Frequent Consumption of Micronutrient-Rich Foods Is Associated With Reduced Risk of Anemia Among Adolescent Girls and Boys in Indonesia: A Cross-Sectional Study.

BACKGROUND: Anemia is a global public health concern. Its devastating consequences include impaired cognitive and motor development, reduced work productivity, and adverse birth outcomes, all of which apply to adolescents, as well as adults and children. OBJECTIVE: This study aimed to examine the determinants of anemia in Indonesian adolescent girls and boys from Klaten and Lombok Barat districts. METHODS: A total of 2150 adolescents who participated in a cross-sectional household survey were included in the analysis. The dietary intake of adolescents was assessed using a 7-day food frequency questionnaire. The relationship between anemia status, dietary intake, and other hypothesized determinants was assessed for adolescent girls and boys on a separate basis, using complex samples Cox regression analysis. Variables were selected for inclusion in multivariate models if they were significantly associated with the dependent variable in univariate models (P < .05). RESULTS: The prevalence of anemia among adolescent girls and boys was 19% and 5%, respectively. In multivariate analyses, frequent consumption of animal-based iron-rich foods was significantly associated with a lower risk of anemia (prevalence ratio [PR]: 0.59; 95% CI: 0.36-0.97) among adolescent girls, whereas a higher intake of vitamin A-rich fruits and vegetables was associated with a reduced risk of anemia (PR: 0.41; 95% CI: 0.20-0.85) among adolescent boys, after adjustment for all potential confounders. CONCLUSIONS: Increased consumption of iron- and vitamin A-rich foods through the implementation of gender-responsive Social Behaviour Change Communication (SBCC) interventions is warranted. This should be coupled with improved coverage and quality of iron and folic acid supplementation programs in adolescents.

Using formative research to inform the design of a home fortification with micronutrient powders (MNP) Program in Aileu District, Timor-Leste.

BACKGROUND: Using formative research to guide the planning and implementation of home fortification programs is critical if they are to achieve the desired level of acceptance and coverage by the target beneficiaries. OBJECTIVE: To explore contextual factors that could influence acceptance, delivery, and use of micronutrient powders (MNP) in Aileu District, Timor-Leste. METHODS: Two focus group discussions were conducted with mothers of children 6 to 23 months of age, and 56 in-depth interviews were conducted with mothers (n = 18), fathers (n = 14), grandmothers (n = 14), health workers (n = 8), and Catholic catechists (n = 2). These were followed by a 14-day usability trial during which 45 mothers fed their children MNP daily and were interviewed about their experience. Participants were selected from three villages. RESULTS: The findings revealed limited exclusive breastfeeding and early introduction of complementary foods due to traditional beliefs and poor knowledge. MNP was generally liked by the respondents. Thirty of the 45 children in the trial consumed all of the 14 MNP sachets provided to them. The majority of mothers (n > or = 30) split and fed the daily dose of MNP at different times of the day. They gave several reasons for this practice, including changes in the color of food when a whole sachet of MNP was added. Only six mothers shared MNP-fortified food among siblings. The participants suggested contextual attributes that could influence their adoption of MNP including preferred name, packaging design, and delivery channel. They preferred orange-colored sachets with a picture of a "healthy" Timorese baby, the logo of the Ministry of Health, and instructions on how to use the product. CONCLUSIONS: The findings offer context-specific knowledge that could guide the success of the MNP program in this district and similar settings.

Cost analysis of community-based daily and weekly programs for treatment of moderate and mild wasting among children on Nias Island, Indonesia.

BACKGROUND: Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for rehabilitation of moderately and mildly wasted (weight-for-height z-score > or = -3 to < -1.5 SD) children on Nias Island, Indonesia. Daily programs were performed in semiurban settings, and weekly programs took place in rural areas. OBJECTIVE: To analyze the cost of daily and weekly distribution and supervision of RUF-Nias biscuit programs. METHODS: The costs of the daily and weekly programs were derived from the financial report and interviews with program implementers and participating households. Costs were calculated on the basis of total rehabilitation costs per child per day required to achieve a target weight-for-height z-score > or = -1.5 SD in daily and weekly programs. RESULTS: Institutional costs to the implementing organization were similar for both programs (approximately US $4 per child per day). The daily programs resulted in a significantly higher proportion of recovered children (78.6% vs. 65.4%) and higher weight gain (3.7 vs. 2.2 g/kg/day) than the weekly programs. About 6% to 7% of the total cost of the programs was accounted for by locally produced RUF-Nias biscuits. The social cost borne by the community for the weekly programs was about half that for the daily programs. CONCLUSIONS: The daily programs achieved better results for the implementing organization than the weekly programs; however, the weekly programs were preferred by the community because of the lower time constraints and the lower opportunity cost of time. The willingness of community and household members to invest their time in more intensive activities in the daily programs led to better program outcomes.

Combined intensive nutrition education and micronutrient powder supplementation improved nutritional status of mildly wasted children on Nias Island, Indonesia.

To assess the impact of intensive nutrition education (INE) with or without the provision of micronutrient powder (MNP) on the nutritional status of mildly wasted children in Nias, Indonesia, two groups of mildly wasted (>=-1.5 to <-1.0 WHZ) children aged >=6 to <60 months in the Church World Service (CWS) project areas were assigned by village randomization to receive INE (n=64) or INE+MNP (n=51) in a weekly program. Another two groups of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to receive a monthly non-intensive nutrition education program (NNE) with or without MNP (n=50 both respectively). WHZ, weight, height, haemoglobin (Hb) level, and morbidity data were assessed at admission, during the study, and at individual discharge. Children's weight gain (g/kg body weight/day) was highest in INE+MNP group (2.2±2.1), followed by INE (1.1±0.9), NNE+MNP (0.3±0.5) and NNE (0.3±0.4) group. In both MNP intervention groups (INE+MNP, NNE+MNP), supplements significantly increased Hb value (g/L) of respective children (10.0±10.0; p<0.001 and 3.0±8.0; p<0.05 respectively). Proportion of children who reached discharge criterion was highest among the INE+MNP (70.6%; n=36), followed by INE (64.1%; n=41), NNE+MNP (26.0%; n=13), and NNE (20.0%; n=10) groups (p<0.001). Shortest length of stay until recovery was observed among children in the INE+MNP group (29.9 days), followed by INE (40.0 days), NNE+MNP (80.6 days), and NNE (86.2 days) respectively (p<0.001). Weekly intensive nutrition education supported by MNP supplementation produced the best results regarding weight gain and haemoglobin status of mildly wasted children.