Determinants of infant care practices in Minangkabau ethnic

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Paediatrica Indonesiana

VOLUME 52 September NUMBER 5

Original Article

280Paediatr Indones, Vol. 52, No. 5, September 2012

Determinants of infant care practices in Minangkabau ethnic

Masrul¹, Hari Basuki²

Abstract

Background &KLOG FDUH SUDFWLFHV DUH LPSRUWDQW IRU JURZWK and development, and are influenced by cultural determinants.

,QGLFDWRUVRILQIDQWFDUHSUDFWLFHVKDYHQRWEHHQGHWHUPLQHGIRU the Minangkabau ethnic group.

Objective To determine indicators of infant care among a Minangkabau ethnic community.

Methods A cross-sectional study was done in Solok, West Sumatera, a region populated by largely Minangkabau ethnic JURXSV,QIDQWIHHGLQJFDUH,)&LQIDQWKHDOWKFDUH,+&LQIDQW FOHDQFDUH,&&DQGLQIDQWSV\FKRVRFLDOVWLPXODWLRQFDUH,36&

were the components of infant care used as indicators. Data on these four components were obtained through interviews with parents and direct observation. A score was assigned to each FRPSRQHQW :H XVHG WKH FRQILUPDWRU\ IDFWRUV DQDO\VLV &)$

method to determine whether the indicators were valid in the studied population.

Results:HHQUROOHGLQIDQWVLQWKHVWXG\ZLWKDPHDQDJHRI PRQWKVDQGZHUHIHPDOH,)&VFRUHVZHUHIDLULQ KLJKLQDQGORZLQ,+&VFRUHVZHUHSRRULQ IDLULQDQGJRRGLQ,&&VFRUHVZHUHSRRULQ IDLULQDQGJRRGLQ,36&VFRUHVZHUHSRRULQ IDLULQDQGKLJKLQ2Q&)$,&&FRQWULEXWHGOHDVWWR the indicator model (L,&&DQG,36&KDGIDLUFRQWULEXWLRQV to the model (LDQGUHVSHFWLYHO\*RRGQHVVRIILWRIWKH PRGHOZDVJRRG3!5RRWPHDQVTXDUHHUURUDSSUR[LPDWLRQ ZDVDQGJRRGQHVVRIILWLQGH[ZDV!

Conclusions,QIDQWFOHDQFDUHZDVWKHPRVWVLJQLILFDQWFRQWULEXWRU to the infant care practice indicator in the Minangkabau ethnic FRPPXQLW\6LPLODUVWXGLHVQHHGWREHGRQHLQRWKHU,QGRQHVLDQ ethnic groups. [Paediatr Indones. 2012;52:280-3].

Keywords: infant, care, indicators

From the Department of Nutrition, Andalas University Medical School, 3DGDQJ ,QGRQHVLDand the Department of Public Health, Airlangga 8QLYHUVLW\0HGLFDO6FKRRO6XUDED\D,QGRQHVLD²

Reprint requests to0DVUXO'HSDUWPHQWRI1XWULWLRQ$QGDODV8QLYHUVLW\

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nfancy is a period most vulnerable to diseases DQG JURZWK GLVRUGHUV ,QIDQWV XQGHUJR UDSLG growth, have an immature immune system, and H[SHULHQFHDGLHWDU\WUDQVLWLRQIURPEUHDVWPLON to solid food.([SHUWVKDYHJLYHQPXFKDWWHQWLRQWR the role of nurture on infant development, particularly in developing countries. Determinants of infant/child FDUHPD\DIIHFWFKLOGJURZWKLQWKUHHZD\VWKURXJK nutritional intake, through child care practices, and through the role of hormonal as well as other biochemical factors.^2-7

The four components of infant care are infant IHHGLQJFDUH,)&LQWKHIRUPRIEUHDVWIHHGLQJDQG FRPSOHPHQWDU\ IHHGLQJ LQIDQW KHDOWK FDUH ,+&

in the form of disease prevention, home care of the sick child, and curative efforts at health centers, LQIDQW FOHDQ FDUH ,&& LQ WKH IRUP RI SURWHFWLQJ the cleanliness of the individual child, preventing contamination of food and drink, and cleanliness of playrooms and beds.^5,6Finally, infant psychosocial VWLPXODWLRQ FDUH ,36& WDNHV WKH IRUP RI JLYLQJ stimulation to infants from an early age to support their development.

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Masrul et al: Determinants of infant care practices in Minangkabau ethnic

Paediatr Indones, Vol. 52, No. 5, September 2012 281 ,QIDQWFDUHLVDFXOWXUDOSURGXFWRIDSDUWLFXODU

HWKQLFJURXSRUFRPPXQLW\&KLOGFDUHSUDFWLFHVDUH passed on from previous generations of mothers or other care givers in the family and are influenced by the changing environment. Thus, patterns of infant and child care may differ across families and cultures.

Understanding community-specific child care patterns is necessary to assess adequacy of care in the particular community. Assessment of such care indicators has UDUHO\ EHHQ GRQH LQ ,QGRQHVLD DQG KDV QRW EHHQ reported in the Minangkabau ethnic group of West Sumatera.This study aims to determine the indicators of infant cares in the Minangkabau ethnic group using DFRQILUPDWRU\IDFWRUDQDO\VLV&)$DSSURDFK

Methods

$ FURVVVHFWLRQDO VWXG\ ZDV FRQGXFWHG LQ LQ three subdistricts in Solok, West Sumatera. Solok is a regency with a homogenous population of Minangkabau ethnicity and relatively high prevalence of nutritional problems in under-five-year-olds.

6XEMHFWVZHUHLQIDQWVWRPRQWKROGLQWKH participating subdistricts.

7R DVVHVV ,)& ZH UHFRUGHG IHHGLQJ SDWWHUQV which covered breastfeeding and/or provision of complementary foods, the age at which complementary foods were introduced, and the frequency of complementary feeding. We also noted the criteria used for starting complementary feeding, nursing frequency, and the characteristics of breastfeeding PRWKHUV 'DWD ZHUH FROOHFWHG GXULQJ D KRXU observation period which ran from 6 AM to 6 PM.

:H DVVHVVHG ,+& E\ QRWLQJ ZKHWKHU WKH infant was weighed monthly for the last three months, whether he had received age-appropriate immunizations and vitamin A supplementation, and how family-based treatments were given for diarrhea and upper respiratory problems. Data were collected through interviews with parents and caregivers, followed by validation of the data.

$VVHVVPHQW RI ,&& ZDV GRQH E\ REVHUYLQJ water resources used for drinking, bathing, processing complementary foods, and washing infant equipment, places to store infant food, habits of cleaning infant feeding equipment, level of infant cleanliness, the frequency of infant bathing, the use of soap in when

bathing the infant, use of infant cosmetic products, and the frequency of changing the infant’s clothes.

Data collection on these three care practices were made by an enumerator specifically trained for this purpose. A score was assigned to each indicator.

,QIDQWSV\FKRVRFLDOVWLPXODWLRQFDUHDVVHVVPHQW was done using the Home Observation for Measure- PHQWRIWKH(QYLURQPHQW+20(LQVWUXPHQWGH- YHORSHGE\&DOGZHOOHWDOTwo measurements were made with a one-month interval by a team of trained psychologists. The average score of the two measurements was used in the analysis.

'DWDZHUHDQDO\]HGXVLQJ(SL,QIRYHUVLRQ

&HQWHUVIRU'LVHDVH&RQWURODQG3UHYHQWLRQ$WODQWD

*HRUJLD$FRQILUPDWRU\IDFWRUDQDO\VLVXVLQJ/,65(/

6FLHQWLILF6RIWZDUH,QWHUQDWLRQDO,QF6NRNLH ,OOLQRLV VRIWZDUH ZDV GRQH WR GHWHUPLQH LQGLFDWRUV of infant care practice.$3YDOXHRIZDV considered statistically significant. This study has EHHQDSSURYHGE\WKH0HGLFDO(WKLFV&RPPLWWHHRI Andalas University Medical School.

Results

$ WRWDO RI LQIDQWV SDUWLFLSDWHG LQ WKH VWXG\

ZHUHIHPDOH 0HDQ VXEMHFWDJH ZDV 6' PRQWKV7KHGLVWULEXWLRQRILQIDQWFDUHSUDFWLFH scores can be seen in Table 1.

Table 1+PHCPVECTGRTCEVKEGUEQTGU

+PHCPVECTGRTCEVKEGU

+PHCPVHGGFKPIECTG+(%

RQQTUEQTG 6.7

HCKTUEQTG

IQQFUEQTG

+PHCPVJGCNVJECTG+*%

RQQTUEQTG

HCKTUEQTG

WPFGTIQQFUEQTG 15.5

+PHCPVENGCPECTG+%%

RQQTUEQTG 0.7

HCKTUEQTG

IQQFUEQTG

+PHCPVRU[EJQUQEKCNUVKOWNCVKQPECTG+25%

RQQTUEQTG 10.6

HCKTUEQTG

IQQFUEQTG 4.5

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282Paediatr Indones, Vol. 52, No. 5, September 2012 2Q &)$ DOO IRXU LQGLFDWRUV RI LQIDQW FDUH SUDFWLFHZHUHYDOLGDQGUHOLDEOH,QIDQWIHHGLQJFDUH has the least contribution compared to other practices, ZLWKDODPEGDRI,QIDQWFOHDQFDUHDQG,36&

offered a fairly large contribution, with a lambda of DQGUHVSHFWLYHO\7KHJRRGQHVVRIILWLQGH[

*),RIWKLVPRGHOZDVZLWKD3YDOXHRI URRW PHDQ VTXDUH HUURU DSSUR[LPDWLRQ 506($

Figure 1:HXVHGD*),FXWRIISRLQWRI!

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Discussion

,Q DOO LQIDQW FDUH SUDFWLFH LQGLFDWRUV ,)&

,+& ,&& DQG ,36& LQ WKH 0LQDQJNDEDX HWKQLF FRPPXQLW\VKRZHGPRVWO\IDLUUHVXOWV,QIDQWKHDOWK care showed a larger percentage in the poor category than the other three indicators. The low scores were mostly due to infants not being brought to weighing stations at community health centers, failure to give vitamin A supplements, and lack of knowledge among mothers on the home treatment of diarrhea and upper respiratory tract infections. Similar problems were also found in studies done in West Sumatera by +HOOHQ .HOOHU ,QWHUQDWLRQDO DQG 81,&()

²³

7KH&)$DQDO\VLVLQGLFDWHGWKDWWKHIRXUSUDFWLFHV remained valid as indicators of child care for the study.

2XUUHVXOWVDUHLQDJUHHPHQWZLWK(QJOH³ and 5DPDNULVKQDQ ⁵who stated that infant care practice should include the four practices jointly. The

four components infant care practice work in synergy for optimal growth and development.^2-5,24

Although all four infant care practices are LQFOXGHGDVLQIDQWFDUHLQGLFDWRUV,)&JLYHVDVPDOOHU contribution (L FRPSDUHG WR RWKHU LQIDQW care practices. This may be due to the frequency of breastfeeding being the largest score contributor to ,)&,QWKLVVWXG\RILQIDQWVZHUHEUHDVWIHG RIZKLFKZHUHEUHDVWIHGRQGHPDQG0RWKHU·V PLONLVLPSRUWDQWIRULQIDQWVWRPRQWKVRIDJH both from as a source of nutrients and to support the infant’s immune system. Whenever possible, breastfeeding should be done on demand.^25,27

:KHQWHVWLQJDPRGHOXVLQJ&)$LWLVQHFHVVDU\

WRDVVHVVWKHPRGHO·VJRRGQHVVRIILW2Q&)$DQDO\VLV PRGHOREWDLQHGD3YDOXHRI7KH506($YDOXH RIWKHPRGHOZDVFXWRIISRLQW7KH

*),YDOXHZDV2XUPRGHOIXOILOOHGUHTXLUHPHQWV for fit.

We conclude that a valid indicator of infant care SUDFWLFHV FDQ EH IRUPHG XVLQJ ,)& ,+& ,&& DQG ,36&DVLWVFRPSRQHQWV7KHUHIRUHWKHVHLQGLFDWRUV need to be developed for scientific purposes and field SUDFWLFHV&RQVLGHULQJWKDWWKHVHLQIDQWFDUHSUDFWLFHV are also cultural products, it is advisable to conduct similar studies in different ethnicities or tribes in ,QGRQHVLD WR GHYHORS D QDWLRQDO LQGLFDWRU RI LQIDQW care practices.

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