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Chewable Vitamins

Vitamins are accessible and affordable in China

Severe iron deficiency (anemia) is known to dramatically slow cognitive, behavioral, and physical development and has been identified as one of the most significant health problems internationally. Anemia is a problem that affects children of all ages, especially those in elementary school and has severe consequences for the educational performance of students in all grades.


Despite the growing wealth in China and the commitment of the government to provide quality education, there is some evidence in the literature that 1 in 4 children (25%) across rural China were found to be so severely iron deficient as to be classified anemic (Ministry of Health). AND, it IS even higher in children from poorer schools. A recent study of a rural junior high school in Shaanxi Province run by the provincial Center for Disease Control found anemia in as many as 40% of 5 to 9 year old students. A study in Guizhou Province found the rates to be 50-60%. Inadequate nutrition in these children adversely affects cognitive abilities and reduces school attendance rates.

The national government has been willing to address nutrient deficiencies and has invested in providing nutritional supplements. However, the time-consuming process of boiling water and cutting into class time to take the current supplements have motivated us to replace them with chewable vitamins instead. We aim to determine their benefits for educational performance and nutritional status.


  • Better understand the incidence and seriousness of iron deficiencies and anemia in elementary schools in poor areas of rural China, specifically demonstrating whether there is low hemoglobin count (which is known to be correlated with iron deficiency (anemia)) among fourth grade students in poor areas of Gansu province
  • Assess the impact of consuming a daily chewable multivitamin on: i) hemoglobin count; ii) grades; iii) cognitive test scores; iv) standard psychological test scores as measured by a written test
    Although schools provide lunch meals, unfortunately, they rarely contain sufficient nutrients
  • Contribute to China Ministry of Education efforts to increase the nutrition of students as a way to increase educational performance


Acquire Baseline Information

  • Give fourth grade students hemocue, finger prick-based tests, on-site, to determine levels of hemoglobin in the blood (that are highly correlated with anemia and iron deficiencies)
  • Develop indicators for measuring the impacts of eliminating anemia such as: collecting student grades from the school officials, administering a standardized cognitive test, and running a standard psychological test

Implement Nutrition Supplementation Program

All fourth grade students in a randomly selected subset of program schools will receive 1 chewable multivitamin with iron per day, 7 days a week, for six months.

Baseline Followup Evaluation

After the multivitamin supplement intervention is completed (in month 7 of the study), we will repeat the same tests conducted at baseline (hemocure finger prick hemoglobin tests AND cognitive and psychological tests) and collect student grades.

Participant Population

The study will be conducted in 20 randomly chosen schools in 6 of the poorest counties in Gansu province. All fourth grade students in each school will be enrolled in the study - an average of 50 students from each school, who may be negatively affected by anemia and whose related educational abilities and performance we are interested in studying. (50 x 20 = 1000).

Preparing for the finger prick hemoglobin test to determine anemia


Blood hemoglobin levels as an indicator of nutritional status and anemia will be obtained. Student grades and standardized cognitive and psychological test results will be obtained before and after intervention to determine whether chewable multivitamins with iron are effective.


Using the anemia cutoff of 120 g/L, we found that 22% of students in Vitamin schools were anemic before the intervention. In other words, one out of every five fourth-grade students in our sample was at risk for irreversible cognitive damage, which could cripple their chances at performing well in school and trap them in a cycle of poverty. For these children, chewable vitamins are the key to a brighter future.

Chewable vitamins are an easy and affordable way to improve child health and nutrition in rural China

In schools that received chewable vitamins, there were significant increases both in hemoglobin levels and standardized math test scores compared to Control schools.

  • Hb levels in Vitamin schools rose by 2 g/L (over 0.2 standard deviations) compared to a -2.25 point drop in Control schools.
  • Standardized math test scores increased on average by 0.40 standard deviations compared to an increase of 0.34 standard deviations in Control schools. 

Policy Implications

Given that policy relevance is always integral to REAP’s work, we are eager to show policymakers that chewable vitamins, costing only 4 US cents a day, are an easy and affordable way to improve child health and nutrition in China. Investing in vitamins would also mean investing in better students and the development of a more highly-skilled workforce to meet the demands of an increasingly competitive global economy.

The nation's US$22.5 billion school lunch program launched in 2011 is a big step forward. We hope our findings will help China's top decision-makers take subsequent steps in the right direction.