Pengaruh Intervensi Ready-to-Use Therapeutic Food (RUTF) Bregas Nutriroll terhadap Status Gizi Balita Severe Acute Malnutrition

Abstract

Malnutrition is a nutritional issue caused by an imbalance between nutritional intake and nutritional needs. Currently, Indonesia remains listed as one of the developing countries facing three burdens of nutritional problems: 1) undernutrition; 2) overnutrition; and 3) micronutrient deficiencies (vitamins and minerals) (UNICEF 2020). Wasting is one of the most common types of undernutrition, both globally and nationally. Wasting is defined as acute malnutrition caused by decreased food intake or reduced diet quality in a relatively short period, closely associated with pathological diseases. If this condition persists, it will hinder a child's height growth, leading to stunting. Under-five children is categorized as having Moderate Acute Malnutrition (MAM) if the weight-for-height z-score is between -3 SD (Standard Deviation) and -2 SD, or the mid-upper arm circumference (MUAC) is between 11.5 cm – 12.5 cm, while Severe Acute Malnutrition (SAM) is indicated by a weight-for-height z-score = -3 SD or MUAC = 11.5 cm. The prevalence of SAM and MAM in Indonesia still requires much attention. The 2021 Indonesia Nutrition Status Survey (SSGI) showed that the prevalence of Chronic Malnutrition (stunting) in Indonesia was around 24.4%, down from 27.7% in 2019. Acute Malnutrition in toddlers is influenced by factors such as gender, age, birth weight, birth length, immunization status, immediate breastfeeding (IMD), exclusive breastfeeding, household socioeconomic status, environmental health, household food security, maternal mental health, and nutritional knowledge. Preventive and remedial actions for under five children showing SAM and MAM symptoms must be promptly undertaken to catch up on their growth and development. One method is through Ready-to-Use Therapeutic Food (RUTF). RUTF is a high-energy recovery food supplemented with micronutrients (vitamins and minerals) given to children under 59 months old experiencing acute malnutrition without accompanying diseases. This study aims to generally assess the intervention of Bregas Nutriroll in improving the nutritional status of SAM toddlers. Specifically, it aims to: 1) analyze the sociodemographic profile of SAM toddlers; 2) evaluate household food security of SAM toddlers; 3) assess the level of nutritional knowledge and mental health of SAM toddlers; 4) examine the factors affecting the nutritional status of SAM toddlers; 5) evaluate compliance and supporting factors in providing Bregas Nutriroll to SAM toddlers; and 6) assess the impact of Bregas Nutriroll intervention on the nutritional status of SAM toddlers. The study consists of two stages, starting with an observational study using a cross-sectional design to analyze factors affecting the nutritional status of toddlers. Variables measured include the characteristics of toddlers, household characteristics, environmental health, household food security, maternal nutritional knowledge, maternal mental health, nutrient intake, and nutritional status of toddlers. The next stage is the intervention stage using a Randomized Controlled Trial design to determine the effect of Bregas Nutriroll RUTF on the nutritional status of SAM toddlers. Variables measured include the characteristics of SAM toddlers, compliance, supporting factors, nutritional status (weight, height, MUAC), nutrient intake, disease incidence, and Hb levels. The RCT study involves two treatment groups: the Bregas Nutriroll group and the F100 milk group. Bregas Nutriroll is produced by PT Java Indo Sejahtera, while F100 milk is prepared according to Indonesian guidelines for the management of severe malnutrition. In the intervention stage, several criteria must be met by prospective research subjects. Inclusion criteria include toddlers aged 12-59 months, SAM nutritional status with weight-for-height z-score < -3 SD or MUAC < 11.5 cm, or edema up to ++, and willingness to follow all research procedures by signing informed assent. Exclusion criteria include suffering from infectious or chronic diseases, having congenital or medical complications, allergies to peanuts, milk, or other ingredients, taking antibiotics, and receiving similar supplementary feeding or RUTF in the past two months. Forty subjects are divided into two groups: the Bregas and F100 groups (20 children each). The intervention is conducted over eight weeks in South Central Timor district, East Nusa Tenggara. Data collected are analyzed descriptively and inferentially with a significance level of 0.05. Household characteristics and sociodemographic data are analyzed univariately and presented as means, standard deviations for numerical data, and percentages for categorical data. Observational study results indicate that 13.6% of children fall under the acute malnutrition category, 44.2% underweight, and 62.3% stunted. About 58.4% of households with toddlers in South Central Timor are food insecure. Most mothers of toddlers do not have mental health disorder symptoms (90.3%), but many still have low nutritional knowledge (59.1%). Bivariate analysis results show that age, birth weight history, mother's occupation, family size, drinking water source, ARI history, diarrhea history, maternal mental health, and protein intake significantly correlate with acute malnutrition (p<0.05). Multivariate analysis indicates that age, birth weight, and ARI history have the most dominant influence on acute malnutrition. Statistical tests show that household food security and nutritional knowledge do not significantly affect acute malnutrition (p > 0.05). Intervention data analysis results show no significant differences in subject characteristics between groups (p>0.05). Compliance levels in the F100 group (98%) are higher than in the Bregas group (78%), but research subjects are still considered compliant with an average compliance rate above 70%. Mothers play an essential role in increasing the consumption of Bregas Nutriroll (94.7%) and F100 (76.4%). In the Bregas Nutriroll group, household members also consume the product (15.8%). Bregas Nutriroll and F100 have similar potential in increasing the weight of SAM toddlers, although both groups show significant weight gain after the two-month intervention. The weight gain difference in the Bregas Nutriroll group (?=1.07 kg) is slightly higher than in the F100 group (?=1.05 kg).