Modelling Factors that Affect Nutritional Status of Toddler in

Coastal Area Surabaya East Java Indonesia

Qori’ Ila Saidah and Ayu Citra Mayasari

STIKES Hang Tuah Surabaya, East Java, Indonesia

Keywords: Modeling Factors, Nutritional Status, Coastal Area.

Abstract: Many factors influence nutritional status in coastal area. This research aimed to analyse factors which have

influence on nutritional status of children in coastal area.This research was use cross-sectional design with

104 child-mothers pairs in coastal area Surabaya taken by simple random sampling technique. FFQ

questionnaire was used to measure selection of daily food consumption. Factors of food hygiene, feeding

frequency, parents education, parent income and frequency of illness taken by questionnaire. Nutritional status

measured by comparison of body weight and height of toddler. The result shows that food hygiene and food

consumption has strong influence to nutritional status. Analyse was used ordinal regression with sig. 0,012

(food hygiene) and sig 0,010 (food consumption). The selection of daily food consumption and food hygiene

were very important to improve nutritional status of toddler in coastal area. Recommendation of this research

was empowering community in nutritional status of toddler by improving hygiene and management selection

of daily food consumption.

1 BACKGROUND

Coastal areas have a characteristic and unique natural

resources. As a fish-producing region, coastal areas

have potential in improving health status, especially

nutrition problems. Nutritional content in fish if

managed properly should be able to improve

nutritional status of children. Several problem in child

nutrition still founded in coastal area of Surabaya.

Nutritional status varied in range severely wasting till

fat.

Nuritional problem in coastal area influenced by

socioeconomic status. The previous study, (Hien &

KamS, 2008) found that maternal, socioeconomic and

environment factor have influenced in nutritional

status of children under 5-years old in Vietnam.

The coastal region of Surabaya has a diverse

community character. Its population consists of

various tribes and occupations. In addition, the

lifestyle of coastal communities Surabaya much

influenced urban lifestyle so that the dissemination of

information and technology is very fast. In addition,

the level of education in coastal communities also

varied from basic education to higher education that

affect the attitude, the pattern of thinking and

behavior of the community in nutrition management

in children.

The income level of coastal population surabaya

also varied. This may also affect the ability of the

family in selecting the daily food menu for their

children so that there are varied nutritional status

ranging from undernutrition to overnutrition children.

This is different from other coastal areas in Indonesia

which are far from urban areas. With these various

potentials, Surabaya coastal areas should be more

able to overcome the problem of nutrition than other

coastal areas in Indonesia (Kurniawan, Muslimatun,

Endang, & Sastromidjojo, 2006), found that

adolescent in peri-urban coastal area of Indonesia has

anaemia and iron deficiency.

Based on the results of field observations,

environmental factors in coastal areas Surabaya still

cause many problems. Many found waste discharged

to the coast in coastal areas, fish populations are

decreased so that fishermen are looking for fish in the

territorial waters farther from the coast. Community

hygiene is also disrupted where there are still

residents who do not have toilets. This has been

overcome by the government by building public

latrines, but some are still far from the reach of

residents. Some residents defecate directly to the

beach, whereas the beach is still a source of water for

580

Saidah, Q. and Mayasari, A.

Modelling Factors that Affect Nutritional Status of Toddler in Coastal Area Surabaya East Java Indonesia.

DOI: 10.5220/0008329005800585

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 580-585

ISBN: 978-989-758-336-0

other residents. The incidence of diarrhoea and skin

diseases are still widely encountered. Therefore it is

necessary to analyze the model related factors that

affect the nutritional status of coastal areas Surabaya.

This study aims to determine the model of the factors

that can affect the nutritional status of children under

five in the coastal area of Surabaya.

2 METHODS

This research was used cross-sectional design. The

samples were 104 child-mother pairs in coastal area

of Surabaya were selected by simple random

sampling. Age of children between 1-3 years old in 3

Posyandu (subunit of community health care center)

in Kejeran Urban Village Surabaya. This research

was conducted in March and April 2017.

The data collecting of this research was

questionnaire to measure nutritional status and 6

factors that affect nutritional pattern of children. The

National Center of Health Statistics (NCHS) was used

to measure nutritional status of toddler. We only use

weight-for-height to make assessment the whole of

nutritional status. We not consider acute nutritional

problem (weight-for-age) and history nutrition

problem in the past (height-for-age) (Indonesian

Ministry of Health, 2011).

Factors that have influence on nutritional status

measured by questionaire wich are contain 6 factor.

We take data by questionaire for 5 factors, food

hygiene, frequency of eating, educational status of

parent, parent income and frequency of toddler illness

(febris, diarrhea and respiratory disease). That are

considered as a factor that affect management on

feeding in toddler. It also influence on kognitif,

affectif and psychomotor of parent who take care

their children.

We measure data selection of daily food

consumption by using Semi Quantitative-Food

Frequency Questionnaire (FFQ). We use FFQ to

assess the frequency of food consumed within the

past month by adding an estimated number of

servings consumed by toddlers. We make interview

mother by use open question. The questionnaire

contains questions about the composition of foods

grouped into types of carbohydrate, protein, fat,

vitamin and mineral composition. The answer given

by the respondent is an answer that contains about

how often to consume foods that have been grouped

by type and how much is eaten in one meal. Based on

respondents' answers, the researchers calculated the

size of grams / day on each food. To determine the

size of each gram, respondents are given a photo of

the food model in which each household size has been

set amount in grams. After knowing the size of each

food, the respondent's food menu calculated the

number of calories by inputting the food menu on the

nutri-survey computer program. In the program, will

produce the number of calories, carbohydrates,

proteins, fats, vitamins, and minerals consumed by

respondents.

The value is classified according to the Indonesian

Ministry of Health 1996 in (Anggraeni, 2012) above

the need if the value is> 120%, normal if the value is

90-119%, the deficit is mild if the value is 80-89%,

moderate deficit if the value is 70-79%, and a heavy

deficit if the value is <70%. Previous research of FFQ

found that FFQ was valid instrument to measure

frequent habitual nutrient. FFQ was used to measure

the frequency of habitual nutrient in Asian ethnic

(Singapore, Chinese, Indian and Malay)

(Neelakantan et al., 2016). FFQ also useful for

assessing habitual dietary intake in collegiate athletes.

Especially for calcium, vitamin C, vegetables, fruits,

and milk and dairy products (Sunami et al., 2016). In

more specific, FFQ also valid instrumen for measure

valid rankings for intake of energy, nutrients, foods,

and food groups in this sample of infants and toddlers

(Palacios et al., 2017).

Data collection conducted by door to door to

interview for questionnaire data. The measurement of

nutritional status held in 3 Posyandu by measure body

weight and height of children. After selection by

simple random sampling we use ordinal regression

statistical test to analyse model of factor that affect

nutritional status.

3 RESULTS

Table 1 presented about nutritional status of toddler

based on weight-for-height in coastal area Surabaya.

The result showed that the most nutritional status of

toddler in normal category (75 children, 71%). There

are 14 children (13,3%) in category wasting and 9

children (8,6%) with severely wasting.

Table 2 showed about selection of daily

consumption for toddler in coastal area in Surabaya.

Most of toddler have a proper daily intake (61 toddler,

58,7%). But 10 toddler get nutrient more than needs.

Its potentially become fat. Another children in severe

deficit consumption in range mild (2 children, 1,9%),

moderate (11 children, 10,6%) and severe (20

children, 19,2%).

Modelling Factors that Affect Nutritional Status of Toddler in Coastal Area Surabaya East Java Indonesia

581

Table 3 presented the food hygiene of toddler in

coastal area mostly in good category (69 children,

66,3%). But we also see that 22 children (21,2%) in

poor hygiene. Otherwise, 13 children (12,5%) very

good in food hygiene.

Table 4 showed that most of toddler eat 3 times a

day (73 children, 70,2 %). 24 children eat twice / day

(23,1%) and 7 children eat more than 3 times / day

(6,7%).

Table 5 showed that the most educational status of

mother is high school (55 mother, 52,9%) and only 2

mother (1,9%) have educational status college /

university. Another mother educational status in

elementary school (18 mother 17,3%) and junior

school (29 mother, 27,9%).

Table 6 showed that almost family income toddler

in coastal area between Rp. 1000.000 till Rp.

3000.000. the amount of this family 97 families

(93,3%). Only 7 families (6,7%) who have income

low than 1000.000 rupiahs.

Table 7 showed that almost of toddler have

experience illness once in one last month (75

children, 72,1%). The result showed that 24 children

healthy and never have sick in one last month (24

children, 23,1%) and 5 children (4,8%) have sick

more than once in one last month before data

collection.

In Model Fitting Information -2log Likelihood

explains that without entering the independent

variable (intercept only) the value is 162.393.

However, by entering an independent variable to the

(final) model there is a decline in value to 126,465.

This value change is a chi-square value of 35,928 and

significant at 5% real level (sig.0.01)

In Model Fitting Information -2log Likelihood

explains that without entering the independent

variable (intercept only) the value is 162.393.

However, by entering an independent variable to the

(final) model there is a decline in value to 126,465.

This value change is a chi-square value of 35,928 and

significant at 5% real level (sig.0.01).

The Goodness of Fit table shows the model

conformity test with the data. Pearson value equal to

216,697 with significance 0,018 (> 0,05) and

Deviance equal to 111,431 with significance 1,000 (>

0,05). This means the model corresponds to empirical

data or a model is worth using.

The Pseudo R-Square table shows how much of

the independent variables are able to explain the

independent variables. This value is like the

coefficient of determination on regression. The value

of Cox and Snell is 0.292 (29.2%) and Nagelkerke is

0.349 (34.9%). Nagelkerke coefficient of 34.9%

means independent variable food hygiene and food

consumption affect the normal nutritional status of

34.9% whereas 65.1% is influenced by other factors

not included in the test model.

Estimate Parameters Table , note the Wald values

and their significance values. Food Hygiene variable

is -2.147 with sig. 0,012 (<0,05) and Food

Table 1: Nutritional status based on weight-for-

height of toddler.

Nutritional status

Frequency

(f)

Percentage

(%)

Severe wastin

9 8,6

Wastin

14 13,3

Normal 75 71,4

Fat 7 6,7

Total 105 100

Table 2: Selection of daily food consumption for

toddler feeding.

Selection of daily

foo

consum

tion

Frequency

(

)

Percentage

(

)

More than needs 10 9.6

Normal 61 58.7

Mild Deficit 2 1.9

Moderate Deficit 11 10.6

Severe Deficit 20 19.2

Total 104 100

Table 3: Food hygiene in daily consumption of

toddler.

Food Hygiene Frequency

(f)

Percentage

(%)

Poo

22 21.2

Goo

69 66.3

Ver

13 12.5

Total 104 100

Table 4 : Frequency of eating in toddler.

Frequency of

Eatin

Frequency

(

)

Percentage

(

)

2x/da

24 23.1

3x/day 73 70.2

> 3x / day 7 6.7

Total 104 100

Table 5 : Mother’s education level of toddler.

Mother’s

Education Level

Frequency

(f)

Percentage

(%)

Elementar

18 17.3

Junior School 29 27.9

h School 55 52.9

College/

universit

2 1.9

Total 104 100

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

582

Consumption 1,537 with sig 0,010 (<0,05). This

value factors of Food Hygiene and Food

Consumption affect the Nutrition Status.

From the above output the ordinal regression

equation is generated as follows

(Y≤0/P(Y>0)=-4.105-2,147 +1,537 (1)

From the model it is said that Food Hygiene which

has less tend to of smaller have normal nutrient status,

with coefficient of variable 2,147 which have tend to

8,55(

,

) to have normal nutrient status. And

Food Consumtion is less tend to of smaller have

normal nutritional status, with coefficient of variable

1,537 which have tend to 2,96 (

,

)to have normal

nutrient status.

4 DISCUSSION

Poor daily food consumption of children, tend to

difficult to achieve normal nutritional status. It has

correlation in nutrition less than needs. Toddler has

various physical activity and need nutrition for their

growth and development. If their daily food

consumption less than their needs, they tend to more

thin and difficult to gain their weight. The incident of

anemia, worsen than condition. Kurniawan, found

that thinnes children have higher anemia and iron

deficiency in coastal area in Indonesia (Kurniawan et

al., 2006)

The good nutrient need for growth and

development of toddler. The variety of food is

important factor. Sometimes mother don't have good

knowledge about proper food for their children.A few

Mother in coastal area of Surabaya, give junk food or

another food with contain of high carbohydrate than

protein or fiber (fruit and vegetable). Good

knowledge and attitude of mother is important factor,

as they have to manage nutritional feeding for their

children.

Toddler have difficulties of feeding. Toddler

chooses instant noddle or another junk food which

contain more carbohydrate than vegetable or protein.

Characteristic some mother in coastal area Surabaya

show that they don't make strong effort to give

nutrition if their children difficult to eat. Mother

should make various pursuade to make their children

want to eat their food. If they don't, the children only

eat in small amount of food.

The other factors, economic status of family also

bring influence to management of nutrition in toddler.

The family income in coastal area varied in less than

Rp.1000.000 till more than Rp. 2.000.000. The most

family in this research have family income in range

Rp. 1.500.000 – 2.000.000. It will affect in daily food

consumption. The variation of food will limited by

family income. Good mother have to make

innovation to make a good selection of daily food.

The previous study found that the prevalence of

early childhood stunting and the number of people

living in absolute poverty have closely associated

with poor cognitive and educational performance in

children and use them to estimate that (Grantham-

McGregor et al., 2007). These disadvantaged children

are likely to do poorly in school and subsequently

have low incomes, high fertility, and provide poor

care for their children, thus contributing to the

intergenerational transmission of poverty.

Table 6 : Family income of toddler.

Family income

Fre

uenc

(

)

Percentage

(

)

<1.000.000 7 6.7

1.000.000 -

3.000.000

97 93.3

Total 104 100

Table 7: Frequency of toddler illness.

Frequency of

Toddler Illness

Frequency

(f)

Percentage

(%)

Never sic

24 23.1

1x / month 75 72.1

>1x / month 5 4.8

Total 104 100

Table 8: Model fit information.

Model

-2 Log

Likelihoo

Chi-

Square df Sig.

Intercept

Onl

162.393

Final 126.465 35.928 14 0.001

Table 9: Goodness-of-fit.

Chi-Square Df Sig.

Pearson 216.697 175 .018

Deviance 111.431 175 1.000

Table 10: Pseudo R-square.

Cox and Snell 0.292

elkerke 0.349

McFadden 0.191

Modelling Factors that Affect Nutritional Status of Toddler in Coastal Area Surabaya East Java Indonesia

583

Otherwise, some children have more nutrient than

their needs. Almost mother give additional milk (not

breast milk) for their children although their children

have normal nutritional status and fat. Almost

children with fat, still have formula milk in their diet.

Mother believes that children have to eat more, this

situation will bring their children become overweight

and obese.

Olivares, found that food consumption in school-

age children has influence in nutritional status. Daily

food consumption has a stronger than daily activity

(such as TV time). Although they have TV time,

intake of food with dense energy and vegetable or

fruit only a risk factor of obesity. But intake of milk

has strong influence in obesity of children in Chili

(Olivares et al., 2004).

The contain of formula milk, have more than their

need (such as lipid). Some children also have allergy,

this incident higher in children with formula milk, it

can cause some disease just like diarrhoea and

cough.The incident of disease will bring decrease of

body weight.

The coastal community in Surabaya is very

complex. From the environmental perspective it is

found that water pollution are still happening. Many

found trash on the beach area. This disturbed

sanitation can trigger the emergence of various

diseases, especially in toddlers. Food hygiene can be

contaminated with poor sanitation.

The result showed that bad sanitation of food has

influence in nutritional status. Sanitation in

processing food will affect the nutrient containt.

Good sanitation will keep nutrient and reduce nutrient

while process of cooking. Good material and good

management to wash the material of food also

important thing. It affected by the water that used to

wash the food. If the mother use polluted water, they

also have risk of diarrhoea.

D’Agnes found that food security in coastal area

of Philippines will be achieved more quickly if there

is together implementation between coastal resources

management and reproductive health (D’Agnes,

Castro, D’Agnes, & Montebon, 2005).

5 CONCLUSIONS

Based on this research, we assume that the selection

of daily food consumption and food hygiene have

strong influence to nutritional status. Good selection

of daily food will influence on the proper nutrient for

toddler to achieve normal nutritional status. Food

Table 11: Parameter estimates.

Parameter Estimates Estimate Std. Error Wald df Sig.

95% Confidence

Interval

Lower

Boun

Upper

Boun

Threshold [NutrionalStatus = 1] -4.105 2.285 3.229 1 0.072 -8.583 .373

[NutrionalStatus = 2] -2.689 2.262 1.413 1 0.235 -7.123 1.744

[NutrionalStatus = 3] 2.431 2.244 1.174 1 0.279 -1.967 6.829

Location [MothersEducation=2] -0.035 1.724 0.000 1 0.984 -3.414 3.345

[MothersEducation =3] 2.087 1.735 1.448 1 0.229 -1.312 5.487

[MothersEducation =4] 1.942 1.700 1.305 1 0.253 -1.389 5.273

[MothersEducation =5] 0

. . 0 . . .

[Famil

Income=1] -0.595 0.907 0.431 1 0.511 -2.372 1.182

[FamilyIncome =2] 0

. . 0 . . .

[FrekuensiOfIlness=0] -1.601 1.210 1.750 1 0.186 -3.972 0.771

[FrekuensiOfIlness =1] -1.355 1.154 1.380 1 0.240 -3.616 0.906

FrekuensiOfIlness =2] 0

. . 0 . . .

[FoodH

iene=1] -2.122 0.941 5.088 1 0.024 -3.967 -0.278

[FoodH

iene =2] -2.147 0.850 6.386 1 0.012 -3.812 -0.482

[FoodHygiene =3] 0

. . 0 . . .

[FeedingFrekuensi=1] -1.021 1.062 0.923 1 0.337 -3.103 1.062

[FeedingFrekuensi =2] -0.603 0.976 0.382 1 0.537 -2.515 1.310

[Feedin

Frekuensi =3] 0

. . 0 . . .

[FoodConsumtion=1] 3.491 1.023 11.655 1 0.001 1.487 5.495

[FoodConsumtion =2] 1.537 0.597 6.635 1 0.010 0.368 2.707

[FoodConsumtion =3] 1.084 1.882 0.332 1 0.565 -2.604 4.772

[FoodConsumtion =4] 0.612 0.837 0.534 1 0.465 -1.029 2.253

[FoodConsumtion =5] 0

. . 0 . . .

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

584

hygiene will bring a good sanitation of the

environment and food processed in feeding

management. Recommendation of this research was

empowering community in nutritional status of

toddler by improving hygiene and management

selection of daily food consumption and food

sanitation.

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