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RELATIONSHIP ON EDUCATION LEVEL AND MOTHER'S
ATTITUDES ABOUT EXCLUSIVE ASSOCIATION WITH
NUTRITIONAL STATUS OF CHILDREN
Mulyadi
Jambi University
E-mail: [email protected]
Received:
May 10
th
,2021
Revised:
May, 16
th
, 2021
Approved:
May, 19
th
, 2021
Abstract
The magnitude of the problem of malnutrition in infants is a health
problem for citizens in Indonesia. This research aims to analyze
the relationship between knowledge and behavior of mothers about
breastfeeding and exclusive breastfeeding with the nutritional
status of infants aged 6- 24 months. This research used a
quantitative observational analytic method with a cross sectional
approach. The research population consisted of 98 mothers and
toddlers aged 6- 24 months in Kayu Raja Village, Keritang
Indragiri Hilir Subdistrict and 78 illustrations, using random
sampling method. The questionnaire instrument for information on
the level of learning, behavior and exclusive breastfeeding as well
as the baby's nutritional status used the BPJS Health Card
information. The results of the analysis show the bonding level of
learning (p = 0, 011 OR = 25, 196; 95% CI = 2, 087 to 304, 158),
behavior (p = 0, 044; OR = 21, 656; 95% CI = 1 , 081 to 434,
028) and exclusive breastfeeding (p = 0, 029; OR = 19, 769; 95%
CI = 1, 361 to 287, 238) as well as all variables (Nagelkerger R
Square of 68.2% ). There is a significant positive relationship
between the level of learning and behavior of mothers about
breastfeeding and exclusive breastfeeding with the nutritional
status of infants aged 6- 24 months.
Keywords: Knowledge, Attitudes, Exclusive Breastfeeding,
Nutritional Status of Toddlers
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International
INTRODUCTION
Universally, the nutritional problem in Indonesia, especially KEP (Lack of
Protein Power), is still bigger than in other ASEAN countries (Mardisantosa, Huri, &
Edmaningsih, 2017). At the world level, it is said that there are at least 17.289 babies die
every day because of hunger and malnutrition with all the consequences it causes. There
is no country in the world like Indonesia which is rich and resourceful agriculture
naturally (perennial factor), however in the country of Indonesia is facing a crisis in the
fields of energy, food, health or natural energy sources (Rahman, 2018), which is caused
by several aspects, one of which is the action of citizens who exploit and use nature in
excess, so that many problems continue to arise, including poverty, food and nutrition
crises, which is a meaningful task for the government and citizens to solve these problems
(Mahyarni, 2016).
The triggers for nutritional problems are influenced by 2 aspects, namely direct
aspects and indirect aspects (Marut, 2007). The immediate trigger is the aspect of eating
and inflammatory diseases (Nihwan, 2019). The indirect trigger aspects are food security
in the family, parenting styles, health care and insufficient sanitation in the area. The four
Mulyadi
Relationship on education level and mother's attitudes about exclusive
association with nutritional status of children 374
indirect aspects relate to the mother's learning, knowledge, income and expertise (Salla,
2017). The results of the national census survey show that the percentage of well-
nourished babies was 71.88% in 2012 and in 2013 it fell to 69.59%. Infants with less /
less good nutrition were 25.82% in 2012 and increased to 28.17% in 2013 (Statistik,
2016). The national prevalence of very thin babies is still quite large, at 6.2%. This matter
means that the problem of being underweight in Indonesia is still a serious health problem
for citizens. Moreover, out of 34 provinces, 18 provinces are among the critical types
(wasting prevalence 15%), 12 provinces are in serious type (wasting prevalence is 10-
15%).
Results of Nutrition Status Monitoring (PSG) in 2013–2019 in Riau Province, the
prevalence of malnutrition faced a decrease along with the improvement of health service
facilities and a reduction in the incidence of inflammatory diseases. Intent, but the
depreciation is still not normal, it can be seen from the results of PSG in 2014 amounting
to: 0.22%, 2015: 0.46% and in 2016 amounted to 0.35% (Riau Provincial Health Office,
2017).
In the area of Kayu Raja Village in 2016, there were 7 babies with a malnutrition
status and in 2017 the number of malnourished was 4 people. The total number of babies
in this village is 366 children, of which babies aged 6- 24 months are some 98 children.
The settlement conditions for the local Village Midwives to this area are malnutrition and
lack of good nutrition. From this phenomenon, things that are important to observe are
the factors that are related to the nutritional status of the baby, such as the characteristics
of the mother, the characteristics of the toddler, the knowledge and behavior of mothers
regarding breastfeeding, the position of posyandu cadres and village midwives, data
media and history of breastfeeding. exclusive and non-ASI milk as well as breastfeeding
couple's meal.
This research aims to analyze the relationship between the level of learning and
the mother's behavior regarding breastfeeding and exclusive breastfeeding with the
nutritional status of babies aged 6- 24 months in Kayu Raja Village, Keritang District.
The lack of knowledge of mothers about breastfeeding is one of the obstacles to the
sustainability of breastfeeding. The level of education of mothers about exclusive
breastfeeding can be obtained from various data sources. Towards the end of pregnancy,
mothers need a variety of meaningful data that are usually provided by health services
and personnel (Arifeen, 2016). Mother's behavior is related to breastfeeding practice.
Mothers who think that breast milk is the best food for toddlers plans to share breast milk
for 6 months (Foo, 2016). Breast milk is a hygienic, inexpensive, easy-to-provide meal
that is available for toddlers. Breast milk is one of the foods that toddlers need during the
first 6 months of their life to become healthy toddlers.
Its dynamic composition that suits the needs of toddlers makes breast milk the
maximum nutritional consumption for toddlers. Breast milk and plasma have the same
ion concentration, so toddlers don't need fluids or bonus meals. Breast milk has all the
elements that meet the needs of toddlers for nutrition throughout the period close to 6
months, unless the mother is experiencing severe malnutrition or other health problems.
The composition of breast milk will change in line with the needs of toddlers (Fawtrell,
2017). The condition of malnutrition status will have broad consequences, including the
ease with which children face inflammation and problems with development and
development as well as constraints for the use of their body organs (Rodrigues, 2016).
One of the ways to know nutritional status is by using anthropometric procedures which
are divided into 2 types, namely measurement of development (body dimensions) and
measurement of body composition (Sarni, 2019). The hypothesis in this research is that
there is a link between the levels of mother's learning about breastfeeding and behavior
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Relationship on education level and mother's attitudes about exclusive
association with nutritional status of children 374
RESEARCH METHODS
This research will be conducted in Kayu Raja Village, Keritang District. This
research is an analytic observational quantitative study with a cross sectional approach.
The population in this study were all mothers whose toddlers aged 6- 24 months in Kayu
Raja Village, Keritang District, totaling 98 people. Data collection was carried out
directly to the research subjects with a questionnaire and recording the results of the
nutritional anthropometric measurements of children under five listed in the KMS. To
determine the relationship between the level of education and attitudes of mothers
regarding breastfeeding and the implementation of exclusive breastfeeding with the
nutritional status of children aged 6-24 months, the statistical analysis used in this study
was multiple logistic regression analysis to test hypotheses 1, 2, 3 and 4.
RESULTS AND DISCUSSION
The level of education of the interviewee is divided into two categories, namely
low education (SD-SMP) and higher education (SMA-Perguruan Tinggi). Among the
respondents with a low level of breastfeeding education, 11 (14.1%) had high attitudes,
and as many as 67 (85.9%) attitude respondents were divided into two categories, namely
low attitudes and high attitudes.
Table 1. Distribution of Respondents based on Mother's Attitude
Category Attitude
Frekuency
Percentage
Low
32
41,0
High
46
59,0
Total
78
100,0
Respondents with low attitudes were 32 respondents (41.0%), and those with
high attitudes were 46 respondents (59.0%). Exclusive breastfeeding data from the
informants is divided into several categories, namely mothers who are not exclusively
breastfed and exclusively breastfed. Respondents who did not provide exclusive
breastfeeding were 19 respondents (24.4%), and those who only gave exclusive
breastfeeding were 59 respondents (75.6%).
Table 2. Distribution of Respondents based on Exclusive Breastfeeding
Exclusive breastfeeding
Frekuency
Percentage
Tidak
19
24,4
Ya
59
75,6
Total
78
100,0
The nutritional status of children under five is divided into two categories,
namely the nutritional status of children under the Red Line (BGM) and not under the
Red Line. There were 8 respondents (10.3%) with nutritional status below the red line
(BGM), and 70 respondents (89.7%) with nutritional status not lower than the red line.
Table 3. Distribution of Respondents Based on Nutritional Status of Toddlers
Toddler Nutritional Status
Frekuency
Percentage
BGM
8
10,3
Tidak BGM
70
89,7
Total
78
100,0
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Table 4. Results of Multiple Logistic Regression Analysis of the relationship between
education level and attitudes of mothers about breastfeeding and exclusive breastfeeding
with nutritional status of children aged 6-24 months
Variable OR Signifikancy (p) Confidence
Interval 95%
Lower Limit Upper Limit
Mother's education level 25, 196 0,011 2,089 304,158
Mother's Attitude 21,656 0,044 1,081 434,028
Breastfeeding
Exclusive 19,769 0,0029 1,361 287,238
N Observasi= 78
-2 log likelihood= 21,093
Negelkerker R
2
= 66,9%
Figure 1. Relationship between mother's education level regarding breastfeeding and
nutritional status of children aged 6-24 months
As can be seen in the figure above, there is a tendency for children under five
with a lower level of breastfeeding education and mothers with a higher level of
breastfeeding education to have a better nutritional status. It can be seen that there are 6
respondents (7%, 7%) and 5 respondents (6%, 4%) whose nutritional status is below the
red line (7%, 7%) and 5 respondents (6%, 4%). Among 83.3% mothers with tertiary
education, the nutritional status of children under five is above the red line, while 2.6% of
children under five are below the red line ..
Through the results of the logistic regression test, it can be seen that the
significance value or p = 0.011 or less than 0.05, and it can be concluded that there is a
significant relationship between the education level of breastfeeding mothers and the
nutritional status of children under five. 6-24 months. And based on the OR value
obtained of 25,196, it can be concluded that the nutritional status of mothers with higher
education may be 25.196 times higher than uneducated mothers. There is a relationship
between mother's attitude towards breastfeeding and the nutritional status of children
aged 6-24 months. The relationship between mothers' attitudes about breast milk and
nutritional status of children aged 6-24 months can be seen in the following figure:
Mulyadi
Relationship on education level and mother's attitudes about exclusive
association with nutritional status of children 376
Figure 2. The relationship between mother's attitudes about breastfeeding and nutritional
status of children aged 6-24 months
As seen in the picture above, there is a tendency that mothers with high attitudes
towards breast milk tend to make their babies more nutritious than mothers with low
attitudes. It can be seen that 32.1% of mothers with low attitudes have children whose
nutritional status is above the red line, 9% of mothers have children whose nutritional
status is below the red line, and among mothers who have high attitudes, 57.7% have
children with higher status. nutrition below the red line. nutritional status is above the red
line and 1.3% of children are below the red line.
Based on the results of the logistic regression test, it can be seen that the
significance value or p = 0, 044 or less than 0, 05. It can be concluded that there is a
significant relationship between mother's attitude towards breastfeeding and the
nutritional status of the baby. . Children aged 6-24 months. Based on the OR value
obtained of 21,656, it can be concluded that mothers with higher attitudes tend to improve
the nutritional status of infants up to the age of 21, which is 656 times higher than
mothers with lower attitudes. This relationship was stated as statistically significant
analysis (p = 0.044; OR = 21.656; 95% CI 1.081 to 434.028). There is a relationship
between exclusive breastfeeding and the nutritional status of children 6-24 months. The
figure below shows the relationship between exclusive breastfeeding and the nutritional
status of children aged 6-24 months:
Figure 3. Relationship between exclusive breastfeeding and nutritional status of children
aged 6-24 months
Sourced from the photo above, shows that there is a tendency that mothers who
distribute exclusive breastfeeding tend to have babies with better nutritional status than
mothers who do not share exclusive breastfeeding. It appears that mothers who do not
share exclusive breastfeeding, as many as 15.4% have babies with nutritional status above
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Relationship on education level and mother's attitudes about exclusive
association with nutritional status of children 378
to mothers who distribute exclusive breastfeeding, as much as 74.4% have babies with
nutritional status above the red line and 1.3% have babies with nutritional status at the
bottom of the red line.
Based on the results of the logistic regression test, it is known that the
significance value or p = 0.029 or less than 0.05, it can be concluded that there is a
significant relationship between exclusive breastfeeding and the nutritional status of
infants aged 6- 24 months. And based on the OR value, it was obtained at 19, 769, where
from this it can be concluded that mothers who distribute exclusive breastfeeding may
have babies with nutritional status 19, 769 times greater than mothers who do not share
exclusive breastfeeding. There is a relationship between knowledge and behavior of
mothers about breastfeeding and exclusive breastfeeding with the nutritional status of
infants aged 6- 24 months.
The results of multiple logistic regression tests can be concluded that there is a
significant correlation between the level of education of mothers regarding breastfeeding,
mother's behavior regarding breastfeeding and exclusive breastfeeding with the
nutritional status of infants aged 6- 24 months in Kayu Raja Village. Based on the
Nagelkerger R Square value, it is known as 0.669, this matter can be explained if the
variable influence of mother's knowledge about breastfeeding, mother's behavior about
breastfeeding and exclusive breastfeeding on the nutritional status of babies aged 6- 24
months is 66.9%, on the contrary the influence of aspects others who were not examined
in this study amounted to 33, 1%. Based on the results of the Hosmer and Lemeshow test
with a significance value of 0, 806 or greater than α 0.05, it can be concluded that the
multiple logistic regression equation model is feasible and can be interpreted.
Based on the regression equation, an analysis is made if the mother has a large
level of education (1), great behavior (2), and distributes exclusive breastfeeding so that it
is possible for the mother to have a baby with a nutritional status above the red line of
66.725 times more. bigger than mothers whose education level and behavior are low and
do not share exclusive breastfeeding.
The results of this study support the hypothesis that the level of mother's learning about
breastfeeding and exclusive breastfeeding has a statistically significant association with
the nutritional status of infants aged 6- 24 months and these results do not vary with the
results of several other studies but there are other studies whose results are not. in line
with this research. This research also shows the nutritional status of babies at the base of
the red line in Kayu Raja Village by 10, 3%. The discovery of the incidence of infants
suffering from malnutrition and malnutrition is one of the images of weak health, food
and nutrition infrastructure and the formation of socio-economic and political
inequalities, in which the problem of malnutrition that arises is one that requires serious
action.
Based on the results of hypothesis testing with, it was found that there was a
significant relationship between the mother's learning level and the baby's nutritional
status where p & lt; 0, 05 (p = 0, 011). The findings of this study are consistent with the
theoretical review, namely the level of education of mothers about breastfeeding ensures
the nutritional status of infants aged 6- 24 months. Some research results show that
mothers' learning levels are significantly related to breastfeeding methods. Continue to
improve the learning level and nutritional behavior of mothers until the provision of a diet
for their babies continues to be good and so does the nutritional status of their toddlers
(Harahap, 2021). The low level of mother's learning about breastfeeding causes mothers
not to share exclusive breastfeeding with their babies, this is to affect the nutritional status
of their toddlers (Sulistiyowati & Siswantara, 2014).
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In his research, (Yudi, 2008) stated that there was a statistical significance with a
value of p = 0.025 by testing the hypothesis that there was a relationship between
mother's knowledge and nutritional status of babies aged 6- 24 months in her research
conducted in 2017 entitled "The ties of socio-cultural aspects with status. nutrition of
babies aged 6- 24 months in Medan Zona Subdistrict, Medan City. "The socio-cultural
aspects studied in this research are learning, work and knowledge of mothers and fathers
and family income and family traditions.
(Rahayu, 2017) research in 2017, entitled Characteristics of mothers who
distribute exclusive breastfeeding with the nutritional status of their toddlers, found that
there was a significant relationship between the mother's level of knowledge and the
nutritional status of her toddler with p value 0, 019 (p & lt; 0, 05). In this research it was
concluded that mothers with low levels of knowledge so that mothers do not share
exclusive breastfeeding and have babies with poor nutritional status as much as 15.1%.
(Rachmadewi & Khomsan, 2009) in her research in 2019 in her research,
Knowledge, behavior, and exclusive breastfeeding practice and nutritional status of
children aged 4- 12 months in rural and urban areas, it is concluded that the knowledge of
mother's nutrition has a positive relationship with the nutritional behavior of mothers in
rural or urban areas. Aspects that are significantly related to the knowledge of nutrition
for mothers in rural areas are the mother's age, work status, and previous breastfeeding
experience. An aspect that is significantly related to the nutritional behavior of mothers in
rural areas is work status. In urban areas, only the mother's level of learning is
significantly related to the mother's level of knowledge and nutritional behavior. The
comparison of this research with this research is not only from the objectives that
describe the condition of urban and rural areas and the use of information analysis
techniques is the difference test is tried using the independent t-test, chi-square test, and
Fishers exact test. The bonds between variables were analyzed using the Spearman
correlation test. All tests were tried at the 5% real level (α). In this research, the bond
between knowledge and behavior affecting breast milk was analyzed and a significant
bond was obtained (p = 0.004), whereas in this study the bond was not analyzed.
This research is also in line with the results of research entitled "Effect of
mother's education on children's nutritional status in the slums of Nairobi" by (Abuya,
Ciera, & Kimani-Murage, 2012), conclusions were obtained through binomial and
multiple logistic regression tests where a significant relationship was obtained if Mother's
knowledge is a strong predictor of the nutritional status of her toddler (p = 0.001). For
(Istiono, Suryadi, & Haris, 2009), in his research entitled Analysis of the factors that
influence the nutritional status of infants where the independent variables are the mother's
job, father's job, infant disease, food expenditure, non-food expenditure, parenting, access
to health, hygiene and area sanitation and knowledge, behavior and attitudes of mothers,
it was concluded that there was no significant relationship between all aspects of these
effects and the nutritional status of children. The insignificance of the research results
was caused by errors in illustration taking and could also be caused by misuse of
information analysis.
The results of this research are not in line with the results of research by Mashal
in 2018 entitled "Factors associated with the health and nutritional status of children
under 5 years of age in Afghanistan: family behavior related to women and past
experience of war-related hardships". if the mother's low level of knowledge, marriage at
an early age, low expertise of the mother, the reduction in the amount of supply needed
by the family every day, and displacement have a significant negative relationship with
the health status and nutritional status of children in this country who are facing a period
of conflict in a long
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Relationship on education level and mother's attitudes about exclusive
association with nutritional status of children 380
time long. The aspect of minimum basic needs was related to the incidence of diarrhea
(odds-ratio = 1.35; 95% CI = 1. 08, 1. 68); displacement was associated with poor
nutritional status (odds-ratio = 2.48; 95% CI 95% = 1.13, 5.44).
Based on the results of the logistic regression hypothesis test, it was found that
there was a significant relationship between the mother's behavior and the nutritional
status of the baby where p & lt; 0.05 (p = 0.044). Rahma Dewi in her research entitled
Knowledge, behavior and practice of exclusive breastfeeding and nutritional status of
children aged 4- 12 months in rural and urban areas, it is concluded that mother's
nutritional knowledge is positively related to women's nutritional behavior in rural or
urban areas. Aspects that are significantly related to the knowledge of nutrition for
mothers in rural areas are the mother's age, work status, and previous breastfeeding
experience. An aspect that is significantly related to the nutritional behavior of mothers in
rural areas is work status. In urban areas, only the mother's level of learning is
significantly related to the mother's level of knowledge and nutritional behavior.
The comparison of this research with this research is not only from the objectives
that describe the condition of urban and rural areas and the use of information analysis
techniques is the difference test is tried using the independent t-test, chi-square test, and
Fishers exact test. The bonds between variables were analyzed using the Spearman
correlation test. All tests were tried at the 5% real level (α). In this research, the bond
between knowledge and behavior affecting breast milk was analyzed and a significant
bond was obtained (p = 0.004), whereas in this study the bond was not analyzed.
The results of this research are not in line with Istiono's comments in 2016 in his
research entitled Analysis of factors that affect the nutritional status of infants, where the
independent variables are the mother's job, father's job, infant disease, food expenditure,
non-food expenditure, parenting style. In terms of access to health, hygiene and sanitation
areas and knowledge, behavior and attitudes of mothers, it was concluded that there was
no significant relationship between all aspects of these effects and the nutritional status of
children under five.
Moelina in 2016 in her research on the relationship between mothers
'assumptions and nutritional status of their toddlers in Brazil and (Abubakar, Holding,
Mwangome, & Maitland, 2011) with the same research title in rural Africa, formulated
that mothers' assumptions about the state of their children's nutritional status were
significantly related to their children's nutritional status. (Aries Dian Pertiwi &
Wirawanni, 2006) in her research "Mother's Characteristics Bond with exclusive
breastfeeding with inflammatory diseases and nutritional status in infants held in
Semarang" in 2016, found that there was a link between age, occupation, previous
breastfeeding experience and mother's learning level with the baby's nutritional status
with significant ties. statistical p = 0, 017 was found in the hypothesis testing that there
was a relationship between the length of exclusive breastfeeding and the nutritional status
of the baby.
This research is not in line with research by Basit in 2017 where through his
research "Risk factors for under-nutrition among children aged one to five years in Udupi
taluk of Karnataka, India" results showed that malnutrition in infants is associated with
illness throughout the year. In the last 1 month [OR– 4. 78 (CI: 1. 83–12. 45)], diluted
prescription milk was given [OR – 14. 26 (CI: 4. 65– 43. 68)] and have children more
than 2 with a distance of children less than 2 years [OR– 4. 93 (CI: 1. 78– 13. 61)]. There
was no link between nutritional status and low exclusive breastfeeding, mother's
knowledge and area sanitation. The association of knowledge and behavior of mothers
regarding breastfeeding and exclusive breastfeeding with the nutritional status of infants
aged 6- 24 months.
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This study has independent variables that were not examined in Yu's study in
2015, entitled "Status of malnutrition and its influencing factors in children under 5 years
of age in poor areas of China in 2015" where the results of the study were obtained. Other
things related to the nutritional status of children under five, such as low birth weight (OR
= 1,975, 95% CI = 1,515-2,575), per capita income less than 2000 yuan (OR = 1,813,
95% CI = 1,364 -2,409), parenting styles father and mother (OR = 1.190, 95% CI =
1.022-1387) and poor water sanitation (OR = 1.282.95% CI = 1.120-1.46). professionals,
cadres, odd jobs, and farmers (OR = 5,384, 95% CI = 2,490- 11,642), (OR = 4,244, 95%
CI 1,953- 9,222), self-employed women and craftsmen (OR = 4.872, 95% CI = 2,169-
10,947), housewives (OR = 5,331, 95% CI = 2,438- 11,654).
CONCLUSION
From the results of research and discussion, it can be concluded that the job
descriptions variable does not have a partial effect on Employee Performance in Case
Resolution at PTUN Bandung. Job specifications variable give a partially significant
influence on Employee Performance in Case Resolution at PTUN Bandung. Job
descriptions and job specifications variables have a significant effect simultaneously
(simultaneously) on Employee Performance in Case Resolution at PTUN Bandung.
Implementation of job descriptions and job specifications can optimize employee
performance so that it can realize case resolution at PTUN Bandung as mandated by
SEMA Number 2 of 2014.
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