Mental Health Awareness and Promotion during the First 1000 Days of Life: An Expert Consensus

The first 1000 days of life constitute a critical phase that will determine the optimum growth and development of a child. An important factor in this phase of life is the perinatal mental health of mothers and children. Mental health awareness is an important public health issue with significant impacts on mothers, spouses, and families, as well as the long-term emotional and cognitive development of children as well. However, the awareness and promotion of mental health within the realms of reproductive health, maternal health, and infant health, i.e., the first 1000 days of life, do not receive high prioritization in Indonesia. Nonetheless, Indonesia, with its existing primary healthcare system, has the potential to raise awareness of and promote the importance of perinatal mental health for its citizens. This experts' consensus proposes several strategies to maximize the usefulness of primary healthcare facilities in Indonesia, including Community Health Centers and Integrated Healthcare Posts, to support perinatal mental health awareness and promotion during the first 1000 days of life. The success of this program, in return, will improve the health status of women and children in Indonesia.

The Notorious Triumvirate in Pediatric Health: Air Pollution, Respiratory Allergy, and Infection

A plausible association is suspected among air pollution, respiratory allergic disorder, and infection. These three factors could cause uncontrollable chronic inflammation in the airway tract, creating a negative impact on the physiology of the respiratory system. This review aims to understand the underlying pathophysiology in explaining the association among air pollution, respiratory allergy, and infection in the pediatric population and to capture the public's attention regarding the interaction among these three factors, as they synergistically reduce the health status of children living in polluted countries globally, including Indonesia.

Indonesian health care practitioner’s perception on gut-brain-axis and social-emotional concept

Background The microbiome-gut-brain-axis (GBA) concept has long been appreciated. It is recognized that the microbes resident in the gastrointestinal tract can influence brain physiology and the social-development competencies, and vice versa. Therefore, it is crucial for health care practitioners (HCPs) to understand this concept, especially in children; however, no study has been reported. Methods: This study used qualitative methods to explore HCPs’ perception and awareness about the microbiome-GBA concept. Data were collected through in-depth interviews using online video calls with HCPs, including general practitioners, pediatricians, and midwives. Results: We found that responders are aware of the microbiome-GBA concept, as this issue is often discussed in seminars and other events. They realized that gut health is a significant concern, and it is significantly impacting brain health and leads to social and emotional development (SED). This process starts from the early stages of life. Conclusion: The HCPs in our study have a good perception of the microbiome-GBA concept, e.g., a healthy brain is not possible without a healthy gut. As far as we are concerned, this is the first study to investigate the knowledge of HCPs about bidirectional communication of microbiome-GBA as an essential factor in child management.

Investing in adult nutrition to reduce mobility problems in ageing population

As people age, most body organs deteriorate. Osteoporosis, arthritis, sarcopenia, muscle aches, low back pain and neuropathy are common mobility issues in the elderly. Body mass index (BMI), physical inactivity, and having comorbidities increase the likelihood to have mobility health problems. One in every ten adults over the age of 45 years in Indonesia develops these mobility problems, and one in every fifteen adults has difficulty in walking/stepping before entering the elderly age. Nutrition has been reported to have important role in controlling weight and physical locomotive organs. Generally, 46% adults in Indonesia have vitamin A deficiency, 70% vitamin C deficiency, 77% vitamin E deficiency, and inadequate calcium intake. Low nutrition intake can result in increasing mobility problems that lead to health issues in the aging population. Dietary strategies are necessary to achieve healthy ageing. Currently, no standardized guideline has been developed for preventing mobility health problems in Indonesia. This calls for urgent need to hinder poor quality of life in elderly population.

General Practitioners’ Perspective towards Healthy Ageing in Indonesia

Background: The rapid ageing population among older adults from 2020 to 2040 has led to an emerging focus as this group begins to experience ageing and has a higher risk of having chronic illness of non-communicable diseases. Therefore, it is important to provide General Practitioners (GPs) with adequate knowledge and attitude of healthy ageing to ensure the quality of health service among older adults.Objectives: To identify the perspective of general practitioners including the knowledge, attitude and practice towards adult health and nutrition to support healthy ageing in Indonesia.Methods: An online survey was conducted among 100 general practitioners registered at the Indonesian Medical Council (KKI) and domiciled in the Greater Jakarta area and outside the Jabodetabek area. The sample recruitment process was carried out using the Alomedika online application. All data were analyzed using SPSS software.Results: Almost all (92%) of respondents who took this survey had a supportive attitude in providing additional nutrition to adults to support healthy ageing. About 76% of the respondents did so by recommending milk. However, in terms of knowledge, around 67% of the respondents showed inadequate results, especially about physiological changes that occurred in adults. There is no statistically significant difference between respondents’ demographic characteristics and all perspectives measured in this study (i.e., knowledge, attitude and practice)Conclusions: The study indicates that it is important to educate general practitioners about the healthy aging process in order to maintain general practitioners' attitudes and behavior in health services to support the success of achieving healthy aging in Indonesia.

The Role of Primary Health Care Toward Healthy Aging

Background: According to the World Health Organization, healthy aging is the process of developing and maintaining functional abilities that make the elderly happy. The increase in the elderly population requires more attention. In particular, health services at the primary health care level face problems related to the limited capacity of overall health services, especially in terms of health promotion and preventive health issues. It is necessary to improve the quality of health care services for the elderly to prevent greater health problems among the elderly population.Objectives: Understand the need to provide holistic health services for healthy aging and use their capabilities, and strengthen cooperation among health professionals in achieving healthy aging.Discusion: Primary health care is pointed out that primary health care should provide comprehensive services in a holistic manner to support a healthy aging process. Therefore, a well-structured, integrated, and cross-industry collaborative primary care system is needed. The system should include changes in professional behavior, coordination of care, and participation of patients' families and communities in comprehensive health care. This can be achieved through inter-professional education, continuous training and education of primary health care professionals, as well as primary health care services and cross-level health care technology innovation.Conclusions: Healthy aging is not just the absence of disease. Everyone in health and social care at all levels can play a role to help improve healthy aging. To make the elderly healthy, starting from the prevention of young health problems, it requires collaboration between health workers, primary health care and other health service levels, and health care that cooperates with patients, families, and communities.Keywords: healthy aging, primary care, preventive, health worker

Perspective of Caesarean section delivery and its health risks on children among Indonesian pediatricians

An increasing trend of C-section delivery In Indonesia was found from 2% in 1986 to 16% in 2012. This delivery method was introduced to save women and their newborn baby’s life. On the other side, it can increase short and long-term health risks for children. This study aims to assess and give an overview of the perspective on pediatrician as medical specialist in managing children of the C-section delivery history. A survey was conducted on 89 Indonesian Pediatricians using an online questionnaire. It was found that most pediatrician chose combination partial hydrolyze milk combined with synbiotic (a combination of prebiotic and probiotic) combination as nutrition intervention to decrease the allergy risk on children with C-section delivery mode, and there is a need to emphasize information about short and long-term health effects of C-section, especially in causing gut dysbiosis and its mechanism, information on non-medical causes of gut dysbiosis to increase awareness of recommending right symbiotic to decrease allergy risk in children with C-section history.

Perspective of Soy Formula and Fiber intake among Non-Cow’s Milk Drinker Pediatric Patients; A Survey among Indonesian Health Care Practitioners

Indonesia is one of the highest countries for soy-based product consumption, which the usage also started from early age as breastmilk substitute product, although local regulation and guideline stated that soy-based formula recommended for cow’s milk protein allergy. However, evidences showed that soy-based formula supplemented with fiber in non-cow’s milk drinker could also have health effect to gastrointestinal system. This online survey aimed to explore the perspective of health care practitioners (HCPs) in recommending soy-based formula for non-cow’s milk drinker pediatric patients, as well as identify the required additional ingredient or supplementation, specifically on fiber, in soy-based formula. Majority of respondents (97% of paediatricians (P < 0.001)), (96% of nurses  (P = 0.003)), (99% of midwives (P < 0.001)) recommended soy-based formula as nutritional product toward non-cow’s milk drinker patients. On the added ingredients required, 43% of respondents mentioned that AA and DHA and 31% mentioned that fibre is the ingredient that need to be added to complete the benefits of soy formula. This study concluded that the overall perspective of HCPs showed that soy-based formula is a nutritional product recommended for non-cow’s milk pediatric patients. However, fiber is required to be added to achieve the potential benefits of soy-based formula.

Dosage-Related Prebiotic Effects of Inulin in Formula-Fed Infants

PURPOSE

The aim of this study was to identify the minimally meaningful dosage of inulin leading to a prebiotic effect in Indonesian infants.

METHODS

In a randomized controlled double-blinded, parallel, 3-arm intervention study, 164 healthy formula-fed infants aged 3 to 5 months first obtained formula-A (without inulin) during a 4-week adaptation period. Subsequently, 142 subjects were subjected to a 4-week feeding period by administering either formula-A (no inulin), formula-B (0.2 g/100 mL inulin) or formula-C (0.4 g/100 mL inulin). The primary outcome parameter was %-bifidobacteria in faecal samples determined using quantitative polymerase chain reaction analyses. Secondary outcome parameters were faecal %-lactobacilli, pH and stool frequency, and consistency. Growth and tolerance/adverse effects were recorded as safety parameters.

RESULTS

Typical %-bifidobacteria and %-lactobacilli at the end of the adaptation period in the study population were 14% and 2%, respectively. For faecal pH, significant differences between formula groups A vs. C and A vs. B were found at the end of the intervention period. Testing for differences in faecal %-bifidobacteria and %-lactobacilli between groups was hampered by non-normal data set distributions; no statistically significant differences were obtained. Comparisons within groups revealed that only in formula group C, all the three relevant parameters exhibited a significant effect with an increase in faecal %-bifidobacteria and %-lactobacilli and a decrease in pH.

CONCLUSION

A consistent prebiotic effect along with a decrease in pH and increase in %-bifidobacteria and %-lactobacilli was found only in the group administered 0.4 g inulin/100 mL.