INTRODUCTION
Based on SKID data in 2007,
mother mortality rate in Indonesia has
reached 228 per 100.000 of birth rate.
Bleeding has the highest percentage of
mother mortality rate (28%), eclampsia
(24%), and infection (11%). Meanwhile,
Chronic Energy Deficiency (CED)
becomes passive factor for mother
mortality rate by 37%
(Hasanah&Minsanarwati, 2012). Primarily,
chronic energy deficiency (CED) is a
condition in which a mother has poor
nutritional status to chronic inadequate
intake, thus interrupts maternal health
(Department of Health, 2002).
The prevalence of pregnant mother
with chronic energy deficiency in
Indonesia increases by 21.6%, especially
pregnant mother rate in East Java increases
highly by 27.5% (Hasanah&Minsarnawati,
2012). Based on the data of pregnant
mother atPuskesmas (Community Health
Center) of Northern Kediri, 212 pregnant
mothers were recorded while 17 (8%)
among them encountered chronic energy
deficiency (CED). In fact, the target that
must be reached by government for
pregnant mother with chronic energy
deficiency in 2015 is less than 5% (Annual
Report at Puskesmas of Northern Kediri,
2015). Primarily, CED is not only
influenced by poor nutritional intake but
also by socio-demography, knowledge
regarding nutrition of pregnancy period,
education level, monthly income factors
(Daba et al, 2012). Lack of nutrition intake
during pregnancy period will cause
inefficient nutritional micro and macro.
Thus, it leads to inadequate growth and
development of disability, premature birth,
pregnancy complication, and infant with
malnutrition. The purpose of this study
was to analyze the influence of knowledge,
socio-economic, and maternal factors
towards chronic energy deficiency on
pregnant women atPuskesmas of Northern
Kediri during January December 2015.
METHOD
This study used analytic
observational design with case control
approach. Also, it was conducted
atPuskesmasof Northern Kediri. The
population involved was all pregnant
women recorded in the data published by
Puskesmasof Northern Kediri during
January December 2015. Samplesof this
research were 90 respondents by
considering the formulation below:
N
n=
1=Ne2
n = sample
N = population
E = margin error 0.10 (10%)
Based on the formulation above,
the 90 respondents consisting of 17
chronic energy deficiency patients and 73
respondents as control group. The data of
knowledge, socio-economic, and maternal
factors were collected through interview
and questionnaire. The selection of CED
status was measured by Mid-Upper Arm
Circumference (MUAC) of pregnant
mother. According to general standard of
Department of Health of the Republic of
Indonesia, it states that a mother suffers
Chronic Energy Deficiency (CED) if her
length of MUAC is lower than 23.5 cm
(<23.5cm).
The status of pregnant mothers
nutrient was actually investigated through
several indicators, such as length and
weight before pregnancy, weight during
pregnancy, and Mid-Upper Arm
Circumference (MUAC). The
measurement of MUAC was one of
alternatives to investigate CED risk.
Basically, MUAC measurement is a
practice tool used to easily investigate
CED risk on pregnant women. The data of
MUAC were recorded in cohort population
for pregnant mothers who
visitedPuskesmasof Northern Kediri. The
data were conducted by means of
designing categories, subsequently
applying univariate analysis to investigate
score frequency and distribution to each
variable of the study. Otherwise, bivariate >1.399.750 14 82,4 27 37,0
analysis was conducted to investigate the Parity
correlation between free and bound <4 17 100 72 98,6
variables by using statistical test of chi >4 0 0 1 1,4
square. Antenatal Care
Routine 4 23,5 24 22,9
RESULTS Not-routine 13 76,5 49 67,1
Based on the data of the study, 17 Mothers Age during Pregnancy
patients were categorized as CED while 73 <20 years old 2 11,8 1 1,4
patients were not categorized as CED at >20 years old 15 88,2 72 98,6
Puskesmasof Northern Kediri.The total
population in this research was 90 Based on table 1 above, most of
respondents. pregnant mothers were in range of 20 35
Univariate Analysis years old for both CED group and non-
Table 1 explains thecharacteristics of CED group. These ages frequently
respondents based on age, nutritional encountered pregnancy due to fit and
status, knowledge level, education level, healthy condition of young mother to
monthly income, job, parity, ANC, and deliver an infant. Based on the data of
mothers age during pregnancy. Department of Health of the Republic of
Indonesia (2008), the youngest age under
Individuals Pregnant Mother 20 yearsand the oldest age above 35
Characteristics CED Non-CED yearsare risky age during pregnancy.
n % n % Meanwhile, the nutritional status of
Mothers Age pregnant mothers for CED group was
<20 years old 2 11,8 1 1,4 categorized underweight while non-CED
20-35 years old 14 82,4 61 83,6 group was categorized normal.
>35 years old 1 5,9 11 15,1 The knowledge level of pregnant
Nutritional Status mothers with CED was categorized poor
Obesity 0 0 20 27,4 while non-CED was categorized good.
Overweight 1 5,8 25 34,2 Both groups were graduates of Senior
Normal 6 35,2 28 38,4 High School. Moreover, most of them
Underweight 10 71 0 0 were unemployed. The expenditure
Knowledge Level proportion upon total budgeting was
Poor 9 52,9 8 11,0 depicted through average household
Enough 3 17,6 18 24,7 incomes. The average of household
Good 5 29,4 47 64,4 incomes with CED was >1.399.750 while
Education Level non-CED was >1.399.750. Most of
Elementary 0 0 1 1,4 pregnant mothers with and without CED
School did not have parity less than 4 children and
Junior High 4 23,5 6 8,2 attended to ANC routinely. Meanwhile,
School the mothers age during pregnancy was
Senior High 11 64,7 56 76,7 average >20 years old for both groups.
School
Higher 2 11,8 10 13,7
Education
Occupation
Employed 4 23,5 28 38,4
Unemployed 13 76,5 45 61,6
Incomes
<1.399.750 3 17,6 46 63,0
 Bivariate Analysis Bivariate analysis aimed at recognizing the
Table 2. illustrates the bivariate correlation between free variable and
analysis on the influence of information, bound variables. Based on the bivariate
socio-economic and maternal factors upon analysis, it was obtained the significant
the chronic energy deficiency: correlation between mothers nutritional
status during pregnancy and chronic
Individuals Pregnant Mothers P value energy deficiency with p=0.000.
Characteristics CED Non- Meanwhile, the correlation on knowledge
CED level obtained p=0.000 indicating that
n % n % there was a significant correlation between
Nutritional Status 0,000 knowledge level and chronic energy
Obesity 0 0 20 27,4 (Fisher deficiency. The bivariate analysis showed
Overweight 1 5,8 25 34,2 exact test)
that the education level obtained p=0.328
Normal 6 35,2 28 38,4
indicating that there was no correlation
Underweight 10 71 0 0
Knowledge Level 0,000
between mothers education level and
Poor 9 52,9 8 11,0 (Fisher chronic energy deficiency. In terms of job
Enough 3 17,6 18 24,7 exact test) analysis, it was obtained p=0.399
Good 5 29,4 47 64,4 indicating that there was no correlation
Education Level between job and chronic energy deficiency.
Elementary 0 0 1 1,4 0,328 It also occurred for the average household
School (likelihood incomes with p=0.160 indicating that there
Junior High 4 23,5 6 8,2 ratio) was no correlation between the average
School incomes and chronic energy deficiency.
Senior High 11 64,7 56 76,7 The bivariate analysis for parity showed
School the value of p=0.811 indicating there was
Higher 2 11,8 10 13,7
no correlation between parity and chronic
Education
Job Status 0,399 energy deficiency. In terms of antenatal
Employed 4 23,5 28 38,4 (Fisher care, it was obtained p=0.568 indicating
Unemployed 13 76,5 45 61,6 exact test) that there was no correlation between
Incomes 0,160 mothers visit on antenatal care and
<1.399.750 3 17,6 46 63,0 (Fisher chronic energy deficiency. Last, in terms
>1.399.750 14 82,4 27 37,0 exact test) of age, it was gained p=0.090 indicating
Parity 0,811 that there was no correlation between
<4 17 100 72 98,6 (Fisher mothers age and chronic energy
>4 0 0 1 1,4 exact test) deficiency.
Antenatal Care 0,568
Routine 4 23,5 24 22,9 (Fisher
Not-routine 13 76,5 49 67,1 exact test)
Mothers Age during Pregnancy 0,0900
<20 years old 2 11,8 1 1,4 (Fisher
>20 years old 15 88,2 72 98,6 exact test)
Multivariate Analysis
Table 3. illustrate the multivariate analysis on the influence of information, socio-
economic and maternal factors upon the chronic energy deficiency.

Individuals Pregnant Mother

Characteristics CED Non- B Crude 95% CI P value
CED OR
n % n %
Nutritional Status
Obesity 0 0 20 27,4 0.379-
Overweight 1 5,8 25 34,2 -42.64 5.136 0.538 0,000
Normal 6 35,2 28 38,4
Underweight 10 71 0 0
Knowledge Level
Poor 9 52,9 8 11,0 -2.934 0.569 0.004-
Enough 3 17,6 18 24,7 0.639 0,000
Good 5 29,4 47 64,4
Incomes 0.143
<1.399.750 3 17,6 46 63,0 0.617 1.854 24.10 0,160
>1.399.750 14 82,4 27 37,0
Mothers Age during Pregnancy 0.001-
<20 years old 2 11,8 1 1,4 -2.534 0.079 4.205 0,0900
>20 years old 15 88,2 72 98,6

Crude odds ratio or OR is the risk status, it was obtained OR=5.136

amount of free variable towards bound
variable which is obtained through the
bivariate analysis. The significance of this
odds ratio can be obtained through the
correlation test. The result of bivariate
analysis with crude OR on each risk factor
is illustrated in Table 5.2. The table
presents each influential factor of chronic
energy deficiency, two of which are
nutritional status before pregnancy and
mothers information level that can be
seen from p value < 0.05. Meanwhile, two
other variables, which are average incomes
and mothers age during pregnancy, did
not show any significant correlation (p
value > 0.05).
Based on B value for nutritional
status, it was obtained -42.64 indicating
that overweight nutritional status was
indeed a risky factor which could decrease
the chronical energy deficiency.
The nutritional status is one of
influential factors for chronic energy
deficiency (OR=5.316, 95% CI=0.379-
0.538, p-0.000). In terms of nutritional
indicating that mothers with underweight
nutritional status were more likely to have
risk of chronical energy deficiency 5 times
higher than those with normal nutritional
status. The second factor significantly
contributing to the chronic energy
deficiency is knowledge level OR=0.569,
95% CI=0.004-0.639, p=0.000). In terms
of knowledge level, it was obtained
OR=0.569 indicating that mothers with
lessknowledge level were more likely to
have risk of chronical energy deficiency
0.5 times higher than those with normal
knowledge level. Meanwhile, the other
two variables, average incomes and
mothers age during pregnancy, showed
value of 1 on CI 95% (incomes=0.143-
24.10, while mothers age=0.001-4.205).
Therefore, the value of these two variables
did not indicate the significant correlation.
Discussion
In this research, the analyzed risk
factors incorporate several variables such
as: mothers knowledge level, socio-
economic factors including education level,
job, and average household incomes, and
maternal factors involving parity, mothers
age during pregnancy, and antenatal care
record. According to chi-square done in
this research, the information variable
obtained p value=0.000 indicating that
there was significant correlation between
knowledge level and chronic energy
deficiency on pregnant mothers. An
individuals knowledge level was
influenced by several factors such as:
individuals characteristics (age, education
level, experiences), socio-economic (job),
mass-media exposure and transportation
ownership. Therefore, the higher
information level mothers possess, the
lesser risk of chronic energy deficiency
they will bear. It corresponds to a research
conducted by Palimbo&Firdaus (2014)
figuring out the significant correlation
between mothers knowledge level and
chronic energy deficiency on pregnant
mothers (p=0.002, coefficient
correlation=0.879, CI 95%=0.800-1.000).
This research figured out the
significant correlation between pre-
pregnancy nutritional status and chronic
energy deficiency. It was due to the fact
that the chronic energy deficiency was a
result of environment and human factors
supported by nutrition intake factors. The
findings of this research are supported by
Abrahams research (2015) investigating
on the correlation between nutritional
status and chronic energy deficiency. This
research figured out the significant
correlation between pre-pregnancy
nutritional status and chronic energy
deficiency during pregnancy (OR=2.982,
CI=1.892-4.835).
The analytical analysis in this
research showed that there was no
significant correlation between education
level and chronic energy deficiency on
pregnant mothers. Mothers with high
education level yet having low incomes
resulted to the insufficient nutrition
whether in terms of quantity or quality,
and vice versa. The chronic energy
deficiency also occurred on those with
high education level due to their lack of
information on proper nutrition. This
research, however, is not in accordance
with a research by Mirsanjari, et.al. (2012)
figuring out the significant correlation
between education level and mothers
knowledge on nutrition (adjusted b=2.893,
CI 95%=2.18-3.47, p=0.001).
According to Sawaswatis research
(2009), mostly mothers with chronic
energy deficiency are those with low
education level in which mothers with
elementary education level or less are
more likely to have higher risk of chronic
energy deficiency compared to those with
elementary education level or higher
(38.3%). An individuals education
background is one of important factors
influencing the nutritional status due to the
fact that most of nutritional deficiency is a
result of insufficient knowledge on health
and nutrition.In this research, job variable
obtained p value=0.399 indicating that
there was no significant difference
between job and chronic energy deficiency.
It did not show any distinct probabilities of
chronic energy deficiency on employed
mothers and unemployed mothers because
of their food consumption during the
pregnancy.
This researchis not in accordance
with a research by Miharawati (2014)
figuring out the significant correlation
between employed mothers and chronic
energy deficiency (with percentage of
mother with CED 52.9%). It is due to their
predisposition on having less time to
prepare the nutritional foods which leads
to their eating pattern as well as food
consumption.Based on a research by
Fouda, et.al. (2012), most of mothers are
unemployed whose average incomes are
low. These highly influence their
nutritional status during pregnancy.
This research figured out that there
was no significant correlation between
average incomes and chronic energy
deficiency (percentage of mother with
CED 29.9%). It corresponds to a research
by Haslinda (2014) figuring out that there
is no significant correlation between 1. Mothers knowledge influenced the
average household incomes and chronic chronic energy deficiency on pregnant
energy deficiency (p=0.384, CI=2.66 (0.5- mothers at Community Health Center
14.2)). of Northern Kediri.
Based on bivariate analysis, it was 2. Mothers nutritional status
found that there was no significant influencedchronic energy deficiency
correlation between parity and chronic on pregnant mothers at Community
energy deficiency. Parity is one of risk Health Center of Northern Kediri.
factors occurred in the chronic energy 3. Socio-economic factors, mothers age
deficiency on pregnant mothers. The during pregnancy, parity, and
findings of this research are in a line with a antenatal care did not influence the
research by Albugis (2008) conveying that chronic energy deficiency on pregnant
there is no significant correlation between mothers at Community Health Center
parity and chronic energy deficiency of Northern Kediri.
(p=0.113). Further, however, it is 4. Mothers with chronic energy
explained that mothers with parity over 4 deficiency at Community Health
children have higher risk on chronic Center of Northern Kediri were 17
energy deficiency compared to those with people.
parity less than 4 children.
Mothers visit on antenatal care in
this research did not indicate the
significant correlation to chronic energy
deficiency. In a research by Fouda, et.al.
(2012), more than 50% mothers indicated
basic knowledge about food sources
containing varied vitamin types and
minerals, which therefore contributes to
their less visit on routine antenatal care.
The discussion above conveys that
the CED prevention efforts must
necessarily be made prior to pregnancy,
for instance: the nutrition improvement on
adolescents should be carried out before
marriage. Mulyaningrums research (2009)
reveals that mothers aged under 20 years
old are more likely to have higher risk on
chronic energy deficiency. In fact, they
could significantly increase the risk of
chronic energy deficiency. Furthermore, it
is explained that early pregnancy on
under-age mothers could lead to the
competition between fetus and mother
under the growth.

CONCLUSION
Based on the findings and
discussion in this research, it can be
concluded that: