Combined nutrition and psychosocial stimulation intervention for child development in rural China: the role of parental resources

Abstract

Early childhood interventions played a critical role in improving child development in impoverished contexts. Combined nutrition and psychosocial stimulation interventions (CNPSI) have shown more benefits than stand-alone supplemental nutrition interventions (SNI) in many developing countries. Based on a cluster randomized controlled trial in rural northwestern China, this study tested alternative theory-driven hypotheses regarding how primary caregiver’s education and family income may moderate the CNPSI’s effects on child growth environment and developmental delay risk. The trial cluster randomized 1,566 children aged 7–33 months from 111 villages (clusters) in Huachi County, Gansu Province, into an SNI group (N = 852) and a CNPSI group (N = 714). Multilevel regression models suggested that the CNPSI group had better home growth environment (p < 0·001) and lower risk of developmental delay (p < 0·001) than the SNI group. The CNPSI’s impacts on home growth environment and development delay were weaker for parents with higher education levels. However, household income did not significantly moderate the CNPSI effect for either outcome. Future interventions need to attend to the educational disparities in the resource-poor context.