Toddler Nutritional Status with Child Health Service in Working Area of Puskesmas Cipadung 2015
1
Siti Nur Endah*,
2Siti Rokhiyatun
1Prodi Bidan Pendidik (D4) Stikes Jenderal Achmad Yani
2Rumah Sakit Khusus Ibu dan Anak Kota Bandung
*Email: siti_nurendah@yahoo.com
Abstract
Healthy can be seen from the nutritional status, nutritional status is a measure of the state of a person's body that can be seen as a result of the consumption of food and nutrients. Nutritional status can be distinguish into poor nutritional status, less, better and more.The research is cross sectional. A proportional random sampling on children aged 1 - 5 years with total sample 97 children were taken whom mothers as respondent in the region of subdistrict Community Health Centers Cipadung Bandung. The result found that 72.2% children health care in good, nutrition status based weight for age 82.5% in good status and weight for height 88.7% normal. The statistic results there is a relationship between children health care and nutritional status weight for age (p
= 0.017) and nutritional status weight for height (p = 0.010). In Cipadung Community Health Centers should have a nutritional counseling service to its community, especially to people who have children under five years of age. This service must collaborate with other health care facilities such as general physicians and midwives and improve supervision of Posyandu services.
Cipadung Community Health Centers have to improve the monitoring of children growth and development by means of the obligation to report the child health care activities so the quality of government program will increase.
Key words: Child health, nutritional status, service, toddler Introduction
Children under 5 years is a very important part because this age is the foundation that shape the future, health, happiness, growth, development and learning outcomes in school children, families, communities and life in general. In addition, children are a group that is still vulnerable to health problems or disease that must be monitored to ensure they are in a good condition. The effort of child health services are expected to reduce child mortality. Grand strategy from Healthcare Department on Survival program expecting any babies and toddlers acquire basic health care plenary, serviced adequately, every infant and toddlers grow and develop optimally1. One of the health indicators in the MDGs is nutritional status of toddler. The problem of public health considered seriusly when the prevalence of toddler underweight 20.0% - 29.0% and also considered a very high prevalence when more than 30% (WHO, 2010). Toddlers were malnourished based on weight/ age at 2013 in Indonesia as much as 19.6% and in West Java as much as 15.7%. In 2013 the national prevalence of malnutrition on toddlers as much as 19.6%, which means that the problem of malnutrition on toddlers in Indonesia closer to serious level.2
Healthy influenced by two factors: behavioral factors and non-behavioral or environmental factors.4 Healthy can be seen from the nutritional status, nutritional status is a measure of the state of a person's body that can be seen as a result of the consumption of food and nutrients. Nutritional status can be distinguish into poor nutritional status, less, better and more.5 The nutritional status has complex dimensions. The factors that affect nutritional status directly are the intake of food and indirectly are healthcare service. One of the healthcare services is the healthcare for toddlers.6
Children Healthcare covers the growth monitoring with weight measurements of toddler every month which recorded at KIA/ KMS book, giving high doses of vitamin A (200,000 IU and 100,000 IU), nutritious meals and counseling.7
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Method
The research was cross sectional.9 The research was conducted from February until June 2015 at Puskesmas of Cipadung in sub-district of Cibiru of Bandung City.
The population is children under five years old with the number of 2,947 children.
10 and the sampling technique using proportional random with the sample 11 as much as 97 children. Statistic test used Kai squared (X2) or Chi square with the level of
significance α = 0.05 and Confidence Interval (CI) of 95%. The Data collection techniques of child healthcare services were collected through interviews using a questionnaire and nutritional status data through observation by weigh and measure the height.
Result
1. Child Health Service
The research indicator/ variable children healthcare services can be seen in the following table:
Table 1. Frequency Distribution of Child Health Indicators
Indicator Frekuency
(n)
Persentage (%)
Growth monitoring Good
Bad
88 90,7
9 9,3
Total 97 100
The provision of vitamin A Good
Bad
93 95,9
4 4,1
Total 97 100
The provision of good nutrition
Good 88 90,7
Bad 9 9,3
Total 97 100
Good
Bad 73 75,3
24 24,7
Total 97 100
Source: primary data
From table 2 it can be seen the percentage of indicators of children healthcare services in the highest category of good value is the indicator of giving vitamin A as much as 93 people (95.9%) while for the worst category (most unfavorable) is the indicator of counseling as much as 24 people (24.7%).
The variable of children healthcare services can be seen in the following table:
Table 2. Variable Frequency Distribution of Children Healthcare
Child health services Frekuency
(n)
Persentage (%)
Good 70 72,2
Bad 27 27,8
Total 97 100
Source: primary data
Based on Table 3 that the percentage of children healthcare services variables was included in both categories as much as 70 peoples (72.2%) while bad category as much as 27 peoples (27.8%). When viewed from the indicators of children healthcare services, the indicator of bad value is in counseling as much as 24 peoples (24.7%). Therefore, to further improve children healthcare services, Puskesmas of Cipadung should improve counseling services to the community, especially people who have a toddler.
Nutritional counseling and similar activities is basically used to guide, educate and direct the public so that they can overcome their own health problems. Counseling also aims to improve the knowledge, attitudes and behavior towards the children healthcare. Hestuningtyas and Noer say that the nutritional counseling can improve knowledge, attitude, and practice of mother in feeding the children. 11 According to Misbakhudin, knowledge and attitudes associated with nutrition conscious behavior, 12 therefore, through counseling of children healthcare will increase access and utilization of health services children.
Sartika researchs states that the utilization analysis of Health Nutritional Status of Toddlers program, the healthcare services are utilized by people other than Puskesmas is practicing doctor, midwife, Posyandu, poskesdes and polindes. 13 Therefore, in improving children healthcare services, Puskesmas of Cipadung must work together with the other healthcare facilities that exist in the work area.
2. Nutritional Status of Toddler
The research results of nutritional status of toddler can be seen in the following table:
Table 3. Variable Frequency Distribution of Toddler Nutritional Status according to Standard WHO-NCHS
The variable of toddler nutritional status
Weight/Age More Good Less Bad
Frequency (n)
3 80 14 0
Persentage (%)
3,1 82,5 14,4 0
Total 97 100
Weight/Height
Fat 3 3,1
Normal 86 88,7
Thin 8 8,2
Very thin 0 0
Total 97 100
Source: primary data
From the table it can be seen that the nutritional status of children based on weight indicator than age (W/A) found that a good nutritional status as much as 80 people (82.5%) and less nutritional status as much as 14 people (14.4%).
The problem of nutrition/ public health seriously considered when the prevalence of malnutrition on toddler ranges from 20.0% - 29.0% and also considered a very high prevalence when more than 30.0% (WHO, 2010). When compared with the results of Riskesdas 2013 the status of malnutrition in Indonesia was 13.9% and in Puskesmas of Cipadung was 14.4%, so malnutrition status in Puskesmas Cipadung still above the national average.
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When viewed from the indicator Weight/Height , it was found as much as 86 people (88.7%) normal nutrient and 3 people (3.1%) fat nutrition. The Indicator of W/H are used as screening the nutritional status of the measurement results W/A so that it can be said that the troubled toddler nutrition in Puskesmas Cipadung was 8.2% nutrition slim/ less and 3.1% fat nutrition/ better. Nutritional deficiency or nutritional excess is a problem that often referred to nutrition or nutrition problems doubles, so Puskesmas of Cipadung facing nutritional problems dual malnutrition and over nutrition.
For the purposes of calculation, the statistical tests of nutritional status are modified as follows:
Table 4. Variable Frequency Distribution of Toddler Nutritional Status (Modified) The variable of toddler
nutritional status W/A
Good Bad
Frequency (n)
80 17
Persentage (%)
82,5 17,5
Total 97 100
W/ H
86
Normal 11
Abnormal
88,7 11,3
Total 97 100
Source: primary data
Based on Table 5 it can be seen that the indicator W/A as much as 80 people (82.5%) for good nutritional status, as much as 17 people (17.5%) for bad nutrition. The indicator W/H as much as 86 people (88.7%) for normal nutritional and 11 people (11.3%) for abnormal nutritional status.
3. The relationship between health service and toddler nutritional status
Table 5. The relationship between health and toddler nutritional status Weight/ Age
Child services
health Nutritional status
Good Bad
P value OR 95%
Cl
Good 62 8
(88,6) (11,4%) 0,017 3,8
Bad 18
(66,7) Source: primary data
9 (33,3%)
1,30 – 11,49
From Table 6 it can be seen that the nutritional status of toddler (based on W/ A) who obtained healthcare services in both categories, from 97 samples was found as much as 62 peoples (88.6%) that have good nutritional status, and 8 peoples (11.4%) nutritional status is not good.
While the bad child health services as much as 18 peoples (66.7%) good nutritient as much as 9 peoples (33.3%) good nutritients.
From the statistical test of Chi square or Kai square obtained Pvalue = 0,017, so making it less rather than or equal to Alpha (α) ≤ 0.05 then there is a significant relationship between child health services and nutritional status W/A with values odds ratio of 3.8.The nutritional status W/
H can be seen in the following table:
Table 6. The relationship between Child health services and Nutritional Status of Toddler W/H
Nutritional status Child health
services
Normal
abnormal
P value OR 95%
Cl
good 66 4
(94,3) (5,7%) 0,010 5,7 1,53 – 21,75
Bad 20
(74,1) Source: primary data
7 (25,9%)
Based on Table 7 it can be seen that the nutritional status of toddler (based on W/H) that obtain healthcare services in both categories, from 97 samples was found as much as 66 peoples (94.3%) who had normal nutritional status, and 4 peoples (5.7 %) with a normal nutritional status.
While those who obtain healthcare services are not good as much as 20 people (74.1%) with a normal nutritional status and 7 peoples (25.9%) with a normal nutritional status.
From the statistical test Chi square Kai square or obtained pvalue = 0.010, making it less than or equal to Alpha (α) ≤ 0.05 then there is a significant relationship between child healthcare and nutritional status W/H with a value odds ratio of 5.7. Toddlers who obtained healthcare services in good categories and have good nutritional status as much as 62 peoples (88.6%) and those who did not get good healthcare services as much as 18 people (66.7%). The results of statistical tests Kai squares or pvalue obtained chi square = 0.017, so it is smaller than the Alpha (α) ≤ 0.05, then Ho is rejected and Ha accepted that concluded there was a significant association between child health and nutritional status W/H, meaning that toddlers who receive good healthcare will likely have a good nutritional status 3.8 times compared with child who receive healthcare service unfavorable.
When viewed from children W/H who obtain good healthcare service and had normal nutritional status as much as 66 peoples (94.3%), while thoose who did not obtain good healthcare service and get a normal nutritional status as much as 20 people (74.1%). From the statistical test Chi square or Kai square obtained pvalue = 0.010, so it is smaller than the Alpha (α) ≤ 0.05, then Ho is rejected and Ha accepted, soit can concluded there was a significant association between children's health and nutritional status W/H, meaning that toddler who obtained good healthcare services will likely have a normal nutritional status 5.7 times compared with children who receive good healthcare. This is in line with the research of Sartika that the rate of mother attending regularity to Posyandu to monitor the growth of children that low and can result in delays the detection of children growth disorders. In line with the research Welasasih and Wirjatmadi say that the level of attendance to Posyandu significantly associated with the occurrence of stunting in the nutritional status balita. 14
The research of Khotimah, Siregar and Mardiana that maternal nutritional knowledge and toddler eating pattern that there are very significant relationship with nutritional status, therefore, through the consulting lectures, discussions, counseling and others by the officer and Posyandu cadre‘s can improve the nutritional status gizi. 15
Persagi 1999 in Supariasa, Bakri, and fajar deliver the factors that affect nutritional status directly one of which is the intake of food, and indirectly the health service. However there is a relationship, although not directly, so that health services include monitoring the growth of children with weight measurements of children under five every month is recorded in the book KIA / KMS.
Conclusion
Child health services in working area of Puskesmas of Cipadung in sub district Cibiru Bandung as much as 70 peoples (72.2%) included in good categories, while as much as 27 peoples (27.8%) is still in bad category.
Nutritional status based on weight indicator rather than age (W/A) known that nutritional status more than 3 peoples (3.1%), good nutritional status as much as peoples (82.5%) and less
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nutritional status as much as 14 peoples (14.4%) and poor nutritional status was not found. When viewed from weight indicator rather than age (W/H) obtained the nutritional status of obese as much as 3 peoples (3.1%), normal nutritional status as much as (88.7%) and underweight nutritional as much as 8 peoples (8.2%) as well as the bad underweight nutrition status also not found.
There is a significant relationship between child health services and nutritional status W/A (Pvalue = 0.017, α ≤ 0.05) OR value of 3.8 and nutritional status W/H (pvalue = 0.010, α
≤ 0.05) the value of OR was 5.7.
The provision of high doses of Vitamin A in February and August, nutritious meals and counseling are government programs must continue to be improved quantity and quality so that Puskesmas of Cipadung can contribute in decreasing the prevalence of malnutrition and less nutrition as expected of MDGs in 2015 was 15.5 %.
Acknowledgment
We would like to thank our Chair Man at STIKES (Higher School of Health Sciences) Jenderal Achmad Yani Cimahi who have supported us to publish the result of this study. This research can be conducted upon the midwife at Primary Health Care of Cipadung in sub district Cibiru Bandung, and all the lecturer at STikes Jenderal Achmad Yani Cimahi.
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