Roles&of&Family&and&Community&in&

Growth&and&Development&
Indah&S.&Widyahening&
Dhanasari&V.&Trisna&
Community&Medicine&Department&
FKUI&

Periods(of(development(
Late&adulthood&

Middle&adulthood&

Early&adulthood&

Biological
processes

Adolescence&

Middle&&&Late&
childhood&

Cognitive
processes

Socioemotional
processes

Early&childhood&

Infancy&

Prenatal&period&

Factors&inuence&growth&&&development&
Intrinsic&I&geneJc&
Extrinsic&&
Environment((life2style,(culture,(economic/social)(
Diseases(
Mothers(condi>on((prenatal(period)(

The&Mandala&of&Health&
A&model&of&human&ecosystem&

culture&
community&
lifestyle&
family&

Personal&
behavior&
Sick&
care&
system&

spirit&

body&

Human&&
biology&

PsychoIsocioI&
Economic&
Environment&

mind&

work&

Physical&
environment&

HumanIMade&Environment&
biosphere&

The concept of Blum

environment&

geneJcs&

Health&status&

Health&services&

behavior&

AGENTS:
-physics
-chemistry
-biologic
-physiologic
-psychologic

HOST

DISEASE

ENVIRONMENT

Gordon & Le Richt

Ecological&Theory&of&Development&
Santrock&JW,&LifeIspan&development.&7th&ed.&p.&42&

The
individual
Sex
Age
Health
etc

Mesosystem

Family

Microsystem

Exosystem
Extended family
- Friends
of family

School
Peers

Church
group

- Neighbors

Neighborhood
play area

Chronosystem
Patterning of environmental
events & transitions over the
life course; sociohistorical
conditions

- Mass
media
- Legal
services

Macrosystem
Attitudes &
ideologies of the
culture

- Social welfare
services

7&

ENVIRONMENTAL HAZARDS & RISK FACTORS

water&supply,&
sanitaJon&
pesticides &&hygiene&

Chemical hazards

food&safety&

lead

Microbiological
hazards

Air&polluJon&

Occupational
environment
EMF

Physical hazards
Risk factors
media
agent

Water&resources&

&

Agricultural&
environments&
Road&
trac&
accident&

Accident

Vectors

High&risk&natural&
environments,&
such&as&wetland&

General Environment

ArboI&
viruses&&
&&proto&
zoans&

The&Inuence&of&Family&on&Health&&&
Disease&
GeneJc&inuences&
The&family&is&crucial&in&child&development&
Some&families&are&more&vulnerable&to&illness&
than&others&
InfecJous&disease&spreads&in&families&
Family&factors&aect&morbidity&&&mortality&in&
adults&
The&family&is&important&in&recovery&from&
illness&

Prenatal&period&
Maternal&characterisJcs&
Mothers&age&(adolescence,&the&thirJes&&&beyond)&
NutriJon&
EmoJonal&states&&&stress&

Maternal&diseases&&&condiJons&&
Rubella,&Syphilis,&Herpes,&HIV&

Drugs&(incl.&tobacco&&&alcohol)&

Prenatal&period&
Environmental&hazards&
RadiaJon&
PesJcides&
Pollutants&and&wastes&(CO,&mercury&&&lead)&
Toxoplasmosis&
Heat&

A]er&birth&period&

Familys&inuence&
ParenJng&styles&
Authoritarian&
AuthoritaJve&
Neglec^ul&
Indulgent&

Cultural,&ethnic&&&social&class&variaJons&in&
families&
Sibling&relaJonships&&&birth&order&

Family&characterisJcs&which&related&to&
be_er&developmental&outcome&
Higher&parents&educaJon&
Higher&income&
EmoJonally&supporJve&and&cogniJvely&
enriched&home&environment&
Good&motherIchild&interacJon&
Mothers&experienced&li_le&psychological&
distress&&
TwoIparent&vs&single&parent&
NICHD&Study&of&early&child&care&and&Youth&Development&
(SECCYD),&h_p://secc.rJ.org&

InteracJon&between&children&&&their&parents:&
Direct&&&Indirect&Eect&
Marital(rela>onship(

Child(behavior(&(
development(

Paren>ng(

Santrock&JW,&LifeIspan&development.&7th&
ed.&p.&172&

The&family&life&cycle&&
Source:(Duvall(1977(

8.&Family&in&&
later&years&

1.&Newly&married&couple&
2.Newborn&children&
2&
3.&The&family&with&&
2.5&
young&children&
3.5&
10I15&
7&
7&

15&
7.&Middle&age&parents&
to&reJre&Jme&

4.&The&family&&
with&schoolIage&
children&
5.&Family&with&
&adolescent&

8&
6.&Launching&family&

The&changing&family&in&a&changing&society&
Working&mothers&
Divorce&&
Depressed&parents&

Other&factors&
Peer&relaJons&
Provide&source&of&informaJon&and&comparison&
about&the&world&outside&the&family&

Play&
Increases&aliaJon&with&peers&
Releases&tension&
Advances&cogniJve&development&
Increases&exploraJon&
Provides&a&safe&haven&

Television&

Television&
PosiJve&inuence&
PresenJng&moJvaJon&educaJon&programs&
Increase&informaJon&about&the&world&beyond&the&
child&immediate&environment&
Providing&models&of&proIsocial&behavior&

NegaJve&inuence&
Taking&children&away&from&homework&
Making&them&passive&learning&
Teaching&stereotypes&
Provide&violent&models&of&aggression&
PresenJng&unrealisJc&views&of&the&world&

Health&problems&of&children&in&
Indonesia&

Infant&Mortality&Rate&in&Indonesia&

Source:(Prol(Kesehatan(Indonesia,2010(

UnderI5&Mortality&Rate&in&Indonesia&

Source:(Prol(Kesehatan(Indonesia,2010(

Source:&h_p://www.bps.go.id/tab_sub/view.php?
kat=1&tabel=1&da]ar=1&id_subyek=30&notab=40&

Some&health&indicators&
Neonatal&mortality&rate,&2004:&17&per&1000&
live&births&
(range:&1I66;&med:&14,&global:28)&

Infant&mortality&rate,&2007:&26&per&1000&live&
births&
(range:&2I156;&med:&22,&global:&46)&&

UI5&mortality&rate,&2007:&31&
(range:&2I262,&med:&25,&global:&67)&
World&Health&StaJsJc,&WHO&2009.&

Basic&Health&Research&2007&
Low&birth&weight&infant&=&11.5%&
In&UnderI5&children,&
UnderInutriJon&=&13.0%&
Severe&underInutriJon&=&5.4%&
OverInutriJon&=&4.3%&
Basic&immunizaJon&coverage&=&62.8%&(HB3)&I&
86.9%&(BCG)&

GOVERNMENT(
PROGRAMS(IN(
CHILD(HEALTH(

Neonatal&
Program:&Minimal&3&visits&
6I48&hrs,&3I7&days,&8I28&days&

Integrated&management&of&newborn:&
Vital&signs&
Neonatal&care&and&exclusive&breast&feeding&counseling&
Vit.&K&injecJon&
ImmunizaJon&
Case&management&and&referral&
Health&educaJon&on&neonatal&care&at&home&using&the&MCH&
book&

Target:&80%&of&complete&visit&

Infant&care&
Program:&minimal&4&visits&a&year&
29&days&&3&months,&3I6&months,&6I9&months,&9I11&
months.&

Care&provided:&
Basic&immunizaJon&
Early&sJmulaJon,&detecJon&and&intervenJon&on&
growth&and&development&
Health&educaJon&on&infant&care&

Target:&84%&of&complete&visits&

UnderI5&
Program:&
Growth&monitoring,&min.&8x&per&year&
Development&monitoring&(early&sJmulaJon,&
detecJon&and&intervenJon&of&growth&and&
development),&min.&2x&per&year&
Vit.&A&supplementaJon,&min.&2x&per&year&(February&
and&August)&

Target:&78%&of&underI5&children&

School&Children&
Program:&
PromoJon&of&clean&and&healthy&lifeIstyle&
(Perilaku&Hidup&Bersih&dan&Sehat&&PHBS)&
Early&detecJon&of&health&problem&among&1st&
grade&students&

Basic&immunizaJon&
Universal&Child&ImmunizaJon&(Lima&Imunisasi&
Dasar&Lengkap&I&LIL)&
BCG,&1&dose&
DPT,&3&doses,&
Polio,&4&doses,&
HepaJJs&B,&4&doses&
Measles,&1&dose&

Posyandu&
A&community&parJcipaJon&eort&for&health&
maintenance&of&community&(Upaya&Kesehatan&
Bersumberdaya&Masyarakat&&UKBM)&
Main&acJviJes:&
KIA&(Mother&&&Child&Health)&
KB&(Family&Planning)&
ImmunizaJon&
NutriJon&&
Management&of&Diarrhea&&

Posyandu&
Aim:&
To&lower&IMR&and&MMR&
To&promote&Norma&Keluarga&Kecil&Bahagia&
Sejahtera&(NKKBS)&
To&encourage&community&parJcipaJon&and&
empowerment&&in&health&to&support&achievement&of&
community&wellbeing&
FuncJon&as&Wahana&Gerakan&Reproduksi&Keluarga&
Sejahtera,&Gerakan&Ketahanan&Keluarga&and&
Gerakan&Ekonomi&Keluarga&Sejahtera.&

Posyandu&acJviJes&

Table&1&:&registraJon&
Table&2&:&weight&measurement&
Table&3&:&Filling&the&KMS&
Table&4&:&health&educaJon&
Table&5&:&Family&Planning&&&Health&services&

UJlizaJon&of&posyandu&
Only&27.3%&of&households&uJlized&posyandu&
underI5&children&who&get&weight&
measurement&>&4&Jmes&within&last&6&months&=&
45.4%&&

Posyandu&

Thank&you&