Understanding the pubertal, psychosocial, and cognitive developmental trajectories of stunted and non-stunted adolescents: protocol of a multi-site Indonesian cohort study

Background

The prevalence of stunting among Indonesian children aged 5-12 years decreased from 30.7% in 2013 to 23.6% in 2018 but has remained among the highest rates worldwide. Furthermore, Indonesian children were shorter than the standard reported by the World Health Organization and experienced obesity. The Indonesian government has created many programs to reduce stunting in children under the age of 5 years. An early preventive strategy is necessary because stunting can manifest within the initial 1,000 days of life, including during pregnancy. Therefore, a newer perspective, such as that achieved by addressing stunting in adolescents, has been deemed useful, given that adolescents are in their pubertal stage and are undergoing lifestyle changes. This cohort study was designed to measure these factors comprehensively in stunted and non-stunted children as they pass through adolescence.

Methods

For the prospective cohort, 560 individuals will be recruited from DKI Jakarta, DI Yogyakarta, and East Java. The participants will be categorized into stunted and non-stunted groups, then undergo annual examinations in which key objectives, such as weight, height, and body mass index ,will be assessed for the growth profile; waist circumference, middle-upper arm circumference, hand-grip strength, body fat percentage, and food intake will be evaluated in a nutritional assessment; psychosocial and mental issues will be evaluated according to behavioral problems, symptoms of depression, quality of life, sleep patterns, anxiety disorders, and parenting style through the use of specific questionnaires; and pubertal stage will be assessed using a self-report questionnaire. Some cross-sectional data, such as cognitive performance, hair zinc levels, vitamin D levels, bone mineral density, and bone age, will also be included. All the outcomes will be analyzed in accordance with the variable types.

Discussion

This study provides a thorough dataset of Indonesian adolescents encompassing several elements, such as growth, nutrition, psychosocial wellbeing, mental health, and pubertal development, for both stunted and non-stunted individuals. The data acquired from this study can be used to formulate policies to prevent stunting through targeted interventions for adolescents. Finally, a better understanding of adolescent health could lead to improved strategies to decrease the number of stunted individuals in the next Indonesian generation.

The Cohort of Indonesian Preterm Infants for Long-term Outcomes (CIPTO) study: a protocol

BACKGROUND

Indonesia has high numbers of preterm birth, i.e., around 600,000 preterm births annually. It imposes a significant burden on the Indonesia's healthcare system. Indonesia therefore requires its own evidence-based reference to manage premature neonates and ex-preterm infants who subsequently survived. No long-term study on preterm infants in Indonesia has been conducted, therefore we aim to evaluate growth and development on ex-preterm infants until the pre-pubertal stage.

METHODS

We at the Cipto Mangunkusumo General Hospital (CMGH) designed a prospective cohort study of preterm infants, i.e., the Cohort of Indonesian Preterm Infants for Long-term Outcomes (CIPTO) study. At least 500 subjects will be recruited with an estimation of two-year recruitment (i.e., the recruitment phase will be completed before 2024). The CIPTO study will observe long-term outcomes of ex-preterm infants, primarily on growth and developmental milestones until 8 years old. Aims of this study are to determine the ex-preterm outcomes and to generate an evidence-based reference of preterm care for ensuring optimum outcomes. The pre-specified long-term outcomes in this study are survival rates, growth outcomes, neurodevelopmental outcomes, feeding behavior, as well as hearing and vision impairments. Growth and neurodevelopmental outcomes will be assessed at 0, 2, 4, 6, 9, 12, 15, 18 and 24 months of corrected age as well as at 3, 4, 5, 6, 7 and 8 years old.

DISCUSSION

The CIPTO study is the first prospective cohort in Indonesia focusing on preterm infants born at the CMGH. With a follow up until 8 years old, this study may provide useful insights to generate an evidence-based, Indonesia's health care reference in managing premature infants and ensuring the optimum outcomes of ex-preterm infants.

Foregone health care in adolescents from school and community settings in Indonesia: a cross-sectional study

Background

Adolescence is a development period marked by the onset of a new set of health needs. The present study sought to quantify the prevalence of foregone care (not seeking medical care when needed) and identify which adolescents are at greater risk of having unmet healthcare needs.

Methods

A multi-stage random sampling strategy was used to recruit school participants (grade 10-12) in two provinces in Indonesia. Respondent driven sampling was used to recruit out-of-school adolescents in the community. All participants completed a self-reported questionnaire which measured healthcare seeking behaviours, psychosocial wellbeing, use of healthcare services, and perceived barriers to accessing healthcare. Multivariable regression analysis was performed to examine factors associated with foregone care.

Findings

A total of 2161 adolescents participated in the present study and nearly one in four adolescents reported foregone care in the past year. Experiences of poly-victimisation and seeking care for mental health needs increased the risk of foregone care. In-school adolescents who reported psychological distress [adjusted risk ratio (aRR) = 1.88, 95%CI = 1.48-2.38] or had high body mass index (aRR = 1.25, 95%CI = 1.00-1.57) were at greater risk of foregone care. The leading reason for foregone care was lack of knowledge of available services. In-school adolescents predominantly reported non-access barriers to care (e.g., perception of the health concern or anxiety about accessing care) whereas most out-of-school adolescents reported access barriers (e.g., did not know where to get care or could not pay).

Interpretation

Foregone care is common among Indonesian adolescents, especially in adolescents with mental and physical health risks. Differences between in-school and out-of-school adolescents suggest that interventions to promote appropriate healthcare use will need tailoring. Further research is needed to determine causal relationships around barriers in access to healthcare.

Funding

Australia-Indonesia Centre.

A Qualitative Exploration of Parenting Adolescents in Indonesia

OBJECTIVE

To explore how parents of Indonesian adolescents conceptualize adolescence and to identify the challenges faced in parenting adolescents, focusing on parents from different sociodemographic backgrounds.

METHOD

Focus group discussions (FGD) were undertaken with parents of adolescents aged 10-18 years old from different sociodemographic backgrounds (urban high socioeconomic; urban low socioeconomic; rural low socioeconomic) using a semi-structured interview guide. Content and thematic analysis were assisted by Nvivo version 12.6.0.

RESULTS

Forty-three parents participated in four FGD. All parents recognized that adolescence was a distinct developmental stage, reflected in changing behaviors, escalation of peer influences and sexual development. Parents from poor, rural backgrounds had relatively limited understanding of the emerging capabilities of adolescents and had a narrow repertoire of responses to challenging behaviors, with heavy reliance on religious rules and punishment. Parents from higher socioeconomic backgrounds displayed a wider range of warmer, more engaging approaches that they reported using to shape their children's behaviors.

CONCLUSION FOR PRACTICE

These findings highlight opportunities to enhance parenting skills, which appear most warranted in parents of adolescents from disadvantaged backgrounds. Embedding basic adolescent parenting information within community programs appears indicated, and enhancing religious leaders' understanding of different approaches to parenting could be helpful in more religious communities.

Deteksi Adiksi Internet dan Faktor-Faktor yang Memengaruhinya pada Remaja di Masa Pandemi Covid-19

Latar belakang. Pandemi Covid-19 memberikan dampak besar secara global, salah satunya di bidang pendidikan. Kegiatan pembelajaran dilakukan secara daring (dalam jaringan). Remaja yang mengikuti sekolah daring lebih banyak menghabiskan waktu di depan layar. Remaja juga merasa kesepian karena adanya pembatasan sosial sehingga mencari pelarian melalui internet. Hal ini menyebabkan semakin meningkatnya waktu di depan layar sehingga meningkatkan adiksi internet pada remaja.Tujuan. Mengetahui prevalens adiksi internet remaja di masa pandemi Covid-19 serta mengetahui hubungannya dengan beberapa faktor sosio-demografik. Metode. Penelitian potong lintang terhadap 332 siswa SMP/SMA/SMK/sederajat yang sedang menjalani sekolah daring, melalui pengisian kuesioner faktor sosio-demografik dan KDAI (kuesioner deteksi adiksi internet), dalam waktu 3 bulan (Maret-Juni 2021).Hasil. Prevalensi adiksi internet remaja sebanyak 29,8%. Faktor yang berhubungan dengan adiksi internet adalah waktu di depan layar untuk kegiatan hiburan ≥3 jam (p=0,001, adjusted OR 4,309, IK 95% 1,833-10,129) serta pengawasan orangtua yang buruk dalam penggunaan internet (p=0,037, adjusted OR 1,827, IK 95% 1,038-3,215). Kesimpulan. Tidak ada peningkatan prevalensi adiksi internet remaja di masa pandemi Covid-19. Variabel yang memiliki hubungan dengan adiksi internet adalah pengawasan orangtua yang buruk dan waktu depan layar untuk kegiatan hiburan ≥3 jam.

Protein and iron intake adequacy among high school girls in Depok, Indonesia

Introduction: Iron deficiency anemia is the most common type of anemia among adolescent girls. The prevalence of anemia among pregnant women increased from 2013 to 2018, and females age 15-24 years had the highest prevalence of anemia. Therefore, knowing the baseline status of protein and iron intake —particularly animal-sourced protein as the main source of heme iron—is important to design future intervention program. Thus, this study was aimed to assess the protein and iron intake adequacy of High School girls in Depok, Indonesia. Methods: 211 girls from Senior High School in Depok, Indonesia participated in this study. Subjects were selected using a multi-stage random sampling method. A questionnaire was administered to obtain general characteristics.  Dietary intake data were obtained using a 3-day non-consecutive 24hr recall 1 weekend 2 weekdays interview. Anthropometric status was measured and calculated. Data were analyzed using IBM SPSS Statistics 20. Spearman’s correlation (significance p<0.05) was used to determine the factors related to protein and iron intake. Results: This population had inadequate intake of energy (97.2%), protein (59.7%), and iron (98.6%). However, intake of fat was higher than recommended in 59.2% of participants. Protein and iron intake were not correlated with age, father’s education, mother’s education, and the number of household member.

Proceedings from the CIHLMU Symposium 2020 on "eHealth: Trends and innovations"

Electronic Health (eHealth) is the use of information and communication technologies for health and plays a significant role in improving public health. The rapid expansion and development of eHealth initiatives allow researchers and healthcare providers to connect more effectively with patients. The aim of the CIH^LMU Symposium 2020 was to discuss the current challenges facing the field, opportunities in eHealth implementation, to share the experiences from different healthcare systems, and to discuss future trends addressing the use of digital platforms in health. The symposium on eHealth explored how the health and technology sector must increase efforts to reduce the obstacles facing public and private investment, the efficacy in preventing diseases and improving patient quality of life, and the ethical and legal frameworks that influence the proper development of the different platforms and initiatives related to the field. This symposium furthered the sharing of knowledge, networking, and patient/user and practitioner experiences in low- and middle-income countries (LMIC) in both public and private sectors.

Direct assessment of mental health and metabolic syndrome amongst Indonesian adolescents: a study design for a mixed-methods study sampled from school and community settings

Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality globally, with the burden largely borne by people living in low- and middle-income countries. Adolescents are central to NCD control through the potential to modify risks and alter the trajectory of these diseases across the life-course. However, an absence of epidemiological data has contributed to the relative exclusion of adolescents from policies and responses. This paper documents the design of a study to measure the burden of metabolic syndrome (a key risk for NCDs) and poor mental health (a key outcome) amongst Indonesian adolescents. Using a mixed-method design, we sampled 16–18-year-old adolescents from schools and community-based settings across Jakarta and South Sulawesi. Initial formative qualitative enquiry used focus group discussions to understand how young people conceptualise mental health and body weight (separately); what they perceive as determinants of these NCDs; and what responses to these NCDs should involve. These findings informed the design of a quantitative survey that adolescents self-completed electronically. Mental health was measured using the Centre for Epidemiologic Studies Depression Scale-Revised (CESD-R) and Kessler-10 (both validated against formal psychiatric interview in a subsample), with the metabolic syndrome measured using biomarkers and anthropometry. The survey also included scales relating to victimisation, connectedness, self-efficacy, body image and quality of life. Adolescents were sampled from schools using a multistage cluster design, and from the community using respondent-driven sampling (RDS). This study will substantially advance the field of NCD measurement amongst adolescents, especially in settings like Indonesia. It demonstrates that high quality, objective measurement is acceptable and feasible, including the collection of biomarkers in a school-based setting. It demonstrates how comparable data can be collected across both in-school and out of school adolescents, allowing a more comprehensive measure of NCD burden, risk and correlates.

Age at menarche and body fat in adolescent girls

Background Menarcheal age is important in adolescent girls due to its associations with health outcomes at adulthood. Modifiable factors that may influence menarcheal age include body fat mass and fat distribution. Objective: To investigate possible correlations between body fat mass and fat distribution with age at menarche in adolescent girls. Methods This study was a cross-sectional study on 32 girls aged 10-15 years in Central Jakarta, who experienced menarche within the time period of July to September 2019. Data on menarcheal age was collected by recall. Body fat mass and distribution were calculated using anthropometric measurements and bioelectrical impedance analyzer (BIA) results. Results  The mean age of study subjects was 12.06 (SD 0.82) years and the mean age at menarche was 11.91 (SD 0.83) years. Correlation tests revealed a moderate negative correlation between body mass index-for-age and menarcheal age (r= -0.45; P=0.01) and weak negative correlation between waist-height ratio and menarcheal age (r= -0.37; P=0.03). Conclusion Menarcheal age is correlated with body mass index-for-age and waist-height ratio. However, no significant correlations between menarcheal age and body fat mass or distribution are found.

Understanding mental health and its determinants from the perspective of adolescents: A qualitative study across diverse social settings in Indonesia

Poor mental health is a leading contributor to the burden of disease experienced by adolescents, including in resource constrained settings. However, little is known about how adolescents in these countries conceptualise mental health and its determinants which is essential to informing effective responses. This study aimed to explore how adolescents in Indonesia (a populous and rapidly developing country) conceptualise mental health and what they identify as important determinants. Eight focus group discussions (FGDs) were conducted with 86 Indonesian adolescents (aged 16-18 years), sampled from schools and community settings from Jakarta and South Sulawesi. FGDs were recorded, transcribed, translated and thematically analysed. Mental health was recognised as a significant concern by adolescents in Indonesia. Good mental health was conceptualised as emotional wellbeing and happiness. By contrast, poor mental health was predominantly described in terms of substantial mental illness manifesting as behavioural and physical disturbance. Further, poor mental health only happened to 'other' people, with stigmatising views prevalent. Absent from the discussions were common symptoms of poor mental health (stress, loneliness, poor sleep) and common mental disorders (e.g. depression, anxiety) or a conceptualisation that reflected poor mental health to be a normal human experience. Discussions around determinants of poor mental health suggested that family connections (particularly with parents), school pressures, and adverse exposures on social media were important drivers of poor mental health, with religion also surfacing as an important determinant. In highlighting mental health as an important issue for Indonesian adolescents, this study provides a foundation for targeted responses.

The Gastroesophageal Reflux Disease Questionnaire in Adolescents: What Is the Best Cutoff Score?

BACKGROUND

A self-assessment questionnaire, the GERD-Questionnaire (GERD-Q) was used to determine the prevalence of GERD in adolescents, describe the related factors, and determine the impact on quality of life (QoL).

METHODS

The incidence of GERD was evaluated using the GERD-Q in adolescents aged 12-18 years. The Pediatric Gastroesophageal Reflux Disease Symptom Questionnaire and Quality of Life Questionnaire (PGSQ-A) for adolescents were additionally administered. Some factors considered related to GERD were also evaluated.

RESULTS

The 520 adolescents were included. The prevalence of suspected GERD, according to a GERD-Q cutoff score of ≥7 was 32.9%, and those drinking soda were 1.7 times more likely to have GERD (95% confidence interval, 1.3-2.2; p<0.001). However, soda consumption was not a risk factor for development of GERD symptoms. Applying a cutoff score of ≥8, only 10.9% of the participants had a positive GERD score, but the association with soda consumption persisted. The median PGSQ-A score in subjects suspected of GERD was 8 (range 0-37) on weekends and 1 (range 0-17) during weekdays (p<0.001) compared to those not suspected of GERD, with a median of 2 (range 0-27) during weekends and 0 (range 0-10) during weekdays. Heartburn, regurgitation, and extraesophageal symptoms correlated significantly with QoL (p<0.001).

CONCLUSION

The prevalence of suspected GERD in adolescents was 32.9% or 10.9%, depending on the cutoff score used. There was a statistically significant difference in PGSQ-A scores between the subjects suspected or not of GERD, indicating an impaired QoL.

Correlation between the Consumption Frequency of Sugar-Sweetened Beverages with Serum Triglyceride Levels in Female Adolescents

Background: The prevalence of overweight and obesity in adolescence increases significantly from year to year particularly in Depok. Consumption of sugar-sweetened beverages is one of the causes. Excess triglyceride levels are one of the risk factor for metabolic syndrome and cardiovascular disease. Consumption frequency of sugar-sweetened beverages is associated with increased serum triglyceride levels.  Method: This study used a cross-sectional design involving 47 subjects recruited through the consecutive sampling method. The consumption frequency of sweetened soft drinks is taken by the semiquantitative FFQ method. Samples of serum triglyceride levels were taken from venous blood and measured using enzymatic methods.Result: Forty-seven subjects finished the study protocol The result showed that there is a significant positive correlation with very strong degrees (p = <0.001, r = 0.88) between the consumption frequency of sugar-sweetened beverages with serum triglyceride levels.Conclusion: There is a significant positive correlation with very strong degrees between the consumption frequency of sugar-sweetened beverages with serum triglyceride levels.Keywords: overweight, female adolescence, sugar-sweetened beverages, triglyceride

Comparing Compliance and Efficacy of Isocaloric Oral Nutritional Supplementation Using 1.5 kcal/mL or 1 kcal/mL Sip Feeds in Mildly to Moderately Malnourished Indonesian Children: A Randomized Controlled Trial

PURPOSE

This study set out to evaluate the compliance to, and efficacy of oral supplementation, using a 1.5 kcal/mL or 1 kcal/mL sip feed, in children with mild to moderate malnutrition.

METHODS

This was a parallel, randomized, controlled open-label trial in children aged 3 to 6 years with a weight for height Z (WHZ) score <-1 and ≥-3, who were randomized to receive a total of 600 kcal/day from either a 1.5 kcal/mL or a 1.0 kcal/mL pediatric sip feed for 28 days. Assessments included daily study product intake, body weight, tolerance and dietary intake from solid food.

RESULTS

Of 110 children recruited, 98 (mean±standard deviation of age 49±7 months) completed the study. Both sip feeds were well tolerated, with high compliance (80±24% and 81±22% of prescribed volume in 1.5 kcal/mL and 1.0 kcal/mL groups respectively, p=0.79). Both study groups gained similar weight during the 28 days intervention period (0.42±0.40 kg in 1.5 kcal/mL group vs. 0.49±0.49 kg in 1.0 kcal/mL group, p=0.43). There were no significant differences between the groups in weight gain and in the change in WHZ score over the intervention period. Dietary analysis at the end of the study did not show replacement of solid food by the oral nutritional supplements.

CONCLUSION

In children with mild to moderate malnutrition, both 1.5 kcal/mL and 1 kcal/mL pediatric sip feeds had high compliance and were well tolerated, and were equally effective in promoting weight gain in the 28 days study period.

Pengaruh Kadar Hemoglobin Pre-transfusi dan Feritin Serum terhadap Pertumbuhan Fisik Pasien Thalassemia β Mayor

Latar belakang. Kadar hemoglobin pre-transfusi dan feritin serum memengaruhi pertumbuhan anak dengan thalassemia β-mayor. Penelitian tentang thalassemia sudah dilakukan di Indonesia, tetapi penelitian tentang hubungan thalassemia dengan pertumbuhan fisik masih terbatas.Tujuan. Mengetahui pengaruh kadar Hb pre-transfusi dan feritin serum terhadap pertumbuhan fisik pasien thalassemia β-mayor.Metode. Penelitian berupa analitik observasional potong lintang, menganalisis pengaruh kadar Hb pre-transfusi dan feritin serum terhadap parameter (perawakan pendek dan sangat pendek, gizi kurang dan buruk, usia tulang yang terlambat). Dilakukan pada bulan Agustus-Oktober 2017 pada pasien thalassemia β-mayor yang berobat ke Thalassemia-Centre RSUD Pekanbaru.Hasil. Subjek 41 orang, rentang usia 18-204 bulan. Jenis kelamin laki-laki lebih banyak daripada perempuan (53,7% vs 46,3%). 40% subjek mengalami retardasi pertumbuhan. Terdapat korelasi bermakna antara kadar Hb pre-transfusi dengan Z-score TB/U (r=0,507, p=0,001) dan LILA/U (r=0,467, p=0,02). Hb pre-transfusi berpengaruh terhadap interpretasi duduk/umur (p=0,007, IK95%: -1,5 - -0,3), subischial leg length/umur (p=0,002), tetapi tidak pada interpretasi rasio segmen atas/bawah dan usia tulang. Hasil berbeda pada kadar feritin yang tidak memiliki korelasi terhadap semua variabel.Kesimpulan. Terdapat pengaruh yang bermakna secara statistik antara kadar Hb pre-transfusi dengan parameter penelitian serta tidak terdapat pengaruh yang bermakna secara statistik antara kadar feritin serum dengan parameter tersebut.

Prognosis Leukemia Limfoblastik Akut pada Anak Obes

Latar belakang. Obesitas merupakan salah satu masalah gizi yang banyak ditemukan pada anak. Beberapapenelitian menunjukkan hubungan obesitas pada peningkatan risiko relatif beberapa keganasan. Keganasanyang paling sering ditemukan pada anak adalah leukemia limfoblastik akut. Bagaimana prognosisleukemia limfoblastik akut pada anak obes?Tujuan. Mengetahui prognosis pasien leukemia limfoblastik akut anak dengan obesitas.Metode. Studi deskriptif menggunakan data registrasi semua pasien baru leukemia limfoblastik akut pada1 Januari 2007 – 31 Desember 2009 di Departemen Ilmu Kesehatan Anak FKUI/RSCM.Hasil. Selama penelitian tiga tahun didapatkan 12 pasien leukemia limfoblastik akut dan obesitas denganprevalens 6,1%. Usia berkisar 2-14 tahun dengan rerata 6,4 tahun. Sembilan dari 12 pasien merupakankelompok risiko tinggi dan sebagian besar (6 dari 9 pasien) datang dengan jumlah rerata leukosit adalah101.650/mm3 (66.700-159.000/mm3). Remisi pada fase induksi didapatkan pada 10 dari 12 pasien. Relapsterjadi pada tiga pasien, semuanya terjadi pada fase pemeliharaan dengan tempat relaps adalah sumsumtulang (dua pasien) dan intrakranial (satu pasien). Dua dari tiga subjek penelitian yang relaps, meninggaldunia dengan penyebab kematian perdarahan intrakranial.Kesimpulan. Obesitas mempengaruhi prognosis pada pasien leukemia limfoblastik akut anak.

Pemberian Nutrisi pada Pasien dengan Penyakit Kritis di Ruang Perawatan Intensif Anak RS. Cipto Mangunkusumo

Latar belakang. Anak yang dirawat di PICU (pediatric intensive care unit) Anak cenderung untuk mengalamimalnutrisi sejak masuk atau selama perawatan. Hal ini akan memperberat penyakit dasar dan komplikasinya,memperpanjang lama rawat, serta meningkatkan mortalitas. Perhitungan kebutuhan kalori yang tepat sertapemberian nutrisi yang adekuat dan sesuai merupakan target perawatan anak di PICU. Baik underfeedingataupun overfeeding dapat terjadi di PICU Anak selama perawatan.Tujuan. Mengetahui status gizi awal pasien masuk PICU Anak, pola pemberian nutrisi, serta faktor yangmemengaruhi pemberian nutrisi pada anak yang di PICU.Metode. Penelitian potong lintang dengan menggunakan data rekam medis pasien yang dirawat di PICUAnak dalam kurun waktu 3 bulan. Didapatkan 45 subjek ikut serta. Dari 45 data pasien didapatkan 127peresepan untuk menilai keseuaian peresepan dengan pemberian nutrisi pada pasien.Hasil. Penelitian ini mendapatkan 47,8% pasien malnutrisi saat awal masuk PICU Anak, 8,7% mengalamiobesitas. Pada hari kedua perawatan, 41,3% pasien mulai mendapat nutrisi. Underfeeding terjadi padapemberian kalori, protein, dan lemak. Selain itu, 44,9% underfeeding terjadi karena perdarahan salurancerna.Kesimpulan. Pemberian nutrisi pada pasien yang dirawat di PICU Anak merupakan hal yang sangat penting.Perlu perhitungan kebutuhan nutrisi yang cermat, pemberian nutrisi tepat yang sesuai kebutuhan pasienagar tidak terjadi malnutrisi yang lebih berat lagi.

Effectiveness of a comprehensive integrated module using interactive lectures and workshops in understanding and knowledge retention about infant feeding practice in fifth year medical students: a quasi-experimental study

BACKGROUND

Sixty percent of the 10.9 million under-5 deaths every year are related to malnutrition. More than two thirds of malnutrition is caused by inappropriate infant feeding practice. Only 35 % of mothers worldwide provide 4 months of exclusive breast-feeding, while complementary feeding is often untimely, nutritionally inadequate, hygienically poor, and improperly delivered. The existing pediatric nutrition module in our institution does not include proper delivery of food that involves oral-motor skills and feeding behavior. To scale up the knowledge and skill of medical students regarding evidence-based infant feeding practice, we designed a new module composed of comprehensive and integrated lectures with additional multidisciplinary lectures on oral-motor skill development and feeding behavior.

METHODS

A quasi-experimental study was conducted to evaluate the efficacy of the new module compared to the previous module. Fifth year medical students of Universitas Indonesia were divided into intervention and control groups. The control group received lectures and a paper-based workshop. The intervention group received comprehensive and integrated interactive lectures with additional multidisciplinary lectures on oral-motor skill development and behavioral approaches to feeding problems. A hands-on workshop using real cases shown on recorded video and role-play sessions was also presented to the intervention group. A pre-/post-test, 3-month retention test, and Observed Structured Clinical Examination (OSCE) were performed to evaluate understanding, knowledge retention, and counseling skills.

RESULTS

A linear mixed effect model with a random intercept analysis for pre-test, post-test, and retention test scores showed significant higher result for intervention group compared to control group (p < 0.001). Comprehensive knowledge and counselling skills were better in the intervention group than in the control group as shown by the OSCE score (68.6 vs 59.3, p < 0.001).

CONCLUSIONS

Our comprehensive integrated infant feeding practice module, which incorporates multidisciplinary learning processes and an interactive hands-on workshop with a role-play session yields better knowledge understanding and counseling skills compared with the existing module. Comprehensive knowledge and good counseling skills of medical students as future doctors are a pre-requisite to provide effective education to parents to support successful infant feeding practices.

Mortality, length of hospital stay, and nutritional status improvement in severely malnourished children with HIV infection in a tertiary center

Background Severe malnutrition contributes to child mortalityrates, especially in children under five HIV infection further increases the risk of death.Objective To evaluate the impact of HIV infection on mortality,length of hospital stay and improvement of nutritional status inseverely malnourished inpatients under five Methods This retrospective study included children aged less than5 years and admitted to a terti ary hospital for severe malnutrition.We excluded those with incomplete data, as well as thosetransferred to other hospitals or discharged against medical advice.Outcome measures were live/death status, length of hospital stayand improvement of nutritional status (weight gain and improvedweight􀁀for􀁀height Z score).Results Of 104 eligible patients, 97 were included as studysubjects. Their mean ages were 25.8 (SD 17.3) months forHIY-infected children and 16.3 (SD 15.3) months for HIYuninfectedchildren. Death occurred in 31.8% and 18.7% ofHIV􀁀infected and uninfected subjects, respectively. Medianlength of hospital stay was 14.5 (range 5􀁀51) days and 11(range 1􀁀99) days, respectively. There were no statisticallysignificant differences in between the two groups. Weight􀁀for􀁀height Z scores (WHZ) onadmission and discharge in HIV􀁀infected children were lowerthan those of uninfected children, but the weight gain (medianweight gain of 0.45 (-0.26 to 1.9) kg vs 0.38 (-0.81 to 2.2) kgin HIV􀁀infected and uninfected children, respectively) andimprovement of WHZ [1 (SD 1.1) vs 0.9 (SD 1), respectively]were similar.Conc l usion Severely malnourished children with HIVinfection had higher mortality rate, and longer hospitalizationsthan the uninfected group, although the differences were notstatistically signific ant. They also had lower mean WHZ scoresat admission and discharge, butnutritionalimprovement wassimilar to those who were HIV􀁀negative. [Paediatr Indones.2012;52:362-6].