BackgroundMaternal health remains a persisting public health challenge in Indonesia. Postnatal complications, in particular, are considered as maternal health problems priority that should be addressed. Conducting adequate care for postnatal complications will improve the quality of life of mothers and babies. With the universal health coverage implementation, the Indonesian government provides free maternal and child health services close to clients at the village level, which include postnatal care. Our study aimed to explore barriers to utilization of postnatal care at the village level in Klaten district, Central Java Province, Indonesia.MethodsA qualitative study was conducted in March 2015 – June 2016 in Klaten district, Central Java, Indonesia. We selected a total of 19 study participants, including eight mothers with postnatal complications, six family members, and five village midwives for in-depth interviews. We conducted a content analysis technique on verbatim transcripts of the interviews using open code software.ResultsThis study found three categories of barriers to postnatal care utilization in villages: mother and family members’ health literacy on postnatal care, sociocultural beliefs and practices, and health service responses. Most mothers did not have adequate knowledge and skills regarding postnatal care that reflected how they lacked awareness and practice of postnatal care. Inter-generational norms and myths hindered mothers from utilizing postnatal care and from having adequate nutritional intake during the postnatal period. Mothers and family members conducted unsafe self-treatment to address perceived minor postnatal complication. Furthermore, social power from extended family influenced the postnatal care health literacy for mother and family members. Postnatal care in the village lacked patient-centered care practices. Additionally, midwives’ workloads and capacities to conduct postnatal information, education and counseling were also issues.ConclusionsDespite the government’s efforts to provide free postnatal care closer to mothers’ homes, other barriers to postnatal care utilization remained. Specifically, among mothers, community, and health services. An innovative approach to increase the health literacy on postnatal care is required. In particular, improving the capacity of midwives to conduct patient-centered care. In addition, village midwives’ tasks should be evaluated and reoriented.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2490-y) contains supplementary material, which is available to authorized users.

Background: Stunting and wasting are a growth disorder in children under five years of age caused by malnutrition. Stunting is generally caused by recurrent acute malnutrition, whereas wasting occurs due to short-term malnutrition. If untreated properly, stunting and wasting may cause low intelligence in adult life. This study aimed to analyze the biopsychosocial determinants of stunting and wasting in children aged 12-48 months. Subjects and Method: This was an analytic observational study with a case-control design. The study was conducted at Mulya Asri, Panaragan, and Dayamurni community health centers, from January to February 2018. A sample of 150 children under-five was selected for this study by fixed disease sampling. The dependent variables were stunting and wasting. The independent variables were birthweight, maternal knowledge, maternal education, maternal nutritional status (midupper arm circumference/ MUAC), exclusive breastfeeding, upper respiratory tract infection, diarrhea, lack of clean water, poor sanitation. The data were collected by questionnaire and maternal and child health monitoring book. The data were analyzed by a logistic regression. Results: The risk of stunting increased with poor maternal knowledge (OR= 5.29; 95% CI= 1.30 to 21.54; p=0.002), low maternal education (OR=10.25; 95%CI= 2.26 to 46.79; p=0.003), poor maternal nutritional status (OR= 8.87; 95% CI= 2.14 to 36.74; p=0.003), low birthweight rendah (OR= 9.86; 95% CI= 2.60 to 37.47; p=0.001), infants receiveing no exclusive breastfeeding (OR= 5.70; 95% CI= 1.59 to 20.46; p=0.008). The risk of wasting increased with poor knowledge (OR= 10.95; 95% CI= 2.14 to 56.91; p= 0.004), low family income (OR= 7.04; 95% CI= 5.51 to 32.78; p=0.013), low birthweight (OR= 14.71; 95% CI= 2.74 to 79.06; p=0.002), URTI history (OR= 4.87; 95% CI= 1.23 to 19.38; p=0.024), diarrhea (OR= 6.09; 95% CI= 1.42 to 26.20; p=0.015), a lack of clean water (OR= 9.78; 95% CI= 2.26 to 42.36; p=0.002), and poor sanitation (OR= 7.67; 95% CI= 1.85 to 31.75; p=0.004). Conclusion: Stunting and wasting are affected by birthweight, URTI history, diarrhea, maternal nutritional status, maternal knowledge, maternal education, family income, lack of clean water, and poor sanitation.

Background: Stunting is a very short body state in children that goes beyond the 2 SD deficit below the child population height. Worldwide stunting affects about 162 million children under five. Indonesia is included in 17 countries that have three nutritional problems in children under five: stunting, wasting, and overweight. This study aimed to investigate the determinants of stunting and child development in children under five. Subjects and Method: This was a retrospective cohort study conducted at Mayangan and Jarak Kulon Community Health Centers, Jombang, East Java, in Januari 2018. A total sample of 58 children were selected for this study by fixed exposure sampling. The dependent variables were stunting and child development. The independent variables were birth-length, maternal age, maternal height, maternal education, and family income. The data were collected by questionnaire. Data on birth length was taken from maternal and child record at community health center. The data were analyzed by path analysis model. Results: The likelihood of good child development increased with maternal education (b= 1.08; 95% CI= 0.41 to 1.75; p= 0.001) and decreased with stunting (b= -0.78; 95% CI= -1.46 to -0.10; p=0.025). The risk of stunting decreased with birth-length (b= -0.90; 95% CI= -1.60 to -0.21; p=0.011) and maternal height (b=-0.92; 95% CI= -1.69 to -0.16; p=0.018). The risk of stunting increased with maternal age <20 y.0. or ≥35 y.o. at pregnancy (b= 0.73; 95% CI= -0.03 to 1.46; p=0.051). The likelihood of maternal age <20 y.0. or ≥35 y.o. at pregnancy decreased with higher education (b=-0.75; 95% CI= -1.44 to -0.06; p=0.033). Birth-length increased with maternal height (b= 1.07; 95% CI= 0.28 to 1.86; p= 0.008) and higher family income (b=0.93; 95% CI = 0.29 to 1.57; p=0.004). Birth-length decreased with maternal age <20 y.0. or ≥35 y.o. at pregnancy (b=-0.74; 95% CI= -1.48 to -0.01; p=0.047). Conclusion: The likelihood of good child development increases with maternal education and decreases with stunting. The risk of stunting decreases with birth-length and maternal height, and increases with maternal age <20 y.0. or ≥35 y.o. at pregnancy.

Background: Stunting in children becomes a health problem that gets priority and must be addressed immediately. Delayed development, a decrease in cognitive function and immune function and the risk of diabetes mellitus, coronary heart disease, hypertension and obesity are the effects of stunting. This study aimed to analyze the determinants of stunting in children aged 2-3 years in Jombang, East Java. Subjects and Method: This was an analytic observational study with case control design. The study was carried out at Plandaan and Kabuh community health centers, Jombang, East Java, from March to April 2019. A sample of 200 children aged 2-3 years old was selected by fixed disease sampling. The dependent variable was stunting. The independent variables were maternal age, maternal height, maternal attitudes, maternal occupation, birth length, infant birth weight, exclusive breastfeeding, breastfeeding, family income, mother's education, and mother's knowledge. The data collection was done using questionnaires and analyzed with path analysis. Results: Stunting was directly and negatively affected by birth length ≥ 48 cm (b= -2.37; 95% CI= -3.25 to -1.50; p <0.001), infant birth weight ≥ 2500 g (b= -1.43; 95% CI= -2.53 to -0.32; p= 0.011), exclusive breastfeeding (b= -1.09; 95% CI= -1.90 to -0.28; p= 0.008), and timely complementary feeding (b= -1.09; 95% CI= -1.94 to -0.24; p= 0.012). Stunting was indirectly affected by family income, maternal age, maternal attitude, maternal height >150 cm, employed mother, maternal education, and maternal knowledge. Conclusion:Stunting is directly and negatively affected by birth length ≥48 cm, birth weight ≥ 2500 g, exclusive breastfeeding, timely complementary feeding. It was indirectly affected by family income, maternal age, attitude, maternal height >150 cm, employment, education, and knowledge.

ObjectivesTo assess the implementation and contextual barriers of POSBINDU, a community-based activity focusing on screening of non-communicable diseases (NCDs), mainly hypertension and diabetes, in Indonesia.DesignThis was a concurrent mixed-methods study, with a cross-sectional analysis of secondary data and focus group discussions (FGDs) on stakeholder of POSBINDU.SettingThe study was conducted in seven districts in three provinces in Indonesia, with approximately 50% of the primary healthcare (PHC) were selected as areas for data collection (n PHC=100).ParticipantsFrom 475 POSBINDU sites, we collected secondary data from 54 224 participants. For the qualitative approach, 21 FGDs and 2 in-depth interviews were held among a total of 223 informants.Primary outcomes and measuresProportion of POSBINDU visitors getting the hypertension screening and risk factors’ assessment, and barriers of POSBINDU implementation.ResultsOut of the 114 581 POSBINDU visits by 54 224 participants, most (80%) were women and adults over 50 years old (50%) showing a suboptimal coverage of men and younger adults. Approximately 95.1% of visitors got their blood pressure measured during their first visit; 35.3% of whom had elevated blood pressure. Less than 25% of the visitors reported to be interviewed for NCDs risk factors during their first visit, less than 80% had anthropometric measurements and less than 15% had blood cholesterol examinations. We revealed lack of resources and limited time to perform the complexities of activities and reporting as main barrier for effective hypertension screening in Indonesia.ConclusionsThis study showed missed opportunities in hypertension risk factors screening in Indonesia. The barriers include a lack of access and implementation barriers (capability, resources and protocols).