Determinant Factors of Children's Blood Lead Levels in Java, Indonesia.

INTRODUCTION: Lead poisoning contributes to a significant burden of disease as a toxic substance found in air, soil, and water. In Indonesia, the risk of exposure is high due to the inappropriate recycling of used lead batteries. The objective was to investigate the factors that influence lead levels in children's blood. METHODS: This cross-sectional study assessed blood lead levels (BLLs) in children aged 12-59 months in four communities exposed to used lead-acid batteries (ULABs) recycling activities, comparing them to a control area. The study employed a threshold level of 20 µg/dL to identify high BLLs and utilized a sample size of 324 children from exposed sites and 240 from control sites. Questionnaires, blood lead tests and a home-based assessment for environmental exposures were applied. RESULTS: The study participants comprised 295 boys and 269 girls, with an average age of 35 months. Significant disparities in soil lead concentrations median: Q1-Q3 were found between exposed (6581.7 : 2432.6-16647.1) ppm and control areas (253.5 : 158.8-417.1) ppm. Children in exposed areas had 3.9 times higher odds of BLL ≥20 µg/dL. Fathers with BLL ≥20 µg/dL had children with similarly elevated BLLs. Multivariate analysis identified socioeconomic status, study areas, environmental factors (cookware, food ware, spices, house cleaning), and children's behavior (breastfeeding duration) as determinants of elevated BLLs. Reported environmental factors had notable impact on BLLs, with aluminum cookware (aOR = 1.4, 95%CI [1.2-1.6]), food ware materials (aOR = 1.15, 95%CI [1.0-1.3]), type of spices (aOR = 2.7, 95%CI [1.7-48.0]), and house cleaning method (aOR = 2.9, 95%CI [1.2-7.1]). CONCLUSION: This study highlighted key risk factors affecting children's blood lead levels (BLL) and emphasized the urgency of employing effective strategies to remediate lead-contaminated soils in exposed regions. The findings underscore the need for prompt medical intervention and monitoring for children in these areas, with additional research essential to fully understand lead poisoning pathways in the environment.

Drivers of Stunting Reduction in Yogyakarta, Indonesia: A Case Study.

BACKGROUND: Chronic malnutrition in children is a severe global health concern. In Yogyakarta, the number of children who are too short for their age has dropped dramatically over the past few decades. OBJECTIVE: To perform an analysis of trends, policies, and programs; and an assessment of government, community, household, and individual drivers of the stunting reduction in Yogyakarta, Indonesia. METHOD: Using a mixed-methods approach, there were three types of research: (1) analysis of quantitative data, (2) evaluation of stunting policy, and (3) focus group discussions and in-depth interviews to collect qualitative data. RESULTS: The prevalence of stunting has decreased from year to year. Mean height-for-age z-scores (HAZ) improved by 0.22 SDs from 2013 to 2021. Male and female toddlers aged <20 months have relatively the same body length as the WHO median, but it is lower for children >20 months old. The COVID-19 pandemic has contributed to an increase in stunting-concurrent wasting. Nutrition-specific and -sensitive interventions have been carried out with coverage that continues to increase from year to year, although in 2020, or at the beginning of the COVID-19 pandemic, the coverage of specific interventions decreased. The government has committed to tackling stunting by implementing the five pillars of stunting prevention and the eight convergent stunting actions. As the drivers of stunting reduction, national and community stakeholders and mothers, at the village level, cited a combination of poverty reduction, years of formal education, prevention of early marriage, access to food, enhanced knowledge and perception, and increased access to sanitation and hygiene. CONCLUSIONS: Nutrition-specific and -sensitive sector improvements have been crucial for decreasing stunting in Yogyakarta, particularly in the areas of poverty reduction, food access, preventing child marriage, sanitation, education, and increasing knowledge and perception.

Impact of an Integrative Nutrition Package through Home Visit on Maternal and Children Outcome: Finding from Locus Stunting in Yogyakarta, Indonesia.

Background: Stunting has been a public health problem in several developing countries including Indonesia. One of the strategies to reduce stunting was family assistance. This study was aimed to estimate the effect of family assistance by using an integrative nutrition package through home visits on the growth and development of stunted children. Method: This was an experimental study using pre-test post-test with control group design, conducted in Yogyakarta, Indonesia, on March to May 2022. The intervention group was provided an integrative nutrition package (INP) including maternal education, behavioral change through home visit, as well as monitoring children's outcome, while the control group was asked to read and follow child care procedure in the maternal and child health (MCH) book as a standard procedure. Both groups were visited by trained health volunteers and had a complementary feeding (CF) package weekly for four weeks. The outcomes of this study were the maternal outcome (knowledge and behavior on children's growth monitoring (CGM), children's development monitoring (CDM), and infant/young children feeding (IYCF) as well as children's outcomes, including body weight (BW), body height (BH), and child score development (CSD). This study used generalized estimating equation (GEE) to estimate the differences in differences (DID) of the impact of intervention compared with control group and compared among three different times (baseline, fourth, and eighth week). Results: There were 60 stunted children under five years in this study, i.e., 30 in intervention group and 30 in control group. From the GEE analysis, it was found that the regression adjusted DID showed statistically significant increase of all outcomes including children's development score (CDS). The adjusted DID effect (95% CI) on 8th week for children's weight, height, and development score were 0.31 (0.25-0.37), 0.41 (0.13-0.68), and -0.40 (-0.59-(-0.21)), respectively, among the intervention group. Conclusions: INP through home visit successfully increased maternal and children's outcomes compared witsh standard procedure. The effect of intervention was found to be consistently significant in the fourth and eighth weeks after intervention. We recommend the local government to apply INP through home visit especially in high-prevalence stunting areas.

Effect of a Short Course on Improving the Cadres' Knowledge in the Context of Reducing Stunting through Home Visits in Yogyakarta, Indonesia.

Background: Stunting is primarily a public health concern in Low- and Middle-Income Countries (LMIC). The involvement of Integrated Health Service Post (Indonesian: Posyandu) cadres is among the strategies to combat stunting in Indonesia. Objective: This study aimed to determine the effect of a short course on cadres' knowledge. Method: A single group pre-test post-test design was conducted in Yogyakarta, Indonesia, from March to May 2022. Thirty cadres were selected based on the following criteria: willingness to participate, the number of stunted children in their Posyandu, able to read and write, and full attendance at the short course. The knowledge scores were measured by a questionnaire using true and false answers after a short course (post-test 1) and 4 weeks later (post-test 2). We apply STATA 16 to calculate the Mean Difference (MD) using a t-test and a Generalized Estimated Equation (GEE). Furthermore, the adequacy of the short course was evaluated with in-depth interviews. Result: GEE analysis showed that after controlling for age, education, occupation, and years of experience, the short course improved cadres' knowledge significantly on post-tests 1 and 2, i.e., knowledge regarding Children Growth Monitoring (CGM) (Beta = 6.07, 95%CI: 5.10-7.03 and Beta = 8.57, 95%CI: 7.60-9.53, respectively), Children Development Monitoring (CDM) (Beta = 6.70, 95%CI: 5.75-7.65 and Beta = 9.27, 95%CI: 8.31-10.22, respectively), and Infant Young Children Feeding (IYCF) (Beta = 5.83, 95%CI: 4.44-7.23 and Beta = 11.7, 95%CI: 10.31-13.09, respectively). Furthermore, the short course increased their self-efficacy, confidence, and ability to assist stunted children through home visits. Conclusion: The short courses consistently and significantly boosted cadres' knowledge of CGM, CDM, and IYCF, and appropriately facilitated cadres in visits to the homes of stunted children's home.