As a key indicator of childhood malnutrition, few studies have focused on stunting in relation to various socio-economic factors in which disadvantaged groups face in China. We conducted a community-based cross-sectional study incorporating forty-two rural counties in seven western provinces of China in 2011. In total, 5196 children aged 6-23 months were included. We used Poisson regression to examine risk factors for inadequate minimum dietary diversity (MDD) and stunting status, respectively. Overall, the proportion of children not meeting MDD was 44·5 %. Children aged 6-11 months (adjusted risk ratio (ARR)=1·39; 95 % CI 1·31, 1·49), with two siblings (ARR=1·09; 95 % CI 1·02, 1·17), delivered at home (ARR=1·30; 95 % CI 1·20, 1·41), within Yi (ARR=1·15; 95 % CI 1·04, 1·28) or Uighur groups (ARR=1·52; 95 % CI 1·36, 1·71), with an illiterate caregiver (ARR=2·12; 95 % CI 1·52, 2·96), receiving lowest income (ARR=1·32; 95 % CI 1·17, 1·50), and with breast-feeding in the last day (ARR=1·55; 95 % CI 1·44, 1·66) were more likely to have inadequate MDD. Moreover, inadequate MDD was positively associated with stunting (ARR=1·15; 95 % CI 1·01, 1·31). Other determinants for stunting were age, sex, place of delivery, minority group and income. The stunting prevalence and proportion of inadequate MDD remained high in Western China; to reduce stunting rates of ethnic minorities, further efforts addressing appropriate dietary feeding practices are needed, especially within these groups.

ObjectiveThe aim of this study was to investigate the nutritional status and its risk factors among children under 5 years, with special focus on the coexistence of under and over nutrition in population level.MethodsWe enrolled 6,570 children under 5 years among 26 counties in poor areas of China. Prevalences of malnutrition (stunting, underweight, wasting, overweight) were calculated. Overweight was evaluated using two indicators–weight for height Z score (WHZ) and body mass index for age Z score (BAZ), and results were compared.ResultsThe total prevalence of malnutrition was 19.2%. The prevalence of stunting and overweight were as high as 8.4% and 8.8%, respectively. The BAZ-estimated prevalence of overweight was 9.9%, which was higher than the WHZ-estimated prevalence (p<0.001). Children older than 12 months age, within a minority group, with a caregiver of illiteracy/primary education level were significantly associated with stunting in multilevel regression models (p<0.05). Children younger than 24 months age and boys were significantly associated with overweight (p<0.05).ConclusionsStunting and overweight were coexisted in surveyed areas. In conclusion, BAZ tended to overestimate the overweight prevalence compared with WHZ. While with the raising problem of childhood overweight, stunting should still be on the agenda for the poor areas in China. To improve children’s nutritional status in poor areas of China, caregivers with children at high risk of malnutrition should be guided for healthy feeding practices.

Limited data exist related to low birth weight (LBW) incidence and risk factors in Western China. This paper aims to assess LBW and its relationship with antenatal care (ANC) in the poor counties of Western China. A community-based study in rural Western China was conducted in 2011. A kernel distribution was used to estimate the adjusted LBW incidence, and associations between LBW and socio-demographic or maternal factors were examined using multilevel logistic regression. Among 8,964 participants, 65.7% were weighed at birth. Crude LBW incidence was 6.6% and the adjusted rate was 9.3%. The study revealed that risk factors of LBW are being female, raised within a minority group, and with a family income below the national poverty line. For maternal risk factors, LBW was positively associated with not attending at least five or eight ANC visits, not receiving any ANC during the first trimester, and not having access to assess certain ANC content (weight, blood pressure, blood test, urine test, B-scan ultrasound, and folic acid supplement). There is urgent need to promote quality ANC in poor and rural areas of Western China and to prioritize vulnerable women and children who will benefit from quality ANC.

Background In addition to providing free hepatitis B vaccine (HBvacc) series to all infants in China since 2005, the national programme on prevention of mother-to-child transmission (PMTCT) of hepatitis B virus (HBV) started providing free hepatitis B immunoglobulin for all new-borns born to hepatitis B surface-antigen (HBsAg) positive mothers in 2010. However, few studies have evaluated the effectiveness of the PMTCT programme. Therefore, we aimed to investigate the outcomes of the programme and identify associated factors. Method Using a cross-sectional study design, we collected data on 4112 pairs of HBsAg-positive mothers and their children aged 7–22 months in four representative provinces through interviews and medical record review. We tested HBsAg and hepatitis B surface antibody (anti-HBs) of children by enzyme-linked immunosorbent assay at designated maternal and child hospital laboratories. We used logistic regression to analyse factors associated with child HBsAg and anti-HBs positivity. Results Thirty-five children were HBsAg positive, indicating the mother-to-child transmission (MTCT) rate was 0.9% (0.6–1.1%). The anti-HBs positive rate was 96.8% (96.3-97.4%). Children receiving HBvacc between 12 and 24 h of birth were 2.9 times more likely to be infected than those vaccinated in less than 12 h (adjusted odds ratio [a OR ] = 2.9, 95% confidence interval [ CI ]: 1.4–6.3, P = 0.01). Maternal hepatitis B e-antigen (HBeAg) positivity was associated with higher MTCT rate (a OR = 79.1, 95% CI : 10.8–580.2, P <  0.001) and lower anti-HBs positive rate (a OR = 0.4, 95% CI : 0.3–0.6, P <  0.001). Children with low birth weight (LBW) were 60% less likely to be anti-HBs positive than those with normal birth weight (a OR = 0.4, 95% CI : 0.2–0.8, P = 0.01). Conclusions The MTCT rate was lower than the 2030 WHO elimination goal, which implies the programme is on track to achieve this target. As earlier HBvacc birth dose (HBvcc-BD) was associated with lower MTCT rate, we suggest that the PMTCT programme work with the Expanded Programme on Immunization (EPI) to modify the current recommendation for early HBvcc-BD to a requirement. Our finding that LBW was associated with lower anti-HBs positivity points to the need for further studies to understand factors associated with these risks and opportunities for program strengthening. The programme needs to ensure providing essential test to identify HBeAg-positive mothers and their infants and provide them with appropriate medical care and follow-up. Electronic supplementary material The online version of this article (10.1...

Socio-emotional challenges and development of children left behind by migrant mothers Background With great economic development and rapid urbanization in China, left-behind children whose parents migrate to big cities for job has become a large special population which requires more attention. The present study aims to explore the specific influence of migrant mothers on early child development, especially on social-emotional problems. Methods The data of this study was obtained from a cross-sectional study in 8 counties of central and western rural China. Development status of 1880 children aged <60 months were assessed by Ages & Stages Questionnaire-Chinese Edition (ASQ) and the Ages and Stages Questionnaire: Social Emotional-Chinese Edition (ASQ: SE). Multivariate logistic regressions were used to analyze the association between being left behand by migrant mothers and developmental problems in various domains, while adjusting socio-demographic, socioeconomic and perinatal co-variates, and effect modification analysis were conducted to explore the effect of age, gender and birth order. Results Children left behind by migrant mothers were more likely to have overall suspected developmental delay (odds ratio (OR) = 1.24, 95% confidence interval (CI) = 1.13-1.35), developmental delay in personal social domain (OR = 1.55, 95% CI = 1.17-2.04) and socio-emotional delay compared with those living with their own mothers (OR = 1.49, 95% CI = 1.11-2.00) after adjusting for potential confounders. Additionally, girls increased the odds of social-emotional problems among children being left behind by migrating mother (P for interaction = 0.037). Conclusions The study concluded that children left behind by migrant mothers were more likely to have suspected developmental delay compared with their peers living with mothers, especially on social emotional development. Future intervention is needed for this special population and should pay more attention to girls. Electronic supplementary material: The online version of this article contains supplementary material.