A developmental view of the effects of an energy and micronutrient supplement in undernourished children in Indonesia

Abstract

Objectives: This paper presents the results of a structural equation model testing whether the longitudinal data of the Pangalengan subjects ®t the theoretical model regarding the intellectual delay of undernourished children. Design: Two cohorts of children were randomly assigned to three treatments: E 1171 kJ 12 mg iron; M 12 mg iron 209 kJ; S 104 kJ. Supplementation was given for 6 months. Setting: The sites were six tea plantations in Indonesia. Subjects: A 12-month-old (n 53) and an 18-month-old (n 83) cohort were recruited from day-care-centers. Inclusion criteria were: no chronic disease; length-for-age `1 standard deviation (s.d.) and weight-for-length between À1 and À2 s.d. of the median of the reference of the World Health Organization. Methods: Twenty-four-hour dietary intakes were assessed using the weighted individual inventory technique. Body weight and length were obtained using standard procedures; motor development was assessed with the Bayley Scale and with a custom made scale for motor development leading to bipedal locomotion. Four-hour observations were made of the child's interactions with the environment. Carrying a child in the arms and exploratory behavior were used as indicators of caregiving and exploration. All measurements were obtained every 2 months. Results: The original model did not ®t the data. The model was then modi®ed with the inclusion of two new pathways: from activity and from motor development to mental development. Following these adjustments the model ®t the data for each cohort and for both cohorts combined.

Effects of an energy and micronutrient supplement on iron deficiency anemia, physical activity and motor and mental development in undernourished children in Indonesia

“…The micronutrient supplement did not improve performance on any of the mental tests or change the behaviors observed under natural conditions. The bene®cial effects of the micronutrient intervention (with and without the condensed milk) on the motor development and activity of the 18 IDA subjects is far more evident than the effects from the micronutrients on these same outcomes in all the subjects that received it in the larger study (Pollitt et al, 2000c;Jahari et al, 2000b). For instance, the micronutrient supplement given to the IDA subjects improved their performance in the BSMOD and increased their activity following iron repletion.…”

A developmental view of the undernourished child: background and purpose of the study in Pangalengan, Indonesia

“…Pollitt et al (2000) assess whether the data from this study ®t the conceptual model outlined in Figure 1.…”

“…The results are presented separately in several of the papers that follow. report the results of a cross-sectional test of the model, while Pollitt et al (2000) report the results of a longitudinal test of the model.…”

Effects of iron deficiency in infancy on patterns of motor development over time

“…Sufficient fine motor control is required for effective object manipulation, through which infants develop their capabilities to process perceptual information. Indeed, a conceptual multi-level model of long-lasting intellectual delays in undernourished infants, developed by Pollitt and colleagues, postulates that poorer motor development is one of the first-level variables influencing cognitive outcome (Pollitt, 2000a;Pollitt, Jahari, & Walka, 2000;.…”