The effect of yoga training on postpartum prolactin and oxytocin levels in primipara women.

Lactation relies on the secretion of two key hormones, prolactin and oxytocin. Studies have shown that yoga in the postpartum period can stimulate feelings of comfort and relaxation, which increases oxytocin production. The aim of this study was to evaluate the effect of yoga training on postpartum prolactin and oxytocin levels in a group of primipara women. This quasi-experimental study included 60 healthy primigravida, primipara women in their third trimester who attended antepartum and postpartum care at four primary healthcare centers in Kediri Regency. The participants were randomly allocated to an intervention group (n = 30) and a control (n = 30) group. The intervention group received health education and participated at eight yoga sessions with a duration of 60 min, from week 32 of gestation until the postpartum period. The control group received standard antepartum and postpartum care. Prolactin and oxytocin levels were measured in weeks 1 and 6 postpartum. Mean prolactin increment was significantly higher in the intervention group (176.8 ± 66.6 ng/ml) than the control group (24.8 ± 39.5 ng/ml). Similarly, mean oxytocin increment was significantly higher in the intervention group (58.6 ± 31.59 pg/ml) than the control group (14.6 ± 36.06 pg/ml). Our results suggest that yoga training in the third trimester until the postpartum period increases prolactin and oxytocin levels among primipara postpartum women.

Comparison of high and low stunting reduction groups using IFE-EFE matrix analysis in Central Java Province, Indonesia.

Background: The results of the 2021 Indonesian Nutritional Status Study (Studi Status Gizi Indonesia, SSGI) showed a 6.8% declining prevalence of stunting in Central Java from 2019 to 2021. However, the prevalence decreases in the regency level of Central Java varied from 0.1 to 20.3%. This study aimed to analyze the external and internal factors that influenced the stunting reduction prevalence in Central Java Province, Indonesia. Methods: This qualitative study was conducted over 2 months, from April to May 2022. In-depth interviews were used to explore the supporting factors (external, internal, and strategies) and the challenges (internal, external, and solutions) in implementing stunting reduction acceleration programs. The supporting factors and challenges were compared between the groups with high Gro, Sra, Kla, and Pek (GSKP) and low Sur, Mag, Teg, and Pat (SMTP) reduction prevalence. Data were analyzed using internal factor evaluation (IFE) and external factor evaluation (EFE). Results: In quadrant II, the high-reduction group (GSKP) had IFE and EFE scores of 2.61 and 2.76, respectively. In quadrant IV, the low-reduction group (SMTP) had IFE and EFE scores of 1.86 and 1.62, respectively. The high-reduction group (GSKP) was better than the low-reduction group (SMTP) in using external opportunities and internal strengths by avoiding external threats and minimizing the weakness in the stunting reduction acceleration program in each area. The existence of superior programs and innovations were the strengths that differentiated the high and low groups. Conversely, the low-stunting reduction group struggled to overcome major challenges, especially lacking leadership capacity. From the outside, lack of program sustainability at the village level and budget restraint were the threats found in both groups. Conclusion: Compared with the low-stunting reduction group, the high group could maximize their strengths and use the opportunities to implement stunting reduction programs.

Vitamin D Supplementation and Sun Exposure Maintain Blood Pressures of Pregnant Women and Increase Birth Weight in a Randomized Controlled Trial.

Background: Vitamin D supplementation or sun exposure increase pregnant women's Calcidiol levels, lower the blood pressures and increase birth weight. We aimed to compare the effects between sun exposure and vitamin D supplementation on pregnant women's Calcidiol levels, blood pressures and newborns' anthropometric indices. Methods: This randomized clinical trial was conducted on 108 pregnant women at 20 wk of gestation on 2021's dry season in Semarang City, Indonesia. The subjects were randomly and evenly divided into 3 groups of 36 subjects (sunlight exposure, vitamin D supplement, and control). Vitamin D group received 1000 IU daily and sun exposure group was recommended to have 15-30 min for 3 times/week for 17 wk. Compliance was monitored every 2 d through home visits. Calcidiol levels, blood pressures, in all groups were compared before and after intervention. The increments and the newborn anthropometric indices were compared between the groups and controlled for confounding factors. Results: At baseline, all groups had vitamin D deficiency, different mean Calcidiol levels, systolic, and diastolic blood pressures. The mean Calcidiol levels increased in the sun exposure and vitamin D group after the intervention. Systolic blood pressure decreased in the vitamin D group only (P=0.019). The mean birth weight was the highest in the vitamin D group (3,172±181.8 g) compared to the sun exposure (3,091±362.5g) and control groups (2,861 ± 208.0 g). Conclusion: Vitamin D supplementation and sun exposure increased Calcidiol levels and birth weights. Vitamin D supplementation maintained systolic blood pressure.

Determinants of length for age Z scores among children aged 6-23 months in Central Java, Indonesia: a path analysis.

Introduction: Length for Age Z (LAZ) score determinants are complex and vary among different areas, but it is important for designing effective and efficient strategies to decrease stunting prevalence among children under 2 years. This study aimed to investigate the determinants of LAZ scores among children under 2 years in Central Java, Indonesia. Methods: This study was conducted on the 2021 Indonesian Nutritional Status Study (INSS) dataset, which was a cross-sectional survey. Data on 3,430 children aged 6-23 months from Central Java province were derived from the 2021 INSS data. After missing data elimination, 3,238 subjects were included in the analysis. Determinant factors included direct and indirect factors. Direct factors were the mother's age, birth weight Z score (BWZ), birth length Z score (BLZ), exclusively breastfed history, dietary diversity scores (DDS), empty calorie drink consumption, unhealthy snacks consumption, and infections. Indirect factors were early initiation of breastfeeding (EIBF) and posyandu (integrated health post) utilization. Underlying factors were socioeconomic status (SES) and the mother's education. Bivariate analyses and multiple linear regressions were conducted. A path analysis with a hypothesized model based on the UNICEF conceptual framework was also performed. Results: Stunting, wasting and underweight proportions among the subjects were 19.1%, 7.6% and 12.3%, respectively. The mean LAZ scores were -0.95 ± 1.22; the mother's age was 29.7 ± 5.95 years; BWZ was -0.47 ± 0.97; BLZ was -0.55 ± 1.05; and DDS was 4.45 ± 1.51. The infection proportion among the subjects was 28%. BWZ and BLZ were positively correlated to LAZ scores, with r = 0.267 (p < 0.01) and r = 0.260 (p < 0.01), respectively. The mother's age was negatively correlated to LAZ scores with r = -0.041 (p < 0.05). Maternal education was positively correlated to SES but had no direct effect on LAZ scores. LAZ score determinants of BLZ (p < 0.001) and SES (p < 0.001) showed positive direct associations with LAZ scores, but the mother's age (p = 0.039), exclusively breastfed history (p < 0.001), and empty calorie drinks consumption (p < 0.001) had negative associations with LAZ scores. Conclusion: To prevent stunting among children aged 6-23 months in Central Java, Indonesia, intervention programs to increase the nutritional status of women at child-bearing age and nutrition education on child feeding practices should be conducted more efficiently and effectively.

Effect of Short Course on the Knowledge and Practice of Housewives Peer Group Activists as Assistance to Lactating Mothers in Providing Exclusive Breastfeeding.

Background: Efforts to increase the coverage of exclusive breastfeeding require extraordinary innovation supported by many parties, such as community leaders, including Housewives Peer Group activist living as a neighborhood of lactating mothers. The aim of this study was to analyze the effect of a short course on the knowledge and practice of Housewives Peer Group activists as assistance to lactating mothers in providing exclusive breastfeeding. Methods: The method of the research was pre and post-test of quasi-experimental. The population was Housewives Peer Group activists in the working area of Tlogosari Wetan Community Health Center, Semarang City. Samples were chosen using purposive random sampling to 37 Housewives Peer Group activists. The intervention given was a short course which should be attended by the group, and the post-test was assessed 1 month after conducting the pre-test. Results: The results of the Wilcoxson Match Paired test showed differences in knowledge (P < 0.05) and practice (P < 0.05) of the Housewives Peer Group activists before and after attending a short course regarding exclusive breastfeeding and lactation management. At the end of the study, the knowledge and practice of the Housewives Peer Group activists increased by 4.21 points and 3.73 points, respectively. Conclusions: Short course on exclusive breastfeeding and lactation management significantly influences the increased knowledge and practice of Housewives Peer Group activists that further improve the quality of transferred information, monitor public health, especially to increase the coverage of exclusive breastfeeding and lactation management for breastfeeding mothers.

Postpartum Care Behavior Improvement during COVID-19 Pandemic in Indonesia Using Mobile-Health Interactive Message.

Background: Since 2018, maternal mortality in Semarang City, Indonesia, has mostly (75%) occurred during the postpartum period. Therefore, a health intervention is necessary to improve safe and effective postpartum care. During the Covid-19 pandemic, a mobile-based health intervention is preferred due to the government's regulation of COVID-19 safety prevention. This study aimed to determine the effectiveness of the mobile-health interactive message on the postpartum care behavior of mothers and their husbands. Methods: The study was conducted in a quasi-experimental design. It includes the treatment group and the control group, in which each group consists of 46 pairs of pregnant women in the third trimester and their husbands. The research subjects were chosen through the purposive sampling technique. Data collection was conducted via interviews and observations. The m-health intervention is carried out in the form of text messages, images, videos, and interactive mentoring. The latter was carried out through group messaging via the WhatsApp application for the treatment group. Meanwhile, the control group received regular counseling from the local Community Health Center. Data analysis was performed by Mann-Whitney test, unpaired T-Test, Chi-Square Test dan Fisher Exact Test. Results: Intervention for 2.5 months increased the knowledge of mothers and husbands. The intervention for 3.5 months improved the mother's attitude, but not the husband's attitude. The intervention also improves maternal practices related to postpartum visits, such as Early Initiation of Breastfeeding assistance requests from health workers, iron tablets and nutritious food consumption, personal hygiene, postpartum danger signs monitoring, and the husband's practice of accompanying mothers during postpartum visits. Conclusion: Mobile-Health interactive messages effectively improved postpartum care behavior for mothers and their husbands.

Prevalence and determinants of obesity among individuals with diabetes in Indonesia.

Background: Obesity and diabetes mellitus (DM), both individually or simultaneously, increase the risk of morbidity and mortality. The present study aimed to determine the prevalence and determinants of obesity among diabetic individuals in Indonesia. Methods: Data were extracted based on 2018 Indonesian Basic Health Survey (Riset Kesehatan Dasar=RISKESDAS). This study involved all individuals with DM and categorized obesity based on body mass index. After data clearing, this study analyzed 3911 DM subjects of the 33.905 subjects acquired from the 2018 RISKESDAS. The study also observed demographic data, diabetes control parameters, history of hypertension, lipid profiles, and food consumption patterns. These variables were involved in a Chi-square test, and related variables were then involved in the Binary logistic regression to define the independent determinants of obesity among DM subjects. Results: Of the 3911 DM subjects included, the study found an obesity prevalence of 32.9%. This study found that female (prevalence odds ratio [POR]=2.15; 95% CI: 1.76-2.62), age 15-44 years (POR=2.46; 95% CI: 1.83-3.33), urban residence (POR=1.49; 95% CI: 1.25-1.77), history of hypertension (POR=1.25; 95% CI: 1.04-1.51), high diastolic blood pressure (POR=1.90; 95% CI: 1.58-2.29), high LDL (POR=1.44; 95% CI: 1.13-1.84), high HDL (POR=0.60; 95% CI: 0.46-0.78, and high triglycerides (POR=1.27; 95% CI: 1.07-1.50) were the risk factor of obesity  among DM subjects; while higher education (POR=0.64; 95% CI: 0.53-0.78) and married (POR=0.73; 95% CI: 0.59-0.90) were protective factors of obesity among DM subjects. Conclusions: The study concluded that almost one-third of DM subjects in Indonesia were obese. Female, age, urban residence, education level, history of hypertension, diastolic blood pressure, and lipid profiles were all associated with obesity among DM subjects in Indonesia. These findings suggest that monitoring and controlling of related determinants is needed to prevent complications caused by the doubled burden of diabetes and obesity.

Effect of zinc and vitamin A supplementation on immune responses in Indonesian pre-schoolers.

BACKGROUND AND OBJECTIVES: Vitamin A and zinc are interrelated, but the effects of zinc on vitamin A supplementation on morbidity are inconsistent and not well understood. We investigated the effects of zinc and vitamin A supplementation on immune responses in Indonesian pre-schoolers. METHODS AND STUDY DESIGN: In a twostage study design, 826 children (2-5year old) were randomly assigned to receive daily zinc supplement (10 mg) or placebo for 4 months. At 2 months, both groups received a 200,000 IU vitamin A capsules through national vitamin A program. Data were collected at baseline, two and four months, resulting in 4 groups for comparisons: - no zinc no vitamin A (Placebo), zinc only, vitamin A only, and zinc plus vitamin A. Hair, blood and saliva samples were collected to measure hair zinc and serum retinol (vitamin A) concentration, ex-vivo IFN-γ, serum IgG and salivary IgA from 81 children selected randomly from each group. RESULTS: At baseline, there were no differences between treatment groups. Zinc supplementation increased ex-vivo IFN-γ production, greatest amongst boys, younger (<3.5 years), normal weight and children with low baseline retinol concentration. Vitamin A supplementation increased IFN-γ only in those with low baseline retinol, with no effect on serum IgG and salivary IgA. After vitamin A supplementation, zinc had an effect on salivary IgA among younger and underweight children. CONCLUSIONS: Zinc supplementation increased IFN-γ (cellular immune responses) and modified the effect of vitamin A supplementation on salivary IgA (mucosal innate immune response) in younger and underweight children.