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Positive Deviance Approach- Nutritional ISSN- 2394-5125 VOL 7, ISSUE 14, 2020 POSITIVE DEVIANCE APPROACH- NUTRITIONAL CENTER IN IMPROVING NUTRITIONAL BEHAVIOR TOWARDS TODDLER SURVIVORS OF NATURAL DISASTER AT TEMPORARY SHELTERS IN CENTRAL SULAWESI Sugeng Eko Irianto1, Bohari2, Fahmi Hafid3, Nur Sefa4 1Graduate School, University of Mitra Indonesia Lampung, City of Lampung, Indonesia 2 Nutrition Department, Faculty of Public Health, Tadulako University, City of Palu, Indonesia 3 Nutrition Department, Poltekkes Kemenkes Palu, City of Palu, Indonesia 4 Faculty of Health, University of Mitra Indonesia Lampung, City of Lampung, Indonesia Email: [email protected] Received: 14 March 2020 Revised and Accepted: 8 July 2020 ABSTRACT: Background: The behavior of families victims of natural disasters in Central Sulawesi who have just lived at temporary shelters urgently needs attention, especially efforts to fulfill nutrition for toddlers. This research aims to determine changes in behavior of mothers and toddlers related to nutrition and health by usingpositive deviance - nutrition post approach. Methods: This research was a nutritional intervention research using the Positive Deviance approach. The numbers of toddlers were 92 toddlers. Positive Deviance family includes eating behavior, hygiene behavior, child care behavior, health maintenance behavior. Analysis of changes in nutritional behavior practiced by toddlers during the nutrition post activities. Results: Behavior practiced in shelters is washing hands before eating, reading prayers before eating, eating together, children eating independently without being bribed by their mother, children spend their food. Thus, behavior change after participating in nutrition post activities at the temporary shelter are eating with family members to increase appetite, consuming fruits and vegetables, washing hands before touching food, not yelling at children when children make mistakes, parents watching over children while playing, children eating while sitting, bathing twice a day, getting children to eat using their hands, children eat independently, not bribed except babies, children brushing their teeth after meals and before going to bed. Conclusion: The implementation of the Positive Deviance approach can positively change the nutrition and health behavior of toddlers and increasing food consumption and weight of toddlers. KEYWORDS: Positive deviance, nutritional post of temporary shelter, toddler survivors of natural disasters, nutrition and health behavior, food consumption I. INTRODUCTION 7.4-magnitude earthquake that struck Palu, Donggala and Sigi District, on Friday (28/9/2018) have claimedt housand of lives and caused displaced communities that spread over 64 evacuation points in Palu, 33 evacuation points in Sigi regency, and 62 evacuation sites in Donggala District. In evacuation site, there is a community that vulnerable from malnutrition, pregnant women, nursing mothers, infants, toddlers, and elderly. The lack availability of food and reliability on the aid from volunteers potentially threatenthe vulnerable community getting small of food (Ainehvand et al., 2019; Tirivangasi, 2018). The problem of malnutrition is a serious public health problem and it is associated with the increased risk of death and morbidity (Blössner & Onís, 2005). These vulnerable groups can bear the burden of illness associated with malnutrition at the evacuation site. The nutrient treatment done to natural disaster victims to save the victims' lives in order to eradicate the crisis through Food for Life and help the most vulnerable community in the time of crisis through the help of Food for Growth (Sudiman, 2011).. One alternative approach that can be used to address nutritional problems and malnutrition and improve the nutritional status of vulnerable community at the temporary shelter by learning from the community itself. Alternative by relying on different behaviors and strategies but able to solve the problems faced with a family in this community group then known as Positive Deviance (PD) approach (Ismail, 2011). 1444 ISSN- 2394-5125 VOL 7, ISSUE 14, 2020 Based on the research problems that are eating behavior, self-hygiene, and lack child health caused by natural disaster and vulnerable to malnutrition problems. Therefore, it takes a positive deviance approach so that the problems can be solved. This research aims to determine changes in behavior of mothers and toddlers related to nutrition and health by using positive deviance - nutrition post approach. II. MATERIAL AND METHOD This research was a nutritional intervention research using the Positive Deviance (PD) approach. The number of toddlers were 92 toddlers. The locations of PD are in: 1) Temporary Shelter of Tongge, Pantoloan Boya, Tawaeli Sub District, Palu; 2) Temporary Shelter of Mamboro, Sub District Office of Mamboro, Palu; 3) Temporary Shelter of Madina Kabonena, Ulu Jadi Sub District, Palu; 4) Beka Village, Marawola Sub District, Sigi District; 5) Temporary Shelter of BUMN, Lolu Village, Biromaru Sub District, Sigi District; 6) Temporary Shelter of Loli Pesua, Banawa Sub District, Donggala District. The criteria of Positive Deviance family are: 1) Residing at the temporary shelter; 2) Having toddler; 3) Willing to follow Nutrition Post Activities The collection of data was done by using the interview guidelines to the families at the temporary shelter including: 1) Eating behavior; 2) Hygiene behavior; 3) Childcare behavior; 4) Healthcare behavior. The concept of the Positive Deviance approach explains a state of positive deviance relating to the health, growth, and development of certain children compared to other children in the same community or family environment. The concept of positive deviance based on; in every society, there must be certain people who demonstrate different behaviors that allow them to find their way out of issues better than their neighbors who have similar opportunities and resources. Analysis of changes in nutritional behavior practiced by toddlers during the nutrition post activities. III. RESULTS Tabel 1 Result of House Visits (Behavior of Positive Deviance (PD) dan Non-PD) Positive Deviance (PD) Behavior Non Positive Deviance (Non-PD) Behavior Eating Behavior Eating Behavior 1. Immediately after birth the child is placed in 1. Immediately after birth given formula the breast mother; milk 2. Breastmilk is given age up to 6 months / 2. The first breastmilk thrown out by the exclusive breastfeeding; mother 3. Continued breastmilk until 2 years old; 3. Type of complementary food for 4. Complementary food for breastmilk is given breastmilk for 6 months to 15 months Sun from the age of 6 months; porridge banana flavor 5. Complementary food for breastmilk added 4. Children often snack on siomay and vegetables and fish/eggs; instant drinks 6. Complementary food for breastmilk is given 5. Mothers rarely cooking food at home 3 times daily and 2 times snacking interlude; 6. Children eat once a day 7. Sick child is given food and continued 7. No supervision when the child eats breastmilk 8. Children are given instant noodle soup on 8. Mother ensures the child's snack does not the food contain monosodium glutamate; 9. Not strict supervision when children buy 9. Do not let child eating while sitting. snacks Hygiene Behavior Hyginene Behavior 1. Child take a shower 2-3 times a day using 1. Children refuse to clean his head soap, toothbrush and toothpaste themselves. 2. Towel is used together with the siblings 2. Wash hands after defecation with clean water 3. Rarely cut the nails and use soap. 4. Home cleanedonce a day 3. Vegetable washed, cut and then cooked; 5. Children bathing does not use soap 4. Before and after eating washing hand 6. Children do not use footwear when 5. Cut the nails 2 times a week playing 6. Children wear sandals while playing 7. House cleaned 2 times a day 8. Change children's clothes every time dirty 9. Before bedtime, children wash their hands and feet with soap and brush the teeth 10. Children are used to use footwear while playing Parenting Behavior Parenting Behavior 1. Mother watching the child while playing 1. Children left to play 2. The child wrong, the mother advise well 2. Father does not participate in parenting 1445 ISSN- 2394-5125 VOL 7, ISSUE 14, 2020 3. Children dressing 3 times a day 3. Mother yell when the child make mistakes 4. Father takes the role to parenting when mother is busy 5. Mom applies play time to children Healthcare Behavior Healthcare Behavior 1. Child is taken to Health Center 1. Sick child is taken to shaman 2. Child is taken to Health Center every month 2. Child does not have growth chart 3. Child is fully immunized and has an Posyandu notebook Table 1 shows that toddler's mothers has practiced PD behavior related to eating, hygiene, childcare, and child health maintenance. However, there are also toddler’s mothers who do not practice PD behavior. The results of this PD behavior identification become a benchmark in the implementation of nutrition post of temporary shelter. Table 2 shows that the behavious of PD practiced are playing, singing, washing hands before meals, praying before eating, children eat independently without being treated by their mother, the children are having the food and eating together in nutrition post of temporary shelter. In addition, the cooked menu varies for 12 days and is subject to food availability and the efficiency of a toddler's mothers and cadres to prepare and process groceries for the next day. Table 2 Behavior practiced at the nutrition post of temporary
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