EFFECTIVENESS OF TRADITIONAL AND COMMUNITY-BASED

COMPLEMENTARY FOOD SUPPLEMENT

PROGRAMS: A CASE STUDY

A Research Presented to
The faculty of Calatagan High School,
Virac, Catanduanes

In Partial Fulfillment
of the Requirements for the Subject
Inquiries, Investigation, Immersion

NOEL B. BARCELON JR
RIGOR D. TANAEL
NOEL B. TOLERO JR
PRINCESS LG T. GARVIDA
SAMANTHA NICOLE V. MAGDARAOG
 Chapter 1

PROBLEM AND ITS SETTINGS

Background of the Study

Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy

and/or nutrients. Malnutrition includes undernutrition (wasting, stunting, underweight),

inadequate vitamins or minerals, overweight, and obesity that leads to diet-related

noncommunicable diseases. Every country in the world is affected by one or more forms of

malnutrition. Combating malnutrition in all its forms is one of the greatest global health

challenges.

Undernutrition contributes to five million deaths of children under five each year.

Furthermore, throughout the life cycle, undernutrition contributes to increased risk of infection,

poor cognitive functioning, chronic disease, and mortality. It is thus important for decision‐

makers to have evidence about the effectiveness of nutrition interventions for young children.

Poor growth and micronutrient deficiency mainly attack older infants and young children. Some

countries have adopted clinically effective measures to combat malnutrition, but the compliance

and improvement in efficacy of intervention vehicles in national programs require evaluation as

stated by Kristjansson et al., (2015)

 Food supplements are necessary to address malnutrition worldwide. Food supplements

are concentrated sources of nutrients, mineral and vitamins or other substances that are intended

to correct nutritional deficiencies, maintain an adequate intake of certain nutrients, or to support

specific phycological and physical function. Partly due to our modern lifestyle, not every child

manages to intake a healthy-foods.

Growth faltering in the first 2 years of life is high in South Asia where prevalence of

stunting is estimated at 40–50%. Although nutrition counselling has shown modest benefits, few

intervention trials of food supplementation exist showing improvements in growth and

prevention of stunting according to Christian et al., (2015).

Based on the Global Nutrition Report 2015 in several countries, including Bangladesh,

Mongolia, Bolivia and China, have implemented national food supplement programs for infants

and young children who are the most susceptible to micronutrient malnutrition. However, the

adherence, acceptance and effectiveness of complementary food supplement programs require

further assessment to provide feedback information for the producers to improve their products

and for the policy-makers to achieve the best cost-effect outcomes. In the present study, we

sought to evaluate the efficacy of different nutritional interventions child growth.

According to a recent National Nutrition Survey by the Food and Nutrition Research

Institute (FNRI), about one million Filipino children suffer from acute malnutrition. For nearly

thirty years, there have been almost no improvements in the prevalence of undernutrition in the

Philippines. One in three children (29%) younger than five years old suffered from stunting

(2019), being small in size for their age. The country is ranked fifth among countries in the East

Asia and Pacific region with the highest prevalence of stunting and is among the 10 countries in

the world with the highest number of stunted children.

 In most developing countries the prevalence of undernutrition and micronutrient

deficiencies is high among infants and young children. As they get older the energy and nutrient

contribution from complementary food becomes increasingly important for meeting daily

requirements. For many young children, however, the small quantities of cereal-based porridges

commonly fed to them do not contain enough energy and micronutrients to meet daily

requirements. The generally accepted recommendations for improving the nutritional status of

children in this age group are to feed children locally available micronutrient-rich foods and to

encourage local production of low-cost, industrially processed, fortified cereal-based

complementary foods. Increasingly, however, both approaches are recognized as having

limitations. Barangay Valencia is one of the communities who reel under the malnutrition among

young children, and also barangay Valencia is a one of the communities whose very active in

terms of nutritional interventions. For preventing dietary inadequacies the complementary

feeding period were recently proposed. These approaches are ready-to-use therapeutic food

(RUTF) and fortified spreads that can be added to food just before feeding or fed as a snack.

These products can be considered as complementary food supplements to meet the nutritional

needs of young children.

Thus, study aims to identify the effectiveness of food supplement than traditional feeding

program in a community. Valencia. This will help the health workers to determine whether the

said program is effective. This research will also assess the effectiveness of supplementary

feeding programs for improving the physical and psychosocial health of disadvantaged children

aged two to five years old. Additional objectives of this study is to assess the potential of such

programs to reduce socio‐economic inequalities in undernutrition, to evaluate implementation

and to understand how this may impact on outcomes. Given this alarming global situation
especially in developing countries including the Philippines, this study conceptualize to evaluate

the efficacy of nutritional intervention on child growth.

Statement of the Problem

This study aims to determine the effectiveness of community-based complementary food

supplement among the malnourished children ages 2-5 years old in Barangay Valencia, Virac,

Catanduanes.

This study seeks to answer the following specific questions:

1. What is the demographic profile of the malnourished children age 2-5 in Brgy. Valencia,

Virac, Catanduanes in terms of;

a. Age

b. Sex

c. Nutritional status

d. Income of the family

e. Number of children in the family

2. What are the reaction of parents with identified malnourished children ages 2-5 years old in

Brgy. Valencia on the level of effectiveness of the following government nutritional

interventions?

a. Traditional feeding program

b. Complementary food supplement program

3. Is there a significant relationship between demographic profile and nutritional status of

malnourished children ages 2-5 years old in Brgy. Valencia, Virac, Catanduanes?

4. Is there a significant difference between the effectiveness of the traditional feeding program

and complementary food supplement?

Hypothesis

 There is no significant relationship between the demographic profile and nutritional

status of malnourished children ages 2-5 years old in Brgy. Valencia, Virac, Catanduanes.

 There is no significant difference between the effectiveness traditional feeding program

and complementary food supplement.

Scope and Delimitation

The study aims to determine the effectiveness of the Traditional feeding program and

complementary food supplement program among malnourished children ages 2-5 years old in

Valencia, Virac, Catanduanes. The study will be limited to children aged 2-5 years old who have
been identified as malnourished based on their weight and height measurements. The study will

not include children who have other medical conditions that will affect their nutritional status

Significance of the Study

The findings of this study are considered beneficial to the following:

Global Health Organizations. It will assess every health department to further develop

effective food supplements to be spread on public considering welfare of its consumers.

Government. It will be beneficial on raising realizations on of the government's

responsibilities via strengthening its citizens' health and welfare.

Community. It will further raise awareness on the effectiveness of food supplements to

the well-being of every malnourished child.

Parents. It will raise awareness to parents about the nutritional statuses of their children.

Future Researchers. The findings of the study will further help future researchers to

refine and expand the grasps of the effects of complementary food supplements to young

individuals.

Definition of Terms

The following terms are defined operationally and conceptually for clearer understanding

of this study.
 Complementary Food Supplement refers to the food supplement provided to a child

between the ages of 2-5 years old in addition to their regular diet, with the intention of increasing

their nutrient intake and addressing any deficiencies.

Malnourished Children are children ages 2-5 years who are suffering from any form of

malnutrition;

Micronutrient deficiencies- a lack of essential vitamins and minerals needed for proper bodily

function.

Overnutrition- refers to a state where an individual's nutrient intake exceeds their body's

needs, leading to excessive weight gain and a range of negative health outcomes, including

obesity, cardiovascular disease, and type 2 diabetes.

Undernutrition- pertains to a state where an individual's nutrient intake is insufficient to

meet their body's needs, leading to malnutrition, and a range of negative health outcomes.

Nutritional Status the health status of children aged 2-5 years old whether they are

wasted, stunted, underweight, overweight and obese.

Traditional Feeding Program pertains to the normal nutrition intervention in a form of

assistive nutritious meal given to the young children aged 2-5 years old.
 Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the related literature and studies after the thorough and in-depth

search done by the researchers. This will also present the synthesis of the art, gaps of the study

and theoretical to fully understand the research to be done and for better comprehension of the

study.

Related Literature

In a study by Acuin et al,.(2019) of the Philippine Statistics Authority (PSA) titled

"Factors Associated with Malnutrition Among Children Aged 6-59 Months in the Philippines,"

the researchers looked at the main causes of malnutrition among Filipino children and discovered
that poverty, a lack of access to healthcare, and poor feeding practices were the main

contributing factors.

The Food and Nutrition Research Institute (FNRI) article "Malnutrition in the

Philippines: Problems and Challenges" examines the different problems and difficulties

associated with malnutrition in the country. The essay emphasizes the necessity of a multi-

sectoral strategy to address the issue, including governmental policies, neighborhood-based

initiatives, and public awareness campaigns. Panganiban et al,.(2016).

Manasan et al,. (2018) conduct a study entitled “Child Malnutrition in the Philippines:

Magnitude, Trends, and Contributing Factors" This paper by the Philippine Institute for

Development Studies (PIDS) gives an overview of the magnitude and trends of child

malnutrition in the Philippines and identifies the contributing factors to malnutrition, such as

poverty, insufficient healthcare, and poor feeding practices.

“The State of the World's Children 2019: Children, Food and Nutrition" - The UNICEF

report highlights the problem of malnutrition in the Philippines and offers suggestions for

solutions, highlighting the significance of enhancing access to nutrient-dense foods, encouraging

exclusive breastfeeding, and implementing efficient nutrition programs, (2019).

Rohner et al,.(2019) stated that the weight and height of malnourished children in

Burkina Faso were improved by a locally produced, fortified food supplement, according to a

randomized controlled trial that was published in the Lancet Global Health.

According to a meta-analysis that was published in PLOS ONE, lipid-based nutrient

supplements (LNS) can help malnourished children under the age of five grow and develop more

normally. Anna Lartey et al,.(2019).

 Khara et al,.(2019) concluded that the Fortified blended foods (FBFs) and lipid-based

nutrient supplements (LNSs), are useful for boosting the nutritional status of malnourished

children in low- and middle-income nations, according to a systematic review.

A randomized controlled trial published in the Journal of Nutrition found that a fortified

complementary food was effective in improving the growth and development of malnourished

children in rural Nepal. Ram K. C. et al,.(2015).

Ramakrishnan et al,.(2000) stated that the children in rural areas of the Philippines

benefited from a community-based nutrition program that included food supplementation,

nutrition education, and growth monitoring.

An overview of various nutritional interventions like food supplements and feeding

programs to prevent and treat childhood malnutrition is given in the article "Nutritional

interventions for preventing and treating malnutrition in children,". Kerac , Woodhead, Berkleyu

et al,.(2020)

The pieces of literature emphasize the need for a collaborative effort to address

malnutrition issue, particularly among children and the state of the malnourished children now a

day. The government, private sector, and local communities must work together to provide

access to nutritious foods, healthcare, and education to ensure the well-being of children.

Related Studies

Roberts et al., (2022), stated that undernourished preschool-aged children who receive

iron and various micronutrient supplements see gains in their cognitive capacities. It was

discovered that increased fish eating benefited children's cognitive development. B-vitamin,
iodized salt, and guava powder therapies, on the other hand, did not show any appreciable

effects.

In low-income households, feeding children well and educating parents and guardians

about nutrition has a good impact on their knowledge and attitudes, reduces anemia, and

promotes growth, all of which have a positive impact on the development of young children. Ok-

Jin Park et al,. (2009).

Improvements in hemoglobin status and modest gains in linear growth were seen when

RUSF (food supplement) was given as a part of a general food distribution, along with an

apparent decrease in morbidity. Huybregts et al,. (2012).

Park et al., (2019) found that the food supplement increased immune function and growth

in the kids who took it, pointing to the possibility that it could be a dietary supplement for

boosting kids' immune systems and growth.

Patel et al., (2019). Stated that children who received ready-to-use supplementary food

(RUSF) including soy, peanut, and milk powder showed improvements in their weight, height,

and mid-upper arm circumference, showing that their nutritional status had improved. According

to the study, RUSF may be a effective and inexpensive intervention for addressing childhood

malnutrition.

According to Campbell et al., (2016) In areas where stunting is frequent, complementary

food supplements (CFSs) can improve growth, but replacing the standard diet with them could

lessen the positive effects that have been seen.

 With or without supplemental feeding, intensive nutrition instruction greatly improves

the condition of children who are moderately malnourished. Roy et al., (2005).

According to (Briend et al., 2013). With recovery rates of up to 90%, ready-to-use

supplementary food (RUSF) was a highly successful treatment for acute malnutrition.

According to Zavoshy et al., (2012), One of the leading causes of death and morbidity in

children is malnutrition. It has long-term implications on children's cognitive development and

societal economic growth in addition to immediate benefits on their health.

Lannotti et al. (2014) found that the children's mid-upper arm circumference

measurements, weight-for-age, and weight-for-height scores were all significantly improved by

the LNS intervention. The increased intake of vital micronutrients from the LNS supplement was

credited with these effects.

Another study by Imdad et al. (2011) revealed the use of multiple micronutrient

supplements (MMS) was successful in lowering the risk of anemia, enhancing cognitive

development, and boosting weight gain in young children.

These studies provide evidence that traditional feeding programs, such as fortified

blended foods, locally produced ready-to-use foods, and complementary foods, can and cannot

be effective in improving the nutritional status of malnourished children. However, it's important

to note that the effectiveness of these interventions may vary depending on the context and the

severity of malnutrition.

Synthesis of the State of the Art

 The researcher presented various related literature and studies regarding the study. To

have a clearer understanding of these literature and studies, the researchers made a synthesis

the succeeding discussion.

One of the highlights was focused on the rate of malnourished children in the Philippines

and around the world. According to the Philippine Statistics Authority (PSA), The Food and

Nutrition Research Institute (FNRI), Philippine Institute for Development Studies (PIDS), and

UNICEF malnourished children is increasing now a days. Lack of access to healthcare, and poor

feeding practices were the main contributing factors as stated by the presented related literature

regarding the food supplements and traditional feeding programs for malnourished children.

Based on the studies mentioned, it appears that ready-to-use supplementary food (RUSF) and

lipid-based nutrient supplements (LNS) intervention can be effective in improving weight gain,

hemoglobin status, linear growth, and mid-upper arm circumference in malnourished children.

The studies presented also suggest that traditional feeding programs, such as fortified blended

foods, locally produced ready-to-use foods, and complementary foods, can be effective in

improving the nutritional status of malnourished children, although the effectiveness may vary

depending on the context and severity of malnutrition.

Overall, the studies and literature provides evidence that food supplements and traditional

feeding programs can play an important role in improving the nutritional status of malnourished

children, particularly when implemented as part of a comprehensive strategy that addresses the

underlying causes of malnutrition. However, further research is needed to determine the most

effective and cost-efficient approaches in different contexts. Also need to assess the underlying

factors that may affect the nutritional status of a child.

Gaps Bridge by the Present Study

There is a considerable body of research indicating that different types of nutritional

interventions can be effective in improving the nutritional status of malnourished children.

Ready-to-use supplementary foods (RUSFs) and lipid-based nutrient supplements (LNS) have

been shown to significantly improve weight gain, height gain, and mid-upper arm circumference

(MUAC) in children with acute malnutrition. A review of traditional feeding programs found

that they can be effective in improving the nutritional status of malnourished children, especially

when combined with other interventions such as micronutrient supplementation and health

education.

There is evidence to suggest that food supplement and traditional feeding programs can

and cannot be effective in improving the nutritional status of malnourished children. However,

the effectiveness of these interventions may depend on factors such as the specific program

design, the availability and accessibility of nutritious foods, and the underlying causes of

malnutrition in the population being targeted. This is the gap in the pool of knowledge which the

present study hopes to have bridged.

Conceptual Framework

This conceptual framework shows the independent and dependent variables of the study.

The researcher will conduct interview schedule to the chosen population. The effectiveness of

traditional feeding program and complementary food supplement can be influenced by various

factors, including the demographic profile of the respondents. In this study, the independent

variables are the respondents' demographic profile in terms of age, sex, nutritional status, and
number of children in the family, while the dependent variable is the effectiveness of traditional

feeding program and complementary food supplement.

Independent variable Dependent variable

Respondents demographic
Effectiveness of Traditional Feeing
profile in terms of:
Program and complementary food

a. Age supplement intervention among

b. Sex malnourished children age 2-5

c. Nutritional status years old in Valencia, Virac,

Catanduanes
d. No. of children in the

family

Figure 1. The schematic diagram of the Independent and Dependent Variables of the
study
 Chapter 3

RESEARCH DESIGN AND METHODOLOGY

This chapter presents the methodology used to conduct a case study and comparative

study that aimed to compare the traditional and community-based complementary food

supplement programs. The chapter includes a case study design to evaluate the reaction of the

parents on the impacts of different nutritional interventions. It also includes the explanation of

the research design, sample selection, data collection methods, and data analysis procedures.
Research Design

The research design used in this study is a case study and comparative design. The study

aims to compare two different nutritional interventions which are traditional feeding program

and community-based complementary food supplement. The researchers want to compare two

interventions to determine their similarities, differences and effectiveness. Researchers choose

comparative and case study type of design to investigate the effects of two different types of

treatments, interventions, or programs related to nutrition and to assess the parents rection

towards these programs.

Sources of Data

The primary sources of data will be taken from responses of three (3) parents with

identified severely wasted children who receives both traditional feeing and food supplement

treatment. Secondary information will be collected from Brgy. Health Center of Valencia, Virac,

Catanduanes to be used in the documentary analysis.

Instrumentation and Validation

This study will utilize an interview schedule to gather data from the respondents. The

questionnaire is composed of questions that will answer those questions in the statement of the

problem. In formulating the questions, the researchers made use of close-ended structured

questions so that they will be understood clearly by the respondents. The researchers will also

ask for help and assistance of the adviser to check the appropriateness and coherence of the

survey questionnaire and checklists.

Data Gathering Procedure

The data for this study was collected using a survey or checklist and interview

questionnaire to collect more in-depth and detailed data from the participant. Before the actual

gathering of data, the researchers will seek written permission form the school head and a letter

addressed to the research adviser to gather the data needed in the study. The researchers will also

address a letter to barangay chairman and to the kagawad on health in-charge to gather the data

needed such as the list of identified malnourished children in the community. The existing

documents data for this study was also collected from the institution or office that are aligned to

the study to conduct a documentary analysis. After retrieving the data, the survey questionnaire

was distributed to the participant personally.

Sampling Procedure

The target population for this study was the parents with identified malnourished children

who experienced the two different nutritional interventions. A purposive sampling technique was

used to select individuals or participants from a population competent on a specific purpose or

criterion. Homogeneous sampling type of purposive technique was used to select individuals

who have similar characteristics or experiences to provide a focused perspective on the research

question.

Statistical Treatment of Data

The data that will be gathered will be analyzed through the following statistical tools.

Frequency Count- used to get the total number of the level of effectiveness of two different

interventions.
Average Mean- will be used to get the total values as well the answers gathered from the

participants response.

Pearson R- will be used to determine the relationship between the traditional feeding program

and food supplement intervention. The coefficient can range from -1 to +1, with -1 indicating a

perfect negative correlation, +1 indicating a perfect positive correlation, and 0 indicating no

correlation at all.

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Christian, P., Shaikh, S., Shamim, A. A., Mehra, S., Wu, L., Mitra, M., Ali, H., Merrill,

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Faruque, A. S. G., Gernand, A. D., Schulze, K. J., Ahmed, T., & West, K. P. Jr. (2015). Effect of
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Food and Nutrition Research Institute. (2019). 2018 National nutrition survey: Key

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Panganiban, L. C., Borlaza, L. J., & Tan, K. C. (2016). Malnutrition in the Philippines:

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Roberts et al. (2022). Iron and Various Micronutrient Supplements Benefit Cognition in

Undernourished Preschool-Aged Children: A Randomized Controlled Trial.

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Ok-Jin Park et al. (2009). Effects of Nutrition Education and Dietary Improvement on

Anemia, Growth and Dietary Intakes of Rural Korean Children: A Controlled Trial.

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interventions for preventing and treating malnutrition in children.

QUESTIONNAIRE

Introduction: The following survey is designed to assess the reaction of parents with identified
malnourished children aged 2-5 years old on the level of effectiveness of the government
nutritional interventions such as Traditional feeding program and Complementary food
supplement program. Your honest and accurate answers will help in the assessment of the
effectiveness of these programs and the improvement of the nutritional status of children in the
community.

I. Demographic Information:

Name of parent or guardian:

Age:
Gender:
Occupation:
Monthly income:
Number of Children:
Educational attainment:
o Primary level
o Secondary level
o Tertiary/College level
o College Graduate
o Others (please specify)
II. Child's Information:

Name of child:
Age:
Gender:
Height:
Weight:
Nutritional status (based on BMI-for-age):

III. Traditional Feeding and Complementary Food Supplement Program:

1. How long has your child been enrolled in the traditional feeding program?
2. How frequently does your child attend the traditional feeding program?
3. How satisfied are you with the traditional feeding program? (1-5, with 1 being very
dissatisfied and 5 being very satisfied)
4. How effective do you think the traditional feeding program has been in addressing your
child's malnutrition? (1-5, with 1 being not effective at all and 5 being very effective)
5. What improvements, if any, would you suggest for the traditional feeding program?
6. How long has your child been receiving the complementary food supplement program?
7. How frequently does your child receive the complementary food supplement?
8. How satisfied are you with the complementary food supplement program? (1-5, with 1
being very dissatisfied and 5 being very satisfied)
9. How effective do you think the complementary food supplement program has been in
addressing your child's malnutrition? (1-5, with 1 being not effective at all and 5 being
very effective)
10. What improvements, if any, would you suggest for the complementary food supplement
program?
11. In your opinion, which program has been more effective in addressing your child's
malnutrition? (1-5, with 1 being the traditional feeding program and 5 being the
complementary food supplement program)
12. What factors, if any, have contributed to the effectiveness or ineffectiveness of the
programs?
13. How likely are you to continue participating in the traditional feeding program and/or
complementary food supplement program in the future? (1-5, with 1 being very unlikely
and 5 being very likely)
14. Can you tell us about your child's eating habits?
15. How often does your child consume fruits and vegetables?
16. What type of food do you usually give to your child?
17. Have you ever faced any difficulty in feeding your child? If yes, can you please explain?
18. How often do you give your child snacks or processed food?
19. What kind of milk does your child drink? How often?
20. Can you tell us about your child's physical activity level?
21. What do you think are the main reasons for your child's malnourishment?
22. Have you ever received any nutritional counseling or education for your child? If yes, can
you please share your experience?
23. How often do you take your child for medical checkups? Have you ever discussed your
child's nutritional status with the doctor?