Objective: To explore the effect of books and toys on early childhood development in poor rural areas of China. Methods: The baseline survey data of the Integrated Early Childhood Development (IECD) conducted in 2013, which was supported by the United Nations International Children's Emergency Fund (UNICEF) China Office, were analyzed retrospectively in this study. The survey was conducted in 6 counties in 2 provinces of China (Shanxi and Guizhou), and all 6 neighboring counties were located in extremely poor areas. The socio-demographic characteristics and caring behaviors of the caregivers (the lack of children's books and toys) were assessed by UNICEF's Multiple Indicator Cluster Surveys-5 and caregivers' depression was assessed by the Zung Self-rating Depression Scale. A total of 2 701 children were enrolled, of these, 1 151(42.62%) were girls, the age (18±10) months and 1 263 (46.76%) children were from Shanxi Province, the remaining 1 438 (53.24%) children were from Guizhou Province. The early childhood developmental status was evaluated by Ages and Stages Questionnaires (ASQ). Log-binomial model was used to analyze the association between early childhood development and the lack of children's books and toys. Furthermore, sensitivity analyses (data stratification) were made to explore the effect of books and toys on early childhood development under different caregiving conditions with different caregivers who were depressive or non-depressive. Results: Among the 2 701 participants, 1 537 (56.90%) children lacked of books, 1 148 (42.50%) children lacked of toys, the suspected development delay (SDD) prevalences of overall ASQ, communication (CM), gross motor (GM), fine motor (FM), cognitivity (CG) and personal-social (PS) domains were 33.02% (892/2 701), 15.51% (419/2 701), 13.25% (358/2 701), 15.66% (423/2 701), 14.96% (404/2 701) and 11.81% (319/2 701). Under adjustment of the potential confounders, the Log-binomial regression showed that children who lacked books had significantly higher risk of SDD in overall ASQ (prevalence ratio (PR)=1.27, 95%CI: 1.11-1.45) and CM (PR=1.64, 95%CI: 1.31-2.07) than those who had sufficient books. Compared with children who had sufficient toys, those who lacked the toys also had the increased risk of SDD in overall ASQ (PR=1.34, 95%CI: 1.19-1.50), CM (PR=1.44, 95%CI: 1.18-1.76), GM (PR=1.54, 95%CI: 1.24-1.91), FM (PR=1.86, 95%CI: 1.52-2.27), CG (PR=1.80, 95%CI: 1.47-2.20) and PS (PR=1.88, 95%CI: 1.49-2.39). Sensitivity analysis revealed that the lack of books increased the risk of SDD in overall ASQ of the caregivers' non-depression group (PR=1.35, 95%CI: 1.08-1.71) and depression group (PR=1.17, 95%CI: 1.01-1.38), and the lack of toys increased the risk of SDD in overall ASQ of the caregivers' depression group (PR=1.54, 95%CI: 1.32-1.79). Conclusion: Lack of childrens' books and shortage of toys were independent risk factors for early childhood development in poor rural areas of China and both of them increased the risk of SDD significantly.
目的： 探讨图书和玩具对中国贫困农村地区儿童早期发展的影响。 方法： 回顾性分析儿童早期发展综合项目2013年进行基线调查的资料，其调查地区来自山西省和贵州省的6个县，均位于国家集中连片特困地区。采用联合国儿童基金会的"多指标聚类调查问卷第五版"收集社会人口学信息和看护人养育照护行为信息（包括儿童图书和玩具缺乏状况），采用"抑郁自评量表"对看护人的抑郁状况进行评估，采用"年龄与发育进程问卷第三版"对儿童的心理行为发育状况进行评估。基线调查共纳入0~35月龄儿童2 701名，其中女童1 151名（42.62%），年龄（18±10）月龄。山西省1 263名（46.76%），贵州省1 438名（53.24%）。采用Log-binomial回归分析图书和玩具缺乏同儿童早期发展之间的关系，进一步按照看护人抑郁状况进行敏感性分析（分层分析）。 结果： 2 701名儿童中缺乏图书的1 537名（56.90%），缺乏玩具的1 148名（42.50%）；总可疑发育迟缓率为33.02%（892/2 701），沟通、大动作、精细动作、解决问题和个人-社会5能区的发育迟缓率分别为15.51%（419/2 701）、13.25%（358/2 701）、15.66%（423/2 701）、14.96%（404/2 701）和11.81%（319/2 701）。在校正看护人年龄、民族、文化程度、家庭经济状况和儿童性别后，缺乏图书[现患比（PR）=1.27，95%CI：1.11~1.45]和玩具（PR=1.34，95%CI：1.19~1.50）可以显著增加儿童的总可疑发育迟缓风险。缺乏图书可以增加沟通能区（PR=1.64，95%CI：1.31~2.07）可疑发育迟缓的风险；缺乏玩具可增加沟通能区（PR=1.44，95%CI：1.18~1.76），大动作能区（PR=1.54，95%CI：1.24~1.91），精细动作能区（PR=1.86，95%CI：1.52~2.27），解决问题能区（PR=1.80，95%CI：1.47~2.20）和个人-社会能区（PR=1.88，95%CI：1.49~2.39）可疑发育迟缓的风险。进一步按看护人抑郁状况进行敏感性分析显示缺乏图书在看护人非抑郁组（PR=1.35，95%CI：1.08~1.71）和看护人抑郁组（PR=1.17，95%CI：1.01~1.38）均可增加总可疑发育迟缓风险，缺乏玩具在看护人抑郁组（PR=1.54，95%CI：1.32~1.79）可增加总可疑发育迟缓风险。 结论： 图书和玩具的缺乏是影响中国贫困农村地区儿童早期发展的独立危险因素，可显著增加儿童可疑发育迟缓的风险。.
Keywords: Books; Depression; Early childhood development; Play and playthings.