲文化程度较高,则身高别体重Z评分(WHZ)较高;母亲年龄较大及外出务工时间较长,则WHZ较低;父亲外出务工时间较长,年龄别身高Z评分(HAZ)较高;出生体重较重、散居、母亲文化程度较高,则年龄别体重Z评分(WAZ)较高;母亲年龄较大,WAZ评分低.结论 湖南省学龄前双亲留守儿童生长发育存在迟缓现象,母亲年龄较大、母亲外出务工而造成的母亲照顾缺失对儿童的生长发育有延缓作用.     

河北省农村5岁及以下儿童生长发育的影响因素

目的分析河北省农村≤5岁儿童生长发育影响因素,为促进农村儿童健康成长提供依据。方法采用多阶段分层整群抽样方法调查河北省农村地区≤5岁儿童身高及其相关信息,通过Z值法计算儿童年龄别身高得分(HAZ)评估其身高生长发育;以身高生长发育迟缓者为病例组,正常者为对照组,分析农村地区小龄儿童身高发育影响因素。结果河北省农村地区≤5岁儿童生长发育迟缓构成比为34.54%。多因素Logistic回归分析发现男孩(OR=4.00,P=0.000)、留守父亲/母亲照顾(OR=2.86,P=0.000)、祖父母及其他人员(OR=1.43,P=0.046)、父亲外出务工(OR=2.68,P=0.005)是留守儿童身高生长发育的危险因素;农村家庭年人均纯收入(OR=0.13,P=0.000)是儿童身高正常增长的保护因素。结论应针对农村地区≤5岁儿童生长发育迟缓影响因素,采取干预措施,促进该人群健康成长。     

中国7省市农村地区4～7岁留守儿童情绪与行为问题及其影响因素研究

目的 了解中国7省市农村地区留守儿童情绪与行为问题及其影响因素.方法 采用长处与困难问卷(SDQ,父母版),对随机选择的3944名农村4～7岁留守儿童看护人进行问卷凋查.结果 留守儿童情绪与行为问题检出率为43.6%;其中,情绪问题检出率8.3%,品行问题检出率9.5%,多动注意不能榆出率8.7%,同伴交往问题检出率18.9%,亲社会行为检出率16.8%.男性留守儿童困难总分、品行问题、多动注意不能和亲社会行为等异常检出率均高于女性,差异有统计学意义;低年龄组留守儿童SDQ困难总分和各因子异常检出率相对较高,其中,品行问题、多动注意不能和亲社会行为等异常榆出率,各年龄组之间差异有统计学意义(P<0.01).多因素分析结果表明,留守儿章得到照顾程度、看护人文化程度、看护意愿以及其父母是否按时寄抚养费等因素与其情绪和行为问题有关.结论 农村留守儿童情绪与行为问题发生率较高,留守儿童心理健康问题值得关注.     

Factors associated with the willingness of primary caregivers to avail of a dengue vaccine for their 9 to 14-year-olds in an urban community in the Philippines

To help address the need for preventive measures against dengue fever, a leading cause of child mortality in the Philippines, vaccine trials are ongoing and a tetravalent vaccine (Dengvaxia™, Sanofi Pasteur) has been developed. It is hypothesized that while acceptability would be high among primary caregivers (i.e., parents/guardians), the willingness to have one's child immunized against dengue would be associated with socio-demographic variables, attitudes and knowledge regarding dengue and vaccination, and past experience with dengue. This study aimed to assess the aforementioned factors’ association with primary caregivers’ willingness to avail of a dengue vaccine for their 9 to 14-year-old children in an urban community in the Philippines.A cross-sectional study utilizing interviews was conducted to determine which factors were associated with willingness-to-avail assuming a free vaccine, and a case study utilizing a focus group discussion was employed to capture some underlying reasons for their willingness. Data were analyzed using multiple logistic regression and thematic analysis.Among the 202 study participants, 193 (95.54%) were willing to avail of the vaccine. There was a high probability of vaccine acceptance by primary caregivers (95.54%), with good attitude towards vaccination (≥12/15 points) [aOR 10.62, 90% CI (1.73–26.28)] and large household size (>5) [aOR 9.63, 90% CI (2.04–45.58)] being positively associated with willingness-to-avail, and good knowledge regarding dengue fever [aOR 0.10, 90% CI (0.03–0.74)] and older age (>44 years) [aOR 0.14, 90% CI (0.03–0.61)] being negatively associated.Crude analysis showed that household size, knowledge regarding dengue, and attitude towards vaccination were significantly associated with willingness. Multivariate analysis revealed that these factors and the primary caregiver’s age were associated with willingness. Thematic analysis showed various perceptions regarding dengue and vaccination. Knowing these factors are associated with willingness-to-avail of the vaccine may help in understanding the audience of health promotion projects aimed at increasing immunization coverage.     

Parent Readiness to Change Differs for Overweight Child Dietary and Physical Activity Behaviors

Parent involvement is important to help overweight children lose weight. However, parent readiness to make changes around child eating and physical activity (PA) behaviors can differ across domains. Using a cross-sectional design, our aim was to examine which factors were associated with parents being in the Action/Maintenance stage of change in each domain. From November 2008 to August 2009, parents of overweight/obese children (n=202) attending a tertiary care obesity clinic in Providence, RI, answered questions assessing their stage of change, beliefs about child health and weight, and provider behaviors. Separate multivariate logistic regression models were created to determine which factors were associated with parent readiness to make changes for child dietary and PA behaviors. Almost 62% of parents were in the Action stage of change for child dietary behaviors, but only 41% were in the Action stage of change for PA behaviors. Parents who believed their own weight was a health problem were less likely to be ready to make changes to their child's dietary behaviors. Physician discussion of strategies was related to readiness to make changes for child dietary behaviors, but not PA behaviors. In the PA domain, parents of younger children were more likely to be ready to make changes. Training health care providers to address PA readiness and be aware of factors influencing dietary and PA readiness may result in more effective conversations with parents and improve behavior change efforts for pediatric weight loss.     

2016年山东省莘县留守儿童预防接种现状及影响因素分析

目的 了解山东省莘县留守儿童预防接种现状及影响因素,为控制当地留守儿童传染病的流行提供科学依据。 方法 2016年6-9月采用分阶段抽样的方法,在山东省莘县选取1 200名留守儿童,通过自行设计的问卷调查留守儿童预防接种情况,运用logistic回归分析影响留守儿童预防接种相关因素。 结果 留守儿童“五苗”接种率为91.41%,合格接种率为81.35%。卡介苗(Bacille Calmette-Guerin, BGG)接种率及合格接种率最高,分别为95.67%、90.16%;以麻疹疫苗(measles vaccine, MV)最低,分别为87.75%、76.08%。单因素分析结果显示,不同年龄组、看护人身份、家庭月收入、是否为独生子女、是否建有儿童预防接种卡,“五苗”合格接种率差异均有统计学意义(P<0.05)。logistic回归分析发现留守儿童留守儿童年龄为3~岁、4~岁、5~岁、看护人身份为外/祖父母、独生子女、建卡是影响接种是否合格的独立影响因素。年龄为3~岁(OR=1.609,95%CI:1.029~2.516)、4~岁(OR=1.846,95%CI:1.414~2.408)、5~岁(OR=2.305,95%CI:1.071~4.960),看护人身份为外/祖父母(OR=2.157,95%CI:1.071~4.344)接种不合格风险度更高,独生子女(OR=0.638,95%CI:0.411~0.991)、建卡(OR=0.601,95%CI:0.390~0.928)接种不合格风险度更低。 结论 山东省莘县留守儿童预防接种现状不容乐观。儿童MV的合格接种率最低,仍存在麻疹暴发的隐患。建议应加强当地基层预防保健能力建设和广大农村预防接种知识宣教,开展入学儿童的预防接种证查验,提高儿童的疫苗接种率和合格接种率。     

农民对合作医疗的支付意愿分析

筹资水平的可行性很大程度上受到农民主观支付意愿的影响。文章利用合作医疗调查数据对农民的支付意愿进行全面的描述,应用有序logistic回归模型深入分析影响农民意愿支付水平的因素及其影响程度。研究结果显示,农民的平均意愿筹资额为50元,对农村家庭意愿支付水平具有显著性影响的因素有劳动力文化程度、家庭收入和非生产性固定资产以及是否参加过合作医疗。据此,提出适当提高个人筹资标准、建立多层次的医疗保障体系等建议。     

An investigation of factors related to the use of respite care services for children with severe motor and intellectual disabilities (SMID) living at home in Japan

Limited time away from the child is cited as the main factor that increases the burden for the primary caregiver of severely disabled children. The aim of this study was to quantitatively elucidate the factors related to the desire to use social services and the actual use of respite care services by the primary caregivers of severely disabled children in Japan. In this study, we investigated the use of respite care services in accordance with the primary caregivers’ wishes by examining inhibiting or promoting factors associated with respite care service use only among those who wished to use social services. A total of 169 Japanese mothers participated and answered the questionnaires. We conducted a logistic regression analysis and a multiple regression analysis to investigate the factors related to respite care service use. The most important factors affecting a primary caregiver's desire to use social services were the belief that the child would enjoy using social services and the family's approval of the social service use. The most important factors affecting respite care service use were the family's approval of the use and a large care burden on the primary caregiver. Respite care services should be sought out before the care burden becomes too great to enable the primary caregiver to more easily contribute to the continuation of home care. A background of mother–child separation anxiety disrupted the use of respite care. However, believing that the child enjoys using social services may reduce primary caregivers’ psychological resistance to being separated from their child, which is supported by tradition. Thus, it is also important for respite care service providers to provide information about the children to their primary caregivers and families while they are using respite care services.     

全国五省市独生与非独生已婚育龄妇女二孩生育意愿的差异分析

目的探讨独生与非独生已婚育龄妇女二孩生育意愿现状及影响因素。方法基于中国五省市(北京市、福建省、陕西省、四川省、甘肃省)940例已婚育龄妇女作为研究对象,其中独生子女育龄妇女(独生组)229例、非独生育龄妇女(非独生组)711例。采用面对面问卷调查,调查两组育龄妇女的一般人口学特征、二孩生育意愿、理想子女数等特征性变量,通过构建单因素及多因素Logistic回归模型分析两组育龄妇女二孩生育意愿的影响因素。结果非独生育龄妇女二孩生育意愿显著高于独生组,差异有统计学意义(59.92%vs 48.91%,χ²=8.57,P=0.003),并且两组育龄妇女在理想子女数的分布也存在显著的统计学差异(χ²=27.92,P<0.001)。多因素Logistic回归分析显示,以20~29岁的育龄妇女为参照,年龄在35~39岁的独生组育龄妇女二孩生育意愿明显下降(OR_独生=0.162,95%CI:0.056~0.463),而对于年龄在40~45岁的育龄妇女而言,独生组的二孩生育意愿也显著低于非独生组(OR_独生=0.115,95%CI:0.025~0.540;OR_非独生=0.266,95%CI:0.146~0.484)。以农村地区为参照,非独生组中,居住地为城市的育龄妇女二孩生育意愿(OR_非独生=0.411,95%CI:0.238~0.711)低于居住地为郊区的育龄妇女二孩生育意愿(OR_非独生=0.498,95%CI:0.263~0.943),但相对于独生组而言,居住在城市的育龄妇女二孩生育意愿下降更为明显(OR_独生=0.130,95%CI:0.027~0.630)。以已婚未育妇女为参照,独生组已婚已育妇女的二孩生育意愿显著高于非独生组(OR_独生=6.179,95%CI:2.236~17.076;OR_非独生=1.820,95%CI:1.099~3.015)。以二孩家庭经济负担重为参照,基本能承受二孩抚养负担的独生育龄妇女生育意愿显著增高(OR_独生=2.962,95%CI:1.408~6.229),而对于非独生育龄妇女而言,基本能承受(OR_非独生=3.806,95%CI:2.629~5.511)和完全能承受二孩抚养负担(OR_非独生=4.263,95%CI:2.138~8.498)的二孩生育意愿也显著高于家庭负担重的妇女。此外,相比于农民,非独生组中职业为工人的育龄妇女的生育意愿更低(OR_非独生=0.389,95%CI:0.189~0.801),但在独生组未观察到该效应。除此之外,其余因素对独生/非独生育龄妇女的二孩生育意愿没有显著影响。结论非独生育龄妇女的二孩生育意愿显著高于独生育龄妇女,且年龄、居住地、婚育情况、家庭经济负担是影响独生/非独生育龄妇女生育意愿的独立危险因素。     

浙江省3~6岁儿童睡眠时间及影响因素分析

  目的  了解浙江省3~6岁儿童睡眠时间现状及影响因素, 为制定儿童睡眠干预措施提供依据。  方法  2019年3—4月采用分层整群抽样方法, 选取浙江省24所幼儿园的7 034名3~6岁儿童为调查对象, 通过对家长发放问卷, 调查儿童的睡眠时间, 采用Logistic回归模型分析睡眠不足的影响因素。  结果  浙江省3~6岁儿童睡眠不足率为56.1%, 男童为57.1%, 女童为55.1%; 睡眠不足率随年龄增加而增加, 3, 3.5, 4, 4.5, 5, 5.5, 6岁分别为46.7%, 49.8%, 50.2%, 55.2%, 64.0%, 65.8%, 68.1%, 差异有统计学意义(χ2=45.17, P<0.01); 每日户外活动时间＜1 h者睡眠不足报告率为59.9%、1~2 h为54.7%、＞2 h为45.6%, 差异有统计学意义(χ2=67.10, P<0.01)。多因素Logistic回归模型显示, 年龄4, 5, 5.5, 6岁, 看护人为其他, 每日户外活动时间＜1 h, 1~2 h, 母亲文化程度为初中及以下、高中/中专与儿童睡眠不足呈正相关。  结论  年龄增加、户外活动不足、屏幕时间过多、非父母看护、母亲文化程度低等是导致幼儿睡眠不足的主要因素。建议增加幼儿户外活动, 尤其关注非父母看护下幼儿的户外活动时间。     

Factors associated with US caregivers’ uptake of pediatric COVID-19 vaccine by race and ethnicity

ObjectivesTo assess differences in willingness to vaccinate children against COVID-19, and factors that may be associated with increased acceptance, among US caregivers of various racial and ethnic identities who presented with their child to the Emergency Department (ED) after emergency use authorization of vaccines for children ages 5–11.Study designA multicenter, cross-sectional survey of caregivers presenting to 11 pediatric EDs in the United States in November-December 2021. Caregivers were asked about their identified race and ethnicity and if they planned to vaccinate their child. We collected demographic data and inquired about caregiver concerns related to COVID-19. We compared responses by race/ethnicity. Multivariable logistic regression models served to determine factors that were independently associated with increased vaccine acceptance overall and among racial/ethnic groups.ResultsAmong 1916 caregivers responding, 54.67% planned to vaccinate their child against COVID-19. Large differences in acceptance were noted by race/ethnicity, with highest acceptance among Asian caregivers (61.1%) and those who did not specify a listed racial identity (61.1%); caregivers identifying as Black (44.7%) or Multi-racial (44.4%) had lower acceptance rates. Factors associated with intent to vaccinate differed by racial/ethnic group, and included caregiver COVID-19 vaccine receipt (all groups), caregiver concerns about COVID-19 (White caregivers), and having a trusted primary provider (Black caregivers).ConclusionsCaregiver intent to vaccinate children against COVID-19 varied by race/ethnicity, but race/ethnicity did not independently account for these differences. Caregiver COVID-19 vaccination status, concerns about COVID-19, and presence of a trusted primary provider are important in vaccination decisions.