Ratna Chrismiari Purwestri

Infant feeding practices among mildly wasted children: a retrospective study on Nias Island, Indonesia

BackgroundThis study investigated the infant feeding practices of participating mothers who were recruited into a research project aimed at improving the nutritional status of mildly wasted children (< -1.0 to ≥ -1.5 Weight-for-Height Z-score s) aged ≥ 6 to < 60 months on Nias Island, Indonesia.MethodsCross-sectional, questionnaire-based interview of mothers of the index children (n = 215) who were admitted to the community program for mildly wasted children in the study area. Four focus groups and twenty in-depth interviews were conducted to explore further information on infant feeding practices in the study area.ResultsRetrospective results indicated that 6% of the mothers never breastfed. Fifty two percent of mothers initiated breastfeeding within six hours of birth, but 17% discarded colostrum. Exclusive breastfeeding until 6 months of age was practiced by 12%. Seventy-four percent of the mothers offered supplementary liquids besides breast milk within the first 7 days of life, and 14% of infants received these supplementary liquids from 7 days onwards until 6 months of age. Moreover, 79% of the infants were given complementary foods (solid, semi-solid, or soft foods) before 6 months of age. About 9% of the children were breastfed at least two years. Less than one in five of the mildly wasted children (19%) were breastfed on admission to the community program. Qualitative assessments found that inappropriate infant feeding practices were strongly influenced by traditional beliefs of the mothers and paternal grandmothers in the study areas.ConclusionGenerally, suboptimal infant feeding was widely practiced among mothers of mildly wasted children in the study area on Nias Island, Indonesia. To promote breastfeeding practices among mothers on Nias Island, appropriate nutrition training for community workers and health-nutrition officers is needed to improve relevant counseling skills. In addition, encouraging public nutrition education that promotes breastfeeding, taking into account social-cultural factors such as the influence of paternal grandmothers on infant feeding practice, is needed.

Improved Nutrition Knowledge and Practice through Intensive Nutrition Education: A Study among Caregivers of Mildly Wasted Children on Nias Island, Indonesia

Background Inappropriate nutrition knowledge and feeding practices of caregivers are among several important causes of persistent malnutrition problems in young children. Thus, it is essential to provide caregivers with the necessary knowledge to help them modify their feeding practices. Objective To examine the effectiveness of two different nutrition education methods, weekly intensive nutrition education (INE) and monthly nonintensive nutrition education (NNE), designed for caregivers of mildly wasted children (weight-for-height z-score ≥ −1.5 to < −1) aged ≥ 6 to < 60 months on Nias Island, Indonesia. Methods To assess the impact of the two different nutrition education approaches on nutrition knowledge and practice of caregivers with their children, respondents were assigned to receive either weekly INE (n = 114) or monthly NNE (n = 96). The knowledge and practice levels of the mothers in each group were assessed and compared using a pretested validated questionnaire at admission and after the intervention period. Results At admission, the knowledge and practice levels of caregivers in both groups were not statistically significantly different. After participating in the nutrition education program, the percentage of correct answers on nutrition knowledge and practice in the INE group was significantly higher than that in the NNE group. Significant improvement in knowledge and practice scores was observed in the INE group after the intervention (p < 0.001), whereas only a significant improvement in knowledge was found in the NNE group (p < .05). Conclusions In comparison with NNE, the INE approach was significantly better in bringing about a positive change in knowledge and practice of caregivers of mildly wasted children in the study area.

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 ≥ −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 ≥ −1.5 SD in daily and weekly programs. Results Institutional costs to the implementing organization were similar for both programs (approximately US

Design and validation of a program to identify inadequate intake of iron, zinc, and vitamin A

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.

Impact of Daily versus Weekly Supply of Locally Produced Ready-to-Use Food on Growth of Moderately Wasted Children on Nias Island, Indonesia

OBJECTIVE The aim of this study was to create an innovative, easy-to-use, and informative web-based application system to calculate the iron, zinc, and vitamin A intake in comparison to the recommended nutrient intake (RNI). METHODS Food survey data on commonly consumed Indonesian foods (122 foods) were recorded from 68,800 households. The data were used to extract 13 relevant food groups representing typical Indonesian dietary patterns and were incorporated into the development of new software called the Calculator of Inadequate Micronutrient Intake (CIMI). To validate, 24-h dietary recall data of children (n = 118) and adult women (n = 124) from Indonesia were collected and analyzed using CIMI and Nutrisurvey (NS) and the results were analyzed. RESULTS CIMI calculates the absolute intake of energy, macronutrients, retinol, ß-carotene, retinol equivalents, iron, and zinc. The percentages of RNI fulfillment with regard to age and sex are presented. The bioavailability levels of iron and zinc are considered. Validation showed that results of CIMI and NS were comparable with regard to the average intake and range of data distribution ratio. Due to bioavailability factors, more participants who had intake of iron (adult group) and zinc (both groups) below the cutoff were detected by CIMI. The range of correlation coefficient of NS and CIMI were from 0.889 (energy) to 0.713 (iron) in the childrens group and from 0.919 (protein) to 0.686 (vitamin A) in the adult group. CONCLUSION CIMI is a simple and rapid tool that calculates energy and nutrient intake, and also the percentage of nutrient fulfillment in comparison with the dietary recommendation.

Role of food taboos in energy, macro and micronutrient intake of pregnant women in western Kenya

This study reports the outcomes of daily (semi-urban areas) and weekly (remote rural regions) programs for moderately wasted children supplemented with locally produced ready-to-use foods in the form of fortified cereal/nut/legume-based biscuits on Nias Island, Indonesia (RUF-Nias biscuit). Thirty-four children in daily and twenty children in weekly programs aged ≥6 to <60 months with weight-for-height z-score (WHZ) ≥ −3 to < −2 SD were recruited (October 2007–June 2008) on Nias and admitted into existing nutrition centers in the Church World Service project area. Individual discharge criterion was WHZ ≥ −1.5 SD. Weight gain of the children in daily and weekly programs was 3.9 ± 3.8 and 2.0 ± 2.0 g/kg/day, respectively. A higher proportion of children in daily than weekly programs reached target WHZ (76% vs. 35%, P = 0.004). Weight gain at program discharge/closure was highly predicted (R 2 = 0.228, P < 0.001) by compliance to RUF biscuits: high vs. low compliance resulted in a 1.33 (95% CI 0.16 to 1.53) g/kg/day higher weight gain. Compliance and admission in daily programs were significant factors in reducing the risk of not reaching the discharge criterion. However, mothers complained more frequently about time constraints in the daily relative to weekly programs.

The influence of traditional stir-frying with oil on acceptability, antioxidant activities, nutrients, and the phytic acid content of fermented soybean (tempeh)

The purpose of this paper is to examine food taboos/habits and dietary patterns of pregnant women in Kenya.,In all, 205 individual 24-h recall interviews were conducted face to face to collect information on pregnant women dietary intake. Women focus group discussions were conducted in seven villages in Kakamega County to determine which foods are avoided during pregnancy and the reasons for avoiding them.,The concept of “baby becoming big” was common advice to pregnant women to reduce intake of large amounts of starchy or high caloric foods. Restriction on the consumption of some parts of cow and chicken and consumption of eggs was widespread. Women with the highest education had significantly higher intake than women with lower education: energy (1,718 vs 1,436 kcal, p = 0.007), protein (45 vs 38 g, p = 0.03), vitamin C (59 vs 39 mg, p = 0.000), calcium (275 vs 222 mg, p = 0.04) and iron (8.5 vs 7.2 mg, p = 0.03). Multivariate binary logistic regression showed that participants with higher education were more likely to reach estimated average intake for energy (OR = 2.82, 95 per cent CI = 1.2-6.5) and vitamin C (OR = 4.1, 95 per cent CI = 1.5-11.0) than women with lower education level.,The observed link between reduced intake of nutrients and low education levels suggests that education is a possible intervention strategy. Incorporating nutrition education in school curriculum and improving knowledge on nutrition among women with low education may help overcome unhealthy food taboos in pregnant women.

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

Purpose – The purpose of this paper was to investigate the acceptability of processed tempeh and the effect of stir-frying on uncooked tempeh composition, total phenolic content (TPC), antioxidant (AO) activities and the phytic acid (PA) concentration. Design/methodology/approach – Fermentation was performed in the solid-state using soybean (Glycine max) inoculated with Rhizopus oligosporus. The acceptability of tempeh was evaluated by administering a questionnaire. The TPC of uncooked and stir-fried tempeh was examined using Folin-Ciocalteu’s method, and PA was analyzed by high-performance liquid chromatography. AO activities were measured by the thiobarbituric acid reactive substance (TBARS) and ferric ion reducing/antioxidant power methods. The stir-fried tempeh was more acceptable than other preparations to the panelists. Findings – In comparison with the uncooked tempeh, stir-fried tempeh showed higher fat composition, in addition to decreased levels of minerals, PA and TBARS. Originality/value – Soy...