Maternal and Child Health handbook and under-6 child overweight in greater Jakarta, Indonesia: a cross-sectional web-based survey | BMC Nutrition

Increasing prevalence of child overnutrition is observed in developing countries where undernutrition remains a public health problem [1]. Childhood obesity increases the risk of adulthood cardiovascular disease [2, 3]. Globally, 38 million (5.6%) children under 5 years of age were estimated to be overweight or obese in 2019 [1]. Indonesia’s 2018 National Basic Health Research Survey (RISKESDAS) reported that 8.0% of children under 5 years of age were overweight, while stunting, wasting, and underweight were identified in 29.8%, 10.3%, and 17.7%, respectively [4].

To tackle the double burden of overnutrition and undernutrition, it is crucial to deliver the necessary information to mothers or caregivers. However, little is known about the sources of information about child nutrition used by caregivers in Indonesia. In rural Indonesia, health facilities are major sources of information about stunting for mothers [5]. Several previous studies have investigated sources of information for pregnant women regarding nutrition, [6,7,8] and multiple sources have been identified, including health professionals and the internet [6].

Internet technology is widely used in Indonesia, and 71% of people were found to possess smartphones in urban areas in 2018 [9]. Consequently, it may be expected that many mothers seek information about child nutrition from the internet. Some previous studies have reported that the internet is used as an information source by pregnant women in Indonesia [6,7,8] and a qualitative study reported that 17 of 23 pregnant women sought nutrition information through the internet [6].

In addition, the nationally distributed Maternal and Child Health (MCH) handbook is also a major source of information about child nutrition in Indonesia. The MCH handbook is a home-based printed booklet that is distributed to all pregnant women at their first antenatal care visit. This handbook functions as a maternal and child health record and information book, and contains nutrition information about various topics, such as exclusive breastfeeding, complementary food, and healthy diets. However, the extent to which mothers use the handbook as a source of information is currently unclear.

Previous studies have investigated the risk factors for child overweight and obesity, [11,12,13,14,15,16,17, 17,18,19] and excess energy intake and low physical activity level have been identified in a number of studies. [10, 12, 17, 19]. The reported associations between parents’ education level, [11, 13, 17, 19] economic level [14, 17, 20] and child obesity have been inconsistent among previous studies. In previous studies in Indonesia, being a male child, having parents who are overweight, having a father with a university education, [13, 14] being part of a family in the higher economic quintile, [14, 17] being stunted, [18, 20] being an urban resident, [13, 16, 17] having a low physical activity level, [17] consuming ultra-processed food, [13] and frequent intake of fried foods [19] have been identified as risk factors for child obesity. However, the way in which the MCH handbook relates to child nutrition in current conditions regarding the increasing prevalence of child overnutrition has not been investigated. Osaki et al. (2019) reported that the prevalence of stunting and underweight in children were significantly lower in families that were guided and sensitized using the MCH handbook compared with families that were not guided or sensitized [10]. However, it is also necessary to explore the association between the MCH handbook and child overweight.

Thus, in the current study, we sought to clarify the sources of information about child nutrition used by mothers, including the internet and the MCH handbook, and to explore the association between overweight and use of the MCH handbook. Although the main focus of the current study was overweight, undernutrition was also included in the analysis.