Empowerment of Posyandu Cadre for Implementation the Policy of

Nutritional Prevention and Stunting on Children

Juanita and D. N. Santi

Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Stunting, Malnutrition, Empowerment, Posyandu Cadres.

Abstract: Malnutrition and stunting among under-fives is one of the main nutritional problems in Indonesia, including

Medan because of its high prevalence of 8.7%. The cause of malnutrition and stunting in multifactor

toddlers so that the handling and prevention of malnutrition must also be multi factor. One of the factors that

cause malnutrition and stunting is low maternal knowledge about infant feeding properly. To improve

mother's knowledge and mother's good and right behavior can be done through empowerment of health

officer and posyandu cadre. The role of posyandu cadres has been helping health workers in posyandu

activities every month. Based on this it is very appropriate to increase the role of posyandu cadres as an

extension of health personnel in the prevention and handling of health problems including malnutrition in

infants. Empowerment of Posyandu cadres by increasing knowledge about correct feeding to under five,

skill in measuring body weight and height of children under five and understanding of monitoring growth

and development of toddlers and the practice of providing food according to the nutritional needs of

children. This community service activity can overcome malnutrition problem in toddlers by empowering

posyandu cadres in primary health center.

INTRODUCTION

Malnutrition and stunting is one of the main

nutritional problems in Indonesia that is

characterized by low body weight. The results of

basic health research in Indonesia found that the

prevalence of malnutrition in infants in Indonesia is

high, namely 8.7% and the prevalence of

malnutrition is 27.3%. In addition, stunting is also

23% high. Causes of malnutrition and stunting in

multi-factor toddlers are low food intake and

infection as a direct cause and families economic,

parenting, and health care as an indirect cause.

Various efforts and programs have been done by the

government to eradicate malnutrition and stunting

but in fact, until now still found cases of

malnutrition of toddlers and stunting in almost all

provinces in Indonesia including the province of

North Sumatra.

Often cases of malnutrition and stunting are

known because mothers of toddlers never

understand the meaning of measuring body weight

and height or never go to posyandu. In addition,

there are still many health workers and also

posyandu cadres who are not correct in measuring

their weight and height.This has an impact on

determining the lack of nutrition or poor nutrition

given, or not understanding correctly the meaning of

each periodic measurement of body weight or

height. Based on the complex causes of malnutrition

and stunting in children under five, the handling of

malnutrition and stunting also requires complex

efforts involving many sectors and many officers

both health workers and non-health workers.

Posyandu cadres are one of the community

health volunteers who can be empowered to

overcome the problem of malnutrition in children

under five. Posyandu cadres with the community

have good emotional ties because the cadres live

close to the community and are very familiar with all

mothers of toddlers. This is very beneficial in

increasing the participation of mothers under five if

there are health activities or programs. Based on

this, posyandu cadres can be considered as an

extension of health workers in an effort to overcome

the problem of nutrition in the community, including

the problem of malnutrition and stunting in children

under five.

Puskesmas Medan Tuntungan and puskesmas

Medan Johor is a community health center in Medan

684

Juanita, . and Santi, D.

Empowerment of Posyandu Cadre for Implementation the Policy of Nutritional Prevention and Stunting on Children.

DOI: 10.5220/0010083906840688

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

684-688

ISBN: 978-989-758-449-7

which still has malnourished children and stunting

when the two puskesmas are located in downtown

Medan. Malnutrition and stunting toddlers who

generally come from poor families are very at risk of

dying if their malnutrition is not immediately

addressed or known. Based on this matter, the

community service activity with Posyandu cadre

empowerment in Medan city is very beneficial for

Medan Tuntungan health center and Medan Johor

community health center. The objectives of this

study are to empower health officer and posyandu

cadre in Medan city health center to help accelerate

the handling of malnutrition and stunting of toddlers

in addition to prevention and handling programs of

malnutrition and stunting which has been done by

health workers at puskesmas. The benefits of this

study are against mothers and toddlers is an effort to

achieve better health by preventing and handling

malnutrition and stunting through improving

nutrition knowledge and maternal behavior of

children under five who are right in the care of

toddlers, the posyandu cadre is an improved

knowledge and skills in helping to overcome

nutritional problems and health problems in the

working areas of the two puskesmas, and health

workers is an effective and useful effort to help

accelerate the eradication of malnutrition in infants.

METHOD OF APPLICATION

OF IPTEKS

2.1

Method of Approach Used in

Program Devotion

The method of approach taken during the

devotion to partners is by conducting training,

guidance and assistance to posyandu cadres, health

workers, and under-five mothers who become

partners. Measurement of changes to the knowledge

and skills of partners can be seen from the

knowledge and skills before and after the existence

of community service activities. In addition,

measurements can also be done by measuring

changes in health conditions of children such as the

frequency of illness, duration of illness, and

mortality in the work area of both puskesmas before

and after community service activities.

2.2

Implementation of Activities

The activities carried out for problem solving

include:

Socialization of devotion activities.

Socialization of devotion activities is

provided to all posyandu cadres, mothers

and health workers in the work area of

Medan Tuntungan and Johor Community

Health Center in order to understand about

the meaning and purpose of devotion

activities. In addition, this socialization will

also form an attitude and desire to want to be

fully involved in the activities of dedication.

Recruit mothers and toddlers as objects

(targets) of service activities.

Recruitment is done after the socialization of

activities. Some mothers who were

motivated to take part in the dedication

activity were asked about their willingness

and commitment by the team. The mothers

who had been recruited at the two

puskesmas followed the training. Recruiting

cadres and health workers after conducting

socialization activities.

Several posyandu cadres who were

motivated to take part in the dedication

activities were asked about their willingness

and commitment by the team. Posyandu

cadres who have been recruited at both

puskesmas subsequently attended the

training.

Training of posyandu cadres on prevention

and handling of malnutrition and stunting of

children under five.

Training on Posyandu cadres on prevention

and handling of malnutrition and stunting of

toddlers such as the method of measuring

body weight and height correctly,

interpretation of the results of weight and

height measurements periodically, the

principle of feeding children according to

nutritional needs, and management of

malnutrition of infants conducted by the

team. This training is required to provide a

sufficient level of understanding of the

purpose and implementation of service

activities.

Implementation of malnutrition management

activities and stunting of toddlers

Implementation of malnutrition management

activities and stunting of children do after the

training. Implementation of activities

includes

measuring the weight and height

of all under- fives in both health centers

for screening of malnourished children

under five and stunting, counseling to

Empowerment of Posyandu Cadre for Implementation the Policy of Nutritional Prevention and Stunting on Children

685

mother about interpretation of weight

measurement result and height

periodically and the principle of infant

feeding according to nutritional needs.

The implementation of this activity is

carried out by posyandu cadres who have

been trained.

Maintenance and management of malnutrition

and stunting of children conducted by health

officers and posyandu cadres with assistance

by a team. Evaluation of activities based on

the implementation of community service

activities.

Evaluation of activities conducted by the team

of devotion based on inputs, suggestions, and

real problems encountered by the mother,

posyandu cadres and health personnel at

Medan Tuntungan health center and Medan

Johor health center during the implementation

of sweeping movement of malnutrition. If

necessary, the results of this evaluation will be

submitted to the North Sumatra Provincial

Health Office or other relevant agencies with

the aim of resolving problems or related

recommendations. One example of follow-up

is based on an evaluation of activities whether

it is proven to improve the health of children

and an increase in knowledge and skills in

posyandu cadres and mothers.

Follow-up based on evaluation of activities on

how to continue activities and how they affect

the frequency of illness and duration of illness

for children (changes in infant morbidity and

mortality.

RESULT AND DISCUSSION

3.1

Preparation of Activities

On May 8, 2018, the team conducted a survey to

Kelurahan Medan Tuntungan and Kelurahan Medan

Johor discussed about community service plan and

planned the time schedule to conduct socialization.

After that, the teams do the socialization on May 17,

2018. Furthermore, the team cooperation with the

head of puskesmas and posyandu cadres invited

mothers to attend community service activities.

3.2

Socialization of Community Service

Activities

The team performs twice socialization of puskesmas

in Medan Tuntungan sub-district and puskesmas in

Johor urban village. Both puskesmas provide

positive response. The team describes the plan of the

implementation of community service activity that is

empowerment of posyandu cadre to increase

knowledge and behavior of cadre about prevention

and handling of malnutrition and stunting in

toddlers. Besides, it was also stated that the team

will do counseling to the mother about prevention of

malnutrition and stunting as well as supplementary

feeding for toddlers.

3.3

Recruit Participant Activities

Devotion (May 18, 2018)

After the socialization is done, the team of recipients

performs recruitment of recruitment of posyandu

cadres who are willing to participate in

empowerment training of posyandu cadres in the

implementation of prevention policy of malnutrition

and stunting in toddlers. The number of cadres and

toddlers who are willing to take part in

empowerment training are 30 people, 2 cadres at

puskesmas of Medan Tuntungan sub-district and 2

cadres at puskesmas of Johor urban village plus

mother of toddler. The team together with posyandu

cadres and heads of puskesmas undertook agreement

on the determination of training schedule on 25 May

2018.

3.4

Implementation of Empowerment

Training of Posyandu cadres

After the recruitment of Posyandu cadre

empowerment training participants was conducted,

the Posyandu cadre empowerment training was held

on May 25, 2018 by lecturing, discussion (question

and answer), and playing. The training material

provided is a method of measuring body weight and

height, interpretation of the results of measuring

periodic body weight and height, the principle of

feeding toddlers according to nutritional needs, and

care and management of malnutrition of children. At

the time of the lecture and discussion there were also

attended by several health center staff. The

implementation of the Posyandu community health

center cadre training at Medan Tuntungan and

Medan Johor health centers was held at Medan

Johor health center because of its larger location and

adequate training room. The lectures were delivered

using flipchart media and distribution of brochures

on how to measure body weight and height,

interpretation of the results of measuring periodic

weight and height, the principle of feeding toddlers

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

686

according to nutritional needs, and care and

management of malnutrition of children. In the

lecture session it was seen that posyandu cadres

were very serious and enthusiastic listening and

actively inquiring about things that had not been

understood. Besides, it also commented on the

experiences and phenomena that exist in the

community. This training was very satisfying for the

posyandu cadres which showed that many posyandu

cadres were frankly saying that they had been

measuring their body weight and height incorrectly.

The presence of this lecture greatly opened up

insight and increased knowledge for cadres about the

interpretation of measurements of weight and height

at regular intervals and the principle of feeding on

children as well as the management of malnutrition

in children.

3.5

Counseling for Malnutrition

Prevention and Supplementary

Feeding

After the training held empowerment of posyandu

cadres, then the team counseling to the mother.

Mothers who are willing to follow the program of

devotion then follow the counseling prevention of

malnutrition and supplementary feeding properly.

This is done in order to further be able to apply

supplementary food properly and properly to

toddlers. In this learning stage, mothers are very

serious about paying attention to every step that is

taught and punctuated by asking questions related to

measuring nutritional status, prevention of

malnutrition, and the principle of giving good and

correct supplementary food.

3.6

Monitoring Posyandu

Implementation

Monitoring of posyandu implementation was done

twice at posyandu at Medan Tuntungan and

Posyandu clinics at puskesmas Medan Johor. From

the monitoring result, it can be seen that some

posyandu cadres are still doing weight weighing or

incorrect measurement of height, such as weighing

tool which has not really zero position, weighing

wears shoes, incorrect toddler's position, or

installation of equipment measure the height on the

wrong wall. Based on this the team of devotion

performs improvement so that the cadres can know

the mistake and can fix it while doing the

measurement of body weight and height. In the

supplementary feeding program at posyandu cadres,

it was suggested that additional food items given to

under-fives depend on the budget provided by the

head of the puskesmas and the head of the PKK

given the budget for the provision of extra

supplementary feeding. Added food that is often

given is green bean porridge, eggs or milk.In

addition the team also evaluated the cadre's

understanding of the interpretation of the results of

weight and height measurements and found that

more than 50% of cadres made improper

interpretations. Improper interpretation has an

impact on the resulting inadequate policies or

nutritional improvement interventions that are not

optimal. Based on this the team again gives an

explanation and gives an example of how the correct

interpretation of some of the measurements of

weight and height.

3.7

Evaluation of Community Service

Activities

Based on the questioning and observation done by

the team to the cadres in the implementation of

posyandu, it is seen that there is an increase of

knowledge and skill of cadre in measuring body

weight and height of children after existence of this

devotion activity than before community service

activity. Understanding about interpretation of the

results of weight measurement and height of

children which is very important in following up the

improvement of nutrition of children also has greatly

increased compared to previous interpretation. Head

of puskesmas at Medan Tuntungan health center and

Medan Johor health center stated very happy and

grateful for the empowerment of cadres because it is

very important in the effort to increase the

knowledge and skill of cadre in doing their duty in

puskesmas. The activeness of cadres at both health

centers is also very good during the implementation

of this empowerment activity.

CONCLUSIONS

Empowerment of Posyandu cadres

successfully increases cadre knowledge and

skills in measuring body weight and height.

Posyandu cadres can interpret the results of

measuring body weight and height better and

correctly than before the community service

activities.

Activities in cadre empowerment can assist

puskesmas heads in implementing policies to

prevent and control malnutrition and stunting

in children.

Empowerment of Posyandu Cadre for Implementation the Policy of Nutritional Prevention and Stunting on Children

687

The interpretation of the results of measuring

the body weight and height of a toddler

properly and monitoring the nutritional status

of children on a regular basis can prevent and

overcome cases of malnutrition and stunting

in children.

It is expected that the head of the puskesmas

will always motivate the cadres in carrying

out their duties at the posyandu, namely the

measurement of body weight and height of

children.

Cadres maintain and maintain tools for

measuring body weight and height of toddlers

given by the team.

Cadres actively coordinate with health

officers in health centers if there are obstacles

encountered in measuring the weight and

height of children and in supplementary

feeding programs.

ACKNOWLEDGEMENTS

This study was supported by the Research Institute

University of North Sumatra In accordance with the

contract of TALENTA Research Implementation

University of North Sumatra 2018 Fiscal Year No:

2590 / UN5.1.R / PPM / 2018 dated March 16, 2018.

REFERENCES

RI Ministry of Health, 2006. Guidelines for Managing

Malnourished Children - Directorate of Community

Nutrition Development

RI Ministry of Health. 2013. Posyandu Cadre Towards a

Nutrition-Conscious Family

RI Ministry of Health. 2013. Strategies to Increase

Toddler Weighing in Posyandu. Directorate General of

Nutrition and MCH

Almatsier Sunita. 2004. Diet Guides. PT Gramedia

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