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1. Consumption of Animal-source Protein is Associated with Improved Height-for-age Z scores in rural Malawian Children Aged 12-36 Months dr. Agrifina Helga Pratiwi Pembimbing : dr. Julius Anzar , SpA (K) dr , Moretta Damayanti, SpA (K), M.Kes

2. Introduction Childhood stunting > the most prevalent form of undernutrition in the world: 22% (151 million) global prevalence in children < 5 years old. In Malawi, 37% of <5 years old are stunted. Factors stunting: H ousehold and family food insecurity, H ousehold food allocation, A bbreviated breast feeding, C omplementary feeding with low energy and nutrient density of traditional foods, Frequent infections such as diarrhea , respiratory infections and environmental enteric dysfunction (EED) S ub-Saharan African societies > monotonous, low-quality protein and micronutrient-poor starchy foods such as maize, cassava, rice and sorghum.

3. Material and Method Secondary analysis of children who participated in two randomized controlled trials (RCTs) of common bean and cowpea flours addition as a part of the complementary food in Malawi. Primary Study: prospective, double-blind, randomized controlled trials that we conducted in two rural southern Malawi villages: Limera village in Nsanje district, The children received isoenergetic amounts of common bean ( Phaseolus vulgaris ), cowpea ( Vigna unguiculata ), or CSB (control) flour to add to their usual complementary porridge RCT 1 enrolled infants at 5.5–6.5 months of age who received the intervention for 6 months RCT 2 enrolled toddlers at 12–23 months of age who received the intervention for 12 months. Inclusiuon : required age and permanent residents Exclusion: All children that had severe or moderate malnutrition, congenital defects or gross developmental delay

4. C ompare the efficacy of legume-based complementary food on infant and toddler linear growth and gut health in children at risk of developing EED Previous Study: The primary outcome measure: change in height-for-age z score (HAZ), changes in percentage of lactulose excretion (%L). The secondary outcomes: intervention effects on gut microbiome, anthropometric indices, clinical morbidity dietary intake assessment Aim of Study

5. C ompare the efficacy of legume-based complementary food on infant and toddler linear growth and gut health in children at risk of developing EED The primary outcome measure: change in height-for-age z score (HAZ), changes in percentage of lactulose excretion (%L). The secondary outcomes: intervention effects on gut microbiome, anthropometric indices, clinical morbidity dietary intake assessment Intervention Flours

6. Asessement

7. 1 Severly Stunted 2 Severly Underweight 4 Usia saat ini 2 tahun 22 bulan 3 Status Gizi: Gizi Buruk Interpretasi 5 Penyakit penyerta: Infeksi dan dehidrasi

8. Penentuan Kebutuhan

9. 5ml x 2.35kg = 11.75ml setiap 30 menit dalam 2 jam pertama Dilanjutkan dengan selang seling ASI atau susu formula selama 10 jam selain mengatasi dehidrasi, cegah hipotermi dan hipoglikemi

10. Penentuan Cara Pemberian

11. Oral-breastfeeding

12. Penentuan Jenis Makanan

13. Monitoring ANP

14. Terapi Infeksi Antibiotik spektrum luas Amoxicillin 2,35 X 15mg (3x/hari selama hari)

15. Usia Tinggi Pada kasus ini, bayi tersebut dianggap dalam fase stabilisasi. Sehingga tidak menggunakan RDA berdasarkan usia tinggi, namun menggunakan panduan tatalaksana gizi buruk Kebutuhan kalori 130x2.35=305.5ml/hari Sufor 8x/hari : 38ml/x pemberian

16. Thank you!