Balance Nutrition Messages Are Still Implemented in Preschools One Year Postintervention: Case Studies in Subang District, West Java, Indonesia.

Thirty-two teachers from 10 preschools in Cisalak subdistrict, Subang district, West Java province, Indonesia, received a two-day training on Balance Nutrition and My Plate in February 2018. The main messages underlined in the training were consume a variety of foods, drink enough water daily, wash your hands with soap, be physically active, and monitor your body weight. The training was followed by an eight-week implementation period to preschoolers aged 3 to 6 y. The knowledge of the teachers increased by up to 33 percentage points (average score: 69 to 82 pre- vs. posttest) after training, and the teachers answered correctly to the same questions 15 mo later. The mothers' knowledge increased by up to 37 percentage points after parenting sessions. All seven teaching aids provided were used by end-line, but their usage decreased after seven months (range: 2 to 7) and further decreased by 12 mo postintervention (range: 2 to 5). A teacher's handbook and a flipchart were the two aids persistently used. The practices of washing hands with soap, bringing healthy packed lunches, and monitoring weight and height continued after 12 mo postintervention. Dissemination of Balance Nutrition knowledge to fellow teachers of the same school, colleagues from different schools, or to representatives of preschool associations was evident. Training should be scaled up to the district level, using trained teachers as trainers and adopting a cascade training method. National roll-out by teachers' associations, in collaboration with the Ministry of Education and the Ministry of Health, could improve the knowledge of over 200,000 preschool teachers and potentially improve the nutrition of 19 million preschoolers.

Do Indonesians follow its Dietary Guidelines?: evidence related to food consumption, healthy lifestyle, and nutritional status within the period 2000-2010.

Dietary Guidelines are sets of advisory statements that give dietary advice for population to promote nutritional well-being. They contain information on foods or behaviors that are encouraged and cautionary messages derived from scientific evidence-based reviews and specific local conditions. The Indonesian Dietary Guidelines consisting of 13 messages that were publicized by the Ministry of Health in 1995 and have not been reviewed afterward in relation to nutritional status and health outcome of the population. By reviewing studies on different age groups in the past 10 years and comparing the results with the recommended guidelines, this paper aims to identify if messages have been successfully applied and if there are relevant issues not yet covered in the guidelines. The reviews covered 29 out of 33 provinces, representing studies from sub-district or higher levels (district, provincial, national). Results showed that some messages have been better implemented than others; also that information for some messages was not available for which to conclude of its implementation. In addition, some practices were identified which are prevalent in several age groups and have important public health consequence, but not yet included in the 13-guidelines. These include: smoking, increased intakes of fruit and vegetables, limited intakes of salt and sugar, increased intakes of foods rich in zinc and calcium (besides iron), hand-washing before food preparation and eating, and weight-monitoring. For infants and young children, nutrient density, feeding responsiveness and stimulation should be specifically highlighted. Based on the results, several recommendations in revising the guidelines were given.

Food and personal hygiene perceptions and practices among caregivers whose children have diarrhea: a qualitative study of urban mothers in Tangerang, Indonesia.

OBJECTIVE: To examine caregivers' perceptions and practices related to food and personal hygiene and its association with diarrhea in children 6 to 36 months of age who suffered recurrent diarrhea. DESIGN: This qualitative study, conducted in March and April 2006, used both in-depth interviews and direct observation data. SETTING: Urban Tangerang, near Jakarta, Indonesia. PARTICIPANTS: Twenty-four mothers whose monthly household income was less than $160 US and had latrines in their homes. PHENOMENON OF INTEREST: To examine the relationship between mothers' perceptions and behaviors related to diarrhea, food hygiene, and personal hygiene. ANALYSIS: Interview transcripts were analyzed based on the phenomenon of interest and coded for common themes. RESULTS: Mothers differentiated diarrhea episodes as either disease or nondisease. Most mothers associated the importance of food hygiene with disease prevention, contaminating agents, and health. Mothers commonly wiped cutting boards with a kitchen towel after slicing vegetables, whereas they washed the board with soap and water after cutting raw meat. Mothers perceived that the importance of personal hygiene was for maintaining health and cleanliness. The majority of mothers washed their hands without soap after performing housework and cooking. CONCLUSIONS AND IMPLICATIONS: Improving mothers' knowledge while incorporating existing perceptions might lead to positive changes.

Expert meeting on Child Growth and Micronutrient Deficiencies--New Initiatives for Developing Countries to Achieve Millennium Development Goals: executive summary report.

Undernutrition in early childhood has long-term physical and intellectual consequences. Improving child growth should start before the age of two years and be an integrated effort between all sectors, covering all aspects such as diet and nutrient intake, disease reduction, optimum child care, and improved environmental sanitation. To discuss these issues, the Indonesian Danone Institute Foundation organized an expert meeting on Child Growth and Micronutrient Deficiencies: New Initiatives for Developing Countries to Achieve Millennium Development Goals. The objective of the meeting was to have a retrospective view on child growth: lessons learned from programs to overcome under-nutrition in the developed countries and to relate the situation to the Indonesian context, as well as to discuss implications for future programs. Recommendations derived from the meeting include focus intervention on the window of opportunity group, re-activation of the Integrated Health Post at the village level, improvement of infant and young child feeding, expand food fortification intervention programs, strengthen supplementation programs with multi-micronutrient, and strengthening public and private partnership on food related programs.

Psychosocial care and nutritional status of children aged 6-36 months among patrilineal (Karo) and matrilineal (Minangkabau) households in Jakarta.

A study on psychosocial care among Karo (patrilineal kinship) and Minangkabau (matrilineal kinship) households who lived in Jakarta, Indonesia was aimed at investigating psychosocial care practices of mothers and the relation of psychosocial care to the nutritional status of children aged 6-36 months as indicated by Weight-for-Age (WFA), Weight-for-Height (WFH), and Height-for-Age (HFA) Z-scores. The study was a cross sectional study. The tool used to assess the psychosocial care was the Home Observation for Measurement of the Environment (HOME) inventory scale for infants and toddlers. Psychosocial care of 52 respondents from Karo and 87 from Minangkabau were generally good. Out of the total 45 items of the six sub-scales HOME inventory, 1 item in sub-scale I (Emotional and verbal responsiveness), 4 items in sub-scale II (Acceptance of child's behavior), 1 item in sub-scale IV (Provision of play materials), 1 item in sub-scale V (Parental involvement with child), and 3 items in sub-scale VI (Opportunities for variety in daily stimulation) were statistically different between the two ethnic groups. More Minangkabau children were underweight and wasting compared to Karo children. Within the Karo group, well-nourished children in terms of WFA and WHA tended to have greater total HOME scores than their underweight and wasting counterparts. Among Minangkabau group, well-nourished children in terms of WFA, WHA, and HFA tended to have greater total HOME scores than their underweight, wasting, and stunting counterparts. The total HOME score of well-nourished Karo children in terms of WFA, WFH and HFA were greater than that of well-nourished Minangkabau children.

Household food security status measured by the US-Household Food Security/Hunger Survey Module (US-FSSM) is in line with coping strategy indicators found in urban and rural Indonesia.

The food security assessment used by the United State's Food Security/Hunger Survey Module (US- FSSM) was used in five studies: these were in two urban and four rural areas in Indonesia between February 2004- August 2005. The number of households assessed was 3,704 and consisted of 45% urban and 55% rural. All households had children below five years. This paper aims to assess the applicability of US-FSSM for measuring household food-insecurity in Indonesia. Common coping-strategies discussed are to borrow money from the family, get an additional job, to lessen portion size of food, and to sell small assets. Although households in urban and rural areas were similar in size/number of children and male headed; the urban households were more income-secure, educated, and had better access to electrical appliances. A majority of the households was food-insecure (77% and 84% in urban and rural consecutively). More food-insecure households without and with hunger were found in rural areas. The number of affirmative responses to 17 out of 18 questions in the USFSSM was more in the rural households, showing less fortunate cases of food-insecurity. For a given coping strategy, as food-security status becomes more severe, the higher the percentage of households employing it. For a given food-security status, percentage of households was higher among lower-degree and less among higher-degree coping. Combining food-security and coping-strategy indicators may help to identify transient-food-secure households. Observing both indicators throughout different time of the year continuously may further identify adaptive mechanism by chronic-food-insecure households. Information on household food diversity could enrich findings on dietary intake modification, hence moving from food-security to nutrition-security.