ASSOCIATION BETWEEN FOOD SECURITY OF THE HOSUEHOLD AND NUTRITION STATUS WITH ACADEMIC PERFORMANCE OF THE ELEMENTARY SCHOOL

STUDENTS AT YOGYAKARTA MUNICIPALITY

Thesis Summary For Fulfilling the Partial of Requirement To Achieve the Master of Public Health Degree Majoring in Nutrition and Health Public Health Program Health Sciences Department

Written by: Akhmad Sujai NIM: 09/293218/PKU/10751 To POSTGRADUATE PROGRAM FACULTY OF MEDICINE GADJAH MADA UNIVERSITY YOGYAKARTA 2011

APPROVAL SHEET THESIS SUMMARY CORRELATION BETWEEN FOOD SECURITY OF THE HOSUEHOLD AND NUTRITION STATUS WITH ACADEMIC PERFORMANCE OF THE ELEMENTARY SCHOOL STUDENTS AT YOGYAKARTA MUNICIPALITY

Written by: Akhmad Sujai NIM: 09/293218/PKU/10751 Approved by: Advisor

DR. Dra. MG. Adiyanti, Psi., Msi Co-advisor

Date : 7 December 2011

dr. Emy Huriyati, M.Kes

Date : 2 December 2011

ASSOCIATION BETWEEN FOOD SECURITY OF THE HOSUEHOLD AND NUTRITION STATUS WITH ACADEMIC PERFORMANCE OF THE ELEMENTARY SCHOOL STUDENTS AT YOGYAKARTA MUNICIPALITY Akhmad Sujai1, MG. Adiyanti2, Emy Huriyati3

ABSTRACT Background: Poverty and lack of income will cause inability of the family to provide enough and nutritious food for all the family members. Fulfillment of nutritious food will bring direct impact to nutrition status of children. Malnutrition will affect brain development and intelligence that in the long run disrupts academic achievement. Objective: To identify assotiation between food security of the household and nutrition status and academic performance of elementary school students at Yogyakarta Municipality. Methods: The study was observational used cross sectional design. Samples were students of grade V of elementary school at Subdistrict of Gedongtengen, Yogyakarta Municipality. Data of food security of the house were obtained through interview based on questionnaire of Radimer/Cornell; data of nutrition status were obtained through assessment and academic performance through secondary data, i.e. original score of final semester examination. Results As much as 67.6% of the household were food insecure; 13.3% of students were stunted. Food security of the household was significantly associated with nutrition status (p=0.033) and achievement in mathematics (p=0.045). There was association between nutrition status and achievement in Mathematics (p=0.035) and in Indonesian Language lessons (p=0.000) and combined performance in Math, Indonesia Language and Natural Science (p=0.004). Conclusion: There was association between food security of the household and nutrition status. There was association between food security of the household and achievement in Mathematics; but not in Bahasa Indonesia and Science. There was correlation between nutrition status in height for age and academic performance of students. Keywords: household food security, nutritional status, academic performance.
1. 2

Health Office, District of West Lombok, Province of West Nusa Tenggara Faculty of Psychology, Gadjah Mada University 3. Graduate Program in Health and Nutrition, Gadjah Mada University

INTRODUCTION The level of income very determines the food security status of the household and will influence the food supply pattern. The household with good food security is depicted by their ability to meet their food need sufficiently and nutritious for all family members. The food availability in the household will influence the nutrition intake for each family member (1). The nutrition intake from the food will be used by the body to provide an energy, development and maintenance of the body tissue and regulate the life process in the body. The manifestation of the nutrition usage by the body can be seen from the physiological appearance that calls as nutrition status (2). Good food security and nutrition status is basic prerequisite to build quality human resources. The household with good food security and nutrition status will result in the children with optimum physical quality and optimum intelligence, and if is supported by suitable environment will able to achieve good performance in their education process
(3)

The study performance of the students is influenced by many factors originated from internal and external, one of them is household environment
(4)

. Poor family and lack of income will cause food fragileness

that will deficient of nutrition intake for the children so can result in health disorder, both physically and psychosocially that in turn able to reduce the study performance (5). This study was aimed to knowing the association between food security of the household and nutrition status with study performance of the students of the elementary school in Yogyakarta Municipality. METHODS This was observational study used cross sectional design. The study 2011. was performed in Gedongtengen Subdistrict, Yogyakarta Municipality, Yogyakarta Special Region Province, in February to April

The subject of the study was the elementary school students in grade 5 based on a predetermined criterion that was the inclusion criterion were: in 10-11 years old, lived with their parents, and had been lived in Gedongtengen Subdistrict for 2 years. The exclusion criterion was: if the students suffered severe infectious diseases or congenital disorder. The number of population was 141 students from 6 elementary schools. The sampling was performed by systematic sampling with the sample size was 105 students. Data on characteristics of the subject was obtained by asked the Head of the school to fill the form that contain: name, age, sex, the name of the students parents, the original value in the last semester for mathematics, Indonesian language and Natural Science. Data on food security of the household was obtained by interview to the mother of the selected students used Radimer/ Cornell questionnaire. While the data on body weight and body height was obtained by direct measurement. Data on nutrition status was processed used antroplus software based on parameter of height for age according to WHO for 2007. Data on food security of the household was categorized to 2 those were: the household with 1) food secure and 2) with no food secure. Whereas, the data on study performance was categorized into good category and less category. The data presentation by univariate analysis was to saw the frequency distribution of the characteristics of the subject, independent variable and dependent variable. To knowing the association between variable was used Chi Square test and Fishers Exact Test. RESULTS Characteristics of the subjects Out of the sample size of 105 students, the percentage for sex and age variable was almost same, that was the number of male students was 53 (50.5%) and female was 52 (49.5%) students and the number of the

students in their 10 years old was 53 (50.5%) students and the number of the students in their 11 years old was 52 (49.5%). The level of income of the household, the most was not poor that was 73 (69.5%) students, the education background of the father the most was low that was 55 (52.4%), the education background of the mother the most was low that was 54 (51.4%). Most of the parents of the students were employed, that was the employed father was 103 (98.1%) and the employed mother was 56 (53.3%). Based on variable of the students performance and food s ecurity, 69 (65.7%) ever absent in one semester, and 34 (32.4%) had food security status of their family at food secure. Based on nutrition status for body height for age, 91 (86.7%) with normal nutrition status. In performance variable, most of students had less value in mathematics lesson that was 55 (52.4%), while for Indonesian language and Natural Science lesson, most of the students had good value that was 81 (77.1%) and 66 (62.9%) students respectively. For more complete can be seen at Table 1.

Table 1. Characteristics of the subject

Variable n
1. Sex Male Female 2. Age 10 years old 11 years old 3. Income Poor Not poor 4.Education background of the father Low High 5. Education background of the mother Low High 6. Employment of the father Unemployed Employed 7.Employment of the mother Unemployed Employed 8. The presention of the students to the school Nul Absent 9. Food security status of the household Severe unsecurity for children and adult Unsecurity for adult Unsecurity for family Uncertain obout food Food secure 10. Nutrition status of height for age Stunted Normal 12. Performance for Mathematic lessons Less Good 13. Performance for Indonesian Language Less Good 14. Performance for Natural Sicience Less Good 15. Composite performance Less Good 53 52 53 52 32 73 55 50 54 51 2 103 49 56

Number %
50,5 49,5 50,5 49,5 30,5 69,5 52,4 47,6 51,4 48,6 1,9 98,1 46,7 53,3

36 69 39 13 14 5 34 14 91 55 50 24 81 39 66 72 33

34,3 65,7 37,1 12,4 13,3 4,8 32,4 13,3 86,7 52,4 47,6 22,9 77,1 37,1 62,9 68,6 31,4

Food Security of the Household and Nutrition Status Based on height for age nutrition status, 13 (18.3%) students had stunted nutrition status and from the household with not food secure status and 1 (2.9%) students were from the household with food secure status. For more complete can be seen at Table 2. Table 2. Association between food security statuses of the household with nutrition status Food security Nutrition status of height for age Stunted n Not secure 13 Secure 1 Total 14
** Fishers Exact test

Normal n % 81,7 97,1 n

Total %

OR (CI) 7,397 (0,926-59,109)

18,3 58 2,9 33 13,3 91

71 100,0 0,033** 34 100,0

86,7 105 100,0

The statistic test resulted that there was significant association between food security status of the household with height for age nutrition status (p= 0.033) with Odd Ratio (OR) at 7.393 that means that the students from the household with not food secure status had risk 7.397 times greater to get stunting compared to the students from the household with food secure. Food Security of the Household with Academic Performance In the non food secure household the number of the student which achieved less value for mathematics lesson was 42 (59.2%), while the students which achieved good value was 29 (40.8%) students. After statistical analysis it was obtained the result that there was significant association between household food security with study performance of the students in mathematics lessons (p= 0.045) and OR= 2.340 that means that the students from the not food secure household had risk

2.340 greater to get less value for mathematics lessons. More complete result can be seen in Table 3. Table 3. Association between food security statuses of the household with performance value for mathematics lessons Food security Not secure 42 Secure Total
Explanation. *

Mathematic Less Good n % N % 59,2 29 38,2 21 52,4 50 40,8

Total n %

OR (CI) 2,340 (1,012-5,409)

71 100,0 0,045*

13 55

61,8 34 100,0 47,6 105 100,0

Chi Square test

In the Indonesian Language lessons most of the students had good performance that was 81 (77.1%) students, 51 (71.8%) students was from the non food secure household and 30 (88.2%) students was from the food secure household. Based on statistical analysis there was significant association between the food security of the household with the performance of the students for Indonesian Language lessons with p value= 0.051 and OR= 2.941. For more complete can be seen in Table 4. Table 4. Association between food securities of the household with the performance for Indonesian Language lessons. Food security Not secure 20 Secure Total
*

Indonesian Language Less Good n % N % 28,2 51 11,8 30 22,9 81 71,8

Total

OR (CI) 2,941 (0,9189,423)

71 100,0 0,061*

4 24

88,2 34 100,0 77,1 105 100,0

Chi Square test

This was also true for Natural Science lessons; most of the students had good performance that was 66 (62.9%) students, 43 (60.60%)

students from the non food secure household and 23 (67.6%) students from the food secure household. Statistical analysis obtained p value= 0.482. Thus there was no significant association between food securities of the household with the performance for Natural Science lessons. The more complete result is shown by Table 5. Table 5. Association between food securities of the household with the performance for Natural Science lessons Food security n Not secure 28 Secure 11 Total
*

Natural Science Low % Good N % 60,6 67,6 71 100,0 0,482* 34 100,0 Total p OR (CI) 1,262 (0,575-3,223)

39,4 43 32,4 23 37,1 66

39

62,9 105 100,0

Chi Square test

Association between food secure of the household with the composite of the performance for those three lessons can be seen in Table 6, where the result was p= 0.136. This means that there was significant association between household foods secure with the composite of the performance for those three lessons of the students. Table 6. Correlation between food secure of the household with the performance of three lessons Composite performance Less Good n % N % 52 Secure Total 20 72 58,8 14 68,6 33 41,2 34 100,0 31,4 105 100,0 (0,809-4,535) 73,2 19 26,8

Food security Not secure

Total

OR (CI) 1,916

71 100,0 0,136*

* Chi Square test

Height for Age Nutrition Status and Performance Mathematics lessons maybe was still considered as difficult lessons by the students because most of the students or 52.4% obtained less value. The result of statistic test obtained p value= 0.035 and OR = 3.197. this means that there was significant association between nutrition status and performance in mathematics lessons, and the stunted students had risk 1.917 times to obtained less value for mathematics lessons compared the students with normal nutrition status. Table 7. Association between nutrition status and performance for mathematics lessons

Nutrition status height for age Stunted Normal Total

* Chi Square test

Mathematic Less Good n % n %

Total n %

OR (CI)

11 44 55

78,6 48,4 52,4

3 47 50

21,4 51,6 47,6

14 91 105

100,0 100,0 100,0

0.035*

3,917 (1,024-14,975)

In Indonesian Language lessons, most of the students (77.1%) obtained good value. But after statistic test obtained p value = 0.000 and OR= 9.12. This means that there was significant association between nutrition status with performance for Indonesian Language lessons and the stunted students had risk 9.12 times to obtained less value for Indonesian Language. The more complete result can be seen at Table 8.

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Table 8. Association between nutrition statuses with performance for Indonesian Language
Indonesian Language

Nutrition Status
n

Less % n

Good %

Number n %

OR (CI)

height for age Stunted Normal

** Fishers Exact test

9 15

64,3 16,5 22,9

5 76 81

35,7 83,5 77,1

14 91 105

100,0 100,0 100,0

0.000**

9,120 (2,678-31,060)

Sum 24

Table 9 showed that there was no significant assiciation between nutrition status with performance for Natural Science Lessons with p value= 0.905 and OR= 0.931. This means there was no significant association between nutrition status and performance for Natural Science lessons. Table 9. Association between nutrition statuses with performance for Natural Science lessons
Natural Sciences

Nutrition Status
n

Less % n

Good % n

Total %

OR (CI)

height for age Stunted Normal

* Chi Square test 5 34 35,7 37,4 37,1 9 57 66 64,3 62,9 62,9 14 91 105 100,0 100,0 100,0 0.905* 0,931 (0,288-3,009)

Total 39

Association between nutrition status of height for age with the composite of performance for those three lessons obtained p value= 0.004. This means that there was significant correlation between nutrition statuses of body height for age with composite performance for those three lessons.

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Table 10. Assiciation between nutrition statuses with composite performance for three lessons Nutrition status height for age Stunted Normal Total
** Fishers Exact test Composite performance Less Good n % n % 14 58 39 100,0 63,7 68,6 0 33 66 0,0 36,3 31,4 Total n 14 91 105 % 100,0 100,0 100,0 0.004** p

DISCUSSION Association between food securities of the household with nutrition status of height for age This study found that analysis on association between food security of the household with height for age nutrition status used Fishers Exact test obtained p= 0.033 and OR= 7.397 that means that there was significant association between food security status of the household with nutrition status of height for age, the students from the not food secure household had risk 7.937 times greater to experienced stunted (Table 2). This can be described that in the non food secure household, the nutritious food availability that is needed by the children for their optimal development was very limited. If the condition of non food secure of food fragility is occurs in the long term will able to disturb the child growth and development. This study discovered that the children from the not food secure household had probability to experienced stunting and underweight compared to the children from the food secure household because consumed more little animal protein and snack (6). Other of that nutrition intake deficiency in the not food secure household can resulted in health disorder more frequently, the body immune become decreased so vulnerable to infected by the disease that can reduce their appetite and cause the children become undernutrition

12

and not growth optimally

(7)

Other study showed that if stunted was

occurs in 2 years in growth period, in the long term can result negative that is retardation of cognitive function and decreasing of the IQ score in the period of childhood to adolescence
(8)

. Improvement of the IQ for the

(9)

stunting child will never achieve the one for non stunting child though through provide supplement and stimulation . Therefore it is expected that each household must able to provide sufficient food to meet the nutrition need for each family members particularly the children that still in their growth and development so able to reduce the stunting incidence in the child. Association between food security of the household with academic performance The food availability in the household is the main prerequisite for the fulfillment of food intake for the family members. The child with sufficient nutrition intake will always health because the nutrition will influence their body immunity and antibody system
(2)

so will increase their

physical quality and intelligence and if is supported by the suitable environmental factors will able to achieve good performance in their education process (3). Another than physical health factors such as hearing and sight, performance are influenced by psychological factors these is their interest, intelligence and motivation
(10)

. Other of that the family factor, teacher and

the way they teach, the equipment that is used in their teaching and learning, curriculum difference and education program and environment very influence the performance of the study (11-12). The result of this study showed that there was significant association between food security status of the household with performance for mathematics lessons (p= 0.045) with OR = 2.340 (Table 3). But it was not true with Indonesian Language lessons and Natural Science lessons. This maybe because the performance for mathematics

13

lessons had correlation with the spatial ability of the child. Special ability is the part of cognitive aspect that related to the perspective understanding, right left, geometrical form, correlate the spatial concept with the visual image. In the elementary school child, the spatial ability has close correlation with the general intelligence of the child (13). The relationship between intelligence with nutritional status very closely, malnutrition in children can affect brain development and intelligence that ultimately reduce learning achievement(14). In the households not food secure, nutrient requirements for optimum growth and development for children are not being met so that they can have an impact on intelligence(7). It has led children who come from households do not food secure have lower math scores than children from households food secure(15-16). But if is viewed from the association between food security with the composite of the performance for these three lessons, there was no significant association because p value= 0.136. This can be described that the food security not directly influenced the study performance. The food availability in sufficient amount in the household uncertainly could be utilized optimally to increased the nutrition feeding in order the children achieve desired nutrition status, that is the prerequisite that is needed to achieve desired performance. Several obstacles which caused the food availability was can not be used to increased nutrition among others was low appetite of the child because an illness certain dietetic for the child
(17) (7)

and cultural factors or

. By not achieving good nutrition status so

the expectation to achieve desired performance will not occurs in the situation of sufficient food availability. Association between nutrition status of height for age with academic performance Stunted or short body for their age able to influence the development of cognitive process in the childhood, the children which

14

experience stunted showed less performance in their examination because experienced disorder in their concentration, verbal understanding, visual perception and memory power.(18) The result of this study showed that nutrition status of height for age had significant association with performance for Mathematics and Indonesian Language lessons (Table 7 and 8). Why only for Mathematics and Indonesian Language lessons which had significant correlation? Maybe because study material for Mathematics and Indonesian Language lessons was still considered difficult by the students, other of that according to several studies, Mathematics and Indonesian Language had close association with intelligence
(5,12)

. While the Natural Science lessons

maybe was considered more easy by the students, because according the study in 41 countries showed that the performance for Natural Science lessons will higher if the students is a native, lived with their both parents, with their sibling, and there was family members involvement in their learning
(19)

. This is which caused the performance for Natural Science

was better relatively compared to the performance for Mathematics and Indonesian Language lessons. But if viewed from the association between nutrition status of height for age with the composite performance of these three lessons there was significant association between nutrition status of height for age with the academic performance (p= 0.004). This association can be explained that nutrition deficiency in the children will influence to the growth and development of the brain the children intelligence
(20) (21)

so both directly and indirectly will decrease

(22)

. Other of that maybe the low of the child and

performance was because the child experienced undernutrition

stunting since their birth. The children which experience stunting in their first 2 years of their life get long term effect that is lower IQ or intelligence compared to the non stunting children, but the intelligence of stunting child

15

can be increased by stimulate using supplement and psychosocial stimulation though can not achieve the intelligence of normal child
(9)

Therefore it is very important to prevent stunting in the children by provide sufficient nutrition for pregnant woman and meet the nutrition need in the first two years of the life and in the next years appropriate to the nutrition need. CONCLUSION AND RECOMMENDATION There was significant association between the nutrition security of the household with nutrition status of the students. There was significant association between the food security of the household with the performance of the students for Mathematics lessons, but not for Indonesian Language and Natural Science lessons. There was significant association between nutrition status with the performance of the students for Mathematics and Indonesian language lessons and the performance composite for Mathematics, Indonesian Language and Natural Science lessons. To knowing the students potency in their performance at the school, it was need to monitoring their nutrition status since their admission to the school (Grade 1), by performing body height measurement so it is known the students which experience stunting and it is advisable to monitoring their development periodically. The students which have less performance is advisable be given with special counseling in order to increase their performance. The study that related to the performance is advisable to measure the intelligence. BIBLIOGRAPHY 1. Matheson DM, Varady J, Varady A, Killen JD. Household food security and nutritional status of Hispanic children in the fifth grade. Am J Clin Nutr. 2002 Jul;76(1):210-7. 2. Almatsier S. Prinsip Dasar Ilmu Gizi. Jakarta: Gramedia Pustaka Utama; 2009.

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3. Suyamto, Indrasari SD, Hanarida I. Biofortifikasi dan Ketahanan Pangan. Proseding Temu Ilmiah XIII PERSAGI. Jakarta: PERSAGI; 2005. p. 100-9. 4. Azwar S. Tes prestasi fungsi pengembangan prestasi belajar. Yogyakarta: Pustaka Pelajar; 2009. 5. Alaimo K, Olson CM, Frongillo EA, Jr. Food insufficiency and American school-aged children's cognitive, academic, and psychosocial development. Pediatrics. 2001 Jul;108(1):44-53. 6. Isanaka S, Mora-Plazas M, Lopez-Arana S, Baylin A, Villamor E. Food insecurity is highly prevalent and predicts underweight but not overweight in adults and school children from Bogota, Colombia. J Nutr. 2007 Dec;137(12):2747-55. 7. Milman A, Frongillo EA, de Onis M, Hwang JY. Differential improvement among countries in child stunting is associated with longterm development and specific interventions. J Nutr. 2005 Jun;135(6):1415-22. 8. Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet. 2002 Feb 16;359(9306):564-71. 9. Walker SP, Chang SM, Powell CA, Grantham-McGregor SM. Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: prospective cohort study. Lancet. 2005 Nov 19;366(9499):1804-7. 10. Suryabrata. Psikologi Pendidikan. Jakarta: Raja Grafindo Persada; 2004. 11. Purwanto MN. Psikologi Pendidikan. Bandung: Remaja Rosdakarya 2008. 12. Djamarah. Psikologi belajar. Jakarta: Rhineka Cipta; 2008. 13. Tambunan SM. Hubungan Antara Kemampuan Spasial Dengan Prestasi Belajar Matematika. Makara Sosial Humaniora. 2006 1 Juni 2006;10 (1):27-32. 14. Gorman kS. Malnutrition and Cognitive Development: Evidence from Experimental/Quasy-Experimental Studies Among the Mild-toModerately Malnourished. The Journal of Nutrition. 1995;1256:22398448. 15. Alaimo K, Olson CM, Frongillo EA, Jr., Briefel RR. Food insufficiency, family income, and health in US preschool and school-aged children. Am J Public Health. 2001 May;91(5):781-6. 16. Jyoti DF, Frongillo EA, Jones SJ. Food insecurity affects school children's academic performance, weight gain, and social skills. The Journal of Nutrition. 2005;135:2831-9. 17. Susanto. Fungsi-fungsi Sosio Budaya Makan. Majalah Pangan 1991:51-6.

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18. Kar BR, Rao SL, Chandramouli BA. Cognitive Development In Children With Chronic Protein Energy Malnutrition. Behavioral and Brain Function [serial on the Internet]. 2008; 4 : 31: Available from: http://behavioralandbrainfunctions.com/content/4/I/31. 19. Chiu MM. Families, economies, cultures, and science achievement in 41 countries: country-, school-, and student-level analyses. J Fam Psychol. 2007 Sep;21(3):510-9. 20. Georgieff MK. Nutrition and the developing brain: nutrient priorities and measurement. The American Journal of Clinical Nutrition. 2007;85. 21. Ariani M. Penguatan ketahanan pangan daerah untuk mendukung ketahanan pangan nasional2010: Available from: http://pse.litbang.deptan.go.id/ind/pdffiles/Mono26-3.pdf. 22. Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG. Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics. 2001 Jun;107(6):1381-6.