Left-behind children (LBC)—a distinctive group in rural China who remain behind when their parents migrate for work—are at heightened risk of child maltreatment than their counterparts. However, there is a shortage of child maltreatment interventions in China, especially for rural LBC who are exposed to multiple risks. This study aims to assess the effectiveness of a home visiting intervention on child abuse and neglect outcomes of rural LBC across five provinces in China. This study utilized a quasi-experimental design. We conducted a pre-intervention survey in 2018 and recruited 855 left-behind children aged 0–3 years with their caregivers. In 2020, after the two-year intervention, 780 left-behind children aged 2–6 years and their caregivers participated in a post-intervention survey. Child abuse was measured with the corresponding module in the Child Discipline Module of Multiple Indicator Cluster Surveys. A difference-in-difference (DID) approach was employed to evaluate the effectiveness of the intervention. We found a significant effect of the home visiting intervention on an increase in caregivers’ non-violent discipline (11.7

Abstract Background The situation of mental health and discipline behaviors of left-behind children’s caregivers were not optimistic in rural China. Caregivers’ depression might increase the risk of using violent discipline. However, the specific ways in which depressive symptoms impact violent discipline have rarely been explored in rural areas. This study aims to assess the prevalence of violent discipline among left-behind children under 6 years of age in rural China and explore the potential mechanisms of how caregivers’ depressive symptoms affect violent discipline. Methods We enrolled a total of 396 pairs of left-behind children and their caregivers in our study, which was conducted in 5 counties of Hebei, Henan, Jiangxi, Guizhou, and Sichuan provinces in China. The depressive symptoms of caregivers were measured by using Zung Self-rating Depression Scale (ZSDS) and violent discipline was assessed by the Child Discipline Module of Multiple Indicator Cluster Surveys (MICS). A self-designed questionnaire was utilized to measure caregiver’s parenting attitude. Based on the cross-sectional data, controlling for potential confounders, structural equation modeling (SEM) was used to assess the direct and indirect effects of the mediation models by applying the weighted least squares with mean and variance adjusted (WLSMV) estimate. Results The prevalence of violent discipline, psychological aggression, and physical punishment was 72.7%, 59.3%, and 60.4% respectively of left-behind children under 6 years of age. According to the results of SEM, parenting attitude acted as a suppressor, suppressing the association between caregivers’ depressive symptoms and physical punishment/psychological aggression/violent discipline. The caregivers’ depressive symptoms positively influenced all the outcome variables by affecting parenting attitudes (p = 0.002, p = 0.013, p = 0.002). Conclusions The presence of depressive symptoms in caregivers increases the use of violent discipline through negative parenting attitudes. The mental health status of primary caregivers of left-behind children in rural China needed emphasis and improvement.

BACKGROUND:The early development of left-behind children requires great concern and improvement. Yet, current interventions for left-behind children are mainly focussed on children older than 3. This study aims to assess the effectiveness of a home visiting programme on family responsive care and early development of rural left-behind children and examine whether family responsive care mediates the effects of intervention on child development.METHODS:A quasi-experimental study design was utilized in this study. A stratified clustered sampling was employed to choose villages in programme towns into intervention group. A control village was matched with every intervention village. All of the left-behind children and their caregivers meeting the inclusion criteria in the chosen villages were enrolled in the survey. The outcomes included child development, caregiver's early stimulation, parent-child communication, and learning materials. Baseline assessments were conducted in 2018, and endline assessments were conducted in 2020.RESULTS:In the endline survey, we enrolled 608 children with 258 in the intervention group and 350 in the control group. Left-behind children in the intervention group were less likely to have development delay compared with the control group (odds ratio [OR] = 0.59, 95% confidence interval [CI]: 0.36, 0.96). Migrant parents of children in the intervention group showed higher proportion of expressing emotional support to their children when communicating (OR = 1.69, 95% CI: 1.05, 2.72). Children who received home visits more than once per 2 months had lower level of suspected development delay than children in the control group (OR = 0.34, 95% CI: 0.18, 0.68). Caregiver's early stimulation and migrant parents' emotional support to left-behind children mediated the intervention dose and left-behind children's development.CONCLUSION:Caregiver's early stimulation mediates the intervention and child's development. The findings suggest a promising future for scaling similar early childhood development interventions for left-behind children in rural settings.

Background:Social-emotional ability is key to the well-being and future success of children; however, disparities in social-emotional development during an individual's early age can last a lifetime, which is particularly evident among children living in poverty-stricken areas. We aimed to determine the effectiveness, cost-effectiveness, and feasibility of a group-based intervention called the Care Group on social-emotional development for families living in poverty-stricken counties.Methods:We conducted a cluster (township) randomized controlled trial (C-RCT) every two weeks from July 2019 to June 2020 in a poverty-stricken area located in Shanxi, China. The outbreak of the COVID-19 pandemic suspended the implementation of the intervention in January 2020. The caregiver-child pairs in the intervention group participated in 12 group-based sessions with a structured curriculum and learning materials emphasizing nurturing ability and early childhood development. We applied a difference-in-differences (DID) model to estimate the intervention's impact. The analysis follows the intention-to-treat (ITT) principle. We used standard economic costing methods to estimate the cost of implementing the Care Group over the intervention period and adopted a societal perspective in the analysis.Results:We included 322 eligible caregiver-child pairs in the baseline (intervention n = 136, control n = 186) and surveyed 258 pairs in the endline (intervention n = 117, control n = 141). Compared with the control group, children in the intervention group had significantly fewer social-emotional problems (adjusted mean difference of Z score = -0.374, 95% CI = -0.718, -0.030, P = 0.033) six months after intervention. In the first year, the annual cost of implementing Care Group was US$146.10 per child, reduced to US$47.20 per child in the second year due to the exclusion of non-recurrent costs. The incremental cost-effectiveness ratio (ICER) was US$390.60.Conclusions:Care Group is an effective approach for promoting children's social-emotional development in poverty-stricken areas at an affordable cost and with high feasibility for scale-up. Considering the planned per capita health expenditure of the Chinese government for 2022, we believe that the presented evidence makes a solid scientific and financial case for integrating the Care Group intervention into the basic public health services (BPHS) package.Registration:Chinese Clinical Trials Registry (ChiCTR): ChiCTR1900022894.

BACKGROUND:Home environment provides stimulation and learning opportunities required for children's early development. However, few studies have focused on the effects of home environment on left-behind children's development in rural China. The study aimed to investigate the relationship between home environment and early childhood development of left-behind children under 3 years old in rural China. METHODS:Information about sociodemographic characteristics, caregivers' mental health, home environment and children's development was collected. Infant/Toddler Home Observation for Measurement of the Environment Inventory (IT-HOME) was used to assess home environment. Child's development was evaluated with the Chinese version of the Ages & Stages Questionnaire - third edition. RESULTS:Elevated caregivers' depressive symptoms were associated with a higher risk of total suspected development delay. An increase of one score in the IT-HOME resulted in a 7% decrease in total suspected development delay. Higher scores in the dimensions of involvement and variety were associated with a lower risk of suspected development delay adjusting for covariates. CONCLUSIONS:Our results have implications for home-based intervention aiming at promoting nurturing care as well as caregivers' mental health, which is required for early development of young left-behind children in rural areas of China.

Purpose: Due to multiple factors, children left behind in rural areas suffer from delayed neurodevelopment (suspected developmental delay, SDD). This study aimed to analyze the effect of caregivers’ depression on left-behind children’s SDD, with early stimulation and responsive care mediating. Methods: A cross-sectional survey was conducted in villages of five Chinese counties. A total of 904 left-behind children and their primary family caregivers were enrolled. Information on the children and their caregivers were collected through face-to-face interviews. The Zung Self-rating Depression Scale (ZSDS) was used to measure caregivers’ depressive symptoms. The Ages and Stages questionnaires, third edition (ASQ-3) was used to screen children for SDD, which contains five domains: communication (CM), gross motor (GM), fine motor (FM), problem-solving (CG), and personal social (PS). Results: Of left-behind children’s caregivers, 39.7% experienced varying symptoms of depression. The prevalence of total SDD among left-behind children under three years was 31.4%. Caregivers’ ZSDS scores were positively correlated with the FM, GM, CG, and PS of the left-behind children. Caregivers’ early stimulation & responsive care was positively correlated with the CM, FM, CG, and PS of the left-behind children. Conclusion: Left-behind children under three years in rural China were at high risk of SDD and their caregivers’ mental health was not good. Caregivers’ depressive symptoms may negatively affect the suspected developmental delay of left-behind children through caregivers providing less early stimulation and responsive care. A comprehensive intervention should be conducted to promote the health of left-behind children and their caregivers.

目的 分析综合干预对6～35月龄留守儿童营养不良改善的效果.方法 采用类实验设计.数据来源于儿童早期综合发展项目基线和干预后调查.项目于2014—2016年在晋黔两省四县的80个村开展,为6～35月龄儿童及其看护人提供包括营养包补充、婴幼儿喂养咨询指导及回应性照护在内的综合干预.分别选取同省具有相似经济发展水平的一个县为对照县,共选取对照县2个.干预县接受项目干预和常规保健服务,对照县仅接受常规保健服务.于2013年和2016年7～9月分别抽取干预县40个村、对照县43个村,以样本村中全部6～35月龄儿童及其看护人为调查对象进行基线和干预后调查.采用双重差分模型,控制时间变化、基线差异及看护人、留守儿童社会人口学特征,估计干预对留守儿童看护人喂养行为及留守儿童营养改善效果.结果 基线期分别纳入干预组695对、对照组478对、终末期纳入740对、对照组514对6～35月龄留守儿童及其看护人样本进行分析.与对照组相比,干预降低了23～29月龄留守儿童发生营养不良的风险(OR:0.30,95％CI:0.10～0.91).结论 综合干预对23～29月龄留守儿童营养不良状况改善有效.建议结合全国贫困地区营养包提升行动,提高干预依从性,促进留守儿童营养处于适宜水平.

目的 探讨贫困农村地区儿童看护人抑郁的影响因素.方法 利用儿童早期发展综合项目基线调查资料,对看护人的基本信息进行统计学描述,对影响看护人抑郁状态的因素进行单因素分析,并采用Logistic回归分析各因素与看护人抑郁发生风险的关系.结果 在2808名调查对象中,儿童看护人抑郁发生率为39.9％(1121/2808).调整了居住地区、看护人的性别、民族以及经济状况后,看护人高年龄(OR=1.96,95％CI:1.41～2.73),家中儿童数量多(OR=1.62,95％CI:1.17～2.26;OR=4.39,95％CI:2.39～8.07),儿童大月龄(OR=1.28,95％CI:1.05～1.57)以及有家人酗酒(OR=1.76,95％CI:1.43～2.17)会增加看护人抑郁发生风险;高学历(OR=0.55,95％CI:0.37～0.81)及有医疗保险(OR=0.61,95％CI:0.46～0.83)会降低看护人抑郁发生风险.结论 中国贫困农村地区儿童看护人抑郁的发生率高.看护人高年龄、低学历、无医疗保险、家中儿童数量多、儿童大月龄以及家人酗酒均为看护人抑郁高发的危险因素.

Introduction Suicide is one of the top five causes of adolescent mortality around the world. The socioecological resilience framework in explaining the risk factors and protective factors for suicidal ideation in left-behind children (LBC) has not been well explored. The current study aims to compare the prevalence of suicidal ideation in LBC and non-LBC, and explore its correlations with resilience factors among LBC. Methodology This study was part of an epidemiological survey conducted by UNICEF exploring mental health outcomes in left-behind children. We implemented a cross-sectional study collecting data from 11 provinces and 1 municipal, with 5,026 participants (3,359 LBC, 1,667 controls) in year one junior high school living in impoverished areas of rural China. Data on suicidal ideation, self-harm, resilience factors including health-risk behaviors, psychological wellbeing as it was measured by the Strengths and Difficulties Questionnaire, peer relationship within the school environment, and family support were collected. Results Overall prevalence of suicidal ideation among LBC was 7.2% which is significantly different from 5.5% reported by NLBC (χ 2 = 4.854, p = 0.028). LBC reported a higher prevalence of self-harm (16.4%) than NLBC (13.0%; χ 2 = 10.232, p = 0.001), but there was no difference in the prevalence of suicide plan, suicide attempt or help-seeking. LBC had significantly poorer psychological feeling, and greater emotional and behavioral difficulties peer relationship in the school environment than controls. In the multiple logistic regression, history of self-harm was the greatest predictor for suicidal ideation among LBC (OR = 2.078, 95% CI: 1.394–3.100, p < 0.001). Health risk behavior including previous smoking attempt, poor psychological feeling, and emotional and behavior difficulties, and poor peer relationship within school environment, were also significant risk factors for suicidal ideation among LBC. Conclusion The prevalence of suicidal ideation and self-harm was greater among left-behind than non-left-behind children. Our results show resilience factors including previous self-harm, emotional and behavioral problems, smoking, and poor peer relationship are significantly associated with suicidal ideation in left-behind adolescents.

目的探究食盐加碘与贫困农村地区0～35月龄儿童早期发展的关系方法以儿童早期综合发展项目贫困农村地区0～35月龄儿童为调查对象,询问家庭碘盐食用情况,并采用《年龄与发育进程问卷》评价儿童早期发展水平.采用中介效应模型分析家庭食用碘盐是否影响看护人抑郁、儿童喂养和养育行为,进而影响儿童早期发展.结果共纳入0～35月龄儿童2591人,其中家庭使用非碘化盐的儿童59人,占2.3％.家庭食用非碘化盐的儿童可疑发育迟缓率为62.7％,显著高于家庭食用碘盐儿童(32.5％).Logistic回归结果显示家庭食用非碘化盐的儿童可疑发育迟缓患病风险显著高于食用碘盐儿童(OR=1.81,95％CI:1.01～3.23).中介效应分析显示家庭食用非碘化盐可以显著增加看护人抑郁风险,降低儿童拥有玩具和对儿童早期学习的支持,进而增加儿童可疑发育迟缓风险.结论家庭食用碘化盐通过改善看护人心理状态和促进适宜的养育看护行为,从而对儿童早期发展具有显著保护作用.

Objective: To investigate the prevalence of emotional and behavioral problems and related factors of left-behind children in impoverished rural China (mainly in the first grade of junior high school).Methods: A cross-sectional survey of rural households in 27 poverty-stricken counties in 12 provinces across China was conducted using the Strengths and Difficulties Questionnaire (SDQ).Results: The prevalence of emotional and behavioral problems in left-behind children was 11.7%, and that of non-left-behind children was 8.9%.There was statistical difference between the two groups (P < 0.01).There are no differences between the two groups in terms of the various factors of SDQ.The incidence of insomnia in the left-behind group was 58.3%, which was higher than that in the non-left-behind group 50.9% (P < 0.01); loneliness (62.1% vs. 51.8%,P < 0.01); running away from home (23.1% vs. 18.8%,P < 0.01), and self-injury behavior (16.8% vs. 12.2%, P < 0.01).Left-behind children are more likely to have negative psychological feelings including insomnia, loneliness, self-injury, and run away from home.They also experienced more bullying including maliciously teased by peers, intentionally excluded or isolated, physically threatened or intimidated.All of these factors are associated with their abnormal emotional and behavioural development.Conclusion: The incidence of emotional and behavioral problems of left-behind children in rural areas in poverty-stricken areas is significantly higher than that of non-left-behind children; Logistic regression analysis showed that bullying behavior and abnormal psychological characteristics are significantly associated with left-behind adolescents abnormal emotional and behavioral development.

The Chinese government has established a three‐tier maternal care system covering the entire country and providing integrated antenatal care (ANC) for pregnancies. This study aimed to analyze the direct and indirect effects of ANC services on early childhood development. A community‐based cross‐sectional survey was conducted for mothers’ ANC visits and assessments of early childhood development in Shanxi and Guizhou provinces, China. A total of 1660 mother–child dyads were included in current analyses: 29.2% of mothers did not receive any ANC (ANC1), 23.3% of mothers received ANC three or fewer times (ANC2), and 47.5% of mothers received ANC four or more times (ANC3). Children whose mothers received ANC services had a significantly lower risk of overall developmental delay (OR = 0.60, 95% CI: 0.44–0.81 for ANC2; and OR = 0.44, 95% CI: 0.34–0.59 for ANC3) and social‐emotional developmental delay (OR = 0.68, 95% CI: 0.49–0.94 for ANC3). Furthermore, a significant pathway relationship mediated by maternal depression and nurturing care was found between ANC and developmental delay. This study showed ANC services significantly reduced the risk of developmental delay in offspring. We also suggest that a nationwide ANC system can be a good delivery platform for scaled‐up early childhood development interventions.

Background Parent-child separation is a considerable adversity for left-behind children (LBC), but there is little evidence on the association between detailed characteristics of parent-child separation and social-emotional development among LBC. This study examined the characteristics of parent-child separation and its impacts on developmental delay among under-3 LBC in poor rural China. Methods We used data from 811 LBC surveyed in five poor counties in rural China in 2018. Detailed characteristics of their parental migration were recalled by their primary caregivers in face-to-face interviews. The children’s social-emotional development was measured by using the Ages and Stages Questionnaire: Social-Emotional. Logistic regression was employed to examine the association of detailed characteristics of parent-child separation with early social-emotional problems after adjusting for the children’s and primary caregivers’ sociodemographic characteristics. Results 287 (35.4%) children were left behind by fathers and cared for by mothers (FM-MC), while 524 (64.6%) were left behind by both parents and cared for by grandparents (PM-GC). The rate of social-emotional problems among LBC was 36.8% (PM-GC vs FM-MC: 40.6% vs 29.5%; aOR 1.51, 95% CI: 1.06 to 2.16). For paternal migration, the medians of the child’s age at the first migration and average duration per migration were 3 months (IQR: 1 to 9 months) and 4.48 months (IQR: 2.38 to 7.54 months), respectively. For maternal migration, the corresponding values were 9 months (IQR: 6 to 13 months) and 4.65 months (IQR: 2.71 to 7.62 months), respectively. On average, LBC had been separated from fathers for 72% of their life due to paternal migration and from mothers for 52% of their life due to maternal migration. No significant association was found between the detailed characteristics of paternal migration and social-emotional development among LBC, while social-emotional problems among LBC were significantly associated with the proportion of cumulative duration of maternal migration in the child’s lifetime (aOR 2.83; 95% CI: 1.13 to 7.10). Conclusions LBC under 3 years had a high risk of social-emotional problems in poor rural China. Cumulative exposure to maternal migration may be detrimental to LBC’s early social-emotional development. Programs are necessary to support these children as well as their families.

Around one-third of children experience separation from parents and absence of parental care due to parental migration in rural China. Despite numerous studies on left-behind children, little is known about early social-emotional development of those who experience parental migration in the first three years. This study explored whether and why parental migration is associated with children's early social-emotional development. We used data of 2,247 children aged 3–35 months with various parental migration statuses who were enrolled in a cross-sectional survey conducted in six counties of northern and southern China in 2013. Social-emotional problems were assessed by the Ages & Stages Questionnaires: Social-Emotional. A structural equation model (SEM) was employed to explore the pathways linking parental migration to children's early social-emotional problems in which family economics, substitute caregivers' education, depressive symptoms and nurturing care practices were measured as mediators. We found that the prevalence of social-emotional problems in children with non-migrant parents and with migrant fathers was 17.4% and 19.9% respectively, with no significant difference between them. The prevalence in children with both migrant parents was 27.2%, which was significantly higher than that in children cared for by mothers (adjusted OR 1.43 [95%CI 1.02, 1.99]). The SEM results show that substitute caregivers' lower education and more depressive symptoms and the consequent more negative parenting practices than mothers accounted for the increased risk of social-emotional problems among children with both migrant parents compared to those with non-migrant mothers. These findings imply a need of a multi-dimensional intervention framework to support these children and their families.

Introduction Early childhood development (ECD) is a critical component for building the foundation of future physical and emotional health and subsequent academic success. The quality of the home environment to promote development is an important factor in ECD. Since large rural–urban disparities in the home environment exist in China, there is a critical need to develop and evaluate interventions to promote ECD in rural areas. Individual center-based or home-based interventions dominate the current ECD programmes in rural China. However, group-based interventions offer potential advantages in terms of both effectiveness and cost. Thus, we aim to: (1) evaluate the effectiveness of an integrated group-based intervention, the Care Group Intervention, in enhancing ECD among children age 6–18 months and (2) conduct a cost-effectiveness analysis. Methods and analysis The Care Group Intervention uses a cluster (by township) randomised controlled trial conducted in Fenxi county, Shanxi province, China, from July 2019, for 1 year. The intervention focuses on five key components of nurturing care including good health, adequate nutrition, responsive caregiving, security and safety, and opportunities for early learning. The intervention comprises small groups of 3–10 children within a certain age range and their primary caregivers that are led by well-trained local facilitators. Outcomes includes infants’ developmental quotient (Bayley Scales of Infant Development III, Ages & Stages Questionnaire: Social–Emotional, second edition); anaemia (HemoCue Hb 301+); nurturing environment (Infant/Toddler Home Observation for Measurement of the Environment), parent-child interaction (Teaching Scale) and caregiver depression (Center for Epidemiological Studies Depression). Cost data are collected throughout the entire study to carry out a cost-effectiveness analysis. Ethics and dissemination This study was approved by the Ethical Committee of Capital Institute of Pediatrics, Beijing, China on 10 July 2018 (SHERLL2018014). Findings and results from this project will be disseminated via publications and presentations. Trial registration number Chinese Clinical Trials Registry: ChiCTR1900022894. Registered on 30 April 2019.

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.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的了解我国中西部农村地区高危儿管理服务现状,为探索我国中、西部地区促进儿童早期发展服务模式提供参考依据。方法以河北、山西、河南、江西和贵州5省11县的儿童保健服务人员为调查对象,采用自填式调查问卷了解我国农村地区儿保人员提供高危儿童管理服务的现状。结果本研究共调查695名儿童保健服务人员,其中区/县级妇幼保健机构人员65名,乡镇卫生院及村卫生室人员630名,过去一年参加过高危儿保健业务培训的人员占48.6%（251/516）。目前项目地区高危儿管理的主要目标人群以早产低体重儿和体弱儿为主（82.1%和80.0%）。基层医疗卫生机构中的儿保人员,分别有73.1%（408/558）和61.8%（345/558）提供了高危儿登记和高危儿转诊服务。区/县妇幼保健机构的儿保人员中,开展高危儿发育监测和筛查者为74%（35/47）,进行专案登记管理的仅为49%（23/47）。对于影响高危儿管理业务开展的因素,业务人员认为最主要的因素是管理手续繁琐（77.8%,402/517）)和人手不够（76.8%,397/517）。对于高危儿管理知识的知晓情况,被调查者中10个题目答对6题以上的占59.2%（409/691）,答对8题以上的为30.0%（207/691）。结论高危儿管理作为我国儿童保健的重要内容,在中西部农村地区已经起步,但针对发育风险儿童服务和专案管理能力尚有待加强。建议针对高危儿管理提供相应的政策保障,开展针对性的解决措施,促进风险儿童的早期发展。</span>

目的 探讨3岁以下儿童身高/长与神经行为发育之间的关系,为后续干预提供建议.方法 数据来源于2013年7-9月在山西、贵州六县开展的3岁以下儿童及其看护人的横断面调查,用非参数检验法和线性回归分析探究儿童身高/长与神经行为发育之间的关系.结果 调查地区3岁以下儿童身高/长标准化得分(HAZ)为-0.73±1.44,年龄与发育进程问卷(ASQ)Z评分为-0.08(-1.30,0.77).1～17月龄身高/长正常组儿童的ASQ-Z评分高于生长不足组0.36,高于生长迟缓组0.78,且差异有统计学意义(P＜0.05).在控制儿童性别、月龄、看护人基本情况、家庭经济状况混杂因素后,HAZ每升高1s,ASQ-Z评分增加0.106s.结论 调查地区儿童身高/长与神经行为发育存在正相关.生长不足是影响低龄儿童神经行为发育的独立因素.生长监测工作中,要兼顾生长不足和生长迟缓儿童的早期发展指导和促进.

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Background: More than one-third of children under 3 years old are left behind at home due to parental migration in rural China, and we know very little about early childhood nutrition of left-behind children (LBC) because of the dearth of research. This study examined the association between parental migration and early childhood nutrition of LBC in rural China. Methods: We used repeated cross-sectional data of rural children aged 6–35 months who participated in two surveys in six counties of northern and southern China in 2013 and 2016 respectively. The length, weight, and hemoglobin concentration were measured by trained health‑care workers blinded to parental migration status. Stunting, underweight, wasting, and anemia were identified with the standards recommended by WHO. Generalized linear regressions and multivariate logistic regressions were employed to explore the association between parental migration and these nutritional outcomes at each time point. Results: 2,336 and 2,210 children aged 6–35 months were enrolled in 2013 and 2016, respectively. The results show a reduction of the risks of stunting, underweight, and wasting from 2013 (16.4%, 8.5%, and 3.5%, respectively) to 2016 (12.1%, 4.0%, and 1.5%, respectively) but highlight a constantly and alarmingly high risk of anemia among these children (44.8% in 2013 and 43.8% in 2016). Children with migrant fathers performed as well as or better than those with non-migrants on these indicators. Children with migrant parents performed slightly worse in 2013, but equal or slightly superior in 2016 on these indicators compared with children with non-migrants and migrant fathers. Children aged 6–17 months with migrant parents had a significantly lower risk of anemia than those living with their mothers or with both parents (43.1% vs . 63.6% and 61.5 in 2013, and 42.5 vs . 60.1% and 66.2% in 2016), even after controlling for children’s sociodemographic characteristics. Conclusions: Parental migration may be not detrimental and even beneficial to early childhood nutrition of LBC in rural China. Continued nutritional support is needed for all rural children, especially interventions for preventing micronutrient deficiency. Programs for LBC are recommended to continue to focus on nutrition but pay more attention to other important health issues.