Faktor Risiko Stunting pada Balita: Studi Ekologi di Provinsi Sumatera Barat

Abstract

Stunting merupakan kondisi gagal tumbuh yang ditandai dengan tinggi badan anak tidak sesuai dengan usia. Status gizi ini merupakan indikasi masalah gizi kronis akibat kekurangan gizi maupun infeksi dalam jangka waktu yang lama. Berdasarkan hasil SSGI 2021 sebanyak 23,3% balita di Sumatera Barat mengalami stunting. Stunting yang tidak ditangani dengan baik akan memberikan dampak pada pertumbuhan dan perkembangan anak dalam jangka pendek maupun jangka panjang. Dampak dari stunting tersebut dapat menurunkan kualitas sumber daya manusia yang dibutuhkan untuk meningkatkan pembangunan bangsa. Oleh sebab itu faktor penyebab stunting perlu diatasi sedari dini. Berbagai upaya telah dilakukan oleh Pemerintah Indonesia untuk menurunkan angka kejadian stunting sesuai dengan target RPJMN pada tahun 2024 sebesar 14%. Upaya yang dilakukan meliputi intervensi gizi secara spesifik dan sensitif. Namun berdasarkan hasil SSGI pada tahun 2021, angka kejadian stunting di Indonesia dan sebagian besar provinsinya masih diatas 20%. Hal tersebut dapat dikarenakan penanganan stunting yang telah dilakukan belum sesuai dengan kondisi sosio demografi dan faktor risiko yang dominan terjadi di wilayah tersebut. Faktor risiko stunting bukan hanya di tingkat individu namun juga di tingkat populasi dan lingkungan. Oleh sebab itu, studi ekologi ini bertujuan untuk menganalisis faktor risiko pada tingkat populasi dan faktor yang dominan di masing-masing kabupaten/kota. Desain yang digunakan dalam penelitian ini adalah studi ekologi menggunakan data sekunder yang bersumber dari Badan Kebijakan Pembangunan Kesehatan (BKPK) Kementerian Kesehatan Republik Indonesia, Dinas Kesehatan, Dinas Sosial, Dinas Pangan, BKKBN dan BPS Provinsi Sumatera Barat. Pengumpulan data sekunder dilakukan pada November 2021 di Sumatera Barat. Selanjutnya pengolahan, analisis, interpretasi dan penyusunan tesis dilaksanakan pada Desember 2023 – Agustus 2024. Populasi pada penelitian adalah seluruh kabupaten/kota di Sumatera Barat. Unit analisis yang diambil yaitu 19 kabupaten/kota di Sumatera Barat. Data yang dikumpulkan dalam penelitian ini yaitu data dari masing-masing kabupaten/kota yang meliputi prevalensi stunting, cakupan ASI eksklusif, angka kejadian diare, prevalensi ISPA, skor Indeks Ketahanan Pangan, cakupan suplementasi vitamin A, cakupan kunjungan Antenatal Care (ANC), cakupan penggunaan Keluarga Berencana (KB), persentase Open Defecation Free (ODF), persentase akses jamban layak, persentase kemiskinan, persentase keluarga risiko stunting, dan persentase penerima PKH. Analisis data meliputi analisis univariat (uji deskriptif), analisis bivariat (uji korelasi: Pearson dan Spearman test), serta analisis multivariat (regresi logistik). Selain itu dilakukan mapping untuk memetakan prevalensi stunting dan faktor-faktor yang berhubungan dengan prevalensi stunting di masing-masing wilayah di Sumatera Barat. Hasil analisis menunjukkan bahwa terdapat perbedaan prevalensi stunting antara data yang bersumber dari SSGI dan dinas kesehatan. Rata-rata prevalensi stunting berdasarkan SSGI yaitu 23,58%, sedangkan berdasarkan dinas kesehatan yaitu 11,97%. Meskipun terdapat perbedaan rata-rata, berdasarkan kedua sumber data tersebut ditemukan bahwa masih terdapat beberapa wilayah di Sumatera Barat yang memiliki prevalensi stunting yang belum mencapai target penurunan angka kejadian stunting sebesar 14%. Seluruh wilayah di Sumatera Barat telah mencapai target cakupan ASI eksklusif dan angka kejadian diare yang ditetapkan oleh pemerintah. Prevalensi ISPA, Skor Indeks Ketahanan Pangan dan cakupan suplementasi vitamin A di sebagian besar wilayah juga sudah terkategori baik dan mencapai target yang telah ditetapkan. Namun demikian, cakupan ANC, cakupan penggunaan KB, persentase penerima PKH, persentase ODF, dan persentase akses jamban layak di sebagian besar wilayah masih rendah. Selain itu persentase kemiskinan juga masih tinggi di beberapa wilayah. Prevalensi ISPA, persentase kemiskinan, persentase keluarga risiko stunting, dan persentase penerima PKH memiliki hubungan yang signifikan positif dengan prevalensi stunting. Semakin tinggi prevalensi ISPA, persentase kemiskinan, persentase keluarga risiko stunting dan persentase penerima PKH maka semakin tinggi prevalensi stunting. Selain itu, cakupan kunjungan ANC memiliki hubungan yang signifikan negatif dengan prevalensi stunting. Semakin tinggi cakupan kunjungan ANC maka semakin rendah prevalensi stunting. Berdasarkan hasil uji regresi logistik ditemukan faktor risiko stunting yaitu persentase keluarga risiko stunting (OR = 0,78; 95% CI = 0,62 – 0,98). Berdasarkan hasil penelitian teridentifikasi bahwa masih terdapat wilayah yang memiliki prevalensi stunting belum mencapai target nasional. Oleh sebab itu, sumber daya spesifik dan upaya kesehatan masyarakat perlu ditingkatkan terkhusus pada wilayah-wilayah dengan prevalensi stunting yang masih tinggi. Hasil penelitian ini juga menemukan bahwa masing-masing wilayah memiliki permasalahan pencapaian indikator yang berbeda. Oleh sebab itu, diharapkan kebijakan dan intervensi yang dilakukan dapat menyesuaikan dengan permasalahan yang ada di masing-masing wilayah. Hasil penelitian ini diharapkan dapat membantu menyediakan data pada tingkat populasi yang lebih terperinci sehingga dapat digunakan untuk menargetkan jenis intervensi yang lebih efektif dan efisien.

Stunting is a condition of failed growth characterized by a child's height not being appropriate for their age. This nutritional status is an indication of chronic nutritional problems due to malnutrition or infection over a long period of time. Based on the results of The Indonesian Nutrition Status Survey in 2021, 23.3% of toddlers in West Sumatra experienced stunting. Stunting that is not handled properly will have an impact on children's growth and development in the short and long term. The impact of stunting can reduce the quality of human resources needed to improve national development. Therefore, the factors that cause stunting need to be addressed early on. Various efforts have been made by the Government of Indonesia to reduce the incidence of stunting in accordance with The National Medium-Term Development Planning target in 2024 of 14%. Efforts made include specific and sensitive nutrition interventions. However, based on the results of The Indonesian Nutrition Status Survey in 2021, the incidence of stunting in Indonesia and most of its provinces is still above 20%. This can be because the handling of stunting that has been carried out is not in accordance with the socio-demographic conditions and risk factors that are dominant in the region. Risk factors for stunting are not only at the individual level but also at the population and environmental levels. Therefore, this ecological study aims to analyze risk factors at the population level and the dominant factors in each district/city. The design used in this study was an ecological study that utilized secondary data sourced from the Health Development Policy Agency (BKPK) of the Ministry of Health of the Republic of Indonesia, Health Agency, Social Affairs Agency, Food Agency, National Population and Family Planning (BKKBN), and the Central Statistics Agency (BPS) of West Sumatra Province. Secondary data collection was conducted in November 2021 in West Sumatra. Furthermore, processing, analysis, interpretation, and thesis preparation were carried out from December 2023 to August 2024. The population in the study encompassed all districts and cities in West Sumatra, with the unit of analysis focusing on 19 districts and cities. Data were collected from each district and city, which included stunting prevalence, exclusive breastfeeding coverage, diarrhea incidence rate, ARI prevalence, Food Security Index score, vitamin A supplementation coverage, Antenatal Care (ANC) coverage, Family Planning (KB) coverage, percentage of Open Defecation Free (ODF), percentage of access to proper latrines, percentage of poverty, percentage of families at risk of stunting, and percentage of Conditional Cash Transfer (CCT) beneficiaries. Data analysis included univariate analysis (descriptive test), bivariate analysis (correlation tests: Pearson and Spearman tests), and multivariate analysis (logistic regression). In addition, mapping was conducted to illustrate the prevalence of stunting and the factors associated with stunting prevalence in each region of West Sumatra. The results of the analysis showed that there were differences in stunting prevalence between data sourced from The Indonesian Nutrition Status Survey and the health agency. The average prevalence of stunting based on The Indonesian Nutrition Status Survey is 23.58%, while based on the health agency is 11.97%. Although there is a difference in average, based on these two data sources, it was found that there are still many areas in West Sumatra that have a stunting prevalence that has not reached the target of reducing the incidence of stunting by 14%. All regions in West Sumatra have reached the exclusive breastfeeding coverage and diarrhea incidence targets set by the government. The prevalence of ARI, Food Security Index Score and vitamin A supplementation coverage in most areas are also categorized as good and have reached the set targets. However, ANC coverage, percentage of family planning, percentage of CCT beneficiaries, percentage of ODF, and percentage of access to proper latrines in most areas are still low. In addition, the percentage of poverty is also still high in some areas. The prevalence of ARI, percentage of poverty, percentage of families mily at risk of stunting, and percentage of CCT recipients have a significant positive relationship with the prevalence of stunting. The higher the prevalence of ARI, percentage of poverty, percentage of families at risk of stunting and percentage of CCT beneficiaries, the higher the prevalence of stunting. In addition, ANC visit coverage has a significant negative relationship with stunting prevalence. The higher the coverage of ANC visits, the lower the prevalence of stunting. Based on the results of the regression test, the risk factor for stunting is the percentage of families at risk of stunting (OR = 0.78; 95% CI = 0.62 – 0.98). Based on the results of the study, it was identified that there are still areas that have a stunting prevalence of more than the national target. Therefore, specific resources and public health efforts need to be improved, especially in areas with a high prevalence of stunting. The results of this study also found that each region has different problems achieving indicators. Therefore, it is expected that the policies and interventions carried out can adjust to the problems that exist in each region. The results of this study are expected to help provide more detailed population-level data that can be used to target more effective and efficient types of interventions.