INTRODUCTION 1Stunting prevalence in Southeast Asia in 2015 was 26.3%. According to UNICEF (United Nation Children's Fund) in 2016 showed that stunting prevalence in children below 5 years old in Indonesia at 2013 was 33 % in cities and 42 % in 2countryside. According to Ikatan Dokter Anak Indonesia (IDAI) in 2016, Indonesia become the fth place of the highest 3stunting prevalence in the world. Stunting was disturbance linear growth causes by chronic malnutrition and or chronic infection or reccuring shown by the z-score height/age < -2 SD according to World Health 4 Organization (WHO). Chang, et al, 2010, showed that stunting in early childhood related with the lack of ne motor works like movement of ngers and hand, hence the children will has 5more risk to be lower in cognitive and academic. Children with anemia also one of the factor that can cause growth disturbance, decrease of cognitive function,ne psychomotor, gross pcychomotor, and language development 6compare to children that are not anemic. METHODS This study was approved by the Health Research Ethical Committee, Medical Faculty of University of Sumatera Utara/Haji Adam Malik General Hospital, Medan, North Sumatera. An analytic observational study with a cross sectional design was performed at elementary school in Sikapas village, Muara Batang Gadis, Mandailing Natal district, North Sumatera from March 2016 to April 2016. The inclusion criteria were children that agreed to be checked anthropometry, haemoglobulin, and intelegent quotient. The exclusion criteria were children with vertebrae deformities, children with central neurology problems, children with severe disease that cannot follow cognitive function test, and children with symptomatic congenital disease (such as cardiac abnormalities etc). Informed consent was obtained from all parents of the subjects prior to subject enrollment. Characteristics of the subjects including sex, age, nutritional status, and cognitive function test. The anthropometry was measured for each subject with Camry wight and height scales. The nutritional status of the subjects were plotted according to weight for length chart from CDC 2000 growth chart for subjects 5-18 years old. The haemoglobin test was performed with haemoglobin strip tes that only shown anemia (Hb<12gr/dl) or not anemia (Hb>12gr/dl). The cognitive function test was performed with Wechsler Intelligence Scale for Children IV (WISC-IV) tools test. Data was analyzed with few steps. The rst step was analyzed to see the distribution and frequency of every variable. The second step was multivariate, Chi-square test with by SPSS Statistics ver. 18.0. Statistical signicance was considered at P value <0.005. RESULT There were 87 children with average age 10,45 years old, and 56,3% were boys and 43,7% were girls. In 87 children, there were 54% with stuntinf condition. The haemoglobin showed that 55,2% of the childred were not anemic. The cognitive test was shown on table 1. After classied, there were 44 children (50,6%) with normal cognitive test and 43 children (49,4%) with lack in cognitive. From table 2, achieved that in 47 children with stunting, 61,7% children had cognitive disturbance 38,3% did not have cognitive impairment. In children with no stunting, 65% did not have cognitive impairment and 35 % had cognitive impairment. Tabel 1. Children Cognitive Test STUNTING AND ANEMIA ARE ASSOCIATED WITH COGNITIVE ABILITIES IN PRIMARY SCHOOL CHILDREN Original Research Paper Nur Arafah Departments of Child Health, University of Sumatera Utara Medical School, Medan, Indonesia. Clinical Research Background Stunting and anemia in children are still a serious problem in Indonesia. Stunting was related to cognitive function in children.In addition ,anemia is also associated with that function. Objective To analize the relationship between stunting and anemia with cognitive ability in primary school children in Sikapas village, Sumatera Utara. Methods A cross-sectional study was performed in Sikapas Village, Sumatera Utara, from March 2016 until April 2016. The population in this study was primary school children in SD Negeri 384, Sikapas vilage. Stunting was assessed by CDC curve with the percentile height of body per age below the 3rd percentile. Anemia as if Hb less than 12 mg/dl.Cognitive ability was examined by psychologist using Weschler IV subtest. Processing and data analysis was conducted using SPSS 18.0 for windows with a signicance level of p <0.05. Results Fifty four percents of student following the study suffered stunting, most students did not suffer anemia (55.2%) and 49.4% have impaired cognitive ability. Bivariat analysis showed that there was a statistically signicant relationship between stunting and cognitive ability in children (p value = 0,023 and OR = 2,992), while there was no statistically signicant relationship between anemia and cognitive ability in children (p value = 0,598 and OR=1,379). Conclusion It can be concluded that there was relationship between stunting with impaired cognitive ability. ABSTRACT KEYWORDS : Stunting, anemia, cognitive ability, primary school children VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Munar Lubis* Departments of Child Health, University of Sumatera Utara Medical School, Medan, Indonesia. *Corresponding Author Isti Ilmiati Fujiati Department of Public Health/Medical Research Unit ,University of Sumatera Utara, Medan, Indonesia. Children Cognitive Function N % 1 Mental Defective 14 16,1 2 Borderline 29 33,3 3 Low Average 21 24,1 4 Average 21 24,1 5 High Average 1 1,1 6 Superior 1 1,1 Total 87 100,0 16 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Tabel 2. Relation of Stunting with Children Cognitive Function *chi-square test In bivariate analaysis between stunting and cognitive function, the p value= 0.023 that can be concluded that there was signicant diference between them means that the children in normal height status are better in cognitive function. The Odds Ratio was= 2.992 measn that in children with stunting had 2.992 times the risk to have cognitive impairment compare to normal height children. From 39 children with anemia, 53.8% had cognitive impairment and in 48 without anemia there were 54,2% that had cognitive impairment as shown in table 3. Bivariat analyzed was done and the p value= 0.598 so there is no signicant difference between anemia and the impairment of cognitive. Table 3. Relation of Anemia With Children Cognitive Function *chi-square test DISCUSSION Stunting was indicator of problem in children nutrition causes by chronic malnutrition relate with environtment and 4,7 socioeconomic status. Stunting prevalence in Southeast 1Asia on 2015 was 26.3%. The children in Sikapas elementary school that suffer from stunting was 54%. Anemia prevalence on the world was 47.4% or around 300 millions children suffer 8from anemia. in this study reported that 44.85% of the sample that had anemia. This study reported that in 47 children that had stunting majority had cognitive impairment that is 61,7% with p value= 0.023% with OR 2.992%. this was in line with other study by Suvarna and Itagi, 2008, that found children with stunting had inferior IQ and mentally retarded in positive correlated by 9 statistic. Pradita, 2009, also showed that there are signicant 10 correlation between IQ score in elementary school children. In Wonogiri on elementary scholld children age 9-12 years old showed that children with stunting had 9.2 risk of getting IQ 11score below average, and average achievements. If intake was inadequate, children's body will limit the social activity and cognitive growth, and the limit the energy for 12 overall growth. Stunting was related with under-developed brain with dangerous consequences with lack of mental ability and capability of learning, lack of school performance, increasing of nutritional risk such as chronic disease, such as 13 diabetes, hypertension, and obesity in future days. There was combination of inadequate nutrition with unsupported environtment maybe disrupts the cognitive development on 14poor children. In this study 39 children with anemia, 53.8% had cognitive impairment and in 48 without anemia there were 54,2% that had cognitive impairment as shown in table 3. Bivariat analyzed was done and the p value= 0.598 so there is no signicant difference between anemia and the impairment of cognitive. This was differ with Kordas, et al, 2004, where he found children with anemia with Hb <12 g/dl worse to done number sequencing compare to that was not anemic (P=0,004). Zulaekah, et al, 2014 explained that children with anemia had low ne motor, gross motor score, and language 6 development compare to children with no anemia. Carter, et al, 2010 and Jauregui, Lobera, 2014 was support iron 8,15deciency anemia can cause decit in kognitive function. Iron was needed to form haemoglobin, an essential protein to bind oxygen. Therefore, if iron was decrease, organs and tissues cannot get adequate oxygen and causes fatigue, decrease of performance, and immunity. Inadequate iron that not treated can cause serious problem like delay of growth 16and cognitive development. In early life, brain, muscle and skeleton of babies was growing so fast. 95% brain was develop in rst 3 years of life. Several essential nutrient for example amino acid and iron was highly needed for formation of synaps and neurotransmitter dan 5affect the speed of mind response. Lack or excess of nutrient in age 0-2 years, commonly 5irreversible and will impact on short-term and long-term life. lack of nutrition affect brain area dan included for cognition, memor, and locomotor skills. Brain need energy especially in early children and most of cerebri development happened in the rst two years of life. Although the correlation of bad linear growh and impairment of neuro development was not yet 3understand very well. Limitation of this study was the sample was not as much as other studies so can gave different interpretation. This study also only measure the hemoglobin with only Hb test trip, this can make bias in anemia result. Our study does not assessed the effect of socioeconomic parenteral education, and environtment hygienity on the suject cognitve test. Conlusion of this study was, that the stunting can affect cognitive function, making it lower than the children with no stunting. But anemia did not proof to have effect on cognitive problems. Further studies on cognitive problems on stunting and anemia are needed. REFERENCES 1. UNICEF, WHO, World Bank. Levels and Trends in Child Malnutrition. UNICEF/ WHO/ World Bank Group Joint Child Malnutrition Estimates, Key ndings of the 2016 edition. New York: UNICEF; Geneva: WHO; and Washington, DC: World Bank; 2016. 2. UNICEF. Global Databases, Stunting Disparity [Internet]. May 2016 [Cited on 24th September 2016]. Available from: www.data.unicef.org. 3. Ikatan Dokter Anak Indonesia (IDAI). 15th Pediatric Update Exploring the Big Picture of Childhood Stunting: Indonesian Perspective rst edition. Bandung: IDAI; 2016. P4-10. 4. Jayanti EN. 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The Effect of Nutritional Status on VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Stunting Cognitive disturbance Total OR (95% CI) P* Yes No n % N % N % Yes 29 61,7 18 38,3 47 54,0 2,992 (1,246 –7,187) 0,023 No 14 35,0 26 65,0 40 46,0 Total 43 49,4 44 50,6 87 100 Anemia Cognitive Impairment Total OR (95% CI) P* Ya Tidak N % N % N % Ya 21 53,8 18 46,2 39 44,8 1,379 (0,591 –3,219) 0,598 Tidak 22 45,8 26 54,2 48 55,2 Total 43 44 87 100 X 17GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Cognitive and Motor Development of Pre- School Children. Tropical Agricultural Research Vol18. 13. Lestari W, Margawati A, Rahludin MZ. Faktor Risiko Stunting pada Anak umur 6-24 bulan di Kecamatan Penanggalan Kota Subulussalam Provinsi Aceh. Jurnal Gizi Indonesia. 2014; 3 (1): 127-8. 14. Lewit EM, Kerrebrock N. Population- Based Growth Stunting. Children and Poverty. 1997; 7 (2): 149- 56. 15. Jauregui-Lobera I. Iron Deciency and Cognitive Functions. 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