Freeman Spogli Institute for International Studies Program on Energy and Sustainable Development Stanford University


Research at PESD


Egg Programs and Nutritional Deficiencies in Gansu: Worth the Effort?

REAP Project
Project Ongoing

Problem

During the 2008/09 school year, REAP conducted their first study of anemia, its causes and its consequences in Shaanxi Province. We found that anemia, or severe iron deficiency, is widespread in poor rural areas of the province, affecting nearly 40 percent of the students in the sample. Poor nutrition was identified as the main source of anemia. According to international literature, this can almost certainly account for part of the poor educational performance of China's rural poor. When children received vitamins with minerals tablets (21) or 21 SUPER-VITA on a daily basis, anemia rates of these children fell and educational test scores rose.

Partly in response to our work and the policy briefs that were written based on the study results (and also due to their own commitment to better nutrition), in September 2009 the provincial governor of Shaanxi announced that he was committing the province to providing every student in the province one egg (or one glass of milk) per day. His hope was that improved nutrition would result in healthier students and better educational performance. By any metric, the efforts of the provincial leadership are laudable. Eating an egg a day is beneficial for many students in Shaanxi's poor rural schools.

The government is able to provide an egg for each of these students, but is that enough?

However, there was still another problem. Unfortunately, the new initiative of the Shaanxi provincial governor should not be expected to do anything to overcome anemia. The reason is that eggs--despite being a nutritious food--contain almost no iron, and neither does milk, which would not alleviate anemia. Remarkably little is known about how serious such nutritional deficiencies are on educational performance. There also has been little research done to test the effectiveness of different approaches to overcome the nutrition problems. The national government now currently supports initiatives of giving children one egg a day, but is that really enough to make a positive impact?

Goals

We have shifted our research to school aged children in Gansu province, where we hope that finding the answer to this question will guide future initiatives rolled out by China's government to address nutritional problems among millions of school aged children throughout the country’s poor, rural areas. 

  • Demonstrate whether there is low hemoglobin count (which is known to be correlated with iron deficiency (anemia)) among fourth grade students in poor areas of Gansu province

  • Assess the impact of consuming an egg per day on i) hemoglobin count; ii) grades; iii) cognitive test scores; iv) standard psychological test scores as measured by a written test

Approach

 

Acquire Baseline information

  • Establish the nutritional status in China's poor rural areas by testing fourth grade students in sample schools in Gansu. Student will be given hemocue, finger prick-based tests, on-site, to determine levels of hemoglobin in the blood (that are highly correlated with anemia and iron deficiencies)
  • Develop indicators for measuring the impacts of eliminating anemia such as: collecting student grades from the school officials, administering a standardized cognitive test, and running a standard psychological test

Implement Nutrition Supplementation Program

All fourth grade students in a randomly selected subset of program schools will receive 1 hard-boiled egg per day, 7 days a week, for six months.

Can eggs improve student health and educational performance?

Execute an Evaluation that will Follow Up on the Baseline

After the egg-a-day intervention is completed (in month 7 of the study), we will repeat the same tests conducted at baseline (hemocure finger prick hemoglobin tests AND cognitive and psychological tests) and collect student grades.

Participant Population

The study will be conducted in 20 randomly chosen schools in 6 of the poorest counties in Gansu province. All fourth grade students in each school will be enrolled in the study - an average of 50 students from each school, who may be negatively affected by anemia and whose related educational abilities and performance we are interested in studying. (50 x 20 = 1000).

Evaluation

Blood hemoglobin levels as an indicator of nutritional status and anemia will be obtained. Student grades and standardized cognitive and psychological test results will be obtained before and after intervention to determine whether one egg a day is effective.

Results

Our results show that eggs did not lead to rises in hemoglobin levels. In fact, average Hb levels fell in schools that received eggs.

We also found no effect of the eggs treatment on students’ standardized math test scores. Compared to the increase seen in the control group (0.37 standard deviations), standardized math scores in egg schools improved by only 0.34 standard deviations.

Policy Implications

 

If eggs are not the answer, try chewable vitamins

However, millions of eggs have already been distributed to students in rural Shaanxi and Ningxia province. At the national level, a US$2.5 billion school lunch program launched in 2011 further promotes eggs as a fundamental strategy.Given that eggs have very little iron (only 0.5 mg vs. 5 mg for a chewable vitamin), the results confirmed our suspicion that eggs, while nutritious, are not enough to significantly decrease anemia rates in China.

We hope our findings will encourage China’s Ministry of Education (MOE) to look beyond eggs when tackling malnutrition in their efforts to improve educational performance. Rather, we encourage policymakers to consider adopting a direct supplementation approach.

A parallel REAP study shows that chewable vitamins fortified with 5 mg of iron and taken regularly over a sixth month period, increases hemoglobin levels, decreases anemia rates, and increases standardized test scores. Compared to eggs, chewable vitamins are also cheaper to buy and easier to distribute. With the right allocation of funding, policymakers can give kids in poor, rural China a healthier, brighter future.