Relationship Between Mother's Knowledge Level In Utilizing The Maternal and Child Health Book With The Nutritional Status Of Toddlers

. The Maternal and Child Health (MCH) book is an initiative by the Indonesian Ministry of Health aimed at addressing child nutrition problems. However, at the Karang Mulia Health Center UPTD, the distribution and utilization of the MCH book among mothers of toddlers have not met the national target. The area has reported 164 cases of undernutrition and 74 cases of overnutrition in children under five. This study aims to determine the relationship between the level of maternal knowledge in utilizing the MCH book and the nutritional status of toddlers aged 12-59 months in the working area of the Karang Mulia Health Center UPTD. This correlational analytic research used a cross-sectional approach. The study population included 640 toddlers, with 90 selected samples of mothers who had the MCH book. Purposive sampling was employed, and data were analyzed using the Statistical Program for Social Science (SPSS) version 16.0, applying the chi-square test. The study found no significant relationship between maternal knowledge in using the MCH book and the nutritional status of toddlers. The p-values for the BB/A, PB/A or TB/A, and BB/PB or BB/TB indices were 0.345, 0.851, and 0.282, respectively, all greater than 0.05. There is no significant relationship between maternal knowledge of the MCH book and the nutritional status of toddlers aged 12-59 months in the Karang Mulia Health Center UPTD.


INTRODUCTION
Nutritional status is an important factor in the development of health status.Nutritional status is a condition that arises due to the balance between the nutrients you get from food and the nutritional needs of the body.The main factor is the condition that affects nutrition due to improper food processing, the second thing is food that does not meet the body's needs due to confusion in the use of nutrients (Ministry of Health of the Republic of Indonesia, 2017).
World Health Organization(WHO) in 2018 reported that in 2018 the prevalence of growth and development disorders in toddlers was 28.7%, andIndonesia is the third country with the highest number in the Southeast Asia Region (SEAR) (WHO, 2018).Riskesdas data (2019), the prevalence of malnutrition nationally is fluctuating because in 2012 the prevalence of malnutrition was 18.4% and decreased in 2015 to 17.9%, but in 2018 the prevalence of malnutrition increased again to 19.6% consisting of 13.9% malnutrition and 5.7% severe malnutrition (Riskesdas, 2019).
Educational efforts of the Ministry of Health of the Republic of Indonesia (Kemenkes RI) to overcome child nutrition problems supported by the Ministry of Health in collaboration

LITERATURE REVIEW
Research on the relationship between maternal knowledge of the MCH book and the nutritional status of toddlers presents mixed findings.Some studies suggest that mothers with a higher level of knowledge and regular use of the MCH book are more likely to have children with optimal nutritional status.These mothers tend to follow growth monitoring charts, adhere to nutritional advice, and seek medical intervention when necessary, leading to better outcomes in child nutrition.However, other studies have found no significant correlation between maternal knowledge of the MCH book and children's nutritional status, indicating that other factors such as socio-economic status, access to healthcare, and cultural practices may also play significant roles.In summary, while maternal knowledge of the MCH book is a crucial factor in improving child nutrition, its impact may vary depending on the broader context in which it

METHODS
This type of research is correlational analytic with a cross sectional approach.isa study that only uses an approach method or data collection to study the correlation between risk factors at one time only (Ariani, 2014).The study was conducted from May 22 to July 8, 2023 in the Working Area of UPTD Karang Mulia Health Center.The population in this study was 640 toddlers who had maternal and child health books at UPTD Karang Mulia Health Center.
The sample of this study was 90 respondents who met the inclusion criteria and exclusion criteria with a sampling technique using purposive sampling, namelythe process of identifying and taking samples that have been decided by researchers for certain purposes (Sugiyono, 2015).
The research instruments used aredigital or foot scales, microtoise, maternal knowledge, and interviews using questionnaire.The research results are processed through the process of editing, scoring, coding, processing, cleaning.
The analysis in this study is divided into univariate and bivariate analysis.Univariate analysis is carried out on each research result variable using a frequency distribution table to produce the distribution and percentage of each research variable, while this bivariate analysis is used to find the relationship between the Independent variable and the dependent variable through statistical tests.Data analysis used the computer program Statistical Program for Social Science (SPSS) version 16.0 and used the chi-square test.

RESULTS
The  Based on table 1.It can be seen that from 90 respondents of toddlers aged 12-59 months, it is known based on the characteristics of male gender, there are 52 people with a percentage of 57.8%, while female gender is 38 people with a percentage of 42.2%.The highest characteristics of the mother's age category are in the 25-31 year age group as many as 44 people or a percentage of 48.9%, while the lowest is the 18-24 year age group as many as 16 people or a percentage of 17.8%.The highest characteristics of the toddler age group in the 12-27 month age group are 68 people with a percentage of 75.6%, while the lowest percentage is in the 44-59 month age group of toddlers is 4 people with a percentage of 4.4%.
The characteristics of the mother's last education are mostly high school/vocational school education of 45 people with a percentage of 50% and the smallest is elementary school education of 4 people with a percentage of 4.4%.Characteristics of mother's work, more are unemployed around 69 people with a percentage of 76.7%, compared to mothers who work around 21 people with a percentage of 23.3%.Characteristics of mother's income stated that mothers who do not have income at the highest level are 59 people or a percentage of 65.6%, compared to the lowest level who have income ≤ Rp. 1,500,000 which is 13 people with a percentage of 14.4%.Characteristics of children's height that the proportion with a height of 66-<85cm is the highest as many as 62 people with a percentage of 68.9%, while a height of 100->118cm as many as 7 people with a percentage of 7.8% is the lowest.Characteristics of children's weight with the highest percentage with a weight of 6-<12kg totaling 64 people with a percentage reaching 71.1%, while children with a weight of 12->20kg totaling 26 people with a percentage reaching 28.9%.Based on table 2, it shows that from the total of 90 respondents, the results obtained were the level of knowledge regarding the use of maternal and child health books, with the largest number of respondents with a good level of knowledge of 33 people or a percentage of 36.7%, while the lowest number of respondents with a poor level of knowledge was 27 people or a percentage of 30%.Regency".Based on the results of the study to determine the relationship between mother's knowledge about KIA books and the nutritional status of toddlers based on the BB/TB index with p (0.633)> 0.05, which means there is no relationship.Because according to the researcher, the questionnaire given to the respondents had been validated in advance, but the questionnaire used was made by the researcher himself.In addition, another factor that is considered irrelevant to the study is the number of respondents whose questionnaire data is incomplete, making it difficult for researchers to analyze.Then the researcher argues that other factors that influence children's nutritional status are not involved in the research variables.

CONCLUSION
Based on the results of the research that has been conducted, it can be concluded that there is no relationship between the level of maternal knowledge in utilizing maternal and child health books with the nutritional status of toddlers aged 12-59 months in the Working Area of the Karang Mulia Health Center UPTD, a conclusion was obtained with a p-value> 0.05.
Maternal and Child Health Book Based on Index BB/PB Or BB/TB Relationship Between Mother's Knowledge Level In Utilizing The Maternal and Child Health Book With The Nutritional Status Of Toddlers with the Japan International Cooperation Agency (JICA)In 1993, began compiling the Maternal and Child Health (KIA) guidelines, which are still under regular assessment and review according to the wishes or interests of mothers and children and in line with the progress of the times, which contain information about pregnancy, childbirth, postpartum and babies such as vaccinations, unhealthy babies, care for disabled children, and efforts to protect against sexual harassment.The use of the Maternal and Child Health (KIA) book can be implemented effectively if officers and cadres say that mothers understand the main ideas of this book (Ministry of Health of the Republic of Indonesia, 2016).Nutrition in 2022, the target achievement for toddlers having KIA books is 75% (Ministry of Health, 2020).Based on data from the Central Statistics Agency (BPS), in Papua Province from 2016 to 2017 there was an increase, but in 2018 there was a decrease.In 2016 the prevalence of malnutrition in toddlers was 3.18% and undernutrition 11.95%, in 2017 the prevalence of malnutrition and undernutrition increased to 6.8 and 12.8%, but decreased in 2018, namely 5.1% malnutrition and undernutrition 11.4% (BPS, 2022).The prevalence of malnutrition in Nabire Regency in 2022 from 32 Health Centers was 3.8% and 8.2% of toddlers were malnourished (Nabire Regency Health Office, 2023).Meanwhile, in the Working Area of the Karang Mulia Health Center UPTD in 2022 according Zebua, S in 2019ults of previous research conducted byZebua, S in 2019, it was found that there was no relationship between knowledge of the use of KIA books and the nutritional status of toddlers using the BB/A index (p=0.776)and TB/A (p=478), while the BB/TB index (p=0.029)there was a relationship between knowledge of the use of KIA books and nutritional status.In addition, according to research conducted byHasyim DIcoverage who have Maternal and Child Health (KIA) books in 2022 is still below the target, which is 55.5%.According to the Action Plan for Activities of the Directorate of Community e-ISSN: 3047-5228; dan p-ISSN: 3047-5236, Hal.79-89 to the weight indicator according to height, there were 164 cases of malnutrition and 74 toddlers were overweight (Karang Mulia Health Center UPTD, 2023).Based on the background description above, this researcher is interested in conducting a study, namely "The Relationship between the Level of Mother's Knowledge in the Utilization of Maternal and Child Health Books with the Nutritional Status of Toddlers Aged 12-59 Months in the Working Area of the Karang Mulia Health Center UPTD".This research was conducted at the Karang Mulia Health Center UPTD, Nabire District, Nabire Regency.The reason the researcher chose this research location was to determine the relationship between the level of mother's knowledge in the utilization of maternal and child health books with the nutritional status of toddlers aged 12-59 months at the Karang Mulia Health Center UPTD and the location has never been studied at this research center.
Relationship BetweenMother's Knowledge Level In Utilizing The Maternal and Child Health BookWith The Nutritional Status Of Toddlers is used.Enhancing maternal education and addressing other determinants of child health are essential steps towards ensuring better nutritional outcomes for toddlers.

Table 1 . Frequency Distribution of Characteristics of Respondent Mothers of Toddlers Age 12-59 Months in the Working Area of the Karang Mulia Health Center UPTD
study was conducted from May 22 to July 8, 2023 in the working area of the UPTD Karang Mulia Health Center located in Karang Mulia Village, Nabire District, Nabire Regency,

Level of Knowledge BB/PB Or BB/TB Category P (Value) Malnutriti on Malnutriti on Good Nutrition At Risk of Overnutrition
Based on table 6, it can be seenthat from the results of the analysis that has been done, the p-value (0.282)> 0.05 is obtained, which means there is no relationship between the level of mother's knowledge in utilizing maternal and child health books with the BB/PB or BB/TB index.This study is supported by the results of research conducted by Farida Adiningrum, Hadyana Sukandar, Merry Wijaya in 2016 "The Relationship Between Mother's Knowledge About KIA Books and the Nutritional Status of Toddlers in Soreang District, Bandung