Objectives: To investigate the screening status of warning signs for mental and behavioral development (WS) and influencing factors of infants and young children (IYC) in poverty eliminated regions of Henan Province. Methods: This study was a cross-sectional study. A total of 15 680 IYC aged 6-23 months from 51 poverty eliminated counties in Henan province from June to September of 2023 were selected through a multi-stage random sampling method. IYC's early warning signs were screened using the WS checklist (WSC). Children's socio-demographic characteristics, maternal information, birth status, and illness conditions such as fever and diarrhea within 2 weeks were measured through a uniformly designed questionnaire. All participants also received the measurement of height, weight, and hemoglobin concentration level. Logistic regression model was used to explore the influencing factors of positive WSC and conducted sensitivity analyses. Results: Among the sample of 15 680 IYC, there were 8 462 boys (53.97%) and 7 218 girls (49.03%), with their age of (15±5) months. A total of 291 (1.86%) IYC were positive in WSC. Parenting risk (OR=5.07, 95%CI 3.93-6.52, P<0.001) and preterm birth (OR=1.63, 95%CI 1.06-2.52, P=0.027) were both positively associated with the odds of WSC's positivity. Being girls (OR=0.66, 95%CI 0.52-0.85, P=0.001), age (12-17 months, OR=0.47, 95%CI 0.35-0.62, P<0.001; 18-23 months, OR=0.40, 95%CI 0.30-0.54, P<0.001), and maternal educational level (junior high school, OR=0.46, 95%CI 0.32-0.66, P<0.001; senior high school or vocational high school, OR=0.35, 95%CI 0.23-0.56, P<0.001; college and above, OR=0.36, 95%CI 0.23-0.57, P<0.001) were all negatively associated with the risk of WSC's positivity. Sensitivity analyses demonstrated that, after excluding anemic children, the association between preterm birth and WSC's positivity was not significant (OR=1.54, 95%CI 0.95-2.49, P=0.081). Despite this situation, being girls, age and maternal educational level were still negatively associated with the odds of WSC's positivity (all P<0.05); preterm birth, parenting risk were remained positive associated with the risk of WSC's positivity (all P<0.05) either by excluding children with protein-energy malnutrition or 2-week morbidity, or using prevalence ratio instead of OR. Conclusions: Among the IYC in poverty eliminated regions of Henan Province, the risk of positivity of WSC was higher for those IYC with parenting risk, preterm birth, boys, younger age, and lower maternal education level. These influencing factors, such as gender, age, preterm birth, parenting risk and maternal educational level, were in certain stability across different IYC characteristics and estimation models.
目的： 了解河南省脱贫地区婴幼儿心理行为发育问题预警征象（简称预警征）筛查状况及其影响因素。 方法： 横断面研究，采用多阶段随机抽样方法，2023年6—9月抽取河南省51个脱贫县共计15 680名6~23月龄婴幼儿作为研究对象。使用预警征筛查表对婴幼儿进行筛查。通过统一设计的调查问卷，调查婴幼儿社会人口学特征、母亲资料、出生状况及2周内发热与腹泻等患病情况，并测量婴幼儿身高、体重与血红蛋白水平。使用Logistic回归模型探讨预警征筛查阳性的影响因素，并进行敏感性分析。 结果： 15 680名婴幼儿中男8 462名（53.97%）、女7 218名（49.03%），年龄（15±5）月龄。291名（1.86%）婴幼儿预警征筛查阳性。预警征筛查阳性与养育风险（OR=5.07，95%CI 3.93~6.52，P<0.001）、早产（OR=1.63，95%CI 1.06~2.52，P=0.027）均正相关；与女童（OR=0.66，95%CI 0.52~0.85，P=0.001）、儿童年龄（12~17、18~23月龄：OR=0.47、0.40，95%CI 0.35~0.62、0.30~0.54，均P<0.001）、母亲学历（初中、高中或职高、大专及以上：OR=0.46、0.35、0.36，95%CI 0.32~0.66、0.23~0.56、0.23~0.57，均P<0.001）均负相关。敏感性分析发现，仅剔除贫血儿童后，早产与预警征筛查阳性的关联无统计学意义（OR=1.54，95%CI 0.95~2.49，P=0.081）；剔除蛋白质-能量营养不良与2周患病或使用患病率比代替优势比，女童、年龄、母亲学历与预警征阳性均负相关（均P<0.05）；早产、养育风险与预警征阳性均正相关（均P<0.05）。 结论： 在河南省脱贫地区6~23月龄婴幼儿中，存在养育风险、早产、男童、小月龄、母亲学历低的婴幼儿预警征筛查阳性风险更高。在不同特征婴幼儿及不同效应类型上，性别、年龄、早产、养育风险与母亲学历等因素对婴幼儿预警征筛查阳性的影响具有一定的稳定性。.