Paying-for-performance and cost effectiveness of strategies to combat anaemia in China

ISRCTN	ISRCTN76158086
DOI	https://doi.org/10.1186/ISRCTN76158086
Secondary identifying numbers	N/A

Submission date: 11/01/2011
Registration date: 31/01/2011
Last edited: 18/12/2020

Recruitment status: No longer recruiting
Overall study status: Completed
Condition category: Haematological Disorders

Prospectively registered

Protocol

Statistical analysis plan

Results

Individual participant data

Plain English summary of protocol

Not provided at time of registration

Contact information

Dr Scott Rozelle
Scientific

616 Serra Street, Encina Hall
East Wing, Room 402
Stanford
94305
United States of America

Study information

Study design	Interventional multicentre cluster-randomised trial
Primary study design	Interventional
Secondary study design	Randomised controlled trial
Study setting(s)	Other
Study type	Quality of life
Scientific title	Paying-for-performance and cost effectiveness of strategies to combat anaemia in China: an interventional, multicentre cluster-randomised trial
Study objectives	To study the impact of financial incentives to primary school principals on anaemia reductions among students in rural China. As of 15/03/2011 the target number of participants for this study has been increased from 2,957 to 3944
Ethics approval(s)	Stanford University Human Subjects Research Institutional Review Board approved on the 21st July 2009 (ref: 17071)
Health condition(s) or problem(s) studied	Iron deficiency anaemia
Intervention	Information only: To some randomly-assigned schools we provided three types of information to school principals: 1. The share of enrolled students who are anaemic 2. Descriptions of efficacious methods for reducing anaemia (including vitamin supplementation, lunch fortification, and other dietary changes as well as the possible role of educating parents about anaemia) 3. Details about anaemia's relationship to school attendance, educational performance, and cognitive development as reported in peer-reviewed academic studies Information and earmarked operating budget subsidy (hereafter termed "Subsidy" for simplicity): Because purchasing inputs to reduce anaemia may be difficult given current operating budgets (which have little discretionary funds available), we randomly assigned some schools to receive earmarked operating budget subsidies. The subsidy schools were given 1.5 RMB per student per day, an amount that was enough to buy two to three ounces of red meat if the entire amount was spent on red meat. These subsidies are only allowed to be used for nutrition-related expenses. However, it is always possible that other components of a school budget could be re-allocated, effectively resulting in subsidies being used for other more highly prioritised purposes (if a school's own nutrition spending fell in response to the subsidy); we investigate this possibility directly. In addition, we provide exactly the same information to principals as in Information only schools. Information and earmarked operating budget subsidy and anaemia reduction incentive (hereafter termed "Incentive"): To test the effectiveness of direct rewards for health improvement, we randomly assigned a third group of school principals to receive performance payments for reductions in anaemia among their student populations. Given the governance structure of Chinese primary schools, school principals make executive decisions about school operations (National People's Congress 1995). Incremental incentive payments were linear in the absolute reduction in students with anaemia (150 RMB per student) between baseline and follow-up. The amount 150 RMB was chosen to equal roughly two months of salary (3000 RMB) if the principal was successful in reducing the number of students with anaemia by 20 students a feasible reduction according to our early pilot experience. These schools also received the same information and subsidies as in the Information only and Subsidy schools. Control Group (Added 15/03/2011): No intervention in these schools. The treatment lasted 6 months. The evaluation survey was done over the course of a week. As of 15/03/2011 the trial record has been updated to include an additional control group.
Intervention type	Other
Primary outcome measure	Haemoglobin concentrations, obtained by finger prick testing using HemoCue AB point-of-care diagnostics, measured during the evaluation survey, six months after the start of the treatment
Secondary outcome measures	Measured during the evaluation survey, six months after the start of the treatment: 1. Differential approaches of principals to reduce anaemia 2. Changes over time in the composition of meals at home (meat, tofu, and fruit) 3. Changes in school budgetary allocations in both the Subsidy, Incentive and Information only groups relative to the Control group
Overall study start date	10/01/2009
Completion date	06/04/2010

Eligibility

Participant type(s)	Patient
Age group	Child
Lower age limit	8 Years
Upper age limit	11 Years
Sex	Both
Target number of participants	3,944 (2,957 at time of registration)
Total final enrolment	3553
Key inclusion criteria	All fourth and fifth grade students (both male and female students ages 8 - 11 years) in 57 randomly selected rural primary schools in ten nationally designated poor counties in China's Ningxia and Qinghai provinces.
Key exclusion criteria	1. Students found to be extremely anaemic were excluded and sent to a clinician for treatment 2. Students identified as having thalassaemia
Date of first enrolment	10/01/2009
Date of final enrolment	06/04/2010

Locations

Countries of recruitment

China
United States of America

Study participating centre

616 Serra Street, Encina Hall

Stanford
94305
United States of America

Sponsor information

Stanford University (USA)
University/education

450 Serra Mall
Stanford
94305
United States of America

Website	http://www.stanford.edu/
"ROR"	https://ror.org/00f54p054

Funders

Funder type

Research organisation

International Initiative for Impact Evaluation (3ie), Inc. (USA)

No information available

Stanford University (USA)
Government organisation / Universities (academic only)

Alternative name(s): Stanford, Leland Stanford Junior University, SU
Location: United States of America

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to share	No
IPD sharing plan summary	Not provided at time of registration
Publication and dissemination plan	Not provided at time of registration
IPD sharing plan

Study outputs

Output type	Details	Date created	Date added	Peer reviewed?	Patient-facing?
Results article	results	27/07/2012	18/12/2020	Yes	No

Editorial Notes

18/12/2020: The following changes were made to the trial record:
1. Publication reference added.
2. The total final enrolment was added.