Research On Nurturing Care And Comprehensive Early Childhood Development In Different Ethnic Areas Of Centraland Western China

ObjectiveTo investigate the nurturing care and early comprehensive development of children under the age of 5 in different ethnic regions in the central and western China,analyze the differences in the early comprehensive development of children in various ethnic regions in terms of physical development,common diseases,injuries,and early development,and explore the impact of nurturing care on the comprehensive development of early childhood,and proposes practical and feasible improvement measures for nurturing care,providing a reference for early comprehensive development intervention services in various regions in the central and western China,and also provides basic data for the future to continue to pay attention to the health and development of this vulnerable group.MethodUsing the questionnaire uniformly designed by the subject expert group,by the probability proportional to size sampling method,on-site face-to-face questionnaire surveys were conducted among caregivers of the youngest children under the age of 5 in 6 counties in Henan Province,Sichuan Liangshan Yi Autonomous Prefecture,and Tibet Autonomous Region,and the children’s hemoglobin,height and weight were measured.SPSS21.0 statistical software was used for data sorting and analysis.Statistical description of the rate and composition ratio of nurturing care,physical development,common diseases and injuries,analysis of influencing factors usingχ~2test and logistic regression;statistical description of early childhood development using mean and standard deviation,t test or analysis of variance and optimal scaling regression for influencing factor analysis.Results1.Basic situation of the survey subjects:A total of 1,348 pairs of children under 5 years old and their caregivers were surveyed.There were483 pairs in Henan,all of Han nationality;720 pairs in Sichuan,mainly Yi nationality(Yi accounted for 83.3%);145 pairs in Tibet,all Tibetans.2.Status of nurturing and care:Among the surveyed children,the left-behind children rate was 45.5%;the health knowledge literacy qualification rate of the caregivers was 34.0%;the hand-washing rate of the caregivers at least at 3 critical moments was 31.2%,and the rate of hand washing with soap for caregivers was 47.0%;the source of drinking water the protection rate was 52.8%;the exclusive breastfeeding rate in the first 6 months was 54.2%,the timely supplementary food supplement rate was 39.3%;the rate of 4 physical examinations and above within 1year old was 7.6%,and the vaccination rate establishment rate was 95.2%;the rate of violent discipline was 72.7%;the rate of participating in early education activities was 24.8%,and the rate of good parent-child interaction was 51.3%.The differences in different regions were statistically significant.3.The status of comprehensive early childhood development:(1)Physical development:The malnutrition rate was 17.8%(the highest in Tibet,33.1%),and the overweight and obesity rate was 8.0%(the highest in Henan,10.6%).(2)Common diseases:The child anemia rate was41.7%(the highest in Sichuan,49.9%);the two-week prevalence of diarrhea was 17.6%(the highest in Sichuan,25.4%);the two-week prevalence of acute respiratory infection syndrome was 35.5%(the highest in Henan,40.6%).(3)Accidental injury:The accidental injury rate for children was 2.1%.(4)Early development:The total score of early development was(2.95±2.38).The differences in physical development,common diseases and early development of children in different ethnic regions were statistically significant.4.Analysis of the influencing factors of comprehensive development of early childhood:(1)Malnutrition:older months(vs 0～:12～:OR=2.006,95%CI=1.196～3.366;24～:OR=4.312,95%CI=2.513～7.400;36～:OR=3.295,95%CI=1.743～6.230;48～59:OR=4.771,95%CI=2.461～9.252),caregivers have low education level(vs high school and above:illiteracy:OR=3.473,95%CI=1.512～7.978;primary school:OR=2.701,95%CI=1.163～6.272),unboiled drinking water(OR=1.627,95%CI=1.039～2.549),caregivers only wash hands with clean water(OR=1.448,95%CI=1.002～2.093)and Tibet and Sichuan(vs Henan:Tibet:OR=5.437,95%CI=2.400～12.319;Sichuan:OR=3.518,95%CI=1.801～6.874)were risk factors for child malnutrition.(2)Common diseases:younger months(vs 48～59:6～:OR=7.575,95%CI=3.874～14.812;12～:OR=4.822,95%CI=2.609～8.912;24～:OR=2.164,95%CI=1.166～4.016),did not reach the minimum eating frequency(OR=1.494,95%CI=1.032～2.162),and did not have a vaccination card(OR=2.562,95%CI=1.017～6.453)were risk factors for anemia in children,Tibet(vs Sichuan:Tibet:OR=0.395,95%CI=0.200～0.780)was protective factors for children with anemia.Less than 24months(vs 48～59:0～:OR=5.751,95%CI=1.881～17.580;12～:OR=5.542,95%CI=1.890～16.247),left-behind children(OR=1.724,95%CI=1.172～2.538),Tibet and Sichuan(vs Henan:Tibet:OR=3.267,95%CI=1.374～7.770;Sichuan:OR=5.080,95%CI=2.208～11.689)were risk factors for children with diarrhea.The Henan and Sichuan(vs Tibet:Henan:OR=3.445,95%CI=1.681～7.061;Sichuan:OR=4.163,95%CI=2.112～8.207),first child in the family(vs third and above:OR=1.530,95%CI=1.021～2.294)were risk factors for childhood acute respiratory infection syndrome.(3)Violent discipline:older months(vs12～:24～:OR=2.615,95%CI=1.674～4.086;48～59:OR=2.602,95%CI=1.459～4.638),mother(OR=1.824,95%CI=1.266～2.628)and support for corporal punishment(OR=9.447,95%CI=6.165～14.475)were risk factors for violent discipline.(4)Early development:older months(β=0.429,P<0.001),good parent-child interaction(β=0.189,P<0.001),at least 3 books(β=0.116,P=0.001),correct guidance(β=0.070,P=0.002)and those who participated in early education activities(β=0.164,P<0.001),the higher the early development score;the underweight(β=-0.055,P=0.034),the more the number of children(β=-0.064,P=0.033)the lower the early childhood development score.ConclusionsThe nurturing care status of children under the age of 5 surveyed in the central and western China is poor,and there are great differences among regions of different ethnic groups.Violent discipline,lack of early education activities,lack of good parent-child interaction,insufficient number of physical examinations within 1 year old,etc.are prominent problems.The lack of health knowledge literacy of caregivers,poor hygienic hand-washing behavior,and children’s lack of scientific feeding cannot be ignored.In terms of the comprehensive early development of children,the 4dimensions of malnutrition,common diseases,injuries,and early development in Tibetan and Yi areas are all in a severe situation and urgently need to be improved.The influencing factors of the 4dimensions mainly include areas,children’s month age,caregiver role caregiver’s education level,left-behind children,drinking water boiling,caregiver’s hand washing method,minimum eating frequency,vaccination card establishment,support for corporal punishment,parent-child interaction,reading materials,underweight,number of children,correct guidance and early education activities.It is suggested that the Tibetan and Yi regions be the key areas for the next intervention project for the healthy development of children,and measures should be taken to improve drinking habits and hand hygiene of caregivers,strengthen scientific feeding and vaccination of children,change the traditional concept of violent discipline,promote good parent-child interaction,strengthen system early education,purchasing more books and more correct guidance to promote the comprehensive development of early childhood.