Unpacking the challenges and potentials of the Ai-Han supersereal program in reducing stunting in Covalima Timor-Leste
Keywords:
ai-han supersereal, program evaluation, stuntingAbstract
Stunting is a chronic nutritional problem that severely affects physical growth, cognitive development, and future productivity. In Timor-Leste, nearly half of children under five are stunted, with the prevalence in Covalima District reaching 49%. Since 2004, the Ministry of Health has implemented the Ai-Han Supersereal Program, providing fortified supplementary food for pregnant and lactating women at risk of malnutrition. This study aimed to evaluate the implementation of the Ai-Han Supersereal Program in Covalima using the CIPP (Context, Input, Process, Product) evaluation model. A qualitative descriptive design was employed with purposive sampling, involving the Covalima Health Office director, nutrition program managers, health center heads, and program beneficiaries. Data were thematically analyzed using NVivo 12 Plus. Results indicated that the program was contextually relevant but constrained by limited human resources, transport facilities, and distribution mechanisms. The implementation process faced irregular distribution schedules and insufficient nutrition education. Despite these challenges, the program improved maternal nutrition knowledge and contributed to better nutritional outcomes. Conclusion: The study concludes that strengthening distribution management, enhancing health worker capacity, and continuous nutrition education are necessary for long-term effectiveness.
References
UNICEF, World Health Organization, & World Bank. (2023). Level and trend in child malnutrition. World Health Organization. https://www.who.int/publications/i/item/9789240073791
Sukamto, I. S., Hartono, R. S., & Mulyani, S. (2021). Community health center worker perspectives on stunting risk factors and challenge of stunting prevention program: A qualitative study. Community Health. https://www.teikyomedicaljournal.com/volume/TMJ/44/05/community-health-center-worker-perspectives-on-stunting-risk-factors-and-challenge-of-stunting-prevention-program-a-qualitative-study-616bfe2cb81de.pdf
Nomura, K., Bhandari, A. K. C., Matsumoto-Takahashi, E. L. A., & Takahashi, O. (2023). Risk factors associated with stunting among children under five in Timor-Leste. Annals of Global Health, 89(1), 1–14.
Timor-Leste Food and Nutrition Survey. (2020). Timor-Leste food and nutrition survey. UNICEF. https://www.unicef.org/timorleste/reports/timor-leste-food-and-nutrition-survey
Widowati, S. W., Nurmala, I., Devy, S. R., & Kiswahono, A. D. (2024). Determinant of early marriage adolescent to risk giving birth child in case of stunting. Jurnal Promkes, 12(SI 1), 195–205.
Thurstans, S., Sessions, N., Dolan, C., et al. (2022). The relationship between wasting and stunting in young children: A systematic review. Maternal & Child Nutrition. https://onlinelibrary.wiley.com/doi/abs/10.1111/mcn.13246
UNICEF. (2022). Planu Estratéjiku Nasionál Nutrisaun Setór Saúde Ministério da Saúde (National Health Sector Nutrition Strategic Plan). UNICEF.
Olney, D. K., Leroy, J., Bliznashka, L., & Ruel, M. T. (2018). PROCOMIDA, a food-assisted maternal and child health and nutrition program, reduces child stunting in Guatemala: A cluster-randomized controlled intervention trial. The Journal of Nutrition, 148(9), 1493–1505.
Leroy, J. L., Olney, D., & Ruel, M. (2018). Tubaramure, a food-assisted integrated health and nutrition program, reduces child stunting in Burundi: A cluster-randomized controlled intervention trial. The Journal of Nutrition, 148(3), 445–452.
Zaidi, S., Das, J. K., Khan, G. N., Najmi, R., Shah, M. M., & Soofi, S. B. (2020). Food supplements to reduce stunting in Pakistan: A process evaluation of community dynamics shaping uptake. BMC Public Health, 20, 91–103. http://dx.doi.org/10.1186/s12889-020-09103-8
Ferreira, A. J., & Sulistyaningsih. (2025). Program kesehatan untuk mengurangi stunting di negara berkembang: Scoping review. Jurnal Health Education Science and Technology, 7(2), 119–132.
Mason, J. B., Shrimpton, R., Saldanha, L. S., et al. (2014). The first 500 days of life: Policies to support maternal nutrition. Global Health Action. https://www.tandfonline.com/doi/abs/10.3402/gha.v7.23623
Kohli, N., Nguyen, P. H., Avula, R., & Menon, P. (2020). The role of the state government, civil society, and programmes across sectors in stunting reduction in Chhattisgarh, India, 2006–2016. BMJ Global Health, 5(7). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342433/
Dewey, K. G., Mridha, M. K., Matias, S. L., Arnold, C. D., Cummins, J. R., & Khan, M. S. A. (2017). Lipid-based nutrient supplementation in the first 1000 days improves child growth in Bangladesh: A cluster-randomized effectiveness trial. The American Journal of Clinical Nutrition, 105(4), 944–957. https://www.sciencedirect.com/science/article/pii/S0002916522048419
Juarez, M., Dionicio, C., Sacuj, N., Lopez, W., et al. (2021). Community-based interventions to reduce child stunting in rural Guatemala: A quality improvement model. International Journal of Environmental Research and Public Health, 18(2), 773. https://www.mdpi.com/1660-4601/18/2/773
Mutebi, R. R., Ario, A. R., Nabatanzi, M., Kyamwine, I. B., Wibabara, Y., & Muwereza, P. (2022). Large outbreak of Jimsonweed (Datura stramonium) poisoning due to consumption of contaminated humanitarian relief food: Uganda, March–April 2019. BMC Public Health, 22(1), 1–10. https://doi.org/10.1186/s12889-022-12854-1
Hoddinott, J., Ahmed, A., & Roy, S. (2018). Randomized control trials demonstrate that nutrition-sensitive social protection interventions increase the use of multiple-micronutrient powders and iron supplements in rural pre-school Bangladeshi children. Public Health Nutrition, 21(9), 1753–1761.
Dewey, K. G., Arnold, C. D., Wessells, K. R., Prado, E. L., et al. (2022). Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: An individual participant data meta-analysis. The American Journal of Clinical Nutrition. https://www.sciencedirect.com/science/article/pii/S0002916523036572
Kushi, E. N., Belachew, T., & Tamiru, D. (2023). The impacts of okra consumption on the nutritional status of pregnant women, West Ethiopia. Food Science & Nutrition, 11(9), 5554–5564.
Ashraf, K., Huda, T. M., Ikram, J., Ariff, S., Sajid, M., Khan, G. N., et al. (2024). The effectiveness of nutritional interventions implemented through lady health workers on the reduction of stunting in children under 5 in Pakistan: The difference-in-difference analysis. Nutrients, 16(13), 1–14.
