Objective To understand factors associated with children's attendance at nursery care institutions (NCIs) and the basic characteristics of the NCIs children were enrolled in, so as to provide scientific evidence for policymakers. Methods During November 2020 and January 2021, parents who visited the Department of Child Health Care in six selected maternal and children's hospitals, as well as nearby NCIs in Zhejiang were invited to finish an online questionnaire. Information such as children's sociodemographic characteristics, parents' knowledge, attitude and practice regarding nursery and feeding, etc. were collected. A total of 1 756 questionnaires were collected. Results Compared to children who were not in NCIs, children enrolled in NCIs were older (94.4% of children ≥24 months vs. 30.1%, χ2=835.27), more likely to be from the local area (87.2% vs. 81.4%, χ2=12.25), more likely to have parents with a college degree (mother:83.6% vs. 74.2%, χ2=35.29; father:79.9% vs. 70.0%, χ2=27.01), had a higher prevalence of family annual income >200 000 CNY (49.5% vs. 28.2%, χ2=110.49), and were less likely to have their grandparents available to take care of them (16.7% vs. 26.8%, χ2=31.4)The difference all have great significant.(P<0.05). In a multivariate Logistic regression model, the older the child, the more likely they were to attend an NCI (for children aged 6 - 23 months, OR=6.70; for children aged 24 - 35 months, OR=134.03; and for children aged 36 - 42 months, OR=699.33; P<0.05). Family annual income was positively associated with children's attendance at NCIs (for those earning 100 000 - 200 000 CNY/year, OR=1.63; for those earning 200 000 - 500 000 CNY/year, OR=2.96; and for those earning >500 000 CNY/year, OR=4.62, P<0.05). Conversely, the higher the level of grandparent involvement in daily care, the lower the attendance at NCIs (for children cared for by both parents and grandparents, OR=0.57; for those primarily cared for by grandparents, OR=0.26, P<0.05). For children who used to stay at NCIs, 82.8% stayed at institutions that only recruited children aged 0 - 3 years, 97.4% spent their whole day in NCIs, and 71.4% spent less than 3 000 CNY per month for NCI services. Additionally, over 95% of parents were satisfied with the food and care services in NCIs, as well as their children's physical development in NCIs. However, 32.1% of NCIs were reported by parents as having no room for breastfeeding. Conclusions Children's age, grandparent involvement in routine care, and family annual income are the main factors associated with children's attendance at NCIs. There is a greater need for more affordable and community-based NCIs, particularly for children under 2 years old. Additionally, more attention should be paid to the quality surveillance, assessment and management of NCIs.
Key words
children under 3 years' old /
nursery care institution /
nursery care
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