MULTIDISCIPLINARY INTERVENTIONAL MODEL FOR REDUCING MALNUTRITION AMONG CHILDREN IN IRAN

Protein-energy malnutrition (PEM) is one of the most common nutritional problems among the children under 5 years in Iran. Based on the 1999 national survey, 15.4% of the children under 5 suffered from moderate or severe stunting, 10.9% were underweight and 4.9% wasted. Considering the consequences of PEM including the decrease in physical and mental performance, and the increase in mortality and morbidity among children, malnutrition prevention and control are among the top priorities of nutritional programs in the Ministry of Health and Medical Education. The main objective of this study was to design an appropriate interventional model to decrease malnutrition among children in rural areas. This study was conducted between the years 1996 and 1999 in the rural areas of Ilam, Bardsir, and Borazjan, the three cities located in the provinces of Ilam (West of Iran), Kerman (central part of Iran), and Boushehr (South of Iran), respectively. The study was carried out in 3 phases: situation analysis, designing intervention, and implementation/evaluation. In the phase of situation analysis, 1,703 children 6 – 35 months old in the rural areas of Ilam (n = 659), Borazjan (n = 532), and Bardsir (n = 512) were selected by random sampling (systematic). Data were collected in terms of the knowledge, attitude, and practice of mothers about child feeding, growth monitoring, family planning, sanitation, safe drinking water, householdʹs food consumption pattern, food production, and socioeconomic conditions. In addition, the anthropometric data for the children 6 – 35 months including weight and height were collected and the main causes of malnutrition were determined. Based on the causes, appropriate strategies such as improvement of sanitation, safe drinking water, breast feeding, complementary feeding by demonstration for mothers, growth monitoring, home gardening, income generation, increasing accessibility of foods, and illiteracy elimination were implemented. Different sectors such as agriculture, education, rural development, and social welfare sectors as well as Literacy Movement Organization collaborated with the program. Three years after intervention, the results showed that the prevalence of the underweight decreased from 23% to 11% in Borazjan, from 28% to 14.5% in Bardsir, and from 21% to 10% in Ilam. Stunting also decreased from 25% to 12% in Ilam, from 41% to 13% in Borazjan, and from 31% to 14.9% in Bardsir (p < 0.0001). This study showed that due to the multidisciplinary character of protein-energy malnutrition, intersectional collaboration, political commitment, and community involvement are very important for improving children’s nutritional status. By designing an interventional model, the community’s nutrition status could be improved.