Influencing Factors in Nutrition Status of 6-12 Years Old Children
Siva Hamdani
Bogor Husada Academy of Midwifery
Jl. Sholeh Iskandar No.4, Bogor
aikoniswa@yahoo.com
Abstract – The nutrition status of school-age children is still poor while the need
for balanced nutrition is very important for school children and this is because the
public's attention to the nutritional needs only focuses in infants, toddlers, and
pregnant women. According to data of Health Research (Riskesdas) in 2010, the
prevalence stunting in the age group of 6-12 years was 25.6%, underweight
prevalence was 11.2% and overweight prevalence was accounted to 9.2%. This
study aimed to determine the nutritional status of children by conducting crosssectional descriptive study with the analysis of invariance and bivariate (Chi
square). The study was conducted at SDN 05 of grade 1-6 Sirnagalih Bogor with
totaling 263 students aged 6-12 years old in November 2014 and assessed the
nutritional status of students based on the z-score of the WHO / NCHS and
reviewing the primary data (weight and height measurement) and secondary data
(data or documents and the identity taken from the student attendance). Nutritional
status average of children in SDN 05 Sirnagalih was in normal nutritional status at
approximately 68.2%. However, it still reflected some nutritional problems (very
underweight, underweight and overweight,) accounted for 31.8%. In underage
group category, there was the nutritional status of malnourishment of 9-12 years
age group with the highest number scored 37.5%. By gender, the malnourishment
of boys acquired at most 34.9%. Based on parent education, malnourishment was
found in students with less educated fathers; it was about 41.6%. Nutritional status
of children based on the number of siblings in the family showed the nutritional
status of malnourishment, showing by the number of brothers and sisters greater
than two sisters and brothers that amounted to 57.9%.
Key Words – Influence; Nutrition; status; Measurement; Prevalence.
1
Introduction
Nutrition is essential in human life because every cell in the body needs nutrients for survival.
Problems on good nutrition in infants to the elderly can cause various health problems that increase in
illness, disability and even death. Thus, either directly or indirectly on nutrition problems can degrade
the quality of human resources (HR) of a nation. In a broader scale, malnourishment can be a threat to
the endurance and survival of a nation.
According to Arisman (2009), nutritional problems that arise in most children are the result of the
imbalance impact between the intake and output of nutrients (nutritional imbalance), the intake
exceeds output, or vice versa. In addition, nutritional problems can arise due to a mistake in choosing
foods to eat. Unbalanced nutritional intake in children, however, will lead to the child stunting,
underweight, and overweight.
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Hamdani
Nutrition problem is a global problem faced by nutritionists in the world. According to Nutritionist
Association Indonesia, in 2005 the prevalence of overweight and obesity has increased very sharply in
the Asia-Pacific region. In Thailand, 16% of the population was overweight and 4% are obese. A
research that was conducted in Malaysia recently has showed that the prevalence of obesity was at
6.6% for the age group of 7 years and to 13.8% in the age group of 10 years. Unexpectedly, more than
one third (36.1%) of school-age children in Indonesia are underweight when entering school age and it
is an indicator of chronic malnutrition.
According to data taken from Indonesian National Economic Social Survey (SUSENAS), until the
year of 2005, the prevalence of poor and less nutrition on children has fallen from around 35.57% in
1992 to almost 24.66% in 2000. Nevertheless, there was an increasing trend of returning prevalence in
subsequent years. In 2005, the number of undernourished increased again to 28% (excluding Aceh).
As a result, it showed that there was a tendency of the number of infant’s malnourishment to increase.
Figures of malnutrition in Indonesia reached 14% but in recent years the decline was slowly that could
be an obstacle of the Millennium Development Goals (MDG's) in 2015 where the target is around
15%. In 1989 the figure was actually not more than 31% and in 2007 was 18.4%. The government
should decrease the malnutrition prevelence in 2015 to almost a half of number in 1990 (Butler, 2013).
Moreover, malnutrition case in Bogor has increased. Commencing in 2010, there were 297 children
were affected by malnutrition, and in 2011 increased to 555 children. For 2012 as of January to July
has recorded 22 malnutrition children (Diani, 2012).
Childhood (6-12 years) is the age range that needs more attention to nutritional needs. When compared
with infants and toddlers, school-age children (age range 6-12 years) received less attention both from
the parents and the environment, because the attention is focused on the nutritional needs of infants
and toddlers. When babies and toddlers can conduct routine monitoring of nutritional status in
Integrated Services Post (POSYANDU). While the government concerns a baby weight, the school
children rarely do monitoring of nutritional status. Therefore, school-age children need good nutrition
because it can affect the health, fitness, and the motivation in learning itself at school as well as school
snacks that tend not healthy to be the daily intake. According to data of Health Research
(RISKESDAS) in 2010, the prevalence stunting in the age group of 6-12 years was 25.6%, 11.2%
reflected underweight and overweight was accounted for about 9.2%. For this reason, the study on the
nutritional status of school-age children is as important as the nutritional status of infants and toddlers.
This study relates with the questions of the nutritional status of children based on age, gender, parental
education, and father’s occupation, number of children in the family, economic status. Next, this
research focuses on relationships between the parental education and nutritional status of children and
father's education with an overview of the nutritional status of children.
2
Literature Review
Nutrient is the study about food and its relationship to health. The science of nutrition (nutrients)
discusses the properties of nutrients (nutrients) contained in food, metabolic influence and the
consequences that arise when there is a lack (insufficiency) in nutrients (Paath, 2004). Almatsier states
that Chemical bonds the body to perform its functions, which produce energy, builds and maintains
the network and to manage the processes of life (2009). Supariasa (2001) then believes that a process
of organisms uses food consumed, normally through the process of digestion, absorption, transport,
storage, metabolism, and expenditure substances that are not used to sustain life, growth and normal
functioning of organs, as well as generate energy.
Nutrition is a very important requirement needs to help the process of growth and development in
infants and children. A nutrient is an essential element in nutrition, since these nutrients may provide a
separate function on nutrition. The nutritional requirements will not function optimally if it does not
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contain some nutrients in accordance with the needs of the body, as well as adequate nutrition on
nutritional needs will provide optimal value. There are several components of nutrients needed in
nutrition of infants and children whose numbers are very different for each age. In general, nutrients
are divided into two classes, namely macro and micro group. Macronutrient contains calories (derived
from carbohydrates, fats and proteins) and H2O (water), whereas the group of micronutrients
composes of vitamins and minerals (Hidayat, 2008).
Consumption of food could affect the nutritional status of a person. Nutritional status is good or
optimal when the body is getting enough nutrients and used efficiently, allowing the physical growth,
brain development, employability and general health at the highest possible level. Malnutrition status
occurs when the body experiences a deficiency of one or more essential nutrients. Nutritional status
occurs when the body gets the nutrients in excessive amounts, causing toxic or harmful effects. The
primary factor will occur if someone has wrong arrangement of food in quantity and quality caused by
the lack of food supply, lack of good distribution of food, poverty, ignorance, wrong eating habits and
so on. Secondly, the factor includes all the factors that cause the nutrients do not reach the cells of the
body after the food is consumed. For example, the factors that lead to the disruption of digestion, such
as teeth are not good, structural abnormalities of the gastrointestinal tract and enzyme deficiency.
Factors that interfere with the absorption of nutrients are the presence of parasites, the use of laxative
and so on. Meanwhile, factors that affect the metabolism and utilization of nutrients are heart disease,
diabetes mellitus, cancer, the use of certain drugs, alcoholic beverages, and others. In addition, factors
that influence the excretion causing much loss of nutrients is a lot of urine (polyuria), a lot of sweat
and use of drugs (Almatsier, 2009).
According Supariasa (2001), in determining the classification of nutritional status, there should be a
standard measure; it is commonly called a reference. Recently, the standard of anthropometric used in
Indonesia is WHO-NCHS Antro, showed by Directorate of Indonesia Community Nutrition that has
been widely used it in monitoring of the nutritional status (PSG) of children under five in 1999.
Workshop on Anthropometrics in 1975 introduced Harvard standard. By spring anthropometry, Ciloto,
the workshop 1991 has recommended the use of the WHO-NCHS reference standard (Indonesian
Nutrition, 1990) which was divided into four aspects, such as:
a)
b)
c)
d)
more nutrition for overweight, including obesity.
good nutrition for well nourished.
malnutrition for under weight that includes mild and moderate PCM (Calorie Protein
Malnutrition).
Malnutrition to severe PCM, including marasmus, and kwashiorkor marasmik-kwasiokor.
Gomez (1956) was the first researcher to publish a way of grouping cases less calorie protein. CTF,
according to Gomez classification, is based on body weight for age (W / A). Children examined
weight expressed as a percentage of the weight of the child's age which is expected in the reference
standard by using the 50th percentile of reference standard of Harvard. Under this system, the CTF is
classified into three levels: grade I, II, III.
Table 1. Classification CTF According to Gomez (as cited in Arisman , 2009)
www.insikapub.com
CTF degrees
Weight / Age (%)
I (Light)
90-76
II (Moderate)
75-61
III (Weight)
< 60
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Essentially, the assessment of nutritional status during the period of assessment is similar to another
life. The greater concern of examination, of course, depends on the form of disorders related to the
incidence of certain diseases. Less calories of protein, for example, commonly can affects children.
Therefore, the examination of signs and symptoms that includes other disorders needs to be sharpened.
(Arisman, 2009).
There are three ways to assess the nutritional status, i.e. percentages, percentiles, and z-score or
standard deviation of the median value of reference. By percentage, weight, height or other
anthropometric measurement at a certain age are divided by the weight of the reference standard.
Another way is the percentile of exposure that refers to the position value of an overall size (100%) of
the measurement of the reference population; it is based on ranking. Percentile is not recommended in
assessing anthropometric indicators in developing countries if the reference data used comes from the
results of measurements of the population in industrialized countries (Waterlow, 1977). With the use
of percentiles, many studies produce indicators under extreme percentile of the reference population
(below 5 percentile). Waterlow, therefore, offered as an alternative to the use of z-score (Arisman,
2009).
Knowledge is a vital weapon in acquiring information that can be used to overcome the nutrient
problems encountered. One way to obtain knowledge is through formal education. Low education
families will be difficult to receive direction in nutrition and they often do not want or do not believe
in the importance of meeting the needs of the importance of nutrition or other health services that
support in helping the growth and development of children. Families with low educational background
are also often unable, unwilling, or do not believe in the importance of the use of health facilities that
can support the growth and development of their children (Supartini, 2004).
In general, the higher the education is gained the more easily a person to receive information (Henry,
2010). Similarly, the education of a mother could determine the supervision of their children in order
to get healthy snacks at school, but if the mother's education is high then the mother can easily keep an
eye on your intake of foods that are consumed in the information acquired.
3
Research Methodology
This study used cross sectional descriptive study method. The population was school age children (612 years) in SDN Sirnagalih 05, Bogor, Indonesia in the academic year of 2014, amounting to 236
children from grades 1-6. The dependent variable in this study was a description of the child's
nutritional status and independent variables were age, gender, parental education, father's occupation,
number of children in the family, economic status, taken from 236 samples.
The Primary data were obtained from the weight and height measurement while secondary data
obtained from the documents on the SDN Sirnagalih 05. In this research, the editing process was done
in a way to re-examine the completeness of the data that has been acquired and re-checking the data.
Later, the data obtained were coded using numbers or numbers that make it easier to enter data into the
computer. The data (numbers or letters) was again inserted into a computer program or software. The
data then was processed into the software program to get a z-score results of the study, further includes
all the research data into the computer manually. Data analysis is done by two methods both invariant
analysis and bivariate analysis.
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4
Results
4.1
Children Nutrition Status SDN Sirnagalih 05
The research showed the overall nutritional status of children SDN Sirnagalih 05 as shown in the
following table.
Table 2. Child Nutrition Status SDN Sirnagalih 05
Nutrion Status
Frequency (person)
Percentage (%)
Normal
161
68,2
Malnutrition
75
31,8
Total
236
100
Based on the table above, there was still malnutrition nutritional status (thin, very thin and Obesity) in
the SDN Sirnagalih 05 students; it was about 75 people (31.8%).
4.2
Nutrition Status of Children by Age Group
Age groupings were created by grouping ages according Salimar (2010). Later, the distribution of the
respondents in this study can be seen as in table 3.
Table 3. Distribution of Respondents by Age Group
Age Group
Frequency (person)
Percentage (%)
6-8 years old
164
69,5
9-12 years old
72
30,5
Total
236
100
Based on the age group most respondents were in the age group 6-8 years, which were accounted for
about 164 students (69.5%). Nutritional Status in Children in Sirnagalih SDN 05 by age group can be
seen in Table 4 below.
Table 4. Child Nutrition Status SDN Sirnagalih 05 by Age Group
Child Nutrition Status
Total
Age
Normal
Malnutrition
n
%
n
%
n
%
6-8 y.o.
116
70,7
48
29,3
164
100
9-12 y.o.
45
62,5
27
37,5
72
100
Total
161
68,2
75
31,8
236
100
www.insikapub.com
OR (95% CI)
P value
1,450
0,272
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By age group, it was discovered that the nutritional status of highest malnourishment percentage was
found in the 9-12 age group as much as 37.5%, with p value 0.272 (> 0.05). Thus, H0 was accepted
and there was no relationship between the age group with the nutritional status of children.
4.3
Child Nutrition Status by Gender
Distribution of respondents by sex can be seen as in table 5 below.
Table 5. Distribution of Respondents by Gender
Gender
Frequency (person)
Percentage (%)
Female
129
54,7
Male
107
45,3
Total
236
100
In this study, male dominated the respondent gender with a number of 129 students (54.7%). The
picture of the nutritional status of children in SDN Kedung Jaya 02 by gender can be seen in table 6
below.
Table 6. Children Nutritional Status SDN Sirnagalih 05 Based on the Group of Gender
Children Nutrition Status
Total
Gender
Normal
Malnutrition
n
%
n
%
N
%
Female
84
65,1
45
34,9
129
100
Male
77
72
30
28
107
100
Total
161
68,2
75
31,8
236
100
OR (95%
CI)
P value
0,727
0,325
Children with nutritional status of malnutrition were most prevalent in male as shown in 45 students
(34.9%). The obtained p value 0.325 (> 0.05) means that H0 is accepted. Thus there is no relationship
between gender and nutritional status of children.
4.4
Child Nutrition Status by Parent’s Education
Based on the parents' level of education, distribution of respondents in this study can be seen as in
table 7. The highest education where education last question was the father of high school and college
students and low education was the father of education ranging from no school until junior high
school.
Table 7. Distribution of Respondents by Parent’s Education
58
Parent’s Education
Frequency (person)
Percentage (%)
Low Education
101
42,8
High Education
135
57,2
Total
177
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International Journal of Basic and Applied Science,
Vol. 04, No. 02, October 2015, pp.53-61
Most respondents who have parents with the level of Higher Education was about 135 students
(57.2%). Nutritional status of children in SDN Kedung Jaya 02 based on parent education can be seen
in table 8 below.
Table 8. Children Nutritional Status SDN Sirnagalih 05 Based Parents Education (Father)
Children Nutrition Status
Total
Parent’s
Education
Normal
Pendidikan
Rendah
Pendidikan
Tinggi
Jumlah
OR (95%
CI)
Malnutrition
n
%
n
%
N
%
59
58,4
42
41,6
101
100
102
75,5
33
24,5
135
100
161
68,2
75
31,8
236
100
P value
0,048
Children with nutritional status of malnutrition were most prevalent in students with low parental
education, as shown by 42 students (41.6%). P value was obtained 0.048 (<0.05) means that H0 was
rejected as such there was a relationship between father's education and nutritional status of children.
4.5
Nutrition Status of Children Under Total Brother In The Family
In this study, the number of children in the family grouping was made based on the grouping made by
BKKBN (2012). Meanwhile, distribution of respondents was based on the number of siblings in the
families in this study can be seen as in table 9.
Table 9. Distribution of Respondents by Number of Children in the Family
Amounts of Children in a Family (orang)
Frequency (person)
Percentage (%)
<2 or = 2
198
83,9
>2
38
16,1
Total
236
100
Most respondents in this study those were included in family groups have the number of children < or
equal to 2 and there were 198 students (83.9%). Nutrition status of children in SDN Sirnagalih 05
based on the number of siblings in the family can be seen in Table 4.9.
Table 10. Children Nutrition Status SDN Sirnagalih 05Based on the amount of Brothers in the Family
Children Nutrition Status
Total
Total of
Siblings
< and =2
>2
Total
www.insikapub.com
Normal
OR (95%
CI)
Malnutrition
n
%
n
%
N
%
145
73,2
53
26,8
198
100
16
42,1
22
57,9
38
100
161
68,2
75
31,8
236
100
P value
0,032
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The results showed that the percentage of malnourishment children with nutritional status at most in a
family group with the number of children was > 2, among others; it was about 57.9%. Obtained p
value of 0.032 (<0.05) showed that H0 was rejected as such there was a relationship between the large
numbers of relatives with the nutritional status of children.
5.
Conclusion
The data indicated that the nutrition status of children in SDN 05 Sirnagalih mainly has a normal
nutrition status (68.2%), but the school still found the nutritional status of malnourished (very thin and
skinny, fat) with a frequency of 75 students (31.8%). This condition reflected that in SDN 05
Sirnagalih still found the nutritional problems of malnutrition and over nutrition. Malnutrition was
characterized by the presence of nutritional status (very thin and thin), while nutritional status is
characterized by fat nutritional status. Meanwhile, by age groups, the nutrition status of
malnourishment in 9-12 years age group saw the highest number with 37.5%, while the frequency of
the normal nutrition status was most prevalent in the age group of 6-8 years, where there was no
relationship between factors the age group with the nutrition status of children. By gender, the
nutrition status of malnourishment of male showed the most significant amount that was equal to
34.9%, and it was found no correlation between gender and nutrition status of children. Nutrition
status of children based on parental education (father) has discovered the malnutrition, which was
most prevalent in students with low parental education, showed by 42 students (41.6%). It also
reflected that there was an association between father's education and nutritional status of children.
Finally, nutrition status of children based on the number of siblings in the family showed the
nutritional status of malnourishment children, found in the number of sisters > 2 which ware amounted
to 57.9%. The result indicated a link between the large numbers of relatives with the nutrition status of
children.
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