Differences in Macronutrient and Micronutrient Intake of Stunted Toddlers in Rural and Urban Areas of Bengkulu Province

68 Suryani et al., Media Gizi Indonesia (National Nutrition Journal) Special Issue: The 3rd Bengkulu International Conference on Health (B-ICON 2023) 2024.19(1SP): 68–75 https://doi.org/10.20473/mgi.v19i1SP.68–75 DIFFERENCES IN MACRONUTRIENT AND MICRONUTRIENT INTAKE OF STUNTED TODDLERS IN RURAL AND URBAN AREAS OF BENGKULU PROVINCE Desri Suryani1*, Kusdalinah 1, Bintang Agustina Pratiwi 2,4, Yandrizal3,4 1Health 2 Polytechnic of Kemenkes Bengkulu, Bengkulu, Indonesia Faculty of Public Health, Universitas Dipenogoro, Bengkulu, Indonesia 3Bengkulu Provincial Health Training Technical Implementation Unit 4Universitas Muhammadiyah Bengkulu, Indonesia *E-mail: ABSTRACT Stunting prevalence in Kepahiang District is the highest compared to other districts. In Bengkulu, the incidence rate is lower than in other districts. Dietary intake is a direct factor causing stunting. This study examines the differences in macronutrient and micronutrient intake in stunted toddlers in rural and urban areas of Bengkulu Province. The study, with a cross-sectional design, was conducted from August to September 2020. A sample of 134 toddlers aged 12-24 months was selected using accidental sampling. Dietary intake data were collected using the Semi-Quantitative Food Frequency Questionnaire (SFFQ), and other data were collected through questionnaires. The collected data were analyzed using univariate and bivariate analyses with T-tests and Mann-Whitney tests. Macronutrient intake in stunted toddlers in rural areas was lower than in urban areas. Micronutrient intake in rural areas was also lower than in urban areas, except for vitamin A. Statistically, there were no differences in macronutrient (carbohydrates, proteins, fats) and micronutrient (vitamin A, calcium, phosphorus, iron, zinc) intake between rural and urban toddler in relation to stunting (p > 0.05). Based on the data obtained, the overall nutrient intake provided to the toddlers has not met the toddlers’ nutritional needs. Regular counselling sessions from house to house for mothers with stunted toddlers are necessary. This would enable mothers to understand better their toddlers’ dietary needs and how to monitor their growth. Keywords: Intake, Macronutrients, Micronutrients, Toddlers, Stunting INTRODUCTION Malnutrition is characterised by over- or undernutrition, which imposes a significant financial burden on the healthcare system(Kizilyildiz et al., 2016). In 2020, it is estimated that 149 million children under the age of 5 will be stunted, a condition characterized by being below the expected height for their age on a global scale. It is estimated that malnutrition is the cause of death in about 45% of all cases involving children less than 5 years old. This is especially true in countries with low or middle incomes. At the same time, rates of overweight and obesity in children are also increasing in the same countries (WHO, 2021). In general, 99 million micronutrient-deficient children (aged 6-59 months) live in South Asia, 98 million in Sub-Saharan Africa, and 85 million in East Asia and the Pacific (Stevens et al., 2022). The government has established five pillars to address stunting, including visionary and committed leadership, national education that leads to behavior change, integrated program at all levels of government and food and nutrition sensitivities (Badan Ketahanan Pangan Kementrian Pertanian, 2019). These efforts must be carried out integrated to achieve maximum results. Based on the results of SSGI 2021, stunting nationally has decreased by 1.6%/year, from 27.7% in 2019 to 24.4% in 2021. Most of the 34 provinces showed signs of decline compared to the previous year (Kemenkes RI, 2021). Toddlers who face stunting often lack proper nutrition. Infectious diseases can also be a significant cause of this problem. In addition, parental health characteristics and background also play an essential role in the development of stunting in children (Ismawati et al., 2020). Food intake and infectious diseases are direct factors in the onset of nutritional problems. The nutrient intake of children under five must fulfil their needs to avoid stunting. Based on observations, children with stunting problems tend to consume foods such as poultry, eggs, and fruits less frequently. ©2024. The formal legal provisions for access to digital articles of this electronic journal are subject to the terms of the Creative CommonsAttribution-NonCommercial-ShareAlike license (CC BY-NC-SA 4.0). Received 21-11-2023, Accepted 20-06-2024, Published online 30-06-2024. Suryani et al., Media Gizi Indonesia (National Nutrition Journal) Special Issue: The 3rd Bengkulu International Conference on Health (B-ICON 2023) 2024.19(1SP): 68–75 https://doi.org/10.20473/mgi.v19i1SP.68–75 This is different from children who are not stunted, who generally have a pattern of consuming these foods with a more frequent frequency. The lack of consumption of these nutritious foods can be one of the factors that cause growth problems in children (Mahfouz et al., 2022). Based on the geographical and socio-economic characteristics of the region, stunting was found to be more common in rural areas than in urban areas. Certain factors in rural areas, such as limited access to health services, income inequality, and possibly less food availability and diversity, may influence the higher prevalence of stunting there compared to urban areas (Kalinda et al., 2023; Sserwanja et al., 2021; Tadesse et al., 2023). Bengkulu Province is one of the regions in Indonesia that also faces nutrition issues in children under five. Data in 2018 from e-PPGBM shows that the stunting rate among children under five reached 17.2%, while the rate of severe stunting children was 6.3%. Kapahyang district recorded the highest rate of stunted children under five with 28.2% and severe stunting children with 7.77%. Meanwhile, in Bengkulu City, the stunting rate of the under-fives was 10.7%. Based on this background, this study wants to see the differences in macronutrient and micronutrient intake in stunted toddlers in rural and urban areas. METHODS This research is an analytical survey with a cross-sectional design. The study is planned to take place from August to September 2020. The research location was selected based on predetermined criteria. An accidental sampling method was used to collect samples. The target population of this study were mothers with children aged 12-24 months in the August-September 2020 period. This age group was chosen purposively because it is in the first 1000 days of life period, a golden age for stunting prevention. The minimum sample size was calculated using Sample Size Determination in Health Sciences using 80% CI. The minimum sample based on that calculation was 63(Ogston et al., 1991). Furthermore, to minimize sample loss by adding 5% of the minimum sample, (Dettori, 2011) 67 samples were obtained in each group. In total, this study 69 involved 134 respondents, divided (...truncated)