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Background: Maternal mental health problems play an important role in infant well-being. Although western countries have extensively studied the associations between maternal mental disorders, hygiene practices and infant health, little is known in developing settings. This study investigates the correlations between postnatal mental health problems, hand washing practices and infant illness in rural western China. Methods: A total of 720 mothers of infants aged 0–6 months from four poor counties in rural western China were included in the survey. Mental health symptoms were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Questions about infant illness and hand washing practices followed evaluative surveys from prior studies. Adjusted ordinary least squares regressions were used to examine correlations between postnatal mental health (depression, anxiety, and stress) symptoms, hand washing practices, and infant illness outcomes. Results: Maternal depression, anxiety and stress symptoms were significantly associated with reduced hand washing overall and less frequent hand washing after cleaning the infant's bottom. Mental health symptoms were also associated with a higher probability of infants showing two or more illness symptoms and visiting a doctor for illness symptoms. Individual hand washing practices were not significantly associated with infant illness; however, a composite measure of hand washing practices was significantly associated with reduced probability of infant illness. Conclusion: Postnatal mental health problems are prevalent in rural China and significantly associated with infant illness. Policy makers and practitioners should investigate possible interventions to improve maternal and infant well-being.

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Objective: Consultation length, the time spent between patient and health care provider during a visit, is an essential element in measuring quality of health care patients receive from a primary care facility. However, the linkage between consultation length and process quality and diagnosis quality of primary care is still uncertain. This study aims to examine the role consultation length plays in delivering process quality and diagnosis quality, two central components of overall primary care quality, in rural China. Methods: We recruited unannounced standardized patients (SPs) to present classic symptoms of angina and tuberculosis in selected healthcare facilities in three provinces of China. The consultation length and primary care quality of SPs were measured and compared with both international and national standards of care. Ordinary Least Squares (OLS) regressions for process quality (continuous dependent variable) and Logistic regressions for diagnosis quality (binary dependent variable) were performed to investigate the relationship between consultation length and primary care quality. Results: The average consultation lengths among patients with classic symptoms of angina and those with symptoms of tuberculosis were approximately 4.33 min and 6.28 min, respectively. Providers who spent more time with patients were significantly more likely to complete higher percentage of recommended checklist items of both questions and examinations for angina (β = 1.39, 95%CI 1.01–1.78) and tuberculosis (β = 0.89, 95%CI 0.69–1.08). Further, providers who spent more time with patients were more likely to make correct diagnosis for angina (marginal effect = 0.014, 95%CI 0.002–0.026) and for tuberculosis (marginal effect = 0.013, 95%CI 0.005–0.021). Conclusions: The average consultation length is extremely short among primary care providers in rural China. The longer consultation leads to both better process and diagnosis quality of primary care. Practice Implications: We recommend primary care providers to increase the length of their communication with patients. To do so, government should implement healthcare reforms to clarify the requirements of affordable and reliable consultation length in medical care services. Moreover, such an experience can also be extended to other developing countries.

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Purpose: This study aims to bridge the gaps in the existing literature by studying the links between children's development and the subjective well-being of the caregivers using first-hand data collected in rural China. Design/methodology/approach: Although the broad array of literature has examined the effects of child development on the subjective well-being of caregivers, the relationship between early childhood development and caregiver subjective well-being has not been well-studied using sample families with potential developmental delay in rural China. Also, existing research has relied on maternal reports to evaluate the developmental status of children. The study used data collected from 32 townships in seven nationally designated poverty counties in the Qinling mountainous area in 2016. The authors measure child development using the social-emotional module of the Ages & Stages Questionnaire and Bayley Scales of Infant and Toddler Development–Third Edition. Findings: The authors find that child development indicators are correlated with caregiver subjective well-being. In particular, social-emotional skills are positively associated with life evaluations and positive emotion. However, we do not find any significant correlation between child development and negative emotion or depression, anxiety and stress scores. Originality/value: The value of this study is to report the indicators of child development in rural China and examines the correlation between child development and caregivers' subjective well-being.

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Objective: To examine the correlation between birth season and early childhood development. Background: Almost all previous studies that examine the effect of birth season on early childhood development were conducted in developed countries with a limited sample size. The present study was conducted in poor, rural areas of western China, a developing region with a continental monsoon climate. Method: We administered a hemoglobin test to 650 infants (52% boys), aged 8–10 months, using a Hemocue Hb 201+ finger prick system, and assessed the cognitive and psychomotor development of sample infants using Bayley Scales of Infant Development. Results: Infants born in winter have higher Hb concentrations (t = 3.63, p 0.001) compared to infants born in summer. Similarly, cognitive development scores (t = 5.17, p 0.001) and psychomotor development scores (t = 10.60, p 0.001) were significantly higher among winter-born infants. Conclusion: The findings point to the involvement of birth season in early childhood development and suggest that aspects of the environment shape the experiences that contribute to early childhood development. Policy suggestions such as providing infants with ample opportunities for movement and stimulation during the cold season are discussed.

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This study examines the effects of local and nationwide COVID‐19 disease control measures on the health and economy of China's rural population. We conducted phone surveys with 726 randomly selected village informants across seven rural Chinese provinces in February 2020. Four villages (0.55%) reported infections, and none reported deaths. Disease control measures had been universally implemented in all sample villages. About 74% of informants reported that villagers with wage‐earning jobs outside the village had stopped working due to workplace closures. A higher percentage of rural individuals could not work due to transportation, housing, and other constraints. Local governments had taken measures to reduce the impact of COVID‐19. Although schools in all surveyed villages were closed, 71% of village informants reported that students were attending classes online. Overall, measures to control COVID‐19 appear to have been successful in limiting disease transmission in rural communities outside the main epidemic area. Rural Chinese citizens, however, have experienced significant economic consequences from the disease control measures.

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Previous studies have been limited by not directly comparing the quality of public and private CHCs using a standardized patient method (SP). This study aims to evaluate and compare the quality of the primary care provided by public and private CHCs using a standardized patient method in urban China. We recruited 12 standardized patients from the local community presenting fixed cases (unstable angina and asthma), including 492 interactions between physicians and standardized patients across 63 CHCs in Xi’an, China. We measured the quality of primary care on seven criteria: (1) adherence to checklists, (2) correct diagnosis, (3) correct treatment, (4) number of unnecessary exams and drugs, (5) diagnosis time, (6) expense of visit, (7) patient-centered communication. Significant quality differences were observed between public CHCs and private CHCs. Private CHC physicians performed 4.73 percentage points lower of recommended questions and exams in the checklist. Compared with private CHCs, public CHC providers were more likely to give a higher proportion of correct diagnosis and correct treatment. Private CHCs provided 1.42 fewer items of unnecessary exams and provided 0.32 more items of unnecessary drugs. Private CHC physicians received a 9.31 lower score in patient-centered communication. There is significant quality inequality in different primary care models. Public CHC physicians might provide a higher quality of service. Creating a comprehensive, flexible, and integrated health care system should be considered an effective approach towards optimizing the management of CHC models.

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Stanford scholars are setting and expanding research agendas to analyze China’s economic development and its impact on the world. The newly launched Stanford Center on China’s Economy and Institutions — co-directed by SIEPR senior fellows Hongbin Li and Scott Rozelle — is supporting their work. In this SIEPR Policy Brief, Li and Rozelle outline the research underway by the new center's affiliates.