kge newsletter 01 2010

8/3/2019 KGE Newsletter 01 2010

http://slidepdf.com/reader/full/kge-newsletter-01-2010 1/6

2010: 5 (MARCH)

Nias island : A project

to overcome children’s

malnourishment with

locally produced thera-

peutic foods

Interview with

Ratna C. Purwestri,

Dyah A. Inayati and

Eko Nugroho

1

1

Interview with

Dr. Veronika Scher-

baum

5

From the Authors of

the Issue6

INSIDE THIS ISSUE: Indonesia, Nias Island:A project to overcome children’s malnourishment with locally

produced therapeutic foods

Ready-to-use-therapeutic-food (RUTF), such as Plumpy’nutTM

, is accepted to treatseverely malnourished children without medical complications at community level.Similar products (e.g lipid pastes) and other Ready-to-Use Foods (RUFs) are cur-rently being developed and recommended for moderately and mildly wasted childrento enhance efficiency and to reach more children at an earlier stage. However, thereis a growing concern about the commercialization of malnutrition. RUTFs like Plum-py’nut

TM, mainly produced in industrialized countries, are expensive and alone can

not solve the complex wider causes of malnutrition (issues related to access andavailability of care, health, education and food, as well violations of human rights ingeneral and specifically women’s) in the long run. Therefore, more research isneeded on sustainable community-based solutions, especially for treatment and pre-vention of moderate and mild forms of malnutrition.

As a possible solution, a research projecton the local production of RUF madefrom locally available ingredients hasbeen developed for Nias Island by stu-dents of the University of Hohenheim.The interviews with doctoral candidatesRatna C. Purwestri and Dyah A.

Inayati and a master student Eko Nu-groho, as well as their supervisor Dr.Veronika Scherbaum tell the storyabout the realization of this research project.

Located northwest of Sumatra, the islandof Nias was affected by the 2004 IndianOcean Tsunami and severely damagedby a consequent earthquake somemonths later.

What are the specific characteristics of food insecurity and women’s status on Nias Island?

Eko: A study by FAO/WFP (2005) showed that three years before the tsunami in 2004 and the earthquake in 2005, Niaswas one of the poorest areas in Indonesia with 32 % of its population living under the poverty line. In addition, 77% per capita expenditure of Nias was spent on food. As for nutrition, 51 % of Nias children under-five were stunted (UNICEF2005). After the tsunami and earthquake disaster, the situation has improved a lot due to aid programs. For instance, theresearch results showed that proportion of households with non-permanent houses became less frequent in the studyarea due to the housing reconstruction programs implemented by the government and NGOs immediately after the dis-asters.

Ratna: When we came in August 2007, many organizations had already arrived after the state of emergency. Currentlythey have a great impact on the economy, infrastructure, and households’ development. In less than six months after thestate of emergency, the infrastructure was restored and the living conditions were improved. Today only 10 % of thepopulation have dirt floors, which is rare in rural areas. Additionally, the employment increased because the develop-ment organizations recruited local people to run their projects. However, this all can end up in a vicious circle. Now,

Interview with Ratna C. Purwestri, Dyah A. Inayati and Eko Nugroho

Das Kompetenzzentrum Gender und Ernährung

AktuellVon und über Studierende und Doktoranden der Universität Hohenheim

From and by students and doctoral candidates of the University of Hohenheim2010: 5 (MARCH)

Map: Centre for Remote Imaging, Sensing and Processing, National University of Singa-

pore http://www.crisp.nus.edu.sg/coverages/reef_near_Nias/index.html (Basemap source: Paskevich, Valerie, 200508)



nated MNP (sprinkles) inorder to support home-

based intervention. CWS,our implementing partner inIndonesia, was also a bighelp for us. They providedin-kind contribution, such asequipments for cooking andbaking, raw materials for RUF biscuits and localPaste/Milk Paste (PMP-Naas), VITALITA micronu-trient sprinkles, etc. Finally,we received additional sup-port from the Eiselen foun-dation and the Neys-van

Hoogstraaten foundation. Inaddition, Ratna is supportedby a DAAD scholarship. Intotal, this funding was es-sential for the training of local counterparts, qualitycontrol, and supervision of

the implementation phase on Nias.

Tell us in a few words about your research.

Ratna: The objectives of my research are to investigatethe effectiveness of locally produced PMP-Nias and RUF-Nias biscuits on weight gain, length of stay and improve-

ment in hemoglobin levels among mildly to moderatelywasted children under 5 years of age on Nias Island. Inaddition, I assess the costs of the food supplements

Inayati: I am focusing on the effectiveness of MNP and/or Intensive Nutrition Education (INE) on the nutritionalstatus of mildly wasted children. Mildly wasted childrenand their caregivers were either directly recruited within theCWS project area, or referred from the Ready-to –USEFood (RUF) study for mild –moderately wasted childrenconducted by Ratna. We explored the kinds of interven-tions that are more effective in improving the nutritionalstatus of mildly wasted children, as well as assessed theknowledge and practice of caregivers before and after theinterventions.

Respective interventions included: (a) the distribution of MNP together with INE, (b) MNP together with Non-intensive Nutrition Education (NNE), (c) INE; and (d)NNE separately without MNP. The discharge criterion wasWHZ ≥ -1.0. Villages assigned with MNP+INE and INEinterventions were distanced out of daily communicationrange from MNP+NNE and NNE.

Eko: My study analyzed socio-economic aspects in thecontext of the Ratna’s and Inayati’s studies, specifically,

comparing the main characteristics of the children, their parents and thehouseholds of wasted children whoreceived RUF-Nias biscuits, and/or MNP for in-home use, as well as cul-

turally sensitive nutrition educationinterventions. In addition, I also com-pared the differences between theparents’ socio-economic conditionswith children who reached, and those

KGE NEWSLETTER, ISSUE 5, MARCH, 2010 PAG E 2

after three to four yearssince the emergency,

many developmentorganizations are clos-ing down their projectsand intend to leave theisland. People involvedin the projects are fac-ing the risk of losingtheir jobs. Without pro-motion of a sustainablelivelihood programs,very soon everythingmay return to the origi-nal state.

Inayati : It is important

to mention that thestatus of women onNias Island is tradition-ally “low”. After mar-riage, women live intheir mother-in-law’shouse. They work hardboth in the field and at home, whereas men work out-side and are free after midday.

Eko: As you see, women have not sufficient time leftto look after their children.

How did you start to get involved in this

project?Ratna: Dr. Scherbaum, University of Hohenheim, in-troduced me to Inayati, and we developed the pro-posal together. Inayati had the topic to work on Micro-nutrient Powder (MNP) and nutrition education, and Iworked on local production of RUF. Dr. Scherbaumhelped us to recruit a nutritional science student, OlgaShapiro, who developed nine recipes of cereal-basedRUF within the context of her diploma thesis. Throughthe Nias Preliminary Baseline Assessment Report con-ducted by Church World Service (CWS), we acquiredessential information about locally available food typeson the Island about which we had known very littleduring the preparatory phase.

Eko: Currently, I am enrolled in the International Mas-ter Program “Agricultural Sciences in the Tropics andSubtropics” in Hohenheim where I specialize in ruraldevelopment economics. Last year I met Ratna, andwe discussed the possibility of my getting involved inthe project. Within the context of my Master thesis, Ihave assessed the socio-economic condition of mod-erately and mildly wasted children admitted into spe-cific intervention programs on Nias Island.

Inayati: In order to implement theproject on a larger scale, weneeded to get adequate funding.After presenting the project pro-

posal to “Sight and Life”, a non-profit humanitarian initiative, wereceived initial funding and thevitamin-mineral premix for RUFdevelopment. Later, they also do-

Dyah A. Inayati , Ratna C. Purwestri and Eko Nugroho (photo by A Pambudi)

Nias Island, Indonesia:A project to overcome malnourishment

INE: Intensive Nutrition Education

NNE: Non-Intensive Nutrition

Education




who did not fully reach discharge criteria during thestudy period.

What was your personal motivation fordoing the research?

Inayati: We wanted to do something useful for our country. The outputs of the research will contributehopefully to solving the problem of malnourishment inIndonesia. It was also very interesting to conduct thestudy on Nias Island, since I had never been therebefore. Although I am from the neighboring Java Is-land of Indonesia, the culture and language are verydifferent on Nias Island.

Ratna: Before starting my research, I had already

worked in the sphere of community nutrition for severalyears in Indonesia. I always wanted to do my PhDresearch in my own country, as I already had an es-tablished network there.

Eko: The study of human nutrition quite new for me.My previous work was related to the analysis of socio-economic aspects of animal husbandry. I am a junior lecturer at the University of Brawijaya, Indonesia. Pre-viously I have worked in several projects conducted bythe Indonesian Government.

My personal interest in the study was a chance to beinvolved in an international research group. I am con-vinced that this will be useful for my future career. At

the same time, the issue of malnutrition in my countryhas awakened my interest. It is a complex topic, and Iwant to contribute to a positive change in Indonesia.

What was the biggest challenge on theIsland?

Inayati : Building trust was very important and chal-lenging. Before the launch of the study on the island,our implementing partner CWS had already startedanother program there, where beneficiaries were in-volved in daily feeding programs. The NGO providedthe children with one cooked meal per day, and theparticipants were supposed to come to the center

every day. However, in the frames of the current RUFproject some of them were asked to come only once aweek to receive MNP (sprinkles) and to learn moreintensively about nutrition, benefits of breastfeeding,appropriate complementary feeding and how to pre-vent malnutrition within their cultural context. It was noteasy to explain to the caregivers reasons for this shiftfrom passive recipience to a more participatory ap-proach. We needed more time than expected to cre-ate an understanding for these changes. Firstly, weneeded to explain the caregivers of admitted childrenwhy they stopped receiving dailycooked meal and receive onlyMNP supplementation and NE

intervention. We explained tothem our hope in improving thenutritional status of their childrenthrough adaption of these newpractices. It took time to build


caregivers’ understanding on why the change should betaken place: from “receiving cooked meal per day” to“receiving only MNP supplementation and INE interven-tion”.

In addition, I consider Nias as a rather closed community;they do not like talking about their own problems with out-siders, such as NGO staff, or researchers.

Ratna: As for me, the biggest challenge was ensuring thesupply of ingredients for the local production of RUF-biscuits. Since the import of the RUF-Nias ingredients inhuge amounts would have been too expensive and notsustainable for the community, we had to use either locallyproduced or imported products from nearby places. RUF-Nias biscuits contain besides wheat flour, peanut flour and

a vitamin-mineral premix, eggs, palm oil, sugar and mungor soybeans. We had to import high quality peanuts fromanother island, therefore we had to order nuts a month inadvance to avoid problems with transportation to the is-land. In addition, we hired people from a village near our base camp to crush peanuts, as well as to grind and makethe mung and soybean flours.

We faced different problems concerning the locally pro-duced Plumpy’nut (Peanut Milk Paste-Nias). At the verybeginning we received many complaints from the mothers,

who saw that PMP-Nias is notcooked.

Inayati: Unheated oil is a big cul-

tural problem: Indonesian people incertain areas do not consume rawproducts because they believe thatthis brings stomachache.

Ratna: Therefore, we modified the

RUFs : Ready-To-Use Foods

RUF—Nias : Ready - To –Use Food—Nias

RUTF: Ready-To-Use-Therapeutic-Food

MNP: Micro-Nutrient Powder

Taking a blood test in Tetehosi Afia (photo by DA Inayati)




recipe during the field-testing. In the second phase,we worked in other villages and made some changes;PMP-Nias was accepted by the caretakers in the newareas where mothers were not involved in the prepara-tion process, though not all children liked to eat it.

How did you motivate the mothers to par-ticipate in the study?

Inayati : The local women had been involved in theactivities of the local NGO since 2006, so it was rela-tively easy for us to recruit mothers into our researchprogram. However, we experienced difficulties withthe children’s blood testing. Many of our caretakersdid not agree to give their children’s blood for differentreasons, for example believing that the blood would belater sold. Even after we had changed blood-takingmethod to finger-prick, some mothers were still reluc-tant to allow us to take the blood test. Fortunately, our implementing partner and some important local peopleconvinced them to let us to do it.

Ratna : From the total number of respondents, only 30-50% participated in the blood test during admission

and before discharge.

In your opinion what has to be done totackle effectively the food security situa-tion on Nias?

Ratna: I think we are on the right track. We startedwith locally produced food supplements accompaniedby nutrition education. Participatory nutrition educationshould be based on the people’s needs, and their cul-

turally determined knowledge. As a first step for im-proving nutritional status, it is necessary to improvetheir body weight. However, in order to ensure thesustainability, we should little by little accompany the


supplementary intervention with nutrition educa-tion. A change of behavior is not that easy, andshould be culturally acceptable. It is especiallyimportant to give more power to the women indeciding on what is the best food for their chil-dren.

Inayati: These changes need time! Initiativesshould be oriented towards long run developmentand be culturally sensitive, be able to understandthe needs of the community and gain their trust.Unfortunately, as we all know, dealing with differ-ent cultures is not so easy and not straightfor-ward.

Eko: To improve the nutritional status of children,it is essential to improve the economic conditions

of households. In fact, most of the respondentshad low wages, which were even below the mini-mum regional wage on Nias. I agree with Ratnathat the status of women, mothers in particular,has to be improved. Women have to have morerights to control household budget. Again, this isdifficult because of the culture, as Inayati has al-

ready mentioned. However, we can promote improvedcare and feeding approaches that include good practicesin addressing the causes of malnutrition.

What are the policy implications of your re-search?

Ratna: Our study was in line with the idea of the localauthorities and NGOs to develop locally produced RUFsthat are accepted by the children and the community. Atthis stage, my colleagues in Indonesia have presented thepreliminary results to the local authority.

As for the sustain-ability, I think fur-ther studies areneeded based onour research.Even though our NGO partner hascompleted theproject on Nias,

they receivedfunding for exam-ining the effect of MNP in combat-ing malaria on theisland. In addi-tion, based on our research they arelaunching a project for another island, which trulyneeds RUF, asthe nutrition con-ditions there are

even worse thanon Nias Island.

Intensive nutrition education training for voluntary workers (photo by DA Inayati)

Ratna Purwestri demonstrates how to make RUF

Biscuits during the training in Gunung Cahaya

(photo by NM Wulansari)





Interviews were conducted by Caroline Stiller and Anna Jenderejian

Interview with Dr. Veronika Scherbaum

Can you tell us more about the launch of the project on Nias Is-land. Why was it selected and what was the prehistory? Haveyou been doing other projects in Indonesia?

Our first PhD student from Indonesia was Rosnani Pangaribuan. The title of her doctoral research was Vitamin A Supplementation Program Evaluation: Effect of Supplementation in Preschool Children and Compliance of the Program, a Possible Useful Tool for Policy Makers in Indonesia.

After completion of her research in 2003, Rosnani organized a workshop in Indone-sia and invited me as a DAAD funded short term guest lecturer to the SEAMEO-TROPMED – RCCN (Regional Center for Community Nutrition), University of Ja-karta.

During this exchange service, I was involved in a three-day training course on“Management of child feeding practices” and a seminar on “Nutrition surveys andsupplementary / therapeutic feeding programs in emergency situations.” During theseminar, I met Ratna, who was a junior research assistant at SEAMEO-Tropmed-RCCN at that time. Ratna expressedher research interest in the field of therapeutic feeding programs. Until that time, there was no local expert trained in thefield of emergency nutrition in Indonesia. This was a starting point for the research project.

What are plans for the future in the context of the research on locally produced therapeuticfood? Do you have any plans to continue the research?

I see further research needs on locally produced RUFs going in two directions:

In the first category I envision research exploring the effectiveness of RUFs for treatment of moderate malnutrition in theemergency context, where food insecurity in certain areas exists and timely response plays an important role. The re-spective RUFs produced at the national or regional level have to be transported weekly to the distribution sites (e.g.health post, school building) of the affected people.

The local production of these RUFs requires usually cereal- and legume flour, peanut butter, milk powder, oil, sugar/saltand MNP added in order to increase the micronutrient content of this therapeutic food. These types of RUFs -locallyproduced at the community level- can also be used for certain vulnerable groups like HIV/AIDS infected infants duringrapid replacement feeding (e.g. after 6 months of exclusive breastfeeding). There is evidence that the addition of smallquantities of animal-source foods to plant-based foods helps to promote the recovery of moderately wasted children. Inaddition, research is needed to assess whether diets (e.g. RUFs) adequate for moderately wasted children are also ef-fective in treating stunted children.

The second category of research needs would focus on exploring the role of RUFs in prevention of mild and moderateforms of malnutrition. In order to ensure sustainability and independency, RUF recipes for prevention of mild/moderatemalnutrition should be developed, where cereals, legumes, nuts/seeds, vegetables and fruits are available and affordableat the household level. In such situations, it is possible to formulate nutrient-enriched multi-mixes of food even withoutadding MNP.

In addition, we should look more carefully into aspects of the feasibility of local RUF production at community- and

household levels, examine the compliance issues of the people/caretakers affected and put a greater emphasis on im-proved dietary counseling (participatory nutrition education methods) as a long term strategy for prevention of malnutri-tion.

What are the policy implications of the research and how does it emphasize the importanceof locally produced RUTF?

RUTFs (for severe cases of malnutrition) produced at large scale in the industrialized world should be mainly used at theonset of acute emergency situations, as it is now with the situation in Haiti. As soon as the emergency situation is under control (e.g. food is regularly and equitably distributed, there is access to water and sanitation, basic health care andshelter), production of RUTFs (for severe cases) and RUFs (for moderate/mild cases of malnutrition) should begin at thenational level even when local food availability is not yet guaranteed. This can be achieved through re-allocation of im-portant food ingredients, like milk powder, nuts, oil, sugar, salt, cereals, legumes, etc.

On the other hand, during the last decade there was a stronger focus on providing food supplements than on utilizingfamily foods and effective dietary counseling including breastfeeding support and improved child feeding practices. A

food multimix concept should be developed for the prevention of mild/moderate malnutrition at community and/or house-hold level utilizing nutrient strengths of individual foods to cook optimal meals within a cultural context without depend-ency on the availability of micronutrient powder (MNP). At the same time, training of nutrition/health care providers in

dietary counseling will be essential for long term success.



KompetenzzentrumGender undErnährung

Universität Hohenheim

Kompetenzzentrum Gender undErnährung

Schloss Museumsflügel70599 Stuttgart

Telefon +49 711 459 24028Telefax +49 711 459 24402www.kge.uni-hohenheim.de

[email protected]

The Competence Centre Gender and Nutrition

(Kompetenzzentrum Gender und

Ernährung—KGE)

was established in 2002 as a scientific center of

the University of Hohenheim.

The aim of the Competence Centre for Gender

and Nutrition is to pursue interdisciplinary

research in the fields of gender and nutrition,

offer teaching on these issues and promote

inter-faculty collaboration.

The Center engages in the following four

research areas:

Gender and food;

Nutrition studies and gender

research;

Gender research in rural and

agrarian sociology;

Household, consumption

economics and gender economics.

To know more about the KGE work,

team and events, please visit our website.

www.kge.uni-hohenheim.de

Caroline Stiller, a KGE in-tern, tells about her motiva-tion and her experience inworking on the current issueof the KGE Newsletter.

KGE NEWSLETTER, ISSUE 5, MARCH, 2010

As a graduate student in the Nutri-tional Sciences, I joined the KGE

for a nine weeks long internship inAugust and September 2009, after attending theInternational Nutrition course at the University of Hohenheim. The course and the internshipstrengthened my growing wish to help marginal-ized people, to get to know other cultures, andlearn about opportunities on how to get involved.

The internship offered me a chance to gain in-sight into KGE’s on-going projects, and into so-cial research that tries to find ways for reducingsocial differences and uncover cultural differ-ences related to nutrition.

I would like to thank Prof. Anne Bellows for her great supervision, Dr. Stefanie Lemke for her

help even afar from South Africa, and Dr. Ve-ronika Scherbaum; Anna, Gabriela for their as-sistance, Jana and Kathleen, and especiallyRatna, Inayati and Eko for their participation inthe interview for this Newsletter .

From the authors of the issue

Issue Editor:

Anna Jenderejian

The next issue of thenewsletter will be dedicatedto the ethics and humanrights in research and

education. Please sharewith us your thoughts andexperiences related to theabove mentioned topics(Fabiola Lopez - flopez@uni- hohenheim.de ).

We hope that you havefound this issue apleasurable, informative andinteresting read. Pleasesend your general

comments or criticism toFabiola Lopez - flopez@uni- hohenheim.de

kge newsletter 01 2010

Documents