The Indonesian Journal of Public Health

MULTIFACTORS GENERALLY EXPLAIN THE EMERGENCE OF STUNTING, CHALLENGES FOR FUTURE STUDIES TO UNCOVER THE CAUSE OF STUNTING

Kuntoro — 2024-08-01

TEENAGE PREGNANCY PREDICTION INDEX DURING THE ONLINE LEARNING PERIOD OF THE COVID-19 PANDEMIC

Eny Qurniyawati — 2024-08-01

Introduction: The impact of the pandemic on adolescents' lives showed that 55.1% stress and 40% anxiety due to online learning along with an increase in teenage pregnancy. Aims: To determine the predictive index of risk variables for teen pregnancy throughout the COVID-19 pandemic's online learning period. Methods: This type of research is analytic observational utilizing a case-control design. Using simple random sampling, the case sample was 40 pregnant adolescents and 80 non-pregnant controls for the Indonesian Regency of Ngawi from July 2021 until January 2022. Once each variable was significant, multivariable logistic regression analysis was performed (p < 0.05) as predictors of teenage pregnancy. Results: The findings revealed that the variables as indicators of the risk of teenage pregnancy were courtship behavior, access to reproductive health media, and parenting. The predictive index of teen pregnancy risk factors was (-7.248 + 3.833 x low risk dating + 7.726 x severe risk dating + 2.773 x access 1 media + 2.773 x access 2/more media + 3.871 x authoritarian and permissive parenting). The high probability of teenage pregnancy with an opportunity value above 0.5 is in adolescents with dating behavior or parenting patterns that show the highest risk, namely high-risk dating behavior or adolescents with authoritarian and permissive parenting patterns. Conclusion: It is hoped that this index can be considered and used as a measuring tool in assisting in reproductive health programs, in screening adolescents so that it can be known early on that adolescents have an increased risk of pregnancy.

INCREASED INCIDENTS OF STUNTING IN MAJENE DISTRICT WEST SULAWESI

Masriadi — 2024-08-01

Introduction: Stunting is a condition of chronic malnutrition caused by malnutrition that occurs over a long period of time, caused by food supply that does not match the nutritional needs of children. Developmental delay occurs when the child is still in the mother's womb and appears when the child is two years old. There is prevalence of stunted toddlers in 6 districts in West Sulawesi, namely Majene District (40.6%), Polewali Mandar District (39.3%), Mamasa (38.6%), Mamuju (33.8%), Central Mamuju (28.1%), and Install Wood (25.8%). Aims: Analysis of risk factors for stunting in Majene district. Method: This type of study is an observational study with a case-control study design. The number of toddlers is 418 toddlers. The sample for this study included 112 toddlers aged 0-59 months. The sampling technique is by means of proportional sampling. Results: the study shows that Kadarzi (OR 17.274), self-efficacy (OR 3.240), and socio-culture are risk factors for increased stunting in Majene District, KAP variable (OR 0.321) is a protective factor against stunting in Majene District. Conclusion: Kadarzi, self-efficacy, and socio-cultural variables are risk factors for stunting in Majene Regency. It is hoped that mothers will pay more attention to their toddler's nutritional intake from birth, especially on exclusive breastfeeding, MP-ASI, and various foods, and routinely bring their toddlers to the posyandu every month to find out their toddler's nutritional growth and development.

A POPULATION-BASED STUDY ON THE DEMOGRAPHIC AND CLINICAL PARAMETERS AMONG CHILDHOOD LEUKEMIA SURVIVAL

Nabihah Ali — 2024-08-01

Introduction: Leukemia is the commonest childhood cancer among children aged 0-19 years in Malaysia, constituting approximately 39.1% of all pediatric cancer cases in the country. Aims: This study aimed to measure the characteristics and survival of childhood leukemia among the local Malaysian population. Methods: This was a retrospective cohort study based on all the childhood leukemia patients aged 0-19 years registered in the Malaysian National Cancer Registry between 2010 and 2014 with the date of death before or on the 31st December 2019. The Kaplan-Meier method and life table were used to estimate five-year survival rates. Statistical analysis was performed using SPSS (version 27). Result: A total of 1,212 participants were included in this study. Their mean (SD) age was 8 (5.6) at the time of diagnosis. The highest five-year survival estimates were seen in females (58%, 95% CI: 54.5-63.1), children aged 1 to 4 (66%, 95% CI: 62.3-70.9), Indian (61.6%, 95% CI: 50.2-73.0), children diagnosed with acute lymphoid leukemia (ALL) (65.7%, 95% CI: 61.6-69.8), and those who had undergone chemotherapy at diagnosis (57.3%, 95% CI: 54.0-60.6). Patients with childhood leukemia in Malaysia reported a 5-year overall survival of 56.4 %. Survival was greater in children aged 1 to 4 years old, Indians, with ALL, and have had chemotherapy treatment at the time of diagnosis. Conclusion: The study demographic and clinical findings were comparable with other Asian countries.

PNEUMONIA CASES AMONG TODDLERS BASED ON EXCLUSIVE BREASTFEEDING COVERAGE, UNDERNUTRITION STATUS, AND POPULATION DENSITY IN SIDOARJO REGENCY IN 2019, 2020, AND 2021

Rezandra Anggita Wigunawanti — 2024-08-01

Introduction: Pneumonia is the leading infectious cause of death among children worldwide accounting for 14% of all under-five deaths. Sidoarjo Regency has the highest incidence of toddlers with pneumonia in East Java. Aims: This study aimed to map and analyze the distribution of pneumonia cases among toddlers in the Sidoarjo Regency based on the risk factors of exclusive breastfeeding coverage, lack of nutrition status, and population density. Methods: This research was a descriptive study using secondary data obtained from the Sidoarjo Regency Health Profile in 2019, 2020, and 2021. This study’s analysis unit included all 18 sub-districts in Sidoarjo Regency. Mapping was done using QGIS software version 3.10, “A Coruña.” Results: The findings showed that the Waru Sub-district was vulnerable to the incidence of pneumonia in toddlers because, apart from consistently having a high prevalence of cases over the last three years, it was also accompanied by high-risk factors, including low coverage of exclusive breastfeeding, high incidence of undernourished toddlers, and high population density. Conclusions: It can be concluded that intervention activities such as socializing and advocating programs of exclusive breastfeeding and balanced toddler nutrition with PMT and immunization are better prioritized in Waru Sub-district.

ASSESSMENT OF RISK FACTORS ASSOCIATED WITH ACUTE RESPIRATORY INFECTIONS (ARIS) AMONG CHILDREN UNDER 5 YEARS OF AGE, PAKISTAN

Tanzeela Adeel — 2024-08-01

Introduction: Acute respiratory infections account for approximately 6% of the total global burden of disease; almost double the proportion compared with the other communicable diseases. Aims: To investigate the link between risk factors & ARIs in Pakistani pediatric population under 5 with different socio-demographic profiles. Methods: Research was conducted as a cross-sectional study, utilizing the Pakistan DHS 2017-18 data, after ethical approval for the utilization of the dataset. Study variables were defined as age and gender of the child, place of residence, maternal education, wealth index, breastfeeding, and the immunization status of the child. Sample size (n = 39,799) was determined as per the inclusion and exclusion criteria. Prevalence of ARIs was estimated and the association between ARIs and socio-demographic factor and child’s immunization was examined. Results: Out of 39,799 children, 51.6% were males, 21.0 % were aged 36 – 47 months, 73.7% were the rural residents, 23% belonged to lowest wealth index quintiles. The mothers of 43.7% children were illiterate and 55.7% of the children were breastfed. ARIs proportion among the sample was 14.3%. Significant association was observed between ARIs and age (p=0.000), gender of the child (p=0.001), residence (p=0.000), economic deprivation (p=0.000), maternal education (p=0.000) and breastfeeding (p=0.000), vitamin A administration (p=0.021), BCG (p=0.008), pentavalent (p=0.008), measles (p=0.000), and pneumococcal vaccination (p=0.020). Conclusion: Socio-demographic characteristics, i.e., age and gender of the child, accommodation, economic deprivation, maternal education, breast-feeding and poor vaccination uptake were observed to be positively correlated with ARIs among children under 5 years of age in Pakistan.

POLICY TO REDUCE UNDER TWO STUNTING IN EAST JAVA REGION, INDONESIA: WHO IS THE RIGHT TARGET?

Agung Dwi Laksono — 2024-08-01

Introduction: Currently, 22% of children worldwide are stunted, and more than half live in Asia. Stunting in East Java is still high in several areas, which should have been prevented, given the relatively good resources. Aims: The study analyzes the policy targets for reducing stunting children in East Java. Methods: The study examined 4,541 children. The study analyzed nutritional status, residence, maternal (age, marriage, education, employment, socioeconomic, prenatal class), and child characteristics (age, gender, and early breastfeeding initiation (EIBF)). Results: Children in urban regions were likelier than those in rural regions to experience stunting. Stunted children were more prevalent among mothers of all ages compared to those <20. Lower education correlated with a greater likelihood of having stunted children. Stunted children were 2.410 times more prevalent among married mothers than divorced/widowed mothers (95%CI 2.292-2.534). Stunted infants were 1.062 times more prevalent among unemployed mothers compared to employed mothers (95%CI 1.050-1.075). All socioeconomic levels have a higher probability than the wealthiest to experience stunting. Mothers with prenatal classes were 1.088 times more likely than those without to have stunted kids (95%CI 1.073-1.103). Children aged 12-23 had a greater likelihood of developing stunting than those younger than <12. Boys were 1.286 times more likely than girls to experience stunting (95%CI 1.272-1.300). Children with EIBF had a 1.081 times higher likelihood of experiencing stunting than those without (95%CI 1.069-1.093). Conclusion: The appropriate policy targets for reducing the stunting prevalence were mothers in urban areas, young age, married, poor educated, unemployed, and poor.

ADOLESCENT MARRIAGES AND RISK OF STUNTING IN CHILDREN UNDER FIVE YEARS IN INDONESIA

Demsa Simbolon — 2024-08-01

Introduction. The 2018 Basic Health Research Report recorded that 58.8% of women aged 10-19 years had been pregnant and 25.2% were pregnant. Aims: The study aimed to determine the relationship between adolescent marriage and the risk of stunting in Indonesia. Method. This research used Indonesian Family Life Survey (IFLS) 2014 data with a cross-sectional approach. The study sample was 4,809 children who met the inclusion criteria, such as biological children, live births, children aged 1-5 years in the 2014 IFLS, children living with biological parents, complete data on the child's length or height, data on the characteristics of the child, mother, and family, the child does not have a disease. Independent variable is the age of the mother at marriage. The dependent variable is the incidence of stunting. Bivariate analysis used the Chi-Square test and multivariate analysis used logistic regression. Result. The risk of stunting in children under five years in Indonesia in 2014 was 36.6%. The risk of stunting is higher in children under five years of married mothers in adolescence (42.4%) compared to mothers who are married at an old age (35%). Adolescent marriage is associated with the risk of stunting in children under five years, married adolescents have a 1.2 times risk of stunting compared to mothers who are married at an older age (p-value 0.046). Conclusion. Adolescent marriage increases the risk of stunting. Cross-sectoral integrated interventions are needed to implement the marriage age maturity program to prevent adolescent marriages to reduce the risk of stunting

RISK FACTOR ANALYSIS OF INCOMPLETE BASIC IMMUNIZATION IN CHILDREN AGED 12-23 MONTHS IN EAST NUSA TENGGARA PROVINCE

Denisca Almeida — 2024-08-01

Introduction: Immunization is an effective effort to prevent some dangerous diseases in children. By providing complete basic immunization, it can reduce child mortality. East Nusa Tenggara province reached a low number of complete basic immunization coverage in 2016 (69.29%), increased in 2017 (72.2%), then decreased again in 2018 (51.72%).Aims: of this study is to analyze risk factors for incomplete immunization status in children aged 12-23 months in NTT province. Method. The method used is analytical observational with a cross-sectional design. The data used are secondary data of Basic Health Research 2018. The study population was household members who could be interviewed at the time of Basic Health Research 2018 in the NTT provincial census block area. Total sample was 674 households. The sampling technique used is two stage one phase stratified sampling. The independent variables include mother's age, father's age, mother's education level, father's education level, number of children, residence, AEFI, and ANC. The dependent variable is the incomplete basic immunization status. Results: In this study, it is known that the candidate in the regression test variables are father's age (p value= 0.005), mother's educational level (p value= 0.000), number of children (p value= 0.007), residence (p value= 0.000), and ANC (p value= 0.000). Conclusion: According to this study, most children under two years were not fully immunized (63.2%). And in this research, the candidate variables will then become a prediction model of incomplete immunization status in children 12-23 months in East Nusa Tenggara province.

PROFILE OF METABOLIC SYNDROME COMPONENTS IN OBESE ADOLESCENTS: STUNTING VS. NON-STUNTING

Muhammad Harits — 2024-08-01

Introduction: Stunted children are more likely to become obese, with a prevalence of 1.33% in children under the age of five. Aims: To evaluate the metabolic syndrome (MetS) profile in overweight/obese adolescents who are either stunted or not, and to determine the associations between stunting characteristics (height-for-age z-score, or HAZ) and anthropometric measurements (waist circumference, hip circumference, and waist-to-hip ratio), as well as MetS indicators. Methods: A retrospective observational study was conducted focusing on adolescents who were overweight or obese. Subjects were divided into 2 groups based on height-for-age z-score (HAZ): stunting group and non-stunting group. Subject numbers were determined by total sampling due to the number of stunted being small. Results: The prevalence of MetS in stunting overweight/ obese adolescents was 18.75%, dominated by female. There was a significant difference on BMI (34.60 (26.80-45.09) vs. 31.11 (27.34-40.13, p=0.040), waist-to-height ratio (0.63 (0.54-0.73) vs. 0.58 (0.52-0.64), p=0.005), hip circumference (111.27 (95-135) vs. 102.50 (87-114) cm, p=0.012) and systole blood pressure (124.37 (110-140) vs. 116.25 (100-130) mmHg, p=0.032), greater in stunting subjects than non-stunting. Waist-to-hip ratio was lower in stunting than non-stunting (0.85 (0.69-0.97) vs. 0.92 (0.81-0.99), p=0.012). HAZ was correlated negatively with BMI (r=-0.358, p=0.044), but correlated positively with hip circumference (r=0.215, p=0.023). Conclusion: Adolescents who were stunted and overweight/obese exhibited higher values for BMI, waist-to-height ratio, hip circumference, and systolic blood pressure compared to non-stunted individuals who were overweight/obese. There was a correlation between the height-for-age z-score and both BMI and waist-to-hip ratio.

THE USE OF SOCIAL MEDIA AS A SOURCE OF COMPLEMENTARY FEEDING INFORMATION FOR MOTHERS

Meta Herdiana Hanindita — 2024-08-01

Introduction: In the digital age, social media (SM) has undeniably transformed the way parents access information, including complementary feeding (CF) practices. Approximately 57.1% mothers in Indonesia obtained information about CF from the internet, ranging from parenting forums to social media platforms like Instagram. Aims: To explore the use of SM as source of CF information among mothers in Indonesia. Method: Exploratory cross-sectional study was conducted in 1631 mothers of children 0-23 months in May 2023, using an online questionnaire. The analysis of the data was conducted using the statistical software SPSS 21.0 Results: Of all the subjects, the largest group consisted of those aged 26-30 years. A majority had a high level of education, had SM, and spent 30-60 minutes (59.2%) searching for CF information. Full-time mothers were more influenced by SM (p=0.043). A notable distinction existed in the choice of social media based on the level of education. The higher the education, the more Instagram was used, while the lower the education, the more TikTok was used (mothers p=0.000; fathers p=0.002). The higher the education, the more information sources were sorted (mothers p=0.014; fathers p=0.000), and the more the educational background of the informant was considered (mothers p=0.000; fathers p=0.000). Conclusion: Mothers seek CF information from SM because it is faster, easier and convenient. However, it is often not evidence-based, and the amount of conflicting information confuses parents. Health efforts with a promotive approach that are evidence-based, understandable and applicable are needed and can be carried out through SM.

STUNTING REDUCTION STRATEGY IN INDONESIA: MATERNAL KNOWLEDGE ASPECTS

Prima Maharani Putri — 2024-08-01

Introduction: Based on an Indonesian Ministry of Health report, the incidence of stunting has decreased from 24.4% in 2021 to 21.6% in 2022. Reducing stunting rates in children is a global nutrition target in 2025. One of the causes of nutritional problems in children is inadequate intake of nutrients according to their nutritional needs. Based on the above explanation, maternal nutritional knowledge and the government’s role are essential in reducing stunting in Indonesia. Aim: The research investigation was aimed at investigating the level of maternal nutritional awareness as well as the government's participation in reducing stunting in children under the age of five. Methods: This quantitative study was an analytical observational design using a cross-sectional study approach. The samples were mothers of children under five carried out using non-probability purposive sampling, while respondents for the stunting intervention program provider used the snowball sampling technique. Data collection was conducted in locations with high prevalence of stunting, comprising two distinct groups of participants. Result: The statistical result using chi-square shows a significant correlation between maternal nutritional knowledge and the government’s role in reducing stunting in children under five, with a p-value (0.000) < α (0.05) and p-value (0.008) < α (0.05). Conclusion: There is a relationship between the level of nutritional knowledge of mothers under five and the role of the government in the incidence of stunting. There is a need for further and multidisciplinary management in stunting cases, especially in Indonesia.

EARLY DETECTION OF ANEMIA IN ADOLESCENT GIRLS THROUGH NUTRITIONAL STATUS EXAMINATION AND IRON PANEL ANALYSIS (TIBC, SERUM IRON, IRON SATURATION)

Ririn Handayani — 2024-08-01

Introduction. The panel iron analysis is an effort made to screen for anemia in adolescent girls. Adolescents with anemia can experience disturbances in growth and development, behavioral changes, and motor disturbances. In Jember district found that on average 30-40% of female students suffer from anemia. Anemia screening is an effort made to maintain the health of adolescents so that they can grow and develop in accordance with their growth and developmental stages. Aims. The purpose of this study is the early detection of anemia in adolescent girls. Methods. This research is an analytical descriptive study with a cross-sectional approach. Data collection was by examining nutritional status and iron panel examination results. The sampling method was accidental, involving 21 female students. The research was conducted in March 2023. Data analysis used frequency distribution. Result. The results showed that some students were undernourished (42.9%) and severely malnourished (4.8%); 18 students (85.7%) were classified as KEK. Meanwhile, from the iron panel analysis, 10 students (47.6%) had abnormal serum iron levels, 6 students (28.6%) had abnormal transferrin saturation levels, and the majority of the respondents, 20 students (95.2%), had normal TIBC. Conclusion. The conclusion from this study is that there are still many adolescent girls, especially in the school environment, who are undernourished to severely malnourished. This result correlates with the iron panel analysis which found that some adolescent girls were diagnosed with iron-deficiency anemia, characterized by a decrease in serum iron, transferrin, and iron reserves levels, accompanied by an increase in the TIBC.

INCREASING ADOLESCENTS’ KNOWLEDGE OF MARRIAGE AGE MATURATION (PUP) THROUGH COMIC MEDIA: AN EXPERIMENTAL STUDY

Sarliana — 2024-08-01

Introduction: Reducing the incidence of child marriage is a component of the national medium-term plan (RPJMN) for 2020-2024, which is targeted to fall to 8.74% in 2024, and 6.94% in 2030. The prevalence of child marriage in Central Sulawesi is 31.91% and Sigi Regency has the third highest prevalence of child marriage, namely aged 10-14 years (0.04%) and aged 15-19 years (2.58%). Aims: To evaluate the impact of providing health education via comic media on adolescent knowledge regarding the age of marriage at SMA Negeri 1 Sigi. Method: The design applied in this research was experimental with pretest-posttest and a control group setup. Twenty-six participants were chosen through random sampling and allocated to either the intervention group (comic media education) or the control group (leaflet media education). The research instrument utilized was a questionnaire. Data analysis was conducted using the Wilcoxon and Mann-Whitney tests. Results: This study shows that, in the control group, knowledge before education was mostly in the sufficient category (42%) and after education increased to good category (74.2%). Meanwhile, in the intervention group, before education, the majority was in the poor category (35.5%) and after education the majority was in the good category (96.8%), with a p value of 0.000 <0.05. Conclusion: Using comics proves more efficacious in enhancing teenagers' knowledge compared to utilizing leaflets. It is hoped that schools and health centers can collaborate to establish youth counseling centers as a platform for counseling students and can utilize comics as one of the educational media.

ONLINE APPLICATION BASED ON KING INTERACTION SYSTEM THEORY TO INCREASE TREATMENT ADHERENCE AND CLINICAL INDICATORS IN TB CHILDREN

Ethyca Sari — 2024-08-01

Introduction: Non-adherence to treatment among TB children in Indonesia varied 40.5%-57.2%. An innovative method of education might improve treatment adherence and clinical recovery of TB children. The aims of this study were to compare the treatment adherence and clinical indicators of TB children who received an intervention using an online application based on King's theory with a conventional method. Methods: This is a quasi-experimental study to educate 55 TB school-age children using a validated online application based on King's interaction system theory, compared with the conventional method in 55 TB children as the control group. The medication regularity and control discipline were observed four times in weeks 2, 4, 6, and 8. Measurements of acid-fast bacilli (AFB) smear sputum examination, TB scoring, chest X-ray examination, level of Hb, and nutritional status were done twice in pre- and post-intervention. Data analysis used chi-square, paired t-test, independent t-test, Mann Whitney, McNemarᵇ. or Wilcoxon test. Results: The results of this study revealed that the intervention group was significantly successful compared to the control group in several indicators, such as increasing treatment adherence (p=0.001), controlling discipline (p=0.001), reducing AFB positive (p=0.001), TB scoring (p=0.001), infiltrate in chest X-ray examination ((p=0.013), and increasing Hb levels (p=0.001). Meanwhile, nutritional status could not be compared because, from the beginning of the study, the nutritional status was unbalanced and benefited the intervention group. Conclusion: The online application based on King's theory has succeeded in increasing medication adherence and clinical improvement of pulmonary TB in children.

MOTHER’S HEALTH LITERACY WITH STUNTING INCIDENCE OF TODDLERS IN JEMBER

Zulfa Mazida — 2024-08-01

Introduction: Mothers have a role in caring for and fulfilling toddler nutrition which is very important to prevent stunting in toddlers. Mothers’ skills in carrying out their roles are influenced by mothers’ knowledge through health literacy, namely the capability to access, assess, and process health information. Prevalence of stunting in East Java was 26.8% in 2019, exceeding the limit set by WHO. Jember is the second area contributing to the largest prevalence of stunting in East Java. Aims: This study aimed to analyze the relationship of mothers’ health literacy with stunting incidence of toddlers. Methods: This study used a case control design. The respondents were mothers with stunting toddlers (n=51) and mothers with non-stunted toddlers (n=51). The secondary data sources were the stunting data of the Kalisat Primary Healthcare in February 2022 and the primary data sources were the results of interviews used the HLS-EU-16 Indonesia Questionnaire. Data analysis used chi-square test. Results: There was a relationship between mothers’ health literacy and stunting incidence of toddlers with a p-value of 0.001 (p-value < 0.05 so that the two variables have a significant relationship. Conclusion: Mothers’ health literacy has a strong association with stunting incidence of toddlers.