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"Dukungan nutrisi bertujuan memperbaiki status gizi dan prognosis pasien bedah dengan status gizi malnutrisi Pasien yang menjalani pembedahan traktus gastrointestinal GI merupakan kelompok pasien berisiko tinggi mengalami malnutrisi Dilaporkan bahwa terdapat hubungan positif antara malnutrisi dengan morbiditas dan mortalitas pasca bedah lama perawatan RS re admisi RS kebutuhan pembedahan sekunder dan diagnosis atau terapi Serial kasus ini terdiri dari empat kasus dukungan nutrisi perioperatif pada pasien malnutrisi dengan berbagai indikasi pembedahan GI dan komorbid yang berbeda Pasien pada serial kasus ini berusia antara 45 hingga 70 tahun Seluruh pasien menjalani pembedahan mayor abdominal atas indikasi kanker GI Status gizi pasien adalah malnutrisi ringan hingga sedang Terapi nutrisi diberikan berdasarkan kebutuhan dan kondisi klinis pasien Kebutuhan energi basal dihitung menggunakan persamaan Harris Benedict Pemberian energi dimulai dari kebutuhan energi basal dan ditingkatkan bertahap hingga mencapai kebutuhan energi total Lama perawatan RS pada pasien ini antara 19 hingga 43 hari Monitoring yang dilakukan meliputi toleransi asupan kapasitas fungsional imbang cairan data antropometri dan laboratorium serta dilakukan edukasi dan konseling nutrisi setiap hari Secara umum pasien mengalami peningkatan kondisi umum status gizi toleransi asupan Periode perioperatif mempengaruhi toleransi pasien terhadap asupan makanan dan status GI Terapi nutrisi pada pasien bedah harus dilakukan secara individual sebagai bagian integral tata laksana pembedahan Dukungan nutrisi harus dilakukan pada periode pra intra dan pasca bedah untuk menyediakan nutrien yang adekuat agar dapat mengatasi perubahan metabolik pada pasien Dukungan nutrisi yang baik pada pasien bedah terutama dengan malnutrisi dapat memperbaiki prognosis pasca bedah dan akan meningkatkan kualitas hidup pasien.

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The aim of nutritional support is to improve nutritional status and clinical outcome in severely malnourished patients Patients who undergone gastrointestinal surgery constitute as important risk group for malnutrition It has been reported that there is a positive correlation between malnutrition and postoperative morbidity and mortality prolonged hospital stays re admissions secondary operation requirement and diagnosis treatment This case series consisted of four cases of periopertive nutrition support in malnutrition patients with different surgical indication and comorbidities The patients in this case series aged between 45 to 70 years old All patients undergoing major abdominal surgery for gastrointestinal cancer Patients have nutritional status ranged from mild nutrition to moderate malnutrition Nutritional therapy was given according to patients needs and clinical condition The basal energy requirement was calculated using the Harris Benedict equation The intake was given begin with basal energy expenditure and gradually increased to the total energy expenditure Monitoring includes food intake tolerance functional capacity fluid balance anthropometric and laboratory data The nutrition education and counseling was conducted everyday In general all the patients show improvement during monitoring The perioperative periode influenced patients tolerance to food intake and gastrointestinal status Nutrition therapy in surgical patient should be done individually as part of integrated therapy in surgical treatment The nutritional support was done in pre intra and post surgery to provide adekuat nutrient to blunt metabolic changes in this patients Each period of perioperative nutrition support have different function and procedure Good nutritional support in surgical patients specially with malnutrition will improved outcome of the surgery and eventually improved quality of life."

"Studi serial kasus ini bertujuan untuk mengetahui pengaruh tata laksana nutrisi perioperatif pada pasien kanker saluran cerna yang menjalani pembedahan elektif dalam menurunkan angka morbiditas dan lama rawat di rumah sakit. Tindakan pembedahan yang dilakukan pada pasien kanker saluran cerna yang sudah mengalami malnutrisi berkaitan dengan serangkaian reaksi inflamasi yang berpotensi memperberat kondisi malnutrisi yang pada akhirnya memperberat gangguan sistem imun. Studi kasus dilakukan terhadap empat pasien dewasa dengan malnutrisi yang direncanakan menjalani pembedahan elektif akibat kanker saluran cerna di divisi Bedah Digestif Departemen Bedah RSUPN dr. Cipto mangunkusumo. Dukungan nutrisi diberikan semenjak periode pra pembedahan sampai dengan periode pasca pembedahan. Penentuan kebutuhan dihitung dengan menggunakan rumus Harris Benedict. Protein diberikan sebesar 1,8?2 g/kgBB kecuali pada satu orang pasien diberikan sebesar 0,8 g/kgBB/hari karena adanya gagal ginjal kronis. Lemak diberikan sebesar 25% dan sisanya berupa karbohidrat. Mikronutrien yang diberikan berupa kapsul multivitamin-multimineral. Hasil studi ini mendapatkan bahwa bahwa pemberian dukungan nutrisi perioperatif yang optimal dapat mempertahankan fungsi fisiologis, berat badan dan kapasitas fungsional serta memberikan kontrol glikemik yang baik pada periode pra pembedahan dan memperbaiki berbagai parameter status nutrisi termasuk fungsi imun pasca pembedahan walaupun tidak didapatkan peningkatan berat badan.

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This case series study aimed to investigate the effect of perioperative nutritional support in gastrointestinal cancer patients who underwent elective surgery in reducing morbidity and and length of hospitalization. Surgery which was performed in patients with gastric cancer who had experienced malnutrition associated with a series of inflammatory reactions that could potentially aggravate the condition of malnourished which in turn aggravate the immune system disorders. The case study was carried out on four adult patients suffer from malnutrition due to elective surgery for gastric cancer at the Surgical Division of The Department of Digestive Surgery RSUPN dr. Cipto Mangunkusumo. The nutritional support was gave since the preoperative to postoperative period. Determination of energy needs was calculated using the Harris benedict equation. Protein was given by 1.8 to 2 g/kg body weight/day except in one patient given at 0.8 g/kg body weight/day due to chronic renal failure. Fats were given by 25% and the rest were given as carbohydrate. Micronutrient was given in the form of multivitamin-multimineral capsule. The results of this study found that the provision of perioperative nutritional support could maintain optimal preoperative physiological function, body weight and functional capacity as well as provide good glycemic control and improve the nutritional status parameters including immune function after surgery althought there were not increased in body weight."

"Latar belakang. Malnutrisi berkaitan dengan memburuknya kondisi selama di perawatan dan berkaitan dengan keluaran yang buruk. Kehilangan berat badan akan menyebabkan penurunan kekuatan otot yang akan menimbulkan penurunan fungsi. Kekuatan genggam tangan mungkin bermanfaat sebagai indikator status nutrisi khususnya bilamana pengukuran antropometri gagal untuk membedakan nutrisi kurang dengan orang yang berat badan kurang. Sampai saat ini belum ada data mengenai kekuatan genggam tangan dengan status nutrisi pasien yang dirawat di bangsal penyakit dalam di Indonesia. Tujuan Penelitian. Mendapatkan perbedaan rerata kekuatan genggam tangan pasien nutrisi kurang dan nutrisi baik di bangsal penyakit dalam. Metodologi. Studi potong lintang pada pasien di ruang perawatan penyakit dalam. Pemilihan subyek dengan cara konsekutif Pasien dinilai dengan Subjective Global Assessment, pengulcuran indeks massa tubuh dan pemeriksaan kekuatan genggam tangan. Basil. Pada bulan Juli - Nopember 2008 telah didapatkan 140 subyek yang memenuhi kriteria. Subyek terdiri dari 70 laki-Iaki dan 70 perempuan. Sebaran umur pada kelompok laki-laki berkisar 18 - 57 tahun dengan rerata umur 39,4 ± 11,4 tahun dan pada kelompok perempuan berkisar 19 - 59 tahun dengan rerata umur 40,1±12,4 tahun. Untuk menentukan perbedaan rerata digunakan uji t test. Rerata kekuatan genggam tangan kelompok laki-laki nutrisi kurang 19,5 ± 7,7 kg, nutrisi baik 29,5 ± 6,7 kg dan rerata kekuatan genggam tangan kelompok perempuan nutrisi kurang 10,2 ± 3,6 kg dan nutrisi baik 14,2 ± 3,7 kg. Penelitian mendapatkan perbedaan rerata yang bermakna pada subyek nutrisi kurang, baik pada kelompok laki-Iaki ataupun perempuan (kelompok lakilaki t = 5,805, P = 0,00 95% IK 6,6; 13,5, kelompok perempuan t = 4,555, P = 0,00 95% IK 2,2;5,7). Simpulan. Penelitian ini mendapatkan perbedaan kekuatan genggam tangan yang bermakna pada subyek kelompok nutrisi kurang dan nutrisi baik.

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Background. Malnutrition is associated with a deterioration of clinical condition during hospitalization hence a poor outcome. A weight loss will cause a decrease of muscle strength thus the function. Handgrip may be useful as an indicator of the nutritional status, especially when the anthropometric measurement fails to differentiate malnutrition with a less than normal body weight person. Up to now, there has been no data regarding the correlation of handgrip and the nutritional status of patients confined at the internal medicine ward in Indonesia. Objective. To obtain a difference of the mean value of handgrip in patients with malnutrition and a good nutrition at the internal medicine ward. Methodology. This is a cross-sectional study of patients confined at the internal medicine ward. Subjects were consecutively included. Patients were evaluated using Subjective Global Assessment, body mass index calculation and handgrip. Result. From July to November 2008, there were 140 subjects who fulfilled the criteria. 70 were male and 70 were female. The range age for the male group was 18-57 years old with means 39,4 ± 11,-1 years old, and the female group was 19-59 years old with means 40, 1±12,4 years old. A t test was used to determine the difference of m~ value. Means handgrip in male subject with malnutrition was 19,5 ± 7,7 kg and good nutrition was 29,5 ± 6,7 kg. Means handgrip in female subject with malnutrition was 10,2 ± 3,6 kg and good nutrition was 14,2 ± 3,7 kg. This study showed a significant difference of mean value in subjects with malnutrition, both male and female groups (male t = 5,805, P = 0,00 95% CI 6,6;13,5, female group t = 4,555, P = 0,00 95% CI 2,2;5,7). Conclusion. This study showed a significant difference means handgrip in subjects with malnutrition."

"Malnutrisi merupakan hal yang umum terjadi pada pasien sirosis hati Tata laksana nutrisi yang optimal bertujuan mempertahankan dan meningkatkan status gizi memperbaiki keadaan klinis dan meningkatkan kualitas hidup pasien Tatalaksana nutrisi pasien sirosis hati mencakup pemberian makronutrien mikronutrien dan nutrien spesifik serta cairan Pasien pada serial kasus ini terdiri atas tiga orang laki laki dan satu orang perempuan dengan rentang usia antara 30 sampai 57 tahun Tiga orang pasien menderita malnutrisi dan satu orang pasien berisiko malnutrisi Berdasarkan skrining seluruh pasien membutuhkan dukungan nutrisi Kebutuhan energi total KET pasien dihitung dengan menjumlahkan kebutuhan energi basal KEB yang didapat dengan menggunakan persamaan Harris Benedict dan faktor stres yang sesuai kondisi klinis pasien Pemberian nutrisi dimulai dengan 80 dari KEB sampai KEB kemudian ditingkatkan secara bertahap hingga mencapai KET Kebutuhan protein dan lemak disesuaikan dengan kondisi pasien Protein yang diberikan mempunyai kandungan asam amino rantai cabang AARC yang tinggi dan lemak jenis medium chain triglyceride MCT trigliserida rantai sedang Makanan diberikan dalam porsi kecil dengan jadwal pemberian sering dan malam hari diberikan late evening snack sebanyak 10 dari asupan harian total mengandung karbohidrat dan AARC Pada pasien dengan hiponatremia dilusional asupan cairan direstriksi Selama pemantauan dengan bertambah baiknya keadaan klinis maka asupan makan pasien dapat mencapai KET Serial kasus ini menunjukkan bahwa pada pasien sirosis hati dengan berbagai komplikasi tata laksana nutrisi yang baik dapat meningkatkan status gizi memperbaiki keadaan klinis dan meningkatkan kualitas hidup pasien

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Malnutrition is common in patients with liver cirrhosis Optimal nutrition support in patients with liver cirrhosis is required to maintain and improve clinical condition nutrition status and quality of life by providing macronutrient micronutrient specific nutrient and fluid according to the recommendation Patients in this case series were three males and one female with age ranged from 30 to 57 years old Three patients were malnourished while one was on risk of being malnourished Based on the screening conducted to these patients while their admission all four patients needed nutrition support therapy Total energy requirements were determined using Harris Benedict equation to calculate basal energy requirements and multiplied by stress factor Nutrition provision initiated from 80 basal energy requirement and increased gradually according to patient rsquo s tolerance until total energy requirements were achieved Protein and lipid were given in accordance with the patients clinical condition with protein contain high branched chain amino acid BCAA and fat which high in medium chain triglyceride MCT The diets delivered in small portion six times per day with late evening snack as much as 10 of total energy intake contained carbohydrate and BCAA Fluid restrictions were applied to patients with dilutional hyponatremia During hospitalization nutrition intake increased as general conditions improved Nutrition status clinical condition and quality of life of liver cirrhotic patients with various complications in this case series were improved by appopriate nutrition support ;Malnutrition is common in patients with liver cirrhosis Optimal nutrition support in patients with liver cirrhosis is required to maintain and improve clinical condition nutrition status and quality of life by providing macronutrient micronutrient specific nutrient and fluid according to the recommendation Patients in this case series were three males and one female with age ranged from 30 to 57 years old Three patients were malnourished while one was on risk of being malnourished Based on the screening conducted to these patients while their admission all four patients needed nutrition support therapy Total energy requirements were determined using Harris Benedict equation to calculate basal energy requirements and multiplied by stress factor Nutrition provision initiated from 80 basal energy requirement and increased gradually according to patient rsquo s tolerance until total energy requirements were achieved Protein and lipid were given in accordance with the patients clinical condition with protein contain high branched chain amino acid BCAA and fat which high in medium chain triglyceride MCT The diets delivered in small portion six times per day with late evening snack as much as 10 of total energy intake contained carbohydrate and BCAA Fluid restrictions were applied to patients with dilutional hyponatremia During hospitalization nutrition intake increased as general conditions improved Nutrition status clinical condition and quality of life of liver cirrhotic patients with various complications in this case series were improved by appopriate nutrition support "

"Malnutrisi dan tuberkulosis seringkali ditemukan secara bersamaan, Adanya malnutrisi pada tuberkulosis meningkatkan morbiditas dan mortalitas. Serial kasus ini bertujuan mempelajari efek terapi nutrisi pada pasien TB paru dengan malnutrisi. Pada serial kasus ini tiga orang pasien mengalami malnutrisi berat dan satu pasien mengalami malnutrisi ringan. Nutrisi tahap awal diberikan ≤ 50% kebutuhan energi total (KET) dan ditingkatkan bertahap. Pada akhir masa perawatan, nutrisi dapat mencapai 90% KET. Protein diberikan sebesar 15-20% total kalori. Konseling gizi diberikan pada akhir masa rawat pada pasien dan keluarga. Terapi nutrisi sebaiknya harus menjadi bagian integral dari terapi tuberkulosis.

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Malnutrition has been found to coexist with tuberculosis (TB). Malnutrition is associated with increased morbidity and mortality in those with TB. Objective of this case serial is to review the impact of nutritional therapy in pulmonary TB patient with malnutrition. All of four patients were malnourished and had pulmonary TB, of which 3 were severely malnourished. Initially, nutrition therapy commenced with ≤ 50% estimated energy requirement (EER) and incrementally increased to 90% EER at the end of hospitalization. Protein was given 15–20% of total calories. Bedside counseling was provided prior to discharge. Nutrition therapy should be considered as integral part of TB treatment."

"ABSTRAKNama : Herlina PurbaNPM : 1306489205Falkultas : Ilmu Keperawatan Program Profesi NersJudul : Analisis Praktik Klinik Keperawatn Anak Kesehatan Masyarakat Perkotaan dengan Masalah Gangguan Kebutuhan Nutrisi pada Klien Gizi Kurang di RSPAD Gatot Subroto Perkotaan dengan penduduk yang memiliki pendapatan tinggi, menengah dan rendah tetap menunjukkan adanya masalah malnutrisi. Malnutrisi ini berakar pada kemiskinan dan ketidakmampuan. WHO 2010 menunjukkan 18 103 juta anak balita di Negara berkembang mengalami kurang gizi. WHO juga memperkirakan 54 kematian bayi dan anak dilatarbelakangi oleh keadaan gizi buruk, sedangkan di Indonesia masalah gizi mengakibatkan 80 kematian anak WHO, 2011 . Anak dengan gizi buruk akan mempengaruhi tumbuh kembangnya. Upaya penanganan balita dengan gizi kurang sudah dilakukan di puskesmas atau rumah sakit. Asuhan perawatan gizi anak memerlukan monitoring yang berkelanjutan mulai dari rumah sakit sampai klien pulang ke rumah. Hal inilah yang mengakibatkan perlunya edukasi pada keluarga klien agar tujuan pencapaian gizi anak dapat optimal. Edukasi adalah salah satu tugas perawat yang penting untuk meningkatkan kesehatan klien. Perawat memberikan informasi kepada klien yang membutuhkan perawatan untuk kelanjutan pelayanan kesehatan dari rumah sakit ke rumah Falvo, 2004 dalam Potter Perry, 2009 .Kata kunci : malnutrisi, anak, perkotaan

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ABSTRACTAbstractName Herlina PurbaStudy Program Ners ProgrammeTitle Analysis of clinical practice children with problem of urban community health disorder nutritional needs of the clients of malnutrition in the RSPAD Gatot SubrotoCities with a population whose income is high, medium and low fixed indicate a problem of malnutrition. Malnutrition is rooted in poverty and disability. WHO 2010 showed 18 103 million of children under five in developing countries are malnourished. WHO also estimates that 54 of deaths of infants and children is motivated by the poor nutritional status, while in Indonesia, nutritional problems resulted in 80 of childhood deaths WHO, 2011 . Children with poor nutrition will affect growth and development. The handling infants with malnutrition has been done in the clinic or hospital. Child nutrition care requires continuous monitoring ranging from hospitals to the clients home. This has resulted in the need to educate the client 39 s family for the purpose of achieving the optimal child nutrition. Education is one of the duties of nurses are critical to improve the health of the client. Nurses provide information to clients who require treatment for the continuation of health care from hospital to home Falvo, 2004 in Perry, 2009 Keywords malnutrition, child,city "

"Malnutrisi sering ditemukan pada pasien pasca bedah dan berhubungan dengan penurunan fungsi otot, respirasi, imun serta terganggunya penyembuhan luka. Penelitian observasional analitik ini bertujuan mengetahui faktor yang mempengaruhi status nutrisi akut pascabedah. Dilakukan pemeriksaan kadar retinol binding protein (RBP) hari ke-1 dan ke-5 pasca bedah sebagai indikator status nutrisi akut. Asupan nutrisi dan prosentasenya terhadap resting energy expenditure (REE) diukur tiap hari. Dilakukan pemeriksaan kortisol dan C-reactive protein (CRP) sebagai marker respons inflamasi. Dari 35 subyek penelitian sesuai kriteria inklusi disimpulkan kadar RBP hari ke-1, kortisol dan CRP berpengaruh terhadap status nutrisi akut pascabedah.

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Malnutrition is common in postoperative patients and is associated with decreased muscle function, respiratory, immune and disruption of wound healing. This analytic observational study aims to determine the factors that affect the nutritional status of acute post operative patients. We examined the levels of retinol binding protein (RBP) on day 1 and 5 post-operative as an indicator of acute nutritional status. Nutrient intake was calculated for each day and the percentage from resting energy expenditure (REE). We also examined cortisol and C-reactive protein (CRP) as markers of inflammatory response. Of the 35 study subjects who met the inclusion criteria, we can conclude that RBP levels, cortisol and CRP in day 1 are indicators of acute post-operative malnutrition"

"ABSTRAKMeningkatnya prevalensi kekurangan gizi dan kelebihan berat badan di Indonesia timur menimbulkan dugaan bahwa keterbatasan akses pangan, baik dari sisi akses ke pasar maupun akses secara ekonomi berpengaruh terhadap beban ganda malnutrisi. Studi ini bertujuan untuk menganalisis pengaruh akses pangan terhadap kekurangan gizi pada balita dan kelebihan berat badan individu dewasa serta kemungkinan terjadinya beban ganda malnutrisi dalam satu rumah tangga di Indonesia timur. Dengan menggunakan data IFLS East tahun 2012 dan metode estimasi OLS serta probit with sample selection, hasil studi menunjukkan bahwa keterbatasan akses pangan secara geografis dapat menyebabkan ketidakterjangkauan pangan yang berakibat pada meningkatnya kekurangan gizi, baik pada anak balita maupun individu dewasa.Sedangkan dari sisi akses pangan secara ekonomi, hasil studi menemukan bahwa keterbatasan akses pangan dari sisi pendapatan maupun harga pangan pokok tidak hanya meningkatkan kemungkinan kekurangan gizi pada anak balita, tetapi juga dapat beban ganda malnutrisi dalam satu rumah tangga. Hasil studi ini mengimplikasikan bahwa diperlukan kebijakan stabilisasi harga pangan, terutama pangan pokok untuk mengatasi malnutrisi, termasuk menurunkan kemungkinan beban ganda malnutrisi dalam satu rumah tangga di Indonesia timur. Namun, untuk daerah yang cenderung mengalami kekurangan gizi, diperlukan pula perbaikan akses pasar untuk dapat meningkatkan status gizi masyarakat di daerah tersebut.

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ABSTRACT

The increasing of overweight and underweight prevalence in Indonesia represent that Indonesia face double burden of malnutrition. In the Eastern of Indonesia, as high as the prevalence of underweight, the prevalence of overweight are also higher than national prevalence. From these fact, we have an opinion that lack of food access, either geographically or economically, lead adult gain overweight, but in other side, child tend to being underweight. Using IFLS East data 2012, this study aim to analyze the impact of food access to child undernutrition, adult overweight, and household double burden of malnutrition in Eastern Indonesia.

Estimate with ordinary least square and probit with sample selection, this study find out that lack of food accessibility lead children and adult being underweight. In other side, food affordability, higher food price lead to double burden malnutrition. These result imply that stabilizing food price would be one of key to attacking double burden of malnutrition in the Eastern of Indonesia. These study also imply that the policies are needed to tackling malnutrition in the Eastern of Indonesia should be different between province, for province with high prevalence of underweight also need to provide better access to market."

"Krisis ekonomi yang terjadi di Indonesia sejak tahun 1997 dan dampak kekeringan yang berkepanjangan telah membawa masalah baru berupa penurunan daya beli dan penurunan konsumsi pangan terutama pada keluarga miskin sehingga mempengaruhi kesehatan dan status gizi masyarakat. Anak usia dibawah lima tahun (balita) adalah golongan usia yang rentan terhadap masalah kesehatan dan gizi, terutama masalah Kurang Energi Protein (KEP) dan hal ini merupakan salah satu masalah gizi utama di Indonesia yang perlu ditanggulangi karena dapat mempengaruhi kecerdasan melalui kerusakan otak yang akan bersifat permanen. Ibu kota propinsi Riau adalah kota Pekanbaru, memiliki 8 kecamatan dan merupakan pusat aktivitas perekonomian, pemerintahan maupun sosial kemasyarakatan. dimana berdasarkan hasil pemantauan status gizi (PSG) balita tahun 2001 didapatkan 5 (lima) kecamatan masih memiliki prevalensi gizi buruk lebih dari atau lama dengan 1% (>1%), sehingga untuk menghindari agar status gizi balita tidak jatuh kepada keadaan yang lebih buruk, dilakukan penelitian terhadap sistem tata laksana kurang energi protein (KEP) balita. Penelitian dilakukan di kota Pekanbaru terhadap kecamatan yang memiliki balita dengan status gizi sedang dimana berdasarkan batasan kritis kesehatan masyarakat dengan berat badan menurut umur (BB/U)adalah lebih dari 15% (<-2SD). Penelitian dilakukan dengan menggunakan metode kualitatif, yang dilaksanakan pada bulan februari 2003. Pengumpulan data dilaksanakan dengan menggunakan teknik wawancara mendalam (in depth Interview), observasi dan telaah dokumen terhadap variabel pengetahuan petugas, dana, sarana dan prasarana, metode, perencanaan, pengorganisasian. penggerakan, pengawasan, cakupan program dan tindak lanjut penanganan masalah. Informan dalam penelitian ini adalah pejabat pengambil keputusan, penanggung jawab operasional program gizi dan masyarakat pengguna dalam hal ini kader dan ibu balita dengan status gizi sedang. Berdasarkan hasil penelilian terhadap penemuan Kurang Energi Protein menunjukkan bahwa kurang lengkapnya pengetahuan petugas lapangan, masih rendahnva kemampuan advokasi Dinas Kesehatan Kota kepada pihak pemerintah Kota dalam hal penyediaan dana bagi penemuan Kurang Energi Protein balita, lemahnya sistim pencatatan dan pelaporan dalam ketersediaan sarana, belum dilaksanakannya penggunaan metode penanggulangan Kurang Energi Protein balita secara optimal, masih lemahnya data dan informasi dalam penyusunan perencanaan dan evaluasi, tidak aktifnya koordinasi lintas sektoral, belum berjalannya fungsi penggerakan secara maksimal di tingkat puskesmas, belum dilaksanakannya fungsi pengawasan secara menyeluruh meliputi komponen input, proses, dan out put, dan belum terkoordinasinya sistim rujukan antara Rumah sakit dan puskesmas maka manajemen penemuan Kurang Energi Protein (KEP) di Dinas Kesehatan Kota Pekanbaru perlu diperkuat. Dalam upaya penemuan Kurang Energi Protein (KEP) di Dinas kesehatan kota Pekanbaru disarankan agar pihak Dinas kesehatan bekerja sama dengan Puskesmas lebih meningkatkan perhatiannva pada kegiatan peningkatan pengetahuan petugas lapangan, advokasi yang efektif kepada pemerintah kota dan DPRD, peningkatan hubungan kerja sama lintas sektoral, peningkatan sistem manajemen data dan informasi terutama pencatatan, pelaporan dan pengolahan data, serta meningkatkan fungsi pengawasan meliputi komponen input, proses dan out put.

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An Analysis of Protein Energy Malnutrition (PEM) Management System for Children Under-Five in District Health Office of Pekanbaru in 2002Economic crisis, which has started since 1997, and the effect of long dry season in Indonesia have brought about some new problems, such as the decrease of public purchasing power and food consumption especially for the poverty family. This decrease may influence public health and nutritional status.

The group of children under five is susceptible to health and nutritional problems, especially to the problem of Protein Energy Malnutrition (PEM), and this is a main nutrient problem in Indonesia that is necessary to prevent due to its bad effect to one's intelligence through permanent brain decay.

The capital city of Riau Province is Pekanbaru. It is a center of economic activities, government administration and social activities and has 8 sub districts. Data of Nutritional Assessment (NA) of children under five in 2001 show that 5 (five) sub districts remained to have bad nutrient prevalence, which is more or equivalent to 1% (> 1%). To prevent the bad nutritional status of children under five is not becoming worse, it is necessary to carry out a research about Protein Energy Malnutrition (PEM) management system for children under five.

This research was conducted in Pekanbaru City in five sub districts that have medium nutritional status, vbere its public health critical limit to the body mass based on age is more than 15% (< -2SD). The research was conducted by using qualitative method, which is conducted in February 2003. The data were collected by using in-depth interview, observation and documents review for the variables of personnel's knowledge, fund, structure and super-structure, methods, planning, organization, movement, supervision, program coverage, and follow up of problem treatment. The informants of the research were policy makers, operational coordinator of nutritional program, and communities: mother candidates or mothers of children under five with medium nutritional status.

According to the result the study of finding management system of protein energy malnutrition, there are less completeness of field personnel?s' knowledge, lack ness of City of Health Office's advocacy ability to the City Government to provide sufficient fund for protein energy malnutrition for children under five, weaknesses in recording and reporting system due to facilities availability: not optimum of using protein malnutrition energy finding method, weaknesses of data and information in plan arrangement and evaluation, inactiveness of cross sectoral coordination, not maximum of moving function in the level of Public health center, not carrying out of overall supervision function, which consists input, process, and output component, and no coordination of reference system between Hospital and Public Health Center. Therefore, Protein Energy Malnutrition (PEM) management system for children under five in the Health Office of Pekanbaru is necessary to be strengthened.

In the effort of Protein Energy Malnutrition (PEM) management system in City Health Office of Pekanbaru, it is suggested to Health Office to work together with Public Health Centers to increase their attention to the programs of field personnel's' knowledge development, to make effective advocacy to the City Government and Local House Representative, to increase cross-sectoral coordination, to improve data and information systems especially in recording, reporting, and data processing, also to increase supervision function, which consists input, process, and output component."