The effect of a community-based, integrated and nurturing care intervention on early childhood development in rural China.

OBJECTIVES: This study investigated whether an integrated, community-based and nurturing care intervention led to a reduction in the prevalence of suspected neurodevelopmental delay in children. The study also considered how the programme could be sustained to promote early development in children aged under 3 years in the poorest areas of rural China. STUDY DESIGN: A quasi-experimental design was applied, with data collection before and after a 2-year programme implementation, in both intervention and comparison (control) areas. METHODS: From July 2014, the Integrated Early Childhood Development (IECD) programme was implemented in poverty-stricken areas in four counties of China. Nurturing care intervention focusing on five components (child health, nutrition, responsive care, protection and early learning support) was delivered mainly by the village early childhood development centre and township/village clinic. Another two counties of similar per capita gross domestic product, geographical characteristics, under-five mortality rate, under-five underweight prevalence and ethnicity to the four programme counties were selected as the comparison and received no IECD programme intervention. The Ages & Stages Questionnaire was used to evaluate the neurodevelopmental outcome of children; the overall suspected developmental delay (SDD) referred to any developmental delay in the communication, gross-motor, fine-motor or problem-solving or personal-social domains of the questionnaire. Children underwent anthropometric measurements and haemoglobin concentration testing through peripheral blood. Face-to-face interviews of caregivers were conducted to collect intervention use, cognitive stimulation and child-protection behaviours. A difference-in-differences regression approach, adjusting for confounding factors, was applied to estimate intervention impact on the neurodevelopmental outcomes in the children. Path analysis was employed to examine the mediating effects of growth, nutrition status, cognitive stimulation and child-protection behaviours through which the IECD intervention predicted children's developmental health. RESULTS: In total, 2953 children aged under 3 years and their caregivers were enrolled at baseline, and 2745 child-caregiver pairs completed the postintervention assessment. Prevalence of overall SDD was reduced by 18% (from 37% at baseline to 19% at postintervention) in intervention counties, which is a significant difference compared with the 10% reduction in control counties (from 30% to 20%), with an adjusted odds ratio of 0.69 (95% confidence interval: 0.54-0.89). Consistent findings were found across domains. Path analysis indicated that the effect of the intervention on promoting developmental health was mediated by multiple nurturing care-associated factors, including cognitive stimulation frequency, positive discipline, length-for-age growth and haemoglobin concentration. CONCLUSIONS: The community-based integrated intervention could significantly prevent developmental delay in children aged under 3 years in rural China.

Poor complementary feeding practices and high anaemia prevalence among infants and young children in rural central and western China.

BACKGROUND/OBJECTIVES: Infant and young child feeding (IYCF) has not been documented in central and western China, where anaemia is prevalent. To support policy advocacy, we assessed IYCF and anaemia there using standardized methods. SUBJECTS/METHODS: A community-based, cross-sectional survey of 2244 children aged 6-23 months in 26 counties of 12 provinces. Analysis of associations between haemoglobin concentration (HC), IYCF indicators and other variables using crude and multivariate techniques. RESULTS: Only 41.6% of those surveyed consumed a minimum acceptable diet. Fewer still-breastfeeding than non-breastfeeding children consumed the recommended minimum dietary diversity (51.7 versus 71.9%; P<0.001), meal frequency (57.7% v. 81.5%; P<0.001) or iron-rich food (63.3% v. 78.9%; P<0.001). Anaemia (51.3% overall) fell with age but was significantly associated with male sex, extreme poverty, minority ethnicity, breastfeeding and higher altitude. Dietary diversity, iron intake, growth monitoring and being left behind by out-migrating parents were protective against anaemia. A structural equation model demonstrated associations between IYCF, HC and other variables. Meal frequency, iron intake and altitude were directly and positively associated with HC; dietary diversity was indirectly associated. Health service uptake was not associated. Continued breastfeeding was directly associated with poor IYCF and indirectly with reduced HC, as were having a sibling and poor maternal education. CONCLUSION: Infant and young child anaemia is highly prevalent and IYCF is poor in rural central and western China. Continued breastfeeding and certain other variables indicate risk of poor IYCF and anaemia. Major policy commitment to reducing iron deficiency and improving IYCF is needed for China's rural poor.

Towards an integrated approach to lung health in adolescents in developing countries.

The World Health Organization strategies, Integrated Management of Childhood Illness and Practical Approach to Lung health provide assessment and management guidelines for health workers in developing countries. We reviewed issues important to lung health in adolescents to highlight whether differences in factors such as adolescent behaviour have consequences for the development of case management guidelines, to form a bridge between guidelines for younger children and for adults and to make suggestions for further study. Pneumonia, asthma and tuberculosis are the leading lung health problems in adolescents. As countries industrialise, the importance of asthma mortality and morbidity increases as that of pneumonia and pulmonary tuberculosis decreases. Guidelines for managing pneumonia and asthma in children and adults in developing and developed countries should be adaptable for use in adolescents in developing countries, although more information is needed on predictors of severity such as respiratory rate cut-offs, level of fever, hypotension, malnutrition and level of consciousness. The effectiveness of low-cost treatment for asthma should be explored further. HIV and the global resurgence of tuberculosis pose significant challenges for improving adolescent lung health, and prevention of smoking initiation during adolescence is a priority goal of any integrated approach to improving lung health.