Abstract
BackgroundThe 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.MethodsA 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.ResultsThe 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]).ConclusionsQuality of care in rural China still had scope for improvement. Better quality of care had negative associations with SDD.
Highlights
The data about quality of care of more than 70 countries were available from United Nations International Children’s Emergency Fund (UNICEF) but little was known about China
It is estimated that more than 250 million children under 5 years of age in low-income and middle-income countries are at risk of not attaining their developmental potential, of that number the 17.43 million that live in China [4, 5]
In this report, we reported quality of care in surveyed areas in China; we observed socioeconomic classifications were associated with availability of children’s books and playthings and age were associated with quality of care; we found that availability of children’s books, playthings and support for learning had negative associations with suspected developmental delay (SDD) and better quality of care was a protective factor for SDD
Summary
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. Disadvantaged exposures and experiences in early years (prenatal to the age of 5 years) increase the risk of poor social, cognitive, and health outcomes and create a trajectory across their whole life [2]. A mounting body of evidence suggests responsive and nurturing care play crucial roles on children’s development [3]. It is estimated that more than 250 million children under 5 years of age in low-income and middle-income countries are at risk of not attaining their developmental potential, of that number the 17.43 million that live in China [4, 5]. Of the various affecting factors, nurturing care provided by parent and family interactions is identified as an important one [4]
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