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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]

Abstract Background The maternal mortality ratio (MMR) remains high in most developing countries. Local, recent estimates of MMR are needed to motivate policymakers and evaluate interventions. But, estimating MMR, in the absence of vital registration systems, is difficult. This paper describes an efficient approach using village informant networks to capture maternal death cases (Maternal Deaths from Informants/Maternal Death Follow on Review or MADE-IN/MADE-FOR) developed to address this gap, and examines its validity and efficiency. Methods MADE-IN used two village informant networks - heads of neighbourhood units (RTs) and health volunteers (Kaders). Informants were invited to attend separate network meetings - through the village head (for the RT) and through health centre for the kaders. Attached to the letter was a form with written instructions requesting informants list deaths of women of reproductive age (WRA) in the village during the previous two years. At a 'listing meeting' the informants' understanding on the form was checked, informants could correct their forms, and then collectively agreed a consolidated list. MADE-FOR consisted of visits relatives of likely pregnancy related deaths (PRDs) identified from MADE-IN, to confirm the PRD status and gather information about the cause of death. Capture-recapture (CRC) analysis enabled estimation of coverage rates of the two networks, and of total PRDs. Results The RT network identified a higher proportion of PRDs than the kaders (estimated 0.85 vs. 0.71), but the latter was easier and cheaper to access. Assigned PRD status amongst identified WRA deaths was more accurate for the kader network, and seemingly for more recent deaths, and for deaths from rural areas. Assuming information on live births from an existing source to calculate the MMR, MADE-IN/MADE-FOR cost only $0.1 (US) per women-year risk of exposure, substantially cheaper than alternatives. Conclusions This study shows that reliable local, recent estimates of MMR can be obtained relatively cheaply using two independent informant networks to identify cases. Neither network captured all PRDs, but capture-recapture analysis allowed self-calibration. However, it requires careful avoidance of false-positives, and matching of cases identified by both networks, which was achieved by the home visit.

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]

In an effort to build iron stores before pregnancy and reduce the high prevalence of anemia in Indonesia, the Ministry of Health/Indonesia and the MotherCare project implemented an anemia control program for newly wed women. As part of an existing program to counsel couples about marriage and require them to obtain tetanus toxoid immunization before obtaining a marriage certificate, women also were counseled to buy and take 30-60 iron-folate (IFA) tablets. Women (n = 344) were enrolled from one of three participating districts in South Kalimantan, Indonesia. At first monitoring, at least 30 d after baseline, 261 women were tested for hemoglobin and asked about their IFA tablet consumption and knowledge of information, education, and communications (IEC) materials promoted through the program. Results showed that there was a decrease in the prevalence of anemia from 23.8 to 14.0% over the course of the program, 98% of women had taken at least some IFA tablets and 56% had taken [is greater than] 30 tablets. J. Nutr. 130: 456S-458S, 2000. KEY WORDS: * anemia * women * iron supplementation

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]

Anaemia due to iron deficiency is still a widespread problem. Among adolescent girls, it will bring negative consequences on growth, school performance, morbidity and reproductive performance. This cross sectional study aimed to identify the different nutritional and iron status characteristics of young adolescent girls 10 - 12 years old with iron deficiency anaemia and anaemia without iron deficiency in the rural coastal area of Indonesia. Anaemic girls (N = 133) were recruited out of 1358 girls from 34 elementary schools. Haemoglobin, serum ferritin, serum transferrin receptor and zinc protophorphyrin were determined for iron status, whilst weight and height were measured for their nutritional status. General characteristics and dietary intake were assessed through interview. Out of 133 anaemic subjects, 29 (21.8%) suffered from iron deficiency anaemia, which was not significantly related to age and menarche. About 50% were underweight and stunted indicating the presence of acute and chronic malnutrition. The proportion of thinness was significantly higher (P <0.05) among subjects who suffered from iron deficiency anaemia (51.7% vs. 29.8%). Furthermore, thin subjects had a 5 fold higher risk of suffering from iron deficiency anaemia (P < 0.05) than non-thin subjects (OR: 5.1; 95%CI 1.34 -19.00). Further study was recommended to explore other factors associated with anaemia and iron deficiency anaemia, such as the thalassemia trait and vitamin A deficiency. The current iron-folate supplementation program for pregnant women should be expanded to adolescent girls. [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]

The article examines the achievements of southeast Asia in reducing maternal, neonatal and child mortality. The diversity of the region is said to be demonstrated in reductions in mortality. Some of the most notable declines in maternal mortality occurred earlier than the rapid increase in gross national income, based on an analysis of mortality reductions against gross national income per capita. Socioeconomic progress is partly credited for improvements in Malaysia, Thailand and Vietnam.

Anaemia due to iron deficiency is still a widespread problem. Among adolescent girls, it will bring negative consequences on growth, school performance, morbidity and reproductive performance. This cross sectional study aimed to identify the different nutritional and iron status characteristics of young adolescent girls 10-12 years old with iron deficiency anaemia and anaemia without iron deficiency in the rural coastal area of Indonesia. Anaemic girls (N =133) were recruited out of 1358 girls from 34 elementary schools. Haemoglobin, serum ferritin, serum transferrin receptor and zinc protophorphyrin were determined for iron status, whilst weight and height were measured for their nutritional status. General characteristics and dietary intake were assessed through interview. Out of 133 anaemic subjects, 29 (21.8%) suffered from iron deficiency anaemia, which was not significantly related to age and menarche. About 50% were underweight and stunted indicating the presence of acute and chronic malnutrition. The proportion of thinness was significantly higher (P < 0.05) among subjects who suffered from iron deficiency anaemia (51.7% vs. 29.8%). Furthermore, thin subjects had a 5 fold higher risk of suffering from iron deficiency anaemia (P< 0.05) than non-thin subjects (OR: 5.1; 95%CI 1.34-19.00). Further study was recommended to explore other factors associated with anaemia and iron deficiency anaemia, such as the thalassemia trait and vitamin A deficiency. The current iron-folate supplementation program for pregnant women should be expanded to adolescent girls.

The purpose of this article is to review current strategies for the reduction of maternal mortality and the evidence pertinent to these strategies. Historical, contextual and current literature were examined to identify the evidence base upon which recommendations on current strategies to reduce maternal mortality are made. Current safe motherhood strategies are designed based mostly on low grade evidence which is historical and observational, as well as on experience and a process of deductive reasoning. Safe motherhood strategies are complex public health approaches which are different from single clinical interventions. The approach to evidence used for clinical decision making needs to be reconsidered to fit with the practicalities of research on the effectiveness of strategies at the population level. It is unlikely that any single strategy will be optimal for different situations. Strengthening of the knowledge base on the effectiveness of public health strategies to reduce maternal mortality is urgently required but will need concerted action and international commitment.