Rural Western China Research Articles

Diffusion of a micronutrient home fortification program for infants and toddlers in a multi-ethnic population in rural western China

BackgroundThe micronutrient home fortification programs contribute to the prevention of childhood anemia. WHO suggested applying culturally appropriate strategies to implement the micronutrient home fortification programs in various communities. However, there is little knowledge on evidence-based effective diffusion strategies of the micronutrient home fortification programs in multi-ethnic populations. This study aims to examine the diffusion of a micronutrient home fortification program with micronutrient powder (MNP) in a multi-ethnic population by investigating factors associated with being an ‘early’ or a ‘later’ adopter of MNP.MethodsWe conducted a cross-sectional study in rural western China. Multistage sampling was used to select children’s caregivers in Han, Tibetan, and Yi ethnic communities (N = 570). The diffusion of innovations theory informed the data collection on caregivers’ decision process and was applied to classify participants into the MNP adopter categories of ‘leaders’, ‘followers’, ‘loungers’, and ‘laggards’. The ordered logistic regression model estimated the factors associated with the MNP adopter categories.ResultsCaregivers from the Yi ethnic subgroup were likely to adopt MNP relatively late (AOR = 1.67; 95%CI = 1.09, 2.54) compared with Han and Tibetan ethnic subgroups. Caregivers with more knowledge regarding the MNP feeding method (AOR = 0.71; 95%CI = 0.52, 0.97) and those with stronger self-efficacy in adopting MNP (AOR = 0.85; 95%CI = 0.76, 0.96) were more likely to adopt MNP earlier than others. The following messages and channels also tend to make caregivers adopt MNP earlier: hearing that ‘MNP was free’ from villagers (AOR = 0.45; 95%CI = 0.20, 0.98), and learning ‘MNP feeding method’ from township doctors (AOR = 0.16; 95%CI = 0.06, 0.48).ConclusionsDisparities in adopting MNP existing among different ethnic groups require more effective diffusion strategies in disadvantaged minority ethnic groups. Enhancing self-efficacy in adopting MNP and knowledge on feeding method of MNP have the potential to make caregivers adopt MNP earlier. Peer networks and township doctors can be effective agencies to facilitate the diffusion and adoption of MNP.

Asthenopia prevalence and vision impairment severity among students attending online classes in low-income areas of western China during the COVID-19 pandemic.

This study explored the impact of online learning during the coronavirus disease 2019 (COVID-19) pandemic on asthenopia and vision impairment in students, with the aim of establishing a theoretical basis for preventive approaches to vision health. This balanced panel study enrolled students from western rural China. Participant information was collected before and during the COVID-19 pandemic via questionnaires administered at local vision care centres, along with clinical assessments of visual acuity. Paired t tests and fixed-effects models were used to analyse pandemic-related differences in visual status. In total, 128 students were included (mean age before pandemic, 11.82 ± 1.46 years). The mean total screen time was 3.22 ± 2.90 hours per day during the pandemic, whereas it was 1.97 ± 1.90 hours per day in the pre-pandemic period (P<0.001). Asthenopia prevalence was 55% (71/128) during the pandemic, and the mean visual acuity was 0.81 ± 0.30 logarithm of the minimum angle of resolution; these findings indicated increasing vision impairment, compared with the pre-pandemic period (both P<0.001). Notably, asthenopia prevalence increased by two- to three-fold, compared with the pre-pandemic period. An increase in screen time while learning was associated with an increase in asthenopia prevalence (P=0.034). During the COVID-19 pandemic, students spent more time on online classes, leading to worse visual acuity and vision health. Students in this study reported a significant increase in screen time, which was associated with increasing asthenopia prevalence and worse vision impairment. Further research is needed regarding the link between online classes and vision problems.

Sex differences in costly signaling in rural Western China

Costly rituals convey commitment to communities and advertise trustworthiness and cooperativeness to peers, which might explain why humans perform costly religious rituals. Here, we compare the efficacy of occasional public displays versus regular but less public acts for prestige enhancement. We collected data on religious behaviors ranging from daily low-cost practices to infrequent high-cost pilgrimages to distant locations among residents of an agricultural Tibetan village, as well as their reputational standings. We find that religious practices are mediated by demographic factors such as wealth, age and gender. Women perform more daily religious activities, but men engage more in distant pilgrimages. Participation in distant pilgrimages increases the perception of all prosocial characteristics. In contrast, daily practices are positively associated with nominations for devoutness but not for other qualities. Devoutness is sometimes negatively associated with other reputational qualities, suggesting that religiosity might be not only about signaling prosociality.

Effects of Land Transfer on Farmer Households’ Straw Resource Utilization in Rural Western China

With the continuous emphasis of the country on the construction of ecological civilization, promoting the utilization of straw resources has become an important measure to achieve green agricultural development. Based on the survey data of 540 households in Sichuan Province and under the guidance of the theory of planned behavior, this paper constructed the IV-Probit model to explore the impact of land transfer on the straw resource utilization of households. The results show that: (1) land transfer in and land transfer out can significantly promote the utilization of straw resources by farmers. (2) Heterogeneity analysis showed that land transfer in had a positive effect on crop straw utilization of the new generation and large-scale farmers. (3) Land transfer in can promote the utilization of straw resources by improving farmers’ economic cognition and efficacy cognition; land transfer out can promote the utilization of straw resources by improving farmers’ efficacy cognition. Accordingly, the government should improve the land transfer market, increase technology propaganda, and create an excellent policy environment to promote farmers’ participation in straw resource utilization.

Do Primary Healthcare Facilities in More Remote Areas Provide More Medical Services? Spatial Evidence from Rural Western China

Do Primary Healthcare Facilities in More Remote Areas Provide More Medical Services? Spatial Evidence from Rural Western China

Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China.

Improving type 2 diabetes (T2D) care is key to managing and reducing disease burden due to the growing prevalence of diabetes worldwide, but research on this topic, specifically from rural areas, is limited. This study uses standardized patients (SPs) to assess T2D care quality among primary care providers to access the healthcare system in rural China. Using multi-stage random sampling, health facilities, providers, and households were selected. SPs were used to evaluate providers' T2D care quality and a questionnaire survey was used to collect patient sorting behaviors from households. Logistic regression was used to explore factors correlated with T2D care quality. Provider referral and treatment rates were combined with patient sorting behaviors to assess the overall quality of T2D management by rural China's healthcare system. A total of 126 providers, 106 facilities, and 750 households were enrolled into this study. During SP interactions, 20% of rural providers followed the national guidelines for T2D consultation, 32.5% gave correct treatment, and 54.7% provided lifestyle suggestions. Multi-variable regression results showed that providers who had earned practicing certificates (β = 1.56, 95% CI: 0.44, 2.69) and saw more patients (β = 0.77, 95%: 0.25, 1.28) were more likely to use a higher number of recommended questions and perform better examinations, whereas providers who participated in online training were less likely to practice these behaviors (β = -1.03, 95%: -1.95, -0.11). The number of recommended questions and examination (NRQE) was the only significant correlated factor with correct treatment (marginal effect = 0.05, 95%: 0.01, 0.08). Throughout the rural healthcare system, 23.7% of T2D patients were treated correctly. The quality of T2D care in rural western China, especially throughout the consultation and treatment process during a patient's first visit, is poor. Online training may not improve T2D care quality and low patient volume was likely to indicate poor care quality. Further research is needed to explore interventions for improving T2D care quality in rural China's healthcare system.

Effects of antenatal micronutrient supplementation regimens on adolescent emotional and behavioral problems: A 14-year follow-up of a double-blind, cluster-randomized controlled trial

Antenatal multiple micronutrient supplementation has been shown to have beneficial effects on birth outcomes and may improve child development. However, whether there is an effect of antenatal micronutrient supplementation strategies on offspring socioemotional outcomes remains unknown. We aimed to examine the effect of antenatal folic acid (FA), iron-folic acid (IFA), and multiple micronutrient (MMN) supplementation on adolescent emotional and behavioral outcomes. We conducted a double-blind, cluster-randomized trial of antenatal micronutrient supplementation in rural western China between 2002 and 2006. Pregnant females were randomized by village to receive either daily (i) 400μg FA, (ii) IFA containing 60mg iron and 400μg FA or (iii) MMN supplementation containing 30mg iron, 400μg FA plus 13 additional vitamins and minerals. A 14-year follow-up of their offspring was conducted in 2016. Adolescents were administered the locally adapted Youth Self-Report-2001 (YSR-2001) which produced internalizing, externalizing, and total behavior problem scores. We applied generalized estimating equations to assess the effect of the randomized regimens on YSR-2001 scores and explored the potential effect modification by household wealth and initial timing and duration of supplementation. A total of 1920 adolescents were included in the analysis, 1130 (58.9%) were male, and the mean (SD) age was 11.8 (0.78) years. Adolescents in IFA group had lower total (mean difference (MD):-2.89; 95% CI -5.73,-0.04) and externalizing (MD:-0.97; 95% CI -1.79,-0.15) problem scores as compared to those in FA group. There was no effect of MMN on behavior problem scores as compared to IFA and FA alone. Although, in effect modification analyses, MMN appeared to have greater beneficial effects in wealthier households than IFA and FA alone. Iron supplementation during pregnancy reduced adolescent emotional and behavioral problem scores which provides additional support for expanding coverage of iron-containing prenatal supplements in resource-limited settings. isrctn. org Identifier: ISRCTN08850194.

Adherence to micronutrient powder for home fortification of foods among infants and toddlers in rural China: a structural equation modeling approach

BackgroundThe WHO recommends daily use of micronutrient powder for infants and toddlers at risk of micronutrient deficiencies in low-and-middle-income countries. China has established a micronutrient powder distribution program in many rural townships and villages, yet adherence to micronutrient powder remains suboptimal; a little is known about the behavioral inputs that may influence adherence. This study examines direct and indirect behavioral inputs in micronutrient powder adherence among caregivers in rural western China following the Integrated Behavioral Model (IBM) framework.MethodsCross-sectional data were collected from April to May 2019 among 958 caregivers of children aged 6 to 24 months in six counties. Data were collected on micronutrient powder adherence behavior, direct behavioral inputs (knowledge and skills, intention, salience, environmental constraints, and habits), and indirect behavioral inputs (attitudes, perceived social norms, and personal agency). Structural equation modeling (SEM) adjusted for sociodemographic covariates was used to evaluate the IBM framework.ResultsMean micronutrient powder adherence in the previous seven days was 53.02%, and only 22.86% of caregivers consistently fed micronutrient powder from the start of micronutrient powder distribution at six months of age. The SEM model revealed small- to medium-sized effects of salience (β = 0.440, P < 0.001), intention (β = 0.374, P < 0.001), knowledge and skills (β = 0.214, P < 0.001), personal agency (st. effect = 0.172, P < 0.001), environmental constraints (β=-0.142, P < 0.001), and caregiver generation (β = 0.119, P < 0.05) on micronutrient powder adherence. Overall, 54.7% of the variance in micronutrient powder adherence was explained by the IBM framework. Salience had the largest impact on micronutrient powder adherence (Cohen’s f2 = 0.227). Compared to parent caregivers, grandparents had a higher degree of micronutrient powder adherence on average (P < 0.001), and behavioral inputs were consistent among both parent and grandparent caregivers.ConclusionThere is a need to improve micronutrient powder adherence among rural caregivers. The IBM framework showed a high degree of explanatory power in predicting micronutrient powder adherence behavior. The findings suggest that increased reminders from doctors regarding micronutrient powder and coaching to improve personal agency in micronutrient powder feeding may increase adherence.

Knowledge of cataracts and eye care utilization among adults aged 50 and above in rural Western China.

Cataracts are highly prevalent in rural China, but patient utilization of eye care services is low. Cataract knowledge is regarded as an important factor in eye care utilization. Few studies, however, have been conducted to measure the level of cataract knowledge and its relationship with eye care utilization among older adults in rural China. Hence, we described cataract knowledge and investigated the relationships between cataract knowledge and eye care utilization among adults (≥50 years) in rural Western China. A large community-based cross-sectional study was conducted from October to December 2020 among adults aged 50 years and older in 73 rural villages in Qingcheng County, Western China. The participants underwent an eye examination at their village clinic to determine whether they had cataracts. Participants also answered a questionnaire about cataracts, eye care utilization status, and sociodemographic characteristics. The collected data underwent descriptive and multiple logistic regression analyses. The eye examinations revealed that 45.15% (675/1,495) of participants had cataracts in at least one eye, yet 90.67% (612/675) were left untreated. The average score achieved by participants about cataract knowledge was 4.91 points (total score was eight points). Correct knowledge about cataracts was positively associated with cataract screening and cataract surgery. Elders with better cataract knowledge were 2.21 times more likely to undergo cataract screening (OR, 2.21; 95% CI, 1.54-3.16) and 5.61 times more likely to undergo cataract surgery (OR, 5.61; 95% CI, 2.87-10.98). More than half had three fundamental misconceptions about how cataracts should be treated, how much they should cost, and when they should be treated. Participants who did not have these misconceptions were more likely to receive cataract screening by 1.21-2.02 times and cataract surgery by 1.76-3.48 times. There are misunderstandings about cataract treatment methods, treatment costs and timing in the sample areas. A better understanding of cataracts was significantly positively associated with cataract screening and cataract surgery. Health education on cataracts and regular eye examinations are needed to improve eye care utilization in rural China.

Teacher trust in others and teacher commitment co-mediate the path from school leadership to students' reading literacy in rural Chinese schools.

This study aimed to understand how teacher trust in others (TTO) and teacher commitment (TC) co-mediate the path from school leadership (SL) to students’ reading literacy (RL). Altogether 1,223 Grade 8 students (female =647; male = 576, Mage = 15.35, SD = 1.28) and their 34 principals from 34 secondary schools in rural western China were sampled and matched. All the students completed the Program for International Student Assessment (PISA 2008) reading tests, and their principals completed the Leading and Teaching in Schools Survey Scale online which the variables of SL, TTO, and TC were evaluated. In addition, the “many to many” step was employed to match principals’ data with the students’ data by STATA analysis. The results indicated that: (1) there were direct and indirect effects of SL on student RL in the mediation model; (2) the serial mediation of TTO and TC was significant between SL and RL. This finding implies that enhancing TTO and TC in rural schools will help improve student’s RL.

The Development Level of Rural Basic Education in China Under the Background of Rural Revitalization Strategy Analyzing —— Empirical Study Based on Panel Data Model

Rural revitalization is a strategic task proposed by the 19th National Congress of the Communist Party of China, and rural areas are the main battlefield of rural revitalization, but seeking the development of rural basic education is undoubtedly the booster for the smooth realization of the rural revitalization strategy. And the countryside needs education and prosperity. [1] In 31 provinces in China as the research object, using hierarchical analysis method and entropy method on the level of rural basic education development factors and weight analysis, get four explanatory variables, reuse panel data model to study the link between four explanatory variables and regional income gap index, analyze the basic education differences in eastern, central, western rural China, and according to the problems existing in the development of corresponding Suggestions.

Medication adherence among community-dwelling schizophrenia patients during the COVID-19 pandemic: A cross-sectional study

ObjectivesThis study aims to investigate medication adherence during the COVID-19 pandemic among community-dwelling schizophrenia patients, and to explore the role of social support in improving medication adherence in a rural community sample in China. MethodsA cross-sectional sample of 800 patients was recruited using a cluster random sampling method in Yingshan County, Sichuan Province. Information on participant demographic characteristics, social support and medication adherence was collected through face-to-face interviews. The data analysis was performed using SAS9.4. Two binary logistic regression models were employed to identify the association between regular medication use and social support. ResultsThe rate of regular medication adherence among community-dwelling patients with schizophrenia was 41.5%,which was lower than that indicated by recent research(Li et al., 2020) before COVID-19 in western rural China. The mean scores and standard deviation of the patient's objective support, subjective support, and support utilization were 4.94 ± 1.57, 17.03 ± 5.24, and 5.25 ± 2.75, respectively. The social support standard deviation was 27.22 ± 6.32. The crude odds ratio of objective support, subjective support, and support utilization were 0.790 (95%CI:0.713–0.876), 0.999 (95%CI:0.971–1.027), and 1.049 (95%CI:0.995–1.105) respectively. After adjusting for potential factors, the adjusted odds ratio of objective support, subjective support, and support utilization were 0.758 (95%CI:0.673–0.853), 1.030 (95%CI:0.994–1.068), and 1.043 (95%CI:0.985–1.105), respectively. ConclusionsDuring the COVID-19 pandemic, community-dwelling schizophrenia patients had a low rate of regular medication adherence. This was particularly true of those who were older adults, less educated and living in rural areas. The results of this study suggest that strengthening social support may effectively improve medication adherence for those patients.

Associations between coping styles, gender, their interaction and non-suicidal self-injury among middle school students in rural west China: A multicentre cross-sectional study.

BackgroundTo investigate the association between coping styles, gender, their interactions and non-suicidal self-injurious (NSSI) behaviors among middle school students in rural western China under COVID-19.MethodsA multicentre cross-sectional study method was used to conduct an online survey of 8,361 students from 23 middle schools in the northern Sichuan region by clustering sampling, using the General Information Questionnaire, the Ottawa Self-Injury Inventory, and the Coping Style Scale for Middle School Students.ResultsThe past year prevalence of NSSI among middle school students in rural west China was 5.7%. The differences in scores between those with and without NSSI on all dimensions of coping styles were statistically significant (p < 0.001). Multivariate logistic regression analysis revealed that vocational high school (OR = 1.67), girls (OR = 2.5), single parent with divorced parents (OR = 1.89), remarriage with divorced parents (OR = 1.81), and tolerance (OR = 1.17), venting emotions (OR = 1.15) and fantasy/denial (OR = 1.07) in coping styles may increase the risk of NSSI among middle school students, while problem solving (OR = 0.9) and seeking social support (OR = 0.9) among coping styles may reduce the risk of NSSI among middle school students. The interaction results show that gender has a moderating role in the process of endurance, avoidance, venting of emotions, and fantasy/denial influencing non-suicidal self-injury in middle school students.ConclusionThere is an association between coping styles and self-injury among middle school students in rural areas in western China, with gender playing a moderating role. Active attention should be paid to students' coping styles and encouraging them to adopt positive coping styles as well as avoid negative coping styles, especially in the case of girls, which can help prevent self-injury.

Effect of disability severity on home-based care quality among families with Uygur and Kazakh disabled older adults in far western rural China: A cross-sectional study.

To explore how family functioning and family resilience mediate the relationship between disability severity and quality of home-based care among families with disabled older adults. A cross-sectional survey was conducted with 431 families with Uygur and Kazakh disabled older adults in Xinjiang, China, in 2020. The data were collected using the Katz Activity of Daily Living Scale; Mini-Mental State Examination; Family Adaptation, Partnership, Growth, Affection and Resolve Index Scale; Family Resilience Assessment Scale; and Family Caregiving Consequences Inventory Scale. All mediation effects were estimated in SPSS26.0. Disability severity, family functioning and family resilience were all significantly correlated with home-based care quality. Disability severity had a 46.16% direct effect on home-based care quality and a 53.84% indirect effect on home-based care quality independently and in series through family functioning and family resilience. Disability severity directly affected home-based care quality and had an indirect influence via family functioning and family resilience. Multidisciplinary care teams should focus on families with disabled older adults and help them improve family functioning and family resilience by implementing targeted interventions, so as to improve home-based care quality.

Prevalence of Anemia and Associated Factors among Infants under Six Months in Rural China.

To examine haemoglobin level and anaemia status among infants under six months of age in rural China. A cross-sectional survey collected data among infants under six months and their primary caregivers in Sichuan, China. Anaemia was defined using both the WHO and China Pediatrics Association thresholds. Multivariable linear regression was used to identify relevant factors among two age groups (<4 months; 4-5 months). 80 townships were selected in Sichuan, China from November to December 2019. 942 infants under six months, while haemoglobin level were tested for 577 infants. The overall mean (±SD) haemoglobin level was 106.03 (± 12.04) g/L. About 62.6% (95%CI: 58.5, 66.6) of sample infants were anemic using the WHO threshold, and 20.5% (95%CI: 17.3, 24.1) were anemic using the China Pediatrics Association thresholds. Anaemia rates rose with increasing age in months. Multivariable linear regressions revealed that lower haemoglobin levels were significantly associated with lower birth weight (<4 months: b = 4.14, 95% CI: 0.19, 8.08; 4-5 months: b = 6.60, 95% CI: 2.94, 10.27) and delivery by cesarean section (<4 months: b = -4.64, 95%CI: -7.79, -1.49; 4-5 months: b = -4.58, 95%CI: -7.45, -1.71). A large share of infants under six months in rural western China are anemic. Infants with low-birth-weight and cesarean-delivered should be prioritized for anaemia testing. Future studies should move the point of focus forward to at least 4 months of age and examine the link between cesarean-section and anaemia to promote health and development in infancy.

A Prospective Study on Resilience Among Children with Different Migrant and Left-behind Trajectories.

Parental migration has been an important predictor of children’s psychological resilience. The present study discusses the effect of parental migration on children’s resilience in rural western China from a dynamic viewpoint. Using sequence analysis, this study investigates children’s entire migration trajectory over the course of childhood (ages 1–12) and identifies the typical patterns of the dynamic family structure associated with parental migration: continuously nonmigrant (N = 4,238), continuously migrant (N = 923), continuously left behind by one parent (N = 872), continuously left behind by both parents (N = 796) and frequent transition between migrant or left-behind statuses (N = 1,624). The results show that the trajectories of left-behind status and transition have a significant negative impact on children’s resilience, which demonstrates that both the effects of parent-child separation and family instability compromise children’s psychological functioning. Family resources can buffer these negative effects, but they work asymmetrically across different groups of children. Family economic resources serve as a significant protective factor among children continuously left behind by both parents, while family social resources are more protective for children in unstable families.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12187-022-09945-1.

Association of Antenatal Micronutrient Supplementation With Adolescent Emotional and Behavioral Health: A 14-Year Follow-Up of a Double-Blind Randomized Controlled Trial

Abstract Objectives To examine the impact of antenatal micronutrient supplementation on adolescent emotional and behavioral health, and to identify the modifying effect of household wealth. Methods We conducted a double-blind cluster-randomized trial of antenatal micronutrient supplementation in rural western China between 2002 and 2008. Pregnant women in every village were randomized to daily take one capsule of folic acid (as control), folic acid plus 60 mg iron (IFA), and multiple micronutrients (MMNs) including 30 mg iron. Singleton births were prospectively followed at early adolescence in 2016. Adolescents actively completed the localized and qualified Youth Self-Report. Scores of Internalizing Behavior Problems (constituting by Anxious/Depressed, Withdrawn and Somatic Complaints), Externalizing Behavior Problems (constituting by Delinquent/Rule-Breaking Behavior and Aggressive Behavior) and Total Behavior Problems, were derived. As priorly specified, we examined the modifying effect of household wealth on the response to antenatal IFA and MMNs vs. folic acid supplementation on adolescent emotional and behavioral health. Results Of 1920 adolescents included in the final analysis, 1130 (58.9%) were male, with a mean (SD) age of 11.8 (0.78) years. As compared to folic acid, adolescents born to mothers who consumed IFA had lower scores of total behavioral problems, externalizing, rule-breaking and aggressive behavior. The adjusted mean differences were −2.94 (95% CI −5.78, −0.11), −1.00 (95% CI −1.82, −0.18), −0.39 (95% CI −0.73, −0.05) and −0.61 (95% CI −1.15, −0.07), respectively. Similar associations were observed among medium-wealth households, while null associations in low-wealth households (all interaction P values &amp;lt; 0.05). Further, among high-wealth households, MMNs show benefits on reducing the risk of adolescent behavioral problems as compared to IFA or folic acid. Conclusions Sufficient iron intake in pregnancy has long-term benefits on reducing the risk of adolescent behavioral problems. Multiple micronutrients including 60 mg iron are recommended in rural areas with micronutrients deficiencies widely prevalent given the benefits of MMNs on improving birth outcomes. Funding Sources National Natural Science Foundation of China and China Postdoctoral Science Foundation.

Geographical disparities in infant mortality in the rural areas of China: a descriptive study, 2010–2018

BackgroundThe infant mortality rate (IMR) is considered a basic measure of public health for countries around the world. The specific aim of our study was to provide an updated description of infant mortality rate among different regions in rural China, and assess the trends and causes of the IMR geographical disparities.MethodsData were collected from China’s Under-5 Child Mortality Surveillance System(U5CMSS). The annual number of deaths and causes of death were adjusted using a 3-year moving average underreporting rate based on annual national data quality control results. The average annual decline rate (AADR) and the relative risk (RR) of the IMR and cause-specific infant mortality were calculated by Poisson regression and the Cochran–Mantel–Haenszel method. Data analysis was completed by SAS software.ResultsThere was an apparent decrease in infant mortality in rural China from 2010 to 2018, at the AADR of 11.0% (95%CI 9.6–12.4), 11.2% (95%CI 10.3–12.1) and 6.6% (95%CI 6.0–7.3) in the eastern, central and western rural areas, respectively. The IMR was highest in the western rural area, followed by the central and eastern rural areas. Compared with the eastern rural area, the RR of infant mortality in the central rural area remained at 1.4–1.6 and increased from 2.4 (95%CI 2.3–2.6) in 2010–2012 to 3.1 (95% CI 2.9–3.4) in 2016–2018 in the western rural area. Pneumonia, preterm birth /LBW and birth asphyxia were the leading causes of infant deaths in the western rural area. Mortality rates of these three causes fell significantly in 2010–2018 but contributed to a higher proportion of deaths in the western rural area than in the central and western rural ares.ConclusionsOur study indicated that the infant mortality rate dropped significantly from 2010 to 2018, however, geographical disparities of IMR in rural China are still persist. Therefore, there is an urgent need for public health programmes and policy interventions for infants in western rural China.

Effects of Disability Severity on the Family Burden of Home-Dwelling Uygur and Kazakh Aged in Rural Western China: Family Function as a Mediator.

Caring for the disabled elderly puts heavy burdens on their families. This study aimed to explore family function (FF) as a mediator in the relationship between disability severity (DS) and family burden (FB) of the Uygur and Kazakh home-dwelling disabled elderly cared for by informal caregivers in China. A cross-sectional design with multistage sampling was used to recruit 431 families with Uygur and Kazakh disabled elderly in Bortala, Xinjiang, China. Data were collected using the Activities of Daily Living Scale, Family Burden Interview Schedule, and Family Adaptation, Partnership, Growth, Affection, and Resolve Index Scale and then analyzed using hierarchical regression. FF had a partial mediating effect on the relationship between DS and FB (β = 0.131; 95% confidence interval [CI] = [0.074, 0.197]; p < .01); the effective rate was 41.46%. Multidisciplinary care teams should implement targeted interventions to improve FF of the disabled elderly to alleviate FB.

Parental Self-Perception, Parental Investment, and Early Childhood Developmental Outcomes: Evidence From Rural China.

Using a three-wave longitudinal survey conducted in 815 households in rural Western China, this study aims to examine the association between parental self-perception and early childhood development and the mediation effect of parental investment on the association between parental self-perception and child development when the sample children are at different ages in the early childhood (18–30, 22–36, and 49–65 months). The results demonstrate that parental self-perception are positively and significantly associated with child social-emotional development in all three ages of childhood (from 18 to 65 months). Positive and significant association between parental self-perception and child cognitive development is found in the ages from 22 to 65 months. In addition, findings of this study show that parental investment plays a mediating role in the association between parental self-perception and child cognitive development. The study calls on policymakers to help to strengthen parental self-perception and parental investment related to early childhood development, which should result in better child development in rural China.