Ready-to-use therapeutic/supplementary foods from local food resources: Technology accessibility, program effectiveness, and sustainability, a review

Ready-to-Use Therapeutic Food (RUTF) or Ready-to-Use Supplementary Food (RUSF) has been widely used in home-based treatment for severely and moderately acute malnourished children. These programs showed positive results in short term nutritional recovery in children, which were reported in some research settings. Nowadays, the RUTF/RUSF formulation has been improved using a variety of RUTF/RUSF from locally available food ingredients. This paper aims to review the essential aspects of the development and provision of RUTF/RUSF made from local food resources and monitor program effectiveness that warrants the program's sustainability. The modified recipes of RUTF/RUSF were developed following the international dietary guidelines for the rehabilitation of severely and moderately acute malnourished children. The local production of RUTF/RUSF provided some benefits that include empowering the local community, consideration of the common eating pattern, promoting the diversification of food consumption, strengthening food security, as well as supporting the sustainability of RUTF/RUSF production. Results of the PRISMA-based systematic literature review revealed various ingredient developments and processing techniques which could improve the product characteristics and sensory evaluation. RUTF/RUSF in local food production provided different food carriers (e.g., biscuits, wafers) and seemed to be more readily accepted by the children. Furthermore, the program sustainability of RUTF/RUSF depends on a continuous ingredients supply and support from the local government. The findings presented the importance of development of such food supplements based on the local food resources and with improved technology for prevention and rehabilitation of malnourished children.

Composite Flour from Indonesian Local Food Resources to Develop Cereal/Tuber Nut/Bean-Based Ready-to-Use Supplementary Foods for Prevention and Rehabilitation of Moderate Acute Malnutrition in Children

Undernourishment is a threat to human health. The prevalence of undernourishment remains alarming, especially among children under five years old in many countries, including Indonesia. Nowadays, the handling of undernourishment has shifted to treatment outside the hospital, utilizing local nutrient-rich foods. At the national level, the utilization of local food resources is a part of the promotion of dietary diversification and the bioeconomy. Ready-to-use supplementary food (RUSF) refers to supplementary foods aimed at improving the nutrition of moderate acute malnutrition (MAM) children under five years old. RUSF biscuit recipes were made using local food resources available in Banten province, Indonesia. To optimize the nutritional profile of the developed RUSF, taro/talas banten were mixed with ground-nut/peanut (Arachis hypogaea L.) and mungbean (Vigna radiata) as protein and lipid sources and red rice (Oryza longistaminata) and maize (Zea mays) as carbohydrate sources, and enriched by the local banana Nangka (Musa textilia). Two formulations were selected for the pilot testing, namely the taro-peanut and taro-peanut/mungbean RUSF biscuits, made from taro Banten, cereal, peanut and/or mungbean, and local banana. The RUSF biscuit showed promising results, presenting a high level of acceptance and a macronutrient composition that meets the standards for MAM children. However, the RUSF biscuits should be fortified with micronutrient premix to fulfill the dietary requirement for the MAM children. The results of this study provide further development opportunities.

Dietary Intake and Nutritional Status of Javanese Women in Rice Producing Areas: a Comparison between Lactating and Non-lactating Women

<p>Maintaining optimal maternal nutrition is essential for the mother’s health and the child’s growth and development. Throughout the lactating period, maternal nutrition is significant due to the child’s high nutritional needs. Therefore, an increase in food consumption is necessary. This research aimed to analyze the dietary intake and nutritional status of lactating and non-lactating women living in rice-producing areas in Central Java, Indonesia. A cross-sectional study was conducted from December 2014 to February 2015 in Demak Regency. As many as 375 participants were recruited and analyzed in this study. The results showed that the mean BMI-score of non-lactating mothers was higher than that of breastfeeding mothers (p=0.039). However, the nutritional status between the two groups of women was not significantly different. Significantly more lactating women consumed dark green leafy-colored vegetables (68.8%) and other vegetables (59.2%) than the non-lactating mothers (54.4%, p=0.065 and 36.8%, p=0.001, respectively). Regarding the selected macro and micronutrient intakes, statistically significant differences between the two groups of women could not be proven. In short, dietary intake between women within the different physiological statuses and BMI categories showed that they consumed around the same amount of macro-and micronutrient intakes and food groups, except for the high vegetable consumption among lactating women.</p>

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

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 children's 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.

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

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.

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 > or = -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 > or = -1.5 SD in daily and weekly programs.

RESULTS

Institutional costs to the implementing organization were similar for both programs (approximately US $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.

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.

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

BACKGROUND

This 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-scores) aged ≥ 6 to < 60 months on Nias Island, Indonesia.

METHODS

Cross-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.

RESULTS

Retrospective 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.

CONCLUSION

Generally, 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.