RESULTS AND DISCUSSION

Characteristics of Research

Variables Research Variables Frequency Distribution

N %

Nutritional Status of Toddlers Before the COVID-19 Pandemic

Normal
86 92.5

Approximately 6 6.4

Pandemic 1 1.1

Nutritional Status of Toddlers During the COVID-19

Normal 73 78.5

less 16 17.2

More 4 4.3

Mother's education

Elementary 5 5.4

Junior High School 20 21.5

Senior High School 45 48.4

Associate’s degree/Bachelor 23 24.7

Mother's Knowledge Regarding the Nutritional Status of Toddlers

Good 76 81.7

Fairly 14 15.1

Poor 3 3.2

Parents' income

More than Sleman Regency minimum wage 62 66.7

Less than Sleman Regency minimum wage 31 33.3

Utilization of Health Facilities

Routine
86 92.5

Not routine 7 7.5

Infectious Diseases of
Toddlers

None 93 100.0

Total 93 100.0

Based on the univariate analysis table above, the results of the description of the
nutritional status of toddlers before the pandemic had a normal nutritional status level, then the
description of the nutritional status of toddlers during the pandemic the majority had normal
nutritional status levels but with changes in the results in the normal category, less and more.
Most of the mothers have a high school education level and the majority of mothers have good
knowledge. Furthermore, the majority of mothers have routinely used health facilities, namely
Integrated Healthcare Center (Posyandu) and all toddlers are in good health and do not have
infectious diseases.

Table of Contingency of Infectious Diseases of Toddlers and Nutritional Status of

Toddlers

During the COVID-19 Pandemic

Overview of the Nutritional Total

Status of Toddlers During
the COVID-19 Pandemic

Normal less More

N % N % N % N %

Infectious None 73 78.5 16 17.2 4 4.3 93 100.0

Diseases of
Toddlers

Total 73 78.5 16 17.2 4 4.3 93 100.0

All children under five did not have infectious diseases because most of them had normal
nutritional status. There was no bivariate analysis between infectious diseases and the nutritional
status of toddlers during the COVID-19 pandemic because all of the children were healthy,
without infectious diseases.
The Relationship between the COVID-19 Pandemic and the Nutritional Status of Toddlers

The Relationship between Total p-

the COVID-19 Pandemic value
and the Nutritional Status
of Toddlers

Normal less More

N % N % N % N %

Before the 86 92.5 6 6.4 1 1.1 93 100.0 <.001

COVID-19
Pandemic

During the 73 78.5 16 17.2 4 4.3 93 100.0

COVID-19
Pandemic

Based on the results of the marginal homogeneity, the p-value is <0.001 so it can be
concluded that the COVID-19 pandemic is correlated to the nutritional status of children under
five. The results of the research before the pandemic the common of the nutritional status of
toddlers was normal, however, during the pandemic, there was a change in the number of
children's nutritional status from normal to less nutritional status. This can happen because of
nutritional factors that have a big role in this condition, and the parents also have to adjust
themselves to difficult conditions to keep providing the best for their children1. In addition, the
restrictive policies conducted by the government have also caused access to health services to be
declined, such as the closing of integrated healthcare center (Posyandu) during the pandemic,
especially when there are increasing cases of Covid 19. There is no balance between the
provisions of nutritional intake and monitoring of the growth and development of toddlers can be
the other problem of malnutrition that occurred during the pandemic 2, 3.
 During this pandemic, there is also an increase in the nutritional status of toddlers which
is excessive. This can happen due to activity factors, there are many policies implemented to
prevent the increase of the virus such as restrictions on the community and also an appeal to stay
at home4. Toddlers have a fairly narrow space of movement only at home, and it is different from
their activity before the pandemic happened. Therefore, the activities carried out during the
pandemic are only monotonous and carried out in a small scope so that the nutritional status of
toddlers can be excessive.

Relationship between Mother's Education and Nutritional Status During the COVID-19 Pandemic
Maternal

Mothers’ Nutritional Status During the Total p-value R

Education COVID-19 Pandemic

Normal Less More

N % N % N % %

Elementary 2 40,0 3 60,0 5 100,0 -

school 0,300**

Junior High 13 65,0 7 35.0 20 100,0 0,003

school

Senior High 36 80,0 6 13.3 3 6,7 45 100,0

school

Associate’s 22 95,7 1 4,3 23 100,0

Degree/Bachelor

Total 73 78,5 16 17,2 4 4,3 93 100,0

**Significant correlation at 0.01 level

 The results of the correlation test here used the Spearman test. From there, the results are
quite correlated and have a negative relationship (not direct) and the relationship between
correlations is significant (r = 0.300, p = 0.003) between a mother's education and the nutritional
status of toddlers at the time of the COVID-19 pandemic.

This research is as same as the research conducted by Herlina & Nurmalisa (2019)
wherein it obtained significant results. The fundamental theory in this research is education can
be the basic thing to improve a person’s quality. Through education, someone can gain
knowledge and accept more useful information. It can be concluded that the higher the education
level of a mother, the greater their understanding of how they can implement behavior in daily
life to make their children’s nutritional status normal. Furthermore, the higher education that
they have, they can more understand how to fulfill the nutritional intake needed by children,
parenting style, as well as maintaining children's health to sustain normal child nutritional status6.

However, the result showed a different result from the fundamental theory. The results of
the study showed a negative direction, which can be concluded that the higher the education, the
more abnormal the nutritional status of children under five. So, the results of this study are not
the same as the existing theory. Statistically, it can happen because it is not only education that
affects the nutritional status of children under five. Yet, many other factors can impact this
condition, one of the factors is the knowledge possessed by the mother. Good knowledge will be
able to provide the best for the intake needed by the child. By putting aside the mother's latest
education, as the person who takes the big responsibility for the children’s needs, the mother
must pursue information and insight about various and balanced nutritional intake as needed to
support normal nutritional status.
 Relationship between Mother’s Knowledge regarding the Nutritional Status of Toddlers and Toddler’s
Nutritional Status During the COVID-19 Pandemic Mother’s Knowledge of the Nutritional Status

Nutritional Status During p -value R

Mothers’ the COVID-19 Pandemic

knowledge
related to
Normal Less More
Toddlers’
nutritional
status N % N % N % N %

Good 66 86,8 6 7,9 4 5.3 76 100.0

Enough 7 50.0 7 50,0 14 100.0

<.001 0.412**

Less 3 100,0 3 100.0

Total 73 78.5 16 17.2 4 4.3 93 100.0

**Significant correlation is at a 0.01 level

The results of the correlation test using Spearman show that the results are moderately
correlated. It has a positive relationship (unidirectional) and the relationship between correlations
is significant (r = 0.412, p = <0.001) among mothers' knowledge regarding the nutritional status
and nutritional status of toddlers during the COVID-19 pandemic.

This study has the same result as research conducted by Herlina & Nurmalisa (2019). It
was established that mothers' knowledge was related to the nutritional status of toddlers during
the COVID-19 pandemic. Mothers are part of the family who knows more about children's
growth and development. Growth and development that occurs in toddlers are also influenced by
their nutritional status of toddlers. In supporting balanced nutrition for their children, good
knowledge of mothers is needed, because starting from choosing, processing, and determining
balanced nutritional intake for children will determine the level of nutritional status. Therefore,
the mother's knowledge will decide the child's nutritional status. The child’s nutritional status
can be at a normal level because of the mother’s knowledge. In addition, knowledge of the
mother can determine how the mother acts to provide nutritional intake to her children7, 8.

In this study, according to the existing theory, mothers who have the better good know
that she has, a better nutritional status for their children as well. Otherwise, if the knowledge of
mothers is less, the worse level children’s nutritional status is. It is due to a lack of insight and
knowledge about nutrition that the intake given is still not balanced to support the nutritional
status of children under five.

Relationship between Income and Nutritional Status of Toddlers during the COVID-19 Pandemic
Parental

Nutritional Status During the Total p- R

COVID-19 Pandemic value

Parents’ Income Normal Less More

N % N % N % N %

4
More 54 87,1 6,5 4 6,5 62 100.0 0.266**

0.010
Less 19 61,3 12 38,7 31 100.0

Total 73 78,5 16 17,2 4 4,3 93 100.0

**Significant correlation is at a 0.01 level

The correlation test using Spearman shows a moderately correlated result. This test shows that it
has a positive (unidirectional) affiliation. The correlation between parental income and the
nutritional status of toddlers during the pandemic COVID-19 shows a significant (r = 0.266, p =
0.010) result. This test shows that most children will have great nutritional status if their parents
come from economically affluent people. While the children will tend to be at a low level or
even at a normal level if their parents have low income.

This study proves the research conducted by Melyani & Alexander (2021) which stated
that there was a relationship between parental income and the nutritional status of toddlers during
the COVID-19 pandemic. Income is the result received by people after they do their job. The
minimum wage for Sleman Regency is Rp.2.001, 000. In addition, most of the subjects (parents)’
income in the Sidokarto area have earned more than the Sleman Regency minimum wage which
has already been set by the government9

From this study, we can state that a family’s nutritional fulfillment depends on the
parent’s revenue. Families who have higher income can understand how nutritional intake needs
should be given to their children. They can accomplish this situation by giving various nutritious
food which can satisfy the balanced nutrition guidelines to achieve the nutritional status of
toddlers who can be in normal level 2.
However, the opposite condition occurred in families with
less income. Families with less income tend to neglect the nutrition within their food because
they just emphasize the food needs that they can spare in this hard condition.10

During the pandemic, many activities and jobs were postponed or terminated considering
the restrictions imposed several times. So, the phenomenon caused economic growth to stagnate
and become paralyzed. The deficient economic conditions during the pandemic can determine
how the family meets their needs. Families who have less income will take other needs more
rather than food needs11.

This study shows the true evidence between the condition and existing theory. The
income earned by parents can determine the quality and quantity of food intake given to the
family, especially kids. Therefore, there is a correlation between higher incomes and a family’s
health improvement, especially the nutritional status of toddlers. The results of the study reveal
that most parents have already earned more than the minimum wage during this pandemic.
Thus, they still can meet the nutritional needs in this current situation of their children in this
difficult time. Moreover, it can be concluded that most toddlers' nutritional status is normal
during the COVID-19 pandemic.

Relationship between Utilization of Health Facilities and Nutritional Status of Toddlers

During the COVID-19 Pandemic

Utilization of Nutritional Status Of Toddlers

health facilities During Pandemic
p- R
value
Normal Less More Total

N % N % N % N %

Routine 68 79,1 14 16,3 4 4,7 86 100,0 0,040**

0.701
Not Routine 5 71,4 2 28,6 7 100,0

Total 73 78,5 16 17,2 4 4,3 93 100,0

**Significant correlation is at a 0.01 level

During the COVID-19 pandemic, the link between the usage of health facilities and the
nutritional state of children under the age of five was minimal, according to the results of the
Spearman correlation test. The test revealed a positive (unidirectional) association, although the
correlations were not statistically significant (r = 0.040, p = 0.701). Many other contributing
factors, such as the mother's education level, knowledge, and parents' wealth, could contribute to
this outcome. This study aims to help parents, particularly mothers, understand the state of their
children even if they are unable to monitor them in an integrated healthcare center (Posyandu).
This study concurs with Nabila's findings (2021). There is no relationship between healthcare
utilization and children's nutritional status during a pandemic. Visiting the integrated healthcare
center (Posyandu) regularly is one of the ways to make use of health services. It is hoped that
visiting an integrated healthcare center, will become an important venue to monitor the growth
and development of children. Moreover, during this pandemic, it is very important to monitor the
health condition of toddlers, so there are no health problems that will emerge especially
abnormal nutritional status. Although the role of the integrated healthcare center (Puskesmas) is
very important for the growth and development of toddlers, people have to delay going to these
health facilities during the pandemic. Because of the pandemic, many people were worried and
afraid of the spread of the coronavirus, so many people decided to postpone or prefer not to visit
the integrated healthcare center (Posyandu). On the other hand, when cases were soaring high,
the integrated healthcare center (Posyandu) could not carry out monitoring for several months12.

The results showed incompatibility with the existing theory. There is indeed the majority
of subjects who routinely use health facilities have normal child nutritional status, yet there are
also many subjects who routinely visit integrated healthcare centers (Posyandu), but their
children's nutritional status is at a low level. On the other hand, some children can have normal
nutritional status levels although they rarely visit integrated healthcare centers (Posyandu). It is
still possible that children were low and more in their average nutritional status even though they
did not go to integrated healthcare centers frequently. These can happen because of some factors,
they are social conditions, family economy, and the surrounding environment12, 13.

There are also subjects (parents) who do not visit an integrated healthcare facility
(Posyandu) regularly, but their children have normal nutritional status. These phenomena can
occur because parents can continue to do the previously described positive factors, such as good
education level, mothers' understanding, and parents' good money, allowing parents to
comprehend and recognize their monthly children's nutritional status. Furthermore, mothers of
toddlers can use this era's constant technology to take advantage of applications such as
PRIMAKU, which was designed by IDAI to track the growth and development of toddlers
online.