Improving Learning by Improving Vision: Evidence from Two Randomized Controlled Trials of Providing Vision Care in China
This paper examines the external validity of health intervention by comparing the impacts of providing free eyeglasses on the educational performance of nearsighted children in two settings: rural public schools in Western China and urban private migrant schools in Eastern China. The intervention significantly improves educational outcomes by 0.14 standard deviations in math in rural public schools but not in private migrant schools. The difference in measured impacts is due in part to lower quality schooling in migrant schools in Eastern China. Our findings show that only when school is providing a quality education, health interventions might increase student learnings.
Visual Impairment in Rural and Migrant Chinese School-Going Children: Prevalence, Severity, Correction and Association
Safety of Eyeglasses Wear for Visual Acuity among Middle School Students in Northwestern Rural China: A Cluster-randomised Controlled Trial
Impact of Spectacles Wear on Uncorrected Visual Acuity among Urban Migrant Primary School Children in China: A Cluster-Randomised Clinical Trial
Effect of Chinese Eye Exercises on Change in Visual Acuity and Eyeglasses Wear among School-Aged Children in Rural China: A Propensity-Score-Matched Cohort Study
Cluster-randomized Controlled Trial of the Effects of Free Glasses on Purchase of Children's Glasses in China: The PRICE (Potentiating Rural Investment in Children's Eyecare) Study
Impact of a Teacher Incentive on Children’s Use of Eyeglasses: A Cluster-Randomized Controlled Trial
Purpose: The impact of school-time wear of glasses on children’s education has been shown to be limited by lack of regular compliance in half or more of children, even when free glasses are given. We sought to study the impact of free glasses combined with teacher incentives on in-school use of glasses among Chinese urban migrant children.
Impact of Free Glasses and a Teacher Incentive on Children's Use of Eyeglasses: A Cluster-Randomized Controlled Trial
Purpose: To study the effect of free glasses combined with teacher incentives on in-school glasses wear among Chinese urban migrant children.
Design: A cluster randomized trial.
Methods: Children with visual acuity (VA) ≤6/12 in either eye owing to refractive error in 94 randomly chosen primary schools underwent randomization by school to receive free glasses, education on their use, and a teacher incentive (Intervention), or glasses prescriptions only (Control). Intervention group teachers received a tablet computer if ≥80% of children given glasses wore them during unannounced visits 6 weeks and 6 months (main outcome) after intervention.
Results: Among 4376 children, 728 (16.7%, mean age 10.9 years, 51.0% boys) met enrollment criteria and were randomly allocated, 358 (49.2%, 47 schools) to Intervention and 370 (50.8%, 47 schools) to Control. Among these, 693 children (95.2%) completed the study and underwent analysis. Spectacle wear was significantly higher at 6 months among Intervention children (Observed [main outcome]: 68.3% vs 23.9%, adjusted odds ratio [OR] = 11.5, 95% confidence interval [CI] 5.91–22.5, P < .001; Self-reported: 90.6% vs 32.1%, OR = 43.7, 95% CI = 21.7–88.5, P < .001). Other predictors of observed wear at 6 months included baseline spectacle wear (P < .001), uncorrected VA <6/18 (P = .01), and parental spectacle wear (P = .02). The 6-month observed wear rate was only 41% among similar-aged children provided free glasses in our previous trial without teacher incentives.
Conclusions: Free spectacles and teacher incentives maintain classroom wear in the large majority of children needing glasses over a school year. Low wear among Control children demonstrates the need for interventions.
Population Prevalence of Need for Spectacles and Spectacle Ownership Among Urban Migrant Children in Eastern China
Importance: The number of urban migrants in China is 300 million and is increasing rapidly in response to government policies. Urban migrants have poor access to health care, but little is known about rates of correction of refractive error among migrant children. This is of particular significance in light of recent evidence demonstrating the educational impact of providing children with spectacles.
Objective: To measure prevalence of spectacle need and ownership among Chinese migrant children.
Design, Setting, and Participants: Population-based, cross-sectional study among children who failed vision testing (uncorrected visual acuity ≤6/12 in either eye) between September 15 and 30, 2013, at 94 randomly selected primary schools in predominantly migrant communities in Shanghai, Suzhou, and Wuxi, China.
Main Outcomes and Measures: Refractive error by cycloplegic refraction; spectacle ownership, defined as producing glasses at school, having been told to bring them; and needing glasses, defined as uncorrected visual acuity of 6/12 or less correctable to greater than 6/12 in either eye, with myopia of −0.5 diopters (D) or less, hyperopia of +2.0 D or greater, or astigmatism of 0.75 D or greater in both eyes.
Results: Among 4409 children, 4376 (99.3%) completed vision screening (mean [SD] age, 11.0 [0.81] years; 55.3% boys; 4225 [96.5%] migrant and 151 [3.5%] local). Among 1204 children failing vision testing (total, 27.5%; 1147 migrant children [27.1%] vs 57 local children [37.7%]; P = .003), 850 (70.6%) completed refraction. Spectacle ownership in migrant children needing glasses (147 of 640 children [23.0%]) was less than among local children (12 of 34 children [35.3%]) (odds ratio = 0.55; 95% CI, 0.32-0.95; P = .03). Having uncorrected visual acuity less than 6/18 in both eyes was associated positively with baseline spectacle ownership (odds ratio = 5.73; 95% CI, 3.81-8.62; P < .001), but parental education and family wealth were not.
Conclusions and Revelance: Among urban migrant children, there was a high prevalence of need for spectacles and a very low rate of spectacle ownership. Spectacle distribution programs are needed specifically targeting migrant children.
Currently available data on myopia and spectacle wear are drawn largely from China’s richer and middle-income areas, and little is known about refractive error and spectacle wear in the lowest income provinces. Studies from China and elsewhere suggest that large differences in myopia prevalence may exist between areas of different socioeconomic status within countries, but reasons for these differences are not well understood.
Using a survey of 19,977 children in two provinces, this paper explores the prevalence, correlates and potential consequences of poor vision among children in China's vast but understudied rural areas. We ﬁnd that 24% of sample students suffer from reduced uncorrected visual acuity in either eye and 16% in both eyes. Poor vision is signiﬁcantly correlated with individual, parental and family characteristics, with modest magnitudes for all correlates but home province and grade level. The results also suggest a possible adverse impact of poor vision on academic performance and mental health, particularly among students with severe poor vision.
This paper examines the prevalence of vision problems and accessibility to and quality of vision care in rural China. We obtained data from 4 sources: 1) the National Rural Vision Care Survey; 2) the Private Optometrists Survey; 3) the County Hospital Eye Care Survey; and 4) the Rural School Vision Care Survey. The data from each of the surveys were collected by the authors during 2012. Thirty-three percent of the rural population surveyed self-reported vision problems. Twenty-two percent of subjects surveryed had ever had a vision exam.
Effect of providing free glasses on children's educational outcomes in China: The "Seeing is Learning" cluster-randomized controlled trial
Objective: To study for the first time using a clinical trial the effect of free glasses on academic performance in rural Chinese children, among whom uncorrected myopia is the leading cause of visual impairment.
Participants: Among 19,934 children in grades 4 and 5 randomly selected for visual acuity screening, 3177 (15.9%, mean age 10.5 years) had visual acuity < 6/12 in either eye without glasses correctable to > 6/12 with glasses, and were eligible for allocation. Among these, 3052 (96.0%) completed the study.
Interventions: Children were randomized by school (84 schools per arm) to one of three interventions at the beginning of the school year: free glasses provided in class, vouchers for free glasses at a local facility or glasses prescriptions only (Control group).
Results: Among 3177 eligible children, 1036 (32.6%), 988 (31.1%) and 1153 (36.3%) were randomized to Control, Voucher and Free Glasses respectively. All eligible children would benefit from glasses, but only 15% had them at baseline. Intention-to-treat analyses were performed on all 1002 (96.8%), 946 (95.9%) and 1104 (95.8%) children completing final testing in Control, Voucher and Free Glasses groups. Effect on test score was 0.11 SD (95% Confidence Interval [CI] 0.01 to 0.21, p = 0.03) comparing the Free Glasses and Control groups. Adjusted effect of providing free glasses (0.10 SD, 95% CI 0.01 to 0.20; p = 0.04) was greater than parental education (0.03, 95% CI -0.03 to 0.10) or family wealth (0.002, 95% CI -0.07 to 0.07). Closeout glasses wear was 41% (observed), 68% (self-reported) in the Free Glasses group.
Conclusions: Providing free glasses improves children's performance on mathematics testing to a statistically significant degree, despite imperfect compliance. Myopia is common and rarely corrected in this setting.
This paper examines the academic performance of migrant students in migrant schools in China and explores determinants of their performance. The paper compares academic performance, student backgrounds and measures of school quality between Beijing migrant schools and rural public schools in Shaanxi province. Furthermore, we employ multivariate regression to examine how individual characteristics and school quality affect migrant student performance and the achievement gap between students in migrant schools and those in rural public schools.
Despite increasing institutional and financial support, certain public health issues are still neglected by the Chinese Government. The present paper examines the soil-transmitted helminth (STH) infection and reinfection rates by conducting a survey on 1724 children in Guizhou Province, China. Our results indicate that 37.5 percent of children had been infected with one or more of the three types of tested STH. However, only 50.4 percent of children reported having taken deworming medicine during the 18-month period before the survey.
266- Ordeal Mechanisms and Information in the Promotion of Health Goods in Developing Countries: Evidence From Rural China
The cost-effectiveness of policies that provide subsidized health goods is often compromised by the fact that many individuals do not use the goods that are provided to them. Cost-sharing strategies can improve targeting efficiency by inducing self-selection, but have been shown to significantly dampen overall take-up (which is often the primary policy goal).
Although rural schools in China are still lagging behind urban schools in the quality of education provided, the government has made considerable efforts in improving rural education. In March of 2006, the central government announced that over the next five years it would provide the funding needed to finally implement the Compulsory Education Law of 1986, which mandated free and compulsory nine-year education (Xinhua, 2006).