Cut Novianti Rachmi

Introduction: The Coronavirus Disease 2019 (COVID‐19) pandemic has profoundly impacted the food environment, affecting consumer’s behavior, retailer strategy, and subsequently dietary and nutritional outcomes. While existing research has explored these effects globally, few studies have focused on Southeast Asia, a region with unique food systems and cultural contexts. Methods: As part of the Southeast Asia Obesogenic Food Environment (SEAOFE) study, data were collected through a multicountry cross‐sectional research, in Indonesia, Malaysia, Thailand, and the Philippines. Data were collected through news searches and interviews with 121 food retailers (73 traditional and 48 modern) between 2021 and 2022 when Delta and Omicron waves occurred. Transcripts were English‐translated and analyzed following thematic analysis, integrating both inductive‐deductive approaches guided by COVID‐19 effects on food environment framework. Results: Despite varying national restrictions, a decrease in foot traffic in offline retail and a rise in online platforms were observed, revealing a paradox of connectivity amid restrictions. Retailers experienced consumers leaning towards healthier food options during specific pandemic periods, potentially driven by health concerns, with essentialism and prudent purchasing behavior increasing due to declining purchasing power. Price fluctuations and supply disruptions had domino effects on food availability and accessibility, prompting retailers to adopt strategic stocking to navigate these challenges. Conclusions: By integrating public health and nutrition perspectives, this study contributes to broader efforts to build sustainable food systems that can withstand future crises. It underscores the importance of long‐term policies that ensure the availability and accessibility of healthy food, emphasizing the need for sustained efforts during crises, even beyond pandemics. Future health and nutrition policy should incorporate these insights into broader health and nutrition policies to build resilient and sustainable food systems.

Community health workers (CHWs)—or ‘cadres’ as they are known in Indonesia—are intermediaries between the health system and the community, providing maternal and child health services at a village level. However, systemic and contextual factors inhibit CHWs from realising their potential impact. Training is essential for improving CHW performance; however, there is a need to understand whether and how this affects the care communities receive. This paper explores how communities in Aceh Province, Indonesia, receive care from cadres and the extent to which training interventions of CHWs influence this care. Semi-structured interviews were conducted remotely with 10 cadres in two districts in Aceh between June and July 2021, and five focus group discussions were conducted face-to-face with 21 caregivers of young children in one district in September 2021. Data were iteratively and thematically analysed throughout data collection. Cadres were seen as ‘of’ the community but not ‘of’ the health system. Cadres found training valuable. However, training did not adequately address the contextual challenges cadres face. From the caregivers’ perspective, cadres’ enhanced knowledge did not translate into credible guidance. Their proximity to the community and perceived distance from the health system undermined caregiver perceptions of cadres’ credibility. Infrastructural limitations of Posyandu inhibited CHW’s perceived ability to perform their roles effectively. To maximise the potential of their role, there must be more investment in enhancing the credibility of cadres within their communities—and programmatic factors such as training must better account for and adapt to the local context.

Objectives: Vaccine hesitancy remains a major barrier to immunisation coverage worldwide. We explored influence of hesitancy on coverage and factors contributing to vaccine uptake during a national measles–rubella (MR) campaign in Indonesia. Design: Secondary analyses of qualitative and quantitative data sets from existing cross-sectional studies conducted during and around the campaign. Methods: Quantitative data used in this assessment included daily coverage reports generated by health workers, district risk profiles that indicate precampaign immunisation programme performance, and reports of campaign cessation due to vaccine hesitancy. We used t-test and χ² tests for associations. The qualitative assessment employed three parallel national and regional studies. Deductive thematic analysis examined factors for acceptance among caregivers, health providers and programme managers. Results: Coverage data were reported from 6462 health facilities across 395 districts from 1 August to 31 December 2018. The average district coverage was 73%, with wide variation between districts (2%–100%). One-third of districts fell below 70% coverage thresholds. Sixty-two of 395 (16%) districts paused the campaign due to hesitancy. Coverage among districts that never paused campaign activities due to hesitancy was significantly higher than rates for districts ever-pausing the campaign (81% vs 42%; p<0.001). Precampaign adequacy of district immunisation programmes did not explain coverage gaps (p=0.210). Qualitative analysis identified acceptance enablers including using digital health monitoring and feedback systems, increasing caregiver knowledge and awareness, making immunisation social norm, effective cross-sectoral collaboration, conducive service environment and positive experiences for mothers and children. Barriers included misinformation diffusion on social media, halal–haram issues, lack of healthcare provider knowledge, negative family influences and traditions, previous poor experiences and misinformation on adverse events. Conclusion: Barriers to vaccine uptake contributed to coverage gaps during national MR campaign in Indonesia. A range of supply-related and demand-related strategies were identified to address hesitancy contributors. Advancing a portfolio of tailored multilevel interventions will be critical to enhance vaccine acceptance.

Effective policies that address both the supply and demand dimensions of access to affordable, healthy foods are required for tackling malnutrition in South East Asia. This paper presents the Protocol for the South East Asia Obesogenic Food Environment (SEAOFE) study, which is designed to analyze the retail food environment, consumers’ and retailers’ perspectives regarding the retail food environment, and existing policies influencing food retail in four countries in South East Asia in order to develop evidence-informed policy recommendations. This study was designed as a mixed-methods sequential explanatory approach. The country sites are Malaysia, Indonesia, the Philippines, and Thailand. The proposed study consists of four phases. Phase One describes the characteristics of the current retail food environment using literature and data review. Phase Two interprets consumer experience in the retail food environment in selected urban poor communities using a consumer-intercept survey. This phase also assesses the retail food environment by adapting an in-store audit tool previously validated in higher-income countries. Phase Three identifies factors influencing food retailer decisions, perceptions, and attitudes toward food retail policies using semi-structured interviews with selected retailers. Phase Four recommends changes in the retail food environment using policy analysis and semi-structured interviews with key stakeholders. For the analysis of the quantitative data, descriptive statistics and multiple regression will be used, and thematic analysis will be used to process the qualitative data. This study will engage stakeholders throughout the research process to ensure that the design and methods used are sensitive to the local context.

Background: Water access, sanitation, and hygiene (WASH) remain a public health concern in Indonesia. Proper WASH practices can decrease risk of stunting, wasting, and disease in children under the age of 2. Objective: The purpose of our study is to examine if using technology to access health information and services among Indonesian women affects knowledge and behaviors regarding handwashing and defecation practices. Methods: Our study is an interview-based cross-sectional survey. Participants included 1734 mothers of children under 2 years of age. These women were randomly selected and interviewed as part of a 3-stage cluster sampling technique. Our study uses data regarding WASH knowledge which includes benefits of handwashing with soap, 5 critical times of handwashing, risks of open defecation, media of disease transmission, defecation locations, and risks of open defecation. Data regarding WASH behaviors were also included: handwashing with soap, type of latrine used at home, and where defecation took place. This investigation used adjusted and unadjusted logistic and linear regression models to determine differences in WASH outcomes between those who use technology to access health information and services and those who did not. Results: One result is that Indonesian women with children under 2 years of age who use technology to access health information and services are more likely to know the advantages of proper handwashing (odds ratio [OR] 2.603, 95% CI 1.666-4.067) and know the 5 critical times of handwashing (OR 1.217, 95% CI 0.969-1.528). Women who use technology to access health information are also more likely to know the risks of open defecation (OR 1.627, 95% CI 1.170-2.264) and use a type of toilet (such as a gooseneck or squat toilet) that limits risk (OR 3.858, 95% CI 2.628-5.665) compared to women who did not use technology to access health information. Conclusions: Using technology to access health information and services was associated with an increase in handwashing and defecation knowledge. In the future, promoting mothers of children under 2 years of age to access health information through technology might be used to increase handwashing and defecation knowledge as well as safe defecation practices. However, further research should be done to determine how technology may increase the frequency of recommended handwashing behaviors.

Background: Air pollution is an important risk factor for the disease burden; however there is limited evidence in Indonesia on the effect of air pollution on health, due to lack of exposure and health outcome data. The objective of this study is to evaluate the potential use of the IFLS data for response part of urban-scale air pollution exposure–health response studies. Methods: Relevant variables were extracted based on IFLS5 documentation review. Analysis of the spatial distribution of respondent, data completeness, prevalence of relevant health outcomes, and consistency or agreement evaluation between similar variables were performed. Power for ideal sample size was estimated. Results: There were 58,304 respondents across 23 provinces, with the highest density in Jakarta (750/district). Among chronic conditions, hypertension had the highest prevalence (15–25%) with data completeness of 79–83%. Consistency among self-reported health outcome variables was 90–99%, while that with objective measurements was 42–70%. The estimated statistical power for studying air pollution effect on hypertension (prevalence = 17%) in Jakarta was approximately 0.6 (α = 0.1). Conclusions: IFLS5 data has potential use for epidemiological study of air pollution and health outcomes such as hypertension, to be coupled with high quality urban-scale air pollution exposure estimates, particularly in Jakarta.

Background: Water, sanitation, and hygiene (WASH) behaviors play a significant role in stunting. Knowledge and behaviors regarding WASH among caregivers are critical to providing children with chances to survive and thrive. The purpose of this study is to determine if exposure to a national communication campaign using media and interpersonal communication (IPC) is associated with WASH-related knowledge and behaviors among Indonesian mothers with children under the age of two. Methods: Data came from a cross-sectional survey of 1734 mothers with children under the age of two. The measures included exposure to two different interventions: media messages (media) and interpersonal communication strategies (IPC) and WASH-related knowledge and behavior. Multiple logistic regression was used to examine the association between intervention exposure and study variables. Results: Exposure to both media and IPC interventions was associated with participants having a higher knowledge of appropriate defecation practices (p < 0.001), higher knowledge of proper handwashing practices (p < 0.001), and higher self-reported handwashing at critical times (p < 0.001) but was not associated with reported practicing of appropriate defecation (OR = 0.780, 95% CI: 0.566–1.101). Mothers exposed to only media interventions were more likely to have knowledge of appropriate defecation practices (p < 0.001) and to have reported practicing appropriate defecation behaviors (OR = 1.539, 95% CI: 1.173–2.019). Mothers exposed to only IPC interventions were more likely to have reported handwashing at critical times (p = 0.009). Conclusions: Exposure to both media and IPC interventions was associated with increased knowledge and optimal behaviors related to WASH. These findings demonstrate the value of communications campaigns that use mass media coupled with IPC to improve WASH knowledge and behavior.

BACKGROUND Water access, sanitation, and hygiene (WASH) remain a public health concern in Indonesia. Proper WASH practices can decrease risk of stunting, wasting, and disease in children under the age of 2. OBJECTIVE The purpose of our study is to examine if using technology to access health information and services among Indonesian women affects knowledge and behaviors regarding handwashing and defecation practices. METHODS Our study is an interview-based cross-sectional survey. Participants included 1734 mothers of children under 2 years of age. These women were randomly selected and interviewed as part of a 3-stage cluster sampling technique. Our study uses data regarding WASH knowledge which includes benefits of handwashing with soap, 5 critical times of handwashing, risks of open defecation, media of disease transmission, defecation locations, and risks of open defecation. Data regarding WASH behaviors were also included: handwashing with soap, type of latrine used at home, and where defecation took place. This investigation used adjusted and unadjusted logistic and linear regression models to determine differences in WASH outcomes between those who use technology to access health information and services and those who did not. RESULTS One result is that Indonesian women with children under 2 years of age who use technology to access health information and services are more likely to know the advantages of proper handwashing (odds ratio [OR] 2.603, 95% CI 1.666-4.067) and know the 5 critical times of handwashing (OR 1.217, 95% CI 0.969-1.528). Women who use technology to access health information are also more likely to know the risks of open defecation (OR 1.627, 95% CI 1.170-2.264) and use a type of toilet (such as a gooseneck or squat toilet) that limits risk (OR 3.858, 95% CI 2.628-5.665) compared to women who did not use technology to access health information. CONCLUSIONS Using technology to access health information and services was associated with an increase in handwashing and defecation knowledge. In the future, promoting mothers of children under 2 years of age to access health information through technology might be used to increase handwashing and defecation knowledge as well as safe defecation practices. However, further research should be done to determine how technology may increase the frequency of recommended handwashing behaviors.

Resting metabolic rate and cognitive function may be associated with several factors, such as birth weight, growth, and fat-free mass in adulthood. The Tanjungsari Cohort Study (TCS) of 1988, to do with a maternal-child Risk Approach Strategy (RAS), provided the opportunity to determine the associations between birth weight, growth at 2 years, and body composition with adult resting metabolic rate and cognitive function. In 2009 some 197 and, in 2017,144 of these representative participants from the TCS were assessed for energy intake, anthropometry, body composition, indirect calorimetry, and cognitive function in relation to low (ALBW, n=66) or normal (ANBW, n=78) birth weight. Associations were adjusted for basic demographic data. Resting metabolic rate was positively associated with birth weight, body weight at 2 years of age, body mass index and fat free mass in adult life. Time to finish the Trail Making Test-A (TMT-A), a test of attention span, was significantly longer in the ALBW than the ANBW group (41.4±12.8 vs 37.8±15.6, p=0.005). In the ALBW group, weight catch-up improved TMT-A and logical memory test scores (29.5 vs 34.9.41, p=0.004; and 39.3 vs 29.4, p=0.04, respectively). Low birth weight was associated with poorer attention span in adult life; body weight gain at 2 years of age with better attention and memory function in adult life; a greater body mass index in adult life with better memory in adult life.