Preplanned Studies: Health Status of Left-Behind Children and Parenting Behaviors of Caregivers in Poor Rural Areas — 6 Provinces, China, 2018

China is experiencing massive population movements from rural to urban areas. In 2015, official estimates suggest there are 68.77 million left-behind children aged 0–17 years old in China, accounting for 25.4% of the entire population of children (1). For left-behind children under the age of 6, the family provides the primary environment for socialization, and family education and healthcare parenting at this stage will affect their future physical and mental health. Some studies showed that children benefited from the allowances their parents sent home. However, some surveys show that the health status of left-behind children is still not adequate and that family separation might have long-term psychological and societal costs. To assess the health status and family support of left-behind children aged 0–6 years old in China, a survey was conducted for left-behind children under 6 years old and their caregivers in 6 project counties of 6 provinces in 2018 based on the Rural Left-Behind Children’s Health and Development Promotion Project, which was implemented in 2016–2020. The prevalence of stunting, being underweight, and often sick were 13%, 3.4%, and 5%, respectively; only 53.9% of left-behind children could eat meat often, and 59.5% could control their intake of sugary drinks. The proportions of children who had a safe home environment, a safe play environment, and no family violence were 22.5%, 75.3%, and 45.9%, respectively. The percentages of caregivers who ensured that they rarely left their children alone and were always in their sight were 76.1% and 92.4%, respectively. Overall, 77.6% were able to maintain hand hygiene in caring for children. The health status of left-behind children and the knowledge and behavior of caregivers still needs to be improved. Early home visits and comprehensive health care services may benefit left-behind children and their families.

The Chinese government conducted the Rural Left-Behind Children’s Health and Development Promotion Project. The purpose of the project is to explore early home visit services and comprehensive healthcare intervention models for left-behind children and their caregivers in rural areas to provide family support and promote the health and development of left-behind children. The project was implemented in Hebei, Henan, Jiangxi, Guizhou, Sichuan, and Shanxi. One low-income county in each province was randomly sampled. Several townships from each project county were selected for investigation. The project started in 2016 and ended in 2020. This cross-sectional survey was conducted in 2018 and was the baseline survey. Ethical approval was obtained from the Peking University Institutional Review Board (No. IRB00001052-17109).

The investigator is the primary staff member in the project counties. Investigators measured the height and weight of left-behind children, and other health indicators were self-reported by the caregivers. According to the home environment risk factor screening form, the investigators observed and evaluated the home environment and recorded and evaluated parent-child interactions and parenting behaviors by questioning caregivers. A stratified analysis was conducted based on age group (<3 years and 3–6 years) and gender (male and female). The determination of stunting and being underweight were based on the World Health Organization (WHO) Child Growth Standard (2). SAS software (version 9.4, SAS Institute, Cary, NC, USA) was used for analysis. Cochran-Mantel-Haenszel χ² tests and Fisher’s exact tests were used for comparison of categorical outcomes. Continuous outcomes were analyzed by using Student’s t-test; P<0.05 were considered to indicate statistical significance.

Table 1 showed the sociodemographic characteristics of left-behind children and caregivers in 6 counties. Overall, 953 children were surveyed in 6 project counties, and the response rate was 100%. Due to the lack of important demographic data, the data of 21 children were withdrawn and 932 children were included in analysis (97.8%). Of these children, 500 (53.6%) were male and 432 (46.4%) were female. The average age of left-behind children was 36.84±17.95 months; 663 (72.1%) children had parents that lived separately and migrated away from the original home; and 767 (82.3%) children had caregivers that were grandparents. The average age of the caregivers was 51.59±12.45 years. Most caregivers were female (81.3%) and had not received high school education or higher (86.1%).

The prevalence of stunting, being underweight, and often sick were 13%, 3.4%, and 5%, respectively. Overall, 59 (6.3%) children were moderately stunted and 62 (6.7%) were severely stunted. No differences in stunting were identified between male and female children(P=0.423); however, the differences between children aged <3 years and 3–6 years old was significant. Furthermore, 21 (2.3%) children were moderately underweight and 10 (1.1%) were severely underweight. No differences were identified between <3 years and 3–6 years old for being underweight. (P=0.468) The differences between male and female was significant (P<0.001) (Table 2).

Table 3 showed the parenting behavior of caregivers in health, nutrition, and family safety. Of the 953 participants, 502 (53.9%) children could eat meat often and 555 (59.5%) could control their intake of sugary drinks. The proportions of children who had safe living environments and safe play environments were 22.5% and 75.3%; 428 (45.9%) children had not experienced family violence; the percentages of caregivers who ensured that they rarely left their children alone and were always in their sight were 76.1% and 92.4%, respectively; and 77.6% of left-behind children could maintain proper hand hygiene.