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?
Scherbaum V.,University of Hohenheim |
Purwestri R.C.,University of Hohenheim |
Purwestri R.C.,Brawijaya University |
Stuetz W.,Friedrich - Schiller University of Jena |
And 4 more authors.
Asia Pacific Journal of Clinical Nutrition | Year: 2015
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.
Tol W.A.,Yale University |
Komproe I.H.,HealthNet TPO |
Komproe I.H.,University Utrecht |
Jordans M.J.D.,HealthNet TPO |
And 3 more authors.
International Journal for Quality in Health Care | Year: 2011
Objective. Practitioners in political violence-affected settings would benefit from rating scales that assess child function impairment in a reliable and valid manner when designing and evaluating interventions. We developed a procedure to construct child function impairment rating scales using resources available in low- and middle-income countries. Design. We applied a mixed methods approach. First, rapid ethnographic methods (brief participant observation, collection of diaries and a focus group with children) were used to select daily activities that best represented children's functioning. Second, rating scales based on these activities were examined for their psychometric properties. Construct validity was assessed through a confirmatory factor analysis procedure. Setting. Central Sulawesi, Indonesia. Participants. Qualitative data were collected for 53 children and psychometric testing was done with 403 children [average age: 9.9 (SD = 1.21), 49% girls] and 385 parents. Results. Using locally available resources, we developed separate child-rated and parent-rated scales, both containing 11 items. The child-rated scale evidenced good internal, test-retest and inter-rater reliability and acceptable convergent and discriminant validity. Construct validity was confirmed by fit of the theorized factor structure-a social-ecological clustering of daily activities. Conclusions. The procedure resulted in a reliable and valid rating scale to assess child function impairment in the context of political violence. Practitioners can apply this procedure to develop new locally adequate rating scales to strengthen epidemiological surveys, baseline assessments, monitoring and evaluation and eventually, interventions. Further research should address the importance of gender differences and criterion-related validity. © The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.