E:\IBUK\NERS DESEMBER 2021\13-- 348 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 348–354 Occurrence of Nutritional Status Problems (Stunting) in Cities and Villages in Children in Kediri Maria Anita Yusiana1, Sandy Kurniajati2, Srinalesti Mahanani3, Dewi Ika Sari HP4 1,2,3,4Nursing Department, STIKes RS Baptis Kediri, Indonesia JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk JNK History Article: Received, 14/10/2021 Accepted, 09/12/2021 Published, 15/12/2021 Keywords: Child, Nutritional Status, BB/U, TB/ U, Village, City Article Information Abstract The current trend of maternal and child health problems is stunting. Health development 2015-2019 is focused on decreased in maternal and infant mor- tality, a decreased in the prevalence of short toddler (Stunting). The purpose of the study was compared stunting in the cities and village to children in Kediri. The research method used a comparative observation with the popu- lation of children in the City of Bangsal Kediri and Dusun Bulakdawung, Parang Kediri Village, with a sample of 49 children. Sampling using Nutri- tional Status based on BB/U and TB/U. Data was collected by observing spring and microtoise scales. The analysis used is Mann-Whitney. Nutri- tional status based on BB/U nutritional problems in the city 13.8% and in the village 5%, nutritional problems TB/U (stunting) in the city 3.4% and in the village 10%. Comparison of nutritional status based on BB/U p = 0.34 and TB/U p = 0.362 there is not significant. The main factor in nutritional prob- lems is that the nutrients consumed are not appropriate, both in quality and quantity.The community in Parang Banyakan Village, Kediri is a mountain- ous community, the dominant vegetable protein rather than animal. Second- ary factors of insufficient nutrition are caused by disruptions in the utiliza- tion of nutrients. In Kediri City Ward, children’s malnutrition problems are not always caused by inadequate nutritional intake, child health factors such as disorders in children that cause nutrition cannot be absorbed by the body, and children experience the frequency of recurrent infections, so the child’s nutrition is not for growth and development but to fight infection. © 2021 Journal of Ners and Midwifery 348 Correspondence Address: STIKes RS Baptis Kediri – East Java, Indonesia P-ISSN : 2355-052X Email: yusianamaria@gmail.com E-ISSN : 2548-3811 DOI: 10.26699/jnk.v8i3.ART.p348–354 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) https://doi.org/10.26699/jnk.v8i3.ART.p348-354 https://crossmark.crossref.org/dialog/?doi=10.26699/jnk.v8i3.ART.p348-354&domain=pdf&date_stamp=2021-12-26 349Yusiana, Kurniajati, Mahanani, Sari HP, Occurrence of Nutritional Status Problems (Stunting) in ... INTRODUCTION Health Development aims to be able to increase awareness, willpower, and the ability to live a healthy life for everyone in order to realize the high- est degree of public health. The framework of thought contains a very deep meaning that every generation must live a healthy life, one of which is the mother and her child. Maternal and child health efforts are an effort in the health sector to provide welfare, and as an effort to facilitate the commu- nity to form the nation’s next generation. The goal of the maternal and child health program to achieve the ability a healthy life through increasing optimal health status for mothers and children and their fami- lies to accelerate the achievement of Indonesia’s Health Development targets. The current trend of maternal and child health problems is stunting. Stunting is a growth and development disorder that describes the failure to achieve growth and development potential as a result of poor health and/ or nutritional status. Stunting is used as an indicator of chronic malnutrition that describes a child’s his- tory of malnutrition in the long term that stunting shows how the previous nutritional state was. Stunt- ing occurs due to nutritional deficiencies (especially protein) that occur repeatedly over a long period of time during the fetus to the first two years of a child’s life. Riskesdas mentioned that 35.6% of tod- dlers in Indonesia experience stunting problems, meaning that almost half of our toddlers have a height lower than the standard height of toddlers his age (Dirjenkesmas, 2017). Based on the results of research the main causes of stunting are nutri- tional problems in preschool-aged children such as lack of food intake and infectious diseases, mater- nal behavior in hygiene is still lacking and the home environment is less supportive for the growth of children. Nutritional needs for the body is a basic hu- man need that is very important. Judging from its usefulness, nutrition is a source of energy for all activities in the body system. Sources of nutrients in the body come from within the body itself such as glycogen contained in the muscles and liver or proteins and fats in tissues and other sources that come from outside the body as daily eaten by hu- mans. Fulfillment of good nutrition needs in moth- ers and children can prevent stunting. To get good nutrition requires good knowledge to be able to present a balanced menu and serve hygienically. Nutrition is an organic substance that organisms need for the normal functioning of the body’s systems, growth, and maintenance of health. The role of a nurse to prevent stunting can be in the form of meeting good nutritional needs. The action that can be done is to perform Health Eduction to the com- munity (RI, Pedoman Gizi Seimbang, 2014). The purpose of the study compared the incidence of nutritional problems (Stunting) in cities and villages in children in Kediri. METHOD The research method used is comparative ob- servation with the population of children in Pesantren in Bangsal Village, Kediri City District and Bulakdawung Hamlet, Parang Village, Banyakan District, Kediri Regency, with a sample of 49 chil- dren consisting of 29 children in the city and 20 in the village. Sampling with the same sampling for every child who came at integrated healthcare cen- ter toddler in RW II Ward Village, and in Kinder- garten PPK Parang Satu, the research varied, namely Nutritional Status based on BB/U and TB/ U. Data collection with observers with spring scales and microtoise. Statistical analysis using Mann- Whitney with 0.05. RESULT No Variable Bangsal Village (City) Dsn Bulakdawung (Village) 1 Number of children 29 (59,2%) 20 (40,8%) 2 Gender:Male Female 16 (53,2%)13 (44,8%) 8 (40%)12 (60%) 3 Average Age 2,05 th 5,6 th 4 Average Weight 11,25 Kg 17,4 Kg 5 Average Height 84,5 cm 106,6 cm Table 1 Comparison of Demographic Data on the Occurrence of Nutritional Status Problems in Children at Pesantren in Bangsal Village, Kediri District and Bulakdawung Hamlet, Parang Village, Banyakan District, Kediri Regency (n = 49) 350 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 348–354 Female tend to have a thin BB/U nutritional status (15.4%) compared to male sex (4.3%), and based on the location of the child in the city are BB/U Thin Usual Fat Total Gender Male Count 1 22 0 23 % within type Gender 4,3% 95,7% ,0% 100,0% Female Count 4 20 2 26 % within type Gender 15,4% 76,9% 7,7% 100,0% Total Count 5 42 2 49 % within type Gender 10,2% 85,7% 4,1% 100,0% Location City Count 4 24 1 29 % within Location 13,8% 82,8% 3,4% 100,0% Village Count 1 18 1 20 % within Location 5,0% 90,0% 5,0% 100,0% Total Count 5 42 2 49 % within Location 10,2% 85,7% 4,1% 100,0% Table 2 Cross-Tabulation of Gender and Location with BB/U of The Incidence of Nutritional Status Problems in Toddlers in The Village Bangsal of Pesantren District of Kediri City and Hamlet Bulakdawung village Parang district Banyakan District Kediri (n = 49) more likely to be thin BB/U Nutrition status (13.8%) than children in the village (5%). TB/U Short/stuting Usual Total Location City Count 1 28 29 % within Location 3,4% 96,6% 100,0% Village Count 2 18 20 % within Location 10,0% 90,0% 100,0% Total Count 3 46 49 % within Location 6,1% 93,9% 100,0% Gender Male Count 1 22 23 % within gender 4,3% 95,7% 100,0% Female Count 2 24 26 % within gender 7,7% 92,3% 100,0% Total Count 3 46 49 % within gender 6,1% 93,9% 100,0% Table 3 Cross Tabulation Location and Gender with Nutritional Status TB/U Comparison of The Incidence of Nutritional Status Problems in Toddlers in The Village Ward of Pesantren District of Kediri City and Hamlet Bulakdawung Village Parang District Banyakan Kediri (n = 49) Comparison of TB/U nutritional ststus based on location that children in the village tend to have short nutritional status (10%) compared to children in the city (3.4%), while by gender tend to girls more short nutritional status (7.7%) than in the elderly aki-male (4.3%). 351Yusiana, Kurniajati, Mahanani, Sari HP, Occurrence of Nutritional Status Problems (Stunting) in ... Based on Table 4, there is a comparison of BB/ U p = 0.340 where p > then there is no signifi- cant difference in the nutritional status of BB/U between children in the city and in the village. The ratio of TB/U p=0.352 where p > then there was no significant difference between the nutritional sta- tus of TB/U between children in the city and in the village. DISCUSSION Nutritional Status based on BB/U The results of research conducted in The Vil- lage of Pesantren District Of Kediri City and Bulakdawung village Parang village of district Banyakan of Kediri district showed the problem of thin nutrition in the city 13.8% and in the village 5%. The problem of undernutrition in Indonesia in 2017 was 19.6% in toddlers (Dirjenkesmas, 2017). One of Indonesia’s goals of healthy 2025 is a de- crease in the prevalence of undernutrition in tod- dlers from 26% in 2005 to 9.5% in 2025 (Kemenkes, 2009). According to Almatsier (Almatsier, 2012) there are two factors that affect the utilization of nutrients by the body, namely primary factors and secondary factors. Primary factors are food intake factors that can cause insufficient or excessive nutrients and secondary factors are factors that affect the utilization of nutrients in the body. (Dirjenkesmas, 2017). In the primary factor, the problem of thin nutri- tion is caused by the arrangement of food consumed is not right both quality and quantity. In general, the people in the hamlet of Bulakdawung village of Parang district of Banyakan District Kediri is a mountain community with a topographic slope of 15-45 degrees, the plan diet is more dominant than the animal diet. Factors that cause thin nutrition problems in the village of Bangsal district Pesantren Kediri city and Bulakdawung hamlet Parang vil- lage many districts Kediri among others are: First poverty, the community in this research location is a community with a poverty line that includes high with jobs as farmers and farm workers, while the land can only be planted only in the rainy season. The second is knowledge. Low knowledge about the importance of nutrients for health. The level of public knowledge is low because many educated people are still in elementary school and access to information on health is very minimal. Nutritional Status based on TB/U The results of research conducted in the Pesa ntren Ba ngsal Villa ge, Kediri City and Bulakdawung Village, Parang Banyakan District, Kediri, showed that nutritional problems (short/stunt- ing) in the city were 3.4% and in the village 10%. Stunting is a condition where a person’s height is shorter than his age (Dirjenkesmas, 2017). Length- Height by Age (PB-TB/U) indicates achievement of body length relative to age compared to median (Line 0). Nutritional Status of boys aged 0-2 years and 2-5 years with a PB-TB / U index: below -2 SD is called short, below -3 elementary school is called Very Short (Titus et al, 2017). Stunted chil- dren who show failure increase in height according to the size of friends of the age. Short Toddler (Stunting) is a nutritional status based on the PB / U index or TB / U where in anthropometric stan- dards assessment of child nutritional status, the measurement results are at the threshold (Z-Score) <-2 SD up to -3 SD (short / stunted) and <-3 SD (very short / severely stunted) (Rahmadhita, 2020). The child will look shorter and this will interfere with psychosocial in the child. The size of the child’s height on a proposed and average basis indicates the level of communal nutritional fulfillment. The average height of a person in a period of time will experience an increase along with economic and community welfare, if many children who experi- ence stunting lead to low community welfare. Cur- rently Indonesia is faced with the problem of Stunt- ing (short) which is quite high when compared to other countries, compared to ASEAN countries even the number of Stunting Indonesia is still classified as the highest. Based on the results of PSG’s 2016 study, showed that the number of toddlers who are classified as very short by 8.5%, and relatively short by 19.0% (Titus, 2017). BB/U TB/U Mann-Whitney U 261,500 271,000 Wilcoxon W 696,500 481,000 Z -,954 -,931 Asymp. Sig. (2-tailed) ,340 ,352 Table 4 Test Comparison of The Incidence of Nutritional Status Problems (BB/U and TB/U) in Toddlers in The Village ward of Pesantren District of Kediri City and Bulakdawung hamlet of Parang village Banyakan of Kediri (n = 49) 352 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 348–354 When compared with the national prevalence of stunting in kindergarten PKK Parang I tends to be better, this indicates that health development is starting to show results. Factors that cause stunt- ing problems both in the village of Bangsal Pesantren Ward, District of Kediri City and Hamlet of Bulakdawung, Parang Banyakan Village, Kediri District among others is first is livelihood. Father as the head of the family many who work outside the area and mothers as a household and also make a living in a gr icultur e. T he second is diet. Breastfeeding patterns that have not been exclu- sive, as well as the pattern of giving drinks in bottles as PMT breast milk is not milk but often still sugar water, the animal diet for children is still low. The third is parenting. Children who experience malnu- trition pr oblems both the village of Bangsal Pesantren in the city of Kediri and the hamlet of Bulakdawung, Parang village, Banyakan sub-dis- trict, Kediri district both parenting fostered by grand- mothers with low education and low socioeconomic as well. Comparison of Nutritional Status Issues in Cities and Villages Based on BB/U and TB/U The results of research conducted in the vil- la ge of Ba ngsa l Pesa ntr en Kedir i city a nd Bulakdawung village Parang sub-district Banyakan, Kediri district show BB/U p = 0.34 where p > and TB / U p = 0.352 where p >  so there is no significant difference in the incidence of nutritional problems in children in the city and in the village based on the nutritional status of BB/U and TB/U. It concluded that the problem of nutrition based on BB/U in the city tends to be larger than in the vil- lage, and the problem of nutrition based on BB/U in the city tends to be bigger than in the village, and the problem of nutritional status of TB/U in the vil- lage tends to be bigger than in the city but there is no significant difference. The primary factor of nutritional problems is caused by the composition of the food consumed is not appropriate, both in quality and quantity. The community in Parang Banyakan Village, Kediri is a mountainous com- munity with a topographic slope of 15-45 degrees, a plant-based diet is more dominant than an ani- mal-based diet. Secondary factors related to insuf- ficient nutrients are caused by disturbances in the utilization of nutrients. The problem of undernutrition in Indonesia in 2017 was 19.6% in toddlers (Dirjenkesmas, 2017). One of Indonesia’s healthy goals in 2025 is a de- crease in the prevalence of undernutrition in tod- dlers from 26% in 2005 to 9.5% in 2025 (RI, Renca na Pemba nguna n Keseha ta n Ja ngka Panjang, 2009). The results of preschool-age research on nu- tritional status are less when compared to the lower national average, but it should be noted that the national average also needs to be compared with the regional average, if seen the prevalence tends to decrease this shows government programs in health development, especially nutrition problems meet the point of success and need to be improved continuously so that health development goals in 2025 can be achieved. According to Almatsier (Almatsier, 2012) there are two factors that affect the utilization of nutri- ents by the body, namely primary factors and sec- ondary factors. Primary factors are food intake factors that can cause insufficient or excessive nutrients and secondary factors are factors that affect the utilization of nutrients in the body (Titus, 2017). In the primary factor is caused by the arrange- ment of food consumed is not right both quality and quantity. In general, the people in the machete vil- lage of Banyakan Kota Kediri district are mountain communities with a topographic slope of 15-45 de- grees, the plant-based diet is more dominant than the animal diet. Secondary factors related to nutri- ents are not sufficient needs due to disruptions in the utilization of nutrients. In general, the commu- nity in the village of Bangsal district Pesantren Kediri city occurs the problem of malnutrition in children is not always by the intake of less nutri- ents, the factors of the child’s health condition also need to be examined, whether there are disorders in the child that cause nutrition can not be absorbed by the body, or children increase the frequency of recurrent infections, so that the child’s nutrition is not for growth and development but to fight infec- tions that occur. Therefore, further examination of malnourished children in kindergarten PKK Parang I needs to be done with examination to public health center Banyakan Kediri and further examination on malnourished children in Bangsal village needs to be done with examination at the health center Pesantren I of Kediri City. One of the strategies of the 2018 public health program is to accelerate the Improvement of Com- munity Nutrition and community Nutrition Program 353Yusiana, Kurniajati, Mahanani, Sari HP, Occurrence of Nutritional Status Problems (Stunting) in ... of supplemental feeding to underweight toddlers (Dirjenkesmas, 2017). School-age children who are underweight or very thin nutritional status should be reported to the health cadres and forwarded to the health center Banyakan and Pesantren I in order to get attention and obtain additional nutrition programs through Supplemental Feeding for School Children (PMT- AS) from health center. The role of the teacher to communicate and bridge children to gain access to nutrition services is needed. Stunting is a chronic malnutrition problem caused by insufficient nutritional intake for a long time due to feeding that is not in accordance with nutritional needs. Stunting can occur starting the fetus is still in the womb and only seen when the child is two years old (RI, Situasi Balita Pendek, 2016). Stunting in preschool-aged children at the lo- cation of community service occurs not in the short term, this occurs during the process of care by the family, related to the fulfillment of nutrition from the fetus to the current condition. Stunting can oc- cur starting from the fetus is still in the womb and only appears when the child is two years old, and if not balanced with catch-up growth (growing up chasing) resulting in decreased growth, stunting problems are public health problems associated with increased risk of pain, death and barriers to growth both motor and mental. (Novery, 2021) Stunting is shaped by inadequate growth fal- tering and catcth up growth that reflects the inabil- ity to achieve optimal growth (WHO, 2014). The health condition of the mother during pregnancy will affect nutrition for fetal development. The cause of stunting is the lack of nutritional intake received by children/babies (Dirjenkesmas, 2017). At the age of infants the role of exclusive breastfeeding and the knowledge and skills of the mother is very im- portant in providing nutritional intake after the needs of the child, if there is a failure in nutritional care can cause stunting. This is in line with the results of Eko Setiawan’s research stating that the level of energy intake, history of the duration of infectious diseases, birth weight, maternal education level and family income level with stunting events (Setiawan, 2018), as well as the results of research yuanti and Festi that state nutritional status, health problems in children, instant food eating habits, and maternal height related to stunting in toddlers (Yuwanti & Festi, 2021) The impact of stunting is easily sick, cognitive ability is reduced, risk of diseases related to diet, unbalanced body functions, resulting in economic losses, improper posture as an adult (Dirjenkesmas, 2017). In children who experience stunting will tend to easily experience pain, especially infectious pain because of low endurance. Diseases such as cough, cold, diarrheal fever will be easily suffered by chil- dren. If the child is easily sick, of course, the cost of health in children will increase this will be an additional burden of the family economy. Infectious diseases that are high in frequency in children, nu- trient intake will be focused on fighting infection so that in the long run the child fails to grow and be- come shorter than the child. Stunting program management there are 3 main pillars: 1. Adequate Nutrition Consumption, 2. Proper parenting, 3. Access to health services, and envi- ronmental health, which are spelled out in 11 activi- ties include: 1. Tablets Add Blood (young women, brides-to-be, and pregnant women), 2. Exclusive Breastfeeding Promotion, 3. Promotion of Comple- mentary Foods 4. Micronutrient supplements (Taburia) 5. Macronutrient supplements (PMT) 6. Nutritional Management Is Lacking/Bad 7. Vit A supplementation 8. Promotion of iodine salts 9. Clean water, sanitation, and hand washing using soap 10. Drug 11. Non-Cash Food Assistance (Dirjenkesmas, 2017). CONCLUSION The conclusion in this study is that nutrition problems based on BB / U in the city tend to be larger than in the village, and the problem of TB/U nutritional status in the village tends to be greater than in the city but there is no significant differ- ence. SUGGESTION Increasing the role of formal (school) and gen- eral communities, especially families in overcom- ing stunting and nutrition problems in children is very important. School can carry out periodic monitor- ing of nutritional status with a nutritional status measurement program every month and hold addi- tional feeding programs every thursday (in the vil- lage of Bangsal, Pesantren district, Kediri city) saturday (Bulakdawung village Parang district of Banyakan Kediri district) through self-help parents/ guardians of students. Mothers as the main role of 354 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 348–354 foster care in children must have a high awareness that the nutritional status in children is an inventation of the child’s future. Mothers need to continue to increase knowledge about the prevention and han- dling of stuting problems by actively accessing in- formation through both digital and conventional means. REFERENCES Almatsier. (2012). Prinsip Dasar Ilmu Gizi. Jakarta: Gramedia Pustaka Utama. Dirjenkesmas. (2017). Pendekatan Program Kesehatan Masyarakat . Jakarta: Kemenkes RI. Indonesia, P. R. (2007). Undang-undang Republik Indo- nesia Nomor 26 Tahun 2007 Tentang Penataan Ruang. Jakarta: Departemen Pekerjaan Umum. Novery. (2021). Upaya Pencegahan Stunting pada Balita Menggunakan Intervensi Pendidikan Kesehatan Gizi pada Ibu Hamil. Jurnal Permas Volume 11 Nomor 1. Rahmadhita, K. (2020). Permasalahan Stunting dan Pence- gahannya, Jurnal Ilmiah Kesehatan Sandi Husada. 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