PERCEPTION OF MOTHERS AND CHILDREN’S PARTICIPATION IN THE NUTRITIONAL PROGRAMS

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PERCEPTION OF MOTHERS AND CHILDREN’ S PARTICIPATION

IN THE NUTRITIONAL PROGRAMS

(Per sepsi Ibu dan Par t isipasi Anak dal am Progr am Gizi)

Dadang Sukandar1 and Ali Khomsan1

ABST RAK

Penel it ian ini ber t uj uan unt uk menget ahui per sepsi masyar akat t er hadap pel ayanan pr ogram gizi ser t a menganal isis par t isipasinya dal am pr ogram posyandu. Disain penel it ian ini menggunakan cr oss-sect ional dengan sampel r umah t angga yang memil iki anak bal it a. Sampel yang diambil sebanyak 300. Pemil ihan sampel dil akukan secar a acak ber l apis (st r at if ied r andom sampl ing). Penel it ian ini dil akukan di dua kecamat an di Kabupat en Cianj ur yang dil akukan pada t ahun 2006-2007. Dat a yang dikumpul kan mel iput i j enis pe-l ayanan gizi, per sepsi t er hadap pr ogr am gizi dan par t isipasi dape-l am pr ogr am gizi. Dat a diper ol eh mel al ui wawancar a. Dat a hasil wawancar a dient r i menggunakan sof t war e excel . Dat a dianal isis dengan SAS (St at ist ical Anal ysis Syst em). Hasil penel it ian ini menunj ukkan bahwa par a ibu ber pendapat bahwa pr ogr am PMT dan penyul uhan gizi har us l ebih diper -baiki. Juml ah dan ket er ampil an kader cukup memadai, namun kahadir an bidan di posyandu kurang mencukupi. Progr am imunisasi bagi bal it a diikut i dengan baik ol eh par a ibu bal it a. Ter kait pel ayanan di puskesmas, sebagian besar ibu mengel uhkan wakt u ant r i yang l ama dan f r ekuensi kehadir an dokt er yang kur ang. Par t isipasi bal it a dal am mengun-j ungi posyandu r el at if baik (92.4%). Lebih dar i 90% bal it a, baik yang ser ing maupun mengun-j ar ang mengunj ungi posyandu t el ah mener ima kapsul vit amin A. Pel ayanan posyandu yang sangat dir asakan ol eh masyar akat adal ah penimbangan bal it a dan imunisasi.

Keywords : per sepsi, par t isipasi, pr ogr am gizi

INTRODUCTION1

Background

Nat ional ef f ort s in improving nut rit ion in Indonesia have been running f or t hirt y years and are st ill f ocused on t he maj or problems of nut rit ion, namely, prot ein energy malnut rit ion (PEM), vit amin A def iciency (VAD), iron anemia and iodine def iciency disorders (IDD). Nut ri-t ional improvemenri-t has succeeded in reducing t he f our maj or nut rit ional problems, but is considered as inef f icient because it is closely relat ed t o t he ef f iciency of cross-sect or ef f ort s such as povert y elevat ion. Hart oyo, Ast ut i, Briawan, and Set iawan (2000) st at e t hat nut ri-t ion programs need supporri-t s by making ef f orri-t s in improving mot ivat ion, knowledge and skills of cadres, part icipat ion of f amilies and public f igures so t hat f acilit ies and inf rast ruct ure of nut rit ion programs provided by t he govern-ment can bring out opt imal result s.

One goal of t he nut rit ion program is t o improve t he st at us of communit y nut rit ion geared t o t he improvement of int elligence and

1

Lect urer on Depart ment of Communit y Nut rit ion, Facult y of Human Ecology, Bogor Agricult ural Universit y (IPB).

work perf ormance t o support t he improvement of human resource qualit y. Anot her obj ect ive is t o reduce t he rat e of nut rit ional diseases (PEM, VAD, iron anemia, and IDD), which are in general experienced by a low income soci-et y (poor household) in rural and urban areas especially children under f ive and pregnant women. The obj ect ive support s at t empt s in reducing t he inf ant mort alit y rat e, children under f ive, and mot hers. The program also support s t he improvement of t he st at us of communit y nut rit ion in general by improving t he pat t erns of f ood consumpt ions t o become more diverse, balanced and nut rit ionally qualif ied. Such improvement oqualif consumpt ion pat -t ern is also required f or a group of people wi-t h t he high risk of some degenerat ive diseases, who t end t o increase in number (At marit a & Fallah, 2004).

The nut rit ion program at dist rict level is a part of nat ional nut rit ion program. The na-t ional policy of nuna-t rina-t ion program consisna-t s of 4 sub programs: program on prot ein–calorie mal-nut rit ion, program on iron-anemia, program on vit amin A def iciency, and program on iodine def iciency.

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discussion wit h st af f of Healt h Of f ice in Cian-j ur Dist rict (February 10, 2006) showed t hat even all programs have been implement ed; t he communit y st ill has problems relat ed t o nut rit ion. Implement at ion of nut rit ion program at communit y level is t hrough Posyandu.

Posyandu has f unct ioned as t he spear-head f or all t he nut rit ion and primary healt h care services provided by healt h cent res and sub-cent res now present in every sub-dist rict and village (Jus’ at , 1992). Thus, Posyandu f unct ions as an inf ormal-ref erral syst em of communit y part icipat ion t o rural healt h cen-t res and sub-cencen-t res. Posyandu makes t he "un-reachable" children and mot hers ""un-reachable".

The occurrence of malnut rit ion is of t en overlooked f rom our common observat ion, but a closer look will indicat e high deat h rat es of mot hers, babies, children under f ive, and a low lif e expect ancy. Alt hough nut rit ion pro-grams have long been in operat ion, t he prob-lems of malnut rit ion st ill happen everywhere.

Goals and Obj ectives

The obj ect ives of t his research were : 1. To f ind out t he mot hers’ s percept ion of

nut rit ion program services.

2. To analyze children’ s part icipat ion in Posyandu program (Healt h and Nut rit ion Int egrat ed Service Cent er).

METHODS

Design

This research used a cross-sect ional de-sign. The research was carried out in t wo sub-dist rict of Cianj ur, t he Province of West Java. The research was conduct ed in 2006.

Sampling

The populat ions st udied in t his research are having children under f ive years old and 300 of t hem were t aken. The populat ions were select ed in t wo subdist rict s of Cianj ur Dist rict , West Java. Those subdist rict s are t he areas wit h a high port ion of poor populat ion and many of t hem ut ilized t he nut rit ion programs of f ered by t he government .

Samples were t aken t hrough st rat if ied random sampling wit h proport ional allocat ion where high and low f requency visit st and as st rat um. Sample size was also proport ional wit h respect t o posyandu size.

Cianj ur Dist rict was select ed since t here were variat ions in nut rit ion program imple-ment ed and variat ions in achieving t he pro-gram obj ect ives (Personal Communicat ion wit h St af f of Healt h Services, Cianj ur, February 10, 2006). The t wo subdist rict s were chosen t o increase het erogeneit y of samples, so t hat t he perf ormance of nut rit ion program was t ruly represent ed by t he select ed samples.

Data collection

Dat a collect ion consist ed of ut ilizat ion of nut rit ional program, nut rit ion service and ac-ces t o serviac-ces of nut rit ion pograms. The secondary dat a involved coverage of nut rit ion programs. The primary dat a were collect ed t hrough quest ionnaires, while t he secondary dat a by means of a complet ion f orm. To be more operat ional, quest ionnaires and comple-t ion f orm comple-t ried oucomple-t bef ore use. Then comple-t he re-vised quest ionnaires and complet ion f orm were use t o collect dat a.

Data Analysis and Management

Dat a processing involves edit ing quest ionnaires, coding, arrangement of f ile st ruct ure, dat a ent ry, edit ing f iles, generat ing variables, merger creat ing and split t ing f iles. The sof t ware used in dat a processing is Excel and St at ist ical Analysis Syst em.

The est imat ions of means, st andard deviat ion, minimum and maximum values made f or all quant it at ive variables. The est i-mat ion of proport ion has been conduct ed f or all cat egorized qualit at ive and quant it at ive variables. All paramet er predict ions have been made f or t he respondent s who ut ilize nut rit ion programs great ly (high f requency visit s) and t he respondent s wit h a low ut ilizat ion (low f requency visit s) in each dist rict . The est imat e result s have been present ed in t he f orms of t ables and diagrams.

RESULTS

Perception of Mothers towards Nutritional Program

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act ivit y of posyandu. Theref ore, an improved service is much needed, which can be done by increasing t he number of weighing scales so t hat posyandu’ s part icipant s do not have t o queue f or a long t ime f or weighing t heir chil-dren. Commonly, at posyandu t here is only one weighing scale t o serve around 50 children.

Table 1. Dist ribut ion of Mot hers based on Per- cept ion about Act ivit y t hat should be Improved at Posyandu

Kinds of Activity Participation

at Posyandu n % part icipat ion group and 36. 1% in t he high par-t icipapar-t ion group say par-t hapar-t par-t he availabilipar-t y of growt h chart cards should be increased. Be-sides a growt h chart result ed f rom t he weigh-ing records of children, t he card cont ains im-munizat ion records. Such card has an impor-t animpor-t f uncimpor-t ion; f rom impor-t he card, a moimpor-t her can look at her child’ s growt h. The f act t hat some mot hers want an increased availabilit y of t he cards indicat es t hat number of cards available may be not enough f or t he number of children part icipat ing at posyandu.

Improvement in immunizat ion service is expect ed by 36. 5% mot hers of children under f ive years in t he low part icipat ion group and 42. 7% in t he high part icipat ion group. It indi-cat es a dissat isf act ion of some mot hers wit h t he immunizat ion act ivit ies so f ar carried out at posyandu. Immunizat ion is given according t o t he dif f erent ages of children and f ree or at a very low cost . This indicat es t he seriousness of t he Indonesian Government t o increase t he healt h level of under-f ive-year children.

There are st ill many mot hers who f eel unsat isf ied wit h t he supply of iron t ablet s. Approximat ely half of respondent s admit t hat it should be improved. Wit h t he dist ribut ion of vit amin-A capsules, about a quart er of respon-dent s say t hat t hey are not sat isf ied, and t heref ore t he service must be improved. The supply of vit amin A in high might be

consid-ered t o be bet t er by respondent s because t he government has int roduced cert ain mont hs, namely February and August as t he mont hs of vit amin A. In bot h mont hs, children are t aken t o get vit amin A.

Supplement ary f eeding program and nut rit ional ext ension at posyandu might be seen as t he weakest point . Over 90% mot hers in t he low and high part icipat ion group expect an improvement in t he service of f ood supple-ment s and more t han 80% hope f or an im-ext ension should be improved.

The ext ension mat erials relat ed t o f ood, nut rit ion, healt h are essent ial f or t he mot her of children under f ive year because wit h such mat erials t hey can prepare a healt hy and nut rit ious menu f or t heir children.

As long as t here is no economic const raint , t he applicat ion of nut rit ional knowledge can be easily done in each house-hold.

Anot her aspect of ext ension needing im-provement is t he use of visual aids. This is ex-pressed by 70. 6% mot hers in t he low part icipa-t ion group and 65. 4% in icipa-t he high paricipa-t icipaicipa-t ion group. A visual aid has an import ant role in allowing mot hers t o underst and t he ext ension mat erial easily. However, because of a lack of f und, such visual aids are rarely available at posyandu t o support t he ext ension act ivit ies.

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areas are volunt eers working wit hout a salary. There are no specif ic requirement s t o be a cadre; anyone having t he t ime and willing t o work volunt arily can become a posyandu’ s cadre. Because women of rural areas have commonly a low educat ion, t hose who become cadres are also of t he low educat ional level. vices launch a regular program of t raining or capacit y building f or cadres t o upgrade t heir knowledge.

The respondent s’ percept ion of cadres and midwif e at posyandu can be seen in Table around 65% in t he high part icipat ion group t hink t hat it is already good. Mot hers’ percep-t ion of cadres is cerpercep-t ainly pleasing, bupercep-t percep-t heir hope f or an improved qualit y of cadres (in ex-t ension) is really an indicaex-t ion ex-t haex-t a more skillf ul cadre is very much expect ed. As t he f ront line in giving nut rit ional service t o t he nut rit ional programs Indonesia. Through im-munizat ion (BCG, DPT, measles, TT, Polio, and Hepat it is), t he Indonesian government would be able t o reduce t he deat h rat e of children.

The immunizat ion programs become a mot ivat ing f act or f or mot hers t o come t o posyandu every mont h. The government sub-sidy has enabled mot hers of children under f ive t o get an opt imum service of immuniza-t ion aimmuniza-t a very low cosimmuniza-t or f ree of charge. The success of immunizat ion programs by t he gov-ernment has so f ar cut down t he children mor-result ed prot ect ion of children f rom inf ect ious diseases means t hat one cause of malnut rit ion problems can be solved. Inf ect ion and malnu-t rimalnu-t ion are synergic or smalnu-t rengmalnu-t hen each omalnu-t her. An inf ect ion will worsen t he nut rit ional st at us, and vise versa – malnut rit ion will make it eas-ier f or a child t o get inf ect ed by a cert ain dis-ease.

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are not f riendly. This indicat es t hat improved services are required so t hat t he complaint s about t he unf riendly medical workers can be reduced.

The daily working hours of puskesmas are 8. 00 – 14. 00. This is suf f icient because most mot hers wit h children under f ive years old st at e t hat t he service hours have already There are 57. 3% mot hers (of children under f ive year) of t he low part icipat ion group and

The doct or puskesmas, besides a medical worker, is also responsible f or t he daily ad-minist rat ive work at puskesmas and at t ends meet ings at t he Healt h Services in t he Re-gency. This condit ion has caused t he presence of a doct or at puskesmas t o give public healt h service is considered t o be less. This percep-t ion is expressed by 46. 2% of mopercep-t her in percep-t he low part icipat ion group and 42. 7% in t he high par-t icipapar-t ion group. Alpar-t hough par-t he docpar-t or is seldom

Children’ s Participation in and Access to Nu-tritional Programs

Vit amin A Capsule Program f or Children The f irst f ive years is an individual developing phase f or children. Based on it s charact erist ic af t er t he inf ant hood (0 – 1 year), it is necessary t o dist inguish it f rom ot her developing phases because t he children have t o begin t o learn t o live in an ext ernal and new environment (Hurlock, 1999).

Table 6 indicat es t hat mot hers are in general aware of t he vit amin A program f or t heir children. Every August and February Posyandus dist ribut e high-dosage capsules of vit amin A t o children f or f ree. Usually many mot hers wit h t heir children visit posyandus f or such capsules. Posyandu has been operat ional in Indonesia f or decades, so generally mot hers already know t he programs of posyandu. And Program f or Chil dren

176 97. 2 117 98. 3 be obt ained f rom newspapers, radios, or t ele-visions f or underst anding (Engle, Manon, & Hadad, 1997). The inf ormat ion about t he pres-ence of vit amin A program can be t aken f rom ot her sources: healt h workers, f riends or neighbors.

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part icipat ion group (87. 0% compared t o 59. 3%). Approximat ely a quart er of respon-dent s receive such inf ormat ion f rom t elevi-sions and only around 2-3% know it f rom ra-dios. This indicat es t hat t elevision is more in-f luent ial and can become a bet t er media oin-f inf ormat ion t han radios f or nut rit ional pro-grams.

More t han 90% of t he samples (children under f ive years) admit obt aining vit amin A capsules, bot h in low and high part icipat ion groups (see Table 7). It shows t hat t he vit amin A dist ribut ion program has been successf ul.

Children under f ive years old are very suscept ible t o inf ect ious diseases (Sat ot o, developing diarrhea, smallpox, or ot her inf ec-t ious diseases, would noec-t geec-t worse or

en-Children’ s Part icipat ion at Posyandu

Regular visit s of children t o posyandu are highly recommended. At posyandu every child is monit ored f or it s body weight by weighing. In t his way, t he body weight changes can be obt ained f rom one mont h t o anot her. In case of a decreased t rend of body weight or below t he red line, posyandus are expect ed t o give nut rit ional advice or f ood supplement s so t hat a declining body weight can be pre-vent ed.

Table 8 indicat es t he suit abilit y of t he crit eria det ermined by t he researchers, i. e. t hose ent ering t he low part icipat ion group in t he last six mont hs are indeed irregular t o visit posyandus. As many as 71. 7% children of t he low part icipat ion group are not regularly t aken t o posyandus, while in t he high group t here are only 7. 6% children who do not regularly visit posyandus.

Table 8. Dist ribut ion of Children according t o Mot her’ s Regular Visit t o Posyandu

Visiting

3. Complet eness of children immunizat ion

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Such irregular visit s t o posyandus have various reasons (see Table 8). The reason most ly given by t he mot hers in t he high par-children have already had a complet e immuni-zat ion, t hus t hey do not need t o come t o vice in villages is commonly open once a mont h, t heref ore mot hers having children un-der f ive years old should be able t o t ake t heir children t o t he posyandu on t he day scheduled t o open.

KMS (Growt h Chart Card) is a simple and inexpensive t echnique t o monit or t he healt h and growt h of children. According t o Sukarni (1994), KMS allows an appropriat e and pract i-cal monit oring of children healt h in all as-pect s. Theref ore, such a card could be very usef ul f or mot hers and f amilies t o observe t heir children growt h so t hat no mist akes or imbalance would occur in f eeding t heir chil-dren.

Every child should have t he card dist rib-ut ed f ree at posyandus. The percent age of t hose holding t he cards varied f rom 65. 3% - 97. 8% f rom 2001 – 2005. The biggest percent -age of card ownership was in 2001 (97. 8%) and t he lowest was in 2005 (65. 3%). The decreased car ownership in 2005 was indeed a problem because children wit hout such cards mean t hat t hey do not visit posyandus; or if t hey do come, t he services provided are less opt imal. Wit h t he regular weighing of children once a mont h, t he ownership of t he cards would be very usef ul f or underst anding t he growt h of a child.

The percent age of children having t he cards t o reach 100% is rat her dif f icult t o at -number of children visit ing posyandus in a cer-t ain moncer-t h (Auguscer-t ) compared cer-t o cer-t he cer-t ocer-t al populat ion of children. Bet ween 2001 and 2005 t he weighing part icipat ion was bet ween 57. 1% and 76. 8%. In 2005, it was t he lowest (57. 1%). This indicat es t hat it is necessary f or posyandus t o make great er ef f ort s t o remind mot hers t o t ake t heir children t o posyandus f or weighing.

Those who do not weigh t heir children might have st opped visit ing posyandus or are 57. 1% must be analyzed f or possible causes so t hat solut ions can be made immediat ely. In t he coming years it is expect ed t hat t he de-gree of part icipat ion will improve.

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assigned by t he government t o open pract ices in every village so t hat t he rural people can get healt h services more easily. Some

respon-dent s visit a village midwif e by a public t rans-port (29. 5%) and mot orcycles (25. 5%).

Table 9. Growt h Chart Card Ownership of Children in Cianj ur Regency in 2001-2005

Variable of Growth Chart Card Ownership Year

2001 2002 2003 2004 2005

Tot al of children under f ive 157 782 171 472 171 696 171 919 198 446

Children under f ive who owned growt h chart card 154 312 129 623 157 960 129 621 129 511

Children under f ive who had been weighed 121 220 104 065 120 874 107 634 113 292

Coverage of growt h chart card ownership (%) 97. 8 75. 6 92. 0 75. 4 65. 3

Part icipat ion of weighing (%) 76. 8 60. 7 70. 4 62. 6 57. 1

Tabel 10. Dist ance of Nut rit ional/ Healt h Service Locat ion f rom Children Homes

Location of Nutritional/ Health Service n Distance

(m)

Category of Distance

Posyandu (Int egrat ed Healt h Service Cent re) 300 84 Close

Healt h Clinics 300 122 Close

Pust u/ Polindes (Auxiliary Public Healt h Cent re) 300 459 Close

Local/ Privat e Midwif e 300 802 Medium

Doct or 300 1510 Far away

Puskesmas (Public Healt h Cent re) 300 1938 Far away

Hospit al 300 5293 Far away

Not e : Close = < 500 m Medium = 500 – 1500 m Far away = > 1500 m

Table 11. Dist ribut ion of Children based on The Transport at ion t aken by Mot hers t o Nut rit ional/ Healt h Service Locat ion

Location of Nutritional/ Health Service Kind of Vehicle n %

Posyandu (Int egrat ed Healt h Service Cent re) Walking 297 99. 3

Riding mot orcycles 2 0. 7

Local/ Privat e Midwif e

Walking 112 44. 6

Public t ransport 74 29. 5

Pust u/ Polindes (Auxiliary Public Healt h Cent re)

Walking 40 31. 5

Puskesmas (Public Healt h Cent re)

Walking 24 10. 5

Riding mot orcycles 45 30. 7 Public t ransport 132 57. 9

Healt h Clinics

Walking 1 7. 7

Privat e car 2 15. 4

Hospit al

Walking 6 2. 8

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To go t o puskesmas, most respondent s t ake public vehicles (57. 9%). A puskesmas is locat ed in t he capit al of Dist rict , which rat her f ar away f rom t he respondent ’ home. Only a small number (10. 5%) of respondent s t ake a walk t o get t o puskesmas.

There is a relat ively small number of respondent s who go t o healt h clinics. The pri-vat ely owned healt h clinics charges higher medical cost s t han puskesmas. Those going t o healt h clinics commonly t ake public vehicles (61. 5%). Similarly t hose going t o t he hospit al locat ed in t he t own use public vehicles (72. 9%).

CONCLUSION AND RECOMENDATION

Conclusion

Mot hers having children under f ive years old t hink t hat t he supplement al f ood program and nut rit ion ext ension at posyandus should be improved. The number and skills of t he cadres are already considered quit e good, t he pres-ence of midwives at posyandus is inadequat e. The immunizat ion program f or children is viewed as very good by mot hers having chil-dren under f ive years old. As f or t he services at puskesmas, t he maj orit y of mot hers wit h children under f ive years old complaint about t he long queuing t ime and t he inf requent presence of doct ors when t hey visit f or medi-cal t reat ment .

The part icipat ion of children (under f ive years old) in visit ing posyandus is relat ively good, namely, 92. 4% (f or t he high part t ion group). However, f or t he low part icipa-t ion group, icipa-t he number of paricipa-t icipaicipa-t ing chil-dren is relat ively low (28. 3%). The absences f rom posyandus are due t o t heir mot hers being busy or children being st ill asleep. More t han 90% of children, bot h of t hose who of t en and seldom visit posyandus, have received vit amin A capsules. This means t hat t here is an ade-quat e dist ribut ion of vit amin A capsules. A posyandu’ s services most ly f elt by t he public are t he weighing of children and immuniza-t ion. The access f rom immuniza-t he homes of moimmuniza-t hers having children under f ive years old t o t he nearest places of nut rit ional services (i. e. posyandu) is < 500 m and t he dist ance is cover-ed by walking.

Recommendation

1. Because t he nut rit ional ext ension is a weak aspect of t he act ivit ies at posyandus, it is necessary t o make ef f ort s in improving

t he nut rit ion knowledge of cadres and midwives who are in charge at posyandus t hrough t rainings. Furt her, t he ext ension act ivit y has t o be an inseparable part of t he nut rit ional program services at posyandus.

2. The supplement al f ood program at posyan-dus has not been opt imally managed be-cause of a limit ed budget of posyandus. Theref ore, t he bet t er-of f communit y or corporat ions around posyandu must be en-couraged t o give volunt ary donat ion or f i-nancial aid so t hat t he operat ion of supplement al f ood program can be more ef -f ect ive. In addit ion, t he Healt h Services should also be able t o allocat e a bigger budget of posyandus t o carry out t he sup-plement al f ood program.

ACKNOWLEDGEMENT

Thank you very much t o t he Neys-van Hoogst rat en Foundat ion (NHF), t he Net her-lands f or f unding t his proj ect . It is a good op-port unit y t o collaborat e wit h t he NHF. Thank you and appreciat ion t o ot her research t eam Hadi Riyadi, Faisal Anwar, and Eddy S. Mudj a-j ant o who part icipat ed in t his proa-j ect .

BIBLIOGRAPHY

At marit a & Tat ang SF. 2004. An Analysis of Nut rit ional Sit uat ion and Public Healt h. Paper of Nat ional Workshop on Food and Nut rit ion 2004. LIPI. Jakart a.

Engle, PLP Menon, & L Hadad. 1997. Care and Nut rit ion. Int ernat ional Food Policy Research Inst it ut e, Washingt on DC, USA.

Hart oyo, D Ast ut i, D Briawan & B Set iawan. 2000. Addit ional Food t o Children Under Five Years Old and Empowerment of Families/ Communit y in Bogor Municipal-it y. Depart ment of CommunMunicipal-it y Nut rMunicipal-it ion and Family Resources, IPB, Bogor.

Hurlock EB. 1999. Child Development (Tj andrasa, t ranslat or). Erlangga, Jakart a.

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Sat ot o. 1990. Growt h and Development of Children on Age 0-18 Mont hs in Mlonggo Sub-dist rict , Jepara Regency, Cent ral Java Province. Doct oral Dissert at ion (unpublished). Post graduat e Program,

Universit y of Diponegoro, Semarang, Cent ral Java.