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Little Han is having her breakfast. Her older brother, too shy to share his own name, stands close by, wearing the typical white skull cap of the Hui ethnic group. Mouthful by mouthful, he watches intently, as his sister is spoon-fed by their Grandmother. Breakfast is a bowl of porridge which has been enriched with a small foil packet of essential nutrients.

Known as Ying Yang Bao, the contents of these amazing packets are mixed into the first solid foods that young children begin to eat.

One Ying Yang Bao sachet per day provides a powerful mixture of essential vitamins, minerals and protein that are often missing in the local diet. Specially formulated for children 6-24 months old, these micro-nutrients will significantly improve Han's growth and nutrition.  

©UNICEF/China/2012/Jerry Liu Grandmother is feeding little Han a bowl of porridge enriched with a packet of essential micro-nutrients.

In Qinghai Province, where the Han family resides, the prevalence of anemia among children from 6 months to 2 years old is astonishingly high at more than 70 per cent.

Local health teams have visited the Han household a number of times to explain the benefits of Ying Yang Bao. Grandmother Han is convinced that little Han will grow “taller and do better in school than her big brother,” pointing to the young boy.

Noticing that attention has shifted towards him, little Han's brother flees.  He is 9-years-old and stands barely 1.2 meter tall.

After comparing the height of the young boy with that of his grandmother, UNICEF Health Specialist Robert Scherpbier concludes, “This is not because of genetic reasons. The boy is definitely suffering from malnutrition, and very likely he's stunted.”

12.7 million Malnourished

A little known malady in China, stunting is the irreversible outcome of chronic nutritional deficiency during the first 1,000 days of a child's life, starting from conception. The effects of chronic malnutrition become a life sentence of stunting, and that child will most likely never learn, nor earn, as much as he or she could have if properly nourished in early life.

In China, there are an estimated 12.7 million stunted children, a population the size of Tokyo. In poor rural communities in China's central and western provinces, one out of 10 children under 5 is stunted.

©UNICEF/China/2012/Jerry Liu Little Han's elder brother (right) is 9-years-old and stands barely 1.2 meter tall. It is likely that he is stunted due to malnutrition during his first two years of life.

UNICEF has been supporting intensive efforts on finding solutions.

Pilot projects in cooperation with the Ministry of Health have demonstrated the effectiveness of Ying Yang Bao, a simple easy-to-use complementary food supplement, in preventing and controlling childhood malnutrition.

From 2008-2011, UNICEF distributed Ying Yang Bao to mothers and babies in 8 counties in Sichuan, Gansu and Shaanxi provinces benefitting of more than 30,000 rural children. The rate of childhood anemia in these counties was reduced by as much as 50 per cent. They also saw reduction of overall childhood malnutrition

Qinghai campaign

In 2011, the Qinghai provincial government, in a landmark decision, announced that it would scale-up Ying Yang Bao distribution to improve infant and young child feeding in 15 of its poorest counties. Hualong County, where the little Han and her family reside, is one of the counties in the campaign.

"Ying Yang Bao will benefit a lot of families in my county,” said Ms An Hongbing, deputy county governor of Hualong.

Hualong has a per capita income of RMB 3,000. The Hui-majority autonomous county is located on the Tibetan plateau. With an altitude of 1,800 to 4,400 meters, farming is very difficult.  One hundred thousand Hualong residents have immigrated to coastal cities, where many operate beef noodle shops under the recognized brand of Lanzhou Beef Noodle. The money they send home constitutes half of the county's income.

Back home, noodles without beef and porridge are the staple foods. For an average rural family in Hualong, potato is almost their sole source of vegetable.  Beef and mutton are only consumed during rare festive occasions.

Many families cannot afford to keep any sheep or cattle, therefore both milk and meat can be rarely found on the dining table.

"Babies eat the same food as their mothers after breastfeeding stops – we all know there is not enough nutrition for them, but we didn't know what to do,” said Dr. Wang Chunhua, from the  township hospital,. She has delivered over 500 babies during her 10 years' service in Hualong. 

Improving impact

Following Qinghai's initiation of the Ying Yang Bao pilot project, the lessons learned from UNICEF's earlier trials in other provinces have been applied to ensure the effectiveness of the programme here.

One lesson is the importance of efficient distribution and handling of the Ying Yang Bao from production to household. County hospitals build warehouses and township hospitals build storerooms for the storage of Ying Yang Bao. At the beginning of each month, a 30-day supply of Ying Yang Bao is transported to village clinics and distributed to each family by the village health workers who also promote the daily consumption of Ying Yang Bao.

©UNICEF/China/2012/Jerry Liu Grandmother Han is very confident that her baby girl will grow stronger and taller because her diet has been enriched with essential micro-nutrients.

UNICEF also supports training on weaning food supplementation in county and township hospitals. Subsequently, the trainees become trainers for the village doctors. There is a monthly face-to-face session and discussion in the township hospital. Every other month, the county doctors will visit villages for field inspection.

In little Han's family yard, a colorful poster with illustrations of Ying Yang Bao with a growth monitoring chart are put in a significant place on the wall facing south. Every day Grandmother Han will tick on the chart after feeding her granddaughter.  “It is certain the baby girl will grow stronger and taller,” she says with confidence.  

By Liang Ruoqiao