Abstract: Objective To analyze prevalence and determinants of suspect developmental delay (SDD) in Warning Sign for Children Mental and Behavioral Development (WSC-MBD) checklist screening among children under 3 years old in rural China,so as to provide evidence for resource allocation for referral and intervention services,as well as the prevention strategy development. Methods A community based cross-sectional study was conducted from July to September 2016 in two poverty counties in Guizhou and Shanxi provinces separately. Cluster sampling by village was used to select children aged <3 years old and ≥ 3 months old. Age appropriate WSC-MBD was used by face-to-face interview with caregivers of children to detect SDD. Chi-square test and Logistic regression were used to examine the determinants of SDD. Results Total 1 298 children were enrolled,of whom 89(6.9%) children were preterm infants,341(26.3%) children with per capita net income of family less than 2 300 RMB/year,and 559(43.1%) were left-behind. Among all children,126(9.7%) children were detected with SDD,although 71.4% of SDDs were mild with only one abnormal warning sign out of 4 signs in total. Both the univariate and multivariate analysis suggested preterm birth was associated with higher risk of SDD (adjusted OR=2.193,95%CI:1.225-3.927). The prevalence of SDD deceased along with the increase of month age within the same WSC-MBD group (adjusted OR=0.823,95%CI:0.701-0.967). Conclusions WSC-MBD is feasible to detect SDD among children in rural China. The risk of SDD is associated with preterm birth,and sensitive to the small month age difference within the same WSC-MBD group.

Key words: Warning Sign for Children Mental and Behavioral Development, rural China, early childhood development, developmental screening

摘要： 目的 探查农村3岁以下儿童心理行为发育现况及影响因素,了解潜在转诊和干预需求,为制定相关防治策略提供证据支持。方法 本研究采用以社区为基础的横断面调查设计,2016年7-9月在贵州和山西各1个贫困县中以村为单位整群抽样,样本村中所有3岁以下且满3月龄儿童为研究对象,采用相适应年龄组的儿童心理行为发育问题预警征象(预警征)分别进行发育筛查。χ²检验和Logistic回归分别用于发育偏异发生的单因素和多因素分析。结果 本研究共纳入1 298名儿童,其中89例(6.9%)早产儿,341例(26.3%)家庭贫困,559例(43.1%)留守儿童。调查儿童中有126例(9.7%)预警征筛查阳性,即发育偏异。但其中大部分偏异程度较轻,71.4%发育偏异儿童只出现4项中的1项预警征象异常。单因素和多因素分析均表明,早产儿发育偏异风险高于非早产儿(校正OR=2.193,95%CI:1.225~3.927),而且发育偏异发生与预警征问卷年龄组内细微月龄差距有关,组内月龄增大,发育偏异风险降低(校正OR=0.823,95%CI:0.701~0.967)。结论 儿童心理行为发育问题预警征象筛查可以在农村地区3岁以下儿童健康体检时发现发育偏异。发育偏异的发生与早产有关,且对同一预警征问卷组内月龄差异敏感。

关键词: 预警征, 农村, 儿童早期发展, 发育筛查