The Nutrition And Economic Evaluation Of School Meal With Different Catering Modes

BackgroundChinese government has been inputting enormous human and financial resources and logistic supply on the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES). The health policy makers are eager to know and pay close attention on its output which includes health outcomes and economic outcomes. The health economic research on the input and output of a national school meal program is crucial and necessary. However, there are not any of these studies or researches done in China yet, and there is not any authoritative or mature health economic model of childhood malnutrition can be used in China. Regarding to the catering modes of school meals, although there are a wide variety of choices worldwide, China has its unique condition when compared with other countries. Therefore, the Chinese government cannot directly borrow the experience from others, and it has to design a more effective catering mode applies to its own condition.ObjectivesTo evaluate and compare the nutritional improvement effects between different catering modes, to evaluate their health economic outcomes by cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis methods, to determine the most cost-effective catering mode of school meal program, and to provide scientific evidence for policy makers.Subjects and MethodsThe multi-stage stratified random clustering sampling method was used in 50 NIPRCES key monitoring counties. In 2012 (baseline) and 2013 (one year after intervention), the height, weight and nutritional status of 44054 and 65681 NIPRCES beneficiaries, the hemoglobin level and anemia status of 29004 and 33938 NIPRCES beneficiaries, the standardized academic testing scores of 22262 and 24858 NIPRCES beneficiaries, and the food supply of 3910 and 5523 NIPRCES schools were collected and compared respectively.The non-probability purposive sampling method was used. Questionnaire survey and qualitative study were conducted in 2 provincial and 2 county level NIPRCES management institutes and 8 NIPRCES schools in Hunan and Yunnan provinces. Among the 8 survey schools,4 chose school feeding mode and 4 chose food package mode. The costs of school meal were collected and analyzed. Based on the data of nutritional effect and costs of school feeding mode and food package mode, the cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis were done.ResultsThe school feeding and food package modes are the major catering modes chosen by the NIPRCES schools. Most schools with school feeding mode provided students with a meal during dinning time (74.2% in 2012 and 70.8% in 2013), and most schools with food package mode provided students with snacks between meals (69.0% in 2012 and 87.5% in 2013). One year after the implementation of NIPRCES, the hemoglobin level increase 4.0 g/L, the prevalence rate of anemia decreased 10.0% and the English testing score increased 3.1 scores among students from schools with food package mode. Meanwhile, the English testing score increased 3.3 scores among students from schools with school feeding mode. The improvement of height, weight and the prevalence rate of malnutrition have not been observed. The schools with school feeding mode provided significantly more dietary energy, vitamin A, vitamin C and iron, and the schools with food package mode provided significantly more calcium and zinc.The average costs of school feeding mode and food package mode were 1021.33 yuan/person and 724.42 yuan/person respectively. When the school feeding mode provided 1 more kcal of energy,1 more gram of protein,1 more μg RE of vitamin A, 1 more mg of vitamin C and 1 more mg of iron than the food package mode, it respectively invested 0.7 yuan/person/year more,74.2 yuan/person/year more,3.9 yuan/person/year more,7.9 yuan/person/year more and 51.2 yuan/person/year more. When the food package mode provided 1 more mg of calcium and 1 more mg of zinc than the school feeding mode, it respectively invested 2.2 yuan/person/year more and 197.9 yuan/person/year more.ConclusionsThe school feeding mode supplied more dietary energy and nutrients than the food package mode, and it is more cost-effective than the food package mode.