Empowering Cadres to Prevent Stunting

. The Province of the Special Region of Yogyakarta has a low stunting rate of 19.8%, however, Bantul Regency has a higher prevalence of stunting than the world's stunting prevalence of 22.9%. Factors causing stunting nutritional problems include direct and indirect factors. Direct factors include infectious diseases and food intake, while indirect factors include food supplies at home and parenting. The prevalence of stunting under five in Timbulharjo Village, one of the villages in Bantul Regency, is 9.48% of a total of 1371 toddlers. Meanwhile, the prevalence of stunting under five aged 24-59 months is 10.13% of 829 and the prevalence of stunting under two years is 8.49 % of 542 children in 2019. Therefore, various efforts have been made by the Ministry of Health, but until now the stunting rate is still high. There needs to be cooperation from various sectors in handling stunting. Besides that, it is also necessary to have the participation of the community and cadres as the front guard. A lecture method related to stunting prevention from adolescence, pregnancy, and after birth was used in this activity. There was a pre-test and a post-test. The pre-test and post-test results showed an increase in the knowledge of cadres and mothers of toddlers regarding stunting prevention. Statistically, this difference is very significant (p<0.05). This increase in knowledge must be carried out continuously to increase the knowledge of the cadres so that they can disseminate it to the people in their environment.


Introduction
Toddlers are an age group that is vulnerable to nutritional problems.Stunting is a nutritional problem that can have bad consequences for toddlers in the future.Stunting affects cognitive and psychomotor development.Stunted toddlers will tend to experience a decrease in brain abilities.This will greatly affect their lives in the future.The definition of stunting is a nutritional problem characterized by shorter height compared to age.This condition is measured by length or height that is more than minus two standard deviations of the WHO child growth standard median (Kemenkes, 2018).
According to data from the World Health Organization (WHO), Indonesia is the third country with the highest prevalence of stunting in the Southeast Asia/South-East Asia Regional (SEAR) (Kemenkes, 2018).Based on data from the 2021 Indonesian Toddler Nutrition Status Survey (SSGBI), the prevalence of stunting is currently still at 24.4 percent or 5.33 million toddlers.
The World Health Organization (WHO) estimates that the prevalence of stunting under five worldwide is 22 percent or as many as 149.2 million in 2020.The Special Region of Yogyakarta has a lower stunting rate of 19.8%.The incidence of stunting in Bantul Regency, however, has a higher prevalence of stunting than the world prevalence of stunting, namely 22.9% (Direktorat SPP, Deputi III, 2013).
Factors causing stunting nutritional problems include direct and indirect factors.Direct factors include infectious diseases and food intake while indirect factors include food supplies at home and parenting styles (Sanjaya & Ayu, 2022).Food and healthy parenting patterns in the first year of a child's life are very important for growth and development which can improve nutritional status (Mardihani & Husain, 2021).
Exclusive breastfeeding becomes one of the influencing factors of stunting (Rachman et al., 2021), (Sanjaya & Ayu, 2022).Exclusive breastfeeding is giving breast milk at the beginning of life until the baby is 6 months old without any additional food or drink.Exclusive breastfeeding is closely related to the incidence of stunting.This is because several studies show that breast milk contains white blood cells, antibodies, hormones, growth factors, enzymes, and substances that can kill bacteria and viruses.Thus, exclusive breastfeeding can prevent infectious diseases (Sanjaya & Ayu, 2022) (Lestari et al., 2019) based on the research conducted under the title 'Factors related to the stunting status of children aged 24-36 months'.Currently, the coverage of exclusive breastfeeding in Bantul Regency in 2017 is 61.6%, when compared with the coverage of exclusive breastfeeding in Sleman of 63.8%, Bantul Regency has a low coverage of exclusive breastfeeding (Direktorat SPP, Deputi III, 2013).
Another factor that determines the incidence of stunting is social factors that are influenced by family income, parental education, and parental occupation.The research conducted by Sanjaya and Ayu (2022) shows that there is a relationship between family income and the incidence of stunting.When viewed from the characteristics of family income, the roots of the problem of infant growth and nutrition problems come from the economic crisis (Priyono, 2020).Most children who experience growth disorders have low economic status.Mother's employment status is one of the supporting factors in improving the family's economy (Lestari et al., 2019).Mother's education level is also a social factor that causes stunting.Mothers who have a high level of education are more able to receive and apply information about stunting prevention (Rachman et al., 2021) (Mardihani & Husain, 2021).In the incidence of stunting, the height of both parents can have an impact on genetic factors that are passed on to their children.

Methodology
This service was carried out through 3 stages of activity, namely: 1) The preparatory phase was carried out by compiling materials and concepts for empowerment activities, as well as coordinating with local stakeholders 2) The implementation phase includes educational activities regarding stunting prevention during pregnancy and stunting prevention in neonates and toddlers.Field activities were carried out on the second lunar day.Before and after the educational process (preposttest).
3) The reporting stage includes the dissemination of the results of community service activities through community service reports and publication articles.

Results and Discussion
Timbulharjo Village is passed by a provincial road which is the economic center of D.I. Yogyakarta, namely Jalan Parangtritis and Jalan Imogiri Barat.In addition, Timbulharjo is also traversed by two major rivers, namely the Winongo River and the Code River.
The location of Timbulharjo Village in an area with fertile soil can encourage the community to conserve agricultural land, which is one of the livelihoods for most of the Timbulharjo community.However, Timbulharjo Village is experiencing such a big problem because of the decreasing agricultural land.This is due to a change in function, both for settlements and public facilities such as schools, offices, factories, hotels, and tourist attractions.
The population of Timbulharjo Village is 7478 heads of families with a total of 22576 residents.The livelihoods of the people of Timbulharjo Village are very diverse.Complete population livelihood data can be seen in Timbulharjo Village, located in Sewon District, Bantul Regency, is one of ten villages in Bantul Regency which is a priority village for stunting management.According to the results of monitoring the nutritional status of toddlers in the Sewon I Health Center area in February 2019, the prevalence of stunting toddlers in Timbulharjo Village was 9.48% of the total 1371 toddlers.Meanwhile, the prevalence of stunting toddlers aged 24-59 months was 10.13% of 829 children, and the prevalence of stunting under the age of 8.49% of 542 (Puskesmas 1 Sewon, 2019) Stunting cases in Bantul Regency in 2021 will increase very significantly.There are around 1850 babies who experience stunting or failure to thrive in children due to chronic malnutrition and repeated infections in the first 1000 days of 2020.Many factors have caused the number of stunting cases in Bantul to increase apart from the Covid-19 pandemic, there are early marriages, other factors include nutrition, and exclusive breastfeeding.To overcome this problem, the Government of Bantul Regency has made various efforts, including a stunting consultation held with the ranks of the district office so that it will encourage cadres and health workers to participate both at the posyandu (integrated service post) and the district level.The health office also provided supplies to 12,000 people to monitor, identify, and report to the puskesmas (community health center).
The capacity building for cadres is implemented based on a situation analysis that has been carried out in Timbulharjo Village.In that village, there are still children who are stunted since stunting is one of the problems included in SDG which is the current government's priority.The government expects the stunting rate in Indonesia to be 0% so that the program for handling stunting cases is carried out synergistically across sectors, even though the health sector is the leader in this program.
Participants who attended this activity were 48 people consisting of health cadres and parents with toddlers.The details are as follows: The participants who attended were all women, the majority of whom were young and had high school education or equivalent.Parents especially mothers have a very important role in monitoring the growth and development of the children.Therefore, mothers are asked to be active in carrying and checking the growth and development of toddlers every month and providing appropriate nutrition for children, especially in the first 1000 days of life because it is an important and critical period for children's growth and development which will have an impact on physical development as well as cognition child (Rarastiti & Syauqy, 2014).
The first material given was related to stunting prevention starting from pre-marital until pregnancy.This period is important for stunting prevention because during pre-marital marriage a woman can be prepared with good knowledge about stunting prevention.During pregnancy, a woman also needs to maintain nutrition for the child in her womb.After giving birth, a mother must also pay attention to the nutritional intake for her child and arrange birth spacing so that the children born receive adequate attention and good nutrition.

Figure 1. Presentation of material 2
The second material was related to the process of child development from birth to the age of 5 years.This period is the early period of life after birth which is the golden period of child growth and development, especially in the first 2 years of birth.The golden age period is a critical period that occurs once in a child's life because at this time no less than 100 billion brain cells are ready to be stimulated so that one's intelligence can develop optimally in the future (1).This period occurs in the first 1000 days, i.e. from pregnancy until the child is 2 years old, and is a critical period that has an impact on the child's physical and cognitive development (2).Children who have good early development and development will grow into healthier adults so that later they will have better life (3).The pretest and posttest results showed that there has been an increase in cadre knowledge about how to prevent stunting.This difference is statistically significant (p<0.05).
Cadres have an important role in the development of children; thus, trained and skilled cadres are needed to carry out early detection of child development.Therefore, it is suggested to the Puskesmas to be able to conduct training for cadres regarding the importance of early detection of growth and development and how to stimulate and detect growth and development in toddlers.The better the knowledge, the better the role in carrying out early detection of child development with KPSP so that this training is expected to produce trained cadres so that if there is a disturbance or deviation in growth and development in toddlers, intervention or referral can be immediately carried out (Pratiwi & Windiyani, 2021).
This approach to solving the problem of stunting is a health promotion approach, namely education and empowerment (Hamilton, 2001).The target of education is health cadres because they occupy a strategic position in efforts to prevent and overcome stunting, namely as the front guard who directly serves pregnant women and toddlers at posyandu.By increasing the knowledge of the cadres about the ins and outs of stunting, it is hoped that they will have the correct perception about stunting which will have an impact on changing their attitudes and behavior in dealing with nutrition and health problems that they find at the posyandu.The knowledge they already have can be a provision in providing counseling to mothers of toddlers at Posyandu in carrying out teaching and caring for their sons or daughters.It is hoped that the cadres will be able to transfer knowledge to mothers who come to posyandu in carrying out efforts to prevent and overcome stunting.This service is expected to increase the knowledge and understanding of health cadres on stunting so that they understand and can apply the knowledge and skills provided in carrying out their duties as health cadres.

Conclusions
Education and empowerment of cadres is a good health promotion step.The educational method used was able to increase the knowledge of cadres regarding stunting prevention.The educational process provided must be carried out on an ongoing basis so that the cadres increase their knowledge and can transfer knowledge to the surrounding residents.

Figure 3 .
Figure 3. Discussion and question and answer

Table 1 Table 1 .
Livelihood data for Timbulharjo Village residents

Table 2 .
Identity of service participants

table : Table 1 .
Analysis of Pre-test and Post-test Results per Item

Table 2 .
Mean Pretest and Posttest Scores