Although the past few decades have seen rising incomes and increased government attention to rural development, many children in poor rural China still lack regular access to micronutrient-rich diets. Insufficient diets and poor nutritional knowledge among the poor result in nutritional problems, including iron-deficiency anaemia, which adversely affect students’ attention and learning in school.

Rural Education Action Project (REAP) ’s research theme on Health, Nutrition and Education led by ZHANG Linxiu (REAP co-director) and LUO Renfu (theme leader) and their research group conducted seven cross-sectional surveys to assess the prevalence of anemia among schoolchildren in western China. The surveys involving 12,768 children aged 8-12 years. Subjects were selected randomly from 283 primary schools in 41 economically disadvantaged counties of Ningxia, Qinghai, Shaanxi, Sichuan and Guizhou Provinces (regions). Trained nurses tested hemoglobin levels on-site using a Hemocue Hb 201+ system, and also measured height and weight. Other enumerators collected data on basic socioeconomic information and administered a standardized mathematics test and a psychological test.

The results show that the anemia prevalence was 34% using the WHO hemoglobin cutoff of <120 g/l, which means that anaemia remains to be a serious health problem among students in parts of China. Students who lived and ate at school had higher rates of anaemia, as did students whose parents worked on farms or were away from home. Students with parents who had lower levels of education and who are female were more likely to be anaemic.

By examining the relationship between students’ anaemia status and their physical, psychological and cognitive outcomes, we find that anaemic status correlated adversely with physical, cognitive and psychological outcomes. Students with anaemia also had lower BMI than non-anaemic students. The percentage of students had stunted growth among anemic students is higher than that of non-anemic students. They also had the worse average test scores than the non-anaemic students in the psychological test, suggesting a possible link between anaemia and mental health. Students with anaemia also performed worse than students without anaemia on the standardized mathematics test.

The related research results have been published in The Southeast Asian Journal of Tropical Medicine and Public Health. (Luo RF, Wang XB, Zhang LX, Liu CF, Shi YJ, Miller G, Rozelle S, Yu E, Martorell R. High Anemia Prevalence in Western China, 2011, 42(5), 1204-1213.) and Journal of Health, Population and Nutrition (Luo RF, Zhang LX, Liu CF, Zhao QR, Shi YJ, Miller G, Yu E, Shaobono, B, Medina A, Rozelle S, Martorell R. Anaemia Among Students of Rural China’s Elementary School: Prevalence and Correlates in Ningxia and Qinghai’s Poor Counties. 2011, 29(5), 471-485).