Effect of a National Nutrition Communications Campaign on Stunting Awareness and Promotion of Exclusive Breastfeeding Behavior among Rural Indonesian Mothers

Authors

DOI:

https://doi.org/10.26911/thejmch.2021.06.05.11

Abstract

Background: Stunting affects 37% of Indonesian children and has lifelong consequences for the affected child. Childhood stunting can be prevented by promoting exclusive breastfeeding (EBF) and helping mothers overcome barriers to EBF. This study aimed to examine the effect of a National Nutrition Communications Campaign (NNCC) on stunting awareness and promotion of exclusive breast­feeding behavior among rural Indonesian mothers.

Subjects and Method: Data came from interviews and a cross-sectional survey of 1,740 mothers with children under the age of 2 in three Indonesian districts, from November 2015 to March 2018. Measures included exposure to two different NNCC interventions: multi-media messages (media) and interpersonal communication strategies (IPC) and associations with stunting knowledge, breast­feeding knowledge, and breastfeeding perceptions/intentions. The data were analyzed by a multiple logistic regression.

Results: Exposure to NNCC was positively associated with knowledge toward EBF (OR= 1.56; 95% CI= 1.10 to 2.19; p= 0.043), awareness of the importance of nutrition during the first 1000 days of life (OR= 1.90; 95% CI= 1.43 to 2.52; p<0.001), and having heard of stunting (OR= 1.93; 95% CI= 1.41 to 2.63; p<0.001). Exposure to IPC was positively associated with knowledge toward EBF (OR=1.78, CI95% 1.37 to 2.30, p<0.001), awareness of the importance of nutrition during the first 1000 days of life (OR= 3.02; 95% CI= 2.40 to 3.80; p<0.001), knowledge of EBF benefit to prevent stunting (OR= 3.05; CI 95%= 2.33 to 3.98; p<0.001), and having heard of stunting (OR= 3.15; CI 95%= 2.49 to 3.98; p<0.001). Exposure to IPC was a significant predictor of an intention to engage in EBF (p <0.050).

Conclusion: These findings point to practical recommendations for national level social and behavior change communication efforts. Future campaigns should aim to be inclusive of: 1) mass media (tele­vision, radio, billboards, and social media) to promote health as these efforts provide for wide exposure while maintaining impact; and 2) IPC (face-to-face communications, classes, and support groups) as these efforts increase knowledge and impact on behavior, beliefs and intentions.

Keywords:

stunting, exclusive breastfeeding, communications campaign

Author Biographies

Ryan Craig Moffat, Brigham Young University

I am an Assistant Professor of Dentistry at Roseman College of Dental Medicine and an MPH candidate at Brigham Young University.

Alexis Sayer, Brigham Young University

MPH candidate at Brigham Young University

Megan Hawks, Brigham Young University

MPH candidate at Brigham Young University

Kiersten DeCook, Brigham Young University

MPH candidate at Brigham Young University

McKayla Traub, Brigham Young University

MPH candidate at Brigham Young University

Josh West, Brigham Young University

Professor, Brigham Young University

Benjamin Crookston, Brigham Young University

Associate ProfessorDirector, MPH Program, Brigham Young University

Cougar Hall, Brigham Young University

Assistant Professor, Brigham Young University

References

Adewuyi E, Adefemi K (2016). Behavior change communication using social media: A review. Int J Commun and Health. 9: 109-116. DOI: https://orcid.org/0000000245330340.

Alderman H, Behrman JR (2006). Reducing the incidence of low birth weight in low-income countries has substantial economic benefits. World Bank Res Obs. 21(1): 25-48. DOI: https://doi.org/10.1093/wbro/lkj001.

Ananta Y, Gandaputra E, Waiman E, Partiwi I, Marzuki N, Yohmi E, Panjaitan E, et al. (2016). Exclusive breastfeeding rate and factors associated with infant feeding practices in Indonesia. PAEDIATR INDONES. 56(1): 24-31. DOI: https://doi.org/10.14238/pi56.1.2016.2431

Azjen I (1991). The theory of planned behavior. Organizational behavior and human decision processes, 50: 179-211. https://doi.org/10.1016/07495978(91)90020T.

Belvedere L, Andreasen R, Smith R, Thomas K, Sever T, Syafiq A, Crookston B, et al. (2018). Facts from Barriers to Optimal Breastfeeding in Rural Indonesia. Archives of Epidemiology, AEPD-124. DOI: 10.29011/25772252. 100024

Beyene M, Worku A, Wassie M (2015). Dietary diversity, meal frequency and associated factors among infant and young children in Northwest Ethiopia: a cross-sectional study. BMC Public Health, 15: 1007. https://doi.org/10.1186/s128890152333x.

Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati, M, Mathers C, et al. (2008). Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet. 371(9608): 243-260.

Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J (2008). Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 371(9608): 24-360. DOI: 10.1016/S01406736(07)616900.

Bozkurt E, Bozkurt HB (2020). Relationship between ocular morbidity and infant nutrition. Breastfeeding and Formula Feeding Infants. IntechOpen. 1-12. DOI: 10.5772/intechopen.92162.

Crookston BT, Dearden KA, Alder SC, Porucznik CA, Stanford JB, Merrill RM, Dickerson TT, et al. (2011). Impact of early and concurrent stunting on cognition. Matern Child Nutr. 7(4): 397-409. DOI: 10.1111/j.17408709.2010.00255.x.

Crookston B, Schott W, Dearden K, Georgiadis A, Penny M, Lundeen E, Behrman J, et al., (2013). Post-infancy growth, schooling, and cognitive achievement: Young Lives. Am J Clin Nutr. 98(6): 1555-1563. DOI: 10.3945/ajcn.113.067561

Onis M, Frongillo EA, Blössner M (2000). Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bull World Health Organ. 78(10): 1222-33.

Kim SS, Nguyen PH, Tran LM, Alayon S, Menon P, Frongillo EA (2020). Different combination of behavior change interventions and frequency of interpersonal contacts are associated with infant and young child feeding practices in Bangladesh, Ethiopia, and Viet Nam. Curr Dev Nutr. 4(2): nnz140. DOI: 10.1093/cdn/nzz140.

Kim SS, Rawat R, Mwangi EM, Tesfaye R, Abebe Y, Baker J, Frongillo EA, et al. (2016). Exposure to large-scale social and behavior change communication interventions is associated with improvements in infant and young child feeding practices in Ethiopia. PLoS One. 11(10): e0164800. DOI: 10.1371/journal.pone.0164800.

Ng C, Dibley M, Agho K (2012). Complementary feeding indicators and determinants of poor feeding practices in Indonesia: a secondary analysis of 2007 Demographic and Health Survey data. Public Health Nutrition, 15(5): 827-839. doi: 10.1017/s1368980011002485.

Ng CS, Dibley MJ, Agho KE (2012). Complementary feeding indicators and determinants of poor feeding practices in Indonesia: a secondary analysis of 2007 Demographic and Health Survey data. Public Health Nutr. 15(5): 827-39. DOI: 10.1017/S1368980011002485.

Prochaska JO, Velicer WF (1997). The transtheoretical model of health behavior change. Am J Health Promot. 12(1): 38-48. DOI: 10.4278/0890117112.1.38.

Rachmi CN, Agho KE, Li M, Baur LA (2016). Stunting, underweight and overweight in children aged 2.0–4.9 years in Indonesia: prevalence trends and associated risk factors. PloS one. 11(5). https://doi.org/10.1371/journal.pone.0154756.

Rosenstock IM, Strecher VJ, Becker MH (1998). Social learning theory and the Health Belief Model. Health Educ Q. 15(2): 175-83. DOI: 10.1177/109019818801500203.

Saha KK, Frongillo EA, Alam DS, Arifeen SE, Persson LÅ, Rasmussen KM (2008). Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh. Am J Clin Nutr.87(6): 1852–1859. DOI: https://doi.org/10.1093/ajcn/87.6.1852

Semba RD, Pee S, Sun K, Sari M, Akhter N, Bloem MW (2008). Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet. 371(9609): 322-8. DOI: 10.1016/S01406736(08)601695.

Snyder L (2007). Health communication campaigns and their impact on behavior. Journal of Nutrition and Education Behavior, 39(2): S32-S40.

Snyder LB (2007). Health communication campaigns and their impact on behavior. J Nutr Educ Behav. 39(2 Suppl): S32-40. DOI: 10.1016/j.jneb.2006.09.004.

Torlesse H, Cronin AA, Sebayang SK, Nandy R. (2016). Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction. BMC public health. 16(1): 669.

Torlesse H, Cronin AA, Sebayang SK, Nandy R (2016). Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction. BMC Public Health.16:669. DOI: 10.1186/s1288901633398.

Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R (2010). Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 125(3): e473-80. doi: 10.1542/peds.20091519.

Wakefield M, Loken B, Hornik R (2010). Use of mass media campaigns to change health behaviour. The lancet, 376(97-48): 1261–1271. doi:10.1016/S01406736(10)608094.

World Bank (2017). Prevalence of stunting, height for age (% of children under 5). Retrieved from: https://data.worldba-nk.org/indicator/SH.STA.STNT.ZS. (Accessed June 2020).

World Health Organization (2017). Stunted Growth and Development Context, Causes and Consequences. Retrieved from: http://www.who.int/nutrition/childhood_stunting_framework_leaflet_en.pdf?ua=1 (Accessed June 2020).

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Published

2021-09-16

How to Cite

Moffat, R. C., Sayer, A., Hawks, M., DeCook, K., Traub, M., Linehan, M., Dearden, K., Rachmi, C. N., West, J., Crookston, B., & Hall, C. (2021). Effect of a National Nutrition Communications Campaign on Stunting Awareness and Promotion of Exclusive Breastfeeding Behavior among Rural Indonesian Mothers. Journal of Maternal and Child Health, 6(5), 612–625. https://doi.org/10.26911/thejmch.2021.06.05.11

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