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Browsing by Person "Fetriyuna, Fetriyuna"

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    Ready-to-Use Food (RUF) from composite flour of local commodities in Banten Province, Indonesia for prevention and rehabilitation of malnutrition in children under five
    (2021) Fetriyuna, Fetriyuna; Biesalski, Hans-Konrad
    Indonesia faces a serious problem of malnutrition especially stunting and underweight caused by micronutrient deficiencies. The high prevalence of undernutrition was also found in Banten Province, Java Island, the most populated island in Indonesia. The Indonesian Demographic and Health Survey (DHS) in 2012 reported that of about 24.5 million children under five years of old, approximately 37% and 12% of them were stunted and wasted. Furthermore, based on the Basic Health Survey (Riskesdas) in 2013 and 2018, the prevalence of stunting in children under five years old was 37.2 % and 30.8%, while the proportion of underweight children was 19.6% and 17.7%. The undernourished children have an increased mortality rate, risk of illness and infections, cognitive shortages, delayed development, and poor school performance. Ready-to-use food (RUF) is a kind of food easily consumed without much preparation and can be made using various techniques for targeted consumers. RUF can be produced using locally available food resources, which may be affordable for most people suffering from undernutrition. To improve and accomplish the nutrient content of RUF to meet the standard for rehabilitation food for malnutrition, the combination of various food resources might enhance the nutritional composition. This nutritious formulation must have the following attributes: good nutritional quality in macro and micronutrient content, highly palatable taste, consistency, and texture suitable for feeding to children, no additional processing required prior to feeding, product stability, long shelf life, and readily available ingredients. This research was divided into three main objectives. The first objective was a baseline assessment of the nutritional condition of the target group of children below five years old. The second section was RUF biscuit product development. The third objective was to investigate the nutritional outcomes of the field study in Banten Indonesia, particularly in WHZ and weight after the RUF provision and weight gain of the children and acceptability. The RUF biscuit was made from the composite flour of local food resources available in Banten province Indonesia which are still underutilized. The result of nutrition content analysis in local food resources showed that the foods have a high nutritional composition as a source of macronutrients and micronutrients (vitamins and minerals). Due to poor handling of post-harvest and processing into the intermediate product (flour), some vitamins were lost during the process. Based on the baseline assessment in 2017, of the 105 children, 4.8% and 11.4% of them were wasted and overweight-obese, while 40% and 23.8% of the children were stunted and underweight. Based on the mid-upper-arm circumference, 16.1% of children were categorized as the risk of chronic energy deficiency (CED). In addition, it was found that most of the children have insufficient intake of protein, Vitamin A, Iron, and Zinc. Twelve recipes developed using the combination of local food resources showed the macronutrient composition that met the requirement for the treatment of Moderate Acute Malnutrition (MAM) children, but not for micronutrient (vitamin and minerals). Five recipes (recipes 3, 4, 7, 11, and 12) were selected based on nutritional composition and sensory evaluation. The selected recipes were continued to further research of acceptability study in Banten, Indonesia. Before the acceptability study in the field, the micronutrient composition of the recipes chosen was improved according to the MAM treatment recommendation. It fortified the RUF with micronutrient premix. The micronutrient stability test was performed to analyze the loss due to baking. Around 15-28% of the vitamins (A, B1, B2, and E) were lost after baking, which was slightly lower than the other published articles, perhaps due to the short process of baking (15 minutes). Furthermore, the micronutrient sources were from the vitamin-mineral premix with higher stability than that from foods. Minerals content was stable during the baking process. Before the acceptability study started, five fortified cookie recipes were tested to select two for the acceptance and intervention pilot study. Most of the children in the acceptance study reported that they accepted and liked the RUF cookies. The consumption of RUF biscuits for two weeks led to an improvement in the nutritional status: Reduction of severe wasting (WHZ) from 5.7% to 4.3% and of severe underweight (WAZ) from 8.6% to 4.3%. There was no difference in terms of stunting (HAZ). Thus, it has been shown that the developed RUF biscuits have the potential to reduce malnutrition in the under 5-year-olds in the target area.