Ai Yue

Nutrition and Educational Performance in Rural China’s Elementary Schools: Results of a Randomized Control Trial in Shaanxi Province

Despite growing wealth and a strengthening commitment from the government to provide quality education, a significant share of students across rural China still have inadequate access to micronutrient-rich regular diets. Such poor diets can lead to nutritional problems, such as iron-deficiency anemia, that can adversely affect attention and learning in school. The overall goal of this article is to test whether simple nutritional interventions lower rates of anemia and to assess whether this leads to improved educational performance among students in poor areas of rural China. To meet this goal, we report on the results of a randomized control trial involving over 3,600 fourth-grade students, mostly aged 9–12, from 66 randomly chosen elementary schools in eight of the poorest counties in Shaanxi Province in China’s poor northwest region. The design called for random assignment of schools to one of three groups: two different types of treatment/intervention schools and a nonintervention, control group. The two interventions were designed to improve hemoglobin (Hb) levels, which is a measure of iron deficiency. One intervention provided a daily multivitamin with mineral supplements, including 5 milligrams of iron, for 5 months. The other informed the parents of their child’s anemia status and suggested several courses of action (henceforth, the information treatment). We found that 38.3% of the students had Hb levels below 120 grams per liter (g/L), the World Health Organization’s cutoff for anemia for children 9–12 years old. In the schools that received the multivitamins with mineral supplements, Hb levels rose by more than 2 g/L (about 0.2 standard deviations). The standardized math test scores of the students in the schools that received the multivitamin with mineral supplements also improved significantly. In schools that received the information treatment, only students who lived at home (and not the students who lived in boarding schools and took most of their meals at schools) registered positive improvements in their Hb levels. The reductions in anemia rates and improvements in test scores were greater for students who were anemic at the beginning of the study period. Overall, these results should encourage China’s Ministry of Education to begin to widen its view of education (beyond teachers, facilities, and curriculum) and to provide better nutrition and health care for students.

Anemia in Rural China's Elementary Schools: Prevalence and Correlates in Shaanxi Province's Poor Counties

Despite growing wealth in China, a significant share of children across rural China still have no access to iron-rich foods, vitamins, and other micronutrients. Such poor diets may result in high incidences of nutritional problems, including anemia. The objective of the study was to increase understanding of the extent of anemia, and identify structural correlates of anemia in poor Shaanxi provinces primary schools. The article shows that the overall anemia rate is 21.5 percent when using a blood hemoglobin cutoff of 115 g/L (39 percent with a cutoff of 120 g/L). We find that those students that are boarding at school and eat lunch away from home are more likely to be anemic. Children with anemia are found to have lower height for age (HAZ) scores. If this part of Shaanxi province is representative of all poor counties in China, these findings mean millions of children in poor rural China may be anemic.

Anemia and Feeding Practices among Infants in Rural Shaanxi Province in China

Anemia is one of the most prevalent public health problems among infants and iron deficiency anemia has been related to many adverse consequences. The overall goal of this study is to examine the prevalence of anemia among infants in poor rural China and to identify correlates of anemia. In April 2013, we randomly sampled 948 infants aged 6–11 months living in 351 villages across 174 townships in nationally-designated poverty counties in rural areas of southern Shaanxi Province, China. Infants were administered a finger prick blood test for hemoglobin (Hb). Anthropometric measurement and household survey of demographic characteristics and feeding practices were conducted in the survey. We found that 54.3% of 6–11 month old infants in poor rural China are anemic, and 24.3% of sample infants suffer from moderate or severe anemia. We find that children still breastfed over 6 months of age had lower Hb concentrations and higher anemia prevalence than their non-breastfeeding counterparts (p < 0.01), and that children who had ever been formula-fed had significantly higher Hb concentrations and lower anemia prevalence than their non-formula-fed counterparts (p < 0.01). The results suggest the importance of iron supplementation or home fortification while breastfeeding.

Nutritional Deficiencies, the Absence of Information and Caregiver Shortcomings: A Qualitative Analysis of Infant Feeding Practices in Rural China

Background and Objectives Development during the first two years of life is critical and has a lasting impact on a child’s health. Poor infant and child nutrition can lead to deficiencies in essential micronutrients, which may cause a weakened immune system and lasting effects on childrens growth and development. Recent studies in rural Shaanxi Province found an anemia prevalence of 54.3% among rural children aged six to twelve months. While new large-scale, quantitative research has begun to catalogue the extent of child malnutrition and anemia, no effort has yet been made to look more closely at the potential reasons for rural children’s nutritional deficiencies through qualitative analysis. This study aims to elucidate some of the fundamental causes of poor complementary feeding practices that may lead to anemia among children in rural Shaanxi Province, China. Methodology We interviewed sixty caregivers participating in a large survey on child health and nutrition. We conducted three waves of interviews with children’s primary caregivers in seventeen rural villages within four nationally-designated poverty counties in the southern part of Shaanxi Province. Results The qualitative analysis reveals that poor complementary feeding practices are common across our sample. Information gathered from our interviews suggests that complementary feeding practices are impeded by two constraints: absence of understanding topics related to infant health and nutrition under caregivers, as well as inadequate sources of information on these topics. Poverty does not appear to constrain child feeding practices. Conclusion Our results uncover lack of proper knowledge on infant and child nutrition among rural caregivers in China. This situation causes them to fail incorporating micronutrient rich foods in their childrens diet. Age-appropriate complementary feeding can stimulate children’s physical and cognitive development, but in its absence it leads to iron-deficiency anemia. We suggest that steps be taken to educate caregivers to improve complementary feeding of their infants and children.

China’s Invisible Crisis: Cognitive Delays among Rural Toddlers and the Absence of Modern Parenting

This article explores the problem of cognitive delays among toddlers in rural China and the role of their caregivers in producing low levels of cognition (i.e., low IQ). According to the results of a well-tested international scale of child development, the Bayley Scales of Infant Development (BSID), cognitive delays are alarmingly common, and nearly half the toddlers in our sample score an IQ of less than 84 on the BSID test (more than one standard deviation below the mean). In analyzing the source of this, we find that poor parenting—for example, not reading to, singing with, or engaging in stimulating play with one’s children—is closely associated with these delays. Even though mothers (as opposed to grandmother caregivers), and especially more educated mothers, are more likely to follow good parenting practices, quality parenting is rare overall. We seek to find out why so many young children appear to be neglected when it comes to modern parenting practices. We empirically rule out the hypotheses that caregivers discriminate according to their child’s gender; that the number of children in a given household is associated with the quality of parenting; or that caregivers living in relative poverty parent differently than their wealthier counterparts. According to the qualitative component of our study, we also find that inadequate parenting does not stem from parental indifference. Parents and grandparents obviously love their children and want them to succeed in life. Instead, the barriers appear to be primarily a lack of time and an absence of knowledge about the importance of good parenting practices. As a result, when they grow up, these children may not possess the levels of cognition needed to thrive in China’s increasingly high-skill-based economy. Overall, our findings suggest that China may be facing a national crisis due to inadequate rural early childhood development.

Micronutrient deficiencies and developmental delays among infants: evidence from a cross-sectional survey in rural China

Objectives Research increasingly indicates the importance of the nutritional programming that occurs in the first 2–3 years of life. Quality nutrition during this brief window has been shown to have large and significant effects on health and development throughout childhood and even into adulthood. Despite the widespread understanding of this critical window, and the long-term consequences of leaving nutritional deficiencies unaddressed, little is known about the status of infant nutrition in rural China, or about the relationship between infant nutrition and cognitive development in rural China. Design, setting and participants In April 2013 and October 2013, we conducted a survey of 1808 infants aged 6–12 months living in 351 villages across 174 townships in nationally designated poverty counties in rural areas of southern Shaanxi Province, China. Main outcome measures Infants were administered a finger prick blood test for haemoglobin and assessed according to the Bayley Scales of Infant Development. They were also measured for length and weight. Caregivers were administered a survey of demographic characteristics and feeding practices. Results We found that 48.8% of sample infants were anaemic, 3.7% were stunted, 1.2% were underweight and 1.6% were wasted. Approximately 20.0% of the sample infants were significantly delayed in their cognitive development, while just over 32.3% of the sample infants were significantly delayed in their psychomotor development. After controlling for potential confounders, infants with lower haemoglobin counts were significantly more likely to be delayed in both their cognitive (p<0.01) and psychomotor development (p<0.01). Conclusions The anaemia rates that we identify in this study classify anaemia as a ‘severe’ public health problem according to the WHO. In contrast, there is virtually no linear growth failure among this population. We find that low haemoglobin levels among our sample population are associated with significant cognitive and psychomotor delays that could eventually affect childrens schooling performance and labour force outcomes. Trial registration number ISRCTN44149146.

Rural education across China’s 40 years of reform: past successes and future challenges

Purpose - The purpose of this paper is to describe the policy and trends in rural education in China over the past 40 years; and also discuss a number of challenges that are faced by China’s rural school system. Design/methodology/approach - The authors use secondary data on policies and trends over the past 40 years for preschool, primary/junior high school, and high school. Findings - The trends over the past 40 years in all areas of rural schooling have been continually upward and strong. While only a low share of rural children attended preschool in the 1980s, by 2014 more than 90 percent of rural children were attending. The biggest achievement in compulsory education is that the rise in the number of primary students that finish grade 6 and matriculate to junior high school. There also was a steep rise of those going to and completing high school. While the successes in upscaling rural education are absolutely unprecedented, there are still challenges. Research limitations/implications - This is descriptive analysis and there is not causal link established between policies and rural schooling outcomes. Practical implications - The authors illustrate one of the most rapid rises of rural education in history and match the achievements up with the policy efforts of the government. The authors also explore policy priorities that will be needed in the coming years to raise the quality of schooling. Originality/value - This is the first paper that documents both the policies and the empirical trends of the success that China has created in building rural education from preschool to high school during the first 40 years of reform (1978-2018). The paper also documents – drawing on the literature and the own research – the achievements and challenges that China still face in the coming years, including issues of gender, urbanization, early childhood education and health and nutrition of students.

Passive parenting and its Association with Early Child Development

ABSTRACT This study aims to investigate the developmental status of rural Chinese children, the extent of interactive parenting they receive, and the relation between the two. A sample of 448 six to eighteen-month-old children and their caregivers were randomly selected from two rural counties in Hebei and Yunnan provinces. According the third edition of the Bayley Scales of Infant and Toddler Development, 48.7% of sample children exhibited cognitive delays, 40.6% language delays, and 35% social-emotional delays. According to responses from caregivers, parenting in rural China is largely passive, lacking in interactive practices like storytelling, singing, and playing. Children-with-siblings, left-behind children, and children with less-educated mothers were even less likely to receive interactive practices. Children of caregivers who did engage in best parenting practices showed better cognitive, language, and social-emotional development; however, the public health system provides no platform for learning about optimal parenting.

Are Children with Siblings Really More Vulnerable Than Only Children in Health, Cognition and Non-cognitive Outcomes? Evidence from a Multi-province Dataset in China

The general goal of the present study is to analyze whether children with siblings lag behind their only-child counterparts in terms of health and nutrition, cognition and educational performance, and non-cognitive outcomes. We draw on a dataset containing 25 871 observations constructed from three school-level surveys spanning four provinces in China. The analysis compares children with siblings and only children aged 9 to 14 years old in terms of eight different health, cognitive and non-cognitive indicators. We find that with the exception of the anemia rate, health outcomes of children with siblings are statistically indistinguishable from those of only children. In terms of cognition, children with siblings performed better than only children. Moreover, outcomes of children with siblings are statistically indistinguishable from those of only children in terms of the non-cognitive outcomes provided by measures of anxiety. According to our results, the same general findings are true regardless of whether the difference between children with and without siblings is disaggregated by gender.

Impact of Text Message Reminders on Caregivers' Adherence to a Home Fortification Program Against Child Anemia in Rural Western China: A Cluster-Randomized Controlled Trial.

OBJECTIVES To test whether text message reminders sent to caregivers improve the effectiveness of a home micronutrient fortification program in western China. METHODS We carried out a cluster-randomized controlled trial in 351 villages (clusters) in Shaanxi Province in 2013 and 2014, enrolling children aged 6 to 12 months. We randomly assigned each village to 1 of 3 groups: free delivery group, text messaging group, or control group. We collected information on compliance with treatments and hemoglobin concentrations from all children at baseline and 6-month follow-up. We estimated the intent-to-treat effects on compliance and child anemia using a logistic regression model. RESULTS There were 1393 eligible children. We found that assignment to the text messaging group led to an increase in full compliance (marginal effect = 0.10; 95% confidence interval [CI] = 0.03, 0.16) compared with the free delivery group and decrease in the rate of anemia at end line relative to the control group (marginal effect = -0.07; 95% CI = -0.12, -0.01), but not relative to the free delivery group (marginal effect = -0.03; 95% CI = -0.09, 0.03). CONCLUSIONS Text messages improved compliance of caregivers to a home fortification program and childrens nutrition.