View of FACTORS ASSOCIATED WITH STUNTING INCIDENCE IN TODDLERS AGED 24-59 MONTHS IN THE WORKING AREA OF THE JAMBULA HEALTH CENTER

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FACTORS ASSOCIATED WITH STUNTING INCIDENCE IN TODDLERS AGED 24-59 MONTHS IN THE WORKING AREA OF THE JAMBULA

HEALTH CENTER

1Sakila Setiawati Sumaga, ²Suharto, ³Agustin Rahayu

1-3Public Health Study Program, Faculty of Health Sciences, University of Muhammadiyah North Maluku K.H. Ahmad Dahlan St., Number 100, Sasa, District of South Ternate, City of Ternate, North Maluku 97712

E-mail: [email protected]

ABSTRACT

The health indicator that assesses the success of achievement of the SDGs is the nutritional status of children under five. Toddlers are a group that is vulnerable to malnutrition, one of which is stunting.

Stunting is a condition that describes toddlers as having a body length or height that is less than their age; this condition uses a length or size that is <2 SD. Stunting toddlers in the future will experience difficulties, one of which is achieving optimal physical and cognitive development. This study determines the factors associated with stunting in toddlers aged 24-59 months in the Jambula Health Center Working Area in 2022. This type of research uses a quantitative analytic design with a cross- sectional study design. The population in this study was 285 toddlers aged 24-59 months. The sample size used was 74 toddlers. The sample used a stratified random sampling method with a systematic random sampling technique. The study's results showed a relationship between a history of infectious disease (p=0.002) and the incidence of stunting. There was no relationship between LBW (p=0.463) and exclusive breastfeeding (p=0.560) with the incidence of stunting. The recommendation to mothers with toddlers under five years old is to increase awareness about toddler health, especially about the fulfillment of toddler nutrition. Mothers can prevent stunting and routinely visit health services to get early detection of toddler health.

Keywords: stunting, infectious disease history, LBW, exclusive breastfeeding.

INTRODUCTION

One health indicator assessed from the success of its achievement in the MDGs is the nutritional status of children under five. Toddlers are a group that is vulnerable to malnutrition, one of which is stunting. Stunting is a linear growth disorder caused by chronic nutrient intake, malnutrition, or chronic or recurrent infectious diseases characterized by a z-score for height according to (TB/U) less than <-3 SD (Hanum, 2014).

Stunting has become a nutritional problem that needs consideration because the impact is very complex and long-term. Ramayulis et al.(2018) explained that stunting toddlers have cognitive abilities that are less than optimal, are more susceptible to disease, and are at risk of decreasing productivity in the future. In addition, This will have an impact on the economic growth of a country.

In 2017 Asia was the continent with the highest incidence of stunting relatively high, with an estimated almost half of the world's children under five at 55%, followed by the African continent with an estimated third of 39% Of 83.6 million toddlers stunted in Asia, numbers stunting are in South Asia, amounting to 58.7%. The incidence rate stunts the least in Central Asia, amounting to 0.9% (Kemenkes RI 2018). According to WHO data, Indonesia is the third country with the highest incidence of stunting highest in Southeast Asia; the average incidence of stunting in Indonesia from 2005 to 2018 was 36.4%.

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Based on data from the Indonesian Nutrition Status Study (SSGI), the prevalence of stunting in Indonesian children reached 27.7% in 2019, decreased to 26.9% in 2020, and 24.4% in 2021. And North Maluku Province has an incidence rate of stunting of 27.5%, which means that in North Maluku Province is still a problem related to stunting because the stunting rate in North Maluku is higher than the national figure

Toddlers are an age group with a vulnerable immune system, and young people are exposed to diseases such as infections, malnutrition, diarrhea, and ARI. Infectious diseases and nutritional disorders are often found together and mutually influence each other. There is a reciprocal relationship between nutritional intake and the incidence of infection (Supariasa ID.B. & Fajar, I. 2012).

Exclusive breastfeeding for less than six months is the factor that leads to stunting. Nutritional problems in infants result from the mother's milk being substituted with formula milk unsuitable for the baby's needs. Based on data from the World Health Organization (WHO), every year there are 1-1.5 million babies die because they have not had exclusive breastfeeding. Therefore, to prevent infant mortality, exclusive breastfeeding for six months can reduce the infant mortality rate by 13% (Hanifah, 2020).

This study aimed to find the relationship between a history of infectious diseases, LBW, and exclusive breastfeeding with the incidence of stunting in toddlers aged 24-59 months in the Jambula Health Center Working Area.

METHOD

This study used a quantitative analytic design with a cross-sectional study design. The total population in this study were 285 children aged 24-59 months. The sample size calculated using the solving formula is 74 children under five, obtained by the stratified random sampling method, with the sampling technique being systematic random sampling.

RESULTS AND DISCUSSION

Table 1 shows that most of the mothers are in the 27-30 year age group, which is 27.0%, and a small proportion are in the 44-47 year age group, which is 2.7%. Most mothers have a secondary education level of 89.2%, and a small proportion of 1.4% are in college.

Table 1. Characteristics of Respondents in the Working Area of Jambula Health Center in 2022

Mother Characteristics n %

Age (Years)

19-22 4 5.4

23-26 16 21.6

27-30 20 27.0

31-34 18 24.3

35-39 11 14.9

40-43 3 4.1

44-47 2 2.7

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Mother Characteristics n % Education

Elementary School 7 9.5

Junior High School 18 24.3

Senior High School 48 64.9

College 1 1.4

Source: Primary Data 2022

Table 2 shows that most toddlers are in the age group of 34-38 months, equal to 18.9%, and a small proportion of toddlers are in the age group of 44-48 months, equivalent to 8.1%. Toddlers who are male 54.1% and a small proportion of female sex by 45.9%

Table 2. Characteristics of Toddlers Ages 24-59 Months in the Jambula Health Center Working Area in 2022

Characteristics n %

Gender

Man 40 54.1

Woman 30 45.9

Age (Month)

24-28 months 11 14.9

29-33 months 12 16.2

34-38 months 14 18.9

39-43 months 11 14.9

44-48 months 6 8.1

49-53 months 10 13.5

54-58 months 10 13.5

Table 3 shows that most children under five have ever suffered from infectious diseases, 79.7%, and a small proportion have never suffered from contagious diseases, 24.3%.

Table 3. Characteristics of History of Infectious Diseases for Toddlers Age 24-59 Months in the Working Area of Jambula Health Center in 2022

Characteristics n %

History of Infectious Diseases

Ever Suffered 56 20.3

Never Suffer 18 79.3

Table 4 shows that under five, stunting suffers the most infectious diseases, namely diarrhea in 18 toddlers, ARI in 10 toddlers, pneumonia in four toddlers, and measles in one toddler.

Table 4. Types of Infectious Diseases in Children Aged 24-59 Months in the Work Area Jambula Health Center 2022

Stunting Incident Types of Infectious Diseases

Total Pneumonia Diarrhea ARI Measles

Stunting 4 18 10 1 25

Normal 5 13 2 3 31

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Table 5 shows the history of infectious disease variables from 56 toddlers who have suffered from infectious diseases, 31 toddlers with normal nutritional status (41.9%), and 25 toddlers experiencing stunting (33.8%). The results of statistical analysis using the chi-square test obtained the p-value=0.002<(α 0.05), which means that there is a relationship between a history of infectious disease and the incidence of stunting in infants 24-59 months in the Jambula Health Center Working Area in 2022.

Table 5. Analysis of the Relationship of History of Infectious Diseases, LBW, and Exclusive Breastfeeding with Stunting Incidence in Toddlers Aged 24-59 Months in the Working Area of Jambula Health Center

in 2022

Variable Stunting Normal

P-value

n % n %

History of Infectious Diseases

Ever Suffered 25 33.8 31 41.9 0.002

Never Suffer 1 1.4 17 23.0

Low Birth Weight

Low Birth Weight 1 1.4 4 5.4 0.463

Normal 25 33.8 44 59.5

Breast Milk

No Exclusive Breastfeeding 11 14.9 17 23 0.560

Exclusive Breastfeeding 15 20.3 31 41.9

Infectious diseases can act as starters for malnutrition due to lack of appetite, impaired absorption in the digestive tract, or the increased ability of nutrients by the presence of disease.

Infections are usually associated with nutritional disorders in several ways, affecting appetite and causing nutritional needs not to be appropriately met (Putri et al., 2015).

One of the factors that cause stunting is diarrhea. Infectious diseases accompanied by diarrhea and vomiting can cause children to lose fluids and nutrients. Children suffering from diarrhea will cause malabsorption and loss of nutrients; if not immediately followed up and balanced with inappropriate intake, failure to thrive will occur. Research conducted by Dewi IAKCH and Adhi KT shows that a history of infectious diseases, including diarrheal disease, is one of the dominant risk factors for stunting (Dewi IAKCH and Adhi KT 2016).

In line with research conducted by Trio Subarto, Linawati Novikasari, Setiawati (2021), Seputin Raman Health Center, Central Lampung, this study showed that there were 45 toddlers (22.1%) suffering from infectious diseases with stunting conditions, and 57 toddlers (27.9%) with stunting conditions. Stunting has never suffered from an infectious disease. Statistic test results obtained p-value

= (0.00) (>α 0.05). There is a relationship between a history of infectious disease and the incidence of stunting in children aged 12-59 months in Lampung Regency in 2021 (Trio subito, Linawati Novikasari, Setiawati 2021).

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On the Low birth weight variable is known that from 5 toddlers who are Low birth weight, there are four toddlers with normal nutritional status (5.4%) and one toddler experiencing stunting (1.4%). The results of statistical analysis using the chi-square test obtained a p-value = 0.463 > (α 0.05), meaning there is no relationship between Low birth weight and the incidence of stunting in toddlers aged 24-59 months in the working area of the Jambula Health Center in 2022.

Low birth weight babies are babies weighing less than 2500 grams regardless of gestational age (considered within 1 hour after birth) (Proverawati and Iswan 2010). This condition is because of the mother's lack of nutrition and food intake during pregnancy, so Interaterui Growth Retradation at birth is manifested by low birth weight.

In contrast to Putri Raisa et al. (2022), Gapong Meunasah Intan Kuta Baro, Aceh Besar District.

This study shows that most toddlers have low birth weight (62.1%) and normal (17.2%). The results of the statistical test obtained a p-value = (0.004) (< 0.05). Low birth weight and the incidence of stunting in toddlers in Gapong Meunasah Intan Kuta Baro, Aceh Besar District is a relationship (Putri Raisa et al. l, 2022).

Furthermore, for the exclusive breastfeeding variable, it is known that from 28 toddlers who did not get exclusive breastfeeding, 17 toddlers with normal nutritional status (23%) and 11 toddlers experienced stunting (14.9%). The results of statistical analysis using the chi-square test, obtained p- value = 0.560 > (α 0.05) ) showed no relationship between exclusive breastfeeding and the incidence of stunting in toddlers aged 24-59 months in the Jambula Health Center Work Area in 2022.

Breast milk is milk produced by the mother and contains the nutrients the baby needs. Babies are only given breast milk without additional fluids such as formula milk, orange juice, tea water, honey, and water, and without other solid foods such as bananas, papaya, milk porridge, or team rice given for six months (Mufdilah 2017).

In line with research conducted by Eko Setiawan, Rizanda Machmud, and Mansur (2018) in the work area of Andalas Public Health Center, East Padang District, Padang City. This study showed that 62.7% of toddlers gave exclusive breastfeeding, and a small proportion of toddlers did not get exclusive breastfeeding (37.3%). The statistic test results obtained a p-value = 0.464 (>α 0.05). There is no relationship between exclusive breastfeeding and the incidence of stunting in children aged 24-59 months in the Andalas Health Center work area, East Padang District, Padang City, in 2018 (Eko Setiawan, Rizanda Machmud and Mansur, 2018).

CONCLUSIONS AND SUGGESTIONS

Based on the results of the analysis of research on factors related to the incidence of stunting in toddlers aged 24-59 months in the working area of the Jambula Care Health Center in 2022, it can conclude that there is a relationship between a history of infectious diseases and the incidence of stunting with a p-value of 0.002. there is no relationship between LBW and the incidence of stunting,

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with a p-value of 0.463. there is no relationship between exclusive breastfeeding and the incidence of stunting, with a P value of 0.560.

From the results of this study, it is hoped that it can be a source of information, especially for mothers who have toddlers under five years old, to increase awareness about toddler health, especially about the fulfillment of toddler nutrition, and mothers can prevent stunting and routinely visit health services to get early detection of toddler health.

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Eko Setiawan, Rizanda, Masrul, 2018. Faktor-Faktor Yang Berhubungan Dengan Kejadian Stunting Pada Anak Usia 24-59 Bulan Di Wilayah Kerja Puskesmas Andalas Kecamatan Padan Timur Kota Padang Timur. Jurnal Kesehatan Andalas Vol 7, No 2 April 2018.

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