Child-care and feeding practices of urban middle class working and non-working Indonesian mothers: A qualitative study of the socio-economic and cultural environment

The double-burden problem of malnutrition in many developing countries is occurring against a backdrop of complex changes in the socio-economic and cultural environment. One such change is the increasing rate of female employment, a change that has attracted researchers to explore the possible relationships between maternal employment and child nutritional status. The present study employs a qualitative approach to explore the socio-economic and cultural environments that may influence child-care practices in families of working and non-working mothers with children of different nutritional status and types of domestic caregiver. It was conducted in Depok, a satellite city of Jakarta, Indonesia, and was designed as a case study involving 26 middle class families. The children were categorized as underweight, normal weight and obese, and caregivers were grouped as family and domestic paid caregivers. Twenty-six mothers and 18 caregivers were interviewed. Data were analysed by the constant comparative approach. The study identified five emerging themes, consisting of reason for working and not working, support for mother and caregivers, decision maker on child food, maternal self-confidence and access to resources. It confirmed that mothers and caregivers need support and adequate resources to perform child-care practices regardless of the child nutritional and maternal working status. Further research is required into how Indonesian mothers across a range of socio-economic strata can have increased options for quality child-care arrangements and support with child feeding. Additionally, this paper discussed the importance of enhanced dissemination of health information addressing both child underweight and obesity problems

Patterns and risk factors of double burden of malnutrition among adolescent girls and boys in Indonesia.

ObjectivesAs an emerging middle-income country, Indonesia is grappling with the double burden of malnutrition across all age groups, including adolescents. Slow gains in reducing undernutrition are compounded by rapidly increasing overnutrition. This study aims to determine the patterns and determinants of this double burden, particularly stunting, thinness and overweight, among adolescent girls and boys aged 12-18 years in Indonesia.MethodsA cross-sectional survey was conducted among 2,160 girls and boys in the districts of Klaten and Lombok Barat in 2017. Data were collected on adolescents' nutritional status, sociodemographic characteristics, morbidity, dietary intake and physical activity and other relevant factors. Multivariable logistic regression models using generalized estimation equation were employed to determine risk factors for stunting, thinness and overweight.ResultsAbout a quarter of adolescent girls (25%) and boys (21%) were stunted. Approximately 5% of girls and 11% of boys were thin, whereas 11% girls and boys each were overweight. Living in a higher wealth household (OR = 0.67; 95% CI: 0.49-0.91), compared to a lower wealth household, and living in a district with higher socioeconomic status (OR = 0.63; 95% CI: 0.51-0.79) were associated with lower odds of being stunted. Adolescent education was also protective against stunting (OR = 0.52; 95% CI: 0.33-0.88). Older adolescents aged 15-18 years were more likely to be stunted (OR = 1.88; 95% CI: 1.42-2.46). Being a girl was associated with reduced odds of being thin (OR = 0.42; 95% CI: 0.30-0.58). Higher household wealth (OR = 1.93; 95% CI: 1.27-2.97) predicted being overweight, while maternal primary or some secondary education, compared to no or incomplete primary education, was protective against adolescent overweight (OR = 0.60; 95% CI: 0.40-0.90).ConclusionIndonesian adolescent girls and boys face both extreme spectrums of malnutrition. Addressing the dual burden of malnutrition requires a multi-pronged approach, and urgent shift is warranted in nutrition policy and programmes targeting adolescents to effectively address the associated underlying determinants

Three Months of Positive Deviance Approach Integrated with Posyandu TKA Increased Development Performance and Decreased Morbidity of Underweight Children (659 Months)

Positive Deviance Approach integrated with Posyandu TKA (Centre for Growth and Development) offered an excellent opportunity to alleviate the health and malnutrition problem. The study aimed to measure the effectiveness of 3-month Positive Deviance Approach (PDA) integrated with posyandu TKA on growth, development and morbidity of underweight children under five in Pandeglang Assessment of growth used anthropometrics measurement; KPSP test for development, feeding practice used 24-hour food recall, and morbidity record on diarrhea and ARI (Acute Respiratory Infection). Results showed that after 3 months of intervention there were no significant changes on growth of the children in term of WAZ, HAZ and WHZ, but prevalence of underweight among intervention children reduced up to 27.5%, whereas amongcontrol children 18.2%. No significant changes in energy and protein intake of the children. However feeding frequency, food diversity and good feeding practices of intervention children were significantly improved. The morbidity was significantly reduced in the intervention group by 1025%. The development score of the intervention group was about 1.9 better than control group. The posyandu TKA was an alternative model in educating mothers for a better feeding practices, and stimulating the children for improving development and prevention from nutritional status deterioration. This should make an ideal model for posyandu in Indonesia.Key words: malnutrition, intervention, positive deviance approach (PDA), posyandu, growth, developmen

Evidence-Based Nutrition Interventions Improved Adolescents’ Knowledge and Behaviors in Indonesia

Adolescence is a nutritionally vulnerable and critical life stage. However, few programs and policies focus on improving adolescent nutrition in Indonesia. To address this gap, we implemented a gender-responsive package of interventions: (1) breakfast and weekly iron-folic acid supplementation (WIFS), (2) a school-based nutrition education program, and (3) a social behavior change communication strategy. We surveyed 514 adolescents at baseline (2019) and endline (2020) in Klaten and Lombok Barat districts in Indonesia. The survey included a knowledge assessment on nutrition, as well as indicators of attitudes and behaviors on diet, physical activity, and WIFS. We employed multivariable linear and logistic regression to test for pre–post intervention differences. Overall knowledge was significantly higher post-intervention (β: 3.3; 95% confidence interval [CI]: 2.6, 3.9). Diet diversity was high at both timepoints, however, at post-intervention there was significantly higher odds of consuming vitamin A-rich fruits and vegetables (Odds Ratio [OR]: 1.5; 95% CI: 1.1, 2.0) and lower odds of consuming sugar-sweetened beverages (OR: 0.4; 95% CI: 0.3, 0.5). Post-intervention, there was higher odds of reporting 60 min of daily physical activity (OR: 2.3; 95% CI: 1.7, 3.2) and WIFS among girls (OR: 6.7; 95% CI: 1.5, 30.9). The package of interventions may be a promising first step to improving adolescent nutrition in Indonesia

Child feeding practices in families of working and nonworking mothers of Indonesian middle class urban families: what are the problems?

This study aims to explore the feeding practices in families of working and nonworking mothers with children (aged 12-36 months) of different nutritional status and types of domestic caregiver in Indonesian urban middle class families. It was designed as a qualitative multiple case study. Mothers and caregivers from 26 families were interviewed in depth, and caregivers were categorized as family and domestic-paid caregivers. The result suggested that offering formula milk to young children was a common practice, and there was a high recognition and familiarity toward a range of formula milk brands. Mothers reported challenges in encouraging their children to eat, and in some cases they appeared to lack knowledge on overcoming their child's feeding problem. The findings suggested the need to address the child feeding problems experienced by mothers in order to overcome the double burden of child nutrition in Indonesia