Baseline Survey on Nutritional and Health Status of Underfive Children at Poor Communities in DKI Jakarta, Tangerang, and Bogor Year 2004

The high prevalence of anemia and vitamin A deficiency among underfive children is related to their food intake and health status. The situation appeared worst after multiple crisis hit Indonesia in 1997/1998. To obtain factors affecting the nutritional status of children aged 1-5 years, a baseline study was conducted in DKI Jakarta, Bogor, and Tangerang in collaboration with UN-WFP. The sample size was 1337 underfive children consisting of 666 boys and 666 girls. The study showed that malnutrition among underfive children was still high which indicated the high prevalence of underweight and stunting, especially in Bogor District and Tangerang District. The micronutrient intake of vitamin A, iron, and zinc among underfive children were certainly below the Indonesian RDA. The level of poverty and the education of woman as well as husbands were two conditions that were obvious from all areas, mainly Tangerang District

The Differences of Haemoglobin changes between two methods of IFA Supplementations among Anemic Female Adolescent Students of Miftahul Huda Al Azhar Langgensari Islamic Boarding School, West Java

AbstractFemale adolescent student s in boarding schools are vulnerable in having anemia due to packed sched ule and limited animal source food. The aim of t his research was to compare the differences of haemoglobin level after weekly Iron Folate Acid (IFA) tablet supplementation and weekly plus daily IFA tablet supplementation during menstruation for 8 week of intervention among anemic students . This study use d qu asi experimental non equivalent control group design. A total of 40 anemic respondents was selected in this study , 20 of them received a weekly IFA tablet s upplementation (treatment 1 group), and the 20 other respondents received weekly plus daily during their menstruation (treatment 2 group). The first hemoglobin measurement and other variables were obtained prior to intervention. Around 52% of all 278 eligible students were anemic at the start of the study. Of the anemic selected sample, 2 of them left the boarding school in the middle of the study because they were ill. A t the end the study 23 out of 38 anemic samples (60.5%) became non anemic. There was a significant increase of haemoglobin level in both groups after the interventio n (both group s have p value < 0.01). This increase was not significant ly different between the two interventions (p = 0.797). This study prove d that weekly supplementation was as effective as weekly plus daily supplemen tation during menstruation in increasing Haemoglobin (Hb ) level among anemic students.AbstrakSantri remaja putri rentan terkena anemia karena kegiatan yang padat dan kurang nya asupan zat gizi terutama makanan sumber pangan hewani . Penelitian ini dilakukan untuk mengetahui perbandingan antara dua program suplementasi tablet tambah darah yang terdiri dari zat besi dan asam folat (TTD), yaitu yang diberi satu tablet per minggu (group perlakuan 1) dan yang diberi satu tablet per minggu ditambah satu tablet sehari saat menstruasi selama 8 ming gu (group perlakuan 2 ) . Penelitian ini menggunakan d isain quasi experimental nonequivalent control group . Responden penelitian ini sebanyak 38 orang dimana 20 orang menerima suplementasi mingguan (2 orang kemudian meninggalkan pondok saat penelitian karena sakit ) dan 20 orang menerima suplementasi mingguan ditambah setiap hari saat menstruasi. Pengukuran data pengetahuan, menstruasi, status g izi, pola konsumsi inhibitor, enhancer dan protein hewani dilakukan sebelum intervensi, data suplementasi diukur setelah intervensi dan data kadar hemoglobin diukur saat sebelum dan sesudah intervensi. Pemeriksaan Hb pertama terhadap semua 278 siswa, seki tar 52% menderita Anemia. Diantara sampel siswa yang anemia, pada akhir intervensi 60.5%nya menjadi tidak anemia. Terjadi kenaikan kadar hemoglobin pada kedua kelompok setelah intervensi selama 8 minggu (kedua grup mempunyai nilai p < 0.01). Kenaikan tersebut tidak berbeda antara kedua kelompok perlakuan (p=0,797). Hasil penelitian ini membuktikan bahwa s uplementasi mingguan pada siswa yang menderita anemia memberikan efektivitas yang sama dalam meningkatkan kadar hemoglobin (Hb) darah dengan suplementasi mingguan ditambah harian selama menstruasi

Factors Determining Successful Exclusive Breastfeeding on Working Mothers in Indonesia: An Exploration by Using Positive Deviance Concept

Despite the fact that exclusive breastfeeding brings a lot of benefits for infants and mothers, breastfeeding rates in Indonesia remain low, standing only at 42% of all infants aged 0-5 months in 2012. This study aims to apply the positive deviance concept to explore the factors determining the success of exclusive breastfeeding among mothers in the high risk group in Indonesia. The study uses the cross-sectional, DHS 2017 data on 1.178 mothers with 0-5 months old infants in Indonesia. Chi-square and multiple logistic regression test with 95% confidence intervals are used in identifying the factors associated with exclusive breastfeeding. Maternal employment is shown to be the most significant risk factor in preventing mothers to breastfeed exclusively. Furthermore, the data suggest that, out of 376 working mothers, 45,5% can be identified as positive deviants – those succeeding in implementing exclusive breastfeeding. The study finds ANC visits, PNC visits, and economic status display significant association with exclusive breastfeeding among working mothers. In the sample, ANC visit is the dominant factor associated with exclusive breastfeeding (OR: 1,831; 95% CI: 1,075-3,118). Completion of ANC and PNC visits should be taken to consideration in improving exclusive breastfeeding rate among working mothers in Indonesia

Did the strategy of skilled attendance at birth reach the poor in Indonesia?

Objective To assess whether the strategy of “a midwife in every village” in Indonesia achieved its aim of increasing professional delivery care for the poorest women. Methods Using pooled Demographic and Health Surveys (DHS) data from 1986–2002, we examined trends in the percentage of births attended by a health professional and deliveries via caesarean section. We tested for effects of the economic crisis of 1997, which had a negative impact on Indonesia’s health system. We used logistic regression, allowing for time-trend interactions with wealth quintile and urban/rural residence. Findings There was no change in rates of professional attendance or caesarean section before the programme’s full implementation (1986–1991). After 1991, the greatest increases in professional attendance occurred among the poorest two quintiles – 11% per year compared with 6% per year for women in the middle quintile ( P = 0.02). These patterns persisted after the economic crisis had ended. In contrast, most of the increase in rates of caesarean section occurred among women in the wealthiest quintile. Rates of caesarean deliveries remained at less than 1% for the poorest two-fifths of the population, but rose to 10% for the wealthiest fifth. Conclusion The Indonesian village midwife programme dramatically reduced socioeconomic inequalities in professional attendance at birth, but the gap in access to potentially life-saving emergency obstetric care widened. This underscores the importance of understanding the barriers to accessing emergency obstetric care and of the ways to overcome them, especially among the poor

Fulfilment of Minimum Acceptable Diet as Dominant Factor in Wasting in Children Aged 6–23 Months in Central Jakarta, Indonesia, 2019

AbstractWasting is a form of acute malnutrition characterized by significant and rapid weight loss resulting from inadequate food intake and infectious diseases. This study was to investigate the factors associated with wasting in children aged 6–23 months and the dominant factor among these. The study followed a cross-sectional study design. A total sample of 261 children was selected using multistage random sampling from 13 integrated healthcare centres in six administrative villages located in three sub-districts of Central Jakarta. Data was collected by measuring body weight and height and questionnaires completed through interviews carried out by trained data collectors. This study shows that the prevalence of wasting in children aged 6–23 months in Central Jakarta is 6.9%. Based on logistic regression analysis, fulfillment Minimum Acceptable Diet (MAD) (OR=3.2 90% CI 1.1-9.5) was found to be the dominant factor in wasting after controlling by mother's level of education (OR=1.7 90% CI 0.7–4.2) and the level of family income (OR=2.9; 90% CI 0.9-8.9). This research shows that there is a need for improvement of maternal behaviour in providing appropriate care for children. Based on this research, we recommend that intervention on appropriate breastfeeding and complementary feeding practices be strengthened, especially for mothers with low levels of education and family income.AbstrakWasting adalah salah satu bentuk malnutrisi akut yang ditandai dengan penurunan berat badan yang signifikan dan cepat akibat asupan makanan yang tidak memadai dan penyakit infeksi. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan wasting pada anak usia 6-23 bulan dan untuk mengetahui faktor dominan di antaranya. Penelitian menggunakan desain studi cross-sectional. Sampel berjumlah 261 anak dipilih dengan menggunakan multistage random sampling dari 13 puskesmas di enam kelurahan yang berada di tiga kecamatan di Jakarta Pusat. Pengumpulan data dilakukan dengan mengukur berat badan dan tinggi badan serta pengisian kuesioner melalui wawancara yang dilakukan oleh pengumpul data terlatih. Hasil penelitian menunjukkan bahwa prevalensi wasting pada anak umur 6–23 bulan di Jakarta Pusat sebesar 6,9%. Berdasarkan analisis regresi logistik, pemenuhan Minimum Acceptable Diet (MAD) (OR = 3,2 90% CI 1,1-9,5) ditemukan menjadi faktor dominan kejadian wasting selah dikontrol oleh tingkat pendidikan ibu (OR = 1,7 90% CI 0,7– 4.2) dan tingkat pendapatan keluarga (OR = 2.9; 90% CI 0.9-8.9). Penelitian ini menunjukkan perlunya peningkatan perilaku ibu dalam memberikan pengasuhan yang tepat kepada anak. Berdasarkan penelitian ini, kami merekomendasikan agar intervensi praktik pemberian ASI dan MP-ASI yang tepat diperkuat, terutama bagi ibu dengan tingkat pendidikan dan pendapatan keluarga yang rendah

Factors Associated with Minimum Dietary Diversity among Breas tfed Children Aged 6-23 Months in Indonesia (Analysis of Indonesia DHS 2017)

AbstractPoor comp lementary feeding practices can lead to malnutrition in infants and young children . Minimum dietary diversity (MDD) is one of the determinants of children’s nutritional status and has been found to predict stunting. This study examined factors associated with MDD achievement among breastfed children aged 6-23 months based on Indonesia’s Demographic and Health Survey 2017. This study us ed chi-square and multiple logistic regression to analyze the data. Among 2,976 children only around 53% children met MDD recommendation. Multivariate analysis found that the diversity of diet is better among older children than younger children. Children aged 18-23 months have possibility of 5.7 times higher to achieve MDD than children aged 6-11 months and 1.3 times higher than children aged 12-17 months . Children of wealthier family (3 rd quintile and above), those delivered by trained healt h personnel, children of higher mothers’ education, working mothers, fathers’ involve in child care , ANC visit >= 4 times, and parents reside in u rban areas have possibility of having higher MDD achievement significantly than the other groups . The low MDD achievement among children aged 6-11 months warrant the importance of prioritizing effort on this age group because this is a period where a child grows rapidly and potentially expose to infection as a result of un -hygienic food preparation , and will affect the child’s growth later on .AbstrakPraktik MP-ASI yang buruk dapat menyebabkan kekurangan gizi pada anak -anak.a Ragam Asupan Minimal ( MDD) merupakan salah satu penentu status gizi anak dan dapat memprediksi terjadinya stunting . Penelitian ini membahas mengenai faktor -faktor yang berhubungan dengan capaian MDD pada anak yang diberi ASI usia 6 -23 bulan berdasarkan data SDKI tahun 2017 . Penelitian ini menggunakan uji Chi -square dan uji regresi logistik ganda untuk menganalisis data. Dari 2 ,976 anak usia 6 -23 bulan yang diberi ASI di Indonesia tahun 201 7, h anya sekitar 5 3 % anak yang telah mencapai MDD. Hasil analisis multivariat menunjukkan ba hwa capaian MDD lebih baik pada anak yang berusia lebih tua. Anak umur 18 -23 bulan mempunyai kemungkinan sebesar 5.7 kalinya untuk mencapai MDD dan anak umur 12 -17 bulan sebesar 1.3 kalinya, dibandingkan dengan bayi umur 6 -11 bulan. Anak yan g berasal da ri keluarga lebih mampu (kuintil 3 atau lebih), yg lahir ditolong tenaga kesehatan terlatih, anak dari ibu yang berpendidikan lebih tinggi, ibu yang bekerja, ayah yang berperan dalam mengurus anak, ibu yang melakukan kunjungan ANC > 4 kali dan orang tua t inggal di perkotaan, mempunyai kemungk inan lebih besar secara bermakna untuk mencapai MDD sesuai anjuran . Rendanhya capaian MDD pada bayi 6 -11 bulan menunjukkan pentingnya memberikan perhatian pada kelopmpok ini karena merupakan kelompok yang masih tumbuh dengan cepat dan mulai terpapar dengan kemungkinan terjadiya infeksi akibat penyiapan makanan yang tidak hygienis, dan akan berpengaruh terhadap pertumbuhan selanjutnya

An economic analysis of midwifery training programmes in South Kalimantan, Indonesia.

In order to improve the knowledge and skills of midwives at health facilities and those based in villages in South Kalimantan, Indonesia, three in-service training programmes were carried out during 1995-98. A scheme used for both facility and village midwives included training at training centres, peer review and continuing education. One restricted to village midwives involved an internship programme in district hospitals. The incremental cost-effectiveness of these programmes was assessed from the standpoint of the health care provider. It was estimated that the first scheme could be expanded to increase the number of competent midwives based in facilities and villages in South Kalimantan by 1% at incremental costs of US$764.6 and US$ 1175.7 respectively, and that replication beyond South Kalimantan could increase the number of competent midwives based in facilities and villages by 1% at incremental costs of US$1225.5 and US$ 1786.4 per midwife respectively. It was also estimated that the number of competent village midwives could be increased by 1% at an incremental cost of US$898.1 per intern if replicated elsewhere, and at a cost of US$ 146.2 per intern for expanding the scheme in South Kalimantan. It was not clear whether the training programmes were more or less cost-effective than other safe motherhood interventions because the nature of the outcome measures hindered comparison

Local food supplementation and psychosocial stimulation improve linear growth and cognitive development among Indonesian infants aged 6 to 9 months

Background and Objectives: To evaluate the effect of culturally-relevant food supplementation and psychoso-cial stimulation on infant growth and development. Methods and Study Design: A community-based random-ized controlled trial was conducted in 40 clusters from 5 selected villages in Tanah Datar District of West Su-matera, Indonesia. We assessed 355 infants aged 6 to 9 months at the beginning of the study. The infants were di-vided into 4 groups: 1) Food Supplementation (FS); 2) Psychosocial Stimulation (PS); 3) Food Supplementation and Psychosocial Stimulation (FS+PS); and 4) Control Group (CG). The formula food supplement was comprised of a variety of local food sources (local MP-ASI) and adjusted for the local habits. The quality of psychosocial stimulation was assessed with the Infant HOME inventory method. Progress at 6 months was assessed by anthro-pometry and the Bayley scores of cognition, language and motor function. Results: There were improvements in linear growth, cognitive and motor development of children in the FS (p<0.05) and the FS+PS (p<0.01) groups compared to the CG. After six months of intervention, mean length increased to 6.862.08 cm and 6.662.41 cm for FS and FS+PS respectively (p<0.05). With the combination of food supplementation and psychosocial stimu-lation (FS+PS), cognitive development increased to 21.412.2 points (effect size 0.56) (p<0.01) and motor devel-opment increased to 20.718.4 points (effect size 0.50) (p<0.001). Conclusion: Combined intervention with local food supplementation and psychosocial stimulation improved infant growth, cognitive and motor development. Key Words: food supplementation, psychosocial stimulation, growth and development, infants, Indonesi

Effect of Formula Food Supplementation (MP-ASI) with Local Product on Growth and Development Among Indonesia Infants 6 to 9 Month of Ages

The purposes of the study were to evaluated the effect formula food supplementation as complementary feeding (MP-ASI) on growth and development of infants 6 to 9 month of ages.  This study setting was in Tanah Datar District West Sumatera Province Indonesia and the participants amount were 355 infants aged 6 to 9 months at beginning of the study. This community trial using Cluster Randomized Control Trial (CRCT) was conducted to 40 clusters  from 5 selected villages were assessed for baseline data . The children were divided into 4 groups: food supplementation group (FS-group), psychosocial stimulation (PS-group), Food and psychosocial stimulation group (FP+PS-group) and control group (C-group). The intervention group received formula food supplementation (MP-ASI)  with local product about 250 to 300 kcal and  6 to 8 gram protein daily for 6 month. The results shows that 271 children completed the study. After 6 month of intervention, for F-Group mean of length is improved 6.61 cm + 2.11 SD and for FP-Group improved 6.27 cm + 2.24 SD. The FP-Group benefitted  in difference Z-score weight for height of nutritional status at baseline and after 6 month of intervention are FP-groups (0.57 + 1.15 SD) compare the F-groups  (-0.16 + 1.12  SD) . There was significant effect of food supplementation and  psychosocial stimulation  on children’s cognitive development,  improving  21.37 + 12.43 SD point and on motoric development improving  20.65 + 18.38 SD point (P&lt;0.001). It can be concluded that the formula food supplementation (MP-ASI) combination with psychosocial stimulation had strong effect to the improvement of  infants’s growth and development

A Stunting Prevention Risk Factors Pathway Model for Indonesian Districts/Cities with a Stunting Prevalence of ≥30%

The prevalence of stunting in Indonesian children aged 0-23 months is a public health problem caused by direct and indirect factors. This study aimed to discover the path of the relationship between various risk factors and the stunting prevalence of ≥30% in 165 districts/cities in Indonesia. Data were obtained from the 2018 National Basic Health Research, National Socioeconomic Survey, and the Statistics Indonesia with a cross-sectional approach. The secondary data on stunting and risk factors were aggregated at the district/city level from individual data; children aged 0-23 months. The path analysis used to determine a stunting prevention model showed that antenatal care at the district/city level decreased stunting rates by at least 2.56% (b = -0.16; p-value = 0.04). A contraceptive user at the district/city level decreased stunting rates by 2.25% (b = -0.15; p-value = 0.05), and handwashing with soap at the district/city level by5.76%, (b = -0.24; p-value = 0.003). Antenatal care, contraceptive use, and handwashing with soap contributed to the reduction of stunting prevalence by18.18%. The study results suggested that districts/cities can play an important role in reducing stunting