Luo, R, Zhou, H, Zhang, L, Medina, A, Li, H, Lien, J, and Cai, J, 2017. Nourishing the future: targeting infants and their caregivers to reduce undernutrition in rural China, 3ie Grantee Final Report. New Delhi: International Initiative for Impact Evaluation (3ie)
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This study, using a cluster-randomised controlled trial design, evaluates the impact of a micronutrient supplement on children’s nutrition, health, and cognitive development and how text messaging can influence the effectiveness of micronutrient supplement programmes in rural Shaanxi.
Despite China’s rapid economic growth, poverty is still prevalent in many of the inland provinces. One of the outcomes of poverty is that up to 50 per cent of preschool and school-going children suffer from micronutrient deficiencies. While micronutrient supplementation has the potential to solve anaemia prevalence, compliance is a major barrier to the success of micronutrient supplement programmes.
The National Population and Family Planning Commission has been involved in projects designed to improve the health of mothers and infants. To gain a better understanding of which nutritional strategies are most effective, this study tests a nutritional supplementation programme for infants that is combined with a SMS text messaging for better compliance.
- What is the impact of an educational campaign, paired with a daily nutritional supplementation programme, on infant health (including anthropometric measures and nutritional deficiencies) and cognitive development (using specially calibrated instruments for measuring infant development)?
- What is the added impact of a text message reminder programme on adherence to the daily nutritional supplementation programme, infant health (including anthropometric measures and nutritional deficiencies) and cognitive development (using specially calibrated instruments for measuring infant development)?
- How do the impacts of these programs vary across demographic groups (age, sex and ethnicity)?
Nutritional training, free nutritional supplement and daily text messages for treatment groups, and personnel inputs, were expected to lead to improved knowledge and attitudes of parents on infant nutrition and feeding. These changes would in turn improve child nutrition and health measured by haemoglobin level and mental developmental index (MDI) and psychomotor developmental index (PDI) scores.
There were three groups in the cluster-randomised controlled trial. The caregivers of children in Treatment Group 1 (free delivery group) received one-on-one health education training on nutrition and feeding practices. Caregivers in this sample also received a free supply of micronutrient supplement packets containing a fortification powder every six months, along with instructions on how to use the powder. The caregivers of children in the Treatment Group 2 (text messaging group) received the same treatment as the free delivery group. However, the text messaging group caregivers were also enrolled in a daily text message reminder programme. The third group served as control group (no intervention).
The study sample consisted of 351 villages in 174 townships. Each village cluster was randomly assigned into one of three groups: free, text or control group. Assignment was cluster-randomised at the village level and stratified at county level, with 117 villages in each treatment group.
The study found that text messaging led to a considerable increase in programme compliance, i.e. increased the consumption of micronutrient supplements provided. Qualitative analysis showed that the compliance increased because text messages impressed on caregivers the importance of providing nutrition. It also addressed caregiver forgetfulness. The findings also show that the increased compliance has led to statistically significant reduction in the rate of anaemia and a significant improvement on the Bayley MDI score at six months after the start of intervention. However, the effects of free micronutrient powder distribution on health indicators and cognitive abilities i.e. haemoglobin concentrations, anaemia prevalence and MDI, were not significantly different from that of the control group after 12 or 18 months of supplementation.
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- Seeking solutions to childhood anemia in China, Standford, 3 June 2014
- Caixin Column 2: China's Inequality Starts During the First 1,000 Days, Standford, 28 Oct 2013
- Can China's One-Child Policy Enforcers Transform Rural Education?, The Huffington Post, 27 Aug, 2012