KNOWLEDGE OF MOTHERS AND TODDLER AGE RELATED TO ACTIVE VISITS IN POSYANDU

ABSTRACT


INTRODUCTION
One of the main objectives of national development is to improve the quality of sustainable human resources.In line with the development paradigm, the direction of health development has been determined as stated in the Medium-Term Development Plan (RPJM) in the health sector.Prioritizing prevention, promotion, empowerment of families and communities in the health sector.One of community empowerment efforts in the health sector is the development of Posyandu.Toddlers are an age group that is prone to health problems.Health problems that occur in toddlerhood affect growth and development both in infancy and beyond.One approach to monitor the growth and development of toddlers is Posyandu.Posyandu is a good place to provide comprehensive and integrated infant health services (Yuliansyah et al., 2018).
Weighing body weight is one of the main activities of the nutrition improvement program focused on preventing and improving nutritional status in children.Weighing toddler body weight is a collaborative effort to monitor growth and development.Toddler weight monitoring can be successful with active community involvement.This is shown by the attendance rate of mothers weighing their children to posyandu (Ridzkyanto, 2020).Posyandu is a means of meeting and collaboration between professional services of health workers and community participation in tackling health problems (Adhi et al., 2016).
There are 3 factors that affect the participation of Posyandu visits, namely predisposing factors, supporting factors and strengthening factors.The participation factor of mothers weighing their children to posyandu is determined by education, knowledge, attitudes, occupation and values prevailing in society (Isnoviana et al., 2020).In addition, the distance to the posyandu, the availability of facilities at the posyandu, the attitude and behavior of officers who provide health services, and the support of posyandu cadres (the community) will support and strengthen the participation of mothers in the use of health services, especially in posyandu (Intan Pariwara, 2021) There is a significant relationship between Posyandu visits with the nutritional status of children under five (Lumongga et al., 2020).The activeness of Posyandu visits is also significantly related to the incidence of stunting in toddlers aged 3-5 years (Destiadi et al., 2015).Basic Health Research Data (Riskesdas) 2018 found 17.78% of malnourished toddlers consisting of 3.9% toddlers with malnutrition and 13.8% with undernutrition status.As well as information on monitoring child growth is obtained from the frequency of weighing children over the past 12 months.Ideally, children are weighed at least 8 times a year.Riskesdas 2018 data still found as many as 40.0% of toddlers weigh less than 8 times a year.This means that the interest of mothers in bringing their children to the posyandu is still low, the impact of the absence of mothers to the posyandu is that the child's growth is not monitored so that it cannot be known if the child has nutritional problems (Kementerian Kesehatan RI, 2021).
Data from the Gorontalo Province Health Office in 2018 is still 42.7% of toddlers who come to the posyandu and weigh ≥ 8 times in 1 year, Gorontalo City Regency ranks first in posyandu visits and the lowest weighing with a frequency of weighing ≥ 8 times a year only 17.82% (Kementerian Kesehatan RI, 2021).D/S coverage at the Hulonthalangi Health Center in 2022 is 82%, there are 1,386 toddlers in the Hulonthalangi Health Center work area who visit posyandu.The low number of Posyandu visits has an impact on the absence of monitoring growth and development in children under five, so that nutritional problems under five cannot be known to be given faster intervention.So the purpose of this study is to analyze a number of factors that affect the activeness of visits to Posyandu.

METHOD Study Design
The type of study was descriptive survey with a cross sectional study design, which analyzes a number of factors that affect on Posyandu visits in the Hulonthalangi Health Center work area of Gorontalo City.The variables in the study used dependent variables, namely maternal age, maternal education, mothers occupation, mothers knowledge, children age, children gender and the independent variable, namely the activeness of Posyandu visits.

Location and Time of Study
The study was carried out in the working area of the Hulonthalangi Health Center in Gorontalo City in April 2023.

Population and Sample
The population in this study was mothers who had toddlers 12-59 months as many as 998 people.The sample in this study was some mothers who had toddlers by sampling using the simple random sampling method, using the slovin formula so that 91 respondents were obtained.

Data Collection
The measurement of the activeness of participation of toddler mothers visiting posyandu was used questionnaires related to posyandu visits in the last 12 months that categorized as active if Posyandu visits ≥ 8 times in the last 1 year and inactive if < 8 times in the last 1 year (Kementerian Kesehatan RI, 2021).Measurement of maternal age variables carried out using questionnaires categorized as high risk if the mothers age < 20 or >29 years and not at risk if the mothers age 20-29 years (Simbolon, 2021).The technique of analyzing maternal education data was carried out with questionnaires categorized as low education when graduating from junior high school or lower level and higher education when graduating from high school or higher level (muhlisin nalahudin, 2018).The technique of analyzing maternal work data was carried out with questionnaires that have two categories, namely work mothers and non-work.The technique of analyzing maternal knowledge data was carried out with questionnaires that have two categories, namely good knowledge if the score value ≥ 60 and low knowledge if the score value < 60 (Intan Pariwara, 2021)

Process and Analysis Data
The analysis data that used in this study was univariate an bivariate analysis.Univariate analysis used in the early stages of data processing by using tables distribution frequency.The purpose of univariate analysis was describe the characteristics of the study sample.Each sample was selected from population so univariate analysis considered to apply population characteristics.Univariate data analysis included maternal age, maternal education, maternal occupation, maternal knowledge, Posyandu visits, children age and gender.While bivariate analysis by assessing the relationship between maternal age, maternal education, maternal occupation, maternal knowledge, children age and gender with the activeness of posyandu visits.Table 1 shows the characteristics of toddlers and parents of toddlers.The description of the age characteristics of toddler mothers shows the age category of mothers 20-35 years as many as 63.7%, while the age group of mothers in the age category of less than 20 years or over 35 years as many as 36.3%.Based on the level of mothers education show that the level of education less than 9 years is 35.2% and the level of education above 9 years is 64.8%.The mothers occupation status shows that as many as 81.3% of toddler mothers are not working.It indicates that toddlers mothers work as housewives high, while 18.7% of toddler mothers have a work.The mothers knowledge level showed low level knowledge 36.3% and good level knowledge category as much as 63.7%.The level of visits to posyandu shows that 42.9% are not active visiting posyandu, while 57.1% are active visiting posyandu.The results of the analysis of a number of variables related to the effectiveness of the Posyandu are shown in Table 2.The age variable showed that mothers aged 20-35 years were mostly active to visit Posyandu (60.3%) compared to inactive, although bivariate analysis showed no relationship between maternal age and Posyandu visits (p value = 0.550).The variable maternal education showed that maternal education ≥ 9 years old had the effectiveness of Posyandu visits (59.3%) compared to inactivity, although bivariate analysis showed no relationship between maternal education and Posyandu visits (p value = 0.727).The maternal employment variable showed that non-working mothers had the effectiveness of Posyandu visits (55.4%) compared to inactivity, although bivariate analysis showed no relationship between maternal occupation with the activeness of Posyandu visits (p value = 0.669).The variable of maternal knowledge showed that mothers who had good knowledge also had the effectiveness of Posyandu visits (67.2%) compared to inactivity, bivariate analysis showed a relationship between maternal knowledge and the activeness of Posyandu visits (p value = 0.018).The variable age category of toddler shows that the age of children 1 -2 years has the effectiveness of Posyandu visits (68.5%) compared to inactive, bivariate analysis shows a relationship between the age of toddler with the activeness of Posyandu visits (p value = 0.015).The gender variable of toddler showed that there was no relationship between the sex of children under five and the activeness of Posyandu visits (p value = 0.094).

RESULTS
http://jurnal.poltekkesmamuju.ac.id/index.php/mDISCUSSION Age has an affect on the formation of abilities possessed by a person that can be obtained through daily experience.Based on Table 1 it can be seen that respondents with a risk age of 33 respondent (36.3%) and respondents who have a non-risk age of 58 (63.7%), this shows that most mothers who have toddlers have age not at risk category, namely the age of 20-35 years and productive age where at this age a person has a good ability to think and act to plan an activity (Intan Pariwara, 2021).Maturity with age can affect the formation of thinking skills obtained through daily experience and through educational factors.The results of this study are in line with study in Timur Tengah Utara District (TTU) which shows that many toddlers mothers who visit Posyandu are aged 20 -29 years (age not at risk) (Simbolon, 2021).However, bivariate analysis showed no relationship between maternal age and the effectiveness of Posyandu visits (p value = 0.550).This can be due to the activeness of visiting Posyandu of toddler mothers both at an age of non-risk and an age at risk of actively visiting Posyandu.
The mothers education in this study was categorized into higher education (graduated from senior high school or higher) and low (graduated from junior high school or lower).The results showed that most of the education levels of mothers ≥ 9 years or higher after graduating from junior high school, namely 59 respondents (64.8%).Bivariate analysis showed no significant relationship between maternal education and active Posyandu visits (p value = 0.727).The results of this study are not in accordance with previous research conducted in Depok City stating that there is a significant relationship between education and the participation of toddler mothers to visit Posyandu.Mothers who have low education have the opportunity to be inactive in participating in Posyandu compared to mothers who have higher education (muhlisin nalahudin, 2018).This can be caused by toddler mothers with low education level having almost the same amount with toddler mothers who are active in Posyandu.Mothers are the most involved in parenting aspect so that the influence is very large for child development.The role of women or housewives is closely related to the progress of childrens growth and development.Education and work of mothers through social interaction between mothers and children will affect the quality of childrens growth and development.
The role of working and non-working mothers is very importance on family care.The study shown that the time given by mothers to take care of and bring their children to the Posyandu is still low because of the allocation of time to complete office work.Mothers who work outside the home have a risk of not being able to be directly involved in bringing their children to the Posyandu.This can have an impact on a children growth and development.So a mother who works outside home should be able to divide time well between work and childcare activities, especially to bring the children to Posyandu.Working is the main activity that carried out routinely as an effort to support the family and household needs (Mathi et al., 2013).The results showed that most toddler mothers did not work, namely toddler mothers as housewives as many as 74 people (81.3%), bivariate analysis showed no relationship between the toddler mothers occupation with the activeness of Posyandu visits (p value = 0.669).The results of this study are in accordance with previous research conducted at the Sugihwaras Ogan Ilir Health Center which found that there was no relationship between mothers occupation with the activeness of Posyandu visit (Munjayatun et al., 2022).The results of this study are not in accordance with the findings of research at Posyandu X Surabaya which found a relationship between mothers occupation with visits to Posyandu (Isnoviana et al., 2020).The difference in the findings of the study results can be caused by differences in the characteristics of the research subject.There are no association between mothers occupation with the activeness of Posyandu visits in this study can be due to the number of toddler mothers who do not work the same with the number of toddler mothers visit Posyandu.The work done by mothers can be the background of the lack of visits by toddler mothers to the Posyandu because of the large amount of work so there is no time to bring toddlers (Lumongga et al., 2020).
The participation of mothers to the posyandu is the activeness of toddler mothers to measure body weigh their children every month in the posyandu.Visiting the posyandu aims to monitor the linear growth of toddlers.The activeness of toddler mother to visit posyandu can be seen from the KMS book owned by mothers who visited < 8 times in the last one year.Based on the results of interviews with toddler mothers stated that the child will be bring to the posyandu to get immunization, he will have a fever (pain) and fussiness, so the mother does not want to bring their children to the Posyandu.Some mothers of toddlers stated that Posyandu is only for children aged 0-9 months, after complete immunization there is no need to bring toddlers to Posyandu.http://jurnal.poltekkesmamuju.ac.id/index.php/mKnowledge is a very important domain in shaping a persons actions.Knowledge is the result of "know" and occurs after people have sensed certain objects.Behavior that is carried out based on knowledge will last longer and is likely to become an inherent behavior in a person if it is not based on knowledge.The higher level of knowledge, the greater the awareness to visit Posyandu or the higher the level of participation.Knowledge is needed as a support in cultivating self-confidence as well as attitudes and behaviors every day, so it can be said that knowledge is a fact that supports one actions.The knowledge possessed by mothers of toddlers also influences the participation of toddlers mothers to visit Posyandu.The basic knowledge about Posyandu, the purpose, and benefits obtained at Posyandu allows mothers to be present at every Posyandu event (Yuliansyah et al., 2018).The results showed a relationship between maternal knowledge and the activeness of Posyandu visits (p = 0.018).The results of this study are in accordance with previous study that found a relationship between maternal knowledge and the activeness of Posyandu visits (p = 0.000) at the Posyandu Watuawu Village, Lage District, Poso Regency (Noeralim, Laenggeng, 2016).Likewise, the results of study in Ogan Ilir Regency found a relationship between maternal knowledge and the level of activity Posyandu visits (Munjayatun et al., 2022).The results of study at the Andalas Health Center found that there was a relationship between knowledge and attitudes with the activeness of Posyandu visits (Trisnadewi et al., 2021).Maternal knowledge also affects the nutritional status of children under five (Gichana, 2013) The results showed that mostly the toddlers age category 1-2 years, namely 54 toddlers (59.3%), bivariate analysis showed a relationship between the age of toddlers with the activeness of Posyandu visits (p value = 0.015).The results of this study are in line with previous studies that the highest participants in Posyandu visits is toddlers in the age category 12 -36 months, namely 41.2% (Nur Fitriah et al., 2023).The age of toddlers affects to Posyandu visits because at the age < 2 years mothers of toddlers in general are still very concerned about immunizing their toddlers, but when they have passed the complete basic immunization, the level to Posyandu visits has begun to decrease.In fact, detection of nutritional problems through Posyandu activities is important to monitor the growth and development of under five children.
The results showed as many as 50 (54.9%)male toddlers, bivariate analysis showed no relationship between the sex of toddlers and the activeness of Posyandu visits (p value = 0.094).The results of this study are in line with previous research which found that the number of male toddlers (52.9%) was higher than female toddlers who visited Posyandu (Nur Fitriah et al., 2023).
Weighing body weight every month aims to find out of normal growth.If you actively visit Posyandu, you can monitor growth and potential growth disorders, so that efforts can be made to handle and prevent stunting cases, such as by providing counseling to mothers or caregivers in an effort to maintain or improve the nutritional status and health of children.Most mothers do not active participate in Posyandu (65.5%).The low coverage of weighing toddlers to Posyandu shows that community behavior in the health sector, especially in monitoring the growth and development of toddlers, is still low.A number of factors that influence the activeness of mothers to visits Posyandu are the mothers age, maternal education, working status and mothers level of knowledge (Simbolon, 2021).
Community participation, especially mothers of toddlers, is very important to be active in Posyandu visit so that Posyandu can carry out its basic function as a child growth and development monitoring unit.Mothers are agents of renewal, mothers who have babies and toddlers need to work on how to take good care of children that support the growth and development of children according to their potential.The activeness of mothers to come to Posyandu and utilize health services at Posyandu can prevent and detect as early as possible disorders and growth obstacles in toddlers.

CONCLUSIONS AND RECOMMENDATIONS
The participation rate of toddler mothers to Posyandu visit is 57.1% who actively participate in Posyandu every month.The results of the bivariate analysis showed that there was a relationship between maternal knowledge and the age of toddlers with the activeness of Posyandu visits, while there was no relationship between maternal age, maternal education, maternal occupation and gender of toddler with the activity to Posyandu visit. http://jurnal.poltekkesmamuju.ac.id/index.php/m

Table 2 .
Analysis of Variables Associated with Posyandu Visit