The association of sociodemographic, nutrition, and sanitation on stunting in children under five in rural area of West Java Province in Indonesia.

Background: The prevalence of stunting in Indonesia has decreased gradually. The strategy to reduce stunting is currently prioritized on improving socio-economic levels, fulfilling food intake, and sanitation conditions. This study aims to analyze the association between sociodemographics, nutrition, and sanitation on stunting in rural West Java Province in Indonesia. Design and methods: A cross-sectional study was conducted in May-August 2022 among 247 mother-children pairs, selected by systematic random sampling from a rural area of West Java Province in Indonesia. The sociodemographic characteristics were measured using a structured questionnaire. The nutritional status of the children under five was assessed by length/height-for-age (HAZ), and was calculated using WHO Anthro software. Sanitation is assessed using observation and interviews with a structured questionnaire. Results: The prevalence of stunting in children under five was 20.7% (5.3% severely stunted and 15.4% stunted). Binary logistic regression analysis using SPSS version 22.0 show that mother's height as the dominant factor associated with stunting in children under five (AOR = 3.45, 95% CI: 1.12-4.67, p = 0.008). In addition, children's age (AOR = 0.250, 95% CI: 0.104-0.598, p = 0.002); balanced diet practices (AOR = 1.57, 95% CI: 0.965-2.56, p = 0.069), and building materials (AOR = 1.869, 95% CI: 0.87-4.00, p = 0.108 are also related to stunting in children under five. Conclusions: Efforts to improve maternal nutrition need to be carried out from the period before pregnancy to the first 1000 days of life. Education on healthy home indicators, especially the use of this type of building materials for houses, needs to be done to improve sanitation as an effort to prevent stunting in children under five.

Assessment of undernutrition using the composite index of anthropometric failure (CIAF) and its determinants: A cross-sectional study in the rural area of the Bogor District in Indonesia.

BACKGROUND: The Composite Index of Anthropometric Failure (CIAF) can comprehensively identify undernutrition by combining several indicators of nutritional status - namely, weight-for-age, length/height-for-age and weight-for-length/height - to determine the nutritional status of children under five years of age. This study aims to assess undernutrition using the CIAF and its determinants on children under five years of age in the Bogor District, Indonesia. METHODS: A cross-sectional study was conducted during February-May 2019 among 330 mother-children pairs (with children under five), selected by systematic random sampling from four villages as undernutrition pockets in the rural area of Bogor District, Indonesia. The nutritional status of the children was assessed by measuring weight and length/height. Z-score was calculated using WHO Anthro software and was categorized based on conventional indices, including weight-for-age (WAZ), length/height-for-age (HAZ) and weight-for-length/height (WHZ). The CIAF is measured based on a combination of conventional index measurements. In addition, mothers' and childrens' characteristics and clean living behaviour are assessed via structured questionnaires. Environmental sanitation is assessed using the environment meter. Binary logistic regression analysis with SPSS version 22.0 is used to analyse the dominant factors associated with undernutrition. RESULTS: Among children under five, 42.1% experienced anthropometric failure (overall prevalence of undernutrition based on the CIAF), 2.4% experienced wasting only, 5.8% were classified as both wasting and underweight, 2.1% as wasting, underweight and stunting, 16.4% as underweight and stunting, 11.5% as stunting only, and 3.9% as underweight only. Assessment of nutritional status using a conventional anthropometric index shows that respective prevalences of underweight, stunted and wasted were 27.8, 29.7, and 10.6%. The mother's height is the most dominant factor associated with anthropometric failure [p = 0.008; AOR = 1.95; 95% CI: 2.19-3.19]. The most dominant factors associated with the conventional undernutrition indices of underweight, stunted and wasted are, respectively, family income [p = 0.018; AOR = 5.44; 95% CI: 1.34-22.11], mother's height [p = < 0.001; AOR = 3.29; 95% CI:1.83-5.91] and child's age [p = 0.013; AOR = 2.59; 95% CI: 1.22-5.47]. CONCLUSION: Nearly half of children under five experience anthropometric failure. Specific nutrition improvement interventions and specific nutrition interventions during pregnancy and lactation are needed, especially for malnourished mothers, to prevent malnutrition in infant.

The relationship between oxytocin levels with empathy and breastfeeding intention in female medical students: A cross-sectional study.

Scientific evidence regarding the relationship of oxytocin to social and emotional behavior is consistently reported. This study aims to analyze the relationship between empathy and breastfeeding intention with oxytocin levels in medical students. A cross-sectional study of 59 female students at the Faculty of Medicine and Health, Universitas Muhammadiyah Jakarta in April 2018-June 2019 selected by purposive sampling technique. The measurement of empathy level using the ©Jafferson Emphatic Scale Student Version (JES-SV) questionnaire, breastfeeding intention using the Infant Feeding Intentions (IFI) questionnaire, and oxytocin levels using the Enzyme-Linked Immunosorbent Assay (ELISA). Analysis of the relationship between oxytocin levels with empathy and breastfeeding intention used the independent samples t-test. The results showed that students' age (p = 0.030) and education stage (p = 0.036) were related to empathy. Age (p = 0.001) and education stage (p = 0.004) of students were also associated with serum oxytocin levels respectively. Empathy was significantly related to breastfeeding intention (p = 0.033). Oxytocin serum levels of female medical students are associated with empathy (p = 0.016) and breastfeeding intention (p= <0.001). Further studies on the role of oxytocin on empathy and breastfeeding intention need to include other factors to obtain more comprehensive information. Empathy and breastfeeding intention was not only associated with oxytocin levels. Psychological or educational interventions during the learning process at the academic and professional levels are also needed to support the process of forming these two social aspects.

The role of exclusive breastfeeding on sIgA and lactoferrin levels in toddlers suffering from Acute Respiratory Infection: A cross-sectional study.

Secretion of Immunoglobulin A (sIgA) and lactoferrin is a nutrient content in breast milk that can increase immunity in preventing infectious diseases such as Acute Respiratory Infection (ARI). This research aims to determine the role of exclusive breastfeeding (EBF) on sIgA and Lactoferrin levels in toddlers suffering from ARI. A cross-sectional study was conducted on 124 toddlers under five from January-July 2021. Toddlers were selected using a purposive technique sampling from three Community Health Centers in Central Jakarta. Data were analyzed using t-test and ANOVA. The history of immunization, EBF, and frequency of ARI was significantly associated with levels of sIgA and lactoferrin. Parity only correlated with sIgA but not with lactoferrin levels. Maternal and toddlers' age, gender, and nutritional status were not significantly related to sIgA and lactoferrin levels. There is a significant (p-value <0.001) difference in the mean protein sIgA and lactoferrin levels in toddlers who were given EBF with ARI frequency <2 times and toddlers who were given EBF with ARI frequency ≥2 times. Toddlers who were exclusively breastfed with ARI frequency <2 times had higher levels of sIgA and lactoferrin (188901.77 pg/ml and 262.32 ng/ml, respectively) compared to infants given EBF with ARI frequency ≥2 times (136683.47 pg/ml and 181.49 ng/ml, respectively). History of immunization was also significantly (p-value <0.05) associated with levels of sIgA and lactoferrin in infants with ARI. The content of sIgA and lactoferrin in breast milk and immunization can increase the body's immune system in toddlers suffering from ARI.

Effect of breastfeeding on children's health and its relationship to NRAMP1 expression: A cross-sectional study.

Toddlers with exclusive breastfeeding can increase immunity in preventing infectious diseases such as Upper Respiratory Tract Infections (ARI). The body's resistance to disease is controlled by Natural Resistance-Associated Macrophage Protein 1 (NRAMP1). NRAMP1 contributes to the pathophysiology of several intercellular infections, including ARI. The purpose of this study was to determine the effect of breastfeeding on children's health and its relationship to NRAMP1 expression. A cross-sectional study was conducted on 124 toddlers in October 2020-June 2021. Toddlers were selected purposively from three Community Health Centers in Central Jakarta. The first group (n = 62) was exclusive breastfeeding and the second group (n = 62) was not exclusive breastfeeding. The characteristics of mothers and toddlers were collected using a structured questionnaire supported by medical record data. Meanwhile, NRAMP1 expression and NRAMP1 protein levels were obtained from the examination of blood samples. Examination of NRAMP1 gene mRNA expression by real-time PCR method and serum NRAMP1 protein levels by ELISA method. Data were analyzed using t-test, ANOVA, and multiple linear regression. The results obtained that the average mRNA expression of NRAMP1 gene and protein levels of NRAMP1 in infants who were not exclusive breastfeeding were 6.88 fold change (FC) and 315.02 pg/ml compared to those who received exclusive breastfeeding of 11.36 FC and 1087.74 pg./ml. Parity, immunization history, exclusive breastfeeding, and frequency of ARI were significantly associated with NRAMP1 gene mRNA expression and NRAMP1 protein levels (P < 0.05). Maternal and under-five age, gender, and nutritional status were not significantly related (P > 0.05). Exclusive breastfeeding was the dominant factor influencing NRAMP1 gene mRNA expression (OR: 4268) and NRAMP1 protein content (OR: 737,362). Antibodies obtained from exclusive breastfeeding in synergy with the NRAMP1 gene form the body's immunity in infants suffering from ARI.

Comparison TLR2 and TLR4 serum levels in children with pulmonary and extrapulmonary tuberculosis with and without a Bacillus Calmette-Guérin (BCG) scar.

The formation of a scar after Mycobacterium bovis Bacillus Calmette-Guérin (BCG) vaccination influences the effectiveness of protection against Mycobacterium tuberculosis (MTB) infection. The innate immunity plays a critical role both in the pathophysiology of tuberculosis (TB) and BCG vaccination protection mechanism. Parts of innate immunity: macrophages, dendritic cells, and neutrophils, have microbial recognition surface receptors called Toll-like receptors (TLR) 2 and 4. The objective of this study is to compare the serum levels of TLR2 and TLR4 in BCG-vaccinated pediatric patients with pulmonary and extrapulmonary TB. This cross-sectional study included children aged less than 18 years old with contracted TB disease and had received BCG vaccination. The subjects were recruited by convenience sampling from both outpatient and inpatient care at Bhakti Medicare and Jakarta Islamic Hospital, from November 2018 to December 2019. Serum TLR2 and TLR4 levels measured using ELISA of the two groups of subjects: children with pulmonary TB (PTB) and extrapulmonary TB (EPTB), were then compared. The presence of BCG scars was included in the analysis. Independent T-test, ANOVA test, and Kolmogorov-Smirnov normality tests on the SPSS program were used to statistically analyze the results. Serum TLR2 and TLR4 levels were higher in EPTB group, but the difference was not significant (TLR2 p = 0.758 and TLR4 p = 0.646, respectively). Subjects with BCG scars in both groups have significantly higher serum TLR2 and TLR4 levels than those without BCG scars in the EPTB group (EPTB p = 0.001 and p = 0.004, respectively); (PTB p < 0.001 and p < 0.001, respectively). BCG vaccination and MTB infection stimulate better innate immune response in EPTB than in PTB and serum TLR2 and TLR4 levels in those with BCG scars were higher when compared to those without BCG scars.

The effect of nutrition and reproductive health education of pregnant women in Indonesia using quasi experimental study.

BACKGROUND: Almost one-third of children under 5 years old in Indonesia suffer from stunting. Stunting can be prevented optimally during pregnancy as the initial phase of the first 1000 days of life. This study aims to determine the effect of nutrition and reproductive health education of pregnant women in Bogor Regency, Indonesia. METHODS: A quasi-experimental study was conducted among 194 pregnant women from August to November 2019. The pregnant women were randomly selected from four different villages in Bogor Regency. The intervention group (n = 97) received 2 h of nutrition and reproductive health education in small groups (four or five mothers per group) every 2 weeks for 3 consecutive months. This interactive education was given by facilitators using techniques such as lectures, role-playing, simulation, and games. The control group (n = 97) received regular health care services. A structured questionnaire was applied to collect data consisting of maternal characteristics, nutritional and reproductive health knowledge, attitudes, and practices in the intervention and control groups. Data were analysed using t-test and chi-square analysis. RESULTS: Pregnant women in the intervention group indicated a significant increase in knowledge, attitudes, and practices regarding nutrition and reproductive health after receiving education. The pre-test and post-test mean scores in the intervention group were 55.1 and 83.1 for overall knowledge, 40.2 and 49.0 for attitudes, and 36.2 and 40.2 for practices, respectively. In the control group, there was no significant difference between the pre-test and post-test mean scores for these three variables. There was a significant difference (P < 0.001) in the post-test mean between the intervention group and the control group, but the difference was not significant (P > 0.05) in the pre-test. CONCLUSION: Providing nutrition and reproductive health education through small groups with interactive methods improves the knowledge, attitudes, and practices of pregnant women. This intervention has the potential to be replicated and developed for large-scale implementation by optimising collaboration between government, non-governmental organizations, and maternal and child health service providers.

Do Health Workers Play a Role in Exclusive Breastfeeding among Working Mothers in Industrial Area?

The culture of breastfeeding has been inherited for a long time in Indonesia. Changes in lifestyle have caused an increase in the number of working mothers. Results of the Basic Health Research in 2018 reported exclusive breastfeeding coverage was decreased as much as 17% between 2013 and 2018. The purpose of this study was to determine association of health workers support and other factors on exclusive breastfeeding practice among working mothers in industrial area. METHODS: A cross-sectional study was conducted in April-June 2018 in industrial area at Cibinong, Bogor, Indonesia. As many as 126 working mothers who had babies aged 7-24 mo were selected using a purposive sampling technique. RESULTS: Only 37.3% of working mothers breastfed their babies exclusively. The support of health workers was the most dominant factor associated with exclusive breastfeeding {(p=0.001; OR: 6.210 (1.184-6.257)}. Husband's support {(p=0.014; OR: 5.228 (1.306-10.234} were also associated with exclusive breastfeeding. Working mothers who obtained support from health workers were 6.210 times more likely to breastfeed exclusively as compared to mothers who did not receive support from health workers. CONCLUSIONS: Actual and direct support from husband and health workers from the period of pregnancy to lactation is important for the success of exclusive breastfeeding among working mothers.