Dampak Edukasi Gizi dan Pemberian Makanan Tambahan (PMT) terhadap Status Gizi Balita Stunting Usia 12-59 Bulan di Kabupaten Cirebon

Abstract

Salah satu masalah gizi yang masih tergolong tinggi di Indonesia yaitu stunting pada balita. Provinsi Jawa Barat merupakan provinsi dengan kasus balita stunting yang masuk kategori tinggi. Hampir keseluruhan kabupaten atau kota di Jawa Barat memiliki prevalensi balita stunting diatas 20%, salah satunya yaitu Kabupaten Cirebon. Beberapa upaya yang dilakukan peneliti terdahulu untuk menanggulangi stunting yaitu dengan edukasi gizi dan Pemberian Makanan Tambahan (PMT). Tujuan umum penelitian ini adalah menganalisis dampak edukasi gizi dan Pemberian Makanan Tambahan (PMT) terhadap status gizi balita stunting (peningkatan skor TB/U) di Kabupaten Cirebon. Penelitian ini merupakan bagian dari studi “Penguatan Posyandu Melalui Model Edukasi Gizi Berbasis Digital untuk Penanggulangan Stunting”. Desain penelitian ini adalah preexperimental dengan model desain one group pretest posttest design. Lokasi penelitian adalah Desa Sibubut, Kedungdalem, dan Bayalangu Kidul, Kecamatan Gegesik, Kabupaten Cirebon, Jawa Barat yang dilakukan pada Agustus sampai November 2020. Subjek pada penelitian ini berjumlah 40 balita stunting. Tahapan penelitian ini yang pertama adalah persiapan yang meliputi perizinan tempat penelitian, penyusunan kuesioner, dan pengambilan data praintervensi meliputi: karakteristik balita (jenis kelamin, umur, berat lahir, riwayat ASI, pola asuh makan dan kesehatan balita), penyakit infeksi, sosio ekonomi demografi ibu balita (umur, pekerjaan, pendidikan, pendapatan, dan pengeluaran), pengetahuan gizi ibu, konsumsi balita, dan antropometri balita. Tahapan kedua adalah pelaksanaan intervensi edukasi gizi dan PMT yang dilaksanakan selama 90 hari dengan bantuan bidan dan kader di tiap desa. Edukasi gizi diberikan dalam tiga kali pertemuan dengan satu kali pertemuan diisi dua materi menggunakan media digital, brosur, leaflet dan poster. Balita sampel usia 12-59 bulan diberi telur ayam dan susu bubuk saset selama 90 hari setiap hari. Tahap ketiga yaitu pengambilan data pascaintervensi meliputi pengetahuan gizi, konsumsi pangan, dan antropometri balita untuk melihat pengaruh dari intervensi edukasi gizi dan PMT yang telah diberikan terhadap peningkatan skor TB/U balita. Pengolahan data yang dilakukan meliputi entry, coding, cleaning, dan analyzing. Data diolah serta dianalisis secara deskriptif dan inferensia. Hasil penelitian ini menunjukkan 67,5% keluarga balita stunting masuk kategori kecil, 95% usia ibu balita berada pada usia >20 tahun, 65% ibu tidak sekolah/SD, 77,5% ibu menjadi Ibu Rumah Tangga (IRT), dan 55% pendapatan berada dibawah UMR. Pengeluaran keluarga balita stunting lebih banyak untuk pengeluaran pangan sebesar 62,6% dan 70% balita stunting berada pada keluarga yang rawan pangan. Sebesar 65% balita stunting berada pada usia 13-36 bulan dengan persentase perempuan 52,5% dan laki-laki 47,5%. Sebesar 15% lahir dengan berat badan lahir rendah. Riwayat ASI balita stunting yaitu sebesar 60% tidak mendapatkan ASI ekslusif. Skor pola asuh makan dan pola asuh kesehatan ibu responden sebagian besar berada dalam kategori baik yaitu 77,5% pada pola asuh makan dan 72,5% pada pola asuh kesehatan. Riwayat penyakit infeksi balita stunting dua minggu terakhir sebesar 25% menderita ISPA, dan 2,5% menderita diare. Adanya peningkatan pengetahuan gizi ibu balita dari 58,2±16,3 (praintervensi) menjadi 67,7±17,1 (pascaintervensi), serta adanya perbedaan yang signifikan (p=0,004) terhadap pengetahuan gizi ibu sebelum dan sesudah intervensi edukasi gizi. Asupan energi, protein, kalsium, seng, zat besi dan vitamin A balita meningkat secara signifikan (p<0,05) pascaintervensi. Keragaman konsumsi pangan balita sebagian besar berada pada kategori sedang dan meningkat secara signifikan (p=0,000) pascaintervensi. Skor TB/U balita saat pascaintervensi -2,6±0,8 mengalami sedikit perbaikan dibandingkan saat praintervensi -2,9±0,7. Terdapat perbedaan yang signifikan pada status gizi TB/U balita (p=0,002)) antara praintervensi dengan pascaintervensi. Terdapat hubungan yang signifikan antara diare dan tingkat kecukupan zat besi dengan skor TB/U balita. Variabel diare dan pola asuh kesehatan merupakan variabel yang berpengaruh terhadap skor TB/U balita.

One of the highest nutritional problems in Indonesia is stunting. West Java Province is a province with highest cases of stunting toddlers. Almost all districts or cities in West Java have stunting prevalence more than 20%. One of them is Cirebon Regency. Several efforts have been made by previous researchers to tackle stunting, such as nutrition education and Supplementary Feeding. The general objective of this study was to analyze the impact of nutrition education and Supplementary Feeding on nutritional status of stunting toddlers (increased HAZ-scores) in Cirebon Regency. This research is part of study "Strengthening Posyandu through a Digital-Based Nutrition Education Model for Stunting Prevention”. Design of this study was preexperimental with one group pretest posttest design model. The research location is Sibubut Village, Kedungdalem, and Bayalangu Kidul, Gegesik District, Cirebon Regency, West Java which was conducted from August to November 2020. The subjects in this study found 40 stunted toddlers. The stages of this research are preparation which includes licensing of research sites, preparation of questionnaires, and preintervention data collection including: characteristics of children under five (gender, age, birth weight, history of breastfeeding, eating patterns and health of children under five), infectious diseases, socio-demographics of mothers of children under five (age, occupation, education, income, expenditure), mother’s knowledge, consumption and anthropometry of toddlers. The second stage of implementation is the nutrition education and supplementary feeding intervention which is carried out for 90 days with the help of midwives and cadres in each village. Nutrition education was given in three meetings with one meeting filled with two materials using digital media, brochures, leaflets and posters. Samples aged 12-59 months were given chicken eggs and milk for 90 days every day. The third stage is collecting postintervention data such as mother’s knowledge, consumption and anthropometry of toddlers to see the effect of nutrition education and supplementary feeding that has been given to increasing the HAZ scores of toddlers. Data processing includes entry, coding, cleaning, and analysis. The data were processed and analyzed descriptively and inferentially. The results of this study indicate that 67,5% of families of stunting toddlers are in the small category, 95% of mothers are >20 years old, 65% of mothers is no education or elementary school, 77,5% of mothers as housewives, and 55 % of income is below the minimum wage. Expenditure for the family of stunting toddlers is more for food expenditure by 62,6% and 70% of stunting toddlers are in food insecure families. As many as 65% of stunting toddlers are at the age of 13-36 months with the percentage of girls 52,5% and 47,5% of boys. 15% were born with low birth weight. The history of exclusive breastfeeding for stunting toddlers is 60% not getting exclusive breastfeeding. Most of the respondents' score on eating parenting and maternal health care were in the good category, 77,5% in eating parenting and 72,5% in health parenting. In the last two weeks 25% had an infectious disease history with ARI, and 2,5% with diarrhea. There was an increase in mother’s nutrition knowledge from 58,2±16,3 (preintervention) to 67,7±17,1 (postintervention), as well as a significant difference (p=0.004) before and after the nutrition education intervention. The intake of energy, protein, calcium, zinc, iron and vitamin A increased significantly (p<0,05) postintervention. The diversity of food consumption under five was mostly in moderate category and increased significantly (p=0,000) postintervention. Height for Age z-scores for postintervention -2,6±0,8 slightly improved compared to preintervention -2,9±0,7. There was a significant difference in the nutritional status of HAZ-scores (p=0,002). There is significant correlation between diarrhea and iron adequacy level with HAZ-scores. Diarrhea and maternal health care variables that affected HAZ-scores of toddlers based on stepwise regression analysis.