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All Publications

  • Early childhood development and parental training interventions in rural China: a systematic review and meta-analysis. BMJ global health Emmers, D., Jiang, Q., Xue, H., Zhang, Y., Zhang, Y., Zhao, Y., Liu, B., Dill, S., Qian, Y., Warrinnier, N., Johnstone, H., Cai, J., Wang, X., Wang, L., Luo, R., Li, G., Xu, J., Liu, M., Huang, Y., Shan, W., Li, Z., Zhang, Y., Sylvia, S., Ma, Y., Medina, A., Rozelle, S. 2021; 6 (8)


    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).

    View details for DOI 10.1136/bmjgh-2021-005578

    View details for PubMedID 34417271

  • Improving learning by improving vision: evidence from two randomized controlled trials of providing vision care in China JOURNAL OF DEVELOPMENT EFFECTIVENESS Ma, X., Wang, H., Shi, Y., Sylvia, S., Wang, L., Qian, Y., Rozelle, S. 2021
  • Effect of Chinese eye exercises on change in visual acuity and eyeglasses wear among school-aged children in rural China: a propensity-score-matched cohort study. BMC complementary medicine and therapies Wang, H., Qian, Y., Congdon, N., Boswell, M., Rozelle, S., Ma, X. 2020; 20 (1): 82


    BACKGROUND: Daily "eye exercises," massaging of periocular acupuncture pressure points, have been part of China's national vision care policy in schools for some 50years. However, the effect of eye exercises on myopia progression and eyeglasses wear has not been definitively investigated. This study evaluates the effectiveness of eye exercises on visual acuity and the propensity of rural children to wear eyeglasses.METHODS: Cohort study in 252 randomly-selected rural schools with baseline in September 2012 and follow up surveys 9 and 21months later. Outcomes were assessed using propensity-score matching (PSM), multivariate linear regression and logistic regression to adjust for differences between children performing and not performing eye exercises.RESULTS: Among 19,934 children randomly selected for screening, 2374 myopic (spherical equivalent refractive error≤-0.5 diopters in either eye) children (11.9%, mean age 10.5 [Standard Error 1.08] years, 48.5% boys) had VA in either eye ≤6/12 without eyeglasses correctable to >6/12 with eyeglasses. Among these who completed the 21-month follow up, 1217 (58.2%) children reported practicing eye exercises on school days and 874 (41.8%) did not. After propensity-score matching, 1652 (79%) children were matched: 826 (50%) in the Eye Exercises group and 826 (50%) in the No Exercise group. Performing eye exercises was not associated with change in LogMAR uncorrected visual acuity and wear of eyeglasses, using either logistic regression or PSM at 9 or 21months.CONCLUSIONS: We found no evidence for an effect of eye exercises on change in vision or eyeglasses wear.TRIAL REGISTRATION: The original trial (Registration site: Registration number: ISRCTN03252665) was retrospectively registered 25/09/2012.

    View details for DOI 10.1186/s12906-020-2878-9

    View details for PubMedID 32164649

  • Correlates of participation in community-based interventions: Evidence from a parenting program in rural China. PloS one Qian, Y. n., Zheng, Y. M., Dill, S. E., Rozelle, S. n. 2020; 15 (9): e0238841


    A growing body of literature has documented that community-based early childhood development (ECD) interventions can improve child developmental outcomes in vulnerable communities. One critical element of effective community-based programs is consistent program participation. However, little is known about participation in community-based ECD interventions or factors that may affect participation. This paper examines factors linked to program participation within a community-based ECD program serving 819 infants and their caregivers in 50 rural villages in northwestern China. The results find that more than half of families did not regularly attend the ECD program. Both village-level social ties within the program and proximity to the program significantly predict program participation. Increased distance from the program site is linked with decreased individual program participation, while the number of social ties is positively correlated with participation. The average program participation rates among a family's social ties is also positively correlated with individual participation, indicating strong peer effects. Taken together, our findings suggest that attention should be given to promoting social interactions and reducing geographic barriers among households in order to raise participation in community-based ECD programs.

    View details for DOI 10.1371/journal.pone.0238841

    View details for PubMedID 32898156

  • The Effect of Providing Free Eyeglasses on Children's Mental Health Outcomes in China: A Cluster-Randomized Controlled Trial INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Guan, H., Wang, H., Du, K., Zhao, J., Boswell, M., Shi, Y., Qian, Y. 2018; 15 (12)