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"ABSTRAKKlinik Gizi Bogor (KGB)-Puslitbang Gizi telah membuat model "paket pemulihan anak balita gizi buruk" selama 6 bulan, sejak tahun 1981, namun sampai sekarang belum pernah dilakukan penelitian khususnya tentang ketahanan gizi buruk selama ikut program. Desain penelitian ini adalah longitudinal selama 6 bulan, subyek sebanyak 384 anak balita gizi buruk yang berkunjung ke KGB dari tahun 1982-1997.Analisis Kaplan Meier dan Life Table dilakukan untuk menentukan probabilitas ketahanan gizi buruk. Analisis multivariat regresi Cox dilakukan untuk menentukan besarnya nilai pemulihan menjadi gizi kurang dari penderita gizi buruk, berdasarkan kecurigaan ada faktor lain secara bersama-sama.Hasil penelitian menunjukkan bahwa Probabilitas Ketahanan Gizi Buruk selama 6 Bulan (PKGB6B) sebesar 35 %, dan median ketahanan gizi buruk sebesar 12 minggu.Secara bivariat ditemukan hasil untuk jenis kelamin laki-laki PKGB6B sebesar 40 % pada perempuan 32 %, dan nilai propabilitas pemulihan (PPR) untuk menjadi gizi kurang anak perempuan 1,41 (95 % CI:1,04; 1,93) kali dibandingkan laki-laki. Pada nomor unit anak, maka PKGB6B untuk anak ke 1 sebesar 30 %, anak ke 2-3 sebesar 36 % dan anak ke z 4 sebesar 39 %. Nilai PPR menjadi gizi kurang anak ke 2-3 sebesar 1,02 kali (95 % CI: 0,70; 1,48) dan anak ke > 4 sebesar 0,66 kali (95 % CI: 0,46; 0,96) dibandingkan anak ke 1. Dilihat jumlah anak hidup, maka PKGB6B untuk kelompok 1 anak sebesar 29 %, kelompok 2-3 anak sebesar 31 % dan > 4 anak sebesar 41 %. Nilai PPR menjadi gizi kurang untuk 2-3 anak sebesar 0,86 kali (95 % Cl: 0,46; 1,61) dan > 4 anak sebesar 0,60 kali (95 % Cl: 0,32; 1,12) dibandingkan kelompok 1 anak. Dilihat dari tipe gizi buruk, maka PKGB6B untuk bukan marasmus-kwashiorkor 33 %, kwashiorkor tidak ada nilai, marasmuskwashiorkor 16 %, dan marasmus 16 %. Nilai PPR menjadi gizi kurang dibandingkan bukan marasmus-kwashiorkor, maka untuk kwashiorkor 0,89 kali (95 % CI: 0,22;3,68), marasmus-kwashiorkor 0,68 kali (95 % CI: 0,42; 1,10) dan marasmus 0,69 kali (95 % CI: 0,49; 0,97). Diliat urnur PKGB6B kelompok 0-11 bulan sebesar 41 %, kelompok 12-35 bulan sebesar 30 % dan kelompok 36-59 bulan sebesar 59 %, Nilai PPR untuk menjadi gizi kurang dibandingkan umur 0-11 bulan, maka untuk umur 12-35 bulan nilai PPR 1,42 kali (95 % CI: 0,97; 2,06), urnur 36-59 bulan nilai PPR 0,61 kali (95 % CI: 0,31; 1,20). Dilihat dari Infeksi Saluran Pernapasan Atas (ISPA), maka PKGB6B untuk tidak ISPA sebesar 58 %, ISPA ringan sebesar 29 %, dan ISPA berat sebesar 35 %. Nilai PPR menjadi gizi kurang untuk ISPA ringan sebesar 1,98 kali (95 % CI: 1,32; 2,96), dan ISPA berat sebesar 1,75 kali (95 % CI: 1,04; 2,96) dibandingkan tidak ISPA. Dilihat dari Infeksi saluran Pernapasan Bawah (ISPB), maka PKGB6B untuk tidak ISPB sebesar 0 %, 1SPB ringan sebesar 32 %, dan ISPB berat sebesar 38 %. Nilai PPR untuk menjadi gizi kurang untuk ISPB ringan 0,86 kali (95 % CI: 0,41; 1,79), dan ISPB berat 0,58 kali (95 % CI: 0,28; 1,21) dibandingkan tidak ISPB.Secara multivariat variabel yang berperanan hanya variabel ISPA, umur dan tipe gizi buruk. Hasilnya, nilai PPR ISPA berubah untuk ISPA ringan 1,88 kali (95 % CI: 1,24; 2,85), dan ISPA berat 1,61 kali (95 % CI: 0,93; 2,78) dibandingkan tidak ISPA untuk menjadi gizi kurang, setelah dikontrol variabel dalam model. Dilihat tipe gizi buruk, maka nilai PPR menjadi gizi kurang dibandingkan bukan marasmuskwashiorkor berubah, untuk kwashiorkor sebesar 584,06 kali, marasmuskwashiorkor 10,18 kali, dan marasmus sebesar 1,46 kali setelah dikontrol variabel dalam model. Dilihat umur, maka nilai PPR menjadi gizi kurang dibandingkan kelompok 0-11 bulan berubah, untuk kelompok 12-35 bulan menjadi 1,43 kali (95 % CI: 0,98; 2,08) dan kelompok 36-59 bulan 0,68 kali (95 % CI: 0,68 kali (0,34; 1,34).

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ABSTRACT

Outpatient nutrition clinic of Center for Research and Development of Nutrition (CRDN) has developed a six-month package with the main objective to improve severe malnourished children in its surrounding areas since 1981. However, there has never been a study to analyze its effectiveness. Therefore, there is a need to analyze its effectiveness and factors associated with the outcome of package. This study was a six-month longitudinal study of 384 patients suffered from severe malnutrition from 1982-1997.

Kaplan Meier survival analysis and life table was used to study the probability of nutritional improvement from severe to moderate or mild malnutrition, while Cox regression model was used to study the relative improvement associated with several factors.

The study revealed that overall probability to remain severe malnutrition (PRSM) for 6 months was 35 % with the median of 12 weeks, which mean that there was an improvement of nutritional status of 65 % cases with the median time of 12 weeks.

Bivariate analysis found that the PRSM differ according to some child characteristics, type of malnutrition, and infections. The PRSM for 6 months was 40 % in girls and 32 in boys, and relative improvement (RI), the opposite direction of relative risk, from severe to moderate or mild malnutrition among girls was 1.41 times (95 % CI: 1.04-1.93) compared the boys. PRSM for 6 months of the first birth order, second to third, and fourth or above was 30 %, 36 % and 39 % respectively. RI of second to third order was 1.02 times (95 % CI: 0.70-1.48) and fourth or above was 0.66 times (95 % CI: 0.46-0.96) compared to the first birth order. PRSM for 6 months of number of children alive in the family of 1 child, 2-3 children, > 4 children was 29 %, 31 %, and 41 % respectively. RI of 2-3 children was 0.86 times (95 % CI: 0.46-1.61) while > 4 children was 0.60 times (95 % CI: 0.32-1,12) compared to one child in the family. PRSM was also differ among different type of malnutrition. PRSM for 6 months of non-marasmus-kwashiorkor, kwashiorkor, marasmic-kwashiorkor, and marasmus was 33 %, not applicable because of a few cases, 16 % and 16 % respectively. RI of kwashiorkor was 0.89 times (95 % CI: 0.22-3.68), marasmic-kwashiorkor was 0.68 times (95 % CI: 0.42-1.10), and marasmus was 0.69 times (95 % CI: 0.49-0.97) compared to non-marasmuskwashiorkor. PRSM was also differ according to age as it was found that PRSM for 6 months of 0-11 month old, 12-35 month cold, and 36 month old was 41 %, 30 %, and 59 % respectively. RI of 12-35 month old was 1.42 times (95 % CI: 0.97-2.06), and > 36 month old was 0.61 times (95 % CI: 031-1.20) compared to 0-11 month old. PRSM for 6 months of cases without URI, mild URI, and moderate URI was 58 %, 29 %, and 35 % respectively, while RI of mild URI was 1.98 times (95 % CL 1.32-2.96), and moderate URI was 1.75 times (95 % CI: 1,04 -2.96) compared to cases without URI. PRSM for 6 months of cases without LRI, mild LRI, and moderate LRI was 0 %, 32 %, and 38 % respectively, while RI of mild LRI was 0.86 times (95 % CI: 0.41-1.79), and moderate URI was 0.58 times (95% CI: 0.28-1.21) compared to cases without LRI.

Analysis of cox regression model showed that only URI, age of the child, and type of malnutrition were significantly associated with relative improvement (RI) of severe malnutrition. RI of mild URI was 1.88 times (95 % CI: 1.24-2.85), moderate URI was 1.61 times (95 % CI: 0.93-2.78) compared to cases without URI after being controlled by other factors in the model. RI of kwashiorkor, marasmic-kwashiorkor, and marasmus was 584.06, 10.I8, and 1.46 times than no-marasmus-kwashiorkor after being controlled by other in the model. RI of children aged 12-35 months was 1.43 times (95 % CI: 0.98-2.08) and 36-59 months was 0.68 times (95 % CI: 0.34 - 1.34) after being controlled by other factors in the model.

References : 39 (1968 - 1998)"

"Tesis ini membahas program pemberian makanan tambahan berupa biskuit pabrikan bagi balita gizi kurang (pengukuran perbandingan berat badan menurut panjang atau tinggi badan balita) yang  telah dilakukan Pemerintah Indonesia sejak tahun 2004-2022. Pada praktiknya Pemberian Makanan Tambahan Pemulihan (PMT-P) berupa biskuit pabrikan juga diberikan bagi balita dengan berat badan kurang (pengukuran perbandingan berat badan menurut umur). Perlu adanya analisis untuk mengetahui hubungan pemberian makanan tambahan dengan Prevalensi Balita Berat Badan Kurang dan Gizi Kurang di Indonesia Tahun 2022. Penelitian ini merupakan studi kuantitatif dengan menggunakan data sekunder dengan desain cross-sectional. Data yang digunakan adalah Data Sekunder Sigizi Terpadu/EPPGBM dari Kementerian Kesehatan RI. Data  tersebut meliputi  jumlah balita penerima PMT-P dan balita dengan berat badan sangat kurang (severely underweight), berat badan kurang (underweight) dan gizi kurang (moderate wasted) seluruh provinsi di Indonesia tahun 2022. Hasil penelitian menunjukkan  ada hubungan antara pemberian makanan tambahan dengan prevalensi balita berat badan kurang (underweight) nilai P = 0,026 (CI = 0,007-0,101), sangat kurang (severely underweight) nilai P = 0,026 (CI = -0,101 s/d -0,007) dan gizi kurang (moderate wasted) nilai P = 0,021(CI = 0,056-0,650). Seluruh nilai P <0.005 menunjukkan ada hubungan prevalensi balita berat badan kurang dan gizi kurang. Penelitian menyarankan program pemberian makanan tambahan berupa biskuit dilanjutkan diikuti dengan program pendekatan keluarga bagi balita gizi kurang dan adanya penambahan pelaporan faktor determinan kejadian balita gizi kurang di aplikasi EPPGBM.

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This thesis discusses the supplementary feeding program in the form of manufactured biscuits for malnourished toddlers (measurement of the ratio of body weight according to the length or height of toddlers) that has been carried out by the Government of Indonesia from 2004-2022. In practice, supplementary feeding in the form of manufactured biscuits is also given to toddlers with underweight (a measure of the ratio of body weight to age). An analysis is needed to determine the relationship between supplementary feeding and the Prevalence of Underweight and Malnourished Children in Indonesia in 2022. This research is a quantitative study using secondary data with a cross-sectional design. The data used is Integrated Nutrition Secondary Data / EPPGBM from the Indonesian Ministry of Health. The data includes the number of toddlers receiving PMT-P and severely underweight, underweight and wasted toddlers in all provinces in Indonesia in 2022. The results show that there is a relationship between supplementary feeding and prevalence of underweight toddlers P value = 0.026 (CI = 0.007-0.101), severely underweight P value = 0.026 (CI = -0.101 to -0.007) and moderate wasted P value = 0.021(CI = 0.056-0.650). All P values <0.005 indicated that there was a relationship between the prevalence of underweight and malnutrition. The research suggested that the supplementary feeding program in the form of biscuits be continued followed by a family approach program for undernourished toddlers and additional reporting of the determinants of the incidence of undernourished toddlers in the EPPGM application."