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"Growth has helped millions to avoid malnutrition but it still threatens to hold back a generation of rural Chinese."

A recent article in The Economist about malnutrition in rural China cites REAP's research on anemia.

“The propaganda message, scrawled in white paint on the side of a wood-frame house, could hardly be more blunt: ‘Cure stupidity, cure poverty’. The cure for both, in one of China’s poorest counties, seems to be a daily nutritional supplement for children. At a pre-school centre in Songjia, as in more than 600 other poor villages across China, children aged three to six gather to get the stuff with their lunch. If China is to narrow its urban-rural divide, thousands more villages will need to do this much, or more....

"'Babies are probably 50% malnourished' in poor rural areas, says Scott Rozelle, co-director of the Rural Education Action Programme (REAP), a research outfit at Stanford University which has done extensive tests on anaemia in rural China. 'But almost no mums are malnourished.' Mr Rozelle says that in one of his surveys rural mothers showed a better understanding of how to feed pigs than babies: 71% said pigs need micronutrients, whereas only 20% said babies need them."

Read more here.

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REAP's efforts on childhood anemia were featured in an article in Scope, an award-winning medical blog produced by writers at Stanford University School of Medicine.

"How can health and nutrition education needs in rural China be addressed? Start by examining infant-feeding practices.

"Scott Rozelle, PhD, director of the Rural Education Action Program, part of the Freeman Spogli Institute for International Studies (FSI) Center on Food Security and the Environment at Stanford, conducted a study on 1,800 babies in China’s Shaanxi province to address high rates of anemia and cognitive delays in children owing to poor nutrition, though not necessarily lack of funds for healthy food...The study is ongoing through April, 2015, but 12 months into the program, the researchers have found that the supplements have reduced anemia rates by 28 percent..." 

Read the article here

Read more about REAP's study on anemia here

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Abstract

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.

Design: Cluster-randomized, investigator-masked, controlled trial carried out in the 2012-2013 school year.

Setting: Primary schools (n=252) randomly selected on a population basis in two prefectures in western China.

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).

Main Outcome: Main study outcome was year-end score on a specially-designed mathematics test, adjusted for baseline score, expressed in units of standard deviation (SD).

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.

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Scott Rozelle
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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.

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Alexis Medina
Scott Rozelle
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Zack Bonzell came to Stanford with a strong interest in human biology and political science. Last summer, the undergraduate had the chance to fuse his interests while doing field research with faculty at the university’s Freeman Spogli Institute for International Studies (FSI). 

During a two-week internship, he travelled to Guatemala with FSI senior fellows Paul Wise, Beatriz Magaloni, Alberto Díaz-Cayeros and Scott Rozelle to learn about the country’s rural health care system by shadowing doctors and interviewing mothers in an impoverished area about the issues leading to the area’s high rates of child malnutrition.

“That experience was an ideal way to blend my interests and gave me a better idea of how to craft my course of study at Stanford,” said Bonzell, who is now a junior. “One of the things that really struck me was when Paul Wise said the health outcomes we were seeing are the result of extreme material deprivation. These people are sick because they are poor. That gave me more of an interest in political economy.”

Students conduct interviews about nutrition with REAP in China. Photo Credit: Matt Boswell

FSI is now expanding its educational opportunities for students, like Bonzell, who want to do research on global issues in Asia, Latin America, Europe and Africa.

The Stanford Global Student Fellows program (SGSF) is being funded in large part through a $1.25 million anonymous gift that will help grow existing programs and create new offerings for graduates and undergraduates.

“This program deepens FSI’s commitment to its mission of educating the next generation of leaders in international affairs,” said FSI Director Mariano-Florentino Cuéllar. “It also offers outstanding opportunities for Stanford students to work closely with the leading thinkers on global policy issues.”

The program, which is part of FSI’s efforts to expand student opportunities, will build on the institute’s undergraduate mentorship programs that allow students to work on faculty research projects each quarter. Those positions will now be available during the summer. Some of the positions will be connected to projects in FSI’s new International Policy Implementation Lab, an initiative that gives students a close-up view of how academics and policy influencers can address some of the world’s thorniest issues.

PoliSci 114S students work together in a UN conflict simulation. Photo Credit: Rod Searcey

Building on FSI’s experience placing students in research opportunities, the program will create and expand summer field research internships. The two- to six-week internships this summer will give undergraduates the opportunity to work with FSI senior fellows in China, Guatemala, India and Mexico who study global health, conflict resolution, governance and poverty reduction.  In coming years, the program will likely include additional fieldwork projects in Rwanda, Tanzania and Brazil. The SGSF program covers all travel expenses for students and provides students with an opportunity to work closely with a faculty member and a team of other students on an ongoing research project addressing real-world problems in a specific region. 

“What makes FSI such an incredible institution is that it attracts faculty who have very pragmatic interests,” Bonzell said. “It seeks to wed academic work with a more direct impact, and there’s a lot of potential for more students to think along similar lines.”

The Stanford Global Student Fellows will also allow FSI to work closely with its partners, including the Program in International Relations, the Haas Center for Public Service, and Stanford in Government to provide opportunities for graduate and undergraduate students. 

Mexican Ambassador Eduardo Medina Mora and Jorge Olarte, '13, speaking with students at the US-Mex FoCUS event. Photo Credit: Rod Searcey

One of the program’s new initiatives geared toward undergraduates is the Global Policy Summer Fellowships. The fellowships help secure placement and a $6,000 stipend for students interested in interning at international policy and international affairs organizations. This summer,The Europe Center at FSI is placing students at the Center for European Policy Studies and Bruegel, two Brussels-based think tanks. Future positions will be created with six offerings abroad and two based in the United States.including the Program in International Relations, the Haas Center for Public Service, and Stanford in Government to provide opportunities for graduate and undergraduate students. 

The Stanford Global Student Fellows program will also commit $400,000 to create a Mentored Global Research Fellowship that will provide research opportunities for students to conduct their own overseas research under the close mentorship of a faculty member. The program will award stipends of $6,000 for summer undergraduate projects and $9,000 for summer graduate projects, and $1,500 for smaller projects executed during the school year.

Thomas Hendee '13 chatting with children in rural Guatemala. Photo Credit: Maria Contreras

The faculty advisory committee overseeing the development and implementation of these new programs includes Scott Rozelle, the Helen F. Farnsworth Senior Fellow and the co-director of FSI’s Rural Education Action ProgramStephen Stedman, a senior fellow at FSI and the deputy director of CDDRL; and Lisa Blaydes, assistant professor of political science.

The application deadline for all summer programs is Feb. 28, 2015. The deadline to apply for academic quarterly programs is the end of the first week of each quarter, beginning in the fall of 2014. 

For more information, students should contact Elena Cryst at ecryst@stanford.edu and watch for postings on FSI’s student program Facebook page. Students can also sign up for the program’s distribution and announcement list.

 

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More than 70 percent of U.S. child health care resources are committed to the 5 percent of children with the most complex of medical conditions.  Fiscal pressures, reforms to the Medicaid program, and implementation of the Affordable Care Act (ACA) provide opportunities to reduce inefficiencies and to expand access to high-quality subspecialty care for these children. 

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