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Abstract Inappropriate
feeding practices could be a major cause of stunting. Stunting was one
of the problems in the growth process because it was associated with an
increased risk of morbidity, mortality, and suboptimal brain
development. Based on data obtained from the electronic data collection
of community-based nutrition recording and reporting in East Manggarai district at August weighing in 2023 from 24,427
toddlers there were 2195 stunted toddlers or 9. 0%. Pota health center
was one of the health centers in East Manggarai
Regency with a high number of stunted toddlers, namely 107 children or 10.
9%. The purpose of this study was to determine, describe and analyze
the feeding patterns of stunted toddlers at Pota health center, East Manggarai regency. Methods: this study used a
qualitative method with phenomenological research approaches. The
informants in this study consisted of 7 main informants, namely mothers who
had stunted toddlers in the pota puskesmas working area who were taken by purposive sampling
technique. Results: mothers' perceptions of stunting tended to be the
physical signs of children without knowing the long-term effects. The
pattern of exclusive breastfeeding was still not good where most children
were not given exclusive breastfeeding and the pattern of complementary
feeding was still inadequate from the age of administration, frequency,
amount, texture, variety and not knowing the complementary feeding of breast
milk. Conclusion: mothers' perceptions of stunting were only related to
the physical signs of the child and most informants did not gave their
children exclusive breastfeeding and the pattern of complementary feeding was
still inadequate from the age of administration, frequency, quantity,
texture, variety and did not knew complementary feeding of breast milk. Keywords: stunting, toddler, eating
patterns, exclusive breastfeeding, complementary feeding |
Introduction
Stunting
in toddlers requires special attention because it could hinder the child's
physical and mental development. Stunting was closely related to the risk
of delays in the growth of motor and mental abilities and increases the risk of
morbidity and death in children and one of the factors that played a role in
contributing to its high the stunting rate was due to inappropriate parenting
and feeding practices (Adji et
al., 2019). Continuous deficiencies in food intake, both
in quality and quantity, cause children to be susceptible to infectious
diseases and hinder children's growth. (Mboi et
al., 2022). The mother's role in the caregiving and giving
process feeding children played a very important role in the process of
children's growth, health, and intelligence. If the eating patterns of
toddlers were not achieved properly, the growth of the toddler would also be
disrupted, the body had been thin, poor nutrition and even short toddlers (
stunting ) could occur, so a good diet was also important. needed have
been developed to avoid malnutrition (purwarni and mariyam, 2013).
� Based on data from the Indonesian nutrition
status surveyed (2021), the prevalence of stunting nationally had decreased
from 24. 4% in 2021 to 21. 6% in 2022. This shows that the implementation
of government policies encouraging the acceleration of stunting reduction in
Indonesia had provided sufficient results. Good. Currently, the
prevalence of stunting in Indonesia was better than Myanmar (35%), but still
higher than Vietnam (23%), Malaysia (17%), Thailand (16%) and Singapore (4%).
East Nusa Tenggara province was one of the provinces where the stunted
toddler�s prevalence rate in 2021 was in the highest position, namely 37.
8%. (ministry of health research and development agency, 2021).
East
Manggarai regency was one of the districts in East
Nusa Tenggara province where the prevalence of stunting in toddlers was still
high. Based on data obtained from community-based electronic recording
and reporting of nutrition data in East Manggarai
regency at the weighing in august 2023, there were 24,427 toddlers. 2195
children under five were stunted or 9. 0%. Pota community health center was one of the community health centers
in East Manggarai regency with a high number of
stunted toddlers, namely 107 children or 10. 9% (pota
community health center eppgbm
data, 2023).
According
to WHO, the impacts caused by stunting could be divided into short-term and
long-term impacts. Short-term impacts include: 1) increased incidence of
morbidity and death, 2) children's cognitive, motor, and verbal development was
not optimal, 3) health cost increase. Meanwhile, the long-term impacts
include: 1) shorter body posture compared to their adult age, 2) increased risk
of obesity and other diseases, 3) decreased reproductive health, 4) learned
capacity and performance at school were less than optimal, 5) productivity and
worked capacity not optimal (data and information center,
2018). Apart from the impacts mentioned by the data and information center, stunting also had an impact on the economy of a
country in the future, including indonesia.
This was since stunting had quite a long-term impact (Sari et
al., 2021). Thus, state funding for children experiencing
stunting could increase. The potential economic losses due to stunting
were also very large. By knowing the factors that caused stunting, one
solution to directly prevent stunting was by means of specific nutritional
interventions targeting pregnant women. This intervention includes
providing additional food (pmt) to pregnant women to
overcome chronic energy and protein deficiencies, overcome iron and folic acid
deficiencies, overcome iodine deficiencies, treat worm infections in pregnant
women and protect pregnant women from malaria (Murcittowati
et al., 2023). A specific nutritional
intervention targeting breastfeeding mothers and children aged 0-6 months was
this intervntion was carried out through several
activities that encouraged early initiation of breastfeeding/imd, especially through the provision of plain breast
milk/colostrum as well as encouraging exclusive breastfeeding. Specific
nutritional intervention targeting breastfeeding mothers and children aged 7-23
months was this intervention includes activities to encouraged the continuation
of breastfeeding until the child/infant was 23 months old and then after the
baby was over 6 months old accompanied by giving mp-asi,
providing worm medicine, providing zinc supplementation, fortifying iron in
food, providing protection against malaria, providing complete immunization,
and preventing and treating diarrhea. Efforts
to indirectly prevent stunting, namely through sensitive intervention efforts,
include various development activities outside the health sector targeting the
public, activities include providing clean watered, sanitation facilities,
various poverty reduction, food security and nutrition, food fortification,
education and kie nutrition, education, and health kie, gender equality, and others in collaboration with
crossed sectors. The combined impact of specific and sensitive activities
was long-lasting and long-term
Previous
research conducted by ridha cahya
prakhasita (2018) in the tambak
wedi kenjeran area, surabaya also showed that there was a significant
relationship between feeding patterns and the incidence of stunting in toddlers
aged 12-59 months.
According
to Pota health center ecologically working area had the potential for abundant
marine natural resources because it was located on the coast. Seafood was
an important source of protein for children, pregnant women, and women of
childbearing age, because of the important role of micronutrients and two types
of omega-3, namely docosahexaenoic acid (dha) and eicosapentaenoic acid (epa) in
the growth and development of fetuses and children (un nutrition; 2021).
Even though the Pota health center was located near the sea and beach areas,
there were still many stuntinng toddler.
Therefore, researchers were interested in analyzing and further researching the
stunting toddlers feeding patterns in the Pota health center working area. The
aimed of this research was to found out, describe, and analyze the feeding patterns
of stunting toddlers at the pota community health
center, East Manggarai regency used a
phenomenological approach.
Research
Methods
This research used qualitative methods with
phenomenological research approaches. This research was conducted in the
working area of the Pota health center, East Manggarai regency, East Nusa Tenggara province. The
informants in this study consisted of 7 informants, namely mothers who had
stunted toddlers in the Pota health center working
area. The data collection method in this research used primary data
obtained directly by conducting semi-structured interviews. Data analysis
in this researched used the miles and huberman model
of data analysis, namely data collection, data reduction, data presentation and
conclusion drawing/verification (Rahayu et al., 2023).
Results
and Discussion
Perceptions about
stunting
From
the interview results, it was found that most informants had the same
perception about stunting, namely children who were small, short and had
stunted growth without knowing the causes and impacts on children. Here
is the quote:
"
What I knew was that stunting was a child who was small and short, ma'am
(informant 01, 04, 05, 06, 07).
There
were also those who said that stunting in children occurs due to hereditary
factors from parents.
"
When it came to stunting, i knew that children were
short, but my child seems have been short because his father was also short, hehehe (informant 02). Another informant also said that
children who were stunted only when they were toddlers, when they reached
school age, the child would grow taller and bigger and compare with his older
siblings.
"
Well, I knew, mother, they often explained that stunting was a small and short
body, and said that the school does not win. My eldest child was also
small, but at school, thank God, he could read and write fluently, ma'am, so I
thought that it was normal for him to have been small like this, but when he
grows up, he would be tall like his older brother (informant 03).
In
this study, it was found that all informants already knew the term stunting,
however, the informants' perceptions of the meaning and characteristics of
stunting tended to be about the child's physical signs. According to the
informant, children were said to have been still normal if their development
was active, spoke fluently and walked according to their age, without knowing
the long-term effects of stunting such as affecting the child's intelligence leveled and ultimately reducing the economic productivity
of individuals and the country collectively. Perception would determine a
person's choice, collection, arrangement and giving meaning which would
influence the behavior (response) that emerges from
within a person. Perception influences the mother's parenting style,
namely the care given by the mother to the child in the form of the mother's
attitudes and behavior (Indah,
2020).
Research
by Putri mm, Mardiah, yulianita
(2021) found that 95 respondents (51. 1%) had low knowledge about
stunting. This was due to the lack of information obtained by mothers of
toddlers, which should have been obtained through counseling
by health workers at integrated healthcare center (Posyandu), which had an impact on mothers' attitudes in
caring for toddlers. Another study conducted by (Nurbaya et
al., 2023) stated that mothers who received knowledge from
professional health workers had a more accurate understanding of stunting,
compared to mothers who received information from friends or neighbors. The method of conveying information was
very important in increasing mothers' knowledge and perceptions.
Extension methods in the form of lectures and discussions have been proven to
increase parents' knowledge about nutrition. In-depth knowledge about
stunting in mothers could help them provide optimal care for babies and
toddlers. With this knowledge, mothers could choose the right types of
food and provide appropriate nutritional intake with the needs of children's
growth and development. In addition, improving maternal beliefs, behavior and education was the key to overcoming
stunting. Research shows that consistently increasing maternal education
could reduce children stunting rates (Hall et
al., 2018). the community's perspective found out on the
meaning of stunting. This information about community perceptions was
useful in selecting intervention activities to change perceptions so that they
did not only focus on the child's physical signs but also other aspects,
including the long-term impact of stunting. With this change in
perception, it was hoped that there had been increased community involvement in
efforts to overcome stunting. Exploration of the perception components in
this research was still limited to informants from mothers whose children were
stunted. The government needed to carry out further outreach or education
to correct the perception of mothers who only focus on the child's physical
signs.
Exclusive breastfeeding
From
the results of in-depth interviews, it was found that most informants did not
give exclusive breast milk to their children for various reasons, namely
because of working, fussy children, feeling that breast milk was not enough and
pressure from their in-laws. Here is the quote:
"
That is what i wanted, ma'am, to just gave him breast
milk for up to 6 months, but i had to worked and went
to school, so he started drinking formula milk from the age of 4 months,"
(informant 02)
"
If I was not mistaken, i gave him breast milk for up
to 5 months, because i knew, living in a village, if
a child was fussy and cries, the neighbors would say
it was because there was not enough breast milk, so at 5 months i gave him starch watered (informant 05. 06)
In
this research, it was found that most informants did not give exclusive breast
milk to their children for various reasons, namely because of working, fussy
children, feeling that there was not enough breast milk and pressure from their
in-laws. When children were 4-5 months old, they were given liquid food
such as starch watered, formula milk and soft porridge.
Exclusive
breastfeeding was giving only breast milk without giving other food and drinks
to babies until they were 6 months old, except for medicines and vitamins (who,
2017). Breast milk was a nutritional intake that was in accordance with
needs and would help children's growth and development. Babies who did
not get enough breast milk had poor nutritional intake and could cause
malnutrition, one of which could cause stunting.
This
was in accordance with researched conducted by (Umiyah
& Hamidiyah, 2020) in the worked area of the selo public health center, Boyolali regency, namely that there was a relationship
between exclusive breastfeeding and the incidence of stunting, namely that
babies who were not given exclusive breast milk had a 3,154 times risk of
experiencing stunting in the future compared to babies who were given exclusive
breast milk.
In
the researched it was also found that informants gave formula milk when their
children were 4 months old because the mother was gone to worked, other
informants gave starch watered and porridge before the children was 6 months
old because they felt there was not enough breast milk and the parents was
forcing them. According to research by (Aulia
& Dafit, n.d.) in malang, the
mother's level of knowledge had an influence on the success of exclusive
breastfeeding. It was believed that knowledge influences a person's
thought patterns or actions. Adequate maternal knowledge about breast
milk had the potential to improve maternal behavior
in breastfeeding her baby. Evidence shows that breastfeeding was
beneficial for improving the baby's immune system.
Giving Weaning food
(MPASI) )
The
feeding pattern in this study included providing complementary breast milk food
with the principle of paying attention to the age or time of giving mp asi, frequency, quantity,
texture, and variety of food to meet the child's nutritional needs and the
nutritional content of the weaning food (MPASI) consumed. Based on the
results of interviews conducted with informants, it was found that most informants
did not give weaning food (MPASI) to their children on time. Here
is the quote:
"
Because he has been on milk since he was 4 months, so around 5 months i gave him soft porridge mixed with vegetable sauce and
small pieces of fish and even then, just a little, i
was afraid his intestines would be disturbed. " (informant 02)
"
My in-laws said i had to feed him porridge so he
would grow up quickly, even though he was still 4 months old (informant 03)
"
My breast milk had not last until 6 months because he was fussy, cried all the
time, finally my mother-in-law said that my breast milk was not good, so i should gave him starch watered with a little banana
," (informant 05)
"
It should have been 6 months, the midwife said, but my child kept crying ma'am,
he was fussy, finally at 5 months I gave him soft porridge " (informant
06).
Based
on the results of interviews, in terms of the texture of weaning food (MPASI)
given to toddlers, it was known that all informants started giving weaning food
(MPASI) to their toddlers with foods that had a liquid texture such as breast
milk. The choices of liquid textured foods given were starch watered and
soft porridge accompanied by vegetable sauce. Here is the quote:
"First
i gave you starch watered and then i gave you moringa vegetable soup " (informant
03,05,07)
"
Well, at first i cooked the porridge until it was
very soft, then after that i mixed in moringa left
(informant 01,02,04)
Regarding
the frequency and amount of giving weaning food (MPASI) to their children, all
informants answered that their children ate 2-3 times a day, 5-6 spoonfuls to � cupped at a time. Here is the quote:
"
2-3 times ma'am, she ate 5-6 spoonfuls, sometimes
when she was really hungry, she finishes 1 scooped or � bowl, but sometimes
when she was hungry she'll definitely asked for food " (informant
01,03,04,05)
�2
-3 x ma'am, he finishes � bowl, sometimes 1 bowl if there were side dishes that
he liked, but sometimes if he had snacks, only 2 meals in the morning and
afternoon. But i still asked for food if i'm hungry� (informant 02,06,07).
Regarding
food variety, based on the results of interviews with informants, it was known
that when giving food to their children there was rarely a variety of
food. Here is the quote:
"
Sometimes I waited for good luck, ma'am, who always had moringa and lettuce,
eggs and fish every day, sometimes too " (informant 01, 05. 07)
"
There was also a lady who often gave me moringa left and gave her carrots and
green beans. When there was helped from the sub-district, she had
carrots, but she was also picky when it went to eating, most often also tofu
because she liked tofu mixed with soy sauce" (informant 03)
"
The routine was moringa left and fish, ma'am, but i
tried with tempeh because he liked eating tempeh mixed with tomatoes and soy
sauce " (informant 06)
When
interviewed regarding the content of weaning food (MPASI) provided, all
informants did not know regarding the nutritional content of mp asi. What they knew was
that if the food given consisted of rice, vegetables, fish, eggs, or meat then
the food contained nutrients without knowing what nutrients they
contained. contained. Here is the quote:
"
I knew that if you had rice with vegetables and side dishes, it already
contains nutrients, especially since it was said that moringa left had lots of
nutrients. (informant 01,05,06)
"
As far as I knew, vegetables, fish, meat, eggs were nutritious foods,
especially if there was milk, but my child often ate fish but his body was
still small. " (informant 02. 07).
The
feeding pattern in this study includes providing complementary breast milk food
with the principle of paying attention to the age or time of giving mp asi, frequency, quantity,
texture, and variety of food to met the child's
nutritional needs and the nutritional content of the weaning food (MPASI)
consumed.
In
this study, the informant had not given weaning food (MPASI) to his child on
time. WHO recommendations for providing appropriate food to infants and
children were early initiation of breastfeeding (imd)
immediately after birth, exclusive breastfeeding for 6 months and providing
complementary breast milk according to need from the age of 6 months and
continued with breastfeeding for up to 2 years or more (who , 2003).
Findings
made by (Waqiyah et
al., 2023) who examined factors such as timeliness, frequency,
and types of mp-asi on the nutritional status of
toddlers, also showed that the nutritional status of toddlers could be
influenced by these factors. In this study, it was found that informants tended
to have mp-asi to children with a liquid texture,
such as breast milk. However, guidelines from the ministry of health
recommend that giving complementary foods to babies aged 6-8 months should have
a thick or creamy texture. Theory also supports that mp-asi
should be given gradually according to the baby's age, because this was
adjusted to their physiological condition (Anggryni
et al., 2023). Babies who were not given food
textures appropriate to their age would easily get diarrhea,
which could indirectly affect their growth, including linear growth (Mufida et
al., 2015).
Regarding
the frequency and amount of giving mp asi, all informants said that their children ate 2-3 times
a day, 5-6 spoonfuls to � bowl at a time. According
to unicef, giving additional food to children aged
12-24 months was 5 times per day. Meanwhile, according to Soetardjo (2011), feeding children 5 to 6 times per day was
better because toddlers had small stomachs. Children who ate less than 4
times per day had less nutritional intake compared to the average of other
children who ate 4 times a day or more. Meanwhile, the frequency of
giving mp-asi should be as frequent as possible,
because children could consume small amounts of food gradually, while the need
for calories and other nutrients must be met.
Research
conducted by Wangiyana (2020) indicates that there
was a significant relationship between the frequency of giving mp-asi and the risk of stunting, with children receiving mp-asi with an inappropriate frequency. If toddlers
were inadequate in providing food portions, it could result in a lack of energy
intake, which would cause the body to conserve energy, which would result in
obstacles to weight gained and linear growth (Hidayat,
2023).
Regarding
food variety, it was known that when giving food to children there was rarely a
variety of food. Apart from rice as the staple food, children were also
more often given one typed of side dishes and vegetables for each meal, such as
eggs and tofu mixed with soy sauce, tempeh, fish. , or chicken.
Lack of variety in the food menu for children was also a factor that influences
children's difficulties in eating. A variety of foods was very necessary
in feeding children because no one type of food contains all the nutrients the
body needs. Regarding the content in the weaning food (MPASI) given, all
informants did not know the nutritional content in the weaning food (MPASI)
given to children.
According
to the infant and child feeding guidelines (ministry of health, 2019) weaning
food (MPASI) must contain enough carbohydrates, protein, fat, vitamins, and
minerals. Carbohydrates could be obtained from staple foods such as rice,
grains, corn, wheat, sago, and tubers. Animal protein could be obtained
from poultry, liver, eggs, fish, beef, milk, and other processed
products. Vegetable protein could be obtained from nuts such as soybeans,
green beans, peas, peanuts, tempeh, tofu, etc. Fat as an efficient energy
source. Using/adding a certain amount of fat during processing, for
example oil/coconut milk in mp asi,
would provide additional energy content without increasing the volume of mp asi. Fruit and
vegetables were sources of vitamins (vitamin a and vitamin c), especially
yellow, orange, and green, but they contain high fiber
(Trumbo et
al., 2002).
The
key to success in teaching healthy eating patterns to children really depends
on the mother's knowledge and understanding of nutrition. (prosperous,
2009). The mother's willingness to overcome this problem appeared have been
poor, which could be seen from the little effort made by the mother to deal
with this problem (Oktaviani
et al., 2022).
Conclusion
The pattern of exclusive
breastfeeding was still not good where most children were not given exclusive
breast milk for various reasons, namely because of working, fussy children,
feeling that there was not enough breast milk and coercion from in-laws. The
pattern of providing complementary breast milk was still inadequate based on
the age at which it was given, frequency, quantity, texture, variety and not
knowing the contents of the complementary breast milk that was given. Health
centers community needed to develop innovative activities related to stunting
and strengthen promotion of exclusive breastfeeding and patterns of providing
complementary foods to children.The mother's active role was needed in
providing appropriate and adequate feeding in terms of feeding time, frequency,
quantity, texture, variety, and content of wealing food (MPASI).
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