| Objective:Schools are perhaps the best setting for promoting migrant children’s healthy eating behavior. A 2-year school-based intervention for Nutrition Health named "Happy Children" was initiated in all 15 migrant schools in one suburban district of Shanghai in 2011 by using strategies of WHO health-Promoting School guideline. The program is carried out by the Shanghai office of (International NGO) Save the Children (UK). The purpose of this study was to investigate whether the school-based intervention can improve the dietary behaviors of migrant school children in Shanghai, and to provide scientific evidence for health promotion in migrant schools.Methods:This study adopts the qualitative and quantitative research methods. For quantitative survey, by using multi-stage cluster sampling method,6 out of 15 migrant schools were randomly selected from one suburban district where the program "Happy Children" was implemented. Meanwhile,3 out of 16 migrant schools were randomly selected from another comparable suburban district of Shanghai in socioeconomic level, and received no intervention and served as the control group. 2995 students of grade 4 and 5 were recruited at baseline during November 2011 to March 2012, and 2200 students of same grades were recruited after 2-year trial after intervention in May 2012. All of the subjects were surveyed by self-administered questionnaire, with information about social-demographic characteristics, knowledge and behavior on dietary health, parental concerns on their children’dietary health, student satisfaction assessment on the food quality and hygiene condition of the school canteen, and the utilization status of the school health room were obtained. For the qualitative study, a total of 68 participants were recruited in four of the intervention schools. In each of the school, in-depth interviews were conducted in 1 headmaster,1 hygiene teacher and 5 teachers, and 1 focus group discussion was conducted by including 10 students of different grades. The main purpose of this qualitative interview was to find out how and why the students’dietary behavior was changed during the program intervention period.Results:A total of 2995 subjects were involved in the baseline survey, with 67.3% in the intervention group,58.2% being male. The mean age of subjects was 10.52±1.17 years. A total of 2200 subjects were involved in the final survey, with 52.3% in intervention group,57.8% being male. Over the course of the study,758 subjects were tracing in the follow-up survey, with 47.4% in intervention group,55.1% being male.The qualified rate of knowledge and behavior on dietary health is 50.7% and 54.9%, respectively. The main factors significantly related to nutritional knowledge (OR,95%CI) was higher self-expectation of educational level (1.76,1.33-2.32), higher grade (1.59,1.36-1.87), earlier time starting living in Shanghai (1.25, 1.03-1.52), parents would take their children to see the doctor if they feel unwell (1.22, 1.00-1.47), parents often supervise their children to buy snacks (1.21,1.02-1.44). The main factors significantly related to dietary behavior was parents often talk about healthy eating habits (1.87,1.58-2.22), higher self-expectation of educational level (1.84,1.36-2.47), female (1.71,1.44-2.02), parents would take their children to see the doctor if they feel unwell (1.71,1.40-2.10), parents often supervise their children to buy snacks (1.62,1.36-1.93), and higher grade (0.76,0.65-0.90).After 2 years intervention, knowledge of nutrition was enhanced in general in the intervention group. Especially the awareness rate of ’the cause of malnutrition’ increased significantly from 47.9% to 83.8% in the intervention group (PO.05), and 56.2% to 65.2% in the control group (P<0.05), the increase range in the intervention group was higher than that in the control group (35.9% vs 9.0%). The awareness rate of’the harm of skipping breakfast’increased significantly from 39.2% to 70.9% in the intervention group (PO.05), and 42.7% to 51.0% in the control group (PO.05), the increase range in the intervention group was higher than that in the control group (31.7% vs 8.3%). After controlling the confounding effects of baseline nutritional knowledge, social-demographics and parental concern about children’eating health, the qualified rate of nutritional knowledge in intervention group was significantly improved compared to that in the control group (OR=3.46,95%CI:2.26-5.28).There was no significant difference in the self-reported rate of eating breakfast everyday between the two groups in baseline (65.8% in intervention group vs 65.3% in control group, P>0.05), but significant difference in final survey (77.5% in intervention group vs 68.2% in control group, P<0.05). At the evaluation, the increase range of vegetable frequencies rate in the intervention group was higher than that in the control group (14.5%vs-2.0%, PO.05). Frequencies of fruits and animal food consumption were significantly increased (P<0.05), and frequencies of carbonated sweet beverage, fried food, puffed food and sweet drinks were significantly decreased in intervention group (P<0.05), while such significant improvement was not seen in the control group. There was no significant difference in the rate of washing hands every time after toilet between the two groups in baseline (66.3% in intervention group vs 65.8% in control group, P>0.05), but significant difference in final survey (74.3% in intervention group vs 66.5% in control group, P<0.05). After controlling the confounding effects of baseline dietary behavior, social-demographics and parental concern about children’eating health, the qualified rate of dietary behavior in intervention group was significantly improved compared to that in the control group (OR=1.49,95%CI:1.04-2.13).After 2 years intervention, self-reported rates of parents often supervise their children to buy snacks increased significantly from 31.8% to 48.2% in the intervention group (P<0.05), but 48.1% to 52.2% in the control group (P>0.05). self-reported rates of parents often talk about healthy eating habits increased significantly from 45.3% to 64.3% in the intervention group (P<0.05), but 57.4% to 58.9% in the control group (P>0.05). Self-reported rates of parents would take their children to see the doctor if they feel unwell increased significantly from 72.4% to 82.3% in the intervention group (P<0.05), but 80.5% to 80.7% in the control group (P>0.05).After 2 years intervention, self-reported rates of satisfaction for the food quality and hygiene condition of the school canteen were significantly increased (P<0.05), while such significant improvement was not seen in the control group. Regarding to the utilization of school health service, self-reported rates of’you can always find the health teacher when need, and she can help to solve your problem’increased significantly from 50.1% to 77.6% in the intervention group (P<0.05), and 70.4% to 64.9% in the control group (P>0.05). Self-reported rates of the health teacher would give you recommendations on diet and exercise if you were overweight increased significantly from 35.8% to 59.5% in the intervention group (P<0.05), and 45.5% to 48.1% in the control group (P>0.05).Conclusion:In this study, it was found that the levels of dietary knowledge and behavior in target population were lower, there were still lots of pupils have poor eating habits. After 2 years comprehensive intervention, school-based dietary health promotion remarkably improved participants’ nutritional knowledge and dietary behaviors. Parental concern on the dietary health of their children were also significantly improved, as well as related school food environments and school health education. Therefore, promising results were seen when the dietary health as the targets of health promotion for migrant schools in metropolitan Shanghai. Sustainability of the program should be focused in future study. |
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