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.

Taenia solium cysticercosis affects millions of impoverished people worldwide and can cause neurocysticercosis, an infection of the central nervous system which is potentially fatal. Children may represent an especially vulnerable population to neurocysticercosis, due to the risk of cognitive impairment during formative school years. While previous epidemiologic studies have suggested high prevalence in rural China, the prevalence in children as well as risk factors and impact of disease in low-resource areas remain poorly characterized.

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. The overall goal of our study is to understand the nature of NCC in China as well as to identify possible interventions that might be useful for helping to control or eradicate the disease. To meet this goal, we use a mixed methods approach, combining quantitative survey data with observational and interview-based qualitative data. We find a significant prevalence of neurocysticercosis in Tibetan school age children in western Sichuan. We identify three interventions with high potential for stopping the spread of the disease: regular composting of human feces, installing sanitation stations outside of school bathrooms to encourage hand washing, and working through the local veterinary networks to administer the newly developed porcine T. solium vaccine.

Keywords: Neurocysticercosis (NCC), tapeworms, cognitive ability, parasites

The debate over whether boarding school is beneficial for students still exists in both developing and developed countries. In rural China, as a result of a national school merger program that began in 2001, the number of boarding students has increased dramatically. Little research has been done, however, to measure how boarding status may be correlated with nutrition, health and educational outcomes. In this paper, we compare the outcomes of boarding to those of non-boarding students using a large, aggregate dataset that includes 59 rural counties across five provinces in China. We fi nd that for all outcomes boarding students perform worse than non-boarding students. Despite these differences, the absolute levels of all outcomes are low for both boarding and non-boarding students, indicating a need for new policies that will target all rural students regardless of their boarding status.

Abstract: The general goal of the present study is to analyze whether children with siblings lag behind their only-child counterparts in terms of health and nutrition, cognition and educational performance, and non-cognitive outcomes. We draw on a dataset containing 25 871 observations constructed from three school-level surveys spanning four provinces in China. The analysis compares children with siblings and only children aged 9 to 14 years old in terms of eight different health, cognitive and non-cognitive indicators. We find that with the exception of the anemia rate, health outcomes of children with siblings are statistically indistinguishable from those of only children. In terms of cognition, children with siblings performed better than only children. Moreover, outcomes of children with siblings are statistically indistinguishable from those of only children in terms of the non-cognitive outcomes provided by measures of anxiety. According to our results, the same general findings are true regardless of whether the difference between children with and without siblings is disaggregated by gender.

China’s rapid development and urbanization have induced large numbers of rural residents to migrate from their homes to urban areas in search of better job opportunities. Parents typically leave their children behind with a caregiver, creating a new, potentially vulnerable subpopulation of left-behind children in rural areas. A growing number of policies and nongovernmental organization efforts target these children. The primary objective of this study was to examine whether left-behind children are really the most vulnerable and in need of special programs. Pulling data from a comprehensive data set covering 141,000 children in ten provinces (from twenty-seven surveys conducted between 2009 and 2013), we analyzed nine indicators of health, nutrition, and education. We found that for all nine indicators, left-behind children performed as well as or better than children living with both parents. However, both groups of children performed poorly on most of these indicators. Based on these findings, we recommend that special programs designed to improve health, nutrition, and education among left-behind children be expanded to cover all children 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. 

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.

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.