Based on SKID data in 2007, This study used analytic
mother mortality rate in Indonesia has observational design with case control reached 228 per 100.000 of birth rate. approach. Also, it was conducted Bleeding has the highest percentage of atPuskesmasof Northern Kediri. The mother mortality rate (28%), eclampsia population involved was all pregnant (24%), and infection (11%). Meanwhile, women recorded in the data published by Chronic Energy Deficiency (CED) Puskesmasof Northern Kediri during becomes passive factor for mother January December 2015. Samplesof this mortality rate by 37% research were 90 respondents by (Hasanah&Minsanarwati, 2012). Primarily, considering the formulation below: chronic energy deficiency (CED) is a N condition in which a mother has poor n= nutritional status to chronic inadequate 1=Ne2 intake, thus interrupts maternal health n = sample (Department of Health, 2002). N = population The prevalence of pregnant mother E = margin error 0.10 (10%) with chronic energy deficiency in Based on the formulation above, Indonesia increases by 21.6%, especially the 90 respondents consisting of 17 pregnant mother rate in East Java increases chronic energy deficiency patients and 73 highly by 27.5% (Hasanah&Minsarnawati, respondents as control group. The data of 2012). Based on the data of pregnant knowledge, socio-economic, and maternal mother atPuskesmas (Community Health factors were collected through interview Center) of Northern Kediri, 212 pregnant and questionnaire. The selection of CED mothers were recorded while 17 (8%) status was measured by Mid-Upper Arm among them encountered chronic energy Circumference (MUAC) of pregnant deficiency (CED). In fact, the target that mother. According to general standard of must be reached by government for Department of Health of the Republic of pregnant mother with chronic energy Indonesia, it states that a mother suffers deficiency in 2015 is less than 5% (Annual Chronic Energy Deficiency (CED) if her Report at Puskesmas of Northern Kediri, length of MUAC is lower than 23.5 cm 2015). Primarily, CED is not only (<23.5cm). influenced by poor nutritional intake but The status of pregnant mothers also by socio-demography, knowledge nutrient was actually investigated through regarding nutrition of pregnancy period, several indicators, such as length and education level, monthly income factors weight before pregnancy, weight during (Daba et al, 2012). Lack of nutrition intake pregnancy, and Mid-Upper Arm during pregnancy period will cause Circumference (MUAC). The inefficient nutritional micro and macro. measurement of MUAC was one of Thus, it leads to inadequate growth and alternatives to investigate CED risk. development of disability, premature birth, Basically, MUAC measurement is a pregnancy complication, and infant with practice tool used to easily investigate malnutrition. The purpose of this study CED risk on pregnant women. The data of was to analyze the influence of knowledge, MUAC were recorded in cohort population socio-economic, and maternal factors for pregnant mothers who towards chronic energy deficiency on visitedPuskesmasof Northern Kediri. The pregnant women atPuskesmas of Northern data were conducted by means of Kediri during January December 2015. designing categories, subsequently applying univariate analysis to investigate score frequency and distribution to each variable of the study. Otherwise, bivariate >1.399.750 14 82,4 27 37,0 analysis was conducted to investigate the Parity correlation between free and bound <4 17 100 72 98,6 variables by using statistical test of chi >4 0 0 1 1,4 square. Antenatal Care Routine 4 23,5 24 22,9 RESULTS Not-routine 13 76,5 49 67,1 Based on the data of the study, 17 Mothers Age during Pregnancy patients were categorized as CED while 73 <20 years old 2 11,8 1 1,4 patients were not categorized as CED at >20 years old 15 88,2 72 98,6 Puskesmasof Northern Kediri.The total population in this research was 90 Based on table 1 above, most of respondents. pregnant mothers were in range of 20 35 Univariate Analysis years old for both CED group and non- Table 1 explains thecharacteristics of CED group. These ages frequently respondents based on age, nutritional encountered pregnancy due to fit and status, knowledge level, education level, healthy condition of young mother to monthly income, job, parity, ANC, and deliver an infant. Based on the data of mothers age during pregnancy. Department of Health of the Republic of Indonesia (2008), the youngest age under Individuals Pregnant Mother 20 yearsand the oldest age above 35 Characteristics CED Non-CED yearsare risky age during pregnancy. n % n % Meanwhile, the nutritional status of Mothers Age pregnant mothers for CED group was <20 years old 2 11,8 1 1,4 categorized underweight while non-CED 20-35 years old 14 82,4 61 83,6 group was categorized normal. >35 years old 1 5,9 11 15,1 The knowledge level of pregnant Nutritional Status mothers with CED was categorized poor Obesity 0 0 20 27,4 while non-CED was categorized good. Overweight 1 5,8 25 34,2 Both groups were graduates of Senior Normal 6 35,2 28 38,4 High School. Moreover, most of them Underweight 10 71 0 0 were unemployed. The expenditure Knowledge Level proportion upon total budgeting was Poor 9 52,9 8 11,0 depicted through average household Enough 3 17,6 18 24,7 incomes. The average of household Good 5 29,4 47 64,4 incomes with CED was >1.399.750 while Education Level non-CED was >1.399.750. Most of Elementary 0 0 1 1,4 pregnant mothers with and without CED School did not have parity less than 4 children and Junior High 4 23,5 6 8,2 attended to ANC routinely. Meanwhile, School the mothers age during pregnancy was Senior High 11 64,7 56 76,7 average >20 years old for both groups. School Higher 2 11,8 10 13,7 Education Occupation Employed 4 23,5 28 38,4 Unemployed 13 76,5 45 61,6 Incomes <1.399.750 3 17,6 46 63,0 Bivariate Analysis Bivariate analysis aimed at recognizing the Table 2. illustrates the bivariate correlation between free variable and analysis on the influence of information, bound variables. Based on the bivariate socio-economic and maternal factors upon analysis, it was obtained the significant the chronic energy deficiency: correlation between mothers nutritional status during pregnancy and chronic Individuals Pregnant Mothers P value energy deficiency with p=0.000. Characteristics CED Non- Meanwhile, the correlation on knowledge CED level obtained p=0.000 indicating that n % n % there was a significant correlation between Nutritional Status 0,000 knowledge level and chronic energy Obesity 0 0 20 27,4 (Fisher deficiency. The bivariate analysis showed Overweight 1 5,8 25 34,2 exact test) that the education level obtained p=0.328 Normal 6 35,2 28 38,4 indicating that there was no correlation Underweight 10 71 0 0 Knowledge Level 0,000 between mothers education level and Poor 9 52,9 8 11,0 (Fisher chronic energy deficiency. In terms of job Enough 3 17,6 18 24,7 exact test) analysis, it was obtained p=0.399 Good 5 29,4 47 64,4 indicating that there was no correlation Education Level between job and chronic energy deficiency. Elementary 0 0 1 1,4 0,328 It also occurred for the average household School (likelihood incomes with p=0.160 indicating that there Junior High 4 23,5 6 8,2 ratio) was no correlation between the average School incomes and chronic energy deficiency. Senior High 11 64,7 56 76,7 The bivariate analysis for parity showed School the value of p=0.811 indicating there was Higher 2 11,8 10 13,7 no correlation between parity and chronic Education Job Status 0,399 energy deficiency. In terms of antenatal Employed 4 23,5 28 38,4 (Fisher care, it was obtained p=0.568 indicating Unemployed 13 76,5 45 61,6 exact test) that there was no correlation between Incomes 0,160 mothers visit on antenatal care and <1.399.750 3 17,6 46 63,0 (Fisher chronic energy deficiency. Last, in terms >1.399.750 14 82,4 27 37,0 exact test) of age, it was gained p=0.090 indicating Parity 0,811 that there was no correlation between <4 17 100 72 98,6 (Fisher mothers age and chronic energy >4 0 0 1 1,4 exact test) deficiency. Antenatal Care 0,568 Routine 4 23,5 24 22,9 (Fisher Not-routine 13 76,5 49 67,1 exact test) Mothers Age during Pregnancy 0,0900 <20 years old 2 11,8 1 1,4 (Fisher >20 years old 15 88,2 72 98,6 exact test) Multivariate Analysis Table 3. illustrate the multivariate analysis on the influence of information, socio- economic and maternal factors upon the chronic energy deficiency.
Individuals Pregnant Mother
Characteristics CED Non- B Crude 95% CI P value CED OR n % n % Nutritional Status Obesity 0 0 20 27,4 0.379- Overweight 1 5,8 25 34,2 -42.64 5.136 0.538 0,000 Normal 6 35,2 28 38,4 Underweight 10 71 0 0 Knowledge Level Poor 9 52,9 8 11,0 -2.934 0.569 0.004- Enough 3 17,6 18 24,7 0.639 0,000 Good 5 29,4 47 64,4 Incomes 0.143 <1.399.750 3 17,6 46 63,0 0.617 1.854 24.10 0,160 >1.399.750 14 82,4 27 37,0 Mothers Age during Pregnancy 0.001- <20 years old 2 11,8 1 1,4 -2.534 0.079 4.205 0,0900 >20 years old 15 88,2 72 98,6
Crude odds ratio or OR is the risk status, it was obtained OR=5.136
amount of free variable towards bound indicating that mothers with underweight variable which is obtained through the nutritional status were more likely to have bivariate analysis. The significance of this risk of chronical energy deficiency 5 times odds ratio can be obtained through the higher than those with normal nutritional correlation test. The result of bivariate status. The second factor significantly analysis with crude OR on each risk factor contributing to the chronic energy is illustrated in Table 5.2. The table deficiency is knowledge level OR=0.569, presents each influential factor of chronic 95% CI=0.004-0.639, p=0.000). In terms energy deficiency, two of which are of knowledge level, it was obtained nutritional status before pregnancy and OR=0.569 indicating that mothers with mothers information level that can be lessknowledge level were more likely to seen from p value < 0.05. Meanwhile, two have risk of chronical energy deficiency other variables, which are average incomes 0.5 times higher than those with normal and mothers age during pregnancy, did knowledge level. Meanwhile, the other not show any significant correlation (p two variables, average incomes and value > 0.05). mothers age during pregnancy, showed Based on B value for nutritional value of 1 on CI 95% (incomes=0.143- status, it was obtained -42.64 indicating 24.10, while mothers age=0.001-4.205). that overweight nutritional status was Therefore, the value of these two variables indeed a risky factor which could decrease did not indicate the significant correlation. the chronical energy deficiency. Discussion The nutritional status is one of In this research, the analyzed risk influential factors for chronic energy factors incorporate several variables such deficiency (OR=5.316, 95% CI=0.379- as: mothers knowledge level, socio- 0.538, p-0.000). In terms of nutritional economic factors including education level, job, and average household incomes, and high education level due to their lack of maternal factors involving parity, mothers information on proper nutrition. This age during pregnancy, and antenatal care research, however, is not in accordance record. According to chi-square done in with a research by Mirsanjari, et.al. (2012) this research, the information variable figuring out the significant correlation obtained p value=0.000 indicating that between education level and mothers there was significant correlation between knowledge on nutrition (adjusted b=2.893, knowledge level and chronic energy CI 95%=2.18-3.47, p=0.001). deficiency on pregnant mothers. An According to Sawaswatis research individuals knowledge level was (2009), mostly mothers with chronic influenced by several factors such as: energy deficiency are those with low individuals characteristics (age, education education level in which mothers with level, experiences), socio-economic (job), elementary education level or less are mass-media exposure and transportation more likely to have higher risk of chronic ownership. Therefore, the higher energy deficiency compared to those with information level mothers possess, the elementary education level or higher lesser risk of chronic energy deficiency (38.3%). An individuals education they will bear. It corresponds to a research background is one of important factors conducted by Palimbo&Firdaus (2014) influencing the nutritional status due to the figuring out the significant correlation fact that most of nutritional deficiency is a between mothers knowledge level and result of insufficient knowledge on health chronic energy deficiency on pregnant and nutrition.In this research, job variable mothers (p=0.002, coefficient obtained p value=0.399 indicating that correlation=0.879, CI 95%=0.800-1.000). there was no significant difference This research figured out the between job and chronic energy deficiency. significant correlation between pre- It did not show any distinct probabilities of pregnancy nutritional status and chronic chronic energy deficiency on employed energy deficiency. It was due to the fact mothers and unemployed mothers because that the chronic energy deficiency was a of their food consumption during the result of environment and human factors pregnancy. supported by nutrition intake factors. The This researchis not in accordance findings of this research are supported by with a research by Miharawati (2014) Abrahams research (2015) investigating figuring out the significant correlation on the correlation between nutritional between employed mothers and chronic status and chronic energy deficiency. This energy deficiency (with percentage of research figured out the significant mother with CED 52.9%). It is due to their correlation between pre-pregnancy predisposition on having less time to nutritional status and chronic energy prepare the nutritional foods which leads deficiency during pregnancy (OR=2.982, to their eating pattern as well as food CI=1.892-4.835). consumption.Based on a research by The analytical analysis in this Fouda, et.al. (2012), most of mothers are research showed that there was no unemployed whose average incomes are significant correlation between education low. These highly influence their level and chronic energy deficiency on nutritional status during pregnancy. pregnant mothers. Mothers with high This research figured out that there education level yet having low incomes was no significant correlation between resulted to the insufficient nutrition average incomes and chronic energy whether in terms of quantity or quality, deficiency (percentage of mother with and vice versa. The chronic energy CED 29.9%). It corresponds to a research deficiency also occurred on those with by Haslinda (2014) figuring out that there is no significant correlation between 1. Mothers knowledge influenced the average household incomes and chronic chronic energy deficiency on pregnant energy deficiency (p=0.384, CI=2.66 (0.5- mothers at Community Health Center 14.2)). of Northern Kediri. Based on bivariate analysis, it was 2. Mothers nutritional status found that there was no significant influencedchronic energy deficiency correlation between parity and chronic on pregnant mothers at Community energy deficiency. Parity is one of risk Health Center of Northern Kediri. factors occurred in the chronic energy 3. Socio-economic factors, mothers age deficiency on pregnant mothers. The during pregnancy, parity, and findings of this research are in a line with a antenatal care did not influence the research by Albugis (2008) conveying that chronic energy deficiency on pregnant there is no significant correlation between mothers at Community Health Center parity and chronic energy deficiency of Northern Kediri. (p=0.113). Further, however, it is 4. Mothers with chronic energy explained that mothers with parity over 4 deficiency at Community Health children have higher risk on chronic Center of Northern Kediri were 17 energy deficiency compared to those with people. parity less than 4 children. Mothers visit on antenatal care in this research did not indicate the significant correlation to chronic energy deficiency. In a research by Fouda, et.al. (2012), more than 50% mothers indicated basic knowledge about food sources containing varied vitamin types and minerals, which therefore contributes to their less visit on routine antenatal care. The discussion above conveys that the CED prevention efforts must necessarily be made prior to pregnancy, for instance: the nutrition improvement on adolescents should be carried out before marriage. Mulyaningrums research (2009) reveals that mothers aged under 20 years old are more likely to have higher risk on chronic energy deficiency. In fact, they could significantly increase the risk of chronic energy deficiency. Furthermore, it is explained that early pregnancy on under-age mothers could lead to the competition between fetus and mother under the growth.
CONCLUSION Based on the findings and discussion in this research, it can be concluded that: