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

The relationship between early childhood development and feeding practices during the dietary transitional period in rural China: a cross-sectional study

Introduction

Early childhood feeding environments and practices not only affect children's nutritional status but also provide children with a variety of external stimulations to affect the development of the child's brain, especially for the first 1,000 days of children. The relationship between early childhood development (ECD) and feeding practices during the dietary transitional period has not previously been described.

Method

This study used quantitative survey data from the Integrated Early Childhood Development Project to investigate this association between ECD and feeding practices during the dietary transitional period in poor rural areas of China. Data concerning the child and family characteristics and feeding practices were collected through the questionnaire completed by caregivers. Developmental delays were explored through a five-pronged, structured, parent-completed Age and Stage Questionnaire. The chi-squared test and multivariate logistic regression analyses were used to explore the associated factors in ECD.

Results

The results showed that 33.6% of children had at least one area of developmental delay during the dietary transitional period. Of all five regions evaluated, the prevalence of fine motor developmental delays was highest (17.7%), followed by communication (14.9%), problem-solving (13.8%), personal-social skills (11.9%), and gross motor (11.8%), respectively. Significant predictors of increased odds of developmental delay included types of complementary foods (OR = 0.70, 95% CI = 0.53-0.94), adequate feeding frequency (OR = 0.69, 95% CI = 0.52-0.90), and breastfeeding time and bottle feeding (OR = 0.66, 95% CI = 0.50-0.88).

Discussion

According to the results, a high prevalence of developmental delay was observed in children during the dietary transitional period in the rural areas of China. The feeding practices of children were associated with their developmental status, including factors such as inadequate feeding frequency, types of complementary foods, breastfeeding duration, and low family income. These findings highlight the focus and potential direction for early identification and intervention.

The prevalence of barriers to rearing children aged 0–3 years following China’s new three-child policy: a national cross-sectional study

Background

To further optimize birth policy, China implemented a new three-child policy to allow per couple to have up to three children on May 31, 2021.

Methods

A national cross-sectional survey was conducted among 18 to 49-year-old Chinese parents who had at least one child in June 2021. We calculated the prevalence of self-reported childrearing barriers and used univariate logistic regression and multivariate logistic regression to analyze associated factors.

Results

94.7% of the respondents self-reported barriers to rearing children aged 0–3 years, and the biggest barrier included high time cost (39.3%), high parenting cost (36.5%) and high education cost (13.5%). Women (aOR 1.49, 95%CI 1.13,1.96) and people with college degree or above (aOR 3.46, 95%CI 2.08, 5.75) were associated with higher prevalence of childrearing barriers, and people who intended to have a second child (aOR 0.58, 95%CI 0.40, 0.83) and people who intended to have a third child (aOR 0.51,95%CI 0.37, 0.71) were less likely to report childrearing barriers. The biggest barrier was more likely to be high time cost for parents one of whom is only child (aOR1.21, 95%CI 1.03, 1.42) and physical factors for parents both of whom are only child (aOR 1.56,95%CI 1.08, 2.26).

Conclusions

The prevalence of barriers to rearing children aged 0–3 years was high among Chinese people of childbearing age who had children. Full consideration should be given to the barriers of people with different sociodemographic characteristics and people with fertility intention, thus making targeted childrearing policies and supporting measures to reduce the burden on people of childbearing age, encourage suitable couples to have a second or third child and then cope with China’s aging population.

Assessing the Inequality of Early Child Development in China - A Population-Based Study

Background

As a country with the second largest child population in the world, China has little population-level evidence on who has been left behind in early childhood development (ECD). Knowledge of inequalities in ECD will inform the Chinese government in policies on promoting ECD and guide global-level monitoring on ECD progress.

Methods

Using data from the first wave of ECD surveys conducted in China at the least-developed region, most-developed region, and a megacity (Shanghai) in 2017 and 2018, we measured population-level ECD with early Human Capability Index for a total of 63,559 children aged 36-59 months old. A child was classified as developmentally on track if his/her overall development score was above the 20^th percentile of the pooled populations. We measured inequalities in ECD with the absolute inequality in five domains: gender/sex, family income, maternal schooling, residential Hukou, and migrant- or left-behind status. Besides observed inequalities, we used a multilevel logistic regression model to generate adjusted inequalities.

Findings

Children developmentally on track ranges from 71% (95% CI 70 to 72%) in the least-developed region, 82% (95% CI 81 to 83%) in the most-developed region, and 86% (95% CI 85 to 87%) in Shanghai. Significant unadjusted inequalities in ECD were observed in all five dimensions. After controlling for other socioeconomic factors, significant differences remained in three dimensions: those living in the poorest families, or with lower maternal schooling, or boys were less likely to be developmentally on track than their counterparts (lower by 10[95% CI 8 to 11]-15[95% CI 13 to 17], 7[95% CI 5 to 10]-10[95% CI 7 to 12], and 5[95% CI 4 to 6]-6[95% CI 5 to 8] percentage points respectively).

Interpretation

Efforts of reducing ECD inequalities in China shall focus primarily on reducing poverty and improving maternal education.

Funding

National Natural Science Foundation of China (81773443), Shanghai Committee of Science and Technology (2018SHZDZX05), Shanghai Municipal Health Commission (GWV-10.1-XK07; GDEK201708), Shanghai Education Committee, Chinese Social Science Foundation (BFA140046), Macao Tong Chai Charity Association, Beijing Sany Charitable Foundation, China Medical Board (#20-388), UNICEF, Faculty Grant of Brigham & Women's Hospital, Economic and Social Research Council [grant reference number ES/T003936/1’] as a UKRI Collective Fund Award “UKRI GCRF Harnessing the Power of Global Data to Support Young Children's Learning and Development Collaborative."

Maternal Glycemia During Pregnancy and Early Offspring Development: A Prospective Birth Cohort Study

CONTEXT

The association of maternal gestational diabetes mellitus (GDM) with neurodevelopmental outcomes remains controversial and evidence that maternal increasing levels of glucose during pregnancy associated with the risk for impaired neurodevelopment were limited.

OBJECTIVE

To identify the continuous association of increasing maternal glucose levels with neurodevelopmental disorders in offspring and explore the potential contribution of cord metabolites to this association.

METHODS

The prospective birth cohort study included 1036 mother-child pairs. Primary predictors were maternal exposure GDM and maternal glucose values at a 75-g oral-glucose-tolerance test at 24 to 28 weeks during pregnancy. Primary neurodevelopmental outcomes at 12 months in offspring were assessed by the Ages and Stages Questionnaires, Third Edition (ASQ-3).

RESULTS

Maternal GDM was associated with failing the communication domain in offspring in the adjusted models [relative risk (RR) with 95% CI: 1.97 (1.11, 3.52)]. Increasing levels of fasting plasma glucose (FPG), 1-h plasma glucose (1-h PG) and 2-h plasma glucose (2-h PG) with 1 SD change were at higher risks in failing the personal social domain of ASQ-3 [RRs with 95% CI for FPG: 1.49 (1.09, 2.04); for 1-h PG: 1.70 (1.27, 2.29); for 2-h PG: 1.36 (1.01, 1.84)]. The linear association was also demonstrated. Compared with girls, boys exposed to higher maternal glucose levels were inclined to the failure of the personal social domain. Mediation analysis showed the contribution of maternal GDM to failure of communication domain mediated by C-peptide.

CONCLUSIONS

Maternal glucose levels below those diagnostic of diabetes are continuously associated with impaired neurodevelopment in offspring at 12 months.

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.

Maternal depressive symptoms and early childhood development: the role of mother-child interactions among mother-child dyads in rural areas of Central and Western China

Background

The associations among maternal depressive symptoms (MDS), mother–child interactions and early child development are poorly understood. This study aimed to explore the role of mother–child interactions on the associations between MDS and child development.

Methods

A cross-sectional study with a multistage sampling method was conducted in rural areas of Central and Western China. MDS, child development outcomes (communication, gross motor function, fine motor function, problem solving and personal social skills) and mother–child interactions were assessed by The Edinburgh Postpartum Depression Scale, the Chinese version of the Ages and Stages Questionnaires and the Multiple Indicator Cluster Surveys, respectively. Regression-based statistical mediation and moderation were conducted using the PROCESS macro for SPSS.

Results

A total of 2,548 participants (mothers: 1,274; children: 1,274) were included in our analyses. MDS was negatively associated with child development outcomes and mother–child interactions partly mediated these associations. The proportion of the mediating effect of mother–child interactions was 7.7% for communication, 8.2% for gross motor, 10.3% for fine motor, 10.1% for problem-solving and 9.5% for personal social domains. In addition, the interaction effects of MDS and mother–child interactions on the communication domain were significant (β = 0.070, 95% CI 0.016, 0.124; p = 0.011). The associations between MDS and child communication abilities were weaker at the high level (simple slope = −0.019, t =  − 0.458, p = 0.647) of mother–child interactions than at the mean level (simple slope = −0.089, t =  − 3.190, p = 0.002) and the low level (simple slope = −0.158, t =  − 4.231, p < 0.001). Similar moderating effects were not observed in the other child development outcomes.

Conclusion

Our results suggest the important role of mother–child interactions on the associations between MDS and early childhood development. Due to the cross-sectional design of this study, these associations require further investigation in prospective studies.

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.

Domain- and sex-specific effects of prenatal exposure to low levels of arsenic on children's development at 6 months of age: Findings from the Ma'anshan birth cohort study in China

The relationship between prenatal arsenic exposure at low levels and poor development in children, especially in regard to neurodevelopment, has aroused several concerns, but the conclusions have been inconsistent. It still remains unclear whether such adverse effect is associated with a specific profile of the developing brain in early life. To investigate the association between arsenic exposure in utero and children's development and behaviour, we performed a large prospective birth cohort study including 2315 mother-infant pairs in Anhui Province, China. The Ages and Stages Questionnaire of China (ASQ-C) was used to assess the status of children's development and behaviour at 6 months postpartum, and the levels of arsenic were determined in umbilical cord serum samples. Odds ratios for suspected developmental delay (SDD) in each domain of the ASQ-C clusters were estimated using logistic regression models. Compared with low arsenic levels group, medium and high arsenic levels were significantly associated with the increased risks of SDD in the personal-social domain among infants aged 6 months after adjustment for all potential confounders (OR = 1.33, 95% CI (1.01, 1.75) and OR = 1.47, 95% CI (1.08, 2.00), respectively). Sex stratification analysis demonstrated that this association was stronger in females. The sensitivity analyses also showed that high cord serum arsenic levels were associated with a 1.80-fold (95% CIs (1.12, 2.90)) higher risk of a more severe developmental delay in the personal-social domain among six-month-old females. Our results suggest that low-level arsenic exposure in utero could have an adverse domain-specific effect on children's development at 6 months of age, particularly among females. Further studies are warranted to support the findings and explore the mechanism of these domain-and sex-specific associations.