FORMULIR FOOD RECALL
Waktu
Nama Hidangan
Makanan
Jenis Bahan
Pangan
Banyaknya yang
dimakan
Jumlah
Kalori
Protein
URT
GR
Kkal
gr
Pagi
Selingan
Siang
Sore
Malam
No
Jenis Bahan Pangan
Frekuensi Konsumsi (Hari/Minggu/Bulan)
1-3 x/hari
1-3 x/ minggu
1-3 x/bulan
Golongan Karbohidrat
1
Nasi
2
Jagug
3
Sagu
4
Mie
5
Roti
6
Umbi-umbian
Golongan Protein
7
Ikan Basah
8
Ikan Kering
9
Telur
10
Ayam
11
Daging
12
Tahu
13
Tempe
Golongan Sayuran
14
Daun Ubi
15
Bayam
16
Kangkung
17
Kacang Panjang
18
Sawi
Golongan Buah-buahan
19
Pisang
20
Jeruk
21
Pepaya
Serba-serbi
DAFTAR RESPONDEN (DATA IBU HAMIL)
No. Responden
:
Nama ibu hamil
:
Umur
:
Pekerjaaan
:
Pendidikan
:
Pendapatan
:
MASTER TABEL
No. Umur Pendidikan Pekerjaan Pendapatan Usia Kehamilan
(Bulan)
73 33 SMP Petani 2 7 1 4 4 3 2 4 3 4 4 4 4 4 3 4 3 4 3 4 2 4 4 3 2 4 4
74 34 SMA Petani 2 6 2 4 2 3 3 4 4 4 4 4 4 2 3 3 4 2 2 2 2 4 4 3 2 3 4
Keterangan Pendapatan:
1. < 1.000.000
2. 1.000.000-2.000.000
3. > 2.000.000
No. Pola Makan (Jenis Makanan) Kecukupan Gizi LILA Status Gizi
64 1 2 2 2 2 1 1 2 2 2 2 2 2 2 2 2 2 2 1 2 2 2 1 2 2 2 1 1805.2 64.5 26.0 Tidak KEK
65 1 2 2 2 2 2 1 2 1 2 1 1 2 2 2 2 2 2 2 2 2 1 1 2 2 2 2 1656.0 66.5 26.0 Tidak KEK
66 1 2 2 2 1 2 1 2 2 2 1 2 2 2 2 2 1 2 2 1 2 2 1 2 2 2 2 1467.0 48.0 19.5 KEK
67 1 1 2 2 1 1 2 2 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2127.2 58.0 26.0 Tidak KEK
68 1 2 2 2 1 2 1 2 2 2 1 2 2 2 2 2 1 2 2 1 2 2 1 2 2 2 2 1458.3 48.0 25.5 Tidak KEK
69 1 1 2 2 1 2 1 2 2 2 2 1 2 2 2 2 1 2 2 2 2 2 1 2 2 2 2 1526.5 52.0 15.0 KEK
70 1 1 1 2 2 1 1 2 2 2 2 2 2 2 1 2 2 2 2 2 2 2 2 2 2 2 2 1549.6 51.8 25.0 Tidak KEK
71 1 2 1 2 2 2 1 2 2 2 2 2 2 1 2 2 2 2 2 2 2 2 2 2 1 1 2 2107.2 52.7 25.0 Tidak KEK
72 1 1 2 2 2 1 2 1 2 2 2 1 2 2 1 2 2 2 2 2 2 2 2 2 2 2 2 1912.2 51.8 24.0 Tidak KEK
73 1 2 1 2 2 2 1 2 2 2 2 2 2 1 2 2 2 2 2 2 2 2 2 1 2 2 2 1489.5 47.1 21.5 KEK
Frequencies
KARAKTERISTIK RESPONDEN
Umur Responden
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Frequency Percent Valid Percent
JENIS MAKANAN
Nasi
Frequency Percent Valid Percent
Cumulative Percent Valid Ya 74 100.0 100.0 100.0
Mie
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative Percent
Valid Ya 19 25.7 25.7 25.7
Telur
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative Percent
Valid Ya 7 9.5 9.5 9.5
Frequency Percent Valid Percent
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative Percent
Valid Ya 6 8.1 8.1 8.1
Kacang Panjang
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative Percent
Valid Ya 1 1.4 1.4 1.4
Frequency Percent Valid Percent
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative Percent
Valid Ya 12 16.2 16.2 16.2
FREKUENSI MAKAN
Nasi
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Frequency Percent Valid Percent
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Ayam
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Frequency Percent Valid Percent
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Pisang
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
TINGKAT KECUKUPAN GIZI
Energi
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Status Gizi
Frequency Percent Valid Percent
Cumulative Percent
Valid Berisiko KEK 4 5.4 5.4 5.4
Tidak berisiko KEK 70 94.6 94.6 100.0
Total 74 100.0 100.0
Energi * Status Gizi Crosstabulation
Count
Status Gizi
Total Berisiko
KEK
Tidak Berisiko KEK
Energi Baik 0 25 25
Sedang 0 35 35
Kurang 4 10 14
Total 4 70 74
Protein * Status Gizi Crosstabulation
Count
Status Gizi
Total Berisiko
KEK
Tidak Berisiko KEK
Protein Baik 0 7 7
Sedang 0 33 33
Kurang 4 30 34
