A Qualitative Study on Knowledge and Dietary Intake among Mothers with Stunted Children Under Five in Jepara, Central Java

Background: Stunting is the impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate psychosocial stimulation. Children are defined as stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median. Some of the consequences of stunting in early life include poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life. This study aimed to describe perception of stunting and analyze the associations of maternal knowledge and dietary intake on the risk of stunted children under five in Jepara, Central Java. Subjects and Method: This was a qualitative study conducted in Jepara, Central Java. A sample of 44 stunted children under five years of age was selected for this study. A sample of mothers of the stunted children was selected as key informants. The dependent variable was stunting. The independent variables were maternal knowledge and child dietary intake. The data on stunting were taken from maternal and child health record at Puskesmas. The other data were collected by in-depth interview, focus group discussion, and document review. The data were analyzed by content analysis. Results: Mothers of stunted children did not worry about their children condition. Stunting was not considered as a serious issue to overcome. Mothers had poor knowledge about stunting, dietary intake, and child health were poor. Conclusion: Stunting in children under five to some communities in Jepara, Central Java, is not considered as an important issue. Correspondingly mothers of stunted children have poor knowledge about stunting, nutrition, and child growth and development. Keywords: stunting, maternal knowledge, dietary intake, children under five

Associations of Healthy Behavior and Environment with Acute Respiratory Infection in Jepara, Central Java

Background: According to earlier studies, except during the neonatal period, Acute Respiratory Infections (ARIs) are the most common causes of both illness and mortality in children under five, who average three to six episodes of ARIs annually regardless of where they live or what their economic situation is. This study aimed to determine the associations of healthy behavior and environment with acute respiratory infectionin Jepara, Central Java. Subjects and Method: A cross-sectional study was conducted in Mororejo village, Mororejo, Jepara, Central Java, from January to February 2018. A sample of 210 families were selected for this study. The dependent variable was ARIs. The independent variables were health behavior and environmental factors. The data were collected by questionnaire. Data on ARIs were taken from medical record. Crude (bivariate) analysis was carried out to show association with prevalence ratio (PR) used as a measure of association and chi square to show statistical significance. Results: Incidence of ARIs was associated with smoking (PR= 1.44; CI= 1.10 to 1.88; p= 0.014), poor ventilation (PR= 1.78; CI= 1.12 to 2.83; p= 0.015), and crowded dwelling (PR= 3.61; CI= 1.37 to 9.50; p= 0.009). The associations of ARIs with washing hand, garbage disposal, bin ownership, floor cleaning, room light, and poultry ownership, were statistically non-significant. Conclusion: Incidence of ARI is associated with smoking, poor ventilation, and crowded dwelling. Keywords: acute respiratory infections, health behavior, environmen

Implementation of SIJAREMAS to Reduce Maternal Mortality at Pku Muhammadiyah, Grobogan, Central Java

Background: Maternal and Neonatal Referal Network Information System (Sistem Informasi Jejaring Rujukan Maternal dan Neonatal, SIJARIEMAS) is a program that seeks to strengthen the referral system of maternal and neonatal health in Indonesia by capitalizing the advancement of information technology. This strategy was developed to reduce maternal mortality rate in Indonesia. This study aimed to analyze the implementation of SIJARIEMAS at PKU Muhammadiyah Hospital in Grobogan District, Central Java. Subjects and Method: This was a mixed qualitative-quantitative study conducted at PKU Muhammadiyah Gubug Hospital, Grobogan, Central Java, from May to October, 2017. The key informants of the qualitative study included manager and head of hospital ward. The variables under study included Input (Man, Machine, Material, Method), SIJARIEMAS implementation, and Output (maternal mortality). Results: Standard Operating Procedure already existed with 20 indicators. Machine and Material: Service Room, PC Client/ Tablet, Internet Connection, Speaker, LED Monitor, Phone line, Mobile Phone, already existed. Man: 1 Information Technology technician who was concurrently also an administration personnel, super administration staff, 2 midwives, 1 nurse, 1 general practitioner, and 2 obstetric specialists. Implementation: 10 out of 20 indicators did not performed well. The lowest compliance was that of the referring midwife, who did not communicate well with the Emergency Officers along the way to the Referral Hospital (72.7%). The most common obstetric problem was premature rupture of membranes (40%). There was no maternal death of SIJARIEMAS referral during the study. Conclusion: SIJARIEMAS has been already implemented at PKU Mu­ham­madiyah Gubug Hospital, Grobogan, Central Java. However, its performance has yet to be improved. The implementation should conform with the standard operating procedure. Keywords: SIJARIEMAS, maternal mortality rat

Association between Refractive Error and Decreasing Visus in Pregnant Women

Background: Refractive error is a problem with focusing light accurately onto the retina due to the shape of the eye. The most common types of refractive error are near-sightedness, far-sightedness, astigmatism, and presbyopia. Visual impairment from uncorrected refractive errors can have immediate and long-term consequences in children and adults, such as lost educational and employment opportunities, lost economic gain for individuals, families and societies, and impaired quality of life. This study aimed to estimate the association between refractive error and decreasing visus in pregnant women. Subjects and Method: This was a cross-sectional study conducted at Puskesmas (community health center) Gunung Pati, Semarang, Central Java. A sample of 76 pregnant women was selected for this study by simple random sampling. The dependent variable was visus (visual acuity). The independent variable was refractive error. The diagnosis of a refractive error is usually confirmed by an eye care professional during an eye examination using a large number of lenses of different optical powers, and often a retino scope. Visus was measured by Snellen optotype. The data were analyzed by chi square with prevalence ratio (PR) as the measure of association. Results: Refractive error was associated with decreasing visus in pregnant women (PR= 15.00; CI 95%= 4.33 to 52.02; p< 0.001). Conclusion: Refractive error is associated with decreasing visus in pregnant women. Keywords: refractive error, visus, pregnant wome

Effect of Child Growth and Development Training on The Knowledge and Attitude among Community Health Workers in Semarang, Central Java

Background: Measuring and monitoring a child’s growth is important to judge the adequacy of diets or supplementary food being given. Monitoring child's development is critical to find out if a child's development is on track. It is important to act early if there are signs of potential development delay because early treatment is so important for improving a child's skills and abilities. This study aimed to determine effect of child growth and development training on the know¬ledge and attitude among community health workers in Semarang, Central Java. Subjects and Method: This study was a quasi-experimental with pretest and posttest with no control design conducted at Rowosari Puskesmas (community health center), Semarang, Central Java. The study subjects involved 62 community health workers (CHWs). The dependent variables were knowledge and attitude about child growth and development. The independent variable was training on how to measure and monitor child growth and development. The data were collected by questionnaire, and analyzed by Wilcoxon test. Results:Knowledge was higher after training (Mean= 77; SD= 9.8) than before (Mean= 68; SD= 11.2), and it was statistically significant (p= 0.001). Attitude was higher after training (Mean= 80; SD= 12.8) than before (Mean= 70; SD= 10.1), and it was statistically significant (p= 0.001). Conclusion: Training is effective in improving knowledge and attitude about child growth and development monitoring among CHWs. Keywords: knowledge, attitude, growth,development, monitoring, children, community health workers

Effect of “Contraceptive Technology Update” Pre-Service Training on the Knowledge and Skill of Medical Student

Background: Contraception is an effective method of lowering the population rate. However, anecdotal evidenceshowed that generally doctors were unable to provide IUD and implant contraceptive installation services. This study aimed to determine the effect of Contraceptive Technology Update (CTU) pre-service training on the knowledge and skill of the medical college students. Subjects and Method: This was a quasi experiment using one group before and after with no comparison design. A sample of 50 college students from the medical college was selected for this study. All of the study subjects received CTU training for 5 days, comprising 3 days of in-class training using mannequin, and 2 days of practical training with patients. The independent variable was CTU pre-service training. The dependent variables were knowledge and skill. The knowledge data were measured by questionnaire. IUD and implant fixing skills were observed using MiniCEX. The data were analyzed by Wilcoxon test. Results: Knowledge after CTU training (median= 77.5) was higher than before CTU training (median= 62.5) with p= 0.001. IUD fixing skills after CTU training (median= 13.0) was higher than before CTU training (median= 10.0) with p= 0.001. Conclusion: CTU pre-service training significantly improves both knowledge and skills of IUD and implant fixingof medical college students. Keywords: CTU pre-service training, contraceptive, medical college studen

Determinant Factors on Stunting Incidence among Children Age 6-24 Months, Pemalang, Central Java: A Case Study

Background: Stunting among children under five can be caused by various factors, including inadequate food intake, characteristics of children, history of infectious diseases, family care pattern, and quality of health services. The dominant cause of stunting is different in each region. This study aimed to determinant the factors on stunting incidence among children age 6-24 months, Pemalang, Central Java. Subjects and Method: This was a case control study conducted in July 2019 in the work area of the Kebondalem Community Health Center in Pemalang, Central Java. A total of 142 stunted children aged 6- 24 months were selected for this study. The dependent variable of this study was stunting. The independent variables were nutritional intake, immunization status, hygene, exclusive breastfeeding, parental education, occupation, family income, and a history of infectious diseases. Data were collected using anthropometric measurements and interviews with a questionnaire. Data were analyzed using logistic regression. Results: Mother’s occupation (OR= 0.26; 95% CI= 0.01 to 0.78; p= 0.035;), history of exclusive breastfeeding (OR= 0.07; 95% CI= 0.02 to 0.25; p= 0.001), history of infectious disease (OR= 0.008; p= 0.010), Nutritional intake (OR= 9.44; 95% CI=1.88 to 47.43; p= 0.006), and they were statistically significant. Conclusion: Mother’s occupation, history of exclusive breastfeeding, history of disease infection, and nutritional intake are factors associated with the risk of stunting. Keywords: mother’s occupation, history of exclusive breastfeeding, history of disease infection, and nutritional intake, stunting Correspondence: Arwinda Nugraheni. Faculty of Medicine, Universitas Diponegoro, Yogyakarta, Indonesia. Email: [email protected]