A new study shows as many as 5.1 million youngsters aged from eight to 12 and 6. 1 million aged between five and seven and 13 to 15 may be intellectually impaired in one of China's poorest rural areas.

Test results indicate the damage is being done by a lack of iron in their diets in what is being dubbed "The Silent Epidemic" by researchers because its symptoms are subtle and hard to detect. Without iron, blood cells cannot carry sufficient oxygen to vital organs, most importantly to the brain.

The findings were made by the Rural Education Action Project (REAP). If the figures were extrapolated across all poor areas of China, it would indicate that approximately 30 million children were anemic. The figures are soon to be published by the World Health Organization's Health Bulletin in a bid to raise awareness of the problem and attract funds to help alleviate it.

REAP, a non-governmental organization, surveyed 4,000 students from 66 randomly chosen elementary schools in eight of the poorest counties in Shanxi in north China.

"The only way people are going to escape poverty is through education," said Scott Rozelle, the group's US director who teaches agricultural economics at Beijing's Renmin University. "The only asset they have is their labor so education, health and nutrition are vital to improving their lives. Anemic children can lag behind their healthy classmates by as much as five to seven IQ points. Even after iron status is restored, these cognitive impairments are often irreversible and afflicted children can never catch up."

REAP identified the high rates of iron deficiency and anemia among the children through simple blood tests. Past studies suggest that inadequate nutrition has an adverse effect on educational performance.

"Public health practitioners around the world have found multiple strategies for effectively eradicating the incidence of iron deficiency anemia among populations," said Rozelle. "We seek to build on these lessons from the international literature and explore ways to reduce iron deficiency in rural China. Our goals in this project are twofold: to improve the nutrition of poor rural elementary students, specifically as related to iron deficiency anemia, in order to raise their educational performance, and to help policymakers understand how they can best act to reduce the incidence of anemia in rural China."

If successful, the work in this study will allow policymakers to compare the effectiveness of supplementing lunches with animal-based protein through existing school feeding programs; giving iron and multivitamin supplements directly to children in schools, and delivering school-level and household-level nutritional education campaigns."

REAP now wants to embark on a more extensive survey. It proposes selecting 100 schools with 43,000 students from poor areas in three areas of rural China: Shaanxi and Gansu provinces, and the Ningxia Hui Autonomous Region.

They would receive one of three treatments. In the first, a lunch program in 20 schools with about 10,000 students would involve giving one ounce of meat to the lunches of students. The second would involve a weekly vitamin supplement for about 10,000 students in 20 schools. The third would take the form of a nutritional education program in 40 schools with 20,000 students. In this, school staff would receive an intensive training course on preparing nutritious and cost-effective school meals, hygiene, food purchasing, and the relationship of these with health and education. Families and students would also receive the training.

A control group would be set up in order to provide a baseline against which the results from the treatment groups could be judged, involving the random selection of schools with 10,000 students. There would be no intervention in these schools.

REAP's work is being assisted by Stanford University and Stanford Nutrition and Education Support Group in the US, China's Ministry of Finance and Peking University's China Institute for Educational Finance Research.

(China Daily May 31, 2010)