DIETARY PATTERN AND TRADITIONAL FOOD CONSUMPTION (SOAMI) AMONG PREGNANT WOMEN IN WEST SERAM REGENCY

Citrakesumasari1*, Devintha Virani1, Andi Imam Arundhana1, Rifany Tiparisa2 1Nutrition Department, Faculty of Public Health, Hasanuddin University 2District Health Office, West Seram Regency

*Corresponding email: [email protected]

ABSTRACT

It is essential to pay attention to the consumption of pregnant women due to the increasing of nutritional requirement in this period. Eating culture factor may also influence the consumption pattern, such as Soami consumption habit. This study aimed to identify how often pregnant women consume Soami as well as their food intake. The study was a cross-sectional analysis of 44 pregnant women in West Seram Regency during April 2018. Using a semi-quantitative food frequency questionnaire (Semi quantitative FFQ), Soami consumption data was collected from participants. Dietary intakes, both macro- and micronutrients, were also measured in this study. The average of respondents was from middle to lower socio-economic (>Rp100.000-

Keywords: Traditional food, eating culture, Soami, pregnant women Introduction is located in a very rich geographical area that consists of land, mountains and islands. Consequently, the availability of foods that can be consumed by local people is affected by these geographical conditions. Moreover, the way people respond to food access and household food security is also affected by the cultural and political socio-economic factors. Indonesia has a diverse ethnic, cultural, socio-economic and religious as well as beliefs, therefore, the eating habits and patterns of Indonesian local community is strongly affected by the diversity and geographical condition. Local food is one of the food sources that is easily accessible to the community, which gives a variety of colors to the Indonesian cuisine that are very diverse. However, local cuisine sometimes might need modifications to meet daily nutritional requirements, especially in vulnarable groups, such as pregnant women, lactating mother, andinfants.These groups plays significant role inthe first 1000 day of life which has become a global program as the best strategy to build healthy human resources including reducing the stunting rate. The first 1000 dayshas become a national agenda to optimize the improvement of health and nutrition services in the first 1000 day of life. One of the Indonesian traditional cuisines is Soami, which is consumed every day by the community from all age and social-economic groups in two villages in the West Seram sub- district. Seram in the western part of Maluku Province. Soami is made from cassava which is easily available at the household leveland do not require much preparation. Soami is made from cassava which is certainly rich in carbohydrates, howevwe, sometimes it is consumed by the community in an unbalanced manner, it means that Soami is only consumed with vegetables or only with side dishes or even as a single dish (without side dishes and without vegetables). If Soami can be use as a substitute for rice, it is certainly will become an advantage to reduce rice dependence by using local potential. Inbalanced dietary intake, especially in pregnant women, will affect their health and nutritional status as well as the pregnancy outcomes.Thus, will affect the efforts to improve public health nutrition problems, such as chronic energy deficiency (CED), nutritional anemia, low birth weight (LBW), poor nutritional status and stunting, and increase risk of degenerative diseases in the future. The West Seram Regency data shows that the anemia of pregnant women has increased very rapidly, namely 31.5% in 2013 and in 2016 62% of the total pregnant women did Hb examinations (West Seram District HealthProfile). The purpose of this study was to determine the Soami Consumption Pattern in Pregnant Women and the characteristics of pregnant women, and what sources of food that are consumed every day and to determine the amount of macro and micro nutrients intake. This research is important to conserve Soami as a local foodand fulfill the daily nutritional requirements of pregnant women, and also to optimize the non-rice-and-wheat basedlocal food.

Materials and Methods This research was conducted in Telaga Piru village, Pulau Osi village, and Wael village, West Seram village, Seram village, of West Maluku Province in April because only in theseareas people are consuming Soami as their main dishes. This research is a descriptive study to get an overview of the consumption patterns of Soami in pregnant women. The population in this study were all pregnant women who consumed Soami residing in Telaga Piru village, Pulau Osi village, and Wael village, West Seram village, Seram villagewho were willing to participate in this study with exclusion criteria namely suffering from chronic infectious diseases and / or being treated in hospital and having their pregnancies checked by midwives village, with a total of 44 pregnant women. Pregnant women knowledge about Soami was measured using a knowledge questionnaire. The scoring scale used Guttman scale with criteria as follows: <60% low knowledge, 60-80% moderate knowledge, and> 80% high knowledge. Soami intake for pregnant women was measured by collecting the intake frequency data, meal times, types of food, the amount of food consumed in a day using semi-quantitative FFQ (SQ-FFQ) and characteristic data were obtained using a questionnaire. SQ-FFQ were measured using scoring system where, 0 = never; 0.07 = 1-3 times/month; 0.14 = 1 time/week; 0.43 = 2-4 times/week; 0.79 = 5-6 times/week; 1 = 1 time/day; 2.5 = 2-3 times/day; and 4 => 4 times/day. The 2013 Indonesian Recommended Dietary Allowance (RDA) was used as a reference. Intake was categorize as good if the consumption fulfill 80-110% of RDA. Data were processed using the SPSS program and presented in the form of narration and tabulation. RESULTS 1. Research Location West Seram District is part of the West Seram Regency and located in the southern part of West Seram Regency. With a total area of 5.393.43 Ha, with the following boundaries:  North: Subdistrict  East: West district  West: Huamual and Waesala districts  South: Sea Administratively, West Seram District is divided into 7 villages, 103 hamlets, with village development all of which are self-sufficient. In terms of community socialization, the West Seram District community is an agrarian society and has diverse cultures and needs to be carried out continuously by the Trustees to support the smooth and successful government activities and development. Most people in the West Seram sub-district live from livelihoods in the agricultural sector and most people embrace Islam. Judging from the condition of the region (geographical location), West Seram Subdistrict is very potential for agricultural development with an area of 5,393.43 ha which is mostly in the form of lowland land. However, in the research locations, especially the Osi Island Hamlet, which is located surrounded by sea and barren land due to many rocks, making it very difficult for local people to grow crops. In the research locations, the Telaga hamlet, Dusun Wael and Dusun Pulau Osi have a considerable distance from the district center of the city and do not have traditional markets or the like, so the community must go to markets located in the city center and the community must issue money of Rp. 15,000 - Rp. 20,000 (USD 1-2) only for transportation.

2. Respondents Characteristics Based on the characteristics in table 1, it was found that most pregnant women who consumed Soami in the West Seram sub-district were aged 20-35 years (84.1%) which were the adult age group. High school is the most recent education level taken by pregnant women in this area which is 43.2% and the work of pregnant women is mostly housewives or it can be said that it does not work (79.5%). Then around 63.6% of pregnant women have low household income. Other aspects show that half of them have low knowledge about Soami and 61.4% of pregnant women did not consume iron tablets.

Table1. Characteristic Distribution of Pregnant Women Consuming Soami in West Seram District in 2018 Characteristics Frequency (N=44) Age [n(%)] < 20 years old 1 (2.3) 20 – 35 years old 37 (84.1) >35 years old 6 (13.6) Pregnancy [n(%)] 3rdTrimester 44 (100) Education [n(%)] Elementary School 10 (22.7) Junior High School 11 (25) Senior High School 19 (43.2) Diploma 1 (2.3) University 3 (6.8) Job [n(%)] Farmer 7 (15.9) enterpreneur 1 (2.3) private employee 1 (2.3) housewives 35 (79.5) Household income [n(%)] Low (< Rp.1.000.000,-) 28 (63.6) Medium (Rp.1.000.000 – Rp.1.900.000,-) 13 (29.5) High (> Rp.1.900.000,-) 3 (6.8) Soami Consumption [n(%)] Yes 44 (100) No 0 (0) Soami Consumption Frequency 1x /day 2 (4.5) 2-3x /day 42 (95.5) Knowledge about Soami [n(%)] Low 22 (50) Medium 21 (47.7) High 1 (2.3) Iron supplement consumption [n(%)] Yes 17 (36.6) No 27 (61.4) 3. Dietary Pattern 3.1. Frequency Analysis Tabel 2. Average score of food intake among pregnant women in West Seram District in 2018 Frequency 2- 5- 2- 1- Tota 1×/da 1×/w neve Foods 3×/da 6×/w 4×/w 3×/m. Averag l y k r Total y k k o e score 2.5 1 0.79 0.43 0.14 0.07 0 Staple food n 42 2 0 0 0 0 0 44 Soami 2.43 s 105 2 0 0 0 0 0 107 n 2 6 0 13 8 15 0 44 rice 0.43 s 5 6 0 5.59 1.12 1.05 0 18.76 Instant n 0 1 0 9 6 3 25 44 0.13 noodles s 0 1 0 3.87 0.84 0.21 0 5.92 Boiled n 0 0 0 5 17 6 16 44 0.11 cassava s 0 0 0 2.15 2.38 0.42 0 4.95 Boiled n 0 0 0 1 4 4 35 44 0.03 banana s 0 0 0 0.43 0.56 0.28 0 1.27 Side dishes n 41 2 0 1 0 0 0 44 Fresh s 102.5 2 0 0.43 0 0 0 104.9 2.38 fish 3 Asar n 2 0 0 8 6 3 25 44 0.22 fish s 5 0 0 3.44 0.84 0.21 0 9.49 n 0 0 0 0 0 6 38 44 Shrimp 0.01 s 0 0 0 0 0 0.42 0 0.42 Chicke n 0 0 0 0 0 12 32 44 0.02 n s 0 0 0 0 0 0.84 0 0.84 n 0 0 0 1 6 16 21 44 eggs 0.05 s 0 0 0 0.43 0.84 1.12 0 2.39 n 0 0 0 1 3 14 46 64 Tofu 0.04 s 0 0 0 0.43 0.42 0.98 0 1.83 Tempe n 22 8 0 26 6 0 2 64 0.04 h s 66 9 0 11.2 0.84 0 0 75.02

Vegetables Cassava n 1 7 0 4 16 14 2 44 0.33 leaves s 2.5 7 0 1.72 2.24 0.98 0 14.44 n 0 0 0 0 1 6 37 44 Green bean 0.01 s 0 0 0 0 0.14 0.42 0 0.56 n 0 0 0 0 6 8 30 44 Long bean 0.03 s 0 0 0 0 0.84 0.56 0 1.4 Mustard n 0 1 0 0 0 2 41 44 0.03 greens s 0 1 0 0 0 0.14 0 1.14 n 0 1 0 3 5 6 29 44 Spinach 0.08 s 0 1 0 1.29 0.7 0.42 0 3.41 Water n 1 5 0 3 12 8 15 44 0.25 Spinach s 2.5 5 0 1.29 1.68 0.56 0 11.03 n 0 1 0 0 2 6 35 44 Carrot 0.04 s 0 1 0 0 0.28 0.42 0 1.7 n 0 1 0 4 6 8 25 44 Banana bud 0.09 s 0 1 0 1.72 0.84 0.56 0 4.12 n 0 0 0 2 0 2 40 44 Bitter melon 0.02 s 0 0 0 0.86 0 0.14 0 1 Moringa n 0 4 2 1 11 9 17 44 0.19 leaves s 0 4 1.58 0.43 1.54 0.63 0 8.18 Half-ripe n 0 0 0 1 1 10 32 44 0.33 papaya s 0 0 0 0.43 0.14 0.7 0 1.27 Melinjo n 0 1 0 2 7 8 26 44 0.08 leaves s 0 1 0 0.86 0.98 0.56 0 3.4 Katuk n 0 0 0 0 3 3 38 44 0.01 leaves s 0 0 0 0 0.42 0.21 0 0.63 n 0 0 0 1 2 2 39 44 Fern leaves 0.02 s 0 0 0 0.43 0.28 0.14 0 0.85 Fruits n 0 0 0 0 1 1 42 44 Ambarella 0.005 s 0 0 0 0 0.14 0.07 0 0.21 n 0 0 0 0 1 4 39 44 Pinaple 0.01 s 0 0 0 0 0.14 0.28 0 0.42 n 0 0 0 3 4 17 20 44 Papaya 0.07 s 0 0 0 1.29 0.56 1.19 0 3.04 n 0 0 0 9 10 24 1 44 Banana 0.16 s 0 0 0 3.87 1.4 1.68 0 6.95

Oil n 7 4 0 12 0 3 18 44 Palm oil 0.61 s 17.5 4 0 5.16 0 0.21 0 26.87 n 0 0 0 0 2 2 40 44 Butter 0.01 s 0 0 0 0 0.28 0.14 0 0.42 Coconut n 0 3 0 9 4 8 20 44 0.18 milk s 0 3 0 3.87 0.56 0.56 0 7.99 Minuman Sweet n 0 0 0 0 1 13 30 44 condensed s 0 0 0 0 0.14 0.91 0 1.05 0.02 milk Tea n 1 1 0 12 1 0 29 44 0.20 s 2.5 1 0 5.16 0.14 0 0 8.8 n 1 0 0 3 2 2 36 44 Coffee 0.10 s 2.5 0 0 1.29 0.28 0.14 0 4.21 Snacks n 1 0 0 0 0 5 38 44 Fried bread 0.06 s 2.5 0 0 0 0 0.35 0 2.85 Fried n 0 1 0 4 12 4 23 44 0.11 banana s 0 1 0 1.72 1.68 0.28 0 4.68 n 0 0 0 0 3 3 38 44 Donuts 0.01 s 0 0 0 0 0.42 0.21 0 0.63 Fried n 0 0 0 0 0 11 33 44 0.02 stuffed tofu s 0 0 0 0 0 0.77 0 0.77 Traditional n 0 0 0 0 1 4 39 44 Banana s 0 0 0 0 0.14 0.28 0 0.42 0.01 pastry

a. Staple food The most frquent consumed staple food is soami, namely> 1x / day and white rice 2-4 times / week. While those that are rarely consumed with a frequency of 1x / week or 1-3x / month are instant noodles, boiled cassava and boiled bananas. b. Side dishes The side dishes consumption pattern of respondents that are often consumed is fish, namely> 1x / day and also asar fish. While those that are rarely consumed with a frequency of 1x / week or 1-3x / month are chicken meat, 0.01 shrimp, chicken eggs, tofu and tempeh. c. Vegetables The most frequently consumedvegetables is cassava leaves, which are 2-4x / week and cassava. While those that are rarely consumed with a frequency of 1x / week or 1-3x / month are green beans, long beans, spinach, mustard greens, cucumbers, carrots, banana heart, bitter melon, Moringa leaves, unriped papaya, melinjo leaves, katuk leaves and fernleaves. d. Fruits Generally, respondents rarely consumed fruits. Banana was consumed 1x / week. While those consumed 1-3x / month are kedondong, pineapple and papaya. e. Oil

The most frequently consumed oil is palm oil, which is 5-6x / week, while respondents rarely consume it with a frequency of 1x / week or 1-3x / month, namely butter and san coconut milk.

f. Drinks Generally respondents rarely consumed beverages. There are several drinks that are consumed once a week, such as tea. Whereas 1-3x / month consumed is sweetened condensed milk and coffee. g. Snacks Generally respondents rarely consumed snacks. There are some snacks consumed 1x / week or 1-3x / month such as fried bread, fried bananas, donuts, fried stuffed tofu and Traditional Banana Pastry.

3.2. Intake analysis Tabel 3. Nutrient intake distribution based on RDA in West Seram Regency in 2018 Frequency Average total Nutrient Intake Adequate High Low[n(%)] intake (%) [n(%)] [n(%)] Energy (kcal) 37 (84.1) 7 (15.9) 0 (0) 1567.97 (62.6) Protein (gr) 27 (61.4) 15 (34.1) 2 (4.5) 55.41 (72.5) Fat (gr) 26 (59.1) 9 (20.5) 9 (20.5) 56.31 (72.3) Carbohydrate (gr) 34 (77.3) 8 (18.2) 2 (4.5) 205.77 (59.6) Fiber (gr) 44 (100) 0 (0) 0 (0) 11.57 (34.9) Vitamin A (µg) 9 (20.5) 6 (13.6) 29 (65.9) 1180.73 (147.6) Vitamin C (mg) 13 (29.5) 7 (15.9) 24 (54.5) 117.57 (138.3) Folat (mg) 44 (100) 0 (0) 0 (0) 1.13 (0.2) B1 (mg) 43 (97.7) 1 (2.3) 0 (0) 0.38 (27.3) B2 (mg) 44 (100) 0(0) 0 (0) 0.48 (28.8) B6 (mg) 16 (36.4) 10 (22.7) 18 (40.9) 1.88 (110.7) Calsium (mg) 38 (86.4) 5 (11.4) 1 (2.3) 664.12 (55.3) Iron (mg) 43 (97.7) 1 (2.3) 0 (0) 16.09 (45) Zinc (mg) 44 (100) 0 (0) 0 (0) 4.02 (28.7)

According to the total intake obtaine from the SQFFQ questionnaire (table 3), it was found that the intake of pregnant women in this area was still inadequate(based on2013 Indonesian RDA). Most of respondents' macro nutrient and micronutrient intake was lacking with an average intake of <80 %. No more than 35% of respondents who are in the sufficient category.

DISCUSSION Many kinds of food that are traditionally processed in each region in Indonesia are things that need to be maintained. But the diversity of food can also cause various problems including in the field of nutrition if not consumed according to the principle of balanced nutrition. The results of this study indicate that consumption of pregnant women every day is Soami and fish, fish consumption is supported because some of the research sites are on the coast, so marine resources can be consumed such as fish and shrimp. However, shrimp and other animal sources, namely chicken and chicken eggs, and vegetable dishes such as tempeh and tofu are only consumed 1-3 times a month. In the vegetable group only consumed 2-4 times a week, fruit is consumed only once a week. While the Balanced Nutrition Guidelines (PGS) recommends consumption in a day must be fulfilled from the elements of staple food, side dishes, vegetables and fruit. Such a diet will affect macronutrient intake and the intake of micronutrients. The diet of pregnant women also rarely consume snacks, both in the form of drinks and cakes. So that the calorie intake only comes from eating the main food. Then calorie intake in pregnant women is found to be still low, which is only an average of 1567.97 kcal (62.6% AKG). Similarly, all of its macronutrient intake, carbohydrates, proteins, and fats, respectively, are as follows 205.77 grams (59.6% AKG), 55.41 grams (72.5% AKG), and 56.31 grams (72.3% AKG). Micronutrient intake is also still low, which is below 80% of the RDA, except for vitamin A, vitamin C, and vitamin B6. Low intake if long lasting will have an impact on the nutritional status of both pregnant women and their pregnancy outcomes such as nutritional anemia, SEZ, LBW, stunting, and others. Unfortunately the data available from the local health office in 2016 reported that nutritional anemia in pregnant women was found to be 62%. Knowledge of Soami food management so that most of the balance is lacking and low income and transport costs to be incurred to the Market, as well as the geographical conditions on the coast contribute to the low intake of pregnant women in the study area. Seeing low income data certainly contributes to family welfare. This Soami diet plus side dishes for pregnant women needs to be maintained so that they do not depend on rice and wheat, only the modification of Soami is needed to fulfill the element of balanced nutrition. For this reason, simple access to food, especially from fruit and vegetable groups, is needed to ensure the accessibility of vegetables and fruits in a manner such as hydroponic. Habits that rarely drink tea / coffee can be advantageous to avoid anemia as long as the intake of protein sources and facilitating substances is considered. Because there is still a low level of knowledge about processing Soami into a balanced diet, it is important to provide information for behavioral changes to supplement balanced foods in pregnancy. Based on several studies, high knowledge can significantly improve daily intake, especially on fruits and vegetables (Mirsanjari, et al., 2012; Wardle, 2000; O'Brien & Davies, 2007; Verbeke, 2008). The presence of the government as a service provider (empowerment), empowerment (development), and development (development) is expected to improve the welfare of its people to be able to access food and reach food-resistant households. One of the policies of the Ministry of Maritime Affairs and Fisheries since 2000 was to hold a Coastal Community Economic Empowerment Program (PEMP) which was also held in the Southeast Maluku district, Maluku province, showing a fairly good implementation rate but institutionally still not as expected (Bandjar , et al, 2013). So that this program would also need to touch other areas, one of which is West Seram sub-district, West Seram district, Maluku province.

CONCLUSSION 1. Soami was more often consumed with fish while nutrient intake from vegetables and fruits is still far from expected. Vegetables and fruit are recommended to be consumed every day. 2. Most of the average energy intake, macronutrients, micronutrients of pregnant women in West Seram sub-district consuming Soami are still in the inadequate category (<80% AKG) If this continues, other nutritional problems such as nutritional anemia, CED, LBW, stunting, etc., will be a threat to this region. The government is expected to immediately anticipate this problem in order to avoid unwanted events. References Bandjar, S.B., Lala, M.K., & Lukman, M.B., 2013. Strategi peningkatan mutu program pemberdayaan ekonomi masyarakat pesisir (PEMP) di kabupaten Maluku Tenggara. Jurnal Manajemen Pembangunan Daerah, 5 (1). p. 62-75. Dinkes, 2016. Profil Dinas Kesehatan Kabupaten Seram Bagian Barat. In : Kesehatan, D (ed.). Piru : Dinas Kesehatan Kabupaten Seram Bagian Barat. Kementerian Kesehatan RI. 2014. Pedoman Gizi Seimbang. Kementerian Kesehatan Republik Indonesia : Indonesia. Mirsanjari, M., Wan, A.M.W.M., Affizal, A., Mohd, S.O., Maryam, M., & Mir, M.M., 2012. Relationship between nutritional knowledge and healthy attitude and practice during pregnancy. Borneo Science. p. 104-112. O’Brien, G., & Davies, M., 2007. Nutrition knowledge and body mass index. Health Education Research, 22(4). p. 571-575. Verbeke, W., 2008. Impact of communication on consumers’ food choices. Proceedings of the Nutrition Society, 67. p. 281-288. Wardle, J., Parmenter, K., & Waller, J., 2000. Nutrition knowledge and food intake. Appetite, 34. p. 269-275.