Effect of books and toys on early childhood development in poor rural areas of China

Abstract

Objective: To explore the effect of books and toys on early childhood development in poor rural areas of China. Methods: The baseline survey data of the Integrated Early Childhood Development (IECD) conducted in 2013, which was supported by the United Nations International Children's Emergency Fund (UNICEF) China Office, were analyzed retrospectively in this study. The survey was conducted in 6 counties in 2 provinces of China (Shanxi and Guizhou), and all 6 neighboring counties were located in extremely poor areas. The socio-demographic characteristics and caring behaviors of the caregivers (the lack of children's books and toys) were assessed by UNICEF's Multiple Indicator Cluster Surveys-5 and caregivers' depression was assessed by the Zung Self-rating Depression Scale. A total of 2 701 children were enrolled, of these, 1 151(42.62%) were girls, the age (18±10) months and 1 263 (46.76%) children were from Shanxi Province, the remaining 1 438 (53.24%) children were from Guizhou Province. The early childhood developmental status was evaluated by Ages and Stages Questionnaires (ASQ). Log-binomial model was used to analyze the association between early childhood development and the lack of children's books and toys. Furthermore, sensitivity analyses (data stratification) were made to explore the effect of books and toys on early childhood development under different caregiving conditions with different caregivers who were depressive or non-depressive. Results: Among the 2 701 participants, 1 537 (56.90%) children lacked of books, 1 148 (42.50%) children lacked of toys, the suspected development delay (SDD) prevalences of overall ASQ, communication (CM), gross motor (GM), fine motor (FM), cognitivity (CG) and personal-social (PS) domains were 33.02% (892/2 701), 15.51% (419/2 701), 13.25% (358/2 701), 15.66% (423/2 701), 14.96% (404/2 701) and 11.81% (319/2 701). Under adjustment of the potential confounders, the Log-binomial regression showed that children who lacked books had significantly higher risk of SDD in overall ASQ (prevalence ratio (PR)=1.27, 95%CI: 1.11-1.45) and CM (PR=1.64, 95%CI: 1.31-2.07) than those who had sufficient books. Compared with children who had sufficient toys, those who lacked the toys also had the increased risk of SDD in overall ASQ (PR=1.34, 95%CI: 1.19-1.50), CM (PR=1.44, 95%CI: 1.18-1.76), GM (PR=1.54, 95%CI: 1.24-1.91), FM (PR=1.86, 95%CI: 1.52-2.27), CG (PR=1.80, 95%CI: 1.47-2.20) and PS (PR=1.88, 95%CI: 1.49-2.39). Sensitivity analysis revealed that the lack of books increased the risk of SDD in overall ASQ of the caregivers' non-depression group (PR=1.35, 95%CI: 1.08-1.71) and depression group (PR=1.17, 95%CI: 1.01-1.38), and the lack of toys increased the risk of SDD in overall ASQ of the caregivers' depression group (PR=1.54, 95%CI: 1.32-1.79). Conclusion: Lack of childrens' books and shortage of toys were independent risk factors for early childhood development in poor rural areas of China and both of them increased the risk of SDD significantly.