Alexander Manu|Fernanda Ewerling|Aluísio J. D. Barros|Cesar G Victora
Association between availability of children’s book and the literacy-numeracy skills of children aged 36 to 59 months: secondary analysis of the UNICEF Multiple-Indicator Cluster Surveys covering 35 countries
London School of Hygiene & Tropical Medicine|Liverpool School of Tropical Medicine
stimulating home environments childrens books pictures play toys facilitate caregiverchild interactions enhance childrens development although demonstrated smallscale intervention studies important document whether book ownership beneficial large scale low middleincome settingswe conducted secondary analysis using data multipleindicator cluster survey covering 100 012 children aged 3659 months 35 countries outcome children ontrack literacynumeracy index lni constructed three questions assessing childrens ability identifyname least 10 letters alphabet read least four simple popular words know names symbols numbers 110 main exposure availability childrens book child within household analysis considered survey design assessed ranked risk ratios track adjusting potential confounders childs age months maternal education household wealth index quintile area residence ruralurban ecological analysis performed using metaregression grouping countries world bank income groups low highincomeonly half 518 children countries analysed least one childrens book home less onethird 299 95 confidence interval ci 235 363 track literacynumeracy adjusting confounders likelihood track literacynumeracy almost doubled least one book available home compared none rr 189 95 ci 175 203 economic gradient showing likelihood children track lni decreased countrys income group adjustedrr ranged 165 upper middle income 223 lic ftest pvalue 00001 three highincome countries included childrens books universally available resulting wide confidence intervals effectthese findings policyrelevant corroborate results small scale experiments making childrens book available children cheap feasible intervention could change home dynamics improve future economic fortunes children especially poorest countries