Research Paper Future of Food: Journal on Food, Agriculture and Society

8 (3) October 2020

Children’s dietary habit in food insecure area Madura

island Indonesia
RIAN DIANA1*, ANNIS CATUR ADI 1, DINI RIRIN ANDRIAS 1
1Department of Nutrition, Faculty of Public Health, Universitas Airlangga

* Corresponding author: [email protected]

Data of the article

First received : 13 January 2020 | Last revision received : 12 July 2020

Accepted : 05 October 2020 | Published online : 18 October 2020
DOI:10.17170/kobra-202007201469

Keywords
Objectives: Food insecurity and malnutrition are still a public health issue, particularly in
Dietary habit, food habit, developing countries. Household food security is a determinant factor of dietary quantity
food-insecure area, food and quality. This study aims to analyse the correlation between household food security and
security children’s dietary habit in food-insecure areas.
Methods: This cross-sectional study was conducted in Bangkalan District, Madura Island,
Indonesia and included 89 households with children under five. The Food Insecurity Ex-
perience Scale (FIES) was administered to assess household food security status. The chil-
dren’s dietary habit was assessed using the Food Frequency Questionnaire (FFQ). Spear-
man’s rank correlation was applied to analyse the correlation between children’s dietary
habits and household food security status in Madura Island, Indonesia.
Results: A high proportion of food-insecure households (71.9%) was found in this study.
Children under five have low consumption of vegetables and fruits. There was no signifi-
cant correlation between household food security status with children’s dietary habits of
staple food, and protein sources of food. There was a significant correlation between house-
hold food security status with children’s dietary habits of vegetables and fruits.
Conclusion: Parents can provide food sources of carbohydrates and protein regardless of
their household food security status. Nonetheless, parents need to encourage the consump-
tion of vegetables and fruits for their children. Food insecure households can provide veg-
etables and fruits that were highly available and accessible such as water spinach, banana,
and orange.

1. Introduction
(McDonald et al., 2015). Food insecure households,
Food insecurity and malnutrition are still a public particularly poor people, tend to have low dietary di-
health issue, particularly in developing countries such versity (McDonald et al., 2015) and have lower con-
as Indonesia. Madura Island is one of the food inse- sumption of healthy food (Araújo et al., 2018). Food
cure areas in Indonesia with a high poverty level and availability is an important factor that influences di-
a high prevalence of stunting (Statistic Bureau of East etary intake (Santiago-Torres et al., 2014). Low food
Java, 2018). Household food security is a determinant availability in the food-insecure area can influence
factor of dietary quantity and quality (Agbadi et al., people’s food habits. This habit is often hard to change
2017; Kim & Oh, 2015). Studies in developing coun- until adulthood.
tries revealed that there was a correlation between a
high poverty level and low access to nutritious food Several studies have explored the correlation between

1
 Future of Food: Journal on Food, Agriculture
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household food security and children’s nutritional sta- food; (3) Consumed a diet based on only a few kinds
tus (Kandeepan et al., 2016; Mulu & Mengistie, 2017; of foods because of lack of money or other resources
Unisa et al., 2016). Nonetheless, a few studies discuss to get food; (4) Did not eat breakfast, lunch or din-
the correlation of household food security with chil- ner [or skipped a meal] because there was not enough
dren’s food habits (Agbadi et al., 2017; Tomayko et al., money or other resources to get food; (5) Ate less than
2017), particularly in food-insecure areas. Therefore, they thought they should because of lack of money
this study aims to analyse the correlation between or other resources to get food; (6) Household ran out
household food security and children’s dietary habit of food because of lack of money or other resourc-
in food-insecure areas. The research hypothesis was es to get food; (7) Felt hungry but didn’t eat because
that children in food-secure households would have there was not enough money or other resources for
healthier eating habits than food insecure ones. Un- food; and (8) Went without eating for a whole day. The
derstanding these food habits enable people to help children’s dietary habit was assessed using the Food
children in food-insecure families to improve their Frequency Questionnaire (FFQ). The questionnaire
diets and reduce the risk of malnutrition. surveyed food consumed during the previous 30 days.
The FFQ consisted of 19 food items, categorised into
2. Materials and Methods five groups. Cereals and grains (4 items), fish, poultry,
and eggs (3 items), legumes (2 items), vegetables (4
2.1. Study Participants items), and fruits (4 items). There were seven options
of food frequency consumption: more than once/day,
This cross-sectional study was conducted in Bang- once/day, 4-6 times/week, 3 times/week, once-twice/
kalan District, Madura Island, Indonesia, in Septem- week, once in 2 weeks, and never. The food consump-
ber-November 2018. The population was households tion then reclassified into three groups: never, seldom
with children under five years old in Bangkalan Dis- (>1-2/weeks), and often (>3-7/weeks).
trict. The sample size was determined by a formula to
estimate the proportion in the population with abso- 2.3. Statistical Analysis
lute precision (Charan & Biswas, 2013). According to
a previous study, moderate food-insecure households A descriptive analysis was presented in proportion,
that received subsidised rice was 6% (Adi, Diana, & median, and interquartile range. Food security status
Andrias, 2018), confidence interval 95%, and absolute categorised into food secure when the household did
precision 0.05. A total of 89 samples were included not experience one of the eight items of FIES, mild
in this study. The sampling procedure was conduct- food insecurity (experience condition 1-3), moderate
ed in two stages. The first stage was the selection of food security (experience condition 4-6), and severe
sub-districts and villages with the inclusion criteria of food insecurity (experience condition 7-8) (Ballard
food-insecure areas. The second stage was the selec- et al., 2013). Spearman’s rank correlation was applied
tion of the household who have children under five. A to analyse the correlation between children’s dietary
total of 89 samples were selected using simple random habits and household food security status.
sampling. The ethical clearance was approved by the
ethical committee of Faculty of Public Health, Univer- 3. Results
sitas Airlangga, Indonesia (No 530/EA/KEPK/2018).
In general, the age of the parents was categorised as a
2.2. Measurements productive age. Most of the fathers were 31-50 years
old. Meanwhile, mothers were 20-40 years old. Fa-
A structured questionnaire obtained household and ther’s age was slightly older than the mothers. On the
children characteristics. The Food Insecurity Expe- other hand, the parents had similar education levels.
rience Scale (FIES) was administered to assess the Most of them had a low education level (≤9 years).
household food security status (Ballard et al., 2013). More than 70% of parents graduated from elementary
There were eight FIES questions, (1) Felt anxiety about school, and less than 15% graduated from junior high
having enough food at any time during the previous school. The low education level was closely related to
12 months; (2) Not able to eat healthy and nutritious the prosperity of the people. Children’s age and sex
food because of lack of money or other resources to get were almost equally distributed in all categories. Most

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of the children were 2-4 years old, which consist of also common for men. Meanwhile, a housewife occu-
38.2% 24-36 months and 37.1% 37-48 months. Mean- pation (68.5%) was dominant among Madurese wom-
while, there were higher female children (55.1%) in- en. Based on the number of household members,
volved than male children (44.9%) (Table 1). most of the families were classified as a small and me-
dium-sized family (Table 1). The median household
The most popular job among men was a seller (31%) income was 420,000 IDR/cap/month or equal to 30
and for women (21.3%). Other occupations such as USD/cap/month (1 USD = 14,000 IDR).
labourers (29.8%) and service providers (23.8%) were Household food security status was determined by the

Table 1. Household characteristics

Characteristics n=89 %
Father’s age
20-30 years 21 25.0
31-40 years 33 39.3
41-50 years 24 28.6
>50 years 6 7.1
Mother’s age
20-30 years 42 47.2
31-40 years 36 40.4
41-50 years 11 12.4
Father’s education
Not enrolled in school 1 1.2
Elementary school 64 76.1
Junior high school 12 14.3
High school 4 4.8
Undergraduate school 3 3.6
Mother’s education
Not enrolled in school 6 6.7
Elementary school 68 76.4
Junior high school 13 14.6
High school 2 2.2
Father’s occupation
Jobless 2 2.4
Seller 26 31.0
Employee 11 13.1
Laborer 25 29.8
Service provider 20 23.8
Mother’s occupation
Housewives 61 68.5
Seller 19 21.3
Employee 3 3.4
Laborer 4 4.5
Service provider 2 2.2
Family size
Small(≤4 people) 35 39.3
Medium (5-6 people) 32 36.0
Big (>6 people) 22 24.7

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Table 1 Cont.

Characteristics n=89 %
Food secure 25 28.1
Mild food insecurity 40 44.9
Moderate food insecurity 20 22.5
Severe food insecurity 4 4.5
Children’s age
24-36 months 34 38.2
37-48 months 33 37.1
49-60 months 22 24.7
Sex
Male 40 44.9
Female 49 55.1
Household income (IDR/cap/month)
Median 420,000
Interquartile range (IQR) 386,429

food insecurity experience scale (FIES) survey mod- food-secure status (Table 3). More than 60% of chil-
ule. About 28.1% of households were food secure. dren often consumed eggs (>3-7 times per week). Fish
Most of the households were food insecure (71.9%) and chicken were also liked and consumed by chil-
at various levels, that consisted of 44.9% mildly food dren; however, their consumption was not as frequent
insecure, 22.5% moderately food insecure, and 4.5% as eggs. Children often consumed fish in mild and
severely food insecure. severe food-insecure households. Meanwhile, chick-
en was seldom consumed by children, particularly
Children’s dietary habits were collected through the among children from severe food-insecure house-
FFQ questionnaire. These food habits were divided holds. There was no significant correlation between
into consumption patterns of food sources of carbo- food sources of protein and household food security
hydrates, protein, vitamins, and minerals. Almost all status. Tempeh and tofu are soy-based foods that are
children consume rice and rice corn, regardless of very popular in Indonesia and often consumed by the
their household food security status (Table 2). Rice people. Most of the children often consumed tempeh
is an Indonesian staple food; therefore, most of them and tofu (Table 3).
consume it daily. Rice corn is also a popular staple
food in Madura Island. Many households provid- In general, the consumption of vegetables and fruits
ed and consumed rice corn more than three times a were relatively low compared to animal and plant
week. Another popular staple food is noodles. More protein. Food sources of vitamin and mineral from
than half of children who had food secure status con- vegetables that were often consumed by children were
sumed noodles 1-2 times/week. Another wheat-based spinach and carrot (Table 4). Water spinach was sel-
food source of carbohydrate was bread. Nevertheless, dom or never consumed by most of the children in the
bread was not consumed as a staple food in Madura food-secure household. Meanwhile, there was a high-
Island but as a snack. Therefore, a lot of children sel-
er proportion of children who consumed water spin-
dom or never consumed it. The present study found ach in food-insecure households (p=0.032; r=0.227).
no significant correlation between food sources of On the other hand, fruits were seldom consumed by
carbohydrate consumption with food security status children. Fruits that were highly available (non-sea-
(p>0.05). sonal) with low prices were consumed by children
regardless of their household food security status.
Egg and fish were popular food sources of animal On the contrary, fruits (watermelon and apple) with
protein for children under five in all households with higher prices were more rarely consumed by children

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Table 2. Percentage of children who consume food sources of carbohydrate by food security status

Food sources of carbohydrate Food secure Mild food Moderate Severe food p-value
insecurity food insecurity
insecurity
Rice
Never 1 (4) 0 (0) 0 (0) 0 (0) 0.886
Seldom (>1-2x/weeks) 1 (4) 1 (2.5) 1 (5) 1 (25)
Often (>3-7x/weeks) 23 (92) 39 (97.5) 19 (95) 3 (75)
Rice corn
Never 7 (28) 8 (20) 4 (20) 1 (25) 0.728
Seldom (>1-2x/weeks) 2 (8) 5 (12,5) 3 (15) 0 (0)
Often (>3-7x/weeks) 16 (64) 27 (67.5) 13 (65) 3 (75)
Noodles
Never 1 (4) 2 (5) 2 (10) 0 (0) 0.571
Seldom (>1-2x/weeks) 15 (60) 27 (67.5) 13 (65) 2 (50)
Often (>3-7x/weeks) 9 (36) 11 (27.5) 5 (25) 2 (50)
Bread
Never 6 (24) 20 (50) 8 (40) 3 (75) 0.087
Seldom (>1-2x/weeks) 14 (56) 17 (42.5) 9 (45) 1 (25)
Often (>3-7x/weeks) 5 (20) 3 (7.5) 3 (15) 0 (0)

Table 3. Percentage of children who consume food sources of protein by food security status

Food sources of protein Food secure Mild food Moderate Severe food p-value
insecurity food insecurity
insecurity
Eggs
Never 2 (8) 2 (5) 1 (5) 0 (0) 0.946
Seldom (>1-2x/weeks) 7 (28) 6 (15) 7 (35) 1 (25)
Often (>3-7x/weeks) 16 (64) 32 (80) 12 (60) 3 (75)
Chicken meat
Never 2 (8) 4 (10) 6 (30) 1 (25) 0.076
Seldom (>1-2x/weeks) 17 (68) 23 (57.5) 11 (55) 3 (75)
Often (>3-7x/weeks) 6 (24) 13 (32.5) 3 (15) 0 (0)
Fish
Never 4 (16) 1 (2.5) 1 (5) 0 (0) 0.254
Seldom (>1-2x/weeks) 11 (44) 14 (35) 10 (50) 1 (25)
Often (>3-7x/weeks) 10 (40) 25 (62.5) 9 (45) 3 (75)
Tempeh
Never 0 (0) 1 (2.5) 1 (5) 0 (0) 0.280
Seldom (>1-2x/weeks) 6 (24) 1 (2.5) 1 (5) 1 (25)
Often (>3-7x/weeks) 19 (76) 38 (95) 18 (90) 3 (75)
Tofu
Never 2 (8) 2 (5) 0 (0) 0 (0) 0.266
Seldom (>1-2x/weeks) 3 (12) 0 (0) 0 (0) 2 (50)
Often (>3-7x/weeks) 20 (80) 38 (95) 20 (100) 2 (50)

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in food-insecure households than food-secure house- 4. Discussion

holds. Spearman correlation showed that there was a
significant correlation between watermelon (p=0.045; A high prevalence of food-insecure households
r=-0.266) and apple (p=0.012; r=-0.213) consumption (71.9%) and low education levels were found in this
with household food security status. This study re- study. Madura Island, particularly Bangkalan District,
vealed that a lower proportion of children in food-in- is a food-insecure area. Therefore, the prevalence of
secure households consumed watermelon and apples. food-insecure households was high. Low food availa-
bility, food access, education level, and access to water,

Table 4. Percentage of children who consume food sources of vitamin and mineral by food security status

Food sources of vitamin and mineral Food secure Mild food Moderate Severe food p-value
insecurity food insecurity
insecurity
Water spinach
Never 12 (48) 19 (47.5) 4 (20) 2 (50) 0.032
Seldom (>1-2x/weeks) 12 (48) 16 (40) 10 (50) 1 (25)
Often (>3-7x/weeks) 1 (4) 5 (12.5) 6 (30) 1 (25)
Spinach
Never 5 (20) 9 (22.5) 3 (15) 1 (25) 0.292
Seldom (>1-2x/weeks) 14 (56) 16 (40) 9 (45) 1 (25)
Often (>3-7x/weeks) 6 (24) 15 (37.5) 8 (40) 2 (50)
Cabbage
Never 14 (56) 26 (65) 11 (55) 2 (50) 0.907
Seldom (>1-2x/weeks) 7 (28) 12 (30) 7 (35) 2 (50)
Often (>3-7x/weeks) 4 (16) 2 (5) 2 (10) 0 (0)
Carrot
Never 5 (20) 3 (7.5) 2 (10) 0 (0) 0.377
Seldom (>1-2x/weeks) 12 (48) 20 (50) 11 (55) 2 (50)
Often (>3-7x/weeks) 8 (32) 17 (42.5) 7 (35) 2 (50)
Orange
Never 6 (24) 7 (17.5) 5 (25) 4 (100) 0.175
Seldom (>1-2x/weeks) 15 (60) 24 (60) 13 (65) 0 (0)
Often (>3-7x/weeks) 4 (16) 9 (22.5) 2 (10) 0 (0)
Banana
Never 16 (64) 19 (47.5) 13 (65) 3 (75) 0.310
Seldom (>1-2x/weeks) 8 (32) 15 (37.5) 7 (35) 0 (0)
Often (>3-7x/weeks) 1 (4) 6 (15) 0 (0) 1 (25)
Watermelon
Never 10 (40) 20 (50) 14 (70) 3 (75) 0.045
Seldom (>1-2x/weeks) 13 (52) 16 (40) 6 (30) 0 (0)
Often (>3-7x/weeks) 2 (8) 4 (10) 0 (0) 1 (25)
Apple
Never 14 (56) 37 (92.5) 16 (80) 4 (100) 0.012
Seldom (>1-2x/weeks) 11 (44) 3 (7.5) 4 (20) 0 (0)
Often (>3-7x/weeks) 0 (0) 0 (0) 0 (0) 0 (0)

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especially in the dry season, cause this region to be- Health, 2014).
come a food-insecure area (East Java Province Food
Security Bureau, 2016). A study by Mulu and Mengis- This study revealed that the consumption of animal-
tie (2017) in Western Ethiopia also found a high prev- and plant-based protein were not correlated with
alence of food-insecure households with children household food security status. High availability and
under five. Smith et al. (2017) found that low levels many options of food sources of protein with afforda-
of education, weak social network, less social capital, ble prices enabled the households to choose and pro-
low household income, and being unemployed were vide any kind of protein food source for their children.
determinant factors for food insecurity. Low consumption of vegetables and fruits were found
in this study. The result of this study is in line with
Spearman’s analysis showed that children’s food con- the study from de Araujo et al. (2018) which revealed
sumption habits of staple foods and animal and plant a negative effect of food insecurity with healthy food
protein foods were not correlated with household such as fruit and vegetable consumption. Food sourc-
food security status. Rice was a staple food and the es of vitamin and mineral from vegetables that are
highest source of protein intake among Indonesian often consumed by children were spinach and carrot
people (Statistic Bureau, 2016). Rice contains a high (regardless of their household food security status).
amount of carbohydrate and enough protein (approx- Water spinach was more prevalent in food-insecure
imately 77.1 g carbohydrate and 8.4 g protein per 100 households than food-secure ones. There was a high-
g edible portion) (Ministry of Health, 2018). A nation- er proportion of children who consumed water spin-
al socio-economic survey in 2016, showed that the ach in food-insecure households (p=0.032; r=0.227).
most significant proportion of protein intake was rice Water spinach contains 17 mg vitamin C, 5542 mcg
(Statistic Bureau, 2016). Furthermore, rice also has a carotene, and 2.3 mg of iron. Meanwhile, spinach
good quality of protein because it has a higher amino contains 41 mg vitamin C, 2293 mcg carotene, and
acid score (AAS=66%) than other staple foods (wheat 3.5 mg of iron (Ministry of Health, 2018). Although
AAS=38%; corn AAS=41%; sorghum AAS=40%) (Ju- water spinach has a lower content of vitamin C and
liano, 1999). Rice corn, quite popular as a staple food iron than spinach, due to the high availability and low
in Madura Island, has high fibre content (Ministry of price of water spinach, it can be a good alternative for
Health, 2018). On the other hand, food-based wheat vitamins and minerals for children in food-insecure
flour (noodles and bread) can be a good source of iron households.
and folic acid because of mandatory fortification of
wheat flour in Indonesian (Minister of Health, 2003; Fruits that were often consumed by children re-
Minister of Industry and Trade, 2001). gardless of household food security status were ba-
nana and oranges. A lower proportion of children in
Animal proteins that are often consumed by children food-insecure households consumed watermelon and
were eggs and fish. Meanwhile, plant proteins con- apples. Banana and orange have an adequate amount
sumed daily were tempeh and tofu. These sources of vitamins. Banana contains 9 mg vitamin C and 37
of protein are highly available and accessible by the mcg carotenes, and orange has 49 mg vitamin C and
household in this food insecure area. Eggs and fish 190 mcg carotenes. Meanwhile, watermelon contains
are loaded with high-quality protein, whereas tempeh 6 mg vitamin C, 590 mcg carotenes, and apples have
and tofu (soybean products) contain a good source of 5 mg vitamin C and 90 mcg carotenes (Ministry of
plant protein besides rice and peanuts (Brody, 1999). Health, 2018). Therefore orange and banana can be
These soy-based foods have an essential role in pro- a healthy choice of fruits for the children in food-in-
viding protein for Indonesians (Statistic Bureau, secure households. Non-seasonal fruit such as papa-
2016). Based on the national socio-economic survey ya and seasonal fruits such as jack fruit, snack fruit,
in 2016, the primary source of protein of Indonesian sugar apple or sweetsop, rose apple, mango, and other
people was rice, fish, tempeh, and tofu (Statistic Bu- inexpensive fruits which are highly available can be an
reau, 2016). Indonesian balance nutrition guidelines alternative to orange and banana. Knowledge about
suggested that children under five should consume the nutrient content in various fruits can be an ad-
3-4 portions of animal protein daily (Ministry of vantage for the household so they can provide healthy

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and cheap fruits for the children. 886/UN/2018.

The present study revealed no significant correlation 7. Conflict of interest

between children’s food habits (food sources of carbo-
hydrate and protein) with household food insecurity. The authors declare no conflict of interest. In addi-
Meanwhile, a higher proportion of water spinach con- tion, the funder had no role in the design of the study;
sumption and lower consumption of watermelon and in the collection, analyses, or interpretation of data; in
apples was significantly correlated with household the writing of the manuscript, and in the decision to
food insecurity. Contrary to the research hypothesis, publish the results.
it seems that young children are protected from hun-
ger and have a good and healthy food habit even in 8. References
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