A New Alternative Quac-Stick to Predict the Risk of Chronic Energy Deficiency in Malay Indonesian Women (18-49 Years)

BACKGROUND: Indicators to assess the nutritional status in women of reproductive age (WRA) in particular to identify chronic energy deficiency (CED) were still limited. Upper arm circumference (MUAC) and the Body Mass Index (BMI) had been used to assess the status of CED, but it still has its limitations. This study aimed to develop a new indicator QUAC-Stick (the ratio of MUAC to Upper Arm Length (UAL)) for the risk asesement of CED on WRA in Malay Indonesia women (18-49 years). SUBJECT AND METHODS: The cross sectional study design, used a part of data from National Basic Health Research (Riskesdas) 2013 and primary collecting data among 1009 WRA aged 18-49 years (not pregnant) in Makassar and Tana Toraja, South Sulawesi Province. Analysis used the ROC to get the optimal formula and the cut off point using BMI as the gold standard. RESULTS: MUAC/UAL (named UMMI index) with a cut-off point < 4.25 to detect the risk of CED, had better validity (Sn=80% (95% CI=70.8 to 87.3 ); Sp = 84% (95% CI = 81.4 to 86.3); PPV = 35% (95% CI = 29.2 to 42.0); NPV = 97% (95% CI = 96.1 to 98.4; ROC = 82% (95% CI = 80.0 to 86.1) compared to MUAC < 23,5 with the gold standard was BMI <18.5. Prevalence of CED on WRA 9.9% (BMI <18.5); 22.4% (MUAC/UAL< 4.25). The validity of MUAC < 23.5 was good (Sn = 76%, Sp = 87.2%), but the optimal cut-off point for screening was MUAC < = 24.0 cm (Sn = 90%, Sp = 77%). The correlation (r) between MUAC-weight = 0.82; UAL-Height = 0.45; MUAC-BMI = 0.82 and MUAC/UAL to BMI = 0.80 (P = 0.000). CONCLUSION: The new alternative indicator was MUAC/UAL <4.25 to assess the risk of CED on WRA in Malay Indonesia women (18-49 years). Further revalidation study is needed to be able applying the indicator to the wider population. Keywords: Ratio, MUAC, Women of reproductive, CED, Arm Lengt

Status Gizi Ibu Hamil dan Penyakit Tidak Menular pada Dewasa

Globally, the concern on high prevalence of chronic diseases on adults is increasing. Current mounting evidence confirmed that nutritional deficiency in early life, i.e. during fetal stage and the first two years of age, contribute significantly to the increasing risk of having chronic noncommunicable diseases (NCD) later in life. The high prevalence of a number of NCDs in Indonesia is high, warrant a special attention. For example, almost one thirdof Indonesian adults having high blood pressure. Hence, Indonesia in the future is facing a considerable financial burden as the result of a high expenditure needed for the treatment and rehabilitation of the diseases, and low productivity related to the disease. The high prevalence of NCDs among poor population in Indonesia indicated that these diseases are not merely the result of unhealthy lifestyle, instead they very likely are the results of undernutrition in early life, which was started since fetal stage. Therefore, an attempt to address these problems through improvement of lifestyle alone will not be effective. Effort directed specifically to the root of the problems,i.e. providing an optimal nutrition environment to the fetus through improvement of maternal nutritional status, and infant 0 – 2 years of age, is recommended

Efektivitas Program Fortifikasi Minyak Goreng dengan Vitamin A terhadap Status Gizi Anak Sekolah di Kota Makasar

Vitamin A deficiency (VAD) remains as one of significant public health problems in Indonesia. Around 50% of under five children are suffering from subclinical VAD. Deficiency of vitamin A will affect several important role in the body, such as immune system, vision, reproductive system and cell differentiation. Therefore, guarding Indonesian children to be free from VAD is crucial for their quality as Human Resources. We assessed the impact of the consumption of vitamin A fortified cooking oil on the improvement of vitamin A and hemoglobin status among school children in urban slum area in Makassar City. The study was an intervention design Before-After. Healthy school children 7-10 years were selected from schools and de-wormed before the intervention. Serum retinol and hemoglobin was measured at baseline and at 3 months after. Fortified oil was made available through distribution at shops and accompanied with social marketing. Eventhough overall there was no change in VAD prevalence, the VAD prevalence is lower among children who consumedfortified oil ³12 weeks (26.6%) compared to those who consumed <12 weeks (42%). Prevalence of anemia decreased from 21.8% to 11.6%. We recommended that fortified oil is made mandatory

Exclusive Breastfeeding Intention Among Pregnant Women

Exclusive breastfeeding intention is a mother's intention to provide her baby only breast milk since the infant was born until at the age of 6 months. Intention in prenatal period is the direct affirmation of exclusive breastfeeding. This study aimed to find out the most dominant factor related to exclusive breastfeeding intention among pregnant women at a mother and child hospital in South Tangerang. A cross-sectional study design was conducted primarily. The samples were 143 pregnant women on their third trimester pregnancy selected by purposive sampling. Intention was measured by the Infant Feeding Intention scalequestionnaire. Meanwhile, attitude, subjective norms, and perceived behavioral control were measured by the modified Breastfeeding Attrition Prediction Tool questionnaire. Data were analyzed using the multivariate logistic regression analysis. It was 61.5% mother had strong exclusive breastfeeding intention. Perceived behavioral control dominantly influenced the exclusive breastfeeding intention (p value = 0.007; Odds Ratio 3.030; 95% CI = 1.361-6.746). The other factors influencing intention were attitude, exposure to exclusive breastfeeding from social media, health workers' support, previous breastfeeding experienceand mothers' occupation. A mother with high perceived behavioral control has three times more likely to have ‘high exclusive breastfeeding intention' than those having the low ones

Pre-pregnancy body mass index and gestational weight gain and their effects on pregnancy and birth outcomes: a cohort study in West Sumatra, Indonesia

Background: Indonesia has a considerably high incidence of maternal and infant mortality. The country has however been experiencing a social and economic transition, influencing its general population demographics and nutritional status including the state of health and nutrition of pregnant women. This study aimed to explore body mass index (BMI) and gestational weight gain (GWG), and their relationship with pregnancy outcomes in a sample of Indonesian pregnant women. Methods: This observational cohort study included a total of 607 pregnant women who were recruited in 2010 from maternity clinics in Western Sumatra, Indonesia. Multiple logistic and regression analyses were undertaken to compare pregnancy and birth outcomes for different BMI and GWG, using normal weight women and women with a recommended weight gain as the referent groups. Results: The prevalence of underweight (BMI < 18.5 kg/m2) in pregnancy was high at 20.1%; while 21.7% of women were overweight (BMI: 23.0–27.4 kg/m2) and 5.3% obese (BMI ≥ 27.5 kg/m2) using the Asian BMI classifications. The incidence of overweight (BMI: 25.0–29.9 kg/m2) and obese (BMI ≥ 30.0 kg/m2) according to the international BMI classifications were 13.5% and 1.1% respectively. The majority of women gained inadequate weight in pregnancy compared to the Institute of Medicine (IOM)recommendations, especially those who had a normal BMI. Birthweight adjusted mean difference aMD (95% confidence interval) 205 (46,365) and the odds of macrosomia adjusted odds ratio aOR 13.46 (2.32–77.99) significantly increased in obese women compared to those with a normal BMI. Birthweight aMD -139 (−215, −64) significantly decreased in women with inadequate GWG compared to those with recommended GWG, while SGA aOR 5.44 (1.36, 21.77) and prematurity aOR 3.55 (1.23, 10.21) increased. Conclusions: Low nutritional status and inadequate GWG remain a cause for concern in these women. The higher odds of macrosomia with increasing maternal BMI and higher odds of prematurity and small for gestational age infants with inadequate weight gain also require attention. Research and practice recommendations: Urgent attention is required by researchers, policy makers and decision makers to facilitate development of culturally sensitive interventions to enhance nutritional status and health of mothers and babies, in an area known for its high incidence of maternal and neonatal mortality. Keywords: Maternal BMI, Gestational weight gain, Pregnancy outcomes, Birthweight, Indonesia, Cohort stud

Does Excessive Gestational Weight Gain Contribute to Preeclampsia?

Preeclampsia is the leading cause of both maternal and infant mortality and morbidity worldwide. It is a disorder of pregnancy characterized by hypertension and high levels of protein in the urine. Preeclampsia has multifactorial determinants, one of which is excessive gestational weight gain. The purpose of this study was todetermine the relationship between weight gain during pregnancy and the incidence of preeclampsia among patients at Panembahan Senopati Bantul Hospital, D.I.Y. in 2014. The assessment of excessive weight gain during pregnancy was based on the weight gain recommendations given by the Institute of Medicine (IOM).This study was conducted using a case-control design. Based on patient medical records, subjects were included if the length of gestation was greater than or equal to 20 weeks, and were excluded if it was the mother’s first pregnancy, the mother was less than 20 years old, or the gestational weight gain was less than the IOM recommendation. After a process ofrandom selection, there were 55 subjects in the case group that met the inclusion criteria. The case to control ratio was 1:1; thus there were also 55 subjects in the control group after random selection.The case and control groups were selected from the same hospital. Data analysis was conducted using a Chi-Square test. The results of the study showed that 63.6% of mothers with preeclampsia exhibited excessive gestational weight gain,while 16.4% of those without preeclampsia exhibited excessive gestational weight gain (p value &lt;0.05, 95% CI: 3.63-22.06 and OR: 8.94). The results confirmed that excessive weght gain during pregnancy increases the incidence of preeclampsia. Keywords: pregnant women, hypertension, preeclampsia, weight gain during pregnanc

Validitas Lingkar Lengan Atas Mendeteksi Risiko Kekurangan Energi Kronis pada Wanita Indonesia

Mid-upper arm circumference has been used in Indonesia as an proxy indicator of chronic energy malnutrition risk for pregnant women because there isn't any data of prepregnancy weight in most of pregnant women. The boundary used was 23,5 cm. The objective of the study is to validate the currentboundary related to body mass index (BMI) indicator, which is believed as a better indicator in identifying women nutritional status. The study is using Riset Kesehatan Dasar 2007 data on Indonesian adult women aged 20 – 45 years old. The study found the boundary is 24,95 cm for detecting chronic energy malnutrition risk among adult women (Se = 85%; Sp = 75%). There are differences among provinces but not more than 2 cm, the lowest is in Nusa Tenggara Timur (23,95 cm) and the highest is in North Sulawesi and Gorontalo (25,95 cm). Mid upper arm circumference has a strong relationto BMI (r = 0,67; p value < 0,000). It is recommended to use mid-upper arm circumference boundary 24,95 cm to detect chronic energy malnutrition on 20 – 45 years old women and 23,5 cm to pregnancy outcome, baby morbidity, and mortality