 And so at this point in time, I would like to welcome our presenter for this session, who is Kusmaira Ambarwati. Kusmaira Ambarwati is a midwife, a midwife, midwifery lecturer with 12 years of work experience at the University of Race Party in Indonesia. She is so passionate about research and volunteering, and she has contributed to a lot of research in Indonesia, which includes breastfeeding mothers association, which is a non-profit organization. So, Kusmaira will be presenting her study on mother-on-mommy-bombie program, which is a program that is supporting prevention of stunting. Over to you, Kusmaira. Thank you very much, Dr. Ambarwati for introducing and welcoming me. Welcome to our audience, wherever you are. I think there's many audience from Indonesia, and it is many countries also, like from Canada, London, Australia. It's cute, Dr. Ambarwati. Okay, may you always be in good health. I'm very happy and grateful to be able to speak on this occasion. I wish you all a happy International Midwife Day. I'm always excited and remember this date because it is almost along with my birthday and my mother. It is my 4th and 2nd, yeah. Well, in this occasion, I don't know, I cannot move the slides. Okay, yeah. Well, I will go to my presentation. It's about a qualitative study of mother-on-mommy-mombie program, stunting prevention. Previously, I turned to ICM for initiating and as the main support of this activity and this program. Then the University of Raspati, Indonesia, which also provides a lot of support for the implementation of this activity. The association of radical response and front-line nursing university will always support from this program. There is a disclaimer that I need to declare here that this program, mother-on-mommy-mombie, is a non-profit program established based on a midwife, midwife and mother-to-mother support group. To designate knowledge and information to combat stenting. And the study activities do not receive any financial support nor any forms of assistance from companies under the scope of the international code, namely business substituted companies, feeding bottles and tea companies, as well as complementary baby food companies. And I have no conflict of interest to declare here. Okay, here is the outline of the presentation. I will tell you first is about background, why I chose this program, and what study about method, result and discussion, and the last is conclusion and closing. Okay, I will begin with the background of the program. So it starts from the stenting, the severity of the stenting. Here being severely malnourished, stenting is a one sign of chronic malnutrition, which can cause various negative heart effects throughout a child's lifespan. It can also lead to poor social skill and academic performance, and being malnourished can also limit a child's ability to manage their heart. And you need to set the specific kind of progress in attressing child under nutrition. It is still a contributing factor to the global burden of diseases. In 2016, about 27% of children under the age of five were considered to be severely or materially stunted. This is a major health issue and has various health implications. Stenting rights in Indonesia alone reported as much as 37% based on data from the Indonesian Children's Nutrition Status Study in 2019. And the prevalence of stenting is currently at 27.7%. Although it has decreased, this figure is still far from the SDGs target. You can see that the World Bank data in 2020 saw that the profile of stenting in Indonesia ranked in 115 out of 151 countries in the world. And the stenting and underweight were related to lower birth weight and paying breastfeed for six months or more, having parents who were underweight or had short steter and mother who never attended formal education. Stenting was also higher in rural area. We can see from this picture that stenting cases occur on almost all islands in Indonesia, parts of the Indonesian basic health research survey publishing from the Institute of Health Research and Reform and Agency of the Ministry of Health Republic of Indonesia. In 2013, the increasingly dark red color indicates a greater number of stenting cases. And we know that being after years or over weight obese were closely related to being in the youngest or group two up to nine years, male having parents who were over weight or obese or having children with university education. Indeed, this improper practice can be prevented by providing proper education. Stenting was associated with reporting morbidity, parental education and socioeconomic status in all seven to 12 years of Indonesian children. Therefore, proper monitoring and education is one of the effective ways in order to prevent stenting. So here's the program. A moment moment program is the pilot program that aims to prevent stenting. The program was initiated by the International Confederation of Midwives in 2018. Education monitoring are carried out from the pregnant woman until their baby's age of two years. And the method used is a combination of the various forms in meeting and educational media. Okay, so about this study. This study is a part of the monitoring and a follow-up of the program. This study used qualitative methods with CAST study approach complemented by verification. And this study was conducted in sub-district eggs in East Jakarta. There were six mother informants and two heart providers who participated in this study. Six informant were selected based on compliance and liveliness following the program. Data collection technique with interviews, observation, verification and documenting. The validity of the data is done by short triangulation, by triangulation technique, that the data processed by the data induction and reduction techniques. Okay, the result of the program evaluation. We can see about the first table here. We can see that the table one solves the characteristic of the informant in the study of the maturity of highly educated half-income below the provincial minimum wage of a projective age and half more than one child. As per the characteristics of this informant, it turns out that it is not always aligned. The parental income and education are not necessarily related to the implementation of the good parenting, especially to prevent the standing cases. And then, especially in the standing prevention effort, informant in this study are mostly highly educated, but the implementation of parenting related to standing prevention is still not appropriate. This is not in line with many previous studies that this is interrelated. The thing that is actually related as the ability of the leadership of parents in their care. In the second table, we saw that the maturity of the informant where exports to the information from the social media and the advertisement for from the social media and other digital media. This is in accordance with the study that caused by exposure to the breast-beast substituted chromosome is highly relevant to existing studies. This exposure greatly affects the attitude of the health workers in the providing support and protection of the breastfeeding. And then the third table here, so that the maturity of the informant should not take action such as early breastfeeding initiation and proper breastfeeding and complementary feeding. This is reinforced by the result of the triangulation. The informants get very different information all along, especially before joining the MOMI-MOMI program. Many things misleading, especially in the implementation of early breastfeeding initiation and breastfeeding and proper complementary feeding. And the triangulation results, the informant stated about the position of the baby when breastfeeding. Here we can see the sum of the capture of the informant data. They said that maybe it was a case to me, I guess it was early breastfeeding initiation. I have done early breastfeeding initiation well because the baby is on my chest long enough, approximately 10 minutes. So the triangulation result, the informant stated that the baby who was corrected in the mother's chest is not always one hour is an initiation of early breastfeeding. This is following of the information of her workers that they do not have sufficient results and protection and regulation for the management of early breastfeeding initiation, actually up to one hour. Likewise in the process of being treated, informants would do not know and do not carry out treatment showing considered this does not matter. I'm confident with how workers say that there are still place health services that do not comply with the rule by having a special baby room and not being treated. And the other one about the understanding, knowledge and implementation of informant related to the standing prevention or the implementation of cold standard of child feeding. This result of the analysis showed that the understanding management of informant parenting and profiting standing prevention, parenting is still not appropriate. One factor is exposure to health workers who are not independent in profiting health information, especially in feeding children. In this case, it's the process of breastfeeding and giving the right complementary feeding. We can see here, I initiated a talk on the name of Dr. Renu Nisha on their Instagram that the best complementary feeding can be given from the manufacturer so the menu is scalable. And the underwear I cut information for my doctor that it is necessary to add fat to my child complementary feeding. So I give additional olive oil or margarine to it before serving. Of course, the process before the mother at some fat, the process already used the fat, whether the oil or butter and the kind of the fat. But after people they serve, they keep the additional fat again. And this is in line with the status that I have been told that the generally health workers profit less precious breast meat substituted in the price of the health services. And mother here, we know that a conclusion from this study mother put a lot of information for all over the environment included and credit hard providers in the effort to maintaining standing prevention. Also, there needs to be a special educate education related to the selection of the literacy of a mother in proper chapter. Here, I have a little closing statement that hard workers should be able to provide balance and independent information without any conflict of interest in standing prevention. So it is the best practice to all of hard workers, not just meatball, but also all of the health providers. So I think I left 10 minutes. Okay, it is the reference of this presentation this night. Maybe you can capture and it is, you can reverse to the original original talk human here. Yeah. Okay, thank you very much. That's all the presentation that I can give to you all. And then thank you for your attention and your time and your attention here. Please, if you have any question or clarification, you can ask to me. And then I give back to Dr. Wamba here. Thank you very much. Thank you very much, Dr. Wamba. I give back to you. It's still eight minutes left. I'm sorry. Thank you very much. Thank you very much. For a wonderful presentation, which has been very informative and thought-provoking. And so for those that have questions, if you're able to unmute and just ask, that would be great so that we can hear your voice. Or the other option is to just type it in the chat box. Then we'll see it and respond. I can read it to her. The presentations are most welcome at this moment. So I'll take three questions if possible at the time and then Chris Mayra will answer them. Then we move on to the other set of three. So Chris Mayra, there's already the first question from Linda. She's asking if you can explain the term stunting to her. She's not familiar with the term. What does stunting mean? Thank you very much. Okay. Thank you very much, Linda. Are you sure? Just testing me. Okay. Thank you very much for the first question from Linda. Dr. Wamba, I will answer the question one by one, right? Yeah, that's fine. That's perfect. You can answer. So you can respond to Linda now. Hi, Chris Mayra. We're waiting for your response to Linda's question. Okay, Linda. Here, I want to explain about what is the stunting? The stunting is a condition where the child or children under two years old is in the depression, poor linear culture during a critical period. And it is diagnosed as a higher for eggless than two standard division. It is based on the World Health Organization child growth standard median. So if we see in the growth chart, especially we can use the World Health Organization growth chart there. So the stunting is diagnosed by the poor linear culture during a critical period which is diagnosed as a high for eggless than two standard division. So it's not only the, some people know that the stunting is the high, it's not like the egg, but not only this. It's also the, we can see the diagnosis from the high for the egg in the growth chart. Not only look for the, you know, the posture, the first inside the posture is not like this. And the, we know that the consequence of the child's stunting, it's part imaged on long term. It is, will be increased morbidity and the mortality. And, and it will be make the poor child department and learning capacity and increase of the risk of infection and non-communicable diseases in adult health. Now the, the, sorry, the, the state, the state of what the stunting is that the, the child nurses of the half for the eggless than two standard of the division from the growth chart. Yeah. It is the standing term on standing condition. It can, it is enough Linda. Yes, indeed. So really it's talking about three. I think we used to call it failure to thrive a baby that or a child doesn't grow properly as it should do. Failure to thrive is the condition before people are standing. Okay. Okay. I was not familiar with that. So if, if the condition that we, we, we didn't take any action. So it will be expand to the standing condition. Yeah. That's okay. Thank you. Thank you very much. It wasn't really, it wasn't really testing you. Just a theory because I'm not familiar with the term. Okay. It is because in, in your country now there is a zero cast standing, right? Well, I don't know. You know, we do have children who do not, who fail to thrive and do not grow because they are malnourished, which is what you're talking about really, isn't it? I'd have to look into it to be honest. Wonderful. Thank you very much, Linda. Thank you. We have another question from Jita. So she wants to learn more about what the mommy book, mommy program is doing to prevent starting that has been carried out in your research. Okay. Thank you very much. Yeah, thanks. Thank you very much. Okay. I want to make explanation about this question. Thank you very much. But Gita about your question. So now the program is still, still working the activities also, but in this, in this term of the pandemic era, we're going to the online education and now the mommy, mommy, not just alone. We have the collaboration with three, three, three non non non government organization and also three senior mid five. So let's leave all of them is the press meeting consular and now so the petty, petty, petty attrition. And then we start going to the Mac and education in the during the social media. Since 2019. But because there is some, some, some obstacle that we face on this program. So the social media with we take turn, take turn from the moment. And also, but the application is still, still on on country. And we have, we have, we have make make a new, new profile, new program and new new, new, new, new menu there, but the education of the prevention of the standing, standing condition. In this term, we also try to collaborate with the, the new application that has been, has been launched in the, in the March, it's about the try five five. We can also use this, this, this application to, to make an activity and also make activity to know what the development of our children. And the next, in the next plan from this program, I think we will, we will, we will make, make, make these programs so far. We will ask to independent to make the education to, especially to prevent standing, but, but we not restrict not only to the standing prevention, but also the, the hot hat, how to care maternal and child, child health. And I think it is the, the, our program here and. Okay, it's kind of the, the best for breastfeeding mothers. Oh yeah, just include about education for the breastfeeding mothers too. So, we start from the teenagers, and then pray preconception, and then pregnant woman, and then a woman, who breastfeed mother up to, up to the children, two years out. And we also have the program for the teenagers too. Perfect. So there's another follow up question from Paloma. Have you seen it? Does the program of health providers as well. Since you mentioned that some doctors told women to add fat to the supplementation. Okay, thank you Paloma about your question. Yeah, this program also attracts education about how to, about how to choose the best, the best health facility, health facility, include of the doctor, sorry, include of the health providers. So, how the, how the, what is it? What should I say, the characteristic, the characteristic of the independent head worker, something like that, something you can see that you can see about the health facility first. There is no advertising, advertising, and then, sorry, there is no advertising about that, they include in the international code. We explain what is it, one by one, about maybe like the sticker, and then the banner, and then many things. We can see this in the room of the maternal room, maybe in the baby room, whether the health facility have another room to help babies. This is how we can avoid it. And after we give the education, the decision we would put back again to the mother because it is their right right. So, it is some, some example, and then about the doctor, we can see, we can also make an example of the health provider who is very independent, maybe from, we can see, but in the social media, there is no advertising, and the health provider also not make advertisement about some product, maybe, and maybe direct to the product that include to the scope of the international code, something like this. Because in Indonesia, the regulation is just only a house up to one year. So, there is many advertisement that very misleading in the television and the social media, then very huge. And also the government, some of the government organization still make collaboration and also to know some, yeah, collaboration with many program of the government, especially of the, for the understanding cases. Thank you very much for that response. We still have some time, so any further questions or maybe I should ask my questions if people have no questions. So my first question is with regards to how you came up with your intervention, the one that you're using to, is it reduce or educate people on the reduction of stunting in Indonesia. What made you choose the model you are using? Why did you choose the education model as a way of reducing stunting in Indonesia? Thank you. Thank you very much. So why I chose this program is about the education technique. Why? Because in my previous study, there is many things that misleading of the information that face to the community, especially to the model. Yeah. How about how about the economy? How about maybe the condition on maternal condition? There is many ways to resolve, maybe we can give the collaboration to make the financial support, something like that, but from the education, it is the main problem to how to make their mind change. Because the first time they caught some advancement, especially for people who can influence in the community, it's very dangerous. So the key points and the words are very mandated from the model. So their practice will be allowed to the influencer. So then it's very easy in Indonesia. There is minus social media, very free in Indonesia, no restriction here. So I think this is the best way because yeah, even we do it very difficult. But we know that there is no one that not be changed. Because in this program, I see many changing practice to the babies, how to make a good complementary teaching, how they can advocate their self. If they face to the health facilitator or health provider will not support of the breastfeeding, who will not support of the early initial breastfeeding, will not allow the mother to make their right. I think this is the best way.