Introduction: Malnutrition remains a significant public health concern, particularly in low- and middle-income countries where children are disproportionately affected. In Indonesia, although various nutrition-specific and nutrition-sensitive interventions have been implemented, stunting, wasting, and growth faltering continue to pose major challenges. Most nutrition programs emphasize food or nutrient provision, yet the behavioural factors influencing feeding practices and intervention adherence often receive less attention. Nutritional education has increasingly been recognized as an important strategy to complement these interventions. This narrative review aims to examine the current evidence on the role of nutritional education in improving the effectiveness of nutrition interventions. Methods: A narrative literature review was conducted by searching PubMed, Scopus, Google Scholar, and ScienceDirect for English-language publications from 2014 to 2026. The review included studies that integrated nutritional education with nutrition interventions, such as food supplementation, complementary feeding, and community-based nutrition programs. Relevant reports from international organizations were also included to provide broader context. Results: The available evidence suggests that nutritional education strengthens the impact of nutrition interventions by improving caregivers' knowledge, infant and young child feeding practices, dietary diversity, adherence to intervention programs, and health-seeking behaviors. Overall, interventions that combined nutritional education with nutrition support showed more favorable improvements in child growth and nutritional outcomes than those focusing solely on nutrient provision. In addition, educational components contributed to more sustainable changes in health and nutrition behaviors. Conclusion: Nutritional education is a valuable complement to nutrition interventions because it addresses the behavioral and knowledge-related factors that influence nutritional outcomes. Integrating evidence-based educational approaches into nutrition programs has the potential to improve program effectiveness and contribute to more sustainable reductions in childhood malnutrition.
Saskia Piscesa, Al Ilham Ksatria Gagah Perkasa, Niken Salsabyla
Background: Iron deficiency anemia (IDA) remains the most common micronutrient deficiency globally and continues to represent a major public health concern among children younger than five years, particularly in low- and middle-income countries. Early identification of children at risk is essential to prevent adverse effects on growth, neurodevelopment, and long-term health outcomes. Methods: A narrative review was undertaken to synthesize evidence from observational studies indexed in Scopus and published between 2019 and 2026. The review focused on studies evaluating screening approaches beyond conventional hemoglobin measurement, with particular emphasis on risk-based and non-invasive strategies for improving the early detection of IDA among Indonesian children. Results: The available evidence indicates that, in settings where access to invasive laboratory investigations is constrained, validated risk-based screening instruments and non-invasive assessment methods may improve the identification of children at risk for IDA. These approaches contribute not only to more accurate estimation of disease burden but also to a broader understanding of the cognitive implications and nutritional determinants of iron deficiency, extending beyond reliance on biomarker-defined diagnostic thresholds. Conclusion: Incorporating a practical risk-based IDA screening tool into routine child growth monitoring has the potential to enhance the early identification of vulnerable children, facilitate appropriate referral for confirmatory testing and timely intervention, and support the integration of anemia prevention within Indonesia's existing child nutrition and growth promotion programs.
Background: Malnutrition in Africa presents an increasingly complex public health dilemma characterised by the coexistence of undernutrition, overnutrition, and micronutrient deficiencies, a phenomenon now recognised as the triple burden of malnutrition (TBM). Method: This narrative review synthesises evidence from demographic and health surveys, regional studies, and peer-reviewed research conducted across Sub-Saharan and North Africa to examine prevalence trends, determinants, and policy responses. Results: The findings reveal that while childhood stunting and wasting remain widespread in East and West Africa, adult overweight and obesity are rising sharply in urban centres such as Accra, Nairobi, Johannesburg, and Cairo. Micronutrient deficiencies, particularly anemia, vitamin A, and zinc deficiencies, continue to affect more than half of women and children across many African countries. Country-specific studies demonstrate distinct but overlapping patterns: in Ghana, TBM prevalence declined modestly from 7.6 % to 5 % between 2003 and 2022 in Ethiopia, spatial clustering of stunting, obesity, and micronutrient deficits indicates strong geo-ecological influences and in South Africa, stunting and obesity coexist in over one-third of households. Conclusions: The review identifies socioeconomic inequality, urbanisation, gender disparity, and weak food-system governance as common structural drivers. Without integrated, multisectoral interventions linking agriculture, health, education, and social protection, the continent risks deepening the nutrition inequality divide. Tackling the triple burden is essential to achieving Sustainable Development Goal 2 (Zero Hunger) and Goal 3 (Good Health and Well-Being) and to realising the African Union’s Agenda 2063 vision for a healthy and productive population.
Akinade Enoch Ogunniyi, Oluwadamilola Elizabeth Adetoro, Genevieve Awuah-Cobbinah et al.
Background: Adequate protein intake is essential for child growth, yet optimal growth depends not only on protein quantity but also on the efficiency of protein utilization. Multiple biological and environmental factors may impair the conversion of dietary protein into functional body proteins, contributing to growth faltering despite sufficient protein intake. Methods: This narrative review synthesized recent evidence published between 2020 and 2026 from PubMed, Scopus, ScienceDirect, and Google Scholar. Relevant peer-reviewed studies, systematic reviews, meta-analyses, and clinical guidelines were critically reviewed to identify determinants affecting protein digestion, absorption, metabolism, and tissue protein synthesis in children. Results: Protein utilization is influenced by dietary protein quality, digestive function, intestinal absorption, environmental enteric dysfunction, gut microbiota, infection, inflammation, micronutrient status, energy adequacy, and socioeconomic and environmental conditions. These factors interact to reduce amino acid bioavailability, suppress anabolic pathways, increase protein catabolism, and impair tissue protein synthesis, thereby limiting linear growth. Conclusions: Optimizing child growth requires integrated nutrition strategies that combine high-quality protein intake with interventions supporting intestinal health, adequate energy and micronutrient intake, infection prevention, and improved environmental conditions to maximize protein utilization.
Background: Several studies have highlighted the high impact of HAIs and their effects on pediatric recovery in Ethiopia. Objectives: This study examined the effect of hospital-acquired infections (HAIs) on the recovery of children with severe acute malnutrition (SAM). Design: A retrospective cohort study was conducted at Asella Referral and Teaching Hospital in Oromia, Ethiopia. Materials and methods: Hospital acquired infections (HAIs) defined as infections occurred within 48 hours or more after admission to the Hospital and documented by treating clinicians in medical records. Diagnosis was made using routine clinical assessment, and available laboratory findings according to the standard hospital practice. Of 635 children admitted during the study period, 142 records were excluded (not meeting SAM criteria, unacceptable age range, or incomplete data). Consequently, 493 eligible children with comprehensive documentation were included in the final study. Kaplan–Meier survival analysis was used to compare recovery times between children with and without HAIs. Time to nutritional recovery (in days), defined as the length of hospital stay until recovery, and compared between children with and without hospital-acquired infections. Results: Children without hospital-acquired infections had a higher probability of recovery over time compared to those with HAIs (log-rank test, p < 0.001). Factors significantly associated with HAIs included rural residence, incomplete immunization, and nasogastric tube feeding. Conclusions: Hospital-acquired infections are a common complication among children admitted with severe acute malnutrition and are associated with slower recovery and prolonged hospital stay. Improving child survival requires an integrated approach that strengthens infection prevention and control (IPC), ensures reliable WASH infrastructure, and promotes safe feeding and hygiene practices in therapeutic feeding units. Addressing these structural and procedural gaps is essential to achieving sustainable improvements in nutrition recovery and infection control in Ethiopian hospitals.
Teshome Bekele Elema, Solomon Gebretsadik, Ashenafi Habtamu et al.
This study aims to provide education on stunting prevention for parents and introduce the concept of balanced nutrition to first-grade elementary school students in Melati II Village, Kenari Hamlet, Perbaungan District, Serdang Bedagai Regency. The activity employed a descriptive approach through a participatory education method involving parents and students as the main participants. The implementation consisted of preparation, material delivery, discussion, question-and-answer sessions, observation, and evaluation of participants’ understanding. The materials provided to parents covered the definition of stunting, contributing factors, impacts, nutritional needs, parenting practices, hygiene, and preventive measures that can be applied within the family. Meanwhile, students were introduced to nutritious foods, dietary diversity, breakfast, fruit and vegetable consumption, adequate water intake, and healthy hygiene practices. The results indicated positive responses and improved understanding among participants. Parents gained better knowledge about the importance of fulfilling children’s nutritional needs and monitoring growth, while students were able to identify nutritious foods and healthy daily habits. These findings indicate that communicative education adapted to participants’ characteristics can support greater awareness of stunting prevention and the implementation of balanced nutrition from an early age.
Kusmilawaty Kusmilawaty, Hotma Tua Rizki, Putra Syahwa Siregar et al.
Stunting is a chronic nutritional condition that can impair physical growth and motor development in early childhood, with maternal parenting practices considered an important factor influencing its occurrence. This study aimed to examine the association between maternal parenting practices, stunting, and motor skill development among children aged 24-59 months at Bontomate’ne Community Health Center, Jeneponto Regency, Indonesia. A quantitative cross sectional design was employed involving 44 children selected through purposive sampling. Maternal parenting practices were assessed using a structured questionnaire, nutritional status was determined based on height-for-age Z-scores (HAZ), and motor development was evaluated using the Denver Developmental Screening Test (DDST). Associations between variables were analyzed using Fisher’s Exact Test. The findings showed that most others demonstrated sufficient parenting practices, accounting for 42 children (95.5%), while good parenting practices were identified in only 2 children (4.5%). Of the total participants, 43 children (97.7%) were classified as stunted. A significant association was found between maternal parenting practices and stunting (p = 0.045). Stunting was also significantly associated with delayed motor development (p = 0.035), with severely stunted children showing a greater tendency to experience delays in motor skills. These findings indicate that maternal parenting practices are associated with the risk of stunting, which is subsequently related to motor development in young children. Therefore, early interventions integrating parenting education and nutritional support are important to prevent stunting and promote optimal growth and motor development during early childhood.
Sri Wahyuni Bahrum, Andi Syarifah Irmadani, Sitti Hasrah Ibrahim et al.
Wasting is an acute form of malnutrition among children under five that remains a significant public health problem in Indonesia. This condition is influenced by several factors, including maternal knowledge and child feeding practices. This study aimed to determine the relationship between maternal knowledge and feeding practices with the incidence of Wasting among children aged 6–59 months in Panawakan Village, the working area of Puskesmas Haur Gading in 2026. This study was a quantitative cross-sectional design. A total of 99 respondents were drawn from the sample. Data collected included respondent characteristics, maternal knowledge, parenting practices regarding feeding, and the incidence of Wasting in toddlers. Data were analyzed using univariate tests with frequency tables and bivariate tests using the Spearman Rank correlation test with a significance level of 0.05. The results showed that the majority of toddlers did not experience Wasting (73.7%), while 26.3% experienced Wasting . Most mothers had sufficient knowledge (46.5%) and poor parenting practices (46.5%). Spearman's test results showed a relationship between maternal knowledge and Wasting (p = 0.000; r = 0.373) and between maternal feeding practices and Wasting (p = 0.003; r = 0.299). It is recommended that mothers of toddlers improve their nutritional knowledge and implement appropriate feeding practices to prevent Wasting in toddlers.
Optimal growth and development in children require adequate nutritional status, which can be assessed using body mass index (BMI). In Indonesia, nutritional problems remain prevalent among school-aged children, including in West Java. Poor nutritional status may be associated with an increased burden of dental caries. This study aimed to determine the association between BMI and dental caries status using the HI-BOGI application among students at SDN Cireundeu. An analytic observational study with a cross-sectional design was conducted among 131 students in grades 1–6, aged 6–12 years. Total sampling was used for participant selection. The independent variable was BMI, and the dependent variable was dental caries status. Data were analyzed using the Spearman correlation test. Most respondents (75.6%) were underweight, while 19.1% had normal weight, 3.8% were overweight, and 1.5% had grade 1 obesity. Regarding dental caries status, 48.1% of respondents had very high caries severity, 21.4% had high severity, 21.4% had moderate severity, 3.1% had low severity, and 6.1% had very low severity. Spearman correlation analysis demonstrated a significant negative association between BMI and dental caries status (r = −0.371; p < 0.01). These findings indicate that lower BMI was associated with greater dental caries severity, whereas children with higher or normal BMI tended to have lower caries severity. The findings highlight the importance of addressing nutritional status as part of comprehensive oral health promotion and preventive dental care among school-aged children.
Background: Multinational food and beverage corporations, collectively termed 'Big Food,' contribute substantially to the global obesity crisis through deliberate product formulation, distribution, sales and marketing. Although food marketing in schools is recognized as a contributor to unhealthy dietary behaviors, evidence on its extent in South African secondary schools is limited. Objective: To identify food and non-alcoholic beverage marketing and sponsorship at secondary schools in the City of Cape Town. Methods: An observational, cross-sectional study was conducted in 37 purposively selected public secondary schools from the two largest educational districts in Cape Town. Fieldworkers captured observations of food and non-alcoholic beverage marketing material (names/logos/brands) visible from outside the school premises and within public view. A web-based search was also done to identify marketing and sponsorship activities on schools’ website pages and Twitter/X accounts. Prominently observed food and non-alcoholic beverage companies were invited to complete an online survey. Results: A total of 137 sightings of visible marketing and sponsorship materials from 35 food and non-alcoholic beverage companies were recorded in and around school premises, on school websites and Twitter/X accounts. One hundred sightings were recorded in and around school premises at 89.2% of the schools, with materials mostly displayed on signboards (40%), retail stores (33%), banners (7%), and flags (5%). The predominant company observed was The Coca-Cola Company, contributing 31.4% of the total sightings. Second was the Spar Group (12.4%). The most observed product was sugar-sweetened beverages (SSBs), contributing 29.2% of the total sightings. No online questionnaires were completed by the seven most prominent companies sighted and approached, regardless of repeated reminders. Conclusions: Food and non-alcoholic beverage marketing and sponsorship were widespread across secondary schools, with SSBs being the most prominent single category, followed by companies and supermarkets that manufacture or sell a combination of ultra-processed food and SSBs. These findings support the need for stronger regulatory measures to protect children and adolescents from unhealthy food marketing within school environments.
