Body mass index as a dominant risk factor for metabolic syndrome among indonesian adults: a 6-year prospective cohort study of non-communicable diseases.

BACKGROUND: Non-communicable diseases (NCDs), notably cardiovascular disease and type 2 diabetes mellitus, are largely driven by metabolic syndrome (MetS), a cluster of critical risk factors. Despite extensive research, the progression of MetS, especially in Indonesia, has received limited attention. This research tracks adult MetS risk dynamics in a populous Bogor District cohort, providing crucial insights into its evolving nature. METHODS: This prospective open cohort study analysed secondary data from the Special Research - Cohort Study of Non-Communicable Diseases by the Ministry of Health, Republic of Indonesia from 2011 to 2018. The final sample was 1,376 Indonesian adult participants, all residents of Bogor District. MetS outcome, dietary assessment, physical activity, and biomarkers were analysed every two consecutive years. RESULTS: The risk of overweight and obese participants developing MetS was 2.4 and 4.4 times higher, respectively (95% CI: 1.176-3.320 and 3.345-5.740) than those with body mass index (BMI) in the normal range. Participants who reported less intentional physical exercise had a MetS risk 1.5 times higher (95% CI: 1.034-2.109) than those with more intentional physical exercise. The role of diet is also significant, evidenced by a 30% reduction in MetS risk for people with fat intakes in the 2nd quartile compared to the 1st quartile (95% CI: 0.505-0.972). Meanwhile, a carbohydrate intake in the 2nd quartile increased the risk of MetS 1.5 times (95% CI: 1.063-2.241) in comparison with the 1st quartile. CONCLUSIONS: Notably, participants with underweight BMI exhibited the highest cumulative survival of MetS, while those with obese BMI recorded the lowest cumulative survival. There is an urgent need for strategic interventions to enhance the existing early detection and NCD monitoring program. This involves a targeted focus on promoting a community-based healthy lifestyle in the Bogor District. The study emphasizes the importance of tailored public health measures to address specific risk factors identified in the local context, aiming to mitigate the prevalence and impact of MetS in the population.

A multilevel analysis of the triple burden of malnutrition in Indonesia: trends and determinants from repeated cross-sectional surveys.

BACKGROUND: Although child malnutrition has been reducing, the coexistence in mothers and children of various forms of malnutrition has continued to rise around the world. In the Indonesian context, a knowledge gap exists on the coexistence of multiple malnutrition burdens. This study examines trends in the coexistence of the triple burden of malnutrition (TBM) among mother-child pairs living in the same house and explores multilevel (individual, household, and community) factors associated with TBM in Indonesia. METHODS: We used data from the 2013 and 2018 Indonesia Basic Health Research, the nationally representative survey of the Indonesian population, as repeated cross-sectional surveys. Study samples were mothers and children (0-59 months old), who resided in the same household and indicated by the same identifier number. The anthropometric measurements of the mothers and children, and the hemoglobin levels of the children were collected. We employed a multilevel mixed-effects model to consider the hierarchical data structure. The model captured the role of cluster, district, provincial differences, and the individual, household, community-level, and TBM status characteristics. RESULTS: Of 3,891 mother-child pairs analyzed, 24.9% experienced TBM. Girls had 63% higher odds than boys of TBM (aOR: 1.63; 95% CI: 1.30 to 2.03). Significantly lower odds were found in children of mothers who had a gestational age lower than 37 weeks (aOR: 0.72; 95% CI: 0.55 to 0.94). At the household level, children with a father who had a high-school, primary-school, or no school education had significantly higher odds of TBM than children of fathers who had graduated from academy. Children of mothers who visited Antenatal Care (ANC) no more than 6 times had significantly lower odds (aOR: 0.65; 95% CI: 0.47 to 0.88). Children of mothers who consumed Iron and Folic Acid (IFA) supplements had significantly lower odds. CONCLUSION: TBM is related to characteristics at not just the individual level but also the family and community levels. To achieve significant outcomes, integrated nutrition interventions in Indonesia should also consider family and community factors.

Continuum of care in maternal, newborn and child health in Indonesia: Evidence from the Indonesia Demographic and Health Survey.

Background: Maternal and child health improved considerably due to the Sustainable Development Goals of the United Nations. However, the rate of preventable death worldwide remains high. Nevertheless, implementation was insufficient in low- and middle-income countries, including Indonesia. The study aims to assess the relationships between continuum of care (CoC) in maternal, neonatal and child health (MNCH) services and levels of care in Indonesia, examine the distribution of utilisation and investigate the associations between CoC in MNCH. Design and methods: Data were derived from the recent 2017 Indonesia Demographic and Health Survey. Fieldwork took place from July 24 to September 30, 2017. The sample included ever-married women aged 15-49 years who had given birth in the last 5 years prior to the survey. The total sample size is 15,288. Results: Only 52.6% (n = 8038) continued to receive the three levels of MNCH services. Multivariate analysis revealed that variables, such as socioeconomic status, parity and distance from health facilities were statistically significantly associated with the continuum from antenatal to postnatal care (PNC). The use of each level of MNCH care is correlated with the next level of care. Antenatal care is associated with delivery care which is subsequently associated with postnatal care. Conclusions: Identifying populations that contribute significantly to overall health inequalities and a well-established follow-up system from pregnancy to PNC may enhance maternal and child health and equity outcomes.

Population-Based Study on the Maternal-Newborn-Child Health Continuum of Care: Evidence From Lower-Middle-Income Countries in Southeast Asia.

This article aimed to assess the relationships within the continuum of care for maternal, neonatal, and child health (MNCH) at four service levels, the utilization distribution, and its contributing factors in six lower-middle-income countries in Southeast Asia. It was based on data from the Demographic and Health Survey, a nationally representative and repeated cross-sectional survey, on 50 619 ever-married women aged 15-49 years. Only 21.9% of women (n = 10 252) obtained all four levels of continuing MNCH services. Women and husbands' education and employment, parity, mass media consumption, and wealth quintiles were the strongest determinants for the continuation of care, apart from access to health care, decision-making autonomy in health care, and women's age. Identifying populations that experience health inequalities, prominent policy intervention, and better health promotion and advocacy systems regarding pregnancy, delivery, and postnatal and immunization care might help to enhance maternal and child health and equity outcomes.

Continuity of maternal healthcare services utilisation in Indonesia: analysis of determinants from the Indonesia Demographic and Health Survey.

OBJECTIVE: WHO recommends that every pregnant woman and newborn receive quality care throughout the pregnancy, delivery and postnatal periods. However, Maternal Mortality Ratio in Indonesia for 2015 reached 305 per 100 000 live births, which exceeds the target of Sustainable Development Goals (<70 per 100 000 live births). Receiving at least four times antenatal care (ANC4+) and skilled birth attendant (SBA) during childbirth is crucial for preventing maternal and neonatal deaths. The study aims to assess the determinants of ANC4 +and SBA independently, evaluate the distribution of utilisation of ANC4 + and SBA services, and further investigate the associations of two levels of continuity of services utilisation in Indonesia DESIGN: Data from the Indonesia Demographic and Health Survey, a cross-sectional and large-scale national survey conducted in 2017 were used. SETTING: This study was set in Indonesia. PARTICIPANTS: The study involved ever-married women of reproductive age (15-49 years) and had given birth in the last 5 years prior to the survey (n=15 288). The dependent variables are the use of ANC4 + and SBA. Individual, family and community factors, such as age, age at first birth, level of education, employment status, parity, autonomy in healthcare decision-making, level of education, employment status of spouses, household income, mass media consumption residence and distance from health facilities were also measured. RESULTS: Results showed that 11 632 (76.1%) women received ANC4 + and SBA during childbirth. Multivariate analysis revealed that age, age at first birth, and parity have a statistically significant association with continuity of services utilisation. The odds of using continuity of services were higher among women older than 34 years (adjusted OR (aOR) 1.54; 95% CI 1.31 to 1.80) compared with women aged 15-24 years. Women with a favourable distance from health facilities were more likely to receive continuity of services utilisation (aOR 1.39; 95% CI 1.24 to 1.57). CONCLUSIONS: The continuity of services utilisation is associated with age, reproductive status, family influence and accessibility-related factors. Findings demonstrated the importance of enhancing early reproductive health education for men and women. The health system reinforcement, community empowerment and multisectoral engagement enhance accessibility to health facilities, reduce financial and geographical barriers, and produce strong quality care.

Birth weight and childhood obesity: effect modification by residence and household wealth.

BACKGROUND: There are both genetic and environmental factors which contribute to a child's chances of being obese. When low birth weight (LBW) has been specifically evaluated relative to its association with childhood obesity, the results have produced conflicting findings. This study aims to describe the relationship between birth weight and childhood obesity and investigate the influence that residence and household wealth has on this relationship. METHODS: I performed a secondary analysis on the 2013 Riskesdas (or Basic Health Research), a cross-sectional, nationally representative survey of the Indonesian population. Height, weight, information regarding child's birth weight, and basic characteristics of the study population were collected from parents with children aged 0 to 5 years (n = 63,237) in 2013. The exposure was child's birth weight and the outcomes were child's current weight, BMI z-score, and obesity. Data were analyzed by using multiple linear regression and multiple logistic regression. RESULTS: I found a significant increase in the weight, BMI z-score, and risk of childhood obesity to be associated with LBW. LBW children in rural area were associated with higher BMI z-score (mean ± standard error: 1.44 ± 0.02) and higher odds (odds ratio (95% confidence interval): 7.46 (6.77-8.23)) of obesity than those in urban area. LBW children from low class families were associated with higher BMI z-score (1.79 ± 0.04) and had higher odds (14.79 (12.47-17.54)) of obesity than those from middle class and wealthy families. CONCLUSIONS: Effective prevention and intervention to childhood obesity as early as possible are imperative. As far as this study was concerned, efforts, policies, and targets are required to reduce the prevalence of LBW. Children born of LBW, who live in a rural area and from low income families, should be emphatically intervened as early as possible.

Effects of changes in smoking status on blood pressure among adult males and females in Indonesia: a 15-year population-based cohort study.

OBJECTIVES: The continuing rise of smoking behaviours will inevitably lead to a further increase in hypertension prevalence. However, limited research has examined the impacts of changes in smoking status on blood pressure (BP). We sought to assess correlations between increases or decreases of males' and females' cigarette consumption on systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP), and to investigate the relationship between smoking status changes and changes in BP through a 15-year examination period. DESIGN: Retrospective, cohort study. SETTING: We used nationally representative secondary data collected in the years 2000, 2007 and 2015 by the Indonesia Family Life Survey. PARTICIPANTS: We measured the smoking habits, BP indices and other socioeconomic factors documented in the multiple follow-up surveys of a sample of 10 338 respondents. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the means of SBP, DBP and PP. The secondary outcome was the changes from baseline in SBP and DBP. RESULTS: Smoking caused different effects on male and female smokers. Female smokers who increased their daily cigarette consumption had significantly higher SBP and PP (p<0.001). During 15 years of follow-up, male and female smokers who decided to quit had the largest change of SBP (adjusted mean=16.64 mm Hg, SE=21.39 and adjusted mean=24.78 mm Hg, SE=23.25, respectively), whereas new male and female smokers exhibited the highest change of DBP (adjusted mean=2.86 mm Hg, SE=11.50 and adjusted mean=7.54 mm Hg, SE=14.39, respectively). CONCLUSIONS: Our study confirmed the adverse effects of smoking on BP, which can be used to inform efforts to tackle the growing cigarette epidemic and its negative effects on hypertension among former and new smokers and develop evidence-based tobacco control policies in Indonesia.

Parental Smoking and Under-Five Child Mortality in Southeast Asia: Evidence from Demographic and Health Surveys.

Smoking remains the main cause of preventable early death. However, little is known about the association between parental smoking and child mortality in under-fives in developing countries. This study assesses the association between parental smoking status, smoking amount and smoking frequency with child mortality in under-fives in four Southeast Asian countries (Cambodia, Indonesia, Lao People's Democratic Republic and Timor Leste). We used the Demographic and Health Survey dataset. The information from couples consisting of fathers and mothers (n = 19,301 couples) in the same household were collected. Under-five child mortality was significantly associated with paternal smoking only (odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.14-1.38), maternal smoking only (OR = 2.40, 95% CI: 1.61-3.59) and both parents smoking (OR = 2.60, 2.08-3.26). Paternal, maternal, both parents' smoking amount and frequency were also assessed. The estimated association decreased after adjusting for covariates but remained highly significant for smoking in both parents, mothers who smoked 1-10 cigarettes/day, when both parents smoked > 20 cigarettes/day, and in mothers who smoked every day. Future behavioural changes and smoking cessation programmes should engage parents as a catalyst for the reduction of child mortality risk in LMICs in the SEA region.

Association of Maternal and Child Health Center (Posyandu) Availability with Child Weight Status in Indonesia: A National Study.

Little is known about the childhood obesity prevention and treatment practices of Maternal and Child Health services (Posyandu) in Indonesia or in other countries. The present study aims to assess the association of the availability of Posyandu with overweight and obesity in children of different household wealth levels. This was a secondary analysis of data collected in the 2013 Riskesdas (or Basic Health Research) survey, a cross-sectional study, representative population-based data. Height and weight, the availability of Posyandu, and basic characteristics of the study population were collected from parents with children aged 0 to 5 years (n = 63,237). Non-availability of Posyandu significantly raised the odds of being obese (OR = 1.13, 95% CI: 1.06-1.21) and did not show a significant relationship in the odds for overweight (OR = 0.99, 95% CI: 0.93-1.07). This relationship persisted after a full adjustment (OR = 1.16, 95% CI: 1.07-1.25 and OR = 1.04, 95% CI: 0.96-1.13, respectively). There was effect modification by household wealth, which was stronger for obese children. The availability of Posyandu has a protective association with childhood obesity in Indonesia. Posyandu services are well placed to play an important role in obesity prevention and treatment in early life.

Parental weight changes as key predictors of child weight changes.

BACKGROUND: Parents are the key agents of behavioural changes in their children. This fact is as an important aspect of obesity treatment and prevention. The present study aims to evaluate the influence of parents who have gained or lost weight on their children's weights and to examine parental and child patterns of weight changes from a baseline over a 14-year duration. METHODS: We performed a secondary analysis on the Indonesia Family Life Survey (IFLS), an ongoing national prospective longitudinal cohort study in Indonesia. Height and weight measurements, information regarding parental education, maternal employment, household income, and residence were collected from children under five years old (n = 3,147) and their parents in 1993. Data were taken from the same individuals at different points in time, in 1997, 2000, and 2007. RESULTS: During each transition, the children of parents who gained weight had a significantly weights than did children of parents who lost weight. A mother's positive weight change increased the chance of her pre-schooler's or school-aged child's positive weight change. However we found no such association between a father's positive weight change and his child's positive weight change. CONCLUSIONS: Parental weight change is an independent predictor of child weight change. Positive weight change in the mother had a more dominant influence than did the father's positive weight change. Future family-based obesity prevention and treatment programs should consider how best to include and engage mothers as a catalyst for the reduction of obesity-related risk factors in the long term.

Adverse effects of parental smoking during pregnancy in urban and rural areas.

BACKGROUND: Parental smoking during pregnancy is associated with lower birthweight and gestational age, as well as with the risks of low birthweight (LBW) and preterm birth. The present study aims to assess the association of parental smoking during pregnancy with birth outcomes in urban and rural areas. METHODS: This was a secondary analysis of data collected in the Indonesia Family Life Survey, between 1993 and 2007, the first national prospective longitudinal cohort study in Indonesia. Retrospective data of parental smoking habits, socioeconomic status, pregnancy history and birth outcomes were collected from parents with children aged 0 to 5 years (n = 3789). We assessed the relationships between the amount of parental smoking during pregnancy with birthweight (LBW) and with gestational age (preterm birth). RESULTS: We found a significant reduction in birthweight to be associated with maternal smoking. Smoking (except for paternal smoking) was associated with a decrease in the gestational age and an increased risk of preterm birth. Different associations were found in urban area, infants born to smoking fathers and both smoking parents (>20 cigarettes/day for both cases) had a significant reduction in birthweight and gestational age as well as an increased risk of LBW and preterm birth. CONCLUSIONS: Residence was found to be an effect modifier of the relation between parental smoking during pregnancy, amount of parental smoking, and birth outcomes on their children. Smoking cessation/reduction and smoking intervention program should be advised and prioritized to the area that is more prone to the adverse birth outcomes.