Chairunnisa1*, Didik Dwi Sanyoto2, Roselina Panghiyangani3,
Ermina Istiqomah4, Syamsul Arifin5
Faculty of Medicine and Health Sciences, Universitas
Lambung Mangkurat, Banjarmasin, South Kalimantan, Idonesia1,2,3,4,5
Email: ppchairunnisa@gmail.com
|
KEYWORDS |
ABSTRACT |
|
TPG
knowledge, TPG availability, facilities, performance, TPG, exclusive
breastfeeding coverage |
Background: In
2022, exclusive breastfeeding coverage in Indonesia will only reach 67.96%,
indicating the need for more intensive support to increase this coverage.
Competent human resources, especially in conducting nutritional surveillance,
as well as the demands and needs of quality health services in dealing with
malnutrition, can describe the current health condition. Objective: This
study aims to analyze the relationship between the knowledge of nutrition
implementers (TPG) about the exclusive breastfeeding program, the
availability of TPG in implementing the exclusive breastfeeding program, and
the facilities in implementing the exclusive breastfeeding program with TPG's
performance in achieving exclusive breastfeeding coverage in North Hulu
Sungai Regency. Methods: This study uses an observational analytical method
with a cross-sectional approach. The sample in this study is 46 TPG. Data
analysis was carried out using the Chi-Square test and multiple logistic
regression. Results: The chi-square test showed that there was a relationship
between TPG knowledge (p=0.007), TPG availability (p=0.013), and facilities
(p=0.020) in the exclusive breastfeeding program and TPG's performance in
achieving exclusive breastfeeding coverage. The results of the multiple
logistic regression test concluded that all independent variables were simultaneously
related to TPG's performance in achieving exclusive breastfeeding coverage in
the North Hulu Sungai Regency.
Conclusion: there is a relationship between TPG knowledge, TPG
availability, and facilities in exclusive breastfeeding programs and TPG's
performance in achieving exclusive breastfeeding coverage. |
|
DOI: 10.58860/ijsh.v3i8.228 |
|
Corresponding Author: Chairunnisa*
Email: ppchairunnisa@gmail.com
INTRODUCTION
Stunting, a growth disorder primarily
caused by poor nutrition, infections, and inadequate social and environmental
conditions, can lead to significant functional impairments in children,
especially within the critical first 1,000 days from conception to age two
Exclusive breastfeeding is crucial for
optimal physical and mental growth, making it a priority for mothers to ensure
that their babies' nutritional needs are met, particularly in the early stages
of life. Recognizing breastfeeding as a human right, both for babies and
mothers, is supported by Indonesian law (Child Protection Law No. 23 of 2002)
and reinforced by various government initiatives, such as the National Movement
for Increasing Breastfeeding (GNPP-ASI) and the Minister of Health Decree No.
450/Menkes/SK/IV/2004, which advocates for exclusive breastfeeding from birth
to six months. Despite these efforts, Indonesia's exclusive breastfeeding
coverage in 2022 was only 67.96%, falling short of the WHO target of 80%. North
Hulu Sungai Regency has responded by implementing a regional regulation (No. 1
of 2016) to support exclusive breastfeeding, yet coverage in 2022 remained at
62.49%, below the target. This shortfall highlights the need for continued
support from all levels of government and the community to achieve the desired
breastfeeding rates.
Competent human resources, especially in
the implementation of nutrition surveillance as well as the demands and needs
of quality health services in dealing with malnutrition problems, can describe
the current health conditions
The results of
The results of observations in the
preliminary study of 16 TPGs showed that the level of knowledge of TPGs
regarding the exclusive breastfeeding program 6 out of 16 TPGs, or 37.5%, had
less knowledge. TPG knowledge is very important in the exclusive breastfeeding
program because TPG is a human resource
The problem found in HSU Regency is the
cause of the reporting of exclusive breastfeeding coverage in North Hulu Sungai
Regency also does not reach the expected target (80%)
Based on the above background, the
researcher is interested in analyzing the factors related to TPG performance in
achieving exclusive breastfeeding coverage in North Hulu Sungai Regency, with a
focus on understanding how these factors influence outcomes and contribute to
the broader field of healthcare performance analysis.
METHOD
Research Design
This
observational study uses a cross-sectional approach and was conducted in the
integrated service unit of the North Hulu Sungai Regency Health Office across
13 health centers from January 22 to February 5, 2024.
Settings and Respondents
The study
population consists of 70 TPGs (health personnel), spread across 13 health
centers in HSU Regency. A sample of 46 TPGs was selected using the Probability
Sampling technique.
Variables, Instruments,
and Measurements
The
independent variables include TPG knowledge, TPG availability, availability of
funds, and facilities for implementing exclusive breastfeeding programs. The
dependent variable is TPG performance in achieving exclusive breastfeeding
coverage in North Hulu Sungai Regency. Data were collected through
questionnaires and secondary data from nutrition surveillance in North Hulu
Sungai Regency
Data Analysis
Univariate
analysis was performed to describe the characteristics of each independent
variable. Bivariate analysis using the Chi-Square test examined the
relationship between the independent variables and the dependent variable,
which is the coverage of exclusive breastfeeding. Multivariate analysis with
multiple logistic regression was used to determine the influence of the
independent variables on the dependent variable and identify the most dominant
factor.
RESULT AND DISCUSSION
Table 1.
Frequency distribution of respondent characteristics
|
Characteristics of
Respondents |
n |
% |
|
Last education |
||
|
DIII Associate Nutrition
Expert |
32 |
69.6 |
|
S1/DIV |
14 |
30.4 |
|
Breastfeeding Counseling
Training (Breastfeeding Counseling) |
||
|
Yes. |
16 |
34.8 |
|
Not. |
30 |
65.2 |
|
Dual duties other than as TPG |
||
|
Yes. |
10 |
21.7 |
|
Not. |
36 |
78.3 |
|
Total |
46 |
100 |
Based on Table 1, it was found that in the last education category, the
most were D-III Nutrition, which was 32 TPG (69.6%), in the category of breast
milk counseling training (Breast Milk Counseling) as many as 30 TPG (65.2%) did
not get breast milk counseling training and for dual tasks other than as TPG,
as many as 36 TPG (78.3%) did not have dual duties.
Table 2.
Distribution of independent and dependent variables in
this study
|
Research
variables |
TPG's
performance in achieving coverage Exclusive
breastfeeding |
P-Value |
|||
|
Not
Optimal |
Optimal |
|
|||
|
n |
% |
n |
% |
|
|
|
TPG's
knowledge of exclusive breastfeeding programs |
|||||
|
Good. |
18 |
39.1 |
6 |
13 |
0.040 |
|
Not
good |
10 |
21.7 |
12 |
26.1 |
|
|
Availability of TPG in implementing exclusive
breastfeeding programs |
|||||
|
Enough |
9 |
19.6 |
15 |
32.6 |
0.001 |
|
Insufficient |
19 |
41.3 |
3 |
6.5 |
|
|
Facilities
in implementing exclusive breastfeeding programs |
|||||
|
Complete |
11 |
23.9 |
16 |
34.8 |
0.001 |
|
Incomplete |
17 |
37 |
2 |
4.3 |
|
Based on the table above, data was
obtained that TPG's knowledge about exclusive breastfeeding programs in the
good category in achieving exclusive breastfeeding coverage was not optimal as
much as 18 TPG (39.1%), this percentage was higher than TPG's knowledge about
exclusive breastfeeding programs in the good category for TPG's performance in
achieving optimal exclusive breastfeeding coverage as much as 6 TPG (13%). In
the chi square test, a significance value of 0.040>0.05 was obtained, which
can be concluded that there is a relationship between TPG's knowledge about
exclusive breastfeeding programs and TPG's performance in achieving exclusive
breastfeeding coverage. The availability of TPG in implementing the exclusive
breastfeeding program was categorized as lacking and the performance of TPG was
not optimal as many as 19 TPG (41.3%) in achieving exclusive breastfeeding
coverage. This percentage is higher than the availability of TPG which is in
the category of less and optimal in the implementation of the exclusive
breastfeeding program of 3 TPG (6.5%). In the chi square test, a significance
value of 0.001>0.05 was obtained, which can be concluded that there is a
relationship between the availability of TPG in the implementation of the
Exclusive Breastfeeding program and the performance of TPG in achieving
Exclusive Breastfeeding coverage. TPG's facilities in implementing the
exclusive breastfeeding program are in the incomplete category and TPG's
performance is not optimal as many as 17 TPGs (37%) in achieving exclusive
breastfeeding coverage. This percentage is higher than TPG facilities which are
in the complete and incomplete categories with the optimal category in
implementing the exclusive breastfeeding program as many as 2 TPG (4.3%). In
the chi square test, a significance value of 0.001>0.05 was obtained, which
can be concluded that there is a relationship between TPG facilities in
implementing exclusive breastfeeding programs and TPG's performance in
achieving exclusive breastfeeding coverage.
Table 3.
Results of Logistic Regression Analysis
|
|
B |
S.E. |
Wald |
Df |
Sig. |
|
Knowledge |
1.726 |
.856 |
4.065 |
1 |
.044 |
|
TPG Availability |
2.130 |
.897 |
5.634 |
1 |
.018 |
|
Facilities |
2.096 |
.963 |
4.736 |
1 |
.030 |
|
Constant |
4.795 |
2.176 |
4.856 |
1 |
.028 |
The results of logistic regression
analysis, the influence of independent variables on dependent variables can be
analyzed, including:
The value of the constant (α) is
4.795, meaning that if the independent variable has a constant value, then the
TPG performance value is 4.795. This shows that there is a relationship between
independent variables (TPG knowledge, TPG availability, availability of funds
and facilities) and dependent variables (TPG performance in achieving exclusive
breastfeeding coverage) in the logistics model.
The TPG Knowledge variable has a positive
coefficient value of 1,726, meaning that every increase in one unit of TPG
knowledge, assuming the value of other variables is fixed, will increase the
TPG performance by 1. This shows that if knowledge increases, TPG's performance
will also increase, which will increase TPG's knowledge related to
breastfeeding programs. For this reason, it is necessary to carry out
breastfeeding counselling training, and it needs to be supported by local
governments by allocating adequate funds to collaborate with Bapelkes (Health
Training Centers in Indonesia) in carrying out breastfeeding counselling
training/breastfeeding counselling. This training is expected to increase TPG's
knowledge about exclusive breastfeeding, which is very useful in implementing
breastfeeding programs such as breastfeeding education and counselling for
pregnant and lactating women so that it can improve TPG's performance in
achieving exclusive breastfeeding coverage.
The TPG availability variable has a
positive coefficient value of 2,130, meaning that every increase in one unit of
TPG availability, assuming the value of other variables is constant, will
increase the TPG performance value by 2,130. The availability of TPG in HSU
Regency is still uneven due to the existence of TPG, which is a PTT
(Non-Permanent Employee) issued directly from the South Kalimantan Provincial
Health Office for remote and very remote areas so that for urban areas where
the number of people served is more but the number of TPG is less. In 2023, the
HSU District Health Office will rearrange the health worker needs plan based on
the Workload Analysis (ABK) in each health centre which will then be proposed
for the recruitment of Government Employees with Work Agreements (PPPK), which
will be adjusted to the needs plan in each health centre to overcome the uneven
distribution of TPG.
The facility variable in the implementation
of the Exclusive Breastfeeding program has a positive coefficient value of
2.096, meaning that every increase in one unit of facilities in the
implementation of the Exclusive Breastfeeding program is assumed to have a
constant value of other variables, which will increase the TPG performance
value by 0.315. Facilities such as lactation rooms are still not available in
several health centres in HSU Regency, which are only available in lactation
corners that are located in the corners of a limited room and are only covered
with cloth or curtains. Likewise, the recording and reporting facilities on the
e-PPGBM application that require laptops/computers connected to the internet
are still limited and slightly damaged. The limitations of these facilities are
very closely related to the achievement of exclusive breastfeeding coverage;
therefore, through DAU (Special Allocation Fund) budgeting, the Health Office
allocates a budget for the procurement of laptops to support the recording and
reporting of exclusive breastfeeding programs.
The relationship between TPG's knowledge
about the exclusive breastfeeding program and TPG's performance in achieving
exclusive breastfeeding coverage in North Hulu Sungai Regency.
Based on Table 2 above, data
was obtained that as many as 18 TPGs (39.1%) had poor knowledge about the
exclusive breastfeeding program and had less than optimal performance. In
comparison, only 6 TPGs (13%) had good knowledge and had optimal performance in
achieving exclusive breastfeeding coverage. In the chi-square test, a
significance value of 0.040 < 0.05 was obtained, so it can be concluded that
there is a relationship between TPG's knowledge about the exclusive
breastfeeding program and TPG's performance in achieving exclusive
breastfeeding coverage.
TPG is responsible for
supporting exclusive breastfeeding programs in the HSU District to ensure the
health of babies and mothers. TPG's performance can make a significant
contribution to increasing exclusive breastfeeding coverage in the community
through an understanding of exclusive breastfeeding and is the basis for an approach
to providing education to breastfeeding mothers. In Table 2, most of the TPG
knowledge data obtained is in a good category, which is 24 TPG (52.2%). Good
TPG knowledge is due to the inter-TPG communication established with the
existence of a conversation group that facilitates coordination and recording
and reporting. Recording and reporting are indicators of the success of an
activity
HSU Regency Nutrition
Surveillance is a monitoring and evaluation program carried out in
collaboration with related parties. One of the objectives of this nutrition
surveillance is to measure the achievement of the exclusive breastfeeding
coverage target
The coverage of exclusive
breastfeeding at the Puskesmas is a public health indicator that shows the
percentage of babies aged 0-6 months who get exclusive breastfeeding without
additional food or other drinks
The correlation between
knowledge and TPG performance is where the results of TPG knowledge are still
in the poor category, and the performance is not optimal at 28 TPG (60.9%).
This requires attention from the local government to increase TPG knowledge
through breastfeeding counselling training by allocating adequate funds to
collaborate with Bapelkes (Health Training Center) in its implementation.
Adequate TPG knowledge provides space to provide education through the
dissemination of information, knowledge, and skills to the community or certain
groups to improve TPG performance in exclusive breastfeeding programs. This
education aims to increase understanding, awareness, and positive behaviour in
order to increase the coverage of exclusive breastfeeding. Nutrition education
can be carried out directly through counselling and counselling as well as by
using various media, both print and electronic
The percentage level of
exclusive breastfeeding coverage is one of the main benchmarks to determine the
success of exclusive breastfeeding programs through intensive efforts to
increase the percentage of babies who receive exclusive breastfeeding in a certain
period. One of the efforts that can be made is through effective counselling
and comprehensive education so that breastfeeding mothers have the knowledge
and motivation to provide exclusive breastfeeding. The effectiveness of
puskesmas management greatly determines the success of the evaluation of
exclusive breastfeeding programs. The success of exclusive breastfeeding
programs is determined by input, creativity, and active efforts in implementing
health promotion strategies
TPG in HSU Regency in
carrying out data collection tasks has been equipped with a Nutrition
Surveillance guidebook and a standardized Nutrition Care Guidebook that has
been distributed by the Health Office to 13 Health Centers which aims to assist
TPG in carrying out its duties and provide the latest guidelines and standards
in the implementation of nutrition in the community which is the essence of
professionalism. The Health Office also periodically conducts technical
guidance and coaching meetings for TPGs at the district level to provide the
latest information and program directions as well as targets for achieving
nutrition activities so that it is hoped that TPGs can improve their knowledge
based on the latest information and can provide excellent services.
The relationship between the
availability of TPG in the implementation of the exclusive breastfeeding
program and TPG's performance in achieving exclusive breastfeeding coverage in
North Hulu Sungai Regency.
The data obtained showed
that the number of TPGs available in the implementation of the exclusive
breastfeeding program was the most in the poor category, and the performance of
TPGs was not optimal, namely 19 TPGs (41.3%) who achieved exclusive
breastfeeding coverage. This percentage is higher than the availability of TPG,
which is in the category of less and optimal in implementing the exclusive
breastfeeding program, which is as many as 3 TPG (6.5%). In the chi-square
test, a significance value of 0.001>0.05 was obtained, which can be
concluded that there is a relationship between the availability of TPG in the
implementation of the Exclusive Breastfeeding program and the performance of
TPG in achieving Exclusive Breastfeeding coverage.
Based on Table 2, data was
obtained that most of TPG's knowledge about the exclusive breastfeeding program
was in the category of good knowledge, and TPG's performance was not optimal in
achieving exclusive breastfeeding coverage, which was 18 TPG (39.1%). North
Hulu Sungai Regency, in 2015-2017, received Non-Permanent Nutrition Workers
(PTT) from the Province with a Decree (SK) of direct placement from the
Provincial Health Office for remote and very remote areas, which caused the
distribution of TPG to be uneven.
Based on Table 2, it can be
seen that the number of TPGs in all health centres with a distribution that
does not match the number of people served, such as the Sungai Karias Health
Center, which is located in an urban area only has 3 TPGs with a total
population of 19,219 people served. On the other hand, the Haur Gading Health
Center has 7 TPGs with a smaller number of people served, namely 16,280 people.
This inequality in the amount of TPG affects the coverage of exclusive
breastfeeding in HSU Regency, which in 2022 is only 62.49% and in 2023 it is
only 65.78%, still below the target of 80%.
The low coverage of
exclusive breastfeeding is explained in the research of Utami et al.
The availability of TPG in
HSU Regency is determined based on planning to ensure that human resources in
the health sector are sufficient to provide effective and quality health
services, especially in the implementation of nutrition surveillance to make
the exclusive breastfeeding program a success.
The HSU District Health
Office will then follow up on the TPG inequality at the health center level in
2023 by redrafting the Renbut (Needs Plan) of health workers based on the
Workload Analysis (ABK) in each health centre to then propose to recruit
Government Employees with Work Agreements (PPPK) in accordance with the planned
needs.
The availability and
performance of TPG are identified from the number, educational qualifications,
and skills of TPG in achieving goals and outcomes in the field of nutrition
Based on Alifah's
TPG's performance includes
all community nutrition measurement activities, including the implementation of
effective exclusive breastfeeding practices. This includes providing adequate
support to breastfeeding mothers, TPG being able to provide correct
information, and supporting and facilitating the exclusive breastfeeding
process. TPG's performance can also be measured from the achievement of the
target of exclusive breastfeeding coverage in the community.
In the results of the
research of Tunggadewi et al.
The relationship between the
facilities implementing the exclusive breastfeeding program and TPG's
performance in achieving exclusive breastfeeding coverage in North Hulu Sungai
Regency.
The data obtained shows that
most of the TPG facilities that implement the exclusive breastfeeding program
are in the incomplete category, and the performance of TPG has not been
optimal, namely, 17 TPGs (37%) that have achieved exclusive breastfeeding
coverage. This percentage is higher than TPG facilities which are in the
complete and incomplete categories, with the optimal category in implementing
the exclusive breastfeeding program as much as 2 TPG (4.3%). In the chi-square
test, a significance value of 0.001>0.05 was obtained, which can be
concluded that there is a relationship between TPG facilities in implementing
exclusive breastfeeding programs and TPG's performance in achieving exclusive
breastfeeding coverage.
The results of the study
showed that the means of implementing the exclusive breastfeeding program
declared by TPG were incomplete, as many as 27 TPGs (52.2%). To support
nutrition reporting activities, especially reporting on the e-PPGBM application
(electronic Community-Based Nutrition Reporting Recording), one of which is reporting
exclusive breastfeeding coverage in each area of North Hulu Sungai Regency.
Since 2016, the health
office has distributed laptops to 13 health centres to facilitate recording and
reporting. However, the laptops are damaged, and some can no longer be used.
There are also internet network problems in several sub-districts and villages.
Thus, recording and reporting activities, which are currently all data-based
and online applications, cannot be done.
According to Handayani
Most of the facilities that
implement the exclusive breastfeeding program are not complete, and the
performance of TPG has not been optimal in achieving exclusive breastfeeding
coverage, which is as many as 17 (37%). Currently, some health centres in HSU
Regency do not have special lactation rooms. Currently, the Breast Milk Corner
is usually located in a limited corner of the room and is only covered by
curtains or clothes that are commonly used by mothers to breastfeed their
babies. Meanwhile, most of the rooms for recording and reporting e-PPGBM
carried out by TPG every month are still in the MTBS (Integrated Management of
Toddlers Sick) or other health programs, so the facilities are inadequate.
In the implementation of the
exclusive breastfeeding program, data collection facilities are an important
element to assess and monitor the effectiveness of the program. The facility is
designed to facilitate accurate and comprehensive data collection, allowing for
in-depth analysis to support informed decision-making. TPG facilities are
required for data collection and are equipped with computer equipment, spacious
workbenches, and adequate communication systems. In the Regulation of the
Minister of Health of the Republic of Indonesia Number 23 of 2014 concerning
Nutrition Improvement Efforts, article 7 states that the district/city local
government is tasked and responsible for organizing and facilitating the
implementation of nutrition, carrying out the prevention of malnutrition on the
district/city scale, improving family and community nutrition, providing
nutrition improvement services at regional health service facilities and
facilitating, licensing, coordinating,
monitoring, and evaluation.
The government has made an
exclusive breastfeeding program policy to improve the health and welfare of
mothers and children. With this program, the government can find out the scope
of breastfeeding in each region
This local regulation
protects mothers from breastfeeding their babies. This regulation has also
encouraged positive changes in the form of support from related parties,
especially in the context of health services. The success of the government's
policy on exclusive breastfeeding can of course be seen from the availability
of Human Resources (HR), supporting facilities and infrastructure, and the
provision of communication, information, and education (KIE).
CONCLUSION
There is a relationship between TPG's
knowledge of exclusive breastfeeding programs and TPG's performance in
achieving exclusive breastfeeding coverage. There is a relationship between the
availability of TPG in implementing exclusive breastfeeding programs and TPG's
performance in achieving exclusive breastfeeding coverage. There is a
relationship between the availability of funds for exclusive breastfeeding
programs and TPG's performance in achieving exclusive breastfeeding coverage. There
is a relationship between the availability of facilities in the exclusive
breastfeeding program and TPG's performance in achieving exclusive
breastfeeding coverage. TPG's knowledge of the exclusive breastfeeding program,
the availability of TPG in implementing the exclusive breastfeeding program,
the availability of funds for the exclusive breastfeeding program, and
facilities in implementing the exclusive breastfeeding program simultaneously
are related to TPG's performance in achieving exclusive breastfeeding coverage
in North Hulu Sungai Regency.
There is a significant relationship between
TPG's knowledge of exclusive breastfeeding programs and their performance in
achieving exclusive breastfeeding coverage. Additionally, the availability of
TPG personnel, funds, and facilities in implementing these programs are also
significantly related to TPG's performance in this area. Collectively, TPG's
knowledge, availability, funding, and facility resources in the exclusive
breastfeeding program are strongly correlated with their success in achieving
exclusive breastfeeding coverage in North Hulu Sungai Regency.
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