Search

Background: Epidemiological studies show that the height-for-age Z-scores (HAZ) falter dramatically shortly after birth until the end of the first two years. Understanding these changes in linear growth in the first two years can help us understand the critical period of child linear growth and propose interventions. Objectives: This study objectives were to describe the pattern of linear growth faltering and analyze the changes in length-for-age Z-scores (LAZs) throughout the first two years based on birthweight and length status. Methods: This study analyzed 408 children, participants in Longitudinal Study on Child Growth and Development in Bogor, Indonesia. The linear growth pattern was described based on birthweight and length status. Birthweight and length status was categorized into normal and Small for Gestational Age (SGA). Changes in LAZs (Δ LAZs) in 0–6 months, 6–12 months, and 12–23 months were calculated. General Linear Model Univariate analysis was conducted to analyze the difference of Δ LAZ between SGA and normal children. Results: Though full-term SGA children have significantly higher linear growth velocity during the first 6 months of the infancy period, full-term SGA children could not catch up with the attained growth/height of normal children throughout the first two years. Thus, full-term SGA children ended up with a higher prevalence of stunted. Both in SGA and normal children, the substantial loss of LAZ occurred between 0–6 months. Conclusion: The finding in this study showed that the first 1000 days of life is still the best period in stunting prevention; however, the stunting prevention program should start earlier, focusing on the first 500 days of life, and potentially the prenatal period. [ABSTRACT FROM AUTHOR]

The prevalence of stunting in Indonesian children aged 0-23 months is a public health problem caused by direct and indirect factors. This study aimed to discover the path of the relationship between various risk factors and the stunting prevalence of =30% in 165 districts/cities in Indonesia. Data were obtained from the 2018 National Basic Health Research, National Socioeconomic Survey, and the Statistics Indonesia with a cross-sectional approach. The secondary data on stunting and risk factors were aggregated at the district/city level from individual data; children aged 0-23 months. The path analysis used to determine a stunting prevention model showed that antenatal care at the district/city level decreased stunting rates by at least 2.56% (b = -0.16; p-value = 0.04). A contraceptive user at the district/city level decreased stunting rates by 2.25% (b = -0.15; p-value = 0.05), and handwashing with soap at the district/city level by 5.76%, (b = -0.24; p-value = 0.003). Antenatal care, contraceptive use, and handwashing with soap contributed to the reduction of stunting prevalence by 18.18%. The study results suggested that districts/cities can play an important role in reducing stunting. [ABSTRACT FROM AUTHOR]

Background: Indonesia's national health information systems collect data on maternal deaths but the completeness of reporting is questionable, making it difficult to design appropriate interventions. This study examines the completeness of maternal death reporting by the district health office (DHO) system in Banten Province. Method: We used a nested-control study design to compare data on maternal deaths in 2016 from the DHO reporting system and the MADE-IN/MADE-FOR method in two districts and one municipality in Banten Province, with the aim of identifying and characterizing missed deaths in the DHO reporting system. The capture-recapture method was used to assess the magnitude of underreporting of maternal deaths by both systems. Results: A total of 169 maternal deaths were reported in the MADE-IN/MADE-FOR study for calendar year 2016 in the three study areas. The DHO system reported 105 maternal deaths for the same period, of which 90 cases were found in both data sources. Capture-recapture analyses suggest that the MADE-IN/MADE-FOR approach identified 92% (95% CI: 87%–95%) of all maternal deaths, while the DHO system captured 57% (95% CI: 50%–64%) of all maternal deaths. Deaths of women who resided in urban areas had four times higher odds (OR 4.3, 95% CI: 1.52–12.3) of being missed by the DHO system compared to deaths among women who lived in rural or remote areas after adjusting for other covariates. Conclusion: The DHO reporting system missed approximately half of the maternal deaths in the 3 study areas, suggesting that the DHO system is likely to grossly underestimate the maternal mortality ratio. The DHO reporting system needs to be improved to capture and characterize all maternal deaths. [ABSTRACT FROM AUTHOR]

Preeclampsia is the leading cause of both maternal and infant mortality and morbidity worldwide. It is a disorder of pregnancy characterized by hypertension and high levels of protein in the urine. Preeclampsia has multifactorial determinants, one of which is excessive gestational weight gain. The purpose of this study was to determine the relationship between weight gain during pregnancy and the incidence of preeclampsia among patients at Panembahan Senopati Bantul Hospital, D.I.Y. in 2014. The assessment of excessive weight gain during pregnancy was based on the weight gain recommendations given by the Institute of Medicine (IOM). This study was conducted using a case-control design. Based on patient medical records, subjects were included if the length of gestation was greater than or equal to 20 weeks, and were excluded if it was the mother's first pregnancy, the mother was less than 20 years old, or the gestational weight gain was less than the IOM recommendation. After a process ofrandom selection, there were 55 subjects in the case group that met the inclusion criteria. The case to control ratio was 1:1; thus there were also 55 subjects in the control group after random selection.The case and control groups were selected from the same hospital. Data analysis was conducted using a Chi-Square test. The results of the study showed that 63.6% of mothers with preeclampsia exhibited excessive gestational weight gain,while 16.4% of those without preeclampsia exhibited excessive gestational weight gain (p value <0.05, 95% CI: 3.63-22.06 and OR: 8.94). The results confirmed that excessive weght gain during pregnancy increases the incidence of preeclampsia. [ABSTRACT FROM AUTHOR]

Indonesia is a rapidly growing middle-income country with 262 million inhabitants from more than 300 ethnic and 730 language groups spread over 17 744 islands, and presents unique challenges for health systems and universal health coverage (UHC). From 1960 to 2001, the centralised health system of Indonesia made gains as medical care infrastructure grew from virtually no primary health centres to 20 900 centres. Life expectancy improved from 48 to 69 years, infant mortality decreased from 76 deaths per 1000 livebirths to 23 per 1000, and the total fertility rate decreased from 5·61 to 2·11. However, gains across the country were starkly uneven with major health gaps, such as the stagnant maternal mortality of around 300 deaths per 100 000 livebirths, and minimal change in neonatal mortality. The centralised one size fits all approach did not address the complexity and diversity in population density and dispersion across islands, diets, diseases, local living styles, health beliefs, human development, and community participation. Decentralisation of governance to 354 districts in 2001, and currently 514 districts, further increased health system heterogeneity and exacerbated equity gaps. The novel UHC system introduced in 2014 focused on accommodating diversity with flexible and adaptive implementation features and quick evidence-driven decisions based on changing needs. The UHC system grew rapidly and covers 203 million people, the largest single-payer scheme in the world, and has improved health equity and service access. With early success, challenges have emerged, such as the so-called missing-middle group, a term used to designate the smaller number of people who have enrolled in UHC in wealth quintiles Q2-Q3 than in other quintiles, and the low UHC coverage of children from birth to age 4 years. Moreover, high costs for non-communicable diseases warrant new features for prevention and promotion of healthy lifestyles, and investment in a robust integrated digital health-information system for front-line health workers is crucial for impact and sustainability. This Review describes the innovative UHC initiative of Indonesia along with the future roadmap required to meet sustainable development goals by 2030. [ABSTRACT FROM AUTHOR]