Effect of a community-based integrated nurturing care interventions on early childhood development in rural China: a quasi-experimental study

Abstract

Background17 million children under the age of 5 years are at elevated risk of poor development outcomes in China. We aimed to assess whether an integrated package of community-based nurturing care intervention led to a reduction in the prevalence of suspected neurodevelopmental delay to promote early development in rural China's poorest children under the age of 3 years. MethodsFrom July 1, 2014, the Integrated Early Childhood Development (IECD) programme composing comprehensive early development services was implemented in four poverty-stricken areas in China (Liping county, Songtao county, Fenxi county, and Lin county). Five nurturing care intervention components (nutrition, responsive care, child safety and social assistance, early learning support, healthy growth, and development assessment) were delivered via home visits, group sessions, ECD centres, village clinics, and mobile resource units. We evaluated the effectiveness of the intervention using a quasi-experimental design, with baseline data collection in 2013 and endline data collection in 2016, in four interventions and two control counties in which no intervention was applied (Pan county and Fangshan county). Risk factors and outcomes were assessed by use of UNICEF's Multiple Indicator Cluster Survey, Zung Self-Rating Depression Scale, and Ages & Stages Questionnaire-Chinese Edition. We applied a difference-in-differences regression approach adjusting confounding factors to estimate the effect of the intervention on the children's neurodevelopmental outcomes. We used a path analysis to examine underlying mechanisms through which the IECD intervention package could predict children's developmental health. Ethical clearance for all aspects of the study was obtained from the Ethics Review Board in Peking University. An informed consent was obtained in writing before data collection. FindingsBetween July and September, 2013, 2953 children younger than 3 years and their caregivers were interviewed at baseline. Between July and September, 2016, 2745 children younger than 3 years and their caregivers were interviewed after intervention. Prevalence of overall suspected developmental delay was reduced by 18% (from 37% at baseline to 19% after intervention) in intervention villages. This reduction significantly differed from the reduction in control villages (from 30% to 20%; adjusted odds ratio 0·69 (95% CI 0·54–0·89). Consistent findings were found across the communication, gross motor, fine motor, problem solving, and personal-social domains. Path analysis indicated that higher developmental health was partly mediated by multiple family nurturing care factors, including cognitive stimulation, positive discipline, length for age, and haemoglobin. InterpretationThe community-based integrated intervention package significantly reduced the prevalence of suspected developmental delay in children under age three in rural China. This nurturing care intervention could maybe to help improve human capital in China's poorest areas. FundingThis work was supported by Porsche (China) Motors Ltd.