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RELATIONSHIP OF EXCLUSIVE ASSOCIATED WITH ACUTE ACUTE DIARRICAL

RATE AT BABY AGES 0-1 YEARS IN PUSKESMAS CAMPALAGIAN CITY OF


POLEWALI MANDAR
ANDI NURHAZIMA WM, Amd.Keb

ABSTRACT

Exclusive breastfeeding is an effort to achieve optimal growth and development and can be
protected from diarrhea. The purpose of this study was to determine the relationship of
exclusive breastfeeding with the incidence of acute diarrhea in infants aged 0-1 years in the
Kuranji Public Health Center Padang. This study conducted a cross sectional observational
study. The sample was a baby aged 0-1 years who visited posyandu in the Kuranji Public Health
Center working area using simple random sampling. The result showed 41 infants (30.4%) aged
0-5 months 29 days which is still breastfed only and other than breast milk were 28 infants
(20.7%). Number of 6-12 months infants are exclusively breastfed as many as 34 babies (25.2%)
while the other 32 babies (23.7%) were not exclusively breastfed. A total of 57 infants (42.2%)
had suffered from diarrhea and the other 78 infants (57.8%) had never. Chi square analysis got
p = 0.001 and the results are significant (p <0.5). Exclusive breastfeeding for 6 months should
be improved because it has relation with diarrhea. Keywords:Baby, Exclusive breastfeeding,
diarrhea

PRELIMINARY
Diarrhea is one of the major causes of morbidity and mortality in children in developing
countries. Children aged 0-3 years on average experienced three times diarrhea per year.
According to WHO (2009) diarrhea is a state of defecation (BAB) with the consistency of flabby
to liquid and frequency more than three times a day. Acute diarrhea lasts for 3-7 days, whereas
persistent diarrhea occurs for 14 days. Clinically the cause of diarrhea is divided into six
groups, namely infection, malabsorption, allergies, food poisoning, immunodeficiency and
other causes, eg : functional disorders and malnutrition.
Based on Basic Health Research (Riskesdas) in 2007, it was found that the cause of
infant death (age 29 days-11 months) was diarrhea (31,4%) and pneumonia (23,8%). Results of
the Diarrhea Morbidity Survey from 2000 s.d. 2010 obtained the morbidity rate of infant
diarrhea Year 2000- 2010 did not show the pattern of increase or pattern of decline (fluctuate).
In 2000 the morbidity rate of under-fives was 1.278 per 1000, slightly decreased in 2003 (1,100
per 1000), slightly increased in 2006 (1,330 per 1000), and in 2010 the morbidity rate decreased
(1,310 per 1000). Viewed from the distribution of aged children under five years old diarrhea in
2010 obtained the largest proportion is age group 6 - 11 month that is equal to 21,65%, then
age group 12-17 month equal to 14,43%, age group 24-29 month equal to 12,37 %, while the
smallest proportion in the age group 54 - 59 months was 2.06%.
MOH RI supported by the Indonesian Doctors Association (IDAI) has launched a new
guide to diarrhea management in children, namely Five Steps to Solve Diarrhea (LINTAS DIARE),
which consists of: fluid administration, zinc for 10 consecutive days, continue breastfeeding and
food, selectively administering antibiotics and giving advice to the mother/family of the patient.
At birth until a few months later, the baby has not been able to form his own immunity
perfectly. Breast milk provides immune substances that can not be made by the baby, so babies
who drink milk more rarely sick, especially at the beginning of his life. The many anti-infective
components in breast milk will protect babies from various infections, whether caused by
bacteria, viruses, and other antigens.
In 2001, following a systematic review of the article and consulting with experts, WHO
revised its exclusive ASI recommendations from 4-6 months to 6 months. The results of the
article conclude that infants who are exclusively breastfed for up to 6 months are generally less
likely to develop gastrointestinal disease and have fewer growth problems. The definition of
exclusive breastfeeding is diverse but the most commonly used definition is the WHO definition
which mentions exclusive breastfeeding is administering only breast milk alone without any
fluids or solids except vitamins, minerals, or drugs in the form of drops or syrup until 6 months
of age.
The practice of breastfeeding in developing countries has managed to save about 1.5
million babies per year from death and illness. On that basis WHO recommends for exclusive
breastfeeding until infants 6 months. Each year more than 25,000 babies in Indonesia and 1.3
million babies in the world can be saved from death with exclusive breastfeeding.
on March 1, 2012 issued PP No. 33 of 2012 on Exclusive Breast Milk (ASI) signed by
President Susilo Bambang Yudhoyono. This regulation implements the provisions of article 129
paragraph (2) of Law Number 36 Year 2009 regarding health. In order to protect, support and
promote exclusive breastfeeding, efforts should be made to increase support from government,
local government, health care facilities and health workers, communities and families so that
mothers can provide exclusive breastfeeding to infants.
Nationally, coverage of exclusive breastfeeding in Indonesia has fluctuated over the last
3 years. The coverage of exclusive breastfeeding in infants 0-5 months fell from 62.2% in 2007
to 56.2% in 2008, but increased again in 2009 to 61.3%. While the coverage of exclusive
breastfeeding in infants up to 6 months fell from 28.6% in 2007 to 24.3% in 2008 and rose again
to 34.3% in 2009. The reasons for the failure of exclusive ASI practices vary such as the culture
of giving pralactal food, giving extra milk formula because breast milk does not come out, stop
breastfeeding because babies or sick mothers, mothers have to work, and mothers want to try
formula milk.
Based on data from Polewali Mandar City Health Office in 2011, data obtained from
diarrhea in infants 0-1 years in Campalagian Health Center were as many as 97 cases, 9.09% of
all cases of diarrhea in Polewali Mandar public health centers. This figure is high compared to
the incidence of diarrhea in other puskesmas in Polewali Mandar City. The purpose of this study
was to look at the relationship of exclusive breastfeeding to the incidence of acute diarrhea in
infants 0-1 years in Campalagian Health Center, Polewali Mandar City.

RESEARCH METHODS
This study is a cross sectional study to determine the relationship of exclusive
breastfeeding with the incidence of acute diarrhea in infants 0-1 years. This cross-cutting
method is a method that examines the relationship between independent variables (risk
factors) with the dependent variable (effect) by performing instantaneous measurements.
The sample was taken from the population of mothers who had a baby aged 0-1 years
who visited the posyandu in the work area of the Campalagian Puskesmas, Polewali Mandar
City with simple random sampling method. According Suyatno, determine the size of the
sample on a cross-sectional study that has known the number of population can be used
formula:

n=Z2

Obtained the number of samples in this study as many as 135 babies. The inclusion
criteria of the research sample were 0-1 year old infant, visiting Posyandu working area of
Campalagian Health Center, Polewali Mandar City, and mother of baby willing to be
respondent. Exclusion criteria included severe illness, chronic diarrhea, low birth weight (LBW)
and premature history (<37 weeks pregnancy).
The dependent variable of this study is the occurrence of acute diarrhea, a disease
characterized by increasing frequency of defecation more than 4 times / day with the
consistency of stools being liquid, with / without mucus or blood and lasting less than 14 days.
While the independent variable is exclusive breastfeeding, ie breastfeeding alone without any
additional fluids, such as formula, honey, tea, water, and without solids such as bananas,
papaya, milk porridge, biscuits, rice porridge and teams, until the age of 6 months. Both
variables were measured using questionnaires with guided interviews to obtain the nominal
size scale. This research was conducted at 23 posyandu work area of Campalagian Health
Center, Polewali Mandar Town. The time of the research has been conducted in November
2011 - September 2012
The steps of data processing are checking the completeness and clarity of the data,
coding on each variable data, entering data in the SPSS program (Statistical Program for Social
Science), and re-examination to ensure that the data has been cleared of errors. The data
analysis consisted of univariate and bivariate analysis. In bivariate analysis sought the
relationship between two variables by using the formula chi square (X2) and the strength of the
relationship of two variables with the formula of contingency coefficient (C) .13 The formula:
C= dan =

Results

a. Characteristics of Respondents
Table 1: Infant frequency distribution by age group in Puskesmas Campalagian Kota
Polewali Mandar City
Baby Age Frequency Persentage (%)
0-5 months 29 days 69 51,1
6-12 months 66 48,9
Total 135 100

Infants <6 months older than infants> 6 months. The division of this age group is
intended to get the number of breastfed babies with exclusively breastfed babies because the
definition of exclusive breastfeeding is done for 6 months.
b. Exclusive Breastfeeding
Table 2: Frequency distribution of infants aged 6-12 months based on exclusive
breastfeeding at Campalagian Public Health Center Polewali Mandar City.
Exclusive breastfeeding Frequency Persentage (%)
Yes 34 51,5
No 32 48,5
Total 66 100

c. Breastfeeding Only
Table 3: Frequency distribution of infants aged 0 - 5 months 29 days who received
breast milk only from birth to be researched at the Campalagian Health Center
Polewali Mandar City.

Breast milk alone Frequency Persentage (%)


Yes 41 59,4
No 28 40,6
Total 66 100

d. The reason the mother did not give exclusive breastfeeding or breast milk alone in
infants
Table 4: Frequency distribution of maternal reasons not providing exclusive
breastfeeding or breast milk to infants at the Campalagian urban center Polewali
Mandar.
Reasons Mom Frequency Persentage (%)
Breast Milk Less 31 32,3
The baby looks not 41 42,7
satisfied with breast milk
Sick mother 9 9,4
Baby sick 4 4,2
Mother works 10 10,4
Others 1 1,1
Total 96 100

Table 4 shows that the state of an infant who has not yet been satisfied with
breast milk alone is the most reason for the 96 reasons that the mother does not give
exclusive breastfeeding or breast milk to infants. This research questionnaire allows
mothers to choose more than one reason not to give exclusive breastfeeding or breast
milk to their babies.
e. History of Acute Diarrhea
Table 5: Frequency distribution of infants aged 6-12 months based on history of
acute diarrhea at Campalagian Public Health Center of Polewali Mandar City.
Acute diarrhea Frequency Persentage (%)
Yes 34 51,5
No 32 48,5
Total 66 100

Table 6: Frequency distribution of infants aged 0 - 5 months 29 days based on


history of acute diarrhea at the Campalagian urban center Polewali Mandar.
Acute diarrhea Frequency Persentage (%)
Yes 22 31,9
No 47 68,1
Total 66 100

f. Results of Bivariate Research


Table 7: Exclusive Breast-Feeding Relationships with Acute Diarrhea Evaluation Rate
in Infants 6-12 Months at Campalagian Public Health Center Polewali Mandar.
Exclusive Acute diarrhea
Total P value
breastfeeding Yes No
Yes 25 (73,5%) 9 (26,5%) 34 (100%)
No 6 (8,7%) 26 (74,3%) 32 (100%) 0,001
Total 31 (41%) 35 (53%) 66 (100%)
Table 7 shows acute diarrhea more frequently in non-exclusive breastfed infants
(74.3%) than those exclusively breastfed (26.5%) with statistically significant (p <0,5).
The X2 value of the contingency table is 19.9 then the value of C (contingency
coefficient) obtained is 0.5 (C 0). This shows there is a relationship between exclusive
breastfeeding and the incidence of acute diarrhea in infants aged 0-1 years in
Campalagian Health Center Polewali Mandar City. According to Effendi and Singarimbun
in his book entitled Surveys Research Methods (2011), the C value between 0.5- 0.75
means that the strength of the relationship between two variables is moderate.

DISCUSSION
Based on bibliographic data on the incidence of diarrhea in infants, Riskesdas (Basic
Health Research) in 2007 stated that infants aged 29 days-11 months are the most diarrhea age
group (31.4%). One of several causes is not giving exclusive breastfeeding so that babies are
more susceptible to the disease that one of them is diarrhea. This research was conducted in 23
posyandu located in the work area of Campalagian Health Center of Polewali Mandar City in
2012. Based on the research, 69 babies (51,1%) 0-5 month 29 and 66 baby (48,8%) age 6 -12
months.
According to Fikawati and Syafiq, 5 WHO states exclusive breastfeeding is breastfeeding
alone with no added fluid or solid foods except vitamins, minerals, or medications in the form
of drops or syrup until 6 months of age. Based on this understanding, this study divided the two
age groups of infants into the sample, namely infants who received exclusive breastfeeding in
the age group of 6 to 12 months and breastfed infants alone in the age group 0-5 months 29
days. The number of exclusively exclusive breastfed infants was 34 (25.2%) compared to non-
exclusive breastfed infants (23.7%). The number of babies who received breast milk alone 41
infants (30.4%) and 28 infants (20.7%) others had been given a mixture of other foods or
beverages other than breast milk. The reason the mother did not give exclusive breastfeeding
or had interfere with breast milk with other foods or beverages before the age of 6 months is a
baby that has not been satisfied with breast milk alone (42.7%), less breast milk (32.3%),
working mother (10.4 %), sick mother (9.4%), sick infants (4.2%), and others (1.1%).
According to WHO1 diarrhea is a state of defecation (BAB) with the consistency of
flabby to liquid and frequency more than three times a day. Acute diarrhea lasts 3-7 days. The
number of infants who had diarrhea in the age group 6-12 months were 34 infants (51.5%). This
figure is more than the number of infants who never diarrhea, which is 32 infants (48.5%). The
number of infants who had had diarrhea in the age group 0-5 months 29 days was 22 infants
(31.9%) and this number was less than infant never diarrhea, ie 47 infants (68.1%).
The exclusive breastfeeding relationship table with the incidence of acute diarrhea in
infants aged 6-12 months at Puskesmas Kuranji Kota Padang showed that the incidence of
diarrhea in exclusively breast-fed infants was 9 (26.5%) and this was lower than the incidence of
diarrhea infants did not receive exclusive breastfeeding, ie 26 infants (74.3%). The number of
non-diarrhea babies was higher in the exclusively breastfed infant group of 25 (73.58%) than
the non-exclusively breastfed infants, 6 (18.7%). Based on these data, it was found that the
incidence of diarrhea in infants who did not receive exclusive breastfeeding was higher than
that of exclusively breast-fed infants. These results suggest that infants who are not exclusively
breastfed are more susceptible to diarrhea.
Hegar and Sahetapy mentioned that one of the unique ingredients of breast milk is an
oligosaccharide that will create an acid atmosphere in the gastrointestinal tract. This acidic
atmosphere serves as a signal for the defense of the gastrointestinal tract, namely SIgA
(Secretory Immunoglobulin A) which is also present in the milk itself. SIgA can bind pathogenic
microbes, prevent attachment to enterocyte cells in the intestine and prevent inflammatory
immune reactions so diarrhea does not occur. This is consistent with Lely's research looking for
the role of exclusive breastfeeding containing SIgA against the risk of acute diarrhea. The study
describes the incidence of acute diarrhea in infants with exclusive breastfeeding 34.8%. This
figure is lower than the incidence of acute diarrhea in infants without exclusive breastfeeding,
which is 65.2%.
According Suradi infants who get milk more rarely affected by diarrhea due to
gastrointestinal protective substances such as Lactobacillus bifidus, lactoferrin, lysozyme, SIgA,
allergic factors, and lymphocytes T and B. This protective substance serves as immunologic
immunity against foreign substances that enter body. A study by Lamberti et al conducted in
developing countries showed a comparison of the risk of diarrhea in infants who were not
exclusively breastfed higher (2.65) than those exclusively breastfed (1.26).
The exclusive breastfeeding relationship table with the incidence of acute diarrhea in
infants aged 6-12 months in Puskesmas Kuranji Kota Padang also showed p value of 0.001 and
this figure is significant (p <0,5). This value indicates a relationship between exclusive
breastfeeding and the incidence of acute diarrhea. The same relationship has also been
demonstrated by Wijayanti in his study comparing the incidence of 0- to 6-month-old baby
diarrhea with exclusive breastfeeding and exclusively breast-fed infants at the Binga Public
Health Center in Banggae sub-district, Mamuju. The results showed that p = 0,000 was
significant and significant (p <0,5).
The value of cotingency coefficients (formula C) which states the strength or closeness
of the relationships between variables is obtained at 0.5 (C 0). This value means an
association between acute diarrhea variables and moderate exclusive breast feeding. This
medium strength states that the cause of diarrhea is not only influenced by breast milk but also
caused by several risk factors such as socioeconomic, cultural, population density, and others.
In this study there are some weaknesses such as excessive time required to examine compared
to the initial estimate of May - June 2012 to May - September 2012. Campalagian Health Center
has 23 posyandu scattered in Kelurahan Pappang and Panyampa. The schedule of posyandu
implementation starts from Monday to Thursday every 9.00-12.00 WIB in the first three weeks
of each month. Every day the posyandu is held in two different places simultaneously. The
researcher can not visit every posyandu at the same time.

CONCLUSION
After doing research in 23 posyandu of working area of Puskesmas campalagian
Polewali Mandar City got the conclusion that more babies get exclusive breastfeeding
compared to not. In addition, the number of babies who have suffered from diarrhea is less
than never. From the statistical test also found a significant value on the relationship of
exclusive breastfeeding with the incidence of acute diarrhea in infants aged 0-1 years in the
Campalagian Health Center Polewali Mandar.
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