Analysis Of Family Behavior With The Incidence Of Stunting In Toddlers Aged 3-5 Years

Backgroud : Currently, stunting is one of the government's main concerns, because cases of stunting are increasing in Indonesia. The prevalence of stunting, which is in the high category, will affect growth and development failure in toddlers and will affect economic status if not taken seriously. One effort that can be done is to increase family empowerment, both through knowledge and attitudes and behavior. Objective: This study aims to determine family behavior with the incidence of stunting in toddlers aged 3-5 years, where the family behavior variables consist of Clean and Healthy Behavior (PHBS), family behavior in food processing, and family behavior in feeding. Methods: In this study using a descriptive research design with a cross sectional study approach. The respondents were mothers who had stunted toddlers aged 3-5 years in the working area of the Kaluku Bodoa Health Center, with a purposive sampling technique of 68 samples. Results : From the data analysis using SPSS with the chi square test, the results showed that there was a relationship between family PHBS behavior in food processing and feeding with the incidence of stunting in toddlers aged 3-5 years. As for each value p is p 1 = 0.014, p 2 = 0.012 and p 3 = 0.000. Conclusion : from the results of this study, it can be concluded that the family is one of the factors that can reduce the incidence of stunting, for this reason it is necessary to increase government programs, especially in health centers that involve families in efforts to prevent stunting.


INTRODUCTION
Stunting is a nutritional problem that is currently being experienced by people around the ABSTRACT Backgroud : Currently, stunting is one of the government's main concerns, because cases of stunting are increasing in Indonesia. The prevalence of stunting, which is in the high category, will affect growth and development failure in toddlers and will affect economic status if not taken seriously. One effort that can be done is to increase family empowerment, both through knowledge and attitudes and behavior. Objective: This study aims to determine family behavior with the incidence of stunting in toddlers aged 3-5 years, where the family behavior variables consist of Clean and Healthy Behavior (PHBS), family behavior in food processing, and family behavior in feeding. Methods: In this study using a descriptive research design with a cross sectional study approach. The respondents were mothers who had stunted toddlers aged 3-5 years in the working area of the Kaluku Bodoa Health Center, with a purposive sampling technique of 68 samples. Results: From the data analysis using SPSS with the chi square test, the results showed that there was a relationship between family PHBS behavior in food processing and feeding with the incidence of stunting in toddlers aged 3-5 years. As for each value p is p1 = 0.014, p2 = 0.012 and p3 = 0.000. Conclusion: from the results of this study, it can be concluded that the family is one of the factors that can reduce the incidence of stunting, for this reason it is necessary to increase government programs, especially in health centers that involve families in efforts to prevent stunting.
Factors that directly cause stunting are infectious diseases and healthy food intake in pregnant women and toddlers, while indirectly caused by the mother's education level, parenting patterns, environmental sanitation, and health services in the local area (Sinatrya & Muniroh, 2019).
Stunted toddlers will have a low immune system and are at risk of germ infections and other diseases, therefore it is necessary for families to pay attention to behavior in feeding, implementing household PHBS and preparing food for toddlers as one of the efforts to prevent stunting in children.
To determine the quality of life of toddlers in the future, the role of mothers is needed, therefore it is very important for mothers to understand how to carry out PHBS properly and how maternal behavior in preparing and processing good food.
In food processing according to Prabatini (2010) that various ways of cooking or processing food can affect the nutritional content of the food to be cooked. Meanwhile, according to (Rahmawati, 2020) the process of preparing good food can provide benefits in increasing nutritional value, digestibility, taste or aroma, and durability (Yati, 2018). Things that need to be considered in processing food ingredients besides cleanliness are also preparation, for example in cutting food ingredients. This is because the chewing process and swallowing reflexes of toddlers are not perfect so that children choke easily. The use of stimulating spices is not recommended, because it harms the digestive tract of toddlers (Rahmawati, 2020).
Based on statistics and data on the prevalence of stunting reported that in Kaluku Bodoa Health Center, it is the second highest prevalence of stunting in the city. Makassar, the results of observations show that stunting in children under five years of age has not been able to reach the predetermined level due to the low level of maternal involvement in learning, attitudes and actions in PHBS, food processing, and feeding. According to preliminary data obtained from the Kaluku Bodoa Health Center, the prevalence of stunting was around 197 or 4.9% in 2021, so this study aims to analyze the relationship between family behavior in food processing, implementation of PHBS and feeding with the occurrence of stunting in children under five years of age 3-5 years

Population and Sample
This study uses descriptive quantitative research with a cross sectional study approach, which is research that connects the two variables. In this study, the independent variable is family behavior, which consists of food processing behavior, PHBS and feeding behavior, while the dependent variable is stunting status.
Data from each variable were collected from a number of samples that met the research criteria.
The inclusion criteria for this study were: toddlers who are psychologically and physically healthy, aged 3-5 years who are stunted, while the exclusion criteria of the study are toddlers who are affected by infectious diseases, illiterate mothers of toddlers.
From these criteria, a sample size of 68 toddlers was obtained, where sample data was collected using non-probability sampling method with purposive sampling technique.

Instrument
Data from independent variables were obtained using a research instrument in the form of a research questionnaire that had previously been tested for reliability and validity. While the dependent variable is obtained by weighing BW and measuring TB using a microtoise scale measuring instrument whose results will be adjusted to the standard deviation of WHO using the z-score tab. After the data from each variable is collected, then further statistical tests are carried out to assess the presence or absence of a relationship between the two variables using the chi-square statistical test.

Data Analysis
Descriptive statistics were used to illustrate the frequencies of the study variables. A bivariate analysis was carried out using a Chi-Square test and P-values less than 0.05 were considered significant.
The statistical analyses were conducted using SPSS, version 25.

RESULT AND DISCUSSIONS
In the results of this study, it is presented about how the relationship between family behavior which consists of 3 components, namely food processing behavior, PHBS and food feeding behavior

Table 1. Relationship between family behavior in food processing and stunting status in toddlers aged 3-5 years in the working area of the Kaluku Bodoa Health Center
From table 1 the results of the analysis using the chi square test, it was obtained a value of p = 0.014, which means that there is a relationship between family behavior in food processing and stunting in toddlers aged 3-5 years.   Table 3 shows the results of the analysis using the chi square test with a value of p = 0.000, which means there is a relationship between family behavior in feeding and stunting in toddlers aged 3-5 years.

Family behavior in food processing with stunting status in toddlers aged 3-5 years
If you look at the data from table 1, there are 42 respondents who do poor food processing, where most of the stunting status of toddlers is in the very short category, namely 33 toddlers. So from these data it can be concluded that poor maternal behavior is more likely to result in stunting status of toddlers in the very short category. According to Supriati (2020), food processing is a component in parenting in paying attention to the nutritional content of each food to be processed.
From the results of this study, most respondents, in this case mothers, still tend to be poor in food processing (42 out of 68 respondents). Among them are still many mothers who wash fruits and vegetables by squeezing, cook vegetables for more than 5 minutes, process fish by frying and provide flavoring to almost all food ingredients. Prakhasita (2018) states that family behavior in food processing is influenced by the age of the mother, where in this study the age of the mother is still relatively young, which is less than 35 years old. In addition to age, the level of education can also affect food processing. Education is needed in obtaining information or knowledge about the growth process of toddlers, the level of education also determines whether or not it is easy for a mother to absorb and understand information in food processing that is obtained and then applied (Nurarif & Kusuma 2016).
In this study, most mothers had a primary school education level (50%), so that poor food processing was dominated by mothers who had a primary school education level.

PHBS with stunting status in toddlers aged 3-5 years
The family principle in the application of PHBS in this study, assessed through 10 indicators of household PHBS, mothers who apply PHBS so as to enable family members to achieve optimal health and achieve the growth and development of toddlers (Wirahatama, 2018). Stunting is one example of how the mother's behavior in the application of PHBS is poor, which is an indirect factor in leading to nutritional problems and stunting toddlers (Wanimbo, et al, 2020).
In addition, respondents have a low educational background, which affects the level of knowledge and actions regarding the implementation of household PHBS which is also not good.

Family behavior in feeding with the occurrence of stunting in toddlers aged 3-5 years
In the age of toddlers, health problems are often found due to improper feeding (Goleman, et al, 2019) Feeding should pay attention to several things, such as the content of nutrients in the ingredients used, giving according to the age of the toddler, and giving according to the proportion and frequency of food.
In this study, family behavior in feeding has a relationship with the occurrence of stunting in toddlers aged 3-5 years. Most families are still in the poor category in feeding, which is 49 samples. Poor feeding could be due to the factor of low education level, where most respondents still have elementary school level education, so that it will affect the family's ability to receive and apply information. In addition, the family income factor is also an important factor in feeding.

LIMITATIONS
In the current situation of the Covid-19 pandemic and the existence of government regulations, namely PPKM (Enforcement of Restrictions on Community Activities), the process of collecting data through google form which makes researchers not interact directly with respondents to provide explanation and understanding in answering questions so as to cause different assumptions and understanding of each respondent in filling out answers through the google form used, besides that the questionnaire in the form of google form and sheets is distributed through intermediary cadres, which causes data collection long enough to fit the desired sample size

CONSLUSIONS AND RECOMENDATION
From the results of this study, it can be concluded that the family is one of the factors that can reduce the incidence of stunting, seen from the analysis test that family behavior has a significant relationship with the incidence of stunting in toddlers. So the researchers suggest that there is a need to increase government programs, especially in health centers that involve families in terms of stunting prevention efforts.