Locally produced cereal/nut/legume-based biscuits versus peanut/milk-based spread for treatment of moderately to mildly wasted children in daily programmes on Nias Island, Indonesia: an issue of acceptance and compliance?
BACKGROUND
Treatment effects of fortified ready-to-use foods for moderately to mildly wasted children are largely unknown.


METHODS
Two nutritionally comparable forms of locally produced ready-to-use foods for daily feeding programmes of moderately to mildly wasted children (weight-for-height Z-score/WHZ>=-3 to <-1.5SD) were assessed on Nias, Indonesia. The frequencies of reaching target WHZ>=-1.5SD, compliance to the ready-touse food programme, and weight gain until recovery or programme closure among children treated with peanut/ milk-based spreads (n=29) were compared among children receiving cereal/nut/legume-based biscuits (n=44) and a second group treated with cereal/nut/legume-based biscuits whose mothers received intensive nutrition education (n=38).


RESULTS
Children in the cereal/nut/legume-based biscuits groups were younger (31 and 33 vs 39 months, p=0.004) and more likely to be moderately wasted (45 and 39 vs 21% with WHZ<-2, p=0.114) at admission, but had a higher rate in recovery (84 and 79 vs 62%, p=0.086) and showed more frequently a high compliance (>80%) to the ready-to-use (86 and 84 vs 45%, p<0.001) than those children in the peanut/milk-based spreads programme. Multivariable logistic regression revealed high compliance followed by weight gain and a lower degree of wasting at admission as independent and significant predictors of reaching target WHZ>=-1.5SD (all p<0.01). Weight gain was positively associated with the consumption of the biscuits (vs peanut//milk-based spreads: r=0.188, p=0.051) and was highest in the cereal/nut/legume-based biscuits plus intensive education compared with the cereal/nut/legume-based biscuits and peanut/milk-based spreads groups.


CONCLUSIONS
Locally produced ready-to-use foods as biscuits or spreads were similarly effective for rehabilitation of moderately to mildly wasted children.
Institute for Social Sciences in Agriculture, Department of Gender and Nutrition (430), University of Hohenheim, Schloss, Museumsfluegel, 70593 Stuttgart, Germany. Email: veronika.scherbaum@uni-hohenheim.de.|Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany.
Veronika
V
Scherbaum
Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany.|Faculty of Medicine, Nutrition Department, University of Brawijaya, Malang, Indonesia.
Ratna Chrismiari
RC
Purwestri
Institute of Nutrition, Friedrich-Schiller-University of Jena, Jena, Germany.
Wolfgang
W
Stuetz
Institute for Social Sciences in Agriculture, Department of Gender and Nutrition (430), University of Hohenheim, Schloss, Museumsfluegel, 70593 Stuttgart, Germany.
Dyah Ayu
DA
Inayati
Church World Service Indonesia, Jakarta, Indonesia.
Julia
J
Suryantan
Church World Service, New York, USA.
Maurice Alexander
MA
Bloem
Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany.
Hans Konrad
HK
Biesalski
D000818:Animals; D010367:Arachis; D002675:Child, Preschool; D002523:Edible Grain; D007887:Fabaceae; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007214:Indonesia; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000178:diet therapy; D008892:Milk; D009754:Nuts; D010349:Patient Compliance; D010353:Patient Education as Topic; D016896:Treatment Outcome; D019282:Wasting Syndrome / Q000178:diet therapy*; D015430:Weight Gain