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Alexis Medina
Journal Articles

Passive Versus Active Service Delivery: Comparing the Effects of Two Parenting Interventions on Early Cognitive Development in Rural China

Sean Sylvia, Renfu Luo, Jingdong Zhong, Sarah-Eve Dill, Alexis Medina, Scott Rozelle
World Development , 2021

We present the results of a cluster-randomized controlled trial that evaluates the effects of a free, center-based parenting intervention on early cognitive development and parenting practices in 100 rural villages in China. We then compare these effects to a previous trial of a home-based intervention conducted in the same region, using the same parenting curriculum and public service system, accounting for potential differences between the studies. We find that the center-based intervention did not have a significant impact on child development outcomes, but did lead to increases in the material investments, time investments, and parenting skills of caregivers. The average impact of the center-based intervention on child skills and investments in children was significantly smaller than the home-visiting intervention. Analysis of the possible mechanisms suggests that the difference in effects was driven primarily by different patterns of selection into program participation.

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Journal Articles

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

Dorien Emmers, Qi Jiang, Hao Xue, Yue Zhang, Yunting Zhang, Yingxue Zhao, Bin Liu, Sarah-Eve Dill, Yiwei Qian, Nele Warrinnier, Hannah Johnstone, Jianhua Cai, Xiaoli Wang, Lei Wang, Renfu Luo, Guirong Li, Jiajia Xu, Ming Liu, Yaqing Huang, Wenjie Shan, Zhihui Li, Yu Zhang, Sean Sylvia, Yue Ma, Alexis Medina, Scott Rozelle
BMJ Global Health , 2021

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.

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Journal Articles

Health, Economic, and Social Implications of COVID-19 for China's Rural Population

Huan Wang, Sarah-Eve Dill, Huan Zhou, Yue Ma, Hao Xue, Sean Sylvia, Kumi Smith, Matthew Boswell, Alexis Medina, Prashant Loyalka, Cody Abbey, Dimitris Friesen, Nathan Rose, Yian Guo, Scott Rozelle
Agricultural Economics , 2021

This study examines the effects of local and nationwide COVID‐19 disease control measures on the health and economy of China's rural population. We conducted phone surveys with 726 randomly selected village informants across seven rural Chinese provinces in February 2020. Four villages (0.55%) reported infections, and none reported deaths. Disease control measures had been universally implemented in all sample villages. About 74% of informants reported that villagers with wage‐earning jobs outside the village had stopped working due to workplace closures. A higher percentage of rural individuals could not work due to transportation, housing, and other constraints. Local governments had taken measures to reduce the impact of COVID‐19. Although schools in all surveyed villages were closed, 71% of village informants reported that students were attending classes online. Overall, measures to control COVID‐19 appear to have been successful in limiting disease transmission in rural communities outside the main epidemic area. Rural Chinese citizens, however, have experienced significant economic consequences from the disease control measures.

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Journal Articles

Early Childhood Reading in Rural China and Obstacles to Caregiver Investment in Young Children: A Mixed-Methods Analysis

Rui Li, Nathan Rose, Yi Ming Zheng, Yunwei Chen, Sean Sylvia, Henry Wilson-Smith, Alexis Medina, Sarah-Eve Dill, Scott Rozelle
International Journal of Environmental Research and Public Health , 2021
Studies have shown that nearly half of rural toddlers in China have cognitive delays due to an absence of stimulating parenting practices, such as early childhood reading, during the critical first three years of life. However, few studies have examined the reasons behind these low levels of stimulating parenting, and no studies have sought to identify the factors that limit caregivers from providing effective early childhood reading practices (EECRP). This mixed-methods study investigates the perceptions, prevalence, and correlates of EECRP in rural China, as well as associations with child cognitive development. We use quantitative survey results from 1748 caregiver–child dyads across 100 rural villages/townships in northwestern China and field observation and interview data with 60 caregivers from these same sites. The quantitative results show significantly low rates of EECRP despite positive perceptions of early reading and positive associations between EECRP and cognitive development. The qualitative results suggest that low rates of EECRP in rural China are not due to the inability to access books, financial or time constraints, or the absence of aspirations. Rather, the low rate of book ownership and absence of reading to young children is driven by the insufficient and inaccurate knowledge of EECRP among caregivers, which leads to their delayed, misinformed reading decisions with their young children, ultimately contributing to developmental delays.
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Journal Articles

Maternal Health Behaviors During Pregnancy in Rural Northwestern China

Yue Ma, Yujuan Gao, Jason Li, Andrew Sun, Baozhu Wang, Jun Zhang, Sarah-Eve Dill, Alexis Medina, Scott Rozelle
BMC Pregnancy and Childbirth , 2020

Background: Maternal health during pregnancy is a key input in fetal health and child development. This study
aims to systematically describe the health behaviors of pregnant women in rural China and identify which
subgroups of women are more likely to engage in unhealthy behaviors during pregnancy.

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Journal Articles

Visual Impairment in Rural and Migrant Chinese School-Going Children: Prevalence, Severity, Correction and Association

Yue Ma, Xinwu Zhang, Fei He, Xiaochen Ma, Hongmei Yi, Nathan Rose, Alexis Medina, Scott Rozelle, Nathan Congdon
BMJ Ophthalmology , 2020
Purpose To describe changes in the prevalence of visual impairment and glasses ownership with age and as associated with income and population density for visual impairment among rural and urban migrant Chinese students. Design Meta-analysis of 12 cross-sectional, school-based studies conducted between 2012 and 2017. Setting Rural and urban migrant schools in seven Chinese provinces. Participants A total of 83 273 rural and urban migrant Chinese students aged 6–17 years. Results Prevalence of visual impairment (uncorrected visual acuity ≤6/12 in either eye) rose from 19.0% at age 6 to 66.9% at 17, with the overall age-adjusted prevalence higher for girls (35.8%) than for boys (30.1%, p
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Journal Articles

Conditional Cash Transfers, Uptake of Maternal and Child Health Services, and Health Outcomes in Western Rural China

Huan Zhou, Yuju Wu, Chengfang Liu, Chang Sun, Yaojiang Shi, Linxiu Zhang, Alexis Medina, Scott Rozelle
BMC Public Health , 2020
Background: Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China. Methods: We designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT). Results: Overall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes. Conclusions: The CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities.
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Working Papers

Passive versus Active Service Delivery: Comparing the Effects of Two Parenting Interventions on Early Cognitive Development in Rural China

Jingdong Zhong, Renfu Luo, Sean Sylvia, Sarah-Eve Dill, Alexis Medina, Scott Rozelle
2020
We present the results of a cluster-randomized controlled trial that evaluates the effects of a free, center-based parenting intervention on early cognitive development and parenting practices in 100 rural villages in China. We then compare these effects to a home-based intervention conducted in the same region, using the same parenting curriculum and public service system. We find that the center-based intervention significantly improved children’s cognitive skills by 0.11 standard deviations, accompanied by increases in the material investments, time investments, and parenting skills of caregivers. The average impact of the center-based intervention, however, was approximately half that of the home-visiting intervention. Analysis of the possible mechanisms suggests that the difference in effects was driven primarily by different patterns of compliance. Although children with lower levels of initial skills at baseline benefited the most from the center-based intervention, they were less likely to participate in the program. Keywords: Center-based parenting intervention; home-based parenting intervention; early cognitive development; randomized controlled trial; program participation
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Journal Articles

Parental Migration and Early Childhood Development in Rural China

Ai Yue, Yu Bai, Yaojiang Shi, Renfu Luo, Scott Rozelle, Alexis Medina, Sean Sylvia
Demography , 2020
Nearly one-quarter of all children under age 2 in China are left behind in the countryside as parents migrate to urban areas for work.We use a four-wave longitudinal survey following young children from 6 to 30 months of age to provide first evidence on the effects of parental migration on development, health, and nutritional outcomes in the critical first stages of life. We find that maternal migration has a negative effect on cognitive development: migration before children reach 12 months of age reduces cognitive development by 0.3 standard deviations at age 2. Possible mechanisms include reduced dietary diversity and engagement in stimulating activities, both known to be causally associated with skill development in early life. We find no effects on other dimensions of physical and social-emotional health.
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Journal Articles

Using Standardised Patients to Assess the Quality of Medical Records: An Application and Evidence from Rural China

Yuju Wu, Huan Zhou, Yaojiang Shi, Hao Xue, Chengchao Zhou, Hongmei Yi, Alexis Medina, Jason Li, Sean Sylvia
BMJ , 2019
Background: Medical records play a fundamental role in healthcare delivery, quality assessment and improvement. However, there is little objective evidence on the quality of medical records in low and middle-income countries. Objective: To provide an unbiased assessment of the quality of medical records for outpatient visits to rural facilities in China. Methods: A sample of 207 township health facilities across three provinces of China were enrolled. Unannounced standardised patients (SPs) presented to providers following standardised scripts. Three weeks later, investigators returned to collect medical records from each facility. Audio recordings of clinical interactions were then used to evaluate completeness and accuracy of available medical records. Results: Medical records were located for 210 out of 620 SP visits (33.8%). Of those located, more than 80% contained basic patient information and drug treatment when mentioned in visits, but only 57.6% recorded diagnoses. The most incompletely recorded category of information was patient symptoms (74.3% unrecorded), followed by non-drug treatments (65.2% unrecorded). Most of the recorded information was accurate, but accuracy fell below 80% for some items. The keeping of any medical records was positively correlated with the provider’s income (β 0.05, 95% CI 0.01 to 0.09). Providers at hospitals with prescription review were less likely to record completely (β −0.87, 95% CI −1.68 to 0.06). Significant variation by disease type was also found in keeping of any medical record and completeness. Conclusion: Despite the importance of medical records for health system functioning, many rural facilities have yet to implement systems for maintaining patient records, and records are often incomplete when they exist. Prescription review tied to performance evaluation should be implemented with caution as it may create disincentives for record keeping. Interventions to improve record keeping and management are needed. 
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Journal Articles

Concurrent Validity of the Ages and Stages Questionnaire and the Bayley Scales of Infant Development III in China

Ai Yue, Qi Jiang, Biaoyue Wang, Cody Abbey, Alexis Medina, Yaojiang Shi, Scott Rozelle
PLoS ONE , 2019

Choosing a valid and feasible method to measure child developmental outcomes is key to addressing developmental delays, which have been shown to be associated with high levels of unemployment, participation in crime, and teen pregnancies. However, measuring early childhood development (ECD) with multi-dimensional diagnostic tests such as the Bayley Scales of Infant and Toddler Development III (Bayley-III) can be time-consuming and expensive; therefore, parental screening tools such as the Ages and Stages Questionnaire (ASQ-3) are frequently an alternative measure of early childhood development in largescale research. The ASQ is also becoming more frequently used as the first step to identify children at risk for developmental delays before conducting a diagnostic test to confirm. However, the effectiveness of the ASQ-3 is uncertain. In this study, we evaluate the accuracy of the ASQ-3 as a screening measure for children at risk of developmental delay in rural China by age group. To do so, we administered the Bayley-III, widely considered to be the “gold standard” of ECD diagnostic tests, to a sample of 1,831 five to twenty-four monthold children and also administered the ASQ-3 to their caregivers. We then compared the outcomes of the ASQ-3 test to those of the Bayley-III. We find that the ASQ-3 was significantly though weakly correlated with the Bayley-III and that the strength of this correlation increased with child age and was stronger when the mother was the primary caregiver (as compared to the grandmother). We also find that the sensitivity and specificity of ASQ-3 ranged widely. The overall findings suggest that the ASQ-3 may not be a very accurate screening tool for identifying developmentally delayed children, especially for children under 13 months of age or children whose primary caregiver is not the mother.

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Journal Articles

Stimulation and Early Child Development in China: Caregiving at Arm's Length

Ai Yue, Yaojiang Shi, Renfu Luo, Boya Wang, Ann Weber, Alexis Medina, Sarah Kotb, Scott Rozelle
Journal of Developmental and Behavioral Pediatrics , 2019
ABSTRACT: Objective: To provide an empirical overview of the parenting landscape in rural China, focusing on 18- to 30-month-old children and their caregivers in rural Shaanxi province. Methods: We collected unique data on 1442 caregiver-toddler dyads in rural areas of Shaanxi province and examined caregiver attitudes toward parenting, sources of information about parenting, and interactive parenting practices, and how each of these differed across generations. We measured how parenting attitudes and sources of information informed parenting practices. Finally, we measured levels of child development in our sample and the association between parenting practices and children’s developmental outcomes. Results: Most of the caregivers did not engage with children in a way that encouraged early development. Caregivers rarely told stories, sang, or used toys to play with their children. Grandmothers were more stressed by the children in their care and engaged significantly less than mothers did in the 3 stimulating interactions. Professional sources of information about parenting were underutilized by all caregivers. We found high rates of developmental delay in our sample and showed that these delays were associated with the lack of caregiver engagement. Conclusion: Our findings suggest that the major economic and social shifts occurring in rural China have not led to a widespread prevalence of stimulative parenting practices. Although caregivers report positive attitudes toward child-rearing, reliable sources of scientific information are lacking. Our results show a troubling generational disconnect between the information-seeking behaviors and parenting practices of rural caregivers.
 
Index terms: caregiver-child interaction, parenting, early child development.
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Journal Articles

Use of maternal health services among women in the ethnic rural areas of western China

Yuju Wu, Huan Zhou, Qingzhi Wang, Min Cao, Alexis Medina, Scott Rozelle
BMC Health Services Research , 2019
Background: The use of maternal health services can markedly promote the maternal health and safety, but there has been a low utilization rate in the ethnic rural areas of western China. Furthermore, the correlated factors have not been well studied. This study aims to assess factors related to the use of maternal health services among women in these areas.
Methods: A cross-sectional study of 68 villages in China’s western Sichuan province was conducted in September 2014. All qualifying women from each sample village were involved. A structured questionnaire was administrated in households through face-to-face interviews by trained enumerators to obtain information of use of maternal health services and related factors. Structural equation modeling (SEM) was used to evaluate the direct and indirect relationships between use of maternal health services and correlated factors.
Results: A total of 760 women from 68 villages were enrolled. The proportion of antenatal care (ANC), hospital delivery and postpartum visits were 68.94, 48.29 and 28.42% respectively. The SEM analysis demonstrated that social economic status (SES) (β= − 0.75, β< 0.01), ANC (β=0.13, β< 0.01), and time from home to the nearest hospital (β= − 0.09, β< 0.05), were positively correlated to hospital delivery and postpartum care visits, while maternal care knowledge and perceived quality of hospital care did not have direct correlation. For ANC, SES (β= − 0.36, β< 0.01), time from home to the nearest hospital (β= − 0.13, β< 0.05), knowledge on maternal care (β=0.12, β< 0.01) and perceived quality of hospital care (β=0.10, β< 0.01) were all directly correlated factors. Treating ANC as an intermediate variable showed the indirect relationship that perceived quality of hospital care (β=0.01, β< 0.01) and maternal care knowledge (β=0.02, β< 0.01) had with hospital delivery and postpartum care rates.
Conclusions: Use of maternal health services is low among women in ethnic rural areas. ANC has important direct and intermediate effects on subsequent use of hospital delivery and postpartum care. Improving ANC behavior should be a priority of maternal health care reforms. Given the long travel times for these women, reforms must also prioritize breaking down practical barriers that prevent this population from accessing care.
Keywords: Maternal health services, Antenatal care, Ethnic areas, Western China
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Journal Articles

Structural Equation Modeling (SEM) of Cysticercosis in School-Aged Children in Tibetan Rural Farming Areas of Western China: Implications for Intervention Planning

Huan Zhou, Qingzhi Wang, Junmin Zhou, Tiaoying Li, Alexis Medina, Stephen Felt, Scott Rozelle, John Openshaw
Environmental Research and Public Health , 2019

Neurocysticercosis (NCC) significantly contributes to morbidity in developing countries. We recently published a study of prevalence and risk factors in school-aged children in three mountainous areas in Sichuan province of western China. Using structural equation modeling (SEM) on data from that study to guide intervention planning, here we examine risk factors grouped into three broad interventional categories: sociodemographics, human behavior, and sources of pork and pig husbandry. Because neuroimaging is not easily available, using SEM allows for the use of multiple observed variables (serological tests and symptoms) to represent probable NCC cases. Data collected from 2608 students was included in this analysis. Within this group, seroprevalence of cysticercosis IgG antibodies was 5.4%. SEM results showed that sociodemographic factors (b = 0.33, p < 0.05), sources of pork and pig husbandry (b = 0.26, p < 0.001), and behavioral factors (b = 0.33, p < 0.05) were all directly related to probable NCC in school-aged children. Sociodemographic factors affected probable NCC indirectly via sources of pork and pig husbandry factors (b = 0.07, p < 0.001) and behavioral variables (b = 0.07, p < 0.001). Both sociodemographic factors (b = 0.07, p < 0.05) and sources of pork and pig husbandry factors (b = 0.10, p < 0.01) affected probable NCC indirectly via behavioral variables. Because behavioral variables not only had a large direct effect but also served as a critical bridge to strengthen the effect of sociodemographics and sources of pork and pig husbandry on probable NCC, our findings suggest that interventions targeting behavioral factors may be the most effective in reducing disease.

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Journal Articles

Breastfeeding and the Risk of Illness among Young Children in Rural China

Shanshan Li, Ai Yue, Cody Abbey, Alexis Medina, Yaojiang Shi
International Journal of Environmental Research and Public Health , 2019

Poor rural areas in China exhibit the country’s highest rates of child mortality, often stemming from preventable health conditions such as diarrhea and respiratory infection. In this study, we investigate the association between breastfeeding and disease among children aged 6–24 months in poor rural counties in China. To do this, we conducted a longitudinal, quantitative analysis of socioeconomic demographics, health outcomes, and breastfeeding practices for 1802 child–caregiver dyads across 11 nationally designated poverty counties in southern Shaanxi Province in 2013–2014. We found low rates of continued breastfeeding that decreased as children developed: from 58.2% at 6–12 months, to 21.6% at 12–18 months, and finally to 5.2% at 18–24 months. These suboptimal rates are lower than all but one other country in the Asia-Pacific region. We further found that only 18.3% of children 6–12 months old met the World Health Organization (WHO)-recommended threshold for minimum dietary diversity, defined as consuming four or more of seven specific food groups. Breastfeeding was strongly associated with lower rates of both diarrhea and cough in bivariate and multivariate analyses. As the first analysis to use longitudinal data to examine the relationship between continued breastfeeding and child illness in China, our study confirms the need for programmatic interventions that promote continued breastfeeding in order to improve toddler health in the region.

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Journal Articles

Caregiver Depression and Early Child Development: A Mixed-Methods Study From Rural China

Ai Yue, Jiaqi Gao, Meredith Yang, Lena Swinnen, Alexis Medina, Scott Rozelle
Frontiers in Psychology , 2018

Half of rural toddlers aged 0–3 years in China’s Qinling Mountainous region are cognitively delayed. While recent studies have linked poor child development measures to the absence of positive parenting behaviors, much less is known about the role that caregiver depression might play in shaping child development. In this paper, a mixed methods analysis is used to explore the prevalence of depression; measure the association between caregiver depression and children’s developmental delays, correlates of depression, and the potential reasons for caregiver depression among women in rural China. The analysis brings together results from a large-scale survey of 1,787 caregivers across 118 villages in one northwestern province, as well as information from in-depth interviews with 55 female caregivers from these same study sites. Participants were asked to respond to the Depression, Anxiety and Stress Scale-21 (DASS-21) as well as a scale to measure children’s social-emotional development, the Ages and Stages Questionnaire: Social-Emotional (ASQ-SE). We also administered a test of early childhood development, the Bayley Scales of Infant and Toddler Development (BSID-III), to all of the study household’s infants and toddlers. The results show that the prevalence of depression may be as high as 23.5 percent among all female caregivers (defined as scoring in the mild or higher category of the DASS-21). Grandmothers have higher prevalence of depression than mother caregivers (p < 0.01). Caregiver depression also is significantly associated with a 0.53 SD worsening of children’s social-emotional development (p < 0.01) and a 0.12 SD decrease in children’s language development (p < 0.05). Our qualitative findings reveal six predominant reasons for caregiver depression: lack of social support from family and friends; the burden of caregiving; lack of control and agency within the household; within-family conflict; poverty; the perception of material wealth as a measure of self-worth. Our findings show a serious lack of understanding of mental health issues among rural women, and suggest that rural communities could benefit greatly from an educational program concerning mental health and its influence on child development. Our findings confirm the need for a comprehensive approach toward rural health, with particular attention paid to mental health awareness and support to elderly caregivers.

 

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Journal Articles

Do Infant Feeding Practices Differ Between Grandmothers and Mothers in Rural China? Evidence From Rural Shaanxi Province

Ai Yue, Nianrui Zhang, Xueyang Liu, Lei Tang, Renfu Luo, Meredith Yang, Scott Rozelle, Alexis Medina
Family & Community Health , 2018
The overall goal of this study is to examine whether infant feeding practices differ between mothers and grandmothers in rural China. We randomly sampled 1383 caregivers of infants aged 18 to 30 months living in 351 villages across 174 townships in nationally designated poverty counties in rural areas. Results show that a high fraction of caregivers of 18- to 30-month-old children living in low-income areas of rural China do not regularly engage in positive infant feeding practices. Only 30% of children in our sample achieved adequate dietary diversity. Only 49% of children in our sample were fed meat in the day prior to survey administration. Few caregivers reported giving any vitamin supplements (such as calcium or iron supplements) to their children. We find that 33% of the children were cared for by grandmothers rather than mothers, and that grandmothers feed a less diversified diet to children than do mothers. Most (84%) caregivers rely solely on their own experiences, friends, and family members in shaping their feeding behaviors. Overall infant feeding practices are poor in rural China. Grandmothers engage in poorer feeding practices than do mothers. Grandmothers have improved their feeding practices compared to when their own children were young. Our results suggest shortcomings in the quality of infant feeding practices, at least in part due to an absence of reliable information sources. Key words: child development, feeding practices, information sources, rural China
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Journal Articles

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

Ai Yue, Yaojiang Shi, Renfu Luo, Jamie Chen, James Garth, Jimmy Zhang, Sarah Kotb, Alexis Medina, Scott Rozelle
2018

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).

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Journal Articles

Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China A Cluster Randomized Clinical Trial

Yue Ma, Nathan Congdon, Yaojiang Shi, Ruth Hogg, Alexis Medina, Matthew Boswell, Scott Rozelle, Mony Iver
JAMA Ophthalmology , 2018

Can a county-based vision center increase eyeglasses use and improve school performance among primary schoolchildren in rural China? This cluster randomized clinical trial of 31 schools and 2613 participants showed that children who received eyeglasses earlier in the school year performed significantly better on an end-of-year mathematics test than children who received eyeglasses later in the year, equivalent to half a semester. Provision of free eyeglasses also improved children's use of spectacles.

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Journal Articles

Prevalence and risk factors for Taenia solium cysticercosis in school-aged children: A school based study in western Sichuan, People’s Republic of China

John J. Openshaw, Alexis Medina, Stephen A. Felt, Tiaoying Li, Zhou Huan, Scott Rozelle, Stephen P. Luby
PLOS Neglected Tropical Diseases , 2018

Taenia solium cysticercosis affects millions of impoverished people worldwide and can cause neurocysticercosis, an infection of the central nervous system which is potentially fatal. Children may represent an especially vulnerable population to neurocysticercosis, due to the risk of cognitive impairment during formative school years. While previous epidemiologic studies have suggested high prevalence in rural China, the prevalence in children as well as risk factors and impact of disease in low-resource areas remain poorly characterized.

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Journal Articles

Rural education across China's 40 years of Reform: past successes and future challenges

Ai Yue, Bin Tang, Yaojiang Shi, Jingjing Tang, Guanminjia Shang, Alexis Medina, Scott Rozelle
China Agricultural Economic Review , 2018

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.

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Journal Articles

The effect of a micronutrient powder home fortification program on anemia and cognitive outcomes among young children in rural China: a cluster randomized trial

Renfu Luo, Ai Yue, Huan Zhou, Yaojiang Shi, Linxiu Zhang, Reynaldo Martorell, Alexis Medina, Scott Rozelle, Sean Sylvia
BMC Public Health , 2017

Background: Anemia early in life has been associated with delayed cognitive and motor development. The WHO recommends home fortification using multiple micronutrient powders (MNPs) containing iron as a strategy to address anemia in children under two. We evaluated the effects of a program freely distributing MNP sachets to caregivers of infants in rural China.

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Working Papers

Neglected Tropical Disease in China: The Case of Neurocystocercosis in Tibetan Farming Communities

Huan Zhou, Ben Hartwell, Grace Barket, Tom Kennedy, Tiaoying Li, Alexis Medina, Scott Rozelle, John Openshaw
Working Paper , 2017

Affecting more than one billion people around the world, neglected tropical diseases are a group of diseases which mainly occur in poor populations living in tropical and subtropical environments. Although considered a middle-income country, neglected diseases persist in many rural areas of China. Neurocysticercosis (NCC), an infection caused when the larvae of the tapeworm Taenia solium (T. solium) enters the human brain, is a prime example of this. Infection can lead to seizures, severe headaches, decreased cognitive abilities and other debilitating neurologic symptoms.

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Journal Articles

The Gender Gap Among School Children in Poor Rural Areas of Western China: Evidence From a Multi-Province Dataset

Hua Zhou, Di Mo, Chengchao Zhou, Alexis Medina, Yaojiang Shi, Linxiu Zhang, Scott Rozelle
International Journal of Equity in Health , 2016
Background: The gender gap remains a major impediment in the path towards equality and it is especially wide in low-income countries. Up to the early 2000s, many studies documented extensive inequalities in China: girls had poorer health, less nutrition and less education than their male counterparts. The goal of this study is to examine whether the gender gap persists, given that China is now making the transition into the ranks of upper-middle income countries. We consider educational outcomes, mental and physical health status, as well as non-cognitive outcomes.
 
Methods: We draw on a dataset containing 69,565 observations constructed by combining data from 7 different school-level surveys spanning 5 provinces. The surveys were all conducted by the authors between 2008 and 2013 using uniform survey instruments and data collection protocols in randomly selected schools across western provinces in rural China. The sample children range in age from 9 to 14 years (with 79 % of the sample being aged 10 to 12). Our analysis compares rural girls with rural boys in terms of 13 different indicators.
 
Results: With the exception of anemia rates, the health outcomes of girls are equal to those of boys. Girls and boys are statistically identical in terms of weight-for-age, height-for-age, and prevalence of intestinal worm infections. Girls performed better than boys on five of six cognitive and educational performance indicators. Girls performed worse than boys on all mental health indicators. All estimates are robust to the inclusion of different age ranges, controlling for the level of household assets, ethnic minority status, as well as the addition of provincial dummies.
 
Conclusions: Our findings suggest that with the exception of non-cognitive outcomes, anemia and standardized math test scores, the gender gap in our study areas in China appears to be diminishing.

 

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Journal Articles

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

Huan Zhou, Shuai Sun, Renfu Luo, Sean Sylvia, Ai Yue, Yaojiang Shi, Linxiu Zhang, Alexis Medina, Scott Rozelle
AJPH Research , 2016

Objectives: To test whether text message reminders sent to caregivers will improve the effectiveness of a home micronutrient fortification program in western China.

Methods: A cluster-randomized controlled trial was carried out in 351 villages in Shaanxi province in 2013-14. We enrolled children aged 6-12 months in target villages. Each village/cluster was randomly assigned into one of three groups: Free Delivery Group (FDG; caregivers received free micronutrient packets); Text Messaging Group (TMG; FDG treatment plus daily text message); and 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 (ITT) effects on compliance and child anemia using a logistic regression model, controlling for infant, caregiver and household characteristics.

Results: There were 1393 eligible children. We found that assignment to TMG led to an increase full compliance (marginal effect = 0.10, 95% CI = 0.03, 0.16) and decrease in the rate of anemia at endline (marginal effect=-0.07, 95% CI= -0.12, -0.01).

Conclusions: Text messages improved compliance of caregivers to a home fortification program and children’s nutrition.

 
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