Environmental Determinants of Nutritional and Health Status of School-Aged Children in Rural China

Background and purpose: The prevalence of underweight and stunting in children in rural China is 3 to 4 times that of children in urban China. The nutritional status of people especially the absorption process, is closely related to water, sanitation, and hygiene related (WASH) facilities. Because of the poor WASH facilities in rural China, there were 727,511 cases of infectious diarrhea reported in 2010; children are the high-risk population, which accounts for more than half of the reported cases.

This paper aims at testing hypothesis of the significant roles of WASH facilities and access to other public goods such as access to the clean cooking fuels and trash services on the nutritional status and health status of children in rural China.  This paper also tests the hypothesis that the public goods play a more important role on nutritional and health status of girls.

Methods: Chinese Family Panel Study 2014 community, family and children datasets are used to test the relationship between the public goods and nutritional and health status of school aged children.  Multilevel logistic regressions were used to control for clustering effects. Undernutrition consists of two types: underweight and stunting. Underweight is defined as BMI for age that is one SD below the Chinese Children Growth Reference Standard. Stunting is defined as the height for age that is lower than the Chinese Children Growth Reference Standard. The type of public goods included in the analysis are access to the tap water, bathrooms, electricity, trash collecting services, and clean cooking fuels. 

Results: WASH facilities are significantly correlated with the odds of undernutrition of school age children, especially the access to flush bathrooms and trash pick-up services. Children having access to flush bathrooms are 2 times less likely to be stunted, and 57% less likely to be underweight. Children living in families having trash pickup services are 42% less likely to be stunted Children in the families that cook with clean fuels are 30% less likely to be stunted, and 23% less likely to be underweight. Family income is not a significant predictor of the odds of undernutrition among children. In addition, accessing to flushing bathrooms has more impact to girls’ nutritional status than boys.

Conclusions and Implications: Chinese government needs to accelerate the speed in providing public goods to the rural communities because public goods play an important role in improving the health and nutritional status of children in rural China, especially for the girls. Therefore, in order to further improve the gender inequality and socioeconomic development of rural region, improving the access to public goods is crucial.