The eco-cultural context of the undernourished children in a study on the effects of early supplementary feeding in Indonesia.

OBJECTIVES: This paper describes the ecological and cultural backdrop of the subjects enrolled in an experimental study to test the validity of a conceptual model about the intellectual delay of undernourished children. DESIGN: The experiment was a 12-month clinical, randomized trial on the effects of early supplementary feeding on two cohorts of children classified as nutritionally-at-risk. Three different supplements (condensed milk + micronutrients; skimmed milk + micronutrients; skimmed milk) were given to the children during 6 or 12 months of the study. SETTING: The plantations are 1500-1800 m above sea level in Pangalengan, 50 km south of Bandung, West Java. Temperature fluctuates from 10 to 17 degrees C. A high yearly precipitation is approximately 3000 mm. Communities are laid out at 5-15 km from one another. Living conditions are modest. SUBJECTS: The 156 subjects were recruited from 24 day-care-centers (DCC) that serviced families of 24 communities in six tea plantations. The 12- and 18-month-old cohorts included 73 and 83 children, respectively; each cohort included three subgroups that received distinct supplements. OBSERVATIONS: The interactions of the caretakers with the children in the DCCs were consistent with the socialization for survival mode. A primary concern was the physical growth, health, cleanliness, sanitation and safety of the children. Stimulating children, providing toys and initiating play or other activities that would emphasize educational development had a low priority.

Effects of an energy and micronutrient supplement on iron deficiency anemia, physical activity and motor and mental development in undernourished children in Indonesia.

OBJECTIVES: This paper reports the effects of an energy and micronutrient supplementation on mental and motor development, activity and behavior under natural conditions of children classified as iron deficient anemic and iron replete. DESIGN: Children were randomly assigned to two different nutritional supplements: (1) 12 mg iron + either 1171 or 209 kJ; (2) 104 kJ + 0 iron. Treatment lasted for 6 months. SETTING: The sites were six tea plantations in Pangalengan, West Java. SUBJECTS: Eighteen anemic subjects (hemoglobin < 110 g/L; transferrin saturation (TS) < 16%) and 18 matched (sex and age) controls (hemoglobin > 110 g/L; TS > 16%) were selected from a pool of children with the following characteristics: no chronic disease; length-for-age < or = -1 standard deviation (s.d.) and weight-for-length between -1 and -2 s.d. of the median of the reference of the World Health Organization. METHODS: Hemoglobin, ferritin, transferrin saturation and erythrocyte protoporphyrin were evaluated before and 6 months after treatment. The following psychological measurements were obtained at baseline and 2, 4 and 6 months later. Mental and motor development was evaluated with the Bayley Scale. Motor activity was measured by 4 h continuous observations at home and at day care centers. The interactions between the child and its social and physical environment were also evaluated during 4 h of observations. RESULTS: Anemic children showed faster motor development and greater physical activity than the control children did. None of the other tests showed inter-group differences.