Volume 1, Number 12, Desember 2021
p-ISSN 2774-7018 ; e-ISSN 2774-700X
1686 http://sosains.greenvest.co.id
DESCRIPTION OF NUTRITIONAL STATUS AND DIFFERENCES IN
STUNTING INCIDENCE IN ACUTE AND CHRONIC DISEASES IN
CHILDHOOD INpatients at RSUD KLUNGKUNG
Putu Wiliska Wilasitha, I Gede Catur Wira Natanagara dan Kadek Wini
Mardewi
Klungkung Hospital Bali, Indonesia
E-mail: w[email protected], [email protected] dan
Received:
December, 13
th
2021
Direvisi:
December, 14
th
2021
Disetujui:
December, 15
th
2021
Abstrak
Latar belakang: Stunting adalah gangguan pertumbuhan linier
yang ditunjukkan dengan nilai Z-score tinggi badan menurut usia
(TB/U) kurang dari -2 standar deviasi (SD) berdasarkan standar
World Health Organization (WHO). Stunting tetap menjadi salah
satu masalah gizi utama di dunia dan mencerminkan efek
kumulatif dari malnutrisi kronis selama 1.000 hari pertama
kehidupan. Penelitian ini bertujuan mengetahui perbedaan
kejadian stunting pada penyakit akut dan kronis pada pasien rawat
inap di RSUD Klungkung. Metode: Desain penelitian analitik
cross sectional. Pengumpulan data melalui rekam medik anak
yang di rawat di RSUD Klungkung periode 1 Januari sampai 31
Desember 2018 dengan metode total sampling yang dipilih
berdasarkan kriteria inklusi dan eksklusi yaitu anak usia 0-60
bulan. Data dianalisis univariat dan bivariat menggunakan uji chi
square. Hasil: Selama periode penelitian tercatat 404 orang anak
dirawat di RSUD Klungkung dengan 356 anak (88,1%) menderita
penyakit akut dan 48 anak (11,9%) menderita penyakit kronis.
Gambaran status gizi anak berdasarkan BB per TB/PB sebagai
berikut: status gizi kurus (<-2SD) sebanyak 45 (11,1%) dan status
gizi normal (≥ -2SD) sebanyak 359 (88,9%). Sedangkan
gambaran TB/PB per Usia: status gizi pendek (<-2SD) sebanyak
45 (11,1%) dan status gizi normal (≥-2SD) sebanyak 359 (88,9%)
anak. Hasil pengolahan data bivariat menunjukkan bahwa tidak
terdapat perbedaan bermakna terhadap kejadian stunting pada
penyakit akut dan kronis pasien rawat inap di RSUD Klungkung.
(p=0,074) OR=2,051 (95% CI 0,919 – 4,577). Kesimpulan:
Tidak terdapat perbedaan kejadian stunting pada penyakit akut
dan kronis pasien rawat inap di RSUD Klungkung.
Kata kunci: Status nutrisi, stunting, penyakit akut dan kronis
Abstract
Background: Stunting is a linear growth disorder indicated by Z-
score of height for age less than -2 standard deviation (SD) based
on World Health Organization (WHO) standards. Stunting is one
of the major nutritional problems in the world. It reflects
cumulative effects of chronic malnutrition during the first 1,000
days of life. Based on the explanation, The researchers want to
know the difference of stunting in acute and chronic diseases in
patients hospitalized at Klungkung Hospital. Methods: The
researchers used an analytic cross-sectional Study, collecting
Description Of Nutritional Status And Differences In
Stunting Incidence In Acute And Chronic Diseases In
Childhood Inpatients At Rsud Klungkung
2021
Putu Wiliska Wilasitha, I Gede Catur Wira Natanagara dan Kadek Wini
Mardewi 1687
data from medical records of children treated at Klungkung
Hospital periods 2018, from 1
st
January until 31
st
December with
total sampling method based on inclusion and exclusion Criteria.
The samples were children aged 0-60 months. Data will be
analyzed with univariate and bivariate with chi square test.
Results: From 404 children hospitalized at Klungkung hospital,
356 children (88,1%) was acute disease and 48 children (11,9%)
chronic disease. The description of nutritional status based on
Weight for Length/Height were wasted (<-2SD) as 45 (11,1%)
and normal nutritional status (≥ -2SD) as 359 (88,9%).
Length/Height for Age were stunted (<-2SD) as 45 (11,1%) and
normal status (≥-2SD) as 359 (88,9%) children. The result form
bivariate analysis reveals that was no differences in the incidence
of stunting in acute and chronic inpatient at Klungkung Hospital.
(p=0,074) OR=2,051 (95% CI 0,919 – 4,577. Conclusion: There
is no differences of incident stunting in acute and chronic disease
in pediatric inpatients in Klungkung Hospital.
Keywords: Nutritional status, stunting, acute and chronic
diseases
Introduction
Stunting is a linear growth disorder indicated by the Z-score of height for age (TB/U)
less than -2 standard deviations (SD) based on World Health Organization standards
(WHO) (Amin & Julia, 2016). Stunting remains one of the main nutritional problems in
the world. This reflects the cumulative effect of chronic malnutrition during the first 1,000
days of life, which is related to lack of education, poverty, morbidity (Helmyati, Atmaka,
Wisnusanti, & Wigati, 2020). This will result in being more vulnerable to non-
communicable diseases in the future which indicates a poor quality of life and has a
negative impact on the human resources of a nation, thereby reducing productivity capacity
in the future.
Stunting is currently in the world's Spotlight. This is due to the high number of
stunting in a country (Marbun, Pakpahan, & Tarigan, 2019). Zero Hunger in the Sustainable
Development Goals (SDGs) for 2030 and the Global Nutrition Target for 2025 states that
the incidence of stunting in the world is currently around 150.8 million or 22.2% so that
many programs are carried out to reduce the stunting rate in the world. In 2018, Indonesia
was ranked 5th in the world with a stunting prevalence of 30.2% or around 9 million
children were stunted, which means that approximately one out of every 3 Indonesian
children was stunted and Bali was ranked 6th with a stunting percentage of 32.6% (Fitri,
2018).
Various factors can influence the occurrence of stunting at the beginning of the
growth period, such as inadequate nutrition, IUGR, not receiving exclusive breastfeeding,
reduced appetite due to infection, insufficient consumption and not guaranteeing optimal
physical growth due to other diseases such as acute infections or illnesses chronic
(Susilowati, 2018). Several diseases that often cause stunting such as acute enteric
infections, diarrhea, worms, respiratory infections, decreased appetite due to attacks of
infection and other inflammation (Andini, 2021). Chronic diseases that can occur such as
heart, liver, kidney, thalassemia or other chronic diseases.
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p-ISSN 2774-7018 ; e-ISSN 2774-700X
1688 http://sosains.greenvest.co.id
The purpose of this study was to determine the difference in the incidence of stunting
in acute and chronic diseases in patients hospitalized at Klungkung Hospital.
Research methods
The research design used was analytic with a cross sectional design. Data was
collected by looking at the medical records of children treated at the Klungkung Hospital
with the total sampling method selected based on inclusion and exclusion criteria. The
inclusion criteria for selecting the sample were children aged 0-60 months who had TB/U
below -2 SD. Excluded patients were those who had congenital abnormalities and physical
disabilities.
Variables that were recorded were weight and length/height, diagnosis or history of
disease while the Patient were being treated. Weight and length/height will be converted
into BB/TB to assess the nutritional status of children. The diagnosis will be divided into
acute and chronic diseases. It is said to be acute disease if the diagnosis or incidence of
disease occurs in less than 2 weeks and chronic disease if the diagnosis or occurrence of
disease occurs more than or equal to 2 weeks.
Research instruments include patient medical records, standard table Z-score WHO.
Data processing using SPSS 26.0 software with all data analyzed univariate and bivariate.
Bivariate analysis using the chi square test to assess differences in the incidence of stunting
in acute and chronic diseases inpatients at the Klungkung Hospital.
Results and Discussion
During the study period, 404 children were treated at the Klungkung Hospital with
the following characteristics.
Table 1. Characteristics of pediatric patients aged 0-60 months undergoing inpatient care
at the Klungkung Hospital in 2018
Characteristics
n (404)
Percent (%)
Gender
Man
227
56,2
Woman
177
43,8
Age (months)
0 – 11
134
33,2
12 – 23
105
36
24 – 35
64
15,8
36 – 47
47
11,6
48 – 60
54
13,4
Disease
Akut
356
88,1
Chronic
48
11,9
Weight per Age (W/W)
Poor (<3 SD)
17
4,2
Less (-3 SD to -2 SD)
27
6,7
Good (-2 SD to 2 SD)
349
86,4
More (>2 SD)
11
2,7
Description Of Nutritional Status And Differences In
Stunting Incidence In Acute And Chronic Diseases In
Childhood Inpatients At Rsud Klungkung
2021
Putu Wiliska Wilasitha, I Gede Catur Wira Natanagara dan Kadek Wini
Mardewi 1689
Body Length/Height per Age (PB/U or TB/U)
Short (<-2SD)
45
11,1
Normal (>-2SD)
359
88,9
Weight per Height/Length (BW/TB or BW/PB)
Thin (<-2SD)
45
11,1
Normal (>-2 SD)
359
88,9
Based on the data obtained, More boys, than girls, were treated at the Klungkung
Hospital with a percentage of 56.2% with the incidence being dominated by acute illness,
almost 88.1% and the most age at 12-23 months with 36%. In BB/U the highest percentage
is in good nutrition (-2 SD to 2 SD) as much as 86.4%. Children with normal height (≥-
2SD) in PB/U or TB/U with the percentage of 88.9%, while the percentage of short children
(<-2SD) is 11.1%. Characteristics of children with BB/TB found thin children (<-2SD)
11.1% and normal children (≥-2SD) 88.9%.
Table 2. Incidence of Stunting in Children Diagnosed with Acute and Chronic Diseases
Disease
Stunting
Total
P value
OR (95% CI)
Yes
No
Akut
36
320
356
0,074
2,051
0,919 – 4,577
Chronic
9
39
48
In the bivariate analysis of stunting in children diagnosed with acute and chronic
diseases analyzed by the chi square test, significant results were obtained where p = 0.074
(p > 0.05) with OR = 2.051 (0.919 – 4.577). It is stated that there is no difference in the
incidence of stunting in acute and chronic diseases inpatients at the Klungkung Hospital.
Stunting is caused by a combination of factors including maternal and intrauterine
malnutrition, inadequate quality or quantity of complementary foods in childhood, and low
absorption of nutrients caused by a high prevalence of infection or disease.10 From this
study, data on the incidence of stunting in children were obtained. boys are taller than girls.
This is in accordance with data by Riskesdas in 2010 that girls have a lower incidence of
stunting than boys. This is also in line with research conducted in West Java, East Nusa
Tenggara and Bali regarding the risk factors for stunting in children aged 0-60 months
which showed that boys were more likely to experience stunting than girls.
The results of statistical tests in this study showed that there was no significant
difference in the incidence of stunting in children diagnosed with acute and chronic
diseases, p = 0.074 (p > 0.05) and OR = 2.051 (0.919 – 4.577). These results are in
accordance with research from Richard et al12 that in the group of children who are
younger and still consuming breast milk, body weight is not significantly affected by the
incidence of acute or chronic disease. This is due to the protective function of breast
milk.12 Even though children have a decreased appetite when sick, The researchers still
consume normal amounts of breast milk. Pascale et al13 conducted a cross sectional study
involving 414 children aged five years and under living in Bangui to determine the risk
factors associated with stunting. The children were recruited from December 2011 to
November 2013. After correcting for age, no statistically significant relationship was found
between the incidence of infectious disease and stunting.
Several studies have shown conflicting results, children who suffer from acute
illness, i.e. illness for more than three days and less than two weeks, are twice as likely to
suffer from stunting.
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p-ISSN 2774-7018 ; e-ISSN 2774-700X
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The interaction between acute and chronic infection and the incidence of
malnutrition is a complex matter. Malnourished children have a higher risk of developing
diarrhea (Kartiningrum, 2015). In a meta-analysis of several cohorts of newborns up to 24
months of age, it was shown that there was a 16% increase in the incidence of stunting for
every 5% increase in the incidence of diarrhea (Dalimunthe, 2015). It should be noted that
the nutritional status of a child is influenced not only by food, but also by the frequency of
infection. Evidence for an association between nutrition and the occurrence of this infection
has been demonstrated in the past and was qualitative, with malnourished children having
higher mortality rates (Renyoet, 2013). Studying the epidemiological relationship between
infection and the development of malnutrition in Guatemala, where children with a high
prevalence of diarrhea had less growth in weight and height over a six-month period,
compared with similar children with a lower prevalence of diarrhea (WAHID, 2020).
In addition to a study by Prendergast, children with chronic disease disorders such
as immunological disorders have a high enough risk of stunting. Studies conducted on
infants in Zimbabwe who were stunted at 18 months of age were found to have higher
plasma concentrations of proinflammatory markers (C-reactive protein, CRP, and /1-acid
glycoprotein, AGP) and lower plasma levels of IGF-1 than normal baby. A better
understanding of the immunopathogenesis of malnutrition is also known from the C57BL/6
mouse model fed a low-fat, low-protein diet experiencing mild stunting and wasting.
Another chronic disease that can lead to stunting is Thalassemia (Adistie, Lumbantobing,
& Maryam, 2018). -thalassemia major as one of the main forms of -thalassemia is the most
severe form of blood disorder. Those who were not treated or transfused showed a variety
of clinical manifestations including stunted growth or stunting, pallor, jaundice and bone
changes. Other chronic diseases that can lead to stunting are heart, liver, and kidney disease
(ALPIN, 2020).
Toddlers have a very fast and rapid growth phase (Murni, 2017). In the process of
growth and development, it is necessary to have adequate nutrition. In developing
countries, the possibility of infection with a disease is still quite high so that disturbances
between nutrient absorption and infection can occur simultaneously. Infection can worsen
children's nutrient uptake (RAHAYU, 2020).
In children with a disease duration of less than one to three months, there is an
improvement in body weight and growth can follow according to children their age.
However, this does not happen if children have lower food intake (Including breast milk
intake), access to health services is more difficult, and socio-economic level is low which
can trigger a higher incidence of diarrhea (Sitti Patimah, 2021). This is supported by the
results of research from de Onis, et al which states that the incidence of stunting in Brazil
has improved from 34% in 1986 to 6% in 2006 along with an increase in income and access
to schools, clean water, sanitation, and health services. This shows that stunting is
associated with both acute and chronic inflammatory diseases. Likewise, the etiology of
acute and chronic diseases experienced by malnourished children will result in different
clinical or with the same bacterial infection but have developed antibiotic resistance.
Other literatures reveal different things where age, gender, and overweight are the
most significant risk factors associated with stunting in children compared to the incidence
of acute and chronic diseases. In a meta-analysis of 18 studies conducted in Sub-Saharan
Africa, the main factors associated with stunting were gender (boys are shorter than girls),
socioeconomic factors and maternal education. Another meta-analysis of 16 demographic
and health surveys from Sub-Saharan Africa showed that boys from socioeconomically
weaker families were at greater risk of stunting or stunted growth than girls.
Description Of Nutritional Status And Differences In
Stunting Incidence In Acute And Chronic Diseases In
Childhood Inpatients At Rsud Klungkung
2021
Putu Wiliska Wilasitha, I Gede Catur Wira Natanagara dan Kadek Wini
Mardewi 1691
Conclusion
The conclusion of this study is that there is no difference in the incidence of stunting
in acute and chronic diseases inpatients at Klungkung Hospital.
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