BACKGROUND:Mental health problems, including depression, anxiety, and suicide, pose a substantial burden on adolescents worldwide, making prevention a priority. In China, major challenges remain in implementing and evaluating school-based mental health programmes. The Adolescent Mental Health Service Package (AMHSP) is a multicomponent, culturally adapted, evidence-informed curriculum that is grounded in Positive Youth Development and designed to reduce depressive and anxiety symptoms and enhance mental wellbeing. The aim of this study was to evaluate the AMHSP for improving adolescent mental health in routine school settings. METHODS:This cluster-randomised controlled trial included public schools across ten provinces in China, with participants nested within schools and classrooms within each school randomly assigned 1:1 to either ten weekly 40-min AMHSP sessions (intervention), delivered by trained school-based mental health teachers or counsellors (facilitators) using standardised manuals and multimedia materials, or routine curriculum without additional mental health content (control). Given the nature of the school-based intervention, neither students nor facilitators were masked to group allocation, but all statistical analyses were done by an independent statistician masked to group allocation, and student self-report data were collected anonymously using secure, standardised platforms. The four primary outcomes were depressive symptoms (measured by nine-item Patient Health Questionnaire), anxiety symptoms (seven-item Generalized Anxiety Disorder Scale), subjective wellbeing (WHO Five-item Well-Being Index), and emotion regulation (ten-item Emotion Regulation Questionnaire, assessing both cognitive reappraisal and expressive suppression), which were self-reported at baseline, immediately after intervention, and at 1-month and 3-month follow-up. The primary outcome analysis of change from baseline at 3 months' follow-up in the four coprimary outcomes was analysed by linear mixed-effects models in the intention-to-treat population, which included all participants who completed at least one assessment. To control for multiple testing, we prespecified the use of the Benjamini-Hochberg false discovery rate (FDR) correction of p values. This trial was prospectively registered with the Chinese Clinical Trial Registry (ChiCTR2300076956) and has been completed. FINDINGS:Between Oct 12, 2023 and Oct 10, 2024, 5222 students from 120 classrooms in 18 public schools (mean age 13·6 years [SD 1·7]; 2687 [51·5%] girls and 2535 [48·5%] boys) were randomly assigned to the AMHSP intervention (n=2620) or control (n=2602), completed the baseline assessments, and were included in the primary outcome analysis. At 3 months, the AMHSP intervention group showed lower depressive symptoms (standardised mean difference [SMD] -0·09 [95% CI -0·14 to -0·04], pFDR=0·0013) and anxiety symptoms (-0·11 [-0·16 to -0·05], pFDR=0·0002) relative to the control group. No differences were seen in subjective wellbeing (SMD 0·02 [-0·03 to 0·08], pFDR=0·85) or emotion regulation (cognitive reappraisal SMD 0·03 [-0·02 to 0·09], pFDR=0·33; expressive suppression -0·08 [-0·14 to -0·01], pFDR=0·10) at 3 months. No adverse events were reported. INTERPRETATION:The reduction in depression and anxiety symptoms 3 months after completing ten AMHSP sessions indicates a slow but meaningful benefit of the programme and supports the potential of a low-intensity, curriculum-integrated approach to promoting adolescent mental health. Delivery of the AMHSP by trained school-based mental health teachers demonstrates a scalable strategy for early mental health promotion in schools. FUNDING:UNICEF.

Neonatal mortality remains a global concern, especially in China, where regional disparities persist. Early essential newborn care (EENC) consists of a set of evidence-based and cost-effective interventions, including but not limited to, skin-to-skin contact, neonatal resuscitation when needed, early breastfeeding initiation, delayed umbilical cord clamping and proper care, and kangaroo mother care for premature and low-birthweight infants to prevent or treat the major causes of neonatal morbidity and mortality. This study aimed to explore the facilitators and barriers to an EENC simulation-based training by examining the perspectives of different stakeholders participating in EENC training and coaching activities in western China. This qualitative study was conducted between December 2020 and April 2021. A total of 190 participants across 15 health facilities were recruited from four western provinces in China. Seven in-depth interviews with national-level experts, 35 in-depth interviews with postpartum mothers who were still hospitalised on the day of the interview, and 21 focus group discussions with 54 policymakers including county mayors in charge of health, county mayors in charge of finance, hospital medical directors, and 94 healthcare providers including obstetricians, paediatricians, nurses, and midwives from different hospitals were conducted to collect data. The number of participants per FGD ranged from 4 to 9, with a total number of 148 participants participating in all FGDs. The interview transcripts were organised and coded by the research team. We used a hybrid inductive-deductive thematic analysis to generate themes. Two main themes and four sub-themes emerged from the data. Following training, healthcare providers reported that the delivery approach and content of the EENC training were acceptable, and postpartum mothers reported satisfaction with the service they received. Facilitators to successful training were the use of an evidence-based approach, practical, skill-based training, and multidisciplinary engagement. Barriers included variations in trainer quality, and staff shortages in county-level hospitals. This study provides insights into stakeholders’ perceptions of EENC training implementation in western China. Participants perceived the training as valuable for enhancing knowledge, skills, and confidence in recommended EENC practices. The findings suggest that the current training model is well accepted and may support the adoption of EENC practices. Future efforts should strengthen post-training quality monitoring, trainer development, and workforce support to facilitate the sustained implementation of EENC recommendations.

Background:Postpartum depression (PPD) is a prevalent mental health issue with significant implications for maternal and infant wellbeing. Despite extensive research, the complex interplay of perinatal factors contributing to PPD remains inadequately characterized. This study utilizes a network analysis approach to identify central depressive symptoms, critical perinatal risk factors, and pathways contributing to PPD among Chinese postpartum women. Methods:A prospective observational study enrolled 377 women from 10 tertiary hospitals in China. Sociodemographic and perinatal factors were assessed shortly after childbirth. At 4-6 weeks postpartum, PPD symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS). Maternal and infant health outcomes, breastfeeding experiences, and family support were captured through self-administered questionnaires. Random forest and Bayesian network analyses were employed to identify influential factors and their interrelationships. Results:Among the participants, 98 women (26.0, 95% CI: 21.6-30.7%) screened positive for PPD (EPDS score ≥10). Anxiety/Worry emerged as the most central symptom in the network, with the highest strength and centrality (Degree = 0.893, Betweenness = 0.888). Key risk factors included breastfeeding challenges (RF = 0.752), maternal physical complaints (RF = 0.431), and adverse infant health conditions (RF = 0.350). Protective effects were observed for prolonged skin-to-skin contact, family support for breastfeeding, and positive childbirth self-perception. Hospital type served as a central bridging node within the network, strongly connected with factors related to peripartum care services, childbirth experience and PPD. Conclusion:This study reveals a significant prevalence of PPD among mothers in China. It underscores the positive impact of skin-to-skin contact, continuous postpartum care and tailored breastfeeding support in addressing PPD. These findings will advance PPD prevention strategies and inform evidence-based clinical practice in postpartum care.

ABSTRACT In China, a range of anemia prevention and treatment measures have been developed and implemented in recent decades. These measures provide a regulatory basis for implementing standardized maternal anemia prevention and treatment services in China. However, little is known about the adoption of these interventions by health professionals, the capacity of health facilities to screen for iron deficiency and anemia, or the level of compliance among pregnant and lactating women (PLW). Thus, this study explored the alignment between maternal anemia prevention and control services provided and generated evidence for potential policy and program revisions and updates. A cross‐sectional survey was conducted between November 2019 and January 2020. A total of 11 counties from 6 provinces across eastern, central and western regions of China were selected for the survey. In the surveyed sites, a total of 42 health institutions were enrolled in the survey, and a total of 201 health providers and 1714 PLW were enrolled in the suervey and completed the questionnaires. The results of this study showed that iron supplements containing 30 and 60 mg of iron were available in one third of the health facilities surveyed. All obstetricians reported ordering the Hb test for pregnant women receiving antenatal care (ANC) services, and 87.6% ordered the ferritin test. The proportion of obstetricians who ordered the ferritin test at the township level facilities (79.4%) was significantly lower than that at the provincial (100%), prefectural (87.5%) and county (87.1%) level facilities (p < 0.05). Around 89.6% and 90.5% of obstetricians prescribed iron to pregnant women when they were diagnosed with anemia and ID, respectively. 41.3% of obstetricians advised women to take preventive iron throughout their pregnancy. The proportion of obstetricians from township level hospitals that advised women to take preventative iron throughout their pregnancy (61.5%) was significantly lower than that from provincial facilities (23.5%) (p < 0.05). A total of 95.2% and 47.9% of PLW reported receiving the Hb test and the serum ferritin test during their pregnancy, respectively. There are some barriers and bottlenecks in the effective implementation of anemia intervention measures for pregnant women in China. Therefore, to achieve international and national targets on further reducing maternal anemia prevalence, comprehensive actions need to be taken.

China is home to the second largest population of children and adolescents in the world. Yet demographic shifts mean that the government must manage the challenge of fewer children with the needs of an ageing population, while considering the delicate tension between economic growth and environmental sustainability. We mapped the health problems and risks of contemporary school-aged children and adolescents in China against current national health policies. We involved multidisciplinary experts, including young people, with the aim of identifying actionable strategies and specific recommendations to promote child and adolescent health and wellbeing. Notwithstanding major improvements in their health over the past few decades, contemporary Chinese children and adolescents face distinct social challenges, including high academic pressures and youth unemployment, and new health concerns including obesity, mental health issues, and sexually transmitted infections. Inequality by gender, geography, and ethnicity remains a feature of health risks and outcomes. We identified a mismatch between current health determinants, risks and outcomes, and government policies. To promote the health of children and adolescents in China, we recommend a set of strategies that target government-led initiatives across the health, education, and community sectors, which aim to build supportive and responsive families, safe communities, and engaging and respectful learning environments.TranslationFor the Chinese translation of the abstract see Supplementary Materials section.

Background Road traffic injuries (RTI) are the second leading cause of death among children and adolescent aged 1–19 in China. However, effective intervention strategies and mechanisms to protect children from RTI in China are not yet fully understood. Objective The study aims to develop a comprehensive intervention model for RTI prevention and evaluate its effectiveness. The result will be used to inform national policies on RTI prevention. Programme Description This programme was conducted jointly by NCNCD ChinaCDC and UNICEF. A quasi-experimental design was applied to evaluate the effectiveness of interventions. Two counties were designated as the intervention group, and two other counties were selected as the control group. The target population was school-age children. The intervention group received comprehensive intervention measures, including enforcement of regulation, education for awareness and behavior change, and environment modification to reduce risks on the road. The control group did not receive any interventions. Evaluation was conducted based on the baseline survey before and endline survey after one year of intervention. Outcomes and learnings The results indicated a significant decrease in the incidence rate of RTI among school-age children in the intervention group, from 0.88% in the baseline survey to 0.18% in the endline survey. In the control group, the incidence of RTI also decreased, albeit at a lesser rate, from 0.24% in the baseline to 0.11% in the endline. The road safety knowledge score and walking and cycling behavior score also increased significantly in the target group of the intervention group. Cooperation with multiple government departments was critical for the successful implementation of the programme. Implication The comprehensive intervention model for children's RTI has proven effective. The strategies and mechanisms of the interventions can be applied in other areas with similar context in China and provide good practices for other countries to learn. Conclusion The study's findings underscore the effectiveness of the interventions implemented in the study not only in reducing the incidence of RTI among school-age children but also enhancing road safety knowledge and behavior in the two intervention counties. The intervention strategies and mechanisms provided valuable experiences on RTI prevention for other areas.

Maternal anaemia is a major public health problem. Developing maternal anaemia prevention and control policies is an important prerequisite for carrying out evidence-based interventions. This article reviews maternal anaemia prevention and control policies in China, identifies gaps, and provides references for other countries. We examined policies concerning maternal nutrition and other related literature in China, identified through key databases and government websites, and conducted a narrative review of the relevant documentations guided by the Smith Policy-Implementing-Process framework. A total of 65 articles and documents were identified for analysis. We found that Chinese government has committed to reducing maternal anaemia at the policy level, with established objectives and a clear time frame. However, most of policies were not accompanied by operational guidelines, standardized interventions, and vigorous monitoring and evaluation mechanisms, and 85% of the policies don't have quantifiable objectives on anaemia. Maternal anaemia prevention and control services offered in clinical settings were primarily nutrition education and anaemia screening. Population-based interventions such as iron fortification have yet to be scaled up. Furthermore, medical insurance schemes in some regions do not cover anaemia prevention and treatment, and in other regions that offer coverage, the reimbursement rate is low. The number and capacity of health professionals is also limited. Policy changes should focus on the integration of evidence-based interventions into routine antenatal care services and public health service packages, standardization of dosages and provision of iron supplementation, streamline of reimbursement for outpatient expenses, and capacity building of health professionals.

The systematic review and meta-analysis were conducted to ascertain the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among Chinese pregnant women. A total of 722 articles on maternal anemia during pregnancy published between January 2010 and December 2020 were compiled, and a systematic review and meta-analysis were conducted on 57 eligible studies including 1,376,204 pregnant women to ascertain the prevalence of anemia and the prevalence in different subgroups. The results showed that the prevalence of anemia, ID, and IDA among pregnant women in China were 30.7% (95% CI: 26.6%, 34.7%), 45.6% (95% CI: 37.0%, 54.2%), and 17.3% (95% CI: 13.9%, 20.7%), respectively. All prevalence increased with the progression of the pregnancy. There were sizable regional variations in the prevalence of anemia, ID, and IDA. Generally, lower prevalence was observed in the economically more advanced eastern region of the country, while the prevalence of ID was higher in the eastern region than that in the western region. The prevalence of anemia and IDA in rural areas was higher than that in urban areas, but ID prevalence was higher in urban areas. In conclusion, the regional differences and urban–rural disparities in the prevalence of anemia indicate the need for more context-specific interventions to prevent and treat anemia. It was found that dietary factors were one of the major causes of anemia, and iron-containing supplements and nutrition counseling could be effective interventions to reduce the prevalence of anemia, ID, and IDA among Chinese pregnant women.

Background Nurturing care is necessary for optimal early childhood development. This study aimed to investigate the prevalence of parental risks in rural East China and assess their impacts on early development in children younger than three years old. Methods This community-based cross-sectional survey was conducted among 3852 caregiver-child pairs in Zhejiang Province from December 2019 to January 2020. Children aged 0 to 3 years were recruited from China’s Early Childhood Development Program (ECD). Local child health care providers conducted face-to-face interviews with the primary caregivers. Demographic information of the participants was collected by questionnaire. Each child was screened for parental risk through the Parental Risk Checklist designed by the ECD program. The Ages and Stages Questionnaire (ASQ) was used to identify children with potential developmental delays. Multinomial logistic regression model and linear trend test were applied to assess the association between parental risks and suspected developmental delays. Results Among the 3852 children included in the analyses, 46.70% had at least one parental risk and 9.01% presented suspected developmental delays in any domain of ASQ. Parental risk was statistically associated with the overall suspected developmental delay in young children (Relative Risk Ratio (RRR): 1.36; 95% confidence interval (CI): 1.08, 1.72; P = 0.010) after adjusting potential confounders. Compared with children with no parental risk, children exposed to 3 or more parental risks had 2.59, 5.76, 3.95, and 2.84 times higher risk of the suspected developmental delay in overall ASQ, communication, problem-solving, and personal-social domain, respectively (P values < 0.05). The linear trend tests found that the more parental risks, the higher possibility of developmental delay (P values < 0.05). Conclusions Parental risks are prevalent among children under three years in rural East China, which may increase the risk of developmental delays in children. Meanwhile, parental risk screening can be used to recognize poor nurturing care in primary health care settings. Targeted interventions are warranted to improve nurturing care for optimal early childhood development.

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 Inequalities in job opportunities and income prompts many Chinese parents to leave rural regions to work in urban regions. Their children are left behind in rural regions, subjected to worse quality of childcare that jeopardizes their development. This study aimed to examine the association between quality of childcare and delayed child development in under-three years children left behind in China. Methods Cross-sectional national survey was conducted in children left behind in rural China in 2017. Exploratory and confirmatory factor analysis was used to develop a quality of childcare index. Mutlilevel analyses determined factors associated with quality of childcare and child development on a province and individual level. Result The largest population of at-risk children left behind were found in higher-GDP provinces. Children left behind had the lowest mean quality of childcare score. Multilevel analysis found that province level accounted for a great proportion of variance observed. Conclusions While migration to urban regions for work may improve household income, a trade-off in worse quality of childcare and developmental delays exists. With improving household income often being the greatest contributing factor for parental migration, policies to reduce inequalities in job opportunities and wealth between rural and urban regions are required. Impact Previous studies identified higher prevalence of developmental delays in children left behind in China. However, quality of childcare has not been examined. Based on WHO’s Nurturing Care Framework, we developed a quality of childcare index to assess its association with child development in children left behind. Greatest proportion of children left behind at-risk of developmental delays resided in higher-GDP states, indicating a trade-off in worse quality of childcare and developmental delays. Since improving household income is the main factor for parental migration, policies to close inequalities in job opportunities and wealth between rural and urban regions are required.

BACKGROUND:In China, the rates of early initiation and exclusive breastfeeding are low. The high cesarean delivery rates further contribute to low breastfeeding outcomes. Skin-to-skin contact, a key component of early essential newborn care, is known to be associated with improved breastfeeding initiation and exclusivity; however, the necessary duration has not been subjected to a randomized control trial. OBJECTIVE:This study aimed to determine the association of the duration of skin-to-skin contact after cesarean delivery with breastfeeding outcomes and maternal and neonatal health outcomes in China. STUDY DESIGN:This was a multicentric randomized controlled trial that was conducted at 4 hospitals in China. A total of 720 participants at ≥37 gestational weeks with a singleton pregnancy and who received an elective cesarean delivery with epidural anesthesia or spinal anesthesia or combined spinal-epidural anesthesia were randomly divided into 4 groups at a ratio of 1:1:1:1. The control group received routine care. Intervention group 1 (G1), 2 (G2), and 3 (G3) received 30, 60, and 90 minutes of skin-to-skin contact immediately after the cesarean delivery, respectively. RESULTS:Between January 3 and October 14, 2021, 659 participants were recruited, including 173 in the control group, 176 in G1, 146 in G2, and 164 in G3. Among G1, G2, and G3, the rate of early initiation of breastfeeding within 60 minutes of birth was 56%, 71%, and 72%, respectively, compared with 22% in the control group (P<.001). The exclusive breastfeeding rate at discharge was 69%, 62%, and 71%, respectively, compared with 57% in the control group (P=.003). Early essential newborn care practices were associated with a reduction in postpartum blood loss and neonatal intensive care unit or neonatal ward admission (P<.001; P=.022) . CONCLUSION:Our findings highlight that prolonged skin-to-skin contact after a cesarean delivery was associated with higher initiation and exclusive breastfeeding at discharge rates. It also found associations with reduced postpartum blood loss and neonatal intensive care unit or neonatal ward admission.

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.

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.

Background The associations among maternal depressive symptoms (MDS), mother–child interactions and early child development are poorly understood. This study aimed to explore the role of mother–child interactions on the associations between MDS and child development. Methods A cross-sectional study with a multistage sampling method was conducted in rural areas of Central and Western China. MDS, child development outcomes (communication, gross motor function, fine motor function, problem solving and personal social skills) and mother–child interactions were assessed by The Edinburgh Postpartum Depression Scale, the Chinese version of the Ages and Stages Questionnaires and the Multiple Indicator Cluster Surveys, respectively. Regression-based statistical mediation and moderation were conducted using the PROCESS macro for SPSS. Results A total of 2,548 participants (mothers: 1,274; children: 1,274) were included in our analyses. MDS was negatively associated with child development outcomes and mother–child interactions partly mediated these associations. The proportion of the mediating effect of mother–child interactions was 7.7% for communication, 8.2% for gross motor, 10.3% for fine motor, 10.1% for problem-solving and 9.5% for personal social domains. In addition, the interaction effects of MDS and mother–child interactions on the communication domain were significant (β = 0.070, 95% CI 0.016, 0.124; p = 0.011). The associations between MDS and child communication abilities were weaker at the high level (simple slope = −0.019, t = − 0.458, p = 0.647) of mother–child interactions than at the mean level (simple slope = −0.089, t = − 3.190, p = 0.002) and the low level (simple slope = −0.158, t = − 4.231, p < 0.001). Similar moderating effects were not observed in the other child development outcomes. Conclusion Our results suggest the important role of mother–child interactions on the associations between MDS and early childhood development. Due to the cross-sectional design of this study, these associations require further investigation in prospective studies.

In this retrospective analysis, we aimed to analyze the epidemic characteristics of neonatal mortality due to preterm birth at 28–36 weeks gestation in different regions from 2009 to 2018. Data were obtained from China’s Under-5 Child Mortality Surveillance System (U5CMSS). The χ2 trend test, Poisson regression and the Cochran-Mantel-Haenszel method were used in this study. We found that 51.3%, 42.0% and 44.5% of neonate deaths were preterm infants, and immaturity was mainly attributed to 60.1%, 64.1% and 69.5% of these deaths, in the eastern, central and western regions, respectively. The preterm neonatal mortality rate due to immaturity dropped from 149.2, 216.5 and 339.5 in 2009 to 47.4, 83.8 and 170.1 per 100 000 live births in 2018, giving an average annual decline rate of 12.1%, 11.6% and 6.3% in the eastern, central and western regions, respectively, during the studying period. The relative risk of preterm neonatal mortality due to immaturity were 1.3 and 2.3 for the central regions and western regions in 2009–2010, ascending to 2.2 and 3.9 in 2017–2018. The proportion of preterm neonatal deaths with a gestational age <32 weeks was highest among the eastern region. There were significantly more preterm neonatal infants who were not delivered at medical institutions in the western region than in the eastern and central regions. The preterm infant, especially with gestational age <32 weeks, should receive the most attention through enhanced policies and programs to improve child survival. Priority interventions should be region-specific, depending on the availability of economic and healthcare resources.

Background: There is an emerging literature on the mental health of both pre-and post-partum mothers during the coronavirus disease 2019 (COVID-19) pandemic. Methods: As of April 1, 2020, 23 mothers confirmed with COVID-19, 15 mothers suspected with COVID-19 but with negative polymerase chain reaction tests, and 33 mothers without COVID-19 (Control Group) were recruited for a study from Hubei Province in China. The Maternal Postnatal Attachment Scale (MPAS), the Zung Self-rating Anxiety Scale, and the Zung Self-rating Depression Scale were applied to investigate the attachment of mothers to their neonates and the postpartum mental health of mothers within the first 3 months after delivery (between 20 to 89 days). Results: The period of mother-child separation among the confirmed group (33.9?20.9 days) was significantly longer than that of suspected group (16.7?12.2 days) and control group (10.7?8.4 days). The total score of the MPAS in mothers confirmed with COVID-19 (45.5?4.2) was significantly lower (indicating less mother-child attachment) than that in the suspected (50.5?4.7) and control (48.8?4.6) groups. A negative correlation was noted between the mother-child separation time and the MPAS scores, including the subscale scores of attachment (MPAS acore: Spearman?s ? =?0.33, 95% CI: ?0.095 to ?0.538, P=0.005; Subscale score of attachment: Spearman?s ? =?0.40, 95% CI: ?0.163 to ?0.592, P=0.001). The incidence of postpartum anxiety in the confirmed, suspected and control groups was 4.3%, 6.7% and 12.1%, respectively; and the incidence of postpartum depression was 39.1%, 33.3% and 30.3%, respectively. No significant difference was found with regards to maternal postpartum anxiety and depression among the three groups. Conclusions: Decreased mother-child attachment found among mothers confirmed with COVID-19, indicates that further intervention is needed to ensure mother-child interaction to appropriately develop attachment. Mother-child attachment experienced disruption due to prolonged mother-child separation necessitated by the COVID-19 management protocol, which needs to be revised to reduce prolonged mother-child separation. Additionally, mothers with and without COVID-19 suffered a high incidence of depression, which warrants further mental health investment for pregnant mothers during the COVID-19 pandemic.