Abstract
Background: Despite rapid economic development, child stunting remains a persistent problem in China. Stunting prevalence varies greatly across geographical regions and wealth groups. To address child undernutrition, the Ying Yang Bao (YYB) nutritional package has been piloted in China since 2001. Objective: We aimed to evaluate the distributional impact of a hypothetical rollout of the YYB nutritional package on child stunting across provinces and wealth groups in China, with a specific focus on equity. Methods: We used data from China Family Panel Studies and built on extended cost-effectiveness analysis methods. We estimated the distributional impact of a 12-month YYB program targeting children aged 6–36 months across 25 provinces and two wealth groups along three dimensions: the cost of the YYB program; the number of child stunting cases averted by YYB; and the cost per stunting case averted. Children in each province were divided into poverty and non-poverty groups based on the international poverty line of $5.50 per day. We also conducted a range of sensitivity analyses. Results: We showed that 75% coverage of YYB could avert 1.9 million stunting cases among children aged 6–36 months, including 1.3 million stunting cases among children living under the poverty line, at a total cost of ¥5.4–6.2 billion ($1.5–1.8 billion) depending on the type of YYB delivery. The cost per stunting case averted would greatly vary across Chinese provinces and wealth groups, ranging from ¥800 (around $220, Chongqing province) to ¥23,300 (around $6600, Jilin province). In most provinces, the cost per stunting case averted would be lower for children living under the poverty line. Conclusions: YYB could be a pro-poor nutritional intervention package that brings substantial health benefits to poor and marginalized Chinese children, but with large variations in value for money across provinces and wealth groups. This analysis points to the need for prioritization across provinces and a targeted approach for YYB rollout in China.
Highlights
As of 2015, China was home to 86 million children under 5 years of age, accounting for 13% of the world’s under-five population [1]
To be consistent with the previous studies evaluating the effects of Ying Yang Bao (YYB) interventions [21], we focused on children from rural areas and aged 6–36 months, assuming that all Chinese children who satisfied the inclusion criteria would be covered by the hypothetical YYB program
We examined the distributional consequences of YYB on child stunting across 25 Chinese provinces and two wealth groups
Summary
As of 2015, China was home to 86 million children under 5 years of age, accounting for 13% of the world’s under-five population [1]. China still has large numbers of stunted children (height-for-age Z score less than minus 2 standard deviations (SD)): it is estimated that. To improve children’s nutritional status in China, the Ying Yang Bao (YYB) nutritional package was introduced to the country’s poor rural areas in 2001 [7]. YYB is a nutrient-dense food supplement targeting infants and young children, usually aged 6–36 months. Child stunting remains a persistent problem in China. The Ying Yang Bao (YYB) nutritional package has been piloted in. Objective: We aimed to evaluate the distributional impact of a hypothetical rollout of the YYB nutritional package on child stunting across provinces and wealth groups in China, with a specific focus on equity.
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