response to a 16 billion RMB school lunch program, one of the most fundamental strategies has been to pass out eggs to students
(Ministry of Education, 2012).
Why is it that provincial governments, which state that they want to improve educational performance, in the face of evidence
that multiple micronutrient supplements are effective, decide to distribute eggs to their students? There are a number of possible
reasons. One answer may be that it is more convenient since eggs can be procured locally. Another reason may be that culturally it
is more acceptable to give out eggs, which are thought to be nutritious. In fact, in certain ways, eggs are nutritious (US
Department of Agriculture: Agricultural Research Service, 1999). But, the fact remains, while protein-rich and readily available,
eggs lack high enough levels of many of the micronutrients that students are deficient in, particularly iron (eggs have only
0.5 mg), the underlying cause of anemia in students in these regions. Is there something about eggs that may be addressing some
other nutritional problem, which when given, will result in even better health and higher test scores? Unfortunately (from the
view point of understanding the impact of the egg programs), in the case of both Shaanxi and Ningxia provinces, the government
chose to distribute eggs to all students in the province, a move that made evaluation impossible.
The goal of this paper is to examine the effect of two separate interventions – an egg treatment and a chewable vitamin
treatment – on the anemia status and educational performance of fourth-grade students in Gansu Province. We hope such a study
will help clarify whether the policy initiatives of educational leaders who are trying to battle malnutrition as a way to improve
educational performance are effective, or whether leaders should consider adopting a direct supplementation approach.
To meet this overall goalwe have three specific objectives. First,wemeasure the extent of anemia among students in our sample.
Second, we seek to measure the impact of the two interventions on hemoglobin levels and anemia status. Third and finally, we
analyze whether the different approaches to improve student health status actually lead to better educational performance.
To meet these objectives, we report on the results of a randomized controlled trial (RCT) that was conducted in 70 elementary
schools in 5 rural counties in Gansu Province. The RCT was made up of three stages. First, we conducted a baseline survey in
November 2010 and collected data from over 2000 fourth grade students (mostly aged 9 to 12) in the sample schools before any
intervention. Second, we implemented two interventions (a six month long chewable vitamin treatment in which students were
given a daily chewable vitamin with iron; and a six month long treatment in which students were given a daily cooked egg).
These two interventions were given to students in a randomly assigned set of 40 schools, with 20 schools randomly assigned to
each intervention. The remaining 30 schools served as a control group and received no intervention. Finally, in June 2011, after
the interventions were completed, we conducted an evaluation survey.
According to our baseline survey, 20% of the students in our 70 sample schools had hemoglobin (Hb) levels below 120 g/L, the
World Health Organization's anemia cutoff for children who aged 9 to 12 years old (Gleason, Scrimshaw, Kraemer, & Zimmermann,
2007; UNICEF, 2001). Our multivariate results show that when students in the chewable vitamin group were given one chewable
vitamin (that contained 5 mg of iron per tablet and 20 other vitamins and minerals) per day for 6 months, their Hb levels rose by 2.5
points more than students in the control, untreated group. The standardized math test scores of students in the chewable vitamin
schools also rose slightly. On the other hand, eggs did not significantly affect the student's Hb levels andwe found no effect of the egg
treatment on students' standardized math test scores.
The rest of this paper is organized as follows. Section 2 explains our methodology, including sampling methods, interventions/
experimental arms, data collection (including our key outcome measures—Hb levels and standardized math test scores) and
statistical approach. Section 3 reports the descriptive statistics and multivariate results of the analysis that studies the impact of
the two interventions (chewable vitamins and eggs) on student Hb levels. Section 4 covers the descriptive statistics and
multivariate results of the analysis that examines the impact of the two interventions on student standardized math test scores.
Section 5 concludes.