Elsevier

Public Health

Volume 155, February 2018, Pages 110-118
Public Health

Original Research
The prevalence and influencing factors for child neglect in a rural area of Anhui province: a 2-year follow-up study

https://doi.org/10.1016/j.puhe.2017.11.024Get rights and content

Highlights

  • A 2-year follow-up study was performed in a rural area of Anhui, China.

  • The longitudinal study was based on the unique social and cultural background.

  • The 2-year follow-up study identified the dynamic change of child neglect.

Abstract

Objectives

The purpose of the current study was to identify the change of prevalence and influencing factors for child neglect in a rural area of Anhui province through the 2-year follow-up study.

Study design

Longitudinal study with 2-year follow-up.

Methods

Analyses were based on data from a longitudinal study, performed in five elementary schools and three secondary schools in Changfeng County. A total of 816 children aged between 7 and 16 years completed the three assessments during the period of 2009–2011. Generalized estimating equations (GEEs) were applied to identify the influencing factors of child neglect.

Results

The prevalence of child neglect was 67.8%, 56.6%, and 57.7% at the three assessments, respectively. There were 272 children (33.3%) having consistently experiencing neglect during three assessments and 106 (13.0%) children had not suffered from neglect during three assessments. Among 553 participants who experienced neglect at the first assessment, 105 (19.0%) children no longer met the diagnosis at the next two assessments. Fifty-two children who did not suffer from neglect at the first assessment experienced neglect at the final assessment. The results of GEEs showed that child neglect was clearly associated with age (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.92–0.99, P = 0.016), male gender (OR = 1.20, 95% CI = 1.00–1.43, P = 0.047), siblings (OR = 1.26, 95% CI = 1.03–1.55, P = 0.028), parental marital disruption (OR = 2.02, 95% CI = 1.09–3.78, P = 0.027), left-behind status (OR = 1.26, 95% CI = 1.06–1.49, P = 0.008), severe family dysfunction (OR = 1.46, 95% CI = 1.03–2.07, P = 0.035), quality of life (OR = 0.98, 95% CI = 0.98–0.99, P < 0.001), positive coping styles (OR = 0.97, 95% CI = 0.94–0.99, P = 0.001), and negative coping styles (OR = 1.03, 95% CI = 1.02–1.05, P < 0.001).

Conclusion

Our studies detected the decreased prevalence of child neglect across the three assessments. Additionally, some sociodemographic, psychosocial and family risk factors of child neglect were identified, which will be helpful for child neglect prevention strategies development and implementation in China.

Introduction

Child neglect is one of the most prevalent types of maltreatment,1, 2 which is a worldwide complex matter and is also a major public health concern. In China, the prevalence of neglect varied across different measurement tools, regions, and ages. The rate of neglect among children aged between 3 and 6 years old ranged from 6.3%3–36.4%,4 among children aged between 6 and 8 years was 53.2%,5 among rural children aged 9–11 years was 31.3%,6 and among children aged 12–17 years was 47.3%.7 Most of these studies reported the neglect prevalence relied upon cross-sectional designs. Few research concerned the change of child neglect over time during childhood. Therefore, a longitudinal study to explore the dynamic development and change of neglect is in demand.

Previous studies have identified factors which were associated with child neglect, including the child's age,3, 8, 9, 10 parental divorce,11 maternal education,12, 13 family structure,14 and quality of life.15, 16 On one hand, the association between part of factors (e.g. child's gender, family income) and neglect has not obtained a conclusion without controversy. On the other hand, most of the prior studies involving associated factors of neglect were cross-sectional designs. Thus, a longitudinal study was needed to clarify these divergences and controversies of the association between variables and child neglect.

The Chinese government started reform and opening-up policy in the late 1970s and launched the one-child policy in 1978. Due to the reform and opening-up policy, the Chinese economy experienced an unprecedented growth. Accompanied by the economic growth, a growing number of rural people have moved to the cities leaving their children in rural hometowns. Ultimately, those children have been described as left-behind children (LBC) in rural China. The usual definition of LBC is those who stay in their hometowns while one or both parents work away from home for at least 6 months.17 The migration has weakened the family function18, 19 and decreased the quality of life of LBC.17 Much research has revealed that LBC suffered more mental health problems and psychological well-being neglect.20, 21

The one-child policy has changed the Chinese traditional family structure.22 So that, most families have only one child. As a result, the only child, often described as the ‘little emperor’ or ‘little sun’,23 has increasingly become the hope of the whole family and more precious to parents and household than ever. For this child, parents and families will give more care and attention. Thus, the prevalence of child neglect in the only-child's family is lower. Zhang et al. conducted a study for the neglect and influencing factors of children aged 3–6 years in Guangzhou and have revealed a different prevalence of neglect between the only child and not the only child, and the only child was the associated factor for neglect.24 The study carried out among the only-child family in Suzhou indicated that the prevalence of child neglect was 32.0% and the main type of neglect was supervision neglect, followed by emotional neglect, physical neglect, and education neglect.25

Given the unique social and cultural background which is different from other countries, better understanding and identifying the factors associated with neglect are important and needed among children in rural China. We therefore performed the longitudinal study in rural Changfeng County to (1) evaluate the dynamic change of child neglect over the three assessments during the follow-up period and (2) identify the protective and risk factors for child neglect in rural China.

Section snippets

Participants

The study selected data from a prospective study of children's mental health in China, which was conducted in Changfeng County, Anhui province. This study contained a baseline survey and two follow-up assessments that began in December 2009 and continued annually until 2011. At the baseline, the random cluster sampling approach was applied to identify five primary schools and three middle schools to participate in the survey. A total of 3169 children from the grades of 3–9 in the selected

Sociodemographic characteristics of the participants

A total of 816 children completed the 2-year follow-up study and the rate of lost follow-up was 22.1%. The characteristics of the initial survey sample are described in Table 1. In the baseline, the ages of the children ranged from 7 to 16 years old, with mean age 11.17 (standard deviation = 2.16) years. A total of 422 (51.7%) were boys, and 394 (48.3%) were girls. More than half of the respondents (58.3%) were LBC. There was no significant difference in baseline child neglect prevalence

Discussion

In the present study, we evaluated the change of child neglect across the follow-up study in rural areas of east-central China and identified the associated factors of neglect. We found that the child neglect prevalence was 67.8%, 56.6%, and 57.7% at three assessments, respectively. The prevalence of child neglect was much higher than that in studies performed in China.3, 4, 6, 7, 24, 25, 37, 38 Anhui province locates in the middle of China. Compared with other economically better provinces,

Acknowledgements

The authors would like to thank all children who participated in the project and the students (Zhen-Qiang Wu, Yu-Hong Jiang, Li-Na Sun, Dong-Dong Zhang, Xiao-Ling Lv, Teng-Wei Han, Chao-Mei Gu, Qing-Qing Cao, Ying Sun, Tie-Zhu Wang, Jian Chen, Xue Zhao, Yi-Le Wu, Hui-Yun Yang, and Yi-Feng Li) and teachers who were involved in the early stages of the project.

Ethical approval

The current study protocol received approval by the Ethics Committee of Anhui Medical University, Hefei, China.

Funding

This study was supported by

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