ANALYSIS OF DETERMINANT FACTORS AFFECTING THE NUTRITION STATUS OF AGE 24-60 MONTH IN HEALTH CENTER REGIONAL REGENCY OF GRESIK IN 2017 Setiya Purbasari

ANALYSIS OF DETERMINANT FACTORS AFFECTING THE NUTRITION STATUS OF AGE 24-60 MONTH IN HEALTH CENTER REGIONAL

1 REGENCY OF GRESIK IN 2017

₂ ₂ Setiya Purbasari , Abdul Muhith , Nurwijayanti Nurwijayanti ₁ Student Post Graduate Program ₂ Lecturer Post Graduate Program

Institute of Health Science Surya Mitra Husada Kediri E-mail:

ABSTRACT

The multidimentional crisis have degraded the nutritional status of Indonesian society. Preschool children are at risk developing PEM as they are not breastfed and the food consumed may not fuilfill the nutrients need for their progressive growth. Nutritional status of preschool children is indirectly associated to the socioeconomic and hygiene status and directly associated to the level of consumptions and infections. The aims of this research is to analyze the associations between socioeconomic factors, hygiene, level of consumptions, and infections with the nutritional status of preschool children in Gresik District. The result of statistical analysis using the Multiple Linear Regression Test showed significant value <= 0.05, meaning H0 rejected and H1 accepted, this means that there is influence of education, mother knowledge, higines environment level, protein energy intake and significant value> = 0,05, meaning H0 accepted and H1 accepted, this means that there is no influence of family income, mother care pattern, and incidence of ispa and diarrhea with nutritional status of children And of the factors that influence the most dominant influence the nutritional status of children aged 24-60 months is knowledge and protein energy intake. Early detection through intensification monitoring of toddler growth at posyandu, followed by determination of nutritional status by village midwife or other health worker. As well as striving for a dynamic Food and Dynamic environment where monitoring of critical indicators of resources, availability and access to food and nutrition at all levels of society is required .

Key word : nutritional status, determinant factors affectin,children aged 24-60

months

A. BACKGROUND

Underweight or poor nutrition in infancy and children, especially at the age of less than 5 years can lead to disruption of physical growth and child intelligence. Growth of brain cells takes place very quickly and will stop or reach the perfect stage at the age of 4-5 years. Rapid brain development can only be achieved if the child has good nutritional status (Ministry of Health RI, 2012). Growth monitoring of infant development is very important to know the existence of early infant growth disorder, by way of weight measurement as the best way to assess the nutritional status of children every month so that child growth will be monitored (Rahmadiliyani, 2012).

How to assess nutritional status can be done with anthropometric, clinical, biochemical, and biophysical measurements. Anthropometric measurements can be performed with several measurements: weight measurement, height, upper arm circumference, and so on. One indicator of health in children under five years old (toddlers) can be seen from the nutritional status. Nutritional status of children can be measured by age, weight (BB), height (TB). Monitoring the nutritional status of children under five can be seen from three indicators of anthropometry, namely: Weight by Age (BB / U), Body Height by Age (TB / U) and Weight by Body (BB / TB) (Profile of East Java Provincial Health Office , 2015). Based on the indicator of BB / TB, nutritional status is divided into 4 namely Malnutrition (Very Thin), Underweight (Skinny), Good Nutrition (Normal), Nutrition Over (Fat).

Based on the results of Basic Health Research (Riskesdas) in 2013 it is known that the percentage of underweighted BB / U status by province in Indonesia is 33 percent higher, the prevalence of malnutrition in infants (BB / TB) by province in Indonesia is 18 , 7 percent in 2013. While the percentage of underweight and underweight nutrition (BB / U) according to Kab / Kota in East Java Province in 2013 was 4.9% and nutritional status less 14.2% (Riskesdas, 2013).

Based on the data of PSG data from the Health Office of Gresik Regency in 2016, it shows that Percentage of Nutritional Status Under Fives Index BC / U in 2014 until 2015 for under-five children with malnutrition decreased significantly from 5.43% to 0.7% but in year 2016 increased slightly to 0.98%, while under-fives with underweight nutrition continued to increase from year to year, ie in 2014 by 0.26% (203 under- fives), by 2015 soaring. equal to 4, 9% (3907 under-fives), and in 2016 increased to 5.93% (4547 children under five).

Malnutrition events need to be detected early on through intensification of infant growth monitoring at posyandu, followed by determination of nutritional status by village midwives or other health workers. Malnutrition data in East Java is based on 2 categories ie by indicator comparing BB / U and second category is compare BB / TB.

B. RESEARCH METHODOLOGY

This research is a quantitative research using analytical survey with cross sectional design or design. Cross-sectional survey is a study to study the correlation dynamics between risk factors and effects by approach, observation or data collection at a time (point time approach) means that each subject is observed only once and the

Table 4.4 Distribution of

measurement is done on the character

Respondents by Revenue in 3

or variable status subject at the time of

Puskesmas Kabupaten Gresik

examination (Soekidjo Notoatmodjo,

2017

2012: 37-38). The population of this study is all mothers who have children

Total Income Rate Percentage (%)

under five in the working area of

(person) Puskesmas Kabupaten Gresik. Low

12.2 Respondent in this research is mother Height

87.8

toddler, while sample unit is toddler age 24-60 month amount 1315 balita.

Total 90 100.0

The minimum sample size in this Based on table 4.4 is known from study was 90 mothers and children a total of 90 respondents almost aged 24-60 months, taken by entirely (87.8%) high income of more proportional random sampling. than Rp.1.200.000, - / month. Respondents were mothers of the sample. The statistical test used is

Multiple Linear Regression. The

Table 4.5 Distribution of

Respondents Based on Mother's

independent variables in this research

Knowledge about Nutrition in 3

are education, mother's knowledge,

Puskesmas of Gresik Regency

environmental higines level, protein energy intake, family income, mother 2017 care pattern, and incidence of ispa and Knowledge Total

Percentage (%) (person)

diarrhea with nutritional status of

level

children. Dependent variable in this

Less

4.4

study is nutritional status of children

Enough

67.8 aged 24-60 months. Good

27.8 Total 90 100.0 C.

RESEARCH RESULTS

Based on table 4.5 it is known 1.

Table 4.3 Distribution of

from a total of 90 respondents (67.8%)

Respondents Based on Maternal

are knowledgeable enough to answer

Education at 3 Puskesmas correctly 56% - 75% of all questions. Kabupaten Gresik 2017

Education Level Total Percentage (%)

Table 4.6 Distribution of Mother (person)

Respondents Based on Maternal SD

3.3 Care Pattern in 3 Puskesmas SMP

13.3 SMA

76.7 Gresik Regency 2017 PT

6.7 Total 90 100.0 Level of Total

Percentage (%)

Based on table 4.3 it is known

(person) Foster Pattern

from a total of 90 respondents almost

Less

25.6

entirely (76.7%) have high school

Enough

51.1 education. Good

23.3 Total 90 100.0

Based on table 4.6 is known from the total of 90 respondents most (51.1%) have enough parenting.

30.0 5.

Good

Table 4.7 Distribution of

Total 90 100.0 Respondents Based on

Based on Table 4.9 it is known

environmental hygiene in 3

from a total of 90 respondents most

Puskesmas Kabupaten Gresik

(63.4%) sufficiency of nutrients

2017

between 80-99% of the recommended

Environment Total nutritional adequacy (AKG).

Percentage (%) al Hygiene

(person) Level

Table 4.10 Distribution of Less

3.3 Respondents Based on the Enough

15.6 Nutritional Status of Toddlers Good

81.1 Age 24-60 weeks in 3 Puskesmas Total 90 100.0 Kabupaten Gresik 2017

Based on table 4.7 it is known

Nutritional Status Total

from a total of 90 respondents almost Percentage (%)

Status (person)

entirely (81.1%) have a good

Malnutrition

3.3 environment.

Malnutrition

11.1 Good Nutrition

72.2 6.

Table 4.8 Distribution of

More nutrition

13.3 Respondents Based on the Total 90 100.0 Incidence of Ispa and Diarrhea in

Based on table 4.10 is known from

3 Puskesmas of Gresik Regency

a total of 90 respondents most (72.2%)

2017

good nutritional status (based on z

Incidence Rate

score with index BB / U)

Total Percentage of Ispa and

(person) (%) Diarrhea

Table 4.11 Cross-education There Is

13.3 tabulation with nutritional status There Is No

86.7 of children aged 24-60 months in Total 90 100.0

3 Puskesmas of Gresik Regency _{Nutritional status Total (person)}

Based on table 4.8 is known from _{Buruk Kurang Normal Lebih Percentage (%)} a total of 90 respondents almost _SD _{3.3% 0.0% 0.0% 0.0% 3.3%} ³ ³ entirely (86.7%) there is no incidence _Education _SMP _{0.0% 8.9% 4.4% 0.0% 13.3%} ⁸ ⁴ ¹² of Ispa and Diarrhea in children aged _SMA _{0.0% 1.1% 64.4% 11.1% 76.7%} ₁ ₅₈ ₁₀ ₆₉ 24-60 months _Total _PT _{0.0% 1.1% 3.3% 2.2% 6.7%} _{3.3% 11.1% 72.2% 13.3% 100.0%} ₃ ₁₀ ₁ ₆₅ ₃ ₁₂ ₂ ₉₀ ₆ 7.

Table 4.9 Distribution of Respondents Based on Energy

Based on Table 4:11 shows that of

and Protein Consumption at 3

90 respondents most of the mothers

Puskesmas Kabupaten Gresik

have high school education

2017

background and normal nutritional

Levels of

status of children (64.4%). Result of

Total Energy

data analysis using t test got t count

Percentage (%) (person) Consumption

equal to 2,526 and p = 0,013, so p

and Protein

<0,05, mean H0 rejected and H1

2.2 Deficit

accepted so there is significant

4.4 Less influence between mother education

63.3

with nutritional status of toddler age

Medium

24-60 month.

10. Table 4.12 Cross-income family tabulation with nutritional status of children aged 24-60 months in

3 Puskesmas Kabupaten Gresik _{Nutritional status} _Total _{Buruk Kurang Normal Lebih} Family income ^{Low (<} ^1.200.000) ^{Count 136.928 0,000} ⁴ ²

¹¹

^{% of Total 1.1% 4.4% 4.4% 2.2% 12.2%} ^{High (>} _1.200.000) ^Count ² ⁶ ⁶¹ ¹⁰

⁷⁹

_{% of Total 2.2% 6.7% 67.8% 11.1% 87.8%} _Total _Count ₃ ₁₀ ₆₅ ₁₂

₉₀

_{% of Total 3.3% 11.1% 72.2% 13.3% 100.0%} _t _hitung _{= 0,561, p =0,567}

Based on table 4:12 shows that of 90 respondents most mothers have high income is> Rp. 1,200,000 and her children have normal nutritional status (67.8%). The result of data analysis using t test got t count equal to 0,561 and p = 0,567, so p> 0,05, mean H0 accepted and H1 is rejected so there is no significant influence between family income with nutritional status of children aged 24-60 months.

11. Table 4.13 Cross-tabulation of mother's knowledge about nutrition with nutritional status of children aged 24-60 months in 3 Puskesmas Kabupaten Gresik _{Nutritional status} _Total _{Buruk Kurang Normal Lebih}

Knowledge ^Less ^Count ⁴

⁴

^{% of Total 0.0% 4.4% 0.0% 0.0% 4.4%} ^Enough ^Count ² ⁵ ⁵⁴

⁶¹

_{% of Total 2.2% 5.6% 60.0% 0.0% 67.8%} _Good _Count ₁ ₁ ₁₁ ₁₂

₂₅

_{% of Total 1.1% 1.1% 12.2% 13.3% 27.8%} _Total _Count ₃ ₁₀ ₆₅ ₁₂

₉₀

_{% of Total 3.3% 11.1% 72.2% 13.3% 100.0%} _t _hitung _{= 5.729, p=0.000}

Based on table 4:13 shows that of 90 respondents most mothers have enough knowledge and balitanya normal nutritional status (60%). The result of data analysis using t test obtained t count equal to 5,729 and p = 0,000, so p <0,05, mean H0 rejected and H1 accepted so there is significant influence between mother's knowledge about nutrition with nutritional status of children aged 24-60 month.

12. Table 4.14 Cross tabulation of mother's parenting with nutritional status of children aged 24-60 months in 3 Puskesmas Kabupaten Gresik _{Nutritional status} _Total _{Buruk Kurang Normal Lebih} _Mother's parenting ^Less ^Count ² ¹⁹ ² ²³ ^{% of Total 0.0% 2.2% 21.1% 2.2% 25.6%} ^Enough ^Count ¹ ⁵ ³⁸ ² ⁴⁶ ^{% of Total 1.1% 5.6% 42.2% 2.2% 51.1%} _Good _Count ₂ ₃ ₈ ₈ ₂₁ _{% of Total 2.2% 3.3% 8.9% 8.9% 23.3%} _Total _Count ₃ ₁₀ ₆₅ ₁₂ ₉₀ _{% of Total 3.3% 11.1% 72.2% 13.3% 100.0%} _t _hitung _{= 0.553, p=0.582}

Based on Table 4:14 shows that of 90 respondents almost half of the mother's parenting pattern is enough and balitanya normal nutritional status (42.2%). The result of data analysis using t test got t count equal to 0,553 and p = 0,582, so p> 0,05, mean H0 accepted and H1 rejected so there is no significant influence between mother care pattern with nutritional status of children aged 24-60 months.

13. Table 4.15 Cross-linking of environmental hygienitas with nutritional status of children aged 24-60 months in 3 Puskesmas Kabupaten Gresik _{Nutritional status} _Total _{Buruk Kurang Normal Lebih} _Tingkat

Higienitas ^Less ^Count ³ ³ ^{% of Total 3.3% 0.0% 0.0% 0.0% 3.3%} ^Enough ^Count ⁸ ⁴ ² ¹⁴ ^{% of Total 0.0% 8.9% 4.4% 2.2% 15.6%} _Good _Count ₂ ₆₁ ₁₀ ₇₃ _{% of Total 0.0% 2.2% 67.8% 11.1% 81.1%} _Total _Count ₃ ₁₀ ₆₅ ₁₂ ₉₀ _{% of Total 3.3% 11.1% 72.2% 13.3% 100.0%} _t _hitung _{= 3.753, p=0.000}

Based on Table 4:15 shows that of 90 respondents most of the good environmental hygienitas and toddlers normal nutritional status (67.8%). Result of data analysis using t test got t count equal to 3,753 and p = 0,000, so p <0,05, mean H0 rejected and H1 accepted so there is significant influence between hygienitas environment with nutritional status of children aged 24-60 month.

14. Table 4.16 Cross tabulation incidence of Ispa and diarrhea with nutritional status of children aged 24-60 months in

3 Puskesmas Kabupaten Gresik _{Nutritional status}

_Total

_{Buruk Kurang Normal Lebih} _{Ispa and} _diarrhea _There _is _Count ₁ ₂ ₅ ₈ _{% of Total 1.1% 2.2% 0.0% 5.6% 8.9%} _There _{is no} _Count ₈ ₆₅ ₇ ₈₂ _{% of Total 2.2% 8.9% 72.2% 7.8% 91.1%} Total ^Count ³ ¹⁰ ⁶⁵ ¹² ⁹⁰ _{% of Total 3.3% 11.1% 72.2% 13.3% 100.0%} _t _hitung _{= -1.313, p=0.193}

Based on Table 4:15 shows that of 90 respondents most of the incidence of ispa and diarrhea is absent and children under normal nutritional status (72.2%). Result of data analysis using t test got t count equal to -1,313 and p = 0,193, so p> 0,05, mean H0 accepted and H1 rejected so there is no significant influence between incidence of ispa and diarrhea with nutritional status of children aged 24- 60 months .

15. Table 4.17 Cross tabulation of energy and protein consumption levels with nutritional status of children aged 24-60 months in 3 Puskesmas Kabupaten Gresik _{Nutritional status}

_Total

_{Buruk Kurang Normal Lebih} nutrition _{al intake} ^Defisit ^Count ¹ ¹ ² ^{% of Total 1.1% 1.1% 0.0% 0.0% 2.2%} ^Kurang ^Count ¹ ¹ ² ⁴ ^{% of Total 1.1% 1.1% 2.2% 0.0% 4.4%} _Sedang _Count ₁ ₇ ₄₇ ₂ ₅₇ _{% of Total 1.1% 7.8% 52.2% 2.2% 63.3%} _Baik _Count ₁ ₁₆ ₁₀ ₂₇ _{% of Total 0.0% 1.1% 17.8% 11.1% 30.0%} _Total _Count ₃ ₁₀ ₆₅ ₁₂ ₉₀ _{% of Total 3.3% 11.1% 72.2% 13.3% 100.0%} _{t hitung = 4.751, p=0.000}

Based on table 4:17 shows that of 90 respondents most of the level of energy and protein consumption is normal and toddlers normal nutritional status (52.2%). The result of data analysis using t test got t count equal to 4,751 and p = 0,000, so p <0,05, mean H0 rejected and H1 accepted so there is significant influence between nutrient intake with nutritional status of children aged 24-60 months.

D. DISCUSSION 1.

Influence of Maternal Education

with Nutritional Status of Toddler Age 24-60 months

Based on table 4.11 mothers who have elementary education as much as 3 (3.3%) with the status of malnutrition of the majority of bad children as much as 3 (3.3%), the mother who has junior high education as many as 12 (13.3%) with less than five 8 (8.9%) toddlers, 69 (76,7%) high school mother with 58,4% toddler, and 6 college educated mothers (6.7%), with normal nutritional status of 3 (3.3%) of children under five. Result of data analysis using t test got t count equal to 2,526 and p = 0,013, so p <0,05, mean H0 rejected and H1 accepted so there is significant influence between mother education with nutritional status of toddler age 24-60 month. From the results if this study shows the majority of mothers have a normal nutritional status of children with high school education as much as 69 (76.7%). Where maternal education affects the nutritional status of children. Because the level of education of many mothers determine their attitudes and actions in dealing with various problems. A mother has an important role in the health and growth of the child. This can be demonstrated by the fact that children from mothers with higher educational backgrounds will have a better chance to live and grow better and more readily accept broader insight into nutrition. Children with low-educated mothers have a higher mortality rate than children with highly educated mothers. The role of parents is very influential, especially in the mother, because a mother plays a role in household management and play a role in determining the type of food that will be consumed by his family. Lack of nutrient intake can be caused by the limited amount of food consumed or the food does not meet the nutrients needed.

Nutritional Status of Toddler Age 24-60 months

Based on table 4.12 Family with low income is 11 (12,2%) with nutritional status of underfive majority and less than 4 (4,4%) toddler, high income family of 79 (87,8%) with nutritional status of under five a normal majority of 61 (67.8%). Result of data analysis using t test got t count equal to 0,561 and p = 0,567, so p> 0,05, mean H0 accepted and H1 is rejected so there is no significant influence between family income with nutritional status of children aged 24-60 month.

High income is not necessarily followed by high nutritional status of children, on the contrary with low income is not necessarily nutritional status balitanya less good. The acceptance of the hypothesis is due to many factors. One factor is related to the size of family expenditure to eat. The totality of family income is not all used to meet food needs, so direct income does not have a real correlation with nutritional status of children. This is due to the absence of a trend that high- income respondents are allocated for high food needs, and vice versa there is no tendency that with low income allocations for low food needs.

In the daily life of the community is often seen families who even earn enough income but food that is served sober. Thus the incidence of nutritional disorders is not only found in families who earn less but also in high-income families because usually they will entrust child care to the helpers, if the maid can know about the nutrients that children need well then the nutritional status of children will be better and vice versa. This situation indicates that ignorance of the benefits of food for the health of the body causes the poor nutritional quality of family food, especially toddlers.

2. Influence of Family Income with

3. Influence of mother's knowledge about nutrition with nutritional status of children aged 24-60 months

Based on table 4:13 mothers have less knowledge about nutrition as much as 4 (4,4%) with less than

4 (4.4%) toddler underweight, mother have enough knowledge 61 (67,8%) with nutritional status of balita majority normal as much as 54 (60%), and mother have good knowledge as much 25 (27,8%) with nutritional status of balita majority of nutrition more 12 (13,3%). The result of data analysis using t test obtained t count equal to 5,729 and p = 0,000, so p <0,05, mean H0 rejected and H1 accepted so there is significant influence between mother's knowledge about nutrition with nutritional status of children aged 24-60 month.

Nutrition knowledge is defined as everything that is known with regard to food substances. In general in developing countries, mothers play an important role in selecting and preparing food for their family consumption so that mother's nutritional knowledge will affect the type of food and nutritional quality of food consumed by family members.

Nutrition knowledge of parents is one of the factors that affect child nutrition. Some of the other factors that influence parents' knowledge include: Age is age affecting the ability formation, because the ability possessed can be obtained through daily experience outside of education factor because most young mothers have very little knowledge about nutrition and experience in nurturing child. Mother's knowledge determines the behavior of food consumption, one of them through nutrition education so that will improve the habit of food consumption. Lack of knowledge about nutrition or the ability to apply in everyday life is an important cause of nutritional disorders.

4. Influence of Maternal Care Pattern with Nutritional Status of Toddler Age 24-60 months

Based on Table 4:14 Maternal care pattern is less as much as 23 (25,6%) with normal child under five nutrition status as much as 19 (21,1%) balita, mother mother pattern enough enough 46 (51,1%) with normal majority child nutrition status 38 (42,2%), and good mother care as much as 21 (23,3%) with nutritional status of children under five of normal nutrition and more 8 (8,9%). The result of data analysis using t test got t count equal to 0,553 and p = 0,582, so p> 0,05, mean H0 accepted and H1 rejected so there is no significant influence between mother parenting pattern with nutritional status of children aged 24-60 months.

Good eating patterns tend to have children with normal nutritional status, eating patterns are quite likely to have children with overweight status and wasted nutrition status, while with eating patterns more or less tend to have children with very thin nutritional status. So the better the parenting patterns of eating the normal nutritional status and the less the increasingly more children's eating patterns and also less nutritional status. According to UNICEF (1999), the factors that affect the growth of children consist of direct causes, because of indirect and underlying causes. The direct causes include food sufficiency and health condition, because it does not directly include family food security, child care pattern, utilization of health service and environmental sanitation, with the basic cause of economic structure (Proverawati and Asfuah, 2009).

Patterns of parenting also contribute to the nutritional status of children, one of the patterns of care related to the nutritional status of children is the pattern of feeding. In addition to eating patterns, mother's health patterns also affect the health status of children and will ultimately affect the child's nutritional status indirectly (Martianto, et al., 2011).

Eating pattern is the practice applied by mother to child related to food situation and situation, it is physiological and psychological requirement for children and parents, so it is necessary to create feeding situation to children that fulfill physiological, psychological and social needs. Children who get poor eating patterns tend to have difficulty eating and result in reduced levels of consumption of both energy and protein. If this goes on long will affect its nutritional status due to poor food input (Tirahiningrum, 2013).

A good nutritional status affects the mother's feeding pattern to her child, such as the better the quality and the intensity of parenting to the child, the more normal the nutritional status of the preschooler and the worse the mother's care for the child the worse the nutritional status of the preschoole.

5. Effect of Hygienitas Environment with Nutritional Status of Toddler Age 24-60 months

Based on the table 4:15 Respondents who have less than 3 (3%) Hygienicity of the children with less than 3 (3.3%) toddler underweight nutritional status, respondents who have enough environmental hygienitas are 14 (15,6%) with nutritional status toddler majority less 8 (8,9%), and Respondent having good environmental hygienitas as much as 73 (81,1%) with normal majority child nutrition status as much 61 (67,8%). Result of data analysis using t test got t count equal to 3,753 and p = 0,000, so p <0,05, mean H0 rejected and H1 accepted so there is significant influence between hygienitas environment with nutritional status of children aged 24-60 month.

Health status can be improved by maintaining health and physical and social environment. Increased health status, the nutritional status also increases. From an epidemiological point of view the nutritional problems are strongly influenced by the host, the agency, the environment. The imbalance between these three factors, such as the occurrence of nutrient insufficiency in the body, the saving of nutrients will decrease and over time the savings become exhausted if this condition is allowed then there will be physiological and metabolic changes and finally enter the clinical threshold. The process continues causing sick people. The degree of illness starts from mild illness to severe illness. From this condition finally there are 4 possibilities namely; death, chronic pain, disability and cured if addressed intensively. And also can be indirect factor that is Infectious disease meaning Children who have less nutrition will easy to get disease especially diarrhea and respiratory diseases. Each of these circumstances encourages and may aggravate the situation. The process will cause worsening pain and can cause death. n a state of good nutrition, the body has enough ability to defend itself against infectious diseases. If the nutritional condition gets worse then the immune reaction will decrease which means the body's ability to defend itself against infection attacks to be down. Infection exacerbates nutritional status, and vice versa nutritional disorder worsens the child's ability to cope with infectious diseases (Aritonang, 2003). Further Environmental Sanitation which means adequate sanitation is the foundation of development. However, sanitation facilities are far below the needs of a growing population. Inadequate environmental conditions allow for various types of diseases, including diarrhea and gastrointestinal tract. In the world of the disease has caused the death of about 2.2 million children per year and spent a lot of money to overcome it (UNICEF, 2008). A person who is deficient in nutrients will be susceptible to disease and growth will be disrupted. Poor environmental sanitation will make children more susceptible to infectious diseases that may ultimately affect nutritional status. Nutritional status other than influenced by environmental sanitation, also influenced by some fakor, among others, food consumption and health status (infectious diseases). If the consumption of less eating will facilitate the emergence of diseases that can affect growth and result in decreased nutritional status. Children suffering from malnutrition will be susceptible to infections, especially diarrhea and respiratory diseases. Each of these factors will make things worse. Environmental sanitation is also closely linked to the availability of clean water, the availability of latrines, the type of flooring of the house and the cleanliness of cutlery in each family. The more available clean water for daily needs, the less risk of children affected by malnutrition. Parents Education Background education of parents, is one important element that plays a role in determining the state of child nutrition. In society with low average education, indicating a high prevalence of low nutrition and vice versa in society with high education level, the prevalence of nutrition is lower. Revenue Rate The income level also determines what diet to buy with the money. If income increases, spending on food also increases. Thus income is a factor that determines the quality and quantity of food which will subsequently affect the nutrients (Kusumo, 2004).

6. Influence of Isp and Diarrhea Occurrence with Nutritional Status of Toddler Age 24-60 months

Based on the table 4.16 children under five years of diarrhea has 8 (8.9%) with a toddler's nutritional status of more than 5 (5.6%) toddlers, and toddlers with no history of diarrhea and diarrhea of 82 (91.1%) with normal child nutrition status as much as 65 (72,2%). The result of data analysis using t test is -1,313 and p = 0,193, so p> 0,05, mean H0 accepted and H1 rejected because there is no significant influence between incidence of ispa and diarrhea with nutritional status of children aged 24-60 months.

Nutrition of children contained in foods that play an important role in child growth, because children are growing desperately need it with adults. Lack of nutritious food will cause disruption to the growth of children. Malnutrition due to dietary intake can be affected by childhood illness, such as ARI and diarrhea. As Supriharti (1994) acknowledges no pain in the respiratory system does not infrequently cause death. This will be important enough to get serious attention in childhood because it can enter a variety of disorders of growth and development of nutritional status. Similarly, diarrhea, diarrhea can cause nutritional disorders due to reduced food intake (Widjaja, 2002). less nutritional status leads to decreased body resistance and stronger viral viral pathogens, resulting in a balance of disorders and infection. One of the determinants in maintaining the balance is the good nutritional status.

Nutrition is one of the determinants of the quality of human resources. Due to malnutrition will cause some serious effects such as failure in physical growth and not optimal development and intelligence. Another result is a decrease in productivity, decreased body resistance to diseases that will increase the risk of illness (Marimbi, 2010). In children who suffer from malnutrition at mild or moderate levels still can beraktifitas, but when observed carefully the body will begin to thin, stamina and endurance decreased, making it easier for the occurrence of infectious diseases, otherwise children suffering from infectious diseases will experience impaired lust eating and absorption of nutrients that cause malnutrition (Andarini et al, 2005). But from this study found also respondents who have good nutrition status but exposed to respiratory infection and diarrhea. This is caused by other factors that can cause the occurrence of ARI and diarrhea in infants such as age, breastfeeding, regularity of vitamin A, air pollution, socioeconomic, immunization density in the home and LBW. In addition, the respondents also got the status of less nutrition but not affected by ARI and diarrhea. This may be possible because of environmental factors where no one is suffering from ARI or diarrhea even though their nutritional status is lacking, or it could be because they have received complete immunization so they have immunity against infection so it is not easy to get ARI. From the above results can be concluded that nutrition has a very big role in maintaining the health of the body of the toddler. If a toddler has a lack of nutritional status, it will make it easier for pathogens to attack the body causing ARI and diarrhea. Therefore, to reduce the incidence of ARI and diarrhea, the nutritional status of toddlers should always be maintained and improved.

7. Effect of Energy Consumption Level and Protein with Nutritional Status of Toddler Age 24-60 months

Based on Table

4.17 Nutritional intake deficit of 2 (2,2%) with nutritional status of toddler majority of less and bad as much as 1 (1,1%) toddler, nutrient intake less as much as 4 (4,4%) with nutritional status of balita majority normal 2 (2,2%) toddler, moderate nutrition as much as 57 (63,3) with normal baby nutrition status as much as 47 (52,2%) toddlers, and normal nutrition intake as much as 16 (17,8%) toddlers.

The result of data analysis using t test got t count equal to 4,751 and p = 0,000, so p <0,05, mean H0 rejected and H1 accepted so there is significant influence between nutrient intake with nutritional status of children aged 24-60 months.

Nutrition is a substance or chemical element contained in the food needed for metabolism in the body normally. Nutrition needed by the body consists of carbohydrates, fats, proteins, vitamins, minerals and water. In an effort to achieve adequate consumption, the two most important factors that can affect the daily consumption of nutrients are: availability of food and nutritional knowledge. A person will be able to provide adequate consumption when they are able to provide food because it is supported with enough views. Nutrients that have been consumed will be used by the body to achieve optimal nutritional status (Almatsier, 2006). Energy is defined as a capacity to perform a job The amount of energy a person needs depends on age, sex, weight and body shape. Energy in the human body arises because of the burning of carbohydrates, proteins and fats. Thus in order to be fulfilled his energy needs required intake of food substances are also into the body. Proteins are part of living cells and are the largest part after water. All enzymes, hormones, carriers of nutrients and blood, and so on are proteins. The main function of protein is to build and maintain body tissues. Another function is to establish the essential bonds of the body, such as hormones, enzymes and antibodies, regulating water balance and transporting nutrients. Protein is also an energy source that is equivalent to carbohydrates.

If the body is in a state of lack of energy source substances such as carbohydrates and fats, the body will use proteins to form energy and defeat its main function as a builder substance. In toddlers this condition has a disruption on growth.

E. CONCLUSION

Based on the results of research and discussion, it can be concluded as follows: 1.

There is a significant influence between maternal education variables on nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik.

2. There is no significant influence between family income variable on nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik.

3. There is a significant influence between the variables of knowledge on nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik.

4. There is no significant influence between the variables of parenting to the nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik.

5. There is a significant influence between the variables of environmental hygienity level to nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik.

6. There is no significant influence between variable incident and diarrhea on nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik.

7. There is a significant influence between the variable of Energy and Protein intake on nutritional status of children aged 24-60 months in 3 Puskesmas Kab. Gresik.

8. Of the factors above the most dominant influence the nutritional status of children aged 24-60 months is the knowledge and protein energy intake

F. SUGGESTIONS 1.

Practical Tips

a) For Community For the community, especially the nanny, or the mother of the child 2- 5 years is expected to increase knowledge about child nutrition. Nutrition knowledge can be gained through experience, mass media, cultural influences, formal or informal education

b) For Puskesmas Provision of education or health education can be a routine program for puskesmas both in mother and children and in working area of posyandu-posyandu of Keputih Public Health Center Surabaya, need to be equipped health promotion media so counseling is easy to be understood. Commonly used media such as brochures, installing banners and posters related to child nutrition.

a) For Midwifery Education For midwifery students are expected to learn better about the definition of nutritional status of children, the classification of nutritional status of children, factors that affect the nutritional status of children, assessment of nutritional status of children, nutritional needs of children, balanced concepts. nutrition. So it can train soft skill in conducting promotive and preventive activities, such as giving more optimal information and education to mother or nanny about child nutrition while doing socialization about child nutrition status in counseling form.

b) For Other Researchers It is hoped that there will be further research on the nutritional status of children under five by adding other factors and with more respondents so that they can be more knowledgeable and get the right solution for the program of handling nutritional status in the future so that the nutritional status is not available.

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ANALYSIS OF DETERMINANT FACTORS AFFECTING THE NUTRITION STATUS OF AGE 24-60 MONTH IN HEALTH CENTER REGIONAL REGENCY OF GRESIK IN 2017 Setiya Purbasari