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Base de datos de evaluación

Evaluation report

IDS 1999/002: Evaluating the Impact of the Indonesian Complementary Food Initiative (CFI) on Reducing Early Childhood Malnutrition



Executive summary

Background

In Indonesia, many infants and young children were consuming an inadequate diet even before the economic crisis started in mid-1997. In order to limit the impact of the crisis and protect children from malnutrition and its far-reaching consequences, the United Nations Children's Fund (UNICEF) supported the Government of Indonesia (GOI) in launching the Rapid Response Complementary Food Initiative (CFI) in 1997. This initiative aims to provide a low-priced, micronutrient-fortified, energy-dense complementary food to infants and young children aged 6-23 months, with priority being given to infants 6-11 months old. The complementary food, called Vitadele, is produced by the Indonesian company Indofood, and is distributed to poor villages in hardest-hit districts. Mothers can obtain Vitadele from the Posyandu (integrated health posts) at a very low cost.

Purpose / Objective

This report describes the results of the Helen Keller International (HKI) CFI-Growth Study designed to assess the impact of Vitadele consumption on linear growth and hemoglobin concentration among young children.

Methodology

For this study, data was collected from three different groups of children -- a Vitadele intervention group, a Vitadele control group and a province-wide comparison group. At the start, the intervention group consisted of 1,771 children aged 6-11 months living in two districts of West Java province. Each child in this group received one bag of Vitadele per week for 28 weeks. Vitadele consumption was recorded each week by HKI fieldworkers. Data on 1,606 children who stayed in the intervention for the entire 28-week period were available for analysis.

The control group consisted, at the start, of 1,784 children of the same age range living in two other districts of West Java. Data on 1,613 children were available for analysis at the end of the time period.

The province-wide comparison group was taken from the HKI/GOI Nutrition Surveillance System (NSS) on 1,044 children aged 6-11 months and, for follow-up, data on 862 children aged 12-17 months.

Key Findings and Conclusions

Considerable effort was needed to persuade mothers to continue feeding their children with Vitadele and to keep children from getting bored with the product. Average consumption was half a pack, or 250g, per week, which provided approximately 8mg iron/day (approximately 100% and 160% of the RDA for children aged 6-11 and 12-36 months respectively).

Nutritional status of children in the Vitadele and province-wide NSS groups was similar, both at baseline and at end line. The control group was worse off at baseline, but improved more than the other two groups during the intervention period. Additional analysis revealed that in the areas of the control group, more relief activities had been conducted, which most likely had a positive impact on the nutritional status of the control children. Therefore, another strategy was chosen for the evaluation of the impact of Vitadele consumption in the Vitadele group.

The Vitadele group was split into four quartiles, based on average consumption of Vitadele during the 28-week intervention period. A dose-responsive relationship was found between the impact on hemoglobin concentration and length gain in the 2nd, 3rd and 4th quartiles of Vitadele consumption. This means that the greater the consumption, the larger the impact. However, the differences in impact were relatively small.

Recommendations

Produce Vitadele with different flavors and/or recommend some ways for changing its taste, for example by adding fruit, in order to prevent children from getting bored with the product and thus decrease consumption.

Assess the bioavailability of the micronutrients in Vitadele, in particular iron, because the amount of iron consumed (8mg/d) should have a larger impact on hemoglobin concentration than what was actually observed. Improving iron bioavailability, in order to increase iron uptake by the body, would be preferred over further increasing the iron content of Vitadele, because the latter could negatively affect the taste of the product.

Increase the micronutrient content of Vitadele in order to meet the needs of the target group, because the average consumption of Vitadele was half a pack per week (250g), rather than one pack. Iron is an exception to this recommendation, because its content was already doubled for this study and a further increase would have a negative impact on the taste of the product. For iron, bioavailability should be increased (see above).

Multi-micronutrient supplements should be given to infants aged 6-11 months (or 6-24 months) because the prevalence of anemia in this age group was very high (65-80%) and the prevalence of other micronutrient deficiencies, such as deficiencies of vitamin A and zinc, is also likely to be high. Supplements can provide a much higher dose of micronutrients, which is necessary for correcting these deficiencies, than fortified foods. Fortified complementary foods, however, are a good means of ensuring a balanced and adequate intake of both macro- and micronutrients, and should thus be continued, even when multi-micronutrient supplements are provided.



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Report information

Date:
2000

Region:
EAPRO

Country:
Indonesia

Type:
Evaluation

Theme:
ECD - Health

Partners:
Helen Keller International, Government of Indonesia

PIDB:

Follow Up:

Language:
English

Sequence Number:
1999/002

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