Health allowance for improving the nutritional status and development of 3-5-year-old left-behind children in poor rural areas of China: study protocol for a cluster randomised trial.
BACKGROUND
Left-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
A 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.


CONCLUSIONS
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.


BACKGROUND
Chinese Trial Register (ChiCTR) identifier: CTXY-140003-2 . Registered on 19 Aug 2014.
School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China. linqian@csu.edu.cn.
Qian
Q
Lin
Department of Public Health, Epidemiology & Biostatistics, University of Birmingham, Birmingham, UK. p.adab@bham.ac.uk.
Peymané
P
Adab
Department of Public Health, Epidemiology & Biostatistics, University of Birmingham, Birmingham, UK. k.hemming@bham.ac.uk.
Karla
K
Hemming
School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China. 63455553@qq.com.
Lina
L
Yang
School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China. qinhong.q@qq.com.
Hong
H
Qin
School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China. lmz1976@126.com.
Mingzhi
M
Li
School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China. dengjing2@126.com.
Jing
J
Deng
School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China. jingzhengs@126.com.
Jingcheng
J
Shi
School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China. 49937268@qq.com.
Jihua
J
Chen
D000367:Age Factors; D018798:Anemia, Iron-Deficiency / Q000191:economics / Q000503:physiopathology / Q000517:prevention & control; D017028:Caregivers / Q000191:economics* / Q000193:education; D002657:Child Development; D002662:Child Health Services / Q000191:economics*; D002664:Child Nutritional Physiological Phenomena; D002670:Child, Abandoned; D002675:Child, Preschool; D002681:China; D003362:Cost-Benefit Analysis; D006130:Growth Disorders / Q000191:economics / Q000503:physiopathology / Q000517:prevention & control; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D009313:National Health Programs / Q000191:economics*; D015596:Nutrition Assessment; D009752:Nutritional Status; D015397:Program Evaluation; D011632:Public Assistance / Q000191:economics*; D012107:Research Design; D019035:Rural Health Services / Q000191:economics*; D012424:Rural Population; D013997:Time Factors