Provision Of Local Food-Based Supplementary Feeding For Undernourished Toddlers In Primary Care: A Systematic Literature Review

Asyifa Tsulus Sandi; Titik Kuntari; Utami Utami; Raden Edi Fitriyanto; Yaltafit Abror Jeem; Yayuk Fathonah; Tien Budi Febriani; Emi Azmi Choironi; Gita Yusmira; Rini Syahriani; Mohamad Rahman Suhendri

doi:10.55227/ijhet.v5i3.1113

Authors

Asyifa Tsulus Sandi a:1:{s:5:"en_US";s:146:"Master’s Program in Public Health, Islamic University of Indonesia, Jl. Kaliurang Km 14.5, Sleman, Special Region of Yogyakarta 55584, Indonesia";}
Titik Kuntari Master’s Program in Public Health, Islamic University of Indonesia. Department of Public Health, Faculty of Medicine, Islamic University of Indonesia
Utami Utami Master’s Program in Public Health, Islamic University of Indonesia,Department of Public Health, Faculty of Medicine, Islamic University of Indonesia
Raden Edi Fitriyanto Department of Biochemistry, Faculty of Medicine, Islamic University of Indonesia
Yaltafit Abror Jeem Master’s Program in Public Health, Islamic University of Indonesia. Department of Public Health, Faculty of Medicine, Islamic University of Indonesia
Yayuk Fathonah Department of Public Health, Faculty of Medicine, Islamic University of Indonesia
Tien Budi Febriani Department of Pediatrics, Faculty of Medicine, Islamic University of Indonesia
Emi Azmi Choironi Department of Pediatrics, Faculty of Medicine, Islamic University of Indonesia
Gita Yusmira Master’s Program in Public Health, Islamic University of Indonesia
Rini Syahriani Master’s Program in Public Health, Islamic University of Indonesia
Mohamad Rahman Suhendri Master’s Program in Public Health, Islamic University of Indonesia

DOI:

https://doi.org/10.55227/ijhet.v5i3.1113

Keywords:

Local Supplementary Feeding, Under-Five Undernutrition, Wasting, Anemia, Tuberculosis.

Abstract

Undernutrition among children under five in Indonesia remains aggravated by poor diet quality and comorbidities such as tuberculosis, anemia, and thalassemia. This review evaluated the effectiveness of local food-based supplementary feeding compared with standard supplements or no intervention, assessed the moderating role of major comorbidities on nutritional recovery, and identified determinants of program success. A PRISMA 2020-guided systematic literature review was conducted using Consensus.app sources published in 2015–2026, prioritizing systematic reviews, meta-analyses, randomized controlled trials, and quasi-experimental studies. Supplementary foods and complementary feeding interventions improve recovery, body weight, Weight-for-Height Z-Score (WHZ), Weight-for-Age Z-Score(WAZ), dan Mid-Upper Arm Circumference (MUAC), sementara perbaikan tinggi badan whereas gains in height/ Height-for-Age Z-Score (HAZ) are smaller and require longer exposure. Local food-based products, including moringa-fortified foods, moringa nuggets, and other locally formulated diets, also improved weight, height, or Mid-Upper Arm Circumference (MUAC) in studies from Indonesia and other low-resource settings. Tuberculosis and anemia consistently predicted slower nutritional recovery, while evidence for thalassemia mainly indicates elevated malnutrition risk rather than tested response to supplementary feeding. Program success depends on adequate duration, adherence, nutrient composition, training, family support, and primary care delivery capacity. The main research gap is the lack of integrated screening for tuberculosis, anemia, and thalassemia within primary-care supplementary feeding programs. Locally-based PMT effectively improves short-term nutritional status of undernourished children, but its effectiveness decreases in children with TB and anemia comorbidities. Integration of tuberculosis, anemia, and thalassemia screening in PMT programs at primary healthcare facilities is needed.

Downloads

Download data is not yet available.

References

'Ulya, N. A., & Maharani, C. (2024). Evaluation of the implementation of the supplementary food program as an effort to improve the nutrition of stunting toddlers in the work area of the Puskesmas Karangdoro. MEDIKORA, *23*(2). https://doi.org/10.21831/medikora.v23i2.79393

Adem, F., Edessa, D., Bayissa, B., Hassen, M. M., & Mohammed, M. A. (2020). Treatment outcomes and associated factors in hospitalised children with severe acute malnutrition: A prospective cohort study. Pediatric Health, Medicine and Therapeutics, *11*, 235-243. https://doi.org/10.2147/phmt.s253396

Ahmad, A., Madanijah, S., Dwiriani, C. M., & Kolopaking, R. (2020). Effect of nutrition education and multi-nutrient biscuit interventions on nutritional and iron status: A cluster randomized control trial on undernourished children aged 6-23 months in Aceh, Indonesia. Journal of Nutritional Science and Vitaminology, *66*(Supplement), S380-S390. https://doi.org/10.3177/jnsv.66.s380

Amelia, S., & Kaswandani, N. (2024). Correlation between tuberculosis type and comorbidities with nutritional recovery rates post-tuberculosis treatment in pediatric patients. Archives of Pediatric Gastroenterology, Hepatology, and Nutrition, *3*(3), 1-11. https://doi.org/10.58427/apghn.3.3.2024.1-11

Aprillianti, L., Nur, T., & Sampurna, R. H. (2025). Implementation of policy to accelerate stunting reduction through supplementary feeding program (PMT) in Warudoyong district, Sukabumi City. Proceeding of International Conference on Digital, Social, and Science, *2*(1). https://doi.org/10.62201/icodss.v2i1.203

Ariesthi, K. D., Pattypeilohy, A., Fitri, H. N., & Paulus, A. Y. (2021). Additional feeding based on local food to improve the nutritional status of toddlers. Jurnal Kesehatan Masyarakat, *17*(1). https://doi.org/10.15294/kemas.v17i1.25862

Ayukarningsih, Y., Amalia, J., & Nurfahfah, G. (2022). Thalassemia and nutritional status in children. Journal of Health and Dental Sciences, *2*(1), 39-52. https://doi.org/10.54052/jhds.v2n1.p39-52

Christiyanti, N. K. W., Janendra, P. S. A., Dwijayantari, S. A. D., & Purnami, K. I. (2025). Evaluation of the effectiveness of local food-based supplementation (Pemberian Makanan Tambahan) in improving the nutritional status of underweight children under five at a public health center. Bali Medical and Wellness Journal, *2*(2). https://doi.org/10.71341/bmwj.v2i2.35

Cichon, B., Das, J. K., Salam, R. A., Padhani, Z., Stobaugh, H., Mughal, M., Pajak, P., Rutishauser-Perera, A., Bhutta, Z., & Black, R. (2023). Effectiveness of dietary management for moderate wasting among children > 6 months of age—A systematic review and meta-analysis exploring different types, quantities, and durations. Nutrients, *15*(5). https://doi.org/10.3390/nu15051076

Darnton-Hill, I., Mandal, P., De Silva, A., Bhatia, V., & Sharma, M. (2022). Opportunities to prevent and manage undernutrition to amplify efforts to end TB. The International Journal of Tuberculosis and Lung Disease, *26*(1), 6-11. https://doi.org/10.5588/ijtld.21.0488

Das, J. K., Salam, R. A., Saeed, M., Kazmi, F. A., & Bhutta, Z. (2020). Effectiveness of interventions for managing acute malnutrition in children under five years of age in low-income and middle-income countries: A systematic review and meta-analysis. Nutrients, *12*(1). https://doi.org/10.3390/nu12010116

Dessie, G., Li, J., Nghiem, S. V., & Doan, T. (2024). Prevalence and determinants of stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies in children under 5 in the least-developed countries: A systematic review and meta-analysis. Nutrition Reviews, *83*(2), e178-e194. https://doi.org/10.1093/nutrit/nuae063

Feleke, B., Feleke, T. E., & Biadglegne, F. (2019). Nutritional status of tuberculosis patients, a comparative cross-sectional study. BMC Pulmonary Medicine, *19*. https://doi.org/10.1186/s12890-019-0953-0

Fetriyuna, F., Purwestri, R., Jati, I., Setiawan, B., Huda, S., Wirawan, N. N., & Andoyo, R. (2023). Ready-to-use therapeutic/supplementary foods from local food resources: Technology accessibility, program effectiveness, and sustainability, a review. Heliyon, *9*. https://doi.org/10.1016/j.heliyon.2023.e22478

Fitrianti, S., Syauqy, A., & Darmawan, S. (2025). Application of modified SGNA (Subjective Global Nutritional Assessment) to assess malnutrition status in children with transfusion-dependent thalassemia. Medical Forum Monthly. https://doi.org/10.60110/medforum.360404

Guo, W., Zgambo, M., Chen, S., & Shimpuku, Y. (2025). Prevalence and trends of coexisting forms of malnutrition and its associated factors among children aged 6–59 months in South and Southeast Asia, 1996–2022: A cross-sectional time series study. BMC Public Health, *25*. https://doi.org/10.1186/s12889-025-23482-w

Haryani, D. A., Amanda, Q., & Sabjan, N. (2024). Locally sourced supplementary feeding programs as a strategic intervention to address weight faltering in children: Insights from a primary health center study. Sains Medika: Jurnal Kedokteran dan Kesehatan, *15*(2). https://doi.org/10.30659/sainsmed.v15i2.40402

Juffrie, M., Helmyati, S., & Hakimi, M. (2020). Nutritional anemia in Indonesia children and adolescents: Diagnostic reliability for appropriate management. Asia Pacific Journal of Clinical Nutrition, *29*(Suppl 1), S18-S31. https://doi.org/10.6133/apjcn.202012_29(s1).0003

Kinyoki, D. K., Ross, J., Lazzar-Atwood, A., Munro, S. B., Schaeffer, L. E., Abbasalizad-Farhangi, M., Abbasi, M., Abbastabar, H., Abdelalim, A., Abdoli, A., Abdollahi, M., Abdollahpour, I., Abdulkader, R., Abebe, N., Abebo, T. A., Abegaz, K. H., Abolhassani, H., Abreu, L., & Hay, S. I. (2020). Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017. Nature Medicine, *26*, 750-759. https://doi.org/10.1038/s41591-020-0807-6

Lassi, Z., Padhani, Z., Ali, A., Rahim, K., Azhar, M., Naseem, H., Salam, R. A., Das, J. K., & Bhutta, Z. (2025). Community-based child food interventions/supplements for the prevention of wasting in children up to 5 years at risk of wasting and nutritional oedema: A systematic review and meta-analysis. Nutrition Reviews, *83*(4), 1402-1424. https://doi.org/10.1093/nutrit/nuaf041

Lassi, Z., Rind, F., Irfan, O., Hadi, R., Das, J. K., & Bhutta, Z. (2020). Impact of infant and young child feeding (IYCF) nutrition interventions on breastfeeding practices, growth and mortality in low- and middle-income countries: Systematic review. Nutrients, *12*(3). https://doi.org/10.3390/nu12030722

Martin, S. L., McCann, J. K., Gascoigne, E., Allotey, D., Fundira, D., & Dickin, K. (2020). Mixed-methods systematic review of behavioral interventions in low- and middle-income countries to increase family support for maternal, infant, and young child nutrition during the first 1000 days. Current Developments in Nutrition, *4*(6). https://doi.org/10.1093/cdn/nzaa085

Melaku, B., Gebremichael, B., Negash, B., Kitessa, M., Kassa, O., Dereje, J., Kefelegn, R., & Firdisa, D. (2024). Time to recovery from moderate acute malnutrition and its predictors among children aged 6–59 months in Fedis Woreda, East Hararghe Zone, Eastern Ethiopia. Frontiers in Nutrition, *11*. https://doi.org/10.3389/fnut.2024.1369419

Moramarco, S., Amerio, G., Ciarlantini, C., Chipoma, J. K., Simpungwe, M., Nielsen-Saines, K., Palombi, L., & Buonomo, E. (2016). Community-based management of child malnutrition in Zambia: HIV/AIDS infection and other risk factors on child survival. International Journal of Environmental Research and Public Health, *13*(7). https://doi.org/10.3390/ijerph13070666

Mudhofar, M. N., Lestaluhu, S. A., Kusumadewi, F., Sugarni, M., Tirtawati, G. A., & Kesehatan, K. (2024). Evaluation of nutrition supplementation and nutrition education program in preventing malnutrition in toddlers. Miracle Get Journal, *1*(3). https://doi.org/10.69855/mgj.v1i3.64

Muslimin, I., Fajriana, H., Salim, A., Salaka, S. A., & Amin, E. (2026). Implementation evaluation of a local food based supplementary feeding program to support child nutrition in West Sulawesi, Indonesia. AcTion: Aceh Nutrition Journal, *11*(1). https://doi.org/10.30867/action.v11i1.3089

Nastiti, A. D., Puspitasari, R. A. H., Handayani, D., & Irwansyah, F. R. (2025). The effect of Moringa leaf fortification on improving the nutritional status of stunting toddlers in coastal areas. Health and Technology Journal, *3*(2). https://doi.org/10.53713/htechj.v3i2.338

Nasution, S. W., Lahagu, Y., & Novalinda, C. (2025). Overcoming implementation barriers in a qualitative study of the supplementary feeding program for malnourished toddlers in rural Indonesia. Contagion: Scientific Periodical Journal of Public Health and Coastal Health, *7*(1). https://doi.org/10.30829/contagion.v7i1.24365

Nnam, N., Ani, P. N., & Chukwuemeka, N. E. (2025). Effect of locally formulated complementary foods on anthropometric parameters and micronutrient status in children (6−23 months) in Enugu State, Nigeria: A randomized controlled trial. Preventive Nutrition and Food Science, *30*(2), 110-119. https://doi.org/10.3746/pnf.2025.30.2.110

Padmapriyadarsini, C., Shobana, M., Lakshmi, M., Beena, T., & Swaminathan, S. (2016). Undernutrition & tuberculosis in India: Situation analysis & the way forward. The Indian Journal of Medical Research, *144*(1), 11-20. https://doi.org/10.4103/0971-5916.193278

Rachmah, S., Mawaddah, N., & Rahim, R. A. A. (2025). The relationship between supplementary feeding consumption made from local foods and the nutritional status of wasting and stunting toddlers. Jurnal Kesehatan Komunitas Indonesia, *5*(2). https://doi.org/10.58545/jkki.v5i2.549

Rachmi, C., Agho, K., Li, M., & Baur, L. (2016). Stunting, underweight and overweight in children aged 2.0–4.9 years in Indonesia: Prevalence trends and associated risk factors. PLoS ONE, *11*(5). https://doi.org/10.1371/journal.pone.0154756

Ramadhania, S., Mulyani, E., & Ariestiningsih, E. S. (2025). Evaluation of local supplemental food program for undernourished toddlers. Jurnal Kesmas dan Gizi, *7*(2). https://doi.org/10.35451/jkg.v7i2.2701

Rashid, M. Y., Kebira, J. Y., Oljira, L., & Dheresa, M. (2022). Time to recovery from moderate acute malnutrition and its predictors among children 6–59 months of age enrolled in targeted supplementary feeding program in Darolebu District, Eastern Ethiopia: A retrospective cohort study. Frontiers in Public Health, *10*. https://doi.org/10.3389/fpubh.2022.914837

Siegal, K., Musau, K., Woodruff, B., Custer, E., Vergari, L., Anyango, H., Donkor, W. E. S., Kiprotich, M., Rohner, F., & Wegmüller, R. (2022). Factors associated with nutrition intervention adherence: Evidence from a cluster-randomised controlled trial in Kenya. Maternal & Child Nutrition, *19*(2). https://doi.org/10.1111/mcn.13467

Ssentongo, P., Ssentongo, A., Ba, D., Ericson, J., Na, M., Gao, X., Fronterrè, C., Chinchilli, V., & Schiff, S. (2021). Global, regional and national epidemiology and prevalence of child stunting, wasting and underweight in low- and middle-income countries, 2006–2018. Scientific Reports, *11*. https://doi.org/10.1038/s41598-021-84302-w

Tam, E., Keats, E., Rind, F., Das, J. K., & Bhutta, Z. (2020). Micronutrient supplementation and fortification interventions on health and development outcomes among children under-five in low- and middle-income countries: A systematic review and meta-analysis. Nutrients, *12*(2). https://doi.org/10.3390/nu12020289

Tan, P., Chan, C., Som, S. V., Dye, L., Moore, J., Caton, S., & Gong, Y. (2024). Prevalence and key determinants of the triple burden of childhood malnutrition in Southeast Asian countries: A systematic review and meta-analysis within an adapted socio-ecological framework. Critical Reviews in Food Science and Nutrition, *65*(15), 5683-5697. https://doi.org/10.1080/10408398.2024.2419539

Teshome, M., Lema, T. B., Abessa, T. G., Mingels, S., Granitzer, M., Rameckers, E. A. A., & Verbecque, E. (2024). Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: A systematic review and meta-analysis. Journal of Nutritional Science, *12*. https://doi.org/10.1017/jns.2023.114

Victora, C., Christian, P., Vidaletti, L., Gatica-Domínguez, G., Menon, P., & Black, R. E. (2021). Revisiting maternal and child undernutrition in low-income and middle-income countries: Variable progress towards an unfinished agenda. Lancet, *397*(10282), 1388-1399. https://doi.org/10.1016/S0140-6736(21)00394-9

Visser, J., Mclachlan, M., Maayan, N., & Garner, P. (2018). Community-based supplementary feeding for food insecure, vulnerable and malnourished populations – An overview of systematic reviews. Cochrane Database of Systematic Reviews, *2018*(11). https://doi.org/10.1002/14651858.cd010578.pub2

Wagnew, F., Dessie, G., Takele, W., Tadesse, A., Islam, S., Mulugeta, H., Haile, D., Negesse, A., & Abajobir, A. (2019). A meta-analysis of inpatient treatment outcomes of severe acute malnutrition and predictors of mortality among under-five children in Ethiopia. BMC Public Health, *19*. https://doi.org/10.1186/s12889-019-7466-x

Wagnew, F., Dejenu, G., Eshetie, S., Alebel, A., Worku, W., & Abajobir, A. (2019). Treatment cure rate and its predictors among children with severe acute malnutrition in northwest Ethiopia: A retrospective record review. PLoS ONE, *14*(2). https://doi.org/10.1371/journal.pone.0211628