Can gossip change nutrition behaviour? Results of a mass media and community-based intervention trial in East Java, Indonesia.

OBJECTIVE: It is unclear how best to go about improving child feeding practices. We studied the effect of a novel behaviour change intervention, Gerakan Rumpi Sehat (the Healthy Gossip Movement), on infant and young child feeding practices in peri-urban Indonesia. METHODS: The pilot intervention was designed based on the principles of a new behaviour change theory, Behaviour Centred Design (BCD). It avoided educational messaging in favour of employing emotional drivers of behaviour change, such as affiliation, nurture and disgust and used television commercials, community activations and house-to-house visits as delivery channels. The evaluation took the form of a 2-arm cluster randomised trial with a non-randomised control arm. One intervention arm received TV only, while the other received TV plus community activations. The intervention components were delivered over a 3-month period in 12 villages in each arm, each containing an average of 1300 households. There were two primary outcomes: dietary diversity of complementary food and the provision of unhealthy snacks to children aged 6-24 months. RESULTS: Dietary diversity scores increased by 0.8 points in the arm exposed to TV adverts only (95% CI: 0.4-1.2) and a further 0.2 points in the arm that received both intervention components (95% CI: 0.6-1.4). In both intervention arms, there were increases in the frequency of vegetable and fruit intake. We found inconsistent evidence of an effect on unhealthy snacking. CONCLUSION: The study suggests that novel theory-driven approaches which employ emotional motivators are capable of having an effect on improving dietary diversity and the regularity of vegetable and fruit intake among children aged 6-24 months. Mass media can have a measurable effect on nutrition-related behaviour, but these effects are likely to be enhanced through complementary community activations. Changing several behaviours at once remains a challenge

Food Insecurity Associated with Double-Burden of Malnutrition among Women in Reproductive Age in Ciampea Sub-district, Bogor, West Java

AbstractDouble burdens of malnutrition among women have occurred across most developing countries including Indonesia. This study compared the associated factors among overweight and underweight of women in reproductive age (WRA) in rural Ciampea Sub-district, Bogor, West Java. This cross-sectional study surveyed the nutritional status of 575 mothers (16-49 years old) who have under two-years-old children. Nutritional status was assessed by body-mass-index (BMI) and mid-upper arm circumference (MUAC), food security status by US-Food Security Survey Module (US-FSSM), dietary intake by a single 24-H dietary recall. The prevalence of underweight, overweight, and obese among this group were 10%, 15.8%, and 34.2%. Food security status was the single factor associated with overweight (p=0.026). However, after adjustment with other factors, food insecurity with hunger was found to be the highest risk of being underweight (AdjOR=3.95; 95%CI: 1.46-10.64). Contrarily, it contributed to lower chances of being overweight among WRA (AdjOR=0.40, 95%CI: 0.21-0.77). In conclusion, food security status in this population associated with both under- and over-nutrition, in addition to other factors such as age and education level of WRA. Ensuring the availability and affordability of nutritious food together with proper nutrition education to rural communities might be worthwhile to improve this condition.AbstrakBeban ganda malnutrisi pada wanita terjadi di sebagian besar negara berkembang, termasuk Indonesia. Penelitian ini membandingkan faktor-faktor yang berhubungan pada wanita usia subur (WUS) dengan status gizi kurang dan lebih di pedesaan Ciampea, Bogor, Jawa Barat. Studi potong lintang ini mensurvei status gizi pada 575 Ibu (usia 16-49 tahun) yang memiliki baduta. Penilaian status gizi menggunakan indeks massa tubuh (IMT) dan lingkar lengan atas (LILA), status ketahanan pangan oleh US-Food Security Survey Module (US-FSSM), asupan makanan dengan food recall 24-jam. Prevalensi gizi kurang, lebih, dan obesitas pada kelompok ini adalah 10%, 15,8%, dan 34,2%. Status ketahanan pangan merupakan faktor tunggal yang terkait dengan kelebihan berat badan (p = 0,026). Namun, setelah disesuaikan dengan faktor lain, kerawanan pangan dengan kelaparan ditemukan sebagai risiko tertinggi terjadinya gizi kurang (AdjOR = 3.95; CI 95%: 1.46-10.64). Sebaliknya, kondisi tersebut berisiko lebih rendah terhadap kejadian gizi lebih pada WUS (AdjOR = 0,40, 95% CI: 0,21-0,77). Kesimpulannya, status ketahanan pangan pada populasi ini berhubungan dengan kejadian ganda malnutrisi, selain faktor lain seperti usia dan tingkat pendidikan. Memastikan ketersediaan dan keterjangkauan pangan bergizi bersama dengan edukasi gizi yang tepat untuk masyarakat pedesaan mungkin bermanfaat untuk memperbaiki kondisi ini

Active Surveillance: Strategy to Reach The Unreported TB Patient In Hospitals

Background and Aims: The National Tuberculosis Program (NTP) conducted active surveillance to find unreported TB patients in hospitals. CTB supports by conducted active surveillance in 6 provinces. This study was conducted to see an overview of the implementation of active surveillance of TB cases in hospitals among districts supported by CTB and non CTB supported, including the challenges of active surveillance implementation to provide recommendations for National TB program. Methods: This study is a qualitative research with a case study design. Data collected by document reviews, observations, discussions, and in-depth interviews with key informants. Results: Only about 23% of TB cases from HIS are reported into SITT. This is partly due to the procedure or the flow of tuberculosis (TB) data from the Hospital to the National TB Program, which is a manuallly input by entry the data into the SITT.There are about 70% of cases that are not reportedly due to lack of human resources in the hospital to do data entry. Findings also show that districts supported by CTB have a percentage of cases gap less (4%-43%) than non CTB supported district (43%-74%). The data shows the importance of partnership or involvement of other partners in TB control programs. Conclusion: Active surveillance shows the need to strengthen hospital internal network. Standardized guideline and treatment monitoring mechanism should be established to support active surveillance nationwide. The NTP needs also to collaborate with the Directorate General of Health Services to establish a linkage between HIS and National TB surveillance system