Factors Associated With Nutritional Status in Toddler

ABSTRACT


INTRODUCTION
Nutrition is one of the important factors in determining the quality of human resources, which has a close relationship with human health and intelligence.Good nutritional status in children under five needs to get more attention, because it can hamper physical growth, mental and thinking abilities (Alpin, 2017).Toddlers who do not get adequate nutritional intake will be susceptible to disease, causing appetite disorders, reduced nutritional intake and causing malnutrition (Apriliana & Rakhma, 2017).
Toddlers are a very valuable period in the process of human growth and development.During the toddler period, nutritional status is a priority because the incidence of malnutrition will affect the quality of child growth and development (Prehana Wati, 2018) The problem of undernutrition is influenced by several factors, including parental education, parental knowledge, parental employment, family income, child diet, number of family members, child gender, socioeconomics and infectious diseases (Wardani, 2017).Malnutrition has a serious impact on future generations.Children suffering from undernutrition will experience impaired physical growth and mental development.Growth disorders are the inability to reach a certain height in accordance with the general.Children will have a lower IQ due to impaired mental development and intelligence.Each malnourished child has a risk of losing 10-13 IQ points (Ucu, 2017).
One of the factors that can affect the nutritional status of children under five is the level of knowledge about nutrition.Poor parental nutrition knowledge can be one of the determinants of nutritional status of children under five, because it determines the attitude and behavior of mothers in choosing foods that will be consumed by children under five as well as eating patterns related to the amount, type and frequency that will affect food intake in toddlers (Nindyna Puspasari & Merryana Andriani, 2017).
Children's diet affects a person's nutritional status.Good and optimal nutritional status occurs when the body obtains enough nutrients that are used efficiently, allowing physical growth, brain development, work ability and general health at the highest possible level (Hakim, 2016).Infectious diseases can affect the nutritional status of children under five.Infectious disease is one of the diseases that often occurs in children under five years of age, where one of the causes of infectious diseases is poor nutritional status.Good nutritional adequacy in children will increase the child's resistance to disease, children who experience malnutrition will be susceptible to infectious diseases.The low immune system of toddlers results in children being susceptible to various diseases (Putri et all., 2015).
The World Health Organization (WHO) estimates that 54% of deaths of children under five in the world are caused by malnutrition (R Yudi Rachman Saleh, 2017).Data in 2018 showed that 4 million toddlers in Indonesia were malnourished, 700 thousand of whom were malnourished (Milah & Zalqiah, 2019).Based on the 2016 PSG in West Java Province, the rate of malnutrition in children based on BB/U was 2.4% and undernutrition was 12.1%.Ciamis Regency is among the ten districts with the highest malnutrition rate in West Java (R Yudi Rachman Saleh, 2017).
Based on data from the Ciamis Regency Health Office in 2020 from 37 Puskesmas spread across Ciamis Regency there were 74,272 toddlers, as many as 1,001 (1.3%) toddlers were malnourished, 5,617 (7.6%) toddlers were malnourished, 54,136 (73%) were well-nourished and 4,573 (6.2%) toddlers were overnourished.Compared to last year, the number of malnourished toddlers has increased, last year it was known that there were 378 malnourished toddlers, while currently reaching 1,001 toddlers (Ciamis District Health Office, 2020).
Based on data information from the Ciamis Health Center, from 7 villages or sub-districts spread across the Ciamis Health Center working area, there are 2,692 toddlers, 33 (1.2%) toddlers are malnourished, 158 (5.9%)

METHOD
The research method used in this study is quantitative analytic method with cross sectional research design.The population in this study were all parents who had children under five in the Benteng village, Ciamis District, Ciamis Regency.The population in this study was 307 children under five in Benteng Village according to data from UPTD Puskesmas Ciamis.The sampling technique used purposive sampling and obtained a sample of 33 respondents.This research was conducted at the Posyandu Pereng Neighborhood, Benteng Village on March 7-8, 2022.
The implementation of the study begins with a time contract (Informed Consent) until an agreement is obtained through the signing of an agreement letter.After that the researcher weighed the toddler's weight and gave a questionnaire to the parents of the toddler.The researcher checked the questionnaire sheet that had been collected, then checked its completeness if there were statements that had not been filled in.Researchers processed the data and analyzed.
The instruments used in this study were weighing toddlers and questionnaire sheets.
Data analysis in this study used Univariate and Bivariate.Univariate analysis was conducted to obtain a description of the characteristics of respondents and the frequency distribution of all observed variables.So that the variation of each variable can be known while the bivariate analysis is presented to see the relationship between each dependent variable and the independent variable.Data processing uses the Chi-Square statistical test with a confidence level of 95% (α = 0.05).so that if p values ≤ 0.05, it shows that there is a relationship between the independent variable and the dependent variable, while if p> 0.05, it shows that there is no relationship between the independent variable and the dependent variable.

RESULTS AND DISCUSSION
Based on the results conducted at the Pereng Environmental Health Post in Benteng Village on 33 respondents, the following research results were obtained  Nutritional status is a picture of health as a reflection of the use of food consumption consumed by a person and its use by the body.This research conducted antopometric measurements to assess the nutritional status of toddlers using the indicator of body weight according to age (BB/U) (Indonesian Ministry of Health, 2020).

Characteristics of Respondents
The overview of the results of the analysis shows that of the 33 respondents showed that the most nutrition of toddlers is good nutrition as many as 24 people (72.7%), but still found malnutrition as many as 7 people (21.2%) and more nutrition as many as 2 people (6.1%)This shows that there is an incidence of malnutrition in children under five as many as 7 people (21.2%).This condition is caused by several things, including the economic status of the family.The economic ability of the family greatly influences buying or providing processed food.The family actually knows how to compile a balanced menu, but due to limited funds, compiling a balanced menu is less fulfilling.And other factors that can affect the incidence of malnutrition are infectious diseases, infectious diseases in children will disrupt metabolism which makes hormonal imbalances and disrupts immune function.So children affected by recurrent and chronic infections will experience nutritional status and immunity disorders, both in absolute and relative terms.Gender can also affect the nutritional status of toddlers, toddlers in this research who have malnutrition are as many as 7 toddlers, with 6 female toddlers and 1 male toddler.This is in line with research in Wardani (2017) that malnutrition is more prevalent in girls than boys.Boys' nutritional needs are different from girls and are usually higher because boys have higher physical activity.Boys usually get a higher priority in terms of food compared to girls (Wardani, 2017).

The relationship between parents'
knowledge and nutritional status of children under five in Benteng Village, Ciamis District, Ciamis Regency.
Based on the results of the frequency distribution calculation, it shows that parents who have sufficient knowledge and have toddlers with poor nutritional status are 1 person (50%), parents who have sufficient knowledge and have toddlers with good nutritional status are 1 person (50%), parents who have good knowledge and have toddlers with poor nutritional status are 6 people (19.4%), parents who have good knowledge and have toddlers with good nutritional status are 23 people (74.2%), and parents who have good knowledge and have toddlers with more nutritional status are 2 people (6.5%).
Based on the results of the Chi-Square statistical test, the significant value of p-value = 0.573 > α = 0.05.So it can be concluded that there is no relationship between parental knowledge and nutritional status in children under five in Benteng Village, Ciamis District, Ciamis Regency.
The level of nutrition knowledge of parents is very necessary for parents, especially mothers who have children under five or for caregivers of children under five.Based on the above research, it can be assumed that the level of knowledge of parents in Benteng Village mostly has a good level of knowledge, but there are some children under five who have poor nutritional status.This is likely to occur because there are other factors that can affect the nutritional status of children under five, such as family income, less family income will lead to a poor family economy so that the needs and nutritional adequacy of children will be less or not well met.Another factor that can affect toddlers with poor nutritional status in parents who have good knowledge is because the toddler has an infectious disease, because there are 3 toddlers with a category of poor nutritional status and good parental knowledge.
The results of this study differ from research conducted by Nurmaliza and Sara Herlina ( 2019) in a study entitled the relationship of knowledge and education to the nutritional status of toddlers.Based on univariate analysis, the majority of the nutritional status of toddlers is good, while based on bivariate analysis using the chisquare test shows that there is a relationship between knowledge and education on the nutritional status of toddlers (Nurmaliza & Herlina, 2019).
Knowledge of balanced nutrition behavior is everything that mothers know about the behavior of regulating the composition or composition of daily food which contains nutrients in the type and amount that are in accordance with the needs required by the toddler's body and shows quantity and quality based on a balanced nutrition cone (Fajriani et all., 2020).
Nutritional knowledge of oral nutrition has an impact on the nutritional status of the baby and the baby's ability to choose nutritious meals for the baby and his/her family.Knowledge about the nutrition that must be consumed by algalr to remain healthy is a factor that determines the health of a person (Nurmallizal & Herlinal, 2019)

The relationship between children's eating patterns and the nutritional status of toddlers in Benteng Village, Ciamis District, Ciamis Regency
Based on the results of the calculation of the frequency distribution, it shows that 1 person (100%) has an inappropriate eating pattern and has a poor nutritional status, 6 toddlers have the right eating pattern and have a less nutritional status (18.8%), 6 children (18.8%) 24 people (75%) had the right diet and had good nutritional status, 2 toddlers had the right diet and had more nutritional status (6.1%).Based on the results of the Chi-Square statistical test, it shows a significant p-value = 0.147 > α = 0.05.So it can be concluded that there is no relationship between children's diet and nutritional status in toddlers in Benteng Village, Ciamis District, Ciamis Regency.
An appropriate feeding pattern is a feeding pattern that is appropriate to the type of food, amount of food and the child's eating schedule.Based on the research above, it can be assumed that the eating patterns of children under five in Benteng Village mostly have appropriate eating patterns, however there are some children under five who have poor nutritional status.This may occur because there are other factors that can influence the nutritional status of children under five, such as infectious diseases.Infectious diseases in children will disrupt metabolism which creates hormonal imbalances and interferes with immune function.So children who are exposed to recurrent and chronic infections will experience impaired nutritional status and immunity, both absolutely and relatively.
Another factor that can influence nutritional status is possibly due to inappropriate parenting patterns from parents.Parents must spend a lot of time caring for and guiding children, especially toddlers, because good parenting must be applied from an early age.
The results of this research are in line with research conducted by Stefani Oktavia Sitompu (2020) in research entitled the relationship between children's eating patterns and the nutritional status of BOPKRI Gondokusuman Kindergarten students in Yogyakarta.It was found that there was no significant relationship between children's eating patterns and the nutritional status of BOPKRI Gondokusuman Kindergarten students in Yogyakarta.(Sitompu et all., 2020).
Parents' diet is a way for parents to use available food as a reaction to the economic and socio-cultural pressures they experience.A balanced diet that is in accordance with needs accompanied by selecting the right food ingredients will produce the best nutritional status.Food intake that exceeds the body's needs will cause excess nutrients.Conversely, food intake that is less than needed will cause the body to become thin and susceptible to disease (Hasibuan & Siagian, 2020)

The relationship between infectious diseases and nutritional status in children under five in Benteng Village, Ciamis District, Ciamis Regency
Based on the results of the calculation of the frequency distribution, it shows that there are 4 toddlers who have infectious diseases and have poor nutritional status (44.4%), 5 toddlers who have infectious diseases and have good nutritional status (55.6%), toddlers who are not 3 people (12.5%) had infectious diseases and had poor nutritional status, 19 children (79.2%) did not have infectious diseases and had good nutritional status, 19 toddlers did not have infectious diseases and had more nutritional status as many as 2 people (8.3%).
Based on the results of the Chi-Square statistical test, it shows a significant p-value = 0.111 > α = 0.05.So it can be concluded that there is no relationship between infectious diseases and nutritional status in children under five in Benteng Village, Ciamis District, Ciamis Regency.
Infectious diseases seen from this study are mild and severe infectious diseases.In this study, the most common types of infectious diseases were mild infectious diseases such as coughs, colds, diarrhea and fever.Based on the research above, it can be assumed that in Benteng Subdistrict there were 5 children who had experienced infectious diseases in the last 7 days or at the time of the research, but had good nutritional status.This probably happens because when a toddler experiences an infectious disease, the child's parents provide good food and nutritional intake, so that the nutritional status of the toddler is well maintained.And there are 3 children under five who do not experience infectious diseases but have poor nutritional status, this is likely due to genetic factors inherited from their parents because the genetics obtained from fertilized eggs can determine the quantity and quality of growth of children under five.
The results of this study are different from the research conducted by Sri Nengsidan and Risma (2017) in a study entitled the relationship between infectious diseases and the nutritional status of toddlers in the work area of the Anreapi Health Center, Polewali Mandar Regency, it is known that there is a relationship between infectious diseases and the nutritional status of toddlers in the work area.Anreapi Health Center (Nengsi & Risma, 2017).
Infectious diseases can negatively affect the immune system of children under five, because infectious diseases can reduce appetite so that food consumption decreases.The nutritional needs of toddlers during illness increase, therefore when children experience infectious diseases, the nutritional needs of children must still be fulfilled (Nengsi & Risma, 2017).

CONCLUSIONS AND RECOMMENDATIONS
Based on the results of data collection, processing and analysis identifying "Factors Associated with Nutritional Status in Toddler Children in Benteng Village, Ciamis District, Ciamis Regency", researchers can provide the following conclusions: 1.The nutritional status of children under five in Benteng Village, Ciamis District, Ciamis Regency with the criteria for malnutrition is 0 people (0%), the number of nutritional status for children under five with the criteria for malnutrition is 7 people (21.2%), the number of nutritional status in There were 24 children under five with good nutrition criteria (72.7%) and the number of children under five with over-nutrition criteria was 2 people (6.1%

Table 1 . 2
Frequency Distribution of Parental Knowledge in Toddlers

Relationship between Parents' Knowledge and Nutritional Status of Toddlers in Benteng Village, Ciamis Subdistrict, Ciamis Regency Table 1.6
Frequency Distribution of the Relationship between Parents' Knowledge and Nutritional Status of Toddler

between children's diet and nutritional status of children under five in Benteng Village, Ciamis District, Ciamis Regency. Table 1.7
Frequency Distribution of the Relationship between Children's Diet and Nutritional Status in Toddlers

The relationship between infectious diseases and nutritional status in children under five in Benteng Village, Ciamis District, Ciamis Regency.
Table 1.8 Frequency Distribution of the Relationship between Infectious Diseases and Nutritional Status in

Toddlers Infection disease Nutritional Status of Toddlersl Total P Value
). 2. There is no relationship between parental knowledge and the nutritional status of children under five in Benteng Village, Ciamis District, Ciamis Regency.3.There is no relationship between children's eating patterns and the nutritional status of children under five in Benteng Village, Ciamis District, Ciamis Regency.4.There is no relationship between infectious diseases and nutritional status in children under five in Benteng Village, Ciamis District, Ciamis Regency.