The Early Impacts of Covid 19 on Nutrition Intake and

Household Dietary Diversity in Kupang District, East Nusa

Tenggara, Indonesia

Lalu Juntra Utama1*, Lina Yunita2, Anita Ch Sembiring3, Santa

Luciana Da Costa3, Astuti Nur3, Lalu Khairul Abdi1, Suhaema1

1 Nutrition Department, Health Polytechnic of Mataram, P.O.

Box 83237 Mataram, West Nusa Tenggara, Indonesia
2 Nutrition Department of Bumi Gora University, P.O. Box
83237 Mataram, West Nusa Tenggara, Indonesia
3 Nutrition Department, Health Polytechnic of Kupang, P.O. Box
85228 Kupang, East Nusa Tenggara, Indonesia

ABSTRACT
The social problems solving due to the COVID-19 pandemic, es-
pecially on the direct impact on the community, one of which is
overcoming household food security. The Corona pandemic
(COVID-19) that has occurred in almost all of the world, includ-
ing Indonesia, has brought many negative impacts on various as-
pects of life, including the food crisis. The risk of food scarcity
as an effect of the COVID-19 pandemic and has caused famine in
various places around the world. This study aims to analyze of
the composite index of household food security during the
COVID-19 pandemic and linked to nutrient intake and nutri-
tional status of children under five in the Kupang District area,
which is valid for measuring regional food security during the
COVID-19 pandemic. This cross-sectional study based on survey
which conducted on the Timorese population in Kupang, East
Nusa Tenggara, Indonesia. The location was performed purpo-
sively considering that Kupang Regency has a high prevalence
of nutritional problems. Data on household dietary diversity was
collected through the food recall 24 hours, using the household
dietary diversity score (HDDS). Study sample was taken from
Timorese population family with toddlers under five years and
1444 families voluntarily participated in this study. The duration
for conducting the survey was from 15 march to 21 June 2021.
Subjects were taken at each public health using a simple ran-
dom method without replacement. A total of 63% of households
had a proportion of less expenditure (<50%) with an average of
63.9. In general, households (90.4%) had a fairly good diet di-
versity score (HDDs). The study results show that as many as
86.6% of households had a fairly high HDD score. The average
score of HDDs as a whole was 6.3. Food groups that were quite
high consumed by most households included cereals (100%),
sugar and sweeteners (90.2%), oils and fats (93.7%), seasonings
and spices (89.4%) According to this study it was found that
there was a change in household food security in the Kupang
district community due to the COVID-19 pandemic. There was a
significant effect on household dietary diversity score during the
COVID-19 pandemic. Several other single indicators widely used
in determining household food security are the Food Consump-
tion Score (FCS), the average household energy intake and the
Household Food Insecurity Access Scale Score (HFIAS). There-
fore, it is necessary to revalidate tests in further studies of these
indicators.
Key words : covid 19, dietary diversity, food security, HDDS,
nutrient intake, diet, pandemic

*Corresponding Author Email : juntra8686@gmail.com;

lalujuntrautama@gmail.com
INTRODUCTIONS
As of March 12, 2020, the Coronavirus Disease 2019 (COVID-19)
has been confirmed in 125,048 people worldwide, bringing a
mortality rate of around 3-7%, compared to a mortality rate of
influenza (less than 1%). There is an urgent need for effective
treatment. The current focus is on developing new therapies, in-
cluding antivirals and vaccines [1]. The first case of the corona
virus emerged and attacked humans in Wuhan, PRC. Initially, it
was suspected as pneumonia with symptoms similar to the flu in
general, including cough, fever, fatigue, shortness of breath and
no appetite [2]. However, unlike influenza, the corona virus de-
veloped rapidly, resulting in severe infections, organ failure, and
death. This emergency condition mainly occurs in patients with
previous health problems [3]. It also affects the social and food
security sectors, both individuals and communities levels. The
resolution of the COVID-19 problem, especially on social im-
pacts, will involve the minor elements of the community, such as
overcoming household food security. Therefore, issues related to
food security challenges all countries due to directly related to
improving the economy and achieving the quality of human life
[4, 5, 6].
According to FAO (2009a)[7], food security is the condi-
tion of food fulfillment for everyone, both in quantity and qual-
ity. The fulfillment of the right to food is the primary key in over-
coming hunger [8]. World data from study reports from Rosen et
al. [9] stated that the number of people who consumed calories
below the recommended in 2015 reached 13.4 per cent. This
data generally occurs in developing countries and is projected to
increase to 15.1 per cent in 2025.
For decades, food security has been a top priority for the
world community in addressing the basic nutritional needs of
the poor and vulnerable. Food insecurity still affects hundreds of
millions of people, as happened in Sub-Saharan Africa, where
more than one in four people (nearly 218 million) are malnour-
ished. Food and nutrition security is a global challenge and a
prerequisite for a healthy and prosperous society. Food security
occurs when "all people, at all times, have physical, social and
economic access to sufficient, safe and nutritious food that
meets their dietary needs and dietary preferences for an active
and healthy life". Nutritional security exists when safe access to
an appropriately nutritious diet is coupled with environmental
sanitation, adequate health services and care to ensure a
healthy and active life [10, 11].
Issues and debates about global food security had resur-
faced since the 2008 food crisis when prices of essential food
commodities spiked dramatically, showing that securing food
supply and accessibility to meet the needs of the world's 9 bil-
lion people by 2050 is a formidable task. About 795 million peo-
ple worldwide were malnourished in 2014 [12] and more than 2
billion people were overweight or obese in 2013 [13]. The need
for food, along with the world population, which is estimated to
increase from 7.3 billion to 9 billion in 2050, requires regular
production systems and consumption patterns that are adjusted
to take policy action [14] and increase agricultural productivity
by 30%-40% so that the need for food can be fulfilled [15].
Therefore, programs integrated into joint efforts politi-
cally, economically, and socially mobilize awareness of the im-
portance of accurate information systems in providing fast and
timely information. Of course, this will help overcome the prob-
lem of changing food consumption patterns during the COVID-
19 pandemic.
METHODS
This research design was a cross-sectional study, and data
collection was carried out in Kupang Regency, East Nusa Teng-
gara Province. The location selection was performed purposively
considering that Kupang Regency has a high prevalence of nu-
tritional problems. This study involved two groups of subjects,
children under five (12 – 59 months old) and mothers. Popula-
tion data were obtained from cadres reports from each village
recorded at each local health centre. Mothers of children were
chosen as research subjects because they were fully involved in
providing food for all family members. The inclusion criteria
considered in determining the child as a subject included: chil-
dren aged 12 to 59 months old, not in severe illness or carrying
out routine treatment processes, the mother's consent as evi-
denced by the signing of the informed consent form. While the
inclusion criteria considered in determining the mother as a
subject were: the subject was the biological mother of the child,
had a husband with the status of the household head, the
mother was entirely responsible for arranging or preparing fam-
ily meals, aged 17 to 50 years old, and the subject agreed to in-
terview, evidenced by the signing of the informed consent form.
The number of subjects was calculated by proportional alloca-
tion by considering each health centre's level/stratum of food
vulnerability. The subjects totaled 1444, consisting of mothers
and children. Subjects were taken at each public health using a
simple random method without replacement. The randomization
process was carried out with the help of the Microsoft Excel
2013 program.
Data on household dietary diversity was collected through
the food recall method 24 hours, earlier, using the Household
Household Dietary Diversity Score (HDDs) indicator. Interviews
were proposed to mothers who were responsible for the prepa-
ration of family meals. Subjects were instructed to tell about all
types of food consumed by each household in the home, sourced
from the purchase process or self-processing at home. In addi-
tion, subjects were instructed to tell about the food prepared at
home for household members outside the home.
The next data was the proportion of food expenditure col-
lected by conducting structured interviews with mothers refer-
ring to the questionnaire sheet. Subjects were instructed to ex-
plain the average expenditure for each type of food consisting of
staple foods (rice, sugar, cooking oil, coffee, tea); side dishes
(chicken eggs, tempeh, tofu, fish, broiled chicken, shrimp,
squid); vegetables and fruits; instant noodles; toddler milk; and
spices. Subjects were asked to explain the average frequency of
each type of food purchase in units of time (day/week/month)
and state the amount of money spent on each purchase. Sub-
jects were instructed to estimate non-food expenditures spent in
one month, such as water, electricity bills, regular installments,
fuel, and others.

RESULTS
Child Characteristics
The table 1 also shows the proportion of child subjects by
gender. Almost half of the subjects (57.1%) were female, while
the proportion of male subjects reached 42.9%.
Table 1: Distribution of children by age and gender
Total
Characteristic Variables
n %
Age
1 - 3 y.o 841 58.2
3 - 5 y.o 603 41.8
Gender
Male 619 42.9
 Female 825 57.1

Household Characteristics
The data on general household characteristics analyzed in
this study consisted of fathers' and mothers' occupations and
household size. Based on the study results in the table 2, Civil
servant/Military/Police was the most dominant type of father
work (33.7%). The proportion of work of the father as a farmer
was 25.4%. Meanwhile, almost half of the children's mothers
(35.4%) roled as housewives or did not work permanently. Some
mothers act as private sector employee (5.7%).

Table 2: Characteristics of the household

Total
Characteristic variable
n %
Father's occupation
Farmer 367 25.4
Fisherman 135 9.4
Trader 261 18.1
Private sector employee 194 13.4
Civil servant/Military/Police officer 487 33.7
Mother's occupation
Housewife 511 35.4
Trader 273 18.9
Farmer 258 17.9
Private sector employee 82 5.7
Civil servant/Military/Police officer 320 22.1
Household size
 Small ≤ 4 persons 461 31.9
Medium 5-6 persons 603 41.8
Big ≥ 7 persons 380 26.3

Parent’s Education Level

The table 3 shows the distribution of parents by education
level. Most of the fathers (39.0%) and mothers (30.4%) had a
history of education, having graduated from secondary educa-
tion. The data shows the low level of parental education.

Table 3: Distribution of parents by education level

Father Mother
Education level
n % n %

None 48 3.3 23 1.6

Basic/lower education (Elementary school/equivalent) 307 21.3 291 20.1

Junior secondary education (Junior high school/equivalent 564 39.0 439 30.4

Upper secondary education (High school/equivalent 281 19.5 417 28.9

Higher education (associate degree diploma-3 / bachelor

244 16.9 274 19.0
degree/ master degree/ doctoral degree
Total 1444 100 1444 100

Proportion of Food Expenditure

The study presents the distribution of households based on
the proportion of food expenditure is described in the table 4.
The study results explained that the proportion of lower expen-
ditures (more than 50% of households) still dominated most
households of 59.1%. Meanwhile, the number of households
with the proportion of food expenditure categorized as good was

40.1%. The average value of the proportion of food expenditure

as a whole household was 60.9%.
Table 4 explained that almost half of the households expe-
rience food insecurity conditions. Income was the main element
that had implications for the proportion of food expenditure.
Table 4: Distribution of households by the proportion of
food expenditure
Categories n %
Low (> 50%) 853 59.1
Adequate (≤ 50%) 591 40.9
Total 1444 100
Average± SD (Proportion) 60.9 ± 19.8

Figure 1: Distribution of households by food group con-

sumed
The distribution of households based on the consumption
of food types is described in detail in the figure below. Food
groups that were quite high consumed by most households in-
cluded cereals (100%), sugar and sweeteners (90.2%), oils and
fats (93.7%), seasonings and spices (89.4%).

Household Dietary Diversity

Dietary diversity illustrates household consumption over a
certain period and is an important indicator of food security.
The study results in the table below show that as many as 86.6%
of households had a fairly high HDD score.
Table 5: Distribution of households based on diversity of food
consumption with HDDs
Categories n %
Low (≤ 3 food types) 52 3.6

Moderate (4-5 food types) 141 9.7

High (≥ 6 food types) 1251 86.6

Total 1444 100
Average ± SD (Proportion) 6.3 ± 1.8

DISSCUSSIONS
The process of growth, health, and psychosocial develop-
ment in children under five are continually occurrence, so good
nutrition is needed during this period [16]. The general charac-
teristics of children under five in this study were the distribution
of subjects based on age and gender. Table 1 explains that most
children were aged 1-3 years (58.2%), and the remaining 41.8%
were aged 3-5 years. The grouping of children's age was deter-
mined based on the division of the age range in the Table of In-
donesian Recommended Dietary Allowances (RDA). Children
from early life to 3 years old need nutrients to support brain de-
velopment which has long-term consequences [17]. Fulfilling nu-
trition, primarily toddlers aged 3-5 years (preschool age), is gen-
erally used to support children's cognitive and motor develop-
ment accompanied by stimulation [18]. Children under five who
lack nutrient intake can cause nutritional problems/malnutrition.
According to WHO [19], malnutrition is the main element or fac-
tor that causes death and reduces the health status of children
under five.
The Economic Survey (2017) data analysis results showed
that employment status and household size are determinant fac-
tors for household food security [20]. According to Edward et al.
[21], households with the father's primary occupation as farmers
generally have dynamic food security conditions because they
follow the harvest season of agricultural production. The fa-
ther's role is vital to creating a good condition of food security in
the household. According to Ochieng et al. [22], children and
women in households headed by a father or a man have signifi-
cantly more diverse diets than households headed by only one
woman.
Meanwhile, mothers' work as housewives is strongly corre-
lated with good food security conditions in the family [23]. This
is related to the number of times mothers are at home to be in-
volved in the buying process to provide food for household mem-
bers [24]. The table 2 also presents data on the distribution of
households based on the number of family members. In general,
households were classified as medium-sized households with a
proportion of 41.8%. The proportion of small-sized households
was 31.9%, and 26.3% were included in large-sized households.
According to Mango et al. [25], a small household size can guar-
antee better food security. The smaller the family size, the more
food opportunities for everyone in the household to eat. This be-
comes important in improving the optimal nutritional status of
each individual in the household [26]. The presence of many
children in the family usually causes limited resources to meet
household needs. In addition, limited access to households in
providing nutritional quality food can have implications for sub-
optimal nutritional conditions in children [27].
The quality of education greatly determines the quality of
human resources because it acts as a means to improve intelli-
gence and human skills [28]. In the food security system, the ed-
ucation level of the head of household and mother is one of the
indicators included in social access from the dimension of food
access [29]. It will affect the low access of parents in obtaining
good jobs to fulfill the needs of family life [30]. The study results
of Petralias et al. [26] stated that fathers or mothers who do not
complete compulsory education would be more at risk of caus-
ing food insecurity conditions. It is due to limited access to nu-
tritious and balanced food. According to Vollmer et al. [31],
higher education levels of mothers and fathers are closely re-
lated to decreased malnutrition in children. Therefore, educa-
tion is essential to support socioeconomic status and food and
nutrition security conditions at the household level. Proportion
of food expenditure is the amount of income allocated to spend
on food every month and divided by total household expenditure
[32].
A household with a large proportion of food expenditure is
quite at risk of experiencing food insecurity [33]. According to
Smith and Subandoro [34], households can achieve a good food
security condition if the average proportion of food expenditure
is less than 50%. Very poor households spend more to access ba-
sic needs, reduce food quality, and reduce the amount of con-
sumption of the cheapest food [35]. These conditions will have
an impact on the achievement of nutritional status that is not op-
timal in individuals. Expenditure on food can be defined as con-
sumption expenditure at current prices for food goods divided
by income [36]. Food is a primary need, so that low household
income can lead to higher expenditure allocations for food [37].
The Household Dietary Diversity score HDDs indicator provides
an overview of the household's ability to access food based on
the food group consumed in the previous 24-hours [38]. Accord-
ing to Russel et al. [39], the diversity of food consumption is an
indicator of food insecurity in households. The average score of
HDDs as a whole was 6.3. Melani [40] supports the results of
this study, where most households in agricultural agro ecologi-
cal areas (72.7%) have high HDD scores.
The food consumed by each individual in determining the
HDDs can be obtained through several ways such as self-cook-
ing, buying, and through assistance or giving. Households in this
study generally obtained food for consumption by cooking and
buying. The main menu for the family, such as rice and side
dishes, generally came from the processing itself at home
through the cooking process. Meanwhile, processed food menus,
including snacks, are mostly consumed by children in the house-
hold from the nearest food stalls. According to Kemendag [41],
the Indonesian people's consumption rate in the four food
groups is relatively high, the leading national strategic point.
Based on the Kemenkes [42] over the total diet study, the main
staple food in Indonesian society still relies on the cereal group
as the main energy source and this is in line with a total diet
study (2014); cereal and processed groups are foodstuffs with a
reasonably high consumption rate by the Indonesian population.
While other food groups, households in this study revealed not
good enough in consuming meat and processed products
(41.4%), milk and derivative products (43.1%), and fruits
(47.8%)..
The dairy and processed food groups in the sample house-
holds are mainly powdered milk by children under five. The total
diet study in 2014 reported that the level of consumption of the
vegetable and processed groups in the population in East Nusa
Tenggara was relatively high, with an average consumption of
92.7 grams per person per day [42]. This is supported by the
high level of community preference for vegetables and their pro-
cessed products with a geographical environment surrounded
by hills and mountains.
The consumption rate of the meat and processed food
group needs to be increased because it contributes to meeting
the needs of protein, vitamins and minerals that can support
body health [43]. Consumption figures for several food groups
are still relatively low by most households. About 48% of house-
holds consume fruits, meat, and their derivatives, milk, and de-
rivatives. Several factors that contribute to the low consumption
of this food group are income level, type of work, gender, house-
hold size, and community knowledge of food and nutrition [44].
The utilization of local food for root crops and legumes and nuts
needs to be increased to diversify food to find alternative
sources of carbohydrates and protein other than rice and meat.

CONCLUSION
In conclusion, According to this study it was found that
there was a change in household food security in the Kupang
district community due to the COVID-19 pandemic. Several
other single indicators widely used in determining household
food security are the Food Consumption Score (FCS), the aver-
age household energy intake and the Household Food Insecurity
Access Scale Score (HFIAS). Therefore, it is necessary to revali-
date tests in further studies of these indicators.
ACKNOWLEDGEMENT
We acknowledge the Kupang Ministry of Health Polytechnic,
who provided research funding through research on Riset Pem-
binaan Tenaga Kesehatan (Risbinakes) in 2021.

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