Effectiveness of an integrated nutrition and developmental stimulation program on growth, dietary intake, and motor development among stunted toddlers in coastal Kendari
Keywords:
Coastal area, Dietary intake, Developmental stimulation, Motor development, Nutrition, ToddlersAbstract
Background: An integrated approach combining nutritional improvement and developmental stimulation may improve multiple domains of child health, particularly in coastal communities facing nutritional challenges.
Objective: This study evaluated the effectiveness of an Integrated Nutrition and Developmental Stimulation Program on growth, dietary intake, and motor development among stunted children aged 24–59 months.
Methods: A quasi-experimental non-randomized controlled trial with a pretest–posttest control group design included 80 stunted children, with 40 assigned to the intervention group and 40 to the control group. The intervention group received a 12-week program comprising nutritional counseling, feeding support, and age-appropriate developmental stimulation, while the control group received routine health services. Continuous outcomes were analyzed using ANCOVA adjusted for baseline values and predefined covariates. Motor development was assessed using the KPSP and analyzed as a categorical outcome using modified Poisson regression with robust variance.
Results: The intervention produced greater improvements in body weight (adjusted mean difference [AMD], 0.47 kg; 95% CI, 0.09–0.85; p = 0.016), height (AMD, 1.18 cm; 95% CI, 0.39–1.97; p = 0.004), and HAZ (AMD, 0.23 SD; 95% CI, 0.06–0.40; p = 0.009). Significant improvements were also observed in energy intake (AMD, 158.6 kcal/day; 95% CI, 102.4–214.8; p < 0.001), protein intake (AMD, 6.81 g/day; 95% CI, 4.12–9.50; p < 0.001), and dietary diversity (AMD, 1.37 points; 95% CI, 0.98–1.76; p < 0.001). Appropriate motor development increased from 42.5% to 80.0% in the intervention group and from 45.0% to 57.5% in the control group. The adjusted categorical analysis showed a significant intervention effect.
Conclusion: The integrated program was associated with greater improvements in growth, dietary intake, and motor developmental status than routine care and may strengthen community-based interventions for stunted children in coastal settings.
References
1. de Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr. 2016;12 Suppl 1:12-26. doi:10.1111/mcn.12231
2. Victora CG, Christian P, Vidaletti LP, Gatica-Domínguez G, Menon P, Black RE. Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda. Lancet. 2021;397(10282):1388-99. doi:10.1016/S0140-6736(21)00394-9
3. Leroy JL, Frongillo EA. Perspective: what does stunting really mean? A critical review of the evidence. Adv Nutr. 2019;10(2):196-204. doi:10.1093/advances/nmy101
4. Black MM, Lutter CK, Trude ACB. All children surviving and thriving: re-envisioning UNICEF's conceptual framework of malnutrition. Lancet Glob Health. 2020;8(6):e766-7. doi:10.1016/S2214-109X(20)30122-4
5. Prado EL, Sebayang SK, Apriatni M, et al. Maternal multiple micronutrient supplementation and other biomedical and socioenvironmental influences on children's cognition at age 9-12 years in Indonesia: follow-up of the SUMMIT randomised trial. Lancet Glob Health. 2017;5(2):e217-28. doi:10.1016/S2214-109X(16)30354-0
6. Dulal S, Prost A, Karki S, Saville N, Merom D. Characteristics and effects of integrated nutrition and stimulation interventions to improve the nutritional status and development of children under 5 years of age: a systematic review and meta-analysis. BMJ Glob Health. 2021;6(7):e003872. doi:10.1136/bmjgh-2020-003872
7. Black MM, Walker SP, Fernald LCH, et al. Early childhood development coming of age: science through the life course. Lancet. 2017;389(10064):77-90. doi:10.1016/S0140-6736(16)31389-7
8. World Health Organization, United Nations Children's Fund, World Bank Group. Levels and trends in child malnutrition: UNICEF/WHO/World Bank Group joint child malnutrition estimates: key findings of the 2025 edition [Internet]. Geneva: World Health Organization; 2025 [cited 2026 Sep 9]. 24 p. Available from: https://www.who.int/publications/i/item/9789240112308
9. Fithria F, Ruwiah R, Jumakil J, Saito R, Sato M. Nutritional intake and breastfeeding practices as determinants of growth and motor development among children aged 6-24 months in rural Indonesia. Retos. 2026;78:565-73. doi:10.47197/retos.v78.118835
10. Dewey KG, Adu-Afarwuah S. Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr. 2008;4 Suppl 1:24-85. doi:10.1111/j.1740-8709.2007.00124.x
11. Zhang L, Ssewanyana D, Martin MC, et al. Supporting child development through parenting interventions in low- to middle-income countries: an updated systematic review. Front Public Health. 2021;9:671988. doi:10.3389/fpubh.2021.671988
12. Yousafzai AK, Obradović J, Rasheed MA, et al. Effects of responsive stimulation and nutrition interventions on children's development and growth at age 4 years in a disadvantaged population in Pakistan: a longitudinal follow-up of a cluster-randomised factorial effectiveness trial. Lancet Glob Health. 2016;4(8):e548-58. doi:10.1016/S2214-109X(16)30100-0
13. Sudfeld CR, Bliznashka L, Ashery G, Yousafzai AK, Masanja H. Effect of a home-based health, nutrition and responsive stimulation intervention and conditional cash transfers on child development and growth: a cluster-randomised controlled trial in Tanzania. BMJ Glob Health. 2021;6(4):e005086. doi:10.1136/bmjgh-2021-005086
14. Badan Kebijakan Pembangunan Kesehatan, Kementerian Kesehatan Republik Indonesia. Laporan Survei Kesehatan Indonesia (SKI) 2023 [Internet]. Jakarta: Kementerian Kesehatan Republik Indonesia; 2024 [cited 2026 Sep 9]. Available from: https://www.badankebijakan.kemkes.go.id/hasil-ski-2023/
15. Kementerian Kesehatan Republik Indonesia. Pedoman pelaksanaan stimulasi, deteksi dan intervensi dini tumbuh kembang anak di tingkat pelayanan kesehatan dasar. Jakarta: Kementerian Kesehatan Republik Indonesia; 2016.
16. World Health Organization. WHO child growth standards: training course on child growth assessment [Internet]. Geneva: World Health Organization; 2008 [cited 2026 Sep 9]. Available from: https://www.who.int/publications/i/item/9789241595070
17. Millward DJ. Nutrition, infection and stunting: the roles of deficiencies of individual nutrients and foods, and of inflammation, as determinants of reduced linear growth of children. Nutr Res Rev. 2017;30(1):50-72. doi:10.1017/S0954422416000238
18. Yousafzai AK, Rasheed MA, Rizvi A, Armstrong R, Bhutta ZA. Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trial. Lancet. 2014;384(9950):1282-93. doi:10.1016/S0140-6736(14)60455-4
19. Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM. Effects of psychosocial stimulation and dietary supplementation in early childhood on psychosocial functioning in late adolescence: follow-up of randomised controlled trial. BMJ. 2006;333(7566):472. doi:10.1136/bmj.38897.555208.2F
20. Vazir S, Engle P, Balakrishna N, et al. Cluster-randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake, growth and development among rural Indian toddlers. Matern Child Nutr. 2013;9(1):99-117. doi:10.1111/j.1740-8709.2012.00413.x
21. Nahar B, Hossain MI, Hamadani JD, et al. Effects of a community-based approach of food and psychosocial stimulation on growth and development of severely malnourished children in Bangladesh: a randomised trial. Eur J Clin Nutr. 2012;66(6):701-9. doi:10.1038/ejcn.2012.13
22. Hamadani JD, Huda SN, Khatun F, Grantham-McGregor SM. Psychosocial stimulation improves the development of undernourished children in rural Bangladesh. J Nutr. 2006;136(10):2645-52. doi:10.1093/jn/136.10.2645
23. Tang MN, Adolphe S, Rogers SR, Frank DA. Failure to thrive or growth faltering: medical, developmental/behavioral, nutritional, and social dimensions. Pediatr Rev. 2021;42(11):590-603. doi:10.1542/pir.2020-001883
24. World Health Organization. Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential [Internet]. Geneva: World Health Organization; 2018 [cited 2026 Sep 9]. 55 p. Available from: https://iris.who.int/handle/10665/272603
25. Grantham-McGregor SM, Powell CA, Walker SP, Himes JH. Nutritional supplementation, psychosocial stimulation, and mental development of stunted children: the Jamaican Study. Lancet. 1991;338(8758):1-5. doi:10.1016/0140-6736(91)90001-6
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