Scaling up a community-based program for maternal and child nutrition in Thailand

Prolonged Egg Supplement Advances Growing Child's Growth and Gut Microbiota

Protein-energy malnutrition still impacts children's growth and development. We investigated the prolonged effects of egg supplementation on growth and microbiota in primary school children. For this study, 8-14-year-old students (51.5% F) in six rural schools in Thailand were randomly assigned into three groups: (1) whole egg (WE), consuming 10 additional eggs/week (n = 238) (n = 238); (2) protein substitute (PS), consuming yolk-free egg substitutes equivalent to 10 eggs/week (n = 200); and (3) control group (C, (n = 197)). The outcomes were measured at week 0, 14, and 35. At the baseline, 17% of the students were underweight, 18% were stunted, and 13% were wasted. At week 35, compared to the C group the weight and height difference increased significantly in the WE group (3.6 ± 23.5 kg, p < 0.001; 5.1 ± 23.2 cm, p < 0.001). No significant differences in weight or height were observed between the PS and C groups. Significant decreases in atherogenic lipoproteins were observed in the WE, but not in PS group. HDL-cholesterol tended to increase in the WE group (0.02 ± 0.59 mmol/L, ns). The bacterial diversity was similar among the groups. The relative abundance of Bifidobacterium increased by 1.28-fold in the WE group compared to the baseline and differential abundance analysis which indicated that Lachnospira increased and Varibaculum decreased significantly. In conclusion, prolonged whole egg supplementation is an effective intervention to improve growth, nutritional biomarkers, and gut microbiota with unaltered adverse effects on blood lipoproteins.

The Intervention Service Coverage on Convergence Action to Reduce Stunting in Riau Province Priority Districts, Indonesia

BACKGROUND: The prevalence of stunting in Riau, Indonesia based on the Indonesian Toddler Nutrition Status Survey in 2019 was 23.95%. Efforts to reduce the prevalence of stunting remain challenging to achieve the target of 18% by 2024. One of the pillars in efforts to reduce stunting is convergence action involving multi-stakeholders to ensure the service delivery interventions received by targeted 1000 days of early life households.   OBJECTIVE: This study objective was to describe the intervention service coverage on stunting convergence action to reduce stunting in Riau Province, Indonesia.  METHODS: The intervention service coverage was obtained from web monitoring convergence Action and Reporting System in 2020 and nutritional status was from the Electronic Community-Based Nutrition Recording. Data was taken from 10 priority districts. There were 11 specific interventions and 9 sensitive interventions were analyzed. The data were analysed descriptively by districts and type of intervention.   RESULTS: The specific and sensitive interventions implemented in 161 priority villages in 2021.The results of the study were 6.0% of 392,444 under-five aged children indicated stunting. The average coverage of specific interventions was 78.3% and sensitive intervention was 50.3%. In specific intervention, supplementary feeding for wasted child (92.4%) and chronic energy deficiency pregnant women (91.1%) were the only indicator that reached the set target. All sensitive intervention were not reached the target.  Rokan Hulu (89.5%), Pekanbaru (88.0%), Kampar (84.4%), Pelawan (82.6%) districts had a high specific intervention. The highest sensitive intervention was in Rokan Hulu (74.6%). The budget from regional development for specific intervention was 28.2% and sensitive intervention was 71.8%.   CONCLUSION: The coverage service of sensitive intervention was lower than specific intervention. Only 2 out of 11 specific interventions coverage had reach the target and all of sensitive intervention coverage had not reach the target. The specific and sensitive intervention coverage was varied among priority district. The strengthening of interventions is required to increase coverage service delivery to the targeted household. The local government convergence action and increasing the role of the village authorities were the main keys in accelerating stunting reduction. 

Health Workers' and Villagers' Perceptions of Young Child Health, Growth Monitoring, and the Role of the Health System in Remote Thailand

BACKGROUND

In Thailand, despite widespread improvements in child nutrition, stunting is still highly prevalent among northern hill tribe children.

OBJECTIVE

To understand how villagers and health workers (volunteers and officials) gauge health of children younger than 5 years, whether growth monitoring is salient, and the relationships of villagers with the health system in this remote location.

METHODS

Qualitative research was undertaken with 8 hill tribe villages. A workshop on infant and young child health and nutrition was held with 8 village health volunteers, 2 per village, selected by a public health officer. In-depth interviews were conducted with 20 villagers and 2 volunteers who had children 0 to 5 years. Eight other health workers were also interviewed. All dialogue was conducted in Thai through bilingual facilitators and recorded, transcribed, and translated into English. Transcripts were coded and analyzed thematically within and across participant groups.

RESULTS

Overall, villagers considered strength and independence of children to be hallmarks of health; the size of children featured rarely. Volunteers did not perceive local benefits of growth monitoring, and the extent of child malnutrition was unclear to them. Nutrition counseling was seldom mentioned by villagers or health workers. Across all accounts, and considering silences, relationships of villagers with the health system seemed fragile.

CONCLUSION

Villagers understand child health in terms of functional abilities rather than size. Volunteer health workers in this remote location have limited resources and support. Together this helps explain why, against a background of poverty and food insecurity, growth monitoring does not translate to improvements in child nutrition.