Optimized Complementary Feeding With or Without Home Fortification Prevents Decrease of Micronutrient and Growth
Condition: Complementary Feeding; Linear Programming; Nutritional Status; Micronutrient Deficiency; Growth Failure
MeSH terms: Failure to Thrive
Study type: Interventional

Summary: 
      Malnourished among under-five children characterized by growth faltering is a public health
      concern in Indonesia. It requires serious action from the governments because of the
      prevalence of underweight, stunting, and wasting are increasing. These impacts are
      irreversible resulting in the low quality of future human resources. Several studies showed
      that growth faltering among under-five children starts at age six months when the amount of
      breastmilk reduced, complementary feeding initiated, and risk for infection is increased. A
      rapid growth phase also causes growth faltering at age 6-24 months. The inadequate amount and
      low quality of food during this period can also lead to reducing nutritional status. The
      Indonesian Government released a national policy in 2013 to address undernutrition among
      under-five children called the Indonesia President Regulation No. 42/2013 regarding national
      movements on the acceleration of nutritional programs to address micronutrients deficiency
      among under-five children by providing micronutrient powder (MNP) (called Taburia) for
      children aged 6 - 59 months. Our literature review documented that there is no study ever
      conducted to evaluate the effectiveness of MNP (Taburia) in improving the weight and height
      of the children. Moreover, behavioral modification interventions to promote food
      diversification to improve nutrient intake and to prevent micronutrient deficiency are also
      never conducted. Based on the rationale and study concept, the following hypotheses are 1).
      Promotion of optimized complementary feeding along with or without multi-micronutrient powder
      or MNP (namely taburia) can prevent reductions in nutrient intake and density; serum ferritin
      and zinc levels; and anthropometric z-score index compared to controls, and 2) provision of
      MNP can prevent reductions in nutrient intake and density; serum ferritin and zinc levels;
      and anthropometric z-score index compared to controls.
    

Detailed description: 
      Our study consists of two phases. The first phase was to develop a combination model of
      Complementary Feeding Recommendation (CFR) or optimized Complementary Feeding (CF) with or
      without MNP home fortification (Taburia) by using a Linear Programming approach. The
      objective of this stage was to address the nutrient gaps. Also, nutrient analysis of Taburia
      by employing an LP approach will provide adequate dosing of Taburia to added to local CF.
      Several studies have documented that MNP supplementation associated with a reduced bacterial
      population in digestive systems (Lactobacillus dan Bifidobacterium spp) and induced
      inflammation on the intestines. These conditions reduce the absorption capacity of digestive
      systems leading to nutrient deficiency among under-five children. Findings from the first
      phase were an optimized model of CF with or without MNP (Taburia) as an intervention media in
      the second phase of our study, which evaluates the effectiveness of a combination of CFRs and
      MNP fortification using an LP approach. This intervention group compared to (1) optimal
      Complementary Feeding (CF) with MNP one sachet per week, (2) optimized CF group alone, (3)
      Provision MNP alone three sachets per week, and (4) control group. Several indicators to be
      evaluated were (1) nutrient intake and density; (2) z-score of anthropometric index; (3)
      micronutrient status; (4) digestive health status (relative population of DNA Bifidobacterium
      and Lactobacillus spp).
    

Intervention name(s): Nutritional education program; Home fortification (Taburia)
Intervention type(s): Behavioral; Dietary Supplement
Intervention description(s): These programs were a process of providing information or knowledge to mother of the children consisting of information on initiation of complementary feeding, variety, and frequency of food, nutrient requirements and diet pattern for children (the amount and types of food), and benefits of Taburia. All this information provided through class-based activities and group discussion by using leaflet and food model conducted by the researchers. Education materials developed based on CFR models from our previous study by applying the LP approach. There was also a demonstration on administering complementary feeding (demo and cooking class) to improve skills of the mother on food from selection, design, handling and preparing, based on requirements of the children. This activity conducted through training once per month for the first four months of the intervention. Components of complementary feeding promoted in this study are based on CFR using LP approach from our previous research.; Taburia is a multivitamin and mineral fortification to provide sufficient amount of nutrient for optimal growth and development of children aged 6-59 months. Every sachet of Taburia prepared to fulfill minimum nutrient requirements for children aged 6-59 months. Each sachet is one gram in weight and contains vitamin A (417 mcg), B1 (0.5 mg), B2 (0.5 mg), B3 (5.0 mg), B6 (0.5 mg), B12 (1 mcg), D3 (5 mcg), E (6 mg), K (20 mcg), C (30 mcg), folic acid (150 mcg), pantothenic acid (3 mcg), Iodium (50 mcg), Iron (10 mg), Zn (5 mg) and Selenium (20 mcg). One sachet of Taburia given to the subject by adding it to their breakfast and must be finished. The frequency of Taburia consumption per week follows the finding of the LP analysis from the previous study. Taburia intervention complemented by health education related to benefits, administration of Taburia, and its side effects. Compliance will be evaluated directly by the researcher based on empty Taburia sachet and conducted every month.
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: The intervention groups consisted of promotion of optimized complementary feeding (CF) with taburia (P1, n=51), optimized CF (P2, n=54) and taburia home fortification (P3, n=47). Control groups will not receive intervention or placebo but will receive only a standardized primary health care education program related to complementary feeding practices for infants and children. Also, the nutritional status of all groups will be measured every month.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Complementary feeding; Linear Programming; Nutritional status; Micronutrient; Growth