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. We report on the results of a randomized control trial (RCT) involving over 2700 fourth grade students, mostly aged 9 to 12, from 54 randomly-chosen elementary schools in 8 of the poorest counties in Shaanxi Province in China’s poor northwest region. The design called for random assignment of schools to one of two groups. One group received a daily multivitamin with mineral supplements, including 5 milligrams of iron, for 5 months while the other group was a non-intervention, control group. Anemia was defined as < 120 g/L. We found that 42.4 percent of students were anemic at baseline In the schools that received the multivitamins with mineral supplements, Hb levels rose by more than 1.7 g/L over the control schools. The test for anxiety showed that students that received the multivitamin with mineral supplements also improved significantly. Overall, these results should encourage further research on the interaction between nutrition and mental health in a development context.

This study uses a randomized controlled trial of a school-based anemia reduction program in rural China to examine how increased school emphasis on health promotion affects academic performance. Although education and health promotion are complementary functions of schools, they do compete for finite school resources. We compare the effects of a traditional program that provided only information about anemia and subsidies to an otherwise identical program that included performance incentives for school principals based on school-level anemia prevalence. By the end of the trial, exam scores among students who were anemic at baseline improved under both versions of the program, but scores among students in the incentive group who were healthy at baseline fell relative to healthy students in the control group. Results suggest that performance incentives to improve student health increase the impact of school-based programs on student health outcomes, but may also lead to reallocation of school resources.

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.  The overall goal of this paper is to assess the impact of the government’s egg distribution program by comparing the effect on anemia rates of an intervention that gives students an egg per day versus an intervention that gives students a chewable vitamin per day. We will also assess whether either intervention leads to improved educational performance among students in poor areas of rural China. To meet this goal, we report on the results of a randomized controlled trial (RCT) involving over 2,600 fourth grade students from 70 randomly-chosen elementary schools in 5 of the poorest counties in Gansu Province in China’s poor Northwest region. The design called for random assignment of schools to one of two intervention groups, or a control group with no intervention. One intervention provided a daily chewable vitamin, including 5 milligrams of iron. The other mimicked the government policy by providing a daily egg. According to the findings of the paper, in the schools that received the chewable vitamins, hemoglobin (Hb) levels rose by more than 2 g/L (over 0.2 standard deviations). The standardized math test scores of students in these schools also improved significantly. In schools that received eggs, there was no significant effect on Hb levels or math test scores. Overall, these results should encourage China’s Ministry of Education (MOE) to look beyond eggs when tackling nutritional problems related to anemia in an education setting.

In this paper we report the results of a randomized controlled trial designed to measure the impact of a parental training program on the nutritional status of primary school students in rural Shaanxi Province, in Northwest China. Using hemoglobin (Hb) levels as the outcome variable, we first measure the overall impact of a nutritional training program, then measure the impact separately by gender. We use both descriptive and multivariate analyses.

The results for the descriptive and econometric results were robust and consistent with the literature. Overall, we find no impact on students’ Hb levels when we trained their parents about undernutrition and anemia. In both the descriptive and multivariate results, there was no difference in the change of Hb levels between control and treatment students. Parents in the treatment group did learn more about anemia than parents in the control group, but this increased knowledge did not lead to sharp changes in behavior, in general. We did find, however, that there was a measurable impact of parental training on the Hb levels of female students. In both the descriptive and econometric results we found that the Hb levels of female students rose more than that of male students, and that this difference was statistically significant. We conjecture that the parents of female students may have recognized from the training that they were not providing their daughters with sufficient nutrition. Our data show that parents in the treatment group responded by increasing the daily provision of meat, fish, eggs and beans, relative to parents of girls in the control group.

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.

Objective. The overall goal of this paper is to test whether simple nutritional interventions lower rates of anemia and to assess whether this leads to improved educational performance among students in poor areas of rural China.

Approach: We report on the results of a randomized control trial (RCT) involving over 3600 fourth grade students, mostly aged 9 to 12, from 66 randomly-chosen elementary schools in 8 of the poorest counties in Shaanxi Province in China’s poor northwest region. The design called for random assignment of schools to one of three groups: two different types of treatment/intervention schools; a non-intervention, control group. The two interventions were designed to improve hemoglobin (Hb) levels, which is a measure of iron deficiency. One intervention provided a daily multivitamin with mineral supplements, including 5 milligrams of iron, for 5 months. The other informed the parents of their child’s anemia status and suggested several courses of action (henceforth, the information treatment).

Findings: Some 38.3 percent of the students had Hb levels of below 120 g/L, the World Health Organization’s cutoff for anemia for children 9 to 12 years old. In the schools that received the multivitamins with mineral supplements, Hb levels rose by more than 2 g/L (about 0.2 standard deviations). The standardized math test scores of the students in the schools that received the multivitamin with mineral supplements also improved significantly. In schools that received the information treatment, only students that lived at home (and not the students that lived in boarding schools and took most of their meals at schools) registered positive improvements in their Hb levels. The reductions in anemia rates and improvements in test scores were greater for students that were anemic at the beginning of the study period. Overall, these results should encourage China’s Ministry of Education (MOE) to begin to widen its view of education (beyond teachers, facilities and curriculum) and provide better nutrition and health care for students.

In this paper we present new evidence on the impact of health and nutrition information on anemia rates from three large-scale randomized controlled trials (RCTs) in rural China. Each RCT studies a different type of health education campaign designed in partnership with the Chinese government to reduce the prevalence of iron-deficiency anemia among rural primary school students. These campaigns include single and multiple face-to-face education sessions for parents at their children’s schools as well as dissemination of written health education materials. Across all three studies, we find little evidence of changes in blood hemoglobin concentration or anemia status. In contrast, in our two studies that also examined a multivitamin supplementation intervention, we find meaningful reductions in anemia.

The main goal of this paper is to analyze the factors (access, attendance and quality of preschools) that may be affecting the educational readiness of China’s rural children before they enter the formal school system. Using data from a survey of 80 preschools and 500 households in 6 counties in 3 provinces of China, this paper documents the nature of early childhood education (ECE) services and the educational readiness of children aged 4-5 in rural China. We present evidence that ECE services are seriously deficient. Households in many areas of rural China do not have convenient access to preschool facilities. Preschools have poor facilities, inadequate health services, and little concern for the nutrition of their students. Most teachers have little formal training. In part due (perhaps) to the poor quality and low participation in preschool, in this paper we will show that China's rural children score much lower on standardized educational readiness tests. In fact, according to our findings, more than one half of the rural children in our sample are “not ready” for continuing into the next level of formal education. Our analysis implies that it is necessary to improve the facilities and quality of teachers and to increase the probability that children will be sent to ECE institution.

Despite rapid growth in China, it is unclear whether the poor have benefited in terms of nutrition. This paper’s goal is to understand the prevalence of anemia among school children in western China.We report on results from seven cross-sectional surveys involving 12,768 age 8-12 students. Sample students were selected randomly from 283 primary schools in 41 poor counties of Ningxia, Qinghai, Shaanxi and Sichuan provinces. Data were collected through questionnaires and hemoglobin tests. The dataset represents 7 million age 8-12 children in poor western counties. The anemia prevalence was 34% using the WHO’s hemoglobin cutoff of < 120g/L. Students who boarded at school and girls were more likely to be anemic. Assuming the sample population is representative of poorregions in western China, nearly2.5 million 8-12 year old school children in the region may be anemic and many more iron deficient. Given China’s growth, such high prevalence of anemia is surprising and illustrative of the large health disparities in the country. Iron deficiency remains a significant nutrition issue, though there appears to be no effort to address this issue.

Opportunities to go to college and earn a degree have risen dramatically in China. Government investment into the college systems has skyrocketed and the size of universities has increased by more than five times over the past decade. With the rise in the opportunity to go to college, several questions naturally arise: Are the rural poor—perhaps those that would most benefit individually as well as provide spillovers to their home communities—being systematically excluded? If they are, what are the barriers that are keeping them from having access to higher education?

The overall goal of this paper is to answer these questions. To do so, we combine two sets of our own primary survey data. One survey covers a group of randomly selected high school students from the poor parts of Shaanxi province, one of China’s poorest provinces. The other survey is a census of all freshman entering into four universities in three poor provinces. With these data we seek to identify if China’s rural poor are being systematically excluded from the university system, and if so, why.

In the first part of the results section of the paper, we show that the participation rate of the poor accessing to college education is substantially lower than the students from nonpoor families. Clearly, there are barriers that are keeping the rural poor out. In the rest of the paper, we examine two general categories of barriers. First, according to our data from Shaanxi province, it does not appear that any real barriers appear at the period of time between the final year of high school and the first year of college. We find no empirical evidence that the College Entrance Exam (CEE) is biased against the poor; the exam scores of poor students are virtually the same as the exam scores of nonpoor students, holding all other factors constant. There is some evidence that the nature of the CEE process—particularly that the timing of when students find out about financial aid—distorts the decisions of poorer students regarding what college to attend and what major to pursue. At the same time, however, we observe that the admission rates between poor and nonpoor are statistically the same when poor students are admitted to university. Contrary to commonly held beliefs, we find that virtually every student who passes the entrance exam (poor and nonpoor alike) is able to find a way to pay the fees and tuition charges that are demanded upon matriculation and is able to enter college, despite the high costs.

Therefore, the paper concludes that if the real barriers are not at the time of admissions to college, there must be a second, remaining set of systematic barriers that prevent poor children from ever making it to the point where they take the CEE. In fact, a close reading of the literature and some of our own data demonstrate that the rural education system—in general—is putting rural children at a severe disadvantage at almost every point of the educational process (low rates of enrollment into early childhood education; low quality elementary schools; poor nutrition and low quality boarding facilities; high levels of high school tuition; a migrant schooling system that is outside of the public education system).

The paper concludes that the real barriers keeping the rural poor from pursuing a college education are being erected early in their educational experience—as early as preschool and elementary school—and are present throughout the entire schooling system.