贫困农村地区婴幼儿发展现状及风险因素分析的队列研究

Early childhood development and risk factors in rural China： a cohort study

目的 了解贫困农村地区婴幼儿发展现状及其风险因素.方法 采用队列研究,选择2013年4月至2015年10月在秦岭和巴山山区（简称秦巴）农村贫困地区开展的婴幼儿营养健康干预项目中未干预对照组603名婴儿（6 ~12月龄）,建立儿童早期发展研究队列,进行Ⅰ期基线评估,之后每间隔半年进行1次追踪随访,共进行3次（Ⅱ期12 ~18月龄,Ⅲ期18 ~24月龄,Ⅳ期24 ~30月龄）,4期评估均采用问卷调查收集婴幼儿及其家庭基本情况,入户体检评估婴幼儿生长发育以及血红蛋白情况,采用贝利婴幼儿发展量表评估婴幼儿发展情况.利用Logistic回归从婴幼儿、监护人及家庭层面分析影响贫困地区婴幼儿发展现状的风险因素.结果 随访婴幼儿Ⅱ期497名、Ⅲ期483名、Ⅳ期486名.秦巴农村贫困地区婴幼儿Ⅰ期（6 ~12月龄）、Ⅱ期（12 ~18月龄）,Ⅲ期（18 ~24月龄）和Ⅳ期（24 ~30月龄）认知发育迟缓（认知发展指数＜80分）发生率分别为13.4％（81/603）,20.1％（100/497）,42.9％（207/483）和50.4％（245/486）,呈现在随访期间随年龄增加显著升高趋势（x2=233.40,P＜0.01）;运动发育迟缓（运动发展指数＜80分）发生率分别为25.0％（151/603）,26.8％（133/497）,8.3％（40/483）和11.9％ （58/486）,在随访期间呈现随年龄增加显著降低趋势（x2=87.08,P＜0.01）.多因素Logistic 回归分析显示,影响24 ~30月龄幼儿认知发育的主要高危因素是母亲受教育程度≤9年（OR=2.56,P＜0.01）,影响运动发育的主要高危因素是母亲受教育程度≤9年（OR=2.64,P＜0.05）以及生长迟缓（OR=2.95,P=0.07）.结论 秦巴贫困农村地区婴幼儿发展情况,尤其是认知发育情况不容乐观,需要引起高度关注,来自母亲低学历家庭的儿童早期发展状况尤为需要重视.

Objective To investigate the development status and risk factors of infants and toddlers in rural China.Methods In this cohort study,603 infants （6-12 months of age,Phase Ⅰ） in the rural areas of QinLing-Bashan （Qin-Ba） in Shaanxi were recruited in the control group that received no intervention from April 2013 to October 2015.Three follow-up visits were performed every six months （Phase Ⅱ （12-18 months of age）,Phase Ⅲ （18-24 months of age） and Phase Ⅳ（24-30 months of age））.In all the 4 phases （Ⅰ-Ⅳ）,general data of the children and the families were collected by questionnaires,early childhood growth and development were assessed by door to door visits,children＇s hemoglobin levels were determined by laboratory tests,and the cognitive and motor development screening was conducted by the Bayley Scales of Infant and Toddler Development.Logistic regression was used to analyze the risk factors affecting the development of infants and toddlers in rural areas and the data were analyzed in terms of risk factors from infants,guardians and family.Results Phase Ⅱ,Phase Ⅲ and Phase Ⅳ survey recruited 497,483 and 486 participants respectively.The incidences of cognitive impairment （mental development scores〈80） in rural areas of southern Shaanxi were 13.4% （81/603） in Phase Ⅰ （6-12 months）,20.1%（100/497） in Phase Ⅱ （12-18 months）,42.9% （207/483） in Phase Ⅲ（18-24 months） and 50.4%（245/486） in Phase Ⅳ（24-30 months） respectively,which showed a significant increase with age （x2=233.40,P〈0.01）;the incidences of psychomotor impairment （psychomotor development scores〈80） of Phase Ⅰ,Phase Ⅱ,Phase Ⅲ and Phase Ⅳ were 25.0% （151/603）,26.8% （133/497）,8.3% （40/483） and 11.9% （58/486）,which showed a significant decrease with age （x2=87.08,P〈0.01）.Multivariate logistic regression analysis showed that the leading risk factor of the cognitive development of 24-30-month-old children was the mothers＇ poor education background （≤9 years of school education） （OR=2.56,P〈0.01）,and the main risk factors affecting psychomotor development were the mothers＇ poor education background （≤9 years of school education） （OR=2.64,P〈0.05） and growth retardation （OR=2.95,P=0.07）.Conclusions The early childhood development （especially cognitive development） in the rural areas of Qin-Ba in Shaanxi of China is not optimistic.More attention should be paid to the early childhood development in rural China,especially to the developinent of children from the mothers with poor education background.