Introduction: Breastfeeding is a double-duty action proposed to protect simultaneously against undernutrition and overnutrition, yet the shape of the duration–response relationship between breastfeeding and nutritional status in early childhood remains contested, particularly in settings experiencing the double burden of malnutrition. This review aimed to synthesise primary evidence published in the last five years on the association between breastfeeding duration (≤1, 3–5, 6, 6–11 and ≥12 months) and the full spectrum of nutritional status (stunting, underweight, normal weight, overweight and obesity) in children aged 2–6 years. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Randomised controlled trials (RCT), prospective and retrospective cohort, case-control and cross-sectional studies were eligible; systematic reviews and meta-analyses were excluded from the evidence tables but used in the discussion. Risk of bias was appraised with a ROBINS-E-adapted domain tool and the Newcastle–Ottawa Scale (NOS) for observational studies and RoB 2 for randomised evidence. Where estimates were comparable, ratio measures were oriented as longer/any versus shorter/no breastfeeding and pooled using DerSimonian–Laird random-effects models, with subgroup, leave-one-out, cumulative, meta-regression and small-study analyses. Certainty was graded with GRADE. Results: 41 studies from 25 countries met eligibility (40 observational, one secondary analysis of a cluster-RCT), comprising more than 161,000 children in the 37 studies that reported sample size. Twenty-seven studies addressed over-nutrition and 13 under-nutrition. Longer or any breastfeeding was associated with lower odds of overweight/obesity (10 estimates from 9 studies; pooled ratio 0.71, 95% CI 0.63–0.80; I² = 60.8%; 95% prediction interval 0.50–1.01), robust to leave-one-out and trim-and-fill adjustment (0.73, 0.64–0.83). The association was stronger for exclusive breastfeeding (0.61, 0.53–0.71) than any/full breastfeeding (0.76, 0.66–0.86; P-between = 0.036) and for obesity (0.55, 0.43–0.71). All seven continuous estimates showed lower BMI z-scores with longer breastfeeding (−0.02 to −0.50). For stunting, pooling was dominated by extreme heterogeneity (0.49, 0.08–3.17; I² = 98.4%) driven by a national survey showing higher stunting with breastfeeding into the third year; after its exclusion the association was protective and homogeneous (0.27, 0.19–0.38; I² = 0%). Most observational studies had some concerns (65.0%) or high (35.0%) overall risk of bias, principally from confounding and recall-based exposure measurement. Discussion: The evidence is compatible with a protective, approximately monotonic association between longer (particularly exclusive) breastfeeding and overweight/obesity at 2–6 years, with benefit already apparent after 3–5 months and extending beyond 12 months. For linear growth, exclusive breastfeeding to 6 months and continued breastfeeding into the second year are associated with less stunting, whereas the apparent harm of breastfeeding beyond 24 months in food-insecure settings is most plausibly explained by reverse causation and inadequate complementary feeding rather than by breast milk itself. Conclusion: Longer breastfeeding is associated with a more favourable nutritional status in early childhood, particularly lower overweight and obesity, with low-certainty evidence; the association with stunting depends on complementary-feeding context and is of very low certainty. Programmes should protect exclusive breastfeeding for six months and continued breastfeeding with adequate complementary feeding, while future cohorts should use prospectively recorded duration categories and causal designs.
Stunting is a disorder of child growth that is caused by a mother’s nutritional status during pregnancy, suboptimal breastfeeding practices, and dietary patterns that do not meet nutritional needs. One of the regions implementing the stunting reduction policy is Sidoarjo Regency under its Health Department. However, less research specifically analyzing how the Health Department integrates organizational, program, resource support, and institutional strategies as the leading sector for accelerating stunting reduction. Therefore, this study aims to analyze the strategies of the Sidoarjo Regency Health Department to hasten the reduction of stunting and explain how integrating these four strategic dimensions contributes to achieving this goal. This study employed a qualitative method, and the research informants included officials from the Sidoarjo District Health Department, health workers, Posyandu cadres, and other stakeholders involved in the program’s implementation. The results show that accelerating the reduction of stunting requires integrating Corporate Strategy, Program Strategy, Resource Support Strategy, and Institutional Strategy into a mutually supportive governance system. Corporate Strategy provides direction for policy and organizational governance; Program Strategy translates policy into integrated interventions; Resource Support Strategy ensures the availability of resources; and Institutional Strategy strengthens cross-sectoral collaboration. Therefore, the effectiveness of implementation is determined by the integration of all four dimensions through mechanisms of coordination, monitoring and evaluation, organizational learning, and continuous feedback. The proposed conceptual model expands on Kooten’s strategic perspective by positioning strategic integration as the foundation of adaptive governance in accelerating the reduction of stunting.
Fajar Muharram, Fauzan Romadlon, Dian Alviana et al.
Professional development for Early Childhood Education (ECE) teachers requires a growth mindset to address instructional challenges and limited access to training, particularly in rural areas. This study aims to examine the association between growth mindset and professional development orientation among ECE teachers in Manggarai Regency, East Nusa Tenggara, Indonesia. Using a descriptive quantitative survey approach, data were collected through a closed-ended Likert-scale questionnaire completed by 29 teachers. Data were analyzed using descriptive statistics (means, standard deviations, and score ranges) across four categories: growth mindset, professional engagement, reflective teaching, and perceived impacts on children’s behavior. The results indicate a strong growth mindset (M = 3.98) and high professional engagement (M = 4.03), although participation in learning communities varied; reflective teaching was also high (M = 3.94), and teachers reported increased children’s independence and learning enthusiasm (M = 3.98). These findings imply the need for context-specific training and strengthened teacher collaboration/learning communities to enhance reflective practice and improve the quality of ECE provision.
Malda district is presently facing a complex nutrition challenge marked by the co–existence of undernutrition and rising lifestyle-related diseases. High levels of anemia, child stunting and underweight persists among women and young children, while overweight, diabetes and hypertension are increasingly observed among adult women. Although calorie intake may be adequate in many households, poor dietary diversity and limited intake of nutrient-rich foods contribute to hidden hunger. Field-level assessments by ICAR-CISH KVK indicated inadequate diversity in household diets, particularly among women. In response, structured nutri-garden models were promoted to enhance yearround availability of vegetables, fruits, legumes and herbs within homesteads. The circular and rectangular models, supported by season-wise crop planning, align with ICMR–NIN dietary guidelines and offer a practical, affordable and locally adaptable strategy to improve diet quality and strengthen household nutritional security in Malda district.
Pavuluri Yasaswini, DUSHYANT KUMAR RAGHAV, Shivam et al.
This study examines Community Health Center (Puskesmas) service innovations for stunting prevention and management in Kerinci Regency and explains their potential contribution to human capital formation and local development. The study employed a qualitative descriptive approach using a multiple-case study design. Eight innovations implemented across seven Community Health Centers were examined through document review of innovation proposals, activity reports, beneficiary data, and available implementation evidence. The analysis combined within-case analysis, cross-case thematic analysis, life-cycle mapping, and a Theory of Change framework. Innovation maturity scores were used descriptively to indicate implementation readiness rather than programme effectiveness. Four cross-case themes emerged: life-course prevention and early risk detection; maternal-risk monitoring and safe delivery; breastfeeding support and nutrition education; and local food-based supplementary feeding and child nutrition support. The innovation portfolio covered adolescent girls, pregnant women, childbirth, infants, and young children, with the strongest concentration of interventions during pregnancy and early childhood. Service mechanisms included home visits, monitoring of high-risk pregnancies, collaboration between midwives and traditional birth attendants, digital nutrition education, breastfeeding support, and local food-based supplementary feeding. The findings show complementary primary health-care responses to stunting risks. Nevertheless, the available documents primarily report activities and programme outputs; they do not yet provide sufficient evidence to establish causal effects on stunting prevalence.
Stunting is a linear growth disorder associated with chronic malnutrition. The development of snacks made from local food ingredients rich in protein and bioactive compounds can support food diversification. This study aims to analyze the protein and flavonoid content, as well as the acceptance level, of catfish (Clarias gariepinus) cakes supplemented with fern leaf flour (Diplazium esculentum). The laboratory phase used a completely randomized design with four formulations. The laboratory phase employed a completely randomized design with four formulations containing 0, 5, 10, and 15 g of fern leaf flour, each with three replicates. Protein content was analyzed using the Kjeldahl method, and flavonoid content was determined using UV-Vis spectrophotometry. Acceptability was assessed using a hedonic test involving 30 untrained child panelists aged 9–11 years. Laboratory data were analyzed according to their distribution; nonparametric comparisons were performed using the Kruskal Wallis test, followed by paired comparisons with multiple comparisons correction if differences were found. Acceptability data were analyzed using the Friedman test, followed by the Wilcoxon signed-rank test. Protein content increased from 11.67 to 15.31 g/100 g of cookies as the fern leaf flour content increased from 0 to 15 g. Flavonoid content also increased from 1.2 to 52.7 mg/100 g cookies. Formula P1, with the addition of 5 g of fern leaf flour, received the highest average acceptability ratings for taste, aroma, texture, color, and overall acceptability. The results of the study indicate that the addition of fern leaf flour can increase the measured protein and flavonoid content in catfish cookies, whereas adding too much can reduce sensory acceptability. The product still requires evaluation of its nutritional adequacy, safety, serving size, and suitability for the target group before it can be recommended as a dietary supplement.
Background: Indonesia reduced its national stunting prevalence from 21.5% in 2023 to 19.5% in 2024 through accelerated multisectoral interventions. However, evidence regarding the characteristics, implementation approaches, and outcomes of these interventions remains fragmented. Objective: This scoping review mapped the evidence on stunting reduction efforts implemented in Indonesia between 2020 and 2025, focusing on intervention characteristics, target populations, implementation approaches, reported outcomes, and research gaps. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology and reported according to the PRISMA-ScR guidelines. Scopus and PubMed/MEDLINE were systematically searched for studies published between January 2020 and December 2025. Eligible studies were selected using the Population–Concept–Context framework, and findings were synthesized through narrative evidence mapping. Results: Thirty-one studies were included. Nutrition supplementation and complementary feeding were the most frequently reported interventions, followed by nutrition education, community empowerment, health cadre strengthening, governance, and multisectoral collaboration. Most interventions improved maternal knowledge, child feeding practices, health worker capacity, community participation, and child growth indicators. Successful implementation consistently depended on implementation capacity, interprofessional collaboration, community engagement, and supportive local governance. Limited evidence was identified regarding implementation fidelity, cost-effectiveness, scalability, and long-term sustainability. Conclusion: Indonesia's stunting reduction efforts have evolved toward integrated, multisectoral strategies addressing both immediate and underlying determinants of child growth. Strengthening implementation research and context-specific, evidence-informed approaches will be essential to sustain equitable reductions in childhood stunting
Toddlers are a vulnerable age group to various health problems and therefore require regular monitoring of their growth and development through Posyandu (Integrated Health Posts) activities. Toddlers’ visits to Posyandu are one of the indicators of the success of maternal and child health services. However, the coverage of toddlers’ visits to Posyandu in the working area of Satria Community Health Center, Tebing Tinggi, has not yet reached the established target. This study aimed to analyze the factors influencing toddlers’ visits to Posyandu in the working area of Satria Community Health Center, Tebing Tinggi, in 2026. This study employed an analytical survey with a quantitative approach and a cross-sectional design. The population and sample consisted of 52 mothers who had toddlers attending Posyandu in the working area of Satria Community Health Center, Tebing Tinggi. Data were analyzed using the Chi-square test and multiple binary logistic regression analysis. The results showed that education (p = 0.001), employment status (p = 0.039), distance from residence (p = 0.001), knowledge (p = 0.003), attitude (p = 0.002), and family head support (p = 0.000) were significantly associated with toddlers’ visits to Posyandu. The multivariate analysis showed that knowledge was the most dominant factor influencing toddlers’ visits to Posyandu (p = 0.003; Exp(B) = 71.005). The study concluded that education, employment status, distance from residence, knowledge, attitude, and family head support were factors influencing toddlers’ visits to Posyandu, with knowledge being the most dominant factor. Therefore, health workers should strengthen health education for mothers of toddlers and involve family members in efforts to improve regular attendance at Posyandu according to the scheduled visits.
Adolescence represents a critical stage of human development characterized by rapid physical growth and increased nutritional requirements.However, adolescents remain underrepresented in nutrition surveillance systems, particularly in low-and middle-income countries where the burden of malnutrition remains high.This study aimed to examine the current state of adolescent nutrition surveillance and identify key gaps in existing data systems that limit evidence-based policy and programming.We conducted a narrative literature review and policy analysis using scientific publications and authoritative institutional reports published between 2000 and 2025.Data sources included peer-reviewed journals and reports from major global health organizations.The analysis focused on measuring adolescent nutritional indicators and integrating these indicators into national health information systems.The findings reveal that current surveillance systems largely prioritize children under five years of age and women of reproductive age, leaving adolescents underrepresented in routine monitoring systems.Existing data sources, including household surveys and school-based health surveys, provide only partial and irregular information on adolescent nutritional status.Furthermore, adolescents are increasingly affected by the triple burden of malnutrition, including undernutrition, overweight and obesity, and micronutrient deficiencies such as anaemia.Strengthening adolescent nutrition surveillance by integrating standardized indicators into national health information systems is essential to support evidencebased decision-making, guide targeted interventions, and improve long-term health outcomes for adolescents.
Exclusive breastfeeding plays a vital role in improving infant health. However, the coverage of exclusive breastfeeding in some areas is still not optimal. One key factor influencing exclusive breastfeeding is maternal knowledge of proper breastfeeding practices. Health education using audio-visual media and booklets can be used as an effort to improve pregnant women's knowledge about breastfeeding practices. This study aims to determine the effect of audio-visual education and booklets on pregnant women's knowledge about breastfeeding practices in the Letis Community Health Center, East Sumba Regency. This study used a quasi-experimental design with a two-group pretest-posttest design. The study sample consisted of 60 pregnant women selected using a total sampling technique. The treatment group (n = 30 people) was given education using audio-visual media and booklets, while the control group (n = 30 people) was given education using booklets only. Data were collected carried out using a knowledge questionnaire about breastfeeding practices. Data analysis was carried out using statistical tests to see differences in knowledge before and after the intervention. The results showed that there was an increase in knowledge of pregnant women after being given education in both the treatment and control groups. Education using the combination of audio-visual and booklet media versus booklet-only are both effective in increasing pregnant women's knowledge about breastfeeding practices.
Paulina Winarastuti Bunga, Helga J. N. Ndun, Galuh Wiedani K.D. Larasati et al.
