Proceedings of International Conference on Applied Science and Health

(No.4,2019)
Science for the mankind: Translating research results into policy and practices

ICASH-A019

THE CORRELATION BETWEEN EDUCATION, WORK, AND

MATERNAL KNOWLEDGE ON COMPLEMENTARY FEEDING WITH
6-24 MONTHS' NUTRITIONAL STATUS
Dina Alfiana*, Witri Pratiwi, Muhammad Edial Sanif

Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon, Indonesia

*Corresponding author’s email: [email protected]

ABSTRACT

Background: Indonesian Basic Health Research in 2018 reported that the prevalence of malnutrition
in Indonesia was 17.7% which consists of 13.8% malnutrition and 3.9% severe malnutrition. In West
Java Province, the prevalence of malnutrition and severe malnutrition is still high at 15.6%. The aim of
this study is to examine the correlation between education, work, and maternal knowledge about
complementary feeding with baby nutrition status aged 6-24 months.
Methodology: This was a cross sectional study. The sample of this study was 100 mothers of infants
aged 6 to 24 months in the Tegalgubug Health Center, in Cirebon City which selected by cluster
sampling. Data have been collected from questionnaires and anthropometric measurement of
weight for age Z (WAZ). Nutritional status was categorized into malnutrition status if z score <-2 SD
up to <-3 SD, and good nutrition status if z score -2 SD to 2 SD. The analysis of the study was tested by
Spearman correlation.
Results: From 100 respondents,51% of them were low educated mother, 55% were working mother,
51% had good knowledge, and 83% had good nutrition’s babies. The bivariate analysis showed that
education, working status, and mother’s knowledge about complementary feeding were statistically
significant correlated with nutritional status of infants (p=0.021, p=0.020, p=0.013, respectively).
Conclusion: Education, working status, and knowledge were significant correlated with nutritional
status of infants aged 6 to 24 months. Malnutrition of infants can be greatly reduced by educating
maternal about complementary feeding and given accurate information about nutritional status of
infants.

Keywords: Education, complementary feeding knowledge, nutritional status

INTRODUCTION
Nutrition is substantial for child growth and development. Adequate nutrition is needed for the
development of children, with the period from pregnancy to the age of two years becomes the most
critical times for growth, health and optimal development in the future. The Global Strategy for Infant
and Young Child Feeding (IYCF) states that the importance of feeding babies and young children
includes breast milk and complementary feeding as main determinant of child nutrition [1].
Indonesian Basic Health Research in 2018 reported that the prevalence of malnutrition in
Indonesia was 17.7% which consists of 13.8% malnutrition and 3.9% severe malnutrition. It declined
1.9% from the result of the Indonesian Basic Health Research in 2013 where the Indonesian toddlers
experienced malnutrition; meanwhile, malnutrition declined 0.1% from 2013. In West Java, the
prevalence of malnutrition and severe malnutrition are still high at 15.6% [2]

154
 Proceedings of International Conference on Applied Science and Health
(No.4,2019)
Science for the mankind: Translating research results into policy and practices

Mother is the main source of care that her child needs during the first five years of life. Knowledge of
food need is very important for good health and overall nutritional status. Sometimes, mothers do not
know the importance of variety and balance in food, the right amount and types of food needed by
children to meet their food needs.Without adequate knowledge, malnutrition and poor nutritional
status may occur in house holds with adequate income, food and health services [3].
Mother’s education has been proven to be the most important predictor of chronic malnutrition. The
possible explanation could be that the knowledge and understanding of mothers have on child nutrition
and feeding practices are likely to have a positive impact on their children nutritional status. Proper
education of mothers, in addition to improving their children’s feeding practices, will lead them to
recognize signs of malnutrition and increase health care seeking behaviors [4].
In addition to mother’s education, what contributes to infant nutritional status is working mother.
Working mothers have higher level of information than normal housewife since the formers
have greater exposure on nutritional status information [5], and have benefit in fulfilling nutrition in the
household. It may also be important for mothers to have their own money so that they can buy
a variety of food for babies. Therefore, working mothers could be an important step to take in
improving child nutritional status [6].
To achieve optimal growth and development, in the Global Strategy for Infant and Young Child
Feeding, WHO/UNICEF recommendations, there are four important things to do. First, giving
breastmilk to the baby immediately within 30 minutes after the baby is born. Second, giving only
breastmilk or exclusive breastmilk from birth until the baby is 6 month old. Third, giving
complementary feeding since the baby is 6 month old to 24 month old. And fourth, continuing
breastmilk until the child is 24 month old or more [7].
In the developing countries, adequate nutrition is not fulfilled as a result of poverty, poor of knowledge
about nutrition, poor child feeding and infections leading to high mortality [8]. In addition,
complementary feeding is given too early and the quality and quantity of food is insufficient; thus,
children are at risk of nutritional deficiency [9]. Seeing this background, the aim of this study
is to assess the correlation of mother’s education, occupation, and knowledge of complementary
feeding with nutrition status of 6-24 month old babies in the Community Health Center of Tegalgubug,
Cirebon Regency.

METHODS
This study used an observational analytical study with a Cross Sectional approach. It emphasizes the
measurement and observation data at one time on the dependent variable and the independent variable.
It was conducted from January to March 2019. It assessed the mother’s education, occupation,
knowledge about complementary feeding and the baby nutritional status from11 [Integrated Health
Post in the working area of the Community Health Center of, Tegalgubug Cirebon Regency. The sample
of 100 mothers with 6-24 month old babies determined using cluster sampling technique. The
respondents participated in this study were asked for written approval by filling out the informed
consent.
Subjects of Research
There are three main subjects included in this study. First, 6-24 month old babies who came to the
Integrated Health Post. Second, the mothers/caregivers who were willing to be the respondents and fill
out the questionnaire. Third, the mothers with 6-24 month old babies living in the working area of the
Community Health Center of Tegalgubug, Cirebon Regency. The excluded subjects in this study
are the babies with an infectious disease and mothers with babies suffering from chronic illness.

155
 Proceedings of International Conference on Applied Science and Health
(No.4,2019)
Science for the mankind: Translating research results into policy and practices

Levels of Mother’s Education, Work and Knowledge about Complementary Feeding

Subjects were given a questionnaire containing about mother’seducation, occupation and knowledge
regarding the complementary feeding. The level of knowledge can be divided into poor knowledge
if < median value and good knowledge if > median value.
Measurements
Anthropometric measurements (weight and age) were obtained from babies included in the study. The
nutritional status indicators, weight for age Z (WAZ), were compared to the reference data from World
Health Organization standards [10]. Children below <-2 up to <-3 standard deviations (<-2 SD to
<−3 SD) of the WHO median for WAZ were considered malnutrition, while below -2 to 2 standard
deviations (-2SD to 2 SD) were considered good nutrition. To find out the correlation of mother’s
education, occupation and knowledge of complementary feeding with nutritional status of 6-24 month
old babies in this study, the collected data were analyzed using Spearman correlation.

RESULTS
Characteristic of respondents
From 100 respondents included in this study, most of the mothers are <35 year old of 76%, 13-24
month old babies of 51%, and the baby’s gender of the babies is mostly female of 57%.

Correlation of mother’s education, occupation and knowledge of complementary feeding with

nutritional status of 6-24-month-old babies
The correlation of education, occupation and knowledge of complementary feeding with nutritional
status of 6-24 months old babies. Data were analyzed using by Spearman’s correlation with significant
level of p<0,05.
Table 1. The correlation of mother’s education, occupation and knowledge of complementary
feeding with nutritional status of 6-24-month-old babies
Nutritionstatus
Variable Total pvalue r
Malnutrition Good
Education
13 38 51
Low
(13%) (38%) (51%)
0.021 0.231
4 45 49
High
(4%) (45%) (49%)
17 83 100
Total
(17%) (83%) (100%)

Occupation
11 34 45
Unemployed
(11%) (34%) (45%)
0.020 0.233
6 49 55
Employed
(6%) (49%) (55%)
17 83 100
Total
(17%) (83%) (100%)

Knowledge
13 36 49
Poor
(13%) (36%) (49%)
0.013 0.249
4 47 51
Good
(4%) (47%) (51%)
17 83 100
Total
(17%) (83%) (100%)

156
 Proceedings of International Conference on Applied Science and Health
(No.4,2019)
Science for the mankind: Translating research results into policy and practices

Spearman’s correlation analysis shows that there was a significant correlation (p=0.021) of the
mother’s education with the nutritional status of 6-24 month old babies, i.e. weak correlation (r = 0.231),
significant correlation (p=0.020) of the mother’s occupation with nutritional status of 6-24 month old
babies, i.e. weak correlation (r=0.233) and significant correlation (p=0.013) of the mother’s
knowledge about complementary feeding with nutritional status of 6-24 month old babies, i.e. weak
correlation (r=0.249).

DISCUSSION
The role of mothers is important in providing care for early childhood. Mother’s education is
one of the key factors for the improvement of child health levels and plays a significant role in child
cognitive development and educated mothers have more accesses to information, implement good
health practices and take part in solving family health issues [5].
Based on the results of Spearman correlation analysis, pvalue was 0.021 with correlation coefficient value
of 0.231, meaning that there was a significant correlation of the mother’s education variables
with nutritional status of 6-24-month-old babies in the Community Health Center of Tegalgubug, Cirebon
Regency, with a weak correlation and positive correlation. These results are in line with previous research
conducted by Berisha (2017) showing that there was a significant correlation of mother’s knowledge of
complementary feeding with their level of education[11].
Mother’s education becomes a factor that influences the knowledge of food security. The level of
knowledge is higher for those who have an academic education because in academic education,
knowledge of providing complementary food, food safety, suitable foods for children, how to cook the
right food is better [12]. It doesn’t mean that someone who has low level of education is also
absolutely poor in knowledge, since it can be obtained not only from formal education, it is also
can also be obtained from non-formal education directly or indirectly such as mass media,
counseling, and leaflets [13]. This study shows that mother’s education in the working area of
the Community Health Center of Tegalgubug is low(51%).
Mother’s occupation is another effective factor for knowledge of food security, and working mothers
have a higher level of information than unemployed mothers since working mothers have greater
exposure to higher levels of information [12].
Based on the results of Spearman’s analysis, pvalue was 0.020 with correlation coefficient value of 0.233.
It means that there was a significant correlation of mother’s occupation with nutritional statusof
6-24 month old babies, with a weak correlation and positive correlation. It is in line with previous
research conducted by Firdisa (2018) stating that mothers’ education level, age and occupation have a
significant influence on the mothers’ knowledge of complementary feeding, attitudes and nutritional
status of infants/young children [14].
In the Community Health Center of Tegalgubung, Cirebon Regency, most of the mothers are working
(55%) and have good nutrition (49%). Working mothers will improve household opinion and have benefit
in fulfilling nutrition for the household and herself. Working mothers can improve the status and
strength of women and their income is used for health and nutrition needs. This affects the welfare of
children, including the development of healthy children. Children of unemployed mothers were
severely wasted compared to children of working mothers [6].
Based on the results of Spearman correlation analysis, pvalue was 0.013 with correlation coefficient value
of 0.249. It means that there was a significant correlation of mother’s knowledge of complementary
feeding with nutritional status of 6-24 month old babies, with weak correlation and positive correlation.
It is inline with previous research conducted by Siagian (2014) stating that there is a correlation

157
 Proceedings of International Conference on Applied Science and Health
(No.4,2019)
Science for the mankind: Translating research results into policy and practices

of mother’s knowledge with children’s nutritional status [15].

In the Community Health Center of Tegalgubug, Cirebon Regency, most of the mothers have a good
knowledge of complementary feeding of 51% and good nutrition of 47%. The knowledge of food
ingredients will affect the dishes served in the family. With adequate knowledge, the mother will
provide good food for the family, especially for babies. Therefore, it is expected that nutrition for children
will be fulfilled as their needs. Poor knowledge of nutrition will affect the emergence of nutritional
problems leading to the emergence of nutritional problems that will disrupt the growth and development
of children [15].
The poor level of mother’s knowledge of children’s health and nutrition shows a lack of adequate nutrition
and health education for mothers. It can be attributed to the mother’s education level because it has an
effect on the mother’s knowledge of health and nutrition, attitudes and food intake of children [3]. It is
important to provide accurate information and education about complementary feeding to prevent
malnutrition and improve children’s health status [16]. Increased mother’s knowledge and attitudes
through nutrition counseling and education can lead to the increased practice of feeding infants
and children, and consequently, enhancing children’s growth and development [17].

CONCLUSION
From the result of this study, it can be concluded that there is significant correlation of mother’s education,
occupation and knowledge of complementary feeding with nutritional status of 6-24 month old babies
with a weak correlation and positive correlation. The limitation of this study is that it depends
on what the respondents remember about the time of giving food and drink to the babies and
the coverage of the research which is less extending. For Community Health Center, malnutrition of
infants can be greatly reduced by educating the mothers about complementary feeding and giving
accurateinformation about nutritional status of thebabies.

CONFLICT OF INTEREST
The authors declare no conflict of interest

REFERENCES
1. Amunga, D. Complementary Feeding Practices And The Anthropometric Status Of Children Aged Six To 23 Months Among The
Pastoralist Communities Of Isiolo County. Afrika : Stellenbosch University;2015. https://scholar.sun.ac.za/handle/10019.1/96623.
(accessed: 25 March2019)
2. RISKESDAS (Indonesian Basic Health Research). Ministry of Health. Indonesia : Health Research. 2018.
http://www.kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Hasil-riskesdas-2018_1274.pdf. (accessed: 10 June2019)
3. Jemide J, Obong H, Edet E, Udoh E. Association of maternal nutrition knowledge and child feeding practices with nutritional status of
children in Calabar South Local Government Area, Cross River State in Nigeria. Home Science. 2016;2(1):293-
298.https://www.researchgate.net/publication/326207982_Association_of_maternal_nutrition_knowledge_and_child_feeding_practice
s_with_nutritional_status_of_children_in_Calabar_South_Local_Government_Area_Cross_River_State_Nigeria. (accessed: 25 March
2019)
4. Eshete H, Abebe Y, Loha E, Gebru T, Tesheme T. Nutritional Status and Effect of Maternal Employment among Children Aged 6–59
Months in Wolayta Sodo Town. A Cross-sectional Study. 2017; 27(1):155. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440830/.
(accessed: 23 April2019)
5. Haq I. et al. Maternal Formal Education in Association with Nutritional Status of Children (Less-than Two Years) in China.
2017;4(2):162. http://www.opensciencepublications.com/wp-content/uploads/IJN-2395-2326-4-162.pdf. (accessed: 23 April2019)
6. Negash C, Whiting S, Henry C, Belachew T, and Hailemariam T. Association between Maternal and Child Nutritional Statusin
Hula. A Cross Sectional Study. 2015. https://jurnals.plos.org/plosone/article?id=10.1371/journal.po ne.0142301. (accessed: 6
June2019)
7. DepKes RI (Indonesia Departement of Health). Pedoman Umum Pemberian Makanan Pendamping Air Susu Ibu Lokal (The General
Guidelines of Local Complementary Feeding). Jakarta : Departemen Kesehatan Republik Indonesia ;2006.
8. Lodha S. Assessment Of Complementary Feeding Practices And Misconceptions Regarding Foods In Young Mothers. Food And
Nutritional. 2013;2(3):85-90. https://www.ijfans.com/vol2issue3/15.pdf. (accessed: 25 March2019)
9. Kimwele A, and Ochola S. Complementary Feeding and the Nutritional Status of Children 6-23 Months Attending Kahawa
West Public HealthCenter in Nairobi. Health Science. 2017;6(2):17-26.
https://www.researchgate.net/publication/316178877_Complementary_Feeding_and_the_Nutritional_Status_of_Children_6-
23_Months_Attending_Kahawa_West_Public_Health_Center Nairobi. (accessed: 25 March2019)

158
 Proceedings of International Conference on Applied Science and Health
(No.4,2019)
Science for the mankind: Translating research results into policy and practices

10. WHO.Child Growth Standards: lenghtth/height-for-age, weight–for-age, weight-for-height and body mass indx-for-age:methodsand
development. Geneva: World Health Organization.2006.
11. Berisha M. et al. Knowledge, Attitudes and Practices of Mothers in Kosovo About Complementary Feeding for Infant and Children 6-
24 Months. 2017;71(1):37-41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364788/. (accessed: 25March(2019
12. Yeganeh S, Motamed N, Boushehri S. Pauladi S, Ravanipour M. Mothers' Knowledge and Attitude toward Food Security in
Complementary Feeding of 1-2 Year Old Offspring and its Relation with Demographic Indices. Evidence Based Care Journal.
2017;7(4):22-29. http://ebcj.mums.ac.ir/article_9983_1195.html. (accessed: 25 March2019)
13. MihretieY. Maternal Knowledge on Complementary Feeding Practice and Nutritional Status of Children 6-23 Months in Jigjiga
Town. 2018;1(1):9-10. https://irispublishers.com/gjnfs/pdf/GJNFS.MS.ID.000505.pdf. (accessed: 10 June2019)
14. Goshu F . Complementary Feeding Knowledge of Mother and Nutritional Status of Infant/Young Children (6-23 Months) in Ethiopia.
Health Economics and Policy.2018;3(4):44-51.
https://www.researchgate.net/publication/331832450_Complementary_Feeding_Knowledge_of_Mother_and_Nutritional_Status_of_I
nfantYoung_Children_6-23_Months_in_Ethiopia. (accessed: 25 March2019)
15. Siagian C, and Halistijayani M. Mothers Knowledge On Balanced Nutrition To Nutritional Status of Children in Puskesmas (Public
HealthCenter)InTheDistrictofPancoran,SouthernJakartainIndonesia.CurrentMicrobiologyandAppliedSciences.2015;4(7):815- 826.
http://repository.uki.ac.id/id/eprint/59. (accessed: 25 March2019)
16. Sethi R, Padhy S, and Raju D. Knowledge, attitude and practices regarding complementary feeding among mothers of children 6 to 24
months of age in Konaseema region. Contemporary Pediatrics. 2017;4(2):394-398.
https://www.ijpediatrics.com/index.php/ijcp/article/view/514 (accessed: 25 March2019)
17. Owais A. et al. Maternal knowledge and attitudes towards complementary feeding in relation to timing of its initiation in rural
Bangladesh. 2019:5-7. https://bmcnutr.biomedcentral.com/articles/10.1186/s40795-019-0272-0. (accessed: 25 March2019)

159