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Abstrak :
ABSTRACT
The study aimed to investigate the impact of 12 weeks supplementation with multi-micronutrient and iron-folate supplements on hematological status, morbidity and work productivity. Female factory workers were selected as the subjects because: high prevalence of anemia found in this group which might have health and economic consequences since anemia was related to decrease work productivity and decrease resistance to infection, and the increasing number of female workers in developing country.

A preliminary study was conducted to investigate the bioavailability of iron from a multi~micronutrient supplement compared to watery ferrous(II)-sulfate solution. In a randomized cross over design, 14 volunteers received 108 mg elemental iron as four tablets of multi-micronutrient supplements (each tablet contained 27 mg elemental iron) or as a solution of 537.60 mg Ferrous(Il)-sulfate. Serum iron concentrations were measured at 0, 2, 4, 6 and 8 hours after dosing. The maximum serum iron level was significantly lower with multi-micronutrient supplement compared to ferrous sulfate solution but the time to reach the peak" serum iron level was not significantly different between those two treatments. The median relative bioavailability of iron in multi-micronutrient supplement was 32.22%

The main study was conducted in a shoe factory, West Java. A total of 308 subjects were selected and divided randomly into three groups that respectively received multi-micronutrient (each tablet contained 27 mg elemental iron), iron-folate supplements (each tablet contained 200 mg ferrous sulfate equal to 60 mg elemental iron) and placebo. Multimicronutrient supplements and placebo were given time times per week and iron-folate supplements were given once a week. All of the supplementations were supervised and last for 12 weeks. Hematological assessed in sub sample of each group based on Willingness; making a total of 140 subjects.

Significant increments in the levels of hemoglobin, serum ferritin, and serum retinol were observed in multi-micronutrient group (0.6 g/dl, 13.44 ug/l, and 0_6 pmol/l respectively) and iron-folate group (0.3 g/dl, 11.26 ug/l, and 0.4 umolfl respectively); the increments were higher in multi-micronutrient group but not statistically different from iron-folate group. In the placebo group, hemoglobin level was decreased by 0_3 g/dl, serum ferritin was increased by 4.28 ug/1, and serum retinol was relatively constant. The prevalence of anemia and low iron status were decreased after treatment with multi-micronutrient (7% and 20.5%, respectively) or iron-folate supplements (91% and 12.8%, respectively). The anemia prevalence in placebo group was increased by 6.6% while the prevalence of low iron status was decreased by 2.5%. The morbidity was increased in all groups with the lowest increment was observed in multi-micronutrient group (65% in multi-micronutrient group compared to 14.1% in iron group and 22.4% in placebo group). The work productivity was increased by 6.3% in iron group and 3.6% in multi-micronutrient group while it was relatively constant in placebo group. In conclusion, multi-micronutrient supplement had better impact on hematological status and reducing morbidity level compared to iron-folate supplement that had better impact on work productivity.

Abstrak :
Dismenore merupakan gejala utama yang dikeluhkan wanita usia subur ketika mengalami menstruasi. Mahasiswi merupakan kelompok yang rentan menderita dismenore karena prevalensi tertinggi kejadian dismenore ditemukan pada usia 20-24 tahun. Dismenore akan berdampak pada performa akademik mahasiswa dan rutinitas hariannya. Penelitian ini bertujuan untuk mengetahui faktor determinan dismenore. Penelitian ini menggunakan disain cross sectional dengan jumlah sampel 148 orang dengan metode sistematik random sampling pada mahasisiwi Fakultas Kedokteran Universitas Andalas usia 17-25 tahun. Hasil analisis memperlihatkan ada hubungan yang signifikan antara aktivitas fisik, status gizi, asupan magnesium, dan riwayat alergi dengan dismenore pada derajat kemaknaan 5%. Terjadi interaksi antara asupan magnesium dan B6. Aktivitas fisik merupakan faktor dominan yang mempengaruhi dismenore setelah dikontrol variabel asupan omega 3, asupan B6, asupan vitamin E, asupan Zn, asupan Cu, stress, riwayat dismenore ibu, siklus menstruasi, lama menstruasi, dan laju menstruasi. Mahasiswi yang beraktivitas fisik rendah berisiko mengalami dismenore 8,8 kali dibanding yang beraktivitas fisik sedang atau tinggi (95% CI : 2,0-38,4). Aktivitas fisik khususnya olahraga merupakan salah satu alternatif yang direkomendasikan dalam mengurangi nyeri haid.

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Dysmenorrhea is the most common complained of women in reproductive age when menstruation. Female college students are vulnerable of dysmenorrhea as the highest prevalence of dysmenorrhea is found at the age of 20-24 years. Dysmenorrhea will have an impact on their academic performance and daily activities. The aim of this study was to examine determinant factors of dysmenorrhea.This study used cross-sectional design, was conducted in medical students Andalas University, with a sample of 148 female used systematic random sampling, aged between 17 and 25 years. The results showed that physical activities, body mass index, magnesium intake, and allergy was significantly associated with dysmenorrhea at significance level of 5%. There is an interaction between magnesium and vitamin B6 intake. Physical activity is a dominant factor of dysmenorrhea after controlled by intake of micronutrient (omega 3, vitamin B6, vitamin E, Zn, Cu), stress, maternal dysmenorrhea, menstrual cycle, menstrual duration and menstrual flow. Female college students who did not exercise or have lower physical activity have the risk of dysmenorrhea 8.8 times higher than who have moderate or high (95% CI : 2.0-38.4). Physical activity especially exercise is the one alternative recommended to prevent dysmenorrhea.

Abstrak :
Pada penelitian ini berhasil disintesis natrium alginat tercangkok poli akrilat-co-akrilamida yang dikompositkan dengan montmorillonite MMT , dan dengan penambahan mikronutrien berupa asam borat dan boraks ke dalam superabsorben nanokomposit dengan metode in situ dan eksitu. Kapasitas swelling optimum superabsorben nanokomposit pupuk lepas lambat asam borat dan boraks dengan metode in situ berturut ndash; turut adalah 247,030 g/g dan 515,093 g/g, sedangkan dengan metode eksitu adalah 305,421 g/g dan 455,514 g/g. Kapasitas release optimum superabsorben nanokomposit pupuk lepas lambat asam borat dan boraks dengan metode in situ berturut ndash; turut adalah 68,59 dan 72,76 , sedangkan pada metode eksitu 61,66 dan 78,08. Digunakan FTIR, SEM, TEM, XRD dan UV-Vis untuk mengkaraterisasi. Di dapatkan kapasitas release optimum mikronutrien dari superabsorben nanokomposit pupuk lepas lambat in situ pada pengujian UV-Vis untuk asam borat sebesar 2,328 ppm, sedangkan boraks sebesar 1,587 ppm. Untuk parameter laju swelling didapatkan dengan parameter laju optimum untuk superabsorben nanokomposit terhadap air, larutan asam borat, dan larutan boraks berturut-turut adalah 256,0177; 227;9296; 173;7719. Untuk parameter laju swelling didapatkan dengan parameter laju optimum untuk superabsorben nanokomposit insitu asam borat dan boraks berturut-turut adalah 241,4187; 203,9398. Orde yang didapatkan pada superabsorben nanokomposit yaitu orde-pseudo 1. ...... In this study succeeded in synthesized sodium alginate poly acrylate co acrylamide with montmorillonite MMT , and by addition of micronutrients in the form of boric acid and borax into nanocomposite superabsorbents by in situ and ex situ method. The optimum swelling capacity of superabsorbent nanocomposite of slow release of boric acid and borax by in situ method were 247.030 g g and 515,093 g g, respectively, with ex situ is 305,421 g g and 455,514 g g. The optimum release capacity of superabsorbent nanocomposite of slow release of boric acid and borax by in situ method was 68.59 and 72.76, respectively, while in the ex situ method 61.66 and 78.08. Used FTIR, SEM, TEM, XRD and UV Vis for electartizing. In obtaining the optimum release capacity of micronutrients from superabsorbent nanocomposite loose in situ fertilizers in UV Vis testing for boric acid was 2,328 ppm, while borax was 1,587 ppm. For swelling rate parameters with optimum rate parameters for superabsorbent nanocomposite to air, boric acid solution, and borax solution were 256,0177 227 9296 173 7719. For swelling rate parameters with optimum rate parameters for superabsorbent nanocomposites in situ boric acid and borax are 241,4187 203.9398. The order

Abstrak :
This randomized double-blind placebo-controlled trial aimed to compare the efficacy of daily iron supplementation and multi-micronutrient supplementation both daily and weekly basis on increasing iron status among 284 apparently healthy Indonesian infants aged 6-12 mo. Infants were randomly assigned to receive either daily 1 RDA multi micronutrient supplement (n = 72), weekly 2 RDA multi micronutrient supplement (n = 70), daily ferrous sulphate 10 mg (n = 72), or placebo (n = 70) for wk. Blood hemoglobin, plasma ferritin, plasma zinc, and plasma C-reactive protein concentrations were measured prior to intervention and after 23 wk of supplementation. At baseline, 58.1% of subjects were anemic, 28.2% were iron deficient, and 11.2% were zinc deficient. After 23 wk of supplementation, both daily 1 RDA multi micronutrient and iron supplemented groups had significantly increased blood hemoglobin and plasma ferritin concentration, furthermore reducing the percentage of anemia and iron deficiency. However, the changes of hemoglobin were not significantly different among the treatment groups. Changes of hemoglobin were significantly higher in daily 1 RDA multi micronutrient group than in placebo group when initial blood hemoglobin was low. The change of plasma ferritin concentration in both daily 1 RDA multi micronutrient and iron groups was significantly higher than in other groups. Hemoglobin and ferritin concentrations of weekly 2 RDA multi micronutrient group were not significantly increase, but there were significantly increased in the subjects with low concentration of blood hemoglobin or plasma ferritin. Proportion of infants with zinc deficiency was increased significantly in iron group Daily I RDA multi micronutrient and daily iron supplementation are efficacious in improving the concentration of blood hemoglobin and plasma ferritin and reducing the percentage of infants with anemia and iron deficiency of Indonesian infants aged 6-12 months in a rural community. However, there was an increasing proportion of infants with zinc deficiency in daily iron supplementation. The efficacy of daily 1 RDA multi micronutrient supplementation was higher among the children with blood hemoglobin < 110 g/L Efficacy of weekly 2 RDA multi micronutrient supplementation on the concentration of blood hemoglobin and plasma ferritin of all subjects was not found, but it affected in children with low concentration of blood hemoglobin or plasma ferritin.

Abstrak :
LATAR BELAKANG : Gangguan implantasi pada awal kehamilan menyebabkanIskemia plasenta dan dapat berakibat preeklamsia pada kemudian hari. Pada tahapselanjutnya iskemia plasenta menghasilkan radikal bebas dan berakibat stres oksidatif.Preeklamsia merupakan hasil dari ketidakseimbangan antara produksi radikal bebasdengan antioksidan sehingga terjadi reaksi inflamasi berlebihan pada kehamilan yangberakibat disfungsi endotel. Antioksidan dan inflamasi dalam tubuh ditentukan oleh statusgizi seseorang yang dinilai dari kadar serum ibu seperti seng, selenium, besi dan tembaga.Oleh karena itu perlu penelitian untuk menilai status gizi mikro dengan preeklamsia. TUJUAN : Diketahuinya perbedaan kadar seng, selenium, besi tembaga, danrasio tembaga seng serum maternal pada preeklamsia dibandingkan kehamilan normal. METODE : Penelitian ini merupakan studi potong lintang dengan jumlah sampel30 preeklampia dan 30 normal yang melakukan persalinan di RS Cipto Mangunkusumodan RSUD Tangerang. Pasien diambil darah untuk kemudian diproses menjadi serum danlalu diukur kadarnya. Setelah itu data disajikan dalam tabel dan dianalisis dengan uji ttidakberpasangan. Penelitian ini sudah lolos kaji etik dan mendapat persetujuanpelaksanaan dari Komite Etik Penelitian Kesehatan FKUI-RSCM. HASIL : Kadar serum seng pada preeklamsia dan normal adalah 45,03?10,84dan 41,37?10,59 ?g/dl dengan p=0,868, IK 95 3,66 -1,87-9,21 . Kadar seleniumadalah 84,93?13,67 dan 65,03?15,28 ?g/l dengan p=0,445, IK 95 19,9 12,4-27,39 .Kadar besi 115,77?49,14 dan 75,63?43,79 ?g/dl dengan p=0,409, IK 95 40,13 16,0964,17 .Kadar tembaga 219,85?45,92 dan 207,98?47,66 ?g/dl dengan p=0,73 IK 95 118,63 -123,25-360,52 dan rasio tembaga seng 5,15?1,54 dan 4,96?1,62 dengan p=0,803 1,9 IK 95 -6,25-10,06. KESIMPULAN : Terdapat perbedaan rerata kadar selenium dan besi pada preeklamsiadengan kehamilan normal namun tidak berbeda bermakna secara statistik. Tidak terdapatperbedaan rerata kadar seng, tembaga dan rasio tembaga seng pada preeklamsia dengankehamilan normal. ...... BACKGROUND: Poor implantation in early pregnancy lead to placental ischemia wasthe pathogenesis of preeclampsia. On further stage, placenta ischemia generated oxidativestress. Preeclampsia was a manifestation of the free radical and antioxidant imbalanceresulting inflammation and endothelial dysfunction. Antioxidant dan inflammation wasdetermined by nutrition status that measured in maternal serum such zinc, selenium, ironand copper. Therefore, measuring micronutritional status in preeclampsia was needed. OBJECTIVE: Investigate the mean difference of zinc, selenium, iron, copper, andcopper zinc ratio of maternal serum in preeclampsia comparing healthy pregnancy. METHOD: This was a cross sectional study enrolled 30 preeclampsia patientsand 30 healthy pregnancy visiting Cipto Mangunkusumo and Tangerang Hospital. Bloodwas withdrawed from vein for further processed. Data was presented in table and wasanalyzed by unpaired t test. This study had been granted ethical clearence and approvedby Ethical Committee for Health Research Faculty of Medicine University of IndonesiaCipto Mangunkusumo Hospital. RESULTS: The zinc maternal serum level in preeclampsia and healthypregnancy were 45.03 10.84 and 41.37 10.59 g dl, p 0.868, 95 CI 3.66 1.87 9.21 respectively. Selenium level were 84.93 13.67 and 65.03 15.28 g l, p 0.445, 95 CI19.9 12.4 27.39 . Iron level were 115.77 49.14 and 75.63 43.79 g dl, p 0.409, 95 CI40.13 16.09 64.17 . Copper level were 219.85 45.92 dan 207.98 47.66 g dl, p 0.7395 CI 118.63 123.25 360.52 and copper to zinc ratio were 5.15 1.54 and 4.96 1.62dengan p 0.803, 1.9 95 CI 6.25 10.06. CONCLUSION: Selenium and iron level in preeclampsia and healthy pregnancy weresignificantly difference. However, it was not significance statistically. Zinc, copper andcopper to zinc ratio were not significantly different.

Abstrak :
Sekitar 15-20% pasien poliklinik dan unit gawat darurat datang dengan masalah sawar kulit seperti pemfigus, toxic epidermal necrolysis (TEN), dan eritroderma. Masalah nutrisi terjadi pada penyakit sawar kulit melalui beberapa hal, yaitu kondisi hipermetabolisme sedang sampai berat, masalah pemenuhan nutrisi, kehilangan protein dari lesi kulit, dan efek samping metabolik akibat terapi steroid dosis tinggi jangka panjang. Empat pasien serial kasus dengan diagnosis pemfigus, TEN, dan eritroderma dengan masing-masing kondisi penyerta seperti gangguan hati, obesitas, DM tipe lain dan sepsis. Terapi medik gizi diberikan berdasarkan kondisi klinis, toleransi asupan, dan hasil laboratorium pasien. Target pemberian nutrisi dihitung menggunakan Harris Benedict dengan tambahan faktor stress 1,3-1,5. Diberikan nutrisi dengan komposisi seimbang, terdiri atas protein 1,32 g/kg BB ideal/hari, lemak 2530%, dan karbohidrat 4565%. Mikronutrien yang diberikan berupa vitamin B kompleks 3x1, asam folat 1x1 mg, vitamin A 12.000 IU, vitamin C 500-1000 mg, dan seng 2x20 mg. dari monitoring dan evaluasi dilaporkan bahwa pemberian mikronutrien pada penyakit sawar kulit dapat meningkatkan penyembuhan luka dan menurunkan risiko metabolik. Dari empat pasien serial kasus ini, didapatkan satu kasus mortalitas yaitu pada pasien dengan penyulit sepsis. Ketiga pasien kasus lainnya mengalami perbaikan kondisi klinis, penyembuhan luka baik, tidak ada infeksi dan komplikasi selama perawatan, kontrol glikemik baik, perbaikan kapasitas fungsional, dan lama rawat pasien lebih singkat. Ketiga pasien dipulangkan untuk rawat jalan. Terapi medik gizi yang optimal dapat memerbaiki luaran klinis serta menurunkan angka morbiditas dan mortalitas pasien pemfigus, TEN, eritroderma tanpa penyulit metabolik ......One in five to six patients at the polyclinic and emergency department present with skin barrier problems such as pemphigus, toxic epidermal necrolysis (TEN), and erythroderma. Nutritional problems occur in skin barrier disease through several things, namely moderate to severe hypermetabolic conditions, problems with nutritional compliance, loss of protein from skin lesions, and metabolic side effects due to long-term high dose steroid therapy. Three case series patients with pemphigus, TEN with hepatic complications, and erythroderma with obese nutritional status I and one case of pemphigus complicating sepsis and other types of DM. Nutritional medical therapy is given based on the clinical condition, intake tolerance, and laboratory results of the patient. The target of nutrition intake is calculated using Harris Benedict with a stress factor of 1.3-1.5, with a balanced composition, consisting of protein 1.3-2 g / kg ideal body weight / day, 25-30% fat, and 45-65% carbihydrates. The micronutrients were given in the form of 3x1 vitamin B complex, 1x1 mg folic acid, 12,000 IU vitamin A, 500-1000 mg vitamin C, and 2x20 mg zinc. Administration of micronutrients in skin barrier disease can improve wound healing and reduce metabolic risk. In four case series patients, there was one case mortality in a patient with complicated sepsis. The others had improved clinical conditions, good wound healing, no infection and complications during treatment, good glycemic control, improved functional capacity, and shorter patient length of stay. The three patients were discharged for outpatient care. Optimal nutritional medical therapy can improve clinical outcomes and reduce morbidity and mortality in patients with pemphigus, TEN, erythroderma without metabolic complications

Abstrak :
A single blind intervention study for 9 weeks was conducted in Kelurahan Cempaka Putih Barat, Center Jakarta. This was to determine the effects of micronutrient supplementation an the immune status and hand grip strength of the free-living male elderly aged 60 -75 years old. The total number of subjects at baseline study were 97 male elderly, which were then randomly assigned into 49 subjects in the supplemented group and 48 subjects in the placebo group. The percentage of T-suppresor cells of the micronutrient supplemented group increased significantly from 28.3 % to 30.7 %. The absolute counts of immune status also increased. In the micronutrient supplemented group TLC , T- cells, T -Helper cells, T-suppresor and NK-cells increased significantly after 9 week micromttrient supplementation. However compared to the placebo group only TLC ( 787.4 vs 287.0), T-cells (453.2 vs 160.3), and T- suppresor cells (183.7 vs 57.4) showed significant improvement. The hand grip strength as expressed by the lefthand, right hand and sum of both values remained similar to baseline. The serum zinc and-retinol of the supplemented group significantly increased after nine weeks micronutrient supplementation (13.7 to 18.8 umol/L and 1.10 to 1.42 umol/L, respectively). The changes of serum zinc and retinol were significantly higher in the supplemented group compared to the placebo group. The micronutrients status (serum retinol and serum Zinc) had increased in the supplemented group and lead to lower prevalence of hyporetinolemia and hypozincemia. The improvement of the immune status in the micronutrient supplemented group were not correlated with the serum retinol and zinc. However in the placebo group the change of serum retinol had negative correlation with the T-cel/, T helper and T -suppresor.

Abstrak :
This cross-sectional study was conducted on 204, 60-75 years old free-living elderly, who were randomly selected from 2 suhvillages of Johar Baru, Jakarta Pusat. The overall health, food and biochemical nutrient status of the elderly were poor. Energy intake was law and 53.9 percent of the subjects had energy intake <2/3 of the RDI. The prevalence of chronic energy deficiency (BMI < 18 .5 kg/rn2) was 26.6 percent More than 75 percent of the elderly had iron and vitamin BI intakes < 2/3 of the RDL Using WHO criteria, the overall prevalence of anemia was 28.9 percent and the elderly females were most affected than the elderly males. Low vitamin Br status (ETK stimulation X14 percent), was found in 64.4 percent of the subjects Low biochemical status of vitamins B12, and A were 8.8 and 5.4 percent, respectively. Folate status was adequate as only 2.9 percent of the elderly had low RBCfolate levels. Intakes of vitamins B, and B12 were related with their biochemical nutrient levels Diseases was a risk factor to low thiamin status but increased RBC folate. Widowhood and less than 6 years schooling were associated with low Hb and serum retina concentrations in elderly males BMI r 18.5 kg/nn was associated with low Hb and RBC folate concentrations. Subjects of household with per capita income less than Rp 41,200.00 had the highest prevalence of anemia compared with subjects of households with higher per capita income Low vitamin B12 status was associated with low Hb while serum vitamin B12 was positively associated with RBC folate.

Abstrak :
Kondisi terkini masalah gizi kurang pada ibu dan anak di tingkat global masih tinggi, termasuk di Indonesia. Sebagai respon terhadap kesehatan ibu, bayi, dan anak, World Health Organization (WHO) telah mengeluarkan rekomendasi tentang perawatan antenatal (ANC) yang telah diperbarui pada tahun 2020 dengan edisi khusus tentang suplementasi multi mikro nutrien (MMN) selama kehamilan. Penelitian ini bertujuan untuk menyelidiki pengelolaan dan penerimaan MMN bagi ibu hamil di Kabupaten Sidoarjo. Penelitian ini merupakan penelitian kualitatif menggunakan pendekatan fenomenologi yang dilakukan di Kabupaten Sidoarjo selama bulan April sampai Mei 2022. Informan penelitian ini terdiri dari 23 orang dari pemangku kepentingan terkait serta 28 orang dari penerima manfaat program. Seluruh data yang diperoleh dalam penelitian ini diinterpretasikan menggunakan template analysis. Kebijakan dan koordinasi multi-pihak terkait program MMN di Kabupaten Sidoarjo telah terbentuk dan melibatkan pemerintah kabupaten, organisasi masyarakat, universitas, puskesmas, bidan, dan kader. Produk MMN yang tersedia di Kabupaten Sidoarjo terdiri dari produk Laduni sebagai bagian dari program kabupaten yang didukung oleh organisasi masyarakat, serta produk komersial yang dijual di pasaran. Meskipun produk Laduni adalah produk impor, beberapa upaya telah dilakukan untuk mengeksplor potensi produksi dalam negeri seperti studi awal dengan universitas, diskusi dengan industri lokal, serta inisiatif untuk membagikan formulasi MMN kepada industri lokal. Mekanisme pengiriman program MMN menggunakan platform yang sudah ada yang sama dengan program tablet tambah darah (TTD) melalui layanan ANC. Penerima manfaat memiliki dukungan yang cukup luas dari suami dan orang tua, serta melalui kelas ibu hamil oleh puskesmas, dan kunjungan rumah oleh bidan dan kader. Penerima manfaat mengonsumsi produk MMN sehari sekali dan tidak ada mitos atau larangan untuk mengonsumsi produk MMN. Berdasarkan survei awal yang dilakukan oleh universitas, tidak ada perbedaan antara kepatuhan konsumsi MMN dan TTD. Namun, media komunikasi terkait MMN masih terbatas dibandingkan TTD dimana kemasan dan label MMN adalah satu-satunya media konseling. Mekanisme pemantauan dan evaluasi masih perlu ditingkatkan karena survei cakupan dan studi efektivitas masih belum tersedia. Program MMN di Kabupaten Sidoarjo telah berhasil diimplementasikan melalui koordinasi multi-pihak, meskipun media komunikasi serta mekanisme pemantauan dan evaluasi masih perlu ditingkatkan. ......Current condition of maternal and child undernutrition in the global level still remain high, including in Indonesia. In order to response maternal, infant, and child health, World Health Organization (WHO) has launched recommendations on antenatal care (ANC) which was updated in 2020 with special issue about multiple micronutrient supplements (MMS) during pregnancy. This study aimed to investigate the management and acceptance of the MMS for pregnant women in Sidoarjo District. This study was qualitative study using phenomenological approach which conducted in Sidoarjo District during April to May 2022. Informants of this study consisted of 23 people from the relevant stakeholders and 28 people from the beneficiaries. Interpretation of all collected data in this study used template analysis. Policy and multi-stakeholder coordination for MMS program in Sidoarjo District has been established and involved district government, civil society organization (CSO), university, public health center (PHC), midwife, and cadre. MMS product in Sidoarjo District consisted of Laduni product as part of the district program which supported by CSO and commercial product which sold in the marketplace. Even though the Laduni product was import product, several efforts have been conducted to explore potential domestic production such as initial study with the university, discussion with the local industry, as well as initiative to share the MMS formulation to the local industry. Delivery mechanism of MMS program used existing platform which similar with iron folic acid supplementation (IFAS) through ANC services. Beneficiaries have wide supporting system from their husband and parents, as well as pregnant woman class by PHC, and home visit by midwife and cadre to consume MMS. Beneficiaries consumed MMS product once every day and there was no myths or prohibition related to MMS consumption. Based on the initial survey of the university, there was no different between adherence of MMS consumption compared to IFAS. However, communication materials of MMS were limited compared to IFAS where MMS package and labeling was the only one counseling material. Monitoring and evaluation mechanism was necessary to be improved since the coverage survey and effectiveness study were unavailable. MMS program in Sidoarjo District has been successfully implemented through multi-stakeholder coordination, despite the communication materials as well as the monitoring and evaluation mechanism are necessary to be improved.

Abstrak :
The high prevalence of anemia and vitamin A deficiency among underfive children is related to their food intake and health status. The situation appeared worst after multiple crisis hit Indonesia in 1997/1998. To obtain factors affecting the nutritional status of children aged 1-5 years, a baseline study was conducted in DKI Jakarta, Bogor, and Tangerang in collaboration with UN-WFP. The sample size was 1337 underfive children consisting of 666 boys and 666 girls. The study showed that malnutrition among underfive children was still high which indicated the high prevalence of underweight and stunting, especially in Bogor District and Tangerang District. The micronutrient intake of vitamin A, iron, and zinc among underfive children were certainly below the Indonesian RDA. The level of poverty and the education of woman as well as husbands were two conditions that were obvious from all areas, mainly Tangerang District.