西部贫困农村地区婴幼儿社会情感现状及其影响因素研究

Social-emotional Status and Correlation Factors of Infants and Toddlers in Poor Rural Areas of Western China

背景婴幼儿的社会情感对其健康成长与未来发展至关重要,是不可忽视的一方面。目的调查西部贫困农村地区婴幼儿的社会情感现状,分析影响婴幼儿社会情感的相关因素,以提出有针对性的改善措施。方法2012年6月,以四川省凉山彝族自治州和甘肃省甘南藏族自治州的贫困农村地区为研究现场,采用多阶段随机抽样法,最终抽取9个县26个乡镇78个村的1 328例3~20个月婴幼儿看护人为调查对象。调查问卷由结构式问卷和婴幼儿社会情感量表(ASQ:SE)组成,并进行面对面访谈式调查。结构式问卷包括婴幼儿人口学资料(性别、月龄、民族、家庭子女数、顺产儿或剖宫产儿、早产儿或非早产儿、出生地、家庭低保情况)、近2周内生病情况、家庭房屋价值以及婴幼儿母亲人口学资料(职业、受教育年限、认为最合适的开奶时间、早开奶情况、购买婴幼儿相关图书情况)。记录婴幼儿的社会情感现状,并采用多元线性回归分析婴幼儿社会情感的影响因素。结果共发放调查问卷1 328份,最终完成问卷调查且为回收有效问卷1 302份,回收有效率98.04%。1 302例婴幼儿中男685例(52.61%),女617例(47.39%);3~8个月393例(30.18%),9~14个月493例(37.87%),15~20个月416例(31.95%);近2周内生过病的婴幼儿737例(56.61%),未生过病565例(43.39%);婴幼儿母亲:在家务农或带孩子1 179例(90.55%),在外打工123例(9.45%);受教育年限<9年991例(76.11%),≥9年311例(23.89%);认为最合适的开奶时间≤1 h 442例(33.95%),2~12 h 372例(28.57%),13~24 h 74例(5.68%),>24 h 414例(31.80%);早开奶445例(34.18%),未早开奶857例(65.82%);购买过婴幼儿相关图书53例(4.07%),未购买过1 249例(95.93%)。3~8、9~14、15~20个月婴幼儿ASQ:SE评分分别为(45.1±26.4)(59.0±30.3)(61.5±34.1)分。3~8、9~14、15~20个月婴幼儿存在社会情感问题的分别为190例(48.35%)、309例(62.68%)、252例(60.58%),即1 302例婴幼儿中共有751例(57.68%)婴幼儿存在社会情感问题。婴幼儿近2周内生病情况(β=7.62,P<0.001)、母亲职业(β=-7.80,P=0.038)、母亲受教育年限(β=-6.18,P=0.020)、母亲早开奶情况(β=-5.15,P=0.011)、母亲购买婴幼儿相关图书情况(β=-8.37,P=0.043)是婴幼儿ASQ:SE评分的影响因素。结论西部贫困农村地区婴幼儿社会情感问题的发生率较高,婴幼儿近2周内生病情况、母亲职业、母亲受教育年限、母亲早开奶情况、母亲购买婴幼儿相关图书情况是婴幼儿社会情感问题的影响因素,建议相关医务人员提高对以上因素的注意,积极营造适合婴幼儿成长的社会文化氛围,降低婴幼儿社会情感问题发生的可能性。

Background Social-emotional development plays a nonnegligible and vital role in the healthy growth and future development of infants and toddlers.Objective To investigate the social-emotional status and correlation factors in infants and toddlers in poor rural areas of western China,so as to put forward targeted improvement measures.Methods This study was conducted in June 2012. The participants were the caregivers （n =1328）of infants （aged 3 -20 months）from 78 selected villages governed by 26 towns in 9 national-level poor counties in Liangshan Yi Autonomous Prefecture in Sichuan and Gannan Tibetan Autonomous Prefecture in Gansu by using multi - stage random sampling method. A face - to - face interview was conducted in the caregivers by using the structured questionnaire and Ages ＆amp; Stages Questionnaires：Social Emotional （ASQ：SE）. The structured questionnaire includes the demographic data of infants or toddlers （gender,age,nationality,the number of sibling,vaginal delivery or cesarean section,premature infants or not,birthplace,family subsistence allowances,the history of illness within two weeks,value of the house the family living in）,and demographic information of the mothers of infants or toddlers （occupation, years of schooling, the most appropriate time for initiating breastfeeding, the situation of initiating breastfeeding,whether purchasing books related to infants or toddlers or not）. We recorded the social-emotional status of the infants and toddlers and analyzed the correlation factors by using a multiple linear regression model.Results Atotal of 1328 questionnaires were issued,and both 1302 responsive ones were returned,suggesting that the responsiveness of the survey was 98. 04%,and the final participants were 1302. Status of the infants and toddlers found by the survey：52. 61%（685/1302）of them were male,47. 39% （617/1302 ）were female;30. 18% （393/1302 ）aged from 3 to 8 months,37. 86% （493/1302）aged from 9 to 14 months,31. 95%（416/1302）aged from 15 to 20 months;56. 61%（737/1302）had a history of illness within two weeks,the other 43. 39% （565/1302 ）did not. Status of the mothers of infants or toddlers：in terms of occupation,1179 cases （90. 55%）were engaged in agriculture or looked after their children at home,123 cases （9. 45%） worked outside the hometown;991 cases （76. 11%）had less than 9 years of schooling,311 cases （23. 89%）had 9 years or over;breastfeeding should be initiated within the first hour after birth was in line with the thought of 442 cases （33. 95%）, within 2-12 h after birth was in line with the view of 372 cases （28. 57%）,within 13-24 h after birth was in line with the ideas of 74 cases （5. 68%）,and over 24 h after birth was supported by 414 cases （31. 80%）;445 cases （34. 18%）initiated breastfeeding early,the other 857 cases （65. 82%）did not;53 cases （4. 07%）had purchased books related to infants or toddlers,while 1249 cases （95. 93%）had not. The scores of ASQ：SE were （45. 1 ± 26. 4）（59. 0 ± 30. 3）（61. 5 ± 34. 1） in the infants or toddlers aged 3 -8 months,9 -14 months,and 15 -20 months,respectively. Of the 1302 infants and toddlers,751 （57. 68%）had social - emotional problems,including 190 （48. 35%） in age group of 3 -8 months,309 （62. 68%）in age group of 9 -14 months,and 252 （60. 58%）in age group of 15 -20 months. The correlation factors for ASQ：SE scores are the following：history of illness in infants or toddlers within two weeks （β =7. 62,P 〈0. 001 ）,the occupation of mother （β = -7. 80,P =0. 038 ）,years of schooling of the mother （β = -6. 18,P =0. 020 ）,status of initiating breastfeeding （β= -5. 15,P=0. 011）,and whether the mother purchasing books related to infants or toddlers or not （β=-8.37,P=0.043）.Conclusion The incidence of social-emotional problems in infants and toddlers in poor rural areas of western China is relatively high. History of illness of the infants or toddlers within two weeks,occupation of the mother,years of schooling of the mother,status of initiating breastfeeding,and whether the mother purchasing books related to infants or toddlers are correlation factors for social -emotional problems occurring in infants or toddlers. Therefore,it is suggested that relevant medical workers should attach importance to the above factors,and actively create social and cultural atmosphere suitable for the growth of infants and toddlers,thereby reducing the likelihood of social-emotional problems occurring in them.