Abstract
BackgroundLeft-behind children (LBC) are recognised as a new social group in China. LBC are young children who are abandoned in rural villages whilst their parents travel to distant urban centres for employment (a new generation of migrant workers). Following the rapid growth in the number of migrant workers, the LBC population is also rapidly increasing. These children are usually left to be raised by elderly grandparents, a single parent, or sometimes distant relatives or neighbours who have limited resources, tend to have a poor education and sometimes are in frail health. Over 40 % of the 61 million LBC in China who are under 5 years old are undernourished, which affects their long-term health and abilities. An intervention that combines a conditional cash transfer (CCT) with nutrition education offers a potential solution.Methods/DesignA cluster randomised controlled trial design will be used to allocate 40 villages to the intervention arm (20 villages) or control arm (20 villages). The caregivers and all of the 3–5-year-old LBC will be the target population. Caregivers in the intervention arm will receive a cash allowance conditional on attending nutrition education sessions, ensuring that the LBC will use basic public health services over a 12-month period. At the baseline, midterm (month 6) and end (month 12) of the intervention period, evaluations will be conducted in all 40 villages. Multilevel generalised linear models will be used to analyse the impact of the intervention on nutrition status and other outcomes, adjusting for baseline levels using an analysis of covariance approach. The cost of the intervention will also be estimated.DiscussionIf found to be cost-effective, the findings will inform the development of a sustainable model to improve nutrition status among LBC in rural areas of China.Trial registrationChinese Trial Register (ChiCTR) identifier: CTXY-140003-2. Registered on 19 Aug 2014.
Highlights
Left-behind children (LBC) are recognised as a new social group in China
If found to be cost-effective, the findings will inform the development of a sustainable model to improve nutrition status among LBC in rural areas of China
We hypothesised that the intervention will affect the nutrition status and development of LBC through the following two pathways: 1. conditional cash transfer (CCT) pathway: Cost of food is a significant barrier to nutrition
Summary
A Chinese national report indicates that the deaths of children younger than 5 years old in China which are attributable to undernutrition decreased from 22 % in 2000 to 13 % in 2010. No suitable interventions are in place for those aged 3–5 years, a group in which undernutrition is prominent The aim of this trial is to evaluate the provision of CCT in combination with nutrition education on improving nutritional status and development of 3–5-yearold LBC. Since CCT interventions have not been assessed previously in relation to improving children’s nutritional status in China, the findings of this study could provide strong evidence for central and local government health policy decision-makers in terms of long-term implementation. The results of this study will provide evidence for whether cashlike instruments would be more appropriate for use in future nutrition interventions in China. HQ participated in developing the study design and the nutrition workshop intervention. JD participated in developing study design and the CCT intervention.
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