婴幼儿家庭养育状况研究
摘要
[目的]
0-2岁是儿童发育的关键时期,是儿童体格发育、智力发展的重要时期,并为一生的发展奠定基础。家庭护理、家庭环境及养育是影响儿童早期发展的重要因素。目前国内此类研究相对较少。研究儿童家庭护理和家庭环境将有助于提高父母的养育知识和养育技能。因此,本研究旨在研究目前家庭护理和家庭养育环境,以期发现养育的潜在领域并在未来进行大力发展。
[方法]
选取北京、长治、黄冈、苏州、南宁做为研究地。婴幼儿年龄在0-24月龄。研究方法包括问卷调查、专题小组讨论、家庭访视和实验研究。调查内容包括：①一般情况,包括月龄、性别、居住地、母亲教育程度；②喂养,母乳喂养、辅食添加情况；③睡眠,夜间睡眠时间、入睡习惯及睡眠方式。④健康状况,包括既往患病情况、疫苗接种和健康体检及家长对于儿童常见病症的知晓情况；⑤意外伤害,意外伤害发生率、意外伤害类型；⑥尿布使用情况,使用的尿布类型、换尿布频率、尿布疹及相关危险因素,不同类型尿布对于皮肤pH和细菌的影响；⑦皮肤清洁包括洗澡频率和皮肤清洁方式。
调查员均为儿童保健医生,采用面对面访谈法。结果用SPSS14.0进行分析,对调查对象的相关研究因素的流行病学特征进行统计描述,计数资料和计量资料分别用χ2,方差分析和t检验比较组间差异,单因素和多因素Logistic回归分析研究0-24月龄婴幼儿尿布疹危险因素。以P=0.05为显著性检验水平。
[结果]
①参加本次调查的婴幼儿共1036人,其中男604人(58.3%),女432人(41.7%)。0-6月303人(29.2%),7-12月322人(31.1%),13-18月237(22.9%),19～24月174人(16.8%)。受访婴幼儿平均月龄为11.35±6.50。640人(61.8%)居住于城市,197人(19.0%)居住于农村,199人(19.2%)属外来务工。
②喂养：受访婴幼儿4个月纯母乳喂养率为55.2%,6个月纯母乳喂养率降至19.0%。断奶月龄中位数是8个月,断奶的主要原因是“母乳不足”,“家长认为应该断奶了’和“母亲上班”。0-5月婴幼儿中辅食添加率为29.9%,6个月为93.5%,7-24月以上99.6%；添加率最高的辅食是蛋类、谷类、水果和蔬菜。在肉类、鱼虾类辅食添加率上,城市显著高于农村和外来务工(P<0.05)。
③睡眠：0-24月龄婴幼儿平均夜间睡眠时间是(9.744±1.12)h,城市和农村间无差异(P>0.05),不同年龄段间和性别间亦无统计学差异。81.5%的婴幼儿与母同睡,城市、农村和外来务工间均存在统计学差异。睡眠习惯上,39.8%可以自己入睡。
④健康状况：受访婴幼儿疫苗接种率和健康体检率分别为96.6%和87.7%；家长对于疾病的认知情况同孩子的患病情况相一致。
⑤意外伤害：0-24月龄婴幼儿意外伤害的发生率是36.4%,男童为37.6%,女童为34.7%,性别间无统计学差异；城市(39.1%)和农村(40.1%)间无统计学意义(P>0.05)；意外伤害呈现随月龄的增加而增高的趋势,0-6月组意外伤害发生率为10.9%,显著低于7-12月组(41.3%)、13-18月组(51.1%)和19-24月组(51.7%),19-24月组意外伤害发生率最高；意外伤害发生的类型由高到低依次是：86.2%曾跌落,19.4%夹到手,8.5%烫伤,5.0%被尖物刺伤,0.5%其他意外。
⑥尿布使用：尿布疹的患病率是43.8%。本研究中,单因素分析：研究地区、年龄、居住地、辅食、腹泻、尿布类型、每天换尿布次数、皮肤清洁方式和每周洗澡次数与尿布疹有显著关系(P<0.05)。多因素条件logistic回归分析结果显示,每天换尿布次数(OR,0.718；95%CI,0.568-0.909)和辅食(鸡蛋)(OR,0.419；95%CI,0.187-0.941)是尿布疹的保护性因素,而研究地区(长治：OR,2.978,95%CI,1.484-5.976；黄冈：OR,5.308,95%CI,2.583-10.908；苏州：OR,3.197,95%CI,1.671-6.117；南宁：OR,7.730,95%CI,3.973-15.041)、腹泻(OR,2.443；95%CI,1.464-4.076)是危险因素。抽取120人进行微生物检测,布尿布组总菌落数和金黄色葡萄球菌检出率显著高于纸尿裤组,其他无显著性。布尿布组婴儿皮肤pH值高于纸尿裤组；pH值在性别间无差异。
[结论]
①调查地区纯母乳喂养率较低,母乳喂养持续时间短。研究表明与缺乏喂养技能、辅食添加过早、产假短和缺乏社区支持相关。
②辅食质量差、添加时间不合理,需增加营养丰富的辅食。辅食添加过早或过晚均会影响孩子的生长发育。
③疫苗接种率和健康体检率均达较高水平,表明这些策略在中国得到成功推广并被大多数的父母接受。
④0-24月龄婴幼儿平均夜间睡眠时间是(9.74±1.12)h,与父母同睡比例较高。睡眠对于2岁以内的儿童,不仅关乎体格生长而且也是智能发育的重要保障。儿童睡眠问题应引起儿科医生、儿童保健医务人员以及家长的高度重视,控制危险因素,以提高儿童睡眠质量。
⑤受访婴幼儿意外伤害率较高,而且以跌落、夹到手和烫伤为主。应采取有效的干预措施,减少意外伤害发生率。对父母及看护人进行儿童意外伤害的健康教育,提高对伤害的认知。
⑥尿布疹在婴幼儿中仍很普遍。影响尿布疹的因素众多,其中腹泻是尿布疹的重要危险因素值得关注,而每天换尿布6次以上时尿布疹的患病率显著下降。本研究对尿布疹危险因素的探讨为尿布疹的防治提供了科学依据。布尿布对皮肤表面细菌有影响；而使用纸尿裤的婴儿其皮肤更干爽,细菌数量更接近非尿布覆盖区皮肤。使用布尿布的婴儿其皮肤pH值较高。皮肤表面pH值是皮肤生理指标之一,将其维持在生理水平对于保持皮肤健康和防治某些皮肤病有重要的指导意义。
⑦本研究表明,在家庭护理中应加强婴幼儿个人卫生,如洗澡、洗手、皮肤清洁及换尿布等。缺乏育儿技能和知识仍是一个突出问题。因此,编制家庭养育宣传材料和家庭教育项目是加强婴幼儿家庭护理的重要策略。
[Objectives]
Young children aged from0to2years are the critical period for physical and mental development, which would build a foundation for lifetime. Home care and home environment, as well as parenting have been recognized as the important factors related to early childhood development. Not many studies on home care and parenting were carried out so far in China. Understanding the current situation of home care and home environment will be useful and valuable to find the appropriate ways to improve parents' knowledge and skills of parenting. Therefore, a study on home care and parenting was carried out. The aim of the study was to investigate the current situation of home care and home environment, and to find the potential areas of parenting, which could be improved in the near future.
[Methods]
The children and their families to be investigated in this study were from five cities, including Beijing, Changzhi (Shanxi province), Huanggang (Hubei province), Suzhou (Jiangsu province), Nanning (Guangxi province). The age of the children was from0to24months. The methods of questionnaire, focus group discussion, home visiting and laboratory tests of bacteria were carried out in this study.
Survey contents included:①Socio-demographic characteristics of the participants, including age, sex, home sites, and maternal education level.②feeding, including breastfeeding, complementary feeding.③Sleep, including night sleep time, sleep location, sleep habit.④States of health, vaccination, physical examination, parents' knowledge about common childhood symptom.⑤Injuries, including the overall injury prevalence rate, categories of injuries.⑥Diaper practice, including type of diaper, frequency of diaper change, diaper dermatitis and its risk factors. Bacteria and PH of skin were tested to compare the influence of different diapers.⑦Skin cleaning, including frequency of shower, skin cleansing and agents.
The participants were underwent interview face-to-face by trained child health workers. All analyses were completed by using SPSS for WINDOWS14.0(SPSS Inc, Chicago). Descriptive statistics was used to describe the epidemiological characteristics of study factors of participants. Chi-square test, ANOVE and T-test were used to compare the difference between group, for categorical and numeric variables, respectively. Univariate and multivariate logistic regression analysis were used to test association between diaper dermatitis and risk factors for children aged0to24months. Values were considered significant at P=0.05.
[Results]
①Total of1036children and their families were recruited in the study. Of them,58.3%(604) were boys,and41.7%(432).were girls.29.2%(303) were age from0to6months,31.1%(322) were from7to12months of age,22.9%(237) were from13to18months of age and19.2%(174) were from19to24months of age. The average age of these children was11.35±6.50months. Of1036recruited children,197were in the rural areas,640were in the urban areas and migrant population were199.
②Feeding:The rate of exclusive breastfeeding in first4months was55.2%, but the rate of exclusive breastfeeding quickly decreased to19.0%at the age of6months. The median of weaning age was at8months. The main reasons of early weaning were "insufficient breast milk secretion","parents'misunderstanding of weaning time","mothers returning to work" and "early complementary food supplement".29.9%of infants aged0-5months had received complementary food,93.5%of infants aged6months and99.6%of infants aged7-24months. The most popular complementary foods were eggs, cereals, fruits and vegetables. Comparing with rural and migrant infants, urban infants were significantly higher on eating meat and fishes (P<0.05).
③The sleep time at night of infants aged0to24months was9.74±1.12hours. There was no difference between the rural and urban (P>0.05). Also, no differences were detected for night sleep time according to the infants'sex and age.81.5%of infants shared bed with parents, and there was a statistically significant difference among rural, urban and migrant infants. In sleep habit,39.8%of infants slept without help.
④General state of health:Vaccination rate and physical examination rate were96.6%and87.7%respectively. Parents' knowledge on common childhood symptom was accordance with infants' health states.
⑤Injuries:The overall injury prevalence rate of children aged0to24months was36.4%. There was no significant difference between boys (37.6%) and girls (34.7%), and also no difference between the urban (39.1%) and the rural (40.1%). The prevalence rate of injury increased with age. The overall injury prevalence rate at the age group of0-6months was10.9%and was significantly lower than the age group of7-12months (41.3%); the rate at the age group of13-18months was51.1%, and the highest rate was found at the age group of19-24months (51.7%)(P<0.05). The results showed the highest frequency was at19to24months of age group. The prevalence of categories of injuries from high to low were fall (86.2%), crash (19.4%), bums (8.5%), cutting and piercing (5.0%), others (0.5%).
⑥Diaper practice:43.8%of infants had experienced diaper dermatitis. Univariate analysis showed that the following factors related to dermatitis, including age, home sites, solid foods (cereals, fish, and eggs), diarrhea, type of diaper worn, and frequency of diaper change, skin cleansing agents, and frequency of shower. Subsequently, multivariate analysis showed the risk of diaper dermatitis was significantly decreased by solid foods (eggs)(OR,0.419;95%CI,0.187-0.941) and frequency of diaper change (OR,0.718;95%CI,0.568-0.909), whereas the risk was increased for diarrhea (OR,2.443;95%CI,1.464-4.076) and living area. The results of tests of skin bacterial colony and pH in babies using different types of diapers showed that the mean number of total bacterial colony and Staphylococcus aurous of babies wearing cloth diapers were higher than those wearing disposable diapers. Significantly higher pH value was detected at the suprapubic area in infants wearing disposable diapers than cloth diapers. No differences were noticeable for pH value according to the infants'.
[Conclusions]
①The rate of exclusive breastfeeding in study areas was still lower, and the duration of breastfeeding was shorter. The reasons of those, shown by this study, included skills of breastfeeding, early complementary food supplement, shorter maternal leaving and less community supports.
②Problems of complementary feeding included introducing complementary foods in improper time or feeding low-energy-density foods, and further effort would be needed to reinforce complementary feeding with nutrition-enhanced weaning food. Inappropriate complementary feeding, for example, too early or too late, is also harm to the growth of children.
③High coverage of vaccination and routine health examination were indicated by this study that means that those programs have been successfully implemented in China and accepted by most of parents.
④The night sleep time of infants aged0-24months was9.74±1.12hours, and the rate of bed-sharing was high. For infants under2years of age, sleep not only has effects on physical growth but intellectual development. To improve infants sleep quality, the sleep problems should be recognized early and paid more attention to by the pedestrians, the child health care staff and children's parents.
⑤The overall injury prevalence rate of children aged0-24months was still at a high level. The main categories of unintentional injury were fall, crash and burns. Effective interventions for unintentional injury should be explored to reduce the prevalence of it. Parents and caregivers should be provided education to increase the awareness of prevention and cognition to control the injury.
⑥Diaper dermatitis was still a problem among young babies. Diarrhea was a major risk factor of diaper dermatitis. Incidence of diaper dermatitis was significantly decreased by diapering children more than6times everyday. Confirmation of these risk factors could lead to better understand the etiology of diaper dermatitis and propose new strategies of diaper dermatitis prevention for infants in China. The use of disposable diapers could keeps skin drier resulted in numbers of organisms closer to those of undiapered skin. Infants wearing cloth diaper had a higher pH value. pH value is one of the physiology parameters of skin. Maintaining an appropriate physiological skin surface pH is effective approach for keeping skin healthy and prevention and treatment of some skin disorders.
⑦The results of this study indicated that more attention of home care should be paid to babies' personal sanitation, such as bath, hand washing, skin cleaning, and frequent change of diaper. Limitation of parenting knowledge and skills is still one of the problems related to home care and home environment. It is strongly suggested by this study that to develop training materials and family education programs of parenting would be one of the most important strategy of child health care.
0-2岁是儿童发育的关键时期,是儿童体格发育、智力发展的重要时期,并为一生的发展奠定基础。家庭护理、家庭环境及养育是影响儿童早期发展的重要因素。目前国内此类研究相对较少。研究儿童家庭护理和家庭环境将有助于提高父母的养育知识和养育技能。因此,本研究旨在研究目前家庭护理和家庭养育环境,以期发现养育的潜在领域并在未来进行大力发展。
[方法]
选取北京、长治、黄冈、苏州、南宁做为研究地。婴幼儿年龄在0-24月龄。研究方法包括问卷调查、专题小组讨论、家庭访视和实验研究。调查内容包括：①一般情况,包括月龄、性别、居住地、母亲教育程度；②喂养,母乳喂养、辅食添加情况；③睡眠,夜间睡眠时间、入睡习惯及睡眠方式。④健康状况,包括既往患病情况、疫苗接种和健康体检及家长对于儿童常见病症的知晓情况；⑤意外伤害,意外伤害发生率、意外伤害类型；⑥尿布使用情况,使用的尿布类型、换尿布频率、尿布疹及相关危险因素,不同类型尿布对于皮肤pH和细菌的影响；⑦皮肤清洁包括洗澡频率和皮肤清洁方式。
调查员均为儿童保健医生,采用面对面访谈法。结果用SPSS14.0进行分析,对调查对象的相关研究因素的流行病学特征进行统计描述,计数资料和计量资料分别用χ2,方差分析和t检验比较组间差异,单因素和多因素Logistic回归分析研究0-24月龄婴幼儿尿布疹危险因素。以P=0.05为显著性检验水平。
[结果]
①参加本次调查的婴幼儿共1036人,其中男604人(58.3%),女432人(41.7%)。0-6月303人(29.2%),7-12月322人(31.1%),13-18月237(22.9%),19～24月174人(16.8%)。受访婴幼儿平均月龄为11.35±6.50。640人(61.8%)居住于城市,197人(19.0%)居住于农村,199人(19.2%)属外来务工。
②喂养：受访婴幼儿4个月纯母乳喂养率为55.2%,6个月纯母乳喂养率降至19.0%。断奶月龄中位数是8个月,断奶的主要原因是“母乳不足”,“家长认为应该断奶了’和“母亲上班”。0-5月婴幼儿中辅食添加率为29.9%,6个月为93.5%,7-24月以上99.6%；添加率最高的辅食是蛋类、谷类、水果和蔬菜。在肉类、鱼虾类辅食添加率上,城市显著高于农村和外来务工(P<0.05)。
③睡眠：0-24月龄婴幼儿平均夜间睡眠时间是(9.744±1.12)h,城市和农村间无差异(P>0.05),不同年龄段间和性别间亦无统计学差异。81.5%的婴幼儿与母同睡,城市、农村和外来务工间均存在统计学差异。睡眠习惯上,39.8%可以自己入睡。
④健康状况：受访婴幼儿疫苗接种率和健康体检率分别为96.6%和87.7%；家长对于疾病的认知情况同孩子的患病情况相一致。
⑤意外伤害：0-24月龄婴幼儿意外伤害的发生率是36.4%,男童为37.6%,女童为34.7%,性别间无统计学差异；城市(39.1%)和农村(40.1%)间无统计学意义(P>0.05)；意外伤害呈现随月龄的增加而增高的趋势,0-6月组意外伤害发生率为10.9%,显著低于7-12月组(41.3%)、13-18月组(51.1%)和19-24月组(51.7%),19-24月组意外伤害发生率最高；意外伤害发生的类型由高到低依次是：86.2%曾跌落,19.4%夹到手,8.5%烫伤,5.0%被尖物刺伤,0.5%其他意外。
⑥尿布使用：尿布疹的患病率是43.8%。本研究中,单因素分析：研究地区、年龄、居住地、辅食、腹泻、尿布类型、每天换尿布次数、皮肤清洁方式和每周洗澡次数与尿布疹有显著关系(P<0.05)。多因素条件logistic回归分析结果显示,每天换尿布次数(OR,0.718；95%CI,0.568-0.909)和辅食(鸡蛋)(OR,0.419；95%CI,0.187-0.941)是尿布疹的保护性因素,而研究地区(长治：OR,2.978,95%CI,1.484-5.976；黄冈：OR,5.308,95%CI,2.583-10.908；苏州：OR,3.197,95%CI,1.671-6.117；南宁：OR,7.730,95%CI,3.973-15.041)、腹泻(OR,2.443；95%CI,1.464-4.076)是危险因素。抽取120人进行微生物检测,布尿布组总菌落数和金黄色葡萄球菌检出率显著高于纸尿裤组,其他无显著性。布尿布组婴儿皮肤pH值高于纸尿裤组；pH值在性别间无差异。
[结论]
①调查地区纯母乳喂养率较低,母乳喂养持续时间短。研究表明与缺乏喂养技能、辅食添加过早、产假短和缺乏社区支持相关。
②辅食质量差、添加时间不合理,需增加营养丰富的辅食。辅食添加过早或过晚均会影响孩子的生长发育。
③疫苗接种率和健康体检率均达较高水平,表明这些策略在中国得到成功推广并被大多数的父母接受。
④0-24月龄婴幼儿平均夜间睡眠时间是(9.74±1.12)h,与父母同睡比例较高。睡眠对于2岁以内的儿童,不仅关乎体格生长而且也是智能发育的重要保障。儿童睡眠问题应引起儿科医生、儿童保健医务人员以及家长的高度重视,控制危险因素,以提高儿童睡眠质量。
⑤受访婴幼儿意外伤害率较高,而且以跌落、夹到手和烫伤为主。应采取有效的干预措施,减少意外伤害发生率。对父母及看护人进行儿童意外伤害的健康教育,提高对伤害的认知。
⑥尿布疹在婴幼儿中仍很普遍。影响尿布疹的因素众多,其中腹泻是尿布疹的重要危险因素值得关注,而每天换尿布6次以上时尿布疹的患病率显著下降。本研究对尿布疹危险因素的探讨为尿布疹的防治提供了科学依据。布尿布对皮肤表面细菌有影响；而使用纸尿裤的婴儿其皮肤更干爽,细菌数量更接近非尿布覆盖区皮肤。使用布尿布的婴儿其皮肤pH值较高。皮肤表面pH值是皮肤生理指标之一,将其维持在生理水平对于保持皮肤健康和防治某些皮肤病有重要的指导意义。
⑦本研究表明,在家庭护理中应加强婴幼儿个人卫生,如洗澡、洗手、皮肤清洁及换尿布等。缺乏育儿技能和知识仍是一个突出问题。因此,编制家庭养育宣传材料和家庭教育项目是加强婴幼儿家庭护理的重要策略。
[Objectives]
Young children aged from0to2years are the critical period for physical and mental development, which would build a foundation for lifetime. Home care and home environment, as well as parenting have been recognized as the important factors related to early childhood development. Not many studies on home care and parenting were carried out so far in China. Understanding the current situation of home care and home environment will be useful and valuable to find the appropriate ways to improve parents' knowledge and skills of parenting. Therefore, a study on home care and parenting was carried out. The aim of the study was to investigate the current situation of home care and home environment, and to find the potential areas of parenting, which could be improved in the near future.
[Methods]
The children and their families to be investigated in this study were from five cities, including Beijing, Changzhi (Shanxi province), Huanggang (Hubei province), Suzhou (Jiangsu province), Nanning (Guangxi province). The age of the children was from0to24months. The methods of questionnaire, focus group discussion, home visiting and laboratory tests of bacteria were carried out in this study.
Survey contents included:①Socio-demographic characteristics of the participants, including age, sex, home sites, and maternal education level.②feeding, including breastfeeding, complementary feeding.③Sleep, including night sleep time, sleep location, sleep habit.④States of health, vaccination, physical examination, parents' knowledge about common childhood symptom.⑤Injuries, including the overall injury prevalence rate, categories of injuries.⑥Diaper practice, including type of diaper, frequency of diaper change, diaper dermatitis and its risk factors. Bacteria and PH of skin were tested to compare the influence of different diapers.⑦Skin cleaning, including frequency of shower, skin cleansing and agents.
The participants were underwent interview face-to-face by trained child health workers. All analyses were completed by using SPSS for WINDOWS14.0(SPSS Inc, Chicago). Descriptive statistics was used to describe the epidemiological characteristics of study factors of participants. Chi-square test, ANOVE and T-test were used to compare the difference between group, for categorical and numeric variables, respectively. Univariate and multivariate logistic regression analysis were used to test association between diaper dermatitis and risk factors for children aged0to24months. Values were considered significant at P=0.05.
[Results]
①Total of1036children and their families were recruited in the study. Of them,58.3%(604) were boys,and41.7%(432).were girls.29.2%(303) were age from0to6months,31.1%(322) were from7to12months of age,22.9%(237) were from13to18months of age and19.2%(174) were from19to24months of age. The average age of these children was11.35±6.50months. Of1036recruited children,197were in the rural areas,640were in the urban areas and migrant population were199.
②Feeding:The rate of exclusive breastfeeding in first4months was55.2%, but the rate of exclusive breastfeeding quickly decreased to19.0%at the age of6months. The median of weaning age was at8months. The main reasons of early weaning were "insufficient breast milk secretion","parents'misunderstanding of weaning time","mothers returning to work" and "early complementary food supplement".29.9%of infants aged0-5months had received complementary food,93.5%of infants aged6months and99.6%of infants aged7-24months. The most popular complementary foods were eggs, cereals, fruits and vegetables. Comparing with rural and migrant infants, urban infants were significantly higher on eating meat and fishes (P<0.05).
③The sleep time at night of infants aged0to24months was9.74±1.12hours. There was no difference between the rural and urban (P>0.05). Also, no differences were detected for night sleep time according to the infants'sex and age.81.5%of infants shared bed with parents, and there was a statistically significant difference among rural, urban and migrant infants. In sleep habit,39.8%of infants slept without help.
④General state of health:Vaccination rate and physical examination rate were96.6%and87.7%respectively. Parents' knowledge on common childhood symptom was accordance with infants' health states.
⑤Injuries:The overall injury prevalence rate of children aged0to24months was36.4%. There was no significant difference between boys (37.6%) and girls (34.7%), and also no difference between the urban (39.1%) and the rural (40.1%). The prevalence rate of injury increased with age. The overall injury prevalence rate at the age group of0-6months was10.9%and was significantly lower than the age group of7-12months (41.3%); the rate at the age group of13-18months was51.1%, and the highest rate was found at the age group of19-24months (51.7%)(P<0.05). The results showed the highest frequency was at19to24months of age group. The prevalence of categories of injuries from high to low were fall (86.2%), crash (19.4%), bums (8.5%), cutting and piercing (5.0%), others (0.5%).
⑥Diaper practice:43.8%of infants had experienced diaper dermatitis. Univariate analysis showed that the following factors related to dermatitis, including age, home sites, solid foods (cereals, fish, and eggs), diarrhea, type of diaper worn, and frequency of diaper change, skin cleansing agents, and frequency of shower. Subsequently, multivariate analysis showed the risk of diaper dermatitis was significantly decreased by solid foods (eggs)(OR,0.419;95%CI,0.187-0.941) and frequency of diaper change (OR,0.718;95%CI,0.568-0.909), whereas the risk was increased for diarrhea (OR,2.443;95%CI,1.464-4.076) and living area. The results of tests of skin bacterial colony and pH in babies using different types of diapers showed that the mean number of total bacterial colony and Staphylococcus aurous of babies wearing cloth diapers were higher than those wearing disposable diapers. Significantly higher pH value was detected at the suprapubic area in infants wearing disposable diapers than cloth diapers. No differences were noticeable for pH value according to the infants'.
[Conclusions]
①The rate of exclusive breastfeeding in study areas was still lower, and the duration of breastfeeding was shorter. The reasons of those, shown by this study, included skills of breastfeeding, early complementary food supplement, shorter maternal leaving and less community supports.
②Problems of complementary feeding included introducing complementary foods in improper time or feeding low-energy-density foods, and further effort would be needed to reinforce complementary feeding with nutrition-enhanced weaning food. Inappropriate complementary feeding, for example, too early or too late, is also harm to the growth of children.
③High coverage of vaccination and routine health examination were indicated by this study that means that those programs have been successfully implemented in China and accepted by most of parents.
④The night sleep time of infants aged0-24months was9.74±1.12hours, and the rate of bed-sharing was high. For infants under2years of age, sleep not only has effects on physical growth but intellectual development. To improve infants sleep quality, the sleep problems should be recognized early and paid more attention to by the pedestrians, the child health care staff and children's parents.
⑤The overall injury prevalence rate of children aged0-24months was still at a high level. The main categories of unintentional injury were fall, crash and burns. Effective interventions for unintentional injury should be explored to reduce the prevalence of it. Parents and caregivers should be provided education to increase the awareness of prevention and cognition to control the injury.
⑥Diaper dermatitis was still a problem among young babies. Diarrhea was a major risk factor of diaper dermatitis. Incidence of diaper dermatitis was significantly decreased by diapering children more than6times everyday. Confirmation of these risk factors could lead to better understand the etiology of diaper dermatitis and propose new strategies of diaper dermatitis prevention for infants in China. The use of disposable diapers could keeps skin drier resulted in numbers of organisms closer to those of undiapered skin. Infants wearing cloth diaper had a higher pH value. pH value is one of the physiology parameters of skin. Maintaining an appropriate physiological skin surface pH is effective approach for keeping skin healthy and prevention and treatment of some skin disorders.
⑦The results of this study indicated that more attention of home care should be paid to babies' personal sanitation, such as bath, hand washing, skin cleaning, and frequent change of diaper. Limitation of parenting knowledge and skills is still one of the problems related to home care and home environment. It is strongly suggested by this study that to develop training materials and family education programs of parenting would be one of the most important strategy of child health care.
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