摘要目的 分析儿童早期发展综合干预策略对改善贫困地区0～35月龄儿童早期家庭养育照护的效果.方法 儿童早期发展综合干预项目(IECD)于2014年开始在4个贫困县农村地区试点开展,通过多种途径为项目地区0～35月龄儿童及其看护人提供儿童养育照护多维度综合干预.采用人群干预对照设计,评价干预对看护人健康与心理、儿童营养、早期学习、儿童保护和社会保障等方面的改善效果,分别于2013年和2016年开展基线和中期调查,采用双重差分模型估计干预效果,并控制社会人口学特征等混杂因素.结果 基线调查纳入0～35月龄儿童干预组1 468名、对照组1 485名,中期调查分别纳入1 384名和1 361名.干预组通过2年的干预,看护人抑郁患病率下降9.1％[中期34.8％ (479/1 377)比基线43.9％ (621/1 414)],对照组下降1.6％[34.3％ (464/1 353)比35.9％(509/1 419)],双重差分模型控制因素混杂后,结果显示干预组下降幅度较同期对照组高7.0％(P=0.008);6～23月龄儿童辅食添加频次合格的比例上升10.4％[69.0％ (532/771)比58.6％(481/821)],对照组上升幅度2.9％[66.4％ (469/706)比63.5％(508/800)],双重差分模型控制混杂因素后,干预组上升幅度比对照组高8.2％(P=0.021);干预组儿童遭受暴力管教的比例下降6.2％ [49.1％ (478/973)比55.3％(554/1 001)],同期对照组上升4.5％[58.4％ (560/959)比53.9％(558/1 036)],双重差分模型控制混杂因素后,两组变化幅度相差11.0％(P=0.001);干预组家庭拥有儿童图书≥3本的比例上升12.7％[42.7％ (588/1 378)比30.0％ (432/1 440)],同期对照组上升幅度4.2％[25.7％ (349/1 357)比21.5％(298/1 388)]双重差分模型控制混杂因素后,干预组比对照组幅度高6.1％(P=0.007).结论 多部门合作儿童早期发展综合干预策略可以有效改善看护人心理状况、促进儿童喂养、支持儿童早期学习,并减少暴力管教等不恰当的养育行为,从而为儿童早期健康发展创造良好养育照护环境.

abstractsObjective To explore whether Integrated Early Childhood Development (IECD) program has effectively improved the nurturing care for children aged 0-35 months in rural China.Methods IECD has been implemented by the government of China with support from the United Nations Children's Fund (UNICEF) in four poverty-stricken rural counties since 2014.The interventions targeting the five key components of nurturing care (i.e.child and caregiver health,child nutrition,early learning support,child protection and social security) were delivered through the IECD program to children aged 0 to 35 months and their caregivers.A population-based intervention trial was designed to evaluate intervention effectiveness with data collected in 2013 (baseline) and 2016 (mid-term).The changes of nurturing care in the intervention and control group were analyzed by using a difference-in-differences (DID) model.This approach provided adjustment for sociodemographic and other confounding factors.Results The baseline and mid-term survey enrolled 1 468 and 1 384 children in the intervention group,and 1 485 and 1 361 in the control group.After two years of implementation,the prevalence of caregiver's depression in the intervention group showed a decrease of 9.1％ (mid-term 34.8％ (479/1 377) vs.baseline 43.9％ (621/1 414)),whereas that in control group showed a decrease of 1.6％ (mid-term 34.3％ (464/1 353) vs.baseline 35.9％ (509/1 419)).With the confounding adjusted in the difference-in-differences model,the decrease of the caregiver's depression prevalence in the intervention group was 7.0％ greater than that in the control group (P=0.008).The qualified rate of minimum meal frequency in the intervention group showed an increase of 10.4％ (mid-term 69.0％ (532/771) vs.baseline 58.6％ (481/821)),whereas the qualified rate in the intervention group showed an increase of 2.9％ (mid-term 66.4％ (469/706) vs.baseline 63.5％ (508/800)).With the confounding adjusted in the difference-in-differences model,the increase of the qualified rate in the intervention group was 8.2％ greater than that in the control group (P=0.021).The proportion of violent discipline by caregivers in the intervention group showed a decrease of 6.2％ (mid-term 49.1％ (478/973) vs.baseline 55.3％ (554/1 001)),whereas the proportion in control group showed an increase of 4.5％ (mid-term 58.4％ (560/959) vs.baseline 53.9％ (558/1 036)),and with the confounding adjusted in the difference-in-differences model,the difference in increase rate between two groups was 11.0％ (P=0.001).The proportion of families with three or more children's books in the intervention group showed an increase of 12.7％ (mid-term 42.7％ (588/1 378) vs.baseline 30.0％ (432/1 440)),whereas the proportion of the control group showed an increase of 4.2％ (mid-term 25.7％ (349/1 357) vs.baseline 21.5％ (298/1 388)),and with the confounding adjusted in the difference-in-differences model,the difference in increase rate between two groups was 6.1％ (P=0.007).Conclusions The IECD intervention strategy implemented in rural China effectively improved the mental health of caregivers,optimizes families' child feeding and early stimulation behaviors,while reducing violent discipline and other risk factors.IECD provides better nurturing care for the early development of children aged 0-35 months in rural China.