AbstractThe government of Serdang Bedagai Regency initiated a supplementation program to reduce the high prevalence of stunting in the area by delivering extra supplementation, which were nutritious biscuits from national government and fish-based supplement produced from local resources. A 6-month study from April 2022 to September 2022 was conducted to monitor and evaluate the government program that involved 219 under-5-year-old children with height-for-age Z-score (HAZ-score) below − 2.

摘要Serdang-Bedagai县政府启动了一项补充计划，通过提供额外的补充来减少该地区发育迟缓的高流行率，这些补充是国家政府提供的营养饼干和当地资源生产的鱼类补充剂。从2022年4月到2022年9月进行了一项为期6个月的研究，以监测和评估政府计划，该计划涉及219名5岁以下儿童，其身高与年龄的Z分数（HAZ分数）低于- 2

We observed the stunting prevalence reduction by 37.00%, where 81 children recovered from stunting (HAZ-score ≥ − 2). Furthermore, the mean HAZ-score and WHZ-score (Weight-for-Height Z-score) were monitored to significantly improve by 0.97 ± 1.45 (P-value = 1.74e−14) and 1.00 ± 2.18 (P-value  = and 2.40e−8), subsequently.

我们观察到发育迟缓患病率降低了37.00%，其中81名儿童从发育迟缓中恢复（HAZ评分 ≥ − 2） 。此外，监测平均HAZ评分和WHZ评分（身高体重Z评分）显着提高0.97 ± 1.45（P值 = 1.74e-14）和1.00 ± 2.18（P值 = 和2.40e-8），随后。

The most significant improvement in HAZ-score was monitored among children receiving fish-based supplements with 1.04 ± 1.44 improvement (P-value = 6.59e−17). Then, a significant WHZ-score improvement was reported from children consuming fish-based supplements and a combination of fish-based supplements with nutritious biscuits (P-value = 2.32e−8 and 5.48e−5) by 1.04 ± 2.29 and 0.83 ± 1.84, respectively.

在接受鱼类补充剂的儿童中，HAZ评分的改善最为显着，为1.04 ± 1.44改进（P值 = 6.59e-17）。然后，据报道，食用鱼基补充剂以及鱼基补充剂与营养饼干相结合的儿童的WHZ得分显着提高（P值 = 2.32e-8和5.48e-5）乘以1.04 ± 2.29和0.83 ± 分别为1.84。

The results of the observation become evidence that the program could effectively reduce the prevalence of stunting in children below five years old, especially among children who received locally produced fish-based supplements..

观察结果证明，该计划可以有效降低5岁以下儿童的发育迟缓患病率，尤其是在接受当地生产的鱼类补充剂的儿童中。。

IntroductionCurrently, stunting remains a significant health burden in developing countries. The World Health Organization (WHO) reported that the global prevalence of stunting was nearly the same percentage in the Asia–Pacific region, amounting to 22.0% in 20201,2. In 2021, the prevalence of stunting in Indonesia was approximately 24.4%, with almost one-quarter of the affected individuals being children under five years-old3.The Ministry of Health of Indonesia has implemented a nationwide program to eliminate stunting.

引言目前，发育迟缓仍然是发展中国家的重大健康负担。世界卫生组织（WHO）报告称，亚太地区发育迟缓的全球患病率几乎相同，20201年达到22.0%，2。2021年，印度尼西亚发育迟缓的患病率约为24.4%，几乎四分之一的受影响个体是五岁以下的儿童3。印度尼西亚卫生部实施了一项全国性的消除发育迟缓计划。

This endeavor encompasses the provision of supplementary nutrition in the form of biscuits enriched with essential nutrients. The Supplementary Feeding Program (SFP), which offers biscuits for Indonesian children, is implemented to address nutritional disorders during their growth period. The biscuits are administered periodically to children aged 6 to 59 months as participants in the programs.

这项努力包括以富含必需营养素的饼干的形式提供补充营养。为印尼儿童提供饼干的补充喂养计划（SFP）旨在解决儿童生长期间的营养障碍。这些饼干定期发放给6至59个月大的儿童作为项目参与者。

The participants were provided with twelve pieces of biscuits or three packs per day a week, and their nutritional status was monitored by the local community health care center or local health officers. The supplementary has been approved for nationwide implementation and each implementation will last for a duration of 90 consecutive days4.A stunting reduction program is also intensively conducted in a newly established regency, Serdang Bedagai Regency in North Sumatera Province, Indonesia, by the local government of the regency due to the high prevalence of stunting in the area.

参与者每周每天被提供十二块饼干或三包饼干，他们的营养状况由当地社区卫生保健中心或当地卫生官员监测。该补充方案已被批准在全国范围内实施，每次实施将持续90天4。由于该地区发育迟缓的普遍性，该县地方政府还在印尼北苏门答腊省新成立的Serdang Bedagai县密集开展了一项减少发育迟缓的计划。

The program is one of the priority programs under regent command due to the high prevalence of stunting in the region with up to 30.8% in 2018 and raised to 36,2% in 2019 or higher than the national average. However, the prevalence reduced to 24,4 percent in 2021 and 21.1% in 20225. Ther.

由于该地区发育迟缓的发生率很高，2018年高达30.8%，2019年提高到36.2%，或高于全国平均水平，该项目是摄政司令部的优先项目之一。然而，2021年患病率降至24.4%，20225年降至21.1%。他们。

Table 1 Characteristics of Children Population from the First Data-Validation.Full size tableThe total percentage of recruited participants with moderately stunted status in the initial observation was 54.79% (n = 120), and severely stunted was 45.21% (n = 99). Along with this, the wasting children observed in this study were 29 children (13.24%), severely wasting children were 33 children (15.07%), and the rest were normal (71.69%).

表1第一次数据验证的儿童人口特征。全尺寸表在最初的观察中，中度发育不良的招募参与者的总百分比为54.79%（n = 120），严重发育不良率为45.21%（n = 99）。除此之外，本研究中观察到的消瘦儿童为29名儿童（13.24%），严重消瘦儿童为33名儿童（15.07%），其余为正常儿童（71.69%）。

The overall mean HAZ score was − 3.26 ± 1.06, and the overall mean WHZ score was − 0.90 ± 1.74.Further, the observation revealed that during the supplementary program by the government of Serdang Bedagai Regency, the children were separated into three different categories based on the supplement they received: fish-based supplement, children supplemented with nutritious biscuits from National Supplementary Feeding Program (nutritious biscuit), and combination both of them (Table 2).

总体平均HAZ得分为-3.26 ± 1.06，总体平均WHZ得分为-0.90 ± 1.74.此外，观察结果显示，在Serdang Bedagai摄政区政府的补充计划期间，根据儿童收到的补充剂，将儿童分为三类：鱼类补充剂，补充国家补充喂养计划营养饼干（营养饼干）的儿童，以及两者的结合（表2）。

However, the number of children in each category was obviously imbalance. The children who received only fish-based supplement was the most abundant population (n = 166 children), followed by children who received combination supplement (n = 39). While the children received nutritious biscuits only was the less abundance among all categories (n = 14).

然而，每个类别的儿童数量明显不平衡。仅接受鱼类补充剂的儿童是最丰富的人群（n = 166名儿童），其次是接受联合补充剂的儿童（n = 39）。虽然孩子们只吃了营养饼干，但在所有类别中含量都较低（n = 14） 。

Nevertheless, mean HAZ score of all categories of supplementation were almost similar, which were − 3.20 ± 1.01, − 3.62 ± 1.00, and − 3.28 ± 1.20 for fish-based supplement, nutritious biscuits, and combination, respectively. The group that received fish-based supplementation was also monitored to own the least mean WHZ score of − 0.92 ± 1.76, while those who were in nutritious biscuits and combination recorded mean WHZ scores of − 1.69 ± 1.38 and − 1.38 ± 1.82, respectively..

然而，所有类别补充剂的平均HAZ得分几乎相似，为-3.20 ± 1.01，-3.62 ± 1.00和-3.28 ± 1.20鱼基补充剂，营养饼干和组合。还监测了接受鱼类补充剂的组的平均WHZ得分最低，为-0.92 ± 1.76，而那些吃营养饼干和组合饼干的人的平均WHZ得分为-1.69 ± 1.38和-1.38 ± 分别为1.82。。

Table 2 The Measurement Based on The First Observation.Full size tableFollowing the six-month supplementary program from the local government of Serdang Bedagai Regency, the mean height of children in this study noticeably increased by 8.10 ± 5.19 cm (P-value  = 2.67e−19) to 87.17 ± 8.60. The mean weight of children also significantly increased by 2.65 ± 1.97 kg (P-value  = 1.10e−25) to 12.15 ± 2.54 (Table 3)..

表2基于第一次观察的测量。全尺寸桌子经过Serdang Bedagai地方政府为期六个月的补充计划，本研究中儿童的平均身高明显增加了8.10 ± 5.19厘米（P值 = 2.67e-19）至87.17 ± 八点六零。儿童的平均体重也显着增加了2.65 ± 1.97千克（P值 = 1.10e-25）至12.15 ± 2.54（表3）。。

Table 3 Measurement after Six-month of Supplementation.Full size tableIn addition, Fig. 3 revealed that the proportion of children who had an initial stunted status (HAZ < − 2) and recovered to a normal status (HAZ > − 2) by the final observation period was 37.00% (n = 81), and 14.16% (n = 31) of the children were depicted to improve the status from severely stunted (HAZ > − 3) to moderately stunted (− 3 < HAZ < − 2).

表3补充六个月后的测量。全尺寸表此外，图3显示，最初发育不良的儿童比例（HAZ < − 2） 并恢复到正常状态（HAZ > − 2） 到最后的观察期为37.00%（n = 81）和14.16%（n = 31）的儿童被描述为改善严重发育不良（HAZ）的状况 > − 3） 中度发育不良（-） 3 < HAZ公司 < − 2） 。

Mean HAZ score was also observed to improve significantly with an overall of − 2.29 ± 1.46 or gained about 0.97 ± 1.45 (P-value  = 2.40e−8) in the span of six months (Table 4). Besides, the mean WHZ-score also obviously improved by 1.00 ± 2.18 (P-value  = 2.40e−8) to − 0.10 ± 1.91. The number of wasted children also reduced to only 13.24% (n = 29) from previously 28.31% (n = 62).Figure 3The progress after 6 months supplementary program.

还观察到平均HAZ评分显着改善，总体为- 2.29 ± 1.46或增加约0.97 ± 1.45（P值 = 2.40e-8）在六个月的时间内（表4）。此外，平均WHZ得分也明显提高了1.00 ± 2.18（P值 = 2.40e-8）至- 0.10 ± 一点九一。浪费儿童的数量也减少到只有13.24%（n = 29）比以前的28.31%（n = 62）。图3 6个月补充计划后的进展。

The graph indicated that the program gained the recovered rate of 37% and improve the status of children by 14.2%. The improved means that the children with HAZ-score of under − 3 and passed it to − 3 < HAZ < 2.Full size imageTable 4 Mean Growth Improvement after Six-month Intervention Programs.Full size tableFurther, Table 5 shows that the children who received supplementation displayed small different mean HAZ scores between categories of supplementation, which were − 2.18 ± 1.49, − 2.92 ± 1.29, and − 2.55 ± 1.31 for fish-based supplement, nutritious biscuits, and combination, respectively.

图表显示，该计划的恢复率为37%，儿童状况改善了14.2%。改进后的方法是，HAZ得分低于-3的儿童通过了-3 < HAZ公司 < 2.Full-size imageTable 4六个月干预计划后的平均生长改善。全尺寸表此外，表5显示，接受补充剂的儿童在补充剂类别之间显示出较小的平均HAZ得分差异，即- 2.18 ± 1.49，- 2.92 ± 1.29和- 2.55 ± 鱼基补充剂，营养饼干和组合分别为1.31。

Furthermore, the group that received fish-based supplementation was also, once again, monitored to own the lowest mean WHZ score by 0.05 ± 1.84 and become the only group that passed a positive value (above WHZ-score 0). Children received nutritious biscuits and combination recorded mean WHZ score of − 0.82 ± 1.41 and − 0.48 ± 1.30..

此外，还再次监测了接受鱼类补充剂的组，其平均WHZ得分最低为0.05 ± 1.84，成为唯一通过正值（WHZ得分0以上）的组。儿童接受了营养饼干，组合记录的平均WHZ得分为- 0.82 ± 1.41和- 0.48 ± 一点三零。。

Table 5 Measurement after Six-month of Supplementation from Local Government of Serdang Bedagai regency.Full size tableTable 6 depicts the growth improvement in height and weight, respectively, among the participants of each supplementary group. The results from both tables indicate that the children’s growth improvement in height and weight was greater in the children who consumed fish-based supplementation, but the difference was not significant (P-value = 0.172 and 0.125 for height and weight, respectively).

表5 Serdang Bedagai县地方政府补充六个月后的测量结果。全尺寸表表6分别描述了每个补充组参与者的身高和体重的增长改善。两个表的结果都表明，食用鱼类补充剂的儿童身高和体重的增长改善更大，但差异不显着（P值 = 身高和体重分别为0.172和0.125）。

The gender also seemed not to affect to the difference in growth improvement both height and weight for all supplementary groups (P-value ≥ 0.05)..

性别似乎也不影响所有补充组的身高和体重的生长改善差异（P值 ≥ 0.05）。。

Table 6 Comparison of The Growth Improvement in Height and Weight between Gender for Each Group of Supplementation from Local Government of Serdang Bedagai Regency.Full size tableFurther, Table 7 describes the results of the paired t-test to test the significant improvement of mean HAZ-score and mean WHZ-score variables within each category of supplementation.

表6 Serdang Bedagai县地方政府提供的每组补充剂的身高和体重增长改善情况的性别比较。全尺寸表此外，表7描述了配对t检验的结果，以测试每种补充剂中平均HAZ评分和平均WHZ评分变量的显着改善。

The significant improvement of mean HAZ-score was monitored only among children supplemented by fish-based supplement (P-value = 6.59e−17) with an improvement of 1.04 ± 1.44. The other two supplementations showed insignificantly different between mean HAZ-score from the initial and final observation (P-value > 0.05).

仅在补充鱼类补充剂的儿童中监测到平均HAZ评分的显着改善（P值 = 6.59e-17），改进了1.04 ± 一点四四。其他两种补充剂的平均HAZ评分与初始和最终观察结果无显着差异（P值 > 0.05）。

A significant improvement in the mean WHZ-score was also recorded by children consuming fish-based supplements (P-value = 2.32e−08) with an improvement of about 1.04 ± 2.29. Mean WHZ-score improvement (0.83 ± 1.84) also monitored from children obtaining combination supplement (P-value = 5.48e−05)..

食用鱼类补充剂的儿童的平均WHZ得分也有显著改善（P值 = 2.32e-08），改进约1.04 ± 二点二九。平均WHZ得分提高（0.83 ± 1.84）也从获得联合补充剂的儿童中进行监测（P值 = 5.48e-05）。。

Table 7 The Improvement Mean of HAZ-score, and WHZ-score after Six-month Intervention Programs (initial vs final observation).Full size tableMeanwhile, Table 8 describes the results of one-way ANOVA to test the significant difference in changes of several anthropometric variables within different groups of supplementation.

表7六个月干预计划（初始与最终观察）后HAZ评分和WHZ评分的改善平均值。全尺寸表同时，表8描述了单向方差分析的结果，以测试不同补充组中几个人体测量变量变化的显着差异。

Using a significant level of 5% again, the tests show that there were no significant mean differences in heigh improvement (P-value  = 0.172) and weight improvement (P-value  = 0.125) within the three groups of supplementation for all participants..

再次使用5%的显着水平，测试表明身高改善没有显着的平均差异（P值 = 0.172）和体重改善（P值 = 0.125）在所有参与者的三组补充剂中。。

Table 8 The comparison of the improvement of mean of height and weight after six-month intervention programs between categories of supplementation.Full size tableFinally, Fig. 4A indicated that the mean HAZ-score and mean WHZ-score in age group of 0–24 months responded differently. The majority improvement in HAZ-score up to more than 2 was reached by age group of 24–60 months children with about 29.3%, compared to the group of children of 0–24 months with 16.7%.

表8补充类别之间六个月干预计划后身高和体重平均改善的比较。全尺寸表最后，图4A表明，0-24个月年龄组的平均HAZ评分和平均WHZ评分反应不同。24-60个月年龄组儿童的HAZ评分提高了约29.3%，而0-24个月年龄组儿童的HAZ评分提高了16.7%。

Comparatively, the children aged 0–24 months tended to reach mean HAZ-score improvement at around 1–2 points. Nevertheless, the most of children population underwent mean HAZ-score improvement of under 1 point with 62.5% and 53.3% for 0–24-month and 24–60-month children. In contrast, the highest percentage of mean WHZ-score improvement of more than 2 points was occupied by age group of 0–24 months at 36.0%, while a group of 24–60 months was at 31.9% (Fig. 4B).

相比之下，0-24个月大的儿童倾向于在1-2分左右达到平均HAZ评分改善。然而，大多数儿童的HAZ评分平均改善不到1分，0-24个月和24-60个月的儿童分别为62.5%和53.3%。相比之下，0-24个月年龄组的平均WHZ评分提高超过2分的百分比最高，为36.0%，而24-60个月年龄组为31.9%（图4B）。

As mentioned above, the majority of children only improve their WHZ-score by less than 1 for all age groups.Figure 4Mean HAZ-score (A) & mean WHZ-score (B) improvement per age group.Full size imageDiscussionThis study provides evidence that the 6-month supplementation program significantly improved the prevalence of stunting in under-5-year-old children in Serdang Bedagai Regency, a newly established Regency in North Sumatra.

如上所述，对于所有年龄组，大多数儿童的WHZ得分仅提高不到1。图4每个年龄组的平均HAZ评分（A）和平均WHZ评分（B）改善。全尺寸图像讨论本研究提供的证据表明，为期6个月的补充计划显着改善了北苏门答腊新成立的Serdang Bedagai县5岁以下儿童发育迟缓的患病率。

The one-semester supplementation program initiated by the local government effectively helped the children suffering from stunting to recover, or at least, to improve the condition. The effective improvement was reflected in the improvement of mean HAZ-score and WHZ-score, particularly for children receiving fish-based supplements.In a study from Jannat et al.12, the supplementation using yogurt in Dhaka found no significance in the .

当地政府发起的为期一个学期的补充计划有效地帮助了发育迟缓的儿童恢复，或者至少改善了状况。有效的改善反映在平均HAZ评分和WHZ评分的改善上，特别是对于接受鱼类补充剂的儿童。在Jannat等[12]的一项研究中，达卡使用酸奶的补充剂没有发现任何意义。

AbbreviationsHAZ-score:

缩写HAZ评分：

Height-for-age Z-score

年龄身高Z分数

WHZ-score:

WHZ-score:

Weight-for-height Z-score

身高体重Z分数

WHO:

谁：

World Health Organization

世界卫生组织

SFP:

SFP：

Supplementary Feeding Program (program from national government)

补充喂养计划（国家政府计划）

BPS:

BPS：

Statistics Indonesia: Indonesian Central Bureau of Statistics

印尼统计局：印尼中央统计局

DBMS:

数据库管理系统：

Database Management System

数据库管理系统

BDSRC:

BDSRC公司：

Data Science Research Center (Bina Nusantara University)

数据科学研究中心（比纳·努桑塔拉大学）

StuntingDB:

令人惊叹的DB：

Database management system (DBMS) to manage stunted children’s data

数据库管理系统（DBMS）管理发育不良儿童的数据

N:

编号：

Number of samples

样本数量

BMI:

体重指数：

Body Mass Index

体重指数

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Download referencesAuthor informationAuthor notesThese authors contributed equally: Bens Pardamean and Rudi Nirwantono.Authors and AffiliationsBioinformatics and Data Science Research Center, Bina Nusantara University, Jakarta, IndonesiaBens Pardamean, Rudi Nirwantono, Alam Ahmad Hidayat, Joko Pebrianto Trinugroho, Mahmud Isnan, Reza Rahutomo, Digdo Sudigyo, Faisal Asadi, Gregorius Natanael Elwireharja & Dedy AriansyahDepartment of Health of Serdang Bedagai Regency, Sei Rampah, IndonesiaRatna Sari & Roma Dame Uli PasaribuSchool of Pharmacy, Bandung Institute of Technology, Bandung, IndonesiaGuntur BerlianDepartment of Pharmacology and Therapeutic, Faculty of Medicine, Universitas Sumatera Utara, Medan, IndonesiaMuhammad IchwanDepartment of Obstetic and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, IndonesiaSarma Nursani LumbanrajaAuthorsBens PardameanView author publicationsYou can also search for this author in.

下载参考文献作者信息作者注意到这些作者做出了同样的贡献：Bens Pardamean和Rudi Nirwantono。作者和附属机构比纳·努桑塔拉大学信息与数据科学研究中心，雅加达，印度尼西亚亚本斯·帕尔达梅恩，鲁迪·尼尔旺托诺，阿拉姆·艾哈迈德·希达亚特，佐科·佩布里安托·特里努格罗霍，马哈茂德·伊斯南，雷扎·拉胡托莫，迪格多·苏迪吉奥，费萨尔·阿萨迪，格雷戈里乌斯·纳塔尼尔·埃尔维雷哈亚和黛迪·阿里安西亚，印尼万隆理工学院，塞伊·兰巴，印尼萨里和罗马达姆·乌利·帕萨里布药学院，万隆，印尼万隆Ur BerlianDepartment of Pharmacology and Therapy，Faculty of Medicine，Universitas Sumatera Utara，Medan，IndonesiaHammad Ichwand Department of Obstetic and妇科，Universitas Sumatera Utara，Medan，IndonesiaArma Nursani LumbanrajaAuthorsBens Pardamenview author Publications您也可以在中搜索这位作者。

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PubMed Google ScholarContributionsConceptualization, B.P.; methodology, R.R., R.N., A.A.H., G.N.E., F.A., and D.A.; data acquisition, R.R and M.I.; data curation, R.S., and R.D.U.P.; data analysis, A.A.H., R.N., G.N.E., and M.I.; investigation, J.P.T., D.A., R.N., and G.B.; writing-original draft preparation, B.P., R.N., A.A.H., J.P.T., R.R., M.I., D.S., F.A., G.N.E., D.A., R.S., R.D.U.P, G.B., M.I., and S.N.L.; supervision, B.P., R.R., and S.N.L.; project administration, B.P., M.I.

PubMed谷歌学术贡献概念化，B.P。；方法论，R.R.，R.N.，A.A.H.，G.N.E.，F.A。和D.A。；数据采集，R.R和M.I。；数据管理，R.S。和R.D.U.P。；数据分析，A.A.H.，R.N.，G.N.E。和M.I。；调查，J.P.T.，D.A.，R.N。和G.B。；撰写原始草案准备，B.P.，R.N.，A.A.H.，J.P.T.，R.R.，M.I.，D.S.，F.A.，G.N.E.，D.A.，R.S.，R.D.U.P.，G.B.，M.I.，和S.N.L。；监督，B.P.，R.R。和S.N.L。；项目管理，B.P.，M.I。

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Reprints and permissionsAbout this articleCite this articlePardamean, B., Nirwantono, R., Hidayat, A.A. et al. Monitoring and evaluation of childhood stunting reduction program based on fish supplement product in North Sumatera, Indonesia.

转载和许可本文引用本文Pardamean，B.，Nirwantono，R.，Hidayat，A.A。等人，印度尼西亚北苏门答腊省基于鱼类补充剂产品的儿童发育迟缓减少计划的监测和评估。

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