Effectiveness in improving knowledge, practices, and intakes of "key problem nutrients" of a complementary feeding intervention developed by using linear programming: experience in Lombok, Indonesia.
BACKGROUND
Complementary feeding recommendations (CFRs) with the use of locally available foods can be developed by using linear programming (LP). Although its potential has been shown for planning phases of food-based interventions, the effectiveness in the community setting has not been tested to our knowledge.


OBJECTIVE
We aimed to assess effectiveness of promoting optimized CFRs for improving maternal knowledge, feeding practices, and child intakes of key problem nutrients (calcium, iron, niacin, and zinc).


METHODS
A community-intervention trial with a quasi-experimental design was conducted in East Lombok, West Nusa Tenggara Province, Indonesia, on children aged 9-16 mo at baseline. A CFR group (n = 240) was compared with a non-CFR group (n = 215). The CFRs, which were developed using LP, were promoted in an intervention that included monthly cooking sessions and weekly home visits. The mother's nutrition knowledge and her child's feeding practices and the child's nutrient intakes were measured before and after the 6-mo intervention by using a structured interview, 24-h recall, and 1-wk food-frequency questionnaire.


RESULTS
The CFR intervention improved mothers' knowledge and children's feeding practices and improved children's intakes of calcium, iron, and zinc. At the end line, median (IQR) nutrient densities were significantly higher in the CFR group than in the non-CFR group for iron [i.e., 0.6 mg/100 kcal (0.4-0.8 mg/100 kcal) compared with 0.5 mg/100 kcal (0.4-0.7 mg/100 kcal)] and niacin [i.e., 0.8 mg/100 kcal (0.5-1.0 mg/100 kcal) compared with 0.6 mg/100 kcal (0.4-0.8 mg/100 kcal)]. However, median nutrient densities for calcium, iron, niacin, and zinc in the CFR group (23, 0.6, 0.7, and 0.5 mg/100 kcal, respectively) were still below desired densities (63, 1.0, 0.9, and 0.6 mg/100 kcal, respectively).


CONCLUSIONS
The CFRs significantly increased intakes of calcium, iron, niacin, and zinc, but nutrient densities were still below desired nutrient densities. When the adoption of optimized CFRs is constrained by economic access for or acceptability of nutrient-dense foods, other strategies need to be incorporated into interventions to ensure adequate intakes of these nutrients.
From the Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition, Universitas Indonesia, Jakarta, Indonesia (UF, OS, and SS); the Faculty of Psychology, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia (RK and JU); the Center of Community Health and Population Studies, The Research Institute, Trisakti University, Jakarta, Indonesia (MKH); and the London School of Hygiene and Tropical Medicine, London, United Kingdom (EF).
Umi
U
Fahmida
From the Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition, Universitas Indonesia, Jakarta, Indonesia (UF, OS, and SS); the Faculty of Psychology, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia (RK and JU); the Center of Community Health and Population Studies, The Research Institute, Trisakti University, Jakarta, Indonesia (MKH); and the London School of Hygiene and Tropical Medicine, London, United Kingdom (EF).
Risatianti
R
Kolopaking
From the Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition, Universitas Indonesia, Jakarta, Indonesia (UF, OS, and SS); the Faculty of Psychology, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia (RK and JU); the Center of Community Health and Population Studies, The Research Institute, Trisakti University, Jakarta, Indonesia (MKH); and the London School of Hygiene and Tropical Medicine, London, United Kingdom (EF).
Otte
O
Santika
From the Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition, Universitas Indonesia, Jakarta, Indonesia (UF, OS, and SS); the Faculty of Psychology, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia (RK and JU); the Center of Community Health and Population Studies, The Research Institute, Trisakti University, Jakarta, Indonesia (MKH); and the London School of Hygiene and Tropical Medicine, London, United Kingdom (EF).
Sriani
S
Sriani
From the Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition, Universitas Indonesia, Jakarta, Indonesia (UF, OS, and SS); the Faculty of Psychology, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia (RK and JU); the Center of Community Health and Population Studies, The Research Institute, Trisakti University, Jakarta, Indonesia (MKH); and the London School of Hygiene and Tropical Medicine, London, United Kingdom (EF).
Jahja
J
Umar
From the Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition, Universitas Indonesia, Jakarta, Indonesia (UF, OS, and SS); the Faculty of Psychology, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia (RK and JU); the Center of Community Health and Population Studies, The Research Institute, Trisakti University, Jakarta, Indonesia (MKH); and the London School of Hygiene and Tropical Medicine, London, United Kingdom (EF).
Min Kyaw
MK
Htet
From the Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition, Universitas Indonesia, Jakarta, Indonesia (UF, OS, and SS); the Faculty of Psychology, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia (RK and JU); the Center of Community Health and Population Studies, The Research Institute, Trisakti University, Jakarta, Indonesia (MKH); and the London School of Hygiene and Tropical Medicine, London, United Kingdom (EF).
Elaine
E
Ferguson
D002136:Calcium, Dietary / Q000627:therapeutic use; D053198:Child Nutrition Sciences / Q000193:education*; D003150:Community Health Workers; D003296:Cooking; D003677:Deficiency Diseases / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006293:Health Promotion; D006792:House Calls; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000208:ethnology; D019266:Iron, Dietary / Q000627:therapeutic use; D008297:Male; D009035:Mothers; D009525:Niacin / Q000172:deficiency / Q000627:therapeutic use; D010353:Patient Education as Topic; D011382:Programming, Linear; D012306:Risk; D012423:Rural Health / Q000208:ethnology; D015032:Zinc / Q000172:deficiency / Q000627:therapeutic use
D002136:Calcium, Dietary; D019266:Iron, Dietary; D009525:Niacin; D015032:Zinc
Indonesia; complementary feeding recommendation; infants and young children; key problem nutrients; linear programming; nutrient density