A preliminary test of a developmental model for the study of undernourished children in Indonesia.

OBJECTIVES: Structural equation modeling of an abbreviated version of the conceptual model of the effects of micronutrient and energy supplementation on growth and development of undernourished children in West Java. The study focused on the baseline data from the Pangalengan longitudinal project. DESIGN: This trial included two cohorts of children classified as nutritionally-at-risk who were randomly assigned to three treatments (condensed milk + micronutrients (E); skimmed milk + micronutrients (M); skimmed milk (S)). Supplements were given for a period of up to 12 months. SETTING: The sites were six tea plantations in Pangalengan. SUBJECTS: A 12-month-old (n=53) and an 18-month-old (n=83) cohort were recruited from 24 day care centers. Twenty children that received the S supplement were part of the 12- and 18-month-old cohorts. Criteria for inclusion were: no chronic disease; length-for-age < -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. VARIABLES: Indicators of socioeconomic status were economic and educational resources; length-for-age and weight-for-length were used as indicators of nutritional status; motor development and motor activity were measured with custom-made procedures; and carrying by caretaker and manipulation of objects were used as indicators of caretaking and exploratory behavior. RESULTS: The model fitted the data of the older but not of the younger cohort (chi2 statistic and three other indices of goodness to fit). However, there were no differences between cohorts in the estimation of the models.

Effects of an energy and micronutrient supplement on play behavior in undernourished children in Indonesia.

OBJECTIVES: This paper reports the effects of an energy and micronutrient supplementation on quantitative and qualitative aspects of play among poorly nourished children. At issue is whether the supplement led to a progression in complexity of play. DESIGN: Two cohorts of children were randomly assigned to three treatments: E = 1171 kJ + 12 mg iron; M = 12 mg iron + 209 kJ; S = 104 kJ. Supplementation was given for 6 months. Evaluations of play behavior were repeated four times. SETTING: The sites were six tea plantations in Pangalengan, West Java. SUBJECTS: The present study utilized a subsample of 55 children recruited for the larger Pangalengan project 6 months into the study. Thirty-eight children were recruited late enough to allow for longitudinal observations. The remaining cases were used for cross sectional observations only. Inclusion criteria were: 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: The children were videotaped during play. These tapes were coded for eight mutually exclusive categories of activities. Four activities coded represented manipulative, relational, functional and symbolic play. RESULTS: Treatment did not affect qualitative play. Girls that received E increased functional play but boys showed the opposite effect. Children in the S group were breastfed more during play as compared to the E group. Children in the E group waited less to begin play.

A developmental view of the effects of an energy and micronutrient supplement in undernourished children in Indonesia.

OBJECTIVES: This paper presents the results of a structural equation model testing whether the longitudinal data of the Pangalengan subjects fit the theoretical model regarding the intellectual delay of undernourished children. DESIGN: Two cohorts of children were randomly assigned to three treatments: E = 1171 kJ + 12 mg iron; M = 12 mg iron + 209 kJ; S = 104 kJ. Supplementation was given for 6 months. SETTING: The sites were six tea plantations in Indonesia. SUBJECTS: A 12-month-old (n = 53) and an 18-month-old (n = 83) cohort were recruited from day-care-centers. Inclusion criteria were: no chronic disease; length-for-age = < 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: Twenty-four-hour dietary intakes were assessed using the weighted individual inventory technique. Body weight and length were obtained using standard procedures; motor development was assessed with the Bayley Scale and with a custom made scale for motor development leading to bipedal locomotion. Four-hour observations were made of the child's interactions with the environment. Carrying a child in the arms and exploratory behavior were used as indicators of caregiving and exploration. All measurements were obtained every 2 months. RESULTS: The original model did not fit the data. The model was then modified with the inclusion of two new pathways: from activity and from motor development to mental development. Following these adjustments the model fit the data for each cohort and for both cohorts combined.