Africa Knowledge Hub for Children

Peer-reviewed articleOpenAlex21 Sept 2026

Determinants of the Use of Maternal and Child Health Services and Pregnancy Risk Prevention Behaviour among Pregnant Women in the Service Area of the Melonguane Community Health Centre, Talaud Islands Regency, North Sulawesi

Maternal and child health service utilisation and pregnancy risk-prevention behaviour remain challenging in geographically isolated and border areas. These outcomes are interrelated because knowledge and attitudes may shape health decisions, while financial, geographical, and social resources determine the ability to translate decisions into action. Purpose: This study aimed to analyse the association of predisposing, enabling, and reinforcing factors with maternal and child health (MCH) service utilisation and pregnancy risk-prevention behaviour among pregnant women in the Melonguane Community Health Centre catchment area, Talaud Islands Regency. Method: An analytical cross-sectional study was conducted among 152 pregnant women from February to May 2026 using total sampling. Data were collected through interviewer-administered questionnaires. Associations were analysed using Chi-square or Fisher’s Exact tests at p<0.05. Multivariable regression was not performed. Results: Knowledge and positive attitudes were significantly associated with both outcomes (p<0.001). JKN coverage, distance to the health centre, transport access, spousal support, and health education were also significantly associated with both outcomes, while household income and community health worker involvement were associated with MCH utilisation. Implications: Maternal health interventions should integrate health education, financial protection, improved geographical and transport access, and family- and community-based support. Conclusion: MCH service utilisation and pregnancy risk-prevention behaviour are associated with interacting individual, enabling, and reinforcing factors. Because the cross-sectional design cannot establish causality and bivariate analysis cannot identify dominant determinants, future studies should use multivariable and longitudinal or intervention designs.

Peer-reviewed articleOpenAlex22 Sept 2026

Maternal and Child Nutrition in Low‐ and Middle‐Income Countries: A Comparative Review of India and Palestine With Policy Implications

BACKGROUND: Maternal and child malnutrition is a serious public health problem in low and middle-income countries (LMICs) and can cause cycles of poverty, disease, and developmental delays. OBJECTIVE: This comparative narrative review explores maternal and child nutrition indicators, determinants, interventions and policies in India and Palestine and identifies common lessons and transferable recommendations for LMICs. METHODS: A structured, non-exhaustive search of the PubMed, Scopus, Web of Science, and WHO/UNICEF data repositories and some relevant grey literature published from 2010 to 2024 was used to obtain these narratives. Records were reviewed with background eligibility criteria and the evidence included was then thematically synthesised in a narrative format rather than systematically. KEY FINDINGS: India has achieved significant improvement in addressing child stunting and maternal anaemia through key initiatives like POSHAN Abhiyaan, ICDS, and Anaemia Mukt Bharat. However, there are still significant geographic and socioeconomic gaps, and the double burden of malnutrition (undernutrition and overweight) is growing. Palestine is experiencing a unique but significant nutrition crisis, due to prolonged conflict, occupation, and economic turmoil: Around 19.6% of Palestinian children are stunted and IDA is common among pregnant women. Both countries face issues of micronutrient deficiencies, poor infant and young child feeding practices, and gender inequities which negatively impact maternal nutrition. POLICY IMPLICATIONS: The two successful interventions have complementary lessons for each other: the convergence model in India, which is community based, and the integration of nutrition into primary healthcare in Palestine, which benefits from international partnerships. Multi-sectoral responses involving collaboration between the health, agriculture, education, and social protection sectors are needed, with a strong governmental commitment and monitoring systems. CONCLUSIONS: This review highlights that nutrition-specific clinical interventions are essential but that sustainable nutrition improvements need to be implemented through policies that address the underlying structural, socioeconomic, and, in Palestine, the political determinants of malnutrition. The lessons learned from India and Palestine are broadly relevant to other LMICs in a similar context of nutrition transitions.

Ali Jebreen, Huma Parveen

SurvivalINPSRead at source

Peer-reviewed articleOpenAlex23 Sept 2026

Age trajectories of infant mortality among Palestinian refugees born in 2010–2020: evidence from electronic health records

Abstract Objectives To estimate age trajectories of infant mortality among Palestinian refugees using electronic health records, addressing the scarcity of reliable mortality data in forced displacement settings. Setting Palestinian refugees living in Gaza, West Bank, Jordan, Syria and Lebanon. Design We fitted a Bayesian Negative Binomial model to observed death counts, using a flexible parametric function (a shifting power function) to capture the shape of the infant mortality curve, across strata to infer age trajectories of infant mortality. Participants Palestinian refugees born in 2010–2020 and registered with UNRWA health services in Gaza, West Bank, Jordan, Syria and Lebanon. The sample was stratified by sex, field, gestational age and birth cohort. Main outcome measures Survival rate to age 1. Results Overall, the survival rate to age 1 was 98.64%, with slightly lower rates for males (98.57%) than females (98.68%). Across settings, West Bank refugees had the lowest infant mortality (99.08% survival rate), and Jordan refugees had the highest (98.22% survival rate). Results by gestational age showed a 98.85% survival rate at age 1 among term births compared to a 73.32% survival rate among very preterm births. Survival rates by cohort (births up to 2015 or after) were 98.78% and 98.42%, respectively. Conclusion Our findings highlight the potential of electronic health records for mortality monitoring in forced displacement settings as they reveal consistent mortality trajectories by sex and gestational age, while identifying meaningful variation across refugee settings and subgroups. Summary boxes What is already known in this topic We searched PubMed and Google Scholar for articles published between Jan 1, 2000, and Feb 20, 2026, in English, using the terms “Palestinian refugees,” “infant mortality,” “neonatal mortality,” and “UNRWA.” We found a handful of studies estimating infant mortality among Palestinian refugees, mostly based on household surveys (eg, MICS, national statistical office surveys) or UNRWA surveys using preceding birth techniques. The preceding birth technique has notable limitations, including recall bias, small sample sizes, and selection bias. The majority of these studies focus exclusively on Palestinian refugees residing in Gaza. Estimates for Gaza suggest a sustained decline, from around 127 deaths per 1,000 births in 1960 to 20.2 per 1,000 births in 2006, with a slowdown thereafter and an increase in more recent years. A combined estimate (excluding Syria) across four settings where Palestinian refugees reside measures infant mortality at 18 per 1,000 births in 2011. What this study adds This study uses a unique data linkage bringing together UNRWA’s obstetric and child health records, providing more extensive information and a larger sample size than previous studies. This is also the first study to assess the data quality of these electronic records and to estimate age trajectories of infant mortality among Palestinian refugees. We developed a statistical strategy that estimated infant mortality trajectories covering all five UNRWA fields (Gaza, Jordan, Lebanon, Syria, and the West Bank) for children born in 2010-2020, and examined differences across subpopulations by sex, field, gestational age and cohort.

Selin Köksal, Yu Chen, Zeina Jamaluddine et al.

SurvivalPSJOLBSYRead at source

Peer-reviewed articleOpenAlex29 Sept 2026

LONG-TERM ASSOCIATION BETWEEN BREASTFEEDING DURATION AND NUTRITIONAL STATUS IN SCHOOL-AGED CHILDREN: A SYSTEMATIC REVIEW

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.

Galuh Indiradini, Rizki Meizikri

SurvivalIDRead at source

Peer-reviewed articleOpenAlex30 Sept 2026

Formulating A Framework Toward Stunting Reduction Strategy: A Case Study of the Sidoarjo Regency Health Department, Indonesia

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.

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Peer-reviewed articleCrossref5 Mar 2026

Growth Mindset and Professional Development among Early Childhood Educators: An Empirical Survey in Early Childhood Education Settings

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.

Theresia Alviani Sum, Emilia Graciela Mega Taran

DevelopmentIDRead at source

Peer-reviewed articleOpenAlex30 Sept 2026

Analysis of Protein, Flavonoids, and Acceptability of Catfish (Clarias gariepinus) Cookies with the Addition of Ferns Flour (Diplazium esculentum)

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.

Fani Lailatul Rochmah, Ninna Rohmawati

SurvivalIDRead at source

Peer-reviewed articleOpenAlex30 Sept 2026

MAPPING STUNTING REDUCTION EFFORTS IN INDONESIA: A SCOPING REVIEW OF EVIDENCE PUBLISHED FROM 2020 TO 2025

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

R.A. Kusuma, Dian Putri Mumpuni, Helmi Prinanda

SurvivalIDRead at source

Peer-reviewed articleOpenAlex30 Sept 2026

FACTORS AFFECTING TODDLERS’ UTILIZATION OF INTEGRATED HEALTH POSTS (POSYANDU) AT SATRIA COMMUNITY HEALTH CENTER, TEBING TINGGI

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.

Nurhidayah Saragih, Asriwati Asriwati, Ramadhani Syafitri Nasution

SurvivalDevelopmentIDRead at source

Peer-reviewed articleOpenAlex30 Sept 2026

THE EFFECT OF AUDIO-VISUAL AND BOOKLET ON PREGNANT WOMEN’S KNOWLEDGE OF BREASTFEEDING PRACTICES

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.

SurvivalExperimentalIDRead at source

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Determinants of the Use of Maternal and Child Health Services and Pregnancy Risk Prevention Behaviour among Pregnant Women in the Service Area of the Melonguane Community Health Centre, Talaud Islands Regency, North Sulawesi

Maternal and Child Nutrition in Low‐ and Middle‐Income Countries: A Comparative Review of India and Palestine With Policy Implications

Age trajectories of infant mortality among Palestinian refugees born in 2010–2020: evidence from electronic health records

LONG-TERM ASSOCIATION BETWEEN BREASTFEEDING DURATION AND NUTRITIONAL STATUS IN SCHOOL-AGED CHILDREN: A SYSTEMATIC REVIEW

Formulating A Framework Toward Stunting Reduction Strategy: A Case Study of the Sidoarjo Regency Health Department, Indonesia

Growth Mindset and Professional Development among Early Childhood Educators: An Empirical Survey in Early Childhood Education Settings

Analysis of Protein, Flavonoids, and Acceptability of Catfish (Clarias gariepinus) Cookies with the Addition of Ferns Flour (Diplazium esculentum)

MAPPING STUNTING REDUCTION EFFORTS IN INDONESIA: A SCOPING REVIEW OF EVIDENCE PUBLISHED FROM 2020 TO 2025

FACTORS AFFECTING TODDLERS’ UTILIZATION OF INTEGRATED HEALTH POSTS (POSYANDU) AT SATRIA COMMUNITY HEALTH CENTER, TEBING TINGGI

THE EFFECT OF AUDIO-VISUAL AND BOOKLET ON PREGNANT WOMEN’S KNOWLEDGE OF BREASTFEEDING PRACTICES

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