| Objectives: To understand the congenital heart defects(CHD)prevalence among nursery,primary,and middle school students in Zhaotong,and analyze the influencing factors,then provide reference for formulating CHD prevention strategies for children and adolescents.Methods: Multistage random cluster sampling was used,all nursery,primary and middle school students in 9 towns in Qiaojia,Yanjin,and Yongshan counties of Zhaotong were sampled for on-site CHD screening and online questionnaire survey,and some research subjects were investigated with qualitative interviews during September in 2021 to September in 2022.A combination of quantitative and qualitative methods was used to study the prevalence and influencing factors of CHD in school-age children.The n(%)was used to describe the prevalence and composition of CHD;chi-square test was used to analyze the distribution characteristics of CHD and compare the differences between different groups;multilevel and single level logistic regression models was all used to analyze the influencing factors of CHD,and the Zero-inflated Poisson regression model was used to explore the influencing factors of the number of combined CHD subtypes;single logistic regression model was used to analyze the influencing factors of screening diagnosis of CHD patients;qualitative interviews were conducted to understand the reasons of why previously diagnosed CHD patients were not treated.Results:1.Basic Information: A total of 25,450 valid questionnaires were analyzed.Baihetan Town,Qiaojia County had the largest number of research subjects(23.25%),and Huanghua Town,Yongshan County had the least number(3.23%)Among the 9town-sampling points.The mean age was 9.50±3.82 years old.Men accounted for51.77%.The residence place was mainly in rural areas(80.91%).The nationality was mainly Han(92.49%).There were the largest number of primary school students(44.57%)and the smallest number of high school students(7.76%).The family population was mainly 3 or 4 persons(55.34%).38.62% of research subjects had an household income of less than 10,000,and 22.28% of research subjects was more then20,000.2.The Distributions of CHD: A total of 266 CHD patients were diagnosed,with a prevalence of CHD was 10.45‰(95%CI: 9.20～11.70‰).A total of 150 existing CHD patients were found,with a prevalence of existing CHD was 5.89‰(95%CI: 4.95～6.83‰).There were no significant differences in the prevalence of CHD and existing CHD among students in different counties,genders,nationalities,family members,average annual temperature of birthplaces,and average annual rainfall of birthplaces(all P>0.05).The prevalence of CHD and existing CHD among students living in rural were higher than those living in urban(=10.626,5.881,all P<0.05).The higher household income,the lower prevalence of CHD and existing CHD(=26.316,21.768,all P<0.05).The prevalence of CHD and existing CHD rose with the average altitude of birthplace(=12.404,10.729,all P<0.05).The prevalence of existing CHD decreased with school stage(=10.719,P<0.05),but there was no difference in the prevalence of CHD(P>0.05).3.The Influencing Factors of CHD: Univariate analysis showed that the prevalence of CHD was higher among students who lived in rural,had a low household income,a high average altitude of their birthplace,a low mother’s educational level,a insufficient weight gain of their mothers during pregnancy,did not take folic acid during pregnancy and pregnancy,smoked by their fathers during pregnancy,drank alcohol by their fathers during pregnancy,smoked(or passive smoking)by their mothers during pregnancy,drank alcohol by their mothers during pregnancy,exposed to toxic substances during pregnancy,experienced negative emotions during pregnancy,had a family history of congenital defects,a family history of CHD,hypertension/diabetes by their mothers during pregnancy,respiratory/reproductive system infection by their mothers during pregnancy,cold by their mothers during pregnancy,medication by their mothers during pregnancy,placental hemorrhage by their mothers during pregnancy,premonitory preterm delivery by their mothers during pregnancy,premature rupture of membranes by their mothers during pregnancy,low birth weight,preterm delivery(all P<0.05).there was no aggregation of CHD prevalence among students at the township or county level.The single-level model results of multivariate analysis showed that the probability to have a CHD was higher among students who lived in rural areas(OR=1.528),a high average altitude of their birthplace(OR=1.445),smoked by their fathers during pregnancy(OR=1.638),drank alcohol by their fathers during pregnancy(OR=2.222),smoked(or passive smoking)by their mothers during pregnancy(OR=2.441),experienced negative emotions during pregnancy(OR=2.178),placental hemorrhage by their mothers during pregnancy(OR=2.144),premature rupture of membranes by their mothers during pregnancy(OR=1.915),preterm delivery(OR=3.271)(all P<0.05).4.The Composition and Influencing Factors of Multiple CHD Subtypes: The main subtypes of CHD were ASD,VSD,and PDA(77.82%),with a large proportion of cases with multiple CHD subtypes(12.79%).The probability to have multiple CHD subtypes was higher among students who lived in rural areas(OR=3.515),drank alcohol by their fathers during pregnancy(OR=2.784),smoked(or passive smoking)by their mothers during pregnancy(OR=2.829),a family history of congenital defects(OR=7.634),premonitory preterm delivery by their mothers during pregnancy(OR=3.109),preterm delivery(OR=2.308)(all P<0.05).The probability to have multiple CHD subtypes was lower among students who had a higher average annual rainfall of birthplaces(OR=0.332)(P<0.05).5.The Influencing Factors of Existing CHD: The main influencing factors for existing CHD among CHD patients were educational level of their mothers,the number of combined CHD subtypes;household income,and high-pressure learning.Univariate analysis showed that the probability to have a screening diagnosis was lower among CHD patients who had a higher educational level of their mothers(OR=0.397)and multiple CHD subtypes(OR=0.127)(all P<0.05).Qualitative analysis showed that the principal reasons of previously diagnosed CHD patients without treated were household income(25.93%)and high-pressure learning(22.22%).Conclusions:1.The prevalence of CHD and existing CHD among students in Zhaotong nursery,primary,and middle schools are higher than the national average.2.The Common risk factors of CHD and existing CHD were low educational level of their mothers and low household income.A high average altitude of their birthplace,smoked by their fathers during pregnancy,experienced negative emotions during pregnancy,placental hemorrhage by their mothers during pregnancy,and premature rupture of membranes by their mothers during pregnancy can increase the probability of CHD among students.The probability to have CHD or multiple CHD subtypes was higher among students who lived in rural areas,drank alcohol by their fathers during pregnancy,smoked(or passive smoking)by their mothers during pregnancy,and preterm delivery.A lower average annual rainfall of birthplaces,a family history of congenital defects,and premonitory preterm delivery by their mothers during pregnancy can increase the probability of multiple CHD subtypes among students.3.We suggest: First,strengthen the citywide screening of CHD;Second,increase the proportion of fund assistance to CHD patients in rural areas,high altitude areas,low family income,and low mother’s educational.Third,strengthen the CHD education for citizen.Inform CHD patients to receive treatment as soon as possible.Call on the public to prevent CHD actively.Develop a good lifestyle during preparation and pregnancy such as not smoking,not drinking alcohol,and stabilizing emotions.Pay attention to physical health during pregnancy such as not exercising vigorously and avoiding premature birth.If pregnant women experience placental hemorrhage or premature rupture of membranes,they should be hospitalized as soon as possible.Fourth,Incorporate CHD into basic public health services,and ensure comprehensive prenatal screening of the fetus and B-ultrasound examination of all children and adolescents. |
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