The Effect of Social Capital, Community Development, and Alert Village Program on the Preparedness Behavior of Pregnant Women at the Tanjungharjo Health Center, Bojonegoro Regency, Indonesia

BACKGROUND: The Maternity Planning and Complications in Prevention (MPCP) program aims to reduce maternal and infant mortality rates in Indonesia and it is implemented in Bojonegoro Regency, East Java Province, Indonesia. This program’s optimum implication is determined by community participation and cross-sector cooperation. AIM: This study aims to analyze the influence of social capital, community development, and prepared village with MPCP on the behavior of pregnant women’s preparedness in Tanjungharjo Community Health Centre, Bojonegoro Regency. METHODS: This is an observational analytical research with a cross-sectional design. The population is the community with 133 respondents selected through simple random sampling. The multiple logistic regression test was used to analyze the data. RESULTS: Community development affects the preparedness behavior of pregnant women with p = 0.042, OR = 4.926 and prepared village with MPCP with p = 0.026, OR of 2.688. CONCLUSIONS: Community development is the most influencing factor in the preparedness behavior of pregnant women.

Implementation of Nutrition Education and Rehabilitation Programs (NERPs) in Viet Nam

Rigorous assessments of program quality are uncommon in developing countries. We evaluated the quality of the two-week, volunteer-facilitated, caregiver-child rehabilitation “hearth,” or nutrition education and rehabilitation program (NERP), sessions in Save the Children's integrated nutrition program in Viet Nam. Field workers observed attendance, food contribution, food preparation, meal consumption, health message delivery, hygiene, and weighing at 240 NERP days at 59 NERP centers during seven months of implementation. Participation in cooking NERP meals (75.8%), washing mothers' and children's hands (75.7% and 81.6%, respectively), and weighing (74.5% on days 1 and 12) were high, but attendance rates (50.3%), food contributions (20.3%), and health message delivery (20.0%) were lower than expected, all with wide variation among communes, ecology, NERP day, and NERP round. Contrary to protocol, food was often delivered to malnourished children who stayed at home to accommodate caregivers' workloads and other constraints. While home-delivery of food prevented caregivers from learning from each other in a group, it did bring “tangible messages” (i.e., a large serving size of a new food) to the doorstep. Health volunteers were wise to stress active learning over repetitive message delivery. In summary, these NERPs were probably typical of previous NERPs although comparable quality measures are lacking. Despite imperfect implementation, the NERP's active-learning and local problem-solving helped achieve measurable impact on growth, diet, morbidity, and empowerment despite uncommon program challenges, such as uncharacteristically low baseline levels of malnutrition and high population dispersion. Regular quality monitoring may enhance impact even further.

Improved nutrition knowledge and practice through intensive nutrition education: a study among caregivers of mildly wasted children on Nias Island, Indonesia

BACKGROUND

Inappropriate nutrition knowledge and feeding practices of caregivers are among several important causes of persistent malnutrition problems in young children. Thus, it is essential to provide caregivers with the necessary knowledge to help them modify their feeding practices.

OBJECTIVE

To examine the effectiveness of two different nutrition education methods, weekly intensive nutrition education (INE) and monthly nonintensive nutrition education (NNE), designed for caregivers of mildly wasted children (weight-for-height z-score ≥ -1.5 to < -1) aged ≥ 6 to < 60 months on Nias Island, Indonesia.

METHODS

To assess the impact of the two different nutrition education approaches on nutrition knowledge and practice of caregivers with their children, respondents were assigned to receive either weekly INE (n=114) or monthly NNE (n=96). The knowledge and practice levels of the mothers in each group were assessed and compared using a pretested validated questionnaire at admission and after the intervention period.

RESULTS

At admission, the knowledge and practice levels of caregivers in both groups were not statistically significantly different. After participating in the nutrition education program, the percentage of correct answers on nutrition knowledge and practice in the INE group was significantly higher than that in the NNE group. Significant improvement in knowledge and practice scores was observed in the INE group after the intervention (p < 0.001), whereas only a significant improvement in knowledge was found in the NNE group (p < .05).

CONCLUSIONS

In comparison with NNE, the INE approach was significantly better in bringing about a positive change in knowledge and practice of caregivers of mildly wasted children in the study area.

Learning From the Community to Improve Maternal—Child Health and Nutrition: The Positive Deviance/Hearth Approach

The "traditional" use of the Positive Deviance approach to behavior change involves studying children who thrive despite adversity, identifying uncommon model behaviors among Positive Deviant families, and then designing and implementing an intervention to replicate these behaviors among mothers of malnourished children. This article presents the results of a literature review designed to gather information on the role of the Positive Deviance/Hearth methodology in social and behavior change. Examples of how the methodology has been applied beyond infant and child malnutrition to address other health areas, such as improving pregnancy outcomes, are explored. An analysis of Positive Deviance programming being carried out by Project Concern International in Guatemala and Indonesia is conducted. The role of cultural context in the design and implementation of Positive Deviance/Hearth, as well as the role of Positive Deviance in affecting social and behavior change, require further exploration. The issues related to cultural context and the challenges for monitoring and evaluation of program outcomes are presented.