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php/icmahs Factors That Contribute To The Incident of Stunting Toddler In Working Area of Puskesmas Pupuan II Ni Kadek Vena Malinda Dewi1* 1 Poltekkes Kemenkes Denpasar.
Indonesia *Corresponding author: ayulinda96@gmail.
Article history Posted :
Reviewed :
Received :
2023-10-25
2023-10-22
2023-10-22
ABSTRACT
Background: Stunting has negative impact to the quality of human resources in the future.
The purpose of this study was to determine factors that can contribute to the incidence of stunting toddlers in the working area of the Puskesmas Pupuan II (Public Health Cente.
Method: This descriptive study used cross-sectional approach.
The sampling technique was non probability sampling and the population was mothers with stunting toddlers in the working area of the Puskesmas Pupuan II with total 43 samples.
The data used are primary data that obtained through interviews with respondents and the secondary data collected from the toddler cohort and the Maternal Child Health handbook.
Data analysis used descriptive univariate.
Result: The result of this study showed that the proportion of stunting incidents based on direct causal factors was found as many as .
,8%) of stunting toddlers did not get exclusive breasfeeding, .
%) stunting toddlers had a history of normal birth weight, .
,5%) of stunting toddlers were male, .
,7%) mothers of the sunting toddlers had a normal nutritional status during pregnancy, .
,3%) mothers were not anemic during pregnancy, while the proportion of stunting incident based on indirect causal factors showed .
,5%) mothers were not at-risk age during pregnancy, .
,3%) mothers had normal weight, .
,1%) mothers had low education, .
,5%) mothers are unemploye, and .
,8%) the family income is low or below the minimum wage.
Conclusions: ResearchersAo suggestions are Public Health Center heve to be more active in socializing the effects of stunting and its prevention and as well as mobilizing community leaders in sensitive nutrition interventions.
Keywords: Direct Causal Factors.
Indirect Causal Factors.
Stunting.
Toddler
Ni Kadek Vena Malinda Dewi : Factors That Contribute To The Incident of Stunting Toddler In Working Area of Puskesmas Pupuan II
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php/icmahs INTRODUCTION The life cycle of toddler is the golden period of the child's growth and development process which will provide provisions for the next phase of life.
A child's growth during toddler years can be measured through height and weight adjusted for age.
It is important for children to have sufficient height and weight, because this will affect their development, including the development of gross motor skills, motoric skills and cognitive development of the However, one condition that can highly affect a child's development is stunting.
Stunting is not only a problem of impaired physical growth, but also causes children to become sick easily, can experience impaired brain development and affects the productivity of children's performance in the future so that, stunting can become a major threat to the quality of human resources in Indonesia in the The regulation of Minister of Health of the Republic of Indonesia Number 2 of 2020 concerning Anthropometric Standards for assessing children's nutritional status states that stunting or short stature is a nutritional status based on the height index for age (TB/U) with a z score of less than -2 SD .
tandard deviatio.
(Ministry of Health of the Republic of Indonesia.
Furthermore, stunting is caused by direct factors, namely family and household factors such as poor nutrition during preconception, complementary feeding, several problems in providing breast milk, infections, and endocrine Meanwhille the indirect causes of stunting are maternal characteristics consisting of maternal age, maternal education, maternal occupation, family income, and maternal knowledge about nutrition (Rahayu, et al.
, 2.
Malnutrition during pregnancy to the first 1000 days of birth also influences the incidence of stunting.
One of the effective concepts for treating stunting is prevention in the first 1000 days of life.
Pregnancy preparation, health services for breastfeeding mothers, babies and toddlers are specific forms of intervention for handling stunting (Ministry of Health of the Republic of Indonesia, 2.
Midwife as a profession in carrying out midwifery practice have duties and authorities including maternal health services and child health services, as stated in Undang-Undang No.
4 of 2019 concerning Midwifery .
In the Republic of Indonesia Minister of Health Regulation no.
28 of 2017 concerning Licensing and Implementation of Midwife Practice (Chapter II article .
, midwife have the authority to provide maternal and child health Article 24 paragraph .
in the Regulation also outlines the authority of midwives based on government programs according to needs as intended in article 22 paragraph .
where midwife carry out community participation in the field of maternal and child health as well as school-age children.
The scope of midwifery services in providing maternal and child health services in carrying out their roles as implementers, service managers, as educators and as researchers in the success of government programs, especially reducing stunting through prevention in the first 1000 days of life.
In correlation with National Medium Term
Development Plan
(RPJMN)
regulated in Presidential Regulation Number 18 of 2020, the Indonesian government targets the stunting rate is decrease by 14% in 2024.
However, the prevalence of stunting toddlers from the results of the 2021 Indonesian Ni Kadek Vena Malinda Dewi : Factors That Contribute To The Incident of Stunting Toddler In Working Area of Puskesmas Pupuan II
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php/icmahs Nutrition Status Survey (SSGI) in Indonesia is still Bali Province has stunting incidence rate 9%, which is the province with the lowest national stunting rate.
The incidence of stunting in Tabanan Regency in 2022 is 8.
2% of the total height of children under five whose height is Data from the Tabanan District Health Service for 2021 shows that the top three sub-districts with high stunting incidence rates in Tabanan district include Marga.
Pupuan and West Selemadeg sub-districts (Tabanan District Health Service, 2.
Thus, authors are interest to determine the cross-program and crosector participation efforts which has been done to reduce stunting rates in Tabanan District of Bali Province, especially in Pupuan.
Registered data from cohorts of infants and toddlers at the Puskesmas Pupuan II (Community Health Cente.
in 2022, whose working area consists of seven villages, namely Kebon Padangan.
Belimbing.
Jelijih Punggang.
Karya Sari.
Sanda.
Batungsel, and Padangan, there are 43 toddlers, 5.
6% of the total 765 toddlers measured based on PB/U experienced stunting in the category of 38 toddlers being short and as many as 5 toddlers being very short.
Based on previous reports on the determinants of stunting, it was found that most stunting toddlers did not receive exclusive breast milk, came from mothers with CED and anemia during pregnancy, were at risk, had a family income below the minimum wage, and toddlers had a history of low birth weight.
Efforts to overcome the direct causes of stunting have been carried out by the Puskesmas Pupuan II namely screening for risk factors for stunting starting from pregnancy, counseling on stunting prevention in pregnant women's classes, monitoring the growth of toddlers through weighing and measuring height, counseling regarding the importance of exclusive breastfeeding, as well as providing additional food (PMT) in Integrated Healthcare Center.
Given this background, the present study was performed to conducting research related to the factors that contribute to the incidence of stunting in toddlers in the working area of Puskesmas Pupuan II.
By assessing these factors, the data obtained can be used as a basis for further research and contribute in policy making in the context of maximizing intervention efforts to overcome stunting in Indonesia.
METHOD
This research was using descriptive with crossectional approach to determine the characteristic attributes of respondents which carried out at a time without any follow-up.
This research was conducted to determine the factors that contribute to the incidence of stunting in toddlers in the work area of the Puskesmas Pupuan II.
There were four main steps of the study, first we conduct preliminary study including journals review and observe research location.
Second, we determine the problem, including research design, population, and sample.
Third, we look after the ethical clearance and research permit.
After obtaining legality, we carried out the research starting from collecting data, data analysis, and presenting the data.
The location of this research was carried out from March to April 2023 in the work area of Pupuan II Publich Health Center which covers 7 villages including Kebon Padangan Village.
Belimbing Village.
Jelijih Punggang Village.
Karya Sari Village.
Sanda Village.
Batungsel Village, and Padangan Village.
The population was all mothers with stunting toddler, totaling 43 people.
The research sample was Ni Kadek Vena Malinda Dewi : Factors That Contribute To The Incident of Stunting Toddler In Working Area of Puskesmas Pupuan II
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php/icmahs respondents who were in accordance with willingness to be involved in this research.
inclusion and exclusion criteria, the number of they agree, then it continued with explanation samples in this study was 43.
The sample was regarding the interview procedure and data given prior explanation regarding the aims of collection through asking a list of questions this research and asked for their consent and according to the interview guidelines.
RESULTS
Incidence of Stunting Toddlers Based on Direct Causation Factors Research data of stunting incidence in toddlers based on direct causation factors can be seen in Table 1 as follows.
Table 1.
Incidence of Stunting Toddlers Based on Direct Causation Factors Characteristic Frequency History of exclusive breasfeeding Yes
Total
History of low birth weight (LBW) Normal
LBW
Total Gender Male Female Total MotherAos nutritional status during pregnancy Chronic energy deficiency No chronic energy deficiency Total MotherAos hemoglobin (H.
during pregnancy Anemia Normal Total Percentage (%) Based on data in Table 1 above, it can be majority .
%) of stunting toddlers had normal seen that of the 43 respondents in terms of birth weight.
Based on the gender characteristics direct causal factors, the incidence of stunting is of toddlers, it was found that the majority based on a history of exclusive breastfeeding, .
5%) were male and nutritional status of the majority of toddlers .
8%) did not received mothers during pregnancy majority .
7%) did exclusive breastfeeding.
Based on the history of not have chronic energy deficiency during low birth weight (LBW), it was found that the Based on maternal hemoglobin
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php/icmahs levels during pregnancy, it was found that the anemia during pregnancy.
3%) of respondents were not Incidence of Stunting Toddlers Based on Indirect Causation Factors Research data of stunting incidence in toddlers based on indirect causation factors can be seen in Table 2 as follows.
Table 2.
Incidence of Stunting Toddlers Based on Indirect Causation Factors Characteristic Age At-risk Not at-risk Total Body Height Normal Short Total MotherAos Education Low Height Total MotherAos Occupation Working Unemployed Total Family Income <Minimum wage OuMinimum wage Total Frequency Percentage (%) Based on Table 2 above, of the 43 respondents Based on family income, it was in terms of indirect causal factors, the incidence found that the majority .
8%) had a family of stunting based on maternal age was mostly income in the low category or below the found in mothers who were not at risk .
5%).
minimum wage.
Based on the mother's height, it was found that most of mothers had normal height .
3%).
Based on the mother's education level, it was found that the majority .
1%) of them had low .
DISCUSSION
Description of stunting incindence in toddlers based on the direct causation of stunting in the working area of Puskesmas Pupuan II
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php/icmahs History of Exclusive Breastfeeding value is 0.
001 with a CI of 95%, meaning that Exclusive breastfeeding means that babies there is a relationship between the history of are only given breast milk for the first 6 months exclusive breastfeeding and the incidence of of life without any additional drinks or food stunting in toddlers.
xcept medicine and vitamin.
Breast milk is a Interviews conducted with respondents liquid that contains antibodies and also lots of related to exclusive breastfeeding showed that protein, carbohydrates, fat which easily digested the average respondent did not breastfeed and absorbed that cannot be found in other exclusively because the mother's breast milk did types of milk, so breast milk is very important in not come out immediately when the baby was supporting the growth, development and born, there were those whose breast milk came nutritional status of children (Fitriahadi dan out after 3 days or more.
Since the parents Enny, 2.
After exclusive breastfeeding for 6 worried about the baby in hunger, then decided months, it can be continued to provide breast to give the baby formula milk.
There are even milk until the child is 2 years old along by mothers who admit that breast milk has not providing complementary foods for breast milk.
come out since birth at all.
Mothers decide to Children who are exclusively breastfed will have give formula milk sometimes also because they naturally formed immunity obtained from breast don't know the importance of breast milk and milk to prevent children from getting sick easily.
the benefits of breast milk for their baby's health Therefore parents, especially mothers are and growth.
encourage to give exclusive breastfeeding to their toddlers (Septikasari, 2.
However, this research data showed that History of low birth weight (LBW) Low birth weight (LBW) is caused by the the stunting toddlers did not receive exclusive breast milk, namely 30.
2% .
and those who received exclusive breast milk were retardation and when the baby is born, they 8% .
This results is in line have low birth weight.
The long-term problem with the results of research conducted by caused by LBW is hampered growth and Nurjanah .
in the work area of the Low birth weight is believed to be Klecorejo Health Center.
Madiun Regency, which one of the factors causing malnutrition in the based on chisquare test analysis show that the p
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php/icmahs form of stunting in children (Fitriahadi dan Enny, suboptimal eating patterns and a history of The results of this study showed that the If these factors are lasts for a long majority of respondents did not have low birth time during the child's growth period, the child weight .
tunting in toddlers with a birth weight can lose nutrients in the body, resulting in a <2,500 grams was 14% .
) and decrease in nutritional status.
stunting in toddlers with a normal birth weight/Ou2,500 grams was 86% .
Gender of the child This result is in line with the results of research The research results show that the conducted by Pardede .
in Muara District majority of toddlers who experience stunting which showed that 1 toddler .
%) was LBW 5% male, while 39.
5% of stunted did not experience stunting, while there were 28 toddlers were female.
This is in accordance with toddlers who had a normal birth weight, so that Taguri .
research in two studies conducted statistical tests showed that birth weight had no in three different countries (Libya.
Bangladesh influence on the incidence of stunting with a p and Indonesi.
, showing that the prevalence of value of 1,000.
stunting is greater in male compared to female.
The size of the baby at birth is related to The results of Sema's research .
also show the size of the child's growth because the baby's that the child's gender is a strong predictor of body size is related to the child's linear growth.
stunting and severe stunting in children under However, as long as the child gets adequate five, which female toddler have a lower risk than nutrition and is maintained in good health, body During infancy and childhood, female tend length or physical condition can be followed by to be less likely to become stunting and severely growth as the child gets older, but cognitive development cannot be pursued or repaired In contrast to the results of research because it is permanent (Fitriahadi dan Enny, conducted by Pardede .
using a cross- sectional research design, there was no There are other factors that contribute relationship between gender and the incidence beyond the child's birth weight which increase of stunting in toddlers aged 24-59 months in the child's chances of experiencing stunting, in Muara District with a p value = 0.
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php/icmahs Researchers believe that this can happen This is not aligned with research because male's nutritional needs are greater conducted at the Tawiri Community Health than female.
Male toddlers tend to be more Center.
Ambon City, where pregnant women active in activities which expend more energy, with KEK during pregnancy were 4.
85 times especially if this condition is along with child who more likely to have stunting children compared has difficulty eating.
If there is a lack of fulfilling to mothers who did not have KEK (Ruaida and the required nutritional intake, it will increase Soumokil, 2.
Likewise, research conducted the risk of nutritional problems.
by Alfarisi, et al .
in Lampung Tenga Regency in Lampung Province with the results of Mother's nutritional status during pregnancy Chronic the analysis obtained an OR value is 2.
means that the nutritional status of mothers inadequate reserves of nutrients needed by the during pregnancy who experienced KEK had fetus in the womb, while in the womb, the fetus 228 times greater risk of stunting in toddlers will grow and develop.
The fetus has high compared to mothers who did not have KEK.
plasticity, meaning that the fetus will easily Researchers believe that this may be due adapt to changes in its environment, both to the high level of achievement in handling KEK beneficial and detrimental.
Malnutrition that cases in Puskesmas Pupuan II made pregnant occurs in the womb and early in life causes the women who potentially experience chronic fetus to undergo an adjustment reaction.
energy deficiency can be immediately treated by parallel, these adjustments include slowing health workers, so that intervention can be growth with a reduction in the number and carried out as early as possible.
Interventions development of body cells.
The results of given to pregnant women can improve their adaptive reactions due to malnutrition are nutritional status, including increasing the baby's expressed in adulthood commonly as a short weight and baby body length.
The existence of a body shape.
supplementary feeding program (PMT) for The results of this study show that the pregnant women who suffer from KEK is one nutritional status of the majority of respondents form of intervention provided so that the baby in during pregnancy did not experience chronic the womb can continue to grow and develop energy deficiency (KEK), namely 90.
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php/icmahs Mother's hemoglobin during pregnancy looked at the first trimester in the MCH book Iron is one of the substances that plays data, so progress in treating anemia in the final role in bone formation.
Iron plays a role as a trimester was not visible.
Reseacrher believed distributor of oxygen to all body tissues and if that optimal treatment of anemia cases oxygenation to the bones is decrease, then the accompanied by early intervention in cases of bones cannot grow optimally.
Iron deficiency can anemia, pregnant women who were known to give serious impact on the bones, affecting bone have anemia from the start in the first trimester mineral density, mineral content in the bones will no longer be anemic in the third trimester.
and the strength of the femur.
A study Interventions given to pregnant women through conducted by Angeles in 1993 in Indonesia regarding iron supplementation in children aged monitoring can increase the Hb levels of 2-5 years showed that there were significant pregnant women in Puskesmas Pupuan II.
changes in height and height-forage z-score after iron supplementation.
Description of stunting incidence in toddlers The results of this study showed that the (H.
pregnancy was mostly normal, namely 88.
based on indirect causation of stunting in the work area of Puskesmas Pupuan II.
Mother's Age respondent.
7% .
had anemic The results of this study showed that during pregnancy.
This is not in line with 5% .
of respondents had a non-risk research which states Hb level of pregnant age when pregnant and 39.
5% .
women is related to the length of the baby that of respondents had a non-risk age when will be born.
The higher the Hb level, the longer The results of this research are in line the size of the baby that will be born (Ruchcayati, with research conducted by Agustiningrum This research is in line with the results of .
which stated that there was no research by Ruaida .
at the Tawiri Health relationship between maternal age and the Center.
Ambon City, which stated that anemia in incidence of stunting in children under five and pregnant women was not related to the maternal age was not a risk factor for incidence of stunting .
value>0.
This can happen because the mother's However, this study did not look at the incidence of anemia in all trimesters but only nutritional status is good, so she requires small
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php/icmahs adjustments will occur such as increasing the Center and Rensing Health Center Working efficiency of the body's metabolism and reducing Areas, the number of mothers whose height was physical activity during pregnancy.
Young below standard (O145 c.
had children with mothers do not necessarily have poor parenting normal growth and development as high as 1 patterns because information and experience person .
6%), while mothers who had normal today are easy to obtain from various sources height (Ou146 c.
had 64 children with normal and does not look at age.
growth and development .
2%).
The results of this study are not in line with Mothers and fathers who are classified as the results of research conducted by Wemakor short tend to have children who have the et al .
in Ghana which stated that maternal potential to have a short body due to genetic age had a significant relationship with the factors in the chromosomes that carry the trait incidence of stunting in toddlers.
Toddlers of stunting.
Apart from this, an individual's whose mothers are teenagers have eight times height is also influenced by other factors such as the risk of experiencing stunting compared to nutritional intake and history of illness.
For mothers old enough to conceive and give birth.
children who experience stunting due to lack of The results of this study are also in line with nutritional intake from an early age, stunting in research conducted by Menggala, et al .
their offspring can be intervened (Larasati et al, which states that maternal age that is too young (<20 year.
and too old (>35 year.
has a The results of this research show that the significant relationship with the incidence of majority of respondents' education level during stunting and is four times higher risk.
pregnancy, 65.
1%, had a low level of education, stunted offspring compared to mothers with the 9% of respondents had a high level of ideal age .
-35 year.
This shows that most cases of stunted toddlers in the Puskesmas Pupuan II work area Mother's height have mothers with low levels of education The results of this study showed that 4.
unior high school level and belo.
Toddlers of respondents had short bodies and the born to educated parents have a lower risk of majority, namely 95.
3%, had normal height.
This stunting than toddlers whose parents are is not in line with the results of Safinatunnaja This is because parents who have .
research conducted in the Terara Health
higher education have access and find it easier to Ni Kadek Vena Malinda Dewi : Factors That Contribute To The Incident of Stunting Toddler In Working Area of Puskesmas Pupuan II
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php/icmahs receive health education during pregnancy, for stunting and 9 people .
%) toddlers who did example in understanding the importance of not stunting, so the results of the research show meeting nutritional needs during pregnancy and that there is no influence of maternal providing exclusive breastfeeding for 6 months.
employment on the incidence of stunting in toddlers aged 24-59 months .
= 0.
Mother's employment status ResearchersAo point of view, work is an important The research results showed that most factor in determining income which ultimately mothers of stunted toddlers did not work, 60.
determines the quality and quantity of adequate .
5% .
of family nutrition.
stunted toddlers whose mothers worked.
The majority of respondents who work have non- Family income formal jobs whose income is not fixed, such as Family income plays a very important role farmers, traders, planters, namely 70.
5% .
in fulfilling family nutrition.
The level of income respondent.
, while respondents who have jobs will affect the purchasing power of the family with a fixed income are 29.
4% .
including fulfilling food consumption.
The higher The results of this study are not in line with the income level of a family, the more budget research conducted by Adyas .
in Lampung allocation it will have to purchase food needs Province showing that working mothers have a such as side dishes, vegetables, fruit and others risk of having children with stunted nutritional to meet the family's nutritional needs (Fikawati status of 4,808 times compared to mothers in and Syafiq, 2.
the non-working category.
The results of this The results of this research show that the research are in line with research conducted by majority of respondents' family incomes are in Pardede .
in Muara District.
North Tapanuli the low category (< Rp.
2,625,.
Regency.
North Sumatra Province on 87 mothers and respondents with high family incomes (OuRp.
of toddlers, of which 76 mothers did not 2,625,.
) are 44.
This is in accordance with work/did not have a fixed income, 25 people research conducted by Nurmalasari, et al .
9%) of toddlers experienced stunting and 51 where it was found that there was a relationship .
1%) toddlers who were not stunted, while of between family income and the incidence of the 12 mothers who worked/had a fixed income stunting in toddlers in Mataram Ilir Village, there were 3 .
0%) toddlers who experienced Seputih District.
Surabaya, where families with Ni Kadek Vena Malinda Dewi : Factors That Contribute To The Incident of Stunting Toddler In Working Area of Puskesmas Pupuan II
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php/icmahs middle income had a 2.
2 higher risk of having with stunting compared to children with high income respondents.
Some factors Conflict of Interest The authors declare that they have no conflict of interest.
that cause nutritional problems are poverty.
Poverty is considered to have an important Acknowledgment reciprocal role as a source of nutritional This study funding was supported by the problems, namely poverty causes malnutrition, research grant of Department of Midwifery, whereas malnourished individuals will slow Poltekkes down economic growth and increase a country's Indonesia.
Kemenkes Denpasar.
Denpasar, poverty rate.
REFERENCES