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Early Childhood Development and Parental Training Interventions in Rural China: A Systematic Review and Meta-Analysis


Emmers, Dorien; Jiang, Qi; Xue, Hao; Zhang, Yue; Zhang, Yunting; Zhao, Yingxue; Liu, Bin; Dill, Sarah-Eve; Qian, Yiwei; & Warrinnier, Nele, et al. (2021). Early Childhood Development and Parental Training Interventions in Rural China: A Systematic Review and Meta-Analysis. BMJ Global Health, 6(8), e005578. PMCID: PMC8381307


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.


Reference Type

Journal Article

Year Published


Journal Title

BMJ Global Health


Emmers, Dorien
Jiang, Qi
Xue, Hao
Zhang, Yue
Zhang, Yunting
Zhao, Yingxue
Liu, Bin
Dill, Sarah-Eve
Qian, Yiwei
Warrinnier, Nele
Johnstone, Hannah
Cai, Jianhua
Wang, Xiaoli
Wang, Lei
Luo, Renfu
Li, Guirong
Xu, Jiajia
Liu, Ming
Huang, Yaqing
Shan, Wenjie
Li, Zhihui
Zhang, Yu
Sylvia, Sean
Ma, Yue
Medina, Alexis
Rozelle, Scott

Article Type







Sylvia - 0000-0002-9508-247X