Development of YYB in China

Transcription

1 Development of YYB in China Huo Junsheng, Chen Junshi and Chen Chunming China CDC/ILSI Focal Point in China October 10-11, Bangkok The importance of the nutritional status of the children under 2 in. China % Growth Retardation Age in Months The peak stunting prevalence is at 18 and 24 months, and no further changes until 5 years old. It means the critical time is under 24 months 1

2 The nutrition security of children under 24 mo. is the windows of opportunity for nutrition of the whole life course Scientific evidences proved Impact on: Individual essence of life (health, capability) Family The happiness and prosperous Society The quality human resources and development Solution-- Realistic proceeding from reality Current situation Conditions Low purchasing power Using available resources staple Time is limited No processing facilities Operation Poornutrition knowledge,not improving in a short run Nutritious food complex practice Nutrition rules are hard to remember What is the solution? conditions Reducing cost, with basic nutritional needs, Keep usual complementary feeding+supplememt Time saving-- one action- open and pour No facilitate needed Publicinformation but no waiting for fully understanding Reducing procedure home fortification Simple memory a pack per day Study on nutrients dense supplement food for complementary feeding for children>6 months of age Conventional complementary foods plus single-dose sachet per day to provide young children with the basic nutrition need. 2

3 Phase I: Observation study on the effectiveness of YingYangBao ( ) and extended to 2010 in 5 poor counties in Gansu 1500 infants from 5 poor counties in Gansu province, aged 4-12 mo, divided into two groups, feed with F-1+high dose VA every 6 mo. and F-2 for two years. Development of body and cognition, Hb, emotion, communication etc. were observed each year until 2010 and the results showed that benefit of F-1 on infants was significant. This study suggested that YingyangBao(YYB) as F-1 can be a effective way to improve the nutrition quality of complimentary food. YYB was then considered an approach to combat infant malnutrition, especially in poor regions. The analysis showed that the costbenefit was 1:15 in Gansu province. Two formulations F-1 F-2 Energy 44 kcal 44 kcal Protein 3.9 g -- Ca 385 mg -- VD 280 IU -- VB2 0.2 mg -- Iron 6.0 mg -- Zinc 4.1 mg -- Physical growth The changes of height-for-age z-score and weight-for-age z-score (from baseline to 24 months) Effect Size Height-for-age z-score 0.20* Weight-for-age z-score 0.15* *P < Baseline children include normal and malnourished children HAZ changes YYB Rice The average height of children at 24 months is 1.3 cm higher * P<0.05. The improvement of height-for-age in YingYangBao group is better than rice flour group. 3

4 Differences in Developmental Comparison of Development Quotient (DQ)and Intelligence Quotient (IQ) after finishing intervention at age of 24 months 24 months,3-4 years,4-6 years IQ at 5-6 years months 3-4 years 4-5 years IQ at age of 8-9 4

5 Improvement of anemia prevalence Anemia prevalence reduced Distribution curve of hemoglobin 营养包 米粉包 % 基线 干预 6 月 干预 12 月 干预 1 5 月 干预 18 月 Hemoglobin (g/l) Formu1 Base Formu1 12m Formu2 Base Formu2 12m Formula 1 YingYangBao Formula 2 rice flour package Phase II: The application of YingYangBao and the draft of the standards (2007-March, 2009) In 2007, the achievements of YingYangBaoin China gained international recognition at the Workshop on Nutrients Requirements and Food Supplements of Young Children In 2008, 6 months later of Wenchuan earthquake, YingYangBaointervention was carried out at Beichuancounty, Li xiancounty and Mao county which benefited more than 6000 children at 6-24 months (under the support of UNICEF and GAIN). Related regulatory activities of YingYangBaohave been initiated, and ILSI FP China and China CDC jointly drafted the food hygiene standards of YYB 5

6 Standard of YYB General standard for complementary food supplements GB Protein based MNP(YYB) Tablets MNP Spread Spreads Sprinkles Foodlets YYB products 6

7 Products of YYB Projects Regions Implement departmentsand partners Organizers/fundingagencies duration 辅食营养包甘肃贫困农村干预 婴幼儿辅食营养包推广研究 陕西梅县婴幼儿喂养和营养综合干预 婴幼儿辅食营养强化效果观察 中国西部四省儿童营养素补充项目 甘肃省天祝 静宁 清水 定西 景泰 5 个贫困县 山西长治与壶关 ILSI China, 甘肃省疾控与卫监 雀巢公司 FFO 首都儿研所 县妇幼保健院 百乐麦公司 ILSI/ILSI 卫生部 /GAIN 陕西眉县 ILSI China, 首都儿研所 UNICEF/UNICEF 甘肃榆中县 永靖县中国 CDC FFO UNICEF/UNICEF 内蒙 4 县 青海 3 县 贵州 3 县 广西 3 县部分人群 卫生部妇女儿童社会发展司 中国疾病预防控制中心妇幼保健中心 卫生部 / 亨氏联合有限公司 四川地震灾区婴幼儿营养干预 四川北川县和理县 FFO 四川省卫生局 县妇幼所 华西公共卫生学院 百乐麦公司 卫生部 /UNICEF GAIN ILSI 百乐麦 甘肃营养包对比研究甘肃榆中县和永靖县 ILSI FFO 甘肃省疾控 百乐麦公司 ILSI/UNICEF 贫困农村地区儿童营养缺乏改善适宜技术的研究 6 省 12 县部分婴幼儿营养食品所 省县 CDC DSM 北京世纪维他 支撑科技项目 社会公平 贫困地区儿童早期发展项目 汶川地震灾区婴幼儿营养干预 千年项目 青海乐都县 云南寻甸县 四川 5 县 陕西 2 县 甘肃 1 县 贵州正安县 陕西镇安县 云南武定县 CDRF 县政府 卫生局 ILSI FFO DSM 等 营养食品所 省县 CDC/ 妇幼所 百乐麦公司 婴幼儿喂养与营养改善项目 12 个省的部分地区 中华预防医学会儿童保健分会 WHO 儿童 卫生合作中心 天添爱公司 CDRF/CDRF 卫生部 /UNICEF USCDC 营养食品所 省县 CDC 百乐麦公司卫生部 /UNICEF 卫生部 / 天添爱生物科技有限公司 国际计划项目区营养包干预 甘肃省舟曲县 6-24 月龄儿童营养与健康干预项目 消除婴幼儿贫血行动 爱心营养包 分社区 甘肃舟曲县中国 CDC 营养与食品所卫生部 /UNICEF 陕西 6 县 宁夏 1 县 云南 2 县的部国际计划 (China Plan) 国际计划 / 国际计划 省覆盖 33 个县, 撒剂中国儿童少年基金会 中国 CDC 妇幼中心 全国妇联 卫生部 / 中国儿童发展基 各省县妇联 / 妇幼所金会 7

8 Nutrition Intervention on 6-24 Months Infants Organized by Ministry of Health. Supported by GAIN, UNICEF, US CDC and ILSI. China CDC, Local CDC and Local MCH conducted the project. YYB was distributed free to the families and health and feeding education conducted in the same period. YYB formula(gb/t ) (12 g/sachet) protein 3 iron (mg) 7.5 zinc (mg) 5 calcium (mg) 200 VA (µg) 250 VD (µg) 5 VB 1 (mg) 0.5 VB 2 (mg) 0.5 VB 12 (µg) 0.5 FA (µg) 75 YYB coverage and compliance 6 mo 12 mo 18 mo P coverage,% NS compliance,% NS Average consumption in past 2 weeks, sachet ,996,030 YYB sachets was distributed and 27, month infants were feed with YYB. 8

9 Survey PPS method was used for sampling of the infants. Height, weight, Hb were measured. Rickets, angular stomatitis and glossitis was diagnosed by doctors from local hospitals. General family information was collected. Feeding practice was collected by questionaires. Number of children Age (in months) Baseline survey 6-month survey 12-month survey 18-month survey General information of surveyed infants Total surveyed numbers of infants were 4517; Percentages of male and female were 52.1% and 47.9%; Percents of 6-11 mo mo 18-23mo were 27.5% 38.9% and 33.6% respectively. General information of the surveyed infants 0-m 6-m 12-m 18-m P Numbers of surveyed infants Average age, month <0.001 Average weight, grams NS Low birth weight,<2500 grams 5.0% 4.4% 7.1% 4.3% <0.05 Different aged groups 6-11 months 37.0% 26.6% 23.6% 22.7% < months 38.9% 40.6% 37.3% 39.2% NS months 24.1% 32.8% 39.0% 38.1% <0.001 Gender male,boy 48.8% 49.4% 48.6% 44.4% female,girl 51.2% 50.6% 51.4% 55.6% NS 9

10 Distribution of Hb changed and anemia rate decreased significantly after 18 mo intervention. 40 Percent of children Baseline survey 6-month survey 12-month survey 18-month survey Hemoglobin concentration (g/dl) anemia rates decreased at 6-m, 12- m, 18-m compared with that of the baseline. Average anemia rate decreased from 52.8% to 24.8%. The dropped rate reached 53%. ratio anemia marginal severe Changes of Hb levels and anemia rates baseline 6-m 12-m 18-m P Average hemoglobin level (g/dl) <0.001 Prevalence of anemia,% <0.001 Severe 0.2% 0 0.1% 0.1% Moderate 20.3% 7.5% 5.8% 7.3% Mild 29.0% 16.7% 18.1% 15.4% None 50.5% 75.8% 76.0% 77.1% 10

11 YYB intervention prevented the malnutrition related diseases 18-m 18 个月后监测 12-m 12 个月后监测 6-m 6 个月后监测 0-m 基线监测 Morbidity in past two weeks 9.3% 12.9% 13.0% 14.4% 29.5% 36.2% 40.6% 39.8% 0% 10% 20% 30% 40% 50% Morbidity, % Morbidity Morbidity of angular stomatitis, glossitisand rickets 20% 15% 10% 5% 0% 1.0% 1.4% 17.1% 0.3% 呼吸系统疾病 Diarrhea 腹泻 Respiratory diseases 0.3% 5.6% 0.0% 0.0% 1.0% 0.0% 0.0% 0.4% 佝偻病 AS 舌炎 G 口角炎 RG morbidity of diarrhea significantly decreased at 12-m and 18-m. no effect showed on morbidity of respiratory disease. Changes of prevalence of angular stomatitis, glossitis and rickets 0-m 6-m 12-m 18-m P Prevalence of angular stomatitis 0.9% 0.3% 0 0 <0.05 Prevalence of glossitis 1.2% 0.3% 0 0 <0.05 Prevalence of rickets 17.8% 4.9% 1.0% 0.4% <0.05 Phase III : The application of YingYangBao and the process of scaling up (March, ) The development pushing work forward leading to the formation of a policy; Technology sectors --providing scientific information for the scaled-up application of YingYangBao obtaining scientific evidence from the practice; Government ---Deep concerns from Professional departments Foundations/civil societies---supports and project practices of all sectors of society; Industry ---positively involving in the project of YingYangBaoto support the scaling up of YYB application. Enterprises have been involved in: public donations, cost reduction(without considering the profit at the beginning) improvement of the taste and quality of the product. 11

12 ,more than 30,000 children in 8 earthquake attacked counties among 3 provinces were intervened for 18 months with monitoring and effect evaluation , All China Women's Federation and Ministry of Health jointly launched an action to eliminate preschooler anemia by providing sprinkles. The action has been carried out in 67 counties across 20 provinces, benefiting about 460,000 children. The initial monitoring were recorded. In 2012, based on the achievement in social equity pilot,qinghai Provincial government scaled up early child development program in 15 counties, providing YYB and village kindergartens free, which has been launched in Application of YYB using various models with differnet targets Social marketing Model, NutriGo project in Hubei and Anhui--For sustainable development purpose, free and low-cost purchasing service were tried. Low cost + cost purchasing the services to see the sustainability and high coverage. Mechanism of YYB distribution at the community --For efficient distribution, with high coverage in 1648 villages, distribution routes were recorded in details. The beginning and prospects of the policy formulation of nutritional security for early childhood , Ministry of Health and Ministry of Finance invested RMB 100 million Yuan on the program among 100 poor counties in 10 provinces offering YingYangBao(1 sachet/day /person) for almost 270,000 children age 6-24mons, which had been initiated in October, This program is planning to be sustainably developed after 2013to benefit overall(699) poor counties.. 12

13 Early Children Nutrition Improvement Projects in Poverty Regions MOH and All-China Women s Federation Organize the project. Target: Improve nutrition and health in poor rural regions through distribution of YYB to 6-24 months early children for free by government and knowledge of infant care and feeding. Project frame work MOH ACWF Expert group Project office Dept. of WCH,MOH INFS, China CDC Implement office MCHC, China CDC leadership Province office PDOH and PWF Technical support County office CDOH and CWF Implement dept. MCH and WF Village doctors 6-24 mo.infants 13

14 14

15 15

16 16

17 It is valuable to work hard to improve the infants nutrition and health! 17