Objective: To examine whether women’s knowledge of pregnancy-related risks and family support received during pregnancy are associated with adherence to maternal iron–folic acid (IFA) supplementation.Design: Secondary data analysis of the 2002–03, 2007 and 2012 Indonesia Demographic and Health Survey. Analysis of the association between factors associated with adherence (consuming ≥90 IFA tablets), including the women’s knowledge and family support, was performed using multivariate logistic regression.Setting: National household survey.Subjects: Women (n19 133) who had given birth within 2 years prior to the interview date.Results: Knowledge of pregnancy-related risks was associated with increased adherence to IFA supplementation (adjusted OR=1·8; 95 % CI 1·6, 2·0), as was full family (particularly husband’s) support (adjusted OR=1·9; 95 % CI 1·6, 2·3). Adequate antenatal care (ANC) visits (i.e. four or more) was associated with increased adherence (adjusted OR=2·2; 95 % CI 2·0, 2·4). However, ANC providers missed opportunities to distribute tablets and information, as among women with adequate ANC visits, 15 % reported never having received/bought any IFA tablets and 30 % had no knowledge of pregnancy-related risks. A significant interaction was observed between family support and the women’s educational level in predicting adherence. Family support significantly increased the adherence among women with <9 years of education.Conclusions: Improving women’s knowledge of pregnancy-related risks and involving family members, particularly the husband and importantly for less-educated women, improved adherence to IFA supplementation. ANC visit opportunities must be optimized to provide women with sufficient numbers of IFA tablets along with health information (especially on pregnancy-related risks) and partner support counselling.

Adolescence is a nutritionally vulnerable and critical life stage. However, few programs and policies focus on improving adolescent nutrition in Indonesia. To address this gap, we implemented a gender-responsive package of interventions: (1) breakfast and weekly iron-folic acid supplementation (WIFS), (2) a school-based nutrition education program, and (3) a social behavior change communication strategy. We surveyed 514 adolescents at baseline (2019) and endline (2020) in Klaten and Lombok Barat districts in Indonesia. The survey included a knowledge assessment on nutrition, as well as indicators of attitudes and behaviors on diet, physical activity, and WIFS. We employed multivariable linear and logistic regression to test for pre–post intervention differences. Overall knowledge was significantly higher post-intervention ($\beta$: 3.3; 95% confidence interval [CI]: 2.6, 3.9). Diet diversity was high at both timepoints, however, at post-intervention there was significantly higher odds of consuming vitamin A-rich fruits and vegetables (Odds Ratio [OR]: 1.5; 95% CI: 1.1, 2.0) and lower odds of consuming sugar-sweetened beverages (OR: 0.4; 95% CI: 0.3, 0.5). Post-intervention, there was higher odds of reporting 60 min of daily physical activity (OR: 2.3; 95% CI: 1.7, 3.2) and WIFS among girls (OR: 6.7; 95% CI: 1.5, 30.9). The package of interventions may be a promising first step to improving adolescent nutrition in Indonesia.

This study aimed to analyze the effectiveness of behavioral-based nutrition education to increase fish consumption among school children using a raised bed pool. This was a randomized control trial study with a 3-months nutrition education intervention using a raised bed pool, as a medium to improve their internalization to increase fish consumption behavior. A paired t-test was used to calculate the difference in the increase of fish consumption, knowledge, attitude, perceived behavioral control, subjective norm, and intention. This study took place in a majority of low to medium urban households in Surabaya in Sidotopo Wetan I and Sidotopo Wetan II elementary school. Elementary school children at 4th and 5th grade and mother of elementary school children with 104 children were eligible and willing to participate. After the completion of interventions, significant improvement in delta-mean and effectiveness observed in attitude, subjective norm, perceived behavioral control, intention, knowledge, and fish consumption (p < 0.001). The 3 months of nutrition education intervention based on the theory of planned behavior significantly increase fish consumption among elementary school children. The increased consumption was believed to be related to the increase in children’s knowledge and attitude towards consuming fish.

Background: Nutrition problems among primary school children increase the risk of illness, reduce school attendance, and impair academic performance. The Indonesian national school feeding program (ProGAS—Program Gizi Anak Sekolah) was developed to address these issues through the provision of healthy breakfast, nutrition education, and character building. Methods: This study employed a mixed-methods design involving 454 primary school students aged 8–14 years from 24 schools across four provinces. Data collection included structured questionnaires, 24 h dietary recalls, and anthropometric measurements. In-depth interviews with school principals, teachers, cooking teams, parents, students, nutritionists, and district education office staff were conducted to capture experiences and opinions on the ProGAS implementation. Results: ProGAS significantly improved students’ dietary diversity, meal frequency, handwashing with soap, and nutrition knowledge, alongside a positive trend in school attendance. Improvements included higher mean dietary diversity, increased proportion of students eating ≥3 meals/day, greater correct responses on balanced nutrition, and higher rates of handwashing before meals (all p < 0.01). Children also developed positive behaviors such as praying before meals, queuing, and taking responsibility for cleaning dishes. However, students’ breakfast habits did not significantly improve, the delivery of nutrition education was suboptimal, and no significant changes were observed in nutrient intakes or nutritional status based on BMI-for-age. While the energy and protein contributions of the ProGAS menu met the recommended 25–30% of daily requirements for breakfast, its micronutrient contributions remained below the recommended levels. Key management gaps include the delivery of nutrition education to students and the monitoring of implementation by local and national authorities. Conclusions: ProGAS demonstrated positive impacts on some dietary and hygiene practices as well as learning environment. To achieve greater improvements in breakfast habits, nutrient intake and nutritional status, it is recommended to strengthen the school feeding menus not only for dietary diversity but also for nutrient density, enhance capacity building for teachers, deliver regular and engaging nutrition education, and reinforce program monitoring.

This qualitative study examines the families' support regarding maternal health and child care toward mothers who demonstrated Good Compliance (GC) and Poor Compliance (PC) with nutrition interventions during the first 1,000 days of their child's life. The study employed an in-depth interview method to gather data from 20 fathers and 7 grandparents residing in Bogor City. The data were analyzed using a constant comparison approach between the GC and PC groups for each theme. The findings indicated that family members provided more specific support for child feeding than for maternal Iron-Folic Acid Supplementation (IFAS), given that the mothers encountered more difficulties on child feeding. Encouraging the mothers to continue taking IFA supplement despite their hesitance was predominantly reported by fathers in the GC fathers. Regarding child feeding, in addition to encouraging the child to eat and feeding them, the GC fathers often engaged in discussions with their wives. In contrast, the PC fathers rarely engaged in such discussions and were only consulted when their wives reported problem. Furthermore, fathers considered their wives to be more knowledgeable on these issues as fathers had limited time due to work commitment. Grandmothers primarily offered advice on child feeding based on their own experiences, sometimes providing less suitable advice for PC mothers. While fathers in both groups did not proactively seek information about maternal health and child care, the GC fathers were more likely to be encountered such information through discussions initiated by their wives, prompting them to pursue further reading. The interaction of fathers in both groups with health professionals only occurred during antenatal visits, with minimal communication. It is recommended that strategies be developed to engage family more highlight their crucial role in fostering a supportive environment for mothers. It is aslo advised that antenal visits be optimized and the Maternal and Child Health (MCH)handbook be utilized to raise awareness and enhance paternal involvement.

Background: Mothers’ compliance with national nutrition programs during the first 1000 days of life is crucial to optimal child growth and development. However, national surveys have revealed low levels of compliance, suggesting challenges faced by mothers. Thus, understanding the facilitating factors of mother’s consistent good compliance is important. Objectives: To explore the facilitating factors of mothers’ good compliance with four national nutrition programs during the first 1000 days of life. Methos: Of the 48 mothers of 6-23-month-old children interviewed in this study, 10 demonstrated consistent compliance with the recommended maternal iron and folic acid (IFA) supplementation, breastfeeding, complementary feeding, and vitamin A capsule (VAC) supplementation programs. In-depth exploration and analysis were carried out on the 10 mothers, focusing on the roles of health staff, information exposure, knowledge, and family support. Results: All mothers had a strong initiative to seek information from various sources, including healthcare staff, the mother and child health book, and Internet (among urban mothers), irrespective of their socio-demographic backgrounds. Frequent information exposure resulted in good knowledge, except on VAC supplementation. Healthcare staff, particularly midwives, played significant roles in mothers’ compliance to IFA supplementation and breastfeeding, but much less for complementary feeding practices. The role of Posyandu cadres was limited to the dissemination of VAC supplementation schedules. Support from family members were observed in all programs, mainly in providing information and maintaining motivation. Conclusions: Information exposure and family support were key to mothers’ good compliance. The roles of healthcare staff, particularly in providing complementary feeding information, should be strengthened.