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The food and nutrition situation in households of East Jakarta was assessed in 1993/1994 and 1998/1999 with the aim of identifying the determinants of potential problems and the dynamics of change. In 1993/1994, the nutritional status of approximately 73% of children under 5 years of age and 60% of mothers was within the normal range, although underweight and overweight were prevalent in almost all households. Between 1998 and 1999, there was a sharp increase in fathers reporting unemployment. The consumption of animal food sources decreased, whereas the consumption of food derivatives such as oils and sugar remained high. Approximately 90% of the population obtained drinking water from wells. By 1998, the public garbage collection system had almost completely collapsed in East Jakarta. Between 1993 and 1998, the prevalence of diarrhoea and acute respiratory infections in children aged under 5 years increased dramatically, from 8 and 44% to 24 and 70%, respectively. The urban environment has undergone significant changes. In Indonesia, as a whole, many achievements in the improvement of household food security and care have been lost due to the economic and political crisis. The statistical association between mothers' and fathers' education and the nutritional status of their children that was observed in 1993/94 did not appear in the 1998 survey. It seems that the education-related coping mechanisms of the parents were inadequate to deal with the rapid deterioration in the economic and political situation.

Introduction:In Indonesia, most training modules for health paraprofessionals have been adapted from existing foreign modules without assessment. In addition, there have been few studies on training development for this group. We aimed to develop, using a systematic tool, implement and evaluate a training module to improve the competencies of voluntary health workers (cadres) in communicating safe complementary feeding practice to caregivers of young children in Indonesia. Methods: A mixed methods approach was used. A qualitative study employing in-depth interviews, focus group discussions, mini-workshops, documentary reviews and expert validation was used to develop the training module, following a systematic approach. The module's effectiveness for improving the health workers' competencies was evaluated using a quantitative study with a non-equivalent pre-test and post-test control group design that included 70 (intervention group) and 68 (comparison group) voluntary health workers from a peri-urban district. Changes in the workers' cognitive, affective and psychomotor competencies were tested before and after attending a 3-day training module (intervention group) or a half-day event (comparison group). Results: A 24-hour learning session module on communicating safe complementary feeding was developed and used to train voluntary health workers. After the training, a significantly higher proportion of workers in the intervention group than in the comparison group were assessed as competent in the psychomotor and composite domains (psychomotor: 67.1% vs. 20.6%; composite: 74.3% vs. 36.8%; p<0.001). Conclusion: This systematically developed module was effective in improving the competencies of voluntary health workers regarding communicating safe complementary feeding practice to caregivers in Indonesia.