Monitoring continuity of maternal and child health services, Indonesia.

OBJECTIVE: To implement an online system to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on maternal and child health and nutrition essential health services in Indonesia. METHODS: We developed an electronic monitoring and evaluation system to assist district health offices in making rapid assessments of the impact of COVID-19 on maternal and child health and nutrition programmes in their area and in developing policy and programme responses. This implementation research was conducted from September to December 2020 in 304 districts. The strategies consisted of technical assistance for district offices by 21 partner universities and development of an online dashboard for rapid situation analyses and reporting. We collected qualitative data on feasibility and adherence to the intervention, as well as quantitative data from routine health databases to analyse the impact of COVID-19 on maternal and child health and nutrition indicators. FINDINGS: In the majority of districts key maternal and child health and nutrition services were moderately or severely affected by the pandemic, particularly child growth monitoring and antenatal care services. Adherence to the protocol of the intervention varied across districts but the system is a feasible approach to be scaled up to other regions and health programmes. High uptake by the health ministry, district office and university partners provided the platform with collaborative efforts for health-systems strengthening. CONCLUSION: The electronic monitoring and evaluation system could be implemented and completed with several modifications to accommodate district offices and universities. There is a potential to scale up the intervention with better implementation planning and training.

Nutritional anemia in Indonesia children and adolescents: Diagnostic reliability for appropriate management.

BACKGROUND: Nutritional anemia in Indonesian children and adolescents is generally regarded and treated as iron-deficient anemia, as it is in individuals in other age groups. OBJECTIVES: Yet, it remains a public health threat without comprehensive management or a sustained solution. METHODS: This review seeks to improve understanding of impediments to its resolution. Relevant studies reported in the past 5 years were identified in PubMed, Science Direct, Crossreff, Google Scholar, and Directory of Open Access Journals databases. RESULTS: In all, 12 studies in several Indonesian cities provided the basis for the review. Most were conducted in schools, indicating the potential of these institutions as targets for intervention but pointing to serious deficiencies in identification of the problem across the archipelago and in remote and rural areas. No study has evaluated coexistent anemia and malnutrition, which likely would have revealed the multi-factoriality of nutritional anemia. Data regarding nutrition education, food-based innovation, and supplementation, which may alleviate anemia in children and adolescents, are available, although study lengths and sample sizes have limited interpretation and comparison. CONCLUSIONS: Broadly, three intervention approaches to nutritional anemia have been undertaken, namely food-based interventions, nutrient supplementation, and nutrition education. Some progress has been made with these approaches, presumably through increases in iron intake. More information is needed regarding the underlying causality and pathogenesis, suboptimal food patterns, and comorbidities, any of which might limit the effectiveness of programs designed to resolve childhood and adolescent anemia in Indonesia.

Educational models of infant and young child feeding among prenatal and postnatal women during the COVID-19 pandemic (January 2020-January 2023): A scoping review.

Infant and young children feeding (IYCF) practices, particularly for infants and young children <2 y old, became increasingly challenging during the COVID-19 pandemic. Several studies have discussed various educational models in the pre-pandemic period, most of which were conducted in person. The last reviews on IYCF interventions were conducted in 2020 and were relevant to pre-pandemic contexts. Thus, there is a need to review IYCF interventions to inform educational models adapted to the COVID-19 pandemic. This study aimed to describe the IYCF educational models proposed during the COVID-19 pandemic. For this relevant literature, we searched PubMed, SCOPUS, EBSCO, ProQuest, Sage Journals, and Wiley Online Library. Thirty-five literature sources were screened, and 7 data sources were included for data extraction and analysis. Many studies on the IYCF educational models focused on exclusive breastfeeding and early initiation of breastfeeding; there was only one study on complementary feeding, and no research was found on continued breastfeeding. Four studies found no significant differences in the intervention given. Three studies had a significant effect, one had in-person meetings, and two consisted of WhatsApp discussions. Most IYCF educational models from the pandemic context comprised online education, whereas WhatsApp was the most popular media used. Future researchers may develop these findings to design research on a larger scale and for a longer period, especially on complementary feeding and continued breastfeeding based on IYCF indicators.

Maternal Characteristics and Socio-Economic Factors as Determinants of Low Birth Weight in Indonesia: Analysis of 2017 Indonesian Demographic and Health Survey (IDHS).

Although low birth weight (LBW) is still a major health problem in Indonesia, studies about determinants of LBW with large sample sizes are still limited. This study aimed to examine the association between LBW and maternal characteristics, as well as socio-economic backgrounds in Indonesia. A secondary analysis of 2017 Indonesian Demographic and Health Survey (IDHS) was conducted, specifically using the questionnaires for women of childbearing age. A bivariate chi-square analysis and a multivariate logistic regression analysis were performed. As many as 6.7% of infants were born with LBW. In terms of maternal characteristics, women who gave birth to twins were 20.30 times more likely to have infants with LBW (p < 0.001). Women with birth intervals of <24 and ≥24 months were likely to have LBW infants (p < 0.05). Complications during pregnancy were also associated with LBW (1.99 times higher than women with no complications) (p < 0.001). In terms of socio-economic factors, women with higher education and higher wealth index were less likely to give birth to infants with LBW. Additionally, marital status and type of residence were also significantly associated with a higher risk of LBW. In conclusion, LBW was associated with maternal characteristics and socio-economic backgrounds among women of childbearing age in Indonesia, including twin births, birth interval, and pregnancy complications as well as educational attainment, wealth index, marital status, and type of residence.

Predictors of Poor Neonatal Outcomes among Pregnant Women in Indonesia: A Systematic Review and Meta-Analysis.

OBJECTIVES: This study aimed to examine the association between maternal health behaviors and neonatal outcomes among the Indonesian population. METHODS: Articles were collected from PubMed, EBSCO, ProQuest, DOAJ, and GARUDA. Funnel plots and Egger's tests analyzed indications of publication bias. A Mantel-Haenszel random-effects model was used to see the overall effect size of exposures on outcomes. Heterogeneity was seen based on I2. Data collected from articles included the author, year of publication, location of the study, study design, number of samples, risk factors, and effect sizes. RESULTS: We identified 24 relevant studies, including eight from the primary databases and 16 from an additional database. A total of 12 studies were included in the meta-analysis, examining the association between maternal health behaviors and neonatal outcomes. The pooled odds ratio (OR) for passive smoking and low-birth-weight (LBW) was 3.41 (95% CI: 1.75-6.63, I2 = 40%, four studies). The pooled OR for incomplete antenatal care (ANC) and LBW was 6.29 (95% CI: 2.11-18.82, I2 = 70%, four studies). The pooled OR for incomplete ANC and neonatal mortality was 2.59 (95% CI: 1.01-6.66, I2 = 93%, four studies). CONCLUSIONS: The results indicated that pregnant women with incomplete ANC had a higher risk of LBW and neonatal mortality, and those who were passively exposed to smoking had a higher risk of LBW. Further investigations are needed, considering the high heterogeneity found, and additional meta-analyses should be based on the variations of socio-demographic conditions.

A Life Course Approach to the Prevention of Iron Deficiency Anemia in Indonesia.

Iron deficiency anemia (IDA) has a long-term impact on each life stage and remains worldwide a major public health problem. Eleven experts were invited to participate in a virtual meeting to discuss the present situation and the available intervention to prevent iron deficiency anemia in Indonesia. The experts consisted of obstetric gynecologists, pediatricians, nutritionists, midwives, a clinical psychologist, and an education expert. Existing interventions focus attention on preconception and early childhood stages. Considering the inter-generational effects of IDA, we call attention to expanding strategies to all life stages through integrating political, educational, and nutritional interventions. The experts agreed that health education and nutritional intervention should be started since adolescence. Further research to explore the effectiveness of these interventions would be important for many regions in the world. The outcome of this Indonesian consensus is applicable worldwide.

The effect of a maternal mentoring program on the timing of first antenatal care visit among pregnant women in Bantul, Indonesia: Results of a cluster randomized trial.

Background: Antenatal care (ANC) is low in developing countries, with an estimated 20% of Indonesian women not initiating ANC during the first trimester. The present study sought to determine the impact of a mentoring program on the timing of the first ANC visit. Methods: This cluster randomized controlled trial was conducted in 3 subdistricts of the Bantul District, divided into 61 clusters per treatment arm, with a final sample size of 205 confirmed pregnant women. The mentoring program consisted of (1) health education, (2) monitoring, and(3) text-message reminders. The primary outcome was the timing of first ANC visit. A multilevel mixed-effect logistic regression model was used to measure the effect of the program on the likelihood of having an earlier first ANC visit, with statistical significance at α=0.05. Results: At the individual-level, the intervention group had a mean time of first ANC visit±2 days earlier than the control group (P<0.05). After adjusted for cluster and other covariates, the odds of starting the first ANC visit early (<39 days of gestation) was higher in the intervention group (adjusted odds ratio [AOR] 3.00; 95% confidence interval [CI] 1.17-7.72). Conclusion: Maternal mentoring can improve the timing of the first ANC visit. This program has the potential to be adopted by health care systems in settings where there is little education on the importance of ANC. Future research could extend the length of mentorship until delivery in order to better understand the relationship between mentorship and early ANC on pregnancy outcomes.

Deficient Nutrient Intake from Complementary Foods among Infants Aged 6-11 Months in Rural Areas of Yogyakarta.

Nutrition education message that is developed based on linear programming could help arrange complementary feeding recommendations (CFR) using locally available food to improve infants' nutrient adequacy. This study examined deficient nutrients to optimize complementary feeding for infants. Data were collected from the Health District Office of Yogyakarta province that consisted of 91 breastfed infants aged 6-11 mo old. Their dietary intake was assessed by quantitative 24-h recall and data were processed using the software Nutrisurvey, MS Excell, and Optifood. Meat, fish, eggs, fruit, legumes, nuts, and seeds were infrequently consumed. Intakes of Fe and Zn could not fully reach the Recommended Nutrient Intake (RNIs), while the vitamins C, B6, folate, B12, and A could achieve 100% of RNIs by using optimized food pattern. Local foods that could be used to help improve the nutrients, except for Fe and Zn. The CFR were as follow: continue breastfeeding frequently; feed quality protein source food such as 3 servings/wk of all type of eggs and liver, 5 servings/wk of locally available flesh of fish; provide 2 servings/wk of enriched/fortified baby porridge; offer plant protein foods (legumes, nuts or seeds) 2 servings/wk including 1 serving/wk of mung bean porridge. Locally available foods had potential to improve diet quality of infants aged 6-11 mo, providing that the consumption frequency is increased. Consumption of food sources for Fe and Zn needs to be improved in terms of both portion and frequency.

Substituting white rice with brown and black rice as an alternative to prevent diabetes mellitus type 2: a case-study among young adults in Yogyakarta, Indonesia.

PURPOSE: The purpose of this study is to explore the preference and acceptance of white rice substitution with brown and black rice among young adults in Indonesia to prevent diabetes. METHODS: This study used a qualitative design. Rice preference deeply explored using focus group discussion as a case-study. 85 informants with an average of ages 20 years old were divided into several groups. Several topics to discuss include the reasons to accept or reject brown and black rice, knowledge, attitude, motivation, and potency to substitute white rice. RESULTS: Price was the main barrier to substitute white rice to brown and black rice. The participants have known brown rice from parents, mass media, and friends. Most of them were still unfamiliar with black rice. Culture also affected the preferences of the participants. To motivate people to change their white rice diet, creative packaging and segmentation of the sale were recommended. CONCLUSION: Substituting white to brown and black rice is still a challenge for young adults in Indonesia. Several barriers such as culture, accessibility, and affordability need to be considered. Further efforts are important to manage a program to increase brown and black rice consumption.