ABSTRACT
Background: The first 1000-days of life are a critical window and can result in adverse-health consequences due to inadequate nutrition. South-Asian (SA) communities face significant health-disparities, particularly in maternal and child-health. Community-based-interventions, often employing Participatory-Learning-and-Action (PLA) approaches, have effectively addressed health-inequalities in lower-income-nations. The aim of this study was to assess the feasibility of implementing a PLA-intervention to improve infant-feeding and care-practices in SA communities in London. Methods: Comprehensive-analyses were conducted to assess the feasibility/fidelity of this pilot-randomised-controlled-trial. Summary-statistics were computed to compare key-metrics (participant consent-rates, attendance, retention, intervention-support, perceived-effectiveness) against predefined-progression-rules guiding towards a definitive-trial. Secondary-outcomes were analysed, drawing insights from sources, such as The-Children's-Eating-Behaviour-Questionnaire (CEBQ), Parental-Feeding-Style-Questionnaires (PFSQ), 4-Day-Food-diary, and the Equality-Impact-Assessment (EIA) tool. Video-analysis of children's mealtime behaviour trends was conducted. Feedback-interviews were collected from participants. Results: Process-outcome measures met predefined-progression-rules for a definitive-trial which deemed the intervention as feasible. The secondary-outcomes analysis revealed no significant changes in children's BMI z-scores. This could be attributed to the abbreviated follow-up period of 6-months, reduced from 12-months, due to COVID-19-related delays. CEBQ analysis showed increased food-responsiveness, along with decreased emotional-over/undereating. A similar trend was observed in PFSQ. The EIA-tool found no potential discrimination areas, and video-analysis revealed a decrease in force-feeding-practices. Participant-feedbacks revealed improved awareness and knowledge-sharing. Conclusion: The study validates the feasibility of a community-oriented, co-adapted Participatory-Learning-and-Action approach for optimising infant-care among South-Asians in high-income countries. It underscores the potential of such interventions in promoting health-equity and improving health-outcomes. Further research is required to evaluate their wider impact.
Subject(s)
COVID-19 , Learning DisabilitiesABSTRACT
Background The Indonesia National Task Force for the Acceleration of COVID-19 Mitigation has developed an integrated monitoring system to measure community compliance with the health protocol Bersatu Lawan COVID-19. The current study aims to evaluate compliance with the health protocol in Indonesia through the Bersatu Lawan COVID-19 digital mobile application. Methods Data was collected from the National Task Force between Oct 1, 2020, and May 2, 2021. A total of 437 093 front-line public order forces (eg, police and the military) and Behavioural Change Ambassadors reported real-time community compliance on mask wearing and physical distance keeping at public places such as markets, malls, schools, offices, and worship places. Individuals who did not comply were reprimanded and educated. Findings As of May 2, 2021, more than 165 million reports were gathered, with 469 million people were monitored in 514 districts or cities across 34 provinces in Indonesia. The overall national figures show a compliance of 322 736 010 (85·9%) of 375 711 304 people in mask wearing, and of 315 973 207 (84·1%) of 375 711 304 people in keeping physical distance, as a cumulative estimate. The results showed the variation of compliance rates among districts and cities in provinces. An analysis of data gathered in the week of April 26 to May 2, 2021, showed that mask wearing compliance was low (defined as observed by less than 75% of people) in 103 (29·6%) of 348 districts and cities across Indonesia, and that physical distance compliance was low in 99 (28·4%) of 348 districts and cities. The temporal pattern analysis estimated that compliance decreased in November and December, 2020 (before the peak of the second wave of the pandemic), and that it increased between January and May, 2021 (during and after the second wave). 321 million people were reprimanded and educated on the importance of adherence to the health protocol. Interpretation This paper discusses an example of the use of the Bersatu Lawan COVID-19 application in Indonesia, the most populous country in southeast Asia. We report the first time that an application for digital health, introduced nationally, produced data that could be analysed on a real-time basis, thus enabling central and local government to strengthen enforcement of the health protocol to stop the potential transmission of COVID-19 in public places. Funding No funding to declare.