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Fulltext Family Resilience With Stunted Children Aged Below 5 Years: A Qualitative Study in Depok City, Indonesia

Rahmadiyah DC, Sahar J, Widyatuti, Sartika RAD, Hassan H

Glob Qual Nurs Res, 2024;11:23333936231221753.
PMID: 38250089 DOI: 10.1177/23333936231221753

Stunting is influenced by family and household factors that affect toddler nutrition. As the primary provider of both physical and psychological resources to prevent health problems, the family has a significant role in preventing stunting. Family resilience in supporting child health is mediated by family functioning. A qualitative descriptive study explored the influence of family resilience in fulfilling the nutritional needs of stunted children. This study involved in-depth interviews with 23 mothers of stunted children aged 24 to 59 months. Through content analysis, we identified three main themes: (1) family belief that stunting is hereditary, (2) family belief that stunted children will "grow up," and (3) lack of communication between family members in discussing stunting. Future studies should explore intervention models to increase family resilience and prevent stunting in children under five.
Association between Iron-Folic Acid Supplementation during Pregnancy and Maternal and Infant Anemia in West Java, Indonesia: A Mixed-Method Prospective Cohort Study

Sartika RAD, Wirawan F, Putri PN, Mohd Shukri NH

Am J Trop Med Hyg, 2024 Mar 06;110(3):576-587.
PMID: 38350155 DOI: 10.4269/ajtmh.23-0411

The Indonesian government has provided iron-folic acid (IFA) supplementation in response to maternal pregnancy iron-deficiency anemia. However, community-based cohorts on IFA's effects on maternal and infant anemia are limited. A mixed-method study design with a primary longitudinal cohort was used to observe the association between IFA and anemia in mothers and infants. Iron-folic acid supplementation was observed throughout pregnancy. Anemia status was based on a single hemoglobin assessment using HemoCue Hb 201 + in the second or third trimester of pregnancy for the mother and at birth for the infant. Qualitative data were collected via in-depth interviews (IDIs) and a forum group discussion (FGD). Iron-folic acid supplementation with > 180 tablets throughout pregnancy was associated with lower pregnancy anemia (adjusted relative risk [aRR] = 0.25, 95% CI: 0.092-0.664, P = 0.006) after adjusting for potential confounding variables. Supplementation with IFA was not associated with infant anemia (RR = 1.033, 95% CI: 0.70-1.54, P = 0.873 for 90-180 tablets and RR = 1.07, 95% CI 0.70-1.63, P = 0.774 for > 180 tablets). The IDIs and FGD suggested that IFA and multivitamin content knowledge, IFA consumption monitoring, and paternal involvement were important in IFA supplementation and effectiveness in reducing anemia. Iron-folic acid supplementation was associated with reduced maternal but not infant anemia. Because maternal anemia is associated with infant anemia, an anemia monitoring program for women in early pregnancy is vital in addressing infant health. Paternal involvement was also identified as a major factor in maternal and child health.
Fulltext Association of birth weight with risk of diabetes mellitus in adolescence and early adulthood: analysis of the Indonesian Family Life Survey

Sartika RAD, Sigit FS, Purwanto E, Aris N, Marjan AQ, Putra WKY, et al.

Ann Pediatr Endocrinol Metab, 2023 Dec;28(4):267-274.
PMID: 38173382 DOI: 10.6065/apem.2346146.073

PURPOSE: We aimed to investigate the association of birth weight with the risk of diabetes mellitus in adolescence and early adulthood in the Indonesian population.
METHODS: This study analyzed data from the Indonesian Family Life Survey, a longitudinal study of the Indonesian population with repeated measurements at 3 time points (1997, 2007, and 2014). The subjects observed were children aged 0-59 months in 1997, who were 10-15 years old in 2007, and 17-22 years in 2014. We performed a generalized linear model to investigate the association between birth weight at baseline and the level of hemoglobin A1c (HbA1c) at the 2 follow-up periods. We adjusted the association for the characteristics of the children, parents, and household.
RESULTS: The mean±standard deviation level of HbA1c was 7.35%±0.95% in 2007 and decreased to 5.30%±0.85% in 2014. The crude β (95% confidence interval [CI]) of the association between birth weight and HbA1c was 0.150 (-0.076, 0.377) in 2007 and 0.146 (-0.060, 0.351) in 2014. After adjustment for the sociodemographic characteristics of the children, parents, and confounding factors, the adjusted β (95% CI) was 1.12 (0.40-1.85) in 2007 and 0.92 (0.35-1.48) in 2014. The HbA1c of the parents, father's employment status, percentage of food expenditure, and underweight were the covariates that had significant associations with HbA1c.
CONCLUSION: HbA1c level was higher in adolescence than in early adulthood. Birth weight was associated with HbA1c level in both periods. The HbA1c of the parents, father's employment, percentage of food expenditure, and underweight partly explained the association between birth weight and the HbA1c level.
Fulltext Parental support and exclusive breastfeeding at 3 months in West Java, Indonesia: a mixed-methods approach

Sartika RAD, Wirawan F, Gunawan W, Putri PN, Shukri NHM

Clin Exp Pediatr, 2024 Jul;67(7):358-367.
PMID: 38902920 DOI: 10.3345/cep.2023.01375

BACKGROUND: The exclusive breastfeeding (EBF) rate in Indonesia is lower than expected. Among the key factors affecting breastfeeding practices, paternal support has been suggested.
PURPOSE: To explore the role of paternal support in EBF failure among 3-month-old infants.
METHODS: This sequential mixed-methods study, part of an ongoing cohort study in West Java in early 2022, included 225 infants. The parents of 3-month-old infants were interviewed. Paternal support was assessed using a 15-point validated questionnaire for a total score of 15-60 points. Multivariate binary regression was used to determine adjusted odds ratios (aORs). The qualitative exploration was based on in-depth interviews (IDIs) and forum group discussions (FGDs) following the quantitative survey.
RESULTS: Of the 225 infants, 52.2% were no longer EBF. High paternal support (greater than the mean score) of breastfeeding was determined in 52.9% of cases (mean± standard deviation, 38.7±6.7 for the overall population vs. 37.5±6.3 and 40.2±6.8 for infants who were and were not EBF at 3 months of age, respectively). Low paternal support was associated with an increased EBF failure rate (aOR, 2.84; 95% confidence interval [CI], 1.46-5.54). Other variables that remained as predictors in the final model were a low birth rate (aOR, 7.35; 95% CI, 1.73-31.20), negative maternal attitude (aOR, 3.31; 95% CI, 1.63-6.75), lower self-efficacy (aOR, 4.82; 95% CI, 2.43-9.57), and lower maternal education level (aOR, 2.87; 95% CI, 1.03- 8.03). The IDIs and FGD observed the importance of the father's support of the mother and EBF. The qualitative exploration revealed a lack of knowledge about EBF as a parental support barrier.
CONCLUSION: Paternal support is important for EBF. Paternal involvement in EBF planning encouraged themother to continue. Plans that include fathers in breastfeeding education may help increase paternal support.