Poor Rural Areas Of China Research Articles

Can Multiple Shocks Affect Household Income? Evidence from Poor Rural Areas in China

Can Multiple Shocks Affect Household Income? Evidence from Poor Rural Areas in China

Can government support improve households’ ability to resist natural disaster shocks? Evidence from poor rural areas in China

Can government support improve households’ ability to resist natural disaster shocks? Evidence from poor rural areas in China

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

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. 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. 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). 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.

Anaemia prevalence and risk factors among children aged 6 to 23 months in rural China.

Anaemia is a global public health problem among children. However, few studies have examined anaemia prevalence and risk factors among Chinese children of different ages, particularly in poor rural areas. This study investigated these two aspects among children aged 6 to 23 months in poor rural areas of China. This cross-sectional study included 1132 children aged 6 to 23 months in three prefectures of the Qinba Mountains area. A finger prick blood test for haemoglobin and anaemia was conducted, along with household surveys of socio-demographic characteristics, illness characteristics, and feeding practices. Multiple linear and logistic regression analyses were used to determine predictors of anaemia. Overall, 42.6% of children in the study displayed anaemia. Children aged 6 to 11 months had the highest anaemia prevalence (53.6%). Anaemia risk factors differed among age-groups and throughout the overall sample. Bivariate and multivariable regression results showed that continued breastfeeding, any history of formula feeding, and consumption of iron-rich or iron-fortified foods were prominent risk factors for anaemia. However, continued breastfeeding and any history of formula feeding had the greatest impact across age-groups (both P<0.05). Anaemia remains a severe public health problem among children aged 6 to 23 months in rural China. Healthy feeding practices, nutritional health knowledge, and nutrition improvement projects are needed to reduce the burden of anaemia among children in rural areas of China.

Yingyangbao Intervention Was Associated with the Improvement of Body Growth and Nutrition Status of Infants and Young Children in Poor Rural Areas of China: The Annual Comparison from 2012 to 2020.

Yingyangbao (YYB) is a soy-based micronutrient-fortified powder used in the Nutrition Improvement Project on Children in Poor Areas of China. After the baseline study in 2012, YYB intervention gradually spread to 21 provinces in China. From 2015 to 2020, a secular trend study was carried out to evaluate the body growth and nutritional status of 6-23-month-old infants and young children (IYC) under YYB intervention. The aim of this research was to investigate whether YYB intervention was associated with the improvement of body growth and development in large populations from broad areas with national and multi-year survey results. The anthropometric data collected in the baseline study and cross-sectional surveys were compared, and the correlation between YYB intake amount and body growth were analyzed. Compared with the results of the baseline study, the 6-23-month-old IYC under YYB intervention showed a significant increase in body weight, body length and Z scores since 2015, and the stunting rate decreased from 9.7% in 2012 to 5.3% in 2020. Significantly positive correlations were observed between the YYB intake amount and the body growth indicators. Therefore, YYB intervention was associated with the improvement of body growth and nutrition status of Chinese IYC. In the future, long-term and continuous efforts are still needed to further reveal the health benefits of YYB in depth.

Government Intervention on Cooperative Development in Poor Areas of Rural China: A Case Study of XM Beekeeping Cooperative in Sichuan

The relationship between government intervention and cooperative development has always been a source of controversy in the developing world. This paper aims to examine the rationale and successful conditions of government intervention to promote cooperative development in poor areas of rural China. In the context of the “targeted poverty alleviation” program (2015–2020), a government-led campaign covering all poverty-stricken villages in west China, cooperative development was listed by the central government as a criterion for evaluating successful intervention at the county government level. Accordingly, the central questions of this paper are: why is government intervention necessary to initiate a process of cooperative development in poor areas of China; and under what conditions can government intervention be successful, leading to sustainable cooperative development? Bearing in mind the complexity of government intervention with mixed results, both successful and failed, the above questions are addressed through a case study of XM Beekeeping Cooperative, representing one type of successful government intervention in poverty-stricken and ethnic-minority-dominated regions of China. Overall, government intervention is crucial in building cooperative ecosystems in poor regions of China. However, government intervention is not invariable because the approaches can be modified to accommodate the effect of the intervention.

Who Lost Most Wages and Household Income during the COVID‐19 Pandemic in Poor Rural China?

China managed to eliminate all extreme poverty in rural areas in 2020. Poor households, however, may risk falling back into poverty due to the COVID‐19. This paper examines the impacts of the pandemic on wages and household incomes among different groups in poor areas of rural China. Using a unique dataset from five poverty‐stricken counties, we found that the pandemic has had large negative effects on wage income for migrant workers and workers in manufacturing, the private sector, and small enterprises. Compared with households relying on wage income, households relying on small businesses have suffered much more from the pandemic, whereas households depending on farming or transfer payments have been less affected. Although poor and ethnic minority households lost significant amounts of wage income due to the pandemic, they did not lose more household income than nonpoor and nonminority households. We conclude that support from the government has kept vulnerable households from suffering more than other households from the effects of COVID‐19. Our findings suggest that the government can play a strong role in alleviating the negative impacts of the COVID‐19.

Prevalence of Complementary Feeding Indicators and Associated Factors Among 6- to 23-Month Breastfed Infants and Young Children in Poor Rural Areas of China.

This study aimed to estimate the status of complementary feeding (CF) and its associated factors among 6–23-month breastfed infants and young children (IYC). We used secondary data from the China Nutrition Improvement Project on Children in Poor Areas in 2018. The status of CF was provided by parents of IYC through 24-h dietary recall. The study included 13,972 6–23-month-old breastfed IYC comprising 24.7% 6–8-month, 28.5% 9–11-month, 31.4% 12–17-month, and 18–23-month IYC. The highest percentage of IYC introduced to cereal foods was 84.8%. Nearly, 83.6% of 6–8-month infants were introduced to solid or semi-solid food. The prevalence of meeting requirements of non-dairy animal source food and minimum acceptable diet (MAD) was 75.3 and 35.1% of 6–23-month IYC, respectively, and was significantly higher in older than younger IYC (p < 0.001). Age of IYC, education level of parents, paternal employment, and nutrition knowledge of parents were positively associated factors for the prevalence of meeting requirements of MAD, and diarrhea at 2 weeks and maternal employment were negatively associated with MAD. Totally, the prevalence of meeting the requirements of MAD was relatively lower in breastfed IYC. The government should scale up appropriate CF with consideration of food availability.

Impact of diurnal temperature range on cardiovascular disease hospital admissions among Chinese farmers in Dingxi (the Northwest China)

BackgroundDiurnal temperature range (DTR) has been widely applied in exploring its effect on cardiovascular disease (CVD). However, few studies have investigated the correlations between DTR and CVD in poor rural areas in China. This study aimed to examine the association between DTR and CVD in rural China.MethodsA distributed lag nonlinear model was used to evaluate the relationship between DTR and CVD risk among farmers living in the city of Dingxi (Northwest China) in the period from January 1, 2016 to December 31, 2019.ResultsWe observed nonlinear M-patterns between the relative risk (RR) of DTR (reference: median DTR, 12 °C) and CVD hospitalizations in all subgroups. The peak RR of CVD was noticed at DTR of 6 °C (total: 1.418; men: 1.546; women: 1.403; young: 1.778; old: 2.549) and 17 °C (total: 1.781; men: 1.937; women: 1.712; young: 2.233; old: 1.798). The adverse effect of DTR on CVD risk was more pronounced in females (RR 1.438) and elderly (RR 2.034) than males (RR 1.141) and younger adults (RR 1.852) at the extremely low (5th, 4 °C) DTR. The reverse was observed at the extremely high DTR (95th, 19 °C) (male: 1.267; females: 0.993; young: 1.586; old: 1.212).ConclusionsDTR is associated with CVD morbidity. This association was more pronounced in women and elderly, but men and younger peoples at extremely high DTR (19 °C). Future measures should take DTR into account to prevent CVD among susceptible populations.

Impact of parent-child separation on children\u2019s social-emotional development: a cross-sectional study of left-behind children in poor rural areas of China

BackgroundParent-child separation is a considerable adversity for left-behind children (LBC), but there is little evidence on the association between detailed characteristics of parent-child separation and social-emotional development among LBC. This study examined the characteristics of parent-child separation and its impacts on developmental delay among under-3 LBC in poor rural China.MethodsWe used data from 811 LBC surveyed in five poor counties in rural China in 2018. Detailed characteristics of their parental migration were recalled by their primary caregivers in face-to-face interviews. The children’s social-emotional development was measured by using the Ages and Stages Questionnaire: Social-Emotional. Logistic regression was employed to examine the association of detailed characteristics of parent-child separation with early social-emotional problems after adjusting for the children’s and primary caregivers’ sociodemographic characteristics.Results287 (35.4%) children were left behind by fathers and cared for by mothers (FM-MC), while 524 (64.6%) were left behind by both parents and cared for by grandparents (PM-GC). The rate of social-emotional problems among LBC was 36.8% (PM-GC vs FM-MC: 40.6% vs 29.5%; aOR 1.51, 95% CI: 1.06 to 2.16). For paternal migration, the medians of the child’s age at the first migration and average duration per migration were 3 months (IQR: 1 to 9 months) and 4.48 months (IQR: 2.38 to 7.54 months), respectively. For maternal migration, the corresponding values were 9 months (IQR: 6 to 13 months) and 4.65 months (IQR: 2.71 to 7.62 months), respectively. On average, LBC had been separated from fathers for 72% of their life due to paternal migration and from mothers for 52% of their life due to maternal migration. No significant association was found between the detailed characteristics of paternal migration and social-emotional development among LBC, while social-emotional problems among LBC were significantly associated with the proportion of cumulative duration of maternal migration in the child’s lifetime (aOR 2.83; 95% CI: 1.13 to 7.10).ConclusionsLBC under 3 years had a high risk of social-emotional problems in poor rural China. Cumulative exposure to maternal migration may be detrimental to LBC’s early social-emotional development. Programs are necessary to support these children as well as their families.

Cognitive ability and academic performance among left-behind children: evidence from rural China

ABSTRACT Little attention has been paid to the role that low levels of cognitive development (or IQ) play among both left-behind children (LBCs) and children living with parents (CLPs) in the context of poor educational attainment in rural China. In this paper, we examine how general cognitive abilities contribute to the academic achievement gains of both LBCs and CLPs in poor areas of rural China. We measure the general cognitive ability of the 4,780 sample students using the Raven’s Standard Progressive Matrices (Raven IQ) and assess academic achievement using a curriculum-based mathematics exam. We find that IQ and left-behind status predict achievement gains for the average student. Among low-IQ students, however, left-behind status does not correlate with a change in achievement, suggesting that the migration of parents does not immediately/automatically translate into a loss of academic achievement for students with delays in their general cognitive ability.

IQ, grit, and academic achievement: Evidence from rural China

Promoting an educated labor force is critical for emerging economies. Educational achievement, in turn, depends heavily on general cognitive abilities as well as non-cognitive skills, such as grit. Current research, however, has not examined how cognition and grit may explain the academic performance of students in an economically disadvantaged context. Thus, this study examines how IQ and grit contribute to academic achievement gains for students in poor areas of rural China. Drawing on data from 2931 students in rural China, we measure general cognitive ability, using the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) and Raven’s Standard Progressive Matrices (Raven IQ); non-cognitive ability, using the Short Grit Scale; and academic achievement, using a curricular-based mathematics exam. We find that IQ and grit each predict achievement gains for the average student. Grit is not positively associated with achievement gains among low-IQ students, however, suggesting that grit does not translate into academic achievement gains for students with delays in general cognitive ability.

Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China

BackgroundEmpirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.MethodsWe designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT).ResultsOverall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.ConclusionsThe CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities.

Personality and career decision-making self-efficacy of students from poor rural areas in China

We examined the correlations between personality and career decision-making self-efficacy (CDMSE) of university students from poor rural areas in China from an educational equity perspective. The results showed that female (vs. male) students were more neurotic, senior (vs. younger) students were more agreeable, and social science students were more neurotic than those in other disciplines. The results also revealed that differences in the total CDMSE were nonsignificant, but there was a gender difference in accurate self-appraisal and a difference by year of study in gathering information. There was a positive correlation between conscientiousness, agreeableness, openness, and extraversion, and CDMSE, and a negative correlation between neuroticism and CDMSE. The 5 personality traits, except for agreeableness, played a crucial role in predicting CDMSE. The results suggest that officials and staff of governments, universities, and industries should work together to develop proactive personality traits of students from poor rural areas in China, facilitate their CDMSE, and help them achieve their employment aspirations, thereby promoting educational equity.

Social-Psychological Factors in Food Consumption of Rural Residents: The Role of Perceived Need and Habit within the Theory of Planned Behavior.

To address the problem of malnutrition in poor rural areas of China, this study aims to examine the effects of social-psychological factors in food consumption of rural residents in poor counties of Southwest China. In addition, it investigates the role of perceived need and habit within the theory of planned behavior (TPB) in predicting food consumption. A survey with random sampling was conducted on rural residents (n = 424), and the theoretical frameworks of both the standard and extended TPB were applied for comparison purposes. Structural equation modeling was applied to test the relationships among constructs. Consumption of five food items was studied, respectively: meat, eggs, dairy, fish, and fruits. Results showed that incorporation of perceived need and habit substantially increased the explanatory power of the TPB, but these factors only had significant direct effects on intention rather than behavior. Perceived need and habit are stronger predictors of intention than any other TPB construct for consumption of all food items except for meat. We found indirect effects of the constructs in the extended TPB model on consumption to be different across food items. Practical implications to improve consumption of different food items were proposed accordingly.

Household Food Insecurity, Dietary Diversity, Stunting, and Anaemia among Left-Behind Children in Poor Rural Areas of China.

Left-behind children (LBC) are a newly emerged social group in China. Poor nutritional status is particularly prominent in this population. However, their food insecurity tends to attract very little attention. This study aims to investigate the relationship between food insecurity and undernutrition (stunting and anaemia) in 3 to 5-year-old LBC in rural China. Face-to-face interviews were administered to 553 LBC caregivers in 40 rural villages of Hunan Province, China. The Household Food Insecurity Access Scale (HFIAS) was used to assess household food insecurity (HFI). Dietary diversity score (DDS) and food group consumption frequency were measured by 24 h-recall and food frequency questionnaires (FFQ). Hemoglobin tests and anthropometric measurements including height and weight were measured by trained health professionals. Logistic regression was constructed to assess the association between household food insecurity and dietary diversity, stunting, and anaemia. A high prevalence of household food insecurity was determined (67.6%). The weighted prevalence of stunting and anaemia were 16.6% and 26.5%, respectively. Food insecurity was positively associate with LBC stunting (severe HFI: OR = 6.50, 95% CI: 2.81, 15.00; moderate HFI: OR = 3.47, 95% CI: 1.60, 7.54), and anaemia (severe HFI: OR = 1.91, 95% CI: 1.02, 3.57). LBC with food insecurity had significantly lower dietary diversity than those who were food-secure (p < 0.001). The prevalence of household food insecurity among LBC in poor rural China is high and is associated with low DDS, stunting, and anaemia. Nutritional intervention programs and policies are urgently needed to reduce household food insecurity and undernutrition for this vulnerable population.

Effects on developmental outcomes after cesarean birth versus vaginal birth in Chinese children aged 1-59 months: a cross-sectional community-based survey.

ObjectiveIt is controversial whether the mode of delivery is associated with developmental outcome, and little was known about growth and development of cesarean children in poor rural areas in China. We aim to measure the development of both cesarean and vaginal-delivered children by Ages and Stages Questionnaires (ASQ) and explore the association between mode of delivery and developmental outcome in poor rural areas in China.MethodsData were collected from a cross-sectional community-based survey, which recruited 1,755 vaginal delivered and cesarean children ages 1 to 59 months in eight counties of China. Caregivers of those children completed the Chinese version of ASQ-3 (ASQ-C) while physical examination andquestionnaires on socio-demographic and neonatal characteristics were conducted. Multivariate logistic regressions were used to measure the association between developmental delay and mode of delivery as well as each socio-demographic factor, respectively, after adjusting other socio-demographic characteristics.ResultsThe prevalence of suspected overall developmental delay was 23.4% in the cesarean group, compared with 21.3% in the vaginal delivered group, yet without statistical difference (p < 0.05). Developmental delay was also not significantly different between cesarean and vaginal delivered group in five ASQ domains of communication (7.7% vs. 7.8%, p = 0.949), fine motor (7.0% vs. 6.1%, p = 0.538), gross motor (8.5% vs. 6.4%, p = 0.154), problem solving (7.2% vs. 6.7%, p = 0.722) and personal social (8.0% vs. 7.9%, p = 0.960).ConclusionsOur findings suggest that cesarean delivery does not increase or decrease the risk of suspected developmental in children delay as compared with vaginal delivery.

Effects of dietary intervention on vitamin B12 status and cognitive level of 18-month-old toddlers in high-poverty areas: a cluster-randomized controlled trial

BackgroundThe local diet in high-poverty areas in China is mainly vegetarian, and children may be more vulnerable to vitamin B12 deficiency.ObjectiveThe aims of this study were to explore the vitamin B12 status of toddlers living in high-poverty areas of China and to observe the effects of different complementary foods on the vitamin B12 status and cognitive level of these toddlers.MethodsThe study was nested within a cluster-randomized controlled trial implemented in 60 administrative villages (clusters) of Xichou County in which infants aged 6 months old were randomized to receive 50 g/d of pork (meat group), an equi-caloric fortified cereal supplement (fortified cereal group) or local cereal supplement (local cereal group) for one year. At 18 months, a subsample of the 180 toddlers (60 from each group) was randomly tested for serum vitamin B12 and total homocysteine (tHcy) levels, and their neurodevelopment was evaluated.ResultsThe median serum concentrations of vitamin B12 and tHcy were 360.0 pg/mL and 8.2 μmol/L, respectively, in children aged 18 months. Serum vitamin B12 concentrations less than 300 pg/mL were found in 62 (34.4%) children, and concentrations less than 200 pg/mL were found in 30 (16.7%) children. The median vitamin B12 concentration was significantly different among the three groups (P < 0.001). The highest vitamin B12 level was demonstrated in the fortified cereal group (509.5 pg/mL), followed by the meat group (338.0 pg/mL) and the local cereal group (241.0 pg/mL). Vitamin B12 concentration was positively correlated with the cognitive score (P < 0.001) and the fine motor score (P = 0.023) of the Bayley Scales of Infant Development, 3rd Edition (BSID III) screening test. Compared to the local cereal group, children in the meat group had higher cognitive scores (P < 0.05).ConclusionIn poor rural areas of China, vitamin B12 deficiency in toddlers was common due to low dietary vitamin B12 intake. Fortified cereal and meat could help improve the vitamin B12 status of children and might improve their cognitive levels.Trial registrationThe larger trial in which this study was nested was registered at clinical trials.gov as NCT00726102. It was registered on July 31, 2008.

Multidimensional child poverty, social relationships and academic achievement of children in poor rural areas of China

Poverty and poverty reduction in mainland China are the main concerns of development discourse and policy. Among poor individuals, children are the most vulnerable. This study aimed to investigate how multidimensional child poverty influenced children's academic achievement in poor rural areas in China. This study examined how this effect might be mediated by the stock of social relationships. Data were obtained from a questionnaire survey of 775 children (grades 4 to 9) living in the most underdeveloped rural areas in southwest China (Eryuan County). Results showed that multidimensional child poverty was negatively related to children's academic achievement. Social relationships played a significant role in mediating the effects of multidimensional child poverty on children's academic achievement. These findings provided valuable insights into the multidimensions of poverty and the underlying mechanisms from poverty to children's academic achievement. Implications in theory, social work practice, and social policy were discussed. Social work intervention and prevention were also developed in terms of fostering the growth of social relationships.

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

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.