Journal of Midwifery Vol 4: No 1 (2019) http://jom.fk.unand.ac.

id

Article

The Effect of Nutrition Counseling on

Complementary Feeding Practice of Mothers Having
Infant Aged 6-12 Month
Yulia Arifin1, Masrul2, Hirowati Ali3
1
Prodi DIII Kebidanan, STIKes Mercubaktijaya, Padang
2
Faculty of Medicine, Universitas Andalas, Padang
3
Faculty of Medicine, Universitas Andalas, Padang

SUBMISSION TRACK A B S T R A C T
Received: March 20, 2019 Nutrition plays an important role in the human life
Final Revision: May 03, 2019
cycle. Nutrition surveillance in the form of Nutritional Status
Available Online: June 28, 2019
Monitoring in 2016 showed that 38.9% of children under five
in Indonesia experienced nutritional problems. One of the
KEYWORDS efforts to improve the health and nutrition status of the baby
is by improving the knowledge and attitude of the mother in
nutrition counseling, feeding practice
giving complimentary food. This study aim is to know the
CORRESPONDENCE effect of nutrition counseling on feeding practice of mothers
having infant aged 6-12 month in pakan rabaa public health
Phone: 085263305274 center area solok selatan district in 2018.
E-mail: [email protected] The design of the study was quasi-experimental with
the design of the control group pretest-posttest. The sample
of this study was 46 experiment group and 46 control group.
Sampling was done by Purposive Sampling technique. Data
analysis using the chi-square test
The results of the study were the absence of
nutritional counseling on knowledge of mothers with p-value
0.361, there was an effect of nutritional counseling on
changes in maternal attitudes with p-value of 0,000 and there
was also the effect of nutritional counseling on
complementary feeding practice with p-value 0.004.
The presence of the influence of nutritional
counseling on attitudes and practices of complementary
feeding. Health workers are expected to be able to spend time
giving counseling about complementary feeding practice
regularly so that the goal of counseling at the public health
center can be achieved.

Attribution-NonCommercial 4.0 International. Some rights reserved

 YULIA ARIFIN/ JURNAL OF MIDWIFERY - VOL.4. NO. 1(2019)

I. INTRODUCTION
Indonesia is a country with complex nutritional problems. Nutritional problems
experienced by infants under five in Indonesia are not only malnutrition but also experience
problems with chronic malnutrition. Chronic malnutrition is longterm malnutrition and causes
stunting in infants and toddlers. The United Nations Children's Fund in 2014 stated that more
than 162 million children under five in the world experienced stunting. Stunting problems are
still a problem that must be dealt with seriously until now.
The 2013 Ministry of Health's Basic Health Research results showed a tendency towards
the short-term prevalence of children under the age of 37.2%. This figure increased compared
to the number of cases based on Riskedas 2007 and 2010 which were 36.8% and 35.6%
respectively. Likewise with underweight or underweight cases, respectively in 2007 amounted
to 18.4%, 2010 amounting to 17.9% and 2013 increased by 19.6% (Ministry of Health, 2013).
In the Province of West Sumatra in 2016, there were 1.6% of children under five with poor
nutrition and 11.4% of children under five with malnutrition (Ministry of Health, 2017).
Malnutrition in infants is not solely caused by food shortages. Some other factors are the
cause of inadequate breastfeeding complementary feeding and too fast weaning. The results of
the study report that the condition of malnutrition in infants and children is caused by the habit
of giving ASI improper complementary foods and ignorance of the mother about the benefits
and methods of giving MP-ASI properly so that it affects the mother's attitude in giving MP-
ASI. In addition, the worsening condition of child nutrition can also occur due to ignorance of
the mother about the procedure for giving MP-ASI right to their children and lack of knowledge
of mothers about how to maintain nutrition and regulate their children's food (Arisman, 2010).
Improving nutrition in the first 1000 days of life can reduce stunted numbers in Indonesia.
WHO recommends that babies get breast milk exclusively at the age of the first 6 months, the
application of early breastfeeding initiation and the provision of complementary food to infants
6 months and continue breastfeeding until 2 years old (Work Plan Nutrition Improvement
Program, 2009). Complementary Food is a food or drink that contains nutrients that are given
to babies or children over the age of 6 months to meet nutritional needs other than breast milk.
The introduction and administration of complimentary food must be done in stages, both in
form and in number, according to the baby's ability infant digestion (Proverawati dan
Kusumawati, 2011).
Efforts to improve the health and nutrition status of infants through improving the
knowledge and attitude of mothers in complementary feeding are an inseparable part of efforts
to improve nutrition as a whole. Efforts to improve this knowledge can be done through
nutritional consultation or counseling. Nutrition Counseling is a series of activities as a two-
way communication process to instill and increase understanding, attitudes, and behavior so
that clients recognize and overcome nutritional problems through food arrangements
(Supariasa, 2013).
Provision of nutritional counseling given to mothers is usually through posyandu
activities. Providing counseling once a month during the implementation of the Posyandu as
an effort to increase the knowledge, attitudes, and behavior of mothers about providing
complementary breastfeeding. Counseling at the fourth table in Posyandu services is still a
serious problem. During this time, what happens in most posyandu is after the baby weighing
is done, then the results are recorded in the KMS. After that, there is no further action for the
mothers, such as how to overcome a decreased or static child's weight. This shows that the
counseling activities at the posyandu have not been optimal enough so that the counseling has
not been able to change the behavior of mothers in providing ASI complementary foods
properly and correctly. Therefore, this study was conducted to look at the effect of counseling
on the knowledge, attitudes, behavior of breastfeeding and nutritional status of infants aged 6-
12 months between the Health Center Working Areas of South Solok Rabaa in 2018.

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II. METHODS
The design of the study was quasi-experimental with the design of the control group pretest-
posttest. The research conducted in Pakan Rabaa Public Health Center Area Solok Selatan
District. The research conducted start in September 2017 - Oktober 2018. The study sample
was all mothers who had babies aged 6-12 months in Pakan Rabaa Public Health Center Area
Solok Selatan District who entered into inclusion and exclusion criteria with the number of
samples in the experimental group 46 respondents and the control group 46 respondents.
Sampling was done by Non-Random Sampling with Purposive Sampling technique, where the
independent variables in this study were nutritional counseling, and the dependent variable was
knowledge, attitudes, and complementary feeding practice. Data analysis using the chi-square
test.

III. RESULT
A. Univariate Analysis

Table 1. Frequency Distribution Based on Characteristics of Mothers Who Have 6-12 Months Babies in
the Intervention and Control Groups
Intervention Groups Control Groups
No Characteristics
f % f %
1 Age
17-25 7 15,5 7 15,2
26-35 30 65,2 29 63
36-45 9 19,6 10 21,8
2 Education
Low 13 28,3 6 13
Medium 26 56,5 24 52,2
High 7 15,2 16 34,8
3 Occupation
Not work 37 80,4 28 60,9
Work 9 19,6 18 39,1
4 Family Income
Poor 22 47,8 17 37
Not poor 24 52,2 29 63

Based on table 1, it can be seen that the age distribution of mothers who have babies in
this study is mostly in the age range of 26-35 years. More than half of the mothers' education
in this study were senior high school and did not work. Less than half of the family income per
capita is still in the poor category.

Table 2. Frequency Distribution Based on Characteristics of Infant of 6-12 Months in the Intervention
and Control Groups
Intervention Groups Control Groups
No Characteristics
f % f %
1 Gender
Boy 21 45,7 26 56,5
Girl 25 54,3 20 43,5
2 Age
6-8 13 27,3 19 41,3
9-12 33 71,7 27 58,7
3 Birth Weight
Normal 43 93,5 41 89,1
BBLR 3 6,5 5 10,9

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Based on table 2, it can be seen that sex distribution in the intervention group more than
half were women and in the control group, more than half were men. More than half the age of
infants in this study were in the age range of 9-12 months in the intervention group. Babies in
this study were small born with low birth weight.

Table 3. Frequency Distribution of Pretest and Posttest Mothers Knowledge in Intervention and Control
Groups
Intervention Groups Control Groups
Knowledge
Pretest Posttest Pretest Posttest
Level
F % f % F % f %
Good 30 65,2 45 97,8 33 71,7 42 91,3
Pretty good 14 30,4 1 2,2 12 26,1 4 8,7
Not Good 2 4,4 0 0 1 2,2 0 0
Total 46 100 46 100 46 100 46 100

Based on table 3, it can be seen that the intervention group at the pretest, more than half
of the respondents had good knowledge about complementary foods. In the intervention group
at the time of the posttest, almost all respondents experienced an increase in knowledge into a
good category.
Table 4. Frequency Distribution of Pretest and Posttest Mothers Attitude in Intervention and Control
Groups
Intervention Groups Control Groups
Attitude Pretest Posttest Pretest Posttest
f % f % f % f %
Positive 19 41,3 35 76,1 20 43,5 22 47,8
Negative 27 58,7 11 23,9 26 56,5 24 52,2
Total 46 100 46 100 46 100 46 100

Based on table 4, it can be seen that the intervention group at pretest more than half of the
respondents had a negative attitude. And when the posttest rise, most of them are a positive
attitude about giving complimentary food.

Table 5. Frequency Distribution of Pretest and Posttest Complementary Feeding Practice in Intervention
and Control Groups
Intervention Groups Control Groups
Complementary Feeding Practice Pretest Posttest Pretest Posttest
f % f % f % f %
Good 22 47,8 41 89,1 26 56,5 28 60,9
Not Good 24 52,2 5 10,9 20 43,5 18 39,1
Total 46 100 46 100 46 100 46 100

Based on table 4, it can be seen that the intervention group at the pretest of more than half
of the respondents complementary feeding practices that were not good and at the posttest the
majority of respondents are good in complementary feeding practice.

B. Bivariate Analysis
Table 6. The Effect of Counseling on the Level of Knowledge of Mothers About Complementary Feeding
Practice
Knowledge Level
Total
Counseling Good Pretty Good Not Goog p-Value
f % f % f % F %
Intervention 45 97,8 1 2,2 0 0 46 100 0,361
Control 42 91,3 4 8,7 0 0 46 100
Total 87 94,6 5 5,4 0 0 92 100

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Based on table 6, it can be seen that the control group had a sufficient level of knowledge
of 8.7% while the intervention group was only 2.2%. The results of the statistical test showed
that there was no effect of counseling on the level of knowledge about complementary feeding
practice after counseling because it had a p-value of <0.05.

Table 7. The Effect of Counseling on Mothers Attitude About Complementary Feeding Practice
Attitude OR
Total
Counseling Positive Negative (95% CI) p-Value
F % f % f %
Intervention 35 76,1 11 23,9 46 100 2,917 0,030
Control 24 52,2 22 47,8 46 100 (1,197-7,109)
Total 59 64,1 33 35,9 92 100

Based on table 7, it can be seen that the results of the statistical test found that there was
an effect of counseling on the attitude of mothers about complementary feeding practice after
the intervention because it had a p-value of <0.05. From the analysis it was also obtained the
OR value = 2.917, meaning that mothers who after being given counseling plus demonstration
had 2 times the chance to have a positive attitude about the implementation of good in
complementary feeding practice

Table 8. The Effect of Counseling on Mothers in Complementary Feeding Practice

Complementary Feeding Practice OR
Total
Counseling Good Not Good (95% CI) p-Value
f % f % f %
Intervention 41 89,1 5 10,9 46 100 5,271 0,004
Control 28 60,9 18 39,1 46 100 (1,753-15,855)
Total 69 75,0 23 25,0 92 100

Based on table 8, it can be seen that the results of statistical tests found that there was an
effect of counseling on the practice of mothers in providing complementary feeding because
they had a p-value of <0.05. From the analysis it was also obtained the OR value = 5.271,
meaning that mothers who were given counseling plus demonstration had the opportunity 5
times to carry out the practice of providing complementary foods well.

IV. DISCUSSION

A. Univariate Analysis
The results showed that the majority of mothers in the intervention group and the control
group were at ages 26-35 years, ie 65.2% in the intervention group and 63% in the control
group. Based on the above results it can be said that the average age of the respondents has
reached the early adult so that the biological and psychological conditions are ready to provide
care and fulfill the needs of the child. Early adult groups allow them to still be able to capture
the information provided and can recall and be responsible for caring for babies and toddlers.
In addition, when the age is sufficient, the level of maturity and strength of a person will be
more mature in thinking and working (Nursalam, 2005).
The results of the study in both groups, more than half of maternal education is high school,
which means that the mother's education level is in the middle category, which is equal to
56.5% in the intervention group and 52.2% in the control group. So that it is easy for mothers
to capture the information provided and will have an open mindset in terms of the information

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provided. Parental education is very influential in child development. Higher education will
make it easier for someone to absorb information, especially about how to care, educate and
maintain the health of their children. Low maternal education allows a mother to lack in
adopting new knowledge, especially regarding matters relating to providing complementary
breastfeeding. Low maternal education is at risk of having under-five malnourished children
compared to mothers with secondary and high education. Maternal education has a positive
effect on children's health (Soetjiningsih and Ranuh, 2015).
The majority of maternal occupational characteristics were not working, ie 80.4% in the
intervention group and 60.9% in the control group. Housewives who do not work outside the
home to make a living automatically have more time to care for and care for children. This
greatly supports them in getting more information. The mothers can get information from
midwives at the posyandu and cadres who have received information on caring for babies and
complementary feeding practice. Working mothers will have limited time to provide care in
terms of preparing good ASI complementary foods so that children tend to experience problems
with their growth and development(Ariefiani R, 2009).
Most subjects do not work so that family income comes only from the husband. Per capita,
family income in both groups is still in the poor category at 47.8% in the intervention group
and 37% in the control group. Because most family heads are farmers and laborers, there are
still many family incomes below the poverty line in South Solok Regency. In 2018 the per
capita poverty line in South Solok Regency is Rp 347,667, - with a total of 11.89 thousand
people (BPS Kab. Solok Selatan, 2018).
A good family economic status is expected to improve parenting for better children so that
the growth of children will be normal. Adequate family income will support the fulfillment of
the baby's basic needs. Children who are raised in high-economic families will be better off to
fulfill their nutritional needs compared to children who are raised in families with moderate or
less economic (Fadhilah, 2009).
The results of this study found that the proportion of infants by sex in the intervention
group was more than half female (54.3%) while in the control group more than half were male
(56.5%). In the intervention and control groups, more than half the age of infants in this study
was in the age range of 9-12 months as many as 71.7% in the intervention group and 56.5% in
the control group. Age is the most important indicator in determining nutritional status that will
be associated with weight, height, and head circumference. Infants aged 9-12 months are the
age at which babies are able to receive food in the form of mushy. As children grow, the amount
of food needed increases.
A small percentage of the babies in this study were born with low birth weight (LBW)
which was 10.9% in the control group and 6.5% in the intervention group. Poor nutrition
generally starts inside the uterus which affects babies born with low birth weight. Children
born with LBW have the potential to have the next life with poor nutritional conditions and
even become malnourished (Devi, 2010).
Based on the results of research that has been done, in the intervention group at the time
of the pretest, more than half of 65.2% of respondents had good knowledge and at the time of
posttests, almost all 97.8% of respondents experienced an increase in knowledge into a good
category. From all the questions about the knowledge of most respondents after getting
nutritional plus demonstration counseling, they can correctly answer questions about the form
of food according to the child's age, frequency of feeding, age-matched portions of
complimentary food and intermittent feeding, many of which were the wrong answer that
question. While in the control group, only 91.3% responded well after being given conventional
nutritional counseling. Therefore, it can be concluded that there is an increase in knowledge of
mothers regarding complementary feeding of breast milk after nutritional counseling.

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The results of this study are in line with Ali J's research in 2017 which states that the
knowledge of mothers under five about nutrition increased from 47.1% to 97.1% after an
intervention in the form of counseling with the demonstration method.
Based on the results of the research that has been done, it can be seen that in the
intervention group at the pretest more than half were 58.7% of respondents had a negative
attitude and at the posters, most of the 76.1% were positive towards providing complementary
feeding after counseling plus demonstrations. Whereas in the control group only 47.8% of
respondents were positive after just being given counseling. Therefore, it can be concluded that
there was an increase in maternal attitudes about complementary breastfeeding after counseling
plus demonstrations.
The results of this study are in line with the 2016 Hariska P et al. Study which stated that
there was an increase in maternal attitudes from 75.6% to 95.1% after intervention in the form
of nutritional counseling.
The increase in attitudes that occur to respondents is caused by the knowledge gained so
as to give rise to understanding and confidence in the needs of those who indeed have to make
efforts to prevent malnutrition in infants through balanced nutrition material given during
nutritional counseling. Changes in attitudes are also inseparable from influencing factors such
as personal experience, culture, other people who are considered important, information
received from various sources, emotions from the mother herself as well as facilities and
support from the family including her husband. Attitude is one of the factors that influence a
person's health behavior. Continuous attitude changes can change a person's behavior where
good feeding behavior can improve children's nutritional status (Azwar, 2003).
Based on the results of the research conducted, in the intervention group before counseling
it was found that more than half of the practices of giving ASI complementary foods were not
as good as 52.2% of respondents while in the control group less than half of the 43.5% of
respondents practiced complementary feeding well. After being given counseling plus
demonstration in the intervention group, almost all respondents (89.1%) found, while in the
control group 60.9% of respondents practiced good ASI supplementary feeding. Therefore it
can be concluded that there was an increase in the practice of providing complementary feeding
after counseling plus demonstrations.
The results of this study are in line with Tamiru D research in 2009 entitled Survey on the
introduction of complementary foods to infants within the first six months and associated
factors in rural communities of Jimma Arjo, which stated that 46.29% of mothers gave
introduction to complementary foods before the age of the baby 6 months, of which 46.29% of
mothers gave cow milk and 13.9% gave yogurt to their babies.
Complimentary food is a food transition from breast milk to family food. The introduction
and administration of complimentary food must be done in stages both in form and in number,
according to the baby's abilities. Early complementary food is food or drinks given to babies
before 6 months of age. The impact of early Complementary Food administration can result in
diarrhea/damage to the digestive system, choking, increasing the risk of allergies, coughing
and obesity (Lewis, 2003)

B. Bivariate Analysis
In this study, it was also found that the intervention group experienced more knowledge
increase as much as 97.8% while the control group was only 91.3%. This research is in line
with Ali J's research in 2017 which states that the knowledge of mothers under five about
nutrition increased from 47.1% to 97.1% after an intervention in the form of counseling with
the demonstration method.
On the results of statistical tests, there was an increase in maternal knowledge about
complementary feeding of breast milk after counseling in both groups. This is because the two

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groups both received counseling, but in the intervention group, a greater increase occurred due
to the demonstration carried out during counseling. Counseling delivered can add sample
information about ASI complementary foods, so that mothers can better understand and be able
to answer questions on the questionnaire properly.
A good mother's knowledge of nutrition will have a positive impact on the child's diet. The
pattern of feeding to children needs to be done precisely because the condition of the child is
different from that of an adult. Children are experiencing the most rapid changes and
developments in their lives, namely the development of maturity of the digestive system,
maturity of organs, brain and soul. At this time parents need to have adequate knowledge and
skills in the selection and method of feeding children.
From the statistical test, this study also found that there was no difference in the level of
knowledge between the control group and the intervention. The results of this study are in line
with the research results of Dewi M in 2016 on the Effect of Nutrition Education on Feeding
Practice Stunting Toddler Mother Aged 6-24 Months, indicating that the knowledge level of
most mothers already has good knowledge, this is indicated by the majority of mothers
obtaining scores > 70% of the total score on the knowledge level questionnaire. One of the
most important factors in increasing knowledge is the method of delivering information that is
tailored to target needs by using appropriate health promotion media (Edberg, 2002).
The government in improving nutrition for infants and toddlers through increasing
nutrition-related knowledge, one of which is nutrition education, namely in the form of
counseling and nutrition counseling. Efforts to increase nutrition knowledge through
counseling plus demonstration are the right steps to be taken by health workers. So that the
better the mother's knowledge about complementary breastfeeding, the better the child's growth
and development. During the counseling, the intervention group received a demonstration
about the provision of complementary breastfeeding, with the demonstration being
demonstrated as an example of providing complimentary food ASI can provide information to
respondents.
The results showed a change in attitude in the intervention group at 76.1%. This is different
from the control group which was only given one-time counseling conventionally and it was
found that the result of a change in the mother's attitude to be positive was 52.2%. The results
of statistical tests show that there is an influence of counseling on the attitude of the mother
after being given nutritional counseling.
The results of this study are in line with the 2016 Hariska P study which stated that there
was an increase in maternal attitudes from 75.6% to 95.1% after intervention in the form of
nutritional counseling. This shows that there is a tendency to change attitudes in a positive
direction.
Attitude is a tendency to act from an individual in the form of a closed response to a
stimulus or a particular object. The attitude shows the suitability of the reaction to a stimulus
that has involved a person's opinion and emotions. In this case, the mother's attitude has been
influenced by counselors who provide knowledge in the form of counseling on how to provide
ASI complementary foods that are good and in accordance with the needs of the baby.
Based on the results of statistical tests, it was found that there was an effect of counseling
on maternal attitudes about the provision of complementary food. From the analysis, it was
also obtained OR = 2.917, meaning that mothers who were given counseling had 2 times the
opportunity to have a positive attitude about providing complimentary food. This research is
in line with the 2013 Hestuningtyas study which stated that there was a significant counseling
effect on positive attitudes of mothers about child feeding.
Nutrition counseling interventions include providing knowledge and giving motivation
towards changes in feeding attitudes and behavior. Nutrition counseling with media
demonstrations on how to make and sample directly (food samples) will be more easily

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understood by research subjects because it attracts attention and is not boring. Counseling as a
health promotion effort has an influence in increasing the mother's knowledge and attitudes
towards providing complementary breastfeeding. This was shown by the intervention group by
increasing maternal attitudes to 87% in providing complementary food.
The increase in maternal attitudes in both groups was in accordance with Notoatmojo's
opinion in 2012, where knowledge plays an important role for someone in determining
attitudes. Because knowledge will form a trust which then becomes the basis for someone in
determining attitudes towards certain objects. If some of the respondents have a positive
attitude, then their actions and behavior will tend to be positive, so that nutritional problems in
children do not occur.
The results of this study indicate that the intervention group of the majority of respondents
89.1% could carry out the complementary feeding practice is good while in the control group
more than half of 60.9% of respondents who carried out the practice in providing
complementary foods properly.
This is consistent with the 2013 Hestuningtyas study which stated that there was a
significant counseling effect on the practice of mothers in feeding children. The practice of
mothers in feeding is one of the factors associated with infant nutrition status. Nutritional
counseling is able to improve the complementary feeding practice which is characterized by
increased child nutritional intake as well as the frequency and form of food accordingly.
However, the baby's health is related to his food intake.
Sometimes a mother shows good actions in fulfilling the nutritional needs of her child
because providing food for children is very important. However, only some of these mothers
understand the diversity of nutrients contained in these foods, how to provide food to be more
attractive so as to provide an appetite for babies, and also how to manage and provide good
food for babies because of the fact that in feeding for babies not the same in adults. That way
even though a mother's actions are good, it still has to be supported by good knowledge and
attitude.
Increased maternal knowledge in the control group did not cause attitudes, and maternal
practices also experienced a significant increase between the beginning and end of the study.
This is because the subject does not get a demonstration that is a combination of subject matter
activities by demonstrating how to spread the message, instilling confidence, and showing the
community a process, situation, or certain object that is being studied both in its actual form
and in an artificial form. In this case, the subject only gets nutritional information from
counseling which is done once without demonstration, so that attitudes and behavior show a
slight increase.

V. CONCLUSION
The conclusion of this study is the presence of the influence of nutritional counseling on
attitudes and complementary feeding practice. To the Public Health Center are expected to hold
nutrition education and training on a regular basis to increase midwife or health workers
knowledge so that it can provide the latest information about complementary feeding practice
especially to mothers with low education, so the goal counseling can be achieved.

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BIOGRAPHY

Yulia Arifin has completed her education Bachelor’s degree from Department of DIV midwife
educator, Poltekkes Kemenkes Padang In 2012. Now, I'm completing my education at Midwife
Magister at Faculty of Medicine, Andalas University, Padang. I am interested in community
midwife.

Masrul is a lecturer in Faculty of Medicine, Andalas University, Padang.

Hirowati Ali is a lecturer in Faculty of Medicine, Andalas University, Padang.

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