Marketing and advocacy of fortified complementary food supplement in rural China is associated with improved infant feeding practices

In China, a powdered complementary food supplement called Ying Yang Bao (YYB) was developed that contains essential fatty acids and protein in addition to micronutrients, via the inclusion of full-fat soy flour. Results of a previously published study conducted in China among 4-12-month-old infants suggested that infants who consumed YYB had a lower risk of anemia and had better growth than children who received an equal amount of calories from unfortified rice flour. While acceptance of the product was high when families received it free from health workers, there was a need to find a sustainable way to market the product due to limited government resources. A marketing option seemed feasible because in rural China even poor families spend money on snack foods for young children.

One of the objectives of the study was to compare anemia prevalence and infant and young child feeding (IYCF) practices before and after a marketing and advocacy campaign for YYB. The study took place in northern rural China and targeted 6,000 6-24-month-old children living in 2 counties.

Marketing of the product was conducted both by the government and by Biomate, the company that developed the product. The government marketing activities included the following: booklets about YYB for health workers, incorporation of the use of YYB into health worker training, brochures and handbooks about IYCF and YYB for parents for distribution by pediatricians, village doctors and health workers, television spots and programs, newspaper articles on YYB, and education of caregivers on IYCF and YYB during their children’s regular doctor visits. Biomate’s marketing activities included the selection of distributors and retailers, selling and promotion of YYB in grocery stores, and encouragement of village doctors to sell YYB in their village clinics by offering a commission.

YYB was marketed over an 8-month period during which 6,500 handbooks were distributed and 38,000 sachets were sold, primarily to low- and middle-income families. A baseline survey was conducted among a sample of caregivers of children 6-24 months of age about a year before marketing activities began and an endline survey was conducted on another sample of 6-24 month old children a month after the end of marketing activities. Approximately 220 caregiver and infant pairs completed each survey.

At the endline survey, more than half (60%) of caregivers knew about YYB and 14% of caregivers had purchased it. Among those aware of YYB, 23% had purchased the product. The prevalence of anemia among all children was similar in the endline and baseline surveys. At the endline survey, children of caregivers who purchased YYB were less likely to have anemia than children of caregivers who did not purchase the product.

There was an increase in the following positive IYCF practices from baseline to endline: early initiation of breastfeeding (9% vs. 17%), dietary diversity of 4 or more food groups (breastfed children: 58% vs. 74%, non-breastfed children: 28% vs. 54%), minimum acceptable diet (breastfed children: 42% vs. 74%, non-breastfed children 25% vs. 45%), and consumption of iron-rich food (19% vs. 57%). The baseline and endline rates of ever breastfed, breastfeeding at 1 and 2 years, age of introduction of solid foods, and meal frequency greater or equal to the minimum were not significantly different.

Expanding the use of YYB could be an effective way of improving the nutritional status of infants and children in China. However, investments in demand creation need more time and effort.

Implementation of a programme to market a complementary food supplement (Ying Yang Bao) and impacts on anaemia and feeding practices in Shanxi, China. Sun J, Dai Y, Zhang S, Huang J, Yang Z, Huo J, Chen C. Matern Child Nutr. 2011 Oct;7 Suppl 3:96-111. doi: 10.1111/j.1740-8709.2011.00353.x

Summary written by A&T to highlight key infant and young child feeding findings as well as program implications.

To read author's abstract, visit PubMed.