Eliminating Iodine Deficiency in China: Achievements, Challenges and Global Implications

The prevention of iodine deficiency through salt iodization has been recognized as a global success story, and China stands at the forefront of this achievement with one of the most successful programs in the world. High level political commitment, national mandatory legislation, a state-managed edible salt industry and a complex and highly sophisticated surveillance system have facilitated the success of the program. Challenges have arisen however, including: (i) concern that adequate iodine status in pregnant women cannot be achieved without causing above adequate iodine intakes in children; (ii) declining iodine intake as a result of reductions in salt consumption and increased consumption of processed foods, which may not be made with iodized salt; (iii) the existence of areas with high iodine content in the water; and (iv) declines in household use of iodized salt due to concerns about excess iodine intake and thyroid disease. This article reviews the achievements and challenges of the Chinese Iodine Deficiency Disorders (IDD) Elimination Program and reflects on lessons learned and implications for other national salt iodization programs

Data from: Effectiveness of complementary food supplement and dietary counseling on anemia and stunting in children aged 6-23 months in poor areas in Qinghai Province, China: a controlled interventional study

Objective: To assess the effectiveness of dietary counseling and complementary food supplements on anemia and stunting prevalence in children aged 6-23 months. Design: A controlled intervention study with measurements of height and hemoglobin levels, and cross-sectional surveys in August 2012 (baseline) and 2013 and 2014 (end-line). Setting: One intervention and 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 counseling were given in the intervention county. Participants: Caregivers and their children aged 6-23 months. Primary and secondary outcomes measures: The effect of the interventions on anemia (hemoglobin< 110g/L) and stunting (z-score of height-for-age< -2.0) prevalence(controlled for differences between the counties), and infant feeding practices. Results: The surveys were conducted among 1804, 2187, and 2186 child 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 baseline and end-line, anemia prevalence decreased more in the intervention county compared to 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 -fortified food, introduced (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. Conclusions: We found much higher anemia prevalence in poor rural areas of Qinghai Province compared to national data. Community-based complementary food supplements combined with dietary counseling can improve feeding practices and reduce anemia prevalence. Future studies should use longer follow-up to assess the effects on stunting

Exclusive Breastfeeding Rate and Complementary Feeding Indicators in China: A National Representative Survey in 2013

Appropriate infant and young child feeding could reduce morbidity and mortality and could improve cognitive development of children. However, nationwide data on exclusive breastfeeding and complementary feeding status in China are scarce. The aim of this study was to assess current exclusive breastfeeding and complementary feeding status in China. A national representative survey (Chinese National Nutrition and Health Survey) of children aged under 6 years was done in 2013. Stratified multistage cluster sampling was used to select study participants. World Health Organization (WHO) infant and young child feeding indicators were firstly used to assess exclusive breastfeeding and complementary feeding practice nationwide. In total, 14,458 children aged under two years (0 to &lt;730 days) were studied from 55 counties in 30 provinces in China. The crude exclusive breastfeeding rate under 6 months was 20.7% (908/4381) and the weighted exclusive breastfeeding rate was 18.6%. The crude prevalence of minimum dietary diversity, minimum meal frequency and minimum acceptable diet were 52.5% (5286/10,071), 69.8% (7027/10,071), and 27.4% (2764/10,071) among children aged 6–23 months, respectively. The weighted rate was 53.7%, 69.1%, and 25.1%, respectively. Residential area, household income and maternal education were positively associated with the three complementary feeding indicators. The exclusive breastfeeding rate under 6 months was low and complementary feeding practice was not optimal in China. Residential area, household income and maternal education might be used to target infants and young children to improve complementary feeding practice