This is an excerpt of the the article, which was first published in Stanford News. You can read the whole article here.

A Stanford-led study in China has revealed for the first time high levels of a potentially fatal tapeworm infection among school-age children. The researchers suggest solutions that could reduce infections in this sensitive age range and possibly improve education outcomes and reduce poverty.

The study, published in PLOS Neglected Tropical Diseases, focuses on Taenia solium, a tapeworm that infects millions of impoverished people worldwide and can cause a disorder of the central nervous system called neurocysticercosis. The World Health Organization estimates that the infection is one of the leading causes of epilepsy in the developing world and results in 29 percent of epilepsy cases in endemic areas. It is thought to affect about 7 million people in China alone.

Science Magazine writes about REAP's work on early childhood development in rural China. Read the full article here.

Glasses askew and gray hair tousled, Scott Rozelle jumps into a corral filled with rubber balls and starts mixing it up with several toddlers. The kids pelt the 62-year-old economist with balls, and squealing, jump onto his lap. As the battle rages, Rozelle chatters in Mandarin with mothers and grandmothers watching the action. 

Elsewhere in this early childhood education center in central China, youngsters are riding rocking horses, clambering on a jungle gym, thumbing through picture books, or taking part in group reading. Once a week, caregivers get one-on-one coaching on how to read to toddlers and play educational games. The center is part of an ambitious experiment Rozelle is leading that aims to find solutions to what he sees as a crisis of gargantuan proportions in China: the intellectual stunting of roughly one-third of the population. "This is the biggest problem China is facing that nobody's ever heard about," says Rozelle, a professor at Stanford University in Palo Alto, California.

Surveys by Rozelle's team have found that more than half of eighth graders in poor rural areas in China have IQs below 90, leaving them struggling to keep up with te fast-paced official curriculum. A third or more of rural kids, he says, don't complete junior high. Factoring in the 15% or so of urban kids who fall at the low end of IQ scores, Rozelle makes a stunning forecast: About 400 million future working-age Chinese, he says, "are in danger of becoming cognitively handicapped."

Matt Sheehan
China Correspondent, The WorldPost
October 12th, 2015

Simply giving nearsighted children glasses can dramatically boost their school performance. Convincing teachers and parents is harder.

This article is the second in a What’s Working series that looks at innovative policy solutions pioneered by the Rural Education Action Program. REAP brings together researchers from Stanford University and China to devise new ways to improve rural education and alleviate poverty. You can read the first article in the series here.  

QIN'AN COUNTY, China -- Wei Wentai can barely be heard over the crescendo of cackles coming from the hallway. Fourth graders everywhere cane be boisterousness, but today the presence of two foreigners, an exotic breed in the rugged hills of western China, has driven these kids into a frenzy.

You could try to reason with the children: tell them they need to quiet down because Dr. Wei is here to train their teachers in how to perform vision tests. Those tests will give some kids free glasses so they can see the blackboard, dramatically improving their grades and chances of graduating high school.

But yeah, that’d be about as effective here in rural Gansu, in China's northwest, as it would be in Alabama, and it takes the lunch bell to drag the mob away from the classroom window. 

With relative peace restored, Wei continues to tutor the 12 village schoolteachers in the basics of eyesight and education. Having grown up nearby, he knows what superstitions to dispel (“No, glasses do not make your eyes worse”) and what points to drive home (“Yes, glasses dramatically improve grades for nearsighted students”). Despite receiving his medical training in Shanghai, Wei returned home after graduating and always speaks in the local dialect when training the teachers to perform this basic eye exam and write referrals.

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It’s a simple presentation tailored to this county, but one predicated on years of trust building and scientific trials by researchers on both sides of the Pacific Ocean.

Driving the project, called Seeing is Learning, are researchers from Stanford University’s Rural Education Action Plan (REAP) and Shaanxi Normal University’s Center for Experimental Economics in Education (CEEE). These groups operate in an emerging field of development economics that prizes rigorous experimentation over theory. Concrete interventions, randomized controlled trials and impact analysis are what drive their research and policy recommendations. Randomized controlled trials compare a randomly assigned group of participants receiving a particular treatment being studied with one not receiving the treatments. These trials are often called the gold standard of scientific research. 

REAP and CEEE have spent almost five years accruing the political capital and research results that they hope will overcome one of the biggest obstacles standing between rural Chinese kids and a high school diploma: most of them can’t even see the writing on the blackboard. 

Like many of their peers around East Asia, rural Chinese children suffer high rates of myopia. Around 57 percent are nearsighted by middle school, according to one REAP study. Unlike schoolchildren in Singapore or in China’s cities, most kids growing up in the Chinese countryside are ignorant of and isolated from vision care. 

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In hundreds of visits to rural Chinese classrooms, REAP program director Matt Boswell has rarely seen a bespectacled face. A patchy and inadequate rural medical system, the high cost of glasses and cultural preferences for eye exercises over glasses (what one researcher calls “voodoo health”) mean that most children growing up in townships and villages never take a vision test. 

“There is no eye care at the township level in China,” said Boswell. “Period.”

That void has a huge impact on education. In a study published in the British Medical Journal, REAP and Chinese researchers showed that giving myopic kids free glasses improved their math test scores by about as much as reducing class sizes. Those improvements came despite the fact that only 41 percent of students who were prescribed glasses actually wore them regularly. According to Boswell, when results were limited to the students who actually wore the glasses they were given, the impact proved enormous: it roughly halved the achievement gap between these rural students and their urban peers in just nine months.

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Improvements of that size represent some of the juiciest low-hanging fruit in Chinese education. Sixty percent of children in the countryside will drop out before high school, many due to failed grades and entrance exams. These tens of millions of dropouts threaten to throw a wrench in the Chinese government's plan to transition to a service- and innovation-based economy.

But when dealing with China’s bureaucracies, having a simple solution to a vexing problem isn’t enough to start harvesting that low-hanging fruit. The real art and science of the project came in aligning bureaucratic interests to get it off the ground.

“Every issue has its own little ecosystem,” Boswell said. 

For Seeing is Learning, that ecosystem involved education officials committed to the eye exercise regime, schools that closely guard access to their students, families who are deeply suspicious of the effect of eyeglasses and hospitals that saw no reason to screen rural kids.

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To break the impasse, the researchers had to first get local education bureaucrats on board. Randomized controlled trials proved the effectiveness of glasses and debunked the myth of eye exercises. They caught the eye of a powerful official in the nearby city of Tianshui, whose backing opened the doors to local schools. With REAP’s pledge to subsidize glasses, the hospitals suddenly saw large new markets materialize.

As a kicker, one trial found that when teachers were offered an iPad if their students were wearing glasses during random inspections, usage rates jumped from 9 to 80 percent.

“Hospitals love it because they get in the schools. Principals love it because of the impact on scores,” said Boswell. “We love it because the kids are learning.”

Turning that newfound excitement into a working program required the creation of two “Model Vision Counties” in which nurses and doctors like Wei Wentai receive accelerated optometry training.  In order to expand that reach from the county seat down to the village,  REAP ran another trial to see if teachers could conduct accurate eye exams after just a half-day training (answer: yes). So the newly trained doctors now rotate through the village schools, training teachers who then refer students to the hospital vision centers for proper prescriptions.

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Now the researchers are looking to scale up the program to six counties and at the same time turn the vision centers into sustainable social enterprises. Using their privileged access to schools, the vision centers can sell glasses to urban children with the resources to pay. Those profits then subsidize the first pair of glasses for rural kids, and repay REAP's initial loan, which REAP can then reinvest in creating further Model Vision Counties.

It’s a new model for REAP and one that prompts many new research questions. Can the vision centers earn enough revenue to both subsidize glasses and keep the hospitals happy? Will teachers enforce wearing eyeglasses if given a simple mandate rather than an iPad? Will the impact of the first pair of glasses convince rural parents to purchase the second pair?

Those questions will be investigated and answered when the project scales up. But as this van winds its way back down from the village to the county hospital, Wei Wentai reflects on the work they’ve done.

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A child takes an eye exam administered by REAP and CEEE.

A REAP project takes on the challenge of teaching parents in rural China that playing with their children is as important as feeding them.

Once every week for six months, a special team of family planning workers fanned out across the remote towns of Shaanxi Province or journeyed to isolated villages in the Qinling Mountains, the cradle of China’s civilization and habitat of the world’s remaining wild pandas. Determined to make a difference, the workers braved downpours in the dead of winter and long, treacherous roads to conduct weekly visits to families living in the region’s rural corners.  

The little children who were their inspiration were often too shy to even make eye contact during the initial family sessions, but the government workers – part of a pilot group of parenting trainers – persevered. Eventually, the children welcomed the trainers with smiles, open arms and confident curiosity.

The parenting trainers brought toys to play with the toddlers, but not just for fun. The act of playing had a higher purpose.

Toddlers in rural China lag far behind their urban cohorts in developmental benchmarks, and Stanford’s Rural Education Action Program launched its Perfecting Parenting Project to tackle a key underlying cause: only a small fraction of rural parents interact with their young children.

“We want to get parents to improve their interactions with their toddlers,” said Alexis Medina, project manager of REAP’s health, nutrition and education initiatives.

That’s because the period between birth and age 3 is a critical developmental window, and interactive playing and verbal stimulation are important components of a child’s growth. REAP researchers know this, but a majority of parents in rural China do not.

For many parents or grandparents who are primary caregivers, the concept of actively engaging with their offspring is foreign. Research surveys revealed that less than 5 percent of parents in rural China regularly read to their babies and toddlers, and only 32 percent of them sing songs or use toys to play together. From their fieldwork, REAP researchers witnessed a pervasive view among parents: their young children are clothed and fed, isn’t that all they need?

In launching the 6-month pilot program in November 2014, researchers designed a week-by-week parenting curriculum – complete with books, balls and building blocks – to target key child development milestones.

“Before, the role of the family planning worker was to manage the quantity of the population,” said He Miao, one of the 70 parenting trainers recruited under the REAP project. “But from now on, our role is to improve the population’s quality.” 

Little Cheng Junya transformed from shy and withdrawn to outgoing and engaged in just two months of parenting visits.

As researchers work to gather project findings, REAP hopes Chinese officials will decide to expand the parenting training program. 

Those at the frontlines are already convinced.

“My child never used to be so comfortable around strangers; I can’t believe she is now so outgoing,” the mother of little Cheng Junya remarked just two months into the program. “This is all because of the visits from such excellent teachers.”

Echoing his fellow parenting trainers, family planning worker Qin Yulu said, "In all the years I’ve been in this position, this is the most meaningful work I have ever done.”

REAP researcher Xueyang Liu summed up her view of the project’s success. “Each family planning worker manages different children and faces different challenges: sometimes the roads are difficult, sometimes the parents are unappreciative, and sometimes the children are unresponsive,” she said. But, she continued, “the parent trainers are united both by their willingness to overcome difficulty and by a passion for their work, and this has earned them the respect and love of the parents.”

For a closer view of the challenges and promise of the Perfecting Parenting Project, take a look at the following stories by REAP researchers who shadowed China’s first crew of parenting trainers.

Modern Parenting 101 
REAP researcher Xinrui Gao joins parent trainer Liu Xianju on several weekly sessions during the six-month pilot program and describes here a caretaker’s dramatic shift in attitude toward modern parenting.

Little Activities Go A Long Way 
REAP researcher Xi Zhiqi witnesses how the parenting program’s activities help to enhance a toddler’s verbal and social-emotional skills. This is her story of Little Wei.

A Mother’s Realization 
REAP researcher Xueyang Liu describes here how a mother literally and metaphorically tramples on the project’s guidance materials before she comes to embrace the methods of active parenting.

These parenting trainers are propelled by thoughts of the children's recognition and trust when enduring tough travel conditions to reach their homes.

Trainers: A Santa Qin and Honorary Godmother  
The following two accounts by REAP researchers Wang Xiaohong and Jia Fang illustrate the immense dedication of two family planning workers from Shanyang County. 

No Easy Road 
REAP researcher Zhang Nianrui describes a-day-in-the-life of a pair of parenting trainers as she joins them on a rough journey to the remote village homes of the families under their charge for the pilot project.