Previous research has found that there are high rates of developmental delays among infants and toddlers in rural areas of China. Caregiver mental health problems might be one significant predictor of developmental delays among infants and toddlers, as has been found in other areas of the world. One way that the mental health of caregivers could affect early childhood development is through its effect on parenting practices. In this study, we used data from four major subpopulations of rural China to measure the correlation of caregiver mental health problems with the developmental outcomes of infants and toddlers. To do so, the study used the Bayley Scales of Infant Development III (BSID III) to examine the rates of developmental delays among 2514 rural infants/toddlers aged 6–30 months old. The results of the testing demonstrate that 48% of the sample’s infants/toddlers have cognitive delays; 52% have language delays; 53% have social-emotional delays; and 30% have motor delays. The data collection team also assessed caregiver mental health by using the Depression Anxiety Stress Scales (DASS-21) questionnaire. According to the findings, 39% of caregivers in the sample have symptoms of at least one kind of mental health problem (depression, anxiety, or stress). We also found that most caregivers do not engage in positive parenting practices, while a significant share of caregivers engage in negative parenting practices. The statistical analysis found that showing signs of mental health problems is significantly and negatively associated with infant/toddler developmental outcomes. The study also found that caregivers who show signs of mental health problems are significantly less likely to engage in interactive parenting practices. The study confirms that society needs to pay more attention to caregiver mental health problems in order to improve infant/toddler developmental outcomes in rural China and increase human capital accumulation in China as a whole.

In the past, iron-deficiency anemia in children has had a widespread presence in rural China. Given the recent economic growth in China, it is unclear if anemia among infants/toddlers remains a problem. The objective of this study is to measure the anemia rate in rural Chainese infants/toddlers across four major subpopulations and attempt to discover the sources of anemia. We use a mixed-methods approach combining quantitative data on 2909 rural Chinese infants/toddlers and their families with qualitative interviews with 84 caregivers of infants aged 6 to 30 months. Quantitative analysis indicates that the overall prevalence of anemia (43%) within sampled infants/toddlers was high, especially in comparison to the low rates of stunting (2–5%), being underweight (2%), and wasting (2–4%). These findings suggest that in rural China, anemia stems from the poor quality of the diets of infants/toddlers, rather than insufficient quantities of food being consumed. Qualitative analysis illustrates the factors that are contributing to anemia. Caregivers do not understand the causes of this condition, the symptoms that would lead one to recognize this condition, or the steps needed to treat their child with this condition. The findings offer a comprehensive understanding of the limited awareness of anemia among rural Chinese caregivers.

China’s competitive education system has produced notably high learning outcomes, but they may be costly. One potential cost is high levels of anxiety. China has launched several initiatives aimed at improving student mental health. However, little is known about how effective these programs and policies are. The goal of this paper is to examine anxiety levels among children and adolescents in rural China, and to identify which subpopulations are particularly vulnerable to anxiety. Data are aggregated from ten different school-­‐‑level surveys conducted in rural areas of five provinces between 2008 and 2015. In total, 50,361 students were evaluated using a 100-­‐‑item, 9-­‐‑subcategory Mental Health Test (a variation of the Children’s Manifest Anxiety Scale). Seven 21 percent of students were at risk for overall anxiety. However, over half of students were at risk for at least one subcategory of anxiety. Students at higher risk for anxiety included students from poorer counties and families, female students, secondary students, and students with lower levels of academic performance. Many students in rural China are at risk for anxiety, and certain student subpopulations are particularly vulnerable. We suggest that China’s government review and update student mental health programs and policies.

The overall goal of this study is to examine whether infant feeding practices differ between mothers and grandmothers in rural China. We randomly sampled 1383 caregivers of infants aged 18 to 30 months living in 351 villages across 174 townships in nationally designated poverty counties in rural areas. Results show that a high fraction of caregivers of 18- to 30-month-old children living in low-income areas of rural China do not regularly engage in positive infant feeding practices. Only 30% of children in our sample achieved adequate dietary diversity. Only 49% of children in our sample were fed meat in the day prior to survey administration. Few caregivers reported giving any vitamin supplements (such as calcium or iron supplements) to their children. We find that 33% of the children were cared for by grandmothers rather than mothers, and that grandmothers feed a less diversified diet to children than do mothers. Most (84%) caregivers rely solely on their own experiences, friends, and family members in shaping their feeding behaviors. Overall infant feeding practices are poor in rural China. Grandmothers engage in poorer feeding practices than do mothers. Grandmothers have improved their feeding practices compared to when their own children were young. Our results suggest shortcomings in the quality of infant feeding practices, at least in part due to an absence of reliable information sources.

Key words: child development, feeding practices, information sources, rural China

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.

Using individual data collected in rural China and adopting Heckman’s two-step function, we examined the impact of childcare and eldercare on laborers’ off-farm activities. Our study finds that having school-aged children has a negative impact on rural laborers’ migration decisions and a positive impact on their decision to work in the local off-farm employment market. As grandparents can help to take care of young children, the impact of preschoolers is insignificant. Having elderly family to care for decreases the income earned by female members of the family. Although both men and women are actively engaged in off-farm employment today in rural China, this study shows that women are still the primary care providers for both children and the elderly. Therefore, reforming public school enrollment and high school/college entrance examination systems so that migrant children can stay with their parents, this will help rural laborers to migrate to cities. The present study also calls for more public services for preschoolers and the elderly in rural China.

Abstract: Soil-transmitted helminths (STHs) infect over one billion people worldwide. There is concern that chronic infection with STHs among school-aged children may detrimentally affect their development, including their health, cognition, and education. However, two recent Cochrane reviews examining the impact of deworming drugs for STH on nutrition, hemoglobin, and school performance found that randomized controlled trials (RCTs) in the literature provide an insufficient evidence base to draw reliable conclusions. This study uses a cluster-RCT to add to existing evidence by assessing the impact of a deworming intervention on nutrition, cognition, and school performance among schoolchildren in rural China. The intervention, implemented by local health practitioners in a setting with a baseline infection prevalence of 41.9% (95% confidence interval [CI] = 39.8%, 43.9%) and infection intensity of 599.5 eggs per gram of feces among positive-tested schoolchildren (95% CI = 473.2, 725.8), consisted of distributing a 400-mg dose of albendazole accompanied with educational training about STH infection, treatment, and prevention. The intervention was conducted twice over the course of the study—at baseline in May 2013 and later in November 2013. We found that the deworming intervention reduced both infection prevalence and infection intensity, but these declines in infection were not accompanied by an impact on outcomes of nutrition, cognition, or school performance. Our interpretation is that the impact of deworming was attenuated by the light infection intensity in our sample population. Evidence from future RCTs is needed to assess the effect of deworming on key outcomes in areas with moderate and severe worm infections.

Abstract: Social interactions in infancy have implications for long-term outcomes. This study uses data from a sample of 1412 rural Chinese infants aged 6–12 and 24–30 months to examine the relationship between peer interactions and cognitive development. Over 75% of the infants in this sample had less than three peers and around 20% had no peers in both periods. The prevalence of cognitive delays is high within this sample and increases as infants age. Multivariate analysis reveals that peer interaction is significantly associated with cognitive development. Heterogeneous analysis suggests that peer interactions and mental development may be related to the child’s primary caregiver and the distance from the child’s household to the center of their village.