Childhood lead exposure is a commonly known risk factor affecting children’s health, and 10 governments have taken actions to reduce children’s lead exposure sources. Because lab testing for children’s blood lead levels (BLLs) was not popularized easily, socioeconomic and behavioural factors have been usually used as predictors of screening methods. Along with the overall decreasing trend of children’s BLLs, the lead-exposure-potential-predicting ability of such factors might be limited or changed over time. Our study aims to compare the predicting ability of multiple factors, including the living environment, economic disparity and personal behaviour differences between 2004 and 2014. With potential predicting factors identified, it could provide direction in identifying individual children facing high-risk lead exposure in the unit of clinics or communities of China. The study was first conducted in 12 cities in China in 2004 and then repeated in 2014 in the same 12 cities with the same method. In total, 27,972 children aged under 7 years were included in this study. With confounding factors adjusted, the child’s age, the family’s socioeconomic status and the child’s personal hygiene habit, especially biting toys, continued to be important predictors of higher blood lead levels among Chinese children. The sex of the child was no longer a predictor. Factors such as the father’s occupational contact with lead, residence near the main road and taking traditional Chinese medicine had the potential to be new predictors.

Objective: To comprehensively evaluate the service quality of primary health care (PHC) for children aged 0–3 years in healthcare facilities of China, and to identify strengths and existing gaps to provide evidence for optimizing regional child health service policies. Methods: A multi-stage stratified random sampling method was used to select 35 healthcare facilities from 4 geographical regions in Hunan province of China. Data were collected using the WHO Western Pacific Regional Office Primary Health Care Quality Improvement Guide, which included facility assessments, medical record reviews, and caregiver interviews. All indicators were assessed against China national basic public health service standards and WHO PHC quality benchmarks. Chi-square test was used for comparative analysis between sick and healthy children. Results: The overall PHC foundation was sound: 85.0% of service rooms had qualified handwashing facilities, 92.0% were equipped with alcohol rub, and over 97% of facilities had standardized protocols for breastfeeding screening and infection control. The key basic medicines and routine growth monitoring supplies achieved an availability rate above 91.4%. The under-6-month exclusive breastfeeding rate was 38.9%, and National Immunization Programme (NIP) vaccine coverage remained over 90% for most routine vaccines. However, significant gaps existed. Well children showed far higher health screening rates than sick children, with growth measurement completion rates of 93.9% vs. 72.2% for weight and 92.1% vs. 9.0% for height; respiratory rate screening remained extremely low at around 17% in both groups. Non-NIP vaccine coverage was only 28.5%–47.1%. The availability of therapeutic food, special vaccines and essential emergency medicines was below 30%, and only 45.8% of rooms were equipped with sharps containers and merely 28.6% of facilities had child abuse and neglect management protocols. Additionally, the staff IMCI training rate was only 54.2%, and patient–staff ratios ranged from 48.6% to 65.9% across clinics. Conclusion: Child PHC services in Hunan Province perform well in basic infrastructure, routine health management and national immunization, but have prominent deficiencies in standardized clinical assessment for sick children, breastfeeding promotion, non-NIP vaccine accessibility, child protection system construction, essential drug supply, and human resource allocation. Targeted interventions on clinical standardization, material guarantee, professional training and child protection mechanism improvement are needed to further elevate the overall quality and equity of early childhood PHC services.