The Investigation On Health Care And Children Nutritional Status Of Kidergartens In Shenzhen

Research objective:To understand the current situation of kindergarten health care and nutritional status of preschoolers in Shenzhen. By means of comprehensive evaluation of the kindergartens health care quality and relevant research to the health care index and children’s nutritional status to find the main problems existing in the work and the associated index to children’s nutrition. Thereby, to provid theoretical basis and suggestions to the government for formulating and improving kindergarten health care management. Meanwhile, standardizing the health care work in kindergartens in the city further and improving the kindergarten health care management and service capabilities. Herein average up the health level of children.Research methods:1. SamplingThe kindergarten in Shenzhen must be performied a statistic to the existing registered which should receive more than 30 children with permission issued by education department more than one year. With stratified random sampling method, specific as follows:stratified kindergarten according to the ownership of maternal and child health care hospital, namely Nanshan District, Yantian District, Luohu District, Futian District, Baoan District, Longgang District, Dapeng new area, Pingshan New District, Guangming New District, Longhua District,Shenzhen Maternity and Child Healthcare Hospital. Total of 11 maternal and child health hospitals were divided into 11 layers, randomly selected 1/4 in the each layer of a total of 317 kindergartens as the research object.2. Data collection methods(1) Health care doctors from extracted kindergartens and directors of each area were trained and data was collected from health care doctors by filling out the questionnaire in the form of " a garden a table ". The original questionnaires were handed on after the District and Municipal two levels of verification.(2) Collected the information of Children’s physical examination data in 2013 from the random samples of 317 kindergartens.3. Evaluation Methods(1) The health care work in Shenzhen kindergartens:from the six aspects of staff equipment, environment and personal hygiene, preventive disinfection methods, health care clinic and health care measures, health education, dietary management to get the corresponding measures and system to implement the standard rate, constituent ratio are used to describe the health status health; By using principal component analysis on the score to evaluate comprehensive quality of each managed area.(2) Physical growth and nutritional status evaluating:With the NCHS standard recommended by WHO, Z score evaluation method was usd. According to WHO recommended Anthro software, Z score was calculated. Z-score=(Children measure height or weight-the median of standard height or weight)/the standard deviation of standard height or weight of this ages, including HAZ(Height-age Z score), WAZ(Weight-age Z Score) and BMIZ(Body Mass Index-for-age Z score).① The developmental level:according to the Z score in the five levels evaluation method, the development level was divided into five different levels: Z-score<-2 is the lower level,-2≤ Z score<-1 is the middle-lower level,-1≤Z score≤1 is the medium level,1<Z score≤Z is the middle-upper level and Z-score>2 is the upper level.② The nutritional status:according to WHO standard and methods to evaluate the nutritional status of children on determining to be malnutrition or nutrition:the low weight, WAZ<-2; the growth retardation, HAZ<-2; the thin, HAZ<-2; the obesity, BMIZ>2.③ The anemia status:the objects who have been diagnosed as mediterranean, Aplastic anemia and other non-nutritional anemia anemia were excluded. Hemoglobin assay:by the Municipal, District Maternal and child health care institutions to send professionals to the kindergartens for children with vein blood collection, the use of cyanide High-speed Rail method determination. Diagnostic criteria:according to the eighth edition of pediatrics to diagnose criteria:6～59 months<110 g/L; 5～11years<115g/L; classification:1) mild anemia:110g/L>HB≥ 90g/L;2) moderate anemia:90g/L> HB≥60 g/L;3) severe anemia:60g/L> HB≥ 30 g/L;4) very severe anemia:30g/L> HB.3. Data collection and analysis methodAll questionnaires were unified collated and code, the Epidata3.1 software unified database and double entry was used, proceed the reliability analysis and consistency test to verify data. Statistical analysis of logical check performed on the data using the SPSS 16.0 software.(1) Descriptive analysis:numerical variable data used the mean, median and standard deviation and soil classification charts to describe; classified variable data used rate or composition to describe.(2) Statistical analysis:numerical variable data used variance analysis, t test, Wilcoxon rank sum test, Kruskal-Wallis H test,correlation analysis used Spearman rank correlation analysis; comprehensive evaluation by principal component analysis. Categorical variable data used chi-square test, Fisher exact probability method, Wilcoxon rank sum test, Kruskal-Wallis H test and linear trend test.(3) The test level was bilateral, a=0.05.Results:(1) Shenzhen kindergartens were mainly full-time form (99.1%), predominately as civilian running(92.4%), and main trend was private contract of the kindergartens.(2) 100% of kindergartens had health care clinic and doctors. The proportion of health care doctors and children was 1:214, and 1:91 for cook and children, and 1:31 for nurseryperson and children. Doctores support reaching rate was 57.7%, cook support reaching rate was 23%.(3) The rate of child and staff physical examination was 100%.93.1% of kindergartens had complete health care system and 89.3% of kindergartens had health care register regulation. More than 87% of kindergartens’hardware facilities, equipment, and safety measures reached the standard, but the achieved rate of faucet quantity in the toilet was as low as 27.7%.94.6% achieved the requirements of personal hygiene and 81.4% of kindergartens met the requirements of refectory sanitation.(4) The health workers and caregiveres equipped and overall quality of health care work in the central area of Shenzhen kindergartens were better than surrounding area. However the surrounding area in the nurseries of hardware facilities within the class to flush toilets with toilet squatting toilet pit rate, compliance rate, the health room area which was larger than 12m2 of the compliance rate were higher than that of the central area.(5) Private and public kindergartens on the health care staff, personal hygiene, health care and measures of health, environment and the implementation of dietary management were no statistical difference. But in the kitchen and the nurse equipped, average green area, ultraviolet bactericidal lamp equipped so all better than the public kindergartens, and the difference was statistically significant.(6) Shenzhen kindergarten children were mainly at 3 to 5 years of age, accounting for 89.8%, child sex ratio in the garden was 122.2, outside the normal range.(7) Shenzhen kindergarten children’s height, weight growth trend was consistent, not straight up, but the waves of progress, in line with the general rules for children. Boys in each age group were higher than girls in height and weight.(8) The kindergarten children’s HAZ, WAZ, BMIZ were higher than 0, which show that the overall level was more than WHO standard. But the kindergarten children’ HAZ and WAZ in different age groups, different districts, different levels and types of nurseries were different. WAZ and BMIZ were higher than those of girls to boys, but there was no difference between male and female students in HAZ.(9) The compliance rate of HAZ for the physical development of children in Shenzhen kindergartens was 83.9%and WAZ was 88.5%, which were both lower than the theoretical value 95.4%. The different age, gender, region, different levels and types of kindergartens in children’s physical development standard rate were different.(10) The kindergarten children’ malnutrition prevalence rate in Shenzhen was 8.23%, led by growth retardation 4.21%, followed by thin 2.18% and low birth weight 1.84%. Growth retardation prevalence rate was lower than the average level of our country, but weight loss and low weight is higher.(11) The malnutrition prevalence increased with the growth of age, showed a linear trend with age. Between boys and girls did not differ much. The different level kindergartens and different administrative regions had different malnutrition prevalence. Public kindergarten children malnutrition prevalence rate was lower than the private kindergartens.(12) The prevalence of obesity in children in kindergartens in Shenzhen was 5.96%, the boy (7.57%) is higher than the girl (4.20%). The boy’s prevalence of obesity increased with the growth of age, the prevalence of obesity in girls not changes with age. Different administrative interval in the children’s obesity rate was different. But there was no significant difference between different levels and the properties kindergartens.(13) The anemia prevalence of children in Shenzhen garden was 6.28%,and mainly was mild anemia (6.05%), moderately severe anemia was less (0.05%) which was lower than the national average. No gender difference,5～6 years old children in anemia peak. There was correlation between anemia prevalence in children and the region, childcare facilities level, the nature of the childcare facilities, and whether suffered from malnutrition.(14) There was correlation between the quality of health care in kindergartens and child nutrition, the correlation between the low weight and growth retardation rate and the comprehensive score of the quality of health care was negative, correlation coefficients were-0.809 and-0.844.(15) There was clear correlation between the nutritional status of children and sanitation configuration, health center configuration, the registration system of health care, health education, preventive disinfection methods, outdoor activities in the area of each child, the average green area per child and the drinking water source.Conclusion:(1) The overall level of health care in Shenzhen kindergartens is high, the central area kindergartens overall quality of health care work is better than the surrounding area. The gap health care between private kindergartens and public kindergartens is narrowing. Private kindergartens hardware facilities have more than public kindergartens. But compare with the national requirements there is still a certain gap, need to further improve the staff quality and bathroom hardware equipment, strengthen supervision and management.(2) The sequence of Children’s prevalence rate of nutritional diseases in Shenzhen is anemia, growth retardation, obesity, wasting, low body weight. Mainly part is mild anemia; the prevalence of obesity is close to the average level in China; growth retardation prevalence rate is lower than the average level of our country; wasting and low body weight is higher than the average level in china.(3) The growth and development of preschool children in Shenzhen conforms the general growth rule. Child malnutrition, obesity and the prevalence rate of anemia are high and increase with the growth of age. There are some differences in different jurisdictions and properties of kindergartens in Shenzhen. It should strengthen the children’s growth and nutrition status monitoring in Shenzhen preschool, earlier detection, earlier correction, reducing the incidence of nutritional diseases and improving the growth and nutrition level on the growth of children in Shenzhen.(4) There is a high negative correlation between the low body weight rate, growth retardation rate of chilren and the comprehensive score of the quality of health care. The quality of health care directly affects children’s nutritional status.(5) There is clear correlation between the nutritional status of children and sanitation configuration, health center configuration, the registration system of health care, health education, preventive disinfection methods, outdoor activities in the area of each child, the average green area per child and the drinking water source. Therefore, to strengthen the sanitation and improve the quality of kindergarten health care work is one of the important conditions for ensuring a good child nutritional status.