oreo in china case study

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Kraft changed its biscuits for China

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The Oreo in China: Time to Get it Right or to Get Out

The Oreo in China: Time to Get it Right or to Get Out ^ SMU101

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Product Description

Publication Date: September 26, 2012

Source: Singapore Management University

Industry: Retail and consumer goods

In late 2005 As Shawn Warren the head of biscuits at Kraft for Asia Pacific, surveys the China market for Oreos he knew he had to make changes, and fast. The company's flagship brand was falling far short of expectations in the world's most populous country. This meant that the turnaround had to be quick to avoid the complete disaster of pulling the product from the shelves altogether. Oreos were first launched in China in 1996, yet sales had been flat since then while the rest of China had been setting record growth in the biscuit industry. The Oreo case illustrates the dilemma faced by a successful multinational brand when entering an emerging market, namely China. It covers the complexity of dealing not only with differing consumer tastes, but also the challenges of local competition and distribution systems. The case provides a rich historical account of Oreo's entry into China and the problems facing Kraft and its management as it strives to reach its full potential in a large and fast-growing emerging market.

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The Real Difference Between Oreos In China And The US

Describing Oreo as famous probably doesn't quite do it justice. Famous would be suitable to describe a footballer or an actor, someone who is highly respected by the people who actually know who they are. Given that YouGovAmerica has found that the Oreo brand is recognised by 98% of people, iconic would definitely be a more appropriate word.

It could well be the quantity and, in some cases, bizarreness of flavors that make Oreos so irresistible to hungry customers. Research revealed by Pattern shows that of the recorded 85 Oreo varieties released through the years (including such wonders as the taste of Hot Chicken Wing), Classic Oreo is considered the queen of them all, closely followed by Chocolate Creme and Most Stuf.

However, even in times of uncontrollable global commercialism, it turns out that Oreo may not be quite so popular outside the U.S. According to NPR , Oreo was a massive flop when it was first released in China, leading to an incredible makeover that left the cookies looking almost unrecognizable.

Chinese people were unimpressed with the look and taste of Oreos

Although everyone across America may recognize Oreos as crunchy circles of chocolate perfection, the cookies were initially less appealing in China. Chinese consumers found Oreos to be far too sweet for their liking, leading Oreo bosses to revamp the cookie's signature flavor for the first time in its history (via Financial Times ).

As the Financial Times explains, this triggered the invention of an Oreo flavor that was less sweet, called LightSweet Oreo, as well as allowing local tastes to influence different Oreo creations. Canadian Business reports that even the legendary Oreo shape was axed in favor of a long wafer chocolate stick filled with crème.

Ultimately, Oreo's unrelenting efforts to succeed in China paid off, leading to the country becoming the company's second-largest market after the U.S. (via Baking Business ). Fascinating Oreo flavors have spread across China, including creations filled with the tastes of green tea, peach and grape, and tiramisu (via Mondelez ).

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Marketing to China: Oreo’s Chinese twist

Jeff Beer for Canadian Business December 06, 2012

For anyone raised in North America, this was a shocking fall for the King of All Cookies. “When I worked in the U.S., it was the biggest mega-brand we had,” says Shawn Warren , a native of Kitchener, Ont., who arrived in 2005 as the company’s newly assigned vice-president of snacks for Asia-Pacific. “Then, when I came over here, Oreo was just this really small brand.”

More than 25 million Oreos are eaten every day in the U.S., but the company considered taking it off the shelves in the fastest-growing consumer market on earth. What could possibly be the problem in China?

It’s a question faced by many western brands that over the past 15 years have flocked east, eager for the potential profits presented by a nation of 1.5 billion people with a ballooning middle class. But brands have often relied too heavily on the same approach that made them popular in the West. Same product, same marketing, just a different language. And it rarely works. As Oreo learned, scoring success in China requires both exploiting the appeal that big brands have to Chinese consumers and adapting products for local tastes. This small insight led the cookie to go from a piddling 3% to 15% in a few short years. Put that in your glass of milk and dunk it.

The best example of this approach is KFC – Chinese sales account for nearly 40% of worldwide operating profits for its parent company Yum Brands , which also owns Pizza Hut and Taco Bell. The Colonel has dominated China’s fast-food landscape since it first landed in 1987, thanks, in part, to adding items like breakfast congee and rice dishes to the menu. Last year there were more than 3,700 KFC outlets in China, compared to 1,464 McDonald’s restaurants.

For many years, the chicken seller was alone in realizing you need to adapt to succeed in China. Only recently have more major western brands begun focusing on the needs of Chinese consumers. In September, Estee Lauder launched an entirely new beauty brand specifically for the Chinese market called Osiao, which the company says was formulated for various types of Asian skin and includes traditional Chinese herbal ingredients like ginseng. Last year, Colgate introduced its Flax Fresh tea mouthwash flavour, catering to China’s love of all things tea-related. In 2006, BMW created a longer version of its 5 Series sedan exclusively for the Chinese car market, where the wealthy have personal drivers and want more room in the back seat. This year, Nestlé altered its Nescafé instant coffee recipe after its research showed Chinese consumers preferred a smoother, milkier cup of joe than their European or North American counterparts.

Whether it’s squid on a stick at KFC, lobster cheese-flavoured Lay’s chips, tea-flavoured mouthwash from Colgate or stretched-out Beemers, these brands are cashing in by balancing an established image with new or adapted products. And one of the biggest success stories is Oreo.

The billion-dollar Chinese biscuit market can be roughly split into seven categories: sandwich biscuits, plain sweet biscuits, wafers, plain savory, cookies, soda crackers and egg-roll biscuits. In 2005, Oreo was competing solely in the sandwich biscuit category. Its 19% share in that segment translated into just 3.5% of the overall biscuit market. Since then, the brand has increased its sandwich biscuit take to 46% and launched an Oreo wafer cookie that’s nabbed 30% of the wafer market, to boost its overall share to almost 15%. That’s the highest market share for Oreo anywhere in the world, including the U.S. or Canada.

Warren was appointed president of Kraft Foods China in 2011, renamed Mondelez International this past October after the company split its snack business into a separate company. Warren says Oreo’s journey to cookie hero has three key components: product, packaging and advertising. Before 2005, each item copied Oreo’s U.S. approach and had little appeal in the new market.

In North America, Oreo is synonymous with one flavour. But global tastes vary. While we like the classic Oreo, in India for example, consumers think it’s not sweet enough. Conversely, Oreo discovered back in 2005 Chinese consumers thought our North American version of the Oreo was too sweet.

According to Kraft, there are 135 components to an Oreo cookie, including roastedness, burntness, bitterness and 132 other “nesses.” To create an “original” Oreo for China, Kraft tested more than 20 unique Oreo formulations.

But they didn’t stop there. More than anything else, it’s been Oreo’s willingness to alter its size, shape and flavour that led to its dominance of the Chinese cookie market. North Americans have had a century to get to know Oreo as both a taste and brand, and it’s consistently been a top-seller. In China, the brand needed to be more innovative if it was to make an impact. The Chinese love wafer cookies, which make up a sizable proportion of the overall cookie market. So in 2006, Kraft launched the Oreo wafer stick with white crème of Oreo but in the form of a rectangle wafer and coated in chocolate. It was a home run, putting Oreo into the popular wafer category, extending its reach to consumers who before never gave it a glance. “It completely changed what an Oreo looked like,” says Warren. ”But it made the brand a lot more relevant to the Chinese market.”

As the company delved deeper into its China market research, they found more opportunities to grow. In China, sales of cookies and other chocolate products tend to slow down in the summer. Warren says the Chinese have what they call “heaty” foods and cooling foods, the former for colder months and the latter for warmer times of the year. Cookies were traditionally a heaty food. To boost summer sales, in 2009 Oreo developed a crème that had a cooling sensation when licked to create both a vanilla and green-tea ice-cream-flavoured cookie. Yep, green-tea ice cream. It’s now the second-most-popular flavour after original Oreo.

That success sparked a cookie Island of Dr. Moreau. Fruits are also cooling foods, so Warren says the success of the ice-cream-flavoured cookies led them to try more cooling variations. In 2011, after researching what fruit flavours Chinese consumers would like best, they launched Oreo double fruits that put combinations like orange-mango and blueberry-raspberry between the familiar biscuits. “It’s about taking a local cultural consumer insight and finding ways to innovate with it,” says Warren.

It wasn’t just the cookies that needed to change. Kraft also found that its traditional package size was too big and expensive for the average Chinese consumer, who have less disposable income than North Americans. “We introduced smaller sizes so we could get into smaller grocery stores and mom-and-pop stores, as well as make it more affordable,” says Warren.

For advertising, the company ditched the subtitled American ads in favour of a focus on kids, who are at the centre of the Chinese family, and homegrown spokespeople like former NBA star Yao Ming.

All of these strategies helped Oreo grow its market share by 10 times over the past five years. Warren says the Oreo model in China has become the company’s model for all its other products. That means get ready for Ritz cracker flavours like “fantastic beef stew” and “very spicy chicken.” “There’s now a different formulation for Chips Ahoy cookies here than in North America,” says Warren.

“We’ve also got the packaging and advertising localized, and as a result over the last few years we’ve tripled the Chips Ahoy business.”

Despite the different shapes, colours and flavours that have catapulted Oreo to the top of the cookie heap in China, some things remain universal. “We do it in different ways around the world,” says Warren. “But it’s still the ritual of twist, lick and dunk.”

This story originally appeared in Canadian Business .

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Oreo’s Full-Fledged Marketing Masterstroke: A Deeper Dive into the Magic

By Aditya Shastri

Oreo is one of the most famous cookies which is loved by almost everyone. In this case study, we will look into the marketing strategies used by Oreo to become one of the leading biscuit companies around the world. 

We will also cover the marketing strategy of Oreo along with its marketing campaigns, SWOT Analysis, and digital marketing strategies implemented by the company.

So let’s get started with knowing about the company in brief:

Oreo is an American cookie brand, owned by Mondelez International & Cadbury Milka. 

Back in the year 1912, this biscuit was developed by the National Biscuit Company in New York. And in the year 2011, this biscuit was brought to the Indian Market by Cadbury India. Now it is having 6% of the market share in the biscuit segment, though it is quite costly as compared to other biscuits and is considered a luxurious biscuit in India.

Oreo is a sandwich cookie consisting of two wafers with a sweet crème filling of various flavours like chocolate, milk, red velvet, etc. The company sells its products in over one hundred countries with different packaging and limited edition offers.

As we have brief knowledge about the company, let’s dive into the marketing mix of Oreo.

Oreo Target Audience

Oreo’s charm transcends age barriers, enchanting both the young and the young at heart. Children delight in the playful ritual of twisting, licking, and dunking their Oreos, forming cherished childhood memories. Meanwhile, adults savor the nostalgia of enjoying a cookie that has been a part of their lives for generations. Oreo serves as a bridge across generations, a beloved treat shared within families, fostering a sense of tradition and joy amongst Oreos target market.

Moreover, Oreo’s target market has successfully expanded through innovative marketing strategies, such as social media campaigns and limited-edition flavors, to appeal to millennials and Gen Z consumers. These efforts aim to position Oreo as a trendy and relevant brand in the ever-evolving snacking industry.

Overall, Oreo’s target audience encompasses a wide range of consumers, from children to adults, united by their love for the brand’s delicious cookies and the nostalgic experiences they evoke.

Marketing Strategy of Oreo 

A marketing mix is a comprehensive series of actions used by a company to introduce or promote its products. It includes 4Ps, Product, Place, Price & Promotion. It helps companies achieve business goals & objectives, and it is widely used to define strategies. Let’s explore Oreo marketing strategy & mix.

1. Oreo Marketing Strategy: Product

Oreo is a leading biscuit brand and has a presence in various countries across the globe. One of the major products of Oreo is the Chocolate Sandwich. The product is also customized as per the target market. There are a lot of varieties available but not all the varieties are available at every location. Most of the Oreo Variants are available in the USA, but in India, you can’t see much variety of flavours.

They are experimenting with flavours in India, recently they launched red velvet and chocolate-flavoured cookies, and are working on more varieties. 

The packaging says a lot about the product because it attracts the customer to purchase it and the same has worked for Oreo very successfully. The packaging style of the company has played a significant role in increasing its popularity, and the design of various products of different varieties has attracted a large customer base for the company.

2. Oreo Marketing Strategy: Place

Oreo started its operations in Birmingham, UK and now it has covered different overseas markets like the United States, India, Ireland, Australia, Canada, and New Zealand.

It uses its parent company Mondelez’s distribution network for availing the product to its end consumers. As it has manufacturing facilities available on each of the continents for different products meeting the demands of the customer.

Oreo is doing great in the urban market as compared to the rural market. It follows the traditional method of distribution in which products are transferred from manufacturing units to distributors via the agents and then to retailers. In India, the channel through which each of these products is sold includes shopping malls, centres, mom and pops stores, retail outlets, etc.  

3. Oreo Marketing Strategy: Price  

Oreo uses a mid-premium pricing policy, it offers quality products and prices them at mid-range which has helped it to gain a loyal customer base .  In India initially, they opted for a lower marketing pricing strategy to gain a higher market share, but eventually, as they saw the popularity of the products increasing, they increased the pricing accordingly.

The company also wanted to enter new markets and hence choose a penetration pricing policy initially to attract new customers. People in urban cities prefer high-quality products and don’t mind paying more for these products therefore the brand can generate high revenues.

4. Oreo Marketing Strategy: Promotion

The Oreo-Cadbury partnership has launched rigorous marketing campaigns displaying creative and innovative themes with different activities to build a connection with the customers and leave a lasting impact on them.

The main target audience for the company is children and youth which it promotes on Tv and social media heavily, it has used every advertising tool like print media, visual media, and digital media.

Oreo’s market leadership isn’t accidental; it’s the outcome of clever marketing tactics that have captivated consumers globally. Through compelling commercials featuring the iconic “twist, lick, and dunk” tradition and interactive social media initiatives prompting fans to share their Oreo experiences, the brand has adeptly engaged with its audience.

The packing also helps the consumer in identifying the brand easily. Milk’s Favorite Cookie is one of the famous hook lines of Oreo. The company also participates and organizes different events to interact with the customers directly and believes strongly in community activities.

Now, let’s deep dive into the marketing strategy used by Oreo to become one of the leading cookie companies in the world.

Marketing Strategies of Oreo

Marketing Strategy is a complete plan of the company which defines how the brand will communicate with its target audience using several innovative strategies. It uses various offline and online ways to market itself and reach out to its customers.

Let’s have a look at the marketing strategy of Oreo;

1. Oreo Customizes its Cookies

Its customized design attracts its customer especially kids and people who follow everything that’s in trend to buy the products which make it stand out from its competitors and builds a unique image.

• We can take the example, back in the year 2019 when the finale season of Game of Thrones was released, Oreo made a limited edition cookie inspired by the show, allowing fans to explore the new product and relate to it. This allowed the brand to find a common interest with its target audience, and therefore, build a more loyal following.
• One more example of the same is, it makes use of holidays to customize the cookies so that people can associate the product in fun times with friends and family.
• To celebrate Halloween in 2020, they had a black cookie with a ghost saying ‘boo’ on it with orange filling.

Such meaningful and creative marketing ad campaigns of the company are a major reason for its success in the industry.

  2. Market Penetration Strategy

When the cookie was launched in the market, the price was low to grab the target market but eventually when it became familiar and popular in the market, the price was increased and now it is considered as one of the branded biscuits around the world.

Initially, as it was available at a nominal price, people didn’t mind trying something new and in time got adapted to it. This strategy worked very well for the company and gave it exceptional results.

3. Content Marketing

Oreo uses content marketing to grab a place in consumers’ minds. It makes sure that the content is relatable and exclusive so that consumers can engage and relate to it. Oreo launched its first-ever Rainbow cookie in honour of its partnership with PFLAG National, which is the largest organization supporting LGBTQ+ people and their parents. Colourful cookies grab the attention of the consumer easily as it’s something unique and as someone buys them, they also generate awareness. The ads on social media and TV always leave sweet messages for their customers to engage them. 

Below images give a glimpse of it:

Oreo also uses celebrity endorsements as one of its marketing strategies to build its brand name and for brand recognition.

The company also does some amazing topical content marketing which means focusing on a specific topic to gain authority. The goal is to produce relevancy to impact search engine rankings naturally.

Bonus: Check out this blog to know the latest Google Ranking Factors

When the lights went out during the 2013 Super Bowl, that time, to grab our attention Oreo posted something on Twitter and Facebook with a simple message “You can still dunk in the dark”.

From these ads and posters, we can say that they use content marketing very effectively in their favour. Now, let’s see some marketing campaigns by Oreo;

Marketing Campaign of Oreo

Oreo is always innovative and creative when it comes to marketing campaigns. Below we have listed some of the best campaigns by Oreo.

1. At Home With Oreo

Oreo has come up with a campaign ‘#AtHomewithOreo’ to help consumers spark their innovative plugs and drive creativity with Oreo cookies. The company tries to add fun to the daily lives by embracing the new normal by the activities that have an unusual way of helping people stay connected.

Oreo has always encouraged playful family moments, and the “At Home With Oreo” campaign aims to encourage people to adopt playfulness while staying indoors. 

From fun recipes with Oreo to keeping its hands busy with Oreo Art, and even giving adults a break from their WFH madness, they’ve ensured that the spirit is alive and well.

2. Make Way for Play

During the lockdown, the 2nd version of this campaign was released. It was to encourage customers to share moments with their loved ones. The company has an anthem “Make Way for Play”.

Oreo has taken the campaign further with #MakeWayForPlay. A fun challenge that brings people into the fold by passing on the Oreo wand virtually. 

Nowadays, people are also using oreo biscuits to prepare cakes, shakes, and other food items, and are uploading various videos and blogs about it. Though this promotion is not done by the company, indirectly the product is being promoted. It is also creating awareness about the product and henceforth increasing its sales.

3. Say it With Oreo

In 2022, Oreo launched a new campaign named #SayItWithOreo featuring MS Dhoni, former team India Cricket Captain, and his daughter Ziva Dhoni. With this campaign, the brand aimed at encouraging family playtime with the introduction of alphabet-embossed, scannable cookies, nudging them to Scan, Play, and Repeat!

You can watch the video here –

Now, let’s have a look at the SWOT analysis of Oreo.

Want to learn how you can leverage the power of Social Media to make such strong marketing campaigns? We have got you covered, here’s a blog that you might find helpful.

SWOT Analysis for Oreo

Swot analysis is a tool that helps an organization identify its strengths, weaknesses, opportunities, and threats. By identifying them they can work on themselves and form a proper marketing plan.

• Good product quality and packaging.
• Leader in the cookie industry.
• Available at Nominal price.
• Its distribution channel
• It has a limited target audience (who loves to eat cream biscuits only)
• High Competition.

  Opportunities

• Launching various flavours with customized versions.
• As a renowned biscuit, it can do tie-ups with different hotels, schools, and corporations.
• After tie-ups with schools, they can target the parents.
• High competition from the wafer and sandwich biscuit segment.
• Pricing competition.

So, by the above analysis, we can say if Oreo keeps its promotion strategies plan on track and collaborates with different institutions, it will be a market leader suppressing its competitors.

Oreo is a renowned cookie brand, having its operation around the world. It is operating in almost every country and is having a sweet relationship with its customers. They always try to grab the customer’s attention through any sort of ad and sometimes merge the same with some trending topic. They have always stayed in the limelight and used ingenious strategies to become a market leader.

Hope you enjoyed reading the marketing strategy of Oreo. Found the blog interesting? If you want to learn more about Digital marketing and how to set up digital marketing strategies for startups do refer to our Free Digital Marketing Masterclass by Karan Shah, founder, and CEO of IIDE.

If you’re looking to improve your digital marketing skills, I would recommend checking out IIDE’s Online Digital Marketing Course . This course can help you start your journey in digital marketing by teaching you various tools and techniques that are required in the industry. It can help you become more fluent in the field and keep up with the latest trends and best practices.

Thank you for reading this case study. Hope you found it interesting. Share it with your peers and comment about your takeaways.

Author's Note: My name is Aditya Shastri and I have written this case study with the help of my students from IIDE's online digital marketing courses in India . Practical assignments, case studies & simulations helped the students from this course present this analysis. Building on this practical approach, we are now introducing a new dimension for our online digital marketing course learners - the Campus Immersion Experience. If you found this case study helpful, please feel free to leave a comment below.

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Aditya Shastri

Lead Trainer & Head of Learning & Development at IIDE

Leads the Learning & Development segment at IIDE. He is a Content Marketing Expert and has trained 6000+ students and working professionals on various topics of Digital Marketing. He has been a guest speaker at prominent colleges in India including IIMs...... [Read full bio]

I would you like to say thank you so much by my heart. Really amazing and impressive post you have share. Please keep sharing.

love the information very useful, thank you very much.

This post is really informative and use full to people who might want to achieve the feat that oreo has achieved in marketing it is really amazing!

I wanted to know about the marketing strategy of Oreo, and this article has covered everything.

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CADBURY OREO VS PARLE FABIO CASE SUMMARY

Everyone knows the America’s best loved cookie which lately emerged into the markets of India and China. That is OREO. It was first developed and produced by the National Biscuit Company in the year 1912 in New York, US. Initially, Oreo focused on the markets of US and successfully covered maximum portion of the market for their product. Lately, the company felt limited growth opportunities in the US market so they decided to emerge into India’s and China’s markets. Mondelez International, launched Oreo in India as CADBURY OREO in March 2011.

Any company uses their creative ability to develop the product that is different from others and have not been created earlier. But what if someone ends up copying the original design and end up deviating a huge mass of their customer base. It is then taken to the court to decide and arbitrate on such matters depending on the provided law and its provisions. One such suit is being filed by Cadbury Oreo.

PARTIES CONCERENED IN THE CASE:

INTERNATIONAL GREAT BRANDS vs. PARLE PRODUCT PRIVATE LIMITED 

2023/DHC/000953

PLAINTIFF – INTERCONTINENTAL GREAT BRAND – CADBURY OREO

DEFENDANT – PARLE PRODUCT PRIVATE LIMITED – PARLE FABIO

PRONOUNCED ON – 10th FEBRUARY 2023

CORAM – HON’BLE MR. JUSTICE C. HARI SHANKAR

I.A.1803/2021 (under Order XXXIX Rules 1 and 2)

BRIEF FACTS OF THE CASE:

As we know, Oreo is an international brand and have emerged in India in 2011 while Parle is a household brand in India. Comparatively, Oreo has a growth in its popularity over the last few years for creamed biscuits in India. Cadbury Oreo had filed a suit against Parle’s biscuit, Fabio, by saying that Parle had infringed the already registered Trademark of Oreo by selling its biscuit naming Fabio which is similar with the original vanilla-cream-filled cookies.

In 2020, OREO filed a suit which alleged that chocolate-vanilla cream biscuits are being sold by Parle in the name of FABIO or FAB! O is similar to OREO in many ways including the mark under which it is being sold.

CONTENTIONS BY THE PLAINTIFF : 

The plaintiff claims that the defendant Parle Products Pvt. Ltd., has introduced its own range of chocolate-vanilla biscuits under the brand FAB!O in or after January 2020.The plaintiff alleges that, prior to 2020, the defendant was using the brands FAB and FAB! For its biscuits. After 2020, the defendant introduced vanilla cream filled chocolate sandwich biscuits under the mark ―FAB! O or FABIO.

The plaintiff points out that the FAB! O mark is being used only for cream filled chocolate sandwich biscuits which were identical to the biscuits manufactured and sold by the plaintiff under the OREO trademark. The plaintiff alleges that the mark on the defendant‘s biscuit, though written as FAB! O is bound to be pronounced FABIO. Therefore, according to the plaintiff, the defendant’s mark is deceptively similar to that of plaintiff’s mark.

The plaintiff also submits that the design of the defendant‘s cookie copies all the essential features of the design of the plaintiff‘s cookie, in which the plaintiff holds trademark registrations. The Plaintiff contended that the defendant‘s FAB!O range of vanilla cream filled chocolate sandwich biscuits was sold in a package, the trade dress of which was nearly identical or, at the very least, deceptively similar, to the trade dress of the plaintiff‘s OREO biscuit packages.

CONTENTIONS BY THE DEFENDANT :

The defendant submits that there is no phonetic similarity between ―OREO and ―FAB! O. The only common letter, between these two words, he points out is ―O. submits that, where the first syllable of the two marks is different, it cannot be said that they are phonetically similar. Also, the defendant submits that the mark FAB! O, as used by the defendant on its biscuit packs is structurally, visually and phonetically dissimilar to the OREO mark of the plaintiff.

Defendant also submits that the aspects emphasised by the plaintiff as being common to the packaging in which the plaintiff sells its OREO biscuits and the defendant sells its FAB!O biscuits are all common to the trade. In fact, the defendant submits that the plaintiff is claiming exclusivity on the basis of the overall appearance of its packing which, again, is common to the trade.

LEGAL ASPECT :

The concept of Trade Dress has been recognised and started by the Indian Court before the year 2003. Section 2 of the Trade Marks Act, 1999 was added in the Act through an amendment. In the present case, trade dress refers to everything ranging from the blue and white packaging of the biscuits to the design imprinted on them and to their structural representation. According to Section 2 of the Act, the overall appearance and graphical representation of a product is what establishes it to be different from other goods and services. It is this shape, unique packaging and the combination of colours that distinguish a product.

This section of the Act defines the terms “Package” and “Mark”.

Section 9(3) provides that, for a mark to be registered it should be distinctive and easily recognisable i.e. it should add a substantial amount of value to the product. Also, the shape of the good should not be one that comes from nature.

JUDGEMENT FROM THE COURT:

The Court orders, for the aforesaid reasons, the defendant as well others acting on behalf of the defendant are restrained from using the impugned FABIO or FAB! O mark for any purpose whatsoever. The defendant is also restrained from manufacturing, packing or selling their vanilla cream filled chocolate sandwich biscuits in the impugned pack or using the impugned trade dress. This injunction shall also apply to stocks presently in the defendant‘s possession and as yet unclear, though it would not apply to stocks which have already been released in the market.

REFERENCES:

1. Contentions and Judgment:

https://www.livelaw.in/pdf_upload/chs10022023sc642021112534-458304.pdf

2. Legal Aspect:

https://blog.ipleaders.in/infringement-design-parles-fabio-biscuit-deceptively-similar-oreo/

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The Brand Hopper

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Case Study | Launching And Establishing Oreo in India

Case Study | Launching And Establishing Oreo in India 11 min read

Table of Contents

Introduction

For most of its 100-year plus existence, Oreo was consistently America’s best loved cookie, but today it is a well-established global brand. Mondelez International moved it into emerging markets quickly learning the rules of success in these hitherto unfamiliar markets, changing and refining the brands strategy and ultimately triumphed in winning over consumers. This case demonstrates how Oreo brand’s successful entry into the Indian market was well orchestrated using the Communication Mix elements such as Advertising, Sales Promotion, Events and experiences and Public Relations to establish the brand during the launch phase and subsequently stabilize and grow the brand in India.

Background and Company Profile

The “Oreo Biscuit” was first developed and produced by the National Biscuit Company (today known as Nabisco) in 1912 at its Chelsea Manhattan factory in New York, US. This factory was located on Ninth Avenue between 15th and 16th Streets. Today, this same location of Ninth Avenue is known as “Oreo Way.”

On March 6, 2012, the famous cookie brand, Oreo, celebrated its 100th birthday. From humble beginnings in a Nabisco bakery in New York City, Oreo has grown to become the bestselling cookie brand of the 21st century generating $2 billion in global annual revenues. Currently owned by Mondelez International, Oreo is one of the company’s dozen billion dollar brands.

Until the mid-1990s, Oreo largely focused on the US market – as reflected in one of its popular advertising slogans from the 1980s, “America’s Best Loved Cookie”. But limited growth opportunities in the US Market spurred the company to turn to emerging markets like China and India. Mondelez International, launched Cadbury Oreo in India in March 2011.

Market Background and Brand Strategy in India

Mondelez was present in India in the Chocolates, Beverages and Candy categories. The company entered the Rs 17,000 crore, competitive India Biscuit market with their lead brand Oreo in 2011. The Biscuits category was growing at 17% in India (Nielsen Survey, 2010). While the Oreo launch presented opportunities, it also posed great challenges. From being a leader in the Chocolates category in India, Mondelez was now a challenger in the Biscuits category.

The challenge was to launch Oreo and peg it against three Biscuit category titans – Parle (41%), Britannia (26%) and ITC (8%), who dominated the biscuit market with a total of 75% market share. These players had been present in the market for many years and had a strong portfolio of established household brands. And the Biscuit category was a very competitive market – only two brands (Parle-G and Britannia Good Day) in a pool of about 1000 brands had garnered more than a 5% market share. Even established brands like Hide and Seek, Monaco and Bourbon had less than 2% market share. This shows the seemingly insurmountable task that a new brand had to circumvent to establish its credentials in this category in India.

Cream biscuits are primarily consumed by households with children. Cream being the central component and biscuit just the shell, the focus for a brand was obvious and undisputable – Cream! It was also known that consumers did not find any differentiation between brands. Therefore, the key challenge for Oreo was to decide on how to get a firm foothold in a fiercely competitive category ruled by familiar household brand names with firmly entrenched buying and consumption habits.

Oreo was launched in India in March 2011. It entered the market as Cadbury Oreo because Cadbury is a strong brand name in India, and initially focused on generating awareness and rapid trials. The key objectives of the launch were:

• Gain a 1% share of the Biscuit category in the first year.
• Build awareness, 40% trials and 40% repeat purchase in priority markets.

The Marketing Mix Imperatives: Oreo in India

The product was fine-tuned to suit the Indian palate and Mondelez leveraged the retail stores reach acquired with the Cadbury acquisition to build distribution.

Oreo launched its traditional chocolate cookie with vanilla cream centre at Rs 5 for a pack of three to drive impulse purchase and trials, Rs 10 for a pack of seven and Rs 20 for a pack of 14 for heavy consumption segment. The cookie design was the same as its international counterpart – a part of the consistent brand imagery of Oreo.

The company maintained the heritage of the two decoratively embossed chocolate cookies filled with sweet vanilla cream to stand out from me-too products and meet customer expectations of having the real Oreo.

Focus on Distribution & In-Store Presence: Launch Phase

Early launch focus was on building strong distribution and adequate availability in Traditional Trade & Modern Trade. However, availability with an emphatic presence at Point of Buying was the need of the hour for Oreo to break through the highly cluttered and fiercely competitive Biscuit Category. In Traditional Trade, a host of unique Point of Purchase (POS) devices were developed to ensure Oreo stands out when stocked within the category. And for the first time, POS devices were executed that brought Oreo outside the category into the front-of-store in a Traditional Trade store.

Counter-top POS devices ensured the brand stands out and is easily spotted by the shopper. In Modern Trade also a similar strategy was followed. Emphatic in-category presence combined with clutter breaking out-of-category POS visibility was executed. This virtually created a “Wall of Blue” effect in the trade channel emphasising and enhancing the brands compelling presence. The primary focus during the in-trade launch was on building the presence of brand Oreo and hence no promotions for trade or consumer were executed in the launch phase. All trade investments were focused on improving the on-shelf presence for Oreo.

Oreo Brand Advertising and Communication

Communication and advertising have been consistent across many markets as the core customer and the brand truths remain the same. The company focused on using the “moments of togetherness” proposition for Oreo in India, with television forming the main medium of communication. In addition, other media platforms were tapped as well. Oreo was present in digital media as well with the Oreo Facebook page adding fans at a rapid rate. The company also created an “Oreo Togetherness Bus” which toured 9 cities and brought alive the Oreo togetherness concept with consumers. A similar campaign was also run with Vans in smaller towns. Oreo strategy was to drive point-of-purchase sales with store displays and in-store consumer activations to generate trial and build consumer preference for the brand.

The brand touch points used for communication included packaging, TV (Spots and programme Sponsorships), Radio spots (including radio programme content), Digital website and social networking sites, host of Out-of Home advertising activities such as hoardings, at airports, in transit communication and billboards. Merchandising, POP, sales promotion, retailtainment to build brand trials and ambient marketing was used to create buzz around the brand launch.

Communication strategy that addresses the mother

In the cream biscuit segment, mothers are the buyers and household with kids form a majority of the consumption. The insight that was leveraged was: mums value the opportunity to create simple, delightful moments for the family to be together. There is nothing that warms the mother’s heart more than seeing her kids share a joyous moment, a smile or a hearty laugh with their dad, siblings or grandparents.

Advertising Theme: Bringing People Together Through the Oreo Ritual of ‘Twist, Lick and Dunk’-TLD

Rituals play a central role in the lives of Indians, and they follow them with zeal and enthusiasm. Rituals also help in bringing people together. So this created an opportunity for Oreo to bring families together. The Oreo ritual of ‘Twist, Lick and Dunk’ became a platform to connect with people beyond the product, and bring about taste, joyousness and family bonding.

Oreo’s communication message focused on creating: 1. A ‘Ritual of Pleasure’ for the child, centred on the joy of consumption. 2. A ‘Ritual of Emotion’ for the parent, that sparks these slowed-down moments of togetherness and enhances the bonding between child and parent.

Implementing the Brand Communication Strategy

Creating simple, everyday family bonding moments became the trump card of the brand’s creative strategy. Therefore, the big idea was: ‘Oreo’s eating ritual elicits childlike delight and creates family moments of togetherness’.

Father-Child Relationship the Most Unique

Unlike the mother, the father spends far lesser time with the kids. So when the father is around, kids want to grab every opportunity they can to spend time with him. Children do this by constantly engaging with the father and bringing him into their world. Fathers, in turn, join in and cherish these delightful poignant moments by becoming childlike themselves and giving in to the kids’ requests.

The Oreo launch TVC captured the nuances of this relationship. The TVC depicted an everyday situation in the home, where Oreo fostered simple family bonding moments through the ‘Twist, Lick, Dunk’ (TLD) ritual that elicited childlike delight.

Oreo twisted, licked and dunked its way into Indian hearts. The communication medium were selected based on their affinity with mothers who were the TG for the communication.

TV Campaign

Oreo TV campaign was launched in March 2011. The first wave of trials happened based on strong in-store presence of the brand. This trade presence was further amplified with the TV investments scaling-up. The brand had one of the highest SOV (Share of Voice) on-air during this phase in the Biscuit category. The brand’s communication also created disruptive aston (ticker) bands and pushback banners during highly popular Cricket World Cup and IPL series to grab attention and create brand saliency amongst the viewers. This further fuelled the fire at the retail trade level through enhanced brand trials.

Billboards, bus wraps, seat backs and handles, backlit boards inside malls and train wraps were swathed in Oreo blue and TLD messaging. Oreo packet-shaped bus shelters strikingly caught the passer-by’s attention. Oreo ‘Twist, Lick and Dunk’ ambient innovation on mobile vans showed the Oreo cookie being dipped into a glass of milk to bring alive the TLD ritual.

Ambient Innovation

Oreo ‘Twist Lick Dunk’ Innovation on mobile vans showed the Oreo cookie being dipped in a glass of milk to bring alive the TLD ritual.

Point of Sale (POS) Activities

Best-in-class presence in Modern Trade stores using dispensers, floor shelf units, standees, vinyl’s on walls and spectacular displays. High visibility in Traditional Trade with branded counter-top outers, sleeve hangers, communication windows and inflated pack danglers to aid purchase.

Oreo ‘Togetherness Movement’

Oreo initiated a ‘Togetherness Movement’ through activities like TQ Quiz, TQ Survey, Togetherness Pledge and TQ Bus, to encourage parents and kids to spend time together. The Oreo Togetherness Bus visited 9 cities across India. The bus gave families an opportunity to bond over the ‘Twist, Lick and Dunk games’, a cookie corner to sample Oreo, a photo corner to capture fun family moments, and a Togetherness wall where parents and kids could make a pledge to spend more time together.

Brand Performance Against Objectives

Brand Share

Oreo’s target 1% share was achieved within the first 6 months of its launch in the market.

Building Brand Trials and Repeats

Brand trials and repeats exceeded targets for both children and adults within four months of the brand’s launch. (Source: IPSOS Brand Tracking Study, 2011).

Brand Awareness Scores

Oreo Brand Awareness beat other cream biscuits brand’s awareness and Oreo performed better than norms on brand linkage. With a strategy focused on rapid brand awareness and extensive distribution, the Oreo India launch story has been a success so far.

Oreo Launch – Facebook Results

Oreo among TOP 30 brands on Facebook in India. Oreo India Facebook Community crossed 45,000 members in just 9 weeks. Within 5 months of the launch, the Oreo India Facebook had 5,00,000 fans.

In Conclusion

Oreo has been able to get a very firm foothold in the highly competitive biscuits market in India by creating compelling differentiation at every level – in product offering, in-store in the Traditional and Modern Trade channels, in leveraging a unique consumer insight, in addressing consumers’ desires and in establishing a new ritual.

This differentiation was amplified and communicated to the target consumers using a plethora of cherry-picked integrated marketing communications tools and techniques- mass media advertising, consumer contact programmes, radio, bill boards, POS material to generate trials and brand conversion, social media networking sites, creating buzz through ambient media communications, exploiting the brand’s website, Out-of Home media etc.

All this has been orchestrated to single-mindedly create differentiation at the consumer level for Oreo brand. Thus making Oreo a part of the consumers’ repertoire in a highly crowded and fiercely competitive biscuit market in India.

In sum: To be different. You have to be seen as different.

Also Read: Case Study | Maggi Ban – Crisis And Repositioning In India

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Terms and Conditions

• Open access
• Published: 21 August 2024

The disease burden and its distribution characteristics of clonorchiasis in Guangdong Province, Southern China

• Datao Lin 1   na1 ,
• Zhuohui Deng 2   na1 ,
• Zebin Chen 3   na1 ,
• Kefeng Jiang 1 ,
• Qiming Zhang 2 ,
• Wenjing Zhou 4 ,
• Qixian Zhang 5 ,
• Jun Liu 2 ,
• Zhongdao Wu 1 ,
• Lan Guo 4 &

Parasites & Vectors volume  17 , Article number:  353 ( 2024 ) Cite this article

53 Accesses

Metrics details

Clonorchiasis has significant socioeconomic importance in endemic areas; however, studies investigating the disease burden in specific sub-regions are lacking. This study aims to address the gap by quantifying the current disease burden caused by clonorchiasis in Guangdong province and assessing its distribution characteristics.

Comprehensive measures, including prevalence rates, disability-adjusted life years (DALYs), and direct medical costs, were used to assess the disease burden of clonorchiasis. To estimate the prevalence rate, the number of infections was divided by the examined population, based on the annual surveillance data on clonorchiasis cases during 2016–2021. The calculation of DALYs was based on the epidemiological parameters according to the definition issued by the World Health Organization. Cost data of clonorchiasis were utilized to quantify the direct medical costs. The distribution characteristics of disease burden were assessed through comparisons of groups of population defined by geographic area, time, and characteristics of people.

In 2021, clonorchiasis posed a significant disease burden in Guangdong Province. The prevalence rate was found to be 4.25% [95% CI (4.02%, 4.49%)], with an associated burden of DALYs of 406,802.29 [95% CI (329,275.33, 49,215,163.78)] person-years. The per-case direct medical costs of patients with clonorchiasis were estimated to be CNY 7907.2 (SD = 5154.4). Notably, while the prevalence rate and DALYs showed a steady decrease from 2016 to 2020, there was a rising trend in 2021. Spatial clustering of clonorchiasis cases and DALYs was also observed, particularly along the Pearl River and Han River. This suggests a concentration of the disease in these regions. Furthermore, significant differences in prevalence rates were found among various demographic groups, including sex, age, occupation, and education level. Additionally, patients with longer hospital stays were more likely to incur higher direct medical costs.

Conclusions

The burden of clonorchiasis in Guangdong Province remains high, despite significant progress achieved through the implementation of the prevention and control programs. It is suggested that measures should be taken based on the distribution characteristics to maximize the effectiveness of prevention and control, with a primary focus on key populations and areas.

Graphical Abstract

Clonorchiasis, caused by Clonorchis sinensis , is a significant neglected tropical disease with features of low mortality and high disability [ 1 , 2 ]. This liver fluke infection is predominantly prevalent in areas with habits of eating raw fish and carries significant socioeconomic implications in endemic areas [ 3 , 4 ]. It has been estimated that the total economic burden of liver and biliary diseases caused by C. sinensis infection in Guangdong Province amounts to 1.6 billion Chinese yuan (CNY) [ 5 ]. This economic burden includes the direct economic burden of the disease, direct non-medical costs, and indirect economic burden, which cover expenditures from medical insurance, out-of-pocket payments, public funding, and other sources.

Clonorchiasis is a food-borne parasitic disease primarily transmitted through the ingestion of raw or undercooked freshwater fish that contain encysted metacercariae of C. sinensis [ 4 , 6 , 7 , 8 ]. Following infection, most of the individuals remain asymptomatic or experience mild symptoms, while some turn into substantial clinical or subclinical liver and biliary diseases, with cholangiocarcinoma (CCA) being the severe and fatal complication [ 9 ]. In 2009, C. sinensis was classified as a definite human carcinogenic (Group 1) by the International Agency for Research on Cancer (IARC) [ 10 , 11 ]. Currently, the main treatment for clonorchiasis is chemotherapy [ 12 ]. Considering the high economic burden caused by symptomatic therapy for sequelae, the prevention strategy, which includes preventive and curative measures, was proposed [ 13 , 14 ].

According to conservative estimation, approximately 15 million people worldwide have been infected with C. sinensis , with 85% of the cases attributed to China [ 15 ]. However, the degree of clonorchiasis endemicity in China varies across regions, with higher concentrations in the southeast and northeast [ 16 ]. Guangdong Province was found to be one of the most severely infected provinces according to the three large-scale nationwide surveys conducted in 1990, 2003, and 2015 [ 16 , 17 ]. The natural conditions, such as abundant river bodies and a climate suitable for the parasite, combined with the local dietary culture of eating raw fish, have contributed to the endemicity of clonorchiasis in Guangdong. The prevalence of the disease has been steadily increasing in Guangdong since 1990 [ 16 , 17 ]. In response, the Guangdong government issued the Prevention and Control Program for Key Parasitic Diseases (2016–2020) in 2016, implementing a series of prevention strategies were adopted [ 18 ]. It was assumed that high infection intensity and number of re-infections among hosts in endemic areas were associated with chronic infection, which might result in more severe health problems and produce a higher disease burden. Thus, it is of great importance to evaluate the current disease burden caused by clonorchiasis and investigate its temporal trends and distribution characteristics in Guangdong to facilitate the development of control strategies.

As defined by the World Health Organization (WHO), the disease burden was not only limited to incidence, mortality, and disability-adjusted life years (DALYs) [ 19 ] but also included the economic burden. Several studies have investigated the disease burden of clonorchiasis, among which most researchers followed the Global Burden of Disease (GBD) study and selected disability-adjusted life years as the measurement, and only one study evaluated the economic burden measured by currency. Furst et al. [ 20 ] found that the global disease burden caused by clonorchiasis in 2005 was approximately 275,370 DALYs, with China accounting for 84.1% (231,547 DALYs) and Vietnam, South Korea and Russia accounting for 15.9% (43,823 DALYs). Another study reported a higher figure with the DALYs owing to clonorchiasis were 489,174.04 person-years in China [ 21 ]. As for the economic burden, it was calculated that 1.3 billion CNY was created by C. sinensis infection in Guangdong [ 5 ]. Although research has been carried out on the estimation of the disease burden of clonorchiasis, only a few studies focused on endemic regions, and there was a lack of studies using comprehensive indicators.

Therefore, the primary objective of this study is to evaluate the current disease burden of clonorchiasis in Guangdong Province by utilizing synthesized indexes such as prevalence, DALYs, and cost of illness. Furthermore, the study aims to analyze the trends and distribution characteristics after the implementation of an integrated preventive strategy.

Study areas

Guangdong was one of the seven high clonorchiasis prevalence settings and was chosen to be the disease surveillance province [ 22 ]. Thus, an annual survey in fixed monitoring stations and mobile monitoring stations was carried out to investigate the current epidemic status of clonorchiasis from 2016 to 2021. The study included 16 fixed national surveillance sites, which were categorized according to their prevalence rate into low prevalence regions (≤ 10%), middle prevalence regions (> 10% and ≤ 30%), and high prevalence regions (> 30%). In each region, five villages or communities were selected from five different directions, including north, south, east, west, and middle. Subsequently, 200 villagers or citizens aged > 3 years were included in the survey from each unit. The study used a stratified random sampling method to select participants from each of the 16 fixed national surveillance sites. The sample size was determined based on the estimated prevalence rate of clonorchiasis in each region. The same sampling method was adopted for mobile surveillance sites.

Data collection

The prevalence survey data from 2016 to 2021 was collected from the Guangdong Provincial Center for Disease Control and Prevention, using methods such as reporting cases and active disease surveillance. The annual survey included fixed monitoring stations and mobile monitoring stations, which were used to collect data from the sampled individuals. Guangdong Province has established six national monitoring sites for liver fluke, two national comprehensive prevention and control demonstration areas, and eight provincial mobile monitoring sites. Among them, there are three fixed national monitoring sites, each with an annual budget of 45,000 CNY (6690.2 United States dollars, USD), totaling 135,000 CNY (20,070.5 USD); three mobile national monitoring sites, each with an annual budget of 50,000 CNY (7,433.5 USD), totaling 150,000 CNY (22,300.5 USD); two comprehensive prevention and control project counties, each with an annual budget of 150,000 CNY (22,300.5 USD), totaling 300,000 CNY (44,601.0 USD); and eight provincial monitoring sites, each with an annual budget of 50,000 CNY (7433.5 USD), totaling 400,000 CNY (59,468.1 USD). The total budget amounts to 985,000 CNY (146,440.1 USD). In addition, the study also utilized data from community health centers, hospitals, and clinics to ensure a comprehensive collection of prevalence data for clonorchiasis.

The sample size for the infection rate is specifically based on the 'Monitoring Plan for Clonorchiasis and Soil-Transmitted Helminthiases in Guangdong Province (Trial).' This study employed the modified Kato-Katz thick smear technique to examine and report egg counts. According to infection intensity classifications, > 98% of the infected individuals in the annual monitoring data had light infections (< 1000 eggs per gram of feces). The data included information on the number of examined persons, the number of persons infected with C. sinensis , and the general demographic information (e.g. age, sex, occupation, and education) of each examined individual. The crucial epidemiological disease parameters and demographic information, which were used to calculate DALYs, were obtained from literature and Guangdong Statistic Yearbooks or official documents. The cost data for treating clonorchiasis were acquired from a tertiary hospital in Guangdong Province, which was selected based on its reputation as a leading provider of healthcare services in the region. The hospital is known for its expertise in the treatment of infectious diseases, including clonorchiasis. While the hospital may not be representative of all healthcare facilities in Guangdong Province, it was chosen due to its status as a tertiary hospital and its extensive experience in treating clonorchiasis. The direct medical cost data were sourced from the medical information system of the hospital. Using International Classification of Diseases ten version (ICD-10) coding, the names of major diagnosed diseases between 2008 and 2022 (Clonorchiasis, Clonorchiasis (Chinese liver fluke disease), Clonorchiasis infection, parasitic infection, trematode infection, and Chinese liver fluke disease) were identified. Sociodemographic information (e.g. age, sex, ethnic and marital status), cost information, and healthcare utilization (length of stay) information of each case was included in the database.

A total of 124 patient medical records were selected for analysis. The costs were adjusted to 2022 CNY levels using the consumer price index, and extreme values ( n  = 114) were excluded before conducting the calculations. Considerations for the inclusion criteria of certain studies were as follows The C. sinensis infection group consisted of patients discharged with diagnoses of C. sinensis infection complicated by obstructive jaundice, cholecystitis, cholangitis, gallstones, cirrhosis, or malignant liver tumors. The non- C. sinensis infection group comprised patients discharged without diagnoses of C. sinensis infection but with complications such as obstructive jaundice, cholecystitis, cholangitis, gallstones, cirrhosis, or malignant liver tumors. Therefore, in this study, we considered the secondary disease burdens of obstructive jaundice, cholecystitis, cholangitis, gallstones, cirrhosis, and malignant liver tumors resulting from C. sinensis infection. Consequently, only patients with uncomplicated C. sinensis infections were included in the analysis for this study, excluding any cases with complications arising from the infection.

Data analysis

Calculation of dalys.

DALY is an index used to quantify health loss caused by a disease, and one DALY can be considered as one lost year of healthy life due to morbidity [ 22 , 23 , 24 , 25 ]. There are two methods for the calculation of DALY. One is based on incidence, and the other is based on prevalence [ 25 ]. DALY is calculated by adding years of life lost (YLLs) due to premature death from disease and years lived with disability (YLDs) owing to morbidity [ 25 ]. The formula was as follows:

In this study, the calculation of DALYs used a prevalence approach. YLDs were calculated by multiplying the number of the infected (number of population*prevalence rate of clonorchiasis) with corresponding disability weights (DW). The disability weights range from zero to one, and one represents the most severe health outcome of death. The specific calculation process is listed in formula (a).

The calculation of YLLs followed the method adopted by previous studies [ 20 , 21 ]. Premature death from C. sinensis was thought to be the attributable case of CCA. The odds ratio between C. sinensis infection and CCA and the incidence of CCA was used to compute the incidence rate of CCA, which was attributable to C. sinensis ( I *( OR -1)). Considering the poor prognosis and short disease duration of CCA [ 12 ], the mortality rate was replaced by its incidence rate. Finally, YLLs were calculated by the summation of all fatal populations multiplied by the life span at the age of death ( L e - L d ). The detailed procedure is expressed in formula (b).

The parameters used for evaluation were listed as follows. An estimation of the infection rate was obtained by dividing the number of infected by the number of examined persons. The provincial and municipal population was derived from the Guangdong Statistic Yearbooks [ 26 ]. The weighted disability weight due to C. sinensis in the Chinese population was 0.075 [95% confidential interval (95% CI): (0.060, 0.091)] [ 9 ]. The incidence rate of CCA among patients infected with C. sinensis was 1.5 per 100,000 population [ 27 ], and the odds ratio between C. sinensis and CCA was 4.47 [95% CI (2.61, 7.66)] [ 15 ]. The average life expectancy of the Guangdong population was 79.6 years old. As for the age of death in patients with CCA, it was replaced by the average age at the time of diagnosis. The figure used in the evaluation was 62.6 [95% CI (62.4, 62.8)] years old [ 28 ].

Calculation of cost of illness

The electronic medical records provided data for calculating direct medical costs from the healthcare system’s perspective. The direct calculation approach was used to evaluate the direct medical costs caused by clonorchiasis. In terms of composition regulated by the government, direct medical costs were made up of bed fees, diagnostic fees, treatment fees, and other fees. Considering the infection characteristics and high cure rate of clonorchiasis [ 29 ], the direct medical costs per case were calculated based on each record. Patients with re-infection were counted as multiple cases. Considering inflation, costs were adjusted to 2021 CNY value using the Consumer Price Index (CPI).

The prevalence rate of C. sinensis infection was calculated for each municipality in Guangdong Province, with the definition of positive infection being the presence of at least one egg. The 95% CI was calculated using a one-sample t-test. Comparisons of prevalence rates among people with different characteristics were achieved through the chi-square test. The significance level was set at 0.05. The main examined variables, DALYs and DALYs per 1000 population, were calculated by definition issued by WHO. The propagating imprecision approach was used to produce a 95% CI of DALYs [ 30 ]. The spatial distributions of DALYs and DALYs per 1000 population were demonstrated through maps, while the temporal trends were illustrated by line chart. As for cost data, descriptive statistics, including mean, standard deviation, median, percentiles, and proportion, were used to depict sociodemographic characteristics and direct medical costs. Due to the skewed distribution of medical costs, comparisons of costs for groups with different characteristics were made through the rank sum test (Mann-Whitney U test for two groups and Kruskal-Wallis H test for three and above groups). Statistical analyses were performed with Microsoft Excel 2019 ((Microsoft, Albuquerque, NM, USA) and R language (version 4.2.2). * P  < 0.05 is considered statistically significant.

A total of 129,582 people were examined to determine the infection level of C. sinensis in Guangdong Province from 2016 to 2021, with 10,270 in 2016, 17,332 in 2017, 21,577 in 2018, 22,879 in 2019, 28,880 in 2020, and 28,644 in 2021. The total number of infections was 4210, and the annual number of infections from 2016 to 2021 was 773, 856, 692, 417, 254, and 1218, respectively. The overall prevalence rate of clonorchiasis was 3.25% [95% CI 3.15%, 3.35%].

The infection rate of C. sinensis in Guangdong Province showed a decreasing trend between 2016 and 2020 and then staged a recovery in 2021. The infection rates from 2016 to 2021 were 7.53 [95% CI (7.02, 8.05)], 4.94 [95% CI (4.62, 5.27)], 3.21 [95% CI (2.98, 3.45)], 1.82 [95% CI (1.65, 2.00), 0.88 [95% CI (0.78, 0.99)], and 4.25 [95% CI (4.02, 4.49)], respectively (Table  1 ). The chi-square test indicated that the difference in infection rates in different years was remarkable ( χ 2  = 1511.1, P  < 0.001).

As for spatial distribution, C. sinensis infection appeared in area clustering in Guangdong Province, concentrating in the Pearl River and Han River basins. Of 21 prefecture-level cities, Jiangmen, Foshan, Zhongshan, and Heyuan had the highest infection rates. In 2021, the figures respectively reached 12.8%, 11.1%, 9.3%, and 37.2%. The prevalence situation was similar to that in other years (Table  1 ).

In terms of population distribution, people of different sex, age, occupation, and education showed significant differences in prevalence rates. Table 2 shows the infection rate of C. sinensis , which was stratified according to sex, age group, occupation, education, and years. Men had a significantly higher prevalence rate (4.27%) than women (2.26%) for infections with C. sinensis ( χ 2  = 413.3, P  < 0.001). People aged < 18 years old were less likely to have C. sinensis infection (0.54%) compared with individuals in other age groups ( χ 2  = 1860.1, P  < 0.001). With increase in age, the prevalence rose at the beginning but then it decreased, and the prevalence peak appeared in the 41–50-year-old group. Students had the lowest prevalence rate (0.69%) among all occupations ( χ 2  = 1041.0, P  < 0.001). The C. sinensis infection rate was the highest in people with a college degree (5.21%), followed by those with high school degrees (5.18%), illiteracy (4.63%), junior school degrees (3.36%), and elementary school education (1.80%). A significant difference was observed in people with different education levels ( χ 2  = 818.4, P  < 0.001).

The overall disease burden resulting from clonorchiasis in Guangdong was 406,802.29 [95% CI (329,275.33, 4,9215,163.78)] person-years in 2021, consisting of 402,390.00 [95% CI (324,984.35, 4,8761,687.27)] YLDs and 4,412.29 [95% CI (2,046.96, 847,007.02)] YLLs. The DALYs per 1000 population were 3.22 [95% CI (2.61, 389.85)] person-years. Among the 21 prefecture-level cities in Guangdong Province, Foshan, Heyuan, and Zhongshan showed the highest disease burden measured by DALYs (Table  3 ). The spatial distribution of DALYs caused by C. sinensis infection in each municipality across Guangdong is displayed in Fig. 1 .

Distribution of the disease burden of clonorchiasis in Guangdong Province in 2021. A DALY. B DALY per 1000 persons

From 2016 to 2021, the disease burden indicators, including DALYs and DALYs per 1000, gradually decreased at the beginning of 5 years and then rose suddenly (Fig.  2 ), consistent with the temporal trends of prevalence rate. However, the overall trends of DALYs and DALYs per 1000 presented a downward trend, decreasing from 618,862.85 and 5.70 in 2016 to 406,802.29 and 3.22 in 2021 (Table  4 ).

Temporal trends of DALYs of clonorchiasis in Guangdong Province

In total, 124 patients with the primary diagnosis of clonorchiasis were identified. After excluding extreme values, 114 patients were included for cost analysis. The basic characteristics are displayed in Table  5 . Out of the total cases, males accounted for 80.7%. The mean age was 44.9 ( SD  = 12.0) years old. Among all age groups, more cases were classified into the age group 40 to 60 years (47.4%), followed by the group < 40 years (37.7%) and > 60 years (14.9%). Of all the ethnic groups, the Han patients comprised the majority, with a proportion of 99.1%. As for marital status, 87.7% of patients were married. The average length of stay was 8.4 ( SD  = 4.4) days.

Overall, the direct medical costs of patients with clonorchiasis per case were CNY 7907.2 ( SD  = 5154.4) (equivalent to 1175.7 USD ± 766.3) (Table  6 ). Costs did not show significant differences among patients with different sex, age, ethnicity, and marital status, while the costs for patients having different lengths of stay were significantly different ( P  < 0.001).

In Guangdong, C. sinensis infections are highly prevalent, and the occurrence of repeated and chronic infection is common [ 13 , 31 , 32 ]. Notably, few studies have previously explored the disease burden of clonorchiasis in endemic areas using synthesized indexes. This study aimed to evaluate the disease burden caused by C. sinensis infection through comprehensive indicators and assess its trends from 2016 to 2021 in Guangdong.

It was found that the burden of disease associated with clonorchiasis in Guangdong was overwhelming, with a prevalence rate of 4.25%, DALYs of 406,802.29 [95% CI (329,275.33, 49,215,163.78)] person-years, and direct medical costs of CNY 7907.2 (USD 1175.7) in 2021. The prevalence rate, DALYs, and DALYs per 1000 population all experienced a downward trend between 2016 and 2020, then an upward trend in 2021, while in general, the situation in 2021 was better than in 2016. Moreover, the distribution of disease burden also showed spatial clustering, with infection cases concentrated in the Pearl River and Han River basins, such as Foshan, Zhongshan, and Heyuan. As for population distribution, people with different characteristics tend to have different prevalence rates and direct medical costs.

Based on the 2021 provincial clonorchiasis surveillance survey results, the prevalence rate of C. sinensis infection was 4.25% [95% CI (4.02, 4.49)]. The DALYs and DALYs per 1000 population due to clonorchiasis were 406,802.29 [95% CI (329,275.33, 49,215,163.78)] person-years and 3.22 [95% CI (2.61, 389.85)], respectively. Zhao et al. [ 20 ] found that the burden of clonorchiasis in Guangdong was 157,245.48 [95% CI (120,532.89, 199,807.40)] DALYs in 2015, and the global burden of clonorchiasis reported by Furst et al. [ 20 ] was 231,547 person-years. Compared with previous research, this study reported a much higher figure. The different computation methods and study time might explain the condition [ 21 ]. In the former study, a standardized prevalence rate was used for calculation, and thus the results might not accurately reflect the reality, while in the latter study, only severe disability due to infection was considered, which might lead to the result of lower disease burden. Different from these two studies, this research considered all severity levels of disability due to C. sinensis infection and adopted the latest raw prevalence rate for calculation. Therefore, to some extent, the results in this study could precisely reflect the current disease burden caused by clonorchiasis in Guangdong.

Through cost analysis of clonorchiasis, we found that the average direct medical costs per case in Guangdong were CNY 7,907.2 ( SD  = 5154.4) (equivalent to 1175.7 USD ± 766.3), lower than the previous research findings [ 5 ]. In that study, the calculated direct medical costs of clonorchiasis-induced gallbladder cholangitis, cholelithiasis, liver cirrhosis, and malignant liver tumor were respectively CNY 5015.52, CNY 9971.76, CNY 13,168.83, and CNY 17,638.28 in 2009 (CNY 7034.32, CNY 13,985.50, CNY 18,469.42, and CNY 24,737.87 in 2022) [ 33 ]. Different selection criteria for the study population might partly explain the situation. In this study, patients whose primary diagnosis was clonorchiasis were chosen, and the symptoms were relatively mild, while in that study, patients with liver and biliary disease were selected. Therefore, the costs in our study were relatively lower and closer to the real world’s true values.

From 2016 to 2021, the prevalence rate and DALYs of clonorchiasis decreased steadily first and then increased in 2021. The continued decline in the first 5 years might be attributed to the implementation of the Clonorchiasis Prevention and Control Project in Guangdong Province. Since 2016, the relevant departments have taken a series of measures such as propaganda and education, surveillance, and deworming treatment to prevent clonorchiasis [ 18 ]. Thus, the main source of contagion and transmission route were controlled, and the prevalence rate and DALYs decreased correspondingly. For the rise in 2021, one possible explanation was that, owing to the pandemic of COVID-19, there was a lack of human, physical, and financial resources. It was indicated that the shortage of resources was an obstacle to the prevention of clonorchiasis [ 34 ]. Therefore, the prevalence rate and DALYs showed a slight rebound in 2021.

The results revealed that the clonorchiasis cases were distributed in most areas of Guangdong Province, with the prevalence rate and DALYs primarily located alongside the Pearl River and Han River, consistent with the results of previous prevalence surveys conducted in Guangdong [ 35 , 36 , 37 ]. There were several reasons for the occurrence of spatial clustering. First, this might be partly due to the livable environments for C. sinensis [ 32 ]. Sufficient freshwater resources and suitable climate conditions in these regions make sure that different growth states of C. sinensis and the competence of infection exist, thus facilitating the spread of clonorchiasis. Second, this fluke develops in two intermediate hosts in fresh water and one definitive host, giving it a clear survival advantage [ 29 , 38 ]. In these settings, the existence of abundant intermediate hosts and definitive hosts laid good foundations for the formation of a relatively suitable food chain for predation and prey, thus making it possible for C. sinensis to develop a complete life history and resulting in clonorchiasis prevalence [ 3 ]. Moreover, studies showed that the well-developed fish breeding in these regions and the dietary habit of eating “sashimi” collaboratively promote the transmission of clonorchiasis [ 32 , 39 ]. In certain areas, poor management of human and animal feces results in their discharge into water sources, potentially containing eggs of C. sinensis , which can release miracidia and thus lead to the formation of an endemic disease [ 3 , 29 ]. Additionally, the high accessibility to infection sources was an important contributor that should not be ignored [ 3 ]. It was shown that habits such as catching fish without washing hands, holding fish with the mouth, and mixed use of the kitchen chopping boards could also increase the risk of infection.

This research, consistent with the previous study [ 17 ], found that the prevalence rate of clonorchiasis in males was significantly higher than that of females in Guangdong. Males have more chances to eat raw fish and are more indulged in this diet [ 40 ]. Although health education has been carried out for a long time, these dietary habits in men were hard to change [ 3 , 17 ]. Moreover, public officials, medical staff, and teachers had been reported to have higher infection rates among all occupations in this study, which further indicated the paradox between knowledge and behavior where the knowledge of clonorchiasis could not prevent people from consuming raw fish [ 32 ]. Additionally, the findings that the infection rate increased with age (0−50 years) and people aged between 40 to 60 years had the largest proportion of C. sinensis infection, in line with a previous study [ 3 ], indicated that the frequency of raw fish consumption was associated with clonorchiasis. As for education level, people with college degrees reported the highest rate. The confounding effect of age might explain the situation. The direct medical costs for patients with clonorchiasis significantly differed according to the length of stay. Generally, patients with severe clinical symptoms are more likely to have longer stays and higher direct medical costs. As previous findings showed, patients with different complications of C. sinensis infection had quite different costs [ 5 ].

This study quantified the current disease burden of clonorchiasis in Guangdong by using indexes of prevalence rate, DALYs, and direct medical costs and demonstrated its distribution characteristics and temporal trends. To the best of our knowledge, this was the first study having evaluated the disease burden of clonorchiasis in endemic areas from diverse dimensions and explained the sub-regional and temporal variation.

However, several limitations need to be acknowledged. First, due to the inaccessibility of data on clonorchiasis deaths in Guangdong, this study followed the approach of previous studies [ 12 , 21 ] and extracted the key parameters from the literature. The parameters used to calculate DALYs were the best available data we could find. Second, in the cost of illness study, because measurement of direct non-medical and indirect costs is not feasible with current data sources, only direct medical costs were included in this analysis. Thus, the economic burden reported in our analysis may be underestimated. It was recommended that the recording and archiving of relevant data should be strengthened in the future to provide more precise information.

Although effective measures have been taken to prevent and control clonorchiasis, the disease burden caused by clonorchiasis in Guangdong is still remarkable and showed a brief rebound in 2021. This situation highlights the urgent need for sustainable prevention and control strategies. Tailored preventive recommendations should be formulated based on an evidence-based scientific approach, considering the distribution characteristics of the disease burden. In endemic areas, it is crucial to prioritize efforts such as strengthening fish farming management, improving food safet,y and enhancing awareness, which plays a vital role in effectively combating clonorchiasis. It is important to pay particular attention to men, adults, and individuals with lower levels of education during the clonorchiasis prevention campaign.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Chinese Yuan

Adding years of life lost

Consumer Price Index

World Health Organization

Global burden of disease

Aisability-adjusted life year

Confidence interval

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Acknowledgements

We would like to express our sincere gratitude to all the units and individuals who participated in the study of disease burden analysis and health economic evaluation of clonorchiasis. We also thank the Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-sen University, for their valuable assistance.

This work was supported by the Key Research and Development Program of Guangdong Province (no. 2022B1111030002), the National Key Research and Development Program of China (nos. 2021YFC2300800 and 2021YFC2300801), the National Natural Science Foundation of China (nos. 82272361, 81902081, 82202560, and 82161160343), the Natural Science Foundation of Guangdong Province (nos. 2024A1515010615 and 2021A1515010976), the Science and Technology Planning Project of Guangdong Province (no. 2021B1212040017), the Science and Technology Projects in Guangzhou (no. 2024A04J4314), the National Parasitic Resource Center of China (no. NPRC-2019–194-30), and the 111 Project (no. B12003). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Datao Lin, Zhuohui Deng and Zebin Chen contributed equally to this work.

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Department of Parasitology, Key Laboratory of Tropical Disease Control (Ministry of Education), Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080, China

Datao Lin, Kefeng Jiang, Zhongdao Wu & Xi Sun

Guangdong Provincial Center for Disease Control and Prevention, WHO Collaborating Centre for Surveillance, Research and Training of Emerging Infectious Diseases, Guangzhou, 511430, China

Zhuohui Deng, Qiming Zhang & Jun Liu

Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China

Wenjing Zhou & Lan Guo

Department of Gastroenterology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China

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ZDW, XS, ZHD, LG, and DTL conceived and designed the research. LG, DTL, and ZBC were responsible for drafted the manuscript. LG, DTL, ZBC, QMZ, and QXZ were responsible for study selection and data extraction. DTL, KFJ, WJZ, LG, ZHD, JL, and XS revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Zhuohui Deng , Lan Guo or Xi Sun .

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Lin, D., Deng, Z., Chen, Z. et al. The disease burden and its distribution characteristics of clonorchiasis in Guangdong Province, Southern China. Parasites Vectors 17 , 353 (2024). https://doi.org/10.1186/s13071-024-06425-z

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DOI : https://doi.org/10.1186/s13071-024-06425-z

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