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Edunity
Volume 2 Number 9, September, 2023
p- ISSN 2963-3648- e-ISSN 2964-8653
Doi:
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DEVELOPMENT OF TODDLERS: ANALYZING OF THE
UTILIZATION OF THE KIA HANDBOOK IN MOTHER IN
INDONESIA
Evi Hasnita
1
, Wenny Lazdia
2
, Savitri Yolanda
3
, Rina Mariyana
4
Fort De Kock University, Bukittinggi, Indonesia
E-mail: hasnit[email protected]
1
, wenny.lazdi[email protected]
2
, [email protected]
3
,
[email protected]
4
ABSTRACT
Abstract: Developmental delays in children are still a serious problem in both developed and
developing countries in the world. The number of developmental disorders in children under five
in Indonesia is still quite high. In Indonesia 13 – 18 % of children under five experience
developmental delays. The Maternal and Child Health Book (KIA) is an important
communication tool and information medium for health workers, pregnant women, families, and
the community. The purpose of this study is to analyze the use of the Maternal and Child Health
Handbook with child development. The method used is Qualitative research. This study uses the
in-depth interview method to find problems more openly. Participants in this study were mothers
of toddlers. The sampling technique used was purposive sampling technique so that the
participants could represent the characteristics of a population of 10 people. The results obtained
by pregnant women who have a negative attitude tend not to use the Maternal and Child Health
handbook properly and the theme of developmental disturbances for toddlers is that toddlers
have unclear speech, and for other developments, there are no problems. It is recommended for
parents to take advantage of the use of health books so that children's development runs
optimally.
Keyword: Toddler; Kia Handbook; Mother
Introduction
The Maternal and Child Health Book (KIA) is a means of communication and recording
of the health of pregnant women as well as counseling for pregnant women, where
health workers can view the contents of the previous KIA book records of pregnant
women from health workers. Every time a pregnant woman or comes to a facility for
weighing, control, control or treatment, she is advised to bring a KIA book so that all
records about the health of pregnant women and children are recorded in the KIA book
(Sari, Waruwu, & Purba, 2021). Growth and development delays in children are still a
serious problem in both developed and developing countries in the world. The incidence
of developmental delays in children in the United States ranges from 12-16%, Argentina
22% (Suwardi, 2021), and Hong Kong 23% (Muslimin & Jannah, 2018). Meanwhile,
developmental disorders in children in Thailand reached 37.1% (Suwardi, 2021), and in
India around 19.8% (Rasoolimanesh & Ali, 2018). This delay in child development
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Evi Hasnita, Wenny Lazdia, Savitri Yolanda, Rina Mariyana
occurs mostly in Asia and Africa (Jing Yan, Michael Grantham, Jovan Pantelic, 2018)
According to UNICEF, in 2015 data obtained that there were still high rates of growth
and development disorders in children under five, especially motor development
disorders (27.5%) or 3 million children experiencing disorders (Watson et al., 2018)
Until now, the number of developmental disorders in children under five in Indonesia
is still quite high. Indonesia's health profile in 2018 shows that 13-18% of children under
five experience developmental delays (Usman et al., 2018) While the results of child
development screening conducted by the Indonesian Ministry of Health in 30 provinces
obtained data on developmental disorders in children of 45.12% (A CC Lee, n.d.).
Monitoring the growth of children under five which is carried out every month shows
that the percentage of children aged 6-59 months who have not been weighed in the last
six months tends to increase from 25.5 percent (2007), 23.8 percent (2010) to 34.3 percent
(2013) (Milita, Handayani, & Setiaji, 2021). Based on the 2018 Riskesdas data regarding
ownership of the Maternal and Child Health handbook in Indonesia, there are still 24.9%
of pregnant women who do not have Maternal and Child Health handbooks.
Meanwhile, for mothers who have children under five, there are still 34.1% who do not
have a Maternal and Child Health book. Regarding understanding of all the information
in the Maternal and Child Health handbook of 67.5%. The results of the 2013 Riskesdas
Basic Health Research showed that as many as 74.5% (around 15 million) toddlers had
been weighed at least once during the last 6 months, 60.9% of them were weighed more
than 4 times. As many as 65% (around 12 million) toddlers have KMS (Appendix to
Kepmenkes Number: 155/Menkes/Per/2010).
Riskesdas data shows an increase in the ownership of the Maternal and Child Health
book from 52.6% in 2013 to 65.9% in 2018. An increase in achievement of 13% in five
years is considered not optimal when viewed from the ease of obtaining the Maternal
and Child Health book for free (Riskesdas , 2018 ). The coverage of health services for
children under five in West Sumatra Province in 2017 was 68.9%, which means that they
had not reached the target of 86%. The highest achievement was in Pesisir Selatan
Regency with 85.9% and the lowest was Mentawai Islands Regency with 41.7% coverage.
(Nofita et al., 2017).
Based on the annual report of the PWS KIA Agam District Health Office from January
to December 2019 the total coverage of the Maternal and Child Health Handbook for
toddlers in the Work Area of the Agam District Health Office totaling 36,881 people, only
27,433 toddlers or 74% had the Maternal and Child Health handbook (Flinardi, n.d.).
Agam Regency has 23 Integrated Healthcare Center, one of which is Pakan Kamis, which
has the lowest coverage of Maternal and Child Health books, that is, out of 1998 toddlers,
only around 59% already have Maternal and Child Health books (Agam District Health
Office, 2019). Maternal Health Book Children (MCH) is an important communication
tool and information media for health workers, pregnant women, families and
communities, which serves as a tool to determine the health status of pregnant women,
[Development of Toddlers: Analyzing of the Utilization of
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documentation, early detection of risks, counseling, and to monitor the growth and
development of toddlers. Increasing the implementation Maternal and Child Health
books is supported by the central government as one of the programs to improve
maternal and child health, guiding health workers to provide Maternal and child health
services are according to standards, properly and correctly documented, and are the
only evidence held by the mother as documentation of her health status during
pregnancy, childbirth, postpartum, immunization and toddler development. The
Maternal and Child Health Handbook is currently spread all over Indonesia and the
Maternal and Child Health handbook can be used if the mother has the Maternal and
Child Health handbook. Based on the results of Riskesdas in 2018 the results of the
Riskesdas research showed that 70% and 30% of mothers who had Maternal and Child
Health books do not have a Maternal and Child Health book, but only 60% can show it
to health workers and 10% cannot show it. In 2018, 65.9% owned Maternal and Child
Health handbooks for children aged 0-59 months (49.7% could show and 16.2% could
not show) and 34.1% did not own Maternal and Child Health handbooks (8). The
Maternal and Child Health handbook itself has a function as a communication tool
between mothers and health workers, to find out about mothers' health, to see and
monitor the growth and development of toddlers, as a media for counseling,
documentation and as early detection of risks.
Research Method
Research Design
This study was Qualitatif research with explanatory research. Using the in-depth
interview method (indepth interview) in order to find problems more openly as well as
observation and study of documents. To study the analysis of utilization of the Maternal
and Child Health hand book for mothers on toddler development in the working area of
the pakan Thursday public health center, agam in 2020.
Population and samples
In this study the researcher used the term participant which refers to those who have the
information needed, and have the ability to share their experiences and are really involved
with the events and problems that occur (Suhartanto, Dean, Semiawan, Kusdibyo, &
Sobarna, 2021). Sampling in qualitative research is not directed at the amount but based
on the principle of conformity and data saturation is achieved (Polit,et al. 2017). In
qualitative research is not neededrandom sampling or random selection of participants
and research locations (Craswell, 2010 in Made, 2017). Selection of participants in this
study using the methodpurposive sampling namely the method of selecting participants
in a study by determining in advance criteria included in the study (Polit, 2017). The
criteria for participants in this study were: Mothers who have Toddlers and MCH Books,
Mothers who are communicative, Willing to become participants which is stated verbally
and by signing the consent form to become participants, Being able to share their
experiences so that richer information is obtained (rich information) The number of
samples in this study were 10 participants, data saturation was the measure, data was said
to be saturated if no new information was obtained from conducting interviews (Creswell
& Sinley, 2017).
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Data collection and data analysis
The data collection technique is by in-depth interview orIndept Interview. Patoon (2017)
emphasized that the purpose of the interview is to get and find out what is on other
people's minds. Researchers do this to find something that is impossible to obtain through
direct observation and cannot be revealed through a questionnaire. Therefore, in
conducting in-depth interviews, the questions that will be asked to participants cannot be
formulated with certainty beforehand, but these questions will depend a lot on the ability
and experience of the researcher to develop follow-up questions according to the
participants' answers. In in-depth interviews, discussions took place between researchers
and participants regarding the problem under study. (Fetters, Curry, & Creswell, 2013)
explaining that the procedure interview
Result And Discussion
The result of this study the use of the handbook as media for mothers and families and as
a reference for service standart for mother and babies by health works . availability and
distribution of handbook can to see the devolepmental care the child the theme is :
Toddler Development
a. Explain the stages of development of toddlers at their age that you know?
“….from the age of one year he can walk, can talk a little bit, eee be active like
that….”(P1)
"...he's three years old, he's starting to be able to read, write, he's starting to recognize
letters..."(P2)
"...he is now two years and eight months old, he can play ball, can wear surang clothes,
can comb his own hair, has started to recognize some letters and numbers, has started to
be able to count..."(P3)
The conclusions drawn from the participants' descriptions were that the participants
explained well the stages of toddler development according to their age.
b. Explain how your child socializes and interacts with his environment?
“….there he plays with his friends, his son is easy to get along with….” (P1).
P2“….sometimes he plays with his friends, sometimes he agrees, sometimes hey, hehe,
it's normal to ask the children to play, right (sometime he plays with his friends,
sometimes he agrees, sometimes he fights, hehe, it's normal, isn't it called children
playing)....(P3)
The conclusions drawn from the participants' descriptions were that the participants said
that toddlers could socialize well with their peers and those who were smaller or older.c.
Describe the development of your child at his age? If there is a delay disorder that occurs
in your child, then explain what disturbance is occurring?
“….he's two years and six months old, he can clearly call mom and dad, brother
and sister, sister, can eat alone, it doesn't feel like there's a delay, when you talk
about dad and mom, that's normal, right, two years and six months old, right?
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I'm starting to know the color too…”(P1)
"…..he can take off his own clothes, can wear his own shoes or sandals, his
speech is also clear, there's no delay in my opinion, just right…."(P2)
"...at least it's because other children at his age are starting to speak quite
clearly, but this child hasn't yet, that's only if the others aren't there..."(P3)
The conclusions drawn from the participants' descriptions were that toddlers
developed well, while some participants said that toddlers had unclear speech, and
for other developments there were no problems.
How do you try to increase your toddler's weight to match his age?
“….eemm give nutritious food, eee that's enough rest….“ (P1)
“….yes by increasing the diet….”(P2)
"...give him something to eat, if you don't want to eat it, then bapasoan juo will
feed it, if you don't eat vegetables sometimes (give him food, if he doesn't want
to eat himself, then force him to eat too, so he eats, yes he want to eat vegetables
sometimes)….“(P3)
Discussion
Readiness of mothers to utilize Maternal and Child Health (MCH) books, with a positive
attitude mothers tend to always carry Maternal and Child Health (MCH) books at every
pregnancy visit to health workers at health care facilities, read Maternal and Child
Health books ( Maternal and Child Health (MCH) books and apply the things contained
in the Maternal and Child Health (MCH) book because they think that the Maternal and
Child Health (MCH) book is important to know or detect the condition of her and her
fetus. However, there are also mothers who have a positive attitude, knowing that the
Maternal and Child Health (MCH) book is important but do not utilize the Maternal and
Child Health (MCH) book due to the mother's negligence which makes the mother
forget to bring the Maternal and Child Health (MCH) book every visit. , when the
mother did not have time to read the Maternal and Child Health (MCH) book and
because she did not read it, the mother also did not carry out the things contained in the
Maternal and Child Health (MCH) book.
Negative mothers tend not to take advantage KIA book properly. This makes it difficult
for mothers to obtain complete information about MCH and the types of health services
that can be obtained at health care facilities. Work factors, fatigue and forgetfulness are
the reasons for pregnant women not to bring their MCH with them during pregnancy
visits. In addition, there is an assumption that pregnant women do not bring the MCH
book, the examination will still be carried out at the service facility where pregnant
women carry out pregnancy checks. So this is also a reason for mothers not to bring
their MCH handbook when carrying out pregnancy checks. The stages of toddler
development according to their age. Participants said that toddlers had no difficulty in
socializing with peers and other friends who were younger or older. Eight participants
said that the toddler was developing well, while the other two participants said that the
toddler had a few problems, namely his speech was not clear, while the other
developments had no problems. Three out of ten participants said that their toddlers did
not gain weight when they were weighed at the Integrated Healthcare Center this month,
while other participants said that when they were weighed this month their children had
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gained weight. When asked about the reasons for not gaining toddler weight, the
participants said that the reason why toddlers did not gain weight was due to illness,
which caused their appetite to decrease even to the point where it was difficult to eat. to
be fed. In responding to this, the participants tried to continue to provide nutritious food
and adequate rest to help increase their toddler's weight every month.
From the explanations given by the participants, the results were found, three
participants said that they rarely compared the theories in the MCH handbook with the
developments that had occurred their child, while other participants said there was a
comparison between the theory and the conditions that happened to their child, and after
the comparison the results were the same. Meanwhile, the way the participants
stimulated the development of toddlers was by frequently inviting children to talk when
the child was not clear about speaking, and teaching children how to walk by being
supported. In terms of showing affection for toddlers, participants used various ways,
namely by giving attention, hugging, being taught good words, while talking to children
while looking into their eyes, and give all the best for children. According to the
Indonesian Ministry of Health (2017) Children have a distinctive feature that is always
growing and developing from conception to the end of adolescence. Children have
growth and development characteristics according to their age. Children also have
different patterns of growth and development, so it is only natural that children
experience various kinds of growth and development, and cannot be compared from one
child to another. In line with the research of Santri, et al (2017), entitled Development
of Toddler Age Children (1-3 years) with The history of low birth weight shows that a
factor that has a significant relationship to the child's developmental level is the parental
stimulus factor. However, in this study the stimulus and quality of parental interaction
with toddlers were not studied. The researcher concluded that delays in the development
of language and personal social aspects were strongly influenced by birth weight history
factors and the stimulus given by parents to toddlers.
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