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Factors Associated with Sibling Rivalry Behavior in Toddlers Rabia Zakaria; Yusni Podungge; Rahma Dewi Agustini
JOURNAL OF NONCOMMUNICABLE DISEASES Vol 1, No 1 (2021): April 2021
Publisher : Poltekkes Kemenkes Gorontalo

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (535.13 KB) | DOI: 10.52365/jond.v1i1.221

Abstract

Sibling rivalry is a form of relationship conflict with siblings that can affect individual development, both positively and negatively and give impact on the child, parents, and society. Puskesmas Kabila is one of the health centers in Bone Bolango Regency, Gorontalo, which has the lowest achievement of health services for children under five, namely 61.1% in 2019 and as many as 70% of mothers who have more than one toddler tend to experience sibling rivalry. This literature study aims to determine the factors associated with the behavior of sibling rivalry in toddlers. This literature study research was conducted by examining 13 literatures consisting of 8 journals and 5 books. The results will be analyzed descriptively. The independent variable in this study is the factors examined in research journal articles, while the dependent variable is the behavior of sibling rivalry in children under five. The research instrument used was a data table to make it easier to interpret the results of a literature study. The results of the literature study show that the factors associated with sibling rivalry include: parenting styles, emotional intelligence, parental knowledge, differences in gender and age as well as parents' attitudes towards children.
PEMBERDAYAAN KELUARGA DALAM RANGKA PENINGKATAN PENGETAHUAN STATUS GIZI BAYI BALITA MELALUI PROGRAM TODDLER’S BERKUALITAS Yusni Podungge; Rahma Dewi Agustini; Nurhidayah Nurhidayah; Puspita Sukmawaty Rasyid; Fatmawati Ibrahim; Hikmandayani Hikmandayani; Herman Priyono Luawo
JMM (Jurnal Masyarakat Mandiri) Vol 6, No 5 (2022): Oktober
Publisher : Universitas Muhammadiyah Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31764/jmm.v6i5.10756

Abstract

Abstrak: Dampak stunting bagi anak yaitu kurangnya perkembangan kognitif, rentan mengalami penyakit, dan juga kekebalan tubuh lebih rendah. Berdasarkan pendataan yang dilakukan di Desa Tanggilingo jumlah balita yang di data sebanyak 58 balita. Dari 58 balita terdapat 17 balita yang mengalami stunting. Keadaan ini menunjukkan bahwa masih rendahnya pengetahuan orang tua tentang pemenuhan kebutuhan nutrisi kepada anak serta kurangnya pengetahuan orang tua tentang pertumbuhan dan perkembangan anak. Tujuan pengabdian kepada masyarakat adalah meningkatnya pengetahuan dan keterampilan ibu dalam pembuatan Makanan Pendamping Air Susu Ibu (MPASI) dan deteksi dini serta teridentifikasinya tumbuh kembang anak. Metode kegiatan adalah pemeriksaan tumbuh kembang anak sesuai KPSP, penyuluhan dan demonstrasi pembuatan MPASI. Evaluasi pengetahuan dalam bentuk pengisian kuesioner pre-test dan post-test dan penilaian tumbuh kembang melalui KPSP. Khalayak sasaran dalam kegiatan ini adalah ibu yang memiliki bayi dan balita berjumlah 45 orang. Hasil kegiatan pengabmas menunjukkan terjadinya peningkatan mengenai pentingnya stimulasi deteksi intervensi dini tumbuh kembang (SDIDTK) sebanyak 66,66% dan terindetifikasi balita tumbuh kembang dengan kategori sesuai sebanyak 64,44%, 28,88% kategori meragukan, dan 6,66% membutuhkan intervensi.Abstract: Stunting has impacted such as lack of cognitive development, disease susceptibility, and lower immunity. Data collection in Tanggilingo Village shows that 17 of 58 toddlers are stunted. This situation indicates that parents' knowledge about the nutritional needs of children and children's growth and development is still low. This community service aims to identify growth and development and increase mothers' knowledge and skills in making complementary food (MPASI) and early detection and identification of child growth and development. The activity method examines children's growth and development under KPSP, counseling, and demonstrations of making complementary food. Evaluation of knowledge by filling out pre-test and post-test questionnaires and assessment of growth and development through KPSP. The participants in this activity are 45 mothers who have babies and toddlers. The results of community service activities showed an increase in the importance of stimulation of early intervention detection of growth and development (SDIDTK) as much as 66.66% and identified growth and development toddlers with 64.44% of the corresponding categories, 28.88% of the categories of doubt, and 6.66% needing intervention.
UPAYA PENCEGAHAN STUNTING MELALUI KONVERGENSI GERAKAN IJAB KABUL Rabia Zakaria; Siti Choirul Dwi Astuti; Rahma Dewi Agustini; Yazmin Armin Abdullah
JMM (Jurnal Masyarakat Mandiri) Vol 6, No 6 (2022): Desember
Publisher : Universitas Muhammadiyah Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31764/jmm.v6i5.10143

Abstract

Abstrak: Pencegahan stunting bisa dilakukan dengan mempersiapkan kesehatan reproduksi remaja putri namun sebaliknya apabila kesehatan reproduksi remaja putri tidak diperhatikan dapat menyebabkan beberapa penyakit termasuk melahirkan bayi stunting. Untuk memantau kesehatan reproduksi remaja putri setiap bulannya dapat dilakukan melalui Posyandu remaja (1) Dalam kegiatan ini melibatkan mitra sebanyak 83 orang yang terdiri dari ketua tim PKK, kepala Puskesmas, kepala desa, PLKB, dinas P&K, kepala sekolah, badan narkotika nasional, kepala kantor urusan agama, petugas pembantu pembina keluarga berencana desa dari kecamatan, bidan desa dan kader. Monitoring dilakukan dengan pemantauan status gizi menggunakan standar antropometri. Salah satu upaya untuk meningkatkan kesehatan reproduksi remaja dengan melakukan konvergensi gerakan ijab Kabul; (2) Tujuan pengabdian mencegah stunting dengan mempersiapkan kesehatan reproduksi melalui konvergensi gerakan ijab Kabul; dan (3) Hasil yang telah sudah ada komitmen melakukan konvergensi gerakan ijab kabul untuk mencegah stunting. Selama kegiatan dilakukan ada penurunan prevalensi faktor risiko stunting pada remaja putri dari 12,7% turun menjadi 10,56%.Abstract: Prevention of stunting can be done by preparing the reproductive health of adolescent girls, but on the contrary if the reproductive health of adolescent girls is not considered, it can cause several diseases including giving birth to stunting babies. To monitor the reproductive health of young women every month it can be done through the youth Posyandu (1) This activity involves 83 partners consisting of the PKK team leader, the head of the Community Health Center, the village head, PLKB, P&K offices, school principals, the national narcotics agency, the head of the National Narcotics Agency. Office of religious affairs, assistant officers for village family planning from the sub-district, village midwives and cadres. Monitoring is done by monitoring nutritional status using anthropometric standards. One of the efforts to improve adolescent reproductive health is by converging the Kabul consent movement; (2) The purpose of the service is to prevent stunting by preparing for reproductive health through the convergence of the Kabul consent movement; and (3) the results of which there is a commitment to the convergence of the consent movement to prevent stunting. During the activity, there was a decrease in the prevalence of stunting risk factors in adolescent girls from 12.7% to 10.56%.
MIDWIFE'S EXPERIENCE IN PROVIDING ANTENATAL CARE DURING THE COVID-19 PANDEMI AT PUBLIC HEALTH CENTER OF BONE BOLANGO DISTRICT Ika Suherlin; Juwita Suma; Febri Dwi Yanti; Rahma Dewi Agustini; Hasnawatty Surya Porouw
Jambura Journal of Health Sciences and Research Vol 5, No 1 (2023): JANUARI: JAMBURA JOURNAL OF HEALTH SCIENCES AND RESEARCH
Publisher : Universitas Negeri Gorontalo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35971/jjhsr.v5i1.15574

Abstract

Menurut data Perhimpunan Obstetri dan Ginekologi Jakarta (POGI) terdapat 13,75 ibu hamil lebih mudah terinfeksi COVID-19 dibandingkan ibu tidak hamil. Pada kondisi ibu hamil melalui Pregnancy Care (ANC) dikenal istilah kunjungan K1, K2, K3 dan K4, pada masa COVID-19 untuk mengurangi kunjungan ibu hamil pelayanan dilakukan dengan tele-konsultasi. Namun, merancang tele-konsultasi menjadi tantangan tersendiri agar dapat dimanfaatkan oleh semua pihak dan efektif dalam pelaksanaannya. Kebaruan penelitian ini karena peneliti mengangkat masalah telekonsultasi pada asuhan antenatal selama panemi Covid-19. Tujuan penelitian adalah untuk mengeksplorasi pengalaman bidan dalam memberikan asuhan antenatal melalui telekonsultasi selama pandemi COVID 19. Metode studi kualitatif fenomenologis, 8 bidan yang bekerja di  Puskesmas Tilongkabila Kabupaten Bone Bolango yang merupakan bidan pelaksana asuhan antenatal. Hasilnya informan mengalami kesulitan dalam berkomunikasi untuk janji temu/teleregistrasi dengan ibu hamil. Ibu hamil tidak menyadari pentingnya memeriksakan kehamilannya dan data yang disampaikan ibu hamil diragukan. Seluruh bidan menjalankan protokol kesehatan saat memberikan asuhan antenatal selama pandemi COVID-19. Tidak adanya pendokumentasian asuhan antenatal melalui media komunikasi sehingga cakupan kunjungan ibu hamil mengalami penurunan dan temuan kecemasan bidan dalam memberikan asuhan antenatal saat ibu hamil datang berkunjung. Kesimpulan bidan masih mengalami kesulitan berkomunikasi untuk janji temu/teleregistrasi dengan ibu hamil.  Kata kunci: Antenatal care; COVID-19; Tele konsultasi; Pengalaman bidan. AbstractA phenomenological qualitative study method, 8 midwives who work at the Tilongkabila Health Center, Bone Bolango Regency, an antenatal midwife. According to data from the Jakarta Obstetrics and Gynecology Association (POGI), 13.75 pregnant women are more easily infected with COVID-19 than non-pregnant women. In the condition of pregnant women through Pregnancy Care (ANC), known as K1, K2, K3, and K4 visits, during the COVID-19 period to reduce visits to pregnant women, services are carried out by teleconsultation. However, designing teleconsultations is a challenge in itself so that it can be utilized by all parties and effective in its implementation. The novelty of this study is that researchers raised the issue of teleconsultation in antenatal care during the Covid-19 pandemic. The study aimed to explore midwives' experiences in providing antenatal care through teleconsultation during the COVID-19 pandemic. All midwives follow health protocols when providing antenatal care during the COVID-19 pandemic. As a result, informants had difficulty communicating for appointments/teleregistration with pregnant women. Pregnant women do not realize the importance of checking their pregnancy, and the data submitted by pregnant women is doubtful. There is no documentation of antenatal care through communication media, so the scope of visits to pregnant women has decreased, and the findings of midwife anxiety in providing antenatal care when pregnant women come to visit. Conclusion midwives still have difficulty communicating for appointments/teleregistration with pregnant women.  Keywords: Antenatal care; COVID-19; Tele consultation; Midwife experience.
LITERATURE REVIEW: FACTORS CAUSING PLACENTA PREVIA IN PREGNANT WOMEN Yusni Podungge; Nurhidayah Nurhidayah; Endah Yulianingsih; Hasnawatty Surya Porouw; Ika Suherlin; Rahma Dewi Agustini
Jambura Journal of Health Sciences and Research Vol 5, No 1 (2023): JANUARI: JAMBURA JOURNAL OF HEALTH SCIENCES AND RESEARCH
Publisher : Universitas Negeri Gorontalo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35971/jjhsr.v5i1.16074

Abstract

AbstrakJumlah kematian ibu di Indonesia sebanyak 4.627 jiwa pada 2020. Jumlah kematian ibu meningkat sebelumnya sebanyak 4.197 jiwa menjadi 8,92%. Penyebab kematian ibu di Indonesia yang paling banyak yaitu perdarahan dan hipertensi dalam kehamilan. Kebaruan penelitian ini karena menganalisis faktor penyebab placenta previa pada ibu hamil melalui metode literatur review. Tujuan penelitian untuk menganalisis faktor penyebab terjadi plasenta previa pada ibu hamil. Metode literatur review menggunakan startegi secara komprehensif, seperti pencarian artikel dalam database jurnal penelitian, pencarian melalui internet, tinjauan ulang artikel dengan kata kunci plasenta previa dan ibu hamil. Pencarian database yang digunakan meliputi google scholar, Pubmed, Science Direct dan perpusnas. Hasil pencaharian didapatkan ada 18 artikel akan tetapi hanya 6 artikel yang digunakan dan menggambarkan faktor resiko yang berhubungan dengan plasenta previa pada ibu hamil. Dan artikel lainnya yang dieliminasi karena tidak menggambarkan  faktor resiko yang berhubungan dengan plasenta previa pada ibu hamil. Kesimpulan faktor penyebab plasenta previa pada ibu hamil meliputi umur, paritas, riwayat persalinan sesar dan jarak kehamilan sebelumnya.Kata kunci : Penyebab; Plasenta previa; Ibu hamil. AbstractThe number of maternal deaths in Indonesia was 4,627 in 2020. The number of maternal deaths increased by 4,197 to 8.92%. The most common causes of maternal death in Indonesia are bleeding and hypertension in pregnancy. The novelty of this study is due to analyzing the causal factors of placenta previa in pregnant women through the literature review method. The purpose of the study was to analyze the factors causing placenta previa in pregnant women. The literature review method uses strategies comprehensively, such as searching for articles in research journal databases, searching through the internet, reviewing articles with the keywords placenta previa and pregnant women. The database searches used include google scholar, Pubmed, Science Direct and libraries. The results found that there were 18 articles, but only 6 articles were used and described the risk factors associated with placenta previa in pregnant women. And other articles that were eliminated because they did not describe the risk factors associated with placenta previa in pregnant women. The conclusion of the factors causing placenta previa in pregnant women includes age, parity, history of cesarean delivery and distance of previous pregnancy.Keywords : Cause; Placenta previa; Expectant mothers.
PERSIAPAN LAKTASI DAN PEMERIKSAAN HEMOGLOBIN IBU HAMIL DAN IBU NIFAS Nurhidayah Nurhidayah; Rahma Dewi Agustini; Nancy Olii; Melisawati L Amu; Febri Dwi Yanti; Puspita Sukmawaty Rasyid; Siti Uswatun Khasanah Nggilu
JMM (Jurnal Masyarakat Mandiri) Vol 7, No 2 (2023): April
Publisher : Universitas Muhammadiyah Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31764/jmm.v7i2.13228

Abstract

Abstrak: Jumlah sesi menyusui dapat ditingkatkan, termasuk perawatan payudara. Menyusui payudara sangat membantu dalam memicu refleks pengeluaran ASI. Tes hemoglobin juga sangat bermanfaat bagi para ibu, karena tes ini memungkinkan mereka untuk mengetahui kadar hemoglobin dalam darah sehingga dapat mencegah anemia. Tujuan pengabmas ini adalah untuk mengedukasi dan mengenalkan perawatan payudara untuk mencegah masalah terkait produksi ASI pada ibu hamil dan nifas. Metode yang digunakan yaitu: (1) menentukan waktu pelaksanaan dan mengumpulkan sasaran sebanyak 18 ibu melalui kader; (2) melakukan pemeriksaan hb; (3) melakukan pre-test; (4) memberikan edukasi; (5) praktik perawatan payudara; dan (6) melakukan post-test. Hasil dari kuesioner pre-test dan Post-test yaitu adanya peningkatan pengetahuan ibu tentang pemberian ASI dan perawatan payudara yaitu sebesar 55,5%. Hasil Pemeriksaan HB pada ibu hamil dan ibu nifas yaitu 2 orang anemia ringan dan 16 orang normal. Abstract: The number of breastfeeding sessions can be increased, including breast care. Breastfeeding is very helpful in triggering the milk ejection reflex. The hemoglobin test is also very useful for mothers, because this test allows them to know the level of hemoglobin in the blood so that they can prevent anemia. The purpose of this writing is to educate and introduce breast care to prevent problems related to milk production in pregnant and postpartum women so that they become fertile mothers. The methods used were: (1) determining the implementation time and collecting targets of 18 mothers through cadres; (2) carry out Hb checks; (3) do a pre-test; (4) providing education; (5) breast care practices; and (6) do a post-test. The results of the pre-test and post-test questionnaires were an increase in mother's knowledge about breastfeeding and breast care, which was 55.5%. HB examination results in pregnant women and postpartum women, namely 2 people with mild anemia and 16 people normal.  
PENCEGAHAN DAN RUJUKAN HIPERTENSI KEHAMILAN MELALUI OPTIMALISASI APLIKASI GO-YOGA SERTA PROGRAM MUTIARA BERLIAN Rabia Zakaria; Rahma Dewi Agustini; Siti Choirul Dwi Astuti
JMM (Jurnal Masyarakat Mandiri) Vol 7, No 5 (2023): Oktober
Publisher : Universitas Muhammadiyah Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31764/jmm.v7i5.16727

Abstract

Abstrak: Hipertensi dalam kehamilan sering terjadi dan menjadi penyebab utama kematian ibu saat melahirkan. Namun, pencegahan dan rujukan untuk mengatasi hipertensi belum optimal, sehingga diperlukan langkah yang lebih efektif dengan menggunakan Aplikasi Go-Yoga dan mengoptimalkan program Mutiara Berlian untuk mencegah serta rujukan dini hipertensi dalam kehamilan. Kegiatan melibatkan 15 mitra, termasuk Kepala Puskesmas, Kepala Desa, Bidan Desa, Tim Mutiara Berlian, dan kader. Sebanyak 14 ibu hamil usia > 20 minggu menjadi peserta dengan dilakukan pemeriksaan dan sosialisasi penggunaan Go-Yoga. Hasilnya, sebanyak 3 ibu hamil (21%) mengalami hipertensi, dan 4 (29%) ditemukan protein urine, total 7 dari 14 ibu hamil (50%) mengalami tanda dan gejala hipertensi. Seluruh ibu hamil (100%) dengan tanda dan gejala hipertensi dimasukkan dalam program Mutiara Berlian dan dirujuk. Pemantauan berkala dilakukan oleh 5 kader (100%) yang telah terlatih dalam pengisian formulir di bawah koordinasi tim pengabmas. Terjadi penurunan jumlah ibu yang menderita hipertensi dari 21% menjadi 7%. Program ini berpotensi membantu menurunkan angka hipertensi yang menjadi penyebab utama kematian ibu.Abstract: Hypertension during pregnancy is a common occurrence and a leading cause of maternal mortality during childbirth. However, suboptimal prevention and referral measures necessitate more effective strategies like utilizing the Go-Yoga application and optimizing the Mutiara Berlian program. The activity involves 15 partners, including the Health Center Head, Village Head, Midwives, Mutiara Berlian Team, and cadres. Fourteen pregnant women aged > 20 weeks participated, with three (21%) identified with hypertension and four (29%) exhibiting proteinuria, totaling seven out of 14 (50%) showing hypertension signs. All were included in the Mutiara Berlian program and referred accordingly. Periodic monitoring by five trained volunteers (100%) using standardized forms resulted in decreased hypertensive cases from 21% to 7%. This program significantly contributes to reducing hypertension rates, a major cause of maternal mortality.
Mastitis Pain in Postpartum Mothers Using Plumeria Rubra L Ointment Zakaria, Rabia; Astuti, Siti Choirul Dwi; Agustini, Rahma Dewi; Damiti, Sukmawati A.; Mashar, Harlyanti Muthmai’nnah
Jurnal Kesehatan Masyarakat Vol 19, No 3 (2024)
Publisher : Department of Public Health, Faculty of Sport Science, Universitas Negeri Semarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15294/kemas.v19i3.45857

Abstract

Treatment of mastitis is usually carried out pharmacologically by giving antibiotics, but the content of antibiotics can enter breast milk, so an alternative solution is needed for the problem of using herbal plants. Plumeria rubra L is processed into an ointment so that it is easy to use. The aim of this study was to determine the intensity of postoartum maternal mastitis pain in the use of 5% Plumeria rubra L ointment. The research design is true experiment pre post test control group design. Respondents were divided into 2 groups, namely intervention and control totaling 32 people. The intervention was given by 5% Plumeria rubra L ointment applied to the breasts of postpartum mothers who were given twice a day in the morning and evening for seven days with a size of 5 grams for each using. The result is the intensity of postpartum mastitis pain in the previous control group, most of the percentage was severe pain as much as 66.7% and after most of the presentations, namely moderate pain as much as 60.0%. The intensity of mastitis pain for postpartum mothers before using red frangipani ointment is mostly the percentage, namely severe pain 73.3% and the intensity of mastitis pain for postpartum mothers after using red frangipani ointment, most of the percentages are moderate pain 53.3%. The conclusion obtained is a p value of 0.004 which indicates a significant difference. To reduce mastitis pain, postpartum mothers can use red frangipani ointment for 7 days.
Determinan Pemberian ASI Eksklusif Agustini, Rahma Dewi; Wahyuni, Sri; Buheli, Kartin L.; Suherlin, Ika
Journal Midwifery Jurusan Kebidanan Politeknik Kesehatan Gorontalo Vol 7, No 1 (2021): March
Publisher : Politeknik Kesehatan Kementrian Kesehatan Gorontalo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52365/jm.v7i1.321

Abstract

The World Health Organization (WHO) urges all mothers to exclusively breastfeed until their babies are 6 months old. Breastfeeding alone without complementary foods until the age of 6 months has enormous benefits for the development and growth of infants and strengthens the affection between mother and child. However, the amount of exclusive breastfeeding coverage is still low. Data from the Health Service in 2018 only 46% received exclusive breastfeeding even though the national exclusive breastfeeding target was 80%. This study aims to analyze the factors that influence exclusive breastfeeding in the working area of the Puskesmas which was carried out for one month. The crosssectional study design was conducted on 101 mothers with babies between 6 and 12 months who were selected by random sampling. The results of the chi-square analysis showed that there was an influence on age (p=0.001), parity (p=0.000), education (p=0.002), and knowledge (p=0.001). Conclusion: The percentage of failure to give exclusive breastfeeding is still high, with the factors of age, parity, education, and knowledge being very influential, so prevention efforts are needed that must be emphasized to mothers before giving birth.
Sociodemographic Factors Toward Stunting: A Community Based Cross Sectional Study Agustini, Rahma Dewi; Z, Sri Nurlaily; Taidi, Jein Eka Wirahmi; Nurhidayah, Nurhidayah; Rasyid, Puspita Sukmawaty
Journal Midwifery Jurusan Kebidanan Politeknik Kesehatan Gorontalo Vol 9, No 1 (2023): March
Publisher : Politeknik Kesehatan Kementrian Kesehatan Gorontalo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52365/jm.v9i1.634

Abstract

Stunting is a malnutrition problem that occurs globally and has long-term impacts on both health and cognitive. There have been no studies related to sociodemographic factors towards stunting in one of the areas with the most stunting rates in Gorontalo. This study aims to provide an overview of the prevalence of stunting and associated factors. This research method is descriptive with a cross-sectional approach in 325 children aged 6-59 months, in 8 villages in Tilango District, Gorontalo Regency. Mothers who met the criteria and came to the posyandu sequentially (consecutive sampling) were given a questionnaire. The prevalence of stunting is 116 (35.7%). Mothers who give birth to children with Birth Length (OR=3.65; 95% CI: 2.261-5.88), Birth Weight (OR:7.3; 95% CI:  3.774-14.238), Exclusive Breastfeeding (OR=3.586; 95% CI: 2.217-5.799, and Complementary Foods (OR=3.586; 95% CI: 2.217-5.799) associating against stunting. The conclusion of this study is that the prevalence of stunting in the Tilango District area is still very high, but only four of the 12 sociodemographic factors studied are associated with stunting. Nutritional status screening, monitoring of weight gain during pregnancy, as well as regular ANC examinations are important for Midwives and pregnant women at every contact, especially in first-level health facilities.