Cooking behavior among mothers of children aged 2-5 years old in Kendari, Southeast Sulawesi, Indonesia.

BACKGROUND: Cooking at home was associated with parental feeding practices. This study aimed to explore the interplay of components in cooking behavior of mothers with young children aged 2-5 years old in Kendari city of Southeast Sulawesi, Indonesia. METHODS: This qualitative study involved 33 mothers from Kendari city, which was represented by each two sub-districts in coastal and mainland areas that were randomlyselected. Six focus group discussions (FGDs) were carried out using 20-item guide questions. The guide questions were developed following the Model of Goal-Directed Behavior (MGDB) theory approach exploring the components of cooking behavior i.e., skill, intention, desire, confidence, and attitude in cooking. Data analysis was performed in the field to assist decision on data saturation, followed by data analysis at desk through multilevel coding from the verbatim transcripts using NVivo R1 software. The data was analyzed thematically using pre-determined themes according to the MGDB theory. Emerging topics on enabling factors and constraints were captured to enhance our understanding of the complexity of cooking behavior. RESULTS: The mothers' mean age was about 30 years old with a comparable representation of younger and older mothers. Most mothers were housewives and accomplished secondary school level. The mothers' intention was shown as they frequently cooked at home and allocated time for cooking. The enabling factors included their knowledge about food and nutrition, food source availability, their confidence in cooking meals and following recipes, and their motivation to keep their children healthy representing some intrinsic factors. The main constraint was the lack of skill to make snacks. The other extrinsic barriers were dependence on mobile food sellers and the availability of food kiosks that facilitated children's snack preferences. CONCLUSION: The study obtained some insights that mothers had favorable cooking intention and desire, were supported with a confidence in some basic cooking skills. However, the existing constraints that encouraged the development of unfavorable children's snacking habit were beyond the mothers' control. A cookbook specifically for snack recipes that utilizes local ingredients may assist mother in preparing more healthier options for the children.

School readiness to adopt a school-based adolescent nutrition intervention in urban Indonesia.

OBJECTIVE: To identify school community readiness to adopt a school-based adolescent nutrition intervention. DESIGN: Cross-sectional study: mixed-methods design. The community readiness model was used to guide instrument development and qualitative analysis. Quantitative data are presented using descriptive statistics. Each statement was rated on a seven-point Likert scale, thereby producing scores between 1 (strongly disagree) and 7 (strongly agree). SETTING: Ten of the twenty current public secondary schools in Bogor, Indonesia. PARTICIPANTS: Ninety teachers and ten school principals. RESULTS: Eating behaviour problem awareness was present among all participants; awareness of efforts to improve eating habits was also present, but these efforts were perceived as having low efficacy; support from the City Education Authority and Health Authority was present, but the support type did not match the perceived needs; nutrition education had not been implemented across the entire school community due to competing priorities; existing nutrition policies did not provide concrete scenarios and clear guidelines for nutrition-friendly schools; the availability and accessibility of healthy foods at schools were considered to be key factors in improved adolescent nutrition; positive attitudes existed among respondents towards the implementation of various nutrition programmes, and the median and mode were seven in all types of school-based intervention. CONCLUSIONS: The school community readiness level regarding school-based adolescent nutrition interventions is currently in the action phase, implying that community leaders have begun organising efforts to address issues in adolescent nutrition and are aware of their consequences. Future support should be directed towards improving existing efforts and offering concrete ideas and clear policy guidelines for implementation.

Violations of the International Code of Marketing of Breast-milk Substitutes: Indonesia context.

OBJECTIVES: To measure compliance with the International Code of Marketing of Breast-milk Substitutes ('the Code') in Indonesia. DESIGN: The study was a cross-sectional survey using the Interagency Group on Breastfeeding Monitoring protocol. SETTING: Public and private health facilities in six provinces on Java island in Indonesia. SUBJECTS: A total of 874 women (382 pregnant women and 492 breast-feeding mothers of infants below 6 months) and seventy-seven health workers were recruited from eighteen participating health facilities. The study also analysed a total of forty-four labels of breast-milk substitute products, twenty-seven television commercials for growing-up milk (for children >12 months) of nine brands and thirty-four print advertisements of fourteen brands. RESULTS: The study found that 20 % of the women had received advice and information on the use of breast-milk substitutes and 72 % had seen promotional materials for breast-milk substitutes. About 15 % reported receiving free samples and 16 % received gifts. Nearly a quarter of the health workers confirmed receiving visits from representatives of breast-milk substitute companies. Two health workers reported having received gifts from the companies. The most common labelling violations found were statements or visuals that discouraged breast-feeding and the absence of mention about the consideration of local climate in the expiration date. CONCLUSIONS: Violations of the Code by health workers, breast-milk substitute companies and their representatives were found in all provinces studied. A regular monitoring system should be in place to ensure improved compliance with and enforcement of the Code.

Feeding practices of young children aged 12-23 months in different socio-economic settings: a study from an urban area of Indonesia.

Poor feeding practices among young children lead to malnutrition, and the poor are at a greater risk than the better off groups. Child-feeding practices in various socio-economic strata, especially in urban settings, have not yet been well studied in Indonesia. This study aims to explore the feeding practices of 12-23 months old children from different socio-economic status (SES) groups. A cross-sectional survey was conducted, which included low (n 207), medium-high (n 205), medium-low (n 208) and high SES households (n 194) in forty-three villages within thirty-three sub-districts of Bandung city. Two non-consecutive 24 h recall and eight core indicators of child-feeding practices were assessed through interviews. The results showed that children from the high SES group were more likely to be exclusively breast-fed and to continue breast-feeding up to 1 year of age, met minimum dietary diversity and minimum acceptable diet, and also consumed Fe-rich or Fe-fortified foods. In contrast, children from low SES consumed more energy-rich food (grain) but fewer foods from the other food groups. Consumption of major nutrients differed across the SES groups. Inadequate nutrition was higher among children from the lower SES groups. Fortified foods were consumed by a larger proportion of children from the high SES group and contributed considerably to their overall nutrient intake. This study shows that young children's feeding practices were not adequate, most notably among the low SES households. However, after adjusting with potential confounders, there was not enough evidence to conclude SES as a risk factor for feeding practice.

Coping strategies for food insecurity among adolescent girls during the lean season in East Nusa Tenggara, Indonesia: a qualitative study.

One in eight people suffer from chronic hunger, leading to an insecure food situation. Chronic hunger mostly occurs in developing countries and includes adolescent girls. Our qualitative study, with data collected in December 2012, provided the results of an exploration of the experiences and strategies implemented by fifteen adolescent girls who tried to cope with their condition of living in food-insecure families. The age of the girls ranged from 10 to 19 years. Their coping strategies were grouped into self-initiated and parent-initiated strategies. Self-initiated coping strategies that were the girls' own initiatives included eating only rice without any vegetables or side dish, eating less-desirable food, reducing portion size, skipping meals, saving pocket money and earning money to buy food. The parent-initiated coping strategies that were initiated by the parents and followed by the girls included selling their own field produce and livestock, asking for food, borrowing food and storing maize for 6 months up to 1 year. These results show that adolescent girls living in food-insecure areas implement several coping strategies in severe conditions, which parents may not be aware of, and such conditions may compromise their growth and health. The acknowledgement of such coping strategies and the girls' food insecurity condition can lead to a useful and suitable food insecurity alleviation programme for the girls and their families.

The International Breakfast Research Initiative-Evaluation and Comparison of Breakfast Nutrient Intakes in Indonesia, Malaysia and the Philippines with a View to Proposing a Harmonised Nutrient-Based Breakfast Recommendation.

The International Breakfast Research Initiative is a global study of breakfast nutrition, involving 17 countries in four continents, aiming to derive nutrient-based regional recommendations for breakfast. This study aimed to propose a harmonised recommendation for three South-East Asian countries: Indonesia, Malaysia, and the Philippines. For each country, data from nationally representative dietary surveys on the contribution of breakfast to daily nutrient intakes at both the adult population level and at the level of the upper tertile of daily nutrient density using the Nutrient Rich Food (NRF) Index were collated and examined. Energy intakes at breakfast ranged from 26 to 27% of daily energy intake. In all three countries, breakfast was carbohydrate-rich, providing 52 to 72% of breakfast energy intake, while it was higher in total and saturated fat in Malaysia and Indonesia. Intakes of fibre and vitamin C were low in all countries, while Malaysia tended to have higher intakes of most minerals, including sodium. Daily and breakfast nutrient intakes (at the population level and in the upper tertile of the NRF Index) were compared to the Codex Alimentarius nutrient reference values (NRVs) to assess adequacy. A decision tree was established based on these data to guide the development of recommendations for nutrient intakes at breakfast across the three countries.

Plant protein consumption is associated with body mass index among women of reproductive age in Indonesia.

Introduction: One of the known determinants of obesity in Southeast Asia countries, including Indonesia, is the nutritional transition, which is indicated by fast changes in food production, dietary habits, and physical activity. With rising incomes, plant protein from grains, tubers, and legumes is gradually being replaced by animal protein from poultry, eggs, dairy, and red meat. This change is identified as a protein transition. Different choices of protein sources in the diet have varying health effects. However, there is limited information on the Asian population on the role of protein consumption on the increasing obesity prevalence. Therefore, this study aimed to investigate the association of protein sources consumption with body mass index (BMI) among women of reproductive age in Indonesia. Methods: This study used secondary data from the 2018 Indonesia Food Barometer (IFB) conducted using a quantitative cross-sectional survey. A total of 467 Indonesian reproductive-aged women (20-49 years) were included in this study. Dietary intake, including protein consumption, was obtained using 24-h dietary recall. Multiple linear regression was applied to find the association of protein consumption with BMI with a p-value <0.05 considered as a significant outcome variable. Results: The Mean BMI was 25.02 kg/m2, median of animal and plant protein was 28.01 g/day and 25.37 g/day, respectively. Consumption of plant protein was significantly associated with BMI after adjusting for marital status and age (p-value = 0.043; R2 = 0.080). The quality of plant protein should be considered to prevent obesity problems among women of reproductive age.

Trends and determinants of early initiation of breastfeeding in Indonesia: A multivariate decomposition analysis.

BACKGROUND: Early initiation of breastfeeding (EIBF) is key to reducing neonatal morbidity and mortality, however, little is known about the determinants of the trends of EIBF prevalence in Indonesia. This study aims to assess the contributing factors to the changes in the prevalence of EIBF between 2007 and 2017. METHODS: We analysed data from the 2007, 2012, and 2017 Indonesia Demographic and Health Surveys to estimate the trends in EIBF. A multivariate logistic decomposition model was fitted to examine variables associated with changes in the percentage of EIBF from 2007 to 2017. The contributing factors to changes in EIBF prevalence were categorized into either compositional or behavioural changes, with each of them divided into portions or percentages of contribution (pct) of the independent variables. The former refers to the changes in the distribution of samples, while the latter refers to the changes in the behavioural responses toward EIBF in both surveys. All analyses accounted for the complex study design and potential confounding factors. RESULTS: An increase in the prevalence of EIBF from 49.9% to 56.5% was recorded between 2012 and 2017, with an overall increase of 16.9 percentage points from 2007 to 2017. At the aggregate level, the compositional differences did not significantly contribute to the changes in the percentage of EIBF, while 98.3pct (p < 0.001) was associated with changes in mothers' behavioural response towards EIBF. The composition changes in the geographical region of Sumatra, and caesarean delivery negatively contributed to the changes in EIBF prevalence with -0.6pct and -14.2pct, respectively. However, the compositional differences in those living in Kalimantan & Sulawesi, first-time mothers, and small-born infants positively contributed to the change. Behaviour changes in mothers with higher education (8.8pct), from higher income households (-17.5pct), and those residing in Sumatra (-8.2pct) and Kalimantan & Sulawesi (-10.2pct) significantly contributed to the upward trend in EIBF prevalence. CONCLUSIONS: Almost half of the newborns experienced delayed breastfeeding initiation despite the improvement in the prevalence of EIBF. Therefore, further research and interventions on behaviour change in mother's attitudes towards EIBF, especially among those undergoing caesarean delivery, living in Kalimantan or Sulawesi, and from wealthier households, are recommended to close this gap.

Breakfast Consumption and Quality of Macro- and Micronutrient Intake in Indonesia: A Study from the Indonesian Food Barometer.

Breakfast is an important meal that has been shown to have a positive effect on health. The current study aimed to assess the patterns of breakfast consumption among adult Indonesians and to estimate the contribution of breakfast to their nutrient intake and dietary quality. The study used 24-h recall data from the 2018 Indonesian Food Barometer study to assess breakfast intake among 1333 adults aged 18 and above from six provinces in Indonesia. Diet quality was measured using the Nutrient Rich Food index (NRF) 9.3, and the nutritional profile of breakfast was compared across tertiles of NRF 9.3. In total, 5.2% of adults in Indonesia skipped breakfast. Breakfast contributed 26% to daily energy intakes and 22-28% to intakes of all reported nutrients, except for total sugar (12%), vitamin C (8%) and vitamin D (7%). With respect to daily requirements, breakfast contributed approximately 20% to energy, protein, fat and sodium requirements, 26% to saturated fat but <15% to the requirements for most micronutrients and only 5% for fiber. Among breakfast consumers, a higher NRF score was associated with higher daily intakes of protein, dietary fiber and micronutrients and lower intakes of sodium from breakfast. This study suggests that a balanced breakfast in Indonesia should aim to lower fat and saturated fat intake while increasing fiber, potassium, calcium and vitamin C and D intake. These findings could inform the development of nutrient-based guidelines for breakfast consumption in Indonesia.

Diversity of protein food sources, protein adequacy and amino acid profiles in Indonesia diets: Socio-Cultural Research in Protein Transition (SCRiPT).

The ongoing nutrition transition in lower- and middle-income countries (LMIC) in South East Asia may have a positive impact on protein nutrition. This study assessed the diversity of plant and animal protein food sources in relation to essential amino acid (EAA) adequacy in a population-based sample (N 1665) in Indonesia. Dietary intakes from in-person 24 h recalls provided data on energy and protein intakes (in g/d) from plants (grains, legumes), meat, poultry and fish, and eggs and dairy. Protein diversity scores were based on the number of protein food sources over 24 h. EAA scores were the ratio of amino acid intakes to recommended values. Protein diversity and EAA scores were then compared across multiple socio-demographic indices. Analysis of variance and χ 2 tests were used to test for differences among groups. Energy intakes were 1678 kcal/d for men and 1435 kcal/d for women. Average protein intakes (and prevalence of inadequacy) were 59⋅4 g/d (41⋅7 %) for men and 51⋅5 g/d (51⋅1 %) for women. In regression analyses, higher protein diversity scores were associated with higher protein intakes, more animal protein and less plant protein and with higher EAA scores. Lower protein diversity scores were associated with lower intakes of lysine, leucine and valine relative to requirements, as well as with lower EAA, rural settings, less wealth and less modernisation. Greater diversity of animal protein food sources, observed among groups of higher socio-economic status, was linked to better amino acid adequacy and protein nutrition.

Animal and Plant Protein Food Sources in Indonesia Differ Across Socio-Demographic Groups: Socio-Cultural Research in Protein Transition in Indonesia and Malaysia.

BACKGROUND: Plant-based diets in lower-income countries are often associated with inadequate protein nutrition and adverse health outcomes. OBJECTIVE: To examine the diversity of protein food sources, in both animal and plant, across diverse socio-demographic groups in Indonesia as compared to Malaysia. DESIGN: The SCRiPT (Socio Cultural Research in Protein Transition) study was based on population-based samples recruited in Indonesia (N = 1665) and in Malaysia (N = 1604). Data from 24-h in-person dietary recalls in each country were used to construct the frequency counts of protein sources by food group. Protein sources were defined as fish, poultry, red meat (beef, pork, and mutton), eggs, dairy, and plants (cereals, pulses, and tubers). The percent reported frequencies for animal and plant proteins were compared across socio-demographic strata and by country. Analyses were based on one-way Anovas and general linear model regressions adjusting for covariates. RESULTS: Animal protein frequency counts were 34% of total in Indonesia, but 50% in Malaysia's. Higher reported consumption frequencies for poultry and red meat in both countries were associated with urban living, greater modernization, and higher socioeconomic status, with stronger social gradients observed in Indonesia. Reported fish consumption was higher in Indonesia than in Malaysia. Fish was more likely to be listed by rural island populations in Indonesia and was associated with lower education and incomes. Consumption frequencies for plant-based proteins were associated with lower socio-economic status in Indonesia and in Malaysia. CONCLUSIONS: More affluent groups in both countries reported higher frequencies for meat, eggs, and dairy as opposed to fish. Greater economic development in Southeast (SE) Asia is associated with more animal protein, particularly from poultry, which may displace fish, the traditional source of high quality protein for the region.

Socio-Cultural and Economic Drivers of Plant and Animal Protein Consumption in Malaysia: The SCRiPT Study.

Countries in South East Asia are undergoing a nutrition transition, which typically involves a dietary shift from plant to animal proteins. To explore the main drivers of protein consumption, the SCRiPT (Socio Cultural Research in Protein Transition) study recruited a population sample in Malaysia (N = 1604). Participants completed in-person 24 h dietary recalls and socio-demographic surveys. Energy and nutrient intakes were estimated using Nutritionist Pro. A novel recipe-based frequency count coded protein sources as meat (chicken, beef, pork, and mutton), fish, eggs, dairy, and plants (cereals, pulses, tubers). Dietary intakes and frequencies were examined by gender, age, income, education, ethnicity, religion, and family status, using ANOVAs and general linear models. Energy intakes were 1869 kcal/d for men and 1699 kcal/d for women. Protein intakes were 78.5 g/d for men and 72.5 g/d for women. Higher energy and protein intakes were associated with Chinese ethnicity, higher education and incomes. Frequency counts identified plant proteins in 50% of foods, followed by meat (19%), fish (12%), eggs (12%), and dairy (7%). Most frequent source of meat was chicken (16%) rather than pork or beef (1.5% each). In bivariate analyses, animal protein counts were associated with younger age, higher education and incomes. In mutually adjusted multivariate regression models, animal proteins were associated with education and ethnicity; plant proteins were associated with ethnicity and religion. Protein choices in Malaysia involve socio-cultural as well as economic variables.

Adolescent women as a key target population for community nutrition education programs in Indonesia.

BACKGROUND AND OBJECTIVES: Adolescence is a critical life-stage that sets the foundation for health in adulthood. Adolescent women are a unique population and should be targeted as such for nutrition promotion activities. Using Indonesia as a case study, this qualitative study aimed to identify existing nutrition promotion programs aimed at adolescent girls, how best to target this population and effective recommendations to inform nutrition education program design for this important group. METHODS AND STUDY DESIGN: Semi-structured interviews and questionnaires were conducted with ten key informants working in public health in Indonesia. Interview transcripts were analysed and coded to identify key themes. RESULTS: No existing nutrition education programs targeting adolescent women in Indonesia were identified. Several strategies apply to nutrition programs for adolescent girls: 1) nutrition promotion messages that are relevant to the lifestyles and interests of adolescent women; 2) technology-based interventions show promise, however, they need to be appropriately targeted to sub-groups; 3) school remains an important setting; and 4) early marriage is an important issue affecting nutritional status and engagement of adolescent girls. The informants recommended that: 1) more research is needed about the underlying motivations for behaviour change among adolescent women and ways to effectively implement the identified engagement strategies; 2) adolescent girls should be included in program design to improve its suitability and uptake; and 3) government budget and policy support is crucial to success. CONCLUSIONS: Adolescent women are an important population group and more research is required to identify the optimal forms of engagement to improve nutrition programs for them.

Family Food Providers' Perceptions of the Causes of Obesity and Effectiveness of Weight Control Strategies in Five Countries in the Asia Pacific Region: A Cross-Sectional Survey.

The rise of the middle classes in developing countries and the associated epidemiological transition raises the importance of assessing this population group's awareness of the causes of obesity and effective weight control strategies in order to develop effective health promotion strategies. The study aimed to examine the perceptions of the causes of obesity and weight control strategies held by middle class household food providers in Melbourne, Singapore, Shanghai, Indonesia and Vietnam. An online survey was conducted in late 2013, early 2014 among 3945 respondents. Information about body weight concerns, perceived causes of obesity, effectiveness of weight control methods, demographics, self-reported height and weight, and personal values was elicited. Confirmatory factor analyses (CFA) derived nine reliable factors which were used in structural equation modelling (SEM). Two thirds of respondents were trying to change their body weight, of them, 71% were trying to lose weight. The CFA and SEM showed that demographics, region of residence, personal values and perceptions of the causes of obesity (Unhealthy food behaviours, influences Beyond personal control and Environmental influences) had direct and indirect associations with three weight control methods factors, named: Healthy habits, Eat less, sit less, and Dieting. Middle class food providers in the study regions share public health views of obesity causation and personal weight control. These findings could inform public health and food policies, and the design of public health interventions and communications. Further research is required among lower socio economic status (SES) populations.

Personal values, marketing attitudes and nutrition trust are associated with patronage of convenience food outlets in the Asia-Pacific region: a cross-sectional study.

BACKGROUND: An online cross-sectional survey examined the relationships between the demographic characteristics, personal values, trust in sources of nutrition information and the use of convenience food outlets among middle-class household food providers in the Asia-Pacific region. METHODS: The survey was administered to 3945 household food providers in Melbourne, Singapore, Shanghai, Vietnam and Indonesia in late 2013. Information about demographics, personal values, trust in sources of nutrition information and use of convenience food outlets was elicited. Exploratory factor analysis, two-step clustering and logistic regression were employed. RESULTS: The analyses found that the use of convenience food outlets was positively related to hedonist values and trust in food industry sources of nutrition information. However, lesser use of convenience food outlets and trust in health sources of nutrition information was associated with traditional (community-oriented) values. CONCLUSIONS: Further replication and extension of these findings would be useful. However, they suggest that improvements in the quality of foods sold in convenience food outlets combined with stronger regulation of food marketing and long-term food education are required.

Food Store Choice Among Urban Slum Women Is Associated With Consumption of Energy-Dense Food.

The aim of this study was to examine the associations of food store choice with food consumption among urban slum women. A cross-sectional survey was carried out among 188 urban slum women (19-50 years old) in Jakarta, Indonesia. A semiquantitative food frequency questionnaire was used to assess food consumption. Associations between food consumption and food store choice were tested by linear regression. This study found that frequencies of buying food from small shops (warung), street food vendors, and modern food stores were significantly associated with consumption of snacks, mixed dishes, and fruit respectively. In addition, buying food from traditional markets and small cafes (warung makan) was not significantly associated with particular types of food consumption. As modern food stores are rarely utilized by these women, small shops (warung) and street food vendors are likely to be important channels to improve slum dwellers' diet.

Nutrition education: it has never been an easy case for Indonesia.

The root of Indonesian education can be traced back to the Dutch colonial period. The country adopts the 6-3-3-4 system of education, which consists of public schooling, Islamic schooling, and out-of-school education. In addition, the country has also been exposed to distance education. The call for this type of education was due to the geographic condition of Indonesia where face-to-face instruction has become limited. Studies on nutrition education in Indonesia covered various topics and teaching methods that were delivered mostly in after-class sessions. Effects on improved knowledge and attitudes were more marked than that of practices in relation to each nutrition topic. Nutrition and its related topics are delivered separately in different school subjects, such as biology, sport, health science, and home economics. Moreover, as the country keeps developing malnutrition problems, the Indonesian government through the Ministry of Health has run a feeding program that covers only children in elementary school aged 6-12 years old both in urban and rural areas. Efforts from private sectors and NGOs on the feeding program for schoolchildren seem to give complementary effects to the existing program. Human resources development of nutrition professionals was started in the early 1950s when a school for food scientists was first established. However, the professionals responsible for delivering nutrition-related topics in the school are the school teachers who mostly have never received relevant training for delivering such topics. For achieving effective children's nutrition education through schools, a solid partnership among stakeholders must be encouraged.

Feeding practices among Indonesian children above six months of age: a literature review on their potential determinants (part 2).

BACKGROUND: Feeding practices among young children are not optimal in Indonesia. Improving these practices is crucial to prevent and reduce malnutrition among young children. A better understanding of the underlying factors to appropriate practices is essential to address barriers and identify opportunities to optimal practices. This paper aims to shed light on potential determinants of feeding practices among children above 6 months of age. METHODS: A systematic research of several databases using combinations of different search terms: feeding, child, Indonesia, MPASI/complementary food, gizi/nutrition, factor, determinant, praktek/practices was conducted. All documents were reviewed using a three-step procedure to assess content appropriateness and research quality. Data were analyzed using the Hector's framework on behaviour change. RESULTS: Available data on individual factors influencing feeding practices related mainly to mother's attributes, namely knowledge, perceptions, attitudes, beliefs and skills. Some of them are positively linked to good practices. Some environmental-related factors such as health services, home and peer environment were conducive to improved practices. Studies on societal factors were mostly restricted to food systems which do not favour optimal feeding practices. CONCLUSIONS: The review provides insights on underlying factors conducive to optimal feeding practices. Yet, relevant and quality research is required to get a better understanding on factors related to the environment and society as well as on how they are related with each other and operate in different contexts. Indonesia has already experimented successful programs which can be used as a reference to strengthen young child feeding practices.

Feeding practices among Indonesian children above six months of age: a literature review on their magnitude and quality (part 1).

BACKGROUND: In Indonesia, 37% of children under-five are stunted, 12% wasted and 12% overweight. Adequate feeding practices among children above 6 months of age are critical to tackle malnutrition. National surveys have been conducted to assess feeding practices but these aggregates hide geographic disparities. While several studies have been conducted in specific country locations to address this gap, no attempt has been made to reconcile available information. This paper aims to provide a comprehensive review of the literature on feeding practices among Indonesian children above six months of age. METHODS: A literature search was conducted in several databases using combinations of different search terms: feeding, child, Indonesia, MPASI/complementary feeding, gizi/nutrition, factor, determinant, praktek/practices. All documents were reviewed using a three-step procedure to assess content appropriateness and research quality. Available information was analyzed using current recommendations on feeding practices. RESULTS: Dietary diversity, consumption of iron-rich foods, active feeding and hygiene practices were among the non-optimal feeding practices. Consequently dietary intakes are not fulfilled for several micronutrients. Some feeding practices are worst in younger children. Differences between data from national and site-specific surveys are noted. Overall quality of the surveys needs to be strengthened. CONCLUSIONS: Generally, child feeding practices are not optimal. Indicators used to assess components of child feeding vary and make inter-survey comparisons challenging. The results also stress the need to investigate the underlying factors to optimal child feeding practices. The results may be used for advocacy of additional resource allocation for effective child feeding promotion programs.