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.

Acknowledgements

Secretary General Mai Lu, Jin Fang and the rest of the CDRF team provided strong support of program management throughout this study. We would like to thank Jingmin Shi of the Shanghai Center for Women and Children’s Health for providing the Chinese version of DDST-II and for organizing professional assessors from Shanghai to administer DDST-II tests in Huachi, and Dr. Junsheng Huo of the Chinese Center for Disease Control and Prevention for assisting in the onsite anthropometric data collection and the hemoglobin tests. We would also like to acknowledge Drs. Sally Grantham-McGregor and Oratio Attanasio at University College London for their advice to the intervention implementation, and the Center for the Economics of Human Development at University of Chicago for their input into the design of cluster-randomized controlled trial. Finally, we are grateful to Dr. Mary Young for her helpful comments.

Authors’ statement

Conception or design of the work: Miao Li; Data collection: Weidong Wang, Bei Liu; Data analysis and interpretation: Miao Li, Sarah Mustillo, Weidong Wang; Drafting the article: Miao Li, Sarah Mustillo; Critical revision of the article: Bei Liu. Final approval of the version to be submitted: all named authors approved the submission.

Additional information

Funding

This research was supported by China Development Research Foundation. The implementation of China REACH in 2015–2016 was funded by the UBS Optimus Foundation.

Notes on contributors

Miao Li

Miao Li is an Assistant Professor at the Department of Sociology, Anthropology, and Criminal Justice at Clemson University. His research focuses on how socio-environmental factors affect health and health behaviours over the life course and across generations.

Sarah Mustillo

Sarah Mustillo is a Professor of Sociology and the I.A. O’Shaughnessy Dean at the University of Notre Dame. Her research interests include the social antecedents of mental illness, statistical methods, and social epidemiology.

Bei Liu

Bei Liu is a senior Program Manager and an Associate Research Fellow of the China Development Research Foundation (CDRF). Her professional experiences concentrate on the design, implementation, and evaluation of CDRF’s early childhood intervention programs.

Weidong Wang

Weidong Wang is an Associate Professor at the School of Sociology and Population Studies at Renmin University of China. He is also the executive director for the China National Survey Research Center. His research focuses on social networks, education, health, and religion.