Nutrition Intervention Program at Human Initiative (HI)

(1)

(2)

INTERNSHIP REPORT

NUTRITION INTERVENTION PROGRAM AT HUMAN INITIATIVE (HI)

By

Gennifer Samuela Kiswanto 19010058

Submitted to

i3L – Indonesia International Institute for Life Sciences School of Life Sciences

in partial fulfillment of the enrichment program for the Bachelor of Science in

Food Science and Nutrition

Internship Project Supervisor: Siti Muslimatun STP, MSc, Ph.D.

Internship Project Field Supervisor: Inke Maesaroh & Isyi Karimah

Jakarta, Indonesia 2022

(3)

(4)

COPYRIGHT NOTICE

whatsoever without permission from the author of this report, Gennifer Samuela Kiswanto

(5)

STATEMENT OF ORIGINALITY

submitted to

Indonesia International Institute for Life Sciences (i3L)

I, Gennifer Samuela Kiswanto, do herewith declare that the material contained in my internship report entitled:

“Nutrition Intervention Program at Human Initiative (HI)” is original work performed by me under the guidance and advise of my Internship Supervisor, Siti Muslimatun STP, MSc, Ph.D. I have read and do understand the definition and information on use of source and citation style published by i3L. By signing this statement I unequivocally assert that the aforementioned thesis conforms to published information.

i3L has my permission to submit and electronic copy of my thesis to a commercial document screening service with my name included. If you check NO, your name will be removed prior to submission of the document for screening.

Yes No

Name of student: Gennifer Samuela Kiswanto Student ID: 19010058 Study Program: Food Science and Nutrition

Signature: Date: 29 January 2023

(6)

ABSTRACT

Human Initiative is a NGO founded in 1999 and now works in three different fields, namely children, empowerment, and disaster. Through this internship, three different projects were assigned; Pahlawan Gizi and Nyalakan Harapan, Rumah Bunda Sehat (RBS), and Smart Organic Farming. In Pahlawan Gizi and Nyalakan Harapan, assessment of nutrition status of 30 beneficiaries were done to see the effect of the intervention done in Losari Village, Central Java; Banyumulek Village, Lombok; and Tanjung Pasir Village, Banten. The results show there is an increase in clean and healthy lifestyle practices such as washing hands with clean water and soap in all three villages.

There also observed an increase of total under-fives with normal nutrition status in Banyumulek Village after the intervention. Doing an interim evaluation and monitoring in RBS through the distribution of On-site Distribution Monitoring (ODM) to the committee and the beneficiaries was also important to improve the program so that it meets the needs of the beneficiaries, as what was observed in the Mama Chef event. Taking documentation and assisting the event are also important to make sure the event runs smoothly and makes a good report to the donors of the program. Lastly, through Smart Organic Farming an empowerment through improving one's farming practices may not only affect the farmers by increasing their welfare but also for future food security in the local area. Thus, evaluation of the program is needed to reflect on the shortcoming and improve it.

Keywords: Malnutrition, Intervention program, Nutrition assessment

(7)

ACKNOWLEDGEMENTS

First and foremost, praises and thanks to Jesus Christ, the Almighty, for His showers of blessings throughout my internship to complete it successfully.

I would like to express my sincere gratitude to my supervisor Siti Muslimatun STP, MSc, Ph.D., Head of the Food Science and Nutrition Department, for guiding and giving me the opportunity to do an internship according to my interests. I will not be able to complete this without her help, kindness, sincerity and motivation. I would also like to express my deepest gratitude to my supervisor here in Human Initiative. Ms. Rizka Azharini, Ms. Inke Maersaroh, Ms. Isyi Karimah and others whom I cannot mention one-by-one to your guidance, kindness, warmth, and advice throughout my 4 months of internship. I also want to specially thank Ms. Dalila Alifia as my supervisor-on-field, who has always been kind to me, teaches me how to do things, gives me so many opportunities to learn, and the endless encouragement, support and advice as someone who I look up to. Without them, this internship would only be an assignment rather than an adventure and journey that I will never forget.

To my classmates in FSN '19, my roommate, my junior- and high school friends, and to my forever moodbooster, inspiration, and motivator SEVENTEEN; thank you for being there. Your presence alone has been a great blessing in my life than I could have ever asked for.

Finally, to my caring, loving, supportive, and first and last love; my family, cannot thank you enough. For always encouraging me, giving an endless amount of support and love throughout my life especially through hard times. You guys are very reliable and made me feel so safe to know that you guys will always be there for me. This internship will not be bearable without you.

(8)

LIST OF FIGURES, TABLES, AND ILLUSTRATIONS

LIST OF FIGURES

Figure 1. Human Initiative’s organizational structure

Figure 2. The z-score growth to the age of children from 1 to 57 months (WHO) Figure 3. Stunting under-fives in Indonesia from 2007-2021 (KEMENKES, SSGI 2021)

Figure 4. Percentage Distribution of respondents who wash their hands with soap and clean water Figure 5. Percentage Distribution of respondents who did physical activity

Figure 6. Percentage Distribution of respondents who consume carbohydrate sources food in a day Figure 7. Percentage Distribution of respondents who consume food sources of animal protein in a

day

Figure 8. Percentage Distribution of respondents who consume food sources of plant protein in a day Figure 9. Percentage Distribution of respondents who consume blood tablet in a day

Figure 10. Hemoglobin level of 9 pregnant women (A-I) in Losari Village, Central Java for 6 months of observation

Figure 11. Percentage Distribution of respondents who breastfed their babies for 6 months

Figure 12. Percentage Distribution of respondents who wash their hands with soap and clean water Figure 13. Percentage Distribution of respondents who consume fruits and vegetables in a day Figure 14. Percentage Distribution of respondents who consume carbohydrate sources food in a day Figure 15. Percentage Distribution of respondents who consume food sources of animal protein in a

day

Figure 16. Percentage Distribution of respondents who consume food sources of plant protein in a day

Figure 17. Percentage Distribution of respondents who consume packaged snacks in a day Figure 18. Percentage Distribution of respondents who breastfed their babies for 6 months

day

Figure 24. Percentage Distribution of respondents who consume packaged snacks in a day Figure 25. Percentage Distribution of respondents who breastfed their babies for 6 months

day

Figure 31. Percentage Distribution of respondents who consume packaged snacks in a day Figure 32. Evaluation of level of convenience and implement of activities held in RBS Figure 33. Evaluation of usefulness level of activities held in RBS

(10)

Figure 34. Evaluation of the level of expert mastery of the material Figure 35. Evaluation of assistance provided by HI and committee

Figure 36. Evaluation of usefulness level of the events done in RBS and towards the committee Figure 37. Evaluation of communicative level of the events done in RBS and towards the committee LIST OF TABLES

Table 1. Demographic Distribution of 7 Pregnant Women in Losari Village, Central Java Table 2. Demographic Distribution of 23 under-fives' Parents in Losari Village, Central Java Table 3. Condition of 23 Respondent under-fives at Birth in Losari Village, Central Java

Tabel 4. Distribution of under-fives Weight at Birth and Length at Birth in Losari Village, Central Java Table 5. Weight-for-age Z-score comparison of 23 under-fives in Losari Village between before and

after intervention

Table 6. Length-for-age Z-score comparison of 23 under-fives in Losari Village between before and after intervention

Table 7. Weight-for-length Z-score comparison of 23 under-fives in Losari Village between before and after intervention

Table 8. Demographic Distribution of 30 under-fives' Parents in Banyumulek Village, Lombok Table 9. Condition of 30 Respondent under-fives at Birth in Banyumulek Village, Lombok

Tabel 10. Distribution of under-fives Weight at Birth and Length at Birth in Banyumulek Village, Lombok

Table 11. Weight-for-age Z-score comparison of 30 under-fives in Banyumulek Village between before and after intervention

Table 12. Length-for-age Z-score comparison of 30 under-fives in Banyumulek Village between before and after intervention

Table 13. Weight-for-length Z-score comparison of 30 under-fives in Banyumulek Village between before and after intervention

Table 14. Demographic Distribution of 28 under-fives' Parents in Tanjung Pasir Village, Banten Table 15. Condition of 28 under-fives at Birth in Tanjung Pasir Village, Banten

Table 16. Distribution of under-fives Weight at Birth and Length at Birth in Tanjung Pasir Village, Banten

Table 17. Weight-for-age Z-score comparison of 21 under-fives in Tanjung Pasir Village between before and after intervention

Table 18. Length-for-age Z-score comparison of 21 under-fives in Tanjung Pasir Village between before and after intervention

Table 19. Weight-for-length Z-score comparison of 21 under-fives in Tanjung Pasir Village between before and after intervention

Table 20. CSI Score Range Conversion Value

Table 21. Results of analysis of two CSI survey methods

Table 22. Nutrition education technical Instructions in giving local food supplementary for pregnant women and toddlers, Indonesian Ministry of Health (2018)

LIST OF ILLUSTRATIONS

Illustration 1. Mama Chef’s activity and coloring competition held in RBS Illustration 2. Dishes made by 4 for the participants in the cooking competition

(11)

I. INTRODUCTION

1. A brief history

Human Initiative (HI) was founded in 1999 while managing humanitarian aid in Maluku that was hit by horizontal conflict. Following that, Human Initiative continues as a National Zakat Charity Institution and manages many humanitarian aid and programs (e.g., Tsunami in Aceh). In 2008, Human Initiative registered in the United Nations as an NGO (non-governmental organization) with Special Consultative Status with the Economic Social Council. In 2010, designated as a National Social Organization and registered as an institutional partner in the European Union for social programs.

Starting from 2016, pivoted their focus and changed their name officially into Human Initiative which focuses on humanitarian programs, no longer managing zakat, infaq, and sadaqah.

In order to reach more people throughout Indonesia and achieve their goal to empower and help the locals, HI have built a lot of branch offices in the entire country. From Aceh, Bengkulu, Riau, Bukittinggi, West-, North- and South Sumatra, to East Kalimantan, Maluku, and some more on the Java Island. However, not limited to that HI also has an overseas branch in Australia, United Kingdom and South Korea as well as some representatives in the United States, Saudi Arabia, Germany, Malaysia, Taiwan, Japan and other countries.

Due to its participation in many humanitarian activities, HI has received many achievements.

Some of them include Pahlawan dari Tanah Bencana (2010), The Best Humanitarian NGO (2011), Appreciation from BNPB (Badan Nasional Penanggulangan Bencana) (2012 & 2018), and MDGs Award Program Finalist for SAGITA (Sadar Gizi Ibu dan Balita) program (2012).

2. Vision and mission Human Initiative’s

● Vision is to become a trusted world humanitarian organization in building self-reliance

● Mission

1. Utilizing emergency, recovery, and empowerment programs in improving the quality and independence of beneficiaries.

2. Establish partnerships and collaborations between humans, business, government, media, academia and other Civil Society Organizations (CSOs) on the basis of the harmony of values adopted by the institution.

3. Conduct relevant study, research, development and capacity building activities for increasing the effectiveness of the role of civil society organizations in providing alternative solutions and/or innovations to protracted humanitarian crises.

4. Building effective, innovative, accountable and service quality-oriented organizational capacities and competencies.

5. Develop advocacy programs both micro, meso and macro to promote justice & equality in society.

3. The main activity

Human Initiative focuses on three main scopes of work, which are:

INITIATIVE FOR CHILDREN

Initiative for Children is a collection of various programs that focus on increasing the knowledge and skills of orphans or poor children. These programs include educational scholarship programs,

(12)

provision of school supplies, worship equipment, psychological support, and various training that support them to be able to live independently.

INITIATIVE FOR EMPOWERMENT

The Initiative for Empowerment or also known as the Empowered Cluster is a collection of various empowerment programs implemented at the individual, family, and wider environmental level to improve the quality of life and the ability of the beneficiaries of this program in an effort to improve sustainable welfare. The Cluster Program takes an empowerment approach through a community facilitation process so that they can organize all their potential to solve their problems. These programs include health, nutrition and food security, water, sanitation and energy, economic empowerment.

INITIATIVE FOR DISASTER

Initiative for Disaster is a collection of various programs that aim to reduce the impact of disasters, through empowering the potential and capacity of the community to recognize potential disasters and make preparations for disasters. In addition to preventive measures, the preparation of the team that will be deployed in the event of a disaster is also a concern for various disaster programs. Post disaster recovery is also included in these programs.

4. Organizational structure

Figure 1. Human Initiative’s organizational structure

(13)

Mr. Tomy as the President of Human Initiative is on the top of the organization structure.

Directly under him there are Mr. Romi, Mr. Rully, and Mr. Andjar who are the vice presidents for communication, network, and development, resources, and operations, respectively. To help Mr.

Andjar who oversees all the projects under Human Initiative, there Mrs. Siti as the general manager and others who were not mentioned in the figure. Under the supervision of Mrs. Siti there are Mrs.

Rifa, Mr. Deni, and Mrs. Rizka who are the managers responsible for the three departments; children, disaster, and empowerment, respectively. Directly under Mrs. Rizka in the empowerment department there are three project managers who worked directly with the author. Namely, Mr.

Yuspi, Ms. Inke, and Mrs. Isyi for Rumah Bunda Sehat, Pahlawan Gizi, and Smart Organic Farming Project, respectively.

5. The student’s unit

Operation Department correlates directly to every program that HI have, which are those inside the three scopes mentioned. As an intern, the author worked under the empowerment unit and was specifically involved in nutrition-related projects. Other than working under the related department, all interns in HI are coordinated under HIVE (Human Initiative Volunteer Energy).

(14)

II. INTERNSHIP ACTIVITIES

The internship activities in Human Initiative correlate closely with both facilitator and project manager. The two have distinct differences in terms of working conditions, thus it will be described separately.

In terms of working with the project manager, as an intern it is required to come to the office for 5 days a week, from Monday to Friday. While the working hours were flexible, it mostly started from 9 AM until 5 PM. The working schedule also varies depending on the task that was assigned to that day. Some of them include but are not limited to, writing reports of the program, compiling files, revising, and analyzing data.

a. Nutrition Project

The period from conception until the child’s 2^ndbirthday is called the first 1000 days of life.

This period is a critical period where it can determine both a child's short- and long-term health.

Environmental factors and a healthy diet during this period can have an effect on the baby’s growth, brain development, digestive system, metabolism, and immune system, thus understanding this critical period may help to produce a healthy generation for the future (EFCNI.org, 2018).

Based on WHO Growth Standard (2013), it also showed that during the first two years of life is the opportunity for growth promotion and thus highlight the need for prenatal and early-life interventions to prevent the growth decline/failure. This correlates directly to cases of stunting in Indonesia.

Figure 2. The z-score growth to the age of children from 1 to 57 months (WHO)

For the past decades, stunting has been the highest malnutrition problem in Indonesia.

Spread throughout the country, Human Initiative takes a small action to address this problem through a program named Pahlawan Gizi. According to the Ministry of Health in collaboration with Indonesian Nutritional Status Study (Studi Status Gizi Indonesia) in 2021, 24,4% of children in Indonesia under the age of 5 years old are stunted. From the distribution mapping of stunting in Indonesia, Java is in yellow or medium while West Nusa Tenggara is in red or high. Thus, from the two provinces, 3 villages are chosen for the intervention program to take place. In order to address this problem, HI made the Pahlawan Gizi and Nyalakan Harapan project.

(15)

Figure 3. Stunting under-fives in Indonesia from 2007-2021 (KEMENKES, SSGI 2021) i. Pahlawan Gizi

Pahlawan Gizi project aims to reduce the number of undernourished and malnourished children under five in the program target areas. In this case, Tanjung Pasir Village (Banten), Banyumulek Village (Lombok), and Losari Village (Central Java) were chosen as the target areas.

In accordance with the objective, the Human Initiative has chosen a total of 30 beneficiaries consisting of both pregnant women and under-fives, with age ranging from 1 to 5 years old. The whole program was delivered for a total of 6 months, starting from the selection of beneficiaries to the end-line survey. There are 4 different kinds of meetings that were held throughout the program:

education class, cooking class, anthropometry measurement, and home visit with the distribution of supplementary feeding or Pemberian Makanan Tambahan (PMT). The meetings were done once every two weeks, with education and cooking class were done alternately while supplementary feeding was given in each meeting with a proportion worth of 2 weeks feeding practices. While home visits were conducted every once a month as a 1-on-1 consultation session.

This program started in April 2022, thus in August upon joining this program it only has 3-4 meetings left. As an intern most tasked were related to help assist the facilitator with on-field tasks such as, taking anthropometry measurement, observing the overall meetings, visiting each beneficiary's house to do 24-hour recall in Tanjung Pasir Village, Banten. Other than on-field related activities, writing the whole report from all target areas was also assigned by the project manager.

Starting from making tables and graphs for the demographic distribution of the beneficiaries in each area, to analyzing the results of baseline and endline surveys and finally compiling all of the documents into one report. As an addition, the facilitator who was in-charge in Tanjung Pasir also offered to make a menu book regarding supplementary feeding of children aged 0-12 months.

ii. Nyalakan Harapan

Similar to Pahlawan Gizi, Nyalakan Harapan project aims to reduce the number of undernourished and malnourished children under five in the program target areas. In this case, Tanjung Pasir Village (Banten) was chosen as the target area. The target beneficiaries for this project are under-five with age ranging from 1 to 5 years old. Different from Pahlawan Gizi, this program was only held for 1 month. Thus, it only consists of 3 types of meetings; education class, cooking class, and anthropometry measurement. As the duration was shorter, the meetings were done once a week with education and cooking class done alternately and anthropometry measurement in each

(16)

meeting. Supplementary feeding was also given in each meeting with a proportion worth of 2 weeks feeding practices.

This program started in November 2022 until the end of December 2022. As the program is similar to Pahlawan Gizi, tasks assigned were more or less the same. Help assist the facilitator by taking anthropometry measurements, taking baseline surveys, doing cooking demo, giving education class, observing the overall meetings in Tanjung Pasir Village, Banten. Other than on-field related activities, analyzing the results of baseline and endline surveys was the only written task that was assigned. While the facilitator was the one who wrote the whole report for this program.

iii. Rumah Bunda Sehat (RBS)

Third project that is still related to the nutrition intervention program is called Rumah Bunda Sehat (RBS). This project aims to improve public health status through strengthening the role of women in building community economic independence and preventing stunting. This program was held for 9 months starting from May 2022 until January 2023. However, unlike Pahlawan Gizi and Nyalakan Harapan, in this project the tasks assigned were to help during an interim monitoring evaluation conducted in RBS Bekasi and during an event called Mama Chef at the same location in October. A one-on-one interview with several participants and committees was done for the interim monitoring evaluation. While during Mama Chef took documentation, printed some banners, and helped prepare the papers for coloring competitions for the children were some of the tasks given.

b. Food Security

The awareness of having a healthy lifestyle through both exercise and healthy diet have increased ever since the pandemic. Not limited to nutrition only, awareness regarding sustainability also arises during pandemics, thus impacting an increase in organic produce (Ashari et al., 2018).

Ashari et al. (2018) explained the potential of organic farming application in Indonesia, although the growth is still slow. Several factors impact the adoption of organic farming in Indonesia, including information and knowledge availability, economic and financial motives, technical and management skills, social consideration, environmental concern, institutional environment, and farmers’

socio-economic and demographic background. By promoting these factors with the help from the government and various stakeholders, organic farming can grow into a huge market that is healthy for the consumer and safe for the environment.

Smith et al. (2019) explained organic are more environment friendly compared to conventional farming due to less-pesticide practices that are applied. This impacts a more pollinator-friendly while equally or if not more nutritious and variety of food with less pesticide residues as a result. Although as a trade-off Smith et al. (2019) mentioned that organic farming may have lower yield compared to conventional. Nevertheless, organic farming is more profitable with similar costs compared to conventional. With higher variability of produce, lower impact to environment, stable ecosystem, and more profit, these combined make quite an effect in overcoming food security by developing the potential of organic farming community-based farmers in Indonesia.

Another challenge that Indonesia faced in the field of agriculture in Indonesia is that most of the farmers are the old generation, a planned succession is needed so that the younger generation is interested in farming, especially in this case organic farming. The next challenge is the perception of people who tend to associate organic farming with traditional natural farming. One strategy that can be done for this is to introduce and use smart organic farming technology to young farmers as has

(17)

been done by the Human Initiative (HI) together with the Innovation Center for Tropical Science (ICTS) in Neglasari Village, Bogor Regency, West Java Province, Indonesia.

Smart Organic Farming (SOF) is the name of the program to address the above problem. The aim of this program is to improve the welfare of farmers through the development of organic farming with modern technology. For this project, HI also collaborated with ICTS (Innovation Centre for Tropical Sciences) to give education as well as building a greenhouse and automatic watering system using wi-fi or also known as Internet of Things (IoT) system. For the assisted farmers to be able to teach the others, HI incorporated ToT (Training of Trainers) to equip them with knowledge and demonstration of the application. The program was done in Bogor and the tasks assigned were given for their last meeting in October. The tasks were to help for a FGD (Focus Group Discussions) as a part of evaluation of the whole program and analyze a community satisfaction index survey or Indeks Kepuasan Masyarakat (IKM).

(18)

III. PROJECT DESCRIPTION

a. Pahlawan Gizi

In total Pahlawan Gizi Project was held for 6 months in Tanjung Pasir Village, Banyumulek Village, and Losari Village. This project starts in April and ends in September, thus in August there is only one month left until the end of the program. The intervention program includes nutrition education, supplementary feeding, home visit, cooking class, anthropometry measurement, and hemoglobin measurement, USG and blood pressure checking for pregnant women. To start the project, beneficiaries were chosen based on the weighing operation results taken before. However, this program was initially meant to be a “trial” program thus the beneficiaries chosen were based on the data from local public health centers or puskesmas. As the target beneficiaries are those in the 1000 first days of life, thus pregnant women and children under the age of 5 that have chronic malnutrition were prioritized with a total of 30 beneficiaries for both categories included for the entire program in each target area. As for the measurement tool and benchmark, baseline survey (BLS) was done before any intervention was given to 30 beneficiaries. The survey included the demography distribution of participants, diet practices, and Perilaku Hidup Bersih dan Sehat (PHBS) or clean and healthy lifestyle. Following that the intervention through meetings that was done once every one to two weeks interval. Usually a meeting lasts for about 3 hours. Upon the participants arrival, they are asked to do anthropometry measurements such as weight and height. Followed with nutrition education for around 20 - 30 minutes by several speakers based on their availability, such as local midwife, health center nutritionist, and HI facilitator with a degree in nutrition. The education covers diversity of food practices, nutrition important for stunted children, feeding practices, the importance of breastfeeding practices, etc. The nutrition education session was done alternately with cooking class to further visualize the application of the theories that were taught. While after those sessions, supplementary feeding is given to the participants to be taken home. On the other hand, home visit activities are done once in a month for 2-3 days. There, we did a 24-hour recall and anthropometry measurement to every participant's houses. Every once a month or two, all pregnant women accompanied by the facilitator from HI and local volunteers were taken to the nearest hospital to take USG treatment. There, each will have an appointment with the doctor there to observe their fetus growth and development. Lastly, to close the program, an end-line survey (ELS) was conducted as a tool to observe the results of the intervention. However due to certain conditions such as moving away from the area, not committing to continue the program, etc the ELS might have different total of beneficiaries and different people from BLS.

The start of the internship was in the last week of August, thus the first task given was just to observe and learn what needed to be done during the on-field meetings for the rest of the program in Tanjung Pasir Village. It includes taking anthropometric measurements, overviewing the overall meetings, and visiting each beneficiary's house to do 24-hour recall.

i. Method

Anthropometry measurement

The anthropometry measurements were done to the children as well as to the pregnant women. For the children, body weight, length/height, head circumference and upper-hand circumference were measured. While for the pregnant women, upper-hand circumference and hemoglobin level was measured.

(19)

For body weight measurement, digital weight scales were used. The children who can stand on their own weigh themselves. However, for those who cannot stand on their own were weighed with their mother and their weight was calculated based on the difference of the children’s weight and their mother and the mother’s weight alone. The length of the children were measured using an infantometer. The children were laid down on the infantometer with their head on the top part and in the straight posture to obtain the accurate measurement. For the head and upper-hand circumference, measuring tape was used to measure. The hemoglobin levels were measured using Easy Touch Hemoglobin Strips Test. An alcohol swab was used on the fingers of the pregnant women to draw their blood using a lancet pen. Using enough blood, then the hemoglobin strip was used and connected to the Easy Touch reader.

24-hour recall

A 24-hour recall was done once a month as a part of a home visit meeting. In practice the parents of the children and the pregnant women were interviewed directly by the facilitator using the food recall form. However, the results of this interview were not included in the end-report and was only used as a reflection of the daily diet practice of the children and pregnant women.

Writing Menu Book

The objective of this menu book was to serve as a pocket book that can be used by the local volunteers, public health officers, and midwives. This book mainly contains some recommended nutritious menu for the children mothers’ to give. The menu ranges for children aged 6-9 months, 9-12 months, and above 12 months years old. This is especially to be taught after the program has ended. First, the menu that was taught in the cooking class were included in the book, then some other new and easy menus were also added. Then each menu was calculated by their nutritional composition for that particular portion written. The nutrition needs for each age category were also included in the book, so that the parents can adjust accordingly. Some additional information obtained from the government regulation regarding children nutrition were also included. Then, after all contents are finished the design of the book comes last before then submitted to the HI for approval and distribution permits.

After the distribution of the book to the local volunteers, public health officer, and midwives, facilitators then explain the content and how to read and teach it to the beneficiaries accordingly.

Writing Report

The task that was given regarding the writing of the report includes; comparing the results between baseline survey (BLS) and endline survey (ELS) in each target area, made each questions regarding the diet practices and clean and healthy lifestyle into a figure, and made narration for each figures, including tables to show the demographic distribution of the beneficiaries in each area. As an addition, the results of the hemoglobin level of the pregnant women in Losari village were also made into a graph using excel. While the results of the anthropometric measurement were analyzed by the facilitator of HI in each target area. After all of the results and data were analyzed, they are all compiled into one document and then proofread by the project manager. Below are the results from anthropometrics measurement of the children, hemoglobin measurement of the pregnant women, and the clean and healthy lifestyle of both the pregnant women and children in each target area.

(20)

ii. Results Central Java

a. Pregnant Women Demographic Distribution

The age range of participating pregnant women was divided into 3 groups. Starting from the first group with an age range of 25-29 years, the second group with an age range of 30-39 years to the last group over 40 years. The percentage of pregnant women in each group was 43%, 43%, and 14% respectively.

The educational level of the families of the pregnant women group is quite diverse. Starting from elementary school graduates to from high school/vocational school graduates. Pregnant women are dominated by elementary school and senior high school graduates with 43% each.

Meanwhile, husband's were dominated by senior high school graduates, with 71%.

Table 1. Demographic Distribution of 7 Pregnant Women in Losari Village, Central Java

Variable Total (n) Percentage (%)

Age

25 - 29 Years Old 3 43

30 - 39 Years Old 3 43

40 - 49 Years Old 1 14

Background Education

Elementary School 3 43

Junior High School 1 14

Senior High School 3 43

Background Education (Husband)

Balanced Nutrition Practices and PHBS

In PHBS practice, 71% or 5 pregnant women admit that they always wash their hands with soap and clean water. Meanwhile, 29% of other pregnant women did not answer. Meanwhile, based on the results of the ELS, there was an increase in the diligence of pregnant women in washing their hands to 86% or 6 people and only 14% or 1 pregnant woman who only occasionally washed her hands using soap and clean water.

(21)

Figure 4. Percentage Distribution of respondents who wash their hands with soap and clean water Based on the results of the BLS, 43% or 3 pregnant women are active in doing physical activity every day. While 14% or 1 person admitted that they only sometimes or rarely did physical activity and the other 29% did not answer. Meanwhile, based on the ELS results, all (100%) pregnant women were diligent in doing physical activity every day.

Figure 5. Percentage Distribution of respondents who did physical activity

Based on the results of BLS, 71% or 5 pregnant women always consume food sources of carbohydrates in a day. While 29% or 2 other people did not answer. While the increase can be seen from the results of the ELS. 86% or 6 pregnant women often consume food sources of carbohydrates in a day, and only 14% or 1 person occasionally.

(22)

Figure 6. Percentage Distribution of respondents who consume carbohydrate sources food in a day In consuming food sources of animal protein, 5 out of 7 (71%) pregnant women admit that they always consume it every day such as eggs, chicken, beef or fish. While the other 29% did not answer. Next, based on the results of the ELS, 71% or 5 people often consumed protein-sourced foods and 29% or 2 others only occasionally.

Figure 7. Percentage Distribution of respondents who consume food sources of animal protein in a day

Based on the results of BLS, 3 out of 7 people or 43% of pregnant women always consume food sources of vegetable protein in a day. While 29% or 2 people only occasionally consumed food sources of vegetable protein such as tofu and tempeh and the other 29% did not answer. Next, the results of the ELS show an increase in the craft of pregnant women in consuming food sources of vegetable protein in a day. 71% or 5 pregnant women often consume food sources of vegetable protein while the other 29% only occasionally.

(23)

Figure 8. Percentage Distribution of respondents who consume food sources of plant protein in a day Based on the results of BLS, 43% or 3 pregnant women are diligent in taking blood tablets every day. However, 29% or 2 pregnant women admitted that they only occasionally took iron tablets every day and the other 29% did not answer. Meanwhile, based on ELS results, 100% of pregnant women often consume iron tablets every day.

Figure 9. Percentage Distribution of respondents who consume blood tablet in a day Hemoglobin Level

The average distribution of hemoglobin (hb) levels of 7 pregnant women is illustrated in Figure 10. Each month has a different total number of pregnant women who actually attend the meeting, thus the results depicted may not be the ideal representation of the whole hemoglobin level of all the pregnant women in this program.

Normal hemoglobin levels for pregnant women are >11 g/dl, if it is below 11 g/dl then pregnant women can be classified into anemia (Moghaddam & Barjasteh, 2015). Overall, the level of hemoglobin in every pregnant woman in Losari Village fluctuates. However, most have a normal hemoglobin level or above 11 g/dl.

(24)

Figure 10. Average hemoglobin level of 7 pregnant women in Losari Village, Central Java for 6 months of observation

b. Under-fives Demographic Distribution

The age range of the participating under-fives is quite diverse. From 1 to 5 Years. The percentage of 3 year olds dominates the under-five age distribution, namely 9 out of 23 people or around 39%.

The educational level of the families of the mothers of the under-aged group is quite diverse.

Starting from elementary school to D3. The highest percentage of the education level of fathers is elementary school graduation, which is equal to 39%. While for the mothers, the highest percentage of education level is elementary school graduates, which is equal to 57%.

Table 2. Demographic Distribution of 23 under-fives in Losari Village, Central Java

Gender

Girl 6 26

Boy 17 74

Age

1 Year Old 3 13

2 Year Old 2 9

3 Years Old 9 39

4 Years Old 6 26

5 Years Old 3 13

(25)

Table 2.Demographic Distribution of 23 under-fives in Losari Village, Central Java (continued) Background Education (Mother)

Diploma 1 4

Background Education (Father)

Based on BLS results, 61% or 14 out of 23 mothers under two had given exclusive breastfeeding to their children when they were 0-6 months old. However, 30% or 7 of the under-aged mothers did not provide exclusive breastfeeding for their children for unspecified reasons and 9% or 2 others did not answer. Next, based on the results of the ELS, 65% or 15 mothers under two did not give exclusive breastfeeding to their children and only 35% or 8 people gave exclusive breastfeeding.

Figure 11. Percentage Distribution of respondents who breastfed their babies for 6 months In the practice of Clean and Healthy Living Behavior or (PHBS), 91% or 21 under-fives admit that they have diligently washed their hands with soap and clean water. While the other 9% did not answer. Next, based on the results of the ELS, all (100%) of the under-fives had diligently washed their hands with soap and clean water.

(26)

Figure 12. Percentage Distribution of respondents who wash their hands with soap and clean water In the practice of balanced nutrition, 57% or 13 mothers under two are diligent in giving fruit and vegetables to their children, 30% or 7 people admit that they only do it sometimes, and 4% or 2 mothers under two rarely give fruits and vegetables to their children. While the other 9% did not answer. An increase in fruit and vegetable consumption can be observed from the results of the ELS, all (100%) of under-fives often eat fruit and vegetables.

Figure 13. Percentage Distribution of respondents who consume fruits and vegetables in a day Based on the results of the BLS, 52% or 12 under-fives often consumed carbohydrate-sourced foods in a day and 26% or 6 others only occasionally consumed carbohydrate-sourced foods in a day. While the other 22% did not answer. Next, based on the results of the ELS, there was an increase to 96% or 22 people in the practice of consuming carbohydrate-sourced foods in a day for under-fives. While 4% or 1 other person sometimes.

(27)

Figure 14. Percentage Distribution of respondents who consume carbohydrate sources food in a day Based on the results of the BLS, 39% or 9 under-fives are diligent in consuming food sources of animal protein in a day. Meanwhile, 39% only occasionally and 4% or 1 person admits that they rarely consume food sources of animal protein a day, such as eggs, chicken, beef or fish. While the other 17% did not answer. Based on the results of the ELS, an increase in the consumption of food sources of animal protein to 96% can be observed in 22 under-fives. While 4% or 1 under-fives only occasionally.

Based on the results of the BLS, 43% or 10 under-fives admitted that they always consumed food sources of vegetable protein in a day. Meanwhile, 39% or 9 under-fives only occasionally consumed food sources of vegetable protein in a day, such as tofu and tempeh, and the other 17%

did not answer. Based on the results of the ELS, 96% or 22 children under five often consume food sources of vegetable protein every day, while 4% or 1 other person only occasionally.

(28)

Based on the results of the BLS, only 4% or 1 under-fives always eat packaged snacks a day.

52% or 12 under-fives only occasionally and 26% or 6 people rarely consume packaged snacks. While the other 17% did not answer. Some examples of packaged snacks consumed by under-fives are chips, biscuits, taro, milk and bandulan tea. Next, based on the results of the ELS, 30% or 7 under-fives often consume packaged snacks in a day, 48% or 11 people only occasionally, and 22% or 5 under-fives who rarely consume packaged snacks. Some examples of packaged food mentioned by the under-fives's mothercare chips, boxed milk, candy, sausages, glass tea, and others.

Figure 17. Percentage Distribution of respondents who consume packaged snacks in a day Anthropometric Measurement

Based on the data below, there were 6 babies who were born with low birth weight (LBW), which weighed between 1000 - 2400 grams. Babies that can be said to be born with low weight are babies who have a birth weight of less than 2500 grams or 2.5 kg.

Apart from LBW, the baby's birth length must also be considered. The birth length standard for babies is said to be normal if the babies have a minimum birth length of 48 cm. Based on the data obtained there are 11 babies whose birth length is below 48 cm, with length ranged from 38 - 47 cm.

(29)

Table 3. Condition of 23 Respondent under-fives at Birth in Losari Village, Central Java Condition of the under-fives

at birth

Total (n) Percentage (%)

Full-term 22 96

Preterm/Premature 1 4

Total 23 100

Tabel 4. Distribution of under-fives Weight at Birth and Length at Birth in Losari Village, Central Java Weight at Birth (grams) Length at Birth (centimeter)

Average 2600 47.5

Maximum 3500 56

Minimum 1000 38

Table 5. Weight-for-age Z-score comparison of 23 under-fives in Losari Village between before and after intervention

Z-score Nutrition Status (weight-for-age)

Before Intervention (n) After Intervention (n)

-2 SD up to + 1 SD Normal 8 6

- 3 SD up to < - 2 SD Underweight 12 12

< - 3 SD Severely underweight 8 10

Table 6. Length-for-age Z-score comparison of 23 under-fives in Losari Village between before and after intervention

Z-score Nutrition Status (length-for-age)

- 2 SD up to + 3 SD Normal 10 5

- 3 SD up to < - 2 SD Stunted 10 18

> +3 SD Severely stunted 8 5

(30)

Table 7. Weight-for-length Z-score comparison of 23 under-fives in Losari Village between before and after intervention

Z-score Nutrition Status (weight-for-length)

- 3 SD up to < - 2 SD Wasted 9 8

< - 3 SD Severely wasted 3 4

LOMBOK

Demographic Distribution

The age range of the participating under-fives are quite diverse, from 1 to 5 Years. The percentage of 2 year olds dominates the under-five age distribution, namely 18 out of 30 under-fives or around 60%.

The highest percentage of education level of fathers is elementary school graduate, which is equal to 43%, while for mothers, the highest education level is senior high school graduation, which is equal to 40%.

Table 8. Demographic distribution of 30 under-fives in Banyumulek Village, Lombok

Gender

Girl 9 30

Boy 21 70

Age

1 Year Old 4 13

2 Year Old 18 60

3 Years Old 4 13

4 Years Old 3 10

5 Years Old 1 3

(31)

Table 8. Demographic distribution of 30 under-fives in Banyumulek Village, Lombok (continued) Background Education (Mother)

Did not go to school 1 3

Income of the Parents per Month (Rp)

< 1.5 Million 17 57

1.5 - 2 Million 11 37

> 2 Million 2 7

Balanced Nutrition Practice and PHBS

Based on the results of the BLS, 97% or 29 mothers under two have carried out the obligation to provide exclusive breastfeeding in the period 0-6 months to their children. However, 1 person or 3% of mothers under two years old admit that they still do not give exclusive breastfeeding to their children for reasons that are not stated. The same results were also seen in the ELS results, 1 mother (3%) still did not give exclusive breastfeeding to her child for reasons not stated.

Figure 18. Percentage Distribution of respondents who breastfed their babies for 6 months

(32)

In PHBS (Clean and Healthy Living Behavior) practice, 83% or 25 under-fives admit that they have washed their hands with soap and clean water. However, it was recorded that 17% or 5 people only occasionally practiced this. Next, in the ELS results, all (100%) of the under-fives had diligently washed their hands using soap and clean water.

Figure 19. Percentage Distribution of respondents who wash their hands with soap and clean water In the practice of balanced nutrition, 70% or 21 mothers under two years old often give fruits and vegetables to their children every day. Only 30% or 9 mothers of infants only occasionally give fruits and vegetables to their children. Next, on the ELS results, it was observed that 100% or 30 under-fives often consumed fruits and vegetables every day.

Figure 20. Percentage Distribution of respondents who consume fruits and vegetables in a day In the practice of consuming carbohydrates in a day by under-aged mothers to their children, 100% of infants often consume carbohydrates in a day. Similar to the results of the ELS, 100% of under-fives often consume carbohydrates in a day.

(33)

Figure 21. Percentage Distribution of respondents who consume carbohydrate sources food in a day Based on the results of the BLS, 90% or 27 under-fives have always consumed food sources of animal protein in a day. However, 10% or 3 people still only occasionally consume food sources of animal protein in a day, such as eggs, chicken, beef or fish. Next, based on the results of the ELS, 100% or 30 under-fives often eat animal protein-sourced foods every day.

As with food sources of animal protein, 90% or 27 under-fives always consume food sources of vegetable protein in a day. Only 10% or 3 under-fives only occasionally consume food sources of vegetable protein in a day, such as tofu and tempeh. Next, based on the results of the ELS, 30 people (100%) under the age of five often consume food sources of vegetable protein every day.

(34)

40% or 12 under-fives admit that they always consume packaged snacks in a day. Meanwhile, 60% or 18 people admit that they still occasionally consume packaged snacks a day. Next, based on the results of the ELS, 100% of under-fives rarely consume packaged snacks that contain preservatives, flavors, dyes, etc. in a day.

The results show that there are variations in the condition of under-fives at birth. Generally divided into 3 groups; namely healthy/normal, premature, and other conditions. The majority of under-fives who were respondents were born under normal conditions, which is around 80%.

However, another 20% were born in premature conditions or other conditions such as Low Birth Weight Babies (LBW), which then affected under-fives’ birth weight and under-fives’ birth length as illustrated in Tables 9 to 10.

(35)

Table 9. Condition of 30 Respondent under-fives at Birth in Banyumulek Village, Lombok Condition of the under-fives at birth Total (n) Percentage (%)

Full-term 24 80

Preterm/Premature 4 13

Other condition* 2 7

Total 30 100

*low birth weight babies

Tabel 10. Distribution of under-fives Weight at Birth and Length at Birth in Banyumulek Village, Lombok

Weight at Birth (grams) Length at Birth (centimeter)

Average 2800 48.5

Maximum 3900 52

Minimum 1400 45

Table 11. Weight-for-age Z-score comparison of 30 under-fives in Banyumulek Village between before and after intervention

Z-score Nutrition Status Before Intervention (n) After Intervention (n)

> +1 SD With risk of overweight 0 1

Table 12. Length-for-age Z-score comparison of 30 under-fives in Banyumulek Village between before and after intervention

(36)

Table 13. Weight-for-length Z-score comparison of 30 under-fives in Banyumulek Village between before and after intervention

< - 3 SD Severely wasted 1 0

> + 3 SD Overweight 0 1

BANTEN

Demographic Distribution

The age range for participating under-fives is quite diverse. From 0 to 3 Years. In the results of BLS, the percentage of 2 year olds dominates the age distribution of under five, namely 12 out of 20 people or around 55%. Next, in the ELS data collection, there were 9 new under-fives who were children of pregnant women who were included in the intervention target. So based on the results of the ELS, ages 1 and 2 years are the majority of beneficiaries, namely as many as 9 people or around 32% in each age group.

Starting from not finishing elementary school to D3. The highest percentage of education level for husbands is elementary school graduates, which is 50%. While the highest level of education for wives is elementary and junior high school graduates, which is 40% each. Next, based on the results of the ELS, the majority of the last education of the husband and wife were elementary school graduates, with percentages of 61% and 50%, respectively.

Table 14. Demographic Distribution of 28 under-fives in Tanjung Pasir Village, Banten

Gender

Girl 17 61

Boy 11 39

Age

0 Year Old 8 29

1 Year Old 9 32

2 Years Old 9 32

3 Years Old 2 7

(37)

Table 14. Demographic Distribution of 28 under-fives in Tanjung Pasir Village, Banten (continued) Background Education (Mother)

Diploma 1 4

Income of the Parents per Month (Rp)

< 1.5 Million 5 18

1.5 - 2 Million 12 43

> 2 Million 8 29

Did not answer 3 11

Based on the results of BLS, 70% or 14 mothers under two have given exclusive breastfeeding to their children when they were 0-6 months old. However, 30% or 6 mothers under two do not give exclusive breastfeeding to their children at the age of 0-6 months for unspecified reasons. Next, based on the results of the ELS, there was an increase in exclusive breastfeeding for under-fives to 75% or 21 people. Another 25% still do not give exclusive breastfeeding because the mother is under two working, the color of the mother's breast milk is clear so it is considered not good for consumption, and/or given other foods, such as formula milk and wafers because the child is considered not full.

(38)

Figure 25. Percentage Distribution of respondents who breastfed their babies for 6 months In the Clean and Healthy Living Behavior (PHBS) practice, 60% or 12 under-fives admitted that they had diligently washed their hands with soap and clean water. However, 30% or 6 people still only occasionally wash their hands with soap and clean water, while 10% or 2 under-fives rarely do so. Next, based on the results of the ELS, 89% 25 mothers under two and under two have often washed their hands using soap and clean water, and 11% or 3 other people only occasionally.

Figure 26. Percentage Distribution of respondents who wash their hands with soap and clean water In the practice of balanced nutrition, only 15% or 3 mothers under two are diligent in giving fruit and vegetables to their children, while the majority (70%) 14 people admit that they only occasionally consume it, and 15% or 3 mothers under two rarely give fruit and vegetables to his son.

Next, based on the ELS results, there was an increase in fruit and vegetable consumption from 15%

to 21% or 6 people. Meanwhile, 79% or 22 people sometimes eat fruit and vegetables.

(39)

Figure 27. Percentage Distribution of respondents who consume fruits and vegetables in a day Based on the BLS results, 95% or 19 under-fives often consume carbohydrate-sourced foods in a day and only 5% or 1 person occasionally consumes carbohydrate-sourced foods in a day. Next, based on the results of the ELS 96% or 27 under-fives often consume carbohydrates every day and the other 4% only occasionally.

Figure 28. Percentage Distribution of respondents who consume carbohydrate sources food in a day Based on the results of the BLS, 85% or 17 under-fives are diligent in consuming food sources of animal protein in a day. Meanwhile, 15% or 3 people admitted that they only occasionally consumed food sources of animal protein in a day, such as eggs, chicken, beef, or fish. Next, based on the results of the ELS, there was an increase to 96% or 27 under-fives who often consumed food sourced from animal protein in a day, and 4% or 1 other person only occasionally.

(40)

Based on the results of the BLS, 45% or 9 under-fives admitted that they always consumed food sources of vegetable protein in a day. Meanwhile, 6 people (30%) admitted that they only occasionally and 5 people (4%) rarely consumed food sources of vegetable protein in a day, such as tofu and tempeh. Next, based on the results of the ELS, there was an increase from 45% to 86% or 24 children under the age of five who often consumed food sources of vegetable protein in a day. While 11% or 3 people only sometimes and 4% or 1 other person it is still rare.

Based on the results of the BLS, 35% or 7 under-fives still frequently consume packaged snacks in a day. Meanwhile, 55% or 11 of the infants admitted that they ate only occasionally and the other 10% rarely consumed packaged snacks. Some examples of packaged snacks that are often consumed by under-fives include; chips, wafers, biscuits, rio tea and tea juice. Next, based on the results of the ELS, there was an increase in absorption of packaged snack consumption from 10% to 36% or 10 under-fives who rarely consumed packaged snacks in a day. Meanwhile, 25% or 7 other people still often and 39% or 11 others only sometimes.

(41)

Based on the data below, there were 1 babies who were born with low birth weight (LBW), which weighed 2400 grams. Babies that can be said to be born with low weight are babies who have a birth weight of less than 2500 grams or 2.5 kg.

Apart from LBW, the baby's birth length must also be considered. The birth length standard for babies is said to be normal if the babies have a minimum birth length of 48 cm. Based on the data obtained all babies have birth length of 48 cm or above, thus all babies are considered normal.

Table 15. Condition of 28 under-fives at Birth in Tanjung Pasir Village, Banten Condition of the under-fives at birth Total (n) Percentage (%)

Normal 27 96

Premature 1 4

Total 28 100

Table 16. Distribution of under-fives Weight at Birth and Length at Birth in Tanjung Pasir Village, Banten

Weight at Birth (grams) Length at Birth (centimeter)

Average 3300 49.4

Maximum 5300 53

Minimum 2400 48

(42)

Table 17. Weight-for-age Z-score comparison of 21 under-fives in Tanjung Pasir Village between before and after intervention

Table 18. Length-for-age Z-score comparison of 21 under-fives in Tanjung Pasir Village between before and after intervention

Table 19. Weight-for-length Z-score comparison of 21 under-fives in Tanjung Pasir Village between before and after intervention

iii. Discussion

Hemoglobin in Pregnant Women

Hemoglobin level is one of the important measurements which is required and needs to be monitored regularly in pregnant women. Not only it is important to ensure the mother’s health but also its fetus. Moghaddam & Barjasteh (2015) explains the effect of hemoglobin status with maternal and perinatal mortality and low birth weight. The incidence of anemia can increase up to fourfold in pregnant women compared to other women in general during their first to third trimester.Laflamme (2011) observed the fluctuation of hemoglobin concentration over the three trimester and found a trend that hemoglobin levels tend to decrease and increase during the first and third trimester, respectively. Unfortunately, the data taken and provided in this report does not take into account the gestational age. Thus, based on the data obtained alone it can only be assumed that all beneficiaries are in their third trimester. If the assumption is taken into consideration then most pregnant women are classified as normal or have hemoglobin level more than 11.0 g/dL, although some can be considered anemic for those whose last measurement is below than 11.0 g/dL. These are some of the examples of the importance in regular monitoring of hemoglobin level, due to the detrimental effects towards fetal growth and development and pregnancy outcomes (Haider, et al., 2013). Low

(43)

Low birth weight is a crucial period that can affect one’s future health, as it is included in 1000 first days of life where most growth and development in a child is the highest. In association with stunting that is highlighted in this program, Putri, et al. (2021) mentioned preterm birth and low birth weight babies are 2.12 times more likely to grow as stunting compared to babies born normal with normal birth weight. Several other studies also mentioned higher risks to subnormal growth, illnesses and neurodevelopmental problems that are associated with social riks as well (Hack, et al., 1995).

In order to reduce the risk, the nutrition of the mother needs to start as early as before conception to be regularly monitored and prepared, including hemoglobin (Putri, et al., 2021). As such, practice of balanced nutrition intake and clean and healthy lifestyle are included in the assessment. Based on the results there is a significant improvement observed after 6 months of intervention. Most importantly regular blood tablet intake is also observed which is very important to be increased especially before giving birth. Hemminki & Starfield (1978) mentioned that taking blood tablets regularly can increase infant birth weight, however Khambalia, et al. (2009) also mentioned that the effect will be more consistent and significant to reduce anemia if the supplements were taken before conception.

Anthropometric Measurement

After 6 months of intervention in all three villages, the highlighted output was observed in anthropometric measurement results of which was further analyzed and standardized using a Z-score from the Ministry of Health, Indonesia (2020).

As the goal of the program is to reduce the number of malnourished and undernourished of under fives, thus based on the body weight and length/height measured every two weeks, these data are converted into 3 categories; weight-for-age, length/height-for-age, and weight-for-length.

Weight-for-age z-score is used to determine if the under fives have the appropriate body weight for their age, if less than the standard then they are categorized as underweight or severely underweight. Length/height-for-age is used to determine if the under fives have the appropriate length/height for their age, if less than the standard then they are considered as stunted or severely stunted. Lastly, weight-for-length is used to determine the overall health status of the under-fives, from severely wasted, wasted, normal, possible risk of being overweight, overweight, and obese.

Tette et al., (2015) & Ahmad et al., (2020) explains the crucial role of community level socioeconomic status to incidence of malnutrition in both developed and developing countries.

Education, poverty, access to clean water, sanitation are some of which factors mentioned to affect health outcomes to the population. Among those mentioned, poverty and maternal education were found to have the most significant effect on malnutrition in children (Ahmad et al., 2020, Abuya et al., 2012). While children in developing countries or with low socioeconomic status are 2.5 times more vulnerable to malnutrition compared to the one in higher socioeconomic status (Ahmad et al., 2020).

In all of the targeted areas, Losari, Banyumulek, and Tanjung Pasir Village all can be classified as areas with low socioeconomic status. Although the data for monthly income in Losari Village was not recorded, both maternal education backgrounds were dominated with elementary school graduates. As for Banyumulek, the mother’s background education was mostly senior high school graduates and elementary school graduates for the father’s. While in Tanjung Pasir both parents are dominated with elementary school graduates, the same as in Losari. The income varies in Banyumulek and Tanjung Pasir starting from below 1.5 Million Rupiah per month to 1.5 - 2 Million

(44)

Rupiah per month, respectively. The effect of low socioeconomic status shown on the number of malnutrition children among the beneficiaries. Furthermore, after the intervention a similar trend was observed in Losari and Tanjung Pasir with a decrease in the number of children with normal z-score of weight-for-age and length-for-age. Contrary to that, results from Banyumulek show a positive increase in the number of children with normal z-score of weight-for-age and length-for-age.

As the data recorded regarding income from each beneficiary were not complete, based on the maternal education alone the highlighted differences were on the background education of the mothers’ in Banyumulek Village. Most mothers there were senior high school graduates which meant a higher education level compared to mothers in Losari and Tanjung Pasir. Abuya et al. (2012) mentioned that there is a strong correlation between maternal education and child’s health, of which children born in higher educated women will be less vulnerable to malnutrition that can manifests into stunting, wasting, and underweight and/or obese compared to those born from women with lower education. Higher knowledge, open-mindedness, and ability to recognize sickness as well as searching for help from the experts are some of the highlighted superiority of higher education women have (Abuya et al., 2012).

Corresponding to the effect of education in the daily practice of balanced nutrition and clean and healthy living (PHBS), there are positive changes observed between before and after intervention in all target areas. The increase in exclusive breastfeeding practices, consumption of carbohydrates, animal protein and plant protein as well as washing hand practices were observed after all education sessions were delivered. This suggests that education plays a crucial role in increasing the healthy diet and clean and healthy living practices. However, the above results are not completely exempted from any other factors that happened both during and after the intervention.

Inconsistency of beneficiaries might be the one the factors that can affect these results.

Throughout 6 months of intervention there are several beneficiaries who got replaced due to moving away, graduated from malnourished status, and other personal reasons of which they did not mention. Thus, some only receive the benefits for several months rather than 6 months. Another factor that might affect the results are the health condition of the under-fives. As body weight can fluctuate from time-to-time, sickness can highly affect the body weight of the under-fives as well.

Children with low birth weight, feeding problems, diarrhea, fever, and other non-communicable diseases may increase the risk of malnutrition (Tette et al., 2015). Over 6 months of intervention, most of the children, especially in Tanjung Pasir got diarrhea and fever alternately, thus a lot have lost a sum of their body weight. Human error can not also be exempted, the condition of measurement in the field especially during the recording of the data may greatly affect the end-results obtained. Other than the facilitator from HI, there are kader, representatives from the village who helped arrange the meetings and thus they were also involved in measuring the body weight and length/height of the children. Additionally, the children sometimes cry or throw tantrums when measured. Thus, an inaccurate measurement of body weight and length/height may affect the results when plotted in the z-score diagram.

b. Nyalakan Harapan

Nyalakan Harapan was a similar project as Pahlawan Gizi where the Human Initiative wants to address the nutrition related problem in the target area. However, different from Pahlawan Gizi, this project was a monthly project thus was only for 1 month due to different sources of funding. It was held from November until December for four weeks in Tanjung Pasir village as the only target area. The intervention program includes nutrition education, supplementary feeding, cooking class,

Nutrition Intervention Program at Human Initiative (HI)

INTERNSHIP REPORT