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POSITIVE DEVIANCE OF MOTHER IN HOUSEHOLD HOUSE IN RELATIONSHIP TO THE PREVALENCE OF NUTRITIONAL STATUS OF TODDLER IN THE VILLAGE OF LEDO BENGKAYANG DISTRICT YEAR 2016

Didik Hariyadi1, Hengky Irawan2, Ayu Rafiony3

1,3Lecturer of Nutrition Department of Health Polytechnic of Kemenkes Pontianak 2Government employees of Health Office, West , .

Abstract

Positive deviance is one approach that can reduce malnutrition prevalence in some countries. The village of Lomba Karya is a subdistrict Ledo Bengkayang Regency, there are 131 poor families with the proportion of children aged 12-59 months with normal nutritional status as much 94,20%. The data shows that families with low economics do not always have children under five with underweight nutrition status. The purpose of this research is to know the relation between positive deviance of mother to the poor economy with nutritional status of children aged 12-59 months in the village of Lomba Karya Ledo Bengkayang Regency. Research method, using case-control study. The number of Sample 36 people, with cases as many as 24 people and control as many as 12 people. The results showed there was a relationship between feeding habits with nutritional status of children aged 12-59 months (p <0.05) and OR 18.3 (2.0 - 166.7) Recommendations, forming a nutrition post for the community, mothers disseminate useful habits for people with toddlers with poor nutritional status around them.

Keywords : Positive deviance, children aged 12-59 months, low economic status, feeding habit

Introduction given properly and correctly can form a healthy, intelligent and productive Nutritional problems occur in every life human resources. Based on the number cycle, beginning in the womb (fetus), of Human Development Index (HDI) for infant, child, adult and old age. Age 12- the Province of in 59 months is an important time as well 2014 amounted to 64.89 and by as a critical period in the growth process calculation with new method (reversed) of infants, both physical and intellectual, Bengkayang Regency HDI is ranked therefore every toddler in this period 11th out of 14 districts/cities in West must obtain health care and nutritional Kalimantan Province of 64.40 ( 1). intake in accordance with his needs. Indonesia is among 31 countries that will Efforts to improve the quality of human not reach global targets to reduce resources began with the fulfillment of malnutrition in 2025 (4). basic human needs with the main There were 37% of children under five concern on the process of child suffering from stunting, 12% suffering development since conception until from wasting and 12% being reaching adulthood. In this period of overweight, and a low prevalence of growth, the fulfillment of basic needs of under five infants from 18.4% in 2007, children such as care and nutritious food

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down to 17.9% at 2010 but increased Lombardo Karya Subdistrict Ledo again to 19.6% in 2013 (6). Bengkayang Regency. Poor families Prevalence of Malnutrition in 2011 in with toddlers with good nutritional status West Kalimantan amounted to 3.29%, as a control group (positive deviance) while in 2012 to 3.8%. The number of while poor families with under-five malnourished infant mortality in 2010- children with less nutritional status as 2012 has decreased from 10 malnutrition case group. infant mortality to 7 malnourished child The analysis used in the univariate malnutrition (3). and bivariate analysis. Univariate Alternative efforts can be made is the analysis was conducted to know the application of positive deviance (PD) frequency of each independent variable, approach that has been proven to reduce that is positive deviance factor with a malnutrition in Vietnam, Myanmar, dependent variable that is nutrition status Bolivia and other countries (8). of children aged 12-59 months, while Positive Deviance (PD) is used to bivariate analysis was done to know the describe a state of positive deviation relation between an independent variable relating to the health, growth, and and the dependent variable, which was development of particular children done statistically with size association. within the community or family In this case the relationship between environment. Such practices may include the dependent variable with the feeding, nurturing, hygiene, and health independent variable, then used chi- care (2) behaviors. square test on categorical data and In Ledo District, there were 57.7% of the logistic regression test on feeding habit clean living house (PHBS), 51.1% of variable, nurturing habit, hygiene habit, families with a protected water source, and health service habits as well as 57.7% of larvae, and 78% of families positive deviance behavior with with healthy latrines. These data indicate nutritional status of children aged 12 -59 that the majority of households still do months, with α = 0.05 and CI = 95%. not fulfill the household health requirements which may decrease the Results nutritional status of children under five years old (who get health services at Characteristics of Respondents least 8 times) by 41.7%. The data shows that there is still a lack of awareness of Table 1 parents in getting their child's health Distribution of Frequency of Occupation, Age, (5) and Education Level of Respondents in Desa check-up in health care facilities . Lomba Karya Kecamatan Ledo Bengkayang Regency Materials And Methods The research was conducted in Desa Characteristics Respondents Lomba Karya Kecamatan Ledo Bengkayang Regency. The research was n % conducted for 3 (three) months starting Occupation 36 100 Housewife 36 100 from August to November 2016. The Age Group research design is a case-control study. Adult Mother (26-45 28 77,8 The sample used is all mothers with low tahun) economic status in the Village of Young mother (21-25 8 22,2 2

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tahun) Table 2 shows data, Nutritional Level of education Overview of Under Fives Age of 12-59 Primary school 17 47,2 Months based on Body height According 3 8,3 Junior high school to Age (BB / U), number of children Senior High School 13 36,1 aged 12-59 months with good nutrition No school 3 8,3 Sumber: Data Primer, 2016 condition as much as 55,6%, malnutrition as much as 2,8% and less nutrition as much as 41.7%. Nutrition of Table 1 shows data that, Underfives Age of 12-59 Months Based Characteristic of work, all respondents on Body Height According to Age (TB / (100%) are housewives. Characteristic- U), the number of under-fives aged 12- based on age, mothers with the most age 59 months with the normal condition as are in the age group of adult mothers much as 52.8%, short of 30.6%, and very (26-45 years) as much as 77.8%, while short as many as 16.7 %. Nutrition of the young age group (21-25 years) is Underfives Age of 12-59 Months Based 22.2%. Characteristic on the basis of on Body Body by Age (BB / TB), the education, mothers with the most number of under-fives aged 12-59 education are in primary education as months with 2.8% obese condition, much as 47.2%, then the least is with normal as much as 66.7%, lean as much junior secondary education and no as 19.4% and very thin as much as school as much as 3% each. 11.1%.

Tabel 3 Univariate Frequency Distribution Classification Nutritional Status Underfives Age 12-59 Tabel 2 Months Based on BB / TB Frequency Distribution Description of Respondent Nutritional Status of Toddler Age 12-59 Nutritional Months Based on BB / U, TB / U, BB / TB Status Respondent N % Normal 31 86,1 Nutritional Status Malnutrition 5 13,9 N % Sumber: Data Primer, 2016 BB/U Over Weight 0 0 Based on table 3, nutrition of toddlers Normal 20 55,6 Malnutrtition 1 2,8 Age of 12-59 Month Based on Severe 15 41,7 Classification (Good / Less Good) BB / Malnutrition TB, number of children aged 12-59 TB/U months with good nutrition condition as Normal 19 52,8 much as 66,7%, and condition less good Stunting 11 30,6 Severe Staunting 6 16,7 33,3%. BB/TB Overweight 1 2,8 Tabel 4 Underweight 7 19,4 Overview of Habit of Parenting, Feeding Normal 24 66,7 Habits, Hygiene Habits, and Habits of Getting Severe 4 11,1 Health Services Underweight Respondent Variable Sumber: Data Primer, 2016 N % 3

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Habit of Parenting Good 6 50 1 58,3 0,729 1,4 4 (0,35-5,6) Good 22 61,1 Not Good 6 50 1 41,7 Not Good 14 38,9 0 Habits of Feeding Habit Getting Health Services Good 16 44,4 Good 9 86,1 2 91,7 0,307 3,7 Not Good 20 55,6 2 (0,52-25,78) Not Good 3 13,9 2 8,3

Hygiene Habit Sumber: Data Primer, 2016

Good 20 55,6 Not Good 16 44,4 Table 5 above shows that nursing habits, Habits of Getting Health hygiene habits, and overall health Services service habits have p-value> 0.05, Good 31 86,1 meaning that these three variables are Not Good 5 13,9 not related to nutritional status of Sumber: Data Primer, 2016 children aged 12-59 months in Desa Table 4 shows that good parenting Lomba Karya Kecamatan Ledo behavior for children aged 12-59 months Kabupaten Bengkayang. Although is 61.1% and 38.9% less well. Good unrelated, good parenting habits have a feeding habits in children aged 12-59 3.4 chance (95% CI: 0.8 - 14.4), good months good as much as 44.4% and less hygiene habits have a chance of 1.4 good as much as 55.6%. Good hygiene times (95% CI: 0.35 to 5.64 ), and good habits in children aged 12-59 bullying health service habits have a 3.7 chance both as much as 55.6% and less good as (95% CI: 0,52 - 25,78) have a good much as 44.4%. The habits of good nutritional status of children aged 12-59 health services for children aged 12-59 months. months good as much as 86.1% and less The variables that related were very good as much as 13.9%. significant that feeding habits with p-

value <0,05. Toddlers age 12-59 months Bivariate with good feeding habits have an

Tabel 5 opportunity of 18.3 times (95% CI: 2.0 - Analysis of the Relationship Between Habit 166.7) have good nutritional status. Parenting, Feeding Habits, Hygiene Habits, From the description above it can be and Habits Getting Health Service With concluded that the variable of feeding Nutritional Status Under Fives Age 12-59 habit is the most dominant variable and Month Variable Nutritional Status OR is closely related to the nutritional status Under Fives Age 12- P (CI 95%) of children aged 12-59 months in 59 Month Value Control Case mothers with low economic status in the N (%) N (%) Habit of Village of Lombardo Karya Subdistrict Parenting Ledo Bengkayang Regency.

Good 5 41,7 1 70,8 0,148 3,4 7 (0,8 – 14,4) Not Good 7 58,3 7 29,2 Discussion Feeding Habit The results of this study showed

that of 36 respondents with low Good 1 8,3 1 62,5 0,004 18,3 5 (2,0 – 166,7) economic status, the proportion of Not Good 1 91,7 9 37,5 1 children aged 12-59 months with good Hygiene Habit nutritional status as much as 66.7%, and 4

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malnutrition as much as 33.3%. One of Based on Chi-Square test result the main factors that may still be the between feeding habits with nutritional main cause of the high number of poor status of a toddler in the village of nutrition status in Desa Lomba Karya is Lomba Karya Subdistrict of Ledo due to economic factors because most of Bengkayang Regency, there is data that them are low-income (pre-prosperous) there is a relationship between feeding families. Families with the low economy habits with nutritional status of children have limitations in order to meet the aged 12-59 months (p <0,05) and OR nutritional intake for toddlers. Food 18.3 (2.0 - 166.7). The results of availability is an indirect problem that statistical analysis showed data that causes nutritional problems (7). respondents with good feeding habits Based on the result of Chi-Square have an opportunity of 18.3 times have test between the nurturing habit and the children aged 12-59 months with the nutritional status of children under five good nutritional status of children years old in the Village of Ledo compared with respondents with poor Subdistrict of Bengkayang Regency, feeding habits. there is no relationship between the Eating patterns in toddlers is a very parenting habit and the nutritional status important role in the growth process in of children aged 12-59 months (p> 0,05) toddlers because the food contains many and OR 3 , 4 (0,8 - 14,4), meaning there nutrients. Nutrition becomes a very is no correlation between parenting habit important part of growth. Nutrition in it with nutritional status of children aged has a very close relationship with health 12-59 months. Although there is no and intelligence. correlation, the result of the statistical When exposed to nutritional analysis shows that the respondents in deficiency then most likely the child will Desa Lomba Karya with bad parenting be susceptible to infection. This nutrient habits have a chance of 3.4 times to have is very influential on appetite. If the diet children aged 12-59 months with under is not well achieved in toddlers, the five nutritional status. growth of children will be disturbed, thin In order to maintain the health status of body, short even can occur malnutrition toddlers in the family, the behaviors and in infants. health-related parenting behaviors that Desa Lomba Karya is located in a should be done include giving attention relatively difficult area to reach from the and affection to the child, involving the capital of Ledo Sub-district, it is caused father in the role of parenting, involving by road conditions that have not been the wider family in parenting such as, allowed to pass, especially if the rainy grandparents, and other families, as well season comes. Access to the Village as keeping in touch with neighbors. Competition is relatively smooth only through the river route, with the distance Analysis of the Relationship Between of approximately 5 hours. These Feeding Habits With Nutritional conditions resulted in slowing economic Status Toddlers Age of 51-59 Months growth in the village and surrounding In The Village of Lombardo Karya villages. Lack of knowledge of parents Subdistrict Ledo Sub-Province about the nutritional needs of the family Bengkayang causes the intake of food given to under-

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fives to be unfocused and potentially status of children aged 12-59 months (p> lead to malnutrition for infants. 0,05) and OR 1, 4 (0.35 - 14.4). From the results of observations Although there is no relationship, the made to the control group, family groups result of the statistical analysis shows with under-five children with poor that the respondents in Desa Lomba nutritional status found the habit of Karya with bad hygiene habits have 1.4 instant noodles and instant canned food times chance of having children aged 12- that did not have good nutritional value, 59 months with under five nutritional and let their children eat without the status. accompanying parents. Most families in Personal hygiene and environmental this group live away from the river, and hygiene play an important role in the still around the house pets are still growth of children because personal roaming freely. hygiene and environmental hygiene are In the case group, families with closely related to infectious diseases. toddlers with good nutritional status also Decent environments are essential to had the same feeding habits as the create a sense of security for the mother control group, which often gave their or caregiver in providing opportunities children food with instant noodles or for her child to exploit the environment. canned food, but which distinguished Hygiene habits concerning personal between case groups and the control hygiene and environmental hygiene. In group was the location of group order to maintain the health of children residence the case is relatively close to under five, hygiene begins with the the river and has a habit of fishing in the child's own hygiene such as regular river for consumption and for sale if the bathing, changing clothes, brushing catch is excessive. teeth, and cleaning nails. To maintain the So the habit that distinguishes cleanliness of the environment begins between case groups and control groups with the use of clean water (minimal is a habit in order to meet the needs of rainwater) and do not use river water that each family. Although both have a habit has been polluted and not wastes water of feeding their toddlers with instant indiscriminately by utilizing existing noodles and other canned foods, in case family latrines. of groups have a habit of eating fish Based on the result of Chi-Square indirectly. Although these habits are not test between health service habits and intentional in economic limitations, nutritional status of children under five many things are still available around the years old in Desa Lomba Karya residence that can be done to meet Kecamatan Ledo Bengkayang Regency, family needs, for example, the habit of there is no relationship between health eating fish. Fish have a better source of service habits with nutritional status of nutrition than packaged foods sold in children aged 12-59 months (p> 0,05) stalls. and OR 3.7 (0.52 - 25.78). Although Based on Chi-Square test result there is no correlation, the result of the between hygiene habit and nutrition statistical analysis shows that the status of a toddler in Desa Lomba Karya respondents in Desa Lomba Karya with Subdistrict of Ledo Bengkayang bad health service habits have a chance Regency, there is no relationship of 3.7 times having children aged 12-59 between hygiene habits with nutritional months with under five nutritional status. 6

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Health services affect the health human life cycle. Malnutrition will cause status. Fast handling, and always close to disturbance and growth and development the community will greatly help improve (9). Positive deviance is used to describe the health status of the community. a state of positive deviation related to the In order to maintain the health status health, growth, and development of of children, health service habits that certain children with other children in must be done is to regularly visit health the same community or family. facilities on a regular basis to get health Particularly positive deviance can be services for toddlers. When infants are used to explain the factors that influence sick, the place to visit is a health facility the growth and good nutritional status of and not a dukun. children living in families with The analysis results obtained data underprivileged economies in that in the Village Lomba Karya environments where most other children Subdistrict Ledo Bengkayang, habits of suffer from nutritional disorders (2). care, hygiene habits and habits of health services as a whole is not related to the Conclusion nutritional status of children aged 12-59 Prevalence of good nutritional status of months in the Village Lomba Karya children aged 12-59 months from low- Subdistrict Ledo Bengkayang. Although income families in Desa Lomba Karya unrelated, parenting habits, hygiene Kecamatan Ledo Bengkayang Regency habits, and good health service habits is higher (66,7%) than malnutrition have an opportunity to have a good children (33,3%). nutritional status of children aged 12-59 There is a significant relationship months. Variables that are related are between feeding habits with nutritional very significant feeding habits. Toddlers status of children aged 12-59 months in age 12-59 months with good feeding Desa Lomba Karya Kecamatan Ledo habits have an opportunity of 18.3 times Kabupaten Bengkayang (p <0.05) and (95% CI: 2.0 - 166.7) have good OR 18.3 (2.0 - 166.7). nutritional status. Feeding habits that distinguish between control groups and case groups are the habit of consuming fish.

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