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Journal Articles

Impact of Childcare and Eldercare on Off-farm Activities in Rural China

Fangbin Qiao, Scott Rozelle, Linxiu Zhang, Yi Yao, Jian Zhang
China & World Economy , 2015

Using individual data collected in rural China and adopting Heckman’s two-step function, we examined the impact of childcare and eldercare on laborers’ off-farm activities. Our study finds that having school-aged children has a negative impact on rural laborers’ migration decisions and a positive impact on their decision to work in the local offfarm employment market. As grandparents can help to take care of young children, the impact of preschoolers is insignificant. Having elderly family to care for decreases the income earned by female members of the family. Although both men and women are actively engaged in off-farm employment today in rural China, this study shows that women are still the primary care providers for both children and the elderly. Therefore, reforming public school enrollment and high school/college entrance examination systems so that migrant children can stay with their parents, this will help rural laborers to migrate to cities. The present study also calls for more public services for preschoolers and the elderly in rural China.

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Journal Articles

Soil-Transmitted Helminths in Southwestern China: A Cross-Sectional Study of Links to Cognitive Ability, Nutrition, and School Performance among Children

Chengfang Liu, Renfu Luo, Hongmei Yi, Linxiu Zhang, Shaoping Li, Yunli Bai, Alexis Medina, Scott Rozelle, D. Scott Smith, Guofei Wang, Jujun Wang
PLOS Negleted Tropical Diseases , 2015

Empirical evidence suggests that the prevalence of soil-transmitted helminth (STH) infections in remote and poor rural areas is still high among children, the most vulnerable to infection. There is concern that STH infections may detrimentally affect children’s healthy development, including their cognitive ability, nutritional status, and school performance. Medical studies have not yet identified the exact nature of the impact STH infections have on children.

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Journal Articles

Gut Instincts: Knowledge, Attitudes, and Practices regarding Soil-Transmitted Helminths in Rural China

Chengfang Liu, Louise Lu, Linxiu Zhang, Alexis Medina, D. Scott Smith, Scott Rozelle
PLoS Neglected Tropical Diseases , 2015
Soil-transmitted helminths (STHs) are parasitic intestinal worms that infect more than two out of every five schoolchildren in rural China, an alarmingly high prevalence given the low cost and wide availability of safe and effective deworming treatment. Understanding of local knowledge, attitudes, and practices regarding STHs in rural China has until now, been sparse, although such information is critical for prevention and control initiatives. This study elucidates the structural and sociocultural factors that explain why deworming treatment is rarely sought for schoolchildren in poor villages of rural China with persistently high intestinal worm infection rates. In-depth, qualitative interviews were conducted in six rural villages in Guizhou Province; participants included schoolchildren, children’s parents and grandparents, and village doctors. We found evidence of three predominant reasons for high STH prevalence: lack of awareness and skepticism about STHs, local myths about STHs and deworming treatment, and poor quality of village health care. The findings have significant relevance for the development of an effective deworming program in China as well as improvement of the quality of health care at the village level.
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Journal Articles

Mental Health and Dropout Behavior: A Cross-Sectional Study of Junior High Students in Northwest Rural China

Huan Wang, Chu Yang, Fei He, Yaojiang Shi, Qinghe Qu, James Chu
International Journal of Educational Development , 2015

Junior high dropout rates are up to 25% in poor, rural areas of China. Although existing studies have examined how factors such as high tuition and opportunity costs contribute to dropout, fewer studies have explored the relationship between dropout rates and mental health in rural China. The overall goal of this study is to examine the relationship between dropout and mental health problems in rural Chinese junior high schools. Correlational analysis was conducted among 4,840 students across 38 junior high schools in rural China. Ordinary least squares (OLS) regressions were used to determine the types of students most at risk for mental health problems and whether mental health problems are correlated with dropout behavior. Our measure for mental health is based on the Children’s Manifest Anxiety Scale. Mental health problems are widespread in the sample of rural children, with 74% of students at risk for mental health problems. The student and family characteristics that correlate with dropout (poverty and low achievement) also correlate with mental health problems. More importantly, even after controlling for these background characteristics, mental health problems remain correlated with dropout rates. Mental health problems, especially among low-achieving poor students, may be contributing to the high dropout rates in rural China today. This finding suggests that interventions focusing on mental health in rural areas may also help reduce dropout.

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Journal Articles

The Prevalence of Anemia in Central and Eastern China: Evidence From the China Health and Nutrition Survey

Liying Li, Renfu Luo, Sean Sylvia, Alexis Medina, Scott Rozelle
Southeast Asian Journal of Tropical Medicine and Public Health , 2015

Although China has experienced rapid economic growth over the past few decades, significant health and nutritional problems remain. Little work has been done to track basic diseases, such as iron-deficiency anemia, so the exact prevalence of these health problems is unknown. The goals of this study were to assess the prevalence of anemia in China and identify individual, household and community-based factors associated with anemia. We used data from the 2009 China Health and Nutrition Survey (CHNS), including the measurement of he- moglobin levels among 7,261 individuals from 170 communities and 7 provinces in central and eastern China. The overall prevalence of anemia was 13.4% using the WHO’s blood hemoglobin thresholds (1968). This means in China’s more developed central and eastern regions up to 180 million people may be anemic. Some vulnerable subgroups were disproportionately affected by anemia. Seniors (aged 60 years and above) were more likely to be anemic than younger age cohorts, and females had higher anemia prevalence among all age groups except among children aged 7 to 14 years. We found a negative correlation between household wealth and the presence of anemia, suggesting anemia prevalence may decline as China’s economy grows. However, the prevalence of anemia was greater in migrant households, which should be experiencing an improved economic status.

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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

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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Journal Articles

Improving the Health and Education of Elementary Schoolchildren in Rural China: Iron Supplementation Versus Nutritional Training for Parents

Hu Lun Wong, Yaojiang Shi, Linxiu Zhang, Renfu Luo, Scott Rozelle
Journal of Development Studies , 2014

We report on the results of a randomised controlled trial conducted among over 2,000 children in 60 elementary schools in rural Shaanxi Province, North-west China. We find that providing children with daily iron supplements for six months improved children’s haemoglobin levels and standardised maths scores. In comparison, educating parents about nutrition and anaemia in a special parents meeting produced a modest impact on children’s haemoglobin levels. We also find heterogeneous intervention effects by children’s gender, anaemia status and boarding status. Overall, iron supplementation is more effective. However, given its low cost and simple implementation, parental education should still be considered.

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Journal Articles

Dormitory Management and Boarding Students in China’s Rural Elementary Schools

Ai Yue, Yaojiang Shi, Fang Chang, Chu Yang, Huan Wang, Hongmei Yi, Renfu Luo, Chengfang Liu, Linxiu Zhang, James Chu, Scott Rozelle
China Agricultural Economic Review , 2014

Purpose – The purpose of this paper is to explore whether an in-service life teacher training program can improve boarding students’ health, behavior, and academic performance.

Design/methodology/approach – The authors conducted a cluster-randomized controlled trial to measure the effect of life teacher training on student health, behavior, and academic performance among 839 boarding students in ten central primary boarding schools in Shaanxi. And the authors also tried to identify why or why not life teacher training works. Both descriptive and multivariate analysis are used in this paper.

Findings – The authors find significant improvements in health and behavior. Specifically, compared to boarding students in control schools, 15 percent fewer students in treatment schools reported feeling cold while sleeping at night. The results also showed that student tardiness and misbehaviors after class declined significantly by 18 and 78 percent, respectively. However, the in-service life teacher training program had no measurable impact on boarding students’ BMI-for-age Z-score, number of misbehaviors in class, and academic performance. The analysis suggests that improved communication between life teachers and students might be one mechanism behind these results.

Originality/value – This is the first empirical work which explored how to improve the welfare of boarding students via their life teachers. Because of the sudden increase in boarding students in rural China, it is almost certain that school personnel lack experience in managing boarding students. As such, one promising approach to improving student outcomes might be in-service training for life teachers.

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Journal Articles

Survey using Incognito Standardized Patients Shows Poor Quality Care in China’s Rural Clinics

Sean Sylvia, Yaojiang Shi, Hao Xue, Xin Tian, Huan Wang, Qingmei Liu, Alexis Medina, Scott Rozelle
Health Policy & Planning , 2014

Over the past decade, China has implemented reforms designed to expand access to health care in rural areas. Little objective evidence exists, however, on the quality of that care. This paper reports results from a standardized patient study designed to assess the quality of care delivered by village clinicians in rural China. To measure quality, we recruited individuals from the local community to serve as undercover patients and trained them to present consistent symptoms of two common illnesses (dysentery and angina). Based on 82 covert interactions between the standardized patients and local clinicians, we find that the quality of care is low as measured by adherence to clinical checklists and the rates of correct diagnoses and treatments. Further analysis suggests that quality is most strongly correlated with provider qualifications. Our results highlight the need for policy action to address the low quality of care delivered by grassroots providers. 

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Journal Articles

The Cost of Disability in China

Prashant Loyalka, Lan Liu, Gong Chen, Xiaoying Zheng
Demography , 2014
We describe the degree to which household income is negatively associated with the prevalence of different types of disability (i.e. medical impairments) in China using data from the 2006 China National Sample Survey of Disabled Persons. We then calculate the extra costs of disability across different types of households and show how these costs differ by the type and severity of disability in both urban and rural areas. We finally use nationally-representative panel data on persons with disabilities from 2007 to 2009 to examine the degree to which social security measures are reaching persons with different types and severity of disabilities in both urban and rural areas. We conclude that while social assistance and insurance for households with disabilities is increasing rapidly over time, it is still not enough to offset the income differential between households with and without disabled persons, especially when accounting for the extra costs of living associated with disability.
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Working Papers

272- Soil-Transmitted Helminths in Southwestern China: Links to Cognitive Ability, Nutrition, and School Performance among Children

Chengfang Liu, Renfu Luo, Shaoping Li, Baiyun Li, Linxiu Zhang, Alexis Medina, D. Scott Smith, Scott Rozelle
2014

Empirical evidence suggests that the prevalence of soil-transmitted helminth (STH) infections in remote and poor rural areas is still high among children, the most vulnerable to infection. There is concern that STH infections may detrimentally affect children’s healthy development, including their cognitive ability, nutritional status, and school performance. Medical studies have not yet identified the exact nature of the impact STH infections have on children.

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Journal Articles

Neglected Rural Public Health Issue: The Case of Intestinal Roundworms

Linxiu Zhang, Yingping Cai, Xiaobing Wang, Xiaochen Ma, Alexis Medina, D. Scott Smith, Scott Rozelle
China & World Economy , 2013

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.

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Journal Articles

Multiple Micronutrient Supplementation Reduces Anemia and Anxiety in Rural China's Elementary School Children

Max Kleiman-Weiner, Renfu Luo, Linxiu Zhang, Yaojiang Shi, Reynaldo Martorell, Scott Rozelle, Alexis Medina
The Journal of Nutrition , 2013

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 health, attention and cognitive ability. The overall goal of this paper is to assess the impact of multiple micronutrient supplementation on anemia and anxiety among students in poor areas of rural China.

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Journal Articles

Meeting the Health-care Needs of the Rural Elderly: The Unique Role of Village Doctors

Kimberly Singer Babiarz, Hongmei Yi, Renfu Luo, Kim Singer Babiarz, Hongmei Yi, Renfu Luo
China & World Economy , 2013

Despite their recent deterioration, village clinics have historically been an important source of health care for the poor and elderly in rural China. In this paper, we examine the current role of village clinics, the patients who use them and some of the services they provide. We focus specifically on the role of village clinics in meeting the health-care needs of the rural poor and elderly. We find that although clinics are continuing to decline financially, they remain a source of care for the rural elderly and poor.

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Journal Articles

Eggs versus Chewable Vitamins: Which Intervention Can Increase Nutrition and Test Scores in Rural China?

Max Kleiman-Weiner, Renfu Luo, Linxiu Zhang, Yaojiang Shi, Alexis Medina, Scott Rozelle
China Economic Review , 2013

Background. 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. Large scale policies in Northwestern China have attempted to tackle these nutritional problems using eggs.

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Journal Articles

Which Households are Most Distant from Health Centers in Rural China? Evidence from a GIS Network Analysis

John Gibson, Xiangzheng Deng, Geua Boe-Gibson, Scott Rozelle, Jikun Huang
GeoJournal , 2011

In this paper we have two objectives - one empirical; one methodological. Although China's leaders are beginning to pay attention to health care in rural China, there are still concerns about access to health services. To examine this issue, we use measure of travel distances to health services to examine the nature of coverage in Shaanxi Province, our case study.

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