The Analysis on Protein Energy Supply Concerning Stunting

Incidents in Young Children Under Five Year Old at Primary Care

Unit of Tanah Kali Kedinding Surabaya

Diyah Arini and Dwi Ernawati

Sekolah Tinggi Ilmu Kesehatan Hang Tuah Surabaya, East Java, Indonesia

Keywords: Energy, Protein, Stunting.

Abstract: The most common problem infectious diseases that can reduce energy and protein intake and could impact

on stunting on toddlers. The highest prevalence of stunting among children under five in Surabaya City in

2016 is found at Tanah Kali Kedinding Primary Care Unit. The purpose of this study is to analyze the intake

of protein energy to stunting events in toddlers. The design is cross-sectional approach with simple random

sampling. The sample size is 71 children. The study population was Toddlers aged 2-5 years who are

stunted. Independent variables are the status of infectious diseases (diarrhea and RTI), economic status,

energy and protein intake . The dependent variable was the incidence of stunting. Microtoise and

questionnaire used to measure the variables with multinomial logit approach. The results showed that there

was a significant relationship between energy intake and incidence of stunting in toddlers with p = 0.001

and there was a significant correlation between protein intake with the incidence of stunting in under five

years, with p-value = 0.006. The primary prevention of stunting events is prenatal and postnatal maternal

and infant interventions in the first 1000th days of life by meeting protein energy requirements.

1 BACKGROUND

Infancy is an important period in the process of

human growth and development. Growth and

development in this age occurs in a rapid period and

will never be repeated, because it is often called the

golden age, but is in this period when they are

susceptible to a disease which affects the nutritional

status of their future. A common problem these days

is that the emergence of infectious diseases can

reduce the intake of toddlers, by consequent it will

have an impact, one of them is

stunting(Soetjiningsih, 2013). Observations and

interviews with health workers in Primary Care Unit

of Tanah Kali Kedinding Surabaya, the incidence of

stunting were higher in the PHC; the main cause is

that the education factor is low (60% majority of

junior), odd jobs such as street vendors and daily

workers whose Minimum Wage income is far from

the other people, only about 500 thousand to 1

million per month. Many mothers also work to

supplement the family income, so it affects the

feeding, nutrition, and parenting / childcare.

Basic Health Research noted that the national

prevalence of stunting was 37.2%, showing an

increase compared to 2010 (35.6%) and 2007

(36.8%), which is composed of 18.0%, is very short

and 19.2 % short, which means there has been an

increase of 1.6%. The prevalence of stunting (height

/ Age) is higher than the prevalence of underweight

or malnutrition (W / A) (19.6%) and the prevalence

of wasting or underweight (weight / height) (5.3%)

among children under five in Indonesia(Kemenkes

RI, 2013). One of the three health centers which

have the highest prevalence of stunting in Surabaya

is Primary Care Unit of Tanah Kali Kedinding

Surabaya equating to 25.37%. In 2013, the

prevalence of stunting in Primary Care Unit of

Tanah Kali Kedinding reached 21.86% and

increased in 2014 to 22.69%, and increased again in

2015 to reach 23.63%. The latest data in 2016,

shows that the prevalence of stunting in the health

center reached 25.37%. Low energy intake on the

incidence of children at risk of stunting 2.52 times

higher compared to the good or normal energy

intake. While the protein intake of <80%. Nutritional

Adequacy Rate (AKG) is at risk of stunting 6.4

596

Arini, D. and Ernawati, D.

The Analysis on Protein Energy Supply Concerning Stunting Incidents in Young Children Under Five Year Old at Primary Care Unit of Tanah Kali Kedinding Surabaya.

DOI: 10.5220/0008329305960600

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 596-600

ISBN: 978-989-758-336-0

times higher than in children with ≥80% protein

consumption. LBW children who experience

indigestion because the gastrointestinal tract is not

functioning properly,(Trihono et al, 2015) , WHO

set of interventions that can be used to combat

stunting is prenatal and postnatal intervention.

Mothers play an important role in supporting efforts

to address nutritional issues, especially in the family

nutritional intake, ranging from food preparation,

selection of groceries, to the food menu. One of the

important programs that should be done by health

workers is Maternal & Child Health Centre. Health

workers should form a cadre of the best goal for the

implementation of education to mothers with young

children effectively and height measurements

reported by appropriate age. The most important

education was exclusively breastfed until 6 months

of age, and from the age of 6 months, in addition to

breastfeeding infants should also be given a

Complementary feeding (MP-ASI) and continued

breastfeeding until the baby is 2 years old or more.

The purpose of this study is to analyze the intake

of protein energy to stunting events in toddlers in the

area of the Tanah Kali Kedinding Surabaya Primary

Care Unit

2 METHODS

This study was design utilizes observational analysis

with cross-sectional approach. The study population

was Toddlers aged 2-5 years who are stunted at

Primary Care Unit of Tanah Kali Kedinding

Surabaya. Probability Sampling with Simple

Random Sampling. The sample size in this study

was 71 respondents. Independent variables in this

study the status of infectious diseases (diarrhea and

RTI), economic status, energy and protein intake.

The dependent variable in this study was the

incidence of stunting. For this study is utilize dan

microtoise instrument used to measure the height of

a toddler with a precision of 0.1 cm and

questionnaires in research Arini Diyah on the

Relationship between breastfeeding patterns with the

frequency of diarrhea and acute respiratory infection

in children 6-12 months of Primary Care Unit at

Balongpangganng Gresik(Arini Diyah, 2011), to

determine the status of infectious disease that affects

children under five as well as a food frequency

questionnaire / FFQ semiquantitative, food intake

Furthermore, the data were processed using

software. The researchers began collecting data after

obtaining informed consent from the parents with

stunting toddler. the researchers measured the height

of the child and provided a questionnaire about the

factors that influence stunting. The questionnaire did

not name each of the toddlers but was given a code

to keep confidentiality. The analysis of data was

multinomial logit approach.

3 RESULTS

3.1. General Data

Table 1: Distribution of respondents by age of the

children, the father's height, mother's height, and

length of infants born at Primary Care Unit of Tanah

Kali Kedinding Surabaya

Characteristics of

Res

ondents

Frequency

(

)

Percentage

(

)

e Toddle

2-3 years 31 43.7

3-4 years 25 35.2

4-5 years 15 21.1

Hei

ht Da

≤ 150 c

57.0

151-160 c

25 35.2

161-170 c

31 43.7

> 170 c

10 14.1

Hei

ht Mrs.

≤ 150 c

26 36.6

151-160 c

37 52.1

161-170 c

8 11.3

> 170 c

The number of

infants in the

famil

<2 37 52.1

≥ 2 34 47.9

The number of

children

dependent parent

erson 17 23.9

ersons 40 56.3

≥ 3 14 19.7

Born Body

Length

≤ 45 c

68.5

46-50 c

49 69.0

51-55 c

16 22.5

> 55 c

The Analysis on Protein Energy Supply Concerning Stunting Incidents in Young Children Under Five Year Old at Primary Care Unit of

Tanah Kali Kedinding Surabaya

597

3.2 Custom Data

Table 7: Distribution of respondents by measurement

results based on the factors that influence the incidence of

stunting in primary care unit of Tanah Kali Kedinding

Surabaya

Variables Score Sign

Status of infectious diseases 7.324 0.007

Family Economic Status 6,918 0.009

Ener

intake 10.701 0,001

Protein intake 7.614 0,006

Table 8: Distribution of respondents by measurement

results based on the factors that most influence the

incidence of stunting in primary care unit of Tanah Kali

Kedinding Surabaya

Dep

ende

Vari

able

Indepen

dent

Variable

value

Exp

(B)

95% C

Lower Upp

Stun

-ting

Status of

infectio

diseases

0.998 3x

108

0,001

Family

Econom

ic Status

0.998 6x

107

0,001

Energy

intake

0.998 3x

108

0,001

Protein

intake

.120 65x

102

.613 68.

The results of the multinomial logit analysis

conducted last modelling results can be inferred

from the 4 factors that affected to the incidence of

stunting in Primary Care Unit of Tanah Kali

Kedinding Surabaya. protein obtained showed the p-

value = 0.12 with OR 65x102 means of protein

intake in infants have risk factors for 65x102 times

higher than any other factor.

4 DISCUSSION

There is a significant association between infectious

disease status in this regarding the incidence of

diarrhea and acute respiratory infection in infants.

This can be seen from the value of p = 0.007 (p

<0.05). The results showed that 36 toddlers and 14

toddlers severe stunting have ever experienced

infectious diseases (diarrhea or RTI) in the past year.

Infectious diseases is one of the direct causes of

infant nutritional status in addition to the

consumption of food.

Children who do not consume the nutrients

needed by the body will result in a low immunity, so

Table 2: Distribution of respondent toddler based on

primary care unit of Tanah Kali Kedinding Surabaya

Height Frequency

(f)

Percentage (%)

Stunting 57 19.7

Severe stuntin

14 80.3

amount 71 100

Table 3: Distribution of respondents by status of

infectious diseases at primary care unit of Tanah Kali

Kedinding Surabaya

Infectious

Disease Status

Frequency (f) Percentage (%)

There is 50 70.4

No 21 29.6

amount 71 100

Table 4: Distribution of respondents by economic status

in primary care unit of Tanah Kali Kedinding Surabaya

Family Economic

Status

Frequency (f) Percentage (%)

Low 50 70.4

secondary 20 28.2

h 1 1.4

mount

Table 5: Distribution of respondents by energy intake in

primary care unit of Tanah Kali Kedinding Surabaya

Energy intake Frequency

(f)

Percentage (%)

Low 44 62.0

Enou

h 27 38.0

amount 71 100

Table 6: Distribution of respondents by protein intake

on primary care unit of Tanah Kali Kedinding Surabaya

Protein intake Frequency (f) Percentage

(%)

Low 43 60.6

Enou

h 28 39.4

amount 71 100

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

598

susceptible to disease infection, otherwise infections

such as diarrhea and RTI will result in the intake of

nutrients cannot be absorbed properly.(Ernawati

Dwi, 2014). The Research on stunting in the UK

shows the results of ongoing analysis of diarrhea to

stunting. Based on 24-month old children who

continuously experienced diarrhea for more than 14

days have a greater chance of experiencing stunting,

than children aged 24 months who had diarrhea for

less than 14 days(Checkley et al., 2008)

Toddlers who often suffer acute diarrhea will be

at greater risk of growing into stunting. During

diarrhea, bacteria get into the small intestine and

undergo multiplication. The bacteria release toxins

that will affect small intestinal mucosal cells

(stimulates enzyme adenilsiklase). These enzymes

transform Adenosine Tri Phosphate (ATP) to cyclic

Adenosine Mono Phosphate (cAMP) and cAMP

increased the expected increase in Cl ion secretion

into the intestinal lumen. Isotonic solution secretion

by intestinal mucosa (hypersecretion) as a result of

the formation of toxins will make the function more

absorption of intestinal mucosa impaired (decreased

number sakaridase enzyme, lipase, and

protease)(Almatsier Sunita, 2011). This results in

malabsorption of nutrients, dehydration and loss of

nutrients. If the condition is not treated immediately

and be balanced with adequate food intake, then

there will be severe dehydration, malnutrition and

failure to thrive. Diarrhea impact on linear growth in

children. If the child often had diarrhea within the

first 24 months of life, the child tends to be shorter

on 1.5 times(Checkley et al., 2008). Based on

previous research, on the 20 largest countries in the

world there is an 80% of children who had suffered

stunting, child malnutrition is accompanied by cases

of diarrhea by 51%, in the case of malaria by 57%,

cases of pneumonia by 52%, and measles cases by

45% ending in death(Hussein and Adam, 2015)

There is a significant correlation between the

economic status of families with incidence of

stunting in children under five in Primary Care Unit

of Tanah Kali Kedinding Surabaya, this can be seen

from the value of p = 0.009 (p <0.05). Showed that

36 toddlers and 14 toddlers severe stunting stunting

have parents with low economic status. Research in

Indonesia and Bangladesh show that children from

low-income families have higher risk of stunting

compared to children from families of higher

socioeconomic. This indicates that the family

economic circumstances affect the incidence of

stunting among children under five(Semba, 2016),

Social and economic factors include per capita

income, parental education, mother knowledge about

nutrition has also indirectly associated with the

incidence of stunting (Dian Hidayati, T. M. Thaib,

2010).

There is a significant relationship between

energy intake with stunting under-fives in Primary

Care Unit of Tanah Kali Kedinding Surabaya, this

can be seen from the value of p = 0.001 (p <0.05).

Showed that 30 toddlers and 14 toddlers severe

stunting has a low energy intake. The body is

experiencing a shortage of energy will experience

negative energy balance will be reduced so that the

weight of body weight should be. This will inhibit

growth in children and cause weight loss and tissue

damage in adults(Siagian Albiner, 2010), The intake

of nutrients that children need a complete continue

during the growth process continues because the

growth process is influenced by the food given to

children. The food given should be appropriate both

type and quantity to their nutritional content. The

child's body still needs all the main nutrients are

carbohydrates, fat, protein, fiber, vitamins and

minerals, if the lack of the growth of children,

including his height will be disrupted(Almatsier

Sunita, 2011), Adequate nutrition is necessary to

ensure optimal growth and development of infants

and children. Daily nutritional needs are used to run

and maintain the normal function of the body can be

done by selecting and food intake was good (quality

and quantity)(Sutomo Anggraini, 2010).

Food is a source of energy to support all human

activities. Their burning carbohydrates, protein, and

fat in the human body produces energy. Therefore,

in order that adequate human energy needed food

into the body adequately. Nutrient intake is not

adequate, especially of total energy, protein, fat and

micronutrients, are associated with physical growth

deficit in pre-school children(Almatsier Sunita,

2011), However, consumption, diet enough not

guarantee normal physical growth, because the

incidence of other diseases, such as acute or chronic

infection, can affect a complex process to the

occurrence or maintenance of growth deficits in

children. RISKESDAS data analysis in 2013 showed

no significant relationship between energy

consumption with the incidence of stunting in

children aged 12-59 months in Sumatra (Almatsier

Sunita, 2011).

There is a significant correlation between protein

intake with the incidence of stunting in children

under five in Primary Care Unit of Tanah Kali

Kedinding Surabaya, that can be seen from the value

of p = 0.006 (p <0.05). Showed that 30 toddlers and

13 toddlers with severe stunting has a low protein

intake. Malawi has a child stunting in serum

The Analysis on Protein Energy Supply Concerning Stunting Incidents in Young Children Under Five Year Old at Primary Care Unit of

Tanah Kali Kedinding Surabaya

599

concentrations of total 9 amino acids that are

required only 10-20 percent lower than a child who

is not stunting. Moreover, stunting children have low

serum concentrations of significant conditions

required amino acids (arginine, glycine, glutamine),

amino acids that are not needed (asparagine,

glutamate, serine), and 6 different sphingolipid than

children who are not stunting (Semba, 2016).

Other studies have shown that there is a

relationship type and amount of consumption can

affect the nutritional status that the end result

appears stunting in infants as in Budiarti research

that the type and amount of food is related to the

incidence of malnutrition in children under five in

Maternal & Child Health Centre of Kenanga 3 Bulak

Banteng Surabaya(Budiarti Astrida, Hastuti Puji,

2017) RISKESDAS shows the results of data

analysis in different provinces, there is a significant

correlation between protein intake with the

incidence of stunting in children under five

(Kemenkes RI, 2013).

Basic health research data consistently shows

that the average intake of calories and protein in

toddlers are still under Nutritional Adequacy Rate

(AKG). As a result of these circumstances, children

under five women and children under five

Indonesian men have an average height of each 6.7

cm and 7.3 cm shorter than the WHO reference

standard, 2005. Protein is needed for physical

growth, especially in height, because proteins are the

main component of bones. Protein is essential for the

normal functioning of almost all cells and metabolic

processes, thus a deficit in this nutrient has many

clinical effect(Kemenkes RI, 2013). Interventions to

address stunting in Indonesia has strived good

government through the Ministry of Health and

related agencies. Interventions related to energy and

protein intake is agriculture ministry efforts to

fortify foodstuffs (Salt, Flour and cooking oil) and

the efforts of the health ministry of education and

nutrition through Maternal & Child Health Centre

so that the incidence of stunting in Indonesia soon

declined and did not happen again (Tim Nasional

Percepatan Penanggulangan Kemiskinan, 2017).

5 CONCLUSIONS

The analysis showed that the factor protein intake

has a protein intake in infants with risk factors for

65x102 times higher than the factor of infectious

disease status, economic status, and energy intake.

The primary prevention of stunting events is prenatal

and postnatal maternal and infant interventions in

the first 1000th days of life by meeting protein

energy requirements.

REFERENCES

Almatsier Sunita (2011) Prinsip Dasar Ilmu Gizi. Jakarta:

PT Gramedia Pustaka.

Arini Diyah (2011) ‘Hubungan Antara Pola Pemberian

ASI Dengan Frekuensi Kejadian Diare Dan ISPA Pada

Anak 6-12 Bulan Di Wilayah Puskesmas

Balongpanggang Gresik’.

Budiarti Astrida, Hastuti Puji, A. V. (2017) ‘Correlation

Between Dietary Intake With Protein Energy

Malnutrition of Child 1-5 Years Old In Posyandu’, in

Proceeding of Surabaya International Health

Conference. Surabaya, pp. 455–460.

Checkley, W. et al. (2008) ‘Multi-country analysis of the

effects of diarrhoea on childhood stunting’,

International Journal of Epidemiology, 37(4), pp.

816–830. doi: 10.1093/ije/dyn099.

Dian Hidayati, T. M. Thaib, D. S. (2010) ‘Faktor-Faktor

Yang Berhubungan Dengan Stunting Pada Balita Usia

12-59 Bulan Di Kecamatan Darul Kamal Kabupaten

Aceh Besar’.

Ernawati Dwi (2014) ‘Pijat Bayi Mempengaruhi Kadar

Kortisol Dan Kuantitas Tidur Bayi Yang Mengalami

Hospitalisasi Dengan Pendekatan Teori Comfort

Kolcaba’, Jurnal Ilmiah Kesehatan, 7, pp. 138–150.

Hussein, A. M. and Adam, D. (2015) ‘Risk Factors of

Protein Energy Malnutrition Deficiency among

Children Under Five Years at Alruhal Camp-Kass

Locality South Darfur State 2012 Sudan’, Journal of

Bacteriology & Parasitology, 6(6), pp. 8–11. doi:

10.4172/2155-9597.1000252.

Kemenkes RI (2013) Riset Kesehatan Dasar. Jakarta:

Badan penelitian dan pengembangan Kesehatan.

Semba, R. D. (2016) ‘The rise and fall of protein

malnutrition in global health’, Annals of Nutrition and

Metabolism, 69(2), pp. 79–88. doi:

10.1159/000449175.

Siagian Albiner (2010) Epidemiologi Gizi. Jakarta: EGC.

Soetjiningsih (2013) Tumbuh Kembang Anak. Jakarta:

EGC.

Sutomo Anggraini (2010) Makanan Sehat Pendamping

ASI. Jakarta: Demedia.

Tim Nasional Percepatan Penanggulangan Kemiskinan

(2017) 100 Kabupaten/Kota Prioritas Untuk

Intervensi Anak Kerdir (Stunting), Ringkasan. Jakarta:

Sekretariat Wakil Presiden Republik Indonesia.

Trihono et al (2015) Pendek (stunting) di Indonesia,

Masalah dan solusinya. Edited by Sudomo. Jakarta:

Lembaga penerbit Balitbangkes.

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