ANALYSIS OF DETERMINANT FACTORS AFFECTING THE NUTRITION STATUS OF AGE 24-60 MONTH IN HEALTH CENTER REGIONAL REGENCY OF GRESIK IN 2017 Setiya Purbasari

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The Proceeding Of International Conference 2017 168 ANALYSIS OF DETERMINANT FACTORS AFFECTING THE NUTRITION

STATUS OF AGE 24-60 MONTH IN HEALTH CENTER REGIONAL REGENCY OF GRESIK IN 2017

Setiya Purbasari1, Abdul Muhith2, Nurwijayanti Nurwijayanti2

Student Post Graduate Program1

Lecturer Post Graduate Program2

Institute of Health Science Surya Mitra Husada Kediri E-mail: [email protected]

ABSTRACT

The multidimentional crisis have degraded the nutritional status of Indonesian society. Preschool children are at risk developing PEM as they are not breastfed and the food consumed may not fuilfill the nutrients need for their progressive growth. Nutritional status of preschool children is indirectly associated to the socioeconomic and hygiene status and directly associated to the level of consumptions and infections. The aims of this research is to analyze the associations between socioeconomic factors, hygiene, level of consumptions, and infections with the nutritional status of preschool children in Gresik District. The result of statistical analysis using the Multiple Linear Regression Test showed significant value <= 0.05, meaning H0 rejected and H1 accepted, this means that there is influence of education, mother knowledge, higines environment level, protein energy intake and significant value> = 0,05, meaning H0 accepted and H1 accepted, this means that there is no influence of family income, mother care pattern, and incidence of ispa and diarrhea with nutritional status of children And of the factors that influence the most dominant influence the nutritional status of children aged 24-60 months is knowledge and protein energy intake. Early detection through intensification monitoring of toddler growth at posyandu, followed by determination of nutritional status by village midwife or other health worker. As well as striving for a dynamic Food and Dynamic environment where monitoring of critical indicators of resources, availability and access to food and nutrition at all levels of society is required

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The Proceeding Of International Conference 2017 169

A. BACKGROUND

Underweight or poor nutrition in infancy and children, especially at the age of less than 5 years can lead to disruption of physical growth and child intelligence. Growth of brain cells takes place very quickly and will stop or reach the perfect stage at the age of 4-5 years. Rapid brain development can only be achieved if the child has good nutritional status (Ministry of Health RI, 2012). Growth monitoring of infant development is very important to know the existence of early infant growth disorder, by way of weight measurement as the best way to assess the nutritional status of children every month so that child growth will be monitored (Rahmadiliyani, 2012).

How to assess nutritional status can be done with anthropometric, clinical, biochemical, and biophysical measurements. Anthropometric measurements can be performed with several measurements: weight measurement, height, upper arm circumference, and so on. One indicator of health in children under five years old (toddlers) can be seen from the nutritional status. Nutritional status of children can be measured by age, weight (BB), height (TB). Monitoring the nutritional status of children under five can be seen from three indicators of anthropometry, namely: Weight by Age (BB / U), Body Height by Age (TB / U) and Weight by Body (BB / TB) (Profile of East Java Provincial Health Office , 2015). Based on the indicator of BB / TB, nutritional status is divided into 4 namely Malnutrition (Very Thin), Underweight (Skinny), Good Nutrition (Normal), Nutrition Over (Fat).

Based on the results of Basic Health Research (Riskesdas) in 2013 it is known that the percentage of

underweighted BB / U status by province in Indonesia is 33 percent higher, the prevalence of malnutrition in infants (BB / TB) by province in Indonesia is 18 , 7 percent in 2013. While the percentage of underweight and underweight nutrition (BB / U) according to Kab / Kota in East Java Province in 2013 was 4.9% and nutritional status less 14.2% (Riskesdas, 2013).

Based on the data of PSG data from the Health Office of Gresik Regency in 2016, it shows that Percentage of Nutritional Status Under Fives Index BC / U in 2014 until 2015 for under-five children with malnutrition decreased significantly from 5.43% to 0.7% but in year 2016 increased slightly to 0.98%, while under-fives with underweight nutrition continued to increase from year to year, ie in 2014 by 0.26% (203 under-fives), by 2015 soaring. equal to 4, 9% (3907 under-fives), and in 2016 increased to 5.93% (4547 children under five).

Malnutrition events need to be detected early on through intensification of infant growth monitoring at posyandu, followed by determination of nutritional status by village midwives or other health workers. Malnutrition data in East Java is based on 2 categories ie by indicator comparing BB / U and second category is compare BB / TB.

B. RESEARCH METHODOLOGY

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The Proceeding Of International Conference 2017 170 observed only once and the

measurement is done on the character or variable status subject at the time of examination (Soekidjo Notoatmodjo, 2012: 37-38). The population of this study is all mothers who have children under five in the working area of Puskesmas Kabupaten Gresik. Respondent in this research is mother toddler, while sample unit is toddler age 24-60 month amount 1315 balita. The minimum sample size in this study was 90 mothers and children aged 24-60 months, taken by proportional random sampling. Respondents were mothers of the sample. The statistical test used is Multiple Linear Regression. The independent variables in this research are education, mother's knowledge, environmental higines level, protein energy intake, family income, mother care pattern, and incidence of ispa and diarrhea with nutritional status of children. Dependent variable in this study is nutritional status of children aged 24-60 months.

C. RESEARCH RESULTS

1. Table 4.3 Distribution of

Respondents Based on Maternal Education at 3 Puskesmas Kabupaten Gresik 2017

Based on table 4.3 it is known from a total of 90 respondents almost entirely (76.7%) have high school education.

2. Table 4.4 Distribution of Respondents by Revenue in 3 Puskesmas Kabupaten Gresik 2017

Income Rate Total

(person) Percentage (%)

Low 11 12.2

Height 79 87.8

Total 90 100.0

Based on table 4.4 is known from a total of 90 respondents almost entirely (87.8%) high income of more than Rp.1.200.000, - / month.

3. Table 4.5 Distribution of

Respondents Based on Mother's Knowledge about Nutrition in 3 Puskesmas of Gresik Regency 2017

Knowledge level

Total

Less 4 4.4

Enough 61 67.8

Good 25 27.8

Total 90 100.0

Based on table 4.5 it is known from a total of 90 respondents (67.8%) are knowledgeable enough to answer correctly 56% - 75% of all questions.

4. Table 4.6 Distribution of Respondents Based on Maternal Care Pattern in 3 Puskesmas Gresik Regency 2017

Based on table 4.6 is known from the total of 90 respondents most (51.1%) have enough parenting. Education Level

Mother

Total

SD 3 3.3

SMP 12 13.3

SMA 69 76.7

PT 6 6.7

Total 90 100.0 _{Level of}

Foster Pattern

Total

Less 23 25.6

Enough 46 51.1

Good 21 23.3

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The Proceeding Of International Conference 2017 171 5. Table 4.7 Distribution of

Respondents Based on environmental hygiene in 3 Puskesmas Kabupaten Gresik 2017

Environment al Hygiene

Level

Total

Less 3 3.3

Enough 14 15.6

Good 73 81.1

Total 90 100.0

Based on table 4.7 it is known from a total of 90 respondents almost entirely (81.1%) have a good environment.

6. Table 4.8 Distribution of Respondents Based on the

Incidence of Ispa and Diarrhea in 3 Puskesmas of Gresik Regency 2017

Incidence Rate of Ispa and

Diarrhea

Total (person)

Percentage (%)

There Is 12 13.3

There Is No 78 86.7

Total 90 100.0

Based on table 4.8 is known from a total of 90 respondents almost entirely (86.7%) there is no incidence of Ispa and Diarrhea in children aged 24-60 months

7. Table 4.9 Distribution of Respondents Based on Energy and Protein Consumption at 3 Puskesmas Kabupaten Gresik 2017

Levels of Energy Consumption

and Protein

Total

Deficit 2 2.2

Less 4 4.4

Medium 57 63.3

Good 27 30.0

Total 90 100.0

Based on Table 4.9 it is known from a total of 90 respondents most (63.4%) sufficiency of nutrients between 80-99% of the recommended nutritional adequacy (AKG).

8. Table 4.10 Distribution of Respondents Based on the Nutritional Status of Toddlers Age 24-60 weeks in 3 Puskesmas Kabupaten Gresik 2017

Nutritional Status Status

Total

Malnutrition ₃ _3.3

Malnutrition ₁₀ _11.1

Good Nutrition ₆₅ _72.2

More nutrition ₁₂ _13.3

Total 90 100.0

Based on table 4.10 is known from a total of 90 respondents most (72.2%) good nutritional status (based on z score with index BB / U)

9. Table 4.11 Cross-education tabulation with nutritional status of children aged 24-60 months in 3 Puskesmas of Gresik Regency

Nutritional status Total (person) Percentage (%) Buruk Kurang Normal Lebih

Education

SD 3 0 0 0 3

3.3% 0.0% 0.0% 0.0% 3.3%

SMP 0 8 4 0 12

0.0% 8.9% 4.4% 0.0% 13.3%

SMA 0 1 58 10 69

0.0% 1.1% 64.4% 11.1% 76.7%

PT 0 1 3 2 6

0.0% 1.1% 3.3% 2.2% 6.7%

Total 3 10 65 12 90

3.3% 11.1% 72.2% 13.3% 100.0%

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The Proceeding Of International Conference 2017 172 24-60 month.

10.Table 4.12 Cross-income family tabulation with nutritional status of children aged 24-60 months in 3 Puskesmas Kabupaten Gresik

Nutritional status

Total Buruk Kurang Normal Lebih Family

income Low (< 1.200.000)

Count 136.928 0,000 4 2 11 % of Total 1.1% 4.4% 4.4% 2.2% 12.2% High (>

1.200.000)

Count 2 6 61 10 79

% of Total 2.2% 6.7% 67.8% 11.1% 87.8%

Total Count 3 10 65 12 90

% of Total 3.3% 11.1% 72.2% 13.3% 100.0% t hitung= 0,561, p =0,567

Based on table 4:12 shows that of 90 respondents most mothers have high income is> Rp. 1,200,000 and her children have normal nutritional status (67.8%). The result of data analysis using t test got t count equal to 0,561 and p = 0,567, so p> 0,05, mean H0 accepted and H1 is rejected so there is no significant influence between family income with nutritional status of children aged 24-60 months.

11.Table 4.13 Cross-tabulation of mother's knowledge about nutrition with nutritional status of children aged 24-60 months in 3 Puskesmas Kabupaten Gresik

Nutritional status

Total Buruk Kurang Normal Lebih

Knowledge

Less Count 0 4 0 0 4

% of Total 0.0% 4.4% 0.0% 0.0% 4.4%

Enough Count 2 5 54 0 61

% of Total 2.2% 5.6% 60.0% 0.0% 67.8%

Good Count 1 1 11 12 25

% of Total 1.1% 1.1% 12.2% 13.3% 27.8%

% of Total 3.3% 11.1% 72.2% 13.3% 100.0%

t hitung= 5.729, p=0.000

Based on table 4:13 shows that of 90 respondents most mothers have enough knowledge and balitanya normal nutritional status (60%). The result of data analysis using t test obtained t count equal to 5,729 and p = 0,000, so p <0,05, mean H0 rejected and H1 accepted so there is significant influence between mother's knowledge about nutrition with nutritional status of children aged 24-60 month.

12.Table 4.14 Cross tabulation of mother's parenting with nutritional status of children aged 24-60 months in 3 Puskesmas Kabupaten Gresik

Nutritional status

Mother's parenting

% of Total 0.0% 2.2% 21.1% 2.2% 25.6%

% of Total 1.1% 5.6% 42.2% 2.2% 51.1%

Good Count 2 3 8 8 21

% of Total 2.2% 3.3% 8.9% 8.9% 23.3%

% of Total 3.3% 11.1% 72.2% 13.3% 100.0%

t hitung= 0.553, p=0.582

Based on Table 4:14 shows that of 90 respondents almost half of the mother's parenting pattern is enough and balitanya normal nutritional status (42.2%). The result of data analysis using t test got t count equal to 0,553 and p = 0,582, so p> 0,05, mean H0 accepted and H1 rejected so there is no significant influence between mother care pattern with nutritional status of children aged 24-60 months.

13.Table 4.15 Cross-linking of environmental hygienitas with nutritional status of children aged 24-60 months in 3 Puskesmas Kabupaten Gresik

Nutritional status

Tingkat Higienitas

% of Total 3.3% 0.0% 0.0% 0.0% 3.3%

% of Total 0.0% 8.9% 4.4% 2.2% 15.6%

Good Count 0 2 61 10 73

% of Total 0.0% 2.2% 67.8% 11.1% 81.1%

% of Total 3.3% 11.1% 72.2% 13.3% 100.0%

t hitung= 3.753, p=0.000

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The Proceeding Of International Conference 2017 173 14.Table 4.16 Cross tabulation

incidence of Ispa and diarrhea with nutritional status of children aged 24-60 months in 3 Puskesmas Kabupaten Gresik

Nutritional status

Total Buruk Kurang Normal Lebih Ispa and

diarrhea There is

Count 1 2 0 5 8

% of Total 1.1% 2.2% 0.0% 5.6% 8.9% There

is no

Count 8 65 7 82

% of Total 2.2% 8.9% 72.2% 7.8% 91.1%

% of Total 3.3% 11.1% 72.2% 13.3% 100.0% t hitung= -1.313, p=0.193

Based on Table 4:15 shows that of 90 respondents most of the incidence of ispa and diarrhea is absent and children under normal nutritional status (72.2%). Result of data analysis using t test got t count equal to -1,313 and p = 0,193, so p> 0,05, mean H0 accepted and H1 rejected so there is no significant influence between incidence of ispa and diarrhea with nutritional status of children aged 24-60 months .

15.Table 4.17 Cross tabulation of energy and protein consumption levels with nutritional status of children aged 24-60 months in 3 Puskesmas Kabupaten Gresik

Nutritional status _Total Buruk Kurang Normal Lebih

nutrition al intake

Defisit Count 1 1 0 0 2

% of Total 1.1% 1.1% 0.0% 0.0% 2.2%

Kurang Count 1 1 2 0 4

% of Total 1.1% 1.1% 2.2% 0.0% 4.4%

Sedang Count _{% of Total} _1.1%1 _7.8%7 _52.2%47 _2.2%2 _63.3%57

Baik Count 0 1 16 10 27

% of Total 0.0% 1.1% 17.8% 11.1% 30.0%

% of Total 3.3% 11.1% 72.2% 13.3% 100.0% t hitung= 4.751, p=0.000

Based on table 4:17 shows that of 90 respondents most of the level of energy and protein consumption is normal and toddlers normal nutritional status (52.2%). The result of data analysis using t test got t count equal to 4,751 and p = 0,000, so p <0,05, mean H0 rejected and H1 accepted so there is significant influence between nutrient intake with nutritional status of children aged 24-60 months.

D. DISCUSSION

1. Influence of Maternal Education with Nutritional Status of Toddler Age 24-60 months

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The Proceeding Of International Conference 2017 174 especially in the mother, because a

mother plays a role in household management and play a role in determining the type of food that will be consumed by his family. Lack of nutrient intake can be caused by the limited amount of food consumed or the food does not meet the nutrients needed.

2. Influence of Family Income with Nutritional Status of Toddler Age 24-60 months

Based on table 4.12 Family with low income is 11 (12,2%) with nutritional status of underfive majority and less than 4 (4,4%) toddler, high income family of 79 (87,8%) with nutritional status of under five a normal majority of 61 (67.8%). Result of data analysis using t test got t count equal to 0,561 and p = 0,567, so p> 0,05, mean H0 accepted and H1 is rejected so there is no significant influence between family income with nutritional status of children aged 24-60 month.

High income is not necessarily followed by high nutritional status of children, on the contrary with low income is not necessarily nutritional status balitanya less good. The acceptance of the hypothesis is due to many factors. One factor is related to the size of family expenditure to eat. The totality of family income is not all used to meet food needs, so direct income does not have a real correlation with nutritional status of children. This is due to the absence of a trend that high-income respondents are allocated for high food needs, and vice versa there is no tendency that with low income allocations for low food needs.

In the daily life of the community is often seen families who even earn enough income but food that is served sober. Thus the incidence of nutritional disorders is not only found in families who earn less but also in high-income families because usually they will entrust child care to the helpers, if the maid can know about the nutrients that children need well then the nutritional status of children will be better and vice versa. This situation indicates that ignorance of the benefits of food for the health of the body causes the poor nutritional quality of family food, especially toddlers.

3. Influence of mother's knowledge about nutrition with nutritional status of children aged 24-60 months

Based on table 4:13 mothers have less knowledge about nutrition as much as 4 (4,4%) with less than 4 (4.4%) toddler underweight, mother have enough knowledge 61 (67,8%) with nutritional status of balita majority normal as much as 54 (60%), and mother have good knowledge as much 25 (27,8%) with nutritional status of balita majority of nutrition more 12 (13,3%). The result of data analysis using t test obtained t count equal to 5,729 and p = 0,000, so p <0,05, mean H0 rejected and H1 accepted so there is significant influence between mother's knowledge about nutrition with nutritional status of children aged 24-60 month.

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The Proceeding Of International Conference 2017 175 selecting and preparing food for

their family consumption so that mother's nutritional knowledge will affect the type of food and nutritional quality of food consumed by family members.

Nutrition knowledge of parents is one of the factors that affect child nutrition. Some of the other factors that influence parents' knowledge include: Age is age affecting the ability formation, because the ability possessed can be obtained through daily experience outside of education factor because most young mothers have very little knowledge about nutrition and experience in nurturing child. Mother's knowledge determines the behavior of food consumption, one of them through nutrition education so that will improve the habit of food consumption. Lack of knowledge about nutrition or the ability to apply in everyday life is an important cause of nutritional disorders.

4. Influence of Maternal Care Pattern with Nutritional Status of Toddler Age 24-60 months

Based on Table 4:14 Maternal care pattern is less as much as 23 (25,6%) with normal child under five nutrition status as much as 19 (21,1%) balita, mother mother pattern enough enough 46 (51,1%) with normal majority child nutrition status 38 (42,2%), and good mother care as much as 21 (23,3%) with nutritional status of children under five of normal nutrition and more 8 (8,9%). The result of data analysis using t test got t count equal to 0,553 and p = 0,582, so p> 0,05, mean H0 accepted and H1 rejected so there

is no significant influence between mother parenting pattern with nutritional status of children aged 24-60 months.

Good eating patterns tend to have children with normal nutritional status, eating patterns are quite likely to have children with overweight status and wasted nutrition status, while with eating patterns more or less tend to have children with very thin nutritional status. So the better the parenting patterns of eating the normal nutritional status and the less the increasingly more children's eating patterns and also less nutritional status. According to UNICEF (1999), the factors that affect the growth of children consist of direct causes, because of indirect and underlying causes. The direct causes include food sufficiency and health condition, because it does not directly include family food security, child care pattern, utilization of health service and environmental sanitation, with the basic cause of economic structure (Proverawati and Asfuah, 2009).

Patterns of parenting also contribute to the nutritional status of children, one of the patterns of care related to the nutritional status of children is the pattern of feeding. In addition to eating patterns, mother's health patterns also affect the health status of children and will ultimately affect the child's nutritional status indirectly (Martianto, et al., 2011).

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The Proceeding Of International Conference 2017 176 fulfill physiological, psychological

and social needs. Children who get poor eating patterns tend to have difficulty eating and result in reduced levels of consumption of both energy and protein. If this goes on long will affect its nutritional status due to poor food input (Tirahiningrum, 2013).

A good nutritional status affects the mother's feeding pattern to her child, such as the better the quality and the intensity of parenting to the child, the more normal the nutritional status of the preschooler and the worse the mother's care for the child the worse the nutritional status of the preschoole.

5. Effect of Hygienitas Environment with Nutritional Status of Toddler Age 24-60 months

Based on the table 4:15 Respondents who have less than 3 (3%) Hygienicity of the children with less than 3 (3.3%) toddler underweight nutritional status, respondents who have enough environmental hygienitas are 14 (15,6%) with nutritional status toddler majority less 8 (8,9%), and Respondent having good environmental hygienitas as much as 73 (81,1%) with normal majority child nutrition status as much 61 (67,8%). Result of data analysis using t test got t count equal to 3,753 and p = 0,000, so p <0,05, mean H0 rejected and H1 accepted so there is significant influence between hygienitas environment with nutritional status of children aged 24-60 month.

Health status can be improved by maintaining health and physical and social environment. Increased health status, the nutritional status

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The Proceeding Of International Conference 2017 177 However, sanitation facilities are

far below the needs of a growing population. Inadequate environmental conditions allow for various types of diseases, including diarrhea and gastrointestinal tract. In the world of the disease has caused the death of about 2.2 million children per year and spent a lot of money to overcome it (UNICEF, 2008). A person who is deficient in nutrients will be susceptible to disease and growth will be disrupted. Poor environmental sanitation will make children more susceptible to infectious diseases that may ultimately affect nutritional status. Nutritional status other than influenced by environmental sanitation, also influenced by some fakor, among others, food consumption and health status (infectious diseases). If the consumption of less eating will facilitate the emergence of diseases that can affect growth and result in decreased nutritional status. Children suffering from malnutrition will be susceptible to infections, especially diarrhea and respiratory diseases. Each of these factors will make things worse. Environmental sanitation is also closely linked to the availability of clean water, the availability of latrines, the type of flooring of the house and the cleanliness of cutlery in each family. The more available clean water for daily needs, the less risk of children affected by malnutrition. Parents Education Background education of parents, is one important element that plays a role in determining the state of child nutrition. In society with low average education, indicating a

high prevalence of low nutrition and vice versa in society with high education level, the prevalence of nutrition is lower. Revenue Rate The income level also determines what diet to buy with the money. If income increases, spending on food also increases. Thus income is a factor that determines the quality and quantity of food which will subsequently affect the nutrients (Kusumo, 2004).

6. Influence of Isp and Diarrhea Occurrence with Nutritional Status of Toddler Age 24-60 months

Based on the table 4.16 children under five years of diarrhea has 8 (8.9%) with a toddler's nutritional status of more than 5 (5.6%) toddlers, and toddlers with no history of diarrhea and diarrhea of 82 (91.1%) with normal child nutrition status as much as 65 (72,2%). The result of data analysis using t test is -1,313 and p = 0,193, so p> 0,05, mean H0 accepted and H1 rejected because there is no significant influence between incidence of ispa and diarrhea with nutritional status of children aged 24-60 months.

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The Proceeding Of International Conference 2017 178 can enter a variety of disorders of

growth and development of nutritional status. Similarly, diarrhea, diarrhea can cause nutritional disorders due to reduced food intake (Widjaja, 2002). less nutritional status leads to decreased body resistance and stronger viral viral pathogens, resulting in a balance of disorders and infection. One of the determinants in maintaining the balance is the good nutritional status.

Nutrition is one of the determinants of the quality of human resources. Due to malnutrition will cause some serious effects such as failure in physical growth and not optimal development and intelligence. Another result is a decrease in productivity, decreased body resistance to diseases that will increase the risk of illness (Marimbi, 2010). In children who suffer from malnutrition at mild or moderate levels still can beraktifitas, but when observed carefully the body will begin to thin, stamina and endurance decreased, making it easier for the occurrence of infectious diseases, otherwise children suffering from infectious diseases will experience impaired lust eating and absorption of nutrients that cause malnutrition (Andarini et al, 2005). But from this study found also respondents who have good nutrition status but exposed to respiratory infection and diarrhea. This is caused by other factors that can cause the occurrence of ARI and diarrhea in infants such as age, breastfeeding, regularity of vitamin A, air pollution, socioeconomic, immunization density in the home

and LBW. In addition, the respondents also got the status of less nutrition but not affected by ARI and diarrhea. This may be possible because of environmental factors where no one is suffering from ARI or diarrhea even though their nutritional status is lacking, or it could be because they have received complete immunization so they have immunity against infection so it is not easy to get ARI. From the above results can be concluded that nutrition has a very big role in maintaining the health of the body of the toddler. If a toddler has a lack of nutritional status, it will make it easier for pathogens to attack the body causing ARI and diarrhea. Therefore, to reduce the incidence of ARI and diarrhea, the nutritional status of toddlers should always be maintained and improved.

7. Effect of Energy Consumption Level and Protein with Nutritional Status of Toddler Age 24-60 months

Based on Table 4.17 Nutritional intake deficit of 2 (2,2%) with nutritional status of toddler majority of less and bad as much as 1 (1,1%) toddler, nutrient intake less as much as 4 (4,4%) with nutritional status of balita majority normal 2 (2,2%) toddler, moderate nutrition as much as 57 (63,3) with normal baby nutrition status as much as 47 (52,2%) toddlers, and normal nutrition intake as much as 16 (17,8%) toddlers.

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The Proceeding Of International Conference 2017 179 so there is significant influence

between nutrient intake with nutritional status of children aged 24-60 months.

Nutrition is a substance or chemical element contained in the food needed for metabolism in the body normally. Nutrition needed by the body consists of carbohydrates, fats, proteins, vitamins, minerals and water. In an effort to achieve adequate consumption, the two most important factors that can affect the daily consumption of nutrients are: availability of food and nutritional knowledge. A person will be able to provide adequate consumption when they are able to provide food because it is supported with enough views. Nutrients that have been consumed will be used by the body to achieve optimal nutritional status (Almatsier, 2006). Energy is defined as a capacity to perform a job The amount of energy a person needs depends on age, sex, weight and body shape. Energy in the human body arises because of the burning of carbohydrates, proteins and fats. Thus in order to be fulfilled his energy needs required intake of food substances are also into the body. Proteins are part of living cells and are the largest part after water. All enzymes, hormones, carriers of nutrients and blood, and so on are proteins. The main function of protein is to build and maintain body tissues. Another function is to establish the essential bonds of the body, such as hormones, enzymes and antibodies, regulating water balance and transporting nutrients. Protein is also an energy source that is equivalent to carbohydrates.

If the body is in a state of lack of energy source substances such as carbohydrates and fats, the body will use proteins to form energy and defeat its main function as a builder substance. In toddlers this condition has a disruption on growth.

E. CONCLUSION

Based on the results of research and discussion, it can be concluded as follows:

1. There is a significant influence between maternal education variables on nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik. 2. There is no significant

influence between family income variable on nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik.

3. There is a significant influence between the variables of knowledge on nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik.

4. There is no significant influence between the variables of parenting to the nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik. 5. There is a significant influence

between the variables of environmental hygienity level to nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik. 6. There is no significant

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The Proceeding Of International Conference 2017 180 7. There is a significant influence

between the variable of Energy and Protein intake on nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik. 8. Of the factors above the most

dominant influence the nutritional status of children aged 24-60 months is the knowledge and protein energy intake

F. SUGGESTIONS

1. Practical Tips a) For Community

For the community, especially the nanny, or the mother of the child 2-5 years is expected to increase knowledge about child nutrition. Nutrition knowledge can be gained through experience, mass

media, cultural

influences, formal or informal education

b) For Puskesmas

Provision of education or health education can be a routine program for puskesmas both in mother and children and in working area of posyandu-posyandu of Keputih Public Health Center Surabaya, need to be equipped health promotion media so counseling is easy to be understood. Commonly used media such as brochures, installing banners and posters related to child nutrition. 2. Theoretical Advice

a) For Midwifery Education

For midwifery students are expected to learn better about the definition of nutritional status of children, the classification of nutritional status of children, factors that affect the nutritional status of children, assessment of nutritional status of children, nutritional needs of children, balanced concepts. nutrition. So it can train soft skill in conducting promotive and preventive activities, such as giving more optimal

information and

education to mother or nanny about child nutrition while doing socialization about child nutrition status in counseling form.

b) For Other Researchers It is hoped that there will be further research on the nutritional status of children under five by adding other factors and with more respondents so that they can be more knowledgeable and get the right solution for the program of handling nutritional status in the future so that the nutritional status is not available.

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