Riwayat Pemberian ASI, Riwayat Infeksi, dan Faktor Lain yang Berpengaruh terhadap Stunting di Perdesaan

Abstract

Usia baduta, termasuk ke dalam periode 1000 hari pertama kehidupan. Masa ini menjadi masa emas tumbuh kembang anak, namun juga menjadi masa kritis karena anak-anak rentan mengalami kekurangan gizi yang bersifat irreversible. Salah satu masalah gizi yang rentan terjadi pada masa ini adalah terhambatnya petumbuhan tinggi badan menurut umur yang lebih rendah dibandingkan dengan standar atau disebut stunting. Stunting merupakan malnutrisi kronis akibat kekurangan asupan makanan bergizi terus menerus dan infeksi berulang. Selain itu, stunting merupakan akibat dari malnutrisi antargenerasi. Berdasarkan data TNP2K 2017 Kabupaten Kebumen di Jawa Tengah merupakan salah satu 100 kabupaten/kota yang menjadi prioritas penanganan stunting. Intervensi gizi sensitif dan spesifik telah dilakukan dalam rangka menangani masalah stunting di Kabupaten Kebumen. Hingga tahun 2020, berdasarkan data pengukuran dari Posyandu, terjadi penurunan prevalensi stunting baduta di Kabupaten Kebumen hingga 13,30%. Namun, data per wilayah Puskesmas menunjukkan masih ada beberapa wilayah yang memiliki prevalensi stunting tinggi. Salah satunya adalah wilayah Puskesmas Puring dengan prevalensi stunting baduta 27,9%. Oleh karena itu, tujuan umum dari penelitian ini adalah menganalisis faktor-faktor risiko yang berhubungan dengan stunting pada anak usia 6-24 bulan di perdesaan. Tujuan khusus penelitian ini adalah (1) mengidentifikasi karekteristik anak, karakteristik keluarga, dan karakteristik ibu; (2) mengidentifikasi riwayat pemberian ASI pada anak usia 6-24 bulan; (3) mengidentifikasi riwayat infeksi anak, riwayat kelahiran, dan riwayat status gizi ibu; (4) menganalisis hubungan antara karakteristik anak, karakteristik keluarga, karakteristik ibu, riwayat pemberian ASI, riwayat infeksi anak, riwayat kelahiran, dan riwayat status gizi ibu dengan stunting pada anak usia 6-24 bulan; (5) menganalisis faktor risiko stunting pada anak usia 6-24 bulan. Penelitian menggunakan desain studi kasus kontrol. Kelompok kasus adalah anak usia 6-24 bulan dengan nilai z-score PB/U <-2SD, sedangkan kelompok kontrol adalah anak dengan usia yang sama, yaitu 6-24 bulan, yang memiliki nilai z-score PB/U >-2SD. Penelitian dilakukan di wilayah kerja Puskesmas Puring, Kecamatan Puring, Kabupaten Kebumen, Jawa Tengah. Pengambilan data dilakukan dari bulan Januari 2021 hingga Maret 2021. Perbandingan sampel antara kasus dan kontrol adalah 1:1. Hasil perhitungan menunjukkan jumlah minimal contoh dari masing-masing kelompok adalah 43 anak. Penentuan lokasi penelitian dari tingkat kabupaten dan kecamatan dilakukan secara purposive, sedangkan tingkat desa dilakuakan secara simple random sampling. Terpilih 4 desa untuk memenuhi minimal sampel baduta. Identifikasi kasus dilakukan di 14 Posyandu dari 4 desa terpilih dengan melakukan pengukuran panjang badan baduta. Setelah mendapatkan baduta stunting untuk kelompok kasus dilakukan simple random sampling untuk mendapatkan baduta kelompok kontrol yang berada pada kelompok usia yang sama dengan kelompok kasus. Data yang dikumpulkan merupakan data primer dan sekunder. Data primer yang dikumpulkan meliputi jenis kelamin anak, status gizi anak berdasarkan PB/U, jumlah anggota keluarga, pendapatan keluarga, pekerjaan ibu, pendidikan ibu, usia ibu saat hamil, jarak antar kehamilan, tinggi badan ibu, riwayat IMD, ASI eksklusif, waktu pengenalan MP-ASI, pemberian ASI, pola asuh makan usia 6 - <9 bulan, pola asuh makan usia 9 - <12 bulan, riwayat diare, riwayat ISPA, berat badan lahir, panjang badan lahir, Indeks Massa Tubuh (IMT) ibu sebelum hamil, dan kenaikan berat badan ibu selama kehamilan. Tinggi badan ibu diukur langsung menggunakan microtoise. Panjang badan anak juga diukur langsung menggunakan length board. Data lainnya diperoleh dari wawancara menggunakan kuisioner. Data sekunder mengenai riwayat IMD, berat badan lahir, panjang badan lahir, riwayat infeksi anak, usia ibu saat hamil, jarak antar kehamilan, dan berat badan ibu saat hamil juga dilihat dari catatan buku KIA. Catatan tersebut digunakan untuk menguatkan hasil wawancara. Hasil penelitian menunjukkan jenis kelamin, jumlah anggota keluarga, pendapatan keluarga, pekerjaan ibu, pendidikan ibu, usia ibu saat hamil, jarak antar kehamilan, IMD, ASI eksklusif, waktu pengenalan MP-ASI, pemberian ASI, ISPA, berat badan lahir, usia kelahiran, dan IMT ibu sebelum hamil tidak berhubungan signifikan dengan stunting pada uji bivariat. Terdapat hubungan yang bermakna antara tinggi badan ibu dengan stunting (p-value 0,028), pola asuh makan usia 6-<9 bulan dengan stunting (p-value 0,001), pola asuh makan usia 9-<12 dengan stunting (p-value 0,007). Diare (p-value 0,010), panjang badan lahir (p-value 0,028), dan kenaikan berat badan ibu saat hamil (p-value 0,028) juga memiliki hubungan bermakna dengan stunting. Model akhir analisis multivariat menunjukkan variabel yang menjadi faktor risiko stunting adalah jenis kelamin, TB Ibu, dan pola asuh makan usia 6-<9 bulan. Anak laki-laki lebih berisiko mengalami stunting dibandingkan anak perempuan (p-value 0,047 OR 3,12, 95% CI:1,01-9,61). Baduta yang mendapat pola asuh makan kurang pada periode awal pemberian makan, yaitu usia 6-<9 bulan, berisiko hingga 5,50 kali mengalami stunting (p-value 0,023 OR 5,50;95% CI:1,27-23,80). Kenaikan berat badan ibu selama kehamilan yag kurang berisiko meningkatkan stunting pada anak hingga 4,22 kali lebih tinggi dibandingkan ibu yang memiliki kenaikan berat badan yang cukup (p-value 0,017 OR 4,22;95% CI:1,30-13,71). Penelitian ini menunjukkan pola asuh makan anak usia 6-<9 bulan dan kenaikan berat badan ibu selama hamil memiliki peran penting terhadap status gizi PB/U anak. Oleh karena itu penguatan program untuk persiapan kehamilan, selama masa kehamilan, dan periode 2 tahun pertama kehidupan anak perlu dilakukan. Perlu adanya dukungan dan keterlibatan kelompok sekunder seperti, wanita usia subur; remaja; lingkungan pengasuh terdekat seperti ayah, nenek, kakek; pemuka masyarakat dan agama dalam program seperti kelas pra nikah, kelas ibu hamil, dan bina kelompok balita.

Keywords: diarrhea, food parenting patterns, maternal weight gain, stunting

Childrens under two years old are included in the period of the first 1000 days of life. This period is a golden period for children's growth and development, but also a critical period because children are vulnerable to irreversible malnutrition. One of the nutritional problems that are prone to occur at this time is stunted growth in height according to age which is lower than the standard or called stunting. Stunting is chronic malnutrition due to lack of continuous nutritional food intake and repeated infections. In addition, stunting is the result of intergenerational malnutrition. Based on TNP2K 2017 data, Kebumen Regency in Central Java is one of 100 districts/cities that are prioritized for stunting management. Sensitive and specific nutrition interventions have been carried out in order to deal with the stunting problem in Kebumen Regency. Until 2020, based on measurement data from Posyandu, there has been a decrease in the prevalence of stunting under children in Kebumen Regency to 13.30%. However, data Public Health Center area shows that there are still some areas that have a high prevalence of stunting. One of them is the Puring Public Health Center area with a prevalence of stunting under children of 27.9%. Therefore, the general objective of this study was to analyze the risk factors associated with stunting in children aged 6-24 months in rural areas. The specific objectives of this study were (1) to identify the characteristics of children, family characteristics, and mother characteristics; (2) identify the history of breastfeeding in children aged 6-24 months; (3) identify the child's infection history, birth history, and history of maternal nutritional status; (4) analyzing the relationship between child characteristics, family characteristics, mother characteristics, breastfeeding history, child infection history, birth history, and history of maternal nutritional status with stunting in children aged 6-24 months; (5) analyzing the risk factors for stunting in children aged 6-24 months. This research uses a case control study design. The case group was children aged 6-24 months with a PB/U z-score <-2SD, while the control group was a child of the same age, 6-24 months, who had a PB/U z-score >-2SD. The research was conducted in the working area of Puring Health Center, Puring District, Kebumen Regency, Central Java. Data collection was carried out from January 2021 to March 2021. The sample comparison between cases and controls was 1:1. The calculation results show that the minimum number of samples from each group is 43 children. Determination of the research location from the district and sub-district levels was carried out purposively, while the village level was carried out by simple random sampling. Selected 4 villages to meet the minimum sample of childrens. Case identification was carried out in 14 Posyandu from 4 selected villages by measuring the body length of the childrens. After getting stunting children for the case group, simple random sampling was carried out to get the control group childrens who were in the same age group as the case group. The data collected is primary and secondary data. The primary data collected included the sex of the child, the nutritional status of the child based on body length, number of family members, family income, mother's occupation, mother's education, maternal age during pregnancy, distance between pregnancies, mother's height, history of early initiation of breastfeeding, exclusive breastfeeding, timing of giving complementary food, breastfeeding, food parenting pattern aged 6 - <9 months, food parenting pattern aged 9 - <12 months, history of diarrhea, history of ARI, birth weight, birth length, maternal BMI before pregnancy, and maternal weight gain during pregnancy. Mother's height was measured directly using a microtoise. The child's body length was also measured directly using the length board. Other data were obtained from interviews using questionnaires. Secondary data regarding the history of early initiation of breastfeeding, birth weight, birth length, history of child infection, maternal age during pregnancy, distance between pregnancies, and maternal weight gain during pregnancy were also seen from MCH book records. These notes were used to corroborate the results of the interviews. The results showed that sex, number of family members, family income, mother's occupation, mother's education, maternal age during pregnancy, distance between pregnancies, early initiation of breastfeeding, exclusive breastfeeding, time of giving complementary feeding, breastfeeding, ARI, birth weight, birth age, and maternal BMI before pregnancy were not related significantly with stunting in the bivariate test. There is a significant relationship between maternal height and stunting (p-value 0.028), food parenting aged 6-<9 months with stunting (p-value 0.001), food parenting aged 9-<12 with stunting (p-value 0.007). Diarrhea (p-value 0.010), birth length (p-value 0.028), and maternal weight gain during pregnancy (p-value 0,011) also had a significant relationship with stunting. The final model of multivariate analysis showed that the variables that became risk factors for stunting were sex, maternal height, and food parenting patterns aged 6-<9 months. Boys are more at risk of stunting than girls (p-value 0,047 OR 3,12, 95% CI:1,01-9,61). Childrens who received poor food parenting in the early feeding period, aged 6-<9 months, had a risk of up to 5.50 for stunting (p-value 0,023 OR 5,50;95% CI:1,27-23,80). Less of maternal weight gain during pregnancy increasing risk of stunting in children up to 4,22 times higher than mother who have sufficient weight gain (p-value 0,017 OR 4,22; 95% CI:1,30-13,71). This study shows that the eating patterns of children aged 6-<9 months and the maternal weight gain during pregnancy have an important role in the nutritional status. Therefore, it is necessary to strengthen programs for preparation for pregnancy, during pregnancy, and the first 2 years of a child's life. There needs to be support and involvement of secondary groups such as women of childbearing age; teenager; the closest caregiver environment such as father, grandmother, grandfather; community and religious leaders in programs such as pre-ma