Indonesia still faced some important issues, including the health and nutritional status of children, especially malnutrition. Riskesdas 2018 data shows the frequency of malnutrition, stunting, and wasting aged 6-23 months of 11.4 percent, 30 percent, and 11.7 percent. Meanwhile, in rural areas, there is a higher prevalence of stunting. Their frequency is 32.8 percent compared to 27.4 percent in urban areas.
Indonesia is included in one of 36 countries where 90 percent of children have stunting problems. Although there have been various attempts to overcome malnutrition in children, the percentage of stunting is still considerably high, and data from the Ministry of Health in 2013 recorded that it reached 37 percent.
"The program to reduce the stunting rate is still considered a government program, especially the Ministry of Health, to accomplish people's welfare. Meanwhile, the World Health Organization (WHO) ought to set a global target of reducing stunting in children by 40 percent by 2025," said Heni Hendriyani, SKM., MPH, a lecturer at Poltekes, Kemenkes Semarang on Monday (21/12).
She said this statement when she took the Doctoral Program's open examination in Medical Sciences, Faculty of Public Health Medicine and Nursing UGM. Supporting her dissertation on the Effect of Comprehensive Complementary Breastfeeding (MP-ASI) Practices Intervention on Mother's Self-Efficacy, Complementary Supplying Food Practices, Dietary Diversity, Food Intake and Growth of Toddlers Ages 6-12 Months, Promovenda accompanied by Dr. Toto Sudargo S.K.M., M.Kes and Dr. Siti Helmyati D.C.N., M.Kes and Dr. Susetyowati D.C.N., M.Kes.
Through online examinations, Heni stated that the research she conducted was to determine the effect of comprehensive complementary breastfeeding intervention practices on increasing maternal self-efficacy, complementary food practices, minimum dietary diversity (MDD), food intake, and growth under-five children aged 6-12 month. Based on various literature works, she agrees that the primary role of supplying food practices, especially complementary supplying food with breastfeeding for children aged six months and over, can reduce malnutrition and child morbidity.
"Malnutrition is a complex phenomenon caused by various determinants, including less than optimal supplying food practices for babies and children. Malnutrition in children can affect children's ability to survive illness, cognitive development, work productivity and health consequences as adults which can later influence financial burdens and economic growth," she said, citing Black's 2008 opinion.
According to her, inadequate supplying food practices, insufficient breastfeeding, excessive use of infant formula, early complementary supplying food, and low quality and frequency of complementary supplying food practices after six months undoubtedly contribute to wasting and stunting in Indonesia. Meanwhile, the inadequate supply of food practices also contributes to micronutrient deficiencies.
"Supplying food behavior and how it can affect food taking and nutritional intake will greatly influence the children's growth. Accordingly, the mother or caregiver's behavior, primarily the mothers' initiative to encourage children when eating, correlates with the food taken by the child. Therefore, children or caregivers should apprehend skills in identifying children when they are hungry and full and can be expected to respond well," said the nutrition department lecturer.
Heni revealed that she wrote this dissertation based on a quasi-experimental research design with the treatment and control groups measured pre and post-treatment simultaneously. There were 83 people in the treatment group, and 82 mothers and their children aged 6-12 months went to control in Kulon Progo Yogyakarta.
There were also home visits conducted every two weeks for three months by enumerators. Data were collected using a questionnaire, 24 hours recall of weighing and measuring body length. The researcher analyzed the data using the Saphiro Wilk test, Mann Whitney, chi-square, and Independent t-test and performed the sequence equation model (SEM) test with SmartPLS.
From the research she conducted, Heni concluded that the child nutrition problem at an early age, especially when supplying complementary foods, is greatly affected when a mother or caregiver supplies food. The practice covered supplying complementary foods includes aspects of quantity and quality.
Meanwhile, the broad practice of complementary supplying food interventions that has been widely practiced in Indonesia has mostly focused on the types and quantities of food provided. One factor that is missed from the concern and intervention is preparing food preparation skills, which will have a considerable impact on mothers' ability to give complementary breastfeeding appropriately and encourage active supplying food practices (responsive feeding).
"The results revealed that there were a better self-efficacy and practice of supplying complementary food to mothers with intervention. Hence, there should be indeed an activity to socialize good complementary breastfeeding practices. This socialization will be very profitable, especially for women of reproductive age who will have children. So hopefully, it can better prepare themselves in terms of supplying food to their children," she said.
Author: Agung Nugroho