Perancangan Sistem Informasi Posyandu Sebagai Upaya Digitalisasi Data Posyandu di UPTD Puskesmas II Dinas Kesehatan Kecamatan Denpasar Timur

Maternal mortality and stunting descent acceleration is one of effort to increase quality and competitive human resources. Posyandu become one of the efforts that can reduce these two indicators through activities that involve the community. Therefore, the quality and accuracy of recording and reporting posyandu data is an important thing. This study aims to design a toddler Posyandu information system as an effort to overcome recording, reporting, and digitizing posyandu data problems. Case study research was design at the UPTD of PHC II East Denpasar Health Service used to design a web-based information system with Waterfall method. Primary data was obtained through interviews with PHC officers and secondary data by reviewing recording and reporting documents. The design stages included defining requirements, system design, implementation and unit testing, and integration and system testing. Total of 240 toddler visited data from posyandu were used for the system testing. The result show that the posyandu information system design help cadres to reduce repetitive data recording incident, can increase the uniformity and punctuality of reporting by cadres, help PHC officers to integrate posyandu data that can be used for nutritional surveillance reporting, and also store the activities posyandu data in digital form. The conclusion of this study is the posyandu information system can be a recording and reporting solution by cadres and PHC officers. Keywords: posyandu, information system, digitalizing, design AbstrakPercepatan penurunan kematian ibu dan stunting menjadi salah satu upaya meningkatkan sumber daya manusia berkualitas dan berdaya saing. Posyandu menjadi salah satu upaya yang dapat menurunkan dua indikator tersebut melalui kegiatan yang melibatkan masyarakat. Oleh karena itu kualitas dan ketepatan pencatatan dan pelaporan data posyandu menjadi hal yang penting. Penelitian ini bertujuan merancang sistem informasi posyandu balita sebagai upaya mengatasi permasalahan pencatatan, pelaporan, dan digitalisasi data posyandu. Rancangan penelitian studi kasus di UPTD Puskesmas II Dinas Kesehatan Denpasar Timur mengunakan perancangan sistem informasi berbasis web dengan metode Waterfall. Data primer diperoleh melalui wawancara dengan petugas puskesmas dan data sekunder dengan menelaah dokumen pencatatan dan pelaporan. Tahapan perancangan meliputi mendefinisikan kebutuhan, desain sistem, implementasi dan pengujian unit, dan integrasi serta pengujian sistem. Sebanyak 240 data kunjungan balita dari posyandu digunakan untuk uji coba sistem. Hasil penelitian menunjukkan perancangan sistem informasi posyandu membantu kader untuk mengurangi kegiatan pencatatan data yang berulang-ulang, dapat meningkatkan keseragaman dan ketepatan waktu pelaporan oleh kader, membantu petugas puskesmas untuk mengintegrasikan data posyandu yang bisa digunakan untuk pelaporan surveilans gizi, serta menyimpan data kegiatan posyandu dalam bentuk digital. Simpulan dalam penelitian ini adalah sistem informasi posyandu dapat menjadi solusi pencatatan dan pelaporan oleh kader dan petugas puskesmas.Kata Kunci: posyandu, sistem informasi, digitalisasi, perancangan

Nutritional Surveillance in Brazil: Challenges and Opportunities. A Mixed-Method Research to Assess the Brazilian Sisvan System

Background: As countries currently face growing malnutrition trends (often with a double burden of malnutrition), data on the nutritional status of the population can provide support to local policies, as well as track progress towards goals, such as the global nutrition targets. Brazil has a national nutritional surveillance system (Sisvan), which provides nutritional status data for municipalities, on all age groups. In an effort to offer a more in-depth analysis of the Sisvan, this study investigated the strengths and limitations of the system regarding the available data on children to explore its contribution to the health information system and policy making potential. Methods: A mixed methods approach was used innovatively, with triangulation of results, to combine quantitative descriptive statistics (to determine national coverage and completeness of nutritional status data among children in the Sisvan between 2008 and 2018), with a qualitative phenomenographic analysis of in-depth interviews with stakeholders involved with the system. Results: Results demonstrated on average an increase in coverage within the system of the nutritional status of children nationally from 14% in 2008 to 35,8% in 2018, with variability in this growth over the different areas of the country. The interviews demonstrated that the Sisvan is a tool to improve health conditions that go beyond nutrition. It has the potential to be integrated in a greater structure of Public Health care. After triangulation of results, there was agreements between the quantitative and qualitative analysis, demonstrating that the surveillance system is embedded in the Primary Health Care strategy, albeit current limitations. Conclusion: The Sisvan has the potential to be an important tool for the monitoring of nutritional targets and provision of information for local and national health and nutrition policies. However, more integration between the several instances involved is still a gap, for a full usage of the system and the generated data.

Agreement between self-reported pre-pregnancy weight and measured first-trimester weight in Brazilian women

Background Self-reported pre-pregnancy weight and weight measured in the first trimester are both used to estimate pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) but there is limited information on how they compare, especially in low- and middle-income countries, where access to a weight scale can be limited. Thus, the main goal of this study was to evaluate the agreement between self-reported pre-pregnancy weight and weight measured during the first trimester of pregnancy among Brazilian women so as to assess whether self-reported pre-pregnancy weight is reliable and can be used for calculation of BMI and GWG. Methods Data from the Brazilian Maternal and Child Nutrition Consortium (BMCNC, n = 5563) and the National Food and Nutritional Surveillance System (SISVAN, n = 393,095) were used to evaluate the agreement between self-reported pre-pregnancy weight and weights measured in three overlapping intervals (30–94, 30–60 and 30–45 days of pregnancy) and their impact in BMI classification. We calculated intraclass correlation and Lin’s concordance coefficients, constructed Bland and Altman plots, and determined Kappa coefficient for the categories of BMI. Results The mean of the differences between self-reported and measured weights was < 2 kg during the three intervals examined for BMCNC (1.42, 1.39 and 1.56 kg) and about 1 kg for SISVAN (1.0, 1.1 and 1.2 kg). Intraclass correlation and Lin’s coefficient were > 0.90 for both datasets in all time intervals. Bland and Altman plots showed that the majority of the difference laid in the ±2 kg interval and that the differences did not vary according to measured first-trimester BMI. Kappa coefficient values were > 0.80 for both datasets at all intervals. Using self-reported pre-pregnancy or measured weight would change, in total, the classification of BMI in 15.9, 13.5, and 12.2% of women in the BMCNC and 12.1, 10.7, and 10.2% in the SISVAN, at 30–94, 30–60 and 30–45 days, respectively. Conclusion In Brazil, self-reported pre-pregnancy weight can be used for calculation of BMI and GWG when an early measurement of weight during pregnancy is not available. These results are especially important in a country where the majority of woman do not initiate prenatal care early in pregnancy.

Nutritional Surveillance for the Best Start in Life, Promoting Health for Neonates, Infants and Children

This Special Issue aims to examine the crucial role of nutritional status starting from pregnancy in modulating fetal, neonatal and infant growth and metabolic pathways, with potential long-term impacts on adult health. Poor maternal nutritional conditions in the earliest stages of life during fetal development and early life may induce both short-term and longer lasting effects; in particular, an increased risk of noncommunicable diseases (NCDs) and other chronic diseases such as obesity, which itself is a major risk factor for NCDs, is observed over the lifespan. Poor maternal nutrition affects the fetal developmental schedule, leading to irreversible changes and slowdown in growth. The fetus limits its size to conserve the little energy available for cardiac functions and neuronal development. The organism will retain memory of the early insult, and the adaptive response will result in pathology later on. Epigenetics may contribute to disease manifestation affecting developmental programming. After birth, even though there is a limited evidence base suggesting a relationship between breastfeeding, timing and type of foods used in weaning with disease later in life, nutritional surveillance is also mandatory in infants in the first year of life. We will explore the latest findings on nutrition in early life and term and preterm babies, as well as the role of malnutrition in the short- and long-term impact over the lifespan. Focusing on nutritional interventions represents part of an integrated life-cycle approach to prevent communicable and non-communicable diseases.

Cadre posyandu empowerment and apparatus village in monitoring status nutrition, food provision of additional pregnant women and children to prevent stunting

The low nutritional status of pregnant women during pregnancy can result in various adverse effects for both mother and baby. Poor nutritional status in infants allows problems / developmental delays. In Langkat District the number of toddlers weighed in 2017 was 98,822 people and there were 189 (0.2%) who were below the Red Line (BGM). Malnutrition sufferers found in 2017 were 110 people. Another nutritional status indicator is Iron Nutrition Anemia (AGB) which is an effort to reduce it by giving iron tablets (Fe) as many as 90 tablets during pregnancy in Langkat Regency which is still below the national percentage of 78.69%. The prevalence of stunting toddlers in Langkat Regency in 2018 is 23.3%. For this reason, empowerment of cadres and village officials to monitor the nutritional status of pregnant women and toddlers to prevent stunting. Through increased knowledge and skills of cadres and village officials to achieve a reduction in the incidence of stunting in improving the nutritional status of pregnant women and toddlers can be done with nutritional surveillance by monitoring activities: PMT recovery, provision of vitamin A, TTD, Taburia, Zinc, Stimulation. The socialization was carried out on 26 June 2019 in the Hall of Karang Rejo Health Center, Langkat Regency. Training was held on June 26, 2019 in the Hall of Karang Rejo Health Center in Langkat Regency to improve the knowledge and skills of cadres and village officials to achieve a reduction in the incidence of stunting in improving the nutritional status of pregnant women and toddlers.

Continuum of Care as An Effort to Reduce Stunting Events in Karawang District

Stunting is a condition of failure to thrive in children under five years due to chronic malnutrition so that the child is too short for his age. Malnutrition appears when the baby is in the womb and the early period after the baby is born. The purpose of this study is how the Continuum of Care Program is implemented, analyze cross-sectoral, and cross-program support in nutritional surveillance to prevent and manage stunting. The study design used a cross-sectional survey approach. The results of research from 6 Puskesmas working areas showed the highest number in Puskesmas Lemah Duhur with an incidence of stunting 81%, had a continuum of ineffective stunting treatments with an average of 63.84 and less available treatment centers with an average of 63.75. There are obstacles in sending information that occurs from the Puskesmas to posyandu cadres related to stunting. The range of treatments in providing effective care and place of care has the most significant impact on maternal health, the health of newborns, and children related to the incidence of stunting in each region. Collaboration and cross-sector programs are needed in stunting prevention by the government.

Dietary intake of sodium by children: Why it matters

Dietary sodium is required in very small amounts to support circulating blood volume and blood pressure (BP). Available nutritional surveillance data suggest that most Canadian children consume sodium in excess of their dietary requirements. Approximately 80% of the sodium Canadians consume comes from processed and packaged foods. High sodium intakes in children may be an indicator of poor diet quality. Results from systematic reviews and meta-analyses have demonstrated that decreasing dietary sodium in children leads to small but clinically insignificant decreases in BP. However, population-level strategies to reduce sodium consumption, such as food product reformulation, modifying food procurement processes, and federal healthy eating policies, are important public health initiatives that can produce meaningful reductions in sodium consumption and help to prevent chronic disease in adulthood.

Impact of FODMAP Content Restrictions on the Quality of Diet for Patients with Celiac Disease on a Gluten-Free Diet

Restrictive diets as gluten-free (GFD) or reduced in Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP) are used to improve gastrointestinal (GI) symptoms in sensitive individuals. Aiming at comparing the nutritional quality and effects of a regular GFD regimen (R-GFD) and a low-FODMAP GFD (LF-GFD), in 46 celiac patients with persistent GI symptoms we conducted a randomized, double-blind intervention-controlled study. Patients received a personalized diet, either a strict GFD (n = 21) or a LF-GFD (n = 25) for 21 days. A validated food-frequency questionnaire before intervention and a 7-day weighed-food record after the intervention assessed the diets. Patients were 41.1 ± 10.1 years (mean ± SD), 94% women, with mean BMI 21.8 ± 2.9 kg/m2. On day 21, patients on R-GFD still showed poor nutritional adequacy compared to dietary recommendations, with decreased energy intake, even though an improvement in carbohydrates and folates was observed (all p < 0.025). In both groups, intake of iron, calcium, vitamin D, sodium and folates did not meet daily recommendations. As expected, consumption of legumes and grains was lower and that of fruits was higher in the LF-GFD group than in the R-GFD one (all p < 0.05). The nutritional quality of both diets was not different. When restrictive diets are useful to improve the persistent GI symptoms, careful nutritional surveillance and counseling is mandatory.