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INTRODUCTION: Indonesia ranks the fifth highest in child stunting among Asian countries. Aceh, a westernmost province in Indonesia recorded the highest prevalence of stunting in children under two years old in the nation. Our study investigated the current government efforts on child stunting reduction activities since the introduction of Governor Regulation No. 14/2019. METHODS: The study investigated the current efforts of Aceh governments and relevant actors on child stunting reduction using in-depth interviews, document reviews and focus group discussions. RESULTS: Thirty-five (35) respondents including policy makers were interviewed, four focus group discussions (15 each group) were conducted, and various official documents were reviewed. Various challenges for reducing child stunting in Aceh were identified: inadequate knowledge and skills of Posyandu cadres on child stunting; reluctance to consume iron and folic acid (IFA), and supplementary foods (PMT Bumil) by many pregnant women due to perceived annoying effects and unappetizing taste; work engagement, insufficient breast milk production and inadequate support from husbands failing to achieve exclusive breastfeeding among nursing women; inadequate provision of complementary fortified foods for children 6-23 months; lack of clean water, waste management and WASH practices. CONCLUSION: The intervention on both nutrition-specific and nutrition-sensitive factors was found to be insufficient in Aceh. Although WASH (water, sanitation and hygiene) practices are the most important contributors to child stunting, only the health agency plays a singular role in reduction efforts by focussing on specific factors. Coordination between relevant agencies to address both factors is required to achieve the effectiveness of child stunting reduction and prevention in Aceh.
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Trastornos del Crecimiento , Estado Nutricional , Niño , Humanos , Femenino , Embarazo , Lactante , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/prevención & control , Indonesia/epidemiología , Alimentos , AguaRESUMEN
OBJECTIVE: To evaluate the effectiveness of a multicomponent intervention (MCI) on children's dietary diversity and its impact pathway components of children's food knowledge and healthy food preferences. DESIGN: A 6-week cluster randomised controlled trial with a MCI consisting of child nutrition education plus family engagement through parental nutrition education, meal preparation and tasting was compared with two groups: single component intervention (SCI) of child nutrition education, and control, conducted during February to July 2018. Preschool centres were randomly assigned to one of the three arms. Children's food knowledge, healthy food preferences and dietary diversity scores were collected. Intervention effects were analysed using a pre-post analysis and a difference-in-difference model. SETTING: Fourteen preschool centres in an urban area of Kurunegala, Sri Lanka. PARTICIPANTS: Child-parent dyads of children aged 4-6 years. Final analyses included 306 (for food knowledge and preferences) and 258 (for dietary diversity) dyads. RESULTS: MCI significantly influenced the impact pathways to children's dietary diversity by increasing children's food knowledge and healthy food preferences scores by 3·76 and 2·79 (P < 0·001), respectively, but not the dietary diversity score (P = 0·603), compared with the control arm. Relative to SCI, MCI significantly improved children's food knowledge score by 1·10 (P < 0·001), but no significant effects were noted for other outcome variables. CONCLUSIONS: Improved food knowledge and preferences require a positive food environment and time to develop into healthy eating behaviours. Research into dietary diversity should broaden to incorporate the contextual roles of the home and general food environments to more completely understand food choices of children.
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Dieta Saludable , Conducta Alimentaria , Niño , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Dieta , Preferencias Alimentarias , Humanos , Sri LankaRESUMEN
Childhood malnutrition, associated with poor diet, is a clear public health threat in Sri Lanka, with high rates of under-nutrition and micronutrient deficiencies coupled with the growing risk of overweight/obesity in urban locations. This study explored the dietary diversity and food intake of urban living Sri Lankan preschool children. A cross-sectional analysis of the baseline data from a cohort study was conducted with parents/caregivers of children aged 2-6 years, from 21 preschool centres in Kurunegala District, Sri Lanka. Demographic and socio-economic factors, dietary diversity score (DDS) (n = 597) and food intake (n = 458) (using a food frequency questionnaire) were assessed. Children had a mean DDS of 4.56 ± 0·85 out of 9, with most (91.1%) in the medium DDS category (DDS of 3.1-6.0), consuming rice as most common food. Lentils were consumed more than any meat or alternative food groups at all DDS levels. Child DDS differs with parent/caregiver age and ethnicity. Mean daily intakes of fruit (1.02) and vegetables (0.84) servings align with approximately half of national recommendations, with less than 20% of children meeting daily recommendations. More than one-third consumed sugary snacks and confectionaries daily and 1 in 10 had them twice a day. Around 40% reported watching television while eating the evening meal. Despite the majority having reasonable DDSs (medium category), findings highlighted inadequate intakes of fruits and vegetables, excessive intakes of sugary snacks and unhealthy dietary and social behaviours, suggests the need for population-based interventions to promote healthier dietary habits.
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Dieta , Verduras , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , Ingestión de Alimentos , Ingestión de Energía , Conducta Alimentaria , Frutas , Humanos , Sri Lanka/epidemiologíaRESUMEN
Poor diet places children at significant risk of over and under-nutrition including micronutrient deficiencies, which is a public health threat to a middle-income country like Sri Lanka. Understanding factors that influence food choices in early childhood is necessary to promote healthy food choices. As parents are the main gatekeepers of children's food environment, this study aimed to explore parents/caregivers' perspectives on the factors that influence their children's food choices. Thirteen focus groups adopting a partial nominal group technique were conducted with 110 parents/caregivers of children aged 2-6 years living in an urban area, Kurunegala District, Sri Lanka. Parents/caregivers were provided with 22 potential factors and asked to rank six most influential and choose six least influential factors on their child's food decisions. Responses were discussed as a group and audio recorded discussions underwent content analysis. Child food preference was ranked as the core driving factor in food decisions of preschool children. Family income, nutritional knowledge of the family, maternal control of food choices and household food preparation facilities were ranked as the next four most influential. Most frequent choices of least influential factors were: individual characteristics of child including sex and nutritional knowledge; and community (environmental) characteristics including seasonal food availability and community cultural food beliefs. Additional influential factors proposed were having a single child, a supportive family network and healthy menu suggestions by the preschool centres. Findings suggest that modifying the food preference of the child and the family characteristics need to be central for effective eating interventions.
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Cuidadores/psicología , Dieta Saludable/psicología , Preferencias Alimentarias/psicología , Padres/psicología , Población Urbana/estadística & datos numéricos , Niño , Preescolar , Conducta de Elección , Análisis Factorial , Femenino , Grupos Focales , Seguridad Alimentaria , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Investigación Cualitativa , Sri LankaRESUMEN
Low and middle-income countries are experiencing the dual burden of malnutrition which is, at least in part, attributable to changes in eating behaviours of children under age five. Development of food choices is influenced by multiple factors and understanding the interplay of these factors in early childhood in these countries is necessary to promote healthy food choices. We conducted a systematic review to examine the evidence of family and community factors targeted in interventions to influence the eating behaviour of preschool-aged children in low and middle-income countries. A search for peer-reviewed papers was conducted using CINAHL, MEDLINE, PsycINFO, Scopus and ProQuest Health Management published prior to September 2018, in English language including preschool-aged children (PROSPERO registration CRD42018108474). Fourteen studies published between 1994 and 2017 were eligible for inclusion. Factors that were consistently and positively associated with children's healthy food consumption were household food availability, nutritional knowledge of family or caregivers and family income. Unhealthy food consumption in children was inversely associated with family or caregivers' nutritional knowledge. Children's micronutrient intake was positively associated with household food availability, nutritional knowledge of family or caregivers and food availability within the surrounding environment. Findings highlight the importance of targeting nutritional knowledge of family or caregivers to facilitate healthy eating behaviours in children. In addition, creating a supportive family environment via increasing household food availability and family income should be considered when designing interventions to promote healthy eating behaviours in preschool-aged children living in low and middle-income countries.