The Economic Evaluation Of The Rural Students’Nutrition Improvement Measures

BackgroundThe dietary and nutrition status for children in remote rural areas is not optimistic. The unreasonable dietary structure, insufficient protein intake and micronutrients deficiency are universal existence. Undernutrition not only hindered the physical and mental development of the rural children also affected the labor productivity in adulthood, causing a great negative impact on the development of national economy. In recent years, with the support of national policy, Local governments and nongovernmental organizations have carried out various forms of nutrition improvement measures, for example, School Economy in northern shaanxi,"Donate One Yuan" project sponsored by China Foundation for Poverty Alleviation,"the action to improve children’s nutrition status in remote areas in shaanxi province", etc. All these measures play roles in student nutrition improvement in rural areas. However, different interventions have different effects and different costs. It is necessary to carry out economic evaluation of rural students’ nutrition improvement measures. Such studies have not been seen in China.ObjectivesTo evaluate the costs and benefits of School Economy in north shaanxi. To evaluate the effects and cost-effectiveness of a combined intervention on students’nutrition improvement in shaanxi province, providing the scientific basis for choosing feasible intervention measures on students’ nutrition improvement in rural areas.Subjects and MethodsPart Ⅰ:Yuyang county and Jiaxian county in shaanxi province were chosen as two typical "School Economy" schools, interviews and questionnaire were used to evaluate the costs and the benefits of School Economy, and to explore the application of different measures in students’ nutrition improvement in rural areas. Part Ⅱ:In each of Chunhua county and Yulin county, two towns were chosen as the intervention group and one town with similar ecomomic level was chosen as the control group. In each town, one elementary school and one middle school was selected, respectively. A total of5238students were enrolled in a combined intervention "an egg one day, vitamin A/D supplement in winter, the nutrition knowledge propaganda and education, and improvement of the canteens infrastructure" for one acadeimic year. For evaluation, one class in each grade in each intervention school and control school was chosen and a total of1440students took part in the eventually period investigation. Using propensity score matching model, the objects with similar characteristics in intervention group and control group were re-matched. The effects was evaluated by comparing the dietary nutrients intake, physical development and blood biochemical indicators. Economy evaluation was carried out by the methods of cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis.ResultsPart Ⅰ:the School Economy of cows, integrated pattern of pigs and home-made tofu are profitable projects. To gain10gram high quality protein, the cost from the school milk, pork and tofu was0.6yuan,1.6yuan and0.3yuan, respectively, lower than the costs of direct purchase from market (2.1yuan,2.0yuan and0.4yuan, respectively). The cost of protein from school chicken was basically the same as that form the direct purchase. School Autotrophic Cows was the lowest cost way to obtain the isoquant high quality animal protein. One year milk production of each School Autotrophic Cow can satisfied93children needs of high-quality protein for one year. The cost of planting one acre of land vegetables was3970yuan and the net benefit was1030yuan. One acre of land vegetables can meet31students one-year vegetable requirements. If milk, chicken or pork is the unique way to provide high quality protein, then11cows,4808chickens or136pigs were needed to meet the high quality protein needs of400students for one year, respectively.Part II:Most of the food and nutrients intake were significantly higher in the intervention group than those in the control group. In boys and girls of7-11years old, there were no significant difference of average height, weight and Body Mass Index (BMI) between the intervention group and the control group. There was no significant difference of BMI in12-16years old students between the intervention group and control group. For each age and gender subgroup, there were no significant difference of HAZ and BAZ (P>0.05) between the intervention students and the controls. The prevalence of severe and moderate underweight was significantly lower and the level of serum vitamin B12is significantly higher in the intervention group, while comparing with the control group. The cost per capita is159.2yuan. Increase one percentage of RNI intake, the cost of vitamin A, potassium, iron, selenium was7.8,7.2,6.0, and4.0yuan, respectively; the cost of vitamin E, niacin, calcium and zinc was between10.1-16.5.The cost of increasing1percentage intake of protein RNI is19.6yuan and the cost of1gram protein intake increasing is27.9yuan.26.1DALYs can be gained from this intervention project. The incremental cost-effectiveness ratio is30415yuan/year and the cost-benefit ratio was2.1:1.ConclusionsThe costs of School Autotrophic Cows and home-made tofu are low. The comprehensive pattern together with breeding and planting can gain good economic benefit. Most School Economy provides the convenience and high quality protein food for students, which promotes the dietary nutrition status and health of the students in a certain extent. So schools with good conditions can take the School Economy as one of the nutrition improvement measures. The comprehensive nutrition improvement measures based one egg supplement can effectively improve the dietary nutrition status and reduce the prevalence of midderate and severe underweight of the students. The costs per capita is less or similar with other homogeneous projects.