Penatalaksanaan Efektif dalam Rangka Peningkatan Pertumbuhan Anak pada Kasus Stunting

Riskiana Putri; Rosmita Nuzuliana

doi:10.22146/jkesvo.54930

Penatalaksanaan Efektif dalam Rangka Peningkatan Pertumbuhan Anak pada Kasus Stunting

https://doi.org/10.22146/jkesvo.54930

Riskiana Putri^(1*), Rosmita Nuzuliana⁽²⁾

(1) Program Studi Magister Kebidanan, Fakultas Ilmu Kesehatan, Universitas ‘Aisyiyah Yogyakarta
(2) Fakultas Ilmu Kesehatan, Universitas ‘Aisyiyah Yogyakarta
(*) Corresponding Author

Abstract

Latar belakang: Stunting merupakan kekurangan gizi kronis yang terjadi selama periode emas pertumbuhan dan perkembangan pada awal kehidupan anak. Stunting dapat menyebabkan dampak jangka panjang pada fisik, imunologi, neurokognitif, dan sosial-ekonomi. Penatalaksanaan untuk meningkatkan pertumbuhan anak perlu dilakukan guna membantu agar memiliki pertumbuhan normal.

Tujuan: Sistematik review ini bertujuan untuk mengetahui penatalaksanaan yang efektif untuk meningkatkan pertumbuhan anak stunting di Indonesia.

Metode: Artikel didapatkan dari pencarian pada dua database, yaitu pubmed dan science direct, disertai dengan artikel dari reference list. Kata kunci utama yang digunakan adalah “management” dan “stunting”. Pemilihan artikel berdasarkan pada panduan PRISMA.

Hasil: Total artikel yang didapatkan adalah 897 artikel, 13 artikel terpilih untuk direview. Terdapat 2 poin penatalaksanaan yaitu 1) pemberian pendidikan kesehatan, nutrisi, dan parenting kepada ibu, 2) pemberian multiple mikronutrien menggunakan berbagai media dan bentuk. Pemberian pendidikan kepada ibu efektif merubah pola asuh ibu dan asupan makan anak, pemberian mikronutrien untuk peningkatan TB dan BB kepada anak lebih efektif jika ditambahkan dengan susu.

Kesimpulan: Penatalaksanaan yang efektif untuk meningkatkan pertumbuhan anak stunting adalah dengan memberikan pendidikan mengenai kesehatan, nutrisi dan parenting kepada ibu/pengasuh anak secara bertahap. Setelah ibu/pengasuh memiliki kemampuan dan pengetahuan mengenai kesehatan dan nutrisi adalah memberikan intervensi asupan mikronutrien.

Keywords

stunting; paket pendidikan; mikronutrien; pertumbuhan linear

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References

Abeway, S., Gebremichael, B., Murugan, R., Assefa, M., & Adinew, Y. M. (2018). Stunting and Its Determinants among Children Aged 6–59 Months in Northern Ethiopia: A Cross-Sectional Study. Journal of Nutrition and Metabolism, 2018, 1–8. https://doi.org/10.1155/2018/1078480

Allen, L. H., Peerson, J. M., & Olney, D. K. (2009). Provision of Multiple Rather Than Two or Fewer Micronutrients More Effectively Improves Growth and Other Outcomes in Micronutrient-Deficient Children and Adults. The Journal of Nutrition, 139(5), 1022–1030. https://doi.org/10.3945/jn.107.086199

Cervo, M. M. C., Mendoza, D. S., Barrios, E. B., & Panlasigui, L. N. (2017). Effects of Nutrient-Fortified Milk-Based Formula on the Nutritional Status and Psychomotor Skills of Preschool Children. Journal of Nutrition and Metabolism, 2017, 1–16. https://doi.org/10.1155/2017/6456738

Cheng, W. D., Wold, K. J., Benzoni, N. S., Thakwalakwa, C., Maleta, K. M., Manary, M. J., & Trehan, I. (2017). Lactoferrin and lysozyme to reduce environmental enteric dysfunction and stunting in Malawian children: study protocol for a randomized controlled trial. Trials, 18(1), 523. https://doi.org/10.1186/s13063-017-2278-8

Christian, P., Shaikh, S., Shamim, A. A., Mehra, S., Wu, L., Mitra, M., Ali, H., Merrill, R. D., Choudhury, N., Parveen, M., Fuli, R. D., Hossain, M. I., Islam, M. M., Klemm, R., Schulze, K., Labrique, A., de Pee, S., Ahmed, T., & West, K. P. (2015). Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial. International Journal of Epidemiology, 44(6), 1862–1876. https://doi.org/10.1093/ije/dyv155

Dewey, K. G., & Begum, K. (2011). Long-term consequences of stunting in early life. Maternal & Child Nutrition, 7, 5–18. https://doi.org/10.1111/j.1740-8709.2011.00349.x

Dewey, K. G., Mridha, M. K., Matias, S. L., Arnold, C. D., Cummins, J. R., Khan, M. S. A., Maalouf-Manasseh, Z., Siddiqui, Z., Ullah, M. B., & Vosti, S. A. (2017). Lipid-based nutrient supplementation in the first 1000 d improves child growth in Bangladesh: a cluster-randomized effectiveness trial. The American Journal of Clinical Nutrition, 105(4), 944–957. https://doi.org/10.3945/ajcn.116.147942

Dinas Kesehatan Provinsi Daerah Istimewa Yogyakarta. (2018). Profil Kesehatan D.I. Yogyakarta Tahun 2018.

Gera, T., Pena-Rosas, J. P., Boy-Mena, E., & Sachdev, H. S. (2017). Lipid based nutrient supplements (LNS) for treatment of children (6 months to 59 months) with moderate acute malnutrition (MAM): A systematic review. PLOS ONE, 12(9), e0182096. https://doi.org/10.1371/journal.pone.0182096

Hess, S. Y., Abbeddou, S., Jimenez, E. Y., Somé, J. W., Vosti, S. A., Ouédraogo, Z. P., Guissou, R. M., Ouédraogo, J.-B., & Brown, K. H. (2015). Small-Quantity Lipid-Based Nutrient Supplements, Regardless of Their Zinc Content, Increase Growth and Reduce the Prevalence of Stunting and Wasting in Young Burkinabe Children: A Cluster-Randomized Trial. PLOS ONE, 10(3), e0122242. https://doi.org/10.1371/journal.pone.0122242

Imelda, I., Rahman, N., & Nur, R. (2018). Risk Factors On Stunting Among Children Age 2-5 Years Old In Biromaru Of Center Public Health. Ghidza: Jurnal Gizi Dan Kesehatan, 2(1), 39. https://doi.org/10.22487/ghidza.v2i1.10369

Joanna Briggs Institute. (2017). Critical Appraisal Checklist for Randomized Controlled Trials. The Joanna Briggs Institute. www.joannabriggs.org

Kementerian Desa Pembangunan Daerah Tertinggal dan Transmigrasi. (2017). Buku Saku Desa dalam Penanganan Stunting. Kementerian Desa Pembangunan Daerah Tertinggal dan Transmigrasi.

Kulwa, K. B., Verstraeten, R., Bouckaert, K. P., Mamiro, P. S., Kolsteren, P. W., & Lachat, C. (2014). Effectiveness of a nutrition education package in improving feeding practices, dietary adequacy and growth of infants and young children in rural Tanzania: rationale, design and methods of a cluster randomised trial. BMC Public Health, 14(1), 1077. https://doi.org/10.1186/1471-2458-14-1077

Kuriyan, R., Thankachan, P., Selvam, S., Pauline, M., Srinivasan, K., Kamath-Jha, S., Vinoy, S., Misra, S., Finnegan, Y., & Kurpad, A. V. (2016). The effects of regular consumption of a multiple micronutrient fortified milk beverage on the micronutrient status of school children and on their mental and physical performance. Clinical Nutrition, 35(1), 190–198. https://doi.org/10.1016/j.clnu.2015.02.001

Lebenthal, Y., Yackobovitch-Gavan, M., Lazar, L., Shalitin, S., Tenenbaum, A., Shamir, R., & Phillip, M. (2014). Effect of a Nutritional Supplement on Growth in Short and Lean Prepubertal Children: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study. The Journal of Pediatrics, 165(6), 1190-1193.e1. https://doi.org/10.1016/j.jpeds.2014.08.011

Lien, D. T. K., Nhung, B. T., Khan, N. C., Hop, L. T., Nga, N. T. Q., Hung, N. T., Kiers, J., Shigeru, Y., & te Biesebeke, R. (2009). Impact of milk consumption on performance and health of primary school children in rural Vietnam. Asia Pacific Journal of Clinical Nutrition, 18(3), 326–334. http://www.ncbi.nlm.nih.gov/pubmed/19786380

Mangani, C., Maleta, K., Phuka, J., Cheung, Y. B., Thakwalakwa, C., Dewey, K., Manary, M., Puumalainen, T., & Ashorn, P. (2015). Effect of complementary feeding with lipid-based nutrient supplements and corn-soy blend on the incidence of stunting and linear growth among 6- to 18-month-old infants and children in rural Malawi. Maternal & Child Nutrition, 11, 132–143. https://doi.org/10.1111/mcn.12068

Manggala, A. K., Kenwa, K. W. M., Kenwa, M. M. L., Sakti, A. A. G. D. P. J., & Sawitri, A. A. S. (2018). Risk factors of stunting in children aged 24-59 months. Paediatrica Indonesiana, 58(5), 205–212. https://doi.org/10.14238/pi58.5.2018.205-12

Martinez, B., Webb, M. F., Gonzalez, A., Douglas, K., Grazioso, M. del P., & Rohloff, P. (2018). Complementary feeding intervention on stunted Guatemalan children: a randomised controlled trial. BMJ Paediatrics Open, 2(1), e000213. https://doi.org/10.1136/bmjpo-2017-000213

Mistry, S. K., Hossain, M. B., & Arora, A. (2019). Maternal nutrition counselling is associated with reduced stunting prevalence and improved feeding practices in early childhood: a post-program comparison study. Nutrition Journal, 18(1), 47. https://doi.org/10.1186/s12937-019-0473-z

Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097

Muthayya, S., Eilander, A., Transler, C., Thomas, T., van der Knaap, H. C., Srinivasan, K., van Klinken, B. J. W., Osendarp, S. J., & Kurpad, A. V. (2009). Effect of fortification with multiple micronutrients and n–3 fatty acids on growth and cognitive performance in Indian schoolchildren: the CHAMPION (Children’s Health and Mental Performance Influenced by Optimal Nutrition) Study. The American Journal of Clinical Nutrition, 89(6), 1766–1775. https://doi.org/10.3945/ajcn.2008.26993

Nair, N., Tripathy, P., Sachdev, H. S., Pradhan, H., Bhattacharyya, S., Gope, R., Gagrai, S., Rath, S., Rath, S., Sinha, R., Roy, S. S., Shewale, S., Singh, V., Srivastava, A., Costello, A., Copas, A., Skordis-Worrall, J., Haghparast-Bidgoli, H., Saville, N., & Prost, A. (2017). Effect of participatory women’s groups and counselling through home visits on children’s linear growth in rural eastern India (CARING trial): a cluster-randomised controlled trial. The Lancet Global Health, 5(10), e1004–e1016. https://doi.org/10.1016/S2214-109X(17)30339-X

Nikièma, L., Huybregts, L., Martin-Prevel, Y., Donnen, P., Lanou, H., Grosemans, J., Offoh, P., Dramaix-Wilmet, M., Sondo, B., Roberfroid, D., & Kolsteren, P. (2017). Effectiveness of facility-based personalized maternal nutrition counseling in improving child growth and morbidity up to 18 months: A cluster-randomized controlled trial in rural Burkina Faso. PLOS ONE, 12(5), e0177839. https://doi.org/10.1371/journal.pone.0177839

Nshimyiryo, A., Hedt-Gauthier, B., Mutaganzwa, C., Kirk, C. M., Beck, K., Ndayisaba, A., Mubiligi, J., Kateera, F., & El-Khatib, Z. (2019). Risk factors for stunting among children under five years: a cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey. BMC Public Health, 19(1), 175. https://doi.org/10.1186/s12889-019-6504-z

Penny, M. E. (2012). Micronutrients in the Treatment of Stunting and Moderate Malnutrition (pp. 11–21). https://doi.org/10.1159/000337388

Phuka, J. C., Maleta, K., Thakwalakwa, C., Cheung, Y. B., Briend, A., Manary, M. J., & Ashorn, P. (2009). Postintervention growth of Malawian children who received 12-mo dietary complementation with a lipid-based nutrient supplement or maize-soy flour. The American Journal of Clinical Nutrition, 89(1), 382–390. https://doi.org/10.3945/ajcn.2008.26483

Ramakrishnan, U., Neufeld, L. M., Flores, R., Rivera, J., & Martorell, R. (2009). Multiple micronutrient supplementation during early childhood increases child size at 2 y of age only among high compliers. The American Journal of Clinical Nutrition, 89(4), 1125–1131. https://doi.org/10.3945/ajcn.2008.26874

Ramakrishnan, U., Nguyen, P., & Martorell, R. (2009). Effects of micronutrients on growth of children under 5 y of age: meta-analyses of single and multiple nutrient interventions. The American Journal of Clinical Nutrition, 89(1), 191–203. https://doi.org/10.3945/ajcn.2008.26862

Reifsnider, E., Shin, C.-N., Todd, M., Jeong, M., Gallagher, M., & Moramarco, M. (2016). How Did They Grow: An Intervention to Reduce Stunted Growth in Low-Income Mexican-American Children. Research in Nursing & Health, 39(2), 105–120. https://doi.org/10.1002/nur.21714

Rismiati, R., Dasuki, M. S., & Candrasari, A. (2016). Hubungan Asupan Mikronutrien Dan Status Gizi Anak Usia 2-5 Tahun Di Wilayah Posyandu Gonilan. Universitas Muhammadiyah Surakarta.

Roche, M. L., Marquis, G. S., Gyorkos, T. W., Blouin, B., Sarsoza, J., & Kuhnlein, H. V. (2017). A Community-Based Positive Deviance/Hearth Infant and Young Child Nutrition Intervention in Ecuador Improved Diet and Reduced Underweight. Journal of Nutrition Education and Behavior, 49(3), 196-203.e1. https://doi.org/10.1016/j.jneb.2016.10.007

Rockers, P. C., Fink, G., Zanolini, A., Banda, B., Biemba, G., Sullivan, C., Mutembo, S., Silavwe, V., & Hamer, D. H. (2016). Impact of a community-based package of interventions on child development in Zambia: a cluster-randomised controlled trial. BMJ Global Health, 1(3), e000104. https://doi.org/10.1136/bmjgh-2016-000104

Rockers, P. C., Zanolini, A., Banda, B., Chipili, M. M., Hughes, R. C., Hamer, D. H., & Fink, G. (2018). Two-year impact of community-based health screening and parenting groups on child development in Zambia: Follow-up to a cluster-randomized controlled trial. PLOS Medicine, 15(4), e1002555. https://doi.org/10.1371/journal.pmed.1002555

Samuel, A., Brouwer, I., Feskens, E., Adish, A., Kebede, A., De-Regil, L., & Osendarp, S. (2018). Effectiveness of a Program Intervention with Reduced-Iron Multiple Micronutrient Powders on Iron Status, Morbidity and Growth in Young Children in Ethiopia. Nutrients, 10(10), 1508. https://doi.org/10.3390/nu10101508

Sazawal, S., Dhingra, U., Dhingra, P., Hiremath, G., Sarkar, A., Dutta, A., Menon, V. P., & Black, R. E. (2010). Micronutrient Fortified Milk Improves Iron Status, Anemia and Growth among Children 1–4 Years: A Double Masked, Randomized, Controlled Trial. PLoS ONE, 5(8), e12167. https://doi.org/10.1371/journal.pone.0012167

Shi, L., Zhang, J., Wang, Y., Caulfield, L. E., & Guyer, B. (2010). Effectiveness of an educational intervention on complementary feeding practices and growth in rural China: a cluster randomised controlled trial. Public Health Nutrition, 13(4), 556–565. https://doi.org/10.1017/S1368980009991364

Singh, V., Ahmed, S., Dreyfuss, M. L., Kiran, U., Chaudhery, D. N., Srivastava, V. K., Ahuja, R. C., Baqui, A. H., Darmstadt, G. L., Santosham, M., & West, K. P. (2017). An integrated nutrition and health program package on IYCN improves breastfeeding but not complementary feeding and nutritional status in rural northern India: A quasi-experimental randomized longitudinal study. PLOS ONE, 12(9), e0185030. https://doi.org/10.1371/journal.pone.0185030

TNP2K. (2017). 100 Kabupaten/Kota Prioritas Untuk Intervensi Anak Kerdil (Stunting). Tim Nasional Percepatan Penanggulangan Kemiskinan.

UNICEF, WHO, & The World Bank. (2019). Levels and trends in child malnutrition: key findings of the 2019 Edition of the Joint Child Malnutrition Estimates. World Health Organization.

Vazir, S., Engle, P., Balakrishna, N., Griffiths, P. L., Johnson, S. L., Creed-Kanashiro, H., Fernandez Rao, S., Shroff, M. R., & Bentley, M. E. (2013). Cluster-randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake, growth and development among rural Indian toddlers. Maternal & Child Nutrition, 9(1), 99–117. https://doi.org/10.1111/j.1740-8709.2012.00413.x

Wang, A. Z., Shulman, R. J., Crocker, A. H., Thakwalakwa, C., Maleta, K. M., Devaraj, S., Manary, M. J., & Trehan, I. (2017). A Combined Intervention of Zinc, Multiple Micronutrients, and Albendazole Does Not Ameliorate Environmental Enteric Dysfunction or Stunting in Rural Malawian Children in a Double-Blind Randomized Controlled Trial. The Journal of Nutrition, 147(1), 97–103. https://doi.org/10.3945/jn.116.237735

Yabancı, N., Kısaç, İ., & Karakuş, S. Ş. (2014). The Effects of Mother’s Nutritional Knowledge on Attitudes and Behaviors of Children about Nutrition. Procedia - Social and Behavioral Sciences, 116, 4477–4481. https://doi.org/10.1016/j.sbspro.2014.01.970

Yackobovitch-Gavan, M., Lebenthal, Y., Lazar, L., Shalitin, S., Demol, S., Tenenbaum, A., Shamir, R., & Phillip, M. (2016). Effect of Nutritional Supplementation on Growth in Short and Lean Prepubertal Children after 1 Year of Intervention. The Journal of Pediatrics, 179, 154-159.e1. https://doi.org/10.1016/j.jpeds.2016.08.100

Yousafzai, A. K., Obradović, J., Rasheed, M. A., Rizvi, A., Portilla, X. A., Tirado-Strayer, N., Siyal, S., & Memon, U. (2016). Effects of responsive stimulation and nutrition interventions on children’s development and growth at age 4 years in a disadvantaged population in Pakistan: a longitudinal follow-up of a cluster-randomised factorial effectiveness trial. The Lancet Global Health, 4(8), e548–e558. https://doi.org/10.1016/S2214-109X(16)30100-0

Yousafzai, A. K., Rasheed, M. A., Rizvi, A., Armstrong, R., & Bhutta, Z. A. (2014). Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trial. The Lancet, 384(9950), 1282–1293. https://doi.org/10.1016/S0140-6736(14)60455-4

Zhang, Y., Wu, Q., Wang, W., van Velthoven, M. H., Chang, S., Han, H., Xing, M., Chen, L., & Scherpbier, R. W. (2016). Effectiveness of complementary food supplements and dietary counselling on anaemia and stunting in children aged 6–23 months in poor areas of Qinghai Province, China: a controlled interventional study. BMJ Open, 6(10), e011234. https://doi.org/10.1136/bmjopen-2016-011234

DOI: https://doi.org/10.22146/jkesvo.54930