Modified Pathway to Survival highlights importance of rapid access to quality institutional delivery care to decrease neonatal mortality in Serang and Jember districts, Java, Indonesia.

Background: Three-quarters of births in Indonesia occur in a health facility, yet the neonatal mortality rate remains high at 15 per 1000 live births. The Pathway to Survival (P-to-S) framework of steps needed to return sick neonates and young children to health focuses on caregiver recognition of and care-seeking for severe illness. In view of increased institutional delivery in Indonesia and other low- and middle-income countries, a modified P-to-S is needed to assess the role of maternal complications in neonatal survival. Methods: We conducted a retrospective cross-sectional verbal and social autopsy study of all neonatal deaths from June through December 2018, identified by a proven listing method in two districts of Java, Indonesia. We examined care-seeking for maternal complications, delivery place, and place and timing of neonatal illness onset and death. Results: The fatal illnesses of 189/259 (73%) neonates began in their delivery facility (DF), 114/189 (60%) of whom died before discharge. Mothers whose neonate's illness started at their delivery hospital and lower-level DF were more than six times (odds ratio (OR) = 6.5; 95% confidence interval (CI) = 3.4-12.5) and twice (OR = 2.0; 95% CI = 1.01-4.02) as likely to experience a maternal complication as those whose neonates fell fatally ill in the community, and illness started earlier (mean = 0.3 vs 3.6 days; P < 0.001) and death came sooner (3.5 vs 5.3 days; P = 0.06) to neonates whose illness started at any DF. Despite going to the same number of providers/facilities, women with a labour and delivery (L/D) complication who sought care from at least one other provider or facility on route to their DF took longer than those without a complication to reach their DF (median = 3.3 vs 1.3 hours; P = 0.01). Conclusions: Neonates' fatal illness onset in their DF was strongly associated with maternal complications. Mothers with a L/D complication experienced delays in reaching their DF, and nearly half the neonatal deaths occurred in association with a complication, suggesting that mothers with complications first seeking care at a hospital providing emergency maternal and neonatal care might have prevented some deaths. A modified P-to-S highlights the importance of rapid access to quality institutional delivery care in settings where many births occur in facilities and/or there is good care-seeking for L/D complications.

Nutritional status, family income and early breastfeeding initiation as determinants to successful exclusive breastfeeding.

Background: The target by the Indonesian public health services to obtain at least 50% exclusively breastfeed babies during the first 6 months has not been achieved, due to the increased in infant morbidity. This study aims to determine factors associated with exclusive breastfeeding. Design and Methods: The cluster random sampling method was used to obtain data from a total of 273 babies in the first 1000 days of life i.e. aged 6-24 months and analyzed using linear regression at α= 0.05. The data obtained were based on exclusive breastfeeding using maternal age, education, family income, frequency of antenatal care, nutritional status before pregnancy, place and mode of delivery, gestational age at delivery. Results: The result showed that exclusive breastfeeding was significantly affected by nutritional status before pregnancy based on MUAC (P=0.15) and BMI (P=0.047), family income (P=0.047) and initiation of early breastfeeding (P=0.001). Conclusions: In conclusion, nutritional status before pregnancy tends to benefit the family income, therefore, initiating early breastfeeding need to be improved for successful exclusive breastfeeding.

The influence of monitoring activities on maternal weight gain among pregnant women.

Background: The relationship between nutritional status in early life and the risk of chronic diseases in the future development of the child is a critical factor that needs to be considered. The basic factors that can help in this case include thrifty phenotype hypothesis, developmental plasticity, fetal programming and weight gain regulation. This study aims to determine the average increase in weight gain before and after mentoring program. Design and methods: The sample was taken randomly from 191 pregnant women. From number of women mentored, 106 that met the inclusion criteria. Wilcoxon Signed Ranks Test then was used in the data analysis. Results: The results show that the average body weight of women increased 18.94%, while the BMI rose by 7.46%. Mentoring program led to an increase in maternal body weight, indicated with a P-value of 0.000. Conclusions: In conclusion, mentoring program influences bodyweight in pregnant women. Therefore, it is vital to maintain a high nutritional status during pregnancy.

Highlighting of Urinary Sodium and Potassium among Indonesian Schoolchildren Aged 9-12 Years: The Contribution of School Food.

BACKGROUND: Sodium (Na) and potassium (K), the essential nutrients, have vital role in promoting cellular growth including growth and development of children. Excessive Na intake and inadequate K consumption, which consequently increases the risk of cardiovascular disease, have been reported. Spot electrolyte urine was highly correlated and validated with gold standard to estimate electrolyte dietary intake. This study aimed at predicting sodium and potassium intake using morning spot urine among Indonesian schoolchildren. METHODS: A cross-sectional study was carried out in 155 healthy elementary students aged 9-12 years. Spot urine samples were collected and analyzed for Na, K, and creatinine. Predicted 24 h Na and K excretions were compared to the Indonesian recommendation dietary allowances. The Na and K contribution from school food was reported by observing directly and the dietary recall method. RESULTS: A total of 80 boys and 75 girls recruited as samples in this study demonstrated that their estimated urinary Na and K were 105.42 ± 66.05 mmol/day and 16.39 ± 12.57 mmol/day, respectively. Na intake was on average higher than recommended; meanwhile, almost all subjects showed very low compliance of K intake recommendation. Furthermore, food intake at school contributed to those conditions. Na and K content of school food contributed 33% and 29% of the daily intake of each nutrient and contributed 125% and 25% higher than the Na and K school standard, respectively. CONCLUSIONS: Indonesian schoolchildren aged 9-12 years are categorized by excessive Na intake and very deficient K intake. The present study highlights the need for policies in the environmental school setting to reduce Na intake and K intake.

Household dietary diversity and child stunting in East Java, Indonesia.

BACKGROUND AND OBJECTIVES: More than one-quarter of under-five children in the developing world are stunted, and those with poor nutrient intake are at risk of irreversible cognitive impairment. The purpose of this study was to determine the relationship between dietary diversity and child stunting in an Indonesian context. METHODS AND STUDY DESIGN: Dietary diversity was assessed using a maternal-reported checklist of 12 food groups, summed as a Household Dietary Diversity Score. Stunting was defined as <=-2.0 height-for-age z-score by WHO-Anthro 2005. Trained interviewers administered the household dietary diversity questionnaire to 768 households with children aged <5 years in East Java, Indonesia. Logistic regression models were constructed to test the association between dietary diversity and child stunting. RESULTS: The prevalence of child stunting was 39.4%, and the percentage of households consuming food groups high in protein and calcium, like dairy products (41%), and meat/poultry, (65%) was lower compared with other food groups. The unadjusted model revealed that higher dietary diversity scores were associated with lower likelihood of child stunting (OR=0.89; 95% CI=0.80-0.98). This relationship remained significant after adjustment for family size, maternal literacy, food expenditure, breastfeeding, energy, and protein intake (OR=0.89; 95% CI=0.80-0.99). CONCLUSIONS: The dietary diversity score was moderate, with consumption of dairy products and meat/poultry lowest among 12 food groups. Hence, population interventions should focus on promoting food groups currently lacking in maternal and child diet, including those rich in growth-promoting nutrients like dairy, meat/poultry. These results, from an Indonesian context, confirm the widely observed protective relationship between dietary diversity and child stunting.