# Effectiveness of a Tiered Referral System and Early Nutritional Intervention to Prevent and Recover Stunting in Under-Five Indonesian Children
> Sjarif D.R.

URL kanonis: https://discover.unhas.ac.id/publications/effectiveness-of-a-tiered-referral-system-and-early-nutritional-intervention-to
Jurnal / Konferensi: Food Science and Nutrition
Tahun terbit: 2025
DOI: https://doi.org/10.1002/fsn3.70945
Kuartil SJR: Q1
Citations: 0

## Authors
- Sjarif D.R.

## Abstract
Stunting remains a major global malnutrition problem in children. A protocol for stunting prevention and management in Indonesia is needed to achieve the WHO's stunting reduction target by 40% in 2025. This study aimed to evaluate the effectiveness of a tiered referral system across different healthcare levels and the importance of animal proteins and food for special medical purposes (FSMP) in preventing and managing stunting in Indonesia. This one-group pre-post experimental study involved children under 5 years old from 14 regencies in Indonesia. All subjects initially received education about breastfeeding and animal proteins. Eligible subjects were then given daily animal protein (milk and/or egg) supplementation. Subjects with weight faltering, underweight, or wasting were referred and given nutritional intervention for 2 weeks. If treatments failed to normalize undernutrition, subjects were referred to regional hospitals. Those confirmed as stunted or with low birth weight were directly referred for treatment and FSMP as indicated. A total of 1841 subjects received egg and/or milk supplementation. In 6 months, animal protein supplementation prevented weight faltering in 1320/1841 subjects (71.7%; 95% CI 69.6%-73.8%). Red flags management successfully prevented stunting in 536/709 subjects (75.6%; 95% CI 72.4%-78.8%) in 2 weeks. FSMP prescription for catch-up growth in regional hospitals led to stunting recovery in 166/381 subjects (43.6%; 95% CI 38.6%-48.5%) in ±14 weeks. A tiered referral system with well-defined treatment guidelines is crucial to address stunting in Indonesia. Timely referral and FSMP prescription for catch-up growth can effectively treat stunting. Animal proteins and education are keys to preventing stunting in children.

## Keywords
- Medicine
- Malnutrition
- Referral
- Wasting
- Medical prescription
- Intervention (counseling)
- Breastfeeding
- Weight loss
- Pediatrics
- Environmental health
- Indonesian
- Kwashiorkor
- Nutrition Disorders
- Integrated Management of Childhood Illness
- Family medicine
- Medical record
- Public health
- Health care
- Stunted growth
- Clinical nutrition
- Developing country
- Protocol (science)
- Bioelectrical impedance analysis
- Intensive care medicine
- Nutrition Education

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Sumber: Discover Unhas — RIMS Universitas Hasanuddin.
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