UNIVERSA MEDICINA
Univ Med 2025.
44:50-56
pISSN: 1907-3062 / eISSN: 2407-2230 DOI: https://doi.
org/10.
18051/UnivMed.
ORIGINAL ARTICLE
Effect of the family medicine approach in reducing stunting among toddlers Retno Asti Werdhani1,2.
Vican Sefiany Koloi2 .
Julietta Tantri3.
Abiyyu Ghiyats Mahardika3.
Lydia Rosalina Widjaja3.
Michelle3, and Tiffany3 Department of Community Medicine.
Faculty of Medicine Universitas Indonesia Family Medicine and Primary Care Specialist Study Program.
Faculty of Medicine Universitas Indonesia Koja Sub District Health Centre.
North Jakarta * Correspondence Author:
asti@ui.
Date of first submission.
October 10, 2024 Date of final revised submission.
February 18, 2025 Date of acceptance.
March 3, 2025 Cite this article as: Werdhani RA.
Koloi VS.
Tantri J.
Mahardika AG.
Widjaja LR.
Michelle.
Tiffany.
Effect of the family medicine approach in reducing stunting among toddlers.
Univ Med
44:50-56
ABSTRACT
BACKGROUND
One health indicator assessed for achieving the Sustainable Development Goals (SDG.
is the nutritional status of toddlers.
Stunting, indicating chronic malnutrition in children, remains a pressing concern globally, especially in lowAc and middleAcincome countries.
Stunting is still prevalent in Jakarta as the capital city of Indonesia.
The study's objective was to evaluate the implementation of the family medicine approach on stunting in toddlers in Koja Sub-District.
North Jakarta.
METHODS
A pre- and post-test design study was conducted involving 40 toddlers who were diagnosed with stunting.
Outcome variables were body weight, height, and stunting while the independent variable was the family medicine approach .
ome visits, family education, and monitoring for 3 month.
The Friedman test was used to determine the difference in height and weight after 3 months of the family medicine approach.
RESULTS
After 3 months of the family medicine approach, consisting of holistic history taking, performing a thorough physical examination, educating parents about toddlers' nutritional issues, and conducting routine monthly home visits, the toddlersAo body weight increased by 0.
68 kg and their height increased by 1.
37 cm .
< 0.
The total number of cases of stunting after the family medicine approach decreased by 30% .
from 40 to CONCLUSION There is a decrease in the number of stunting cases after the family medicine approach, but further research is The study findings will help to improve policy measures focusing on the family medicine approach to reduce childhood stunting.
Keywords: Stunting, family medicine, home visit, monitoring Copyright@Author.
- https://univmed.
org/ejurnal/index.
php/medicina/article/view/1544 Sepsis mortality risk factors INTRODUCTION One of the health indicators assessed for achievement in the Sustainable Development Goals (SDG.
is the nutritional status of .
Toddlers are a group that is vulnerable to malnutrition, which will be characterized by According to the WHO, stunting is a disorder of child growth and development due to chronic malnutrition and repeated infections, characterized by below-standard length or .
Furthermore, according to the WHO, stunting is short or very short stature based on height for age, that is less than -2 standard deviations (SD) on the WHO growth curve, and occurs due to irreversible conditions as a result of and/or repeated/chronic infections occurring in the first 1000 days of life.
Severe wasting can increase morbidity and mortality rates and the risk of stunting.
Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients, or impaired nutrient utilization.
Wasting is defined as low weight-for-height, whereas stunting is defined as low height-for-age.
According to the policy direction of the 2020-2024 Indonesian National Medium-Term Development Plan (Rencana Pembangunan Jangka Menengah Nasional.
RPJMN), the target for 2024 was to reduce the prevalence of wasting to 7% and stunting to 14%.
Malnutrition is a nutritional status based on the weight-for-age index (W/A), equivalent to underweight and severely underweight.
Toddlers are considered malnourished if their W/A is less than -3 SD.
Malnutrition is a state of severe energy and protein deficiency .
rotein-energymalnutrition.
PEM) due to a lack of nutritious food and/or characterized by severely thin BMI-for-age.
There is a need for a family medicine approach with holistic diagnosis in toddlers with malnutrition and stunting.
Holistic diagnosis is an approach model that can reveal aspects of social life related to complaints and clinical diagnoses, internal and external risk factors, and also the patient's social function.
comprehensive, integrated, and sustainable/ continuity approach is also needed to achieve optimal patient conditions.
Koja Sub-District is a sub-district located in North Jakarta City and is the cityAos government Based on data on the nutritional status of underfives .
hildren under five years of ag.
from January to May 2023 in the Koja Sub-District, 5 nutritional problems were found among underfives in Koja Sub-District, namely 1,378 cases of low fetal weight (LFW) with weight faltering, 151 LFW with underweight, 106 LFW with wasting, 35 LFW with malnutrition, and 230 LFW with stunting.
Other studies similar to the present study were the one conducted by Insani et al.
on the holistic management of 2-year-old toddlers with nutritional problems through a family medicine approach as well as the study conducted by Hardani and Zuraida .
on the management of malnutrition and stunting in 14-month-old toddlers with a family medicine approach.
The results obtained in both studies showed an increase in knowledge and attitudes about balanced nutrition.
On the other hand, in the present study the researchers conducted consecutive observations for 3 months on the weight changes and stunting of the study subjects.
This study aimed to investigate a family medicine approach as part of weight and height management and stunting in toddlers.
METHODS
Research design This study was a pre-posttest study without a control group using secondary data from patient medical record files from May to July 2023.
This research was conducted at the Koja Sub-District Health Center from October to November 2023.
Study subjects The target population in this study were toddlers with stunting.
The outreach population in this study were toddlers with stunting in Koja SubDistrict.
The study sample consisted of toddlers with stunting in the Koja Sub-District who were followed up by an intern in the Koja Sub-District Public Health Center.
A total of 40 toddlers who were diagnosed with stunting in Koja Sub-District and became part of internship activities for general practioner were included in the study.
All the 40 toddlers who were diagnosed as being stunted were selected according to the data in the medical records as part of the internship coaching program, where there were 4 interns assigned to 10 patients each for 3 months.
Inclusion criteria were toddlers who came to visit the Koja Sub-District Public Health Center and were diagnosed with stunting.
Exclusion criteria were incomplete data in the medical records.
Werdhani RA.
Koloi VS.
Tantri J, et al Family medicine approach The four principles of family medicine are: .
holistic history taking: an in-depth history taking was conducted to identify risk factors of stunting in toddlers.
This includes the histories of diet, pregnancy and childbirth, growth and breastfeeding, comorbidities, and other topics.
thorough physical examination: physical examination from head to toe, accompanied by measurement of height and weight.
education related to attitudes and knowledge about nutritional problems of toddlers and counseling related to balanced nutrition and clean and healthy living behaviors.
routine home visits every month to monitor the weight and height of the toddlers.
Measurements Measurements were taken every month for 3 consecutive months.
The persons taking the measurements were the physician together with the nutrition officer.
The anthropometry measurement tools used were of the ArnezA brand that had been purchased by the Public Health Center and were routinely calibrated every year.
Statistical analysis Data were analyzed with the Friedman test for k-related samples.
A p<0.
05 was used to determine statistical significance.
Ethical clearance This research was approved by the Ethics Committee of the Faculty of Medicine Universitas Indonesia Ae Cipto Mangunkusumo Hospital with KET/749/UN2.
F1/ETIK/PPM.
02/2023.
RESULTS
study due to pain and swelling in the knee, such that weight and height measurements could not be taken, and one toddler was excluded from data analysis due to weight loss.
Therefore, there were 38 toddlers included in this study.
Table 1 describes the characteristics of respondents in this study.
The age of 24Ae60 months was the most frequently found at 73.
and the majority of the toddlers were male at At base-line, body weight was 8.
61 A 2.
kg and height was 81.
11 A 7.
34 cm (Table .
Table 1.
Characteristics distribution in stunted toddlers .
Variables Age .
< 24 Sex Female Male Weight .
Height .
n (%) 10 .
61 A 2.
11 A 7.
Note: Data presented as mean A SD and n (%) Table 2 shows that there were no significant differences in initial body weight and height by age group and sex at the beginning of the study.
Table 3 below shows significant p values for the increase in weight and height over 3 consecutive In the three months following the family medicine approach, which included taking a holistic history, performing a thorough physical examination, educating parents about toddlers' nutritional issues, and conducting routine monthly home visits, the toddlersAo body weight increased 68 kg and the height increased by 1.
37 cm .
<0.
The total number of cases of stunting after 3 months of family medicine approach decreased by 30% .
from 39 to 28 children.
Of the 39 toddlers included in this study, there was one toddler who could not complete the Table 2.
Distribution of age, sex, height, and weight of respondents at base-line Variable Age .
< 24 24 Ae 60 Sex Female Male Weight .
p value Height .
p value* 90 A 1.
32 A 2.
05 A 5.
53 A 7.
86 A 1.
34 A 2.
88 A 9.
35 A 8.
*Independent t-test, data presented as mean A S Universa Medicina.
Vol.
44 No.
1, 2025
Sepsis mortality risk factors Table 3.
Body weight and height after 3 months of family medicine intervention Variable Body weight .
Height .
Month 1 74 A 2.
55 A 9.
Month 2 16 A 2.
09 A 8.
Month 3 42 A 2.
92 A 8.
< 0.
< 0.
*Friedman test for k-related samples.
data presented as mean A SD Body Weight .
p<0.
p<0.
p<0.
Month 1 Month 2 Month 3 Figure 1.
Graphic increases in body weight in 3 months Body Height .
p<0.
p<0.
Month 1 Month 2 Month 3 Figure 2.
Graphic increases in height in 3 months In Figure 1, there is a significant increase in body weight each month.
For Figure 2, there is a significant increase in height from the first month to the second month, and a non-significant increase in height from the second month to the third month, but an overall significant increase in Werdhani RA.
Koloi VS.
Tantri J, et al
DISCUSSION