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Original research
Early childhood development and parental training interventions in rural China: a systematic review and meta-analysis
  1. Dorien Emmers1,2,
  2. Qi Jiang2,
  3. Hao Xue2,
  4. Yue Zhang3,
  5. Yunting Zhang4,
  6. Yingxue Zhao5,
  7. Bin Liu6,
  8. Sarah-Eve Dill2,
  9. Yiwei Qian7,
  10. Nele Warrinnier1,8,
  11. Hannah Johnstone2,
  12. Jianhua Cai9,
  13. Xiaoli Wang10,
  14. Lei Wang11,
  15. Renfu Luo12,
  16. Guirong Li13,
  17. Jiajia Xu13,
  18. Ming Liu14,
  19. Yaqing Huang14,
  20. Wenjie Shan4,
  21. Zhihui Li4,15,
  22. Yu Zhang16,
  23. Sean Sylvia17,
  24. Yue Ma2,
  25. Alexis Medina2,
  26. Scott Rozelle2
  1. 1LICOS Centre for Institutions and Economic Performance, KU Leuven, Leuven, Belgium
  2. 2Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
  3. 3National Center for Women and Children Health, Chinese Center for Disease Control and Prevention, Beijing, China
  4. 4Child Health Advocacy Institute, Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  5. 5The Thousand Day Initiative, Beijing, China
  6. 6Xinhe Foundation, Beijing, China
  7. 7Department of Economics, University of Southern California, Los Angeles, California, USA
  8. 8School of Economics and Finance, Queen Mary University of London, London, UK
  9. 9Administrators of Training Center of the National Health Commission of the PRC, Beijing, China
  10. 10School of Public Health, Peking University Health Science Centre, Beijing, China
  11. 11International Business School, Shaanxi Normal University, Xi'an, Shaanxi, China
  12. 12School of Advanced Agricultural Sciences, Peking University, Beijing, China
  13. 13International Center for Action Research on Education, Henan University School of Education, Kaifeng, Henan, China
  14. 14Save the Children International China Program, Beijing, China
  15. 15Vanke School of Public Health, Tsinghua University, Beijing, China
  16. 16Hupan Modou Foundation, Hangzhou, China
  17. 17Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Yue Zhang; zhangyue0416{at}163.com

Abstract

Introduction Inadequate care during early childhood can lead to long-term deficits in skills. Parenting programmes that encourage investment in young children are a promising tool for improving early development outcomes and long-term opportunities in low-income and middle-income regions, such as rural China.

Methods We conducted a systematic review and a meta-analysis to investigate the prevalence of early developmental delays and stimulating parenting practices as well as the effect of parental training programmes on child development outcomes in rural China. We obtained data in English from EconPapers, PubMed, PsycARTICLES, Cochrane Library, Web of Science and Scopus (Elsevier) and in Chinese from China National Knowledge Infrastructure, Wanfang Data and VIP Information. We conducted frequentist meta-analyses of aggregate data and estimated random-effects meta-regressions. Certainty of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation approach.

Results We identified 19 observational studies on the prevalence of developmental delays and stimulating parenting practices for children under 5 years of age (n=19 762) and ten studies on the impact of parental training programmes on early child development (n=13 766). Children’s risk of cognitive, language and social-emotional delays in the rural study sites (covering 14 provinces mostly in Central and Western China) was 45%, 46%, and 36%, respectively. Parental training programmes had a positive impact on child cognition, language and social-emotional development.

Conclusion There is evidence to suggest that early developmental delay and the absence of stimulating parenting practices (ie, reading, storytelling and singing with children) may be prevalent across rural, low-income and middle-income regions in Central and Western China. Results support the effectiveness of parental training programmes to improve early development by encouraging parental engagement.

Trial registration number This study was registered with PROSPERO (CRD42020218852).

  • systematic review
  • child health
  • treatment
  • public health
  • other infection
  • disease
  • disorder
  • or injury

Data availability statement

Data are available on request. The Stata code and data permissible for sharing will be made available on request from DE (dorien.emmers@kuleuven.be).

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2021-005578

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    Data availability statement

    Data are available on request. The Stata code and data permissible for sharing will be made available on request from DE (dorien.emmers@kuleuven.be).

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    Footnotes

    • DE and QJ are joint first authors.

    • Handling editor Seye Abimbola

    • Contributors DE and QJ contributed equally to this study. DE conceived the study, collected the data, verified the underlying data, conducted the statistical analysis, interpreted the data and drafted the manuscript. QJ conducted the statistical analysis, interpreted the data, and provided critical edits to the manuscript. HX contributed to the statistical analysis, verified the underlying data, interpreted the data, conducted the bias assessment, and provided critical edits to the manuscript. YueZ contributed to the statistical analysis, verified the underlying data, interpreted the data, and provided critical edits to the manuscript. YTZ contributed to the statistical analysis, verified the underlying data, interpreted the data, and provided critical edits to the manuscript. YXZ reviewed and provided critical edits to the manuscript. BL reviewed and provided critical edits to the manuscript. S-ED collected the data, conducted the bias assessment, interpreted the data and helped to draft the manuscript. YQ conducted the statistical analysis, interpreted the data, and provided critical edits to the manuscript. NW conducted the statistical analysis, interpreted the data, and provided critical edits to the manuscript. HJ conducted the bias assessment, interpreted the data and provided critical edits to the manuscript. JC provided critical edits to the manuscript. XW conducted the statistical analysis, interpreted the data, and provided critical edits to the manuscript. LW conducted the statistical analysis, interpreted the data and provided critical edits to the manuscript. RL reviewed and provided critical edits to the manuscript. GL conducted the statistical analysis, interpreted the data, and provided critical edits to the manuscript. JX conducted the statistical analysis and interpreted the data. ML conducted the statistical analysis, interpreted the data, and provided critical edits to the manuscript. YH conducted the statistical analysis, interpreted the data and provided critical edits to the manuscript. WS conducted the statistical analysis, interpreted the data and provided critical edits to the manuscript. ZL conducted the statistical analysis, interpreted the data and provided critical edits to the manuscript. YuZ conceived the study, interpreted the data, and provided critical edits to the manuscript. SS conceived the study, interpreted the data and provided critical edits to the manuscript. YM conducted the statistical analysis, interpreted the data, and provided critical edits to the manuscript. AM interpreted the data, conducted the bias assessment and drafted the manuscript. SR conceived the study, collected the data, interpreted the data and provided critical edits to the manuscript.

    • Funding DE acknowledges support from KU Leuven, Long-term structural funding-Methusalem funding by the Flemish Government and by the Fonds voor Wetenschappelijk Onderzoek-Vlaanderen (FWO), and the Fonds de la Recherche Scientifique-FNRS under EOS Project No. G0G4318N (EOS ID 30784531).

    • Competing interests We have listed the institutions or organisations that were in charge of programme implementation and the involvement of coauthors of this manuscript in reviewed intervention studies in online supplemental appendix table 7.1.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.