The effects of mother's education on achieving exclusive breastfeeding in Indonesia.

BACKGROUND: Even though the Indonesian government have set regulations for maintaining exclusive breastfeeding practices, the coverage remains low. The study aims to analyze the effects of mother's education level on the coverage of exclusive breastfeeding in Indonesia. METHODS: This study used data from the 2017 Nutrition Status Monitoring Survey. It covered data of 53,528 children under 5 years old (7-59 months) as the samples. Variables included exclusive breastfeeding status, mother's education level, mother's age, marital status, employment status, gender, residence, under five's age and gender. A binary logistics regression was performed in the final test. RESULTS: Mothers who graduated from elementary school were 1.167 times more likely to perform exclusive breastfeeding compared to mothers who never attended schools. Additionally, those who graduated from junior high school had 1.203 times possibilities to give exclusive breastfeeding compared to mothers without educational records. While, mothers who graduated from high school were 1.177 times more likely to perform exclusive breastfeeding compared to those without educational records. Mothers who graduated from tertiary education had 1.203 times more possibilities to perform exclusive breastfeeding compared to mothers who were never enrolled to schools. Other variables also became affecting predictors on exclusive breastfeeding, such as mother's age, mother's employment status, child's age, and residence. CONCLUSIONS: The mother's education level positively affects exclusive breastfeeding practice in Indonesia.

Pandemic Pressure: Changes in Hypertensive Management Adherence in Indonesia.

PURPOSE: This study aimed to determine factors associated with changes in adherence to hypertension management (medication adherence and blood pressure control) in respondents with hypertension before and during the COVID-19 pandemic in Bogor city, Indonesia. METHODS: An observational study was conducted using two sources of data (before and during COVID-19 pandemic). Data before the pandemic were derived from the 2019 Cohort Study of non-communicable disease risk factors. Data during the pandemic were derived from an online survey conducted in September and October 2020. Information from 880 participants were analyzed. The dependent variable was the change in adherence to hypertension management before and during the COVID-19 pandemic. Multivariate analysis was performed using logistic polynomial regression. RESULTS: Respondents who adhered to hypertension management decreased from 82.0% in 2019 to 47.8% in 2020. The likelihood of non-adherence (respondents who did not adhere to hypertension management both before and during the pandemic) increased in respondents below 55 years old, who did not own any healthcare insurance, who were not obese, and who had no other comorbidities. In the partial adherence group (respondents who did not adhere to hypertension management either before or during the pandemic), we found that most respondents adhered before the pandemic but no longer adhered during the COVID-19 pandemic. We found an increased partial adherence in young and highly educated respondents. CONCLUSIONS: Efforts to improve adherence to hypertension management after the COVID-19 pandemic should target those who were young, highly educated, who did not have any healthcare insurance, and who did not perceive themselves as not having comorbidities.

Nonadherence to anti-tuberculosis treatment, reasons and associated factors among pulmonary tuberculosis patients in the communities in Indonesia.

BACKGROUND: Tuberculosis (TB) is the world's major public health problem. We assessed the proportion, reasons, and associated factors for anti-TB treatment nonadherence in the communities in Indonesia. METHODS: This national coverage cross-sectional survey was conducted from 2013 to 2014 with stratified multi-stage cluster sampling. Based on the region and rural-urban location. The 156 clusters were distributed in 136 districts/cities throughout 33 provinces, divided into three areas. An eligible population of age ≥15 was interviewed to find TB symptoms and screened with a thorax x-ray. Those whose filtered result detected positive followed an assessment of Sputum microscopy, LJ culture, and Xpert MTB/RIF. Census officers asked all participants about their history of TB and their treatment-defined Nonadherence as discontinuation of anti-tuberculosis treatment for <6 months. Data were analyzed using STATA 14.0 (College Station, TX, USA). RESULTS: Nonadherence to anti-TB treatment proportion was 27.24%. Multivariate analysis identified behavioral factors significantly associated with anti-TB treatment nonadherence, such as smoking (OR = 1.78, 95% CI (1.47-2.16)); place of first treatment received: government hospital (OR = 1.45, 95% CI:1.06-1.99); private hospital (OR = 1.93, 95% CI: 1.38-2.72); private practitioner (OR = 2.24, 95% CI: 1.56-3.23); socio-demographic and TB status included region: Sumatera (OR = 1.44, 95% CI: 1.05-1.98); other areas (OR = 1.84, 95% CI: 1.30-2.61); low level of education (OR = 1.60, 95% CI: 1.27-2.03); and current TB positive status (OR = 2.17, 95% CI: 1.26-3.73). CONCLUSIONS: Nonadherence to anti-TB drugs was highly related to the personal perception of the respondents, despite smoking, current TB status, a place for the first treatment, education, and region. The position of the first TB treatment at the private practitioner was significantly associated with the risk of Nonadherence to treatment.

The Targets for Stunting Prevention Policies in Papua, Indonesia: What Mothers' Characteristics Matter?

The study aimed to analyze the most appropriate maternal characteristics for stunting prevention policies. The study employed secondary data from the 2017 Indonesia Nutritional Status Monitoring Survey. The study obtained weighted samples of 11,887 Papuan children under five years of age. On the other hand, the study used the nutritional status as an outcome variable and maternal characteristics as an exposure variable. The research employed the following four control variables: residence, region, under-five age, and gender. The study occupied the binary logistic regression. The results show that mothers who graduated from primary school and under were 1.263 times more likely than mothers with a college education to have stunted children. Mothers who graduated from junior high school are 1.222 times more likely than mothers with a college education to have stunted children. Mothers who graduated from senior high school were 1.122 times more likely than mothers with a college education to have stunted children. Mothers with a never-married status have a 1.138 times greater probability than divorced/widowed mothers to have stunted children. Meanwhile, married mothers are 0.936 times more likely than divorced/widowed mothers to have stunted children. The study concluded that the target group for stunting prevention policies are mothers with poor education and who are single.

The Influence of Iron Depletion and Chronic Energy Deficiency on the Risk of Hypothyroidism in Pregnant Women Living in Iodine Deficiency Disorders Endemic Areas in Badegan Ponorogo District East Java, Indonesia.

Several minerals are needed for thyroid hormone to work properly, such as iodine and iron. Iron is one of important essential trace elements that serves as co-factor for thyroid peroxidase (TPO). Those with iron deficiency have lower ferritin serum level than those who are normal. In particular, pregnant women with chronic energy deficiency (CED) have higher anemia risk than the otherwise. The study aimed to measure ferritin level, CED and hypothyroidism among pregnant women living in iodine deficiency disorders (IDD) endemic areas. A total of 37 pregnant women aged 18-45 y-oldwith pregnancy of 2 to 8 mo living in ID Dendemic of Dayakan and Watu Bonang Villages of Ponorogo District were include dinthestudy. Two different measurements were taken namely, anthropometric measurement of mid-upper arm circumference (MUAC) or upper circumference (UAC) which is more correct term to use, and blood markers of iodine and iron status were assessed using thyroid stimulating hormone (TSH), free thyroxine (fT4), and bloodferritin. Among pregnant women, 27% had hypothyroidism and 54.05% had iron depletion, with 30% had both conditions. The hypothyroidism was higher in pregnant women had CED than those non-CED, 50% vs. 18.5%. No significant correlation (p≥0.05) between hypothyroidism and both ferritin and CED, but adjusted odds ratio (AOR) was found at 7.7 (95% CI: 1.2-52.9), indicated more than four times higher risk of hypothyroidism in pregnant women with CED than the otherwise. Hypothyroidism in pregnant women living in Ponorogo was not caused by iron deficiency, but allegedly by lack of other nutritional intake. Conclusion: Integrated and sustainable efforts to improve nutritional status is needed since pre-conception and throughout pregnancy.

Pathway Analysis of Growth Faltering Pattern Based on Height for Age in Children Under Five in Indonesia Based on Indonesian National Health Survey 2013.

Growth failure has a severe impact on public health problems. Stunting is a particular growth failure contributing to the child mortality and morbidity of non-communicable diseases in adults. Objective: To analyze the determinants of growth failure patterns in children under five years in Indonesia. The further analysis was taken from 6,020 samples, based on the Indonesian National Health Survey (Riskesdas) 2013 (cross-sectional survey with a multistage cluster sampling method). Inclusion criteria are data that have completed records. The exclusion criteria were data having no outlier in anthropometric measurement. Nutrition status is analyzed using WHO AnthroPlus 2009. Data analysis is taken by path analysis in SPSS 21. The growth curve height for the under five-year children in Indonesia is less than the WHO growth standard. The mean height for age z-score (HAZ) has declined in linear patterns among the first five years of life. The determinant of growth is divided into two age groups. Overall, socioeconomic status has an indirect effect adjusted by both age and gender with r 0.10. In children <36 mo, the nutrition status of the mother has a direct and indirect effect on the birth nutrition status with r 0.17, while low birth weight, breastfeeding status, infectious disease, and immunization are the direct factor to HAZ score. In children aged 37-59 mo, infectious disease is a direct factor. Socioeconomic status, BMI of a mother, breastfeeding status, immunization, and infectious disease are the determinants of growth failure patterns in Indonesia.

Adequately iodized salt is an important strategy to prevent iodine insufficiency in pregnant women living in Central Java, Indonesia.

Iodine is an essential micronutrient for cognitive development and growth. Optimal intakes are critical during pregnancy. We report the iodine status and thyroid function of pregnant women living in areas previously affected by severe iodine deficiency and in longstanding iodine sufficient areas in Java, Indonesia. This cross-sectional study was conducted in Magelang, Java, from July to November 2015, in four sub-districts; two previously affected by severe iodine deficiency (area 1) and two that were iodine-sufficient (area 2). Iodine intake was estimated using median urinary iodine concentration in spot samples and mean urinary iodine excretion in 3 x 24-hour samples, thyroid hormones (thyroid-stimulating hormone and free thyroxine) were measured in venous blood samples, and iodine content of household salt samples was estimated by titration. We recruited a total of 244 pregnant women, 123 in area 1 and 121 in area 2. Urinary iodine results suggested adequate habitual iodine intakes in both areas (median urinary iodine concentration in area 1: 222 µg/l (interquartile range 189, 276 µg/l), area 2: 264 µg/l (interquartile range 172, 284 µg/l), however, the risk of inadequate intakes increased with advancing trimester (Odds Ratio = 2.59 (95% CI 1.19-5.67) and 3.85 (95% CI 1.64-9.02) at second and third trimesters, respectively). Estimated prevalence of thyroid function disorders was generally low. Salt was iodized to approximately 40 ppm and foods rich in native iodine did not contribute significantly to dietary intakes. Adequately iodized salt continues to prevent iodine insufficiency in pregnant women living in areas previously affected by severe iodine deficiency in Java, Indonesia. Monitoring and surveillance, particularly in vulnerable groups, should be emphasized to ensure iodine sufficiency prevails.

Assesment of Thyroid Function and Its Association with Free Thyroxin Hormone among Pregnant Women in Areas with Previous History Iodine Deficiency in Magelang, Indonesia.

Iodine deficiency in pregnant woman can affect growth and development of fetus. People who live in an area that had affected by previous iodine deficiency may continuously affect by abnormal thyroid function. The aim of the study is to assess thyroid function, that was measured by the concentrations of thyroid stimulating hormone, and its relationships with free thyroxine (fT4) among pregnant women in the two different geographic areas with previous history of iodine deficiency in Magelang, Central Java, Indonesia. Cross-sectional study was conducted in two types of location (replete and non-replete area) in Magelang, Central Java, Indonesia. A total of 243 aged between 15-45 y old with no pregnancy complication from two different geographics areas of iodine replete and sufficient were include in study. Blood biochemical markers such as free thyroxine hormone and thyroid stimulating hormone were assessed by Elisa method. Median of fT4 in non-replete and replete area was 1.18 (0.63-3.5) ng/dL; 1.12 (0.37-1.95) ng/dL, respectively. Whilst, median of TSH in replete area was 1.27 (0.09-8.21) ng/dL and non replete area was 1.3 (0.01-8.67) ng/dL. Correlation between fT4 and TSH showed significat relationship in non-replete area, r=-0.39 (<0.05), but it was not significant in replete area, r=-0.08 (>0.05). In addition, scatter plot showed the relationship between fT4 and TSH levels pattern in the replete area more widespread. Pregnant womens who live in areas that had affected severe iodine deficiency intake may have abnormal thyroid function but it still euthyroid maintain by adequate iodine intake.

Variation of preventive practices and its association with malaria infection in eastern Indonesia: Findings from community-based survey.

BACKGROUND: Geographical variation may likely influence the effectiveness of prevention efforts for malaria across Indonesia, in addition to factors at the individual level, household level, and contextual factors. This study aimed to describe preventive practices at individual and a household levels applied by rural communities in five provinces in eastern Indonesia and its association with the incidence of malaria among adult (≥15 years) populations. METHODS: This study analyzed a subset of data of nationally representative community-based survey 2018 Riset Kesehatan Dasar (Riskesdas). Data for socio-demographic (age, gender, education and occupation) and preventive behaviors (use of mosquito bed nets while slept, insecticide-treated mosquito nets (ITNs), mosquito repellent, mosquito electric rackets, mosquito coil/electric anti-mosquito mats, and mosquito window screen) were collected. Data were analyzed using bivariate and multivariable logistic regression model. RESULTS: Total of 56,159 respondents (n = 23,070 households) living in rural areas in Maluku (n = 8044), North Maluku (n = 7356), East Nusa Tenggara (n = 23,254), West Papua (n = 5759) and Papua (n = 11,746) were included in the study. In the multivariable models, using a bed net while slept likely reduced the odds of self-reported malaria among Maluku participants. Reduced odds ratios of self-reported malaria were identified in those participants who used ITNs (North Maluku, ENT, Papua), repellent (Maluku, West Papua, Papua), anti-mosquito racket (ENT), coil (Maluku, North Maluku, Papua) and window screen (West Papua, Papua). CONCLUSION: Our study concluded that the protective effects of preventive practices were varied among localities, suggesting the need for specific intervention programs.