Abstract A report is presented on the preliminary findings based on a larger ongoing research pro... more Abstract A report is presented on the preliminary findings based on a larger ongoing research project (Effectiveness of Locally Produced Ready-to-Use Foods (Part I) and Home-Based Foods (HBF) Fortified with Micronutrient Powder (Part II) for Wasted Children in ...
Background. Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for... more Background. Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for rehabilitation of moderately and mildly wasted (weight-for-height z-score ≥-3 to <-1.5 SD) children on Nias Island, Indonesia. Daily programs were performed in semiurban settings, and weekly programs took place in rural areas. Objective. To analyze the cost of daily and weekly distribution and supervision of RUF-Nias biscuit programs. Methods. The costs of the daily and weekly programs were derived from the financial report and interviews with program implementers and participating households. Costs were calculated on the basis of total rehabilitation costs per child per day required to achieve a target weight-for-height z-score ≥-1.5 SD in daily and weekly programs. Results. Institutional costs to the implementing organization were similar for both programs (approximately US$4 per child per day). The daily programs resulted in a significantly higher proportion of recovered children (78.6% vs. 65.4%) and higher weight gain (3.7 vs. 2.2 g/kg/day) than the weekly programs. About 6% to 7% of the total cost of the programs was accounted for by locally produced RUF-Nias biscuits. The social cost borne by the community for the weekly programs was about half that for the daily programs. Conclusions. The daily programs achieved better results for the implementing organization than the weekly programs; however, the weekly programs were preferred by the community because of the lower time constraints and the lower opportunity cost of time. The willingness of community and household members to invest their time in more intensive activities in the daily programs led to better program outcomes.
To assess the impact of intensive nutrition education (INE) with or without the provision of micr... more To assess the impact of intensive nutrition education (INE) with or without the provision of micronutrient powder (MNP) on the nutritional status of mildly wasted children in Nias, Indonesia, two groups of mildly wasted (>=-1.5 to <-1.0 WHZ) children aged >=6 to <60 months in the Church World Service (CWS) project areas were assigned by village randomization to receive INE (n=64) or INE+MNP (n=51) in a weekly program. Another two groups of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to receive a monthly non-intensive nutrition education program (NNE) with or without MNP (n=50 both respectively). WHZ, weight, height, haemoglobin (Hb) level, and morbidity data were assessed at admission, during the study, and at individual discharge. Children's weight gain (g/kg body weight/day) was highest in INE+MNP group (2.2±2.1), followed by INE (1.1±0.9), NNE+MNP (0.3±0.5) and NNE (0.3±0.4) group. In both MNP intervention...
Ready-to-Use Foods (RUFs) in the form of fortified cereal/nut/legume-based biscuits (±500 kcal an... more Ready-to-Use Foods (RUFs) in the form of fortified cereal/nut/legume-based biscuits (±500 kcal and 8-10% protein per 100 g) were tested among mildly wasted children from October 2007 to June 2008, and were labelled as RUF-Nias biscuits. This study reports on a comparison of supplementary feeding program outcomes of mildly wasted children with weight-for-height z-score (WHZ) >=-2 to <-1.5 SD aged >=6 to <60 months old given locally produced RUF-Nias biscuits within daily (in semi-urban areas) and weekly (in rural remote regions) distribution and supervision program settings. In the Church World Service project area, all eligible children were recruited continuously from monthly community-based screening programs and admitted into existing nutrition centers managed by the community on Nias Island, Indonesia. Individual discharge criterion of the programs was WHZ >=-1.5 SD. Of the index children admitted in daily programs (n=51), 80.4% reached target WHZ, which was highe...
Treatment effects of fortified ready-to-use foods for moderately to mildly wasted children are la... more Treatment effects of fortified ready-to-use foods for moderately to mildly wasted children are largely unknown. Two nutritionally comparable forms of locally produced ready-to-use foods for daily feeding programmes of moderately to mildly wasted children (weight-for-height Z-score/WHZ>=-3 to <-1.5SD) were assessed on Nias, Indonesia. The frequencies of reaching target WHZ>=-1.5SD, compliance to the ready-touse food programme, and weight gain until recovery or programme closure among children treated with peanut/ milk-based spreads (n=29) were compared among children receiving cereal/nut/legume-based biscuits (n=44) and a second group treated with cereal/nut/legume-based biscuits whose mothers received intensive nutrition education (n=38). Children in the cereal/nut/legume-based biscuits groups were younger (31 and 33 vs 39 months, p=0.004) and more likely to be moderately wasted (45 and 39 vs 21% with WHZ<-2, p=0.114) at admission, but had a higher rate in recovery (84 a...
Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for rehabilitat... more Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for rehabilitation of moderately and mildly wasted (weight-for-height z-score > or = -3 to < -1.5 SD) children on Nias Island, Indonesia. Daily programs were performed in semiurban settings, and weekly programs took place in rural areas. To analyze the cost of daily and weekly distribution and supervision of RUF-Nias biscuit programs. The costs of the daily and weekly programs were derived from the financial report and interviews with program implementers and participating households. Costs were calculated on the basis of total rehabilitation costs per child per day required to achieve a target weight-for-height z-score > or = -1.5 SD in daily and weekly programs. Institutional costs to the implementing organization were similar for both programs (approximately US $4 per child per day). The daily programs resulted in a significantly higher proportion of recovered children (78.6% vs. 65.4%) and...
Inappropriate nutrition knowledge and feeding practices of caregivers are among several important... more Inappropriate nutrition knowledge and feeding practices of caregivers are among several important causes of persistent malnutrition problems in young children. Thus, it is essential to provide caregivers with the necessary knowledge to help them modify their feeding practices. To examine the effectiveness of two different nutrition education methods, weekly intensive nutrition education (INE) and monthly nonintensive nutrition education (NNE), designed for caregivers of mildly wasted children (weight-for-height z-score ≥ -1.5 to < -1) aged ≥ 6 to < 60 months on Nias Island, Indonesia. To assess the impact of the two different nutrition education approaches on nutrition knowledge and practice of caregivers with their children, respondents were assigned to receive either weekly INE (n=114) or monthly NNE (n=96). The knowledge and practice levels of the mothers in each group were assessed and compared using a pretested validated questionnaire at admission and after the interventi...
This study reports the outcomes of daily (semi-urban areas) and weekly (remote rural regions) pro... more This study reports the outcomes of daily (semi-urban areas) and weekly (remote rural regions) programs for moderately wasted children supplemented with locally produced ready-to-use foods in the form of fortified cereal/nut/legume-based biscuits on Nias Island, Indonesia (RUF-Nias biscuit). Thirty-four children in daily and twenty children in weekly programs aged ≥6 to <60 months with weight-for-height z-score (WHZ) ≥ −3 to < −2 SD were recruited (October 2007–June 2008) on Nias and admitted into existing nutrition centers in the Church World Service project area. Individual discharge criterion was WHZ ≥ −1.5 SD. Weight gain of the children in daily and weekly programs was 3.9±3.8 and 2.0±2.0 g/kg/day, respectively. A higher proportion of children in daily than weekly programs reached target WHZ (76% vs. 35%, P=0.004). Weight gain at program discharge/closure was highly predicted (R2=0.228, P<0.001) by compliance to RUF biscuits: high vs. low compliance resulted in a 1.33 (...
Disaster Prevention and Management: An International Journal, 2003
This study examines the mental health initiatives in two locations of Loluccan internally displac... more This study examines the mental health initiatives in two locations of Loluccan internally displaced persons (IDPs) in Sulawesi, Indonesia, and investigates whether those fit the local needs. The locations of IDPs are described based on observations, in‐depth interviews and dicussions with refugees and relief workers. Results showed that the Moluccan IDPs suffered from almost all short‐term mental health symptoms indicated in literature. Long‐term consequences, such as aggression, behavioural changes and family problems have been recognised among IDPs in both areas, but these could be a result of the local IDP situation rather than signs of traumatisation. Women are more at risk of developing mental health problems owing to their specific roles. Children are more at risk, because parents seem reluctant to explain the events to them. Some recommendations for services that target the social aspects of suffering and healing are presented.
SATHI (Sex Workers and Associates Training and Health Initiatives) is a small participatory actio... more SATHI (Sex Workers and Associates Training and Health Initiatives) is a small participatory action research project funded by the Royal Netherlands Embassy in Dhaka, Bangladesh, and implemented by CARE Bangladesh in close cooperation with the members of Durjoy Nari Shanga, an organization of female street based sex workers. The goal of the project is to develop proper HIV/AIDS strategies for targeting clients of female sex workers through active involvement of sex workers themselves. Combined qualitative and quantitative research shows that clients' knowledge, attitude and behaviour call for immediate interventions, which should probably first target the five major client groups: rickshaw-pullers, service employees, students, police and businessmen. Policy makers and implementers of HIV interventions need to be convinced that these are needed and feasible. The fact that lack of income is extremely important in the life of sex workers is another barrier to behavioural change. Fees and condom use decrease as the night progresses as a result of a changing 'market', probably because of the need for income. However, the largest barrier seems to be the very low status of women in Bangladesh society, particularly that of female sex workers. Violence against women, their own low self-esteem and the dominant role of men as policemen, pimps, local gangsters or clients, along with the growing number of HIVpositive people, make Bangladesh extremely vulnerable to a huge AIDS epidemic. In this chapter, results of a participatory action research project called SATHI, funded by the Royal Netherlands Embassy in Dhaka, are discussed, and a short overview of the situation in Bangladesh with regard to HIV/AIDS and prostitution is given. The background of the project, the methodology and some of the findings of the research are discussed. In the conclusion, future interventions are proposed. AIDS is posing a threat to South Asia, including Bangladesh. According to UNAIDS (1999), by the end of 1997 there were an estimated 21,000 adults and children with HIV/AIDS in Bangladesh. More detailed and updated information collected through the Bangladesh National STD/AIDS Surveillance System in mid-1998 will be published soon. The percentage of HIV-infected people among sex workers is under one per cent and among injecting drug users more than two per cent; therefore Bangladesh is still considered a lowprevalence country. However, all high-prevalence countries were once low-prevalence countries.
Abstract A report is presented on the preliminary findings based on a larger ongoing research pro... more Abstract A report is presented on the preliminary findings based on a larger ongoing research project (Effectiveness of Locally Produced Ready-to-Use Foods (Part I) and Home-Based Foods (HBF) Fortified with Micronutrient Powder (Part II) for Wasted Children in ...
Background. Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for... more Background. Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for rehabilitation of moderately and mildly wasted (weight-for-height z-score ≥-3 to <-1.5 SD) children on Nias Island, Indonesia. Daily programs were performed in semiurban settings, and weekly programs took place in rural areas. Objective. To analyze the cost of daily and weekly distribution and supervision of RUF-Nias biscuit programs. Methods. The costs of the daily and weekly programs were derived from the financial report and interviews with program implementers and participating households. Costs were calculated on the basis of total rehabilitation costs per child per day required to achieve a target weight-for-height z-score ≥-1.5 SD in daily and weekly programs. Results. Institutional costs to the implementing organization were similar for both programs (approximately US$4 per child per day). The daily programs resulted in a significantly higher proportion of recovered children (78.6% vs. 65.4%) and higher weight gain (3.7 vs. 2.2 g/kg/day) than the weekly programs. About 6% to 7% of the total cost of the programs was accounted for by locally produced RUF-Nias biscuits. The social cost borne by the community for the weekly programs was about half that for the daily programs. Conclusions. The daily programs achieved better results for the implementing organization than the weekly programs; however, the weekly programs were preferred by the community because of the lower time constraints and the lower opportunity cost of time. The willingness of community and household members to invest their time in more intensive activities in the daily programs led to better program outcomes.
To assess the impact of intensive nutrition education (INE) with or without the provision of micr... more To assess the impact of intensive nutrition education (INE) with or without the provision of micronutrient powder (MNP) on the nutritional status of mildly wasted children in Nias, Indonesia, two groups of mildly wasted (>=-1.5 to <-1.0 WHZ) children aged >=6 to <60 months in the Church World Service (CWS) project areas were assigned by village randomization to receive INE (n=64) or INE+MNP (n=51) in a weekly program. Another two groups of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to receive a monthly non-intensive nutrition education program (NNE) with or without MNP (n=50 both respectively). WHZ, weight, height, haemoglobin (Hb) level, and morbidity data were assessed at admission, during the study, and at individual discharge. Children's weight gain (g/kg body weight/day) was highest in INE+MNP group (2.2±2.1), followed by INE (1.1±0.9), NNE+MNP (0.3±0.5) and NNE (0.3±0.4) group. In both MNP intervention...
Ready-to-Use Foods (RUFs) in the form of fortified cereal/nut/legume-based biscuits (±500 kcal an... more Ready-to-Use Foods (RUFs) in the form of fortified cereal/nut/legume-based biscuits (±500 kcal and 8-10% protein per 100 g) were tested among mildly wasted children from October 2007 to June 2008, and were labelled as RUF-Nias biscuits. This study reports on a comparison of supplementary feeding program outcomes of mildly wasted children with weight-for-height z-score (WHZ) >=-2 to <-1.5 SD aged >=6 to <60 months old given locally produced RUF-Nias biscuits within daily (in semi-urban areas) and weekly (in rural remote regions) distribution and supervision program settings. In the Church World Service project area, all eligible children were recruited continuously from monthly community-based screening programs and admitted into existing nutrition centers managed by the community on Nias Island, Indonesia. Individual discharge criterion of the programs was WHZ >=-1.5 SD. Of the index children admitted in daily programs (n=51), 80.4% reached target WHZ, which was highe...
Treatment effects of fortified ready-to-use foods for moderately to mildly wasted children are la... more Treatment effects of fortified ready-to-use foods for moderately to mildly wasted children are largely unknown. Two nutritionally comparable forms of locally produced ready-to-use foods for daily feeding programmes of moderately to mildly wasted children (weight-for-height Z-score/WHZ>=-3 to <-1.5SD) were assessed on Nias, Indonesia. The frequencies of reaching target WHZ>=-1.5SD, compliance to the ready-touse food programme, and weight gain until recovery or programme closure among children treated with peanut/ milk-based spreads (n=29) were compared among children receiving cereal/nut/legume-based biscuits (n=44) and a second group treated with cereal/nut/legume-based biscuits whose mothers received intensive nutrition education (n=38). Children in the cereal/nut/legume-based biscuits groups were younger (31 and 33 vs 39 months, p=0.004) and more likely to be moderately wasted (45 and 39 vs 21% with WHZ<-2, p=0.114) at admission, but had a higher rate in recovery (84 a...
Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for rehabilitat... more Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for rehabilitation of moderately and mildly wasted (weight-for-height z-score > or = -3 to < -1.5 SD) children on Nias Island, Indonesia. Daily programs were performed in semiurban settings, and weekly programs took place in rural areas. To analyze the cost of daily and weekly distribution and supervision of RUF-Nias biscuit programs. The costs of the daily and weekly programs were derived from the financial report and interviews with program implementers and participating households. Costs were calculated on the basis of total rehabilitation costs per child per day required to achieve a target weight-for-height z-score > or = -1.5 SD in daily and weekly programs. Institutional costs to the implementing organization were similar for both programs (approximately US $4 per child per day). The daily programs resulted in a significantly higher proportion of recovered children (78.6% vs. 65.4%) and...
Inappropriate nutrition knowledge and feeding practices of caregivers are among several important... more Inappropriate nutrition knowledge and feeding practices of caregivers are among several important causes of persistent malnutrition problems in young children. Thus, it is essential to provide caregivers with the necessary knowledge to help them modify their feeding practices. To examine the effectiveness of two different nutrition education methods, weekly intensive nutrition education (INE) and monthly nonintensive nutrition education (NNE), designed for caregivers of mildly wasted children (weight-for-height z-score ≥ -1.5 to < -1) aged ≥ 6 to < 60 months on Nias Island, Indonesia. To assess the impact of the two different nutrition education approaches on nutrition knowledge and practice of caregivers with their children, respondents were assigned to receive either weekly INE (n=114) or monthly NNE (n=96). The knowledge and practice levels of the mothers in each group were assessed and compared using a pretested validated questionnaire at admission and after the interventi...
This study reports the outcomes of daily (semi-urban areas) and weekly (remote rural regions) pro... more This study reports the outcomes of daily (semi-urban areas) and weekly (remote rural regions) programs for moderately wasted children supplemented with locally produced ready-to-use foods in the form of fortified cereal/nut/legume-based biscuits on Nias Island, Indonesia (RUF-Nias biscuit). Thirty-four children in daily and twenty children in weekly programs aged ≥6 to <60 months with weight-for-height z-score (WHZ) ≥ −3 to < −2 SD were recruited (October 2007–June 2008) on Nias and admitted into existing nutrition centers in the Church World Service project area. Individual discharge criterion was WHZ ≥ −1.5 SD. Weight gain of the children in daily and weekly programs was 3.9±3.8 and 2.0±2.0 g/kg/day, respectively. A higher proportion of children in daily than weekly programs reached target WHZ (76% vs. 35%, P=0.004). Weight gain at program discharge/closure was highly predicted (R2=0.228, P<0.001) by compliance to RUF biscuits: high vs. low compliance resulted in a 1.33 (...
Disaster Prevention and Management: An International Journal, 2003
This study examines the mental health initiatives in two locations of Loluccan internally displac... more This study examines the mental health initiatives in two locations of Loluccan internally displaced persons (IDPs) in Sulawesi, Indonesia, and investigates whether those fit the local needs. The locations of IDPs are described based on observations, in‐depth interviews and dicussions with refugees and relief workers. Results showed that the Moluccan IDPs suffered from almost all short‐term mental health symptoms indicated in literature. Long‐term consequences, such as aggression, behavioural changes and family problems have been recognised among IDPs in both areas, but these could be a result of the local IDP situation rather than signs of traumatisation. Women are more at risk of developing mental health problems owing to their specific roles. Children are more at risk, because parents seem reluctant to explain the events to them. Some recommendations for services that target the social aspects of suffering and healing are presented.
SATHI (Sex Workers and Associates Training and Health Initiatives) is a small participatory actio... more SATHI (Sex Workers and Associates Training and Health Initiatives) is a small participatory action research project funded by the Royal Netherlands Embassy in Dhaka, Bangladesh, and implemented by CARE Bangladesh in close cooperation with the members of Durjoy Nari Shanga, an organization of female street based sex workers. The goal of the project is to develop proper HIV/AIDS strategies for targeting clients of female sex workers through active involvement of sex workers themselves. Combined qualitative and quantitative research shows that clients' knowledge, attitude and behaviour call for immediate interventions, which should probably first target the five major client groups: rickshaw-pullers, service employees, students, police and businessmen. Policy makers and implementers of HIV interventions need to be convinced that these are needed and feasible. The fact that lack of income is extremely important in the life of sex workers is another barrier to behavioural change. Fees and condom use decrease as the night progresses as a result of a changing 'market', probably because of the need for income. However, the largest barrier seems to be the very low status of women in Bangladesh society, particularly that of female sex workers. Violence against women, their own low self-esteem and the dominant role of men as policemen, pimps, local gangsters or clients, along with the growing number of HIVpositive people, make Bangladesh extremely vulnerable to a huge AIDS epidemic. In this chapter, results of a participatory action research project called SATHI, funded by the Royal Netherlands Embassy in Dhaka, are discussed, and a short overview of the situation in Bangladesh with regard to HIV/AIDS and prostitution is given. The background of the project, the methodology and some of the findings of the research are discussed. In the conclusion, future interventions are proposed. AIDS is posing a threat to South Asia, including Bangladesh. According to UNAIDS (1999), by the end of 1997 there were an estimated 21,000 adults and children with HIV/AIDS in Bangladesh. More detailed and updated information collected through the Bangladesh National STD/AIDS Surveillance System in mid-1998 will be published soon. The percentage of HIV-infected people among sex workers is under one per cent and among injecting drug users more than two per cent; therefore Bangladesh is still considered a lowprevalence country. However, all high-prevalence countries were once low-prevalence countries.
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Papers by Maurice Bloem