我国部分地区留守儿童体质健康现状的系统评价

Physical health status of left-behind children in some rural areas of China:a systematic review

目的系统评价我国部分地区留守儿童体质健康现状,为留守儿童健康保健服务提供循证医学证据。方法计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普及万方数据库中,关于我国留守儿童体质健康现状相关的横断面研究文献。文献检索时间设定为数据库建库至2019年8月。由2位研究人员按照本研究设定的纳入和排除标准,独立筛选文献,并评价文献质量、提取数据,进行交叉核对后,采用RevMan 5.3统计软件,对符合纳入与排除标准文献的儿童体质健康现状指标进行Meta分析。采用美国卫生保健质量和研究机构(AHRQ)推荐的横断面研究评价标准,对纳入文献的方法学质量进行评价。对各研究间的异质性采用I^2检验,若P≥0.10和(或)I^2≤50%,则采用固定效应模型进行Meta分析;若P<0.10和(或)I^2>50%,则采用随机效应模型进行Meta分析。留守儿童体质健康现状评价指标,包括儿童营养性疾病(营养性贫血、营养不良、锌缺乏)检出率,以及生长发育迟缓检出率与体重不达标率。结果①通过文献检索,共计9篇横断面研究文献符合本研究纳入与排除标准,研究对象为14588例来自安徽省、广东省、河南省、湖北省、湖南省、山东省、陕西省的儿童。按照本研究对留守儿童的定义,将其分别纳入留守儿童组(n=8010)与非留守儿童组(n=6578)。②对纳入文献的方法学质量评价结果显示,低质量文献为1篇,中等质量文献为5篇,高质量文献为3篇。③对本研究纳入的儿童健康现状的Meta分析结果显示,营养不良检出率与儿童生长发育迟缓检出率比较,差异均无统计学意义(P>0.05)。留守儿童组儿童的营养性贫血及锌缺乏检出率、体重不达标率,均显著高于非留守儿童组,并且差异均有统计学意义(OR=1.93、1.64、1.22,95%CI:1.20~3.11、1.19~2.27、1.03~1.44,P=0.006、0.003、0.020)。结论我国部分地区留守儿童,较非留守儿童存在更多健康问题,营养性贫血与锌缺乏检出率及体重不达标率更高。本研究受到纳入文献数量和质量的限制,并且各研究间存在异质性,因此尚需开展大样本、多中心、高质量研究,才能全面了解我国留守儿童体质健康现状,更好地为其提供健康保健服务。

Objective To evaluate physical health status of left-behind children in some rural areas of China,and to provide evidence-based medical evidence for left-behind children′s health care services.Methods Cross-sectional studies about physical health status of left-behind children in China were searched from China National Knowledge Infrastructure(CNKI),China Biology Medicine(CBM),VIP,and Wanfang Database.Retrieval time was set from the inception of each database to August 2019.Two researchers independently screened the studies according to the inclusion criteria and exclusion criteria of this study,and evaluated the quality of each literature and extracted data from each literature.After cross-checking by these two researchers,Meta-analysis of physical health status of left-behind children in some rural areas of China was conducted by RevMan 5.3 software.The Agency for Healthcare Research and Quality(AHRQ)recommendation for cross-sectional study analysis criteria was used to evaluate the methodological quality of included literature.I^2 test was used for the heterogeneity analysis among the studies.Fixed effect model Meta-analysis was used when P≥0.10 and/or I^2≤50%,and random effect model Meta-analysis was used when P<0.10 and/or I^2>50%.The evaluation indexes of health situation of left-behind children included detection rate of nutritional diseases(nutritional anemia,malnutrition and zinc deficiency)and detection rate of growth retardation,and rate of underweight.Results①A total of 9 articles involving 14588 cases of children were included.They were from Anhui,Guangdong,Henan,Hubei,Hunan,Shandong,and Shaanxi Province,respectively.According to the definition of left-behind children in this study,they were divided into left-behind children group(n=8010)and non-left-behind children group(n=6578).②The methodological quality evaluation results of included studies showed that there were 1 low-quality study,5 medium-quality studies and 3 high-quality studies.③Meta-analysis showed that there was no statistical difference between two groups in detection rate of malnutrition,and detection rate of growth retardation(P>0.05).The detection rate of nutritional anemia,detection rate of zinc deficiency,and rate of underweight in left-behind children group all were significantly higher than those in non-left-behind children group,and all the differences were statistically different(OR=1.93,1.64,1.22;95%CI:1.20-3.11,1.19-2.27,1.03-1.44;P=0.006,0.003,0.200).Conclusions Current evidence shows that left-behind children still have more health problems than non-left-behind children in parts of China.The detection rates of nutritional anemia and zinc deficiency,and rate of underweight are higher than those of non-left-behind children.However,due to the limitation of quantity and quality of studies included in this research,and the heterogeneity among the studies,large-sample,multi-center and high-quality studies are still needed to conduct to fully grasp the health problems of left-behind children in China,and then providing better health care services for them.