scholarly journals Child Development and Nutritional Status in Ecuador

2019 ◽  
Vol 6 ◽  
pp. 2333794X1882194
Author(s):  
Lourdes Huiracocha-Tutiven ◽  
Adriana Orellana-Paucar ◽  
Victoria Abril-Ulloa ◽  
Mirian Huiracocha-Tutiven ◽  
Gicela Palacios-Santana ◽  
...  
Keyword(s):  
Child Development ◽  
Nutritional Status ◽  
Developmental Delay ◽  
Complementary Feeding ◽  
Dietary Diversity ◽  
High Energy ◽  
Child Growth ◽  
World Health ◽  
Nutrient Supplementation ◽  
Nutrient Density

We assessed the development, nutritional status, and complementary feeding of 12- to 23-month-old children from Cuenca, Ecuador in 2013. Ecuador, an upper-middle-income country, developed a child policy in accordance with World Health Organization (WHO) guidelines. We collected cross-sectional survey data. Child development was assessed using the Integrated Management of Childhood Illness Guide–2011. The nutritional status was defined with WHO Child Growth Standards−2006. We investigated nutrient density, WHO Infant and Young Child Feeding Indicators, and nutrient supplementation intake of the complementary feeding. In all, 11.7% of children had “possible developmental delay,” stunting was identified in 29.4% of the children, and 25.3% faced overnutrition (overweight risk/overweight/obesity). The complementary feeding composition can be summarized as having adequate fat, high energy (MJ/day) and protein, and low iron and zinc. Children with “possible developmental delay” received less iron ( P < .05) than children with normal development. Overall, 30.4% of children had minimum dietary diversity. A total of 47.7% of children received nutrient supplementation. This epidemiological profile of infants remains a challenge for Ecuador’s health programs.

scholarly journals The Saqmolo’ Project: Protocol for a Randomized Controlled Trial Examining the Impact of Daily Complementary Feeding of Eggs on Infant Development and Growth in Guatemala

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 162-162
Author(s):  
Gabriela Montenegro-Bethancourt ◽  
Taylor Wallace ◽  
Peter Rohloff ◽  
Elizabeth Yakes Jimenez ◽  
Gabriela Proaño ◽  
...  
Keyword(s):  
Child Development ◽  
Complementary Feeding ◽  
Child Growth ◽  
World Health ◽  
Growth Monitoring ◽  
Randomized Controlled ◽  
Nutrition Care ◽  
Phone Calls ◽  
High Prevalence ◽  
The Impact

Abstract Objectives Studies in Ecuador and Malawi have demonstrated mixed effects of interventions involving daily complementary feeding of eggs on child growth. For example, in Malawi, the egg intervention had no overall effect on child development. There is a need to test the effects of egg interventions on child growth and development in other settings with high prevalence of stunting and in the context of other nutritional interventions. The Saqmolo’ (i.e.,“egg” in the Mayan language, Kaqchiquel) study aims to evaluate the impact of adding 1 egg per day to local standard nutrition care (LSNC) on child development, in rural Maya infants from Guatemala. Methods In a community-based, individually randomized, controlled comparative effectiveness trial among rural indigenous Maya children (n = 1200), starting at 6–9 months at baseline, we will compare the impact of adding one egg per day to LSNC with LSNC alone. LSNC includes: growth monitoring, medical care, deworming medication, multiple micronutrient powders for point of use food fortification, and individualized complementary and responsive feeding education for caregivers. Intervention and control groups will be visited once per month during 6-months and adherence will be monitored during the visits and through phone calls for the first 2 months in both groups at the same frequency. The primary outcome is differences in child global development (measured by Caregiver Reported Child Development Instruments –CREDI-and the Guide for Monitoring Child Development GMCD); secondary outcomes include: growth (z-scores for weight for age, length for age, weight for length, and head circumference for age), and diet quality (using the World Health Organization's infant and young child feeding indicators). Results N/A (submitting study protocol abstract). Conclusions This study will provide new evidence on the potential effect of increased egg accessibility in high prevalence stunting areas along with integrated nutrition care on child development. The results may help to inform public health decision-making regarding resource allocation for effective nutrition interventions during the complementary feeding period in Guatemala. Funding Sources This work was supported by the Academy of Nutrition and Dietetics Foundation via an investigator-initiated research grant from the Egg Nutrition Center.

scholarly journals Maternal nutritional status mediates the linkage between household food insecurity and mid-infancy size in rural Bangladesh

2020 ◽  
Vol 123 (12) ◽  
pp. 1415-1425
Author(s):  
Muzi Na ◽  
Abu Ahmed Shamim ◽  
Sucheta Mehra ◽  
Alain Labrique ◽  
Hasmot Ali ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Food Insecurity ◽  
Complementary Feeding ◽  
Dietary Diversity ◽  
Child Growth ◽  
Household Food Insecurity ◽  
Rural Bangladesh ◽  
Maternal Nutritional Status ◽  
Prenatal Factors ◽  
Household Food

AbstractHousehold food insecurity (HFI) is a major concern in South Asia. The pathways by which HFI may reduce child growth remain inadequately understood. In a cohort study of 12 693 maternal–infant dyads in rural Bangladesh, we examined association and likely explanatory pathways linking HFI, assessed using a validated nine-item perception-based index, to infant size at 6 months. Mothers were assessed early in pregnancy for anthropometric status, dietary diversity and socio-economic status. Infants were assessed for weight, length, and arm, chest and head circumferences and breast and complementary feeding status at birth and 6 months of age. Extent of HFI shared a negative, dose–response association with all measures of infant size at 6 months and odds of wasting and stunting; 57–89 % of variances in the unadjusted models were explained by prenatal factors (maternal nutritional status and dietary diversity), and birth size adjusted for gestational age. Postnatal infant breast and complementary feeding and morbidity exposures explained the remaining fraction of the significant association between HFI and differences in infant arm and chest circumferences and odds of underweight. Contextual (i.e. socio-economic) factors finally brought remaining non-significant fractions of the food insecurity-related mid-infancy growth deficit to practically zero. Improving food security prior to pregnancy and during gestation would likely improve infant growth the most in rural Bangladesh.

Nutritional Status of Pediatric Patients in Ramathibodi Hospital Using the WHO Child Growth Standard and the Thai Growth Reference

2020 ◽  
Vol 103 (10) ◽  
pp. 1099-1106
Keyword(s):  
Nutritional Status ◽  
Pediatric Patients ◽  
Chronically Ill ◽  
Child Growth ◽  
World Health ◽  
Healthy Children ◽  
Growth Standard ◽  
Growth Reference ◽  
Child Growth Standard

Background: The appropriate assessment of nutritional status in children is an essential aspect of health supervision. Currently, there are two references used for growth assessment in Thailand. The WHO child growth standard, which has been widely used since 2007, and the Thai growth reference developed by the Ministry of Public Health, which has been used since 1998. However, there were very few studies that made a direct comparison between both tools. Objective: To compare the nutritional status of healthy pediatric patients in Ramathibodi Hospital assessed by the World Health Organization (WHO) child growth standard and the Thai growth reference. Materials and Methods: The present study was a cross-sectional study. The data were collected from all pediatric patients registered in the outpatient department (OPD) of Faculty of Medicine, Ramathibodi Hospital between January 2013 and December 2018. All healthy children (aged 0 to 15 years) were included. Exclusion criteria of possibly chronically ill children were defined by those who were 1) visiting subspecialty clinics, 2) OPD and emergency room (ER) visits more than ten times per year, 3) having ICD-10 of chronic conditions, or 4) had been admitted in the hospital during the study. The weight and height or length data were extracted from the Electronic Medical Record system. All data were analyzed by the Stata Statistical Software focusing on age and sex-specific Z-scores, which references the WHO child growth standard and the Thai growth reference. Results: Sixty-two thousand one hundred four OPD visits were divided into 31,662 OPD visits for boys and 30,442 OPD visits for girls. Percent of weight for age and height or length for age more than +2 Z-score of both boys and girls when using the Thai growth reference was greater than that using the WHO child growth standard, especially for children aged 0 to 12 months. The Thai growth reference classified as overweight were approximately 10.26% to 31.12% more than using the WHO child growth standard. There was no difference in classification of height by both standards. Conclusion: There was a difference in classification of nutritional status between the Thai growth reference and the WHO child growth standard. Keywords: Nutritional status, Pediatric growth reference, Assessment tool, Overweight

scholarly journals IMPLEMENTATION ON STIMULATION, DETECTION, AND EARLY INTERVENTION OF CHILD GROWTH AND DEVELOPMENT (SDIDTK) PROGRAM IN PUSKESMAS MOJO, SURABAYA STILL EMPHASIZE ON GROWTH SCREENING

2017 ◽  
Vol 52 (1) ◽  
pp. 51 ◽  
Author(s):  
Dwi Susanti ◽  
Florentina Sustini
Keyword(s):  
Early Intervention ◽  
Child Development ◽  
Developmental Delay ◽  
Growth And Development ◽  
Screening Program ◽  
Child Growth ◽  
Primary Data ◽  
Health Staff ◽  
Cross Sectional ◽  
Nutrition Screening

It’s Important to conduct child development screening regularly in primary health services, so child developmental delay cases can be detected and treated as early as possible. Child development screening program in Puskesmas should been carried out integrated with growth screening in Stimulation, Detection, and Early Intervention of Child Growth and Development (SDIDTK) Program. Aims of this study was to gathering informations about the implementation of child development screening activity conducted by Puskesmas Mojo. This was a cross sectional study with kualitatif method. Primary data taken from under 5 years old child’s mothers, kindergarten teachers, cadres, and health staff of Puskesmas Mojo. Secondary data gotten from PWS KIA report of Puskesmas Mojo.Results of SDIDTK activities in Puskesmas Mojo according to PWS KIA report, achieve 88.1% in 2013 and 95.2% in 2014. Child development screening activities done infrequenly in Posyandu. Routine activities of Posyandu was growth/nutrition screening. Child development screening activities done by visiting kindergarten school every 6 month but not every child getting development screen, only those who suspicious have developmental delay because of minimum number of staff and aids. Results of SDIDTK activities in Puskesmas Mojo only represents child growth screening activities.

scholarly journals Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?

2006 ◽  
Vol 9 (5) ◽  
pp. 644-650 ◽  
Author(s):  
NP Steyn ◽  
JH Nel ◽  
G Nantel ◽  
G Kennedy ◽  
D Labadarios
Keyword(s):  
Sensitivity And Specificity ◽  
Dietary Diversity ◽  
Pearson Correlation ◽  
Child Growth ◽  
World Health ◽  
Food Groups ◽  
Nutrient Adequacy ◽  
Z Scores ◽  
Food Variety ◽  
The Mean

AbstractObjectiveTo assess whether a food variety score (FVS) and/or a dietary diversity score (DDS) are good indicators of nutrient adequacy of the diet of South African children.MethodsSecondary data analyses were undertaken with nationally representative data of 1–8-year-old children (n = 2200) studied in the National Food Consumption Study in 1999. An average FVS (mean number of different food items consumed from all possible items eaten) and DDS (mean number of food groups out of nine possible groups) were calculated. A nutrient adequacy ratio (NAR) is the ratio of a subject's nutrient intake to the estimated average requirement calculated using the Food and Agriculture Organization/World Health Organization (2002) recommended nutrient intakes for children. The mean adequacy ratio (MAR) was calculated as the sum of NARs for all evaluated nutrients divided by the number of nutrients evaluated, expressed as a percentage. MAR was used as a composite indicator for micronutrient adequacy. Pearson correlation coefficients between FVS, DDS and MAR were calculated and also evaluated for sensitivity and specificity, with MAR taken as the ideal standard of adequate intake. The relationships between MAR and DDS and between anthropometric Z-scores and DDS were also evaluated.ResultsThe children had a mean FVS of 5.5 (standard deviation (SD) 2.5) and a mean DDS of 3.6 (SD 1.4). The mean MAR (ideal = 100%) was 50%, and was lowest (45%) in the 7–8-year-old group. The items with the highest frequency of consumption were from the cereal, roots and tuber group (99.6%), followed by the ‘other group’ (87.6%) comprising items such as tea, sugar, jam and sweets. The dairy group was consumed by 55.8%, meat group by 54.1%, fats by 38.9%, other vegetables by 30.8%, vitamin-A-rich by 23.8%, other fruit by 22%, legumes and nuts by 19.7% and eggs by 13.3%. There was a high correlation between MAR and both FVS (r = 0.726; P < 0.0001) and DDS (r = 0.657; P < 0.0001), indicating that either FVS or DDS can be used as an indicator of the micronutrient adequacy of the diet. Furthermore, MAR, DDS and FVS showed significant correlations with height-for-age and weight-for-age Z-scores, indicating a strong relationship between dietary diversity and indicators of child growth. A DDS of 4 and an FVS of 6 were shown to be the best indicators of MAR less than 50%, since they provided the best sensitivity and specificity.ConclusionEither FVS or DDS can be used as a simple and quick indicator of the micronutrient adequacy of the diet.

Nutritional Status Among School-Age Children of Bangladeshi Tea Garden Workers

2020 ◽  
Vol 41 (4) ◽  
pp. 424-429
Author(s):  
Mohd Shamim Iqbal ◽  
Amanda C. Palmer ◽  
Jillian Waid ◽  
S. M. Mustafizur Rahman ◽  
Md. M. Islam Bulbul ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Food Insecurity ◽  
Dietary Diversity ◽  
Underserved Populations ◽  
World Health ◽  
School Age Children ◽  
School Age ◽  
The Past ◽  
Household Food ◽  
Plasma Retinol

Background: While considerable progress has been made in reducing undernutrition in Bangladesh, regional disparities are known to exist, and certain population subgroups may lag behind. Objective: To characterize nutritional status among school-age children in a historically marginalized population of Bangladesh. Methods: We conducted a cross-sectional assessment of children attending 14 nongovernmental organization-operated schools serving the tea estate population in Kulaura Upazila, Sylhet Division. We randomly selected 168 children from a population of 418 whose parents attended school-organized Parent–Teacher Association meetings. Parents provided consent and data on household food consumption in the past week, foods consumed by children in the past 24 hours, and household food insecurity. We drew venous blood from assenting children for the analysis of hemoglobin and plasma retinol, C-reactive protein, and α1-acid glycoprotein. Children were classified as stunted, underweight, or thin based on comparisons with the World Health Organization standards for height-for-age, weight-for-age, or body mass index-for-age, respectively. Results: Food insecurity was highly prevalent, with ∼85% of households affected. Roughly half of children had low dietary diversity. Prevalence estimates for stunting, underweight, and thinness were 32%, 50%, and 49%, respectively. Approximately 60% of children had a hemoglobin concentration <11 g/dL. The mean (±SD) plasma retinol concentration was 0.79 μmol/L (±0.23 μmol/L), with 34% deficient using a 0.70 μmol/L cutoff. Conclusions: A heightened focus on tracking progress in underserved populations and appropriately targeted programming will be critical as Bangladesh seeks to accelerate progress toward global development goals for nutrition.

Factors Associated With Feeding And Caregiving Practices For Children Under Five In Lowland Nepal: A Community-Based Cross-Sectional Survey

2021 ◽  
Author(s):  
Sophiya Dulal ◽  
Audrey Prost ◽  
Surendra Karki ◽  
Dafna Merom ◽  
Bhim Prasad Shrestha ◽  
...  
Keyword(s):  
Early Childhood ◽  
Complementary Feeding ◽  
Dietary Diversity ◽  
Controlled Trial ◽  
Childhood Development ◽  
World Health ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Access To Books

Abstract Background: While nurturing care, including adequate nutrition and responsive caregiving and early learning, is critical to early childhood development, national surveys in Nepal highlight inequalities in feeding and parental caregiving practices. This study aimed to document and analyse infant and young child feeding (IYCF) and cognitive and socio-emotional caregiving practices among caregivers of children under age five in Dhanusha district, Nepal. Methods: We used a subset of data from the MIRA Dhanusha cluster randomised controlled trial, including mother-child dyads (N=1360) when children were aged 0-12 months and a follow-up survey of the same mother-child dyads (N=1352) when children were 7-59 months. We used World Health Organization IYCF indicators and questions from the Multiple Indicator Cluster Survey-4 tool to obtain information on IYCF and cognitive and socio-emotional caregiving practices, respectively. We collected data on breastfeeding practices in a postpartum 6-week questionnaire and on complementary feeding and caregiving practices in the follow-up survey. Using multivariable logistic regression models, potential explanatory household, parental and child-level variables were tested to determine their independent associations with IYCF and caregiving indicators. Results: The prevalence of feeding indicators varied. Ever breastfed (99%), exclusive breastfeeding in past 24-hours at 0-12 months (89%), and vegetable or fruit consumption (84%) were common, and minimum dietary diversity reached 63%. Problem areas were early initiation of breastfeeding (16%), feeding of colostrum (67%), no pre-lacteal feeding (53%), timely introduction of complementary feeding (56%), and animal-source food consumption (29%). Amongst caregiving indicators, access to books (7%), early stimulation and responsive caregiving (11%), and access to early childhood education (27%) were of particular concern, while 64% had access to toys and 71% received adequate care. Only 38% of children were developmentally on track. Younger children from poor households with young mothers who had not received antenatal visits and delivered at home were at risk of poor IYCF and caregiving practices. Conclusions: Poor IYCF and cognitive and socio-emotional caregiving practices are widely prevalent in lowland Nepal, which highlights the importance of improved integrated nutrition and caregiving interventions in resource-constrained settings.

Nutrition Education and Introduction of Broad Bean—Based Complementary Food Improves Knowledge and Dietary Practices of Caregivers and Nutritional Status of Their Young Children in Hula, Ethiopia

2014 ◽  
Vol 35 (4) ◽  
pp. 480-486 ◽  
Author(s):  
Canaan Negash ◽  
Tefera Belachew ◽  
Carol J. Henry ◽  
Afework Kebebu ◽  
Kebede Abegaz ◽  
...  
Keyword(s):  
Young Children ◽  
Nutritional Status ◽  
Nutrition Education ◽  
Complementary Feeding ◽  
Dietary Diversity ◽  
Intervention Group ◽  
Baseline Survey ◽  
Control Group ◽  
Broad Beans ◽  
Knowledge And Practice

Background Nutritious complementary foods are needed in countries where undernutrition and stunting are major problems, but mothers may be reluctant to change from traditional gruels. Objective To test whether a recipe-based complementary feeding education intervention would improve knowledge and practice of mothers with young children in Hula, Ethiopia. Methods A baseline survey of 200 eligible, randomly selected mother—child pairs gathered data on sociodemographic characteristics, food security status, knowledge and practices concerning complementary feeding, food group intakes of children aged 6 to 23 months by 24-hour recalls, and children's anthropometric measurements. Twice a month for 6 months, women in the intervention group received an education session consisting of eight specific messages using Alive and Thrive posters and a demonstration and tasting of a local barley and maize porridge recipe containing 30% broad beans. The control group lived in a different area and had no intervention. Results At 6 months, knowledge and practice scores regarding complementary feeding were significantly improved ( p < .001) in the intervention group but not in the control group. The intervention resulted in improvement of children's dietary diversity, as well as mean intake of energy and selected nutrients, compared with children in the control group. Changes in height and weight did not differ between the two groups. Conclusions Community-based nutrition education over 6 months that included demonstration of a local porridge recipe with broad beans added improved the complementary feeding practices of caregivers and the nutritional status of their young children.

scholarly journals Adoption of the WHO Child Growth Standards to Classify Indonesian Children under 2 Years of Age According to Nutrition Status: Stronger Indication for Nutritional Intervention

2009 ◽  
Vol 30 (3) ◽  
pp. 254-259 ◽  
Author(s):  
Madarina Julia
Keyword(s):  
Nutritional Status ◽  
Nutritional Intervention ◽  
Child Growth ◽  
World Health ◽  
Nutrition Status ◽  
Cluster Sampling ◽  
Cross Sectional ◽  
Growth Standards ◽  
Feeding Program ◽  
Z Scores

Background The National Center for Health Statistics/World Health Organization (NCHS/WHO) reference is considered unsuitable for assessing the nutritional status of breastfed children. It is gradually being replaced by the WHO Child Growth Standards in many countries. Objective To assess the implications of adopting the WHO Child Growth Standards to classify Indonesian children according to nutrition status. Methods Data were obtained from two cross-sectional surveys in two districts in Indonesia in 1998. Children under 2 years of age were randomly selected using a two-stage cluster sampling. Z-scores of weight-for-length (WLZ), length-for-age (LAZ), and weight-for-age (WAZ) were calculated based on both the NCHS/WHO reference and the WHO Child Growth Standards. Wasting, stunting, and underweight were defined as z-scores less than −2.0. Results We included 1,374 children, of whom 693 (50.4%) were male and 681 (49.6%) were female. Almost all of the children had initiated breastfeeding and were still being breastfed when the data were collected. According to the WHO Child Growth Standards, the prevalence of wasting did not change with age, but the prevalence rates of stunting and underweight rose steadily with age. Although the contribution of wasting to the classification of underweight was relatively constant, the contribution of stunting increased as the children grew. Conclusions The WHO Child Growth Standards are a better tool for assessing the nutritional status of Indonesian children than the NCHS/WHO reference. However, low WAZ is not a suitable indicator for commencing an extra feeding program, because it reflects stunting instead of wasting. The high prevalence of stunting indicates the need to perform preventive nutritional intervention beginning earlier in life, i.e., in utero.

scholarly journals Pola Pengasuhan Pada Anak Dengan Hambatan Perkembangan

2020 ◽  
Vol 48 (1) ◽  
Author(s):  
Sri Poedji Hastoety ◽  
Rika Rachmalina ◽  
Irlina Raswanti Irawan ◽  
Febriani Febriani
Keyword(s):  
Child Development ◽  
Early Detection ◽  
Developmental Delay ◽  
Parenting Style ◽  
Health Workers ◽  
Child Growth ◽  
Economic Factors ◽  
Individual Interview ◽  
Printed Media ◽  
Early Developmental

Abstract Parenting is a factor that is directly related to child development. This study aims to explore the parenting style among children with developmental delay. This qualitative study nested in a Child Growth and Development Cohort Study that was conducted in Bogor in October 2019. Six children aged 2 to 6 years with developmental delay were recruited in this study. Mother of these children were purposely selected as informants and participated in individual interview about parenting Style of Baurimnd. The mothers as the main caregiver of their children applied control and warmth parenting. The mothers did not know if their children suffered from developmental delay and they had never been informed about this problem by health workers. Economic factors were the reason why mother did not check up their child development. Family had an important role to prevent developmental delay of their children. Parents did not realize that their children had developmental delay, thus there was no specific parenting style applied to cope with this problem. Early detection and early developmental stimulation for children are necessary. It is important to develop indirect counselling media, both electronic and printed media, for mothers of children with developmental delay; hence they can perform early detection and early developmental stimulation by themselves. Keywords: developmental delay, parenting style Abstrak Pola asuh merupakan faktor yang terkait langsung dengan perkembangan anak. Penelitian ini bertujuan untuk mengeksplorasi pola asuh orang tua pada anak dengan hambatan perkembangan. Penelitian ini merupakan bagian dari Studi Kohor Tumbuh Kembang Anak yang dilaksanakan di Bogor pada bulan oktober 2019. Jumlah sampel 6 anak yang mengalami hambatan perkembangan berusia 2 hingga 6 tahun, informan adalah ibu dari anak yang mengalami hambatan perkembangan tersebut, yang dipilih secara purposive untuk diwawancara terkait informasi dimensi pola asuh Baumrind. Pengasuhan anak lebih banyak dilakukan oleh ibu dengan menerapkan pola asuh kontrol dan kehangatan. Ibu tidak tahu jika anak mereka mempunyai hambatan dalam perkembangannya dan belum pernah mendapatkan informasi tersebut dari tenaga kesehatan. Faktor ekonomi merupakan alasan ibu tidak melakukan pemeriksaan terhadap perkembangan anak. Keluarga berperan besar dalam mengatasi hambatan perkembangan anak. Orang tua tidak menyadari bahwa anaknya memiliki hambatan perkembangan sehingga tidak ada pola asuh spesifik yang diterapkan untuk menangani masalah tersebut. Kegiatan deteksi dini dan stimulasi perkembangan sejak dini perlu digiatkan, serta pentingnya mengembangkan media penyuluhan tidak langsung baik media elektronik maupun media cetak, bagi ibu yang memiliki anak dengan hambatan perkembangan agar bisa melakukan deteksi dini dan stimulasi terhadap gangguan tumbuh kembang anak secara mandiri. Kata kunci: Hambatan perkembangan, Pola asuh

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