Is Infant/Toddler Anemia a Problem across Rural China? A Mixed-Methods Analysis
Abstract
:1. Introduction
2. Methods
2.1. Study Location and Sample Selection
2.1.1. Quantitative Data Sets
2.1.2. Qualitative Data Sets
2.2. Data Collection
3. Results
3.1. Quantitative Results
3.2. Qualitative Results
“(Anemia happens when) nutrition is poor, and there is an iron deficiency.”(Mother, central China rural village, 1231128)
“Anemia is low levels of hemoglobin.”(Grandmother, migrant community, 1221161)
“I don’t really know (what anemia is). It should be something to do with lacking nutrition.”(Grandmother, western China rural village, 1402116)
“The child’s nutrition isn’t good, which leads to the child not having enough blood.”(Grandmother, western China rural village, 1402110)
“Anemia means there isn’t enough blood, which happens because of an iron deficiency.”(Mother, resettlement community, 1112114)
“I can’t control (anemia in my child) by myself. It has to do (among other things) … with genes getting passed down, so who really knows?”(Grandmother, migrant community, 1221304)
“I really don’t know. There’s way too much going on with kids, who knows?”(Grandmother, western China rural village, 1406115)
“I don’t know—actually, it’s this, sometimes you squat down, and then after you get up you’re dizzy. That’s an example of the effect of anemia.”(Father, western China rural village, 1221123)
“You don’t want to be anemic … there’s no energy. It’s like a car without oil.”(Grandmother, migrant community, 1221304)
“(When a child is anemic), there’s dizziness, there’s not enough blood, (the child) won’t eat enough food, and (the child) won’t sleep well at night.”(Mother, migrant community, 1221130)
“(Anemia happens when) there’s a lack of iron … and it’s easier to get sick and intelligence decreases.”(Mother, resettlement community, 1112104)
“There’s no effect. Eating, sleeping, playing, whatever—they’re all fine.”(Grandmother, central China rural village, 1231135)
“Generally speaking, my child catches cold frequently, gets sick easily. Their constitution is not so good. (Because of this), anemia shouldn’t have too much of an effect.”(Mother, western China rural village, 1402130)
“When you’re looking after the child, you have to pay attention to what’s going on. Sometimes the color of the child’s face isn’t quite right. (If) it’s a little yellow, that could be anemia.”(Grandmother, western China rural village, 1406112)
“Their face will be yellow, and they’ll be short for their age.”(Mother, resettlement community, 1112114)
“I saw on TV that anemic children are thin.”(Father, resettlement community, 1112137)
“I’ve heard other people say anemia is when there’s high blood pressure and dizziness.”(Mother, resettlement community, 1112123)
“When nutrition is bad, when (the child) doesn’t eat well, when nutrition is uneven, that sort of thing (can cause anemia).”(Mother, resettlement community, 1112115)
“I think if the baby is anemic, the baby will cry a lot, misbehave, be uncomfortable, be noisy. The baby’s mood will be unstable. The baby’s constitution will be bad and droopy. They’ll be dispirited.”(Grandmother, migrant community, 1221116)
“My child is in good health.”(Mother, resettlement community, 1112110. Child moderately anemic, Hb = 74)
“My child is … fine.”(Mother, migrant community, 1221145. Child moderately anemic, Hb = 99)
“No way. My granddaughter is not anemic.”(Grandmother, western China rural village, 1402116. Child moderately anemic, Hb = 82)
“Doesn’t it have to do with (the child) being picky? And not giving the child well-arranged servings of rice, meat, and vegetables, giving (those things) unevenly. But exactly what causes anemia, I’m not too sure about that.”(Grandmother, migrant community, 1221119)
“I would provide food that is good for the child’s stomach. But I’m really not clear what food that is exactly. If the child is only a little anemic, I would not try to manage it.(Mother, migrant community, 1221329)
“You should give the child lots of water to drink.”(Grandmother, migrant community, 1221119)
“My child had a full body exam at the hospital when she was born, so she’s fine. She does not need treatment.”(Mother, migrant community, 1221145. Child moderately anemic, Hb = 99)
“No, (she is not anemic). But, even if she were anemic, nothing is needed be done.”(Grandmother, western China rural village, 1402116. Child is moderately anemic, Hb = 82)
“I use the internet on my phone to learn about (anemia.) But there are many different opinions so I do not know which one is right.”(Mother, western China rural village, 1402120)
“I listen to the village doctor. He said that if the child’s face is yellow, he has anemia and that this is bad for the child.”(Mother, western China rural village, 1112110)
“I listen to my family and close friends in the village. They say that it is easy to know if your child has anemia. You just look at your child and see if they’re dizzy.”(Mother, western China rural village, 1406103)
“I don’t trust anyone else. It’s just based on my own knowledge.”(Mother, western China rural village, 1402101)
“The information comes from my own life, and from my cell phone.”(Father, migrant community, 1221328)
3.2.1. The Environment in Poor, Rural China
“It is inconvenient to buy meat. After all, there is still some distance from the county seat to my home.”(Grandmother, western China rural village, 1402114)
“It isn’t convenient to buy meat here. The store that sells meat is too far away.”(Mother, resettlement community, 1112116)
“It’s inconvenient. You have to go to the main road to buy (meat), it’s so far.”(Mother, resettlement community, 1112114)
3.2.2. Absence of Quality Health Care
“Sometimes when you see the doctor, the anemia medicine they prescribe would make (the child) feverish …”(Grandmother, central China rural village, 1231124)
“The hospital isn’t very good. If we went to the hospital (my child) might get sick in another way.”(Mother, western China rural village, 1402118)
“I would never bring a child to the hospital …”(Grandmother, migrant community, 1221126)
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Study | Location of Study | Date | Community Type | Ages of Children | Number of Observations |
---|---|---|---|---|---|
Project 1 | Southern Shaanxi | 2015–2016 | Western Rural Communities | 6–24 months | 1804 |
Project 2 | Hebei; Yunnan | 2015–2016 | Western Rural Communities | 6–30 months | 638 |
Project 3 | Southern Shaanxi, Henan | 2017 | Resettlement Migration Communities | 6–30 months | 135 |
Project 4 | Henan; Central Shaanxi | 2017 | Central China Rural Communities | 6–30 months | 128 |
Project 5 | Beijing; Zhengzhou, Henan; Xi’an, Shaanxi | 2017 | Migrant Communities | 6–30 months | 204 |
Variables | Full Sample | Western Rural Villages | Resettlement Migration Communities | Difference (2)−(3) | Central China Rural Villages | Difference (2)−(5) | Migrant Communities | Difference (2)−(7) |
---|---|---|---|---|---|---|---|---|
Mean (SD) (1) | Mean (SD) (2) | Mean (SD) (3) | p-Value (4) | Mean (SD) (5) | p-Value (6) | Mean (SD) (7) | p-Value (8) | |
Characteristics of the infants | ||||||||
Age (in month) | 16.50 | 15.44 | 16.41 | 0.330 | 17.62 | 0.001 | 16.09 | 0.524 |
(6.73) | (5.72) | (6.80) | (7.39) | (6.74) | ||||
Gender (1 = male) | 0.53 | 0.51 | 0.54 | 0.885 | 0.56 | 0.659 | 0.49 | 0.961 |
(0.50) | (0.50) | (0.50) | (0.50) | (0.50) | ||||
Premature (1 = yes) | 0.06 | 0.05 | 0.04 | 0.983 | 0.06 | 0.849 | 0.09 | 0.025 |
(0.24) | (0.21) | (0.19) | (0.24) | (0.29) | ||||
Characteristics of the parents and the households | ||||||||
Maternal age | 0.70 | 0.67 | 0.71 | 0.802 | 0.70 | 0.949 | 0.75 | 0.137 |
(1 = above 25 years old) | (0.46) | (0.47) | (0.45) | (0.46) | (0.43) | |||
Maternal education level | 0.34 | 0.23 | 0.36 | 0.009 | 0.32 | 0.143 | 0.61 | <0.001 |
(1 = 12 years or higher) | (0.47) | (0.42) | (0.48) | (0.47) | (0.49) | |||
Primary caregiver | 0.67 | 0.73 | 0.58 | 0.004 | 0.59 | 0.012 | 0.73 | 0.999 |
(1 = mother) | (0.47) | (0.45) | (0.50) | (0.49) | (0.44) | |||
Household receives social | 0.11 | 0.11 | 0.11 | 0.996 | 0.13 | 0.971 | 0.09 | 0.791 |
security support (1 = yes) | (0.32) | (0.32) | (0.31) | (0.33) | (0.28) | |||
Household asset index | 0.36 (1.21) | −0.19 (1.21) | 0.37 (1.22) | <0.001 | 0.48 (1.08) | <0.001 | 1.23 (0.86) | <0.001 |
Observations | 2909 | 2442 | 135 | 128 | 204 |
Variables | Full Sample | Western Rural Villages | Resettlement Migration Communities | Difference (2)−(3) | Central China Rural Villages | Difference (2)−(5) | Migrant Communities | Difference (2)−(7) |
---|---|---|---|---|---|---|---|---|
Mean (SD) (1) | Mean (SD) (2) | Mean (SD) (3) | p-Value (4) | Mean (SD) (5) | p-Value (6) | Mean (SD) (7) | p-Value (8) | |
Anemic (Hb < 110 g/L) | 0.43 | 0.40 | 0.52 | 0.118 | 0.46 | 0.716 | 0.43 | 0.947 |
(0.50) | (0.49) | (0.50) | (0.50) | (0.50) | ||||
Stunting (Height for age z-score < −2) | 0.04 | 0.05 | 0.05 | 1.000 | 0.03 | 0.921 | 0.02 | 0.490 |
(0.19) | (0.21) | (0.22) | (0.18) | (0.15) | ||||
Underweight (Weight for age z-score < −2) | 0.01 | 0.02 | 0.02 | 0.999 | 0.02 | 0.999 | 0.00 | 0.352 |
(0.12) | (0.13) | (0.12) | (0.13) | (0.00) | ||||
Wasting (Weight for height z-score < −2) | 0.04 | 0.03 | 0.02 | 0.991 | 0.04 | 0.914 | 0.04 | 0.914 |
(0.18) | (0.17) | (0.15) | (0.20) | (0.19) | ||||
Observations | 2842 | 2380 | 127 | 125 | 184 |
Health Outcomes | Age (6–18 Months) | Age (18–30 Months) | Difference (1)–(2) |
---|---|---|---|
Mean (SD) (1) | Mean (SD) (2) | p-Value (3) | |
Anemic (Hb < 110 g/L) | 0.51 | 0.30 | <0.001 |
(0.50) | (0.46) | ||
Stunting (Height for age z-score < −2) | 0.04 | 0.03 | 0.199 |
(0.20) | (0.17) | ||
Underweight (Weight for age z-score < −2) | 0.01 | 0.01 | 0.959 |
(0.12) | (0.12) | ||
Wasting (Weight for height z-score < −2) | 0.04 | 0.03 | 0.181 |
(0.19) | (0.17) | ||
Observations | 1878 | 967 |
Variables | Anemic |
---|---|
Child characteristics | |
Child age (months) | −0.01 *** (0.00) |
Male (1 = yes) | −0.04 (0.03) |
Premature (1 = yes) | 0.00 (0.07) |
Household characteristics | |
Maternal age (1 = above 25 years old) | −0.04 (0.05) |
Maternal education level (1 = 12 years or higher) | −0.05 (0.03) |
Primary caregiver (1 = mother) | 0.07 (0.05) |
Household receives social security support (1 = yes) | −0.03 (0.08) |
Household asset index | −0.01 (0.02) |
Western rural community (1 = yes) | −0.07 (0.21) |
Resettlement migration community (1 = yes) | 0.11 (0.09) |
Central rural community (1 = yes) | 0.10 (0.07) |
Tester Fixed Effect | YES |
Observations | 2682 |
Adj. R2 | 0.139 |
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Share and Cite
Wang, L.; Sun, Y.; Liu, B.; Zheng, L.; Li, M.; Bai, Y.; Osborn, A.; Lee, M.; Rozelle, S. Is Infant/Toddler Anemia a Problem across Rural China? A Mixed-Methods Analysis. Int. J. Environ. Res. Public Health 2018, 15, 1825. https://doi.org/10.3390/ijerph15091825
Wang L, Sun Y, Liu B, Zheng L, Li M, Bai Y, Osborn A, Lee M, Rozelle S. Is Infant/Toddler Anemia a Problem across Rural China? A Mixed-Methods Analysis. International Journal of Environmental Research and Public Health. 2018; 15(9):1825. https://doi.org/10.3390/ijerph15091825
Chicago/Turabian StyleWang, Lei, Yonglei Sun, Buyao Liu, Lijuan Zheng, Mengjie Li, Yu Bai, Annie Osborn, Maggie Lee, and Scott Rozelle. 2018. "Is Infant/Toddler Anemia a Problem across Rural China? A Mixed-Methods Analysis" International Journal of Environmental Research and Public Health 15, no. 9: 1825. https://doi.org/10.3390/ijerph15091825