Abstract
BackgroundInfant morbidity and mortality rates remain high in Indonesia, with acute respiratory illnesses (ARI) and diarrhea the leading two health problems in children under 5 years. We aimed to describe the nutritional status, feeding practice and case management of ARI and diarrhea of infants from two regions of Indonesia during the first 6 months of life.MethodsThis study was an observational study conducted in parallel to an immunogenicity and efficacy trial of an oral rotavirus vaccine (RV3-BB) in the Klaten and Yogyakarta regions, Indonesia. Mothers were interviewed at 3 time points: within the first 6 days of their infant’s life, and at 8–10 and 22–24 weeks of age. Questions asked included pregnancy history, infant nutritional status, feeding status and health of infants within up to 2 weeks prior to the assessment.ResultsBetween February 2013 and January 2014, 233 mother-infant pairs were recruited. 60% (136/223) of infants were exclusively breastfed (EBF) until 6 months of age with the strongest support for EBF reported by mothers themselves 70% (101/223) and 25% (36/223) from their partners. At 6 months, 6% (14/223) of infants were underweight and severely underweight; 4% (8/ 223) wasted and severely wasted; and 12% (28/223) were stunted and severely stunted. Non-recommended medication use was high, with 54% (21/39) of infants with reported cough within 2 weeks of an assessment receiving cough medication, 70% (27 /39) an antihistamine, 26% (10/39) a mucolytic and 15% (6 /39) an oral bronchodilator. At age 22–24 week, infants with reported diarrhea within 2 weeks of an assessment had low use of oral rehydration solutions (ORS) (3/21;14%) and zinc therapy (2/ 21;10%).ConclusionIn this unique observational study, breastfeeding rates of 60% at 6 months were below the Indonesian national target of >75%. Adherence to WHO guidelines for management of ARI and diarrhea was poor, with high use of non-recommended cough medications and oral bronchodilators in the first 6 months of life and low use of ORS and zinc therapy. Ongoing education of primary health care workers and parents regarding management of common illness is needed in Indonesia.
Highlights
Infant morbidity and mortality rates remain high in Indonesia, with acute respiratory illnesses (ARI) and diarrhea the leading two health problems in children under 5 years
We aimed to describe the nutritional status, feeding practice and case management of ARI and diarrhea of infants enrolled in a rotavirus vaccine clinical trial during the first 6 months of life in the Klaten and Jogjakarta regions in Indonesia
In particular this study focuses on the rate of exclusively breastfed (EBF), the infants’ nutritional status assessed at three time-point visits and the medication prescribed for ARI and diarrhea
Summary
Infant morbidity and mortality rates remain high in Indonesia, with acute respiratory illnesses (ARI) and diarrhea the leading two health problems in children under 5 years. We aimed to describe the nutritional status, feeding practice and case management of ARI and diarrhea of infants from two regions of Indonesia during the first 6 months of life. Despite the improvement in the health status of Indonesian infants in the last two decades, mortality rates remain high, estimated at 24.5 deaths per 1000 live births in 2013 [1, 2]. Acute respiratory illnesses (ARI) and diarrhea are the leading causes of mortality in Indonesian children under 5 years of age [3] and were the main targets of the fourth millennium development goal (MDG) to reduce child mortality by two thirds by 2015 [3]. Macronutrient deficiencies have been associated with an increased risk of developing ARI and diarrhea, [7] with a 4-fold increase in ARI-related deaths in severely malnourished children compared to children with normal nutritional status [8, 9]
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