Factors Influencing Toddler Nutritional and Developmental Outcomes at the Bangkalan Health Center, Madura Island, Indonesia: A PRECEDE–PROCEED Model Approach
DOI:
https://doi.org/10.31674/mjn.2026.v17i03.015Abstract
Background: The nutritional and developmental status of toddlers in Indonesia remains a significant concern, requiring further analysis of influencing factors to enable more comprehensive interventions. Objectives: This study aimed to analyze the factors that influence the nutritional and developmental status of toddlers using the PRECEDE–PROCEED Model. Methods: This is a cross-sectional study that involved 472 mothers who had children aged 12-60 months, selected by cluster sampling through 88 Integrated Service Posts in the Bangkalan Health Center area. The dependent variables in this study were the nutritional status and developmental status of toddlers aged 12-60 months. While the independent variables in this study were predisposing factors, enabling factor, and reinforcing factor. Data collection was conducted using questionnaires, the child development pre-screening questionnaire, and the ‘Maternal and Child Health’ handbook. Logistic regression analysis was performed with a significance level of 0.05. Results: The results showed that the factors influencing toddlers’ nutritional status included predisposing factors such as maternal knowledge, maternal education level, and maternal participation in monthly Integrated Service post activities. Reinforcing factors such as husband's support, families, healthcare, and exposure to health information also affect toddler nutrition. In terms of toddler development, there are reinforcing factors in the form of husband and family support for mothers in providing developmental stimulation to their toddlers. Conclusion: The critical role of husband and family support in shaping the nutritional and developmental status of toddlers aged 12-60 months. Therefore, educational interventions should target not only mothers but also their families to optimize child health and development.
Keywords:
Nutritional Status, Precede-Proceed Model, Stunting, Toddler DevelopmentDownloads
References
Addae, H. Y., Apprey, C., & Kwarteng, A. (2024). Gut microbiome-targeted nutrition interventions and growth among children in low-and middle-income countries: A systematic review and meta-analysis. Current Developments in Nutrition, 8(3), 102085. https://doi.org/10.1016/j.cdnut.2024.102085
Alvarado-Domenech, L. I., Rivera-Amill, V., Appleton, A. A., Rosario-Villafañe, V., Repollet-Carrer, I., Borges-Rodríguez, M., Pérez-Rodríguez, N. M., Olivieri-Ramos, O., González, M., González-Montalvo, C., Muñiz-Forestier, W., Vargas-Lasalle, L., Pérez-Padilla, J., Paz-Bailey, G., & Rodríguez-Rabassa, M. (2022). Early childhood neurodevelopmental outcomes in children with prenatal zika virus exposure: A cohort study in Puerto Rico. The Journal of Pediatrics, 247, 38-45. https://doi.org/10.1016/j.jpeds.2022.05.016
Au, L. E., Arnold, C. D., Ritchie, L. D., & Frongillo, E. A. (2023). The infant diet quality index predicts dietary and adiposity outcomes in US children 2 to 4 years old. The Journal of Nutrition, 153(3), 741-748. https://doi.org/10.1016/j.tjnut.2023.01.037
Ballarotto, G., Murray, L., Bozicevic, L., Marzilli, E., Cerniglia, L., Cimino, S., & Tambelli, R. (2023). Parental sensitivity to toddler’s need for autonomy: An empirical study on mother-toddler and father-toddler interactions during feeding and play. Infant Behavior and Development, 73, 101892. https://doi.org/10.1016/j.infbeh.2023.101892
Cantoral, A., Téllez-Rojo, M. M., Malin, A. J., Schnaas, L., Osorio-Valencia, E., Mercado, A., Martínez-Mier, E. Á., Wright, R. O., & Till, C. (2021). Dietary fluoride intake during pregnancy and neurodevelopment in toddlers: A prospective study in the progress cohort. Neurotoxicology, 87, 86–93. https://doi.org/10.1016/j.neuro.2021.08.015
Constantino, J. L., Romeiro, F. D., Diaz, T., Moran, A. C., & Boschi-Pinto, C. (2020). Data collection tools for maternal and child health in humanitarian emergencies: An updated systematic review. Disaster Medicine and Public Health Preparedness, 14(5), 601-619. https://doi.org/10.1017/dmp.2019.103
Coyle-Asbil, H. J., Breau, B., Ma, D. W., Haines, J., Buchholz, A. C., Vallis, L. A., & Study, G. F. H. (2024). Compliance with the 24-hour movement behavior guidelines and the impact of sleep methods among toddler, preschool, and school-aged children enrolled in the Guelph Family Health Study. Journal of Science and Medicine in Sport, 27(9), 631-639. https://doi.org/10.1016/j.jsams.2024.05.014
Deoni, S. C. L., D’Sa, V., Volpe, A., Beauchemin, J., Croff, J. M., Elliott, A. J., Pini, N., Lucchini, M., & Fifer, W. P. (2022). Remote and at-home data collection: Considerations for the NIH Healthy Brain and Cognitive Development (HBCD) study. Developmental Cognitive Neuroscience, 54, 101059. https://doi.org/10.1016/j.dcn.2022.101059
Dewey, K. G., Pannucci, T., Casavale, K. O., Davis, T. A., Donovan, S. M., Kleinman, R. E., Taveras, E. M., Bailey, R. L., Novotny, R., Schneeman, B. O., Stang, J., de Jesus, J., & Stoody, E. E. (2021). Development of food pattern recommendations for infants and toddlers 6–24 months of age to support the dietary guidelines for Americans, 2020–2025. The Journal of Nutrition, 151(10), 3113–3124. https://doi.org/10.1093/jn/nxab201
Hasken, J. M., Adair, L. S., Martin, S. L., Thompson, A. L., Marais, A.-S., de Vries, M. M., Kalberg, W. O., Buckley, D., Eugene Hoyme, H., Seedat, S., Parry, C. D. H., & May, P. A. (2022). The influence of maternal weight and alcohol exposure on infant physical characteristics and neurodevelopmental outcomes. Current Research in Toxicology, 3, 100076. https://doi.org/10.1016/j.crtox.2022.100076
Hocking, J., & Carlin, J. B. (1999). Design of cross-sectional surveys using cluster sampling: An overview with Australian case-studies. Australian and New Zealand Journal of Public Health, 23(5), 546-551. https://doi.org/10.1111/j.1467-842X.1999.tb01317.x
Hossain, S. J., Rahman, S. M., Fisher, J., Rahman, A., Tofail, F., & Hamadani, J. D. (2024). Effect of a parenting and nutrition education programme on development and growth of children using a social safety-net platform in urban Bangladesh: a cluster randomized controlled trial. The Lancet Regional Health-Southeast Asia, 25, 100388. https://doi.org/10.1016/j.lansea.2024.100388
Johnson, S. L., Moding, K. J., Flesher, A., Boenig, R., & Campain, J. (2024). I'll never give up: A qualitative study of caregivers’ perceptions and decisional processes when feeding infants and toddlers novel and disliked foods. Journal of Nutrition Education and Behavior, 56(5), 287-299. https://doi.org/10.1016/j.jneb.2024.01.007
Johnson, S. L., Moding, K. J., Grimm, K. J., Flesher, A. E., Bakke, A. J., & Hayes, J. E. (2021). Infant and toddler responses to bitter-tasting novel vegetables: Findings from the good tastes study. The Journal of Nutrition, 151(10), 3240-3252. https://doi.org/10.1093/jn/nxab198
Joshi, R. O., Chellappan, S., & Kukshal, P. (2020). Exploring the role of maternal nutritional epigenetics in congenital heart disease. Current Developments in Nutrition, 4(11), nzaa166. https://doi.org/10.1093/cdn/nzaa166
Kang, W., Baer, N., Ramsan, M., Vermeylen, F., Stoltzfus, R. J., & O’Brien, K. O. (2021). Iron supplementation in anemic Zanzibari toddlers is associated with greater loss in erythrocyte iron isotope enrichment. The American Journal of Clinical Nutrition, 114(1), 330-337. https://doi.org/10.1093/ajcn/nqab044
Krombholz, H. (2023). Motor development of first born compared to later born children in the first two years of life–A replication. Heliyon, 9(10), e20372. https://doi.org/10.1016/j.heliyon.2023.e20372
Landry, M. J., Ruiz, L. D., Gibbs, K., Radtke, M. D., Lerman, J., & Vargas, A. J. (2022). Perspective: early-life nutrition research supported by the US national institutes of Health from 2018 to 2020. Advances in Nutrition, 13(5), 1395-1401. https://doi.org/10.1093/advances/nmac044
Maidoumi, S., Ouaziz, C. R., Ouisselsat, M., El Maouaki, A., Loukid, M., Lekouch, N., Pineau, A., Ahami, A., & Sedki, A. (2022). Iron deficiency and cognitive impairment in children with low blood lead levels. Toxicology Reports, 9, 1681–1690. https://doi.org/10.1016/j.toxrep.2022.08.008
Mak, R. H., Iyengar, A., & Wang, A. Y.-M. (2023). Nutrition management for chronic kidney disease: Differences and special needs for children and adults. Seminars in Nephrology, 43(4), 151441. https://doi.org/10.1016/j.semnephrol.2023.151441
Matsubara, K., Hattori, T., & Narumi, S. (2022). Achievement of developmental milestones recorded in real time: A mobile app-based study. The Journal of Pediatrics, 245, 201-207. https://doi.org/10.1016/j.jpeds.2022.02.018
Mihrshahi, S., Ara, G., Khanam, M., Rasheed, S., Agho, K. E., Kabir, A. I., ... & Dibley, M. J. (2022). The Shishu Pushti Trial–extended peer counseling for improving feeding practices and reducing undernutrition in children aged 0-48 months in urban Bangladesh: Protocol for a cluster-randomized controlled trial. JMIR Research Protocols, 11(2), e31475. https://doi.org/10.2196/31475
Mills-Koonce, W. R., Willoughby, M. T., Short, S. J., & Propper, C. B. (2022). The brain and early experience study: Protocol for a prospective observational study. JMIR Research Protocols, 11(6), e34854. https://doi.org/10.2196/34854
Nasution, Z., Nurhayati, I., & Mahdiyah. (2023). The effectiveness of counseling and mung bean (Vigna radiata L) premix cookies as complementary food to prevent stunting. Current Nutrition & Food Science, 19(3), 317-323. https://doi.org/10.2174/1573401318666220628102359
Pancheva, R., Chamova, R., Marinov, D., Toneva, A., Dzhogova, M., Eyubova, S., & Usheva, N. (2024). Therapeutic diets and supplementation: exploring their impact on autism spectrum disorders in childhood–A narrative review of recent clinical trials. Research in Autism Spectrum Disorders, 112, 102352. https://doi.org/10.1016/j.rasd.2024.102352
Posmontier, B., Horowitz, J. A., Geller, P. A., Elgohail, M., McDonough, M., Alvares, K., ... & Ma, T. (2024). Applying the PRECEDE-PROCEED model to develop MommaConnect: a digital healthcare platform for addressing postpartum depression and improving infant well-being. Exploration of Neuroscience, 3(4), 309. https://doi.org/10.37349/en.2024.00052
Ramphal, B., Whalen, D. J., Kenley, J. K., Yu, Q., Smyser, C. D., Rogers, C. E., & Sylvester, C. M. (2020). Brain connectivity and socioeconomic status at birth and externalizing symptoms at age 2 years. Developmental Cognitive Neuroscience, 45, 100811. https://doi.org/10.1016/j.dcn.2020.100811
Rivera, E., Hesketh, K. D., Orellana, L., Taylor, R., Carson, V., Nicholson, J. M., Barnett, L. M., Löf, M., Koorts, H., Becker, D., Galland, B., Salmon, J., & Downing, K. L. (2024). Prevalence of toddlers meeting 24-hour movement guidelines and associations with parental perceptions and practices. Journal of Science and Medicine in Sport, 27(4), 250-256. https://doi.org/10.1016/j.jsams.2023.12.008
Schneider, N., Mainardi, F., Budisavljevic, S., Rolands, M., & Deoni, S. (2023). Associations between early life nutrient intakes and brain maturation show developmental dynamics from infancy to toddlerhood: A neuroimaging observation study. The Journal of Nutrition, 153(3), 897-908. https://doi.org/10.1016/j.tjnut.2023.01.017
United Nations Children’s Fund (UNICEF). (2023). UNICEF-WHO-The World Bank: Joint Child Malnutrition Estimates (JME) - Levels and Trends. https://data.unicef.org/resources/jme/?utm_id=JME-2023#archive
Wei, L., Huang, H., Chen, X., Wang, X., Zhang, R., Su, L., Duan, W., Rahman, M., Golam Mostofa, M., Qamruzzaman, Q., Shen, H., Hu, Z., Wei, Y., Christiani, D. C., & Chen, F. (2022). Umbilical cord serum elementomics of 52 trace elements and early childhood neurodevelopment: Evidence from a prospective birth cohort in rural Bangladesh. Environnent International, 166, 107370. https://doi.org/10.1016/j.envint.2022.107370
Zeru, N. G., Tolessa, D. B., Fufa, J. A., & Fufa, B. G. (2023). Multilevel logistic regression analysis of factors associated with delivery care service utilization among childbearing women in Ethiopia. Frontiers in Reproductive Health, 5, 1045964. https://doi.org/10.3389/frph.2023.1045964
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