Nutrition and Educational Performance in Rural China's Elementary Schools: Results of a Randomized Control Trial in Shaanxi Province

Despite growing wealth and a strengthening commitment from the government to provide quality education, a significant share of students across rural China still have inadequate access to micronutrient-rich regular diets. Such poor diets can lead to nutritional problems, such as iron-deficiency anemia, that can adversely affect attention and learning in school. The overall goal of this article is to test whether simple nutritional interventions lower rates of anemia and to assess whether this leads to improved educational performance among students in poor areas of rural China. To meet this goal, we report on the results of a randomized control trial involving over 3,600 fourth-grade students, mostly aged 9-12, from 66 randomly chosen elementary schools in eight of the poorest counties in Shaanxi Province in China's poor northwest region. The design called for random assignment of schools to one of three groups: two different types of treatment/intervention schools and a nonintervention, control group. The two interventions were designed to improve hemoglobin (Hb) levels, which is a measure of iron deficiency. One intervention provided a daily multivitamin with mineral supplements, including 5 milligrams of iron, for 5 months. The other informed the parents of their child's anemia status and suggested several courses of action (henceforth, the information treatment). We found that 38.3% of the students had Hb levels below 120 grams per liter (g/L), the World Health Organization's cutoff for anemia for children 9-12 years old. In the schools that received the multivitamins with mineral supplements, Hb levels rose by more than 2 g/L (about 0.2 standard deviations). The standardized math test scores of the students in the schools that received the multivitamin with mineral supplements also improved significantly. In schools that received the information treatment, only students who lived at home (and not the students who lived in boarding schools and took most of their meals at schools) registered positive improvements in their Hb levels. The reductions in anemia rates and improvements in test scores were greater for students who were anemic at the beginning of the study period. Overall, these results should encourage China's Ministry of Education to begin to widen its view of education (beyond teachers, facilities, and curriculum) and to provide better nutrition and health care for students.