ECONOMIC EVALUATION OF HEALTH SYSTEMS IN NUTRITIONAL IMPROVEMENT CONTROL FOR PREGNANT MOTHERS AND NUTRITIONAL STATUS OF STUNTING TODDLERS TO THE POOR POPULATION IN CENTRAL
SULAWESI INDONESIA
SITTI RAHMAWATI,SE., M.Si
DEPARTMENT FACULTY OF ECONOMIC AND BUSINESS TADULAKO UNIVERSITY CENTRAL SULAWESI-INDONESIA
PRESENTED PAPER INTERNATIONAL CONFERENCE " THE FOURTH POSTGRADUATE FORUM on HEALTH SYSTEM S AND POLICY 26-27 JULY 2010 at
FACULTY of MEDICINE, NASERUAN UNIVERSITY HAT HAI- THAILAND 99 Moo, Tha Pho ,Muang , Pitsihanulok 65000 Thailand
ABSTRACT INTRODUCTION
In 2019, the prevalence of stunting (short toddlers) in the Central Sulawesi Province, either urban or rural areas, was 32%. It was still above the national average of 28%. The stunting problems above 20%
indicate a community problem in Indonesia.
The objective of the study was to determine the distribution of stunting events based on socio-economic characteristics, and factors related to the incidence of stunting risk in toddlers aged 12 months – 36 months, and the stunting policy model applied in health programs in an effort to improve the nutritional status of toddlers.
Research Method
The research sample, sample in this study was stunting toddlers, under five and three. The sample was taken by the census method, and two villages were selected according to the sampling strata. The number of respondents involved as the sample was 90 respondents. The technical analysis of the data in this study was done using cross-tabulation analysis with the Chi-square analysis method and percentages. The unit of analysis in this study was pregnant women who had children under five and were seen from the socio- economic aspects of the family.
Research Findings. It was found that stunting in under-five nutrition with Chi-Square and OR (Odd Ratio) statistical tests that family support variables greatly influenced the incidence of stunting risk, and what needs to be done is that the community is given health education about nutritious eating patterns in preventing stunting. This is necessary to be done by the community to improve nutrition-conscious behavior. Other supporting variables, namely health information media factors, health facilities, knowledge of nutrition for pregnant women, immunizations, knowledge of body weight, and additional food patterns, had an indirect effect on stunting toddlers. Other supporting factors, namely socio- economic factors are very influential on the stunting case, such as the level of poverty, environment, income, and the number of family members.
Conclusion
Stunting prevention can be done by working across sectors in the health sector and other fields, especially in health centers and hospitals by providing health promotion related to the growth and development of children under five, aged 12 – 59 months. It is expected that pregnant women when carrying out pregnancy checks in health services should be given knowledge in the form of stunting prevention stickers through increasing income, improving eating and health care patterns, increasing food availability through the use of yards as a source of food, and family nutrition and improving environmental sanitation.
Keywords: economic evaluation, pregnant women, stunting children, under-five nutrition.
I. INTRODUCTION
In the Millennium Development Goals document, which is a sustainable development goal, in September 2000, 189 UN member countries agreed to eight Millennium Development Goals (MDGs), namely a commitment to achieve real progress in efforts to alleviate poverty and achieve other human development goals by 2015. The MDGs are the strongest statement of the international commitment to eradicating global poverty (Todaro, M and Smith S, 2006).
The MDGs recognize the multidimensional nature of development and poverty alleviation, eradicating poverty. The eight goals are very ambitious. They are to eradicate extreme poverty and hunger, provide universal primary education, support gender equality, and women's empowerment, reduce child mortality, improve maternal health, prevent HIV/AIDS, malaria, and other diseases, maintain ecological balance and develop global cooperation for development. The main focus of the MDGs is on the problem of severe poverty and hunger and reducing the issues on nutritional status of children under five in developing countries.
According to WHO (UNICEF, 2003), improper feeding can result in children suffering from malnutrition. The phenomenon of “failure to thrive” or growth faltering in Indonesian children begins to occur at the age of 4-6 months when the baby is given supplementary food and continues to worsen until the age of 18-24 months. Malnutrition contributes to 2/3 under-five death worldwide. Two-thirds of these deaths are related to feeding practices such as exclusive breastfeeding and inappropriate complementary feeding in infants and early childhood.
Global studies have proven that exclusive breastfeeding is the health intervention that has the greatest impact on the safety of children under five, namely 13 percent of under-five deaths can be prevented around 22% of neonatal deaths (neonates are infants aged 0 to 28 days). Timely and quality complementary feeding can reduce under-five mortality by 6%
(Jones et.al., The Lancet, July 2003).
According to Alma Ata Center For Healthy Life and Food (2010), this special program in the field of nutrition includes behavioral changes/improvements in the pattern of supplementary feeding by providing micronutrients, as well as the importance of hygiene.
The description of the basic model used to improve the maternal and child nutrition program by carrying out the followings several activities: 1) Making nutritious food with local ingredients, given to pregnant women who are breastfeeding in the form of food rations; 2)
Creating communication materials for behavioral change; 3) Partnering to share costs with local and national stakeholders; 4) Assisting in the planning of food and nutrition assistance at the provincial level; 5) Activities to improve ability; 6) Creating a training module for Feeding Infants and Young Children; 7) Directing provision of nutritious food specifically locally produced through Integrated Healthcare Center for children aged 6-23 months, pregnant and lactating women in the first 6 months after giving birth; 8) Improving infant and young child feeding, including complementary feeding through training to change one’s life behavior and economic support.
The nutritional status of children under five is one of the main predictors of the survival of a child. Malnutrition is a major public health problem experienced by most developing countries. It is estimated that around 151 million children in the world are stunted and 83.5 million of them are from Asia, as well as thin women, out of 51 million in the world, 35 million of whom are in Asia.
II. LITERATURE REVIEW
Fundamental Concepts of Stunting (Short Children)
According to the Ministry of Health of the Republic of Indonesia (2010), stunting is a condition of failure to thrive in children under five as a result of chronic malnutrition, causing children to be too short for their age. What causes stunting is the lack of nutritional intake received by the fetus. Stunting is a serious threat to Indonesian children nowadays. The issue of malnutrition is big as seen from the Indonesian nutrition data. About 10.2% of babies in Indonesia are born with low birth weight (<2,500 grams), and 19.6% of children under five in Indonesia have a weight that is not following their ideal body weight (undernourished) and 37.2% of children under five in Indonesia have a height that is not following their age (short).
Currently, around 8 million Indonesian children experience suboptimal growth, and stunting occurs in the womb and will appear when the child is 2-year-old. The impact of stunting is susceptibility to disease and reduced cognitive abilities. Furthermore, when they are old, they are at risk for diseases related to diet, unbalanced body function, not optimal adult body posture, and this might result in economic losses.
Stunting Prevention Concept in the First 1000 Days of Life
Stunting prevention can be carried out in the first 1,000 days of life, by handling stimulation-nurturing and continuing education. The pillars of stunting handling can be carried out, namely: Pillar 1, the commitment and vision of the highest leadership of the state; Pillar 2, national campaigns focused on understanding, behavior change, political commitment, and accountability; Pillar 3, convergence, coordination, and consolidation of national, regional, and community programs; Pillar 4, encouraging “nutritional” food security policies. Pillar 5, monitoring and evaluation. Specific Nutrition Interventions for maximum growth and development of children (with emotional, social, and physical abilities ready to learn, innovate and compete in increasing competitiveness and reducing inequality) (Indonesian Ministry of Health, 2009). Stunting is a nutritional problem, the results of monitoring that stunting or stunted body growth is a form of malnutrition characterized by height for age below the standard deviation (<4) concerning the World Health Organization (WHO, 2005). Stunting is a long-term reflection of inadequate food quality and quantity and suffering from infectious
during childhood. Stunting children are the result of chronic nutritional problems as a result of poor-quality food, coupled with morbidity, infectious diseases, and environmental problems.
Indonesia Basic Health Research Results (Basic Health Research, 2010) show that Indonesia is one of 36 countries in the world that contributes 90 percent of the world's nutritional problems. the prevalence of stunting in toddlers is 35.6%, consisting of 25.5% very short and 21.4% short. This prevalence rate is higher than the prevalence of undernutrition (23.4%), poor nutrition (18.9%), and overnutrition. Besides hormonal factors, genetics and low parental knowledge in parenting, poverty, low environmental sanitation, low food accessibility at the family level, especially in poor families, are factors that affect stunting.
Of all the factors studied, infectious disease factors showed the greatest value as a risk factor for stunting in toddlers (under three years). This supports a study conducted by Gibson (2010), which states that linear growth disorders (stunting) often occur in poor toddlers in Peru, the average child is 24 months old with an average height of 2.5 centimeters shorter than international standards. Moreover, diarrheal disease is significantly associated with the incidence of stunting during childhood. A study conducted by Tanziha and Kusriadi in 2010 indicates that infectious disease was associated with stunting in toddlers in West Nusa Tenggara. Another study was conducted by Siti Rahmawati (2010) indicates that infectious diseases that mostly suffered by under three in North Lore Subdistrict, Wuasa Village, Poso Regency were ARI and diarrhea (65%). Stunting children are more likely to suffer from infectious diseases with a longer duration of time.
According to Van der Hoek, W. Feenstra, SG Korandson, F (2002), the environmental factor that is at risk for stunting in toddlers is that poor environmental sanitation is higher than good sanitation. This happens because most of the toddler’s residences do not meet the requirements for healthy homes, lack of ventilation and lighting, no garbage disposal, and no family latrines, as well as supported by low family economic conditions. From the multivariate analysis, environmental factors had a significant risk (p-value > 0.05) for toddler stunting.
Regression Test on the logistics of food availability had a p-value of 0.018 and OR of 5.64 which can be interpreted that low family food availability can increase the risk of 5.64 times greater to produce stunting children compared to good family food availability. The low availability of food threatens to reduce the consumption of diverse and nutritionally balanced and safe foods at the household level. At last, it might have an impact on the severity of the nutritional problems of the community, including stunting in toddlers.
RESEARCH METHOD
Research Method. This study involved under five years old and three years old children with stunting conditions. The sample was taken using the census method, and two villages were selected according to the sampling strata. The number of respondents involved as a sample was 90 respondents. The data analysis technique used in this study was cross-tabulation analysis with Chi-square and percentage analysis method. The unit of analysis in this study was pregnant women who had toddlers and were seen from the socio-economic aspect of the family. The data were collected using observation, and interviews with respondents.
FINDINGS
The Influence of Socio-Economic and Cultural Factors on Behavior of Nutritional Status of Pregnant Women
The behavior of the nutritional status of pregnant women in childbirth is influenced by other variables, namely family support, health information media factors, health facilities factors, and external factors. The strong support of external factors for safe delivery behavior, and high material social values led to external factors with a standard deviation of 2.25 and a minimum value of 6, and a maximum of 17. The media and health facilities were factors with a standard deviation of 1.059 with a minimum value of 1 and a maximum of 7. This means that the quality of the social status of the mother and wife in the family is indicated by the position and function of the wife/mother being equal to the husband. Thus, the wife is given the same authority as the husband. Childbirth assistants and the safety of the mother/wife during childbirth should be prioritized in safe health care places such as health centers or hospitals.
Table 1. Descriptive Statistics
Regency Family
support
Health information
media factor
Health facility
factor External factor
Poso N 45 45 45 45
Sum 204 158 202 564
Mean 4,53 3.51 4.49 12.53
Mean
Weight 0.7556 0.5852 0.7526 0.6963
Minimum 2 1 1 10
Maximum 6 6 6 16
Std.
Deviation 1.100 1.254 1.160 1.575
Sigi N 45 45 45 45
Sum 217 152 211 580
Mean 4.82 3.38 4.69 12.89
Mean
Weight 0.8074 0.5630 0.7815 0.7160
Minimum 0 0 3 6
Maximum 6 6 6 17
Std.
Deviation 1.542 1.723 0.949 2.773
Total N 90 90 90 90
Sum 421 310 413 1144
Mean 4.68 3.44 4.59 12.71
Mean
Weight 0.7815 0.5741 0.7670 0.7062
Minimum 0 0 1 6
Maximum 6 6 6 17
Std.
Deviation 1.339 1.500 1.059 2.250
Source: Primary data, 2019
In terms of family support, a mother's safety during childbirth is very important. Strong social support can be shown by many relatives, cadres, village officials, and health workers who recommend giving birth at a health facility, facilitating in taking care of the guarantee of childbirth costs. Family support can also be in the form of many relatives and neighbors who are ready to help take care of family members when left to give birth at a health facility. The high social value of the mother is indicated by the mother's values in continuing the lineage, helping colleagues carry out social duties in the community, protecting the name of husband and family, allowing the husband to do economic activities in supporting the family's economic needs.
Nutritional Status of Toddlers and Stunting (Short Children)
The development of healthy, intelligent, and productive human resources is a global commitment and a very valuable asset for the Indonesian nation and state, which is manifested among other things by improving optimal nutrition and health. One of the indicators used as a barometer to assess the quality of human resource development is the Human Development Index (HDI). Health development policies are directed at improving access and quality of health services in order to achieve the targets of the National Medium-Term Development Plan (NMTDP) in the health sector for 2010-2014, which contributes to the acceleration of the Minimum Development Goals (MDGs) targets, among others, to reduce the prevalence of malnutrition in children under five to a maximum of 15.5% in 2015. To realize the achievement of the NMTDP target, health development policies are directed, among others, through increasing efforts to improve community nutrition with a continuum of care approach carried out by every life cycle, especially since the first 1,000 days of life, school-age children and adolescents, pregnant women, postpartum mothers, working-age, and elderly. The policy for improving community nutrition is directed at increasing the commitment of stakeholders to strengthen the implementation of nutrition programs in Central Sulawesi, which are directly and indirectly based on the concept or mindset of the causes of nutritional problems as described below:
The behavior of the nutritional status of pregnant women in childbirth is influenced by the strong social environment support for unsafe delivery behavior and financial support from the husband in terms of inadequate needs and sufficient for family needs. The standard deviation for health services was relatively small at 0.949 because access to health services to health service centers and hospitals is very far. Thus, people often did not go to health services but seek treatment at village midwives and traditional birth attendants. Furthermore, external factors had a significant effect of 2.773, as well as the behavior of the nutritional status of pregnant women was influenced by the strong support from the social and cultural environment for unsafe delivery behavior and financial support from husbands who are inadequate in meeting the economic needs of the family. Thus, children born might be malnourished or stunted (short children). Although there had been a significant decrease in the prevalence of undernourishment, the absolute number of malnourished children is still relatively large.
With the prevalence of malnutrition, the proportion of underweight children under five years old (BMI < 19.80) for Poso Regency was 22.22% (Poso Regional Health Office, 2010), and Sigi Regency was 11.24% for a total of 22.47%. moreover, the proportion of under-fives with moderate nutrition (BMI 19.80 – 26) for Poso Regency was 66.7% and Sigi Regency was 75%, and the proportion of under-five nutrition was overweight > 26, for Poso Regency of 11.11% and Sigi Regency of 1.12%. the results of Basic Health Research (2010) showed that the prevalence of malnutrition was 5.7%, indicating that there are more than 1 million children who suffer from malnutrition spread throughout Indonesia. Short Toddler, in addition to a fairly high prevalence, the impact harms the quality of growth
and development of children. Besides the problem of under-nutrition and stunting, the proportion of obese children is also quite high, at 6.74% in Central Sulawesi Province.
Table 2. Nutritional Status Trends in Proportion of Undernourished, Short, Thin, and Fat Toddlers
Regency Thin
(IMT <
19.80)
Moderate (IMT 19.80 -
26)
Over weight (>
26)
Poso Count 10 30 5 45
% within
Regency 22.22% 66.67% 11.11% 100.00%
% of Total 11.24% 33.71% 5.62% 50.56%
Sigi Count 10 33 1 44
% within
Regency 22.73 75.00 2.27 100.00
% of Total 11.24 37.08 1.12 49.44
Total Count 20 63 6 89
% within
Regency 22.47% 70.79% 6.74% 100.00%
% of Total 22.47% 70.79% 6.74% 100.00%
Source: Primary Data, 2019
Improvement and welfare of the community through efforts to improve nutrition was carried out with a continuum of care approach according to the life cycle from pregnancy, childbirth, postpartum mothers, infants, toddlers, adolescents, adults, and the elderly. Priority intervention in the period of the first 1,000 days of life, i.e., during pregnancy until the child is 23 months old.
Community nutrition development activities aim to increase the coverage and quality of family nutrition services to improve the nutritional status of pregnant women, breastfeeding mothers, infants, and toddlers.
Promotive activities are activities carried out at the community level by the community and officers. Their activities include growth monitoring, counseling on infant and child feeding, administration of high-dose vitamin A capsules every 6 months, administration of blood-added tablets to pregnant women, promotion of iodized salt, tracking and follow-up of malnutrition cases. Preventive activity is the provision of additional food for recovery for undernourished or underweight children. Supplementary food is provided in the form of local food with recommended recipes. Curative activities are in the form of management of malnutrition both inpatient and outpatient.
Table 3. Consumption of Pregnant Women
Regency
Daily Consumption of Pregnant Women
Total Staples,
fruit, vegetables
& snacks
Staples, fruit, vegetables
& milk, processed and
products
Stables, fruit, vegetables
& milk, and snacks
Poso Count 6 26 13 45
% within
Regency 13.33% 57.78% 28.89% 100.00%
% of
Total 6.67% 28.89% 14.44% 50.00%
Sigi Count 5 28 12 45
% within
Regency 11.11% 62.22% 26.67% 100.00%
% of
Total 5.56% 31.11% 13.33% 50.00%
Total Count 11 54 25 90
% within
Regency 12.22% 60.00% 27.78% 100.00%
% of
Total 12.22% 60.00% 27.78% 100.00%
Analysis of Factors Associated with Stunting Toddlers
Table 4: Analysis of Factors Associated with Stunting Toddlers The Poor in Poso Regency and Sigi Regency, Indonesia
Variable Category Frequency Percentage (%)
ῤ Χ²(CI 95%)
Family Support Insufficient 27 30.0 0.000
Sufficient 63 70.0 14.400
Health Information Media Insufficient 35 38.9 0.035
Sufficient 55 61.1 4.444
Medical Facility Insufficient 19 21.1 0.000
Sufficient 71 79.9 30.044
Knowledge of Weight Monitoring
Insufficient 13 14.4
0.000
Sufficient 77 85.6 45.511
Knowledge of Pregnancy Nutrition
Insufficient 8 8.89
0.000
Sufficient 82 91.1 60.844
Knowledge of Tetanus Toxoid Immunization
Insufficient 8 8.89
0.000
Sufficient 82 91.1 60.844
Knowledge of Pregnancy
Checkup Insufficient 11 12.2 0.000
Sufficient 79 87.8 51.378
Attitude about Weight
Monitoring Negative 13 14.4 0.000
Positive 77 85.6 45.511
Attitude about Pregnancy Nutrition
Negative 23 25.6 0.000
Positive 67 74.4 21.511
Attitude about Tetanus Toxoid Immunization
Negative 41 45.6
0.399
Positive 49 54.4 0.711
Attitude about Pregnancy
Check-Up Negative 29 32.2 0.001
Positive 61 67.8 11.378
Pregnancy Nutrition Fulfillment Not Done 8 8.9 0.000
Done 82 91.1 60.844
Nutrition Fulfillment in Trimester 1
Not Done 21 23.3 0.000
Done 69 76.7 25.600
Nutrition Fulfillment in Trimester 2
Not Done 21 23.3 0.000
Done 69 76.7 25.600
Nutrition Fulfillment in Trimester 3
Not Done 18 20.0 0.000
Done 72 80.0 32.400
Source: Primary Data, 2010
Poverty is closely related to the incidence of malnutrition in children under five, due to lack of food intake in fulfilling nutrition in stunted child growth (UNICEF, 2010). Stunting or short children is a chronic malnutrition problem caused by inadequate nutritional intake for a long time due to feeding that is not following nutritional needs. Stunting occurs when the fetus is still in the mother’s womb and is seen when the child is two years old. Stunting can have a significant effect on health status and can increase morbidity and mortality in the course of a person’s life (MCA Indonesia, 2010).
Children with stunting can slow cognitive development, slow child development in the body, decrease productivity and experience decreased health including cardiometabolic diseases that have an impact on the next generation. In developing countries, there are about 165 million children and about 80% of developing countries donate to cases of editing (MCA-Indonesia, 2013). Based on the results of the statistical test in table 14, it shows that the factors related to stunting under five for the poor in Poso and Sigi Regencies have several variables and categories, namely family support of 70% in the sufficient category and the poor category of 30%. According to the Chi-Square, the X2 was 14,400.
Meanwhile, health information media of 38.9% are categorized as insufficient, and health facilities are categorized as insufficient by 21.1%, nutritional knowledge of pregnant women is categorized as low at 8.89%. The coverage of immunization knowledge is categorized as low at 8.89%, knowledge about immunization is still low at 87.8%, and weight monitoring is categorized as low at 85.6%.
The results of the Chi-Square statistical test showed that the correlation between attitudes about Tetanus Toxoid (TT) immunization had a negative correlation of 45.6% with Chi-Square obtained an X2 of 0.399, indicating that there is a negative correlation between the incidence of stunting and immunization in children under five. Seen from the research variable, the incidence of stunting with pregnancy checkup had a positive correlation with Chi-Square obtained X2 of 11.378 or sufficient category. Pregnancy nutrition variable was not carried out and nutritional fulfillment consisting of tri semester 1, tri semester 2, and tri semester 3 was carried out by each respondent of 76-80%, with a Chi-Square X2 of 32,400, indicating that there was a positive correlation between nutrition fulfillment per tri semester and the incidence of stunting. These findings
support a previous study conducted by GC Mandal et al (2010) which stated that nutritional fulfillment had a positive effect on stunting. This study also supports other studies saying that mothers who have stunting children can be given counseling about nutrition that has changed in the knowledge of providing nutrition to children. Thus, adequate nutrition knowledge can prevent stunting in children.
Fulfillment of nutrition that must be known by the mother is adjusted to the different nutritional needs of children. This can be done by providing provision or counseling through public health education, communication, information, and education, as well as community-based health efforts. For information, stunting is a condition of failure to thrive in children under five due to chronic malnutrition in the first 1,000 days of life. Based on the Indonesian Basic Health Research (2008), around 9 million children under five in Indonesia are stunted. To prevent stunting, investment is needed for the future of the nation’s children, efforts are made to increase the capacity of health programs related to Community Health Services and the Health Office. The impact of editing is very influential on the quality of human resources (HR) and child development. Low income and poverty are strongly associated with stunting. The poverty that lasts for a long time can result in households not being able to meet their food needs and in good quantity and quality. The decline in the quality of family food consumption greatly determines household needs which are characterized by food purchasing power, sources of protein, vitamins, and other minerals resulting in nutritional deficiencies, both macro, and micronutrients. A large number of members in one household greatly affects the food for each child and the nutritional needs of the dependents in the family are quite large.
A large number of family members can cause the distribution of food to children and the under three to decrease, causing the children to be malnourished.
Tri semester examination is very influential on the incidence of editing, indicating that the fulfillment of toddler nutrition will have an impact on growth and development as adults. Undernourished children cause decreased IQ, decreased immunity, and productivity, mental and emotional health problems, and growth failure (Gibson, 2010). One of the causes of stunting is the low economic condition of the family (poor) (Tanziha, et al, 2010). Poverty causes the family to experience limitations in meeting the nutritional needs of the family in terms of quality and quantity. The percentage of poverty rate in Central Sulawesi is around 12.73%.
CONCLUSION
1) This study found that stunting can have an indirect effect by statistical testing with Chi-Square OR (Odd Ratio), that the family support variable (husband) is why a family because if the family is aware of the importance of nutrition it will change and improve behaviors aware of nutrition to prevent stunting. For if the stunting rate is too high in a certain period, it can trigger the emergence of a generation that is less productive. The next variable, namely the media factors of health information, health facilities, has an indirect or not significant
effect and knowledge about pregnancy, weight monitoring, knowledge of nutrition for pregnant women has a positive effect on toddlers.
2) Socio-economic factors, namely the poor, environment, nutritional intake of food, per capita income, number of family members, can affect the nutritional status of stunting toddlers. Nutrition is an important part of the continuity of the human life cycles as well as for the growth of quality development of the Indonesian nation by producing quality food.
SUGGESTIONS
1) Stunting prevention can be carried out with two approaches, namely the first approach, specific interventions that on the health sector, which are short-term in nature, and the second approach is sensitive interventions that involve collaboration across sectors other than health.
2) To control stunting in toddlers, it is necessary to increase family empowerment related to preventing infectious diseases through improving eating and health care patterns, increasing food availability through the use of yards as a source of food and family nutrition, and improving environmental sanitation.
REFERENCES
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Statistics of Central Sulawesi Province. 2010. Angka Stunting di Sulawesi Tengah masih diatas 30%. Merdeka com
National Institute of Health Research and Development. 2010. The 2010 Indonesian Basic Health Research. Jakarta: Ministry of Health of the Republic of Indonesia.
Poso Regional Health Office. 2010. Penanganan Stunting di Kabupaten Poso.
Gibson. 2010. Pencegahan Holistik Nutrition Sunting. Artikel Diseminasi pada Seminar Internasional Nutrisi Universitas Tadulako Mei
Ministry of Health of the Republic of Indonesia. 2010. Pedoman Kader seri Kesehatan Anak. Jakarta: Ministry of Health of the Republic of Indonesia. Indonesian Basic Health Research.
MAC- Indonesia 2010. Stunting dan Masa Depan Indonesia terdapat dalam www.Mca.Indonesia go.id diakses pada tanggal 28 Desember 2015 pukul 09.00 Wib.
Rahmawati, Stiti. 2009. Analisis Sosial Ekonomi Gizi Buruk Desa Wuasa Di Daerah Kecamatan Lore Utara Kabupaten Poso
Tanziha I, Kusriadi. Faktor Faktor yang mempengaruhi Kejadian stunting pada Balita di Kabupaten Lombok Tengah Propinsi Nusa Tenggara .Barat Jurnal Ilmiah Agropolitan, 2010 : 3 (2).
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Van der Hoek W, Feenstra. SG, Kondradsen F. Availability of irrigation water for domestic use in Pakistan; its impact on prevalence of diarrhea and nutritional status of children. Journal of Health Population and Nutrition [serial on internet} 2002 [cited 2010 Aug]
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KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI UNIVERSITAS TADULAKO
Kampus Bumi Tadulako Tondo Palu - Sulawesi Tengah 94111 JI. Soekarno Hatta Km. 9 Telp : (0451) 422611 – 422355 Fax: (0451)
422844
email: untad@untad.ac.id SURAT IZIN
Nomor: 3192/UN.28/KP/2010 Yang bertanda tangan dibawah ini :
Nama : Prof Dr.Ir Muhammad Basir , SE.,M.Si
NIP : 19610202 198903 1 001
Jabatan : Rektor Universitas Tadulako Dengan ini memberikan izin kepada :
Nama : Dr.Sitti Rahmawati,SE.,M.Si
NIP : 196209131990012001
Pangkat/Gol : Pembina Tkt I , IV/b
Unit Kerja : Fakultas Ekonomi Universitas Tadulako
Untuk mengikuti dan menjadi pembicara pada konferensi International (as presenter) Oral Presentation dengan judul “ Health System And Policy for The Benefit of Humankind.Oral Presentation title : Evaluasi Ekonomi pada Sistem Kesehatan Pengendalian Perbaikan Gizi Ibu Hamil dan Status Gizi Balita Stunting Terhadap Penduduk Miskin di Sulawesi Tengah Pada Tanggal 26-27 Juli Tahun 2010 di Faculty of Medicine, Naseruan University Hat-Hai- Thailand .
Demikian surat ini dibuat digunakan sebagaimana mestinya.
Palu, 16- Juli 2010
Tembusan:
1. Dekan Fakultas Ekonomi Untad
2. Ketua Jurusan Ekonomi Pembangunan
