The effectiveness of nutrition education for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition in Indonesia: study protocol for a randomized controlled trial.

BACKGROUND: Nutrition transition in developing countries were induced by rapid changes in food patterns and nutrient intake when populations adopt modern lifestyles during economic and social development, urbanization and acculturation. Consequently, these countries suffer from the double burden of malnutrition, consisting of unresolved undernutrition and the rise of overweight/obesity. The prevalence of the double burden of malnutrition tends to be highest for moderate levels (third quintile) of socioeconomic status. Evidence suggests that modifiable factors such as intra-household food distribution and dietary diversity are associated with the double burden of malnutrition, given household food security. This article describes the study protocol of a behaviorally based nutrition education intervention for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition. METHODS: NEO-MOM is a randomized controlled trial with a three-month behavioral intervention for households involving pairs of 72 stunted children aged 2-5 years old and overweight/obese mothers (SCOWT) in urban Indonesia. The SCOWT pairs were randomly assigned to either an intervention group or to a comparison group that received usual care plus printed educational materials. The intervention consisted of six classroom sessions on nutrition education and home visits performed by trained community health workers using a motivational interviewing approach. The primary outcomes of this study are the prevalence of double burden of malnutrition as measured in SCOWT, child's height-for-age z-score (HAZ) and maternal body mass index (BMI). DISCUSSION: Because previous studies are mainly observational in nature, this study advances understanding of the double burden of malnutrition through a fully powered randomized controlled trial. The intervention assists participants in self-administered goal setting to improve diet and child feeding behaviors by improving self-efficacy. Maternal self-efficacy may be enhanced through vicarious and active mastery of experiences gained during six sessions of nutrition education and verbal persuasion during home visits. TRIAL REGISTRATION: The Universal Trial Number (UTN) for this study is U1111-1175-5834. This trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) and is allocated the registration number: ACTRN12615001243505 on 12 November 2015.

Nutrition Education Intervention Increases Fish Consumption among School Children in Indonesia: Results from Behavioral Based Randomized Control Trial.

This study aimed to analyze the effectiveness of behavioral-based nutrition education to increase fish consumption among school children using a raised bed pool. This was a randomized control trial study with a 3-months nutrition education intervention using a raised bed pool, as a medium to improve their internalization to increase fish consumption behavior. A paired t-test was used to calculate the difference in the increase of fish consumption, knowledge, attitude, perceived behavioral control, subjective norm, and intention. This study took place in a majority of low to medium urban households in Surabaya in Sidotopo Wetan I and Sidotopo Wetan II elementary school. Elementary school children at 4th and 5th grade and mother of elementary school children with 104 children were eligible and willing to participate. After the completion of interventions, significant improvement in delta-mean and effectiveness observed in attitude, subjective norm, perceived behavioral control, intention, knowledge, and fish consumption (p < 0.001). The 3 months of nutrition education intervention based on the theory of planned behavior significantly increase fish consumption among elementary school children. The increased consumption was believed to be related to the increase in children's knowledge and attitude towards consuming fish.

Ownership of mother and children's health book and complete basic immunization status in slums and poor population.

Background: The percentage of complete immunization in urban areas is higher than rural areas. The purpose of the study was to analyze the relationship between ownership of Maternal and Child Health (MCH) books with Complete Basic Immunization (CBI) coverage in slums and poor areas. Design and Methods: A rapid survey was conducted in selected slums and poor groups based on medical records from Public Health Center. Informants were mothers with a sample of 325 infants aged 12 to 23 months. Results: The lowest coverage of CBI for slum and poor residents is Pasuruan, which is 55.4%. The results of statistical analysis showed that there was a significant relationship between ownership of MCH books and the complete coverage of basic immunization in Malang (P = 0.000; PR = 3.682); Pasuruan (P = 0.002; PR = 1.854); Sidoarjo (P = 0.000; PR = 4.042); Surabaya (P = 0.000; PR = 2.425). Conclusions: It is recommended that the government should improve access to complete immunization programs in slums and poor population.

The maternal referral mobile application system for minimizing the risk of childbirth.

Background: The maternal mortality rate in Surabaya is still quite high due to ineffectice referral health systems. Primary Health Care (PHC) has difficulty referring patients to hospitals which have available resources. The purpose of this study is to develop a mobile app system framework for the maternal referral system. Design and Methods: This study was developed based on the results of the Focus Group Discussion (FGD) with midwives, doctors and primary health care heads about the referral system regulation in Surabaya City. Results: A mobile app system can be used to communicate patients' conditions to the hospital. The hospital then will refer back to the PHC as a home care service after the birth. This mobile app has gone through a trial and a development process; it is currently in the process of structuring the mobile app based on the bugs that occur in the system. Conclusions: This mobile app still needs development, especially in minimizing system bugs, and providing faster, more accurate communication.

Self-efficacy to Engage in Physical Activity and Overcome Barriers, Sedentary Behavior, and Their Relation to Body Mass Index Among Elderly Indonesians With Diabetes.

OBJECTIVES: Elderly individuals with diabetes should maintain a normal body mass index (BMI) to help control their blood glucose levels. This study investigated barriers to physical activity (PA), self-efficacy to overcome those barriers, and PA self-efficacy among elderly individuals with diabetes in relation to BMI. METHODS: This cross-sectional study included 56 participants. Data were collected by a questionnaire interview and direct measurements for anthropometric data. PA self-efficacy was measured using 8 questions describing different levels of PA, where participants rated the strength of their belief that they could engage in that activity. Self-efficacy to overcome barriers was measured using 10 questions capturing participants' confidence in their ability to engage in PA despite different possible barriers. Mean scores for these parameters were analyzed using the chi-square test and the independent t-test. RESULTS: In total, 89.3% of participants had a low PA level and 58.9% had more than 3 hours of sedentary activity per day. Furthermore, 55.4% were obese and 14.3% were overweight. The mean scores for PA self-efficacy and self-efficacy to overcome barriers were 59.1± 26.4 and 52.5±13.8, respectively. PA level was related to BMI (p<0.001; r=0.116) and sedentary activity (p<0.05; r=0.274). PA self-efficacy and age were not related to BMI. Barriers to PA were associated with PA levels (p<0.05). CONCLUSIONS: Physical inactivity was a major problem in elderly individuals with diabetes, and was correlated with higher BMI. Lower levels of PA might be mediated by sedentary activity.

Household Food Insecurity as a Predictor of Stunted Children and Overweight/Obese Mothers (SCOWT) in Urban Indonesia.

(1) Background: The double burden of malnutrition has been increasing in countries experiencing the nutrition transition. This study aimed to determine the relationship between household food insecurity and the double burden of malnutrition, defined as within-household stunted child and an overweight/obese mother (SCOWT). (2) Methods: A cross-sectional survey was conducted in the urban city of Surabaya, Indonesia in April and May 2015. (3) Results: The prevalence of child stunting in urban Surabaya was 36.4%, maternal overweight/obesity was 70.2%, and SCOWT was 24.7%. Although many households were food secure (42%), there were high proportions of mild (22.9%), moderate (15.3%) and severe (19.7%) food insecurity. In a multivariate logistic regression, the household food insecurity access scale (HFIAS) category significantly correlated with child stunting and SCOWT. Compared to food secure households, mildly food insecure households had the greatest odds of SCOWT (adjusted odds ratio (aOR) = 2.789; 95% confidence interval (CI) = 1.540⁻5.083), followed by moderately food insecure (aOR = 2.530; 95% CI = 1.286⁻4.980) and severely food insecure households (aOR = 2.045; 95% CI = 1.087⁻3.848). (4) Conclusions: These results support the hypothesis that the double burden of malnutrition is related to food insecurity, and the HFIAS category is a predictor of SCOWT.

The Effectiveness of Nutrition Education for Overweight/Obese Mother with Stunted Children (NEO-MOM) in Reducing the Double Burden of Malnutrition.

(1) Background: In households experiencing the double burden of malnutrition, stunted children are in a better position for growth improvement when parents are able to direct their resources to support nutrition requirements. This study assesses the effectiveness of maternal nutrition education to reduce child stunting. (2) Methods: This was a Randomized Controlled Trial involving pairs of overweight/obese mothers with stunted children aged 2 to 5 years old in urban Indonesia. Methods: Seventy-one mother-child pairs were randomly assigned to receive either a 12-week nutrition education or printed educational materials. Mixed factorial ANOVA was used to test for between-group differences over time in relation to child's height, weight, maternal self-efficacy, outcome expectation, and caloric intake. (3) Results: Across groups, there was a significant effect of time on child height and weight but no significant differences were observed between-groups. Maternal self-efficacy, outcome expectations in providing animal protein for the children (p-value = 0.025) and mother's total caloric intake (p-value = 0.017) favored the intervention group over the comparison group. (4) Conclusions: The behavioral intervention produced strong improvement in maternal self-efficacy to engage in physical activity, eat fruits and vegetables and to provide children with growth-promoting animal protein, but did not significantly influence child height gain.