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Effectiveness of complementary food supplements and dietary counselling on anaemia and stunting in children aged 6–23 months in poor areas of Qinghai Province, China: a controlled interventional study
  1. Yanfeng Zhang1,
  2. Qiong Wu1,
  3. Wei Wang1,
  4. Michelle Helena van Velthoven2,
  5. Suying Chang3,
  6. Huijun Han4,
  7. Min Xing5,
  8. Li Chen1,
  9. Robert W. Scherpbier3
  1. 1Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
  2. 2Health and Nutrition, Water, Environment and Sanitation Section, UNICEF China, Beijing, China
  3. 3Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
  4. 4Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
  5. 5Department of Health Education in Framing and Pastoral Areas, Qinghai Health Education Center, Qinghai, China
  1. Correspondence to Yanfeng Zhang, MSc, Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing 100020, China; summyzh{at} Suying Chang, PhD, Health and Nutrition, Water, Environment and Sanitation Section, UNICEF China, 12, Sanlitun Lu, Beijing 100600, China; schang{at}


Objective To assess the effectiveness of dietary counselling and complementary food supplements on anaemia and stunting prevalence in children aged 6–23 months.

Design A controlled intervention study with measurements of height and haemoglobin levels, and cross-sectional surveys in August 2012 (baseline), 2013 (mid-term) and 2014 (end-line).

Setting One intervention county and one control county in rural Qinghai Province, China.

Intervention Complementary food supplements (containing protein, fat, carbohydrate, vitamin A, B1, B2, B12, D3, folic acid, iron, zinc and calcium) and complementary feeding counselling were given in the intervention county.

Participants Caregivers and their children aged 6–23 months.

Primary and secondary outcome measures Effect of the interventions on the prevalence of anaemia (haemoglobin <110 g/L) and stunting (z-score of height-for-age <−2.0) (controlled for differences between the counties), and on infant feeding practices.

Results The surveys were conducted on 1804, 2187 and 2186 children aged 6–23 months in the intervention county in August 2012, 2013 and 2014, respectively, and 804, 680 and 790 children in the control county, respectively. Between the baseline and end-line surveys, anaemia prevalence decreased more in the intervention county than in the control county (71.1% to 47.8% vs 86.3% to 75.3%, respectively; p<0.0001). There was no difference in the decrease in stunting prevalence between the counties (9.7% to 7.1% vs 17.0% to 15.0%; p=0.7954). The proportions of children given iron-rich or iron-fortified food, introduced to (semi-) solid food at 6–8 months, and given food with minimum dietary diversity increased from 43.2% to 88.8% (p<0.0001), 81.4% to 96% (p=0.0470) and 53.0% to 59.8% (p<0.0001), respectively in the intervention county.

Conclusions We found much higher anaemia prevalence in poor rural areas of Qinghai Province compared with the national data. Community-based complementary food supplements combined with dietary counselling can improve feeding practices and reduce anaemia prevalence. Future studies should use longer follow-up to assess the effects on stunting.

Strengths and limitations We included a large number of participants and assessed a combined complementary food supplements and dietary counselling intervention in a poor rural area in China with high anaemia prevalence. Although the study took place in only one intervention county and one control county, we conducted an analysis that controlled for differences between the two counties. Also, although we made significant efforts to train village doctors, their education was not systematically assessed after training and thus their delivery of the interventions may have been variable.

Trial registration number ChiCTRPRC12002444; Pre-results.

  • Undernutrition
  • complementary food supplements
  • dietary counseling
  • anemia
  • China

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  • Contributors RWS, SC, YZ, QW, WW and HH designed the study; QW, WW and MX collected and analysed data; RWS, SC, YZ, QW, MHvV and LC interpreted data; YZ and MHvV wrote the first and subsequent drafts of the paper; all authors reviewed the paper and approved the publication.

  • Funding The study was funded by the United Nations Children's Fund (UNICEF). The funder was involved in study design, data interpretation, preparation of the manuscript, and decision to publish.

  • Competing interests None declared.

  • Data sharing statement Additional data can be accessed via the Dryad data repository at with the doi:10.5061/dryad.52mt5