Large and increasing numbers of rural-to-urban migrants provided new challenges for tuberculosis control in large cities in China and increased the need for high quality tuberculosis care delivered by clinics in urban migrant communities. Based on a household survey in migrant communities, we selected and separated clinics into those that mainly serve migrants and those that mainly serve local residents. Using standardized patients, this study provided an objective comparison of the quality of tuberculosis care delivered by both types of clinics and examined factors related to quality care. Only 27% (95% confidence interval (CI) 14–46) of cases were correctly managed in migrant clinics, which is significantly worse than it in local clinics (50%, 95% CI 28–72). Clinicians with a base salary were 41 percentage points more likely to demonstrate better case management. Furthermore, clinicians with upper secondary or higher education level charged 20 RMB lower out of pocket fees than less-educated clinicians. In conclusion, the quality of tuberculosis care accessed by migrants was very poor and policies to improve the quality should be prioritized in current health reforms. Providing a base salary was a possible way to improve quality of care and increasing the education attainment of urban community clinicians might reduce the heavy barrier of medical expenses for migrants
Background: China has one of the highest rates of antibiotic resistance. Existing studies document high rates of antibiotic prescription by primary care providers but there is little direct evidence on clinically inappropriate use of antibiotics or the drivers of antibiotic prescription.
Methods: To assess clinically inappropriate antibiotic prescriptions among rural primary care providers, we employed unannounced standardized patients (SPs) who presented three fixed disease cases, none of which indicated antibiotics. We compared antibiotic prescriptions of the same providers in interactions with SPs and matching vignettes assessing knowledge of diagnosis and treatment to assess overprescription attributable to deficits in diagnostic knowledge, therapeutic knowledge and factors that lead providers to deviate from their knowledge of best practice.
Results: Overall, antibiotics were inappropriately prescribed in 221/526 (42%) SP cases. Compared with SP inter- actions, prescription rates were 29% lower in matching clinical vignettes (42% versus 30%, P,0.0001). Compared with vignettes assessing diagnostic and therapeutic knowledge jointly, rates were 67% lower in vignettes with the diagnosis revealed (30% versus 10%, P , 0.0001). Antibiotic prescription in vignettes was in- versely related to measures of diagnostic process quality (completion of checklists).
Conclusions: Clinically inappropriate antibiotic prescription is common among primary care providers in rural China. While a large proportion of overprescription may be due to factors such as financial incentives tied to drug sales and perceived patient demand, our findings suggest that deficits in diagnostic knowledge are a major driver of unnecessary antibiotic prescriptions. Interventions to improve diagnostic capacity among providers in rural China are needed.
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 ahigh 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 thatgrandmothers feed a less diversified diet to children than do mothers. Most (84%) caregivers rely solely ontheir 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 ofreliable information sources.
Key words: child development, feeding practices, information sources, rural China
Importance:Uncorrected refractive error causes 90% of poor vision among Chi-nese children.
Background:Little is known about teachers' influence on children's glasses wear.
Participants:Children at 138 randomly selected primary schools in Guangdongand Yunnan provinces, China, with uncorrected visual acuity (VA)≤6/12 in eithereye correctable to >6/12 in both eyes, and their teachers.
Methods:Teachers and children underwent VA testing and completed question-naires about spectacles use and attitudes towards children's vision.
Main Outcome Measures:Children's acceptance of free glasses, spectacle pur-chase and wear.
Results:A total of 882 children (mean age 10.6 years, 45.5% boys) and276 teachers (mean age 37.9 years, 67.8% female) participated. Among teachers,20.4% (56/275) believed glasses worsened children's vision, 68.4% (188/275) felteye exercises prevented myopia, 55.0% (151/275) thought children with modestmyopia should not wear glasses and 93.1% (256/275) encouraged children toobtain glasses.Teacher factors associated with children's glasses-related behaviour includedbelieving glasses harm children's vision (decreased purchase, univariate model: rel-ative risk [RR] 0.65, 95% CI 0.43, 0.98,P< 0.05); supporting children's classroomglasses wear (increased glasses wear, univariate model: RR 2.20, 95% CI 1.23,3.95,P< 0.01); and advising children to obtain glasses (increased free glassesacceptance, multivariate model: RR 2.74, 95% CI 1.29, 5.84,P< 0.01; increasedwear, univariate model: RR 2.93, 95% CI 1.45, 5.90,P< 0.01), but not teacher'sownership/wear of glasses.
Conclusions and Relevance:Though teachers had limited knowledge about chil-dren's vision, they influenced children's glasses acceptance.
Education of poor and disadvantaged populations has been a long-standing challenge for education systems in both developed and developing countries. In China, millions of students in rural areas and migrant communities lag far behind their urban counterparts in terms of academic achievement. When they fall behind, they often have no way to catch up. Many of their parents have neither the skills nor the money to provide remedial tutoring; rural teachers often do not have time to give students the individual attention they need.
The objective of this paper is to assess the nature of China’s human capital. To achieve our objective, we both measure the share of the labor force that has attained upper secondary schooling levels (high school) as well as examine recent trends of 15–17 year olds who are attending high school. Using two sets of national representative data, we are able to show that, while the human capital of China’s labor force is still low (30%), between 2005 and 2015 the share of rural youth who attended high school rose sharply. According to Ministry of Education–reported statistics, in 2015 87% of 15–17 year olds were attending high school, up from around 50% in 2005. Given the recent pronouncements of the government to make high school universal by 2020, the challenges for the education system are to increase the attendance of rural as well as vocational education and training students.
This special issue is based on a seminar held at the Institute of Developing Economies, Japan External Trade Organization (IDE-JETRO) in 2017, focusing on human capital. In a panel discussion at the seminar, the audience and speakers posed questions and offered comments. Below are the interactions summarized according to three major topics covered in this discussion, that is, China’s human capital, clusterbased industrial development, and urban development.
The goal of this paper is to describe and analyze the relationship between ability tracking and student social trust, in the context of low-income students in developing countries. Drawing on the results from a longitudinal study among 1,436 low-income students across 132 schools in rural China, we found a significant lack of interpersonal trust and confidence in public institutions among poor rural young adults. We also found that slow-tracked students have a significantly lower level of social trust, comprised of interpersonal trust and confidence in public institutions, relative to their fast-tracked peers. This disparity might further widen the gap between relatively privileged students who stay in school and less privileged students who drop out of school. These results suggest that making high school accessible to more students may improve social trust among rural low-income young adults.
This article explores the problem of cognitive delays among toddlers in rural China and the role of their caregivers in producing low levels of cognition (i.e., low IQ). According to the results of a well-tested international scale of child development, the Bayley Scales of Infant Development (BSID), cognitive delays are alarmingly common, and nearly half the toddlers in our sample score an IQ of less than 84 on the BSID test (more than one standard deviation below the mean).
China’s rapid urbanization in the past several decades have been accompanied by rural labor migration. An important question that has emerged is whether rural labor migration has a positive or negative impact on the depressive symptoms of children left behind in the countryside by their migrating parents. This paper uses a nationally representative panel dataset to investigate whether parental migration impacts the prevalence of depressive symptoms among left-behind children in China.
In the 1990s, rural youth from poor counties in China had limited access to college. After mass college expansion started in 1998, however, it was unclear whether rural youth from poor counties would gain greater access. The aim of this paper is to examine the gap in college and elite college access between rural youth from poor counties and other students after expansion.
Can a county-based vision center increase eyeglasses use and improve school performance among primary schoolchildren in rural China? This cluster randomized clinical trial of 31 schools and 2613 participants showed that children who received eyeglasses earlier in the school year performed significantly better on an end-of-year mathematics test than children who received eyeglasses later in the year, equivalent to half a semester. Provision of free eyeglasses also improved children's use of spectacles.
Taenia solium cysticercosis affects millions of impoverished people worldwide and can cause neurocysticercosis, an infection of the central nervous system which is potentially fatal. Children may represent an especially vulnerable population to neurocysticercosis, due to the risk of cognitive impairment during formative school years. While previous epidemiologic studies have suggested high prevalence in rural China, the prevalence in children as well as risk factors and impact of disease in low-resource areas remain poorly characterized.
Abstract: More than 60 million children in rural China are “left-behind”—both parents live and work far from their rural homes and leave their children behind. This paper explores differences in how left-behind and non-left-behind children seek health remediation in China’s vast but understudied rural areas. This study examines this question in the context of a program to provide vision health care to myopic rural students. The data come from a randomized controlled trial of 13,100 students in Gansu and Shaanxi provinces in China.
An increasing number of policymakers in developing countries have made the mass expansion of upper-secondary vocational education and training (VET) a top priority. The goal of this study is to examine whether VET fulfills the objectove of building skills and abilities along multiple dimensions and further identify which school-level factors help vocational students build these skills and abilities. To fulfill this goal, we analyzed representative, longitudinal data that we collected on more than 12,000 students from 118 schools in once province of central China. First, descriptive analysis shows approximately 90% of VET students do not make any gains in vocational or general skills. In addition, negative behaviors (misbehavior in the classroom, anti-social behavior, and other risky behaviors) are highly prevalent among VET students. A nontrivial proportion of student internships also fail to meet minimum government requirements for student safety and well-being. Perhaps as a result of these outcomes, more than 60% of students express dissatisfaction with their VET programs, as evidenced by eitehr self-reports or dropping out. Finally, using a multi-level model, we find that school inputs (such as school size, teacher qualifications, and per pupil expenditure) are not correlated with vocational and general skill at the end of the school year, or student dropout in the academic year.
Economic growth and socioeconomic changes have transformed nearly every aspect of childhood in China, and many are worried by the increasing prevalence of mental health issues among children, particularly depression. To provide insight into the distribution of depressive symptoms among children in China and identify vulnerable groups, we use data from the 2012 China Family Panel Survey (CFPS), a survey that collected data from a large, nationally representative sample of the Chinese population.
Purpose – Low levels of human capital in rural China are rooted in the poor schooling outcomes of elementary school students. The purpose of this paper is to provide insight into the distribution of academic performance in rural China and identify vulnerable groups.
Design/methodology/approach – The authors draw on a data set of 25,892 observations constructed from 11 school-level surveys spanning nine provinces and one municipality in China conducted from 2013 to 2015. Findings – The authors find that the distribution of academic performance is uneven across provinces and subgroups. In general, male students, Han, living in richer counties, living with their parents and studying in rural public schools do better academically than female students, non-Han, living in poorer counties, left behind and studying in private migrant schools in cities.
Research limitations/implications – Using the results of this study, policymakers should be able to better target investments into rural education focusing on at risk subpopulations.
Originality/value – With limited data sources, the research on the academic performance of students in rural China is largely absent. The findings of this study help to fill the gaps in the literature base.
Keywords China, Rural areas, Academic performance Paper type Research paper
Purpose – The purpose of this paper is to describe the policy and trends in rural education in China over the past 40 years; and also discuss a number of challenges that are faced by China’s rural school system.
Design/methodology/approach – The authors use secondary data on policies and trends over the past 40 years for preschool, primary/junior high school, and high school.
This study aims to investigate the developmental status of rural Chinese children, the extent of interactive parenting they receive, and the relation between the two. A sample of 448 six to eighteen-month-old children and their caregivers were randomly selected from two rural counties in Hebei and Yunnan provinces. According the third edition of the Bayley Scales of Infant and Toddler Development, 48.7% of sample children exhibited cognitive delays, 40.6% language delays, and 35% social-emotional delays.
Background: Anemia early in life has been associated with delayed cognitive and motor development. The WHO recommends home fortification using multiple micronutrient powders (MNPs) containing iron as a strategy to address anemia in children under two. We evaluated the effects of a program freely distributing MNP sachets to caregivers of infants in rural China.
Offering free glasses can be important to increase children's wear. We sought to assess
whether ªUpgrade glassesº could avoid reduced glasses sales when offering free glasses to
children in China.
In this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/
12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools
in 9 counties in Guangdong and Yunnan provinces, China, were randomized by school to
one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer
of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase
(main outcome) was assessed 6 months after randomization.
Among 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible
and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to
Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%)
at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children
needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up.
Glasses purchase was significantly less likely when free glasses were given: Control: 59/
250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated
this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk
(RR) 0.90 (0.56±1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59,
1.42), P = 0.69.
Upgrade glasses can prevent reductions in glasses purchase when free spectacles are provided,
providing important program income.
This paper aims to investigate student confidence in reading in a developing and middle-income country by collecting and reporting on survey data from 135 primary schools in rural China. In the survey, we adopted and conducted the Progress in International Reading Literacy Study (PIRLS) scales of confidence in reading and reading skills test items. Our analysis shows that compared to the other 45 countries/regions that took the PIRLS tests, rural China ranks last (or the lowest) with regard to student confidence in reading and reading achievement.
This paper aims to explore and quantify the reading achievement of primary school students from three different regions in rural China. Using survey data on 23,143 students from Shaanxi, Guizhou, and Jiangxi provinces, we find that although gaps in student reading achievement exist among the three sample provinces, all sample students exhibit low levels of reading achievement. Compared to students from other countries that took part in the Progress in International Reading Literacy Study reading tests, our sample students from rural China ranked last.