A Study of Food Acces, Food Hygiene, Environmental Sanitation, And Coping Mechanisms of The Households At Slum Area

Abstract

1. Family characteristics at riverbank and railway side were relatively similar. Wives and husbands were in their productive age and had low education level. Most husbands worked as labor, merchant and service provider. Most wives didn’t work, although some worked to help their husbands by trading. Based on number of family members, most families in the slum area were middle size and big families with family members more than four. 2. Most of house ownership status were personal owned with narrow house condition. Average house floor width at the railway side was 30.8 m2 and at the riverbank was 33.4 m. Railway side had higher population density than riverbank. The house usually consists of two main rooms, bedroom and kitchen with inadequate condition because children and parents sleep together and some house didn’t have window. Based on average income level, respondents were in non-poor category because the income was above the poverty line of DKI Jakarta province (IDR 355 480/capita/month) and World Bank (IDR 540 000/capita/month). Expenditure percentage were balanced between food and non-food expenses. The highest food expenses were for side dishes, rice and snacks. While the highest non-food expenses were for transportation, house rent, debt repayments, water bill, phone credit , recreation and saving/money gathering. School children (7-15 years old) who were not schooling anymore were more in railway side (22.6%) than riverbank (2.7 %). Children aged 16-18 years who were not schooling anymore were even higher (>50%) in both slum areas. Households at railway side and riverbank had relatively adequate nutrition knowledge and practice. Whilst, good nutrition attitude were commonly found among wives who lived at riverbank than railway side. Rice was the main staple food and consumed most frequently, other staple food oftenly consumed was noodle. Expensive protein source food like beef, chicken or fresh fish were rarely consumed. Nuts and lentils most frequently consumed were tempeh and tofu, which were consumed almost everyday. Average frequency of fruit consumption was less than once a week. Frequency of snacks consumption at both slum areas was relatively high, and fried snacks were the most frequent. Average energy and calcium adequacy level was still deficit. Almost half of households were in severe deficiency and a quarter were in mild deficiency. Meanwhile, adequacy level of protein, iron (Fe) and vitamin A in both areas were in excess. Analysis of clean water in both slum areas showed it wasn’t safe. Although analysis of water from the well at railway side and riverbank showed that it was physically and chemically safe, microbiology analysis showed that the water was not safe for consumption. Analysis of snacks showed rhodamine B was found in 1 out of 6 samples of crackers usually consumed by the community in the slum area. Meanwhile, heavy metal analysis of several vegetables showed they were not safe for consumption. Communities living in this slum area were facing double burden nutritional problem. The prevalence of underweight, wasting and stunting among underfive children were 25.6%, 28.9% and 28.2%, respectively whereas the prevalence of obese underfive children was also high (18.8%). Overnutrition problem not only happened in underfive children, but also in wives as their average BMI were in the obese category. Nonetheless, all pregnant and lactating respondents had good nutritional status as their MUAC percentile was >85%. Slum areas had high morbidity rate. Most common disease suffered by respondents’ family members in the last two weeks was ARI such as cough and influenza, while diarrhea and skin disease were rare. Physical access to get treatment was not an issue because there were a lot of health care spread evenly in the area. Community health center was the most visited health care. Less than a half respondent families were members of health fund (Health Insurance, Health Insurance for the Poor, or health fund/Public Health Insurance). Almost all mothers gave birth with help from health worker such as midwives or doctors, but only half of them routinely visited the Integrated Health Post. Only less than half underfive children received complete immunization. Most families had smoking member and only a few exercised regularly. Breakfast habit was practiced by most of slum community, but consuming variety of food, especially vegetables and fruits everyday, hadn’t been a habit. Personal hygiene was good, consisted of several habits such as brushing teeth, washing hands, utilizing clean water, availability of bathroom and toilet. Nevertheless, there was still some people who didn’t practice good hygiene like throwing trash to the Ciliwung river. Stress underwent frequently by both slum areas was chronic stress. Economic factors as the main cause of household stress in both slum areas were unmet needs to sustain family expenses and unsatisfied with the family income. Planful problem solving was used as coping strategy to solve the problem. Coping strategies done to fulfill family needs/expenxes were wives also worked, looking for extra work and borrowing money from family or non family especially to purchase basic needs. Trade/pawn gold, electronic and non-electronic stuff were only done by a few respondents. Coping strategies related to food expenses were varied starting from reducing amount of side dishes and staple food bought, reducing children snacks, reducing tea/coffee/sugar consumption, reducing meal frequency, bringing food to the workplace and leaving food for the day after. Coping strategies related to non food expenses such as cleanliness and health, more respondents from the railway side chose low-cost health care or used herbs than modern medication. For education, reducing children pocket money was most commonly done by respondents. Dropping out from school was not considered as a good way by people of slum area. Reducing daily expenses by changing fuel and reducing cigarette purchase were the most difficult coping strategies done by people in both slum areas. There were three coping strategies done by all selected cases in both slum areas to fulfill food needs. They were positive reappraisal, accepting responsibility and self controlling.