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Huan Zhou
Journal Articles

The Association between Micronutrient Powder Delivery and Caregiver Feeding Behaviors in Rural China

Rong Liu, Ruixue Ye, Qingzhi Wang, Lucy Pappas, Sarah-Eve Dill, Scott Rozelle, Huan Zhou
BMC Public Health, 2022 July 16, 2022

Background
High adherence and proper usage of micronutrient powder (MNP) influence child nutritional outcomes, yet few studies explore the role of delivery patterns. This study explores the association between MNP delivery patterns and MNP feeding behaviors among Han and minority caregivers in rural Western China.

Methods
In August 2019, a total of 1021 caregiver-child pairs were selected through a four-stage cluster sampling process. A cross-sectional survey collected information on caregiver demographics, MNP delivery patterns (channel and frequency), and MNP feeding behaviors (proper usage and adherence). Using logistic regression, we examined which delivery channels and delivery frequencies were associated with proper usage and high adherence.

Results
The results indicated that minority caregivers had lower levels of proper MNP usage than did Han caregivers (89.2%), with Tibetan caregivers’ reporting the lowest rates of adherence (32.6%). Logistic regression revealed that that township-based channel was significantly correlated with proper usage among Tibetan and Yi caregivers (Odds Ratio, OR = 2.0, p < 0.01; and OR = 3.5, p < 0.001). Overall, the township-based and home-visit channels were significantly correlated with high adherence (OR = 1.7 and OR = 2.3, respectively; p < 0.001); delivery frequency was significantly correlated with high adherence (2 months: OR = 2.2, p < 0.001 and ≤ 1 month: OR = 3.5, p < 0.001) but not correlated with proper usage among the whole sample and individual ethnic groups.

Conclusions
In conclusion, the study finds evidence of a correlation between MNP delivery channel and both proper usage and high adherence as well as a correlation between MNP delivery frequency and high adherence.

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Journal Articles

Off the COVID-19 Epicentre: The Impact of Quarantine Controls on Employment, Education and Health in China's Rural Communitites

Huan Wang, Sarah-Eve Dill, Huan Zhou, Yue Ma, Hao Xue, Prashant Loyalka, Sean Sylvia, Matthew Boswell, Jason Lin, Scott Rozelle
The China Quarterly, 2022 March 9, 2022

This study documents the COVID-19 disease-control measures enacted in rural China and examines the economic and social impacts of these measures. We conducted two rounds of surveys with 726 randomly selected village informants across seven provinces. Strict disease-control measures have been universally enforced and appear to have been successful in limiting disease transmission in rural communities. The infection rate in our sample was 0.001 per cent, a rate that is near the national average outside of Hubei province. None of the villages reported any COVID-19-related deaths. For a full month during the quarantine, the rate of employment of rural workers was essentially zero. Even after the quarantine measures were lifted, nearly 70 per cent of the villagers still were unable to work owing to workplace closures. Although action has been taken to mitigate the potential negative effects, these disease-control measures might have accelerated the inequality between rural and urban households in China.

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Journal Articles

Postnatal Mental Health, Hand Washing Practices, and Infant Illness in Rural China

Qi Jiang, Nourya Cohen, Mika Ohtori, Jie Gao, Qingzhi Wang, Evelyn Zhang, Sabrina Zhu, Hannah Johnstone, Yian Guo, Sarah-Eve Dill, Huan Zhou, Scott Rozelle
Frontiers in Global Women's Health, 2021 November 18, 2021

Background: Maternal mental health problems play an important role in infant well-being. Although western countries have extensively studied the associations between maternal mental disorders, hygiene practices and infant health, little is known in developing settings. This study investigates the correlations between postnatal mental health problems, hand washing practices and infant illness in rural western China. Methods: A total of 720 mothers of infants aged 0–6 months from four poor counties in rural western China were included in the survey. Mental health symptoms were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Questions about infant illness and hand washing practices followed evaluative surveys from prior studies. Adjusted ordinary least squares regressions were used to examine correlations between postnatal mental health (depression, anxiety, and stress) symptoms, hand washing practices, and infant illness outcomes. Results: Maternal depression, anxiety and stress symptoms were significantly associated with reduced hand washing overall and less frequent hand washing after cleaning the infant's bottom. Mental health symptoms were also associated with a higher probability of infants showing two or more illness symptoms and visiting a doctor for illness symptoms. Individual hand washing practices were not significantly associated with infant illness; however, a composite measure of hand washing practices was significantly associated with reduced probability of infant illness. Conclusion: Postnatal mental health problems are prevalent in rural China and significantly associated with infant illness. Policy makers and practitioners should investigate possible interventions to improve maternal and infant well-being.

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Journal Articles

Consultation Length, Process Quality and Diagnosis Quality of Primary Care in Rural China: A Cross-Sectional Standardized Patient Study

Qingzhi Wang, Sasmita Adhikari, Yuju Wu, Thankam Sunil, Yuping Mao, Ruixue Ye, Chang Sun, Yaojiang Shi, Chengchao Zhou, Sean Sylvia, Scott Rozelle, Huan Zhou
Patient Education and Counseling, 2021 August 8, 2021

Objective: Consultation length, the time spent between patient and health care provider during a visit, is an essential element in measuring quality of health care patients receive from a primary care facility. However, the linkage between consultation length and process quality and diagnosis quality of primary care is still uncertain. This study aims to examine the role consultation length plays in delivering process quality and diagnosis quality, two central components of overall primary care quality, in rural China.

Methods: We recruited unannounced standardized patients (SPs) to present classic symptoms of angina and tuberculosis in selected healthcare facilities in three provinces of China. The consultation length and primary care quality of SPs were measured and compared with both international and national standards of care. Ordinary Least Squares (OLS) regressions for process quality (continuous dependent variable) and Logistic regressions for diagnosis quality (binary dependent variable) were performed to investigate the relationship between consultation length and primary care quality.

Results: The average consultation lengths among patients with classic symptoms of angina and those with symptoms of tuberculosis were approximately 4.33 min and 6.28 min, respectively. Providers who spent more time with patients were significantly more likely to complete higher percentage of recommended checklist items of both questions and examinations for angina (β = 1.39, 95%CI 1.01–1.78) and tuberculosis (β = 0.89, 95%CI 0.69–1.08). Further, providers who spent more time with patients were more likely to make correct diagnosis for angina (marginal effect = 0.014, 95%CI 0.002–0.026) and for tuberculosis (marginal effect = 0.013, 95%CI 0.005–0.021).

Conclusions: The average consultation length is extremely short among primary care providers in rural China. The longer consultation leads to both better process and diagnosis quality of primary care.

Practice Implications: We recommend primary care providers to increase the length of their communication with patients. To do so, government should implement healthcare reforms to clarify the requirements of affordable and reliable consultation length in medical care services. Moreover, such an experience can also be extended to other developing countries.

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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 May 11, 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

Tracking the Effects of COVID-19 in Rural China Over Time

Huan Wang, Markus Zhang, Robin Li, Oliver Zhong, Hannah Johnstone, Huan Zhou, Hao Xue, Sean Sylvia, Matthew Boswell, Prashant Loyalka, Scott Rozelle
International Journal for Equity in Health, 2021 January 14, 2021
Background: China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time. Methods: We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China’s overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February. Results: There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas. Conclusions: By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities.
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Working Papers

Off the Epicenter: COVID-19 Quarantine Controls and Employment, Education, and Health Impacts in Rural Communities

Huan Wang, Sarah-Eve Dill, Huan Zhou, Yue Ma, Hao Xue, Prashant Loyalka, Sean Sylvia, Matthew Boswell, Jason Lin, Scott Rozelle
2020 October 19, 2020

In late January 2020, China’s government initiated its first aggressive measures to combat COVID-19 by forbidding individuals from leaving their homes, radically limiting public transportation, cancelling or postponing large public events, and closing schools across the country. The rollout of these measures coincided with China’s Lunar New Year holiday, during which more than 280 million people had returned from their places of work to their home villages in rural areas. The disease control policies remained in place until late February and early March, when they were gradually loosened to

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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 August 17, 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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Journal Articles

“At Three Years of Age, We Can See the Future”: Cognitive Skills and the Life Cycle of Rural Chinese Children

Huan Zhou, Ruixue Ye, Sean Sylvia, Nathan Rose, Scott Rozelle
Demographic Research, 2020 July 24, 2020
BACKGROUND: Although the Chinese education system has seen massive improvements over the past few decades, there are still large academic achievement gaps between rural and urban areas that threaten China’s long-term development. In addition, recent literature underscores the importance of early childhood development (ECD) in later-life human capital development. OBJECTIVES: We analyze the life cycle of cognitive development and learning outcomes in rural Chinese children by first exploring whether ECD outcomes affect cognition levels, then determining whether cognitive delays persist as children grow, and finally examining connections between cognition and education outcomes. METHODS: We combine data from four recent studies that examine different age groups (0–3, 4–5, 10–11, 13–14) to track cognitive outcomes. RESULTS: First, we find that ECD outcomes for children in rural China are poor, with almost one in two children who are cognitively delayed. Second, we find that these cognitive delays seem to persist into middle school, with almost 37% of rural junior high school students who are cognitively delayed. Finally, we show that cognition has a close relationship to academic achievement. CONCLUSION: Our results suggest that urban–rural gaps in academic achievement originate at least in part from differences in ECD outcomes. CONTRIBUTIONS: Although many papers have analyzed ECD, human capital, and inequality separately, this is the first paper to explicitly connect and combine these topics to analyze the life cycle of cognitive development in the context of rural China.
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Journal Articles

Epidemiology, Causes, Clinical Manifestation and Diagnosis, Prevention and Control of Coronavirus Disease (COVID-19) During the Early Outbreak Period: A Scoping Review

Sasmita Poudel Adhikari, Sha Meng, Yuju Wu, Yuping Mao, Ruixue Ye, Qingzhi Wang, Chang Sun, Sean Sylvia, Scott Rozelle, Hein Raat, Huan Zhou
Infectious Diseases of Poverty, 2020 March 17, 2020
Background The coronavirus disease (COVID-19) has been identified as the cause of an outbreak of respiratory illness in Wuhan, Hubei Province, China beginning in December 2019. As of 31 January 2020, this epidemic had spread to 19 countries with 11 791 confirmed cases, including 213 deaths. The World Health Organization has declared it a Public Health Emergency of International Concern. Methods A scoping review was conducted following the methodological framework suggested by Arksey and O’Malley. In this scoping review, 65 research articles published before 31 January 2020 were analyzed and discussed to better understand the epidemiology, causes, clinical diagnosis, prevention and control of this virus. The research domains, dates of publication, journal language, authors’ affiliations, and methodological characteristics were included in the analysis. All the findings and statements in this review regarding the outbreak are based on published information as listed in the references. Results Most of the publications were written using the English language (89.2%). The largest proportion of published articles were related to causes (38.5%) and a majority (67.7%) were published by Chinese scholars. Research articles initially focused on causes, but over time there was an increase of the articles related to prevention and control. Studies thus far have shown that the virus’ origination is in connection to a seafood market in Wuhan, but specific animal associations have not been confirmed. Reported symptoms include fever, cough, fatigue, pneumonia, headache, diarrhea, hemoptysis, and dyspnea. Preventive measures such as masks, hand hygiene practices, avoidance of public contact, case detection, contact tracing, and quarantines have been discussed as ways to reduce transmission. To date, no specific antiviral treatment has proven effective; hence, infected people primarily rely on symptomatic treatment and supportive care. Conclusions There has been a rapid surge in research in response to the outbreak of COVID-19. During this early period, published research primarily explored the epidemiology, causes, clinical manifestation and diagnosis, as well as prevention and control of the novel coronavirus. Although these studies are relevant to control the current public emergency, more high-quality research is needed to provide valid and reliable ways to manage this kind of public health emergency in both the short- and long-term.
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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 November 27, 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

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 March 26, 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 March 4, 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

Diagnostic Ability and Inappropriate Antibiotic Prescriptions: A Quasi-experimental Study of Primary Care Providers in Rural China

Hao Xue, Yaojiang Shi, Lei Huang, Hongmei Yi, Huan Zhou, Chengchao Zhou, Sarah Kotb, Joseph D. Tucker, Sean Y. Sylvia
Journal of Antimicrobial Chemotherapy, 2018 August 28, 2018

Background: China has one of the highest rates of antibiotic resistance. Existing studies document high rates of antibiotic prescription by primary care providers but there is little direct evidence on clinically inappropriate use of antibiotics or the drivers of antibiotic prescription.

Methods: To assess clinically inappropriate antibiotic prescriptions among rural primary care providers, we employed unannounced standardized patients (SPs) who presented three fixed disease cases, none of which indicated antibiotics. We compared antibiotic prescriptions of the same providers in interactions with SPs and matching vignettes assessing knowledge of diagnosis and treatment to assess overprescription attributable to deficits in diagnostic knowledge, therapeutic knowledge and factors that lead providers to deviate from their knowledge of best practice.

Results: Overall, antibiotics were inappropriately prescribed in 221/526 (42%) SP cases. Compared with SP inter- actions, prescription rates were 29% lower in matching clinical vignettes (42% versus 30%, P,0.0001). Compared with vignettes assessing diagnostic and therapeutic knowledge jointly, rates were 67% lower in vignettes with the diagnosis revealed (30% versus 10%, P , 0.0001). Antibiotic prescription in vignettes was in- versely related to measures of diagnostic process quality (completion of checklists).

Conclusions: Clinically inappropriate antibiotic prescription is common among primary care providers in rural China. While a large proportion of overprescription may be due to factors such as financial incentives tied to drug sales and perceived patient demand, our findings suggest that deficits in diagnostic knowledge are a major driver of unnecessary antibiotic prescriptions. Interventions to improve diagnostic capacity among providers in rural China are needed.

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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 November 22, 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 October 28, 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

Tuberculosis Detection and the Challenges of Integrated Care in Rural China: A Cross-sectional Standardized Patient Study

Sean Sylvia, Hao Xue, Chengchao Zhou, Yaojiang Shi, Hongmei Yi, Huan Zhou, Scott Rozelle, Madhukar Pai, Jishnu Das
PLoS Medicine, 2017 October 17, 2017

Despite recent reductions in prevalence, China still faces a substantial tuberculosis (TB) burden, with future progress dependent on the ability of rural providers to appropriately detect and refer TB patients for further care. This study (a) provides a baseline assessment of the ability of rural providers to correctly manage presumptive TB cases; (b) measures the gap between provider knowledge and practice and; (c) evaluates how ongoing reforms of China’s health system—characterized by a movement toward “integrated care” and promo- tion of initial contact with grassroots providers—will affect the care of TB patients.

 

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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 July 28, 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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Journal Articles

Maternal Health Services in China’s Western Rural Areas: Uptake and Correlates

Chengfang Liu, Linxiu Zhang, Yaojiang Shi, Huan Zhou, Alexis Medina, Scott Rozelle
China Agricultural Economic Review, 2016 May 10, 2016

Purpose

  • Many public health systems have struggled with the dual questions of: why the uptake rate of maternal health (MH) services is low among some subpopulations; and how to raise it. The purpose of this paper is to assess the uptake rate of a new set of MH services in poor rural areas of China.
 

Design/methodology/approach

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Journal Articles

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

Ai Yue, Lauren Marsh, Huan Zhou, Alexis Medina, Renfu Luo, Yaojiang Shi, Linxiu Zhang, Scott Rozelle
PLOS One, 2016 April 13, 2016

Development during the first two years of life is critical and has a lasting impact on a child’s health. Poor child nutrition can lead to a weakened immune system and deficiencies in essential micronutrients, which in turn have lasting and detrimental impacts on a child’s 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 a more richly textured qualitative analysis. This study aims to elucidate some of the fundamental causes of poor feeding practices that may lead to anemia among children in rural Shaanxi Province, China.

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Journal Articles

Micronutrient Deficiencies and Developmental Delays in Infants: Evidence from a cross-sectional survey in rural China

Renfu Luo, Yaojiang Shi, Huan Zhou, Ai Yue, Linxiu Zhang, Sean Sylvia, Alexis Medina, Scott Rozelle
British Medical Journal, 2015 September 14, 2015

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.

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Journal Articles

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

Renfu Luo, Yaojiang Shi, Huan Zhou, Ai Yue, Linxiu Zhang, Sean Sylvia, Alexis Medina, Scott Rozelle
2015 January 6, 2015

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. 

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