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.

Prevalensi stunting secaca global di dunia termasuk di Indonesia masih tinggi. Pola asuh pemberian makan pada 1000 Hari Pertama Kehidupan memengaruhi asupan gizi yang berdampak langsung terhadap kejadian stunting. Tujuan penelitian untuk mengetahui faktor dominan yang mempengaruhi terjadinya stunting pada balita di wilayah kerja Puskesmas Kecamatan Senen, Provinsi DKI Jakarta. Penelitian menggunakan desain cross-sectional dilakukan di wilayah kerja puskesmas Kecamatan Senen pada bulan April 2019. Sampel sebanyak 182 ibu-balita diambil dengan teknik simple random sampling yang berasal dari 5 (lima) puskesmas kelurahan. Stunting diukur dengan antropometri menggunakan indikator tinggi badan menurut umur (TB/U). Variabel independen (pola asuh pemberian makan, tinggi badan Ibu, pemberian ASI eksklusif, berat badan lahir bayi, frekuensi konsumsi energi, dan riwayat penyakit infeksi) serta variabel dependen (stunting) dianalisis menggunakan regeresi logistik ganda. Stunting dialami oleh sebanyak 31,8% (14,8% balita sangat pendek dan 17,0% pendek). Faktor dominan yang berpengaruh terhadap kejadian stunting adalah pola asuh pemberian makan (OR: 6,496 95% CI: 2,486-16,974). Balita yang memeroleh pola asuh pemberian makan yang kurang berisiko 6 kali lebih tinggi mengalami stunting dibandingkan balita yang pola asuh makannya baik. Perlu kebijakan terkait pengasuhan balita terutama bagi ibu bekerja seperti penyediaan fasilitas day care ditempat kerja sehingga dapat memperbaiki pola asuh pemberian makan. Kata kunci: Balita, BBLR, Pola asuh pemberian makan, Stunting THE IMPACT OF FEEDING PARENTING TOWARDS STUNTING AMONG CHILDREN UNDER FIVE YEARS OLDThe prevalence of stunting globally in the world including in Indonesia is still high. Parenting in the First 1000 Days of Life, affects nutritional intake which has a direct impact on stunting. The study aimed to determine the dominant factors that influence stunting in children under five. A cross-sectional study was conducted in Senen District health center's working area in April 2019. A sample of 182 mothers and children under five was taken using a simple random sampling technique from 5 community health centers. Stunting was measured by anthropometry using height-for-age indicators. The independent variables (parenting style, mother's height, exclusive breastfeeding, baby's birth weight, frequency of energy consumption, and history of infectious diseases) and the dependent variable (stunting) were analyzed using multiple logistic regression. As many as 31.8% were stunting (14.8% severe stunting and 17.0% stunting). The dominant factor influencing the stunting is feeding parenting (OR: 6.496 95% CI: 2,486-16,974). Children who were given poor feeding parenting are 6 times more at risk stunted than children who have good parenting. Policies need to be related to caring for children under five, especially for working mothers such as the provision of daycare facilities in the workplace to improve parenting care.

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.

Exclusive breastfeeding intention is a mother’s intention to provide her baby only breast milk since the infant was born until at the age of 6 months. Intention in prenatal period is the direct affirmation of exclusive breastfeeding. This study aimed to find out the most dominant factor related to exclusive breastfeeding intention among pregnant women at a mother and child hospital in South Tangerang. A cross-sectional study design was conducted primarily. The samples were 143 pregnant women on their third semester pregnancy selected by purposive sampling. Intention was measured by the Infant Feeding Intention scale questionnaire. Meanwhile, attitude, subjective norms, and perceived behavioral control were measured by the modified Breastfeeding Attrition Prediction Tool questionnaire. Data were analyzed using the multivariate logistic regression analysis. It was 61.5% mother had strong exclusive breastfeeding intention. Perceived behavioral control dominantly influenced the exclusive breastfeeding intention (p value = 0.007; Odds Ratio 3.030; 95% CI = (1.361-6.746)). The other factors influencing intention were attitude, exposure to exclusive breastfeeding from social media, health workers’ support, previous breastfeeding experienceand mothers’ occupation. A mother with high perceived behavioral control has three times more likely to have ‘high exclusive breastfeeding intention’ than those having the low ones.AbstrakIntensi pemberian ASI eksklusif adalah intensi ibu untuk memberikan hanya ASI pada bayinya sejak dilahirkan hingga berusia enam bulan. Intensi pada periode prenatal merupakan penentu langsung pemberian ASI eksklusif. Penelitian ini bertujuan mengetahui faktor paling dominan berhubungan dengan intensi pemberian ASI eksklusif pada ibu hamil di sebuah rumah sakit ibu dan anak di Kota Tangerang Selatan. Penelitian dengan desain studi potong lintang dilakukan secara primer. Sampel berjumlah 143 ibu hamil trimester ketiga dipilih secara purposive sampling. Intensi pemberian ASI eksklusif diukur menggunakan kuesioner the Infant Feeding Intentions scale. Sedangkan sikap, norma subjektif dan persepsi kontrol perilaku dinilai menggunakan modifikasi kuesioner Breastfeeding Attrition Prediction Tool. Data dianalisis menggunakan analisis regresi logistik ganda. Sebanyak 61,5% ibu memiliki intensi kuat memberikan ASI eksklusif. Persepsi kontrol perilaku paling dominan berhubungan dengan intensi pemberian ASI eksklusif, (p=0,007; Odds Ratio 3,030; 95% CI (1,361-6,746). Faktor lainnya yang berhubungan dengan intensi adalah sikap, keterpaparan ibu terhadap ASI eksklusif dari media sosial, dukungan tenaga kesehatan, pengalaman menyusui sebelumnya, dan pekerjaan ibu dengan persepsi kontrol perilaku tinggi berpeluang tiga kali lebih besar memiliki ‘intensi tinggi’ untuk memberikan ASI eksklusif dibandingkan ibu berpersepsi kontrol perilaku rendah.

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.

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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 {(p50.001; OR: 6.210 (1.184-6.257)}. Husband's support {(p50.014; 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.

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