Mother’s Nutritional Knowledge, Posyandu Participation, and

Nutritional Status of Children Under Two Years in Tenggarong

District, Indonesia

Ratih Wirapuspita Wisnuwardani, Lisa Ariana Putri and Ismail Kamba

Faculty of Public Health, Universitas Mulawarman, Samarinda, East Kalimantan, Indonesia

Keywords: Education Program, Stunting, Weight.

Abstract: Most nutrition education in Indonesia operates on the promise that nutritional knowledge can have an impact

on children’s nutritional status. In addition, the participation of mothers in Posyandu (integrated service post)

can improve the basic health effort of mothers and children. This study aims to evaluate the association

between mothers’ nutritional knowledge, posyandu participation, and the nutritional status of children. This

study was a cross-sectional study with purposive sampling which takes in the working area of Rapak Mahang

Health Centre, Tenggarong district, nutritional status of 103 children aged six to 23 months was measured.

Moreover, mothers’ nutritional knowledge and mothers’ participation in Posyandu were assessed using an

interviewer-administered questionnaire. Data were analyzed using Rank Spearmen Correlation and Chi-

Square. Amount of 48% of mothers have good knowledge regarding balanced nutrition fulfillment, while only

19.4% of mothers are inactive in taking their children to the Integrated Services Posts (Posyandu). Data

analysis showed no significant association was found between mothers’ knowledge of balanced nutrition

fulfillment and nutrition status (p=0.590) and a significant association for mother’s participation in Posyandu

(p=0.0001). There is an association between mothers’ participation in Posyandu and the nutritional status of

children aged 6-23 months in the working area of Rapak Mahang Community Health Center. It is

recommended that Rapak Mahang Health Center improve nutritional education programs and promote

mothers to Posyandu with a digital system and local wisdom in Tenggarong.

1 INTRODUCTION

A significant public health issue is child

undernutrition. In 2020, it was anticipated that 149

million children under the age of 5 were stunted (too

short for their age), 45 million were wasting (too thin

for their height), and 38.9 million were overweight

(United Nations Children’s Fund (UNICEF)., World

Health Organization., & Bank., 2021). In Indonesia,

the stunting rate was 21.6% in children under five

years old, while the prevalence rates of wasting,

underweight, and overweight were 7.7%, 17.1%, and

3.5%, respectively (Indonesia, 2022). In addition, the

prevalence of malnutrition in Kutai Kartanegara was

higher than in Indonesia. In Kutai Kartanegara, the

prevalence of stunting, wasting, underweight, and

overweight was 27.1%, 9.4%, 25.1%, and 4.1%,

respectively (RI, 2021).

Malnutrition is caused by various factors,

including economic vulnerability, maternal

education, and regular growth monitoring. A

systematic review study of 37 studies in India,

Ethiopia, Bangladesh, Ghana, Nepal, Benin,

Netherlands, Columbia, Pakistan, Malaysia, Africa,

Egypt, Ecuadorian, and Indonesia found that maternal

education was one of the most consistent factors

associated with child malnutrition (Katoch, 2022). A

previous study in Indonesia also found that the

prevalence of underweight and stunting among

children under five years old in rural areas was

influenced by maternal knowledge of nutrition and

health issues as well as growth monitoring programs

(Sahanggamu, Purnomosari, & Dillon, 2017).

Indonesia has Posyandu (Integrated Service Post) that

provides basic health services such as mother and

child health, nutrition, immunization, disease control

(diarrhea prevention), and family planning (Health,

2006). Monitoring the nutritional status of children

under five was the main reason mothers attended

Posyandu in Indonesia (Nazri et al., 2016). Moreover,

improved health services and providing mothers and

Wisnuwardani, R. W., Putri, L. A. and Kamba, I.

Mother’s Nutritional Knowledge, Posyandu Participation, and Nutritional Status of Children Under Two Years in Tenggarong District, Indonesia.

DOI: 10.5220/0012902500004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 155-159

ISBN: 978-989-758-727-6; ISSN: 2975-8297

155

caregivers with nutrition and health information will

have a significant impact on young children’s

nutritional status, especially in rural areas where

accessibility is a major challenge. Besides, similar

studies have not been undertaken in children under

five years in Kutai Kartanegara. Therefore, this study

aimed to examine the association between mothers’

nutritional knowledge, posyandu participation, and

the nutritional status of children in Kutai Kartanegara.

2 MATERIAL AND METHODS

2.1 Study Population

This cross-sectional study collected data from 103

mothers who have children aged 6 to 23 months at the

Rapak Mahang Health Center, Kutai Kartanegara, in

July 2022. The study population was mothers who

had children aged 6 to 23 months (399 participants).

Purposive sampling was used to select the sample,

including mothers with children aged 6-23 months

residing in the service area of Health Centre Rapak

Mahang, Tenggarong, Kutai Kartanegara. Eligibility

criteria encompassed willingness to participate and

possession of a maternal and child health book.

Exclusion criteria involved mothers or children with

illnesses.

2.2 Demographic Measurement

Sex, age, maternal education, and maternal

employment data were collected using the

standardized questionnaire. Maternal education was

categorized into four levels: lower education,

secondary education, higher secondary education, or

university education. Maternal employment was

classified as housewife, civil servant, or entrepreneur.

Children’s age was categorized into 6-8 months, 9-11

months, and 12-23 months, defined as the dietary

pattern.

2.3 Mother’s Knowledge, Mother’s

Participation, and Nutritional

Status of Under-Five Children

Mother’s knowledge was defined as understanding

the principles of balanced nutrition and insight into

providing appropriate food for children based on their

age, including the type of food, quantity, and meal

schedule. The questionnaire for assessing maternal

knowledge consisted of 20 questions related to

toddler feeding. Each question was scored with 5

points for ‘True’ and 0 points for ‘Wrong.’ Mother’s

knowledge was categorized as follows :≥ average and

below average.

Mother’s participation involved mothers bringing

their children under five to Posyandu for monthly

weighing. Questionnaires and data were employed to

assess maternal activity. A mother was categorized

active if her child under five is weighted at Posyandu

a minimum of 8 times per year.

The nutritional status of children under five was

assessed through anthropometric measurements,

including weight/height, and recorded in the maternal

and child books. The criteria for nutritional status

followed the World Health Organization guidelines

and categorized as malnutrition (severely wasted,

wasted, overweight, and obesity) and good nutritional

status (-2 sd to +2sd IMT/U).

2.4 Statistical Analysis

Statistical analyses were performed using IBM SPSS

Statistics version 23 (IBM, New York, USA), and the

significance level was established at a two-sided p-

value of less than 0.05. Data were displayed as

percentages and number of samples.

The correlation between maternal knowledge,

maternal participation, and the nutritional status of

children under the age of five was examined through

the Chi-Square test.

3 RESULTS

3.1 General Characteristics of the

Subjects

The baseline characteristics of 103 participants are

summarized in Table 1. Most participants were aged

between 20 and 35 years (73%), had attained higher

education (80%), were housewives (87%), had

children aged 12 to 23 months (42%) and of those

children, the majority were boys (52%). No

significant difference between general characteristics

and the nutritional status of children, except the

children’s gender. Boys were higher in malnutrition

status.

ICSDH 2023 - The International Conference on Social Determinants of Health

156

Table 1: General characteristics (n=103).

Characteristics Nutritional Status

-value

Goo

Malnutrition

Maternal age 0.534

20-35

ears 58 17

>35 years 20 8

Maternal education 0.767

Universit

8 2

her education 62 20

Secondary

education

6 3

Low education 2 0

Maternal em

ment 0.600

Civil servant 5 0

Entre

reneu

4 1

Housewife 67 23

Others 2 1

Age of children 0.553

6-8 months 17 8

9-11 months 28 7

12-23 months 33 10

Sex of children 0.018

s 35 18

Girls 43 7

*chi-s

uare test

3.2 Mother’s Knowledge and

Nutritional Status

The majority of participants (60.2%) possessed

sufficient knowledge of balanced nutrition (60.2%).

However, no correlation was found between mothers’

nutrition knowledge and their children’s nutritional

status (p value=0.982) as indicated in Table 2. It was

observed that mothers with a good or medium

understanding of balanced nutrition generally had a

higher proportion of children with better nutritional

statuses.

3.3 Mother’s Participation, and

Nutritional Status

A significant association was discovered between

mothers’ participation in Posyandu and nutritional

status (as shown in Table 2). The majority of active

participants exhibited favorable nutritional status for

their children.

Table 2: Mother’s knowledge, mother’s participation, and

nutritional status of children (6-23 months)

Variable Nutritional Status p-value

Goo

Malnutrition

Mother’s knowled

e 0.982

≥average 47 15

<average 31 10

Mother’s participation <0.0001

Active 71 12

Non-active 7 13

*Chi-square analysis

4 DISCUSSION

The proportion of baby girls with a good nutritional

status was higher compared to baby boys. This trend

is consistent with a systematic review study that

highlighted the association between the sex of

children and malnutrition (Katoch, 2022). A similar

finding was also discovered in Ethiopia (Yirga,

Mwambi, Ayele, & Melesse, 2019). This difference

may be attributed to various biological factors. Baby

girls might follow distinct growth patterns and

possess distinct nutrient requirements when

compared to baby boys. Biological variances in

metabolism, hormonal influences, and nutrient

utilization could contribute to the observed variation

in nutritional status.

Furthermore, cultural practices and gender norms

might account for disparities in the care and feeding

of baby girls and boys. For example, a prior study

conducted in Indonesia indicated that gender-related

and socio-economic status-related effects of ethnicity

on dietary diversity were present (Kunto & Bras,

2019). These factors collectively shape the nutritional

outcomes of infants.

No significant association was identified between

mothers’ knowledge and the nutritional status of

children in the working area of Rapak Mahang

Community Health Center

. Similar findings were

also found in Ghana (Forh, Apprey, & Frimpomaa

Agyapong, 2022). This absence of a significant

association can be attributed to various factors.

Nutritional status is influenced by a wide range of

factors, including dietary habits (Khadija et al., 2022),

access to healthcare, socioeconomic status, and

overall living conditions (Ernawati, Syauqy, Arifin,

Soekatri, & Sandjaja, 2021; Eshete, Abebe, Loha,

Gebru, & Tesheme, 2017; Katoch, 2022; Maulina,

Qomaruddin, Kurniawan, Fernandes, & Astuti, 2022;

Yirga et al., 2019). While mothers’ knowledge about

nutrition is indeed important, it might not directly

translate into improved nutritional outcomes for

children (Khadija et al., 2022). Challenges in

converting knowledge into practical dietary choices

or caregiving practices could weaken the observed

association. Furthermore, cultural beliefs, practices,

and societal norms related to child nutrition might

interact with mothers’ knowledge in intricate ways,

Mother’s Nutritional Knowledge, Posyandu Participation, and Nutritional Status of Children Under Two Years in Tenggarong District,

Indonesia

157

potentially influencing the observed association

(Kunto & Bras, 2019). Additionally, the small sample

size could potentially reduce the statistical power

necessary to detect a significant association that

might indeed exist in the broader population.

A significant association was observed for

mothers’ participation in Posyandu. A similar finding

was reported in the Cianjur District, West Java, where

a study indicated that the more frequent the visits to

Posyandus, the better the nutritional statuses would

be (Anwar, Khomsan, Sukandar, Riyadi, &

Mudjajanto, 2010). The primary reason participants

attend Posyandu is to monitor the nutritional status of

children under five. As a result, enhancing the quality

of Posyandu services and providing qualified

resources are essential to promote mothers’

participation (Nazri et al., 2016). Therefore, effective

coordination between relevant agencies is necessary

to address multiple factors influencing the nutritional

status of children. The coordination is crucial to

achieve the reduction and prevention of child

malnutrition effectively (Sufri et al., 2023).

5 CONCLUSIONS

No significant association was found between

mothers’ knowledge and the nutritional status of

children (6-23 months), whereas a significant

association was found for mothers’ participation in

Posyandu in the working area of Rapak Mahang

Community Health Center, Kutai Kartanegara.

Future studies should consider a larger sample size,

conduct longitudinal analyses, and explore other

factors that influence the nutrition of children.

ACKNOWLEDGEMENTS

The author expresses gratitude to the Kutai

Kartanegara Health Office, Rapak Mahang

Community Health Center, and all participants who

willingly took part in this research.

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