Effect of an Integrated Package of Nutrition Behavior Change Interventions on Infant and Young Child Feeding Practices and Child Growth from Birth to 18 Months: Cohort Evaluation of the Baduta Cluster Randomized Controlled Trial in East Java, Indonesia

Abstract

The need for a multisectoral approach to tackle stunting has gained attention in recent years. Baduta project aims to address undernutrition among children during their first 1000 days of life using integrated nutrition-specific and nutrition-sensitive interventions. We undertook this cohort study to evaluate the Baduta project’s effectiveness on growth among children under 2 years of age in two districts (Sidoarjo and Malang Districts) in East Java. Six subdistricts were randomly selected, in which three were from the intervention areas, and three were from the control areas. We recruited 340 pregnant women per treatment group during the third trimester of pregnancy and followed up until 18 months postpartum. The assessment of breastfeeding and complementary feeding practices used standard infant and young child feeding (IYCF) indicators in a tablet-based application. We measured weight and length at birth and every three-months after that. The enumerators met precision and accuracy criteria following an anthropometry standardization procedure. Among the breastfed children, the percentage of children who achieved the minimum dietary diversity score (DDS) and minimum acceptable diet (MAD) was higher for the intervention group than the comparison group across all age groups. The odd ratios were 3.49 (95% CI: 2.2–5.5) and 2.79 (95% CI: 1.7–4.4) for DDS and 3.49 (95% CI: 2.2–5.5) and 2.74 (95% CI: 1.8–5.2) for MAD in the 9–11 month and 16–18-month age groups, respectively. However, there was no significant improvement in growth or reduction in the prevalence of anemia. The intervention was effective in improving the feeding practices of children although it failed to show significant improvement in linear growth of children at 18 months of age.

Trends and determinants of minimum dietary diversity among children aged 6–23 months: a pooled analysis of Indonesia Demographic and Health Surveys from 2007 to 2017

“…Furthermore, enhancing access to nutritionrelated information from various resources, such as the internet and health facilities, may help improve this outcome since the children of some poor mothers can meet MDD-8 when they have access to appropriate information. Nutrition education (48) and behaviour change communication activities (49) can improve infant and young child feeding practices. Such interventions should target mothers from pregnancy (49) , particularly those of lower socio-economic status, those living in rural and underdeveloped regions where access to information is limited.…”

“…Nutrition education (48) and behaviour change communication activities (49) can improve infant and young child feeding practices. Such interventions should target mothers from pregnancy (49) , particularly those of lower socio-economic status, those living in rural and underdeveloped regions where access to information is limited. Furthermore, the country will require sufficient resources to train health practitioners and community health workers (48,49) to deliver high-quality counselling and education for all women throughout the 1000 d of life.…”

“…Such interventions should target mothers from pregnancy (49) , particularly those of lower socio-economic status, those living in rural and underdeveloped regions where access to information is limited. Furthermore, the country will require sufficient resources to train health practitioners and community health workers (48,49) to deliver high-quality counselling and education for all women throughout the 1000 d of life. We should integrate nutrition with agriculture activities to improve household dietary diversity and the nutritional status of infants and young children (48,50) .…”

Can the Target of 40% Stunting Reduction by 2024 Be Reached?

“…Multiple studies have demonstrated that the most effective treatment is a home-visiting and integrative intervention. The nutritional intervention improves weight gain, child development scores, breastfeeding ( 8 ), and complementary feeding practices ( 9 ), children's growth, health, and survival ( 10 ). Our findings showed that after adjusting for the DID impact, integrated intervention increased children's weight, height, and development scores by 0.31 (0.25–0.37), 0.41 (0.13–0.68), and −0.40 (−0.59-(−0.21)), respectively.…”

Penuntasan Stunting pada Anak sebagai Masalah Multi-Faktorial: Medis, Sosial, Ekonomi, Politik, dan Emosional

“…Data stunting Indonesia dihitung berdasarkan kurva standar WHO, sedangkan penggunaan kurva standar WHO dapat menyebabkan overestimation angka stunting karena rerata tinggi badan yang tidak representatif Berbagai penelitian menunjukkan bahwa intervensi berupa peningkatan asupan gizi tidak dapat memperbaiki pertumbuhan linear secara bermakna. [12][13][14] Penelitan kohort di Nusa Tenggara Barat menunjukkan bahwa pemberian makanan tambahan berupa susu formula, biskuit tinggi kalori, dan telur kepada 23 anak stunted selama 60 hari sesuai anjuran Kementerian Kesehatan tidak menghasilkan kenaikan berat badan dan tinggi badan yang signifikan setelah follow-up selama 10 bulan. 15 Sebagian besar anak yang disebut stunted itu sebenarnya hanya pendek karena sebab lain, bukan karena masalah gizi atau kesehatan.…”