Maternal and infant health in urban and rural areas in Morocco: Analysis of the preliminary results of the National Survey on Population and Family Health (EPSF 2011)

Background: The last Moroccan population and family health survey (EPSF 2011) was carried out between November 2010 and March 2011. The final report and the whole database are not yet accessible while a preliminary report was released early March 2012. The information given so far does not allow for a complete evaluation of the present health situation in Morocco. However, a partial equity analysis can be devoted to the comparison of health indicators in terms of gender and urban-rural gaps. Method: 1) Questionnaires: a household questionnaire dealt with household characteristics, general health, housing condition and anthropometric data for children less than six years of age. A second questionnaire was devoted specifically to ever married women and dealt with their resources, marriage, reproductive health, family planning, AIDS/SIDA, healthcare and nutrition. 2) Data collection: data were collected through the national survey using a three-stage stratified sampling design to select 640 clusters covering the 16 Moroccan regions. A total of 15,577 households were randomly drawn, providing a sample of 75,061 individuals (51.1% females and 48.9% males) for investigation. 3) Analysis: in this short report, we relied only on partial data released by the Ministry of Health in a preliminary report. We used absolute differences and relative ratios to study the evolution of gender and urban-rural gaps on the basis of socioeconomic indicators. Results and Discussion: The Moroccan population seems to be in the last phase of its demographic transition. The total fertility rate decreased from 5.6 children per woman in 1980 to 2.5 in 2011. The mean age of first marriage went from 24 years for men and 17.5 years for women in 1960 to 31.5 years and 26.3 in 2011 for men and women respectively. The age structure is showing a trend of ageing population. Generally, health indicators related to reproductive and women’s health improved noticeably and consequently, maternal and infant mortality also decreased. However, while these achievements are praiseworthy as national averages, they remain insufficient in terms of equitable healthcare and access to health services since there is still a long way to go in order to reduce the huge gender gaps and rural-urban disparities. Conclusion: In this short report, we showed that, as averages, health indicators improved noticeably during the last decade but gender inequality and urban-rural disparities are still challenging health decision makers. Moroccan health decision makers are urged to adopt an equitable health strategy, starting by giving access to data for analysis, monitoring and evaluation.

乡村家庭处境不利婴幼儿早期教育的困境与出路

乡村家庭处境不利婴幼儿在发展过程中面临多种困境,即家庭环境受限、教育资源匮乏和生态文明失衡。为了走出上述困境,应该建立早期发展政府项目,构建多方参与的利益共同体,优化早期教育内容,创建早期教育数据平台,培养优质早期教育师资和强化乡村处境不利家庭自主参与。

“三孩”政策背景下乡村婴幼儿托育服务体系构建路径探索

为了探索“三孩”政策下乡村婴幼儿托育服务体系的构建路径,基于已有文献对乡村托育服务体系构建的意义展开讨论,并对当前存在的师资水平不高、托育服务数量存在供需矛盾、支持与保障政策缺失及监管机制不完善等现实问题展开剖析。通过深入分析其原因,进而提出要从优化托育师资水平、提升托育质量,创新托育形式、扩大普惠性托育服务供给,完善保障政策、创设良好发展环境,健全监管机制、落实监管责任等四个方面展开思考,以提高乡村婴幼儿照料水平,促进婴幼儿早期发展,实现“幼有所育”“幼有优育”,在缓解乡村父母生育与教养压力的同时推动落实“三孩”政策,助推我国人口增长。

后乡土时代下当代陶瓷婴戏图情感表达研究

陶瓷婴戏图是陶瓷人物图的重要类型之一,以儿童为表现对象。我国已经由乡土时代步入到后乡土时代,基于后乡土时代变迁,以当代陶瓷婴戏图的情感表达为研究对象,通过与传统的对比和对现实的分析阐释当代陶瓷婴戏图情感表达的成因、方式、价值及局限性。基于后乡土时代变迁,当代陶瓷婴戏图情感表达的成因主要是创作者乡愁与怀旧的情感寄托、对平和与宁静的生活向往以及创作区域的乡土性,在内容、技法和思想上采取了契合于后乡土时代的情感表达方式。

母婴健康素养问卷的编制及其在农村孕产妇中的应用

目的:编制适用于农村地区孕产妇的母婴健康素养(maternal and infant health literacy,MIHL)问卷,并在广西灵山县进行应用,为广西壮族自治区农村乃至更广泛的我国农村地区开展有指向性的妇幼健康保健工作提供测评工具和科学依据。方法:通过文献检索和专家讨论,建立MIHL框架体系,并初步确定条目清单,采用德尔菲法确定问卷核心条目。于2022年10月—2023年9月将该问卷应用于灵山县妇幼保健院就诊的1743名孕产妇,同时收集孕产妇的基本信息;采用Cron⁃bach’s α系数和验证性因子分析进行问卷的信效度检验,采用χ^(2)检验对不同组别间MIHL水平进行单因素分析,采用多元logistic回归分析MIHL的影响因素。结果:问卷共包含24个条目,总问卷Cronbach’s α系数为0.719;验证性因子分析结果提示模型拟合良好。应用结果显示,灵山县孕产妇MIHL得分为46分,MIHL具备率为27.25%。多因素分析显示,孕产阶段、产次、文化程度、与配偶关系、与父母关系是MIHL的影响因素。结论:该研究编制的MIHL问卷在农村孕产妇中具备良好的信度和效度,使用该问卷测评得到的灵山县孕产妇MIHL水平较低,需加强健康教育的精准度和实效性,应重点关注孕期阶段、初产、文化程度低、与父母及配偶关系一般的群体。

Knowledge, Attitudes and Practices of Mothers Regarding Exclusive Breastfeeding in Rural Areas of Brobo (Côte d’Ivoire)

Introduction:In C?te d’Ivoire, despite awareness raising among mothers by health authorities and health care providers, the exclusive breastfeeding rate is still low, 23%. This rate seems even lower in rural areas. The objective of the study was to evaluate the knowledge, attitudes and practices of mothers regarding exclusive breastfeeding for the reduction of malnutrition in rural areas. Methods: This was a descriptive and analytical cross-sectional study conducted in Brobo from July to September 2020. It included consenting mothers of infants aged 0 to 24 months. Mothers’ knowledge, attitudes and practice were assessed by an anonymous structured questionnaire with a performance threshold set at 75%. Factors associated with exclusive breastfeeding were investigated by the Chi-square test at the 5% level of significance. Results: The average age of the 183 mothers was 25 years (extremes 13 and 49 years). They were primigravida (33%) and had a low socioeconomic level (84%). The mothers knew the definition of exclusive breastfeeding (33%). They knew that breastfeeding promoted ideal infant growth (64%) and protected against diarrhea and infection (18%). They also knew that breastfeeding reduced the mother’s risk of cancer (16%) and strengthened the mother-infant bond (7%). The mothers interviewed stated that they had put the baby to the breast within the first hour after delivery in 2% and 63% of them gave the baby colostrum. Mothers were confident about breastfeeding (91%) and exclusive breastfeeding until 6 months of age represented 9%. The factor associated with lack of knowledge of exclusive breastfeeding was not attending school (OR 0.26;95%CI 0.14 - 0.48;p < 0.01) and those associated with good practice of exclusive breastfeeding were not attending school (OR 4.94;95%CI 1.09 - 22.21;p = 0.03) and multiparity (OR 0.30;95%CI 0.09 - 0.97;p = 0.04). Conclusion: The mothers interviewed in the rural areas of Brobo have insufficient knowledge, attitudes and practices regarding exclusive breastfeeding. To improve this situation, we recommend capacity building of mothers through awareness raising.

The Issue of Care Given to Premature Infants in the Provincial Hospital Center of Missour

Background: Preterm birth is common in Morocco and it’s around 8%. Several management rules of taking care of preterm infants have been developed but have not been put into action. The geo-graphical inaccessibility to specialized hospitals and the weakness of the reception capacity of the care centers hinder the management of the complications associated with preterm birth. Purpose: The present study is designed to present some epidemiological data of preterm births within the Provincial Hospital Center of Missour during 2012 and to discuss the various problems emerging in the management of treatment and care. Materials and Methods: Retrospective study of preterm births in the maternity ward in the Hospital of Missour during 2012. Results: 37 preterm births among 1121 (3.3%) have been analyzed (51.3% severe premature infants, 45.9% late preterm infants and 2.7% extremely premature infants). 64.2% are originally from difficult areas to reach during winter. All mothers have received upon arrival at the maternity a corticosteroid and calcium antagonists (Adalate*) and an antibiotic treatment to those with a positive infectious anamnesis found in half of the women. We have recorded 3 twin pregnancies and 2 gravidic toxemias. Only 21 babies have been given back to their mothers (namely 56.7%). 5 premature infants (namely 13%) have been referred to the university hospital center of Fez (2 respiratory distress, a malformation and 2 severe premature births) given that there is an absence of a specialized care unit at the hospital, knowing that no baby has received neither surfactant nor caffeine at birth. 14 premature babies (namely 37.8%) have been transferred to the pediatric unit with a total death rate of 16.2% (6 premature) mainly related to neonatal infection and to suffering of the hyaline membranes disease. Conclusion: We emphasize the interest of prevention programs which demand an early diagnosis of preterm birth threats and monitoring high-risk pregnancies, improving the medical care given to low-weight premature by creating “Kangaroo” units at a regional level and the targeting of measures for rural and under-covered areas.

农村0~3岁婴幼儿照护的家庭支持需求分析

提高人口出生率和人口质量是当前我国的一项基本国策,要提升社会的生育意愿,就需要做好家庭婴幼儿照护的支持工作。当前我国农村地区0~3岁婴幼儿照护社会公共服务体系建设还不完善,社会各界对农村家长的照护需求缺乏必要的关注和了解。本研究通过半结构化访谈对河南、江苏、安徽三省33位农村0~3岁婴幼儿家长的照护需求进行调查发现,农村家庭0~3岁婴幼儿照护的支持需求主要体现在婴幼儿养育支持、教育支持和条件性支持三个方面。进一步研究发现,农村家庭在婴幼儿照护过程中对经济、家长教育、心理健康、再就业等方面的条件性支持的需求更为强烈,对家庭内部的协同照护、邻里支持等非正式支持更为偏爱,同时对心理健康的支持也有明显的需求。为提升农村家庭的婴幼儿照护质量,促进婴幼儿身心健康协调以及家庭的可持续发展,政府部门应进一步加强农村婴幼儿照护公共服务体系建设,引导妇联、学校等社团组织和专业机构积极参与农村婴幼儿照护服务,强化新型农村邻里互助组织和互助文化建设。

农村0~3岁婴幼儿父母胜任力测评模型构建及应用

父母胜任力是影响农村0~3岁婴幼儿(以下将“0~3岁婴幼儿”简称为“婴幼儿”)发展的关键要素,关系家庭教育质量和社会公平,而科学有效的测评工具是提升农村婴幼儿父母胜任力的基础。以斯潘塞通用胜任力词典模型为基础,综合采用文献法行为事件访谈法、德尔菲法和问卷法,构建了农村婴幼儿父母胜任力测评模型:Y=0.167A+0.269B+0.244C+0.128D+0.194E。应用该模型对全国2560位农村婴幼儿父母进行测评,结果表明,我国农村婴幼儿父母胜任力总体水平一般且能力堕距明显,在性别、收入和学历、子女数量、地域方面分别存在分工效应、临界点效应、稀释效应和中部塌陷现象。测评模型的实践应用验证了该模型的科学性和可操作性。

城乡居民托育认知水平对其托育服务意愿的影响——基于对浙江省4市的调查

为推进婴幼儿照护服务发展,更好地满足家庭对婴幼儿照护的需求,基于浙江省4个地级市城乡居民的调查数据,利用二元Probit模型,研究城乡居民托育服务认知水平对其托育服务意愿的影响。结果显示:浙江省城乡居民对托育服务认知水平整体偏低,大多数父母并不十分了解托育机构以及相关服务,不同特征群体对托育服务的需求存在较大差异;居民对托育服务认知水平的提升会提高他们对托育服务的意愿,信任程度在城乡居民托育服务认知水平对其托育服务需求行为的关系中存在中介效应,认知水平可通过信任程度对托育服务意愿产生间接影响。有鉴于此,建议拓展媒体宣传渠道,提高居民认知水平;出台相关政策,加大支持力度;推进托育服务供给侧结构性改革,构建特色服务模式。

乡村幼儿教师集体教学活动中教学支持质量的提升策略——基于幼儿多层次支持模型

采用课堂评估计分量表考察乡村幼儿教师集体教学活动中的教学支持质量问题,并以幼儿多层次支持模型为理论基础,探析有针对性的提升策略。调查结果显示:乡村幼儿教师集体教学活动中教学支持水平偏低,质量较差,在概念发展、反馈质量和语言示范维度的得分均较低。深入探究后发现,乡村幼儿园教学管理体系僵化、课程发展模式固化、幼儿教师培训形式单一、教师专业发展动力不足、对边缘儿童补偿机制匮乏是造成乡村幼儿教师教学支持质量提升举步维艰的关键因素。因此,应健全乡村幼儿园课程开发体系,重视乡村幼儿园课程可持续发展,开展乡村幼儿教师分层培训,拓宽教师专业发展视野,同时增加乡村幼儿园教育包容度。

陕西农村社区0～18个月婴幼儿辅食添加现状及健康教育效果评价

目的 了解陕西省农村社区 0～ 18个月婴幼儿辅食添加现状。方法 采用整群随机抽样方法 ,抽取337例 0～ 18个月婴幼儿的母亲 ,对其进行问卷调查。结果 6 9 3%的母亲有一定的辅食添加知识 ,掌握知识的多少与母亲的文化程度 ,家庭经济状况有关。结论 陕西农村社区辅食添加整体情况较差 ,还有待进一步提高 ,可使用“以电视宣传为主 ,村医人际传播为辅”的模式进行教育。

城乡幼儿父母教养方式比较研究

在幼儿教育方式上,城市父母大多数采取以“孩子”为中心的教养方式,而农村父母则大多数采取以“成人”为中心的教养方式;城市的父母在情感温暖和过分干涉方面多于农村父母,农村父母则在惩罚严厉和拒绝否认方面多于城市父母;城市和农村幼儿父母教养方式存在较为一致的四种类型——民主型、纵容型、溺爱型、专断型,其中纵容型的父母教养方式最多。

云南贫困农村婴幼儿喂养方式的现状

目的了解云南贫困农村4个县4种民族婴幼儿喂养的现状。方法采用随机整群抽样法和典型调查法，对3072名3岁以下婴幼儿的喂养情况、体格发育、患病情况进行问卷调查和体检，并对数据进行统计学分析。结果婴幼儿4个月内纯母乳喂养率为31．0％；4～9个月纯母乳喂养并添加辅食的比例为93．5％；20～23个月仍采用母乳喂养为22．7％。3岁以内断奶率为97．6％。影响婴幼儿4个月内纯母乳喂养率的因素为民族地区和剖宫产率。在婴幼儿6个月内已添加谷类、蛋类、奶类、水果蔬菜类的比例为69．6％、23．8％、34．2％、66．4％；在21～24个月还未添加谷类、蛋类、奶类、水果、蔬菜的比例分别为12．5％、52．6％、52．6％、46．0％、38．7％；发育迟缓率非纯母乳喂养组高于4个月内纯母乳喂养组。结论4个县农村婴幼儿纯母乳喂养率较低，辅食添加不合理、儿童辅食添加过早和过晚同时存在。

幼儿游戏:回归自然与回归生活

游戏是幼儿的存在方式,幼儿以游戏的方式与整个世界建立联系,因此教育以游戏的方式存在也是幼儿教育本身的要求。然而在我们近年来的教育中追求"高大全"和尽善美,外在的强加和过度的人为干预,教育脱离了本真的轨道。农村幼儿园游戏活动实践中,游戏观念与具体行动还存在着一定的差距。因此实践游戏回归自然,首先是精神层面上的回归,教育遵循幼儿成长的自然法则,游戏回归童心,回归生活;其次是物质层面上的回归,游戏环境和材料是幼儿游戏的支架,游戏回归大自然。

中部两省农村6个月~2岁婴幼儿贫血状况及影响因素分析

目的了解我国中部地区农村婴幼儿贫血状况,探讨其主要影响因素,为降低农村地区婴幼儿贫血患病率提供科学依据。方法采用多阶段分层随机抽样的方法,抽取湖南和湖北两省＂中澳项目＂6个项目县/市的农村6个月~2岁婴幼儿为研究对象,对其进行体格测量和血红蛋白检测,并对其抚养者进行问卷调查,采用SPSS 12.0进行统计分析。结果 1 461名6个月~2岁婴幼儿的贫血患病率为31.96%,其中有93.15%为轻度贫血。单因素分析结果显示,主要看护人、家庭收入水平、看护人对孩子未来身高有无期望、6月龄以内喂养方式、是否了解监测生长发育的方法、1年以内健康体检次数、泥糊状食物和肉类食物添加时间、是否补充维生素D、每周食用肉类和禽蛋的频率、有无体质量低下和生长迟缓为婴幼儿贫血的影响因素。多因素Logistic回归分析结果显示：生长迟缓、家长对婴幼儿无身高期望是贫血的危险因素;按期体检、6月龄以内喂养方式为混合喂养和人工喂养、食肉及食禽蛋频率高是贫血的保护因素。结论中部两省农村6个月~2岁婴幼儿贫血率较高,贫血程度以轻度为主。加强普及抚养人科学喂养及育儿知识、提高农村地区儿童保健服务水平将有助于降低婴幼儿贫血患病率。

878例0～3岁农村儿童血清25(OH)D水平调查分析

目的了解广州市花都区0~3岁农村儿童维生素D水平及缺乏率,探索解决的对策。方法选取近2015至2016年来花都区人民医院儿童保健科体检的0~3岁的农村儿童878例进行维生素D检测,并调查儿童的相关信息。结果受检的农村儿童中血清25（OH）D的总体水平为（47.02±17.86）ng/ml,不足和缺乏率为18.9%。2~3岁组血清25（OH）D不足和缺乏率为30.1%,缺乏率最高。户外活动时间、维生素D补充剂量是重要影响因素。结论花都区0~3岁农村儿童维生素D不足和缺乏现象普遍存在,应加强宣教,定期检测血清25（OH）D水平,降低维生素D缺乏性佝偻病发病率。

陕西农村婴幼儿家长对喂养的知-信-行现状

目的了解西部贫困地区农村婴幼儿喂养现状和影响家长喂养行为的因素，为进一步进行营养综合干预提供依据。方法在国家级和省级贫困县陕西省商南县，应用自编问卷对2个乡镇的504名儿童及家长进行现况调查；并对35名儿童家长进行访谈及专题小组讨论。结果63.6%的家长认为婴儿6个月内纯母乳喂养好；6个月内纯母乳喂养率为65.3%；46.4%的家长了解正确开始添加辅食的时间。结论6个月婴儿纯母乳喂养率和适时添加辅食率低于同期其他农村地区水平。建议加强对农村妇幼保健人员的培训，更新相关知识，提高健康教育技能；开发适合农村家长的科普书报、杂志等健康教育材料。

我国中西部4省(自治区)农村婴幼儿喂养情况及其影响因素研究

目的了解我国中西部地区农村婴幼儿母乳喂养和辅食添加的现状及其影响因素,为今后有针对性地开展干预提供科学依据。方法采用多阶段分层随机抽样方法,对我国中西部4省(自治区)农村地区1272名婴幼儿进行母乳喂养和辅食添加情况调查。应用SPSS 19.0软件进行分析。结果婴幼儿6个月龄内纯母乳喂养率为70.0%,33.0%的婴幼儿在6个月龄内添加了强化铁米粉。多因素分析,接受过母乳喂养宣传(OR=2.191,95%CI:1.695～2.833)、民族(OR=1.173,95%CI:1.080～1.275)和出生低体重(OR=0.579,95%CI:0.376～0.892)与6个月龄内是否纯母乳喂养有关联;民族(OR=1.141,95%CI:1.047～1.242)和婴幼儿贫血(OR=1.406,95%CI:1.054～1.877)与添加强化铁米粉有关联。结论我国中西部农村地区纯母乳喂养率有待提高,辅食添加不合理,应通过电视、广播、热线电话等方式宣传通俗易懂的科学喂养知识,提高母乳喂养率,促进合理喂养。

农村3-5岁幼儿分享行为的观察研究

分享行为是亲社会行为的一种表现形式,幼儿分享意识和分享行为的发展是幼儿建立良好同伴关系、形成道德的基础。通过创设糖果分享、玩具分享和奖品分享3种情景,对农村3-5岁幼儿的分享行为进行观察与分析。结果显示：农村幼儿的分享水平较低,分享水平随年龄的增长而提高;玩具分享上存在性别和是否独生的差异,不存在年龄差异;糖果分享和奖品分享上存在年龄差异,但不存在性别和是否独生上的差异。基于对农村3-5岁幼儿分享行为的特点分析,进一步提出提高农村幼儿分享水平的建议。