Article Type: Research Article Article Citation: Trini Handayani. (2021). FAMILY FOOD SECURITY IMPROVEMENT BY
USING POSITIVE DEVIANCE APPROACH. International Journal of Research
-GRANTHAALAYAH, 9(2), 120-126. https://doi.org/10.29121/granthaalayah.v9.i2.2021.3441 Received Date: 04 January 2021 Accepted Date: 25 February 2021 Keywords: Food Security Nutrition
Improvement Positive Deviance
Background and Objective: Food is a basic human need whose fulfilment cannot be substituted with other materials. Food security is perfectly adequate for a country and its individuals, reflected insufficient food availability, both in terms of its quantity, quality, safe, diverse, nutritious, equitable and affordable. Toddler still had low nutrition and malnutrition of more than 18 % of children throughout Indonesia. The purpose of this study was to assess the Positive Deviance parenting towards toddler in Cianjur. Material and Method: An Observation of the family with low economics levels but have a good nutrition toddler. The sample was 15 families. Interview and observation of the family are used to guide the study. The instruments used were structural and un-structural interviewing. The participant had their economic and nutrition assessed through financial and food sections. The data analysis consisted of the answer to the question that has been asked with using qualitative study. Result: In this study, some individuals or groups have behaviour and strategy that are unusual but successful and have allowed them to find better solutions to their problems. PD is based on the belief that it is solving problems that society faces. Conclusion: PD in nutrition improvement program aims to have under-five children with low nutrition and malnutrition, finding positive deviance behaviour in the community. This behaviour is then followed by the families of low-nourished and malnourished children, increasing their nutritional status.
1. INTRODUCTIONNational development aims to improve human resources. Nutrition is one
quality determinant of quality, healthy, intelligent and productive human
resources. The developmental success of human resources of a nation can be
measured by the Human Development Index (HDI) which is based upon three
indicators; education, life expectancy, and productivity (Dahlia, 2012).
According to Law No. 18 of 2012 about food, food security is a condition in
which food is perfectly adequate for a country and its individuals, which is
reflected in the availability of food that is sufficient, both in quantity and
quality, safe, diverse, nutritious, equitable, and affordable. It does not
contradict with religion, beliefs, and culture, to be able to live healthily,
actively, and productively in a sustainable manner. Thus, an area is deemed
successful in developing food security if there are improved food production,
smooth food distribution, safe food consumption and nutritional sufficiency of
the whole society (Jimba,
2013). Food security consists of three subsystems, namely 1) Food Availability,
2) Food Access, and 3) Food Utilization (Ismail, (2011). Food is one of the basic human needs that its fulfilment is included in the
fundamental rights, cannot be delayed and cannot be substituted with other
materials. Besides, food is part of the culture as a result of adaptation
between humans and their environment. Food is any things that come from
biological sources of agricultural products, agriculture, forestry, fisheries,
livestock, and water, either processed or unprocessed, designated as foods or
beverages for human consumption, including different foods, raw materials of
foods, and other materials used in the preparation, processing, and production
of foods or drinks. Nutritional status is a condition of the body caused by the balance between
nutrient intake and needs or consumption, absorption, and food consumption.
Good nutritional status is an essential factor in achieving optimal health
status and increasing their endurance, intelligence, and expected growth.
However, half of the children under five years of age (infants) have a short
body of 52%, 22% have a concise body, 16% are thin, and 3% are skinny. This
case is an early manifestation of protein-energy malnutrition of children aged
6-24 months because of delay in introducing nutritious food and being
influenced by an infectious disease that is often suffered. Malnutrition is a
complex issue, and its solution requires a comprehensive approach in the form
of healing, recovering, preventing, and improving to keep or maintain a healthy
child healthy. The right answer is to empower the family. An alternative effort
that can be done is the implementation of the Positive Deviance (PD) approach.
PD is used to describe a state of positive deviation related to health, growth,
and development of confident children within the community or family. The
practice in question may be feeding, caring, hygiene and health care.
Determining the behaviour and habits performed by PD
families becomes very important to be applied by the families who have other
health problems, and to come out of these problems. Research conducted by an
Institute of Social Organizations discovered a decrease in malnutrition from
47% to 13% compared to the group who did not get the PD (48% to 46%). Besides,
there were behavioural changes in mothers and other
family members in maintaining the toddlers' nutritional status (Merita, Sari, & Hesty,
2017). Positive deviance can be used to describe the quality of a positive
deviation related to health, particularly to explain the factors that affect
the growth or nutritional status (Hayati, Marianthi, & Suwarni, 2012). This study discovers the positive deviance used by low economics level of a
family that has toddlers with good nutrition that can be beneficial for all of
the family in Indonesia. The positive deviance can be tools to reduce the
malnutrition toddler. Positive deviance had to be accompanied by the competence
people to identify the low economics level family's positive behaviour. The result of the identification can be adapted
to other families with malnutrition toddlers. This study will help the
researcher uncover the critical areas of poor economics behaviour
that have a toddler with good nutrition, which many researchers could not
explore. Thus a new theory on positive deviance may be
arrived at. 2. METHOD The method used in this activity was
observing the families with toddlers and then assessing the children's nutritional
status. Assessment of nutritional status can be checked in the Integrated
Service Post (IHC). Observations were conducted in several IHC in Cianjur that low-nourished or malnourished children live.
Targets of field observations were the toddlers with good nutritional status.
His families were questioned about the families' habits related to the children
and toddlers' feeding habits. From the few observations and questions, it was
obtained that there was something different with the families that the families
of toddlers with good nutritional status fed the toddler with Rarong, Gehu, Bakwan, tumis sayur ja'at and peanut bread. This
statement is different from other families having infants with low or poor
nutritional status. After identifying the deviant behaviour, the mothers gathered in IHC to agree with and
practice how to cook ingredients available in the vicinity of the environment.
Mothers agreed the time and frequency of cooking practice and feeding infants
up. Some decided to do so three (3) times a week. Some others chose to do it
five (5) times a week, and so on. The practice is done until children's
nutritional status improves, usually after an average of 3 (three) months. Once
the nutritional quality improved, the families agreed to cook and feed her
toddlers in the house. 3. DISCUSSION One of the definitions of food
security is outlined in the policy of Law No. 8 2012 following what is proposed
by Sudiman,(2011), that food security has
three (3) main components, namely: a. Availability of Food (food availability),
which according to Tirivangasi,(2018), at the household level, can be met from its food
production and purchasing the food available in the market; b. Food Access
(food accessibility), which is associated with economic access for individuals
to obtain food and is assured when households and individuals in it have
sufficient resources to bring appropriate food for consumers whose access
depends on household income, distribution of payment within the household and
food prices; and c. Nutrition (food utilization), which constitutes biological
properties in food, the need for consumption that provides essential energy and
nutrients, pure water, and adequate sanitation. At the same time, nutritional
status is the outcome of food security (Novera, Iram,
2011). Table 1: Food Security
Indicators
Food
security lately becomes a national issue that withdraws attention. Malnutrition
problems that attack under-five children in different regions are only small
fractions of the sample that are still low in Indonesia's food security. There
are four (4) levels of household food security, including 1) Household food
security; 2) The vulnerable households food; 3) Lacking food households, and 4)
Food insecurity household. The categorization of household food security levels
can be seen from household income and household consumption of nutrition. PSG results
in 2015 are as follows: 1) Toddler Nutritional Status by Index Weight per age
(W/A), showed: 79.7% good nutrition; 14.9% low nutrition; 3.8% malnutrition,
and 1.5% high nutrition; 2) Toddler Nutritional Status Index According to
Height per Age (TB/U) resulted in: 71% normal and 29.9% short and very short;
3) Nutritional Status Toddler According to Index Weight per Height (BB/TB)
resulted in: Normal as many as 82.7%, 8.2% underweight, 5.3% fat and 3.7%
extremely thin. Specific
interventions or health sector intervention, with a particular target group of
First 1000 Days of Life, Pregnant Mothers, Nursing Mothers and 0-23 Months,
children. The other activities include immunization, supplementary nutrition
for pregnant mothers, additional nutrition for Toddlers and health monitoring
of Toddlers' growth. Simultaneously, Sensitive intervention or Non-Health
targets the general public, which is usually in the form of development
activities of non-health activities in general. The activities include the
provision of clean water, the alleviation of poverty and gender equality. January
25th is celebrated as National Nutrition Day (NND). The NND 2016 theme
accelerated nutrition improvement in the first 1000 days of life (continuum
care). The program of increasing community food security is an effort to reduce
poverty levels in each region and fulfil food needs of household levels that
are quantitatively sufficient and qualitatively reasonable, safe, equitable and
affordable. The concept of Positive Deviance (PD) is based on the observation
that some individuals or group behaviour and strategy
in any community or organization are unusual but successful. Besides, it has
allowed them to find better solutions to problems than their neighbours who face challenges and obstacles altogether and
also have access to the same resources. PD in the recovery program of nutrition
is designed explicitly for under-five children with mal- or poor-nutrition by
finding positive deviance behaviour in a society
having toddlers with good food. This behaviour is
then followed by the families of low nourished and malnourished children,
increasing their nutritional status. The
status of malnutrition in children can be overcome by knowing the behaviour and habits performed by PD families. This means
that families can be a successful PD (not malnourished infants) because they
have individual behaviour and patterns not carried
out by another family. The action and habits that they do include feeding,
caring, hygiene and health care. PD approach is a solution to solve a health
problem like malnutrition in pregnancy, malnutrition of infants and toddlers,
and HIV/AIDS (Machado, Cotta, & Silva, 2014). The
interviews on child eating habits found that mothers tend to involve children
to eat while the whole family eats, meaning that the family does not let them
feed themselves. It is an effort to create a pleasant dining atmosphere since
the atmosphere at mealtimes affects the child's appetite. The implementation of
various food, frequency of eating and good eating habits can reduce the
incidence of malnutrition of up to 27.5%. Food consumed by the PD family is the
food affordable and available to the whole community, among others, Rarong, Gehu, Bakwan, sauteed sayur ja'at and peanut bread. "Rarong"
(Sundanese) is a tiny shrimp that has the Latin name Acetes indices or Acetes japonicas. The shrimp is well-known by the
name rebon. Its size is between 1-3 centimetres.
The Rebon price is low but has very optimal
nutritional contents. Rarong nutrient contents or rebon per 100 grams are as follows:
Source: Nutrition Directorate of
Ministry of Health "Gehu" is an abbreviation of Toge (Bean Sprouts) Tahu (Tofu). Bean sprouts are
inserted into the Tofu, and they are fried with flour. In addition to bean sprouts,
leeks and carrots are added. "Gehu" already meets the nutritional balance
and contains macronutrient and micronutrient. Macronutrient in "Gehu" is carbs disaccharide
(flour), vegetable protein (Tofu), fats in cooking oils, while the
micronutrients entail minerals and vitamins contained in Tofu (carrots, bean
sprouts, leeks). Simultaneously, bakwan is a kind of
snacks made of flour mixed with vegetables such as carrots, bean sprouts,
cabbage, and sometimes eggs. (Cowpeas Sundance: jaat) are sauteed in the oil. A Cowpea
plant (Psophocarpus
tetragonolobus)
is a tropical plant whose number is abundant in agricultural country, for
example in Indonesia. This plant originates in eastern Indonesia. In Sumatra,
it is known as bottle beans, belonging beans/embed beans, jaat (Sunda), kelongkang (Bali), biraro (Ternate), or cubilet (Banda). In English, it is
called the winged bean. Winged bean plant is easy to cultivate. Generally,
people plant it just to cover the fence. This is possible because public
knowledge about the benefits of cowpeas is still lacking. Old winged seeds have
the best nutritional contents. They contain protein, fat, carbohydrates,
vitamins and minerals, which are relatively high compared to the young pods,
tubers or leaves. Protein and carbohydrate in cowpeas seed even surpass peanuts
and are almost equivalent to soybeans. Its amino acid content is similar to
soy, as a good source of protein. Winged beans are rich in amino acid Lysine,
containing 413 up to 600 mg per 100 grams, while soybeans are only 399 mg per
100 grams. Amino acid Lysine plays an essential role in the growth process. The
shortage of amino acid lysine can be dealt with by combining critical
commodities such as rice, corn, and tubers. Vitamins in cowpea oil are Beta
carotene, Thiamin, Riboflavin, Niacin, Acid Askrobat,
and Tocopherol. Moreover,
cowpea oil can catalyze vitamin A, Calcium (2.3 g), Magnesium (2.25 g),
Potassium (1.10 g), Phosphorus (4.5 g) and Iron (10.8 g), which is suitable for
pregnant and breastfeeding mothers. Cowpeas are a source of fiber. In 100 grams
cowpeas, there are 20% proteins and 20% fiber per day (Sudiman,
2011). Cowpea trees in some areas in Cianjur are
planted in the yard and used for their consumption. In the
meantime, giving a snack of bread beans to young children was also an excellent
deviant habit. Peanut bread is a mixture of flour, sugar, butter, and nuts,
containing vegetable protein and carbohydrates. Many people have primarily
recognized the impact of malnutrition on child development. Malnutrition is not
only the dreaded stigma, but this is, of course, related to the socio-economic
impact on the family and the state, in addition to a variety of consequences
received by the children themselves. Poor nutrition condition affects many
organs and systems because this condition is often accompanied by a deficient
intake of other micro-/macro-nutrients necessary for the body. Malnutrition
will disrupt the body defence system against
microorganisms and mechanical defence, so it will be
straightforward to cause infection. Conditions
of acute malnutrition could be life-threatening due to various dysfunctions
that are experienced. Emerging threats, among others, are hypothermia (severe
cold) because of their thin fatty tissues, hypoglycemia (blood sugar levels
below normal levels), and the lack of essential electrolytes as well as body
fluids. Suppose the acute phase is treated but is not followed up well enough.
As a result, the child cannot catch up and is left behind. Then in the long term,
these conditions adversely affect growth and development. As a result of poor
nutrition on the increase, performance is very detrimental to a child, causing
small and squat posture (stunting) due to chronic malnutrition. What is
more worrying is that child development was disrupted. The effects of
malnutrition on the mental and brain development depend upon the severity and
the growth length of the brain. Suppose the condition of malnutrition occurs
during the golden period of brain development (0-3 years). In that case, it is
conceivable that the brain cannot develop as a healthy child does, and the
condition is irreversible conditions (challenging to recover). The
impact on brain growth is vital because the brain is one of the essential
'assets' for children to become a man of quality in the future. Several studies
have described that short-term effects of malnutrition on child development are
an apathetic child, impaired speech and other developmental disorders. The
long-term impacts are the decline in Intelligent Quotient (IQ) test scores, a
decrease in cognitive development, reduced integration of sensory,
concentration problems, self-confidence, and the reduction in academic
performance in school. Poor nutrition could potentially be the cause of poverty
through low quality of human resources and productivity. No wonder if
malnutrition is not managed correctly, the acute phase will be life-threatening
and in the long run will be a threat of the loss of a future generation
(Dahlia, 2012). Mother's
knowledge will affect parenting and have an impact on her children. Maternal
experience is associated with: 1) Feeding habit. Feeding habit for your baby or
toddler affects the growth and nutritional status of children. Infant feeding
for 6 (six) months with exclusive breastfeeding (breastfeeding) is required; 2)
Parenting toddlers. According to Sudirman (2011), a child raised well by her
mother will be interacting positively than one being taken care of by other
than his mother. Parenting a child by her mother will cause the child to feel
safe. Kids will get a partner to communicate, and the mother is a role model
for children directly concerning verbal skills. Parenting children is very
important because it will affect the growth process. It is closely linked with
the mother's state especially health, education, knowledge, attitudes, and
practices about parenting. According to Ismail (2011), an attitude does not
automatically manifest in way or action. To turn mood into practice, the
supporting factors are necessary, which are the facilities and the support of
other parties, such as husbands, parents or parents-in-law; 3) The habit of
maintaining personal hygiene. Personal hygiene is essential for the environment
associated with the causative agent, such as diarrhoea,
dengue fever; 4) Habits of utilizing health services. The toddler is a period
that is easily infected by the disease. Therefore, his mother's persistence to
bring the child to a health facility is necessary if the child has an
infectious disease. In addition to providing full immunization to children
before the age of one year, disease treatment at childhood and getting
professional help at the right time are essential in maintaining the health of
children (Dahlia, 2012). Efforts
can be made by utilizing local wisdom based upon the belief that every
individual has the habit and unique or unusual behaviour
that enables them to find better ways to prevent malnutrition. It will be
better than their neighbours who have the same
economic conditions but do not have any positive deviance behaviour.
PD examines why, of many babies and young children in a poor community, only a
small number of them undergo malnutrition. The beneficial household practices
as core PD program is divided into four (4) major
categories, namely, feeding, caring, hygiene, and health services. PD
Advantages methods: a) Fast. This approach provides a solution that can
solve a problem immediately; b) Affordable. PD is affordable, and the family
does not need to rely on outside resources to practice new behaviour.
The implementation is cheaper but effective than establishing a nutrition
rehabilitation centre or investing in a hospital;
c) Participatory. Public participation is an essential
component in the success of the PD. Society plays a significant role in the
entire process of finding successful practices and strategies among the
community to support mothers after the auction has ended; d) Sustainable
Approach. PD
approach is sustainable because new behaviour is
internalized and continued after the intervention has ended. This activity
changes the behaviour of individual families and
changes how a community perceives malnutrition and their ability to change the
situation; e) Original. Because the solution is in place, then
progress can be made quickly without much analysis or external resources. Such
an approach can be widely applied as positive deviance exists in almost every
community; f) Culturally acceptable. This approach is based on
indigenous behaviour identified in social, ethnic,
language and religion in every society; g) Based upon Behavior
Change. This
approach does not give priority to the acquisition of knowledge. Still, there
are three steps of behaviour change process included
in it, namely the discovery (investigation, PD), Demonstration (Hearth
sessions) and application (Hearth sessions and home). The
research conducted by Piroska A. Bisits
Bullen11 at Walden University, Minneapolis, USA, concluded that the PD approach
to reducing child malnutrition was practical. Study and implementation of the
PD need to be developed in some areas. Positive deviance studies in various
countries, such as Guatemala and Costa Rica, showed that some women had had
useful techniques on the practice, traditions, and beliefs in preparing food, feeding
children, and caring for the children at the time of illness and recovery.
Mothers who have a good technique is not the mother who comes from higher
education (Mohammed, Mangala, Subrahmanyam, 2014). In
Indonesia, a study has been conducted by Tirivangasi
(2018) in Jakarta, Bogor, and East Lombok. The result was that mothers with
children aged (6-17) months were positively related to the state of child
nutrition. Children who always strived to consume food responded when the
chattering ever got a smile from the mother. The nutritional situation is
better if compared with their peers who received less parental attention.
Meanwhile, Frisda Turnip researched the impact of PD
on mothers' nutritional status towards toddler in Dairi,
North Sumatra, and the results showed a significant difference. Meanwhile,
another study conducted by Sudirman (2011) examined the PD approach nutrition
(Hearth) and its impact on a toddler in the district of Aceh Besar, Aceh Province, which showed that the post nutrition
as potential strategies to improve nutritional status (Dahlia, 2012). 4. CONCLUSION AND RECOMMENDATIONThere are
still nutrition problems in under-five children in Indonesia, which requires
the family strength to overcome the difficulties. The food Security subsystem
encompasses three items: availability, affordability, and food and nutrition
consumption. Food Consumption and Nutrition consist of the consumption of food,
diversity consumption, and improved nutrition. One effort to improve nutrition
is by PD approach. However, the PD implementation is not carried out
simultaneously throughout Indonesia, even though several studies have been
proven that PD can overcome nutritional problems with the existing potential in
each area. As a recommendation, the ministries in charge of dealing with this issue are to reactivate the family plants by providing vegetable seeds following the culture and local soil conditions, to make the PD as a priority program and to thoroughly consider that if the nutrition problem is not resolved immediately, it will lead to a 'loss of generation' where the next generation is lacking intelligent. SOURCES OF FUNDINGThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. CONFLICT OF INTERESTThe author have declared that no competing interests exist. ACKNOWLEDGMENTNone. REFERENCES [1] Dahlia, S. (2012). The Effect of
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