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Effectiveness Study of Program Taburia (Multi Micronutrition Supplement) on

Children 6 24 Months in South Sulawesi Province

Veni Hadju, Khidri Alwi, A. Razak Thaha

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Research Question

How far effectiveness of Taburia Program in children 6 24 mo in

South Sulawesi

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PROGRAM NICE (Nutrition Improvement Through Community Empowerment)

1. Tenaga (SDM) a.Kader , KGM, FM, PKK &

ORMAS , idan, TPG dan Kepala Seksi Gizi

2. Dana a.Oprasional Pendistribusian b.Pertemuan, Pelatihan, Promosi c.Pencatatan & Pelaporan

3. Sarana dan Prasarana a.T4 pendistribusian b.T4 penyimpanan c.Ketersediaan taburia d.Data sasaran e.Fom pencatatan dan pelaporan

4. Metode a.Buku panduan, b.Juklat, c.Juknis,

5. Sasaran a Balita umur 6-24 bulan bGakin

Input Proses Output Outcome

EVALUASI PROGRAM TABURIA (Pemberian Taburia Anak Umur 6-24 bulan)

1 Perencanaan Sosialisasi, Pertemuan theniks, t4, Mobilisasi, Promosi, ketersediaan Taburia, jadwal supervisi

2 Pengorganisasian Pembagian tugas dan tanggung jawab

3 Pelaksanaan kegiatan aSebelum Pemberian bSaat Pemberian c Setelah Pemberian 4Controliing

aSupervisi bMonitoring

5 Evaluasi aTingkat desa bTingkat Kecematan cTingkat Kabupaten

1Ketepatan sasaran aBalita Umur 6-24 bln bGakin 2 K e t e p a t a n

pendistribusian aJumlah pemberian bFrekuensi pemberian cTata cara pembrian

bubuk taburia 3Cakupan bubuk

Taburia aBaik bSedang cKurang 4Kepatuahan

aPatuh bTidak Patuh

Status Gizi

Anak Umur 6-24 bulan

INPUT

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Ideal/standard Program

Reality in one the field

1.Man a.Kader Posyandu b.Village midwife c.Puskesmas staff d. Other e. KGM, FM, TPG

-Enough as needed. The work of kader was overloaded due to also involved with other progra.PNPM, Posyandu -Kader and midwife distributed to subjects.

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Ideal/standar Program

Reality at the field

2. Budget a. Distribution

- Supported by local and central government. - There was not money/budget at Puskemas and Village.

b. Meeting, Training, and promotion

- Only for consumption - Makassar has for Monev

c. Recording and reporting

- Not available

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Ideal/standar Program

Kenyataan di lap. (reality)

3. Meterials a.Distribution place b. Storage

- Dinkes ; Taburia stored at Farmacy warehouse - PKM; medicine storage - Partly at kader house

c. Availability of taburia

- Adequate

d. Targeted subjects - Available and adequate

e. Form recording and reporting

- Available at district and PKM, - - but not in Kader

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Ideal/standard Program

Reality at the field

4. Method Guidance book

- Available at PKM - Kader: has booklet (juklak)

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PROSES

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Ideal/standard Program

Reality in the field

1.Planning - Socialization,

technical meeting, place, mobilization, promotion, availability of Taburia, schedule for supervision

- Dinkes plan socialization at district level or PKM - Plan promotion by Dinkes - Monev was done by Dinkes at PKM level

Ideal/standard Program

Reality in the field

2. Organization - Responsibility

- Dinkes responsible for the program

-District by PKM. -TPG facilitate and evaluate kader and socialization to community.

-GM and Kader; distribute to target group and control.

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3. Implementa-tion

a. P r e -intervention

- Sosialization and promotion targeted to 6-24 mo, malnourished and low SES

- Training not for all kader - Distribution, in some areas, prior to training of kader.

- Few subjects were normal children and from moderate SES.

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b. During supplementation

- Kader distributed the to targetted children

- Kader take the Taburia directly to the children houses.

- Some distributed Taburia more than recommended, 1 mo >15 sachet.

- Some received more than one or twice. - Distributed at Posyandu

c. Post intervention

- Recording and acceptance were noted. - Shown appetite increased and practically served.

- Accompanied complimentary feeding.

- Problem taste and smell - Error at served, mixed with soup - Kader sometimes do observation.

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4.Controliing a.Supervision b.Monitoring

- Supervision by Health Depart. - Supervision at PKM for adequate distribution

- Observed how kader bagaimana distribute taburia and gave information to subjects.

-Only few kader did monitoring - No evidence for recording

5. Evaluation a.At village b.At

subdistrict c.At district

- Supervision was done at PKM towards kader at Posyandu day.

- Recording and reporting Taburia was available made by health staffs but it is not concerned number of children with full received Taburia was not written.

- At PKM evaluation was done for availability of planning for targetted number and Taburia needed.

- Local Health Depdo evaluation of training for kader, orientation program, and orientasi for widwife as well as other health staffs.

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OUTPUT

Ideal/standard Program

Reality in the field

1.Adequacy of target

a.Under two yr old

b.Poor family

- Children 6-24 bulan - Only those who are malnourished

- Poor family or UMP less than Rp. 1.100.000)

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1.Adequacy of distribution

- Taburia was distributed to all targeted children but it was not suited to guidance (should be step by step)

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a.Amount of Taburia

- In general, from health office to PKM was suited to guidance.

- Tahap I; -15 pieces52.89% -16-30 pieces; 46.22% - 31-45 pieces0,.44%, - 46 pieces0.44%. - Tahap II; - 80,8% not received anymore still has from the first step. - Tahap III: - 96,44%.not received anymore still has from the second step.

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a.Frequency of giving.

- Received Taburia at the last month, 71,56%

- Consume once in two days 39.11%

- 1 piece 1 child, 90.22%, 1 piece two children, 8.89% , 1 piece > 2 children, 0,89%.

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a.Procedure of giving

- Consume at breakfast, 70,22% - Once a day, 82.67%, twice a day,

1.78%, three times a day, 1.78%. - Mixed with porridge, 20.89% - Mixed with rice, 69.33%, - Mixed with soup, 6.67%, - Mixed with fried noodle 1.78% , - Provided by mother, 93.33%, - Provided by grandma, 5.78%, - Provided by other member of

family, 0.44%

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a.Coverage of Taburia

b.Good; On track > 80%

c.Enough(To wacth) 50-79%,

d.Poor (High Alert) < 50%.

- Coverage of taburialevel enough; 78,86%

- Received taburia 64,527 children under two yr old.

- Lot of children ate snack such as, cemilan; kerupuk, biskuit or bread.

- Some didnt like taste and smell

- Some children rewel and refused the food.

- Some like soup food mother didnt give taburia kepatuhan was low

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a.Compliance - Compliance cut off point 60% (n = 398)

- Comply only 21,9%

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OUTCOME

Mean of hemoglobin and ferritin before and after intervention

No Measurem. x SD Min Max p value

1 Hb. baseline 10.88 1.17 7,00 13.40

0.000 Hb.eEndline 11.24 1.07 6.90 13.20

2 Fe baseline 28.09 25.99 1.50 114.00

0.332 Fe endline 30.13 23.14 1.16 99.49

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Mean of hemoglobin endline based on compliance of Taburia

Measurement Mean

(mg/dl)

SD (mg/dl)

p value

Did not comply 11,19 1,096

0,709

Comply 11,35 1,026

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Determinant factors for compliance

References person or family Kader Posyandu Social support: - father- other family members - Kader

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Easy to feed the children Increase appetite and want to eat frequently Adequacy of nutrient for the child Cognitive and brain development

Positive attitude due to providing Taburia :

Conclussion

Taburia has been successfully distributed and accepted by children 6 24 mo of age from poor family at Nice Project areas.

Some aspects of management and compliances prevent children to have a better nutritional status in this study.

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