Damayanti Rusli Sjarif, Klara Yuliarti, Lanny Christine Gultom, Cut Nurul Hafifah, I. Gusti Lanang Sidiartha, Meta Herdiana Hanindita, Neti Nurani, Aidah Juliaty, Ali Alhadar, Anik Puryatni, Arief Budiarto, Endy Paryanto Prawirohartono, Irma Sri Hidayati, Julius Anzar, Moretta Damayanti, Nur Aisiyah Widjaja, Nice Rachmawati Masnadi, Rina Pratiwi, Rini Andriani, Ronald Rompies, Novitria Dwinanda, Winra Pratita, William Jayadi Iskandar, Jessy Hardjo
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. © 2025 The Author(s). Food Science & Nutrition published by Wiley Periodicals LLC.
Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Department of Child Health, Fatmawati General Hospital, Jakarta, Indonesia; Department of Child Health, Faculty of Medicine, Universitas Udayana/Sanglah Hospital, Denpasar, Indonesia; Department of Child Health, Faculty of Medicine, Universitas Airlangga/Dr Soetomo Hospital, Surabaya, Indonesia; Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia; Department of Pediatrics, Faculty of Medicine, Hasanuddin University/Dr Wahidin Sudirohusodo Hospital, Makassar, Indonesia; Department of Child Health, Hermina Jatinegara Hospital, Jakarta, Indonesia; Department of Pediatrics, Faculty of Medicine, Universitas Brawijaya/Saiful Anwar Hospital, Malang, Indonesia; Department of Pediatrics, Faculty of Medicine, Lambung Mangkurat University/Ulin Banjarmasin Hospital, Banjarmasin, Indonesia; Department of Pediatrics, Faculty of Medicine, Universitas Sriwijaya/Dr Mohammad Hoesin General Hospital, Palembang, Indonesia; Department of Pediatrics, Faculty of Medicine, Universitas Andalas, Padang, Indonesia; Department of Pediatrics, Faculty of Medicine, Universitas Diponegoro/Dr Kariadi Hospital, Semarang, Indonesia; Department of Pediatrics, Medical Faculty of Tanjungpura University/Kharitas Bhakti Hospital, West Kalimantan, Pontianak, Indonesia; Department of Pediatrics, National Women and Children Health Center RSAB Harapan Kita, Jakarta, Indonesia; Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
