Poor environmental sanitation in coastal areas is closely associated with environmentally related diseases and malnutrition among under-five children, but participatory interventions are rarely evaluated at the household level. Therefore, this study aimed to implement and evaluate a family-centered adaptation of the Participatory Hygiene and Sanitation Transformation (PHAST) method in Medan Belawan District, Indonesia. A Participatory Action Research (PAR) design engaged 30 households with children under five years of age. Qualitative interview and observation data were triangulated with descriptive pre- and post-intervention sanitation indicators and anthropometric data to validate the thematic evidence. The results from the baseline assessment showed inadequate sanitation conditions, including unsafe toilets, open wastewater channels, as well as poor hygiene and waste management. Following the intervention, all families stored water and food in covered containers, 83.3% disposed of waste daily, and 50% performed actions such as closing toilet holes and cleaning up scattered waste. The intervention increased household environmental awareness, strengthened shared family responsibility for sanitation, and produced measurable improvements in sanitation practices. This reduced the risk of environmentally related diseases, and malnutrition remains a plausible, unmeasured downstream benefit. In conclusion, the adaptation appears feasible and acceptable for strengthening household sanitation ownership in low-resource coastal communities, warranting further evaluation of its longer-term health impact.
Evi Naria, Indra Chahaya, Rusmalawaty Rusmalawaty et al.
Introduction: The high rate of stunting in East Nusa Tenggara Province is related to patriarchal cultural practices that affect decision-making patterns in households. The dominance of fathers in determining aspects of child nutrition and health has an impact on the fulfillment of children's rights, especially in North Central Timor Regency. Purposes of the Research: This study aims to analyze the relationship between patriarchal culture and stunting and assess the role of the Child Protection Law in efforts to overcome it. Methods of the Research: This study uses a descriptive normative-empirical legal research method with a qualitative approach through non-participatory observations, direct interviews, and normative studies of the Child Protection Law. Results Main Findings of the Research: The results of the study showed a significant relationship between patriarchal culture and the increase in stunting rates in Noemuti District, North Central Timor Regency. The main findings included maternal dependence on husbands' decisions, low discipline in children's feeding time since pregnancy and breastfeeding, and the phenomenon of double burdens experienced by mothers. These conditions have an impact on the non-optimal fulfillment of child nutrition and health. The Child Protection Law has the potential to be used as a normative, imperative, and repressive instrument through socialization and enforcement of the obligations of parents, especially fathers (in patriarchal culture), in ensuring the fulfillment of children's rights.
Ellon Belwan Cornelius Mau, Yanto Melkianus Paulus Ekon, Adriani Rafael et al.
Abstrak: Anemia pada balita masih menjadi masalah kesehatan masyarakat yang signifikan, terutama di wilayah dengan tingkat sosial ekonomi menengah ke bawah. Prevalensi anemia anak balita cenderung menunjukkan kenaikan dari tahun ke tahun. Dampak terhadap kematian dan kualitas sumber daya manusia di masa mendatang akibat kejadian anemia, mendorong pemerintah untuk melakukan penanganan yang lebih optimal. Tujuan pengabdian dilakukan untuk meningkatkan pengetahuan dan keterampilan mitra mengenai pemanfaatan hati ayam sebagai sumber protein hewani untuk mencegah anemia pada balita. Metode pengabdian dilakukan melalui penyuluhan, pelatihan, dan pendampingan. Mitrra sasaran pada kegiatan ini yaitu kader posyandu Sarinita sejumlah 20 orang. Evaluasi kegiatan dilaksanakan dengan melakukan pretest dan posttest melalui kuesioner dan lembar observasi dengan jumlah pertanyaan 10 butir mengenai pengetahuan tentang anemia balita, pengukuran antropometri, dan keterampilan mengolah hati ayam menjadi cemilan stik. Hasil pretest peserta sebelum dilakukan kegiatan pengabdian ini menunjukkan sebanyak 60% peserta memiliki pengetahuan rendah dan 100% peserta tidak terampil membuat cemilan kerupuk stik hati ayam. Hasil posttest melalui kuesioner dan lembar observasi menunjukkan bahwa terjadi peningkatan pengetahuan dan keterampilan pada peserta yakni pengetahuan kategori tinggi sebesar 75% dan 100% peserta terampil membuat kerupuk stik hati ayam.Abstract: Anemia among children under five remains a significant public health issue, particularly in areas with low-to-middle socioeconomic status. The prevalence of anemia in this age group has shown a tendency to rise over the years. The potential impact of anemia on mortality and the future quality of human resources has prompted the government to seek more optimal interventions. This community service activity aimed to enhance the partners' knowledge and skills regarding the use of chicken liver as a source of animal protein to prevent anemia in children under five. The activity was conducted through health education, training, and mentoring. The target partners consisted of 20 participants from the Sarinita group.The activity was evaluated using pre-tests and post-tests—administered via questionnaires and observation sheets—comprising 10 questions covering knowledge of anemia in toddlers, anthropometric measurements, and skills in processing chicken liver into snack sticks. Pre-test results indicated that 60% of participants had low knowledge, and none possessed the skills to make chicken liver snack sticks. Post-test results demonstrated an improvement in both knowledge and skills: 75% of participants reached the high-knowledge category, and all participants became skilled in making chicken liver snack sticks.
Nurqalbi SR, Husnul Khatimah, Nurjannah Supardi et al.
Adolescence (10–19 years) is a critical period of rapid growth and development with increased nutritional needs. Adolescent girls are particularly vulnerable to anaemia and malnutrition due to growth, menstrual blood loss, gender inequalities, early pregnancy and limited access to health services. Globally, undernutrition, micronutrient deficiencies and anaemia coexist with rising overweight and obesity. In India, the CNNS 2016–18 reported substantial levels of stunting, thinness and anaemia among adolescents, with about 40% of adolescent girls affected by anaemia. This article reviews the nutritional status, dietary practices, determinants and major nutrition programmes for adolescent girls in India. The evidence highlights the need for a life-course and multisectoral approach integrating nutritious diets, micronutrient interventions, health services, education and gender-responsive strategies.
Chronic aflatoxins exposure may impair immune function, but evidence in African children is limited. We assessed their association with hepatitis B surface antibody (Anti-HBs) levels in Rwandan children receiving nutritional support for malnutrition recovery or prevention. A total of 216 children aged 7–59 months were enrolled, including 70 malnutrition cases and 146 controls. Anti-HBs concentrations were measured using the ARCHITECT System (Abbott Diagnostics), and aflatoxins (AFB1, AFB2, AFG1, AFG2 and AFB1-lysine) were quantified by liquid chromatography-tandem mass spectrometry (LC–MS/MS). Anti-HBs levels were highly variable (median = 84.8 IU/ml, IQR 14.0–283.4). Serum analysis for AFB1-lysine revealed a mean concentration of 23.43 ± 5.76 pg/mg albumin, while none of the samples showed detectable levels of AFB1, AFB2, AFG1, or AFG2 above the limit of detection. In unadjusted analyses, no significant differences in Anti-HBs or aflatoxin levels were observed between cases and controls (Mann–Whitney U, p = 0.452 and p = 0.119, respectively) or between sexs (t-test, p = 0.642 and p = 0.352). Age was not correlated with aflatoxin levels (r = 0.06, p = 0.556). In multivariable linear regression analyses adjusting for age, place of residence, socioeconomic status, and sex, nutritional status emerged as a significant determinant of Anti-HBs levels. Specifically, the control group had higher Anti-HBs levels than the case group (β = 0.573, 95% CI 0.076–1.070, p = 0.024), while aflatoxin exposure showed no independent association with Anti-HBs levels (β = − 0.003, 95% CI − 0.031–0.025, p = 0.832). These findings suggest that, in this population, nutritional status rather than chronic aflatoxins burden, is the primary determinant of Anti-HBs response, highlighting the importance of targeted nutritional interventions to support immune protection in children.
The early 2020s have been shaped by ‘polycrisis’ – global public health crises, climate disasters, political and economic instability – which has reversed or stalled decades of progress in human development, and which has disproportionately affected children. Children are at least twice as likely as adults to live in poverty, and even brief instances of hardship in a child’s life can have lifelong developmental consequences. Although poverty is traditionally measured using monetary methods, these measures often miss what is most important for children. Child poverty is different from adult poverty because children lack agency and rely on public goods, such as schools and health clinics, and a child whose household may not be counted as income-poor can still lack access to adequate food, safe drinking water, shelter, schooling, or healthcare, among other essential resources. This thesis examines child poverty, vulnerability, and exclusion across different low- and middle-income contexts, revealing how 1) measurement choices determine who is considered poor; 2) interconnected and overlapping deprivations can reinforce each other and harm children’s development; 3) early, integrated and context-specific interventions are necessary to protect vulnerable children and safeguard their lifelong potential. It does this through four separate but interconnected research papers, and using large, nationally representative household survey datasets. The first assesses three multidimensional poverty measurement frameworks, and how they each identify different shares of children as poor in Uganda, demonstrating how technical and conceptual measurement choices are crucial in deciding who is identified as poor. The second investigates how overlapping deprivations in essential dimensions like nutrition, health, sanitation, water and housing are associated with child stunting (a signifier of a child’s physical growth being held back over a long period of time) among children in Cambodia, showing that children who faced fewer than three deprivations were significantly less likely to be stunted. The third investigates the relationship between maternal educational achievement and the extent to which it protects against child stunting across fourteen Sub-Saharan African countries, finding that when the mother achieved higher levels of schooling, children generally were less likely to be stunted, but other deprivations, as well as intergenerational, biological and contextual factors, also mattered. The last study examines how disability intersects with other disadvantages such as rurality and poverty in Viet Nam, to create barriers to school completion, digital access, and overall child well-being. The research suggests that policies aiming to break intergenerational cycles of poverty should holistically support children across all dimensions of their well-being, instead of addressing only one need at a time, and be implemented early in their life and adapted to their needs across different ages. Policies should also be adapted to the local conditions, instead of applying “one-size-fits-all” metrics. Evidence to inform policies should also be based on measurement tools that are chosen carefully and whose choices and limitations are stated openly, because the answer to the question, “which children are poor?”, depends on these choices. Inclusive future research and policy design should consider longitudinal and qualitative lenses, and treat vulnerable children with dignity and empathy, ensuring that applied frameworks actively remove the structural, environmental, and social barriers that keep them excluded.
Abstrak: Pemanfaatan Kartu Menuju Sehat (KMS) yang belum optimal dapat menghambat pemantauan pertumbuhan balita dan penyampaian informasi pertumbuhan kepada keluarga. Kegiatan pengabdian kepada masyarakat ini bertujuan meningkatkan kapasitas kader dalam pengisian dan pemanfaatan KMS sebagai instrumen pendukung deteksi dini gangguan pertumbuhan serta memperkuat pemahaman ibu balita terhadap hasil pemantauan pertumbuhan. Kegiatan melibatkan 24 kader melalui pelatihan, edukasi, praktik, dan pendampingan langsung pada pelayanan posyandu. Evaluasi pengetahuan dilakukan menggunakan pre-test dan post-test yang masing-masing terdiri dari 15 pertanyaan, sedangkan keterampilan diamati selama praktik pengisian dan interpretasi KMS. Rata-rata skor pengetahuan meningkat dari 60,5% pada pengukuran awal menjadi 82% setelah kegiatan, dengan peningkatan sebesar 22,5%. Observasi selama pendampingan menunjukkan antusiasme kader dan meningkatnya pemahaman mengenai fungsi KMS dalam pencatatan serta pemantauan pertumbuhan anak. Pendekatan pendampingan berbasis praktik memberikan pengalaman langsung bagi kader dalam menerapkan KMS pada pelayanan posyandu.Abstract: Suboptimal utilization of the Growth Monitoring Card (KMS) may hinder the routine monitoring of child growth and the delivery of growth-related information to families. This community service activity aimed to strengthen cadres’ capacity to complete and utilize the KMS as a supporting instrument for early detection of growth disorders and to improve mothers’ understanding of child growth monitoring. The program involved 24 community health cadres through training, health education, practical sessions, and direct mentoring during integrated health post (posyandu) services. Knowledge was assessed using pre-test and post-test measures, each consisting of 15 questions, while practical skills were observed during KMS completion and growth-chart interpretation. The mean knowledge score increased from 60.5% at baseline to 82% after the intervention, representing an increase of 22.5%. Observations during the mentoring process indicated high cadre engagement and improved understanding of the role of the KMS in documenting and monitoring child growth. Practice-based mentoring provided cadres with direct experience in applying KMS procedures during posyandu services.
Maxsi Irmanto, Anneke Yacob, Syaharuddin Nur et al.
ABSTRAK Stunting merupakan kondisi gagal tumbuh dalam balita akibat kekurangan gizi kronis, yang dapat memengaruhi perkembangan fisik dan kognitif anak. Di Posyandu Bougenvelle, pelaksanaan program “Zero New Stunting” menghadapi berbagai kendala, seperti keterlambatan pencatatan data dan kurangnya standar pemberian asupan gizi. Penelitian ini merancang sistem berbasis Internet of Things (IoT) untuk memonitoring dan pemberian rekomendasi asupan gizi balita yang berisiko stunting. Sistem terdiri dari perangkat keras berupa sensor tinggi badan (VL53L1X) dan berat badan (Load Cell serta modul HX711) yang terintegrasi dengan mikrokontroler ESP8266, serta sistem berbasis web yang menyimpan dan menimpilkan riwayat data pertumbuhan. Sistem ini juga menghitung Z index Score untuk klasifikasi status gizi dan mengirim rekomendasi asupan protein melalui WhatsApp. Metode pengembangan yang digunakan adalah prototype, yang memungkinkan penyesuaian sistem secara iteratif berdasarkan kebutuhan pengguna. Hasil implementasi menunjukan bahwa sistem dapat membantu meningkatkan akurasi data dan mempermudah proses evaluasi serta pemantauan pertumuhan balita oleh tenaga Kesehatan dan Orang tua. ABSTRACT Stunting is a condition of growth failure in toddlers caused by chronic malnutrition, which affects children's physical and cognitive development. In Posyandu Bougenvelle, the “Zero New Stunting” program faces challenges such as delayed data recording and lack of standardized nutritional intake guidelines. This research designs an Internet of Things (IoT)-based system for monitoring and recommending nutritional intake for toddlers at risk of stunting. The system consists of hardware using height (VL53L1X) and weight (Load Cell and Modul HX711) sensors integrated with an ESP8266 microcontroller, as well as a web-based platform to store and display growth history data. The system also calculates Z-scores to classify nutritional status and sends daily protein intake recommendations via WhatsApp. The prototype development method was used to allow iterative adjustments based on user feedback. Implementation results indicate the system improves data accuracy and facilitates growth monitoring and evaluation by healthcare workers and parents.
Abstract Background Undernutrition remains a leading driver of child mortality and morbidity in low- and middle-income countries, yet surveillance and case management in Pakistan still rely largely on infrequent surveys and paper-based registers that cannot track nutritional status in real time. The private sector, where most Pakistani households seek care, has been largely excluded from nutrition programming. We describe the development and early implementation of Mazboot Bunyad, a digital nutrition registry embedded within an integrated nutrition–immunization programme at private provider clinics in high-risk, low-income settlements of Karachi. Methods The Android application and web dashboard used in this implementation study were designed through a participatory process using the AHEAD framework, in consultation with provincial health authorities, immunization staff, and community nutrition worker. The system used QR-linked child records, an embedded digital decision-support system that classified children by mid-upper arm circumference and has automated follow-up reminders. The tool was deployed across 33 clinics, and routinely collected programme data, a preliminary analysis of data from 1 July to 31 December 2024 were retrospectively reviewed. Results During the period of 6 months, the Mazboot Bunyad application was used to screen and enroll 8,406 children aged 6–59 months. Field teams used the embedded Digital Decision Support System (DDSS) to classify children aged 6–59 months in real-time. Of these, 71.4% were classified as normal, 22.3% as moderately acutely malnourished (MAM), and 6.2% as severely acutely malnourished (SAM). The largest share of enrollments was among children aged 13–24 months (40.5%). Male children represented a slightly larger share of total enrollments (52.2%), but SAM burden was higher among females (7.3%) compared to males (5.3%). Supervisory teams used the dashboard to identify defaulters, monitor stock availability, and follow case recovery timelines. Conclusions Early implementation of Mazboot Bunyad highlighted opportunities for enhanced nutritional surveillance using real-time tracking, but also challenges such as supply chain gaps that could affect the overall implementation. These offer valuable lessons for scaling digital tools in real world settings across Pakistan and other LMICs.
Shifa Salman Habib, Ammarah Ali, Muhammad Fazal Hussain Qureshi et al.
Background. Stunting and wasting drive child mortality and are central to Sustainable Development Goal target 2.2. In 2025, 24.0% of Bangladeshi children under five were stunted and 12.9% wasted, meeting the national stunting target but missing the 8% wasting target. We compared where the two occur and tested whether environmental factors explain the patterns. Methods. We linked the 2025 Bangladesh Multiple Indicator Cluster Survey to cluster GPS locations and environmental data. Moran's I tested clustering and Getis-Ord Gi* found hotspots across 64 districts and 3,144 clusters. We tested whether six environmental and access factors explained the hotspots, estimated what share of affected children each hotspot list reached, and used a joint model to compare factor associations between outcomes. Results. Stunting clustered by region (district Moran's I 0.21, P=0.002), with a north-eastern hotspot centred on Sylhet and Sunamganj. Six environmental factors together removed this clustering (I −0.01, P=0.45) and about 60% of between-district variation (95% CI 28 to 84), more than rainfall alone, with the gain over generic regional terms uncertain. Wasting showed no clear regional clustering (I 0.05, P=0.17), and district stunting and wasting rates were unrelated (r −0.01). Stunting hotspot districts held 5.9% of wasted children, the same as their 5.9% population share. Children with both conditions (902 cases) did not cluster. Altitude and rainfall related differently to stunting than to wasting (all P<0.004), but altitude associations were sensitive to how altitude was modelled. Conclusion. Stunting in Bangladesh is concentrated in the north-east, and six environmental and access factors together account for much of this, though no single factor, including rainfall, does. Wasting shows no clear regional pattern. A stunting hotspot list reached no more wasted children than population share, so surveillance may need both measures, with finer-scale data for wasting.
S.M. Ashraf Ul Hoque, Khairul Islam, Mohammad Khalid Hasan et al.
