This systematic review and meta-analysis summarizes existing evidence to establish whether vision impairment, ocular morbidity and their treatment are associated with depression and anxiety in children.
Understanding and quantifying these associations support early detection and management of mental health symptoms in children with vision impairment and ocular morbidity. Additionally, this review provides evidence in favour of insurance coverage for timely strabismus surgery.
We searched nine electronic databases from inception to February 18, 2021, including observational and interventional studies assessing whether vision impairment and/or ocular morbidity and their treatment are associated with depression and/or anxiety in children. We used narrative synthesis and meta-analysis with the residual maximum likelihood method. A protocol was registered and published on The International Prospective Register of Systematic Reviews (PROSPERO, CRD42021233323).
Among 28,992 studies, 28,956 (99.9%) were excluded as duplicates or unrelated content. Among 36 remaining studies, 21 (58.3%) were observational studies concerning vision impairment, eight (22.2%) were observational studies concerning strabismus, and seven (19.4%) were interventional studies. Vision-impaired children experienced significantly higher scores of depression (Standard Mean Difference [SMD] 0.57, 95% Confidence Interval (CI) 0.26-0.89, 11 studies) and anxiety (SMD 0.61, 95% CI 0.40-0.821, 14 studies) than normally-sighted children. In particular, myopic children experienced higher scores of depression (SMD 0.59, 95% CI 0.36-0.81, six studies) than normally-sighted children. Strabismus surgery significantly improved symptoms of depression (SMD: 0.59 95% CI 0.12-1.06, three studies) and anxiety (SMD: 0.69 95% CI 0.24-1.14, four studies) in children.
Among children, vision impairment is associated with greater symptoms of depression and anxiety. Surgical treatment of strabismus improved these symptoms. Further randomized controlled trials exploring the impact of public health measures for myopia correction on mental health in children are needed. Scaling up access to strabismus surgery could improve the mental health of affected children.
Although children living in low- and middle-income countries (LMICs) account for 90% of the global population of children, depression, and anxiety among children in LMICs have been understudied. This study examines the prevalence of depression and anxiety and their associations with biological and psychosocial factors among children across China, with a focus on rural areas. We conducted a large-scale epidemiological study of depression and anxiety among 53,421 elementary and junior high school-aged children across China. The results show that 20% are at risk for depression, 6% are at risk for generalized anxiety, and 68% are at risk for at least one type of anxiety. Girls and junior high school students show a higher risk for both depression and anxiety symptoms, while socioeconomic status has varying associations to depression and anxiety symptoms. Our results also show consistent correlations between depression and anxiety symptoms and standard math test scores. These findings underscore the importance of identification, prevention, and treatment of youth depression and anxiety in underdeveloped areas. As China constitutes 15% of the global population of children under age 18, this study offers valuable information to the field of global mental health.
Extant research continues to establish the importance of teacher job satisfaction to student performance, yet teacher job satisfaction remains under-investigated in rural China. In this paper, we examine the prevalence and correlates of teacher job satisfaction. Using data from 634 teachers across 120 schools in rural China, we find an alarmingly high prevalence of teacher job dissatisfaction: roughly 21% of rural teachers were less than satisfied with their jobs. In addition, we find that several individual- and school-level characteristics, including being a male teacher, being a homeroom teacher, not having a management role in school, being a middle-aged teacher, and a school’s boarding status, are correlated with teacher job dissatisfaction. In sum, the results demonstrate a need for further research and policy interventions to improve teacher job satisfaction in rural schools.
This study documents the COVID-19 disease-control measures enacted in rural China and examines the economic and social impacts of these measures. We conducted two rounds of surveys with 726 randomly selected village informants across seven provinces. Strict disease-control measures have been universally enforced and appear to have been successful in limiting disease transmission in rural communities. The infection rate in our sample was 0.001 per cent, a rate that is near the national average outside of Hubei province. None of the villages reported any COVID-19-related deaths. For a full month during the quarantine, the rate of employment of rural workers was essentially zero. Even after the quarantine measures were lifted, nearly 70 per cent of the villagers still were unable to work owing to workplace closures. Although action has been taken to mitigate the potential negative effects, these disease-control measures might have accelerated the inequality between rural and urban households in China.
Despite rising incomes and rapid economic growth, there remains a significant gender gap in health outcomes among rural children in China. This study examines whether the gender gap in child health is related to the behavior of caregivers when seeking healthcare, and whether healthcare subsidies help to bridge the gender gap in rural health outcomes.
Focusing on vision care specifically, we draw on data from a randomized controlled trial of 13,100 children in Gansu and Shaanxi provinces in China that provided subsidized eyeglasses to myopic children in one set of schools (henceforth, referred to as the treatment schools) and provided prescription information but not subsidized eyeglasses to myopic children in another set of schools (control schools).
The baseline results reveal that while female students generally have worse vision than male students, they are significantly less likely than male students to be taken by their caregivers to a vision exam. The experimental results indicate, however, that caregivers respond positively to both health information and subsidized healthcare, regardless of the gender of their children. When prescription information is paired with a subsidy voucher for healthcare (a free pair of eyeglasses), the uptake rate rises dramatically.
The gender gap in healthcare can be minimized by implementing subsidized healthcare policies.
School bullying is a widely recognized problem in developed countries, but remains under-investigated in developing countries, especially in remote rural areas. In this paper, we examine the prevalence, correlates, and consequences of bullying victimization and its relation to educational performance and creative attitudes. Using data from 10,528 students across 120 primary schools in rural China, we find an alarmingly high prevalence of bullying victimization and that several individual, family, and school characteristics are correlated with bullying victimization. Analyses indicate students who are bullied frequently score lower in Chinese, reading, and math tests and creative attitudes. Taken together, the results demonstrate a need for further research and policy interventions to reduce bullying in schools.
Background: Attention deficit hyperactivity disorder (ADHD) is a widely recognized mental health problem in developed countries but remains under-investigated in developing settings. This study examines the prevalence, correlates, and consequences of ADHD symptoms among elementary school students in rural China.
Methods: Cross-sectional data were collected from 6,719 students across 120 rural primary schools in China on ADHD symptoms, demographic characteristics, and academic performance in reading and math. ADHD symptoms were evaluated using the caregiver-reported ADHD Rating Scale-IV.
Results: The prevalence of ADHD symptoms was 7.5% in our sample. Male students, students in lower grade levels, and students with lower cognitive ability showed a significantly higher prevalence of ADHD symptoms (ORs = 2.56, 2.06, and 1.84, respectively; p<0.05). Left-behind children showed a significantly lower prevalence of ADHD symptoms than did children who were living with their parents (OR = 0.74, p < 0.05). Adjusted regressions show that students with ADHD symptoms scored 0.12 standardized deviations lower in reading (p < 0.05) and 0.19 standardized deviations lower in math (p < 0.01).
Limitations: The ADHD Rating Scale-IV is a screening scale rather than a diagnostic test. Caregiver self-report measures also may underestimate ADHD symptoms for our sample.
Conclusions: ADHD is a common disorder among rural students in China and appears to be contributing to poor academic outcomes. The higher prevalence of ADHD among students with low cognitive ability also suggests that many rural children in China face multifactorial learning challenges. Taken together, the findings indicate a need for educators and policymakers in rural China to develop programs to reduce risk and support students with ADHD symptoms.
China’s economy has doubled in size every eight years since 1979, making it over 32 times bigger now then it was then and the second largest in the world today.1 Four decades of growth have ushered more than 400 million people in China into the global middle class.2 According to the World Bank, China is currently an upper middle-income country. The country is the only major economy on earth to report growth in 2020 in the wake of the coronavirus pandemic.3 What are the prospects for China to continue its spectacular economic rise and become a high-income country? In this article, we aim to draw attention to an underappreciated factor that we believe may complicate China’s continued economic ascent: hundreds of millions of poorly educated, increasingly underemployed workers hailing from China’s rural hinterland.
This study examines the effects of local and nationwide COVID‐19 disease control measures on the health and economy of China's rural population. We conducted phone surveys with 726 randomly selected village informants across seven rural Chinese provinces in February 2020. Four villages (0.55%) reported infections, and none reported deaths. Disease control measures had been universally implemented in all sample villages. About 74% of informants reported that villagers with wage‐earning jobs outside the village had stopped working due to workplace closures. A higher percentage of rural individuals could not work due to transportation, housing, and other constraints. Local governments had taken measures to reduce the impact of COVID‐19. Although schools in all surveyed villages were closed, 71% of village informants reported that students were attending classes online. Overall, measures to control COVID‐19 appear to have been successful in limiting disease transmission in rural communities outside the main epidemic area. Rural Chinese citizens, however, have experienced significant economic consequences from the disease control measures.
In late January 2020, China’s government initiated its first aggressive measures to combat COVID-19 by forbidding individuals from leaving their homes, radically limiting public transportation, cancelling or postponing large public events, and closing schools across the country. The rollout of these measures coincided with China’s Lunar New Year holiday, during which more than 280 million people had returned from their places of work to their home villages in rural areas. The disease control policies remained in place until late February and early March, when they were gradually loosened to
Previous literature suggests subpar teaching is a primary reason why rural Chinese students lag behind academically. We initiate an investigation into the potential of educational technology (EdTech) to increase teaching quality in rural China. First, we discuss why conventional approaches of improving teaching in remote schools are infeasible in China’s context, referring to past research. We then explore the capacity of technology-assisted instruction to improve academic performance by examining previous empirical analyses. Third, we show that China is not limited by the resource constraints of other developing countries due to substantial policy support and a thriving EdTech industry. Finally, we identify potential implementation-related challenges based on the results of a preliminary qualitative survey of pilots of EdTech interventions. With this paper, we lay the foundation for a long-term research investigation into whether EdTech can narrow China’s education gap.
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.
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.
Purpose – The purpose of this paper is to produce a high-quality measure of the nature of healthcare resources available in China’s Township Health Centers (THCs), paying particular attention to equity between high- and low-income areas.
Design/methodology/approach – This study makes use of data from a nearly nationally representative survey in rural China conducted by the Center for Chinese Agricultural Policy at the Chinese Academy of Sciences in 2011. The samples of towns were selected randomly from 25 counties located in five provinces from different regions of China. Data were collected through questionnaires and direct observation.
Findings – The THCs located in rich areas have higher levels of human resources than poor areas. THCs in rich areas also have more fixed assets than those in poor areas. In fact, even though the Chinese Ministry of Health mandates that all THCs have certain basic levels of medical equipment and facilities, many THCs in poor areas do not have them. The allocation of mandated equipment is unequal.
Practical implications – These findings suggest that China’s government should pay more attention to THCs located in poor areas, especially in light of new initiatives to improve health care in poor rural areas.
Originality/value – This is the first nationally representative study to employ rigorous empirics to investigate the extent of inequality in allocation of resources within THCs across China.
Keywords China, Health, Inequality, Rural development, Medical resources, Township health centers
Paper type Research paper
Recent attention has been placed on whether integrating Information Communication Technology (hereafter, ICT) into education can effectively improve learning outcomes. However, the empirical evidence of the impact of programmes that adopt ICT in schooling is mixed. Theory suggests it may be due to differences in whether or not the ICT pro-grammes are integrated into a teaching programme of a class. Unfortunately, few empirical studies compare the relative effectiveness of programmes that integrate ICT into teaching with the ones that do not. In order to understand the most effective way to design new programmes that attempt to utilize ICT to improve English learning, we conducted a clustered randomized controlled trial (RCT) with some schools receiving ICT that was in-tegrated into the teaching programme of the class; with some schools that received ICT without having it integrated into the teaching programme; and with other schools being used as controls. The RCT involved 6304 ﬁfth grade students studying English in 127 rural schools in rural China. Our results indicate that when the programme is integrated into the teaching programme of a class it is effective in improving student test scores relative to the control schools. No programme impact, however, is found when the ICT programme is not integrated into the teaching program. We also ﬁnd that when ICT programmes are inte-grated into teaching, the programmes work similarly for students that have either high or low initial (or baseline) levels of English competency. When ICT programmes are not in-tegrated with teaching, they only raise the educational performance of English students who were performing better during the baseline.
The education of poor and disadvantaged populations, particularly those from minority subgroups, has been a long-standing challenge to education systems in both developed and developing countries (e.g., World Bank 2001, 2004; Glewwe and Kremer 2006; Planty et al. 2008). For example, over the past decade in the United States the high school dropout rate of Hispanic students has remained at least twice as high as that of white students (Aud et al.