COMPLEMENTARY FEEDING PRACTICE OF MOTHERS WITH CHILDREN SIX MONTH TO TWO YEARS OLD IN THE CIREUNDEU INDIGENOUS COMMUNITIES
Siti Nur Endah Hendayani*1, Nanik Cahyati1, Dyan Kunthi Nugrahaeni2, Novie Mauliku2 Siti_nurendah@yahoo.com
1Department of Midwifery, School of Health Sciences Jenderal Achmad Yani, Cimahi, Indonesia
2Department of Public Healt, School of Health Sciences Jenderal Achmad Yani, Cimahi, Indonesia ABSTRACT
Fulfilling adequate nutritional needs is a basic right of children, which starts from infancy to childhood.
Fulfillment of children's nutrition from birth to the age of two years greatly affects the child's growth, development and subsequent behavior. Poor complementary feeding behavior in infancy is a major cause of malnutrition in the first two years of age. The aim of this study was to explore complementary feeding practice in the Cireundeu Indigenous Communities.
This study was conducted using ethnograpy study with qualitatif approach. The main data was collected from interviews with 24 mothers, while additional data were collected by observing during the interviews. Analyses were using the content analysis
The results of this research that complementary feeding practices by mothers is influenced by the social structure that exists in the Cireundeu Indigenous Communities. The customary leader regulates the civilization and socio-cultural traditions in the Cireundeu Indigenous Communities, which is consuming non-rice food, namely cassava, called cassava rice . The frequency of giving complementary food as much as 2 times a day and this tradition has been carried out long ago and passed down from the ancestors of the Cireundeu Indigenous Communities by introducing to children since infants with food derived from non-rice, and introducing children cassava rice since childhood as staple food. Activities undertaken by mothers include processing cassava into cassava rices, preparing complementary foods for babies such as porridge which comes from non-rice materials, processing vegetables and side dishes that will be given to children. Suggested conducting community development through community empowerment activities in the use of food technology in the management of staple foods to increase nutritional content, developing guidelines for providing complementary food based on local food, fortification and providing supplementation.
Keywords: Complementary Feeding, Cassava Rice, Social Structure
INTRODUCTION
Fulfillment of nutrition is a basic right of children. One effort to improve the health and nutrition of children as mandated by UUD 1945 such as the Convention on the Rights of the Child (United Nations Commission on the Rights of the Child, 1989, Article 24), is to provide the best food for children under 2 years old. World Health Organization (WHO) in the World Health Assembly (WHA) Resolution number 55.25 of 2002 on the Global Strategy of Infant and Young Child Feeding reports that 60% of under-five deaths are directly or indirectly caused by malnutrition and 2/3 of these deaths are related to improper feeding practices in infants and children1.
To achieve optimal growth and development, in the Global Strategy for Infant and Young Child Feeding, WHO / UNICEF recommends four important things to do, first, giving breast milk to the baby immediately within 30 minutes after the
baby is born; second, giving only breast milk or exclusive breastfeeding from birth until the baby is 6 months old; third, providing complementary foods for breast milk (MPASI) from infants aged 6 months to 24 months; and fourth, continuing breastfeeding until the child is 24 montkhs or older. The recommendation emphasized that socially, complemetary food should be made from cheap food that is easily available in the local area (indigenous food).2
In the Decree of the Minister of Health of the Republic Indonesia No.450 / MenKes SK / IV dated 7 April 2004, which refers to the resolution of the World Health Assembly (WHO, 2001) states that to achieve optimal growth, development and health, infants must be given exclusive breastfeeding for 6 first month. The survey results indicate that one of the causes of developmental disorders of infants and children aged 12-24 months
in Indonesia is the low quality of complementary food.3
Complementary feeding is defined as a process that begins when breast milk alone is no longer sufficient to fullfill the nutritional needs of the baby, and therefore other food and fluids are needed, along with breast milk. The target age range for complementary feeding is generally taken at 6 to 24 months of age, although breastfeeding can continue beyond two years. Optimal complementary feeding depends not only on what is fed, but also on how, when, where and by whom the child is fed.4
Too early and inappropriate feeding results in many children suffering from malnutrition. For this reason, it is necessary to monitor growth from birth routinely and continuously. Growth faltering is a commonly observed phenomenon in developing countries after about 3 months of age.This growth faltering has traditionally been attributed to three factors: (1) the inadequacy of energy intake from breast milk alone after 3 or 4 months; (2) the poor nutritional quality (i.e., low energy and micronutrient content) of the complementary foods commonly introduced in many developing countries; and (3) the adverse effects of infection on energy intake and expenditure.5 The phenomenon of "growth failure" or growth faltering in Indonesian children begins to occur at the age of 4- 6 months when the baby is given food other than breast milk and continues to deteriorate until the age of 18-24 months. The results of Riskesdas 2013 showed 19.6% of children under five in Indonesia suffering from malnutrition (weight / U <-2 Z- Score) and 37.2% included in the short category (TB / U <- 2 Zscore. One of the efforts to overcome the above problem is to promote complementary feeding in the right amount, quality and on time1
Nutrition improvement program aimed at increasing the number and quality of complementary food has been carried out so far, including the complementary feeding to infants and children aged 6-24 months from poor families.
Generally, there are two types of complementary food which are the result of factory processing or referred to as complementary food manufacturer and those processed in the household or called the local complementary food2
Based on several research results it was found that the concept of breastfeeding infants and complementary feeding was transferred from their ancestors through knowledge, skills and beliefs that they understood, then practiced in the implementation of daily foster patterns.6,7 8
Based on the background above, the aim of this research is to explore Complementary Feeding
Practice of Mothers with Children Six Month To Two Years Old in The Cireundeu Indigenous Communities
METHODS
This research is etnography study with a qualitative approach. Data collection techniques through observation and indepth interviews. The study was conducted for 3 months starting in July - October 2019 in Cireundeu Indigenous Village, Cimahi City.
The informants in this study were 24 of informants who were selected through a purposive sampling technique. Information collected about the mother's perception of the complementary food and the mother's behavior at the time of giving the complementary food. The instruments to collect data use a Fieldnote. Data was analyzed by content analysis
RESULT
The informan are 24 mothers who had children aged 6 months - 24 months. Based on age categories, informants majority at range of 20 years old - <25 years, graduated from junior high school, all of them are housewives. The age of the child ranges from 6 months - 2 years old.
Mother perceptions and complementary feeding practice are expressions and action of the mother in providing complementary feeding to children aged 6 months - 2 years old in Cireundeu Indigenous Village, which includes perceptions / assessments and action of mothers regarding the appropriate age of the child to be given Complementary Foods and their reasons, the types of food used in providing complementary foods and the reason, frequency of complementary feeding and the reasons, how the way to give the complementary feeding and the reasons, the mother's evaluation of the benefits of complementary feeding in children aged 6 months - 2 years old.
The behavior of complementary feeding practice can be seen by how mothers provide complementary feeding for children aged 6 months - 2 years in Cireundeu Indigenous Village of Cimahi City which includes the age when the child is given complementary food, the frequency of complementrary feeding and what types of food mothers give for children aged of 6 months - 2 year old and the reasons. Mothers perceptions and practice about complementary feeding are based on a combination of knowledge obtained from information from health workers and from ancestral culture.
Of the 24 mothers, 19 of them giving the complementary food to the children at the age 6 month years old, and all of them thought that the child was better given complementary food when the child was 6 months with the reason that the child's digestion was strong. 5 people among them giving the complementary food to the children at the age 4 month years old and has perception that a child can be given complementary food at the age of 4 months with the reason that digestion is strong and so that the child does not fuss, and according to the experiences of previous children given at the age of 4 years old
“Children should be given complementary food at 6 months because of information from the
Midwife, that it is better to feed children at 6 months and older"
(Mrs Y, 18 Years Old)
"Appropriate age for complementary feeding is 4 months and older, children are given enough of breast milk and so they are not fussy”
(Mrs K, 38 Years Old)
Of the 24 mothers, 15 of them giving various types of complementary food, all of them perceive that children are better given various types of complementary food but are not given rice as a staple food, as a rice substitute for children aged 6 months - 12 months is read beans instans porridge, added with vegetables, fruits, fish and meat. While for ages 12-24 months the staple food of children is rasi (cassava rice). Nine mothers said giving various types of complementary food including rice based food. The type of complementary food given to babies 6 months to 12 months is instant porridge and rice-based porridge added with vegetables, fruits, fish, tofu, tempeh and meat. While children aged 12-24 years were the same as the above types added with rice as staple food.
"Children at the age of 6-12 months can be given rice porridge, and if children over 12 months old children can be given rice, eggs, vegetables, and tempeh, because children at the age of more than 6 months already have a desire for a variety of flavors in their food, besides that the food is nutritious food "
(D, 38 years old, IRT)
“ Complementary foods that can be given to children at 6-8 months are instant porridge such red bean flavored porridge, whereas when children are more than 8 months old, they can
make their own bean porridge, because at 6-8 months, Instant porridge has a finer texture than homemade bean porridge, so that children will find it easier to digest. Whereas at the age of children 8 months and above (8-12 months) digestion is good and accustomed to eating porridge. Children over 12 months can be given rice with the same adults side dishes”.
(N, 35 years old)
All of respondents has giving complementary food 1-3 times a day every morning and evening, they percieved that the best frequency and schedule for complementary feeding is 1-3 times a day.
"Frequency of complementary feeding for children aged 0-2 years as much as 3 times a day, at 08.00 am, 01.00 pm and 07.00 pm. It is make a child full and not cry all the time. "
(M, 27 years old)
"Complementary feeding to children aged 6-2 years old as much as 2 times a day, with a small portion and added with breastmilk. The frequency of 2 times a day is enough to satisfying the children and will not be hungry anymore.
(Y, 18 years old).
DISCUSSION
Based on the results of the study, majority of mothers giving complementary food according to the recommended age (6 month above). But there are still several mothers who give under 6 months with the reason that the child digestive is already strong and based on previous child experience.
Experience as a source of knowledge is a way to obtain the truth of knowledge by repeating the knowledge gained in solving problems faced by the past. The mother's experience when giving complementary food to a first child can affect the provision of complementary feeding for the next children.6
Based on the results of the study most of the mothers giving complementary food with a variety of types, but most do not provide complementary food from rice based.
Cassava planting activities carried out periodically by the head of the family, so that cassava harvest can also be carried out alternately, so that it will guarantee the availability of food in the family (family food security).
Mothers process cassava into cassava rice (rasi).
Cassava rice (rasi) made by grating cassava, squeezed, then the water is allowed to stand
overnight. Then the residu is separated to be sold again as starch. The waste which still leaves a little cassava juice is made into a cassava rice, the pulp is dried, then crushed until smooth. Under these conditions, cassava rice can be stored for up to three months. When it will be served, stay mixed with cold water to form lumps like rice grains, then steamed for 10 minutes. Whereas for babies, it is preferred to make foods derived from non-rice ingredients such as porridge from green beans, potatoes, fruits and vegetables such as bananas, avocados, broccoli. Mother makes vegetables and side dishes to meet the needs of children aged 6 months - 2 years old. Vegetables are processed from cassava leaves or other vegetables, while side dishes such as rolade from cassava leaves, jerky from cassava skins added with fish, and other side dishes such as: fish, meat and chicken. Feeding is adjusted to the age of the child, for children aged 6 months to 24 months, complementary feeding in the form of milk, porridge nuts, vegetables and fruits.
Whereas for children aged 1-2 years can already be given cassava rice and side dishes and vegetables that have been made and prepared by the mother.
Local complementary food processed at household are made from locally available food, are easily obtained at affordable prices by the community, and require processing before being consumed.
Providing of local complementary food has several positive impacts, including; mother more understand and be more skilled in making complementary food from local food ingredients accordingly with local customs and social culture, so that mothers can continue giving independent complementary food independently; increase community participation and empowerment and strengthening institutions such as Posyandu; has potential increasing people's income through selling agricultural products; and as facilities in education or nutrition counseling.2
The frequency of complementary feeding twice a day and the frequency increases with the age of the baby. The amount is uncertain. Complementary feeding does not interfere with giving breast milk, breast milk is given on the sidelines of complementary feeding with the frequency in accordance with the request of the child.
In the Cireundeu Indigenous Communities, this positive habit has freed them from their dependence on rice consumption and replaced it with cassava.
And they hold on to the ancestors says: ‘It doesn't matter even if you don't have rice field as long as you have rice, ‘It doesn't matter if you don't have rice as long as you can cook rice, ‘It doesn't matter
if you don't cook rice as long as you can eat, ‘It doesn't matter if you don't eat it as long as you strong’
Due of this principle is that humans as God's creations are not dependent on just one, for example as a staple food, do not have to depend on rice, but must have other alternative staples food such cassava .The concept of dietary restrictions for complementary feeding for children aged 6 months - 24 months in In the Cireundeu Indigenous Communities is based on the type of food. Staple food, do not have to depend on rice, but must have alternative other basic foodstuffs.
The choice of food is the amount of food consumed by a person or a group of people who aim to meet physiological, psychological, and needs sociological. The physiological goal is an attempt to fulfill the desire to eat (hunger) or to get the nutrients needed by the body. Psychological purpose is to fulfill emotional satisfaction or tastes, whereas sociological goals are for maintain human relationships in family and society. There are various factors that influence individual and family food selection, grouped into three determinants, namely individual characteristics, food, and environment. Individual characteristics include age, sex, level of education, and condition of psychological. Organoleptic properties of food, food preparation methods, ease of use digestible, and availability is a determinant of food characteristics. There is research by Rahman, Khattak, Mansor, about food selection, there are various factors that encourage in the selection of food 1) concern for health, 2) convinience, 3) familiarity, 4) mood, 5) sensory appeal 6) price 7) control weight 8) ethical concerns 9) food composition 10) risk perception 11) Religion.
CONCLUSION
The concept of complementary feeding in the Cireundeu Indigenous Communities originating from customs is food made from cassava as the most preferred type of food. Complementary food began to be given since the baby was 6 months old aims to fulfill nutritional needs of infants and children aside from breast milk. Complementary food in the form of local food based foods. Providing complementary food based local is intended so that families can prepare healthy complementary food nutritionally balanced for infants and children 6-24 months in the household as well as a counseling media. Health workers should conducting community development through community empowerment activities in the use of food technology in the management of staple foods to
increase nutrient content, developing guidelines for providing complementary food based on local food, fortification and providing supplementation, upholding the traditional values of Cireundeu Indigenous Communities so that it can become local wisdom in the health sector.
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