We conducted an interdisciplinary One Health study of potential links between agricultural, health and associated livelihood factors on the livelihoods of smallholder cocoa-growing families in West Sulawesi. Our 2017 survey of 509 cocoa smallholder family members in 120 households in Polewali-Mandar District, West Sulawesi, Indonesia showed that farmers face many challenges to improving their livelihoods, including land management, agricultural practices, nutrition and human health, animal health, aging and demographic changes. Price fluctuations, limited access to capital and poor health deterred farmers from applying agricultural inputs and resulted in levels of low cocoa production (275 kg/annum per household). While market demand for live goats in the region is substantial and expected to increase, uptake of mixed farming with goats by smallholders was low. However, most households kept chickens. Bank accounts were held by 31% of households. Inadequate sanitation and unsafe water were reported in >50% households. Anthropometric measures showed that 42% of children under five years were significantly stunted and 32% of women were overweight. Joint, back pain and blurry vision were reported by 30% of adult respondents. High blood pressure contributed to complications in 20% of pregnancies. Primary health care provided by district health services mainly focuses on maternal and child health, leaving chronic health problems such as Type 2 diabetes, cataracts, arthritis and mental illness under-diagnosed, and if diagnosed, with inadequate treatment. Availability of food was a source of worry for 58% of households with 63% reporting limited food variety. Dietary diversity was low with an average of four out of ten food categories consumed in each household. Positive correlations were recorded for household cocoa productivity, land size, dietary diversity and perceptions that food availability and variety was sufficient. The results showed that an integrated One Health approach provides deep understanding of priority areas for improving livelihoods.

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ABSTRACT<br /><br />Background: According to Basic Health Research (Riskesdas) 2010 the prevalence of obesity in Yogyakarta was 78% in 2010. Increasing prevalence of obesity in school children is mainly related to sedentary activities and decreasing medium-high physical activities.<br /><br />Objective: To fi nd out whether sedentary behavior was risk factor for obesity in school children and identify the level of its contribution.<br />Method: The study used case-control design. Population consisted of elementary school (either state or private) children of grade 1-5 at Yogyakarta and Bantul. The selection of school during screening phase was based on probability proportional to size (PPS) method. The choice of cases in children diagnosed obese during screening phase used simple random sampling supported with random table tool and matching of school. Based on sample basic calculation there were 488 samples consisting of 244 cases and 244 controls. Data of physical activities were obtained through modifi ed questionnaire on children’s physical activities (CPAQ).  Data were processed using software of Epidata v 3.1 and STATA v.11. Analysis used univariate, bivariate, and multivariate analysis with t-test, anova, and logistic regression. <br /><br />Result: Duration of sedentary behavior in obese students was longer than those not obese with average difference 49.81 minutes/day (p&lt;0.01). The result of Chi-square analysis showed sedentary activities had signifi cant correlation with the incidence of obesity with OR=6.93 (95%CI: 4.56-10.54). Based on types of sedentary activities, there was signifi cant correlation for category of screen based and sitting around (p&lt;0.05).<br /><br />Conclusion: Sedentary behavior was risk factor for the incidence of obesity in elementary school children. Average duration of sedentary activities of obese children was higher than those not obese. Based on residency, average duration of sedentary activities of obese children in urban area was higher than those living in rural area. <br /><br />KEYWORDS: physical activities, overweight, rural, urban, elementary school children<br /><br />ABSTRAK<br /><br />Latar belakang: Berdasarkan Riset Kesehatan Dasar (Riskesdas) tahun 2010, prevalensi obesitas di Yogyakarta adalah 78% pada tahun 2010. Peningkatan prevalensi obesitas pada anak sekolah sangat berkaitan dengan aktivitas sedentari dan berkurangnya aktivitas fi sik.<br /><br />Tujuan:  Untuk Mengetahui apakah perilaku sedentari merupakan faktor risiko terhadap obesitas anak sekolah dan mengidentifi kasi seberapa besar kontribusinya.<br />Metode: Penelitian ini merupakan penelitian kasus kontrol. Populasi terdiri dari anak-anak sekolah dasar (baik negeri maupun swasta) kelas 1-5 di Yogyakarta dan Bantul. Pemilihan sekolah selama fase skrining berdasarkan metode probability proportional to size (PPS). Kasus adalah anak-anak yang didiagnosis obesitas pada saat fase skrining, menggunakan simple random sampling didukung dengan tabel random dan dilakukan matching pada sekolah tersebut. Berdasarkan perhitungan sampel, terdapat 488 sampel yang terdiri dari 244 kasus dan 244 kontrol. Data aktivitas fisik diperoleh menggunakan formulir CPAQ. Data diproses menggunakan Epidata v 3.1 and STATA v.11.  Analisa data yang digunakan adalah univariat, bivariat, and analisa multivariat dengan t-test, anova, dan logistic regression.<br /><br />Hasil: Durasi perilaku sedentari pada siswa obesitas lebih lama dibandingkan mereka yang tidak obesitas dengan ratarata perbedaan 49,81 menit/hari (p&lt;0,01). Hasil analisis Chi-square menunjukkan perilaku sedentari memiliki hubungan yang signifikan dengan kejadian obesitas dengan OR=6.93 (95%CI: 4,56-10,54). Berdasarkan jenis perilaku sedentari, terdapat hubungan yang signifikan untuk kategori screen based dan duduk-duduk (p &lt;0,05).<br /><br />Kesimpulan:<br />Perilaku sedentari merupakan faktor risiko terhadap kejadian obesitas pada anak-anak sekolah dasar. Rata-rata durasi perilaku sedentari pada anak yang obes lebih tinggi dibandingkan anak yang tidak obes. Berdasarkan tempat tinggal, rata-rata durasi perilaku sedentari pada anak obes di kota lebih tinggi dibandingkan yang di desa.<br /><br />KATA KUNCI: aktivitas fi sik, overweight, desa, kota, anak SD

The nutrition transition in low-middle income countries is marked by rising intakes of highly caloric, low nutrient-dense (junk) foods, decreasing intakes of fruits and vegetables, and sedentary behavior. The objective of this study was to explore interactions among fruit-and-vegetable intake, junk food energy intake, sedentary behavior, and obesity in Indonesian children. We conducted this school-based, case-control study in 2013 in Yogyakarta Special Province, Indonesia. The cases were 244 obese children aged 7–12 years having a BMI ≥95th percentile of an age- and sex-specific distribution from the Centers for Disease Control and Prevention. The controls (n = 244) were classroom-matched children with a BMI <85th percentile. Using conditional logistic regression, the relative odds (95% confidence intervals; OR: 95% CI) of obesity given reported frequent fruit-and-vegetable intake (≥3 servings/day), low junk food energy (≤1050 kcal/day) intake and low sedentary behavior (<5 h/day) was 0.46 (0.30–0.69), 0.61 (0.37–0.98), and 0.18 (0.12–0.28), respectively. Effect sizes were dose-responsive and appeared additive. For example, children with low sedentary behavior and frequent fruit-and-vegetable intake were 92% less likely (OR = 0.08; 0.04–0.15) to be obese than children not exceeding either of these thresholds. Similarly, children frequently eating fruits and vegetables and reporting a low junk food energy intake were 70% less likely (OR = 0.30; 0.15–0.59) to be obese. The findings were unchanged after adjusting for child, maternal, and household covariates. Preventive interventions for child obesity need multiple components to improve diets and raise levels of physical activity rather than just addressing one of the three types of assessed behaviors.