High prevalence of developmental delay among children under three years of age in poverty-stricken areas of China

Interplay of paternal caregiving and screen use habits on early childhood development and children's tantrums

BACKGROUND

This study aims to examine the association for paternal care and father-child screen use with early childhood development and children's temper tantrums.

METHOD

Study file included questions about paternal characteristics, child care, father-child screen habits, and utilized the UNICEF Early Childhood Development Index (ECDI). Factors influencing ECDI-on-track status and children's responses when screen use was restricted were investigated with Chi-square test and multiple logistic regression.

RESULTS

The study included 464 fathers having children aged 3-4 years. The findings showed that 89.7% of the children were on track in three out of the four ECDI subgroups. When screen use was restricted, 55.6% of the children engaged in another activity, while 44.4% reacted by crying. Multiple logistic regression analysis revealed that the father's education level, the child's age and gender, the starting age for screen usage, the child's reaction to screen restriction, and having three or more books were associated with ECDI. Furthermore, the child's reaction to screen restriction was related to the child's and father's screen time, the presence of three or more books, the adequacy of care, and being on track in the literacy-numeracy ECDI subgroup.

CONCLUSION

Screen usage habits significantly impact early childhood development and children's reactions to screen restrictions. These findings underscore the importance of educating fathers about the effects of their own and their child's media habits, the quality of fatherly caregiving, and the presence of books in fostering positive child development.

A predictive model for stunting among children under the age of three

Background

In light of the global effort to eradicate stunting in childhood, the objective of this research endeavor was to assess the prevalence of stunting and associated factors, simultaneously construct and validate a risk prediction model for stunting among children under the age of three in Shenzhen, China.

Methods

Using the stratified random sampling method, we selected 9,581 children under the age of three for research and analysis. The dataset underwent a random allocation into training and validation sets, adhering to a 8:2 split ratio. Within the training set, a combined approach of LASSO regression analysis and binary logistic regression analysis was implemented to identify and select the predictive variables for the model. Subsequently, model construction was conducted in the training set, encompassing model evaluation, visualization, and internal validation procedures. Finally, to assess the model's generalizability, external validation was performed using the validation set.

Results

A total of 684 (7.14%) had phenotypes of stunt. Utilizing a combined approach of LASSO regression and logistic regression, key predictors of stunting among children under three years of age were identified, including sex, age in months, mother's education, father's age, birth order, feeding patterns, delivery mode, average daily parent-child reading time, average time spent in child-parent interactions, and average daily outdoor time. These variables were subsequently employed to develop a comprehensive prediction model for childhood stunting. A nomogram model was constructed based on these factors, demonstrating excellent consistency and accuracy. Calibration curves validated the agreement between the nomogram predictions and actual observations. Furthermore, ROC and DCA analyses indicated the strong predictive performance of the nomograms.

Conclusions

The developed model for forecasting stunt risk, which integrates a spectrum of variables. This analytical framework presents actionable intelligence to medical professionals, laying down a foundational framework and a pivot for the conception and execution of preemptive strategies and therapeutic interventions.

Maternal depression and early childhood development among children aged 24-59 months: the mediating effect of responsive caregiving

This study examined whether maternal depression is related to Early Childhood Developmental (ECD) delay among children by quantifying the mediating contribution of responsive caregiving. We used data from 1235 children (Children's mean age = 50.4 months; 582 girls, 653 boys, 93.9% were Han), selected through convenience sampling, in 2021. 4.7% of children had ECD delay, 34.3% of mothers had depression. Children with depressed mothers were less likely to receive responsive caregiving (OR 4.35, 95% CI 2.60-7.27), and those who did not receive responsive caregiving were more likely to experience ECD delay (OR 3.89, 95% CI 1.89-8.02). Responsive caregiving partly mediated the relationship between maternal depression and ECD. Early intervention for children with depressed mothers is worthy of further investigation.

Roles of caregiver-child interaction on the association of socioeconomic status with early childhood development: a population-based study in rural China

OBJECTIVE

Socioeconomic status (SES) has been previously associated with children's early development, health, and nutrition; however, evidence about the potential role of caregiver-child interaction in such associations was limited. This study aimed to explore the effect of caregiver-child interaction on the associations of SES with child developmental outcomes, including early neurodevelopment and social-emotional behavior.

METHODS

A cross-sectional survey was conducted among 2078 children aged 0-6 in a rural county that just lifted out of poverty in 2020 in Central China. The Ages & Stages Questionnaires-Chinese version (ASQ-C) and the Social-Emotional (ASQ: SE) questionnaire were used to assess children's early neurodevelopment and social-emotional behavior, respectively. Caregiver-child interaction was evaluated with the Brigance Parent-Child Interactions Scale. Regression-based statistical mediation and moderation effect were conducted with the PROCESS macro of SPSS.

RESULTS

Children with low SES had an increased risk of suspected neurodevelopmental delay [OR = 1.92, 95% CI: 1.50, 2.44] and social-emotional developmental delay [OR = 1.31, 95% CI: 1.04, 1.66]. The caregiver-child interaction partially mediated the associations of SES with child developmental outcomes; the proportion of the indirect effect was 14.9% for ASQ-C total score and 32.1% for ASQ: SE score. Moreover, the caregiver-child interaction had a significant moderation effect on the association of SES with ASQ-C total score (P < 0.05). A weaker association was observed in children with high-level caregiver-child interaction than in medium and low ones. Similar moderating effects were found among boys but not girls.

CONCLUSION

Caregiver-child interaction plays a vital role in the relationship between SES and child development. Children with low SES households will benefit more in terms of their early development from intervention programs strengthening caregiver-child interaction.

Prevalence and determinants of developmental delay among children in low- and middle-income countries: a systematic review and meta-analysis

Background

Developmental delay is a public health problem in low- and middle-income countries. However, there is no summarized evidence in low- and middle-income countries on developmental delay, and primary studies on this issue show varied and inconclusive results. This systematic review and meta-analysis aimed to assess the pooled magnitude of confirmed developmental delay and its determinants among children in low- and middle-income countries.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to write this systematic review and meta-analysis. Primary studies were searched from PubMed, PsycINFO, Hinari, Science Direct, African Journal of Online, Web of Science, and Google Scholar databases. The Newcastle-Ottawa Scale, adapted for the cross-sectional studies, was used to assess the quality of the included studies. Heterogeneity and publication bias were assessed by the I2 and Eggers tests, respectively. Due to the high heterogeneity, the random effects model was used for analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to show the association between developmental delay and its determinants.

Results

The pooled prevalence of confirmed developmental delay was 18.83, 95% CI (15.53-22.12). In the subgroup analysis, a high prevalence of developmental delay [26.69% (95% CI, 15.78-37.60)] was observed in studies performed in Africa. Maternal education [3.04; 95% CI (2.05, 4.52)] and low birth weight [3.61; 95% CI (1.72, 7.57)] were significant determinants of developmental delay.

Conclusion

The pooled prevalence of developmental delay in low- and middle-income countries was high as compared to that in high-income countries. Maternal education level and weight at birth were significantly associated with developmental delays. Therefore, strategies should be designed to decrease the rate of low birth weight and the number of illiterate mothers living in low- and middle-income countries.

Systematic review registration

PROSPERO, CRD42024513060.

Associations of father absence and limited access to books and toys with early childhood development among children aged 0-6 years in a rural county lifted out of poverty in China

OBJECTIVES

This study aimed to understand the early development and nurturing care environment of children aged 0-6 years in rural China and to evaluate the sex- and age-specific associations of nurturing care environment with child developmental outcomes.

METHODS

A cross-sectional survey involving 2078 children aged 0-6 years was conducted using a stratified cluster sampling strategy. We used face-to-face interviews to collect information on child, family and nurturing care. The Ages & Stages Questionnaires-Chinese version and ASQ: Social-Emotional were applied to assess children's neuro- and social-emotional development, respectively. Lower neurodevelopmental scores indicate an increased risk for neurodevelopmental delay, and higher social-emotional scores are indicative to a risk of social-emotional problems. The multiple linear regression model examined the associations of nurturing care environments with childhood development.

RESULTS

Among the investigated children, the average age was (42.9 ± 19.8) months and 55.8% were boys; 67.9% of the children had absent fathers because of labour migration and 54.0% had limited access to books and toys. Overall, boys had a lower total neurodevelopmental score than girls; similar gender patterns were also found in the domains of communication, fine motor, problem-solving and person-social. Concurrent absent fathers and limited access to books and toys were significantly associated with reduced neurodevelopmental scores [β - 11.44, 95% CI (-18.20, -4.68)] and increased social-emotional developmental scores [β 5.88, 95%CI (1.35, 10.41)] after controlling for confounding factors. Sex-specific analysis only echoed the results in boys. Additionally, having an absent father and limited access to books and toys was associated with lower neurodevelopmental scores [β - 14.58, 95%CI (-25.41, -3.75)] in children under 3 years of age and higher social-emotional developmental scores among children aged 3-6 years [β 10.66, 95%CI (5.09, 16.24)].

CONCLUSIONS

Children, especially boys, with absent fathers due to labour migration have poorer neuro- and social-emotional development. Limited access to books and toys and father absence are linked to the children's developmental delay, especially for those under 3 years of age. Our findings suggest that intervention programs in resource-constrained rural areas are desirable; more importantly, such programs should begin before 3 years of age to achieve a benefit-cost outcome.

Early stimulation and responsive care: A mediator of caregivers' depression on the suspected developmental delay of left-behind children in China

BACKGROUND

Due to multiple factors, left-behind children in rural areas suffer from neurodevelopment delay and their caregivers suffer from depressive symptoms. This study aimed to analyze the effect of caregivers' depressive symptoms on left-behind children's neurodevelopment, with early stimulation and responsive care mediating.

METHODS

We conducted a cross-sectional survey in five counties in China. A total of 904 left-behind children aged 0-3 and their primary caregivers were enrolled. The Zung Self-rating Depression Scale (ZSDS) was used to measure caregivers' depressive symptoms. The Ages and Stages questionnaires-third edition (ASQ-3), which contains five domains: communication (CM), gross motor (GM), fine motor (FM), problem-solving (CG), and personal social (PS), was used to screen children for suspected developmental delay (SDD).

RESULTS

31.4 % of left-behind children suffered from SDD, while 39.7 % of left-behind children's caregivers experienced depressive symptoms. Caregivers' ZSDS scores were positively correlated with the SDD on four domains (FM, GM, CG, and PS), while Early stimulation and responsive care was negatively correlated with the SDD on four domains (CM, FM, CG, and PS).

LIMITATIONS

The cross-sectional design limited the ability to ascertain causal relations. Besides, the findings may not be generalized to all regions of China due to the heterogeneity of the study population.

CONCLUSIONS

Left-behind children under three years old in rural China were at high risk of SDD, while a substantial proportion of their caregivers had depressive symptoms. Caregivers' depressive symptoms may negatively affect the SDD of left-behind children through caregivers providing less early stimulation and responsive care.

Effect of a mental health education intervention on children's life satisfaction and self-confidence in rural China

Children living in rural areas may potentially experience low levels of life satisfaction and face challenges in developing self-confidence. The purpose of the current study was to examine the impact of a mental health education intervention on the life satisfaction and self-confidence of children residing in rural areas of China. A total of 1,001 children from grades 4 to 6 were randomly assigned to an intervention group (475 children, 250 boys, M = 11.57 years, SD = 1.082 years) and a control group (526 children, 279 boys, M = 11.38 years, SD = 0.980 years). Over 16 weeks, the intervention group received a mental health education program, while the control group did not. The levels of life satisfaction (including five dimensions: family, school, environmental, friends, and self-satisfaction) and self-confidence (including three dimensions: self-efficacy, self-assurance, and self-competence) were rated by all children at baseline and post-intervention. Results from paired samples t-test showed that post-intervention, the intervention group exhibited significant improvements in the areas of family, environmental, school, and self-satisfaction as well as self-efficacy, self-assurance, and self-competence. However, there was no significant improvement in friend satisfaction. Conversely, the control group showed decreases in school, environmental, and friend satisfaction, along with decreases in self-efficacy, self-assurance, and self-competence. No significant change was observed in family and self-satisfaction in this group. These findings emphasize the importance of implementing mental health education interventions for rural children, who are at risk for low life satisfaction and self-confidence. Some specific recommendations are provided for policymakers and practitioners.

Prevalence and trends of developmental disabilities among US children and adolescents aged 3 to 17 years, 2018-2021

Developmental disabilities prevalence seem to be high in countries around the world. It's worth understanding the most recent prevalence and trends of developmental disabilities. The objective of this study is to examine the prevalence and trends of developmental disabilities of US children and adolescents. A total of 26,422 individuals aged 3-17 years were included. Annual data were examined from the National Health Interview Survey (2018-2021). Weighted prevalence for each of the selected developmental disabilities were calculated. The prevalence of any developmental disabilities in individuals was 16.65% (95% CI 16.03-17.26%), prevalence of attention deficit/hyperactivity disorder (ADHD), learning disability (LD), autism spectrum disorder (ASD), intellectual disability (ID), and other developmental delay were 9.57% (95% CI 9.09-10.06%), 7.45% (95% CI 7.00-7.89%), 2.94% (95% CI 2.67-3.21%), 1.72% (95% CI 1.51-1.93%), and 5.24% (95% CI 4.89-5.59%), respectively. Significant increases were observed for other developmental delay (4.02-6.05%) and co-occurring LD & ID (1.03-1.82%). Findings form this study highlight a high prevalence of any developmental disabilities, although no significant increase was observed. The prevalence of other developmental delay and co-occurring LD & ID were significantly increased. Further investigation is warranted to assess potentially modifiable risk factors and causes of developmental disabilities.

The association between parental risks and childhood development: findings from a community-based survey in East China

BACKGROUND

Nurturing care is necessary for optimal early childhood development. This study aimed to investigate the prevalence of parental risks in rural East China and assess their impacts on early development in children younger than three years old.

METHODS

This community-based cross-sectional survey was conducted among 3852 caregiver-child pairs in Zhejiang Province from December 2019 to January 2020. Children aged 0 to 3 years were recruited from China's Early Childhood Development Program (ECD). Local child health care providers conducted face-to-face interviews with the primary caregivers. Demographic information of the participants was collected by questionnaire. Each child was screened for parental risk through the Parental Risk Checklist designed by the ECD program. The Ages and Stages Questionnaire (ASQ) was used to identify children with potential developmental delays. Multinomial logistic regression model and linear trend test were applied to assess the association between parental risks and suspected developmental delays.

RESULTS

Among the 3852 children included in the analyses, 46.70% had at least one parental risk and 9.01% presented suspected developmental delays in any domain of ASQ. Parental risk was statistically associated with the overall suspected developmental delay in young children (Relative Risk Ratio (RRR): 1.36; 95% confidence interval (CI): 1.08, 1.72; P = 0.010) after adjusting potential confounders. Compared with children with no parental risk, children exposed to 3 or more parental risks had 2.59, 5.76, 3.95, and 2.84 times higher risk of the suspected developmental delay in overall ASQ, communication, problem-solving, and personal-social domain, respectively (P values < 0.05). The linear trend tests found that the more parental risks, the higher possibility of developmental delay (P values < 0.05).

CONCLUSIONS

Parental risks are prevalent among children under three years in rural East China, which may increase the risk of developmental delays in children. Meanwhile, parental risk screening can be used to recognize poor nurturing care in primary health care settings. Targeted interventions are warranted to improve nurturing care for optimal early childhood development.

The relationship between home environment and early childhood development of left-behind children under 3 years in rural China

BACKGROUND

Home environment provides stimulation and learning opportunities required for children's early development. However, few studies have focused on the effects of home environment on left-behind children's development in rural China. The study aimed to investigate the relationship between home environment and early childhood development of left-behind children under 3 years old in rural China.

METHODS

Information about sociodemographic characteristics, caregivers' mental health, home environment and children's development was collected. Infant/Toddler Home Observation for Measurement of the Environment Inventory (IT-HOME) was used to assess home environment. Child's development was evaluated with the Chinese version of the Ages & Stages Questionnaire - third edition.

RESULTS

Elevated caregivers' depressive symptoms were associated with a higher risk of total suspected development delay. An increase of one score in the IT-HOME resulted in a 7% decrease in total suspected development delay. Higher scores in the dimensions of involvement and variety were associated with a lower risk of suspected development delay adjusting for covariates.

CONCLUSIONS

Our results have implications for home-based intervention aiming at promoting nurturing care as well as caregivers' mental health, which is required for early development of young left-behind children in rural areas of China.

Prediction of cord blood leptin on infant's neurodevelopment: A birth cohort in rural Yunnan, China

BACKGROUND

Leptin, one of the peptide hormones secreted by adipocytes, plays a vital part in metabolism, but its role in early-life neurodevelopment remains poorly understood.

METHODS

We performed leptin analysis on 323 cord blood samples collected from a birth cohort in Yunnan rural area, China, and assessed infants' neurodevelopment at one year of age by the Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III). Multiple linear regression and binary logistic regression models were used to explore the associations between cord blood leptin (CBL) concentrations and infants' neurodevelopment and the ability of CBL to predict the probabilities of infants' neurodevelopment delay.

RESULTS

Overall, 323 infants were included in this study. The median concentration of CBL was 4.7 ng/ml. The proportion of 1-year-old infants identified as being neurodevelopmental delayed was 34.5%, and delays in cognitive, language, and motor domains were 11.1%, 26.6%, and 13.9%, respectively. Multiple linear regression analyses manifested that the CBL concentration (log10-transformed) was positively correlated with the cognitive, language, and motor composite scores in infants, respectively (β = 7.76, 95%CI: 3.81-11.71; β = 6.73, 95%CI: 3.41-10.06; and β = 6.88, 95%CI: 3.48-10.29, respectively). Binary logistic regression analysis showed that compared with the higher, lower CBL (< 4.7 ng/ml) yielded a 1.41-fold increase in the risk of language development delay (OR = 2.41，95%CI: 1.42-4.09), a 1.49-fold higher risk of motor development delay (OR = 2.49, 95%CI: 1.25-4.96), and a 1.71-fold higher risk of neurodevelopment delay (OR = 2.71, 95%CI: 1.64-4.48) among infants. The prediction models showed that the probabilities of development delay in infants' language, motor, and neurodevelopment increased with the decline of CBL concentrations [r_s = -0.63 (95% CI: -0.71, -0.56), r_s = -0.46 (95% CI: -0.55, -0.38), r_s = -0.55 (95% CI: -0.63, -0.46), respectively].

CONCLUSION

The decline of CBL was associated with the decrease in infants' neurodevelopment scores at one year of age. CBL below 4.7 ng/ml may increase the risk of infants' neurodevelopment delay. The probabilities of infants' neurodevelopment delay increased with the decrease of CBL concentrations. CBL may be a predictor of the probability of children's neurodevelopment delay.

Impact of an Early Childhood Development Intervention on the Mental Health of Female Caregivers: Evidence from a Randomized Controlled Trial

Investing in early childhood development is an effective way to enhance human capital accumulation. Caregivers' mental health is one of the most important factors influencing children's development. Previous studies have found that mental health issues in caregivers are widespread all over the world, especially in low- and middle-income countries. In this study, we explored the effects of the "Integrated Program for Early Childhood Development" on the mental health of female caregivers in Southwest China through a randomized intervention trial, with infants aged 5-25 months and their caregivers as the target subjects. The heterogeneity of the effects of different characteristics of the caregivers and the mechanism of the intervention effect were also analyzed. Primary caregivers were provided comprehensive early development interventions for the children in the treatment group via bi-weekly home visiting activities and monthly family group activities. The results showed that the prevalence of depression, anxiety, and stress symptoms among female caregivers in this rural area were 32%, 42%, and 30%, respectively. Whether the child was breastfed, parent's age, parent's education level, primary caregiver type, the ratio of the number of months the mother was at home full time to the child's age, the grandmother's rearing ability, and the family asset index were the factors influencing the mental health of female caregivers. The intervention significantly increased the proportion of depressive symptoms in 28% of the grandmothers. It significantly reduced the anxiety symptoms of daughters-in-law not from the local town, while the social interactions of both local and non-local daughters-in-law were significantly improved.

Study protocol for Attachment & Child Health (ATTACHTM) program: promoting vulnerable Children’s health at scale

Background

Children’s exposure to toxic stress (e.g., parental depression, violence, poverty) predicts developmental and physical health problems resulting in health care system burden. Supporting parents to develop parenting skills can buffer the effects of toxic stress, leading to healthier outcomes for those children. Parenting interventions that focus on promoting parental reflective function (RF), i.e., parents’ capacity for insight into their child’s and their own thoughts, feelings, and mental states, may understand help reduce societal health inequities stemming from childhood stress exposures. The Attachment and Child Health (ATTACH^TM) program has been implemented and tested in seven rapid-cycling pilot studies (n = 64) and found to significantly improve parents’ RF in the domains of attachment, parenting quality, immune function, and children’s cognitive and motor development. The purpose of the study is to conduct an effectiveness-implementation hybrid (EIH) Type II study of ATTACH^TM to assess its impacts in naturalistic, real-world settings delivered by community agencies rather than researchers under more controlled conditions.

Methods

The study is comprised of a quantitative pre/post-test quasi-experimental evaluation of the ATTACH^TM program, and a qualitative examination of implementation feasibility using thematic analysis via Normalization Process Theory (NPT). We will work with 100 families and their children (birth to 36-months-old). Study outcomes include: the Parent Child Interaction Teaching Scale to assess parent-child interaction; the Parental Reflective Function and Reflective Function Questionnaires to assess RF; and the Ages and Stages Questionnaire – 3rd edition to examine child development, all administered pre-, post-, and 3-month-delayed post-assessment. Blood samples will be collected pre- and post- assessment to assess immune biomarkers. Further, we will conduct one-on-one interviews with study participants, health and social service providers, and administrators (total n = 60) from each collaborating agency, using NPT to explore perceptions and experiences of intervention uptake, the fidelity assessment tool and e-learning training as well as the benefits, barriers, and challenges to ATTACH^TM implementation.

Discussion

The proposed study will assess effectiveness and implementation to help understand the delivery of ATTACH^TM in community agencies.

Trial registration

Name of registry: https://clinicaltrials.gov/. Registration number: NCT04853888. Date of registration: April 22, 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03439-3.

Early neurological development and nutritional status in Mexican socially deprived contexts

Early childhood development (ECD) is a critical stage in the intergenerational process of human development. Targeted interventions depend on accurate and up-to-date ECD measurements. This paper presents estimates for the nutritional and neurodevelopmental status of socially marginalized children in Mexico. We performed a cross-sectional study based on data collected in 2019-2020 during home visits to 1,176 children aged 0-38 months across 24 highly marginalized locations in Oaxaca. We assessed nutritional status according to the World Health Organization 2006 child-growth standards and ECD status using the Child Development Evaluation Test, 2nd Edition. We stratified results by sex. Prevalence of stunting was 5.3 percentage points (p.p.) higher (p = 0.023) in males (25.3%; 95% CI: 20.2%, 31.1%) compared to females (20.0%; 95% CI: 15.0%, 26.1%). Overall prevalence rates stood at 5.7% (95% CI: 4.0%, 8.1%) for underweight, 1.5% (95% CI: 0.9%, 2.7%) for wasting and 3.6% (95% CI: 2.3%, 5.7%) for overweight/obesity, with no significant differences by sex. Prevalence of normal development was 8.3 p.p. lower (p = 0.001) in males (39.3%; 95% CI: 34.5%, 44.4%) compared to females (47.6%; 95% CI: 41.6%, 53.6%). By development area, the highest prevalence of suboptimal outcomes among children with developmental lag or at risk of delay was observed in their gross motor and language skills: 24.1% (95% CI: 20.0%, 28.8%) and 38.6% (95% CI: 34.0%, 43.3%), respectively. The largest difference between the sexes was found in the language area. Our results show that childhood development strategies have been insufficient thus far in the studied population. Programs specifically designed to prevent ECD lags and bridge inequality gaps are urgently needed. Trial registration: ClinicalTrials.gov ID: NCT04210362.

Impact of Parental Beliefs on Child Developmental Outcomes: A Quasi-Experiment in Rural China

This paper examines the impact of parental beliefs on child development outcomes (for both cognitive and social−emotional skills) based on a three-wave longitudinal survey in rural China. The survey waves were conducted when the sample children were 18−30 months, 22−36 months, and 49−65 months, respectively. A total of 815 children and their primary caregivers who participated in all three wave surveys were enrolled in this study. Using difference-in-differences and propensity score matching approaches, the results indicate that strengthened parental beliefs have a positive and significant impact on child social−emotional development. Specifically, between the periods of the Wave 1 survey (when children were 18−30 months old) and the Wave 3 survey (when children were 49−65 months old), and between the Wave 2 survey (when children were 22−36 months old) and the Wave 3 survey, strengthened parental beliefs were causally associated with more favorable child social−emotional scores by 0.44 SD (p < 0.01) and 0.49 SD (p < 0.01), respectively. No significant impact, however, was found between the period of the Wave 1 survey and the Wave 2 survey. In contrast, weakened parental beliefs had a negative and significant impact on child social−emotional development. Specifically, weakened parental beliefs were causally associated with worse child social−emotional abilities by 0.35 SD (p < 0.01), 0.30 SD (p < 0.01), and 0.22 (p < 0.05) for the time period of the Wave 1 to Wave 2, Wave 1 to Wave 3, and Wave 2 to Wave 3, respectively. No significant impact of parental beliefs, however, was found on child cognitive development. In addition, the findings of the mediation analysis show that only a marginal impact of parental beliefs on child social−emotional development can be indirectly explained by parental beliefs through parenting practices. This study calls on policy makers to improve parental beliefs and parenting practices in the hope that it will lead to better child development in rural China.

Gender inequality in nutrition intake: Evidence from a large assistance program

This paper examines the growth effect of one of the largest nutrition assistance programs in early life. The program covers 5.8 million children in poor rural China and provides 6-24-month old children with a free nutrition supplement that contains nine essential micronutrients. We utilize a phase-in procedure by county for identification and estimate its impact on several early-life health indicators. Robust evidence shows that such nutrition supplements effectively increase boys' weight and reduce their probability of being underweight. No effect is observed on girls of similar age. These health indicators are related to long-term human capital development. The gender differences in policy impact that are identified in this paper have important implications for nutrition subsidy in the early years of life in developing countries.

Capacity Building of Frontline Workers for Detection of Children (0-6 Years) with Developmental Delays in a Rural Setting: A Cluster-Randomized Trial

INTRODUCTION

Development during the early stage of life i.e. in the first 1000 d is crucial in determining the psychosocial productivity of a child in the future. Frontline workers (FLWs) are not trained to detect of developmental delays (DDs) in children under the national programme of Rashtriya Bal Swasthya Karyakram (RBSK) in India.

OBJECTIVE

To train the FLWs and assess the effectiveness of a training strategy in detection of DDs in children less than 6 y of age using a cluster-randomized trial approach.

METHODS

A community-based interventional study was conducted in Khurdha district of Odisha. Training was imparted to FLWs in intervention arm using a training module developed in regional language. Knowledge level of FLWs was assessed before and after the training in both study arms using a structured questionnaire, and data were analyzed in IBM SPSS 22. Outcomes were compared using chi square, Student t (both paired and unpaired) and Man-Whitney U test. After 3 mo of intervention, the investigator examined a sample of children (intervention arm: 870, control arm: 847) for DDs using the Denver Developmental Screening Test II.

RESULTS

The mean difference in knowledge scores of FLWs was found to be 7.26 (8.8 to 5.7) and 1.11 (1.38 to 0.84) in intervention and control arm, respectively. Case detection rate by FLWs in intervention and control arm was 61.5% and 9.09%, respectively.

CONCLUSION

Capacity building of the FLWs should be considered by the government for integrating them in the Rashtriya Bal Swasthya Karyakram (RBSK) programme for screening children.

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.

Socio-demographic, maternal, and infant characteristics associated with early childhood development delays among children of young mothers in Brasília, Brazil

BACKGROUND

Holistic attention to adolescent health is needed to sustain the benefits of investment in early childhood development. Any such interventions must make sure to address the needs of adolescent and young adult parents. This study explored the social and demographic maternal variables associated with risk of early childhood development (ECD) delay for children of young mothers in Brazil.

METHODS

Cross-sectional secondary data analysis was done using data from young mothers (aged 13-24) and their children (aged 0-2), collected from community health centers in Brasília, Brazil, between 2017-2018. The Denver Developmental Screening Test II was used to assess risk of ECD delay outcomes. Descriptive analyses were conducted across the full sample and sub-groups of adolescent (13-19) and young adult (20-24) mothers. Multivariable logistic regressions based on theory modelling approach were conducted for the full sample to examine the associations between maternal age and risk of ECD delay, adjusted for a battery of household, maternal, pregnancy, and infant variables.

RESULTS

Risk of ECD delay was found in 17.39% (N = 76) of the children who participated (N = 437). No significant differences in risk of ECD delay were found for children of adolescent mothers compared to children of young adult mothers. Across the full sample, 60.36% (N = 236) of mothers were living in poverty, 73.17% (N = 319) had 9 or more years of education, and 86.14% (N = 373) were not working outside the home at time of data collection. Furthermore, 90.11% (N = 392) did not identify as head of their household and 73.68% (N = 322) were primiparous. Socially-mediated factors such as lower maternal educational attainment, unemployment, and lack of household support were associated with increased risk of ECD delays for children under age 2. Adjusted logistic regression identified multiparity as an independent maternal factor associated with increased risk of ECD delay (AOR = 2.51; 95% CI, 1.23-5.13).

CONCLUSIONS

Multiparity was the only independent maternal factor associated with ECD delay among children under 2 years old. Other socio-demographic factors relevant to young mothers may influence ECD delays. Ensuring sustained, concurrent attention to children's and young parent's developmental needs may improve multi-generational health outcomes.

Developmental delay and its associated factors among children under five years in urban slums of Nepal

INTRODUCTION

Children from low-resource settings are more likely to encounter those factors that adversely influence their ability to acquire developmental potential. This study was conducted to assess the developmental status and its associated factors among children under five years of slum areas of Butwal Sub Metropolitan City, Rupandehi, Nepal.

METHODS AND FINDINGS

We conducted a community-based cross-sectional descriptive study using Developmental Milestone Chart (DMC) among 165 children under five years. Ethical approval was obtained from Ethical Review Board of Nepal Health Research Council. R software was used for data analysis. The association between developmental status and associated factors were examined with Chi-square and followed by logistic regression. Notably, more than half of the children (56.4%) had delayed development across two or more domains of gross motor, fine motor, language/ speech, and social development. Age, sex, socio-economic status, availability of learning materials, the occurrence of infectious diseases, and height-for-age of children were found to be significantly associated with the developmental status of children under study (p<0.05).

CONCLUSIONS

More than half of the children taken under the study had delayed development on different four domains. Findings from the study suggest that there should be similar studies conducted among children living in slum-like conditions. Additionally, programs should be designed as such which aims to mitigate the effect of socio-economic status on child development and has learning and nutritional aspects embedded central to its deliverance.

Paths of social-emotional development before 3 years old and child development after 5 years old: Evidence from rural China

BACKGROUND

Social-emotional development during the first three years of life is associated with later social-emotional development and cognitive development. In rural China, research has found large shares of children under age three are developmentally delayed, yet little is known about the paths of social-emotional development before age 3 or how developmental paths predict later social-emotional skills and cognitive skills.

AIMS

To investigate the paths of child social-emotional development during ages 0-3 and examine how different paths predict social-emotional development and cognitive development at preschool age.

METHODS

Three waves of longitudinal panel data from 1245 children in rural Western China was collected. Child social-emotional development was measured by the Ages and Stages Questionnaire: Social-Emotional. Child cognitive development was measured by the Bayley Scales of Infant Development and by the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition. Four paths of child social-emotional development were classified: "never" social-emotionally delayed; "persistently" social-emotionally delayed; "improving," or "deteriorating."

RESULTS

331 (27%) were never social-emotionally delayed; 373 children (30%) were persistently social-emotionally delayed; 149 children (12%) experienced improving social-emotional development; and 392 children (31%) experienced deteriorating social-emotional development. Children who were never social-emotionally delayed or who were on an "improving" path had higher social-emotional development at preschool age (p < .01). Children who were persistently social-emotionally delayed (p < .5) and on a deteriorating path (p < .01) had lower social-emotional development at preschool age. Children on the persistently delay path also were shown to have lower levels of cognitive development at preschool age (p < .01).

CONCLUSIONS

Different paths of child social-emotional development before age 3 are associated with different social-emotional and cognitive development at preschool age.

Prenatal Drug Exposure in Children With a History of Neuropsychiatric Care: A Nested Case-Control Study

BACKGROUND AND OBJECTIVES

Neuropsychiatric disorders in childhood after prenatal drug exposure raises concerns. Most of the published studies focused on psychotropic medications. This study investigated which prenatal medication exposure was associated with neuropsychiatric disorders in childhood.

METHODS

A case-control study, nested in the French POMME cohort, was conducted to compare prenatal medication exposure between children with a history of neuropsychiatric care (ages 0-8 years) and children in a control group. POMME included children born in Haute-Garonne to women covered by the general Health Insurance System, between 2010 and 2011 (N = 8,372). Cases were identified through: (1) reimbursement for neuropsychiatric care; (2) psychomotor development abnormalities specified on health certificates; and (3) reimbursement for methylphenidate or neuroleptics. Controls had none of these criteria. Prenatal exposure to each of the major "Anatomical Therapeutic Chemical" classes was compared between the groups. Class(es) for which there was a statistically significant difference (after Bonferroni adjustment, i.e., p < 0.0033) was(were) compared using logistic regression.

RESULTS

A total of 723 (8.6%) cases and 4,924 (58.8%) controls were identified. This study showed a statistically significant difference in prenatal exposure to nervous system drugs (excluding analgesics) between the groups [ORa: 2.12 (1.55; 2.90)]. Differences (not statistically significant at the 0.0033 threshold) were also observed for the ATC classes: Musculoskeletal, Genito-urinary System and Sex Hormones, Alimentary Tract and Anti-infectives.

CONCLUSION

Through identification of children with neuropsychiatric disorders and of their prenatal medication exposure, this study provides guidance for the assessment of long-term neuropsychiatric effects after prenatal medication exposure, without focusing on psychotropic medications.

Cross-sectional examination of 24-hour movement behaviours among 3- and 4-year-old children in urban and rural settings in low-income, middle-income and high-income countries: the SUNRISE study protocol

INTRODUCTION

24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap.

METHODS AND ANALYSIS

SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study.

ETHICS AND DISSEMINATION

The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions.

Early childhood development and parental training interventions in rural China: a systematic review and meta-analysis

INTRODUCTION

Inadequate care during early childhood can lead to long-term deficits in skills. Parenting programmes that encourage investment in young children are a promising tool for improving early development outcomes and long-term opportunities in low-income and middle-income regions, such as rural China.

METHODS

We conducted a systematic review and a meta-analysis to investigate the prevalence of early developmental delays and stimulating parenting practices as well as the effect of parental training programmes on child development outcomes in rural China. We obtained data in English from EconPapers, PubMed, PsycARTICLES, Cochrane Library, Web of Science and Scopus (Elsevier) and in Chinese from China National Knowledge Infrastructure, Wanfang Data and VIP Information. We conducted frequentist meta-analyses of aggregate data and estimated random-effects meta-regressions. Certainty of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

We identified 19 observational studies on the prevalence of developmental delays and stimulating parenting practices for children under 5 years of age (n=19 762) and ten studies on the impact of parental training programmes on early child development (n=13 766). Children's risk of cognitive, language and social-emotional delays in the rural study sites (covering 14 provinces mostly in Central and Western China) was 45%, 46%, and 36%, respectively. Parental training programmes had a positive impact on child cognition, language and social-emotional development.

CONCLUSION

There is evidence to suggest that early developmental delay and the absence of stimulating parenting practices (ie, reading, storytelling and singing with children) may be prevalent across rural, low-income and middle-income regions in Central and Western China. Results support the effectiveness of parental training programmes to improve early development by encouraging parental engagement.

TRIAL REGISTRATION NUMBER

This study was registered with PROSPERO (CRD42020218852).

The Effectiveness and Cost-effectiveness of a Parenting Intervention Integrated with Primary Health Care on Early Childhood Development: a Cluster-Randomized Controlled Trial

Developing countries require interventions that can sustainably improve early childhood development (ECD) at scale because hundreds of millions of children are at risk of poor development. This study examined the effectiveness and cost-effectiveness of a parenting intervention integrated with primary health care in terms of ECD. A cluster-randomized controlled trial was conducted in 20 urban communities in China, with 82 and 86 children aged 1-2 months enrolled in the intervention and control groups, respectively, and 71 and 69 children, respectively, followed to 14 months of age. All children in both groups received routine primary health care services. Intervention caregivers received a parenting pamphlet and two parenting training sessions during well-child clinic visits; those with children with suspected developmental delay received additional parenting guidance by telephone. Compared with controls, children receiving the intervention had similar developmental outcomes, measured with the Chinese version of the Ages & Stages Questionnaires third edition (ASQ-C), at baseline, but had significantly higher communication (adjusted mean difference = 0.26; 95% CI 0.03, 0.51), fine motor (adjusted mean difference = 0.19; 95% CI 0.01, 0.37), and overall (adjusted mean difference = 0.25; 95% CI 0.10, 0.41) ASQ-C z-scores after 12 months of the intervention. The intervention cost per child was $50.87, and the costs for increasing the communication, fine motor, and overall ASQ-C scores by one SD were $195.65, $267.74, and $203.48, respectively. Our findings indicate that the integration of a parenting intervention with existing primary health care is a cost-effective way to improve ECD.

Psychometric properties of the ASQ-3 in a nationally representative sample of Uruguay

BACKGROUND

The Ages & Stages Questionnaires Third Version (ASQ-3) identifies the risk of developmental delay in children aged 2 to 66 months. The ASQ-3 is available in many languages. However, there is little evidence of the psychometric properties of the Spanish version and using nationally-representative samples.

AIMS

This study evaluates the reliability and factor solution of the Spanish version of the ASQ-3 (18- to 54-month questionnaires) in a large, representative sample of Uruguayan children. Besides, it explores the association of ASQ-3 scores with sociodemographic characteristics.

METHOD

Participants were 4016 main caregivers selected randomly across the country who completed the ASQ-3 for their children. All participants responded to the ASQ-3 and a sociodemographic questionnaire within the context of a government-run survey of child development.

RESULTS

Most versions of the ASQ-3 in Spanish have acceptable-to-good psychometric properties, supporting the 5-factor-solution. Personal-Social and, to a lesser extent, Problem-solving scores were the subscales that showed more suboptimal internal consistency coefficients. Scores showed higher ceiling effects than the original US sample but varied across domains, with Gross Motor showing the highest pattern. Sex and socioeconomic status are associated with scores of most age-versions and subscales of the ASQ-3.

CONCLUSIONS

In general, results support the reliability and dimensionality of ASQ-3 scores, but psychometric properties varied across age-version and domains. Overall, earlier versions presented less precision, while the Personal-social domain showed reduced reliability in most age-versions.

Trajectories of child cognitive development during ages 0-3 in rural Western China: prevalence, risk factors and links to preschool-age cognition

BACKGROUND

Cognitive development after age three tends to be stable and can therefore predict cognitive skills in later childhood. However, there is evidence that cognitive development is less stable before age three. In rural China, research has found large shares of children under age three are developmentally delayed, yet little is known about the trajectories of cognitive development between 0 and 3 years of age or how developmental trajectories predict later cognitive skills. This study seeks to describe the trajectories of child cognitive development between the ages of 0-3 years and examine how different trajectories predict cognitive development at preschool age.

METHODS

We collected three waves of longitudinal panel data from 1245 children in rural Western China. Child cognitive development was measured by the Bayley Scales of Infant Development when the child was 6-12 months and 22-30 months, and by the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition when the child was 49-65 months. We used the two measures of cognitive development before age three to determine the trajectories of child cognitive development.

RESULTS

Of the children, 39% were never cognitively delayed; 13% were persistently delayed; 7% experienced improving cognitive development; and 41% experienced deteriorating development before age 3. Compared to children who had never experienced cognitive delay, children with persistent cognitive delay and those with deteriorating development before age 3 had significantly lower cognitive scores at preschool age. Children with improving development before age 3 showed similar levels of cognition at preschool age as children who had never experienced cognitive delay.

CONCLUSIONS

Large shares of children under age 3 in rural Western China show deteriorating cognitive development from infancy to toddlerhood, which predict lower levels of cognition at preschool age. Policymakers should invest in improving cognitive development before age 3 to prevent long-term poor cognition among China's rural children.

Child Diet and Household Characteristics Relate Differently to Child Development at the Beginning and the End of the Second "1000 Days" in Rural Nepal

The "second 1000 days" is a period of rapid brain growth which consolidates developmental foundations and establishes school readiness. Understanding the relation between household characteristics, child diet, and child development remains incomplete, especially in resource-poor settings where >250 million children risk not achieving their full developmental potential. Child developmental performance was assessed (Ages & Stages Questionnaire [ASQ]) at ages 2 and 5 years in a cohort of Nepali children (n = 207) whose families participated in a nutrition/livestock management+community development intervention trial. Relationships between child developmental performance and mother's education, family wealth, child diet (animal source food [ASF] consumption, dietary diversity score [DDS]), school attendance, and intervention group were examined by adjusted linear regressions. These relationships varied at the 2 ages. At age 2 years, ASQ scores related positively to "Full Package Intervention" and negatively to "Partial Package Intervention" membership. At age 5 years, intervention group did not relate to ASQ scores. Mother's education did not relate to developmental findings for 2-year-olds. Mother's education, wealth, and school attendance positively predicted ASQ scores for these same children as 5-year-olds. Animal source food consumption was related to child development more strongly at age 5 than at 2 years. DDS had a less pronounced relationship to development than ASF consumption at both ages. Over this time span bracketing the second 1000 days, household characteristics and child diet related differentially to developmental performance depending on child age. Better understanding of the timing and mechanisms of these relationships is needed to effectively design interventions targeting improved child development in resource-poor settings.

China's antenatal care promoting early childhood development: evidence from a cross-sectional survey

The Chinese government has established a three-tier maternal care system covering the entire country and providing integrated antenatal care (ANC) for pregnancies. This study aimed to analyze the direct and indirect effects of ANC services on early childhood development. A community-based cross-sectional survey was conducted for mothers' ANC visits and assessments of early childhood development in Shanxi and Guizhou provinces, China. A total of 1660 mother-child dyads were included in current analyses: 29.2% of mothers did not receive any ANC (ANC1), 23.3% of mothers received ANC three or fewer times (ANC2), and 47.5% of mothers received ANC four or more times (ANC3). Children whose mothers received ANC services had a significantly lower risk of overall developmental delay (OR = 0.60, 95% CI: 0.44-0.81 for ANC2; and OR = 0.44, 95% CI: 0.34-0.59 for ANC3) and social-emotional developmental delay (OR = 0.68, 95% CI: 0.49-0.94 for ANC3). Furthermore, a significant pathway relationship mediated by maternal depression and nurturing care was found between ANC and developmental delay. This study showed ANC services significantly reduced the risk of developmental delay in offspring. We also suggest that a nationwide ANC system can be a good delivery platform for scaled-up early childhood development interventions.

Mental Health Issues among Caregivers of Young Children in Rural China: Prevalence, Risk Factors, and Links to Child Developmental Outcomes

Previous research has found that there are high rates of mental health problems among caregivers in rural China and that caregiver mental health may be a significant predictor of developmental delays among infants and toddlers in these rural areas. In this paper, we use data from a survey of 986 caregiver-child pairs in rural China to examine the risk factors of caregiver mental health and measure the association between caregiver mental health and child development outcomes. To conduct the empirical analysis, we assess caregiver mental health using the Depression Anxiety Stress Scales-21 (DASS-21) questionnaire and measure child developmental outcomes using the Bayley Scales of Infant and Toddler Developmental Third Edition (Bayley-III). The results show that 32% of caregivers have depressive symptoms, 42% have anxiety symptoms, and 30% have symptoms of stress. The data also demonstrate that caregiver identity and age as well as different measures of socioeconomic status (SES) (characterized by caregiver education, father’s education, and household wealth) are all significantly linked to symptoms of caregiver mental health problems. The analysis shows that caregiver depression, anxiety, and/or stress are significantly associated with lower early childhood development (ECD) outcomes in all areas measured (cognition, language, social-emotion, and motor skills). The heterogeneous analysis demonstrates that there are differences in the effects of caregiver mental health problems on ECD among households are from families that are endowed with different levels of SES. On the basis of the findings the study concludes that policymakers should pay more attention to caregiver mental health problems in order to improve child developmental outcomes in rural China. The study cannot, however, draw casual conclusions and cannot rule out the possibility of recall bias when measuring caregiver mental health, which may limit the external validity of the findings.

The Effect of Parenting Quality on Child Development at 36-48 Months in China's Urban Area: Evidence from a Birth Cohort Study

Environmental exposures, especially parenting quality, are critical for later child development. This study aimed to determine the status of parenting quality and suspected development delay of preschool children in China's urban area and explore the associations between these two factors. The research was based on a birth cohort study conducted in Changsha, Hunan province, China. We used the Parenting Assessment Tool and Ages and Stages Questionnaires, Third Edition (ASQ-3), to measure parenting quality and child development status, respectively. Other data were collected from maternal health manuals and self-administered questionnaires during the follow-up period. The generalized estimating equation was used to examine whether parenting quality was significantly associated with child development outcomes. In the study, good parenting quality was 33.6% measured at 18 months, and suspected development delay was below 10% at 36-48 months among urban China; we observed negative associations between parenting quality scores and child development scores; poor parenting quality had a negative association with suspected development delay [OR and 95% CI: 2.74 (1.17, 6.40)], girls [OR and 95% CI: 0.33 (0.16, 0.69)] and maternal education years (>12 years) [OR and 95% CI: 0.27 (0.12, 0.64)] were protective factors for suspected development delay. Our findings highlighted the importance of good parenting quality among children in urban areas of China through a birth cohort study and may be used to reduce the children at high risk of developmental delay as a future intervention program.

Poverty increases the risk of incident cognitive impairment among older adults: a longitudinal study in China

Objectives: With a longitudinal design, we aimed to investigate the relationship between poverty and the risk of incident cognitive impairment in China.Methods: We used three waves of the Chinese Longitudinal Healthy Longevity Survey (2008-2014). Cognitive impairment was assessed using the Chinese version of the Mini Mental State Examination. Poverty was measured according to the latest national poverty line settled at an annual per-capita income of 2300 yuan (approximately equivalent to 1.25 dollar/day) in 2011 in China. A marginal structural model was utilized to explore the association between poverty and the risk of incident cognitive impairment. The subgroup analyses were also conducted in this study.Results: The cumulative incidence of cognitive impairment over 6 years was 30.69% (1936/6309). Poverty increased 34% risk of incident cognitive impairment in the elderly (odds ratio = 1.34, 95% confidence interval (CI): 1.15-1.56) after controlling behavioral factors and health status covariates. Participants who were male (OR = 1.38, 95% CI: 1.08-1.76), lived in urban areas (OR = 1.55, 95% CI: 1.22-1.98), and were married (OR = 1.72, 95% CI: 1.28-2.32) had higher poverty risks on incident cognitive impairment in subgroup analyses.Conclusions: Our results provide empirical support for the ongoing discussion about how economic hardship impacts of cognitive functioning, and highlight the negative health risks that economically disadvantaged individuals may experience.

Reliability and validity of the Caregiver Reported Early Development Instruments (CREDI) in impoverished regions of China

Background

There is a great need in low- and middle- income countries for sound qualitative and monitoring tools assessing early childhood development outcomes. Although there are many instruments to measure the developmental status of infants and toddlers, their use in large scale studies is still limited because of high costs in both time and money. The Caregiver Reported Early Development Instruments (CREDI), however, were designed to serve as a population-level measure of early childhood development for children from birth to age three, and have been used in 17 low- and middle-income countries. This study aimed to examine the reliability and validity of the CREDI in China, which is still unknown.

Methods

The CREDI and the ASQ-3 was administered to a sample of 946 children aged 5–36 months from urban and rural communities, in which 248 children was administered with Bayley-III.

Results

The internal consistency of the CREDI was high, which indicates that the scale internal consistency reliability is quite good. The results also indicated that the concurrent validity of the CREDI with the Bayley-III scale was high in general. Ordinary least squares regression showed that the CREDI is highly consistent with previous widely used instruments in some key predictors (such as the home stimulation) of early childhood development level.

Conclusions

All the results in the current study indicate that the CREDI may be considered an appropriate instrument to measure early childhood development status on a large scale in impoverished regions of China.

Stimulation and Early Child Development in China: Caregiving at Arm's Length

OBJECTIVE

To provide an empirical overview of the parenting landscape in rural China, focusing on 18- to 30-month-old children and their caregivers in rural Shaanxi province.

METHODS

We collected unique data on 1442 caregiver-toddler dyads in rural areas of Shaanxi province and examined caregiver attitudes toward parenting, sources of information about parenting, and interactive parenting practices, and how each of these differed across generations. We measured how parenting attitudes and sources of information informed parenting practices. Finally, we measured levels of child development in our sample and the association between parenting practices and children's developmental outcomes.

RESULTS

Most of the caregivers did not engage with children in a way that encouraged early development. Caregivers rarely told stories, sang, or used toys to play with their children. Grandmothers were more stressed by the children in their care and engaged significantly less than mothers did in the 3 stimulating interactions. Professional sources of information about parenting were underutilized by all caregivers. We found high rates of developmental delay in our sample and showed that these delays were associated with the lack of caregiver engagement.

CONCLUSION

Our findings suggest that the major economic and social shifts occurring in rural China have not led to a widespread prevalence of stimulative parenting practices. Although caregivers report positive attitudes toward child-rearing, reliable sources of scientific information are lacking. Our results show a troubling generational disconnect between the information-seeking behaviors and parenting practices of rural caregivers.

Relationships between dietary diversity and early childhood developmental outcomes in rural China

The period from birth to 2years of age is highly sensitive with respect to the relationship between nutrition and neurodevelopment, but data regarding the association between dietary diversity and early childhood neurodevelopment are limited. We sought to examine the association of two feeding indicators-minimum dietary diversity (MDD) and minimum meal frequency (MMF)-with the neurodevelopment of children aged 6-23 months, using data from a cross-sectional survey conducted in six rural counties in China. Data on 1,534 children were analysed using logistic regression to explore the associations between dietary diversity and early neurodevelopment, with adjustments for the age, sex and prematurity of the child; the age, sex and educational level of the caregiver; and family size, income and simulative care practices and resources. We found that 32.4% of children had suspected developmental delays based on the Chinese version of the Ages and Stages Questionnaires Version 3, whereas 77.0% and 39.2% failed to meet the MDD and MMF, respectively. Meeting the MDD was associated with a 39% lower risk of developmental delays (AOR = 0.61, 95% CI [0.43, 0.86]). There was a significant association between MDD and reduced likelihood of developmental delays in gross motor, fine motor, problem-solving and personal social subscales, whereas MMF was only associated with a lower risk of developmental delays in the gross motor subscale (AOR = 0.63, 95% CI [0.42, 0.94]). We observed an inverse dose-response relationship between the number of food groups consumed and the risk of developmental delays (P < .001).

Construct validity of the PERF-FIT, a test of motor skill-related fitness for children in low resource areas

BACKGROUND

Given the relationship between physical fitness and motor performance a test battery was developed that measures both components combined.

AIM

Following the development of the Performance and Fitness (PERF-FIT) battery, this study investigated the construct validity with the ultimate aim of identifying attributes that discriminate between different levels of motor abilities and anaerobic or musculoskeletal fitness.

METHODS

In this cross-sectional study, 34 children with developmental coordination disorder (DCD) and 34 matched typically developing children participated (7-10 years). The PERF-FIT was used to examine known group validity. The PERF-FIT items were also compared to test items of well-known standardized tests to examine concurrent validity.

RESULTS

Concurrent validity was found to be of the expected low to moderate magnitude. Children with DCD were consistently found to have lower levels of motor skill-related fitness compared to typically developing children.

CONCLUSION AND IMPLICATIONS

The PERF-FIT seems to be a valid test to measure movement skills, musculoskeletal fitness and agility in children between the ages of 7 and 10 years in low resourced communities. The test seems to discriminate between gross motor skills, and agility and power in children with and without DCD.

Adapting the Ages and Stages Questionnaire to Identify and Quantify Development Among Children With Evidence of Zika Infection

This article describes novel methods of applying the Ages and Stages Questionnaire-3rd edition (ASQ-3) to assess and quantify developmental delay among children following the 2015-2016 Zika virus outbreak in Brazil. Many of the children with Zika virus infection were expected to have severe developmental delay. However, administering the ASQ-3 to caregivers of these children according to standard protocol would have screened for the overall presence of delay but not the severity of delay. We adopted an amended protocol for administration of the ASQ-3 to quantify the developmental functioning of children severely affected by Zika virus infection in this investigation. Protocols for administering the ASQ-3 among this population were drafted in consultation with developmental measurement experts and are presented here. Specific developmental estimates are discussed, including developmental age equivalents, developmental quotients, and developmental quotient z scores. The calculations of these estimates are presented with examples in the context of the 2015-2016 Zika virus outbreak and associated microcephaly among prenatally infected children from 2 states in northeastern Brazil. Potential applications of these methods for estimating developmental ability among similar pediatric populations are discussed.

Prevalence and risk factors of gross motor delay in pre-schoolers

AIM

Gross motor skills are important for children's health and development. Delays in these skills are a concern for healthy developmental trajectories and therefore early identification of delay is important. This study screened for gross motor delay in children from low-income communities and investigated potential risk factors associated with gross motor delay.

METHODS

This cross-sectional study involved 701 pre-schoolers (M_age = 54.1 ± 8.6 months, 52.8% boys) from childcare services in low-income and remote communities in Australia. Gross motor delay was assessed using the Ages and Stages Questionnaire - third edition. Potential risk factors included: sex, age, birthweight, prematurity status, weight status, childcare service, postcode, parent's education, parent's marital status, parent's employment and family income.

RESULTS

Results showed 4.4% of the children were delayed in gross motor skills and 8.8% were at risk of delay. Logistic regression showed being a boy (odds ratio (OR) 1.78, 95% confidence interval (CI) 1.12-2.84), underweight (OR 2.72, 95% CI 1.18-6.30) or overweight (OR 1.83, 95% CI 1.00-3.33), and parental unemployment (OR 1.79, 95% CI 1.01-3.16) were factors associated with a higher odds of children being delayed or at risk of gross motor delay. A higher family income (OR 0.35, 95% CI 0.13-0.93) was associated with lower odds of delay.

CONCLUSION

This unique study demonstrated children in low-income communities, especially boys, underweight and overweight children, have higher odds of being at risk of gross motor delay. Therefore, early screening is vital in this population in order to identify delays and potentially intervene with appropriate motor skill interventions.

Relationship between moderate to late preterm, diet types and developmental delay in less-developed rural China

Aim: To measure the development of moderate to late preterm children by Ages and Stages Questionnaires (ASQ) and explore the relationship between moderate to late preterm, diet types and development delay in less-developed rural China.Methods: Data were collected from a cross-sectional community-based survey, which recruited 1748 children aged 1-59 months in eight counties of China. Caregivers of these children completed the Chinese version of ASQ-3 (ASQ-C) while physical examination and questionnaires on socio-demographic characteristics were conducted. Multivariate logistic regressions were used to analyze the association between moderate to late preterm and suspected developmental delay, as well as the association between diet types and suspected developmental delay. Consumption of certain food types was compared between moderate to late preterm and full-term children.Results: The prevalence of suspected overall developmental delay was 31.3% in the moderate to the late preterm group, compared with 21.6% in the full-term group. Moderate to late preterm birth was not associated with total suspected developmental delay and developmental delay in all the domains of ASQ, except for fine motor (OR = 2.43 95% C.I.: 1.04-5.56). The intake of vegetables and fruits had a protective influence on developmental delay in fine motor function, and moderate to late preterm children had lower relative consumption of fruits and vegetables than full-term children.Conclusion: Moderate to late preterm children in rural China showed an increased likelihood of developmental delay in fine motor function. Future interventions to improve the intake of vegetables and fruits in moderate to late preterm children are recommended.

Avaliação do desenvolvimento motor infantil e sua associação com a vulnerabilidade social

RESUMO O objetivo deste estudo foi avaliar o desenvolvimento motor de crianças de quatro a 17 meses e investigar sua associação com fatores de risco sociodemográficos. Estudo transversal, descritivo, composto por crianças de quatro a 17 meses provenientes da unidade de internação pediátrica de um hospital público de Porto Alegre (RS), clinicamente estáveis e com alta breve prevista. Para a avaliação dos fatores de risco sociodemográficos foi utilizado um questionário elaborado pelas pesquisadoras, que abordou fatores biológicos, sociais e ambientais. Para a avaliação do desenvolvimento motor foi utilizada a Alberta Infant Motor Scale na versão traduzida, adaptada e validada para a população brasileira. Para a análise estatística foi utilizado o teste t de Student e o teste qui-quadrado, com nível de significância de 5% (p≤0,05). De um total de 110 crianças avaliadas, o desempenho motor se mostrou aquém do esperado em mais da metade delas (63,6%, n=70). Houve associação estatisticamente significativa entre o desenvolvimento motor e vacinas atrasadas (p=0,005), convivência com tabagistas em casa (p=0,047) e recebimento de benefício socioeconômico (p=0,036). Conclui-se que esses fatores sociais podem estar associados a fatores de risco ao desenvolvimento motor de crianças de quatro a 17 meses.

Quality of care and suspected developmental delay among children aged 1-59 months: a cross-sectional study in 8 counties of rural China

BACKGROUND

The data about quality of care of more than 70 countries were available from UNICEF but little was known about China. We examined the status about quality of care and explored its associations with developmental outcomes in Chinese children.

METHODS

A cross-sectional study with probability proportional to size sampling method was conducted in 8 counties of rural China. A total 1927 children were assessed on development status using Ages and Stages Questionnaires-Chinese (ASQ-C) based on Chinese normative data. Nutritional status was derived from the anthropometric method following WHO guidelines. Caregivers were interviewed through household questionnaires from UNICEF's 5th Multiple Indicator Cluster Survey to understand the quality of care, including the status of availability of children's books, availability of playthings, support for learning, fathers' support for learning and inadequate care. Moreover, quality of care was explored to be categorized into three levels (poor, medium and good) for overall assessment. Multivariable logistic regression model was applied to estimate the odds ratios and 95% confidence intervals between quality of care and suspected developmental delay (SDD) after adjustment for potential confounding variables.

RESULTS

The proportions of availability of children's books, playthings, support for learning, fathers' support for learning and inadequate care were 36.8, 91.3, 83.1, 16.4 and 4.9%, respectively. When compared to available data of more than 70 countries and areas, the quality of care in rural China was in the middle to upper level. After adjustment for potential confounding variables, multivariable analysis showed that SDD in overall ASQ remained negatively associated with availability of children's books (odds ratio [OR] and 95% confidence interval [CI]: 1.64 [1.27-2.12]), playthings (OR and 95% CI: 2.23 [1.52-3.27]) and support for learning (OR and 95% CI: 1.81 [1.06-3.10]). When compared with children under good quality of care, children under medium and poor quality of care had higher prevalence of SDD in overall ASQ (OR and 95% CI: 1.59 [1.21-2.07]; 3.05 [1.96-4.74]).

CONCLUSIONS

Quality of care in rural China still had scope for improvement. Better quality of care had negative associations with SDD.

The effect of a community-based, integrated and nurturing care intervention on early childhood development in rural China

OBJECTIVES

This study investigated whether an integrated, community-based and nurturing care intervention led to a reduction in the prevalence of suspected neurodevelopmental delay in children. The study also considered how the programme could be sustained to promote early development in children aged under 3 years in the poorest areas of rural China.

STUDY DESIGN

A quasi-experimental design was applied, with data collection before and after a 2-year programme implementation, in both intervention and comparison (control) areas.

METHODS

From July 2014, the Integrated Early Childhood Development (IECD) programme was implemented in poverty-stricken areas in four counties of China. Nurturing care intervention focusing on five components (child health, nutrition, responsive care, protection and early learning support) was delivered mainly by the village early childhood development centre and township/village clinic. Another two counties of similar per capita gross domestic product, geographical characteristics, under-five mortality rate, under-five underweight prevalence and ethnicity to the four programme counties were selected as the comparison and received no IECD programme intervention. The Ages & Stages Questionnaire was used to evaluate the neurodevelopmental outcome of children; the overall suspected developmental delay (SDD) referred to any developmental delay in the communication, gross-motor, fine-motor or problem-solving or personal-social domains of the questionnaire. Children underwent anthropometric measurements and haemoglobin concentration testing through peripheral blood. Face-to-face interviews of caregivers were conducted to collect intervention use, cognitive stimulation and child-protection behaviours. A difference-in-differences regression approach, adjusting for confounding factors, was applied to estimate intervention impact on the neurodevelopmental outcomes in the children. Path analysis was employed to examine the mediating effects of growth, nutrition status, cognitive stimulation and child-protection behaviours through which the IECD intervention predicted children's developmental health.

RESULTS

In total, 2953 children aged under 3 years and their caregivers were enrolled at baseline, and 2745 child-caregiver pairs completed the postintervention assessment. Prevalence of overall SDD was reduced by 18% (from 37% at baseline to 19% at postintervention) in intervention counties, which is a significant difference compared with the 10% reduction in control counties (from 30% to 20%), with an adjusted odds ratio of 0.69 (95% confidence interval: 0.54-0.89). Consistent findings were found across domains. Path analysis indicated that the effect of the intervention on promoting developmental health was mediated by multiple nurturing care-associated factors, including cognitive stimulation frequency, positive discipline, length-for-age growth and haemoglobin concentration.

CONCLUSIONS

The community-based integrated intervention could significantly prevent developmental delay in children aged under 3 years in rural China.

Caregiver Depression and Early Child Development: A Mixed-Methods Study From Rural China

Half of rural toddlers aged 0-3 years in China's Qinling Mountainous region are cognitively delayed. While recent studies have linked poor child development measures to the absence of positive parenting behaviors, much less is known about the role that caregiver depression might play in shaping child development. In this paper, a mixed methods analysis is used to explore the prevalence of depression; measure the association between caregiver depression and children's developmental delays, correlates of depression, and the potential reasons for caregiver depression among women in rural China. The analysis brings together results from a large-scale survey of 1,787 caregivers across 118 villages in one northwestern province, as well as information from in-depth interviews with 55 female caregivers from these same study sites. Participants were asked to respond to the Depression, Anxiety and Stress Scale-21 (DASS-21) as well as a scale to measure children's social-emotional development, the Ages and Stages Questionnaire: Social-Emotional (ASQ-SE). We also administered a test of early childhood development, the Bayley Scales of Infant and Toddler Development (BSID-III), to all of the study household's infants and toddlers. The results show that the prevalence of depression may be as high as 23.5 percent among all female caregivers (defined as scoring in the mild or higher category of the DASS-21). Grandmothers have higher prevalence of depression than mother caregivers (p < 0.01). Caregiver depression also is significantly associated with a 0.53 SD worsening of children's social-emotional development (p < 0.01) and a 0.12 SD decrease in children's language development (p < 0.05). Our qualitative findings reveal six predominant reasons for caregiver depression: lack of social support from family and friends; the burden of caregiving; lack of control and agency within the household; within-family conflict; poverty; the perception of material wealth as a measure of self-worth. Our findings show a serious lack of understanding of mental health issues among rural women, and suggest that rural communities could benefit greatly from an educational program concerning mental health and its influence on child development. Our findings confirm the need for a comprehensive approach toward rural health, with particular attention paid to mental health awareness and support to elderly caregivers.

Effect of Caregiver's Mental Health on Early Childhood Development across Different Rural Communities in China

Previous research has found that there are high rates of developmental delays among infants and toddlers in rural areas of China. Caregiver mental health problems might be one significant predictor of developmental delays among infants and toddlers, as has been found in other areas of the world. One way that the mental health of caregivers could affect early childhood development is through its effect on parenting practices. In this study, we used data from four major subpopulations of rural China to measure the correlation of caregiver mental health problems with the developmental outcomes of infants and toddlers. To do so, the study used the Bayley Scales of Infant Development III (BSID III) to examine the rates of developmental delays among 2514 rural infants/toddlers aged 6–30 months old. The results of the testing demonstrate that 48% of the sample’s infants/toddlers have cognitive delays; 52% have language delays; 53% have social-emotional delays; and 30% have motor delays. The data collection team also assessed caregiver mental health by using the Depression Anxiety Stress Scales (DASS-21) questionnaire. According to the findings, 39% of caregivers in the sample have symptoms of at least one kind of mental health problem (depression, anxiety, or stress). We also found that most caregivers do not engage in positive parenting practices, while a significant share of caregivers engage in negative parenting practices. The statistical analysis found that showing signs of mental health problems is significantly and negatively associated with infant/toddler developmental outcomes. The study also found that caregivers who show signs of mental health problems are significantly less likely to engage in interactive parenting practices. The study confirms that society needs to pay more attention to caregiver mental health problems in order to improve infant/toddler developmental outcomes in rural China and increase human capital accumulation in China as a whole.

The relationship between birth season and early childhood development: Evidence from northwest rural China

OBJECTIVE

To examine the correlation between birth season and early childhood development.

BACKGROUND

Almost all previous studies that examine the effect of birth season on early childhood development were conducted in developed countries with a limited sample size. The present study was conducted in poor, rural areas of western China, a developing region with a continental monsoon climate.

METHOD

We administered a hemoglobin test to 650 infants (52% boys), aged 8-10 months, using a Hemocue Hb 201+ finger prick system, and assessed the cognitive and psychomotor development of sample infants using Bayley Scales of Infant Development.

RESULTS

Infants born in winter have higher Hb concentrations (t = 3.63, p < 0.001) compared to infants born in summer. Similarly, cognitive development scores (t = 5.17, p < 0.001) and psychomotor development scores (t = 10.60, p < 0.001) were significantly higher among winter-born infants.

CONCLUSION

The findings point to the involvement of birth season in early childhood development and suggest that aspects of the environment shape the experiences that contribute to early childhood development. Policy suggestions such as providing infants with ample opportunities for movement and stimulation during the cold season are discussed.