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. The objective of this study is to examine the relationship between STH infections and developmental outcomes among a primary school-aged population in rural China.

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. 

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. The current report details the prevalence and predictors of myopia measured using the identical protocols and equipment in adjoining provinces of western China, middle-income Shaanxi and low-income Gansu. Study methods including institutional review board approvals and consent have been described elsewhere.

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.

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. The objective of this study is to examine the relationship between STH infections and developmental outcomes in 2,180 school-aged children in seven nationally-designated poverty counties in rural China. We conducted a large-scale survey in Guizhou province in southwest China in May, 2013. Overall, 42 percent of elementary school-aged children were infected with one or more of the three types of STH—Ascarislumbricoides (ascaris), Trichuris trichuria (whipworm) and the hookworms Ancylostoma duodenaleor Necator americanus. After controlling for socioeconomic status, we observed that children infected with one or more STHs have worse cognitive ability, worse nutritional status, and worse school performance than their uninfected peers.