Health Care-seeking Behaviour of Coastal Communities in Banyuwangi, Indonesia: Results of a Cross-sectional Survey

Introduction: Improving health care-seeking behavior of the coastal communities is a pathway to improve their health. This analysis aims to explore the health care-seeking behavior of the coastal communities in Banyuwangi District to recommend the room for improvement for health promotion and health service improvement for these communities. Method: Data from a cross-sectional survey of metabolic syndrome and mental health conducted in coastal communities in Banyuwangi was used for analysis. Randomly selected participants from a list of members of Family Welfare Development Group (Pembinaan Kesejahteraan Keluarga /PKK) were asked for an interview at corresponding village office in Ketapang, Bangsring, Bulu Agung, Grajagan and Kampung Mandar village. Distribution of health care-seeking behaviors was analyzed individually and where possible were segregated by gender and age. Results: More than half of the coastal communities in Banyuwangi District went to health care service to seek health and 7 out of 10 turned to health care service to seek health for their family members. Women more than men turned to health care service when they or their family members fell ill. Private doctors rather than Puskesmas were more popular. Private midwives were the most popular service for antenatal care (ANC) and delivery. Although there was not a clear increase in health care service utilization over time, we found that contraceptive utilization increased with time. Conclusion: The utilization of health care service in Banyuwangi needs to be more promoted especially for men\u27s health

Determinants of age‐appropriate breastfeeding, dietary diversity, and consumption of animal source foods among Indonesian children

Global child feeding practices remain suboptimal. In this study, we assess the determinants of age‐inappropriate breastfeeding, dietary diversity, and consumption of 3+ types of animal source foods (ASFs) using 11,687 observations from combined data from the Indonesian Demographic Health Survey of 2012 and 2017. We used linear and logistic regression after adjusting for the complex sampling design. Child's age and quality of antenatal care (ANC) were associated with all outcomes. Socio‐ economic status and labour force participation were positively associated with higher dietary diversity score, ASF consumption, and age‐inappropriate breastfeeding. More ANC visits and having consultation at ANC were associated with more dietary diversity. Higher women's knowledge level was associated with more dietary diversity and consuming more ASF. Compared with western Indonesia, more children in eastern Indonesia were age‐inappropriately breastfed and had lower dietary diversity. The Indonesian government needs to develop programmes to improve child feeding particularly in eastern Indonesia, focusing on improving dietary diversity and ASF consumption in poorer households and on prolonging breastfeeding in richer households. Women's labour force participation should be encouraged, but programmes for working mothers are also needed to support continued breastfeeding and to express breast milk. ANC and postnatal programmes need improved consultation sessions for child feeding. KEYWORDS breastfeeding, dietary diversity, animal source food, child feeding, Indonesi

Determinants of age‐appropriate breastfeeding, dietary diversity, and consumption of animal source foods among Indonesian children

Global child feeding practices remain suboptimal. In this study, we assess the determinants of age‐inappropriate breastfeeding, dietary diversity, and consumption of 3+ types of animal source foods (ASFs) using 11,687 observations from combined data from the Indonesian Demographic Health Survey of 2012 and 2017. We used linear and logistic regression after adjusting for the complex sampling design. Child's age and quality of antenatal care (ANC) were associated with all outcomes. Socio‐ economic status and labour force participation were positively associated with higher dietary diversity score, ASF consumption, and age‐inappropriate breastfeeding. More ANC visits and having consultation at ANC were associated with more dietary diversity. Higher women's knowledge level was associated with more dietary diversity and consuming more ASF. Compared with western Indonesia, more children in eastern Indonesia were age‐inappropriately breastfed and had lower dietary diversity. The Indonesian government needs to develop programmes to improve child feeding particularly in eastern Indonesia, focusing on improving dietary diversity and ASF consumption in poorer households and on prolonging breastfeeding in richer households. Women's labour force participation should be encouraged, but programmes for working mothers are also needed to support continued breastfeeding and to express breast milk. ANC and postnatal programmes need improved consultation sessions for child feeding

Demographical Factors, Not Lifestyle Factors, Associated with the Increase of Random Blood Glucose in Coastal Areas

Introduction: Blood glucose is an important component in the body produced by the consumption of carbohydrates, proteins, and fats. A blood glucose imbalance causes an increase in the blood glucose level in the body. The occurrence of economic changes due to tourism may lead to a change in diet that can lead to increased blood glucose levels. This study aims to analyse the factors related to random blood glucose in people living in coastal tourism areas in Banyuwangi Methods: The study used a cross-sectional survey. A total of 112 respondents were recruited using the random sampling method, using two-stage cluster sampling techniques taken from the Head of household data in multiple villages. The factors studied included demographic, socioeconomic, lifestyle, and family health history. Results: The results showed that men had 28% higher random blood glucose compared to woman. People living in Bangsring had 31% higher random blood glucose compared to those in Buluagung. Conclusion: Local health care services should put extra effort into include men and those living in Bangsring in programs to prevent Diabetes Mellitus in coastal areas

Maternal multiple micronutrient supplementation and other biomedical and socioenvironmental infl uences on children’s cognition at age 9–12 years in Indonesia: follow-up of the SUMMIT randomised trial

Background Brain and cognitive development during the fi rst 1000 days from conception are aff ected by multiple biomedical and socioenvironmental determinants including nutrition, health, nurturing, and stimulation. An improved understanding of the long-term infl uence of these factors is needed to prioritise public health investments to optimise human development. Methods We did a follow-up study of the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT), a double-blind, cluster-randomised trial of maternal supplementation with multiple micronutrients (MMN) or iron and folic acid (IFA) in Indonesia. Of 27 356 live infants from birth to 3 months of age in 2001–04, we re-enrolled 19 274 (70%) children at age 9–12 years, and randomly selected 2879 from the 18 230 who were attending school at a known location. Of these, 574 children were oversampled from mothers who were anaemic or malnourished at SUMMIT enrolment. We assessed the eff ects of MMN and associations of biomedical (ie, maternal and child anthropometry and haemoglobin and preterm birth) and socioenvironmental determinants (ie, parental education, socioeconomic status, home environment, and maternal depression) on general intellectual ability, declarative memory, procedural memory, executive function, academic achievement, fi ne motor dexterity, and socioemotional health. The SUMMIT trial was registered, number ISRCTN34151616. Findings Children of mothers given MMN had a mean score of 0·11 SD (95% CI 0·01–0·20, p=0·0319) higher in procedural memory than those given IFA, equivalent to the increase in scores with half a year of schooling. Children of anaemic mothers in the MMN group scored 0·18 SD (0·06–0·31, p=0·0047) higher in general intellectual ability, similar to the increase with 1 year of schooling. Overall, 18 of 21 tests showed a positive coeffi cient of MMN versus IFA (p=0·0431) with eff ect sizes from 0·00–0·18 SD. In multiple regression models, socioenvironmental determinants had coeffi cients of 0·00–0·43 SD and 22 of 35 tests were signifi cant at the 95% CI level, whereas biomedical coeffi cients were 0·00–0·10 SD and eight of 56 tests were signifi cant, indicating larger and more consistent impact of socioenvironmental factors (p<0·0001). Interpretation Maternal MMN had long-term benefi ts for child cognitive development at 9–12 years of age, thereby supporting its role in early childhood development, and policy change toward MMN. The stronger association of socioenvironmental determinants with improved cognition suggests present reproductive, maternal, neonatal, and child health programmes focused on biomedical determinants might not suffi ciently enhance child cognition, and that programmes addressing socioenvironmental determinants are essential to achieve thriving populations

KORESPONDENSI :Sistem Informasi untuk Pemantauan di Bidang Kesehatan

Koson

THE ASSOCIATION BETWEEN SOCIODEMOGRAPHIC FACTORS AND TEACHERS’ GUIDANCE TOWARDS STUDENTS’ ADVERSITY QUOTIENT

This paper aims to report results of research on the association between sociodemographic indicators and teachers’ efforts to help students cope with problems and help build students’ Adversity Quotient. A questionnaire in the form of self-report inventory was distributed to 102 fourth, fifth, and sixth grade students of A- and C-accredited primary schools in Bantul Regency, Yogyakarta, Indonesia. Multiple regression and inductive reasoning were used for analysis. FGDs with teachers were conducted in order to explore teachers’ efforts in helping improve students’ adversity quotient. Research results showed that students who were middle child had significantly lower AQ compared to those of first-born or earlier-born child, while sixth-graders had significantly higher AQ scores compared to fourth graders, and children whose fathers were skilled workers had greater odds of having high AQ. Teachers had already done some LEAD sequence, but had not guided students to explore and analyze the problem by themselves. The results have some implications for the education policy to integrate religious teachings into the curriculum that can facilitate the improvement of students’ Adversity Quotient

Maternal depression is the predominant persistent risk for child cognitive and social-emotional problems from early childhood to pre-adolescence: A longitudinal cohort study

Rationale Brain development occurs rapidly during early childhood and continues throughout middle childhood. Early and later windows of opportunity exist to alter developmental trajectories. Few studies in low- and middle-income countries have examined the importance of the timing of exposure to risks for poor pre-adolescent cognitive and social-emotional outcomes. Methods We assessed 359 children who participated in two follow-up studies of the Supplementation with Multiple Micronutrients Intervention Trial conducted in Indonesia in 2001–2004: at 3.5 years in 2006 and 9–12 years in 2012–2014. Using structural equation models, we examined indicators of early childhood (3.5 y) and pre-adolescent (9–12 y) exposure to risks (child height-for-age z-score [HAZ], hemoglobin [Hb], maternal depressive symptoms [MDS], home environment [HOME]), with two developmental outcomes: cognitive ability and social-emotional problems. We characterized patterns of change by calculating residuals of indicators measured earlier (3.5 y) predicting the same indicators measured later (9–12 y), for example, the residual of 3.5 y MDS predicting 9–12 y MDS (rMDS). Results Three early risk indicators (HOME, Hb, and MDS) were indirectly associated with pre-adolescent cognitive scores through early cognitive scores (HOME: 0.15, [95% CI 0.09, 0.21]; Hb: 0.08 [0.04, 0.12], MDS: −0.07 [-0.12, −0.02]). Pre-adolescent cognitive scores were also associated with change in MDS (rMDS: −0.13 [-0.23, −0.02]) and Hb (rHb: 0.10 [0.00, 0.20]) during middle childhood. For pre-adolescent social-emotional problems, both early childhood MDS (0.31 [0.19, 0.44]) and change in MDS during middle childhood (rMDS: 0.48 [0.37, 0.60]) showed strong direct associations with this outcome. Conclusions Our findings confirm those of previous studies that prevention of risk exposures during early childhood is likely to support long-term child development. It also adds evidence to a previously scarce literature for the middle childhood period. Prevention of maternal depressive symptoms and child anemia during middle childhood should be assessed for effectiveness to support child development

Associations of Nutritional and Social Exposures in Utero, Early, and Later Childhood with Cognitive, Motor, and Social-Emotional Development in Indonesia (OR10-03-19)

Objectives: To determine the association of biomedical and socioenvironmental risk factors during pregnancy, early, and later childhood with cognitive (IQ), motor, social-emotional (SE), and executive function (EF) at age 3.5 and 9–12 y in Indonesia. Methods: Children born to pregnant women enrolled in the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT) in 2001–2004 participated in follow-up studies at age 3.5 y in 2006 and 9–12 y in 2013. We assessed 359 children at both time points for outcomes of IQ, motor, SE and EF. We also assessed predictors of outcomes including biomedical risks (small for gestational age at birth: SGA; height-for-age z-score: HAZ; and child hemoglobin: Hb) and socio-environmental risks (HOME Inventory; maternal depression: MD). We calculated the residuals of earlier risks predicting the later scores, e.g., the residual of SGA at birth predicting HAZ at 3.5 y (rHAZ1), representing the deviation of HAZ at 3.5 y from the child’s expected HAZ based on SGA. In Model 1, we entered SGA, representing in utero exposures. In Model 2, we added indicators at 3.5 y (rHAZ1, Hb, HOME, MD). In Model 3, we added indicators at 9–12 y (rHAZ2, rHb, rHOME, rMD) and the corresponding 3.5 y IQ, motor, SE, or EF scores. Results: The coefficients for outcomes at early and later time points (Figure 1) show that SGA was not associated with any scores. Early (3.5 y) childhood rHAZ1 was associated with early IQ, motor, and EF, but was not independently associated with later (9–12 y) IQ, motor, or EF. Later childhood rHAZ2 was not associated with any scores. Early childhood HOME was independently associated with both early and later IQ, motor, and EF, while later childhood rHOME was not associated with any scores. Early Hb was not associated with any scores and later rHb was associated with motor scores only. MD during early childhood and rMD during later childhood were independently associated with later childhood SE. Conclusions: These findings support the importance of early and continual intervention throughout childhood to support healthy growth and even more importantly maternal mental health and nurturing home environments. This is essential for longer-term IQ, motor, SE, and EF

The Relative Association of Bio-Medical and Socio-Environmental Risk Factors with School-Age Child Cognition in Indonesia

<p>(A) Scheme of the TcNRBD1 gene. (B) TcNRBD1 expression throughout the parasite's life cycle: 1 –epimastigote in exponential growth, 2—epimastigote under nutritional stress, 3 –epimastigotes adhered to the substrate for 24 hours, 4—metacyclic trypomastigote, 5—amastigote (5x10⁶ parasites in each lane). Secondary antibodies: anti-rabbit peroxidase (1:1000) and anti-mouse phosphatase (1:10000). (C) Immunolocalization of TcNRBD1 during the <i>T</i>. <i>cruzi</i> lifecycle. The bottom panel is the promastigote form of <i>T</i>. <i>brucei</i>. The primary antibody was diluted 1:300. The kinetoplast and nucleus were stained with DAPI (4',6-diamidino-2-phenylindole dihydrochloride) 1:1000. The secondary antibody was Alexa Fluor 488 conjugated anti-rabbit diluted 1:400. Field 1, DIC; Field 2, immunofluorescence of TcNRBD1; Field 3, DAPI.</p