J Community Med Pub Health Res Moediarso et al

Vol 1, No 1, June 2020 Pregnant Women With Chronic Energy Deficiency

DIFFERENTIATE FACTORS OF PREGNANT WOMEN WITH CHRONIC

ENERGY DEFICIENCY OCCURRENCE IN BAJULMATI VILLAGE,
WONGSOREJO DISTRICT, BANYUWANGI REGENCY 2019

Bisyamsi Nawaijaya Moediarso1, Perthdyatama Syifaq Budiono1, Mohammad Fata

Fatihuddin1, Theophilus Tan Zhu En1, Berli Arfani Rantam1, Ayu Liana Gunawan1,
Masyithoh Wahyu Diani1, Anjelina Kristina Mogi1, Koyuki Atifa Rahmi1, Auliai
Khoirunnisa1, Birgitta Vania Rarasati1, Cincin Hari Purwati2, Linda Dewanti3, Djohar
Nuswantoro3
1
Medical Students, Faculty of Medicine, Universitas Airlangga, 2Head of Puskesmas
Bajulmati, Banyuwangi Regency, 3Community Medicine Coordinating Bureau, Faculty of
Medicine, Universitas Airlangga

ABSTRACT

Riskesdas result in 2013 showed that the prevalence of WUS / eligible women population who
were pregnant and at risk of CED was 24,2%. CED in pregnant women can cause abortion
and premature birth, low birth weight babies and infant disability, children become
malnourished and brain development is hampered, and children are at risk of developing
metabolic diseases. In Bajulmati Village there were 15 pregnant women. 40% of 15 pregnant
women suffer from CED. The purpose of this study was to determine differences between
groups based on maternal age, maternal occupation, family income, previous pregnancy
history, history of chronic illness, and maternal knowledge about nutrition in the incidence of
pregnant women with CED in Bajulmati Wongsorejo Banyuwangi and differences in
knowledge levels and attitudes towards behavior about nutrition after an intervention. An
observational analytic, cross-sectional research design using questionnaires and
observations. The sample selection technique uses a total sampling technique. There were
significant differences between groups based on family income in the incidence of CED in
pregnant women and previous pregnancy history in the incidence of CED in pregnant
women. The level of knowledge gained after the intervention was in the form of counseling to
Prevent CED significantly.

Keywords : Pregnant women, CED, balanced nutrition, level of knowledge

Correspondence : Linda Dewanti, Community Medicine Coordinating Bureau, Faculty of

Medicine, Faculty of Medicine, Universitas Airlangga, Jl. Mayjen. Prof. Dr. Moestopo 47
Surabaya 60131 Gedung DR-C, 08123510016, [email protected]

INTRODUCTION public health efforts available, there are

issues to be addressed, namely the
Essential public health efforts prevention and control of disease. Chronic
include the promotion of health, Energy Deficiency (CED) is a lack of
environmental health, maternal and child energy intake that lasts longer.
health, family planning, nutrition services, Anthroprometically, CED can be
and prevention and control of diseases, as established if MUAC <23,5 cm or BMI is
well as treatment. Of the six essential less than 18.5kg / m2. Indonesia is a

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country rich in natural resources but there needs increase by requiring an additional
are many cases of chronic energy about 80,000 calories for approximately
deficiency (CED). This is caused by an 280 days.3 Poor dietary patterns and poor
imbalance in nutrient intake so that it can portions are a common cause of chronic
lead to imperfect body growth both energy deficiency sufferers.4 Chronic
physically and mentally.1 energy deficiency can cause problems for
pregnant women and the fetus they
According to the 2007 Riskesdas contain. To identify pregnant women who
results, the province of East Java is one of are at risk of chronic energy deficiency
10 provinces in Indonesia with a CED (CED), measurement of upper arm
prevalence of women of childbearing age circumference (MUAC) and body mass
above the national prevalence (13,6%). index (BMI) can be used. If a pregnant
While the results of Riskesdas in 2013 woman has a MUAC size of less than 23,5
showed that the prevalence of female cm and or a BMI of less than 18,5 kg / m2
population of childbearing age (ages 15– then the pregnant woman has reached the
49 years) was pregnant and at risk of CED risk limit for CED.5
in East Java by 29,8%, while at the
national level the prevalence of WUS MATERIALS AND METHODS
population who were pregnant and at risk
of CED was 24,2%. This shows that the This is an observational analytic
population of pregnant women and CED in study with cross sectional research design.
East Java is still higher than at the national This research will find out the factors that
level.2 distinguish the incidence of CED in
pregnant women in Bajulmati Village,
The prevalence of CED risk in Wongsorejo District, Banyuwangi
pregnant women (15-49 years) is 24.2%, Regency. Collection in this study is to use
especially the highest prevalence found in primary data, namely data taken directly
adolescents (15-19 years) by 38.5% by researchers with questionnaires, the
compared to the older group (20-24 years) questionnaire used is a questionnaire to
of 30, 1%. The proportion of pregnant know the factors which distinguishes the
women with an energy adequacy level of incidence of CED in pregnant women.
less than 70% of the energy adequacy rate Data processing is done through several
is slightly higher in rural areas compared stages, the first stage of editing is the
to urban areas, which is 52.9% compared activity to check the questionnaire sheet
to 51.5%. While the proportion of pregnant and observation for completeness of the
women with a protein adequacy level of data so that if there is a discrepancy can be
less than 80% the protein adequacy rate is completed immediately by the researcher.
also higher in rural areas compared to The second stage of coding is to give a
urban areas that is 55.7% compared to certain code or number to the
49.6%.2 questionnaire to make it easier when
conducting tabulation and analysis. The
Chronic energy deficiency is one third stage is the entry of entering data
thing that causes a high risk in a from the questionnaire into SPSS software
pregnancy. During pregnancy, energy version 17.0. Data analysis to see the

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difference was done by chi-square test and was measured by 1 question in the
fischer exact. questionnaire. The questionnaire
instrument to determine the knowledge of
The population is pregnant women pregnant women about nutrition in this
in Bajulmati Village, Wongsorejo District, study was measured by 12 questions in the
Banyuwangi Regency. The sample questionnaire with an Alpha Cronbanch
selection technique uses total sampling questionnaire value of 0,621.
with 15 pregnant women. The target
sample is pregnant women in Bajulmati Variable Factors Distinguishing
Village. In the study sample, researchers CED Incidence in Pregnant Women in
included criteria for the samples taken. Bajulmati Village, Wongsorejo
Samples taken are based on inclusion Subdistrict, Banyuwangi Regency in 2019
criteria, which are characteristics of Dependent Variables are CED in pregnant
samples that can be included or deserve to women and Independent Variables are the
be studied. Inclusion criteria in this study age of pregnant women, maternal
are: Pregnant women, willing to be occupation, family income, previous
respondents, able to communicate actively. pregnancy history, history of chronic
Exclusion criteria: Can not read, write, illness and levels of chronic illness and
hear. levels knowledge about nutrition.

The instruments used in this study Test Validity According to

were structured questionnaires, gauges, Notoatmodjo (2010), validity is an index
body scales, and stationery. The that shows the measuring instrument
questionnaire instrument to measure the actually measures what is measured.6 The
nutritional status of pregnant women in instrument used in this study was a
this study is a meter to measure MUAC questionnaire. To get valid and reliable
and maternal height and scales to measure data, the questionnaire must be tested for
maternal weight. The questionnaire validity and reliability. Before the
instrument to determine the age of questionnaire was used in the study, the
pregnant women in this study was questionnaire was tested for validity using
measured by 1 question in the the Pearson product moment correlation
questionnaire. The questionnaire formula. If the value of r count is greater
instrument to find out the work of mothers than r table means it is valid whereas if the
in this study was measured by 1 question value of r count is smaller than r table
in the questionnaire. The questionnaire means it is invalid. Reliability is an index
instrument to determine family income in that shows the extent to which a
this study was measured by 1 question in measurement tool can be trusted or
the questionnaire. The questionnaire reliable. This means showing the extent to
instrument to determine the history of which the measurement results remain
previous maternal pregnancy in this study consistent when measuring twice or more
was measured by 2 questions in the of the same symptoms, using the same
questionnaire. The questionnaire measuring instrument. Reliability
instrument to determine the history of measurement using the help of computer
suffering from chronic illness in this study software with Cronbach Alpha formula. A

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variable is said to be reliable if it gives an out a reliability test with the results of the
Alpha Cronbanch value> 0,60. Validity Alpha Cronbanch 0,621, so the
and Reliability Test Results The questionnaire was declared valid.
questionnaire used in this study had carried

RESULTS

Table 1. The results of the study below show the factors that are thought to distinguish the incidence
of CED in pregnant women in Bajulmati Village, Wongsorejo District, Banyuwangi
Regency in 2019

Frequency Percentage (%)

Nutritional Status of Pregnant Women
Normal 9 60
CED 6 40
Total 15 100
Age when pregnant
21-35 years old 11 73.3
<21 /> 35 years old 4 26.7
Total 15 100
Profession
Work 3 20
Does not work 12 80
Total 15 100
Income
Above Regional Minimum Wages 53 33.3
Under Regional Minimum Wages 10 66.7
Total 15 100
Previous Pregnancy
Ever pregnant 12 80
Never pregnant 3 20
Total 15 100
History of Chronic Disease
Yes 2 13.3
No 13 86.7
Total 15 100
Knowledge level
High 10 66.7
Moderate 5 33.3
Low 0 0
Total 15 100

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Table 2. Factors Differentiating CED Maternal in the Wongsorejo District, Banyuwangi Regency in
2019

Normal Nutritional Total Significance

status of Value
CED
Age when pregnant
21-35 years old 8 (%) 3 (%) 11 (100%) 0.235
<21 /> 35 years old 1 (%) 3 (%) 4 (100%)
Profession
Work 3 (100%) 0 (0%) 3 (100%) .229
Does not work 6 (50%) 6 (50%) 12 (100%)
Income
Above Regional Minimum Wages 5 (100%) 0 (0%) 5 (100%) 0.044 *
Under Regional Minimum Wages 4 (40%) 6 (60%) 10 (100%)
Previous Pregnancy
Ever pregnant 9 (%) 3 (%) 12 (100%) 0.044 *
Never pregnant 0 (%) 3 (%) 3 (100%)
History of Chronic Disease
Yes 1 (50%) 1 (50%) 2 (100%) 1,000
No 8 (%) 5 (%) 13 (100%)
Knowledge level
High 7 (70%) 3 (30%) 10 (100%)
0.329
Moderate 2 (40%) 3 (60%) 5 (100%)
Low 0 (0%) 0 (0%) 0 (100%)

From the table above, it can be seen no significant differences between groups
that there were no significant differences based on the age of pregnant women in the
between groups based on age during incidence of CED. This is in accordance
pregnancy, occupation, history of chronic with research conducted by Wijayanti
illness, and the level of maternal (2016) which states that there is no
knowledge in the incidence of CED in significant corellation between age and the
pregnant women, indicated by a incidence of CED in pregnant women.
significance value > 0,05. There were This is consistent with the theory which
significant differences between groups states that the best age to get pregnant is
based on family income and previous more than 20 years and less than 35 years
pregnancy history in the incidence of CED in the hope that the nutrition of pregnant
in pregnant women, indicated by a women will be better.7
significance value < 0,05.
However, based on data from
DISCUSSION research conducted by Triatmaja (2017)
and Mulyaningrum (2009), maternal age is
Maternal age is one of the factors related to the prevalence of CED in
that influence the nutritional status of pregnant women. This is because pregnant
pregnant women. In this study, there were women who are young, ie less than 20

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years, require far more nutrients for fetal significant corellation between monthly
growth and growth of the mother's own income and the incidence of CED in
body than pregnant women who are of pregnant women. This situation concludes
ideal age, thereby increasing the risk of that the proportion of CED pregnant
CED.8-9 women is higher for mothers from families
with income less than Rp.1,120,000 in a
Work is also thought to affect the month. The higher the level of family
occurrence of CED in pregnant women. In income, the higher the purchasing power
this study, there were no significant of the family to meet household needs so
differences between groups based on the that the nutritional status of pregnant
workings of pregnant women in the women tends to be better so that it is less
incidence of CED. This is in accordance likely to risk CED compared to pregnant
with research conducted by Indriani et al women who come from low
(2014) which found no significant socioeconomic status.
corellation between maternal work with
CED in pregnant women. This is because This study found significant
work does not directly affect the differences between groups based on
nutritional status of the mother. However, previous pregnancy history in the
different results were shown by several incidence of CED in pregnant women.
other studies. According to Mahmudiono This is consistent with research conducted
(2017), many working mothers experience by Mahmudiono (2017) that first-time
CED incidents. This is because pregnant pregnant mothers and young people tend to
women who work have less time in be more at risk of CED because the
preparing food that affects the amount of mother's body is not ready to fulfill the
food consumed so that it affects the energy for fetal growth. In addition,
nutritional status of pregnant women. On pregnancy that is too frequent (a distance
the contrary, according to Surasih (2005), of < 2 years) can cause malnutrition
mothers who do not work are IRT because it can deplete the body's
(Housewives), in fact many experience nutritional reserves and reproductive
CED incidents. This is due to mothers who organs are not yet perfect as before
do not work just do not have the time to pregnancy. Mothers are also still in the
meet the required energy and do not have breastfeeding period and must meet their
access to much information because of the nutritional needs during breastfeeding,
lack of time between homework. Mothers where when they are breastfeeding they
also need a high energy intake because the need extra calories every day to meet their
workload that is done everyday is very nutrition and milk production (Handayani
much to do homework such as taking care and Budianingrum, 2011). This can also be
of the house, children, and husband.10-12 caused by more and more pregnant
women, so the mother will become less
In this study, family income provides concerned about her pregnancy because it
a significant difference in the incidence of is considered normal and has already been
CED in pregnant women. This is in experienced, so that mothers do not pay
accordance with research conducted by much attention to their health compared to
Mahirawati (2014), which revealed a early pregnancy (Mahmudiono, 2017).

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Different results were found in a study by

Wijayanti (2016), namely there was no Mother's knowledge about nutrition
significant corellation between parity and is thought to influence the mother's diet in
CED in pregnant women. This result is fulfilling balanced nutrition. One way to
supported by research by Syafuruddin et al increase one's knowledge is through
(2018) who also did not find a significant education, where the higher a person's
corellation between the number of children education the higher the knowledge that
with the incidence of CED.11,13,14,15 person has. Education will enlighten a
person, especially in the knowledge of
In this study, there were no nutrition in pregnant women. But a
significant differences between groups person's education is not the only
based on a history of chronic illness in the guarantee of one's knowledge, but the
incidence of CED in pregnant women. higher a person's education is, the easier
This is in accordance with research they will receive information, and the
conducted by Wijayanti, 2016 which states more knowledge he has. Mothers with
there is no corellation between the history high levels of education have a high
of the disease with the incidence of CED interest to find out early on the kinds of
in pregnant women. Research conducted nutrients needed by mothers while
by Hidayati (2011) also showed results pregnant and preparing for pregnancy.
that there was no corellation between With good knowledge, an individual will
tuberculosis and diarrheal disease and the try to apply that knowledge into his life
risk of CED in pregnant women.16 practice, such as the fulfillment of
balanced nutrition during pregnancy.6
Chronic diseases that have occurred
for a long time cause the mother's body Research conducted by Suryaningsih
has adapted to the increased energy needs, and Trisusila (2017) found a significant
so it does not affect the incidence of CED. corellation between the level of knowledge
Conversely, there are research results that of pregnant women with the incidence of
show a corellation between infectious CED. Good knowledge about a person's
diseases with Chronic Energy Deficiency nutrition, making that person will
Events (CED), Infectious diseases can act increasingly take into account the amount
as a starter for malnutrition as a result of and type of food they choose to consume.
decreased appetite, impaired absorption in Those who have good knowledge tend to
the channel digestion or increased need for use more rationally and knowledge about
nutrients by disease. The association of the nutritional value of these foods. The
infectious diseases with poor nutrition is a knowledge possessed by a mother will
reciprocal corellation, that is a causal influence the decision making and also
corellation. Infectious diseases can worsen influence the behavior. Mothers with good
nutritional conditions and poor nutritional nutritional knowledge are likely to provide
conditions can facilitate infection. adequate nutrition for their babies.
Diseases that are commonly associated However, in this study there were no
with nutritional problems include diarrhea, significant differences between groups
tuberculosis, measles and whooping based on mother's knowledge about
cough.17 nutrition in the CED incident. The same

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results were also obtained in another study, An evaluation of community therapy

there was no corellation between maternal activities has been carried out. Based on
knowledge and the incidence of CED. This the indicators of success, the three
is because even though the mother's programs carried out were fully realized or
knowledge about nutrition is already good, the success rate was 100%.
her application in fulfilling nutritional
needs is still not applied.17 ACKNOWLEDGMENT

The study in Bajulmati Village, -

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