Prevalensi dan Faktor yang Memengaruhi Ketidakcukupan Asupan Zat Gizi Mikro Anak Usia 6-23 Bulan di Perdesaan dan Perkotaan Indonesia

Abstract

Kerawanan terhadap terjadinya defisiensi berbagai zat gizi terutama zat gizi mikro dimulai saat usia 6 bulan saat diperkenalkan MP-ASI. Hal tersebut dikarenakan terdapat kesenjangan kecukupan gizi, jika ASI diberikan kepada anak usia 12-23 bulan sebanyak 550 ml/hari, seperti energi 60%, protein 40%, zat besi 90%, dan vitamin A 20%. Zat besi, seng, kalsium, vitamin A, dan C merupakan zat gizi mikro yang sering mengalami kekurangan pada anak baduta. Kualitas MP-ASI yang rendah dengan asupan zat gizi mikro yang tidak mencukupi, membuat anak usia baduta di negara berkembang berisiko tinggi mengalami gizi kurang. Asupan zat gizi dan pola konsumsi pangan dikeluarga dipengaruhi juga oleh faktor sosial, ekonomi, demografi, gaya hidup, kesehatan, kebiasaan, dan nilai budaya. Wilayah perdesaan dan perkotaan memiliki karakteristik sosial-ekonomi yang cenderung berbeda, sehingga dapat memengaruhi kemampuan rumah tangga dalam menyediakan jenis pangan untuk keluarganya. Tujuan utama penelitian yaitu menganalisis prevalensi dan faktor yang memengaruhi ketidakcukupan asupan zat gizi mikro pada anak usia 6-23 bulan di wilayah perdesaan dan perkotaan Indonesia. Tujuan khusus penelitian yaitu 1) Menganalisis perbedaan karakteristik subjek, karakteristik sosial-ekonomi keluarga, status gizi, riwayat pada anak usia 6-23 bulan berdasarkan wilayah perdesaan dan perkotaan ; 2) Menganalisis perbedaan asupan zat gizi makro dan mikro anak usia 6-23 bulan berdasarkan wilayah perdesaan dan perkotaan; 3) Menganalisis perbedaan prevalensi ketidakcukupan asupan zat gizi makro dan mikro anak usia 6-23 bulan berdasarkan wilayah perdesaan dan perkotaan; 4) Menganalisis pemenuhan kebutuhan dari ASI dan MP-ASI anak usia 6-23 bulan berdasarkan wilayah perdesaan dan perkotaan; 5) Menganalisis perbedaan keragaman konsumsi pangan anak usia 6-23 bulan berdasarkan wilayah perdesaan dan perkotaan; 6) Menganalisis hubungan variabel bebas dengan ketidakcukupan asupan zat gizi mikro berdasarkan wilayah perdesaan dan perkotaan; 7) Menganalisis faktor yang memengaruhi ketidakcukupan asupan zat gizi mikro anak 6-23 bulan berdasarkan wilayah perdesaan dan perkotaan. Desain penelitian ini menggunakan studi potong-lintang. Penelitian ini menggunakan data SKMI 2014 dari Badan Penelitian dan Pengembangan Kesehatan Republik Indonesia dengan unit analisis nasional. Penelitian dilaksanakan dari November 2020-November 2021. Total subjek penelitian berjumlah 1575 anak usia 6-23 bulan. Variabel yang digunakan pada penelitian berupa karakteristik subjek, karakteristik sosial-ekonomi keluarga, status gizi (BB/U), riwayat menyusui, wilayah tempat tinggal, dan konsumsi pangan (ASI dan MP-ASI), keragaman pangan, asupan zat gizi makro dan mikro, dan ketidakcukupan asupan zat gizi mikro. Keragaman konsumsi pangan subjek menggunakan Minimum Dietary Diversity (MDD) dengan 8 kelompok pangan. Data asupan zat gizi dan estimasi kebutuhan zat gizi atau Estimated Average Requirement (EAR) digunakan untuk menghitung prevalensi ketidakcukupan asupan zat gizi mikro berdasarkan metode probabilitas kecukupan. Analisis data yang digunakan yaitu uji deskriptif, uji bivariat seperti uji beda dan uji hubungan, serta uji logistik regresi biner untuk analisis multivariat. Sebanyak 55,9% subjek tinggal di perdesaan dengan status ekonomi tingkat bawah, jumlah anggota rumah tangga lima atau lebih, pendidikan ibu dan ayah rendah, ibu tidak bekerja, dan pekerjaan ayah sebagai petani/nelayan/buruh. Sebesar 44,1% subjek tinggal di perkotaan dengan status ekonomi menengah, jumlah anggota rumah tangga lima atau lebih, usia ibu <35 tahun, pendidikan ayah dan ibu tinggi, ibu tidak bekerja, dan pekerjaan ayah sebagai wiraswasta/pegawai swasta. Persentase subjek yang masih konsumsi ASI lebih besar di perdesaan yaitu 52,7% subjek dibandingkan perkotaan. Median asupan energi, protein, kalsium, besi, seng, vitamin A signifikan lebih tinggi pada wilayah perdesaan dibandingkan perkotaan. Prevalensi ketidakcukupan keseluruhan asupan zat gizi mikro pada wilayah perdesaan yaitu 66,1% dan perkotaan sebesar 56,5%. Prevalensi ketidakcukupan asupan vitamin C merupakan prevalensi tertinggi pada wilayah perdesaan dan perkotaan, sedangkan yang paling rendah yaitu seng. Lebih dari 50% dan 20% subjek memiliki asupan energi dan protein kurang dari kebutuhan, secara berturut-turut, baik itu di perdesaan dan perkotaan. Persentase subjek yang mencapai MDD di perkotaan sebesar 22,1% dan perdesaan 11,2%. Konsumsi pangan subjek pada wilayah perdesaan dan perkotaan masih rendah akan kelompok kacang-kacangan, telur, sayur dan buah kaya vitamin A, dan sayur dan buah lainnya. Tidak tercapai minimal keragaman pangan, asupan energi kurang dari kebutuhan, status ekonomi keluarga tingkat bawah, pekerjaan ayah sebagai petani/nelayan/buruh, pekerjaan ibu sebagai petani/nelayan/buruh dan tidak bekerja, pendidikan ayah dan ibu rendah berhubungan dengan ketidakcukupan asupan zat gizi mikro di perdesaan. Tidak tercapai minimal keragaman pangan, asupan energi kurang dari kebutuhan, tidak konsumsi ASI, status ekonomi keluarga tingkat bawah dan menengah, pendidikan ayah dan ibu rendah berhubungan dengan ketidakcukupan asupan zat gizi mikro di perkotaan. Faktor yang memengaruhi ketidakcukupan asupan zat gizi mikro anak usia 6-23 bulan di perdesaan yaitu pendidikan ibu rendah [OR=1,72 (95% CI: 1,17-2,55)], tidak tercapai minimal keragaman pangan [OR=5,94 (95% CI: 3,61-9,77)], asupan energi kurang dari kebutuhan [OR=5,44 (95% CI: 43,85-7,89)]. Faktor yang memengaruhi ketidakcukupan asupan zat gizi mikro anak usia 6-23 bulan di perkotaan yaitu pendidikan ibu rendah [OR=1,71 (95% CI: 1,19-2,46)], tidak tercapai minimal keragaman pangan [OR=4,11 (95% CI: 2,63-6,42)], asupan energi kurang dari kebutuhan [OR=7,34 (95% CI: 5,08-10,61)], dan tidak konsumsi ASI [OR=0,47 (95% CI: 0,33-0,69)]. Ketidakcukupan keseluruhan asupan zat gizi mikro masih menjadi masalah gizi pada lebih dari setengah anak dan bayi di perdesaan dan perkotaan Indonesia. Dua faktor terbesar memengaruhi ketidakcukupan asupan zat gizi mikro anak usia 6-23 bulan di perdesaan dan perkotaan yaitu tidak tercapainya minimal keragaman pangan dan asupan energi kurang dari kebutuhan. Perlu adanya upaya peningkatan kualitas dan kuantitas pangan dengan pemberian edukasi kepada ibu atau pengasuh tentang praktik pemberian makan bayi dan anak yang tepat.

Vulnerability for having inadequate nutrient intake, especially micronutrient, occurs in infants aged six months, while complementary feeding was introduced. There is a gap of nutrient adequacy if 550 ml/days amount of human milk given to children aged 12-23 months, such as energy 60%, protein 40%, iron 90%, and vitamin A 20%. Iron, zinc, calcium, vitamin A, and vitamin C were nutritional problems in children under two years old. Low quality of complementary food with insufficient micronutrient intake might cause children aged 12-23 months in developing countries at high risk of under nutrition. Food consumption patterns and nutrient intake were also affected by household factors such as social, economic, demography, lifestyle, health, habit, custom, and culture. Rural areas tended to have low social-economy characteristics that can influence the household to provide and prepare food for their families. The study objective was to analyze the prevalence and factors affecting inadequate micronutrient intake among children aged 6-23 months in rural and urban Indonesia: 1) To analyze the differences in subject characteristics, family socio-economic characteristics, nutritional status, breastfeeding history in children aged 6-23 months based on rural and urban areas; 2) To analyze the differences in macro and micro-nutrient intake among children aged 6-23 months based on rural and urban areas; 3) To analyze the differences of prevalence of inadequate macro and micro-nutrient intake among children aged 6-23 months based on rural and urban areas; 4) To analyze the requirements fulfillment from breastmilk and complementary food in children aged 6-23 months based on rural and urban areas; 5) To analyze the differences in the dietary diversity of children aged 6-23 months based on rural and urban areas; 6) To analyze the correlation between independent variables and inadequate micronutrient intake based on rural and urban areas; 7) To analyze the factors that affecting the inadequate micronutrient intake for children 6-23 months based on rural and urban areas. This research was cross-sectional study used SKMI 2014 data from Indonesian Health Research and Development Agency with national unit analysis. This research was conducted from November 2020 until September 2021. The total subject of this research was 1575 children aged 6-23 months. The data included such as subject characteristics, social-economy of family characteristics, nutritional status (WAZ), breastfeeding history, residence area, and food consumption (breast milk and complementary food), dietary diversity, inadequacy of micronutrient intake. Minimum Dietary Diversity (MDD) was used to determine child dietary diversity with eight food groups. Nutrient intake and Estimated Average Requirement (EAR) were used to calculate the prevalence of inadequacy of micronutrient intake based on the probability of adequacy method. Data analysis was used descriptive test and bivariate test such as difference test and correlation test, also binary regression logistic test was used during the multivariate analysis. About 55,9% of the subjects lived in rural areas with lower economic status, the number of family size was five or more, the mother's age was <35 years, low mother and father education, not working mother, and the father's occupation was a farmer/fisherman/labor. On the other hand, 44,1% of the subjects lived in urban areas with middle economic status, the number of family size was five or more, the mother's age was <35 years, high mother and father education, not working mother, and the father's occupation was as an entrepreneur/private employee. The percentage of subjects who still consume breast milk is greater in rural areas, namely 52,7% of subjects compared to urban areas. The median intake of energy, protein, calcium, iron, zinc, and vitamin A was significantly higher in rural areas than in urban areas. The prevalence of overall inadequate micronutrient intake in rural areas was 66,1%, urban areas was 56,5%. The prevalence of inadequate vitamin C intake was the highest in rural areas and urban areas while the lowest was zinc. More than 50% and 20% of subjects had energy and protein intakes which less than requirements, respectively, either in rural and urban area. The percentage of subjects who achieved MDD in urban areas was 22,1% and rural 11,2%. Food consumption of subjects in rural and urban was still low for legumes and nuts, eggs, fruits and vegetables rich-vitamin A, and other vegetables and fruits. Not achieved MDD, energy intake was less than requirements needs, lower level of family economic status, father's occupation as farmer/fisherman/labor, mother's occupation as farmer/fisherman/labor and not working, low father and mother ecucation correlated to inadequate micronutrient intake in the rural area. Whereas in urban areas, not achieved MDD, energy intake was less than requirements, did not consume breastmilk, low and middle level of family economic status, low education of fathers and mothers were correlated to inadequate micronutrient intake. Factors affecting the inadequate micronutrient intake for children aged 6-23 months in rural areas were low mother education [OR=1,72 (95% CI: 1,17-2,55)], not achieved minimum dietary diversity [OR= 5,94 (95% CI: 3,61-9,77)], energy intake was less than requirement [OR=5,44 (95% CI: 3,85-7,89)]. Factors affecting the inadequate micronutrient intake for children aged 6-23 months in urban areas were low mother education [OR=1,71 (95% CI: 1,19-2,46)], not achieved minimum dietary diversity [OR= 4,11 (95% CI: 2,63-6,42)], energy intake was less than requirement [OR=7,34 (95% CI: 5,08-10,61)], and did not consume breast milk [OR= 0,47 (95% CI: 0,32-0,69)]. Inadequate intake of overall micronutrient were still nutritional problem in more than half of children and infants in rural and urban Indonesia. The biggest factors affecting the inadequate micronutrient intake for children aged 6-23 months in rural and urban Indonesia were not achieved dietary diversity and energy intake was less than requirement. Thus improving food quality and quantity by providing education for mothers or caregivers about an appropriate infant and child feeding practices was recommended.